# EDGAR Filing Document

**Accession Number:** 0001464521
**File Stem:** 0001628280-25-038091
**Filing Date:** 2025-8
**Character Count:** 1158210
**Document Hash:** cc11f174d5a750a8f5e4078f2f863d94
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001628280-25-038091.hdr.sgml**: 20250806

**ACCESSION NUMBER**: 0001628280-25-038091

**CONFORMED SUBMISSION TYPE**: S-1/A

**PUBLIC DOCUMENT COUNT**: 34

**FILED AS OF DATE**: 20250806

**DATE AS OF CHANGE**: 20250806

**FILER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Heartflow, Inc.
- **CENTRAL INDEX KEY:** 0001464521
- **STANDARD INDUSTRIAL CLASSIFICATION:** SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
- **ORGANIZATION NAME:** 08 Industrial Applications and Services
- **EIN:** 260506743
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** S-1/A
- **SEC ACT:** 1933 Act
- **SEC FILE NUMBER:** 333-288733
- **FILM NUMBER:** 251187486

**BUSINESS ADDRESS:**
- **STREET 1:** 331 E EVELYN AVENUE
- **CITY:** MOUNTAIN VIEW
- **STATE:** CA
- **ZIP:** 94041
- **BUSINESS PHONE:** 650-241-1221

**MAIL ADDRESS:**
- **STREET 1:** 331 E EVELYN AVENUE
- **CITY:** MOUNTAIN VIEW
- **STATE:** CA
- **ZIP:** 94041

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** Cardiovascular Simulation, Inc.
- **DATE OF NAME CHANGE:** 20090519

**As filed with the U.S. Securities and Exchange Commission on August 6, 2025.**

**Registration No. 333-288733**

**UNITED STATES**

**SECURITIES AND EXCHANGE COMMISSION**

**Washington, D.C. 20549**

**AMENDMENT NO. 2** 

**TO**

**FORM S-1**

**REGISTRATION STATEMENT**

**UNDER**

**THE SECURITIES ACT OF 1933**

**Heartflow, Inc.**

**(Exact name of registrant as specified in its charter)**

---

| | | |
|:---|:---|:---|
| **Delaware** | **3841** | **26-0506743** |
| **(State or other jurisdiction of**<br>**incorporation or organization)**<br>| **(Primary Standard Industrial**<br>**Classification Code Number)**<br>| **(I.R.S. Employer**<br>**Identification Number)**<br>|

---

**331 E. Evelyn Avenue**

**Mountain View, California 94041**

**(650) 241-1221**

**(Address, including zip code, and telephone number, including area code, of registrant's principal executive offices)**

**John C.M. Farquhar**

**President and Chief Executive Officer** 

**Heartflow, Inc.**

**331 E. Evelyn Avenue**

**Mountain View, California 94041**

**(650) 241-1221** 

**(Name, address, including zip code, and telephone number, including area code, of agent for service)**

***Copies to:***

---

| | | |
|:---|:---|:---|
| **Shelly Heyduk** | **Angela Ahmad** | **Dave Peinsipp** |
| **Ryan Coombs** | **Heartflow, Inc.** | **Kristin VanderPas** |
| **O'Melveny & Myers LLP** | **331 E. Evelyn Avenue** | **Denny Won** |
| **610 Newport Center Drive, 17th Floor** | **Mountain View, California 94041** | **Charles S. Kim** |
| **Newport Beach, California 92660** | **(650) 241-1221**  | **Cooley LLP** |
| **(949) 823-6900** |  | **3 Embarcadero Center, 20th Floor** |
|  |  | **San Francisco, California 94111** |
|  |  | **(415) 693-2000** |

---

**Approximate date of commencement of proposed sale to the public:** As soon as practicable after the effective date of this Registration Statement.

If any of the securities being registered on this Form are to be offered on a delayed or continuous basis pursuant to Rule 415 under the Securities Act of 1933, check the following

box. ☐

If this Form is filed to register additional securities for an offering pursuant to Rule 462(b) under the Securities Act, please check the following box and list the Securities Act

registration statement number of the earlier effective registration statement for the same offering. ☐

If this Form is a post-effective amendment filed pursuant to Rule 462(c) under the Securities Act, check the following box and list the Securities Act registration statement number

of the earlier effective registration statement for the same offering. ☐

If this Form is a post-effective amendment filed pursuant to Rule 462(d) under the Securities Act, check the following box and list the Securities Act registration statement number

of the earlier effective registration statement for the same offering. ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company.

See the definitions of "large accelerated filer," "accelerated filer," "smaller reporting company," and "emerging growth company" in Rule 12b-2 of the Exchange Act.

---

| | | | |
|:---|:---|:---|:---|
| Large accelerated filer | ☐ | Accelerated filer | ☐ |
| Non-accelerated filer | ☒ | Smaller reporting company | ☐ |
|  |  | Emerging growth company | ☒ |

---

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial

accounting standards provided pursuant to Section 7(a)(2)(B) of the Securities Act. ☐

**The registrant hereby amends this registration statement on such date or dates as may be necessary to delay its effective date until the registrant shall file a further** 

**amendment which specifically states that this registration statement shall thereafter become effective in accordance with Section 8(a) of the Securities Act of 1933, as** 

**amended, or until the registration statement shall become effective on such date as the U.S. Securities and Exchange Commission, acting pursuant to said Section** 

**8(a), may determine.**

**Subject to Completion, dated August 6, 2025**

**The information in this preliminary prospectus is not complete and may be changed. We may not sell these securities until the registration statement filed**

**with the U.S. Securities and Exchange Commission is effective. This preliminary prospectus is not an offer to sell these securities and it is not soliciting an**

**offer to buy these securities in any jurisdiction where the offer or sale is not permitted.**

**Preliminary prospectus**

***16,666,667 shares***

![heartflowlogo.jpg](heartflowlogo.jpg)

***Common stock***

This is an initial public offering of shares of common stock of Heartflow, Inc. We are offering 16,666,667 shares of

our common stock to be sold in this offering. The initial public offering price is expected to be between $17.00 and

$18.00 per share.

Prior to this offering, there has been no public market for our common stock. We have applied to list our common

stock on the Nasdaq Global Select Market under the trading symbol "HTFL," and this offering is contingent upon

obtaining such approval.

Upon completion of this offering, our executive officers, directors, owners of 5% or more of our capital stock and

their respective affiliates will own, in the aggregate, approximately 50.1% of our common stock (assuming no

exercise of the underwriters' option to purchase additional shares and no purchases of shares in this offering by

anyone in this group). These stockholders will be able to exercise significant control over matters requiring

stockholder approval, including the election of directors, amendment of our organizational documents, and

approval of any merger, sale of assets, and other major corporate transactions.

We are an "emerging growth company" as defined under the U.S. federal securities laws and, as such, have

elected to comply with certain reduced public company reporting requirements in this prospectus and may elect to

do so in future filings. See the section titled "<u>[Prospectus summary—Implications of being an emerging growth](#ica9aca2e3edd4ac39266d8c9cedc6eee_290985)</u>

<u>[company](#ica9aca2e3edd4ac39266d8c9cedc6eee_290985)</u>."

---

| | | |
|:---|:---|:---|
|  | **Per share** | **Total** |
| Initial public offering price................................................................................................... | $&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  | $&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  |
| Underwriting discounts and commissions<sup>(1)</sup>.................................................................... | $&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  | $&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  |
| Proceeds to Heartflow, Inc., before expenses................................................................. | $&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  | $&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  |

---

(1)See the section titled "<u>[Underwriting](#i2341357d54884756b9e9172f0a83cd6b_1434)</u>" for a description of the compensation payable to the underwriters.

We have granted the underwriters an option for a period of 30 days to purchase up to 2,500,000 additional shares

of common stock.

**Investing in our common stock involves a high degree of risk. Please see "<u>[Risk factors](#i2341357d54884756b9e9172f0a83cd6b_697)</u>" beginning on** 

**page <u>[22](#i2341357d54884756b9e9172f0a83cd6b_697)</u>.**

**Neither the Securities and Exchange Commission ("SEC") nor any state securities commission has** 

**approved or disapproved of these securities or determined if this prospectus is truthful or complete. Any** 

**representation to the contrary is a criminal offense.**

The underwriters expect to deliver the shares of common stock to the purchasers on or about&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; , 2025.

---

| | | |
|:---|:---|:---|
| **J.P. Morgan** | **Morgan Stanley** | **Piper Sandler** |

---

---

| | |
|:---|:---|
| **Stifel** | **Canaccord Genuity** |

---

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; , **2025**

i

**Table of contents**

---

| | |
|:---|:---|
|  | **Page** |
| <u>[Prospectus summary](#i2341357d54884756b9e9172f0a83cd6b_691)</u>..................................................................................................................................... | <u>[1](#i2341357d54884756b9e9172f0a83cd6b_691)</u> |
| <u>[Risk factors](#i2341357d54884756b9e9172f0a83cd6b_697)</u>...................................................................................................................................................... | <u>[22](#i2341357d54884756b9e9172f0a83cd6b_697)</u> |
| <u>[Special note regarding forward-looking statements](#i2341357d54884756b9e9172f0a83cd6b_1039)</u>................................................................................. | <u>[72](#i2341357d54884756b9e9172f0a83cd6b_1039)</u> |
| <u>[Market and industry data](#i2341357d54884756b9e9172f0a83cd6b_1064)</u>............................................................................................................................... | <u>[74](#i2341357d54884756b9e9172f0a83cd6b_1064)</u> |
| <u>[Use of proceeds](#i2341357d54884756b9e9172f0a83cd6b_1089)</u>............................................................................................................................................. | <u>[75](#i2341357d54884756b9e9172f0a83cd6b_1089)</u> |
| <u>[Dividend policy](#i2341357d54884756b9e9172f0a83cd6b_1114)</u>................................................................................................................................................ | <u>[77](#i2341357d54884756b9e9172f0a83cd6b_1114)</u> |
| <u>[Capitalization](#i2341357d54884756b9e9172f0a83cd6b_1139)</u>.................................................................................................................................................. | <u>[78](#i2341357d54884756b9e9172f0a83cd6b_1139)</u> |
| <u>[Dilution](#i2341357d54884756b9e9172f0a83cd6b_1164)</u>............................................................................................................................................................. | <u>[81](#i2341357d54884756b9e9172f0a83cd6b_1164)</u> |
| <u>[Management's discussion and analysis of financial condition and results of operations](#i2341357d54884756b9e9172f0a83cd6b_533)</u>................... | <u>[85](#i2341357d54884756b9e9172f0a83cd6b_533)</u> |
| <u>[Business](#i2341357d54884756b9e9172f0a83cd6b_1189)</u>.......................................................................................................................................................... | <u>[105](#i2341357d54884756b9e9172f0a83cd6b_1189)</u> |
| <u>[Management](#i2341357d54884756b9e9172f0a83cd6b_1233)</u>................................................................................................................................................... | <u>[155](#i2341357d54884756b9e9172f0a83cd6b_1233)</u> |
| <u>[Executive and director compensation](#i2341357d54884756b9e9172f0a83cd6b_1258)</u>......................................................................................................... | <u>[165](#i2341357d54884756b9e9172f0a83cd6b_1258)</u> |
| <u>[Certain relationships and related-party transactions](#i2341357d54884756b9e9172f0a83cd6b_1286)</u>................................................................................ | <u>[181](#i2341357d54884756b9e9172f0a83cd6b_1286)</u> |
| <u>[Principal stockholders](#i2341357d54884756b9e9172f0a83cd6b_1309)</u>.................................................................................................................................... | <u>[187](#i2341357d54884756b9e9172f0a83cd6b_1309)</u> |
| <u>[Description of capital stock](#i2341357d54884756b9e9172f0a83cd6b_1337)</u>........................................................................................................................... | <u>[192](#i2341357d54884756b9e9172f0a83cd6b_1337)</u> |
| <u>[Shares eligible for future sale](#i2341357d54884756b9e9172f0a83cd6b_1360)</u>....................................................................................................................... | <u>[199](#i2341357d54884756b9e9172f0a83cd6b_1360)</u> |
| <u>[Material U.S. federal income tax consequences to non-U.S. holders](#i2341357d54884756b9e9172f0a83cd6b_1408)</u>................................................... | <u>[202](#i2341357d54884756b9e9172f0a83cd6b_1408)</u> |
| <u>[Underwriting](#i2341357d54884756b9e9172f0a83cd6b_1434)</u>.................................................................................................................................................... | <u>[206](#i2341357d54884756b9e9172f0a83cd6b_1434)</u> |
| <u>[Legal matters](#i2341357d54884756b9e9172f0a83cd6b_1505)</u>.................................................................................................................................................. | <u>[218](#i2341357d54884756b9e9172f0a83cd6b_1505)</u> |
| <u>[Experts](#i2341357d54884756b9e9172f0a83cd6b_1531)</u>............................................................................................................................................................. | <u>[218](#i2341357d54884756b9e9172f0a83cd6b_1531)</u> |
| <u>[Where you can find additional information](#i2341357d54884756b9e9172f0a83cd6b_1578)</u>................................................................................................. | <u>[218](#i2341357d54884756b9e9172f0a83cd6b_1578)</u> |
| <u>[Index to consolidated financial statements](#i2341357d54884756b9e9172f0a83cd6b_77)</u>................................................................................................ | <u>[F-1](#i2341357d54884756b9e9172f0a83cd6b_77)</u> |

---

Through and including &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;, 2025 (the 25th day after the date of this prospectus), all dealers effecting

transactions in our common stock, whether or not participating in this offering, may be required to deliver

a prospectus. This delivery requirement is in addition to a dealer's obligation to deliver a prospectus when

acting as an underwriter and with respect to an unsold allotment or subscription.

We have not, and the underwriters have not, authorized anyone to provide you any information or to

make any representations other than those contained in this prospectus or in any free writing prospectus

prepared by or on behalf of us or to which we have referred you. Neither we nor the underwriters take

responsibility for, or provide any assurance as to the reliability of, any other information others may give

you. We and the underwriters are offering to sell only the shares offered hereby, and only under

circumstances and in jurisdictions where it is lawful to do so. We are not, and the underwriters are not,

making an offer to sell these securities in any jurisdiction where the offer or sale is not permitted. The

ii

information contained in this prospectus is accurate only as of the date of this prospectus, regardless of

the time of delivery of this prospectus or any sale of the shares of our common stock. Our business,

financial condition, and results of operations may have changed since that date.

For investors outside the United States: We have not, and the underwriters have not, done anything that

would permit this offering or the possession or distribution of this prospectus or any free writing

prospectus in connection with this offering in any jurisdiction where action for that purpose is required,

other than in the United States. Persons outside the United States who come into possession of this

prospectus must inform themselves about, and observe any restrictions relating to, the offering of the

shares of common stock and the distribution of this prospectus outside the United States. "Heartflow," the

Heartflow logos, and other trade names, trademarks, or service marks of Heartflow appearing in this

prospectus are the property of Heartflow. Other trade names, trademarks, or service marks appearing in

this prospectus are the property of their respective holders. We do not intend our use or display of other

companies' trade names, trademarks, or service marks to imply a relationship with, or endorsement or

sponsorship of us, by these other companies. Solely for convenience, trade names, trademarks, and

service marks referred to in this prospectus appear without the®,™, and <sup>SM</sup> symbols, but those

references are not intended to indicate, in any way, that we will not assert, to the fullest extent under

applicable law, our rights or that the applicable owner will not assert its rights, to these trade names,

trademarks, and service marks.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**Prospectus summary**

*This summary highlights select information contained in greater detail elsewhere in this prospectus. This* 

*summary is not complete and does not contain all of the information you should consider in making your* 

*investment decision. Before investing in our common stock, you should carefully read this entire* 

*prospectus. You should carefully consider, among other things, the sections titled "Risk factors," "Special* 

*note regarding forward-looking statements," "Business," and "Management's discussion and analysis of* 

*financial condition and results of operations" and our consolidated financial statements and the related* 

*notes included elsewhere in this prospectus before making an investment decision. Unless the context* 

*otherwise requires, the terms "Heartflow," "the Company," "we," "us," and "our" in this prospectus refer to* 

*Heartflow, Inc. and its wholly owned subsidiaries, or either or both of them as the context may require.*

**Overview**

We have pioneered the use of software and AI to deliver a more accurate and clinically effective non-

invasive solution for diagnosing and managing coronary artery disease ("CAD"), a leading cause of death

worldwide. As of March 31, 2025, our Heartflow Platform has been used to assess CAD in more than

400,000 patients, including 132,000 in 2024 alone. We believe that we are the most widely adopted AI-

powered test for CAD. Our novel platform leverages AI and advanced computational fluid dynamics to

create a personalized 3D model of a patient's heart from a single coronary computed tomography

angiography ("CCTA"), a specialized type of scan that provides detailed images of the heart's arteries.

Our Heartflow Platform delivers actionable insights on blood flow, stenosis, plaque volume and plaque

composition thereby overcoming the limitations of traditional non-invasive imaging tests which rely on

indirect measures of coronary disease and lead to higher false negative and false positive rates, as

demonstrated by our PRECISE trial. We believe the differentiated accuracy and clinical utility of our

Heartflow Platform, along with its ability to enhance workflows, will continue to support our growth and

advance the "CCTA + Heartflow" pathway as the definitive standard for the non-invasive diagnosis and

management of CAD.

Cardiovascular disease is the leading cause of death worldwide, with CAD being the most lethal form.

CAD occurs when plaque—a buildup of cholesterol, fat, calcium and other substances—accumulates on

the walls of the coronary arteries, restricting blood flow and increasing the risk of heart attack or stroke.

This condition is responsible for half of all cardiovascular-related deaths globally. In the United States

alone, the Centers for Disease Control ("CDC") estimates that approximately 805,000 people suffer a

heart attack each year. Despite significant advancements in therapeutic and interventional treatments,

CAD remains a leading cause of death globally because healthcare systems generally lack scalable

methods to efficiently detect, diagnose and quantify CAD at a personalized level.

Based on our analyses using Clarivate's ProcedureFinder data repository, we estimate that there were

approximately 9.5 million non-invasive tests ("NITs") in the United States in 2023 for patients experiencing

stable or acute chest pain, which we refer to as symptomatic CAD patients. These NITs primarily include

stress tests, such as single-photon emission computed tomography ("SPECT"), echocardiography and

positron emission tomography ("PET"), which infer the presence of heart disease based on how well

blood is supplied to the heart, and do not measure the actual disease itself. Accordingly, these tests have

been shown to be unreliable and inconsistent.

CCTA has emerged as a leading non-invasive imaging method for evaluating CAD, offering direct and

detailed visualization of the coronary arteries. Unlike traditional stress-based NITs, CCTA enables

physicians to identify the presence and extent of coronary blockage. As a result, CCTA has become the

preferred first-line test for patients with suspected CAD, as evidenced by the AHA and ACC guidelines

elevating CCTA to Class 1, Level A. However, while CCTA provides superior anatomical imaging, it does

not independently quantify the severity of CAD, assess blood flow limitations, or characterize plaque

composition—critical factors for determining the most appropriate, personalized course of treatment for a

patient.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

Our Heartflow Platform builds upon the well established strengths of CCTA by going beyond its limitations

and providing new quantified insights and compelling visualizations of data. By applying our advanced AI-

powered technology to a single CCTA scan, we generate a precise, patient-specific analysis that

quantifies blood flow, measures plaque burden, and characterizes plaque composition—at every point in

the major coronary arteries.

To date, we have developed three software products (with a fourth product expected to launch in 2026)

under the Heartflow Platform that provide physicians with the critical insights needed to effectively

diagnose and manage CAD:

• *Heartflow RoadMap Analysis* offers a highly intuitive anatomic visualization of the coronary arteries,

helping physicians quickly identify clinically relevant areas to focus their review. We provide Heartflow

RoadMap Analysis to accounts as an integrated feature to enhance the efficiency of their CCTA

program and it is not a stand-alone product.

• *Heartflow FFR*CT *Analysis* calculates blood flow and pinpoints clinically significant CAD, which is CAD

with a fractional flow reserve ("FFR") value of 0.80 or below, at every point in the major coronary

arteries. FFR measures the severity of blood flow restriction in the coronary arteries on a scale of 1.0

(no restriction) to 0.0 (complete blockage) by assessing pressure differences across a stenosis during

induced stress, guiding decisions on whether a patient requires invasive revascularization.

• *Heartflow Plaque Analysis* provides a comprehensive assessment of coronary plaque, enabling

optimized medical treatment strategies.

• *Heartflow PCI Planner*, which we expect to launch in 2026, will provide advanced visualization and

clinical insights to optimize revascularization strategies, guide device selection, enhance procedural

efficiency, and improve patient care. We plan to provide Heartflow PCI Planner to accounts as an

integrated feature to enhance procedural efficiency, not as a stand-alone product.

We believe we are the first and most widely-adopted AI-powered test for CAD. With over a decade of

commercial presence, we have established a competitively differentiated data set of approximately 110

million annotated images, which is primarily sourced from our commercial relationships with customers,

driving training and refinement of our algorithms for over 10 years and the ability to train new AI models

for future products.

We believe our Heartflow Platform delivers the following key benefits:

• **More accurate non-invasive test for CAD**, clinically validated to provide superior assessment of

blood flow, plaque volume and plaque characterization compared to traditional non-invasive methods.

• **More informed assessments, personalized care, and better risk stratification**, positively

impacting physician decisions on which patients should receive an intervention, supporting more

efficient intervention planning and driving more personalized medical management.

• **Superior economic efficiency and enhanced interventional treatment planning**, accurately

identifying more patients who need interventional treatment while reducing unnecessary invasive

procedures—significantly improving the efficiency of the catheterization lab and therefore hospital

economics.

• **Proprietary, secure bi-directional data communication with customers** that feeds a growing

database of approximately 110 million annotated CCTA images that we leverage to improve the

Heartflow Platform's accuracy, automation and clinical utility and seamlessly deliver new features and

workflow efficiencies to our customers.

• **Improved workflow** through our Heartflow RoadMap Analysis that, as demonstrated in our SMART-

CT study, reduces CCTA interpretation times by approximately 25% and reduces variability between

reviewing physicians by approximately 40%, leading to more consistent diagnoses and standardized

patient care.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

• **Better patient and provider experience**, by leveraging a single CCTA for all of our products,

patients complete their test in approximately 20 minutes with significantly lower radiation exposure

compared to nuclear imaging tests such as SPECT and PET that take multiple hours and require

radioactive tracers to be injected into the bloodstream. By providing a definitive diagnosis upfront, the

Heartflow Platform eliminates the need for layered testing, streamlining the patient journey and

reducing anxiety associated with uncertain or inconclusive results.

We estimate our current market opportunity in the United States for our Heartflow FFRCT Analysis and

Heartflow Plaque Analysis is approximately $5 billion. Based on our analyses using Clarivate's

ProcedureFinder data repository, we estimate that approximately 9.5 million unique stable chest pain

patients receive NITs in the United States annually. In addition, based on our FORECAST randomized

trial, we further estimate that 33% of patients have stenosis levels between 40% and 90%, which results

in approximately 2.8 million patients eligible for our Heartflow FFRCT Analysis in the stable setting. Based

on the Martin paper, where there were approximately 577,000 hospital discharges in the United States in

2020 due to a principal diagnosis of acute chest pain, and the Bhatt paper, where No ST Elevation

("NSTE") related acute chest pain accounted for approximately 70% of acute chest pain, we further

estimate that the annual incidence of patients who have acute chest pain with NSTE is approximately 0.4

million patients. Of these approximately 0.4 million patients, we estimate based on the Kofoed paper that

approximately 70% have obstructive disease and are eligible for our Heartflow FFRCT Analysis, which

results in approximately 0.3 million acute chest pain patients eligible for our Heartflow FFRCT Analysis.

Therefore, we believe there is a market opportunity of approximately 3.1 million patients eligible for our

Heartflow FFRCT Analysis, which, at a U.S. average sales price of $1,067, translates to an estimated

market opportunity of approximately $3.3 billion in the United States.

In addition, we believe our Heartflow Plaque Analysis is applicable to approximately 60% of those 9.5

million NIT patients annually and the majority of patients experiencing acute chest pain. Based on our

PROMISE trial and the Hoffmann paper, we estimate that approximately 60% of CCTA patients have

plaque and are eligible for plaque analysis, which translates to approximately 5.1 million patients eligible

for our Heartflow Plaque Analysis in a stable setting. Based on our internal analysis and the findings in the

Wang paper, where less than 5% of patients were expected to be contraindicated for CCTA, we also

estimate that all of the approximately 0.4 million patients with acute chest pain with NSTE referred to

above will be eligible for our Heartflow Plaque Analysis. Therefore, we believe there is a market

opportunity of approximately 5.5 million patients eligible for our Heartflow Plaque Analysis, which, at an

estimated U.S. sales price of $300, translates to an estimated market opportunity of approximately an

incremental $1.7 billion in the United States.

Beyond the commercialization of Heartflow FFRCT Analysis and Heartflow Plaque Analysis in symptomatic

CAD, we see a significant market opportunity for our technologies in at-risk individuals who show no

symptoms, a segment comprised of approximately 200 million people globally, based on data from the

U.S. Census Bureau, CDC, Eurostat, United Kingdom Office of National Statistics, the Yang paper and

the MacDonald paper. To unlock this potential, we are continuing to evaluate new product opportunities

and appropriate clinical evidence supporting eventual regulatory approval, payor coverage and

commercialization.

We believe the Heartflow Platform is the most extensively studied AI-enabled test for CAD. Our belief is

grounded in our analysis, including that the Heartflow Platform and its accuracy, clinical utility and

economic benefits have been evaluated in over 100 clinical studies and more than 130,000 patients,

including our PRECISE and FORECAST trials, each a large randomized controlled trial, with results

published in over 600 peer-reviewed clinical publications. Our studies, including the PRECISE, NXT and

PACIFIC trials, have consistently demonstrated that the Heartflow Platform is more accurate than

traditional non-invasive tests and highly concordant to invasive testing, reduces unnecessary invasive

testing, and enables physicians to optimize treatment and ultimately provide more efficient care.

We have developed a highly scalable, capital efficient commercial model that combines Territory Sales

Managers ("TSMs") who drive new account adoption with Territory Account Managers ("TAMs") who focus

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on increasing utilization by educating referring physicians. Our commercial team does not cover cases or

otherwise spend time in an operating room or lab setting, which enables them to focus solely on driving

commercial adoption and educational activities.

Our technology is simple and intuitive and does not require the purchase of any capital equipment. Our

onboarding process seamlessly integrates the Heartflow Platform into the customer's daily workflow.

These unique attributes of our business model afford our commercial organization a differentiated level of

efficiency and scalability.

Current clinical guidelines strongly support the adoption of the Heartflow Platform. The CCTA + Heartflow

FFRCT Analysis pathway is supported by the American Heart Association ("AHA") and American College of

Cardiology ("ACC") guidelines, with CCTA identified as a Class 1, Level A test and Heartflow FFRCT

Analysis identified as a Class 2a, Level B test for the diagnosis of CAD in certain patients with stable or

acute chest pain and no known CAD. The AHA and ACC guidelines utilize Classes and Levels to indicate

the strength of a recommendation and the quality of supporting evidence, respectively. Class 1 represents

the strongest recommendation, followed by Class 2a, which represents a moderate recommendation.

Similarly, Level A signifies the highest quality of evidence, while Level B indicates moderate quality.

We believe current reimbursement policies support the adoption of the Heartflow Platform. Our Heartflow

FFRCT Analysis is reimbursed under a dedicated Category I Current Procedural Terminology ("CPT")

code, effective as of January 1, 2024, and has established coverage policies representing approximately

99% of covered lives in the United States. A Category I CPT code was recently established for Heartflow

Plaque Analysis. It will go into effect on January 1, 2026, and is covered by all seven Medicare

administrative contractor ("MACs"). A Category I CPT code designates a procedure or service that uses

device(s) with Food and Drug Administration ("FDA") clearance or approval (when required), is performed

by many physicians across the United States for its intended clinical use, aligns with current medical

practice, and has documented efficacy in literature. The Category I CPT status for our Heartflow FFRCT

Analysis and Heartflow Plaque Analysis validates their widespread use and distinguish them from

emerging technologies that are assigned Category III CPT codes.

We primarily generate revenue on a "pay-per-click" basis each time a physician chooses to review either

our Heartflow FFRCT Analysis, Heartflow Plaque Analysis, or both. Heartflow FFRCT Analysis has served

as our commercial foundation, representing 99% of our total revenue as of March 31, 2025. In the second

half of 2023, we initiated limited market education efforts for Heartflow Plaque Analysis, our second

commercial product. Our Heartflow RoadMap Analysis is generally provided as a workflow efficiency tool

to drive customer retention and loyalty and is not a stand-alone product. We expect to launch our next

product, Heartflow PCI Planner, in 2026 as an integrated feature to enhance procedural efficiency, not as

a stand-alone product.

We have experienced significant revenue growth since we began commercializing the Heartflow Platform

in 2015. We recognized revenue of $125.8 million for the year ended December 31, 2024, compared to

revenue of $87.2 million for the year ended December 31, 2023, representing 44% year-over-year growth.

We recognized revenue of $37.2 million for the three months ended March 31, 2025, compared to

revenue of $26.8 million for the three months ended March 31, 2024, representing 39% growth over the

prior year period. The software-based nature of our Heartflow Platform produces an attractive gross

margin profile, which continues to expand as we leverage AI to automate an increasing portion of our

"human-in-the loop" quality control process, where learnings are fed back into our algorithms to make

them smarter and more efficient. For the twelve months ended December 31, 2024, we generated gross

margins of 75%, an increase of 8 percentage points year-over-year from December 31, 2023. Our net

losses were $95.7 million and $96.4 million for the years ended December 31, 2023 and 2024,

respectively. Our accumulated deficit was $874.5 million and $971.0 million as of December 31, 2023 and

2024, respectively. Our net losses were $20.9 million and $32.3 million for the three months ended March

31, 2024 and 2025, respectively. Our accumulated deficit was $1.0 billion as of March 31, 2025. For the

three months ended March 31, 2025, we generated gross margins of 75%, an increase of 3 percentage

points over the three months ended March 31, 2024.

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**Market overview and opportunity** 

***Overview of CAD***

Cardiovascular disease is the leading cause of death worldwide, with CAD being the most lethal form.

CAD occurs when plaque—a buildup of cholesterol, fat, calcium and other substances—accumulates on

the walls of the coronary arteries, restricting blood flow and increasing the risk of heart attack or stroke.

This condition is responsible for half of all cardiovascular-related deaths globally.

Key risk factors, including high cholesterol, hypertension, smoking, diabetes, obesity, physical inactivity,

and genetic predisposition, accelerate plaque formation and destabilization. In the United States alone,

the CDC estimates that approximately 805,000 people suffer a heart attack each year. CAD can be

effectively treated with well-established therapeutics designed to reduce plaque progression and change

its composition, or interventional procedures used to open the arteries and restore blood flow. However,

achieving an accurate diagnosis for the condition has historically been the primary roadblock for the

effective care and management of CAD.

NITs are the first line approach for detecting CAD in symptomatic patients. Based on our analyses using

Clarivate's ProcedureFinder data repository, with 9.5 million tests performed for the diagnosis of CAD in

the United States in 2023, NITs are by far the most widely used method to diagnose CAD. However,

traditional NITs are not able to measure lesion-specific blood flow and are not an efficient or effective way

to calculate plaque volume and composition. As a result, they lack the key metrics physicians need to

guide treatment decisions and have been clinically shown to be unreliable and inconsistent for diagnosing

CAD.

***Limitations of traditional non-invasive tests for CAD***

There are two primary types of NITs: (i) stress tests, which infer the presence of CAD based on blood

perfusion, and (ii) CCTA, which directly images the patient's coronary arteries.

Stress-based NITs include SPECT, PET and stress echocardiography. Stress-based NITs rely on

surrogate markers of CAD to deduce the disease in the coronary artery without actually assessing the

coronary arteries or the disease itself. As a result, approximately 20–50% of patients who undergo stress-

based NITs go home with false negatives, or undetected CAD that should have required an intervention,

based on the Nakanishi paper and the Yokota paper. In addition, based on the 2014 Patel paper, up to

55% of patients receive false positives and are sent to the cardiac catheterization lab for an invasive

diagnostic angiography when an intervention was never needed exposing patients to unnecessary risks

including vascular injury and bleeding complications. This results in significant additional costs to the

healthcare system and poor patient experience.

CCTA is a high-resolution 3D imaging method that uses X-rays to produce detailed pictures of the heart's

arteries and other structures. The analyses performed by our Heartflow Platform rely on CCTA images

from third-party CT manufacturers. Because CCTA images are used across multiple medical practices, by

different medical professionals and others, CT scanners have historically and currently output CCTA

images in standard file formats rather than proprietary formats. Unlike stress tests that rely on indirect

measures to infer heart disease, CCTA provides direct visualization of the patient's anatomy and can

allow for a comprehensive visual assessment of coronary stenosis and plaque burden. CCTA has been

clinically demonstrated in the SCOT-HEART trial to have the highest diagnostic performance of all

traditional non-invasive imaging tests for CAD. In recognition of its superior diagnostic accuracy, in

October 2021 the AHA and ACC elevated CCTA to a first line Class 1, Level A test in the guidelines for

certain patients with stable or acute chest pain and no known CAD, above stress testing which is Class 1,

Level B. While CCTA accurately identifies stenosis in the coronary arteries, it does not calculate the blood

flow through the arteries to identify whether the stenosis is clinically significant and does not provide

plaque quantification or composition without significant and time-consuming and variable manual

calculations.

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Our Heartflow Platform, which requires a CCTA image from a CT scanner to perform its analysis,

significantly improves the clinical utility of CCTA and addresses the limitations of traditional non-invasive

CAD testing by combining existing CCTA images with our AI algorithms to provide actionable data on

blood flow, stenosis, plaque volume and plaque composition. This delivers superior clinical utility relative

to other NITs and compelling economic benefits, which are supported by extensive clinical evidence. As a

result, we believe the CCTA + Heartflow pathway will become the standard of care for the non-invasive

diagnosis of CAD over time.

---

| | | | |
|:---|:---|:---|:---|
| **<u>Traditional NITs vs. Heartflow</u>** | **<u>Traditional NITs vs. Heartflow</u>** | **<u>Traditional NITs vs. Heartflow</u>** | **<u>Traditional NITs vs. Heartflow</u>** |
| Stress Echocardiogram | SPECT and PET | CCTA | Heartflow FFRCT Analysis |
| ![prospectussummary1b.jpg](prospectussummary1b.jpg) | ![prospectussummary1b.jpg](prospectussummary1b.jpg) | ![prospectussummary1b.jpg](prospectussummary1b.jpg) | ![prospectussummary2c.jpg](prospectussummary2c.jpg) |

---

*Figure 1: A comparison of the visual output of traditional non-invasive tests. Left: Stress echocardiogram.* 

*Center: SPECT and PET. Right: CCTA image. Far Right: Heartflow FFRCT Analysis image which color* 

*codes coronary blood flow to identify clinically significant blockages.*

***Our symptomatic CAD market opportunity***

We estimate our current market opportunity in the United States for our Heartflow FFRCT Analysis and

Heartflow Plaque Analysis is approximately $5 billion. Based on our analyses using Clarivate's

ProcedureFinder data repository, we estimate that there were approximately 9.5 million NITs in the United

States for the diagnosis of CAD in 2023. In addition, based on our FORECAST randomized trial and the

Wang paper, we believe there were approximately 8.6 million patients that were addressable with CCTA

after accounting for layered testing and contraindications to CCTA. CCTA testing volumes have grown

rapidly, and we believe they will continue to outpace the broader market growth driven by the recently

established Class 1, Level A guidelines, superior clinical utility to stress tests and improved

reimbursement.

Our Heartflow FFRCT Analysis is reimbursed for use on any CCTA showing 40% to 90% stenosis, which,

based on our FORECAST randomized trial, we estimate to be approximately 33% of all CCTAs annually.

We believe that CCTA + Heartflow FFRCT Analysis therefore is applicable to 33% of the NIT market and a

majority of patients experiencing acute chest pain, which represents 3.1 million patients and an estimated

market opportunity of approximately $3.3 billion in the United States. Our Heartflow Plaque Analysis is

reimbursed for plaque identified on CCTA with 1% to 69% stenosis, which, based on our PROMISE trial

and the Hoffmann paper, we estimate to cover approximately 60% of all CCTAs annually and a majority of

patients experiencing acute chest pain. We believe that CCTA + Heartflow Plaque Analysis is therefore

applicable to 60% of the NIT market, which represents 5.5 million patients and an estimated market

opportunity of an incremental approximately $1.7 billion in the United States.

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While our current focus is on the United States and the Heartflow Platform has been cleared by the FDA

(K213857), our Heartflow FFRCT Analysis has commercial presence and regulatory approval in the United

Kingdom, European Union, Australia, Canada and Japan. The Heartflow Platform has also been cleared

by the equivalent regulatory authorities in Israel, Saudi Arabia, United Arab Emirates, and licensed in

Bahrain. In the future we may expand our international presence beyond these markets and extend our

platform to additional indications.

**Our technology**

Heartflow enhances CCTA, the most advanced non-invasive imaging modality for assessing CAD, with

AI-powered analysis to deliver more accurate and clinically actionable insights for diagnosing and

managing CAD. The Heartflow Platform applies deep learning, an advanced form of AI, and

computational fluid dynamics to CCTA images to create a personalized 3D model of a patient's heart

based on a single CCTA image. This model provides actionable insights into blood flow, stenosis, plaque

volume and plaque composition allowing precise diagnosis, risk stratification, and treatment planning –

without the need for an invasive procedure.

The CCTA + Heartflow pathway addresses the limitations of traditional non-invasive tests that only assess

indirect measures for coronary disease and therefore result in higher rates of false negative and false

positive CAD diagnoses, as demonstrated by our PRECISE trial. We believe the differentiated accuracy

and clinical utility of the CCTA + Heartflow pathway will continue to support our growth and advance the

standard for the non-invasive diagnosis and management of CAD.

We designed our AI-powered software platform to be highly scalable, seamlessly integrate into existing

physician workflows for diagnosing CAD, and improve as we ingest more data over time. By leveraging AI

to process massive volumes of cases and a "human-in-the loop" quality control process, where learnings

are fed back into our algorithms to improve their performance and efficiency, we have rapidly scaled our

platform to deliver accurate, timely results to benefit physicians and patients alike.

![prospectussummary3c.jpg](prospectussummary3c.jpg)

 *Figure 2: The CCTA + Heartflow pathway*

***Our product portfolio***

To date, we have created three software products (with a fourth product expected to launch in 2026) in a

unified platform and user experience that provide the critical data physicians need to effectively manage

patients with suspected CAD.

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**Heartflow RoadMap Analysis:** The Heartflow RoadMap Analysis provides

![prospectussummary5ca.jpg](prospectussummary5ca.jpg)

![picture1number3.jpg](picture1number3.jpg)

a highly intuitive anatomic visualization of the patient's coronary anatomy

based on CCTA images. It rapidly orients the imaging physician to clinically

relevant areas of the patient anatomy and provides a preview of what they

will review in the native CCTA images to aid the physician in accurately,

efficiently and consistently identifying stenosis in the coronary arteries.

Heartflow RoadMap Analysis supports more efficient radiology workflow,

improving CCTA read times by 25% and increasing consistency between

reviewing physicians by approximately 40%, as demonstrated in our

SMART-CT study. Physicians use Heartflow Roadmap Analysis as a first-

line assessment tool along with CCTA interpretation to determine whether

to order our more detailed Heartflow FFRCT Analysis or Heartflow Plaque

Analysis reports. We generally provide Heartflow RoadMap Analysis to

accounts as an integrated feature to enhance the efficiency and

consistency of their CCTA programs and it is not a stand-alone product.

We believe the efficiency that Heartflow RoadMap Analysis provides our

customers has resulted in enhanced customer loyalty and retention.

**Heartflow FFRCT Analysis:** Our flagship product, Heartflow FFRCT

Analysis, consists of a patient-specific, interactive, 3D anatomical

reconstruction of the coronary anatomy that identifies clinically significant

CAD at every point in the major coronary arteries to determine the need

for intervention. Our Heartflow FFRCT Analysis has the highest diagnostic

accuracy for a non-invasive CAD test and has demonstrated a high level

of concordance to invasive FFR, as seen in our PRECISE, NXT and

PACIFIC trials. Current AHA and ACC guidelines designated CCTA as a

Class 1, Level A test for CAD in certain patients with stable or acute chest

pain and no known CAD, and Heartflow FFRCT Analysis as a Class 2a,

Level B test to help physicians guide patient treatment decisions. As of

March 31, 2025, Heartflow FFRCT Analysis represented 99% of our total

revenue.

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**Heartflow Plaque Analysis:**Heartflow Plaque Analysis transforms

![prospectussummary6a.jpg](prospectussummary6a.jpg)

coronary plaque assessment from a time-consuming and variable manual

process, which is seldom clinically used, into a rapid, automated, and

highly precise AI-driven solution. The Heartflow Plaque Analysis

automatically provides a comprehensive 3D assessment of a patient's

coronary plaque, including a characterization of plaque types and

quantification of plaque volumes at every point in the major coronary

arteries. The Heartflow Plaque Analysis has been validated against the

reference standard of invasive intravascular ultrasound ("IVUS") and

shown to have a 95% agreement with IVUS in quantifying total coronary

plaque volume in our REVEALPLAQUE study. Moreover, our current

findings from the DECIDE registry show the Heartflow Plaque Analysis

led to medical management change in over half of patients beyond CCTA

alone. Because coronary plaque volume is a strong predictor of a

patient's risk of having a heart attack, this data offers incremental

predictive power over risk factors and stenosis alone and can aid the physician in optimizing medical

management. Our Heartflow Plaque Analysis was cleared by the FDA in October 2022. We began our

limited market education efforts in the second half of 2023, and we expect to broaden our market

education efforts as payor coverage for Heartflow Plaque Analysis increases. We also anticipate our

Heartflow Plaque Analysis to be included in updated cardiac imaging guidelines by radiology benefit

manager EviCore by Evernorth, which provides coverage guidelines to leading commercial health

insurers, effective October 1, 2025.

**Heartflow PCI Planner:** Heartflow PCI Planner, which we expect to launch in 2026, will enable pre-

percutaneous coronary intervention ("PCI") assessment of coronary anatomy, lesion-specific physiology

and plaque localization through an interactive 3D model, combined in a single interface. The tool will

provide interventional cardiologists with advanced visualization and clinical insights to help answer critical

questions for revascularization strategies, such as which lesions to treat, how to treat them, the

complexity of PCI, the need for calcium modification, what ancillary tool to use and how to optimize stent

quantity, size and placement. We expect Heartflow PCI Planner to offer procedural efficiency through

advanced preparation, improved patient care by ensuring optimal treatment at the right time and

increased clinician confidence with detailed pre-procedure knowledge. We plan to provide Heartflow PCI

Planner to accounts as an integrated feature to enhance procedural efficiency, not as a stand-alone

product.

***Key benefits of our Heartflow Platform***

We believe the unique features of our technology allow us to offer superior clinical utility and economic

value to our customers and the broader healthcare system. The key benefits offered by our Heartflow

Platform include:

• **More accurate non-invasive test for CAD:** Our Heartflow products provide a more accurate non-

invasive assessment of blood flow, plaque characterization and plaque volume compared to

traditional non-invasive tests. Our clinical trials have demonstrated that Heartflow FFRCT Analysis and

Heartflow Plaque Analysis have a high level of concordance to the invasive reference standards of

FFR and IVUS, respectively, and that Heartflow FFRCT Analysis has superior diagnostic accuracy to

CCTA alone as well as both SPECT and PET.

• **More informed assessments and personalized care:** Our Heartflow FFRCT Analysis and Heartflow

Plaque Analysis have been clinically demonstrated to improve physician decisions on intervention

and treatment planning. Multiple studies and registries have demonstrated that physicians changed

their treatment approach after reviewing our AI-powered reports.

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• **Superior economic efficiency:** Our PRECISE prospective randomized controlled trial demonstrated

that our Heartflow FFRCT Analysis was 78% more likely to identify patients in need of

revascularization and showed a 69% reduction in unnecessary invasive tests as compared to a "usual

care" pathway. The net effect of this pathway was 2x the yield of invasive coronary angiography

leading to a revascularization procedure. As a result, our internal analysis based on the PRECISE

data demonstrated a 20% increase in net revenue for the cardiac catheterization lab, on average.

• **Improved workflow:** Our Heartflow RoadMap Analysis offers significant workflow benefits, including

improving workflow efficiency by reducing CCTA interpretation times by approximately 25%, as

demonstrated in our SMART-CT study.

• **Enhanced interventional treatment planning:** The additional detail on individual patient anatomy

and disease state provided by our Heartflow Platform allows for pre-operative selection of appropriate

tools. We believe this saves valuable cardiac catheterization lab time and facilitates a more efficient

procedure.

• **Better patient and provider experience:** By leveraging a single CCTA for all of our products,

patients complete their test in approximately 20 minutes with significantly lower radiation exposure

compared to nuclear imaging tests such as SPECT and PET that take multiple hours and require

radioactive tracers to be injected into the bloodstream. By providing a definitive diagnosis upfront, the

Heartflow Platform eliminates the need for layered testing, streamlining the patient journey and

reducing anxiety associated with uncertain or inconclusive results.

We believe the benefits of our Heartflow Platform add significant value across all the subspecialties that

impact cardiovascular care including referring cardiologists, imaging physicians and interventionalists. We

have structured our sales force to efficiently call on these key physician stakeholders, with a primary

focus on the imaging physicians who are instrumental in new account adoption and the referring

physicians who are critical to driving volume growth at our existing accounts.

**Our success factors**

We believe the continued growth of our company will primarily be driven by the following success factors:

***•Differentiated approach to the non-invasive diagnosis and management of CAD***

***•Market leader in AI-powered quantitative CAD analysis with strong customer relationships***

***•Attractive revenue model with significant operating leverage potential***

***•Large addressable market opportunity with a significant unmet need***

***•Robust and compelling portfolio of clinical evidence***

***•Established reimbursement coverage and favorable society support***

***•Unique and scalable AI, data and R&D capabilities***

***•Experienced leadership team***

**Our growth strategies**

We believe the following key strategies will play a critical role in our continued growth:

***•Expand adoption of our Heartflow Platform by new accounts***

***•Broaden awareness of the CCTA + Heartflow pathway to drive volume at existing accounts***

***•Launch and drive adoption of our Heartflow Plaque Analysis product***

***•Invest in additional clinical evidence to support adoption and expand our indications***

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***•Extend our technology leadership through continued investment in our platform***

***•Leverage our platform to pursue adjacent and international markets***

**Recent developments**

***Preliminary estimated consolidated financial results as of and for the three months ended June***

***30, 2025***

Our consolidated financial results as of and for the three months ended June 30, 2025 are not yet

complete and will not be available until after the completion of this offering. Accordingly, we are presenting

below certain preliminary estimated and unaudited consolidated data as of and for the three months

ended June 30, 2025. Actual results remain subject to the completion of our financial close processes and

management's final reviews of our consolidated financial data. Such estimated and unaudited

consolidated data constitute forward-looking statements based solely on information available to us as of

the date of this prospectus and may differ from actual results. This data should not be considered a

substitute for the consolidated financial information to be filed with the SEC in our Quarterly Report on

Form 10-Q for the quarter ended June 30, 2025, when it is due after the completion of our initial public

offering. For additional information, see "Special note regarding forward-looking statements" and "Risk

factors."

The preliminary consolidated financial data included in this registration statement as of and for the three

months ended June 30, 2025, has been prepared by, and is the responsibility of, Heartflow, Inc.'s

management. PricewaterhouseCoopers LLP has not audited, reviewed, examined, compiled, nor applied

agreed-upon procedures with respect to the preliminary consolidated financial data. Accordingly,

PricewaterhouseCoopers LLP does not express an opinion or any other form of assurance with respect

thereto.

After our quarter-end financial closing process is completed, we may report consolidated financial results

and other data that could differ, although we do not expect the actual results to differ materially from those

reflected in the preliminary estimates. While we believe that such information and estimates are based on

reasonable assumptions, our actual results may vary. Factors that could cause the preliminary estimated

and unaudited consolidated data to differ include, but are not limited to: additional adjustments arising

from discovery of new information that affects accounting estimates, management judgment, or impacts

valuation methodologies underlying these estimated results.

The following preliminary estimated and unaudited consolidated data as of and for the three months

ended June 30, 2025 is presented below:

---

| | | | |
|:---|:---|:---|:---|
|  | **Three months ended** <br>**June 30,** | **Three months ended** <br>**June 30,** | **Three months ended** <br>**June 30,** |
|  | **2025** | **2025** | **2024** |
| **(dollars in thousands)** | **(estimated** <br>**low)**<br>| **(estimated** <br>**high)**<br>| **(actual)** |
| Consolidated statements of operations data: |  |  |  |
| Revenue........................................................................................ | $42900 | $43400 | $31054 |
| Gross margin................................................................................ | 74.5% | 75.5% | 76.8% |
| Total operating expenses........................................................... | $46500 | $47500 | $38016 |

---

As of June 30, 2025, our cash and cash equivalents balance is expected to be $80.2 million as compared

to $109.8 million as of March 31, 2025. The decrease in cash and cash equivalents as of June 30, 2025

compared to March 31, 2025, was primarily attributable to the payment of annual bonuses, as well as the

payment of IPO related offering costs and other professional fees and interest related to our debt

obligations.

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Information regarding comparisons to prior quarters is provided below for additional context.

We expect preliminary unaudited revenue for the three months ended June 30, 2025 to be approximately

$42.9 million to $43.4 million, as compared to $31.1 million for the same period in 2024, an increase of

38% to 40%, and our gross margin to be between 74.5% and 75.5% for the three months ended June 30,

2025, as compared to 76.8% for the same period in 2024. The estimated increase in revenue is primarily

attributable to an increase in revenue case volume. We expect the number of revenue cases to be

approximately 48,420 in the three months ended June 30, 2025 as compared to 33,039 for the same

period in 2024, an increase of 47%. The estimated decrease in our gross margin for the three months

ended June 30, 2025 was primarily attributable to our investment in the hiring and training of additional

personnel in our production team to support our increasing revenue case volume. Although we expect to

continue to invest in the hiring and training of additional personnel in our production team, we expect our

gross margin will increase over the longer term.

We expect preliminary unaudited operating expenses for the three months ended June 30, 2025 to be

approximately $46.5 million to $47.5 million, as compared to $38.0 million for the same period in 2024, an

increase of 22% to 25%.

**Risk factors summary**

Our business is subject to a number of risks and uncertainties, as more fully described in the section titled

"Risk factors" immediately following this prospectus summary. You should read these risks before you

invest in our common stock. These risks include, among others, the following:

• We have incurred significant net losses since our inception, we expect to incur additional substantial

losses in the foreseeable future and we may not be able to achieve or sustain profitability.

• Our revenue is currently generated almost entirely from the sales of only one product, Heartflow

FFRCT Analysis, and we are therefore highly dependent on the success of this product, which makes

it difficult to evaluate our current business, predict our future prospects and forecast our financial

performance and any growth.

• If healthcare providers are unwilling to change their standard practice regarding the evaluation of

CAD, our business, financial condition, results of operations and prospects will be adversely affected.

• If third-party payors, including government payors, do not cover and provide adequate, or any,

reimbursement for the Heartflow Platform, or if existing payment amounts are reduced or coding

changes, adoption of the Heartflow Platform by healthcare providers will be negatively impacted, and

our business, financial condition, results of operations and prospects will be adversely affected.

• We face risks associated with a concentrated customer base.

• We face significant competition in an environment of rapid technological change, and there is a

possibility that our competitors may develop products that are more effective, accurate, reliable, cost-

effective or more advanced than ours, which may harm our financial condition. If we are unable to

compete successfully or our potential market share is reduced, we may be unable to increase or

sustain our revenue or achieve profitability.

• The commercialization of the Heartflow Plaque Analysis product is nascent, and we may not be able

to achieve or maintain sufficient market acceptance or the levels of utilization we expect from the

Heartflow Plaque Analysis product or any other future product.

• We face risks associated with our use and development of artificial intelligence models, which may

result in operational challenges, legal liability, reputational concerns and competitive risks.

• If we fail to properly manage our future growth, our business could suffer.

• Our business could be disrupted by catastrophic events.

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• We depend on our information technology systems, and any failure of these systems could harm our

business and adversely affect our business and operating results.

• Our networks and those of our third-party service providers may become the target of bad actors or

security breaches that we cannot anticipate or successfully defend, which could have an adverse

impact on our business.

• We face extensive, regulatory requirements to bring our products to market, and our failure to receive

and maintain regulatory clearances or approvals of our current and future products in the United

States or abroad or to comply with medical device regulatory requirements could adversely affect our

business.

• If we are unable to obtain and maintain sufficient intellectual property rights, or the scope of our rights

is not sufficiently broad, third parties could develop and commercialize technology and products

similar or identical to ours, and our ability to successfully commercialize our technology and products

may be adversely affected.

• Our credit agreement contains certain restrictions that may limit our ability to operate our business. If

we raise additional capital through debt financing, the terms of any new debt could further restrict our

ability to operate our business.

The summary risk factors described above should be read together with the text of the full risk factors in

the section titled "Risk factors" and the other information set forth in this prospectus, including our

consolidated financial statements and the related notes. The risks summarized above or described in full

elsewhere in this prospectus are not the only risks that we face. Additional risks and uncertainties not

presently known to us, or that we currently deem to be immaterial, may also materially adversely affect

our business, financial condition, results of operations, and prospects.

**Corporate information**

We were incorporated under the laws of the State of Delaware in 2007. On March 1, 2021, we completed

an internal reorganization in which a newly formed parent holding company was put in place. The

previous holders of our common stock and preferred securities became holders of common stock and

preferred securities of HeartFlow Holding, Inc. The equity incentive plan, outstanding equity awards,

outstanding warrants and certain other equity-related agreements of HeartFlow, Inc. were assumed by

HeartFlow Holding, Inc. Our operations and business activities remained at HeartFlow, Inc., and the

wholly-owned non-U.S. subsidiaries of HeartFlow, Inc. remained in place. On July 17, 2025, we

consolidated HeartFlow Holding, Inc. into HeartFlow, Inc. and the previous holders of HeartFlow Holding,

Inc. common stock and preferred securities became holders of our common stock and preferred

securities, and the equity incentive plan, outstanding equity awards, outstanding warrants and certain

other equity-related agreements of HeartFlow Holding, Inc. were assumed by us. In connection with this

consolidation, we changed our name to Heartflow, Inc., whose name appears on the cover of this

prospectus. Our principal executive offices are located at 331 E. Evelyn Avenue, Mountain View,

California 94041, and our telephone number is (650) 241-1221. Our corporate website address is

www.heartflow.com. Information contained on, or accessible through, our website shall not be deemed

incorporated into and is not a part of this prospectus or the registration statement of which it forms a part.

We have included our website in this prospectus solely as an inactive textual reference.

**Implications of being an emerging growth company**

We qualify as an "emerging growth company" as defined in the Jumpstart Our Business Startups Act of

2012 (the "JOBS Act"). We will remain an emerging growth company until the earliest of: (i) the last day of

the fiscal year following the fifth anniversary of the completion of this offering; (ii) the last day of the fiscal

year in which we have total annual gross revenue of at least $1.235 billion; (iii) the last day of the fiscal

year in which we are deemed to be a "large accelerated filer" as defined in Rule 12b-2 under the

Securities Exchange Act of 1934, as amended (the "Exchange Act"), which would occur if the market

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value of our common stock held by non-affiliates exceeded $700.0 million as of the last business day of

the second fiscal quarter of such year; or (iv) the date on which we have issued more than $1.0 billion in

non-convertible debt securities during the prior three-year period. An emerging growth company may take

advantage of specified reduced reporting requirements and is relieved of certain other significant

requirements that are otherwise generally applicable to public companies. As a result, the information that

we provide to our stockholders may be different than you might receive from other public reporting

companies in which you hold equity interests.

As an emerging growth company, we have elected to take advantage of certain reduced disclosure

obligations in the registration statement that this prospectus is a part of, and may elect to take advantage

of other reduced reporting requirements in future filings. In particular:

• we will present in this prospectus only two years of audited financial statements, plus any required

unaudited financial statements, and related management's discussion and analysis of financial

condition and results of operations;

• we will avail ourselves of the exemption from the requirement to obtain an attestation and report from

our independent registered public accounting firm on the assessment of our internal control over

financial reporting pursuant to the Sarbanes-Oxley Act of 2002;

• we will avail ourselves of relief from compliance with the requirements of the Public Company

Accounting Oversight Board regarding the communication of critical audit matters in the auditor's

report on the financial statements;

• we will provide less extensive disclosure about our executive compensation arrangements; and

• we will not be required to hold stockholder non-binding advisory votes on executive compensation or

golden parachute arrangements.

In addition, the JOBS Act provides that an emerging growth company can take advantage of an extended

transition period for complying with new or revised accounting standards. This provision allows an

emerging growth company to delay the adoption of some accounting standards until those standards

would otherwise apply to private companies. We have elected to use the extended transition period for

any other new or revised accounting standards during the period in which we remain an emerging growth

company; however, we may adopt certain new or revised accounting standards early. As a result of these

elections, the information that we provide in this prospectus, including our financial statements, may be

different than the information you may receive from other public companies in which you hold equity

interests. In addition, it is possible that some investors will find our common stock less attractive as a

result of these elections, which may result in a less active trading market for our common stock and

higher volatility in our share price.

**Basis of presentation**

Certain monetary amounts, percentages, and other figures included elsewhere in this prospectus have

been subject to rounding adjustments. Accordingly, figures shown as totals in certain tables or charts may

not be the arithmetic aggregation of the figures that precede them, and figures expressed as percentages

in the text may not total 100% or, as applicable, when aggregated may not be the arithmetic aggregation

of the percentages that precede them.

The consolidated financial statements include the accounts of HeartFlow Holding, Inc. and its

subsidiaries. On July 17, 2025, we consolidated HeartFlow Holding, Inc. into HeartFlow, Inc., and the

previous holders of HeartFlow Holding, Inc. common stock and preferred securities became holders of

our common stock and preferred securities and the equity incentive plan, outstanding equity awards, the

outstanding warrants and other equity agreements of HeartFlow Holding, Inc. have been assumed by us.

The consolidation did not have a material effect on our consolidated financial statements included

elsewhere in this prospectus. The consolidated financial statements of HeartFlow Holding, Inc. are that of

Heartflow, Inc., the registrant whose name appears on the cover of this prospectus.

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**The offering**

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| | |
|:---|:---|
| **Common stock offered by us**....... | 16,666,667 shares. |
| **Option to purchase additional** <br>**shares**.................................................<br>| We have granted the underwriters an option for a period of 30 <br>days to purchase up to 2,500,000 additional shares of common <br>stock from us at the public offering price, less underwriting <br>discounts and commissions on the same terms as set forth in this <br>prospectus.<br>|
| **Common stock to be outstanding** <br>**after this offering**.............................<br>| 81,168,388 shares (or 83,668,388 shares if the underwriters <br>exercise in full their option to purchase additional shares).<br>|
| **Use of proceeds**............................... | We estimate that the net proceeds from this offering will be <br>approximately $265.8 million (or approximately $306.4 million if <br>the underwriters exercise in full their option to purchase up <br>to 2,500,000 additional shares of common stock), based on the <br>assumed initial public offering price of $17.50 per share, which is <br>the midpoint of the estimated price range set forth on the cover <br>page of this prospectus, after deducting estimated underwriting <br>discounts and commissions and estimated offering expenses <br>payable by us.<br>In connection with the completion of this offering, we are obligated <br>to use certain of the net proceeds from this offering to repay $50.0 <br>million (or $55.0 million if the underwriters exercise any portion of <br>their option to purchase additional shares of common stock) of the <br>indebtedness outstanding under the amended credit agreement <br>and guaranty (as amended, the "2024 Credit Agreement") with <br>Hayfin Services, LLP ("Hayfin") and to pay approximately <br>$6.2 million of fees in connection therewith. In connection with the <br>issuance of the 2025 Convertible Notes (as defined below) in <br>January 2025, we entered into Amendment No. 1 to the 2024 <br>Credit Agreement, pursuant to which entities affiliated with Hayfin <br>converted $23.0 million of outstanding indebtedness under the <br>2024 Credit Agreement in connection with the 2024 Term Loan <br>Conversion (as defined in the section titled "Certain relationships <br>and related-party transactions") and became holders of 5% or <br>more of our capital stock as of March 31, 2025. <br>We expect to use the remainder of the net proceeds from this <br>offering, together with our existing cash and cash equivalents, to <br>fund our sales and marketing efforts, fund research and product <br>development activities and for other general corporate purposes, <br>including working capital, operating expenses, and capital <br>expenditures. <br>|

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| | |
|:---|:---|
|  | We may also use a portion of the net proceeds from this offering to <br>acquire complementary businesses, products, services, or <br>technologies. We periodically evaluate strategic opportunities; <br>however, we have no current understandings or commitments to <br>enter into any such acquisitions or make any such investments.<br>We will have broad discretion in the way that we use the net <br>proceeds of this offering. See the section titled "Use of proceeds" <br>for additional information.<br>|
| **Risk factors**....................................... | You should read the section titled "<u>[Risk factors](#i2341357d54884756b9e9172f0a83cd6b_697)</u>" for a discussion of <br>factors to consider carefully, together with all the other information <br>included in this prospectus, before deciding to invest in our <br>common stock.<br>|
| **Proposed Nasdaq trading** **symbol** | "HTFL" |
| **Lock-up agreements** **and market** <br>**standoff arrangements**....................<br>| In connection with this offering, we, our directors, our executive <br>officers, and the holders of substantially all of our common stock, <br>stock options, and other securities convertible into or exercisable <br>or exchangeable for our common stock, have entered into lock-up <br>agreements or are subject to market standoff arrangements and <br>have agreed that, without the prior written consent of J.P. Morgan <br>Securities LLC, Morgan Stanley & Co. LLC and Piper Sandler & <br>Co. on behalf of the underwriters, subject to certain exceptions <br>more fully described under the section titled "Underwriting", we <br>and they will not, among other things, sell or otherwise transfer or <br>dispose of any of our securities during the period from the date of <br>this prospectus continuing through the date 180 days after the <br>date of this prospectus. See the section titled "Underwriting" for <br>additional information.<br>|

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The number of shares of our common stock to be outstanding after this offering is based on 64,501,721

shares of our common stock outstanding as of March 31, 2025, after giving effect to the Preferred Stock

Conversion (as defined below) and the Convertible Notes Conversion (as defined below),and excludes:

• 8,583,703 shares of our common stock issuable upon the exercise of outstanding stock options as of

March 31, 2025 under our HeartFlow Holding, Inc. Amended and Restated 2009 Equity Incentive Plan

(the "2009 Equity Incentive Plan"), with a weighted-average exercise price of $4.98 per share;

• 212,888 shares of our common stock issuable upon the exercise of outstanding stock options granted

subsequent to March 31, 2025 under our 2009 Equity Incentive Plan, with a weighted-average

exercise price of $13.64 per share;

• 1,647,667 shares of our common stock issuable upon the exercise of warrants outstanding as of

March 31, 2025 held by Hayfin, with an exercise price of $0.03 per share;

• 323,173 shares, including 129,577 shares reserved subsequent to March 31, 2025, of our common

stock reserved for future issuance under our 2009 Equity Incentive Plan;

• 17,401,370 shares of our common stock to be reserved for future issuance under our 2025

Performance Incentive Plan (the "2025 Plan"), which will become effective upon the commencement

of trading of our common stock on the Nasdaq Global Select Market, from which we will grant

restricted stock units ("RSUs") covering approximately 550,000 shares of common stock concurrently

with this offering (based on the assumed initial public offering price of $17.50 per share, which is the

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midpoint of the price range set forth on the cover page of this prospectus), as well as any future

increases in the number of shares of common stock reserved for issuance under the 2025 Plan; and

• 1,242,241 shares of our common stock reserved for future issuance under our 2025 Employee Stock

Purchase Plan (the "ESPP"), which will become effective upon the commencement of trading of our

common stock on the Nasdaq Global Select Market, as well as any future increases in the number of

shares of common stock reserved for issuance under the ESPP.

Unless otherwise indicated, all information contained in this prospectus assumes or gives effect to:

• the adoption, filing, and effectiveness of our amended and restated certificate of incorporation, to be

in effect upon the completion of this offering, and the adoption of our amended and restated bylaws,

to be in effect upon the effectiveness of the amended and restated certificate of incorporation;

• the automatic conversion of 122,231,454 outstanding shares of our Series A, Series B-1, Series B-2,

Series C, Series D, Series E, Series F and Series F-1 redeemable convertible preferred stock

(collectively, our "redeemable convertible preferred stock") as of March 31, 2025 into an aggregate

of 51,226,348 shares of our common stock, the conversion of which will occur immediately prior to the

completion of this offering (the "Preferred Stock Conversion");

• the automatic conversion of $98.3 million of convertible promissory notes with original maturity dates

of 48 months from the dates of issuance into an aggregate of 7,022,512 shares of our common stock,

which amount includes the $23.0 million aggregate principal amount of notes issued in the 2024 Term

Loan Conversion (collectively, the "2025 Convertible Notes"), assuming the assumed initial public

offering price of $17.50 per share, which is the midpoint of the estimated price range set forth on the

cover page of this prospectus, issued by us in January and March 2025, which will be automatically

converted upon the completion without interest (the "Convertible Notes Conversion");

• a 1.0-for-2.92 reverse stock split of our common stock, which we effected on July 31, 2025 and a

corresponding adjustment to the Preferred Stock Conversion and adjustment to our outstanding

warrants;

• no exercise, settlement or termination of the outstanding options or warrants described above; and

• no exercise by the underwriters of their option to purchase up to 2,500,000 additional shares of our

common stock in this offering.

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**Summary consolidated financial data**

The following tables summarize our consolidated financial data for the periods and as of the dates

indicated. The following summary consolidated statements of operations data for the years ended

December 31, 2023 and 2024 have been derived from our audited consolidated financial statements and

related notes included elsewhere in this prospectus. The following summary interim consolidated

statements of operations data for the three months ended March 31, 2024 and 2025, and the summary

interim consolidated balance sheet data as of March 31, 2025, have been derived from our unaudited

interim consolidated financial statements included elsewhere in this prospectus. Our audited consolidated

financial statements and unaudited interim consolidated financial statements included elsewhere in this

prospectus have been prepared in accordance with U.S. generally accepted accounting principles

("GAAP"). Our unaudited interim consolidated financial statements were prepared on a basis consistent

with our audited consolidated financial statements and include, in our opinion, all adjustments of a normal

and recurring nature that are necessary for the fair statement of the financial information set forth in those

statements included elsewhere in this prospectus. Our historical results are not necessarily indicative of

the results that may be expected for any period in the future and results for the three months ended

March 31, 2025 are not necessarily indicative of results to be expected for the year ended December 31,

2025. You should read the following summary consolidated financial data together with our audited

consolidated financial statements and unaudited interim consolidated financial statements and the related

notes included elsewhere in this prospectus and the section titled "Management's discussion and analysis

of financial condition and results of operations." The summary consolidated financial data included in this

section are not intended to replace the consolidated financial statements and the related notes included

elsewhere in this prospectus and are qualified in their entirety by the consolidated financial statements

and the related notes thereto included elsewhere in this prospectus.

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| | | | | |
|:---|:---|:---|:---|:---|
| | **Year ended** <br>**December 31,** | **Year ended** <br>**December 31,** | **Three months ended** <br>**March 31,** | **Three months ended** <br>**March 31,** |
| <br>**(in thousands, except share and per share** <br>**amounts)**<br>| **2023** | **2024** | **2024** | **2025** |
| **Consolidated statements of** <br>**operations data:**<br>|  |  |  |  |
| Revenue......................................................... | $87174 | $125808 | $26843 | $37205 |
| Cost of revenue............................................. | 29123 | 31359 | 7420 | 9264 |
| Gross profit.................................................... | 58051 | 94449 | 19423 | 27941 |
| Operating expenses:.................................... |  |  |  |  |
| Research and development................... | 35854 | 43517 | 9443 | 13924 |
| Selling, general and administrative....... | 95111 | 112154 | 26038 | 31519 |
| Total operating expenses .................. | 130965 | 155671 | 35481 | 45443 |
| Loss from operations ................................... | (72914) | (61222) | (16058) | (17502) |
| Interest expense, net............................... | (19237) | (18702) | (4731) | (4550) |
| Other expense, net.................................. | (2957) | (16449) | (215) | (10293) |
| Loss before provision from income taxes. | (95108) | (96373) | (21004) | (32345) |
| (Provision for) benefit from income <br>taxes...........................................................<br>| (547) | (53) | 72 |  |
| Net loss........................................................... | $(95655) | $(96426) | $(20932) | $(32345) |
| Cumulative dividends on Series C <br>redeemable convertible preferred <br>stock...........................................................<br>| (1239) |  |  |  |
| Deemed dividend upon down round of <br>redeemable convertible preferred <br>stock...........................................................<br>| (26794) |  |  |  |
| Net loss attributable to common <br>stockholders...................................................<br>| $(123688) | $(96426) | $(20932) | $(32345) |
| Net loss per share attributable to <br>common stockholders, basic and <br>diluted<sup>(1)</sup>..........................................................<br>| $(25.32) | $(17.98) | $(4.23) | $(5.25) |
| Weighted-average shares used to <br>compute net loss per share attributable <br>to common stockholders, basic and <br>diluted<sup>(1)</sup>..........................................................<br>| 4885231 | 5363435 | 4943430 | 6164617 |
| Pro forma net loss per share attributable <br>to common stockholders, basic and <br>diluted<sup>(2)</sup>..........................................................<br>|  | $(1.47) |  | $(0.35) |
| Pro forma weighted-average shares used <br>to compute net loss per share <br>attributable to common stockholders, <br>basic and diluted<sup>(2)</sup>........................................<br>|  | 63612295 |  | 64413477 |

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(1)See Notes 2 and 16 to our consolidated financial statements included elsewhere in this prospectus for an explanation of the calculation

of our basic and diluted net loss per share attributable to common stockholders and the weighted-average number of shares used in the

computation of the per share amounts.

(2)Unaudited pro forma net loss per share attributable to common stockholders, basic and diluted, for the year ended December 31, 2024

and for the three months ended March 31, 2025 is calculated by giving effect to (i) removal of the effect of interest expense related to

the 2024 Term Loan Conversion of $23.0 million and the $50.0 million partial repayment of the indebtedness outstanding, (ii) loss on

extinguishment of debt related to the $6.2 million of fees payable in connection with the $50.0 million partial repayment of indebtedness

outstanding, (iii) the Preferred Stock Conversion, as if the shares resulting from the Preferred Stock Conversion were outstanding as of

January 1, 2024, (iv) the Convertible Notes Conversion at the assumed initial public offering price of $17.50 per share, which is the

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midpoint of the estimated price range set forth on the cover page of this prospectus, as if the shares resulting from the Convertible

Notes Conversion were outstanding as of January 1, 2024, (v) the removal of other expense, net related to the change in fair value of

the derivative liability, and (vi) stock-based compensation expense related to the grant of 550,000 RSUs concurrent with this offering at

the assumed initial public offering price of $17.50 per share, which is the midpoint of the estimated price range set forth on the cover

page of this prospectus, as if the RSUs had been granted on January 1, 2024. The total stock-based compensation expense related to

the concurrent RSU award is estimated to be $9.6 million. The RSUs will be settled in shares of common stock and vest over four years

in annual equal increments, subject to continued service, on the anniversary of the grant date. The following table summarizes our

unaudited pro forma net loss per share for the year ended December 31, 2024 and the three months ended March 31, 2025:

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| | | |
|:---|:---|:---|
| **(in thousands, except share and per share amounts)** | **Year ended** <br>**December 31,** <br>**2024**<br>| **Three months** <br>**ended** <br>**March 31,** <br>**2025**<br>|
| **Numerator:** |  |  |
| Net loss attributable to common stockholders, basic and diluted.................. | $(96426) | $(32345) |
| Pro forma adjustment to remove interest expense related to debt <br>conversion and repayment...................................................................................<br>| 11265 | 1602 |
| Pro forma adjustment to remove other expense, net related to the change <br>in fair value of derivative liability..........................................................................<br>|  | 9045 |
| Pro forma adjustment to add loss on debt extinguishment related to fees <br>paid in connection with debt repayment.............................................................<br>| (6216) |  |
| Pro forma adjustment to add stock-based compensation expense related <br>to the RSUs............................................................................................................<br>| (2406) | (602) |
| Pro forma net loss attributable to common stockholders................................ | $(93783) | $(22300) |
| **Denominator:** |  |  |
| Weighted-average shares used in computing net loss per share <br>attributable to common stockholders, basic and diluted..................................<br>| 5363435 | 6164617 |
| Pro forma adjustment to reflect the Preferred Stock Conversion.................. | 51226348 | 51226348 |
| Pro forma adjustment to reflect the Convertible Notes Conversion.............. | 7022512 | 7022512 |
| Pro forma weighted-average shares used in computing pro forma net loss <br>per share attributable to common stockholders, basic and diluted................<br>| 63612295 | 64413477 |
| Pro forma net loss per share attributable to common stockholders, basic <br>and diluted..............................................................................................................<br>| $(1.47) | $(0.35) |

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| | | | |
|:---|:---|:---|:---|
| | **As of March 31, 2025** | **As of March 31, 2025** | **As of March 31, 2025** |
| <br>**(in thousands)** | **Actual** | **Pro forma**<sup>(1)</sup> | **Pro forma as** <br>**adjusted**<sup>(2)(3)</sup><br>|
| **Consolidated balance sheet data:** |  |  |  |
| Cash and cash equivalents....................................................... | $109786 | $109786 | $320318 |
| Working capital<sup>(4)</sup>........................................................................ | 101231 | 101231 | 314088 |
| Total assets.................................................................................. | 184441 | 184441 | 391650 |
| 2024 Term Loan.......................................................................... | 113831 | 113831 | 62132 |
| 2025 Convertible Notes............................................................. | 65824 |  |  |
| Derivative liability........................................................................ | 40945 |  |  |
| Redeemable convertible preferred stock................................ | 768566 |  |  |
| Accumulated deficit.................................................................... | (1003304) | (1003304) | (1007821) |
| Total stockholders' equity (deficit)............................................ | (888995) | (13660) | 247573 |

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(1)The pro forma column above reflects (a) the Preferred Stock Conversion, which will occur immediately prior to the completion of this

offering, as if it had occurred on March 31, 2025, (b) the Convertible Notes Conversion at the assumed initial public offering price of

$17.50 per share, which is the midpoint of the estimated price range set forth on the cover page of this prospectus and the resultant

reclassification of our derivative liability to additional paid-in capital, a component of stockholders' equity (deficit), which will occur upon

the completion of this offering, as if each had occurred as of March 31, 2025, and (c) the adoption, filing, and effectiveness of our

amended and restated certificate of incorporation, to be in effect upon or following the completion of this offering.

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(2)The pro forma as adjusted column gives effect to (a) the pro forma adjustments set forth in (1) above, (b) the issuance and sale

of 16,666,667 shares of our common stock in this offering at the assumed initial public offering price of $17.50 per share, which is the

midpoint of the estimated price range set forth on the cover page of this prospectus, after deducting estimated underwriting discounts

and commissions and estimated offering expenses payable by us, and (c) the assumed repayment of $50.0 million of the indebtedness

outstanding under the 2024 Credit Agreement and payment of approximately $6.2 million of fees in connection therewith.

(3)The pro forma as adjusted information above is illustrative only and will depend on the actual initial public offering price and other terms

of this offering determined at pricing. Each $1.00 increase or decrease in the assumed initial public offering price of $17.50 per share of

our common stock, which is the midpoint of the estimated price range set forth on the cover page of this prospectus, would increase or

decrease, as applicable, each of our pro forma as adjusted cash and cash equivalents, additional paid-in capital, total stockholders'

equity (deficit), and total capitalization by approximately $15.5 million, assuming the number of shares offered by us, as set forth on the

cover page of this prospectus, remains the same, and after deducting estimated underwriting discounts and commissions and

estimated offering expenses payable by us. Similarly, each increase or decrease of 1.0 million shares in the number of shares of

common stock offered by us would increase or decrease, as applicable, each of our pro forma as adjusted cash and cash equivalents,

additional paid-in capital, total stockholders' equity (deficit), and total capitalization by approximately $16.3 million, assuming the

assumed initial public offering price of $17.50 per share of our common stock, which is the midpoint of the estimated price range set

forth on the cover page of this prospectus, remains the same, and after deducting estimated underwriting discounts and commissions

and estimated offering expenses payable by us.

(4)Working capital is defined as current assets less current liabilities. See our unaudited interim consolidated financial statements and

related notes included elsewhere in this prospectus for further details regarding our current assets and current liabilities.

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**Risk factors**

*Investing in our common stock involves a high degree of risk. You should carefully consider the risks* 

*described below, as well as the other information in this prospectus, including our financial statements* 

*and the related notes and "Management's discussion and analysis of financial condition and results of* 

*operations," before deciding whether to invest in our common stock. The occurrence of any of the events* 

*or developments described below could have a material adverse effect on our business, financial* 

*condition, results of operations and prospects. In such an event, the market price of our common stock* 

*could decline, and you may lose all or part of your investment. Additional risks and uncertainties not* 

*presently known to us or that we currently believe are not material may also impair our business, financial* 

*condition, results of operations and prospects. Please also see the sections titled "Special note regarding* 

*forward-looking statements" and "Market and industry data."*

**Risks related to our business and industry**

***We have incurred significant net losses since our inception, we expect to incur additional***

***substantial losses in the foreseeable future and we may not be able to achieve or sustain***

***profitability.***

We have incurred significant net losses since our inception in 2007, and we expect to incur additional

substantial losses in the foreseeable future. For the fiscal years ended December 31, 2023 and 2024, and

the three months ended March 31, 2025, we incurred net losses of $95.7 million, $96.4 million and $32.3

million, respectively. As of December 31, 2023 and 2024, we had an accumulated deficit of $874.5 million

and $971.0 million, respectively. As of March 31, 2025, we had an accumulated deficit of $1.0 billion.

Since inception, we have spent significant amounts of cash to develop the Heartflow Platform, to fund

research and development, including our preclinical research and development activities and clinical trials

related to our products, to scale our commercial operations and to recruit and retain key talent.

The net losses we incur may fluctuate significantly from quarter to quarter and year to year, such that a

period-to-period comparison of our results of operations may not be a good indication of our future

performance. We expect to continue to incur significant research and development, sales and marketing,

regulatory and other expenses as we expand our marketing efforts to increase adoption of our products,

expand existing relationships with our customers, obtain regulatory clearances or approvals for our

planned or future products, conduct clinical trials to extend applicability of our platform into new

indications or to develop new products or add new features to our existing products. The investments in

our business may be more costly than we expect, and if we do not achieve the benefits anticipated from

these investments, or if the realization of these benefits is delayed, they may not result in increased

revenue or growth in our business. In addition to the anticipated costs of growing our business, we expect

our general and administrative expenses to increase following this offering due to the additional costs of

being a public company. If our revenue growth does not increase to more than offset the anticipated

increases in our operating expenses, we may not be able to achieve or sustain profitability and our

business, financial condition, results of operations and prospects will be harmed.

In addition, our revenue may decline or our revenue growth, if any, may be constrained. Our ability to

increase sales is uncertain, and we may never be able to achieve or sustain profitability for many

reasons, including that: our Heartflow FFRCT Analysis may not achieve widespread adoption among

healthcare providers and we may be unable to increase revenue generated from sales of our Heartflow

FFRCT Analysis; our Heartflow Plaque Analysis may not achieve widespread adoption among healthcare

providers and we may be unable to generate sufficient revenue from sales of our Heartflow Plaque

Analysis; payors, such as insurance companies and government insurance programs, may decide not to

reimburse for our products, may set the amount of such reimbursement too low or reduce the amount of

such reimbursement; healthcare industry trends, including growth in CCTA usage, may move in directions

that do not allow for adoption of our products or that do not provide adequate incentives for the adoption

of our products; competitors may develop or acquire a product that successfully competes with ours;

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manufacturers of CT scanners may partner with our competitors or develop or acquire a competing

product and integrate one or more products that successfully competes with ours; we may not be able to

obtain regulatory approval for future versions of our products (including improved versions of our AI

algorithms), new indications for use of our products or other future products; and there may be changes in

existing or anticipated clinical guidelines, including the current ACC and AHA Class 1, Level A guidelines

for CCTA and Class 2a, Level B guidelines for Heartflow FFRCT Analysis for certain patients with stable or

acute chest pain and no known CAD, or the timing of adoption of positive clinical guidelines that support

the use of the Heartflow FFRCT Analysis.

Because of these and the other risks and uncertainties described in this prospectus, we are unable to

predict the extent to which we will be able to increase sales, if at all, or the timing for when or the extent to

which we will become profitable, if ever. We will need to generate significant additional revenue to achieve

and sustain profitability, and even if we do achieve profitability, we may not be able to sustain or increase

profitability. Our failure to become and remain profitable would depress the value of our company and our

stock price and could impair our ability to raise capital, fund our research and development efforts,

expand our business, diversify our product offerings or continue our operations. A decline in the value of

our company could cause you to lose all or part of your investment.

***Our revenue is currently generated almost entirely from the sales of only one product, Heartflow***

***FFRCT Analysis, and we are therefore highly dependent on the success of this product, which***

***makes it difficult to evaluate our current business, predict our future prospects and forecast our***

***financial performance and any growth.***

As of March 31, 2025, our Heartflow FFRCT Analysis represented 99% of our total revenue. In the second

half of 2023, we began limited market education efforts of our second product, Heartflow Plaque Analysis.

Over the next several years, we expect to continue to devote a substantial amount of resources to

increase sales of our Heartflow FFRCT Analysis and also expand our commercialization efforts and drive

increased adoption of our Heartflow Plaque Analysis. However, we may not succeed in increasing sales

of our Heartflow FFRCT Analysis or in increasing adoption of our Heartflow Plaque Analysis. We expect to

continue to derive almost all of our revenue from sales of Heartflow FFRCT Analysis for the foreseeable

future, so we are highly dependent on its success.

In addition, because we plan to devote substantial resources to increase sales of Heartflow FFRCT

Analysis and rely on it as our main source of revenue, any factors that negatively impact these efforts, our

Heartflow Plaque Analysis commercialization efforts or our ability to diversify our products would have a

material adverse effect on our business, financial condition, results of operations and prospects.

Therefore, it is difficult to predict our future prospects and forecast our financial performance and any

growth, and any such forecasts are inherently limited and subject to a number of uncertainties. If our

assumptions regarding the risks and uncertainties we face, which we use to plan our business, are

incorrect or change due to circumstances in our business or our markets, or if we do not address these

risks successfully, our operating and financial results could differ materially from our expectations and our

business, financial condition, results of operations and prospects could suffer.

***If healthcare providers are unwilling to change their standard practice regarding the evaluation of***

***CAD, our business, financial condition, results of operations and prospects will be adversely***

***affected.***

Our success depends on physicians, hospitals and other healthcare providers adopting and using the

Heartflow Platform to aid in the evaluation of CAD. While we have had some recent success in achieving

broader adoption of the Heartflow Platform, we have in the past faced, and may in the future face,

challenges in achieving higher rates of adoption. Many healthcare providers have extensive experience

with existing non-invasive tests for CAD and have established relationships with the companies that

provide these tests or in some instances own or manage the equipment for these tests in their offices.

Existing tests are performed in a high enough volume that healthcare providers generate sufficient

revenue from their use and are well versed in their use, reimbursement and outcomes. The outcomes and

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workflow efficiencies that we believe our Heartflow Platform provides may not be valued by healthcare

providers as highly as we expect or at all. In addition, healthcare providers have been, and may continue

to be, slower to adopt or recommend our products because we have a more limited commercial track

record and healthcare providers may feel they can generate more revenue from existing tests. Healthcare

providers also may not find our clinical data compelling and may not recommend or use our products until

they receive additional recommendations from other healthcare providers that our products have a clinical

benefit, or at all.

In addition, the Heartflow Platform relies on healthcare providers following the ACC and AHA guidelines

by referring certain patients with stable or acute chest pain and no known CAD to undergo a CCTA, with

the CCTA images to be analyzed by our Heartflow FFRCT Analysis. Although the ACC and AHA guidelines

support CCTA plus our Heartflow FFRCT Analysis as the preferred pathway for diagnosing and managing

CAD in certain patients with stable or acute chest pain and no known CAD, these guidelines may not be

widely adopted by healthcare providers. Moreover, healthcare providers may choose not to adopt the

Heartflow Platform if they are not able to obtain an adequate CCTA. Further, if future studies and trials or

other events, including reimbursement rates of CCTA, adversely impact the rate of use of CCTAs in

practice, then healthcare providers may be less willing to adopt a technology that uses CCTAs.

Also, the Heartflow Platform may be more difficult than we expect to integrate into standard practice

because a provider may be resistant to introduce our embedded information technology and workflow

infrastructure. Due to different laws, policies and preferences of healthcare providers regarding patient

privacy both in the United States and abroad, they may be averse to sending data externally (outside of

their facility) or abroad. Furthermore, if healthcare providers using the Heartflow Platform experience what

they perceive to be false negative result or imprecise readings, including due to user error, they may

determine not to continue using our platform going forward.

We expect that addressing these and similar issues will require a significant amount of our time and

resources, and if we are unsuccessful, we would be unable to achieve broader adoption of the Heartflow

Platform by healthcare providers. If our products do not gain broader acceptance by healthcare providers,

our business, financial condition, results of operations and prospects will be adversely affected.

***If third-party payors, including government payors, do not cover and provide adequate***

***reimbursement for the Heartflow Platform, or if existing payment amounts are reduced or coding***

***policies change, adoption of the Heartflow Platform by healthcare providers may be negatively***

***impacted, and our business, financial condition, results of operations and prospects will be***

***adversely affected.***

Our ability to grow sales and revenue from our Heartflow FFRCT Analysis and to successfully

commercialize our Heartflow Plaque Analysis depend, in large part, on whether third-party payors,

including private health insurers, managed care plans and government healthcare programs, such as

Medicare and Medicaid, cover and adequately reimburse for the use of the Heartflow Platform and the

underlying CCTA. Patients generally rely on payors to reimburse all or a significant part of the costs

associated with their treatment. As a result, appropriate coding, coverage determinations, and

reimbursement levels are critical to the commercial success of the Heartflow Platform. Reimbursement is

obtained from a variety of sources, including government sponsored and private health insurance plans,

and varies by country and by region within some countries. These payors determine whether to provide

coverage and payment for specific products and procedures.

In addition, payors continually review new technologies and can, without notice, change coverage

parameters, deny coverage, bundle services, or reduce payment amounts. As a result, the coverage

determination process is often time consuming and costly, with no assurance that coverage and adequate

reimbursement will be obtained or maintained if obtained. If payors change their reimbursement policies,

or if the current Category I CPT codes related to our Heartflow FFRCT Analysis or future Category I CPT

codes related to our Heartflow Plaque Analysis are not favorably categorized or priced, reimbursement for

the Heartflow Platform could be reduced to an amount that would make adoption of our Heartflow

Platform challenging.

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Moreover, physicians, hospitals and other healthcare providers may decline to adopt or reduce usage of

the Heartflow Platform due to the economic impact a negative change in reimbursement may have on

their business and, as a result, we may experience a significant loss of revenue, which would have a

material adverse effect on our business, financial condition, results of operations and prospects.

Reimbursement for our Heartflow Platform, which includes the separately billable services, Heartflow

FFRCT Analysis and Heartflow Plaque Analysis, is subject to periodic changes to reimbursement levels by

government payors and private health insurers. For example, the Centers for Medicare and Medicaid

Services ("CMS") adopts changes to reimbursement policies during the annual Medicare rulemaking

process, which includes updates to Medicare payment levels to hospitals under the Medicare Hospital

Outpatient Prospective Payment System ("OPPS") rule, and updates to Medicare payment rates to

physician offices, independent diagnostic testing facilities, and freestanding imaging centers under the

Medicare Physician Fee Schedule ("MPFS") rule. In addition to risks associated with government

reimbursement, our Heartflow FFRCT Analysis and Heartflow Plaque Analysis technologies face

reimbursement uncertainty from commercial payors, such as UnitedHealthcare, Aetna, Cigna, Anthem,

and regional Blue Cross Blue Shield plans. Such commercial payors routinely reassess their medical

policies, coverage criteria and payment policies and rates, and may choose to deny coverage or payment,

impose restrictive utilization management protocols (such as prior authorization), or reduce or bundle

payment amounts based on internal cost-effectiveness assessments or evolving clinical guidelines. Even

if Medicare maintains favorable reimbursement, commercial payors may independently determine

whether Heartflow FFRCT Analysis or Heartflow Plaque Analysis meets their plans' medical necessity

standards, which may vary among commercial payors.

As part of their participation in the Medicare program and in support of the annual rulemaking process,

hospitals submit Medicare cost reports and report their charges for specific services provided in the

hospital setting. These cost and charge data reported from hospitals can impact reimbursement rates

because CMS uses that data to determine future Medicare reimbursement levels on an annual basis. In

the aggregate, when costs associated with a specific service reported by the hospitals decrease, there is

a risk that CMS will reduce the reimbursement rate proportionately. These lower reported costs can be a

result of coding errors or erroneous denials of claims, the inclusion of lower-cost services within the APC,

reductions in costs for services within the APC, or other similar issues. For example, in July 2025, CMS

issued the proposed 2026 OPPS rule, which, if finalized as proposed, could result in a reduction of up to

15% in the Medicare reimbursement rate for the clinical APC that includes our Heartflow FFRCT Analysis,

along with other hospital services. CMS publishes final OPPS and MPFS rules in the fourth quarter each

year. We cannot be sure at this time whether the proposed hospital reimbursement rate for Heartflow

FFRCT Analysis for 2026 will be finalized, modified, or if CMS will increase the rate back to 2025 levels.

There is a risk that similar or other coding or claims issues may occur and lead CMS to lower the

reimbursement rate for the Heartflow Platform for 2027 or in future years. In addition, we may not become

aware of any such issues early enough to prevent any adverse impacts to the reimbursement for our

products, and our ability to remedy any such issues may be limited by applicable laws, regulations or

policies.

Given the evolving nature of the healthcare industry and ongoing healthcare cost reforms, we are and will

continue to be subject to effects of changes in the level of reimbursement for our products. We cannot be

sure that third-party payors will maintain the current level of coverage and payment to our customers for

use of our existing products. A reduction in coverage or payment or change in policy by the Medicare

program could cause some commercial third-party payors to implement similar reductions in their

coverage or payment amounts for the Heartflow Platform. Unfavorable coverage or payment

determinations at the national or local level could adversely affect our business, financial condition,

results of operations and prospects.

***We face risks associated with a concentrated customer base.***

Our Heartflow Platform had an installed base of more than 1,100 accounts in the United States as of

December 31, 2024. We define an "account" as any individual facility that orders a Heartflow FFRCT

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Analysis, Heartflow Plaque Analysis, or both. We define an account as "new" if a unique facility begins

generating revenue cases for our FFRCT Analysis, Plaque Analysis, or both. Accounts may have more

than one reading physician or CT machine. Conversely, a "customer" can be either an individual account

or a health or hospital system with multiple accounts. While a single customer may include multiple

accounts, no single customer accounted for 10% or more of our revenue during the years ended

December 31, 2023 and 2024 or for the three months ended March 31, 2024 and 2025. However, the

decision-making function for some of these accounts is concentrated in a relatively small number of

customers, such that the loss of one customer could result in a disproportionate loss across our accounts.

For example, for the year ended December 31, 2024, our top two largest customers, both large health

systems with multiple accounts, collectively represented approximately 8% of our revenue.

We cannot guarantee that that we will continue to generate revenue from these customers, whether due

to increase in competition, new technologies, our customers' ability to terminate their contracts with us or

reduce order volumes, or other factors outside of our control. If we do not increase the number of our

customers and drive increased use of the Heartflow Platform as the preferred non-invasive testing

method for assessing CAD, we will continue to face risks associated with a more concentrated customer

base.

Revenue from these customers may fluctuate from time to time due to demand for the Heartflow Platform,

the timing of which may be affected by seasonality or other factors outside of our control such as CT

scanner capacity, contrast availability and staffing availability. These customers could also potentially

pressure us to reduce the prices we charge for the Heartflow Platform, which could have a material

adverse effect on our margins and business. For example, during the year ended December 31, 2024,

our average sales price was impacted by customer pricing contracts that included utilization and volume

rebates and by changes in the mix of customer accounts, which trend we expect to continue in the near

term, and it is possible that similar trends in customer pricing contracts may continue to have a negative

impact on our average sales price in the future. In addition, if any of our largest customers terminates its

relationship with us or otherwise reduces its FFRCT Analysis volumes for any reason, we may be unable

to replace them with a customer who refers a similar number of patients for the Heartflow Platform, and

such termination or reduction in volume could have a material adverse effect on our business, financial

condition, results of operations and prospects.

***We face significant competition in an environment of rapid technological change, and there is a***

***possibility that our competitors may develop products that are more effective, accurate, reliable,***

***cost-effective or more advanced than ours, which may harm our financial condition. If we are***

***unable to compete successfully or our potential market share is reduced, we may be unable to***

***increase or sustain our revenue or achieve profitability.***

The medical technology industry is highly competitive, subject to rapid change and significantly affected

by the introduction of new products and technologies and other activities of industry participants. Because

of the size of the market opportunity for the treatment of CAD, we believe current and potential future

competitors will dedicate significant resources to aggressively promote their products or develop new

products or treatments. Our principal competition comes from companies that provide traditional non-

invasive tests that aid physicians in the evaluation of CAD, such as SPECT, stress echocardiography and

PET. Established, traditional non-invasive tests for CAD have been used for many years and are therefore

difficult to change or supplement. Many of the companies that sell these traditional non-invasive tests or

the equipment they require have established relationships with healthcare providers. One of the major

hurdles to adoption of our products is overcoming established testing patterns, which requires education

of physicians and supportive clinical data.

The companies that sell the traditional non-invasive tests for CAD include companies that offer: (i) cardiac

specific tests to primary care and cardiology offices, such as manufacturers of capital equipment for

stress echocardiography and SPECT, including GE Healthcare, Siemens Healthineers AG and Koninklijke

Philips N.V.; and (ii) products used for the invasive FFR testing market.

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With the greater resources of some of these competitors and their more diversified product offerings, it is

possible that they or other entrants into the market may develop competing products or technologies that

could be more effective, accurate, reliable, cost-effective, more advanced or otherwise improved relative

to the Heartflow Platform, which could render our products obsolete or less competitive. In addition, one

or more competitors could develop and market an on-premise solution, which may be more appealing

than our cloud-based offering. Moreover, new treatments, such as GLP-1s, may indirectly reduce stenosis

or plaque build-up, which could reduce the market opportunity for non-invasive CAD tests and, as a

result, our Heartflow Platform. In addition, we currently target our Heartflow Platform for use only on

symptomatic patients and expanding the Heartflow Platform for asymptomatic patients may take years,

with potential delays due to the high-risk nature of the effort. Our competitors who offer traditional non-

invasive tests offer those tests to both symptomatic and asymptomatic patients, and this increased market

penetration could create additional price pressure for our products.

In addition, the field of cardiovascular genomics is subject to rapidly changing technology, and others may

invent and commercialize technology platforms such as next generation sequencing approaches that

could compete with our products or could make our products or any product we may sell in the future

obsolete. We also face competition and price pressure from companies that have developed or are

developing AI-based platforms that leverage CCTA to diagnose CAD, including earlier-stage companies

such as Cleerly, Inc., Elucid Bioimaging Inc. and Keya Medical Technology Co., Ltd. We may also face

competition from companies developing AI-based platforms, even if they are not currently in the CAD

market and recent and future advances in AI may allow other companies to quickly create competing

products, and they may be able to create such products less expensively and benefit from FDA and

reimbursement approvals we and others have obtained. For us to remain competitive, we must

continuously work on our products' design and features, improve our algorithms, and invest in and

develop new technologies, including in the rapidly evolving area of AI. If we are unable to introduce

products, features and improvements aimed at increasing the value proposition of the Heartflow Platform

for our customers, or if the products, features and improvements we introduce are viewed less favorably

than our competitors' products, we may be unable to compete successfully. If we are unable to compete

successfully against our current or future competitors, we may be unable to increase market acceptance

for our products, which could prevent us from increasing or sustaining our revenue or achieving

profitability and could cause the market price of our common stock to decline.

In addition, the Heartflow Platform relies on a CCTA first being performed, as the Heartflow Platform

requires a CT image from a CT scanner to perform its analysis. A number of companies manufacture CT

scanners, including, among others, GE Healthcare, Hitachi, Ltd., Koninklijke Philips N.V., Samsung

Electronics Co., Ltd., Siemens Healthineers AG and Canon Medical Systems Corporation. These

companies are more diversified than we are and have substantial financial, manufacturing, sales and

marketing distribution and other resources. Any of these companies or others could determine to develop,

partner with or acquire and offer a product that competes with ours or manufacture CT scanners that are

no longer compatible with our Heartflow Platform. Further, these larger companies have market

penetration in the CT scanner market and understand the market for CAD and, if they are able to develop,

partner with or acquire a competing product, they may offer it as a bundle with the purchase of a CT

scanner, which could prevent us from increasing or sustaining our revenue or achieving profitability. In the

past, three of these companies, Siemens Healthineers AG, Koninklijke Philips N.V. and Canon Medical

Systems Corporation, considered development of a local workstation-based technology prototype aimed

at deriving CT-based blood flow data without an invasive procedure. If these companies decide to further

pursue this technology and obtain regulatory approval or clinical validation, it may become competitive

with our products. In addition, we are reliant on these third-party CCTAs and CT scanners continuing to

support standard output file formats that our Heartflow Platform supports. If a CT manufacturer were to

change to a proprietary format or develop a novel method of performing CT scans, we would need to

further develop our existing technology to accommodate the images its scanners output, which could

materially affect the ability of physicians to use the Heartflow Platform, increase our R&D expenses, and

could adversely affect our business, financial condition, results of operations and prospects.

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***The size and expected growth of our addressable market may be smaller than we estimate.***

Our estimate of the addressable market for our current products and any future products is subject to

significant uncertainty and is based on assumptions and estimates, including our internal analysis and

industry experience. While we believe our assumptions and the data underlying our estimates are

reasonable, these assumptions and estimates may not be correct. As a result, our estimates of the

addressable market for our current or future products may prove to be incorrect. Moreover, our ability to

serve a significant portion of this estimated market is subject to many factors, including our success in

promoting the use of CCTA as a non-invasive diagnostic test that can be combined with the Heartflow

Platform, which is subject to many risks and uncertainties, and relies on the availability and proximity of

healthcare facilities with active CCTA programs to the patients in our estimated market. Accordingly, if we

are unable to increase the use of CCTA at the rates we estimate, if the actual number of patients who

would benefit from our products is less than we estimate, or if the price at which we can sell future

products or the reimbursement rate received by healthcare providers is less than we estimate, the size

and expected growth of our addressable market would be smaller than our estimates, which could have a

material adverse effect on our business, financial condition, results of operations and prospects.

***We may not be successful in updating or otherwise enhancing the Heartflow Platform.***

A part of our strategy is bringing new enhancements to our customers through updates to the Heartflow

Platform, which may include offering new products, additional features, applications and improvements to

our technology. We expect to make significant investments to advance these efforts, and enhancing the

Heartflow Platform is a complex and time-consuming endeavor. New products, additional features,

applications and improvements to our technology that initially show promise may fail to achieve the

desired results or may not achieve acceptable levels of analytical accuracy, utility or user friendliness.

Product development and improvement is expensive, may take months or years to complete and can

have uncertain outcomes. Failure can occur at any stage of the development or improvement process

and may occur only after substantial work has been completed, or after completion.

Even if, after development, an updated product appears successful, we may, depending on the nature of

the update, need to obtain regulatory clearances, authorizations or approvals before we can market the

updated product. Such regulatory clearances, authorizations or approvals are likely to require significant

time and expenditures and the applicable regulatory authority may not clear, authorize or approve any

product, update or new product we develop. Obtaining such clearances, authorizations or approvals may

require data from clinical trials, which can be costly and time-consuming to obtain. In certain jurisdictions

or in certain cases, clinical data may also be required in order to obtain reimbursement coverage, and this

clinical data may be in addition to data required to obtain regulatory clearances, authorizations or

approvals. Some clinical studies may fail to meet their endpoints, introducing risk or delay in the ability to

commercialize a new feature or product. In light of these requirements, we may choose to limit the scope

of any new products, additional features, applications and improvements we seek to develop.

Even if we develop a product update or new product that receives regulatory clearance, authorization or

approval, and for which we obtain sufficient commercial third party and government reimbursement

coverage, we would need to commit substantial resources to commercialize and market the updated

product, new product or new application of our existing product, which may never achieve market

acceptance among various stakeholders or be commercially successful. Further, the applicable

regulations or the application of those regulations could change in ways that would impact the Heartflow

Platform and our ability to successfully manufacture or market our products. The expenses or losses

associated with unsuccessful updates to or expansion of the Heartflow Platform could adversely affect our

business, financial condition, results of operations and prospects.

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***The commercialization of Heartflow Plaque Analysis is nascent, and we may not be able to***

***achieve or maintain sufficient market acceptance or the levels of utilization we expect from***

***Heartflow Plaque Analysis or any other future product.***

We began limited market education efforts for our Heartflow Plaque Analysis in the second half of 2023,

and we have generated very minimal revenue from this product. Heartflow Plaque Analysis has taken

time and significant resources to develop, and we may not be able to achieve customer acceptance or

broad commercial reimbursement coverage, which could limit its adoption.

The market for alternative plaque analysis products is competitive in terms of development, availability,

pricing, product quality and time-to-market. We face competition from companies that provide or are

developing similar plaque analysis products, which may distinguish themselves from us through, among

other things, perceived product quality, style and visuals, sleek design, enhanced user-friendliness and

innovative features. In addition, some of these competitors are agile, early-stage companies that may be

able to respond more quickly and effectively than we can to new or changing opportunities, technologies,

standards or customer requirements in the plaque analysis category. Some of these competitors

commercially launched competing plaque analysis products prior to our launch of Heartflow Plaque

Analysis and may have a first-mover advantage as a result. For more information on risks related to our

competition, see the risk factor titled "We face significant competition in an environment of rapid

technological change, and there is a possibility that our competitors may develop products that are more

effective, accurate, reliable, cost-effective or more advanced than ours, which may harm our financial

condition. If we are unable to compete successfully or our potential market share is reduced, we may be

unable to increase or sustain our revenue or achieve profitability."

Our competitors may also be able to offer plaque analysis products similar or superior to ours at a more

attractive price than we can or may be better positioned to serve certain segments of our market, which

could create additional price pressure. For example, our competitors have in the past, and may in the

future, offer plaque analysis and other products at a more attractive price than we can such that current or

potential customers may select our competitors' products in lieu of purchasing and using our Heartflow

Plaque Analysis. Moreover, our competitors have in the past, and may in the future, suggest that their

plaque analysis and other products could replace both our Heartflow Plaque Analysis and our Heartflow

FFRCT Analysis, which would adversely affect our ability to achieve sufficient market acceptance for our

Heartflow Plaque Analysis, could affect sales of our Heartflow FFRCT Analysis and could cause our

Heartflow FFRCT Analysis to lose market share. While we believe Heartflow Plaque Analysis represents a

significant long-term opportunity for us, there can be no assurances that we will successfully compete in

such market and our business, financial condition, results of operations and prospects could be materially

and adversely affected.

***We face risks associated with our use and development of AI models, which may result in***

***operational challenges, legal liability, reputational concerns and competitive risks.***

We use and develop AI and automated analysis and decision-making technologies, including proprietary

AI algorithms and models and computational fluid dynamics (collectively, "AI Technologies") to power the

Heartflow Platform. In addition, we use AI Technologies to drive improvements in the performance of the

Heartflow Platform. We expect that significant increased investment will be required in the future to

improve our use and development of AI Technologies.

As with many technological innovations, there are significant risks involved in developing, maintaining and

deploying these technologies. In particular, if the AI Technologies underlying our Heartflow Platform are

incorrectly designed or implemented; trained or reliant on incomplete, inadequate, inaccurate or otherwise

poor quality data; used without sufficient oversight and quality control; misused or used outside of scope

of applicable regulatory authorizations; and/or adversely impacted by unforeseen bugs, defects, technical

challenges, cybersecurity threats or material performance issues, the performance of our Heartflow

Platform and business, as well as our reputation and the reputations of our customers, could suffer or we

could incur liability resulting from the violation of laws or contracts to which we are a party, regulatory

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enforcement actions or civil claims. This could result in fines, penalties and damage awards and

disgorgement of any output, development or technology developed as a result of such violations.

In addition, we leverage a human-in-the-loop AI system that combines advanced algorithms with an

analyst-based quality inspection and monitoring process to create patient-specific reports based on CCTA

images. While we constantly work to improve our Heartflow Platform and algorithms, the AI Technologies

we work with are novel and complex, and we cannot assure you that our AI Technologies will be able to

perform as intended under all circumstances, or that our analyst-based review process will identify and

correct any errors in the outputs of our AI Technologies.

The regulatory framework for AI Technologies is rapidly evolving as many federal, state and foreign

government bodies and agencies have introduced or are currently considering additional laws, regulations

and guidance. For example, the FDA has issued guidance documents relating to the incorporation of AI

Technologies into medical devices and marketing submissions for AI-enabled devices. Specifically, draft

guidance issued on January 7, 2025, titled Artificial Intelligence-Enabled Device Software Functions:

Lifecycle Management and Marketing Submission Recommendations, proposes recommendations for the

design, development and implementation of AI-enabled devices that FDA encourages manufacturers

consider using throughout the total product lifecycle. In addition, the California Privacy Protection Agency

has approved for rulemaking regulations under the CCPA regarding the use of automated decision-

making that may require risks and providing notice and rights to opt-out and access to information

underlying the logic and outputs. Colorado passed the Colorado AI Act, which will go into effect in

February 2026. This law creates duties for developers and deployers to use reasonable care to protect

consumers from any known or reasonably foreseeable risks of "algorithmic discrimination" arising from

the intended and contracted uses of "high-risk AI systems," including those that impact healthcare

services. Such additional laws, regulations and guidance may impact our ability to develop, use and

commercialize AI Technologies in the future.

It is possible that further new laws and regulations will be adopted in the United States and in other non-

U.S. jurisdictions, or that existing laws and regulations, including competition and antitrust laws, may be

interpreted in ways that would limit our ability to use AI Technologies for our business, or require us to

change the way we use AI Technologies in a manner that negatively affects the performance of our

Heartflow Platform and the way in which we use AI Technologies. We may need to expend resources to

adjust our Heartflow Platform in certain jurisdictions if the laws, regulations or decisions are not consistent

across jurisdictions. Further, the cost to comply with such laws, regulations or decisions and/or guidance

interpreting existing laws, could be significant and would increase our operating expenses (such as by

imposing additional reporting obligations regarding our use of AI Technologies). Such an increase in

operating expenses, as well as any actual or perceived failure to comply with such laws and regulations,

could materially and adversely affect our business, financial condition, results of operations and

prospects.

***Our Heartflow Platform and the data and models it generates could have bugs, defects or errors,***

***including human quality control errors, or otherwise fail to meet the expectations of patients,***

***physicians and third-party payors, which could adversely affect our reputation, business and***

***operating results.***

We cannot provide assurance that the proprietary technology and algorithms used in our Heartflow

Platform do not contain undetected bugs, defects or errors or that our analyst-based review process will

identify and correct any errors in the outputs of our AI Technologies. We cannot provide assurance that

limitations of the inbound CCTA images and image quality will always allow a true representation of the

patient anatomy, and any such limitations in CCTA images could affect the results of our analyses. We

have in the past, and may in the future, experience defects or errors in our Heartflow Platform or the data

and models it generates that remain undetected by our analyst-based review process, our reputation,

business and operating results could be adversely affected.

Furthermore, the success of the Heartflow Platform depends in part on patients', physicians' and third-

party payors' confidence that our platform can provide reliable, high-quality actionable data and analysis

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that will improve clinical decision making. We believe that patients, physicians and third-party payors are

likely to be sensitive to product defects and errors in the use of our products, including if the defects and

errors affect a physician's ability to use the CCTA imaging results or result in a misdiagnosis. In the past,

we have experienced software code defects and software release process defects that have resulted in

intermittent interruptions to the physician's ability to use our Heartflow Platform, and we may experience

such defects in the future. A subset of these defects were reported as part of the FDA's Manufacturer and

User Facility Device Experience ("MAUDE") disclosure. For more information, see the risk factor titled

"The Heartflow Platform may be subject to recalls, which could be costly and could harm our reputation

and business." As a result, the failure of our Heartflow Platform to perform as expected, including to

reduce unnecessary invasive testing or fail to enable physicians to optimize treatment planning or provide

more efficient care, could significantly impact a physician's willingness to use and rely on the Heartflow

Platform, which would impair our operating results and our reputation. In addition, we may be subject to

legal claims arising from any such failures.

Bugs, defects or errors in the Heartflow Platform or the failure of third-party service providers we rely on,

such as AWS or other cloud storage and telecommunications services providers, to block a virus or

prevent a security breach could harm our reputation and adversely impact our results of operations.

Defects may cause our products to be vulnerable to security attacks, cause them to fail to produce

accurate results or temporarily interrupt our commercial operations. Because the techniques used by

computer hackers to access or sabotage networks change frequently and generally are not recognized

until launched against a target, we or our third-party services providers may be unable to anticipate these

techniques and provide a corrective measure in time to protect the Heartflow Platform and our networks.

Potential defects may further cause the platform to be unavailable for a period of time, affect ability of a

customer to access information, result in a slow or suboptimal user experience, impact turnaround time of

an analysis, or provide other forms of degradation to the overall service.

***We depend on our talent to grow and operate our business, and if we are unable to hire, integrate,***

***develop, motivate and retain our personnel, including highly qualified, technical personnel, we***

***may not be able to grow effectively and this could adversely affect our business.***

To execute our growth plan, we must attract and retain highly qualified, technical personnel. Competition

for these personnel is intense, especially for engineers with high levels of expertise in AI, cloud

architecture, 3D visualization, research scientists and senior sales executives with experience in the

cardiology industry. We may experience difficulty in hiring and retaining employees with appropriate

qualifications. Many of the companies with which we compete for experienced personnel have greater

resources than we have. We also compete with companies that are believed to have high potential growth

opportunities or that have experienced rapid recent growth.

Our future success depends in part on our ability to continue to retain our executive officers and other key

employees and to recruit and hire new employees, including engineers, research scientists, case analysts

and production team members. We do not maintain "key person" insurance for any of our executives or

other employees. The loss of the services of any of these persons could impede the achievement of our

development, research and commercialization objectives. Any of our executive officers and other

employees may terminate employment with us at any time with no advance notice. The replacement of

any of our key personnel likely would involve significant time and costs, may significantly delay or prevent

the achievement of our business objectives and may harm our business.

In addition, job candidates and existing employees often consider the value of the stock awards they

receive in connection with their employment. If the perceived value of our stock awards declines or is

perceived to be less valuable than stock awards of other competing employers, it may adversely affect

our ability to recruit and retain highly skilled employees. In addition, many of our employees have become

or will soon become vested in a substantial amount of stock or number of stock options. Our employees

may be more likely to leave us if the shares they own or the shares underlying their vested options have

significantly appreciated in value relative to the original purchase prices of the shares or the exercise

prices of the options, or if the exercise prices of the options that they hold are significantly below the

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market price of our common stock. If we fail to attract new personnel, or fail to retain and motivate our

current personnel, our business and prospects could be adversely affected.

***If we fail to properly manage our future growth, our business could suffer.***

We intend to continue to grow and may experience periods of rapid growth and expansion, which could

place a significant additional strain on our limited personnel, information technology systems and other

resources. Our future growth will impose significant added responsibilities on management, including the

need to identify, recruit, train and integrate additional employees. In order to manage our operations and

growth we will need to continue to improve our operational and management controls, administrative and

operational infrastructure, reporting and information technology systems and financial internal control

procedures. Due to our limited financial resources and the limited experience of our management team in

managing a company with such future growth expectations, we may not be able to effectively manage the

expected expansion of our operations or recruit and train additional qualified personnel. Moreover, the

expected expansion of our operations may lead to significant costs and may divert our management and

business development resources. Any inability to manage growth could delay the execution of our

business plans or disrupt our operations.

In addition, as demand for the Heartflow Platform increases, we will need to scale our capacity, expand

customer service and enhance our internal quality assurance program. We may fail to implement any

increases in scale, related improvements and quality assurance, and we may fail to find appropriate

personnel to facilitate the growth of our business. Due to our limited resources, we may not be able to

effectively manage this simultaneous execution and expansion of our operations. This may result in

weaknesses in our infrastructure, give rise to operational mistakes, legal or regulatory compliance

failures, loss of business opportunities, loss of employees and reduced productivity among remaining

employees. The expansion of our operations may lead to significant costs and may divert financial

resources from other projects, such as the development of any new products. If our management is

unable to effectively manage our expected development and expansion, our expenses may increase

more than expected, our ability to generate or increase our revenue could be reduced and we may not be

able to implement our business strategy. Our future financial performance and our ability to compete

effectively and commercialize our Heartflow Plaque Analysis or any of our future products will depend in

part on our ability to effectively manage the future growth and expansion of our company. If we are unable

to manage our growth effectively, it may be difficult for us to execute our business strategy and our

business, financial condition, results of operations and prospects may be adversely affected.

***Our business could be disrupted by catastrophic events.***

The occurrence of any catastrophic event, including earthquake, fire, flood, tsunami or other weather

event, power loss, telecommunications failure, software or hardware malfunctions, pandemics, political

unrest, geopolitical instability, severe or prolonged economic downturn, cyberattack (including a

ransomware attack), war or terrorist attack, could result in lengthy interruptions in our ability to serve our

customers. In addition, acts of terrorism could cause disruptions to the internet or the economy as a

whole and could disproportionately affect us given our reliance on the internet and cloud-based services.

Specifically, our corporate headquarters are located in Mountain View, California and our production

related computers are currently located in our Mountain View office and in Austin, Texas. California is

considered to be an active earthquake zone, is prone to catastrophic fires, severe weather events and the

follow-on effects thereof, including tsunamis, mudslides, flooding, power outages and other events that

could disrupt our business. Texas is also subject to severe weather events, power outages and other

events that could disrupt our business. Any event that prevents our access to such facilities, physically or

virtually, would prevent us from operating our business and have an adverse effect on our business,

financial condition, results of operations and prospects.

In addition, we rely on our network and third-party infrastructure, including our cloud-based infrastructure

which we outsource to Amazon Web Services ("AWS"), and enterprise applications, internal technology

systems and our website, for our development, marketing, operational support hosted services and sales

activities. In the event of a catastrophic event, we may be unable to continue our operations and may

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endure system interruptions, delays in our ability to generate reports and output them to physicians,

reputational harm, delays in our product development, breaches of data security and loss of critical data,

all of which could have an adverse effect on our future operating results. If we are unable to develop

adequate plans to ensure that our business functions continue to operate during and after a disaster and

to execute successfully on those plans in the event of a disaster or emergency, our business would be

harmed. Even with our disaster recovery arrangements and insurance coverage, the ability of our

customers to access and utilize our Heartflow Platform could be interrupted, or we could close critical

data, which would have a negative impact on our business.

In addition, the occurrence of a catastrophic event could impact providers of CCTAs, contrast agents for

CCTAs or suppliers of iodinated contrast media or similar supplies that are necessary to perform CCTAs.

For example, in 2022, the shutdown of an iodinated contrast media manufacturing facility led to a

significant shortage of iodinated contrast media, which resulted in the cancellation or rescheduling of non-

urgent contrast-requiring cardiac procedures and imaging. Any of these events could affect demand for

the Heartflow Platform, which could have a material adverse effect on our business, financial condition,

results of operations and prospects.

***Consolidation among healthcare providers could have an adverse effect on our business,***

***financial condition, results of operations and prospects.***

In the United States, there has been a trend of consolidation among healthcare providers and purchasers

of medical technology devices, often to gain greater market power. As healthcare providers consolidate,

they may try to use their market power to negotiate price concessions or reductions for the products and

services they purchase and use, including our Heartflow Platform. As result, it is unknown whether such

purchasers will decide to stop purchasing our Heartflow Platform or demand discounts on our prices. If we

reduce our prices in response to these industry trends, our revenue would decrease, which could have a

material adverse effect on our business, financial condition, results of operations and prospects.

***We may acquire other companies, solutions or technologies, which could divert our***

***management's attention, result in additional dilution to our stockholders and otherwise disrupt***

***our operations and adversely affect our operating results.***

We may in the future seek to acquire or invest in companies, solutions or technologies that we believe

could complement or expand our products, enhance our technical capabilities or otherwise offer growth

opportunities. The pursuit of potential acquisitions or other investment opportunities may divert the

attention of management and cause us to incur various expenses in identifying, investigating and

pursuing suitable transactions, whether or not they are consummated.

If we acquire any businesses, we may not be able to integrate the acquired personnel, operations and

technologies successfully, or effectively manage the combined business following the acquisition. We also

may not achieve the anticipated benefits from the acquired business due to a number of factors,

including: inability to integrate or benefit from acquired technologies or services in a profitable manner;

unanticipated costs or liabilities associated with the acquisition; incurrence of acquisition related costs;

difficulty integrating the accounting systems, operations and personnel of the acquired business;

difficulties and additional expenses associated with supporting legacy products and hosting infrastructure

of the acquired business; diversion of management's attention from other business concerns; use of

resources that are needed in other parts of our business; adverse effects to our existing business

relationships with business partners and customers as a result of the acquisition; the potential loss of key

employees; and use of substantial portions of our available cash to consummate the acquisition.

In addition, a significant portion of the purchase price of any companies, solutions or technologies that we

may acquire may be allocated to acquired goodwill and other intangible assets, which must be assessed

for impairment at least annually. If our acquisitions do not yield expected returns, we may be required to

take charges to our operating results based on this impairment assessment process, which could

adversely affect our results of operations.

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Acquisitions could also result in dilutive issuances of equity securities or the incurrence of debt, which

could adversely affect our operating results and cause the market price of our common stock to decline. If

an acquired company, solution or technology fails to meet our expectations and does not complement or

expand our products, enhance our technical capabilities or otherwise offer growth opportunities, our

business, financial condition, results of operations and prospects may suffer. In addition, the 2024 Credit

Agreement restricts our ability to pursue certain mergers, acquisitions, amalgamations or consolidations

that we may believe to be in our best interest.

***Sales to customers outside the United States or with international operations expose us to risks***

***inherent in international sales.***

In our fiscal years ended December 31, 2023 and 2024 and three months ended March 31, 2024 and

2025, sales to customers outside the United States accounted for approximately 11%, 9%, 9% and 8% of

our revenue, respectively. One element of our growth strategy is to further expand our international

operations and worldwide customer base. Operating in international markets requires significant

resources and management attention and subjects us to regulatory, economic and political risks that are

different from those in the United States.

We have limited operating experience in international markets, and we cannot assure you that our

existing presence in the United Kingdom, Europe and Japan or any expansion efforts into other

international markets will be successful. Our experience in the United States and international markets

may not be relevant to our ability to expand in other markets. Our international expansion efforts may not

be successful in creating further demand for our products outside of the United States or in effectively

selling our products in the international markets we enter. In addition, expansion into other international

markets will be costly and will impose additional burdens on our executive and administrative personnel,

finance and legal teams, sales and marketing teams and general managerial resources. If our efforts to

introduce our products into other international markets are not successful, we may have expended

significant resources without realizing the expected benefit. Ultimately, the investment required for

international expansion could exceed the results of operations generated from this expansion.

In addition, we operate in an industry which is subject to significant enforcement scrutiny by both U.S. and

non-U.S. government authorities. Our international business requires us to comply with U.S. and foreign

laws and regulations, such as various anti-bribery and anti-corruption laws, including the U.S. Foreign

Corrupt Practices Act ("FCPA"), the U.S. Fraud Act and in certain cases the U.K. Bribery Act of 2010.

Compliance with these is costly and exposes us to significant civil and criminal penalties for non-

compliance. Any failure to comply with applicable legal and regulatory obligations could impact us in a

variety of ways that include, but are not limited to, significant criminal, civil and administrative fines,

penalties and disgorgement of profits, including imprisonment of individuals, denial of export privileges,

seizure of shipments, restrictions on certain business activities and exclusion or debarment from

government contracting. Our international operations expose us to risks inherent in operating in foreign

jurisdictions that could adversely affect our business.

***If we do not obtain and maintain international regulatory registrations, clearances or approvals for***

***our Heartflow Platform, we will be unable to market and sell our products outside of the United***

***States.***

Any future sales of our products outside of the United States are subject to foreign regulatory

requirements that vary widely from country to country. While the regulations of some countries may not

impose barriers to marketing and selling our products or only require notification, others require that we

obtain the clearance or approval of a specified regulatory authority or a Certificate of Conformity of a

notified body. Complying with foreign regulatory requirements, including obtaining registrations,

clearances or approvals, can be expensive and time consuming and we may not receive regulatory

clearances or approvals in each country in which we plan to market our products or we may be unable to

do so on a timely basis. The time required to obtain registrations, clearances or approvals, if required by

other countries, may be longer than that required for FDA clearance or approval, and requirements for

such registrations, clearances or approvals may significantly differ from FDA requirements. If we modify

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our products, we may need to apply for regulatory clearances or approvals before we are permitted to sell

the modified product.

In addition, AI governing regulations around medical devices evolve rapidly and we may not continue to

meet the quality and safety standards required to maintain the authorizations that we have received. If we

are unable to maintain our authorizations in a particular country, we will no longer be able to sell the

applicable product in that country.

Regulatory registration, clearance, marketing authorization, or approval by the FDA does not ensure

registration, clearance, marketing authorization, or approval by foreign regulatory authorities or authorized

representatives in other countries. Registration, clearance, marketing authorization, or approval by one or

more foreign regulatory authorities or authorized representatives do not ensure registration, clearance,

marketing authorization, or approval by regulatory authorities in other foreign countries or by the FDA.

However, a failure or delay in obtaining registration or regulatory clearance or approval in one country

may have a negative effect on the regulatory process in others.

**Risks related to data privacy and information technology**

***Failure to comply with laws and regulations affecting the transmission, security and privacy of***

***personal information (including health information) could result in significant penalties.***

Federal, state and foreign government bodies and authorities have adopted, are considering adopting, or

may adopt laws and regulations regarding the collection, use, processing, storage and disclosure of

personal information obtained from consumers and individuals. In the United States, federal, state, and

local governments have enacted numerous data privacy and security laws, including data breach

notification laws, personal data privacy laws, consumer protection laws (e.g., Section 5 of the Federal

Trade Commission Act), and other similar laws (e.g., wiretapping laws). Under these laws we may be

required to obtain certain consents to process personal data. For example, some of our data processing

practices have been, and may in the future continue to be, subject to challenges or lawsuits under

privacy, security, and communications laws, including, for example, challenges based on wiretapping laws

for sharing consumer information with third parties through various methods, such as via third-party

marketing pixels or software development kits. Our inability or failure to obtain consent for these practices

could result in adverse consequences, including class action litigation and mass arbitration demands. In

addition, numerous federal and state laws and regulations, including the Health Insurance Portability and

Accountability Act of 1996 ("HIPAA"), as amended by the Health Information Technology for Economic

and Clinical Health Act of 2009 ("HITECH"), govern the collection, dissemination, security, use and

confidentiality of patient identifiable health information. HIPAA and the HITECH Act require us to comply

with standards for the use and disclosure of health information within our company and with third parties.

The Standards for Privacy of Individually Identifiable Health Information ("Privacy Standards"), and the

Security Standards for the Protection of Electronic Protected Health Information ("Security Standards"),

under HIPAA establish a set of basic national privacy and security standards for the protection of

individually identifiable health information by health plans, healthcare clearinghouses and certain

healthcare providers, referred to as covered entities, and the business associates with whom such

covered entities contract for services. As a result, both covered entities and business associates can be

subject to significant civil and criminal penalties for failure to comply with the Privacy Standards or the

Security Standards.

HIPAA, the HITECH Act and the Affordable Care Act ("ACA") also include standards for common

healthcare electronic transactions and code sets, such as claims information, plan eligibility, payment

information and the use of electronic signatures, unique identifiers, operating rules. Companies that bill

payors for healthcare-related services and device use are required to conform to the transaction

standards. CMS, on behalf of HHS, has the authority to investigate complaints and audit for compliance

with the HIPAA standards for transactions, code sets, unique identifiers and operating rules, including the

Administrative Simplification provisions of HIPAA and the ACA. Failure to comply with these standards,

and any investigation or audit and penalties imposed may have an adverse impact on our business.

HIPAA requires covered entities and business associates to develop and maintain policies and

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procedures with respect to protected health information that is used or disclosed, including the adoption of

administrative, physical and technical safeguards to protect such information. The HITECH Act expands

the notification requirement for breaches of patient identifiable health information, restricts certain

disclosures and sales of patient identifiable health information and provides a tiered system for civil

monetary penalties for HIPAA violations. The Final HIPAA Omnibus Rule modifies the breach reporting

standard in a manner that will likely make more data security incidents qualify as reportable breaches.

The HITECH Act also increased the civil and criminal penalties that may be imposed against covered

entities, business associates and possibly other persons and gave state attorneys general new authority

to file civil actions for damages or injunctions in federal courts to enforce the federal HIPAA laws and seek

attorney fees and costs associated with pursuing federal civil actions. Additionally, states have adopted

comparable privacy and security laws and regulations that differ somewhat from federal and other states'

laws, and that govern where more stringent than federal law.

As a business associate under HIPAA, if we do not comply with the requirements of HIPAA, the HITECH

Act or applicable state privacy and security laws, we could be subject to criminal or civil sanctions that

could adversely affect our financial condition. The costs of complying with privacy and security related

legal and regulatory requirements are substantial and could have an adverse effect on our business. In

addition, we are unable to predict what changes to the HIPAA Privacy Standards and Security Standards

might be made in the future or how those changes could affect our business. Any new legislation or

regulation in the area of privacy and security of personal information, including personal health

information, could also adversely affect our business operations. In addition, a security breach could

require reporting to federal and state government entities, notification to affected individuals, expensive

investigation and remediation and mitigation. Government agencies could, in their discretion, impose fines

and penalties relating to the breach, that would have an adverse effect on our business.

Foreign data privacy regulations, such as the General Data Protection Regulation (E.U.) 2016/679

("GDPR"), the European Union's Data Protection Directive (Directive 95/46/EC), and the country specific

regulations that implement Directive 95/46/EC, also govern the processing of personally identifiable data,

and a number of these regulations are stricter than U.S. laws.

In addition, many states have laws, regulations and other authorities that govern data privacy, security

and breach notification. While some of these laws exempt protected health information subject to HIPAA,

they may apply to other personal information we collect, including personal information collected from

employees or from visitors to our website. Failure to comply with these authorities may have an adverse

impact on our business.

We expect to expend significant resources to comply with these laws and regulations. The functional and

operational requirements and costs of compliance with such laws and regulations may adversely impact

our business, and failure to enable our solutions to comply with such laws and regulations could lead to

significant fines and penalties imposed by regulators, as well as claims, lawsuits and contractual

indemnification obligations by or for our customers or third parties and significant reputational harm.

***We depend on our information technology systems, and any failure of these systems could harm***

***our business and adversely affect our business and operating results.***

Information technology and telecommunications systems are vulnerable to damage from a variety of

sources, including telecommunications or network failures, failures during the processes of upgrading or

replacing software, power outages, hardware failures, user or human errors and natural disasters.

Moreover, despite network security and back up measures, some of our servers are potentially vulnerable

to cybersecurity incidents, including phishing attacks by computer hackers or other malicious human acts,

computer viruses, ransomware, malware and similar disruptive problems or other methods of

compromising employee or customer administrator credentials to access protected health information and

our internal data. Failures or significant downtime of our information technology or telecommunications

systems could prevent us from operating our business. Any disruption or loss of information technology or

telecommunications systems on which critical aspects of our operations depend could have an adverse

effect on our business and our operating results may suffer.

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In addition, our brand, reputation and ability to attract, retain and serve our customers are dependent

upon the reliable performance of our Heartflow Platform, including our underlying information technology

systems and infrastructure. Our technical infrastructure may not be adequately designed with sufficient

reliability and redundancy to avoid performance delays or outages that could be harmful to our business.

If our Heartflow Platform is unavailable when physicians attempt to access it, or if it does not load as

quickly as they expect, physicians may not use our Heartflow Platform as often in the future, or at all. As

our customer base continues to grow, we will need an increasing amount of technical infrastructure,

including network capacity and computing power, to continue to satisfy the needs of our users.

***We rely upon AWS to operate our cloud offering; any disruption of or interference with our use of***

***AWS would adversely affect our business, results of operations and financial condition.***

We outsource all of our cloud-based infrastructure to AWS. Our customers need to be able to access our

cloud-based infrastructure at any time, without interruption or degradation of performance. AWS runs its

own platform that we access, and we are, therefore, vulnerable to service interruptions at AWS. We may

experience interruptions, delays and outages in service and availability from time to time as a result of

problems with our AWS provided infrastructure. For example, in September 2015, AWS suffered a

significant outage that had a widespread impact on cloud-based software and services companies.

Although our customers were not affected by that outage, a similar outage could render our cloud offering

inaccessible to customers. Additionally, AWS has suffered outages at specific customer locations in the

past, rendering the customer unable to access our offering for periods of time. Lack of availability of our

AWS infrastructure could be due to a number of potential causes including technical failures, natural

disasters, fraud or security attacks that we cannot predict or prevent.

In addition, if the security of the AWS infrastructure is compromised or believed to have been

compromised, our business, results of operations and financial condition could be adversely affected. It is

possible that our customers and potential customers would hold us accountable for any breach of security

affecting the AWS infrastructure and we may incur significant liability from those customers and from third

parties with respect to any breach affecting AWS systems. For more information, see the risk factor titled

"Failure to comply with laws and regulations affecting the transmission, security and privacy of personal

information (including health information) could result in significant penalties." Because our agreement

with AWS limits AWS' liability for damages, we may not be able to recover a material portion of our

liabilities to our customers and third parties from AWS. Customers and potential customers may refuse to

do business with us because of the perceived or actual failure of our cloud offering as hosted by AWS and

our operating results could be harmed.

Our agreement with AWS allows AWS to terminate the agreement by providing 30 days' advance notice,

and allows AWS to terminate in case of a material breach of contract if such breach is uncured for 30

days following receipt of notice of such breach, or to terminate immediately upon notice to us (i) if AWS

has the right to suspend our account; (ii) if AWS' relationship with a third-party software or technology

provider terminates, expires or requires AWS to change the way it provides its services; or (iii) in order to

comply with the law or requests of governmental entities. Although we expect that we could receive

similar services from other third parties, if any of our arrangements with AWS are terminated, we could

experience interruptions on our platform and in our ability to make our platform available to customers, as

well as delays and additional expenses in arranging alternative cloud infrastructure services.

***If we fail to offer high quality customer support, our business and reputation could suffer.***

Our customers rely on our customer support teams to resolve technical and operational issues if and

when they arise. We may be unable to respond quickly enough to accommodate short-term increases in

customer demand for customer support. We also may be unable to modify the nature, scope and delivery

of our customer support to compete with changes in customer support services provided by our

competitors or to adapt to product and industry developments. Increased customer demand for customer

support, without corresponding revenue, could increase costs and harm our results of operations. In

addition, as we continue to grow our operations and reach a large global customer base, we need to be

able to provide efficient customer support that meets our customers' needs globally at scale. The number

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of our customers has grown significantly, and that growth has and will continue to put additional pressure

on our support organization. As our business scales, we may need to engage third-party customer

support service providers, which could negatively impact the quality of our customer support if such third

parties are unable to provide customer support that is as effective as that we provide ourselves. Our sales

are highly dependent on our business reputation and on positive recommendations from our existing

customers. Accordingly, high quality customer support is important for the renewal and expansion of our

agreements with existing customers and any failure to maintain such standards of customer support, or a

market perception that we do not maintain high quality customer support, could harm our reputation, our

ability to sell product to existing and prospective customers and our business, financial condition, results

of operations and prospects.

***We invest significantly in research and development, and to the extent our research and***

***development investments do not translate into new products, features or improvements to our***

***current products, or if we do not use those investments efficiently, our business, financial***

***condition, results of operations and prospects would be harmed.***

A key element of our strategy is to invest significantly in our research and development efforts to

introduce new products, features and improvements aimed at increasing the value proposition of the

Heartflow Platform for our customers. For the years ended December 31, 2023 and 2024 and three

months ended March 31, 2024 and 2025, our research and development expenses were 41%, 35%, 35%

and 37% of our revenue, respectively. If we do not spend our research and development budget efficiently

or effectively on compelling innovation and technologies, our business may be harmed and we may not

realize the expected benefits of our strategy. Moreover, research and development projects can be

technically challenging and expensive. The nature of these research and development cycles may cause

us to experience delays between the time we incur expenses associated with research and development

and the time we are able to offer compelling solutions and generate revenue, if any, from such

investment. For example, investments made to expand the Heartflow Platform to asymptomatic patients

may be expensive, technically challenging, experience delays and may not be successful. Additionally,

anticipated customer demand for a product or feature we are developing could decrease after the

development cycle has commenced, and we would nonetheless be unable to avoid substantial costs

associated with the development of any such product or features. If we expend a significant amount of

resources on research and development and our efforts do not lead to the successful introduction or

improvement of products or features that are competitive in our current or future markets, it would harm

our business, financial condition, results of operations and prospects.

***Our networks and those of our third-party service providers may become the target of bad actors***

***or security breaches that we cannot anticipate or successfully defend, which could have an***

***adverse impact on our business.***

The Heartflow Platform involves the storage and transmission of our customers' personal information or

identifying information of their patients. Increasingly, we and other companies are subject to a wide variety

of attacks on their networks on an ongoing basis. In addition to attacks from traditional computer

"hackers," malicious code (such as viruses and worms), employee theft or misuse, ransomware attacks

and denial of service attacks, sophisticated nation state and nation state supported actors now engage in

intrusions and attacks (including advanced persistent threat intrusions), and add to the risks to our

internal networks and the information they store and process. Additionally, such bad actors frequently

attempt to fraudulently induce employees or customers into disclosing sensitive information such as user

names, passwords or other information in order to gain access to our customers' data, their patient's data

or our data, including our intellectual property and other confidential business information, or our

information technology systems. Because techniques used to obtain unauthorized access or to sabotage

systems change frequently and generally are not recognized until successfully launched against a target,

we may be unable to anticipate these techniques or to implement adequate preventative measures.

Despite significant efforts to create process and security barriers to such threats, it is virtually impossible

for us to entirely mitigate these risks. Any such breach could compromise our networks, creating system

disruptions or slowdowns and exploiting security vulnerabilities of our products, and the information stored

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on our networks could be accessed, publicly disclosed, lost or stolen, which could subject us to liability

and cause us significant financial harm. Such breaches often result in reputational damage, negative

publicity, loss of industry data security certifications, customers and sales, increased costs to remedy any

problem, costly litigation and contractual indemnification obligations by or for impacted customers or third

parties any of which could adversely affect our business. In addition, although we have, and intend to

maintain, insurance with respect to any such indemnification obligations, the coverage limits of our

insurance policies may not be adequate and one or more successful claims brought against us may have

an adverse effect on our business, financial condition, results of operations and prospects.

We also rely on third-party service providers, such as cloud storage and telecommunications services

providers. Such service providers are also potentially vulnerable to cybersecurity incidents that could

result in the interruption of their services to us or unauthorized access, use or disclosure of our

confidential information and confidential information of our customers and protected health information of

their patients.

Our products are also targets for malicious cybersecurity acts. While some of our products contain

encryption or security algorithms to protect third-party content or patient information or other data stored

in our products, these products could still be hacked or targeted by malicious software programs or other

attacks or the encryption schemes could be compromised, breached or circumvented by motivated or

sophisticated hackers, which could harm our business and our reputation. In addition, see the risk factor

titled "Our Heartflow Platform and the data and models it generates could have bugs, defects or errors,

including human quality control errors, or otherwise fail to meet the expectations of patients, physicians

and third-party payors, which could adversely affect our reputation, business and operating results" for

more information on bugs, defects or errors in the Heartflow Platform.

**Risks related to legal and regulatory matters**

***We face extensive, regulatory requirements to bring our products to market, and our failure to***

***receive and maintain regulatory clearances or approvals of our current and future products in the***

***United States or abroad or to comply with medical device regulatory requirements could***

***adversely affect our business.***

In order to market any product, we must establish and comply with numerous and varying regulatory

requirements that vary by country and by region within certain countries. Approval, clearance or marketing

authorization in the United States by the FDA or by a regulatory authority or other body in another country

does not ensure approval by the regulatory authorities in other countries or jurisdictions or ensure

approval, clearance or other marketing authorization for the same conditions of use. Approval processes

vary among countries and can involve additional product testing and validation and additional

administrative review periods. In general, unless an exemption applies, in the U.S. current and future

versions of our products must receive pre-market notification ("510(k)"), de novo classification ("de novo")

or pre-market approval ("PMA") from the FDA before they can be marketed in the United States. We

cannot provide assurance that any of our future products, to the extent required, will be cleared, approved

or otherwise authorized by the FDA through any of its pre-market review processes, or that the FDA will

provide export certificates that are necessary to export certain products to certain countries. In addition,

the national health or social security organizations of certain foreign countries, including those outside

Europe, require our products to be qualified before they can be marketed in those countries. Failure to

receive, or delays in the receipt of, relevant foreign qualifications in the European Economic Area or other

foreign countries could have an adverse effect on our business.

Pre-market notification, de novo classification request or PMA applications may require support by data

from clinical trials. We are subject to requirements to publicly register and report the results of our clinical

trials. We must also abide by good clinical practice ("GCP") requirements in the conduct and

documentation of our clinical trials and report to the FDA significant financial interests of investigators in

any clinical trials we submit to support marketing applications for our products. We, the FDA or an

institutional review board ("IRB"), may suspend or terminate clinical trials at any time on various grounds,

including a finding that patients are being exposed to an unacceptable health risk or that the treatment

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does not have any effect. If the FDA considers data from our clinical trials to be actually or potentially

biased due to investigators' financial interests, or unreliable due to GCP noncompliance, it can require us

to implement extensive data analyses or other corrective actions, or exclude data from consideration in

support of our marketing applications. These outcomes could result in delay or denial of FDA clearance or

approval and could result in the need to conduct additional, costly and time-consuming clinical trials.

Additionally, we are required to obtain pre-market clearance or approval to market significantly modified

versions of our currently cleared Heartflow Platform, as well as to market the existing product for new

indications. The FDA requires us to make and document a determination as to whether or not a

modification requires a new 510(k) clearance, de novo classification or PMA approval; however, the FDA

can review and disagree with our decision. Although we have received 510(k) clearance from the FDA for

the current version of the Heartflow Platform, we may not be successful in receiving clearances, de novo

classifications or approvals in the future or the FDA may not agree with our decisions not to seek

clearances, de novo classifications or approvals for any new products or particular product modifications

or updates. The FDA may require us to obtain a new 510(k) clearance, de novo classifications or approval

for any past or future modification or a new indication for our existing products. Such submissions may

require the development and submission of additional data, may be time consuming and costly, and

ultimately may not be cleared or approved by the FDA.

If the FDA requires us to obtain pre-market clearances, de novo classifications or approvals for any

marketed modification to a previously cleared version of the Heartflow Platform, we may be required to

cease manufacturing and marketing of the modified product or to recall the modified product until we

obtain such FDA marketing authorization. The FDA may not clear, grant or approve such submissions in a

timely manner, if at all. The FDA also may change its policies, adopt additional regulations, or revise

existing regulations, each of which could prevent or delay pre-market clearance, de novo classification or

approval of our devices, or could impact our ability to market a device that was previously cleared. Any of

the foregoing could adversely impact our business and financial condition.

In addition, the FDA and other comparable foreign regulatory authorities may delay, limit or deny

clearance, de novo classification or approval of future versions of or future indications for our products or

any other potential product for many reasons, including, among others:

• the results of our clinical trials may not meet the level of statistically significant and clinically

meaningful efficacy with an acceptable safety profile as required by FDA, or other comparable

regulatory authorities in other countries, for marketing approval;

• the FDA or other comparable regulatory authorities in other countries may disagree with the number,

design, size, conduct or implementation of our clinical trials;

• the FDA or other comparable regulatory authorities in other countries may disagree with our

interpretation of data from our clinical trials;

• the FDA or other comparable regulatory authorities in other countries may not accept data generated

at one or more of our clinical trial sites;

• if our 510(k) notifications, de novo classification requests, PMA applications, or similar notifications or

applications, if and when submitted, are reviewed by the FDA or other comparable regulatory

authorities, as applicable, the regulatory authorities may have difficulties scheduling the necessary

review meetings in a timely manner, or may recommend against clearance or approval of our

application; or

• the FDA may determine that our 510(k) notifications for new indications, if and when submitted, must

follow a different regulatory pathway than we have attempted, and there may be potentially extended

standards, timelines, reviews (such as by an FDA Advisory Committee) and costs in order to pursue

approval.

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Any of these factors, many of which are beyond our control, could jeopardize our ability to obtain

regulatory clearance, de novo classification or approval for current or future versions of the Heartflow

Platform and could result in difficulties and costs for us. If we fail to comply with regulatory requirements in

international markets or to obtain and maintain required marketing authorizations, or if marketing

authorizations in international markets are delayed, our ability to realize the full market potential of our

new potential products will be limited.

***Healthcare policy changes, including recently enacted legislation reforming the U.S. healthcare***

***system could have an adverse effect on our business, financial condition, results of operations***

***and prospects.***

In the United States, there have been and continue to be a number of legislative and regulatory initiatives

to contain healthcare costs. Federal and state lawmakers regularly propose and, at times, enact

legislation that would result in significant changes to the U.S. healthcare system, some of which are

intended to contain or reduce the costs of medical products and services, including our own products. For

example, on July 4, 2025, the annual reconciliation bill, the "One Big Beautiful Bill Act," or OBBBA, was

signed into law which is expected to reduce Medicaid spending and enrollment by implementing work

requirements for some beneficiaries, capping state-directed payments, reducing federal funding, and

limiting provider taxes used to fund the program. OBBBA also narrows access to ACA marketplace

exchange enrollment and declines to extend the ACA enhanced advanced premium tax credits, set to

expire in 2025, which, among other provisions in the law, are anticipated to reduce the number of

Americans with health insurance. Current and future legislative proposals to further reform healthcare or

reduce healthcare costs may limit coverage of or lower reimbursement for the diagnostic tests associated

with the use of our products. The cost containment measures that payors and providers are instituting and

the effect of any healthcare reform initiative implemented in the future could impact our revenue from the

sale of our products.

We expect additional state and federal healthcare policies and reform measures to be adopted in the

future, particularly in light of the recent changes in the White House and Congress, any of which could

limit reimbursement for healthcare products and services or otherwise result in reduced demand for our

products or additional pricing pressure and have a material adverse effect on our industry generally and

on our customers. We cannot predict what other healthcare programs and regulations will ultimately be

implemented at the federal or state level or whether any future legislation or regulation in the United

States may negatively affect our business, financial condition, results of operations and prospects. The

continuing efforts of the government, insurance companies, managed care organizations and other

payors of healthcare services to contain or reduce costs of healthcare may adversely affect our ability to

set a price that we believe is fair for our products, our ability to generate revenue and achieve or maintain

profitability and the availability of capital.

Any changes of, or uncertainty with respect to, future coverage or reimbursement rates could affect

demand for our products, which may prevent us from being able to generate additional revenue or attain

profitability.

***We are subject to many laws and governmental regulations affecting our marketed products, both***

***domestically and internationally, and any adverse regulatory action may adversely affect our***

***business, financial condition, results of operations and prospects.***

The Heartflow Platform is subject to regulation by numerous government authorities, including the FDA

and comparable foreign authorities, after clearance or approval of current and future versions of the

product. To varying degrees, each of these authorities requires us to comply with laws and regulations

governing the development, design, testing, manufacture, labeling, advertising, promotion, distribution,

import and export of our products. The Heartflow Platform (also referred to as Heartflow Analysis, which

consists of four main functions, the Heartflow FFRCT Analysis, the Heartflow Plaque Analysis, the

Heartflow RoadMap Analysis and the Heartflow PCI Planner (which we expect to launch in 2026)) has

been cleared by the FDA (K213857), and only the Heartflow FFRCT Analysis function of the Heartflow

Platform is CE Marked in the European Economic Area, the United Kingdom and Australia, received

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medical device licensing in Canada and has been approved for marketing authorization in Japan by the

Pharmaceuticals and Medical Devices Agency ("PMDA"), all for specific indications for use. The Heartflow

Platform has also been cleared by the equivalent regulatory authorities in Israel, Saudi Arabia, United

Arab Emirates, and licensed in Bahrain.

We currently have ongoing responsibilities under U.S., U.K., European Economic Area, Switzerland,

Canada, Australia, Japan, Saudi Arabia, United Arab Emirates, Bahrain and Israel (registered or licensed

regions) regulations, including requirements related to product and facility registration, device listing,

adverse event reporting, reporting of recalls and field corrective actions, manufacturing, advertising,

promotion, distribution, import, and export. In certain jurisdictions outside of the United States, we

contract with third parties (i.e., notified bodies, authorized representatives, manufacturing authorization

holders) who either oversee regulatory compliance or assume regulatory responsibilities for our products

distributed by those third parties. We are subject to periodic inspections and audits by the FDA, notified

bodies, authorized representatives and comparable foreign authorities to determine compliance with

regulatory requirements, including good manufacturing practices such as the Quality System Regulation

of the FDA, Medical Device Single Auditing Program, ISO 13485:2016, and EN ISO 13485:2021

concerning the EU, establishment registration and device listing, medical device reporting, vigilance

reporting of adverse events, notification of corrections, recalls, field safety corrective actions and product

labeling and marketing. These inspections and audits can result in inspectional observations or reports,

warning letters or other forms of enforcement action. If the FDA or comparable foreign authorities

conclude, as a result of these inspections or audits or from any other source of information, that we are

not in compliance with applicable laws or regulations, or that our products are ineffective or pose an

unreasonable health risk, such authorities could ban these products, suspend or cancel our marketing

authorizations, impose "stop sale" and "stop import" orders, refuse to issue export certificates, detain or

seize adulterated or misbranded products, order a recall, repair, replacement, correction or refund of such

products, require us to conduct post-market surveillance studies or change the labeling for our products,

or require us to notify health professionals and others that the products present unreasonable risks of

substantial harm to the public health. Failure to comply with regulatory requirements may also subject us

to additional administrative and judicially imposed sanctions, warning letters, civil and criminal penalties,

injunctions, interruption of manufacturing or clinical trials, total or partial suspension of production and

resulting adverse publicity.

Discovery of previously unknown problems with our products' design or manufacture may result in

restrictions on the use of the Heartflow Platform, restrictions placed on us or our suppliers or withdrawal

of the existing regulatory clearance of the Heartflow Platform. The FDA or comparable foreign authorities

may also impose operating restrictions, enjoin and restrain violations of applicable law pertaining to

medical devices, assess civil or criminal penalties against our officers, employees or us or recommend

criminal prosecution of our company. Adverse regulatory action of a certain magnitude may restrict us

from effectively marketing and selling our products. In addition, negative publicity or product liability

claims resulting from any adverse regulatory action could have an adverse effect on our business,

financial condition, results of operations and prospects.

In many of the foreign countries in which we market our products, we are subject to extensive medical

device regulations that are similar to those of the FDA, including those in Europe. The regulation of our

products in Europe falls within the European Economic Area, which consists of the 27 member states of

the European Union, as well as Iceland, Liechtenstein and Norway. Only medical devices that comply with

certain conformity requirements of the Medical Devices Regulation (E.U.) 2017/745 ("MDR") concerning

Medical Devices, or the E.U. Medical Devices Directive, Directive 2006/114/EC are allowed to be

marketed within the European Economic Area.

Foreign governmental regulations have become increasingly stringent and more extensive, and we may

become subject to even more rigorous regulation by foreign governmental authorities in the future.

Penalties for a company's noncompliance with foreign governmental regulation could be severe, including

revocation or suspension of a company's business license and civil or criminal sanctions. In some

jurisdictions, such as Germany, any violation of a law related to medical devices is also considered to be

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a violation of unfair competition law. In such cases, governmental authorities, our competitors and

business or consumer associations may then file lawsuits to prohibit us from commercializing the

Heartflow Platform in such jurisdictions. Our competitors may also sue us for damages. Any domestic or

foreign governmental law or regulation imposed in the future may have an adverse effect on our business,

financial condition, results of operations and prospects.

***Delays in the commencement or completion of future or ongoing clinical testing could result in***

***increased costs to us and delay our ability to market the Heartflow Platform for additional***

***indications.***

We are currently enrolling patients for our DECIDE clinical trial to evaluate our Heartflow Plaque Analysis

in a real-world setting. We do not know whether our DECIDE clinical trial will be completed on schedule,

or at all. The commencement or completion of clinical trials can be disrupted for a variety of reasons,

including difficulties in:

• recruiting and enrolling patients to participate in, and investigators to conduct, a clinical trial;

• reaching agreements on acceptable terms with prospective clinical research organizations and trial

sites;

• obtaining approval of an investigational device exemption ("IDE"), application from the FDA or

equivalent authorization from foreign regulatory authorities, if required; or

• obtaining IRB approval to conduct a clinical trial at a prospective site.

A clinical trial may also be suspended or terminated by us, an IRB, the FDA or other regulatory authorities

due to a number of factors, including:

• failure to conduct the clinical trial in accordance with regulatory requirements or in accordance with

our clinical protocols;

• inspection of the clinical trial operations or trial site by the FDA or other regulatory authorities resulting

in the imposition of a clinical hold;

• safety or effectiveness issues; or

• lack of adequate funding to continue the clinical trial.

In addition, changes in regulatory requirements and guidance may occur, and we may need to amend

clinical trial protocols to respond to such changes, which could impact the cost, timing or successful

completion of a clinical trial. If we experience delays in the commencement or completion of our clinical

trials, the commercial prospects for additional indications for our products will be harmed.

***Interim, "top-line" and preliminary data from our clinical trials that we announce or publish from***

***time to time may change as more patient data become available and are subject to audit and***

***verification procedures that could result in material changes in the final data.***

From time to time, we may publicly disclose interim, top-line or preliminary data from our clinical trials,

including our DECIDE clinical trial, which is based on a preliminary analysis of then-available data, and

the results and related findings and conclusions are subject to change following a more comprehensive

review of the data related to the particular trial or additional data collected at a later time. We also make

assumptions, estimations, calculations and conclusions as part of our analyses of data, and we may not

have received or had the opportunity to fully and carefully evaluate all data. As a result, the interim, top-

line or preliminary results that we report may differ from future results of the same trial, or different

conclusions or considerations may qualify such results, once additional data have been received and fully

evaluated. Interim, top-line or preliminary data also remain subject to audit and verification procedures

that may result in the final data being materially different from the interim, top-line or preliminary data we

previously announced. As a result, interim, top-line and preliminary data should be viewed with caution

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until the final data are available. Adverse differences between interim data and final data could

significantly harm our business prospects. Further, disclosure of interim data by us or by our competitors

could result in volatility in our share price.

Further, others, including the FDA and other regulatory authorities or other bodies, may not accept or

agree with our assumptions, estimates, calculations, conclusions or analyses or may interpret or weigh

the importance of data differently, which could impact the value of the particular trial, or the approvability

or potential for commercialization of the particular medical device. In addition, the information we choose

to publicly disclose regarding a particular study or clinical trial is based on what is typically extensive

information, and others may not agree with what we determine is material or otherwise appropriate

information to include in our disclosure. The interim, top-line or preliminary data that we report may differ

from final results, and regulatory authorities and other bodies may disagree with the conclusions reached,

which may harm our ability to obtain marketing authorization for, and commercialize, our future products,

which could harm our business, financial condition, results of operations and prospects.

***We may face product liability claims that could result in costly litigation and significant liabilities.***

***We may not be able to maintain adequate product liability insurance.***

Development, marketing and clinical testing of our products may expose us to product liability and other

tort claims. Although we have, and intend to maintain, liability insurance, the coverage limits of our

insurance policies may not be adequate and one or more successful claims brought against us may have

an adverse effect on our business, financial condition, results of operations and prospects. For example,

the U.S. Supreme Court declined to hear an appeal where the U.S. Court of Appeals for the Ninth Circuit

ruled that the 1976 Medical Device Amendments to the Federal Food, Drug and Cosmetic Act did not

preempt state laws in a product liability case involving a medical device company. If other courts in the

United States adopt similar rulings, we may be subject to increased litigation risk in connection with our

products. Product liability claims could negatively affect our reputation, product sales, and our ability to

obtain and maintain regulatory approval for our products.

In addition, although we have product liability and clinical study liability insurance, this insurance is

subject to deductibles and coverage limitations. Our current product liability insurance may not continue to

be available to us on acceptable terms, if at all, and, if available, coverage may not be adequate to protect

us against any future product liability claims. If we are unable to obtain insurance at an acceptable cost,

on acceptable terms with adequate coverage, or at all, or otherwise protect against potential product

liability claims, we will be exposed to significant liabilities, which may harm our business. A product liability

claim, recall or other claim with respect to uninsured liabilities or for amounts in excess of insured

liabilities could have an adverse effect on our reputation, business, financial condition, results of

operations and prospects.

***The Heartflow Platform may be subject to recalls, which could be costly and could harm our***

***reputation and business.***

We are subject to ongoing medical device reporting regulations that require us to report to the FDA or

similar governmental authorities in other countries if our products cause, or contribute to, death or serious

injury, or if they malfunction and would be likely to cause, or contribute to, death or serious injury if the

malfunction were to recur. We could voluntarily elect to, or the FDA and similar governmental authorities

in other countries could require us to, perform a correction, field safety corrective action, removal or other

recall of our products in the event of material deficiencies or defects in design, manufacturing or labeling

that could cause harm. Our products have been in the past, and may in the future, be the subject of

medical device reports of adverse events with the MAUDE database, including reports of false negative

results and incorrect or imprecise results or readings. Between 2017 and 2025, 116 Heartflow Platform

MAUDE reports were made, with 104 of those reports due to false negative results, 11 reports due to

incorrect, inadequate or imprecise results or readings, and one report due to an adverse event without an

identified device or use problem. While none of these MAUDE reports resulted in a mandated or voluntary

correction, field safety action, removal or a recall, a government mandated or voluntary correction, field

safety corrective action, removal or other recall could occur as a result of manufacturing errors or design

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defects, including defects in labeling. Any correction, field safety corrective action, removal or other recall

would divert managerial and financial resources and could lead to a substantial loss of physician and

patient confidence in our products and, consequently, have an adverse effect on our growth prospects or

operating results. A correction, field safety corrective action, removal or other recall could also result in

substantial litigation, including product liability claims, with liabilities well in excess of our insurance

coverage limits. Any of these events could have an adverse effect on our reputation, business, financial

condition, results of operations and prospects.

***Off-label or other unlawful promotion of our products could result in costly investigations and***

***sanctions from the FDA and other regulatory bodies.***

The Heartflow Platform (also referred to as Heartflow Analysis, which consists of four main functions, the

Heartflow FFRCT Analysis, the Heartflow Plaque Analysis, the Heartflow RoadMap Analysis and the

Heartflow PCI Planner (which we expect to launch in 2026)) has been cleared by the FDA (K213857), and

only the Heartflow FFRCT Analysis function of the Heartflow Platform is CE Marked in the European

Economic Area, the United Kingdom and Australia, received medical device licensing in Canada and has

been approved for marketing authorization in Japan by the PMDA, all for specific indications for use. The

Heartflow Platform has also been cleared by the equivalent regulatory authorities in Israel, Saudi Arabia,

United Arab Emirates, and licensed in Bahrain. We may only promote or market our products for their

specifically cleared or approved indications. We train our marketing and sales force against promoting our

products for uses outside of the cleared or approved indications for use ("off-label use").

If the FDA determines that our promotional materials or training constitute promotion of an off-label use,

or of claims that are not adequately substantiated or that are otherwise false or misleading, it could

request that we modify our training or promotional materials or subject us to regulatory or enforcement

actions, including the issuance of an untitled letter, a warning letter, injunction, seizure, civil fine or

criminal penalties. It is also possible that other federal, state or foreign enforcement authorities, including

the Federal Trade Commission or Department of Justice, might take action if they consider our business

activities to constitute promotion of an off-label use or other unlawful promotion, which could result in

significant penalties, including criminal, civil and administrative penalties, damages, fines, disgorgement,

exclusion from participation in government healthcare programs and the curtailment of our operations.

Any of these events could significantly harm our business, results of operations, financial condition and

prospects.

Further, the advertising and promotion of our products are subject to European Economic Area Member

States laws implementing the Medical Devices Directive concerning misleading and comparative

advertising, and Directive 2005/29/EC on unfair commercial practices, as well as other European

Economic Area Member State legislation governing the advertising and promotion of medical devices.

European Economic Area Member State legislation may also restrict or impose limitations on our ability to

advertise our products directly to the general public. In addition, voluntary E.U. and national codes of

conduct provide guidelines on the advertising and promotion of our products to the general public and

may impose limitations on our promotional activities with healthcare professionals harming our business,

financial condition, results of operations and prospects.

***We are subject to numerous federal, state and foreign healthcare fraud and abuse, compliance,***

***transparency and privacy laws and regulations, and a failure to comply with such laws and***

***regulations could have an adverse effect on our business; similarly, an investigation, inquiry or***

***audit by a government agency that alleges violations of law or regulations may have an adverse***

***effect on our business.***

Our operations are, and will continue to be, directly and indirectly affected by various federal, state and/or

foreign healthcare laws, including those described below. In particular, because the use of our products

are directly or indirectly reimbursed by U.S. federal health care programs, for example Medicare, we are

subject to the federal Anti-Kickback Statute, a criminal law that prohibits, among other things, any person

or entity from knowingly and willfully offering, paying, soliciting or receiving any remuneration in cash or

in-kind (including any kickback or bribe, but also common forms of remuneration, such as service or

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consulting fees, service fees, meals, travel expenses, discounts or rebates), directly or indirectly, overtly

or covertly, in cash or in kind, in return for or to induce the referring, ordering, leasing, purchasing or

arranging for or recommending the referring, ordering, purchasing or leasing of any good, facility, item or

service, for which payment may be made, in whole or in part, under federal healthcare programs, such as

the Medicare and Medicaid programs. The term "remuneration" has been broadly interpreted to include

anything of value. Although there are a number of statutory exceptions and regulatory safe harbors

protecting certain common activities, the exceptions and safe harbors are drawn narrowly. Failure to meet

all of the requirements of a statutory exception or regulatory safe harbor does not make the conduct per

se illegal under the Anti-Kickback Statute. Instead, the arrangement will be evaluated on a case-by-case

basis based on a cumulative review of all of its facts and circumstances. Several courts have interpreted

the statute's intent requirement to mean that if any one purpose of an arrangement involving

remuneration is to induce referrals of (or purchases, uses or recommendations of prescriptions, uses or

purchases related to) federal healthcare program covered business, the Anti-Kickback Statute has been

implicated and potentially violated. Our practices may not in all cases meet all of the criteria for safe

harbor protection from Anti-Kickback Statute liability. Further, the ACA, amends the intent requirement of

the federal Anti-Kickback Statute and certain criminal healthcare fraud statutes. A person or entity no

longer needs to have actual knowledge of the statute or specific intent to violate it. In addition, the

government may assert that a claim for payment by a government health care program including items or

services resulting from a violation of the Anti-Kickback Statute constitutes a false or fraudulent claim for

purposes of the false claims laws.

The U.S. civil False Claims Act prohibits, among other things, any person or entity from knowingly

presenting, or causing to be presented, a false or fraudulent claim for payment or approval to the federal

government or knowingly making, using, or causing to be made or used a false record or statement

material to a false or fraudulent claim to the federal government. A claim includes "any request or

demand" for money or property presented to the U.S. government. The civil False Claims Act also applies

to false submissions that cause the government to not receive a benefit to which it is entitled, such as a

discounted sales price for products covered by federal healthcare programs. Intent to deceive is not

required to establish liability under the civil False Claims Act. In addition, the civil False Claims Act

includes a whistleblower provision that allows private citizens to bring claims on behalf of the U.S.

government alleging violations of the law. Whistleblowers may be entitled to up to as much as thirty

percent (30%) of the government's financial recovery resulting from such claims. This incentivizes

potential whistleblowers to file complaints in federal court, which complaints are relied upon heavily by the

government to investigate and prosecute allegations of violations of both the civil False Claims Act and

the Anti-Kickback Statute. U.S. enforcement authorities or private whistleblowers acting on behalf of the

U.S. government may file complaints under the civil False Claims Act alleging that we have caused one or

more of our customers to submit false submissions for reimbursement from federal health care programs,

including Medicare, Medicaid, or the Veterans Affairs program due to alleged kickbacks, the sale of

adulterated or misbranded products, or the provision of false or misleading information to our customers

or other third parties.

Additionally, under the federal Civil Money Penalty Statute, the Department of Health and Human

Services ("HHS") may impose civil money penalties against entities that make offers to transfer or transfer

remuneration, including gifts, payments or routine waivers of co-payments or deductibles, to any

Medicare beneficiary in order to influence such individual to order or receive any item or service for which

payment may be made, in whole or in part, under Medicare and/or a State health care program.

Violations of these laws and regulations may result in significant criminal and/or civil fines and penalties,

as well as potential exclusion from participation in federal health care programs, that could significantly

impact our business and operations.

We are also subject to other federal and state fraud and abuse laws, including HIPAA's fraud provisions,

which among other things, are criminal laws that prohibit, among other actions, knowingly and willfully

executing, or attempting to execute, a scheme or artifice to defraud any healthcare benefit program,

including private payors, knowingly and willfully embezzling or stealing from a healthcare benefit program,

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willfully preventing, obstructing, misleading, delaying or attempting to delay a criminal investigation of a

healthcare offense and knowingly and willfully falsifying, concealing or covering up a material fact or

making any materially false, fictitious or fraudulent statement or representation in connection with the

delivery of or payment for healthcare benefits, items or services. Many of these state laws closely mirror

the federal Anti-Kickback Statute or civil False Claims Act, but apply more broadly to products and

services that are paid for in any way, whereas the federal law pertains only to those reimbursed by federal

health care programs. In addition, many states have also adopted laws prohibiting fee-splitting (the

sharing of professional fees with non-state licensed persons or entities), restricting marketing activities

with physicians and/or prohibiting the practice of medicine (or the direction of the practice of medicine) by

corporations or others that are not specifically licensed to practice medicine within the state. While under

our model, licensed practitioners independently are providing any and all medical treatment and

diagnostic services for which a state license is required, these state laws still may apply to us.

We also are subject to foreign fraud and abuse laws and regulations, which vary by country, and can

prohibit many of the same activities addressed by U.S. laws.

We are also subject to the federal and state transparency reporting laws and regulations, gift bans and

compliance reporting provisions. The Physician Payments Sunshine Act (also known as Open Payments)

requires manufacturers of drugs, devices, biologics and medical supplies for which payment is available

under Medicare, Medicaid or the State Children's Health Insurance Program to report annually to the

Centers for Medicare and Medicaid Services information related to payments and other transfers of value

provided directly or indirectly to physicians (defined to include doctors, dentists, optometrists, podiatrists

and chiropractors), other healthcare providers (such as physician assistants and nurse practitioners) and

teaching hospitals. Such manufacturers are also required to annually report certain ownership and

investment interests held by such U.S. physicians and their immediate family members. Certain states,

like Massachusetts and Vermont have similar reporting requirements. Some states, like Vermont, prohibit

gifts and certain benefits from being provided to physicians licensed within that state. Other states, such

as California and Nevada mandate implementation of compliance programs to ensure compliance with

fraud and abuse laws and regulations, as well as with industry codes of conduct, such as the AdvaMed

Code of Ethics on Interactions with Health Care Professionals. Our business is subject to these many

requirements, which can be nuanced and lacking in clear guidance. Our failure to comply with these laws

or regulations could result in substantial fines or penalties. Further, our reports made pursuant to these

laws may be used by enforcement authorities or whistleblowers to raise or substantiate allegations

against us.

We are also subject to the federal physician self-referral prohibitions, commonly known as the Stark Law,

which prohibits, among other things, physicians who have a financial relationship, including an

investment, ownership or compensation relationship with an entity that submits claims for payment to the

Medicare or Medicaid programs, from referring Medicare or Medicaid patients for certain "designated

health services," which include diagnostic imaging services related to our products, unless an exception

applies. Similarly, entities may not bill Medicare or any other party for services furnished pursuant to a

prohibited referral. Many states have their own self-referral laws as well, which in some cases apply to all

payors, not just Medicare and Medicaid.

If our operations are found to be in violation of any of the laws described above or any other

governmental regulations that apply to us now or in the future, we may be subject to significant penalties,

including civil and criminal penalties, damages, fines, disgorgement, exclusion from governmental

healthcare programs and the curtailment or restructuring of our operations, any of which could adversely

affect our ability to operate our business and our financial results.

We also note that there is risk of our being found in violation of these laws by the fact that many of them

have not been fully, clearly or consistently interpreted by the regulatory authorities or the courts, and their

provisions are open to a variety of interpretations. Any action against us for violation of these laws, even if

we successfully defend against it, could cause us to incur significant legal expenses and divert our

management's attention from the operation of our business. Moreover, to achieve compliance with

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applicable federal and state privacy, security and electronic transaction laws, we may be required to

modify our operations with respect to the handling of patient information. Similarly, to achieve compliance

with other applicable federal and state anti-fraud, open payments or other healthcare regulations, we may

be required to modify our operations. Implementing any of these modifications may prove costly. At this

time, we are not able to determine the full consequences to us, including the total cost of compliance, of

these various federal and state laws.

***We are subject to U.S. and foreign anti-corruption and anti-money laundering laws with respect to***

***our operations and non-compliance with such laws can subject us to criminal and/or civil liability***

***and harm our business.***

We are subject to the FCPA, the U.S. domestic bribery statute contained in 18 U.S.C. § 201, the

U.S. Travel Act, the USA PATRIOT Act, the U.K. Bribery Act of 2010 and Proceeds of Crime Act 2002 and

possibly other state and national anti-bribery and anti-money laundering laws in countries in which we

conduct activities. Anti-corruption laws are interpreted broadly and prohibit companies and their

employees and third-party intermediaries from authorizing, promising, offering or providing, directly or

indirectly, improper payments or benefits to recipients in the public or private sector. We use third-party

representatives to support sales of our products abroad. In addition, as we increase our international

sales and business, we may engage with additional business partners and third-party intermediaries to

sell our products abroad and to obtain necessary permits, licenses and other regulatory approvals. We or

our third-party intermediaries may have direct or indirect interactions with officials and employees of

government agencies or state owned or affiliated entities. We can be held liable for the corrupt or other

illegal activities of these third-party intermediaries, our employees, representatives, contractors, partners

and agents, even if we do not explicitly authorize or have actual knowledge of such activities.

Noncompliance with anti-corruption and anti-money laundering laws could subject us to whistleblower

complaints, investigations, sanctions, settlements, prosecution, other enforcement actions, disgorgement

of profits, significant fines, damages, other civil and criminal penalties or injunctions, suspension or

debarment from contracting with certain persons, the loss of export privileges, reputational harm, adverse

media coverage and other collateral consequences. If any subpoenas or investigations are launched, or

governmental or other sanctions are imposed, or if we do not prevail in any possible civil or criminal

litigation, our business, results of operations and financial condition could be materially harmed. In

addition, responding to any action will likely result in a materially significant diversion of management's

attention and resources and significant defense and compliance costs and other professional fees. In

certain cases, enforcement authorities may even cause us to appoint an independent compliance monitor,

which can result in added costs and administrative burdens. As a general matter, enforcement actions

and sanctions could harm our business, financial condition, results of operations and prospects.

***We are subject to governmental export and import controls that could impair our ability to***

***compete in international markets due to licensing requirements and subject us to liability if we are***

***not in compliance with applicable laws.***

Our products are subject to export control and import laws and regulations, including the U.S. Export

Administration Regulations, U.S. Customs regulations and various economic and trade sanctions

regulations administered by the U.S. Treasury Department's Office of Foreign Assets Control. Exports of

our products must be made in compliance with these laws and regulations. If we fail to comply with these

laws and regulations, we and certain of our employees could be subject to substantial civil or criminal

penalties, including: the possible loss of export or import privileges; fines, which may be imposed on us

and responsible employees or managers; and, in extreme cases, the incarceration of responsible

employees or managers. Obtaining the necessary authorizations, including any required license, for a

particular sale may be time consuming, is not guaranteed and may result in the delay or loss of sales

opportunities. In addition, changes in our products or changes in applicable export or import regulations

may create delays in the introduction and sale of our products in international markets, prevent our

customers with international operations from deploying our products or, in some cases, prevent the export

or import of our products to certain countries, governments or persons altogether. Any change in export or

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import regulations, shift in the enforcement or scope of existing regulations or change in the countries,

governments, persons or technologies targeted by such regulations, could also result in decreased use of

our products, or in our decreased ability to export or sell our products to existing or potential customers

with international operations. Any decreased use of our products or limitation on our ability to export or

sell our products would likely adversely affect our business.

Furthermore, we incorporate encryption technology into certain of our products. Various countries

regulate the import of certain encryption technology, including through import permitting and licensing

requirements, and have enacted laws that could limit our ability to distribute our products or could limit our

customers' ability to implement our products in those countries. Encrypted products and the underlying

technology may also be subject to export control restrictions. Governmental regulation of encryption

technology and regulation of imports or exports of encryption products, or our failure to obtain required

import or export approval for our products, when applicable, could harm our international sales and

adversely affect our revenue. Compliance with applicable regulatory requirements regarding the export of

our products, including with respect to new releases of our products, may create delays in the introduction

of our products in international markets, prevent our customers with international operations from

deploying our products throughout their globally distributed systems or, in some cases, prevent the export

of our products to some countries altogether.

Moreover, U.S. export control laws and economic sanctions programs prohibit the shipment of certain

products and services to countries, governments and persons that are subject to U.S. economic

embargoes and trade sanctions. Any violations of such economic embargoes and trade sanction

regulations could have negative consequences, including government investigations, penalties and

reputational harm.

***Any future litigation against us could be costly and time-consuming to defend.***

We have been in the past, and we may become in the future, subject to legal proceedings and claims that

arise in the ordinary course of business, such as claims brought by our third-party vendors, our customers

or their patients in connection with contractual disputes or the use of our Heartflow Platform, claims

brought by us or by competitors related to intellectual property or employment claims made by our current

or former employees. Litigation might result in substantial costs and may divert management's attention

and resources, which might seriously harm our business, financial condition, results of operations and

prospects. Insurance might not cover such claims, might not provide sufficient payments to cover all the

costs to resolve one or more such claims, and might not continue to be available at all or on terms

acceptable to us (including premium increases or the imposition of large deductible or co-insurance

requirements). A claim brought against us that is uninsured or underinsured could result in unanticipated

costs, potentially harming our business, financial condition, results of operations and prospects. In

addition, we cannot be sure that our existing insurance coverage will continue to be available on

acceptable terms or at all or that our insurers will not deny coverage as to any future claim.

**Risks related to our intellectual property** 

***If we are unable to obtain and maintain sufficient intellectual property rights, or the scope of our***

***rights is not sufficiently broad, third parties could develop and commercialize technology and***

***products similar or identical to ours, and our ability to successfully commercialize our technology***

***and products may be adversely affected.***

Our commercial success will depend, in part, on our ability to continue obtaining and maintaining

intellectual property protection for our technology and products, in both the United States and certain

other countries, successfully defending this intellectual property against third-party challenges and

successfully enforcing this intellectual property to prevent third-party infringement. We rely upon a

combination of patents, trade secrets, know-how, copyrights, trademarks, license agreements and

contractual provisions to establish our intellectual property rights and protect our products.

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Our ability to protect our technologies and products from unauthorized or infringing use by third parties

depends in substantial part on our ability to obtain and maintain valid and enforceable patents in both the

United States and certain other countries. The patent positions of medical technology and software

companies can be highly uncertain and involve complex legal, scientific and factual questions for which

important legal principles remain unresolved. In addition, the patent prosecution process is expensive,

time-consuming and complex, and we may not be able to file, prosecute, maintain, enforce, defend or

license all necessary or desirable patents or patent applications at a reasonable cost or in a timely

manner, or in all jurisdictions.

We cannot guarantee that any patents will issue from any pending or future patent applications owned by

or licensed to us, or if issued, the breadth of such patent coverage. In particular, during prosecution of any

patent application, the issuance of any patents based on the application may depend upon our ability to

generate additional preclinical or clinical data that support the patentability of our proposed claims. We

may not be able to generate sufficient additional data on a timely basis, or at all. It is also possible that we

may fail to identify patentable aspects of inventions made in the course of our development and

commercial activities before it is too late to obtain patent protection on such inventions. If we fail to timely

file for patent protection in any jurisdiction, we may be precluded from doing so at a later date.

The issuance of a patent is not conclusive as to its inventorship, ownership, scope, validity or

enforceability, and our owned or licensed patents may be challenged in the courts or the patent offices of

the United States or abroad. Such challenges may result in a loss of exclusivity or in the patent's claims

being narrowed, invalidated or held unenforceable, in whole or in part, which could limit our ability to stop

third parties from using or commercializing similar or identical products, or limit the duration of patent

protection for our technology and products. In addition, changes in either the patent laws, implementing

regulations or interpretations of patent laws in the United States or foreign countries may diminish the

value of our patent rights.

Even if unchallenged, our owned or licensed patents may not provide us with exclusivity or commercial

value for our products or any significant protection against competitive products or prevent others from

designing around our claims. Our competitors might conduct research and development activities in

countries where we do not have patent rights (or in those countries where we do, under safe harbor

provisions) and then use the information learned from such activities to develop competitive products for

sale in our major commercial markets. Further, if we encounter delays in regulatory approvals, the period

of time during which we could market our products under patent protection could be reduced. Any of

these outcomes could impair our ability to prevent competition from third parties, which may have an

adverse impact on our business.

Patent applications are generally maintained in confidence until publication. In the United States, for

example, patent applications are maintained in secrecy for up to 18 months after their filing. Similarly,

publication of discoveries in scientific or patent literature often lag behind actual discoveries.

Consequently, we cannot be certain that we or our licensors were the first to invent, or the first to file

patent applications on our products. There is also no assurance that all of the potentially relevant prior art

relating to our patents and patent applications has been found, which could be used by a third party to

challenge validity of our patents or prevent a patent from issuing from a pending patent application.

In addition to patents, proprietary trade secrets and unpatented know-how are important to our business.

For information about risks related to these intellectual property rights, see the risk factor titled "If we are

unable to protect the disclosure and use of our confidential information and trade secrets, the value of our

products and technologies and our business and competitive position could be harmed" below. We also

rely on the trademarks we own to distinguish our products from the products of our competitors. We

cannot guarantee that any trademark applications filed by us will be approved. Third parties may also

oppose or attempt to cancel our trademark applications or trademarks, or otherwise challenge our use of

the trademarks. In the event that the trademarks we use are successfully challenged, we could be forced

to rebrand our products, which could result in loss of brand recognition, and could require us to devote

resources to advertising and marketing new brands. Competitors or other parties may adopt trade names

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or trademarks similar to ours, thereby impeding our ability to build brand identity and possibly leading to

market confusion.

Further, we cannot provide assurance that competitors will not infringe the trademarks we use, or that we

will have adequate resources to enforce these trademarks. If we attempt to enforce our trademarks and

assert trademark infringement claims, a court may determine that the marks we have asserted are invalid

or unenforceable, or that the party against whom we have asserted trademark infringement has superior

rights to the marks in question. In this case, we could ultimately be forced to cease use of such

trademarks. We may license our trademarks and trade names to third parties, such as distributors.

Though these license agreements may provide guidelines for how our trademarks and trade names may

be used, a breach of these agreements or misuse of our trademarks and trade names by our licensees

may jeopardize our rights in or diminish the goodwill associated with our trademarks and trade names.

Over the long term, if we are unable to establish name recognition based on our trademarks and trade

names, then we may not be able to compete effectively and our business may be adversely affected.

For information about risks related to our inability to protect our intellectual property rights outside the

United States, see the risk factor titled "We may not be able to adequately protect our intellectual property

rights throughout the world" below.

***If we are unable to protect the disclosure and use of our confidential information and trade***

***secrets, the value of our products and technologies and our business and competitive position***

***could be harmed.***

In addition to patent protection, we also rely on other intellectual property rights, including trade secrets,

know-how, and/or other proprietary information that is not patentable or that we elect not to patent.

However, trade secrets can be difficult to protect, and some courts are less willing or unwilling to protect

trade secrets. Although we have taken steps to protect our trade secrets and unpatented know-how,

including by entering into confidentiality agreements with third parties, and proprietary information and

invention agreements with our employees, consultants and advisors, third parties may still obtain this

information or we may be unable to protect our rights. There can be no assurance that binding

agreements will not be breached, that we would have adequate remedies for any breach, or that our trade

secrets and unpatented know-how will not otherwise become known or be independently discovered by

our competitors. We also seek to preserve the integrity and confidentiality of our data and trade secrets

by maintaining physical security of our premises and physical and electronic security of our information

technology systems. While we have confidence in these individuals, organizations and systems, our

security measures may be breached, and we may not have adequate remedies for any such breach.

If any of our trade secrets were to be lawfully obtained or independently developed by a competitor, we

would have no right to prevent them, or those to whom they communicate it, from using that information to

compete with us. Any exposure of our trade secrets and other proprietary information would impair our

competitive advantages and could have a material adverse effect on our business, financial condition,

results of operations and prospects. In particular, a failure to protect our proprietary rights may allow

competitors to copy our products or technologies, which could adversely affect our pricing and market

share. Unauthorized parties may also attempt to copy or reverse engineer certain aspects of our products

or technologies that we consider proprietary.

Costly and time-consuming litigation could be necessary to enforce and determine the scope of our trade

secret rights and related confidentiality, non-disclosure and non-use provisions, and outcomes of such

litigation are unpredictable. Enforcing a claim that a party illegally disclosed, used or misappropriated a

trade secret can be difficult, expensive and time-consuming, and the outcome is unpredictable. While we

use commonly accepted security measures, trade secret claims are often based on a combination of

federal and state law in the United States, and the criteria for protection of trade secrets can vary among

different jurisdictions. If the steps we have taken to maintain our trade secrets are deemed inadequate,

we may have insufficient recourse against third parties for misappropriating the trade secret. In addition,

agreement terms that address non-competition are difficult to enforce in many jurisdictions and might not

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be enforceable in certain cases. Even if we were to be successful in the enforcement of our claims, we

may not be able to obtain adequate remedies.

***Reliance on third parties requires us to share our trade secrets, which increases the possibility***

***that a competitor will discover them or that our trade secrets will be misappropriated or disclosed***

***to others.***

Any collaboration or other engagement with third parties for the development of our products may require

us, at times, to share trade secrets with them. We may also conduct joint research and development

programs that may require us to share trade secrets under the terms of our research and development

partnerships or similar agreements. We seek to protect our trade secrets and other proprietary technology

in part by entering into confidentiality agreements with third parties prior to beginning research or

disclosing proprietary information. These agreements typically limit the rights of the third parties to use or

disclose our confidential information, including our trade secrets. Despite the contractual provisions

employed when working with third parties, the need to share trade secrets and other confidential

information increases the risk that such trade secrets become known by our competitors, are

inadvertently incorporated into the technology of others, or are disclosed or used in violation of these

agreements. Given that our proprietary Heartflow Platform is based, in part, on our know-how and trade

secrets, a competitor's discovery of our trade secrets or other unauthorized use or disclosure could have

an adverse effect on our business, financial condition, results of operations and prospects.

In addition, these agreements typically restrict the ability of our advisors, employees, third-party

contractors and consultants to publish data potentially relating to our trade secrets. Despite our efforts to

protect our trade secrets, we may not be able to prevent the unauthorized disclosure or use of our

technical know-how or other trade secrets by the parties to these agreements. Moreover, we cannot

guarantee that we have entered into such agreements with each party that may have or have had access

to our confidential information or proprietary technology and processes. Monitoring unauthorized uses

and disclosures is difficult, and we do not know whether the steps we have taken to protect our

proprietary technologies will be effective. If any of the collaborators, scientific advisors, employees,

contractors and consultants who are parties to these agreements breaches or violates the terms of any of

these agreements, we may not have adequate remedies for any such breach or violation, and we could

lose our trade secrets as a result. Moreover, if confidential information that is licensed or disclosed to us

by our partners, collaborators, or others is inadvertently disclosed or subject to a breach or violation, we

may be exposed to liability to the owner of that confidential information. Enforcing a claim that a third

party illegally obtained and is using our trade secrets, like patent litigation, is expensive and time

consuming, and the outcome is unpredictable. In addition, courts outside the United States are

sometimes less willing to protect trade secrets, and we may need to share our trade secrets and

proprietary know-how with current or future partners, collaborators, contractors and others located in

countries at heightened risk of theft of trade secrets, including through direct intrusion by private parties or

foreign actors, and those affiliated with or controlled by state actors.

***Obtaining and maintaining our patent protection depends on compliance with various procedural,***

***document submission, fee payment and other requirements imposed by governmental patent***

***agencies, and our patent protection could be reduced or eliminated for noncompliance with these***

***requirements.***

The U.S. Patent and Trademark Office ("USPTO") and various foreign governmental patent agencies

require compliance with a number of procedural, documentary, fee payment and other similar provisions

during the patent application process. In addition, periodic maintenance fees, renewal fees, annuity fees,

and various other government fees on patents and/or applications will be due to be paid to the USPTO

and various governmental patent agencies outside of the United States over the lifetime of our patents

and/or applications and any patent rights we may obtain in the future. We have systems in place to

remind us to pay these fees, and we employ outside firms to remind us to pay annuity fees due to patent

agencies on our patents and pending patent applications. In many cases, an inadvertent lapse can be

cured by payment of a late fee or by other means in accordance with the applicable rules. However, there

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are situations in which noncompliance can result in abandonment or lapse of the patent or patent

application, resulting in partial or complete loss of patent rights in the relevant jurisdiction. In such an

event, our competitors might be able to enter the relevant market, which would have an adverse effect on

our business. Noncompliance events that could result in abandonment or lapse of a patent or patent

application include failure to respond to official actions within prescribed time limits, non-payment of fees

and failure to properly legalize and submit formal documents.

***Changes in patent law, precedents and policies in the United States and other jurisdictions could***

***diminish the value of patents in general, thereby impairing our ability to protect our products.***

Our ability to obtain patents is highly uncertain because, to date, some legal principles remain unresolved,

and there has not been a consistent policy regarding the breadth or interpretation of claims allowed in

patents in the United States. Furthermore, the specific content of patents and patent applications that are

necessary to support and interpret patent claims is highly uncertain due to the complex nature of the

relevant legal, scientific, and factual issues. The United States Supreme Court has ruled on several

patent cases in recent years, either narrowing the scope of patent protection available in certain

circumstances or weakening the rights of patent owners in certain situations. Changes in either the patent

laws or interpretations of patent laws in the United States or other jurisdictions may diminish the value of

our intellectual property. In the United States, in certain circumstances, court rulings may narrow the

scope of patent protection and weaken the rights of patent owners. We cannot predict how decisions by

the courts, the U.S. Congress, the USPTO or changes in the patent laws of other jurisdictions may impact

the value of our patents. Changes in the laws, regulations, precedents and procedures governing patents

could have a material adverse effect on our existing patent portfolio and our ability to protect and enforce

our intellectual property in the future, which could have a material adverse effect on our business,

financial condition, results of operations and prospects.

Further, patent coverage in medical devices and technologies is a subject of evolution and differences

between countries. This is especially true of the definition of patentable subject matter which affects both

computer related inventions and biological inventions. This evolution may cause current granted patents

to be considered non-patent eligible or prevent us from protecting future inventions. U.S. Supreme Court

and Federal Circuit decisions interpreting and/or limiting the scope of patentable subject matter under 35

U.S.C. § 101, in addition to examination guidelines from the USPTO, have made it more difficult for

patentees to obtain and/or maintain patent claims in the United States that are directed to medical

technologies involving computer-implemented applications. Several precedential decisions regarding

patentable subject matter are of particular relevance to patents in the computer-implemented applications

space. Our efforts to seek patent protection for our technologies and products may be impacted by the

evolving case law and guidance or procedures issued by the USPTO or authorities in other jurisdictions

based on such evolving case law.

Similarly, changes in patent laws and regulations in other countries or jurisdictions, changes in the

governmental bodies that enforce them or changes in how the relevant governmental authority enforces

patent laws or regulations may weaken our ability to obtain new patents or to enforce patents that we may

obtain in the future. For example, the complexity and uncertainty of European patent laws have also

increased in recent years. In Europe, a new unitary patent system took effect June 1, 2023, which will

significantly impact European patents, including those granted before the introduction of the new unitary

patent system. Under the unitary patent system, European applications have the option, upon grant of a

patent, of becoming a Unitary Patent which will be subject to the jurisdiction of the Unitary Patent Court

("UPC"). As the UPC is a new court system, there is no precedent for the court, increasing the uncertainty

of any litigation. Patents granted before the implementation of the UPC have the ability to opt out of the

jurisdiction of the UPC and remain as national patents in the UPC countries. The UPC will provide our

competitors with a new forum to centrally revoke European patents, and allow for the possibility of a

competitor to obtain pan-European injunctions, since patents that remain under the jurisdiction of the UPC

will be potentially vulnerable to a single UPC-based revocation challenge that, if successful, could

invalidate the patent in all countries who are signatories to the UPC. We cannot predict with certainty the

long-term effects of any potential changes.

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Further, the laws of some foreign countries do not protect proprietary rights to the same extent or in the

same manner as the laws of the United States and Europe. As a result, we may encounter significant

problems in protecting and defending our intellectual property both in the United States and abroad. For

example, if the issuance in a given country of a patent covering an invention is not followed by the

issuance in other countries of patents covering the same invention, or if any judicial interpretation of the

validity, enforceability or scope of the claims or the written description or enablement, in a patent issued in

one country is not similar to the interpretation given to the corresponding patent issued in another country,

our ability to protect our intellectual property in those countries may be limited. Changes in either patent

laws or in interpretations of patent laws in the United States and other countries may materially diminish

the value of our intellectual property or narrow the scope of our patent protection.

In addition, on September 16, 2011, the Leahy-Smith America Invents Act (the "Leahy-Smith Act") was

signed into law. The Leahy-Smith Act includes a number of significant changes to U.S. patent law.

Assuming that other requirements for patentability are met, prior to March 16, 2013, in the United States,

the first to invent the claimed invention was entitled to the patent, while outside the United States, the first

to file a patent application was entitled to the patent. On or after March 16, 2013, under the Leahy-Smith

Act, the United States transitioned to a first inventor to file system in which, assuming that other

requirements for patentability are met, the first inventor to file a patent application will be entitled to the

patent on an invention regardless of whether a third party was the first to invent the claimed invention.

Under this system, a third party that files a patent application in the USPTO before us could be awarded a

patent covering an invention of ours even if we had made the invention before it was made by such third

party. Since patent applications in the United States and most other countries are confidential for a period

of time after filing or until issuance, we cannot be certain that we or our licensors were the first to either (i)

file any patent application related to our products or (ii) invent any of the inventions claimed in our or our

licensors' patents or patent applications.

The Leahy-Smith Act also changed the way patent applications are prosecuted, including by allowing

third-party submission of prior art to the USPTO during patent prosecution and additional procedures to

challenge the validity of a patent by USPTO administered post-grant proceedings to attack the validity of

a patent. Because of a lower evidentiary standard in USPTO proceedings compared to the evidentiary

standard in U.S. federal courts necessary to invalidate a patent claim, a third party could potentially

provide evidence in a USPTO proceeding sufficient for the USPTO to hold a claim invalid even though the

same evidence might not be sufficient to invalidate the claim if presented in a district court action.

Accordingly, third parties may use USPTO proceedings to invalidate our patent claims that would not have

been invalidated if first challenged in a district court action. Therefore, the Leahy-Smith Act and its

implementation could increase the uncertainties and costs surrounding the prosecution of our patent

applications and the enforcement or defense of our issued patents, which could have a material adverse

effect on our business, financial condition, results of operations and prospects.

***We may not be able to adequately protect our intellectual property rights throughout the world.***

Our patent portfolio includes patents and patent applications in countries outside of the United States,

including Japan, Korea, China, Canada, Australia, Israel, India and countries in Europe. The requirements

for patentability differ from country to country, the breadth of allowed patent claims can be inconsistent,

the scope of coverage provided by these patents varies and the laws of some foreign countries may not

protect our intellectual property rights to the same extent as laws in the United States. In addition, filing,

prosecuting and defending patents on our products in all countries throughout the world would be

prohibitively expensive. For those countries where we do not have granted patents, we may not have any

ability to prevent the unauthorized sale of our products.

In addition, we may decide to abandon national and regional patent applications before they are granted.

The examination of each national or regional patent application is an independent proceeding. As a result,

patent applications in the same family may issue as patents in some jurisdictions, such as in the United

States, but may issue as patents with claims of different scope or may even be refused in other

jurisdictions. It is also quite common that depending on the country, the scope of patent protection may

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vary for the same product or technology. For example, certain jurisdictions do not allow for patent

protection with respect to methods of treatment.

Consequently, we may not be able to prevent third parties from practicing our inventions in all countries

outside the United States. Competitors may use our technologies in jurisdictions where we have not

obtained patent protection to develop their own products and, further, may export otherwise infringing

products to territories in which we have patent protection that may not be sufficient to terminate infringing

activities. Accordingly, our efforts to enforce our intellectual property and proprietary rights around the

world may be inadequate to obtain a significant commercial advantage from the intellectual property that

we develop or license.

Many countries have compulsory licensing laws under which a patent owner may be compelled to grant

licenses to third parties, government agencies or government contractors. In these countries, the patent

owner may have limited remedies, which could materially diminish the value of such patent. If we or any

of our licensors is forced to grant a license to third parties with respect to any patents relevant to our

business, our competitive position may be impaired, and our business, financial condition, results of

operations and prospects may be adversely affected.

We do not seek or have patent rights in certain foreign countries in which a market may exist. Accordingly,

our efforts to protect our intellectual property rights in such countries may be inadequate, which may have

an adverse effect on our ability to successfully commercialize our products in all of our expected

significant foreign markets. Moreover, in foreign jurisdictions where we do have patent rights, proceedings

to enforce such rights could result in substantial costs and divert our efforts and attention from other

aspects of our business, could put our patents at risk of being invalidated or interpreted narrowly, and our

patent applications at risk of not issuing. Additionally, such proceedings could provoke third parties to

assert claims against us. We may not prevail in any lawsuits that we initiate and the damages or other

remedies awarded, if any, may not be commercially meaningful. Thus, we may not be able to stop a

competitor from marketing and selling in foreign countries products that are the same as or similar to our

products, and our competitive position in the international market would be harmed.

***We may be involved in lawsuits to protect or enforce our patents or other intellectual property, or***

***the patents of our licensors, which could be expensive, time consuming and unsuccessful.***

Competitors or other third parties may infringe, misappropriate or otherwise violate our owned or licensed

patents, trade secrets or other intellectual property. To counter infringement or unauthorized use, we may

be compelled to file infringement or misappropriation claims, which can be expensive and time

consuming. We do not carry intellectual property insurance that would cover such claims. In certain

circumstances it may not be practicable or cost effective for us to enforce our intellectual property rights

fully, particularly in certain developing countries or where the initiation of a claim might harm our business

relationships. If we initiate legal proceedings against a third party to enforce a patent covering our

products, the defendant could counterclaim that our patent(s) are invalid and/or unenforceable. In patent

litigation in the United States, counterclaims alleging invalidity and/or unenforceability are common, and

there are numerous grounds upon which a third party can assert invalidity or unenforceability of a patent.

In an infringement proceeding, a court may decide that a patent we own or license is not valid, is

unenforceable or is not infringed, or may refuse to stop the other party from using the technology at issue

on the grounds that our patents do not cover the technology in question. The outcome following legal

assertions of invalidity and unenforceability is unpredictable. With respect to the validity question, for

example, we cannot be certain that there is no invalidating prior art. If a defendant were to prevail on a

legal assertion of invalidity and/or unenforceability, we may lose some, and perhaps all, of the patent

protection covering our products. An adverse result in any litigation or defense proceeding could put one

or more of our patents at risk of being invalidated or interpreted narrowly, could put our patent

applications at risk of not issuing and could have a material adverse impact on our business.

Our defense of litigation may fail and, even if successful, may result in substantial costs and distract our

management and other employees. Even if we establish infringement, the court may decide not to grant

an injunction against further infringing activity and instead award only monetary damages, which may or

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may not be an adequate remedy. For example, the amount of any monetary damages may be inadequate

to compensate us for damage as a result of the infringement and the proceedings. We may not be able to

prevent, alone or with our suppliers, misappropriation of intellectual property rights important to our

business, particularly in countries where the laws may not protect those rights as fully as in the United

States.

Furthermore, because of the substantial amount of discovery required in connection with intellectual

property litigation, there is a risk that some of our confidential information could be compromised by

disclosure during this type of litigation. There could also be public announcements of the results of

hearings, motions or other interim proceedings or developments. If securities analysts or investors

perceive these results to be negative, it could have an adverse effect on the price of our common stock.

Third-party defendants may challenge any patent we own or in-license through adversarial proceedings in

the issuing offices, which could result in the invalidation or unenforceability of some or all of the relevant

patent claims. If a third party asserts a substantial new question of patentability against any claim of a

U.S. patent we own or license, the USPTO may grant a request for reexamination, which may result in a

loss of scope of some claims or a loss of the entire patent. The adoption of the Leahy-Smith Act has

established additional opportunities for third parties to invalidate U.S. patent claims, including inter partes

review and post grant review, on the basis of lower legal standards than reexamination and additional

grounds. Outside of the United States, patents we own or license may become subject to patent

opposition or similar proceedings, which may result in loss of scope of some claims or loss of the entire

patent. Participation in adversarial proceedings is very complex, expensive and may divert our

management's attention from our core business and may result in unfavorable outcomes that could

adversely affect our ability to prevent third parties from competing with us.

***We may be subject to claims challenging the inventorship or ownership of our patents and other***

***intellectual property rights or alleging that we have violated the intellectual property rights or***

***other proprietary rights of third parties.***

Our commercial success depends, in part, upon our ability to develop, manufacture, market and sell our

products and use our proprietary technologies without infringing the proprietary rights and intellectual

property of third parties. The medical device industry is characterized by extensive and complex litigation

regarding patents and other intellectual property rights. We may be exposed to, or threatened with, future

litigation by third parties having patent or other intellectual property rights alleging that our products or

proprietary technologies infringe on their intellectual property rights. There is a risk that third parties may

choose to engage in litigation with us to enforce or to otherwise assert their patent rights against us. Even

if we believe such claims are without merit, a court of competent jurisdiction could hold that these third-

party patents are valid, enforceable and infringed, which could have a negative impact on our ability to

commercialize our products. This includes litigation, or threatened litigation, with non-practicing entities

that have no relevant product revenue and against whom our own patent portfolio may have no deterrent

effect. The legal threshold for initiating litigation or contested proceedings is low, so that even lawsuits or

proceedings with a low probability of success might be initiated and require significant resources to

defend.

We may also be subject to claims that former employees, collaborators or other third parties have an

ownership interest in our patent rights or other intellectual property, for example, based on conflicting

obligations of consultants or others who are involved in developing our products. Although it is our policy

to require our employees and contractors who may be involved in the conception or development of

intellectual property to execute agreements assigning such intellectual property to us, we may be

unsuccessful in executing such an agreement with each party who, in fact, conceives or develops

intellectual property that we regard as our own, and we cannot be certain that our agreements with such

parties will be upheld in the face of a potential challenge, or that they will not be breached, for which we

may not have an adequate remedy. The assignment of intellectual property rights may not be self-

executing or the assignment agreements may be breached, and litigation may be necessary to defend

against these and other claims challenging inventorship or ownership. If we fail in defending any such

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claims, in addition to paying monetary damages, we may lose valuable intellectual property rights, such

as exclusive ownership of, or right to use, valuable intellectual property. Such an outcome could have a

material adverse effect on our business. Even if we are successful in defending against such claims,

litigation could result in substantial costs and be a distraction to management and other employees.

We employ individuals who were previously employed at other medical technology companies. In

addition, we use publications that are subject to copyright, as well as proprietary information and

materials from third parties in our research. Some of the information and materials we use from third

parties may be subject to agreements that include restrictions on use or disclosure. Although we strive to

ensure proper safeguards, we cannot guarantee strict compliance with such agreements, nor can we be

sure that our employees, consultants and advisors do not use proprietary information, materials or know-

how of others in their work for us. In addition, we may be subject to claims that we or our employees,

consultants or independent contractors have inadvertently or otherwise used or disclosed alleged trade

secrets or other proprietary information of former employers or other third parties. Although we have

procedures in place that seek to prevent our employees and consultants from using the intellectual

property, proprietary information, know how or trade secrets of others in their work for us, we may in the

future be subject to claims that we caused an employee to breach the terms of his or her non-competition

or non-solicitation agreement, or that we or these individuals have, inadvertently or otherwise, used or

disclosed the alleged trade secrets or other proprietary information of a former employer or competitor.

We may also be subject to claims that former employers or other third parties have an ownership interest

in our future patents. In addition, we may be subject to claims that we are infringing other intellectual

property rights, such as trademarks or copyrights, and to the extent that our employees, consultants or

contractors use intellectual property or proprietary information owned by others in their work for us,

disputes may arise as to the rights in related or resulting know-how and inventions. Litigation may be

necessary to defend against these claims. There is no guarantee of success in defending these claims,

and even if we are successful, litigation could result in substantial cost and be a distraction to our

management and other employees.

An unfavorable outcome for any such claim could require us to cease using the related technology or to

attempt to license rights to it from the prevailing party. Our business could be harmed if the prevailing

party does not offer us a license on commercially reasonable terms.

If a third party claims that we infringe its intellectual property rights, we may face a number of issues,

including:

• infringement and other intellectual property claims which, regardless of merit, may be expensive and

time consuming to litigate and may divert our management's attention from our core business;

• substantial damages for infringement, which we may have to pay if a court decides that the product at

issue infringes or violates the third party's rights, and if the court finds that the infringement was

willful, we could be ordered to pay treble damages and the patent owner's attorneys' fees;

• a court prohibiting us from selling or licensing the product unless the third-party licenses its product

rights to us, which it is not required to do;

• if a license is available from a third party, we may have to pay substantial royalties, upfront fees or

grant cross licenses to intellectual property rights for our products; and

• redesigning our products or processes so they do not infringe, which may not be possible or may

require substantial monetary expenditures and time.

In order to successfully challenge the validity of a U.S. patent in federal court, we would need to

overcome a presumption of validity. As this burden is a high one requiring us to present clear and

convincing evidence as to the invalidity of any such U.S. patent claim, there is no assurance that a court

of competent jurisdiction would invalidate the claims of any such U.S. patent. Foreign courts will have

similar burdens to overcome in order to successfully challenge a third-party claim of patent infringement.

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Some of our competitors may be able to sustain the costs of complex patent litigation more effectively

than we can because they have substantially greater resources. In addition, any uncertainties resulting

from the initiation and continuation of any litigation could have an adverse effect on our ability to raise

additional funds or on our business, financial condition, results of operations and prospects.

***The terms of our patents may not be sufficiently long to effectively protect our products and***

***business.***

Patents have a limited lifespan. In the United States, the natural expiration of a patent is generally 20

years after its first effective non-provisional filing date, but can be shorter due to terminal disclaimers or

similar term reductions in other jurisdictions. Although various extensions may be available, the term of a

patent, and the protection it affords, is limited. Even if patents covering our technologies or products are

obtained, once the patent term has expired, we may be open to competition. In addition, although upon

issuance in the United States, a patent's term can be increased based on certain delays caused by the

USPTO, this increase can be reduced or eliminated based on certain delays caused by the patent

applicant during patent prosecution. Given the amount of time required for the development, testing and

regulatory review of products, patents protecting such potential products might expire before or shortly

after such products are commercialized. If we do not have sufficient patent life to protect our technologies

and products, our business, financial condition, results of operations and prospects will be adversely

affected.

***If we do not obtain additional protection under the Hatch-Waxman Amendments or similar foreign***

***legislation, our business may be materially affected.***

Depending upon the timing, duration and specifics of FDA marketing approval for our future products, one

or more of our U.S. patents may be eligible for limited patent term restoration under the Drug Price

Competition and Patent Term Restoration Act of 1984 (the "Hatch-Waxman Amendments"). The Hatch-

Waxman Amendments permit a patent term extension of up to five years beyond the normal expiration of

the patent as compensation for patent term lost during product development and the FDA regulatory

review process, which is limited to the approved indication (or any additional indications approved during

the period of extension). This extension is limited to one patent that covers the approved product, the

approved use of the product, or a method of manufacturing the product. A patent term extension cannot

extend the remaining term of a patent beyond a total of 14 years from the date of product approval, and

only those claims covering such approved product, a method for using it or a method for manufacturing it

may be extended. However, the applicable authorities, including the FDA and the USPTO in the United

States, and any equivalent regulatory authority in other countries or areas, may not agree with our

assessment of whether such extensions are available, and may refuse to grant extensions to our patents,

or may grant more limited extensions than we request. We may not be granted an extension because of,

for example, failing to apply within applicable deadlines, failing to apply prior to expiration of relevant

patents or otherwise failing to satisfy applicable requirements. Moreover, the applicable time period or

scope of patent protection afforded could be less than we request. If we are unable to obtain patent term

extension or restoration of the term of any such extension is less than we request, our competitors may

obtain approval for competing products following our patent expiration, and our ability to generate

revenues may be adversely affected.

***Open-source software licenses often impose unanticipated or unclear restrictions on us or could***

***expose us to litigation, and using open-source software has inherent risks, any of which could***

***impair our ability to successfully commercialize the Heartflow Platform.***

Our technology platform implements software modules licensed to us by third parties under "open source"

licenses. The terms of many open source licenses have not been interpreted by U.S. courts, and there is

a risk that these licenses could be construed in ways that could impose unanticipated conditions or

restrictions on our ability to commercialize our products. Moreover, we cannot be certain that our

processes for controlling our use of open-source software in connection with our products will be

effective. From time to time, we may face claims from third parties asserting ownership of, or demanding

release of, the open-source software or derivative works that we developed using such software (which

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could include our proprietary source code), or otherwise seeking to enforce the terms of the applicable

open source license. These claims could result in litigation. If we are held to have breached the terms of

an open source software license, we could be required to seek licenses from third parties to continue

offering our products on terms that are not economically feasible, to re-engineer our proprietary code, to

discontinue the sale of our products if re-engineering could not be accomplished on a timely or cost

effective basis, or to make generally available, in source code form, our proprietary code, any of which

could adversely affect our business, financial condition, results of operations and prospects.

The use of open-source software may entail greater risks than the use of third-party commercial software,

as open source licensors generally do not provide warranties or other contractual protections regarding

infringement or the quality or ownership of the code. Many of these risks cannot be eliminated, and could,

if not properly addressed, negatively affect our business. We cannot be sure that all open source software

is submitted for approval prior to use in connection with our products.

In addition, some open-source licenses contain requirements that we make available source code for

modifications or derivative works we create based upon the type of open-source software we use. If we

combine our proprietary software with open-source software in a certain manner, we could, under certain

open-source licenses, be required to release portions of the source code of our proprietary software to the

public. This would allow our competitors to create similar products with less development effort and time

and ultimately could result in a loss of sales for us.

***Intellectual property rights do not necessarily address all potential threats to our competitive***

***advantage.***

The degree of future protection afforded by our intellectual property rights is uncertain because

intellectual property rights have limitations and may not adequately protect our business or permit us to

maintain our competitive advantage. The following examples are illustrative:

• others may be able to make products that are similar to or otherwise competitive with our potential

products but that are not covered by the claims of our current or future patents;

• an in-license necessary for the manufacture, use, sale, offer for sale or importation of one or more of

our potential products may be terminated by the licensor;

• we or future collaborators might not have been the first to make the inventions covered by our issued

or future issued patents or our pending patent applications;

• we or future collaborators might not have been the first to file patent applications covering certain of

our inventions;

• others may independently develop similar or alternative technologies or duplicate any of our

technologies without infringing our intellectual property rights;

• it is possible that our pending patent applications will not lead to issued patents;

• issued patents that we own or in-license may be held invalid or unenforceable as a result of legal

challenges by our competitors;

• issued patents that we own or in-license may not provide coverage for all aspects of our new potential

products in all countries;

• our competitors might conduct research and development activities in countries where we do not

have patent rights and then use the information learned from such activities to develop competitive

products for sale in our major commercial markets;

• we may not develop additional proprietary technologies that are patentable; and

• the patents of others may have an adverse effect on our business.

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Should any of these events occur, they could significantly harm our business, results of operations and

prospects.

**Risks related to financing and tax matters**

***We may require additional capital to support business growth, and this capital might not be***

***available on terms favorable to us, or at all, and may dilute ownership of our common stock for***

***our stockholders, including purchasers of common stock in this offering.***

We intend to continue to make investments to support our business growth and may require additional

funds to respond to business challenges and opportunities, including the need to develop new products,

enhance our existing products, enhance our operating infrastructure, potentially expand internationally

and potentially acquire complementary businesses and technologies. In order to achieve these objectives,

we may make future commitments of capital resources. Accordingly, we may need to engage in equity or

debt financings to secure additional funds. If we raise additional funds through further issuances of equity

or convertible debt securities, our stockholders, including any purchasers of common stock in this

offering, could suffer significant dilution, and any new equity securities we issue could have rights,

preferences and privileges superior to those of holders of our common stock. In addition, our ability to

incur indebtedness is subject to limitations under the 2024 Credit Agreement and, if incurred, would

increase our fixed obligations and could include covenants or other restrictions that would impede our

ability to manage our operations. Further, if additional financing is needed, we may not be able to obtain

additional financing on terms favorable to us or at all. Our inability to obtain adequate financing or

financing on terms satisfactory to us, when we require it, could significantly limit our ability to continue

supporting our business growth and responding to business challenges and opportunities.

***Our operating results may fluctuate significantly, which makes our future operating results***

***difficult to predict and could cause our operating results to fall below expectations or any***

***guidance we may provide.***

Our quarterly revenue and results of operations may fluctuate from quarter to quarter due to, among

others, the following reasons:

• the level of physicians' acceptance and adoption of our products, and changes in the rates at which

physicians order our Heartflow FFRCT Analysis or the percentage of CCTA scans for which our

Heartflow FFRCT Analysis is ordered;

• determinations, including the timing of determinations, by payors concerning coverage and

reimbursement of our products;

• changes in coverage amounts or government and payors' reimbursement policies;

• the timing, expense and results of research and development activities, clinical trials and any

additional regulatory approvals;

• changes in AHA or ACC guidelines, or guidelines in other countries, that lower support for our

products or elevate alternative products as the preferred pathway for diagnosis and management of

CAD;

• fluctuations in our expenses associated with expanding our commercial operations and operating as

a public company;

• patients meeting their annual health insurance deductible later in the calendar year;

• the introduction of new products and technologies by our competitors;

• changes in our pricing policies or in the pricing policies of our competitors;

• the productivity of our sales and marketing teams, and their ability to identify physicians who

consistently refer appropriate patients for CCTAs in accordance with AHA and ACC guidelines;

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• quality problems with our products or the Heartflow Platform; and

• the impact of catastrophic events such as a pandemic.

Because of these and other factors, it is likely that in some future period our operating results will not

meet investor expectations or those of public market analysts. Any unanticipated change in revenue or

operating results is likely to cause our stock price to fluctuate. New information may cause investors and

analysts to revalue our business, which could cause a decline in our stock price.

***Our credit agreement contains certain restrictions that may limit our ability to operate our***

***business. If we raise additional capital through debt financing, the terms of any new debt could***

***further restrict our ability to operate our business.***

The terms of the 2024 Credit Agreement and related collateral documents contain, and any future debt

agreements would likely contain, a number of restrictive covenants that impose significant operating and

financial restrictions on us, including restrictions on our ability, and the ability of our subsidiaries, to take

actions that may be in our best interests, including, among others, disposing of assets, entering into

change of control transactions, mergers or acquisitions, incurring additional indebtedness, granting liens

on our assets and declaring and paying dividends. Our ability to meet covenants can be affected by

events beyond our control, and we may not be able to continue to meet such covenants. We have in the

past, and may in the future, breach our covenants under the 2024 Credit Agreement. In March 2023, we

entered into an agreement with Hayfin to temporarily waive certain covenant requirements that had not

been met pursuant to our prior credit agreement with Hayfin. In the future, a breach of the covenants or

the occurrence of other events (including, among others, a material adverse effect or the inability to

generate cash to service our obligations under our debt agreements) specified in the 2024 Credit

Agreement and/or the related collateral documents or a future debt agreement could result in an event of

default. Upon the occurrence of an event of default, our lenders could elect to declare all obligations

owing under the debt documents, if any, to be immediately due and payable, terminate all commitments to

extend further credit and/or proceed against the collateral, if any, pledged to them to secure such

indebtedness. For example, we have pledged substantially all of our assets, including, among others, our

intellectual property, all of Heartflow's ownership interests in Heartflow, Inc. and our foreign subsidiaries

as collateral under the 2024 Credit Agreement and related collateral documents. For additional

information on the 2024 Credit Agreement, see the section titled "Management's discussion and analysis

of financial condition and results of operations—Liquidity and capital resources—Hayfin credit

agreement." If lenders accelerate the repayment of borrowings, if any, we may not have sufficient funds to

repay our existing debt and the lenders could seize collateral that was pledged as guarantee for the loan,

which would harm our business and financial condition.

Amounts borrowed under the 2024 Credit Agreement can be repaid at any time, subject to applicable

prepayment fees, prior to the June 14, 2028 maturity date, at which time all obligations owing under the

debt documents will be due and payable. The 2024 Credit Agreement contains customary affirmative and

negative covenants, indemnification provisions and events of default. The affirmative covenants include,

among others, covenants requiring us to deliver certain financial reports and to maintain our legal

existence, regulatory authorizations and certain intellectual property rights. The negative covenants

include, among others, restrictions on changing our business activities, incurring additional indebtedness

and creating liens on our assets, requirements to maintain certain levels of liquidity and minimum net

sales, restrictions on making investments, paying dividends, issuing securities, engaging in mergers or

acquisitions, licensing our assets or making other distributions, in each case subject to customary

exceptions. If we default under the 2024 Credit Agreement, Hayfin will be able to declare all obligations

immediately due and payable and take control of our pledged assets, which may require us to renegotiate

our agreement on terms less favorable to us or to immediately cease operations. Any event of default by

us could significantly harm our business, financial condition, results of operations and prospects and

could cause the price of our common shares to decline. Further, if we are liquidated, Hayfin's right to

repayment would be senior to the rights of the holders of our common shares to receive any proceeds

from the liquidation.

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In connection with the completion of this offering, we are obligated to repay indebtedness outstanding

under the 2024 Credit Agreement in an amount equal to the lesser of (i) net cash proceeds in excess of

$150.0 million and (ii) $50.0 million (or $55.0 million if the underwriters exercise any portion of their option

to purchase additional shares). While we currently anticipate paying off $50.0 million of outstanding

indebtedness under the 2024 Credit Agreement immediately following the completion of this offering, a

portion of the indebtedness under the 2024 Credit Agreement will remain outstanding and we will be

subject to the ongoing requirements of the 2024 Credit Agreement and related collateral documents.

***We are subject to risks associated with currency fluctuations, and changes in foreign currency***

***exchange rates could impact our results of operations.***

All of our revenue and the majority of our expense and capital purchasing activities through the year

ended December 31, 2024 and the three months ended March 31, 2025 were transacted in U.S. dollars.

Approximately 11% of our 2023 revenue, approximately 9% of our 2024 revenue and approximately 8% of

our revenue for the three months ended March 31, 2025 was generated from customers outside the

United States. However, because a portion of our operations consists of business activities outside of the

United States, we have foreign currency operating expenses as well as asset and liability balances.

During the year ended December 31, 2024, we were exposed to foreign currency risks in connection with

our non-U.S. operations, and we anticipate that, over time, an increasing portion of our international

agreements may provide for payment denominated in foreign currencies. Changes in the exchange rates

between such foreign currencies and the U.S. dollar could therefore materially impact our reported results

of operations and distort period-to-period comparisons. Fluctuations in foreign currency exchange rates

also impact the reporting of our receivables and payables in non-U.S. currencies. As a result of such

foreign currency fluctuations, it could be more difficult to detect underlying trends in our business and

results of operations. In addition, to the extent that fluctuations in currency exchange rates cause our

results of operations to differ from our expectations or the expectations of our investors, the trading price

of our common stock could be adversely affected.

We do not currently engage in currency hedging activities to limit the risk of exchange rate fluctuations. In

the future, we may engage in exchange rate hedging activities in an effort to mitigate the impact of

exchange rate fluctuations but we may not be successful in doing so. If our hedging activities are not

effective, changes in currency exchange rates may have a more significant impact on our results of

operations.

***Our ability to use our net operating losses and tax credits to offset future taxable income and***

***taxes may be subject to certain limitations.***

As of December 31, 2024, we had net operating loss ("NOL") carryforwards of approximately $542.9

million and $435.5 million for federal and state income tax purposes, respectively, which may be utilized

against future federal and state income taxes. Federal NOL carryforwards we generated in tax years

through December 31, 2017 generally may be carried forward for 20 years and may fully offset taxable

income in the year utilized, and federal NOLs we generated in tax years beginning after December 31,

2017 generally may be carried forward indefinitely but may only be used to offset 80% of our taxable

income annually for tax years beginning after December 31, 2017.

In general, under Section 382 of the Internal Revenue Code of 1986, as amended (the "Code"), a

corporation that undergoes an "ownership change" is subject to limitations on its ability to utilize its pre-

change NOLs, carryforwards and other tax attributes, such as research and development tax credits, to

offset future taxable income and taxes. In general, an ownership change occurs if the aggregate stock

ownership of certain stockholders, generally stockholders beneficially owning five percent or more of our

common stock, applying certain look through and aggregation rules, increases by more than 50% over

such stockholders' lowest percentage ownership during the testing period, generally three years.

Purchases of our common stock in amounts greater than specified levels, which will be beyond our

control, could create a limitation on our ability to utilize our NOLs for tax purposes in the future. We

completed a Section 382 study of our historic ownership changes through December 31, 2024 and no

significant limitations were identified. In addition, this offering or future issuances or sales of our stock,

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including certain transactions involving our stock that are outside of our control, could result in future

"ownership changes." "Ownership changes" that have occurred in the past or that may occur in the future,

including in connection with this offering, could result in the imposition of an annual limit on the amount of

pre-ownership change NOLs and other tax attributes we can use to reduce our taxable income, potentially

increasing and accelerating our liability for income taxes, and also potentially causing those tax attributes

to expire unused.

If we are limited in our ability to use our NOLs and tax credits in future years in which we have taxable

income, we will pay more taxes than if we were able to fully utilize our NOLs and tax credits, and we could

be required to pay taxes earlier than we would otherwise be required, which could cause such NOLs to

expire unused. This could adversely affect our results of operations. Furthermore, we may not be able to

generate sufficient taxable income to utilize our pre-2018 NOLs before they expire beginning in 2030. If

any of these events occur, we may not derive some or all of the expected benefits from our NOLs, and

our business, financial condition, results of operations and prospects may be adversely affected as a

result.

***Our international operations subject us to potentially adverse tax consequences.***

We currently report our taxable income in various jurisdictions based upon our business operations in

those jurisdictions, including in the United States, United Kingdom, and Japan. We may in the future be

subject to reporting requirements in other foreign jurisdictions. The international nature and organization

of our business activities are subject to complex transfer pricing regulations administered by taxing

authorities in various jurisdictions. The relevant taxing authorities may disagree with our determinations

as to the income and expenses attributable to specific jurisdictions. If such a disagreement were to occur,

and our position were not sustained, we could be required to pay additional taxes, interest and penalties,

which could result in one time tax charges, higher effective tax rates, reduced cash flows and lower

overall profitability of our operations. We believe that our consolidated financial statements reflect

adequate reserves to cover such a contingency, but there can be no assurances in that regard.

***Our effective tax rate may vary significantly from period to period.***

Various internal and external factors may have favorable or unfavorable effects on our future effective tax

rate. These factors include, but are not limited to, changes in tax laws, regulations or rates, both within

and outside the United States, structural changes in our business, new accounting pronouncements or

changes to existing accounting pronouncements, non-deductible goodwill impairments, changing

interpretations of existing tax laws or regulations, changes in the relative proportions of revenue and

income before taxes in the various jurisdictions in which we operate that have different statutory tax rates,

the future levels of tax benefits of equity-based compensation, changes in overall levels of pretax

earnings or changes in the valuation of our deferred tax assets and liabilities. Additionally, we could be

challenged by state and local tax authorities as to the propriety of our sales tax compliance, and our

results could be materially impacted by these compliance determinations.

In addition, our effective tax rate may vary significantly depending on the market price of our common

stock. The tax effects of the accounting for share-based compensation may significantly impact our

effective tax rate from period to period. In periods in which the market price of our common stock is higher

than the grant price of the share-based compensation vesting in that period, we will recognize excess tax

benefits that will decrease our effective tax rate. In future periods in which our stock price is lower than

the grant price of the share-based compensation vesting in that period, our effective tax rate may

increase. The amount and value of share-based compensation issued relative to our earnings in a

particular period will also affect the magnitude of the impact of share-based compensation on our effective

tax rate. These tax effects are dependent on the market price of our common stock, which we do not

control, and a decline in our stock price could significantly increase our effective tax rate and adversely

affect our financial condition.

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***Taxing authorities may successfully assert that we should have collected or in the future should***

***collect sales and use, value added or similar taxes, and we could be subject to tax liabilities with***

***respect to past or future sales, which could adversely affect our results of operations.***

We do not collect sales and use, value added and similar taxes in all jurisdictions in which we have sales,

based on our belief that such taxes are not applicable or that we are not required to collect such taxes

with respect to the jurisdiction. Sales and use, value added and similar tax laws and rates vary greatly by

jurisdiction. Certain jurisdictions in which we do not collect such taxes may assert that such taxes are

applicable, which could result in tax assessments, penalties and interest, and we may be required to

collect such taxes in the future. Such tax assessments, penalties and interest or future requirements may

adversely affect our results of operations.

**Risks related to our common stock and this offering**

***There may not be an active trading market for our common stock, which may cause shares of our***

***common stock to trade at a discount from the initial public offering price and make it difficult to***

***sell the shares of common stock you purchase.***

Prior to this offering, there was no public market for our common stock. It is possible that after this

offering, an active trading market will not develop or, if developed, that any market will not be sustained,

which would make it difficult for you to sell your shares of common stock at an attractive price or at all.

The initial public offering price per share of common stock was determined by agreement among us and

the representatives of the underwriters and may not be indicative of the price at which shares of our

common stock will trade in the public market, if any, after this offering. The market value of our common

stock may decrease from the initial public offering price. It is possible that in one or more future periods

our results of operations may be below the expectations of public market analysts and investors, and, as

a result of these and other factors, the price of our common stock may fall. Furthermore, an inactive

market may also impair our ability to raise capital in the future by selling shares of our common stock.

***The market price of our common stock may be volatile, which could cause the value of your***

***investment to decline and could result in substantial losses for investors purchasing shares in***

***this offering.***

This initial public offering price may vary from the market price of our common stock after the offering. The

market price of our common stock may be highly volatile and could be subject to wide fluctuations.

Securities markets worldwide experience significant price and volume fluctuations. This market volatility,

as well as general economic, market or political conditions, could reduce the market price of our common

stock regardless of our operating performance. These fluctuations may be even more pronounced in the

trading market for our stock shortly following this offering. You may be unable to resell your shares of

common stock at or above the initial public offering price or at all.

***We are an emerging growth company, and the reduced reporting requirements applicable to***

***emerging growth companies could make our common stock less attractive to investors.***

We are an "emerging growth company," as defined in the JOBS Act. We will remain an "emerging growth

company" until the earliest to occur of:

• the last day of the fiscal year during which our total annual revenue equals or exceeds $1.235 billion

(subject to adjustment for inflation);

• the last day of the fiscal year following the fifth anniversary of this offering;

• the date on which we have, during the previous three-year period, issued more than $1 billion in non-

convertible debt; or

• the date on which we are deemed to be a "large accelerated filer" under the Exchange Act.

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As a result of our "emerging growth company" status, we may take advantage of exemptions from various

reporting requirements that would otherwise be applicable to public companies including, but not limited

to, reduced disclosure obligations regarding executive compensation in our periodic reports and proxy

statements and exemptions from the requirements of holding a nonbinding advisory vote on executive

compensation and stockholder approval of any golden parachute payments not previously approved.

Investors may find our common stock less attractive because we may rely on these exemptions. If some

investors find our common stock less attractive as a result, there may be a less active trading market for

our common stock and the market price of our common stock may be adversely affected and more

volatile.

***We will incur increased costs and become subject to additional regulations and requirements as a***

***result of becoming a public company, which could lower our profits or make it more difficult to***

***run our business.***

As a public company, we will incur significant legal, accounting and other expenses that we have not

incurred as a private company, including costs associated with public company reporting requirements.

We have also incurred and will continue to incur costs associated with the Sarbanes-Oxley Act and

related rules implemented by the SEC and the listing requirements of the Nasdaq Global Select Market.

The expenses generally incurred by public companies for reporting and corporate governance purposes

have been increasing. We expect these rules and regulations to increase our legal and financial

compliance costs and to make some activities more time-consuming and costly, although we are currently

unable to estimate these costs with any degree of certainty. These laws and regulations also could make

it more difficult or costly for us to obtain certain types of insurance, including director and officer liability

insurance, and we may be forced to accept reduced policy limits and coverage or incur substantially

higher costs to obtain the same or similar coverage. These laws and regulations could also make it more

difficult for us to attract and retain qualified persons to serve on our board of directors, on our board

committees or as our executive officers. Furthermore, if we are unable to satisfy our obligations as a

public company, we could be subject to delisting of our common stock, fines, sanctions, other regulatory

action and potentially civil litigation.

***If we are unable to design, implement and maintain effective internal control over financial***

***reporting in the future, investors may lose confidence in the accuracy and completeness of our***

***financial reports and the market price of our common stock may decline.***

As a public company, we will be required to maintain internal control over financial reporting and to report

any material weaknesses in such internal controls. In addition, beginning with our second annual report

on Form 10-K, we will be required to furnish a report by management on the effectiveness of our internal

control over financial reporting, pursuant to the rules and regulations of the SEC regarding compliance

with Section 404 of the Sarbanes-Oxley Act. The process of designing, implementing and testing the

internal control over financial reporting required to comply with this obligation is time consuming, costly

and complicated. We have in the past and may in the future identify control deficiencies, including

material weaknesses in our internal control over financial reporting. In connection with the preparation of

our consolidated financial statements, material weaknesses in our internal control over financial reporting

were identified as of and prior to December 31, 2023, which were remediated in connection with the

preparation of our consolidated financial statements as of and for the year ended December 31, 2024.

Any failure to maintain effective internal control over financial reporting could severely inhibit our ability to

accurately report our financial condition, results of operations or cash flows. Further, if we identify one or

more material weaknesses in our internal control over financial reporting, if we are unable to comply with

the requirements of Section 404 of the Sarbanes-Oxley Act in a timely manner or if we and, if required,

our auditors, are unable to assert that our internal control over financial reporting is effective, investors

may lose confidence in the accuracy and completeness of our financial reports and the market price of

our common stock could decline, and we could also become subject to investigations by the stock

exchange on which our common stock is listed, the SEC or other regulatory authorities, which could

require additional financial and management resources. Failure to remedy any material weakness in our

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internal control over financial reporting, or to implement or maintain other effective control systems

required of public companies, could also restrict our future access to the capital markets.

***Our disclosure controls and procedures may not prevent or detect all errors or acts of fraud.***

Upon effectiveness of the registration statement of which this prospectus forms a part, we will become

subject to the periodic reporting requirements of the Exchange Act. Our disclosure controls and

procedures are designed to reasonably ensure that information required to be disclosed by us in reports

we file or submit under the Exchange Act is accumulated and communicated to management and

recorded, processed, summarized and reported within the time periods specified in the rules and forms of

the SEC. We believe that our disclosure controls and procedures as well as internal control over financial

reporting, no matter how well conceived and operated, can provide only reasonable, not absolute,

assurance that the objectives of the control system are and will be met. These inherent limitations include

the realities that judgments in decision making can be faulty and that breakdowns can occur because of

simple error or mistake. Additionally, controls can be circumvented by the individual acts of some persons,

by collusion of two or more people or by an unauthorized override of the controls. Accordingly, because of

the inherent limitations in our control system, misstatements due to error or fraud may occur and not be

detected.

***If our estimates or judgments relating to our critical accounting policies are based on***

***assumptions that change or prove to be incorrect, our operating results could fall below our***

***publicly announced guidance or the expectations of securities analysts and investors, resulting in***

***a decline in the market price of our common stock.***

The preparation of financial statements in conformity with the United States generally accepted

accounting principles ("GAAP") requires management to make estimates and assumptions that affect the

reported amounts of assets, liabilities, revenue, expenses and related disclosures. We base our estimates

on historical experience and various other factors that we believe are reasonable under the

circumstances, the results of which form the basis for making judgments about the carrying value of

assets and liabilities that are not readily apparent from other sources. Actual results may differ from these

estimates under different assumptions or conditions and any such differences may be material. If our

assumptions change or if actual circumstances differ from our assumptions, our operating results may be

adversely affected and could fall below our publicly announced guidance or the expectations of analysts

and investors, resulting in a decline in the market price of our common stock.

***Our principal stockholders and management own a significant percentage of our stock and will be***

***able to exert significant control over matters subject to stockholder approval.***

Prior to this offering, as of June 30, 2025, our executive officers, directors, owners of more than 5% of our

capital stock and their respective affiliates beneficially owned approximately 69.0% of our outstanding

shares and, upon the completion of this offering, that same group will beneficially own approximately

50.1% of our outstanding shares (assuming no exercise of the underwriters' option to purchase additional

shares). Therefore, even after this offering, these stockholders will have the ability to influence us through

this ownership position. These stockholders may be able to determine all matters requiring stockholder

approval. For example, these stockholders may be able to control elections of directors, amendments of

our organizational documents, or approval of any merger, sale of assets or other major corporate

transaction. This may prevent or discourage unsolicited acquisition proposals or offers for our common

stock that you may feel are in your best interest as one of our stockholders.

***A significant portion of our total outstanding shares is restricted from immediate resale but may***

***be sold into the market in the near future, and any sales of a substantial number of shares of our***

***common stock in the public market could cause our stock price to decline significantly, even if***

***our business is doing well.***

Sales of a substantial number of shares of our common stock in the public market could occur at any

time. These sales, or the perception in the market that the holders of a large number of shares of

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common stock intend to sell shares, could reduce the market price of our common stock. If our existing

stockholders sell, or indicate an intention to sell, substantial amounts of our common stock in the public

market after the lock-up agreements, market standoff and other legal restrictions on resale discussed in

this prospectus, including as described under the section titled "Shares eligible for future sale—Lock-up

agreements and market standoff arrangements," lapse, the trading price of our common stock could

decline. Based upon the number of shares outstanding as of March 31, 2025 and assuming (i) the

Preferred Stock Conversion, (ii) the Convertible Notes Conversion, (iii) no exercise of the underwriters'

option to purchase additional shares of our common stock, and (iv) no exercise of outstanding options or

warrants, upon the completion of this offering, we will have outstanding a total of 81,168,388 shares of

common stock. Of these shares, all of the shares of our common stock sold in this offering, plus any

shares sold upon exercise of the underwriters' option to purchase additional shares, if any, will be freely

tradable, without restriction, in the public market immediately following this offering, other than shares

purchased by our "affiliates" (as such term is defined in Rule 144 under the Securities Act). See the

section titled "Shares eligible for future sale" in this prospectus for restrictions applicable to our affiliates.

We and each of our directors, our executive officers and substantially all of our other securityholders have

entered or will enter into lock-up agreements with the underwriters prior to the completion of this offering

or are subject to market standoff arrangements, which are described, including certain exceptions to such

agreements, in the section titled "Underwriting". After the expiration of the lock-up agreements and market

standoff arrangements, as of June 30, 2025, up to approximately 64.6 million additional shares of

common stock will be eligible for sale in the public market, approximately 60.5% of which shares are

owned by directors, executive officers and other owners of more than 5% of our outstanding common

stock, stock options, warrants and securities convertible into our common stock and will be subject to

Rule 144 under the Securities Act.

Approximately 6.5% of our outstanding common stock, stock options, warrants and other securities

convertible into or exercisable or exchangeable for our common stock are subject to market standoff

restrictions with us that include restrictions on the sale, transfer or other disposition of shares, among

other things and subject to certain exceptions, for a period of 180 days commencing on the date of this

prospectus. As a result of the foregoing, substantially all of our outstanding common stock, stock options,

warrants and other securities convertible into or exercisable or exchangeable for our common stock are

subject to a lock-up agreement or market standoff provisions for a period of 180 days commencing on the

date of this prospectus. See the section titled "Shares eligible for future sale" for additional information.

After this offering, based upon the number of shares outstanding as of March 31, 2025, the holders of

approximately 55.6 million shares of our common stock, or approximately 68% of our total outstanding

common stock, will be entitled to rights with respect to the registration of their shares under the Securities

Act, subject to the lock-up agreements and market standoff restrictions described above. Registration of

these shares under the Securities Act would result in the shares becoming freely tradable without

restriction under the Securities Act, except for shares purchased by affiliates. Any sales of securities by

these stockholders or any perception that these shares may be sold could have a material adverse effect

on the trading price of our common stock. In addition, a security holder who is not subject to market

standoff restrictions with us nor a lock-up agreement with the underwriters may be able to sell, short sell,

transfer, pledge or otherwise dispose of their equity interests at any time.

***Our amended and restated certificate of incorporation will provide that the Court of Chancery of***

***the State of Delaware (or, if such court does not have jurisdiction, Delaware federal district court)***

***will be the exclusive forum for certain disputes between us and our stockholders, which could***

***limit our stockholders' ability to obtain a favorable judicial forum for disputes with us or our***

***directors, officers or employees.***

Our amended and restated certificate of incorporation will provide that, unless we consent in writing to the

selection of an alternative forum, the Court of Chancery of the State of Delaware (or, in the event that the

Court of Chancery does not have jurisdiction, the federal district court for the District of Delaware) is the

exclusive forum for any derivative action or proceeding brought on our behalf, any action asserting a

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claim of breach of fiduciary duty owed by any of our current or former directors, officers, employees or

stockholders to us or to our stockholders, any action asserting a claim against us arising pursuant to the

Delaware General Corporation Law, our amended and restated certificate of incorporation, or our

amended and restated bylaws (as either may be amended from time to time) or as to which the Delaware

General Corporation Law confers jurisdiction on the Delaware Court of Chancery, or any action asserting

a claim against us that is governed by the internal affairs doctrine of the State of Delaware. Our amended

and restated certificate of incorporation will also provide that the federal district courts of the United States

will be the exclusive forum for the resolution of any complaint asserting a cause of action arising under

the Securities Act. Further, our amended and restated certificate of incorporation will provide that the

foregoing choice of forum provisions will not apply to suits brought to enforce any liability or duty created

by the Exchange Act, or any other claim for which the federal courts of the United States have exclusive

jurisdiction.

Our amended and restated certificate of incorporation will also provide that any person or entity

purchasing or otherwise acquiring or holding any interest in any of our securities shall be deemed to have

notice of and consented to the foregoing provisions of the amended and restated certificate of

incorporation. Although our amended and restated certificate of incorporation will contain the choice of

forum provision described above, it is possible that a court could find that such a provision is inapplicable

for a particular claim or action or that such provision is unenforceable.

We believe these provisions may benefit us by providing increased consistency in the application of

Delaware law and federal securities laws by chancellors and judges, as applicable, particularly

experienced in resolving corporate disputes, efficient administration of cases on a more expedited

schedule relative to other forums, and protection against the burdens of multi-forum litigation. However,

this choice of forum provision may limit a stockholder's ability to bring a claim in a judicial forum that it

finds favorable for disputes with us or any of our directors, officers, other employees or stockholders,

which may discourage lawsuits with respect to such claims, although our stockholders will not be deemed

to have waived our compliance with federal securities laws and the rules and regulations thereunder.

Furthermore, the enforceability of similar choice of forum provisions in other companies' certificates of

incorporation has been challenged in legal proceedings, and it is possible that a court could find these

types of provisions to be inapplicable or unenforceable. While the Delaware courts have determined that

such choice of forum provisions are facially valid, a stockholder may nevertheless seek to bring a claim in

a venue other than those designated in the exclusive forum provisions, and there can be no assurance

that such provisions will be enforced by a court in those other jurisdictions. If a court were to find the

choice of forum provision that will be contained in our amended and restated certificate of incorporation to

be inapplicable or unenforceable in an action, we may incur additional costs associated with resolving

such action in other jurisdictions, which could adversely affect our business, financial condition, results of

operations and prospects.

**General risk factors**

***We will have broad discretion in the use of net proceeds to us from this offering and may not use***

***them effectively.***

In connection with the completion of this offering, we are obligated to use certain of the net proceeds from

this offering to repay $50.0 million (or $55.0 million if the underwriters exercise any portion of their option

to purchase additional shares of common stock) of the indebtedness outstanding under the 2024 Credit

Agreement and to pay approximately $6.2 million of fees in connection therewith. We expect to use the

remainder to fund our sales and marketing efforts, fund research and product development activities and

for other general corporate purposes, including working capital, operating expenses, and capital

expenditures. We may also use a portion of the net proceeds from this offering to acquire complementary

businesses, products, services, or technologies. See the section titled "Use of proceeds" for additional

information. We periodically evaluate strategic opportunities; however, we have no current

understandings or commitments to enter into any such acquisitions or make any such investments. The

expected use of net proceeds from this offering represents our intentions based upon our present plans

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and business conditions. We cannot predict with certainty all of the particular uses for the proceeds of this

offering or the amounts that we will actually spend on the uses set forth above. Accordingly, our

management will have broad discretion in applying the net proceeds of this offering, including for any of

the purposes described in the section titled "Use of proceeds," and you will not have the opportunity as

part of your investment decision to assess whether the net proceeds are being used appropriately. The

timing and amount of our actual expenditures will be based on many factors, including cash flows from

operations and the anticipated growth of our business. Pending their use, we intend to invest the net

proceeds of this offering in a variety of capital-preservation investments, including government securities

and money market funds.

If we do not use the net proceeds that we receive in this offering effectively, our business, financial

condition, results of operations and prospects could be harmed, and the market price of our common

stock could decline. Pending their use, we intend to invest the net proceeds of this offering in a variety of

capital-preservation investments, including government securities and money market funds. These

investments may not yield a favorable return to our investors.

***Investors in this offering will experience immediate and substantial dilution.***

The initial public offering price of our common stock is substantially higher than the pro forma as adjusted

net tangible book value per share of our common stock. Therefore, if you purchase shares of our common

stock in this offering, you will pay a price per share that substantially exceeds our pro forma as adjusted

net tangible book value per share after this offering. Based on the assumed initial public offering price of

$17.50 per share, which is the midpoint of the estimated price range set forth on the cover page of this

prospectus, you will experience immediate dilution of $14.64 per share, representing the difference

between our pro forma as adjusted net tangible book value per share after giving effect to this offering

and the initial public offering price. In addition, purchasers of common stock in this offering will have

contributed 25% of the aggregate price paid by all purchasers of our common stock but will own only

approximately 21% of our total equity outstanding after this offering. Furthermore, you will experience

additional dilution if the underwriters exercise their option to purchase additional shares, outstanding

options and warrants are exercised, upon the vesting of outstanding restricted stock awards or when we

otherwise issue additional shares of common stock. For a further description of the dilution that you will

experience immediately after this offering, see the section titled "Dilution" included elsewhere in this

prospectus.

***We do not intend to pay dividends in the foreseeable future. As a result, your ability to achieve a***

***return on your investment will depend on appreciation in the market price of our common stock.***

We have never declared or paid cash dividends on our capital stock. We currently intend to retain all

available funds and any future earnings, if any, to fund the development and expansion of our business,

and we do not anticipate paying any cash dividends in the foreseeable future. Any future determinations

regarding the declaration and payment of dividends, if any, will be at the discretion of our board of

directors, subject to applicable law, and will depend upon then-existing conditions, including our financial

condition, results of operations, contractual restrictions, general business conditions, capital

requirements, and other factors our board of directors may deem relevant. In addition, our ability to pay

cash dividends is currently restricted by the terms of the 2024 Credit Agreement. Our ability to pay cash

dividends on our capital stock in the future may also be limited by the terms of any preferred securities we

may issue or agreements governing any additional indebtedness we may incur.

***If our operating and financial performance in any given period does not meet any guidance that***

***we provide to the public, the market price of our common stock may decline.***

We may, but are not obligated to, provide public guidance on our expected operating and financial results

for future periods. Any such guidance will be comprised of forward-looking statements subject to the risks

and uncertainties described in this prospectus, including in the section titled "Risk factors," and in our

future public filings and public statements. Our actual results may not always be in line with or exceed any

guidance we have provided, especially in times of economic uncertainty. If actual circumstances differ

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from those in our assumptions, our operating and financial results could fall below our publicly announced

guidance or the expectations of investors. If, in the future, our operating or financial results for a particular

period do not meet any guidance we provide or the expectations of investment analysts or investors

generally, or if we reduce our guidance for future periods, the market price of our common stock may

decline. Even if we do issue public guidance, there can be no assurance that we will continue to do so in

the future.

***If securities or industry analysts do not publish research or reports about our business, or if they***

***issue an adverse or misleading opinion regarding our stock, our stock price and trading volume***

***could decline.***

The trading market for our common stock will be influenced by the research and reports that industry or

securities analysts publish about us or our business. We do not currently have and may never obtain

research coverage by securities and industry analysts. If no or few securities or industry analysts

commence coverage of us, the market price for our stock would be negatively impacted. In the event we

obtain securities or industry analyst coverage, if any of the analysts who cover us downgrade their

evaluations of our stock or issue an adverse opinion regarding us, our business model, our intellectual

property or our stock performance, or if our results of operations fail to meet the expectations of analysts,

our stock price would likely decline. If one or more of these analysts cease coverage of us or fail to

publish reports on us regularly, we could lose visibility in the financial markets, which in turn could cause

our stock price or trading volume to decline.

***We may be subject to securities litigation, which is expensive and could divert management***

***attention.***

In the past, following periods of volatility in the overall market and the market price of a company's

securities, securities class action litigation has often been instituted against these companies. Because of

the potential volatility of our stock price, we may become the target of securities litigation in the future.

These events may also result in or be concurrent with investigations by the SEC. We may be exposed to

such litigation or investigation even if no wrongdoing occurred. Such litigation, if instituted against us,

could result in substantial costs and a diversion of our management's attention and resources, which

could seriously harm our business.

***Provisions in our charter documents and under Delaware law could discourage a takeover that***

***stockholders may consider favorable and may lead to entrenchment of management.***

Our amended and restated certificate of incorporation, to be in effect upon the completion of this offering,

and our amended and restated bylaws, to be in effect upon the effectiveness of the amended and

restated certificate of incorporation, will contain provisions that could delay or prevent changes in control

or changes in our management without the consent of our board of directors. These provisions will

include the following:

• a classified board of directors with three-year staggered terms, which may delay the ability of

stockholders to change the membership of a majority of our board of directors;

• our directors may be removed by our stockholders only for cause;

• no cumulative voting in the election of directors, which limits the ability of minority stockholders to

elect director candidates;

• the exclusive right of our board of directors to change the size of the board of directors and to elect a

able to change the board's size or fill new directorships and vacancies on our board of directors;

• the ability of our board of directors to authorize the issuance of shares of preferred stock and to

determine the price and other terms of those shares, including preferences and voting rights, without

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stockholder approval, which could be used to significantly dilute the ownership of a hostile acquiror or

adopt a stockholder rights plan;

• the ability of our board of directors to alter our amended and restated bylaws without obtaining

stockholder approval;

• the required approval of at least sixty-six and two-thirds percent (66-2/3%) of the voting power of all

then-outstanding shares of capital stock entitled to vote generally in the election of directors to

remove directors or to adopt, amend, alter or repeal our amended and restated bylaws and certain

provisions of our amended and restated certificate of incorporation;

• a prohibition on stockholder action by written consent, which forces stockholder action to be taken at

an annual or special meeting of our stockholders;

• the requirement that a special meeting of stockholders may be called only by our secretary at the

request of our board of directors, the chairman of our board of directors, or our chief executive officer,

which may delay the ability of our stockholders to force consideration of a proposal or to take action,

including the removal of directors; and

• advance notice procedures that stockholders must comply with in order to nominate candidates to our

board of directors or to propose matters to be acted upon at a stockholders' meeting, which may

discourage or deter a potential acquiror from conducting a solicitation of proxies to elect the acquiror's

own slate of directors or otherwise attempting to obtain control of us.

We are also subject to the anti-takeover provisions contained in Section 203 of the Delaware General

Corporation Law ("Section 203"). Under Section 203, a corporation may not, in general, engage in a

business combination (as defined in Section 203) with any interested stockholder (generally defined by

Section 203 to include holders of 15% or more of our capital stock) unless the interested stockholder has

held the stock for three years or, among other exceptions and exclusions, the board of directors has

approved the business combination transaction or the transaction that resulted in the stockholder

becoming an interested stockholder. For a description of our capital stock, see the section titled

"Description of capital stock."

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**Special note regarding forward-looking statements**

This prospectus, including the sections titled "Prospectus summary," "Risk factors," "Management's

discussion and analysis of financial condition and results of operations," and "Business," contains express

or implied forward-looking statements about us and our industry that involve substantial risks and

uncertainties. All statements other than statements of historical facts contained in this prospectus,

including statements regarding our strategy, future financial condition, future operations, projected costs,

prospects, plans, objectives of management, and expected market growth, are forward-looking

statements. In some cases, you can identify forward-looking statements by words such as "may," "will,"

"shall," "should," "expects," "plans," "anticipates," "could," "intends," "target," "projects," "contemplates,"

"believes," "estimates," "predicts," "potential," "goal," "objective," "seeks," or "continue" or the negative of

these words or other similar terms or expressions that concern our expectations, strategy, plans, or

intentions. Forward-looking statements contained in this prospectus include, but are not limited to,

statements about:

• our business model and strategic plans for our products, technologies and business, including our

implementation thereof;

• our ability to continue improving our products and technologies, including our AI Technologies;

• our expectations regarding government and third-party payor coverage and reimbursement;

• the implementation of our business model and strategic plans;

• our ability to commercialize, manage and grow our business by increasing our sales to existing

customers or introducing our products to new customers;

• our ability to compete with other companies engaged in the development of products, including

algorithm-based diagnostic analysis products, that provide existing non-invasive tests that aid in the

evaluation of CAD;

• our expectations regarding the potential addressable market size for our products;

• our expectation about market trends;

• our ability to attract, hire and retain key personnel and additional qualified personnel;

• our ability to effectively manage our growth;

• FDA or other U.S. or foreign regulatory actions affecting us or the healthcare industry generally,

including potential effects of evolving and/or extensive government regulation;

• our ability to obtain, maintain and expand regulatory clearances for our products and any new

products we create;

• our ability to establish and maintain intellectual property protection for our products or avoid claims of

infringement;

• our expectations regarding the use of the net proceeds from this offering and our existing cash and

cash equivalents;

• estimates of our expenses, future revenue, capital requirements, needs for additional financing and

our ability to obtain additional capital;

• our ability to expand internationally;

• general economic, industry, and market conditions, including rising interest rates and inflation;

• our future financial performance; and

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• other risks and uncertainties, including those listed under the caption "Risk factors."

You should not rely on forward-looking statements as predictions of future events. We have based the

forward-looking statements contained in this prospectus primarily on our current expectations, estimates,

forecasts, and projections about future events and trends that we believe may affect our business,

financial condition, results of operations, and prospects. Although we believe that we have a reasonable

basis for each forward-looking statement contained in this prospectus, we cannot guarantee that the

future results, levels of activity, performance, or events and circumstances reflected in the forward-looking

statements will be achieved or occur at all. The outcome of the events described in these forward-looking

statements is subject to risks, uncertainties, and other factors described in the section titled "Risk factors"

and elsewhere in this prospectus. Moreover, we operate in a very competitive and rapidly changing

environment. New risks and uncertainties emerge from time to time, and it is not possible for us to predict

all risks and uncertainties that could have an impact on the forward-looking statements contained in this

prospectus. The results, events, and circumstances reflected in the forward-looking statements may not

be achieved or occur, and actual results, events, or circumstances could differ materially from those

described in the forward-looking statements.

The forward-looking statements made in this prospectus relate only to events as of the date on which the

statements are made. We undertake no obligation to update any forward-looking statements made in this

prospectus to reflect events or circumstances after the date of this prospectus or to reflect new

information or the occurrence of unanticipated events, except as required by law. We may not actually

achieve the plans, intentions, or expectations disclosed in our forward-looking statements, and you should

not place undue reliance on our forward-looking statements. Our forward-looking statements do not

reflect the potential impact of any future acquisitions, mergers, dispositions, joint ventures, or investments

we may make.

In addition, statements that "we believe" and similar statements reflect our beliefs and opinions on the

relevant subject. These statements are based upon information available to us as of the date of this

prospectus, and while we believe such information forms a reasonable basis for such statements, such

information may be limited or incomplete, and our statements should not be read to indicate that we have

conducted an exhaustive inquiry into, or review of, all potentially available relevant information. These

statements are inherently uncertain, and you are cautioned not to unduly rely on these statements.

You should read this prospectus and the documents that we reference in this prospectus and have filed

as exhibits to the registration statement, of which this prospectus is a part, completely and with the

understanding that our actual future results may be materially different from what we expect. We qualify

all of the forward-looking statements in this prospectus by these cautionary statements.

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**Market and industry data**

This prospectus contains estimates, projections, and other information concerning our industry and our

business, as well as data regarding market research, estimates, and forecasts prepared by our

management or third parties, including but not limited to, Clarivate and the publications listed below.

Information that is based on estimates, forecasts, projections, market research, or similar methodologies

is inherently subject to uncertainties, and actual events or circumstances may differ materially from events

and circumstances that are assumed in this information. These data and the industry in which we operate

is subject to a high degree of uncertainty and risk due to a variety of factors, including those described in

the section titled "Risk factors." These and other factors could cause results to differ materially from those

expressed in these estimates, publications, and reports made by third parties or us.

Unless otherwise expressly stated, we obtained such industry, business, market, and other data from

reports, research surveys, studies, and similar data prepared by market research firms and other third

parties, industry and general publications, government data, and similar sources. In some cases, we do

not expressly refer to the sources from which this data is derived. In that regard, when we refer to one or

more sources of this type of data in any paragraph, you should assume that other data of this type

appearing in the same paragraph is derived from sources which we paid for, sponsored, or conducted,

unless otherwise expressly stated or the context otherwise requires. The content of these third-party

sources, except to the extent specifically set forth in this prospectus, does not constitute a portion of this

prospectus and is not incorporated herein.

The sources of certain statistical data, estimates and forecasts contained in this prospectus are from the

following publications:

• Martin et al., Circulation 149:e347, 2024 (the "Martin paper");

• Bhatt et al., JAMA 327:662, 2022 (the "Bhatt paper");

• Kofoed et al., Journal of the American College of Cardiology 77:1044, 2021 (the "Kofoed paper");

• Hoffmann et al., Circulation 135:2320, 2017 (the "Hoffman paper");

• Yang et al., BMJ Open 2017;7:e011684, 2017 (the "Yang paper");

• MacDonald, Current Developments in Nutrition 6:925, 2022 (the "MacDonald paper");

• Nakanishi et al., The International Journal of Cardiovascular Imaging 33: 2067, 2017 (the "Nakanishi

paper");

• Yokota et al., Netherlands Heart Journal 26:192, 2018 (the "Yokota paper");

• Patel et al., American Heart Journal 167:846, 2014 (the "2014 Patel paper");

• Patel et al., New England Journal of Medicine 362:886, 2010 (the "2010 Patel paper");

• Wang et al., American Journal of Roentgenology 191:409, 2008 (the "Wang paper"); and

• Ni et al., American Heart Journal 157:46, 2009 (the "Ni paper").

Forecasts and other forward-looking information with respect to industry, business, market, and other data

are subject to the same qualifications and additional uncertainties regarding the other forward-looking

statements in this prospectus. See the section titled "Special note regarding forward-looking statements."

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**Use of proceeds**

We estimate that the net proceeds from this offering will be approximately $265.8 million (or

approximately $306.4 million if the underwriters exercise in full their option to purchase up to 2,500,000

additional shares of common stock), based on the assumed initial public offering price of $17.50 per

share, which is the midpoint of the estimated price range set forth on the cover page of this prospectus,

after deducting estimated underwriting discounts and commissions and estimated offering expenses

payable by us.

Each $1.00 increase or decrease in the assumed initial public offering price of $17.50 per share of our

common stock, which is the midpoint of the estimated price range set forth on the cover page of this

prospectus, would increase or decrease, as applicable, the net proceeds to us from this offering by

approximately $15.5 million, assuming the number of shares offered by us, as set forth on the cover page

of this prospectus, remains the same, and after deducting estimated underwriting discounts and

commissions and estimated offering expenses payable by us. Similarly, each increase or decrease of 1.0

million shares in the number of shares of common stock offered by us would increase or decrease, as

applicable, the net proceeds to us from this offering by approximately $16.3 million, assuming the

assumed initial public offering price of $17.50 per share of our common stock, which is the midpoint of the

estimated price range set forth on the cover page of this prospectus, remains the same, and after

deducting estimated underwriting discounts and commissions and estimated offering expenses payable

by us.

In connection with the completion of this offering, we are obligated to use certain of the net proceeds from

this offering to repay $50.0 million (or $55.0 million if the underwriters exercise any portion of their option

to purchase additional shares of common stock) of the indebtedness outstanding under the 2024 Credit

Agreement and to pay approximately $6.2 million of fees in connection therewith. In connection with the

issuance of the 2025 Convertible Notes in January 2025, we entered into Amendment No. 1 to the 2024

Credit Agreement, pursuant to which entities affiliated with Hayfin converted $23.0 million of outstanding

indebtedness under the 2024 Credit Agreement in connection with the 2024 Term Loan Conversion and

became holders of 5% or more of our capital stock as of March 31, 2025. The 2024 Credit Agreement

bears interest equal to the sum of (i) 7.0% (or 6.0% if the alternative base rate is in effect) plus (ii) the

greater of (x) the forward-looking term rate based on the Secured Overnight Financing Rate ("SOFR") for

a respective tenor (or the alternative base rate, if applicable), and (y) 2.0%. The alternative base rate

equals to the sum of (i) 6.0% plus (ii) the greater of (1) the Wall Street Journal Prime Rate, plus 0.5%, (2)

the Federal Reserve Bank of New York rate plus 0.5% or (3) CBA Term SOFR for one month tenor plus

1.0%. The 2024 Credit Agreement matures on June 14, 2028. Borrowings under the 2024 Credit

Agreement were used to refinance outstanding indebtedness.

We expect to use the remainder of the net proceeds from this offering, together with our existing cash and

cash equivalents, to fund our sales and marketing efforts, fund research and product development

activities and for other general corporate purposes, including working capital, operating expenses, and

capital expenditures. With respect to funding research and product development activities, we plan to

deploy net proceeds from this offering into three main areas of research and development: (i) new

products to drive greater efficiency and reduce manual involvement by the imaging physician, including

software tools that reduce imager time spent reading and reporting on CCTA images; (ii) new features

that enhance the clinical utility and ease of use of our existing products, including a more intuitive and

simplified user interface; and (iii) new clinical evidence to support expanded indications of our Heartflow

Platform into high risk asymptomatic patients and longer term, lower risk asymptomatic patients.

We may also use a portion of the net proceeds from this offering to acquire complementary businesses,

products, services, or technologies. We periodically evaluate strategic opportunities; however, we have no

current understandings or commitments to enter into any such acquisitions or make any such

investments.

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Based on our current operating plan, we estimate that our existing cash and cash equivalents as of the

date of this prospectus, together with the estimated net proceeds from this offering, will be sufficient to

fund our planned operations for at least the next twelve months. We have based this estimate on our

current assumptions, which may prove to be wrong, and we may exhaust our available capital resources

sooner than we expect. The expected use of net proceeds from this offering represents our intentions

based upon our present plans and business conditions. We cannot predict with certainty all of the

particular uses for the proceeds of this offering or the amounts that we will actually spend on the uses set

forth above. Accordingly, our management will have broad discretion in applying the net proceeds of this

offering, and investors will be relying on the judgment of our management regarding the application of

these net proceeds. The timing and amount of our actual expenditures will be based on many factors,

including cash flows from operations and the anticipated growth of our business. Pending their use, we

intend to invest the net proceeds of this offering in a variety of capital-preservation investments, including

government securities and money market funds.

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**Dividend policy**

We have never declared or paid cash dividends on our capital stock. We currently intend to retain all

available funds and any future earnings, if any, to fund the development and expansion of our business,

and we do not anticipate paying any cash dividends in the foreseeable future. Any future determinations

regarding the declaration and payment of dividends, if any, will be at the discretion of our board of

directors, subject to applicable law, and will depend upon then-existing conditions, including our financial

condition, results of operations, contractual restrictions, general business conditions, capital

requirements, and other factors our board of directors may deem relevant. In addition, our ability to pay

cash dividends is currently restricted by the terms of our 2024 Credit Agreement. Our ability to pay cash

dividends on our capital stock in the future may also be limited by the terms of any preferred securities we

may issue or agreements governing any additional indebtedness we may incur.

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**Capitalization**

The following table sets forth our cash and cash equivalents and our capitalization, as of March 31, 2025:

• on an actual basis;

• on a pro forma basis, giving effect to (i) the Preferred Stock Conversion, which will occur immediately

prior to the completion of this offering, (ii) 7,022,512 shares issuable in connection with the

Convertible Notes Conversion at the assumed initial public offering price of $17.50 per share, which is

the midpoint of the estimated price range set forth on the cover page of this prospectus, and the

resultant reclassification of our derivative liability to additional paid-in capital, a component of

stockholders' equity (deficit), which will occur upon the completion of this offering, as if each had

occurred as of March 31, 2025, and (iii) the adoption, filing, and effectiveness of our amended and

restated certificate of incorporation, to be in effect upon the completion of this offering; and

• on a pro forma as adjusted basis, giving effect to (i) the pro forma adjustments discussed above, (ii)

the issuance and sale of 16,666,667 shares of common stock in this offering at the assumed initial

public offering price of $17.50 per share, which is the midpoint of the estimated price range set forth

on the cover page of this prospectus, after deducting estimated underwriting discounts and

commissions and estimated offering expenses payable by us, and (iii) the assumed repayment of

$50.0 million of the indebtedness outstanding under the 2024 Credit Agreement and payment of

approximately $6.2 million of fees in connection therewith.

You should read this table together with the sections titled "Summary consolidated financial data,"

"Management's discussion and analysis of financial condition and results of operations" and our

consolidated financial statements and the related notes included elsewhere in this prospectus. The pro

forma as adjusted information below is illustrative only and our capitalization following the completion of

this offering will depend on the actual initial public offering price and other terms of this offering

determined at pricing.

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| | | | |
|:---|:---|:---|:---|
| | **As of** <br>**March 31, 2025** | **As of** <br>**March 31, 2025** | **As of** <br>**March 31, 2025** |
| <br>**(in thousands, except share and per share amounts)** | **Actual** | **Pro forma** | **Pro forma as** <br>**adjusted**<sup>(1)</sup><br>|
| Cash and cash equivalents....................................................... | $109786 | $109786 | $320318 |
| 2024 Term Loan.......................................................................... | 113831 | 113831 | 62132 |
| 2025 Convertible Notes............................................................. | 65824 |  |  |
| Derivative liability........................................................................ | 40945 |  |  |
| Redeemable convertible preferred stock, $0.001 par <br>value; 122,231,454 shares authorized; <br>122,231,454 shares issued and outstanding, actual; no <br>shares authorized, issued or outstanding, pro forma and <br>pro forma as adjusted................................................................<br>| 768566 |  |  |
| Stockholders' equity (deficit): |  |  |  |
| Preferred stock, $0.001 par value; no shares <br>authorized, issued and outstanding, actual; no shares <br>authorized, no shares issued or outstanding, pro <br>forma; 50,000,000 shares authorized and no shares <br>issued and outstanding, pro forma as adjusted................<br>|  |  |  |
| Common stock, $0.001 par value; 210,300,000 shares <br>authorized, 6,252,861 shares issued and outstanding, <br>actual; 210,300,000 shares authorized <br>and 65,160,085 shares issued and outstanding, pro <br>forma; 250,000,000 shares authorized <br>and 81,168,388 shares issued and outstanding, pro forma <br>as adjusted..................................................................................<br>| 6 | 65 | 81 |
| Additional paid-in capital........................................................... | 115311 | 990587 | 1256321 |
| Accumulated other comprehensive loss................................. | (1008) | (1008) | (1008) |
| Accumulated deficit.................................................................... | (1003304) | (1003304) | (1007821) |
| Total stockholders' equity (deficit)............................................ | (888995) | (13660) | 247573 |
| Total capitalization...................................................................... | $100171 | $100171 | $309705 |

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(1)Each $1.00 increase or decrease in the assumed initial public offering price of $17.50 per share of our common stock, which is the

midpoint of the estimated price range set forth on the cover page of this prospectus, would increase or decrease, as applicable, each of

our pro forma as adjusted cash and cash equivalents, additional paid-in-capital, total stockholders' equity (deficit), and total

capitalization by approximately $15.5 million, assuming the number of shares offered by us, as set forth on the cover page of this

prospectus, remains the same, and after deducting estimated underwriting discounts and commissions and estimated offering

expenses payable by us. Similarly, each increase or decrease of 1.0 million shares in the number of shares of common stock offered by

us would increase or decrease, as applicable, each of our pro forma as adjusted cash and cash equivalents, additional paid-in-capital,

total stockholders' equity (deficit), and total capitalization by approximately $16.3 million, assuming the assumed initial public offering

price of $17.50 per share of our common stock remains the same, and after deducting estimated underwriting discounts and

commissions and estimated offering expenses payable by us.

If the underwriters exercise in full their option to purchase up to 2,500,000 additional shares of common

stock, pro forma as adjusted cash and cash equivalents, 2024 Term Loan, additional paid-in capital, total

stockholders' equity (deficit), total capitalization, and shares of common stock outstanding as of March 31,

2025 would be $356.0 million, $57.1 million, $1.3 billion, $288.3 million, $345.4 million,

and 83,668,388 shares, respectively.

The number of shares of our common stock to be outstanding after this offering, pro forma and pro forma

as adjusted, in the table above is based on 64,501,721 shares of our common stock outstanding as of

March 31, 2025, after giving effect to (i) the Preferred Stock Conversion, which will occur immediately

prior to the completion of this offering, (ii) the Convertible Notes Conversion, which will occur upon the

completion of this offering, and (iii) the adoption, filing, and effectiveness of our amended and restated

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certificate of incorporation, to be in effect upon the completion of this offering, as if each had occurred as

of March 31, 2025, and excludes:

• 8,583,703 shares of our common stock issuable upon the exercise of outstanding stock options as of

March 31, 2025 under our 2009 Equity Incentive Plan, with a weighted-average exercise price of

$4.98 per share;

• 212,888 shares of our common stock issuable upon the exercise of outstanding stock options granted

subsequent to March 31, 2025 under our 2009 Equity Incentive Plan, with a weighted-average

exercise price of $13.64 per share;

• 1,647,667 shares of our common stock issuable upon the exercise of warrants outstanding as of

March 31, 2025 held by Hayfin, with an exercise price of $0.03 per share;

• 323,173 shares, including 129,577 shares reserved subsequent to March 31, 2025, of our common

stock reserved for future issuance under our 2009 Equity Incentive Plan;

• 17,401,370 shares of our common stock to be reserved for future issuance under the 2025 Plan,

which will become effective upon the commencement of trading of our common stock on the Nasdaq

Global Select Market, from which we will grant RSUs covering approximately 550,000 shares of

common stock concurrently with this offering (based on the assumed initial public offering price of

$17.50 per share, which is the midpoint of the price range set forth on the cover page of this

prospectus), as well as any future increases in the number of shares of common stock reserved for

issuance under the 2025 Plan; and

• 1,242,241 shares of our common stock reserved for future issuance under the ESPP, which will

become effective upon the commencement of trading of our common stock on the Nasdaq Global

Select Market, as well as any future increases in the number of shares of common stock reserved for

issuance under the ESPP.

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**Dilution**

If you purchase shares of our common stock in this offering, your ownership interest will be immediately

and substantially diluted to the extent of the difference between the initial public offering price per share of

our common stock and the pro forma as adjusted net tangible book value per share of our common stock

immediately after this offering.

As of March 31, 2025, our historical net tangible book value (deficit) was $(939.9) million, or $(150.31) per

share of our common stock. Our historical net tangible book value (deficit) is the amount of our total

tangible assets less our total liabilities and the carrying values of our redeemable convertible preferred

stock. Our historical net tangible book value (deficit) per share represents historical net tangible book

value (deficit) divided by the aggregate number of shares of our common stock outstanding as of March

31, 2025. Total tangible assets represents total assets less capitalized internal-use software, capitalized

contract costs, unamortized debt discount and issuance costs, and deferred initial public offering costs.

Our pro forma net tangible book value (deficit) as of March 31, 2025 was $(32.1) million, or $(0.50) per

share. Pro forma net tangible book value per share represents total tangible assets, less total liabilities,

divided by the total aggregate number of shares of our common stock outstanding as of March 31, 2025,

after giving effect to:

• the Preferred Stock Conversion, which will occur immediately prior to the completion of this offering,

as if it had occurred as of March 31, 2025;

• the Convertible Notes Conversion, which will occur upon the completion of this offering, as if it had

occurred as of March 31, 2025; and

• the adoption, filing, and effectiveness of our amended and restated certificate of incorporation, to be

in effect upon the completion of this offering.

After giving further effect to the issuance and sale by us of 16,666,667 shares of our common stock in this

offering at the assumed initial public offering price of $17.50 per share, which is the midpoint of the

estimated price range set forth on the cover page of this prospectus, and after deducting estimated

underwriting discounts and commissions and estimated offering expenses payable by us and the

assumed repayment of $50.0 million of the indebtedness outstanding under the 2024 Credit Agreement

and to pay approximately $6.2 million of fees in connection therewith, our pro forma as adjusted net

tangible book value (deficit) as of March 31, 2025 would have been $232.5 million, or $2.86 per share.

This represents an immediate increase in pro forma net tangible book value to existing stockholders of

$3.36 per share and an immediate dilution in pro forma net tangible book value to new investors of

$14.64 per share. Dilution per share represents the difference between the price per share to be paid by

new investors for the shares of our common stock sold in this offering and the pro forma as adjusted net

tangible book value per share immediately after this offering.

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The following table illustrates this dilution on a per share basis:

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| | | |
|:---|:---|:---|
| Assumed initial public offering price per share................................................... |  | $17.50 |
| Historical net tangible book value (deficit) per share as of March 31, 2025.. | $(150.31) |  |
| Pro forma increase in net tangible book value per share as of <br>March 31, 2025 attributable to the pro forma adjustments described <br>above....................................................................................................................<br>| $149.81 |  |
| Pro forma net tangible book value per share as of March 31, 2025.......... | $(0.50) |  |
| Increase in pro forma net tangible book value per share attributable to <br>new investors participating in this offering.....................................................<br>| $3.36 |  |
| Pro forma as adjusted net tangible book value per share after this offering. |  | $2.86 |
| Dilution per share to new investors participating in this offering..................... |  | $14.64 |

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The dilution information discussed above is illustrative only and may change based on the actual initial

public offering price, the number of shares we sell, and other terms of this offering that will be determined

at pricing.

Each $1.00 increase or decrease in the assumed initial public offering price of $17.50 per share, which is

the midpoint of the estimated price range set forth on the cover page of this prospectus, would increase or

decrease, as applicable, our pro forma as adjusted net tangible book value per share after this offering by

$0.21 per share and $0.20 per share, respectively, and the dilution per share to investors participating in

this offering by $0.79 per share and $0.80 per share, respectively, assuming that the number of shares of

common stock offered by us, as set forth on the cover page of this prospectus, remains the same, and

after deducting estimated underwriting discounts and commissions and estimated offering expenses

payable by us. Similarly, each 1.0 million share increase in the number of shares offered by us would

increase our pro forma as adjusted net tangible book value per share after this offering by $0.17 per

share and decrease the dilution per share to investors participating in this offering by $0.17 per share,

and each 1.0 million share decrease in the number of shares offered by us would decrease our pro forma

as adjusted net tangible book value per share after this offering by $0.16 per share and increase the

dilution per share to investors participating in this offering by $0.16 per share, in each case assuming the

initial public offering price of $17.50 per share remains the same, and after deducting estimated

underwriting discounts and commissions and estimated offering expenses payable by us.

If the underwriters exercise in full their option to purchase up to 2,500,000 additional shares of common

stock, the pro forma as adjusted net tangible book value (deficit) per share of our common stock after this

offering would be $3.27 per share, and the dilution per share to investors participating in this offering

would be $14.23 per share, assuming the assumed initial public offering price of $17.50 per share, which

is the midpoint of the estimated price range set forth on the cover page of this prospectus.

The following table summarizes, as of March 31, 2025, on a pro forma as adjusted basis as described

above, the number of shares of our common stock, the total consideration and the average price per

share (i) paid to us by existing stockholders and (ii) to be paid by new investors acquiring our common

stock in this offering at the assumed initial public offering price of $17.50 per share, the midpoint of the

estimated price range set forth on the cover page of this prospectus, before deducting estimated

underwriting discounts and commissions and estimated offering expenses payable by us. As the table

below shows, investors participating in this offering will pay an average price per share substantially

higher than our existing stockholders paid.

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| | | | | | |
|:---|:---|:---|:---|:---|:---|
|  | **Shares purchased** | **Shares purchased** | **Total consideration** | **Total consideration** | **Weighted-** <br>**average** <br>**price per** <br>**share** |
|  | **Number** | **Percent** | **Amount** | **Percent** | **Weighted-** <br>**average** <br>**price per** <br>**share** |
| Existing stockholders...................... | 64501721 | 79% | $878715 | 75% | $13.62 |
| New investors................................... | 16666667 | 21% | 291667 | 25% | $17.50 |
| Total................................................... | 81168388 | 100% | $1170382 | 100% | $14.42 |

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Each $1.00 increase or decrease in the assumed initial public offering price of $17.50 per share, which is

the midpoint of the estimated price range set forth on the cover page of this prospectus, would increase or

decrease, as applicable, the total consideration paid by new investors and total consideration paid by all

stockholders by approximately $15.5 million, assuming that the number of shares of common stock

offered by us, as set forth on the cover page of this prospectus, remains the same, before deducting

estimated underwriting discounts and commissions and estimated offering expenses payable by us.

Similarly, each 1.0 million share increase or decrease in the number of shares offered by us would

increase or decrease, as applicable, the total consideration paid by new investors and total consideration

paid by all stockholders by $16.3 million, assuming the assumed initial public offering price of $17.50 per

share of common stock remains the same, before deducting estimated underwriting discounts and

commissions.

Except as otherwise indicated, the above discussion and tables assume no exercise of the underwriters'

option to purchase additional shares. If the underwriters exercise in full their option to purchase up

to 2,500,000 additional shares of common stock, our existing stockholders would own 77%, and our new

investors would own 23% of the total number of shares of our common stock outstanding upon the

completion of this offering.

The foregoing tables and calculations (other than historical net tangible book value) are based

on 64,501,721 shares of our common stock outstanding as of March 31, 2025, after giving effect to (i) the

Preferred Stock Conversion, which will occur immediately prior to the completion of this offering, (ii) the

Convertible Notes Conversion, which will occur upon the completion of this offering, as if it had occurred

as of March 31, 2025 and (iii) the adoption, filing, and effectiveness of our amended and restated

certificate of incorporation, to be in effect upon the completion of this offering, and excludes:

• 8,583,703 shares of our common stock issuable upon the exercise of outstanding stock options as of

March 31, 2025 under our 2009 Equity Incentive Plan, with a weighted-average exercise price of

$4.98 per share;

• 212,888 shares of our common stock issuable upon the exercise of outstanding stock options granted

subsequent to March 31, 2025 under our 2009 Equity Incentive Plan, with a weighted-average

exercise price of $13.64 per share;

• 1,647,667 shares of our common stock issuable upon the exercise of warrants outstanding as of

March 31, 2025 held by Hayfin, with an exercise price of $0.03 per share;

• 323,173 shares, including 129,577 shares reserved subsequent to March 31, 2025, of our common

stock reserved for future issuance under our 2009 Equity Incentive Plan;

• 17,401,370 shares of our common stock to be reserved for future issuance under the 2025 Plan,

which will become effective upon the commencement of trading of our common stock on the Nasdaq

Global Select Market, from which we will grant RSUs covering approximately 550,000 shares of

common stock concurrently with this offering (based on the assumed initial public offering price of

$17.50 per share, which is the midpoint of the price range set forth on the cover page of this

prospectus), as well as any future increases in the number of shares of common stock reserved for

issuance under the 2025 Plan; and

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• 1,242,241 shares of our common stock reserved for future issuance under the ESPP, which will

become effective upon the commencement of trading of our common stock on the Nasdaq Global

Select Market, as well as any future increases in the number of shares of common stock reserved for

issuance under the ESPP.

To the extent that any outstanding options are exercised, new options or other equity awards are issued

under our equity incentive plans, or we issue additional shares in the future, there will be further dilution to

new investors participating in this offering. In addition, we may choose to raise additional capital because

of market conditions or strategic considerations, even if we believe that we have sufficient funds for our

current or future operating plans. If we raise additional capital through the sale of equity or convertible

debt securities, the issuance of these securities could result in further dilution to our stockholders.

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**Management's discussion and analysis of financial condition** 

**and results of operations**

*You should read the following discussion and analysis of our financial condition and results of operations* 

*in conjunction with our consolidated financial statements and the related notes and other financial* 

*information included elsewhere in this prospectus. This discussion and analysis and other parts of this* 

*prospectus contain forward-looking statements based upon our current plans and expectations that* 

*involve risks, uncertainties and assumptions, such as statements regarding our plans, objectives,* 

*expectations, intentions and beliefs. Our actual results and the timing of events could differ materially* 

*from those anticipated in these forward-looking statements as a result of various factors, including those* 

*set forth under the section titled "Risk factors" and elsewhere in this prospectus. You should carefully read* 

*the section titled "Risk factors" to gain an understanding of the important factors that could cause actual* 

*results to differ materially from our forward-looking statements. Please also see the section titled "Special* 

*note regarding forward-looking statements." Our historical results are not necessarily indicative of the* 

*results that may be expected for any period in the future.*

**Overview**

We have pioneered the use of software and AI to deliver a more accurate and clinically effective non-

invasive solution for diagnosing and managing coronary artery disease ("CAD"), a leading cause of death

worldwide. As of March 31, 2025, our Heartflow Platform has been used to assess CAD in more than

400,000 patients, including 132,000 in 2024 alone. We believe that we are the most widely adopted AI-

powered test for CAD. Our novel platform leverages AI and advanced computational fluid dynamics to

create a personalized 3D model of a patient's heart from a single coronary computed tomography

angiography ("CCTA"), a specialized type of scan that provides detailed images of the heart's arteries.

Our Heartflow Platform delivers actionable insights on blood flow, stenosis, plaque volume and plaque

composition thereby overcoming the limitations of traditional non-invasive imaging tests which rely on

indirect measures of coronary disease and lead to higher false negative and false positive rates as

demonstrated by our PRECISE trial. We believe the differentiated accuracy and clinical utility of our

Heartflow Platform, along with its ability to enhance workflows, will continue to support our growth and

advance the "CCTA + Heartflow" pathway as the definitive standard for the non-invasive diagnosis and

management of CAD.

To date, we have developed three software products (with a fourth product expected to launch in 2026)

under the Heartflow Platform that provide physicians with the critical insights needed to effectively

diagnose and manage CAD:

• *Heartflow RoadMap Analysis* offers a highly intuitive anatomic visualization of the coronary arteries,

helping physicians quickly identify clinically relevant areas to focus their review. We provide Heartflow

RoadMap Analysis to accounts as an integrated feature to enhance the efficiency of their CCTA

program and it is not a stand-alone product.

• *Heartflow FFRCT Analysis* calculates blood flow and pinpoints clinically significant CAD, which is CAD

with a fractional flow reserve ("FFR") value of 0.80 or below, at every point in the major coronary

arteries. FFR measures the severity of blood flow restriction in the coronary arteries on a scale of 1.0

(no restriction) to 0.0 (complete blockage) by assessing pressure differences across a stenosis during

induced stress, guiding decisions on whether a patient requires invasive revascularization.

• *Heartflow Plaque Analysis* provides a comprehensive assessment of coronary plaque, enabling

optimized medical treatment strategies.

• *Heartflow PCI Planner*, which we expect to launch in 2026, will provide advanced visualization and

clinical insights to optimize revascularization strategies, guide device selection, enhance procedural

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efficiency, and improve patient care. We plan to provide Heartflow PCI Planner to accounts as an

integrated feature to enhance procedural efficiency, not as a stand-alone product.

The Heartflow Platform has an existing commercial presence and regulatory approval in the United

States, United Kingdom, European Union, Australia, Canada and Japan. We have developed a highly

scalable, capital efficient commercial model that combines Territory Sales Managers ("TSMs") who drive

new account adoption with Territory Account Managers ("TAMs") who focus on increasing utilization by

educating referring physicians. Our commercial team does not cover cases or otherwise spend time in an

operating room or lab setting, which enables them to focus solely on driving commercial adoption and

educational activities. We also have small, direct commercial teams in our international markets. In the

future, we may expand our international presence beyond these markets.

Our technology is simple and intuitive and does not require the purchase of any capital equipment. Our

onboarding process seamlessly integrates the Heartflow Platform into the customer's daily workflow.

These unique attributes of our business model afford our commercial organization a differentiated level of

efficiency and scalability.

We have experienced considerable revenue growth since we began commercializing the Heartflow

Platform in 2015, driven primarily by growth in our account base and increasing test volumes at accounts

in our installed base. We recognized revenue of $87.2 million for the year ended December 31, 2023,

compared to revenue of $125.8 million for the year ended December 31, 2024. For the three months

ended March 31, 2024 and 2025, we recognized revenue of $26.8 million and $37.2 million, respectively.

Substantially all of our revenue is generated on a "pay-per-click" basis each time a physician chooses to

review either our Heartflow FFRCT Analysis, Heartflow Plaque Analysis, or both and we recognize usage-

driven fee revenue upon delivery of the requested analysis to the physician. Heartflow FFRCT Analysis

has served as our commercial foundation, representing 99% of our total revenue as of March 31, 2025. In

the second half of 2023, we initiated limited market education efforts for Heartflow Plaque Analysis, our

second commercial product. Our Heartflow RoadMap Analysis is generally provided as a workflow

efficiency tool to drive customer retention and loyalty and is not a stand-alone product.

To date, we have primarily funded our operations with proceeds from sales of shares of our redeemable

convertible preferred stock, common stock and convertible promissory notes, borrowings under our term

loans and revenue received from our customers. As of March 31, 2025, we had $109.8 million in cash and

cash equivalents. In January and March 2025, we issued $98.3 million in aggregate principal amount of

the 2025 Convertible Notes to investors, including related parties, with original maturity dates of 48

months from the dates of issuance. The consideration for the issuance of the 2025 Convertible Notes was

comprised of $74.0 million in cash, $1.3 million in aggregate principal amount of notes issued in lieu of

cash compensation to certain employees, and the exchange of $23.0 million of outstanding indebtedness

under the 2024 Credit Agreement (as defined below).

We have incurred significant operating losses and negative cash flows since our inception and we expect

to continue to incur losses as we grow and transition to operating as a public company. Our net loss for

the years ended December 31, 2023 and 2024 was $95.7 million and $96.4 million, respectively. For the

three months ended March 31, 2024 and 2025, our net loss was $20.9 million and $32.3 million,

respectively. As of December 31, 2023 and 2024, we had an accumulated deficit of $874.5 million and

$971.0 million, respectively. As of March 31, 2025, we had an accumulated deficit of $1.0 billion.

Based on our current operating plan, we believe that the expected cash generated from revenue

transactions with customers and our existing cash and cash equivalents will be sufficient to fund our

planned operating expenses and capital expenditure requirements for at least the next 12 months. We

have based this estimate on assumptions that may prove to be wrong, and we could deplete our capital

resources sooner than we expect. We may experience lower than expected cash generated from

operating activities or greater than expected capital expenditures, cost of revenue, or operating expenses,

and may need to raise additional capital to fund operations, further research and development activities,

or acquire, invest in, or in-license other businesses, assets, or technologies.

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**Key factors affecting our results of operations and performance** 

We believe there are several important factors that have impacted and that we expect will continue to

impact our operating performance and results of operations for the foreseeable future. These factors

include, among others:

• Rate of adoption of CCTA in the market and our ability to increase adoption of the CCTA + Heartflow

pathway among both referring and reading physicians.

• Ability to successfully introduce our Heartflow Plaque Analysis and other new products and the rate at

which they are adopted by physicians.

• Ability to automate an increasing number of the manual components of our production process and

the rate at which we hire and train analysts to full productivity.

• We experience seasonality throughout the year based on a number of factors, including staff

availability, vacations, weather and other macro economic events.

• Publications of clinical results by us and third parties.

**Heartflow revenue cases**

We regularly review a number of operating and financial metrics to evaluate our business, measure our

performance, identify trends affecting our business, formulate our business plan and make strategic

decisions. Substantially all of our revenue is generated on a "pay-per-click" basis each time a physician

chooses to review either our Heartflow FFRCT Analysis, Heartflow Plaque Analysis, or both and we

recognize usage-driven fee revenue upon delivery of the requested analysis to the physician. We define a

"Heartflow revenue case" as each time an account orders and we deliver the requested analysis to the

physician. For example, the ordering of both an Heartflow FFRCT Analysis and a Heartflow Plaque

Analysis from a single CCTA counts as two revenue cases. We define an "account" as any individual

facility that orders a Heartflow FFRCT Analysis, Heartflow Plaque Analysis, or both. Accounts may have

more than one reading physician or CT machine. The following table lists these revenue cases in each of

the three month periods as indicated:

---

| | | | | | | | | | | | | | |
|:---|:---|:---|:---|:---|:---|:---|:---|:---|:---|:---|:---|:---|:---|
|  | **Q1** <br>**2022**<br>| **Q2** <br>**2022**<br>| **Q3** <br>**2022**<br>| **Q4** <br>**2022**<br>| **Q1** <br>**2023**<br>| **Q2** <br>**2023**<br>| **Q3** <br>**2023**<br>| **Q4** <br>**2023**<br>| **Q1** <br>**2024**<br>| **Q2** <br>**2024**<br>| **Q3** <br>**2024**<br>| **Q4** <br>**2024**<br>| **Q1** <br>**2025**<br>|
| Revenue <br>cases..........<br>| 12316 | 12701 | 14865 | 16697 | 19537 | 21769 | 23195 | 24897 | 28803 | 33039 | 34970 | 37805 | 40336 |

---

The period-to-period change in Heartflow revenue cases is an indicator of our ability to drive adoption and

generate sales revenue, and is helpful in tracking the progress of our business. We believe that Heartflow

revenue cases are representative of our current business; however, we anticipate this metric may be

substituted for additional or different metrics as our business grows.

**Components of our results of operations**

***Revenue***

Substantially all of our revenue comprises usage-driven fees from accounts who order either our

Heartflow FFRCT Analysis, Heartflow Plaque Analysis, or both. We recognize usage-driven fee revenue

upon delivery of the requested analysis to the physician. Key factors that drive our revenue include

revenue case growth from our installed base and the success of our sales force in expanding adoption of

the Heartflow Platform to new accounts and expanding the utilization of our system by accounts in our

installed base. We consider an account that has our Heartflow solution deployed with the ability to send

us CCTA images for processing as being part of our installed base. New accounts generally take 12

months to reach steady state revenue case volumes. We consider steady state case volumes to be

attained once the account reaches FFRCT utilization rates approaching 33% of CCTAs occurring at the

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account—a level that is generally sustained over time based on historical trends. Our Heartflow FFRCT

Analysis is indicated for patients with stenosis levels between 40% and 90% and we believe

approximately 33% of patients have this level of stenosis. For purposes of managing our business, we do

not separately track increases in revenue solely attributable to new accounts. Revenue cases generated

from clinic or office-based accounts typically carry a lower pricing than hospital-based accounts,

commensurate with their lower reimbursement levels. We expect the percentage of our revenue cases

generated from clinic or office-based accounts to continue to increase over time. For the years ended

December 31, 2023 and 2024, the percentage of our U.S. revenue cases attributable to office and clinic-

based accounts was 22% and 28%, respectively. For the three months ended March 31, 2024 and 2025,

the percentage of our U.S. revenue cases attributable to office and clinic-based accounts was 28% and

30%, respectively.

While a single customer may include multiple accounts, no single customer accounted for 10% or more of

our revenue during the years ended December 31, 2023 and 2024 or for the three months ended March

31, 2024 and 2025. However, the decision-making function for some of these accounts is concentrated in

a relatively small number of customers, such that the loss of one customer could result in a

disproportionate loss across our accounts. For example, for the year ended December 31, 2024, our top

two largest customers, both large health systems with multiple accounts, collectively represented

approximately 8% of our revenue. As we expand the adoption of the Heartflow Platform, we expect a

majority of new accounts to come from new customers, decreasing our customer concentration risk.

Our revenue has fluctuated, and we expect it to continue to fluctuate from quarter-to-quarter due to a

variety of factors including the number of accounts in our installed base, the volume of Heartflow Platform

usage by accounts in our installed base, changes in the mix of customer accounts and seasonality. We

may experience fluctuations in the volume of Heartflow Platform usage by our customers based on

seasonal factors that impact the number of radiologists and support staff available to conduct CCTAs at

customer accounts.

***Cost of revenue and gross margin***

Cost of revenue consists of personnel and related expenses, including stock-based compensation costs,

primarily related to our production team. Additional costs include third-party hosting fees, amortization of

capitalized internal-use software, amortization of contract fulfillment costs as well as royalties associated

with technology licenses used in connection with the delivery of our product and allocated overhead,

which includes facilities expenses, equipment, depreciation and technology services. The role of the

production team is to support our patient case volume revenue by performing defined quality-related

activities on CCTA scans submitted by our customers for analysis. The portion of these costs that

supports patient case volume revenue is recorded as cost of revenue. The production team also supports

activities in our clinical trials and research and development, which are allocated as research and

development expense. We expect cost of revenue to increase as we hire additional personnel in our

production team to support our increasing patient case volume.

We calculate gross margin as gross profit divided by revenue. Our gross margin has been and will

continue to be affected by a variety of factors, primarily by our production team costs, the timing of hiring

new production team members and training them to full productivity, the timing of our acquisition of new

customers and pricing and commercialization of Heartflow Plaque Analysis and other new products.

Although, we expect our gross margin to fluctuate from period to period, based upon the factors described

above, we believe our gross margin will increase over the long term as we leverage the AI-based nature

of our software platform to automate an increasing number of the manual components of our production

teams' process, thereby lowering the cost of revenue per analysis. We also expect increased revenues

from our Heartflow Plaque Analysis, to positively impact our gross margin, as it runs on the same CCTA

scan as Heartflow FFRCT Analysis. In the short term, we expect gross margin to decrease as we hire and

train additional personnel in our production team to support our increasing patient case volume.

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***Operating expenses***

*Research and development*

Research and development expenses are incurred in connection with the advancement of the Heartflow

Platform with the goal to introduce products, features and improvements aimed at increasing the value

proposition for our customers by expanding its applicability to additional disease states and patient

populations. Research and development expenses consist primarily of engineering, product development,

consulting services, clinical studies to develop and support our products, regulatory activities, medical

affairs, and other costs associated with products and technologies that are in development. Research and

development expenses consist of personnel and related expenses, including stock-based compensation

costs, clinical trials, third-party consulting costs, the portion of the costs incurred by our production team

to support clinical trials and research and development efforts, and allocated overhead, including facilities

expenses, equipment and depreciation. Our research and development team is comprised of PhD

research scientists with expertise in AI-based algorithms and medical imaging, alongside software

engineers skilled in cloud architecture, AI algorithms, machine and deep learning and 3D visualization, as

well as product managers and designers who ensure optimal customer experience and design. We record

research and development expenses in the periods in which they are incurred. We expect our research

and development expenses to increase as we conduct clinical studies for expanded indications for use

and to hire additional personnel to develop new product offerings and product enhancements.

*Selling, general and administrative*

Selling, general and administrative expenses consist of personnel and related expenses, including stock-

based compensation costs, related to selling and marketing, commercial operations, reimbursement,

finance, legal, information technology and human resources functions. Other expenses include sales

commission, marketing initiatives, professional service fees (including legal, audit, accounting and tax

fees), market access work to secure reimbursement for our technologies, travel expenses, conferences

and trade shows, and allocated overhead, which includes facilities expenses, software licenses,

depreciation and other miscellaneous expenses.

We expect that our selling, general and administrative expenses will increase in the future as a result of

expanding our operations, including hiring personnel, to both drive and support anticipated growth as well

as various incremental costs associated with operating as a public company. We expect that our costs will

increase related to legal, audit, accounting fees, consulting fees, regulatory and tax-related services

associated with maintaining compliance with exchange listing and SEC requirements, director and officer

insurance costs, investor and public relations costs and other expenses that we did not incur as a private

company. However, we expect selling, general and administrative expenses to decrease as a percentage

of revenue primarily as, and to the extent, our revenue grows.

*Interest expense, net*

Interest expense, net consists primarily of interest expense on our 2024 Term Loan and related

amortization of debt discount and debt issuance costs. Interest income is primarily interest earned on our

cash and cash equivalents.

*Other expense, net* 

Other expense, net consists primarily of changes in fair value related to our Convertible Notes, common

stock warrant and derivative liability as well as foreign exchange transaction gains or losses from

transactions and asset and liability balances denominated in currencies other than the U.S. dollar. We will

continue to record adjustments to the estimated fair value of the common stock warrant liability until the

warrants are exercised or expire and to the estimated fair value of the derivative liability until the

convertible notes are repaid or converted.

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*Provision for income taxes*

Provision for income taxes consists of income tax expense in foreign jurisdictions. To date, we have not

recorded any U.S. federal or state income tax expense. We have net deferred tax assets for U.S. federal

income taxes for which we provide a full valuation allowance. Due to our history of net operating losses

since inception, we expect to maintain a full valuation allowance in the foreseeable future due to

uncertainties regarding our ability to realize these assets.

**Results of operations**

***Comparison of three months ended March 31, 2024 and 2025***

The following table summarizes our results of operations for the three months ended March 31, 2024 and

2025:

---

| | | | |
|:---|:---|:---|:---|
|  | **Three months ended** <br>**March 31,** | **Three months ended** <br>**March 31,** | **Change** |
| **(dollars in thousands)** | **2024** | **2025** | $**%** |
| Revenue............................................................. | $26843 | $37205 | 39% |
| Cost of revenue................................................ | 7420 | 9264 | 25% |
| Gross profit........................................................ | 19423 | 27941 | 44% |
| Operating expenses: |  |  |  |
| Research and development............................ | 9443 | 13924 | 47% |
| Selling, general and administrative............... | 26038 | 31519 | 21% |
| Total operating expenses................................ | 35481 | 45443 | 28% |
| Loss from operations....................................... | (16058) | (17502) | 9% |
| Interest expense, net....................................... | (4731) | (4550) | -4% |
| Other expense, net........................................... | (215) | (10293) | \* |
| Loss before provision for income taxes........ | (21004) | (32345) | 54% |
| (Provision for) benefit from income taxes..... | 72 |  | -100% |
| Net loss.............................................................. | $(20932) | $(32345) | 55% |

---

\*: Not Meaningful

***Revenue***

Revenue increased $10.4 million, or 39%, to $37.2 million during the three months ended March 31,

2025, compared to $26.8 million during the three months ended March 31, 2024. The increase in revenue

was primarily attributable to a 40% increase in revenue case volume.

***Cost of revenue and gross margin***

Cost of revenue increased $1.8 million, or 25%, to $9.3 million during the three months ended March 31,

2025, compared to $7.4 million during the three months ended March 31, 2024. This increase was

attributable to $0.7 million in personnel and related expenses, $0.3 million in amortization of capitalized

internal-use software, $0.3 million in allocated overhead, and a net change of $0.2 million in capitalized

and amortized contract fulfillment costs. Personnel and related expenses included $0.1 million and $0.1

million of stock-based compensation costs during the three months ended March 31, 2025 and 2024,

respectively. Gross margin for the three months ended March 31, 2025 increased to 75% as compared to

72% for the three months ended March 31, 2024. The gross margin increase during the three months

ended March 31, 2025 was primarily driven by increased revenue cases as compared to the three months

ended March 31, 2024. The three months ended March 31, 2025 also benefited from efficiency

improvements that were introduced throughout 2024 and were in place during the entire three months

ended March 31, 2025, which lowered the cost of revenue per analysis.

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***Research and development expenses***

Research and development expenses increased $4.5 million, or 47%, to $13.9 million during the three

months ended March 31, 2025, compared to $9.4 million during the three months ended March 31, 2024.

The increase in research and development expenses was primarily attributable to an increase of

$2.9 million in personnel and related expenses directly associated with an increase in headcount,

$0.7 million in clinical trial expenses, $0.6 million in consulting and professional fees, and $0.1 million in

software-related costs. Personnel and related expenses included $0.5 million and $0.5 million of stock-

based compensation costs during the three months ended March 31, 2025 and 2024, respectively.

***Selling, general and administrative expenses***

Selling, general and administrative expenses increased $5.5 million, or 21%, to $31.5 million during the

three months ended March 31, 2025, compared to $26.0 million during the three months ended March 31,

2024. The increase in selling, general and administrative expenses was primarily attributable to an

increase of $2.8 million in personnel and related expenses directly associated with an increase in

headcount, $2.6 million in professional fees, including legal, audit and consulting fees, and $0.9 million in

marketing expenses, partially offset by a decrease of $0.3 million in allocated overhead and $0.6 million

of capitalized commission costs. Personnel and related expenses included $1.9 million and $2.1 million of

stock-based compensation costs for the three months ended March 31, 2025 and 2024, respectively.

***Interest expense, net***

Interest expense, net decreased to an expense of $4.6 million during the three months ended March 31,

2025, compared to an expense of $4.7 million during the three months ended March 31, 2024. This

decreased expense was attributable to a lower aggregate outstanding principal balance under our 2024

Term Loan related to the conversion of $23.0 million in principal to convertible notes in January 2025

offset by lower interest rates earned on money market funds. As of March 31, 2025 and 2024, the

aggregate outstanding principal balance (including interest paid-in-kind) under our 2024 Term Loan was

$115.1 million and $138.1 million, respectively.

***Other expense, net***

Other expense, net increased to an expense of $10.3 million during the three months ended March 31,

2025, compared to an expense of $215,000 during the three months ended March 31, 2024. The increase

was primarily attributable to the remeasurement and recognition of the change in fair value related to our

common stock warrant liability of $1.6 million and the remeasurement and recognition of $9.0 million

related to the derivative liability during the three months ended March 31, 2025.

***(Provision for) benefit from income taxes***

Benefit from income taxes was $72,000 for the three months ended March 31, 2024 related to our foreign

taxes. There was no provision for income taxes during the three months ended March 31, 2025.

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***Comparison of years ended December 31, 2023 and 2024***

The following table summarizes our results of operations for the years ended December 31, 2023 and

2024:

---

| | | | |
|:---|:---|:---|:---|
|  | **Year ended December 31,** | **Year ended December 31,** | **Change** |
| **(dollars in thousands)** | **2023** | **2024** | $**%** |
| Revenue............................................................. | $87174 | $125808 | 44% |
| Cost of revenue................................................ | 29123 | 31359 | 8% |
| Gross profit........................................................ | 58051 | 94449 | 63% |
| Operating expenses: |  |  |  |
| Research and development............................ | 35854 | 43517 | 21% |
| Selling, general and administrative............... | 95111 | 112154 | 18% |
| Total operating expenses................................ | 130965 | 155671 | 19% |
| Loss from operations....................................... | (72914) | (61222) | -16% |
| Interest expense, net....................................... | (19237) | (18702) | -3% |
| Other expense, net........................................... | (2957) | (16449) | 456% |
| Loss before provision for income taxes........ | (95108) | (96373) | 1.3% |
| Provision for income taxes.............................. | (547) | (53) | -90% |
| Net loss.............................................................. | $(95655) | $(96426) | 0.8% |

---

***Revenue***

Revenue increased $38.6 million, or 44%, to $125.8 million during the year ended December 31, 2024,

compared to $87.2 million during the year ended December 31, 2023. The increase in revenue was

primarily attributable to a 51% increase in revenue case volume, partially offset by a reduction in average

sales price due to a higher percentage of revenue cases generated from clinic and office-based accounts.

***Cost of revenue and gross margin***

Cost of revenue increased $2.2 million, or 8%, to $31.4 million during the year ended December 31, 2024,

compared to $29.1 million during the year ended December 31, 2023. This increase was attributable to

$0.8 million in allocated overhead, $0.5 million in personnel and related expenses, $0.5 million in

amortization of capitalized internal-use software, $0.4 million in third-party hosting fees and a net change

of $0.3 million in capitalized and amortized contract fulfillment costs, partially offset by a $0.6 million

decrease in royalties. Personnel and related expenses included $0.3 million and $0.4 million of stock-

based compensation costs during the year ended December 31, 2024 and 2023, respectively. Gross

margin for the year ended December 31, 2024 increased to 75% as compared to 67% for the year ended

December 31, 2023. The gross margin increase during the year ended December 31, 2024 was primarily

driven by increased revenue cases over the prior year and was aided by efficiency improvements, which

lowered the cost of revenue per analysis. The efficiency improvements included the release of new

algorithms that automated the modeling of significant components of the coronary anatomy reducing

manual components of our production teams' process, updated software that improved analyst efficiency,

improved coaching and training, and other one-time efficiency projects. These improvements resulted in

an approximate 50% reduction to average per analyst case processing time, which lowered the cost of

revenue per analysis. Gross margin during the year ended December 31, 2024, also benefited from a

temporary 100 basis point reduction in royalty rates. We expect that future new algorithm launches will

have significantly less impact on automation increases and associated gross margin expansion.

***Research and development expenses***

Research and development expenses increased $7.7 million, or 21%, to $43.5 million during the year

ended December 31, 2024, compared to $35.9 million during the year ended December 31, 2023. The

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increase in research and development expenses was primarily attributable to an increase of $3.7 million

in personnel and related expenses directly associated with an increase in headcount, $2.0 million in

consulting and professional fees, $1.2 million in software-related costs, $0.5 million in clinical trial

expenses and $0.5 million of capitalized internal-use software costs, partially offset by a $0.6 million

decrease in allocated overhead. Personnel and related expenses included $2.2 million and $3.3 million of

stock-based compensation costs during the year ended December 31, 2024 and 2023, respectively.

***Selling, general and administrative expenses***

Selling, general and administrative expenses increased $17.0 million, or 18%, to $112.2 million during the

year ended December 31, 2024, compared to $95.1 million during the year ended December 31, 2023.

The increase in selling, general and administrative expenses was primarily attributable to an increase of

$13.5 million in personnel and related expenses directly associated with an increase in headcount,

$5.3 million in professional fees, including legal, audit and consulting fees, and $1.7 million in marketing

expenses, partially offset by a decrease of $1.0 million in software-related costs and $2.9 million of

capitalized commission costs. Personnel and related expenses included $7.8 million and $8.7 million of

stock-based compensation costs for the year ended December 31, 2024 and 2023, respectively.

***Interest expense, net***

Interest expense, net decreased to an expense of $18.7 million during the year ended December 31,

2024, compared to an expense of $19.2 million during the year ended December 31, 2023. This

decreased expense was attributable to more favorable interest rates under the 2024 Term Loan. As of

December 31, 2024 and 2023, the aggregate outstanding principal balance (including interest paid-in-

kind) under our 2024 Term Loan was $138.1 million and $138.1 million, respectively.

***Other expense, net***

Other expense, net increased to an expense of $16.4 million during the year ended December 31, 2024,

compared to an expense of $3.0 million during the year ended December 31, 2023. The increase was

primarily attributable to the remeasurement and recognition of the change in fair value related to our

common stock warrant liability of $14.1 million. Other expense, net also included the remeasurement and

recognition of the changes in fair value related to our Convertible Notes through their conversion in March

2023 and to the derivative liability through the 2024 Term Loan Refinancing (as defined below) in June

2024. ***Provision for income taxes***

Provision for income taxes was $547,000 and $53,000 for the years ended December 31, 2023 and 2024,

respectively, related to our foreign taxes.

**Selected quarterly results of operations data**

The following table sets forth selected unaudited quarterly consolidated statements of operations data for

each of the four fiscal quarters during the years ended December 31, 2023 and 2024 and the fiscal

quarter ended March 31, 2025. The unaudited information for each of these quarters has been prepared

in accordance with U.S. generally accepted accounting principles ("GAAP"), on the same basis as our

audited annual consolidated financial statements included elsewhere in this prospectus and includes, in

the opinion of management, all adjustments, consisting only of normal recurring adjustments, necessary

for the fair statement of the results of operations for these periods. This data should be read in

conjunction with our consolidated financial statements and related notes included elsewhere in this

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prospectus. These historical quarterly operating results are not necessarily indicative of our operating

results for the full year or any future period.

---

| | | | | | | | | | |
|:---|:---|:---|:---|:---|:---|:---|:---|:---|:---|
|  | **Three months ended** | **Three months ended** | **Three months ended** | **Three months ended** | **Three months ended** | **Three months ended** | **Three months ended** | **Three months ended** | **Three months ended** |
| **(in thousands)** | **March 31,** <br>**2023**<br>| **June 30,** <br>**2023**<br>| **September** <br>**30, 2023**<br>| **December** <br>**31, 2023**<br>| **March 31,** <br>**2024**<br>| **June 30,** <br>**2024**<br>| **September** <br>**30, 2024**<br>| **December** <br>**31, 2024**<br>| **March 31,** <br>**2025**<br>|
| Revenue........................................... | $18844 | $21412 | $22753 | $24165 | $26843 | $31054 | $32934 | $34977 | $37205 |
| Gross profit...................................... | 11314 | 13978 | 15851 | 16908 | 19423 | 23839 | 24937 | 26250 | 27941 |
| Total operating expenses.............. | 31764 | 32528 | 30731 | 35942 | 35481 | 38016 | 39866 | 43208 | 45443 |
| Loss from operations..................... | (20450) | (18550) | (14880) | (19034) | (16058) | (14177) | (14929) | (16058) | (17502) |
| Net loss............................................ | $(30755) | $(22710) | $(19599) | $(22591) | $(20932) | $(23379) | $(19140) | $(32975) | $(32345) |

---

***Quarterly trends***

*Revenue*

Our quarterly revenue increased sequentially in each of the periods presented primarily due to revenue

growth from the expansion of revenue cases volume within our existing installed base and the addition of

new customers.

*Cost of revenue and gross margin*

With the exception of the three months ended September 30, 2023, cost of revenue generally increased

sequentially in each of the quarters presented, driven by increased sales. During the three months ended

September 30, 2023, cost of revenue decreased as we introduced the automation of certain manual

components of our production teams process thereby resulting in decreased personnel and related

expenses and allocated overhead.

Our quarterly gross margins have fluctuated between 60% and 77% in each period presented.

***Operating expenses***

Total operating expenses have generally increased sequentially in each period presented with the

exception of the three months ended September 30, 2023 and March 31, 2024. Operating expenses

fluctuated primarily due to timing of consulting projects, legal and professional expenses, clinical studies,

stock-based compensation and the capitalization of internal-use software costs.

**Liquidity and capital resources**

***Sources of liquidity***

As of March 31, 2025, we had $109.8 million in cash and cash equivalents and an accumulated deficit of

$1.0 billion, compared to $51.4 million in cash and cash equivalents and an accumulated deficit of $971.0

million as of December 31, 2024. Since inception, we have primarily funded our operations with proceeds

from sales of shares of our redeemable convertible preferred stock, common stock and convertible

promissory notes, borrowings under our term loans and revenue received from our customers, which we

expect to be our primary source of future liquidity. During the years ended December 31, 2023 and 2024,

we incurred significant operating losses and net cash outflows from our operations, which resulted in an

increase in stockholders' deficit, a reduction in working capital, and a net liabilities position as of

December 31, 2024. On January 24, 2025 and January 31, 2025, we reduced our outstanding

indebtedness under our 2024 Term Loan by $23.0 million, decreased our accrued cash compensation

within accrued expenses and other current liabilities to certain employees by $1.3 million, and also

received $24.0 million in cash in exchange for the issuance of $48.3 million in aggregate principal amount

of 2025 Convertible Notes, as described below. In March 2025, we issued an additional $50.0 million in

aggregate principal of 2025 Convertible Notes to an investor. As of March 31, 2025, we had $98.3 million

outstanding under our 2025 Convertible Notes and $115.1 million outstanding under our 2024 Term Loan

which have respective maturities of 48 months from their issue date and June 14, 2028.

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***Hayfin credit agreement***

On June 14, 2024, we entered into a Credit Agreement and Guaranty for a $138.1 million term loan to

refinance the outstanding obligations under the initial credit agreement we entered into with Hayfin on

January 19, 2021 and the additional term loans entered into with Hayfin on March 17, 2022 in exchange

for the payment of exit fees and early prepayment fees in the aggregate amount of $8.3 million payable in

sixteen equal quarterly installments, or immediately upon the occurrence of a financing event, including

but not limited, to the completion of this offering. On January 24, 2025, in connection with the issuance of

the 2025 Convertible Notes as further described below, we entered into Amendment No. 1 to the Credit

Agreement and Guaranty (as amended, the "2024 Credit Agreement") to amend the terms and conditions

governing the term loan outstanding thereunder (as amended, the "2024 Term Loan"). In connection with

the refinancing of the original 2021 Credit Agreement with Hayfin with the 2024 Term Loan (the "2024

Term Loan Refinancing"), we remeasured the fair value of the derivative liability immediately before the

2024 Term Loan Refinancing and recognized a $0.2 million loss from the change in fair value in the

consolidated statements of operations and comprehensive loss for the year ended December 31, 2024.

The associated current fair value of the derivative liability of $1.1 million, as remeasured at the date of

2024 Term Loan Refinancing, was derecognized and recorded as a debt discount to the 2024 Term Loan

on the consolidated balance sheet.

The 2024 Term Loan matures on June 14, 2028 and bears interest equal to the sum of (i) 7.0% (or 6.0% if

the alternative base rate ("ABR") is in effect) plus (ii) the greater of (x) the forward-looking term rate based

on Secured Overnight Financing Rate ("SOFR") for a respective tenor in effect on such day (or the

alternative base rate, if applicable), and (y) 2.0%. The ABR equals to the sum of (i) 6.0% plus (ii) the

greater of (1) the Wall Street Journal Prime Rate, plus 0.5%, (2) the Federal Reserve Bank of New York

rate plus 0.5% or (3) CBA Term SOFR for one month tenor plus 1.0%. We have an option to pay interest

in-kind at the rate equal to the cash interest rate plus 1.0% through the last interest period ending before

the 18th month anniversary of the 2024 Credit Agreement. We have an option to prepay the 2024 Term

Loan subject to a prepayment fee of 1.5% for prepayments after the second anniversary but on or prior to

the third anniversary of the 2024 Term Loan and a prepayment fee of 3% for prepayments thereafter. The

2024 Term Loan must be repaid in full immediately upon the occurrence of a change in control. In

connection with the completion of this offering, we are obligated to use certain of the net proceeds from

this offering to repay the 2024 Term Loan in an amount equal to the lesser of (i) the net cash proceeds of

this offering in excess of $150.0 million and (ii) $50.0 million (or $55.0 million if the underwriters exercise

any portion of their option to purchase additional shares).

The 2024 Credit Agreement contains customary representations and warranties, events of default and

affirmative and negative covenants, including, among others, covenants that limit or restrict our (and our

subsidiaries) ability to incur additional indebtedness, grant liens, merge or consolidate, make acquisitions,

pay dividends or other distributions or repurchase equity, make investments, dispose of assets and enter

into certain transactions with affiliates, in each case subject to certain exceptions. Financial covenants

require us to maintain a $15.0 million minimum liquidity balance in cash and cash equivalents at all times

and minimum net sales for twelve consecutive month periods ending on the last day of a fiscal quarter,

which is not tested as long as the we maintain minimum liquidity of at least $60.0 million and there has

been no decline in net sales for two-consecutive fiscal quarters at the end of such fiscal quarter. The

minimum twelve months trailing net sales covenant increases each quarter and is $78.8 million for the

quarter ended June 30, 2024 up to a minimum net sales amount of $110.0 million for the quarter ended

June 30, 2025 and each quarter thereafter. Events of default in the 2024 Credit Agreement include,

among others, non-payment of principal, interest or fees, violation of covenants, inaccuracy of

representations and warranties, bankruptcy and insolvency events, material judgments, cross-defaults to

material contracts and events constituting a change of control. Upon the occurrence of an event of

default, the interest rate applicable to the 2024 Term Loan shall increase by 3.0% per annum and the

outstanding principal balance, along with any accrued interest, shall become immediately due and

payable. As of March 31, 2025, the aggregate outstanding principal balance under the 2024 Term Loan

was $115.1 million and the effective interest rate was 15.2%. As of March 31, 2025, we were in

compliance with the 2024 Credit Agreement covenants.

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***Convertible notes***

During the period from September 2022 through December 2022, we issued convertible promissory notes

(the "2022 Convertible Notes") to certain investors (the "2022 Convertible Notes Investors"), with an

aggregate principal amount of $40.0 million. The 2022 Convertible Notes bore interest at a rate of 8% per

annum, compounded monthly. The aggregate principal amount and interest accrued on the 2022

Convertible Notes was due September 30, 2026, and could not be prepaid by us without the consent of a

majority of the 2022 Convertible Notes Investors.

In March 2023, we completed a Qualified Financing (as defined in the 2022 Convertible Notes) and all of

the 2022 Convertible Notes, including principal and interest, were converted into 21,465,064 shares of our

Series F-1 redeemable convertible preferred stock. In connection with the conversion of the 2022

Convertible Notes into the shares of our Series F-1 redeemable convertible preferred stock, we

derecognized the 2022 Convertible Notes in our consolidated balance sheet. We remeasured the fair

value of the 2022 Convertible Notes immediately before the conversion and recognized a $5.1 million loss

from the change in fair value in the consolidated statements of operations and comprehensive loss for the

year ended December 31, 2023.

In January and March 2025, we issued convertible promissory notes to various investors and certain

employees (the "Requisite Holders") in the aggregate amount of $98.3 million, which was comprised of

$74.0 million in aggregate principal amount of notes issued for cash consideration, $1.3 million in

aggregate principal amount of notes issued in lieu of cash compensation to certain employees and $23.0

million in aggregate principal amount of notes issued in the 2024 Term Loan Conversion (collectively, the

"2025 Convertible Notes"). The 2025 Convertible Notes are due and payable in full 48 months from the

issue date. Upon completion of an IPO transaction, the 2025 Convertible Notes shall automatically

convert into shares of our common stock at the IPO price per share at the lower of a 20% discount and a

valuation cap of $2.0 billion on a pre-money basis. In the event we complete a sale of shares of our

preferred stock, the Requisite Holders may elect to convert the outstanding 2025 Convertible Notes into

shares of such series of preferred stock at the same terms. Further, upon a change of control transaction,

the Requisite Holders may elect to convert the outstanding 2025 Convertible Notes into shares of our

common stock at the lower of a 20% discount to the implied price per share of common stock in the

change of control transaction and a valuation cap of $2.0 billion on a pre-money basis, or receive

payment of all principal and any accrued but unpaid 2025 Convertible Notes paid in-kind ("PIK") interest.

The 2025 Convertible Notes do not accrue interest for one year following the date of issuance. Following

the one-year anniversary of the issue date and for the remainder of the term, the 2025 Convertible Notes

interest will accrue on an annual basis at the rate of 7.0% per annum. All PIK interest accrued and

payable will be paid by capitalizing such interest on an annual basis and adding it to the outstanding

principal amount of the 2025 Convertible Notes.

In connection with the issuance of the 2025 Convertible Notes, we entered into Amendment No.1 to the

2024 Credit Agreement, in which our lender, Hayfin, converted $23.0 million of principal under the 2024

Term Loan to 2025 Convertible Notes under the same terms as the other purchasers of the 2025

Convertible Notes.

The issuance date estimated fair values of the derivative liability was $11.1 million and $20.8 million in

January and March 2025, respectively, which were recorded as debt discounts. The derivative liability was

remeasured to fair value of $40.9 million as of March 31, 2025, resulting in a loss of $9.0 million within the

consolidated statements of operations and comprehensive loss.

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***Cash flows***

The following table summarizes our cash flows for each of the periods presented:

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| | | | | |
|:---|:---|:---|:---|:---|
|  | **Year ended**<br>**December 31,** | **Year ended**<br>**December 31,** | **Three months ended** <br>**March 31,** | **Three months ended** <br>**March 31,** |
| **(in thousands)** | **2023** | **2024** | **2024** | **2025** |
| Net cash used in operating activities............. | $(76434) | $(69001) | $(22133) | $(13166) |
| Net cash used in investing activities............. | (6105) | (4357) | (1749) | (1101) |
| Net cash provided by financing activities..... | 169318 | 2237 | 77 | 72922 |

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***Net cash used in operating activities***

Net cash used in operating activities was $76.4 million for the year ended December 31, 2023,

attributable to a net loss of $95.7 million and a net change in operating assets and liabilities of $8.5

million, partially offset by non-cash charges of $27.8 million. Non-cash charges primarily consisted of

$11.9 million in stock-based compensation expense, $5.1 million of change in fair value of convertible

note, $4.7 million of depreciation and amortization, $2.8 million of amortization of debt discount and debt

issuance costs, $2.3 million of change in fair value of common stock warrant and $0.9 million of non-cash

interest charges, partially offset by $4.2 million of change in fair value of derivative liability. The net

changes in operating assets and liabilities primarily consisted of an increase of $9.4 million in accounts

receivable and a decrease of $1.8 million in operating lease liabilities, partially offset by an increase of

$3.8 million in accrued expenses and other current liabilities.

Net cash used in operating activities for the year ended December 31, 2024 was $69.0 million,

attributable to a net loss of $96.4 million and a net change in operating assets and liabilities of

$10.9 million, partially offset by non-cash charges of $38.3 million. The non-cash charges primarily

consisted of $10.2 million in stock-based compensation expense, $16.4 million of change in fair value of

common stock warrant, $5.4 million of depreciation and amortization, $2.7 million of amortization of right-

of-use asset, $2.0 million of non-cash interest charges and $1.6 million of amortization of debt discount

and debt issuance costs. The increase in net operating assets was primarily due to an increase of $3.8

million in accounts receivable, a $1.0 million increase in prepaid expenses and other current assets, a

$2.7 million increase in other non-current assets and a $3.2 million decrease in operating lease liabilities.

Net cash used in operating activities during the three months ended March 31, 2024 was $22.1 million,

attributable to a net loss of $20.9 million and a net change in operating assets and liabilities of

$6.8 million, partially offset by non-cash charges of $5.6 million. The non-cash charges primarily consisted

of $2.7 million in stock-based compensation expense, $1.2 million of depreciation and amortization, $0.7

million of amortization of right-of-use asset, $0.7 million of amortization of debt discount and debt

issuance costs, and $0.2 million of non-cash interest charges. The decrease in net operating assets was

primarily due to a $0.7 million increase in prepaid expenses and other current assets, a $0.3 million

increase in other non-current assets, a decrease of $1.5 million in accounts receivable, a $0.4 million

decrease in accounts payable, a decrease of $6.0 million in accrued expenses and other current

liabilities, and a $0.7 million decrease in operating lease liabilities.

Net cash used in operating activities during the three months ended March 31, 2025 was $13.2 million,

attributable to a net loss of $32.3 million and a net change in operating assets and liabilities of

$2.5 million, partially offset by non-cash charges of $16.7 million. The non-cash charges primarily

consisted of $2.5 million in stock-based compensation expense, $9.0 million of change in fair value of

derivative liability, $1.6 million of change in fair value of common stock warrant, $1.4 million of

depreciation and amortization, $0.7 million of amortization of right-of-use asset, $0.5 million of non-cash

interest charges and $1.0 million of amortization of debt discount and debt issuance costs. The increase

in net operating assets was primarily due to an increase of $3.6 million in accounts receivable, a $0.4

million increase in prepaid expenses and other current assets, a $0.3 million increase in other non-current

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assets, a $9.3 million increase in accrued expenses and other current liabilities, a $1.6 million decrease in

accounts payable and a $0.9 million decrease in operating lease liabilities.

***Net cash used in investing activities***

Net cash used in investing activities for the year ended December 31, 2023 was $6.1 million consisting of

purchases of property and equipment.

Net cash used in investing activities for the year ended December 31, 2024 was $4.4million consisting of

purchases of property and equipment.

Net cash used in investing activities for the three months ended March 31, 2024 was $1.7 million

consisting of purchases of property and equipment.

Net cash used in investing activities for the three months ended March 31, 2025 was $1.1 million

consisting of purchases of property and equipment.

***Net cash provided by financing activities***

Net cash provided by financing activities for the year ended December 31, 2023 was $169.3 million,

primarily attributable to net proceeds of $169.0 million from the issuance of our Series F redeemable

convertible preferred stock.

Net cash provided by financing activities for the year ended December 31, 2024 was $2.2million primarily

attributable to $4.6million in proceeds from the exercise of stock options offset by payments of $2.3

million in exit, prepayment penalty and lender fees related to our 2024 Term Loan Refinancing.

Net cash provided by financing activities during the three months ended March 31, 2024 consisted

primarily of $77,000 in proceeds from the exercise of stock options.

Net cash provided by financing activities during the three months ended March 31, 2025 consisted

primarily of $73.9 million in net proceeds from the issuance of our 2025 Convertible Notes, $0.6 million in

proceeds from the exercise of stock options, offset by $0.5 million in exit and prepayment penalty fees

related to our 2024 Term Loan and $1.0 million in payments of deferred IPO offering costs.

***Future funding requirements***

Based on our current operating plan, we believe that the expected cash generated from revenue

transactions with customers and our cash and cash equivalents of $109.8 million as of March 31, 2025,

which includes the $75.3 million in proceeds from our January and March 2025 convertible promissory

notes offering, will be sufficient to fund our planned operating expenses and capital expenditure

requirements for at least the next 12 months. Our losses primarily resulted from the costs incurred in the

development and sales and marketing of our products and providing general and administrative support

for our operations. We expect to continue to incur losses and to expend significant amounts of cash in the

foreseeable future as we continue to scale our business, invest in research and development activities,

increase sales and marketing efforts to support commercial expansion, and increase general and

administrative expenses to support being a publicly-traded company. Our ability to meet our short term

requirements and plans for cash do not include the net proceeds from this offering. We have based our

estimate of future funding requirements on assumptions that may prove to be wrong, and we could

deplete our capital resources sooner than we expect. We may experience lower than expected cash

generated from operating activities or greater than expected capital expenditures, cost of revenue, or

operating expenses, and may need to raise additional capital to fund operations, further research and

development activities, or acquire, invest in, or in-license other businesses, assets, or technologies.

In the long term, our ability to support our working capital and capital expenditure requirements will

depend on many factors, including the following:

• the market acceptance of our products;

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• the timing, scope, rate of progress, results and costs of our research and development activities;

• the number, scope and duration of current or future clinical studies and additional regulatory

clearances or approval;

• the effect of competing technological and market developments;

• the costs and timing of future commercialization activities, including marketing and sales, for

Heartflow Plaque Analysis and any other new products;

• the amount of revenue, if any, received from commercial sales of our Heartflow Plaque Analysis and

any other new products;

• the impact of competitors' products and technological advances and other market developments;

• the expenses needed to attract and retain skilled personnel;

• the size of the markets and degree of market acceptance of any products in territories in which we

receive regulatory approval, including product pricing, product coverage, and the adequacy of

reimbursement by third-party payors;

• Whether we acquire third-party companies, products or technologies;

• Restructuring, refinancing or repayment of debt;

• the increase in the number of our employees to support growth initiatives;

• the cost of attaining, defending and enforcing our patents and other intellectual property rights;

• the timing of when we pay our operating expenses;

• the costs associated with being a public company; and

• other factors, including economic uncertainty, geopolitical tensions, healthcare reform and changes in

administration, which may exacerbate the magnitude of the factors discussed above.

Furthermore, our operating plans may change, and we may need additional funds to meet operational

needs and capital requirements for clinical trials and other research and development expenditures.

Should we obtain additional equity or debt financing to satisfy our liquidity needs, the issuance of

additional debt or equity securities could be dilutive to existing stockholders. Furthermore, any new

securities could have rights that are senior to existing stockholders and could contain covenants that

would restrict operations. There can be no assurance that we will generate sufficient future cash flows

from operations or that financing will be available on terms commercially acceptable to us or at all. If we

are unable to obtain future funding, we would curtail expenses by reducing some of our research and

development programs and commercialization efforts in order to maintain liquidity, if necessary.

**Contractual obligations and commitments**

Our contractual commitments will have an impact on our future liquidity. These commitments include

future payments on non-cancellable facility leases, purchase obligations related to research and

development and professional services under non-cancellable contracts, royalty obligations for exclusive

technology licensing agreements and future payments on our 2024 Term Loan and 2025 Convertible

Notes. Where applicable, we calculate our obligation based on termination fees that can be paid to exit

the contract.

***Lease agreements***

We have operating lease arrangements for office space in Mountain View, California, Santa Rosa,

California, San Francisco, California, Austin, Texas, and Tokyo, Japan. As of March 31, 2025 we had total

lease payment obligations under non-cancelable leases of $27.5 million, including $4.2 million payable

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through December 31, 2025. See Note 6 to our consolidated financial statements included elsewhere in

this prospectus.

***Royalty payments***

We entered into various exclusive technology licensing agreements that requires us to make annual

royalty payments in fixed amounts as well as certain milestone and revenue-based payments. As of

March 31, 2025, the remaining aggregate royalty obligations under these agreements is $0.3 million, of

which minimum royalty obligations have been met for 2025. See Note 7 to our consolidated financial

statements included elsewhere in this prospectus.

***2024 Term Loan***

The principal balance on debt outstanding under our 2024 Term Loan as of March 31, 2025 was

$115.1 million and approximately $10.0 million of interest is payable through December 31, 2025. See

Note 8 to our consolidated financial statements included elsewhere in this prospectus.

***2025 Convertible Notes***

The principal balance outstanding under our 2025 Convertible Notes as of March 31, 2025 was

$98.3 million. The 2025 Convertible Notes do not accrue interest for one year following the date of

issuance. See Note 9 to our consolidated financial statements included elsewhere in this prospectus.

**Recently issued accounting pronouncements**

A description of recently issued accounting pronouncements that may potentially impact our financial

position, results of operations or cash flows is disclosed in Note 2 to our consolidated financial statements

included elsewhere in this prospectus.

**Critical accounting policies and estimates**

Our management's discussion and analysis of our financial condition and results of operations is based

on our consolidated financial statements, which have been prepared in accordance with U.S. GAAP. The

preparation of these consolidated financial statements requires us to make estimates and assumptions

that affect the reported amounts of assets, liabilities, revenue, expenses and related disclosures. Our

estimates are based on our historical experience and various other factors that we believe are reasonable

under the circumstances, the results of which form the basis for making judgments about the carrying

value of assets and liabilities that are not readily apparent from other sources. Actual results may differ

from these estimates under different assumptions or conditions and any such differences may be

material.

While our significant accounting policies are described in more detail in Note 2 to our consolidated

financial statements included elsewhere in this prospectus, we believe that the following discussion

addresses our most critical accounting policies, which are those most important to our financial condition

and results of operations and require our most difficult, subjective and complex judgments.

***Common stock warrants***

We have issued freestanding warrants to purchase shares of common stock in connection with our 2024

Term Loan. We classify these warrants as a liability because they do not meet the equity indexation

criteria. We record the fair value of the warrant on the consolidated balance sheet upon issuance and is

subject to remeasurement at each balance sheet date. The changes in the fair value of the warrants are

recorded in the consolidated statements of operations and comprehensive loss. We utilize the Black-

Scholes option-pricing model, which incorporates assumptions and estimates, to value the common stock

warrant liability. Significant estimates and assumptions impacting fair value include the stock price,

contractual term, expected volatility and weighted average risk-free interest rate.

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The estimated aggregate fair value of the warrants issued in connection with the 2024 Term Loan in

January 2021 and March 2022 was $4.3 million and $3.5 million, respectively. We recognized a $2.3

million and $16.4 million loss from the change in fair value in the consolidated statements of operations

and comprehensive loss during the years ended December 31, 2023 and 2024, respectively. We

recognized a $1,000 gain and $1.6 million loss from the change in fair value in the consolidated

statements of operations and comprehensive loss during the three months ended March 31, 2024 and

2025, respectively.

***Derivative liability***

Term Loan

Prior to the 2024 Term Loan Refinancing in June 2024, we determined that our 2024 Term Loan contained

certain prepayment features, default put option and default interest adjustment features that were

determined to be embedded derivatives requiring bifurcation and separate accounting as a single

compound derivative. The impact of bifurcation of the embedded derivative on the date of issuance was

reflected as a debt discount. The instrument was classified as a liability on the consolidated balance sheet

and is subject to remeasurement at each balance sheet date. Any change in fair value of the derivative

liability is recognized in the consolidated statements of operations and comprehensive loss.

We utilize both the Black-Scholes-Merton and option-pricing method, which incorporates certain

assumptions and estimates, to value the derivative liability. These include the estimated time and

probability of a business combination or IPO, default, change of control and incurrence of new debt,

weighted common stock value, debt yield, expected volatility and risk-free interest rate.

The estimated fair value of the derivative liability was $2.1 million at the issuance date in January 2021.

We recognized a $4.2 million gain and $0.2 million loss from the change in fair value in the consolidated

statements of operations and comprehensive loss during the years ended December 31, 2023 and 2024,

respectively. In connection with the 2024 Term Loan Refinancing on June 14, 2024, the associated

current fair value of the derivative liability of $1.1 million, as remeasured at the date of 2024 Term Loan

Refinancing, was derecognized and recorded as a debt discount to the 2024 Term Loan.

2025 Convertible Notes

The 2025 Convertible Notes were determined to contain certain settlement features and conversion put

options which require bifurcation and separate accounting as a single compound embedded derivative.

The fair value of the derivative liability was recorded at the issuance dates as debt discounts and

reductions to the carrying value of the 2025 Convertible Notes on the consolidated balance sheet. The

derivative liability is remeasured to fair value at each reporting period and the related changes in fair

value are recorded on the consolidated statements of operations and comprehensive loss.

The fair value of the derivative liability was estimated using a scenario-based analysis comparing the

probability-weighted present value of the 2025 Convertible Notes with and without the bifurcated features.

We utilize both the Monte Carlo Simulation and option-pricing method, which incorporates certain

assumptions and estimates, to value the derivative liability. These include the estimated time and

probability of an IPO and change of control, with resulting cash flows discounted using appropriate

discount rates.

The issuance date estimated fair values of the derivative liability was $11.1 million and $20.8 million in

January and March 2025, respectively, which were recorded as debt discounts. The derivative liability was

remeasured to fair value of $40.9 million as of March 31, 2025, resulting in a loss of $9.0 million within the

consolidated statements of operations and comprehensive loss.

***Stock-based compensation***

Stock-based compensation related to share-based awards granted to employees, consultants and to

members of our board of directors is measured at fair value. Compensation expense for those awards is

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recognized on a straight-line basis over the requisite service period, which is generally the vesting period.

For performance-based stock options, we assess the probability of performance conditions being

achieved in each reporting period. The amount of stock-based compensation expense recognized in any

one period related to performance-based stock options can vary based on the achievement or anticipated

achievement of the performance conditions. We account for forfeitures of stock-based awards as they

occur.

We estimate the fair value of each option award on the date of grant using the Black-Scholes option -

pricing model. This model requires the use of highly subject assumptions to determine the fair value,

including:

• *Fair value of common stock.* See the subsection titled "—Determination of fair value of common

stock" below.

• *Expected term.* The expected term represents the period that the stock-based awards are expected to

be outstanding. The expected term for our stock options was calculated based on the weighted-

average vesting term of the awards and the contract period, or simplified method.

• *Expected volatility.* Since we are not yet a public company and do not have any trading history for our

common stock, the expected volatility was estimated based on the average historical volatilities of

common stock of comparable publicly traded entities over a period equal to the expected term of the

stock option grants. The comparable companies were chosen based on their size, stage of their life

cycle or area of specialty.

• *Risk-free interest rate.* The risk-free interest rate is based on the U.S. Treasury yield in effect at the

time of grant for zero-coupon U.S. Treasury notes with maturities approximately equal to the expected

term of the awards.

• *Expected dividend yield.* The expected dividend yield is zero as we have not paid dividends nor do we

anticipate paying any dividends on our common stock.

We expect to continue to grant equity-based awards in the future, and to the extent that we do, our stock-

based compensation expense recognized in future periods will likely increase.

Based on the assumed initial public offering price per share of $17.50, which is the midpoint of the

estimated offering price range set forth on the cover page of this prospectus, the aggregate intrinsic value

of our outstanding stock options as of March 31, 2025 was $107.7 million, with $83.1 million related to

vested stock options.

See Note 14 to our consolidated financial statements included elsewhere in this prospectus for further

details.

***Determination of fair value of common stock***

As there has been no public market for our common stock to date, the estimated fair value of our common

stock underlying our share-based awards was estimated on each grant date by our management and

approved by our board of directors. Our board of directors exercised reasonable judgment and

considered a number of objective and subjective factors, as well as valuations prepared by independent

third-party valuation firms. The methodologies used to estimate the enterprise value are performed using

methodologies, approaches and assumptions consistent with the American Institute of Certified Public

Accountants Accounting and Valuation Guide, *Valuation of Privately-Held-Company Equity Securities* 

*Issued as Compensation* (the Practice Aid).

In addition to considering the results of independent third-party valuations, our board of directors

considered various objective and subjective factors to determine the fair value of common stock as of

each grant date, including:

• contemporaneous valuations performed by independent third-party specialists;

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• the prices, rights, preferences and privileges of our redeemable convertible preferred stock relative to

those of our common stock;

• the prices of common or preferred stock sold to third-party investors by us and in secondary

transactions or repurchased by us in arms-length transactions;

• lack of marketability of our common stock;

• our actual operating and financial performance;

• current business conditions and projections;

• our stage of development;

• likelihood of achieving a liquidity event, such as an initial public offering or a merger or acquisition of

our company given prevailing market conditions;

• the market performance of comparable publicly traded companies; and

• the U.S. and global capital market conditions.

For our valuations performed, the allocation of these enterprise values to each our share classes utilized

the hybrid method. The hybrid method considered the stay private scenario and IPO exit scenario. In the

stay private scenario, three market methodologies were employed including (i) a market indexing

valuation analysis based on the Series F Preferred financing round, (ii) a guideline public company

analysis based on historical and forecast operating metrics for us, and (iii) a guideline transaction analysis

based on historical and forecast operating metrics for us. In the IPO exit scenario, the total equity value

was estimated based on the expected timing, offering size and pre-money valuation.

The assumptions underlying these valuations represented management's best estimate, which involved

inherent uncertainties and the application of management's judgment. As a result, if we had used

significantly different assumptions or estimates, the fair value of our common stock and our stock-based

compensation expense could be materially different.

Once a public trading market for our common stock has been established in connection with the

completion of this offering, it will no longer be necessary for our board of directors to estimate the fair

value of our common stock in connection with our accounting for share-based payments, as the fair value

of our common stock will be based on the quoted market price of our common stock.

**Off-balance sheet arrangements**

During the periods presented we did not have, nor do we currently have, any off-balance sheet

arrangements as defined in the rules and regulations of the SEC.

**Quantitative and qualitative disclosures about market risks**

***Interest rate risk***

As of March 31, 2025, we had cash and cash equivalents of $109.8 million. Our cash and cash

equivalents are held for working capital purposes. We do not enter into investments for trading or

speculative purposes. Due to the short-term nature of our cash equivalents, we have not been exposed

to, nor do we anticipate being exposed to, material risks due to changes in interest rates.

Our exposures to market risk for changes in interest rates relate primarily to our 2024 Term Loan

(described above) which bears floating interest rates and a rising interest rate environment will increase

the amount of interest paid on these loans. Each 100 basis point increase in these initial rates would

increase annual interest expense by approximately $1.2 million assuming the 2024 Term Loan remain

outstanding for the annual period.

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***Credit risk***

Our cash and cash equivalents, which at times may exceed federally insured limits, is maintained with

large financial institutions. As of the issuance date of the financial statements included in this report, we

have not experienced any losses on our deposits and all of our cash deposits have been accessible to us.

Our accounts receivable primarily relate to revenue from the sale of our products to medical providers. No

customer represented 10% or more of our accounts receivable as of December 31, 2023, 2024 and

March 31, 2025.

***Foreign currency exchange risk***

The vast majority of our cash generated from revenue is denominated in U.S. dollars, with a small amount

denominated in other foreign currencies. Our expenses are generally denominated in the currencies of

the jurisdictions in which we conduct our operations, which are primarily in the United States, United

Kingdom and Japan. Our results of operations and cash flows are, therefore, subject to fluctuations due to

changes in foreign currency exchange rates. The effect of a hypothetical 10% change in foreign currency

exchange rates applicable to our business would not have had a material impact on our consolidated

financial statements during any of the periods presented. As the impact of foreign currency exchange

rates has not been material to our historical operating results, we have not entered into derivative or

hedging transactions, but we may do so in the future if our exposure to foreign currency becomes more

significant.

***Effects of inflation***

Inflation generally affects us by increasing our cost of labor and overhead costs. We do not believe that

inflation has had a material impact on our business, results of operations, or financial condition, or on our

consolidated financial statements included elsewhere in this prospectus.

**Emerging growth company status**

We are an "emerging growth company" under the JOBS Act, which permits us to take advantage of an

extended transition period to comply with new or revised accounting standards applicable to public

companies. We have elected to use this extended transition period until we are no longer an emerging

growth company or until we affirmatively and irrevocably opt out of the extended transition period. As a

result, our consolidated financial statements may not be comparable to companies that comply with new

or revised accounting pronouncements applicable to public companies. The JOBS Act also exempts us

from having to provide an attestation and report from our independent registered public accounting firm

on the assessment of our internal control over financial reporting pursuant to the Sarbanes-Oxley Act of

2002. We will remain an emerging growth company until the earliest of: (i) the last day of the fiscal year

following the fifth anniversary of the completion of this offering; (ii) the last day of the fiscal year in which

we have total annual gross revenue of at least $1.235 billion; (iii) the last day of the fiscal year in which

we are deemed to be a "large accelerated filer" as defined in Rule 12b-2 under the Exchange Act, which

would occur if the market value of our common stock held by non-affiliates exceeded $700.0 million as of

the last business day of the second fiscal quarter of such year; or (iv) the date on which we have issued

more than $1.0 billion in non-convertible debt securities during the prior three-year period.

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**Business**

**Overview**

We have pioneered the use of software and AI to deliver a more accurate and clinically effective non-

invasive solution for diagnosing and managing coronary artery disease ("CAD"), a leading cause of death

worldwide. As of March 31, 2025, our Heartflow Platform has been used to assess CAD in more than

400,000 patients, including 132,000 in 2024 alone. We believe that we are the most widely adopted AI-

powered test for CAD. Our novel platform leverages AI and advanced computational fluid dynamics to

create a personalized 3D model of a patient's heart from a single coronary computed tomography

angiography ("CCTA"), a specialized type of scan that provides detailed images of the heart's arteries.

Our Heartflow Platform delivers actionable insights on blood flow, stenosis, plaque volume and plaque

composition thereby overcoming the limitations of traditional non-invasive imaging tests which rely on

indirect measures of coronary disease and lead to higher false negative and false positive rates, as

demonstrated by our PRECISE trial. We believe the differentiated accuracy and clinical utility of our

Heartflow Platform, along with its ability to enhance workflows, will continue to support our growth and

advance the "CCTA + Heartflow" pathway as the definitive standard for the non-invasive diagnosis and

management of CAD.

Cardiovascular disease is the leading cause of death worldwide, with CAD being the most lethal form.

CAD occurs when plaque—a buildup of cholesterol, fat, calcium and other substances—accumulates on

the walls of the coronary arteries, restricting blood flow and increasing the risk of heart attack or stroke.

This condition is responsible for half of all cardiovascular-related deaths globally. In the United States

alone, the Centers for Disease Control ("CDC") estimates that approximately 805,000 people suffer a

heart attack each year. Despite significant advancements in therapeutic and interventional treatments,

CAD remains a leading cause of death globally because healthcare systems generally lack scalable

methods to efficiently detect, diagnose and quantify CAD at a personalized level.

Based on our analyses using Clarivate's ProcedureFinder data repository, we estimate that there were

approximately 9.5 million non-invasive tests ("NITs") in the United States in 2023 for patients experiencing

stable or acute chest pain, which we refer to as symptomatic CAD patients. These NITs primarily include

stress tests, such as single-photon emission computed tomography ("SPECT"), echocardiography and

positron emission tomography ("PET"), which infer the presence of heart disease based on how well

blood is supplied to the heart, and do not measure the actual disease itself. Accordingly, these tests have

been shown to be unreliable and inconsistent.

CCTA has emerged as a leading non-invasive imaging method for evaluating CAD, offering direct and

detailed visualization of the coronary arteries. Unlike traditional stress-based NITs, CCTA enables

physicians to identify the presence and extent of coronary blockage. As a result, CCTA has become the

preferred first-line test for patients with suspected CAD, as evidenced by the AHA and ACC guidelines

elevating CCTA to Class 1, Level A. However, while CCTA provides superior anatomical imaging, it does

not independently quantify the severity of CAD, assess blood flow limitations, or characterize plaque

composition—critical factors for determining the most appropriate, personalized course of treatment for a

patient.

Our Heartflow Platform builds upon the well established strengths of CCTA by going beyond its limitations

and providing new quantified insights and compelling visualizations of data. By applying our advanced AI-

powered technology to a single CCTA scan, we generate a precise, patient-specific analysis that

quantifies blood flow, measures plaque burden, and characterizes plaque composition—at every point in

the major coronary arteries.

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To date, we have developed three software products (with a fourth product expected to launch in 2026)

under the Heartflow Platform that provide physicians with the critical insights needed to effectively

diagnose and manage CAD:

• *Heartflow RoadMap Analysis* offers a highly intuitive anatomic visualization of the coronary arteries,

helping physicians quickly identify clinically relevant areas to focus their review. We provide Heartflow

RoadMap Analysis to accounts as an integrated feature to enhance the efficiency of their CCTA

program and it is not a stand-alone product.

• *Heartflow FFRCT Analysis* calculates blood flow and pinpoints clinically significant CAD, which is CAD

with a fractional flow reserve ("FFR") value of 0.80 or below, at every point in the major coronary

arteries. FFR measures the severity of blood flow restriction in the coronary arteries on a scale of 1.0

(no restriction) to 0.0 (complete blockage) by assessing pressure differences across a stenosis during

induced stress, guiding decisions on whether a patient requires invasive revascularization.

• *Heartflow Plaque Analysis* provides a comprehensive assessment of coronary plaque, enabling

optimized medical treatment strategies.

• *Heartflow PCI Planner*, which we expect to launch in 2026, will provide advanced visualization and

clinical insights to optimize revascularization strategies, guide device selection, enhance procedural

efficiency, and improve patient care. We plan to provide Heartflow PCI Planner to accounts as an

integrated feature to enhance procedural efficiency, not as a stand-alone product.

We believe we are the first and most widely-adopted AI-powered test for CAD. With over a decade of

commercial presence, we have established a competitively differentiated data set of approximately 110

million annotated images, which is primarily sourced from our commercial relationships with customers,

driving training and refinement of our algorithms for over 10 years and the ability to train new AI models

for future products.

We believe our Heartflow Platform delivers the following key benefits:

• **More accurate non-invasive test for CAD**, clinically validated to provide superior assessment of

blood flow, plaque volume and plaque characterization compared to traditional non-invasive methods.

• **More informed assessments, personalized care, and better risk stratification**, positively

impacting physician decisions on which patients should receive an intervention, supporting more

efficient intervention planning and driving more personalized medical management.

• **Superior economic efficiency and enhanced interventional treatment planning**, accurately

identifying more patients who need interventional treatment while reducing unnecessary invasive

procedures—significantly improving the efficiency of the catheterization lab and therefore hospital

economics.

• **Proprietary, secure bi-directional data communication with customers** that feeds a growing

database of approximately 110 million annotated CCTA images that we leverage to improve the

Heartflow Platform's accuracy, automation and clinical utility and seamlessly deliver new features and

workflow efficiencies to our customers.

• **Improved workflow** through our Heartflow RoadMap Analysis that, as demonstrated in our SMART-

CT study, reduces CCTA interpretation times by approximately 25% and reduces variability between

reviewing physicians by approximately 40%, leading to more consistent diagnoses and standardized

patient care.

• **Better patient and provider experience**, by leveraging a single CCTA for all of our products,

patients complete their test in approximately 20 minutes with significantly lower radiation exposure

compared to nuclear imaging tests such as SPECT and PET that take multiple hours and require

radioactive tracers to be injected into the bloodstream. By providing a definitive diagnosis upfront, the

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Heartflow Platform eliminates the need for layered testing, streamlining the patient journey and

reducing anxiety associated with uncertain or inconclusive results.

We estimate our current market opportunity in the United States for our Heartflow FFRCT Analysis and

Heartflow Plaque Analysis is approximately $5 billion. Based on our analyses using Clarivate's

ProcedureFinder data repository, we estimate that approximately 9.5 million unique stable chest pain

patients receive NITs in the United States annually. In addition, based on our FORECAST randomized

trial, we further estimate that 33% of patients have stenosis levels between 40% and 90%, which results

in approximately 2.8 million patients eligible for our Heartflow FFRCT Analysis in the stable setting. Based

on the Martin paper, where there were approximately 577,000 hospital discharges in the United States in

2020 due to a principal diagnosis of acute chest pain, and the Bhatt paper, where No ST Elevation

("NSTE") related acute chest pain accounted for approximately 70% of acute chest pain, we further

estimate that the annual incidence of patients who have acute chest pain with NSTE is approximately 0.4

million patients. Of these approximately 0.4 million patients, we estimate based on the Kofoed paper that

approximately 70% have obstructive disease and are eligible for our Heartflow FFRCT Analysis, which

results in approximately 0.3 million acute chest pain patients eligible for our Heartflow FFRCT Analysis.

Therefore, we believe there is a market opportunity of approximately 3.1 million patients eligible for our

Heartflow FFRCT Analysis, which, at a U.S. average sales price of $1,067, translates to an estimated

market opportunity of approximately $3.3 billion in the United States.

In addition, we believe our Heartflow Plaque Analysis is applicable to approximately 60% of those 9.5

million NIT patients annually and the majority of patients experiencing acute chest pain. Based on our

PROMISE trial and the Hoffmann paper, we estimate that approximately 60% of CCTA patients have

plaque and are eligible for plaque analysis, which translates to approximately 5.1 million patients eligible

for our Heartflow Plaque Analysis in a stable setting. Based on our internal analysis and the findings in the

Wang paper, where less than 5% of patients were expected to be contraindicated for CCTA, we also

estimate that all of the approximately 0.4 million patients with acute chest pain with NSTE referred to

above will be eligible for our Heartflow Plaque Analysis. Therefore, we believe there is a market

opportunity of approximately 5.5 million patients eligible for our Heartflow Plaque Analysis, which, at an

estimated U.S. sales price of $300, translates to an estimated market opportunity of approximately an

incremental $1.7 billion in the United States.

Beyond the commercialization of Heartflow FFRCT Analysis and Heartflow Plaque Analysis in symptomatic

CAD, we see a significant market opportunity for our technologies in at-risk individuals who show no

symptoms, a segment comprised of approximately 200 million people globally, based on data from the

U.S. Census Bureau, CDC, Eurostat, United Kingdom Office of National Statistics, the Yang paper and

the MacDonald paper. To unlock this potential, we are continuing to evaluate new product opportunities

and appropriate clinical evidence supporting eventual regulatory approval, payor coverage and

commercialization.

We believe the Heartflow Platform is the most extensively studied AI-enabled test for CAD. Our belief is

grounded in our analysis, including that the Heartflow Platform and its accuracy, clinical utility and

economic benefits have been evaluated in over 100 clinical studies and more than 130,000 patients,

including our PRECISE and FORECAST trials, each a large randomized controlled trial, with results

published in over 600 peer-reviewed clinical publications. Our studies, including the PRECISE, NXT and

PACIFIC trials, have consistently demonstrated that the Heartflow Platform is more accurate than

traditional non-invasive tests and highly concordant to invasive testing, reduces unnecessary invasive

testing, and enables physicians to optimize treatment and ultimately provide more efficient care.

We have developed a highly scalable, capital efficient commercial model that combines Territory Sales

Managers ("TSMs") who drive new account adoption with Territory Account Managers ("TAMs") who focus

on increasing utilization by educating referring physicians. Our commercial team does not cover cases or

otherwise spend time in an operating room or lab setting, which enables them to focus solely on driving

commercial adoption and educational activities.

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Our technology is simple and intuitive and does not require the purchase of any capital equipment. Our

onboarding process seamlessly integrates the Heartflow Platform into the customer's daily workflow.

These unique attributes of our business model afford our commercial organization a differentiated level of

efficiency and scalability.

Current clinical guidelines strongly support the adoption of the Heartflow Platform. The CCTA + Heartflow

FFRCT Analysis pathway is supported by the American Heart Association ("AHA") and American College of

Cardiology ("ACC") guidelines, with CCTA identified as a Class 1, Level A test and Heartflow FFRCT

Analysis identified as a Class 2a, Level B test for the diagnosis of CAD in certain patients with stable or

acute chest pain and no known CAD. The AHA and ACC guidelines utilize Classes and Levels to indicate

the strength of a recommendation and the quality of supporting evidence, respectively. Class 1 represents

the strongest recommendation, followed by Class 2a, which represents a moderate recommendation.

Similarly, Level A signifies the highest quality of evidence, while Level B indicates moderate quality.

We believe current reimbursement policies support the adoption of the Heartflow Platform. Our Heartflow

FFRCT Analysis is reimbursed under a dedicated Category I Current Procedural Terminology ("CPT")

code, effective as of January 1, 2024, and has established coverage policies representing approximately

99% of covered lives in the United States. A Category I CPT code was recently established for Heartflow

Plaque Analysis. It will go into effect on January 1, 2026, and is covered by all seven Medicare

administrative contractor ("MACs"). A Category I CPT code designates a procedure or service that uses

device(s) with Food and Drug Administration ("FDA") clearance or approval (when required), is performed

by many physicians across the United States for its intended clinical use, aligns with current medical

practice, and has documented efficacy in literature. The Category I CPT status for our Heartflow FFRCT

Analysis and Heartflow Plaque Analysis validates their widespread use and distinguish them from

emerging technologies that are assigned Category III CPT codes.

We primarily generate revenue on a "pay-per-click" basis each time a physician chooses to review either

our Heartflow FFRCT Analysis, Heartflow Plaque Analysis, or both. Heartflow FFRCT Analysis has served

as our commercial foundation, representing 99% of our total revenue as of March 31, 2025. In the second

half of 2023, we initiated limited market education efforts for Heartflow Plaque Analysis, our second

commercial product. Our Heartflow RoadMap Analysis is generally provided as a workflow efficiency tool

to drive customer retention and loyalty and is not a stand-alone product. We expect to launch our next

product, Heartflow PCI Planner, in 2026 as an integrated feature to enhance procedural efficiency, not as

a stand-alone product.

We have experienced significant revenue growth since we began commercializing the Heartflow Platform

in 2015. We recognized revenue of $125.8 million for the year ended December 31, 2024, compared to

revenue of $87.2 million for the year ended December 31, 2023, representing 44% year-over-year growth.

We recognized revenue of $37.2 million for the three months ended March 31, 2025, compared to

revenue of $26.8 million for the three months ended March 31, 2024, representing 39% growth over the

prior year period. The software-based nature of our Heartflow Platform produces an attractive gross

margin profile, which continues to expand as we leverage AI to automate an increasing portion of our

"human-in-the loop" quality control process, where learnings are fed back into our algorithms to make

them smarter and more efficient. For the twelve months ended December 31, 2024, we generated gross

margins of 75%, an increase of 8 percentage points year-over-year from December 31, 2023. Our net

losses were $95.7 million and $96.4 million for the years ended December 31, 2023 and 2024,

respectively. Our accumulated deficit was $874.5 million and $971.0 million as of December 31, 2023 and

2024, respectively. For the three months ended March 31, 2025, we generated gross margins of 75%, an

increase of 3 percentage points over the three months ended March 31, 2024. Our net losses were $20.9

million and $32.3 million for the three months ended March 31, 2024 and 2025, respectively. Our

accumulated deficit was $1.0 billion as of March 31, 2025.

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**Our success factors**

We believe the continued growth of our company will primarily be driven by the following success factors:

• ***Differentiated approach to the non-invasive diagnosis and management of CAD:*** We are the

first medical technology company authorized for marketing in the United States to leverage software

and AI to accurately and non-invasively diagnose and manage CAD using a single CCTA. As of

March 31, 2025, our Heartflow Platform has been used to assess CAD in more than 400,000 patients,

including 132,000 in 2024 alone. Our Heartflow Platform applies AI and advanced computational fluid

dynamics to generate a personalized 3D model of a patient's heart, delivering actionable data on

blood flow, stenosis, plaque volume and plaque composition. This enables physicians to diagnose

CAD, assess risk and develop individualized care plans without requiring an invasive procedure.

Unlike traditional NITs that use surrogate measures to diagnose heart disease, which results in higher

rates of false negatives and false positives, as demonstrated by our PRECISE trial, the Heartflow

Platform measures and quantifies the actual disease and has been proven to more accurately

diagnose CAD. Our proprietary database of approximately 110 million annotated CCTA images, which

is primarily sourced from our commercial relationships with customers and growing daily, has fueled

ongoing AI-driven algorithm refinement for over a decade—enhancing our platform's value for

patients, physicians, and payors. Our standard commercial agreements provide us with the right to

use submitted images for product support and development. We perform regular updates and

upgrades to the Heartflow Platform and don't charge customers for the rollout of those

enhancements. We believe the unique software technology attributes of our Heartflow Platform will

continue to support our commercial presence and help us establish the CCTA + Heartflow pathway as

the standard of care for the non-invasive diagnosis and management of CAD.

• ***Market leader in AI-powered quantitative CAD analysis with strong customer relationships:*** We

believe our Heartflow Platform is the most widely adopted AI-powered test for CAD, to date, with an

installed base of more than 1,100 accounts in the United States as of December 31, 2024, reflecting a

CAGR of 44% from December 31, 2021, including leading academic institutions, integrated delivery

networks, physician offices and outpatient imaging centers. Our value proposition resonates across

multiple subspecialties, including radiology, cardiology, and interventional cardiology. Our deep

integration into customer workflows and IT infrastructure, including electronic medical record systems,

ensures seamless utilization and efficiency. We believe our long-standing customer relationships,

continuously improving AI-powered software and the highly embedded nature of our customer

integrations will continue to support the rapid adoption of our Platform. Additionally, as we expand our

AI capabilities, introduce new applications such as Heartflow Plaque Analysis, and further optimize

workflow integration, we expect our Platform's value proposition to grow—deepening customer

reliance on our solutions and accelerating broader market penetration.

• ***Attractive revenue model with significant operating leverage potential:*** We primarily generate

revenue on a scalable "pay-per-click" model, in which we charge per physician review of our

Heartflow FFRCT Analysis, Heartflow Plaque Analysis, or both. Utilization rates for Heartflow FFRCT

Analysis typically scale rapidly after onboarding, approaching approximately 33% of CCTA tests within

an account—a level that is generally sustained over time. Utilization rates for an account are

calculated as the number of Heartflow FFRCT Analysis ordered divided by the total number of CCTA

tests performed at an account. Our TAMs measure this utilization rate in the first twelve months

following the onboarding of a new account to ensure onboarding was successful. As CCTA +

Heartflow referral volumes increase, these stable utilization rates translate into increasing Heartflow

revenue cases. These aspects of our revenue model afford us significant predictability and

consistency. Additionally, the AI-based nature of our software platform produces an attractive gross

margin profile that has improved over time as we have leveraged AI to automate an increasing

number of the manual components of our "human-in-the loop" quality control process thereby

lowering the cost of revenue per analysis. For the twelve months ended December 31, 2024, we

generated gross margins of 75%, an increase of 8% year-over-year from December 31, 2023. For the

three months ended March 31, 2025, we generated gross margins of 75%, an increase of 3

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percentage points over the three months ended March 31, 2024. Given our established relationships

and bi-directional data sharing infrastructure with customers, we also have the opportunity to add and

rapidly scale revenue streams from new software products or indications, such as Heartflow Plaque

Analysis, with minimal additional setup and installation cost and effort for our customers. Since

Heartflow Plaque Analysis runs on the same CCTA scan as Heartflow FFRCT Analysis, we expect

favorable operating and gross margin leverage as its adoption increases. We have also developed a

highly scalable enterprise commercial model that combines TSMs who focus on driving new account

adoption with TAMs who educate referring physicians and drive increased volumes at accounts in our

installed base. Unlike traditional medical technology companies, our software is fully cloud-based,

simple to implement, and does not require case coverage or on-site support. This streamlined,

capital-light model enables us to scale efficiently while maintaining a lean commercial footprint. We

believe these structural advantages will enable us to continue investing in growth while advancing

towards profitability.

• ***Large addressable market opportunity with a significant unmet need:*** CAD is a leading cause of

death and a highly prevalent condition worldwide with well-established pathways for diagnosis,

primarily through NITs. In the United States alone, based on our analyses using Clarivate's

ProcedureFinder data repository, we estimate approximately 9.5 million NITs were performed for the

diagnosis of CAD in 2023. However, the majority of these tests measure only surrogate markers for

CAD and are therefore often inaccurate leading to missed diagnosis or unnecessary invasive

procedures. By contrast, CCTA imaging combined with our Heartflow Platform provides a more

accurate and actionable NIT for CAD, driving rapid adoption. We believe this approach will ultimately

become the standard of care. Accordingly, based on our FORECAST randomized trial, our PROMISE

trial, the Wang paper and the Hoffman paper, we believe our market opportunity represents the

approximately 8.6 million patients non-invasively tested for CAD in 2023 that are indicated for our

Heartflow FFRCT Analysis and Heartflow Plaque Analysis products based on their stenosis and plaque

levels, respectively, representing a market value of approximately $5 billion in the United States

alone. While we have rapidly scaled the adoption of our Heartflow Platform to achieve $125.8 million

of revenue in 2024, we believe the Heartflow Platform analyzed only approximately 10% of U.S.

CCTA volumes and represented less than 1% of all NITs in 2023, highlighting a substantial runway for

growth. Looking ahead, we see the potential to expand both our geographic footprint and clinical

applications. Beyond symptomatic CAD, we believe our technology can play a pivotal role in risk

stratification and preventive therapy optimization for the approximately 200 million asymptomatic

individuals globally considered high risk for a cardiac event, based on data from the U.S. Census

Bureau, CDC, Eurostat, United Kingdom Office of National Statistics, the Yang paper and the

MacDonald paper.

• ***Robust and compelling portfolio of clinical evidence:*** We believe the Heartflow Platform is the

most extensively studied AI-enabled test for CAD. Our belief is grounded on our analyses, including

that the Heartflow Platform and its accuracy, clinical utility and economic benefits have been

evaluated in over 100 clinical studies and more than 130,000 patients, including our PRECISE and

FORECAST trials, each a large randomized controlled trial, with results published in over 600 peer-

reviewed clinical publications. Our studies, including the PRECISE, NXT and PACIFIC trials, have

consistently demonstrated that the Heartflow Platform is more accurate than traditional non-invasive

tests and highly concordant to invasive testing, reduces unnecessary invasive testing, and enables

physicians to optimize treatment and ultimately provide more efficient care. As a result, the clinical

evidence demonstrates that the Heartflow Platform reduces unnecessary invasive testing, and

enables physicians to make more informed revascularization decisions, delivering more efficient,

cost-effective care. For example, our PRECISE randomized controlled trial showed that our Heartflow

FFRCT Analysis was 78% more likely than traditional testing to identify patients in need of intervention

and 69% less likely to progress patients to unnecessary invasive testing, leading to 2x the yield of ICA

leading to revascularization such as percutaneous coronary intervention ("PCI") or coronary artery

bypass grafting ("CABG"), compared to standard care. This reduction in unnecessary diagnostic

procedures and higher rate of revascularization procedures represents a clinical benefit for patients

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and significant economic benefit for providers. We believe that our extensive body of clinical evidence

will drive continued adoption, and we expect to continue to invest in evidence generation that will

expand the applicability of our Heartflow Platform into new indications.

• ***Established reimbursement coverage and favorable society support:*** Our rapid growth is

underpinned by a favorable reimbursement landscape and strong clinical guidelines that drive

adoption of the Heartflow Platform. Our Heartflow FFRCT Analysis is reimbursed under a dedicated

Category I CPT code, effective as of January 1, 2024, and has established coverage policies

encompassing approximately 99% of covered lives in the United States. In addition, a Category I CPT

code was also recently established for our Heartflow Plaque Analysis, set to take effect in January

2026. Heartflow Plaque Analysis is already covered by all seven local MAC regions, with five of the

seven MACs issuing final local coverage determinations ("LCD"). We expect to leverage our

experience in establishing commercial policies for Heartflow FFRCT Analysis to efficiently establish

commercial coverage for our Heartflow Plaque Analysis. In addition, CCTA combined with our

Heartflow FFRCT Analysis is supported by the AHA and ACC guidelines, with CCTA a Class 1, Level A

test and FFRCT a Class 2a, Level B test for the diagnosis of CAD in certain patients with stable or

acute chest pain and no known CAD. We believe our favorable reimbursement and society support

provides a strong foundation and tailwind for our continued growth.

• ***Unique and scalable AI, data and R&D capabilities:*** We designed our AI-powered software

platform to be high quality, highly scalable, integrate seamlessly with physician workflows and

improve as we ingest more data, and leverage that data to improve our algorithms' performance and

our business efficiency. Our proprietary technology stack includes secure data transfer software, a

scalable cloud database, a web and mobile interface, quality review tools and an AI algorithm pipeline

that delivers diagnostic accuracy, utility, workflow efficiency, and operational scalability. By harnessing

AI to process massive volumes of cases while maintaining a "human-in-the loop" quality control

process, where learnings are fed back into our algorithms to improve their performance and

efficiency, we have been able to rapidly grow our platform while delivering accurate, timely results for

physicians and patients. We have also built a substantial and growing data asset that has driven

ongoing refinement of our algorithms for more than 10 years with approximately 110 million annotated

CCTA images. Additionally, our bi-directional data sharing relationship with our customers enables us

to deliver even greater value by ensuring they benefit from ongoing feature additions, workflow

enhancements and performance improvements. Unlike traditional CAD diagnostic tools, our AI

platform can be updated with improved features, better performance and can improve from one of the

largest CCTA datasets globally, creating a competitive advantage that continues to grow over time.

We believe our differentiated AI, data and R&D capabilities and proven dedication to improvement

ensures that Heartflow remains at the forefront of precision coronary care.

• ***Experienced leadership team:*** Our senior management team consists of seasoned executives with

deep industry expertise across various disciplines, including biomedical and software engineering,

clinical evidence, medical technology and medical imaging, AI, data science and sales and marketing.

With backgrounds at leading medical technology companies, our leadership has a proven track

record of scaling businesses, securing market adoption and driving innovation.

The convergence of AI advancements, cutting-edge imaging technologies, and broad-based guideline

adoption is accelerating a shift toward more precise, personalized approaches to cardiovascular care. By

integrating anatomical and physiological insights, our technology enables physicians to tailor therapies

more effectively, optimizing treatment decisions and improving patient outcomes. With Heartflow FFRCT

Analysis reimbursement firmly established, growing physician acceptance, and a proven track record of

real-world impact, Heartflow is well-positioned to lead the transformation of coronary care on a global

scale.

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**Our growth strategies**

We believe the following strategies will play a critical role in our continued growth:

• ***Expand adoption of our Heartflow Platform by new accounts:*** We believe that all accounts with

an active CCTA program would benefit from adopting the Heartflow Platform into their workflow in

order to improve efficiency and patient care. We estimate that as of December 31, 2023, there were

approximately 2,700 hospitals and outpatient facilities in the United States that perform CCTA, and

this target account base has grown at a 10% CAGR from 2018 to 2023, based on our analyses using

Clarivate's ProcedureFinder data repository. As of December 31, 2024, we have successfully

deployed our Heartflow Platform in more than 1,100 accounts in the United States. Our TSMs are

responsible for acquiring new accounts. Our TSMs engage with physicians to communicate the value

proposition of the Heartflow Platform, leveraging our large base of clinical evidence to extoll its clinical

and economic benefits. Once onboarded, providers typically reach utilization rates approaching 33%

of CCTAs eligible for Heartflow FFRCT Analysis. Unlike traditional sales models, our TSMs are not

required to support case coverage or ongoing account maintenance, allowing them to focus on new

account acquisition efficiently. We intend to drive further adoption by leveraging our existing 44 TSMs,

as of March 31, 2025, while selectively expanding our team to capture additional geographic

opportunities.

• ***Broaden awareness of the CCTA + Heartflow pathway to drive volume at existing accounts:***

While we have achieved significant commercial adoption to date, including 132,000 patients on our

Heartflow Platform in 2024 alone, we believe this represented less than 1% of our overall market

opportunity of 9.5 million total NITs, and approximately 10%, of current U.S. CCTA volumes. To

expand adoption, we are actively educating physicians on the AHA and ACC chest pain guidelines

that support CCTA plus Heartflow FFRCT Analysis as the preferred pathway for diagnosis and

management of CAD. Our commercial team includes TAMs who are responsible for educating the

cardiologists who refer patients to accounts in our installed base and driving increasing Heartflow

Platform volumes. These TAMs utilize our extensive clinical compendium to educate and train

physicians on the benefits of our platform. Similar to our TSMs, our TAM model is highly efficient and

scalable. We also invest in robust medical education, including peer-to-peer discussions,

symposiums, podium presentations, and other educational events. These initiatives, combined with

strong society support, our leading field presence, and continued technology investment, contribute to

the expansion of both the CCTA market and the CCTA + Heartflow pathway.

• ***Launch and drive adoption of our Heartflow Plaque Analysis product:*** We initiated limited market

education efforts for our second product, Heartflow Plaque Analysis, in the second half of 2023. We

believe there is broad recognition among the cardiology physician community of the importance of

quantifying and characterizing plaque composition as a key indicator of cardiovascular risk. Existing

clinical trials have demonstrated plaque volume and plaque composition correlate with heart attack

risk. There are also multiple pharmaceutical therapies that have proven to slow or halt plaque

progression and reduce the risk of cardiovascular events. However, current non-invasive risk

assessment methods are often inadequate due to their reliance on manual, time-consuming, or

largely visual assessments, leaving physicians with limited actionable data for prescribing optimal

therapies. Our Heartflow Plaque Analysis fills this critical gap in care by enabling rapid and precise

quantification of plaque volume and composition at the vessel and patient level, down to the cubic

millimeter. We believe that broad commercial reimbursement coverage will be important for

widespread adoption of Heartflow Plaque Analysis and are working to secure coverage. In 2024, CMS

assigned Heartflow Plaque Analysis a Category I CPT Code, which will be effective as of January

2026, and as of December 2024, Heartflow Plaque Analysis is covered by all MACs. We intend to

leverage our learnings from the successful reimbursement coverage expansion and commercial

launch of Heartflow FFRCT Analysis to drive commercial coverage and adoption of Heartflow Plaque

Analysis. Since Heartflow Plaque Analysis runs on the same CCTA scan as Heartflow FFRCT

Analysis, we expect favorable operating and gross margin leverage as its adoption increases.

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• ***Invest in additional clinical evidence to support adoption and expand our indications:*** We

believe we have developed the largest clinical evidence base supporting a non-invasive AI-powered

diagnostic for CAD and that our extensive evidence demonstrates the superior accuracy, clinical utility

and economic benefits of our Heartflow Platform relative to other non-invasive methods. We expect to

continue to invest in clinical evidence to extend our leadership position. For example, we are currently

conducting the DECIDE registry, a 20,000-patient study which aims to demonstrate how Heartflow

Plaque Analysis impacts physician decision-making. Beyond the commercialization of Heartflow

FFRCT Analysis and Heartflow Plaque Analysis in symptomatic CAD, we see a significant market

opportunity for our technologies in at-risk individuals who show no symptoms, a segment comprised

of approximately 200 million people globally, based on data from the U.S. Census Bureau, CDC,

Eurostat, United Kingdom Office of National Statistics, the Yang paper and the MacDonald paper. To

unlock this potential, we are continuing to evaluate new product opportunities and appropriate clinical

evidence supporting eventual regulatory approval, payor coverage and commercialization.

• ***Extend our technology leadership through continued investment in our platform:*** Our ongoing

research and development initiatives are focused on introducing products, features and

improvements to maximize customer value. We prioritize advancements in four key areas including:

improving our algorithms by leveraging extensive clinical data to improve accuracy and efficiency;

optimizing clinical utility to better support physicians in diagnosis, patient management, and treatment

planning; enhancing ease of use through seamless workflow integration to improve operational

efficiency; and expanding our platform's applications to serve a broader patient population. By

executing on these priorities, we aim to deepen engagement with existing customers, attract new

ones, and further solidify our leadership in AI-driven cardiovascular diagnostics.

• ***Leverage our platform to pursue adjacent and international markets:*** We believe our installed

base and deeply integrated platform technology approach allows us to add on new analysis and

insights within the same product experience. Our relationships with referring and imaging physicians

provide us with insights into unmet clinical and workflow needs, while our extensive database of

CCTA images and AI capabilities enable us to develop and integrate new algorithm-based solutions.

Additionally, while our current commercial focus is on the U.S. market, we have an existing presence

in the United Kingdom, European Union, Australia, Canada and Japan. In the future we may choose

to selectively expand our geographic footprint by strengthening our presence in existing international

markets, entering new international markets, or exploring adjacent market opportunities in the U.S.

and abroad.

**Market overview and opportunity**

***Overview of CAD***

Cardiovascular disease is the leading cause of death worldwide, with CAD being the most lethal form.

CAD occurs when plaque—a buildup of cholesterol, fat, calcium and other substances—accumulates on

the walls of the coronary arteries, restricting blood flow and increasing the risk of heart attack or stroke.

This condition is responsible for half of all cardiovascular-related deaths globally. Key risk factors,

including high cholesterol, hypertension, smoking, diabetes, obesity, physical inactivity, and genetic

predisposition, accelerate plaque formation and destabilization. In the United States alone, the CDC

estimates that approximately 805,000 people suffer a heart attack each year. The CDC estimates that

approximately 1 in 20 adults over the age of 20 have CAD, which is approximately 12.5 million individuals

with CAD in the United States. The CDC also estimates that CAD killed 371,506 people in 2022. Given its

morbidity and mortality, CAD places a significant cost burden on the healthcare system and is projected to

reach $215 billion by 2035.

CAD is caused by the build-up of calcified and non-calcified plaque in the coronary arteries. This plaque

build-up results in a narrowing of the arteries, or stenosis, which may require an intervention if the

reduction in blood flow caused by the stenosis is determined to be clinically significant. Effectively

diagnosing CAD in order to inform the optimal treatment pathway requires a measurement of the blood

flow through the stenosis as well as quantifying the amount and type of plaque causing the stenosis. For

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example, the foundational FAME 1 and FAME 2 randomized controlled trials showed that deferring

intervention is superior when blood flow, as measured by FFR, was greater than 0.80 but that when FFR

was below this same level, intervention was superior to optimal medical therapy. Similarly, a follow-up

analysis to the foundational SCOT-HEART trial showed that plaque volumes greater than 238 mm<sup>3</sup>

resulted in a 7x greater risk of heart attack than lower plaque volumes and higher concentrations of low-

attenuation plaque burden were associated with a nearly 5x greater risk of heart attack. This is due to the

unstable nature of low-attenuation plaque, which can result in a higher risk of rupture leading to occlusion

of coronary blood flow. Based on these trials, the cardiology community has recognized the importance of

accurately measuring FFR values and characterizing plaque, and has supported this perspective with

clinical guidelines that stratify treatment recommendations based on FFR values and plaque metrics.

***Traditional methods for the non-invasive diagnosis of CAD and their limitations***

When patients present with symptoms of CAD, such as chest pain, they are typically referred for a NIT.

There are two primary types of NITs: stress-based tests, which measure surrogate markers for CAD to

infer the presence of heart disease based on blood perfusion, or CCTA, which directly images the

patient's coronary arteries. Based on the output of a patient's NIT, the imaging physician and managing

physician determine the appropriate next step which can include sending the patient home with only

lifestyle modifications if the disease is not determined to be significant, initiating pharmaceutical therapy if

there is assumed plaque burden without significant stenosis, or sending the patient to catheterization lab

for intervention if there is significant stenosis.

When appropriately diagnosed and managed, CAD can be effectively treated with well-established

therapeutics and devices. These therapeutics, which include statins, PCSK-9s and GLP-1s, among

others, have been proven to effectively manage CAD by reducing plaque progression, changing plaque

composition, and reducing the risks of a major adverse cardiovascular event. Similarly, when indicated,

procedures to open the arteries, including percutaneous coronary intervention with intravascular

lithotripsy, atherectomy and/or stenting, and coronary artery bypass grafting, have been shown over

decades to be highly efficacious in reducing mortality risk and relieving the symptoms of CAD.

*Stress tests*

Stress-based NITs include SPECT, PET and stress echocardiography. These tests use imaging to

evaluate heart function under exercise or pharmacologically-induced stress. The tests image the heart

muscles and identify the differences in blood perfusion to the myocardium between the rest and stress

state images to infer the presence of CAD. Stress-based NITs rely on surrogate markers of CAD to

deduce the disease in the coronary artery without actually assessing the coronary arteries or the disease

itself. According to the 2010 Patel paper, which determined patterns of non-invasive testing and the

diagnostic yield of catheterization among patients with suspected coronary artery disease, these NITs are

inaccurate a majority of the time, and often result in either missed CAD diagnoses or unnecessary

invasive procedures as demonstrated by our PRECISE trial. In the PRECISE trial, among those who

underwent invasive catheterization, in the Usual Care arm (in which most patients initially underwent NIT)

there was 60% incidence of finding no obstructive coronary disease upon catheterization, whereas in the

Precision Care arm this incidence was only 20%. Finding no obstructive disease indicates that, in

retrospect, the procedure was avoidable. As for missed CAD diagnoses, 5.2% of patients in the Usual

Care arm had diagnosis made of CAD requiring revascularization, where 9.2% of patients in the Precision

Care arm had such diagnosis made. This indicates missed diagnosis of significant CAD in 4% of Usual

Care patients, and in approximately 43% of patients with significant CAD.

As a result, approximately 20–50% of patients who undergo stress-based NITs go home with false

negatives, or undetected CAD that should have required an intervention, based on the Nakanishi paper

and the Yokota paper. In addition, based on the 2014 Patel paper, up to 55% of patients receive false

positives and are sent to the cardiac catheterization lab for an invasive diagnostic angiography when an

intervention was never needed exposing patients to unnecessary risks including vascular injury and

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bleeding complications. This results in significant additional costs to the healthcare system and poor

patient experience.

![business1a.jpg](business1a.jpg)

*Figure 3: Traditional non-invasive tests. Left: Stress echocardiogram. Right: SPECT and PET*

*CCTA*

CCTA is a high-resolution 3D imaging method that uses X-rays to produce detailed pictures of the heart's

arteries and other structures. CT imaging itself has been widely available and its use in cardiology is

growing rapidly. The analyses performed by our Heartflow Platform rely on CCTA images from third-party

CT manufacturers. Because CCTA images are used across multiple medical practices, by different

medical professionals and others, CT scanners have historically and currently output CCTA images in

standard file formats rather than proprietary formats. In October 2021, the AHA and ACC elevated CCTA

to a first line Class 1, Level A test in the guidelines for certain patients with stable or acute chest pain and

no known CAD, above stress testing which is Class 1, Level B. This made CCTA a first line test for CAD

owing to the strong evidence supporting its differentiated clinical utility. As of December 31, 2023, we

estimate there were approximately 2,700 sites with an active CCTA program in the United States.

Similarly, CCTA now has guideline support from the European Society of Cardiology Clinical Practice

guidelines on Chronic Coronary Syndromes (1B), is included in the National Institute for Health and Care

Excellence guidelines in the United Kingdom, and in the Japanese Circulation Society 2022 Guidelines in

Japan. We believe these guidelines further support the growth of CCTA tests outside the United States

and specifically in the European Union, United Kingdom and Japan.

Unlike stress-based NITs that rely on indirect functional assessments of heart muscle activity to infer

CAD, CCTA enables direct visualization of the patient's coronary anatomy and can allow for a

comprehensive assessment of coronary stenosis and plaque burden. CCTA has been clinically

demonstrated in the SCOT-HEART trial to have the highest diagnostic performance of all traditional non-

invasive imaging tests for CAD.

The foundational SCOT-HEART randomized controlled trial, highlighted the clinical superiority of CCTA

over traditional stress-based NITs. The study found a significant 41% reduction in the rate of death or

non-fatal heart attacks after five years in patients who underwent CCTA evaluations. The study also

demonstrated that patients in the CCTA group were more likely to be started on lipid lowering, anti-

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hypertensive, anti-platelet, and anti-anginal medication, which improved outcomes in patients with

disease that may not have been detected with stress-based testing alone.

![business2b.jpg](business2b.jpg)

*Figure 4: CCTA image*

With the elevation of CCTA to a Class 1, Level A guideline recommendation by the AHA and ACC

guidelines in 2021, CCTA test volumes have grown at a 22% CAGR from 2018 to 2023 while SPECT

volumes have grown at a 2% CAGR over the same time period, based on our analyses using Clarivate's

ProcedureFinder data repository. We believe CCTA test volumes will continue to grow rapidly, ultimately

replacing other NIT methods based on increasing awareness of the superior diagnostic accuracy,

workflow efficiencies and clinical guideline recommendations. Furthermore, favorable reimbursement

trends are expected to accelerate adoption. In 2025, CMS reimbursement levels for hospital outpatient

CCTA are set to increase by 104% based on the OPPS final rule, published in the Federal Register on

November 27, 2024.

***Catheterization lab-based invasive diagnostics for CAD***

Invasive methods of diagnosing CAD are typically performed in the catheterization lab and provide highly

accurate assessments of blood-flow and plaque. However, they are not practical or cost-effective as a

first-line diagnostic due to procedural risks, patient discomfort, as well as cost and availability of

catheterization lab time. As a result, these technologies are utilized downstream in the catheterization lab

after a patient has been identified as having suspected CAD based on an NIT and referred for an

interventional procedure. Because of the invasive nature of these tests, they serve as valuable reference

points for validating the accuracy of our technology, however, we do not directly compete with them.

These invasive catheter-based procedures, which include FFR and Intravascular ultrasound ("IVUS"),

have been the reference standard for obtaining FFR values and assessing plaque burden for decades.

FFR requires inserting a pressure wire into the coronary arteries under stress conditions to assess the

severity of blood flow restriction and IVUS uses a catheter-based ultrasound probe to directly image

plaque within the arteries.

**Our symptomatic CAD market opportunity**

We estimate our current market opportunity in the United States for our Heartflow FFRCT Analysis and

Heartflow Plaque Analysis is approximately $5 billion. Based on our analyses using Clarivate's

ProcedureFinder data repository, we estimate that there were approximately 9.5 million NITs performed

for the diagnosis of CAD in the United States in 2023. This includes an estimated 6.8 million SPECTs, 0.8

million PETs, 1.2 million stress echocardiograms, and 0.7 million CCTAs, based on our analyses using

Clarivate's ProcedureFinder data repository.

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![business3e.jpg](business3e.jpg)

(1)Clarivate's ProcedureFinder data repository; ~73,000 U.S. Heartflow tests billed in FY23

(2)ZS NIT for CAD Market Assessment, Survey of 246 HCPs and 81 administrators, December 2024

*Figure 5: Pie chart of U.S. non-invasive test market*

CCTA testing volumes have grown 22% between 2018 and 2023, based on our analyses using Clarivate's

ProcedureFinder data repository, and we believe they will continue to outpace the broader NIT market

growth driven by the recently established Class 1, Level A guidelines, due to superior clinical utility

compared to stress-based tests, and improved reimbursement. Of the approximately 9.5 million NITs

performed for the diagnosis of CAD in the United States in 2023, we believe, based on our FORECAST

randomized trial and the Wang paper, there were approximately 8.6 million patients that were addressable

for CCTA after accounting for layered testing due to the inconclusive nature of traditional tests and the

need for multiple re-tests and contraindications to CCTA.

Our Heartflow Platform, which requires a CCTA image from a CT scanner to perform its analysis,

significantly improves the clinical utility of CCTA and addresses the limitations of traditional non-invasive

CAD testing by combining existing CCTA images with our AI algorithms to provide actionable data on

blood flow, stenosis, plaque volume and plaque composition. This delivers superior clinical utility relative

to other NITs and compelling economic benefits, which are supported by extensive clinical evidence. As a

result, we believe the CCTA + Heartflow pathway will become the standard of care for the non-invasive

diagnosis of CAD over time.

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*Addressing the limitations of traditional CAD testing*

![business4f.jpg](business4f.jpg)

*Figure 6: Image of SPECT test result on left; image of Heartflow FFRCT Analysis result on right*

Our Heartflow FFRCT Analysis is reimbursed for use on any CCTA showing 40% to 90% stenosis, which,

based on our FORECAST randomized trial, we estimate to be approximately 33% of all CCTAs annually.

We believe that CCTA + Heartflow FFRCT Analysis therefore is applicable to 33% of the NIT market and a

majority of patients experiencing acute chest pain, which represents 3.1 million patients and an estimated

market opportunity of approximately $3.3 billion in the United States. Our Heartflow Plaque Analysis is

reimbursed for plaque identified on CCTA with 1% to 69% stenosis, which, based on our PROMISE trial

and the Hoffmann paper, we estimate to cover approximately 60% of all CCTAs annually and a majority of

patients experiencing acute chest pain. We believe that CCTA + Heartflow Plaque Analysis is therefore

applicable to 60% of the NIT market, which represents 5.5 million patients and an estimated market

opportunity of an incremental approximately $1.7 billion in the United States.

While our current focus is on the United States and the Heartflow Platform has been cleared by the FDA

(K213857), our Heartflow FFRCT Analysis has commercial presence and regulatory approval in the United

Kingdom, European Union, Australia, Canada and Japan. The Heartflow Platform has also been cleared

by the equivalent regulatory authorities in Israel, Saudi Arabia, United Arab Emirates, and licensed in

Bahrain. In the future we may expand our international presence beyond these markets and extend our

platform to additional indications.

***Asymptomatic CAD market opportunity***

For asymptomatic patients, current clinical practice guidelines (Class 1, Level B) recommend using risk

factors such as age, sex, smoking status, hyperlipidemia, hypertension, and diabetes, among others, to

calculate a risk score, called an ASCVD score, for assessing overall cardiovascular event risk and guiding

preventive therapy. However, this approach does not account for the actual disease state of an

individual's arteries leading to imprecise risk assessment and suboptimal management. As a result,

despite the widespread availability of proven, preventative pharmaceutical treatments, up to 25% of heart

attacks occur in those with no symptoms and approximately 50% of sudden heart deaths occur without

any prior diagnosis or testing according to the Ni paper.

We believe there is a significant opportunity for our Heartflow Platform to materially improve risk

stratification and patient management. Clinical data supports our belief that AI-based risk calculation

predicated on the combination of individual-specific CAD measures enables more accurate and effective

management and preventative measures as compared to those based on an ASCVD score alone. For

example, our EMERALD 2 study showed that combining certain CCTA-derived quantitative features from

coronary physiology via Heartflow FFRCT Analysis and from plaque metrics via Heartflow Plaque Analysis

predicted future plaque rupture more accurately than CCTA alone. Serial AI-based risk assessment of

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asymptomatic patients can also capture temporal changes in disease state and cardiovascular risk, which

can be used to personalize preventative medical therapy over time. We estimate that there are

approximately 200 million patients globally with a high risk of cardiovascular events, of which 71 million

live in the United States, based on data from the U.S. Census Bureau, CDC, Eurostat, United Kingdom

Office of National Statistics, the Yang paper and the MacDonald paper. In the future, we believe certain

sub-segments of this population may be appropriate candidates for our platform.

Beyond the commercialization of Heartflow FFRCT Analysis and Heartflow Plaque Analysis in symptomatic

CAD, we see a significant market opportunity for our technologies in at-risk individuals who show no

symptoms, a segment comprised of approximately 200 million people globally. To unlock this potential, we

are continuing to evaluate new product opportunities and appropriate clinical evidence supporting

eventual regulatory approval, payor coverage and commercialization.

*Our technology*

Heartflow enhances CCTA, the most advanced non-invasive imaging modality for assessing CAD, with

AI-powered analysis to deliver more accurate and clinically actionable insights for diagnosing and

managing CAD. The Heartflow Platform applies deep learning, an advanced form of AI, and

computational fluid dynamics to CCTA images to create a personalized 3D model of a patient's heart

based on a single CCTA image. This model provides actionable insights into blood flow, stenosis, plaque

volume and plaque composition allowing precise diagnosis, risk stratification, and treatment planning –

without the need for an invasive procedure.

The CCTA + Heartflow pathway addresses the limitations of traditional non-invasive tests that only assess

indirect measures for coronary disease and therefore result in higher rates of false negative and false

positive CAD diagnoses, as demonstrated by our PRECISE trial. We believe the differentiated accuracy

and clinical utility of the CCTA + Heartflow pathway will continue to support our growth and advance the

standard for the non-invasive diagnosis and management of CAD.

We designed our AI-powered software platform to be highly scalable, seamlessly integrate into existing

physician workflows for diagnosing CAD, and improve as we ingest more data over time. By leveraging AI

to process massive volumes of cases and a "human-in-the loop" quality control process, where learnings

are fed back into our algorithms to improve their performance and efficiency, we have rapidly scaled our

platform to deliver accurate, timely results to benefit physicians and patients alike. Our cloud-based

technology has enabled us to rapidly scale to an installed base of more than 1,100 accounts in the United

States as of December 31, 2024, reflecting a CAGR of 44% from December 31, 2021. We have also built

a substantial and growing data asset that has driven refinement of our algorithms for over 10 years and

as of March 31, 2025, we have analyzed and annotated approximately 110 million annotated CCTA

images. Additionally, through our bi-directional data sharing relationship with our customers we ensure

platform enhancements, delivering immediate and tangible benefits through new features, workflow

efficiencies, and improved performance.

***The CCTA + Heartflow pathway***

When a patient presents with symptoms of CAD and their physician follows the AHA and ACC Class 1,

Level A chest pain guidelines by referring the patient for a CCTA, the patient will undergo standard CCTA

imaging at the relevant hospital or outpatient facility. At Heartflow-enabled accounts, CCTA images are

securely transmitted directly to our cloud-based platform through our embedded software in the hospital

or outpatient imaging center. Leveraging proprietary AI and advanced computational fluid dynamics, we

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create a personalized, 3D digital model of the patient's coronary arteries, unlocking critical insights

beyond what is visible on standard imaging.

![business5d.jpg](business5d.jpg)

*Figure 7: The CCTA + Heartflow pathway*

Our Heartflow Platform includes a suite of innovative, AI-powered products designed to deliver

comprehensive coronary artery assessment:

1)**Heartflow RoadMap Analysis:** Coronary anatomy modeling that enables clinicians to interpret CCTA

accurately, efficiently and consistently while identifying whether the patient requires further evaluation

with our other products.

2)**Heartflow FFRCT Analysis:** Accurate 3D model of blood flow that identifies clinically-significant CAD

at the lesion level to inform whether the patient requires revascularization and identifies which lesions

should be addressed.

3)**Heartflow Plaque Analysis:** Precise quantification of plaque volume and plaque composition down

to the cubic millimeter to help assess risk and determine optimal medical treatment.

4)**Heartflow PCI Planner:** Will provide advanced visualization and clinical insights to optimize

revascularization strategies, guide device selection, enhance procedural efficiency, and improve

patient care. We expect to launch this product in 2026.

These analyses provide the critical complementary data that are lacking from other non-invasive tests but

that we believe physicians need to diagnose, assess risk and make optimal, patient-specific decisions

about medical and interventional therapies.

![business6e.jpg](business6e.jpg)

*Figure 8: The Heartflow Portfolio*

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Our Heartflow Platform seamlessly integrates into our customer workflows, providing clinically actionable

insights directly to the account in a median turnaround time of 1.6 hours, which we believe is sufficient for

the workflows of our customers. We deliver the Heartflow RoadMap Analysis automatically to the imaging

cardiologist or radiologist for every acceptable CCTA patient at our accounts to help drive more efficient

CCTA interpretation, workflows and revascularization strategies. In conjunction with the Heartflow

RoadMap Analysis, we also provide physicians with a case list that catalogs all their CCTAs and identifies

the cases where our Heartflow FFRCT Analysis, Heartflow Plaque Analysis or both would enable them to

accurately diagnose clinically significant CAD and plan treatment. With a single click, Physicians can

access these analyses on-demand, and we bill the account directly for each product selected. Because

Heartflow FFRCT Analysis and Heartflow Plaque Analysis have distinct clinical indications and dedicated

billing codes, our workflow helps ensure physicians can order the most appropriate analyses for each

patient, supporting both high-quality care and efficient reimbursement processes.

![business7e.jpg](business7e.jpg)

*Figure 9: The Heartflow Platform and workflow*

***The Heartflow Platform portfolio***

**Heartflow RoadMap Analysis**: The Heartflow RoadMap Analysis provides a

![picture1number3.jpg](picture1number3.jpg)

highly intuitive anatomic visualization of the patient's coronary anatomy based

on CCTA images. It rapidly orients the imaging physician to clinically relevant

areas of the patient anatomy and provides a preview of what they will review in

the native CCTA images to aid the physician in accurately, efficiently and

consistently identifying stenosis in the coronary arteries. Heartflow RoadMap

Analysis supports more efficient radiology workflow, improving CCTA read

times by 25% and increasing consistency between reviewing physicians by

approximately 40%, as demonstrated in our SMART-CT study. Physicians use

Heartflow Roadmap Analysis as a first-line assessment tool along with CCTA

interpretation to determine whether to order our more detailed Heartflow

FFRCT Analysis or Heartflow Plaque Analysis reports. The Heartflow RoadMap

Analysis was cleared by the FDA in October 2022, and we began providing it

to our customers in the second quarter of 2023. We generally provide

Heartflow RoadMap Analysis to accounts as an integrated feature to enhance

the efficiency and consistency of their CCTA programs and it is not a stand-

alone product. We believe the efficiency that Heartflow RoadMap Analysis provides our customers has

resulted in enhanced customer loyalty and retention.

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**Heartflow FFRCT Analysis:**Our flagship product, Heartflow FFRCT Analysis,

![prospectussummary5ca.jpg](prospectussummary5ca.jpg)

consists of a patient-specific, interactive, 3D anatomical reconstruction of the

coronary anatomy that identifies clinically significant CAD at every point in the

major coronary arteries to determine the need for intervention. The model is

color-coded along vessel length, indicating Heartflow FFRCT Analysis values

which assist the physician in rapidly and precisely assessing blood flow

through the coronary arteries. Our Heartflow FFRCT Analysis has the highest

diagnostic accuracy for a non-invasive CAD test and has demonstrated a high

level of concordance to invasive FFR, as seen in our PRECISE, NXT and

PACIFIC trials. Our product can measure the FFR value and determine

whether a lesion is clinically significant – a "clinically significant lesion" means

an FFR value of 0.80 or below. Because FFR values are the guideline directed

measure to determine the need for invasive revascularization, this data offers

a more clinically accurate, non-invasive basis for determining the need for

interventional treatment.

Current AHA and ACC guidelines support CCTA + Heartflow FFRCT Analysis as a more efficient care

pathway. The guidelines designate CCTA as a Class 1, Level A test for CAD in certain patients with stable

or acute chest pain and no known CAD, with our Heartflow FFRCT Analysis given a Class 2a, Level B

recognition to help physicians guide patient treatment decisions. This CCTA + Heartflow FFRCT Analysis

pathway enables physicians to identify lesions that require revascularization in less than two hours, and

guidelines recommend patients with positive Heartflow FFRCT Analysisfindings be sent directly to the

cardiac catheterization lab for possible treatment. Comparatively, AHA and ACC guidelines provide stress-

based testing a Class 1, Level B recommendation, suggesting patients with suspected CAD and positive

stress-based test findings first initiate guideline directed medical therapy. Only if symptoms are not

resolved by medical therapy, which can last weeks or months, are patients then sent to the cardiac

catheterization lab.

![business10d.jpg](business10d.jpg)

*Figure 10: AHA and ACC chest pain guidelines*

Our Heartflow FFRCT Analysis is indicated for patients with stenosis levels between 40% and 90% in any

vessel because a physician's review of a CCTA alone may not appropriately identify the need for

treatment in these cases. For example, in the figure below, two patients with >70% stenosis based on

CCTA alone would likely be referred for invasive coronary angiography ("ICA"). However, Heartflow FFRCT

Analysis reveals that while Patient A has an FFRCT value >0.80—indicating no need for intervention—

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Patient B has an FFRCT value <0.80 and should be referred for revascularization. As of March 31, 2025,

Heartflow FFRCT Analysis represented 99% of our total revenue.

![business11f.jpg](business11f.jpg)

*Figure 11: Heartflow FFRCT AnalysisSignificantly Improves CCTA – anatomy from CCTA + Physiology* 

*from Heartflow FFRCT Analysisbetter informs clinical decisions*

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**Heartflow Plaque Analysis**: Heartflow Plaque Analysis transforms coronary

![prospectussummary6a.jpg](prospectussummary6a.jpg)

plaque assessment from a time-consuming and variable manual process,

which is seldom clinically used, into a rapid, automated, and highly precise AI-

driven solution. The Heartflow Plaque Analysis automatically provides a

comprehensive 3D assessment of a patient's coronary plaque, including a

characterization of plaque types and quantification of plaque volumes at every

point in the major coronary arteries. The Heartflow Plaque Analysis has been

validated against the reference standard of invasive IVUS and shown to have

a 95% agreement with IVUS in quantifying total coronary plaque volume in

our REVEALPLAQUE study. Moreover, our current findings from the DECIDE

registry show the Heartflow Plaque Analysis led to medical management

change in over half of patients beyond CCTA alone. Because coronary plaque

volume is a strong predictor of a patient's risk of having a heart attack

regardless of ASCVD risk score, coronary artery calcium ("CAC") score, or

stenosis, this data offers incremental predictive power over risk factors and

stenosis alone and can aid the physician in optimizing medical management. Furthermore, only quantified

plaque analysis based on CCTA can assess non-calcified plaque, which has a higher risk for causing a

heart attack as compared to calcified plaque. In contrast, while CAC scores also use a CT scan to

measure plaque, they estimate CAD risk based solely on calcified plaque. We believe that our Heartflow

Plaque Analysis is applicable to the approximately 60% of CCTA patients identified as having 1% to 69%

stenosis and adds significant value over review of CCTA alone, which is unable to precisely quantify or

characterize the type or volume of plaque that would impact a physician's treatment plan.

***Heartflow Plaque Analysis guides medical management***

![business13d.jpg](business13d.jpg)

*Figure 12: Plaque is critical to guide medical management, regardless of FFRCT results*

In addition to its comprehensive plaque assessment capabilities, Heartflow Plaque Analysis incorporates

a nomogram derived from an extensive international cohort of over 11,000 patients. This nomogram

stratifies coronary atherosclerotic plaque volumes by age and sex, providing physicians with a valuable

reference to contextualize individual patient data against population-based benchmarks. By leveraging

this tool, clinicians can more precisely assess a patient's CAD risk, facilitating personalized treatment

strategies. This integration of large-scale data enhances the actionable insights delivered by Heartflow

Plaque Analysis, supporting more informed clinical decision-making.

Our Heartflow Plaque Analysis was cleared by the FDA in October 2022. We began our limited market

education efforts in the second half of 2023, and we expect to broaden our market education efforts as

payor coverage for Heartflow Plaque Analysis increases. We also anticipate our Heartflow Plaque

Analysis to be included in updated cardiac imaging guidelines by radiology benefit manager EviCore by

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Evernorth, which provides coverage guidelines to leading commercial health insurers, effective October 1,

2025. **Heartflow PCI Planner**: Heartflow PCI Planner, which we expect to launch in 2026, will enable pre-PCI

assessment of coronary anatomy, lesion-specific physiology and plaque localization through an

interactive 3D model, combined in a single interface. The tool will provide interventional cardiologists with

advanced visualization and clinical insights to help answer critical questions for revascularization

strategies, such as which lesions to treat, how to treat them, the complexity of PCI, the need for calcium

modification, what ancillary tool to use and how to optimize stent quantity, size and placement. We expect

Heartflow PCI Planner to offer procedural efficiency through advanced preparation, improved patient care

by ensuring optimal treatment at the right time and increased clinician confidence with detailed pre-

procedure knowledge. We plan to provide Heartflow PCI Planner to accounts as an integrated feature to

enhance procedural efficiency, not as a stand-alone product.

***Key benefits of our Heartflow Platform***

We believe the unique features of our technology allow us to offer superior clinical utility and economic

value to our customers and the broader healthcare system. The key benefits offered by our Heartflow

Platform include:

• **More accurate non-invasive test for CAD:** Our Heartflow products have been clinically validated to

provide a more accurate non-invasive assessment of blood flow, plaque characterization and plaque

volume compared to traditional non-invasive tests, parameters that have been established to be

highly clinically relevant. Our prospective, core-lab adjudicated NXT trial demonstrated that Heartflow

FFRCT Analysis is able to accurately calculate lesion-specific FFR values with a high level of

concordance to the invasive reference standard of FFR. In addition, our retrospective, core-lab

adjudicated PACIFIC trial demonstrated that our Heartflow FFRCT Analysis offered superior diagnostic

accuracy relative to CCTA alone as well as SPECT and PET. Individually and collectively, these

studies support the differentiated level of precision that Heartflow FFRCT Analysis offers relative to

other non-invasive tests as well as its clinical reliability. Similarly, our prospective REVEALPLAQUE

study validated our Heartflow Plaque Analysis relative to the invasive reference standard of IVUS,

demonstrating 95% agreement for overall plaque volume and excellent agreement in identifying

plaque volume and sub-types at the lesion level.

• **More informed assessments and personalized care:** Our Heartflow FFRCT Analysis has been

clinically demonstrated in multiple studies to positively impact physician decisions on intervention and

patient management. The ADVANCE prospective registry which included over 5,000 patients globally

showed that in 67% of cases physicians changed their patient management plans, predominantly with

respect to revascularization, based on review of Heartflow FFRCT Analysis relative to CCTA alone.

Similarly, our DECODE study, which included 100 patients, demonstrated that in 66% of cases

physicians changed preventative medical therapy plans based on a review of Heartflow Plaque

Analysis relative to CCTA alone. Further supporting the value of our Heartflow Plaque Analysis

product, among patients with a CAC score of 0, physicians revised their management plan to a more

aggressive therapy approach in nearly 50% of cases after reviewing our Heartflow Plaque Analysis

report. In 63% of cases in the DECODE study, physicians increased the dosage of the patient's

medication, indicating that patients were being under-treated based on conventional non-invasive

testing methods that fail to both quantify and characterize plaque volumes.

• **Superior economic efficiency:** Our Heartflow FFRCT Analysis has been clinically demonstrated to

reduce rates of false positive CAD diagnoses relative to other non-invasive tests and more accurately

identify the patients that actually need an invasive procedure. Our PRECISE prospective randomized

controlled trial which enrolled over 2,100 patients and compared Heartflow FFRCT Analysis with

standard of care, demonstrated that our Heartflow FFRCT Analysis was 78% more likely to identify

patients in need of revascularization and showed a 69% reduction in false positives, or unnecessary

ICA tests. It also showed 2x the yield of ICA leading to a revascularization procedure such as a PCI or

CABG. These are economically important procedures for our customers which, when done in place of

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a diagnostic only catheterization, result in more efficient use of valuable cardiac catheterization lab

facilities and staff time. As a result, our calculations based on the PRECISE trial indicate that net

average cardiac catheterization lab revenue increased 20%.

• **Improved workflow:** Our Heartflow RoadMap Analysis offers significant workflow benefits, including

improving workflow efficiency by reducing CCTA interpretation times. Our SMART-CT study

demonstrated that the use of our Heartflow RoadMap Analysis reduced read time by approximately

25%. In addition to reducing read times, our Heartflow RoadMap Analysis enhances consistency

across a radiology program resulting in a more than 40% increase in inter-reader agreement. Given

the intense demands on radiologist time resulting from an increasing number of images to review on a

daily basis, we believe this added efficiency and consistency strengthens the competitive

differentiation of our platform.

• **Enhanced interventional treatment planning:** Once the patient is diagnosed with clinically

significant CAD and referred to the catheterization lab for an intervention, our Heartflow Platform

provides information that is useful to interventional cardiologists in planning for the most efficient

treatment based on individual anatomy and disease state.The Heartflow Platform enables early,

detailed pre-operative planning, allowing physicians to triage patients to the most appropriate site of

service—whether a hospital-based catheterization lab or an outpatient interventional center. By

identifying the complexity and severity of disease in advance, our technology ensures that high-risk

patients receive care in fully equipped facilities, while lower-risk cases can be efficiently managed in

outpatient settings, reducing strain on hospital resources. Heartflow's 3D model provides a precise

preview of the anatomy corresponding to specific views used in invasive catheterizations. Heartflow

FFRCT Analysis and Heartflow Plaque Analysis provide quantitative and visual insights on lesion

severity, plaque burden and type, and hemodynamic significance, which enable more precise pre-

selection of interventional tools. This allows catheterization labs to be better prepared with the

necessary guidewires, catheters, and adjunctive devices before the procedure, thereby reducing

inefficiencies. With growing demand for complex structural heart procedures—such as transcatheter

aortic valve replacement, left atrial appendage closure, and transcatheter mitral interventions—

catheterization lab capacity is increasingly a constraint for hospitals. By reducing unnecessary

diagnostic angiograms and increasing the efficiency of PCI planning, we believe the Heartflow

Platform frees up catheterization lab time for these higher-acuity, resource-intensive procedures.

• **Better patient and provider experience:** By leveraging a single CCTA for all of our products,

patients complete their test in approximately 20 minutes with significantly lower radiation exposure

compared to nuclear imaging tests such as SPECT and PET that take multiple hours and require

radioactive tracers to be injected into the bloodstream. A fundamental challenge with traditional

stress-based testing is the lack of a definitive diagnosis, which often results in a cascade of follow-up

tests. Stress tests frequently produce inconclusive or false-positive results, requiring additional

imaging studies such as cardiac catheterization to confirm or rule out disease. This layered testing

approach prolongs the diagnostic journey, delays appropriate treatment, and adds unnecessary costs

and inconvenience for patients. The Heartflow Platform offers an entirely digital and non-invasive

experience that better serves both patients and providers. The CCTA + Heartflow Pathway provides a

fulsome array of insights with only a single patient exam. All results can then be viewed and

distributed digitally to all of the patient's care providers. In addition, our platform offers the flexibility to

add new visualizations, insights and updates as the technology evolves, and physicians can receive

the benefits of these updates conveniently through the same software platform. For example, when

Heartflow RoadMap Analysis and Heartflow Plaque Analysis were introduced, our accounts were able

to access these technologies through the same connection infrastructure and platform that they

utilized for Heartflow FFRCT Analysis without the need to buy new equipment or establish new

connections.

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***Our production process***

Our production process involves a sophisticated and highly refined system that combines advanced

machine learning algorithms with "human-in-the loop" quality control process, where learnings are fed

back into our algorithms to improve their performance and efficiency. After the CCTA test is complete, the

patient's images are securely transferred to our cloud-based system through our established software that

integrates directly into the account's infrastructure.

When the images arrive, we leverage multiple machine learning algorithms which have been trained from

a database of millions of annotated CCTA images to precisely segment CCTA data and extract patient-

specific 3D anatomy, which includes the coronary tree, myocardium and other anatomic features. The

quality of CT images and the anatomy extracted by our algorithms is inspected through propriety software

that guides quality-oriented production analysts through each step to review and potentially correct the

segmentation, as needed. Our machine learning algorithms then utilize any analyst inputs to generate a

final 3D model of the coronary vessels. Our algorithms then compute stenosis, plaque volumes and

plaque characteristics as well as blood flow simulation with computational fluid dynamics over the entire

coronary tree. The simulated blood flow and pressures allow calculation of quantitative Heartflow FFRCT

Analysis values at every point on the coronary tree. Once complete, our Heartflow RoadMap Analysis,

Heartflow FFRCT Analysis and Heartflow Plaque Analysis are securely delivered directly to the physician in

multiple formats: an interactive web experience where they can explore the data in detail, PDF

summaries, and direct delivery into the electronic medical record.

The corrections and changes from the analyst quality inspection step are stored in a database as labels

for training our algorithms. New and improved versions of our algorithms using the latest machine

learning methodologies are trained with incrementally more labels and released over time and

incorporated into our platform. The core algorithms for the 3D coronary anatomic model and Heartflow

FFRCT Analysis are now on their 3<sup>rd</sup> generation with improvements over time. This iterative approach of

combining improved algorithms with human quality control processes continues to enhance the accuracy

and efficiency of our technology.

We have also invested significantly in automating our production process through improved algorithm

performance, visualization, and internal workflow enhancements, which have materially reduced our

analyst processing times from 69 minutes in 2021 to 26 minutes in the fourth quarter of 2024, significantly

enhancing our margin profile.

***Our data security***

Our Heartflow Platform relies on industry-leading security controls, including encryption at rest and in

transit, multi-factor and single-sign on authentication, granular authorization and a secure development

lifecycle. We have designed the Heartflow Platform to de-identify data for processing, ensuring the most

identifiable sensitive data (including PHI) remains segregated, encrypted, and within source regions,

limiting privacy and security risk. Our commitment to information security is demonstrated by our

HITRUST, ISO 27001, and SOC 2 Type II certifications.

***Our clinical results and economic evidence***

We believe the Heartflow Platform is the most studied AI-enabled test for CAD. The accuracy, clinical

utility and economic benefits of our Heartflow Platform have been evaluated in over 100 clinical studies

and more than 130,000 patients, including our PRECISE and FORECAST trials, each a large randomized

controlled trial, with results published in over 600 peer-reviewed clinical publications. Collectively, this

extensive body of clinical evidence has supported regulatory approvals for our products, established

broad payor coverage and society guideline inclusion for our Heartflow FFRCT Analysis, and is driving

rapid commercial adoption of our portfolio of products. We have sponsored 50 of the 100 clinical studies

and are continuing to invest in evidence that highlights the clinical utility and economic benefits of our

Heartflow Plaque Analysis to support expansion of payor coverage and commercial adoption. In the future

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we may also invest in clinical studies of the Heartflow Platform to expand indications to broader

populations.

Our clinical programs have been focused on (i) validating the accuracy and reproducibility of our product

offerings relative to invasive reference standards and non-invasive alternatives, (ii) establishing the

differentiated clinical utility of our products relative to non-invasive alternatives, and (iii) demonstrating the

economic benefits associated with our products including reduced costs for payors and improved

efficiency for providers. Our studies, including the PRECISE, NXT and PACIFIC trials, have consistently

demonstrated that the Heartflow Platform is more accurate than traditional non-invasive tests and highly

concordant to invasive testing, reduces unnecessary invasive testing, and enables physicians to optimize

treatment and ultimately provide more efficient care. The "p-values" noted below indicate the measure of

the study's "statistical significance," which refers to the likelihood that a result or relationship is caused by

something other than random chance or error. The "p-value" indicates the probability value that the

results observed in a study were due to chance alone. A p-value of < 0.05 is generally considered

statistically significant, meaning that the probability of the results occurring by chance alone is less than

five percent. The lower the p-value, the less likely that the results observed were random.

None of the studies discussed below that collected adverse event data related to the Heartflow Platform

reported adverse events related to the Heartflow Platform.

***Our Heartflow FFRCT Analysis***

<u>Accuracy and reproducibility</u>: Numerous foundational clinical trials in cardiology, including the FAME 1

and FAME 2 RCTs have demonstrated that FFR values are the most accurate predictors of the need for

intervention in patients with CAD. Key clinical studies that have supported the accuracy and

reproducibility of Heartflow FFRCT Analysis relative to invasive FFR testing and non-invasive alternatives

include:

• ***NXT (2014):*** Our Company-sponsored NXT trial was the was the basis for de novo 510(k) FDA

clearance of Heartflow FFRCT Analysis. It was a prospective, blinded, core-lab adjudicated trial in

which CCTA was performed prior to non-emergent ICA in stable patients with suspected CAD.

Heartflow FFRCT Analysis values based on the CCTA were compared to invasive FFR values. The trial

also compared the efficacy of Heartflow FFRCT Analysis relative to CCTA alone for predicting FFR

values. NXT studied 254 patients who were scheduled to undergo clinically indicated ICA and who

had CCTA performed within 60 days before ICA or who agreed to undergo CCTA within 60 days

before ICA and studied 484 vessels at 10 centers in Europe, the United Kingdom, Japan, Korea, and

Australia. The results showed that Heartflow FFRCT Analysis is highly accurate compared to the

reference standard of invasive FFR, with a per vessel accuracy of 86% compared with 65% for CCTA

alone (p < 0.001).

• ***PACIFIC (2019):*** The PACIFIC trial was an investigator-initiated, prospective study funded by the

Company to evaluate in a head-to-head manner the diagnostic performance of several non-invasive

tests commonly used to identify functionally significant CAD. At a single site in the Netherlands, a total

of 208 patients with suspected stable CAD underwent CCTA, SPECT and PET, and then used ICA

with invasive FFR as the reference standard. The Heartflow FFRCT Analysis was not initially included

in the PACIFIC study, but the investigators subsequently undertook a retrospective PACIFIC FFRCT

sub-study to evaluate the diagnostic performances of Heartflow FFRCT Analysis compared to CCTA,

SPECT, and PET. Using invasive FFR as the reference standard, the Heartflow FFRCT Analysis

demonstrated the highest diagnostic performance for vessel-specific ischemia of all tested

noninvasive tests, with an AUC (Area Under the Curve) of 0.94 compared with PET (0.87), CTA

(0.83), and SPECT (0.70) (p < 0.001 for all).

<u>Differentiated utility, improved clinical and economic outcomes</u>: Numerous studies have demonstrated

that use of Heartflow FFRCT Analysis favorably impacts clinical management, supporting physicians in

making more informed and better patient-specific decisions about intervention which drives more efficient

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use of resources. Key company-sponsored clinical studies that demonstrated the impact of Heartflow

FFRCT Analysis on clinical decision-making, outcomes and provider and payor economics include:

• ***ADVANCE (2018):*** Our Company-sponsored ADVANCE prospective registry studied 5,083 patients

at 38 centers across the United States, United Kingdom, Europe, and Japan whose CCTA showed

CAD, in order to determine whether the incremental addition of Heartflow FFRCT Analysis resulted in a

change in patient management.Results at 90 days showed that Heartflow FFRCT Analysis findings

drove a change in management plan for 67% of patients and that Heartflow FFRCT Analysis values

>0.80 did not have any reported major adverse cardiovascular events compared to those with values

0.80 or below who experienced higher rates of major adverse cardiovascular events (p < 0.01)

despite overwhelmingly non-invasive patient management. Additionally, CCTA-based stenosis

severity was determined to be a poor predictor of Heartflow FFRCT Analysis values, demonstrating

that CCTA alone was not as effective for clinical decision-making. A review of outcomes at one year

showed that physician management decisions were safe and durable and that deferral of an invasive

procedure based on Heartflow FFRCT Analysis was safe and appropriate, as it was highly unlikely to

result in a later revascularization or adverse clinical event.

• ***PRECISE (2023):*** Our Company-sponsored PRECISE trial was a prospective randomized controlled

study conducted at 65 centers across the United States, Canada, the United Kingdom, and Europe

which compared decision-making and outcomes based on a CCTA + Heartflow FFRCT Analysis

pathway with the "usual care" pathway which involved alternative non-invasive or invasive testing

methods chosen by the clinician, such as exercise electrocardiogram, stress echocardiogram, stress

nuclear myocardial perfusion imaging (single-photon emission CT or positron emission tomography),

stress cardiovascular magnetic resonance imaging, or catheterization. The study included 2,103

participants without known CAD or prior testing and had a median follow up of 11.8 months. The

study found that, compared with the "usual care" pathways, CCTA + Heartflow FFRCT Analysis was

78% more likely to identify patients in need of revascularization (p < 0.001), and resulted in a 69%

reduction in diagnostic-only ICA. The net effect of this pathway was 2x the yield of ICA leading to a

revascularization procedure, from 30.5% of cases to 71.9% of cases. As a result, our internal analysis

based on the PRECISE data demonstrated a 20% increase in net revenue for the cardiac

catheterization lab, on average.

• ***PLATFORM (2015):*** Our Company-sponsored PLATFORM trial was a prospective controlled study of

sequential cohorts that enrolled 584 patients across 11 centers in the United Kingdom and Europe.

The study assessed the clinical and economic impacts of using a CCTA + Heartflow FFRCT Analysis

pathway to select patients with stable, new onset chest pain for ICA. The study compared outcomes

between cohorts with a "usual care" invasive pathway to a CCTA + Heartflow FFRCT Analysis

pathway. The study found that the CCTA + Heartflow FFRCT Analysis pathway reduced the rate of

unnecessary ICA by 83% from 73% to 12% (p < 0.0001) and showed a 23% reduction in costs at 90

days and a 32% reduction (p < 0.0001) in costs at one year based primarily on the avoidance of

unnecessary invasive procedures.

***Our Heartflow Plaque Analysis***

Our clinical portfolio includes 10 studies and over 25 peer-reviewed publications specific to Heartflow

Plaque Analysis. These studies and publications, which include large, multi-center, international trials,

document the performance, accuracy and clinical utility of Heartflow Plaque Analysis as well as its

positive impact on the physician's ability to assess risk and manage outcomes. By providing more

accurate and detailed information on plaque types and volumes than can be achieved with traditional non-

invasive tests or risk measures, Heartflow Plaque Analysis supports more appropriate, precise medical

management. Key studies that support the clinical benefits of Heartflow Plaque Analysis include:

• ***REVEALPLAQUE (2024):*** Our Company-sponsored REVEALPLAQUE study demonstrated the

accuracy of Heartflow Plaque Analysis relative to IVUS, the accepted reference standard for coronary

plaque measurement and characterization. REVEALPLAQUE was a prospective, blinded, core-lab

adjudicated trial that enrolled 237 patients, with 432 lesions, in the United States and Japan and

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compared coronary plaque quantification and characterization between Heartflow Plaque Analysis

and IVUS. The study showed that Heartflow's Plaque Analysis results for total plaque volume,

calcified plaque, and non-calcified plaque were strongly correlated with IVUS measurements,

achieving 95% agreement with IVUS.

• ***DECODE (2024):*** Our Company-sponsored DECODE study evaluated the impact of the Heartflow

Plaque Analysis on clinical decision-making using data from 100 patients who underwent CCTA. For

each case, three cardiologists with expertise in reading CCTA and preventive therapies aligned on a

management plan based on patient demographics, clinical history, and the CCTA alone. The

cardiologists were then provided with Heartflow Plaque Analysis for the same patients and asked to

determine a management plan. The results showed that the use of Heartflow Plaque Analysis led to

changes in treatment plans for 66% of patients, including 63% of patients who had medical

management up-titrated. The likelihood of changing the management plan increased with higher CAC

scores and was more pronounced in patients with significant coronary stenosis; however, even 50%

of patients with a CAC score of 0 had a revised management plan with Heartflow Plaque Analysis.

• ***ADVANCEPLAQUE (2024):***The ADVANCEPLAQUE study is a retrospective analysis of our

ADVANCE trial after 1-year follow up (see above for more information related to our Company-

sponsored ADVANCE trial). In a multi-variate analysis of the data, high total plaque volume as

identified by Heartflow Plaque Analysis was shown to be an independent predictor for the risk of

adverse clinical cardiac events. In addition, the risk of an adverse cardiac event was shown to be 2x

higher in patients where Heartflow Plaque Analysis showed a higher total plaque burden compared to

those with a lower plaque burden.

• ***EMERALD 2 (2024)***: The EMERALD 2 study, funded by the Company, enrolled 351 patients who

presented with acute coronary syndrome, including specifically-identified culprit plaque rupture, within

3 years following a CCTA across the United States, Canada, Denmark, Italy, Hungary, Belgium,

Australia, Japan and South Korea. The study sought to investigate the additive value of AI–enabled

quantitative coronary plaque analysis together with hemodynamic analysis as predictors of the

subsequent plaque rupture. The study showed that adding the CCTA-derived, AI-enabled measures

derived from FFRCT and Plaque Analyses predicted plaque rupture more accurately the reference

model of CCTA alone (p < 0.001).

• ***DECIDE***: Based on the success of our DECODE study, which supported CMS coverage for Heartflow

Plaque Analysis, we initiated in March 2024 the DECIDE registry, a prospective real world analysis

measuring the impact of Heartflow Plaque Analysis on changes in treatment decisions compared to CCTA

alone or alternative non-invasive tests. In contrast with DECODE in which physicians retrospectively

identified revised patient management plans, physicians in our DECIDE registry will use Heartflow Plaque

Analysis information to implement real world patient management changes, with medical management

changes being defined to include a treatment modification, such as initiating, discontinuing or changing

dosage for a preventative or anti-ischemic therapy, additional laboratory testing, a referral for a specialist,

or undergoing stress testing or ICA between 90 and 180 days post-CCTA. The study's primary endpoint is

change in medical management following Heartflow Plaque Analysis, performed 90 days after the CCTA

and made available to the clinician already treating the patient, compared to the initial medical

management plan determined by the clinician based on the CCTA alone, and the secondary endpoint will

examine changes in key outcomes including death, heart attack, revascularization, cardiovascular

medication changes and cardiovascular hospitalizations at both 90-days and one-year follow-up. DECIDE

was initiated in March 2024 and we expect to enroll approximately 20,000 patients across over 30 sites in

the United States. As of March 31, 2025, we have enrolled over 10,000patients. Our current findings from

the DECIDE registry show the Heartflow Plaque Analysis led to medical management change in over half

of patients beyond CCTA alone, demonstrating a high clinical utility in guiding individualized management

of patients. We believe that the outcomes of the DECIDE registry will support expanded commercial

payor coverage and continued adoption of Heartflow Plaque Analysis.

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***Other Company sponsored or funded clinical studies***

The table below summarizes the results of additional clinical studies of the Heartflow Platform that we

have sponsored or funded to date.

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| | | |
|:---|:---|:---|
| **Reference** | **Source** | **Study summary** |
| Koo et al. (2011) | Journal of the <br>American <br>College of <br>Cardiology<br>| **DISCOVER-FLOW study**<br>Authors: Bon-Kwon Koo, James K. Min, Bjarne L. Nørgaard, et al.<br>Institution: Seoul National University Hospital<br>N: 103<br>Description: Prospective, multicenter trial sponsored by the Company, <br>aimed at evaluating the diagnostic performance of non-invasive <br>fractional flow reserve derived from CCTA in assessing the functional <br>significance of coronary artery disease. The study involved patients <br>with suspected CAD who underwent CCTA and Heartflow FFRCT<br>Analysis, with results compared to invasive FFR as the reference <br>standard.<br>Conclusions: The study concluded that Heartflow FFRCT Analysis <br>demonstrated high diagnostic accuracy in identifying functionally <br>significant coronary stenosis, with improved diagnostic discrimination (p <br>< 0.001) compared to CCTA alone. These findings support the potential <br>of Heartflow FFRCT Analysis as a reliable non-invasive method for <br>assessing coronary artery disease, offering a promising alternative to <br>invasive FFR for guiding clinical decision-making.<br>|
| Morris et al. (2024) | Journal of <br>Cardiovascular <br>Computed <br>Tomography<br>| **SMART-CT 2.0**<br>Authors: Michael F. Morris, Mahesh Chandrasekhar, Harish Gudi, et al.<br>Institution: Banner University Medical Center, Phoenix<br>N: 120<br>Description: The Company-sponsored SMART-CT 2.0 study (also <br>referred to as the SMART-CT study) was designed to evaluate the <br>effectiveness of an AI-informed coronary stenosis quantification tool, <br>known as AI-CSQ, in assisting the interpretation of CCTA. This tool, <br>aims to reduce the time required for CCTA interpretation, while <br>maintaining or enhancing the accuracy and confidence of the readers. <br>The study involved 120 CCTAs from patients at 2 sites with stable chest <br>pain or symptoms of CAD. These were analyzed by six readers of <br>varying experience levels, including cardiologists and radiologists, to <br>determine the impact of AI-CSQ on interpretation time, diagnostic <br>accuracy, and inter-reader variability.<br>Conclusions: The study concluded that the use of AI-CSQ significantly <br>decreased the overall time required for CCTA interpretation by 25.8%, <br>regardless of the reader's experience level (p < 0.001). It also improved <br>inter-reader agreement and boosted reader confidence in diagnosing <br>coronary artery disease. These findings underscore the potential of <br>advanced AI tools like AI-CSQ to enhance the efficiency and reliability <br>of CCTA interpretation in clinical practice, addressing challenges such <br>as time-consuming post-processing and variability in reader accuracy.<br>|

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| | | |
|:---|:---|:---|
| **Reference** | **Source** | **Study summary** |
| Curzen et al. <br>(2021)<br>| European Heart <br>Journal<br>| **FORECAST**<br>Authors: Nick Curzen, Zoe Nicholas, Beth Stuart, et al.<br>Institution: Multiple centers across the United Kingdom<br>N: 1,400<br>Description: The FORECAST (Fractional Flow Reserve Derived from <br>Computed Tomography Coronary Angiography in the Assessment and <br>Management of Stable Chest Pain) study, funded by the Company, was <br>a prospective, randomized controlled trial across 11 sites, designed to <br>assess the clinical and economic impact of using CCTA combined with <br>Heartflow FFRCT Analysis in the management of patients presenting <br>with stable chest pain. The study compared this approach to standard <br>care pathways that did not include Heartflow FFRCT Analysis, aiming to <br>determine its effectiveness in reducing unnecessary invasive <br>procedures and improving patient outcomes.<br>Conclusions: The study concluded that the integration of CCTA with <br>Heartflow FFRCT Analysis into the diagnostic pathway for stable chest <br>pain resulted in a significant reduction in the need for ICA and <br>unnecessary procedures, without an increase in adverse patient <br>outcomes. It found that random assignment to the study arm using <br>CCTA and our Heartflow FFRCT Analysis was associated with a 22% <br>reduction in the need for ICA, a 52% reduction in the frequency of <br>unnecessary ICA, 40% fewer layered non-invasive tests, and no <br>increase in adverse patient outcomes or in costs (in the United <br>Kingdom).<br>|

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| | | |
|:---|:---|:---|
| **Reference** | **Source** | **Study summary** |
| Min et al. (2012) | Journal of the <br>American <br>Medical <br>Association<br>| **DeFACTO study**<br>Authors: James K. Min, Jonathon Leipsic, Michael J. Pencina, et al.<br>Institution: Multiple international centers (United States, Belgium, <br>Canada, Latvia and South Korea)<br>N: 252<br>Description: Multicenter diagnostic performance study, sponsored by <br>the Company, involving 252 stable patients with suspected or known <br>CAD from 17 centers in 5 countries who underwent CT, ICA, FFR, and <br>Heartflow FFRCT Analysis between October 2010 and October 2011. <br>Computed tomography, ICA, FFR, and Heartflow FFRCT Analysis were <br>interpreted in blinded fashion by independent core laboratories. <br>Accuracy of Heartflow FFRCT Analysis plus CT for diagnosis of <br>ischemia was compared with an invasive FFR reference standard. <br>Ischemia was defined by an FFR or Heartflow FFRCT Analysis of 0.80 <br>or less, while anatomically obstructive CAD was defined by a stenosis <br>of 50% or larger on CT and ICA. The primary study outcome assessed <br>whether Heartflow FFRCT Analysis plus CT could improve the per-<br>patient diagnostic accuracy such that the lower boundary of the 1-sided <br>95% confidence interval of this estimate exceeded 70%.<br>Conclusions: The study did not meet its primary goal for per-patient <br>diagnostic accuracy, as it resulted in diagnostic accuracy of 73%, with a <br>lower bound of the 95% CI of 67%. However, the use of noninvasive <br>Heartflow FFRCT Analysis combined with CT in stable patients with <br>suspected or known CAD showed improved diagnostic accuracy and <br>discrimination compared to CT alone for identifying hemodynamically <br>significant CAD, using invasive FFR as the reference standard. This <br>suggests that Heartflow FFRCT Analysis could enhance the noninvasive <br>assessment of CAD by providing physiologic insights that CT alone <br>cannot offer, potentially reducing unnecessary invasive procedures. <br>Following the completion of the DeFACTO study, we substantially <br>redesigned our technology, which improved product performance. The <br>results of this improvement were validated in the NXT study, which <br>resulted in a per vessel 86% accuracy and was the central evidence for <br>the initial De Novo 510(k).<br>|

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***Other clinical studies***

The following summarizes the results of additional clinical studies that were not supported, sponsored, or

funded by the Company.

• ***SCOT-HEART (2015):***SCOT-HEART was a foundational open-label, multi-center, parallel group

randomized controlled trial that compared the standard of care against the standard of care with

CCTA. The study registered 4,146 patients across 12 sites in Scotland. Enrollment was open to

patients aged 18–75 years who had been referred by a primary-care physician to a dedicated

cardiology chest pain clinic with suspected stable angina due to coronary heart disease. The study

highlighted the clinical superiority of CCTA over traditional stress-based NITs, finding a significant

41% reduction in the rate of death or non-fatal heart attacks after five years in patients who

underwent CCTA evaluations. The study also demonstrated that patients in the CCTA group had

higher rates of preventative therapies throughout follow-up: antiplatelet therapy use fell from 48%

(baseline) to 41% (at 1 year) in the standard of care group (p < 0.001), whereas it increased from

49% (baseline) to 52% (at 1 year) in those in the CCTA group (p = 0.017). Statin use increased in

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both groups, from 43% to 50% (at 1 year) in the standard of care group and from 44% to 59% (at 1

year) in the CCTA group (p < 0.001 for both groups), but this was greater in those assigned to the

CCTA group (p < 0.001).

• ***FAME 1 (2009):*** The foundational FAME 1, a prospective randomized controlled trial, enrolled 1,005

patients with multi-vessel CAD across 20 sites in the United States and Europe. The study, along with

FAME 2, showed that deferring intervention is superior when blood flow, as measured by FFR, was

greater than 0.80 but that when FFR was below this same level, intervention was superior to optimal

medical therapy. In FAME 1, patients diagnosed with CAD by ICA and planned ICA had rates of major

adverse cardiovascular events that were lower with deferral of FFR negative lesions than with angio-

guided PCI of all lesions independent of FFR (18.3% vs. 13.2%) (p = 0.02). In addition, 78% of the

patients in the angiography group were free from angina at 1 year, as compared with 81% of patients

in the FFR group (p = 0.20).

• ***FAME 2 (2014):*** The foundational FAME 2, a prospective randomized controlled trial, enrolled 1,220

patients across 28 sites in Europe and North America. The enrolled patients were appropriate

candidates for PCI in stable condition who had angiographically assessed one-, two-, or three-vessel

CAD suitable for PCI. The study demonstrated that patients diagnosed with CAD by ICA and with

invasively-measured positive FFR had rates of major adverse cardiovascular events that were lower

with PCI and medical management than with medical management alone (8.1% vs. 19.5%) (p <

0.001). This reduction was driven by a lower rate of urgent revascularization in the PCI group (4.0%

vs. 16.3%) (p < 0.001), with no significant between-group differences in the rates of death and

myocardial infarction.

**Sales and marketing**

We believe the Heartflow Platform adds significant value across all the subspecialties that impact

cardiovascular care including referring cardiologists, imaging physicians, and interventionalists. We have

structured our sales force to efficiently call on these key physician stakeholders, with a primary focus on

the imaging physicians who are instrumental in new account adoption and the referring physicians who

are critical to driving volume growth at accounts in our installed base.

We market and sell our Heartflow Platform in United States through a direct sales organization. As of

March 31, 2025, our U.S. commercial team included 44 TSMs focused on opening new accounts, 55

TAMs who are focused on broadening referring physician awareness of the CCTA + Heartflow pathway

and driving increased volumes at accounts in our installed base, and our customer success organization

that supports seamless onboarding, implementation and ongoing utilization at our accounts. We support

our direct commercial efforts with a marketing team that generates demand for the CCTA + Heartflow

pathway and highlights clearly defined value propositions for the various stakeholders across our

customer base including cardiologists, radiologists and interventional cardiologists.

Our TSMs engage with physicians to communicate the value proposition of the Heartflow Platform,

leveraging our large base of clinical evidence to highlight its clinical and economic benefits as well as the

lack of any new capital equipment purchase to drive new account adoption. Our TSMs have substantial

experience selling into cardiology and radiology practices as well as engaging with broad stakeholders to

establish new diagnostic and therapeutic solutions, employing an enterprise sales strategy. Our TAMs

utilize our extensive clinical compendium to educate and train physicians on the benefits of our platform,

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ultimately driving more referrals to our accounts. Our TAMs have strong backgrounds in establishing new,

disruptive therapies and growing a cardiology referral base.

![business15b.jpg](business15b.jpg)

*Figure 13: Overview of Heartflow call points*

Our software is simple, intuitive and does not require case coverage by our sales reps, which affords our

commercial organization a differentiated level of efficiency relative to most other medical device

technology companies. We intend to drive further adoption of our Heartflow Platform by leveraging our

existing and highly efficient cohort of TSMs and TAMs to continue opening new accounts and driving

volume growth. We expect to selectively add additional TSMs to grow our geographic presence where we

see areas of opportunity and modestly grow our team of TAMs to continue to drive awareness of the

benefits of our technology and broaden our referring physician population as our installed base grows.

We believe that all accounts with a CCTA program would benefit from adopting the Heartflow Platform.

We estimate that as of December 31, 2023, there were approximately 2,700 hospitals and outpatient

facilities in the United States that perform CCTA, and this target account base has grown at a 10% CAGR

from 2018 to 2023 as accounts increasingly recognize the benefits of a guideline directed CCTA program,

based on our analyses using Clarivate's ProcedureFinder data repository.

We also have small, direct commercial teams in the United Kingdom and Japan. We may continue to

expand our commercial activities outside the United States in areas where we see potential opportunity

and supportive reimbursement dynamics.

**Research and development**

We have invested significantly in research and development efforts over more than a decade to establish

the first and most widely adopted AI-enabled non-invasive test for CAD that is authorized for marketing in

the United States. We have built sophisticated AI-based algorithms and established an intuitive, easy to

use web and mobile customer interface, developed secure data transfer software, a scalable cloud

database, and quality review software, all while facilitating operational scalability. Our highly skilled and

focused research and development ("R&D") team has been pioneering AI-based coronary imaging for

over a decade and remains uniquely positioned to continuously advance our Heartflow Platform. Our R&D

team is comprised of PhD research scientists with expertise in AI-based algorithms and medical imaging,

alongside software engineers skilled in cloud architecture, AI algorithms, machine and deep learning and

3D visualization, as well as product managers and designers who ensure optimal customer experience

and design.

We are continuing to invest in research and development efforts with the goal of driving improvements to

the Heartflow Platform and expanding its applicability to additional disease states and patient populations.

Our near to medium term research and development priorities include: (i) continuing to train and improve

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our AI algorithms to drive greater quality and efficiency and reduce manual involvement; (ii) enhancing

product features for both Heartflow FFRCT Analysis and Heartflow Plaque Analysis; (iii) developing

additional workflow enhancements for our customers; and (iv) expanding indications for our platform,

including asymptomatic risk prediction.

**Reimbursement** 

The ability of our customers to obtain third-party payor coverage and payment for our Heartflow Platform

products for their patients is important to our business. Demand for our existing and new products is, and

will continue to be, affected by the extent to which government healthcare programs, such as Medicare

and Medicaid, and private health insurers, reimburse our customers for the use of our products with their

patients in the countries where we do business. We have successfully engaged with third-party payors in

major markets throughout the world to obtain coverage, coding, and payment rates for our products.

Nonetheless, not all third-party payors reimburse our customers for our products in all situations. Third-

party payor reimbursement for the Heartflow FFRCT Analysis is broad; however, Heartflow Plaque Analysis

is our second commercial product, and we continue to work to expand coverage and payment for its use.

Even if we develop or acquire a promising new product that has been cleared for commercial distribution

by the FDA, demand for the product may be limited unless our customers are reimbursed at favorable

rates by private health insurers and government healthcare programs.

Our Heartflow FFRCT Analysis is reimbursed under a Category I CPT code, 75580, effective as of January

1, 2024, and third-party payors have established coverage policies for Heartflow FFRCT Analysis that

apply to approximately 99% of covered lives in the United States. A new Category I CPT code was also

recently established to describe our Heartflow Plaque Analysis, which will take effect in January 2026.

Our Heartflow Plaque Analysis is generally covered by Medicare, with five of the seven MACs issuing final

LCDs that determined this analysis is medically necessary for certain Medicare patients in these MACs'

jurisdictions, and the remaining MACs providing coverage on a case-by-case basis. In July 2025, CMS

proposed to establish a national payment rate for the Category I CPT code that will describe our

Heartflow Plaque Analysis when performed in the physician office setting. If finalized in the final Physician

Fee Schedule rule expected to be published in the fourth quarter of 2025, a national Medicare payment

rate for our Heartflow Plaque Analysis will take effect on January 1, 2026.

In the United States, our customers purchase Heartflow FFRCT Analysis and Heartflow Plaque Analysis

reports generated by our products for their patients. These customers then submit a claim to the

applicable third-party payor for reimbursement. To the extent that coverage is denied on such claims, or

the reimbursement paid does not exceed the customer's cost for our products, demand for our products

will be reduced or our charges for our products will have to be materially reduced. Internationally,

healthcare reimbursement systems vary significantly. In some countries, our customers, such as

hospitals, are constrained by fixed global budgets, regardless of the volume or nature of patient

treatment. Other countries require application for, and approval of, government or third-party payor

reimbursement. Without both favorable coverage determinations by, and the financial support of,

government and private third-party payors, the market for our products would be adversely affected. We

cannot be sure that third-party payors will maintain the current level of coverage and payment to our

customers for use of our existing products. Adverse coverage determinations, or reductions in the amount

of reimbursement, could harm our business by discouraging customers' ordering of, and reducing the

prices they are willing to pay for, our products.

It is our intent to complete additional clinical studies and analyses, as needed, to obtain and continue to

expand coverage and payment at favorable rates for our products in countries or regions where it makes

economic sense to do so. Nonetheless, coverage and payment for our products can differ from payor to

payor. Furthermore, as a result of their influence over the healthcare system, third-party payors have

implemented, and are continuing to implement, cost-cutting measures such as seeking discounts, price

reductions or other incentives from medical products manufacturers, and imposing limitations on

coverage and payment for medical technologies and procedures. These trends could compel us to reduce

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prices for our products and could cause a decrease in the size of the market or a potential increase in

competition that could negatively affect our business, financial condition and results of operations.

In addition to uncertainties surrounding insurance coverage policies, our Heartflow Platform, which

includes the separately billable services, Heartflow FFRCT Analysis and Heartflow Plaque Analysis, is

subject to periodic changes to reimbursement levels by government payors and private health insurers.

For example, CMS adopts changes to reimbursement policies during the annual Medicare rulemaking

process, which includes updates to Medicare payment levels to hospitals under the Medicare Hospital

Outpatient Prospective Payment System ("OPPS"), and updates to Medicare payment levels to physician

offices, independent diagnostic testing facilities, and freestanding imaging centers under the Medicare

Physician Fee Schedule ("MPFS").

Updates to payments under OPPS, which are in the form of Ambulatory Payment Classifications ("APC")

are made annually and primarily driven by the geometric mean cost ("GMC") of the service, which is

calculated based on hospital cost reports submitted to CMS and hospital claims submitted during the prior

calendar year before the rule's publication. If the reported GMCs for these services decline, whether due

to miscoding, erroneous claims denials, use of alternative revenue codes, underreporting costs by

hospitals, a reduction in the cost of the service, or a change in payment policy by CMS, CMS may assign

such service to a lower APC, resulting in a materially lower reimbursement rate for at least the next

calendar year. We may not become aware of our hospital customers reporting a lower GMC, or the

reason for any such reduction, early enough to prevent an impact to the GMC for the applicable period or

any potential payment classification change that CMS could make as a result of a decrease in the GMC.

Once hospitals submit their claims and CMS calculates the GMC for each procedure, our ability to

remedy any such issues may be limited by CMS rules and regulations.

Heartflow's FFRCT and Heartflow Plaque Analysis are also subject to reimbursement changes under the

MPFS, which determines payment rates to physician offices, independent diagnostic testing facilities and

freestanding imaging centers. Like OPPS, CMS evaluates and updates payments rates on the MPFS on

an annual basis, and changes to the conversion factor, relative value units ("RVUs"), practice expense

allocations or procedure code valuations can affect the reimbursement available for Heartflow FFRCT

Analysis and Heartflow Plaque Analysis. For example, services that convert from Category III CPT codes

to Category I CPT code status are subject to review and re-survey by the American Medical Association

Relative Value Scale Update Committee, which may recommend an updated physician work value or

practice expense calculation in the form of updated RVUs. This initial review and any subsequent

resurvey can impact Medicare payment rates established in the annual MPFS. We believe the American

Medical Association may resurvey the CPT codes describing our Heartflow FFRCT Analysis as early as

2027 and our Heartflow Plaque Analysis as early as 2029. Additionally, the American Medical Association

and CMS continue to evolve the CPT coding structure and payment calculation for AI-enabled healthcare

services. Changes to existing codes or coding policies, or our ability to obtain new codes and establish

appropriate values, may impact future reimbursement for the Heartflow Platform.

In addition to risks associated with coding and government reimbursement, our Heartflow FFRCT Analysis

and Heartflow Plaque Analysis products face reimbursement uncertainty from commercial payors, such

as UnitedHealthcare, Aetna, Cigna, Anthem, and regional Blue Cross Blue Shield plans. Commercial

payors routinely reassess their medical policies, coverage criteria, and payment rates, and may choose to

deny coverage, impose restrictive utilization management protocols (such as prior authorization), or

reduce or bundle payment amounts based on internal cost-effectiveness assessments or evolving clinical

guidelines. Even if CMS maintains favorable Medicare reimbursement, commercial payors may

independently determine whether Heartflow FFRCT Analysis or Heartflow Plaque Analysis meets their

plans' medical necessity standards, which can vary among commercial payors.

The overall escalating cost of medical products and services being paid for by the government and private

health insurance has led to, and may continue to lead to, increased pressures on the healthcare and

medical device industries to reduce the costs of products and services. Third-party payors are developing

increasingly sophisticated methods of controlling healthcare costs through prospective reimbursement

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and capitation programs, group purchasing, redesign of benefits, and exploration of more cost-effective

methods of delivering healthcare. In the United States, some insured individuals enroll in managed care

programs, which monitor and often require pre-approval for the services that a member will receive. Some

managed care programs pay their providers on a per capita (patient) basis, which puts the providers at

financial risk for the services provided to their patients by paying these providers a predetermined

payment per member per month and, consequently, may limit the willingness of these providers to use

our products.

**Competition**

We consider our primary competition to be traditional non-invasive tests for CAD including primarily stress

tests such as SPECT, stress echocardiography and PET. The primary providers of imaging systems that

perform these tests include Siemens Healthineers AG, GE Healthcare, Koninklijke Philips N.V. and Canon

Medical Systems Corporation. These companies also manufacture CT scanners and therefore have a

vested interest in growing the CCTA market in addition to protecting their share of the non-invasive

market. These are large, multi-national, commercial organizations with significant resources and

distribution capabilities.

We also face competition from companies that have developed or are developing AI-based platforms that

leverage CCTA to diagnose CAD, including earlier-stage companies such as Cleerly, Inc., Elucid

Bioimaging Inc. and Keya Medical Technology Co., Ltd. We may also face competition from companies

developing AI-based platforms, even if they are not currently in the CAD market.

We believe the primary competitive factors in our market include: (i) the accuracy, reliability, and utility of

the test as demonstrated by the strength and quality of clinical data directly utilizing the test and

supporting it; (ii) speed and efficiency of achieving a definitive diagnosis at scale; (iii) per patient

economics including reimbursement rates and relative costs; (iv) availability and ease of use including

integration within hospital systems and clinical workflows as well as customer support; and (v) effective

marketing and physician education efforts as well as ability to impact physician mindshare and historical

practice patterns.

**Intellectual property**

Our success depends in part on our ability to obtain, maintain and defend our patent and other proprietary

rights for the Heartflow Platform, the validity and enforceability of our patents, our ability to operate

without infringing the valid and enforceable patents and proprietary rights of third parties and the

continued confidentiality of our know-how and trade secrets. We are actively involved in research and

development and therefore seek to protect the investments we have made into the development of the

Heartflow Platform and our proprietary technology by relying on a combination of patents, trademarks,

trade secrets, and licenses, as well as through internal compartmentalization processes, confidentiality

agreements and proprietary information agreements with suppliers, employees, consultants and others

who may have or gain access to our proprietary information. We seek patent protection in the United

States and key markets internationally for the Heartflow Platform, and any other inventions to which we

have rights, where available and appropriate. We also rely upon trademarks to build and maintain the

integrity and identity of our brand, and we seek to protect the confidentiality of trade secrets that may be

important to the development of our business, especially where we do not believe patent protection is

appropriate or obtainable. We license from third parties certain patent rights and proprietary know-how

that we believe to be useful to our business. We have non-exclusively licensed some patents in our

patent portfolio to a small number of licensees in a limited field of use that is outside of CCTA, and we

believe that those licensees' product offerings covered by our patent portfolio are complementary to our

product offerings.

Our patent portfolio, described more fully below, includes claims directed to the Heartflow Platform and its

delivery, as embodied in various systems, computer programs, computer implemented methods and

related methods of use. These claims are directed to various aspects of deriving anatomical and

physiological information from image data for the Heartflow Platform, aspects of the Heartflow Platform

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user interface, machine learning methods for generation of the 3D models used for our FFRCT Analysis

and Plaque Analysis products, and methods of deriving blood flow, anatomy, plaque and organ tissue

information from the image data. A number of our issued patents also cover indications other than CAD,

such as peripheral artery disease, stroke, or aneurysms as well as technical applications related to image

data analysis and processing, and platform-related PHI and data transfer methodologies and a number of

issued patents cover alternative methods such as deriving FFRCT using purely machine learning methods

or from other imaging modalities.

As of December 31, 2024, our owned and licensed patent portfolio includes approximately five hundred

and eighty-six (586) issued patents and one hundred and three (103) pending patent applications globally,

of which nine (9) are allowed. In the U.S. this includes three hundred and nine (309) issued U.S. patents

and fifty-six (56) pending non-provisional U.S. patent applications (of which three (3) are allowed). In

foreign jurisdictions our owned and licensed patent portfolio includes two-hundred and eighty (280) issued

foreign patents and forty-seven (47) pending foreign patent applications (of which five (5) are allowed).

The two-hundred and eighty (280) issued foreign patents include one or more issued patents in Europe,

Japan, Korea, China, Australia, Canada, India, Hong Kong, and Israel. We also filed twenty-three foreign

utility models between 2011 and 2014, having ten-year terms, all of which have expired. The forty-seven

(47) pending foreign patent applications include one or more pending applications in jurisdictions such as

Europe, Canada, China, and Japan. We own all of our issued patents except for 7 issued U.S. patents

and 8 issued foreign patents, for which we have exclusive licenses. All of the issued U.S. patents in the

portfolio are utility patents. Assuming payment of all appropriate maintenance, renewal, annuity or other

governmental fees, as applicable, our owned and licensed issued U.S. patents expire between 2018 and

2041. If issued, our last to expire pending patent application (without accounting for potentially applicable

patent term adjustments or extensions) is expected to expire in 2045. One of our U.S. patents expired in

2018 and we do not expect any additional expirations in the near-term. The next expiration of a Heartflow-

licensed patent is expected to be in 2028. The next expiration of a Heartflow-owned patent is expected to

be in 2031.

Our patents and applications generally fall into three broad categories:

• applications and patents relating to our Heartflow FFRCT Analysis, including claims directed to

segmentation, determining blood flow characteristics using artificial intelligence and/or fluid dynamics,

and visualization generation;

• applications and patents relating to our Heartflow Plaque Analysis, including claims directed to plaque

and vessel visualization and characterization; and

• applications and patents relating to our Heartflow RoadMap Analysis, including claims directed to

image quality and annotation, segmentation, and vascular tree generation.

The term of individual patents depends upon the legal term of the patents in the countries in which they

are obtained. In most countries in which we file or intend to file, including the United States, the patent

term is 20 years from the earliest date of filing a non-provisional patent application. Additionally, a U.S.

provisional patent application expires twelve months from its filing date, and its subject matter can only be

claimed in an issued patent if, among other things, we timely file a non-provisional patent application

making a valid priority claim to that provisional patent application before it expires. In the United States, a

patent's term may be lengthened by patent term adjustment, which compensates a patentee for

administrative delays by the USPTO in examining and granting a patent, or may be shortened if a patent

is terminally disclaimed over an earlier filed patent. The coverage sought in a patent application can be

denied or significantly reduced either before or after the patent is issued. We cannot be sure that patents

will be granted with respect to any current pending patent application or with respect to any patent

applications filed by us in the future, nor can we be certain that any current pending or published patent

application will be granted with the current claims or that any current or future patents will be

commercially useful in protecting the Heartflow Platform and our proprietary technology. In addition, any

patents that we may hold, whether owned or licensed, may be challenged, circumvented or invalidated by

third parties.

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The success of our business strategy also depends in part on our continued ability to protect our brand.

We own registered trademarks for the Heartflow Platform. We also own and maintain registration for a

number of domain names. As of December 31, 2024, we have registered the trademarks "HEARTFLOW"

word mark and logo with the USPTO. Although we own registered trademarks and domain names in the

United States and certain other countries, and have filed trademark applications and secured domain

name registrations in the United States and in certain other countries, we do not have assurance that our

trademark portfolio will be adequate to secure or protect all necessary trademarks that we use.

The Heartflow Platform also implements software modules licensed to us by third-party authors under

"open source" licenses. The use of open source software may entail greater risks than the use of third-

party commercial software. Please see "Risk factors—Risks related to our intellectual property" for more

description of these risks. We have established a review process for screening requests from our

development organizations for the use of such software that is designed to help us mitigate risks related

to the quality of any open source software implemented in our technology platform. We also review any

open source software used to support our software development, but not directly incorporated into the

Heartflow Platform, as part of our general quality management processes. While these review processes

help us mitigate risks associated with the quality of the open source software incorporated into or used in

developing the Heartflow Platform, we cannot be sure that all open source software is submitted for

approval prior to use in connection with the Heartflow Platform.

We also rely on trade secrets, including know-how, unpatented technology and other proprietary

information, to strengthen our competitive position. We seek to protect trade secrets and confidential and

unpatented know-how, in part, by entering into non-disclosure and confidentiality agreements with parties

who have access to such knowledge, such as our employees, collaborators, manufacturers, consultants,

advisors and other third parties. We also seek to enter into confidentiality and invention or patent

assignment agreements with our employees and consultants that obligate them to maintain confidentiality

and assign their inventions to us. We also seek to preserve the integrity and confidentiality of our data

and trade secrets by maintaining the physical security of our premises and physical and electronic

security of our information technology systems.

Our ability to stop third parties from making, using, selling, offering to sell or importing the Heartflow

Platform depends on the extent to which we have rights under valid and enforceable patents, trade

secrets or other intellectual property and proprietary rights that cover these activities. We pursue

intellectual property protection to the extent we believe it would advance our business objectives.

Notwithstanding these efforts, there can be no assurance that we will adequately protect our intellectual

property or provide any competitive advantage. For more information regarding risks relating to

intellectual property, see "Risk factors—Risks related to our intellectual property."

**Government regulation**

***United States regulation of medical devices***

Our products are medical devices subject to extensive and ongoing regulation by the FDA, CMS, the

Department of Health and Human Services Office of Inspector General ("OIG") and regulatory bodies in

the United States and other countries. Regulations govern virtually every critical aspect of a medical

device company's business operations, including research activities, product development and testing,

manufacturing and production, contracting, reimbursement, product messaging, medical communications,

sales, marketing and advertising. In the United States, the Federal Food, Drug and Cosmetic Act

("FDCA") and the implementing regulations of the FDA govern product design and development,

preclinical and clinical testing, premarket clearance or approval, product manufacturing, product labeling,

product storage, advertising and promotion, product sales and distribution, import, export and post market

clinical surveillance. Our business is subject to federal, state, local, and foreign regulations, such as ISO

13485:2016, ISO 14971:2019, FDA's Quality System Regulation ("QSR") contained in 21 CFR Part 820,

and the EU's Medical Devices Directive 93/42/EEC and its replacement, Regulation (EU) 2017/745. The

Heartflow Platform consists of three main analyses; Heartflow FFRCT Analysis, Heartflow Roadmap

Analysis, and Heartflow Plaque Analysis. All three are authorized for clinical use in the United States,

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Bahrain, Israel, Saudi Arabia, and the United Arab Emirates. Only the FFRCT Analyses is authorized for

clinical use in the European Economic Area, United Kingdom, Australia, Canada, and Japan.

***FDA premarket clearance and approval requirements***

Unless an exemption applies, each medical device commercially distributed in the United States requires

either FDA clearance of a 510(k) premarket notification, grant of a de novo classification request, or

approval of a premarket approval ("PMA") application. Our Heartflow Platform is regulated in the United

States by the FDA as a Class II medical device. The FDA classifies medical devices into one of three

classes. Devices deemed to pose low to moderate risk are designated as either Class I or II. Class I

devices are subject to general controls such as establishment registration and device listing, labeling,

adherence to current good manufacturing practices outlined in the QSR, maintenance and investigation of

product complaint records, and adverse event reporting, but are usually exempt from premarket

notification requirements. Class II devices are subject to the same general controls and may be subject to

special controls such as performance standards, post-market surveillance, particularized labeling

requirements and/or clinical testing prior to clearance. Manufacturers of Class II devices, absent an

exemption, are required to submit to the FDA a premarket notification prior to commercial distribution.

Devices are designated as Class III, which requires approval of a PMA application, if they are deemed by

the FDA to pose the greatest risk. These high-risk devices include life sustaining or life supporting

devices, certain implantable devices, and other devices that are intended for a use that is of substantial

importance in preventing impairment of human health or that present a potential unreasonable risk of

illness or injury. The PMA approval process is more comprehensive than the 510(k) clearance process

and typically takes several years to complete.

***510(k) clearance marketing pathway***

A 510(k) notification requires the sponsor to demonstrate that a medical device is substantially equivalent

to another marketed device, termed a "predicate device," that is legally marketed in the United States and

for which a PMA was not required. A device is substantially equivalent to a predicate device if it has the

same intended use and technological characteristics as the predicate, or has the same intended use but

different technological characteristics that do not raise new questions of safety and effectiveness, and

information submitted to the FDA demonstrates that the device is at least as safe and effective as the

predicate device.

If the FDA agrees that the device is substantially equivalent to a predicate device currently on the market,

it will grant 510(k) clearance to commercially market the device. If there is no viable predicate device for a

new device because, for example, of a new intended use, the device is automatically designated as a

Class III device. Unless the De Novo pathway is available for the new device, the device sponsor must

fulfill more rigorous PMA requirements. The PMA process requires that the manufacturer demonstrate

that the device is safe and effective for its intended uses, which generally requires the submission of

extensive data, including results from pre-clinical studies and human clinical trials. A PMA must also

contain a full description of the device and its components, the methods, facilities, and controls used for

manufacturing, and proposed labeling. The PMA process is burdensome, and in practice, the FDA's

review of a PMA application may take up to several years following initial submission.

After a device receives 510(k) clearance, any modification that could significantly affect its safety or

effectiveness, or that would constitute a new or major change in its intended use, requires a new 510(k)

clearance, or depending on the modification, could require the filing of a de novo classification request or

a PMA application, which would require the submission to the FDA of clinical trial data, among other

information. We are required to determine, for each modification to our cleared products, whether to

submit a new 510(k) notification for the modification, based on the nature of the modification. If we

determine a new 510(k) submission is not required, the decision and justification are documented in a

"letter to file." If the FDA disagrees with our determination, the FDA can require us to cease marketing or

recall the modified device until 510(k) clearance, grant of a de novo classification request or approval of a

PMA is obtained. We have made, and we plan to continue to make, minor product enhancements to our

cleared products that we believe do not require new 510(k) clearances and that we document in letters to

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file. We also intend to make product enhancements from time to time that we expect may require new

510(k) clearances.

***De novo classification process***

A manufacturer can request a risk-based classification determination for a novel device in accordance

with the "de novo" process. Medical device types that the FDA has not previously classified as Class I, II,

or III are automatically classified into Class III regardless of the level of risk they pose. The Food and Drug

Administration Modernization Act of 1997 established a route to market for low-to-moderate risk medical

devices that are automatically placed into Class III due to the absence of a predicate device, called the

"Request for Evaluation of Automatic Class III Designation," or the de novo classification procedure. This

procedure allows a manufacturer whose novel device is automatically classified into Class III to request

down-classification of its medical device into Class I or Class II on the basis that the device presents low

or moderate risk, rather than requiring the submission and approval of a PMA application. Pursuant to the

Food and Drug Administration Safety and Innovation Act ("FDASIA"), manufacturers may request de novo

classification directly without first submitting a 510(k) pre-market notification to the FDA and receiving a

not-substantially-equivalent determination. De novo classification requests, like PMA applications and

510(k) notifications, are subject to the payment of user fees.

Under the FDASIA, the FDA is required to reach a decision within 120 days following receipt of the de

novo request, although the process may take significantly longer. If the manufacturer seeks

reclassification into Class II, the manufacturer must include a draft proposal for special controls that are

necessary to provide a reasonable assurance of the safety and effectiveness of the medical device. If the

FDA grants the de novo request, the device may be legally marketed in the United States. However, the

FDA may reject the request if the FDA identifies a legally marketed predicate device that would be

appropriate for a 510(k) notification, determines that the device is not low-to-moderate risk, or determines

that General Controls would be inadequate to control the risks and/or special controls cannot be

developed. After a device receives de novo classification, any modification that could significantly affect

its safety or efficacy, or that would constitute a major change or modification in its intended use, will

require a new 510(k) clearance or, depending on the modification, another de novo request or even PMA

approval.

We obtained initial marketing authorization for Heartflow FFRCT Analysis through the FDA's "de novo"

classification process, supported by clinical data from our NXT clinical trial. Through this process, the FDA

agreed that special controls provide reasonable assurance of the safety and effectiveness of the

Heartflow FFRCT Analysis and therefore it can be classified as a Class II device. We received a de novo

authorization on November 26, 2014 for version 1.4 of the Heartflow FFRCT Analysis. We received the

510(k) clearance for version 2.x of the FFRCT product in January 2015, and 510(k) clearance for a

modification to the intended use language in August 2016. Additional clearances were received for a

strategic architecture scope change in December 2018, which is the device we refer to as Heartflow

Platform. The Heartflow Platform version 2.0, which added the PCI Planner function, received FDA

clearance in August 2019. The Heartflow Platform version 3.0 received FDA clearance in January 2021,

and the newest product generation, Heartflow Platform version 3.18, adding Roadmap and Plaque

functions, received FDA clearance in October 2022. The Heartflow Platform version 4.0, with improved

Plaque detection, received its clearance in July 2025.

***Medical device clinical trials***

Clinical trials are sometimes required to support 510(k) or de novo submissions. All clinical investigations

of devices to determine safety and effectiveness must be conducted in accordance with the FDA's

investigational device exemption ("IDE") regulations which govern investigational device labeling, prohibit

promotion of the investigational device, and specify an array of recordkeeping, reporting and monitoring

responsibilities of study sponsors and study investigators. If the device presents a "significant risk" to

human health, as defined by the FDA, the FDA requires the device sponsor to submit an IDE application

to the FDA, which must become effective prior to commencing human clinical trials. If the device under

evaluation does not present a significant risk to human health, then the device sponsor is not required to

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submit an IDE application to the FDA before initiating human clinical trials, but must still comply with

abbreviated IDE requirements when conducting such trials. A significant risk device is one that presents a

potential for serious risk to the health, safety or welfare of a patient and either is implanted, used in

supporting or sustaining human life, substantially important in diagnosing, curing, mitigating or treating

disease or otherwise preventing impairment of human health, or presents a potential for serious risk to a

patient in some other way. An IDE application must be supported by appropriate data, such as animal and

laboratory test results, showing that it is safe to test the device in humans and that the testing protocol is

scientifically sound. The IDE will automatically become effective 30 days after receipt by the FDA unless

the FDA notifies the company that the investigation may not begin. If the FDA determines that there are

deficiencies or other concerns with an IDE for which it requires modification, the FDA may permit a clinical

trial to proceed under a conditional approval.

Regardless of the degree of risk presented by the medical device, clinical studies must be approved by,

and conducted under the oversight of, an Institutional Review Board ("IRB") for each clinical site. The IRB

is responsible for the initial and continuing review of the clinical study, and may pose additional

requirements for the conduct of the study. If an IDE application is approved by the FDA and one or more

IRBs, human clinical trials may begin at a specific number of investigational sites with a specific number

of patients, as approved by the FDA. If the device presents a non-significant risk to the patient, a sponsor

may begin the clinical trial after obtaining approval for the trial by one or more IRBs without separate

approval from the FDA, but must still follow abbreviated IDE requirements, such as monitoring the

investigation, ensuring that the investigators obtain informed consent, and labeling and record-keeping

requirements. Acceptance of an IDE application for review does not guarantee that the FDA will allow the

IDE to become effective and, if it does become effective, the FDA may or may not determine that the data

derived from the trials support the safety and effectiveness of the device or warrant the continuation of

clinical trials.

During a study, the sponsor is required to comply with the applicable FDA requirements, including, for

example, trial monitoring, selecting clinical investigators and providing them with the investigational plan,

ensuring IRB review, adverse event reporting, record keeping and prohibitions on the promotion of

investigational devices or on making safety or effectiveness claims for them. The clinical investigators in

the clinical study are also subject to FDA's regulations and must obtain patient informed consent,

rigorously follow the investigational plan and study protocol, control the disposition of the investigational

device, and comply with all reporting and recordkeeping requirements. Additionally, after a trial begins,

we, the FDA or the IRB could suspend or terminate a clinical trial at any time for various reasons, such as

strategic business decisions or a belief that the risks to study subjects may outweigh the anticipated

benefits.

***Expedited development and review programs***

Following passage of the 21st Century Cures Act, the FDA implemented the Breakthrough Devices

Program, which is a voluntary program offered to manufacturers of certain medical devices and device-

led combination products that may provide for more effective treatment or diagnosis of life-threatening or

irreversibly debilitating diseases or conditions. The goal of the program is to provide patients and

healthcare providers with more timely access to qualifying devices by expediting their development,

assessment and review, while preserving the statutory standards for PMA approval, 510(k) clearance and

de novo classification. The program is available for medical devices that meet certain eligibility criteria,

including that the device provides more effective treatment or diagnosis of a life-threatening or irreversibly

debilitating disease or condition, and that: (i) the device represents a breakthrough technology, (ii) no

approved or cleared alternatives exist, (iii) the device offers significant advantages over existing approved

or cleared alternatives, or (iv) the availability of the device is in the best interest of patients. Breakthrough

Device Designation provides certain benefits to device developers, including more interactive and timely

communications with FDA staff; use of post-market data collection, when scientifically appropriate, to

facilitate expedited and efficient development and review of the device; opportunities for more efficient

and flexible clinical study design; and prioritized review of premarket submissions. When reviewing

Breakthrough Device Designation requests, the FDA may require a combination of literature or

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preliminary bench, animal or clinical data to demonstrate a reasonable likelihood of clinical and

technological success. Receiving a Breakthrough Device Designation from the FDA does not guarantee

that the FDA will grant marketing authorization for the device.

***Post-market regulation***

After a device is approved or cleared and placed in commercial distribution, numerous FDA regulatory

requirements apply. These include, but are not limited to, requirements to:

• register establishments and list devices with the FDA;

• maintain a quality system that is compliant with the QSR, which governs design, development, and

manufacture of devices;

• establish various specifications and controls for incoming components and finished devices;

• ensure that devices are designed to meet user needs;

• verify that finished devices are manufactured to the appropriate controls and that they meet

specifications;

• ensure that devices are assigned and labeled with a Unique Device Identifier ("UDI") and that certain

UDI information is provided to FDA's Global Unique Identification Database ("GUDID");

• ensure that labeling and advertising and promotional activities are consistent with cleared/approved

uses, adequately substantiated, and truthful and not misleading;

• analyze quality data to identify and correct quality problems;

• submit notifications or applications for clearance or approval of product modifications that could

significantly affect safety or effectiveness or that would constitute a major change in intended use;

• review, evaluate and investigate complaints and report adverse events to the FDA when a device may

have caused or contributed to a death or serious injury or malfunctioned in a way that would be likely

to cause or contribute to a death or serious injury if the malfunction were to recur;

• report to FDA corrections and removals undertaken to reduce a risk to health posed by the device or

to remedy a violation of the FDCA that may present a risk to health. In addition, FDA may order a

mandatory recall if there is a reasonable probability that the device would cause serious adverse

health consequences or death;

• comply with any post-approval restrictions or conditions, including requirements to conduct post-

market surveillance studies to establish continued safety data; and

• conduct clinical studies in accordance with good clinical practices and applicable regulations,

including requirements for clinical trial registration and results reporting on ClinicalTrials.gov.

Manufacturing processes for medical devices are required to comply with the applicable portions of the

QSR, which cover the methods and the facilities and controls for the design, manufacture, testing,

production processes and controls, quality assurance, labeling, packaging, distribution, installation and

servicing of finished devices intended for human use. The QSR also requires, among other things,

maintenance of a device master file, device history file, device history record and complaint files. As a

manufacturer, we are subject to periodic scheduled or unscheduled inspections by the FDA. Failure to

maintain compliance with the QSR requirements could result in the shutdown of, or restrictions on,

manufacturing operations and the recall or seizure of marketed products. In February 2024, the FDA

issued the Quality Management System Regulation Final Rule ("QMSR") to amend the QSR,

incorporating by reference the international standard for medical device quality management systems,

ISO 13485:2016. The rule becomes effective on February 2, 2026. Until then, manufacturers are required

to comply with the QSR.

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The FDA polices these requirements by inspection, review of required reports or submissions, and market

surveillance, and the agency has broad enforcement powers to address any violations. The FDA may

conduct announced or unannounced facility inspections to determine compliance with the QSR and other

regulations, and these inspections may include our manufacturing facilities. Failure to comply with

applicable regulatory requirements can result in enforcement action by the FDA or other regulatory

authorities, which may result in sanctions and related consequences, including:

• untitled letters or warning letters or it has come to our attention letters;

• injunctions or consent decrees;

• fines or civil penalties;

• recall, detention, or seizure of our product;

• operating restrictions, partial suspension, or total shutdown of production;

• the FDA's refusal of or delay in granting 510(k) clearance or premarket approval of new or modified

products;

• withdrawal of 510(k) clearances or PMA approvals;

• the FDA's refusal to grant export certificates;

• criminal prosecution;

• unanticipated expenditures to address or defend such actions; and

• reputational harm resulting from such actions.

Other regulatory authorities overseeing the implementation and adherence of applicable state, federal

and analogous foreign regulatory authorities may also conduct unannounced inspections. Such

inspections may result in similar administrative, civil and criminal penalties. The discovery of previously

unknown problems with marketed medical devices, including unanticipated adverse events or adverse

events of increasing severity or frequency, whether resulting from the use of the device within the scope

of its clearance or off-label by a physician in the practice of medicine, could result in restrictions on the

device, including the removal of the product from the market or voluntary or mandatory device recalls.

***International regulation — European Union, United Kingdom, Japan and Canada***

In order to market and sell our product outside of the United States, we must comply with numerous and

varying regulatory requirements of other countries and jurisdictions regarding quality, safety, and efficacy

and governing, among other things, clinical trials, marketing authorization, commercial sales and

distribution of our product.

Although many of the regulatory issues we face in the United States are similar to the issues in other

geographies, the approval or certification process varies between countries and jurisdictions and can

involve additional testing and additional administrative review periods. The time required to obtain

approval or certification in other countries and jurisdictions might differ from and be longer than that

required to obtain clearance from the FDA. Regulatory approval or certification in one country or

jurisdiction does not ensure regulatory approval or certification in another, but a failure or delay in

obtaining regulatory approval or certification in one country or jurisdiction may negatively impact the

regulatory process in others.

***European Union***

The primary regulatory environment in Europe is that of the European Union, which includes most of the

major countries in Europe. The law regarding medical devices is harmonized in the European Union. Until

a few years ago, medical devices were governed by the Medical Devices Directive 93/42/EEC ("MDD")

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and the Active Implantable Medical Devices Directive 90/385/EEC ("AIMD"), implemented by the member

states of the European Union into their national law. However, on May 26, 2021,the Medical Devices

Regulation (EU) 2017/745 ("MDR") entered into application, repealing and replacing the MDD and the

AIMD. As a Regulation, the MDR is directly applicable in all member states of the European Union and

does not require further implementation into national law. The MDR and its associated guidance

documents and harmonized standards govern, among other things, device design and development,

preclinical and clinical or performance testing, premarket conformity assessment, registration and listing,

manufacturing, labeling, storage, claims, sales and distribution, export and import and post-market

surveillance, vigilance, and market surveillance. The MDR is based on very similar general system as the

MDD, but adds obligations on manufacturers and distributors of medical devices.

Since May 26, 2021, medical devices placed on the European Union market must conform to the

requirements set out by the MDR. Medical devices must comply with the General Safety and

Performance Requirements ("GSPRs") set out in Annex I of the MDR. Compliance with these

requirements is a prerequisite to be able to affix the CE mark to devices, without which they cannot be

marketed or sold in the European Union. To demonstrate compliance with the GSPRs provided in the

MDR and obtain the right to affix the CE mark, medical devices manufacturers must undergo a conformity

assessment procedure. The conformity assessment procedure varies depending on the class of the

product, but most cases involve an assessment by a Notified Body. Depending on the relevant conformity

assessment procedure, this assessment may consist of a review of the technical file submitted by the

manufacturer, an audit of the quality system of the manufacturer, and testing of the product of the

manufacturer. Even though a Notified Body is a private organization in one of the member states of the

European Union, all Notified Bodies in the European Union are designated and accredited by a national

government of the European Union based on stringent criteria. Only such accredited Notified Bodies may

give a CE Certificate of Conformity following successful completion of a conformity assessment procedure

conducted in relation to the medical device and its manufacturer and their conformity with the GSPRs.

The CE Certificate of Conformity confirms the conformity of the device to the GSPRs and allows the

applicant to affix the CE mark on the assessed medical device and to commercialize it in the European

Union after having prepared and signed a related European Union Declaration of Conformity.

As a general rule, demonstration of conformity of medical devices and their manufacturers with the

GSPRs must be based, among other things, on the evaluation of clinical data supporting the safety and

performance of the products during normal conditions of use. Specifically, a manufacturer must

demonstrate that the device achieves its intended performance during normal conditions of use and that

the known and foreseeable risks, and any adverse events, are minimized and acceptable when weighed

against the benefits of its intended performance, and that any claims made about the performance and

safety of the device (e.g., product labeling and instructions for use) are supported by suitable evidence.

This assessment must be based on clinical data, which can be obtained from (i) clinical studies conducted

on the devices being assessed, (ii) scientific literature from similar devices whose equivalence with the

assessed device can be demonstrated or (iii) both clinical studies and scientific literature. The conduct of

clinical studies in the European Union is governed by detailed regulatory obligations. These may include

the requirement of prior authorization by the Competent Authorities of the country in which the study takes

place and the requirement to obtain a positive opinion from a competent Ethics Committee. This process

can be expensive and time-consuming. After a device is placed on the market in the European Union, it

remains subject to significant regulatory requirements.

The MDR also establishes transitional provisions, amended by Regulation (EU) 2023/607, permitting

certain devices that have been CE marked in accordance with the MDD or the AIMD to continue to be

placed on the European Union market under strict conditions and for a specific period of time depending

on the risk classification of the device and the date of issuance of any related CE Certificate of

Conformity. Accordingly, CE Certificates of Conformity issued by Notified Bodies in accordance with the

MDD or the AIMD from May 25, 2017, and which remained valid on May 26, 2021 and have not since

been withdrawn will, with certain exceptions, remain valid until December 31, 2027 for Class III and Class

IIb implantable medical devices and until December 31, 2028 for other Class IIb, Class IIa and Class I

devices with a measuring function or which are sterile. Class I medical devices, for which the conformity

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assessment procedure in accordance with the MDD or the AIMD did not require the involvement of a

Notified Body but will require the involvement of a Notified Body in accordance with the MDR and for

which an European Union Declaration of Conformity was issued in accordance with the MDD or the AIMD

prior to May 26, 2021, can continue to be placed on the European Union market until December 31, 2028.

Manufacturers of medical devices may only benefit from the above extended transitional provisions

deadlines if the following conditions are fulfilled: (i) the devices continue to comply with the requirements

of the MDD or AIMD, as applicable, (ii) there are no significant changes in the design and intended

purpose, (iii) the devices do not present an unacceptable risk to the health or safety of patients, users or

other persons, or to other aspects of the protection of public health, (iv) the manufacturer implements a

quality management system by May 26, 2024 which complies with the requirements of the MDR, (v) by

May 26, 2024 an application is lodged with a Notified Body for conduct of the conformity assessment of

the devices covered by the CE Certificate of Conformity, or the devices intended to substitute for such

devices, in accordance with the MDR and a related written agreement is signed with the Notified Body by

September 26, 2024, and (vi) from May 26, 2021, compliance with the MDR relating to post-market

surveillance, market surveillance, vigilance, registration of economic operators and of devices is ensured

in place of the corresponding requirements in the MDD or AIMD.

In addition, CE Certificates of Conformity issued by Notified Bodies in accordance with the MDD or the

AIMD from May 25, 2017, which were valid on May 26, 2021 and have not been withdraw since but which

expired before March 20, 2023, will only continue to be valid in accordance with the extended transitional

deadlines above if either (i) the manufacturer signed a written agreement with a Notified Body for the

conformity assessment of the device covered by the expired CE Certificate of Conformity, or the device

intended to substitute that device, in accordance with the MDR before the date of expiry of the CE

Certificate of Conformity, or (ii) a competent authority of an European Union Member State has granted a

derogation from the application conformity assessment procedure in accordance with Article 59(1) or

Article 97(1) of the MDR.

On July 26, 2011, our Notified Body at the time, TUV Nord, issued a CE Certificate of Conformity for, and

thus allowed us to affix the CE mark, version 1.0 of the Heartflow Platform (July 26, 2011). The CE

Certificate of Conformity was subsequently reviewed for version 2.x of the Heartflow Platform and

confirmed in March of 2017. Our current version, version 3.x is also CE marked under the MDD

(November 20, 2019). We currently rely on the transitional provisions of the MDR to continue to place

version 3.x of the Heartflow Platform on the market in the European Union.

In addition, TUV Nord assessed the conformity of our quality management system ("QMS") with the

industry standard, EN ISO 13485, and TUV Nord issued the certificate confirming that we meet all EN ISO

13485 requirements. Based on the EN ISO certificate, TUV Nord also issued a certificate under the

MDSAP (Medical Device Single Audit Program), stating that the requirements of EN ISO 13485:2016 for

quality management systems are met in Australia, Canada, USA and Japan.

In the second half of 2024, we changed Notified Bodies from TUV Nord to BSI by an agreement between

TUV Nord, BSI and us. BSI has taken over Notified Body responsibilities concerning all MDD/MDR

requirements. BSI has also taken over our QMS certifications. After this transfer, all certificates issued by

TUV Nord remain valid and in effect.

The advertising and promotion of medical devices in the European Union is subject to the national laws of

the individual European Union Member States that implemented the MDD, the AIMD and that apply the

MDR, Directive 2006/114/EC concerning misleading and comparative advertising, and Directive 2005/29/

EC on unfair commercial practices, as well as other national legislation of individual European Union

Member States governing the advertising and promotion of medical devices. European Union Member

States' national legislation may also restrict or impose limitations on our ability to advertise our products

directly to the general public. In addition, voluntary European Union and national industry Codes of

Conduct provide guidelines on the advertising and promotion of our products to the general public and

may impose limitations on our promotional activities with healthcare professionals.

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In addition, other countries, such as Switzerland, have voluntarily adopted laws and regulations relating to

medical devices that mirror those of the European Union. Medical devices certified by a Notified Body and

CE marked in the European Union may be placed on Swiss market.

***United Kingdom***

The United Kingdom left the European Union in January of 2020 and the transitional period ended on

December 31, 2020. In light of the fact that the CE Marking process is set out in European Union law,

which no longer applies in the United Kingdom, the United Kingdom has devised a new route to market

culminating in a UKCA Mark to replace the CE Mark. Northern Ireland will, however, continue to be

covered by the regulations governing CE Marks. The United Kingdom Medicines and Healthcare products

Regulatory Agency ("MHRA") has established transitional provision to recognize the acceptance of certain

CE marked medical devices on the Great Britain market until June 30, 2030, at the latest, depending on

the type of device and its classification. Accordingly, medical devices which, for example, meet all

requirements of the European Union MDD and have a valid CE Certificate of Conformity and European

Union Declaration of conformity issued under the MDD prior to May 26, 2021, may be placed on the

market until the sooner of expiry of the CE Certificate of Conformity or June 30, 2028. Medical devices

which meet all requirements of the European Union MDR may be placed on the market until June 30,

2030. Manufacturers of medical devices located outside the United Kingdom, including manufacturers of

CE marked medical devices, need to appoint a United Kingdom Responsible Person before the devices

may be placed on the United Kingdom market. The United Kingdom government plans on introducing

new legislation governing medical devices which will be delivered though secondary legislation. The first

piece of legislation was laid in 2024 and updates post-market surveillance requirements. Additional

instruments will follow in 2025 and 2026 to introduce new pre-market requirements including international

reliance, and further enhancements to the regulations.

***Japan***

We applied for marketing authorization with the PMDA in Japan in February 2015, which was approved in

November 2016. As a result, we are able to commercially market the product in Japan. Our initial

SHONIN application is still current and includes a minor change notification.

***Canada***

Heartflow received our initial Canadian Medical Device License in August 2015. This remains current and

updated frequently with amendments for every minor software release. As well, Canada recognizes the

Heartflow Mobile application as a separate device identified within our Heartflow device family and

requires amendments for Mobile updates.

***Other regulations — federal and state fraud and abuse, data privacy and security and***

***transparency laws***

In addition to FDA restrictions on marketing and promotion of medical devices, there are numerous U.S.

federal and state laws, regulations, and guidance documents pertaining to healthcare compliance

protections against fraud and abuse, including anti-kickback laws, payment transparency laws, patient

inducement laws, and false claims laws, and, in some states, prohibitions against the corporate practice

of medicine and the unlicensed practice of medicine (collectively, fraud and abuse laws and regulations).

Our relationships with physicians, hospitals and other healthcare providers and referral sources for our

products are subject to scrutiny under these laws. Violations of these laws may be punishable by criminal

and civil sanctions, including, in some instances, imprisonment and exclusion from participation in federal

and state healthcare programs, including the Medicare, Medicaid and Veterans Administration health

programs. Because of the breadth and far-reaching nature of these laws, we may be required to alter or

discontinue one or more of our business practices to be in compliance with these laws.

These healthcare fraud and abuse laws and regulations are complex, and even minor departures from

what is expressly permitted under the laws and regulations can potentially give rise to claims that a

statute or regulation has been violated in a manner that could result in serious criminal or civil

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consequences. Several of the more significant healthcare fraud and abuse laws and regulations that may

affect our business or ability to operate are summarized below.

The federal Anti-Kickback Statute is a criminal law that prohibits, among other things, knowingly and

willfully offering, paying, soliciting, or receiving any remuneration in cash or in-kind (including any

kickback or bribe, but also common forms of remuneration, such as service or consulting fees, service

fees, meals, travel expenses, discounts, or rebates), directly or indirectly, overtly or covertly, to induce or

in return for purchasing, leasing, ordering or arranging for or recommending the purchase, lease or order

of any item or service reimbursable, in whole or in part, under Medicare, Medicaid or other federal

healthcare programs. The term "remuneration" has been broadly interpreted to include anything of value.

Although there are a number of statutory exceptions and regulatory safe harbors protecting some

common activities, the exceptions and safe harbors are drawn narrowly. Practices that involve

remuneration that may be alleged to be intended to induce prescribing, uses, purchases, or

recommendations of prescriptions, uses, or purchases of our products may be subject to scrutiny if they

do not qualify for an exception or safe harbor. Failure to meet all of the requirements of a particular

applicable statutory exception or regulatory safe harbor does not make the conduct per se illegal under

the Anti-Kickback Statute. Instead, the legality of the arrangement will be evaluated on a case-by-case

basis based on a review of all relevant facts and circumstances. Several courts have interpreted the

statute's intent requirement to mean that if any one purpose of an arrangement involving remuneration is

to induce referrals of (or purchases, uses, or recommendations of prescriptions, uses, or purchases)

federal healthcare program covered business, the Anti-Kickback Statute has been implicated and

potentially violated.

Additionally, the Anti-Kickback Statute was amended by the ACA. Specifically, as noted above, under the

Anti-Kickback Statute, the government must prove that a defendant acted "knowingly" to prove a violation.

The ACA added a provision that clarifies that with respect to violations of the Anti-Kickback Statute, "a

person need not have actual knowledge" of the Statute or specific intent to commit a violation of the

Statute. This change effectively overturns case law interpretations that set a higher standard under which

prosecutors had to prove the specific intent to violate the law. In addition, the ACA codified case law that a

claim including items or services resulting from a violation of the federal Anti-Kickback Statute may

constitute a false or fraudulent claim for purpose of the federal civil False Claims Act.

The federal civil U.S. False Claims Act prohibits, among other things, any person or entity from knowingly

presenting, or causing to be presented, a false or fraudulent claim for payment or approval to the federal

government or knowingly making, using or causing to be made or used a false record or statement

material to a false or fraudulent claim to the federal government. A claim includes "any request or

demand" for money or property presented to the United States government. The civil False Claims Act

also applies to false submissions that cause the government to not receive a benefit to which it is entitled,

such as a discounted sales price for products covered by federal healthcare programs. Intent to deceive

is not required to establish liability under the civil False Claims Act. In addition, the civil False Claims Act

includes a whistleblower provision that allows private citizens to bring claims on behalf of the United

States government alleging violations of the law. Whistleblowers may be entitled to up to as much as

thirty percent (30%) of the government's financial recovery resulting from such claims. This incentivizes

potential whistleblowers to file complaints in federal court, which complaints are relied upon heavily by the

government to investigate and prosecute allegations of violations of both the civil False Claims Act and

the Anti-Kickback Statute.

Many medical device, pharmaceutical, biotech and other healthcare companies have been investigated or

prosecuted under these healthcare fraud and abuse laws and regulations. Investigations, prosecutions

(and settlements) relate to a wide range of activities, including among other things, improper clinical

studies, provision of consulting fees to physicians for services that were not commercially reasonable,

providing free product to customers to induce them to do business with the manufacturer, providing high

value meals to customers to induce them to do business with the manufacturer, or providing non-

compliant discounts or rebates to customers, with the expectation that the customers would bill federal

programs for the product or the medical services that involve the product. Other companies have been

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investigated or prosecuted for causing false claims to be submitted by, among other things, marketing of

products for unapproved, and thus noncovered, uses, or for promotion of uses inconsistent with approved

labeling ("off label" promotion).

The United States government may further prosecute conduct constituting a false claim under the criminal

False Claims Act. The criminal False Claims Act prohibits the making or presenting of a claim to the

government knowing such claim to be false, fictitious, or fraudulent and, unlike the civil False Claims Act,

requires proof of intent to submit a false claim.

In addition to the Anti-Kickback Statute and the civil and criminal False Claims Acts, the United States

federal government has the authority to seek civil monetary penalties, assessments and exclusions

against an individual or entity based on a wide variety of prohibited conduct. For example, the Civil

Monetary Penalties Law authorizes the imposition of substantial civil money penalties against an entity

that engages in activities including: (i) knowingly presenting or causing to be presented, a claim for

services not provided as claimed or which is otherwise false or fraudulent in any way; (ii) knowingly giving

or causing to be given false or misleading information reasonably expected to influence the decision to

discharge a patient; (iii) offering or giving remuneration to any beneficiary of a federal healthcare program

likely to influence the receipt of reimbursable items or services; (iv) arranging for reimbursable services

with an entity which is excluded from participation from a federal healthcare program; (v) knowingly or

willfully soliciting or receiving remuneration for a referral of a federal healthcare program beneficiary; or

(vi) using a payment intended for a federal healthcare program beneficiary for another use.

There are other federal anti-fraud laws, including the Health Information Portability and Accountability

Act's fraud provisions, that prohibit, among other actions, knowingly and willfully executing, or attempting

to execute, a scheme to defraud any healthcare benefit program, including private payors, knowingly and

willfully embezzling or stealing from a healthcare benefit program, willfully obstructing a criminal

investigation of a healthcare offense, and knowingly and willfully falsifying, concealing or covering up a

material fact or making any materially false, fictitious or fraudulent statement in connection with the

delivery of or payment for healthcare benefits, items or services.

Finally, many states and foreign countries have similar healthcare fraud and abuse statutes or regulations

that may be broader in scope and may apply regardless of payor, in addition to items and services

reimbursed under Medicaid and other state programs.

Violations any of these laws or any other governmental regulations that may apply to us may result in

significant civil, criminal and administrative penalties, damages, fines, disgorgement, imprisonment or

exclusion of devices from government-funded healthcare programs, such as Medicare and Medicaid or

comparable foreign programs.

***Physician Payment Sunshine Act***

Transparency laws regarding payments or other transfers of value provided to certain licensed healthcare

professionals and teaching hospitals may also impact our business practices. The federal Physician

Payment Sunshine Act requires most medical device manufacturers, including Heartflow, to track and

report annually to the Secretary of the United States Department of Health and Human Services ("HHS")

financial arrangements, payments, and other transfers of value made by that entity to physicians (defined

to include doctors, dentists, optometrists, podiatrists, and chiropractors), other healthcare providers (such

as physician assistants and nurse practitioners) and teaching hospitals, as well as ownership and

investment interests held by such physicians and their immediate family members. The payment

information is made publicly available in a searchable format on the CMS Open Payments website.

Similar laws have been enacted or are under consideration in several states and foreign jurisdictions,

including states such as Massachusetts and Vermont, and countries like France, which has adopted the

Loi Bertrand, or French Sunshine Act, which became effective in 2013. We will need to dedicate

significant resources to establish and maintain systems and processes in order to comply with these

regulations. Failure to comply with these federal reporting requirements can result in significant civil

monetary penalties. In addition, information reported to HHS, since it is publicly reported, can potentially

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be used by a whistleblower to bring claims under the civil False Claims Act alleging that certain payments

or transfers of value gave rise to kickbacks or false claims.

***The Foreign Corrupt Practices Act***

The U.S. Foreign Corrupt Practices Act ("FCPA") prohibits any U.S. individual or business from promising,

offering, paying, providing or authorizing the provision of money or anything else of value, directly or

indirectly, to any foreign official, political party candidate or certain other persons (including health care

professionals of state-funded hospitals) for the purpose of influencing any act or decision of the foreign

entity in order to assist the individual or business in obtaining, retaining or directing business. The FCPA

also obligates companies whose securities are listed in the United States to comply with accounting

provisions requiring them to maintain books and records that accurately and fairly reflect all transactions

of the corporation, including international subsidiaries, and to devise and maintain an adequate system of

internal accounting controls for domestic and international operations. Activities that violate the FCPA,

even if they occur wholly outside the United States, can result in criminal and civil fines, imprisonment,

disgorgement, oversight, and debarment from government contracts. In addition, several other domestic

and international anti-corruption or anti-bribery laws within and outside the United States apply to our

business.

***Privacy, security and breach notification***

Other federal and state laws and regulations restrict or otherwise impact our business practices. These

laws include, without limitation, data privacy, security and breach notification authorities.

HIPAA, as amended by HITECH, requires health plans, certain healthcare providers and healthcare

clearinghouses, referred to as "Covered Entities," to protect the privacy and security of certain types of

health information, referred to as protected health information ("PHI"). HIPAA also imposes various

requirements on "Business Associates" — entities performing services for, or on behalf of, a Covered

Entity that has access to the Covered Entity's PHI in connection with providing those services as well as

their covered subcontractors. Three key sets of federal regulations implementing HIPAA — the Privacy,

Security Breach Notification and Omnibus Rules (collectively, "HIPAA Rules") set forth a number of

standards that Covered Entities and Business Associates must meet with respect to protecting the privacy

and security of PHI. HIPAA also regulates standardization of data content, codes and formats used in

healthcare transactions and standardization of identifiers for health plans and providers.

Our customers are Covered Entities under HIPAA, and, in some cases, Heartflow may be considered a

Business Associate to such Covered Entities when they pay Heartflow for certain services that involve the

sharing of PHI with Heartflow. When Heartflow bills payors directly for the services, Heartflow is acting as

a Covered Entity. Whether acting as a Business Associate, covered subcontractor, or a Covered Entity,

Heartflow has obligations to comply with HIPAA and the HIPAA Rules, and either contractual obligations

to its Covered Entity Customers or statutory and contractual obligations to ensure that any sub-Business

Associates comply. This requires risk assessments and a wide range of compliance policies, procedures

and practices to safeguard.

Penalties for violations of HIPAA regulations include civil and criminal penalties. Our failure to comply with

HIPAA could result in significant criminal and civil penalties and other damages which could adversely

affect our results of operations, financial position or cashflows. We have developed and implemented

processes designed to comply with HIPAA and are continuing to assess the need for additional

safeguards, policies, procedures, and programing and to develop them where necessary. The

requirements under HIPAA may change periodically and could have an effect on our business operations

if compliance becomes substantially more costly than under current requirements. Additionally, a breach

of unsecured PHI, such as by employee error or an attack by an outsider, could have an adverse effect on

our business in terms of potential penalties and corrective action required, in addition to reputational

damage.

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In addition to HIPAA and other federal privacy regulations, there are a number of state laws governing

privacy, confidentiality and security of health information that apply to our business. Most states also have

authorities governing breach notification. New laws governing privacy, security, and breach notification

may be adopted in the future as well. We have undertaken measures to comply with health information

privacy requirements to which we know we are subject. However, we can provide no assurance that we

are or will always remain in compliance with diverse and changing privacy, security, and breach

notification requirements in all of the jurisdictions in which we do business. Failure to comply with privacy

security or breach notification requirements could result in civil or criminal penalties, which could have an

adverse effect on our business. Our failure to adequately protect personal or health related information

could have an adverse effect on our business. A wide variety of provincial, state, national and

international laws and regulations apply to the creation, collection, use, retention, protection, disclosure,

transfer, and other processing of personal information, including protected health information. These data

protection and privacy and security related laws and regulations are evolving and being tested in courts,

and may result in ever increasing regulatory and public scrutiny and escalating levels of enforcement and

sanctions. Our failure to comply with applicable laws and regulations, or to protect such data, could result

in enforcement action against us, including fines, imprisonment of company officials and public censure,

claims for damages by end customers and other affected individuals, damage to our reputation and loss

of goodwill (both in relation to existing end customers and potential end customers), any of which could

have an adverse effect on our operations, financial performance, and business. Evolving and changing

definitions of personal data and personal information, within the European Union, the United States and

elsewhere, especially relating to classification of IP addresses, machine identification, location data, and

other information, may limit or inhibit our ability to operate or expand our business. Even the perception of

privacy concerns, whether or not valid, may harm our reputation and inhibit adoption of our product by

current and future end customers.

***Healthcare reform***

Current and future U.S. legislative proposals to further reform healthcare or reduce healthcare costs may

result in low, or even no, reimbursement for our product, or for the procedures associated with the use of

our product, or limit coverage of our product. The cost containment measures that payors and providers

are instituting and the effect of any healthcare reform initiative implemented in the future could

significantly reduce our revenues from the sale of our product. Alternatively, the shift away from fee-for-

service agreements to capitated payment models supports the value of our product, as they are intended

to reduce longitudinal resource utilization, which can be cost saving for both payors and providers.

The ACA was enacted in March 2010. As a U.S.-based company with anticipated sales in the United

States, these healthcare reform laws will materially impact our business. Certain provisions of the ACA

are still set to become effective in future years and the administrative agencies responsible for issuing

regulations that implement some aspects of the laws have yet to do so.

There have been numerous legal challenges and Congressional actions and amendments to certain

aspects of the ACA. For example, on August 16, 2022, the Inflation Reduction Act of 2022 ("IRA") was

signed into law, which, among other things, extends enhanced subsidies for individuals purchasing health

insurance coverage in ACA marketplaces through plan year 2025. The IRA also eliminates the "donut

hole" under the Medicare Part D program beginning in 2025 by significantly lowering the beneficiary

maximum out-of-pocket cost and creating a new manufacturer discount program. Additionally, on July 4,

2025, the annual reconciliation bill, the "One Big Beautiful Bill Act," or OBBBA, was signed into law which

is expected to reduce Medicaid spending and enrollment by implementing work requirements for some

beneficiaries, capping state-directed payments, reducing federal funding, and limiting provider taxes used

to fund the program. OBBBA also narrows access to ACA marketplace exchange enrollment and declines

to extend the ACA enhanced advanced premium tax credits, set to expire in 2025, which, among other

provisions in the law, are anticipated to reduce the number of Americans with health insurance. Further, it

is unclear whether there will be additional attempts to repeal the ACA outright or further pare back its

subsidies and enrollment periods.

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The uncertain fate of the ACA notwithstanding, we expect that the ACA, as well as other healthcare

reform measures that may be adopted in the future, particularly in light of the recent changes in the White

House and Congress, may result in more rigorous coverage criteria and in additional downward pressure

on the price that we may receive for our products. Any reduction in payments from Medicare or other

government programs may result in a similar reduction in payments from private payors. The

implementation of cost containment measures or other healthcare reforms may prevent us from being

able to generate additional revenue or attain profitability.

**Employees and human capital resources**

As of March 31, 2025, we had 699 full-time employees globally. We believe the success of our business

will depend, in part, on our ability to attract and retain qualified personnel, in particular highly skilled

technology personnel. Our employees are not subject to a collective bargaining agreement, and we

believe that we have good relations with our employees.

Our human capital resources objectives include attracting and retaining top talent, investing in our talent

with leadership development and job-related technical training, and increasing diverse representation in

our employee base through inclusivity initiatives that build on our culture of inclusion and belonging. The

principal purposes of our equity incentive plans are to attract, retain and motivate employees, consultants

and directors through the granting of stock-based compensation awards and cash-based performance

bonus awards.

**Facilities**

Our corporate headquarters and research and development facilities are located in Mountain View,

California, where we lease approximately 61,500 square feet of office space under a lease agreement

that expires in August 2030. We also lease and occupy approximately 26,400 square feet in Austin, Texas

primarily for additional production personnel under a lease agreement that expires in December 2026. We

do not own any real property. We believe that these facilities are adequate for the foreseeable future.

**Legal proceedings**

We have become, and we may become in the future, involved in various legal proceedings arising from

the normal course of business activities. We are not presently a party to any litigation the outcome of

which, we believe, if determined adversely to us, would individually or taken together, materially and

adversely affect our business, financial condition, or results of operations. However, we may from time to

time be involved in various claims and legal proceedings of a nature we believe are normal and incidental

to a business such as ours. These matters may include employment, contract, intellectual property,

product liability and other general claims. Regardless of outcome, litigation can have an adverse impact

on us because of defense and settlement costs, diversion of management resources and other factors.

**Corporate information**

We were incorporated under the laws of the State of Delaware in 2007. On March 1, 2021, we completed

an internal reorganization in which a newly formed parent holding company was put in place. The

previous holders of our common stock and preferred securities became holders of common stock and

preferred securities of HeartFlow Holding, Inc. The equity incentive plan, outstanding equity awards,

outstanding warrants and certain other equity-related agreements of HeartFlow, Inc. were assumed by

HeartFlow Holding, Inc. Our operations and business activities remained at HeartFlow, Inc., and the

wholly-owned non-U.S. subsidiaries of HeartFlow, Inc. remained in place. On July 17, 2025, we

consolidated HeartFlow Holding, Inc. into HeartFlow, Inc. and the previous holders of HeartFlow Holding,

Inc. common stock and preferred securities became holders of our common stock and preferred

securities and the equity incentive plan, outstanding equity awards, outstanding warrants and certain

other equity-related agreements of HeartFlow Holding, Inc. were assumed by us. In connection with this

consolidation, we changed our name to Heartflow, Inc. Our principal executive offices are located at 331

E. Evelyn Avenue, Mountain View, California 94041, and our telephone number is (650) 241-1221. Our

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corporate website address is www.heartflow.com. Information contained on, or accessible through, our

website shall not be deemed incorporated into and is not a part of this prospectus or the registration

statement of which it forms a part. We have included our website in this prospectus solely as an inactive

textual reference.

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**Management**

The following table sets forth information regarding our executive officers and directors, including their

ages as of June 30, 2025:

---

| | | |
|:---|:---|:---|
| **Name** | **Age** | **Position(s)** |
| ***Executive officers and employee director*** |  |  |
| John C.M. Farquhar............................................... | 53 | President, Chief Executive Officer and Director |
| Vikram Verghese.................................................... | 41 | Chief Financial Officer |
| Campbell D.K. Rogers, M.D................................. | 64 | Chief Medical Officer |
| ***Non-employee directors*** |  |  |
| William C. Weldon<sup>(3)</sup>............................................... | 76 | Director and Chair of the Board of Directors |
| Timothy C. Barabe<sup>(1)</sup>.............................................. | 72 | Director |
| Julie A. Cullivan<sup>(1)</sup>................................................... | 59 | Director |
| Nicholas Downing, M.D.<sup>(4)</sup>.................................... | 40 | Director |
| Jeffrey C. Lightcap<sup>(2)(3)</sup>........................................... | 66 | Director |
| Wayne J. Riley, M.D.<sup>(1)(2)</sup>....................................... | 66 | Director |
| Lonnie M. Smith<sup>(4)</sup>.................................................. | 80 | Director |
| Casey M. Tansey<sup>(2)(3)</sup>............................................. | 67 | Director |
| Charles A. Taylor, Jr., Ph.D.<sup>(4)</sup>............................... | 61 | Director |

---

(1)Member of our audit committee.

(2)Member of our compensation committee.

(3)Member of our nominating and corporate governance committee.

(4)Dr. Downing, Mr. Smith and Dr. Taylor have each notified us that they will resign from our board of directors upon the commencement of

trading of our common stock on the Nasdaq Global Select Market.

**Executive officers and employee director**

***John C.M. Farquhar*** has served as our Chief Executive Officer and as a member of our board of

directors since March 2022, and as our President since January 2022, and he served as our Chief

Operating Officer from July 2021 to March 2022. Prior to joining the Company, from March 2008 to July

2021, Mr. Farquhar held numerous positions of increasing responsibility across the cardiovascular and

diabetes portfolios of Medtronic plc ("Medtronic"), a global medical technology company, most recently

serving as a President and General Manager from June 2018 until July 2021. Prior to that, Mr. Farquhar

served as a Marketing Manager at General Mills, Inc., a multinational manufacturer and marketer of

branded consumer foods, from January 2004 until March 2008. He received a B.A. in Psychology and

History from Duke University and an M.B.A. from Northwestern University's Kellogg School of

Management. We believe that Mr. Farquhar's extensive experience in the medical sector qualifies Mr.

Farquhar to serve on our board of directors and his role as our Chief Executive Officer provides a vital link

between our board of directors and our management team.

***Vikram Verghese*** has served as our Chief Financial Officer since June 2023. He joined the Company in

November 2021 as Senior Vice President of Upstream Marketing, Business Development, and Strategy.

Prior to that, Mr. Verghese held various positions at Medtronic from 2008 until July 2021 in various

leadership roles spanning global marketing, regulatory and clinical affairs and business development.

After completing his undergraduate degree in Electrical and Electronic Engineering in India, Mr. Verghese

received an M.S. in Biomedical Engineering from the University of Southern California and an M.B.A. from

University of Pennsylvania's The Wharton School. He is also a CFA charter holder.

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***Campbell D.K. Rogers, M.D.*** has served as our Chief Medical Officer since March 2012. Prior to joining

the Company, Dr. Rogers was the Chief Scientific Officer and Global Head of Research and Development

at Cordis Corporation ("Cordis"), a medical device company that was formerly part of the Johnson &

Johnson family of companies, from July 2006 until February 2012, where he was responsible for leading

investments and research in cardiovascular devices. Prior to Cordis, Dr. Rogers was an Associate

Professor of Medicine at Harvard Medical School and the Harvard-M.I.T. Division of Health Sciences and

Technology from July 1994 until July 2006, and a director of the Cardiac Catheterization and Experimental

Cardiovascular Interventional Laboratories at Brigham and Women's Hospital in Massachusetts from

October 2000 until June 2006, where he was responsible for clinical care, education and research. Dr.

Rogers served as a Principal Investigator for numerous interventional cardiology device, diagnostic, and

pharmacology trials, is the author of numerous publications in the area of coronary artery and other

cardiovascular diseases, and was the recipient of research grant awards from the National Institute of

Health and American Heart Association. Dr. Rogers previously served on the boards of directors of

Corindus Vascular Robotics, Inc. (formerly NYSE: CVRS) from 2016 until 2019, where he was a member

of the Audit Committee, and InspireMD, Inc. (Nasdaq: NSPR) from 2013 until 2022, where he was a

member of the Research and Development Committee. He received an A.B. in English from Harvard

College and an M.D. from Harvard Medical School.

**Non-employee directors**

***William C. Weldon*** has served as Chair of our board of directors from June 2017 to May 2019 and since

2020, and also as a member of our board of directors since September 2014. Mr. Weldon is the former

Chairman of the board and Chief Executive Officer of Johnson & Johnson (NYSE: JNJ), a global

developer and manufacturer of healthcare products, having served in those positions from 2002 until his

retirement in 2012. Mr. Weldon previously served in a variety of senior executive positions during his 41-

year career with Johnson & Johnson until his appointment as Chairman of the board and Chief Executive

Officer. Mr. Weldon has served on the board of directors of Fairfax Financial Holdings Limited since April

2020. Mr. Weldon previously served as a director of CVS Health Corporation (NYSE: CVS) until his

retirement from that board in May 2023, Exxon Mobil Corporation (NYSE: XOM) until his retirement from

that board in May 2021, JPMorgan Chase & Co. (NYSE: JPM) until his retirement from that board in May

2019, and The Chubb Corporation until its acquisition by ACE Limited in January 2016. He is a member of

various not-for-profit organizations and is also a member of the Board of Trustees for Quinnipiac

University. Mr. Weldon received his B.A. in Biology from Quinnipiac University. We believe that Mr.

Weldon's knowledge of the healthcare industry and his experience as chief executive officer and

chairman of the board at Johnson & Johnson and on the boards of other publicly traded companies,

which have exposed him to reporting and governance requirements, qualify him to serve on our board of

directors.

***Timothy C. Barabe*** has served as a member of our board of directors since January 2022. Mr. Barabe

served as the Chief Financial Officer and Executive Vice President at Affymetrix Inc. (acquired by Thermo

Fisher Scientific, Inc.), a provider of life science productions and molecular diagnostic products, from

2010 until his retirement in June 2013. Prior to that, Mr. Barabe served as Senior Vice President and

Chief Financial Officer of Human Genome Sciences, Inc., a biopharmaceutical company, from July 2006

until March 2010. From 2004 until 2006, he served as Chief Financial Officer of Regent Medical Limited, a

U.K.-based, privately held surgical supply company, and with Novartis AG, a pharmaceutical company,

from 1982 until August 2004 in a succession of senior executive positions in finance and general

management, most recently as the Chief Financial Officer of Sandoz GmbH, the generic pharmaceutical

subsidiary of Novartis AG. Prior to that, Mr. Barabe served as the President of the Specialty Lens

Business Franchise and Group Vice President and Chief Financial Officer of CIBA Vision Corporation, a

contact lenses and lens care product manufacturer, until 2003. Mr. Barabe has served on the board of

directors of Cartesian Therapeutics, Inc. (Nasdaq: RNAC) since 2016 and previously served on the board

of directors of Veeva Systems Inc. (NYSE: VEEV) from September 2015 until June 2021, ArQule, Inc.,

from 2001 until January 2020, and Opexa Therapeutics, Inc. from 2014 until 2017. Mr. Barabe also

currently serves on the board of directors of Vigilant Biosciences, Inc., a private company. Mr. Barabe

received a B.B.A. in General Business, Finance from the University of Massachusetts at Amherst and an

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M.B.A. from the University of Chicago. We believe that Mr. Barabe's extensive finance experience, and

his service on the board of directors of several other publicly traded companies, qualifies Mr. Barabe to

serve on our board of directors.

***Julie A. Cullivan*** has served as a member of our board of directors since November 2020. She has

served as a Special Advisor to Brighton Park Capital, L.P., an investment firm specializing in software,

information services and technology-enabled services, since June 2020, and previously served as the

Chief Technology and People Officer at Forescout Technologies Inc. ("Forescout"), a network security

software company, from June 2017 until January 2021. Prior to joining Forescout, Ms. Cullivan served as

the Executive Vice President, Business Operations and Chief Information Officer of FireEye, Inc., an

enterprise cybersecurity company, from January 2013 until May 2017, and as a Senior Vice President at

McAfee Corp., a global computer security software company, from April 2008 until October 2011. Earlier in

her career, Ms. Cullivan held executive roles at Autodesk, Inc., EMC Corporation, and Oracle Corporation.

Ms. Cullivan has served on the board of directors of Axon Enterprise, Inc. (Nasdaq: AXON) since 2017,

where she has been a member of the Audit Committee since July 2017, Chair of the Enterprise Risk

Committee since March 2022, and a member of the of the Nominating and Governance Committee since

July 2024. She has also served on the boards of directors of Cobalt Labs Inc. (dba Cobalt.io) since 2022,

where she is a member of the Compensation Committee, and OPSWAT Inc. since 2021. Ms. Cullivan

previously served on the boards of Astra Space Inc. (Nasdaq: ASTR), where she was a member of the

Audit Committee from February 2023 to July 2024, SADA, where she was a member of the

Compensation Committee from May 2021 to December 2024, and AaDya Security Inc. (dba Judy

Security) from March 2021 to August 2024. Ms. Cullivan received a B.S. in Finance from Santa Clara

University. We believe that Ms. Cullivan's extensive experience in the technology sector, including her

past roles at leading technology, cybersecurity and digital infrastructure companies, qualifies Ms. Cullivan

to serve on our board of directors.

***Nicholas Downing, M.D.*** has served as a member of our board of directors since March 2023. Since

2018, Dr. Downing has worked at Bain Capital, a private investment firm, currently serving as a Managing

Director on the Bain Capital Life Sciences team. Prior to joining Bain Capital, Dr. Downing was a Resident

Physician at the Brigham and Women's Hospital in Boston from 2015 until 2018. Dr. Downing is the

author of over 40 peer-reviewed scientific articles. Prior to his medical career, Dr. Downing was a

Consultant at McKinsey and Company, a global management consulting firm, where he worked with

clients in the pharmaceutical, hospital and financial services industries. Dr. Downing has served as a

member of the board of directors and the Nominating and Corporate Governance Committee of

NewAmsterdam Pharma Company N.V. (Nasdaq: NAMS) since November 2022. Dr. Downing received

an A.B. in Chemistry from Harvard College and an M.D. from Yale University School of Medicine. We

believe that Dr. Downing's extensive investment and financial experience, particularly in the medical

sector, as well as his medical background qualifies Dr. Downing to serve on our board of directors. Dr.

Downing has notified us that he will resign from our board of directors upon, and subject to, the

commencement of trading of our common stock on the Nasdaq Global Select Market. Dr. Downing's

resignation is not due to any disagreement with us or any matters relating to our operations, policies or

practices.

***Jeffrey C. Lightcap*** has served as a member of our board of directors since December 2011. Since

2007, Mr. Lightcap has served as a Senior Managing Director at HealthCor Partners Management, L.P.

("HealthCor Partners"), a venture capital investment manager focused on late-stage venture and early

commercial stage healthcare companies. Since 2019, Mr. Lightcap also serves as a Senior Managing

Director at Healthcare Venture Partners, LLC, a venture capital investment manager focused on

investments in technology driven companies in the diagnostic, therapeutic and medtech sectors. From

1997 until 2006, Mr. Lightcap served as a Senior Managing Director at JLL Partners, a leading middle-

market private equity firm. Prior to JLL Partners, from 1993 until 1997, Mr. Lightcap served as a Managing

Director in the mergers and acquisitions group at Merrill Lynch & Co., Inc. ("Merrill Lynch"), a global

financial services company. Prior to joining Merrill Lynch, Mr. Lightcap was a Senior Vice President in the

mergers and acquisitions group at Kidder, Peabody & Co., an investment banking company, and briefly at

Salomon Brothers, a global financial institution. Mr. Lightcap currently serves on the board of directors of

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Careview Communications, Inc. (OTC: CRVW), KellBenx, Inc. and Paige.AI, Inc. Mr. Lightcap also

previously served on the board of directors of a number of HealthCor Partners' portfolio companies,

including Corindus Vascular Robotics Inc. (March 2008 to October 2019), Practice Partners in Healthcare,

LLC (September 2007 to April 2019), Paradigm Spine, LLC (April 2008 to March 2019) and RTI Surgical

Holdings, Inc. which became Surgalign Holdings, Inc. (March 2019 to September 2021). Mr. Lightcap

received a B.E. in Mechanical Engineering from the State University of New York at Stony Brook and an

M.B.A. from the University of Chicago. We believe that Mr. Lightcap's extensive experience in the medical

sector, including his service on the boards of directors of multiple healthcare companies, qualifies Mr.

Lightcap to serve on our board of directors.

***Wayne J. Riley, M.D.*** has served as a member of our board of directors since November 2021. Dr. Riley

has served as the President of the State University of New York Downstate Health Sciences University

since April 2017, where he is also a Tenured Professor of Internal Medicine and Health Policy and

Management. From 2013 until 2017, Dr. Riley was an Adjunct Professor of Healthcare Management at

Owen Graduate School of Management, Vanderbilt University and a Clinical Professor of Medicine at

Vanderbilt University School of Medicine. From 2007 until 2013, Dr. Riley served as President and Chief

Executive Officer of Meharry Medical College, and from 2003 until 2006, served as Vice President and

Vice Dean of Health Affairs and Governmental Relations at Baylor College of Medicine. Dr. Riley has

served on the board of directors of Compass Pathways, plc (Nasdaq: CMPS) since 2021 and HCA

Healthcare, Inc. (NYSE: HCA) since 2012, where he also serves as the chair of the patient safety and

quality committee and as a member of the audit and compliance committee and nominating and corporate

governance committee. Dr. Riley previously served as a director of Vertex Pharmaceuticals Inc. (Nasdaq:

VTRX) from 2010 until 2015, Pinnacle Financial Partners, Inc. from 2007 until 2013, and the Federal

Reserve Bank of Atlanta, Nashville Branch Bank Board from January 2013 to June 2013. He is President

Emeritus of the American College of Physicians and an elected member of the National Academy of

Medicine. Dr. Riley is also a commissioner of the Medicare Payment Advisory Commission, chair of the

Board of Trustees and of The New York Academy of Medicine since 2019. Dr. Riley received a B.A. in

Anthropology from Yale University, an M.P.H. in Health Systems Management from the Tulane University

School of Public Health and Topical Medicine, an M.D. from the Morehouse School of Medicine, and an

M.B.A. from Rice University's Jesse H. Jones Graduate School of Business. We believe that Dr. Riley's

experience as a practicing physician and his leadership, executive management and patient care skills at

other leading medical and educational institutions, as well as his prior public company board service,

qualify him to serve on our board of directors.

***Lonnie M. Smith*** has served as a member of our board of directors since September 2011. From 1997

until April 2020, Mr. Smith was the President and Chief Executive Officer and then Chairman of Intuitive

Surgical, Inc., a developer and manufacturer of surgical robotic products designed to improve clinical

outcomes of patients. From 1978 until 1997, Mr. Smith was Senior Executive Vice President of

Hillenbrand Industries, a manufacturer and provider of products and services for the health care and

funeral services industries. During his tenure at Hillenbrand Industries, he was a member of the executive

committee, the office of the president and the board of directors. Mr. Smith has also held positions at The

Boston Consulting Group, a management consulting firm, and International Business Machines Corp, a

technology and consulting company. Mr. Smith served as chairman of the board of Tandem Diabetes

Care, Inc. (Nasdaq: TNDM), from 2013 until 2015. Mr. Smith received a B.S.E.E. from Utah State

University and an M.B.A. from Harvard Business School. We believe that Mr. Smith's extensive medical,

management and directorship experience in the medical sector qualifies him to serve on our board of

directors. Mr. Smith has notified us that he will resign from our board of directors upon, and subject to, the

commencement of trading of our common stock on the Nasdaq Global Select Market. Mr. Smith's

resignation is not due to any disagreement with us or any matters relating to our operations, policies or

practices.

***Casey M. Tansey*** has served as a member of our board of directors since August 2010. Since 2005, he

has served as a General Partner of U.S. Venture Partners, a venture capital firm. From 2001 until 2004,

Mr. Tansey served as the Chief Executive Officer and President of Epicor Medical, a medical device

company. Prior to Epicor Medical, Mr. Tansey was Chief Executive Officer and President of Heartport,

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Inc., a medical device company, which is now part of the Johnson & Johnson family of companies. Prior

to that, he was with the cardiovascular division at Baxter Edwards, a medical technology company, for

nearly ten years, holding various sales and marketing positions. Mr. Tansey currently serves on the board

of directors and as a member of the organization and compensation committee of Inspire Medical

Systems, Inc. (NYSE: INSP) and previously served on the board of directors of Intersect ENT, Inc. from

2006 until 2017. He also serves on the board of directors for a number of U.S. Venture Partners' portfolio

of private companies, including Cagent Vascular Inc., HighLife Medical Inc., Luminopia, Inc.,

MicroTransponder Inc., Neochord, Inc., Neuros Medical, Inc., ShiraTronics, Inc. and Shoulder

Innovations. Mr. Tansey received a B.S. and an M.B.A. from the Notre Dame De Namur University. We

believe that Mr. Tansey's extensive experience as a venture capital investor and as a member of the

boards of directors of multiple companies in the medical sector qualify him to serve on our board of

directors.

***Charles A. Taylor, Ph.D.*** is one of our founders, and has served as a member of our board of directors

since July 2007. He is currently the W.A. "Tex" Moncrief, Jr., Chair in Computational Medicine, and a

Professor in the Department of Internal Medicine and the Oden Institute for Computational Engineering

and Sciences at the University of Texas at Austin. Dr. Taylor served as the Chief Technology Officer from

April 2010 to February 2022 and then Chief Scientific Officer of the Company from February 2022 through

December 2023. Prior to joining the Company, Dr. Taylor was an Associate Professor in the Department

of Bioengineering and Surgery at Stanford University from July 1997 until August 2010, where he held

courtesy faculty appointments in the Departments of Mechanical Engineering and Radiology. He received

a B.S. in Mechanical Engineering, M.S. in Mechanical Engineering and M.S. in Mathematics from

Rensselaer Polytechnic Institute and a Ph.D. in Mechanical Engineering from Stanford University. Dr.

Taylor has published over 450 publications in scientific journals and conference papers related to

cardiovascular bioengineering and patient-specific modeling of blood flow in the cardiovascular system

and is also an inventor on more than 300 issued patents worldwide. In 2024, Dr. Taylor was inducted into

the U.S. National Academy of Engineering. We believe that Dr. Taylor's extensive knowledge of the

Company as its founder, Chief Technology Officer and Chief Scientific Officer, experience as an inventor

and knowledge of our industry qualifies him to serve on our board of directors. Dr. Taylor has notified us

that he will resign from our board of directors upon, and subject to, the commencement of trading of our

common stock on the Nasdaq Global Select Market. Dr. Taylor's resignation is not due to any

disagreement with us or any matters relating to our operations, policies or practices.

**Family relationships** 

There are no family relationships among any of our executive officers or directors.

**Board composition and election of directors**

Our business and affairs are managed under the direction of our board of directors. Our board of directors

currently consists of ten members: Mr. Barabe, Ms. Cullivan, Dr. Downing, Mr. Farquhar, Mr. Lightcap, Dr.

Riley, Mr. Smith, Mr. Tansey, Dr. Taylor, and Mr. Weldon. Dr. Downing, Mr. Smith and Dr. Taylor have each

notified us that they will resign from our board of directors upon the commencement of trading of our

common stock on the Nasdaq Global Select Market. Under our amended and restated voting agreement

("Voting Agreement"), which would terminate at the completion of this offering, the stockholders who are

party to the Voting Agreement have agreed to vote their respective shares to elect: (i) one director

designated by BCLS Fund III Investments, LP, currently Nicholas Downing, (ii) two directors designated

by the holders of our Series A, Series B-1, Series B-2, Series C, Series D and Series E redeemable

convertible preferred stock, currently Casey M. Tansey and Jeffrey C. Lightcap, (iii) our Chief Executive

Officer, John C.M. Farquhar, (iv) one director designated by our founders, currently Charles A. Taylor, and

(v) Timothy C. Barabe, Julie A. Cullivan, Wayne J. Riley, Lonnie M. Smith and William C. Weldon, as

directors designated by the majority of the foregoing directors. In connection with this offering, the Voting

Agreement will terminate. As a result, following this offering there will be no contractual obligations

regarding the election of our directors.

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After this offering, the authorized number of directors may be changed by resolution of our board of

directors, subject to the terms of our amended and restated certificate of incorporation that will become

effective upon the completion of this offering.

**Director independence**

We have applied to have our common stock listed on the Nasdaq Global Select Market and this offering is

contingent upon obtaining such approval. Under the listing rules of the Nasdaq Global Select

Market ("Listing Rules"), independent directors must comprise a majority of a listed company's board of

directors within a specified period following completion of this offering. In addition, the Listing Rules

require that, subject to specified exceptions, each member of a listed company's audit, compensation,

and nominating and corporate governance committees be independent. Under these rules, a director will

only qualify as an "independent director" if, in the opinion of the company's board of directors, that person

does not have a relationship that would interfere with the exercise of independent judgment in carrying

out the responsibilities of a director. Under the Listing Rules, certain types of relationships generally

occurring within the last three years will automatically disqualify a director as independent, such as if the

director is one of our employees, is in receipt of direct compensation from us in excess of $120,000 in a

twelve-month period, or is engaged, directly or indirectly in certain business dealings with us in excess of

specified thresholds.

Our board of directors has determined that none of Mr. Barabe, Ms. Cullivan, Mr. Lightcap, Dr. Riley, Mr.

Tansey or Mr. Weldon has a relationship that would interfere with the exercise of independent judgment in

carrying out the responsibilities of a director, and that each of such individuals are "independent directors"

in accordance with the Listing Rules. In making these determinations, our board of directors reviewed and

discussed information provided by the directors and us with regard to each director's business and

personal activities and relationships as they may relate to us and our management. Mr. Farquhar is not

considered independent by virtue of his position as our Chief Executive Officer, and Dr. Taylor is not

considered independent by virtue of his former employment with us within the last three years.

**Classified board of directors**

In accordance with our amended and restated certificate of incorporation, which will be effective upon the

completion of this offering, our board of directors will be divided into three classes with staggered three-

year terms. At each annual general meeting of stockholders, the successors to directors whose terms

then expire will be elected to serve from the time of election and qualification until the third annual

meeting following election. Our directors will be divided among the three classes as follows:

• The Class I directors will be John C.M. Farquhar and Julie A. Cullivan, and their terms will expire at

the first annual meeting of stockholders following effectiveness of the amended and restated

certificate of incorporation;

• The Class II directors will be Jeffrey C. Lightcap, Casey M. Tansey and Timothy C. Barabe, and their

terms will expire at the second annual meeting of stockholders following effectiveness of the

amended and restated certificate of incorporation; and

• The Class III directors will be William C. Weldon and Wayne Riley, M.D., and their terms will expire at

the third annual meeting of stockholders following effectiveness of the amended and restated

certificate of incorporation.

The division of our board of directors into three classes with staggered three-year terms may delay or

prevent a change of our management or a change in control.

**Leadership structure of the board**

Our corporate governance guidelines to be in place upon the commencement of trading of our common

stock on the Nasdaq Global Select Market will provide our board of directors with flexibility to combine or

separate the positions of Chair of the board of directors and Chief Executive Officer and to implement a

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lead independent director in accordance with its determination regarding which structure would be in the

best interests of our company.

Mr. Weldon currently serves as our Chair of the board of directors and Mr. Farquhar serves as our Chief

Executive Officer. Our board of directors has concluded that our current leadership structure is

appropriate at this time. However, our board of directors will continue to periodically review our leadership

structure and may make such changes in the future as it deems appropriate.

**Board committees**

Our board of directors has established an audit committee, a compensation committee, and a nominating

and corporate governance committee. Our board of directors may establish other committees to facilitate

the management of our business. The composition and functions of each committee are described below.

Members serve on these committees until their resignation or until otherwise determined by our board of

directors. Our board of directors has adopted a written charter for each committee that satisfies the

applicable rules and regulations of the Securities and Exchange Commission (the "SEC") and Listing

Rules, which we will post on our website at www.heartflow.com upon the completion of this offering.

**Audit committee**

Our audit committee oversees our corporate accounting and financial reporting process and the quality

and integrity of our financial statements, the qualifications and performance of our independent registered

public accounting firm, our internal audit function and our risk management program. Among other

matters, the audit committee:

• oversees our independent registered public accounting firm, and has sole responsibility for the

appointment, compensation, retention and oversight of the work of our independent registered public

accounting firm;

• evaluates the independent registered public accounting firm's qualifications, independence, and

performance;

• reviews and approves the scope of the annual audit and pre-approves all audit and non-audit fees

and services to be performed by our independent registered public accounting firm;

• reviews with management and our independent registered public accounting firm the results of the

annual audit and the review of our interim financial statements, and reviews our financial statements

and our management's discussion and analysis of financial condition and results of operations to be

included in our annual and quarterly reports to be filed with the SEC;

• oversees our internal audit function;

• oversees our risk management program and reviews risks related to major financial risk exposures,

information security, regulatory compliance, and the steps our management has taken to monitor and

control these risks and exposures;

• establishes procedures for the receipt, retention, and treatment of any complaints received by us

regarding accounting, internal accounting controls, or auditing matters;

• reviews and approves all related person transactions; and

• reviews the audit committee charter and the audit committee's performance on an annual basis.

Our audit committee consists of Timothy C. Barabe, Julie A. Cullivan and Wayne Riley, M.D. Our board of

directors has determined that all members are independent under the Listing Rules and Rule 10A-3(b)(1)

of the Exchange Act. The chair of our audit committee is Mr. Barabe. Our board of directors has

determined that Mr. Barabe is an "audit committee financial expert" as such term is currently defined in

Item 407(d)(5) of Regulation S-K. Our board of directors has also determined that each member of our

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audit committee can read and understand fundamental financial statements as required by the Listing

Rules.

**Compensation committee** 

Our compensation committee oversees our compensation policies, plans and benefit programs,

particularly as they apply to our executive officers. Among other matters, the compensation committee:

• reviews and approves corporate goals and objectives relevant to compensation of our Chief

Executive Officer, evaluates the performance of the Chief Executive Officer in light of those goals and

objectives and approves the compensation of Chief Executive Officer based on such evaluations;

• reviews and approves the compensation of our other executive officers;

• reviews and makes recommendations to our board of directors regarding non-employee director

compensation;

• reviews and approves or makes recommendations to our board of directors regarding the issuance of

stock options and other equity awards under our performance incentive plans;

• engages in risk assessments of our compensation programs; and

• reviews the compensation committee charter and the compensation committee's performance on

annual basis.

Our compensation committee consists of Jeffrey C. Lightcap, Wayne Riley, M.D. and Casey M. Tansey.

Our board of directors has determined that all members are independent under the Listing Rules. The

chair of our compensation committee is Dr. Riley.

**Nominating and corporate governance committee** 

Our nominating and corporate governance committee oversees the nomination process for our directors

and policies relating to our corporate governance. Among other matters, the nominating and corporate

governance committee:

• identifies individuals qualified to be members of our board of directors, including candidates

recommended by stockholders, consistent with criteria approved by our board of directors;

• evaluates and makes recommendations to our board of directors of candidates for membership on

our board of directors and on each of the board's committees;

• develops and reviews the adequacy of our corporate governance guidelines and code of business

conduct and ethics and recommends and proposed changes to our board of directors;

• oversees the process of evaluating the performance of our board of directors;

• oversees management succession planning; and

• assists our board of directors on corporate governance matters and board of directors performance

matters, including recommendations regarding the size, structure and composition of our board of

directors and its committees.

Our nominating and corporate governance committee consists of Jeffrey C. Lightcap, Casey M. Tansey,

and William C. Weldon. Our board of directors has determined that all members are independent under

the Listing Rules. The chair of our nominating and corporate governance committee is Mr. Weldon.

**Compensation committee interlocks and insider participation** 

None of the members of our compensation committee (Jeffrey C. Lightcap, Wayne Riley, M.D. and Casey

M. Tansey) is or has been during the past fiscal year one of our employees or has been at any time one of

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our officers, and none of such individuals has any relationship requiring disclosure under SEC rules

applicable to related person transactions. None of our executive officers currently serves, or has served

during the last fiscal year, as a member of the board of directors or compensation committee (or other

board committee performing equivalent functions) of any entity that has one or more executive officers

serving as a member of our board of directors or on our compensation committee.

**Code of business conduct and ethics** 

In connection with this offering, our board of directors has adopted a written code of business conduct

and ethics to be effective upon the commencement of trading of our common stock on the Nasdaq Global

Select Market, which applies to all of our directors, executive officers, and employees, including our

principal executive officer, principal financial officer, and principal accounting officer or controller, or

persons performing similar functions. The full text of our code of business conduct and ethics will be

posted on our website at www.heartflow.com upon the completion of this offering. The nominating and

corporate governance committee of our board of directors will be responsible for overseeing our code of

business conduct and ethics. We intend to disclose any future amendments to or waivers of our code of

business conduct and ethics applicable to our directors and officers, including our principal executive

officer, principal financial officer, principal accounting officer or controller, or persons performing similar

functions to the extent required by applicable rules of the SEC or the Nasdaq Global Select Market, on

our website at the address identified above.

**Limitations on liability and indemnification matters** 

Our amended and restated certificate of incorporation, which will become effective upon the completion of

this offering, limit our directors' and officers' liability to us and our stockholders for monetary damages for

breach of fiduciary duty as a director or officer to the fullest extent permitted under the General

Corporation Law of the State of Delaware (the "DGCL"). Such provision will not eliminate or limit the

liability of:

• a director or officer for any breach of the director's or officer's duty of loyalty to the corporation or its

stockholders;

• a director or officer for any act or omission not in good faith or that involves intentional misconduct or

a knowing violation of law;

• a director for an unlawful payment of dividends or redemption of shares;

• a director or officer for any transaction from which the director or officer derived an improper personal

benefit; or

• an officer in any action by or in the right of the corporation.

These limitations of liability do not apply to liabilities arising under federal securities laws and do not affect

the availability of equitable remedies such as injunctive relief or rescission.

As permitted by the DGCL, our amended and restated certificate of incorporation will provide that we will,

in certain situations, indemnify our directors and officers and may indemnify other employees and other

agents, to the fullest extent permitted by law. Any indemnified person is also entitled, subject to certain

limitations, to payment of expenses (including attorneys' fees) in advance of the final disposition of the

proceeding.

In addition, we have entered, and intend to continue to enter, into separate indemnification agreements

with our directors and officers. These indemnification agreements, among other things, require us to

indemnify our directors and officers for certain expenses, including attorneys' fees, judgments, fines, and

settlement amounts incurred by a director or officer in any action or proceeding arising out of their

services as a director or officer, or any other company or enterprise to which the person provides services

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at our request. We also maintain a directors' and officers' insurance policy pursuant to which our directors

and officers are insured against liability for actions taken in their capacities as directors and officers.

We believe that these provisions in our amended and restated certificate of incorporation and these

indemnification agreements are necessary to attract and retain qualified persons as directors and officers.

Insofar as indemnification for liabilities arising under the Securities Act may be permitted to directors,

officers, or control persons, we have been advised that, in the opinion of the SEC, such indemnification is

against public policy as expressed in the Securities Act and is therefore unenforceable.

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**Executive and director compensation**

This section discusses the material components of the executive compensation program for our executive

officers who are named in the "Summary Compensation Table" below. In 2024, our "named executive

officers," comprised of our principal executive officer and the two most highly compensated executive

officers (other than our principal executive officer) and their positions with the Company, were as follows:

• John C.M. Farquhar, President and Chief Executive Officer;

• Vikram Verghese, Chief Financial Officer; and

• Campbell D.K. Rogers, M.D., Chief Medical Officer.

As an "emerging growth company" as defined in the JOBS Act, we are not required to include a

Compensation Discussion and Analysis section and have elected to comply with the scaled disclosure

requirements applicable to emerging growth companies.

**2024 summary compensation table**

The following table sets forth information concerning the compensation of our named executive officers

for the year ended December 31, 2024:

---

| | | | | | | |
|:---|:---|:---|:---|:---|:---|:---|
| **Name and principal** <br>**position**<br>| **Salary**<br>**($)**<br>| **Bonus**<br>**($)**<sup>(1)</sup><br>| **Option** <br>**awards**<br>**($)**<sup>(2)</sup><br>| **Non-equity** <br>**incentive plan** <br>**compensation** <br>**($)**<sup>(3)</sup><br>| **All other** <br>**compensation** <br>**($)**<sup>(4)</sup><br>| **Total ($)** |
| John C.M. Farquhar................ | 590480 |  | 1030400 | 654369 | 5200 | 2280449 |
| *President and Chief* <br>*Executive Officer*<br>|  |  |  |  |  |  |
| Vikram Verghese..................... | 400548 |  | 1067295 | 222338 | 5200 | 1695381 |
| *Chief Financial Officer* |  |  |  |  |  |  |
| Campbell D.K. Rogers, M.D.. | 535600 | 230000 |  | 294580 | 5200 | 1065380 |
| *Chief Medical Officer* |  |  |  |  |  |  |

---

(1)Amount represents a $57,500 bonus paid at the end of each quarter to Dr. Rogers during 2024.

(2)Amounts reflect the grant date fair value of stock options granted during 2024 computed in accordance with ASC Topic 718, rather than

the amounts paid to or realized by the named individual. See Note 14 of the consolidated financial statements elsewhere included in

this prospectus for a discussion of valuation assumptions made in determining the grant date fair value and compensation expense of

our stock options.

(3)Amounts represent annual bonuses earned by each named executive officer in 2024 which were paid by us after certification of

performance achievement in early 2025. See "2024 Bonuses" below.

(4)Amounts disclosed reflect Company contributions to our 401(k) plan.

**Narrative to the summary compensation table**

Each of our Named Executive Officers will participate in our senior leadership severance policy, as

described in "Senior leadership severance policy" below.

***Elements of compensation***

*2024 salaries*

In 2024, the named executive officers received an annual base salary to compensate them for services

rendered to the company. The base salary payable to each named executive officer is intended to provide

a fixed component of compensation reflecting the executive's skill set, experience, role, and

responsibilities.

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For fiscal year 2024, Mr. Farquhar's annual base salary was $594,881 effective as of March 3, 2024 (and

it was $572,000 prior), Mr. Verghese's base salary was $404,250 effective as of March 3, 2024 (and it

was $385,000 prior) and Dr. Rogers's base salary was $535,600 effective as of February 7, 2021.

*2024 bonuses*

In 2024, Mr. Farquhar, Mr. Verghese and Dr. Rogers were eligible to earn annual cash bonuses targeted

at 100%, 50% and 50%, respectively, of their annual base salaries. Pursuant to our annual cash bonus

program, each named executive officer was eligible to earn his annual cash bonus based on the

attainment of pre-established annual company objectives. These pre-established objectives include

revenue, with a target of $120.1 million (weighted 40%), gross margin, with a target of 70.1% (weighted

20%), interactive product validation (weighted 20%), asymptomatic strategy (weighted 10%) and patient

care (weighted 10%). The actual achieved bonus amount was paid in 2025 based on achievement of

such objectives.

*Equity compensation*

Each of our named executive officers currently holds outstanding stock option awards granted pursuant to

the Company's 2009 Equity Incentive Plan as described in more detail in the section titled "—Outstanding

equity awards at year end" below.

In connection with this offering, we intend to adopt the 2025 Plan (as defined below) in order to facilitate

the grant of cash and equity incentives to directors, employees (including our named executive officers)

and consultants of our company and certain of our subsidiaries (if any) and to enable us to obtain and

retain the services of these individuals, which is essential to our long-term success. We expect that the

2025 Plan will be effective upon the commencement of trading of the Company's common stock on the

Nasdaq Global Select Market. For additional information about the 2025 Plan, please see the section

titled "—2025 performance incentive plan" below.

***Other elements of compensation***

*Retirement plans* 

We maintain a 401(k) retirement savings plan for our employees, including our named executive officers,

who satisfy certain eligibility requirements. Our named executive officers are eligible to participate in the

401(k) plan on the same terms as other full-time employees. We anticipate that, following the completion

of this offering, our named executive officers will continue to participate in this 401(k) plan on the same

terms as other full-time employees.

*Employee benefits and perquisites* 

All of our full-time employees, including our named executive officers, are eligible to participate in our

health and welfare plans, including:

• medical, dental, and vision benefits;

• medical and dependent care flexible spending accounts;

• short-term and long-term disability insurance; and

• life insurance.

We believe that the employee benefits described above are necessary and appropriate to provide a

competitive compensation package to our named executive officers.

*No tax gross-ups*

We do not make gross-up payments to cover our named executive officers' personal income taxes that

may pertain to any of the compensation or perquisites paid or provided by the Company.

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**Outstanding equity awards at fiscal year-end**

The following table summarizes the number of shares of common stock underlying outstanding equity

incentive plan awards for each named executive officer as of December 31, 2024:

---

| | | | | | |
|:---|:---|:---|:---|:---|:---|
| **Name**  | **Grant date** | **Option awards** | **Option awards** | **Option awards** | **Option awards** |
| **Name**  | **Grant date** | **Number of** <br>**securities** <br>**underlying** <br>**unexercised** <br>**options -** <br>**exercisable** <br>**(#)**<sup>(1)</sup><br>| **Number of** <br>**securities** <br>**underlying** <br>**unexercised** <br>**options -**<br>**unexercisable** <br>**(#)**<sup>(2)</sup><br>| **Option** <br>**exercise** <br>**price ($)**<br>| **Option** <br>**expiration** <br>**date**<br>|
| John C.M. Farquhar.................... | 8/24/2021<br><sup>(3)</sup> | 57070 | 11422 | $8.33 | 8/24/2031 |
|  | 3/23/2022<br><sup>(3)</sup> | 70633 | 32106 | $8.33 | 3/23/2032 |
|  | 7/10/2023 | 468380 | 1534951 | $2.22 | 7/10/2033 |
|  | 12/26/2024 | 3996 | 187784 | $9.58 | 12/26/2034 |
| Vikram Verghese......................... | 3/23/2022<br><sup>(3)</sup> |  | 7849 | $8.33 | 3/23/2032 |
|  | 7/10/2023 |  | 77413 | $2.22 | 7/10/2033 |
|  | 12/24/2023 |  | 111633 | $2.22 | 12/24/2033 |
|  | 12/26/2024 |  | 197573 | $9.58 | 12/26/2034 |
| Campbell D.K. Rogers, M.D...... | 3/9/2016 | 39709 |  | $8.33 | 3/9/2026 |
|  | 2/28/2020 | 43785 |  | $8.33 | 2/28/2030 |
|  | 4/22/2020 | 2231 |  | $8.33 | 4/22/2030 |
|  | 4/12/2021 | 3395 | 194 | $8.33 | 4/12/2031 |
|  | 7/10/2023<br><sup>(4)</sup> | 6849 |  | $2.22 | 7/10/2033 |
|  | 7/10/2023 | 77698 | 158136 | $2.22 | 7/10/2033 |

---

(1)Amounts disclosed in this column reflect the number of options granted to our named executive officers that were subject to time-based

vesting and have vested.

(2)Unless otherwise noted, the stock option vests and becomes exercisable as to 1/48th of the total number of shares underlying the stock

option monthly following the vesting commencement date, subject to the applicable named executive officer's continued service through

the applicable vesting date.

(3)The stock option vests and becomes exercisable as to 1/4th of the total number of shares underlying the stock option on the first

anniversary of the vesting commencement date and 1/48th monthly thereafter, subject to the applicable named executive officer's

continued service through the applicable vesting date.

(4)The stock option fully vests and becomes exercisable on the first anniversary of the vesting commencement date, subject to Dr. Rogers'

continued service through the applicable vesting date.

**Senior leadership severance policy**

In connection with the completion of this offering, we have adopted a senior leadership severance policy

(the "Severance Policy") covering each of our named executive officers, which sets forth the benefits

payable to participants upon qualifying terminations of employment. Under the Severance Policy, upon a

termination without "cause" or a resignation for "good reason" (as such terms are defined in the

Severance Policy) (a "Qualifying Termination"), provided that the participant executes and does not

revoke a general release of claims in favor of the Company and adheres to any restrictive covenants with

the Company to which he or she is bound, the participant will be entitled to receive a certain number of

months of base salary continuation based on his or her position at the Company (twelve (12) months for

Mr. Farquhar, nine (9) months for other C-level participants, and six (6) months for senior vice president-

level participants) (the "Severance Period"), with payment commencing on or within ten (10) days

following the sixtieth (60<sup>th</sup>) day following the participant's termination date. In addition, if the participant

elects continuation coverage under the Consolidated Omnibus Budget Reconciliation Act ("COBRA"), the

Company will pay or reimburse the participant for his or her COBRA premiums during the Severance

Period.

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Upon a Qualifying Termination occurring within three (3) months prior to or twelve (12) months following a

"change in control" (as such term is defined in the Severance Policy), provided the participant executes

and does not revoke a general release of claims in favor of the Company and adheres to any restrictive

covenants with the Company to which he or she is bound, the participant will be entitled to receive a

certain number of months of base salary continuation based on his or her position at the Company

(eighteen (18) months for Mr. Farquhar, twelve (12) months for other C-level participants, and nine (9)

months for senior vice president-level participants) (the "CIC Severance Period") plus the participant's

target bonus for the year of termination, with payment commencing on or within ten (10) days following

the sixtieth (60<sup>th</sup>) day following the participant's termination date. In addition, all of the participant's

outstanding equity awards, to the extent unvested, will become fully vested and exercisable as of the

participant's termination date, and if the participant elects continuation coverage under COBRA, the

Company will pay or reimburse the participant for his or her COBRA premiums during the CIC Severance

Period.

The Severance Policy also contains a net-better Section 4999 cutback provision, which provides that, if

payments to a participant are subject to an excise tax under Section 4999 of the Code, then such

payments would be reduced by the amount needed to avoid triggering such tax, provided that such

reduction leaves the participant in a better after-tax position than if such payments had not been reduced

(taking into account the effect of the excise tax).

**2024 non-employee director compensation table** 

We have paid certain of our non-employee directors, Mr. Weldon, Mr. Barabe, Mr. Riley, Mr. Smith, Mr.

Taylor and Ms. Cullivan, cash fees as set forth in the table below for their service on our board. We have

also reimbursed our directors for expenses associated with attending meetings of our board of directors

and committees of our board of directors.

Mr. Taylor, one of the Company's founders, served as our Chief Technology Officer from April 2010 to

February 2022 and as our Chief Scientific Officer from February 2022 through December 2023. In

connection with his termination of employment, we entered into a separation agreement with Mr. Taylor

with an employment termination date of December 1, 2023, which provided for certain benefits in

consideration for his execution of a general release of claims and adherence to the protective covenants

set forth therein. Those benefits include (i) severance payments equal to $658,341.76, payable 50% on

the effective date of the agreement and 50% on June 1, 2024, (ii) payment of COBRA benefits for 12

months, (iii) if the Company paid bonuses with respect to the 2023 fiscal year, payment of Mr. Taylor's

target bonus for such year, payable 50% in April 2024 and 50% in June 2024 and (iv) acceleration of 25%

of his then-unvested options.

In addition to his service on the board, since December 2023, Mr. Taylor has served as a consultant to us

and was paid cash fees of $3,178 in 2024 in consideration of his consulting services.

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The following table sets forth information regarding the compensation of our non-employee directors for

the fiscal year ended December 31, 2024:

---

| | | | | |
|:---|:---|:---|:---|:---|
| **Name**  | **Fees earned** <br>**or**<br>**paid in cash** <br>**($)**<br>| **Option** <br>**awards**<br>**($)**<sup>(1)</sup><br>| **All other** <br>**compensation** <br>**($)**<br>| **Total**<br>**($)**<br>|
| William C. Weldon......................................... | 65000 |  |  | 65000 |
| Timothy C. Barabe........................................ | 40000 |  |  | 40000 |
| Julie A. Cullivan............................................. | 40000 |  |  | 40000 |
| Nicholas Downing, M.D................................ |  |  |  |  |
| Jeffrey C. Lightcap........................................ |  |  |  |  |
| Wayne J. Riley, M.D...................................... | 40000 |  |  | 40000 |
| Lonnie M. Smith............................................. | 40000 |  |  | 40000 |
| Casey M. Tansey........................................... |  |  |  |  |
| Charles A. Taylor, Jr., Ph.D.......................... | 40000 |  | 571082<sup>(2)</sup> | 611082 |

---

(1)The aggregate number of stock option awards (whether exercisable or unexercisable) held as of December 31, 2024, by Mr. Weldon,

Mr. Barabe, Ms. Cullivan, Dr. Downing, Mr. Lightcap, Mr. Riley, Mr. Smith, Mr. Tansey and Mr. Taylor was 520,730, 100,730, 87,188, 0,

0, 185,000, 135,000, 0 and 460,301, respectively.

(2)This amount includes: (i) $329,171 in severance payments; (ii) $40,015 in COBRA payments; (iii) $198,718 as a target bonus for 2023;

and (iv) $3,178 in consulting fees.

In connection with the completion of this offering, we intend to approve and implement a compensation

program for our non-employee directors that consists of annual retainer fees and long-term equity

awards.

**Director compensation policy**

In connection with the completion of this offering, we have adopted a director compensation policy

covering our non-employee directors (the "Director Compensation Policy"), which sets out a

compensation program for our non-employee directors consisting of annual retainer fees and long-term

equity awards. The Director Compensation Policy will become effective upon the commencement of

trading of the Company's common stock on the Nasdaq Global Select Market.

Under our Director Compensation Policy, each non-employee director is entitled to receive the following

cash compensation while serving on our Board:

---

| | |
|:---|:---|
| **Cash Compensation** | |
| Annual Cash Retainer...................................................................................................................... | $50000 |
| Annual Chairperson Retainer.......................................................................................................... | $45000 |
| Annual Audit Committee Chairperson Retainer........................................................................... | $20000 |
| Annual Compensation Committee Chairperson Retainer.......................................................... | $15000 |
| Annual Nominating and Corporate Governance Committee Chairperson Retainer.............. | $10000 |
| Annual Audit Committee Member Retainer.................................................................................. | $10000 |
| Annual Compensation Committee Member Retainer.................................................................. | $7500 |
| Annual Nominating and Corporate Governance Committee Member Retainer...................... | $5000 |

---

All annual retainers will be paid on a quarterly basis following the end of each calendar quarter in arrears,

and will be pro-rated if a non-employee director serves for only a portion of the calendar quarter.

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In addition, under the Director Compensation Policy, non-employee directors are entitled to receive the

following equity-based compensation while serving on our Board:

• New directors: Each new non-employee director appointed or elected to our Board (or any non-

employee director serving on the Board prior to the offering who did not receive compensation for

such services prior to such date) is entitled to receive a new director equity award valued at $500,000

in the form of nonqualified stock options as of the director's first date of service or the IPO, as the

case may be. Subject to the non-employee director's continued service through the applicable vesting

date, 1/3 of the new director equity award will vest on the first anniversary of the grant date and the

remaining 2/3 of the new director equity award will vest in 24 substantially equal monthly installments

thereafter.

• Continuing directors: On the date of the offering and on the date of each annual meeting of the

Company's stockholders thereafter, each continuing non-employee director is entitled to receive an

annual equity award valued at $250,000 in the form of nonqualified stock options. Subject to the non-

employee director's continued service through the applicable vesting date, the annual equity award

will vest on the earlier of the first anniversary of the date of grant and the Company's annual meeting

of stockholders in the year following the year in which the annual equity award was granted.

**2025 performance incentive plan**

In connection with the completion of this offering, we have adopted the Heartflow, Inc. 2025 Performance

Incentive Plan (the "2025 Plan"), which will become effective upon the commencement of trading of the

Company's common stock on the Nasdaq Global Select Market. The principal terms of the 2025 Plan are

summarized below.

***Purpose***

The purpose of the 2025 Plan is to promote the success of the Company by providing an additional

means for us to attract, motivate, retain and reward selected employees and other eligible persons

through the grant of awards. Equity-based awards are also intended to further align the interests of award

recipients and our stockholders.

***Administration***

Our Board of Directors or one or more committees appointed by our Board of Directors will administer the

2025 Plan. Our Board of Directors has delegated general administrative authority for the 2025 Plan to the

Compensation Committee and has also formed an Equity Awards Committee that is authorized to grant

awards under the 2025 Plan to participants who are not executive officers of the Company. The Board of

Directors or a committee thereof (within its delegated authority) may delegate different levels of authority

to different committees or persons with administrative and grant authority under the 2025 Plan. (The

appropriate acting body, be it the Board of Directors or a committee or other person within its delegated

authority is referred to in this proposal as the "Administrator").

The Administrator has broad authority under the 2025 Plan, including, without limitation, the authority:

• to select eligible participants and determine the type(s) of award(s) that they are to receive;

• to grant awards and determine the terms and conditions of awards, including the price (if any) to be

paid for the shares or the award and, in the case of share-based awards, the number of shares to be

offered or awarded;

• to determine any applicable vesting and exercise conditions for awards (including any applicable

performance and/or time-based vesting or exercisability conditions) and the extent to which such

conditions have been satisfied, or determine that no delayed vesting or exercise is required, to

determine the circumstances in which any performance-based goals (or the applicable measure of

performance) will be adjusted and the nature and impact of any such adjustment, to establish the

events (if any) on which exercisability or vesting may accelerate (including specified terminations of

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employment or service or other circumstances), and to accelerate or extend the vesting or

exercisability or extend the term of any or all outstanding awards (subject in the case of options and

stock appreciation rights to the maximum term of the award);

• to cancel, modify, or waive the Company's rights with respect to, or modify, discontinue, suspend, or

terminate any or all outstanding awards, subject to any required consents;

• subject to the other provisions of the 2025 Plan, to make certain adjustments to an outstanding award

and to authorize the conversion, succession or substitution of an award;

• to determine the method of payment of any purchase price for an award or shares of the Company's

common stock delivered under the 2025 Plan, as well as any tax-related items with respect to an

award, which may be in the form of cash, check, or electronic funds transfer, by the delivery of

already-owned shares of the Company's common stock or by a reduction of the number of shares

deliverable pursuant to the award, by services rendered by the recipient of the award, by notice and

third party payment or cashless exercise on such terms as the Administrator may authorize, or any

other form permitted by law;

• to modify the terms and conditions of any award, establish sub-plans and agreements and determine

different terms and conditions that the Administrator deems necessary or advisable to comply with

laws in the countries where the Company or one of its subsidiaries operates or where one or more

eligible participants reside or provide services;

• to approve the form of any award agreements used under the 2025 Plan; and

• to construe and interpret the 2025 Plan, make rules for the administration of the 2025 Plan, and make

all other determinations for the administration of the 2025 Plan.

***Availability of repricing***

The Administrator may (1) amend an outstanding stock option or stock appreciation right to reduce the

exercise price or base price of the award, (2) cancel, exchange, or surrender an outstanding stock option

or stock appreciation right in exchange for cash or other awards for the purpose of repricing the award, or

(3) cancel, exchange, or surrender an outstanding stock option or stock appreciation right in exchange for

an option or stock appreciation right with an exercise or base price that is less than the exercise or base

price of the original award.

***Eligibility***

Persons eligible to receive awards under the 2025 Plan include officers or employees of the Company or

any of its subsidiaries, directors of the Company, and certain consultants and advisors to the Company or

any of its subsidiaries.

***Aggregate share limit***

The maximum number of shares of the Company's common stock that may be issued or transferred

pursuant to awards under the 2025 Plan equals the sum of the following (such total number of shares, the

"Share Limit"):

• an aggregate number of shares of the Company's common stock equal to ten percent (10%) of the

total number of fully diluted shares of the Company's common stock outstanding (including, without

limitation, any outstanding warrants) as of the date of commencement of trading of the shares of the

Company's common stock on the Nasdaq Global Select Market (the "Initial Trading Date"), plus

• the number of shares available for additional award grant purposes under the 2009 Plan as of the

Initial Trading Date and determined immediately prior to the termination of the authority to grant new

awards under that plan as of the Initial Trading Date, plus

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• the number of any shares subject to stock options granted under the 2009 Plan and outstanding as of

the Initial Trading Date which expire, or for any reason are cancelled or terminated, after the date of

the Initial Trading Date without being exercised (which, for purposes of clarity, will become available

for award grants under the 2025 Plan on a one-for-one basis).

In addition, the Share Limit will automatically increase, if on the last day of the Company's fiscal year, the

Share Limit has not increased during such fiscal year pursuant to any Board-approved increase(s) by an

aggregate amount equal to or greater than five percent (5%) of the total number of fully diluted shares of

the Company's common stock outstanding (including, without limitation, any outstanding warrants) on the

first day of such fiscal year (the "Minimum Annual Increase"), then in an amount equal to the difference

between the Minimum Annual Increase and the aggregate amount by which the Share Limit increased

pursuant to any Board-approved increase(s) during such fiscal year, effective as of the last day of such

fiscal year.

As noted above, no additional awards will be granted under the 2009 Plan if stockholders approve the

2025 Plan.

***Additional share limits***

The following other limits are also contained in the 2025 Plan. These limits are in addition to, and not in

lieu of, the Share Limit for the plan described above.

• The maximum number of shares that may be delivered pursuant to options qualified as incentive

stock options granted under the plan is 2,000,000 shares. (For clarity, any shares issued in respect of

incentive stock options granted under the plan will also count against the overall Share Limit above.)

• The maximum number of shares subject to awards that are granted under the 2025 Plan during any

one calendar year to any person who, on the grant date of the award, is a Non-Employee Director

shall not exceed the number of shares that produce a grant date fair value for the award that, when

combined with (i) the grant date fair value of any other awards granted under the 2025 Plan during

that same calendar year to that individual in his or her capacity as a Non-Employee Director and (ii)

the dollar amount of all other cash compensation payable by the Company to such Non-Employee

Director for his or her services in such capacity during that same calendar year (regardless of whether

deferred and excluding any interest or earnings on any portion of such amount that may be deferred),

is $750,000, provided that this limit is $1,000,000 as to any new Non-Employee Director for the

calendar year in which the non-employee director is first elected or appointed to the Board of

Directors. For purposes of this limit, the "grant date fair value" of an award means the value of the

award on the date of grant of the award determined using the equity award valuation principles

applied in the Company's financial reporting. This limit does not apply to, and will be determined

without taking into account, any award granted to an individual who, on the grant date of the award, is

an officer or employee of the Company or one of its subsidiaries. This limit applies on an individual

basis and not on an aggregate basis to all Non-Employee Directors as a group.

***Share-limit counting rules***

The Share Limit of the 2025 Plan is subject to the following rules:

Shares that are subject to or underlie awards which expire or for any reason are cancelled or terminated,

are forfeited, fail to vest, or for any other reason are not paid or delivered under the 2025 Plan will not be

counted against the Share Limit and will again be available for subsequent awards under the 2025 Plan.

Except as described below, to the extent that shares are delivered pursuant to the exercise of a stock

appreciation right granted under the 2025 Plan, the number of underlying shares which are actually

issued in payment of the award shall be counted against the Share Limit. (For purposes of clarity, if a

stock appreciation right relates to 100,000 shares and is exercised at a time when the payment due to the

participant is 15,000 shares, 15,000 shares shall be charged against the Share Limit with respect to such

exercise.)

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Shares that are exchanged by a participant or withheld by the Company to pay the exercise price of a

stock option or stock appreciation right granted under the 2025 Plan, as well as any shares exchanged or

withheld to satisfy the tax withholding obligations related to any stock option, stock appreciation right or

any other award will not be counted against the Share Limit and will again be available for subsequent

awards under the 2025 Plan. Shares that are exchanged by a participant or withheld by the Company as

full or partial payment in connection with any award granted under the 2025 Plan will not be counted

against the Share Limit and will again be available for subsequent awards under the 2025 Plan.

In addition, shares that are exchanged by a participant or withheld by the Company after the Initial

Trading Date as full or partial payment in connection with any award granted under the 2009 Plan, as well

as any shares exchanged by a participant or withheld by the Company after the Initial Trading Date to

satisfy the tax withholding obligations related to any award granted under the 2009 Plan, shall be

available for new awards under the 2025 Plan.

To the extent that an award is settled in cash or a form other than shares, the shares that would have

been delivered had there been no such cash or other settlement will not be counted against the Share

Limit and will again be available for subsequent awards under the 2025 Plan.

In the event that shares are delivered in respect of a dividend equivalent right, the actual number of

shares delivered with respect to the award shall be counted against the Share Limit. (For purposes of

clarity, if 1,000 dividend equivalent rights are granted and outstanding when the Company pays a

dividend, and 50 shares are delivered in payment of those rights with respect to that dividend, 50 shares

shall be counted against the Share Limit.) Except as otherwise provided by the Administrator, shares

delivered in respect of dividend equivalent rights shall not count against any individual award limit under

the 2025 Plan other than the aggregate Share Limit.

In addition, the 2025 Plan generally provides that shares issued in connection with awards that are

granted by or become obligations of the Company through the assumption of awards (or in substitution for

awards) in connection with an acquisition of another company will not count against the shares available

for issuance under the 2025 Plan. The Company may not increase the applicable share limits of the 2025

Plan by repurchasing shares of common stock on the market (by using cash received through the

exercise of stock options or otherwise).

***Types of awards***

The 2025 Plan authorizes stock options, stock appreciation rights, and other forms of awards granted or

denominated in the Company's common stock or units of the Company's common stock, as well as cash

bonus awards. The 2025 Plan retains flexibility to offer competitive incentives and to tailor benefits to

specific needs and circumstances. Any award may be structured to be paid or settled in cash.

A stock option is the right to purchase shares of the Company's common stock at a future date at a

specified price per share (the "exercise price"). The per share exercise price of an option generally may

not be less than the fair market value of a share of the Company's common stock on the date of grant.

The maximum term of an option is ten years from the date of grant. An option may either be an incentive

stock option or a nonqualified stock option. Incentive stock options may only be granted to employees of

the Company or a subsidiary.

A stock appreciation right is the right to receive payment of an amount equal to the excess of the fair

market value of share of the Company's common stock on the date of exercise of the stock appreciation

right over the base price of the stock appreciation right. The base price will be established by the

Administrator at the time of grant of the stock appreciation right and generally may not be less than the

fair market value of a share of the Company's common stock on the date of grant. Stock appreciation

rights may be granted in connection with other awards or independently. The maximum term of a stock

appreciation right is ten years from the date of grant.

The other types of awards that may be granted under the 2025 Plan include, without limitation, stock

bonuses, restricted stock, performance stock, restricted stock units, stock units or phantom stock (which

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are contractual rights to receive shares of stock, or cash based on the fair market value of a share of

stock), dividend equivalents which represent the right to receive a payment based on the dividends paid

on a share of stock over a stated period of time, or similar rights to purchase or acquire shares, and cash

awards.

Any awards under the 2025 Plan (including awards of stock options and stock appreciation rights) may be

fully-vested at grant or may be subject to time- and/or performance-based vesting requirements.

***Dividend equivalents; deferrals***

The Administrator may provide for the deferred payment of awards, and may determine the other terms

applicable to deferrals. The Administrator may provide that awards under the 2025 Plan (other than

options or stock appreciation rights), and/or deferrals, earn dividends or dividend equivalents based on

the amount of dividends paid on outstanding shares of Common Stock, provided that any dividends and/

or dividend equivalents as to the portion of an award that is subject to unsatisfied vesting requirements

will be subject to termination and forfeiture to the same extent as the corresponding portion of the award

to which they relate in the event the applicable vesting requirements are not satisfied (or, in the case of a

restricted stock or similar award where the dividend must be paid as a matter of law, the dividend

payment will be subject to forfeiture or repayment, as the case may be, if the related vesting conditions

are not satisfied).

***Assumption and termination of awards***

If an event occurs in which the Company does not survive (or does not survive as a public company in

respect of its common stock), including, without limitation, a dissolution, merger, combination,

consolidation, conversion, exchange of securities, or other reorganization, or a sale of all or substantially

all of the business, stock or assets of the Company, awards then-outstanding under the 2025 Plan will not

automatically become fully vested pursuant to the provisions of the 2025 Plan so long as such awards are

assumed, substituted for or otherwise continued. However, if awards then-outstanding under the 2025

Plan are to be terminated in such circumstances (without being assumed or substituted for), such awards

would generally become fully vested (with any performance goals applicable to the award being deemed

met at the "target" performance level), subject to any exceptions that the Administrator may provide for in

an applicable award agreement. The Administrator also has the discretion to establish other change in

control provisions with respect to awards granted under the 2025 Plan. For example, the Administrator

could provide for the acceleration of vesting or payment of an award in connection with a corporate event

or in connection with a termination of the award holder's employment.

***Transfer restrictions***

Subject to certain exceptions contained in Section 5.6 of the 2025 Plan, awards under the 2025 Plan

generally are not transferable by the recipient other than by will or the laws of descent and distribution

and are generally exercisable, during the recipient's lifetime, only by the recipient. Any amounts payable

or shares issuable pursuant to an award generally will be paid only to the recipient or the recipient's

beneficiary or representative. The Administrator has discretion, however, to establish written conditions

and procedures for the transfer of awards to other persons or entities, provided that such transfers comply

with applicable federal and state securities laws and are not made for value (other than nominal

consideration, settlement of marital property rights, or for interests in an entity in which more than 50% of

the voting securities are held by the award recipient or by the recipient's family members).

***Adjustments***

As is customary in incentive plans of this nature, each share limit and the number and kind of shares

available under the 2025 Plan and any outstanding awards, as well as the exercise or purchase prices of

awards, and performance targets under certain types of performance-based awards, are subject to

adjustment in the event of certain reorganizations, mergers, combinations, recapitalizations, stock splits,

stock dividends, or other similar events that change the number or kind of shares outstanding, and

extraordinary dividends or distributions of property to the stockholders.

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***No limit on other authority***

Except as expressly provided with respect to the termination of the authority to grant new awards under

the 2009 Plan if stockholders approve the 2025 Plan, the 2025 Plan does not limit the authority of the

Board of Directors or any committee to grant awards or authorize any other compensation, with or without

reference to the Company's common stock, under any other plan or authority.

***Termination of or changes to the 2025 plan***

The Board of Directors may amend or terminate the 2025 Plan at any time and in any manner.

Stockholder approval for an amendment will be required only to the extent then required by applicable law

or deemed necessary or advisable by the Board of Directors. Unless terminated earlier by the Board of

Directors and subject to any extension that may be approved by stockholders, the authority to grant new

awards under the 2025 Plan will terminate at the close of business on the day before the tenth

anniversary of the effective date of the 2025 Plan. Outstanding awards, as well as the Administrator's

authority with respect thereto, generally will continue following the expiration or termination of the plan.

Generally speaking, outstanding awards may be amended by the Administrator (except for a repricing),

but the consent of the award holder is required if the amendment (or any plan amendment) materially and

adversely affects the holder.

**Amended and restated 2009 equity incentive plan**

The following summarizes the material terms of our Amended and Restated 2009 Equity Incentive Plan

(the "2009 Plan"), under which we have previously made periodic grants of equity and equity-based

awards to our named executive officers and other key employees. Upon the commencement of trading of

the Company's common stock on the Nasdaq Global Select Market, the 2025 Plan will become effective

and no more grants may be made under the 2009 Plan.

The 2009 Plan was adopted by the board of directors of Heartflow, Inc. in 2009 and was amended and

restated effective March 1, 2021 in connection with a reorganization of Heartflow, Inc. in which the 2009

Plan and all outstanding award agreements thereunder were assigned to and assumed by HeartFlow

Holding, Inc. As of March 31, 2025, a total of 8,583,703 shares of common stock were then subject to

outstanding awards granted under the 2009 Plan, and an additional 193,596 shares of common stock

were then available for new award grants under the 2009 Plan. With respect to the stock options then-

outstanding on this date, the weighted-average exercise price of such options was $4.98 per share, and

the weighted-average remaining term of these options was 7.77 years.

***Purpose***

The purpose of the 2009 Plan is to attract and retain the best available personnel for positions of

substantial responsibility, to provide additional incentive to employees, directors and consultants, and to

promote the success of our business.

***Administration***

The 2009 Plan is administered by our board of directors (the "Board") or a committee thereof (the

"Administrator"). The Administrator has the discretion to (i) determine the fair market value of our common

stock, (ii) select the employees, directors and consultants to whom awards may be granted under the

2009 Plan, (iii) determine the number of shares of our common stock to be covered by each award

granted under the 2009 Plan, (iv) approve forms of award agreements for use under the 2009 Plan, (v)

determine the terms and conditions of any award granted under the 2009 Plan, (vi) institute and

determine the terms and conditions of an award exchange, (vii) construe and interpret the terms of the

2009 Plan and awards granted thereunder, (viii) prescribe, amend and rescind rules and regulations

relating to the 2009 Plan, (ix) modify or amend outstanding awards granted under the 2009 Plan, subject

to certain restrictions set forth in the 2009 Plan, (x) determine procedures for recipients to satisfy

withholding tax obligations, (xi) authorize any person to execute on our behalf any instrument required to

effect the grant of an award previously granted by the Administrator, (xii) allow a recipient to defer the

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receipt of the payment of cash or the delivery of shares that otherwise would be due to such recipient

under an award, (xiii) establish additional rules to accommodate the rules or laws of applicable non-U.S.

jurisdictions and afford recipients who are foreign nationals or are employed outside the United States

favorable treatment under such rules or laws, and (xiv) make all other determinations deemed necessary

or advisable for administering the 2009 Plan. All decisions, or actions taken, by the plan administrator or

in connection with the administration of the 2009 Plan shall be final, conclusive and binding on all persons

having an interest in the 2009 Plan.

***Eligibility***

Our employees and consultants, employees and consultants of our parents or subsidiaries (if any), and

non-employee members of our Board are eligible to receive awards under the 2009 Plan, provided that

only employees may be granted awards intended as incentive stock options. As of December 31, 2024,

approximately 606 of our and our subsidiaries' officers and employees (including all of our named

executive officers), and each of the nine non-employee members of our Board, were considered eligible

under the 2009 Plan. In addition, approximately 13 individual consultants and advisors engaged by us

and our subsidiaries were then considered eligible under the 2009 Plan.

***Share reserve***

As of March 31, 2025, a total of 10,543,521 shares of our common stock had been authorized for

issuance under the 2009 Plan, 8,583,703 shares were subject to stock options then-outstanding under

the 2009 Plan, no shares were subject to restricted stock and restricted stock unit awards then-

outstanding under the 2009 Plan, and 193,596 shares were available for issuance under the 2009 Plan.

***Types of awards***

The 2009 Plan authorizes the grant of stock options, stock appreciation rights, restricted stock and

restricted stock units. Awards granted under the 2009 Plan are generally not transferable by the recipient

other than by will or the laws of descent and distribution and are generally exercisable, during the

recipient's lifetime, only by the recipient.

• *Stock Options*. A stock option is the right to purchase shares of our common stock at a future date at

a specified price per share (the "exercise price"). The per share exercise price of an option generally

may not be less than the fair market value of a share of our common stock on the date of grant. The

maximum term of an option is ten years from the date of grant. An option may either be an incentive

stock option or a non-qualified stock option. Incentive stock option benefits are taxed differently from

nonqualified stock options, are subject to more restrictive terms, and are limited in amount by the U.S.

Internal Revenue Code and the 2009 Plan. Incentive stock options may only be granted to our and

our subsidiaries' employees.

• *Stock Appreciation Rights*. A stock appreciation right is the right to receive payment of an amount

equal to the excess of the fair market value of share of our common stock on the date of exercise of

the stock appreciation right over the base price of the stock appreciation right. The base price will be

established by the Administrator at the time of grant of the stock appreciation right and generally may

not be less than the fair market value of a share of our common stock on the date of grant. Stock

appreciation rights may be granted in connection with other awards or independently.

• *Restricted Stock*. A share of restricted stock is granted subject to vesting, transfer restrictions and

other restrictions as determined by the Administrator, or is a share issued pursuant to the early

exercise of a stock option. Recipients of restricted stock, unlike recipients of stock options and

restricted stock units, have voting rights and the right to receive dividends, if any, prior to the time

restrictions lapse with respect to such shares, however, extraordinary dividends will generally be

placed in escrow, and will not be released until restrictions are removed or expire.

• *Restricted Stock Units*. A restricted stock unit is a bookkeeping entry representing an amount equal to

the fair market value of a share that is granted subject to vesting, transfer restrictions and other

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restrictions as determined by the Administrator. Unlike restricted stock, shares underlying restricted

stock units will not be issued until the restricted stock units have vested, and recipients of restricted

stock units generally have no voting or dividend rights prior such conditions being satisfied.

***Adjustments***

As is customary in incentive plans of this nature, the share limit, the number and kind of shares available

under the 2009 Plan, any outstanding awards as well as the exercise or purchase prices of awards, and

performance targets under certain types of performance-based awards, are subject to adjustment in the

event of certain reorganizations, mergers, combinations, recapitalizations, stock splits, stock dividends, or

other similar events that change the number or kind of shares outstanding, and extraordinary dividends or

distributions of property to the stockholders.

***Assumption and termination of awards***

If an event occurs that results in a change in control of us or in which we otherwise do not survive (or do

not survive as a public company in respect of our common stock), including, without limitation, a merger,

combination, consolidation, conversion, exchange of securities, or other reorganization, or a sale of all or

substantially all of our business, stock or assets, awards then-outstanding under the 2009 Plan will not

automatically become fully vested pursuant to the provisions of the 2009 Plan so long as such awards are

assumed or substituted. However, if awards then-outstanding under the 2009 Plan are to be terminated in

such circumstances (without being assumed or substituted), such awards would generally become fully

vested (with any performance goals applicable to the award being deemed met at the "target"

performance level and all other terms and conditions met), subject to any exceptions that the

Administrator may provide for in an applicable award agreement. The Administrator also has the

discretion to establish other change in control provisions with respect to awards granted under the 2009

Plan. If we are wound up pursuant to a dissolution or liquidation, awards then-outstanding under the 2009

Plan will terminate immediately prior to such event.

***No limit on other authority***

The 2009 Plan does not limit the authority of the Board or any committee thereof to grant awards or

authorize any other compensation, with or without reference to our common stock, under any other plan

or authority.

***Termination of or changes to the 2009 plan***

The Board may amend or terminate the 2009 Plan at any time and in any manner. Stockholder approval

for an amendment will be required only to the extent then required by applicable law or deemed

necessary or advisable by the Board. Unless terminated earlier by the Board, the authority to grant new

awards under the 2009 Plan will terminate on March 21, 2031. Outstanding awards, as well as the

Administrator's authority with respect thereto, generally will continue following the expiration or

termination of the 2009 Plan. Generally speaking, outstanding awards may be amended by the

Administrator (except for a repricing), but the consent of the award holder is required if the amendment

(or any plan amendment) impair the rights of the holder.

**2025 employee stock purchase plan**

In connection with the completion of this offering, we have adopted the Heartflow, Inc. 2025 Employee

Stock Purchase Plan (the "ESPP"), which will become effective upon the commencement of trading of the

Company's common stock on the Nasdaq Global Select Market. The principal terms of the ESPP are

summarized below.

***Purpose***

The purpose of the ESPP is to provide eligible employees with an opportunity to purchase shares of the

Company's common stock at a favorable price and upon favorable terms in consideration of the

participating employees' continued services. The ESPP is intended to provide an additional incentive to

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participating eligible employees to remain in the Company's employ and to advance the best interests of

the Company and those of the Company's stockholders.

***Operation of the ESPP***

It is currently expected that the ESPP will operate in successive periods referred to as "Offering Periods."

The ESPP administrator may change the duration of Offering Periods from time to time in advance of the

applicable Offering Period, provided that no Offering Period may be shorter than three months or longer

than 27 months. The ESPP administrator may also provide that an Offering Period will consist of multiple

"purchase periods," with a purchase of shares under the ESPP to occur at the end of each such purchase

period. However, only one Offering Period may be in effect at any one time.

On the first day of each Offering Period (referred to as the "Grant Date"), each eligible employee who has

timely filed a valid election to participate in the ESPP for that Offering Period will be granted an option to

purchase shares of the Company's common stock (each, a "Purchase Option"). A participant must

designate in the election the percentage of the participant's compensation to be withheld from his or her

pay during that Offering Period for the purchase of stock under the ESPP. The participant's contributions

under the ESPP will be credited to a bookkeeping account in his or her name. A participant generally may

elect to terminate, but may not otherwise increase or decrease, his or her contributions to the ESPP

during an Offering Period. Amounts contributed to the ESPP constitute general corporate assets of the

Company and may be used for any corporate purpose.

Each Purchase Option granted under the ESPP will automatically be exercised on the last day of the

Offering Period with respect to which it was granted, or the last day of each purchase period for an

Offering Period that consists of multiple purchase periods (each such date on which ESPP Purchase

Options are exercised is referred to as an "Purchase Date"). The number of shares acquired by a

participant upon exercise of his or her Purchase Option will be determined by dividing the participant's

ESPP account balance as of the Purchase Date by the "Purchase Price" (as such term is defined in the

ESPP) for the applicable period. The determination of the Purchase Price for each Offering Period (or

each purchase period within an Offering Period) will be established by the ESPP administrator in advance

of the applicable period, except that in no event may the Purchase Price be lower than the <u>lesser</u> of (i)

85% of the fair market value of a share of the Company's common stock on the applicable Grant Date, or

(ii) 85% of the fair market value of a share of the Company's common stock on the applicable Purchase

Date. A participant's ESPP account will be reduced upon exercise of his or her Purchase Option by the

amount used to pay the Purchase Price for the shares acquired by the participant. No interest will be paid

to any participant or credited to any account under the ESPP.

***Eligibility***

Only certain employees will be eligible to participate in the ESPP. To participate in an Offering Period, on

the Grant Date of that period an individual must:

• be employed by the Company or one of its subsidiaries that has been designated as a participating

subsidiary;

• be customarily employed for more than 20 hours per week; and

• be customarily employed for more than five months per calendar year.

***Limits on authorized shares; limits on contributions***

The maximum number of shares of the Company's common stock initially available for delivery under the

plan will be an aggregate number of shares equal to one and a half percent (1.5%) of the total number of

fully diluted shares of the Company's common stock outstanding (including, without limitation, any

outstanding warrants) as of the date of commencement of trading of the shares of the Company's

common stock on the Nasdaq Global Select Market. In addition, this share limit will automatically increase

on the first trading day in January of each of the calendar years during the term of the ESPP, with the first

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such increase to occur in January 2026, by an amount equal to the <u>lesser</u> of (A) one percent of the total

number of shares of the Company's common stock issued and outstanding on December 31 of the

immediately preceding calendar year or (B) such number of shares of the Company's common stock as

may be established by the Board of Directors.

Participation in the ESPP is also subject to the following limits:

• A participant cannot contribute more than 15% of his or her compensation to the purchase of stock

under the ESPP in any one payroll period.

• A participant cannot purchase more than 50,000 shares of the Company's common stock under the

ESPP in any one Offering Period (subject to adjustment by the ESPP administrator for any Offering

Period that is longer or shorter than six months).

• A participant cannot purchase more than $25,000 of stock (valued at the start of the applicable

Offering Period and without giving effect to any discount reflected in the purchase price for the stock)

under the ESPP in any one calendar year.

• A participant will not be granted a Purchase Option under the ESPP if it would cause the participant to

own stock and/or hold outstanding options to purchase stock representing 5% or more of the total

combined voting power or value of all classes of stock of the Company or one of its subsidiaries or to

the extent it would exceed certain other limits under the U.S. Internal Revenue Code (the "Code").

We have the flexibility to change the 15%-contribution and the individual-share limit referred to above

from time to time without stockholder approval. However, we cannot increase the aggregate-share limit

under the ESPP, other than to reflect stock splits and similar adjustments as described below, without

stockholder approval. The $25,000 and the 5% ownership limitations referred to above are required under

the Code.

***Antidilution adjustments***

As is customary in stock incentive plans of this nature, the number and kind of shares available under the

ESPP, as well as ESPP purchase prices and share limits, are subject to adjustment in the case of certain

corporate events. These events include reorganizations, mergers, combinations, consolidations,

recapitalizations, reclassifications, stock splits, stock dividends, asset sales or other similar unusual or

extraordinary corporate events, or extraordinary dividends or distributions of property to our stockholders.

***Termination of participation***

A participant's election to participate in the ESPP will generally continue in effect for all Offering Periods

until the participant files a new election that takes effect or the participant ceases to participate in the

ESPP. A participant's participation in the ESPP generally will terminate if, prior to the applicable Purchase

Date, the participant ceases to be employed by the Company or one of its participating subsidiaries or the

participant is no longer scheduled to work more than 20 hours per week or five months per calendar year.

If a participant's ESPP participation terminates during an Offering Period for any of the reasons discussed

in the preceding paragraph, the participant will no longer be permitted to make contributions to the ESPP

for that Offering Period and, subject to limited exceptions, the participant's Purchase Option for that

Offering Period will automatically terminate and his or her ESPP account balance will be paid to him or

her in cash without interest. However, a participant's termination from participation will not have any effect

upon his or her ability to participate in any succeeding Offering Period, provided that the applicable

eligibility and participation requirements are again then met.

***Transfer restrictions***

A participant's rights with respect to Purchase Options or the purchase of shares under the ESPP, as well

as contributions credited to his or her ESPP account, may not be assigned, transferred, pledged or

otherwise disposed of in any way except by will or the laws of descent and distribution.

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***Administration***

The ESPP is administered by the Board of Directors or by a committee appointed by the Board of

Directors. The Board of Directors has appointed the Compensation Committee of the Board of Directors

as the administrator of the ESPP. The administrator has full power and discretion to adopt, amend or

rescind any rules and regulations for carrying out the ESPP and to construe and interpret the ESPP.

Decisions of the ESPP administrator with respect to the ESPP are final and binding on all persons.

***No limit on other plans***

The ESPP does not limit the ability of the Board of Directors or any committee of the Board of Directors to

grant awards or authorize any other compensation, with or without reference to the Company's common

stock, under any other plan or authority.

***Amendments***

The Board of Directors generally may amend or terminate the ESPP at any time and in any manner,

provided that the then-existing rights of participants are not materially and adversely affected thereby.

Stockholder approval for an amendment to the ESPP will only be required to the extent necessary to

meet the requirement of Section 423 of the Code or to the extent otherwise required by law or applicable

listing rules. The ESPP administrator also may, from time to time, without stockholder approval, designate

those subsidiaries of the Company whose employees may participate in the ESPP and make certain

other administrative changes as authorized by the plan.

***Termination***

No new Offering Periods will commence under the ESPP on or after the tenth anniversary of the effective

date of the ESPP, unless the Board of Directors terminates the ESPP earlier. The ESPP will also

terminate earlier if all of the shares authorized under the ESPP have been purchased. If an event occurs

in which the Company does not survive (or does not survive as a public company in respect of its

common stock), subject to any provision made by the Board of Directors for the assumption or

continuation of the Purchase Options then outstanding under the ESPP, the Offering Period then in

progress will be shortened and the outstanding Purchase Options will automatically be exercised on a

date established by the ESPP administrator that is not more than 10 days before the closing of the

transaction.

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**Certain relationships and related-party transactions**

The following includes a summary of transactions since January 1, 2022 and any currently proposed

transactions to which we were or are expected to be a participant in which (i) the amount involved

exceeded or will exceed $120,000, and (ii) any of our directors, executive officers, or holders of more than

5% of our capital stock, or any affiliate or member of the immediate family of the foregoing persons, had

or will have a direct or indirect material interest, other than compensation and other arrangements that are

described under the section titled "Executive and director compensation."

**2025 convertible promissory notes financing**

In January and March 2025, we entered into note purchase agreements with various investors, pursuant

to which we issued an aggregate of $98.3 million in principal amount of subordinated convertible

promissory notes (the "2025 Convertible Notes") to investors, including related parties, with original

maturity dates of 48 months from the initial issuance of the notes. Pursuant to the January 2025 note

purchase agreement, (i) the first closing occurred on January 24, 2025, at which time we issued $44.6

million in principal amount of the 2025 Convertible Notes and (ii) the second closing occurred on January

31, 2025, at which time we issued $3.7 million in principal amount of the 2025 Convertible Notes.

Pursuant to the March 2025 note purchase agreement, the closing occurred on March 26, 2025, at which

time we issued $50.0 million in principal amount of the 2025 Convertible Notes. The aggregate principal

amount outstanding under the 2025 Convertible Notes will be automatically converted upon the

completion of this offering into shares of our common stock without interest.

The following related parties, or their respective affiliates, participated in the 2025 Convertible Notes

offering:

---

| | |
|:---|:---|
| **Name**<sup>(1)</sup> | **Aggregate** <br>**purchase price** <br>**($)**<br>|
| Hayfin HeartFlow UK Limited<sup>(2)</sup>................................................................................................. | $23000000.00 |
| BCLS Fund III Investments, LP<sup>(3)</sup>............................................................................................. | $6595648.51 |
| Capricorn Entities<sup>(4)</sup>..................................................................................................................... | $2078516.75 |
| Timothy C. Barabe<sup>(5)</sup>................................................................................................................... | $2000000.00 |
| Lonnie M. Smith<sup>(6)</sup>....................................................................................................................... | $1822713.44 |
| HCPCIV 1, LLC<sup>(7)</sup>........................................................................................................................ | $1460234.00 |
| U.S. Venture Partners Funds<sup>(8)</sup>................................................................................................. | $811558.22 |
| Casey M. Tansey<sup>(9)</sup>...................................................................................................................... | $250000.00 |
| Vikram Verghese<sup>(10)</sup>.................................................................................................................... | $144650.88 |

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(1)For additional information regarding these stockholders and their equity holdings, see the section titled "Principal stockholders."

(2)Hayfin HeartFlow UK Limited, as nominee for entities affiliated with Hayfin HeartFlow UK Limited, owns more than 5% of our

outstanding capital. See "Principal stockholders," note 3, for additional details. Hayfin HeartFlow UK Limited is an entity affiliated with

Hayfin Services, LLP, which is the administrative agent under our 2024 Credit Agreement.

(3)BCLS Fund III Investments, LP owns more than 5% of our outstanding capital. Dr. Nicholas Downing, M.D. is a member of our board of

directors and is a managing director of Bain Capital Life Sciences.

(4)Consists of $1,929,687.95 in principal amount of the 2025 Convertible Notes purchased by Capricorn Healthcare & Special

Opportunities II, LP, $57,996.00 in principal amount of the 2025 Convertible Notes purchased by The Skoll Foundation, $52,169.37 in

principal amount of the 2025 Convertible Notes purchased by Capricorn Healthcare & Special Opportunities II-A, LP, and $38,663.43 in

principal amount of the 2025 Convertible Notes purchased by The Skoll Fund. Capricorn Entities own more than 5% of our outstanding

capital.

(5)Mr. Timothy C. Barabe is a member of our board of directors.

(6)Mr. Lonnie M. Smith and entities affiliated with Mr. Smith own more than 5% of our outstanding capital. Mr. Smith is a member of our

board of directors.

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(7)HCPCIV 1, LLC and entities affiliated with HCPCIV 1, LLC own more than 5% of our outstanding capital. Mr. Jeffrey C. Lightcap is a

member of our board of directors and is a controlling member of HCPCIV 1, LLC.

(8)Consists of $786,399.92 in principal amount of the 2025 Convertible Notes purchased by U.S. Venture Partners X, L.P. and $25,158.30

in principal amount of the 2025 Convertible Notes purchased by USVP X Affiliates, L.P. U.S. Venture Partners Funds own more than 5%

of our outstanding capital. Mr. Casey M. Tansey is a member of our board of directors and is a controlling member of U.S. Venture

Partners Funds.

(9)Mr. Casey M. Tansey is a member of our board of directors.

(10)Mr. Vikram Verghese is our Chief Financial Officer.

**Amendment No. 1 to 2024 Credit Agreement and related matters**

On January 24, 2025, in connection with the issuance of the 2025 Convertible Notes, we entered into

Amendment No. 1 to the 2024 Credit Agreement, pursuant to which our lender, Hayfin, converted $23.0

million of outstanding indebtedness under the 2024 Term Loan to 2025 Convertible Notes (the "2024 Term

Loan Conversion") under the same terms as the other purchasers of the 2025 Convertible Notes, as

described above. As a result, Hayfin became a holder of 5% or more of our capital stock. For more

information about the 2024 Credit Agreement, as amended, see "Management's discussion and analysis

of financial condition and results of operations—Liquidity and capital resources—Hayfin credit agreement"

and Note 8 to our consolidated financial statements included elsewhere in this prospectus.

In connection with the prior credit agreement with Hayfin that was refinanced by the 2024 Credit

Agreement, we issued warrants to purchase an aggregate of 185,407 shares of common stock to Hayfin.

As a result of the Series F redeemable convertible preferred stock financing referred to below, the

antidilution adjustments of these warrants resulted in the issuance to Hayfin in March 2023 of additional

warrants to purchase an aggregate of 1,462,260 shares of our common stock. The warrants have an

exercise price of $0.03 per share of common stock.

**Series F and Series F-1 redeemable convertible preferred stock financing**

In March 2023, we entered into a Series F and Series F-1 redeemable convertible preferred stock

purchase agreement with various investors, pursuant to which we issued an aggregate of 61,344,029

shares of Series F redeemable convertible preferred stock at a cash purchase price of $2.8505 per share

for gross proceeds of $174.9 million in multiple closings and 21,465,064 shares of Series F-1 redeemable

convertible preferred stock at a purchase price of $1.9098 per share for gross proceeds of $41.0 million

(the "Series F and Series F-1 redeemable convertible preferred stock financing"). The Series F-1

redeemable convertible preferred stock was issued upon conversion of the indebtedness under

outstanding subordinated convertible promissory notes issued by the Company from September 30, 2022

to December 16, 2022, in the aggregate principal amount of $40.0 million.

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The table below sets forth the number of shares of our Series F and Series F-1 redeemable convertible

preferred stock purchased by our executive officers, directors, holders of more than 5% of our capital

stock at the time of the transaction, and their affiliated entities or immediate family members. Each share

of Series F and Series F-1 redeemable convertible preferred stock in the table below will convert into

shares of our common stock at the then effective conversion rate per share for such share immediately

prior to the completion of this offering.

---

| | | | |
|:---|:---|:---|:---|
| **Name**<sup>(1)</sup> | **Series F** <br>**redeemable** <br>**convertible** <br>**preferred** <br>**stock (#)**<br>| **Series F-1** <br>**redeemable** <br>**convertible** <br>**preferred** <br>**stock (#)**<br>| **Aggregate** <br>**purchase price** <br>**($)**<sup>(2)</sup><br>|
| BCLS Fund III Investments, LP<sup>(3)</sup>....................................... | 35081564 |  | $99999998.18 |
| The Lonnie and Cheryl Smith Family Trust<sup>(4)</sup>................... |  | 8068125 | $15408505.15 |
| Hayfin HeartFlow UK Limited<sup>(5)</sup>.......................................... | 3508156 | 2689375 | $15136167.06 |
| HCPCIV 1, LLC<sup>(6)</sup>.................................................................. | 3905025 | 1321383 | $13654851.50 |
| Wellington Entities<sup>(7)</sup>............................................................. | 4169444 |  | $11885000.12 |
| U.S. Venture Partners Funds<sup>(8)</sup>.......................................... | 3508156 |  | $9999998.68 |
| Capricorn Entities<sup>(9)</sup>.............................................................. | 3013904 |  | $8591133.35 |
| The Schiehallion Fund Limited<sup>(10)</sup>...................................... | 2490791 |  | $7099999.75 |
| William C. Weldon<sup>(11)</sup>............................................................ | 73469 | 80898 | $363922.46 |

---

(1)For additional information regarding these stockholders and their equity holdings, see the section titled "Principal stockholders."

(2)The consideration for the Series F-1 redeemable convertible preferred stock was funded through the conversion of outstanding

subordinated convertible promissory notes.

(3)BCLS Fund III Investments, LP owns more than 5% of our outstanding capital. Dr. Nicholas Downing, M.D. is a member of our board of

directors and is a managing director of Bain Capital Life Sciences.

(4)Mr. Lonnie M. Smith and entities affiliated with Mr. Smith own more than 5% of our outstanding capital. Mr. Smith is a member of our

board of directors.

(5)Hayfin HeartFlow UK Limited, as nominee for entities affiliated with Hayfin HeartFlow UK Limited, owns more than 5% of our

outstanding capital. See "Principal stockholders," note 3, for additional details. Hayfin HeartFlow UK Limited is an entity affiliated with

Hayfin Services, LLP, which is the administrative agent under our 2024 Credit Agreement.

(6)HCPCIV 1, LLC and entities affiliated with HCPCIV 1, LLC own more than 5% of our outstanding capital. Mr. Jeffrey C. Lightcap is a

member of our board of directors and is a controlling member of HCPCIV 1, LLC.

(7)Consists of 3,176,720 shares of Series F redeemable convertible preferred stock held by Hadley Harbor Master Investors (Cayman) II

LP and 992,724 shares of Series F redeemable convertible preferred stock held by Texas Hidalgo CoInvestment Fund, L.P.

(8)Consists of 3,399,403 shares of Series F redeemable convertible preferred stock held by U.S. Venture Partners X, L.P. and 108,753

shares of Series F redeemable convertible preferred stock held by USVP X Affiliates, L.P. U.S. Venture Partners Funds own more than

5% of our outstanding capital.

(9)Consists of 1,402,222 shares of Series F redeemable convertible preferred stock held by Capricorn Healthcare & Special Opportunities

II, LP, 37,909 shares of Series F redeemable convertible preferred stock held by Capricorn Healthcare & Special Opportunities II-A, LP,

12,729 shares of Series F redeemable convertible preferred stock held by Carthage, LP, 1,142,851 shares of Series F redeemable

convertible preferred stock held by Pacific Sequoia Holdings, LLC, 223,661 shares of Series F redeemable convertible preferred stock

held by The Skoll Foundation, and 194,532 shares of Series F redeemable convertible preferred stock held by The Skoll Fund.

Capricorn Entities own more than 5% of our outstanding capital.

(10)The Schiehallion Fund Limited and Baillie Gifford Funds affiliated with The Schiehallion Fund Limited own more than 5% of our

outstanding capital.

(11)Mr. William C. Weldon is a member of our board of directors.

**2022 convertible promissory notes financing** 

In September 2022, we entered into a note purchase agreement with various investors, pursuant to which

we issued an aggregate of $40.0 million in principal amount of subordinated convertible promissory notes

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(the "2022 Convertible Notes") to investors with original maturity dates of 48 months from the dates of

issuance. The 2022 Convertible Notes automatically converted into shares of Series F-1 convertible

preferred stock on March 2, 2023. For more information, see the subsection titled "—Series F and Series

F-1 redeemable convertible preferred stock financing."

The following related parties, or their respective affiliates, participated in the 2022 Convertible Notes

offering:

---

| | |
|:---|:---|
| **Name**<sup>(1)</sup> | **Aggregate** <br>**purchase price** <br>**($)**<br>|
| The Lonnie and Cheryl Smith Family Trust<sup>(2)</sup>......................................................................... | $15000000.00 |
| Hayfin HeartFlow UK Limited<sup>(3)</sup>................................................................................................. | $5000000.00 |
| HCPCIV 1, LLC<sup>(4)</sup>........................................................................................................................ | $2458284.00 |
| William C. Weldon<sup>(5)</sup>.................................................................................................................... | $150501.65 |

---

(1)For additional information regarding these stockholders and their equity holdings, see the section titled "Principal stockholders."

(2)Mr. Lonnie M. Smith and entities affiliated with Mr. Smith own more than 5% of our outstanding capital. Mr. Smith is a member of our

board of directors.

(3)Hayfin HeartFlow UK Limited, as nominee for entities affiliated with Hayfin HeartFlow UK Limited, owns more than 5% of our

outstanding capital. See "Principal stockholders," note 3, for additional details. Hayfin HeartFlow UK Limited is an entity affiliated with

Hayfin Services, LLP, which is the administrative agent under our 2024 Credit Agreement.

(4)HCPCIV 1, LLC and entities affiliated with HCPCIV 1, LLC own more than 5% of our outstanding capital. Mr. Jeffrey C. Lightcap is a

member of our board of directors and is a controlling member of HCPCIV 1, LLC.

(5)Mr. William C. Weldon is a member of our board of directors.

**Investors' rights agreement**

We are party to an amended and restated investors' rights agreement, as amended, dated March 2, 2023

(the "Investors' Rights Agreement"), with the purchasers of our outstanding redeemable convertible

preferred stock, including the following directors, holders of more than 5% of our capital stock and entities

with which certain of our directors are affiliated: BCLS Fund III Investments, LP, Lonnie M. Smith, Hayfin

HeartFlow UK Limited (an entity affiliated with Hayfin Services, LLP, which is the administrative agent

under our 2024 Credit Agreement), HealthCor Partners Funds, Wellington Entities, U.S. Venture Partners

Funds, Capricorn Entities, Baillie Gifford Funds, William C. Weldon and Charles A. Taylor, Jr., Ph.D.

Following the completion of this offering, the holders of approximately 55.6 million shares of our common

stock, which includes all shares of our common stock issuable upon the conversion of our outstanding

redeemable convertible preferred stock, are entitled to rights with respect to the registration of their

shares under the Securities Act. For a more detailed description of these registration rights, see the

section titled "Shares eligible for future sale—Registration rights."

**Voting agreement**

We are party to an amended and restated voting agreement, as amended, with certain holders of our

common stock and redeemable convertible preferred stock, including the following directors and

executive officers, holders of more than 5% of our capital stock, and entities with which certain of our

directors are affiliated: BCLS Fund III Investments, LP, Lonnie M. Smith, Hayfin HeartFlow UK Limited (an

entity affiliated with Hayfin Services, LLP, which is the administrative agent under our 2024 Credit

Agreement), HealthCor Partners Funds, Wellington Entities, U.S. Venture Partners Funds, Capricorn

Entities, Baillie Gifford Funds, William C. Weldon and Charles A. Taylor, Jr., Ph.D. Pursuant to the

amended and restated voting agreement, BCLS Fund III Investments, LP has the right to designate one

member to be elected to our board of directors, which designee is currently Nicholas Downing. Upon the

completion of this offering, the amended and restated voting agreement will terminate. Members

previously elected to our board of directors pursuant to this agreement will continue to serve as directors

until they resign, are removed or their successors are duly elected by holders of our common stock. The

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composition of our board of directors after this offering is described in more detail in the section title

"Management—Board composition."

**Right of first refusal and co-sale agreement**

We are party to an amended and restated right of first refusal and co-sale agreement with certain holders

of our common stock and redeemable convertible preferred stock, including the following directors,

holders of more than 5% of our capital stock, and entities with which certain of our directors are affiliated:

BCLS Fund III Investments, LP, Lonnie M. Smith, Hayfin HeartFlow UK Limited (an entity affiliated with

Hayfin Services, LLP, which is the administrative agent under our 2024 Credit Agreement), HealthCor

Partners Funds, Wellington Entities, U.S. Venture Partners Funds, Capricorn Entities, Baillie Gifford

Funds, William C. Weldon and Charles A. Taylor, Jr., Ph.D. This agreement provides for rights of first

refusal and co-sale relating to the shares of our common stock and convertible securities, other than

Series F and Series F-1 redeemable convertible preferred stock and the common stock issuable upon

conversion of such preferred stock, held by certain parties to the agreement. Upon the completion of this

offering, the amended and restated right of first refusal and co-sale agreement will terminate.

**Management rights letters**

In connection with the issuance of our Series F and Series F-1 convertible preferred stock, we entered

into management rights letters with certain purchasers of our redeemable convertible preferred stock,

including holders of more than 5% of our capital stock, Wellington Entities, U.S. Venture Partners X, L.P.

and Baillie Gifford Funds, pursuant to which such entities were granted certain management rights,

including the right to consult with and advise our management on significant business issues, review our

operating plans, examine our books and records and inspect our facilities. These management rights

letters and the rights granted to the parties thereto will terminate upon completion of this offering. Certain

of our obligations under the management rights letters will remain in effect after the completion of this

offering, including certain tax reporting and financial disclosures.

**Letter agreement with Bain Capital Life Science**

In connection with our Series F redeemable convertible preferred stock financing, we entered into a letter

agreement with BCLS Fund III Investments, LP (the "BCLS Letter Agreement"), which holds more than

5% of our outstanding capital stock. Pursuant to the BCLS Letter Agreement, BCLS Fund III Investments,

LP was granted the right to designate a board observer in a nonvoting capacity, which right will terminate

upon the completion of this offering. Certain of our obligations under the BCLS Letter Agreement will

remain in effect after the completion of this offering, including our obligation to obtain the consent of Bain

Capital prior to making certain public disclosures about Bain Capital or certain of its affiliates and certain

pro rata lock-up release rights of Bain Capital which provide that, in the event we or the managing

underwriter waive or terminate the lock-up restrictions contained in the Investors' Rights Agreement or

certain lock-up agreements (including certain lock-up agreements for this offering), then such restrictions

applicable to Bain Capital under the Investors' Rights Agreement or any lock-up agreement will be waived

or terminated, as applicable, to the same extent and with respect to the same percentage of securities.

**Letter agreement with Capricorn Entities**

In connection with our Series F redeemable convertible preferred stock financing, we entered into a letter

agreement with the Capricorn Entities (the "Capricorn Letter Agreement"), which collectively hold more

than 5% of our outstanding capital stock. Pursuant to the Capricorn Letter Agreement, the Capricorn

Entities were granted the right to designate a board observer in a nonvoting capacity. The Capricorn

Letter Agreement will terminate by its terms in connection with the completion of this offering and the

Capricorn Entities will not have any continuing rights following this offering.

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**2023 Taylor Trust repurchase**

On March 29, 2023, we entered into a common stock repurchase agreement in connection with the

Series F and Series F-1 redeemable convertible preferred stock financing, pursuant to which we

repurchased 102,739 shares of common stock from the Taylor Family Revocable Trust, a family trust held

by Charles A. Taylor, Jr., Ph.D., one of our directors, at $8.3235 per share for an aggregate purchase

price of $855,150.00.

**Other**

Michael Smith, a relative of Mr. Lonnie M. Smith, one of our directors, has been one of our non-executive

employees since 2014. His overall cash compensation for each of 2022, 2023 and 2024 did not exceed

$300,000. He did not receive any equity compensation in 2024, and has received an aggregate of less

than 17,123 incentive stock options during his employment with us.

**Executive officer and director compensation**

Please see the section titled "Executive and director compensation" for information regarding the

compensation of our directors and executive officers and the new severance plan we intend to enter into

prior to this offering.

**Indemnification agreements**

We have entered into indemnification agreements with certain of our current directors and executive

officers and intend to enter into new indemnification agreements with each of our current directors and

executive officers before the completion of this offering. Our amended and restated certificate of

incorporation and our amended and restated bylaws will provide that we will indemnify our directors and

officers to the fullest extent permitted by applicable law. Further, we have purchased a policy of directors'

and officer' liability insurance that insures our directors and officers against the cost of defense,

settlement or payment of a judgment under certain circumstances. See the section titled "Management—

Limitations on liability and indemnification matters."

**Policies and procedures for related-party transactions**

Our board of directors has adopted a written related-party transaction policy, to be effective upon the

commencement of trading of our common stock on the Nasdaq Global Select Market, which sets forth the

policies and procedures for the review and approval or ratification of related-party transactions. This

policy will cover, with certain exceptions set forth in Item 404 of Regulation S-K, any transaction,

arrangement, or relationship, or any series of similar transactions, arrangements, or relationships, in

which we were or are to be a participant, where the amount involved exceeds $120,000 and a related

person had or will have a direct or indirect material interest, including without limitation purchases of

goods or services by or from the related person or entities in which the related person has a material

interest, indebtedness, guarantees of indebtedness, and employment by us of a related person. In

reviewing and approving any such transactions, our audit committee is tasked to consider all relevant

facts and circumstances, including but not limited to whether the transaction is on terms comparable to

those that could be obtained in an arm's length transaction with an unrelated third party and the extent of

the related person's interest in the transaction. All of the transactions described in this section occurred

prior to the adoption of this policy.

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**Principal stockholders**

The following table sets forth, as of June 30, 2025, information regarding beneficial ownership of our

capital stock by:

• each person, or group of affiliated persons, known by us to beneficially own more than 5% of our

common stock;

• each of our named executive officers;

• each of our directors; and

• all of our executive officers and directors as a group.

The percentage ownership information under the column titled "Beneficial ownership prior to this offering"

is based on 64,638,406 shares of our common stock outstanding as of June 30, 2025

including 51,226,348 shares of our common stock resulting from the Preferred Stock Conversion

and 7,022,512 shares of our common stock resulting from the conversion of the 2025 Convertible Notes

(based on the assumed initial public offering price of $17.50 per share, which is the midpoint of the price

range set forth on the cover page of this prospectus), in each case as if such conversion had occurred as

of June 30, 2025. The ownership information under the column titled "Beneficial ownership after this

offering" assumes the foregoing and the issuance of 16,666,667 shares of common stock in this offering

and assumes no exercise of the underwriters' option to purchase additional shares. In addition, the

following table does not reflect any shares of common stock that may be purchased in this offering.

We have determined beneficial ownership according to the rules and regulations of the SEC, which

generally means that a person has beneficial ownership of a security if they or it possesses sole or

shared voting or investment power of that security. In addition, shares of common stock issuable upon the

exercise of stock options or warrants that are currently exercisable or exercisable within 60 days of June

30, 2025 are included in the following table. These shares are deemed to be outstanding and beneficially

owned by the person holding those options or warrants for the purpose of computing the percentage

ownership of that person, but they are not treated as outstanding for the purpose of computing the

percentage ownership of any other person. The information contained in the following table does not

necessarily indicate beneficial ownership for any other purpose. Unless otherwise indicated, the persons

or entities identified in this table have sole voting and investment power with respect to all shares shown

as beneficially owned by them, subject to applicable community property laws.

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Unless otherwise noted below, the address for each beneficial owner listed in the table below is c/o

Heartflow, Inc., 331 E. Evelyn Avenue, Mountain View, California 94041.

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| | | | | |
|:---|:---|:---|:---|:---|
| | **Beneficial ownership** <br>**prior to this offering** | **Beneficial ownership** <br>**prior to this offering** | **Beneficial ownership** <br>**after this offering** | **Beneficial ownership** <br>**after this offering** |
| <br>**Name of beneficial owner** | **Number of** <br>**shares** <br>**beneficially** <br>**owned**<br>| **Percentage** <br>**of beneficial** <br>**ownership**<br>| **Number of** <br>**shares** <br>**beneficially** <br>**owned**<br>| **Percentage** <br>**of beneficial** <br>**ownership**<br>|
| ***5% and greater stockholders:*** |  |  |  |  |
| BCLS Fund III Investments, LP<sup>(1)</sup>.......................... | 12485351 | 19.3% | 12485351 | 15.4% |
| HealthCor Partners Funds<sup>(2)</sup>.................................. | 6705790 | 10.4% | 6705790 | 8.2% |
| Entities affiliated with Hayfin Services, LLP <sup>(3)</sup>.... | 5412966 | 8.2% | 5412966 | 6.5% |
| Wellington Entities<sup>(4)</sup>................................................ | 4414491 | 6.8% | 4414491 | 5.4% |
| Capricorn Funds<sup>(5)</sup>................................................... | 3934557 | 6.1% | 3934557 | 4.8% |
| FMR LLC<sup>(6)</sup>................................................................ | 3571420 | 5.5% | 3571420 | 4.4% |
| Lonnie M. Smith<sup>(7)</sup>.................................................... | 3508661 | 5.4% | 3508661 | 4.3% |
| ***Named executive officers and directors:*** |  |  |  |  |
| John C.M. Farquhar<sup>(8)</sup>............................................. | 1430094 | 2.2% | 1430094 | 1.7% |
| Vikram Verghese<sup>(9)</sup>.................................................. | 206765 | \* | 206765 | \* |
| Campbell D.K. Rogers, M.D.<sup>(10)</sup>............................. | 360215 | \* | 360215 | \* |
| William C. Weldon<sup>(11)</sup>............................................... | 290948 | \* | 290948 | \* |
| Timothy C. Barabe<sup>(12)</sup>.............................................. | 182281 | \* | 182281 | \* |
| Julie A. Cullivan<sup>(13)</sup>................................................... | 46340 | \* | 46340 | \* |
| Nicholas Downing, M.D.<sup>(14)</sup>..................................... |  |  |  |  |
| Jeffrey C. Lightcap<sup>(2)</sup>............................................... | 6705790 | 10.4% | 6705790 | 8.2% |
| Wayne Riley, M.D.<sup>(15)</sup>............................................... | 40131 | \* | 40131 | \* |
| Lonnie M. Smith<sup>(7)</sup>.................................................... | 3508661 | 5.4% | 3508661 | 4.3% |
| Casey M. Tansey<sup>(16)</sup>................................................. | 3193496 | 4.9% | 3193496 | 3.9% |
| Charles A. Taylor, Jr., Ph.D.<sup>(17)</sup>............................... | 1110535 | 1.7% | 1110535 | 1.4% |
| All current directors and executive officers as a <br>group (12 persons)<sup>(18)</sup>.............................................<br>| 17075256 | 25.7% | 12456060 | 15.0% |

---

\*Indicates beneficial ownership of less than 1% of the total outstanding common stock.

(1)Consists of (A) 12,014,234 shares of our common stock issuable upon conversion of our redeemable convertible preferred stock held

directly by BCLS Fund III Investments, LP and (B) 471,117 shares of common stock issuable upon conversion of the 2025 Convertible

Notes purchased by BCLS Fund III Investments, LP. Bain Capital Life Sciences Investors, LLC ("BCLSI") is the manager of Bain Capital

Life Sciences III General Partner, LLC, which is the general partner of Bain Capital Life Sciences Fund III, L.P., which is the managing

member of BCLS Fund III Investments GP, LLC, which is the general partner of BCLS Fund III Investments, LP. As a result, BCLSI may

be deemed to share voting and dispositive power with respect to the securities held by BCLS Fund III Investments, LP. Voting and

investment decisions with respect to the securities held by BCLS Fund III Investments, LP are made by the partners of BCLSI, of whom

there are three or more and none of whom individually has the power to direct such decisions. The principal address for BCLS Fund III

Investments, LP is 200 Clarendon Street, Boston, Massachusetts 02116.

(2)Consists of (A) shares of our common stock issuable upon conversion of our redeemable convertible preferred stock expected to be

held by the following entities, collectively referred to as "HealthCor Partners Funds": (i) 4,519,474 shares of common stock issuable

upon conversion of our redeemable convertible preferred stock held by HCPCIV 1, LLC; (ii) 1,248,939 shares of common stock issuable

upon conversion of our redeemable convertible preferred stock held by HealthCor Partners Fund, L.P; and (iii) 833,075 shares of

common stock issuable upon conversion of our redeemable convertible preferred stock held by HealthCor Partners Fund II, L.P. and (B)

104,302 shares of common stock issuable upon conversion of the 2025 Convertible Notes purchased by HCPCIV 1, LLC. Mr. Lightcap,

a member of our board of directors, is a controlling member of each of the HealthCor Partners Funds. Mr. Lightcap disclaims beneficial

ownership of these shares except to the extent of his pecuniary interest therein. Collectively, together with Mr. Lightcap, Arthur Cohen

and Joseph Healey form the investment committee on behalf of HealthCor Partners Management, LP, the investment manager for the

Healthcor Partners Funds, and have sole discretion for voting and disposal of HealthCor Partners Funds' shares. The address for the

HealthCor Partners Funds is 186 Seven Farms Drive, Suite F-371, Daniel Island, South Carolina 29492.

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(3)Consists of: (A)(i) 2,122,442 shares of common stock issuable upon conversion of our redeemable convertible preferred stock held by

Hayfin Heartflow UK Limited as nominee for the following beneficial owners: (a) Hayfin Healthcare Opportunities Invest LP and (b)(I)

Hayfin Special Opportunities Fund III SCSp, (II) Hayfin Hostplus LP, (III) Hayfin Chief LP, (IV) SunHay LP, (V) Hayfin Big Cypress LP,

(VI) Hayfin Hamilton LP, (VII) Hayfin Opal 2020 (A) LP, and (VIII) Hayfin Opal 2020 (B) LP (collectively, the "Hayfin Special

Opportunities Preferred Stock Beneficial Owners" and, together with Hayfin Healthcare Opportunities Invest LP, the "Hayfin Preferred

Stock Beneficial Owners, and each, a "Hayfin Preferred Stock Beneficial Owner"); and (ii) 1,647,667 shares of our common stock

subject to warrants exercisable by Hayfin Tourmaline Luxco S.a r.l. and held as nominee for the following beneficial owners: (a) Hayfin

Healthcare Opportunities Invest LP and (b)(I) Hayfin Special Opportunities Fund II LP, (II) Hayfin Special Opportunities Fund III SCSp,

(III) Hayfin Hostplus LP, (IV) Hayfin Chief LP, (V) SunHay LP, (VI) Hayfin Big Cypress LP, (VII) Hayfin Opal 2020 (A) LP and (VIII) Hayfin

Opal 2020 (B) LP (collectively, the "Hayfin Special Opportunities Warrant Beneficial Owners" and, together with Hayfin Healthcare

Opportunities Invest LP, the "Hayfin Warrants Beneficial Owners", and each, a "Hayfin Warrants Beneficial Owner"); and (B) 1,642,857

shares of common stock issuable upon conversion of the 2025 Convertible Notes purchased by Hayfin HeartFlow UK Limited and held

as nominee for the following beneficial owners: (a) Hayfin AUS AIV LP, acting through the Hostplus Series, (b) Hayfin Special

Opportunities Fund III AIV LP, (c) Hayfin AUS AIV LP, acting through the AUS SOF III Series, (d) Hayfin Chief LP, (d) Hayfin Big Cypress

LP, (e) Hayfin Opal 2020 (A) LP, and (f) Hayfin Opal 2020 (B) LP (collectively, the "Hayfin 2025 Convertible Notes Beneficial Owners,"

and each, a "Hayfin 2025 Convertible Notes Beneficial Owner").

Each Hayfin Preferred Stock Beneficial Owner has shared voting power and shared dispositive power with respect to our common stock

issuable upon conversion of the redeemable convertible preferred stock in proportion to its pro rata beneficial interest in the redeemable

convertible preferred stock. Each Hayfin Warrants Beneficial Owner has shared voting power and shared dispositive power with respect

to our common stock issuable upon exercise of the warrants in proportion to its pro rata beneficial interest in the warrants. Each Hayfin

2025 Convertible Notes Beneficial Owner has shared voting power and shared dispositive power with respect to our common stock

issuable upon conversion of the 2025 Convertible Notes in proportion to its pro rata beneficial interest in the 2025 Convertible Notes.

Each Hayfin Preferred Stock Beneficial Owner, each Hayfin Warrants Beneficial Owner and each Hayfin 2025 Convertible Notes

Beneficial Owner is structured as a limited partnership acting by its general partner, which in each case is ultimately a private limited

company. The general partners of Hayfin Healthcare Opportunities Invest LP, Hayfin Special Opportunities Fund III SCSp, Hayfin

Hostplus LP, Hayfin Chief LP, SunHay LP, Hayfin Big Cypress LP and Hayfin Hamilton LP are Hayfin HF GP LLC acting through Hayfin

Healthcare Opportunities Fund GP S.à r.l., Hayfin SOF III GP S.à r.l., Hayfin Hostplus GP Limited, Hayfin Chief GP Limited, SunHay GP

Limited, Hayfin Big Cypress GP Limited and Hayfin Hamilton GP Limited, respectively. The general partner of Hayfin Opal 2020 (A) LP

and Hayfin Opal 2020 (B) LP is Hayfin Opal 2020 GP Limited. The general partner of Hayfin Special Opportunities Fund II LP is Hayfin

SOF II GP LP acting through Hayfin SOF II GP Limited. The general partner of Hayfin AUS AIV LP, acting through the Hostplus Series,

and Hayfin AUS AIV LP, acting through the AUS SOF III Series, is Hayfin AUS AIV GP LLC acting through Hayfin SOF III AIV GP S.à.r.l.

The general partner of Hayfin Special Opportunities Fund III AIV LP is Hayfin SOF III AIV GP LLC acting through Hayfin SOF III AIV GP

S.à.r.l. Each such private limited company may be deemed to share voting and investment power over the Heartflow securities held by

the limited partnership for which it acts as general partner. The number of board members of each such private limited company ranges

from three to five (other than for Hayfin Hostplus GP Limited, SunHay GP Limited and Hayfin Big Cypress GP Limited, for which the

number of board members is two). In all cases decision-making on the exercise of voting and investment power with respect to the

Heartflow securities held by the limited partnership requires a majority of the board members of its general partner present at a quorate

meeting, at least two board members are required to form a quorum, and no single board member has the power to direct such

decisions.

The principal address for Hayfin Heartflow UK Limited, Hayfin Services, LLP and their affiliates is 65 Davies Street, London W1K 5JL.

The registered office for Hayfin Tourmaline Luxco S.à.r.l is 15 Boulevard F.W. Raiffeisen, L-2411 Luxembourg.

(4)Consists of (i) 3,388,522 shares of common stock issuable upon conversion of our redeemable convertible preferred stock held by

Hadley Harbor Master Investors (Cayman) II LP and (ii) 1,025,969 shares of our common stock issuable upon conversion of our

redeemable convertible preferred stock held by Texas Hidalgo Co-Investment Fund, L.P. (each a "Wellington Entity" and, collectively,

the "Wellington Entities"). Wellington Management Company LLP, a registered investment adviser under the Investment Advisers Act of

1940, as amended, is the investment adviser to each Wellington Entity, and Wellington Alternative Investments LLC is general partner

to each Wellington Entity. Wellington Management Investment, Inc. is the managing member of Wellington Alternative Investments LLC.

Wellington Management Company LLP is an indirect subsidiary of Wellington Management Group LLP. Wellington Management Group

LLP and Wellington Management Company LLP may be deemed beneficial owners with shared voting and investment power over the

shares held by each Wellington Entity. Wellington Management Group LLP is a Massachusetts limited liability partnership, privately held

by 181 partners (as of June 30, 2025). There are no external entities with any ownership interest in Wellington Management Group LLP.

Individual percentages of ownership are confidential. However, no single partner owns or has the right to vote more than 5% of the

Wellington Management Group LLP's capital. Additional information about Wellington Management Company LLP is available in its

Form ADV filed with the SEC. The address of all entities referenced in this footnote is 280 Congress Street, Boston, Massachusetts

02210. (5)Consists of (A) shares of our common stock issuable upon conversion of our redeemable convertible preferred stock held by the

following entities, collectively referred to as the "Capricorn Funds": (i) 857,457 shares of common stock issuable upon conversion of our

redeemable convertible preferred stock held by Capricorn Healthcare and Special Opportunities, LP; (ii) 1,058,496 shares of common

stock issuable upon conversion of our redeemable convertible preferred stock held by Capricorn Healthcare & Special Opportunities II,

LP; (iii) 28,616 shares of common stock issuable upon conversion of our redeemable convertible preferred stock held by Capricorn

Healthcare & Special Opportunities II-A, LP; (iv) 71,238 shares of common stock issuable upon conversion of our redeemable

convertible preferred stock held by Capricorn S.A. SICAV — SIF — Global Non-Marketable Strategies Sub-Fund; (v) 31,526 shares of

common stock issuable upon conversion of our redeemable convertible preferred stock held by Carthage, LP; (vi) 41,641 shares of

common stock issuable upon conversion of our redeemable convertible preferred stock held by CHSO CIG, LP; (vii) 50,870 shares of

common stock issuable upon conversion of our redeemable convertible preferred stock held by CHSO SFP, LP; (viii) 76,067 shares of

common stock issuable upon conversion of our redeemable convertible preferred stock held by CHSO TSF, LP; (ix) 1,162,999 shares of

common stock issuable upon conversion of our redeemable convertible preferred stock held by Pacific Sequoia Holdings, LLC;

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(x) 216,570 shares of common stock issuable upon conversion of our redeemable convertible preferred stock held by The Skoll

Foundation; and (xi) 190,614 shares of common stock issuable upon conversion of our redeemable convertible preferred stock held by

The Skoll Fund and (B) (i) 137,834 shares of common stock issuable upon conversion of the 2025 Convertible Notes purchased by

Capricorn Healthcare & Special Opportunities II, LP, (ii) 4,142 shares of common stock issuable upon conversion of the 2025

Convertible Notes purchased by The Skoll Foundation, (iii) 3,726 shares of common stock issuable upon conversion of the 2025

Convertible Notes purchased by Capricorn Healthcare & Special Opportunities II-A, L.P., and (iv) 2,761 shares of common stock

issuable upon conversion of the 2025 Convertible Notes purchased by The Skoll Fund.

CHSO Partners, LLC, is the general partner of Capricorn Healthcare and Special Opportunities, LP, CHSO CIG, LP, CHSO SFP, LP,

and CHSO TSF, LP. CHSO Partners, LLC has sole investment and voting authority over the shares held by these funds. Voting and

dispositive decisions on behalf of CHSO Partners LLC are made by the separate decisions of Barry Uphoff, the Principal Manager of

CHSO Partners LLC and a majority of the CIG Managers of CHSO Partners. Messrs. Eric Techel and Ion Yadigaroglu are the CIG

Managers of CHSO Partners LLC. Messrs. Uphoff, Techel and Yadigaroglu may be deemed to have shared voting and investment

control with respect to the shares held by the funds managed by CHSO Partners LLC.

CHSO Partners II, LLC, is the general partner of Capricorn Healthcare & Special Opportunities II, LP and Capricorn Healthcare &

Special Opportunities II-A, LP. CHSO Partners II, LLC has sole investment and voting authority over the shares held by these funds.

Voting and dispositive decisions on behalf of CHSO Partners II, LLC are made by the separate decisions of Barry Uphoff, the Principal

Manager of CHSO Partners II, LLC and one designated representative of Capricorn Investment Group, LLC. Mr. Uphoff and Capricorn

Investment Group may be deemed to have shared voting and investment control with respect to the shares held by the funds managed

by CHSO Partners II, LLC.

Capricorn Investment Group, LLC is the general partner of Carthage, LP and the investment manager of Pacific Sequoia Holdings, LLC,

The Skoll Foundation and The Skoll Fund.

The address for each of the Capricorn Funds is c/o Capricorn Investment Group LLC, 250 University Avenue, Palo Alto, California

94301. CHSO Partners, LLC and CHSO Partners II, LLC's address is 2020 K Street NW, STE 720, Washington, DC 20006.

(6)Consists of shares of common stock issuable upon conversion of the 2025 Convertible Notes. These shares are owned by funds and

accounts managed by direct or indirect subsidiaries of FMR LLC, all of which shares are beneficially owned, or may be deemed to be

beneficially owned, by FMR LLC, certain of its subsidiaries and affiliates and other companies. Abigail P. Johnson is a Director, the

Chairman and the Chief Executive Officer of FMR LLC. Members of the Johnson family, including Abigail P. Johnson, are the

predominant owners, directly or through trusts, of Series B voting common shares of FMR LLC, representing 49% of the voting power of

FMR LLC. The Johnson family group and all other Series B shareholders have entered into a shareholders' voting agreement under

which all Series B voting common shares will be voted in accordance with the majority vote of Series B voting common shares.

Accordingly, through their ownership of voting common shares and the execution of the shareholders' voting agreement, members of

the Johnson family may be deemed, under the Investment Company Act of 1940, to form a controlling group with respect to FMR LLC.

The business address of FMR LLC is 245 Summer Street, Boston, Massachusetts 02210.

(7)Consists of (A) (i) 2,763,056 shares of our common stock issuable upon conversion of our redeemable convertible preferred stock

expected to be held by Lonnie M. Smith HeartFlow IV Grantor Retained Annuity Trust u/a June 24, 2023, (ii) 417,208 shares of our

common stock issuable upon conversion of our redeemable convertible preferred stock held by Lonnie M. Smith HeartFlow GRAT III,

(iii) 139,879 shares of our common stock issuable upon conversion of our redeemable convertible preferred stock held by McKram

Investment Capital II LLC, (iv) 34,246 shares of our common stock held directly by Mr. Smith and (v) 24,079 shares of our common

stock subject to options exercisable by Mr. Smith within 60 days of June 30, 2025 and (B) 130,193 shares of common stock issuable

upon conversion of the 2025 Convertible Notes purchased by Lonnie M. Smith. Mr. Smith has voting and investment power over the

shares held by McKram Investment Capital II LLC. Mr. Smith has notified us that he will resign from our board of directors upon, and

subject to, the commencement of trading of our common stock on the Nasdaq Global Select Market.

(8)Consists of (i) 373,380 shares of our common stock and (ii) 1,056,714 shares of our common stock subject to options exercisable within

60 days of June 30, 2025.

(9)Consists of (A) (i) 114,815 shares of our common stock and (ii) 81,618 shares of our common stock subject to options exercisable

within 60 days of June 30, 2025 and (B) 10,332 shares of common stock issuable upon conversion of the 2025 Convertible Notes

purchased by Vikram Verghese.

(10)Consists of (i) 214,675 shares of our common stock subject to options exercisable within 60 days of June 30, 2025, and includes (ii)

119,528 shares of our common stock expected to be held by family trusts established by Dr. Rogers for the benefit of certain members

of his family and (iii) 26,012 shares of our common stock expected to be held by a trust beneficially owned by his wife. Dr. Rogers may

be deemed to beneficially own such shares.

(11)Consists of (i) 56,256 shares of our common stock, (ii) 136,306 shares of our common stock issuable upon conversion of our

redeemable convertible preferred stock and (iii) 98,386 shares of our common stock subject to options exercisable within 60 days

of June 30, 2025.

(12)Consists of (A) (i) 36,779 shares of our common stock and (ii) 2,645 shares of our common stock subject to options exercisable within

60 days of June 30, 2025 and (B) 142,857 shares of common stock issuable upon conversion of the 2025 Convertible Notes purchased

by Timothy C. Barabe.

(13)Consists of (i) 44,413 shares of our common stock and (ii) 1,927 shares of our common stock subject to options exercisable within 60

days of June 30, 2025.

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(14)Does not include shares of our common stock issuable upon conversion of our redeemable convertible preferred stock held by BCLS

Fund III Investments, LP or our 2025 Convertible Notes purchased by BCLS Fund III Investments, LP. Dr. Downing is a managing

director of Bain Capital Life Sciences. Dr. Downing, a current member of our board of directors, has notified us that he will resign from

our board of directors upon, and subject to, the commencement of trading of our common stock on the Nasdaq Global Select Market.

(15)Consists of 40,131 shares of our common stock subject to options exercisable within 60 days of June 30, 2025.

(16)Consists of (A) shares of our common stock issuable upon conversion of our redeemable convertible preferred stock expected to be

held by the following entities, collectively referred to as the "U.S. Venture Partners Funds": (i) 3,021,023 shares of common stock

issuable upon conversion of our redeemable convertible preferred stock held by U.S. Venture Partners X, L.P. and (ii) 96,648 shares of

common stock issuable upon conversion of our redeemable convertible preferred stock held by USVP X Affiliates, L.P., (B) (i) 56,171

shares of common stock issuable upon conversion of the 2025 Convertible Notes purchased by U.S. Venture Partners X, L.P. and (ii)

1,797 shares of common stock issuable upon conversion of the 2025 Convertible Notes purchased by USVP X Affiliates, L.P. Presidio

Management Group X, L.L.C. ("PMG X") is the general partner of the U.S. Venture Partners Funds, and (C) 17,857 shares of common

stock issuable upon conversion of the 2025 Convertible Notes purchased by Casey M. Tansey. Casey Tansey, a member of our Board

of Directors, is a managing member of PMG X and shares voting and investment power over the shares held by U.S. Venture Partners

X, L.P. and USVP X Affiliates, L.P., but disclaims beneficial ownership except to the extent of his pecuniary interests therein. The

address for the U.S. Venture Partners Funds is 1460 El Camino Real, Suite 100, Menlo Park, California 94025.

(17)Consists of (i) 136,986 shares of our common stock and (ii) 157,628 shares of our common stock subject to options exercisable within

60 days of June 30, 2025, and includes (iii) 775,779 shares expected to be held by various family trusts established by Dr. Taylor and

(iv) 40,142 shares expected to be held by various family members. Dr. Taylor may be deemed to beneficially own such shares. 205,479

shares expected to be held by Dr. Taylor and his trust have been pledged to Section Capital Partners, LP. Dr. Taylor, a current member

of our board of directors, has notified us that he will resign from our board of directors upon, and subject to, the commencement of

trading of our common stock on the Nasdaq Global Select Market.

(18)Includes the shares described in footnotes 2 and 7 through 17 above for beneficial ownership prior to this offering and, since Mr. Smith,

Dr. Downing and Dr. Taylor have each notified us of their intent to resign from our board of directors, excludes the shares described in

footnotes 7, 14, and 17, respectively, for beneficial ownership after this offering.

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**Description of capital stock**

*The following descriptions are summaries of our capital stock and the material terms of our amended and* 

*restated certificate of incorporation, which will become effective upon the completion of this offering, and* 

*our amended and restated bylaws, which will become effective upon the effectiveness of the amended* 

*and restated certificate of incorporation. Because the following descriptions are only summaries, they do* 

*not contain all of the information that may be important to you. Reference is made to the more detailed* 

*provisions of, and the descriptions are qualified in their entirety by reference to, these documents, copies* 

*of which are filed with the SEC as exhibits to the registration statement of which this prospectus is a part,* 

*and applicable law.*

**General**

Upon the completion of this offering and the filing of our amended and restated certificate of incorporation,

our authorized capital stock will consist of 300,000,000 shares of capital stock, par value $0.001 per

share, of which:

• 250,000,000 shares are designated as common stock; and

• 50,000,000 shares are designated as preferred stock.

As of June 30, 2025, there would have been 64,638,406 shares of common stock outstanding, held of

record by 577 stockholders, assuming the Preferred Stock Conversion immediately prior to the

completion of this offering into 51,226,348 shares of common stock and the Convertible Notes

Conversion upon the completion of this offering into 7,022,512 shares of common stock, based on the

assumed initial public offering price of $17.50 per share, which is the midpoint of the price range set forth

on the cover page of this prospectus. On July 31, 2025, we consummated a 1.0-for-2.92 reverse stock

split of our common stock.

**Common stock**

***Voting rights***

Holders of our common stock are entitled to one vote per share on all matters submitted to a vote of

stockholders.

Our amended and restated certificate of incorporation will not provide for cumulative voting for the

election of directors. Subject to the rights of the holders of one or more series of preferred stock, director

candidates standing for election will be elected by a plurality of the votes cast by our stockholders present

in person or represented by proxy at the meeting and entitled to vote thereon. Our amended and restated

certificate of incorporation will retain a classified board of directors, divided into three classes with

staggered three-year terms. Only one class of directors will be elected at each annual meeting of our

stockholders, with the other classes continuing for the remainder of their respective terms.

***Dividend rights***

Subject to preferences that may be applicable to any preferred stock, the holders of our common stock

will be entitled to receive ratably, on a per share basis, any dividends declared by our board of directors

out of assets legally available.

***Liquidation rights***

Subject to preferences that may be applicable to any preferred stock, in the event of any voluntary or

involuntary liquidation, dissolution or winding up, after payment or provision for payment of our debts and

other liabilities, the holders of shares of our common stock will be entitled to receive, ratably in proportion

to the number of shares held by the holder, all our remaining assets available for distribution to our

stockholders.

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***No preemptive or similar rights***

The holders of our common stock will not be entitled to preemptive, subscription or conversion rights.

There will be no redemption or sinking fund provisions.

**Preferred stock**

Immediately prior to the completion of this offering, all outstanding shares of our redeemable convertible

preferred stock will be converted into shares of our common stock. Our amended and restated certificate

of incorporation will authorize 50,000,000 shares of preferred stock and will provide that preferred stock

may be issued from time to time in one or more series. Our board of directors will be authorized to fix the

voting rights, if any, designations, powers, preferences, the relative, participating, optional, special and

other rights and any qualifications, limitations and restrictions thereof, applicable to the shares of each

series. These rights, powers and preferences could include dividend rights, conversion rights, voting

rights, terms of redemption, liquidation preferences, sinking fund terms, and the number of shares

constituting, or the designation of, such series, any or all of which may be greater than the rights of

common stock. Our board of directors will be able to, without stockholder approval, issue shares of

preferred stock with voting and other rights that could adversely affect the voting power and other rights of

the holders of the common stock and could have anti-takeover effects. The ability of our board of directors

to issue shares of preferred stock without stockholder approval could have the effect of delaying,

deferring or preventing a change of control or the removal of existing management.

**Stock options**

As of March 31, 2025, we had outstanding 8,583,703 shares of our common stock issuable upon the

exercise of outstanding stock options, with a weighted-average exercise price of $4.98 per share, and

5,326,194 shares were unvested, with a weighted average exercise price of $4.63 per share. For

additional information regarding the terms of our equity incentive plans, see the section titled "Executive

and director compensation—2025 Performance incentive plan" and "Executive and director compensation

—Amended and restated 2009 equity incentive plan."

**Warrants**

As of March 31, 2025, we had outstanding warrants to purchase an aggregate of 1,647,667 shares of our

common stock, with an exercise price of $0.03 per share, issuable upon the exercise of such outstanding

warrants. The warrants will terminate on the ten-year anniversary of the issuance date, however, the

warrants will automatically net exercise immediately prior to termination if the fair market value of one

share of common stock exceeds the then current exercise price per share of common stock. In

connection with certain change of control transactions, which include SPAC combinations, mergers,

consolidations and the sale or lease of substantially all of the assets of the Company, the warrants will

also automatically net exercise if the fair market value of one share of common stock exceeds the then

current exercise price per share of common stock. The warrants do not automatically net exercise in

connection with an initial public offering.

**Registration rights**

Upon the completion of this offering and subject to the lock-up agreements entered into in connection with

this offering and federal securities laws, holders of shares of our common stock that will be issued upon

the conversion of our redeemable convertible preferred stock in connection with this offering and the

holder of shares of our common stock issuable or issued upon exercise of certain outstanding warrants to

purchase shares of our common stock will initially be entitled to certain registration rights under the

Securities Act. These securities are referred to as registrable securities. The holders of these registrable

securities possess registration rights pursuant to the terms of the Investors' Rights Agreement and are

described in additional detail below. The registration of shares of our common stock pursuant to the

exercise of the registration rights described below would enable the holders to trade the registered shares

without restriction under the Securities Act when the applicable registration statement is declared

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effective. We will pay the registration expenses, other than underwriting discounts, selling commissions,

stock transfer taxes, and fees and disbursements in excess of $100,000 to one counsel for the holders, of

the securities registered pursuant to the demand, Form S-3 and piggyback registrations described below.

Generally, in an underwritten offering, the managing underwriter, if any, has the right, subject to specified

conditions and limitations, to limit the number of securities the holders may include. The demand, Form

S-3 and piggyback registration rights described below will terminate upon the earliest to occur of (i) a

Liquidation Event (as defined in our amended and restated certificate of incorporation) where the

stockholders receive cash and/or publicly traded securities or the holders receive reasonably comparable

registration rights, (ii) with respect to each holder, such time after the completion of this offering after

which Rule 144 of the Securities Act ("Rule 144") or another similar exemption under the Securities Act is

available for the sale of all of such holder's shares without limitation, during a three-month period without

registration and such holder holds less than 1% of the outstanding capital stock of the company or (iii) the

date three years after the completion of this offering.

***Demand registration rights***

Upon the completion of this offering, holders of up to approximately 55.6 million shares of our common

stock, which includes all shares of our common stock issued upon conversion of our redeemable

convertible preferred stock and the holder of warrants to purchase up to an aggregate

of 1,647,667 shares of our common stock, will be entitled to certain demand registration rights. Beginning

six months after the effectiveness of the registration statement of which this prospectus is a part, holders

holding, collectively, at least a majority of the registrable securities held by the holders of common stock

issued upon conversion of our redeemable convertible preferred stock then outstanding may, on not more

than two occasions, request that we register at least 40% of the registrable securities held by the holders

of common stock issued upon conversion of our redeemable convertible preferred stock then outstanding

on a Form S-1 registration statement, subject to certain specified exceptions. If we determine that it would

be seriously detrimental to us and our stockholders to effect such a demand registration, we have the

right to defer such registration, not more than twice in any 12-month period, for a period of up to 120

days. In addition, we will not be required to effect a demand registration during the period beginning 60

days prior to our good faith estimate of the date of the filing of and ending on a date 180 days following

the effectiveness of a registration statement relating to a registration initiated by us or if registration on

Form S-3 is available.

***Form S-3 registration rights***

Upon the completion of this offering, holders of up to approximately 55.6 million shares of our common

stock, which includes all shares of our common stock issued upon conversion of our redeemable

convertible preferred stock and the holder of warrants to purchase up to an aggregate

of 1,647,667 shares of our common stock, will be entitled to certain Form S-3 registration rights. At any

time when the company is qualified to file a Form S-3 registration statement, holders holding, collectively,

at least 30% of the registrable securities then outstanding may request that we register registrable

securities having an anticipated aggregate offering price of at least $10.0 million, net of underwriting

discounts and certain other expenses. These holders may make an unlimited number of requests for

registration on Form S-3; however, we will not be required to effect a registration on Form S-3 if we have

effected two such registrations pursuant to such requests within the 12-month period preceding the date

of the request. In addition, if we determine that it would be seriously detrimental to us and our

stockholders to effect such a registration, we have the right to defer such registration, not more than twice

in any 12-month period, for a period of up to 120 days. Lastly, we will not be required to effect a

registration on Form S-3 during the period beginning 30 days prior to our good faith estimate of the date

of the filing of and ending on a date 90 days following the effectiveness of a registration statement relating

to a registration initiated by us.

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***Piggyback registration rights***

Pursuant to the Investors' Rights Agreement, if we register any of our securities either for our own account

or for the account of other security holders, other than through this offering, holders of up

to approximately 55.6 million shares of our common stock, which includes all shares of our common stock

issued upon conversion of our redeemable convertible preferred stock and the holder of warrants to

purchase up to an aggregate of 1,647,667 shares of our common stock, will be entitled to customary

"piggyback" registration rights allowing them to include their securities in such registration, subject to

specified conditions, limitations and exceptions.

**Anti-takeover effects of provisions of the proposed amended and restated** 

**certificate of incorporation and bylaws and applicable law**

Our amended and restated certificate of incorporation and bylaws will contain provisions that could have

the effect of delaying, deferring or discouraging another party from acquiring control of us. These

provisions and certain provisions of Delaware law, which are summarized below, could discourage

takeovers, coercive or otherwise, and as a consequence, they might also inhibit temporary fluctuations in

the market price of our common stock that often result from actual or rumored hostile takeover attempts.

These provisions are also designed, in part, to encourage persons seeking to acquire control of us to

negotiate first with our board of directors. It is also possible that these provisions might have the effect of

preventing changes in our management and could make it more difficult to accomplish transactions that

stockholders might otherwise deem to be in their best interests.

***Classified board of directors***

Our amended and restated certificate of incorporation will provide that our board of directors be classified

into three classes of directors, with each class serving a staggered three-year term. As a result, in most

circumstances, a person can gain control of our board of directors only by successfully engaging in a

proxy contest at two or more annual meetings of our stockholders.

***Authorized but unissued shares***

Our authorized but unissued common stock and preferred stock will be available for future issuances

without stockholder approval and could be utilized for a variety of corporate purposes, including future

offerings to raise additional capital, acquisitions and employee benefit plans. The existence of authorized

but unissued and unreserved common stock and preferred stock could render more difficult or discourage

an attempt to obtain control of us by means of a proxy contest, tender offer, merger or otherwise.

***Written consent; special meeting of stockholders***

Our amended and restated certificate of incorporation and bylaws will provide that stockholder action may

not be taken by written consent, which forces stockholder action to be taken at an annual or special

meeting of our stockholders.

Our amended and restated certificate of incorporation and bylaws will provide that, subject to the rights of

any holders of preferred stock, special meetings of our stockholders, for any purpose or purposes, may

be called only by (i) the chair of the board, (ii) the chief executive officer or (iii) the secretary at the

direction of our board of directors pursuant to a resolution adopted by a majority of our board of directors.

***Advance notice requirements for stockholder proposals and director nominations***

Our amended and restated bylaws will provide that stockholders seeking to bring business before the

annual meeting of our stockholders or to nominate candidates for election as directors at the annual

meeting of our stockholders or, in certain instances as provided in our bylaws, a special meeting of our

stockholders must provide timely notice of their intent in writing.

To give timely notice, the notice must be delivered to the secretary at our principal executive offices not

later than the close of business on the 90th day nor earlier than the 120th day prior to the first anniversary

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of the preceding year's annual meeting. However, if the date of the annual meeting is more than 30 days

before or more than 70 days after such anniversary date, the notice must be delivered not earlier than the

120th day prior to such annual meeting and not later than the close of business on the later of the 90th

day prior to such annual meeting or the tenth day following the day on which public announcement of the

date of the annual meeting is first made or sent by us.

Our amended and restated bylaws will also specify certain informational and other requirements as to the

form and content of the notice. These provisions, if not satisfied on a timely basis or at all, may preclude

our stockholders from bringing business or director nominations before the meeting of our stockholders.

***Election and removal of directors***

Our amended and restated certificate of incorporation and bylaws will contain provisions that establish

specific procedures for appointing and removing members of the board of directors.

Under the amended and restated certificate of incorporation, our directors may be removed from office,

but only for cause, which requires approval by the holders of at least sixty-six and two-thirds percent

(66-2/3%) of the voting power of all then-outstanding shares of capital stock entitled to vote generally in

the election of directors.

Vacancies and newly created directorships on our board of directors may be filled only by a majority vote

of the directors then in office, even if less than a quorum, or by a sole remaining director (and not by

stockholders). Any new director shall hold office for the remainder of the full term of the class of directors

to which the new directorship was added or in which the vacancy occurred and until his or her successor

has been elected and qualified, subject, however, to such director's earlier death, resignation, retirement,

disqualification or removal. The treatment of vacancies has the effect of making it more difficult for

stockholders to change the composition of the board of directors.

***No cumulative voting***

The DGCL provides that stockholders are not entitled to cumulate votes in the election of directors unless

a corporation's certificate of incorporation provides otherwise. Our amended and restated certificate of

incorporation will not authorize cumulative voting rights for our stockholders.

The absence of cumulative voting makes it more difficult for a minority stockholder to gain a seat on our

board of directors to influence a decision by our board of directors, including regarding any potential

merger, tender offer or other potential takeover transaction.

***Amendments to our certificate of incorporation and bylaws***

Our amended and restated certificate of incorporation and bylaws will provide that the affirmative vote of

holders of at least sixty-six and two-thirds percent (66-2/3%) of the voting power of all then-outstanding

shares of capital stock entitled to vote generally in the election of directors is required to amend certain

provisions of our certificate of incorporation, including provisions relating to the size of the board, removal

of directors, special meetings, actions by written consent and cumulative voting. The affirmative vote of

holders of at least sixty-six and two-thirds percent (66-2/3%) of the voting power of all of the then

outstanding shares of capital stock entitled to vote generally in the election of directors will be required to

amend or repeal our bylaws, although our bylaws may be amended by a simple majority vote of our board

of directors.

***Delaware anti-takeover statute***

We are subject to the provisions of Section 203 of the DGCL regulating corporate takeovers. In general,

Section 203 prohibits a publicly held Delaware corporation from engaging, under certain circumstances, in

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a business combination with an interested stockholder for a period of three years following the date the

person became an interested stockholder unless:

• prior to the date of the transaction, our board of directors approved either the business combination or

the transaction that resulted in the stockholder becoming an interested stockholder;

• upon completion of the transaction that resulted in the stockholder becoming an interested

stockholder, the interested stockholder owned at least 85% of the voting stock of the corporation

outstanding at the time the transaction commenced, excluding for purposes of determining the voting

stock outstanding, but not the outstanding voting stock owned by the interested stockholder, (A)

shares owned by persons who are directors and also officers and (B) shares owned by employee

stock plans in which employee participants do not have the right to determine confidentially whether

shares held subject to the plan will be tendered in a tender or exchange offer; or

• at or subsequent to the date of the transaction, the business combination is approved by our board of

directors and authorized at an annual or special meeting of stockholders, and not by written consent,

by the affirmative vote of at least sixty-six and two-thirds percent (66-2/3%) of the outstanding voting

stock that is not owned by the interested stockholder.

Generally, a business combination includes a merger, asset or stock sale, or other transaction resulting in

a financial benefit to the interested stockholder. Subject to certain exceptions, an "interested stockholder"

is a person who, together with affiliates and associates, owns or, within three years prior to the

determination of interested stockholder status, owned 15% or more of our outstanding voting stock. This

provision is expected to have an anti-takeover effect with respect to transactions our board of directors

does not approve in advance. Moreover, Section 203 may discourage attempts that might result in a

premium over the market price for the shares of our common stock held by stockholders.

***Choice of forum***

Our amended and restated certificate of incorporation will generally designate, unless we otherwise

consent in writing, the Court of Chancery (or, if such court does not have subject matter jurisdiction

thereof, the federal district court of the State of Delaware) as the sole and exclusive forum for (i) any

derivative action or proceeding brought on our behalf, (ii) any action asserting a claim of breach of a

fiduciary duty owed by any current or former director, officer, employee or agent to us or our stockholders,

or any claim for aiding and abetting any such alleged breach, (iii) any action asserting a claim arising

pursuant to any provision of the DGCL, our amended and restated certificate of incorporation or bylaws or

as to which the DGCL confers jurisdiction on the Court of Chancery of the State of Delaware or (iv) any

action asserting a claim governed by the internal affairs doctrine of the law of the State of Delaware.

Our amended and restated certificate of incorporation will also provide that the federal district courts of

the United States will be the exclusive forum for the resolution of any complaint asserting a cause of

action arising under the Securities Act. Further, our amended and restated certificate of incorporation will

provide that the foregoing choice of forum provisions will not apply to suits brought to enforce any liability

have exclusive jurisdiction.

Our amended and restated certificate of incorporation will also provide that any person or entity

purchasing or otherwise acquiring or holding any interest in any of our securities shall be deemed to have

notice of and consented to the foregoing provisions of the amended and restated certificate of

incorporation. Although our amended and restated certificate of incorporation will contain the choice of

forum provision described above, it is possible that a court could find that such a provision is inapplicable

for a particular claim or action or that such provision is unenforceable.

This choice of forum provision may limit a stockholder's ability to bring a claim in a judicial forum that it

finds favorable for disputes with us or any of our directors, officers, other employees or stockholders,

which may discourage lawsuits with respect to such claims, although our stockholders will not be deemed

to have waived our compliance with federal securities laws and the rules and regulations thereunder.

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Furthermore, the enforceability of similar choice of forum provisions in other companies' certificates of

incorporation has been challenged in legal proceedings, and it is possible that a court could find these

types of provisions to be inapplicable or unenforceable.

***Limitations on liability and indemnification***

For a discussion of liability and indemnification, see the section titled "Management—Limitations on

liability and indemnification matters."

**Transfer agent and registrar**

The transfer agent and registrar for our common stock will be Fidelity Stock Transfer Solutions LLC. The

transfer agent's address is 245 Summer Street, Boston, MA 02210.

**Nasdaq listing** 

We have applied to list our common stock on the Nasdaq Global Select Market under the symbol "HTFL,"

and this offering is contingent upon obtaining such approval.

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**Shares eligible for future sale**

Prior to this offering, there has been no public market for our common stock, and a liquid trading market

for our common stock may not develop or be sustained after this offering. Future sales of our common

stock, including shares issued upon the Preferred Stock Conversion, the Convertible Notes Conversion

and the exercise of outstanding options or warrants, in the public market after the completion of this

offering, or the perception that those sales may occur, could adversely affect the prevailing market price

for our common stock from time to time or impair our ability to raise equity capital in the future. Although

we have applied to have our common stock listed on the Nasdaq Global Select Market, we cannot assure

you that there will be an active public market for our common stock. As described below, only a limited

number of shares of our common stock will be available for sale in the public market for a period of

several months after the completion of this offering due to contractual and legal restrictions on resale

described below. Future sales of our common stock in the public market either before or after restrictions

lapse, or the perception that those sales may occur, could adversely affect the prevailing market price of

our common stock at such time and our ability to raise equity capital at a time and price we deem

appropriate.

**Sale of restricted shares**

Based on the number of shares of our common stock outstanding as of March 31, 2025, upon the

completion of this offering and assuming (i) the Preferred Stock Conversion, (ii) the Convertible Notes

Conversion, (iii) no exercise of the underwriters' option to purchase additional shares of our common

stock and (iv) no exercise of outstanding options or warrants, we will have outstanding an aggregate

of 81,168,388 shares of common stock.

Of these shares, all of the 16,666,667 shares of common stock to be sold in this offering will be freely

tradable in the public market without restriction or further registration under the Securities Act, unless the

shares are held by any of our "affiliates" as such term is defined in Rule 144 or subject to lock-up

agreements. All remaining shares of common stock held by existing stockholders will be "restricted

securities," as such term is defined in Rule 144. These restricted securities were issued and sold by us in

private transactions and are eligible for public sale only if registered under the Securities Act or if they

qualify for an exemption from registration under the Securities Act, including the exemptions provided by

Rule 144 or Rule 701 of the Securities Act ("Rule 701"), which rules are summarized below.

As a result of the lock-up agreements and market standoff arrangements referred to below and the

provisions of Rule 144 and Rule 701, based on the number of shares of our common stock outstanding

(calculated as of March 31, 2025 on the basis of the assumptions described above and assuming no

exercise of the underwriters' option to purchase additional shares, if any, and no exercise of outstanding

options), the shares of our common stock (excluding the shares sold in this offering) that will be available

for sale in the public market are as follows:

---

| | |
|:---|:---|
| **Approximate** <br>**number of shares**<br>| **First date available for sale into public market** |
| 65 million&nbsp;&nbsp;&nbsp;&nbsp;  | 181 days after the date of this prospectus, upon expiration of the lock-up agreements or <br>market standoff arrangements referred to below, subject in some cases to applicable <br>volume, manner of sale and other limitations under Rule 144 and Rule 701.<br>|

---

We may issue shares of common stock from time to time as consideration for future acquisitions,

investments, or other corporate purposes. In the event that any such acquisition, investment, or other

transaction is significant, the number of shares of common stock that we may issue may in turn be

significant. We may also grant registration rights covering those shares of common stock issued in

connection with any such acquisition and investment.

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In addition, the shares of common stock reserved for future issuance under the 2025 Plan will become

eligible for sale in the public market to the extent permitted by the provisions of various vesting schedules,

the lock-up agreements, a registration statement under the Securities Act, or an exemption from

registration, including Rule 144 and Rule 701.

**Rule 144**

Under Rule 144, as currently in effect, once we have been subject to the public company reporting

requirements of the Exchange Act for at least 90 days, and we are current in our Exchange Act reporting

at the time of sale, a person (or persons whose shares are required to be aggregated) who is not deemed

to have been one of our "affiliates" for purposes of Rule 144 at any time during the 90 days preceding a

sale and who has beneficially owned restricted securities within the meaning of Rule 144 for at least six

months, including the holding period of any prior owner other than one of our "affiliates," is entitled to sell

those shares in the public market (subject to the lock-up agreement or market standoff arrangements

referred to below, if applicable) without complying with the manner of sale, volume limitations, or notice

provisions of Rule 144, but subject to compliance with the public information requirements of Rule 144. If

such a person has beneficially owned the shares proposed to be sold for at least one year, including the

holding period of any prior owner other than "affiliates," then such person is entitled to sell such shares in

the public market without complying with any of the requirements of Rule 144 (subject to the lock-up

agreement referred to below, if applicable).

In general, under Rule 144, as currently in effect, once we have been subject to the public company

reporting requirements of the Exchange Act for at least 90 days, our "affiliates," as defined in Rule 144,

who have beneficially owned the shares proposed to be sold for at least six months, are entitled to sell in

the public market, upon expiration of any applicable lock-up agreements and within any three-month

period, a number of those shares of our common stock that does not exceed the greater of:

• 1% of the number of shares of common stock then outstanding, which will equal approximately

811,684 shares of common stock immediately upon the completion of this offering (calculated as of

March 31, 2025 on the basis of the assumptions described above and assuming no exercise of the

underwriters' option to purchase additional shares and no exercise of outstanding options or warrants

subsequent to March 31, 2025); or

• the average weekly trading volume of our common stock on the Nasdaq Global Select Market during

the four calendar weeks preceding the filing of a notice on Form 144 with respect to such sale.

Such sales under Rule 144 by our "affiliates" or persons selling shares on behalf of our "affiliates" are also

subject to certain manner of sale provisions, notice requirements, and requirements related to the

availability of current public information about us. Notwithstanding the availability of Rule 144, the holders

of substantially all of our restricted securities have entered into lock-up agreements as referenced above,

and their restricted securities will become eligible for sale (subject to the above limitations under Rule

144) upon the expiration of the restrictions set forth in those agreements.

**Rule 701**

In general, under Rule 701 as currently in effect, any of our employees, directors, officers, consultants, or

advisors who acquired common stock from us in connection with a written compensatory stock or option

plan or other written agreement in compliance with Rule 701 before the effective date of the registration

statement of which this prospectus is a part (to the extent such common stock is not subject to a lock-up

agreement) and who are not our "affiliates" as defined in Rule 144 during the immediately preceding 90

days, is entitled to rely on Rule 701 to resell such shares beginning 90 days after the date of this

prospectus in reliance on Rule 144, but without complying with the notice, manner of sale, public

information requirements, or volume limitation provisions of Rule 144. Persons who are our "affiliates"

may resell those shares beginning 90 days after the date of this prospectus without compliance with

minimum holding period requirements under Rule 144 (subject to the terms of the lock-up agreement

referred to below, if applicable).

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**Lock-up agreements and market standoff arrangements**

In connection with this offering, we, our directors, our executive officers, and the holders of substantially

all of our common stock, stock options, and other securities convertible into or exercisable or

exchangeable for our common stock, have entered into lock-up agreements with the underwriters or are

subject to market standoff arrangements, and have agreed, with respect to the lock-up agreements, that

without the prior written consent of J.P. Morgan Securities LLC, Morgan Stanley & Co. LLC and Piper

Sandler & Co. on behalf of the underwriters, subject to certain exceptions more fully described under the

section titled "Underwriting", we and they will not, among other things, sell or otherwise transfer or

dispose of any of our securities during the period from the date of this prospectus continuing through the

date 180 days after the date of this prospectus. See the section titled "Underwriting" for additional

information.

In addition to the restrictions contained in the lock-up agreements described above, we have entered into

agreements with certain securityholders, including the Investors' Rights Agreement, our standard form of

option agreement and warrants that contain market standoff provisions or incorporate market standoff

provisions from our equity incentive plan imposing restrictions on the ability of such securityholders to

offer, sell, or transfer our equity securities for a period of 180 days following the date of this prospectus.

Following the lock-up periods set forth in the agreements described above, and assuming that J.P.

Morgan Securities LLC, Morgan Stanley & Co. LLC and Piper Sandler & Co. do not release any parties

from these agreements, all of the shares of our common stock that are restricted securities or are held by

our affiliates as of the date of this prospectus will be eligible for sale in the public market in compliance

with Rule 144 under the Securities Act.

**Registration rights**

Upon the completion of this offering, the holders of approximately 55.6 million shares of our common

stock will be entitled to rights with respect to the registration of their shares under the Securities Act,

subject to the lock-up agreements and market standoff arrangements described under "—Lock-up

agreements and market standoff arrangements" above. Registration of these shares under the Securities

Act would result in the shares becoming freely tradable without restriction under the Securities Act, except

for shares purchased by affiliates, immediately upon the effectiveness of the relevant filed registration

statement, subject to the terms of the lock-up agreements and market standoff arrangements described

above. Any sales of securities by these stockholders could have a material adverse effect on the trading

price of our common stock.

**Equity incentive plans**

We intend to file with the SEC a registration statement on Form S-8 under the Securities Act to register

our shares issued or reserved for issuance under our equity incentive plans. Such registration statement

is expected to be filed and become effective as soon as practicable after the completion of this offering.

Accordingly, shares registered under such registration statement will be available for sale in the open

market following its effective date, subject to Rule 144 volume limitations, vesting restrictions, and the

lock-up agreements described above, if applicable.

**Rule 10b5-1 trading plans**

Following the completion of this offering, certain of our officers, directors, and significant stockholders may

adopt written plans, known as Rule 10b5-1 trading plans, in which they will contract with a broker to buy

or sell shares of our common stock on a periodic basis to diversify their assets and investments. Under

these Rule 10b5-1 trading plans, a broker may execute trades pursuant to parameters established by the

officer, director, or stockholder when entering into the plan, without further direction from such officer,

director, or stockholder. Such sales would not commence until the expiration of the applicable lock-up

agreements entered into by such officer, director, or stockholder in connection with this offering.

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**Material U.S. federal income tax consequences to non-U.S.** 

**holders**

The following discussion is a summary of the material U.S. federal income tax consequences to Non-U.S.

Holders (as defined below) of the purchase, ownership, and disposition of our common stock issued

pursuant to this offering, but does not purport to be a complete analysis of all potential tax effects. The

effects of other U.S. federal tax laws, such as estate and gift tax laws, and any applicable state, local, or

non-U.S. tax laws are not discussed. This discussion is based on the U.S. Internal Revenue Code of

1986, as amended (the "Code"), Treasury Regulations promulgated thereunder, judicial decisions, and

published rulings and administrative pronouncements of the U.S. Internal Revenue Service (the "IRS"), in

each case in effect as of the date hereof. These authorities may change or be subject to differing

interpretations. Any such change or differing interpretation may be applied retroactively in a manner that

could adversely affect a Non-U.S. Holder. We have not sought and will not seek any rulings from the IRS

regarding the matters discussed below. There can be no assurance the IRS or a court will not take a

contrary position to that discussed below regarding the tax consequences of the purchase, ownership,

and disposition of our common stock.

This discussion is limited to Non-U.S. Holders that hold our common stock as a "capital asset" within the

meaning of Section 1221 of the Code (generally, property held for investment). This discussion does not

address all U.S. federal income tax consequences relevant to a Non-U.S. Holder's particular

circumstances, including the impact of the Medicare contribution tax on net investment income and the

alternative minimum tax. In addition, it does not address consequences relevant to Non-U.S. Holders

subject to special rules, including, without limitation:

• U.S. expatriates and former citizens or long-term residents of the United States;

• persons holding our common stock as part of a hedge, straddle, or other risk reduction strategy or as

part of a conversion transaction or other integrated investment;

• banks, insurance companies, and other financial institutions;

• brokers, dealers, or traders in securities;

• "controlled foreign corporations," "passive foreign investment companies," and corporations that

accumulate earnings to avoid U.S. federal income tax;

• partnerships or other entities or arrangements treated as partnerships for U.S. federal income tax

purposes (and investors therein);

• tax-exempt organizations or governmental organizations;

• persons deemed to sell our common stock under the constructive sale provisions of the Code;

• persons who hold or receive our common stock pursuant to the exercise of any employee stock

option or otherwise as compensation;

• tax-qualified retirement plans; and

• "qualified foreign pension funds" as defined in Section 897(l)(2) of the Code and entities all of the

interests of which are held by qualified foreign pension funds.

If an entity treated as a partnership for U.S. federal income tax purposes holds our common stock, the tax

treatment of a partner in the partnership will depend on the status of the partner, the activities of the

partnership, and certain determinations made at the partner level. Accordingly, partnerships holding our

common stock and the partners in such partnerships should consult their tax advisors regarding the U.S.

federal income tax consequences to them.

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**THIS DISCUSSION IS FOR INFORMATIONAL PURPOSES ONLY AND IS NOT TAX ADVICE.** 

**INVESTORS SHOULD CONSULT THEIR TAX ADVISORS WITH RESPECT TO THE APPLICATION** 

**OF THE U.S. FEDERAL INCOME TAX LAWS TO THEIR PARTICULAR SITUATIONS AS WELL AS** 

**ANY TAX CONSEQUENCES OF THE PURCHASE, OWNERSHIP, AND DISPOSITION OF OUR** 

**COMMON STOCK ARISING UNDER THE U.S. FEDERAL ESTATE OR GIFT TAX LAWS OR UNDER** 

**THE LAWS OF ANY STATE, LOCAL, OR NON-U.S. TAXING JURISDICTION OR UNDER ANY** 

**APPLICABLE INCOME TAX TREATY.**

**Definition of a Non-U.S. Holder**

For purposes of this discussion, a "Non-U.S. Holder" is any beneficial owner of our common stock that is

neither a "U.S. person" nor an entity treated as a partnership for U.S. federal income tax purposes. A U.S.

person is any person that, for U.S. federal income tax purposes, is or is treated as any of the following:

• an individual who is a citizen or resident of the United States;

• a corporation created or organized under the laws of the United States, any state thereof or the

District of Columbia;

• an estate, the income of which is subject to U.S. federal income tax regardless of its source; or

• a trust that (i) is subject to the primary supervision of a U.S. court and all substantial decisions of

which are subject to the control of one or more "United States persons" (within the meaning of Section

7701(a)(30) of the Code), or (ii) has a valid election in effect to be treated as a United States person

for U.S. federal income tax purposes.

**Distributions**

As described in the section titled "Dividend policy," we do not anticipate paying any cash dividends in the

foreseeable future. However, if we do make distributions of cash or property on our common stock, such

distributions will constitute dividends for U.S. federal income tax purposes to the extent paid from our

current or accumulated earnings and profits, as determined under U.S. federal income tax principles.

Amounts not treated as dividends for U.S. federal income tax purposes will constitute a return of capital

and first be applied against and reduce a Non-U.S. Holder's adjusted tax basis in its common stock, but

not below zero. Any excess will be treated as capital gain and will be treated as described under the

subsection titled "—Sale or other taxable disposition" below.

Subject to the discussion below regarding effectively connected income, dividends paid to a Non-U.S.

Holder will be subject to U.S. federal withholding tax at a rate of 30% of the gross amount of the dividends

(or such lower rate specified by an applicable income tax treaty, provided the Non-U.S. Holder furnishes a

valid IRS Form W-8BEN or W-8BEN-E (or other applicable documentation) certifying qualification for the

lower treaty rate). A Non-U.S. Holder that does not timely furnish the required documentation, but that

qualifies for a reduced treaty rate, may obtain a refund of any excess amounts withheld by timely filing an

appropriate claim for refund with the IRS. Non-U.S. Holders should consult their tax advisors regarding

their entitlement to benefits under any applicable tax treaties.

If dividends paid to a Non-U.S. Holder are effectively connected with the Non-U.S. Holder's conduct of a

trade or business within the United States (and, if required by an applicable income tax treaty, the Non-

U.S. Holder maintains a permanent establishment in the United States to which such dividends are

attributable), the Non-U.S. Holder will be exempt from the U.S. federal withholding tax described above.

To claim the exemption, the Non-U.S. Holder must furnish to the applicable withholding agent a valid IRS

Form W-8ECI, certifying that the dividends are effectively connected with the Non-U.S. Holder's conduct

of a trade or business within the United States.

Any such effectively connected dividends will be subject to U.S. federal income tax on a net income basis

at the regular rates applicable to U.S. persons. A Non-U.S. Holder that is a corporation also may be

subject to a branch profits tax at a rate of 30% (or such lower rate specified by an applicable income tax

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treaty) on such effectively connected dividends, as adjusted for certain items. Non-U.S. Holders should

consult their tax advisors regarding any applicable tax treaties that may provide for different rules.

**Sale or other taxable disposition**

A Non-U.S. Holder will not be subject to U.S. federal income tax on any gain realized upon the sale or

other taxable disposition of our common stock unless:

• the gain is effectively connected with the Non-U.S. Holder's conduct of a trade or business within the

United States (and, if required by an applicable income tax treaty, the Non-U.S. Holder maintains a

permanent establishment in the United States to which such gain is attributable);

• the Non-U.S. Holder is a nonresident alien individual present in the United States for 183 days or

more during the taxable year of the disposition and certain other requirements are met; or

• our common stock constitutes a U.S. real property interest ("USRPI") by reason of our status as a

U.S. real property holding corporation ("USRPHC") for U.S. federal income tax purposes.

Gain described in the first bullet point above generally will be subject to U.S. federal income tax on a net

income basis at the regular rates applicable to U.S. persons. A Non-U.S. Holder that is a corporation also

may be subject to a branch profits tax at a rate of 30% (or such lower rate specified by an applicable

income tax treaty) on such effectively connected gain, as adjusted for certain items.

A Non-U.S. Holder described in the second bullet point above will be subject to U.S. federal income tax at

a rate of 30% (or such lower rate specified by an applicable income tax treaty) on gain realized upon the

sale or other taxable disposition of our common stock, which may be offset by certain U.S. source capital

losses of the Non-U.S. Holder (even though the individual is not considered a resident of the United

States), provided the Non-U.S. Holder has timely filed U.S. federal income tax returns with respect to

such losses.

With respect to the third bullet point above, we believe we currently are not, and do not anticipate

becoming, a USRPHC. Because the determination of whether we are a USRPHC depends, however, on

the fair market value of our USRPIs relative to the fair market value of our non-U.S. real property interests

and our other business assets, there can be no assurance we currently are not a USRPHC or will not

become one in the future. Even if we are or were to become a USRPHC, gain arising from the sale or

other taxable disposition of our common stock by a Non-U.S. Holder will not be subject to U.S. federal

income tax if our common stock is "regularly traded," as defined by applicable Treasury Regulations, on

an established securities market, and such Non-U.S. Holder owned, actually and constructively, 5% or

less of our common stock throughout the shorter of the five-year period ending on the date of the sale or

other taxable disposition or the Non-U.S. Holder's holding period.

Non-U.S. Holders should consult their tax advisors regarding any applicable tax treaties that may provide

for different rules.

**Information reporting and backup withholding**

Payments of dividends on our common stock will not be subject to backup withholding, provided the Non-

U.S. Holder certifies its non-U.S. status, such as by furnishing a valid IRS Form W-8BEN, W-8BEN-E, or

W-8ECI, or otherwise establishes an exemption. However, information returns are required to be filed with

the IRS in connection with any distributions on our common stock paid to the Non-U.S. Holder, regardless

of whether such distributions constitute dividends or whether any tax was actually withheld. In addition,

proceeds of the sale or other taxable disposition of our common stock within the United States or

conducted through certain U.S.-related brokers generally will not be subject to backup withholding or

information reporting if the applicable withholding agent receives the certification described above or the

Non-U.S. Holder otherwise establishes an exemption. Proceeds of a disposition of our common stock

conducted through a non-U.S. office of a non-U.S. broker that does not have certain enumerated

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relationships with the United States generally will not be subject to backup withholding or information

reporting.

Copies of information returns that are filed with the IRS may also be made available under the provisions

of an applicable treaty or agreement to the tax authorities of the country in which the Non-U.S. Holder

resides or is established.

Backup withholding is not an additional tax. Any amounts withheld under the backup withholding rules

may be allowed as a refund or a credit against a Non-U.S. Holder's U.S. federal income tax liability,

provided the required information is timely furnished to the IRS.

**Additional withholding tax on payments made to foreign accounts**

Withholding taxes may be imposed under Sections 1471 to 1474 of the Code (such Sections commonly

referred to as the Foreign Account Tax Compliance Act ("FATCA")) on certain types of payments made to

non-U.S. financial institutions and certain other non-U.S. entities. Specifically, a 30% withholding tax may

be imposed on dividends on, or (subject to the proposed Treasury Regulations discussed below) gross

proceeds from the sale or other disposition of, our common stock paid to a "foreign financial institution" or

a "non-financial foreign entity" (each as defined in the Code), unless (i) the foreign financial institution

undertakes certain diligence and reporting obligations, (ii) the non-financial foreign entity either certifies it

does not have any "substantial United States owners" (as defined in the Code) or furnishes identifying

information regarding each substantial United States owner, or (iii) the foreign financial institution or non-

financial foreign entity otherwise qualifies for an exemption from these rules. If the payee is a foreign

financial institution and is subject to the diligence and reporting requirements in (i) above, it must enter

into an agreement with the U.S. Department of the Treasury requiring, among other things, that it

undertake to identify accounts held by certain "specified United States persons" or "United States owned

foreign entities" (each as defined in the Code), annually report certain information about such accounts,

and withhold 30% on certain payments to non-compliant foreign financial institutions and certain other

account holders. Foreign financial institutions located in jurisdictions that have an intergovernmental

agreement with the United States governing FATCA may be subject to different rules.

Under applicable Treasury Regulations and administrative guidance, withholding under FATCA generally

applies to payments of dividends on our common stock. While withholding under FATCA would have

applied also to payments of gross proceeds from the sale or other disposition of our common stock

beginning on January 1, 2019, proposed Treasury Regulations eliminate FATCA withholding on payments

of gross proceeds entirely. Taxpayers generally may rely on these proposed Treasury Regulations until

final Treasury Regulations are issued.

Prospective investors should consult their tax advisors regarding the potential application of withholding

under FATCA to their investment in our common stock.

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**Underwriting**

We are offering the shares of common stock described in this prospectus through a number of

underwriters. J.P. Morgan Securities LLC, Morgan Stanley & Co. LLC and Piper Sandler & Co. are acting

as joint book-running managers of the offering and as representatives of the underwriters. We have

entered into an underwriting agreement with the underwriters. Subject to the terms and conditions of the

underwriting agreement, we have agreed to sell to the underwriters, and each underwriter has severally

agreed to purchase, at the public offering price less the underwriting discounts and commissions set forth

on the cover page of this prospectus, the number of shares of common stock listed next to its name in the

following table:

---

| | |
|:---|:---|
| **Name** | **Number of** <br>**shares**<br>|
| J.P. Morgan Securities LLC.................................................................................................................. |  |
| Morgan Stanley & Co. LLC................................................................................................................... |  |
| Piper Sandler & Co................................................................................................................................ |  |
| Stifel, Nicolaus & Company, Incorporated......................................................................................... |  |
| Canaccord Genuity LLC....................................................................................................................... |  |
| Total.......................................................................................................................................................... | 16666667 |

---

The underwriters are committed to purchase all the shares of common stock offered by us if they

purchase any shares. The underwriting agreement also provides that if an underwriter defaults, the

purchase commitments of non-defaulting underwriters may also be increased or the offering may be

terminated.

The underwriters propose to offer the shares of common stock directly to the public at the initial public

offering price set forth on the cover page of this prospectus and to certain dealers at that price less a

concession not in excess of $&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; per share. After the initial offering of the shares to the public, if all of

the shares of common stock are not sold at the initial public offering price, the underwriters may change

the offering price and the other selling terms. Sales of any shares made outside of the United States may

be made by affiliates of the underwriters.

The underwriters have an option to buy up to 2,500,000 additional shares of common stock from us to

cover sales of shares by the underwriters which exceed the number of shares specified in the table

above. The underwriters have 30 days from the date of this prospectus to exercise this option to purchase

additional shares. If any shares are purchased with this option to purchase additional shares, the

underwriters will purchase shares in approximately the same proportion as shown in the table above. If

any additional shares of common stock are purchased, the underwriters will offer the additional shares on

the same terms as those on which the shares are being offered.

The underwriting fee is equal to the public offering price per share of common stock less the amount paid

by the underwriters to us per share of common stock. The underwriting fee is $&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; per share. The

following table shows the per share and total underwriting discounts and commissions to be paid to the

underwriters assuming both no exercise and full exercise of the underwriters' option to purchase

additional shares.

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| | | |
|:---|:---|:---|
| | **Without** <br>**option to** <br>**purchase** <br>**additional** <br>**shares** <br>**exercise**<br>| **With full** <br>**option to** <br>**purchase** <br>**additional** <br>**shares** <br>**exercise**<br>|
| Per Share................................................................................................................ | $| $|
| Total.......................................................................................................................... | $| $|

---

We estimate that the total expenses of this offering, including registration, filing and listing fees, printing

fees and legal and accounting expenses, but excluding the underwriting discounts and commissions, will

be approximately $5.5 million. We have agreed to reimburse the underwriters for expenses relating to the

clearance of this offering with the Financial Industry Regulatory Authority, Inc. in an amount up to $40,000.

A prospectus in electronic format may be made available on the web sites maintained by one or more

underwriters, or selling group members, if any, participating in the offering. The underwriters may agree to

allocate a number of shares to underwriters and selling group members for sale to their online brokerage

account holders. Internet distributions will be allocated by the representatives to underwriters and selling

group members that may make Internet distributions on the same basis as other allocations.

We have agreed that we will not, subject to certain exceptions, (i) offer, pledge, sell, contract to sell, sell

any option or contract to purchase, purchase any option or contract to sell, grant any option, right or

warrant to purchase, hedge, lend, or otherwise transfer or dispose of, directly or indirectly, or submit to, or

file with, the SEC a registration statement under the Securities Act relating to, any shares of our common

stock or any securities convertible into or exercisable or exchangeable for any shares of our common

stock, or (ii) enter into any swap, hedging, or other agreement that transfers, in whole or in part, any of the

economic consequences of ownership of any shares of common stock or any such other securities, or

publicly disclose the intention to undertake any of the foregoing (regardless of whether any of these

transactions are to be settled by the delivery of shares of common stock or such other securities, in cash

or otherwise), in each case without the prior written consent of J.P. Morgan Securities LLC, Morgan

Stanley & Co. LLC and Piper Sandler & Co. for a period of 180 days after the date of this prospectus,

other than the shares of our common stock to be sold in this offering.

The restrictions on our actions, as described above, do not apply to certain transactions, including (i) the

issuance of shares of common stock or securities convertible into or exercisable for shares of our

common stock pursuant to the conversion or exchange of convertible or exchangeable securities or the

exercise of warrants or options (including net exercise) or the settlement of RSUs (including net

settlement), in each case outstanding on the date of the underwriting agreement and described in this

prospectus; (ii) grants of stock options, stock awards, restricted stock, RSUs, or other equity awards and

the issuance of shares of our common stock or securities convertible into or exercisable or exchangeable

for shares of our common stock (whether upon the exercise of stock options or otherwise) to our

employees, officers, directors, advisors, or consultants pursuant to the terms of an equity compensation

plan in effect as of the closing date of this offering and described in this prospectus, provided that such

recipients enter into a lock-up agreement with the underwriters; (iii) the issuance of up to 5% of the

outstanding shares of our common stock, or securities convertible into, exercisable for, or which are

otherwise exchangeable for, our common stock, immediately following the closing date of this offering, in

acquisitions or other similar strategic transactions, provided that such recipients enter into a lock-up

agreement with the underwriters; or (iv) the filing of any registration statement on Form S-8 relating to

securities granted or to be granted pursuant to any plan in effect on the date of the underwriting

agreement and described in this prospectus or any assumed benefit plan pursuant to an acquisition or

similar strategic transaction.

Our directors and executive officers, and holders of substantially all of our common stock, stock options,

and other securities convertible into or exercisable or exchangeable for our common stock (such persons,

the "lock-up parties") are subject to market standoff arrangements or have entered into lock-up

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agreements with the underwriters prior to the commencement of this offering pursuant to which each lock-

up party, with limited exceptions, for a period of 180 days after the date of this prospectus (such period,

the "restricted period"), may not and may not cause any of their direct or indirect affiliates to, without the

prior written consent of J.P. Morgan Securities LLC, Morgan Stanley & Co. LLC and Piper Sandler & Co.,

(i) offer, pledge, sell, contract to sell, sell any option or contract to purchase, purchase any option or

contract to sell, grant any option, right or warrant to purchase, lend, or otherwise transfer or dispose of,

directly or indirectly, any shares of our common stock or any securities convertible into or exercisable or

exchangeable for our common stock (including without limitation, our common stock or such other

securities which may be deemed to be beneficially owned by the lock-up party in accordance with the

rules and regulations of the SEC and securities which may be issued upon exercise of a stock option or

warrant) (collectively with our common stock, the "lock-up securities"), (ii) enter into any hedging, swap or

other agreement or transaction that transfers, in whole or in part, any of the economic consequences of

ownership of the lock-up securities, whether any such transaction described in clause (i) or (ii) above is to

be settled by delivery of the lock-up securities, in cash or otherwise, (iii) make any demand for or exercise

any right with respect to the registration of any lock-up securities, or (iv) publicly disclose the intention to

do any of the foregoing.

Such persons or entities have further acknowledged that these undertakings preclude them from

engaging in any hedging or other transactions or arrangements (including, without limitation, any short

sale or the purchase or sale of, or entry into, any put or call option, or combination thereof, forward, swap

or any other derivative transaction or instrument, however described or defined) designed or intended, or

which could reasonably be expected to lead to or result in, a sale or disposition or transfer (whether by

the lock-up party or any other person) of any economic consequences of ownership, in whole or in part,

directly or indirectly, of any lock-up securities, whether any such transaction or arrangement (or

instrument provided for thereunder) would be settled by delivery of lock-up securities, in cash or

otherwise.

The restrictions described in the immediately preceding paragraph and contained in the lock-up

agreements between the underwriters and the lock-up parties do not apply, subject in certain cases to

various conditions, to certain transactions, including:

(a) transfers of lock-up securities: (i) as a bona fide gift or gifts or charitable contribution, or for bona fide

estate planning purposes, (ii) by will or intestacy or any other testamentary document, (iii) to any member

of the lock-up party's immediate family or to any trust for the direct or indirect benefit of the lock-up party

or the immediate family of the lock-up party, or if the lock-up party is a trust, to a trustor, trustee or

beneficiary of the trust or to the estate of a trustor, trustee or beneficiary of such trust (for purposes of the

lock-up agreement, "immediate family" means any relationship by blood, current or former marriage,

domestic partnership or adoption, not more remote than first cousin), (iv) to a corporation, partnership,

limited liability company, investment fund or other entity (A) of which the lock-up party and/or the

immediate family of the lock-up party are the legal and beneficial owner of all of the outstanding equity

securities or similar interests, or (B) controlled by, or under common control with, the lock-up party or the

immediate family of the lock-up party, (v) to a nominee or custodian of a person or entity to whom a

disposition or transfer would be permissible under clauses (i) through (iv) above, (vi) in the case of a

corporation, partnership, limited liability company, trust or other business entity, (A) to another corporation,

partnership, limited liability company, trust or other business entity that is an affiliate of the lock-up party,

or to any investment fund or other entity controlling, controlled by, managing or managed by or under

common control or common investment management with the lock-up party or its affiliates or (B) as part

of a disposition, transfer or distribution to limited partners, members or shareholders of the lock-up party;

(vii) by operation of law, such as pursuant to a qualified domestic order, divorce settlement, divorce

decree or separation agreement, (viii) to us upon death or disability of the lock-up party, or, if the lock-up

party is an employee of ours upon death, disability or termination of employment, in each case, of such

employee, (ix) as part of a sale or transfer of lock-up securities acquired (A) from the underwriters in this

offering or (B) in open market transactions after the completion of this offering, (x) to us in connection with

the vesting, settlement, or exercise of restricted stock units, options, warrants or other rights to purchase

shares of our common stock (including, in each case, by way of "net" or "cashless" exercise), including for

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the payment of exercise price and tax and remittance payments due as a result of the vesting, settlement,

or exercise of such restricted stock units, options, warrants or rights, provided that any such shares of our

common stock received upon such exercise, vesting or settlement shall be subject to the terms of the

lock-up agreement, and provided further that any such restricted stock units, options, warrants or rights

are held by the lock-up party pursuant to an agreement or equity awards granted under a stock incentive

plan or other equity award plan, each such agreement or plan which is described herein, or (xi) pursuant

to a bona fide third-party tender offer, merger, consolidation or other similar transaction that is approved

by the Board of Directors and made to all holders of our capital stock involving a Change of Control (for

purposes hereof, "Change of Control" means the transfer (whether by tender offer, merger, consolidation

or other similar transaction), in one transaction or a series of related transactions, to a person or group of

affiliated persons, of shares of capital stock if, after such transfer, such person or group of affiliated

persons would hold more than 50% of our outstanding voting securities (or the surviving entity)); provided

that in the event that such tender offer, merger, consolidation or other similar transaction is not completed,

the lock-up party's lock-up securities shall remain subject to the restrictions in the immediately preceding

paragraph; provided that (X) in the case of any transfer or distribution under (i), (ii), (iii), (iv), (v), (vi) and

(vii) above, such transfer shall not involve a disposition for value and each donee, distributee or

transferee shall sign and deliver a lock-up agreement, (Y) in the case of any transfer or distribution under

(ii), (iii), (iv), (v), (vi) and (ix) above no public disclosure or filing shall be made voluntarily during the

restricted period, and (Z) in the case of any transfer or distribution under (i), (vii), (viii) and (x) no public

disclosure or filing shall be made voluntarily during the restricted period, and to the extent a filing under

16(a) of the Exchange Act, or other public filing, report or announcement reporting a reduction in

beneficial ownership of shares of common stock be legally required during the restricted period, such

filing, report or announcement shall clearly indicate the circumstances described in (i), (vii), (viii) or (x)

above, including that the securities remain subject to the terms of the lock-up agreement;

(b) exercise of the options, settlement of RSUs or other equity awards, or the exercise of warrants

granted pursuant to plans described in this prospectus, provided that any lock-up securities received upon

such exercise, vesting or settlement be subject to restrictions similar to those in the immediately

preceding paragraph;

(c) the conversion of outstanding preferred stock, warrants to acquire preferred stock, or convertible

securities into shares of our common stock or warrants to acquire shares of our common stock, provided

that any common stock or warrant received upon such conversion would be subject to restrictions similar

to those in the immediately preceding paragraph; and (d) the establishment by lock-up parties of trading

plans under Rule 10b5-1 under the Exchange Act, provided that (1) such plans do not provide for the

transfer of lock-up securities during the restricted period and (2) any required public announcement or

filing under the Exchange Act made by any person regarding the establishment of such plan during the

restricted period shall include a statement that the lock-up party is not permitted to transfer, sell or

otherwise dispose of lock-up securities under such plan during the restricted period in contravention of the

lock-up agreement and no public filing, report or announcement by any party shall be made voluntarily in

connection with such trading plan.

J.P. Morgan Securities LLC, Morgan Stanley & Co. LLC and Piper Sandler & Co., in their sole discretion,

may release the securities subject to any of the lock-up agreements with the underwriters described

above, in whole or in part at any time.

We have agreed to indemnify the underwriters against certain liabilities, including liabilities under the

Securities Act.

We have applied to have our common stock approved for listing on the Nasdaq Global Select Market

under the symbol "HTFL" and this offering is contingent upon obtaining approval of such listing.

In connection with this offering, the underwriters may engage in stabilizing transactions, which involves

making bids for, purchasing and selling shares of common stock in the open market for the purpose of

preventing or retarding a decline in the market price of the common stock while this offering is in

progress. These stabilizing transactions may include making short sales of common stock, which involves

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the sale by the underwriters of a greater number of shares of common stock than they are required to

purchase in this offering, and purchasing shares of common stock on the open market to cover positions

greater than the underwriters' option to purchase additional shares referred to above, or may be "naked"

shorts, which are short positions in excess of that amount.

The underwriters may close out any covered short position either by exercising their option to purchase

additional shares, in whole or in part, or by purchasing shares in the open market. In making this

determination, the underwriters will consider, among other things, the price of shares available for

purchase in the open market compared to the price at which the underwriters may purchase shares

through the option to purchase additional shares. A naked short position is more likely to be created if the

underwriters are concerned that there may be downward pressure on the price of the common stock in

the open market that could adversely affect investors who purchase in this offering. To the extent that the

underwriters create a naked short position, they will purchase shares in the open market to cover the

position.

The underwriters have advised us that, pursuant to Regulation M of the Securities Act, they may also

engage in other activities that stabilize, maintain or otherwise affect the price of the common stock,

including the imposition of penalty bids. This means that if the representatives of the underwriters

purchase common stock in the open market in stabilizing transactions or to cover short sales, the

representatives can require the underwriters that sold those shares as part of this offering to repay the

underwriting discount received by them.

These activities may have the effect of raising or maintaining the market price of the common stock or

preventing or retarding a decline in the market price of the common stock, and, as a result, the price of

the common stock may be higher than the price that otherwise might exist in the open market. If the

underwriters commence these activities, they may discontinue them at any time. The underwriters may

carry out these transactions on the Nasdaq Global Select Market, in the over-the-counter market or

otherwise.

Prior to this offering, there has been no public market for our common stock. The initial public offering

price will be determined by negotiations between us and the representatives of the underwriters. In

determining the initial public offering price, we and the representatives of the underwriters expect to

consider a number of factors including:

• the information set forth in this prospectus and otherwise available to the representatives;

• our prospects and the history and prospects for the industry in which we compete;

• an assessment of our management;

• our prospects for future earnings;

• the general condition of the securities markets at the time of this offering;

• the recent market prices of, and demand for, publicly traded common stock of generally comparable

companies; and

• other factors deemed relevant by the underwriters and us.

Neither we nor the underwriters can assure investors that an active trading market will develop for shares

of our common stock, or that the shares will trade in the public market at or above the initial public offering

price.

**Other relationships**

Certain of the underwriters and their affiliates have provided in the past to us and our affiliates and may

provide from time to time in the future certain commercial banking, financial advisory, investment banking

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and other services for us and such affiliates in the ordinary course of their business, for which they have

received and may continue to receive customary fees and commissions. In addition, from time to time,

certain of the underwriters and their affiliates may effect transactions for their own account or the account

of customers, and hold on behalf of themselves or their customers, long or short positions in our debt or

equity securities or loans, and may do so in the future.

**Selling restrictions**

Other than in the United States, no action has been taken by us or the underwriters that would permit a

public offering of the securities offered by this prospectus in any jurisdiction where action for that purpose

is required. The securities offered by this prospectus may not be offered or sold, directly or indirectly, nor

may this prospectus or any other offering material or advertisements in connection with the offer and sale

of any such securities be distributed or published in any jurisdiction, except under circumstances that will

result in compliance with the applicable rules and regulations of that jurisdiction. Persons into whose

possession this prospectus comes are advised to inform themselves about and to observe any

restrictions relating to the offering and the distribution of this prospectus. This prospectus does not

constitute an offer to sell or a solicitation of an offer to buy any securities offered by this prospectus in any

jurisdiction in which such an offer or a solicitation is unlawful.

**Notice to prospective investors in the European Economic Area**

In relation to each Member State of the European Economic Area (each a "Relevant State"), no shares

have been offered or will be offered pursuant to the offering to the public in that Relevant State prior to the

publication of a prospectus in relation to the shares which has been approved by the competent authority

in that Relevant State or, where appropriate, approved in another Relevant State and notified to the

competent authority in that Relevant State, all in accordance with the Prospectus Regulation, except that

offers of shares may be made to the public in that Relevant State at any time under the following

exemptions under the Prospectus Regulation:

(i)to any legal entity which is a qualified investor as defined under Article 2 of the Prospectus

Regulation;

(ii)to fewer than 150 natural or legal persons (other than qualified investors as defined under Article 2 of

the Prospectus Regulation), subject to obtaining the prior consent of the underwriters; or

(iii)in any other circumstances falling within Article 1(4) of the Prospectus Regulation,

provided that no such offer of shares shall require us or any underwriter to publish a prospectus pursuant

to Article 3 of the Prospectus Regulation or supplement a prospectus pursuant to Article 23 of the

Prospectus Regulation. and each person who initially acquires any shares or to whom any offer is made

will be deemed to have represented, acknowledged and agreed to and with each of the underwriters and

to us that it is a "qualified investor" within the meaning of Article 2(e) of the Prospectus Regulation. In the

case of any shares being offered to a financial intermediary as that term is used in the Prospectus

Regulation, each such financial intermediary will be deemed to have represented, acknowledged and

agreed that the shares acquired by it in the offer have not been acquired on a non-discretionary basis on

behalf of, nor have they been acquired with a view to their offer or resale to, persons in circumstances

which may give rise to an offer of any shares to the public other than their offer or resale in a Relevant

State to qualified investors as so defined or in circumstances in which the prior consent of the

underwriters have been obtained to each such proposed offer or resale.

For the purposes of this provision, the expression an "offer to the public" in relation to shares in any

Relevant State means the communication in any form and by any means of sufficient information on the

terms of the offer and any shares to be offered so as to enable an investor to decide to purchase or

subscribe for any shares, and the expression "Prospectus Regulation" means Regulation (EU) 2017/1129.

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**Notice to prospective investors in the United Kingdom**

No shares have been offered or will be offered pursuant to the offering to the public in the United Kingdom

prior to the publication of a prospectus in relation to the shares which (i) has been approved by the

Financial Conduct Authority or (ii) is to be treated as if it had been approved by the Financial Conduct

Authority in accordance with the transitional provisions in Article 74 (transitional provisions) of the

Prospectus Amendment etc (EU Exit) Regulations 2019/1234, except that the shares may be offered to

the public in the United Kingdom at any time:

(i)to any legal entity which is a qualified investor as defined under Article 2 of the UK Prospectus

Regulation;

(ii)to fewer than 150 natural or legal persons (other than qualified investors as defined under Article 2 of

the UK Prospectus Regulation), subject to obtaining the prior consent of underwriters for any such

offer; or

(iii)in any other circumstances falling within Section 86 of the FSMA,

provided that no such offer of the shares shall require the Issuer or any Manager to publish a prospectus

pursuant to Section 85 of the FSMA or supplement a prospectus pursuant to Article 23 of the UK

Prospectus Regulation. For the purposes of this provision, the expression an "offer to the public" in

relation to the shares in the United Kingdom means the communication in any form and by any means of

sufficient information on the terms of the offer and any shares to be offered so as to enable an investor to

decide to purchase or subscribe for any shares and the expression "UK Prospectus Regulation" means

Regulation (EU) 2017/1129 as it forms part of domestic law by virtue of the European Union (Withdrawal)

Act 2018.

In addition, in the United Kingdom, this document is being distributed only to, and is directed only at, and

any offer subsequently made may only be directed at persons who are "qualified investors" (as defined in

the Prospectus Regulation) (i) who have professional experience in matters relating to investments falling

within Article 19(5) of the Financial Services and Markets Act 2000 (Financial Promotion) Order 2005, as

amended (the "Order") and/or (ii) who are high net worth companies (or persons to whom it may

otherwise be lawfully communicated) falling within Article 49(2)(a) to (d) of the Order (all such persons

together being referred to as "relevant persons") or otherwise in circumstances which have not resulted

and will not result in an offer to the public of the shares in the United Kingdom within the meaning of the

Financial Services and Markets Act 2000.

Any person in the United Kingdom that is not a relevant person should not act or rely on the information

included in this document or use it as basis for taking any action. In the United Kingdom, any investment

or investment activity that this document relates to may be made or taken exclusively by relevant persons.

**Notice to prospective investors in Canada**

The shares may be sold only to purchasers purchasing, or deemed to be purchasing, as principal that are

accredited investors, as defined in National Instrument 45-106 Prospectus Exemptions or subsection

73.3(1) of the Securities Act (Ontario), and are permitted clients, as defined in National Instrument 31-103

Registration Requirements, Exemptions and Ongoing Registrant Obligations. Any resale of the shares

must be made in accordance with an exemption from, or in a transaction not subject to, the prospectus

requirements of applicable securities laws.

Securities legislation in certain provinces or territories of Canada may provide a purchaser with remedies

for rescission or damages if this prospectus (including any amendment thereto) contains a

misrepresentation, provided that the remedies for rescission or damages are exercised by the purchaser

within the time limit prescribed by the securities legislation of the purchaser's province or territory. The

purchaser should refer to any applicable provisions of the securities legislation of the purchaser's

province or territory for particulars of these rights or consult with a legal advisor.

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Pursuant to section 3A.3 of National Instrument 33-105 Underwriting Conflicts (NI 33-105), the

underwriters are not required to comply with the disclosure requirements of NI 33-105 regarding

underwriter conflicts of interest in connection with this offering.

**Notice to prospective investors in Switzerland**

This prospectus does not constitute an offer to the public or a solicitation to purchase or invest in any

shares. No shares have been offered or will be offered to the public in Switzerland, except that offers of

shares may be made to the public in Switzerland at any time under the following exemptions under the

Swiss Financial Services Act ("FinSA"):

(i)to any person which is a professional client as defined under the FinSA;

(ii)to fewer than 500 persons (other than professional clients as defined under the FinSA), subject to

obtaining the prior consent of the representatives of the underwriters for any such offer; or

(iii)in any other circumstances falling within Article 36 FinSA in connection with Article 44 of the Swiss

Financial Services Ordinance,

provided that no such offer of shares shall require the Company or any investment bank to publish a

prospectus pursuant to Article 35 FinSA.

The shares have not been and will not be listed or admitted to trading on a trading venue in Switzerland.

Neither this document nor any other offering or marketing material relating to the shares constitutes a

prospectus as such term is understood pursuant to the FinSA and neither this document nor any other

offering or marketing material relating to the shares may be publicly distributed or otherwise made publicly

available in Switzerland.

**Notice to prospective investors in the Dubai International Financial Centre**

This document relates to an Exempt Offer in accordance with the Markets Law, DIFC Law No. 1 of 2012,

as amended. This document is intended for distribution only to persons of a type specified in the Markets

Law, DIFC Law No. 1 of 2012, as amended. It must not be delivered to, or relied on by, any other person.

The Dubai Financial Services Authority (DFSA) has no responsibility for reviewing or verifying any

documents in connection with Exempt Offers. The DFSA has not approved this prospectus supplement

nor taken steps to verify the information set forth herein and has no responsibility for this document. The

securities to which this document relates may be illiquid and/or subject to restrictions on their resale.

Prospective purchasers of the securities offered should conduct their own due diligence on the securities.

If you do not understand the contents of this document you should consult an authorized financial advisor.

In relation to its use in the DIFC, this document is strictly private and confidential and is being distributed

to a limited number of investors and must not be provided to any person other than the original recipient,

and may not be reproduced or used for any other purpose. The interests in the securities may not be

offered or sold directly or indirectly to the public in the DIFC.

**Notice to prospective investors in the United Arab Emirates**

The shares have not been, and are not being, publicly offered, sold, promoted or advertised in the United

Arab Emirates (including the Dubai International Financial Centre) other than in compliance with the laws

of the United Arab Emirates (and the Dubai International Financial Centre) governing the issue, offering

and sale of securities. Further, this prospectus does not constitute a public offer of securities in the United

Arab Emirates (including the Dubai International Financial Centre) and is not intended to be a public offer.

This prospectus has not been approved by or filed with the Central Bank of the United Arab Emirates, the

Securities and Commodities Authority, Financial Services Regulatory Authority (FSRA) or the Dubai

Financial Services Authority (DFSA).

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**Notice to prospective investors in Australia** 

This prospectus:

• does not constitute a disclosure document or a prospectus under Chapter 6D.2 of the Corporations

Act 2001 (Cth) (the "Corporations Act");

• has not been, and will not be, lodged with the Australian Securities and Investments Commission

("ASIC"), as a disclosure document for the purposes of the Corporations Act and does not purport to

include the information required of a disclosure document for the purposes of the Corporations Act;

and

• may only be provided in Australia to select investors who are able to demonstrate that they fall within

one or more of the categories of investors, available under section 708 of the Corporations Act

("Exempt Investors").

The shares may not be directly or indirectly offered for subscription or purchased or sold, and no

invitations to subscribe for or buy the shares may be issued, and no draft or definitive offering

memorandum, advertisement or other offering material relating to any shares may be distributed in

Australia, except where disclosure to investors is not required under Chapter 6D of the Corporations Act

or is otherwise in compliance with all applicable Australian laws and regulations. By submitting an

application for the shares, you represent and warrant to us that you are an Exempt Investor.

As any offer of shares of our common stock under this prospectus will be made without disclosure in

Australia under Chapter 6D.2 of the Corporations Act, the offer of those securities for resale in Australia

within 12 months may, under section 707 of the Corporations Act, require disclosure to investors under

Chapter 6D.2 if none of the exemptions in section 708 applies to that resale. By applying for the shares of

our common stock you undertake to us that you will not, for a period of 12 months from the date of issue

of the shares, offer, transfer, assign or otherwise alienate those shares of our common stock to investors

in Australia except in circumstances where disclosure to investors is not required under Chapter 6D.2 of

the Corporations Act or where a compliant disclosure document is prepared and lodged with ASIC.

**Notice to prospective investors in Japan**

The shares have not been and will not be registered pursuant to Article 4, Paragraph 1 of the Financial

Instruments and Exchange Act. Accordingly, none of the shares nor any interest therein may be offered or

sold, directly or indirectly, in Japan or to, or for the benefit of, any "resident" of Japan (which term as used

herein means any person resident in Japan, including any corporation or other entity organized under the

laws of Japan), or to others for re-offering or resale, directly or indirectly, in Japan or to or for the benefit of

a resident of Japan, except pursuant to an exemption from the registration requirements of, and otherwise

in compliance with, the Financial Instruments and Exchange Act and any other applicable laws,

regulations and ministerial guidelines of Japan in effect at the relevant time.

**Notice to prospective investors in Hong Kong**

The shares have not been offered or sold and will not be offered or sold in Hong Kong, by means of any

document, other than (a) to "professional investors" as defined in the Securities and Futures Ordinance

(Cap. 571 of the Laws of Hong Kong) (the "SFO") of Hong Kong and any rules made thereunder; or (b) in

other circumstances which do not result in the document being a "prospectus" as defined in the

Companies (Winding Up and Miscellaneous Provisions) Ordinance (Cap. 32) of Hong Kong) (the "CO") or

which do not constitute an offer to the public within the meaning of the CO. No advertisement, invitation or

document relating to the shares has been or may be issued or has been or may be in the possession of

any person for the purposes of issue, whether in Hong Kong or elsewhere, which is directed at, or the

contents of which are likely to be accessed or read by, the public of Hong Kong (except if permitted to do

so under the securities laws of Hong Kong) other than with respect to shares which are or are intended to

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be disposed of only to persons outside Hong Kong or only to "professional investors" as defined in the

SFO and any rules made thereunder.

**Notice to prospective investors in Singapore**

This prospectus has not been registered as a prospectus with the Monetary Authority of Singapore.

Accordingly, no shares have been or will be offered or sold and no shares have been or will be made the

subject of an invitation for subscription or purchase, and no prospectus or any other document or material

in connection with the offer or sale, or invitation for subscription or purchase, of the shares, has been or

will be circulated or distributed, whether directly or indirectly, to any person in Singapore other than (i) to

an institutional investor (as defined in Section 4A of the Securities and Futures Act 2001 of Singapore, as

modified or amended from time to time (the "SFA")) pursuant to Section 274 of the SFA, (ii) to a relevant

person (as defined in Section 275(2) of the SFA) pursuant to Section 275(1) of the SFA, or any person

pursuant to Section 275(1A) of the SFA, and in accordance with the conditions specified in Section 275 of

the SFA, or (iii) otherwise pursuant to, and in accordance with the conditions of, any other applicable

provision of the SFA.

Singapore SFA Product Classification — In connection with Section 309B of the SFA and the CMP

Regulations 2018, unless otherwise specified before an offer of shares of our common stock, we have

determined, and hereby notify all relevant persons (as defined in Section 309A(1) of the SFA), that the

shares of common stock are ''prescribed capital markets products'' (as defined in the CMP Regulations

2018) and Excluded Investment Products (as defined in MAS Notice SFA 04-N12: Notice on the Sale of

Investment Products and MAS Notice FAA-N16: Notice on Recommendations on Investment Products).

**Notice to prospective investors in Bermuda**

Shares may be offered or sold in Bermuda only in compliance with the provisions of the Investment

Business Act of 2003 of Bermuda which regulates the sale of securities in Bermuda. Additionally, non-

Bermudian persons (including companies) may not carry on or engage in any trade or business in

Bermuda unless such persons are permitted to do so under applicable Bermuda legislation.

**Notice to prospective investors in Saudi Arabia**

This document may not be distributed in the Kingdom of Saudi Arabia except to such persons as are

permitted under the Rules on the Offer of Securities and Continuing Obligations Regulations as issued by

the board of the Saudi Arabian Capital Market Authority ("CMA") pursuant to resolution number

3-123-2017 dated 27 December 2017, as amended (the "CMA Regulations"). The CMA does not make

any representation as to the accuracy or completeness of this document and expressly disclaims any

liability whatsoever for any loss arising from, or incurred in reliance upon, any part of this document.

Prospective purchasers of the securities offered hereby should conduct their own due diligence on the

accuracy of the information relating to the securities. If you do not understand the contents of this

document, you should consult an authorised financial adviser.

**Notice to prospective investors in the British Virgin Islands**

The shares are not being, and may not be offered to the public or to any person in the British Virgin

Islands for purchase or subscription by or on behalf of us. The shares may be offered to companies

incorporated under the BVI Business Companies Act, 2004 (British Virgin Islands), "BVI Companies"), but

only where the offer will be made to, and received by, the relevant BVI Company entirely outside of the

British Virgin Islands.

**Notice to prospective investors in China**

This prospectus will not be circulated or distributed in the PRC and the shares will not be offered or sold,

and will not be offered or sold to any person for re-offering or resale directly or indirectly to any residents

of the PRC (for such purposes, not including the Hong Kong and Macau Special Administrative Regions

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

or Taiwan), except pursuant to any applicable laws and regulations of the PRC. Neither this prospectus

nor any advertisement or other offering material may be distributed or published in the PRC, except under

circumstances that will result in compliance with applicable laws and regulations.

**Notice to prospective investors in Korea**

The shares have not been and will not be registered under the Financial Investments Services and

Capital Markets Act of Korea and the decrees and regulations thereunder (the "FSCMA"), and the shares

have been and will be offered in Korea as a private placement under the FSCMA. None of the shares

may be offered, sold or delivered directly or indirectly, or offered or sold to any person for re-offering or

resale, directly or indirectly, in Korea or to any resident of Korea except pursuant to the applicable laws

and regulations of Korea, including the FSCMA and the Foreign Exchange Transaction Law of Korea and

the decrees and regulations thereunder (the "FETL"). Furthermore, the purchaser of the shares shall

comply with all applicable regulatory requirements (including but not limited to requirements under the

FETL) in connection with the purchase of the shares. By the purchase of the shares, the relevant holder

thereof will be deemed to represent and warrant that if it is in Korea or is a resident of Korea, it purchased

the shares pursuant to the applicable laws and regulations of Korea.

**Notice to prospective investors in Malaysia**

No prospectus or other offering material or document in connection with the offer and sale of the shares

has been or will be registered with the Securities Commission of Malaysia ("Commission") for the

Commission's approval pursuant to the Capital Markets and Services Act 2007. Accordingly, this

prospectus and any other document or material in connection with the offer or sale, or invitation for

subscription or purchase, of the shares may not be circulated or distributed, nor may the shares be

offered or sold, or be made the subject of an invitation for subscription or purchase, whether directly or

indirectly, to persons in Malaysia other than (i) a closed end fund approved by the Commission; (ii) a

holder of a Capital Markets Services Licence; (iii) a person who acquires the shares, as principal, if the

offer is on terms that the shares may only be acquired at a consideration of not less than RM250,000 (or

its equivalent in foreign currencies) for each transaction; (iv) an individual whose total net personal assets

or total net joint assets with his or her spouse exceeds RM3 million (or its equivalent in foreign

currencies), excluding the value of the primary residence of the individual; (v) an individual who has a

gross annual income exceeding RM300,000 (or its equivalent in foreign currencies) per annum in the

preceding twelve months; (vi) an individual who, jointly with his or her spouse, has a gross annual income

of RM400,000 (or its equivalent in foreign currencies), per annum in the preceding twelve months; (vii) a

corporation with total net assets exceeding RM10 million (or its equivalent in a foreign currencies) based

on the last audited accounts; (viii) a partnership with total net assets exceeding RM10 million (or its

equivalent in foreign currencies); (ix) a bank licensee or insurance licensee as defined in the Labuan

Financial Services and Securities Act 2010; (x) an Islamic bank licensee or takaful licensee as defined in

the Labuan Financial Services and Securities Act 2010; and (xi) any other person as may be specified by

the Commission; provided that, in the each of the preceding categories (i) to (xi), the distribution of the

shares is made by a holder of a Capital Markets Services License who carries on the business of dealing

in securities. The distribution in Malaysia of this prospectus is subject to Malaysian laws. This prospectus

does not constitute and may not be used for the purpose of public offering or an issue, offer for

subscription or purchase, invitation to subscribe for or purchase any securities requiring the registration of

a prospectus with the Commission under the Capital Markets and Services Act 2007.

**Notice to prospective investors in Taiwan**

The shares have not been and will not be registered with the Financial Supervisory Commission of

Taiwan pursuant to relevant securities laws and regulations and may not be sold, issued or offered within

Taiwan through a public offering or in circumstances which constitutes an offer within the meaning of the

Securities and Exchange Act of Taiwan that requires a registration or approval of the Financial

Supervisory Commission of Taiwan. No person or entity in Taiwan has been authorised to offer, sell, give

advice regarding or otherwise intermediate the offering and sale of the shares in Taiwan.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**Notice to prospective investors in South Africa**

Due to restrictions under the securities laws of South Africa, no "*offer to the public*" (as such term is

defined in the South African Companies Act, No. 71 of 2008 (as amended or re-enacted) (the "South

African Companies Act") is being made in connection with the issue of the shares in South Africa.

Accordingly, this document does not, nor is it intended to, constitute a "*registered prospectus*" (as that

term is defined in the South African Companies Act) prepared and registered under the South African

Companies Act and has not been approved by, and/or filed with, the South African Companies and

Intellectual Property Commission or any other regulatory authority in South Africa. The shares are not

offered, and the offer shall not be transferred, sold, renounced or delivered, in South Africa or to a person

with an address in South Africa, unless one or other of the following exemptions stipulated in section 96

(1) applies:

---

| | |
|:---|:---|
| Section 96 (1) (a) | the offer, transfer, sale, renunciation or delivery is to:  |
|  | (i) persons whose ordinary business, or part of whose ordinary business, is to deal in <br>securities, as principal or agent; <br>|
|  | (ii) the South African Public Investment Corporation;  |
|  | (iii) persons or entities regulated by the Reserve Bank of South Africa;  |
|  | (iv) authorised financial service providers under South African law;  |
|  | (v) financial institutions recognised as such under South African law;  |
|  | (vi) a wholly-owned subsidiary of any person or entity contemplated in (c), (d) or (e), <br>acting as agent in the capacity of an authorised portfolio manager for a pension fund, <br>or as manager for a collective investment scheme (in each case duly registered as <br>such under South African law); or <br>|
|  | (vii) any combination of the person in (i) to (vi); or |
| Section 96 (1) (b)  | the total contemplated acquisition cost of the securities, for any single addressee <br>acting as principal is equal to or greater than ZAR1,000,000 or such higher amount as <br>may be promulgated by notice in the Government Gazette of South Africa pursuant to <br>section 96(2)(a) of the South African Companies Act.<br>|

---

Information made available in this prospectus should not be considered as "*advice*" as defined in the

South African Financial Advisory and Intermediary Services Act, 2002.

**Notice to prospective investors in Israel**

This prospectus does not constitute a prospectus under the Israeli Securities Law, 5728-1968, or the

Israeli Securities Law, and has not been filed with or approved by the Israel Securities Authority. In Israel,

this prospectus is being distributed only to, and is directed only at, and any offer of the shares is directed

only at, (i) a limited number of persons in accordance with the Israeli Securities Law and (ii) investors

listed in the first addendum, or the Addendum, to the Israeli Securities Law, consisting primarily of joint

investment in trust funds, provident funds, insurance companies, banks, portfolio managers, investment

advisors, members of the Tel Aviv Stock Exchange, underwriters, venture capital funds, entities with

equity in excess of NIS 50 million and "qualified individuals," each as defined in the Addendum (as it may

be amended from time to time), or, collectively referred to as qualified investors (in each case, purchasing

for their own account or, where permitted under the Addendum, for the accounts of their clients who are

investors listed in the Addendum). Qualified investors are required to submit written confirmation that they

fall within the scope of the Addendum, are aware of the meaning of same and agree to it.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**Legal matters**

The validity of the issuance of our common stock offered in this prospectus will be passed upon for us by

O'Melveny & Myers LLP. King & Spalding LLP is acting as regulatory counsel to us in connection with this

offering and will pass upon certain legal matters. Certain legal matters in connection with this offering will

be passed upon for the underwriters by Cooley LLP, San Francisco, California.

**Experts**

The financial statements as of December 31, 2024 and 2023 and for the years then ended included in this

Prospectus have been so included in reliance on the report of PricewaterhouseCoopers LLP, an

independent registered public accounting firm, given on the authority of said firm as experts in auditing

and accounting.

**Where you can find additional information**

We have filed with the SEC a registration statement on Form S-1, including exhibits and schedules, under

the Securities Act, with respect to the shares of common stock being offered by this prospectus. This

prospectus, which constitutes part of the registration statement, does not contain all of the information in

the registration statement and its exhibits. For further information with respect to us and the common

stock offered by this prospectus, we refer you to the registration statement and its exhibits. Statements

contained in this prospectus as to the contents of any contract or any other document referred to are

summary in nature and not necessarily complete, and in each instance, we refer you to the copy of the

contract or other document filed as an exhibit to the registration statement. Each of these statements is

qualified in all respects by reference to the full text of such contract or other document.

You may read our SEC filings, including this registration statement, over the Internet at the SEC's website

at www.sec.gov. Upon the completion of this offering, we will be subject to the information reporting

requirements of the Exchange Act, and we will file reports, proxy statements, and other information with

the SEC. These reports, proxy statements, and other information will be available for review at the SEC's

website referred to above. We also maintain a website at www.heartflow.com, at which, following the

completion of this offering, you may access these materials free of charge as soon as reasonably

practicable after they are electronically filed with, or furnished to, the SEC. Information contained on or

accessible through our website is not a part of this prospectus or the registration statement of which it

forms a part, and the inclusion of our website address in this prospectus is an inactive textual reference

only. You should not consider the contents of our website in making an investment decision with respect

to our common stock.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**INDEX TO CONSOLIDATED FINANCIAL STATEMENTS**

**Years Ended December 31, 2023 and 2024, and**

**Three Months Ended March 31, 2024 and 2025 (unaudited**)

---

| | |
|:---|:---|
| | **Page** |
| <u>[Report of Independent Registered Public Accounting Firm](#i2341357d54884756b9e9172f0a83cd6b_113)</u>................................................................... | <u>[F-2](#i2341357d54884756b9e9172f0a83cd6b_113)</u> |
| **Financial Statements:** |  |
| <u>[Consolidated Balance Sheets](#i2341357d54884756b9e9172f0a83cd6b_461)</u>............................................................................................................... | <u>[F-3](#i2341357d54884756b9e9172f0a83cd6b_461)</u> |
| <u>[Consolidated Statements of Operations and Comprehensive Loss](#i2341357d54884756b9e9172f0a83cd6b_447)</u>................................................ | <u>[F-4](#i2341357d54884756b9e9172f0a83cd6b_447)</u> |
| <u>[Consolidated Statements of Redeemable Convertible Preferred Stock and Stockholders'](#i2341357d54884756b9e9172f0a83cd6b_432)</u><br><u>[Deficit](#i2341357d54884756b9e9172f0a83cd6b_432)</u>.........................................................................................................................................................<br>| <u>[F-5](#i2341357d54884756b9e9172f0a83cd6b_432)</u> |
| <u>[Consolidated Statements of Cash Flows](#i2341357d54884756b9e9172f0a83cd6b_418)</u>............................................................................................. | <u>[F-7](#i2341357d54884756b9e9172f0a83cd6b_418)</u> |
| <u>[Notes to Consolidated Financial Statements](#i2341357d54884756b9e9172f0a83cd6b_129)</u>...................................................................................... | <u>[F-8](#i2341357d54884756b9e9172f0a83cd6b_129)</u> |

---

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**Report of Independent Registered Public Accounting Firm**

To the Board of Directors and Stockholders of Heartflow, Inc.

***Opinion on the Financial Statements***

We have audited the accompanying consolidated balance sheets of HeartFlow Holding, Inc. and its

subsidiaries (the "Company") as of December 31, 2024 and 2023, and the related consolidated

statements of operations and comprehensive loss, of redeemable convertible preferred stock and

stockholders' deficit and of cash flows for the years then ended, including the related notes (collectively

referred to as the "consolidated financial statements"). In our opinion, the consolidated financial

statements present fairly, in all material respects, the financial position of the Company as of December

31, 2024 and 2023, and the results of its operations and its cash flows for the years then ended in

conformity with accounting principles generally accepted in the United States of America.

***Basis for Opinion***

These consolidatedfinancial statements are the responsibility of the Company's management. Our

responsibility is to express an opinion on the Company's consolidated financial statements based on our

audits. We are a public accounting firm registered with the Public Company Accounting Oversight Board

(United States) (PCAOB) and are required to be independent with respect to the Company in accordance

with the U.S. federal securities laws and the applicable rules and regulations of the Securities and

Exchange Commission and the PCAOB.

We conducted our audits of these consolidatedfinancial statements in accordance with the standards of

the PCAOB. Those standards require that we plan and perform the audits to obtain reasonable assurance

about whether the consolidated financial statements are free of material misstatement, whether due to

error or fraud.

Our audits included performing procedures to assess the risks of material misstatement of the

consolidatedfinancial statements, whether due to error or fraud, and performing procedures that respond

to those risks. Such procedures included examining, on a test basis, evidence regarding the amounts and

disclosures in the consolidatedfinancial statements. Our audits also included evaluating the accounting

principles used and significant estimates made by management, as well as evaluating the overall

presentation of the consolidatedfinancial statements. We believe that our audits provide a reasonable

basis for our opinion.

/s/ PricewaterhouseCoopers LLP

San Jose, California

March 26, 2025, except for the effects of the reverse stock split discussed in Note 1 to the consolidated

financial statements, as to which the date is August 1, 2025

We have served as the Company's auditor since 2009, which includes periods before the Company

became subject to SEC reporting requirements.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Consolidated Balance Sheets**

**(in thousands, except share and per share amounts)**

---

| | | | |
|:---|:---|:---|:---|
|  | **December 31,** | **December 31,** | |
|  | **2023** | **2024** | **March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| **Assets** |  |  |  |
| Current assets: |  |  |  |
| Cash and cash equivalents............................................................................ | $122767 | $51367 | $109786 |
| Accounts receivable, net of allowance for credit losses of $1,058, <br>$814 and $742 at December 31, 2023 and 2024, and March 31, 2025 <br>(unaudited), respectively................................................................................<br>| 20546 | 24639 | 28312 |
| Restricted cash, current.................................................................................. |  | 150 |  |
| Prepaid expenses and other current assets................................................ | 5134 | 6132 | 6541 |
| Total current assets................................................................................... | 148447 | 82288 | 144639 |
| Property and equipment, net................................................................................ | 9921 | 8920 | 8655 |
| Operating lease right-of-use assets.................................................................... | 20961 | 18805 | 18642 |
| Restricted cash, non-current................................................................................ | 4467 | 4325 | 4475 |
| Other non-current assets...................................................................................... | 1255 | 4366 | 8030 |
| Total assets................................................................................................. | $185051 | $118704 | $184441 |
| **Liabilities, redeemable convertible preferred stock and** <br>**stockholders' deficit**<br>|  |  |  |
| Current liabilities: |  |  |  |
| Accounts payable............................................................................................ | $2887 | $2870 | $1972 |
| Accrued expenses and other current liabilities........................................... | 24790 | 25319 | 35983 |
| Operating lease liabilities, current................................................................. | 5138 | 5416 | 5453 |
| Total current liabilities................................................................................ | 32815 | 33605 | 43408 |
| Convertible notes................................................................................................... |  |  | 65824 |
| Term loan................................................................................................................ | 134008 | 136431 | 113831 |
| Common stock warrant liability............................................................................ | 4440 | 20835 | 22441 |
| Derivative liability................................................................................................... | 903 |  | 40945 |
| Operating lease liabilities, non-current .............................................................. | 21454 | 18537 | 18173 |
| Other non-current liabilities.................................................................................. | 429 | 214 | 248 |
| Total liabilities............................................................................................. | 194049 | 209622 | 304870 |
| Commitments and contingencies (Note 7) |  |  |  |
| Redeemable convertible preferred stock issuable in series, $0.001 par <br>value; 122,231,454 shares authorized, issued and outstanding as of <br>December 31, 2023 and 2024, and March 31, 2025 (unaudited); <br>aggregate liquidation value of $951,917 as of December 31, 2023 and <br>2024, and March 31, 2025 (unaudited)..............................................................<br>| 768566 | 768566 | 768566 |
| Stockholders' deficit: |  |  |  |
| Common stock, $0.001 par value; 210,000,000, 210,300,000 and <br>210,300,000 shares authorized as of December 31, 2023 and 2024, and <br>March 31, 2025 (unaudited), respectively; 4,940,925, 6,122,048 and <br>6,252,861 shares issued and outstanding as of December 31, 2023 and <br>2024, and March 31, 2025 (unaudited), respectively.......................................<br>| 5 | 6 | 6 |
| Additional paid-in capital....................................................................................... | 97465 | 112241 | 115311 |
| Accumulated other comprehensive loss............................................................ | (501) | (772) | (1008) |
| Accumulated deficit............................................................................................... | (874533) | (970959) | (1003304) |
| Total stockholders' deficit.......................................................................... | (777564) | (859484) | (888995) |
| Total liabilities, redeemable convertible preferred stock and <br>stockholders' deficit...................................................................................<br>| $185051 | $118704 | $184441 |

---

*The accompanying notes are an integral part of these consolidated financial statements.*

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Consolidated Statements of Operations and Comprehensive Loss**

**(in thousands, except share and per share amounts)**

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** | **Three Months Ended** <br>**March 31,** | **Three Months Ended** <br>**March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| Revenue..................................................................... | $87174 | $125808 | $26843 | $37205 |
| Cost of revenue......................................................... | 29123 | 31359 | 7420 | 9264 |
| Gross profit................................................................. | 58051 | 94449 | 19423 | 27941 |
| Operating expenses: |  |  |  |  |
| Research and development.................................... | 35854 | 43517 | 9443 | 13924 |
| Selling, general and administrative........................ | 95111 | 112154 | 26038 | 31519 |
| Total operating expenses......................................... | 130965 | 155671 | 35481 | 45443 |
| Loss from operations................................................ | (72914) | (61222) | (16058) | (17502) |
| Interest income.......................................................... | 5457 | 4066 | 1512 | 543 |
| Interest expense........................................................ | (24694) | (22768) | (6243) | (5093) |
| Change in fair value of convertible note................ | (5120) |  |  |  |
| Change in fair value of common stock warrant <br>liability.........................................................................<br>| (2320) | (16395) | 1 | (1606) |
| Change in fair value of derivative liability.............. | 4158 | (222) | (61) | (9045) |
| Other income (expense), net................................... | 325 | 168 | (155) | 358 |
| Loss before provision for income taxes................. | (95108) | (96373) | (21004) | (32345) |
| (Provision for) benefit from income taxes............. | (547) | (53) | 72 |  |
| Net loss....................................................................... | $(95655) | $(96426) | $(20932) | $(32345) |
| Cumulative dividends on Series C redeemable <br>convertible preferred stock......................................<br>| (1239) |  |  |  |
| Deemed dividend upon down round of <br>redeemable convertible preferred stock................<br>| (26794) |  |  |  |
| Net loss attributable to common stockholders..... | $(123688) | $(96426) | $(20932) | $(32345) |
| Comprehensive loss: |  |  |  |  |
| Net loss....................................................................... | $(95655) | $(96426) | $(20932) | $(32345) |
| Other comprehensive loss: |  |  |  |  |
| Foreign currency translation gain (loss)................ | (504) | (271) | 1 | (236) |
| Total comprehensive loss........................................ | $(96159) | $(96697) | $(20931) | $(32581) |
| Net loss per share attributable to common <br>stockholders, basic and diluted...............................<br>| $(25.32) | $(17.98) | $(4.23) | $(5.25) |
| Weighted-average shares used to compute net <br>loss per share attributable to common <br>stockholders, basic and diluted...............................<br>| 4885231 | 5363435 | 4943430 | 6164617 |

---

*The accompanying notes are an integral part of these consolidated financial statements.*

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Consolidated Statements of Redeemable Convertible Preferred Stock and Stockholders' Deficit**

**(in thousands, except share and per share amounts)**

---

| | | | | | | | | |
|:---|:---|:---|:---|:---|:---|:---|:---|:---|
|  | **Redeemable Convertible** <br>**Preferred Stock** | **Redeemable Convertible** <br>**Preferred Stock** | **Common Stock** | **Common Stock** | **Additional** <br>**Paid-In** <br>**Capital** | **Accumulated** <br>**Other** <br>**Comprehensive** <br>**Income (Loss)** | **Accumulated** <br>**Deficit** | **Total** <br>**Stockholders'** <br>**Deficit** |
|  | **Shares** | **Amount** | **Shares** | **Amount** | **Additional** <br>**Paid-In** <br>**Capital** | **Accumulated** <br>**Other** <br>**Comprehensive** <br>**Income (Loss)** | **Accumulated** <br>**Deficit** | **Total** <br>**Stockholders'** <br>**Deficit** |
| **Balance at January 1, 2023**........................ | 39422361 | $538423 | 4943764 | $5 | $58436 | $3 | $(752084) | $(693640) |
| Issuance of common stock upon <br>exercise of stock options..........................<br>|  |  | 99900 |  | 589 |  |  | 589 |
| Issuance of Series F redeemable <br>convertible preferred stock at $2.8505 <br>per share, net of issuance costs of <br>$5,904.........................................................<br>| 61344029 | 168957 |  |  |  |  |  |  |
| Issuance of Series F-1 redeemable <br>convertible preferred stock at $1.9098 <br>per share upon conversion of <br>convertible notes and accrued interest..<br>| 21465064 | 61186 |  |  |  |  |  |  |
| Deemed dividend upon down round of <br>redeemable convertible preferred stock<br>|  |  |  |  | 26794 |  | (26794) |  |
| Repurchase of common stock................. |  |  | (102739) |  | (228) |  |  | (228) |
| Stock-based compensation expense..... |  |  |  |  | 11874 |  |  | 11874 |
| Foreign currency translation loss............ |  |  |  |  |  | (504) |  | (504) |
| Net loss....................................................... |  |  |  |  |  |  | (95655) | (95655) |
| **Balance at December 31, 2023**................. | 122231454 | 768566 | 4940925 | 5 | 97465 | (501) | (874533) | (777564) |
| Issuance of common stock upon <br>exercise of stock options..........................<br>|  |  | 1181123 | 1 | 4563 |  |  | 4564 |
| Stock-based compensation expense..... |  |  |  |  | 10213 |  |  | 10213 |
| Foreign currency translation loss............ |  |  |  |  |  | (271) |  | (271) |
| Net loss....................................................... |  |  |  |  |  |  | (96426) | (96426) |
| **Balance at December 31, 2024**................. | 122231454 | 768566 | 6122048 | 6 | 112241 | (772) | (970959) | (859484) |
| Issuance of common stock upon <br>exercise of stock options (unaudited).....<br>|  |  | 130813 |  | 578 |  |  | 578 |
| Stock-based compensation expense <br>(unaudited).................................................<br>|  |  |  |  | 2492 |  |  | 2492 |
| Foreign currency translation loss <br>(unaudited).................................................<br>|  |  |  |  |  | (236) |  | (236) |
| Net loss (unaudited).................................. |  |  |  |  |  |  | (32345) | (32345) |
| **Balance at March 31, 2025 (unaudited)**.. | 122231454 | $768566 | 6252861 | $6 | $115311 | $(1008) | $(1003304) | $(888995) |

---

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

---

| | | | | | | | | |
|:---|:---|:---|:---|:---|:---|:---|:---|:---|
|  | **Redeemable Convertible** <br>**Preferred Stock** | **Redeemable Convertible** <br>**Preferred Stock** | **Common Stock** | **Common Stock** | **Additional** <br>**Paid-In** <br>**Capital** | **Accumulated** <br>**Other** <br>**Comprehensive** <br>**Income (Loss)** | **Accumulated** <br>**Deficit** | **Total** <br>**Stockholders'** <br>**Deficit** |
|  | **Shares** | **Amount** | **Shares** | **Amount** | **Additional** <br>**Paid-In** <br>**Capital** | **Accumulated** <br>**Other** <br>**Comprehensive** <br>**Income (Loss)** | **Accumulated** <br>**Deficit** | **Total** <br>**Stockholders'** <br>**Deficit** |
| **Balance at December 31, 2023**................. | 122231454 | $768566 | 4940925 | $5 | $97465 | $(501) | $(874533) | (777564) |
| Issuance of common stock upon <br>exercise of stock options (unaudited).....<br>|  |  | 10561 |  | 77 |  |  | 77 |
| Stock-based compensation expense <br>(unaudited).................................................<br>|  |  |  |  | 2723 |  |  | 2723 |
| Foreign currency translation gain <br>(unaudited).................................................<br>|  |  |  |  |  | 1 |  | 1 |
| Net loss (unaudited).................................. |  |  |  |  |  |  | (20932) | (20932) |
| **Balance at March 31, 2024 (unaudited)**.. | 122231454 | $768566 | 4951486 | $5 | $100265 | $(500) | $(895465) | $(795695) |

---

*The accompanying notes are an integral part of these consolidated financial statements.*

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Consolidated Statements of Cash Flows**

**(in thousands)**

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** | **Three Months Ended**<br> **March 31,** | **Three Months Ended**<br> **March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| **Cash flows from operating activities:** |  |  |  |  |
| Net loss.............................................................................................................................................................................. | $(95655) | $(96426) | $(20932) | $(32345) |
| Adjustments to reconcile net loss to net cash used in operating activities: |  |  |  |  |
| Depreciation and amortization................................................................................................................................. | 4744 | 5358 | 1192 | 1372 |
| Stock-based compensation expense..................................................................................................................... | 11874 | 10213 | 2723 | 2492 |
| Amortization of debt discount and debt issuance costs...................................................................................... | 2777 | 1609 | 719 | 998 |
| Amortization of right-of-use asset........................................................................................................................... | 2889 | 2735 | 669 | 724 |
| Change in fair value of convertible note................................................................................................................ | 5120 |  |  |  |
| Change in fair value of common stock warrant liability....................................................................................... | 2320 | 16395 | (1) | 1606 |
| Change in fair value of derivative liability.............................................................................................................. | (4158) | 222 | 61 | 9045 |
| Paid-in-kind interest.................................................................................................................................................. | 144 |  |  |  |
| Non-cash interest charges....................................................................................................................................... | 865 | 2016 | 217 | 545 |
| Change in allowance for credit losses................................................................................................................... | 1190 | (244) | (1) | (72) |
| Changes in assets and liabilities:............................................................................................................................ |  |  |  |  |
| Accounts receivable, net................................................................................................................................... | (9350) | (3849) | 1455 | (3601) |
| Prepaid expenses and other current assets................................................................................................... | (357) | (998) | (722) | (409) |
| Other non-current assets................................................................................................................................... | (402) | (2698) | (334) | (341) |
| Accounts payable............................................................................................................................................... | (623) | (327) | (401) | (1627) |
| Accrued expenses and other current liabilities.............................................................................................. | 3759 | 426 | (6030) | 9301 |
| Operating lease liabilities.................................................................................................................................. | (1761) | (3218) | (748) | (888) |
| Other non-current liabilities............................................................................................................................... | 190 | (215) |  | 34 |
| Net cash used in operating activities........................................................................................................ | (76434) | (69001) | (22133) | (13166) |
| **Cash flows from investing activities** |  |  |  |  |
| Purchase of property and equipment..................................................................................................................... | (6105) | (4357) | (1749) | (1101) |
| Net cash used in investing activities ........................................................................................................ | (6105) | (4357) | (1749) | (1101) |
| **Cash flows from financing activities** |  |  |  |  |
| Proceeds from issuance of Series F redeemable convertible preferred shares, net of issuance costs...... | 168957 |  |  |  |
| Proceeds from convertible notes offering, net of issuance costs...................................................................... |  |  |  | 73860 |
| Proceeds from exercise of stock options............................................................................................................... | 589 | 4564 | 77 | 578 |
| Payments of exit, prepayment penalty and lender fees...................................................................................... |  | (2327) |  | (518) |
| Payments of deferred offering costs....................................................................................................................... |  |  |  | (998) |
| Repurchase of common stock................................................................................................................................. | (228) |  |  |  |
| Net cash provided by financing activities ................................................................................................ | 169318 | 2237 | 77 | 72922 |
| Effect of foreign exchange rates.................................................................................................................................... | (504) | (271) | 1 | (236) |
| Net increase (decrease) in cash, cash equivalents and restricted cash.......................................................... | 86275 | (71392) | (23804) | 58419 |
| Balance, beginning of period................................................................................................................................... | 40959 | 127234 | 127234 | 55842 |
| Balance, end of period.............................................................................................................................................. | $127234 | $55842 | $103430 | $114261 |
| **Supplemental disclosure of cash flow information:** |  |  |  |  |
| Cash paid (refunded) for taxes................................................................................................................................ | $405 | $(72) | $(72) | $— |
| Cash paid for interest................................................................................................................................................ | $20800 | $19163 | $5308 | $3439 |
| **Supplemental disclosure of non-cash investing and financing activities:** |  |  |  |  |
| Purchases of property and equipment included in accounts payable............................................................... | $808 | $— | $— | $6 |
| Derecognition of derivative liability in connection with debt refinancing........................................................... | $— | $1125 | $— | $— |
| Right-of-use asset obtained in exchange for lease obligation........................................................................... | $— | $579 | $— | $561 |
| Conversion of term loan principal to convertible notes....................................................................................... | $— | $— | $— | $23000 |
| Issuance of convertible notes to certain employees in lieu of cash compensation........................................ | $— | $— | $— | $1353 |
| Reclassification of term loan debt discount to convertible notes debt discount.............................................. | $— | $— | $— | $239 |
| Unpaid deferred offering costs included in accounts payable and accrued expenses and other current <br>liabilities.......................................................................................................................................................................<br>| $— | $413 | $— | $2325 |
| Unpaid convertible notes issuance costs included in accounts payable and accrued expenses and <br>other current liabilities...............................................................................................................................................<br>| $— | $— | $— | $1114 |
| Reduction in right-of-use asset and lease obligation due to amendment in lease terms.............................. | $1776 | $— | $— | $— |
| Deemed dividend upon down round of redeemable convertible preferred stock............................................ | $26794 | $— | $— | $— |
| Conversion of convertible note into Series F-1 redeemable convertible preferred stock.............................. | $61186 | $— | $— | $— |

---

*The accompanying notes are an integral part of these consolidated financial statements.*

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

**1. Business Overview**

***Description of Business***

HeartFlow Holding, Inc. (the "Company") was incorporated in the state of Delaware in July 2007 as

Cardiovascular Simulation, Inc. and changed its name to HeartFlow, Inc. in May 2009. On March 1, 2021,

the Company completed an internal reorganization in which a newly formed parent holding company,

HeartFlow Holding, Inc., was established.

The Company is a commercial-stage medical technology company that has pioneered the use of software

and AI to deliver a non-invasive solution for diagnosing and managing coronary artery disease ("CAD").

The Company's novel HeartFlow Platform uses AIand advanced computational fluid dynamics to create a

personalized 3D model of a patient's heart based off a single coronary computed tomography

angiography ("CCTA"). This results in actionable data on blood flow, stenosis, plaque volume and plaque

composition. The Company's HeartFlow FFRCT Analysis and Plaque Analysis software assists physicians

in diagnosing, managing and delivering precision care to patients with CAD. The Company was awarded

Conformité Européene Mark ("CE Mark") for its HeartFlow FFRCT Analysis in July 2011. The Company

received clearance from the U.S. Food and Drug Administration ("FDA") in November 2014 for its

HeartFlow FFRCT Analysis and in October 2022 for its Plaque Analysis.

The Company's United States ("U.S.") headquarters is located in Mountain View, California, and the

Company also has offices in Santa Rosa, California, Austin, Texas, and Tokyo, Japan.

The Company had the following wholly-owned subsidiaries as of March 31, 2025:

---

| | |
|:---|:---|
| **Entity Name** | **Country of Incorporation** |
| HeartFlow, Inc................................................................ | United States |
| HeartFlow Japan G.K................................................... | Japan |
| HeartFlow U.K. Ltd........................................................ | United Kingdom |
| HeartFlow Technology U.K. Limited........................... | United Kingdom |

---

Effective July 2024, HeartFlow International Sarl, a wholly-owned subsidiary in Switzerland, was

dissolved.

***Liquidity***

The Company has incurred operating losses and negative cash flows from operations since its inception

and has an accumulated deficit of $874.5 million, $971.0 million and $1.0 billion as of December 31, 2023

and 2024 and March 31, 2025 (unaudited), respectively. The Company expects to incur losses for the

foreseeable future. Historically, the Company's activities have been financed through sales of shares of

redeemable convertible preferred stock, common stock and convertible promissory notes, borrowings

under term loans and revenue received from customers.

As of December 31, 2024 and March 31, 2025 (unaudited), the Company had $51.4 million and $109.8

million in cash and cash equivalents, respectively.

Based on the Company's current operating plan as of June 20, 2025, the date these interim financial

statements (unaudited) were available to be issued, the Company believes that the expected cash

generated from revenue transactions with customers and its existing cash and cash equivalents will be

sufficient to fund the Company's planned operating expenses and capital expenditure requirements for at

least the next 12 months from the date these interim consolidated financial statements (unaudited) were

available to be issued.

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**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

However, the Company may experience lower than expected cash generated from operating activities or

greater than expected capital expenditures, cost of revenue, or operating expenses, and may need to

raise additional capital to fund operations, further research and development activities, or acquire, invest

in, or license other businesses, assets, or technologies. The Company's future capital needs will depend

upon many factors, including the market acceptance of the Company's products, the cost and pace of

developing new products, and the costs of supporting sales growth.

Should the Company obtain additional equity or debt financing to satisfy its liquidity needs, the issuance

of additional debt or equity securities could be dilutive to existing stockholders. Furthermore, any new

securities could have rights that are senior to existing stockholders and could contain covenants that

would restrict operations. There can be no assurance that the Company will generate sufficient future

cash flows from operations or that financing will be available on terms commercially acceptable to the

Company or at all. If the Company is unable to obtain future funding, the Company would curtail

expenses by reducing some of its research and development programs and commercialization efforts in

order to maintain liquidity, if necessary.

***Reverse Stock Split***

On July 31, 2025, the Company's Board of Directors approved an amendment to the Company's

amended and restated certificate of incorporation to immediately effect a reverse stock split of the shares

of the Company's outstanding common stock at a ratio of 1.0-for-2.92 (the "Reverse Stock Split"). The

number of authorized shares and par value per share were not adjusted as a result of the Reverse Stock

Split. All references to shares, options to purchase common stock, share amounts, per share amount, and

related information contained in the consolidated financial statements have been retrospectively adjusted

to reflect the effect of the Reverse Stock Split for all periods presented. The shares of common stock

underlying outstanding stock options and other equity instruments were proportionately reduced and the

respective exercise prices, if applicable, were proportionately increased in accordance with the terms of

the agreements governing such securities. In addition, the conversion ratios for each series of the

Company's redeemable convertible preferred stock, which will automatically convert into shares of

common stock upon the closing of the Company's initial public offering (the "IPO") of common stock, were

proportionally adjusted.

**2. Summary of Significant Accounting Policies**

***Basis of Presentation***

The accompanying consolidated financial statements include the accounts of the Company as well as its

wholly owned subsidiaries and have been prepared in accordance with accounting principles generally

accepted in the United States of America ("U.S. GAAP"). All significant intercompany balances and

transactions have been eliminated in consolidation.

***Reclassification of Prior Period Presentation***

Certain prior year amounts have been reclassified for consistency with the current year presentation. A

reclassification was made to the Consolidated Statements of Cash Flows for the year ended December

31, 2023 to identify non-cash interest charges of $865,000. This change in classification does not affect

previously reported cash flows from operating activities in the Consolidated Statements of Cash Flows

and had no effect on the reported results of operations.

***Unaudited Interim Financial Information***

The accompanying consolidated balance sheet as of March 31, 2025, the consolidated statements of

operations and comprehensive loss and cash flows for the three months ended March 31, 2024 and

2025, and the consolidated statements of redeemable convertible preferred stock and stockholders' deficit

as of March 31, 2024 and 2025, are unaudited. The financial data and other information disclosed in

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

these notes to the consolidated financial statements related to March 31, 2025, and the three months

ended March 31, 2024 and 2025, are also unaudited. The unaudited interim consolidated financial

statements have been prepared on the same basis as the annual consolidated financial statements and,

in the opinion of management, reflect all adjustments, which include only normal recurring adjustments,

necessary to a fair statement of the Company's financial position as of March 31, 2025, and the results of

its operations and cash flows for the three months ended March 31, 2024 and 2025. These interim

financial results are not necessarily indicative of results expected for the full fiscal year or for any

subsequent interim period.

***Use of Estimates***

The preparation of financial statements in conformity with U.S. GAAP requires management to make

estimates and assumptions that affect the amounts reported in the financial statements and

accompanying notes. Management used significant judgement when making estimates in the

determination of the fair value of its common stock and stock options, deferred income tax valuation

allowance, capitalized internal-use software, depreciation of property and equipment, allowance for credit

losses, revenue recognition, valuation of operating lease right-of-use ("ROU") assets and operating lease

liabilities, and the fair value of convertible debt, warrants to purchase common stock and embedded

derivatives. Management evaluates its estimates and assumptions on an ongoing basis using historical

experience and other factors and adjusts those estimates and assumptions as facts and circumstances

dictate. Actual results could materially differ from those estimates.

***Segment Information***

The Company operates and manages its business as one reportable and operating segment, which is the

business of non-invasive coronary artery disease detection solutions. The Company's Chief Executive

Officer, who is the Chief Operating Decision Maker ("CODM"), reviews financial information, including

revenue and net loss, presented on a consolidated basis for purposes of making operating decisions,

allocating resources and evaluating financial performance.

The Company's measure of segment profit or loss is consolidated net loss, which is used by the CODM to

measure actual results versus expectations, set performance metrics, and develop the annual budget to

achieve the Company's long-term objectives. Significant segment expenses within consolidated net loss

includes cost of revenue, research and development, and selling, general and administrative expenses,

which are each separately presented on the Company's consolidated statements of operations and

comprehensive loss. Other expense items that are presented on the consolidated statements of

operations include interest income, interest expense, changes in fair value of warrant liability, other

income, net, and provision for income taxes.

The following table is representative of the significant expense categories regularly provided to the CODM

when managing the Company's single reporting segment and includes a reconciliation to the consolidated

net loss shown in the consolidated statements of operations and comprehensive loss for the years ended

December 31, 2023 and 2024 and for the three months ended March 31, 2024 and 2025 (unaudited) (in

thousands):

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** | **Three Months Ended** <br>**March 31,** | **Three Months Ended** <br>**March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| Revenue............................................................. | $87174 | $125808 | $26843 | $37205 |
| Less<sup>(1)</sup>:  |  |  |  |  |
| Cost of revenue............................................ | 29123 | 31359 | 7420 | 9264 |
| Research and development expenses: |  |  |  |  |
| Research and development.................. | 22330 | 25983 | 5897 | 8328 |
| Regulatory and clinical........................... | 13524 | 17534 | 3546 | 5596 |
| Selling, general and administrative <br>expenses:<br>|  |  |  |  |
| Sales......................................................... | 53374 | 66895 | 15554 | 16953 |
| Marketing................................................. | 9949 | 14470 | 2901 | 4682 |
| General and administrative................... | 31788 | 30789 | 7583 | 9884 |
| Loss from operations....................................... | (72914) | (61222) | (16058) | (17502) |
| Other income (expense), net<sup>(2)</sup>.................. | (22194) | (35151) | (4946) | (14843) |
| (Provision for) benefit from income taxes | (547) | (53) | 72 |  |
| Segment net loss.............................................. | $(95655) | $(96426) | $(20932) | $(32345) |

---

(1)The significant expense categories and amounts align with the segment-level information that is regularly provided to the CODM.

(2)Other income (expense), net represents the consolidated amounts for interest income, interest expense, change in fair value of

convertible note, change in fair value of common stock warrant liability, change in fair value of derivative liability and other income

(expense), net as shown on the consolidated statements of operations and comprehensive loss.

The Company derives revenue and has long-lived assets primarily in the United States of America.

Revenue by geography is further described in Note 3.

***Cash, Cash Equivalents and Restricted Cash***

The Company considers all highly liquid investments that are readily convertible to known amounts of

cash and purchased with an original maturity of three months or less to be cash equivalents. Cash

equivalents consist primarily of amounts invested in money market accounts.

The following table provides a reconciliation of cash, cash equivalents and restricted cash within the

consolidated balance sheets to the total shown in the consolidated statements of cash flows (in

thousands):

---

| | | | |
|:---|:---|:---|:---|
|  | **December 31,** | **December 31,** | |
|  | **2023** | **2024** | **March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| Cash and cash equivalents........................................................ | $122767 | $51367 | $109786 |
| Restricted cash............................................................................ | 4467 | 4475 | 4475 |
| Total cash, cash equivalents and restricted cash................... | $127234 | $55842 | $114261 |

---

As of December 31, 2023 and 2024 and March 31, 2025 (unaudited), restricted cash represents deposits

held as security in connection with the Company's facility lease agreements.

***Fair Value of Financial Instruments***

The Company measures certain financial assets and liabilities at fair value on a recurring basis. Fair value

is an exit price, representing the amount that would be received to sell an asset or paid to transfer a

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

liability in an orderly transaction between market participants. As such, fair value is a market-based

measurement that should be determined based on assumptions that market participants would use in

pricing an asset or a liability.

The Company discloses and recognizes the fair value of its assets and liabilities using a hierarchy that

prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest

priority to valuations based upon unadjusted quoted prices in active markets for identical assets or

liabilities (Level 1 measurements) and the lowest priority to valuations based upon unobservable inputs

that are significant to the valuation (Level 3 measurements). The accounting guidance establishes three

levels of the fair value hierarchy as follows:

*Level 1 -* Observable inputs, such as quoted prices in active markets for identical assets or liabilities;

*Level 2 -* Observable inputs other than Level 1 prices, such as quoted prices for similar assets or

liabilities, quoted prices in markets that are not active, or other inputs that are observable or can be

corroborated by observable market data for substantially the full term of the assets or liabilities;

*Level 3 -* Unobservable inputs that are supported by little or no market activity and that are significant to

the fair value of the assets or liabilities.

Assets and liabilities measured at fair value are classified in their entirety based on the lowest level of

input that is significant to the fair value measurement. The Company's assessment of the significance of a

particular input to the fair value measurement in its entirety requires management to make judgments and

considers factors specific to the asset or liability.

As of December 31, 2023 and 2024 and March 31, 2025 (unaudited), the carrying amounts of the

Company's financial instruments, including cash equivalents, accounts receivable, accounts payable and

accrued liabilities approximate fair value due to their relatively short maturities and market interest rates, if

applicable. Management believes that the Company's Term Loan and 2025 Convertible Notes bear

interest at the prevailing market rates for instruments with similar characteristics; accordingly, the carrying

value of these instruments approximate its fair value. Fair value accounting is applied to the 2022

Convertible Notes, common stock warrant liability and derivative liability. No convertible notes or

derivative liability were outstanding as of December 31, 2024.

***Concentration of Credit Risk and Significant Customers***

Financial instruments that potentially subject the Company to credit risk consist primarily of cash and cash

equivalents, restricted cash and accounts receivable. The Company maintains bank deposits in federally

insured financial institutions and these deposits may at times exceed federally insured limits. To date, the

Company has not experienced any losses on its cash deposits. The Company currently has full control of

its cash and cash equivalents balance.

On March 10, 2023, Silicon Valley Bank ("SVB") was closed by the California Department of Financial

Protection and Innovation, which appointed the Federal Deposit Insurance Corporation ("FDIC") as

receiver. On March 13, 2023, the FDIC announced that it had transferred all insured and uninsured

deposits and substantially all assets of SVB to a newly created, full-service FDIC-operated "bridge bank"

called Silicon Valley Bridge Bank, N.A. ("SVBB"), where depositors would have full access to their money

immediately. On March 27, 2023, First Citizens BancShares, Inc. ("First Citizens Bank") acquired SVBB

from the FDIC and operated SVBB as Silicon Valley Bank, a division of First Citizens Bank. The Company

successfully transferred all funds to another financial institution and did not incur any losses on its

deposits as a result of SVB's closure.

No single customer represented more than 10% of the Company's revenue during the years ended

December 31, 2023 and 2024 or for the three months ended March 31, 2024 and 2025 (unaudited).

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

No single customer represented more than 10% of the Company's accounts receivable as of

December 31, 2023 and 2024 and March 31, 2025 (unaudited).

***Accounts Receivable***

The Company performs ongoing credit evaluations of its customers' financial conditions and generally

extends credit to customers without requiring collateral. Accounts receivable are recorded at the amounts

billed less estimated allowances for credit losses for any potential uncollectible amounts. The Company

continually monitors customer payments and maintains an allowance for estimated losses resulting from a

customer's inability to make required payments. The Company considers factors such as historical

experience, credit quality, age of the accounts receivable balances, geographic related risks and

economic conditions that may affect a customer's ability to pay. Accounts receivable are written-off and

charged against an allowance for credit losses when the Company has exhausted collection efforts

without success.

***Property and Equipment***

Property and equipment are stated at cost less accumulated depreciation or amortization. Depreciation

and amortization is computed using the straight-line method over the estimated useful lives of assets,

which generally ranges from two to five years. Leasehold improvements are amortized over the lesser of

their useful life or the remaining life of the lease. Upon sale or retirement of assets, the cost and related

accumulated depreciation are removed from the balance sheet and the resulting gain or loss is reflected

in results from operations in the period realized. Maintenance and repairs are expensed as incurred.

***Impairment of Long-Lived Assets***

The Company reviews its long-lived assets, including property and equipment, for impairment at least

annually and whenever events or changes in circumstances indicate that the carrying amount of an asset

may not be recoverable. When factors indicate that long-lived assets should be evaluated for possible

impairment, the Company uses an estimate of the related undiscounted future cash flows over the

remaining useful life of the long-lived assets in measuring whether they are recoverable. If the carrying

value of the asset exceeds the estimated undiscounted future cash flows, a loss is recorded as the

excess of the asset's carrying value over its fair value. No assets were determined to be impaired during

the years ended December 31, 2023 and 2024 or for the three months ended March 31, 2024 and 2025

(unaudited).

***Deferred Offering Costs***

The Company capitalizes certain legal, accounting and other third-party fees that are directly associated

with in-process equity financings as deferred offering costs until such financings are consummated. After

consummation of the equity financing, these costs are recorded as a reduction of the proceeds from the

offering, either as a reduction of the carrying value of preferred stock or in stockholders' deficit as a

reduction of additional paid-in capital generated as a result of the offering. Should the in-process equity

financing be abandoned, the deferred offering costs would be expensed immediately as a charge to

operating expenses in the consolidated statements of operations and comprehensive loss. No deferred

offering costs were capitalized as of December 31, 2023. As of December 31, 2024 and March 31, 2025

(unaudited), deferred offering costs of $413,000 and $3.3 million, respectively, were capitalized within

other non-current assets in the consolidated balance sheets.

***Internal-Use Software***

The Company capitalizes certain costs related to internal-use software during the application

development stage. Costs related to planning and post implementation activities are expensed as

incurred. Capitalized internal-use software is amortized on a straight-line basis over the estimated useful

life, which is generally two years, after the product is deployed and ready for use. The Company

evaluates the useful lives of these assets on an annual basis and tests for impairment whenever events

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

or changes in circumstances occur that could impact the recoverability of these assets. Capitalized

internal-use software costs are classified as a component of property and equipment, net.

***Leases***

At the inception of a contractual arrangement, the Company determines whether the contract contains a

lease by assessing whether there is an identified asset and whether the contract conveys the right to

control the use of the identified asset in exchange for consideration over a period of time.

An ROU asset and corresponding lease liability are recorded on the consolidated balance sheets based

on the present value of lease payments over the lease term. An ROU asset represents the right to control

the use of an identified asset over the lease term and a lease liability represents the obligation to make

lease payments arising from the lease. Leases with an initial term of 12 months or less are not recorded

in the consolidated balance sheets. The Company uses its incremental borrowing rate to determine the

present value of lease payments, as the discount rate implicit in the lease is not readily available. The

lease terms used to calculate the ROU asset and related lease liabilities include options to extend or

terminate the lease when it is reasonably certain that the Company will exercise that option. The

Company elected to account for contracts that contain lease and non-lease components as a single lease

component. For the years ended December 31, 2023 and 2024 and the three months ended March 31,

2025 (unaudited), the Company's only leases were for its facilities, which are classified as operating

leases with lease expense recognized on a straight-line basis over the lease term. Variable lease costs,

which primarily consist of common area maintenance, taxes, and utility charges are expensed as

incurred. The Company does not have any finance leases.

***Term Loan***

The Term Loan is accounted for at amortized cost. Original debt issuance costs are deferred and

presented as a reduction to the carrying value of the Term Loan. Debt discount and debt issuance costs

are amortized using the effective interest method and recorded in interest expense within the

consolidated statements of operations and comprehensive loss. Refer to Note 8 for additional information.

***2022 Convertible Notes***

The Company issued convertible notes from September 2022 to December 2022 (the "2022 Convertible

Notes") to certain investors (the "2022 Convertible Note Investors"), which were all converted to Series

F-1 redeemable convertible preferred stock in March 2023. Refer to Notes 9 and 10 for additional

information. The 2022 Convertible Notes contained embedded features that provided the 2022

Convertible Note Investors with multiple settlement alternatives. Rather than accounting for the

embedded features that qualified as derivatives separately, the Company elected to account for the 2022

Convertible Notes at fair value each reporting period. Debt issuance costs were expensed as incurred.

Until their conversion in March 2023, the Company recognized the changes in fair value (including

interest) as change in fair value of convertible note within the consolidated statements of operations and

comprehensive loss.

***2025 Convertible Notes (unaudited)***

The Company issued convertible notes in January 2025 and March 2025 (the "2025 Convertible Notes")

to various investors and certain employees (the "Requisite Holders"), which are accounted for at

amortized cost. Debt issuance costs are deferred and presented as a reduction to the carrying value of

the 2025 Convertible Notes. The Company determined that certain features of the 2025 Convertible

Notes contain embedded derivatives that provide the Requisite Holders with multiple settlement

alternatives and the embedded features that qualified as derivatives were accounted for separately. Debt

discount and debt issuance costs are amortized using the effective interest method and recorded to

interest expense within the consolidated statements of operations and comprehensive loss. The

Company recognized the changes in fair value of the derivative liability as change in fair value of

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**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

derivative liability within the consolidated statements of operations and comprehensive loss. Refer to Note

9 and Note 13 for additional information.

***Common Stock Warrants***

The Company's warrants to purchase common stock that were issued in connection with the Term Loan

do not meet the equity indexation criteria and are classified as a liability. The warrants are recorded at fair

value upon issuance and are subject to remeasurement to fair value at each balance sheet date, with any

changes in fair value recognized as change in fair value of common stock warrant within the consolidated

statements of operations and comprehensive loss. Refer to Note 12 for additional information.

***Embedded Derivatives***

Prior to its refinancing in June 2024, the Term Loan contained certain prepayment features, default put

option and default interest adjustment features that were determined to be embedded derivatives

requiring bifurcation and separate accounting as a single compound derivative, as discussed in Note 13.

The impact of bifurcation of the embedded derivative on the date of issuance was reflected as a debt

discount. The fair value of the derivative liability related to the Company's Term Loan, as discussed in

Note 8, was estimated using a scenario-based analysis comparing the probability-weighted present value

of the Term Loan payoff at maturity with and without the bifurcated features. This method isolates the

value of the embedded derivative by measuring the difference in the host contract's value with and

without the isolated features. The resulting cash flows are discounted at the Company's borrowing rate,

as adjusted for fluctuations in the market interest rate from the inception of the Company's comparative

borrowings to the reporting date, to measure the fair value of the embedded derivative. Until its

derecognition in June 2024, the derivative liability was remeasured to fair value at each reporting period

and the related change was reflected as change in fair value of derivative liability on the consolidated

statements of operations and comprehensive loss.

The 2025 Convertible Notes contain certain settlement features and default put options that were

determined to be embedded derivatives requiring bifurcation and separate accounting as a single

compound derivative, as discussed in Note 13. The impact of bifurcation of the embedded derivatives on

the date of issuance during the three months ended March 31, 2025 (unaudited) was reflected as a debt

discount. The fair value of the derivative liability related to the Company's 2025 Convertible Notes, as

discussed in Note 9, were estimated using a scenario-based analysis comparing the probability-weighted

present value of the 2025 Convertible Notes with and without the bifurcated features. This method

isolates the value of the embedded derivatives by measuring the difference in the host contract's value

with and without the isolated features. To measure the fair value of the embedded derivatives, the

resulting cash flows were discounted using appropriate discount rates that reflect the overall implied risk

of the instruments based on their purchase prices and adjusted for fluctuations in the market and

Company interest rates when necessary. The derivative liability was remeasured to fair value at March 31,

2025 (unaudited) and the related change was reflected as change in fair value of derivative liability on the

consolidated statements of operations and comprehensive loss for the three months ended March 31,

2025 (unaudited).

***Redeemable Convertible Preferred Stock***

The Company records redeemable convertible preferred stock at fair value on the dates of issuance, net

of issuance costs. The redeemable convertible preferred stock is recorded outside of stockholders' deficit

because the preferred shares are contingently redeemable upon the occurrence of an event that is

outside of the Company's control. The Company has elected not to adjust the carrying values of the

redeemable convertible preferred stock to the liquidation preferences of such shares because it is

uncertain whether or when an event would occur that would obligate the Company to pay the liquidation

preferences to holders of shares of redeemable convertible preferred stock. Subsequent adjustments to

the carrying values to the liquidation preferences will be made only when it becomes probable that such

liquidation event will occur. The redemption value of each series of redeemable convertible preferred

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

stock is equal to their respective original issue price plus accrued but unpaid dividends on Series C

redeemable convertible preferred shares and all declared but unpaid dividends (if any) for other series of

redeemable convertible preferred shares. In connection with the Series F redeemable convertible

preferred stock financing, the cumulative dividends payable to holders of Series C redeemable convertible

preferred stock upon a liquidation event were capped from $6.66 to $8.25 per share depending on the

time of issuance, with an aggregate total of $88.5 million as of December 31, 2023 and 2024 and March

31, 2025 (unaudited). Refer to Note 10 for additional information.

***Revenue Recognition***

The Company sells its HeartFlow Platform to medical providers in the United States and in select

international markets. The Company determines revenue recognition through the following steps:

• Identification of the contract, or contracts, with a customer;

• Identification of the performance obligations in the contract;

• Determination of the transaction price;

• Allocation of the transaction price to the performance obligations in the contract; and

• Recognition of revenue when, or as, the Company satisfies a performance obligation.

The Company identified a single performance obligation, which is comprised of a highly interdependent

bundle of goods or services that are not distinct on their own but are as a group and consists of providing

implementation services and the requested analysis, including an image file and related licenses and

support. Revenue recognition commences only after completion of installation, implementation and

training for new customer accounts. The Company's service consists of providing a visualization of the

patient's coronary arteries and enables physicians to create more effective treatment plans. This service

is normally billable upon delivery of the analysis to the physician. Payment terms are generally net 30

days.

Substantially all of the Company's revenue is from usage-driven fees and generated on a "pay-per-click"

basis each time a physician orders the Company's HeartFlow FFRCT Analysis and Plaque Analysis. The

Company also derives revenue from subscription fees from customers accessing the Company's hosted

software service during the subscription period. During the years ended December 31, 2023 and 2024

and three months ended March 31, 2024 and 2025 (unaudited), 98.1%, 98.8%, 97.6% and 98.9% of

revenue was from usage-driven fees, respectively, and the remainder was from subscription fees.

Revenue is recognized when control of these services is transferred to the customer, at an amount that

reflects the consideration the Company expects to be entitled to receive in exchange for those services.

The Company recognizes usage-driven fee revenue upon delivery of the requested analysis to the

physician, which is when control of these services is transferred to the customer. The Company

recognizes revenue on a straight-line basis over the contract term for subscriptions where the customer

pays a fixed amount upfront for unlimited analyses. Contracts with customers typically include a fixed

amount of consideration and are generally cancellable with 30 days' written notice.

The transaction price consists of fixed consideration and variable consideration related to utilization and

volume rebates for reimbursement claims from government and commercial payers which are known and

determinable based on the number of analyses delivered within each quarterly period. The transaction

price (inclusive of both fixed consideration and variable consideration that is not constrained) is

recognized as revenue when control transfers. The Company uses a portfolio approach to estimate

variable consideration using the expected value method.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

***Unbilled Receivables***

Unbilled receivables generally represent revenue in which the Company has satisfied its performance

obligation prior to invoicing. The Company records unbilled receivables within accounts receivable, net on

the consolidated balance sheets, based on the Company's unconditional right to payment at the end of

the applicable period.

***Contract Costs***

Costs associated with product revenue include a flat rate commission per analysis and new customer site

commissions as well as implementation and onboarding costs. The Company capitalizes new customer

site commissions and certain implementation and onboarding costs that are considered to be incremental

to the acquisition of new customer contracts. Capitalized implementation and onboarding costs are

amortized over an estimated period of benefit of two years and capitalized new site commission costs are

amortized over an estimated period of benefit of three years. The estimated period of benefit is

determined by evaluating average customer life, the nature of the related benefit, and the specific facts

and circumstances of its arrangements. The Company evaluates these assumptions at least annually and

periodically reviews whether events or changes in circumstances have occurred that could impact the

period of benefit.

The Company expenses flat rate commissions when incurred as commensurate with its usage-driven fee

revenue recognition and amortizes capitalized new customer site commissions to selling, general and

administrative expense in the consolidated statements of operations and comprehensive loss. During the

year ended December 31, 2023, new site commission costs were not capitalized as the amount was not

material. The Company amortizes capitalized implementation and onboarding costs to cost of revenue in

the consolidated statements of operations and comprehensive loss. Short-term capitalized contract costs

are included in prepaid expenses and other current assets and the long-term portion is included in other

non-current assets in the consolidated balance sheets.

***Remaining Performance Obligations***

Revenue allocated to remaining performance obligations represents the transaction price allocated to

performance obligations that are unsatisfied, or partially unsatisfied. It includes contract liabilities and

amounts that will be invoiced and recognized as revenue in future periods and does not include contracts

where the customer is not committed. The customer is not considered committed when they are able to

terminate for convenience without payment of a substantive penalty under the contract. Additionally, as a

practical expedient, the Company has not disclosed the value of unsatisfied performance obligations for

contracts with an original expected length of one year or less.

***Contract Liabilities***

The Company records contract liabilities when billings or payments are received in advance of revenue

recognition from subscription services. The contract liabilities balance is reduced as the revenue

recognition criteria are met, generally within 12 months. Once services are available to customers, the

Company records amounts due in accounts receivable, net and contract liabilities within accrued

expenses and other current liabilities on the consolidated balance sheets. To the extent the Company bills

customers in advance of the billing period commencement date, the accounts receivable and

corresponding contract liabilities amount are netted to zero on the consolidated balance sheets, unless

such amounts have been paid as of the balance sheet date.

***Cost of Revenue***

Cost of revenue includes, but is not limited to, personnel and related expenses, stock-based

compensation costs, third-party hosting fees, amortization of capitalized internal-use software,

amortization of contract fulfillment costs as well as royalties associated with technology licenses used in

connection with the delivery of the Company's HeartFlow Platform and allocated overhead, including rent,

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

equipment, depreciation, technology services and utilities, related to the Company's production team. The

role of the production team is to support the Company's patient case volume revenue by performing

defined quality-related activities on CCTA scans submitted by its customers for analysis. The production

team also supports activities in the Company's clinical trials and research and development, which are

allocated as research and development expense.

***Research and Development***

Costs related to research, design, development, clinical studies, regulatory activities, and medical affairs

are charged to research and development and are expensed as incurred. These costs include, but are not

limited to, personnel and related expenses, clinical trials, stock-based compensation costs, third-party

consulting costs, the portion of the costs incurred by the production team to support clinical trials and

research and development efforts, and allocated overhead, including rent, equipment, depreciation and

utilities.

***Clinical Trials***

The Company accrues and expenses costs for its clinical trial activities performed by third parties,

including clinical research organizations and other service providers, based upon estimates of the work

completed over the life of the individual study in accordance with associated agreements. The Company

determines these estimates through discussion with internal personnel and outside service providers as

to progress or stage of completion of trials or services pursuant to contracts with clinical research

organizations and other service providers and the agreed-upon fee to be paid for such services.

***Advertising Costs***

The Company expenses advertising costs as incurred. Advertising costs includes design and production

costs, including website development, testimonial videos, written media campaigns and other items.

Advertising costs of $778,000, $1,538,000, $327,000 and $384,000 was expensed during the years

ended December 31, 2023 and 2024, and three months ended March 31, 2024 and 2025 (unaudited),

respectively.

***Stock-Based Compensation***

The Company accounts for share-based payments at fair value. The grant date fair value of options

granted is measured using the Black-Scholes option pricing model. Option awards vest based on the

satisfaction of a service requirement and stock-based compensation expense is recorded on a straight-

line basis over the applicable service period, which is generally four years. For performance-based stock

options, the Company will assess the probability of performance conditions being achieved in each

reporting period. The amount of stock-based compensation expense recognized in any one period related

to performance-based stock options can vary based on the achievement or anticipated achievement of

the performance conditions. Forfeitures are recognized in the period in which the forfeiture occurs.

***Income Taxes***

The Company accounts for income taxes under the asset and liability method. Under this method,

deferred tax assets and liabilities are determined based on the temporary differences between the

financial statement and tax basis of assets and liabilities using enacted tax rates in effect for the year in

which the differences are expected to reverse. As a result of the history of net operating losses, the

Company has provided for a full valuation allowance against the deferred tax assets for assets that are

not more-likely-than-not to be realized.

The Company applies a comprehensive model for the recognition, measurement, presentation and

disclosure in the consolidated financial statements of any uncertain tax positions that have been taken or

expected to be taken on a tax return using a two-step approach. The first step is to evaluate the tax

position taken or expected to be taken in a tax return by determining if the weight of available evidence

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**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

indicates that it is more likely than not that the tax position will be sustained upon examination by the

relevant taxing authorities, based on the technical merits of the position. For tax positions that are more

likely than not to be sustained upon audit, the second step is to measure the tax benefit in the financial

statements as the largest benefit that has a greater than 50% likelihood of being sustained upon

settlement. Significant judgment is required to evaluate uncertain tax positions. Changes in facts and

circumstances could have a material impact on the Company's effective tax rate and results of operations.

The Company recognizes interest and penalties, if any, related to unrecognized tax benefits as a

component of provision for income taxes in the consolidated statements of operations and comprehensive

loss.

***Comprehensive Loss***

Comprehensive loss is comprised of net loss and foreign currency translation gains and losses.

***Foreign Currency***

The functional currency of the Company's foreign subsidiaries is the local currency except for HeartFlow

International Sarl, which was the U.S. Dollar. For all non-functional currency balances, the

remeasurement of such balances to the functional currency results in either a foreign exchange

transaction gain or loss, which is recorded within other income, net within the consolidated statements of

operations and comprehensive loss. The Company recognized foreign exchange transaction losses of

$172,000, $269,000, $137,000 and $357,000 during the years ended December 31, 2023 and 2024, and

three months ended March 31, 2024 and 2025 (unaudited), respectively. During the years ended

December 31, 2023 and 2024, and three months ended March 31, 2024 and 2025 (unaudited), the

Company recognized $504,000, $271,000, $(1,000) and $236,000 of foreign currency translation (gain)

loss, respectively, in the statements of comprehensive loss related to foreign subsidiaries which have

local functional currencies.

***Net Loss Per Share Attributable to Common Stockholders***

Basic net loss per common share is calculated by dividing the net loss attributable to common

stockholders by the weighted-average number of shares of common stock outstanding during the period,

without consideration of potentially dilutive securities. Diluted net loss per share is computed by dividing

the net loss attributable to common stockholders by the weighted-average number of shares of common

stock and potentially dilutive securities outstanding for the period. For purposes of the diluted net loss per

share calculation, the redeemable convertible preferred stock, common stock warrants and stock options

are considered to be potentially dilutive securities.

Basic and diluted net loss attributable to common stockholders per share is presented in conformity with

the two-class method required for participating securities as the redeemable convertible preferred stock

and common stock subject to repurchase are considered participating securities. The Company's

participating securities do not have a contractual obligation to share in the Company's losses. As such,

the net loss is attributed entirely to common stockholders. Diluted net loss per share is the same as basic

net loss per share because the effects of potentially dilutive items were anti-dilutive given the Company's

net loss position during the years ended December 31, 2023 and 2024 and three months ended March

31, 2024 and 2025 (unaudited).

**Recent Accounting Pronouncements**

From time to time, new accounting pronouncements are issued by the Financial Accounting Standards

Board ("FASB") or other standard setting bodies and adopted by the Company as of the specified

effective date. The Company qualifies as an "emerging growth company" as defined in the Jumpstart Our

Business Startups Act of 2012 and has elected not to "opt out" of the extended transition related to

complying with new or revised accounting standards, which means that when a standard is issued or

revised and it has different application dates for public and nonpublic companies, the Company will adopt

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**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

the new or revised standard at the time nonpublic companies adopt the new or revised standard and will

do so until such time that the Company either i) irrevocably elects to "opt out" of such extended transition

period or ii) no longer qualifies as an emerging growth company. The Company may choose to early

adopt any new or revised accounting standards whenever such early adoption is permitted for nonpublic

companies.

***Recently Adopted Accounting Pronouncements***

In August 2020, the FASB issued Account Standards Update ("ASU") 2020-06, *Debt-Debt with* 

*Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity's Own* 

*Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity's Own* 

*Equity*. The amendment simplifies the accounting for certain financial instruments with characteristics of

liabilities and equity, including convertible instruments and contracts on an entity's own equity. The new

standard requires entities to provide expanded disclosures about the terms and features of convertible

instruments, how the instruments have been reported in the entity's financial statements, and information

about events, conditions, and circumstances that can affect how to assess the amount or timing of an

entity's future cash flows related to those instruments. On January 1, 2024, the Company adopted ASU

2020-06, which had an immaterial impact on its financial statements.

In November 2023, the FASB issued ASU 2023-07, *Segment Reporting (Topic 280): Improvements to* 

*Reportable Segment Disclosures*. The amendment expands segment disclosures by requiring disclosure

of significant segment expenses that are regularly provided to the chief operating decision maker

("CODM"), the amount and description of other segment items, permits companies to disclose more than

one measure of segment profit or loss, and requires all annual segment disclosures to be included in the

interim periods. The amendments do not change how an entity identifies its operating segments,

aggregates those operating segments, or applies quantitative thresholds to determine its reportable

segments. During the year ended December 31, 2024, the Company adopted ASU 2023-07, which had a

disclosure only impact on its financial statements.

***Recent Accounting Pronouncements Not Yet Adopted***

In December 2023, the FASB issued ASU 2023-09, *Income Taxes (Topic 740): Improvements to Income* 

*Tax Disclosures*, which requires enhanced income tax disclosures, including specific categories and

disaggregation of information in the effective tax rate reconciliation, disaggregated information related to

income taxes paid, income or loss from continuing operations before income tax expense or benefit, and

income tax expense or benefit from continuing operations. This guidance is effective for annual periods

beginning after December 15, 2024. The adoption of ASU 2023-09 is expected to have a disclosure only

impact on the Company's financial statements for the year ended December 31, 2025.

In November 2024, the FASB issued ASU 2024-03, *Income Statement – Reporting Comprehensive* 

*Income – Expense Disaggregation Disclosures (Subtopic 220-40): Disaggregation of Income Statement* 

*Expenses*, which requires more detailed disclosures about specified categories of expenses (including

employee compensation, depreciation, and amortization) included in certain expense captions presented

on the face of the income statement. This ASU is effective for fiscal years beginning after December 15,

2026, and for interim periods within fiscal years beginning after December 15, 2027, with early adoption

permitted. The amendments may be applied either (i) prospectively to financial statements issued for

reporting periods after the effective date of this ASU or (ii) retrospectively to all prior periods presented in

the financial statements. The Company is currently evaluating the impact of this pronouncement on the

disclosures in its consolidated financial statements.

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**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

**3. Revenue and Contract Balances**

***Disaggregation of Revenue***

The following table summarizes total revenue from customers by geographic region (in thousands):

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** | **Three Months Ended** <br>**March 31,** | **Three Months Ended** <br>**March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| United States............................................................... | $77725 | $115036 | $24394 | $34298 |
| United Kingdom........................................................... | 4492 | 5185 | 1210 | 1452 |
| Japan............................................................................. | 4003 | 4297 | 979 | 1194 |
| Rest of Europe............................................................. | 954 | 1290 | 260 | 261 |
| Total revenue............................................................... | $87174 | $125808 | $26843 | $37205 |

---

Revenues by geography are determined based on the region of the Company's contracting entity, which

may be different than the region of the customer.

***Contract Balances***

Unbilled receivables included within accounts receivable on the consolidated balance sheets as of

December 31, 2023 and 2024 and March 31, 2025 (unaudited) was $342,000, $574,000 and $861,000,

respectively.

The following table provides the breakdown of capitalized contract costs on the consolidated balance

sheets (in thousands):

---

| | | | |
|:---|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** | |
|  | **2023** | **2024** | **Three Months** <br>**Ended**<br>**March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| Balance at beginning of period.................................................. | $2077 | $2941 | $6154 |
| Contract costs capitalized.......................................................... | 3081 | 6952 | 2064 |
| Contract costs amortized............................................................ | (2217) | (3739) | (1307) |
| Balance at end of period............................................................. | $2941 | $6154 | $6911 |

---

The following table provides the breakdown of contract liabilities included within accrued expenses and

other current liabilities on the consolidated balance sheets (in thousands):

---

| | | | |
|:---|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** | |
|  | **2023** | **2024** | **Three Months** <br>**Ended**<br>**March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| Balance at beginning of period.................................................. | $118 | $498 | $182 |
| Contract liabilities added............................................................ | 470 |  |  |
| Contract liabilities recognized as revenue............................... | (90) | (316) | (27) |
| Balance at end of period............................................................. | $498 | $182 | $155 |

---

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**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

**4. Fair Value Measurement**

The following table summarizes the Company's financial assets and liabilities measured at fair value on a

recurring basis by level within the fair value hierarchy (in thousands):

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **December 31, 2023** | **December 31, 2023** | **December 31, 2023** | **December 31, 2023** |
|  | **Level 1** | **Level 2** | **Level 3** | **Total** |
| **Assets** |  |  |  |  |
| Money market funds included in cash and <br>cash equivalents...............................................<br>| $115636 | $— | $— | $115636 |
| Total.................................................................... | $115636 | $— | $— | $115636 |
| **Liabilities** |  |  |  |  |
| Common stock warrant liability...................... | $— | $— | $4440 | $4440 |
| Derivative liability.............................................. |  |  | 903 | 903 |
| Total.................................................................... | $— | $— | $5343 | $5343 |

---

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **December 31, 2024** | **December 31, 2024** | **December 31, 2024** | **December 31, 2024** |
|  | **Level 1** | **Level 2** | **Level 3** | **Total** |
| **Assets** |  |  |  |  |
| Money market funds included in cash and <br>cash equivalents...............................................<br>| $36882 | $— | $— | $36882 |
| Total.................................................................... | $36882 | $— | $— | $36882 |
| **Liabilities** |  |  |  |  |
| Common stock warrant liability...................... | $— | $— | $20835 | $20835 |
| Total.................................................................... | $— | $— | $20835 | $20835 |

---

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **March 31, 2025 (unaudited)** | **March 31, 2025 (unaudited)** | **March 31, 2025 (unaudited)** | **March 31, 2025 (unaudited)** |
|  | **Level 1** | **Level 2** | **Level 3** | **Total** |
| **Assets** |  |  |  |  |
| Money market funds included in cash and <br>cash equivalents...............................................<br>| $48363 | $— | $— | $48363 |
| Total.................................................................... | $48363 | $— | $— | $48363 |
| **Liabilities** |  |  |  |  |
| Common stock warrant liability...................... | $— | $— | $22441 | $22441 |
| Derivative liability.............................................. |  |  | 40945 | 40945 |
| Total.................................................................... | $— | $— | $63386 | $63386 |

---

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

The following tables present a reconciliation of the Company's financial liabilities measured at fair value

as of December 31, 2023 and 2024 and March 31, 2025 (unaudited) using significant unobservable inputs

(Level 3), and the change in fair value (in thousands):

---

| | |
|:---|:---|
|  | **2022** <br>**Convertible** <br>**Notes**<br>|
| Fair value as of January 1, 2023..................................................................................................... | $56066 |
| Change in fair value........................................................................................................................... | 5120 |
| Derecognition of convertible notes upon conversion into redeemable convertible preferred <br>stock.....................................................................................................................................................<br>| (61186) |
| Fair value as of December 31, 2023............................................................................................... | $— |

---

The 2022 Convertible Notes, which are not regularly traded, are classified as Level 3, since their values

cannot be determined by using readily observable inputs or measures, such as market prices (see Note

9). The fair value of the 2022 Convertible Notes was estimated as the sum of its components (conversion

features and the debt component) as of the issuance dates and as of the subsequent balance sheet

dates. To value each of the conversion features, a "with and without" methodology was employed. The

debt component was valued using a discounted cash flow method that measured the net present value of

the principal and interest payments to be received by the holders of the 2022 Convertible Notes

(excluding the conversion features) through the estimated maturity date.

---

| | |
|:---|:---|
|  | **Common** <br>**Stock** <br>**Warrant** <br>**Liability**<br>|
| Fair value as of January 1, 2023..................................................................................................... | $2120 |
| Change in fair value........................................................................................................................... | 2320 |
| Fair value as of December 31, 2023............................................................................................... | 4440 |
| Change in fair value........................................................................................................................... | 16395 |
| Fair value as of December 31, 2024............................................................................................... | 20835 |
| Change in fair value (unaudited)...................................................................................................... | 1606 |
| Fair value as of March 31, 2025 (unaudited)................................................................................. | $22441 |

---

In determining the fair value of the common stock warrant liability, the Company used the Black-Scholes

option pricing model to estimate the fair value using unobservable inputs including the expected term,

expected volatility, risk-free interest rate and dividend yield (see Note 12).

---

| | |
|:---|:---|
|  | **Term Loan** <br>**Derivative** <br>**Liability**<br>|
| Fair value as of January 1, 2023..................................................................................................... | $5061 |
| Change in fair value........................................................................................................................... | (4158) |
| Fair value as of December 31, 2023............................................................................................... | 903 |
| Change in fair value........................................................................................................................... | 222 |
| Derecognition in connection with debt refinancing....................................................................... | (1125) |
| Fair value as of December 31, 2024............................................................................................... | $— |

---

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

In determining the fair value of the term loan derivative liability, a two-step valuation approach was

employed, which included a probability-weighted scenario valuation method, the Black-Scholes-Merton

method, and the option pricing method, using unobservable inputs (see Note 13), which are classified as

Level 3 within the fair value hierarchy, and then comparing the instrument's value with and without the

derivative features to estimate their combined fair value. The debt instrument is carried at amortized cost,

which approximates its fair value.

---

| | |
|:---|:---|
|  | **2025 Convertible Notes** <br>**Derivative Liability**<br>**(unaudited)**<br>|
| Fair value as of January 1, 2025.................................................................................... | $— |
| Recognition in connection with convertible notes offering (unaudited).................... | 31900 |
| Change in fair value (unaudited)..................................................................................... | 9045 |
| Fair value as of March 31, 2025 (unaudited)................................................................ | $40945 |

---

In determining the fair value of the convertible notes derivative liability, a two-step valuation approach was

employed, which included a probability-weighted scenario valuation method, the Monte Carlo Simulation

method, and the option pricing method, using unobservable inputs (see Note 13), which are classified as

Level 3 within the fair value hierarchy, and then comparing the instrument's value with and without the

derivative features to estimate their combined fair value. The debt instrument is carried at amortized cost,

which approximates its fair value.

**5. Balance Sheet Components**

***Allowance for Credit Losses***

The following table presents a reconciliation of the allowance for credit losses (in thousands):

---

| | | | |
|:---|:---|:---|:---|
|  | **Year Ended** <br>**December 31,** | **Year Ended** <br>**December 31,** | |
|  | **2023** | **2024** | **Three Months Ended**<br>**March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| Balance at beginning of period.................................. | $212 | $1058 | $814 |
| Additions....................................................................... | 1190 |  |  |
| Write-offs....................................................................... | (344) | (244) | (72) |
| Balance at end of period............................................ | $1058 | $814 | $742 |

---

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

***Prepaid Expenses and Other Current Assets***

Prepaid expenses and other current assets are comprised of the following (in thousands):

---

| | | | |
|:---|:---|:---|:---|
|  | **December 31,** | **December 31,** | |
|  | **2023** | **2024** | **March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| Prepaid expenses........................................................................ | $2583 | $3017 | $3633 |
| Contract costs, current................................................................ | 1953 | 2453 | 2453 |
| Other.............................................................................................. | 598 | 662 | 455 |
| Total prepaid expenses and other current assets ................. | $5134 | $6132 | $6541 |

---

***Property and equipment, net***

Property and equipment consisted of the following (in thousands):

---

| | | | |
|:---|:---|:---|:---|
|  | **December 31,** | **December 31,** | |
|  | **2023** | **2024** | **March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| Property and equipment at cost: |  |  |  |
| Computer equipment and software........................................... | $8842 | $4489 | $4489 |
| Furniture, fixtures and equipment............................................. | 1095 | 1233 | 1233 |
| Capitalized internal-use software.............................................. | 48535 | 52606 | 53542 |
| Leasehold improvements........................................................... | 2057 | 2057 | 2079 |
| Construction in progress............................................................. | 57 | 27 | 176 |
| Total property and equipment .............................................. | 60586 | 60412 | 61519 |
| Less: Accumulated depreciation and amortization................. | (50665) | (51492) | (52864) |
| Property and equipment, net .................................................... | $9921 | $8920 | $8655 |

---

The Company capitalized certain internal-use software costs totaling $4.6 million, $4.1 million, $796,000

and $936,000, including stock-based compensation of $408,000, $393,000, $77,000 and $6,000 related

to internal-use software development efforts, during the years ended December 31, 2023 and 2024, and

three months ended March 31, 2024 and 2025 (unaudited), respectively. Amortization of capitalized

internal-use software totaled $3.2 million, $3.7 million, $733,000 and $1.0 million for the years ended

December 31, 2023 and 2024, and three months ended March 31, 2024 and 2025 (unaudited),

respectively.

Depreciation and amortization expense related to property and equipment, excluding capitalized internal-

use software, was $1.5 million, $1.7 million, $471,000 and $370,000 for the years ended December 31,

2023 and 2024, and three months ended March 31, 2024 and 2025 (unaudited), respectively.

***Other Non-Current Assets***

Other non-current assets are comprised of the following (in thousands):

---

| | | | |
|:---|:---|:---|:---|
|  | **December 31,** | **December 31,** | |
|  | **2023** | **2024** | **March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| Contract costs, net....................................................................... | $988 | $3701 | $4458 |
| Deferred offering costs................................................................ |  | 413 | 3323 |

---

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

---

| | | | |
|:---|:---|:---|:---|
| Other.............................................................................................. | 267 | 252 | 249 |
| Total other non-current assets .................................................. | $1255 | $4366 | $8030 |

---

***Accrued Expenses and Other Current Liabilities***

Accrued expenses and other current liabilities are comprised of the following (in thousands):

---

| | | | |
|:---|:---|:---|:---|
|  | **December 31,** | **December 31,** | |
|  | **2023** | **2024** | **March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| Accrued payroll and related expenses..................................... | $15228 | $18206 | $20758 |
| Customer contract and rebate liabilities................................... | 2109 | 1041 | 3421 |
| Accrued royalty............................................................................ | 1604 | 736 | 1149 |
| Accrued professional fees.......................................................... | 1188 | 1672 | 7597 |
| Accrued clinical trial expenses.................................................. | 1148 | 1215 | 1363 |
| Other.............................................................................................. | 3513 | 2449 | 1695 |
| Total accrued expenses and other current liabilities ............. | $24790 | $25319 | $35983 |

---

**6. Leases**

The Company leases office space in Mountain View, California, Santa Rosa, California, Austin, Texas,

and Tokyo, Japan.

***Mountain View, California***

In August 2021, the Company entered into a facility lease agreement with MV Campus Owner, LLC. (the

"Landlord"), for approximately 61,000 rentable square feet in Mountain View, California through August

2030. The Company received a tenant improvement allowance of $1.8 million, in which the remaining

unused amount of $1.4 million was credited against rent expense during the year ended December 31,

2023. In connection with the lease, the Company established a standby letter of credit for the benefit of

the landlord in the amount of $4.3 million in August 2021, which is classified as non-current restricted

cash on the consolidated balance sheets as of December 31, 2023 and 2024 and March 31, 2025

(unaudited).

***Santa Rosa, California***

In October 2024, the Company entered into an agreement to sublease approximately 4,000 rentable

square feet of office space in Santa Rosa, California for 29 months commencing on November 1, 2024. In

connection with this sublease, the Company paid a security deposit of $8,000 and recorded an ROU

asset and lease liability of $169,000.

***Austin, Texas***

In January 2023, the Company amended its facility lease agreement in Austin, Texas, which provides for

approximately 26,000 square feet of space, to extend the lease term which expired in November 2023

with a five-year renewal option to December 2025 with no renewal option. In connection with the lease

amendment, the Company recorded a reduction of $1.8 million in ROU asset and lease liability from the

remeasurement that previously included the renewal option during the year ended December 31, 2023. In

March 2025, the Company amended the lease for its Austin, Texas facility to extend the lease term an

additional 12 months through December 2026 and recorded an ROU asset and lease liability of $561,000

in connection with the lease extension. A security deposit of $150,000 was recorded as non-current

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

restricted cash as of December 31, 2023 and March 31, 2025 (unaudited) and as current restricted cash

as of December 31, 2024, on the consolidated balance sheets related to this lease.

***Tokyo, Japan***

The Company has one non-cancellable operating lease for its facility in Tokyo, Japan which was set to

expire in November 2024. In April 2024, the Company entered into an agreement to extend the lease for

an additional three years through November 2027. In connection with the new lease agreement, the

Company recorded an ROU asset and lease liability of $420,000.

Operating lease cost consisted of the following (in thousands):

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **December 31,** | **December 31,** | **March 31,** | **March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| Operating lease cost......................................... | $4906 | $4900 | $1222 | $1251 |
| Variable lease cost............................................ | 1120 | 1597 | 378 | 363 |
| Total lease cost.................................................. | $6026 | $6497 | $1600 | $1614 |

---

Cash paid for amounts included in the measurement of operating lease liabilities during the years ended

December 31, 2023 and 2024, and the three months ended March 31, 2024 and 2025 (unaudited) was

$4.1 million, $5.2 million, $1.3 million and $1.4 million, respectively.

The following table summarizes the maturities of the aggregate lease payments under the Company's

operating lease liabilities as of December 31, 2024 and March 31, 2025 (unaudited) (in thousands):

---

| | | |
|:---|:---|:---|
|  | **December 31,**<br>**2024** | **March 31,**<br>**2025** |
| **Operating Leases:** |  | **(unaudited)** |
| 2025.......................................................................................................................... | $5647 | $4243 |
| 2026.......................................................................................................................... | 5109 | 5797 |
| 2027.......................................................................................................................... | 5177 | 5185 |
| 2028.......................................................................................................................... | 5155 | 5155 |
| 2029.......................................................................................................................... | 5309 | 5309 |
| Thereafter................................................................................................................ | 3645 | 3645 |
| Total minimum lease payments............................................................................ | 30042 | 29334 |
| Less: Amount of lease payments representing interest.............................. | 6089 | 5708 |
| Present value of future minimum lease payments............................................ | $23953 | $23626 |
| Less: current portion......................................................................................... | 5416 | 5453 |
| Operating lease liabilities, net of current portion............................................... | $18537 | $18173 |

---

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

The following table summarizes additional information related to the Company's operating leases (in

thousands, except weighted-average data):

---

| | | | |
|:---|:---|:---|:---|
|  | **December 31,** | **December 31,** | |
|  | **2023** | **2024** | **March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| Right-of-use assets..................................................................... | $20961 | $18805 | $18642 |
| Weighted-average remaining lease term (years)................... | 6.5 | 5.5 | 5.2 |
| Weighted-average discount rate............................................... | 9.0% | 9.0% | 9.2% |

---

**7. Commitments and Contingencies**

***Royalty Commitments***

The Company has entered into various exclusive technology licensing agreements and other software

licensing agreements. The terms of the agreements require the Company to make annual royalty

payments in fixed amounts as well as certain milestone and revenue-based payments. The revenue-

based royalty percentage is in the low single digits, subject to reductions and offsets in certain

circumstances with a minimum royalty commitment of $50,000 annually. Future minimum royalty

commitments due under the terms of these exclusive agreements as of December 31, 2024 and March

31, 2025 (unaudited) are as follows (in thousands):

---

| | | |
|:---|:---|:---|
|  | **December 31,**<br>**2024** | **March 31,**<br>**2025** |
| **Minimum Royalty Commitments:** |  | **(unaudited)** |
| 2025.......................................................................................................................... | $50 | $— |
| 2026.......................................................................................................................... | 50 | 50 |
| 2027.......................................................................................................................... | 50 | 50 |
| 2028.......................................................................................................................... | 50 | 50 |
| 2029.......................................................................................................................... | 50 | 50 |
| Thereafter................................................................................................................. | 50 | 50 |
| Total minimum royalty commitments.................................................................... | $300 | $250 |

---

The Company incurred royalty expense of $2.1 million, $1.5 million, $336,000 and $414,000 for the years

ended December 31, 2023 and 2024, and three months ended March 31, 2024 and 2025 (unaudited),

respectively.

***Purchase Commitments***

Open purchase commitments consist of agreements to purchase of goods and services entered into in

the ordinary course of business. These amounts were not recorded as liabilities on the consolidated

balance sheets as of December 31, 2024 as the Company had not yet received the related goods or

services. As of December 31, 2024 and March 31, 2025 (unaudited), the Company had estimated open

purchase commitments for goods and services of $5.2 million and $4.3 million over the next four and

three years, respectively.

***Contingencies***

The Company is not involved in any pending legal proceedings that it believes could have a material

adverse effect on its financial condition, results of operations or cash flows. The Company may pursue or

be subject to litigation and other legal actions from time to time arising in the ordinary course of business,

including intellectual property, products liability, breach of contract, commercial, employment, and other

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

similar claims which could have an adverse impact on its reputation, business and financial condition and

divert the attention of its management from the operation of its business. The Company accrues a liability

for such matters when it is probable that future expenditures will be made, and such expenditures can be

reasonably estimated. There were no contingent liabilities requiring accrual or disclosures as of

December 31, 2023 and 2024 and March 31, 2025 (unaudited).

***Indemnifications***

The Company provides general indemnifications to management and the members of the Company's

board of directors (the "Board of Directors") when they act, in good faith, in the best interest of the

Company. The Company is unable to develop an estimate of the maximum potential amount of future

payments that could potentially result from any hypothetical future claim, but expects the risk of having to

make any payments under these general business indemnifications to be remote. The Company also

maintains insurance coverage that would generally enable the Company to recover a portion of any future

amounts paid.

**8. Term Loan**

***Initial Term Loan***

On January 19, 2021, the Company entered into a Credit Agreement with Hayfin Services, LLP ("Hayfin")

for total borrowings of up to $70.0 million (the "Initial Term Loan"). The Company received net cash

proceeds of $68.1 million, after deducting $1.3 million of lender fees as a discount to the debt, and

$629,000 of debt issuance costs. The Company also issued a warrant to the lender to purchase a total of

108,154 shares of its common stock. The fair value of the warrant was $4.3 million as of the issuance

date, which was accounted for as a debt discount. Refer to Note 12 for additional information.

***New Money Term Loan***

On March 17, 2022, the Company entered into Amendment No. 1 to the Credit Agreement with Hayfin for

an additional $50.0 million term loan (the "New Money Term Loan"), collectively with the Initial Term Loan,

(the "Term Loan"). Additionally, certain terms of the Initial Term Loan were amended. The Company

received net cash proceeds of $49.2 million, after deducting $820,000 of lender fees as a discount to the

debt. The Company also issued an additional warrant to the lender to purchase a total of 77,253 shares of

common stock. The fair value of the warrant was $3.5 million as of the issuance date, which was

accounted for as a debt discount. Refer to Note 12 for additional information.

***Other Amendments***

The Company entered into Amendments No. 2 and No. 3 to the Credit Agreement in September 2022 and

December 2022, respectively, which enabled the Company to issue Subordinated Convertible Promissory

Notes and to increase the aggregate principal of the Subordinated Convertible Promissory Notes that can

be issued to $42.0 million (see Note 9).

In the first quarter of 2023, the Company entered into three amendments to the Credit Agreement with

Hayfin. In March 2023, the Company entered into Amendment No. 4 and Waiver to Credit Agreement with

Hayfin to temporarily waive various covenant requirements that had not been met through the waiver date

and to enable the Company to amend certain terms of the Credit Agreement. Under Amendment No. 4, as

part of the Series F redeemable convertible preferred stock financing closing (see Note 10), the Company

issued to Hayfin 1,462,260 warrants for shares of common stock for no consideration and committed to

sell 921,018 and 1,201,423 shares of Series F-1 and Series F redeemable convertible preferred stock,

respectively. These shares were issued to Hayfin Heartflow UK Limited upon Convertible Note conversion

and upon the initial closing of Series F redeemable convertible preferred stock with the same terms as all

other investors. In March 2023, the Company entered into Amendment No. 5 to the Credit Agreement with

Hayfin, which required the Company's securities at JPMorgan Chase Bank to become a "Controlled

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

Account", as defined by the Credit Agreement. Also in March 2023, the Company entered into

Amendment No. 6 to the Credit Agreement with Hayfin, which permitted the reacquisition of 102,739

shares of common stock from an employee/founder of the Company. In connection with these

amendments, the Company paid $94,000 in lender fees, which were recorded as a debt discount.

Amendments No. 4 through No. 6 were accounted for as debt modifications for accounting purposes.

***2024 Credit Agreement***

On June 14, 2024, the Company entered into a Credit Agreement and Guaranty (the "2024 Credit

Agreement") with Hayfin for a $138.1 million term loan (the "2024 Term Loan") to refinance its outstanding

loan obligations under the 2021 Credit Agreement, as amended (the "2021 Credit Agreement"). In

addition, in connection with the 2024 Term Loan, the Company entered into several other adjoining

agreements with Hayfin. The 2024 Term Loan extended the maturity date from January 19, 2026 to

June 14, 2028. The 2024 Credit Agreement was accounted for as a debt modification for accounting

purposes.

On January 24, 2025, in connection with the issuance of the 2025 Convertible Notes, the Company

entered into Amendment No.1 to the 2024 Credit Agreement, in which Hayfin converted $23.0 million of

principal under the 2024 Term Loan to 2025 Convertible Notes under the same terms as the other

purchasers of the 2025 Convertible Notes. The principal balance outstanding under the 2024 Term Loan,

as amended, is $115.1 million as of March 31, 2025 (unaudited). The amendment was accounted for as a

debt modification for accounting purposes.

***Prepayment Terms and Other Fees***

Any prepayment or repayment of the principal balance are subject to an exit fee. The Company is

accreting the exit fee over the loan term using the effective interest method. Under the 2024 Term Loan,

the Company has the option to prepay the 2024 Term Loan subject to a prepayment fee of 1.5% for

prepayments after the second anniversary but on or prior to the third anniversary of the 2024 Term Loan

and a prepayment fee of 3% for prepayments thereafter. The Company must repay the loan in full

immediately upon the occurrence of a change in control. In addition, immediately upon the consummation

of an IPO or SPAC, as defined in the terms of the 2024 Credit Agreement, the Company shall repay the

2024 Term Loan in an amount equal to the lesser of (i) the net cash proceeds of such IPO or SPAC in

excess of $150.0 million and (ii) $35.0 million. In connection with Amendment No.1 to the 2024 Term Loan

in January 2025, the amount immediately payable upon the consummation of an IPO or SPAC, as defined

in the terms of the 2024 Credit Agreement, was amended where repayment of the 2024 Term Loan will be

at an amount equal to the lesser of (i) the net cash proceeds of such IPO or SPAC in excess of $150.0

million and (ii) $50.0 million (or $55.0 million if the underwriters exercise any portion of their option to

purchase additional shares).

On June 14, 2024, concurrently with entering the 2024 Credit Agreement, the Company signed a fee

letter agreement with Hayfin under which the Company agreed to pay $9.2 million in fees to Hayfin, which

consists of a 3% exit fee and 3% early prepayment fee due under the 2021 Credit Agreement in the

amount of $8.3 million payable in sixteen equal quarterly installments of approximately $518,000 through

March 31, 2028, agent fees of $150,000, due in annual installments of $30,000 through March 31, 2028

and an upfront fee of $721,000. The Company paid the $721,000 upfront fee and $30,000 agent fee upon

the closing of the 2024 Term Loan. The exit fee and early prepayment fee must be repaid in full

immediately upon the occurrence of a financing event, including, but not limited to, any IPO, SPAC, or

issuance of convertible notes or equity. The exit fee and early prepayment fee remaining under the

original terms of the 2024 Term Loan, which were immediately due and payable upon issuance of the

2025 Convertible Notes was amended in January 2025 to be immediately due and payable upon the next

occurrence of a financing event as described above.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

***Interest***

The Initial Term Loan had an interest rate equal to the sum of the applicable margin of 6.0% plus the

higher of SOFR and 1.0%, and the New Money Term Loan had an interest rate equal to the sum of the

applicable margin of 15.25% plus the higher of the adjusted term for such interest period and 1.0%.

Interest payments are due quarterly. The Company may elect to pay the quarterly interest in-kind ("PIK")

through the last interest period ending before the second anniversary of the original Credit Agreement.

However, if the Company elects to pay interest in-kind after the first anniversary, the applicable margin

increases by 1.0%.

With respect to the New Money Term Loan, the Company may elect to pay PIK Interest, provided that, (i)

prior to December 31, 2023, a minimum of 3% per annum shall be payable in cash and (ii) on or after

December 31, 2023, a minimum of 6% per annum shall be payable in cash. During the year ended

December 31, 2023, $144,000 of interest was paid-in-kind and was added to the outstanding principal

balance of the Term Loan.

The 2024 Term Loan bears interest at a floating per annum rate in an amount equal to the sum of (i) 7.0%

(or 6.0% if the alternative base rate ("ABR") is in effect) plus (ii) the greater of (x) the forward-looking term

rate based on SOFR for a respective tenor (or the alternative base rate, if applicable), and (y) 2.0%. The

ABR equals to the sum of (i) 6.0% plus (ii) the greater of (1) the Wall Street Journal Prime Rate, plus

0.5%, (2) the Federal Reserve Bank of New York rate plus 0.5% or (3) CBA Term SOFR for one month

tenor plus 1.0%. The Company has the option to pay interest in-kind at the rate equal to the cash interest

rate plus 1.0%.

***Debt Issuance Costs and Debt Discount***

Debt issuance costs include third-party costs incurred in connection with the original Credit Agreement.

Debt discount includes fees paid to the lender, warrants issued to the lender and the embedded derivative

liability as described below.

Prior to the refinancing of the 2021 Credit Agreement with the 2024 Term Loan (the "2024 Term Loan

Refinancing"), certain prepayment features of the Term Loan, default put option and default interest

adjustment features were determined to be embedded derivatives requiring bifurcation and separate

accounting for at fair value as a single compound derivative. The fair value of the derivative liability was

$2.1 million, as of the issuance date in January 2021, and is remeasured to fair value at each reporting

period. In connection with the 2024 Term Loan Refinancing, the associated current fair value of the

derivative liability of $1.1 million was remeasured at the date of refinancing and was derecognized and

recorded as a debt discount to the 2024 Term Loan. Refer to Note 13 for additional information.

In connection with the conversion of $23.0 million of principal under the 2024 Term Loan to 2025

Convertible Notes under Amendment No.1 to the 2024 Credit Agreement in January 2025, $239,000 of

pro-rata debt discount under the 2024 Term Loan was reclassified as a debt discount under the 2025

Convertible Notes.

The debt issuance costs and debt discount are classified as an offset to the Term Loan on the

consolidated balance sheets, and is accreted over the loan term using the effective interest method.

As of December 31, 2023, the effective interest rate of the Initial Term Loan and the New Money Term

Loan was 16.1% and 26.8%, respectively. As of December 31, 2024 and March 31, 2025 (unaudited), the

effective interest rate of the 2024 Term Loan was 16.0% and 15.2%, respectively.

***Collateral and Covenants***

The 2024 Term Loan is collateralized by substantially all of the Company's assets. The 2024 Credit

Agreement contains certain customary representations and warranties, covenants, events of default,

termination provisions and affirmative and negative covenants, including, among others, covenants that

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**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

limit or restrict the Company's (and its subsidiaries) ability to incur additional indebtedness, grant liens,

merge or consolidate, make acquisitions, pay dividends or other distributions or repurchase equity, make

investments, dispose of assets and enter into certain transactions with affiliates, in each case subject to

certain exceptions. Events of default include, among others, non-payment of principal, interest or fees,

violation of covenants, inaccuracy of representations and warranties, bankruptcy and insolvency events,

material judgments, cross-defaults to material contracts and events constituting a change of control. Upon

the occurrence of an event of default, the interest rate applicable to the 2024 Term Loan shall increase by

3.0% per annum and the outstanding principal balance, along with any accrued interest, shall become

immediately due and payable. The Company is subject to financial covenants which requires the

Company to maintain a $25.0 million minimum liquidity balance in cash and cash equivalents at all times

and minimum net sales for twelve consecutive month periods ending on the last day of a fiscal quarter,

which is not tested as long as the Company maintains minimum liquidity of at least $60.0 million and there

has been no decline in net sales for two-consecutive fiscal quarters at the end of such fiscal quarter. The

minimum twelve months trailing net sales covenant increases each quarter and is $70.0 million for the

quarter ended March 31, 2024 up to a minimum net sales amount of $110.0 million for the quarter ended

June 30, 2025 and each quarter thereafter. In connection with Amendment No.1 to the 2024 Term Loan in

January 2025, the minimum liquidity cash balance covenant under the 2024 Term Loan was reduced to

$15.0 million from the previous $25.0 million. Other non-financial covenants are outlined in the 2024

Credit Agreement.

As of December 31, 2024 and March 31, 2025 (unaudited), the Company was in compliance with the

2024 Term Loan covenants.

***Debt Components***

The components of the Term Loan are as follows (in thousands):

---

| | | | |
|:---|:---|:---|:---|
|  | **December 31,**  | **December 31,**  | |
|  | **2023** | **2024** | **March 31,**<br>**2025** |
|  |  |  | **(unaudited)** |
| Principal value of Term Loan...................................................... | $120000 | $138137 | $115137 |
| PIK interest added to principal................................................... | 18118 |  |  |
| Accreted exit fee.......................................................................... | 1819 | 567 | 770 |
| Debt discount............................................................................... | (5664) | (2095) | (1910) |
| Debt issuance costs.................................................................... | (265) | (178) | (166) |
| Total Term Loan .......................................................................... | $134008 | $136431 | $113831 |

---

The 2024 Term Loan was classified as long-term on the consolidated balance sheets as of December 31,

2023 and 2024 and March 31, 2025 (unaudited). As of December 31, 2023, the estimated fair value of

the Term Loan was $132.4 million. As of December 31, 2024 and March 31, 2025 (unaudited), the

Company believes the fair value of the 2024 Term Loan approximates its carrying value due to the

relatively close proximity of the 2024 Term Loan Refinancing and amendment to the balance sheet date.

**9. Convertible Notes**

***2022 Convertible Notes***

During the period from September 2022 through December 2022, the Company issued convertible

promissory notes to the 2022 Convertible Note Investors, with an aggregate principal amount of $40.0

million. The 2022 Convertible Notes bore interest at a rate of 8% per annum, compounded monthly. The

aggregate principal amount and interest accrued on the 2022 Convertible Notes was due September 30,

2026, and could not be prepaid by the Company without the consent of a majority of the 2022 Convertible

Note Investors.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

The principal and accrued interest on the 2022 Convertible Notes was subject to automatic conversion

upon a Qualified Financing (defined as a transaction or series of transactions in which the Company sells

shares of its capital stock for cash proceeds of at least $100 million, including the 2022 Convertible

Notes) at a conversion price equal to 67% of the price per share paid by the investors purchasing such

capital stock in such Qualified Financing. Upon a Non-Qualified Financing, whereby the cash proceeds

are less than $100 million, upon the written consent of a majority of the 2022 Convertible Note Investors,

the 2022 Convertible Notes shall convert on the same terms as a Qualified Financing.

The 2022 Convertible Notes were also subject to repayment upon a Change of Control. A Change of

Control is defined as a sale of all or substantially all of the Company's assets, a merger or business

combination with a change in more than 50% of the voting interest, or after a person or group, directly or

indirectly, owns more than 35% of the capital stock of the Company after the Company becomes publicly

traded.

In March 2023, the Company completed a Qualified Financing and all of the 2022 Convertible Notes,

including principal and interest, were converted into 21,465,064 shares of Series F-1 redeemable

convertible preferred stock and the Company derecognized the 2022 Convertible Notes from its

consolidated balance sheets. The Company remeasured the fair value of the 2022 Convertible Notes

immediately before the conversion and recognized a loss of $5.1 million from the change in fair value

within the consolidated statements of operations and comprehensive loss for the year ended

December 31, 2023.

***2025 Convertible Notes (unaudited)***

In January and March 2025, the Company issued convertible promissory notes to Requisite Holders in

the aggregate amount of $98.3 million, which was comprised of $74.0 million in aggregate principal

amount of notes issued for cash consideration, $1.3 million in aggregate principal amount of notes issued

in lieu of cash compensation to certain employees and $23.0 million in aggregate principal amount of

notes issued from the conversion of principal under the 2024 Term Loan. Net cash proceeds was $72.7

million after deducting $1.2 million of debt issuance costs, of which $1.1 million was unpaid as of March

31, 2025 (unaudited).

The 2025 Convertible Notes are due and payable in full 48 months from the issue date. Upon completion

of an IPO transaction, the 2025 Convertible Notes shall automatically convert into shares of the

Company's common stock at the IPO price per share at the lower of a 20% discount and a valuation cap

of $2.0 billion on a pre-money basis. In the event the Company completes a sale of shares of preferred

stock, the Requisite Holders may elect to convert the outstanding 2025 Convertible Notes into shares of

such series of preferred stock at the same terms. Further, upon a change of control transaction, the

Requisite Holders may elect to convert the outstanding 2025 Convertible Notes into shares of the

Company's common stock at the lower of a 20% discount to the implied price per share of common stock

in the change of control transaction and a valuation cap of $2.0 billion on a pre-money basis, or receive

payment of all principal and any accrued but unpaid PIK interest.

The 2025 Convertible Notes do not accrue interest for one year following the date of issuance. Following

the one-year anniversary of the issue date and for the remainder of the term, the 2025 Convertible Notes

interest will accrue on an annual basis at the rate of 7.0% per annum (PIK Interest). All PIK Interest

accrued and payable will be paid by capitalizing such interest on an annual basis and adding it to the

outstanding principal amount of the 2025 Convertible Notes.

The 2025 Convertible Notes contain embedded derivative features, including conversion upon a change

in control and automatic conversion upon completion of a qualified IPO, that were required to be

bifurcated and accounted for separately as a single derivative instrument. The issuance date estimated

fair values of the derivative liability was $11.1 million and $20.8 million in January and March 2025

(unaudited), respectively, which was accounted for as a debt discount. See Note 13 for additional

information. The debt issuance costs and debt discount are classified as an offset to the 2025 Convertible

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

Notes on the consolidated balance sheets, and are accreted over the loan term using the effective

interest method.

As of March 31, 2025 (unaudited), the aggregate principal balance due under the 2025 Convertible Notes

was $98.3 million and was classified as long-term on the consolidated balance sheets.

The components of the 2025 Convertible Notes are as follows (in thousands):

---

| | |
|:---|:---|
|  | **March 31,**<br>**2025** |
|  | **(unaudited)** |
| Principal value of Convertible Notes............................................................................................ | $98315 |
| Debt discount.................................................................................................................................. | (31279) |
| Debt issuance costs....................................................................................................................... | (1212) |
| Total Convertible Notes.................................................................................................................. | $65824 |

---

**10. Redeemable Convertible Preferred Stock**

In March 2023, the Company issued 61,344,029 shares of Series F redeemable convertible preferred

stock to existing and new investors at a price per share of $2.8505 for an aggregate cash consideration of

$174.9 million, net of $5.9 million issuance costs. Contemporaneously with the issuance of the Series F

redeemable convertible preferred stock, the Company converted all of the outstanding Convertible Notes

issued by the Company from September 30, 2022 to December 16, 2022, in the aggregate principal

amount of $40.0 million plus accrued, unpaid interest of $994,000 into 21,465,064 shares of Series F-1

redeemable convertible preferred stock at a price per share of $1.9098, which represents a discount of

33% from the cash purchase price per share. Additionally, in connection with the Series F redeemable

convertible preferred stock financing, the cumulative dividends payable to holders of Series C redeemable

convertible preferred stock upon a liquidation event were capped from $6.66 to $8.25 per share

depending on the time of issuance, with an aggregate total of $88.5 million.

The issuance of the Series F redeemable convertible preferred stock triggered the anti-dilution protection

provision for Series B-1, Series B-2, Series C, Series D and Series E stockholders. As a result, the

Company recorded a $26.8 million deemed dividend in the amount equal to the change in fair value of the

abovementioned series of convertible preferred stock before and after the anti-dilution adjustment. The

fair value of the Series B-1, Series B-2, Series C, Series D and Series E redeemable convertible preferred

stock was determined using a "with-and-without" model under which the equity value of the Company was

allocated using a hybrid method, whereby the enterprise value in the IPO scenario is allocated to each

class of shares using the fully-diluted shares outstanding and whereby the enterprise value in the non-

IPO scenario is allocated using an option-pricing model to reflect the full distribution of possible non-IPO

outcomes, both before and after the anti-dilution adjustment. The following table summarizes information

about the significant Level 3 unobservable inputs used to estimate the fair value of the Company's

preferred stock at the modification date:

---

| | |
|:---|:---|
|  | **March 2, 2023** |
| Risk-free interest rate........................................................................................................................ | 4.8% |
| Expected volatility............................................................................................................................... | 88.0% |
| Expected term (in years)................................................................................................................... | 2.0 |
| Expected dividend yield.................................................................................................................... | 0.0% |

---

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

Redeemable convertible preferred stock consists of the following as of December 31, 2023 and 2024 and

March 31, 2025 (unaudited) (in thousands, except share amounts):

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **December 31, 2023 and 2024 and March 31, 2025 (unaudited)** | **December 31, 2023 and 2024 and March 31, 2025 (unaudited)** | **December 31, 2023 and 2024 and March 31, 2025 (unaudited)** | **December 31, 2023 and 2024 and March 31, 2025 (unaudited)** |
| **Series** | **Number of** <br>**Shares** <br>**Authorized**<br>| **Number of**<br>**Shares Issued** <br>**and Outstanding**<br>| **Carrying** <br>**Value**<br>| **Liquidation** <br>**Value**<br>|
| Series A.................................................... | 4082965 | 4082965 | $2041 | $2041 |
| Series B-1................................................ | 1954846 | 1954846 | 6940 | 6940 |
| Series B-2................................................ | 2848263 | 2848263 | 10111 | 10111 |
| Series C................................................... | 11343434 | 11343434 | 104378 | 193167 |
| Series D................................................... | 7151873 | 7151873 | 110756 | 110854 |
| Series E................................................... | 12040980 | 12040980 | 304197 | 305018 |
| Series F.................................................... | 61344029 | 61344029 | 168957 | 262295 |
| Series F-1................................................ | 21465064 | 21465064 | 61186 | 61491 |
| Total ......................................................... | 122231454 | 122231454 | $768566 | $951917 |

---

The significant rights and obligations of the Company's redeemable convertible preferred stock are as

follows:

***Dividends***

The holders of Series A, Series B-1, Series B-2, Series C, Series D, Series E, Series F and Series F-1

redeemable convertible preferred stock are entitled, on a pro rata, pari passu basis, when and if declared

by the Board of Directors, to non-cumulative dividends out of the Company's assets legally available

therefore at the rate of $0.030, $0.284, $0.284, $0.7384, $1.24, $2.0265, $0.2281 and $0.1528 per share

per annum, respectively. No distributions will be made with respect to the common stock until all declared

but unpaid dividends on redeemable convertible preferred stock have been paid or set aside for payment

to the convertible preferred stockholders. Except with respect to the rights of the holders of Series C

redeemable convertible preferred stock upon a liquidation event, the right to receive dividends on shares

of redeemable convertible preferred stock are non-cumulative, and no right to such dividends accrues to

holders of redeemable convertible preferred stock by reason of the fact that dividends on such shares are

not declared or paid in any years. At December 31, 2023 and 2024 and March 31, 2025 (unaudited), no

dividends had been declared or paid.

Dividends are payable to preferred stockholders in the order of: first, the Series F and Series F-1

redeemable convertible preferred stock, then the Series E redeemable convertible preferred stock, then

the Series D redeemable convertible preferred stock, then the Series C redeemable convertible preferred

stock, then the Series B-1 and B-2 redeemable convertible preferred stock, and then finally, the Series A

redeemable convertible preferred stock. After payment of the full amount of any dividends described

above, any additional dividends shall be distributed among all holders of common stock and all holders of

redeemable convertible preferred stock on an as-converted basis.

The holders of Series C redeemable convertible preferred stock are the only preferred stockholders

entitled to cumulative dividends upon a liquidation event. In connection with the Series F redeemable

convertible preferred stock financing, the cumulative dividends payable to holders of Series C redeemable

convertible preferred stock upon a liquidation event were capped from $6.66 to $8.25 per share

depending on the time of issuance, with an aggregate total of $88.5 million, provided, however, that the

Company shall be under no obligation to pay such Series C preferred accruing dividends until a

liquidation event; provided further, that a holder of shares of Series C redeemable convertible preferred

stock shall automatically forfeit any then accrued but unpaid Series C redeemable convertible preferred

accruing dividends with respect to such shares upon conversion of such shares into shares of common

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

stock. As of December 31, 2023 and 2024 and March 31, 2025 (unaudited), the total accumulated, but not

yet declared or paid, dividends of $88.5 million related to the Series C redeemable convertible preferred

stock was not recorded in the consolidated financial statements as an accrued dividend as such an event

was not considered probable to occur.

***Liquidation Rights***

In the event of any liquidation, dissolution or winding up of the Company, either voluntary or involuntary,

the holders of Series F, Series F-1, Series E, Series D, Series C, Series B-1, Series B-2 and Series A

redeemable convertible preferred stock are entitled to liquidation preferences in the amount of $4.2758,

$2.8647, $25.3317, $15.50, $9.23, $3.55, $3.55, and $0.50 per share, respectively, for each outstanding

share plus all declared but unpaid dividends, if the shares are not converted to common stock.

Payment of liquidation rights to preferred stockholders are in the order of: first, the Series F and Series

F-1 redeemable convertible preferred stock, then the Series E redeemable convertible preferred stock,

then the Series D redeemable convertible preferred stock, then the Series C redeemable convertible

preferred stock, then the Series B-1 and B-2 redeemable convertible preferred stock, and then finally, the

Series A redeemable convertible preferred stock. The remaining assets, if any, shall be distributed to the

holders of common stock.

If upon the liquidation, dissolution or winding up of the Company, the assets of the Company legally

available for distribution to the holders of the Series F, Series F-1, Series E, Series D, Series C, Series

B-1, Series B-2 and Series A redeemable convertible preferred stock are insufficient to permit the

payment to such holders of the full liquidation preferences to which they are entitled, then the holders of

the Company's common stock will receive nothing in respect of their equity holdings in the Company.

Upon such an event, the assets of the Company legally available for distribution shall satisfy the

respective liquidation preferences of the preferred stockholders with equal pro rata priority in the same

preferential order as described above.

***Conversion Rights***

Each share of Series A, Series B-1, Series B-2, Series C, Series D, Series E, Series F and Series F-1

redeemable convertible preferred stock shall automatically be converted into fully-paid, nonassessable

shares of common stock at the then effective conversion rate per share for such share prior to the closing

of a firm commitment underwritten IPO pursuant to an effective registration statement filed under the

Securities Act of 1933, as amended, or SPAC transaction covering the offer and sale of the Company's

common stock, provided that (i) the aggregate gross proceeds to the Company are not less than

$100,000,000 and (ii) the per share price of the shares sold in the public offering shall be no less than

$4.9884 per share or $5.7010 per share (subject to adjustment from time to time for Recapitalizations and

as otherwise set forth elsewhere herein) so long as a certain investor holds at least 11,693,855 shares of

Series F redeemable convertible preferred stock (a ''Qualified Public Offering'') shall automatically be

converted into fully-paid, nonassessable shares of common stock at the then effective conversion rate for

such share upon the written consent of the holders of a majority of the Series F and F-1 redeemable

convertible preferred stock (voting as a single class and on an as-converted basis). The conversion rates

per share for previously issued preferred stock were amended as a result of the Series F redeemable

convertible preferred stock financing from the original conversion rates per share for Series B-1, Series

B-2, Series C, Series D and Series E redeemable convertible preferred stock. Upon a Qualified Public

Offering, shares of each series of the outstanding redeemable convertible preferred stock are convertible

into the number of shares of common stock determined by dividing the original issue price for the relevant

series of redeemable convertible preferred stock by the conversion price for such series. As of

December 31, 2023 and 2024 and March 31, 2025 (unaudited), shares of Series A, Series B-1, Series

B-2, Series C, Series D, Series E, Series F and Series F-1 outstanding redeemable convertible preferred

stock are convertible into shares of common stock on a 0.342466:1, 0.403088:1, 0.403088:1, 0.576386:1,

0.646673:1, 0.695098:1, 0.342466:1, and 0.342466:1 basis, as adjusted for the reverse common stock

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

split, respectively.

***Voting Rights***

The holder of each share of Series A, Series B-1, Series B-2, Series C, Series D, Series E, Series F and

Series F-1 redeemable convertible preferred stock is entitled to one vote for each share of common stock

into which it could be converted.

**11. Common Stock**

Under the Company's Amended and Restated Certificate of Incorporation, the Company is authorized to

issue 210,300,000 shares of $0.001 par value common stock.

Common stock reserved for issuance, on an as-converted basis, consisted of the following:

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **December 31,** | **December 31,** | **March 31,** | **March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| Redeemable convertible preferred stock...... | 51226348 | 51226348 | 51226348 | 51226348 |
| Options to purchase common stock.............. | 8268314 | 8537203 | 7905811 | 8583703 |
| Common stock warrants................................. | 1647667 | 1647667 | 1647667 | 1647667 |
| Total ................................................................... | 61142329 | 61411218 | 60779826 | 61457718 |

---

**12. Common Stock Warrant Liability**

On January 19, 2021, in connection with entering into the Credit Agreement, the Company issued Hayfin

a warrant to purchase 108,154 shares of common stock at an exercise price of $0.03 per share. On

March 17, 2022, upon amendment to the Credit Agreement, the Company issued Hayfin a warrant to

purchase 77,253 shares of common stock at an exercise price of $0.03 per share. On March 3, 2023,

upon Amendment No. 4 to the Credit Agreement and as a result of antidilution adjustment provisions in

connection with the Series F redeemable convertible preferred stock financing, the Company issued

Hayfin a warrant to purchase 1,462,260 shares of common stock at an exercise price of $0.03 per share

(collectively, the "Warrants"). As of December 31, 2023 and 2024 and March 31, 2025 (unaudited), all

warrants remained outstanding.

The Warrants have a net exercise provision under which their holders may, in lieu of payment of the

exercise price in cash, surrender the warrant and receive a net amount of shares based on the fair market

value of the Company's stock at the time of exercise of the Warrants after deduction of the aggregate

exercise price. The Warrants contain provisions for adjustment of the exercise price and number of

shares issuable upon the exercise of the Warrants, if upon the issuance of next round securities, the

Warrants are then currently exercisable and the next round price is less than $25.3317 per share (as

adjusted for any stock splits, recapitalizations, and the like). In such case, the number of exercise shares

shall be increased to equal the quotient obtained by dividing (a) $8.0 million by (b) the next round price.

The Warrants also have customary antidilution protection provisions. The Warrants will terminate on the

ten-year anniversary of the issuance date, however, the Warrants will automatically net exercise

immediately prior to termination if the fair market value of one share of common stock exceeds the then

current exercise price per share of common stock. In connection with certain change of control

transactions, which include SPAC combinations, mergers, consolidations and the sale or lease of

substantially all of the assets of the Company, the Warrants will also automatically net exercise if the fair

market value of one share of common stock exceeds the then current exercise price per share of

common stock. The Warrants do not automatically net exercise in connection with an initial public offering.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

The aggregate fair value of the Warrants issued in connection with the initial Credit Agreement and the

amended Credit Agreement was $4.3 million and $3.5 million, respectively, at issuance and was

recognized as a debt discount and recorded as a warrant liability.

The warrant liabilities were remeasured to fair value as of December 31, 2023 and 2024 and March 31,

2024 and 2025 (unaudited), resulting in a (gain) loss of $2.3 million, $16.4 million, $(1,000) and $1.6

million, respectively, within the consolidated statements of operations and comprehensive loss.

The fair value of the common stock warrant liability was determined using the Black-Scholes option

pricing model based on the following weighted average assumptions:

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** | **Three Months Ended** <br>**March 31,** | **Three Months Ended** <br>**March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| Stock price......................................................... | $0.93 | $4.34 | $0.93 | $4.67 |
| Exercise price................................................... | $0.01 | $0.01 | $0.01 | $0.01 |
| Contractual term (in years)............................. | 7.6 | 6.6 | 7.3 | 6.3 |
| Expected volatility............................................. | 84.5% | 72.1% | 79.4% | 71.1% |
| Weighted-average risk-free interest rate...... | 3.88% | 4.44% | 4.20% | 4.04% |
| Dividend yield.................................................... |  |  |  |  |

---

**13. Derivative Liability**

***Term Loan***

Prior to the 2024 Term Loan Refinancing in June 2024, the Term Loan contained certain prepayment

features, default put option and default interest adjustment features that were determined to be

embedded derivatives requiring bifurcation and separate accounting as a single compound derivative, as

discussed in Note 8. The fair value of the derivative liability was recorded at the issuance date as debt

discounts and reductions to the carrying value of long-term debt on the consolidated balance sheets. The

derivative liability is remeasured to fair value at each reporting period and the related changes in fair

value are recorded on the consolidated statements of operations and comprehensive loss. Through the

time of the 2024 Term Loan Refinancing in June 2024, the Company continued to adjust the derivative

liability for changes in fair value of the Term Loan.

Estimating fair values of the derivative liability requires the development of significant and subjective

estimates that may, and are likely to, change over the duration of the instrument with related changes in

internal and external market factors. Since the derivative financial instrument is initially and subsequently

carried at fair value, the Company's income will reflect the volatility in these estimate and assumption

changes.

The derivative liability was remeasured to fair value as of December 31, 2023 and June 14, 2024,

resulting in a gain of $4.2 million and a loss of $222,000, respectively, within the consolidated statements

of operations and comprehensive loss. In connection with the 2024 Term Loan Refinancing on June 14,

2024, the associated current fair value of the derivative liability of $1.1 million as remeasured at the date

of refinancing was derecognized and recorded as a debt discount to the 2024 Term Loan.

The fair value of the derivative liability was estimated using a scenario-based analysis comparing the

probability-weighted present value of the Term Loan payoff at maturity with and without the bifurcated

features. The Company used both the Black-Scholes-Merton and option pricing method to estimate the

fair value of the derivative liability because it believes these techniques are reflective of all significant

assumption types and ranges of assumption inputs that market participants would likely consider in

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

transactions involving compound embedded derivatives. The option pricing method was employed as part

of a back-solve analysis to the Company's Series F Preferred round of financing. The Company's

assumptions used in determining the fair value of the derivative liability is as follows:

---

| | | |
|:---|:---|:---|
|  | **December 31,**<br>**2023** | **June 14,**<br>**2024** |
| Debt yield................................................................................................................. | 17.7% | 18.5% |
| Probability of business combination or IPO (with feature)............................... | 70.0% | 80.0% |
| Event date of business combination or IPO (with feature)............................... | 6/30/2025 | 6/30/2025 |
| Probability of Default.............................................................................................. | 10.0% | 5.0% |
| Event date of Default.............................................................................................. | 9/30/2025 | 9/30/2025 |
| Probability to incur new debt................................................................................. | 0.0% | 0.0% |
| Event date to incur new debt................................................................................. | n/a | n/a |
| Probability of change of control............................................................................ | 10.0% | 10.0% |
| Event date of change of control............................................................................ | 6/30/2025 | 6/30/2025 |
| Event date (without feature).................................................................................. | 1/19/2026 | 1/19/2026 |

---

*Debt yield* — Discount rate that reconciles the total fair value of the Warrants and 2021 Credit Agreement

with the transaction value. Debt yield reflects a change in the credit benchmark for a "CCC" rated

obligation.

***2025 Convertible Notes (unaudited)***

The 2025 Convertible Notes were determined to contain certain settlement features and conversion put

options which require bifurcation and separate accounting as a single compound embedded derivative, as

discussed in Note 9. The fair value of the derivative liability was recorded at the issuance dates as a debt

discount and reduction to the carrying value of the 2025 Convertible Notes on the consolidated balance

sheets. The derivative liability is remeasured to fair value at each reporting period and the related

changes in fair value are recorded on the consolidated statements of operations and comprehensive loss.

The fair value of the derivative liability was estimated using a scenario-based analysis comparing the

probability-weighted present value of the 2025 Convertible Notes with and without the bifurcated features.

The Company used the Monte Carlo Simulation method to estimate the fair value of the derivative liability

because it believes this technique is reflective of all significant assumption types and ranges of

assumption inputs that market participants would likely consider in transactions involving compound

embedded derivatives. The option pricing method was employed as part of a back-solve analysis for

scenarios in which the Company was expected to raise another financing round. The Company also

employed a waterfall analysis that allocated certain exit proceeds to its outstanding share classes for

scenarios in which the Company was assumed to exit via change of control or initial public offering. The

Company's assumptions used in determining the issuance date fair value of the derivative liability is as

follows:

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

---

| | | |
|:---|:---|:---|
|  | **January 31,**<br>**2025** | **March 26,**<br>**2025** |
|  | **(unaudited)** | **(unaudited)** |
| Debt yield................................................................................................................. | 7.0% | 7.0% |
| Probability of IPO.................................................................................................... | 60.0% | 75.0% |
| Event date of IPO.................................................................................................... | 5/5/2025 | 5/9/2025 |
| Probability of change of control............................................................................ | 20.0% | 10.0% |
| Event date of change of control............................................................................ | 1/31/2026 | 3/26/2026 |
| Discount rate............................................................................................................ | 31.3% | 63.7% |

---

The issuance date estimated fair values of the derivative liability was $11.1 million (unaudited) and $20.8

million (unaudited) in January and March 2025, respectively, which were recorded as debt discounts. The

January 2025 derivative liability was remeasured to fair value as of March 31, 2025 (unaudited) using the

March 26, 2025 assumptions, resulting in a loss of $9.0 million within the consolidated statements of

operations and comprehensive loss. The aggregate fair value of the derivative liability as of March 31,

2025 (unaudited) was $40.9 million.

**14. Equity Incentive Plan**

In 2009, the Company adopted its 2009 Equity Incentive Plan (the "Plan") which provides for the grant of

stock options to the Company's employees, members of the Board of Directors and consultants. Options

granted under the Plan may be either incentive stock options ("ISOs") or nonqualified stock options

("NSOs"). ISOs may be granted only to employees. NSOs, Stock Appreciation Rights, Restricted Stock,

and Restricted Stock Units may be granted to employees, members of the Board of Directors and

consultants. As of December 31, 2024 and March 31, 2025 (unaudited), the Company reserved

10,543,521 shares for issuance under the Plan.

Options under the Plan have a term of ten years from the grant date. The option exercise price will be

determined by the Board of Directors, but will be no less than 100% of the fair market value per share on

the date of grant. In addition, in the case of an ISO granted to an employee who owns stock representing

more than 10% of the voting power of all classes of stock of the Company, the per share exercise price

will be no less than 110% of the fair market value per share on the date of grant. Through December 31,

2024 and March 31, 2025 (unaudited), options granted generally vest over (i) four years with 25% vesting

on the first anniversary of the issuance date and 1/48th per month thereafter or (ii) vesting monthly in

equal installments over four years.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

Stock option activity under the Company's 2009 Equity Incentive Plan is set forth below (in thousands,

except share and per share amounts):

---

| | | | | | |
|:---|:---|:---|:---|:---|:---|
|  | **Shares** <br>**Available for** <br>**Grant**<br>| **Number of** <br>**Options**<br>| **Awards** <br>**Weighted-**<br>**Average** <br>**Exercise** <br>**Price**<br>| **Weighted-**<br>**Average** <br>**Remaining** <br>**Contractual** <br>**Life (Years)**<br>| **Aggregate**<br>**Intrinsic**<br>**Value**<br>|
| Balance at December 31, 2022..... | 4312292 | 3225122 | $28.52 | 6.17 | $3561 |
| Authorized......................................... | 16018730 |  |  |  |  |
| Options granted............................... | (16881199) | 5780871 | $2.22 |  |  |
| Options exercised............................ |  | (99900) | $5.89 |  |  |
| Options canceled............................. | 1863212 | (637772) | $21.45 |  |  |
| Balance at December 31, 2023.... | 5313035 | 8268321 | $4.13 | 8.19 | $– |
| Authorized......................................... | **—** |  | $— |  |  |
| Options granted............................... | (6533982) | 2237514 | $6.46 |  |  |
| Options exercised............................ | **—** | (1181123) | $3.87 |  |  |
| Options canceled............................. | 2300439 | (787502) | $4.79 |  |  |
| Balance at December 31, 2024..... | 1079492 | 8537210 | $4.72 | 7.96 | $68256 |
| Vested and exercisable, <br>December 31, 2024.....................<br>|  | 2886835 | $5.86 | 6.22 | $19989 |
| Vested and expected to vest, <br>December 31, 2024.....................<br>|  | 8537210 | $4.72 | 7.96 | $68256 |

---

---

| | | | | | |
|:---|:---|:---|:---|:---|:---|
|  | **Shares** <br>**Available for** <br>**Grant**<br>| **Number of** <br>**Options**<br>| **Awards** <br>**Weighted-**<br>**Average** <br>**Exercise** <br>**Price**<br>| **Weighted-**<br>**Average** <br>**Remaining** <br>**Contractual** <br>**Life (Years)**<br>| **Aggregate**<br>**Intrinsic**<br>**Value**<br>|
| Balance at December 31, 2024..... | 1079492 | 8537210 | $4.72 | 7.96 | $68256 |
| Authorized (unaudited)................... | **—** |  | $— |  |  |
| Options granted (unaudited).......... | (796801) | 272831 | $12.67 |  |  |
| Options exercised (unaudited)...... | **—** | (130813) | $4.42 |  |  |
| Options canceled (unaudited)........ | 279047 | (95525) | $4.21 |  |  |
| Balance at March 31, 2025 <br>(unaudited)....................................<br>| 561738 | 8583703 | $4.98 | 7.77 | $74619 |
| Vested and exercisable, March <br>31, 2025 (unaudited)...................<br>|  | 3257512 | $5.54 | 6.27 | $26657 |
| Vested and expected to vest, <br>March 31, 2025 (unaudited).......<br>|  | 8583703 | $4.98 | 7.77 | $74619 |

---

The weighted-average grant date fair value of options granted during the years ended December 31,

2023 and 2024 and three months ended March 31, 2025 (unaudited) was $1.26, $3.59 and $7.10 per

share, respectively. There were no options granted during the three months ended March 31, 2024

(unaudited). The total grant date fair value of options vested was $3.2 million, $2.0 million, $477,000 and

$811,000 during the years ended December 31, 2023 and 2024 and three months ended March 31, 2024

and 2025 (unaudited), respectively.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

The following table summarizes information about stock options outstanding as of December 31, 2024:

---

| | | | | | |
|:---|:---|:---|:---|:---|:---|
| **Range of**<br>**Exercise Prices**<br>| **Number** <br>**Outstanding**<br>| **Weighted-**<br>**Average** <br>**Remaining** <br>**Contractual** <br>**Life (Years)**<br>| **Weighted-**<br>**Average** <br>**Exercise** <br>**Price**<br>| **Number** <br>**Exercisable**<br>| **Weighted-**<br>**Average** <br>**Exercise** <br>**Price**<br>|
| $2.22 - $2.22......................... | 4523524 | 8.38 | $2.22 | 1227106 | $2.22 |
| $2.72 - $2.72......................... | 837855 | 9.31 | $2.72 | 35313 | $2.72 |
| $5.08 - $5.08......................... | 159745 | 9.70 | $5.08 | 1640 | $5.08 |
| $8.32 - $8.32......................... | 1792026 | 4.99 | $8.32 | 1553500 | $8.32 |
| $9.58 - $9.58......................... | 1162762 | 9.99 | $9.58 | 7978 | $9.58 |
| $12.26 - $12.26.................... | 5136 | 0.60 | $12.26 | 5136 | $12.26 |
| $12.38 - $12.38.................... | 35615 | 1.41 | $12.38 | 35615 | $12.38 |
| $27.97 - $27.97..................... | 20547 | 3.86 | $27.97 | 20547 | $27.97 |
| $2.22 - $27.97...................... | 8537210 | 7.96 | $4.72 | 2886835 | $5.86 |

---

The following table summarizes information about stock options outstanding as of March 31, 2025

(unaudited):

---

| | | | | | |
|:---|:---|:---|:---|:---|:---|
| **Range of**<br>**Exercise Prices**<br>| **Number** <br>**Outstanding**<br>| **Weighted-**<br>**Average** <br>**Remaining** <br>**Contractual** <br>**Life (Years)**<br>| **Weighted-**<br>**Average** <br>**Exercise** <br>**Price**<br>| **Number** <br>**Exercisable**<br>| **Weighted-**<br>**Average** <br>**Exercise** <br>**Price**<br>|
| $2.22 - $2.22......................... | 4420470 | 8.18 | $2.22 | 1492291 | $2.22 |
| $2.72 - $2.72......................... | 790324 | 9.00 | $2.72 | 101456 | $2.72 |
| $5.08 - $5.08......................... | 156835 | 8.61 | $5.08 | 2389 | $5.08 |
| $8.32 - $8.32......................... | 1720271 | 4.71 | $8.32 | 1549980 | $8.32 |
| $9.58 - $9.58......................... | 1161674 | 9.60 | $9.58 | 49545 | $9.58 |
| $12.26 - $12.26.................... | 5136 | 0.36 | $12.26 | 5136 | $12.26 |
| $12.38 - $12.38.................... | 35615 | 1.16 | $12.38 | 35615 | $12.38 |
| $12.67 - $12.67.................... | 272831 | 9.90 | $12.67 | 553 | $12.67 |
| $27.97 - $27.97.................... | 20547 | 3.61 | $27.97 | 20547 | $27.97 |
| $2.22 - $27.97...................... | 8583703 | 7.77 | $4.98 | 3257512 | $5.54 |

---

The aggregate intrinsic value is calculated as the difference between the exercise price of the underlying

stock options and the fair value of the Company's common stock for stock options that were in-the-money

at each reporting period. The aggregate intrinsic value of stock options exercised for the years ended

December 31, 2023 and 2024 and three months ended March 31, 2024 and 2025 (unaudited) was

$4,000, $1.7 million, $1,000 and $1.1 million, respectively.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

***Stock-Based Compensation***

The Company estimated the fair value of stock options using the Black-Scholes option-pricing model

based on the following assumptions:

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** | **Three Months Ended**<br>**March 31,** | **Three Months Ended**<br>**March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| Expected life (in years)......................... | 6.0 | 6.0 | n/a | 6.0 |
| Expected volatility.................................. | 54.7%-55.7% | 53.7%-55.0% | n/a | 55.0%-%55.4% |
| Risk-free interest rate............................ | 4.2% | 3.5%-4.5% | n/a | 4.0% |
| Dividend yield......................................... | –% | –% | n/a | –% |

---

The significant assumptions used in these calculations are summarized as follows:

*Fair value of common stock*. Because there has been no public market for the Company's common stock,

the fair value of common stock shares underlying stock options has historically been determined by the

Board of Directors at the time of option grant by considering independent valuation performed by third-

party valuation firm as well as a number of objective and subjective factors, including valuation of

comparable companies, sales of convertible preferred stock to unrelated third parties, operating and

financial performance, the lack of liquidity of capital stock and general and industry specific economic

outlook, among other factors. The fair value of common stock was determined in accordance with

applicable elements of the American Institute of Certified Public Accountants Practice Aid, Valuation of

Privately-Held-Company Equity Securities Issued as Compensation. In 2023, the Company considered

the stay private scenario and IPO exit scenario. In the stay private scenario, three market methodologies

were employed including (i) a market indexing valuation analysis based on the Series F Preferred

financing round, (ii) a guideline public company analysis based on the Company's historical and forecast

operating metrics, and (iii) a guideline transaction analysis based on the Company's historical and

forecast operating metrics. In the IPO exit scenario, the total equity value was estimated based on the

expected timing, offering size and pre-money valuation. A hybrid method was used to allocate equity

value to common stock under the stay private and IPO scenarios.

*Expected term*. The expected term of stock options represents the weighted-average period the stock

options are expected to remain outstanding. The Company does not have sufficient historical exercise

and post-vesting termination activity to provide accurate data for estimating the expected term of options

and has opted to use the "simplified method," whereby the expected term equals the arithmetic average

of the vesting term and the original contractual term of the option.

*Expected volatility*. As the Company is not publicly traded, the expected volatility for the Company's stock

options was determined by using an average of historical volatilities of selected industry peers deemed to

be comparable to the Company's business corresponding to the expected term of the awards.

*Risk-free interest rate*. The risk-free interest rate is based on the U.S. Treasury yield curve in effect at the

time of grant for zero-coupon U.S. Treasury notes with maturities corresponding to the expected term of

the awards.

*Expected dividend yield*. The expected dividend rate is zero as the Company currently has no history or

expectation of declaring dividends on its common stock.

The Company also issues stock options with vesting based upon completion of performance goals. The

fair value for these performance-based awards is recognized over the period during which the goals are

to be achieved. Stock-based compensation expense recognized at fair value includes the impact of

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

estimated probability that the goals would be achieved, which is assessed prior to the requisite service

period for the specific goals.

Total stock-based compensation expense is as follows (in thousands):

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** | **Three Months Ended** <br>**March 31,** | **Three Months Ended** <br>**March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| Cost of revenue................................................ | $440 | $307 | $82 | $57 |
| Research and development<sup>(1)</sup>......................... | 3339 | 2151 | 517 | 547 |
| Selling, general and administrative............... | 8722 | 7755 | 2124 | 1888 |
| Total stock-based compensation expense .. | $12501 | $10213 | $2723 | $2492 |

---

(1)Includes stock-based compensation expense of $627,000 during the year ended December 31, 2023 related to a repurchase of

common shares from one employee, as described below.

As of December 31, 2023 and 2024 and March 31, 2025 (unaudited), total unrecognized stock-based

compensation costs related to unvested stock options was $20.7 million, $16.5 million and $15.7 million,

respectively, which is expected to be recognized over a remaining weighted-average period of 3.22 years,

2.79 years and 2.65 years, respectively.

In January 2023, the fair value of the Company's common stock declined from $41.67 to $2.22 per share,

prompting the Company to reduce the exercise price of certain stock options to $2.22, effective July 10,

2023. No other changes to the stock options' terms were made. The Company calculated the incremental

fair value by calculating the fair value of the award immediately before and immediately after the

modification. The fair value of the award immediately before the repricing is based on assumptions

(including volatility, expected term and risk free interest rate) that reflect the facts and circumstances on

the modification date and therefore, differ from the fair value calculated on the grant date. The average

additional compensation per award from the modification was $0.09 and the aggregate incremental

expense was $649,000, of which $340,000 was immediately recognized on the modification date and the

remaining amount is recognized over the options' remaining requisite service period.

In March 2023, the Board of Directors approved a repurchase of 102,739 common shares from an

employee of the Company at a purchase price of $8.32 per share for total consideration of $855,000. The

fair value of the repurchased common shares was $228,000, and the difference between the repurchase

price and fair value of the common shares of $627,000 was recorded as stock-based compensation

expense within research and development expense in the consolidated statements of operations and

comprehensive loss during the year ended December 31, 2023.

**15. Employee Retirement Plan**

The Company has a qualified retirement plan under section 401(k) of the Internal Revenue Code ("IRC")

under which participants may contribute up to 100% of their eligible compensation, subject to maximum

deferral limits specified by the IRC. The Company may make matching contributions of up to 4.0% of an

employee's eligible compensation, subject to conditions specified by the IRC. During the years ended

December 31, 2023 and 2024, and three months ended March 31, 2024 and 2025, the Company's

matching contributions totaled $1.4 million, $1.5 million, $356,000 and $688,000, respectively.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

**16. Net Loss Per Share Attributable to Common Stockholders**

The following table sets forth the computation of basic and diluted net loss per share attributable to

common stockholders (in thousands, except share and per share amounts):

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** | **Three Months Ended** <br>**March 31,** | **Three Months Ended** <br>**March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| Numerator: |  |  |  |  |
| Net loss.............................................................. | $(95655) | $(96426) | $(20932) | $(32345) |
| Cumulative dividends on Series C <br>redeemable convertible preferred stock.......<br>| (1239) |  |  |  |
| Deemed dividend upon down round of <br>redeemable convertible preferred stock.......<br>| (26794) |  |  |  |
| Net loss attributable to common <br>stockholders .....................................................<br>| $(123688) | $(96426) | $(20932) | $(32345) |
| Denominator: |  |  |  |  |
| Weighted-average shares used to compute <br>net loss per share, basic and diluted.............<br>| 4885231 | 5363435 | 4943430 | 6164673 |
| Net loss per share attributable to common <br>stockholders, basic and diluted......................<br>| $(25.32) | $(17.98) | $(4.23) | $(5.25) |

---

The following outstanding shares of potentially dilutive securities were excluded from the computation of

diluted net loss per share attributable to common stockholders for the period presented because including

them would have been antidilutive:

---

| | | | | |
|:---|:---|:---|:---|:---|
|  | **December 31,** | **December 31,** | **March 31,** | **March 31,** |
|  | **2023** | **2024** | **2024** | **2025** |
|  |  |  | **(unaudited)** | **(unaudited)** |
| Redeemable convertible preferred stock...... | 122231454 | 122231454 | 122231454 | 122231454 |
| Outstanding options to purchase common <br>stock...................................................................<br>| 8268314 | 8537203 | 7905811 | 8583703 |
| Common stock warrants................................. | 1647667 | 1647667 | 1647667 | 1647667 |
| Total.................................................................... | 132147435 | 132416324 | 131784932 | 132462824 |

---

**17. Income Taxes**

The components of net loss before income taxes are as follows (in thousands):

---

| | | |
|:---|:---|:---|
|  | **December 31,** | **December 31,** |
|  | **2023** | **2024** |
| United States........................................................................................................... | $(95634) | $(96422) |
| International............................................................................................................. | 526 | 49 |
| Net loss before income taxes................................................................................ | $(95108) | $(96373) |

---

For the years ended December 31, 2023 and 2024, the Company did not record any federal or state

provision for income tax expense. For the years ended December 31, 2023 and 2024, the Company

recorded an income tax provision of $547,000 and $53,000, respectively, from international jurisdictions.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

The following table presents a reconciliation of the statutory federal rate and the Company's effective tax

rate (in thousands):

---

| | | |
|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** |
|  | **2023** | **2024** |
| Tax at federal statutory rate................................................................................... | $(20003) | $(20027) |
| State taxes, net of federal benefit......................................................................... | (4032) | (2247) |
| Change in valuation allowance............................................................................. | 20418 | 16563 |
| Stock-based compensation................................................................................... | 3722 | 1706 |
| Fair value remeasurement..................................................................................... | 1075 | 3482 |
| R&D credits.............................................................................................................. | (391) | (281) |
| Foreign rate differential.......................................................................................... | (50) | 41 |
| Other......................................................................................................................... | (192) | 816 |
| Provision for income taxes.................................................................................... | $547 | $53 |

---

Significant components of the net deferred tax assets for federal and state income taxes are as follows (in

thousands):

---

| | | |
|:---|:---|:---|
|  | **Year Ended**<br>**December 31,** | **Year Ended**<br>**December 31,** |
|  | **2023** | **2024** |
| **Deferred tax assets:** |  |  |
| Net operating loss carryforwards..................................................................... | $142089 | $143066 |
| Research and development credits................................................................. | 6586 | 7111 |
| Stock-based compensation.............................................................................. | 1316 | 1611 |
| Interest limitation................................................................................................ | 4551 | 8964 |
| Accruals and reserves....................................................................................... | 3493 | 9502 |
| Fixed asset and intangible asset basis........................................................... | 7250 | 4615 |
| Operating lease liabilities.................................................................................. | 6791 | 5955 |
| Section 174 research and development capitalization................................. | 12432 | 20675 |
| Total deferred tax assets........................................................................................ | 184508 | 201499 |
| **Deferred tax liabilities:** |  |  |
| Capitalized implementation costs.................................................................... | (756) | (1556) |
| Operating lease right-of-use assets................................................................ | (5346) | (4653) |
| Other.................................................................................................................... |  | (66) |
| Total deferred tax liabilities.................................................................................... | (6102) | (6275) |
| Deferred tax assets, net......................................................................................... | 178406 | 195224 |
| Valuation allowance................................................................................................ | $(178406) | $(195224) |

---

As the Company has incurred annual net operating losses since inception, a full valuation allowance is

provided against U.S. net deferred tax assets due to uncertainties regarding the Company's ability to

realize these assets. The valuation allowance increased by $20.4 million and $16.8 million for the years

ended December 31, 2023 and 2024, respectively.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

As of December 31, 2024, the Company had net operating loss carryforwards of approximately $542.9

million and $435.5 million available to reduce future taxable income, if any, for federal and state income

tax purposes, respectively. Of these amounts, $355.9 million of federal net operating losses are carried

forward indefinitely, and $187.0 million are limited to 80% of future taxable income. The remaining federal

net operating losses will expire starting in 2030. Utilization of net operating loss carryforwards may be

subject to an annual limitation in certain situations where changes occur in the stock ownership of a

company. In the event the Company has undergone or undergoes a change in ownership, utilization of

the carryforwards could be limited.

The Company also had federal and California research and development credit carryforwards of

approximately $9.4 million and $7.0 million, respectively, as of December 31, 2024. The federal credits

will expire starting in 2030, if not utilized. The California credits have no expiration date.

Deferred income taxes have not been provided for undistributed earnings of the Company's consolidated

foreign subsidiaries because of the Company's intent to reinvest such earnings indefinitely in active

foreign operations. The Company believes that future domestic cash generation will be sufficient to meet

future domestic cash needs. The Company has not recorded a deferred tax liability on the undistributed

earnings of non-U.S. subsidiaries. The foreign withholding taxes would not have a material impact on the

Company's financial position and results of operation. As of December 31, 2023 and 2024, the Company

had $0.6 million and $1.1 million, respectively, in unremitted earnings that were indefinitely reinvested

related to its consolidated foreign subsidiaries.

The Company's gross unrecognized tax benefits as of December 31, 2023 and 2024 was $8.2 million and

$8.6 million, respectively, all of which would affect the Company's income tax expense if recognized

before consideration of the Company's valuation allowance. The Company does not expect its

unrecognized tax benefits to change significantly over the next 12 months. The Company recognizes

interest and penalties accrued on any unrecognized tax benefits as a component of provision for income

taxes.

The following table summarizes the activity related to unrecognized tax benefits as follows (in thousands):

---

| | | |
|:---|:---|:---|
|  | **December 31,** | **December 31,** |
|  | **2023** | **2024** |
| Balance at beginning of period............................................................................. | $7371 | $8188 |
| Increase related to current year tax positions.................................................... | 817 | 558 |
| Changes related to prior year tax positions........................................................ |  | (149) |
| Balance at end of period........................................................................................ | $8188 | $8597 |

---

The Company files income tax returns in the U.S. federal jurisdiction, various state and certain foreign

jurisdictions. In the normal course of business, the Company is subject to examination by their respective

taxing authorities. The Company has been selected for audit by the Internal Revenue Service for its 2022

tax year. The examination is at its early stages. However, no tax adjustments are anticipated. The statute

of limitations remains effectively open for the U.S. federal and state tax jurisdictions for all tax years from

2010 through 2024. Tax years outside the normal statute of limitations remain open to examination by tax

authorities due to tax attributes generated in earlier years which have been carried forward and may be

examined and adjusted in subsequent years when utilized.

***Three Months Ended March 31, 2024 and 2025 (unaudited)***

The Company had an effective tax rate of 0% for both the three months ended March 31, 2024 and 2025

(unaudited). The Company continues to incur operating losses.

During the three months ended March 31, 2024 and 2025 (unaudited), the Company has evaluated all

available evidence, both positive and negative, including historical levels of income, expectations and

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

risks associated with estimates of future taxable income and has determined that it is more likely than not

that its net deferred tax assets will not be realized. Due to uncertainties surrounding the realization of the

deferred tax assets, the Company continues to maintain a full valuation allowance against its net deferred

tax assets.

**18. Subsequent Events**

The Company has reviewed and evaluated subsequent events as of December 31, 2024 through March

26, 2025, the date that the consolidated financial statements were available to be issued.

*2025 Convertible Notes*

In January and March 2025, the Company issued convertible promissory notes to various investors and

certain employees (the "Requisite Holders") in the aggregate amount of $98.3 million, which was

comprised of $75.3 million in aggregate principal amount of notes issued for cash consideration, $1.3

million in aggregate principal amount of notes issued in lieu of cash compensation to certain employees,

and $23.0 million in aggregate principal amount of notes issued in the 2024 Term Loan Conversion

(collectively, the "2025 Convertible Notes"). The 2025 Convertible Notes are due and payable in full 48

months from the issue date. Upon completion of an IPO transaction, the 2025 Convertible Notes shall

automatically convert into shares of the Company's common stock at the IPO price per share at the lower

of a 20% discount and a valuation cap of $2.0 billion on a pre-money basis. In the event the Company

completes a sale of shares of preferred stock, the Requisite Holders may elect to convert the outstanding

2025 Convertible Notes into shares of such series of preferred stock at the same terms. Further, upon a

change of control transaction, the Requisite Holders may elect to convert the outstanding 2025

Convertible Notes into shares of the Company's common stock at the lower of a 20% discount to the

implied price per share of common stock in the change of control transaction and a valuation cap of $2.0

billion on a pre-money basis, or receive payment of all principal and any accrued but unpaid PIK interest.

The 2025 Convertible Notes do not accrue interest for one year following the date of issuance. Following

the one-year anniversary of the issue date and for the remainder of the term, the 2025 Convertible Notes

interest will accrue on an annual basis at the rate of 7.0% per annum (PIK Interest). All PIK Interest

accrued and payable will be paid by capitalizing such interest on an annual basis and adding it to the

outstanding principal amount of the 2025 Convertible Notes. The Company is currently analyzing the

appropriate accounting treatment and financial statement impact related to the 2025 Convertible Notes on

its consolidated financial statements.

*2025 Amendment to 2024 Credit Agreement*

On January 24, 2025, in connection with the issuance of the 2025 Convertible Notes, the Company

entered into Amendment No.1 to the 2024 Credit Agreement, in which its lender, Hayfin, converted $23.0

million of principal under the 2024 Term Loan to 2025 Convertible Notes under the same terms as the

other purchasers of the 2025 Convertible Notes. The principal balance outstanding under the 2024 Term

Loan, as amended, is $115.1 million. The minimum liquidity cash balance covenant under the 2024 Term

Loan was reduced to $15.0 million from the previous $25.0 million. In addition, the amount immediately

payable upon the consummation of an IPO or SPAC, as defined in the terms of the 2024 Credit

Agreement, was amended where repayment of the 2024 Term Loan will be at an amount equal to the

lesser of (i) the net cash proceeds of such IPO or SPAC in excess of $150.0 million and (ii) $50.0 million

(or $55.0 million if the underwriters exercise any portion of their option to purchase additional shares).

The exit fee and prepayment fee remaining under the original terms of the 2024 Term Loan, which were

immediately due and payable upon issuance of the 2025 Convertible Notes was also amended to be

immediately due and payable upon the next occurrence of a financing event as described in Note 8.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**HeartFlow Holding, Inc.**

**Notes to Consolidated Financial Statements**

*2025 Facility Lease Amendment*

On March 12, 2025, the Company amended the lease for its Austin, Texas facility to extend the lease term

an additional 12 months through December 31, 2026. The monthly lease payments are approximately

$57,000 per month during the one-year extension period.

*Grant of Option Awards*

Subsequent to December 31, 2024, the Company granted options for 272,831 shares of common stock,

subject to service-based vesting conditions, with an exercise price of $12.68 per share to employees.

**19. Subsequent Events (unaudited)**

For the interim consolidated financial statements as of March 31, 2025, and for the three months then

ended, the Company has evaluated events through June 20, 2025, which is the date the unaudited

interim consolidated financial statements were available to be issued and through August 6, 2025, which

is the date the consolidated financial statements were available to be reissued.

*Authorized Shares Increase*

In May 2025, the Company's stockholders and Board of Directors approved an additional 1,000,000

shares of common stock to be authorized for issuance under the 2009 Equity Incentive Plan.

*Grant of Option Awards*

Subsequent to March 31, 2025, the Company granted options for 212,888 shares of common stock,

subject to service-based vesting conditions, with an exercise price of $13.64 per share to employees.

*2025 Facility Lease*

On July 2, 2025, the Company entered into a facility lease agreement for approximately 8,100 rentable

square feet of office space in San Francisco, California for 39 months through November 30, 2028, with

the option to extend for one additional three-year period. In connection with the lease, the Company paid

a security deposit of $90,000. The average monthly lease payments are approximately $40,000 per

month during the lease term.

*Consolidation of HeartFlow Holding, Inc. With and Into HeartFlow, Inc.*

On July 17, 2025, the Company's stockholders and Board of Directors approved the consolidation of

HeartFlow Holding, Inc. with and into HeartFlow, Inc., with HeartFlow, Inc. continuing as the surviving

company. The previous holders of HeartFlow Holding, Inc.'s common stock and preferred securities

became holders of HeartFlow, Inc.'s common stock and preferred securities, and the equity incentive

plan, outstanding equity awards, outstanding warrants and certain other equity-related agreements of

HeartFlow Holding, Inc. were assumed by HeartFlow, Inc. In connection with this consolidation, the

Company changed its name to Heartflow, Inc.

*Amended and Restated Certificate of Incorporation*

In July 2025, the Company's Board of Directors approved that immediately prior to the consummation of

the Company's IPO, the Company will file an amended and restated certificate of incorporation that

authorizes 250,000,000 shares of common stock, $0.001 par value per share, and 50,000,000 shares of

preferred stock, $0.001 par value per share.

*2009 Equity Incentive Plan*

In July 2025, the Company's Board of Directors approved the termination of the 2009 Equity Incentive

Plan effective immediately prior to consummation of the Company's IPO.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

***16,666,667 shares***

![heartflowlogo.jpg](heartflowlogo.jpg)

***Common stock***

**Preliminary prospectus**

---

| | | |
|:---|:---|:---|
| **J.P. Morgan** | **Morgan Stanley** | **Piper Sandler** |

---

---

| | |
|:---|:---|
| **Stifel** | **Canaccord Genuity** |

---

**&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;, 2025**

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**Part II**

**Information not required in prospectus**

**Item 13. Other expenses of issuance and distribution.**

The following table sets forth the costs and expenses, other than the underwriting discounts and

commissions, payable by Heartflow, Inc. (the "Registrant") in connection with the sale of the Registrant's

common stock, par value $0.001 per share (the "Common Stock"), being registered. All amounts are

estimates except for the Securities and Exchange Commission (the "SEC") registration fee, the Financial

Industry Regulatory Authority ("FINRA") filing fee, and the Nasdaq Global Select Market listing fee.

---

| | |
|:---|:---|
|  | **Amount to be** <br>**paid**<br>|
| SEC registration fee........................................................................................................................... | $37414 |
| FINRA filing fee................................................................................................................................... | 37156 |
| Nasdaq listing fee............................................................................................................................... | 295000 |
| Transfer agent's fees and expenses............................................................................................... | 10000 |
| Printing and engraving expenses.................................................................................................... | 250000 |
| Legal fees and expenses.................................................................................................................. | 3500000 |
| Accounting fees and expenses........................................................................................................ | 1200000 |
| Miscellaneous expenses................................................................................................................... | 170430 |
| Total...................................................................................................................................................... | $5500000 |

---

**Item 14. Indemnification of directors and officers.** 

Section 145 of the General Corporation Law of the State of Delaware (the "Delaware General Corporation

Law") provides that a corporation may indemnify directors and officers as well as other employees and

individuals against expenses (including attorneys' fees), judgments, fines, and amounts paid in settlement

actually and reasonably incurred by such person in connection with any threatened, pending, or

completed actions, suits, or proceedings in which such person is made a party by reason of such person

being or having been a director, officer, employee, or agent to the Registrant. The Delaware General

Corporation Law provides that Section 145 is not exclusive of other rights to which those seeking

indemnification may be entitled under any bylaw, agreement, vote of stockholders or disinterested

directors, or otherwise. Article X of the Registrant's current amended and restated certificate of

incorporation and VIII of the Registrant's amended and restated certificate of incorporation to be effective

upon completion of the sale of the Registrant's common stock being registered each provide for

indemnification by the Registrant of its directors and officers to the fullest extent permitted by the

Delaware General Corporation Law. The Registrant has entered into indemnification agreements with

each of its current directors, executive officers, and certain other officers to provide these directors and

officers additional contractual assurances regarding the scope of the indemnification set forth in the

Registrant's amended and restated certificate of incorporation and to provide additional procedural

protections. There is no pending litigation or proceeding involving a director or executive officer of the

Registrant for which indemnification is sought.

Section 102(b)(7) of the Delaware General Corporation Law permits a corporation to provide in its

certificate of incorporation that a director or an officer of the corporation shall not be personally liable to

the corporation or its stockholders for monetary damages for breach of fiduciary duty as a director or an

officer, except for liability (i) for any breach of the director's or officer's duty of loyalty to the corporation or

its stockholders, (ii) for acts or omissions not in good faith or which involve intentional misconduct or a

knowing violation of law, (iii) in the case of directors, for unlawful payments of dividends or unlawful stock

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

repurchases, redemptions, or other distributions, or (iv) for any transaction from which the director or

officer derived an improper personal benefit; provided that officers may not be indemnified for actions by

or in the right of the corporation. The Registrant's amended and restated certificate of incorporation to be

effective upon completion of the sale of the Registrant's common stock being registered provides for such

limitation of liability.

The Registrant maintains standard policies of insurance under which coverage is provided (a) to its

directors and officers against loss rising from claims made by reason of breach of duty or other wrongful

act and (b) to the Registrant with respect to payments that may be made by the Registrant to such

officers and directors pursuant to the above indemnification provision or otherwise as a matter of law.

The proposed form of underwriting agreement to be filed as Exhibit 1.1. to this registration statement

provides for indemnification of officers and directors of the Registrant by the underwriters against certain

liabilities.

**Item 15. Recent sales of unregistered securities.**

Since January 1, 2022, to the date of this registration statement, the Registrant made sales of the

following unregistered securities:

***(a) Equity plan-related issuances***

1. Since January 1, 2022, the Registrant granted to its directors, employees, consultants, and other

service providers options to purchase an aggregate of 9,103,504 shares of its Common Stock under

its HeartFlow Holding, Inc. Amended and Restated 2009 Equity Incentive Plan ("2009 Equity Incentive

Plan"), with a weighted-average exercise price of $4.83 per share.

2. Since January 1, 2022, the Registrant issued and sold to its directors, employees, consultants, and

other service providers an aggregate of 1,700,695 shares of its Common Stock upon the exercise of

stock options under its 2009 Equity Incentive Plan, with a weighted-average exercise price of $4.60

per share.

***(b) Sales of preferred stock***

3. In March 2023, the Registrant sold an aggregate of (i) 61,344,029 shares of its Series F redeemable

convertible preferred stock to 29 accredited investors at a purchase price of $2.8505 per share and

(ii) 21,465,064 shares of its Series F-1 redeemable convertible preferred stock to 19 accredited

investors at a purchase price of $1.9098 per share, for an aggregate purchase price of $215.9 million.

The Series F-1 redeemable convertible preferred stock were issued upon conversion of the

indebtedness under outstanding subordinated convertible promissory notes.

***(c) Warrants***

4. On March 17, 2022, the Registrant issued a warrant to Hayfin Tourmaline Luxco S.a.r.l. to purchase

an aggregate of 77,253 shares of its Common Stock at a purchase price of $0.03 per share (the

"2022 Hayfin Warrant").

5. On March 2, 2023, the warrant issued to Hayfin Tourmaline Luxco S.a.r.l. on January 19, 2021 (the

"2021 Hayfin Warrant") was adjusted in connection with the Series F and Series F-1 Convertible

Preferred Stock Financing, allowing Hayfin Tourmaline Luxco S.a.r.l. to purchase an aggregate of

961,138 shares of its Common Stock at a purchase price of $0.03 per share pursuant to the 2021

Hayfin Warrant.

6. On March 2, 2023, the 2022 Hayfin Warrant was adjusted in connection with the Series F and

Series F-1 Convertible Preferred Stock Financing, allowing Hayfin Tourmaline Luxco S.a.r.l. to

purchase an aggregate of 686,529 shares of its Common Stock at a purchase price of $0.03 per

share pursuant to the 2022 Hayfin Warrant.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

***(d) Convertible notes***

7. From September 30, 2022 to December 16, 2022, the Registrant issued $40.0 million principal

amount of the 2022 Convertible Promissory Notes to investors, including related parties, with original

maturity dates of 48 months from the dates of issuance. The 2022 Convertible Notes automatically

converted into shares of Series F-1 convertible preferred stock on March 2, 2023.

8. In January and March 2025, the Registrant issued an aggregate of $98.3 million principal amount of

the 2025 Convertible Promissory Notes to investors, including related parties, with original maturity

dates of 48 months from the dates of issuance. The 2025 Convertible Promissory Notes will be

automatically converted upon the completion of this offering into shares of Common Stock without

interest.

No underwriters were involved in these transactions. The offers, sales, and issuances of the securities

described in paragraphs (1) through (2) were deemed to be exempt from registration under Rule 701

promulgated under the Securities Act of 1933, as amended (the "Securities Act") as transactions under

compensatory benefit plans and contracts relating to compensation, or under Section 4(a)(2) of the

Securities Act as a transaction by an issuer not involving a public offering. The recipients of such

securities were our directors, employees, or bona fide consultants and received the securities under the

Registrant's equity incentive plans. Appropriate legends were affixed to the securities issued in these

transactions. Each of the recipients of securities in these transactions had adequate access, through

employment, business or other relationships, to information about the Registrant.

The offers, sales, and issuances of the securities described in paragraphs (3) through (8) were deemed to

be exempt under Section 4(a)(2) of the Securities Act or Rule 506 of Regulation D under the Securities

Act as a transaction by an issuer not involving a public offering. The recipients of securities in each of

these transactions acquired the securities for investment only and not with a view to or for sale in

connection with any distribution thereof and appropriate legends were affixed to the securities issued in

these transactions. Each of the recipients of securities in these transactions was an accredited investor

within the meaning of Rule 501 of Regulation D under the Securities Act and had adequate access to

information about the Registrant.

**Item 16. Exhibits and financial statement schedules.**

**(a)Exhibits.** See the Exhibit Index attached to this registration statement, which Exhibit Index is

incorporated herein by reference.

**(b)Consolidated financial statement schedules.** Schedules not listed above have been omitted

because the information required to be set forth therein is not applicable or is shown in the financial

statements or notes thereto.

**Item 17. Undertakings.**

Insofar as indemnification for liabilities arising under the Securities Act may be permitted to directors,

officers, and controlling persons of the Registrant pursuant to the foregoing provisions, or otherwise, the

Registrant has been advised that in the opinion of the SEC such indemnification is against public policy

as expressed in the Securities Act, and is, therefore, unenforceable. In the event that a claim for

indemnification against such liabilities (other than the payment by the Registrant of expenses incurred or

paid by a director, officer, or controlling person of the Registrant in the successful defense of any action,

suit, or proceeding) is asserted by such director, officer, or controlling person in connection with the

securities being registered, the Registrant will, unless in the opinion of its counsel the matter has been

settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such

indemnification by it is against public policy as expressed in the Securities Act and will be governed by the

final adjudication of such issue.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

The undersigned Registrant hereby undertakes that:

1. For purposes of determining any liability under the Securities Act, the information omitted from the

form of prospectus filed as part of this registration statement in reliance upon Rule 430A and

contained in a form of prospectus filed by the Registrant pursuant to Rule 424(b)(1) or (4) or 497(h)

under the Securities Act shall be deemed to be part of this registration statement as of the time it was

declared effective.

2. For the purpose of determining any liability under the Securities Act, each post-effective amendment

that contains a form of prospectus shall be deemed to be a new registration statement relating to the

securities offered therein, and the offering of such securities at that time shall be deemed to be the

initial *bona fide* offering thereof.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**Exhibit index**

---

| | |
|:---|:---|
| **Exhibit** <br>**number**<br>| **Exhibit description** |
| 1.1++ | <u>[Form of Underwriting Agreement.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025037144/exhibit11-sx1a1.htm)</u> |
| 3.1++ | <u>[Amended and Restated Certificate of Incorporation, as amended, currently in effect.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit31-sx1.htm)</u> |
| 3.2++ | <u>[Certificate of Amendment to the Amended and Restated Certificate of Incorporation,](https://www.sec.gov/Archives/edgar/data/1464521/000162828025037144/exhibit32-sx1a1.htm)</u><br><u>[currently in effect.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025037144/exhibit32-sx1a1.htm)</u><br>|
| 3.3++ | <u>[Form of Amended and Restated Certificate of Incorporation, to be in effect upon the](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit32-sx1.htm)</u><br><u>[completion of this offering (previously filed as Exhibit 3.2).](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit32-sx1.htm)</u><br>|
| 3.4++ | <u>[Amended and Restated Bylaws, currently in effect (previously filed as Exhibit 3.3).](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit33-sx1.htm)</u> |
| 3.5++ | <u>[Form of Amended and Restated Bylaws, to be in effect](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit34-sx1.htm)</u><u>[upon the effectiveness of the](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit34-sx1.htm)</u><br><u>[amended and restated certificate of incorporation](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit34-sx1.htm)</u><u>[(previously filed as Exhibit 3.4)](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit34-sx1.htm)</u><u>[.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit34-sx1.htm)</u><br>|
| 4.1++ | <u>[Warrant to Purchase Common Stock, dated January 19, 2021, between Hayfin Tourmaline](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit42-sx1.htm)</u><br><u>[Luxco S.a.r.l. and HeartFlow, Inc. (previously filed as Exhibit 4.2).](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit42-sx1.htm)</u><br>|
| 4.2++ | <u>[Warrant to Purchase Common Stock, dated March 17, 2022, between Hayfin Tourmaline](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit43-sx1.htm)</u><br><u>[Luxco S.a.r.l. and HeartFlow Holding, Inc. (previously filed as Exhibit 4.3).](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit43-sx1.htm)</u><br>|
| 4.3++† | <u>[Amended and Restated Investors' Rights Agreement, dated March 2, 2023, by and among](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit44-sx1.htm)</u><br><u>[HeartFlow Holding, Inc. and the investors listed therein. (previously filed as Exhibit 4.4).](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit44-sx1.htm)</u><br>|
| 5.1+ | <u>[Opinion of O'Melveny & Myers LLP.](exhibit51-sx1a2.htm)</u> |
| 10.1#++ | <u>[HeartFlow Holding, Inc. Amended and Restated 2009 Equity Incentive Plan, as amended,](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit101-sx1.htm)</u><br><u>[and forms of award agreements.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit101-sx1.htm)</u><br>|
| 10.2#++ | <u>[2025 Performance Incentive Plan, to become effective on upon the commencement of](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit102-sx1.htm)</u><br><u>[trading of Heartflow, Inc. common stock on the Nasdaq Global Select Market, and forms of](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit102-sx1.htm)</u><br><u>[award agreements.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit102-sx1.htm)</u><br>|
| 10.3#++ | <u>[2025 Employee Stock Purchase Plan, to become effective on upon the commencement of](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit103-sx1.htm)</u><br><u>[trading of Heartflow, Inc. common stock on the Nasdaq Global Select Market, and forms of](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit103-sx1.htm)</u><br><u>[award agreements.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit103-sx1.htm)</u><br>|
| 10.4#++ | <u>[Senior Leadership Severance Policy, effective as of July 17, 2025](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit104-sx1.htm)</u> |
| 10.5#++ | <u>[Director Compensation Policy, to become effective on upon the commencement of trading of](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit105-sx1.htm)</u><br><u>[Heartflow, Inc. common stock on the Nasdaq Global Select Market](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit105-sx1.htm)</u><br>|
| 10.6++† | <u>[Lease, dated August 9, 2021, by and between MV Campus Owner, LLC and HeartFlow, Inc.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit106-sx1.htm)</u> |
| 10.7++† | <u>[Credit Agreement and Guaranty, dated June 14, 2024, by and among HeartFlow, Inc.,](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit107-sx1.htm)</u><br><u>[HeartFlow Holding, Inc., Hayfin Tourmaline Luxco S.a.r.l. and Hayfin Services, LLP.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit107-sx1.htm)</u><br>|
| 10.8++ | <u>[Amendment No. 1 to Credit Agreement and Guaranty, dated January 24, 2025, by and](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit108-sx1.htm)</u><br><u>[among HeartFlow, Inc., HeartFlow Holding, Inc., Hayfin Tourmaline Luxco S.a.r.l. and Hayfin](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit108-sx1.htm)</u><br><u>[Services, LLP.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit108-sx1.htm)</u><br>|
| 10.9++ | <u>[Form of Indemnification Agreement for Directors and Officers.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025037144/exhibit109-sx1a1.htm)</u> |
| 21.1++ | <u>[List of Subsidiaries.](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/exhibit211-sx1.htm)</u> |
| 23.1+ | <u>[Consent of PricewaterhouseCoopers LLP, independent registered public accounting firm.](exhibit231-sx1a2.htm)</u> |
| 23.2+ | <u>[Consent of O'Melveny & Myers LLP (included in Exhibit 5.1).](exhibit51-sx1a2.htm)</u> |
| 24.1++ | <u>[Power of Attorney (reference is made to the signature page to the Registration Statement).](https://www.sec.gov/Archives/edgar/data/1464521/000162828025035242/heartflowinc-sx1.htm#i2341357d54884756b9e9172f0a83cd6b_712)</u> |
| 107.1+ | <u>[Filing Fee Table.](exfilingfees8625.htm)</u> |

---

#Indicates management contract or compensatory plan.

+Filed herewith.

++Previously filed.

†Annexes, schedules and/or exhibits have been omitted pursuant to Item 601(a)(5) of Regulation S-K. The registrant agrees to furnish

supplementally a copy of any omitted attachment to the SEC on a confidential basis upon request.

<u>[**Table of Contents**](#i2341357d54884756b9e9172f0a83cd6b_688)</u>

**Signatures**

Pursuant to the requirements of the Securities Act of 1933, the registrant has duly caused this registration

statement to be signed on its behalf by the undersigned, thereunto duly authorized, in the City of

Mountain View, State of California on August 6, 2025.

---

| | |
|:---|:---|
| **HEARTFLOW, INC.** | **HEARTFLOW, INC.** |
| By: | /s/ John C.M. Farquhar |
|  | John C.M. Farquhar |
|  | *President and Chief Executive Officer* |

---

Pursuant to the requirements of the Securities Act of 1933, this Registration Statement has been signed

by the following persons in the capacities and on the dates indicated.

---

| | | |
|:---|:---|:---|
| **Signature** | **Title** | **Date** |
| /s/ John C.M. Farquhar | President, Chief Executive Officer and Director<br>(*Principal Executive Officer*) | August 6, 2025 |
| John C.M. Farquhar | President, Chief Executive Officer and Director<br>(*Principal Executive Officer*) | August 6, 2025 |
| /s/ Vikram Verghese | Chief Financial Officer<br>(*Principal Financial Officer*) | August 6, 2025 |
| Vikram Verghese | Chief Financial Officer<br>(*Principal Financial Officer*) | August 6, 2025 |
| /s/ Mhairi L. Jones | Chief Accounting Officer<br>(*Principal Accounting Officer*) | August 6, 2025 |
| Mhairi L. Jones | Chief Accounting Officer<br>(*Principal Accounting Officer*) | August 6, 2025 |
| \* | Chair of the Board of Directors | August 6, 2025 |
| William C. Weldon | Chair of the Board of Directors | August 6, 2025 |
| \* | Director | August 6, 2025 |
| Timothy C. Barabe | Director | August 6, 2025 |
| \* | Director | August 6, 2025 |
| Julie A. Cullivan | Director | August 6, 2025 |
| \* | Director | August 6, 2025 |
| Nicholas Downing, M.D. | Director | August 6, 2025 |
| \* | Director | August 6, 2025 |
| Jeffrey C. Lightcap | Director | August 6, 2025 |
| \* | Director | August 6, 2025 |
| Wayne J. Riley, M.D. | Director | August 6, 2025 |
| \* | Director | August 6, 2025 |
| Lonnie M. Smith | Director | August 6, 2025 |
| \* | Director | August 6, 2025 |
| Casey M. Tansey | Director | August 6, 2025 |
| \* | Director | August 6, 2025 |
| Charles A. Taylor, Jr., Ph.D. | Director | August 6, 2025 |

---

---

| | |
|:---|:---|
| \* By: | /s/ Angela Ahmad |
|  | Angela Ahmad |
|  | *Attorney-in-Fact* |

---

## Ex-Filing

?xml version='1.0' encoding='ASCII'? EX-FILING FEES

---

| |
|:---|
| &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Calculation of Filing Fee Tables**  |
| &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **S-1**  |
| &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Heartflow, Inc.**  |

---

---

| | | | | | | | | | |
|:---|:---|:---|:---|:---|:---|:---|:---|:---|:---|
| | | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Security Type**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Security Class Title**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Fee Calculation or Carry Forward Rule**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Amount Registered**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Proposed Maximum Offering Price Per Unit**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Maximum Aggregate Offering Price**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Fee Rate**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Amount of Registration Fee**  |
| **Newly Registered Securities** | **Newly Registered Securities** | **Newly Registered Securities** | **Newly Registered Securities** | **Newly Registered Securities** | **Newly Registered Securities** | **Newly Registered Securities** | **Newly Registered Securities** | **Newly Registered Securities** | **Newly Registered Securities** |
| Fees to be Paid | 1 | Equity | Common stock, $0.001 par value per share | 457(a) | 19166667 | $18.00 | $345000006.00 | 0.0001531 | $52819.50 |
| Fees Previously Paid |  |  |  |  |  |  |  |  |  |
| **Carry Forward Securities** | **Carry Forward Securities** | **Carry Forward Securities** | **Carry Forward Securities** | **Carry Forward Securities** | **Carry Forward Securities** | **Carry Forward Securities** | **Carry Forward Securities** | **Carry Forward Securities** | **Carry Forward Securities** |
| Carry Forward Securities |  |  |  |  |  |  |  |  |  |
|  |  |  | Total Offering Amounts: | Total Offering Amounts: | Total Offering Amounts: |  | $345000006.00  |  | $52819.50  |
|  |  |  | Total Fees Previously Paid:  | Total Fees Previously Paid:  | Total Fees Previously Paid:  |  |  |  | $0.00  |
|  |  |  | Total Fee Offsets:  | Total Fee Offsets:  | Total Fee Offsets:  |  |  |  | $37413.81  |
|  |  |  | Net Fee Due:  | Net Fee Due:  | Net Fee Due:  |  |  |  | $15405.69  |

---

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Offering Note** <br>

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <sup>1</sup> 1a. Includes 2,500,000 shares that the underwriters have the option to purchase, if any. 1b. Estimated solely for the purpose of computing the amount of the registration fee pursuant to Rule 457(a) under the Securities Act of 1933, as amended.

---

| | | | | | | | | |
|:---|:---|:---|:---|:---|:---|:---|:---|:---|
| | | Registrant or Filer Name | Form or Filing Type | File Number | Initial Filing Date | Filing Date | Fee Offset Claimed | Fee Paid with Fee Offset Source |
| **Rules 457(b) and 0-11(a)(2)** | **Rules 457(b) and 0-11(a)(2)** | **Rules 457(b) and 0-11(a)(2)** | **Rules 457(b) and 0-11(a)(2)** | **Rules 457(b) and 0-11(a)(2)** | **Rules 457(b) and 0-11(a)(2)** | **Rules 457(b) and 0-11(a)(2)** | **Rules 457(b) and 0-11(a)(2)** | **Rules 457(b) and 0-11(a)(2)** |
| Fee Offset Claims | 1 |  | S-1 | 333-288733 | 07/17/2025 |  | $15310.00 |  |
| Fee Offset Claims | 2 |  | S-1 | 333-288733 | 07/17/2025 |  | $22103.81 |  |
| Fee Offset Sources |  | Heartflow, Inc. | S-1 | 333-288733 |  | 07/17/2025 |  | $15310.00 |
| Fee Offset Sources |  | Heartflow, Inc. | S-1 | 333-288733 |  | 08/01/2025 |  | $22103.81 |
| **Rule 457(p)** | **Rule 457(p)** | **Rule 457(p)** | **Rule 457(p)** | **Rule 457(p)** | **Rule 457(p)** | **Rule 457(p)** | **Rule 457(p)** | **Rule 457(p)** |
| Fee Offset Claims |  |  |  |  |  |  |  |  |
| Fee Offset Sources |  |  |  |  |  |  |  |  |

---

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Explanation of the basis for claimed offset:** <br>

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <sup>1</sup> 1a. The Registrant previously paid registration fees of (a) $15,310.00 in connection with the initial filing of this Registration Statement on Form S-1 on July 17, 2025 and (b) $22,103.81 in connection with the filing of Amendment No. 1 to this Registration Statement on Form S-1 on August 1, 2025.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <sup>2</sup> See note 1a.

---

| | | | | | | | |
|:---|:---|:---|:---|:---|:---|:---|:---|
| | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Security Type**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Security Class Title**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Amount of Securities Previously Registered**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Maximum Aggregate Offering Price of Securities Previously Registered**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Form Type**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **File Number**  | &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; **Initial Effective Date**  |
| N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |

---

## Exhibit 5.1

**Exhibit 5.1**

---

| | | |
|:---|:---|:---|
| | | ![omelvenylogoa.jpg](omelvenylogoa.jpg) |
| O'Melveny & Myers LLP | T: +1 415 984 8700 | File Number: |
| Two Embarcadero Center | F: +1 415 984 8701 | 0368375-00001 |
| 28th Floor | omm.com | |
| San Francisco, CA 94111-3823 | | |

---

August 6, 2025

Heartflow, Inc.

331 E. Evelyn Avenue

Mountain View, California 94104

**Re:&nbsp;&nbsp;&nbsp;&nbsp;Registration Statement on Form S-1 (File No. 333-288733)**

We have acted as special counsel to Heartflow, Inc., a Delaware corporation (the "**Company**"), in connection with the offer and sale by the Company of up to 19,166,667 shares (the "**Shares**") of the Company's common stock, par value $0.001 per share (the "**Common Stock**"), pursuant to an underwriting agreement (the "**Agreement**") among the Company and J.P. Morgan Securities LLC, Morgan Stanley & Co. LLC and Piper Sandler & Co., as representatives of the underwriters. The Shares are being offered and sold pursuant to the registration statement on Form S-1 (File No. 333-288733) (as amended, the "**Registration Statement**"), including a related prospectus filed with the Registration Statement, initially filed by the Company with the Securities and Exchange Commission (the "**Commission**") under the Securities Act of 1933, as amended (the "**Securities Act**"), on July 17, 2025. The term "**Shares**" is inclusive of 2,500,000 shares of Common Stock subject to the underwriters' option to purchase additional shares of Common Stock from the Company pursuant to the Agreement, and shall include any additional shares of Common Stock registered by the Company pursuant to Rule 462(b) under the Securities Act in connection with the offering contemplated by the Registration Statement.

In our capacity as such counsel, we have examined originals or copies of those corporate and other records and documents we considered appropriate, including, among other things, the following:

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(a)&nbsp;&nbsp;&nbsp;&nbsp;the Registration Statement;

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(b)&nbsp;&nbsp;&nbsp;&nbsp;the Amended and Restated Certificate of Incorporation and Amended and Restated Bylaws of the Company, each as amended through the date hereof; and

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(c)&nbsp;&nbsp;&nbsp;&nbsp;originals or copies of resolutions and actions by written consent of the board of directors of the Company relating to the preparation and filing of the Registration Statement, the offering of the Shares and related matters.

We have assumed the genuineness of all signatures, the authenticity of all documents submitted to us as originals and the conformity with originals of all documents submitted to us as copies. In addition, we have obtained and relied upon those certificates of public officials we considered appropriate.

Based on this examination, our reliance upon the assumptions in this letter and our consideration of those questions of law we considered relevant, and subject to the limitations and qualifications in this letter, we are of the opinion that the issuance of the Shares has been duly authorized by all necessary corporate action on the part of the Company, and upon payment for and delivery of the Shares in accordance with the Agreement, the Shares will be validly issued, fully paid and non-assessable.

Austin • Century City • Dallas • Houston • Los Angeles • Newport Beach • New York • San Francisco • Silicon Valley • Washington, DCBeijing • Brussels • Hong Kong • London • Seoul • Shanghai • Singapore • Tokyo

------

![omelvenylogoa.jpg](omelvenylogoa.jpg)<br>

The law covered by this letter is limited to the present General Corporation Law of the State of Delaware. We express no opinion as to the laws of any other jurisdiction and no opinion regarding the statutes, administrative decisions, rules, regulations or requirements of any county, municipality, subdivision or local authority of any jurisdiction.

This letter is being furnished in accordance with the requirements of Item 601(b)(5) of Regulation S-K promulgated under the Securities Act, and no opinion is expressed herein as to any matter pertaining to the contents of the Registration Statement, the prospectus included in the Registration Statement, any registration statement under Rule 462(b) or any prospectus supplement, other than as expressly stated herein with respect to the Shares.

This letter is expressly limited to the matters set forth above, and we render no opinion, whether by implication or otherwise, as to any other matters. This letter speaks only as of the date hereof and we assume no obligation to update or supplement this letter to reflect any facts or circumstances that arise after the date hereof and come to our attention or any future changes in laws.

We hereby consent to the use of this letter as an exhibit to the Registration Statement and to the reference to this firm under the heading "*Legal matters*" in the prospectus constituting part of the Registration Statement. We further consent to the incorporation by reference of this letter and the foregoing consent into any registration statement filed pursuant to Rule 462(b) under the Securities Act with respect to the Shares. In giving such consent, we do not admit that we are in the category of persons whose consent is required under Section 7 of the Securities Act or the rules and regulations of the Commission thereunder.

Respectfully submitted,

/s/ O'Melveny & Myers LLP

## Exhibit 23.1

**Exhibit 23.1**

CONSENT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

We hereby consent to the use in this Registration Statement on Form S-1 of Heartflow, Inc. of our report dated March 26, 2025, except for the effects of the reverse stock split discussed in Note 1 to the consolidated financial statements, as to which the date is August 1, 2025 relating to the financial statements of HeartFlow Holding, Inc., which appears in this Registration Statement. We also consent to the reference to us under the heading "Experts" in such Registration Statement.

/s/ PricewaterhouseCoopers LLP

San Jose, California

August 6, 2025 

<br>