In a recent episode of the Dealmakers’ Podcast, John Milad shared insights from his remarkable journey – a trajectory that took him from a quaint small town to the bustling financial districts of major cities like Chicago, New York, and London.
His venture, Quanta Dialysis, attracted funding from top-tier investors like BlackRock, Eldridge, Segulah Medical, and Monashee Investment Management LLC.
In this episode, you will learn:
- Broad education at the University of Chicago that equipped him with a versatile skill set, enabling him to participate in various disciplines and fields of interest meaningfully
- Bridging the gap between industry expertise and financial acumen being crucial for successful deal-making; collaboration with subject matter experts is invaluable
- Deals must be structured to ensure both sources and users of capital derive tangible benefits, creating a win-win scenario for all parties involved
- The fascination with the convergence of science, technology, and healthcare’s direct impact on well-being that led him to focus exclusively on revolutionizing the industry.
- Navigating the unpredictable landscape of entrepreneurship that required humility, adaptability, and the ability to integrate new knowledge swiftly
- Quanta Dialysis’s portable hemodialysis machine revolutionized patient care, enabling greater control and convenience in treatment.
- Whether as an investor or an operator, being a world subject matter expert in a defined field is essential for driving meaningful change and success.
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About John Milad:
John E. Milad has extensive experience in the healthcare industry, with a focus on medtech startups and venture capital. John E. is currently a Partner & Co-Head of Healthcare Ventures at Downing LLP since 2023. Prior to that, they served as a Board Member at Otivio AS since 2022.
From 2009 to 2022, Milad held various roles at Quanta Dialysis Technologies, including Chief Executive Officer and Founding Board Member. During their tenure, they transformed the startup into a successful transatlantic business and developed innovative hemodialysis devices, water purification systems, and digital health platforms. John E. received multiple awards for engineering and innovation during this time.
Milad also served as a Board Member at Cellnovo Group from 2011 to 2013 and as a Board Member at Advanced Cardiac Therapeutics (later renamed Epix Therapeutics) and Symetis from 2010 to 2013. John E. was a Board Observer at BONESUPPORT AB from 2009 to 2013.
Prior to these roles, Milad worked as an Investment Director at NBGI Ventures from 2009 to 2013, where they managed a venture capital fund supporting medtech startups. John E. was also the President of Insight Capital & Advisory from 2005 to 2008.
Earlier in their career, Milad was the Head of Finance and Business Development at Nitec Pharma AG, where they led finance and business development activities and successfully raised Series B funding.
Overall, Milad’s experience spans leadership positions, board memberships, and investment roles within the healthcare industry, showcasing their expertise in growing startups and supporting innovation in MedTech.
John E. Milad attended the University of Chicago from 1990 to 1994, where they pursued a Bachelor of Arts degree in Political Science.
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Connect with John Milad:
Read the Full Transcription of the Interview:
Alejandro Cremades: Alrighty hello everyone and welcome to the deal maker show. So today. We have a very exciting guest. You know like we’re going to be talking about many of the differences between being an operator being an investor I mean he’s taking a company from nothing to taking over you know 400000000 you know of capital you know, just when he stepped in and. And I think that he has you know some of the different hats. You know that they that really allow you to understand well the venture world you know from a investment banking. You know perspective from an operator perspective from an investor perspective. So I think that we’re going to be learning quite a bit and I’m sure that you’re all going to find the episode today very inspiring so without further ado. Let’s welcome our guest today johnmy lad welcome to the show.
John Milad: Um, hello good morning pleased to be here. Thanks for having me.
Alejandro Cremades: So originally born in New Hampshire so give us our walk through memory lane. How was life growing up there.
John Milad: Ah, you know in hindsight it was quite idyllic. Actually a small town but pretty pretty wholesome. Pretty safe gave me a lot of space to explore and pursue the things that I wanted to um, but also left me with a hunger for something more and something bigger. Which ultimately you know, fueled me to go off into the world and do to move to different places live in big cities like Chicago New York London and to pursue a career in fields that I didn’t even know existed when I was a young man.
Alejandro Cremades: And you studied in Chicago and you did political science there. But then you know eventually you know you went into wall street you know out of all places after college. So why wall street you know what got you into into wall street.
John Milad: Yeah, good question. It’s all but thing about 1 thing to know about the University Of Chicago is it really emphasizes a broad grounding in all of the major academic fields and so even with a degree in political science I took University Level Physics Chemistry Biology calculus statistics so it did give me a good set of tools. Go out into the world and you know meaningfully participate in many different disciplines and fields of interest I would I chose to go to wall street because it was in the 90 s and when you were young and ambitious and wanted to make a name for yourself and do something that was you know hard and rewarding wall street was you know or magic consulting with the 2 things that people went off to. I liked the idea of doing deals and getting exposed to the commercial world. So um I chose I chose chose to go from from college to work at Lehman Brothers in the 90 s which was ah you know a great investment bank that had a broad international platform had a little bit of a boutique feel but it was one of the large players. Um, and that was really where I cut my teeth learning about yeah valuation capital markets analyzing things transactions I know those are skills that have you know remained valuable to me throughout my career.
Alejandro Cremades: So then let’s talk about the investment banking because I mean you did the investment banking quite a bit. You know you did that you know ah Lehman you know, then you know like you went to an noura as well. You know like you’ve done it all. You know you’ve done in multiple places like New York or londonon I guess from the investment banking you know side of things. What were some of the important things that you learned you know, especially when it came to understanding you know how to get deals done.
John Milad: That’s a good it’s a good thought so um firstly one of the things that I learned I started to appreciate this whole idea of the curse of knowledge. You know the things that we know aren’t necessarily things that other people know and so you know as I develop my knowledge of investment banking. How to value things how capital markets work. To structure things how to put deals together. Yeah I started to realize that you know even though my clients were industry experts in their industries which ah was mainly in the health care industry and ved tech biotech. They didn’t necessarily understand how the markets work or how to raise money and all that and so. Ah, started to gain an appreciation that you know my perspective um is differentiated and valuable and you know you collaborate with those subject matter experts to figure things out together and so it’s kind of the idea of an orchestra having many different instruments and. Um, just because someone’s a virtuoso on the Violin doesn’t mean they would know a whole lot about playing the flute and you got to compose all that um and so that was one thing I learned the other I learned is you know deals only make sense to people if they understand what they’re getting out of it right? and so early on as a junior banker you’re just processing a lot of stuff. But what you quickly learn is actually this is all for some end and either and generally what you’re trying to do is match. You know, sources of capital with users of capital and you need to make sure that on both sides someone’s getting something out of it. Um, the users of capital are you know, getting access to funding.
John Milad: At you know a cost or rates that are you know that are reasonable and the sources of capital are able to get a return and it was actually that as I started to understand that like you know that’s why people invest in companies on an ipo or they’ll buy a business them and a deal I started to really develop an affinity for that. It’s called the buyer perspective. Um and which that will led them to the next. Step in my career which was to go over to the buy side. You know where I worked at ah, a family office that was doing a range of private equity strategies a couple of venture funds and now today I’m back in the venture world. You know, understanding, why would someone choose to put their money in 1 place as opposed to another basically is what investors need to do. And it’s all about and being able to have a coherent proposition around well that’s the equity story and how is that going to generate a return that makes sense for the risk that you’re presenting right.
Alejandro Cremades: Now out of all things you know healthcare you know it sounds like during your time you know on the buy side especially at the family office that you were working at you know it sounds like healthcare was what got you hooked? You know what? what was it about healthcare because it sounds like you know once you got that first date you know you having. Tastes you haven’t stopped you know in the in the in this in this industry.
John Milad: Yeah that’s a really good. That’s a really good observation and you know before that I was sort of I probably was a bit industry agnostic. It was more about doing the financing work that was interesting to me and then when I came across the health care sector. You know I discovered something really interesting right? Which is it’s a big industry. It accounts for something like 20% of the Us economy. So there’s there’s a lot of business. There. A lot of money to be made a lot of money to be wasted. So it’s big and it matters and there are opportunities. The other thing is I’ve always been fascinated by science and technology you know and health care is where science and technology come to play ah and um. And and then it’s applied in a way that makes a difference in something that matters to every single person which is their health and well-being and so it was the combination of those things commercially significant intriguing from a technical perspective and the science and technology and having the ability to move the needle on something that’s important. And everyone’s life that I you know I got I came I stayed and I was hooked as you say and it’s been my focus now for the last twenty five years.
Alejandro Cremades: So in your case you know, eventually you ended up you know, ah helping you know at last venture with the with the with the fund that they had going in there and I find that you know this actually gave you the opportunity to really get your feet wet. You know as a first time you know operator there. With a company called basically a what? what? What was the company called again it was it was called nighting.
John Milad: It was nitech pharma. It was a german specialty farmer that yeah that was ah that was my first operational experience.
Alejandro Cremades: Yeah but but there you know there was something really unique that you did which was to eventually prepare the company for Ipo and get it to go public I guess you know there is many folks that right now are listening to us and that are perhaps on the gros stage. You know. Trying to think about like how to look ahead and and think about like what could that look like for them. What were some of the things that they perhaps like the key things that you learned on preparing a company to to go ipo.
John Milad: Yes, I will just clarify when I was there. The main thing that I did is I put in place the series b funding round and helped with some product licensing um and then put preparations in place that were ultimately intended to lead to an ipo as you say. Ah, but you know, but the the actual ipo itself was was intendeded to be executed by the team that was my successor team and actually the ipo didn’t happen because 2008 financial crisis came and that shut the markets down. Um and and I just the ultimate what happened in nighttech is it merged with horizon therapeutics. Which ah we all know has come to a really exciting and recently um, so that was it that was I helped prepare for everything to get to that Ipo. But then um I stepped out and the the markets shut down so that didn’t happen unfortunately but it had so it had to 1 thing a lesson from that is you got to be nimble right. Think you’re preparing for an ipo. But then maybe you’re doing an m and a deal or maybe it’s a strategic sale and actually one of the things I’ve seen time and again is in order to get a good trade sale a good strategic takeout. You need to convince strategic buyers that you have a strong batner. You have a strong. Best alternative to negotiated agreement with them that you have something else. You can do and so oftentimes the companies that get you know, really good m and a takeouts are the ones that have been preparing for ipo and have a credible path to Ipo so strategics know if they don’t pay fairly the companies.
John Milad: Going to have the ability to grow and continue to become a competitive threat either alone or in the hands of someone else. So That’s often one of the key lessons I’ve learned is make sure you’ve got like multiple multiple arrows in your Quiver. You’re not just relying on one path. Um, because that’s the way that you get the best possible outcome right.
Alejandro Cremades: Now in your case, you know 1 thing that that that I’ve observed too is that you you really like to get involved and with the companies that you end up investing in because you know, basically what what you did next you know is you went to to deploy you know from a $200000000 fund and eventually one of the companies that that you deployed in was a company that you ended up going fully. You know, ah both feed in so tell us about like this approach you know, like really rolling up the sleeves like to the next level and then also how was. That experience with what became a pivotal moment. You know in in your career which was leading quanta dia like Dialysis technologies.
John Milad: Yeah, that was um, that was a really interesting journey and one that I wouldn’t have fully predicted but you’re right? it started when as ah as somebody leading a venture fund. Um I you know found a company or actually I found a technology and a team. Were trapped inside of an industrial um, a larger industrial concern. Um, that had nothing to do with medical devices. But the technology had the potential to be applied in Dialysis. So I helped you know structure the spin out of that to pull the team. The ip. Technology out create an independent company which went on to be called quantum dialysis technologies that would be formed to develop all of that into a portable hemo analysilysis system that could do things differently from the current state of state of care. Um, so we created that vehicle funded the series. A I joined the board as a founding non-exec and from day one I went very deep I always wanted to understand how does the product work. What problem is really being solved who’s going to pay for it. How valuable can that be what are the things we need to do to generate the evidence. Unlock value as we go along and I was always very deep in that and if I couldn’t you know answer those questions to satisfy myself then I didn’t feel I was doing my job that always led to a ah hunger to dig deeper and to understand what was going on and um because I got so close the board invited me to take on.
Alejandro Cremades: Oh.
John Milad: Ceo role a few years later when there was ah a succession opportunity from the founding team. Um, and I you know I hadn’t necessarily ah had I didn’t have a generalized ambition to be a Ceo at that point I kind of felt that was probably something other people did um, but then. Yeah I got comfort from the fact that I had a high level of conviction around the company and its need to and deserving to be successful but also needing the kind of leadership that could help steer that so I jumped in feed first as a first time Ceo first time general manager. Um. And actually it was wonderful. I mean it was. It was very challenging. Very hard. Ah, but you know I immersed myself in it and you know, surrounded myself with great people and we did some really hard things I mean there are only a handful of phal of systems that have ever been developed to see the light of day. Um, especially those that are novel like ours and not just me too. Clones. And in fact, there’s you know there a lot of there’s a lot of there’s a lot of roadkill along the way you know famously Baxter spent half a billion dollars trying to develop a home hemo system that never never never saw the light of day you know medtronics been working on 1 for 10 years that’s still ‘t come through the fda. So you know these are hard problems. We set out to solve and um, you know I was just really excited though by the possibility that if we could solve these problems and have a dialysis system that could go to where the patients are as opposed to the current.
John Milad: Care paradigm of making patients go to dialysis machines that we can move the needle by improving their quality of life by improving outcomes. Ah and as well offering something that offers very attractive health economics when you look at it in a broad sense. So the mission was just so important that it made it worthwhile. And so I you know took my mission became to be a subject matter expert in that I started off knowing very little about dialysis and for 10 years I cultivated as much knowledge as I could about every facet of the business so that I could be a good you know a good a good good copilot and leader. The organization and I think we got to some really good places I’m very proud of what we’ve achieved there. Ah qantta is now one of the most prominent vd tech companies in Europe. It’s one of the most prominent emerging dialysis players. You know we have some some ah some some ah some things that we achieved that remain industry records. Like you know raising the largest funding around ever in dialysis larger than our peers ipos. So we done. We did some really good things. But most importantly, we saw the effect of what we were doing on patients and that was you know I literally had one of the most memorable moments was when we were pilot when we were rolling our device out in the u k. Ah, the family of one of our home patients contacted us and said thank you, you have given us our father back now that he’s dialyzing on your device at home. He has energy. He has ambition. He has a positive outlook. He feels better. He’s more functional.
John Milad: Um, this is the this is the man we know and love and we had been losing him for years as he succumbed to Kidney failure and ah the experience of normal center-based dialysis and hearing things like that you know just made the the. Journey worthwhile and it’s ah, there’s nothing that can replace hearing something like that.
Alejandro Cremades: Because for the people that are listening to get it. You know what is the business model of quanile ilysis technologies.
John Milad: So developed a portable hemodialysis machine that and it was easy to use so it removed a lot of the obstacles of getting patients onto dialysis dialing theizing themselves at home because it was easy to use. It was easy to train. It was less intimidating. It was small. It fit in the house. It was not something that looked like a scary piece of hospital equipment looked like a nice piece of consumer electronics. We provided a lot of support around that putting a digital health ecosystem that automated a lot of stuff and provided a lot of information so because of those things patients were. More comfortable taking the therapy home. Ah, it was easier for them to learn to use the device than traditional. So the combination of those things ah meant that more patients are able to enjoy the benefits of home hemo which includes the ability to dialize more frequently and to not have to dialize. So for example, you know one of the big problems is that within center dialysis is patients can’t dialize over the weekend and so they just pick up all this extra fluid and then you see this thing this horrible thing called the Monday morning death where there’s a 23% elevation and mortality in dialysis patients on Mondays because of all the extra fluid. They’ve got a device and they can dialize at home. They can do that on a Saturday or a Sunday they don’t have that extra fluid and therefore they shouldn’t have that excess mortality so you can really move the needle on their well-being by making it available to them. So.
Alejandro Cremades: So then a obviously when you stepped in. There was just an r and d team you know engineers for the most part. How did you think about like building the team around you and what did that look like as you were scaling this you know through 1 cycle to the next. Okay.
John Milad: Yeah, yeah, there was a really cool and inspiring team of innovative engineers and without them you know Kwanta never would have got to where it did because they were trying to do things that people in the industry basically said was not possible, not possible to make the device that small. Not possible to do all the fluidics operations on a disposable cut and sometimes it takes that outsider who doesn’t know that it’s not supposed to be possible to do it and say you know you know quanta is forever indebted to that team that got things going and many of them continue to this day to drive the. But there was 1 thing. There was some things that were missing. There wasn’t a whole lot of knowledge about medical device development. There wasn’t a whole lot of knowledge about how you bring that through a regulator or how um you think about positioning that in a way that’s going to be commercially successful and so you know my job. There was really to build that out to build out. More capability on operations and supply chain to build out capability in terms of commercial positioning to build out capability for the regulatory and quality piece and to work with the team to think through what is going to be ah the right? Go-to-market strategy and therefore the equity story. How do you raise money around that. So it was the miss. It was. It was basically filling the gaps along the way and you know over time. The team got larger and better and you know people who had higher levels of capability. So. It’s very exciting to watch the company grow I imagine it’s a lot like you know watching watching a child grow in flower and blossom that was you know that was the joy I had at quanta seeing that.
John Milad: Unfold over time. Um, and it still continues on an excellent trajectory. Um, and and no doubt will make a big difference in patients’ lives.
Alejandro Cremades: So as you were going with quanta too. I mean you guys you know it was not like ah like a path you know like a straight lineup. You know you really need to stick to to what you were doing. You know, keep the focus keep the belief and the conviction as you were so sharing earlier. So walk us through through how did that look like you like make us insiders.
John Milad: Yeah, so part of it was that um, it’s never clear. Um, you start off with an idea right? and you have some sort of vision and that 1 thing that’s been true to quants all all whole way is portable system cartridge-based fluidics. Helping patients in the home. That’s a core of the mission. But there’s a lot of details along the way that you don’t even know until you go on start on that mission. So there’s a kind of humility. You need to bring with you which is just accept. They’re going to be unknown unknowns in addition to the known unknowns and you need to integrate that knowledge as quickly as you can as you go along. And you know there so the shape of the journey I could not have predicted. Ah you know I’ll be honest, we had we we had an initial help that the the journey would be quicker and shorter. But we also did not even imagine that we could create something of the value that we ended up creating right? So um, and um. And and you know qnta story is yet to be written. It still has an upward trajectory and I have no doubt it will become a multi-billion dollar business. Um, and well we didn’t really have a credible credible plan for how we were going to get there back in the day and we thought most likely a strategic would take it out and that would be someone else’s problem and. And we ended up having to take it a lot further than we originally imagined but we ended up having something as a business that was a lot more exciting and we discovered additional market segments that we could tap into so at 1 point along the way we did some creative thinking and asked ourselves. What are the set of things that make this good for home dialysis.
John Milad: Might be useful in other applications and as we started to unpack that we saw well actually the fact that it’s portable and small and easy to use yet flexible and powerful that could all be very useful in other settings like a hospital where it’s Crowded. You have. Nurses who have different levels of skill and knowledge and different mix of instruments like if you could wheel that in and bring it to the patient’s bedside and maybe use it compare that compared to big bulky machines that are heavy and hard to move around difficult to use by anyone other than a dedicated technician. We saw that there were other applications actually where the device So as we unpacked that we understood that the addressable market ah was much larger than we originally thought and you know subject to very different dynamics different reimbursement different pricing. And so we started to see something that much bigger more complex for sure but more beautiful ah than our ah our original understanding of what we were going to do and you know that was really interesting part of the journey is helping to like unfold and unpack that as we went along.
Alejandro Cremades: And how much capital did you guys raise day for the company.
John Milad: Yeah, so um, it was during so until you know until I left in 2022 the company raised just under $400000000 which included the series d funding round in 2021 ah, which is remains the the largest funding round ever for a dialysis equipment company. Um, even larger than the ipos of our peers. You know, outset and next stage. So definitely. Ah, you know a banner revenge in the industry which speaks very well to um the the type of opportunity that we were pursuing. And the the just that the ability for ah for the company and its platform to win by taking market share ultimately in that market.
Alejandro Cremades: That’s amazing now you are actually you know switching gears and you are co-heading the healthcare care ventures at the downing. Not now always you know I get saying that there you guys are doing good stuff. You know, 2000000000 of hassets under management but 1 question comes to mind you know now that you’ve come. Ah, long way you know a investment banking turn to investor then turn operator then turn investor again, what are the real differences like how do you How do you see? How are they lenses a differentiating from when you put them on us on operator versus when you put them on us an investor.
John Milad: Yeah that’s a great question and I’ve had to flip out of those into and out of those modes 2 3 times now in my career I’d say one of the big differences is in ah as a vc as an investor um people who are good at it tend to have a high level of. But I call intellectual promiscuity the ability to kind rapidly learn about a bunch of different things dig into them then move on to something else and so youve got to cover a lot of area and very quickly sort of grasp some fundamentals so you can assess. Um. What you’re looking at the quality of the opportunity interact with the people who are active in that field but you need to be able to switch modes very quickly right now one day you’re looking at if you’re a life sciences investor maybe one day you’re looking at a structural heart device and the next you’re looking at an immunotherapy and um, there’s just very different therapy areas very different modalities. You need to have the ability to like flit around those different areas. Ah and not and I don’t mean suggest superficiality but you’re going to cover a lot of bread right? and to be able to shift in and out of those things. Um, when you’re an operator when you’re running a company or building a technology. Your job is to become the world’s subject matter expert in that thing and in the things that relate to that so you tend to go. You tend to have a much narrower field of focus and you got to go way deeper if you’re not becoming the world subject matter expert in that field then you’re probably doing something wrong because ah good because you’re you You’re generally.
John Milad: Proposing to change the world in some way to do something that’s going to be commercially successful and without and that can only be done by being a world leader in something and so there’s a they both request. It’s a different set of skills 1 is about you know going really deep into ah a defined. Ah. Realm of knowledge and the other is about being really broad and ah so that’s one difference and I and I and I and I you know I don’t know that you know investors always understand appreciate that that you know good management teams will have a depth of knowledge that it’s impossible for them. Fully communicate to investors because just so they’re spending all of their intellectual bandwidth every day thinking about these things and absorbing the information and then part of the job of a leadership team and a startup is to distill that into some abstractions that are true but nonetheless generalized or simplified. That allow for meaningful interaction with board of investors and investors. Um, and and you know having coming and out of those modes a couple timess now you know I can just see that there’s just a depth of knowledge and awareness that yeah that you have inside a company that can be can be challenging to communicate in its fullness. Somebody who’s not doing that every day. Um, and I find it’s useful to be aware of that right? as now I’m in the other vote I’m an investor I sit on boards you know and understanding that and respecting that um and you know knowing then um, when it’s important.
John Milad: Get down into the details because sometimes you have to but knowing that it’s not always getting down into every detail on every topic is impractical when you’re in that role as a board member or an investor. Um, and so knowing how to focus on what’s truly important is you know is important when you’re when you’re doing when you’re in that role. Um, and I think that translates to stuff like ah as an investor now if I’m conducting diligence on something you know, really knowing what are the what are the white hot issues that are going to speak to whether this thing will succeed or fail and not necessarily spending a lot of time on Tick Spot Tick box issues. That aren’t super relevant to the company and its success and knowing how to differentiate between those and allocate your your bandwidth in an appropriate way and also you know you’re taking up time of management teams and so you know doing that in a respectful way.
Alejandro Cremades: I love that I love that well there’s probably a lot of founders that they right now I’m sure they are you know executing in the health care space that I’m wondering hey you know how can I you know reach out to John and and and and say hi. You know how can they do so.
John Milad: Brought now there are many ways you can you can start I’m on social media I’m on Twitter at je muad I’m on Linkedin under my own name. So those are probably the 2 best ways to contact me through social media and you know if you. If you if you give me a little sense of what you’re what you’re what you’re looking for then we can pick that up in more conventional ways you know email phone calls etc. I’m always interested in meeting other people who are doing interesting things I’m intensely curious I always want to know more? ah. And you know the more you know the more you realize you don’t know it’s a great It’s a short’s of truism. Um, so um’ always exciting to meet other people I’m now as ah in the as a fund manager. It is my job to be intellectually promiscuous. So um, you know, ah any anyone has something ah that they want to discuss.
Alejandro Cremades: Amazing. Well hey John thank you so much for being on the deal maker show. It has been and on earth to have you with us today.
John Milad: Then please reach out to me. Thank you.
John Milad: Thank you Great being here. Thanks so much.
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