Cumaen — founder sprint
Three days in San Francisco. Draft, October 2026.
How to use this
- Read the whole thing once.
- Answer every numbered question on your own, in writing, before day 1. Keep your answers private until we're in the room.
- Bring real numbers where a question asks for one.
- Nothing here is decided. The order is deliberate: who we are and how we work first, the business second, money and equity and legal last. Equity gets decided on day 3, after everything else.
- Day 3 ends with a short founders' memo that all three of us sign. The last section lists what goes in it.
Founding teams mostly break on misaligned motives, unclear roles, and equity decided fast. A company that is wrong at its foundation is rarely fixed later. We do the slow version once, together, and write it down.
| Day | Theme | Ends with |
|---|---|---|
| 1 | Us: motives, mission and values, runway, strengths, learning from each other, roles, decision rights, commitment, how we operate, culture and fun | a roles-and-decisions sheet we all agree with |
| 2 | The business: patient, strategy, payer, product, regulatory, competition, expansion, success, failure | a 90-day plan and the success and kill measures |
| 3 | Money, equity, legal, exit scenarios, the founders' memo, next 30 days | a signed memo and a dated list of who does what next |
Day 1 — Us
A1. Why
1
Why do you want to do this? Rank these honestly: money, patient impact, autonomy, status, learning, working with these two people, escaping something.
2
What would have to be true in five years for you to say it was worth it?
3
What would you be doing instead if Cumaen did not exist?
4
What are you most afraid of in doing this?
5
Picture yourself at eighty looking back. Which would you regret more: trying this and failing, or never trying? One line.
6
Rich or king. If forced to choose, would you rather own a smaller piece of a bigger company run by whoever is best for each job, or keep control of a smaller one? Honest answer; we compare all three.
7
Any misgiving about this team or this idea that you have not said out loud. Say it here. Fixing it before we start is far cheaper than after.
A2. Mission, vision, values
8
The mission in one sentence a patient would understand. Then one a cardiac surgeon would respect. Are they the same sentence? Bring both.
9
The ten-year picture. What does Cumaen look like: patients, team, where it is, what it is known for. And what does each of our lives look like inside it?
10
Three to five values, each with one real hard call it would decide. Name one thing we would let a brilliant person go for.
11
What Cumaen is not. Three things we say no to even when they pay.
A3. Runway and constraints
12
How many months can you go with no salary? Give the number and what it assumes.
13
What are your hard constraints: job, family, visa, location, health, debt, a date you cannot move?
14
What do you need to keep in your life for this to be sustainable (training, sport, partner, kids, sleep, a day off)? Be specific. We build the working norms around the real answers, not the heroic ones.
15
Where do you want to live for the next 12 months, and the 12 after that?
A4. Strengths and weaknesses
16
Your own top five strengths and top three weaknesses as a cofounder.
17
The same for each of the other two. We compare the sheets on day 1.
18
What is the job you would be worst at and should never own?
19
Your specific knowledge: what you know or can do that cannot be hired or trained inside a year. One paragraph for yourself and one for each of the other two.
20
The last time you were under real pressure: what you did, how you behaved, and what the people around you saw. One true story each.
A5. Learning from each other
21
What do you want to learn from each of the other two, and what can you teach them? Propose how the teaching actually happens: pairing, a clinic day shadowed, a code walk-through, a monthly teach-in.
22
How the company learns. What gets written down after a mistake, who reads it, how often we review it. Propose a format we would really keep up.
A6. Roles and decision rights
23
What does each of the three roles own day to day? One line each.
24
Fill in the matrix below with D (decides), C (must be consulted), I (informed). Someone holds D on every line. We reconcile the three versions on day 1.
| Decision | Person 1 | Person 2 | Person 3 |
|---|---|---|---|
| Company strategy and pivots | |||
| Fundraising: who, when, terms | |||
| Hiring and firing | |||
| Product roadmap and priorities | |||
| Engineering architecture and vendors | |||
| Clinical protocol, alert thresholds, escalation rules | |||
| Hospital and clinician relationships | |||
| Regulatory strategy | |||
| Spending above an agreed amount | |||
| Equity grants and option pool | |||
| Anything that binds the company legally |
25
Who is CEO, and what does that title mean for us day to day? Which decisions need all three of us (selling the company, raising money, changing equity, adding a founder, taking on debt), and which belong to one person?
26
How do we break a deadlock on a decision that needs all three?
27
Decision types. Sort the matrix above into one-way doors (hard to reverse: all three decide, slowly, in writing) and two-way doors (cheap to reverse: one owner decides within a day). Which decisions are we most likely to treat as one-way when they are two-way?
28
Believability. For each topic on the matrix, who should carry the most weight when we disagree, and who the least? Weight follows a track record of being right and being able to explain why, not title.
29
Ownership, possession, control. Who owns the company (shares), who runs it day to day, and who controls it (board seats, votes)? Three different things; put a name on each.
A7. Commitment
30
When is each of us full-time, and what has to be true for that date to hold?
31
Until then, what hours per week can each of us really give, and which hours?
32
What would make you leave within the first year?
A8. The operating system
33
Location: where is the company based, who is in the room, and for how long? What happens after the first three months?
34
Hours and life. Propose a weekly shape. What is protected (training, evenings, a full day off, family) and what is not?
35
Cadence: weekly planning, daily check-in or not, monthly review. Propose one.
36
Tools: where do decisions get written down, where does work live, where do we talk?
37
Conflict: how do we disagree well? Propose a rule for when two of us disagree and the third is absent.
38
Time off: how much, how it is agreed, who covers.
39
Anything you would find intolerable in a cofounder's working style.
40
The whole picture on one page. Draw the company as one map: patient, clinician, payer, product, data, money, the three of us. Put one owner on every box. Mark any box with two owners or none.
41
One source of truth per fact. Where does each thing live: customers, metrics, decisions, code, money, patient data? One place each, or say why not.
42
Meetings. Which ones exist, who is in them, how long, and which ones should not exist.
43
Disagree and commit. Once a decision is made, what does commitment look like from the person who argued against it? Write the rule in one sentence.
44
Written or spoken. Do big decisions start from a short written memo everyone reads first, or from a conversation? Propose a maximum length and a template.
45
Speed versus care. Where do we move fast and accept mess, and where (patient safety, data, clinical claims) do we refuse to? Draw the line now, before a deadline tempts us.
46
Founder psychology. The lows are lower than people expect and the CEO's are loneliest. Who do you call, how do we check on each other, and what is the early sign that one of us is not okay?
A9. Culture and fun
47
Office or not. Describe the ideal workplace for year one: a room, a house, a hospital office, a coworking desk, nothing fixed. What must it have, and what would make you dread going in?
48
What does fun look like for you at work? Three things that would make a week good regardless of the numbers.
49
Rituals. What do we do weekly, monthly, and when something ships? And what do we do when something fails?
50
Outside work. Propose one thing the three of us do together in the first month that has nothing to do with the company.
51
Written culture. Which norms do we write down in month one: how we talk to patients, how we treat each other when tired, how we talk about each other when one is absent.
52
The "we are not that company" list. Three things you have seen at other companies that we will not do.
53
First hires. If we get to hire, what matters to each of you: where they sit, pay, how we decide, who has a veto, and what we never compromise on. And what do we do when a friend applies and does not meet the bar?
54
Front page test. If every message in our group chat appeared on a newspaper front page, which would we regret? What does that tell us about how we write about patients, hospitals and each other?
55
Protecting the friendship. Founding teams of friends break up more often than teams of former colleagues, because they avoid the hard talks. What one rule protects the friendship if the company fails?
Day 2 — The business
B1. Problem and patient
56
Which patient, exactly, on day one? Post-TAVR only, all structural heart, or all cardiac surgery? Name the procedure, the discharge window, and the complication we catch.
57
What do the patient's first 30 days after discharge look like today, and where in that timeline does Cumaen change something?
58
What have the patients so far told us? Enrollment, adherence, alerts fired, true and false alerts, anything acted on, anything missed. Bring the actual data.
59
Which of us is the user? Who has been the patient, the nurse on the floor, the surgeon on call at 2am, the discharge coordinator, the family member at home? For each role none of us has lived, how do we spend real time with that person in the next 30 days?
B2. Strategy on one page
60
Where we play: which patient, which procedure, which care setting, which geography. And where we deliberately do not.
61
How we win: the one thing a hospital gets from us that it cannot get from the ring vendor, the EHR, or a nurse with a phone.
62
The strategy sentence. Each of us writes one: "We help ___ do ___ by ___, and we win because ___." We compare the three on day 2.
63
Sequence. The three bets, in order, for the first eighteen months, and what each must show before the next one starts.
64
What we will not build in year one, even if a customer asks and pays.
65
Why now. What changed in the last two years (the device, reimbursement, hospital pressure, patient habit) that makes this possible now and not in 2019? If nothing changed, why has nobody done it?
66
The secret. What do we believe about recovery after heart surgery that most cardiologists, hospital executives and device companies would disagree with? What evidence makes us right and them wrong?
67
Ten times, not ten percent. Against the best current practice (a nurse phoning every patient, the device vendor's own program, the EHR's own module), is what we do ten times better on some axis or somewhat better on several? Name the axis.
68
Durability. What stops the ring vendor, the EHR, or the hospital's own nurses from doing this in three years? If the honest answer is nothing, what would we have to build or own so that it is something?
69
Best in the world at. What can we be the best in the world at, what drives the money (per patient, per hospital, per procedure, per month), and what do we actually care about? Where do the three overlap, and is that overlap big enough?
B3. Customer and who pays
70
Who pays, and why? Candidates: the structural heart program billing remote monitoring, the hospital avoiding readmissions, a payer, a bundled-payment entity, the device company, the patient. Rank them.
71
Remote monitoring billing. Which CPT codes would we bill (remote physiologic monitoring and remote therapeutic monitoring families), who bills them, what documentation each needs, and who in the program does the management minutes? Bring the current Medicare rates for each code.
72
Is a TAVR readmission a financial penalty for the hospital today? If not, where is the program's real pain, in dollars or in staff time?
73
What does a program have to do to use us: who orders it, who watches the dashboard, who calls the patient, who bills?
74
Distribution, walked once on paper. How does a hospital actually buy this: who champions it, who signs, who can block it, how many months, what is the first contract worth, and who sells it (one of us, or someone we have not hired)?
75
Watchers and liability. Who watches the alerts, at which hours, who responds within how long, and who is liable when one is missed? Does that work land on the hospital, on us, or on a nurse who did not ask for it?
B4. Product
76
What exists today: app, wearable integration, scale, backend, alerting, dashboard. Who built each piece, and what does it run on?
77
What is the minimum product a program would pay for? What is the minimum product that is safe to put in front of a patient?
78
Build versus buy: which pieces are commodities (devices, data ingestion) and which are ours?
79
The eleven-star version. Write the absurd, impossible version of the first 30 days after discharge. Then find the seven-star version we can actually ship, and say which parts of the absurd version made it in.
80
For your own parent. Describe the first week home after heart surgery the way you would want it for your own mother or father. Where does the current product fall short of that?
81
Delete first. Which parts of the current product, workflow or data collection exist because someone assumed a requirement? Who checks whether each requirement is real? What would we delete if nobody forced us to keep it?
82
By hand. Which things do we do personally for the first fifty patients that we would never scale: who sits with the patient at setup, who phones the nurse, who writes the thank-you note, who reads every alert?
B5. Regulatory and data
83
Is the alerting a regulated device, or clinical decision support that is exempt? What is our position and what is it based on? Who has read the current FDA guidance?
84
If it is regulated: classification, predicate devices, cost, time.
85
Patient data: where is it stored, who has access, what agreements exist today with any site, and is any of it on a personal device or account?
86
Were the patients so far enrolled under a research protocol or a program approval? Does that approval cover a company using the data?
B6. Competition
87
Every company doing post-discharge remote monitoring for cardiac or surgical patients that you know of. For each: what they sell, who buys, what they charge, why a program would pick us instead.
88
What happened to the ones that shut down, and why would we be different?
89
Inflection points. Which single outside change (a reimbursement change, the ring vendor launching its own program, the EHR adding this module, a big negative or positive trial) would change everything? How would we see it coming six months early?
B7. Wedge and expansion
90
Where do we start, and why there and not somewhere wider?
91
Expansion order. One candidate: TAVR → structural heart → cardiac surgery → orthopedic surgery. What does each step need that the previous one did not?
92
What would make us stop at step one?
B8. What we know versus what we believe
93
The five beliefs the business depends on. For each: evidence we have, evidence we need, and the cheapest way to get it in 90 days.
94
Trials of remote monitoring that did not reduce readmissions exist. Name the two we know best. What is different about our patient, our signal, or our response that would make ours differ? If we cannot say, that is the first study to run.
95
If the first wedge fails, would you stay for a different idea with these same two people? Which areas are off the table for you?
B9. Success
96
What does success look like at 90 days, 6 months, and 12 months? Write it as measures, not feelings. Candidates to pick from or replace:
- a signed pilot agreement with a named program, and the date
- patients enrolled and still transmitting at 30 days
- alert precision, and the time from alert to a human acting on it
- readmissions or emergency visits in enrolled patients versus the program's baseline
- first remote monitoring claim submitted and paid
- a pre-seed round closed: amount and lead
- each founder full-time by a date
97
Which one measure, if it moved, would make an investor say yes?
98
One number. The single metric we run the company on this quarter, visible to all three of us every day. Name it, and say what we would do the week it stops moving.
B10. Failure
99
What does failure look like at 90 days, 6 months, and 12 months? Write it as measures. Candidates:
- no program willing to sign a pilot within 90 days
- no billing path that covers the cost of monitoring a patient
- a regulatory path that needs money and time we cannot raise
- a founder not full-time by the agreed date
- enrolled patients stop transmitting
- we cannot work together
100
Kill criteria. The conditions under which we agree now to stop, so the decision is not made in the moment by whoever is most tired.
101
What happens to the company, the code, the data, and the equity if we stop?
Day 3 — Money, equity, legal
C1. Money
102
Who is putting in cash, how much, and is it a loan, equity, or a gift to the company?
103
Salaries: none until a raise, or a minimum? Propose numbers for before and after a seed round.
104
What do the first 90 days cost? Devices, cloud, legal, formation, travel, living.
105
Fundraising plan: pre-seed or seed first, how much, from whom, by when, and who runs it.
106
What do we do if we cannot raise within six months?
107
Bootstrap, raise small, or raise big and fast. Pick one for year one and say why. Then say what you would do if the other two picked differently.
108
Ramen profitable. What is the smallest monthly revenue that would let the three of us keep going without investors, and which two customers would get us there?
109
The order when money is tight. People, product, profit, in which order? Who is paid last, what is cut first, and who makes that call?
C2. Equity and vesting
110
Which factors should set the split, and how much weight does each get? Candidates: full-time versus not yet, opportunity cost given up, cash contributed, ability to raise, importance of the role over the next 18 months, idea and work to date. Write the split you think is fair and your reasoning. We compare on day 3, not before.
111
Vesting: length, cliff, credit for work already done, and how a stake changes if someone goes full-time later or steps back.
112
Acceleration on acquisition: single trigger, double trigger, or none. Propose one.
113
Option pool for early hires: size, and when it is created.
114
What happens to a departing founder's unvested and vested shares? Buyback rights, price, timing.
C3. Legal and confidentiality
115
Entity and state. Delaware C-corp is the usual answer if we ever raise venture money. Any reason to do something else?
116
IP today. Who wrote the code, designed the hardware, built the protocol, and under what agreements? Was any of it built on an employer's or university's time, resources, or patients, and has it been disclosed where it needs to be? We want this answered on day 3, not after a raise.
117
Current and prior employers. Each of us lists the agreements we are under: invention assignment, non-compete, non-solicit, outside-activities and conflict-of-interest policies. Read your own before day 1 and bring the relevant lines.
118
Confidentiality rules, between us and outward. A starting list to add to or strike:
- a mutual NDA among the three of us now, before incorporation
- all IP assigned to the company at incorporation, by all three
- no public posts, talks, or demos about Cumaen without the three of us agreeing
- no deck, code, or data to anyone outside the three of us without agreement; investors do not sign NDAs, so we decide in advance what is shareable
- no patient data on personal devices or personal accounts, ever
- a written list of who outside the company knows what, kept current
119
Company counsel: which firm, and on what fee basis. Each founder may take an hour of personal counsel on the founders' agreement.
C4. Exit scenarios
Write your answer to each before day 1.
120
One of us leaves at month six.
121
An acquisition offer arrives at a price that is life-changing for one of us and not the others.
122
An investor says a founder who is not full-time must go full-time or step back.
123
One of us wants to be CEO and the others disagree.
124
We need a fourth founder with a skill none of us has.
125
It is month twelve and we have missed every measure in B9.
C5. The founders' memo we sign on day 3
- roles, one line each, and the decision matrix from A6
- CEO, the decisions that need all three, and the deadlock rule
- full-time dates and what happens if they slip
- working norms: location, protected time, cadence, conflict rule
- the 90-day plan with named owners
- success measures and kill criteria with dates
- money: cash in, salaries, first-90-day budget, fundraising plan
- equity split, vesting, acceleration, pool, departure terms
- entity, IP assignment, employer-policy clearances, confidentiality rules
- next 30 days: incorporation, IP assignment, stock issuance, 83(b) elections within 30 days of issuance, bank account, counsel
C6. Next 30 days
126
The ten things that have to happen in the 30 days after the sprint, with a name on each.
Homework, per person, before day 1
- Written answers to all 126 questions, kept private until day 1
- Your own decision matrix (A6) and your own proposed split with reasoning (C2)
- Your employer and university agreements, with the relevant lines marked (C3)
- Real data from the patients so far (B1)
- Current remote monitoring code list with current rates (B3)
- Competitor list (B6)
- Your runway number and what it assumes (A3)
- Your mission sentence and your strategy sentence (A2, B2)
- Your one-page map of the company with an owner on every box (A8)