www.medistim.com
2023
2023
CORPORATE ANNUAL REPORT
Contents
1. MEDISTIM IN BRIEF 4
2. KEY FIGURES 6
3. HISTORY 8
4. LETTER FROM THE CEO 10
5. EXECUTIVE MANAGEMENT & BOARD OF DIRECTORS 12
5.1 Management Team 12
5.2 Board of Directors 14
6. BOARD OF DIRECTOR’S REPORT 16
6.1 Operational review 16
6.2 Regional development 17
6.3 Organization, HSEQ and sustainability 20
6.4 Financial Review 20
6.5 Parent company financial review 22
6.6 Corporate governance 22
6.7 Main risk factors 22
6.8 Events after the balance sheet date 23
6.9 Outlook 23
6.10 Shareholder information 24
7. COMPANY DESCRIPTION 26
7.1 Vision, mission, values 26
7.2 Medistim’s solutions 27
7.3 Strategy 27
7.4 Technology and Products 29
7.5 Research and Development 30
7.6 Clinical application areas and target markets 32
7.7 Market for cardiac procedures 32
7.8 Market for Vascular Surgeries 33
7.9 Geographical target markets 34
8. CORPORATE GOVERNANCE REPORT 36
8.1 Implementation and reporting on corporate governance 36
8.2 Business activity 36
8.3 Equity and dividend 36
8.4 Equal treatment of shareholders and transactions with closely related parties 37
8.5 Shares and negotiability 37
8.6 The general meeting 37
8.7 Nomination committee 38
8.8 Board of directors, composition and independence 38
8.9 The work of the Board of directors 39
8.10 Risk management and internal control 39
8.11 Remuneration of the board of directors 40
8.12 Remuneration of executive personnel 40
8.13 Information and communications 40
8.14 Takeovers 41
8.15 Takeovers 42
8.16 Auditor 42
9. SUSTAINABILITY REPORT 43
9.1 Strengthening human health through improved surgery 43
9.2 Product stewardship 45
9.3 Responsible business 47
9.4 People 49
10. GROUP CONSOLIDATED FINANCIAL STATEMENTS 51
10.1 Consolidated Income Statement of Profit or Loss and other Comprehensive Income 51
10.2 Statement of Financial Position 52
10.3 Consolidated Cashflow Statement 53
10.4 Statement of change in equity 54
10.5 Basis for preparation of financial statements 55
10.6 Use of estimates and judgement 55
10.7 New and amended standards effective from 2023 55
10.8 New and amended standards not yet effective 55
10.9 Notes to the accounts 56
11. PARENT COMPANY FINANCIAL STATEMENTS 88
11.1 Income Statement Medistim ASA 88
11.2 Balance Sheet Medistim ASA 89
11.3 Cash Flow Statement 90
11.4 Accounting Principles 91
11.5 Notes to the accounts 92
12. ALTERNATIVE PERFORMANCE MEASURES 105
13. AUDITORS REPORT 108
1. MEDISTIM IN BRIEF
Cardiac and vascular diseases continue to be the
most common cause of death in the western
world. Globally, more than 700,000 patients
undergo coronary artery bypass surgery annually
while more than 1,300,000 patients have vascular
surgery procedures performed. Over the past four
decades, Medistim’s mission has been to serve
patients, surgeons and health care providers with
innovative and cost-effective medical devices that
measure blood flow and visualize atherosclerosis,
and thereby help improve the quality and outcome
of cardiac and vascular surgery.
One million beating hearts later,
Medistim has set the standard in
the field.
Today, Medistim’s proprietary products are regarded
to be standard-of-care in most European countries
and Japan, while market adoption is growing in
the USA, Asia and the Middle East. In addition,
Medistim’s third party business represents about
100 different medical technology companies as a
distributor of their products in Scandinavia.
Medistim is a market leader within intra-operative
transit time flow measurement (TTFM) and
ultrasound imaging, providing the MiraQ™ system
to the global market. These systems enable
medical professionals to reduce risk and enhance
quality of cardiac, vascular and transplant surgery.
They provide clinically relevant information that
empowers surgeons to make better-informed
decisions in the operating room.
The company’s devices are developed by working
closely together with surgeons, who in turn have
produced a growing amount of clinical data and
studies that point to their efficacy and cost-
effectiveness. Medistim is committed to continuing
to serve the cardiac and vascular surgeons by
investing in new product development.
Medistim has wholly owned subsidiaries with
marketing and sales organizations in the USA,
Germany, China, Spain, Canada, the United Kingdom,
Denmark, Sweden and Norway. In addition, a global
distributor network is representing the company
in more than 60 countries in Asia, Europe, Latin
America and Africa. Medistim ASA is listed on the
Oslo Stock Exchange and has its global head office
in Oslo, Norway.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Each of us likely knows a
friend or family member
grappling with some
form of cardiovascular
disease. When facing
invasive surgical
procedures, we naturally
seek out the expertise
of top surgeons. These
leaders in the field
have already embraced
flow measurement and
ultrasound imaging
technologies to guarantee
the finest surgical quality
and outcomes for their
patients. Consequently,
in numerous countries,
the utilization of these
techniques has become
the gold standard in
the operating room. It
is Medistim’s vision to
extend these benefits
universally so that every
patient and surgeon
worldwide can access
optimal cardiovascular
health care.
Kari E. Krogstad
President & CEO
“
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
2. KEY FIGURES
Sales in MNOK
EBIT in MNOK and EBIT %
0
20 000
40 000
60 000
80 000
100 000
120 000
0%
5%
10%
15%
20%
25%
30%
202020192018201720162015201420132012201120102009200820072006200520042003200220012000
0
5
10
15
20
25
30
Ebit Prosent
202020192018201720162015201420132012201120102009200820072006200520042003200220012000
EBIT per year
EBIT %
8 %
37 %
55 %
Leader in a large
untapped CABG market
Competition market share
Medistim market share
Open market (finger palpation)
(332M people)
200,000 procedures
>35 % market share
(83M people)
44,000 procedures
> 80 % market share
USA
(68M people)
16,000 procedures
market share
UK
(213M people)
40,000 procedures
< 5 % market share
Brazil
Germany
>700.000
procedures
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Headquartered in Oslo, with production facilities in Horten, Norway. Medistim sells its products through more than 60
distributors world-wide, including Medistim’s own sales offices in USA, China, Germany, Spain, UK, Canada, Norway,
Denmark, and Sweden.
Dividend in NOK per share and Pay-out ratio
Recurring sales
Capital sales
Capital sales and recurring sales of own
products in MNOK
Dividend per share per year Payout ratio
0
20 000
40 000
60 000
80 000
100 000
120 000
0%
5%
10%
15%
20%
25%
30%
202020192018201720162015201420132012201120102009200820072006200520042003200220012000
0
5
10
15
20
25
30
Ebit Prosent
202020192018201720162015201420132012201120102009200820072006200520042003200220012000
0
20 000
40 000
60 000
80 000
100 000
120 000
0%
5%
10%
15%
20%
25%
30%
202020192018201720162015201420132012201120102009200820072006200520042003200220012000
0
5
10
15
20
25
30
Ebit Prosent
202020192018201720162015201420132012201120102009200820072006200520042003200220012000
0
20 000
40 000
60 000
80 000
100 000
120 000
0%
5%
10%
15%
20%
25%
30%
202020192018201720162015201420132012201120102009200820072006200520042003200220012000
0
5
10
15
20
25
30
Ebit Prosent
202020192018201720162015201420132012201120102009200820072006200520042003200220012000
(83M people)
44,000 procedures
> 80 % market share
(1.4 B people)
60,000 procedures
market share
China
(1.3 B people)
160,000 procedures
< 1 % market share
India
(126 M people)
13,000 procedures
> 90 % market share
Japan
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
3. HISTORY
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Medism’s Milestones
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
21
st
March 2024
Kari E. Krogstad
President & CEO
I am pleased to report that our total sales
for the year reached a new high of MNOK
526.4, representing 7 % growth over 2022.
Throughout the year, we remained
committed to engaging with customers
and prospects and educating them
about the value proposition of our TTFM
and HFUS technologies. These efforts
have been met with positive response,
particularly within the vascular product
segment, which experienced significant
growth over the past year. We are excited
to further explore opportunities in this
area, including the planning of a clinical
study in vascular peripheral bypass
surgery.
In 2023, Medistim strategically invested in
several key areas to drive future growth
and enhance our competitive position. We
embarked on a journey of geographical
expansion, significantly growing our direct
sales footprint by adding China, Canada,
and Sweden to our list of direct countries.
By establishing closer relationships with
end-users and reducing distributor
mark-ups, we aim to accelerate
revenue growth and capture
market share more
effectively.
Additionally, we
made advancements
in our operations by
implementing a second
shift in probe production,
enabling us to meet growing
demand and ensure timely
delivery to our customers.
These initiatives have led to an increase
in expenses, and we acknowledge the
short-term impact on our EBIT margin,
which ended at 25.0 % for the year. We
remain confident in the long-term value
that these initiatives will deliver to our
business and our shareholders.
Medistim continues to maintain a
robust competitive stance, coupled
with significant interest in our product
offerings. Notwithstanding the
favorable momentum in our business,
we remain aware of the hurdles posed
by macroeconomic dynamics, such as
increased deliberation in procurement
processes and a lower inclination towards
investment in higher-priced capital
equipment within specific markets.
Looking to 2024 and beyond, we are
excited about the opportunities that lie
ahead. With a dedicated and increasingly
global team, innovative products, and
a clear strategic direction, we are well-
positioned to deliver sustainable growth
and create long-term value for our
stake holders.
Thank you for your
continued support and
investment in Medistim.
We look forward to
updating you on our
progress in the time to
come.
4. LETTER FROM THE CEO
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
5. EXECUTIVE MANAGEMENT & BOARD OF DIRECTORS
5.1 Management Team
Kari Eian Krogstad
President and CEO, Medism ASA
Kari E. Krogstad joined Medistim as CEO in September 2009. She has more than 30 years of experience
from the biomedical industry, from commercial leadership roles within the international pharma,
biotech and medtech sectors. Before joining Medistim, she spent 11 years at Dynal and held the
position as General Manager of Invitrogen Dynal after the acquisition from U.S. based Invitrogen in
2005. Ms. Krogstad holds a Cand. Scient. degree in Molecular Biology from the University of Oslo as
well as a Business degree from IHM Business School.
Helge Børslid
VP Manufacturing, Medism ASA
Helge Børslid joined Medistim as Vice President Manufacturing in January 2017. Before joining
Medistim, he was production manager at Halliburton, a company that offers products to the oil and
gas industry. Previous experience ranges from test engineer to quality engineer at Norautron, Infineon
Technologies, Kongsberg Maritime, and Sensor Development. Mr. Børslid holds a B.Sc. in Electronics
Engineering from Vestfold University in Norway and a Master’s degree in Management from the
Norwegian Business School (BI).
Ole Arne Eiksund
Chief Business Development Ocer, Medism ASA
Ole Arne Eiksund joined Medistim as CBDO in April 2022. He has more than 25 years of experience
from the biomedical industry, with commercial leadership roles within the pharma and biotech sectors.
Former positions include Commercial Director at GSK Pharma, VP Global Sales at Hofseth BioCare and
before joining Medisitim he was the CEO of Arctic Bioscience. Mr. Eiksund holds a M.Sc. degree in
Computational Science from the University of Manchester (UMIST) and an Executive MBA from Hult
International Business School, London.
Mike Farbelow
President, Medism USA, Inc.
Mike Farbelow joined Medistim as Vice President of the US sales team in May 2012. He has extensive
sales and management experience from the medical device industry. He served for many years with
Smith & Nephew’s Endoscopy division both as a sales representative and the Director of Sales for the
central region. His most recent position prior to joining Medistim was with Richard Wolf USA where he
served as their national sales manager in spinal endoscopy. Farbelow holds a degree in management
from the University of Minnesota Carlson School of Management.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Håkon Grøthe
Chief Innovaon Ocer, Medism ASA
Håkon Grøthe joined Medistim as CIO in April 2019. He is an experienced leader with a passion for
increasing customer value through digital innovation. Grøthe has put disruptive technologies such as AI,
VR and Machine learning into work in his leadership roles from IT technology companies such as Impact
Reality and Inspera. He also brings methodology experience relevant for agile processes, such as Google
Sprint, Design Thinking and Kanban. Grøthe holds an M.Sc. degree in Industrial Economics/Computer
Science from the Norwegian University of Science and Technology (NTNU).
Thomas Jakobsen
CFO, Medism ASA
Thomas Jakobsen joined Medistim as VP Finance in 2001. Previous experience includes Controller and
Finance Manager at Sysdeco (1993-1998), and Finance Director of Microtronica Nordic (1998-2001),
where he was responsible for building the finance team and converting to a new MIS system. Mr. Jakobsen
holds a B.Sc. in Management from the Norwegian Business School (BI).
Roger Morberg
VP Sales APAC, Medism ASA
Roger Morberg joined Medistim as VP Sales in June 2010. He has extensive experience from the healthcare
industry and is a trained medical professional. Before joining Medistim he worked for Siemens Medical
as Country Manager for Ultrasound. Morberg has previously held various roles within sales and senior
management positions in Marquette Electronics, GE Healthcare and Hewlett Packard.
Stephanie d’Avout Stenhagen
VP Sales EMEA, Medism ASA
Stephanie d’Avout Stenhagen joined Medistim in 2017 as Sales Manager Europe. With over two decades
of experience in the medical device industry, she brings a wealth of expertise and strategic vision to drive
Medistim’s sales efforts across the EMEA region. Prior to joining Medistim she held various leadership
roles in strategic marketing and business expansion at Medtronic Inc. and served in a Global Marketing
capacity for Nobel Biocare. Ms. Stenhagen holds an MBA in Marketing from the Fox School of Business
at Temple University.
Erik Swensen
VP R&D, Medism ASA
Erik Swensen joined Medistim as VP Research & Development in 2002. Previous experience includes
Development Engineer at ABB, Norway, where he participated in the development of advanced process
control systems and developing ABB’s new control system for safety critical applications. Swensen holds
a M.Sc. degree in Engineering Cybernetics from the Norwegian University of Science and Technology
(NTNU).
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Tone Veiteberg
VP Regulatory Aairs & Quality Assurance, Medism ASA
Tone Veiteberg joined Medistim as VP Quality Assurance & Regulatory Affairs in 2013. She has more than
35 years of experience in Medical and Regulatory Affairs from the pharmaceutical and medical device
industry, including Clavis Pharma, the Norwegian Association of Pharmaceutical Manufacturers, Leo
Pharmaceuticals, and Glaxo/GlaxoWellcome (now GlaxoSmithKline). Veiteberg holds a M.Sc. in Pharmacy
from the University of Oslo.
VP Markeng, Medism ASA
Hæge J.K. Wetterhus joined Medistim as VP Marketing in 2010. She has more than 25 years of experience
working with diagnostic, analytical and biotech device companies. Before joining Medistim, she worked for
Invitrogen Dynal where she held a variety of leadership roles in strategic marketing, product development
and business development in the area of life science and biotechnology – always with an international
focus. Wetterhus is a business economist from BI Norwegian School of Management, a chemical engineer
from the Technical University of Bergen and holds a B.Sc. Honour in molecular biology from the University
of Glasgow, United Kingdom.
Anne Waaler
VP Medical Department, Medism ASA
Anne Waaler joined Medistim as VP Medical Department in 2016. She has more than 25 years of experience
from the pharma and medtech industry, including roles within medical, marketing and strategy with
Nycomed and GE Healthcare. Waaler holds a M.Sc. in Pharmacy from the University of Oslo, an MBA
from the BI Norwegian School of Management in Oslo, and an ESCP-EAP in Paris.
5.2 Board of Directors
Øyvin Brøymer
Chair
Øyvin Brøymer has served as Chair of Medistim since 2000. He works as an investor through his own
company Intertrade Shipping AS and Fløtemarken AS, holds the position as Chair in Vistin Pharma ASA.
Previous experience includes executive positions in The Aker Group, Hafslund Nycomed ASA and Leif
Höegh & Co ASA, as well as broad board room experience from many other companies. He holds a degree
within economics and business from Norwegian School of Management and an MBA from the University
of Wisconsin. He is also Chair of the remuneration committee.
Anna Ahlberg
Board Member
Anna Ahlberg is the CFO at the Swedish medical simulation company Surgical Science. Her previous career
includes executive positions at several listed Swedish companies, such as med-tech companies Q-Med
and Vitrolife. Ms. Ahlberg holds a MSc in Business Administration and Economics from the School of
Business, Economics and Law, University of Gothenburg. She is an independent Board member and is a
member of the audit committee.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Board member
Anthea Arff-Pettersen is a Partner and Investment Director at Aeternum Capital. She holds a Master’s
in Investment Management from Cass Business School and a BSc in Business Administration from the
University of Bath. Her previous experiences are from Schroders and M&G investments in London,
private equity firm Credo Partners in Oslo, as well as Höegh Autoliners in New York. She is a member of
the audit committee.
Ole J. Dahlberg
Board Member
Ole Dahlberg is CEO at Curida, a life science company that develops and manufactures medicines,
ensuring a safe supply of life-improving products. He has been in executive leadership roles both on the
commercial side and in R&D at Dynal Biotech, German Biotech company Qiagen, and more recently for
Thermo Fisher Scientific in the US. Mr. Dahlberg holds a MSc in Genetics and Marine Biology from the
University of Oslo.
Jon H. Hoem
Board member
Jon Hoem was one of the early employees at Medistim, joining the company in 1994, and contributing to
structuring Medistim’s initial sales effort in Europe, Japan, and the United States. He has founded multiple
early-stage cardiovascular medical device companies. Mr. Hoem holds a MSc degree in microelectronics
and organizational development from the Norwegian Institute of Technology (NTNU).
Lars Rønn
Board member
Lars Rønn has been board member in Medistim since 2010. He works as a consultant for Korn Ferry with
focus on recruitment of executives within the med-tech area. He has previous experience as Executive
Vice President, Sales & Marketing in Ambu, a Danish med-tech company and as CEO in Origio. He has
also experience from several positions in Maersk-Medical AS. Rønn holds a BSc in Business, Language
& Culture and has a Graduate Diploma in Int. Trade from Copenhagen Business School. He also has a
Management Program from INSEAD. He is member of the remuneration committee.
Tove Raanes
Board member
Tove Raanes has been board member in Medistim since 2014. She works as an advisor in the investment
companies Dyvi Invest AS and Nore-Invest AS and serves as board member in Bouvet ASA, Multiconsult
ASA, Krefting AS, and Noria Group AS. Her experience includes strategy, finance and business development
from investment companies and management consulting from McKinsey & Company. Raanes holds a
MSc from the Norwegian School of Economics (NHH). She is also Chair of the audit committee.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
6. BOARD OF DIRECTOR’S REPORT
The global market is facing macro-economic turmoil,
with energy crisis, inflation pressure, increasing
interest rates and cost levels and uncertainty related
to the Palestinian and Ukrainian war. In this situation
the company has been able to deliver solid profit and
cash flow, and the need for Medistim’s products has
not changed. The long-term consequences of the
growing geopolitical uncertainty are unclear but might
lead to continuing challenges in the global flow of
goods. Medistim is taking mitigating actions to ensure
access to key components to secure production and
maintain growth and profitability also for the future.
Further, the company is financially sound to face future
challenges, with no interest-bearing debt and an equity
ratio of 78.7 %.
With these uncertainties, the need for Medistim’s
products has been confirmed through the last two
years' development. The company's solutions continue
to be in increasing demand among cardiac and vascular
surgeons.
Medistim's core business is within developing,
producing, servicing, leasing and distributing medical
devices. The Group is headquartered in Oslo, with
production facilities in Horten, Norway. Medistim
sells its products through 60 distributors world-
wide, including Medistim’s own sales offices in
USA, Germany, China, Spain, UK, Canada, Denmark,
Sweden and Norway. At the end of 2023, Medistim’s
equipment was in use in more than 60 countries with
about 3,500 clinics all over the world.
The business is focused on ensuring quality within
cardiac and vascular surgery. Cardiovascular diseases are
the most common cause of death in the western world
and on the rise in Asian and Latin American countries
adopting western lifestyles. The Group’s products
contribute to improved quality of surgery, which in turn
reduces risk to the patients and contributes to a more
efficient health economy. Worldwide, over 700,000
CABG (Coronary artery bypass Graft procedures) and
1,300,000 vascular procedures are performed each
year. On a global scale Medistim has a leading position
within quality control of CABG.
Medistim is also a distributor of other medical devices
through its subsidiaries Medistim Norge AS, Medistim
Danmark Aps and Medistim Sverige AB. The products
distributed are medical devices within all types of
surgery.
6.1 Operational review
Medistim increased its coverage of cardiovascular
surgery procedures in 2023. The medical facilities
strict requirements for distance-keeping and
comprehensive infection control regimes during
the pandemic has affected Medistim’s customer
relations activities positively. During the pandemic
Medistim adopted digital solutions for conferences
and meetings by applying digital communication
platforms and remotely controlling ultrasound
systems. This has created a new meeting place that
Medistim actively continues to use to demonstrate
products and perform end-user training efficiently.
However, with less restrictions and infection control,
physical meetings and exhibition participation has
increased in 2023. Medistim experiences that
this improves close customer contact, exchange
of information, influence and business progress.
Cost related to travel and physical meetings went
up in 2023, but the improved customer contact
contributed to a positive development and a solid
pipeline of leads entering 2024. However, due to
the macroeconomic turmoil, Medistim experienced
weaker capital sales in 2023 compared to 2022,
especially in USA. As a consequence, operating
profit (EBIT) ended at MNOK 131.4 with an EBIT
margin of 25 % compared to last year EBIT of MNOK
141.2 or 28.7 %.
Adjusted for currency effects, sales revenue declined
2.5 %. Sale of own products declined 3.8 % while
sale of third-party products was up 4.7 % from 2022.
Note:
Medistim has adjusted its geographic regions
from the former USA, Asia, Europe and
ROW to AMERICAS (USA, Canada and Latin
America), APAC (China, Japan and rest of Asia
Pacific and EMEA (Europe, Middle East and
Africa) when reporting sales of own products.
Third party sales will be reported separately
without any geographic split, as sales are
only in Norway and Denmark. All comparable
numbers are adjusted according to the new
region split.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Despite weaker capital sales the consumable
sales were maintained in the major markets like
AMERICAS and EMEA. The reduction in consumables
in APAC and Europe was related to stock buildup
due to the 10 % price increase entering 2023 and
the transition period changing the Chinese setup
establishing a direct presence in the Chinese market.
During 2023, Medistim sold 240 new systems (250),
where 50 were replacement of old systems and
at year-end the total installed base of Medistim
systems was 3500 units (3300). Probes and other
consumables related to use of the medical systems
represent a significant share of total sales for
Medistim, depending on number of systems installed
and utilization. Increased market penetration and
surgical activity positively impacted Medistim’s sales
of consumables for the year.
Medistim continues to strengthen its position within
both cardiac and vascular segments. Sales revenue
from the cardiac segment ended in 2023 at MNOK
365.6 (MNOK 346.5), a 5.5 % growth. Sales revenue
from the vascular segment ended at MNOK 81.3
(MNOK 69.5), a 16.9 % growth. Sales of imaging
products decreased with 1.6 % after a record year
in 2022 with 44 % growth.
Medistim’s strategic progress relies on strong clinical
documentation by leading medical centers to create
support from Key Opinion Leaders (KOLs) within
cardiac surgery and vascular surgery. It is a strategic
priority to support this by increasing the focus on
blood flow measurements, ultrasound imaging,
surgical guidance, and quality assurance in relevant
forums and channels. Clinical studies is described
in more detailed under chapter 7.
For some time and in parallel with cardiac surgery,
it is Medistim’s goal to develop a strong position
for the transit time flow measurement (TTFM) and
high-frequency ultrasound (HFUS) imaging devices
within the Vascular market. The recommendation
of ultrasound imaging as an alternative to the
current gold-standard angiography marks another
milestone for Medistim in the efforts to establish
HFUS technology for completion control in
Carotid Endarterectomy (CEA). In the CIDAC study,
which was part of the Knappich meta-analysis,
Medistim’s MiraQ Vascular device was used, and it
demonstrated the benefits of using HFUS compared
to angiography. In 2023 the vascular product
portfolio revenues have grown 16.9 %, and with
the support of these revised Guidelines, Medistim
is in a great position to continue this growth path.
Medistim’s success is explained by the company’s
focus on customer, market, product development
and people skills. This requires a strong and
competent management and Medistim’s team
represent several years of experience within the
MedTech field.
A key to succeeding with winning in both Cardiac
(CABG) and Vascular markets is continued innovation
and product development. Customers expect to see
improved performance from both the Flow and
Imaging core technologies, as well as new features
that will advance the clinical value and make the
products even more user-friendly and attractive to
build into their workflows.
Medistim has expanded the Innovation and Product
Development teams with additional headcount, as
an important investment for the future. Not only
does this increase the capacity to drive innovation
initiatives, but it also brings in new competencies,
experience, and ideas.
6.2 Regional development
Americas
USA is the largest market within the region and is the
largest market in the world for Medistim’s products,
representing 33 % of global CABG procedures. Total
U.S. sales amounted to MNOK 197.1 (MNOK 198.1)
in 2023 and represented 95 % of sales for the region.
Adjusted for currency effects, sales were down 9.5 %.
Sales development for the USA has been weak in
2023 compared to 2022 and 2021 with less capital
sales in general, but especially the combined flow
and imaging system.
We attribute these repercussions to the prevailing
macroeconomic landscape characterized by high
inflation and escalating interest rates, corresponding
also to what we experienced during the financial
crisis around 2009 and during Covid in 2020. In
addition to the macroeconomy, burnout among
nurses post-Covid may be adding to the hospitals’
MNOK 2023 2022 CHANGE IN %
AMERICAS 209.0 203.6 2.7 %
APAC 83.0 79.0 5.0 %
EMEA 155.0 133.5 16.0 %
THIRD PARTY 79.4 75.8 4.7 %
TOTAL 526.4 491.9 7.0 %
expenses as well as challenging their ability to
uphold surgical procedure volumes. However, the
total number of flow procedures sold in 2023 is up
by 5 %. While the global economy is expected to
remain uncertain throughout 2024, there are signs
of an improving economic outlook, that will fuel
our US growth engine. Utilization of installed base
however continue to grow as number of procedures
covered increases.
During the year, 89,526 procedures were sold,
(86,030) of which 72,873 were flow procedures
(69,417) and 16,653 were imaging (16,613). Capital
sales were 33 units, compared with 46 units in
2022. In 2023, 86 % of sales was within the cardiac
segment, hence the vascular segment is a large
untapped opportunity for Medistim USA.
Some 60 % of all bypass surgeries in the U.S. are
performed by surgeons, using their fingertips to
check for a pulse as the only quality assurance.
This is a clinically proven unreliable method,
highlighting the need and potential for Medistim’s
products. Medistim’s current market penetration is
30 % of the total market of approximately 200,000
bypass surgery procedures performed annually. In
comparable markets like Germany, Scandinavia,
and Japan, Medistim has achieved TTFM market
penetration exceeding 80 %. Medistim expects that
market penetration in USA will develop in the same
manner over time.
To strengthen its market outreach, Medistim offers
several business models in the USA. In addition
to traditional capital investments and purchase
of consumables, hospitals can choose to either
pay per procedure or enter leasing agreements. In
2023, procedural sales amounted to 76 % of the
total sales, ending at MNOK 151.6 (MNOK 139.1).
This is up 9 % from 2022 (0 % currency adjusted).
Total capital sales in systems and probes as
consumable in number of units for the region is
shown in table below.
Number of procdures from:
2023 2022 CHANGE IN %
PPP smart cards or lease flow 29 168 30 005 -2.8 %
Flow probes to capital customers 43 706 39 412 10.9 %
Total flow procedures 72 873 69 417 5.0 %
PPP smart cards or lease imaging 11 153 10 713 4.1 %
Imaging probes to capital customers 5500 5900 -6.8 %
Total imaging procedures 16 653 16 613 0.2 %
Total flow and imaging procedures 89 526 86 029 4.1 %
18
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Note:
From 2023 onwards, Medistim will report on
the split between the number of procedures
sold based on sales of ‘pay per procedure’
(PPP) smart cards and estimated number of
procedures from sales of capital probes, see
table geographic split of sales in units.
AMERICAS 2023 2022 CHANGE IN %
Flow systems 16 17 -5.9 %
Flow & imaging systems 23 32 -28.1 %
Flow probes 1 806 1 707 5.8 %
Imaging probes 58 60 -3.3 %
Medistim strengthened its position in the region and
announced in 2023 that a direct sales operation had
been established in Canada. Medistim already had
a strong position in Canada with presence in 15 of
Canadas 38 cardiac centers. About 18 000 coronary
bypass surgeries are performed in Canada per year,
and about 37 % are supported with Medistim’s
technology. The company is well positioned to
continue the growth with local sales representatives
who will focus on attracting new customers as well
as driving the conversion from devices with Transit
Time Flow Measurement (TTFM) technology only,
to devices combining TTFM and High Frequency
Ultrasound (HFUS). In addition, the market within
Vascular surgery provides further opportunities for
growth. The Canadian team is supported by the
US management in the daily operations. Sales to
Canada ended at MNOK 6.7 in 2023.
In Latin America, Medistim is represented through
local distributors and sales ended at MNOK 5.1.
Sales in APAC and EMEA
In these markets, the systems are owned by the
hospitals and revenues are more evenly split
between capital sales and sale of consumables.
In 2023, sales of flow and imaging measurement
probes amounted to 64 % of total sales, ending at
MNOK 152, compared with MNOK 134 in 2022.
Currency neutral sales were at the same level as
last year, where EMEA had a 3 % increase and APAC
12 % decline year-over-year. The increased market
penetration within both the cardiac segment and
Vascular segment contributes to increase sale of
consumables. In 2023, consumable sale amounted
to 62 % of total sales. Sale of consumables is
expected to increase as sale of systems continues
to increase from MNOK 78 in 2022 to MNOK 85
in 2023.
EMEA
More than 90 % of the revenue from the region is
from Europe either through direct representation
or through distributors. Medistim has developed a
strong market position in Europe with about 1150
systems installed, representing a solid base for future
recurring revenues. Total European sales of own
products in 2023 ended at MNOK 143.6, up 15 %
from MNOK 124.8 in 2022. Currency neutral sales
were up 2 %. 59 % of sales from Europe was through
direct channel and 41 % of the sales was through
distributors. Direct sales channel had a 5.5 % currency
neutral increase while distributor sales had a 2.5 %
currency neutral decrease in sales. Total capital sales
in systems and probes as consumable in number of
units for the region is shown in table below.
EMEA 2023 2022 CHANGE IN %
Flow systems 58 57 1.8 %
Flow and imaging
systems 37 35 5.7 %
Flow probes 4 737 4 943 -4.2 %
Imaging probes 50 63 -20.6 %
Medistim’s direct representation in Europe is in
Norway, Denmark, UK, Spain, Germany and Sweden.
Both Spain and Germany are mature markets within
cardiac, but have large opportunities within the
vascular segment and converting cardiac customers
to the combined flow and imaging solution. Norway
and Denmark are well penetrated in both segments,
while in the UK there is growth potential within both
segments. In Sweden Medistim established a direct
sales office in 2023. The company is well positioned
to continue its growth by further developing the
conversion from devices with Transit Time Flow
Measurement (TTFM) technology only, to devices
combining TTFM and High-Frequency Ultrasound
(HFUS). In addition, the company has established
exclusive distribution agreement with the Austrian
manufacturer Agency for Medical Innovations
(A.M.I.) with their product portfolio in urology,
coloproctology and urogynecology. Medistim
already has the rights for A.M.I. products in Norway
and Denmark. With a direct presence in these three
countries, Medistim is positioned to build a broader,
Scandinavian distribution business for third party
products.
Sales through distributors of own products ended
at MNOK 53.8, up 11 % compared to 2022. The
installed base continued to increase, which will
secure future consumable sales of probes.
APAC
Sale to Asian markets were MNOK 83 for the year,
up from MNOK 79 in 2022. Currency neutral sales
was a 7 % decline. Sales in the region was driven
by sales to China. Sales to China ended at MNOK
42.6, up 15 % compared to 2022. Currency neutral
growth was 5 %. The number of CABG procedures
increased with 5 to 10 % per year, and China is a
strategic market for Medistim. Medistim covers
about 70 % of the 60,000 procedures performed
in China.
19
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
20
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
To follow this opportunity Medistim established
a direct sales representation in 2023. Medistim’s
equipment is today installed in all the nation’s
top 10 cardiac surgical centers. The company is
well positioned to continue its growth by further
expanding the local distributor network and building
on the ongoing conversion from devices with Transit
Time Flow Measurement (TTFM) technology only,
to devices combining TTFM and High-Frequency
Ultrasound (HFUS). In addition, a large market
within Vascular and Transplant surgery provides
opportunities for further growth.
The second largest market in the region is Japan and
sales ended at MNOK 24.0, down 6 % compared to
2022. The introduction of MiraQ to the Japanese
market late 2019 continues to drive system sales
in Japan. Total capital sales in systems and probes
as consumable in number of units for the region is
shown in table below.
The volume reduction of flow probes is explained
by the 10 % price increase announced in 2022 for
2023, where distributors purchased for inventory.
It is also explained by the transition period with the
former Chinese distributor completed projects and
filled local Chinese distributors inventory before
Medistim established direct presence during the
first half of the year.
Third party products
Medistim established a presence in Sweden during
2023 explained under EMEA section. Medistim also
has agency on third party products in Sweden and
can now offer to distribute third party products in
Scandinavia.
6.3 Organization, HSEQ and
sustainability
Medistim has sales representation in its main
markets and production and main office functions
in Norway. At year-end 2023, Medistim had 152
employees, compared to 131 in 2022. The working
environment and culture in Medistim are considered
strong, and there is continuous focus on initiatives
for improvement. In 2023, absence due to sickness
was 4.0 % or 1598 days. This compares to 4.4 % or
1510 days in 2022.
Medistim strives to be an attractive workplace that
offers challenging and motivating jobs and equal
development opportunities for all. There is no
discrimination due to gender, nationality, culture
or religion with respect to remuneration, promotion
or recruitment. The Company is committed to
recognize diversity and ensure equal opportunities,
including fair employment conditions. Medistim
supports the United Nations Universal Declaration
of Human Rights and the standards advised by the
International Labour Organisation (ILO).
For more information, please see Chapter "9.
Sustainability Report" of this Annual Report.
6.4 Financial Review
Going concern
The Board of Directors confirms that the financial
statement has been prepared based on the
assumption of a going concern.
Profit & Loss
Medistim's sales for the full year 2023 ended at
MNOK 526.4 (MNOK 491.9). Currency neutral, sales
declined 2.5 %.
Sales in AMERICAS increased 2.7 %, while sales in
APAC and EMEA increased 5 % and 16 %, respectively.
Sales of third-party product in Scandinavia through
the subsidiaries in Norway, Denmark and Sweden
rose 4.7 %.
Total sales of own products in 2023, amounted
to MNOK 446.9 (MNOK 416.1), while sales of
third-party products were MNOK 79.4 (MNOK
75.8). Currency adjusted, sales of own products,
decreased 3.8 % during the year, while sale of third-
party products increased 4.7 %. The development
in the markets are described under 1.2 regional
development. Average NOK exchange rates
towards USD and EUR in 2022 were 9.61 and 10.10
APAC 2023 2022 CHANGE IN %
Flow systems 70 75 -6.7 %
Flow & imaging systems 33 34 -2.9 %
Flow probes 2 573 3 296 -21.9 %
Imaging probes 60 48 -25.0 %
21
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
respectively, while equivalent rates in 2023 were
10.56 for USD and 11.42 for EUR.
Cost of goods sold (COGS) amounted to MNOK
112.3 (MNOK 106.5), representing 21.3 % of sales
(21.7 %). Weaker sales through direct operation
and a growth in sale of third-party products, explain
why COGS in percent is unchanged from 2022. In
recent years, COGS in precent of sales has declined,
since sales of Medistim's own products have grown
at a higher pace than third party products.
Salary and social expenses were MNOK 162.6
(MNOK 146.4), while other operating expenses
were MNOK 96.4 (MNOK 74.5). The main reason
for higher salary and social expenses is related to
increased number of employees. The organization
has been strengthened primarily within Innovation
and Product development (R&D), but also within
business development, sales, service, and
administration. The increase is also related to the
establishing direct presence in China, Canada and
Sweden.
The activity level in marketing and sales were higher
this year, explaining the increased other operating
expenses in addition to the establishment of direct
operations described above. In total for salaries
and other operating expenses, there is a negative
impact of MNOK 11.7 related to foreign exchange
rates differences.
Medistim continuously invests in existing and new
products to cover the surgical requirements for
quality verification. The company has historically
invested between 4 % and 10 % of annual sales
in research and development (R&D). In 2023,
total R&D investments amounted to MNOK 29.0
(MNOK 23.8), corresponding to 6.5 % of sales of
own products. Of this, MNOK 13.3 (MNOK 9.9) was
activated in the balance sheet.
Operating profit before depreciation and
amortization expenses (EBITDA) ended at MNOK
155.1 (MNOK 164.5). Depreciation for the year
amounted to MNOK 23.6 (MNOK 23.4).
The operating profit (EBIT) ended at MNOK 131.4
(MNOK 141.3), corresponding to an EBIT-margin
of 25.0 % (28.7 %)
The Group recorded net financials of MNOK 3.8
(MNOK 4.8), of which MNOK 13.3 of financial
expenses (MNOK 11.7) and MNOK 17.1 of financial
income (MNOK 16.5). Net finance was related to
realized and unrealized gains or losses related
to currency, cash in USD and EUR and customer
receivables.
Profit before tax was MNOK 135.2 (MNOK 146.0).
Tax amounted to MNOK 31.4 (MNOK 32.1) and the
net profit for the year was MNOK 103.8 (MNOK
114.0), corresponding to earnings per share for the
full year of NOK 5.68 (NOK 6.25).
The average number of shares outstanding during
the year was 18.267.157 (18.247.550).
Cash Flow Statement
Net cash flow from operating activities amounted
to MNOK 113.2 (MNOK 113.5). Working capital
increased MNOK 3.1 during the year, driven by a
MNOK 31.1 increase in inventories and MNOK 27.3
decrease in receivables.
Net cash flow from investing activities was negative
MNOK 29.7 (MNOK 21.1) where MNOK 16.4 as
related to investments in assets and MNOK 13.3
was related to product development.
Net cash flow from financing activities was negative
MNOK 84.9 (MNOK -70.3), of which MNOK 82.2
(MNOK 68.4) was payment of dividends. Leases
amounted to MNOK 8.7 (MNOK 7.3).
At 31 December 2023, total cash and cash
equivalents amounted to MNOK 153.9 (MNOK
152.6).
Financial position
At 31 December 2023, Medistim’s working capital
totaled MNOK 188.8, compared with MNOK 185.7
the year before. During the year, inventory increased
by MNOK 31.1. Even with increased sales, account
receivables decreased MNOK 27.3 during the
year. Account payables ended at the same level
as last year. By year end the group had MNOK
17.6 in interest bearing liability related to lease
contracts. MNOK 9.3 of this was long term liability
and MNOK 8.3 was short term liability. Total long
term liability of MNOK 13.5 was related to MNOK
9.3 lease contracts and MNOK 4.2 was related to
deferred revenue.
The total balance sheet amounted to MNOK 505.7
(MNOK 482.7). Total equity was MNOK 397.9 (MNOK
367.7), corresponding to an equity ratio of 79 % (76
%). Book value of properties, plants and equipment
amounted to MNOK 57.3 (MNOK 51.3). Intangible
assets were MNOK 45.4 (MNOK 36.1), of which
product development and goodwill represented
MNOK 31.3 and MNOK 14.1 respectively. The group
22
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
has a deferred tax asset of MNOK 5.1 (MNOK 3.6)
related to temporary differences between carrying
amount and tax values. The year-end cash position
was MNOK 153.9 (MNOK 152.6).
Medistim's financial position, cash flow and ability
to finance its activities is considered satisfactory.
Share capital and number of shareholders
At 31 December 2023 the share capital of the
Medistim ASA parent company was NOK 4,584,334
distributed on 18,337,336 shares outstanding at
par value of NOK 0.25 per share. The share is freely
traded on the Oslo Stock Exchange. The company
had over 1000 shareholders and owned 55,617
treasury shares at year-end.
6.5 Parent company financial review
The parent company Medistim ASA had 2023 sales
of MNOK 341.0 (MNOK 308.6). Operating profit was
MNOK 108.0 (MNOK 101.7) and profit before tax
amounted to MNOK 124.7 (MNOK 129.4). Medistim
received a dividend from its subsidiary in Norway
of MNOK 11.0 in 2023 (MNOK 26.8). No group
contribution was received in 2023 or 2022. Profit
after tax for the parent company was MNOK 99.5
for the full year (MNOK 108.1).
At 31 December 2023, the parent company’s total
assets amounted to MNOK 402.2 compared to
MNOK 382.2 as of 31 December 2022. Equity
in the company was NOK 201.1 (MNOK 191.7),
corresponding to an equity ratio of 50.0 % (50.2 %).
At year-end 2023, the parent company had MNOK
82.5 in cash. The company’s financial position and
ability to finance future activities and investments
was considered satisfactory. Cash flow from
operating activities was MNOK 96.9 for the parent
company in 2023.
Allocation of profit
The Board of Directors suggests that MNOK 82.3
of the 2023 net profit is allocated to ordinary
shareholder dividend, equal to NOK 4.50 per share
(NOK 4.50 for 2022). The remaining MNOK 17.2 is
allocated to other equity.
The Board of Directors will propose the dividend to
the general meeting general. The proposed dividend
equals a pay ratio of 79.2 % (72.1 %). The dividend
reflects the Board's positive expectations of future
earnings. Over the past 10 years, the company has paid
MNOK 490 in accumulated dividends to shareholders.
6.6 Corporate governance
Medistim depends upon good relations with
its stakeholders to succeed. Good corporate
governance is important to build and maintain
trust and confidence in the company and ensure
long-term value creation in the best interest of the
company’s shareholders. The company’s corporate
governance structure is based on Norwegian
legislation and the Norwegian Code of Practice for
Corporate Governance, last revised in October 2021.
Medistim complies with the Code of Practice, with
certain deviations, as outlined and explained in the
Corporate Governance Report in this annual report.
6.7 Main risk factors
MARKET/OPERATIONAL RISK
Competition: Medistim has one single direct
competitor for TTFM technology. Medistim today
has about 80 % of the penetrated market. Medistim
is not aware of new competitors or technologies
that could change the competitive landscape
significantly.
Risks related to device malfunction: Medistim has
established comprehensive procedures as part of
its Quality Management System in compliance with
ISO 13485:2016 to ensure the safety of its products.
There were no events reported in 2023.
FINANCIAL RISK
Foreign exchange risk
Medistim is exposed to changes in exchange rates
with most of the company’s revenues generated in
USD and EUR. The company has entered hedging
contracts to reduce exposure to changes to foreign
exchange rates and the potential impact on financial
performance.
Liquidity risk
Medistim prioritizes managing liquidity risk to
ensure the company meets its obligations in time
and maintains its financial flexibility. Cash generated
from operations is Medistim’s main source of
liquidity. Over the past five years, Medistim has
utilized strong revenue and profit development
to build a cash reserve to meet increased working
capital requirements as the company grows.
23
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Interest rate risk
The company is exposed to changes in interest rate
levels through its long-term lease contracts.
Macroeconomic risk, international conflicts and
pandemics
The global market is facing macro-economic turmoil,
with energy crisis, inflation pressure, increasing
interest rates and cost levels. The long-term
consequences of the pandemic aftermath and
growing geopolitical uncertainty are unclear but
might lead to continuing challenges in the global
flow of goods. Medistim is taking mitigating actions
to ensure access to key components to secure
production and maintain growth and profitability
also for the future. Further, the company is
financially solid to face future challenges, with no
interest-bearing debt and an equity ratio of 79 %.
The global economic situation will affect the
company since Medistim is a supplier to the health
care sector in many countries. Management closely
monitors the associated financial risks.
Credit risk
Medistim considers the risk that customers are
unable to fulfill economic obligations as low,
which is confirmed by the level of historic losses
on receivables. The customers are mainly public
hospitals with secure financing.
OTHER RISK FACTORS
Regulatory risk
Medistim depends upon regulatory approvals from
health authorities for permission to sell its products.
The company is revised on a regular basis to verify
that approvals can be maintained. There is a latent
risk that changes in regulatory conditions can result
in a loss-off-approval to sell products in a given
market.
Health care priorities
In general, health care institutions have many
priorities and limited resources. For this reason,
it is imperative for Medistim that the company's
solutions have clinical acceptance in order for health
care systems and institutions to invest in Medistim’s
products.
The Russia/Ukraine and Israel/Palestine conflicts
The Russia/Ukraine and Israel/Palestine conflicts
are expected to have minor impact on Medistim
sales, since sales revenues from these countries
were less than 2 % of total sales in 2023.
Insurance and transparency act
The company has director and officer's liability
insurance. The insurance covers the board of
directors' and management officers' legal personal
liability for pure property damage related to the
duties performed as directors and officers.
The updated transparency act report from Medistim
will no later than the 30
th
of June be published on
the Medistim website www.medistim.com
6.8 Events after the balance sheet date
The Board of directors has no knowledge about
events after 2023 that will affect the annual report
and financial statement for 2023.
6.9 Outlook
Medistim’s ambition is making blood flow
measurements and intraoperative ultrasound
imaging standard-of-care in clinical practice for
CABG procedures and vascular surgery and making
its technology available for all patients and surgeons
worldwide.
Medistim is already the global leading provider of
flow and imaging systems, with dominant market
positions in most developed markets, continuously
expanding its footprint represented by a current
installed base of about 3,500 systems in more than
65 countries.
However, market penetration varies from above
80 % in selected European and Asian markets, to
30 % in USA, the world’s largest market for CABG
procedures. This represents a significant market
opportunity for Medistim. Through continued
strengthening of its sales organization, introduction
of alternative business models and convincing
clinical documentation and support from KOLs,
Medistim aims to develop this large under-
penetrated market. The company has also extensive
growth ambitions in developing economies.
Medistim has delivered solid profit and cash flow
despite the impact from conflicts and macro-
economic turmoil in 2023. The need for Medistim’s
products has not changed.
Medistim will also continue its technology and
product development to improve its offering
and combined with recurring revenues from its
already installed base of about 3,500 systems, the
company is well positioned to continue its journey
of profitable growth.
24
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
6.10 Shareholder information
Share price development
Medistim ASA has one class of shares. There were
18,337,336 shares issued at the end of 2023, each
with a nominal value of NOK 0.25, unchanged from
end of 2022. During the year, the shares traded
between NOK 181 and NOK 300 per share, and 3.85
million shares were traded in total.
Major shareholders and voting rights
Medistim had 1028 registered shareholders in the
Norwegian Central Securities Depository (VPS)
at 31 December 2023, whereof the 20 largest
shareholders owned 73.3 %. The percentage of
issued shares held by foreign shareholders was 57
%. All the shares registered by name carry equal
voting rights. The shares are freely negotiable.
20 largest shareholders is shown in note 20. An
overview of the 20 largest shareholders is available
on Medistim’s website, updated every week.
Dividends and dividend policy
Medistim aims to maximize shareholder value.
This will be achieved through sound business
development and an ambitious growth strategy.
Medistim will seek to provide annual dividends,
depending upon the company’s financial capacity
and financing needs to ensure future growth. The
company will at all times ensure that it has the
financial capacity and equity to achieve future plans
for growth.
Based on the 2023 results, the Board of Directors
will propose to pay a dividend of 4.50 for 2023
corresponding to a pay-out ratio of 79 %. For 2022,
Medistim paid a dividend of NOK 4.50 per share
corresponding to and a pay-out ratio of 71 %. Over
the last ten years, Medistim has paid MNOK 490 in
accumulated dividend to shareholders.
Analyst coverage
DNB, Danske Bank and Sparebank1 had active
coverage of Medistim ASA in 2023. For contact
details, please see the company website www.
medistim.com.
General Meetings and Board authorisations
The 2023 AGM granted the Board of Directors the
following authorizations:
1. Authorisation to increase the share capital
by up to NOK 458,433.25.
2. Authorisation to acquire treasury shares
in Medistim ASA for up to a maximum
nominal value of NOK 458,433.25.
Further information can be found in the minutes
from the Annual General Meeting, available from
the company’s website www.medistim.com and
www.newsweb.no
Corporate actions
2023
2022 Financial statements approved by the Board 23.03.23
Annual report 2022 disclosed 30.03.23
Annual General Meeting 24.04.23
Resolution to distribute dividend of NOK 4.50 per share 24.04.23
Ex dividend NOK 4.50 25.04.23
25
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Øyvin A. Brøymer
Chair
Sign.
Ole J. Dahlberg
Board member
Sign.
Lars Rønn
Board member
Sign.
Anna Ahlberg
Board member
Sign.
Jon H. Hoem
Board member
Sign.
Kari Eian Krogstad
President & CEO
Sign.
Board member
Sign.
Tove Raanes
Board member
Sign.
Oslo, 21
st
March 2024
Board of Directors and CEO of Medistim ASA
26
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
7.1 Vision, mission, values
Medistim’s technologies and solutions increase the
probability of a positive outcome of surgery for the
patient and enable greater efficiency and lower costs
for health care providers by reducing additional and
unnecessary surgical re-interventions. The company’s
long-term vision is stated as:
Medistim is standard-of-care in the operating
room.
This implies, making Medistim’s solutions the
standard-of-care in clinical practice for Coronary
Artery Bypass Graft (CABG) surgery procedures
and vascular surgery, ensuring that blood flow
measurements and intraoperative ultrasound
imaging are performed on all patients.
Values
All conduct is based on the four elements of the
company’s core values – Courage, Innovation,
Quality and People.
Addressing serious, common and increasing global
medical problems
Cardiovascular diseases (CVDs) are the number
one cause of death, representing approximately
1/3 of all deaths worldwide
1
. CVD is a general
term for conditions affecting the heart or blood
vessels. It is usually associated with a build-up of
fatty deposits inside the arteries (atherosclerosis)
and an increased risk of blood clots. It can also be
associated with damage to arteries in organs such
as the brain, heart, kidneys and eyes.
1 Journal of the American College of Cardiology Volume 76, Issue 25, 22 December 2020
The main risk factors for CVD are high blood
pressure, dietary risks leading to obesity, diabetes,
smoking, in addition to higher age. Both obesity
and diabetes are increasing world-wide, reflecting
economic growth and a growing middle class in
developing economies. In parallel, the number
of people above 60 years of age is also growing
globally.
Treatment alternatives include the use of
pharmaceuticals, endovascular procedures and
open surgery.
7. COMPANY DESCRIPTION
COURAGE INNOVATION QUALITY PEOPLE
To set challenging goals
To be open and transparent
To share knowledge and
experience
To try without fearing to
fail
To challenge accepted
beliefs
Encourage creativity, dis-
covery, and innovation
Value new ideas and test
them out
Problem-solving and solu-
tion-oriented mindset
Outstanding quality in every-
thing we do
Commitment to Medistim QMS
High competence and unique
expertise
World-class products and
services
Amazing customer experience
Trustworthy, honest, and
ethical
Generous and welcoming to
customers and colleagues
Value, trust and respect
each other
Promote physical and
emotional health and
quality of life
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Endovascular procedures, including Percutaneous
Coronary Intervention (PCI), are considered less invasive
by accessing blood vessels through a surgical small
incision and using a catheter to insert and to place a
stent inside the arteries to obtain revascularization.
A coronary artery bypass graft (CABG) is an open
chest surgery and involves taking a blood vessel,
also known as a graft from another part of the body
(usually the chest, leg or arm) and attaching it to
the coronary artery above and below the narrowed
area or blockage.
7.2 Medistim’s solutions
Medistim’s devices are increasingly used to support
CABG and other vascular surgical procedures.
The solutions enable cardiac imaging, blood flow
measurement and provides surgeons with immediate
feedback on procedure outcome.
Intraoperative surgical guidance and quality
assessment with ultrasonic imaging and blood flow
measurement reduces risk of stroke for the patient.
It also provides the surgeon with a tool to verify graft
functionality, indicate when revisions are needed and
to optimize graft strategy during surgery.
Globally, more than 700,000 CABG procedures are
carried out on an annual basis. Although the use of
solutions for real-time blood flow measurement and
ultrasound imaging during procedures is increasing,
the vast majority are executed by surgeons merely
relying on experience and physical finger palpation
for graft patency assessment.
Currently only approximately 45 % of the global CABG
market is utilizing support systems. Development of
the overall market, by increasing acceptance and
use of supporting technology such as Transit Time
Flow Measurement (TTFM) and High-Frequency
Ultrasound Imaging (HFUS) represents Medistim’s
main growth opportunity.
Medistim is already the leading provider of flow and
imaging systems, with dominant market positions in
most developed markets. The offering is two-fold;
1) medical systems for monitoring and analysis, and
2) consumables, including re-usable cardiac and
vascular probes and ultrasound imaging probes.
Sales of consumable correlates to the number of
procedures executed and is highly dependent on
size of installed base of systems. The company is
continuously expanding its footprint represented
by a current installed base of approximately 3,500
systems in more than 65 countries.
Medistim develops this large under-penetrated
market through convincing clinical documentation
and support from Key Opinion Leaders (KOLs), to
make HFUS and TTFM standard of care for CABG
surgery.
Medistim will continue its technology and product
development to maintain its strong position and
strengthen its sales and marketing organization
improving capacity and outreach. Medistim’s
ambition is that its products and solutions shall
benefit all patients and surgeons all over the world.
Medistim assembles and manufactures its devices
and probes in Horten, Norway, except for the
imaging probes which are produced by third parties.
7.3 Strategy
Medistim’s strategic progress relies on strong clinical
documentation, technology and product innovation
and development, and the ability to effectively
commercialize its product portfolio worldwide.
Strong clinical studies by leading medical centers
create support from KOLs, and it is a strategic
priority to support this by sharpening the focus on
blood flow measurements, ultrasound imaging,
surgical guidance, and quality assurance in relevant
forums and channels.
Continuous technology and product development are
required to maintain and develop Medistim’s leading
position within cardiac as well as vascular surgery, and
the company plans to launch new products tailored
to the specialties within these fields.
The company is continuously strengthening all
parts of its organization. This includes the sales,
service, marketing and medical teams which
interact directly with customers, and the innova-
tion, R&D, QA & Regulatory, and manufacturing
departments.
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Medistim’s strategic priorities
1. Convert Flow-only market to a Flow-and-
Imaging market by establishing surgical
guidance and quality assessment as the new
standard of care through:
a. Early adopter and KOL support
b. REQUEST study
c. Ease conversion from Flow to Imaging
with MiraQ
2. Achieve routine use of both Flow and Imaging
by fighting ignorance, indifference and ease-
of-use objections through:
a. Clinical marketing, guidelines and
educational programs
b. Product innovation for ease of use
c. Increased sales force capacity
3. Offer an entry-level solution to reach
emerging, price-sensitive, high-growth
markets
4. Build and strengthen position in vascular
surgery through:
a. Dedicated system (MiraQ Vascular) &
probes
b. Building position with societies and KOLs
5. Expand direct market coverage
7.4 Technology and Products
Medistim’s medical devices are used to improve
quality of cardiovascular surgery and are subject
to high requirements and product certifications
with regards to quality and safety, and require high
competence and excellent quality systems.
Technology
Medistim’s blood flow measurement (TTFM) and
high-frequency ultrasound imaging (HFUS) systems
measure, monitor and image blood flow through
veins or arteries with precise accuracy during surgery.
The solution comprises two different modalities:
a quantitative measuring modality (TTFM) and a
qualitative imaging modality (HFUS).
The sensor technology is based on probes. The
flow probes are placed on a blood vessel, with the
volumetric flow measured and analyzed by the system
unit and displayed on-screen as blood flow curves,
values, and images. The imaging functionality provides
surgeons with real-time guidance during surgery and
enables them to uncover possible causes of poor blood
flow, correct technical problems, and achieve optimal
clinical outcomes.
Transit Time Flow Measurement -TTFM
With TTFM, ultrasound is used to measure blood
flow volume directly, based on the fact that the time
required for ultrasound to pass through blood is
slightly longer upstream (tu) than downstream (td).
The MiraQ offers the fastest and most accurate
flow measurements, verifying graft patency while
the patient is still in the operating table.
High-Frequency Ultrasound Imaging – HFUS
Ultrasound Imaging can generate images of
target areas by transmitting ultrasound pulses
and receiving different echoes depending on
density. To help locate and understand technical
imperfections during blood vessel surgery, the high
frequency ultrasound imaging probe can image
areas of concern on a real-time basis and reveal
morphological (structural) issues for immediate
correction before closure.
Epiaortic imaging allows a sensitive, direct diagnosis
of aortic disease, which can lead to modifications
in intraoperative surgical management.
Epicardial imaging can be used intraoperatively to
assess coronary quality, strategize graft placement,
and visualize constructed anastomosis (connections).
Imaging of the major carotids blood vessels in the
neck after carotid endarterectomies (CEA) can
reveal technical imperfections that may lead to
thrombus formation and stroke if left unrepaired.
Medistim also provides equipment for Doppler
measurements of blood flows. However, this
technology is increasingly being replaced by HFUS.
Products
Medistim launched its first flowmeter based on
transit time flow measurement (TTFM) technology
in 1994, the CardioMed. Since then, the company
has developed several generations of quality
assurance equipment. In 2009, Medistim introduced
the first ultrasound imaging probe, and the company
is currently the only supplier in the world that offers
a user-friendly integrated TTFM and intraoperative
high frequency ultrasound (HFUS) imaging system.
Solutions for cardiac and vascular surgery
The MiraQ™ is Medistim’s most advanced product
line with configurations for both cardiac and vascu-
lar surgery. The MiraQ platform offers specialized
configurations for cardiac and vascular applications
in the products MiraQ Cardiac and MiraQ Vascular,
respectively. The MiraQ Vascular system includes a
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specialized application menu with a customized user
interface adapted to vascular surgeons’ require-
ments, and probes tailored for vascular applications.
The MiraQ is also available with both configurations,
as the MiraQ Ultimate.
TTFM probes (cardiac and vascular family)
Flow probes utilize the reliable transit time technology
to accurately measure blood volume flow intraoper-
atively in a wide range of applications, from cardiac
and vascular, to transplant surgery. Used together
with Medistim’s systems, they provide fast, accurate
and reproducible information to the surgeon instan-
taneously to provide verification of graft patency and
function. The ultimate benefit is quality assurance with
immediate feedback that leads to improved surgical
outcomes.
Imaging probes
Medistim’s imaging probes are used to provide intra-
operative surgical guidance. Epiaortic imaging allows
a sensitive, direct diagnosis of aortic disease, which
can lead to modifications in intraoperative surgical
management. Epicardial imaging can be used intra-
operatively to assess coronary quality, strategize graft
placement and visualize constructed anastomosis.
Medistim’s flow probes can be used 50 times and the
imaging probe can be used 100 times and even more if
treated properly. All the electrical components in use
comply with environmental standards for electronic
waste.
7.5 Research and Development
Medistim continuously invests in existing and new
products to cover the surgical requirements for
quality verification. The company has historically
invested between 4 % and 10 % of annual sales
in research and development (R&D). In 2023, the
company invested 6,5 % of annual sales of own
products in research and development (R&D).
Product development for increased “ease of use”
In order to grow technology adoption, it is pivotal
to make the products as easy to learn and use
as possible. Medistim is therefore focusing on
innovation to develop new features and ensure
“ease of use” for the end-customer. The company’s
innovation team collaborates closely with a network
of surgeons and hospitals to test prototypes and
new ideas. The goal is to capture the end-customers’
needs and expectations before initiation of costly
development projects which are subject to strict
regulatory regimes. The ambition is to accelerate
product innovation and reduce development time
by clarifying product design and functionality before
a formal development process is initiated. The
Innovation team has developed a prototype of a
new user interface which is under development.
New production technology
A separate project is established to redesign the
flow probes in order to be able to automate the
production process of flow probes. The project is
expected to go on for several years and will improve
the probe production capacity vastly.
Guideline endorsements
Inclusion in the leading health organizations’
guidelines for clinical surgery is vital to achieve
«Standard of Care» status for TTFM and HFUS
in coronary bypass surgery. Medistim engages
in continuous dialogue with a broad range of
organizations to increase awareness of and
knowledge on the company’s solutions.
Currently, TTFM during CABG procedures are
endorsed by the guidelines from the European
Society of Cardiology (ECS), the European Association
for Cardio-Thoracic surgery (EACTS), and The British
National Institute for Health and Clinical Excellence
(NICE). All are highly respected organizations and
their recommendations are expected to influence
clinical practice also in countries outsides their
jurisdictions, including in the USA.
The health care providers and surgeons performing
CABG procedures are conservative and it is hard to
measure the direct effect from recommendations
and studies. However, it is Medistim’s experience
that the recommendations have influenced
demand positively over time and expects increasing
recognition to continue to support demand in the
years to come.
Clinical studies support routine use of Medistim’s
technology
Medistim’s strategic progress relies on strong clinical
documentation by leading medical centers to create
support from Key Opinion Leaders (KOLs) within
cardiac surgery and vascular surgery. It is a strategic
priority to support this by increasing the focus on
blood flow measurements, ultrasound imaging,
surgical guidance, and quality assurance in relevant
forums and channels.
The circulation publication in 2021 and the use
of TTFM during CABG: In 2021 Medistim ‘s Transit
Time Flow Measurement (TTFM) technology
received strong support from leading experts, in
a new publication in the top journal Circulation.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Circulation – the official journal of the American
Heart Association – and one of the highest ranked
journals in cardiology and cardiovascular medicine,
published a consensus paper by 19 of the world’s
highest renowned specialists in coronary artery
bypass surgery (CABG) on October 5th. The
study describes a systematic review to identify
best practice evidence for guideline development
published the last 20 years. Over 2,200 articles
identified, more than 1,550 of them screened, and
38 of them included in this review paper. The expert
consensus process resulted in a new flowchart for
decision making guidance to cardiac surgeons on
how to utilize TTFM during surgery. The first of
the 10 consensus statements and justifications
states “TTFM should be used in every CABG case”.
The panelists agree “that quality assurance in
CABG procedures should be established as a key
component to improve patient outcomes”.
This is a pivotal paper for Medistim that clearly
graces all the initiatives to position MiraQ™
technology for routine use during CABG surgery.
Having the technology in focus in one of the world’s
most renowned cardiovascular journals indicate
that Medistim is moving in the right direction with
its strategy. Medistim’s REQUEST study published in
2020 was one of the key papers that was assessed
to underpin the importance of routine use of
quality assessment. This strong advocacy will not
only exert peer influence within the community of
cardiac surgeons, but it may pave the way for new
and enhanced clinical guidelines worldwide.
In 2022, Mojgan Laali et al. published the study
“Impact of transit-time flow measurement on
early postoperative outcomes in total arterial
coronary revascularization with internal thoracic
arteries: a propensity score analysis on 910 patients”.
Outcome in 430 CABG patients where TTFM was used
was compared with outcome from 480 CABG patients
where the surgeons were unwilling to perform TTFM.
The key finding is a significant reduction in Major
Adverse Cardiovascular Events (MACE) from 6.9 % to
3.3 % - a 50 % reduction by adding 3 extra minutes on
TTFM. This result was so convincing that the previous
non-believers at the hospital have adopted TTFM for
graft evaluation. This set of data is included in a large
multi-center study in France that Medistim believe
might ease the adaptation of TTFM in France.
In 2023 Medistim announced its partnership
with ROMA-Women, a groundbreaking cardiac
surgery trial that is specifically focused on women.
Historically, cardiovascular research and treatment
protocols have primarily focused on men, leaving
women underrepresented in clinical studies and
potentially receiving suboptimal care. Recognizing
this disparity, Medistim has joined forces with
the trial to champion gender-specific healthcare
advancements.
The multicenter randomized clinical trial, ROMA-
Women, will enroll about 2,000 women, studying
the use of single versus multiple arterial grafts in
coronary artery bypass (CABG) surgery. The trial
is spearheaded by renowned experts in the field
of cardiac surgery, including principal investigators
Mario Gaudino, Professor at Weill Cornell Medicine,
USA, and Stephen Fremes, Professor at Sunnybrook
Health Sciences, Canada. More than 100 centers
across the world are expected to participate. The
trial is an extension of the ongoing ROMA trial and
has already enrolled about 700 women.
ROMA-Women aims to address the unique
cardiovascular needs and challenges faced by
women. Compared to men, women are referred
for CABG at an older age and have more frequently
diabetes, hypertension, and dyslipidemia. From a
surgical perspective, the CABG operation is generally
more complex in women because of smaller and
more spastic coronary arteries than men. Hence,
it is believed that graft assessment may be even
more important in women, and in this trial, graft
patency will be assessed with Medistim’s Transit
Time Flow Measurement (TTFM) and High Frequency
Ultrasound (HFUS) technologies.
Guidelines recommend intraoperative ultrasound
after Carotid Endarterectomy (CEA) in 2022:
The European Society of Vascular Surgery (ESVS)
revised their Clinical Practice Guidelines in 2022
on the management of atherosclerotic carotid and
vertebral artery disease by among others, adding
a recommendation of the use of intra-operative
completion control with ultrasound imaging, to
reduce risk of peri-operative stroke for patients
undergoing carotid endarterectomy.
The Guidelines are set to identify luminal thrombus
after flow restoration, diagnose intimal flaps and
diagnose residual stenoses during surgery. The new
recommendation is based on a meta-analysis by
Knappich et al. 2021 that shows that both ultrasound
imaging and angiography are associated with a
reduced risk of death and stroke after CEA.
Professor Eckstein, University Hospital Rechts der Isar,
Munich, Germany, states that “This new guideline
recommendation clarifies that intraoperative
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morphological control is worthwhile. In my practice,
ultrasound imaging for completion control after CEA
has become the standard of care, especially when
surgery is performed under locoregional anesthesia.
Intraoperative angiography is only needed if a
cerebral problem is suspected.”
It is Medistim’s goal to develop a strong position for
its transit time flow measurement (TTFM) and high-
frequency ultrasound (HFUS) imaging devices within
the Vascular market, including the CEA segment.
The recommendation of ultrasound imaging as an
alternative to the current gold-standard angiography
marks another milestone for Medistim in the efforts
to establish the HFUS technology for completion
control in CEA. In the CIDAC (Comparison of Intra-
operative Duplex Ultrasound and Angiography after
Carotid Endarterectomy) study, which was part of the
Knappich meta-analysis, Medistim’s MiraQ Vascular
device was used, and it demonstrated the benefits
of using HFUS compared to angiography.
The results demonstrated that HFUS detected
significantly more high-grade defects that needed
revision compared to angiography, and with significantly
higher interobserver reliability. The authors conclude
that given the lesser invasiveness, HFUS could be
considered as an alternative to angiography for
intra-operative completion control in CEA, further
strengthening the support of using Medistim’s
ultrasound imaging device and probe for reducing the
risk of stroke after CEA. Based upon the results from the
study The European Society of Vascular Surgery (ESVS)
included the use of HFUS when treating CEA patients.
7.6 Clinical application areas and target
markets
Lifestyle diseases such as obesity and diabetes have
increased significantly in recent decades, increasing
the need for revascularization procedures.
Cardiovascular diseases (CVDs) are the most
common cause of death in the western world and
on the rise in Asian and Latin American countries
adopting western lifestyles.
The adoption of TTFM and HFUS for surgical
guidance and quality control is increasing. However,
over 60 % of surgeons still rely on physical palpation
for graft patency assessment, even though “feeling”
the pulse is an unreliable indicator of actual blood
flow through the vessel.
Hospitals and payers for surgery, such as
insurance companies, are increasingly requiring
documentation of performance and quality control
during any procedure, which is expected to support
the adoption of Medistim’s solution over time.
7.7 Market for cardiac procedures
Percutaneous Coronary Intervention (PCI), i.e. the
use of stents, covers approximately 80 % of the
revascularization procedures, with CABG covering
the remaining 20 %. Clinical trials document
superior results achieved with CABG compared to
PCI for patients with multi-vessel disease.
The number of coronary artery bypass surgeries
performed has been stable over the past several years,
of more than 700,000 globally per annum.
A decrease in the number of procedures performed
in Western countries in recent years has been
compensated by an increase in the BRICS countries
(Brazil, Russia, India, China and South Africa).
Globally, Medistim expects a stable to growing trend
in coming years.
Approximately 80 % of CABG procedures are on-
pump procedures while 20 % are off-pump. Both
are equally relevant for Medistim’s technology for
Transit Time Flow Measurement (TTFM) and High
Frequency Ultrasound Imaging (HFUS). The US is
the single largest market for Medistim’s products,
representing close to 30 % of the world market,
with a combined European market of a similar size.
Large untapped market
To date, Medistim has installed about 3,500 systems
in more than 65 countries, and Medistim’s flow
meters have been used on more than two million
patients worldwide. Medistim is the clear market
leader in its niche, and its systems are currently
being used in about 37 % of all bypass surgeries
performed worldwide. Competing providers
using the transit time measurement principle are
estimated to be used in about 8 % of the procedures
performed.
This implies that no equipment is being used to verify
blood flow in about 55 % of the bypass surgeries.
This untapped market represents Medistim’s largest
opportunity. Medistim expects market penetration
and market share to increase gradually, as surgical
quality assurance gains more attention and the
superiority of the Company’s solutions gain wider
acceptance.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Total value of the global TTFM market for CABG is
estimated at to BNOK 1 per year.
A unique product offering
Adding intraoperative ultrasound imaging more
than doubles Medistim’s market potential, due to
an expanded number of applications and higher
pricing compared to traditional flow measurement
technology. The total market size within cardiac
bypass surgery is therefore estimated at around
BNOK 2 annually.
The MiraQ imaging functionality makes the system
relevant also for other types of cardiac surgery,
such as heart valve surgery. Medistim estimates
this added market potential to be approximately
BNOK 1 on an annual basis. This market represents
an add-on opportunity to widen the use of the
device beyond CABG only and is not considered an
independent commercial strategy.
The combination of Medistim’s ultrasound imaging
technology and the MiraQ platform represents a
unique and differentiated product offering in this
market segment, which provides Medistim with a
competitive advantage.
Medistim recognizes the value of clinical
documentation and has initiated clinical studies to
support verification of the impact from its solutions
on CAGB surgery. The published results from the
REQUEST study in 2020 proved the clinical value
of adding HFUS to TTFM and the advantages of
combining the two modalities are increasingly being
recognized by the medical societies and cardiac
surgeons. This is supported by the study published
in the Circulation where 19 of the world’s highest
renowned specialists in coronary artery bypass
surgery (CABG) makes the statement: “TTFM should
be used in every CABG case”.
Penalties for readmissions
Several countries are going through reforms to
make quality healthcare available to a growing
population in a financially sustainable way. This
includes demands for higher quality procedures
with less errors and re-interventions. In the US,
the Centers for Medicare and Medicaid Services
have, for example, cut reimbursement for 30-days
re-admission after CABG as a penalty if hospitals
have not been able to deliver and document high
quality surgical results. Implementing technology
that provides intraoperative surgical guidance and
quality assessment is one way of achieving and
document improved quality and outcomes.
Installed base conversion
Medistim expects several hospitals to upgrade
current systems to the more advanced MiraQ
system. It offers a wider range of uses and the
system’s imaging functionality provides valuable
additional information to current TTFM, increasing
the economic value for the users.
7.8 Market for Vascular Surgeries
Medistim has a strong position in the vascular
market in the Nordic countries and in Germany
and is working to build similar positions in other
markets as well. Medistim’s focus areas within
Vascular Surgery include peripheral bypass, CEA
and AV access. The addressable market includes
about 1,300,000 procedures and a market potential
of BNOK 4.
Peripheral bypass surgery is primarily performed
on the major arteries in the legs, whereas CEA is
a procedure where blockages in the neck arteries
are surgically removed to reduce risk of stroke. AV
access surgery is performed to create a successful
shunt or fistula that are used to connect a patient
in need of dialysis to a dialysis machine. The
MiraQ Vascular solution supports all three types
Applications # of procedures Clinical needs
Peripheral bypass > 500,000 Improve long-term graft patency | Improve quality of life
CEA > 250,000
Reduce risk of death and stroke | Improve cost effectiveness
AV Access > 500,000
Secure maturation of shunt/fistula |Reduce risk of cardiac
failure and hand ischemia
Liver transplant surgery > 35,000 Increase success rate for this costly procedure
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
of interventions with ultrasound imaging and blood
flow measurements guiding the surgeon during
the procedure to assure the quality of the clinical
outcome. The MiraQ Vascular is a “versatile tool
for a variety of applications.”
Clinical support and studies are key enablers for
Medistim to increase market penetration, also in
vascular surgery, which the CIDAC study mentioned
in section 1.5 is a good example of.
7.9 Geographical target markets
Medistim is the undisputed market leader
in the global CABG market with a strong
position in core geographical markets.
AMERICAS (USA, Canada and Latin America)
Representing close to 30 % of the global CABG
market, USA is the most important market for
Medistim, accounting for 48 % of total revenue
from own products in 2023. The US subsidiary has
25 employees and sales representatives covering
all states, all of which have extensive healthcare
experience. The company has had direct sales
operations in the US since 2007. Medistim has over
650 systems installed in the US.
In addition to regular sales activities, the commercial
strategy includes cooperation with influential
surgeons and key opinion leaders at leading cardiac
centers. Company representatives are in close
dialogue with medical associations like The American
Association for Thoracic Surgery (AATS) and The
Society of Thoracic Surgeons (STS), to motivate these
organizations to include Medistim’s equipment in
guidelines for standard of care for CABG.
The US CABG-market is underdeveloped, with less
than 35 % of surgeries performed with support
from medical systems ensuring proper blood flow.
Medistim has a market share of approximately 30 %
of a total market of approximately 200,000 annual
bypass surgery procedures and sees a substantial
market potential due to the still low penetration of
CABG surgery support systems.
To strengthen its offering, Medistim has introduced a
flexible business model for the US market. In addition
to traditional capital investments and purchase of
consumables, hospitals can choose to either pay per
procedure or enter leasing agreements. Under these
agreements the systems are placed at the hospitals
free of charge, with the customer purchasing a “per’
surgery” smartcard or paying a monthly lease.
In 2023, Medistim established a direct sales
operation in Canada. Medistim already has a
strong position in Canada with presence in 15 of
Canada’s 38 cardiac centers. About 18,000 coronary
bypass surgeries are performed in Canada per year,
and about 37 % are supported with Medistim’s
technology. The company is well positioned to
continue the growth with local sales representatives
who will focus on attracting new customers as well
as driving the conversion from devices with TTFM
technology only, to devices combining TTFM and
High Frequency Ultrasound (HFUS). In addition, the
market within Vascular surgery provides further
opportunities for growth.
In Latin America, Medistim is represented through
a distributor network.
EMEA
EMEA and Europe in particular represents Medistim’s
second largest market. The main European markets
are served through direct in-country operations,
while remaining markets are covered by distributor
agreements.
Nordic countries
Medistim has a strong position within all cardiac
centers in Norway, Sweden, Finland and Denmark,
with directs sales in Norway, Denmark and from
late 2023, Sweden. Several vascular centers
also have Medistim systems that are being used
on a regular basis. The market share of CABG
procedures is above 70 %. Both markets are
mature, with revenues mainly generated from
sale of consumables and irregular replacement
of old systems. In Norway, Denmark and Sweden,
Medistim also operates as distributor for other
surgical products.
Germany
Germany is the largest market in Europe, with
about 44,000 CABG procedures performed per
year and Medistim has had direct representation
there since 2002. Medistim has a high penetration
within coronary surgery in Germany with a market
share of more than 80 % but still have opportunities
for growth by converting customers to become both
flow and imaging customers. The vascular market
represents an opportunity for growth in the future.
United Kingdom
In the UK, Medistim has had direct representation
since 2012. Some 16,000 CABG procedures are
performed in the UK every year, and Medistim’s
equipment is currently used in about 10 % of these.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Market penetration in the UK has taken longer than
anticipated, and sales are still modest compared
to the perceived potential. Medistim expects
increased adoption of TTFM and HFUS following
the 2018 update to the NICE recommendation
for use of Medistim’s solutions. The company has
also established a solid reference center in Oxford
through the REQUEST study, further supporting
marketing of Medistim medical solutions. Based on
the US model, pay-per-procedure or enter leasing
agreements were introduced to UK customers in
2023.
Spain
Medistim established direct representation in Spain
in 2017. Around 7,000 coronary artery bypass
surgery (CABG) procedures and 8,000 vascular
procedures are performed per year.
Medistim has an installed base of 80 systems, most
of them on the VeriQ platform and older versions.
These versions only include TTFM and do not
support imaging modality. Medistim sees great
potential in upgrading of the installed base to the
MiraQ platform, which provides the combination
of ultrasound imaging and TTFM in one system.
Medistim's technology is used in 80 % of all coronary
surgical procedures as the installed base is primarily
in cardiac centers. This indicates an untapped
potential in the vascular market, which represent
only a small number of Medistim’s installed base.
European distributor markets
Elsewhere in Europe, Medistim is represented
through distributors. This includes countries such
as Poland, Italy and France which are considered
promising long-term growth markets.
APAC
China
In order to expand the market coverage in China,
Medistim opened a direct sales office in Guangzhou
in 2023. This move was part of the company's
ongoing commitment to providing exceptional
service to customers as well as fulfilling the
company’s global growth strategy. More than 60,000
coronary bypass procedures are performed in China
annually and the number is expected to continue to
grow high single digit in the years to come. Today,
about 70 % of these procedures are supported by
Medistim’s equipment, which is installed in all the
nation’s top 10 cardiac surgical centers.
Japan
With over 90 % of all CABG procedures using
Medistim technology for blood flow measurement
systems and ultrasound imaging, Japan is one
of the most developed markets for Medistim’s
solutions. The Japanese market counts some 13,000
procedures annually.
India
Approximately 160,000 CABG procedures are
performed annually. Medistim’s market share is
below 5 %. This is an interesting target market for
Medistim and with the new distributor partnership
with LivaNova, it is expected that the Indian market
will become a future driver for growth.
Other markets
Medistim has established distributor partnerships
with LivaNova in Australia and India, and Pacific
Medical Systems in Asia and is experiencing positive
development in these markets. The company has a
high market share in the Middle East.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
8. CORPORATE GOVERNANCE REPORT
Medistim depends upon good relations with
its stakeholders to succeed. Good corporate
governance is important to build and maintain
trust and confidence in the company and ensure
long-term value creation in the best interest of the
company’s shareholders.
8.1 Implementation and reporting on
corporate governance
Medistim is a Norwegian public limited company
listed on Oslo Stock Exchange and bases its corporate
governance structure on Norwegian legislation
and recommended guidelines. The corporate
governance policy is subject for an annual review
by the Board of Directors.
The company observes the Norwegian Code of
Practice (“Code” or “Code of Practice”) for Corporate
Governance, last revised 14 October 2021, issued
by the Norwegian Corporate Governance Board.
This report discusses Medistim’s main corporate
governance policies and practices and how
Medistim has complied with the Code of Practice in
the preceding year. Application of the Code is based
on the “comply or explain” principle, and deviations
from the Code is explained under each item.
8.2 Business activity
Medistim’s mission is to develop cost-effective
solutions to health-care providers, patients and
payers in the global surgical market. Its Ultrasonic
Surgical Guidance & Quality Assessment systems are
built for intuitive imaging of vascular morphology
and instant assessment of blood flow. With its tools,
Medistim helps surgeons improve surgical quality
to reduce adverse events and re- interventions,
and ultimately improve the patients’ quality of life.
The company’s business scope is clearly described in
section 3 in the articles of association: “to conduct
research, development, production, distribution and
sale of medical equipment through its own business
or through participation in other companies, as well
related activities”.
Medistim was founded in 1984 and develops
innovative technology and devices which increase
the probability of a positive outcome of surgery for
patients and enable greater efficiency and lower
costs for healthcare providers by reducing additional
and unnecessary surgical re-interventions. The
company’s long-term objective is to make its
solutions “standard-of-care” in the operating room.
The board has developed a clear strategy to
effectively commercialize its existing product
portfolio worldwide. Risk management and internal
control systems are in place to manage operational
and financial risks. A description of the key risk
factors and risk management can be found in the
board of director’s report in the annual report.
The company has prepared a code of conduct
including principles for ethical behavior, trade and
anti-corruption that applies for all employees.
A separate report on how these guidelines and
procedures are integrated with the company’s
activities and how they relate to value creation
for the company’s stakeholders can be found in
Chapter "9. Sustainability Report" of this Annual
Report for 2023.
The company’s objectives, strategies and risk profile
are subject to annual review by the Board.
Deviaons from the Code of Pracce: None
8.3 Equity and dividend
At 31 December 2023, the company’s equity was
MNOK 398, which is equivalent to 78.7 % of total
assets. The board continuously evaluates the
company’s capital requirements to ensure that the
company has a suitable capital structure considering
its objectives, strategy and risk profile.
Medistim aims to maximize shareholder value.
This will be achieved through sound business
development and an ambitious growth strategy.
Medistim will seek to provide annual dividends,
depending upon the company’s financial capacity
and financing needs to ensure future growth. The
company will at all times ensure that it has the
financial capacity and equity to achieve future plans
for growth.
The Board of Directors proposes to pay a dividend
for 2023 of NOK 4.50 per share corresponding
to MNOK 82.1 based on the financial results for
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
the year. For 2022, the company paid a dividend
of NOK 4.50 per share, corresponding to MNOK
82.1. Over the past ten years, Medistim has paid
a total of MNOK 490 in dividend to shareholders,
corresponding to an average payout ratio of 77 %.
At the annual general meeting on 24 April 2023,
the board was granted two authorizations:
1. Authorisation to increase the share capital
up to NOK 458,433.25 by issuing 1,833.733
new shares at par value of NOK 0.25. The
authorisation covers both cash and non-cash
considerations, including mergers. As of 31
December 2023, the authorisation had not
been used.
2. Authorisation to purchase own shares for up
to NOK 458,433.25, equal to 1,833,733 new
shares at par value NOK 0.25. The authorisation
can be used for financing purposes, acquisitions
or other commitments related to strategic or
industrial partners. As of 31 December 2023,
the authorisation had not been used.
Both authorizations are valid until the next annual
general meeting. There was a separate vote on
each of the two authorizations. For supplementary
information, see the minutes of the annual general
meeting available at www.medistim.com.
Deviaons from the Code: None
8.4 Equal treatment of shareholders
and transactions with closely
related parties
Medistim has one class of shares. Each share
carries equal voting rights, including the right to
participate in general meetings. All shareholders
shall be treated on an equal basis, unless there is
just cause for treating them differently.
In the event of a capital increase based on an
authorization from the annual general meeting,
where the pre-emptive rights of shareholders are
set aside, the company shall provide reasons for
the action in the stock exchange release in which
the capital increase is announced. There were no
such events during 2023.
Any transactions in own shares, i.e. a share buy-back
program, will be carried out either through Oslo
Stock Exchange or at otherwise at stock exchange
prevailing prices. If there is limited liquidity in the
company’s shares, the company will consider other
ways to ensure equal treatment of all shareholders.
There were no purchases of own shares during
2023. Previously purchased own shares has been
used to fore fill option grants and share program
to management.
When there are major transactions between the
company, its shareholders, subsidiaries, members
of the board, leading employees or other close
related parties, an evaluation will be performed by
an independent third party. The general meeting will
treat the matter according to law and jurisdiction
for Norwegian public companies. There were no
such transactions in 2023.
Deviaons from the Code: None
8.5 Shares and negotiability
The shares of Medistim are freely negotiable. There
are no restrictions on owning, trading or voting for
shares in the company’s articles of association.
Deviaons from the Code: None
8.6 The general meeting
The general meeting is the company's highest
decision-making body. The general meeting is
open to all shareholders, and Medistim encourages
shareholders to participate and exercise their rights
at the company's general meetings. The board, or
shareholders representing at least five percent of
the shares, may call for an extraordinary general
meeting when deemed necessary.
Notice will be sent to shareholders minimum 21 days
before the meeting as required by law. The agenda,
related documents and information about the issues
to be considered will be included in the notice.
To participate, shareholders will have to register at
the latest one day before the meeting. Shareholders
unable to attend, may vote by proxy. Guidelines for
proxy voting is given in the notice documents, with
the opportunity for separate voting instructions.
The board of directors is represented at the
meeting. The chairperson of the board normally
chairs the general meeting. The company’s auditor
and nomination committee will participate at the
meeting.
In 2023, Medistim held its annual general meeting on
24
th
of April with 62.76 % of the shares represented.
There were no extraordinary general meetings during
the year.
Deviaons from the Code: None.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
8.7 Nomination committee
Medistim has established a nomination committee, as regulated in the articles of association section
7. The committee consists of three members elected by the general meeting for a term of two years.
Name Role
Considered
independent of the
main shareholder
and management
Representing a specific
shareholder
Served
since
Term
expires
Participation
in nomination
committee meetings
in 2023
Bjørn Henrik
Rasmussen
Chair Yes Follum Capital 2009 AGM 2025 100 %
Jonathan
Schönbäck
Member
Yes Odin Forvaltning 2022 AGM 2024 100 %
Vegard
Søraunet
Member
Yes Aeternum Capital AS 2021 AGM 2024 100 %
The guidelines for the nomination committee are
governed by the company’s articles of association,
which stipulate that members of the nomination
committee shall be shareholders in the company
or shareholder representatives when elected as
committee members.
The nomination committee is responsible for
suggesting candidates to the board of directors
and yearly compensation to the board and board
committees. Proposals for candidates to the board
must be sent to the nomination committee at
latest 14 days before the notice of the general
assembly is distributed Proposals are to be sent to
the nomination committee chair on email to: Bjørn
H. Rasmussen post@folluminvest.no
Remuneration of the members of the nomination
committee is determined by the general meeting.
Deviations from the Code: None
8.8 Board of directors, composition and
independence
The board of directors shall constitute of up to seven
directors as regulated in the articles of association
section 5. The board and the chairperson are
elected by the general meeting for a period of
two years and may be re-elected. The nomination
committee ensures that not all board members are
up for election at the same time. At 31 December
2023, the board consisted of the following seven
directors:
Name Role
Considered
independent of
main shareholders
Served
since
Term
expires
Participation
board meetings
2023
Share ownership in
Medistim (direct/
indirect)
Øyvin A. Brøymer Chair No 2000 AGM 2025 100 % 7.01 %
Anna Ahlberg Director Yes 2023 AGM 2025 100 % 0 %
Anthea Arff-
Pettersen
Director No 2022 AGM 2025 100 % 0 %
Ole J. Dahlberg Director Yes 2023 AGM 2025 100 % 0.01 %
Jon H. Hoem Director Yes 2023 AGM 2024 83 % 0 %
Tove Raanes Director Yes 2014 AGM 2024 100 % 0.01 %
Lars Rønn Director Yes 2010 AGM 2024 100 % 0,01 %
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
The composition of the board is based on
representation of the company’s shareholders,
as well as the company’s need for competence,
experience, capacity and ability to form balanced
decisions. Information on each director’s expertise,
background and capabilities can be found on the
company’s website www.medistim.com.
The nomination committee has evaluated all the
directors to be independent of the company’s
executive management and material business
contacts. Five out of seven members are regarded as
independent of the company’s main shareholders.
The independence of board members is also
evaluated by the board.
Deviaons from the Code: None
8.9 The work of the Board of directors
The board has the ultimate responsibility for the
management of the company and for supervising
management, while the CEO is responsible for the
day-to-day management.
The board has adopted instructions for the board
and the CEO, which are focused on determining
allocation of internal responsibilities and duties. The
board normally meets six to seven times a year, while
the CEO and Chair has continuous dialogue on the
company’s development.
The board has implemented procedures to ensure
that members of the board and executive personnel
make the board aware of any material (direct or
indirect) interests that they may have in items the
company is about to enter. The board will also be
chaired by some other member of the board if the
board is to consider matters of a material character
in which the chair of the board is, or has been,
personally involved.
The board has appointed an audit committee and a
remuneration committee.
The board performs a self-assessment of its work
once per year.
Deviaons from the Code: None
8.10 Risk management and internal
control
The board carries the responsibility to ensure that
the board carries the responsibility to ensure that
the company has sound and appropriate internal
control systems and risk management systems
reflecting the extent and nature of the company’s
activities. Sound risk management is an important
tool to create trust, ensure good environment, health
and safety standards and enhance value creation.
Internal control should ensure effective operations
and prudent management of significant risks that
could prevent the company from attaining its targets.
The board holds at least one meeting a year with the
auditor, to review the company’s internal control
routines, including identified weaknesses and areas
subject to improvements.
Medistim complies with all laws and regulations
that apply to the group’s business activities. The
group’s ethical guidelines, anti-corruption policy and
code of conduct for ethical trade describes the main
principles for ethical behavior which applies to all
employees and suppliers. A quality manual has been
prepared based on internationally recognized quality
standards, to ensure that the company delivers high
quality products and services in accordance with
product specifications, relevant acts and regulations.
The guidelines and quality manual are subject to
annual review by the board in connection with
the evaluation of the company’s internal control
and risk management. Medistim is also subject
to strict medical rules and regulations, requiring
close monitoring and frequent audits of medical
equipment and the company’s practices concerning
health, safety and environment (HSE).
Medistim prepares its accounts in accordance with
the International Financial Reporting Standards (IFRS),
which are intended to give a true and fair overview of
the company’s assets, financial obligations, financial
position and operating profit. The board receives
monthly reports from management on developments
and results related to finance and risk management,
which is compared against budget, strategy approved
by the board and last year’s performance. In addition,
quarterly reports are prepared in accordance with
the recommendations from Oslo Stock Exchange,
which are reviewed and approved by the board prior
to disclosure.
The board has an annual meeting to review the
company’s strategy for the next three years, risk
exposure and such internal control arrangements.
A summary of the main risks and risk management
is presented in the director’s report in the annual
report.
Deviaons from the Code: None
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
8.11 Remuneration of the board of
directors
The board of directors receives a fixed yearly
compensation decided by the general assembly,
based on the nomination committee’s
recommendation. The remuneration reflects the
board’s responsibilities, competence, time involved
and the complexity of the business.
The remuneration of the board members is not
performance based and the company does not grant
share options to any board members. No loans are
provided to board members.
The board members, or companies with which they
are associated, have not been engaged in specific
assignments for the company in addition to their
appointments as members of the board.
More information on remuneration to the board can
be found in note 21 to the annual accounts.
Deviaons from the Code: None
8.12 Remuneration of executive
personnel
The main principle of Medistim’s executive
remuneration policy is that the compensation
shall be competitive and provide the motivation
to attract and retain individuals with the required
competence.
The board determines remuneration for the
CEO, while the CEO determines remuneration for
the management team and leading employees.
Compensation of the management is based on
market terms and evaluated on a yearly basis. The
terms have remained the same over several years.
Remuneration of the CEO includes a share-based
incentive plan.
The executive remuneration consists of a fixed
salary and a variable part linked to the company’s
achievement, and pension schemes. No executives
will receive additional compensation when leaving
the company.
Details on executive remuneration can be found on
note 21 of the annual accounts.
Deviaons from the Code: The Code recommends
that the company’s guidelines are included as a
separate appendix to the noce calling for the
general meeng. The guidelines should inform which
aspects that are advisory and which, if any, are
binding. The general meeng should vote separately
on each of these aspects of the guidelines. Further,
the Code recommends that the guidelines contain
informaon on criteria related to performance related
remuneraon, which should be subject to an absolute
limit. Medism includes a general descripon of the
company’s guidelines for remuneraon in the annual
report, alongside informaon on remuneraon to
each director. Execuve remuneraon is treated as
one item by the general meeng.
8.13 Information and communications
The board has adopted a shareholder and information
policy which sets the basic principles for the
company’s communication and dialogue with capital
markets participants. The company is committed to
provide its shareholders timely, relevant and accurate
information on the company’s developments and
plans. Communication with stakeholders shall be
based on the principles of equal treatment and
transparency in order to build trust and stakeholder
confidence. The responsibility for the company’s
investor relations activities lies with the CEO and
the CFO.
Medistim’s IR activities shall help capital markets
participants to make an informed view on Medistim
as an investment case, including its financial situation
and prospects, which will contribute to optimize the
cost of capital and support a fair valuation of the
company’s shares. The company does not give any
guiding on future sales and results.
Medistim provides interim reports in line with Oslo
Stock Exchange’ recommendations. Presentations are
given in connection with the disclosure of the interim
results to provide an overview of operational and
financial developments. The presentations are open
to the public and made available through a webcast.
All information is provided in English, and is
distributed to the company’s shareholders through
Oslo Stock Exchange’ news channel www.newsweb.
no and on the company’s website www.medistim.
com.
Deviaon from the Code. The company has not
prepared any policy or guidelines specifying who
is entled to speak on behalf of the company or
regulang communicaon with shareholders outside
general meengs, as recommended by the Code. As
a general principle, the board has decided that the
company’s spokespersons are the CEO and CFO on
investor maers, while the CEO handles media and
other inquiries.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
8.14 Takeovers
In a potential offer where the effect of the
transaction is a takeover, the Board of Directors
will handle the matter in a professional manner
and ensure same information and treatment of
all shareholders. A takeover requires a general
meeting and the board of directors will give their
recommendation related to a potential offer for
the company’s shares.
Deviaons from the Code: The board has not
established separate guidelines in the event of a take-
over bid as recommended by the Code. Take-over
bids are usually specic, one-o, events which makes
preparaon of guidelines challenging. In the event
of a take-over process, the Board will ensure that
the company’s shareholders are treated equally, and
that the company’s acvies are not unnecessarily
interrupted. The board will further seek to comply with
the relevant recommendaons from the Code.
Communication with stakeholders shall be based on
the principles of equal treatment and transparency in
order to build trust and stakeholder confidence. The
responsibility for the company’s investor relations
activities lies with the CEO and the CFO.
Medistim’s IR activities shall help capital markets
participants to make an informed view on Medistim
as an investment case, including its financial situation
and prospects, which will contribute to optimize the
cost of capital and support a fair valuation of the
company’s shares. The company does not give any
guiding on future sales and results.
Medistim provides interim reports in line with Oslo
Stock Exchange’ recommendations. Presentations are
given in connection with the disclosure of the interim
results to provide an overview of operational and
financial developments. The presentations are open
to the public and made available through a webcast.
All information is provided in English, and is distributed
to the company’s shareholders through Oslo Stock
Exchange’ news channel www.newsweb.no and on
the company’s website www.medistim.com.
Deviaon from the Code. The company has not
prepared any policy or guidelines specifying who
is entled to speak on behalf of the company or
regulang communicaon with shareholders outside
general meengs, as recommended by the Code. As
a general principle, the board has decided that the
company’s spokespersons are the CEO and CFO on
investor maers, while the CEO handles media and
other inquiries.
8.15 Auditor
BDO AS has been the company’s auditor since
2010. The auditor is considered independent of
Medistim ASA. Medistim uses the same auditor
for all companies within the group. The board
receives an annual confirmation from the auditor
that the requirements regarding independence and
objectivity have been satisfied. In 2023, a tender
process for audit services was performed, with
all major audit firms invited to give an offer. The
process was thorough, and meetings were held
with several of the main audit firms. The outcome
of the tender process was that the company chose
to continue using BDO as the company auditor as
they proved to be competitive both in regard to
competence and pricing.
The auditor participates in the board meeting
dealing with the annual accounts. In this meeting,
the auditor gives their views on accounting matters
and principles, risk areas and internal control. The
auditor participates in other board meetings on the
request from the board when the board wants to
get the auditors view in a specific matter.
The auditor has attended four meetings with the
audit committee during 2023.
Remuneration paid to the auditor is set by the
general meeting and described in the notes to the
annual accounts. The auditor attends the annual
general meeting.
Deviaons from the Code: None
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Medistim distributors
Medistim subsidiaries
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
9. SUSTAINABILITY REPORT
9.1 Strengthening human health
through improved surgery
Medistim develops and sells products contributing
to improve patients’ quality of life and supporting
effective health care systems by enhancing quality
during surgical procedures. The quality assurance
improves surgical outcomes and increases the
likelihood that the procedure is performed in a
correct manner the first time. This benefits patients,
the health care system and reduces negative impacts
and cost for society at large.
Medistim’s mission over the past three decades
has been to serve patients, surgeons and health
care providers with innovative and cost effective
medical devices that measure blood flow and
visualize atherosclerosis, and thereby help improve
the quality and outcome of cardiac and vascular
surgery.
Medistim’s organization and culture are key drivers
for the stakeholder value creation. The culture is
built on its four core values, described in Chapter
7.1 which guides the daily activities.
The Board of Directors has the overall responsibility
for aligning Medistim’s strategy and sustainability
considerations, while the day-to-day responsibility
lies with the CEO, supported by the Group
management.
Medistim operates in a highly regulated market with
regards to product quality, safety and compliance
with requirements. The company has a history
of technical innovation and financial growth. It
recognizes sustainability as an important part of
product and service development and operations,
and that it is a key contributing factor to the long
term growth and value creation for all stakeholders.
We believe that, over time, companies that
place environmental, social and governance
considerations at the top of their agendas will be
able to capitalize on growth opportunities, increase
returns on capital and reduce the cost of capital.
Contribution to UN Sustainable Development
Goals (SDGs)
Medistim supports the UN SDGs.
The company considers
its greatest impact is
helping to strengthen
human health through
improved surgical out-
come by providing high
quality medical devices
meeting strict safety requirements.
SDG 3.4 specifies a targeted reduction of premature
mortality by 2030 from non-communicable diseases
through prevention and treatment of amongst other
cardiovascular disease. Medistim can definitely
contribute to that through the use of quantitative
measuring modality and qualitative imaging
modality. Several papers and journals have been
written on the topic. The REQUEST study published
in 2020 was one of the key papers that was assessed
to underpin the importance of routine use of quality
assessment. In 2021, Circulation (the official journal
of the American Heart Association), stated that
“TTFM should be used in every CAGB case”.
The company also supports SDG target 12.6 by
adopting sustainable business practices and
integrating sustainability information into its
reporting cycle.
Stakeholder engagement and materiality
In 2021, Medistim conducted a materiality analysis
following a stakeholder identification process.
Investors, distributors, suppliers and employees
were identified as key company stakeholders and
invited to participate in the materiality analysis
via a digital survey, followed up with selected in-
depth interviews. The stakeholders were asked
to grade the importance of ESG related factors,
based on the SASB materiality map and selected
additional factors, by importance for Medistim. A
total of 46 stakeholders participated in the survey.
Their answers combined with interviews and a
weighting of the stakeholder groups provided the
external stakeholder ranking of the ESG factors. This
was contrasted with the responses of an internal
Medistim working group and summarized in the
materiality matrix.
1. The Sustainability Accounng Standards Board (SASB)
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
By summarizing the factors identified through
the analysis, Medistim has defined the following
themes as material to the company. The themes
form the foundation for this report:
• Product stewardship
• Responsible business
• People
Priorities going forward
This is the company’s fourth ESG report. Medistim
has continued to work with the material topics
identified and considered initiatives on how the
company can improve performance for a more
sustainable business conduct. This includes seeking
to develop relevant ESG KPI’s and GRI’s related to
Medistim’s activity.
9.2 Product stewardship
Patient safety is Medistim’s absolute priority as a
producer of medical devices. This means focusing on
quality and compliance with applicable international
and national laws and regulations. Increasingly, in
line with stakeholders’ priorities, the company is
working to reduce the environmental impact of
Medistim’s products, manufacturing process and
distribution.
Product quality and safety
Medistim develops and produces medical devices
used to improve quality of cardiac and vascular
surgery. The products are subject to high quality
and safety requirements and product certifications
and require high competence and excellent quality
systems.
Medistim’s quality management system (QMS)
ensures that its products and services are delivered
in accordance with relevant acts, regulations and
requirements. The company’s QMS is based on the
ISO 9000:2015 and ISO 13485:2016 standards, and
complies with national and international standards,
rules and regulations for manufacturers and
suppliers of medical devices. The QMS consists of a
set of policies, standard operation procedures, forms
and work instructions to ensure that the products
meet required quality and safety standards.
During the last few years, Medistim has put efforts
in the preparation for MDR, the new Medical
Device Regulation (2017/745/EU). This is the new
regulation from EU that will strengthen patient
safety through stricter demands related to quality
and safety. All medical device manufacturers must
be compliant with the MDR regulation within 2027
and 2028, depending on Medical device risk class.
However, since Medistim is focusing on quality and
safety in general, much preparations for the new
regulation has already been done the last few years.
Medistim relies on third-party suppliers to achieve
desired quality results for products and services.
All vendors of products, raw materials and services
used in the design, development, production and
servicing of Medistim medical devices is subject
to supplier qualification. This includes consulting
services that can affect the quality management
system and product quality. The QMS also includes
procedures for selecting, assessing and approving
third-party suppliers such as supplier audit programs
and necessary documentation to verify quality and
ensure traceability.
The QMS is subject to regular reviews by the
management team. Employees are trained on the
company’s quality policies and standard operating
procedures which are continuously evaluated and
refined. All reports of adverse events and product
complaints are promptly investigated and addressed.
Adverse events are reported to applicable health
authorities according to procedures.
Medistim had no quality incidents affecting patient
safety that led to any market actions or need for
reporting to health authorities e.g. product recall
or field corrective action in 2023.
Product life cycle and environmental footprint
Medistim has implemented an environmental policy
to increase environmental focus, ensure sustainable
operations and reduce its environmental footprint.
The company’s direct environmental impact relates
primarily to the production facilities in Horten, the
distribution of products as well as some traveling
in connection with sales and training activities.
Medical equipment is distributed by postal services
with commercial logistics providers based in the
Nordic region. Employees are encouraged to take
environmentally friendly options into consideration,
e.g.; minimize number of flights. Employees are
further encouraged to reduce consumption and
waste generated from their daily business activities.
Medistim has established routines for management
of chemicals and waste.
The lifetime of Medistim’s products is defined
either by the number of use or expected time
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
of performance after distribution to the market.
Average lifetime of the MiraQ machines is seven
years. The upgrade option with the MiraQ platform
from a flow system to a flow and imaging system
reduces electronic waste.
Flow probes can be used 50 times and the imaging
probe can be used 100 times and even more if
treated properly. All the electrical components in use
comply with environmental standards. Hospitals and
treatment centers are responsible for safe disposal
of the equipment when it has reached end-of life.
All relevant materials used are subject to
biocompatibility testing to ensure that they are not
harmful for the patient or operator. All equipment
which is in contact with human tissue is designed
to withstand required sterilization processes. In
addition, Medistim seeks to include in the supplier
agreements the intent to use environmentally
friendly materials and transport.
Medistim is assessing the opportunity to provide
remote servicing of its devices, which may reduce
travel activity and reduce shipping.
The goals for 2023 were:
• Developing KPIs for Energy and Water
consumption to Medistim reporting
• Introduce lead-free soldering of wires
for all TTFM transducers
Medistim has through 2023 started to establish
measuring points and initiated data collection for
energy consumption in order to be ready to report
on ESG KPIs in line with established guidelines for
companies of Medistim’s size. Also, discussions have
been held with logistics suppliers, with the aim of
switching to sustainable fuel for transportation of
goods.
A project for lead-free soldering of wires has been
initiated, and testing with positive indications are
performed through the year.
Focus areas going forward are to continue reducing
plastics used in packaging of products and increase
the use of recyclable cardboard for packaging and
transportation of products. Further, the company aims
to minimize waste of plastic material, electronics and
molded silicone parts and glue in production. Also,
when developing new and improved products, a
sustainability evaluation will be part of the assessment
for new product ideas. Medistim is assessing the
opportunity to provide remote servicing of its devices,
which may reduce travel activity and reduce shipping.
Goals for 2024:
• Refine ESG strategy for Medistim ASA
in order to comply with CSRD in 2025
• Continue working on KPIs for emissions
and consumption
• Reduce carbon footprint related to
transportation of goods by switching
to sustainable fuel on goods in and out
of production site in Horten
• Update the company’s Transparency
Act report from 2023
Product risk management
Risk management of Medistim’s products’ life
cycle is based on current standards, regulations
and national legislation related to medical
devices, clinical experience and documentation
with these and similar devices as well as state-of-
the-art technology. The company’s product risk
management procedures are governed by the QMS.
In the making of upgrades, new products or next
generation of product, the company strives to
focus on “ease of use”. Not only does it lower the
threshold for surgeons to take the equipment in use
to improve quality of the surgery, it also reduces
the risk of making an error during the procedure.
9.3 Responsible business
Ethical business conduct and compliance with
Norwegian Transparency Act
Compliance with national, regional and international
laws and regulations is mandatory in all of
Medistim’s activities, but good business ethics
goes beyond mere compliance. In order to live up
to the company’s mission and values and achieve
its strategic goals, everyone is responsible for
acting in a manner that safeguards the interests of
Medistim and its stakeholders. This way, Medistim
will continue to build trust and credibility as a
foundation for sustainable operations over time.
Medistim’s framework for good business conduct
includes ethical guidelines and an anti-corruption
handbook that together shall ensure compliance
and sustainable operations across the company
and its supply chain.
The ethical guidelines are built on central UN and
ILO (International Labour Organization) conventions
and principles for human and labor rights and
reflects Medistim’s values and ethical view on good
business conduct. The guidelines clarify Medistim’s
expectations to employees’ behavior and cover
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
areas such as discrimination and harassment,
substance abuse, confidentiality and protection
of information, privacy protection, conflicts of
interest, communication, inside information and
whistle blowing.
Medistim is committed to a zero-tolerance policy of
corruption, which means that the company strictly
opposes all forms of corruption. The anti-corruption
handbook describes and explain the company’s anti-
corruption policy and how employees shall act to
avoid any illegal or unethical situations in relation
to existing and potential business partners.
The ethical guidelines and anti-corruption manual
are applicable to all Medistim’s employees, including
subsidiaries and board of directors, as well as
business partners for sales and distribution. All
employees and partners must approve in writing
that the guidelines are read and understood. This
is also followed up after revisions and updates to
the guidelines. Violation of the guidelines may
have consequences for the employment or partner
relationship.
There were no reported concerns during 2023.
In July 2022, the Norwegian Transparency act
based on OECD guidelines was implemented. The
new act obligates companies to conduct human
rights and decent work due diligence and follow-
ups throughout their supply chain and business
relationships. Medistim has conducted such due
diligences on suppliers and business relationships
for many years and has a well-established routine
for such due diligences. The Medistim Transparency
Act Report was presented during the first half of
2023 and shows that Medistim is operating in line
with Transparency guidelines set by OECD. The
complete report can be found at www.medistim.
com.
Whistle blowing
Medistim has established routines for reporting
concerns related to illegal or unethical conduct,
including a whistle blowing channel for discrete and
confidential handling of any potential reports. There
were no reported concerns during 2023.
Responsible selling practices
Medistim is a global leader in developing products
for quality control within of cardiac and vascular
surgery. The company's products are sold either
directly through subsidiaries or distributors in all
continents. A standardized sales process has been
established to ensure truthful and responsible selling
practices as well as clearly defined requirements
related to implementation of the solutions. All
customer communication is done by trained and
authorized personnel.
Medistim has a flexible business model in which
product offerings and prices are adapted to
individual markets. Each distributor sets the local
end user-price in their markets.
The company engages in continuous dialogue with a
broad range of organizations to increase awareness
and knowledge of its solutions. Inclusion in leading
health organizations’ guidelines for clinical surgery
is vital to achieve “Standard of Care” status.
Data security and customer privacy
As a healthcare company, Medistim may gather
and store personal data as part of its research and
development projects. At the same time, personal
data is increasingly at risk of being misplaced, stolen
or shared without consent. Medistim recognizes
its responsibility of managing the data collected in
a responsible manner and keeping the data safe.
The company is subject to laws and regulations
that stipulate how personal data can be collected
and managed, such as General Data Protection
Regulation (GDPR). Strict guidelines and procedures
have been implemented to ensure compliance.
This involves regular reviews and development of
the company’s internal control systems and risk
management processes to continuously improve
and address existing and emerging data security
and privacy threats. No service is conducted on
equipment before patient data have been deleted.
To ensure a modern, secure and well-functioning
IT platform, the company has outsourced its IT
management to a professional service provider. Any
breaches to data security and consumer privacy
will be reported and followed up immediately.
Medistim registered no data and GDPR breaches
and no wrongful sharing of personal customer data
incidents in 2023.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
9.4 People
Medistim is committed to being a responsible
employer and promotes an open and strong
corporate culture. The company supports
internationally recognized human rights and labor
standards, as defined by the International Labour
Organization’s (ILO) fundamental conventions and
the UN Declaration of Human Rights.
When assessing compensation there is a distinction
between educated and skilled employees. The
skilled group is typically trained employees by
Medistim where formal education is not required.
In total, the gender balance is equal, but more
women are in the group of skilled employees. This
explains the difference in average salary. Comparing
men and women in the same groups the terms
are equal. The compensation includes both fixed
salary and bonuses. There is only one part time
female employee and this is by own choice. All other
employees are compensated with a 100 % position.
Goal for 2024:
• Complete employee engagement survey
Employee skills and job engagement
The ability to attract and retain a skilled workforce
is imperative for Medistim to succeed over time.
At year-end, Medistim employed 152 people (131).
The company has developed a competence matrix
which clarifies required competence and resources
needed to ensure the right quality of the products
and services provided and to meet customers’
needs. Individual training programs are set up
for each employee, either when onboarding new
workers or after individual evaluations. The training
is tailored to each role, tasks and duties and includes
tutoring and participation at internal and external
courses, seminars and other relevant arrangements.
Working environment
Medistim strives to ensure a good working
environment. All employees are entitled to an
annual performance review with its immediate
supervisor.
Sick leave for the year totaled 4,0 % or 1,598 days
(4,4 % or 1,505 days). In 2020, Medistim moved
its production facility to new and more functional
premises, with recreational areas and easy access to
massage and chiropractor services. No work-related
incidents or accidents were registered in 2023 (0).
In order to improve the working environment,
actions are taken to reduce static load for the
operators in production and reduce exposure
towards dust, gases and chemicals. Long term, the
goal is to add automation in the production process.
A separate project is established to redesign the PS
probes through machine learning and automation.
The project is expected to go on for several years
and will improve the probe production capacity
vastly.
Furthermore, Medistim has established a
company sports team, of which taking part in
the Holmenkollen relay race was a highlight also
in 2023. Also, vegetarian lunch every Tuesday is
implemented at the Head Quarter in Oslo.
Diversity and equal opportunities
Medistim promotes a productive and inclusive
working environment, free from harassment,
discrimination, and disrespectful behavior. All
employees are offered equal opportunities with
regards to hiring, compensation, training and
promotion regardless of gender, age, ethnic and
national origin, religion, sexual orientation, social
background or other distinguishing characteristics.
Competence is the main priority when recruiting
for new positions. Medistim has equal gender
distribution with 52 % women and 48 % men, as the
Group traditionally has recruited from environments
where women and men are equally represented.
The company practices equal pay within the same
salary range, but on average Group level, men are
paid more due to the higher share of higher-level
positions.
Medistim offers full pay during parental leave
for both men and women, and in 2023 1.3 % of
Medistim’s female and 1,4 % of male employees
took parental leave. On average, women took 18
weeks, while men took 14 week.
Medistim is a company in growth with an increasing
number of employees, which increase diversity and
complexity. Medistim acknowledges this and an HR
function was established 2021.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
INDICATORS 2023 2022
Working environment, health and safety
Number of employees 152 131
Number/ share of part-time employees 1 1
Turnover - number of employees leaving 14 12
Sickleave (%) 4.0 % 4.4 %
Number of work-related injuries 0 0
Gender balance, % women of group total 52.0 % 51.1 %
Gender balance, % women executive management 41.7 % 38.5 %
Gender balance, % women Board of Directors 42.9 % 50.0 %
Number of women hired during the year 25 13
Number of men hired during the year 10 14
Age distribution, employees < 30 years 7 5
Age distribution, employees 30-50 years 80 67
Age distribution, employees > 50 years 65 59
Average salary female employees in NOK 766 814 698 789
Average salary male employees in NOK 1 217 246 1 134 203
All employees incl. management level, womens share of salary per position 983 140 911 510
Executive management, womens share of salary per position (Hay Grade) 34 % 21 %
Number of weeks for maternity leave (women) 18 16
Number of weeks for paternity leave (men) 14 1
Responsible operations
Employees conducted training in ethical guidelines/ Code of Conduct ( %) All
Reported whistleblower incidents 0 % 0 %
Reported incidents of corruption 0 % 0 %
Breaches of labour practices in the supply chain 0 % 0 %
Governance
Number of board members 7 6
Independent board members 5 3
Average age of board members 54 57
% meeting participation 97 % 100 %
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
INCOME STATEMENT 2023 2022
1 = NOK 1000 Note
Operating income and expenses
Revenue 521 109 486 262
Other income 5 255 5 675
Total revenue 1,2 526 364 491 937
Change inventories of finished goods and work in progress 3 92 876 95 574
Raw materials, consumables used, freight, and other 3 19 404 10 912
Salary and social expenses 4,5,21 162 597 146 376
Other operating expenses 8 96 388 74 537
Total operating expenses before depreciation and amortizataion expenses
Operating profit before depreciation and amortizataion expenses 155 099 164 539
Depreciation and amortisation expenses 6,7,12 23 657 23 288
Operating profit 131 442 141 251
Financial income and expenses
Financial income
9,20 17 123 16 546
Financial expenses 9,20 13 352 11 748
Net finance 3 770 4 799
Profit before tax 135 212 146 049
Tax expense 10 31 389 32 077
Profit for the year 103 823 113 973
Earnings pr. share
Basic 11 5.68 6.25
Diluted 11 5.67 6.24
Statement of other comprehensive income 2023 2022
Profit for the year 103 823 113 973
Items that may be reclassified to profit and loss
Exchange differences arising on translation of foreign operations 2 597 10 659
Total comprehensive income 106 420 124 632
10. GROUP CONSOLIDATED FINANCIAL STATEMENTS
10.1 Consolidated Income Statement of Profit or Loss and other Comprehensive
Income
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
10.2 Statement of Financial Position
Consolidated balance sheet Note 31.12.2023 31.12.2022
1=NOK 1000
Assets
Non-current assets
Property, plant and equipment 6 57 305 51 312
Deferred tax asset 10 5 142 3 591
Intangible assets 12 45 375 36 069
Other long term receivable 21 6 331 5 793
Total non current assets 114 152 96 764
Current assets
Inventory 14 145 391 114 333
Accounts receivable 15 74 303 101 657
Other receivables 15 18 000 17 263
Cash 16 153 872 152 641
Total current assets 391 566 385 894
Total Assets 505 718
Equity and liabilities
Equity
Share capital 17 4 585 4 585
Treasury shares 17 -13 -21
Share premium 17 41 852 41 852
Other paid in capital 17 24 743 18 742
Issued capital 17 71 167 65 158
Other reserves 17 19 394 16 797
Retained earnings 17 307 380 285 737
Retained earnings 326 774 302 533
Total equity 397 941 367 691
Non current liabilities
Lease liabilities 7,24 9 260 10 020
Deferred revenue 24 4 234 5 126
Total non current liabilities 18 13 493 15 146
Current liabilities
Accounts payable 25 083 24 470
Income tax payable 10 28 404 25 873
Other current liabilities 19 31 426 42 043
Provisions 22 988 350
Lease liabilities 18,24 8 384 7 086
Total current liabilities 18 94 284 99 822
Total liabilities 107 777 114 967
Total equity and liabilities 505 718 482 659
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
10.3 Consolidated Cashflow Statement
Consolidated Cashflow statement 2023 2022
1 = NOK 1000 Note
Cash flow from operations:
Profit before tax 135 212 146 049
Income tax paid -25 699 -19 167
Plus depreciations 6,7,12 23 657 23 288
Change in inventory 14 -31 058 -16 920
Change in accounts receivable 15 27 354 -33 023
Change in accounts payable 613 11 265
Change in other accruals* -16 891 1 999
Net cash from operating activities 113 189 113 491
Investing activities:
Purchase of property, plant and equipment 6 -16 399 -9 251
Product development investments 12 -13 327 -11 851
Net cash from investing activities -29 726 -21 102
Financing activities:
Dividend 11 -82 180 -68 396
Principle and interest paid on lease liabilities 7, 24 -8 712 -7 312
Other financing activities 6 009 5 404
Net cash from financing activities -84 883 70 304
Foreign currency effect on cash 2 651
Net change in cash and cash equivalents 1 231 23 151
Cash and cash equvivalents as of 01.01 152 641 129 490
Cash and cash equvivalents as of 31.12 16 153 872 152 641
Available cash and cash withholding
Available cash as of 31.12 16 146 082 144 164
Cash withholding for taxes 16 7 790 8 477
Cash and cash equivalents as of 31.12 153 872 152 641
*13.8 MNOK was related to bonus and commission payment accrued in 2022 and paid in 2023.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
10.4 Statement of change in equity
CONSOLIDATED CHANGE IN EQUITY
1 = NOK 1000
Note
Share
capital
Treasury
shares
Share
premium
fund
Other
paid in
capital
Total
paid in
capital
Other
reserves
Retained
earnings
Other
equity
Total
Equity
Equity as of 31.12.21
Total comprehensive
income for the period
Sharebased payments
17
Dividend
11
Equity as of 31.12.22
Total comprehensive
income for the period
Sharebased payments
17
Dividend
11
Equity as of 31.12.23 4 585 -13 41 852 24 743 71 167 19 394 307 380 326 774 397 941
Comments to other reserves:
Other reserves in the equity reconciliation are differences related to translating equity from foreign
subsidiaries to NOK. The subsidiaries present their financial statements in EUR, GBP, DKK, CAD, SEK,
CNY and USD. When translated to NOK a difference occur due to the change in the exchange between
NOK and these currencies. By year end 2022 this difference was 16,797 TNOK and the change for the
year was TNOK 10,569. By year-end 2023, the equivalent was TNOK 19,394, a change of TNOK 2,597
from the year before.
Treasury shares
When treasury shares are purchased, the purchase price including directly attributable costs
is recognized in equity. Treasury shares are presented as a reduction of equity. Loss or gain on
transactions of treasury shares are not recognized in the income statement.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
CONSOLIDATED CHANGE IN EQUITY
1 = NOK 1000
Note
Share
capital
Treasury
shares
Share
premium
fund
Other
paid in
capital
Total
paid in
capital
Other
reserves
Retained
earnings
Other
equity
Total
Equity
Equity as of 31.12.21
4 585 -26 41 852 13 344 59 754 6 138 240 160 246 298 306 052
Total comprehensive
income for the period
- - - - - 10 659 113 973 124 632 124 632
Sharebased payments
17
- 6 - 5 398 5 404 - - - 5 404
Dividend
11
- -68 396 -68 396 -68 396
Equity as of 31.12.22
4 585 -21 41 852 18 742 65 158 16 797 285 736 302 533 367 691
Total comprehensive
income for the period
- - - - - 2 597 103 823 106 420 106 420
Sharebased payments
17
- 8 - 6 001 6 009 - - - 6 009
Dividend
11
- - - - - - -82 180 -82 180 -82 180
Equity as of 31.12.23 4 585 -13 41 852 24 743 71 167 19 394 307 380 326 774 397 941
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
10.9 Notes to the accounts
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11. PARENT COMPANY FINANCIAL STATEMENTS
11.1 Income Statement Medistim ASA
INCOME STATEMENT MEDISTIM ASA 2023 2022
1 = NOK 1000 Note
Operating income and expenses
Revenues
Sales revenue 26 324 056 293 169
Other income 26 16 968 15 476
Total revenue 341 024 308 645
Operational expenses 66 583 63 993
Cost of goods sold 27 89 360 80 239
Salary and social expenses 28 12 599 13 888
Depreciation on assets 27,29,39 64 457 48 832
Other operating expenses 232 999 206 952
Total operating expenses 108 025 101 693
Operating profit
Financial income and expenses
Dividend from subsidiaries 31 11 006 26 762
Other financial income 37 15 160 14 280
Financial expenses 37 9 504 13 286
Net finance 16 663 27 756
Profit before tax 124 687 129 449
Tax expense 30 25 233 21 342
Profit for the year
99 454 108 107
Allocations
Dividend 82 256 82 126
Other equity 36 17 198 25 981
Total Allocation 36 99 454 108 107
Earnings per share
Ordinary 2023 2022
Diluted 5,46 5,93
5,45 5,92
Dividend per share 4.50 4.50
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
11.2 Balance Sheet Medistim ASA
BALANCE SHEET MEDISTIM ASA 31/12/23 31/12/22
1 = NOK 1000 Note
ASSETS
Non current assets
Intangible assets
Deferred tax 30 2 592 2 275
Marketing rights 28 1 1
R & D 28,29 31 246 21 940
Fixed assets
Property, plant and equipment 28 27 394 26 693
Office equipment 28 2 945 2 759
Financial assets
Shares in subsidiaries 31 38 395 37 392
Other long term receivables 13 290 11 974
Total non current assets 115 864 103 035
Current assets
Inventory
33
114 039 84 702
Accounts receivables 32,41 69 212 91 109
Other receivables 32,41 20 632 19 298
Cash 34 82 485 84 033
Total current assets 286 368 279 143
TOTAL ASSETS 402 231 382 178
EQITY AND LIABILITY
Equity
Issued capital
Share capital 35,36 4 585 4 585
Share premium 35,36 41 852 41 852
Other paid in equity 36 24 730 18 721
Other equity
Retained earnings 36 143 681 126 538
Total equity 214 849
191 696
Liabilities
Other long term debt
Long term debt 40 40 690 39 429
Total other long term debt 40 690 39 429
Short term debt
Accounts payable 10 397 18 024
Payable tax 30 25 550 22 116
Employee withholding, social security taxes 16 211 13 025
Dividend 36 82 256 82 126
Other short term debt
38,41
12 279 15 761
Total short term debt 146 693 151 052
TOTAL EQUITY AND LIABILITY 402 231 382 178
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
CASH FLOW STATEMENT 2023 2022
1 = NOK 1000 Note
Cash flow from operations:
Profit/loss before tax 124 687 129 449
Minus income tax paid -22 914 -16 521
Plus this years tax expense
Plus depreciations 28 12 599 13 888
Change in inventory 33 -29 337 -10 997
Change in accounts receivable 32 21 898 -42 201
Change in accounts payable -7 627 11 233
Other changes -2 380 7 150
Net cash from operating activities 96 925 92 001
Investing activities:
Minus investment in assets 28 -22 303 -20 124
Ney cash from investing activities -22 303
-20 124
Financing activities:
Minus down payment of long term debt - -
Dividend 36 -82 180 -68 396
Issue of new equity 36 6 009 5 404
New loans - -
Net cash from financing activities -76 171 -62 992
Net change in cash -1 549 8 885
Cash as of 01.01 84 034 75 149
Cash as of 31.12 82 485 84 034
Available cash and cash withholding
Available cash as of 31.12 34 75 470 77 019
Cash withholding for taxes 34 7 015 7 015
Cash and cash equivalents as of 31.12 82 485 84 034
11.3 Cash Flow Statement
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11.4 Accounting Principles
The financial statement and notes are according to
Norwegian GAAP, Norwegian accounting law and
according to best practice within Norwegian GAAP.
Sales revenue
Sales revenue is recognized in the profit and loss on
the date of delivery and when the major risk and
ownership of the product have been transferred to
the customer. Systems and probes are recognized as
revenue when the goods are shipped from Medistim
ASA and the risk and ownership is transferred to
the distributor or end customer. The same is the
case for sale of procedures for quality control of
cardiac surgery and other third-party products.
Services are recognized as revenue at the time the
service is performed.
Current assets and short-term debt
Current assets and short-term debt are defined as
items that are due for payment within one year at the
last day of the accounting year, and items defined as
working capital. Current assets are evaluated at the
lowest of cost and net sales value. (The lowest value
principle).
Fixed assets and long-term debt
Fixed assets are defined as property for long-term
use. Fixed assets are valued at cost in the balance
sheet and depreciated of the expected economic
lifetime. Fixed assets are written down to real value
if the reduction in value is expected to be permanent.
Write down is reversed if the basis for the write down
no longer exists.
Shares in subsidiaries
Shares in subsidiaries are valuated according to
cost. Shares in Medistim Norge AS, Medistim US
Inc, Medistim Denmark Aps, Medistim UK Ltd, and
Medistim Deutschland GmbH are owned 100 %. The
shares are recorded at cost or written down to real
value if real value is assumed to be the lowest and
that it is permanent. Dividend and group contributions
are recognized as revenue in the holding company as
financial revenue in the year that it has been accrued
given that Medistim had the ownership of the shares
in this period.
Foreign currency
Balance sheet items in foreign currency are valued
at the exchange rate on the balance sheet day. Sales
revenue is recorded at the exchange rate that was
at the time of the sale. Unrealized gains or losses on
hedging contracts are recorded in the profit and loss.
Inventory
Inventory is valued at the lowest of cost (FIFO principle)
and net sales value (lowest value principle). For
components, the lowest of historic cost and current
price is used to value the component inventory.
Work in progress and finished goods
Cost for finished goods includes direct cost and a
portion of indirect and fixed production cost. Basis
for the allocated cost to the products is a normal
production situation. Goods in progress are valued
at the component cost price.
Accounts receivables
Account receivables and other receivables are
recorded in the balance sheet at par value with
deduction for estimated losses. The accrual for
losses is based upon a separate evaluation in
each case. In addition, there has been made
an unspecified accrual on receivables to cover
expected losses. The same evaluation is made for
other receivables.
Taxes
Tax cost in the income statement includes payable
tax for the current accounting year and changes in
temporary differences that are due for payment
the coming accounting year. Temporary differences
occurs using the tax rate by the end of the accounting
year (22 %) and comparing tax increasing or tax
reducing temporary differences between accounting
values and tax values. Tax increasing or reducing
temporary differences that can be reversed in the
same period is recorded at net value. Deferred tax
asset is recorded if it is likely that the company will
be able to utilize the tax asset.
Pension liabilities
All employees have a contribution pension plan.
Share based payments
The Group has a share-based payment scheme for its
CEO, the program is measured at fair value at grant
date. The share-based payment for the company’s top
leader is a scheme by issuing shares. For transactions
that are settled in equity instruments (arrangements by
issuing shares), recognize the value of shares granted
during the period as a compensation expense in the
income statement and a corresponding additional
paid-in capital.
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Research and development
The activities in the development department are split in 3 categories. These are maintenance, general
research and development of new products. Maintenance and general research is expensed in the P & L
while new products are recorded as an asset and depreciated over expected lifetime. When recorded as an
asset it is expected that revenues from the product will exceed activated amounts. An immaterial asset that
is acquired, or other immaterial assets that are developed, are recorded as an asset in the balance sheet if
they are identifiable and that it is likely to give future economic benefits. The asset is amortized over the
expected economic lifetime of the asset. The values of the assets are evaluated yearly and if the book value
exceeds future economic benefit the asset is written down. The evaluation is performed by the management
in the company.
Cash flow analysis
The cash flow analysis is prepared using indirect method. Cash is defined as cash in bank and other
financial assets that are due within 3 months after it is acquired.
Other financial assets
Shares and other financial assets are evaluated at the lowest of cost and market value. The company enters
hedging contracts in USD and EUR. The value of the contracts is based upon the exchange rate at the balance
sheet day and a change in value is recorded in the P & L.
Accruals
Obligations and accruals are made if it is more than 50 % likely that the obligation is real. Best estimate
is used to estimate the obligation.
11.5 Notes to the accounts
Note 26 Geographic split of sales
GEOGRAPHIC SPLIT OF SALES 2023 2022
1 = NOK 1000
USA 131 137 120 518
Asia 82 984 76 793
Europe 112 527 100 443
Rest of the world 14 376 10 891
Total sales 341 024 308 645
Other income amounted to TNOK 16,968, where TNOK 3,264 was income related to services towards subsidiaries
and TNOK 13,704 was management fee. For 2022 other income amounted to TNOK 15,476 where TNOK 3,145
was services towards subsidiaries and TNOK 12,331 was management fee.
93
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
The total number of employees was through the year 97. Medistim has a pension plan for all its employees.
This is a contribution plan that covers 5 % of salary up to 7.1 G and 8 % of salary for G between 7.1 and 12.
1G is the base amount (NOK 118.620) in the social security system. The cost for the contribution plan was in
2023 TNOK 4,518, while it was TNOK 3,400 in 2022. It is compulsory by law for the company to have a pension
plan for its employees. The pension plans in the company fulfill the obligation in the law.
SALARIES AND OTHER BENEFITS 2023 2022
1 = NOK 1000
Salary 73 451 67 564
Social taxes 13 700 10 734
Other salary and social expenses 2 209 1 940
Total salary expenses 89 360 80 239
COMPENSATION AND BENEFITS TO THE MANAGEMENT GROUP IN 2023
Management Position Salary Bonus Pension Other Total
Hæge Johanne
Krogh Wetterhus
VP Marketing 1 503 782 226 831 100 808 42 037 1 873 458
Anne Waaler VP Medical 1 477 427 227 994 84 870 3 647 1 793 939
Roger Reino
Morberg
VP Sales APAC 1 840 941 476 081 94 635 142 287 2 691 694
Erik Swensen VP Development 1 475 389 185 680 91 509 4 537 1 757 115
Tone Ann
Veiteberg
VP QA\Reg 1 277 464 241 587 80 766 4 537 1 604 354
Stephanie d'Avout
Stenhagen
VP Sales EMEA 1 325 985 259 192 95 607 104 537 1 885 321
Helge Børslid VP Operations 1 355 084 214 576 93 202 4 537 1 667 399
Håkon Grøthe VP Innovation 1 387 576 286 963 93 153 4 537 1 909 979
Ole Arne Eiksund CBDO 1 417 361 164 435 92 000 142 287 1 816 083
Kari Eian Krogstad CEO Medistim ASA 3 025 202 1 272 321 107 642 2 800 537 7 205 702
Thomas Jakobsen CFO Medistim ASA 1 995 659 498 138 92 371 188 287 2 774 455
Total 18 081 871 4 053 798 1 026 563 3 441 767 26 979 499
There are no special agreements towards any in the management team in case of leaving the company. All in
the team has a two-way arrangement of 3 months’ noce. There are no opons to employees or members
of the Board except for CEO. The CEO will receive up to 24,500 shares as part of compensaon if in posion
in 2026. Bonus paid in 2023 was based upon 2022 results.
In relaon to the share program for management except CEO, following members of management parcipated
in the share program. See below schedule showing value of the shares, discount given and nancing from
the company to parcipate in the share program.
Note 27 Salaries and other benefits
94
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Under other benefits it is included an expense related to CEO share option. CEO receives shares over a time
period if in position as CEO. The share program is described in the annual report under the chapter “salary
and benefits to management and leading employees”. The expense for the share option is calculated based
upon the share price at the time of the granted option. The expense is distributed in equal rates over the
vesting period. The share program is described in detail under note 21 in the group accounts.
The amounts are without VAT
COMPENSATION TO AUDITOR
1 = NOK 1000 2023 2022
Statutory audit 1 704 1 605
Other services 115 85
Total compensation to auditor 1 819 1 690
SHARE PROGRAM FOR THE MANAGEMENT GROUP IN 2023
Group Management Position
Shares
purchased
in NOK
Match
25 % in
NOK
Total purchase
of shares in
NOK
Number of
shares
Financing by
Medistim in
NOK
Ole Arne Eiksund
Busines
developer
551 000 137 750 688 750 3 410 551 000
Roger Reino
Morberg
VP Sales APAC 551 000 137 750 688 750 3 410 551 000
Ole Jørgen
Robsrud
CEO Medistim
Norge AS
200 000 50 000 250 000 1 237 -
Hæge Johanne
Krogh Wetterhus
VP Marketing 150 000 37 500 187 500 928 75 00
Stephanie d'Avout
Stenhagen
VP Sales EMEA 400 000 100 000 500 000 2 474 -
Håkon Grøthe VP Innovation 551 000 137 750 688 750 3 410 -
Thomas Jakobsen
CFO Medistim
Group
735 000 183 750 918 750 4 547 735 000
Total 3 138 000 784 500 3 922 500 19 416 1 912 000
COMPENSATION TO THE BOARD OF DIRECTORS
DIRECTORS FEE
AUDIT OR REMUNERATION
COMMITTE
1 = NOK 1000
Chair Øyvin Brøymer 475 20
Board member Torben Jørgensen 265 15
Board member Siri Fürst 265 25
Board member Anthea Arff-Pettersen 265 -
Board member Tove Raanes 265 35
Board member Lars Rønn 265 25
Total compensation to the Board of Directors 1 800 120
95
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Note 28 Assets and Depreciation
ASSETS AND DEPRECIATION
Plant &
Machinery
Equipment
Total fixed
assets
Activated
Development
Total
1= NOK 1000
Historic cost as of 1/1 83 315 13 219 96 534 92 764 191 996
Additions 7 462 1 514 8 976 13 327 22 303
Disposals - - - - -
Historic cost as of 31/12 90 778 14 733 105 511 106 091 214 299
Accumulated depreciation as of 1/1 56 622 10 461 67 083 70 824 140 604
Ordinary depreciation 7 263 1 328 8 591 4 021 12 612
Disposals 504 - 504 - 503
Accumulated depreciation as of 31/12 63 381 11 789 75 170 74 845 152 711
Book value at 31/12 27 396 2 944 30 341 31 247 61 588
Plant and machinery is depreciated over 3 to 7 years on a straight-line basis dependent upon expected
economic lifetime. Tools and equipment is depreciated over 3 to 5 years on a straight-line basis dependent
upon expected economic lifetime.
Development cost is recorded as intangible assets when a project has reached technological feasibility
and it is likely that it will result in a new product or improved product that has revenue potential that
exceeds the investment. Maintenance of existing products is expensed. The investment is depreciated
over 3 to 8 years dependent upon whether it is a new product or improvement of existing product. A new
product that represents a new technological platform has a longer expected lifetime and for Medistim
products this is 8 to 10 years. Product improvements on existing technological platform is replaced more
rapid and is therefore depreciated over 3 years.
Note 29 Research and development
In total MNOK 15.7 of the R & D expenses was recorded in the P & L in 2023. Similar expense was MNOK
13.9 in 2022. With MNOK 13.30 recognized as asset a total of MNOK 29.00 was used in R & D in 2023.
Comparable number for 2022 was MNOK 25.80. Medistim received TNOK 309 in Skattefunn funds in
2023 and TNOK 236 in 2022. From Innovasjon Norge a support of TNOK 522 was received in 2023.The
capitilized expense in 2023 were related to the coronary and vascular products on the MiraQ platform.
96
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Note 30 Income tax and temporary differences
INCOME TAX AND TEMPORARY DIFFERENCES 2023 2022
1 = NOK 1000
Current income tax charge for the year before deferred tax asset is utilised 25 550 23 089
Correction from previous year -973
Change in deferred tax -317 -775
Income tax expense reported 25 233
21 342
Reconciling income tax expense against profit :
Income tax expense for the year 25 233 21 342
22 % of profit before tax 27 431 28 479
Permanent differences -2 198 -7 137
Specification of taxable income: 2 023 2022
Profit before tax 124 687 129 449
Permanent differences -12 704 -28 019
Change in temporary differences 2 712 3 521
Correction from previous year -4 423
Taxable profit 114 695 100 528
Payable tax in balance sheet: 2 023 2022
Tax expense for the year 25 233 21 342
Change in deffered tax -317 -775
Total payable tax 25 550 22 116
Specification of deferred tax asset
Differences in accounting and tax values 2 023 2022
Fixed assets 1 742 1 194
Current assets -13 454 -11 534
Accrual for obligations -71 -2
Total differences -11 783 -10 341
Deferred tax asset 22 % 2 592 2 275
Deferred tax asset in balance sheet 2 592 2 275
Deferred tax asset in the balance sheet increased from MNOK 2.3 in 2022 to MNOK 2.6 in 2023. Deferred
tax asset consists of temporary differences in valuation of assets. All deferred tax asset is recorded in the
balance sheet as of 31.12.2023, since it is likely that the company will have future taxable income that
will exceed temporary differences.
97
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Medistim Norge AS has a subsidiaries Medistim ASA owns indirectly through Medistim Norge AS in
Denmark and Sweden. The company is named Medistim Danmark Aps and Medistim Sverige AB and is
within the same segment as Medistim Norge AS.
MEDISTIM ASA HAS INVESTMENTS IN THE FOLLOWING SUBSIDIARIES
Unit Country Segment Ownership
Balance
sheet value
31 Dec 23
Profit in
2023
1 = NOK 1000
Medistim USA Inc. USA Lease and sale within bypass
surgery and vascular surgery
100 %
135 5 536
Medistim
Deutschland GmbH
Germany Capital sales within bypass
surgery and vascular surgery 100 %
188 6 207
Medistim Norge AS Norway Sale of 3 pary products and
capital sales within bypass
surgery and vascular surgery
100 %
36 953 10 945
Medistim UK LTD UK Capital sales within bypass
surgery and vascular surgery 100 %
1 -918
Medistim Japan KK Japan Dornmat company 100 % 86 -
Medistim Canada
Inc.
Canada Capital sales within bypass
surgery and vascular surgery 100 %
1
Medistim China Ltd China Service provider for
distributors in China 100 %
1 002
Medistim Spain S.L Spain Capital sales within bypass
surgery and vascular surgery 100 %
28 3 686
Sale of 3 pary products and
capital sales within bypass
surgery and vascular surgery 100 %
468
Medistim Danmark
Aps
Denmark Sale of 3 pary products and
capital sales within bypass
surgery and vascular surgery
100 % -257
Medistim Sverige AB Sweden
Total 38 395 22 404
Note 31 Shares in subsidiaries
98
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Note 32 Account receivables and other receivables
SUMMARY OF FINANCIAL INFORMATION FROM SUBSIDIARIES ALL 100 % OWNED
Unit Assets Debt Equity Income Profit
1 = NOK 1000
Medistim USA Inc. 140 298 27 295 113 003 206 335 5 536
Medistim Deutschland GmbH 15 439 3 468 11 971 55 463 6 207
Medistim Danmark Aps 2 343 1 732 611 6 282 468
Medistim Japan KK 86 0 86 0 0
Medistim Canada Inc. 6 095 9 564 -3 469 2 668 -3 556
Medistim China Ltd 2 247 1 130 1 116 3 130 295
Medistim Sverige AB 2 974 2 949 25 1 392 -257
Medistim Spain S.L 21 400 3 232 21 388 3 686
Medistim UK LTD 1 848 -8 950 3 510 -918
Medistim Norge AS 40 537 32 228 80 974 10 945
Total 233 266 83 412 149 854 381 141 22 404
Medistim Norge AS has offices in Oslo, Norway. Medistim USA Inc has offices in Minneapolis in the USA.
Medistim Deutschland GmbH has offices in Munich in Germany, Medistim UK has offices in Nottingham
in UK, Medistim Japan KK has offices in Tokyo, Japan and Medistim Denmark has offices in Copenhagen
in Denmark. Medistim Spain S.L has offices in Madrid. Medistim Canada has offices in Toronto, Canada,
Medistim China has offices in Guangzhou in China and Medistim Sweden has offices in Gothenburg,
Sweden. Book value of goodwill related to the acquisition of Medistim Norge AS was as of 31.12.2023
TNOK 14,128. Goodwill at the time of acquisition was TNOK 16,097. None of the subsidiaries are listed
at a stock exchange.
Of Medistim UK’s debt of TNOK 10,798, TNOK 7,587 is a long-term debt towards Medistim ASA. The debt
is part of a cash transfer to finance and establish the company in UK. Interest has been charged on this
debt. Medistim ASA received from its Norwegian subsidiary a dividend of MNOK 11.0 in 2023. Medistim
ASA has interest bearing debt towards Medistim US Inc of MNOK 40.7.
All receivables are due within one year. Losses in 2022 were TNOK 6 and losses in 2023 were TNOK 288. It
is recorded an accrual of TNOK 899 to cover expected losses. Historically the company has small losses on
receivables. Other receivables are shown below.
ACCOUNTS RECEIVABLE 2023 2022
1 = NOK 1000
Accounts receivable 70 111 92 008
Provision for bad debt -899 -899
Total salary expenses
69 212 91 109
99
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
OTHER RECIEVABLES 2023 2022
1= NOK 1000
Pre payments 2 174 2 338
Prepaid taxes and VAT 2 788 4 935
Accrued revenue 1 281 247
Unrealized gain hedging 3 389 779
Dividend subsidiaries 11 000 11 000
Total other receivables 20 632 19 299
INVENTORY 2023 2022
1= NOK 1000
Components 78 278 66 185
Finished goods 43 779 25 245
Inventory accrual -8 017 -6 728
Total 114 039 84 702
SPECIFICATION OF ACCRUAL 2023 2022
1= NOK 1000
Demonstration units 2 150 2 687
Service parts 1 687 1 643
Other 4 180 2 398
Total 8 017 6 728
Note 34 Cash in Bank
Restricted cash amounted to TNOK 5,652 as of 31.12.2023 and was related to tax withheld on salary
paid to employees. The comparable amount as of 31.12.2022 was TNOK 7,016.
Finished goods are valued at production cost that includes cost for components and internal labor cost. Work
in progress is valued at the total of the component cost. Inventory accrual is related to service inventory and
demonstration inventory. The sales value of the products is assessed and found lower than historic cost. See
table below:
Note 33 Inventory
100
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Note 35 Shareholder affairs
The company had 18,337,336 shares at par value of NOK 0.25 per share and total share capital amount
to NOK 4,584,334. There is only one class of shares, and all shares are treated equally. Each share
represents one vote.
Change in issued share capital in 2023:
The Board of Directors received by the shareholders meeting the 24th of April 2023 permission to
purchase up to 1,833,733 Medistim ASA shares at par value NOK 458,433.25. The permission is valid
until the next ordinary general assembly in 2024 in the price range of NOK 0.25 to NOK 500 per share.
Further the Board of Directors got permission to increase share capital with NOK 458,433.25 or issue
1,833,733 new shares at par value NOK 0.25. The permission can be used if there is a decision to enter
into a merger, acquire another company or to create an option program. The permission is valid until
the next ordinary shareholders meeting in 2024. See below for changes in the equity for the last year.
Status for the permissions as of 31.12.2023:
The company owned 55,617 Medistim shares as of 31.12.2023. Number of Medistim shares by 01.01.2023
was 80,046.
Number of shares
Par value per
share Share capital in NOK
Share capital 01.01.2023 18 337 336 NOK 0.25 NOK 4 548 334.00
Changes - - NOK
Share capital 31.12.23 18 337 336 NOK 0.25 NOK 4 584 334.00
Capital increase
Medistim
shares
Permission given at the shareholders
meeting in 2023
18 337 336 18 337 336
Permissions used - -
Status for the permissions as of 31.12.2023 18 337 336 18 337 336
101
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
SHAREHOLDER
Number of
shares
In % of total
ACAPITAL MEDI HOLDCO AS 1 900 219 10,36
STATE STREET BANK AND TRUST COMP 1 296 373 7,07
FLØTEMARKEN AS 1 285 000 7,01
VERDIPAPIRFOND ODIN NORDEN 1 180 000 6,43
FOLLUM INVEST AS 970 000 5,29
STATE STREET BANK AND TRUST COMP 920 390 5,02
SKANDINAVISKA ENSKILDA BANKEN AB 874 584 4,77
STATE STREET BANK AND TRUST COMP 637 398 3,48
ODIN SMALL CAP 600 000 3,27
THE NORTHERN TRUST COMP, LONDON BR 440 375 2,40
SKANDINAVISKA ENSKILDA BANKEN AB 429 248 2,34
SKANDINAVISKA ENSKILDA BANKEN AB 389 966 2,13
VERDIPAPIRFONDET HOLBERG NORGE 383 421 2,09
BUANES ASBJØRN JOHN 381 876 2,08
STATE STREET BANK AND TRUST COMP 336 919 1,84
SKANDINAVISKA ENSKILDA BANKEN AB 305 318 1,67
J.P. MORGAN SE 286 334 1,56
BNP PARIBAS 275 041 1,50
SKANDINAVISKA ENSKILDA BANKEN AB 274 380 1,50
THE BANK OF NEW YORK MELLON SA/NV 250 000
1,36
Total number owned by top 20 13 416 842
Total number of shares 18 337 336
Total number of shares outstanding 18 337 336
20 largest shareholders in % 73.31 %
Shareholder structure
102
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
SHAREHOLDER
Number of
shares Shares in % Nationality
Tove Raanes via Trane AS 1 990 0.01 % Board Member
Roger Morberg 16 259 0.09 % VP Sales APAC
Erik Swensen 10 994 0.06 % VP development
Thomas Jakobsen 30 526 0.17 % CFO
Kari Eian Krogstad 38 083 0.21 % CEO
Øyvin A. Brøymer (Fløtemarken AS) 1 285 000 7.01 % Chairman
Anne Waaler 2 440 0.01 % VP Medical
Håkon Grøthe (Grøten Invest AS) 7 821 0.04% VP Innovation
Stephanie d'Avout Stenhagen 2 784 0.02% VP Sales EMEA
Ole Jørgen Robsrud 3 442 0.02% Man.Dir. MSN AS
Tone Veiteberg 1 990 0.01% VP QA\Regulatory
Hæge Wetterhus 1 591 0.01% VP Marketing
Ole Arne Eiksund 5 872 0.03% Busines developer
Lars Rønn 885 0.004 % Board member
There were no share options outstanding as of 31.12.2023 except from the share program to CEO
described under chapter 8 Corporate Governance under compensation to management and note 21.
Note 36 Change in equity
CHANGE IN EQUITY
Share
capital
Treasury
shares
Share
premium
Other paid
in capital
Retained
earnings
Total
1 = NOK 1000
Equity 31.12.23
4 586 (21) 41 852 18 743 126 537 191 696
Change in equity:
Change in treasury shares - 8 - 6 001 6 009
Other corrections - - - - -55 -55
Profit for 2022 - - - - 99 455 99 455
Dividend to shareholders - - - - -82 256 -82 256
Equity 31.12.23 4 586 -13 41 852 24 743 143 681 214 849
103
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Note 37 Financial risk
Change in exchange rates involves a direct and indirect
financial risk for Medistim ASA. The company has
revenue and expenses in EUR and USD where most
revenue is in another currency and expenses mostly
in NOK. Efforts are made to neutralize net exposure.
Hedging contracts are evaluated to reduce exposure.
The development in NOK towards USD and EUR is
continuously monitored
Unrealized gain or loss related to the contracts is
recorded in the balance sheet and the change of
the value related to the contracts is recorded in the
profit and loss. By year end 2023 the company had
6 hedging contracts in USD totaling MUSD 1.8 and
6 hedging contracts in EUR totaling MEUR 2.4. By
year end there was an unrealized gain related to the
contracts of MNOK 3.4. The management and Board
of directors evaluate the handling of risks related to
exchange rates fluctuations continuously together
with its professional advisers.
2023 2022
1= NOK 1000
Bonus and commission 2 058 8 479
Board compensation 2 236 1 835
Debt towards subsidiary - -
Accrual for investment 350 350
Other 7 635 5 097
Total short term debt 12 279 15 761
Note 38 Specification of short-term debt
Note 39 Other operating expenses
GAINS AND LOSSES RELATED TO CURRENCY 2023 2022
1= NOK 1000
Foreign exchange gain 12 932 13 335
Foreign exchange loss 8 594 12 525
Total 4 338 810
OTHER OPERATING EXPENSES 2023 2022
1= NOK 1000
Office rental 9 193 8 824
Travel expense 5 145 3 268
Marketing 3 212 2 706
Consultancy fee 21 316 13 126
Insurance 1 018 978
Freight 1 254 1 270
Communication 18 232 14 056
Other 5 087 4 603
Total other operating expenses 64 457 48 832
104
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Note 40 Long-term debt and loan security
Medistim ASA had no long-term debt by the end of 2023.
Medistim ASA has a credit facility of MNOK 6.0 to enter foreign currency hedging contracts. The facility
represents 10 % of the total value the company can sign up contracts for. As security for the facilities are
assets, accounts receivable and inventory with MNOK 10. Book value of secured items was as of 31.12.2023
MNOK 30.2 for assets, MNOK 69.2 for accounts receivables and MNOK 114.0 for inventory.
Note 41 Receivables and debt towards subsidiaries
Note 42 Events after 2023
The Board of directors has no knowledge about events after 2023 that will affect the annual report and
financial statement for 2023.
Statement pursuant to section 5-5 of the Securities Trading Act
We hereby confirm that the annual accounts for the group and the company for 2023 to the best of our
knowledge have been prepared in accordance applicable accounting standards and give a true and fair view of
assets, liabilities, financial position and profit and loss for the group and the company as a whole. The director’s
report give a true and fair view over development and performance of the business and the position of the
group and the company, and a description of principal risk and uncertainties facing the group.
RECEIVABLES AND DEBT TOWARD SUBSIDIARIES 2023 2022
1 = NOK 1000
Account receivable 47 106 43 659
Other receivable 7 587 7 587
Short-term debt - 4 056
Long-term debt 40 689
39 429
105
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Alternative performance measures, concepts and abbreviations
Alternative performance measures are used by
investors, securities analysts and other interested
parties. The intention with the alternative
performance measures is to provide a better
overview of achieved results and development in the
company. In addition, concepts and abbreviations
that are relevant for the branch Medistim operates
in is explained in the below list. The company has
referred to these measures over many years and has
continued to do so to be consistent. Since Medistim
develops its own products it is a point to put focus
on how much is used within R & D. High values of
intangible assets could result in a one time expense
if the impairment test fail, and is highlighted for
this reason. The company's exposure to foreign
currency, the regulatory regime that forces the
company to secure end of life parts and international
customers with longer credit time, makes it useful
to have measures for currency neutral development
and changes in working capital. Below is the list of
alternative performance measures, concepts and
abbreviations Medistim uses in its reporting.
ALTERNATIVE PERFORMANCE MEASURES
Profit before R&D,
depreciation and impairment:
Margin after cost of goods, salary and social expenses and other operating
expenses are deducted except for R & D expenses
EBITDA: Earnings before interest, taxes, depreciation and amortization expenses.
Corresponds to operating profit before depreciations and amortization
expences.
EBIT: Earnings before interest and taxes. Corresponds to operating result.
Currency neutral growth: Compares this years sales with previous year sale when sale in foreign currency is
recalculated using the same average currency rate in the reporting period to get a
neutral comparison
Working capital: Inventory plus accounts receivable minus accounts payable
CONCEPTS AND ABBREVIATIONS
VeriQ: Medistim’s 3. Generation system platform
MiraQ: Medistim’s 4. generation system platform
TTFM: Transit time flow measurement
Vascular Surgery: Surgery involving veins and arteries in the body except on the heart
CABG: Coronary Artery Bypass Surgery
REQUEST: Registry for Quality Assessment with Ultrasound imaging and TTFM in Cardiac
Bypass surgery. A study initiated by Medistim ASA to collect data regarding the
combined use of ultrasound imaging and TTFM.
HFUS: High-frequency Ultrasound
CIDAC: Comparison of intraoperative duplex ultrasound and angiography after Carotid
Endarterectomy
NICE: British National Institute for Health and Clinical Excellence; an organization
that recommends standard of care within healthcare.
AATS: The American Association for Thoracic Surgery
ESC: European Society of Cardiology
STS: Society for Thoracic Surgery - an American organization focusing on thoracic surgery
EACTS: European Association for Cardio-Thoracic Surgery - a European organization
focusing on Thoracic surgery
ASCVS: Asian Society for Cardiovascular and Thoracic Surgery - an Asian organization
focusing on cardiovascular surgery
ICC: International Coronary Congress - an organization that focuses on CABG surgery
CEA: Carotid Endarterectomy
CIDAC study: Prospective Comparison of Duplex Ultrasound and Angiography for Intra-
operatvie Completion Studies after Carotid Endarterectomy
ROMA-Women trial: Randomized Comparison of the Outcomes of Single vs Multiple Arterial
Grafts in Women
12. ALTERNATIVE PERFORMANCE MEASURES
106
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
RECONSILIATION OF CURRENCY NEUTRAL REVENUE: RATES 2023 RATES 2022
USD average rate for the year 10,56 9,61
EUR average rate for the year 11,42 10,10
GBP average rate for the year 13,14 11,87
DKK average rate for the year 1,53 1,36
SPLIT OF REVENUE IN USD, EUR AND NOK 2023
REVENUE 2022
WITH 2021 RATES
1 = NOK 1000
Sales in USD
Procedural revenue Imaging and flow 100 611 91 565
Capital sales MiraQ flowmeasurement instruments 15 492 14 099
Capital sales MiraQ imaging and flowmeasurement instrument 35 566 32 368
Flow measurement probes 48 980 44 576
Imaging probes 8 374 7 405
Sales in EUR
MiraQ flowmeasurement instrument 40 057 35 421
MiraQ imaging and flowmeasurement instrument 45 919 40 605
Imaging probes 7 858 6 948
Flowmeasurement probes 144 078 127 404
Other - -
Revenue in USD and EUR 446 935 400 393
Revenue in NOK 79 429 79 429
Total revenue 526 364 479 822
Reconciliation of working capital:
Accounts receivable in balance sheet at year end 74 303 101 657
Inventory in the balancesheet at year end 145 391 114 333
Accounts payable in balance sheet at year end -25 083 -30 258
Working capital 194 611 185 733
Reconsiliation of profit before R & D and depreciation:
EBITDA 155 099 164 539
Expensed R & D 13 607 14 476
Profit before R & D and depreciation: 168 706 179 015
107
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
Øyvin A. Brøymer
Chair
Sign.
Ole J. Dahlberg
Board member
Sign.
Lars Rønn
Board member
Sign.
Anna Ahlberg
Board member
Sign.
Jon H. Hoem
Board member
Sign.
Kari Eian Krogstad
President & CEO
Sign.
Board member
Sign.
Tove Raanes
Board member
Sign.
Oslo, 21
st
March 2024
Board of Directors and CEO of Medistim ASA
108
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
13. AUDITORS REPORT
109
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
110
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
111
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2023
marketing@medistim.com
www.medistim.com
medistim.com/
contact