www.medistim.com
CORPORATE
ANNUAL
REPORT
2022
www.medistim.com
CORPORATE
ANNUAL
REPORT
2022
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 18
6.3 Organization, HSEQ and sustainability 19
6.4 Financial Review 20
6.5 Parent company financial review 21
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 23
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 31
7.7 Market for cardiac procedures 31
7.8 Market for Vascular Surgeries 33
7.9 Geographical target markets 33
8. CORPORATE GOVERNANCE REPORT 35
8.1 Implementation and reporting on corporate governance 35
8.2 Business activity 35
8.3 Equity and dividend 35
8.4 Equal treatment of shareholders and transactions with closely related parties 36
8.5 Shares and negotiability 36
8.6 The general meeting 36
8.7 Nomination committee 37
8.8 Board of directors, composition and independence 37
8.9 The work of the Board of directors 38
8.10 Risk management and internal control 38
8.11 Remuneration of the board of directors 39
8.12 Remuneration of executive personnel 39
8.13 Information and communications 39
8.14 Takeovers 40
8.15 Auditor 40
9. SUSTAINABILITY REPORT 41
9.1 Strengthening human health through improved surgery 41
9.2 Product stewardship 43
9.3 Responsible business 45
9.4 People 47
10. GROUP CONSOLIDATED FINANCIAL STATEMENTS 49
10.1 Consolidated Income Statement of Profit or Loss and other Comprehensive Income
Medistim ASA Group 49
10.2 Statement of Financial Position Medistim ASA Group 50
10.3 Consolidated Cashflow Statement 51
10.4 Consolidated Change in Equity for Medistim ASA 52
10.5 Accounting Principles 52
10.6 Notes to the accounts 58
11. PARENT COMPANY FINANCIAL STATEMENTS 82
11.1 Income Statement Medistim ASA 82
11.2 Balance Sheet Medistim ASA 83
11.3 Cash Flow Statement 84
11.4 Accounting Principles 84
11.5 Notes to the accounts 86
12. ALTERNATIVE PERFORMANCE MEASURES 95
13. RESPONSIBILITY STATEMENT 98
14. AUDITORS REPORT 99
4
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022MEDISTIM ANNUAL
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 900,000 patients have vascular
surgery procedures performed. 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.
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 in Norway represents about
100 different medical technology companies, as a
distributor of their products in this country.
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, the United Kingdom, Spain, Denmark
and Norway, in addition to a global distributor
network representing the company in more than
65 countries in Asia, Europe, America and Africa.
Medistim ASA is listed on the Oslo Stock Exchange
and has its global head office in Oslo, Norway.
5
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Our vision is that blood flow measurements and intra-operative
ultrasound imaging shall benefit all patients and surgeons, regardless
of where in the world they are located, and that Medistim’s device
and solution represent standard clinical practice in all countries.
- Kari E. Krogstad - CEO
“
6
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
2. KEY FIGURES
Sales in TNOK
EBIT in TNOK 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 share
Medistim share
Open market (finger palpation)
(332M people)
200,000
procedures
>30 % Medism share
(83M people)
44,000 procedures
> 80% Medism share
USA
(68M people)
16,000 procedures
Medism share
UK
(213M people)
40,000 procedures
< 5 % market share
Brazil
Germany
>700.000
procedures
7
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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, Denmark, Germany, Spain and Norway.
Dividend in NOK per share and Pay-out ratio
0
50000
100000
150000
200000
250000
300000
Capital Sales
Recurring Sales
2022202120202019201820172016
Recurring sales
Capital sales
Capital sales and recurring sales of own
products in TNOK
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
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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% Medism share
(145M people)
40,000 procedures
Medism share
Russia
(1.4B people)
50,000 procedures
Medism share
China
(1,3B people)
160,000 procedures
< 1 % market share
India
(126M people)
13,000 procedures
> 90 % market share
Japan
8
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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3. HISTORY
9
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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
2021



1. HISTORY




2011
Medism’s Milestones
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
23
rd
March 2023
Kari E. Krogstad - President & CEO
4. LETTER FROM THE CEO
Looking back at 2022, there are many achievements
worth noting and celebrating.
First, we are delivering our best year yet,
setting a new all-time high for sales, reaching
MNOK 491.9 in revenues for the year.
In addition to delivering on this ever so important
goal of continued growth in both Cardiac bypass
and Vascular surgery, we had
a tremendous year for Imaging product growth.
In Medistim, we strongly believe that combining
the use of Flow measurement technology (TTFM)
with near-field ultrasound imaging is the future
- for patients, for surgeons and for the company.
Our High Frequency Ultrasound (HFUS) innovation
is offered in our latest platform, the MiraQ. The
clinical value of the combined use was supported
by the compelling clinical data from the REQUEST
study, published in 2020.
To accelerate growth of our Imaging products, we
decided to run a marketing campaign throughout
2022 in a range of digital media. We shared
great clinical case examples showing the practical
value from adding imaging to the CABG surgery
procedure, under the
campaign slogan “TTFM is not enough”.
Further supported by several
high-quality symposia at the
largest heart surgery conferences,
we succeeded with achieving
44 % growth in the imaging
product portfolio in 2022.
And while steadily penetrating the Cardiac bypass
market, we build and strengthen our position in the
Vascular segment as well. In 2022, we end up at
MNOK 69.5 in
vascular product revenues, growing at 27.3 %.
Geographically, USA lead the way with 22.2 %
growth for the full year, currency neutral. Based
on the estimated 69,417 TTFM procedures sold,
we can calculate our market penetration rising
to >30 %. In other words, we are well under way
towards achieving the same strong position with
flow measurement adoption in the USA as we have
in central and northern Europe and Japan.
On the operating profit side, we are happy to
see that activity levels are back to normal in the
operating rooms and in our marketing, sales, and
product development departments. Through the
year we have also strengthened our organization
further, hence total operating expenses increase
for the year. Still, we are setting a
record EBIT of MNOK 141.2 and
corresponding EBIT margin of 28.7 %.
This is outstanding performance, and my
appreciation and gratitude go to all Medistim
colleagues and partners worldwide.
While the general global economic and geopolitical
outlook for 2023 may be
somewhat gloomy and uncertain,
Medistim’s pledge is to continue
to develop, present and position
our life-saving products to
surgeon users and hospital
administration, with all our best
efforts and optimism. Follow us
in 2023!
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
5. EXECUTIVE MANAGEMENT & BOARD OF DIRECTORS
5.1 Management Team
Kari Eian Krogstad
President and CEO, Medism ASA
Kari E. Krogstad joined Medistim as CEO in September 2009. She has 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. 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, Medism ASA
Helge Børslid joined Medistim as Vice President Manufacturing in January 2017 from the position as
production manager at Halliburton. Previous experience includes roles as test engineer and quality
engineer at Norautron, Infineon Technologies, Kongsberg Maritime, and Sensor Development. Børslid
holds a B.Sc. in Electronics Engineering from Vestfold University in Norway and is currently completing his
final year of a Master’s degree in Management from the BI Norwegian Business School.
Ole Arne Eiksund
Chief Business Development Ocer, Medism 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, Medism 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.
Håkon Grøthe
Chief Innovaon Ocer, Medism 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).
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Thomas Jakobsen
CFO, Medism ASA
Thomas Jakobsen joined Medistim as VP Finance in 2001. He has broad experience from finance positions,
including Controller and Finance Manager at Sysdeco and Finance Director of Microtronica Nordic.
Jakobsen holds a B.Sc. in Management from the BI Norwegian School of Management.

Country Manager, Medism Deutschland GmbH
Cindy Kaffai joined Medistim as Territory Sales Manager for Germany in 2005. She has 18 years of
experience from the medical device industry. Since 2015, Kaffai has led Medistim Deutschland GmbH as
General Manager and is responsible for all activities and sales efforts in Germany & BeNeLux. Prior to
Medistim she was Territory Sales and Key Account Manager for Stryker Corporation.
Roger Morberg
VP Sales, Medism 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.
Ole Jørgen Robsrud
Managing Director, Medism Norge AS
Ole Jørgen Robsrud joined Medistim Norge AS as Managing Director in 2010, from the position as
Country Manager in HemoCue Norway. He has 13 years of experience in the pharmaceutical company
Pfizer, where he has held a variety of management positions in sales and marketing both on national
and international level. Robsrud holds a M.Sc. in Business and Economics from the Norwegian Business
School (BI) and the University of Florida.
Erik Swensen
VP R&D, Medism 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).
Tone Veiteberg
VP Regulatory Aairs & Quality Assurance, Medism 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.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022

VP Markeng, Medism 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, Medism 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.

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.
Siri Fürst
Board member
Siri Fürst was elected as board member in Medistim in 2013. She has been a partner of Considium
Consulting Group AS since 2005. She offers expertise in business development and strategy work, in
addition to corporate governance and management. She also serves as board member in Norinnova AS,
GC Rieber VivoMega AS, Røros Produkter AS and JM Hansen AS. She has broad experience from executive
positions within strategy, business development, finance and investor relations from management
positions in Hafslund, Hafslund Nycomed and DiaGenic. Fürst holds a degree in economics and finance
from the Norwegian School of Economics (NHH). She is also member of the audit committee.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Torben Jørgensen
Board member
Torben Jørgensen holds a B.S.c. in Economics from Copenhagen Business School CBS and is an independent
advisor, consultant and board member. He is currently the chair of the board of Biotage and Genovis
AB. He is also board member of Boule Diagnostics and Advanced Instruments. Torben Jørgensen has
previous experience as CEO of Biotage AB, Affibody AB, Karo Bio AB and DAKO AS. He is also member of
the remuneration committee.
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 also member of the audit 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 and Krefting 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 2022
6. BOARD OF DIRECTOR’S REPORT
Since the pandemic started to affect the Medistim
business in second quarter of 2020, the effect has
become gradually smaller, and in the second quarter
of 2021, there was a strong rebound in procedures
performed and hence in the sales revenues. This
rebound has continued throughout 2022.
While Medistim has been affected by the COVID
situation, the company have been able to deliver
solid profit and cash flow. The need for Medistim’s
products has not changed, and the strong recovery
seen through 2021 and the growth that continues
in 2022, may indicate that cardiac bypass surgeries
are back to normal. However, there are still some
uncertainties related to new variants of the virus.
The global market is facing macro-economic turmoil,
with energy crisis, inflation pressure, increasing
interest rates and cost levels and uncertainty related
to the Ukrainian war. 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 76.6 %.
With these uncertainties, the need for Medistim’s
products has been confirmed through the last two
years' growth development. Despite the pandemic,
macroeconomic turmoil and the Ukrainian war, the
company's solutions continue to have an increasing
demand among cardiac and vascular surgeons.
The Medistim Group’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, Denmark, Germany, Spain and
Norway. At the end of 2022, Medistim’s equipment
was in use in more than 60 countries and 3,300
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 900,000 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 and
Medistim Denmark Aps. The products distributed
are medical devices within all types of surgery.
6.1 Operational review
Medistim increased its coverage of cardiovascular
surgery procedures in 2022. The medical facilities
strict requirements for distance-keeping and
comprehensive infection control regimes during
the pandemic in 2020 and 2021 was less strict in
2022. This affected Medistim’s customer relations
activities positively in 2022. 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 2022.
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 2022, but
the improved customer contact contributed to a
sales growth of 16.6% in NOK and an operating
profit (EBIT) growth of 21.2% in NOK
Adjusted for currency effects, sales revenue was
up 11.9%. Sale of own products was up 14.0%
while sale of third-party products was up 2%
from 2021. The strong growth is a combination of
Medistim increasing its market penetration and
closer customer and exhibition participation to
collect leads as COVID restrictions were reduced
in 2022.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
During 2022, Medistim sold 250 new systems (230),
where 100 were repacement of old systems and
at year-end the total installed base of Medistim
systems was 3300 units (3150). 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 grow within both cardiac
and vascular segments and the imaging module
is the main driver for the growth. Sales revenue
from the cardiac segment ended in 2022 at MNOK
346,5 (MNOK 293), an 18.3% growth. Sales
revenue from the vascular segment ended at
MNOK 69.5 (MNOK54.6), a 27.3% growth. Sales of
imaging products increased with MNOK 44 which
represents a 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.
In October 2021, another clinical study was
published in a top journal, Circulation. Circulation
is 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). 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
TM
technology for routine use during CABG surgery.
Having the technology in focus in one of the
world’s most renowned cardiovascular journals
indicates 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 September 2022 the European Society of
Vascular Surgery (ESVS) has revised their Clinical
Practice Guidelines 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 (CEA).
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. 2022 that shows
that both ultrasound imaging and angiography are
associated with a reduced risk of death and stroke
after CEA.
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 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 2022 the
vascular product portfolio revenues have grown
more than 27%, 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. In 2022 the 18
th
annual
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Arthur D. Little Nordic Life Science Award went to
Kari E. Krogstad, CEO of Medistim ASA. The award
was given to a person in the Nordic region that
has demonstrated outstanding management and
leadership in the Life Science industry.
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.
In 2022, 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.
Also, to make flexible and ease of use solutions
for the customers, Medistim implemented the Pay
Per Procedure functionality on the MiraQ platform
for US and UK customers.
6.2 Regional development
USA
2022 2021 % chg y-o-y
Flow procedures 69,417 59,397 17 %
Imaging procedures 16,613 12,635 31 %
Capital sales 46 38 21 %
Lease 8 19 -58 %
OUTSIDE USA
2022 2021 % chg y-o-y
Flow systems 135 125 8 %
Flow and imaging systems 69 67 3 %
Imaging probes 112 107 5 %
Flow probes 8,606 7,988 8 %
USA
USA is the largest market for the Medistim’s
products, representing 33% of global CABG
procedures. Total U.S. sales amounted to NOK
198.1 million in 2022, up 28.5% from 2021.
Adjusted for currency effects, sales were up 14.9%.
Total revenues for 2021 include an extraordinary
recording of 5.3 MNOK as other revenues in the
USA in 2021. This was related to the Paycheck
Protection Program established by the U.S.
federal government to help businesses keep
employees employed during the COVID pandemic.
Medistim kept all its USA employees throughout
the pandemic and was therefore qualified for
the program. Hence, U.S. product sales, when
excluding this extraordinary income, increased
with 33% compared to 2021. Adjusted for currency
effects, product sales were up 26%.
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 and
the Group has high market ambitions. 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%. The Group 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
2022, procedural sales amounted to 71% of the
total sales, ending at MNOK 139.1. This is up 23%
from 2021 (+12% currency adjusted).
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
During the year, 86,030 procedures were sold,
(72,032) of which 69,417 were flow procedures
(59,397) and 16,613 were imaging (12,635). Capital
sales were 46 units, compared with 38 units in 2021.
In 2022, 88% of sales was within the cardiac
segment, hence the vascular segment is a large
untapped opportunity for Medistim in USA.
Outside USA
Sales in markets outside USA, mainly Europe and Asia,
ended at MNOK 218, up from MNOK 199 in 2021.
Adjusted for currency effects, sales were up 16%.
In these markets, the systems are owned by the
hospitals and revenues are more evenly split
between capital sales and sale of consumables.
In 2022, sales of flow and imaging measurement
probes amounted to 62% of total sales, ending at
NOK 134 million, compared with NOK 123 million
in 2021. Currency neutral sales were up 15% year-
over-year. The increased market penetration within
both the cardiac segment and Vascular segment
contributes to increase sale of consumables. In
2021, consumable sale amounted to 60% of total
sales. Sale of consumables is expected to increase
as sale of systems continues to increase from
MNOK 72 in 2021 to MNOK 78 in 2022.
Europe
Medistim has developed a strong market position
in Europe with about 1100 systems installed,
representing a solid base for future recurring
revenues. Total European sales of own products in
2022 ended at MNOK 124.8, up 7.8% from MNOK
115.8 in 2021. Currency neutral sales were up 8.4%.
During the year 4,714 probes were sold, (4,574) of
which 4,659 were flow probes (4,524) and 55 were
imaging (50). Capital sales were 84 units (81). The
direct representation in Norway, Denmark, UK,
Spain, and Germany ended sales at the same
level as last year. Both Spain and Germany are
mature markets within cardiac, but have large
opportunities within the vascular segment.
Norway and Denmark are well penetrated in both
segments, while in the UK there is growth potential
within both segments. Sales through distributors
ended at NOK 49 million, up 16% compared to
2021. The installed base continued to increase,
and solid probe demand resulted in a 15% growth
in sales compared to 2021.
Asia
Sale to Asian markets were MNOK 77 for the year,
up from MNOK 67 in 2021. The increase is driven by
sales to China. Sales to China ended at NOK 37 million,
up 16% compared to 2021. The number of CABG
procedures increases with 5 to 10 % per year, and
China is a strategic market for Medistim. Medistim
covers more than 50 % of the 50,000 procedures
performed in China and is well represented in the
Chinese market. Sales to Japan ended at NOK 25,6
million, down 3% compared to 2021. The introduction
of MiraQ to the Japanese market late 2019 continues
to drive system sales in Japan.
During 2022, 103 MiraQ systems were sold in
the Asian markets, compared with 93 systems in
2021. Sale of the combined ultrasound flow- and
imaging system was at the same level as last year
and the growth of system sales was the ultrasound
flow system. Total number of probes sold in Asia
increased 15% from 2021, reflecting increased
CABG activity. The increase is explained by
increased market penetration, but also inventory
build-up at distributors. During 2022, Medistim
sold 3,140 probes, (2,729) of which 3,101 were
flow probes (2,683) and 39 were imaging (46).
Other markets
Sales in other markets amounted to MNOK 16.4
(MNOK 16.1).
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 2021, Medistim had
121 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 2022, absence
due to sickness was 4.4% or 1510 days. This
compares to 3.2% or 1109 days in 2021.
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
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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
The Medistim Group’s sales for the full year 2022
ended at MNOK 491.9 (MNOK 427.3). Currency
neutral, sales increased 11.9%.
Sales in Asia increased 15.0%, while sales in the U.S.
and Europe increased 28.5% and 5.5%, respectively.
Regional sales in “Rest of the world” increased 1.6%.
In Europe sales of own products rose 7.8% and
third-party product sales through the subsidiaries
in Norway and Denmark rose 2.0%.
Total revenues for 2021 include an extraordinary
recording of 5.3 MNOK as other revenues in the
USA. This was related to the Paycheck Protection
Program established by the U.S. federal government
to help businesses keep employees employed
during the COVID pandemic. Medistim kept all its
USA employees throughout the pandemic and was
therefore qualified for the program. Hence, U.S.
product sales, when excluding this extraordinary
income, increased with 33.1% in 2022.
Total sales of own products in 2022, amounted
to MNOK 416.1 (MNOK 347.6), while sales of
third-party products were MNOK 75.8 (MNOK
74.3). Currency adjusted, sales of own products,
excluding the PPP in 2021, increased 14.0%
during the year, while sale of third-party products
increased 2%. The growth was related to increased
market share within both the cardiac segment and
the vascular segment. Average NOK exchange
rates towards USD and EUR in 2021 were 8.59 and
10.16 respectively, while equivalent rates in 2022
were 9.61 for USD and 10.10 for EUR.
Cost of goods sold (COGS) amounted to MNOK
106.5 (MNOK 97.1), representing 21.7% of sales
(23%). The higher level of sales through direct
operation and less growth in sale of third-party
products, explain the decline in COGS in percent in
2022 compared to 2021.
Salary and social expenses were MNOK 146.4
(MNOK 134.1), while other operating expenses
were MNOK 74.5 (MNOK 56.2). 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.
In addition, strong sales result increases sales
commissions and bonuses.
Compared to the COVID-affected last year, the
activity level in marketing and sales were higher
this year, explaining the increased other operating
expenses.
Medistim continuously invests in existing and
new products to cover the surgical requirements
for quality verification. The company invests
between 4% and 10% of annual sales in research
and development (R&D). In 2022, total R&D
investments amounted to MNOK 23.8 (MNOK
18.6), corresponding to 5.7 % of sales of own
products. Of this, MNOK 9.9 (MNOK 4.1) was
activated in the balance sheet.
Operating result before depreciation and write-
offs (EBITDA) ended at MNOK 164.5 (MNOK 139.7).
Depreciation for the year amounted to MNOK 23.3
(MNOK 23.4).
The operating result (EBIT) was a record MNOK
141.3 (MNOK 116.3), corresponding to an EBIT-
margin of 28.7 % (27.6 %)
The Group recorded net financials of MNOK 4.8
(MNOK -2.2), of which MNOK 11.7 of financial
expenses (MNOK 10.4) and MNOK 16.5 of financial
income (MNOK 8.1). 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 146.0 (MNOK 114.1).
Tax amounted to MNOK 30.8 (MNOK 23.3) and the
net profit for the year was MNOK 114.0 (MNOK
90.9), corresponding to earnings per share for the
full year of NOK 6.25 (NOK 4.99).
Average number of shares outstanding during the
year were 18.247.550 (18.215.938) by the end of
December 2022.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Cash Flow Statement
Net cash flow from operating activities amounted
to MNOK 113.5 (MNOK 127.4). Working capital
increased MNOK 40.6 during the year, driven by
a MNOK 16.9 increase in inventories and MNOK
33.0 increase in receivables.
Net cash flow from investing activities was negative
NOK 20.1 million (NOK 11.5 million) where MNOK
10.2 as related to investments in assets and MNOK
9.9 was related to product development.
Net cash flow from financing activities was negative
MNOK 70.2 (MNOK -58.8), of which MNOK 68.4
(NOK 54.6 million) was payment of dividends.
Leases amounted to MNOK 7.4 (MNOK 6.9).
During the year cash and cash equivalents
increased by MNOK 23.1 (MNOK 57.6). At 31
December 2022, total cash and cash equivalents
amounted to MNOK 152.6 (MNOK 129.5).
Financial position
At 31 December 2022, Medistim’s working capital
totaled MNOK 187.8, compared with MNOK 145.7
the year before. During the year, inventory increased
by MNOK 16.9. As a consequence of increased
sales, account receivables increased MNOK 33.1
during the year. Account payables increased MNOK
7.8 compared to last year. By year end the group
had MNOK 17.1 in interest bearing liability related
to lease contracts. MNOK 10 of this was long term
liability and MNOK 7.1 was short term liability.
Total long term liability of MNOK 15.1 was related
to MNOK 10 lease contracts and MNOK 5.1 was
related to deferred revenue.
The total balance sheet amounted to MNOK
482.7 (MNOK 403.2). Total equity was MNOK
366.7 (MNOK 306.1), corresponding to an equity
ratio of 76% (76%). Book value of properties,
plants and equipment amounted to MNOK 51.3
(MNOK 58.8). Intangible assets were MNOK 36.1
(MNOK 30.1), of which product development and
goodwill represented MNOK 22.0 and MNOK 14.1
respectively.
The group has a deferred tax asset of MNOK 3.6
(MNOK 3.2) related to temporary differences
between carrying amount and tax values.
The year-end cash position was MNOK 152.6
(MNOK 129.5).
The Medistim Group’s financial position, cash flow and
ability to finance its activities is considered satisfactory.
Share capital and number of shareholders
At 31 December 2022 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 85 046
treasury shares at year-end.
6.5 Parent company financial review
The parent company Medistim ASA had 2022 sales
of MNOK 308.6 (MNOK 258.5). Operating profit
was MNOK 101.7 (MNOK 77.3) and profit before
tax amounted to MNOK 129.4 (MNOK 97.4).
Medistim received a dividend from its subsidiary
in Norway and Germany of MNOK 26.8 in 2022
(MNOK 24.0). No group contribution was received
in 2021 or 2022. Profit after tax for the parent
company was NOK 107.1 for the full year (MNOK
80.7).
At 31 December 2022, the parent company’s
total assets amounted to MNOK 382.2 compared
to MNOK 310.4 as of 31 December 2021. Equity
in the company was NOK 191.7 (MNOK 160.3),
corresponding to an equity ratio of 50.2% (51.6%).
At year-end 2022, the parent company had MNOK
84.0 in cash. The company’s financial position and
ability to finance future activities and investments
was considered satisfactory. Cash flow from
operating activities was NOK 92.0 million for the
parent company in 2022.
Allocation of profit
The Board of Directors suggests that MNOK 108.1
of the 2022 net profit is allocated to ordinary
shareholder dividend, equal to NOK 4.50 per share
(NOK 3.75 for 2021), which amounts to MNOK
82.1 corrected for the company’s holding of own
shares. The remaining MNOK 26.0 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 72.1% (75.2%). The
dividend reflects the Board's positive expectations
of future earnings. Over the past 10 years, the
company has paid MNOK 407 in accumulated
dividends to shareholders.
22
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
6.6 Corporate governance
Medistim depends upon good relations with its
stakeholders to succeed. Good corporate gover-
nance is important to build and maintain trust and
confidence in the company and ensure long-term
value creation in the best interest of the compa-
ny’s shareholders. The company’s corporate gover-
nance structure is based on Norwegian legislation
and the Norwegian Code of Practice for Corporate
Governance, last revised October 2021. Medistim
complies with the Code of Practice, with certain
deviations, as outlined and explained in the Cor-
porate 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 82% 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 reportable events in
2022.
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.
The group has over the past five years utilized
strong revenue and profit development to build
a cash reserve to meet increased working capital
requirements as company grows.
Interest rate risk
The company is exposed to changes in interest rate
levels via long-term debt with a floating interest rate.
Macroeconomic risk
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 76 %.
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.
COVID 19
Cardiac bypass surgery is to a large extent an elective
procedure that can be scheduled with some time delay.
When the outbreak of the COVID pandemic was a fact,
several by-pass surgeries were postponed. Therefore,
the number of bypass procedures was reduced
compared to the normal level. While Medistim has
over several years shown a currency neutral growth
of 7% to 10 % per year, 2020 ended without growth
compared to 2019, all due to the pandemic.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Since the pandemic started to affect the Medistim
business in second quarter of 2020, the effect
became gradually smaller, and in the second quarter
of 2021, there was a strong rebound in procedures
performed and hence in the sales revenues. This
rebound continued through 2021.
While Medistim has been affected by the COVID
situation, the company have been able to deliver
solid profit and cash flow. The need for Medistim’s
products has not changed, and the strong recovery
seen through 2021 and the growth that continues
in 2022, may indicate that cardiac bypass surgeries
are back to normal. However, there are still some
uncertainties related to new variants of the virus.
Medistim’s production activities depend on
employees physically being present at the
production facilities. A large or local outbreak may
result in several employees being infected by the
virus or quarantined to avoid the spread of the virus,
potentially affecting productivity and output.
The situation is being continuously monitored,
contingency plans are in place and the level of
measures are being adjusted as appropriate.
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 new transparency act report from Medistim will
no later than the 30
th
of June be published on the
Medistim website www.medistim.com.
The Russian and Ukraine conflict
The Russian and Ukrainian conflict is expected to
have minor impact on Medistim sales, since sales
revenues from these countries were less than 2%
of total sales in 2022.
6.8 Events after the balance sheet date
The Board of directors has no knowledge about
events after 2022 that will affect the annual report
and financial statement for 2022.
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 regardless of economy or geography.
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 3,300 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 record profit and cash flow
despite the impact from COVID-19 and macro-
economic turmoil in 2022. The need for Medistim’s
products has not changed, hence the expectation
is that it is only a matter of time before cardiac
bypass surgery activity recover normal levels.
Medistim will also continue its technology and
product development to improve its offering and
combined with recurring revenues from its already
installed base of 3,300 systems, the company is
well positioned to continue its journey of profitable
growth.
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 2022, each
with a nominal value of NOK 0.25, unchanged from
end of 2021. During the year, the shares traded
between NOK 196 and NOK 382 per share, and
2.03 million shares were traded in total.
Major shareholders and voting rights
Medistim had 1016 registered shareholders in the
Norwegian Central Securities Depository (VPS)
at 31 December 2022, whereof the 20 largest
shareholders owned 74.3%. The percentage of
issued shares held by foreign shareholders was
57.2%. 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.
24
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Corporate actions
CORPORATE ACTION
2021 Financial statements approved by the Board 23.03.22
Annual report 2021 disclosed 29.03.22
Annual General Meeting 27.04.22
Resolution to distribute dividend of NOK 3.75 per share 27.04.22
Ex dividend NOK 3.75 28.04.22
SHARE PRICE DEVELOPMENT OVER THE PAST 5 YEARS
Dividends and dividend policy
Medistim’s shareholder policy is to maximize shareholder value. This will be achieved through sound business
development and an aggressive 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 2022 results, the Board of Directors will propose to pay a dividend of 4.50 for 2022 corresponding
to a pay-out ratio of 71%. For 2021, Medistim paid a dividend of NOK 3.75 per share corresponding to and
a pay-out ratio of 75%. Over the last ten years, Medistim has paid NOK 407 million in accumulated dividend
to shareholders.
Analyst coverage
DNB, Danske Bank and Sparebank 1 had active coverage of Medistim ASA in 2022. For contact details,
please see the company website www.medistim.com.
General Meetings and Board authorisations
The 2022 AGM granted the Board of Directors the following authorizations:
2. Authorisation to increase the share capital by up to NOK 458,433.25.
3. 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.
25
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Oslo, 23
rd
March 2023
Board of Directors and CEO of Medistim ASA
Øyvin A. Brøymer
Chair

Board member
Siri Fürst
Board member
Sign. Sign. Sign.
Torben Jørgensen
Board member
Tove Raanes
Board member
Lars Rønn
Board member
Sign. Sign. Sign.
Kari Eian Krogstad
President & CEO
Sign.
26
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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 2022
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, some 700-800,000 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 some 40% 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 3,300
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 Key Opinion Leaders (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 innovation, R&D,
QA & Regulatory, and manufacturing departments
.
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
28
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Surgical
Guidance
29
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Guidance
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 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 vas-
cular surgery. The MiraQ platform offers special-
ized configurations for cardiac and vascular appli-
cations in the products MiraQ Cardiac and MiraQ
Vascular, respectively. The MiraQ Vascular system
includes a specialized application menu with a
customized user interface adapted to vascular sur-
geons’ requirements, and probes tailored for vas-
cular applications. The MiraQ is also available with
both configurations, as the MiraQ Ultimate.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
TTFM probes (cardiac and vascular family)
Flow probes utilize the reliable transit time technolo-
gy to accurately measure blood volume flow intraop-
eratively in a wide range of applications, from cardi-
ac 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 in-
traoperatively to assess coronary quality, strategize
graft placement and visualize constructed anasto-
mosis. 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 com-
ponents 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 invests
between 4% and 10% of annual sales in research
and development (R&D). In 2022 The company
invested 5.7 % 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 that entered into
formal development in 2022.
New production technology
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.
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.
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
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
the community of cardiac surgeons, but it may pave
the way for new and enhanced clinical guidelines
worldwide.
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 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 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.
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,
varying between 700-800,000 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 3,300 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 more than 35% of all bypass surgeries
performed worldwide. Competing providers using
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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.
Total value of the global TTFM market for CABG is
estimated at to NOK 1 billion 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
NOK 2 billion 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 NOK 1
billion 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”.
Guideline endorsements
Inclusion in the leading health organizations’ guide-
lines 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 aware-
ness 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 during 2021 and 2022 and
expects increasing recognition to continue to
support demand in the years to come.
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.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
7.8 Market for Vascular Surgeries
Applications # of procedures Clinical needs
Peripheral bypass > 450,000 Improve long-term graft patency | Improve quality of life
CEA > 250,000 Reduce risk of death and stroke | Improve cost effectiveness
AV Access > 200,000 Secure maturation of shunt/fistula |Reduce risk of cardiac failure
and hand ischemia
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 900,000 procedures and a market potential
of 1.5 billion NOK.
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 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.”
The CIDAC study
Clinical support and studies are key enablers for
Medistim to increase market penetration, also in
vascular surgery. In 2020, the CIDAC (Comparison of
Intra- operative Duplex Ultrasound and Angiography
after Carotid Endarterectomy) study was published
in the European Journal of Vascular and Endovascular
Surgery (EJVES). 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.
7.9 Geographical target markets
Medistim is the undisputed market leader
in the global CABG market with a strong
position in core geographical markets.
USA
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 2022. 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.
34
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
EUROPE
Europe 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 with all cardiac
centers in Norway, Sweden, Finland and Denmark,
with directs sales in Norway and Denmark. 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 and Denmark, 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.
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 late 2022.
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 Russia, Poland, Italy and France which are
considered as promising long-term growth markets.
ASIA
China
About 50,000 CABG procedures are performed
annually and Medistim’s share of this market is
above 50 %. The number of CABG procedures
increases by 5 to 10 % per year in this market, and
China is therefore a strategic market for Medistim.
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 Medtronic in Canada and LivaNova in Australia
and is experiencing positive development in these
markets. The company has a high market share
in the Middle East, while Latin America to date
represents a very small part of business activities.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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 help 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 2022.
The company’s objectives, strategies and risk
profile are subject to annual review by the Board.
Deviaons from the Code of Pracce: None
8.3 Equity and dividend
At 31 December 2022, the company’s equity was
NOK 369 million, which is equivalent to 76.6% 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’s shareholder policy is to maximise
shareholder value. This will be achieved through
sound business development and an aggressive
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
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
NOK 82.1 million based on the financial results for
the year. For 2021, the company paid a dividend
of NOK 3.75 per share, corresponding to NOK
68.4 million. Over the past ten years, Medistim
has paid a total of NOK 407 million in dividend to
shareholders, corresponding to an average payout
ratio of 75 %.
At the annual general meeting on 27 April 2022,
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 2022, 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 2022,
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 from www.medistim.com.
Deviaons 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 2022.
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 2022. 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 2022.
Deviaons 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.
Deviaons 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 2022, Medistim held its annual general meeting
on 27 April with 51.95% of the shares represented.
There were no extraordinary general meetings
during the year.
Deviaons from the Code: None.
37
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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 2022
Bjørn Henrik
Rasmussen
Chair Yes Follum Capital 2009 AGM 2023 100%
Jonathan
Schönbäck
Member Yes Odin Forvaltning 2022 AGM 2023 100%
Vegard Søraune 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 three to six 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 2022, the board consisted of the following six directors:
Name Role
Considered
independent of
main shareholders
Served
since
Term
expires
Participation
board meetings
2022
Share ownership in
Medistim (direct/
indirect)
Øyvin A. Brøymer Chair No 2000 AGM 2023 100% 7.01%
Torben Jørgensen Director No 2021 AGM 2024 100% 0%
Lars Rønn Director Yes 2012 AGM 2024 100% 0,01%
Anthea Arff-
Pettersen
Director No 2022 AGM 2024 100% 0%
Siri Fürst Director Yes 2013 AGM 2023 100% 0.01%
Tove Raanes Director Yes 2014 AGM 2024 100% 0.01%
38
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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. Three out of six members are regarded as
independent of the company’s main shareholders.
The independence of board members is also
evaluated by the board.
Deviaons 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
renumeration committee.
The board performs a self-assessment of its work
once per year.
Deviaons 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.
Deviaons from the Code: None
39
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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.
Deviaons 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.
Deviaons from the Code: The Code recommends
that the company’s guidelines are included as a
separate appendix to the noce calling for the
general meeng. The guidelines should inform which
aspects that are advisory and which, if any, are
binding. The general meeng should vote separately
on each of these aspects of the guidelines. Further,
the Code recommends that the guidelines contain
informaon on criteria related to performance related
remuneraon, which should be subject to an absolute
limit. Medism includes a general descripon of the
company’s guidelines for remuneraon in the annual
report, alongside informaon on remuneraon to
each director. Execuve remuneraon is treated as
one item by the general meeng.
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.
Deviaon from the Code. The company has not
prepared any policy or guidelines specifying who
is entled to speak on behalf of the company or
regulang communicaon with shareholders outside
general meengs, 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 maers, while the CEO handles media and
other inquiries.
40
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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.
Deviaons 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 specic, one-o, events which makes
preparaon 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 acvies are not unnecessarily
interrupted. The board will further seek to comply with
the relevant recommendaons from the Code.
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.
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 2022.
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.
Deviaons from the Code: None
Medistim distributors
Medistim subsidiaries
41
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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 consid-
ers its greatest impact is
helping to strengthen hu-
man health through improved surgical
outcome by providing high quality medi-
cal devices meeting strict safety require-
ments.
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 inte
-
grating 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,
42
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
based on the SASB
1
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.
1 The Sustainability Accounng Standards Board (SASB)
This was contrasted with the responses of an
internal Medistim working group and summarized
in the materiality matrix.
By summarizing the factors identified through
the analysis, Medistim has defined the following
43
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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 third 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 2022.
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
People
People
44
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
45
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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
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 2022 were:
• Remove plastic bags used for probes in IFU’s
(Instructions For Use). This could potentially
save 26 kg of plastic per year.
This goal was achieved during 2022, and plasc
bags are no longer used for probes
• Implement sustainability as assessment
criteria in the product development process.
It has been implemented as a roune, that sustain-
ability is assessed in product development discus-
sions.
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 2023:
• Developing KPIs for Energy and Water
consumption to Medistim reporting
• Introduce lead-free soldering of wires for all
TTFM transducers
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, which were last updated in
2019, 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
46
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
to employees’ behavior and cover 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 2022.
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. This work has been led
by the QA/RA department and is based on a risk
based approach. During 2022, further efforts have
been put into structuring this work. A separate
Transparency Act report will be prepared during
the first half of 2023, in line with Transparency Act
guidelines.
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 2022.
The goal for 2022 was:
• Repeat training to employees on routines for
whistle blowing.
The training has been completed.
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 2022.
47
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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 employee and this is by own choice. All
other employees are compensated with a 100 %
position.
Goal for 2023:
• 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 131 people (116).
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 4,4 % or 1510 days
(3.2% or 1109 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 2022 (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, during 2022 Medistim has
established a company sports team, of which
taking part in the Holmenkollen relay race was a
highlight. 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 fairly equal
gender distribution, 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 share of higher-level positions.
Medistim offers full pay during parental leave
for both men and women, and in 2022 3,0 % of
Medistim’s female and 1,5 % of male employees
took parental leave. On average, women took 8
weeks, while men took 1 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 late 2021.
• The goal for 2022 was to update and revise the
employee handbook.
This was done during 2022.
48
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
INDICATORS 2022 2021
Working environment, health and safety
Number of employees 131 116
Number/ share of part-time employees 1 1
Turnover - number of employees leaving 12 12
Employees' co-ownership in the company (% employees owning shares in
Medistim)
0.60 % 0.64 %
Skickleave (%) 4.4 % 3.2 %
Number of work-related injuries 0 0
Gender balance, % women of group total 51.1 % 52 %
Gender balance, % women executive management 38.5 % 41 %
Gender balance, % women Board of Directors 50 % 40 %
Number of women hired during the year 13 2
Number of men hired during the year 14 6
Age distribution, employees < 30 years 5 4
Age distribution, employees 30-50 years 67 61
Age distribution, employees > 50 years 59 51
Average salary female employees in NOK 698 789 649 409
Average salary male employees in NOK 1 134 203 1 135 773
All employees incl. management level, womens share of salary per position 911 510 888 399
Executive management, womens share of salary per position (Hay Grade) 21 % 28 %
Number of weeks for maternity leave (women) 16 52
Number of weeks for paternity leave (men) 1 0
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 6 5
Independent board members 3 3
Average age of board members 57 62
% meeting participation 100% 95%
49
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
10. GROUP CONSOLIDATED FINANCIAL STATEMENTS
10.1 Consolidated Income Statement of Profit or Loss and other Comprehensive
Income Medistim ASA Group
INCOME STATEMENT MEDISTIM ASA GROUP 2022 2021
1 = NOK 1000
Note
Operating income and expenses
Revenue 486 262 417 817
Other income 5 675 9 459
Total revenue 1,2 491 937 427 276
Operating expenses
Cost of goods sold 3 106 485 97 114
Salary and social expenses 4,5,21 146 376 134 507
Other operating expenses 8 74 537 55 950
Total operating expenses before depreciation and amortisation 327 398 287 571
Operating profit before depreciation and impairment 164 539 139 705
Depreciation and amortization on assets 6,7,12 23 288 23 427
Operating profit 141 251 116 278
Financial income and expenses
Total financial income 9,20 16 546 8 173
Total financial expenses 9,20 11 748 10 380
Net finance 4 799 -2 207
Profit before tax 146 049 114 071
Tax expense 10 32 077 23 171
Profit for the year 11 113 973 90 900
Earnings pr. share 2022 2021
Basic 11
6.25 4.99
Diluted 11
6.24 4.98
STATEMENT OF OTHER COMPREHENSIVE INCOME 2022 2021
Net profit 113 973 90 900
Items that may be reclassified to profit and loss
Exchange differences arising on translation of foreign operations 10 659 5 357
TOTAL COMPREHENSIVE INCOME 124 632 96 257
50
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
10.2 Statement of Financial Position Medistim ASA Group
Consolidated balance sheet Medistim group ASA 12/31/2022 12/31/2021
1=NOK 1000 Note
Assets
Non-current assets
Property, plant and equipment 6,7 51 312 58 862
Deferred tax asset 10 3 591 3 240
Intangible assets 12 36 069 30 170
Other long term receivable 21 5 793 4 475
Total non current assets 96 764 96 747
Current assets
Inventory 14 114 333 97 413
Accounts receivable 15 101 657 68 634
Other receivables 15 17 263 10 960
Cash 16 152 641 129 490
Total current assets 385 894 306 497
Total Assets 482 659 403 244
Equity and liabilities
Equity
Share capital 17 4 585 4 585
Treasury shares -21 -26
Share premium 41 852 41 852
Other paid in capital 18 742 13 344
Issued capital 65 158 59 754
Other reserves 17 184 6 138
Retained earnings 285 350 240 160
Retained earnings 302 534 246 298
Total equity 367 691 306 052
Non current liabilities
Lease liabilities 7,24 10 020 17 079
Deferred revenue 24 5 126 2 510
Total non current liabilities 15 146 19 589
Current liabilities
Accounts payable 24 470 13 205
Income tax payable 10 25 873 20 327
Other short term liabilities 19 42 043 36 609
Provisions 22 350 350
Lease liabilities 18,24 7 086 7 113
Total current liabilities 18 99 822 77 604
Total liabilities 114 967 97 192
Total equity and liabilities 482 659 403 244
51
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
10.3 Consolidated Cashflow Statement
CONSOLIDATED CASHFLOW STATEMENT 2022 2021
1 = NOK 1000 Note
Cash flow from operations
Profit/loss after tax 113 973 90 900
Minus income tax paid -19 167 -13 336
Plus this years tax expense 10 32 077 23 171
Plus depreciations and amortisations 6,7,12 23 288 23 427
Change in inventory 14 -16 920 15 254
Change in accounts receivable 15 -33 023 -11 149
Change in accounts payable 11 265 -324
Change in other accruals 1 999 -568
Net cash from operating activities 113 491 127 374
Investing activities
Purchase of property, plant and equipment 6,12 -9 251 -7 403
Product development investments -11 851 -4 083
Net cash from investing activities -21 102 -11 486
Financing activities
Repayment of liability 18,24 - -4 500
Dividend 11 -68 396 -54 640
Principle and interest paid on lease liabilities 7,24 -7 312 -7 502
Other financing activities 5 404 7 589
Net cash from financing activities -70 304 -59 053
Foreign currency effect on cash 1 066 764
Net change in cash 23 151 57 599
Cash as of 01.01 129 490 71 891
Cash as of 31.12 16 152 641 129 490
Available cash and cash withholding
Available cash as of 31.12 16 144 164 124 866
Cash withholding for taxes 16 8 477 4 624
Cash and cash equivalents as of 31.12 152 641 129 490
52
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
10.4 Consolidated Change in Equity for Medistim ASA
Comments to other reserves:
Other reserves in the equity reconciliation are differences related to translating equity from foreign
subsidiaries to NOK.
CONSOLIDATED CHANGE IN EQUITY FOR MEDISTIM ASA
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 Dec 2020 4 585 -33 41 852 5 762 52 165 781 203 899 204 680 256 845
Total comprehensive
income for the period
- - - - - 5 357 90 900 96 257 96 257
Share-based payments
17 - 7 - 7 582 7 589 - - - 7 589
Dividend
11 - - - - - - -54 640 -54 640 -54 640
Equity as of 31 Dec 2021 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
Share-based payments
17 - 6 - 5 398 5 404 - - - 5 404
Dividend
11 - - - - - - -68 396 -68 396 -68 396
Equity as of 31 Dec 2022 4 585 -21 41 852 18 742 65 158 16 797 285 736 302 533 367 691
10.5 Accounting Principles
Medistim ASA is a public company listed at the Oslo
stock exchange. Medistim ASA is incorporated in
Norway. The main office is located in Økernveien
94, 0579 Oslo, Norway. The Medistim group’s
business is within developing, producing, service,
leasing and distribution of medical devices.
The board of Directors and the CEO authorized
these financial statements for issue on March 23,
2023.
Basis for preparation of financial statements
The financial statement for the group is prepared in
accordance with International Financial Reporting
standard (IFRS) as adopted by the EU and effective as
of 31.12.2022.
The annual accounts for the group and the group
has been prepared based on historical cost with
exception of financial derivatives which are measured
at fair value.
The consolidated accounts have been prepared using
consistent accounting policies for similar transactions
and events.
The accounting principles for the group for 2022 are
the same as for the principles used in 2021. New
standards from 2022 have not had any significant
effects compared to 2021 standards.
Functional currency and the presentation currency
The group presents its financial statements in NOK.
This is also the functional currency for the parent
company. Asset and liabilities of subsidiaries with
other functional currency than NOK, are translated
to NOK using the exchange rate at the balance
sheet date. For the income statement, the average
monthly rate in the period is used. Translation
differences arising from translation to presentation
currency, is recognized in other comprehensive
income.
Principles for consolidation
The consolidated accounts include Medistim ASA
and companies controlled by Medistim ASA. Control
normally exists when the Group has more than 50 %
of the shares in the investee. Currently all subsidiaries
are wholly owned.
Intercompany transactions, balances and unrealized
gains and losses are eliminated.
Cash and cash Equivalents
Cash includes cash in hand and bank deposits.
Cash equivalents are short-term, highly liquid
investments that are readily convertible to cash and
which are subject to an insignificant risk of changes in
value. Classified as financial asset.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Accounts receivable
Accounts receivable that do not contain a
significant financing component, are recognized at
the transaction price with a deduction for expected
credit losses. Classified as financial asset.
Inventory
Inventory is valued at the lower of cost, using the
FIFO principle, and net realizable value. Production
cost includes the cost for components, cost of
conversion (including direct labor cost) and other
cost in bringing the inventories to their present
location and condition. Net realizable value is the
estimated sales price in the ordinary course of
business less cost of completion and selling cost.
Property, plant and equipment
Property, plant and equipment is recorded at cost
less accumulated depreciations and write-downs.
When an asset is sold, the carrying value of the
asset is derecognized and any gain or loss from the
sale is recognized in the income statement.
The cost of an acquired item of property, plant and
equipment comprises of the purchase price, non-
refundable taxes and other direct cost incurred in
order to be able to use the asset as intended.
The cost for a self-constructed item of property,
plant or equipment is the same as the cost of
construction the asset for sale. Cost include
materials, labor costs and an allocation of
production overheads. The cost allocated to the
asset is based upon the time spent to build the
asset.
Costs incurred for major replacements and
updates are added to cost if it is probable that the
cost will bring future economic benefit and the
cost can be reliably measured. If new parts are
capitalized, replace parts are derecognized. Repair
and maintenance costs are expensed as incurred.
Items of property, plant and equipment are
depreciated straight line over the estimated useful
life from the time it is available for use. Useful life
is as follows:
• Machinery and equipment 3-7 years
• Other assets 3-5 years
Depreciation time and method is evaluated on a
yearly basis.
Property, plant and equipment are tested for
impairment if there are indication of impairment. If
the carrying amount exceeds the assets recoverable
amount, being the higher of value in use and fair
value less cost of disposal, the asset is written
down to the recoverable amount.
Leasing
The group as a lessee
The company recognizes a lease liability and a right-
of-use asset for leases with a duration of more than
12 months, provided that the underlying asset is
not of low value.
The lease liability is the present value of the lease
payment over the lease term. Lease payment
includes fixed payments and variable lease
payments that depend on an index or a rate. The
lease term is the non-cancelable period of the
lease together periods covered by an option to
extend the lease when the exercise of the option is
reasonably certain.
The lease payments are generally discounted using
the company’s incremental borrowing rate, as the
rate implicit in the lease generally cannot easily be
determined.
The cost of the right of use assets comprises the
initial measurement of the lease liability, any lease
payments made before the commencement date
an any initial direct cost incurred.
Right-of-use assets are depreciated over the
shortest of the lease term and useful life.
Depreciation of right-of-use assets is presented
together with other depreciation in the income
statement.
Lease payments are allocated between installments
and interest based on a constant periodic rate of
interest being the interest used to calculate the
lease liability. The interest expense is presented as
a financial expense in the income statement.
The group as lessor
The assets that are leased to customers are recognized
as property, plant and equipment in the balance
sheet. Direct cost related to the leasing agreement
is added to the carrying amount of the leased assets
and is depreciated over the lease term.
The group has one type of lease agreement. See
note
1 for a description of recognition of lease
revenue, and note 2 for a split of lease revenue on
different product categories.
54
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Derivatives
The group may use forward exchange contracts to
reduce exposure towards USD and EUR. Financial
derivates are recognized at fair value through profit
and loss. Change in fair value is recognized in profit
and loss and is presented as financial income or
expense. Unrealized gains or losses are recorded
in the same manner as realized gains and losses.
Hedge accounting is not applied.
Intangible assets
Intangible assets are recognized in the balance
sheet if it is probable that the future economic
benefits will flow to the company, and the cost of
the asset can be measured reliable.
Intangible asset with finite economic life is
measured at cost less accumulated amortization
and write-downs. Amortization is done on a
straight-line basis over expected lifetime. The
amortization period and method, are reviewed on
a yearly basis.
Intangible assets with indefinite useful life are
not amortized, but tested for impairment at least
annually.
Business combinations and goodwill
Business combinations are accounted for using the
acquisition method.
Goodwill is recognized as the difference between
the aggregate of the consideration transferred and
the amount of any non-controlling interest less
the fair value of the net identifiable assets at the
acquisition date.
Goodwill is not depreciated, but is tested for
impairment at least annually.
Research and development
Research cost is expensed as incurred.
Cost to internal development of technology or
software is capitalized as an intangible asset when
it is demonstrated that
-it is technically feasible to complete the asset,
-the company has the recourse to complete the project
-the product will generate future economic benefits, and
-expenditure can be reliably measured.
Cost capitalized include materials, salary and social
expenses and other expenses that can be allocated
to the development of the asset.
Internally developed intangible assets are amortized
on a straight-line basis over the expected useful life.
Amortization starts when the asset is available for
use. Intangible assets not ready for use, is tested for
impairment on a yearly basis.
Capitalized development costs are written down
when a new product is ready for sale or an improved
product is ready for sale.
Internally developed intangible asset is tested
for impairment on a regular basis by discounting
expected cash flow generated from the asset. If the
discounted value is lower than the carrying amount
the asset is written down.
Own products
Capitalized cost related to development of own
products are depreciated on a straight-line basis
over expected lifetime. Expected lifetime varies
from 3 to 8 years.
Provisions
A provision is recognized when the group has an
obligation arising from a past event, when it is probable
that company will be required to settle the obligation,
and the obligation can be reliable measured.
The Group provides warranties for general repairs of
defects that existed at the time of sale, as required
by law. Provisions related to these assurance-type
warranties are recognized when the product is sold
or the service is provided to the customer. Initial
recognition is based on historical experience. The
initial estimate of warranty-related costs is revised
annually.
Equity and debt
Financial instruments are classified as debt or equity
according the economic substance of the financial
instrument.
Interest, dividend, profit and loss related to a financial
instrument are classified as debt, will be presented
as an expense or revenue. Amounts distributed to
holders of financial instruments classified as equity
will be recorded directly against equity.
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.
55
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Cost related to equity transactions
Transaction costs related to equity transactions are
recorded directly against equity in the balance sheet
net after tax.
Translation differences
Translation differences arise in connection with ex-
change-rate differences of consolidated foreign en-
tities. Translation differences are recognized in other
comprehensive income and presented as “other re-
serves” in the balance sheet. Translation differences
is recognized in profit and loss when the investment
is sold.
Exchange rate differences on monetary assets and lia-
bilities that in substance is part of the net investment
in a foreign operation, is also included in translation
differences.
Revenue recognition
Revenue from contracts with customers is recognized
when control of the goods or services are transferred
to the customer at an amount that reflects the
consideration to which the Group expects to be
entitled in exchange for those goods or services.
Revenue recognition policies are described in detail
in note
1.
FOREIGN CURRENCY
Transactions in foreign currency
Transactions in foreign currency are translated to
functional currency using the exchange rate at the
date of the transaction. Financial instruments in
foreign currency are translated to Norwegian kroner
at the closing rate of the balance day. Non-financial
items measured at historic cost are translated to
Norwegian kroner using the exchange rate at the
time of the transaction. Changes in exchange rates
are recorded in the profit and loss statement as
either financial income or financial expense.
Foreign subsidiaries
Assets, liabilities and goodwill in foreign subsidiaries
that are consolidated are translated to Norwegian
kroner at the date of the balance sheet. Revenue
and expenses are translated to Norwegian kroner
using the monthly average rate.
PENSION AND OTHER EMPLOYEE BENEFITS
Contribution pension plan
Employees in Medistim with a pension plan are included
in a contribution plan where an agreed percentage of
the employee’s salary is paid to the employee pension
account. The company’s payment of contributions is
expensed in the period it is incurred.
Share based payments
The Group has a share-based payment scheme
for its CEO. The program is settled in shares. The
fair value of the share program at the grant date,
is expensed over the vesting period. The expense
is included in “salary and social expenses” in the
income statement and a corresponding amount is
recognized as other paid-in capital.
Interest bearing loans and borrowings.
Loan and borrowings are initially recognized at fair
value net of directly attributable transaction costs,
and subsequently measuring at amortized cost.
Tax
The tax expense in the income statement includes
both payable taxes for the period and changes in
deferred tax. Deferred tax is calculated based on
temporary differences between tax values and
carrying amount of assets and liabilities.
A deferred tax asset is recognized when it is
convincing evidence that the company will have
sufficient taxable profit in the future to utilize the
tax asset. The companies recognize previously
unrecognized deferred tax assets to the extent it
has become probable that the company can utilize
the deferred tax asset. Similarly, the company will
reduce a deferred tax asset to the extent that the
company no longer regards it as probable that it
can utilize the deferred tax asset.
Deferred tax and deferred tax assets are determined
using the tax rates that have been enacted or
substantively enacted by the reporting date and
are expected to apply when the deferred tax asset
is settled/recovered. Deferred tax and tax assets
are measured at nominal value and is classified as
a non-current asset in the balance sheet.
Tax payable and deferred tax is recorded against
equity if the transaction is an equity transaction.
56
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Segment
The group is organized, for management purpose, in
two divisions dependent upon products and services.
The segments are identified based upon different
risk and return on investment profile. Information
regarding segments is presented in note 2.
Internal profit between the segments is eliminated .
The segment reporting is similar to the internal
reports that are given to the decision makers in the
company. The decision makers are responsible for
allocating resources and assessing profitability within
the segments, and are identified as the management
team that takes strategic decisions.
Contingent liabilities and assets
Contingent liabilities are not recognized in the
financial statements. Information about significant
contingent liabilities is disclosed.
Contingent assets are not recognized in the
financial statements, but are disclosed if an inflow
of economic benefits is probable.
Events after the balance sheet date
Information after the reporting period that provide
evidence of conditions that existed at the end of
the reporting (”adjusting events”), are reflected in
the amounts recognized in the financial statement.
Information after the reporting period that are
indicative of conditions that arose after the
reporting period (“non-adjusting events”) are not
reflected in the amounts recognized in the financial
statement, but are disclosed if material.
Use of estimates and judgement
The preparation of the consolidated financial
statements requires management to make judgments,
estimates and assumptions that effect the recognition
and measurement of certain assets, liabilities, revenue
and expense. The following area involves the most
critical estimates and judgments for the company:
ͳ Research and development cost relating to
internally developed technology and software
ͳ Goodwill.
Future events could lead to a change in estimates.
The estimates and assumptions for the estimates
are continuously evaluated. Changes in accounting
estimates are recognized in the period the change
take place. If the change also affect future periods,
the effect on future periods will be recognized as
income or expense in those future periods.
Of events that has affected future estimates is
the COVID 19 pandemic. By-pass surgery is to a
large extent elective surgery. When the outbreak
of COVID 19 was a fact, several by-pass surgeries
where postponed. As a consequence, the activity
level within by-pass surgery was reduced compared
to normal level. Medistim has over several years
had a growth of 7% to 10 % per year, but because of
COVID 19 sales in 2020 without growth compared
to 2019. The reduced activity level was as expected
temporary, and in 2021 activity level increased
above normal to reduce the build up of patient
queues.
While Medistim has been affected by the COVID
situation, the company have been able to deliver
solid profit and cash flow. The need for Medistim’s
products has not changed, and the strong recovery
seen through 2022 may indicate that cardiac
bypass surgeries are at large back to normal.
However, there are still some uncertainties related
to new variants of the virus. The expected COVID
19 effects are included in the estimates and none
of the balance sheet values was impaired. See also
note
12.
Goodwill
The group’s goodwill in the balance sheet is yearly
tested for impairment. Goodwill occurred with
the acquisition of Medi-Stim Norge AS, which
was executed with effect from 01.01.02, and the
acquisition of Kir-Op AS that was executed with
effect from 06.07.06. Total recorded goodwill by
year-end 2020 was 14.1 MNOK. Goodwill of MNOK
7.9 was allocated to the Medi-Stim Norge AS
acquisition and MNOK 6.2 was allocated at the Kir-
Op AS acquisition. Goodwill in both companies is
related to employee know-how, experience in the
distribution business and cost savings by gathering
common functions. Both companies distribute
third party products within surgery. During 2006,
there was a fusion of the two companies and a
otal evaluation for both companies in relation
to impairment was done for goodwill thereafter.
Both entities are within the same segment. The
total value of the business is dependent upon the
success of maintaining and increasing the product
portfolio. The value from the cash-generating unit
exceeded the book value in the balance sheet and
the goodwill value for 2021 was not impaired.
See also note
12 for the assumptions used in the
estimate.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Research and development
Development cost related to technology and
software has been recognized as an intangible asset
because Medistim can demonstrate technological
feasibility for the asset to be available for sale
for both existing products and new products.
The revenue potential for the projects exceeds
the investment. The balance sheet value as of
31.12.2021 was MNOK 16.0. The estimates that
form the basis for the intangible asset are performed
by the management of the company, and there will
always be a level of uncertainty in relation to the
assessments that are performed on future revenue
for future products. Activated development costs
are depreciated over 3 to 8 years. 8 years is used if
it is a new product on a new technological platform
that creates the basis for a new generation of
products. Based upon a platform or new generation
of products there will be further developments
and improvements. These enhancements of the
products are depreciated over 3 years because of
rapid technological development. Within 3 years, it
is assumed that parts or all of existing technology
is updated.
New and amended standards not yet effective
There are no new standards, interpretations or
amendments that are issued, but not yet effective,
that are expected to cause any significant changes
for Medistim.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
10.6 Notes to the accounts
Note 1 Revenue
Group revenue can be split in three different
categories that have different risk and return
on investment profile. The split is according to
the company’s internal reporting structure. The
categories are as follows:
1. Revenue from sale of capital equipment (MiraQ)
and consumable (probes)
2. Revenue from lease of equipment (MiraQ and
probes)
3. Distribution and sales of third-party products
Category 1 and 2 covers the same equipment
(MiraQ system) and consumables (probes). These
are the products that are developed and produced
by Medistim and distributed through local partners
unless Medistim has local representation.
1. Sale of capital equipment and consumable:
The sale of the equipment and the sale of the
consumables are considered separate deliveries
(performance obligations). Revenue recognition
varies with shipping and delivery terms that
decide the timing of when the customer takes
over control of the goods. Payment terms
varies from 30 to 90 days. The Group provides
warranties for general repairs of defects that
existed at the time of sale. This is considered as
a separate performance obligation. A warranty
provision is recognized, see note 21.
2. Revenue from lease of equipment and probes:
The group has a range of contracts related to
lease of equipment and probes and can be split
in two categories:
a. Payment per procedures
b. Lease of equipment and sale of probes
Payment per procedure:
Under this model, the equipment and probes
are placed at the customer site free of charge.
Medistim owns all equipment placed at the
customer site. For the customer to be able to use
the equipment a procedure (smart card) must be
purchased. One procedure equals one surgery. The
customer purchases a smart card that makes the
system available for use.
The agreement is considered a lease with variable
lease payments. Revenue is variable and recognized
related to the actual use of the equipment and
probes. For Medistim this means that revenue
is recognized when a new card is shipped to a
customer. There are two types of customers, flow
customers and flow and imaging customers. Flow
customers purchases a flow procedure, while
flow and imaging customers purchase both a flow
procedure and an imaging procedure. It is therefore
a split of revenue between flow procedures and
imaging procedures. Revenue is recognized when
smart cards are purchased by the customer. The
customer is dependent upon the smart card in
order to open the equipment and probe for use.
The agreements are operational since equipment
is returned when the agreement expires.
The individual agreement contains a minimum use
clause. The duration of the agreement is 1-3 years,
but divided into 12-month cycles, so minimum
usage applies for 12 months at a time. If minimum
usage is not achieved, Medistim has the right to
extract the equipment from the customer site.
Lease of systems and sales of probes:
Under this model, the customer leases the system
and purchases probes when needed. The system
revenue is recognized on a straight-line basis over
the lease term. Probe revenue is recognized when
the probe is delivered to the customer.
Other terms in the agreements:
If a customer with a pay per procedure or lease
agreement does not handle the equipment
properly, the customer is liable towards Medistim to
compensate for the damage and repair. It happens
that customers after too low consumption want to
keep the equipment. In such cases, the customer
may purchase the equipment. In this case, this is
registered as a system sale.
3. Third party sales: Sale of other third-party
medical equipment is recognized when the
equipment is delivered to the customer.
Payment from customers are mainly due within
30 days.
Other income in the P&L includes service, spare
parts, grants and other income that is not own
products or third party products.
See note 1 for
split of revenue.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 2 Segments
The Group's activities are divided into strategic
business units that are organized and managed
separately. The division is also in accordance with
the Group's internal reporting structure. The main
divisions are sale of own products and sale of 3
rd
party
products. Sale of own products has two business
models, the capital model and the lease model.
Transactions between internal business units
are performed at market terms. Revenue, cost
and result for each segment includes transaction
between the segments. On group level these
transactions are eliminated.
Own Products category:
Medistim has a flexible business model in the USA
and leaves it up to the customer whether they want
to lease the equipment or purchase the capital
equipment and buy probes as consumable. Most
customers in the USA lease the equipment. The lease
model in the USA has been successful since it does
not demand upfront capital to have the equipment
available. Medistim has direct representation in the
USA, which makes it manageable to handle the lease
model properly. However, several customers prefer
to invest in the equipment and purchase probes as
consumables and Medistim promotes both solutions.
The lease model has not been successful outside
USA. It is often so that hospitals have a policy
that the equipment they use must be hospital
property. In addition, Medistim can only follow up
this model properly where the company has direct
representation, since lease customers require
Medistim property at the customer site. Medistim
serves around 60 distributors around the world. To
follow up assets placed at customer sites in a global
scale, and have distributors to manage Medistim
assets, is considered to be to complex and risky.
Third party products category:
Distribution and sale of third-party products is a
separate segment. The group sells medical devices from
third party manufacturers in Norway and Denmark.
The product portfolio is carefully selected and mainly
instruments and consumables within surgery.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
SPLIT OF REVENUE AND OPERATING PROFIT FOR OPERATING SEGMENTS
Segment
OWN PRODUCTS THIRD PARTY PRODUCTS GROUP
1 = NOK 1000 2 022 2 021 2 022 2 021 2 022 2 021
Revenue
Sales in USA
Lease revenue from flow procedures 61 096 50 380 - - 61 096 50 380
Lease revenue from imaging procedures 32 693 23 949 - - 32 693 23 949
Flow probes 37 066 31 594 - - 37 066 31 594
Flow systems 13 248 18 108 - - 13 248 18 108
Ultrasound imaging systems 44 984 18 984 - - 44 984 18 984
Ultrasound imaging probes 9 000 5 831 - - 9 000 5 831
Other revenue - 5 290 - - 5 290
Total revenue USA 198 087 154 135 - - 198 087 154 135
Sales outside USA
Flow probes 125 908 115 704 - - 125 908 115 704
Flow systems 36 567 32 898 - - 36 567 32 898
Ultrasound imaging systems 41 651 38 912 - - 41 651 38 912
Ultrasound imaging probes 8 216 7 118 - - 8 216 7 118
Third party sales - - 75 833 74 340 75 833 74 340
Other revenue 5 675 4 169 - - 5 675 4 169
Total revenue outside USA 218 016 198 800 75 833 74 340 293 850 273 141
Total revenue 416 104 352 936 75 833 74 340 491 937 427 276
Cost of goods sold 66 195 56 194 40 291 40 920 106 485 97 114
Salary and social expenses 131 182 120 893 15 194 13 614 146 376 134 507
Other operating expenses 67 133 50 031 7 405 5 920 74 537 55 950
Depreciation 22 923 23 078 365 349 23 288 23 427
Operating profit per segment 128 671 102 740 12 579 13 537 141 250 116 277
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Additional sales information:
A geographical sales split is monitored to be able to follow the development in sales in the USA with the greatest
potential, Europe where market penetration is strong and Asia with the largest future growth potential.
INFORMATION ABOUT GEOGRAPHICAL AREAS
Geographic split of
segments
USA Europe Asia
Rest of the
world Group
1 = NOK 1000
2 022 2 021 2 022 2 021 2 022 2 021 2 022 2 021 2 022 2 021
Revenue own
products
198 087 154 135 124 811 115 849 76 793 66 805 16 412 16 146 416 104 352 936
Revenue 3. party
products
- - 75 833 74 340 - - - - 75 833 74 340
Revenue in units
own products
Procedures flow 69 417 59 397 - - - - - - 69 417 59 397
Procedures imaging 16 613 12 635 - - - - - - 16 613 12 635
Flow probes 3 174 3 080 4 659 4 524 3 101 2 683 846 781 11 780 11 068
Flow systems 14 22 55 54 73 59 7 12 149 147
Ultrasound imaging
systems
32 16 29 27 30 34 10 6 101 83
Ultrasound imaging
probes
158 133 55 50 39 46 18 11 270 240
Lease of flow
systems
4 9 - - - - - - 4 9
Lease of flow and
imaging systems
4 10 - - - - - - 4 10
Revenue in units 3.
party
N.A N.A N.A N.A N.A N.A N.A N.A N.A N.A
Information about geographical areas
Split of revenue between coronary surgery and vascular surgery
The company has in addition to coronary surgery a strategy and focus towards vascular surgery. The principles for
guiding and quality assurance within vascular surgery is the same as within coronary surgery. The difference is that
within coronary surgery the surgeons focus is to supply the hart with blood, while within vascular surgery the focus
is to ensure blood flow in other parts in the body or organs. The vascular market has gained increased focus from the
company in order to ensure that the products from the company gets a foothold within more than just coronary surgery.
It is therefore natural to report sales split between cardiac surgery and vascular surgery.
SPLIT OF R
EVENUE BETWEEN CORONARY- AND VASCULAR SURGERY
FOR OWN PRODUCTS AND 3 PARTY PRODUCTS
2 022 2021
1 = NOK 1000
Split of own products
Sales within coronary surgery 346 550 293 025
Sales within vascular surgery 69 554 54 619
Other revenue USA - 5 292
Sales of 3. party products 75 833 74 340
Total sales 491 937 427 276
62
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Major Customers
Where Medistim has direct representation the customers are hospitals and none of these are dominant
in the sense that they represent a major part of the group revenue. Of Medistim's installed base of about
3300 systems, the largest customer has 7 systems. This means that this customer would represent about
0.25 % of total revenue. However, Medistim is also represented through distributors, and the two largest
distributors represent 7.5 % and 6 % of the groups revenue respectively. The two largest distributors are
independent of each other and operates in different geographical areas.
Note 3 Split of Cost of Goods Sold
SPLIT OF COST OF GOODS SOLD 2022 2021
1 = NOK 1000
Third party products 42 828 40 215
Components 52 746 45 240
3.party services 767 1 169
Change in stock level 6 059 5 525
Packing material and other materials 54 620
Freight 4 032 4 345
Total cost of goods sold 106 485 97 114
Note 4 Salary and social expenses
SPLIT OF SALARY EXPENSES 2022 2021
1 = NOK 1000
Salary 108 056 99 262
Employeers tax 15 778 13 405
Bonus 14 878 14 444
Cost for contribution pension plan 5 590 4 905
Compensation to the Board 1 558 1 350
Other social costs 517 1 141
Total salary and social cost 146 376 134 507
Full time equivalent employees
USA 25 23
Germany 3 3
UK 1 1
Spain 4 2
Denmark 1 1
Norway 98 86
Total 132 116
AUDIT FEE FOR THE GROUP 2022 2021
1 = NOK 1000
Statutory Audit 1 842 1 685
Other services 110 155
Total Audit fee 1 952 1 840
The amounts are without VAT
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 5 Pension expenses and obligations
For Norwegian employees there is a contribution plan that covers 5 % of salary up to 7,1 G and 8 % of
salary between 7,1 and 12. 1G is the base amount in the social security system. Employees in the US
follows a pension plan, a 401k match that covers 4 % of salary. The total cost for the contribution plans
was in 2022 TNOK 5.590, while it was TNOK 4.905 in 2021. It is compulsory by law for the company to have
a pension plan for its employees in Norway. The pension plans in the company fulfill the obligation in the
Norwegian law. Employees outside Norway and US do not have a pension plan.
Note 6 Property, plant and equipment
PROPERTY PLANT AND EQUIPMENT
2022 2021
1 = NOK 1000
Equipment
Other
assets
Right-of-
use assets
Total
assets
Equipment
Other
assets
Right-of-
use assets
Total
assets
Historical cost
Balance 1. January
85 868 25 497 43 688 155 053 79 234 24 517 40 276 144 028
Additions
7 109 2 647 - 9 756 6 633 1 150 3 412 11 195
Disposals
- - - - - -170 - -170
31.December
92 977 28 144 43 688 164 809 85 868 25 497 43 688 155 052
Accumulated
depreciation and
impairment
Balance 1. January 58 821 17 875 19 496 96 191 52 065 14 952 12 328 79 345
Depreciation this
year
7 198 3 054 7 086 17 337 6 724 2 946 7 156 16 826
Disposals 32 - - 32
Exchange rate
differences
-4 36 -1 31 0 23 -12 11
31. December 66 023 20 892 26 583 113 497 58 821 17 875 19 496 96 191
Book value
26 954 7 253 17 105 51 312 27 047 7 623 24 192 58 862
Depreciation in %
14-33 % 20-33 % 12,5-50 % 14-33 % 20-33 % 12,5-50 %
Useful life
3-7 years 3-5 years 2-8 years 3-7 years 3-5 years 2-8 years
Depreciation
method
Linear Linear Linear Linear Linear Linear
Fully depreciated assets
Some assets with total historic cost value of 4.8 MNOK is fully depreciated as of 31.12.2022 but are still in use.
Security and right of use assets
Equipment and other assets is pledged as security as of 31.12.2022. The security is related to bank warranties
and hedging credit facility. The group’s bank had the same security as of 31.12.2021. See note
7 for right of
use assets.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 7 Right of use assets and lease liabilities
The company is renting offices in Økernveien 94 in Oslo, Bromsveien 17 in Horten and in 14000 25ave. N. Suite
108 in Plymouth in Minneapolis, Minnesota, USA. In Oslo and Horten the rental agreement expires in 2025 and
2027 respectively. In the USA the rental agreement expire year-end 2023. The rental is adjusted yearly according to
National indexes for goods and services. The lease in Økernveien 94 may be prolonged with 5 years after 2025, the
lease in Bromsveien 17 may be prolonged with 2 years after 2027. It is at present uncertain whether these leases
will be prolonged. The group also leases office equipment and cars. The longest remaining lease term for office
equipment and cars is until November 2024 and August 2025 respectively. Expenses related to short-term leases
amounted to 410 TNOK.
According to IFRS 16 leased assets are to be recorded in the balance sheet with a corresponding debt and the
lease expense recorded as depreciation and interest expense. Medistim's leased assets with right to use and
liabilities are shown below.
NOTE RIGHT-OF -USE ASSETS AND LEASE LIABILITIES 2022
1 =NOK 1000
Right-of-use assets
Buildings
Machinery and
equipment Vehicles
Recognition of right to use of asset 1 January 20 782 206 3 204 24 192
Addition of right-of-use assets, CPI adjustments and
other reassessment
- - - -
Amortisation 5717 80 1289 7 086
Carrying amount of right-of-use assets 31 December 15 065 126 1 915 17 105
Lower of remaining lease term or economic life 4-8 years 2-5 years 1-5 years
Depreciation method Linear Linear Linear
Lease liabilities
Undiscounted lease liabilities and maturity of cash
outflows
Less than 1 year 5 773 80 1 315 7 168
1-2 years 5 340 74 742 6 156
3-4 years 2 962 - 167 3 129
4-5 years 2 212 - - 2 212
More than 5 years - - - -
Total undiscounted lease liabilities at 31 December 16 287 154 2 224 18 665
Summary of the lease liabilities in the financial
statements
Statement of:
Lease liabilities as of January 1st 24 192
New lease liabilities recognised in the year -
Cash payments for the principal portion of the lease
liability
Cash flows
7 086
Interest expense on lease liabilities Profit and loss
226
Total lease liabilities at 31. December 17 105
Current lease liabilities Financial position 7 086
Non-current lease liabilities Financial position 10 020
Total cash outflows for leases Cash flows 7 312
65
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 8 Other operating expenses
OTHER OPERATING EXPENSES 2022 2021
1 = NOK 1000
Office expenses 1 722 152
Travel cost 10 843 4 955
Marketing 5 910 2 197
Consultants 27 254 25 194
Insurance 2 465 2 229
Freight 2 596 1 906
Communication 1 313 1 039
IT cost 14 463 12 253
Other 7 971 6 028
Total 74 537 55 950
Note 9 Financial revenue and expenses
As of 31.12.2022, the company had 17.1 MNOK in interest bearing liabilities. Additional cash in the group
gave interest revenue of 920 TNOK. Other finance revenue and expenses was realized or unrealized gains
or losses towards foreign currency. Financial revenue and expenses are shown below. See note 20 for
comment about financial risks and exposure.
FINANCIAL REVENUE AND EXPENSES 2 022 2 021
1 = 1000 NOK
Interest income 920 16
Other financial income 1 199 172
Gains on foreign exchange 14 427 7 985
Total financial income 16 546 8 173
Loss on foreign exchange 11 363 9 790
Interest cost on loans 123 178
Other financial expenses 262 412
Total financial expenses 11 748 10 380
Total financial income (+) expenses (-) 4 799 -2 207
66
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 10 Income tax
INCOME TAX 2022 2021
1 = NOK 1000
Current income tax charge 32 879 25 594
Correction from previous year -450 -
Deferred tax expense -352 -2 423
Income tax expense reported in income statement 32 077 23 171
Reconciling tax expense towards income before tax
Tax expense for the year 32 077 23 171
22% of income before tax 32 131 25 095
Change in deferred tax, temporary differences - -2 423
Permanent differences and different tax rates 54 -499
Calculation of effective tax rate 2022 2021
Expected income tax at tax rate 22 % in Norway 32 131 25 095
Permanent and other differences - -2 423
Foreign tax rate differences -54 499
Income tax expense 32 077 23 171
Effective income tax rate 22,0 % 20,3 %
Payable tax in the balance sheet
Income tax expense 32 879 25 594
Prepaid tax -7 006 -5 267
Total payable tax 25 873 20 327
Specification of deferred tax
Difference in values
Non current assets -1 769 317
Current assets -14 905 -15 479
Other obligations 348 435
Total differences -16 326 -14 726
Deferred tax asset 22 % -3 592 -3 240
Deferred tax asset recognized in the balance sheet -3 592 -3 240
The deferred tax asset in the balance sheet is based upon future utilization of deductible temporary
differences. There is no time limitation for utilization of the temporary differences. Tax rates in Germany
and in the US are different from Norwegian rates. The difference in tax rates reduces average tax rate in
2022 to 21.9%.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
TAX EXPENSE FOR THE GROUP IS GEOGRAPHICALLY SPLIT AS FOLLOWS: 2022 2021
1 = NOK 1000
Norway 26 231 17 390
Germany 2 354 2 479
USA 3 154 2 779
Spain - 265
Denmark 338 258
Total 32 077 23 171
Note 11 Earnings per share
EARNINGS PER SHARE 2022 2021
1 = NOK 1000
Profit for the year 113 973 90 900
Weighted average numbers of shares outstanding
Weighted average number of shares used in basic EPS 18 248 18 216
Effect of share options 29 33
Weighted average numbers of shares used in diluted EPS 18 277 18 249
Profit per share
Ordinary 6,25 4,99
Diluted 6,24 4,98
Paid dividend 54 640 54 640
Dividend per share 3,75 3,00
Suggested dividend per share 4,50 3,75
The company has only one class of shares. Ordinary earning per share is calculated as the relation between
profits for the year that is allocated to ordinary shareholders divided with average number of shares
outstanding. Treasure shares are not included and average number of treasury shares are excluded from
the calculation. In 2022, there were share options to CEO. The share option plan to CEO is described under
8.12 Remuneration of executive personnel and note 21. By year-end the company had 87 033 own shares.
Note 12 Intangible assets
Product technology and additions, goodwill and license agreement
In 2022, 11.85 MNOK of product technology additions, was recognized in the balance sheet related to the
MiraQ products. The MiraQ platform forms the basis for future models from Medistim. All development
activity is performed in the parent company.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
INTANGIBLE ASSETS 2022
Product under
development
Technology and
development cost
Goodwill
License
agreement
Total
intangible
1 = NOK 1000
Historic cost
Historic cost 31 Dec 22 1 334 80 594 14 128 2 158 98 214
Internal additions in use (1 334) 1 334 - - -
External additions in use - - - - -
Additions under development 11 851 - - - 11 851
Historic cost 31 Dec 22 11 851 81 928 14 128 - 107 907
Accumulated depreciation and
write downs
- 65 887 - 2 158 68 045
Depreciations for the year - 5 952 - - 5 952
Total depreciation as of 31 Dec 22 - 71 839 - - 71 839
Carrying amount 31 Dec 22 11 851 10 089 14 128 - 36 068
INTANGIBLE ASSETS 2021
Product under
development
Technology and
development cost
Goodwill
License
agreement
Total
intangible
1 = NOK 1000
Historic cost
Historic cost 31 Dec - 77 844 14 128 2 158 94 131
Internal additions in use - 1 952 - - 1 952
External additions in use - 797 - - 797
Additions under development 1 334 - - - 1 334
Historic cost 31 Dec 1 334 80 594 14 128 2 158 98 214
Accumulated depreciation and write
downs
- 59 824 - 1 618 61 442
Depreciations for the year - 6 063 - 539 6 602
Total depreciation as of 31 Dec - 65 887 - 2 158 68 044
Net value in balance sheet 1 334 14 707 14 128 - 30 170
Intangible assets are depreciated on a straight-line
basis over the useful life. Useful life for capitalized
product development is 3 to 8 years.
Product technology
Probes to vascular surgery – the PV probe
Within vascular surgery, there is a corresponding
need to measure blood flow in the same manner as
within cardiac surgery. Some vascular surgeons are
already using Medistim’s equipment despite the fact
that the probes are designed for cardiac surgery. The
company has seen an increasing demand over time
and in 2011, the company developed a specially
designed probe for use in the vascular area. The
market in vascular surgery is large and it is performed
about 900,000 procedures annually. In comparison,
about 700,000 procedures are performed per year
within cardiac surgery. This is a significant market
where Medistim can customize its solution with a
modest investment. Book value as of 31.12.2022 was
1.7 MNOK. Expected useful life for the PV probes are
8 years.
4th generation of systems; the MiraQ
Entering into 2022, Medistim had invested 39.2
MNOK in the system platform that represent
Medistim's 4th generation of systems within flow
69
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
measurement and imaging to ensure quality
and guiding during surgery. The platform has a
flexibility that will allow customer adaption and
new applications. The technological improvements
have secured and strengthen Medistim’s leading
position. The product, MiraQ Cardiac, based upon
the platform, was launched by the end of 2014.
The MiraQ Vascular system was introduced in
2015 together with the new vascular flow probes
late 2015. At the same time the MiraQ Ultimate
was introduced that combines the two cardiac
and vascular modalities. Book value for the MiraQ
platform by year-end was 8.3 MNOK. Expected
lifetime for the product is 8 years.
Additions under development:
This is related to the development of new cardiac
flow probes. The aim is to modernize design for
the user to make it easier to use, but also develop a
design that is more efficient to have in production.
Medistim has several years of experience with in
house production and input from customers on a
better design on the probe for the user. With this
extensive experience and knowledge it is likely
that a new probe will be developed with success.
In 2022 3.3 MNOK was invested in the project and
book value by year end 2022 was 4.9 MNOK.
The next generation of software within both
cardiac segment and vascular segment was under
development during 2022. The new software
has a new user interface and tools to aid the
interpretation of the results. Medistim’s Innovation
team has together with Key Opinion Leaders
tested several prototypes to identify the preferred
solution. In 2022 5.1 MNOK was invested in the
software project and book value by year end 2022
was 5.1 MNOK.
Medistim needs to be compliant with the new
Medical Device Regulation (MDR) In 2022 1.9
MNOK was invested in making Medistim MDR
compliant.
Summary product technology
In total 13.9 MNOK of the R & D expenses was
recorded in the P & L in 2022. Similar expense was
14.5 MNOK in 2021. With 11.85 MNOK recognized
as asset a total of 25.75 MNOK was used in R & D
in 2022. Comparable number for 2021 was 18.6
MNOK. Medistim received TNOK 376 in Skattefunn
funds in 2021 and TNOK 236 in 2022.
In the estimates used to test for impairment, the
3-year strategy plan is used with a discount rate of
14.6%. See comment under goodwill with regard
to discount rate.
Goodwill
A yearly test of values is done for the cash flow
generating units that has a goodwill value in the
balance sheet.
GOODWILL 2022 2021
1 = NOK 1000
Acquisition of Medi-Stim
Norge AS
7 960 7 960
Acquisition of Kir-Op AS
(merged with Medistim
Norge AS in 2006)
6 168 6 168
Total goodwill 14 128 14 128
A test of values is performed by estimating the
cash flow for Medistim Norge AS. This is estimated
using the company’s budget for 2023 and 3-year
strategy plan for the years 2024 to 2026 with the
assumption of 2 % growth in 2026 compared to
2025. Cash flows for more than five years are
estimated by using Gordon’s growth formula with
a 2 % growth in the terminal year. The cash flow
is discounted using 14.6 % discount rate. This
includes an additional yield of 9.1 % compared
to risk free interest. The value of the discounted
cash flow exceeded the recorded book value in the
balance sheet and there was no need for a write
down of goodwill.
The estimates in the tests are most sensitive to
changes in the following parameters:
• Maintaining market share and product lines
• Maintaining margins and keep competitive prices
• Level of minimum return on investment
• Future growth
• Employee know-how
Maintaining market share and product lines:
Within the medical device industry there are
major investments done in the development of
products. Medistim Norge has certain product lines
that have a large portion of total sales. Medistim
Norge’s financial situation will be affected if a new
product was released in the market that would
replace existing key products, and Medistim Norge
is not distributor for the new product. The company
would also be affected if a supplier changes
70
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
distributor or chooses to go direct in the Norwegian
market. For this reason it is important for the
company to maintain know how and performance
to secure key product lines. It is equally important
that the company is able to see trends and take in
new products with a future potential. The largest
product line for the company has 20 % of total sales.
If this product line is lost together with another line
that is 5 – 10 % of total sales, all goodwill needs to
be written down.
Maintain margins and keep competitive prices:
The company is well connected to its suppliers
and when the competition increases the suppliers
is contributing by lowering their prices. However,
it is not realistic to expect that the suppliers will
compensate for all of the reduction in prices. The
company’s experience is that about 50 % of the price
change is covered by the suppliers in an increased
competitive situation. A price reduction of 10 %
without any compensation from the suppliers is the
break even level for write down of goodwill.
Rated average capital cost (WACC):
The company uses a WACC that is equal to risk
free interest with an addition of 9.1 %). This level
is evaluated on a yearly basis and a change in the
WACC could affect the evaluation of the intangible
assets. Risk-free interest rate is based on 10-year
government bond that at the beginning of the year
was 5.5%. Including risk free interest of 5.5 % the
total discount rate in 2022 is set to 14.6%.
Future growth:
It is projected growth in sales with a variation
from 3% to 2% in the budget and strategy period,
and with 2% growth in the terminal value. To be
able to maintain this increase it is crucial that
the company handles existing product lines in an
effective manner and that the company is able to
identify and get distribution agreements for new
product lines that create more business than lost
product lines.
Employee know-how:
Medistim Norge has over the years built a
competence within the medical device industry
and distribution. It is essential that this know-how
is updated and passed on to new employees.
Sensitivity analysis:
With the assumption used in the impairment test,
the recoverable amount exceeds the carrying
amount with 80,0 MNOK ("headroom"), and no
impairment loss is recognized. Operating margin
and growth is based upon historic achieved margin
and sales growth. In the estimates the budget and
the projections from the 3 year strategy update
is used. The operating margin in the projections
vary between 13.7 and 15.7 %. Sales growth vary
between 3% and 2 %
If the operating margin is reduced from 15.0%
to 3.5% everything else equal, carrying amount
would require an evaluation of impairment loss. A
change in the discount rate from 14.6 % to 55.0 %
everything else equal, would cause an impairment
loss. See overview below.
HEADROOM
WACC 14,6 % 28,0 % 55,0 %
Headroom in MNOK 80,0 34,6 11,9
Operating margin 15,0 % 10,0 % 3,5 %
Headroom in MNOK 80,0 16,8 -5,3
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 13 Shares in subsidiaries
All subsidiaries are 100 % owned and Medistim has all votes. Medistim Norge AS has offices at Økern in Oslo.
Medistim USA Inc has offices in Minneapolis in the USA. Medistim Deutschland GmbH has offices in Munich
in Germany, Medistim Denmark has offices in Copenhagen Denmark, Medistim Spain S.L has offices in Madrid
and Medistim UK has offices in London UK. None of the subsidiaries are listed at a stock exchange.
SHARES IN SUBSIDIARIES
1 = NOK 1000
Unit Country Segment Ownership
Value
31.12.22
Medistim USA Inc. USA Lease and sale within bypass surgery and
vascular surgery
100% 135
Medistim Deutschland
GmbH
Germany Capital sales within bypass surgery and
vascular surgery
100% 188
Medistim Norge AS Norway Sale of 3 party products and capital sales
within bypass surgery and vascular surgery
100% 36 953
Medistim UK LTD UK Capital sales within bypass surgery and
vascular surgery
100% 1
Medistim Japan KK Japan
Dormant company
100% 86
Medistim Spain S.L
Spain
Capital sales within bypass surgery and
vascular surgery
100% 28
Medistim Danmark Aps Denmark Sale of 3 party products and capital sales
within bypass surgery and vascular surgery
100% - Owned
indirectly
through
Medistim
Norge AS with
book value of
TNOK 1 103
Note 14 Inventory
SPECIFICATION OF INVENTORY 2022 2021
1 = NOK 1000
Raw material 54 263 51 861
Work in progress 2 467 2 139
Finished goods 42 836 30 711
Spare parts 9 694 7 146
Third party products 12 001 12 235
Inventory provision -6 928 -6 678
Total 114 333 97 413
Finished goods are measured at cost which includes cost for components and internal labor cost. Work
in progress is valued at the total of the component cost and labor cost. The inventory level in 2022 is
at a higher level than compared to 2021. It is necessary for the company to keep an additional security
inventory for critical components for own developed products. Due to a strict regulatory regime within
medical device it takes time to introduce new devices or components. At the same time the tendency is
that electronic components life circle is shorter. For this reason inventory level is high to secure future
deliveries for Medistim developed products. Inventory is used as security for loan, see note 18.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
SPECIFICATION OF INVENTORY PROVISION 2022 2021
1=NOK 1000
Gross value Provision Gross value Provision
Demonstration products 4 763 2 687 6 105 3 074
Spare parts 7 327 4 041 4 170 3 404
Third party products 200 200 200 200
Total 12 290 6 928 10 475 6 678
Note 15 Accounts receivables and other receivables
ACCOUNTS RECEIVABLE 2022 2021
1 = NOK 1000 2022 2021
Accounts receivable 102 654 68 993
Provision for bad debt -997 -359
Total 101 657 68 634
POVISION FOR BAD DEBT 2022 2021
1 = NOK 1000
Inbound provision 359 359
Increased provision 638 -
Total 997 359
AGING ACCOUNTS RECEIVABLE
1 = NOK 1000
Not due 0-30 days 31 - 60 days 61 - 90 days Total
Year
2022
Expected loss in % 0,00 % 0,00 % 0,00 % 11,34 %
Book value of receivables 72 381 9 885 11 597 8 791 102 654
Expected credit loss - - - 997 997
Total 72 381 9 885 11 597 7 794 101 657
1 = NOK 1000
Not due 0-30 days 31 - 60 days 61 - 90 days Total
Year
2021
Expected loss in % 0,00% 0,00% 1,00% 7,75%
Book value of receivables 43 640 16 847 3 862 4 284 68 634
Expected credit loss - - 27 331 358
Total 43 640 16 847 3 835 3 953 68 275
All receivables are due within one year. Historically the group losses have been limited. End customers
are often public hospitals with government funding and the risks for losses are low. However, days sales
outstanding is high compared to other businesses, something that the aging receivables confirm.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Receivables is used as security, see note 18. Other receivables are shown in the following table:
OTHER RECEIVABLES 2022 2021
1 = NOK 1000
Other pre-payments 4 553 6 076
Accrued income - 4 571
Unrealized foreign currency 3 880 -
VAT receivable 8 840 -
Other (10) 312
Total 17 263 10 960
Note 16 Cash
CASH 2022 2021
1 = NOK 1000
Available cash in bank 144 164 124 866
Restricted cash in bank 8 477 4 624
Total cash in bank 152 641 129 490
Credit limit - 22 500
Cash available 144 164 147 366
Restricted cash as of 31.12.2022 was 8 477 TNOK and was related to tax withheld from salaries. As of
31.12.2021 the restricted cash was 4 624 TNOK related to tax withheld on salaries. The holding company
terminated the credit facility of 22.5 MNOK in 2022.
Note 17 Shareholder information
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 2022
Number of shares Par value per share Share capital in NOK
Share capital 01.01.2022 18 337 336 NOK 0.25 NOK 4 548 334.00
Changes - - -
Share capital 31.12.2022 18 337 336 NOK 0.25 NOK 4 548 334.00
The Board of Directors received by the shareholders meeting the 27th of April 2022 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 2023 in the price range of NOK 0.25 to NOK 400 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 2023. See below for changes in the equity for the last year.
74
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
STATUS FOR THE PERMISSIONS AS OF 31.12.2022
Capital increase Medistim shares
Permission given at the shareholders meeting in 2022 1 833 733 1 833 733
Permissions used - -
Number of shares 31.12.2022 1 833 733 1 833 733
The company owned 87 033 Medistim shares as of 31.12.2022. Number of Medistim shares by 01.01.2022
was 108 422.
The 20 largest shareholders in the company were as of 31 December 2022:
20 LARGEST SHAREHOLDERS
Shareholder Number of shares In % of total Nationality
AETERNUM CAPITAL AS 1 862 500 10,16 % Norway
FLØTEMARKEN AS 1 285 000 7,01 % Norway
State Street Bank and Trust Comp 1 238 298 6,75 % United States
VERDIPAPIRFOND ODIN NORDEN 1 200 000 6,54 % Norway
FOLLUM INVEST AS 970 000 5,29 % Norway
State Street Bank and Trust Comp 925 561 5,05 % United States
Skandinaviska Enskilda Banken AB 905 805 4,94 % Sweden
State Street Bank and Trust Comp 667 953 3,64 % United States
ODIN Small Cap 600 000 3,27 % Sweden
Skandinaviska Enskilda Banken AB 526 693 2,87 % Denmark
The Northern Trust Comp, London Br 433 545 2,36 % United States
State Street Bank and Trust Comp 422 259 2,30 % United States
Skandinaviska Enskilda Banken AB 414 011 2,26 % Sweden
SKANDINAVISKA ENSKILDA BANKEN AB 396 843 2,16 % Luxembourg
BUANES 381 876 2,08 % Norway
RBC Investor services bank S.A. 330 708 1,80 % Luxembourg
Skandinaviska Enskilda Banken AB 275 048 1,50 % Sweden
The Bank of New York Mellon SA/NV 270 000 1,47 % Denmark
BNP Paribas 265 000 1,45 % France
BNP Paribas 243 491 1,33 % France
Total 20 largest shareholders 13 614 591
Total number of shares outstanding 18 337 336
20 largest shareholders in % 74,25 %
75
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
BOARD MEMBERS AND MANAGEMENT TEAM WITH SHARES IN THE COMPANY
Shareholder Number of shares In % of total Position
Tove Raanes via Trane AS 1 990 0,01 % Board member
Roger Morberg 12 849 0,07 % VP sales
Erik Swensen 10 994 0,06 % VP development
Thomas Jakobsen 25 979 0,14 % CFO
Kari Eian Krogstad 63 802 0.35 % CEO
Siri Fürst 2 000 0.01 % Board member
Øyvin A. Brøymer (Fløtemarken AS) 1 285 000 7.01 % Chair
Anne Waaler 2 440 0,01 % VP medical dep.
Håkon Grøthe (Grøten Invest AS) 4 411 0,02% CIO
Mike Farbelow 1 990 0,01% President MSUS
Ole Jørgen Robsrud 2 205 0,01% Adm.dir MSN
Tone Veiteberg 1 990 0,01% VP QA\Regulatory
Hæge Wetterhus 663 0,004% VP Marketing
Lars Rønn 885 0.005 % Board member
Ole Arne Eiksund 2 422 0,01% Chief Bus.Dev. Officer
There were no share options outstanding as of 31.12.2022 except from the share program to CEO
described under 8.12 Remuneration of executive personnel and note 21.
Note 18 Long-term liabilities
LONG-TERM
LIABILITIES 2022 2021
Interest rate Last due date
Carrying
amount
Carrying
amount
Secured loan
Lease liabilities 3-4 % 30/09/27
17 106 24 192
Deferred revenue
5 126 2 510
Total liabilities
22 231 26 702
Lease liabilities due within one year -7 086 -7 113
Total non current liabilities 15 145 19 589
The bank has collateral in property, plant and equipment, accounts receivable and inventory in the
holding company and the Norwegian subsidiary. The collateral in property, plant and equipment, accounts
receivables and inventory is not limited. Book value of pledged property, plant and equipment was as of
31.12.2022 30.5 MNOK, 80.2 MNOK for accounts receivables and 84.7 MNOK for inventory. The company
had no interest bearing debt. The lease agreements are described under note 7.
76
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 19 Other short term liabilities:
OTHER LIABILITIES 2022 2021
1 = NOK 1000
Accrual for public taxes 7 168 8 972
Accrual for holiday pay 8 511 7 140
Accrual for salaries, commission and board member fee 17 070 14 703
Accrual for customer and supplier obligations 6 354 966
Other 2 938 4 828
Total 42 042 36 609
Note 20 Financial Risk
The group’s financial liabilities are leasing agreements, and accounts payable. The financial liabilities and
facilities are important instruments that contribute to the financing of the group’s operational activities.
The group’s financial assets are accounts receivables, and cash. From time to time the group also enters
into financial derivative contracts to hedge currency exposure. Hedge accounting is not applied. The risk
arising from financial instruments is market risk, credit risk towards customers, and liquidity risk.
Interest rate risk:
The group had as of 31 December 2022 no interest bearing debt. If the group needs a loan it is group
policy to have floating interest since this will be the lowest interest rate over time. In general, the group
considers the exposure towards changes in interest rates as low.
Foreign exchange rates risk:
Change in exchange rates involves a direct and indirect financial risk for Medistim ASA. The group has
revenue and expenses in EUR and USD where most revenue is in EUR and USD and expenses mostly in
NOK. To neutralize net exposure derivative contracts are evaluated. The development in NOK towards
USD and EUR is continuously monitored. By the end of 2022, the group had derivative contracts for USD as
shown below. Hedging contracts are entered to reduce the exchange risk towards currencies. Unrealized
gain or loss related to the contracts are recorded in the balance sheet and the change of value related
to the contracts is recorded in the profit and loss. The management and Board of directors evaluate
the handling of risks related to exchange rates fluctuations continuously together with its professional
advisers.
HEDGING CONTRACTS
Currency
Number of
contracts from
March 2023
Amount per
month
Total value of
contracts in
currency
Average rate
on contracts
Rate
31.12.2022
Unrealized
gain/loss
USD 6 200 000 1 200 000 10,50 9,86 775 800
The group had a credit facility of 6.0 MNOK to enter hedging contracts. The facility represents 10 % of
the value of the contracts the group can use and the Group can enter hedging contracts for a total of
60 MNOK. Security related to the facility is related to assets, accounts receivable and inventory with no
limit. Book value of secured items was as of 31.12.2022 30.5 MNOK for assets, 80.2 MNOK for accounts
receivables and 84.7 MNOK for inventory
77
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
FINANCIAL ASSETS AND LIABILITIES
1 = NOK 1000
2022 2021
Original value Gain\loss Book value Original value Gain\loss Book value
Financial assets
Cash in USD 1 373 1 236 2 609 9 985 709 10 694
Cash in EUR 9 511 -129 9 382 13 026 82 13 108
Accounts receivable in EUR 44 881 530 45 411 28 364 -541 27 823
Forward curency contracts - 775 775 - - -
Financial debt
Accounts payable in EUR 2 670 1 2 669 2 855 17 2 838
Accounts payable in USD 332 3 335 207 -3 204
EFFECT ON PROFIT IF CURRENCY CHANGES WITH 5%
1 = NOK 1000 2022 2021
Original value Gain\loss Book value Original value Gain\loss Book value
Total exposure towards EUR 51 722 400 52 124 38 535 -476 38 093
Total exposure towards USD 1 041 2 008 3 049 9 778 712 10 490
5 % increase EUR 2 606 1 905
5 % increase USD 152 525
5 % decrease EUR -2 482 -1 814
5 % decrease USD -145 -500
Credit and liquidity risk:
Other financial risk as credit risk and liquidity risk is viewed by the group as low based upon the group’s
financial position as of 31 December 2022.
Credit risk:
The group is at some extent exposed towards credit risk. The general risk is low since the majority of
customers are financed by public authorities. Still history records for payments, the size of the transaction
and the other party’s credit risk is evaluated from case to case. The level of credit given is evaluated
when there is a change in market conditions. The level of risk is reduced by using bank guaranties and
prepayments in cases where the level of risk is found to be higher than normally accepted.
See note 15 for a table showing the aging of accounts receivable.
Liquidity risk:
Liquidity risk is the risk that the group is not able to meet its obligations in time. Managing liquidity risk is
therefore prioritized to secure financial flexibility. Medistim main source of cash is cash generated from
operations. The group has over the last 5 years experienced an increase in profit and available cash.
Therefore, the group has been able to build up a cash reserve due to strong profits to handle the increased
need for working capital as the group grows. The liquidity buffer also secures cash in situations where the
incoming cash is delayed.
78
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
COVID 19 pandemic and macroeconomic turmoil
Since the pandemic started to affect the Medistim business in second quarter of 2020, the effect has
become gradually smaller, and in the second quarter of 2021, there was a strong rebound in procedures
performed and hence in the sales revenues. This rebound has continued throughout 2021. While Medistim
has been affected by the COVID situation, the company have been able to deliver solid profit and cash flow.
The need for Medistim’s products has not changed, and the strong recovery seen through 2021 and the
growth that continues in 2022, may indicate that cardiac bypass surgeries are back to normal. However,
there are still some uncertainties related to new variants of the virus.
The global market is facing macro-economic turmoil, with energy crisis, inflation pressure, increasing
interest rates and cost levels and uncertainty related to the Ukrainian war. 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
76.6 %.
With these uncertainties the need for Medistim’s products has been confirmed through the last two years
growth development. Despite the pandemic, macroeconomic turmoil and the Ukrainian war, the companies
solutions continue to have an increasing demand among cardiac and vascular surgeons.
The table below sets out the maturity profile of the financial liabilities based on contractual undiscounted
payments.
OVERVIEW OF DEBT
1 = NOK 1000
Year 2022
Within 3 months Between 3-12 months 1 to 5 years Over 5 years Total
Lease liabilities
1 410 4 230 11 787 17 427
Accounts payable 24 470 - - - 24 470
Deferred revenue 338 1 015 3 773 5 126
Income tax - 25 873 25 873
Other debt (see note 19 & 22) 42 072 - - - 42 071
Total 68 290 31 118 15 560 - 114 967
Year 2021
Within 3 months Between 3-12 months 1 to 5 years Over 5 years Total
Interest bearing loans - - - - -
Lease liabilities 1 778 5 335 11 738 5 341 24 192
Accounts payable 13 205 - - - 13 205
Deferred revenue 2 510 2 510
Income tax 20 327 20 327
Other debt (see note 18,19,22) 33 815 3 143 - - 36 958
Total 48 799 28 804 14 248 5 341 97 192
Financial strategy:
Management strives to strengthen the group’s healthy financial position through profit and a high level
of equity. This will secure continued growth and will maximize shareholders values. The group will adjust
capital structure to adapt to changes in the financial climate. Capital structure can be adjusted through
dividend, repayment of share capital or issue new shares. There were no changes in the financial strategy
in the group in 2021 or 2022.
79
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 21 Related party transactions
Compensation to management
The management group consists of 13 people including CEO. The managing directors in the subsidiaries
are included in the management group.
COMPENSATION AND BENEFITS TO THE MANAGEMENT GROUP IN 2022
Management Position Salary Bonus Pension
Share based
compensation Other Total
Hæge Johanne
Krogh Wetterhus
VP Marketing 1 529 890 198 839 97 464 - 7 909 1 834 102
Anne Waaler VP Medical 1 525 816 178 571 80 424 - 10 723 1 795 534
Roger Reino
Morberg
VP Sales 1 821 454 383 929 94 584 137 750 9 783 2 447 500
Erik Swensen VP Development 1 526 290 162 500 90 864 - 4 524 1 784 178
Tone Ann
Veiteberg
VP QA\Reg 1 323 097 196 429 72 708 - 4 524 1 596 758
Ole Jørgen
Robsrud
CEO Medistim
Norge AS
1 435 094 240 000 91 800 50 000 8 863 1 825 757
Helge Børslid VP Operations 1 417 244 73 661 84 600 - 4 524 1 580 029
Ole Arne Eiksund Chief Bus.Dev.
Officer
902 297 58 208 137 750 1 101 183
Håkon Grøthe VP Innovation 1 427 634 205 357 84 900 137 750 4 530 1 860 171
Mike Farbelow President
Medistim USA
2 233 316 800 311 89 333 - 108 583 3 231 543
Cindy Kaffai CEO Medistim
Germany
1 358 834 296 778 - - 1 655 612
Kari Eian
Krogstad
CEO Medistim
group
3 144 358 1 205 357 101 592 4 410 000 4 527 8 865 834
Thomas
Jakobsen
CFO Medistim
Group
2 050 394 312 500 91 800 183 750 4 530 2 642 974
Total
21 695 717 4 254 233 1 038 277 5 057 000 179 186 32 224 412
There are no severance pay agreements towards any in the management team in case of leaving the company.
All members of the management group have a two-way arrangement of 3 months’ notice. The exception is
management in the US that has no notice period. The management group has the same pension plan as other
employees. For Norwegian members of the management group, 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 equals NOK 111.477. Management in the US
has a contribution plan that covers 4 % of salary.
The board decides incentives to CEO. Bonus and incentives to the management group is decided by the CEO.
Bonus and incentives for both management group and CEO is based on achieved results. The table shows the
bonus paid in 2022. Some members of the management group has loan from the company related to the share
program offered to the Management team in 2022. The below table shows who in the management team
purchased shares at a discount and has loan form the company.
80
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
SHARE PROGRAM FOR THE MANAGEMENT GROUP IN 2022
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 Chief Bus.Dev.
Officer
551 000 137 750 688 750 2 422 551 000
Roger Reino
Morberg
VP Sales 551 000 137 750 688 750 2 422 -
Ole Jørgen
Robsrud
CEO Medistim
Norge AS
200 000 50 000 250 000 879 200 000
Håkon Grøthe VP Innovation 551 000 137 750 688 750 2 422 -
Thomas Jakobsen CFO Medistim
Group
735 000 183 750 918 750 3 231 735 000
Total
2 588 000 647 000 3 235 000 11 376 1 486 000
For every fourth share purchased one share was given for free with a vesting period of 3 years. The loans
are at tax free rate and are due for payment when the vesting period is over. The agreements was entered
the 25th of June 2022.
Compensation to the board was 1 450 TNOK in 2022 and 1 300 TNOK in 2021. The Chair received 450 TNOK
as compensation in 2022 and 400 TNOK in 2021 The four board members received a total 250 TNOK each as
compensation in 2022, a total of 1000 TNOK. In 2021 they received 225 TNOK each, a total of 900 TNOK.
The nomination committee leader received a compensation of 20 TNOK, while the two other members
received 15 TNOK each. In total, the nomination committee received 50 TNOK as compensation.
Compensation to Audit committee and renumeration committee was 50 TNOK and 35 TNOK respectively.
CEO has an agreement with the Board that she can receive up to 28.500 Medistim shares as part of
compensation if in position until 2025. The Shares is received by the CEO free of charge and last shares
will be received in 2026. Fair value of the share based payment is the share price at grant date multiplied
with the and number of shares granted. The fair value of the share based payment is expensed over the
vesting period. In 2022, TNOK 2 475 including social security tax was expensed in the accounts related to
the arrangement. See also overview below.
SHARE PROGRAM CEO
Year 2022 2023 2024
Opening balance
Exercised
Shares granted 12 000 9 000 7 500
Ending balance 12 000 21 000 28 500
Share price at the time of grant in NOK 167 254 296
Total expense in NOK 2 004 000 2 286 000 2 220 000
Expense per grant per year in NOK 668 000 762 000 740 000
Annual expense in NOK for the grant in 2022 2 170 000
Transactions with related parties
There were no other transactions towards related parties in 2021 or in 2022.
81
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 22 Provisions
PROVISIONS 2022 2021
1 = NOK 1000
Warranty provision 350 350
Sum 350 350
Note 23 Exchange rates foreign currency
EXCHANGE RATES FOREIGN CURRENCY
Currency Rate 01.01.2022 Average rate Rate 31.12.2022
USD 8.8194 9.6245 9.8573
DKK 134.32 135.81 141.38
EUR 9.9888 10.1040 9.9888
GBP 11.8875 11.8176 10.5138
Note 24 Changes in liabilities arising from financial activities
CHANGES IN LIABILITIES ARISING FROM FINANCIAL ACTIVITIES
1 = NOK 1000
Interest
bearing short
term debt
Deferred revenue
and interest
bearing long term
debt
Lease
agreements
short term
Lease
agreements
long term
Total
2022
At 1st of January 2022 - 2 510 7 114 17 078 26 701
Cash flows lease agreements - - -7 312 - -7 312
Debt becomming current in 2022 - - 7 284 -7 058 226
Effects of foreign exchange - - - - -
Deferred revenue - 2 616 - - 2 616
31.December 2022
- 5 126 7 086 10 020 22 232
1 = NOK 1000
Interest
bearing short
term debt
Deferred revenue
and interest
bearing long term
debt
Lease
agreements
short term
Lease
agreements
long term
Total
2021
At 1st of January 2021
3 000 7 845 6 881 21 651 39 377
Debt forgiveness - -5 348 - - -5 348
New lease agreements - - - 3 412 3 412
Interest bearing debt -3 000 -1 500 - - -4 500
Cash flows lease agreements - - -7 502 - -7 155
Debt becoming current in 2021 - 0 7 754 -7 985 -578
Effects of foreign exchange - - -19 - -19
Deferred revenue - 1 513 - - 1 513
31.December 2021
0 2 510 7 114 17 078 26 701
Note 25 Events after 2022
The Board of directors has no knowledge about events after 2022 that will affect the annual report and
financial statement for 2022.
82
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
11. PARENT COMPANY FINANCIAL STATEMENTS
11.1 Income Statement Medistim ASA
INCOME STATEMENT MEDISTIM ASA 2022 2021
1 = NOK 1000 Note
Operating income and expenses
Revenues
Sales revenue 26 293 169 255 574
Other income 26 15 476 2 944
Total revenue 308 645 258 518
Operational expenses
Cost of goods sold 63 993 54 582
Salary and social expenses 27 80 239 73 536
Depreciation on assets 28 13 888 13 715
Other operating expenses 27,29,39 48 832 39 405
Total operating expenses 206 952 181 238
Operating profit 101 693 77 280
Financial income and expenses
Dividend from subsidiaries 31 26 762 24 000
Other financial income 37 14 280 7 529
Financial expenses 37 13 286 11 446
Net finance 27 756 20 083
Profit before tax 129 449 97 363
Tax expense 30 21 342 16 682
Profit for the year 108 107 80 681
Allocations
Dividend 36 82 135 68 358
Other equity 36 25 972 12 324
Total Allocation 108 107 80 681
Earnings per share
Ordinary 5,93 4,43
Diluted 5,92 4,42
Dividend per share 4,50 3,75
83
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
11.1 Income Statement Medistim ASA
INCOME STATEMENT MEDISTIM ASA 2022 2021
1 = NOK 1000 Note
Operating income and expenses
Revenues
Sales revenue 26 293 169 255 574
Other income 26 15 476 2 944
Total revenue 308 645 258 518
Operational expenses
Cost of goods sold 63 993 54 582
Salary and social expenses 27 80 239 73 536
Depreciation on assets 28 13 888 13 715
Other operating expenses 27,29,39 48 832 39 405
Total operating expenses 206 952 181 238
Operating profit 101 693 77 280
Financial income and expenses
Dividend from subsidiaries 31 26 762 24 000
Other financial income 37 14 280 7 529
Financial expenses 37 13 286 11 446
Net finance 27 756 20 083
Profit before tax 129 449 97 363
Tax expense 30 21 342 16 682
Profit for the year 108 107 80 681
Allocations
Dividend 36 82 135 68 358
Other equity 36 25 972 12 324
Total Allocation 108 107 80 681
Earnings per share
Ordinary 5,93 4,43
Diluted 5,92 4,42
Dividend per share 4,50 3,75
11.2 Balance Sheet Medistim ASA
BALANCE SHEET MEDISTIM ASA 31/12/22 31/12/21
1 = NOK 1000 Note
Assets
Non current assets
Intangible assets
Deferred tax 30 2 275 1 501
Marketing rights 29 1 1
R & D 28,29 21 940 16 041
Fixed assets
Property, plant and equipment 28 26 693 26 297
Office equipment 28 2 759 2 316
Financial assets
Shares in subsidiaries 31 37 392 37 392
Other long term receivables 31 11 974 10 992
Total non current assets 103 035 94 540
Current assets
Inventory 33 84 702 73 704
Accounts receivables 32,41 91 109 48 908
Other receivables 32,41 19 298 18 145
Cash 34 84 033 75 149
Total current assets 279 143 215 907
Total assets 382 178 310 447
Equity
Issued capital
Share capital 30,36 4 585 4 585
Share premium 30,36 41 852 41 852
Other paid in equity 36 18 721 13 317
Other equity
Retained earnings 36 126 538 100 595
Total equity 191 696 160 349
Liability
Other long term debt
Long term debt 40 39 429 35 278
Total other long term debt 39 429 35 278
Short term debt
Interest bearing short term debt 40 - -
Accounts payable 18 024 6 791
Payable tax 30 22 116 16 700
Employee withholding, social security taxes 13 025 11 025
Dividend
36
82 126 68 358
Other short term debt 38,41 15 761 11 946
Total short term debt 151 061 114 820
Total equity and liability 382 178 310 447
84
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
11.3 Cash Flow Statement
CASH FLOW STATEMENT 2022 2021
1 = NOK 1000 Note
Cash flow from operations:
Profit/loss before tax 129 449 97 363
Minus income tax paid -16 521 -9 749
Plus this years tax expense
Plus depreciations 28 13 888 13 715
Change in inventory 33 -10 997 13 850
Change in accounts receivable 32 -42 201 -11 383
Change in accounts payable 11 233 -1 852
Other changes 7 150 -8 910
Net cash from operating activities 92 001 93 035
Investing activities:
Minus investment in assets 28 -20 124 -11 124
Net cash from investing activities -20 124 -11 124
Financing activities:
Minus down payment of long term debt 40 - -4 500
Dividend 36 -68 396 -54 640
Issue of new equity 5 404 7 589
New loans - 24 834
Net cash from financing activities -62 992 -26 717
Net change in cash 8 885 55 194
Cash as of 01.01 75 149 19 955
Cash as of 31.12 84 034 75 149
Available cash and cash withholding
Available cash as of 31.12 34 77 019 71 931
Cash withholding for taxes 34 7 015 3 218
Cash and cash equivalents as of 31.12 84 034 75 149
85
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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.
86
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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 2022 2021
1 = NOK 1000
USA 120 518 89 062
Asia 76 793 66 804
Europe 100 443 91 151
Rest of the world 10 891 11 501
Total sales 308 645 258 518
Other revenue amounted to TNOK 15 476, where TNOK 3145 was income related to services towards
subsidiaries and TNOK 12 331 was management fee. For 2021 other income amounted to 2 944 TNOK and
was related to services towards subsidiaries.
The total number of employees was through the year 84. 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 111.477) in the social security system. The cost for the contribution plan was in 2021 TNOK 3 015, 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.
87
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
The total number of employees was through the year 84. 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 111.477) in the social security system. The cost for the contribution plan was in 2021 TNOK 3 015, 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.
Note 27 Salaries and other benefits
SALARIES AND OTHER BENEFITS 2022 2021
1 = NOK 1000
Salary 67 564 61 047
Social taxes 10 734 8 815
Other salary and social expenses 1 940 3 674
Total salary expenses 80 239 73 536
The total number of employees was through the year 84. 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 111.477) in the social security system. The cost for the contribution plan
was in 2021 TNOK 3 015, 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.
COMPENSATION AND BENEFITS TO THE MANAGEMENT GROUP IN 2022
Management Position Salary Bonus Pension Other Total
Hæge Johanne
Krogh Wetterhus
VP Marketing 1 529 890 198 839 97 464 7 909 1 834 102
Anne Waaler VP Medical 1 525 816 178 571 80 424 10 723 1 795 534
Roger Reino
Morberg
VP Sales 1 821 454 383 929 94 584 9 783 2 447 500
Erik Swensen VP Development 1 526 290 162 500 90 864 4 524 1 784 178
Tone Ann Veiteberg VP QA\Reg 1 323 097 196 429 72 708 4 524 1 596 758
Helge Børslid VP Operations 1 417 244 73 661 84 600 4 524 1 580 029
Håkon Grøthe VP Innovation 1 427 634 205 357 84 900 4 530 1 860 171
Ole Arne Eiksund
Chief Bus.Dev.
Officer
902 297 - 58 208 2 928 963 433
Kari Eian Krogstad CEO Medistim ASA 3 144 358 1 205 357 101 592 4 414 527 8 865 834
Thomas Jakobsen CFO Medistim ASA 2 050 394 312 500 91 800 188 280 2 642 974
Total 16 668 474 2 917 143 857 144 4 652 252 25 370 513
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’ noce. There are no opons to employees or
members of the Board except for CEO. The CEO will receive up to 24 500 shares as part of compensaon if
in posion in 2026. Bonus paid in 2022 was based upon 2021 results.
In relaon to the share program for management except CEO, following members of management
parcipated in the share program. See below schedule showing value of the shares, discount given and
nancing from the company to parcipate in the share program.
88
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
SHARE PROGRAM FOR THE MANAGEMENT GROUP IN 2022
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 Eiksrud Busines
developer
551 000 137 750 688 750 2 422 551 000
Roger Reino
Morberg
VP Sales
551 000 137 750 688 750 2 422 -
Ole Jørgen
Robsrud
CEO Medistim
Norge AS
200 000 50 000 250 000 879 200 000
Håkon Grøthe VP Innovation 551 000 137 750 688 750 2 422 -
Thomas Jakobsen CFO Medistim
Group
735 000 183 750 918 750 3 231 735 000
Total 2 588 000 647 000 3 235 000 11 376 1 486 000
Under other benefits 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 chapter "8.12
Remuneration of executive personnel" on page 39
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.
COMPENSATION TO THE BOARD OF DIRECTORS
1 = NOK 1000
Chair Øyvin Brøymer 450
Board member Torben Jørgensen 250
Board member Siri Fürst 250
Board member Tove Raanes 250
Board member Lars Rønn 250
Total compensation to the Board of Directors 1 450
COMPENSATION TO AUDITOR 2022 2021
1 = NOK 1000
Expenses for auditing 1 605 1 535
Compensation for other services 85 120
Total compensation to Auditor 1 690 1 655
89
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 28 Assets and Depreciation
ASSETS AND DEPRECIATION
Plant &
Machinery
Equipment
Total fixed
assets
Activated
Development
Trade name Total
1= NOK 1000
Historic cost as of 1/1 76 728 11 533 88 261 80 913 2 697 171 871
Additions 6 587 1 686 8 273 11 851 - 20 124
Historic cost as of 31/12 83 315 13 219 96 534 92 764 2 697 191 996
Accumulated depreciation as of 1/1 50 432 9 217 59 649 64 872 2 698 127 219
Ordinary depreciation 6 694 1 243 7 937 5 952 - 13 889
Disposals 504 - 504 - 1 503
Accumulated depreciation as of 31/12 56 622 10 461 67 082 70 824 2 697 140 603
Book value at 31/12 26 692 2 758 29 452 21 940 0 51 393
Plant and machinery are depreciated over 3 to 7 years on a straight-line basis dependent upon expected
economic lifetime. Tools and equipment are 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 13.9 MNOK of the R & D expenses was recorded in the P & L in 2022. Similar expense was 14.5 MNOK
in 2021. With 11.85 MNOK recognized as asset a total of 25.75 MNOK was used in R & D in 2022. Comparable
number for 2021 was 18.6 MNOK. Medistim received TNOK 376 in Skattefunn funds in 2021 and TNOK 236
in 2022. The activated expense in 2021 were related to the coronary and vascular products on the MiraQ
platform.
90
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 30 Income tax and temporary differences
INCOME TAX AND TEMPORARY DIFFERENCES 2022 2021
1 = NOK 1000
Current income tax charge for the year before deferred tax asset is utilised 23 089 16 700
Correction from previous year -973 0
Change in deferred tax -775 -18
Income tax expense reported 21 342 16 682
Reconciling income tax expense against profit :
Income tax expense for the year 21 342 16 682
22 % of profit before tax 28 479 21 420
Permanent differences -7 137 -4 738
Specification of taxable income:
Profit before tax 129 449 96 609
Permanent differences -28 019 -25 264
Change in temporary differences 3 521 4 565
Correction from previous year -4 423 0
Taxable profit 100 528 75 909
Payable tax in balance sheet:
Tax expense for the year 21 342 16 700
Change in deffered tax -775 0
Total payable tax 22 116 16 700
Specification of deferred tax asset
Differences in accounting and tax values
Fixed assets 1 194 -23
Current assets -11 534 -6 883
Accrual for obligations -2 85
Total differences -10 341 -6 821
Deferred tax asset 22 % 2 275 1 501
Deferred tax asset in balance sheet 2 275 1 501
Deferred tax asset in the balance sheet increased from 1.5 MNOK in 2021 to 2.3 MNOK in 2022. Deferred
tax asset consists of temporary differences in valuation of assets. All deferred tax asset is recorded in the
balance sheet as of 31.12.2022, since it is likely that the company will have future taxable income that will
exceed temporary differences.
91
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 31 Shares in Subsidiaries
MEDISTIM ASA HAS INVESTMENTS IN THE FOLLOWING SUBSIDIARIES
Unit Country Segment Ownership
Balance
sheet value
31 Dec 21
Profit in
2022
1 = NOK 1000
Medistim USA Inc. USA Lease and sale within bypass
surgery and vascular surgery
100%
135 10 631
Medistim
Deutschland GmbH
Germany Capital sales within bypass
surgery and vascular surgery 100%
188 7 226
Medistim Norge AS Norway Sale of 3 pary products and
capital sales within bypass
surgery and vascular surgery
100%
36 953 10 692
Medistim UK LTD United
Kingdom
Capital sales within bypass
surgery and vascular surgery 100%
1 -1 561
Medistim Japan KK Japan Dormant company 100% 86 -
Medistim Spain S.L Capital sales within bypass
surgery and vascular surgery 100%
28 -850
Medistim Danmark Aps Denmark Sale of 3
rd
party products
and capital sales within
bypass surgery and vascular
surgery
100% - Owned
indirectly through
Medistim Norge
AS with book value
of TNOK 1 103
1 173
Total 37 392 27 311
Medistim Norge AS has a subsidiary Medistim ASA owns indirectly through Medistim Norge AS in Denmark.
The company is named Medistim Denmark Aps and is within the same segment as Medistim Norge AS.
SUMMARY OF FINANCIAL INFORMATION FROM SUBSIDIARIES ALL 100 % OWNED
Unit Assets Debt Equity Income Profit
1 = NOK 1000
Medistim USA Inc. 141 211 36 914 104 297 203 608 10 631
Medistim Deutschland GmbH 11 841 6 320 5 520 47 137 7 226
Medistim Danmark Aps 6 196 4 827 1 369 9 142 1 173
Medistim Japan KK 86 - 86 - -
Medistim Spain S.L 15 567 15 607 -40 16 093 -850
Medistim UK LTD 2 376 9 770 -7 395 2 771 -1 561
Medistim Norge AS 41 159 8 833 32 325 76 923 10 692
Total 218 435 82 272 136 163 355 675 27 311
Medistim Norge AS has offices in Oslo, Norway and production facilities in Horten, Norway. Medistim USA Inc has
offices in Minneapolis in the USA. Medistim Deutschland GmbH has offices in Munich in Germany, Medistim UK
92
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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. Book value of goodwill related to the acquisition
of Medistim Norge AS was as of 31.12.2022 14 128 TNOK. Goodwill at the time of acquisition was 16 097 TNOK. None
of the subsidiaries are listed at a stock exchange.
Of Medistim UK’s debt of 9 770 TNOK, 7 587 TNOK 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 26.8 MNOK in 2022. Medistim ASA has interest bearing debt
towards Medistim US Inc of MNOK 39.4.
Note 32 Account receivables and other receivables
ACCOUNTS RECEIVABLE 2022 2021
1 = NOK 1000
Accounts receivable 92 008 49 169
Provision for bad debt -899 -261
Total salary expenses 91 109 48 908
All receivables are due within one year. Losses in 2021 were 0 TNOK and losses in 2022 were 6 TNOK. It is recorded
an accrual of 899 TNOK to cover expected losses. Historically the company has small losses on receivables.
Other receivables are shown below
OTHER RECIEVABLES 2022 2021
1= NOK 1000
Pre payments 2 338 1 417
Prepaid taxes and VAT 4 935 157
Accrued revenue 247 4 571
Unrealized gain hedging 779 -
Dividend subsidiaries 11 000 12 000
Total other receivables 19 299 18 145
Note 33 Inventory
INVENTORY 2022 2021
1= NOK 1000
Components 66 185 52 311
Finished goods 25 245 27 872
Inventory accrual -6 728 -6 478
Total 84 702 73 704
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 the
following table:
93
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
SPECIFICATION OF ACCRUAL 2022 2021
1= NOK 1000
Demonstration units 2687 3074
Service parts 1643 1117
Other 2398 2287
Total 6 728 6 478
Note 34 Cash in Bank
Restricted cash amounted to 7 016 TNOK as of 31.12.2022 and was related to tax withheld on salary paid
to employees. The comparable amount as of 31.12.2021 was 3 218 TNOK.
Note 35 Shareholder affairs - See note 17 in group accounts
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.
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 31.12.21
4 585 (27) 41 852 13 317 100 595 160 322
Change in equity:
Change in treasury shares - 6 - 5 426 (27) 5 405
Other corrections - - - - -11 -11
Profit for 2022 - - - - 108 107 108 107
Dividend to shareholders - - - - -82 126 -82 126
Equity 31.12.22 4 585 -21 41 852 18 721 126 537 191 696
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 2022 the company had 6 hedging
contracts in USD totaling MUSD 1.2. By year end there was an unrealized gain related to the contracts of
MNOK 0.8. The management and Board of directors evaluate the handling of risks related to exchange rates
fluctuations continuously together with its professional advisers.
GAINS AND LOSSES RELATED TO CURRENCY 2022 2021
1= NOK 1000
Foreign exchange gain 13 335 7 256
Foreign exchange loss 12 525 10 773
Total 810 -3 517
94
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Note 38 Specification of short-term debt
 2022 2021
1= NOK 1000
Bonus and commission 8 479 7 527
Board compensation 1 835 1 300
Debt towards subsidiary - 1 778
Accrual for investment 350 350
Other 5 097 992
Total short term debt 15 761 11 946
Note 39 Other operating expenses
OTHER OPERATING EXPENSES 2022 2021
1 = NOK 1000
Office rental 8 824 7 141
Travel expense 3 268 601
Marketing 2 706 846
Consultancy fee 13 126 13 517
Insurance 978 863
Freight 1 270 852
Communication 14 056 12 065
Other 4 603 3 519
Total other operating expenses 48 832 39 405
Note 40 Long-term debt and loan security
Medistim ASA had no long-term debt by the end of 2022.
Medistim ASA has a credit facility of 6.0 MNOK 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 10 MNOK. Book value of secured items was as of 31.12.2022 29.4
MNOK for assets, 91.1 MNOK for accounts receivables and 84.7 MNOK for inventory.
Note 41 Receivables and debt towards subsidiaries
RECEIVABLES AND DEBT TOWARD SUBSIDIARIES 2022 2021
1 = NOK 1000
Account receivable 43 659 26 795
Other receivable 7 587 7 587
Short-term debt 4 056 -
Long-term debt 39 429 35 277
Note 42 Events after 2022
The Board of directors has no knowledge about events after 2022 that will affect the annual report and
financial statement for 2022.
95
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
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. Corresponds to
operating profit before depreciations and impairment loss.
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
12. ALTERNATIVE PERFORMANCE MEASURES
96
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
RECONSILIATION OF CURRENCY NEUTRAL REVENUE: RATES 2022 RATES 2021
USD average rate for the year 9,61 8,59
EUR average rate for the year 10,10 10,16
GBP average rate for the year 11,87 11,82
DKK average rate for the year 1,36 1,37
SPLIT OF REVENUE IN USD, EUR AND NOK 2022
REVENUE 2022
WITH 2021 RATES
1 = NOK 1000
Sales in USD
Procedural revenue Imaging and flow 139 855 125 011
Capital sales MiraQ flowmeasurement instruments 13 248 11 842
Capital sales MiraQ imaging and flowmeasurement instrument 44 984 40 210
Capital sales in Canada\LA 5 520 5 553
Sales in EUR
MiraQ flowmeasurement instrument 35 236 35 445
MiraQ imaging and flowmeasurement instrument 41 651 41 898
Imaging probes 8 143 8 191
Flowmeasurement probes 121 792 122 515
Other 5 675 5 709
Revenue in USD and EUR 416 104 396 374
Revenue in NOK 75 833 75 833
Total revenue 491 937 472 207
Reconciliation of working capital:
Accounts receivable in balance sheet at year end 101 657 68 634
Inventory in the balancesheet at year end 114 333 97 413
Accounts payable in balance sheet at year end (30 258) (20 318)
Working capital 185 733 145 730
Reconsiliation of profit before R & D and depreciation:
EBITDA 164 539 139 705
Expensed R & D 13 607 14 476
Profit before R & D and depreciation: 178 146 154 181
97
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Oslo, 23
rd
March 2023
Board of Directors and CEO of Medistim ASA
Øyvin A. Brøymer
Chair

Board member
Siri Fürst
Board member
Sign. Sign. Sign.
Torben Jørgensen
Board member
Tove Raanes
Board member
Lars Rønn
Board member
Sign. Sign. Sign.
Kari Eian Krogstad
President & CEO
Sign.
98
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
13. RESPONSIBILITY STATEMENT
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 2022 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.
Oslo, 23
rd
March 2023
Board of Directors and CEO of Medistim ASA
Øyvin A. Brøymer
Chair

Board member
Siri Fürst
Board member
Sign. Sign. Sign.
Torben Jørgensen
Board member
Tove Raanes
Board member
Lars Rønn
Board member
Sign. Sign. Sign.
Kari Eian Krogstad
President & CEO
Sign.
IBDO
Independent Auditor's Report
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  
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

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
 
 
  
IBDO





  


Revenue recognition:

 
  


 

 









 



 





How the key audit matter was addressed 
the audit


 


 








 
  
IBDO




 
 
  

 
 

Opinion on the Board of Director's report
 









 
 

 


 
 




  


 

  
  

IBDO

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

  


 


   







  
 

 

et  
  bestar    
side 4 av 4

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Erik Helge Lie
Paer
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
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;=: bank ID
         
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f

r 
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        er   
     

   a         
 
103
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2022
Medistim ASA (Head office)
Økernveien 94
0579 Oslo
Norway
Phone +47 23 05 96 60
Medistim ASA (Manufacturing)
Bromsveien 17
3183 Horten
Norway
Phone +47 33 03 17 26
Medistim Norge AS
Økernveien 94
0579 Oslo
Norway
Phone +47 23 03 52 50
Medistim Danmark ApS
Søgade 16
4100 Ringsted
Denmark
Phone +45 23 800 300
Medistim USA Inc.
14000 25th Ave N. Ste. 108
Plymouth, MN 55447
USA
Phone +1 763 208 9852
Medistim Deutschland GmbH
Bahnhofstr. 32
82041 Deisenhofen
Germany
Phone +49 (0) 89 62 81 90 33
Medistim Spain S.L.
Calle Balmes 173, 4º, 2
08006 Barcelona,
Spain
Phone +34 911 238 318
Medistim UK Limited
34 Nottingham South Ind Est
Ruddington Lane Wilford
NG11 7EP Nottingham, UK
Phone +44 (0) 115 981 0871
marketing@medistim.com
www.medistim.com
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