CORPORATE
ANNUAL
REPORT
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0
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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 11
5.1 Management Team 11
5.2 Board of Directors 13
6. BOARD OF DIRECTOR’S REPORT 14
6.1 Operational review 14
6.2 Regional development 15
6.3 Organization, HSEQ and sustainability 17
6.4 Financial Review 17
6.5 Parent company financial review 19
6.6 Corporate governance 19
6.7 Main risk factors 19
6.8 Events after the balance sheet date 20
6.9 Outlook 20
6.10 Shareholder information 21
7. COMPANY DESCRIPTION 23
7.1 Vision, mission, values 23
7.2 Medistim’s solutions 24
7.3 Strategy 24
7.4 Technology and Products 26
7.5 Research and Development 27
7.6 Clinical application areas and target markets 28
7.7 Geographical target markets 30
8. CORPORATE GOVERNANCE REPORT 32
8.1 Implementation and reporting on corporate governance 32
8.2 Business activity 32
8.3 Equity and dividend 32
8.4 Equal treatment of shareholders and transactions with closely related parties 33
8.5 Shares and negotiability 33
8.6 The general meeting 33
8.7 Nomination committee 34
8.8 Board of directors, composition and independence 34
8.9 The work of the Board of directors 35
8.10 Risk management and internal control 35
8.11 Remuneration of the board of directors 35
8.12 Remuneration of executive personnel 36
8.13 Information and communications 36
8.14 Takeovers 36
8.15 Auditor 37
9. SUSTAINABILITY REPORT 38
9.1 Strengthening human health through improved surgery 38
9.2 Product stewardship 40
9.3 Responsible business 41
9.4 People 43
10. GROUP CONSOLIDATED FINANCIAL STATEMENTS 45
10.1 Consolidated Income Statement Medistim ASA Group 45
10.2 Consolidated Balance Sheet Medistim ASA Group 46
10.3 Consolidated Cashflow Statement 47
10.4 Consolidated Change in Equity for Medistim ASA 48
10.5 Accounting Principles 49
10.6 Notes to the accounts 54
11. PARENT COMPANY FINANCIAL STATEMENTS 77
11.1 Income Statement Medistim ASA 77
11.2 Balance Sheet Medistim ASA 78
11.3 Cash Flow Statement 79
11.4 Accounting Principles 79
11.5 Notes to the accounts 81
12. ALTERNATIVE PERFORMANCE MEASURES 88
13. RESPONSIBILITY STATEMENT 91
14. AUDITORS REPORT 92
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
about 600,000 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 Norwa y , in addition to a global distributor
network representing the company in more than
65 countries and 3,150 systems in Asia, Europe,
America and Africa. Medistim ASA is listed on the
Oslo Stock Exchange and has its global head office
in Oslo, Norway.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021MEDISTIM ANNUAL
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
“
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 %
7 %
35 %
58 %
Leader in a large
untapped CABG market
Competition share
Medistim share
Open market (finger palpation)
(332M people)
200,000 procedures
23 %
(83M people)
44,000 procedures
> 80%
USA
(68M people)
16,000 procedures
≈10 %
UK
(213M people)
40,000 procedures
< 5 % market share
Brazil
Germany
>700.000
procedures
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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
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
40 000
60 000
80 000
100 000
120 000
0%
5%
10%
15%
20%
25%
30%
202020192018201720162015201420132012201120102009200820072006200520042003200220012000
0
5
10
15
20
25
30
Ebit Prosent
202020192018201720162015201420132012201120102009200820072006200520042003200220012000
(83M people)
44,000 procedures
> 80%
(145M people)
40,000 procedures
≈25 %
Russia
(1.4B people)
50,000 procedures
≈45 %
China
(1,3B people)
100,000 procedures
< 1 % market share
India
(126M people)
13,000 procedures
> 80 % market share
Japan
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2020
3. HISTORY
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2020
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
March 2022
Kari E. Krogstad
President and CEO
4. LETTER FROM THE CEO
What a joy and relief it is to report that 2021 was the
year when we put most of the COVID-19 pandemic
behind us, and we can report record numbers in
several areas:
• 17.7% total revenue growth to
MNOK 427.3.
• Imaging portfolio growing 29%
• Vascular portfolio growing 21%
• EBIT margin at 27.3%
• Pre-tax profit at MNOK 90.9
• And, when adjusting for the
unfavorable currency effects, we
get 26% growth for Medistim
own products, which is really the
most important indicator for our
performance.
This means that we have more than caught up
with the lack of growth during the first pandemic
year 2020, and that we are all set to continue our
growth path, consistent with the previous two
decades of solid performance.
We have seen strong rebound from all geographical
markets; Europe, Asia, and particularly from our
largest market USA, with 28% sales growth in USD
and 28% growth in number of procedures for the
full year. This reflects the high activity level in
the surgical operating rooms driven by the need
to treat patients put on waiting lists during the
first year of the pandemic. While it is a
challenge to estimate a realistic market
penetration in an extraordinary
situation, we believe it is fair to
say that Medistim now supports
more then 25% of the coronary
bypass surgeries in the USA.
Our strong and consistently
growing position in this key
market is a result of priority
and determination, executing
on strategic initiatives over many
years.
It is rewarding to experience the positive response
from the market.
In the low end of the market penetration scale, we
can look to India, which we predict to be a future
considerable growth market for the company,
about half the size of the USA, and where we have
less than 1% of the market today. LivaNova, our
new distribution partner there since the beginning
of 2021, was challenged by a huge Covid outbreak
and was prevented from executing on many of
their planned marketing activities. Still, progress
have been made and we look forward to 2022 and
the first results of the initiatives.
While numbers and records are important and
speak for themselves, unquestionable, the
most important news to report from 2021 is the
publication of an expert group consensus paper in
the top medical journal Circulation. Here, 19 world
renowned cardiac surgeons have, on their own
initiative, found it pressing to advocate for routine
use of transit time flow measurement (TTFM)
during every CABG surgery, performed by all
cardiac surgeons – for the benefit of the patients’
health and life expectancy. We believe this paper
will contribute to cement the clinical value of
the technology and accelerate change in clinical
practice. Entering 2022, we will continue our
work to support influential opinion leaders in the
field, with the goal of achieving surgical guideline
support from associations and geographies that
are still lacking them.
As we close another great year in Medistim’s proud
history, I take the opportunity to thank every
Medistim colleague around the globe, as well
as our partners, for their relentless efforts
and stamina throughout the pandemic
period, and for a spectacular 2021
result.
When writing this, an unjust,
inapprehensible war is going
on in Ukraine. It reminds us
of the unpredictable world
we live in and forces us all to
imagine the unimaginable. Our
thoughts, compassion and support
go out to our friends in the affected
areas and to all that are suffering.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
5. EXECUTIVE MANAGEMENT & BOARD OF DIRECTORS
5.1 Management Team
Kari Eian Krogstad
President and CEO, Medism ASA
Kari E. Krogstad joined Medistim as CEO in September 2009. She has 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, Medism 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.
Mike Farbelow
President, Medism USA, Inc.
Mike Farbelow joined Medistim as Vice President of the US sales team in May 2012. He has extensive
sales and management experience from the medical device industry. He served for many years with
Smith & Nephew’s Endoscopy division both as a sales representative and the Director of Sales for the
central region. His most recent position prior to joining Medistim was with Richard Wolf USA where he
served as their national sales manager in spinal endoscopy. Farbelow holds a degree in management
from the University of Minnesota Carlson School of Management.
Håkon Grøthe
Chief Innovaon Ocer, Medism ASA
Håkon Grøthe joined Medistim as CIO in April 2019. He is an experienced leader with a passion for increasing
customer value through digital innovation. Grøthe has put disruptive technologies such as AI, VR and Machine
learning into work in his leadership roles from IT technology companies such as Impact Reality and Inspera.
He also brings methodology experience relevant for agile processes, such as Google Sprint, Design Thinking
and Kanban. Grøthe holds an M.Sc. degree in Industrial Economics/Computer Science from the Norwegian
University of Science and Technology (NTNU).
Thomas Jakobsen
CFO, Medism ASA
Thomas Jakobsen joined Medistim as VP Finance in 2001. He has broad experience from financing
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.
Cindy Kaai
Country Manager, Medism 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.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Roger Morberg
VP Sales, Medism ASA
Roger Morberg joined Medistim as VP Sales in June 2010. He has extensive experience from the healthcare
industry and is a trained medical professional. Before joining Medistim he worked for Siemens Medical
as Country Manager for Ultrasound. Morberg has previously held various roles within sales and senior
management positions in Marquette Electronics, GE Healthcare and Hewlett Packard.
Ole Jørgen Robsrud
Managing Director, Medism 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, Medism ASA
Erik Swensen joined Medistim as VP Research & Development in 2002. Previous experience includes
Development Engineer at ABB, Norway, where he participated in the development of advanced process
control systems and developing ABB’s new control system for safety critical applications. Swensen holds
a M.Sc. degree in Engineering Cybernetics from the Norwegian University of Science and Technology
(NTNU).
Tone Veiteberg
VP Regulatory Aairs & Quality Assurance, Medism ASA
Tone Veiteberg joined Medistim as VP Quality Assurance & Regulatory Affairs in 2013. She has more than
35 years of experience in Medical and Regulatory Affairs from the pharmaceutical and medical device
industry, including Clavis Pharma, the Norwegian Association of Pharmaceutical Manufacturers, Leo
Pharmaceuticals, and Glaxo/GlaxoWellcome (now GlaxoSmithKline). Veiteberg holds a M.Sc. in Pharmacy
from the University of Oslo.
Anne Waaler
VP Medical Department, Medism ASA
Anne Waaler joined Medistim as VP Medical Department in 2016. She has more than 25 years of experience
from the pharma and medtech industry, including roles within medical, marketing and strategy with
Nycomed and GE Healthcare. Waaler holds a M.Sc. in Pharmacy from the University of Oslo, an MBA from
the BI Norwegian School of Management in Oslo, and an ESCP-EAP in Paris.
Hæge J.K. Weerhus
VP Markeng, Medism ASA
Hæge J.K. Wetterhus joined Medistim as VP Marketing in 2010. She has more than 25 years of experience working
with diagnostic, analytical and biotech device companies. Before joining Medistim, she worked for Invitrogen
Dynal where she held a variety of leadership roles in strategic marketing, product development and business
development in the area of life science and biotechnology – always with an international focus. Wetterhus is a
business economist from BI Norwegian School of Management, a chemical engineer from the Technical University
of Bergen and holds a B.Sc. Honour in molecular biology from the University of Glasgow, United Kingdom.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 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.
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, Unicef Norge 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.
Torben Jørgensen
Board member
Torben Jørgensen holds a B.S.c. in Economics and is an independent advisor, consultant and board
member. He is currently the chairman of the board of Biotage, Atlas Antibodies AB and Genovis AB. He is
also the board member of Micropos Medical AB and Advanced Instrments Inc. He is also member of the
remuneration committee.
Tove Raanes
Board member
Tove Raanes has been board member in Medistim since 2014. She works as an advisor in the investment
companies Dyvi Invest AS and Nore-Invest AS and serves as board member in Bouvet ASA, Multiconsult
ASA 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.
Lars Rønn
Board member
Lars Rønn has been board member in Medistim since 2010. He works as a consultant for Korn Ferry
Associates 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.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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
2021, and Medistim has experienced strong growth
in revenues due to the increase in number of CABG
procedures performed. This increase corresponds
with the reduction in hospitalizations of patients
with COVID disease, which is again an effect of
the growing vaccination rates in Medistim’s core
markets, Europe, and USA, and to some degree
also in Japan and China.
This confirms that the need for Medistim’s
products has not changed during the pandemic,
and the strong recovery seen through 2021 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 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 65 distributors world-wide, including
Medistim’s own sales offices in USA, Denmark,
Germany, Spain, United Kingdom and Norway. At
the end of 2021, Medistim’s equipment was in use
in more than 65 countries and 3,150 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 contribute to a more efficient
health economy. Worldwide, over 700,000 CABG
(Coronary artery bypass Graft procedures) and
600,000 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
Even though cardiovascular surgery procedures
increased in 2021, medical facilities are still faced
with strict requirements for distance-keeping and
comprehensive infection control regimes. This
continued to affect Medistim’s customer relations
activities negatively in 2021. To maintain functional
customer, supplier and stakeholder relations,
Medistim adopted digital solutions for conferences
and meetings. By applying digital communication
platforms and remotely controlling ultrasound
systems, Medistim was also able to demonstrate
products and perform end-user training.
The experience is that it is possible to maintain
close customer contact, exchange information,
influence, and make business progress, while
saving cost and time by using digital tools. With
mainly digital client interaction, cost related to
travelling and physical meetings were reduced to
a minimum. As a result Medistim reports best year
ever for sales and profit. The sales growth was
17.6 % in NOK and operating profit (EBIT) growth
was 21.8% in NOK.
Adjusted for currency effects, sales were up 24.6%.
Sale of own products was up 26% when excluding
debt forgiveness of 5.3 MNOK, while sale of
third-party products were up 10% from 2020.
The strong growth is a combination of Medistim
increasing its market penetration and the fact that
patient queues after COVID has increased number
of procedures.
During 2021, Medistim sold 230 new systems (197),
and at year-end total installed base of Medistim
systems was 3,150 units (3,000). Probes and other
consumables related to use of the medical systems
represent a significant share of total sales for
Medistim, depending of number of systems installed
and utilization. Increased market penetration and
surgical activity positively impacted Medistim’s
sales of consumables for the year.
Medistim focuses on customer and market
development. Early in 2021, the company announced
the Distributor Agreement with LivaNova, a global
medical technology and innovation company, for
distribution of Medistim products in India, one of
the world’s largest and fastest growing markets
for cardiovascular surgery. LivaNova is already the
distributor for Medistim in Australia.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
To make flexible and ease of use solutions for the
customers, Medistim implemented the Pay Per
Procedure functionality on the MiraQ platform for
US customers.
Medistim’s strategic progress relies on strong
clinical documentation by leading medical centers
to create support from Key Opinion Leaders
(KOLs). 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 the 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 of 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
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.
6.2 Regional development
USA
2021
2020 % chg y-o-y
Flow procedures
59,397 47,256 +26%
Imaging procedures 12,635 8,803 +44%
Capital sales 38 26 -+46%
Lease 19 13 +46%
OUTSIDE USA
2021
2020 % chg y-o-y
Flow systems
125 124 +1%
Flow and imaging systems 67 47 +43%
Imaging probes 107 75 +43%
Flow probes 7,988 6,218 +28%
USA
USA is the largest market for the Medistim’s
products, representing 33% of global CABG
procedures. Total US revenues amounted to NOK
154.1 million in 2021, up 22% from 2020. Adjusted
for currency effects, sales were up 33%.
Total revenues for 2021 include a one-off recording
of 5.3 MNOK as other revenues. This was related
to the Paycheck Protection Program established
by the US federal government to help businesses
keep employees employed during the COVID
pandemic. Medistim has 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 17.7% year to date. Adjusted for
currency effects, product sales were up 28.4%.
Some 70% 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
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
products and the Group has high market ambitions.
Medistim’s current market penetration is over
25% of the total market of approximately 200,000
bypass surgery procedures performed annually. In
comparable markets like Germany, Scandinavia,
and Japan, Medistim has achieved 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
2021, procedural sales amounted to 73% of the
total sales, ending at NOK 112 million. This is up
12% from 2020 (+23% currency adjusted).
During the year, 72,032 procedures were sold,
(56,059) of which 59,397 were flow procedures
(47,256) and 12,635 were imaging (8,803). Capital
sales were 26 units, compared with 26 units in 2020.
Outside USA
Sales in markets outside USA, mainly Europe and
Asia, were NOK 199 million, up from NOK 169
million in 2020. Adjusted for currency effects,
sales were up 24%.
In these markets, the systems are owned by the
hospitals and revenues are more evenly split
between capital sales and sale of consumables.
In 2021, sales of flow and imaging measurement
probes amounted to over 60% of total sales, ending
at NOK 123 million, compared with NOK 98 million
in 2020. Currency neutral sales were up 29%
year-over-year. In addition to increased market
penetration there was a higher activity within
CABG surgery due to patient queues because of
COVID-19. Sale of systems continue to increase to
NOK 72 million from NOK 64 million in 2020.
Europe
Medistim has developed a strong market position
in Europe with about 1050 systems installed,
representing a solid base for future recurring
revenues. Total European sales of own products in
2021 were NOK 115.8 million, up 10% from NOK
105.7 million in 2020. Currency neutral sales were
up 15.7%.
During the year 4,574 probes were sold, (3,979) of
which 4,524 were flow probes (3,943) and 50 were
imaging (36). Capital sales were 81 units (71). The
direct representation in the United Kingdom, Spain
and Germany continue with positive development
and sales increased with 58%, 28% and 7%
respectively. Sales through distributors ended at
NOK 42 million, up 21% compared to 2020. The
installed base continued to increase and solid
probe demand resulted in a 15% growth in sales
compared to 2020.
Asia
Sale to Asian markets were NOK 67 million for
the year, up from NOK 47 million in 2020. The
increase is driven by sales to Japan and China.
Sales to Japan ended at NOK 26,5 million, up 33%
compared to 2020. Similar for China sales ended
at NOK 32 million, up 68% compared to 2020. In
China number of CABG procedures increases with
5 to 10 % per year and is a strategic market for
75 %
25 %
Market penetration in USA Cardiac
market
Market potential for Medistim in USA
Medistim market penetration in USA
Procedure sales in the USA
>200.000
procedures
++A
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Medistim. Medistim covers more than 50 % of
the 50,000 procedures performed in China and
is well represented in the Chinese market. The
introduction of MiraQ to the Japanese market late
2019 continue to drive system sales in Japan.
During 2021, 93 MiraQ systems were sold in the
Asian markets, compared with 82 systems in
2020. Sale of flow system was at the same level as
last year and the growth of system sales was the
combined ultrasound flow- and imaging system.
Total number of probes sold in Asia increased 58%
from 2020, reflecting increased CABG activity.
The increase is explained by increased market
penetration and treating patient queues because
of COVID 19. During 2021, Medistim sold 2,729
probes, (1,719) of which 2,683 were flow probes
(1,693) and 46 were imaging (26).
Other markets
Sales in other markets amounted to NOK 16 million,
down from NOK 17 million the previous year.
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
116 employees, compared to 121 in 2020. The
working environment and culture in Medistim are
considered strong, and there is continuous focus
on initiatives for improvement. In 2021, absence
due to sickness was 3.2%. This compares to 3.8%
in 2020.
Medistim strives to be an attractive workplace
that offers challenging and motivating jobs and
equal development opportunities for all. There
is no discrimination due to gender, nationality,
culture or religion with respect to remuneration,
promotion or recruitment. The Company is
committed to recognize diversity and ensure
equal opportunities, including fair employment
conditions. Medistim supports the United Nations
Universal Declaration of Human Rights and the
standards advised by the International Labour
Organisation (ILO). For more information, please
see Chapter "9. Sustainability Report" of this
Annual Report.
6.4 Financial Review
Going concern
The Board of Directors confirms that the financial
statement has been prepared based on the
assumption of a going concern.
Profit & Loss
The Medistim Group’s sales for the full year 2021
ended at NOK 427.3 million (NOK 363.1 million).
Currency neutral, sales increased 24.6%.
Sales in Asia increased 42.7%, while sales in the
U.S. and Europe increased 21.9% and 9.8%,
respectively. Regional sales in “Rest of the world”
declined 3.0%. In Europe sales of own products
rose 9.6% and third-party product sales through
the subsidiaries in Norway and Denmark rose
10.0%.
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 has 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 17.7% in
2021.
Total sales of own products in 2021, amounted to
NOK 347.6 million (NOK 295.6 million), while sales
of third-party products were NOK 74.3 million
(NOK 67.5 million). Currency adjusted, sales of
own products, excluding the debt forgiveness,
increased 26% during the year, while sale of
third-party products increased 10%. Average NOK
exchange rates towards USD and EUR in 2021 were
8.59 and 10.16 respectively, while equivalent rates
in 2020 were 9.37 for USD and 10.72 for EUR.
Currency adjusted development of total sales in
2021, excluding the debt forgiveness, was 23%
(-6,1%). For own products the volume was 26.0%
(-7.2%) while volume for third-party products
increased 10.0% (0.0%). The growth was related
to increased market share and increased activity
within CABG surgery to reduce patient queues
because of COVID 19.
Cost of goods sold (COGS) amounted to NOK 97.1
million (NOK 76.6 million), representing 22.7 % of
sales (21.1 %). The higher level of sales through
distributors, product mix and increased sale of
third-party products, explain the increase in COGS
in percent in 2021 compared to 2020.
Salary and social expenses were NOK 134.5
million (NOK 119.1 million), while other operating
expenses were NOK 56 million (NOK 48.8 million).
Strong sales results increased sales commissions
and bonus achievements. Higher activity level
17
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
also explains the increased expenses for the year.
Expenses in 2020 was unnaturally low because of
the COVID situation. For comparison, expense level
in 2021 was 8 % above the expense level in 2019.
Medistim continuously invests in existing and new
products to cover the surgical requirements for
quality verification. The company spends between
4% and 5% of annual sales in research and
development (R&D). In 2021, total R&D spends
amounted to NOK 18.6 million (NOK 16.5 million),
corresponding to 5.4 % of sales of own products.
Of this, NOK 4.1 million (NOK 1.9 million) was
activated in the balance sheet.
The result before R&D, depreciation and write-offs
was MNOK 154.2 (MNOK 133.1 million), equaling
a margin of 36.0% (36.6%). Operating result before
depreciation and write-offs (EBITDA) ended at MNOK
139.7 (MNOK 118.6). Depreciation for the year
amounted to NOK 23.4 million (NOK 23.1 million).
The operating result (EBIT) was a record NOK
116.3 million (NOK 95.5 million), corresponding to
an EBIT-margin of 27.3 % (26.3 %)
The Group recorded net financials of NOK -2.2
million (NOK -3.9 million), of which NOK 10.4
million of financial expenses (NOK 18.0 million)
and NOK 8.1 million of financial income (NOK 14.1
million). 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 NOK 114.1 million (NOK 91.6
million). Tax amounted to NOK 23.2 million (NOK
22.2 million) and the net profit for the year was
NOK 90.9 million (NOK 69.4 million), corresponding
to earnings per share for the full year of NOK 4.99
(NOK 3.81).
Average number of shares outstanding during the
year were [18.215.938] (18.200.391) by the end of
December 2021.
Cash Flow Statement
Cash flow from operating activities amounted to
NOK 128.1 million (NOK 74.3 million). Working
capital decreased NOK 4.1 million during the
year, driven by a NOK 15.2 million decrease in
inventories.
Cash flow from investing activities was negative
NOK 11.5 million (NOK 10.6 million) all related to
investments in assets.
Cash flow from financing activities was negative
NOK 58.8 million (NOK -58.3 million), of which
NOK 55 million (NOK 50.0 million) was payment of
dividends. Debt repayment was at NOK 4.5 million
during the year (NOK 3 million), while leases
amounted to NOK 6.9 million (NOK 6.7 million).
During the year cash and cash equivalents
increased by NOK 57.6 million (NOK 5.1 million).
At 31 December 2021, total cash and cash
equivalents amounted to NOK 129.5 million (NOK
71.9 million). Sales of own shares contributed with
7.6 MNOK.
Financial position
At 31 December 2021, Medistim’s working capital
totaled NOK 145.7 million, compared with NOK 149.9
million the year before. During the year, inventory
decreased by NOK 15.2 million. As a consequence
of increased sales, accounts receivables increased
NOK 11.1 million during the year. Accounts payables
were on par with last year. By year end the company
had no interest bearing debt and long term debt of
NOK 19.6 million. NOK 17.1 million of the debt was
related to lease agreements and NOK 2.5 million
was related to deferred revenue.
The total balance sheet amounted to NOK 403.2
million (NOK 345.8 million). Total equity was NOK
306.1 million (NOK 256.8 million), corresponding
to an equity ratio of 76% (74%). Book value of
properties, plants and equipment amounted to
NOK 58.8 million (64.6). Intangible assets were NOK
30.1 million (NOK 33.5 million), of which product
development and goodwill represented NOK 16.0
million and NOK 14.1 million respectively.
The company has a deferred tax asset of NOK
3.2 million (0.8) related to temporary differences
between carrying amount and tax values.
Interest-bearing debt at the end of the year
amounted to NOK 0.0 million, down from NOK 4.5
million at the end of 2020.
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 2021 the share capital of the
Medistim ASA parent company was NOK 4 584
334,00 split on 18 337 336 shares issued 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 108 422 treasury
shares at year-end.
18
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
6.5 Parent company financial review
The parent company Medistim ASA had 2021
sales of NOK 258.5 million (NOK 195.4 million).
Operating profit was NOK 77.3 million (NOK 45.4
million) and profit before tax amounted to NOK
97.4 million (NOK 70.0 million). Medistim received
a dividend from its subsidiary in Norway of NOK
24.0 million in 2021 (NOK 25.2 million). No group
contribution was received in 2021 or 2020. Profit
after tax for the parent company was NOK 80.7
million for the full year (NOK 60.2 million).
At 31 December 2021, the parent company’s total
assets amounted to NOK 310.4 million compared
to NOK 244.7 million as of 31 December 2020.
Equity in the company was NOK 165,8 million
(NOK 140.5 million), corresponding to an equity
ratio of 53.4% (57.4%).
At year-end 2021, the parent company had NOK
75.1 million 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 93.0 million for
the parent company in 2021
Allocation of profit
The Board of Directors suggests that NOK 80.7
million of the 2021 net profit is allocated to
ordinary shareholder dividend, equal to NOK 3.75
per share (NOK 3.00 for 2020), which amounts
to NOK 68.4 million corrected for the company’s
holding of own shares. The remaining NOK 12.3
million 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 75.2% (78.7%) of
the consolidated result. The dividend reflects the
Board's positive expectations of future earnings.
Over the past 10 years, the company has paid
NOK 388 million in accumulated dividends to
shareholders.
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; Transonic Inc.
Transonic has offered their flowmeters to the
market for as long as Medistim has been in the
market. Medistim today has about 80% of the
penetrated market. Medistim is not aware of new
competitors or technologies that could change the
competitive landscape significantly.
Risks related to device malfunction: Medistim has
established comprehensive procedures as part of
its Quality Management System in compliance with
ISO 13485:2016 to ensure the safety of its products.
There were no reportable events in 2021.
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 enters 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. Additionally,
Medistim has a credit facility with a limit of 22.5
MNOK as a source of additional liquidity.
Interest rate risk
The company is exposed to changes in interest
rate levels, but has no long-term debt.
Macroeconomic risk
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
19
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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-of-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
The outbreak of the Corona and ensuing COVID-19
pandemic affects Medistim’s operations and
markets. In 2021 there were still cases where
health authorities and hospitals delayed surgeries,
prioritizing acute treatment of Corona virus patients.
Some hospitals have denied unnecessary access
to external personnel which may affect sales of
new equipment. Virtual meetings and online
demonstrations have been implemented to offset
these potential effects. Medistim is well positioned
in regard its components situation with up to
12 months inventory levels and many company
functions are handled through home office.
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.
6.8 Events after the balance sheet date
The Russian and Ukraine conflict is expected to
have minor impact on Medistim business. Sales
to these countries was less than 2% of total sales
in 2021. The Board of directors has no knowledge
about other events after 2021 that will affect the
annual report and financial statement for 2021.
See Board of director’s report under other risk
related to the Corona virus situation.
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 approximately 3,150 systems in
more than 65 countries.
However, market penetration varies from above
80% in selected European and Asian markets,
to 25% 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, confirmed with the recent Distributor
Agreement with LivaNova for the Indian market.
Medistim has delivered record profit and cash flow
despite the impact from COVID-19 in 2021. 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 more than 3,150 systems, the
company is well positioned to continue its journey
of profitable growth as markets gradually recover
to pre-COVID 19 conditions.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 2021, each
with a nominal value of NOK 0.25, unchanged from end of 2020. During the year, the shares traded
between NOK 250 and NOK 409 per share, and 9.3 million shares were traded in total.
SHARE PRICE DEVELOPMENT OVER THE PAST 5 YEARS
Major shareholders and voting rights
Medistim had 1,073 registered shareholders in the Norwegian Central Securities Depository (VPS) at 31
December 2021, whereof the 20 largest shareholders owned 75.4%. The percentage of issued shares
held by foreign shareholders was 58.5%. 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.
Corporate actions
CORPORATE ACTION
2020 Financial statements approved by the Board
19.03.21
Annual report 2020 disclosed
29.03.21
Annual General Meeting
27.04.21
Resolution to distribute dividend of NOK 3.00 per share
27.04.21
Ex dividend NOK 3.00
28.04.21
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.
21
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Based on the 2021 results, the Board of Directors
will propose to pay a dividend of 3.75 for 2021
corresponding to a pay-out ratio of 75.2%. For
2020, Medistim paid a dividend of NOK 3.00 per
share corresponding to and a pay-out ratio of 79%.
Over the last ten years, Medistim has paid NOK 388
million in accumulated dividend to shareholders.
Analyst coverage
DNB, Danske Bank and Sparebank 1 Norwegian
and Nordic investment banks had active coverage
of Medistim ASA in 2021 For contact details, please
see the company website www.medistim.com.
General Meetings and Board authorisations
The 2021 AGM granted the Board of Directors the
following authorizations:
1. Authorisation to increase the share capital by
up to NOK 458,433.25.
2. Authorisation to acquire treasury shares in
Medistim ASA for up to a maximum nominal
value of NOK 458,433.25.
Further information can be found in the minutes
from the Annual General Meeting, available from
the company’s website www.medistim.com and
www.newsweb.no.
FINANCIAL CALENDAR 2022
Event Date
4th quarter 2021 results
25.02.2022
Annual General Meeting
27.04.2022
1st quarter 2022 results
28.04.2022
Half-yearly 2022 results
23.08.2022
3rd quarter 2022 results
28.10.2022
Oslo March 22
nd
2022
Board of Directors and CEO of Medistim ASA
Øyvin A. Brøymer
Chairman
Siri Fürst
Board member
Torben Jørgensen
Board member
Sign. Sign. Sign.
Tove Raanes
Board member
Lars Rønn
Board member
Kari Eian Krogstad
CEO
Sign. Sign. Sign.
22
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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) is 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 2021
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 3,150
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 probe and SonoQ system, 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:
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2020
25
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
a. Clinical marketing, guidelines and
educational programs
b. Product innovation for ease of use
c. Increased sales force capacity
3. Offer an entry-level solution to reach emerging,
price-sensitive, high-growth markets
4. Build and strengthen position in vascular
surgery through:
a. Dedicated system (MiraQ Vascular) & probes
b. Building position with societies and KOLs
5. Expand direct market coverage
7.4 Technology and Products
Medistim’s medical devices are used to improve
quality of cardiovascular surgery and are subject
to high requirements and product certifications
with regards to quality and safety, and require high
competence and excellent quality systems.
Technology 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.
26
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 spends between
4% and 5% of annual sales in research and
development (R&D). In 2021 The company spent
5.4 % of annual sales of own products in research
and development (R&D).
Utilizing the MiraQ platform
In 2021, the company released an entry level
version of the MiraQ platform for low cost markets
such as India. This version of MiraQ replaces the
SonoQ product that was terminated in 2021.
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 will enter
into formal development in 2022.
New production technology
Medistim is part of a collaborative project together
with GE Vingmed Ultrasound and Sensocure, to
develop new production technology within medical
devices. The project, «Advanced Manufacturing
Technologies for High Impact Medical Devices»,
has been granted funding of NOK 14.4 million over
3 years by the Norwegian Research Council’s BIA
Health program. The project which is executed in
collaboration with University College of Southeast
Norway and the research institutions SINTEF and
NORNER, was finalized in 2021.
The new knowledge from this unique project is
brought forward to develop technology which
improves efficiency and quality of ultrasound
probe production.
Clinical study supports routine use of Medistim’s
technology
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 of the initiatives to position MiraQ™
technology for routine use during CABG surgery.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Having the technology in focus in one of the world’s
most renowned cardiovascular journals indicate
that Medistim is moving in the right direction with
its strategy. Medistim’s REQUEST study published in
2020 was one of the key papers that was assessed
to underpin the importance of routine use of
quality assessment. This strong advocacy will not
only exert peer influence within the community of
cardiac surgeons, but it may pave the way for new
and enhanced clinical guidelines worldwide.
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.
7.6.1 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 3,150 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 the transit
time measurement principle are estimated to be
used in about 5% of the procedures performed.
This implies that no equipment is being used to verify
blood flow in about 60% 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 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.
MiraQ’s 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.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 en-
dorsed by the guidelines from the European Soci-
ety of Cardiology (ECS), the European Association
for Cardio-Thoracic surgery (EACTS), and The Brit-
ish National Institute for Health and Clinical Ex-
cellence (NICE). All are highly respected organiza-
tions and their recommendations are expected to
influence clinical practice also in countries outside
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 2020 and 2021 and expects increas-
ing 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.
7.6.2 Market for Vascular Surgeries
Applications
# of
procedures
Value
potential
NOK million Clinical needs
Peripheral
bypass
> 200,000 Improve long-term graft patency | Improve quality of life
CEA > 200,000 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
Vasular Surgery include peripheral bypass, CEA
and AV access.
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
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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.
7.7 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 44% of total revenue from
own products in 2021.
The US subsidiary has 25 employees 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 30% of surgeries performed with support
from medical systems ensuring proper blood flow.
Medistim has a market share of approximately 25 %
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” smart card or paying a monthly lease.
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 Denmark since 2011. 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 United Kingdom, Medistim has had direct
representation since 2012. Some 16,000 CABG
procedures are performed in the United Kingdom
every year, and Medistim’s equipment is currently
used in about 10% of these.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Market penetration in the United Kingdom 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.
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
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.
China
About 50,000 CABG procedures are performed
annually and Medistim’s share of this market is
about 45%.
India
Approximately 100,000 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.
Medistim distributors
Medistim subsidiaries
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 limit ed compan y
listed on Oslo Børs, 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 health care 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
a separate “sustainability” chapter in the annual
report for 2021.
The company’s objectives, strategies and risk
profile are subject to annual review by the Board.
Deviations from the Code: None
8.3 Equity and dividend
At 31 December 2021, the company’s equity was
NOK 306 million, which is equivalent to 75.9% 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 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.
The Board of Directors proposes to pay a dividend
for 2021 of NOK 3.75 per share corresponding to
NOK 68.4 million based on the financial results for
the year. For 2020, the company paid a dividend
32
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
of NOK 3.00 per share, corresponding to NOK
54.6 million. Over the past ten years, Medistim
has paid a total of NOK 388 million in dividend to
shareholders, corresponding to an average payout
ratio of 75 %.
At the annual general meeting on 27 April 2021,
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 at 31
December 2021, 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 at 31 December 2021,
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.
Deviations 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 2021.
Any transactions in own shares, i.e. a share buy-
back program, will be carried out either through
Oslo Børs 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 transactions in own
shares during 2021. 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 2021.
Deviations 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.
Deviations 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 2021, Medistim held its annual general meeting
on 27 April with 36.82% of the shares represented.
There were no extraordinary general meetings
during the year.
Deviations from the Code: None.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 2021
Bjørn Henrik
Rasmussen
Chair Yes Follum Capital 2009 AGM 2023 100%
Asbjørn Buanes Member Yes Asbjørn Buanes 2005 AGM 2023 100%
Vegard Søraune Member Yes Aeternum Capital
AS
2021 AGM 2022 100%
The guidelines for the nomination committee is
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 2021, the board consisted of the
following five directors:
Name Role
Considered
independent of main
shareholders
Served
since Term expires
Participation board
meetings 2021
Share ownership in
Medistim (direct/
indirect)
Øyvin A. Brøymer Chair No 2000 AGM 2023 100% 7.01%
Torben Jørgensen Director No 2021 AGM 2022 100% 0%
Lars Rønn Director Yes 2012 AGM 2022 100% 0%
Siri Fürst Director Yes 2013 AGM 2023 100% 0.01%
Tove Raanes Director Yes 2014 AGM 2022 100% 0.01%
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
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
contacts. Three out of five members are regarded as
independent of the company’s main shareholders.
The independence of board members is also
evaluated by the board.
Deviations 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 entire board functions as the audit committee.
The board has, considering the size of the company,
deemed it unnecessary to appoint other steering
committees based upon the issues considered by
the board in 2021.
The board performs a self assessment of its work
once per year.
Deviations from the Code: The entire board functions
as the audit committee. All board members are
independent from the company’s management, and
has collectively the competence required, including
accounting and auditing experience. However, for
2022 a separate audit committee is established.
8.10 Risk management and internal control
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 Børs, 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.
Deviations from the Code: None
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.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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.
Deviations 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
principles have remained the same over several
years. These principles are also the basis for future
evaluations. Remuneration of the CEO includes a
share-based incentive plan. The board introduced
a share-based incentive plan for the remainder of
the management group in 2021.
The executive remuneration consists of a fixed
salary and a variable part linked to the company’s
targets, 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.
Deviations from the Code: The Code recommends
that the company’s guidelines are included as
a separate appendix to the notice calling for the
general meeting. The guidelines should inform
which aspects that are advisory and which, if
any, are binding. The general meeting should
vote separately on each of these aspects of the
guidelines. Further, the Code recommends that the
guidelines contain information on criteria related
to performance related remuneration, which
should be subject to an absolute limit. Medistim
includes a general description of the company’s
guidelines for remuneration in the annual report,
alongside information on remuneration to each
director. Executive remuneration is treated as one
item by the general meeting. A separate appendix
will be included in the notice to the general
meeting in 2022.
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
Børs’ 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 Børs’ news channel www.newsweb.no and on
the company’s website www.medistim.com.
Deviation from the Code. The company has not
prepared any policy or guidelines specifying who
is entitled to speak on behalf of the company
or regulating communication with shareholders
outside general meetings, 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 matters, while the CEO
handles media and other inquiries.
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
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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.
Deviations 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 specific, one-off, events which
makes preparation 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 activities
are not unnecessarily interrupted. The board
will further seek to comply with the relevant
recommendations 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.
Remuneration paid to the auditor is set by the
general meeting and described in the notes to
the annual accounts. The auditor may attend the
annual general meeting.
Deviations from the Code:
The board has not established separate guidelines
on the use of auditor for other purposes than
auditing, as recommended by the Code. Only the
CEO or the CFO hires services from the auditor. If
deemed necessary, the auditor is consulted for
mechanical tax issues. For other matters, other
advisors will be consulted. For the future, these
matters are decided by the audit committee that
was established in 2022.
Dating its governance documents and practices
and aligning with the recommendations by the
Code of Practice where relevant.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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.
Contribution to UN Sustainable Development Goals
(SDGs)
Medistim supports the UN SDGs.
The company considers its greatest
impact is helping to strengthen human
health through improved surgical
outcome by providing high quality
medical devices meeting strict safety
requirements.
SDG 3.4 specifies a targeted reduction of premature
mortality by 2030 from non-communicable
diseases through prevention and treatment of
amongst other cardiovascular disease.
The company also supports SDG target 12.6 by
adopting sustainable business practices and integrat-
ing sustainability information into its reporting cycle.
Stakeholder engagement and materiality
In 2021, Medistim conducted a materiality analysis
following a stakeholder identification process.
Investors, distributors, suppliers and employees
were identified as key company stakeholders and
invited to participate in the materiality analysis
via a digital survey, followed up with selected in-
depth interviews. The stakeholders were asked
to grade the importance of ESG related factors,
based on the SASB
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.
This was contrasted with the responses of an
internal Medistim working group and summarized
in the materiality matrix on the following page.
By summarizing the factors identified through
the analysis, Medistim has defined the following
themes as material to the company. The themes
form the foundation for this report:
• Product stewardship
• Responsible business
• People
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Priorities going forward
This is the company’s second 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 related to Medistim’s activity.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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.
In 2021 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 May 2024. However,
since Medistim is focusing on quality and safety in
general, much preparations for the new regulation
was done already in 2021.
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 are subject
to supplier qualification. This includes consulting
services that can affect the quality management
system and product quality. The QMS also include
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 2021.
Product life cycle and environmental footprint
Medistim has prepared an environmental policy,
last updated in 2020, 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 to European countries and the US as well
as some travelling in connection with sales 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 considerations,
like minimize number of flights. Employees are
further encouraged to reduce consumption and
waste generated from their daily business activities.
Medistim has established routines for management
of chemicals and waste.
The lifetime of Medistim’s products is defined
either by the number of use or expected time
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 vendors of products, raw materials and services
used in the design, development, production and
servicing of Medistim medical devices are subject
to supplier qualification. All relevant materials
used are subject to biocompatibility testing to
ensure that they are not harmful for the patient
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
or operator. All equipment which is in contact with
human tissue is designed to withstand required
sterilization processes. In addition, Medistim seek to
include in the supplier agreements the intent to use
environmentally friendly materials and transport.
Focus areas in 2022 are to reduce plastics used
in packaging of products and increase the use of
recyclable cardboard for packaging and transportation
of products. Further, 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.
The goals for 2022 are:
• Remove plastic bags used for probes in IFU’s
(Instructions For Use). This could potentially
save 26 kg of plastic per year.
• Implement sustainability as assessment
criteria in the product development process.
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 strive
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
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
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
oppose 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 2021.
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 2021.
The goal for 2022 is:
• Repeat training to employees on routines for
whistle blowing
Responsible selling practices
Medistim is a global leader in developing products
for quality control within of cardiac and vascular
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 with to ensure compliance.
This involves regularly 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 2021.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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.
To update status in 2021 with regard to ESG,
management created a team to updater status
related to the topic. Important part of the ESG
update is related to employees and working
environment to secure diversity and equal
opportunities for employees in Medistim.
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 a
higher level of 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
inly one part time employee and this is by own
choice. All other employees are compensated with
a 100 % position.
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 116 people
(120), of which no one were part-time employees.
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 3.2% or 1109 days
(3.8% or 1277 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
2021 (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. In 2021 a project to develop
new and advanced manufacturing technologies
in collaboration with Innovasjon Norge, GE and
Sensocure was completed. Long term, the goal is to
add automation in the production process.
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 2021 3.3% of
Medistim’s female and 0 % of male employees
took parental leave. On average, women took 36
weeks, while men took 0 weeks.
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 is:
• Update and revise the employee handbook.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Indicators 2021 2020
Working environment, health and safety
Number of employees 116 120
Number/ share of part-time employees 1 3
Turnover - number of employees leaving 12 6
Employees' co-ownership in the company (% employees owning shares in
Medistim) 0.64 % 0.82 %
Skickleave (%) 32 % 3.8 %
Number of work-related injuries 0 0
Gender balance, % women of group total 52 % 48 %
Gender balance, % women executive management 41 % 41 %
Gender balance, % women Board of Directors 40 % 40 %
Number of women hired during the year 2 2
Number of men hired during the year 6 4
Age distribution, employees < 30 years 4 4
Age distribution, employees 30-50 years 61 63
Age distribution, employees > 50 years 51 53
Average salary female employees in NOK
649 409 626 796
Average salary male employees in NOK 1 135 773 795 686
All employees incl. management level, womens share of salary per position 888 399 711 241
Executive management, womens share of salary per position (Hay Grade) 28 % 22 %
Number of weeks for maternity leave (women) 52 35
Number of weeks for paternity leave (men) 0 9
Responsible operations
Employees conducted training in ethical guidelines/ Code of Conduct (%)
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 5 5
Independent board members 3 3
Average age of board members 62 60
% meeting participation 95% 100%
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Indicators 2021 2020
Working environment, health and safety
Number of employees 116 120
Number/ share of part-time employees 1 3
Turnover - number of employees leaving 12 6
Employees' co-ownership in the company (% employees owning shares in
Medistim) 0.64 % 0.82 %
Skickleave (%) 32 % 3.8 %
Number of work-related injuries 0 0
Gender balance, % women of group total 52 % 48 %
Gender balance, % women executive management 41 % 41 %
Gender balance, % women Board of Directors 40 % 40 %
Number of women hired during the year 2 2
Number of men hired during the year 6 4
Age distribution, employees < 30 years 4 4
Age distribution, employees 30-50 years 61 63
Age distribution, employees > 50 years 51 53
Average salary female employees in NOK
649 409 626 796
Average salary male employees in NOK 1 135 773 795 686
All employees incl. management level, womens share of salary per position 888 399 711 241
Executive management, womens share of salary per position (Hay Grade) 28 % 22 %
Number of weeks for maternity leave (women) 52 35
Number of weeks for paternity leave (men) 0 9
Responsible operations
Employees conducted training in ethical guidelines/ Code of Conduct (%)
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 5 5
Independent board members 3 3
Average age of board members 62 60
% meeting participation 95% 100%
10. GROUP CONSOLIDATED FINANCIAL STATEMENTS
10.1 Consolidated Income Statement Medistim ASA Group
INCOME STATEMENT MEDISTIM ASA GROUP
2021
2020
1=NOK 1000 Note
Operating income and expenses
Revenue
Other income
Total revenue 1,2
Operating expenses
Cost of goods sold 3
Salary and social expenses 4,5,21
Other operating expenses 8
Operating profit before depreciation and amortization
Depreciation and amortization on assets 6,7,12
Operating profit
Financial income and expenses
Total financial income 9,20
Total financial expenses 9,20
Net finance
-2 207 -3 878
Profit before tax
Tax expense 10
Profit for the year 11
Earnings pr. share
2021 2020
Basic 11
Diluted 11
Statement of other comprehensive income
Net profit
Items that may be reclassified to profit and loss
Exchange differences arising on translation of foreign operations
Total comprehensive income
45
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
10.2 Consolidated Balance Sheet Medistim ASA Group
CONSOLIDATED BALANCE SHEET MEDISTIM GROUP ASA
31 Dec 2021
31 Dec 2020
1=NOK 1000
NOTE
ASSETS
Non-current assets
Property, plant and equipment 6
Deferred tax asset 10
Intangible assets 12
Other long term receivable 21
Total non current assets
Current assets
Inventory 14
Accounts receivable 15
Other receivables 15
Cash
16
Total current assets
Total assets
EQUITY AND LIABILITIES
Equity
Share capital 17
Treasury shares 17
-27 -33
Share premium 17
Other paid in capital 17
Issued capital 17
Other reserves 17
Retained earnings
Other equity
Total equity
Non current liabilities
Long-term debt 18,24
(0 )
Lease obligations 7,24
Deferred revenue 24
Total non current liabilities 18
Current liabilities
Accounts payable
Income tax payable
10
Other short term liabilities
19
Provisions
22 350 150
Lease obligations
18,24
Total current liabilities
18
Total liabilities
Total equity and liabilities 403 244 345 820
46
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
10.3 Consolidated Cashflow Statement
CASHFLOW STATEMENT
2021 2020
1= NOK 1000 Note
Cash flow from operations:
Profit/loss after tax
Minus income tax paid -13 336 -19 045
Plus this years tax expense 10
Plus depreciations 6,7,12
Change in inventory 14 15 254 -22 597
Change in accounts receivable 15 -11 149 4 704
Change in accounts payable -324 -1 298
Change in other accruals 196 -2 378
Net cash from operating activities
Investing activities:
Purchase of property, plant and equipment 6 -7 403 -7 450
Activated development expenses 12
-4 083
-3 189
Net cash from investing activities
-11 486 -10 639
Financing activities:
Repayment of interest bearing debt 18,24
-4 500
-3 000
Dividend 11 -54 640 -50 052
Principle and interest pain on lease liabilities 7,24 -7 502 -6 680
Other financing activities 23 7 589 1 385
Net cash from financing activities
-59 053
-58 347
Net change in cash 57 599 5 147
Cash as of 01 January 71 891 66 745
Cash as of 31 December 16 129 490 71 891
Available cash and cash withholding
Available cash as of 31 December 16
Cash withholding for taxes 16 4 624 6 130
Cash and cash equivalents as of 31 December 129 490 71 891
The group has a credit facility of 22.5 MNOK. The facility was not used by year end.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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. The subsidiaries present their financial statements in EUR, GBP, DKK and USD.
When translated to NOK a difference occur due to the change in the exchange between NOK and these
currencies. By year end 2020
this difference was 781 TNOK and the change for the year was -965 TNOK.
By year-end 2021, the equivalent was 6138 TNOK a change of 5357 TNOK from the year before.
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 2019 4 585 -36 41 852 4 330 50 730 1 746 184 384 186 130 236 861
Total comprehensive
income for the period - - - - - -965 69 387 68 422 68 422
Share-based payments
17 - 3 - 1 432 1 435 - 180 180 1 615
Dividend
11 - - - - - - -50 052 -50 052 -50 052
Equity as of 31 Dec 2020 4 585 -33 41 852 5 762 52 165 781 203 899 204 680 256 846
Total comprehensive
income for the period - - - - - 5 357 90 900 96 257 96 257
Share-based payments
17 - 6 - 7 582 7 589 - - - 7 589
Dividend
11 - - - - - - -54 640 -54 640 -54 640
Equity as of 31 Dec 2021 4 585 -27 41 852 13 344 59 754 6 138 240 160 246 298 306 052
48
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
10.5 Accounting Principles
stock exchange. Medistim ASA is incorporated in
Norway. The main office is located in Økernveien
94, 0579 Oslo , Norwa y . The Medistim group ’ s
The board of Directors and the CEO authorized these
financial statements for issue on March 22, 2022.
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 December 2021.
The annual accounts for the company 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.
New standards from 2021 has not had any significant
effects compared to 2020 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 Medis tim 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.
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
49
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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-cancellable 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.
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.
50
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 develop 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.
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
liabilities that in substance is part of the net invest-
ment in a foreign operation, is also included in trans-
lation 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 rate at the transaction
date. See also comment under 1.14 iv regarding
exchange rate differences.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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.
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
in a separate column in the segment report.
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:
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.
52
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 temporarily 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 2021 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
total 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.
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.
53
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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
an ordinary assurance type warranty, and not
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 revenue in the P&L includes service, spare
parts, grants and other revenue 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 2021
Note2 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.
Own Products category:
Medistim has a flexible business model in the US
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 US 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.
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.
SPLIT OF REVENUE AND OPERATING PROFIT FOR OPERATING SEGMENTS
Segment Own products Third party products Group
1 = NOK 1000 2 021 2 020 2 021 2 020 2 021 2 020
Revenue:
Sales in USA
Lease revenue from flow procedures
50 380 52 848 - - 50 380 52 848
Lease revenue from imaging procedures
23 949 20 686 - - 23 949 20 686
Probes
31 594 22 636 - - 31 594 22 636
Systems
18 108 12 022 - - 18 108 12 022
Ultrasound imaging
18 984 15 011 - - 18 984 15 011
Ultrasound imaging probes
5 831 3 205 - - 5 831 3 205
Other revenue
5 290 5 290
Sales outside USA
- -
Probes-
115 704 92 626 - - 115 704 92 626
Systems-
32 898 35 225 - - 32 898 35 225
Ultrasound imaging A
38 912 29 179 - - 38 912 29 179
Ultrasound imaging probes-
7 118 5 219 - - 7 118 5 219
Third party sales
- - 74 340 67 549 74 340 67 549
Other revenue-
4 169 6 927 - - 4 169 6 927
Total external revenue
- - 74 340 67 549 427 276 363 134
Total revenue
352 936
295 585
74 340
67 549
427 276
363 134
Cost of goods sold
56 194 41 494 40 920 35 083 97 114 76 577
Salary and social expenses
120 893 104 522 13 614 14 543 134 507 119 066
Other operating expenses
50 031 42 863 5 920 6 002 55 950 48 865
Depreciation
23 078 20 372 349 2 769 23 427 23 141
Operating profit per segment
102 740
86 334
13 537
9 151
116 277
95 485
55
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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
2 021
2 020
2 021
2 020
2 021
2 020
2 021
2 020
2 021
2 020
Revenue own
products
154 135 126 408 115 849 105 201 66 805 46 811
16 146
16 651 352 936 295 071
Assets
103 966 90 364 213 286 160 371 12 269 12 269 6 588 6 588 336 109 269 592
Investments
4 415 4 967 9 268 11 405 - - - - 13 682 16 372
Revenue 3. party
products
- - 74 340 68 063 - - - - 74 340 68 063
Revenue in units
own products
Procedures flow
59 397 47 256 - - - - - - 59 397 47 256
Procedures imaging
12 635 8 803 12 635 8 803
Probes
3 080 2 606 4 524 3 943 2 683 1 693 781 582 11 068 8 824
Systems
22 14 54 52 59 63 12 9 147 138
Ultrasound imaging
16 12 27 19 34 19 6 9 83 59
Ultrasound imaging
probes
133 95 50 36 46 26 11 13 240 170
Lease of flow
systems
9 10 - - - - - - 9 10
Lease of flow and
imaging systems
10 3 - - - - - - 10 3
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.
FOR OWN PRODUCTS AND 3 PARTY PRODUCTS
2 021
2020
All numbers in NOK 1000
Split of own products
Sales within coronary surgery 293 025 250 482
Sales within vascular surgery 54 619 45 102
Other revenue USA 5 292 -
Sales of 3. party products 74 340 67 549
Total sales 427 276 363 133
56
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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
2 021
2 020
2 021
2 020
2 021
2 020
2 021
2 020
2 021
2 020
Revenue own
products
154 135 126 408 115 849 105 201 66 805 46 811
16 146
16 651 352 936 295 071
Assets
103 966 90 364 213 286 160 371 12 269 12 269 6 588 6 588 336 109 269 592
Investments
4 415 4 967 9 268 11 405 - - - - 13 682 16 372
Revenue 3. party
products
- - 74 340 68 063 - - - - 74 340 68 063
Revenue in units
own products
Procedures flow
59 397 47 256 - - - - - - 59 397 47 256
Procedures imaging
12 635 8 803 12 635 8 803
Probes
3 080 2 606 4 524 3 943 2 683 1 693 781 582 11 068 8 824
Systems
22 14 54 52 59 63 12 9 147 138
Ultrasound imaging
16 12 27 19 34 19 6 9 83 59
Ultrasound imaging
probes
133 95 50 36 46 26 11 13 240 170
Lease of flow
systems
9 10 - - - - - - 9 10
Lease of flow and
imaging systems
10 3 - - - - - - 10 3
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.
FOR OWN PRODUCTS AND 3 PARTY PRODUCTS
2 021
2020
All numbers in NOK 1000
Split of own products
Sales within coronary surgery 293 025 250 482
Sales within vascular surgery 54 619 45 102
Other revenue USA 5 292 -
Sales of 3. party products 74 340 67 549
Total sales 427 276 363 133
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
3150 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 operate in different geographical areas.
Note 3 Split of Cost of Goods Sold
SPLIT OF COST OF GOODS SOLD 2021
2020
1 = NOK 1000
Third party products 40 215 37 307
Components 50 765 33 023
3.party services
1 169 1 983
Packing material and other materials
620 1 106
Freight
4 345 3 158
Total cost of goods sold
97 114
76 577
Note 4 Salary and social expenses
SPLIT OF SALARY EXPENSES
2021
2020
1 = NOK 1000
Salary
99 262 94 965
Employeers tax
13 405 12 475
Bonus
14 444 3 903
Cost for contribution pension plan
4 905 4 661
Compensation to the Board
1 350 1 350
Other social costs
1 141 1 713
Total salary and social cost
134 507
119 066
Average number of employees:
USA
23 23
Germany
3 4
UK
1 1
Spain 2 2
Denmark 1 1
Norway 86 87
Total 116 118
AUDIT FEE FOR THE GROUP
2021
2020
1 = NOK 1000
Statutory Audit
1 685 1 053
Other services 155 154
Total Audit fee
1 840
1 207
The amounts are without VAT
57
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 12G. 1G is the base amount in the social security system. Employees in the US
follow a pension plan, a 401k match that covers 4 % of salary. The total cost for the contribution plans
was in 2020 TNOK 4.661, 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
Equip-
ment
Other
assets
Right-of-
use assets
Total
assets
Equip-
ment
Other
assets
Right-of-
use assets
Total
assets
1 = NOK 1000 2021 2020
Historical cost
Balance 1. January 79 234 24 517 40 276 144 028 76 949 17 406 34 319 128 674
Additions 6 128 1 150 3 412 10 690 7 123 7 111 5 985 20 219
Disposals 505 -170 335 -4 838 0 -28 -4 866
31.December 85 868 25 497 43 688 155 052
79 234 24 517 40 276 144 027
Accumulated depreciation
and impairment
Balance 1. January
52 065 14 952 12 328 79 345 45 447 12 688 5 648 63 782
Depreciation this year
6 724 2 946 7 156 16 826 6 220 2 813 6 680 15 714
Disposals
32 - -
32
- - - -
Exchange rate
differences
0 23 -12 11 59 93 - 153
31. December
58 821 17 875 19 496 96 191
51 607 15 408 12 328 79 343
Book value 27 047 7 623 24 192 58 862
27 627 9 110 27 948 64 684
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 6.1 MNOK is fully depreciated as of 31 December 2021 but are still
in use.
Security
Equipment and other assets is pledged as security as of 31 December 2021. The security is related to
long-term loan and hedging credit facility. The group’s bank had the same security as of 31 December
2020.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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.
In Økernvein 94 Medistim has entered an agreement to increase the facilities with 500 square meters. 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.
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.
Right-of-use assets
Buildings
Machinery and
equipment Vehicles 2 021
Recognition of right to use of asset 1 January
24 762 276 2 910 27 948
Addition of right-of-use assets, CPI adjustments and other
reassessment
1 781 - 1 631 3 412
Other\exhangerate difference
-12 - 0 -12
Amortisation
5749 70 1337 7 156
Carrying amount of right-of-use assets at 31 December 2021 20 782 206 3 204
24 192
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
2 021
Less than 1 year
5 761 80 1315 7 156
1-2 years
5 773 80 1 315 7 168
3-4 years
5 340 74 742 6 156
4-5 years
2 962 167 3 129
More than 5 years
2 212 - - 2 212
Total undiscounted lease liabilities at 31 December 2021 22 048 234 3 539
25 821
Summary of the lease liabilities in the financial statements
Statement of: 2 021
Lease liabilities as of January 1st
28 167
New lease liabilities recognised in the year
3 412
Cash payments for the principal portion of the lease liability
Cash flows 7 375
Interest expense on lease liabilities
Profit and loss 127
Other\exhangerate difference
Profit and loss (12)
Total lease liabilities at 31 December 2021
24 192
Current lease liabilities
Financial position 7 113
Non-current lease liabilities
Financial position 17 079
Total cash outflows for leases
Cash flows 7 502
59
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
OTHER OPERATING EXPENSES
2021
2020
1 = NOK 1000
Office expenses
152 2 429
Travel cost 4 955 3 788
Marketing 2 197 1 803
Consultants
25 194 20 744
Insurance 2 229 2 087
Freight 1 906 1 302
Communication 1 039 1 090
IT cost
12 253 9 258
Other 6 028 6 365
Total
55 950
48 865
Note 9 Financial revenue and expenses
As of 31 December 2021, the company had 0.0 MNOK in interest bearing loan. Additional cash in the
group gave interest revenue of 15 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
2 021
2 020
1 = 1000 NOK
Interest income 16 5
Other financial income
172 12
Gains on foreign exchange 7 985 14 120
Total financial income
8 173
14 137
Loss on foreign exchange 9 790 17 599
Interest cost on loans 178 146
Other financial expenses
412 270
Total financial expenses 10 380 18 015
Net financial expenses
-2 207
-3 878
60
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Note 10 Income tax
INCOME TAX
2021
2020
1 = NOK 1000
Current income tax charge 25 594 24 046
Deferred tax expense -2 423 -1 827
Income tax expense reported in income statement
23 171
22 219
Reconciling tax expense towards income before tax
Tax expense for the year 23 171 22 219
22% of income before tax 25 095 20 154
Change in deferred tax, temporary differences
-2 423 -
Permanent differences and different tax rates
-499 -2 065
Specification of taxable income 2021 2020
Expected income tax at tax rate 22 % in Norway 25 095 20 153
Permanent and other differences -2 423 823
Foreign tax rate differences
499 1 242
Income tax expense 23 171 22 219
Effective income tax rate
20,3 % 24,3 %
Payable tax in the balance sheet 2021 2020
Income tax expense 25 594 24 046
Prepaid tax
-5 267 -11 739
Utilizing deferred tax asset - -
Total payable tax 20 327 12 307
Specification of deferred tax
Difference in values: 2021 2020
Non current assets 317 -1 178
Current assets -15 479 -2 889
Other obligations 435 544
Total differences -14 726 -3 523
Deferred tax asset 22 % -3 240 -775
Deferred tax asset recognized in the balance sheet -3 240 -775
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
2021 to 20.3%.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
TAX EXPENSE FOR THE GROUP IS GEOGRAPHICALLY SPLIT AS FOLLOWS:
2021
2020
1 = NOK 1000
Norway 17 390 13 393
Germany 2 479 2 442
USA 2 779 6 255
Spain
265 -
Denmark
258 130
Total
23 171
22 219
Note 11 Earnings per share
EARNINGS PER SHARE
2021
2020
1 = NOK 1000
Profit for the year
90 900 69 387
Average numbers of shares outstanding
Average number of shares used in basic EPS 18 216 18 200
Effect of share options 33 37
Average numbers of shares used in diluted EPS 18 249 18 237
Profit per share
Ordinary 4.99 3.81
Diluted 4.98 3.80
Paid dividend 54 640 50 052
Dividend per share 3.00 2.75
Suggested dividend per share 3.75 3.00
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 2021, there were share program to CEO. The share program to CEO is described under
8.12 Remuneration of executive personnel note 21. By year-end the company had 108 422 own shares.
Note 12 Intangible assets
COVID 19 effect on estimates and impairment testing of intangible assets.
Medistim has in 2020 been affected by the COVID 19 pandemic. Instead of an annual growth in sales of
around 10 %, sales in 2020 ended at the same level as 2019. As an international company the experience
in 2020 was that the timing during the year was different from region to region dependent upon how
the pandemic developed. During the first outbreak all elective surgery was on hold, but as the health
care system gained experience dealing with COVID 19, it was opened for elective surgery. However, the
activity level was not as high as normal and only the most critical patient received treatment. For 2021
the company has experienced increased activity level since the patient group Medistim is addressing
are critical conditions that at some point will demand treatment. This has required additional efforts
than normal activity in order to reduce healthcare needs. With vaccines available and a large portion of
populations vaccinated, it is the managements evaluation that the situation will be under control at some
point. However, there are still some uncertainties related to new variants of the virus. In the estimates
used to test for impairment, it is assumed that the situation normalizes in 2022. The pandemic will not
change the need for the company’s products and services as other branches might experience.
62
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Product technology and additions, goodwill and license agreement
In 2021, 4.1 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. The license agreement is externally acquired from Em-tec
for the use of the SonoQ products.
INTANGIBLE ASSETS 2021
Product under
development
Completed product
development Goodwill
License
agreement
Total
intangible
1 = NOK 1000
Historic cost
Historic cost 31 Dec 21 - 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 December 21
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 21 - 65 887 - 2 158 68 044
Carrying amount 31 December 21 1 334 14 707 14 128 0 30 170
INTANGIBLE ASSETS 2020
Product under
development
Completed product
development
Goodwill
License
agreement
Total
intangible
1 = NOK 1000
Historic cost
Historic cost 31 December 2020
- 75 897 14 128 2 158 92 183
Internal additions in use - 1 865 - 1 865
External additions in use - 82 - 82
Additions under development 1 242 1 242
Historic cost 31 December 2020 76 602 14 128 2 158 94 130
Accumulated depreciation and write
downs 52 936 - 1 079 54 015
Depreciations for the year 6 888 - 539 7 427
Total depreciation as of 31
December 2020 - 59 824 - 1 618 61 442
Net value in balance sheet 1 242 16 778 14 128 540 32 688
Intangible assets are depreciated on a straight-line basis over the useful life. Useful life for capitalized
product development is 3 to 8 years. The license agreement is depreciated over 5 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
63
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
vascular surgery is large and it is performed about
600,000 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 December
2021 was 2.4 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 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 13.6 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.
Summary product technology
In total 14.5 MNOK of the R & D expenses was
recorded in the P & L in 2021. Similar expense was
14.6 MNOK in 2020. With 4.1 MNOK recognized
as asset a total of 18.6 MNOK was used in R & D
in 2021. Comparable number for 2020 was 16.5
MNOK. Medistim received TNOK 376 in Skattefund
funds in 2021.
License agreement:
Medistim entered a license and an OEM agreement
with em-tec GmbH in 2015. With the agreement,
Medistim obtains exclusive, worldwide rights
to market and sell em-tec's transit time flow
measurement (TTFM) technology, the SonoQ,
for use on human blood vessels within cardiac-,
vascular- and transplant surgery. em-tec's flow
measurement device was designed as a basic, entry-
level customer solution that meets lower price-point
market segments. The product was discontinued
in 2021. To fill the gap within Medistim's product
portfolio, Medistim has developed its own entry-
level solution to meet the demand in lower price
point market segments. Book value by year end
2021 for SonoQ products was 0.0 MNOK.
Goodwill
A yearly test of values is done for the cash flow
generating units that has a goodwill value in the
balance sheet.
GOODWILL
2021
2020
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 2022 and 3-year
strategy plan for the years 2023 to 2025 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 12.1 % the weighted average
cost of capital (WACC). 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
64
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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
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 3.5 %. Including risk free interest of 3.0 % the
total WACC in 2021 is set to 12.1%.
Future growth:
It is projected growth in sales with a variation
from 7 % 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:
The company’s largest customers are Norwegian
hospitals. The hospitals are continuously improving
their purchasing routines and purchasing is
centralized and professionalized. This increases
the demand for better quality and prices from the
suppliers. The company’s ability to maintain prices
by offering quality products and services is crucial in
the competition for future contracts.
With the assumption used in the impairment test,
the recoverable amount exceeds the carrying
amount with 49,6 MNOK (“headroom”), and no
impairment loss is recognized. Operating margin
and growth is based upon historic achieved
margins and sales growth.
Operating margin and growth is based upon
historic achieved margin and sales growth. In the
estimates the budget and the projections of the
3-year strategy update is used. The operating
margin in the projections vary between 14% and
14.5% .Sales growth varies from 7%-2%.
If the operating margin is reduced from 15.0%
to 3.6% everything else equal, carrying amount
would require an evaluation of impairment loss.
A change in the WACC from 12.1 % to 55.0 %
everything else equal, would cause an impairment
loss. See overview below.
HEADROOM
WACC 12.1 % 28 % 55.0 %
Headroom in MNOK 59.4 24.2 1.7
Operating margin 15 % 7.4 % 3.6 %
Headroom in MNOK 59.4 32.9 -0.9
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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
Unit Country Segment Ownership
1 = NOK 1000
Medistim USA Inc. USA
Lease and sale within bypass surgery and
vascular surgery 100%
Medistim Deutschland
GmbH Germany
Capital sales within bypass surgery and vascular
surgery 100%
Medistim Norge AS Norway
Sale of 3 pary products and capital sales within
bypass surgery and vascular surgery 100%
Medistim UK LTD UK
Capital sales within bypass surgery and vascular
surgery 100%
Medistim Japan KK Japan Dornmat company 100%
Medistim Spain S.L Spain
Capital sales within bypass surgery and vascular
surgery 100%
Medistim Danmark Aps Denmark Sale of 3 pary 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
2021
2020
Raw material 51 861 54 115
Work in progress 2 139 6 909
Finished goods 30 711 36 434
Spare parts 7 146 3 504
Third party products 12 235 14 047
Inventory provision -6 678 -2 343
Total 97 413 112 667
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 2020 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.
66
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
SPECIFICATION OF INVENTORY PROVISION 2021
2020
1=NOK 1000
Gross value Provision Gross value Provision
Demonstration products
6 105 3 074 1 562 1 172
Spare parts
4 170 3 404 1 942 970
Third party products
200 200 200 200
Total
10 475 6 678
3 704 2 342
Note 15 Accounts receivables and other receivables
ACCOUNTS RECEIVABLE 2021
2020
1 = NOK 1000
Accounts receivable 68 993 57 844
Provision for bad debt -359 -359
Total 68 634 57 485
POVISION FOR BAD DEBT 2021
2020
1 = NOK 1000
Inbound provision 359 212
Increased provision - 147
Total 359 359
AGING ACCOUNTS RECEIVABLE
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
Year 2020
Expected loss in % 0,00% 0,00% 0,00% 3,45%
Book value of receivables 40 020 5 249 2 157 10 412 57 839
Expected credit loss - - - 358 358
Total 40 232 5 249 2 157 10 054 57 480
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.
Receivables is used as security for loan, see note 18. Other receivables are shown in the following table:
67
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
OTHER RECEIVABLES 2021
2020
1 = NOK 1000
Other pre-payments
6 076 761
Accrued income 4 571 -
VAT receivable - 1 949
Other
312 1 035
Total 10 960 3 744
Note 16 Cash
CASH
2021
2020
1 = NOK 1000
Available cash in bank 124 866 65 761
Restricted cash in bank 4 624 6 130
Total cash in bank 129 490 71 891
Credit limit 22 500 22 500
Cash available
147 366
88 261
Restricted cash as of 31 December 2020 was 6 130 TNOK and was related to tax withheld from salaries.
As of 31 December 2021 the restricted cash was 4 624 TNOK related to tax withheld on salaries. The
holding company had a credit facility of 22.5 MNOK in 2020 and 22.5 MNOK in 2021. The credit facility
was not in use as of 31 December 2021 or 31 December 2020.
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 2021
Number of shares Par value per share Share capital in NOK
Share capital 01.01.2021 18 337 336 NOK 0.25 NOK 4 548 334.00
Changes - - -
Share capital 31.12.2021 18 337 336 NOK 0.25 NOK 4 548 334.00
The Board of Directors received by the shareholders meeting the 27th of April 2021 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 2022 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 2022. See the following table for changes in the equity for the last year.
68
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
STATUS FOR THE PERMISSIONS AS OF 31.12.2021
Capital increase Medistim shares
Permission given at the shareholders meeting in 2021 1 833 733 1 833 733
Permissions used - -
Share capital 31.12.2021 1 833 733 1 833 733
The company owned 108 422 Medistim shares as of 31 December 2021. Number of Medistim shares by
01 January 2021 was 126 500.
The 20 largest shareholders in the company were as of 31 December 2021:
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 1 240 079 6.76 % United States
VERDIPAPIRFOND ODIN NORDEN 1 200 000 6.54 % Norway
State Street Bank and Trust Comp 1 117 246 6.09 % United States
Skandinaviska Enskilda Banken AB 1 017 484 5.55 % Sweden
FOLLUM INVEST AS 970 000 5.29 % Norway
State Street Bank and Trust Comp 686 139 3.74 % United States
ODIN Small Cap 600 000 3.27 % Sweden
Skandinaviska Enskilda Banken AB
594 221 3.24 %
Denmark
State Street Bank and Trust Comp 466 805 2.55 % United States
Skandinaviska Enskilda Banken AB 414 011 2.26 % Sweden
SKANDINAVISKA ENSKILDA BANKEN AB 394 180 2.15 % Luxembourg
The Northern Trust Comp, London Br 382 845 2.09 % United States
BUANES 379 936 2.07 % Norway
The Bank of New York Mellon SA/NV 257 500 1.40 % Denmark
RBC Investor services bank S.A. 254 188 1.39 % Luxembourg
Skandinaviska Enskilda Banken AB 238 314 1.30 % Sweden
BNP Paribas Securities Services 233 392 1.27 % Italy
Danske Invest Norge Vekst 228 000 1.24 % Norway
Total 20 largest shareholders 13 821 840
Total number of shares outstanding 18 337 336
20 largest shareholders in % 75,38%
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
10 427 0.06 % VP Sales International
Erik Swensen
10 994 0.06 % VP R&D
Thomas Jakobsen
22 748 0.12 % CFO
Kari Eian Krogstad
51 802 0.28 % CEO
Siri Fürst
2 000 0.01 % Board member
Øyvin A. Brøymer (Fløtemarken AS)
1 285 000 7.01 % Chairman
69
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
BOARD MEMBERS AND MANAGEMENT TEAM WITH SHARES IN THE COMPANY
Anne Waaler
2 440 0.01 % VP Medical
Håkon Grøthe (Grøten Invest AS)
1 990 0.01 % VP Innovation
Mike Farbelow
1 990 0.01 % President Medistim USA
Ole Jørgen Robsrud 1 326
0.01 % CEO Medistim Norge
Tone Veiteberg 1 990
0.01 % VP QA&RA
Hæge Wetterhus 663
0.004 % VP Marketing
Lars Rønn
885 0.005 %
Board member
There were no share options outstanding as of 31.12.2021 except from the share program to CEO
described under 8.12 Remuneration of executive personnel and note 21.
Note 18 Long-term debt
2021
2020
1 = NOK 1000 Interest rate Last due date
Carrying
amount
Carrying
amount
Secured loan
PPP loan from USA - debt forgivness in 2021 n.a n.a - 6 080
Lease obligations 2-4 % 30/09/27 24 192 28 368
Deferred revenue 2 510 265
Loan from DNB NIBOR + 1.90 % 18/10/22 - 4 500
Total debt 26 702 39 213
Debt due within one year 0 -3 000
Lease obligations due within one year -7 113 -6 715
Total non.current liabilities 19 589
29 497
Medistim borrowed 15.0 MNOK in 2017 and the remaining balance of the loan was 4.5 MNOK by 31 December
2020. 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 December 2021 30.2 MNOK, 57.0 MNOK for accounts receivables and 73.3 MNOK for inventory. The
remaining debt of 4.5 MNOK from 2020 was repaid during 2021. The lease agreements are described under
note 7.
During 2020 Medistim qualified for a Payroll Protection Program (PPP) loan of MNOK 6.1 or TUSD 627 in the
US. This is part of US government support program during COVID 19 to keep employees employed. The loan
was forgiven in 2021 since the criteria related to debt forgiveness was achieved. In 2021 the debt forgiveness
was recorded as other revenue.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Note 19 Other short term debt:
OTHER LIABILITIES
2021
2020
1 = NOK 1000
Accrual for public taxes
8 972 9 613
Accrual for holiday pay
7 140 7 386
Accrual for salaries, commission and board member fee
14 703 4 628
Accrual for customer and supplier obligations
966 631
Other
4 828 1 353
Total
36 609
23 610
Note 20 Financial Risk
The group’s financial liabilities are leasing agreements, and accounts payable. The group also has a credit facility.
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 2021 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 company 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 2021, the company had no derivative contracts for EUR or
USD. 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.
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 December 2021 30.2 MNOK for assets, 57.0 MNOK for accounts
receivables and 73.3 MNOK for inventory. The financial assets and liabilities in the balance sheet by year
end 2021 and 2020 is shown below:
71
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
FINANCIAL ASSETS AND LIABILITIES
2021
2020
1 = NOK 1000
Original value Gain\loss Book value Original value Gain\loss Book value
Financial assets
Cash in USD
9 985 709 10 694 6 252 -173 6 079
Cash in EUR
13 026 82 13 108 14 388 70 14 458
Accounts receivable in EUR
28 364 -541 27 823 38 558 480 39 038
Accounts receivable in USD
- - - 181 7 188
Financial debt
Accounts payable in EUR
2 855 17 2 838 2 182 154 2 028
Accounts payable in USD
207 -3 204 337 14 351
Interest bearing loan
Bank loans in NOK
- - - 4 500 - 4 500
Forward currency contracts
- - - - - -
EFFECT ON PROFIT IF CURRENCY CHANGES WITH 5%
1 = NOK 1000
2021 2020
Original value Gain\loss Book value Original value Gain\loss Book value
Total exposure towards EUR
38 535 -476 38 093 50 764 396 51 468
Total exposure towards USD
9 778 712 10 490 6 096 -180 5 916
5 % increase EUR
1 905 2 573
5 % increase USD
525 296
5 % decrease EUR
-1 814 -2 451
5 % decrease USD
-500 -282
Credit and liquidity risk:
Other financial risk as credit risk and liquidity risk is viewed by the company as low based upon the
group’s financial position as of 31 December 2021.
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 company 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 company has been able to build up a cash reserve due to strong profits to handle
the increased need for working capital as the company grows. The liquidity buffer also secures cash in
situations where the incoming cash is delayed. In addition, the company has a credit facility with a limit
of 22.5 MNOK to secure available cash.
72
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
COVID 19 pandemic:
Cardiac by-pass 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 by-pass 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. 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, and continue to experience strong growth in revenues due to
the increase in number of CABG procedures performed. This increase corresponds with the reduction
in hospitalizations of patients with COVID disease, which is again an effect of the growing vaccination
rates in Medistim’s core markets, Europe, and USA, and to some degree also in Japan and China. Due to
lower operating costs from travelling, conferences, general cost containment and sales growth, Medistim
reports an all-time high EBIT result for 2021. Cash flow from operation was a solid MNOK 127.6 and the
cash position was MNOK 129.5 by year end. 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 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.
undiscounted payments:
OVERVIEW OF DEBT
1 = NOK 1000
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 19 & 22) 33 815 3 143 - - 36 958
Total 48 799 28 804 14 248 5 341 97 192
Year 2020
Within 3 months Between 3-12 months 1 to 5 years Over 5 years Total
Interest bearing loans
- 3 000 7 580 - 10 580
Lease liabilities
1 753 5 259 14 640 21 652
Accounts payable 13 530 - - - 13 530
Deferred revenue 265 265
Income tax 12 307 12 307
Other debt (see note 18,19,22) 30 639 - - - 30 639
Total
45 922 20 566 22 485 - 88 973
Financial strategy:
73
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Compensation to management
The management group consists of 10 people including CEO. The managing directors in the subsidiaries
are included in the management group.
COMPENSATION AND BENEFITS TO THE MANAGEMENT GROUP IN 2021
Management Position Salary Bonus Pension
Share based
compensation Other Total
Hæge Johanne
Krogh Wetterhus
VP Marketing 1 327 426 66 905 90 000 - 4 392 1 488 723
Anne Waaler VP Medical 1 291 382 83 631 77 736 - 4 392 1 457 141
Roger Reino
Morberg
VP Sales 1 530 580 88 314 84 552 - 4 392 1 707 838
Erik Swensen VP Development 1 352 031 69 581 81 456 - 4 392 1 507 460
Tone Ann
Veiteberg
VP QA\Reg 1 132 394 58 876 73 920 - 4 392 1 269 582
Ole Jørgen
Robsrud
CEO Medistim
Norge AS
1 241 558 64 286 84 000 - 15 000 1 404 844
Helge Børslid VP Operations 1 246 512 98 127 82 704 - 4 392 1 431 735
Håkon Grøthe VP Innovation 1 222 257 102 587 82 656 - 4 392 1 411 892
Mike Farbelow
President
Medistim USA 1 909 488 773 100 78 667 - 97 058 2 858 314
Cindy Kaffi
CEO Medistim
Germany 1 277 478 406 400 - - - 1 683 878
Kari Eian
Krogstad
CEO Medistim
group 2 827 824 347 904 90 348 3 125 000 4 392 6 395 468
Thomas
Jakobsen
CFO Medistim
Group
1 820 331 93 666 82 116 - 4 392 2 000 505
Total
18 179 261 2 253 377 908 155 3 125 000 151 586 24 617 380
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 106.300. 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 2020 and 2021. Some members of the management group has loan from the company
related to the share program offered to the Management team in 2021. The following table shows who in the
management team purchased shares at a discount and has loan form the company.
74
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
SHARE PROGRAM FOR THE MANAGEMENT GROUP IN 2021
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
Hæge Johanne
Krogh Wetterhus VP Marketing 200 000 50 000 250 000 663 100 000
Anne Waaler VP Medical 600 000 150 000 750 000 1 989 -
Roger Reino
Morberg VP Sales 600 000 150 000 750 000 1 989 600 000
Erik Swensen VP Development 300 000 75 000 375 000 994 -
Tone Ann Veiteberg VP QA\Reg 600 000 150 000 750 000 1 989 600 000
Helge Børslid VP Operations 400 000 100 000 500 000 1 326 200 000
Håkon Grøthe VP Innovation 600 000 150 000 750 000 1 989 -
Kari Eian Krogstad
CEO Medistim
Group 600 000 150 000 750 000 1 989 600 000
Thomas Jakobsen
CFO Medistim
Group 800 000 200 000 1 000 000 2 652 800 000
Total 4 700 000 1 175 000 5 875 000 15 578 2 900 000
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 were en-
tered the 15th of November 2021.
Compensation to the board was 1 300 TNOK in 2020 and 1 300 TNOK in 2021. The chairman received
400 TNOK as compensation in 2020 and 400 TNOK in 2021 The four board members received a total 225
TNOK each as compensation in 2020, a total of 900 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.
CEO has an agreement with the Board that she can receive up to 33.000 Medistim shares as part of
compensation if in position until 2024. The Shares is received by the CEO free of charge and last shares
will be received in 2025. 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 2021, TNOK 2 285 including social security tax was expensed in the accounts related to
the arrangement. See also in the following table:
OUTSTANDING SHARES
2021
Outstanding 1.1
45 500
Granted
12 500
Exercised
-12 500
Outstanding 31 December
45 500
Vested as of 31 December
12 500
Remaining options as of 31 December
33 000
Current year expense for share based payment
1 714 000
Year 2022 2023 2024
Vesting of share options
12 000 12 000 9 000
Share price time of grant
71.0 167.0 254.0
Transactions with related parties
There were no transactions towards related parties in 2021 or in 2020.
75
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Note 22 Provisions
PROVISIONS 2021
2020
1 = NOK 1000
Warranty provision 350 150
Sum 350 150
Note 23 Exchange rates foreign currency
EXCHANGE RATES FOREIGN CURRENCY
Currency
Rate 01.01.2021
Average rate Rate 31.12.2021
USD 8.5326 8.5889 8.8194
DKK 140.71 136.59 134.32
EUR 10.4703 10.1633 9.9888
GBP 11.6462 11.8176 11.8875
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
2020
At 1st of January 2020 3 000 7 580 6 680 22 465 39 251
New lease agreements - - 5 957 5 957
Interest bearing debt -3 000 -3 000
Cash flows lease agreements - -6 680 -6 206
Debt becoming current in 2020 3 000 0 6 881 -6 680 3 201
Effects of foreign exchange - - -91 -91
Deferred revenue - 265 - 265
31.December 2020 3 000 7 845 6 881 21 651 39 377
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
The Russian and Ukraine conflict is expected to have minor impact on Medistim business. Sales to these
countries was less than 2% of total sales in 2021. The Board of directors has no knowledge about events
after 2021 that will affect the annual report and financial statement for 2022.
76
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
11. PARENT COMPANY FINANCIAL STATEMENTS
11.1 Income Statement Medistim ASA
INCOME STATEMENT MEDISTIM ASA 2021 2020
1 = NOK 1000
Note
Operating income and expenses
Revenues
Sales revenue 26 255 574 192 259
Other revenue 27 2 944 3 185
Total revenue 258 518 195 444
Operational expenses
Cost of goods sold 54 582 37 663
Salary and social expenses 27 73 536 62 858
Depreciation on assets 28 13 715 13 961
Other operating expenses 27,29,39 39 405 35 553
Total operating expenses 181 238 150 036
Operating profit
77 280
45 408
Financial income and expenses
Financial income
Dividend from subsidiaries 31 24 000 25 230
Other financial income 37 7 529 15 920
Financial expenses 37
11 446 16 519
Net finance 20 083 24 631
Profit before tax 97 363 70 039
Tax expense 30 16 682 9 864
Profit for the year 80 681 60 175
Allocations
Dividend 36 68 358 54 597
Other equity 36 12 324 5 578
Total allocation 80 681 60 175
Earnings per share 2021 2020
Ordinary 4.43 3.31
Diluted 4.42 3.31
Dividend per share 3.75 3.00
77
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
11.2 Balance Sheet Medistim ASA
BALANCE SHEET MEDISTIM ASA
31/12/21
31/12/20
1 = NOK 1000
Note
Assets
Non current assets
Intangible assets
Deferred tax
30
1 501 1 483
Marketing rights 29
1 540
R & D 28,29
16 041 18 020
Fixed assets
Property, plant and equipment 28
26 297 28 269
Office equipment 28
2 316 2 049
Financial assets
Shares in subsidiaries 31
37 392 37 392
Other long term receivables 31
10 992 8 559
Total non current assets
94 540
96 313
Current assets
Inventory 33
73 704
87 555
Accounts receivables 32,41
48 908
37 525
Other receivables 32,41
18 145
3 359
Cash 34
75 149
19 955
Total current assets
215 907
148 393
Total assets
310 447
244 706
Equity and liability
Equity
Share capital 35,36
4 584
4 584
Share premium 35,36
40 253
40 253
Other paid in equity 36
13 348
5 769
Other equity
Retained earnings 36
102 164 89 862
Total equity
160 349
140 468
Liabilities
Accruals for obligations
Deferred income 29
-
2 132
Total accruals
-
2 132
Other long term debt
Long term debt 40
35 278
10 030
Total other long term debt
35 278
10 030
Short term debt
Interest bearing short term debt 40
-
3 000
Accounts payable
6 791
8 643
Payable tax 30
16 700
10 903
Employee withholding, social security taxes
11 025
10 272
Dividend 36
68 358
54 596
Other short term debt 38,41
11 946 4 661
Total short term debt
114 820
92 075
Total equity and liability
310 447
244 706
78
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
11.3 Cash Flow Statement
CASH FLOW STATEMENT
2021
2020
1 = NOK 1000 Note
Cash flow from operations:
Profit/loss before tax
97 363 70 039
Minus income tax paid -9 749 -8 485
Plus this years tax expense
Plus depreciations 28 13 715 13 961
Change in inventory 33 13 850 -24 114
Change in accounts receivable 32 -11 383 -1 832
Change in accounts payable -1 852 -2 602
+/- Change in paid and expensed pension - -
Other changes -8 910 1 361
Net cash from operating activities 93 035 48 328
Investing activities:
Minus investment in assets 28 -11 124 -9 672
Net cash from investing activities -11 124 -9 672
Financing activities:
Minus down payment of long term debt 40 -4 500 -3 000
Dividend 36 -54 640 -50 052
Issue of new equity 7 589 -
Interest on loans - -
Dividend from subsidiaries -
New loans 41 24 834 11 000
Net cash from financing activities -26 717
-42 052
Net change in cash 55 194 -3 396
Cash as of 01.01 19 955 23 351
Cash as of 31.12 75 149 19 955
Available cash and cash withholding
Available cash as of 31.12 34 71 931 15 658
Cash withholding for taxes 34 3 218 4 297
Cash and cash equivalents as of 31.12 75 149 19 955
11.4 Accounting Principles
The financial statement and notes is 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.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 defined 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.
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
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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 2021 2020
1 = NOK 1000
USA 89 062 64 476
Asia
66 804 45 342
Europe
91 151 74 640
Rest of the world 11 501 10 986
Total sales 258 518 195 444
Other revenue amounted to TNOK 3 185, where
TNOK 2 392 and was income related to services
towards subsidiaries and TNOK 793 a grant from
Innovasjon Norge. For 2020 other income amounted
to 2 903 TNOK and was also related to services
towards subsidiaries.
SALARIES AND OTHER BENEFITS
2021
2020
1 = NOK 1000
Salary
61 047 52 433
Social taxes
8 815 7 974
Other salary and social expenses
3 674 2 451
Total salary expenses
73 536 62 858
COMPENSATION AND BENEFITS TO THE MANAGEMENT GROUP IN 2021
Management Position Salary Bonus Pension Other Total
Hæge Johanne
Krogh Wetterhus
VP Marketing
1 327 426 66 905 90 000 4 392 1 488 723
Anne Waaler VP Medical 1 291 382 83 631 77 736 4 392 1 457 141
Roger Reino
Morberg
VP Sales
1 530 580 88 314 84 552 4 392 1 707 838
Erik Swensen VP Development 1 352 031 69 581 81 456 4 392 1 507 460
Tone Ann Veiteberg VP QA\Reg 1 132 394 58 876 73 920 4 392 1 269 582
Helge Børslid VP Operations 1 246 512 98 127 82 704 4 392 1 431 735
Håkon Grøthe VP Innovation 1 222 257 102 587 82 656 4 392 1 411 892
Kari Eian Krogstad
CEO Medistim
Group 2 827 824 347 904 90 348 3 129 392 6 395 468
Thomas Jakobsen CFO Medistim Group
1 820 331 93 666 82 116 4 392 2 000 505
Total 13 750 737 1 009 591 745 488 3 164 528 18 670 344
The total number of employees was through the year 73. 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 101.351) in the social security system. The cost for the contribution plan was in 2021
TNOK 2 752, while it was TNOK 2 531 in 2020. 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.
81
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
SHARE PROGRAM FOR THE MANAGEMENT GROUP IN 2021
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
Hæge Johanne
Krogh Wetterhus VP Marketing 200 000 50 000 250 000 663 100 000
Anne Waaler VP Medical 600 000 150 000 750 000 1 989 -
Roger Reino
Morberg VP Sales 600 000 150 000 750 000 1 989 600 000
Erik Swensen VP Development 300 000 75 000 375 000 994 -
Tone Ann Veiteberg VP QA\Reg 600 000 150 000 750 000 1 989 600 000
Helge Børslid VP Operations 400 000 100 000 500 000 1 326 200 000
Håkon Grøthe VP Innovation 600 000 150 000 750 000 1 989 -
Kari Eian Krogstad
CEO Medistim
Group 600 000 150 000 750 000 1 989 600 000
Thomas Jakobsen
CFO Medistim
Group 800 000 200 000 1 000 000 2 652 800 000
Total 4 700 000 1 175 000 5 875 000 15 578 2 900 000
Under other benefits it is included an expense related to CEO share option. CEO receives shares over a time
period if in position as CEO. The share program is described in the annual report under the chapter 8.12
remuneration of executive personell. 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
Chairman Øyvin Brøymer 400
Deputy chairman Bjørn Wiggen
225
Board member Siri Fürst 225
Board member Tove Raanes
225
Board member Lars Rønn 225
Total compensation to the Board of Directors 1 300
Compensation to Auditor
1 = NOK 1000 2021 2020
Expenses for auditing 1 535 1 053
Compensation for other services
120 154
Total compensation to Auditor
1 655
1 206
There are no special agreements towards any in the
management team in case of leaving the company.
All in the team have a two-way arrangement of 3
months’ notice. There are no options to employees
or members of the Board except for CEO. The
CEO will receive up to 33 000 shares as part of
compensation if in position in 2025. Bonus paid in
2021 was based upon 2020 results. In relation to
the share program for management except CEO,
following members of management participated
in the share program. See the following table
showing value of the shares, discount given and
financing from the company to participate in the
share program.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
ASSETS AND DEPRECIATION
Plant &
Machinery Equipment
Total fixed
assets
Activated
Development
Trade
name Total
1= NOK 1000
Historic cost as of 1/1 70 837 10 383 81 220 76 830 2 697 160 747
Additions 5 891 1 150 7 041 4 084 0 11 124
Disposals 0 0 0 0 0 -
Historic cost as of 31/12 76 728 11 533 88 261 80 913 2 697 171 871
Accumulated depreciation
as of 1/1 44 202 8 333 52 535 58 809 2 158 113 502
Ordinary depreciation 6 229 884 7 113 6 063 539 13 715
Reversed depreciation 0 0 0 0 0 -
Accumulated depreciation
as of31/12 50 431 9 217 59 648 64 872 2 697 127 218
Book value at 31/12 26 297 2 316 28 613 16 041 -0 44 654
Plant and machinery is depreciated over 3 to 7 years on a straight-line basis dependent upon expected
economic lifetime. Tools and equipment is depreciated over 3 to 5 years on a straight-line basis dependent
upon expected economic lifetime. Development cost is recorded as intangible assets when a project has
reached technological feasibility and it is likely that it will result in a new product or improved product that
has revenue potential that exceeds the investment. Maintenance of existing products is expensed. The
investment is depreciated over 3 to 8 years dependent upon whether it is a new product or improvement
of existing product. A new product that represents a new technological platform has a longer expected
lifetime and for Medistim products this is 8 to 10 years. Product improvements on existing technological
platform is replaced more rapid and is therefore depreciated over 3 years.
Note 29 Research and development
In total 14.5 MNOK of the R & D expenses was recorded in the P & L in 2021. Similar expense was
14.6 MNOK in 2020. With 4.1 MNOK recognized as asset a total of 18.6 MNOK was used in R & D in
2021. Comparable number for 2020 was 16.5 MNOK. The activated expense in 2021 were related to the
coronary and vascular products on the MiraQ platform. The company did receive TNOK 376 in Skattefunn
funds in 2021.
Medistim entered a license and an OEM agreement with em-tec GmbH in 2015. With the agreement,
Medistim obtains exclusive, worldwide rights to market and sell em-tec's transit time flow measurement
(TTFM) technology, the SonoQ, for use on human blood vessels within cardiac-, vascular- and transplant
surgery. em-tec's flow measurement device was designed as a basic, entry-level customer solution that
meets lower price-point market segments. The product was discontinued in 2021. To fill the gap within
Medistim's product portfolio, Medistim has developed its own entry-level solution to meet the demand
in lower price point market segments. Book value by year end 2021 for SonoQ products was 0.0 MNOK.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
INCOME TAX AND TEMPORARY DIFFERENCES
2021
2020
1= NOK 1000
Current income tax charge for the year before deferred tax asset is utilised
16 700 10 903
Tax penalty
0 0
Change in deferred tax
-18 -1 039
Income tax expense reported
16 682
9 864
Reconciling income tax expense against profit :
Income tax expense for the year
16 682 9 864
22 % of profit before tax
21 420 14 865
Additional tax
Difference because of permanent differences
-4 738 -5 001
Specification of taxable income:
2021 2020
Profit before tax
96 609 70 039
Permanent differences
-25 264 -25 204
Change in temporary differences
4 565 4 723
Skattefunn
0 0
Losses carry forward
- -
Taxable profit: 75 909 49 559
Payable tax in balance sheet:
Tax on profit for the year 16 700 10 903
Other adjustments 0 304
Total payable tax 16 700 10 599
Specification of deferred tax asset
Differences in accounting and tax values 2021 2020
Fixed assets -23 -2 962
Current assets -6 883 -1 593
Accrual for obligations 85 -2 185
Total differences -6 821 -6 740
Deferred tax asset 22 % 1 501 1 483
Deferred tax asset in balance sheet 1 501 1 483
Deferred tax asset in the balance sheet was unchanged from last year. Deferred tax asset consist of
temporary differences in valuation of assets. All deferred tax asset is recorded in the balance sheet as of
31 December 2021, since it is likely that the company will have future taxable income that will exceed
temporary differences.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
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
2021
1 = NOK 1000
Medistim USA Inc. USA Lease and sale within bypass
surgery and vascular surgery
100% 135 16 358
Medistim
Deutschland GmbH
Germany Capital sales within bypass
surgery and vascular surgery 100% 188 6 996
Medistim Norge AS Norway Sale of 3 pary products and
capital sales within bypass
surgery and vascular surgery
100% 36 953 10 935
Medistim UK LTD United
Kingdom
Capital sales within bypass
surgery and vascular surgery 100% 1 913
Medistim Japan KK Japan Dormant company 100% 86 0
Medistim Spain S.L Capital sales within bypass
surgery and vascular surgery 100% 28 906
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
909
Total 37 392 37 017
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. 108 458 25 030 83 428 158 779 16 358
Medistim Deutschland GmbH 15 001 1 442 13 558 46 076 6 996
Medistim Danmark Aps 3 295 2 266 1 030 7 480 909
Medistim Japan KK 86 0 86 0 0
Medistim Spain S.L 11 412 10 609 803 15 615 906
Medistim UK LTD 4 002 10 464 -6 462 6 575 913
Medistim Norge AS 44 897 11 054 33 843 73 779 10 935
Total 187 151 60 865 126 286 308 304 37 017
Medistim Norge AS has offices at Økernveien 94 in Oslo. Medistim USA Inc has offices in Minneapolis in the USA.
Medistim Deutschland GmbH has offices in Munich in Germany, Medistim UK has offices in Nottingham in United
Kingdom, 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 December 2020 14 128 TNOK. Goodwill at the time of acquisition was 16 097 TNOK. None
of the subsidiaries are listed at a stock exchange.
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Of Medistim UK’s debt of 10 509 TNOK, 7 743 TNOK
is a long-term debt towards Medistim ASA. The debt
is part of a cash transfer to finance and establish the
company in the United Kingdom. Interest has been
charged on this debt. Medistim ASA received from its
German and Norwegian subsidiary a dividend of 15.2
MNOK and 10.0 MNOK respectively in 2020. Medistim
ASA has interest bearing debt towards Medistim US Inc
of MNOK 11.0.
Note 32 Account receivables and other
receivables
ACCOUNTS RECEIVABLE
2021
2020
1 = NOK 1000
Accounts receivable 49 169 37 786
Provision for bad debt -261 -261
Total salary expenses
48 908 37 525
All receivables are due within one year. Losses in 2020
were 0 TNOK and losses in 2019 were 0 TNOK. It is
recorded an accrual of 115 TNOK to cover expected
losses. Historically the company has small losses on
receivables. Other receivables are shown below.
OTHER RECIEVABLES
2021
2020
1= NOK 1000
Pre payments 1 417 796
Prepaid taxes and VAT 157 1 949
Accrued revenue 4 571 1 044
Dividend subsidiaries 12 000 -429
Total other receivables 18 145 3 359
Note 33 Inventory
INVENTORY 2021
2020
1= NOK 1000
Components 52 311 62 966
Finished goods 27 872 26 731
Inventory accrual -6 478 -2 143
Total 73 704 87 554
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 are assessed and found
lower than historic cost. See table below:
SPECIFICATION OF ACCRUAL
2021
2020
1= NOK 1000
Demonstration units 3074 1 172
Service parts 1117 971
Other 2287 -
Total 6 478 2 143
Note 34 Cash in Bank
Restricted cash amounted to 3 218 TNOK as of 31
December 2021 and was related to tax withheld on
salary paid to employees. The comparable amount
as of 31 December 2020 was 4 297 TNOK.
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 December 2020 4 584 (34) 40 253 5 766 89 899 140 468
Change in equity:
Change in treasury shares - 7 - 7 582 - 7 589
Other corrections - - - - -32 -32
Profit for 2021 - - - - 80 681 80 681
Dividend to shareholders - - - - -68 358 -68 358
Equity 31 December 2021 4 584 -27 40 253 13 348 102 191 160 349
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
The Russian and Ukraine conflict is expected to have minor impact on Medistim business. Sales to these
countries was less than 2% of total sales in 2021. The Board of directors has no knowledge about events
after 2021 that will affect the annual report and financial statement for 2022.
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. By year end 2021 the company had no
hedging contracts.
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. 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
1= NOK 1000
2021
2020
Foreign exchange gain
7 256 15 755
Foreign exchange loss
10 773 16 206
Total
-3 517
-451
1= NOK 1000
2021
2020
Bonus and commission
7 527 2 000
Goods received not invoiced
Board compensation
1 300 1 300
Debt towards subsidiary
1 778 1 079
Accrual for incestment
350
Other
992 282
Total short term debt
11 946
4 661
OTHER OPERATING EXPENSES
1 = NOK 1000
2021
2020
Office rental 7 141 7 071
Travel expense 601 945
Marketing 846 811
Consultancy fee 13 517 12 323
Insurance 863 949
Freight 852 571
Communication 12 065 8 410
Other 3 519 4 473
Total other operating expenses 39 405 35 553
Note 40 Long-term debt and loan security
Medistim ASA had no long-term debt by the end
of 2021.
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. In addition, the company
has a credit facility of 22.5 MNOK. As security for
the facilities are assets, accounts receivable and
inventory with 10 MNOK. Book value of secured
items was as of 31 Decenber 2021 28.6 MNOK for
assets, 48.9 MNOK for accounts receivables and
73.7 MNOK for inventory.
Note 41 Receivables and debt towards
subsidiaries
RECEIVABLES AND DEBT TOWARD SUBSIDIARIES
1 = NOK 1000 2021 2020
Account receivable 26 795 21 667
Other receivable 7 587 7 743
Short-term debt - 1 079
Long-term debt 35 277 11 000
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Alternative performance measures, concepts and abbreviations
Alternative performance measures are used by
investors, securities analysists 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 intangable assets could result in a
one time expense if the impairment test fail, and is
highlighted for this reason. The companys 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 otheroperating
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 preavious 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
SonoQ: Medistim’s basis solution for alternative markets
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 Cadiac
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 CLlinical 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
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MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
RECONCILIATION OF CURRENCY NEUTRAL REVENUE
Rates 2021
Rates 2020
USD Average rate towards NOK 8.59 9.37
EUR Average rate towards NOK 10.16 10.73
GBP Average rate towards NOK 11.82 12.06
DKK Average rate towards NOK 1.37 1.44
Revenue 2021
Split of revenue in USD, EUR and NOK Rates 2021 Rates 2020
1= NOK 1000
Sales in USD
Procedural revenue Imaging and flow 111 754 121 901
Capital sales MiraQ flow measurement instruments 18 108 19 752
Capital sales MiraQ imaging and flow measurement instrument 18 984 20 708
Debt forgiveness 5 290 5 770
Capital sales in Canada\LA 4 632 4 892
Sales in EUR
MiraQ flow measurement instrument 31 970 33 764
MiraQ imaging and flow measurement instrument 38 302 40 451
Imaging probes 7 052 7 448
Flow measurement probes 112 675 118 997
Other 4 169 4 403
Revenue in USD and EUR 352 936 378 085
Revenue in NOK 74 340 74 340
Total revenue 427 276
452 425
Reconciliation of own products, 3rd party products and other revenue
Own products 347 646 372 315
3rd party products 74 340 74 340
Other revenue 5 290 5 770
Total revenue 427 276 452 425
Reconciliation of working capital:
Accounts receivable in balance sheet at year end
68 634 57 485
Inventory in the balance sheet at year end 97 413 112 667
Accounts payable in balance sheet at year end (20 318) (20 210)
Working capital 145 730 149 942
Reconciliation of profit before R & D and depreciation:
All numbers in NOK 1000 2 021 2 020
EBITDA 139 705 118 626
Expensed R & D 14 476 14 622
Profit before R & D and depreciation 154 181 133 248
89
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Oslo March 22
nd
2022
Board of Directors and CEO of Medistim ASA
Øyvin A. Brøymer
Chairman
Siri Fürst
Board member
Torben Jørgensen
Board member
Sign. Sign. Sign.
Tove Raanes
Board member
Lars Rønn
Board member
Kari Eian Krogstad
CEO
Sign. Sign. Sign.
90
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
Oslo March 22
nd
2022
Board of Directors and CEO of Medistim ASA
Øyvin A. Brøymer
Chairman
Siri Fürst
Board member
Torben Jørgensen
Board member
Sign. Sign. Sign.
Tove Raanes
Board member
Lars Rønn
Board member
Kari Eian Krogstad
CEO
Sign. Sign. Sign.
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 2021 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.
91
MEDISTIM ANNUAL REPORT - FISCAL YEAR 2021
BDO AS
Munkedamsveien 45
Postboks 1704 Vika
0121 Oslo
Independent Auditor's Report Medistim ASA - 2021 side 1 av 4
Independent Auditor's Report
To the General Meeting in Medistim ASA
Opinion
We have audited the financial statements of Medistim ASA.
The financial statements comprise:
• The financial statements of the parent
company, which comprise the balance
sheet as at 31 December 2021, income
statement and cash flows for the year
then ended, and notes to the financial
statements, including a summary of
significant accounting policies, and
• The financial statements of the group,
which comprise the balance sheet as at
31 December 2021, and income
statement, statement of
comprehensive income, statement of
changes in equity and cash flows for
the year then ended, and notes to the
financial statements, including a
summary of significant accounting
policies.
In our opinion:
• The financial statements comply with
applicable statutory requirements.
• The accompanying financial statements
give a true and fair view of the
financial position of the company as at
31 December 2021, and its financial
performance and its cash flows for the
year then ended in accordance with
the Norwegian Accounting Act and
accounting standards and practices
generally accepted in Norway.
• The accompanying financial statements
give a true and fair view of the
financial position of the group as at 31
December 2021, and its financial
performance and its cash flows for the
year then ended in accordance with
International Financial Reporting
Standards as adopted by the EU.
Our opinion is consistent with our additional report to the Audit Committee.
Basis for Opinion
We conducted our audit in accordance with International Standards on Auditing (ISAs). Our
responsibilities under those standards are further described in the Auditor’s Responsibilities for the
Audit of the Financial Statements section of our report. We are independent of the Company and
the Group as required by laws and regulations and International Ethics Standards Board for
Accountants’ International Code of Ethics for Professional Accountants (including International
Independence Standards) (IESBA Code), and we have fulfilled our other ethical responsibilities in
accordance with these requirements. We believe that the audit evidence we have obtained is
sufficient and appropriate to provide a basis for our opinion.
To the best of our knowledge and belief, no prohibited non-audit services referred to in the Audit
Regulation (537/2014) Article 5.1 have been provided.
We have been the auditor of the Company for 13 years from the election by the general meeting of
the shareholders in May 2009 for the accounting year 2009.
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Key Audit Matters
Key audit matters are those matters that, in our professional judgment, were of most significance in
our audit of the financial statements of the current period. These matters were addressed in the
context of our audit of the financial statements as a whole, and in forming our opinion thereon, and
we do not provide a separate opinion on these matters.
Description of the key audit matter
How the key audit matter was addressed in
the audit
Revenue recognition:
The Group revenue recognition policy for sales
in the United States of America (USA) is
different from the policy used for sales in the
rest of the world. The Group's deliveries
outside the USA entail regular sales of goods
where revenue is recognized upon delivery. In
the US market, there are different sales
models. Both regular sales, operational leasing
and a sales model based on payment in relation
to the use of the equipment and consumables.
Under the sales model based on use,
equipment located at the end customer’s
premises is recognized as assets in the group’s
and parent company’s balance sheet, and is
amortized over the estimated useful life.
Consumables are recognized upon delivery,
unless they are an integrated part of the total
delivery, making the consideration for the
consumables variable.
The difference between the sales models, and
the complexity this causes in the accounting –
including assessment of possible IFRS 15 effects
- has led us to focus specifically on this during
our audit.
We refer to the Annual Report under
Accounting policies and note 1 and 2 to the
Group financial statements.
We have assessed the appropriateness of
management's revenue recognition policies and
the application of these policies. Our work
includes review and evaluation of procedures
and systems related to the Company and Group
revenues. We have obtained an understanding
of the relevant internal controls and tested
these controls and conducted additional tests
to verify that the revenue recognition has been
performed in accordance with the policies
described. Further, we have assessed the
adequacy of the description of the Group's
policies for revenue recognition in the notes to
the financial statements.
Other information
The Board of Directors and the Managing Director (management) is responsible for the other
information. The other information comprises the Board of Directors’ report and other information
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Independent Auditor's Report Medistim ASA - 2021 side 3 av 4
in the Annual Report, but does not include the financial statements and our auditor’s report
thereon. Our opinion on the financial statements does not cover the other information.
In connection with our audit of the financial statements, our responsibility is to read the other
information and, in doing so, consider whether the other information is materially inconsistent with
the consolidated financial statements or our knowledge obtained in the audit or otherwise appears
to be materially misstated. If, based on the work we have performed, we conclude that there is a
material misstatement of this other information, we are required to report that fact. We have
nothing to report in this regard.
Opinion on the Board of Director’s report
Based on our knowledge obtained in the audit, in our opinion the Board of Directors’ report
• is consistent with the financial statements and
• contains the information required by applicable legal requirements.
Our opinion on the Board of Director’s report applies correspondingly for statements on Corporate
Governance and Corporate Social Responsibility.
Responsibilities of the Board of Directors and the Managing Director for the Financial Statements
Board of Directors and the Managing Director (management) are responsible for the preparation of
financial statements that give a true and fair view, for in accordance with the Norwegian
Accounting Act and accounting standards and practices generally accepted in Norway, and for the
preparation and fair presentation of the financial statements of the group in accordance with
International Financial Reporting Standards as adopted by the EU, and for such internal control as
management determines is necessary to enable the preparation of financial statements that are
free from material misstatement, whether due to fraud or error.
In preparing the financial statements, management is responsible for assessing the Company’s
ability to continue as a going concern, disclosing, as applicable, matters related to going concern.
The financial statements of the Company use the going concern basis of accounting insofar as it is
not likely that the enterprise will cease operations. The financial statements of the Group use the
going concern basis of accounting unless management either intends to liquidate the Group or to
cease operations, or has no realistic alternative but to do so.
Auditor’s Responsibilities for the Audit of the Financial Statements
Our objectives are to obtain reasonable assurance about whether the financial statements as a
whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s
report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a
guarantee that an audit conducted in accordance with ISAs will always detect a material
misstatement when it exists. Misstatements can arise from fraud or error and are considered
material if, individually or in the aggregate, they could reasonably be expected to influence the
economic decisions of users taken on the basis of these financial statements.
For further description of Auditor’s Responsibilities for the Audit of the Financial Statements
reference is made to:
https://revisorforeningen.no/revisjonsberetninger
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Independent Auditor's Report Medistim ASA - 2021 side 4 av 4
BDO AS, et norsk aksjeselskap, er deltaker i BDO International Limited, et engelsk selskap med begrenset ansvar, og er en del av det internasjonale nettverket BDO,
som består av uavhengige selskaper i de enkelte land. Foretaksregisteret: NO 993 606 650 MVA.
Report on Other Legal and Regulatory Requirements
Report on compliance with Regulation on European Single Electronic Format (ESEF)
Opinion
We have performed an assurance engagement to obtain reasonable assurance that the financial
statements with file name Medistim ASA-2021-12-31-en.zip have been prepared in accordance with
Section 5-5 of the Norwegian Securities Trading Act (Verdipapirhandelloven) and the accompanying
Regulation on European Single Electronic Format (ESEF). In our opinion, the financial statements
have been prepared, in all material respects, in accordance with the requirements of ESEF.
Management’s Responsibilities
Management is responsible for preparing, tagging and publishing the financial statements in the
single electronic reporting format required in ESEF. This responsibility comprises an adequate
process and the internal control procedures which management determines is necessary for the
preparation, tagging and publication of the financial statements.
Auditor’s Responsibilities
For a description of the auditor’s responsibilities when performing an assurance engagement of the
ESEF reporting, see: https://revisorforeningen.no/revisjonsberetninger
BDO AS
Steinar Andersen
State Authorised Public Accountant
(This document is signed electronically)
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Steinar Harry Andersen
Oppdragsansvarlig revisor
Serienummer: 9578-5999-4-1359329
IP: 188.95.xxx.xxx
2022-03-28 17:36:11 UTC
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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 ASA (Head office)
Norway
Phone +47 23 05 96 60
Medistim ASA (Manufacturing)
Bromsveien 17
3183 Horten
Norway
Phone +47 33 03 17 26
Me
distim 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