Medistim

Earnings Release • Feb 25, 2022

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Welcome to Medistim ASA's Interim report Q4 2021

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Medistim ASA Q4 2021 and preliminary full year results

February 25th 2022

Kari E. Krogstad Thomas Jakobsen

PRESIDENT & CEO CFO

Disclaimer

The information included in this Presentation contains certain forward-looking statements that address activities, events or developments that Medistim ASA ("the Company") expects, projects, believes or anticipates will or may occur in the future. These statements are based on various assumptions made by the Company, which are beyond its control and are subject to certain additional risks and uncertainties. The Company is subject to a large number of risk factors including but not limited to economic and market conditions in the geographic areas and markets where Medistim is or will be operating, IP risks, clinical development risks, regulatory risks, fluctuations in currency exchange rates, and changes in governmental regulations. For a further description of other relevant risk factors, we refer to Medistim's Annual Report for 2020. As a result of these and other risk factors, actual events and our actual results may differ materially from those indicated in or implied by such forward-looking statements. The reservation is also made that inaccuracies or mistakes may occur in this information given above about current status of the Company or its business. Any reliance on the information above is at the risk of the reader, and Medistim disclaims any an all liability in this respect.

Table of Contents

01 Highlights

Highlights 4th Quarter

	Q4 2021	Q o Q	All time high sales for a quarter
Revenue	MNOK 112.7 (94.2)	+19.7 %
EBIT	MNOK 19.5 (22.1)	-12.1 %
Currency		- 7.1 %
Number of	units sold or outplaced:		38.4% for own products:
Flow systems	52	+ 49 %
Imaging systems	25	+ 47 %
Flow probes	(ex USA) 2 261	+ 27.9 %	 Third-party products down by 13.4 %
Imaging probes	50	+ 100 %
Procedures (USA)	17 821	+ 28.2 %	Weaker EBIT margin at 17.3% due to high activity level

• 4th quarter in a row above MNOK 100 in sales revenues
  • o Imaging sales up 50.2% in NOK, Flow sales up 26.3% in NOK
  • o Vascular sales up 54.2% in NOK, Cardiac sales up 24.8 %in NOK
  • o Currency neutral growth was 26.8% in total and 38.4% for own products:
    • o USA up 58.1%, Europe down 5.6%, Asia up 143%, RoW up 66%
• Third-party products down by 13.4 %

Procedures (USA) 17 821 + 28.2 % Weaker EBIT margin at 17.3% due to high activity level The Board suggest a dividend of NOK 3.75 per share

Preliminary results for 2021

	2021	Y o Y	Best year ever for revenue and EBIT
Revenue	MNOK 427.3 (363.1)	+ 17.6 %	 Record year for sales revenue, up 16.3% to MNOK 422
EBIT	MNOK 116.3 (95.5)	+ 21.8 %	Imaging sales up 29.3%, Flow up 15.5% in NOK o
Currency		- 7.0 %	Vascularsales up 21.1 %, Cardiac up 17.2% in NOK o
Number of	units sold or outplaced:		Currency neutral growth was 24.6% in total and o 26.0% for own products (excl. the PPP income)
Flow systems	156	+ 5.4 %
Imaging systems	93	+ 50.0 %
Flow probes	(ex USA) 7 988	+ 28.4 %	 Total revenue for the full year is up 17.6 % to MNOK 427.3
Imaging probes	154	+ 52.4 %	U.S. Paycheck Protection Program granted in Q2
Procedures (USA)	72 032	+ 28.5 %

• Record year for sales revenue, up 16.3% to MNOK 422
  • o Imaging sales up 29.3%, Flow up 15.5% in NOK
  • o Vascularsales up 21.1 %, Cardiac up 17.2% in NOK
  • o Currency neutral growth was 24.6% in total and 26.0% for own products (excl. the PPP income) o USA up 28.4%, Europe up 15.7%, Asia up 50.7%, RoW up 2.4%
• Total revenue for the full year is up 17.6 % to MNOK 427.3 due to the extraordinary revenue of MNOK 5.3 from the COVID-related U.S. Paycheck Protection Program granted in Q2
• Third-party products grow by 10.0 %

Record EBIT margin at 27.3 %

02 Financial Statements

Profit and loss Q4 2021

Profit & loss	Q4 2021	Q4 2020
1=NOK 1000
Sales revenue	112 740	94 184
Other revenue	-	-
Total revenue	112 740	94 184
Cost of goods sold	27 884	22 232
Salary and social expenses	41 418	32 177
Other operating expenses	17 951	11 348
Total operating expenses	87 252	65 756
EBITDA	25 488	28 429
EBITDA%	22,61 %	30,18 %
Depreciation	6 027	6 293
Operating result (EBIT)	19 461	22 136
EBIT %	17,26 %	23,50 %
Financial income	1 664	1 433
Financial expenses	1 710	3 648
Net finance	(46)	(2 216)
Pre tax profit	19 415	19 920
Tax	3 302	6 352
Profit after tax	16 113	13 568
Dividend	-	-

Sales per Quarter (TNOK)

Profit and loss 2021 (preliminary)

Profit & loss	FY 2021	FY 2020
1=NOK 1000
Sales revenue	421 984	363 133
Other revenue	5 292	-
Total revenue	427 276	363 133
Cost of goods sold	97 114	76 577
Salary and social expenses	134 507	119 066
Other operating expenses	55 950	48 865
Total operating expenses	287 571	244 508
EBITDA	139 705	118 626
EBITDA%	33,11 %	32,67 %
Depreciation	23 427	23 141
Operating result (EBIT)	116 278	95 484
EBIT %	27,56 %	26,29 %
Financial income	8 173	14 137
Financial expenses	10 380	18 015
Net finance	(2 207)	(3 878)
Pre tax profit	114 071	91 606
Tax	23 171	22 219
Profit after tax	90 900	69 387
Dividend	54 640	50 052

Sales per Quarter (TNOK)

Balance sheet – Assets

Cash position by end of the year was MNOK 129.5

Securing end -of -life components and keeping security stocks

explain the high inventory level. Still, somewhat reduced due to longer lead times for some components.

The Board purpose a dividend of NOK 3.75 per share, total MNOK 68.4

Balance sheet	31.12.2021	31.12.2020
All numbers in NOK 1000
Assets
Intangible assets	33 410	33 464
Fixed assets	63 337	66 570
Total intangible and fixed assets	96 747	100 034
Inventory	97 413	112 667
Customers receivables	68 634	57 485
Other receivables	10 960	3 744
Cash	129 490	71 891
Total current assets	306 497	245 786
Total assets	403 244	345 820

Balance sheet	31.12.2021	31.12.2020
All numbers in NOK 1000
Share capital	4 585	4 585
Premium fund	44 172	44 172
Other equity	257 295	208 089
Total equity	306 052	256 846
Total long term debt	19 589	29 497
Total short term debt	77 603	59 477
Total equity and liability	403 244	345 820

Balance sheet – Equity and Liability

No interest-bearing debt

24.2 MNOK in obligations related to lease contracts where 17.1 MNOK is long term

Strong balance sheet with 75.9 % equity ratio

03 Business segments update

Imaging systems in units (capital sales)

Imaging probes in units (capital sales)

Imaging probes US imaging probes

Imaging probes and systems in units

Unit sales of imaging systems sold as capital equipment continue to be strong, growing 64% this quarter

Unit sales of imaging probes are also recovering strongly, growing 100% this quarter

Flow probes and systems in units

• Number of flow systems sold as capital equipment is up 53% from Q4 last year.
• It is Medistim's strategy to convert the market from Flow -only to Flow -and -Imaging technology
• The total sale of systems (Flow and Flow -and -Imaging) sold as capital equipment shows an increase of 26 units or 56 %
• 27.9% growth in number of flow probes sold this quarter reflects that the surgical activity level is getting back to normal and filling the pent -up demand

Flow systems in units (capital sales)

Revenue performance by region

Mill NOK	Q4 21	Q4 20	Q / Q	2021	2020	Y / Y
Europe	49,3	55,8	-11,6 %	190,2	173,3	9,8 %
USA	39,1	27,0	44,9 %	154,1	126,4	21,9 %
Asia	20,3	8,8	129,9 %	66,8	46,8	42,7 %
ROW (MEA, CAN, SA, AUS)	4,0	2,5	57,3 %	16,1	16,7	-3,0 %
Total	112,7	94,2	19,7 %	427,3	363,1	17,7 %

• In Europe, Q4 sales of own products decreased with 10.5% in NOK and 5.6% currency neutral. For 2021, sales of own products increased with 9.6% in NOK and 15.7% currency neutral. 3. party decreased with 13.4% in Q4 and increased 10.0% for 2021.

• In the USA, currency neutral sales for the quarter increased with 58.1%. Total revenues for 2021 include the extraordinary MNOK 5.3 related to the U.S. Paycheck Protection Program. When excluding this, currency neutral increase for the year was 28.4 %.
• In Asia, solid growth both for the quarter and YTD.
• ROW continues to be a smaller sales territory for Medistim, with significant quarter to quarter variation.

Negative currency effects for 2021 vs 2020 was 25 MNOK .

Average actual exchange rate for USD 8.59 and EUR 10.16 versus last year USD 9.37 and EUR 10.73.

Revenue performance by product category

Mill NOK	Q4 21	Q4 20	Q / Q	2021	2020	YoY
Procedures (USA)	28,6	23,4	22,3 %	111,8	99,4	12,5 %
Flow probes	30,3	22,8	32,8 %	115,7	92,6	24,9 %
Flow systems (MiraQ)	17,6	13,5	30,2 %	51,0	47,2	8,0 %
Imaging systems (MiraQ)	15,1	10,0	51,4 %	57,9	44,2	31,0 %
Imaging probes	2,0	1,3	57,3 %	7,1	5,2	36,4 %
3rd party	18,4	21,2	-13,4 %	74,3	67,5	10,1 %
Other	0,8	2,0	-62,3 %	9,5	6,9	36,6 %
Total revenues	112,7	94,2	19,7 %	427,3	363,1	17,7 %

• Procedure sale in the USA: The total number of procedures increased with 28.2% for the quarter and 28.5 % for 2021. Lower % growth in NOK is mainly explained by unfavorable currency.

• Flow probes: In units, the growth is 27.9 % for the quarter and 28.5 % for 2021. The higher % growth in NOK for the quarter is due to higher sales through direct channels. For the year, unfavorable currency reduces sales in NOK.
• Flow systems (capital): Units increases with 53% for the quarter and 6.5% for the year. Strong sales through distributors results in lower sales in NOK for the quarter. For the year, increased sales through direct channels compensates for a stronger NOK.
• Imaging systems (capital): 64% increase in capital units for the quarter and 41% for the year. The lower increase in NOK is related currency and to high sales through distributors this quarter.
• 3rd party products: Slow quarter but strong sales for the year.
• Other: Includes an extraordinary revenue of MNOK 5.3 related to the U.S. Paycheck Protection Program

Covid-19: From gradually decreasing impact to strong recovery

-

04 Implementing the strategy

Medistim growth strategy

• 1. Convert the routine Flow market to a Flow-and-Imaging market by establishing Surgical Guidance and Quality Assessment as the new standard of care through
  2. → Early adopter & KOL support
  3. → REQUEST study
  4. → Ease conversion from flow to imaging with MiraQ
• 1. Achieve routine use of both Flow and Imaging by fighting ignorance, indifference and ease-of-use objections through
  2. → Clinical marketing, guidelines and educational programs
  3. → Product innovation for ease of use
  4. → Increased sales force capacity
• 1. Offer an entry-level solution to reach emerging, price-sensitive, high-growth markets
• 1. Build and strengthen position in vascular surgery
  2. → Dedicated system (MiraQ Vascular) & probes
  3. → Build position with societies and KOLs
• 1. Expand our direct market coverage

GEOGRAPHIES

Developing the US market

Performance US sales

Currency neutral sales revenue grows by 58.1% in Q4 and 28.4%*) for 2021

*) When including the Paycheck Protection Program revenue of TUSD 630, total revenue grows by 33%

• Total number of procedures was up 28.2% in Q4 and 28.5% for 2021
• o Flow procedures up 22.5% in Q4
• o Imaging procedures up 63.6% in Q4

Strong capital systems sales

• o 11 units in Q4 vs 3 LY
• o 38 units in 2021 vs 26 LY

Strong growth in new customers

• o 7 (7) new customers in Q4
• o 40 (25) new customers in 2021

Number of procedures per year

Number of procedures per quarter

Medistim growth strategy

Emerging high-growth economies (e.g. BRIC)	3
Developing Medistim markets (e.g. USA, UK, France)	2
Strong Medistim markets (e.g. Jp, Nordic, Germany) >50% CABG share	1	4
	CABG surgery (2 BNOK)	Vascular surgery (>1 BNOK)	Other open heartsurgery (1BNOK)

GEOGRAPHIES

• 1. Convert the routine Flow market to a Flow-and-Imaging market by establishing Surgical Guidance and Quality Assessment as the new standard of care through
  2. → Early adopter & KOL support
  3. → REQUEST study
  4. → Ease conversion from flow to imaging with MiraQ
• 1. Achieve routine use of both Flow and Imaging by fighting ignorance, indifference and ease-of-use objections through
  2. → Clinical marketing, guidelines and educational programs
     • → Product innovation for ease of use
     • → Increased sales force capacity
• 1. Offer an entry-level solution to reach emerging, price-sensitive, high-growth markets
• 1. Build and strengthen position in vascular surgery
  2. → Dedicated system (MiraQ Vascular) & probes
  3. → Build position with societies and KOLs
• 1. Expand our direct market coverage

APPLICATION AREAS

24

Clinical marketing

2021 – a breakthrough year for expert CONSENSUS STATEMENTS

Cementing the clinical value of Transit Time Flow Measurement (TTFM) in CABG

the Operating Room?	market marke armiri meelle) internet l'indosamilleller Time to Recognize the Elephant Outside	Article reuse guidelines sagepub.com/journals-peri DOI: 10.1177115569845211015892 lournals.sagepub.com/hor SAGE
David P. Taggart', MD, PhD	Gregory D. Trachiotis', MD, Michael A. Napolitano 12, MD @, Ethan S. Rosenfeld 12, MD, and
	Editorial
Introduction				00(0) 1-5
Coronary artery bypass grafting (CAB commonly performed procedure for th geon. The metrics for success of CABG on decreasing mortality, improving qualit symptom severity. All of these outcomes technical success of the operation itself, tion of adequately patent bypass grafts. While there have been many advances	The 10 Commandments for Multiarterial Grafting	@ The Author(s) 2021 Article reuse guidelines sarepub.com/lournals-permissions DOL 10.1177/15569845211003094 journals.sagepub.com/home/inv CSAGE
	Rami Akhrass , MD and Faisal G. Bakaeen , MD @
developed in recent years to improve clinis surgery, less attention has been given to the
ing the technical success of the procedure in several tools are available, including tran		DOI: 10.1111/jocs.15994
ment (TTFM; Fig. 1), high-frequency	Introduction Coronary artery bypass grafting (CABG), intre	EDITORIAL		CARDIAC SURGERY WILET
(HFUS; Fig. 2, Fig. 3), thermal coronary an erative fluorescence imaging. In structural l echocardiography to immediately evaluat valve replacement/repair is widely accepto tice.36 However, although CABG is technis ing with regards to precision, and where th distal anastomosis is <1 mm, there is no su operative quality assessment of grafts or wi should be. Furthermore, it is inconceivable cardiologist would not perform a completio ing a stent in a coronary artery, a proced demanding than a bypass graft. It is also both off-pump CABG (OPCAB) and use of which have well-defined roles in partic increase that level of technical complexity. Perioperative graft failure may occur in 9% of patients undergoing CABG surgery. though underutilized, tool to address this qu rarely discussed "elephant outside t (Supplemental Video). The first published 1 CABG date back to 1994 in 2 separate publ as well as Canver and Dame.8 Since that tim been well validated as a means of intraor ment, and from 2010 through its most rece European Society of Cardiology and Eur Cardio-Thoracic Surgery guidelines	neered over 50 years ago at the Cleveland Cli- Favalloro, has remained the gold standard in t multivessel coronary artery disease with heavy burden.1 While utilizing the internal thoracic bypass the left anterior descending artery (LA comerstone of CABG since 1986,2 there has be sensus on the importance of multiarterial grafti the use of at least 2 arterial grafts, resulting i vival and freedom from major adverse cardiac reinterventions.314 Indeed, the most recent CA set forth by the Society of Thoracic Surgeons supplementation of the ITA graft to the LAD, multivessel disease, with the use of additional I artery (RA) grafts.2 The incremental benefit o graft has been somewhat equivocal, although of observational studies suggested better lon with 3, compared to 2, arterial grafts.6 The outcome advantage attained with CAF percutaneous coronary intervention is most e nounced in patients that receive at least one IT/ conduits, in particular the ITA, are rarely affe sclerosis making them ideal conduits to use with rates. The ITA has unique biological charact increased nitric oxide levels that may also expla effect on native coronary circulation that has be lowing bypass surgery.8 In spite of the above, in the United States, over are saphenous vein grafts (SVG) and less than undergoing CABG receive more than one arteri: barriers are implicated in the lack widespread ad including increased technical complexity and op lier suboptimal results with RA use, wound heali bilateral ITA (BITA) harvesting especially in diab tion to the somewhat long latency period, ust decade from index operation, until the impact of ir with MAG is generally realized.33 While MAG may not be suitable to all CAl use of arterial grafts is encouraged and shou heart-team discussion in determining the opti ization strategy. The strategy of revascula	Transit time flow measurement in coronary artery bypass grafting: For every patient and every surgeon Quality assurance in cardiac surgery has evolved over the past decade to include intraoperative performance measures, pre- dicated on the fact that intraoperative evaluation of quality leads to improved patient outcomes. Routine intraoperative quality control mea- sures have been implemented in most aspects of cardiac surgery, in- cluding treatment of structural valve disease, and congenital and pediatric cardiac surgery. However, this is not the case in coronary surgery, In the United States, 18.2 million adults age 20 and older have coronary artery disease.2 With close to 200,000 coronary artery bypass graft (CABG) surgeries performed in the U.S per year,2 this is the most frequently performed cardiac surgical procedure. The STS Adult Cardiac Surgery performance measure assesses surgical performance based on a combination of CABG process and outcomes measures, including risk-adjusted opera- tive mortality and morbidity, use of an internal mammary artery, and secondary prevention measures at discharge. And yet, the ultimately relevant outcomes for the patient-survival and symptom relief-are based on a single primary underlying premise-that the patient leaves the operating room with functioning grafts. So why is there no routine intraoperative graft quality control measure in place in coronary surgery? Several modalities for intraoperative quality assessment of CABGs exist, among them coronary angiography and intraoperative fluorescence imaging. However, these are limited mainly by cost and/or practical ap- plicability. Intraoperative transit time flow measurement (TTFM) is the technology most frequently adopted, yet it is used in only 20% of CABG procedures in the United States." The most frequently cited limitations to widespread adoption are: (i) a lack of standardization of how TTFM should be performed; (11) a lack of standardization of how TTFM measurements should be	e review-articl	Circulation IN DEPTH The Use of Intra Measurement fo Systematic Review of the Mario Gaudino®, MD, MSCE; Sigrid San Hirokuni Arai, MD; Tohru Asai®, MD; Fai David Glineur, MD; Teresa M. Kieser®, M John D. Puskas, MD; James Tatoulis, MD ABSTRACT: Transit time flow measureme underused, probably because of limite the evidence on TTFM and other meth and elaborated expert recommendatio process using a 3-step modified Delph meeting. Eighty percent agreement wa used to grade the statements based of The existing evidence supports an
	among patients, taking into consideration ov	interpreted, based on the concern that some grafts may be re- vised unnecessarily;		outcomes, although there is high meth for arterial, rather than venous, grafts
		(iii) the expectation that TTFM should be able to predict not only the immediate intraoperative status of the graft but also long-term pa-		the duration and the cost of surgery, 1
		tency and clinical outcomes, for which there is little robust evidence; (iv) intraoperative quality control is not addressed in current clinical practice guidelines of any of the North American cardiovascular societies: and		statements for TTFM use in clinical pra round, and 1 at the virtual meeting. In conclusion, although TTFM use curve, its cost/benefit ratio seems lar
		(v) differences in opinion among CABG leaders exist as to when TTFM should be used.		These consensus statements will help decision-making.

Pivotal review-article in CIRCULATION, Oct 5th 2021

• Published in Circulation, the top 1-2 journal in cardiology and cardiovascular medicine
• Authored by 19 world renowned cardiac surgeon experts (4 from REQUEST study) from all over the world

	Title	Type	↓ SJR	н index	Total Docs. (2020)	Total Docs. (Зуеаrs)	Total Refs. (2020)	Total Cites (3years)	Citable Docs. (3years)	Cites / Doc. (2years)	Ref. / Doc. (2020)
	Journal of the American College of Cardiology	journal	10.315 Q1	431	බිරිම	2960	22363	23475	1191	7.44	23.92	1
വ	Circulation	journal	7.795 Q1	607	778	2685	22242	26532	1702	9.48	28.59	=
3	JACC: Heart Failure	journal	6.123 Q1	67	184	596	2888	2708	262	4.38	15.70
বা	JAMA Cardiology	journal	6.108 Q1	63	349	944	4752	4608	486	4.92	13.62	1
5	JACC: Cardiovascular Imaging	journal	5.790 Q1	120	481	1051	9756	4889	422	4.57	20.28	1
6	Nature Reviews Cardiology	journal	5.495 Q1	130	175	550	8971	3856	268	7.24	51.26	网
7	European Journal of Heart Failure	journal	5.149 Q1	133	397	855	12087	5341	445	6.01	30.45	PE
8	Circulation Research	journal	4.899 Q1	336	352	1256	19861	10880	933	7.71	56.42	1
ਰੇ	European Heart Journal	journal	4.336 Q1	293	1008	2579	16028	14482	1859	5.52	15.90	网
10	Journal of Heart and Lung Transplantation	journal	3.549 Q1	135	1537	645	4734	3313	371	4.74	3.08	=
11	Stroke	iournal	3.397	210	775	2080	15700	11722	1627	A QQ	20 26	F

27

"The Use of Intraoperative TTFM for CABG"

Circulation, October 2021

• o Systematic review of 229 publications
  • o 2,200 articles identified
  • o 1,550 screened
  • o 38 cited in the review
• o 10 expert statements for TTFM use were formulated
  • o 2 x electronic voting, 1 F2F
  • o 80% agreement was required for acceptance of the statements
  • o 2-level scale for clinical benefit (strong, moderate)

Method Conclusion

CONSENSUS STATEMENTS #1:

"TTFM should be used in every CABG case"

"These consensus statements will help to standardize the use of TTFM in clinical practice and provide guidance in clinical decisionmaking"

20 largest shareholders per February 22nd

Rank		Holding	Stake %	Name	Citizenship	Type of account
		1 1 862 500	10.15687	AETERNUM CAPITAL AS	Norway	Ordinary
		2 1 285 000	7.00756	FLØTEMARKEN AS	Norway	Ordinary
		3 1 206 680	6.58045	State Street Bank and Trust Comp	United States	Nominee
		4 1 200 000	6.54403	VERDIPAPIRFOND ODIN NORDEN	Norway	Ordinary
		5 1 120 288	6.10933	State Street Bank and Trust Comp	United States	Nominee
	6	991 437	5.40666	Skandinaviska Enskilda Banken AB	Sweden	Nominee
	7	970 000	5.28975	FOLLUM INVEST AS	Norway	Ordinary
	8	651 953	3.55533	State Street Bank and Trust Comp	United States	Nominee
	9	600 000	3.27201	ODIN Small Cap	Sweden	Ordinary
	10	575 793	3.14000	Skandinaviska Enskilda Banken AB	Denmark	Nominee
	11	414 011	2.25775	Skandinaviska Enskilda Banken AB	Sweden	Nominee
	12	406 752	2.21816	State Street Bank and Trust Comp	United States	Nominee
	13	398 823	2.17492	SKANDINAVISKA ENSKILDA BANKEN AB	Luxembourg	Nominee
	14	382 845	2.08779	The Northern Trust Comp, London Br	United States	Nominee
	15	379 936	2.07193	BUANES	Norway	Ordinary
	16	266 881	1.45540	RBC Investor services bank S.A.	Luxembourg	Nominee
	17	257 500	1.40424	The Bank of New York Mellon SA/NV	Denmark	Nominee
	18	238 314	1.29961	Skandinaviska Enskilda Banken AB	Sweden	Nominee
	19	232 194	1.26624	BNP Paribas Securities Services	Italy	Nominee
	20	228 000	1.24336	Danske Invest Norge Vekst	Norway	Ordinary