Rimini Street Inc

NASDAQ:RMNI

Very good morning, and welcome to Medistim's First Quarter 2025 Results Presentation. My name is Kari Krogstad and together with CFO, Thomas Jakobsen, we are going to take you through the first quarter's results. And we will start with the highlights. But before that, we like to also remind everyone of Medistim's track record, which has been very positive, showing a consistent delivery of sales growth, profitable sales growth over the years.

And as the last 12 months 2025 columns are indicating, we can already from this graph, disclose that Q1 was a very strong start to 2025 for the company. So let's go directly into the highlights for the first quarter. So this is really a quarter when the business is firing on all cylinders. It is an exceptionally strong sales and EBIT for the quarter, representing a new record for both. NOK 181.5 million in revenues. That's actually 20% higher than our previous record, which we set in the fourth quarter last year. So that ends up with a 35.7% growth in total, which is, of course, extremely high.

We see that we have a little bit help from currency, but still adjusting for that, the total sales is up 31.8%. And as I said, it's really firing on all cylinders. So Americas is up 28%, EMEA is up 18%. Asia Pacific is up almost 63%. And also the third-party products is showing fantastic growth this quarter. This is, of course, also enabling us to deliver a very strong operating profit for the quarter. So NOK 59.2 million, that's actually 84% better than the same quarter last year.

And it's very much related to the strong growth that we're seeing in our own products. And we will go into all of these details through the presentation. News from the first quarter, we have worked with strengthening our commercial operations with some organizational changes and adaptations, and I'll get a little bit back into that. And yesterday, the general assembly decided to pay out a dividend of NOK 6 per share, a total of NOK 109.6 million. So with that introduction, I leave the word to Thomas.

Thank you, Kari. I will take us through the financial statements as usual. And as Kari is going to comment on sales by region and product later on, I will not go into details related to that. So I will go straight to the gross margin, which has improved here by almost 2%. And that despite the fact that third-party products is increasing with more than 40%. However, third-party products are less than 20% of total revenue. And when we, at the same time, increase sales of our own products with almost 35%, we are able to increase our gross margin with almost 2%.

Salary and social expenses increases. There are 2 major reasons for it. Kari had this word here with strengthening commercial operations. That's one explanation. We have strengthened our team there. In addition, we have had a fantastic quarter with growth in all regional areas and a fantastic growth in third-party products. And as a result, we do have a higher commission and bonuses related to that fantastic result.

In addition to that, we do have salary adjustments from 2024, which was adjusted with effect from April, so that we bring into the first quarter this year as a difference. And we also have currency effects increasing expenses since the Norwegian kroner is weaker this quarter compared to same quarter last year.

All in all, top line increases almost 36%. Total operating expenses, including cost of material increases 22%. That gives us a strong operating profit before depreciation ending at NOK 64.7 million, which is about 65% increase. Depreciation expense is down. That means that previously product development projects are fully depreciated, and we do not depreciate on the 2 major development projects that we have going. We are only capitalizing on those since the products are with INTUI is just about to be launched, and we also have this automation project related to flow probes that are not completed.

This brings us an EBIT of NOK 51.2 million. That's up 84.5% compared to last year. So it's a very strong quarter, obviously, and an EBIT margin of over 30%, 32.6% to be exact. Net finance is related to our currency positions and the Norwegian krone has strengthened itself towards especially dollar, but also euro throughout the first quarter, leaving us with a net finance negative with just under NOK 2.5 million.

Profit before tax ends at NOK 56.7 million then and profit after tax ends at NOK 43.4 million. That's up 78% compared to the same period last year. So again, an excellent quarter. If you go to the balance sheet, we have an increase in tangible assets, and I touched upon the reason in the P&L comments since we do capitalize more on development projects than what we are depreciating.

When it comes to fixed assets, it's the opposite situation. Inventory this quarter is increasing. We are still securing critical stocks in the same manner as we've done before. So the policy hasn't changed. We have, however, on critical components, adjusted our orders. So we should expect a decline in the inventory related to our own products going forward. However, we still have some deliveries on those old orders that go 12 to 18 months back in time.

So the main reason for our inventory increase this period is related to third-party products. And as you've seen, we had an excellent quarter in the first quarter for third-party products. And one of the major reasons is that we are equipping a new hospital in Norway, Drammen Sykehus, and that is still not complete by the end of the quarter. So with this increase in revenue, we will also have to, of course, purchase the equipment that is needed for the hospital. So this is a temporary increase in the third-party product inventory level as such.

Accounts receivable increases. Sales for the quarter increased almost NOK 48 million. So it's then expected that the accounts receivable also increases. So we end the quarter with an increase here of NOK 23 million. Cash position is strong, as you can see. And as Kari mentioned, our -- and as we announced yesterday after the general meeting, there will be a dividend of NOK 6 per share paid out by, I think, 19th of May, and that will be a payout of just under NOK 110 million.

Equity and liability, strong equity over 75%, however, with the dividend of 110%, that will clearly adjust our equity as such, but we do have strong profit going for this quarter and hopefully going forward, so that will soon be recovered. We have no interest-bearing debt. The long-term debt that we do have is related to extended warranty. So it's deferred revenue, but the major part is related to our lease obligations related to premises. Yes. So that was the total for the balance sheet.

Going -- looking at some key figures. We do see that we have a strong earning per share, it's 78 -- sorry, it's a good growth from last year, 78% growth, which is the same as the profit, obviously, and we also see that as of this first quarter, we do have earnings per share being 42% of the total earnings per share in the fiscal year 2024. So that obviously tells you that we have had a very strong start in 2025.

When it comes to cash flow, we are sharing some additional information this quarter and going forward, even though we have a strong profit for the quarter, cash from operation is only NOK 18.8 million. Two major reasons, and that is prepayment of taxes, NOK 15.5 million that is, and with the increased sales, the working capital also increases quite dramatically, almost NOK 20 million. So that's the main reason for cash flow from operation being lower than the profit for the period.

Cash flow from investments, NOK 3.6 million is related to development projects. The remaining is related to infrastructure. Cash from finance ends at negative NOK 10 million. We do have this share buy back program that we initiated in March and ended in April. As of -- by the end of the first quarter, we paid NOK 7.9 million buying back our own shares. The remaining NOK 2.2 million is related to lease obligations and net cash from -- for the period ends at positive NOK 4.2 million and cash equivalents ends at NOK 183.4 million by the end of the quarter. So that is a good place to be when it comes to cash. So with that, I will pass on the word further on to Kari. Thank you.

Yes. So let's look at some of the details on the sales side here. So starting with the number of flow and imaging systems sold in units. This is obviously our highest value and priced ultrasound system. So very important to see good developments here. This quarter, we are selling 11 more of these units compared to the same quarter last year, and we can see that it's really the Americas region that is driving this quarter's result.

EMEA down with 1 unit, Asia Pacific up by 3. And it's really a very high correlation with results and the number of imaging units. So this is really a development that we like to see. And as we saw through 2023 and '24, we've had some headwinds in selling these higher-valued systems, although we never lost confidence that our customers are interested in purchasing this technology and adopting it. So we always explained that this has been temporary delays in purchasing processes, and now we're seeing that we're capitalizing on a buildup demand in our pipeline.

When it comes to imaging probes, so naturally, imaging probes has a tendency to follow the development of imaging systems. So we're selling 13 more imaging probes this quarter, 39 in total, again, Americas as the driver. When it comes to the unit sales of Flow-only systems, this quarter, we have an increase of 7 units.

When it comes to Americas, that is down, but of course, related to the much higher growth in the Flow and Imaging systems for the quarter. EMEA, on the other hand, is up by 10 units, and we can see that this growth is coming both from our distributor channels and also from our direct markets. Asia Pacific also up by 2.

Flow probes in units, the sales is up 18.5% in the first quarter to 2,000 more than -- yes, I can't even see 800, yes. And again, we can see that the Americas is really driving this, and we will analyze a little bit further why that is so. EMEA is up 1%, Asia Pacific coming back also strongly after a softer period, up 60% this quarter. Okay. So taking a closer look at the Americas. So NOK 74.1 million in sales this quarter, currency neutral, we're looking at a very high growth of 28.4% for the quarter. So just keeping in mind that 2023, we actually had a decline in sales revenues of 6.5%, coming back stronger with 11.6% growth last year with really increasing growth through last year, and we are then following up in the first quarter this year with this very strong growth.

So we saw that the total number of systems sold as capital is up 4 units in total, but it's really the Flow and Imaging systems that is driving the revenues with these 9 units. Also part of the Americas region, Canada and Latin America. So Canada as a new direct market for us, they had a very strong first quarter last year, and they are repeating the same level this first quarter, while the distributors in Latin America had a very low sales this particular quarter. But of course, this is a smaller part of the total sales.

Further looking into our performance in the U.S.A. It's a busy slide, but let's start with taking a look at the system sales and outplacement. So we're seeing that we are outpacing and selling a total of 18 units this quarter compared to the same number last year. But as already explained, we have a higher portion of these units being sold as capital, and that is, of course, driving the quarterly revenues.

We can also say now that the capital sales of systems are at an improved level. I wouldn't say at the highest level, but it's really starting to stabilize again at a higher level. When we are selling more capital systems in the U.S., that will also influence the number of flow probes that we're selling. So you can see from the table below that the number of flow probes to capital customers are growing by 32%. And this is typically driven because a new capital customer will buy a start-up probe package with a number of probes. So this will be counted as procedures, and as we have explained before, the number of procedures, we're using that as an estimate for utilization.

But obviously, this high number of procedures are not used immediately. So it's only an estimate. If you look at the number of flow procedures as in relation to market share because, of course, that translates into market share. On the top here, we can see the past several years, and we can see that '22 to '24 was really flat development in number of Flow probes or Flow procedures sold. That actually told us that we had about 35% of the total number of CABG procedures in the U.S.A., which is counting around 200,000 procedures a year.

If we're now making a new last 12-month number here based on the growth in the first quarter, that actually is increasing and suggesting somewhere close to 37% of the U.S. CABG procedures. Again, only estimates. And when it comes to number of flow procedures sold in U.S.A. per quarter, of course, we can see in the graphs on the low end here, the high growth that we are delivering in the first quarter. So positive developments here, absolutely.

But also the other areas are going very well this quarter. So Asia Pacific, NOK 27.9 million in sales, currency neutral. This is a growth of almost 63%. As we've talked about extensively through, I would say, both '23 and '24, we have gone through some changes, of course, in China, where we established a direct sales operation. And we've also here been very confident that we would see a recovery of that normalization of that sales in China, and that is what we are seeing here.

So Q1 was very strong, up 72% in China specifically. And I would warn that we will continue to see some quarterly variations from China and Asia Pacific, but we are definitely expecting this to be a normalized year. Also Japan showed further signs of normalizing. We've had quarters in '24, where we saw very low sales and of course, causing some concern. We came back quite strong in the fourth quarter, and this is continuing into the first quarter. So then we will follow on and see how this is continuing to develop into the rest of this year.

Europe, Middle East and Africa, so ending at NOK 47.9 million in sales for the first quarter, currency neutral. This is corresponding to an 18.2% growth for the quarter. And it's very satisfying to see that this continued strong development is seen both from the direct markets and also from the distributor market.

So direct markets growing currency neutral 16.1% and distributors at 22.2%, very solid. Third-party products, yes, over time, I guess we've seen around 5% annual growth from the third-party product portfolio. So a quarterly growth of 41.2% is extraordinary definitely. We've seen good developments all through last year as well. I think we're making good progress with establishing our Scandinavian third-party distribution franchise, adding new agencies to our portfolio as well. But as Thomas was explaining, the strong results this quarter is very much connected to equipping the new hospital outside of Oslo, of course, driving this very, very high growth.

So summarizing everything, and this is in Norwegian currency, 35% growth from Americas, 66% from APAC, 20% from EMEA, 41.2% from the third party, ending at a total of 35.7%. We are, of course, very interested in following closely the development in the Vascular business. So this quarter, we see that the vascular product portfolio is growing also at a very high level, 45% growth over the same quarter last year, now making up 20% of the total sales of own products.

There's no particular news really to provide on the PATENT study. But just as a reminder, the PATENT study for peripheral bypass surgery is one of the key initiatives and investments we're making in developing this vascular surgery business for Medistim. And we are making progress in patient enrollment and getting all the centers able to start enrolling. Of course, many of the centers that are participating in the study are actually new users to the technology, and they need time to get acquainted and get trained on the technology before they can be allowed to enroll patients.

It's also very good when we see that Vascular, of course, is growing at a higher percentage, which is to be expected, but cardiac sales is also very strong for the quarter, 32% growth. When it comes to Imaging, yes, Imaging, I already mentioned, been weak through 2023 and '24. Actually, we've seen a decline in the sales from the imaging product portfolio in both years, coming back very strongly this quarter, 85% up.

And as I said, we have really expected this to come back because all the feedback we're getting from potential new users is really that people get the concept of adding imaging to the CABG procedures, first and foremost. And I'm sure that we will see the same tendency in Vascular as we build that business as well. But extremely good to see this development.

When it comes to recurring and capital revenues and the split between them, so we are looking at Flow probe sales, PPP card sales and also our lease contracts, we regard all of that as recurring revenues. And it's typically been laying around, well, 70% this first quarter is that the recurring is making up 67.7%, so a little bit lower than the same quarter last year, of course, directly a consequence of the high capital sales this quarter. And the last 12 months 2025 is at 71.6%.

So that was really going through the details of the sales performance within the different areas of the business. Just as a reminder, we have our growth strategy adapted to the various markets and related to the market position that we have in any geography. We are continuing to push, of course, conversion from flow to imaging in strong CABG markets. And then we're using marketing efforts to get adoption also in the underpenetrated markets, a lot to do with the clinical markets and the clinical projects that we are engaged with.

We are continuing to be flexible on pricing and offering various business models in order to also find solutions for emerging markets such as India and working very hard to build our position in vascular surgery. Going direct in more markets, the last market was China and Canada and Sweden, and we will see what will be the next market here.

I mentioned briefly that we have made very deliberate strong investments in our vascular space with the patent study. As we have also talked about, we have -- we are in the launch phase of the INTUI software platform. And that's also starting to find its way out to the market. I can say that in first quarter, we had no sales influence from INTUI. So that was not the cause of the great results this first quarter, but it's going to be booked revenues from the INTUI systems in the second quarter.

But as I stated in the press release in the end of January, this is really a perfect time to strengthen our commercial efforts. We want to make sure that we have the best possible organization and operations that can really handle and develop these markets with the new tools that we are providing.

So this has been announced before, but it's worth repeating and it belongs to the first quarter. We have organized now all our regions into one common leader. So Mike Karim has been appointed as our Chief Commercial Officer. And we've also appointed Tony Winter as our Vice President of the Americas Sales region.

And this is, of course, to make sure that we are optimizing all our strategies, all our tools and also sharing best practices across these regions. And from what we've seen through the first quarter, I think we're making very good progress with this new organization. So we entered 2025 with this slogan, one team, bold moves, excellence redefined. And I think we've started very well according to this slogan. So with that, we are opening up for questions.

Yes. And we have some questions coming in here. The first one is more of a general question. First of all, congratulations on a strong Q1. All markets delivered strong growth for the quarter. Can you attribute this to a relatively soft 2024 seasonality effects? Or is it just down to strong sales performance from your team?

Yes. Well, I guess, first of all, 2024 wasn't that bad. I mean we showed currency-neutral growth of, I think, 5.5%, which is, of course, not at the level that we have performed at previously. So -- and also keeping in mind that '23 was really challenging with a decline currency neutral. So I guess it's a point to say that we are coming out of a softer period.

Having said that, I think the second half of 2024 showed that we were on our way sort of out of that more challenged period, and we've related this to the general economy with high inflation and high interest rates and really delays in some purchasing processes. So it's never been something in the market or in the demand and/or lack of interest from our customers, and we have been able to build up a robust pipeline, and I think that over the second half last year and definitely into this third quarter, we're really capitalizing on that robust pipeline.

So -- and I think that goes across the board, but in particular, in the United States. So I think when it comes to the team performance, of course, I'm very pleased with the strong results, very proud of the teams, both out in the field, but also equally proud of the back office team.

So every result is really the result of a team effort and it's very satisfying to deliver these results as a result of the collaboration from all aspects of the business. If you're asking whether the new organization and the commercial operations is the cause of this fantastic results, I think that's too early. I don't think we can attribute the results to those changes. And that, again, probably shows that there is upside potential for the next quarters over the year as well. So yes, I think there's good things to look forward to.

Thank you. The next one is on the tariffs. How do you expect tariffs to impact sales and margin going forward? Do you expect margin pressure? Or will you be able to pass the increased cost on to the customer? And do you see some effect of orders ahead of the tariffs in Q1?

Yes. I guess I'll answer that one, Kari. First of all, when it comes to the tariff, it's 10%. And if you look at the split of revenue between our U.S. entity and Norway, we leave 40% of the value in U.S. to cover expenses for our U.S. operation. That means that the import tax will be on 60% of end customer value. So for us to absorb the tariff as such, we would need to increase our end customer pricing with 6%.

Having said that, the U.S. is less price sensitive than other markets. The most important thing are the clinical value. And regardless of the tariff, we were actually planning on increasing the prices anyway with the launch of INTUI, which then will more than absorb the 6% that we're talking about here.

So yes, it's never good for us to sort of pay a tariff. We would rather have those 6% as a margin for medicine. But again, with the introduction and the launch of INTUI, we think that we will more than absorb the tariff and maintain and maybe even increase our margin as a consequence. We have not seen any rush from the customer so far related to the tariff when it comes to purchasing as such.

The next one is on margin.

Just to -- the concern actually when it comes to the tariff -- sorry, is more related to how it affects the general economy and the macro economy. And that means the financing of the hospitals, which are often bond related. And if the tariff affects the global economy and the macro economy negatively, that could take us back to the macroeconomic challenges that we have been through before. So that, I think, is the biggest uncertainty related to the tariff as such.

The next one is on margins. After some weak quarters in 2024, it's great to see EBIT margin at 32.6% for Q1. What is the main driver for this margin improvement? And do you expect this trend to continue in 2025?

Before I answer that, I think we should go back a little. Up until 2022, we saw a gradually increasing margin. And the reason for it was that we grew more on sales of our own product compared to third-party products, and we delivered EBIT margin at the range of high 20s and even in the 30s at that time, a little depending on where sales were coming from in the different quarters.

Entering 2023, we did have some major initiatives going direct in 3 different markets, investing in setting up those direct operations. And Kari has also already mentioned the transition effects on that, where our distributor were really utilizing short-term opportunities, leaving less sales to Medistim. So I think all the way through 2023 and 2024, we suffered from that actually in addition to the macroeconomic situation where we had soft capital sales in the U.S. And on top of that, we did have some kind of unexplained drop in sales in Japan.

So when we now come into the first quarter in 2025, we see a tremendous growth in all markets, and we do not have these investments going direct in this quarter. And obviously, then we are then delivering a very good EBIT margin with almost 33%. Going forward, the uncertainty related to it is the tariff, as mentioned, and how it will affect global economy and macroeconomic situation.

Also, I would say that having a record as we have had now with 20% above last record is not something that we should expect from every quarter going forward. But if we are sort of back on track, having an increase of 8% to 10% or close -- 10% growth per quarter, I think we should be able to see again margins at high level 20s and maybe even 30% as such, depending upon how good sales are in direct markets compared to distributor markets. So I think this is an exceptional quarter as such. So going forward, I think we should be -- the expectation should be a little bit more modest.

The next one is on INTUI. Have you seen any effect of the INTUI launch yet? The report indicates first sales in Q2. Have you identified specific markets for this upgrade? Or do you expect it to be adopted worldwide?

Okay. So as I mentioned, we did not book any sales in the first quarter on INTUI and the first sales will be booked now in the second quarter. We just sort of passed through the production and are able to deliver systems. And that, of course, speaks to the upside potential, as I mentioned, for the upcoming quarters. But we should be aware that the INTUI software version that was released now is only for the cardiac systems. It's not for Vascular yet.

Of course, cardiac is the biggest portion of our business. So it should reach out to most of our potential customers. There will also be some countries like China who will need some more regulatory clearance before we can start selling locally, but the product is going to be available for the large markets such as the U.S.A. and Europe and most of Asia as well.

So we will see a mix of INTUI software sales, also some systems on the legacy software. As we say, we have some tender commitments that we also need to fulfill with the legacy software. So it will be, I would say, a gradual uptake of INTUI-based systems going forward.

And then we have some questions on APAC from the web. Was it China that drove the growth in APAC?

Yes. So more than half of the growth coming from Asia Pacific this quarter came from China. And then we also had positive contributions from Japan and South Korea and India as well. So it was more than China, but China was really the biggest impact.

Another on APAC. The growth in APAC, is that the result of the investment in larger team in the region?

No, the growth that we're seeing now is back to normal. So we've had a period where we have suffered after the transition. We had a former partner that was filling up the pipelines, you could say, both in -- with the local distributors and out to the customers as well. So it was really hard for us to get the high traction through our own organization in these first periods.

So now we are actually coming back to, I would say, a much more normalized level, and we're handling this with a pretty slim organization. Of course, our ambition is to now start really growing in China going forward, and that will also require further investments in the teams locally.

Yes. Another one here coming in. Can you also reiterate what markets you have today where you are not going direct?

Okay. It's most all the countries we are not direct. But let's make it simple and go through where we are direct. So that is U.S.A., Canada, it's China, it is Germany, Spain, U.K., Norway, Sweden and Denmark. I think that was all.

Yes. I think we're moving to that. Thank you.

Okay. So with that, we are thanking everyone for the attention and participation during this first quarter presentation, and we look forward to meeting again for the second quarter results. Thank you very much.