UTAH MEDICAL PRODUCTS INC MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS (type 10-Okay)

Currency amounts are in thousands except per-share amounts and where noted.

Currencies are abbreviated as follows: the U.S. Dollar (USD or $), the Great

Britain Pound (GBP or £), the Euro (EUR or €), the Australian Dollar (AUD or

A$), the New Zealand Dollar (NZD) and the Canadian Dollar (CAD or C$).

The following comments should be read in conjunction with the accompanying

financial statements.

Overview.

The 2021 year financial results demonstrate Utah Medical Products, Inc.’s

(Nasdaq: UTMD’s) continuing performance improvement despite many challenges

related to the COVID-19 pandemic including on-again/off-again restrictions on

so-called nonessential medical procedures, supply chain disruption, high

inflation on raw materials, freight and labor costs as well as a continued

shortage of labor from higher employee turnover. Because of UTMD’s unusual dip

in 2020 financial performance, UTMD continues to report its income statement

results compared to the same periods not only for 2021 compared to 2020, but

also for 2021 compared to the pre-pandemic year of 2019. In that regard, the

Company exceeded its stated objective for 2021 to try to fully recover back to

its 2019 financial performance.

UTMD management believes that the presentation of three years of annual income

statement comparisons provides meaningful supplemental information to both

management and investors due to the impact of several factors related to the

COVID-19 pandemic including economic variations affecting foreign currency

exchange rates for sales invoiced in foreign currencies, uneven customer demand

from the timing of ups and downs in government restrictions on “nonessential”

medical procedures, supply disruptions and inflation in input costs.

Consolidated Income 2021 2021 Compared to 2020 2021 Compared to 2019

Statement 2020 2019

Worldwide Revenues $ 49,054 +16.3% $ 42,178 + 4.6% $ 46,904

Gross Profit 30,917 +21.0% 25,548 + 4.9% 29,466

Operating Income 18,880 +37.7% 13,708 + 7.1% 17,633

Earnings Before Income 19,061 +37.7% 13,840 + 6.6% 17,884

Tax

Net Income (US GAAP) 14,788 +37.0% 10,798 + 0.4% 14,727

Earnings Per Share (US $ 4.041 +37.4% $ 2.941 + 2.6% $ 3.939

GAAP)

For perspective, as stockholders may recall, total worldwide revenues for the

2020 pandemic year were 10% lower than in pre-pandemic 2019. Sales outside the

U.S. (OUS) were more negatively affected by the reaction to the pandemic than

inside the U.S., and recovered more slowly in 2021. Direct to end-user sales,

which drive UTMD’s overall profitability, were 14% lower for the 2020 pandemic

year. Operating Income in 2020 was 22% lower than in pre-pandemic 2019. UTMD

maintained its manufacturing operations in the U.S. and Ireland throughout the

pandemic, without government assistance, in order to support important clinical

needs of patients. During the pandemic, UTMD protected its critical mass of

overhead resources and did not adjust relative to the decline in sales, which

proved to be a good decision given 2021 results and future resource needs.

A comparison of 2021 bottom line results with the results of 2020 and 2019,

according to U.S. Generally Accepted Accounting Principles (US GAAP), is

affected by some income tax provision adjustments not related to normal

operations: 1) in 4Q 2019, net income was increased $582 ($.156 increase in

EPS) as a result of final adjustments made to state of Utah tax estimates

following the December 2017 U.S. “Tax Cuts and Jobs Act” (TCJA), enacted in late

2017; 2) in 2Q 2020, net income was decreased $225 ($.061 decrease in EPS) by a

long term deferred tax liability increase on the balance of Femcare intangible

assets (the amortization of which is not tax-deductible in the UK) as a result

of a delay in the enacted UK income tax rate reduction, and 3) in 2Q 2021, net

income was decreased $390 ($.107 decrease in EPS) by a long term deferred tax

liability increase on the balance of Femcare intangible assets (the amortization

of which is not tax-deductible in the UK) as a result of an enacted increase in

the UK income tax rate effective in 2023. The 2020 $225 increase in deferred UK

taxes over the following six years, and the 2021 $390 increase in deferred UK

taxes from 2023 through 2026, according to US GAAP, must be booked in the

quarter in which the tax law change was enacted. The UK decided to not reduce

its corporate income tax rate from 19% to 17% beginning in 2Q 2020, as was

previously enacted, and then in 2Q 2021 decided to increase its corporate income

rate to 25% as of April 1, 2023. UTMD management believes that the presentation

of results excluding the unfavorable deferred tax liability adjustment to its

2020 and 2021 net income and the favorable U.S. tax-related adjustment to 2019

net income provides meaningful supplemental information to both management and

investors that is more clearly indicative of UTMD’s operating results in 2021

compared to 2020 and 2019. Please note that the non-US GAAP exclusions only

affects Net Income and Earnings Per Share. All other income statement

categories at and above the EBT line were unaffected by the UK tax rate

adjustments.

Excluding the 2021 and 2020 deferred tax liability increases and concomitant

“one-time” income statement tax provision increase resulting from the enactment

of the UK corporate income tax changes, and favorable tax provision adjustment

in 2019 related to the U.S. TCJA, UTMD’s non-US GAAP Net Income and Earnings Per

Share (EPS) percentage changes follow:

Consolidated Income 2021 2021 Compared to 2020 2021 Compared to 2019

Statement 2020 2019

Net Income (Non-US GAAP) $15,178 +37.7% $11,023 + 7.3% $14,145

EPS (Non-US GAAP) $4.147 +38.2% $3.002 + 9.6% $3.784

Key profit margins (profits as a percentage of sales) in 2021 compared to 2020

and 2019 calendar years follow:

2021 2020 2019

Gross Profit Margin (GPM) 63.0% 60.6% 62.8%

Operating Income Margin 38.5% 32.5% 37.6%

Income Before Tax Margin 38.9% 32.8% 38.1%

Net Income Margin before tax adjusts 30.9% 26.1% 30.2%

Net Income Margin per US GAAP 30.1% 25.6% 31.4%

Profit margins in 2021 recovered to be consistent with UTMD’s pre-pandemic

performance. In 2020, Gross Profit declined more than Sales as a result of less

absorption of fixed overheads and marginal costs associated with the pandemic

including personal protective equipment for employees, cleaning supplies, extra

pay to encourage employees to come to work, pay continuation beyond normal sick

pay and accrued vacation pay for those quarantined with symptoms or exposed to

someone with symptoms, lower productivity as a result of social distancing and

higher costs levied by some suppliers and service providers. In contrast and

despite higher variable costs in 2021, UTMD’s 2021 Gross Profit increased more

than Sales due to lower U.S. employee medical plan costs and improved labor

productivity, in addition to better absorption of fixed manufacturing overhead

expenses.

In 2020, Operating Income was leveraged down from lower GP compared to 2019

primarily due to the fixed $6,470 noncash expense resulting from amortizing

Identifiable Intangible Assets (IIA) which resulted from the purchase of Femcare

in 2011 and the remaining life of the U.S. exclusive distribution rights for the

Filshie Clip System from CooperSurgical Inc. (CSI) in 2019. Also, the CSI IIA

amortization expense in 2019 was only $6,089 because of a partial year of

amortization plus a stronger USD in 2019 which reduced fixed GBP Femcare IIA

amortization expense in USD terms. In contrast, the fixed IIA amortization

expenses, which are included in General & Administrative (G&A) operating

expense, were diluted by substantially higher sales in 2021 than in 2020 and a

6.6% stronger GBP in 2021 relative to the 2020 USD, which reduced the USD value

of the fixed GBP Femcare IIA amortization expense.

Non-US GAAP Net Income and EPS increased the same as Operating Income in 2021

compared to 2020 because the consolidated total income tax rate prior to US GAAP

tax adjustments was the same in both years at 20.4%.

Measures of the Company’s liquidity and overall financial condition improved as

of the end of 2021 compared to the end of 2020 with year-end working capital up

19% and Stockholders’ Equity up 4% despite a $7,309 special dividend paid to

stockholders near the end of 2021 which reduced both cash and Stockholders’

Equity by that same amount. The improvement was the result of continued strong

positive cash flow from normal operations. In total, UTMD paid $11,465 in

stockholder cash dividends in 2021 compared to $4,116 in 2020. In 2020, the

Company also used $6,976 of its cash to repurchase its shares. UTMD did not

repurchase shares in 2021. The Company also used $552 in cash in 2021 to invest

in new manufacturing equipment for a future need in addition to maintaining

Property, Plant and Equipment (PP&E) in good working order.

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In spite of the combined $12,017 use of cash for stockholder dividends and

capital expenditures, UTMD’s cash equivalent balances at the end of 2021

increased $9,384 to $60,974 from $51,590 at the end of 2020. Working capital

increased $10,941 to $69,412 at the end of 2021 from $58,471 at the end of 2020.

Total liabilities declined $425. The Company remained without debt. UTMD’s

total debt ratio (total liabilities to total assets) was 7% at the end of 2021

compared to 8% at the end of 2020. Stockholders’ Equity at the end of 2021

increased to $107,138 from $102,822 at the end of 2020, despite the $11,465 in

2021 cash dividends to stockholders which reduce Stockholders’ Equity.

Productivity of Fixed Assets and Working Capital Assets.

Assets.

Year-end 2021 total consolidated assets were $115,636 comprised of $73,158 in

current assets, $11,067 in consolidated net PP&E and $31,412 in net intangible

assets. This compares to $111,745 total assets at the end of 2020 comprised of

$62,262 in current assets, $11,326 in consolidated net PP&E and $38,157 in net

intangible assets. Total asset turns (total consolidated sales divided by

average total assets for the year) in 2021 were 43% compared to 38% in 2020, as

sales increased faster than the increase in average assets.

Current assets increased $10,896 due to the $9,384 increase in year-end cash

and investments, $1,028 higher accounts and other receivables, $374 higher

year-end inventories and $110 higher other current assets, all due to the higher

sales activity. Year-end 2021 and 2020 cash and investment balances were $60,974

and $51,590, representing 53% and 46% of total assets, respectively. Net (after

allowance for doubtful accounts) year-end trade accounts receivable (A/R)

balances were $1,025 higher at the end of 2021 compared to 2020. This due to 4Q

2021 sales $903 higher than in 4Q 2020, and average days in A/R of 36 days based

on 4Q trade sales instead of 31 days at the end of 2020. Average days in A/R

from date of invoice of 36 days is well within UTMD’s objective. A/R over 90

days from invoice date rose from 1.7% of total A/R at the end of 2020 to 2.4% at

the end of 2021. The Company believes any older A/R will be collected or are

within its reserve balances for uncollectible amounts. Inventories at 2021

year-end were only 6% higher from the end of 2020, despite a 16% increase in

annual shipments.

Working capital (current assets minus current liabilities) at year-end 2021 was

19% higher at $69,412 compared to $58,471 at year-end 2020. Consistent with

Federal and State rules, the TCJA repatriation tax current liability at the end

of 2021 was $220 compared to $80 at the end of 2020. The end of 2021 working

capital exceeds UTMD’s needs for normal operations in an uncertain economic

environment, funding of future organic growth and timely payment of accrued tax

liabilities, in addition to allowing for substantial funding of any future

acquisition without diluting stockholder interest, as well as continued payment

of stockholder dividends and repurchase of UTMD shares. Despite a negative

impact on Return on Stockholders’ Equity of retaining a high cash balance, UTMD

believes that in times of high economic uncertainty and change, maintaining

substantial cash balances increases its likelihood of being able to take

advantage of opportunities that will benefit stockholders in the longer term,

and retain key resources that will help ensure continued excellent long term

performance.

December 31, 2021 net $11,067 total PP&E includes Utah, Ireland and England

manufacturing molds, production tooling and equipment, test equipment, and

product development laboratory equipment. In addition, PP&E includes computers

and software, warehouse equipment, furniture and fixtures, facilities and real

estate for all five locations in Utah, Ireland, UK, Canada and Australia.

Manufacturing facilities in Utah, Ireland and the UK are standalone buildings

with a combined 220,000 square feet on 15 acres of land. The distribution

facilities in Australia and Canada with a combined 8,000 square feet are part of

larger industrial condominiums. Management estimates the fair market value of

the five owned facilities to be at least $25 million excluding the contents, the

fungible value of which increases stockholder enterprise value relative to most

of UTMD’s industry peers which lease their facilities.

Ending 2021 net consolidated PP&E (depreciated book value of all fixed assets)

declined $259 as a result of the combination of capital expenditures of $552,

depreciation of $636 and the effect of foreign currency exchange (FX) rates on

year-end foreign subsidiary asset balances.

The following end-of-year FX rates to USD were applied to assets and liabilities

of each applicable foreign subsidiary:

12-31-21 12-31-20

EUR 1.1377 1.2228

GBP 1.3536 1.3663

AUD 0.7268 0.7708

CAD 0.7902 0.7841

The year-end 2021 net book value (after accumulated depreciation) of

consolidated PP&E was 33% of purchase cost. End-of-year PP&E turns (Net Sales

divided by Net PP&E) was 4.4 in 2021 compared to 3.7 in 2020 due to 16% higher

2021 sales and lower USD asset values of foreign subsidiaries, offset by

investment in new PP&E assets needed for the future which are not in use yet. A

future leverage in productivity of fixed assets which will not have to be

further increased to support new business activity will be a source of continued

incremental profitability.

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Net intangible assets (after accumulated amortization) are comprised of the

capitalized costs of obtaining patents and other intellectual property, as well

as the value of identifiable intangible assets (IIA) and goodwill resulting from

acquisitions. Net intangible assets were $31,412 (27% of total assets) at the

end of 2021 compared to $38,157 (34% of total assets) at the end of 2020. Per

US GAAP, intangible assets are categorized as either 1) IIA, which are amortized

over the estimated useful life of the assets, or 2) goodwill, which is not

amortized or expensed until the associated economic value of the acquired asset

becomes impaired. Those two categories of Femcare intangibles at year-end 2021

were net IIA of $9,064 and goodwill of $6,907. The accumulated amortization of

Femcare IIA as of December 31, 2021 since the March 18, 2011 acquisition was

$23,419. The remaining Femcare IIA will be fully amortized in 4 more years. The

goodwill portion of intangible assets resulting from the Femcare acquisition,

which is not amortized, declined $65 due to a weaker GBP at year-end, i.e. the

different FX rate on fixed goodwill in GBP terms. In early 2019, UTMD acquired

an additional $21,000 IIA from the purchase of the remaining life of exclusive

U.S. distribution rights for the Filshie Clip System from CSI, of which $12,895

has been amortized through year-end 2021. The remaining CSI IIA will be fully

amortized in less than 2 more years. UTMD’s goodwill balance from prior

acquisitions including Femcare, Columbia Medical, Gesco and Abcorp was $14,098

at the end of 2021.

Because the products associated with UTMD’s acquisitions of Columbia Medical in

1997, Gesco in 1998, Abcorp in 2004 and Femcare in 2011 continue to be viable

parts of UTMD’s overall business, UTMD does not expect the current goodwill

value associated with the four acquisitions to become impaired in 2022.

Amortization of IIA was $6,645 in 2021 compared to $6,515 in 2020. The

difference was due to £5 lower Femcare IIA amortization and the GBP FX

difference on all Femcare IIA amortization. Specifically, the 2021 non-cash

amortization expense of Femcare IIA was $2,189 (£1,590) compared to $2,049

(£1,595) in 2020. The 2022 non-cash amortization expense (included as part of

consolidated G&A operating expenses) of Femcare IIA will be £1,589, or $2,161 if

the USD/GBP average FX rate is 1.36. In other words, the 2022 Femcare IIA

amortization expense is expected to be about $28 lower because of a slightly

lower GBP amount and a projected weaker GBP relative to the USD. Both the 2021

and 2020 non-cash amortization expense of CSI IIA was $4,421. The 2022 operating

expense resulting from amortization of CSI IIA will again be $4,421.

Liabilities.

As a reminder, payments for the Federal and State repatriation (REPAT) tax

liability which resulted from the U.S. TCJA enacted in 2017 is 8% of the

respective tax liability per year for the first five years, 15% in the sixth

year, 20% in the seventh year and 25% in the eighth year. Calendar year 2022

represents the fifth year, but the $220 current liability is somewhat less than

8% of UTMD’s $2,792 total REPAT tax liability due to earlier overpayment because

earlier Federal and State payments were based on an initial estimate which was

conservatively too high at $6,288 compared to the final adjusted estimate of

$2,792. The long term $1,675 REPAT tax liability, to be paid in years 2023-2025,

represents 60% of the total liability.

Year-end 2021 current liabilities were $45 lower than at the end of 2020.

Ending accrued liabilities were $159 lower due primarily to $585 higher OEM

customer deposits and $279 higher accrued payroll and bonuses offset by $1,038

lower dividends payable. The $1,038 stockholder dividend declared in 4Q 2020 was

paid in January 2021, whereas the $7,309 dividend declared in 4Q 2021 was paid

in December 2021. Total liabilities were $425 lower at the end of 2021 compared

to the end of 2020. The resulting 2021 year-end total debt ratio was 7% compared

to 8% at the end of 2020.

The year-end 2021 DTL balance created as a result of the fifteen-year deferred

tax consequence of the amortization of Femcare’s IIA was $2,105, down from

$2,151 at the end of 2020. The relatively small $47 decline in this DTL

considering the $2,189 in 2021 amortization of IIA was due to the UK tax law

change in 2Q 2021 which increased the DTL $390, together with a difference in

GBP FX rate at the end of 2021. Without the tax law change, the theoretical tax

effect at the 2021 19% tax rate for the 2021 IIA amortization expense would have

been $416. In addition to liabilities stated on the balance sheet, UTMD has

operating lease and purchase obligations described in Note 14 and Note 12,

respectively, to the financial statements.

Results of Operations.

a)Revenues.

Under accounting standards applicable for 2021, the Company believed that

revenue should be recognized at the time of shipment as title generally passes

to the customer at the time of shipment, or completion of services performed

under contract. Revenue recognized by UTMD is based upon documented

arrangements and fixed contracts in which the selling price is fixed prior to

acceptance and completion of an order. Revenue from product or service sales is

generally recognized at the time the product is shipped or service completed and

invoiced, and collectability is reasonably assured. Over 99% of UTMD’s revenue

is recognized at the time UTMD ships a physical device to a customer’s

designated location, where the selling price for the item shipped was agreed

prior to UTMD’s acceptance and completion of the customer order. There are no

post-shipment obligations which have been or are expected to be material to

financial results.

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There are circumstances under which revenue may be recognized when product is

not shipped, which have met the criteria of ASC 606: the Company provides

engineering services, for example, design and production of manufacturing

tooling that may be used in subsequent UTMD manufacturing of custom components

for other companies. This revenue is recognized when UTMD’s service has been

completed according to a fixed contractual agreement.

Terms of sale are established in advance of UTMD’s acceptance of customer

orders. In the U.S., Ireland, UK, France, Australia and Canada since the

beginning of 2017, UTMD has generally accepted orders directly from and shipped

directly to end-user clinical facilities, as well as third party

medical/surgical distributors, under UTMD’s Standard Terms and Conditions (T&C)

of Sale. About 11% of UTMD’s domestic end-user sales went through third party

med/surg distributors which contract separately with clinical facilities to

provide purchasing, storage and scheduled delivery functions for the applicable

facility. UTMD’s T&C of Sale to end-user medical facilities are substantially

the same in the U.S., Canada, Ireland, UK, France, Australia and New Zealand.

UTMD may allow separate discounted pricing agreements with a specific clinical

facility or group of affiliated facilities based on volume of purchases.

Pricing agreements which are documented arrangements with clinical facilities,

or groups of affiliated facilities, if applicable, are established in advance of

orders accepted or shipments made. For existing customers, past actual shipment

volumes typically determine the fixed price by part number for the next

agreement period. For new customers, the customer’s best estimate of volume is

usually accepted by UTMD for determining the ensuing fixed prices for the

agreement period. Prices are not adjusted after an order is accepted. For the

sake of clarity, the separate pricing agreements with clinical facilities based

on volume of purchases disclosure is not inconsistent with UTMD’s disclosure

above that the selling price is fixed prior to the acceptance of a specific

customer order.

UTMD’s global consolidated trade sales are comprised of domestic and OUS sales.

Domestic sales in 2021 included 1) direct domestic sales, sales of finished

devices to end-user facilities and med/surg distributors in the U.S., and 2)

domestic OEM sales, sales of components or finished products, which may not be

medical devices, to other companies for inclusion in their products. OUS sales

are export sales from UTMD in the U.S. to customers outside the U.S. invoiced in

USD, and sales from UTMD subsidiaries in Ireland, Canada, Australia and the UK

which may be invoiced in EUR, GBP, CAD, AUD, NZD or USD. The term “trade” means

sales to customers which are not part of UTMD. Each UTMD entity had 2021

intercompany sales of components and/or finished devices to other UTMD

entities.

The following table shows the 2021 USD denominated revenues by sales channel

compared to 2020 and 2019. Australia domestic sales included sales directly to

New Zealand medical facilities beginning in 4Q 2020:

Revenue (USD denominated) 2021 2021 Compared 2020 2021 Compared 2019

to 2020 to 2019

U.S. domestic (excluding OEM) $21,096 + 8.9% $19,373 + 0.7% $20,949

Canada domestic 1,382 (6.7%) 1,481 (34.4%) 2,107

Ireland domestic 446 +17.7% 379 (18.8%) 549

UK domestic 2,388 +18.1% 2,023 (24.7%) 3,171

France domestic 1,424 +13.6% 1,253 (20.2%) 1,785

Australia domestic 1,705 +20.0% 1,421 ( 0.1%) 1,706

Subtotal, Direct to End-User: $28,441 + 9.7% $25,930 ( 6.0%) $30,267

All Other OUS (Sales to Int’l 11,050 +13.3% 9,753 + 9.5% 10,092

Distributors)

U.S. OEM Sales

9,563 +47.3% 6,495 + 46.1% 6,545

Worldwide Revenues $49,054 +16.3% $42,178 + 4.6% $46,904

Except for Canada, sales in all channel categories rebounded well from 2020.

Whereas UTMD total consolidated sales in 2021 were almost 5% higher than in the

pre-pandemic year of 2019, direct sales in Europe and Canada remained 20-30%

lower than in 2019, indicating a slower recovery from the pandemic in those

regions. Global consolidated trade sales in 2021 were $49,054 compared to

$42,178 in 2020 and $46,904 in 2019. The $4,726 (10.1%) lower sales in 2020 from

2019 were primarily the result of restrictions on medical procedures that

government officials worldwide deemed nonessential during the COVID-19 pandemic,

presumably to conserve medical facility capacity. Total U.S. domestic sales

including OEM were up $4,793 (+18.5%) in 2021, at $30,659 compared to $25,866 in

2020, and $27,493 in 2019. OUS sales were up $2,083 (+12.8%) at $18,395 compared

to $16,312 in 2020, and $19,411 in 2019.

Domestic Sales.

U.S. domestic sales in 2021 were $30,659 (63% of total sales) compared to

$25,866 (61% of total sales) in 2020, and $27,493 (59% of total sales) in 2019.

The components of the $4,793 higher 2021 domestic sales were $209 (3.3%) lower

sales of the Filshie Clip System devices in the U.S., $3,069 (+47.3%) higher

sales of components and finished devices used in other companies’ products (OEM

customers), and $1,933 (+14.8%) higher direct sales of all other UTMD

(non-Filshie) finished devices to domestic end-users. Domestic sales in 2019

were $27,493.

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Domestic Filshie Clip System sales in 2021 were 20% of total U.S. domestic sales

compared to 24% in 2020 and 25% in 2019. Filshie sales did not recover as well

as the other domestic sales categories. Looking forward to 2022, despite a

continued recovery in overall surgical sterilization procedures including

laparoscopic interval procedures, as there is a medical procedure trend in the

U.S. to choose salpingectomy versus tubal ligation for permanent contraception

post C-Section, UTMD expects U.S. Filshie device sales in 2022 will remain about

the same as in 2021.

Domestic OEM sales in 2021 were 31% of total U.S. domestic sales compared to 25%

in 2020 and 24% in 2019. UTMD sold components and finished devices to 155

different U.S. companies in 2021, compared to 139 different companies in 2020

and 147 companies in 2019, for use in their product offerings. Sales to UTMD’s

largest OEM customer represented 82% of total domestic OEM sales in 2021

compared to 75% of total domestic OEM sales in both 2020 and 2019. UTMD’s

largest OEM customer markets biopharmaceutical manufacturing control systems

which exclusively utilize UTMD’s pressure monitoring technology, and for which

demand is booming. If UTMD had had the manufacturing capacity primarily in

terms of assembly operators in 2021, OEM sales would have been much higher.

Looking forward to 2022, UTMD again expects substantial growth in OEM sales as

engineering projects for manufacturing expansion come to fruition.

Domestic direct end-user sales excluding the Filshie Clip System were 49% of

total U.S. domestic sales in 2021 compared to 51% in both 2020 and 2019. Of

UTMD’s four domestic direct product categories, neonatal products were $5,343

(22% higher), labor & delivery (L&D) products were $3,940 (7% higher),

gynecology/ electrosurgery/ urology products excluding the Filshie Clip System

were $4,837 (12% higher), and blood pressure monitoring devices were $873 (25%

higher).

OUS Sales.

Sales OUS in 2021 were $18,395 (12.8% higher) compared to $16,312 in 2020. OUS

sales were $19,411 in 2019. Europe and Canada were particularly affected by

government restrictions during the pandemic.

Because a significant portion of UTMD’s OUS sales are invoiced in foreign

currencies, changes in FX rates can potentially have a material effect on

period-to-period USD-denominated sales. Although a weaker USD in the first half

of the year helped increase foreign currency sales in USD terms, the FX rate

impact for the year 2021 was a minor factor compared to the negative impact of

the pandemic on OUS sales. UTMD’s FX rates for income statement purposes are

transaction-weighted averages. The average rates from the applicable foreign

currency to USD during 2021 compared to 2020 follow. The average FX rates for

2019 are also listed for reference:

2021 Change 2020 2019

GBP 1.376 +6.6% 1.291 1.277

EUR 1.183 +3.2% 1.146 1.119

AUD 0.751 +8.6% 0.692 0.696

CAD 0.798 +6.2% 0.751 0.754

The sales weighted FX rate change in 2021 compared to 2020 was +4.9%. In other

words, consolidated USD sales in 2021 were increased $619 from what they would

have been using the prior year’s FX rates.

Seventy-two percent of (USD denominated) 2021 OUS sales were invoiced in foreign

currencies compared to 58% in 2020 and 66% in 2019. As a portion of total USD

consolidated sales, 27% of UTMD’s USD-equivalent sales were invoiced in foreign

currencies in 2021 compared to 22% in 2020 and 27% in 2019. The GBP, EUR, AUD

and CAD converted sales represented 6%, 15%, 3% and 3% of total 2021 USD sales,

respectively. This compares to 6%, 10%, 3% and 3% of total 2020 USD sales, and

to 8% GBP, 11% EUR, 4% AUD and 4% CAD of total 2019 USD sales.

USD-denominated trade (excludes intercompany) sales of devices to OUS customers

(excluding France) by UTMD’s Ireland facility (UTMD Ltd) were $7,439 in 2021

(39% higher) compared to $5,347 in 2020, and were $5,894 in 2019. In addition,

UTMD Ltd also sold devices that it had manufactured directly to France in 2021

due to BREXIT, which in prior years were sold to Femcare Ltd in the UK on an

intercompany basis and then sold by Femcare Ltd directly to French medical

facilities. USD-denominated sales to France in 2021 were $1,424 (14% higher)

compared to $1,253 in 2020, and were $1,785 in 2019. Some sales, mostly to

Northern Ireland, were invoiced in GBP which was up 6.6% in 2021 compared to the

2020 USD. In addition, as the 2021 EUR was 3.2% higher relative to the 2020

USD, the total FX impact added $226 to Ireland’s total 2021 sales.

In 2021, UTMD’s UK subsidiary, Femcare Ltd., had $2,451 trade sales of devices

to domestic UK and certain international distributor customers, up 12% compared

to $2,183 in 2020. The total FX impact added $170 in USD terms. Femcare

USD-denominated sales excluding France in 2019 were $3,596.

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USD-denominated sales of devices to end-users in Australia by Femcare’s

Australia distribution subsidiary (Femcare Australia Pty Ltd) were $1,705 (20%

higher) in 2021 compared to $1,421 in 2020. In 4Q 2020, UTMD converted from

selling devices by Femcare in the UK to a third party distributor in New Zealand

(NZ) to distributing devices directly to NZ medical facilities from Femcare

Australia. In addition, an 8.6% stronger AUD in 2021 added $135 in

USD-denominated sales. Femcare Australia sales in 2019, which did not include

sales to NZ, were $1,706.

UTMD’s Canada distribution subsidiary (Utah Medical Products Canada, Inc.) had

the weakest sales results of UTMD’s OUS subsidiaries. USD-denominated sales of

devices to end-users in Canada were $1,382 (7% lower) than $1,481 in 2020

despite a CAD which was 6.2% stronger than in the prior year. The stronger CAD

added $88, so 2021 sales were $1,294 (13% lower) in constant currency terms.

Canada sales were $2,107 in 2019.

UTMD groups its sales into four general product categories: 1) obstetrics,

comprised of labor and delivery management tools for monitoring fetal and

maternal well-being, for reducing risk in performing difficult delivery

procedures and for improving clinician and patient safety; 2) gynecology/

electrosurgery/ urology, comprised of tools for gynecological procedures

associated primarily with cervical/ uterine disease including LETZ, endometrial

tissue sampling, transvaginal uterine sonography, diagnostic laparoscopy,

surgical contraception and other MIS procedures; specialty excision and incision

tools; conservative urinary incontinence therapy devices; and urology surgical

procedure devices; 3) neonatal critical care, comprised of devices that provide

developmentally-friendly care to the most critically ill babies, including

providing vascular access, enteral feeding, administering vital fluids, oxygen

therapy while maintaining a neutral thermal environment, providing protection

and assisting in specialized applications; and 4) blood pressure monitoring/

accessories/ other, comprised of specialized transducers and components as well

as molded parts and assemblies sold on an OEM basis to other companies. In

these four categories, UTMD’s primary revenue contributors enjoy significant

brand awareness by clinical users.

Global revenues by product category:

2021 % 2020 % 2019 %

Obstetrics $4,675 9 $4,523 11 $5,000 11

Gynecology/ Electrosurgery/ Urology 21,973 45 20,552 49 25,354 54

Neonatal

6,691 14 5,870 14 6,066 13

Blood Pressure Monitoring and Accessories* 15,715 32 11,233 26 10,484 22

Total:

$49,054 100 $42,178 100 $46,904 100

OUS revenues by product category:

2021 % 2020 % 2019 %

Obstetrics $ 735 4 $ 846 5 $ 947 5

Gynecology/ Electrosurgery/ Urology 11,053 60 9,934 61 13,731 71

Neonatal

1,347 7 1,490 9 1,412 7

Blood Pressure Monitoring and Accessories* 5,260 29 4,042 25 3,321 17

Total:

$ 18,395 100 $ 16,312 100 $ 19,411 100

* includes molded components and finished medical and non-medical devices sold

to OEM customers.

Looking forward to 2022, continuing government restrictions on so-called

“non-essential” medical procedures seems unlikely. Although there remains much

room for pandemic recovery in UTMD’s direct distribution OUS, UTMD projects a

3-4% stronger USD on the average which will offset the unit growth in direct

foreign currency sales in USD terms. OUS distributor order patterns vary and

are less predictable, but UTMD’s largest OUS distributor has placed a fixed 2022

order for BPM devices that is $550 higher than in 2021 based on an average EUR

FX rate of 1.13 in 2022. Domestically, OEM sales are projected to be over $700

higher with projected capacity limits, but could be even higher if production

worker hiring constraints in Utah become less severe. A key to sales results

will be retaining U.S. Filshie device sales at a similar level as in 2021.

Except for Filshie devices in the U.S., UTMD raised product prices across the

board an average of about 5% in late 4Q 2021, which will benefit 2022 sales in

comparison to 2021 assuming customer demand remains relatively inelastic. In

summary, management’s best estimate at this time is that 2022 revenues will be

up in the range of mid-single digit percentage growth.

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b)Gross Profit (GP).

UTMD’s 2021 consolidated GP, the surplus after subtracting costs of

manufacturing, which includes purchasing raw materials, forming components,

assembling, inspecting, testing, packaging and sterilizing products, from net

revenues, was $30,917 (63.0% of sales) compared to $25,548 (60.6% of sales) in

2020 and $29,466 in 2019 (62.8% of sales). GP in 2021 increased $5,369 (+21.0%)

with a 16.3% increase in revenues.

The Gross Profit Margin (GPM), which is GP divided by sales, expanded primarily

due to the fact that a large portion of UTMD’s manufacturing expenses were fixed

compared to the prior year. Another way to say this is that in 2020, a greater

decline in GP than in sales was a result of UTMD’s decision to not cut important

manufacturing overhead resources in the same proportion as the decline in sales,

which would sacrifice future capabilities just to maintain a short term GPM. In

addition to the lower absorption of fixed manufacturing overhead costs in 2020,

there were two other categories of increased costs that reduced the 2020 GPM

compared to 62.8% in 2019: 1) marginal costs associated with the COVID-19

pandemic including personal protective equipment for employees, cleaning

supplies, extra pay to encourage employees to come to work, pay continuation

beyond normal sick pay and accrued vacation pay for those quarantined with

symptoms or exposed to someone with symptoms, lower productivity as a result of

social distancing and higher prices levied by some suppliers and service

providers, and 2) an unusually unfavorable year for UTMD’s self-insured health

care plan in the U.S. Self-insured health care plan costs in 2021 returned to

be more consistent with prior years’ levels. Despite higher variable costs in

2021, particularly freight on incoming materials and a cost of living adjustment

for Utah and Ireland production workers, the GPM in 2021 recovered to be

consistent with the pre-pandemic year of 2019.

In 2022, UTMD plans to help manage inflationary manufacturing cost pressures

with administering higher prices for its devices, as and when necessary.

Nevertheless, management expects that manufacturing costs in 2022 will increase

faster than revenues resulting in a lower GPM. However, UTMD also expects that

GP will still be higher than in 2021. If sales increase as a mid-single digit

percentage, then GP are projected to increase as a low single-digit percentage.

UTMD’s Ireland subsidiary’s (UTMD Ltd’s) GP was EUR 6,788 compared to EUR 4,198

in 2020 and EUR 2,908 in 2019. The associated GPMs were 61.2% in 2021, 54.4% in

2020 and 43.1% in 2019. Femcare UK 2021 GP was GBP 913 compared to GBP 1,495 in

2020 and GBP 3,884 in 2019. The UK 2021 GPM was 46.3% compared to 56.0% in 2020

and 70.2% in 2019. The transfer from the UK to Ireland of direct sales to France

primarily explains the GP changes for both Ireland and the UK. Femcare Australia

and Femcare Canada are simply distribution facilities for UTMD finished devices

in their respective countries. GP is the result of subtracting intercompany

purchase prices of devices plus freight from sales. Australia GP was AUD 1,399

(61.6% of sales) compared to AUD 1,194 (58.1% of sales) in 2020 and AUD 1,415

(57.7% of sales) in 2019. Canada GP was CAD 907 (52.4%of sales) in 2021 compared

to CAD 1,128 (57.2% of sales) in 2020 and CAD 1,670 (54.5% of sales) in 2019. In

the U.S., GP was $20,100 in 2021, $17,043 in 2020 and $19,180 in 2019. UTMD U.S.

GPMs were 55.8% in 2021, 54.2% in 2020 and 57.1% in 2019. A summation of the

above GP of each subsidiary will not yield UTMD’s consolidated total GP because

of elimination of profit in inventory of intercompany goods.

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c)Operating Income.

Operating Income results from subtracting operating expenses from GP. Operating

Income in 2021 was $18,880 (38.5% of sales) compared to $13,708 (32.5% of sales)

in 2020 and $17,632 (37.6% of sales) in 2019. On top of benefitting from a

higher GPM, the higher 2021 Operating Income margin (Operating Income divided by

sales) additionally reflected better absorption of relatively fixed IIA

amortization expense, included in General and Administrative (G&A) operating

expenses, which was 13.5% of sales in 2021 compared to 15.3% of sales in 2020

and 13.0% of sales in 2019. Excluding the non-cash Femcare and CSI IIA

amortization expenses, UTMD consolidated operating expenses were $5,427 (11.1%

of sales) compared to $5,370 (12.7% of sales) in 2020 and $5,744 (12.2% of

sales) in 2019. In other words, holding operating expense (excluding the IIA

amortization expense) growth to 1% while sales increased 16% and GP increased

21%, leveraged the overall growth in Operating Income to almost 38% compared to

2020.

The UTMD Ltd (Ireland) Operating Income margin in 2021 was 57.8% compared to

50.5% in 2020 and 38.5% in 2019. Femcare UK’s Operating Income margin per US

GAAP, which includes the IIA amortization expense of the 2011 acquisition, was

negative in both 2021 and 2020 compared to 27.8% in 2019. Femcare Australia’s

2021 Operating Income margin was 45.9% compared to 41.7% in 2020 and 38.6% in

2019. Femcare Canada’s 2021 Operating Income margin was 34.5% compared to 40.7%

in 2020 and 41.9% in 2019. UTMD’s 2021 Operating Income margin in the U.S. was

33.2% compared to 28.5% in 2020 and 33.7% in 2019. For clarity, the CSI IIA

amortization expense hit the U.S. Operating Income margin, and the Femcare IIA

amortization expense hit the Femcare UK Operating Income margin.

Operating expenses include sales and marketing (S&M) expenses, product

development (R&D) expenses and G&A expenses. Consolidated operating expenses

were $12,037 (24.5% of sales) in 2021, $11,840 (28.1% of sales) in 2020 and

$11,834 (25.2% of sales) in 2019. The following table provides a comparison of

operating expense categories, as well as further segmentation of G&A expenses,

for the last three years.

2021 2020 2019

S&M expenses $ 1,414 $ 1,554 $ 1,738

R&D expenses 526 486 483

G&A expenses:

a) litigation expense provision 22 – 16

b) corporate legal 1 14 32

c) outside directors fees 125 116 118

d) stock option compensation 166 160 113

e) profit-sharing bonus accrual 448 587 653

f) outside accounting audit/tax 179 223 216

g)Femcare IIA amortization 2,189 2,049 2,037

h) CSI IIA amortization 4,421 4,421 4,053

i) property & liability insurance premiums 99 95 91

j)all other G&A expenses 2,447 2,135 2,284

G&A expenses – total 10,097 9,800 9,613

Total Consolidated Operating Expense: $ 12,037 $ 11,840 $ 11,834

Percent of sales:

24.5% 28.1% 25.2%

Description of Operating Expense Categories:

i) S&M expenses:

S&M expenses in 2021 were $1,414 (2.9% of sales) compared to $1,554 (3.7% of

sales) in 2020 and $1,738 (3.7% of sales) in 2019. UK sales salaries were $130

lower in 2021 than in 2020 due to a reduction in the UK sales force.

S&M expenses are the costs of communicating UTMD’s differences and product

advantages, providing training and other customer service in support of the use

of UTMD’s solutions, attending clinical meetings and medical trade shows,

administering customer agreements, advertising, processing orders, shipping, and

paying commissions to outside independent representatives. In markets where UTMD

sells directly to end-users, which in 2019-2021 included the U.S., Ireland, UK,

Australia, France and Canada plus New Zealand in 2021, the largest components of

S&M expenses were the cost of customer service required to timely process orders

and the distribution costs associated with shipping products.

S&M expenses include all customer support costs including training. In general,

training is not required for UTMD’s products since they are well-established and

have been clinically widely used. Written “Instructions For Use” are packaged

with all finished devices. Although UTMD does not have any explicit contracts

with customers to provide training, it does provide hospital in-service and

clinical training as required and reasonably requested.

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UTMD promises prospective customers that it will provide, at no charge in

reasonable quantities, electronic media and other instructional materials

developed for the use of its products. UTMD provides customer support from

offices in the U.S., Canada, Ireland, UK and Australia by telephone to answer

user questions and help troubleshoot any user issues. Occasionally, on a

case-by-case basis, UTMD may utilize the services of an independent practitioner

to provide educational assistance to clinicians. All in-service and training

expenses are routinely expensed as they occur. Except for the consulting

services of independent practitioners and occasional use of marketing

consultants, all of these services are allocated from fixed S&M overhead costs.

Historically, additional consulting costs have been immaterial to financial

results, which is also UTMD’s expectation for the future.

ii) R&D expenses:

R&D expenses in 2021 were $526 (1.1% of sales) compared to $486 (1.2% of sales)

in 2020 and $483 (1.0% of sales) in 2019. R&D expenses include the costs of

investigating clinical needs, developing innovative concepts, testing concepts

for viability, validating methods of manufacture, completing any necessary

premarketing clinical trials, regulatory documentation and other activities

required for design control, responding to customer requests for product

enhancements, and assisting manufacturing engineering on an ongoing basis in

developing new processes or improving existing processes. Although no new UTMD

devices were launched in 2021, UTMD continued to customize configurations of its

existing devices based on specific clinical requests and R&D played a

significant role in manufacturing process improvements that were needed to

support fast growing OEM product sales, in addition to continuing work on new

product projects. UTMD does not pre-announce new devices that are being

developed.

iii) G&A expenses:

G&A expenses in 2021 were $10,096 (20.6% of sales) compared to $9,800 (23.2% of

sales) in 2020 and $9,613 (20.5% of sales) in 2019. G&A expenses include the

“front office” functional costs of executive management and outside directors,

finance and accounting, corporate information systems, human resources,

stockholder relations, corporate risk management, corporate governance,

protection of intellectual property, amortization of identifiable intangibles

and legal costs. The table above helps identify certain specific categories of

G&A expenses which might be of interest to stockholders.

As indicated in the table above, amortization of the Femcare IIA acquired in

2011 is part of G&A expenses. The IIA GBP amortization expense in 2021 was

£1,590 compared to £1,595 in 2020, practically the same. However, because of a

stronger GBP for the year as a whole, the USD 2021 IIA amortization expense was

$140 higher than in 2020. But 16.3% higher consolidated sales allowed better

absorption of the resulting 6.8% higher USD Femcare IIA expense, i.e. Femcare

IIA amortization expense was 4.5% of sales in 2021 compared to 4.9% of 2020

sales. The G&A noncash amortization expense of Femcare IIA was 4.3% of 2019

total consolidated sales. The Femcare IIA amortization expense will continue

until March 2026 (or until the value of any remaining IIA becomes impaired).

UTMD estimates that the Femcare IIA amortization expense in 2022 may be $25

lower due to an average stronger USD in 2022 compared to 2021.

The early 2019 $21,000 purchase of CSI exclusive Filshie Clip System U.S.

distribution rights also represents an IIA which is being amortized on a

straight line basis over the remaining life of the Femcare distribution

agreement with CSI which will be through 3Q 2023 (unless it becomes impaired

before that, which is unlikely). This CSI IIA amortization expense is included

in U.S. G&A expenses. In 2021 and 2020, the CSI IIA amortization expense was

the same at $4,421. But again, due to the 16.3% higher consolidated sales, the

CSI IIA amortization expense represented only 9.0% of sales compared to 10.5% of

sales in 2020. The CSI IIA amortization expense in 2019, which was a partial

year due to the timing of the acquisition, was $4,053 (8.6% of 2019 annual

sales). In 2022, the constant $4,421 CSI IIA amortization expense will lower as

a percentage of sales if further diluted by projected higher sales.

It seems worth noting that the combined Filshie Clip System and Femcare non-cash

IIA amortization expenses represented more than half of all of UTMD’s total

consolidated operating expenses during the three years of 2019-2021; 54.9% in

2021, 54.6% in 2020 and 51.5% in 2019.

d)Non-operating income/Non-operating expense, and Income Before Taxes (EBT).

Non-operating income includes royalties from licensing UTMD’s technology, rent

from leasing underutilized property to others, income earned from investing the

Company’s excess cash and gains from the sale of assets. Non-operating expense

includes interest on bank loans, bank service fees, excise taxes and losses from

the sale of assets. Also, the period-to-period remeasured value of EUR cash

balances held in the UK, and GBP balances held in Ireland, generates a gain or

loss which is booked at reporting period end as non-operating income or expense,

as applicable.

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Net non-operating income (combination of non-operating income and non-operating

expense) was $181 in 2021, $132 in 2020 and $252 in 2019. The higher

non-operating income in 2021 compared to 2020 was due to $142 higher rent income

in Ireland from renting unneeded warehouse space. A description of components of

UTMD’s non-operating income or expense follows:

1) Interest Expense. There was no interest expense in 2019-2021. Absent an

acquisition or large repurchase of shares that requires new borrowing, UTMD does

not expect any interest expense in 2022.

2) Investment of excess cash. Consolidated investment income (including gains

and losses on sales of investments) was $46 in 2021, $64 in 2020 and $255 in

2019. Interest rates in 2021 remained practically zero, and UTMD had to pay

negative interest on EUR bank balances in Ireland. UTMD is expecting interest

rates to improve marginally in 2022.

3) Royalties. Royalties in 2021 were $15 compared to $20 in 2020, and $5 in

2019. Presently, there is only one arrangement which began in 2020 under which

UTMD is receiving royalties on its technology.

4) Gains/ losses from remeasured currency in bank accounts. UTMD recognized a

$23 loss in 2021 compared to a $45 gain in 2020 and a $76 loss in 2019 from

gains or losses on remeasured foreign currency bank balances. EUR currency cash

balances in the UK, and GBP currency cash bank balances in Ireland, are subject

to remeasured currency translation gains/ losses as a result of period to period

changes in FX rates.

5) Other non-operating income or expense. Income received from renting unused

warehouse space in Ireland and parking lot space in Utah for a cell phone tower,

offset by bank fees, and other miscellaneous non-operating expenses resulted in

net non-operating income of $124 in 2021 compared to a net non-operating expense

of $10 in 2020 and $85 in 2019.

EBT results from adding net non-operating income or subtracting net

non-operating expense from Operating Income. Consolidated EBT was $19,061 (38.9%

of sales) in 2021 compared to $13,840 (32.8% of sales) in 2020 and $17,884

(38.1% of sales) in 2019. The 2021 EBT of UTMD Ltd. (Ireland) was €6,277 (56.6%

of sales) compared to €3,728 (48.3% of sales) in 2020 and €2,577 (38.2% of

sales) in 2019. Femcare Ltd’s (UK) 2021 EBT was (£1,003) compared to (£593) in

2020 and £1,566 (28.3% of sales) in 2019. Femcare Ltd, as the legal

manufacturer of the Filshie Clip System, supports worldwide regulatory

requirements in addition to absorbing the IIA amortization expense of the 2011

Femcare Group acquisition. Femcare AUS’s 2021 EBT was AUD 1,042 (45.9% of sales)

compared to AUD 857 (41.8% of sales) in 2020 and AUD 952 (38.8% of sales) in

2019. Femcare Canada’s 2021 EBT was CAD 592 (34.2% of sales) compared to CAD 798

(40.5% of sales) in 2020 and CAD 1,280 (41.8% of sales) in 2019.

As a side note for clarity of financial results, UTMD’s EBT, as well as all

other income statement measures above the EBT line in the Income Statements,

were unaffected by 2019-2021 adjustments to income tax provisions as a result of

income tax rate changes in the UK enacted in 2Q 2020 and 2Q 2021, which

increased UTMD’s long term deferred tax liability, and the 2019 corrected

estimate of the repatriation tax and associated GILTI tax and FDII tax credit,

all of which resulted from the U.S. TCJA enacted in December 2017.

EBITDA is a non-US GAAP metric that UTMD management believes is of interest to

investors because it provides meaningful supplemental information to both

management and investors that represents profitability performance without

factoring in effects of financing, accounting decisions regarding non-cash

expenses, capital expenditures or tax environments. If the Company were to need

to borrow to pay for a major asset or acquisition, the projected EBITDA metric

would be of primary interest to a lending institution to determine UTMD’s credit

worthiness. Although the U.S. Securities and Exchange Commission advises that

EBITDA is a non-GAAP metric, UTMD’s non-US GAAP EBITDA is the sum of the

following elements in the table below, each of which is a US GAAP number:

2021 2020 2019

EBT $19,061 $13,840 $17,884

Depreciation Expense 636 655 700

Femcare IIA Amortization Expense 2,189 2,049 2,037

CSI IIA Amortization Expense

4,421 4,421 4,053

Other Non-Cash Amortization Expense 34 45 54

Stock Option Compensation Expense 166 160 113

Remeasured Foreign Currency Balances 23 (45) 76

UTMD non-US GAAP EBITDA: $26,530 $21,125 $24,917

In summary, UTMD’s 2021 non-US GAAP EBITDA increased 25.6% compared to 2020 and

6.5% compared to 2019, when 2021 sales were 16.3% higher than in 2020 and 4.6%

higher than in 2019. This metric is expected to also grow faster than the

projected increase in sales in 2022.

e)Net Income, Earnings Per Share (EPS) and Return on Equity (ROE).

Net Income

Net Income results after subtracting a provision for estimated income taxes from

EBT. UTMD’s US GAAP Net Income in 2021 was $14,788 (30.1% of sales) compared to

$10,798 (25.6% of sales) in 2020 and $14,727 (31.4% of sales) in 2019. Because

of changes in UTMD’s repatriation tax estimate in the year 2019 due to the TCJA

enacted in December 2017, as well as UK income tax changes enacted in 2020 and

2021, management does not believe either that the tax provision adjustments have

a direct relationship to sales in the same periods, or that the year-to-year

changes in US GAAP Net Income is an accurate measure of UTMD’s bottom-line

financial performance in the applicable time periods. Ignoring the income tax

adjustments, 2021 non-US GAAP Net Income was $15,178 (30.9% of sales) compared

to $11,023 (26.1% of sales) in 2020 and $14,145 (30.2% of sales) in 2019.

Please see the table below which presents Net Income both according to US GAAP

and also prior to recognition of the various tax estimate adjustments.

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The US GAAP consolidated income tax provision rate for 2021 was 22.4% compared

to 22.0% in 2020 and 17.7% of EBT in 2019. The estimated tax provision

adjustments in 2019 reduced the 2019 average rate, whereas the adjustments in

2020 and 2021 increased the average rates. The non-US GAAP consolidated

combined income tax provision rate for both 2021 and 2020 was 20.4% compared to

20.9% of EBT in 2019. For clarity, the UK income tax rate change in 2021 from

19% to 25% beginning in April 2023 added $390 to UTMD’s 2021 income tax

provision, representing the increased tax which will be due over the remaining

life of amortization of Femcare’s IIA, which is not a tax deductible expense in

the UK. Similarly, the UK income tax rate change in 2020 from 17% to 19% added

$225 to UTMD’s 2020 income tax provision, representing the increased tax which

will be due over the remaining life of amortization of Femcare’s IIA, which is

not a tax deductible expense in the UK. The income tax adjustment in 2019

subtracted $582 from UTMD’s 2019 income tax provision due to UTMD’s initial

estimates of taxes due under the TCJA being too high.

More normally and in general, year-to-year fluctuations in the combined average

tax provision rate will result from variation in EBT contribution from

subsidiaries in jurisdictions with different corporate income tax rates. Taxes

in foreign subsidiaries are based on taxable EBT in those sovereignties, which

can be different from the contribution to consolidated EBT per US GAAP. UTMD

expects, barring any new tax law changes which are currently unknown, that its

combined income tax rate for 2022 will be within the (non-GAAP) 20.4%-20.9%

range of the three years of 2019-2021.

The UK had an income tax rate of 19% for all three years 2019-2021. The UK also

allowed a tax deduction for sales of UK patented products which varied from

year-to-year based on somewhat complicated rules which are sorted out for UTMD

by independent UK tax specialists. The income tax rate for AUS was 30% for all

three years. The income tax rate for Canada was about 26% for the three years.

Profits of the Ireland subsidiary were taxed at a 12.5% rate on exported

manufactured products, and a 25% rate on rental and other types of income

including income from sales of medical devices in Ireland domestically. As UTMD

stockholders likely remember, in the U.S. the Federal income tax rate was

changed after 2017 to 21% from 34% prior to the TCJA. Federal taxes are not 21%

of U.S. EBT, however, as income taxes paid to the State are a deductible expense

for Federal tax purposes, other expenses are not deductible and there remains an

R&D tax credit along with other credits, not to mention a GILTI tax related to

foreign income and FDII tax credit related to profits on export sales. The Utah

state income tax rate declined to 4.95% from 5% prior to the TCJA, and the State

enacted income apportionment rules that provide for additional tax relief.

Earnings Per Share (EPS)

EPS are Net Income divided by the number of shares of stock outstanding (diluted

to take into consideration stock option awards which are “in the money,” i.e.,

have exercise prices below the applicable period’s weighted average market

value). Diluted EPS in 2021 per US GAAP were $4.041 ($4.147 prior to the UK

deferred tax liability adjustment) compared to $2.941 ($3.002 prior to the UK

deferred tax liability adjustment) in 2020 and $3.939 ($3.784 prior to the Utah

state TCJA tax correction) in 2019. The 2021 non-US GAAP EPS result exceeded

management’s projection at the beginning of the year.

The 2021-ending weighted average number of diluted common shares (the number

used to calculate diluted EPS) was 3,660 (in thousands) compared to 3,672 in

2020 and 3,739 in 2019. Dilution for “in the money” unexercised options for the

year 2021 was 13 (in thousands) shares compared to 14 shares in 2020 and 18

shares in 2019. Actual outstanding common shares as of December 31, 2021 were

3,655.

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UTMD management believes the presentation of Net Income and EPS results

excluding the tax liability estimate adjustments in 2021, 2020 and 2019 provides

meaningful supplemental information to both management and investors that is

more clearly indicative of UTMD’s bottom line results for comparison purposes.

US GAAP:

2021 2020 2019

Net Income $14,788 $10,798 $14,727

Net Income Margin 30.1% 25.6% 31.4%

EPS $ 4.041 $ 2.941 $ 3.939

Non-US GAAP (excluding 2020 and 2021 UK DTL changes and TCJA tax adjustments in

2019):

2021 2020 2019

Net Income $15,178 $11,023 $14,145

Net Income Margin 30.9% 26.1% 30.2%

EPS $ 4.147 $ 3.002 $ 3.784

Please note: The tax provision adjustments only affected UTMD’s income tax

provision, Net Income and EPS, not consolidated revenues (sales), GP, Operating

Income or EBT.

The non-US GAAP financial measures also facilitate management’s internal

comparisons for purposes of planning future performance. The non-US GAAP

financial measures disclosed by UTMD should not be considered a substitute for

or superior to financial measures calculated in accordance with US GAAP, and the

financial results calculated in accordance with US GAAP and reconciliations to

those financial statements should be carefully evaluated.

In short, UTMD realized a substantial recovery in 2021 revenues from 2020, and

profitability returned to pre-pandemic levels.

Looking forward to 2022, there remains a significant lack of predictability of

demand for UTMD’s medical devices due to governments’ now entrenched desire to

control people’s health care as a result of the pandemic. Nevertheless,

management believes that 2022 sales are likely to be higher than in 2021 due to

UTMD having to raise prices of its devices, offset by a slower recovery OUS

combined with a stronger USD reducing foreign currency sales. Because the high

rate of inflation in costs and the difficulty in hiring people which resulted

from uncontrolled government spending continues to grow at a rate that is likely

to exceed the rate of growth in sales, the Company also expects that the rate of

growth in Gross Profit in 2021 will be lower than the growth in sales. A lower

GPM will be partially offset by better absorption of UTMD’s high fixed IIA

amortization expenses. For the sake of specificity and as an example, UTMD

estimates that a 5% increase in sales in 2022 will yield a 1% increase in EBT

compared to 2021 results.

ROE

Maintaining a high ROE remains a key management objective for UTMD in order to

grow without diluting stockholder interest. ROE is the quotient of Net Income

divided by average Stockholders’ Equity, but more specifically it is the product

of the Net Income margin, productivity of assets and financial leverage.

Although UTMD’s high Net Income margin is the primary factor that continues to

drive its ROE, cash dividends to stockholders and repurchase of shares help in

lowering average Stockholders’ Equity, reducing the denominator in calculating

ROE. The income tax estimate adjustments in all three years had an impact on the

overall ROE ratios using US GAAP Net Income. UTMD’s 2021 ROE before stockholder

dividends (with US GAAP Net Income) was 14.1%. In comparison, 2020 ROE was

10.6% and 2019 ROE was 15.5%.

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Before dividends, UTMD’s 2021 ROE (using non-US GAAP Net Income) was 14.5%

compared to 10.8% in 2020 and 14.9% in 2019, excluding the effect of the tax

adjustments on Net Income. The higher 2021 ROE compared to 2020 was the result

of 37.7% higher non-US GAAP Net Income with 3.0% higher average Stockholders’

Equity. Average Stockholders’ Equity was $104,980 in 2021 compared to $101,957

in 2020 and $95,042 in 2019. UTMD’s Stockholders’ Equity has more than doubled

over the last ten years despite being reduced by $46 million in dividends and

$14 million in share repurchases over that same period of time.

Maintaining a high ROE with the dilutive effect of rapidly growing Average

Stockholders’ Equity (despite reductions from dividends and stock repurchases),

while maintaining excellent Net Income results, suggests an excellent increase

in stockholder value. UTMD’s average ROE over the last 29 years was 25%.

Liquidity and Capital Resources

Cash Flows.

Net cash provided by operating activities totaled $21,203 compared to $20,137 in

2020 and $17,056 in 2019. Net Profit at $3,990 higher in 2021 compared to 2020

allowed net cash provided by operating activities in 2020, including adjustments

for depreciation and other non-cash operating expenses, along with changes in

working capital and the tax benefit attributable to exercise of employee

incentive stock options, to be $1,066 higher than in 2020. Total cash provided

by operating activities was not in the magnitude of increased Net Profit as a

result of changes in 2021 cash required for operating activities compared to

2020 changes (second order derivative), which were a function of the higher 2021

business activity related to recovering from restrictions on nonessential

medical procedures during the pandemic, i.e. 1) a $1,705 higher use of cash as a

result of increasing trade accounts receivable (A/R) $1,088 instead of the $617

decrease in 2020, and 2) a $1,408 higher use of cash as a result of increasing

inventories $485 instead of the $923 decrease in 2020. Additional changes that

consumed more cash in 2021 than in 2020 included a $66 greater reduction in

deferred income taxes, a $42 reduction in interest and other receivables instead

of a $45 increase in 2020 and an $81 reduction in prepaid expenses and other

current assets instead of a $108 increase in 2020. In addition to higher Net

Profit, greater cash was provided in 2021 compared to 2020 from $129 higher

non-cash amortization expense, a $32 higher tax benefit attributable to exercise

of employee stock options and a $106 higher increase in accrued expenses.

In investing activities, during 2021 UTMD used $552 in capital expenditures to

purchase new molds and manufacturing equipment for new capabilities as well as

to maintain, improve or expand existing operating capabilities, compared to

investing $860 in 2020.

In 2021 UTMD received $560 and issued 11,702 shares of stock upon the exercise

of employee stock options. Employees exercised a total of 13,711 option shares

in 2021, with 2,009 shares immediately being retired as a result of optionees

trading the shares in payment of the exercise price of the options. Option

exercises in 2021 were at an average price of $57.40 per share. The Company

received a $39 tax benefit from option exercises in 2021. UTMD did not

repurchase shares of its stock in the open market during 2021.

In comparison, in 2020 UTMD received $358 and issued 8,278 shares of stock upon

the exercise of employee and director stock options. Option exercises in 2020

were at an average price of $43.26 per share. The Company received a $7 tax

benefit from option exercises in 2020. UTMD repurchased 87,000 shares of its

stock in the open market during 2020 at an average cost of $80.19 per share.

In further comparison, in 2019 UTMD received $283 and issued 7,042 shares of

stock upon the exercise of employee and director stock options. Employees and

directors exercised a total of 7,110 option shares in 2019, with 68 shares

immediately being retired as a result of optionees trading the shares in payment

of the exercise price of the options. Option exercises in 2019 were at an

average price of $40.80 per share. The Company received a $23 tax benefit from

option exercises in 2019. UTMD repurchased 5,000 shares of its stock in the open

market during 2019 at an average cost of $79.52 per share.

UTMD did not borrow in any of the three years 2019-2021. Cash dividends paid to

stockholders were $11,465 in 2021 compared to $4,116 in 2020 and $4,096 in

2019.

Management believes that future income from operations and effective management

of working capital will continue to provide the liquidity needed to finance

internal growth plans. In an uncertain economic environment, UTMD’s cash

balances allow management to operate with the long-term best interest of

stockholders in mind. Planned 2022 capital expenditures for ongoing operations

are expected to be about the same in magnitude as depreciation of PP&E, although

additional capital expenditure opportunities are being considered.

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Management plans to utilize cash not needed to support normal operations in one

or a combination of the following: 1) in general, to continue to invest at

opportune times in ways that will enhance future profitability; 2) to make

additional investments in new technology and/or processes; and/or 3) to acquire

a product line or company that will augment revenue and EPS growth and better

utilize UTMD’s existing infrastructure. If there are no better strategic uses

for UTMD’s cash, the Company will continue to return cash to stockholders in the

form of dividends and share repurchases when the stock appears undervalued.

Management’s Outlook.

UTMD remains relatively small compared to many other companies, but its

employees are experienced and remain diligent in their work. UTMD’s passion is

in providing differentiated clinical solutions that will help improve the

effectiveness of medical procedures and reduce health risks, particularly for

women and their babies.

The safety, reliability and performance of UTMD’s medical devices are high and

represent significant clinical benefits while providing minimum total cost of

care. UTMD will continue to leverage its reputation as a device innovator and

reliable manufacturer which will responsively take on challenges to work with

clinicians who use its specialty devices. In doing so, UTMD will continue to

differentiate itself, especially from commodity-oriented competitors. In 2022,

UTMD again plans to

1) leverage distribution and manufacturing synergies by further integrating

capabilities and resources in its multinational operations;

2) expand manufacturing capacity at a time when resources are particularly

scarce;

3) focus on effectively differentiating the benefits of the Filshie Clip System

in the U.S.;

4) introduce additional products helpful to clinicians through internal product

development;

5) continue to achieve excellent overall financial operating performance;

6) utilize positive cash generation to continue providing cash dividends to

stockholders and make open market share repurchases if/when the UTMD share price

seems undervalued; and

7) remain vigilant for affordable accretive acquisition opportunities which may

be brought about by difficult burdens on small, innovative companies.

The Company has a fundamental focus to do an excellent job in meeting

clinicians’ and patients’ needs, while providing stockholders with excellent

returns. In the combined form of cash dividends and share repurchases, UTMD

“returned” $11,465 (78% of Net Income) to stockholders in 2021 compared to

$11,092 (103% of Net Income) in 2020 and $4,494 (31% of Net Income in 2019).

In 2021, the value of UTMD’s stock improved 19%, ending the year at $100.00/

share, while $3.14 in cash dividends/ share were paid. The DJIA, S&P 500 and

NASDAQ (where UTMD is traded) indices were up 19%, 27% and 27% respectively in

2021.

In comparison, in 2020, the value of UTMD’s stock declined 22%, ending the year

at $84.30/ share, while $1.12 in cash dividends/ share were paid. The DJIA, S&P

500 and NASDAQ (where UTMD is traded) indices were up 7%, 16% and 44%

respectively in 2020.

In further comparison, in 2019 the value of UTMD’s stock increased 30%, ending

the year at $107.90/ share, while $1.10 in cash dividends/ share were paid. The

DJIA, S&P 500 and NASDAQ indices were up 22%, 29% and 35% respectively in 2019.

The average compounded appreciation in UTMD stock value for the last 23 years

was 12.6% per year, substantially outpacing all of the major indices. Adding

dividends, UTMD stockholder value increased at an annually compounded rate of

13.4% over the last 23 years since 1998.

Combining share price appreciation as a result of a long term financial

performance and a capital allocation strategy that includes opportunistic share

repurchases with steadily growing quarterly cash dividends paid to stockholders

since 2004, longer term UTMD stockholders have experienced excellent returns.

Management is committed to continue that performance.

Off Balance Sheet Arrangements

None

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Contractual Obligations

The following is a summary of UTMD’s significant contractual obligations and

commitments as of December 31, 2021:

Contractual Obligations and Total 2022 2023- 2024 2025-2026 2027 and

Commitments thereafter

Long-term debt obligations $ – $ – $ – $ – $ –

Operating lease obligations 523 66 123 98 236

Purchase obligations 4,368 4,353 15 – –

Total $ 4,891 $ 4,419 $ 138 $ 98 $ 236

Critical Accounting Policies and Estimates

The preparation of these financial statements requires management to make

estimates and assumptions that affect the reported amounts of assets and

liabilities as well as the reported amounts of revenues and expenses during the

reporting period.

Management bases its estimates and judgments on historical experience, current

economic and industry conditions and on various other factors that are believed

to be reasonable under the circumstances. This forms the basis for making

judgments about the carrying values of assets and liabilities that are not

readily available from other sources. Management has identified the following as

the Company’s most critical accounting policies which require significant

judgment and estimates. Although management believes its estimates are

reasonable, actual results may differ from these estimates under different

assumptions or conditions.

·Allowance for doubtful accounts: The majority of the Company’s receivables are

with healthcare facilities and medical device distributors. Although the

Company has historically not had significant write-offs of bad debt, the

possibility exists, particularly with foreign distributors where collection

efforts can be difficult or in the event of widespread hospital bankruptcies.

·Inventory valuation reserves: The Company strives to maintain inventory to 1)

meet its customers’ needs and 2) optimize manufacturing lot sizes while 3) not

tying-up an unnecessary amount of the Company’s capital increasing the

possibility of, among other things, obsolescence. The Company believes its

method of reviewing actual and projected demand for its existing inventory

allows it to arrive at a fair inventory valuation reserve. While the Company has

historically not had significant inventory write-offs, the possibility exists

that one or more of its products may become unexpectedly obsolete for which a

reserve has not previously been created. The Company’s historical write-offs

have not been materially different from its estimates.

Accounting Policy Changes

The Company’s management has evaluated the recently issued accounting

pronouncements through the filing date of these financial statements and has

determined that the application of these pronouncements will not have a material

impact on the Company’s financial position and results of operations.

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