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Edap Tms S.a.

edap · NASDAQ Healthcare
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Industry Medical - Devices
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FY2023 Annual Report · Edap Tms S.a.
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ANNUAL
ANNUAL
REPORT
REPORT
2023
2023

ANNUAL
ANNUAL
REPORT
REPORT
2023
2023

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EDAP Technomed, Inc. I 4410 El Camino Real, #50 I Los Altos, CA 94022, USA
____________________
EDAP TMS SA I 4, rue du Dauphiné - PA La Poudrette Lamartine - 69120 Vaulx-en-Velin - FRANCE
____________________
FocalOne.com I www.edap-tms.com I contact@edap-tms.com

EDAP Technomed, Inc. I 4410 El Camino Real, #50 I Los Altos, CA 94022, USA
____________________
EDAP TMS SA I 4, rue du Dauphiné - PA La Poudrette Lamartine - 69120 Vaulx-en-Velin - FRANCE
____________________
FocalOne.com I www.edap-tms.com I contact@edap-tms.com

The Global Leader
in Therapeutic Ultrasound

The Global Leader
in Therapeutic Ultrasound

 
 
June 4th, 2024 

Dear Fellow Shareholders: 

Looking back, 2023 proved to be a very productive and successful year for our company. We achieved both record 
revenue and placed a record number of Focal One systems, establishing robotic HIFU as a fast growing treatment 
modality  for  the  management  of  prostate  cancer.  We  also  experienced  strong  Focal  One  procedure  growth,  which 
reflects increasing adoption of robotic HIFU technology, as well as our growing installed base of Focal One systems.    

In parallel with our commercial success, we also achieved significant clinical and regulatory milestones throughout the 
year. In December, we announced a positive opinion for reimbursement from the French National Authority for Health 
(HAS)  for  the  treatment  of  localized  prostate  cancer  with  HIFU  technology.  In  July,  we  announced  reimbursement 
approval in Switzerland for the use of HIFU in the treatment of prostate cancer, enabling Swiss patients to have greater 
access to a precise and effective treatment option with the potential of fewer side effects. Earlier in 2023, we announced 
the approval of our ExactVu™ micro-ultrasound biopsy platform in Japan, which represents the second largest market 
for advanced medical device technology in the world.  

We also made significant progress in our clinical pipeline in 2023, highlighted by the progress on our Phase 2 and 
Phase 3 clinical trials evaluating Focal One robotic HIFU technology to treat women with deep infiltrating endometriosis. 
Of  particular  note,  FDA  recently  granted  Breakthrough  Device  designation  for  Focal  One  for  the  treatment  of  deep 
infiltrating endometriosis, which speaks to the importance of developing new treatment approaches for addressing this 
painful and debilitating condition impacting thousands of women each year. We look forward to sharing topline results 
from the study in the second half of 2024.   

EDAP has also taken steps to ensure that our board and senior leadership continues to evolve as we redefine the 
treatment paradigm for prostate cancer. In December, we appointed Lance Willsey, MD, as a new independent director 
who brings a strong expertise in both urology and prostate cancer. Dr. Willsey also has an accomplished background 
in serving healthcare and cancer focused companies, and in his brief time on the Board, he has already made significant 
contributions  to  help  guide  our  corporate  strategy.  More  recently,  we  also  announced  the  appointments  of  two 
international senior executives, Damien Desmedt and Alexander Fromm, who each bring significant commercialization 
experience in the field of disruptive, robotic capital equipment.    

As previously noted on our first quarter earnings call, this year’s EAU and AUA meetings were major successes for 
EDAP, showcasing the growing brand recognition for our best-in-class Focal One robotic HIFU platform. A major impact 
at both of these scientific meetings was the final results from the HIFI study, which provided conclusive clinical evidence 
that treatment with robotic HIFU technology was at least equivalent to surgery (radical prostatectomy), but with the 
added benefit of improved functional outcomes with respect to both erectile function and urinary continence. As results 
from the HIFI study become more widely disseminated amongst the urology community, we anticipate seeing a positive 
impact on the demand for our leading Focal One platform.      

Looking ahead in 2024, we believe that, despite the impact from inflation, the U.S. economy still appears to be resilient. 
From our perspective, the current economic backdrop is translating into capital expenditure budgets for hospitals and 
urology  practices  that  are  relatively  stable,  with  a  modest  elongation  to  some  purchasing  cycles.  Nonetheless,  we 
believe a growing number of hospitals and clinics view Focal One as a clinically necessary, strategic investment that 
will enable urologists to remain at the forefront of prostate cancer management. Based on these underlying dynamics, 
we believe our Focal One pipeline will continue to remain strong throughout 2024 and beyond, and we remain fully 
engaged in productive discussions with existing and potentially new customers.   

Finally, we would like to acknowledge all of the hard work and dedication of our employees who have helped make 
such important contributions to our ongoing success and growth. We have carefully selected an extraordinary group of 
individuals  to  both  lead  and  contribute  across  our  Focal  One  capital  and  clinical  sales  teams,  and  each  day  our 
relationships with key stakeholders continue to strengthen. We are very excited about our progress and what it means 
for our future.      

I would like to thank our shareholders for your continued support, and I look forward to sharing with you additional 
progress throughout 2024.  

Sincerely, 

Ryan Rhodes 
Chief Executive Officer  

Table of Contents 

UNITED STATES SECURITIES AND EXCHANGE COMMISSION 
Washington, D.C. 20549 

 FORM 20-F 
 ☐ REGISTRATION STATEMENT PURSUANT TO SECTION 12(B) OR (G) OF THE SECURITIES EXCHANGE 
ACT OF 1934, 

OR 
☒ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT OF 1934 

For the Fiscal Year Ended December 31, 2023 

OR 

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT OF 
1934 

OR 
☐ SHELL COMPANY REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT 
OF 1934 

Date of the event requiring this shell company report_______________________ 
For the transition period from ________ to _________ 

000-29374 
(Commission file number) 

EDAP TMS S.A. 
(Exact name of registrant as specified in its charter) 
France 
(Jurisdiction of incorporation or organization) 

Parc d’Activites la Poudrette-Lamartine 
4/6, rue du Dauphiné 
69120 Vaulx-en-Velin, France 
(Address of principal executive offices) 

 Blandine Confort 
Head of Legal Affairs & Investor Relations 
 Parc d’Activites la Poudrette-Lamartine  
4/6, rue du Dauphiné,  
69120 Vaulx-en-Velin, France 
Tel. +33 4 72 15 31 50, E-mail : bconfort@edap-tms.com 
(Name, Telephone, E-mail and Address of Company Contact Person) 

 Securities registered or to be registered pursuant to Section 12(b) of the Act: 

Title of each class 

American Depositary Shares, each representing 
one Ordinary Share 

(Ordinary Shares, nominal value €0.13 per share) 

Trading 
Symbol 

EDAP 

Name of each exchange on which registered 

Nasdaq Global Market 

 Securities registered or to be registered pursuant to Section 12(g) of the Act: None 

 Securities for which there is a reporting obligation pursuant to Section 15(d) of the Act: None 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Table of Contents 

 Outstanding shares of each of the issuer’s classes of capital or common stock as of December 31, 2023:  37,103,779 
Ordinary Shares 

 Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. 
Yes __         No_X 

 If this report is an annual or transition report, indicate by check mark if the registrant is not required to file reports pursuant 
to Section 13 or 15(d) of the Securities Exchange Act of 1934. Yes __        No _X 

 Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the 
Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required 
to file such reports) and (2) has been subject to such filing requirements for the past 90 days.  Yes _X          No __ 

 Indicate  by  check  mark  whether  the  registrant  has  submitted  electronically  every  Interactive  Data  File  required  to  be 
submitted and posted pursuant to Rule 405 of Regulation S-T (§ 232.405 of this chapter ) during the preceding 12 months 
(or for such shorter period that the registrant was required to submit and post such files).Yes _X          No __ 

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or an 
emerging growth company. See definition of “large accelerated filer”, “accelerated filer” and “emerging growth company” 
in Rule 12b-2 of the Exchange Act. (Check one): 

Large accelerated filer __        Accelerated filer _X         Non-accelerated filer __        Emerging growth company __ 

 If an emerging growth company that prepares its financial statements in accordance with U.S. GAAP, indicate by check 
mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial 
accounting standards† provided pursuant to Section 13(a) of the Exchange Act. __ 

 †  The  term  “new  or  revised  financial  accounting  standard”  refers  to  any  update  issued  by  the  Financial  Accounting 
Standards  Board  to  its  Accounting  Standards  Codification  after  April 5,  2012. Indicate  by  check  mark  which  basis  of 
accounting the registrant has used to prepare the financial statements included in this filing: 

Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the 
effectiveness of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 
7262(b)) by the registered public accounting firm that prepared or issued its audit report. _X__ 

If securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the financial statements 
of the registrant included in the filing reflect the correction of an error to previously issued financial statements. __        

Indicate  by  check  mark  whether  any  of  those  error  corrections  are  restatements  that  required  a  recovery  analysis  of 
incentive- based compensation received by any of the registrant’s executive officers during the relevant recovery period 
pursuant to §240.10D-1(b). __ 

Indicate by check mark which basis of accounting the registrant has used to prepare the financial statements included in 
this filing: 

U.S.  GAAP  _X           International  Financial  Reporting  Standards  as  issued  by  the  International  Accounting  Standards 
Board __        Other __ 

 If "Other" has been checked in response to the previous question indicate by check mark which financial statement item, 
the registrant has elected to follow. Item 17 __       Item 18 __ 

 If  this  is  an  annual  report,  indicate  by  check  mark  whether  the  registrant  is  a  shell  company  (as  defined  in 

Rule 12b-2 of the Exchange Act).Yes __       No _X 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Table of Contents 

PART I 

PART II 

Item 1. 
Item 2. 
Item 3. 
Item 4. 
Item 4A. 
Item 5. 
Item 6. 
Item 7. 
Item 8. 
Item 9. 
Item 10. 
Item 11. 
Item 12. 

Item 13. 
Item 14. 
Item 15. 
Item 16A. 
Item 16B. 
Item 16C. 
Item 16D. 
Item 16E. 
Item 16F. 
Item 16G. 
Item 16H. 
Item 16I. 
Item 16J. 
Item 16K. 

TABLE OF CONTENTS 

Presentation of Financial and Other Information 
Cautionary Statement on Forward-looking Information 

Identity of Directors, Senior Management and Advisors  
Offer Statistics and Expected Timetable 
Key Information 
Information on the Company 
Unresolved Staff Comments 
Operating and Financial Review and Prospects 
Directors, Senior Management and Employees 
Major Shareholders and Related Party Transactions 
Financial Information 
The Offer and Listing 
Additional Information 
Quantitative and Qualitative Disclosures about Market Risk 
Description of Securities Other than Equity Securities 

Defaults, Dividend Arrearages and Delinquencies 
Material Modifications to the Rights of Security Holders and Use of Proceeds 
Controls and Procedures 
Audit Committee Financial Expert. 
Code of Ethics 
Principal Account Fees and Services 
Exemptions from the Listing Standards for Audit Committees 
Purchases of Equity Securities by the Issuer and Affiliated Purchasers 
Change in Registrant’s Certifying Accountant 
Corporate Governance 
Mine Safety Disclosure 
Disclosure Regarding Foreign Jurisdictions That Prevent Inspections 
Insider Trading Policies  
Cybersecurity 

PART III 

Item 17. 
Item 18. 
Item 19. 

Financial Statements 
Financial Statements 
Exhibits 

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PRESENTATION OF FINANCIAL AND OTHER INFORMATION 

Unless  the  context  otherwise  requires,  references  herein  to  “we,”  “us,”  “our”  or  “group”  are  to  EDAP  TMS  S.A.  and  its 

consolidated subsidiaries and references herein to the “Company,” “EDAP” or “EDAP TMS” are to EDAP TMS S.A. 

We prepare our consolidated financial statements in conformity with United States generally accepted accounting principles 
(“U.S. GAAP”). In this annual report, references to “euro” or “€” are to the legal currency of the countries of the European Monetary 
Union, including the Republic of France, and references to “dollars,” “U.S. dollars” or “$” are to the legal currency of the United States 
of America. Solely for the convenience of the reader, this annual report contains translations of certain euro amounts into dollars at 
specified  rates.  These  translations  should  not  be  construed  as  representations  that  the  euro  amounts  actually  represent  such  dollar 
amounts or could be converted into dollars at those rates. See Item 11, ‘‘Quantitative and Qualitative Disclosures about Market Risk’’ 
for a discussion of the effects of fluctuations in currency exchange rates on the Company. 

The following are registered trademarks of the Company in the United States: EDAP®, Ablatherm®, Ablasonic®, Ablapak® and 

Focal.One®. This annual report also makes references to trade names and trademarks of companies other than the Company. 

CAUTIONARY STATEMENT ON FORWARD-LOOKING INFORMATION 

This  annual  report  includes  certain  forward-looking  statements  within  the  meaning  of  applicable  federal  securities  laws, 
including Section 27A of the U.S. Securities Act of 1933 (the “Securities Act”) or Section 21E of the U.S. Securities Exchange Act of 
1934 (the “Exchange Act”), which may be identified by words such as “believe,” “can,” “contemplate,” “could,” “plan,” “intend,” “is 
designed  to,”  “may,”  “might,”  “potential,”  “objective,”  “target,”  “project,”  “predict,”  “forecast,”  “ambition,”  “aim”,  “guideline,” 
“should,” “will,” “estimate,” “expect” and “anticipate,” or the negative of these and similar expressions, which reflect our views about 
future  events  and  financial  performance.  Forward-looking  statements  involve  inherent  known  and  unknown  risks  and  uncertainties 
including matters not yet known to us or not currently considered material by us. Actual events or results may differ materially from 
those expressed or implied in such forward-looking statements as a result of various factors that may be beyond our control. Factors that 
could  affect  future  results  or  cause  actual  events  or  results  to  differ  materially  from  those  expressed  or  implied  in  forward-looking 
statements include, but are not limited to: 

- 

- 
- 
- 
- 

- 

risks  associated  with  the  current  worldwide  inflationary  environment,  uncertain  worldwide  economic,  political  and 
financial environment, geopolitical instability, climate change impact, pandemics and each of their related impacts on our 
business operations; 
the success of our High Intensity Focused Ultrasound (“HIFU”) technology; 
the uncertainty of market acceptance for our HIFU devices; 
the clinical and regulatory status of our devices in various geographical territories; 
the uncertainty in the regulatory agencies review and approval process for any of our devices and changes in their 
recommendations and guidance; 
the impact of government regulation, particularly relating to public healthcare systems and the commercial distribution 
of medical devices; 
effects of intense competition in the markets in which we operate; 
the uncertainty of reimbursement status of procedures performed with our products and their level of reimbursement; 
the market potential for our HIFU devices; 

- 
- 
- 
-  dependence on our strategic suppliers and distribution partners; 
-  difficulties to attract and recruit high-level experts in software, design, and development of high technology devices such 

as our HIFU products 
any event or other occurrence that would interrupt operations at our primary production facility; 
reliance on patents, licenses and key proprietary technologies; 
cybersecurity risks and incidents, 

- 
- 
- 
-  product liability risk; 
- 

risk of exchange rate fluctuations, particularly between the euro and the U.S. dollar and between the euro and the 
Japanese yen; 
fluctuations in results of operations due to the cyclical nature of demand for medical devices; 
risks relating to ownership of our securities; and 
risks relating to securities litigations involving class actions. 

- 
- 
- 

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You should also consider the information contained in Item 3, “Key Information—Risk Factors” and Item 5, “Operating and 
Financial Review and Prospects,” or further discussion of the risks and uncertainties that may cause such differences to occur. In light 
of  the  significant  uncertainties  in  these  forward-looking  statements,  you  should  not  regard  these  statements  as  a  representation  or 
warranty by us or any other person that we will achieve our objectives and plans in any specified time frame or at all. Moreover, forward-
looking statements speak only as of the date they are made. Other than required by law, we do not undertake any obligation to update 
them in light of new information or future developments. These forward-looking statements are based upon information, assumptions 
and estimates available to us as of the date of this annual report, and while we believe such information forms a reasonable basis for 
such  statements,  such  information  may  be  limited  or  incomplete,  and  our  statements  should  not  be  read  to  indicate  that  we  have 
conducted an exhaustive inquiry into, or review of, all potentially available relevant information. 

You  should  read  this  annual  report  and  the  documents  that  we  reference  in  this  annual  report  and  have  filed  as  exhibits 
completely and with the understanding that our actual future results may be materially different from what we expect. We qualify all of 
our forward-looking statements by these cautionary statements. 

Item 1. Identity of Directors, Senior Management and Advisors 

PART I 

Not applicable. 

Item 2. Offer Statistics and Expected Timetable 

Not applicable. 

Item 3. Key Information 

Risk Factors 

In addition to the other information contained in this annual report, the following risk factors should be carefully considered in 
evaluating us and our business. These statements are intended to highlight the material risk factors that may cause actual financial, 
business, research or operating results to differ materially from expectations disclosed in this annual report. See also factors disclosed 
under “Cautionary statement on forward-looking information.” 

Summary of Key Risks  

Our business and our industry are subject to numerous risks described in the following risk factors and  elsewhere 

in 

this 

annual report, Investors should carefully consider these risks before making a decision to invest in our securities. 

The main risk factors relating to the Company and its business operations are grouped into the seven categories listed below. 
The most important risk factors have been identified and assessed considering the likelihood of occurrence and the possible negative 
effect on the Company, in each case also taking into account corrective actions and risk management measures that have been put in 
place. The occurrence of new events, whether internal or external to the Company, is therefore likely to modify this ranking in the future. 

Risks Relating to our Business, Financial Position and Capital Needs 

•  The  worldwide  inflationary  environment  could  have  a  material  adverse  effect  on  our  business,  results  of  operations  and 

financial condition. 

•  Our future revenue and income growth depends, among other things, on implementing our business strategy, which largely 
depends on the success of our HIFU technology, and our capacity to scale our operations to manage and sustain our future 
growth.     

•  Our cash flow is highly dependent on cyclical demand for our products. 
•  Our results of operations have fluctuated significantly from quarter to quarter in the past and may continue to do so in the 
future, as we experience long and variable product sales cycles which are long and seasonal and are partly dependent on access 
to sufficient financing. 

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Risks Related to our Product Candidates and the Industry in which we Operate 

• 

If we do not successfully optimize and operate our sales, marketing, and potential future distribution channels or we do not 
effectively expand and update our infrastructure, our operating results may be negatively impacted. 

•  New device developments and introductions may adversely impact our financial results. 
•  We operate in a highly regulated industry and our future success depends on obtaining and maintaining government regulatory 
approval of our products, which we may not receive or be able to maintain or which may be delayed for a significant period of 
time. 

•  Our clinical trials related to products using HIFU technology may not be successful, and we may not be able to obtain regulatory 

approvals necessary for commercialization of all of our HIFU products. 

•  The  commercial  success  of  our  products  depends  on  whether  procedures  performed  by  those  products  are  eligible  for 

reimbursement approved by national health authorities and third-party payers. 

•  HIFU technology may not be adopted by the medical community and may never become a standard of care and we may be 

unable to generate sufficient revenue to sustain our business. 

•  Competition in the markets in which we operate is intense and is expected to increase in the future, and there is a substantial 

risk our products or service offerings could become obsolete or uncompetitive. 

Risks Related to our Organization and Operations 

•  We face a significant risk of exposure to product liability claims if the use of our products results in personal injury or death 

and our insurance coverage may be inadequate. 

•  We depend on a single site to manufacture our products, and any interruption of operations could have a material adverse effect 

on our business. 

•  For certain components or services, we depend on a small number of suppliers who, due to events beyond our control may fail 
to deliver sufficient supplies to us or increase the cost of items supplied, which would interrupt our production processes or 
negatively impact our results of operations. 

•  We utilize distributors for our sales abroad, which subjects us to a number of risks that could harm our business. 
•  We are a relatively small company with a limited number of products and staff. Sales fluctuations and employee turnover may 

adversely affect our business. 

•  The loss of key members of our executive management team could adversely affect our business.  
•  We may have difficulties in attracting and recruiting highly qualified experts in software, design and  development of high 

technology devices.  

•  We have identified a material weakness in our internal control over financial reporting with respect to our U.S. subsidiary and 
if we fail to remediate this material weakness or if we experience additional material weaknesses in the future or otherwise fail 
to achieve an effective system of internal controls, we may not be able to report our financial results accurately or timely. In 
addition, the trading price of our securities may be adversely affected by a related negative market reaction.   

•  We are exposed to risks related to cybersecurity threats and incidents. 
•  The expansion of social media platforms and new technologies present risks and challenges for our business and reputation. 

Risks Related to Intellectual Property Rights 

• 

Intellectual property rights are essential to protect our medical devices, and any dispute with respect to these rights could be 
costly and have an uncertain outcome and may prevent or delay our development and commercialization efforts. 

•  The U.S. laws relating to the patentability of certain inventions in the life sciences and medical technology industry is uncertain 

and rapidly changing, which may adversely impact our existing patents or our ability to obtain patents in the future. 

•  We may not be able to protect or enforce our intellectual property rights throughout the world.  
•  Our use of “open source” software could negatively affect our ability to sell our products and subject us to possible litigation. 

Risks Relating to our Status as a Foreign Private Issuer or a French Company 

•  Our French and international operations expose us to additional costs, legal and regulatory risks, which could have a material 

adverse effect on our business, financial condition and results of operations. 

•  We sell our products in many parts of the world and, as a result, our business is affected by fluctuations in currency exchange 

rates. 

•  Our by-laws and French corporate law contain provisions that may delay or discourage a takeover attempt.  
•  The  rights  of  shareholders  in  companies  subject  to  French  corporate  law  differ  in  material  respects  from  the  rights  of 

shareholders of corporations incorporated in the United States. 

•  French law may limit the amount of dividends we are able to distribute, and we do not currently intend to pay dividends.  

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•  We may lose our foreign private issuer status in the future, which could result in significant additional cost and expenses.   
• 

Judgments of U.S. courts, including those predicated on the civil liability provisions of the federal securities laws of the United 
States, may not be enforceable in French courts. 

Risks Related to Ownership of our Ordinary Shares and the ADSs 

•  Our securities may be affected by volume fluctuations, and may fluctuate significantly in price, causing investors to lose some 

or all of their investment. 

•  Holders of ADSs have fewer rights than shareholders and must act through the Depositary to exercise those rights. 
• 

If securities or industry analysts do not publish research, or publish inaccurate or unfavorable research, about our business, our 
ADS price and trading volume could decline.  

•  We are subject to different corporate disclosure standards that may limit the information available to holders of our ADSs.  
•  Preferential subscription rights may not be available for U.S. persons. 

General Risk Factors 

•  Our results of operations and financial condition could be adversely affected by the adverse economic changes, geopolitical 

developments, financial changes, and the impact of climate changes.  

•  We may issue additional securities that may be dilutive to our existing shareholders, in view of funding our new developments 

and accelerating our business expansion. 

•  We may acquire other companies or technologies, which could fail to result in a commercial product or net sales, divert our 
management’s attention, result in additional dilution to our stockholders and otherwise disrupt our operations and harm our 
operating results. 

•  We may in the future be the target of securities class action or other litigation, which could be costly and time consuming to 

defend. 

Risks Relating to Our Business, Financial Position and Capital Needs 

The worldwide inflationary environment could have a material adverse effect on our business, results of operations and financial 
condition. 

Current geopolitical instability including the conflict in Ukraine and the related sanctions and the conflict in Israel, and other 
factors including, but not limited to, global supply chain constraints, key components sourcing issues, increase in prices and disruptions 
of energy supply, and labor shortages, have led to higher worldwide inflation, which is likely, in turn, to lead to an increase in costs and 
may cause additional changes in tax and governmental policies. We may be unable to raise the prices of our devices and services in a 
higher inflationary environment and keep up with the rate of inflation. Such inflationary pressures may materially impact our business. 
We may not be able to adjust pricing, reduce our costs or implement counter measures quickly enough to offset cost increases. Our 
customers  (i.e.,  hospitals  and  clinics)  are  also  experiencing  financial  and  operational  pressures  directly  related  to  this  inflationary 
environment, which may impact their ability or willingness to spend on capital equipment and this may have an adverse impact on our 
business, financial condition, results of operations, or cash flows. 

Our future revenue and income growth depends, among other things, on implementing our business strategy, which largely depends 
on the success of our HIFU technology, and our capacity to scale our operations to manage and sustain our future growth.     

Our business strategy depends on the success of our High Intensity Focused Ultrasound (“HIFU”) technology for future revenue 
growth and net profit generation. We are dependent on the successful development and commercialization of other product lines, such 
as devices based on HIFU but not limited to the Focal One System, to generate significant additional revenues and to achieve and sustain 
profitability in the future. To implement our business strategy, we need to (among other things) develop new applications for our HIFU 
technology, to improve our products and service offerings, and to educate physicians and patients about the clinical and cost benefits of 
our products, all of which we believe could increase acceptance of our products. Our focus is to primarily expand our HIFU business in 
the U.S. as HIFU is FDA approved for ablation of prostate tissue and reimbursed at an acceptable level. Although we are particularly 
dependent on the success of our HIFU technology to grow our business through our HIFU division, other revenues, generated by our 
Extracorporeal  ShockWave  Lithotripsy  (“ESWL”)  division  and  our  Distribution  (“Distribution”)  division  directly  linked  to  the 
distribution of other complementary products on behalf of third-party medical companies, continue to contribute to our global revenue 
growth. While we anticipate potential renewals of distribution agreements with third parties, we have no assurance that our existing 
agreements will be renewed and any termination of distribution commitments from such medical third parties could have a material 

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adverse effect on our business, financial condition or results of operations. See Item 4, “Information on the Company—Distribution 
Division—Distribution Division Sales and Distribution of Products.” 

In addition, there can be no assurance that we will be able to manage our future growth efficiently or profitably and actual 
revenue, operating margins and net income, or revenue, margin and net income growth, may be less than expected. If we are unable to 
scale our production capabilities efficiently or maintain pricing, we may fail to achieve expected operating margins, which would have 
a material and adverse effect on our operating results. Growth may also stress our ability to adequately manage our operations, quality 
of  products,  safety,  and  regulatory  compliance.  Failure  to  implement  necessary  procedures,  equipment,  or  processes  or  to  hire  the 
necessary personnel in a timely and effective manner could result in higher costs or an inability to meet market demand and could have 
a material adverse impact on our business, results of operations, financial condition, and prospects. Additionally, our future growth will 
increase  the  demands  placed  on  our  third-party  suppliers,  and  there  is  no  guarantee  that  our  suppliers  will  be  able  to  support  our 
anticipated  growth.  If  growth  significantly  changes,  it  can  negatively  impact  our  cash  reserves,  and  we  may  be  required  to  obtain 
additional financing, which may increase indebtedness or result in dilution to shareholders. Further, there can be no assurance that we 
would be able to obtain additional financing on acceptable terms, if at all. 

Although we achieved operational profitability in 2019 and 2020, we incurred operating losses in 2021, 2022 and 2023. We 
expect  that  our  marketing,  selling  and  research  and  development  expenses  will  increase  as  we  attempt  to  further  develop  and 
commercialize our HIFU devices and particularly with the acceleration of our U.S. HIFU expansion plan. In this respect, we may not 
generate a sufficient level of revenue to offset these expenses and may not be able to adjust spending in a timely manner to respond to 
any unanticipated decline in revenue. We cannot guarantee that we will realize sufficient revenue to achieve profitability in the future. 
See Item 5, “Operating and Financial Review and Prospects.” 

Our cash flow is highly dependent on cyclical demand for our products. 

Our cash flow has historically been subject to significant fluctuations over the course of any given fiscal year due to cyclical 
demand for medical devices, in particular with hospital budgets being mostly spent at year-end, and the resulting annual and quarterly 
fluctuations  in  trade  and  other  receivables  and  inventories.  This  has  in  the  past  resulted  in  significant  variations  in  working  capital 
requirements  and  operating  cash  flows.  Since  we  anticipate  relying  on  cash  flow  from  operating  activities  to  meet  our  liquidity 
requirements,  a  decrease  in  the  demand  for  our  products,  or  the  inability  of  our  customers  or  distributors  to  meet  their  financial 
obligations to us, would reduce the funds available to us. In the future, our liquidity may be constrained, and our cash flows may be 
uncertain, negative or significantly different from period to period. Our cash flow is affected by increased expenses in clinical trials, 
sales efforts and other market costs related to implementing our expanded U.S. and global strategy which require significant additional 
resources. However, there is no assurance that this will result in an increase in the demand for our products and services.  

Our results of operations have fluctuated significantly from quarter to quarter in the past and may continue to do so in the future, 
as we experience long and variable product sales cycles which are long and seasonal and are partly dependent on access to sufficient 
financing. 

Our results of operations have fluctuated in the past and are expected to continue to fluctuate significantly from quarter to 
quarter depending upon numerous factors, including, but not limited to, the timing and results of clinical trials, changes in healthcare 
reimbursement  policies,  cyclicality  of  demand  for  our  products,  changes  in  pricing  policies  by  us  or  our  competitors,  new  product 
announcements by us or our competitors, customer order deferrals in anticipation of new or enhanced products offered by us or our 
competitors, product quality problems and exchange rate fluctuations. Furthermore, because our main products have relatively high unit 
prices, the amount and timing of individual orders can have a substantial effect on our results of operations in any given quarter. 

The sales cycle of our products is lengthy as our products are high value capital items for our customers to purchase and often 
requires  the  approval  of  multiple  levels  of  management  or  Boards  of  hospitals,  purchasing  groups  and,  in  some  cases,  government 
authorities. In addition, some sales are subject to a public tender offer process with  many approvals which could be lengthy to obtain, 
and, as a result, hospitals may delay their purchase orders according to their timelines and budget allocations. It is difficult to predict 
the exact timing for closing product sales directly linked to the length of capital expenditure cycles.  

In addition, our customers may rely on the credit market to secure dedicated lease financing to purchase or lease our equipment. 
Due to the limited availability of lending, we may be unable to access sufficient lease financing to support these transactions. Without 
lease financing, we may be unable to continue the development of our RPP model or we may need to fund such activity out of our 
existing  working  capital.  Similarly,  some  of  our  clients  rely  on  lease  financing  to  finance  their  purchases  of  equipment.  Limited 
availability of lease financing facilities may also affect their purchasing decisions and may adversely impact our equipment sales. In 
addition, the current macro-economic environment with elevated or increasing interest rates as compared to prior years, may make lease 
financing less attractive and more difficult to implement for our customers. 

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Risks Related to our Product Candidates and the Industry in which we Operate 

If we do not successfully optimize and operate our sales, marketing, and potential future distribution channels or we do not effectively 
expand and update our infrastructure, our operating results may be negatively impacted. 

If we do not adequately predict market demand or otherwise optimize and operate our sales, marketing and potential future 
distribution channels successfully, it could result in excess or insufficient inventory or fulfillment capacity, increased costs, or immediate 
shortages in product or component supply, or harm our business in other ways. In addition, if we do not maintain adequate infrastructure 
to enable us to, among other things, manage our purchasing and inventory levels, it could negatively impact our cash flow and operating 
results. 

Moreover, our future success will depend largely on our ability to continue to hire, train, retain and motivate skilled sales 
representatives  or  distributors  with  significant  technical  and  clinical  knowledge  about  our  products.  New  hires  require  training, 
supervision and take time to achieve full productivity. If we fail to train and supervise new hires adequately, or if we experience a high 
turnover in our sales force or trained professionals in the future, we cannot be certain that we will maintain or increase our sales. If we 
are unable to expand our sales and marketing capabilities, we may not be able to effectively commercialize our HIFU devices or our 
other products and service offerings in development, which would adversely affect our business, results of operations, and financial 
condition. 

New device developments and introductions may adversely impact our financial results. 

From  time  to  time,  we  develop  and  introduce  new  devices  with  enhanced  features  and  extended  or  additional  capabilities, 
targeting new clinical applications or improving existing approaches. The success of new device introductions depends on a number of 
factors including, but not limited to, timely and successful research and development, receipt of regulatory clearances or approvals, 
pricing, competition, market and consumer acceptance, manufacturing and supply costs, and the risk that new devices may have quality 
or other defects. 

We invest in various research and development projects to expand our product offerings. Our research and development efforts 
are critical to our success, and our research and development projects may not be successful. We may be unable to develop and market 
new products successfully, and the products we invest in and develop may not be well received by customers or meet our expectations. 
Our research and development investments may not generate significant operating income or contribute to our future operating results 
for  several years,  and  such  contributions  may  not  meet  our  expectations  or  even  cover  the  costs  of  such  investments.  If  we  fail  to 
effectively develop new products, obtain regulatory clearances or approvals and manage new product introductions in the future, our 
business, financial condition, results of operations, or cash flows could be materially and adversely impacted. 

We operate in a highly regulated industry and our future success depends on obtaining and maintaining government regulatory 
approval of our products, which we may not receive or be able to maintain or which may be delayed for a significant period of time. 

Government regulation significantly impacts the development and marketing of our products, particularly in the United States, 
European Union and Japan. We are regulated in each of our major markets with respect to preclinical and clinical testing, manufacturing, 
labeling, distribution, sale, marketing, advertising and promotion of our products. To market and sell products, we are required to obtain 
approval or clearance from the relevant regulatory agencies, including the U.S. Food and Drug Administration (“FDA”) with respect to 
the  United  States.  The  process  of  applying  for  regulatory  approval  or  clearance  is  often  lengthy  and  requires  the  expenditure  of 
substantial resources. Further, there can be no assurance that we will receive the required approvals or clearance for our products from 
the  required  regulatory  authorities  or,  if  we  do  receive  the  required  approvals,  that  we  will  receive  them  on  a  timely  basis,  on  the 
conditions and for the indications we seek, or that we will otherwise be able to satisfy the conditions of such approval, if any. 

The regulatory agencies may not act favorably or quickly in their review of our submissions, or we may encounter significant 
difficulties in our efforts to obtain their clearance or approval, or to maintain our existing approvals, all of which could delay or preclude 
the sale of new or existing products in the related territories. Our manufacturing operations must comply with regulations established 
by  regulatory  agencies  in  the  United  States,  the  European  Union  and  other  countries,  and  in  particular  with  the  Current  Good 
Manufacturing  Practices  (“CGMP”)  and  other  standards  for  quality  assurance  and  manufacturing  process  control  under  applicable 
regulatory authorities. Such standards may change or evolve, requiring that we change or evolve our manufacturing operations. We may 
not, always, comply with all applicable standards and, as a result, would be unable to manufacture our products for commercial sale or 
for clinical trial supply. Our manufacturing facilities are subject to inspection by regulatory authorities at any time. If any inspection by 
the regulatory authorities reveals deficiencies in manufacturing, we could be required to take immediate corrective or remedial actions, 

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suspend production or close the current and future production facilities, which would disrupt our manufacturing processes. Accordingly, 
failure  to  comply  with  these  regulations  could  have  a  material  adverse  effect  on  our  business,  financial  condition  and  results  of 
operations. 

In  the  European  Union,  the  regulation  of  medical  devices  is  being  updated  by  the  European  Medical  Device  Regulation 
(“MDR”) imposing stricter requirements on the conformity assessment and the commercialization of our products. A transition period 
to conform to MDR requirement has been adopted based on MDR classification of devices with a latest application date of December 
31, 2028. The extension of the period during which the devices can be placed on the market is subject to certain conditions. To benefit 
from the new provisions, the manufacturer must have implemented and must maintain a Quality Management System that complies 
with  the  MDR  requirements  before  May  26,  2024.  An  MDR  compliance  action  plan  has  been  put  in  place  in  preparation  of  MDR 
enforcement within the expected timelines. We are implementing operational actions to ensure our devices may be distributed on the 
European  and  international  market  and  conform  to  MDR  requirements,  where  applicable.  However,  the  uncertainty  of  continuing 
healthcare changes, regulations, and our ability to maintain MDR compliance of our products may negatively affect our business. 

Even if regulatory approval to market a product is granted, it may include limitations on the indicated uses for which the product 
may be marketed. Failure to comply with regulatory requirements can result in fines, suspension or withdrawal of regulatory approvals, 
product recalls, seizure of products, operating restrictions and criminal prosecutions. Regulatory policy may change, and additional 
government regulations may be established that could prevent or delay regulatory approval of our products. Any delay, failure to receive 
regulatory approval or the loss of previously received approvals could have a material adverse effect on our business, financial condition 
and  results  of  operations.  For  more  information  on  the  regulation  of  our  business,  see  Item 4,  “Information  on  the  Company—
Government Regulation” and “Information on the Company—HIFU Division—HIFU Division Clinical and Regulatory Status.” 

Our clinical trials related to products using HIFU technology may not be successful and we may not be able to obtain regulatory 
approvals necessary for commercialization of all of our HIFU products. 

Before obtaining regulatory approvals or clearance for the commercial sale of any of our devices under development, we must 
demonstrate through preclinical testing and clinical trials that the device is safe and effective in each intended use. Product development, 
including pre-clinical studies and clinical trials is a long, expensive and uncertain process, and is subject to delays and failures at any 
stage. We or the relevant regulatory authorities may suspend or terminate clinical trials at any time and regulating agencies may even 
refuse to grant exemptions to pursue clinical trials. The results from preclinical testing and early clinical trials may not predict the results 
that will be obtained in large-scale clinical trials. We could suffer significant setbacks in later-stage clinical trials, even after promising 
results  in  earlier  trials.  Furthermore,  data  obtained  from  a  trial  might  be  insufficient  to  demonstrate  that  our  products  are  safe,  and 
effective. The commencement, continuation or completion of any of our clinical trials may be delayed or halted, or inadequate to support 
approval of an application to regulatory authorities for numerous reasons including, but not limited to: 

• 

that regulatory authorities do not approve a clinical trial protocol or a clinical trial, or place a clinical trial on hold, discussions with 
regulatory authorities to improve our clinical protocols may prove difficult and lengthy; see Item 4, “Information on the 
Company—HIFU Division Clinical and Regulatory Status;” 
•  slower than expected rates of patient recruitment and enrollment; 
inability to adequately monitor patients during or after treatment; 
• 
failure of patients to complete the clinical trial; 
• 
•  prevalence and severity of adverse events and other unforeseen safety issues; 
• 
•  governmental and regulatory delays or changes in regulatory requirements, policies or guidelines; 
• 

that regulatory authorities conclude that our trial design is inadequate to demonstrate safety and efficacy. 

third-party organizations not performing data collection and analysis in a timely and accurate manner; 

The data we collect from our preclinical studies, current clinical trials,  and other clinical trials may not be sufficient to support 
requested regulatory approval. Additionally, certain regulatory authorities may disagree with our interpretation of the data from our 
preclinical studies and clinical trials, or may find the clinical trial design, conduct or results inadequate to prove safety or efficacy, and 
may require us to pursue additional preclinical studies or clinical trials, which would increase costs and could further delay the approval 
of our products. If we are unable to demonstrate the safety and/or efficacy of our products in our clinical trials, we will be unable to 
obtain regulatory approval to market our products. 

Moreover, we may also be required to abandon previous strategies for regulatory approval or clearance, despite having made 
significant financial and time investments, or refocus our efforts on alternative regulatory strategies, resulting in increased costs and 
efforts of management, without any guarantee of success, which could materially adversely affect our business, financial condition and 
results of operations. 

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The commercial success of our products depends on whether procedures performed by those products are eligible for reimbursement 
approved by national health authorities and third-party payers. 

Our success depends, among other things, on the extent to which reimbursement can be obtained from healthcare payers for 
procedures  performed  with  our  products.  In  the  United  States,  we  are  dependent  upon  favorable  coverage  and  benefit  decisions  by 
Centers for Medicare and Medicaid Services (“CMS”) for Medicare reimbursement, state Medicaid agencies, individual managed care 
organizations, private insurers and other payers. With the support of the American Urological Association and the American Association 
of Clinical Urologists, the American Medical Association (“AMA”) established a new Category 1 CPT code for the ablation of malignant 
prostate  tissue  with  HIFU  technology,  effective  January 1,  2021.  In  late  2022,  CMS  published  its  final  rules  for  the  calendar  year 
2023 for ambulatory payment classification (“APC”) procedures and physician fee schedule, which established reimbursement rates that 
recognize both facility or hospital payment and physician professional service payments for HIFU procedures. CMS final rule included 
a reimbursement level close to surgery, effective on January 1, 2023. The 2024 final rule maintained APC 6 payment level. For private 
insurers, policy coverage decisions supporting coverage and reimbursement related to HIFU procedures are limited given that HIFU is 
a new technology. With expanded third party coverage decisions, our Focal One HIFU procedure will have broader market access in 
the United States. However, public or private payors may decide to limit coverage or reimbursement of HIFU technologies that are 
available to individuals, including potentially modifying existing guidance to further limit available coverage. Changes to coverage 
decisions, which may be revised from time to time, could negatively impact reimbursement for procedures performed using our devices 
and may result in a material adverse effect on our business, financial condition and results of operations. Outside the United States, and 
in particular in the European Union and Japan, third-party reimbursement is generally conditioned upon decisions by national health 
authorities and we cannot guarantee that a definitive reimbursement will be granted. See Item 4, “Information on the Company——
HIFU Division—HIFU Reimbursement Status.” Lithotripsy procedures currently are reimbursed by public healthcare systems in the 
European Union, in Japan and in the United States. However, a decision in any of those countries to modify reimbursement policies for 
these procedures could have a material adverse effect on our business, financial conditions and results of operations.  

We cannot assure investors that expanded coverage decisions or additional reimbursement approvals will be obtained in the 
near future, if ever. If payor coverage or reimbursement for procedures related to our products is unavailable, limited in scope or amount, 
or if certain levels of public or private payor reimbursement or coverage policies change, it could have a material adverse effect on our 
business, financial condition and results of operations.  

HIFU technology may not be adopted by the medical community and may never become a standard of care and we may be unable 
to generate sufficient revenue to sustain our business. 

Our success depends on the market’s confidence that our HIFU devices can provide reliable, high-quality results or treatments 
and we believe that physicians are likely to be particularly sensitive to any test defects and errors in our devices. Our robotic HIFU 
devices represent new therapies for the conditions that they are designed to treat. Notwithstanding any positive clinical results that our 
HIFU devices may have achieved or may achieve in the future in terms of safety and efficacy and any marketing approvals that we have 
obtained  or  may  obtain  in  the  future,  there  can  be  no  assurance  that  such  products  will  gain  adoption  by  the  medical  community. 
Physician adoption depends, among other things, on evidence of the cost effectiveness of a therapy as compared to existing therapies 
and on adequate coverage policies supporting reimbursement from healthcare payers. Furthermore, acceptance by patients depends in 
part on physician recommendations, as well as other factors, including the degree of invasiveness, the rate and severity of complications 
and other side effects associated with the therapy as compared to other therapies.  

If our robotic HIFU devices do not achieve an adequate level of acceptance by physicians, patients, health care payers and the 
medical community and never become a standard of care, we may not generate or maintain positive cash flows and we may not become 
profitable or be able to sustain profitability. The failure of our current HIFU devices to perform as expected would significantly impair 
our reputation. If we do achieve market acceptance of our products, we may not be able to sustain it or otherwise achieve it to a degree 
which would support the ongoing viability of our operations. 

Competition in the markets in which we operate is intense and is expected to increase in the future, and there is a substantial risk 
our products or service offerings could become obsolete or uncompetitive. 

Competition  in  the  markets  in  which  we  operate  is  intense  and  is  expected  to  increase  in  the  future.  In  each  of  our  main 
businesses, we face competition both directly from other manufacturers of medical devices that apply the same technologies that we 
use, as well as indirectly from existing or emerging therapies for the treatment of urological disorders. 

In the markets that we target for our robotic HIFU products, competition comes from new market entrants and alternative 
therapies, as well as from current manufacturers of robotic medical devices. In the HIFU market, the Focal One system competes with 
all current treatments for localized tumors, including surgery, external beam radiotherapy, brachytherapy, irreversible electrocorporation 

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and cryotherapy. See Item 4, “Information on the Company—HIFU Division— HIFU Competition.” In our ESWL division, we are also 
facing competition from lower priced laser systems. Item 4, “Information on the Company—ESWL Division.” 

Many  of  our  competitors  have  significantly  greater  financial,  technical,  research,  marketing,  sales,  distribution  and  other 
resources than we have and may have more experience in developing, manufacturing, marketing and supporting new medical devices. 
In addition, our future success will depend in large part on our ability to maintain a leading position in technological innovation, and we 
cannot assure investors that we will be able to develop new products or enhance our current ones to compete successfully with new or 
existing technologies. Rapid technological development by competitors may result in our products becoming obsolete before we recover 
a significant portion of the research, development and commercialization expenses incurred with respect to those products. 

Risks Related to our Organization and Operations 

We face a significant risk of exposure to product liability claims in the event that the use of our products results in personal injury 
or death and our insurance coverage may be inadequate. 

Our products are designed to be used safely in the treatment of severe afflictions and conditions. Despite the use of our products, 
patients may suffer personal injury or death, and we may, as a result, face significant product liability claims. We maintain separate 
product liability insurance policies for the United States and Canada and for the other markets in which we sell our products. Product 
liability insurance is expensive and there can be no assurance that it will continue to be available on commercially reasonable terms or 
at all. In addition, our insurance may not cover certain product liability claims or our liability for any claims may exceed our coverage 
limits. A product liability claim or series of claims brought against us with respect to uninsured liabilities or in excess of our insurance 
coverage, or any claim or product recall that results in significant cost to or adverse publicity against us could have a material adverse 
effect on our business, financial condition and results of operations. Also, if any of our products prove to be defective, we may be 
required to recall or redesign the product which could result in costly corrective actions and harm to our business reputation, which 
could materially affect our business, financial condition and results of operations. 

We depend on a single site to manufacture our products, and any interruption of operations could have a material adverse effect on 
our business. 

Most of our manufacturing currently takes place in a single facility located in Vaulx-en-Velin, near Lyon, France. In the event 
of a significant interruption in the operations of our sole facility for any reason, such as fire, cyber-attack, supply disruption on a critical 
component, weather conditions,  or other natural disaster or pandemic diseases such as the COVID-19 virus necessitating quarantine 
implementation or a failure to obtain or maintain required regulatory approvals, we would have no other means of manufacturing our 
products until we would be able to restore the manufacturing capabilities at our facility or develop alternative facilities, which could 
take considerable time and resources and have a material adverse effect on our business, financial condition and results of operations.  

For certain components or services, we depend on a small number of suppliers who, due to events beyond our control may fail to 
deliver sufficient supplies to us or increase the cost of items supplied, which would interrupt our production processes or negatively 
impact our results of operations. 

We purchase most of the components used in our products from a number of suppliers but rely on a small number of suppliers 
for some key components. In addition, we rely on a small number of suppliers for certain services. If the supply of these components or 
services were interrupted for any reason, including geopolitical tensions or instability, global supply chain failures, weather conditions, 
large  scale  cyber-attack  or  infrastructure  disruption,  a  pandemic  and  implied  restrictions,  our  manufacturing  and  marketing  of  the 
affected  products  would  be  delayed.  Certain  of  these  key  suppliers  may  be  exposed  to  variations  in  the  costs  of  raw  materials  and 
components,  and,  consequently,  may  suffer  issues  or  delays  in  sourcing  these  components,  which  would  harm  their  business  and 
operations. These delays could be extensive, especially in situations where a component substitution would require regulatory approval. 
In addition, such suppliers could decide unilaterally to increase the price of supplied items for any reason, including higher energy, raw 
material  or  component  prices,  therefore  causing  additional  charges  for  us  and  impacting  our  margins.  We  renegotiated  a  supply 
agreement concerning a key component for our HIFU devices as prices increased substantially following a strategic shift in our supplier’s 
marketing strategy. Such a substantial price increase will negatively impact our margins. We expect to continue to depend upon our 
suppliers for the foreseeable future, while we explore  new sourcing alternatives. Failure to obtain adequate supplies of components or 
services in a timely manner and at an acceptable price could have a material adverse effect on our business, financial condition and 
results of operations.  

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We utilize distributors for our sales abroad, which subjects us to a number of risks that could harm our business. 

We have developed strategic relationships with a number of distributors for sales and service of our devices in certain foreign 
countries where we are not directly represented by a subsidiary. If these relationships are terminated and not replaced, our revenues 
and/or ability to market or service our devices in the related territories could be adversely affected. Our distributors’ actions may affect 
our ability to effectively market our devices in certain foreign countries if, for example, a distributor holds the regulatory authorizations 
in such countries and causes, by action or inaction, the suspension of such regulatory authorizations or sanctions for non-compliance. It 
may be difficult, expensive, and time consuming for us to re-establish reputation, market access or regulatory compliance in such cases. 
Moreover, our distributors must be in compliance with anti-corruption laws and applicable sanctions, such as the U.S. Foreign Corrupt 
Practices Act (“FCPA”), sanctions imposed by the U.S. Department of the Treasury’s Office of Foreign Assets Control, the European 
Union, His Majesty’s Treasury, or other governmental or supranational entities, and other local laws prohibiting corrupt payments to 
governmental officials or to customers and we may not be able to trace or be kept informed of such corruption. In addition, we may be 
named as a defendant in lawsuits against our distributors related to sales or service of our devices performed by these distributors. See 
our risk factor below: “—We face a significant risk of exposure to product liability claims in the event that the use of our products results 
in personal injury or death.” 

We  are  a  relatively  small  company  with  a  limited  number  of  products  and  staff.  Sales  fluctuations  and  employee  turnover  may 
adversely affect our business. 

We are a relatively small company. Consequently, compared to larger companies, sales fluctuations could have a greater impact 
on our revenue and profitability on a quarter-to-quarter and year-to-year basis and delays in customer orders could cause our operating 
results to vary significantly from quarter-to-quarter and year-to-year. In addition, as a small company we have limited staff and are 
heavily reliant on certain key personnel to operate our business. If a key employee were to leave our company it could have a material 
impact  on  our  business  and  the  results  of  operations  as  we  might  not  have  sufficient  depth  in  our  staffing  to  fill  the  role  that  was 
previously being performed. A delay in filling the vacated position could put a strain on existing personnel or result in a failure to satisfy 
our contractual obligations or to effectively implement our internal controls, and materially harm our business.  

The loss of key members of our executive management team could adversely affect our business.  

Our success in implementing our business strategy depends largely on the skills, experience and performance of key members 
of our executive management team and others in key management positions. The collective efforts of each of these people, and others 
collaborating with them as a team, are critical to us. As a result of the difficulty in locating qualified personnel and new management, 
the loss or incapacity of existing members of our executive management team could adversely affect our operations. If we were to lose 
one or more of these key employees, we could experience difficulties in finding qualified successors, competing effectively, developing 
our technologies and implementing our business strategy.  

In  addition,  we  rely  on  collaborators,  consultants  and  advisors,  including  scientific  and  clinical  advisors,  to  assist  us  in 
formulating our research and development and commercialization strategy. Our collaborators, consultants and advisors are generally 
employed by employers other than us and may have commitments, or conflict of interest, or be subject to other agreements with other 
entities that may limit their availability to us. 

We may have difficulties in attracting and recruiting highly qualified experts in software, design and development of high technology 
devices.  

Our devices require highly qualified individuals with a high-level of expertise and experience in design, software, mechanics 
and electronics. We are highly dependent on our ability to attract and retain qualified personnel and engineers to develop our devices. 
In addition, the learning curve required to master our systems is lengthy and, if we do not find qualified experts and engineers, we may 
not be able to meet our development schedule and obtain market approval in due time, which in time may delay market introduction of 
new products. Failure to recruit and attract experts in a timely manner may have a material adverse effect on our development, business, 
financial condition and results of operations. 

We have identified a material weakness in our internal control over financial reporting with respect to our U.S. subsidiary and if 
we fail to remediate this material weakness or if we experience additional material weaknesses in the future or otherwise fail to 
achieve an effective system of internal controls, we may not be able to report our financial results accurately or timely. In addition, 
the trading price of our securities may be adversely affected.  

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As a publicly traded company, we are subject to the reporting requirements of the Exchange Act and the Sarbanes-Oxley Act of 2002. 
We have incurred, and expect to continue to incur, significant continuing costs, including accounting fees and staffing costs, to maintain 
compliance with the internal control requirements of the Sarbanes-Oxley Act of 2002. As described in Item 15, we have identified one 
material  weakness  with  respect  to  internal  controls  in  our  U.S.  subsidiary,  Edap  Technomed  Inc:  an  ineffective  design  and 
implementation of the subsidiary’s control over the recording of third-party vendor invoices. This was due to insufficient resources in 
the finance department of the subsidiary and IT environment limitations. Our management has concluded that, as a result, our internal 
control over financial reporting was not effective as of December 31, 2023. Nevertheless, we have concluded that this material weakness 
did not result in a material misstatement of the consolidated financial statements for the year ended December 31, 2023, or require a 
restatement of consolidated financial statements with respect to any prior period previously reported by the Company. 

Although we have initiated remediation actions to address this material weakness, as a small company, we may have insufficient 

personnel to allow us to segregate duties, and consistently execute the Company’s internal controls. 

Furthermore,  the  ongoing  requirements  of  the  Sarbanes-Oxley  Act  may  place  a  strain  on  our  systems  and  resources.  Our 
management is required to evaluate the effectiveness of our internal control over financial reporting as of each year-end, and we are 
required to disclose management’s assessment of the effectiveness of our internal control over financial reporting, including any material 
weakness in our internal control over financial reporting. 

Our  internal  control  over  financial  reporting  has  been  designed  to  provide  our  management  and  Board  of  Directors  with 
reasonable assurance regarding the preparation and fair presentation of our consolidated financial statements. On an on-going basis, we 
are reviewing, documenting and testing our internal control procedures. To maintain and improve the effectiveness of our disclosure 
controls and procedures and internal control over financial reporting, and as our business develops, additional resources and management 
oversight may be required. 

In an effort to remediate the material weakness that was identified as of December 31, 2023, and to enhance our overall control 
environment, we hired new resources in 2023 and plan to hire additional resources in 2024. We are also working at deploying another 
IT system in our U.S. subsidiary and already hired an IT VP Manager to supervise such deployment. We believe this will allow us to 
remediate this material weakness in the short term. See Item 15, “Controls and Procedures.” 

Any failure to complete our assessment of our internal control over financial reporting, to remediate any material weaknesses 
that we have identified or may identify in the future, and any failure to implement new or improved controls, or difficulties encountered 
in  their  implementation,  could  harm  our  operating  results,  cause  us  to  fail  to  meet  our  reporting  obligations  or  result  in  material 
misstatements  in  our  financial  statements.  Any  failure  to  maintain  adequate  internal  controls  over  financial  reporting  and  provide 
accurate financial statements may subject us to litigation, render future financings more difficult or expensive, and could cause the 
trading price of our securities to decrease substantially. Inferior controls and procedures could cause investors to lose confidence in our 
reported financial information, which may give rise to securities claims and have a negative effect on the value of our securities. Any 
such failure could also adversely affect the results of the periodic management evaluations of our internal controls and, in the case of a 
failure to remediate any material weaknesses that we have identified or may identify in the future, would adversely affect the annual 
auditor attestation reports regarding the effectiveness of our internal control over financial reporting that are required under Section 404 
of the Sarbanes-Oxley Act of 2002. 

We are exposed to risks related to cybersecurity threats and incidents. 

In the conduct of our business, we collect, use, transmit and store data on information technology systems. This data includes 
confidential information belonging to us, our customers and other business partners, as well as personally identifiable information of 
individuals. We also store data related to our clinical trials on our information technology systems. We also rely in part on the reliability 
of certain tested third parties’ cybersecurity measures, including firewalls, virus solutions and backup solutions. Cybersecurity incidents, 
such as breaches of data security, disruptions of information technology systems and cyber threats, may result in business disruption, 
the misappropriation, corruption or loss of confidential information and critical data (ours or that of third parties), reputational damage, 
litigation with third parties, diminution in the value of our investment in research and development, data privacy issues and increased 
cybersecurity  protection  and  remediation  costs.  Like  many  companies,  we  may  experience  certain  of  these  incidents  given  that  the 
external cyber-attack threat continues to grow in part due to a perceived increased vulnerability associated with partly remote working 
conditions. While we have protocols in place to protect against such threats , we may fail to identify all threats like fraudulent payment 
requests that we may receive in the future and may inadvertently provide payment in connection with such requests, which may have a 
material adverse effect on our business, financial condition or results of operations. 

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We devote significant resources to network security, data encryption and other measures to protect our systems and data from 
unauthorized access or misuse, including meeting certain information security standards that may be required by our customers, all of 
which increases cybersecurity protection costs. As these threats and incidents, and government and regulatory oversight of associated 
risks, continue to grow, we may be required to expend additional resources to enhance or expand upon the security measures we currently 
maintain. Nevertheless, with the current ongoing conflict between Russia and Ukraine and the related political uncertainty, there is an 
increased possibility that cybersecurity incidents or cyberattacks may occur and impact our results of operations.  

There can be no assurance that our efforts or those of our third-party service providers to implement adequate security and 
control measures would be sufficient to protect against breakdowns, service disruption, data deterioration or loss in the event of a system 
malfunction, or prevent data from being stolen or corrupted in the event of a cyber-attack, security breach, industrial espionage attacks 
or insider threat attacks which could result in financial, legal, business or reputational harm. Future cybersecurity breaches or incidents 
or further increases in cybersecurity protection costs may have a material adverse effect on our business, financial condition or results 
of operations. 

The expansion of social media platforms and new technologies present risks and challenges for our business and reputation. 

We increasingly rely on social media and new technologies to communicate about our products and technologies. The use of 
these media requires specific attention. Unauthorized communications, such as press releases or posts on social media, purported to be 
issued by the Company, may contain information that is false or otherwise damaging and could have an adverse impact on our stock 
price. Negative or inaccurate posts or comments about the Company, our business, directors or officers on any social networking website 
could  seriously  damage  our  reputation.  In  addition,  our  employees  and  partners  may  use  social  media  and  mobile  technologies 
inappropriately, which may give rise to liability for the Company, or which could lead to breaches of data security, loss of trade secrets 
or other intellectual property or public disclosure of sensitive information, including information about our employees, clinical trials or 
customers. Such uses of social media, mobile technologies, or information technology more generally could have a material adverse 
effect on our reputation, business, financial condition and results of operations. 

Risks Related to Intellectual Property Rights 

Intellectual property rights are essential to protect our medical devices, and any dispute with respect to these rights could be costly 
and have an uncertain outcome and may prevent or delay our development and commercialization efforts. 

Our success depends in large part on our ability to develop proprietary products and technologies and to establish and protect 
the related intellectual property rights, without infringing the intellectual property rights of third parties. We or our licensors may be 
subject to claims that former employees, collaborators or other third parties have an interest in our owned or in-licensed patents, trade 
secrets or other intellectual property as an inventor or co-inventor. The validity and scope of claims covered in medical technology 
patents involve complex legal and factual questions and, therefore, the outcome of such claims may be highly uncertain. The medical 
device industry has been characterized by extensive patents and other intellectual property rights litigation. We may receive letters from 
third parties drawing our attention to their patent rights, or patent grant contestations may be filed. Third parties also may challenge our 
patents before administrative bodies in the United States or abroad. Such mechanisms include re-examination, post-grant review, inter 
partes review, interference proceedings, derivation proceedings, and equivalent proceedings in foreign jurisdictions (e.g., opposition 
proceedings). Such proceedings could result in the revocation or cancellation of or amendment to our patents in such a way that they no 
longer cover our product candidates and existing products or provide any competitive advantage. The outcome of future such challenges 
is unpredictable, and the loss of patent protection could have a material adverse impact on our business, financial condition and result 
of operations. 

If  third  parties,  including  our  competitors,  believe  that  our  products  or  technologies  infringe,  misappropriate  or  otherwise 
violate their intellectual property rights, such third parties may seek to enforce against us their intellectual property rights, including 
patent rights, by filing against us an intellectual property-related lawsuit, including a patent infringement lawsuit. Even if we believe 
third-party intellectual property claims are without merit, there is no assurance that a court would find in our favor on questions of 
infringement, validity, enforceability, or priority. If any third parties were to assert these or any other patents against us and we are 
unable to successfully defend against any such assertions, we may be required, including by court order, to cease the development and 
commercialization of the infringing products or technology and we may be required to redesign such products and technologies so they 
do not infringe such patents, which may not be possible or may require substantial monetary expenditures and time. We could also be 
required to pay damages, which could be significant, including treble damages and attorneys’ fees if we are found to have willfully 
infringed such patents. We could also be required to obtain a license to such patents to continue the development and commercialization 
of the infringing  product or technology. However, such a license may  not be available  on  commercially reasonable terms or at all, 
including  because  certain  of  these  patents  may  be  held  by  or  exclusively  licensed  to  our  competitors.  Even  if  such  a  license  were 

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available, it may require substantial payments or cross-licenses under our intellectual property rights, and it may only be available on a 
nonexclusive basis, in which case third parties, including our competitors, could use the same licensed intellectual property to compete 
with us. Any of the foregoing could have a material adverse effect on our business, financial condition, results of operation and prospects. 

Our products, including our HIFU devices, may be subject to litigation involving claims of patent infringement or violation of 
other intellectual property rights of third parties. The defense and prosecution of intellectual property suits, patent opposition proceedings 
and related legal and administrative proceedings are both costly and time consuming and may result in a significant diversion of effort 
and  resources  by  our  technical  and  management  personnel.  In  addition  to  being  costly,  drawn-out  litigation  to  defend  or  prosecute 
intellectual property rights could cause our customers or potential customers to defer or limit their purchase or use of our products until 
the litigation is resolved. See Item 4, “Information on the Company—HIFU Division—HIFU Division Patents and Intellectual Property” 
and Item 4, “Information on the Company—ESWL Division—ESWL Division Patents and Intellectual Property.” 

We own or co-own patents covering several of our technologies and have additional patent applications pending in the United 
States, the European Union, Japan and elsewhere. The process of seeking patent protection can be long and expensive and there can be 
no assurance that our patent applications will result in the issuance of patents. We also cannot assure investors that our current or future 
patents are or will be sufficient to provide meaningful protection or commercial advantage to us. Our patents or patent applications could 
be challenged, invalidated or circumvented in the future. Failure to maintain or obtain necessary patents, licenses or other intellectual 
property rights from third parties on acceptable terms or the invalidation or cancellation of material patents could have a material adverse 
effect on our business, financial condition or results of operations. Litigation may be necessary to enforce patents issued to us or to 
determine the enforceability, scope and validity of the proprietary rights of others. Our competitors, many of which have substantial 
resources and have made substantial investments in competing technologies, may apply for and obtain patents that will interfere with 
our ability to make, use or sell certain products, including our HIFU devices and/or our ESWL medical equipment, either in the United 
States or in foreign markets.  

Patents have a limited lifespan. In the United States, if all maintenance fees are timely paid, the natural expiration of a utility 
patent is generally 20 years from its earliest U.S. non-provisional filing date. While extensions may be available, the life of a patent, and 
the protection it affords, is limited, and certain of our patents may also expire and fall into the public domain, as has already occurred 
with certain patents in the HIFU division’s patent portfolio. See Item 4, “Information on the Company—HIFU Division—HIFU Division 
Patents and Intellectual Property.” 

As is common in the life sciences and medical industry, we engage the services of consultants and independent contractors to 
assist us in the development of our products. We rely on trade secrets and proprietary know-how, which we seek to protect through non-
disclosure agreements with employees, consultants and other parties. It is possible, however, that those non-disclosure agreements will 
be  breached,  that  we  will  not  have  adequate  remedies  for  any  such  breach,  or  that  our  trade  secrets  will  become  known  to,  or 
independently developed by, competitors. We also rely on copyright protection. Litigation may be necessary to protect trade secrets, 
know-how or copyrights owned by us. In addition, effective copyright and trade secret protection may be unavailable or limited in 
certain countries. 

The occurrence of any of the foregoing could have a material adverse effect on our business, financial condition and result of 

operations. 

U.S. laws relating to the patentability of certain inventions in the life sciences and medical technology industry are uncertain and 
rapidly changing, which may adversely impact our existing patents or our ability to obtain patents in the future. 

Changes in either the patent laws or interpretation of the patent laws in the United States or in other jurisdictions could increase 
the uncertainties and costs surrounding the prosecution of patent applications and the enforcement or defense of issued patents. For 
instance,  under  the  Leahy-Smith  America  Invents  Act  (the  “America  Invents  Act”),  enacted  in  September  2011,  the  United  States 
transitioned to a first inventor to file system in which, assuming that other requirements for patentability are met, the first inventor to 
file a patent application is entitled to the patent on an invention regardless of whether a third party was the first to invent the claimed 
invention.  These  changes  include  allowing  third-party  submission  of  prior  art  to  the  United  States  Patent  and  Trademark  Office 
(“USPTO”) during patent prosecution and additional procedures to challenge the validity of a patent through USPTO administered post-
grant proceedings, including post-grant review, inter partes review, and derivation proceedings.  

Various courts, including the U.S. Supreme Court, have rendered decisions that impact the scope of patentability of certain 
inventions or discoveries relating to life sciences and medical technology. Specifically, these decisions stand for the proposition that 
patent claims that recite laws of nature, natural phenomena, and abstract ideas are not themselves patentable unless those patent claims 
have sufficient additional features that provide practical assurance that the processes are genuine inventive applications of those laws, 
phenomena, and abstract ideas. What constitutes a “sufficient” additional feature is somewhat uncertain. Furthermore, in view of these 

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decisions, since December 2014, the USPTO has published and continues to publish revised guidelines for patent examiners to apply 
when examining process claims for patent eligibility. 

In addition, U.S. Supreme Court rulings have narrowed the scope of patent protection available in certain circumstances and 
weakened the rights of patent owners in certain situations. In addition to some degree of uncertainty with regard to the Company’s 
ability to obtain patents in the future, this combination of events has created a degree of uncertainty with respect to the value of patents, 
once obtained. Depending on relevant laws enacted by the U.S. Congress, and decisions by the federal courts and the USPTO, the laws 
and regulations governing patents could change in unpredictable ways that may have a material adverse effect on our ability to obtain 
new patents and to defend and enforce our existing patents and patents that we might obtain in the future. 
Our patent portfolio may be negatively impacted by current uncertainties in the state of the law, new court rulings or changes in guidance 
or procedures issued by the USPTO or other similar patent offices around the world. From time to time, the U.S. Supreme Court, other 
federal courts, the U.S. Congress or the USPTO may change the standards of patentability, scope and validity of patents within the life 
sciences and medical technology and any such changes, or any similar adverse changes in the patent laws of other jurisdictions, could 
have a negative impact on our business, financial condition, prospects and results of operations. 

We may not be able to protect or enforce our intellectual property rights throughout the world.  

Filing, prosecuting and defending patents and trademarks on all of our current or our planned products throughout the world 
would  be  prohibitively  expensive  to  us.  Competitors  may  use  our  technologies  in  jurisdictions  where  we  have  not  obtained  patent 
protection to develop their own products and, further, may export otherwise infringing products to territories where we have patent 
protection but where enforcement is not as strong as in the U.S. or France. These products may compete with our products in jurisdictions 
where we do not have any issued patents and our patent claims or other intellectual property rights may not be effective or sufficient to 
prevent them from competing. Many companies have encountered significant problems in protecting and defending intellectual property 
rights  in  foreign  jurisdictions.  The  legal  systems  of  certain  countries,  particularly  certain  developing  countries,  do  not  favor  the 
enforcement of patents and other intellectual property protection, particularly those relating to the healthcare sector, which could make 
it  difficult  for  us  to  stop  the  infringement  of  our  patents  or  marketing  of  competing  products  in  violation  of  our patents  or  other 
intellectual property. Proceedings to enforce our patent rights in foreign jurisdictions could result in substantial cost and divert our efforts 
and attention from other aspects of our business. 

Our use of “open source” software could negatively affect our ability to sell our products and subject us to possible litigation. 

Our products incorporate so-called “open source” software, and we may incorporate additional open source software in the 
future. Open source software is generally licensed by its authors or other third parties under open source licenses. According to certain 
of these licenses, we may be subject to certain conditions, including requirements that we offer our products that incorporate the open 
source  software  for  no  cost,  that  we  make  available  source  code  for  modifications  or  derivative  works  we  create  based  upon, 
incorporating or using the open source software and/or that we license such modifications or derivative works under the terms of the 
particular open source license. If an author or other third party that distributes such open source software were to allege that we had not 
complied with the conditions of one or more of these licenses, we could be required to incur significant legal expenses defending against 
such allegations and could be subject to significant damages, enjoined from the sale of our products that contained the open source 
software and required to comply with the foregoing conditions, which could disrupt the distribution and sale of our products. 

Risks Related to our Status as a Foreign Private Issuer or a French Company 

Our  French  and  international  operations  expose  us  to  additional  costs,  legal  and  regulatory  risks,  which  could  have  a  material 
adverse effect on our business, financial condition and results of operations. 

We have significant French and international operations. We have direct distribution channels in almost fifty countries outside 
of France, our country of incorporation, and through our foreign subsidiaries. Compliance with complex foreign and French laws and 
regulations that apply to our international operations increases our cost of doing business. These regulations include, among others, U.S. 
laws such as FCPA and other U.S. federal laws and regulations established by the Office of Foreign Asset Control, laws such as the UK 
Bribery Act 2010 or other local laws, which prohibit corrupt payments to governmental officials or certain payments or remunerations 
to customers. We have adopted a Code of Ethics that requires employees to comply with applicable laws and regulations and particularly 
with the applicable provisions of the French law known as the Sapin II law, and the related implementing decrees, and notably the 
requirements of Article 8 of the law, which requires the establishment of a whistle-blowing policy.  EDAP employees can raise any 
issue  by  reporting  on  our  hotline  at  alerteprofessionnelle@edap-tms.com.  These  numerous  and  sometimes  conflicting  laws  and 
regulations include, among others, data privacy requirements, labor relations laws, tax laws, anti-competition regulations, “Know Your 
Customer” requirements, import and trade restrictions, export requirements. 

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We  are  also  subject  to  healthcare  laws  and  regulations  pertaining  to  physician  payment  transparency,  privacy,  and  data 
protection  regulations.  These  regulations  include,  but  are  not  limited  to  (i) the  U.S.  federal  Health  Insurance  Portability  and 
Accountability Act (“HIPAA”) of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act, 
which  governs  the  conduct  of  certain  electronic  healthcare  transactions  and  protects  the  security  and  privacy  of  protected  health 
information;  (ii) the  U.S.  federal  Physician  Payment  Sunshine  Act  (the  “Sunshine  Act”),  which  requires  manufacturers  of  medical 
devices for which payment is available under Medicare, Medicaid, to report annually to the CMS information related to payments or 
other  “transfers  of  value”  made  to  physicians,  (iii) two  main  sets  of  laws  enacted  in  France  about  transparency  requirements:  “The 
French Anti-Gift Law” –updated in 2020 and 2022- which regulates the provision of gifts, discounts and other incentives to physicians 
and  the  “Bertrand  law”  which  imposes  disclosure  obligations  on  companies  relating  to  benefits  and  remunerations  granted  to,  and 
agreements concluded with, physicians and (iv) the provisions of the French Public Health Code relating to the processing and/or hosting 
of health-related personal data. Any failure to comply with these regulations may have a material adverse effect on our business, financial 
condition and results of operations. 

Furthermore, in addition to HIPAA we are subject to other data privacy and protection laws and regulations that apply to the 
collection, transmission, storage and use of personally identifying information, which among other things, impose certain requirements 
relating to the privacy, security and transmission of personal information. The legislative and regulatory landscape for privacy and data 
protection continues to evolve in jurisdictions worldwide, and there has been an increasing focus on privacy and data protection issues 
with the potential to affect our business. There are numerous European, French, U.S. federal and U.S. state laws and regulations related 
to the privacy and security of personal information. For example, in the European Union, the collection and use of personal data is 
governed  by  the  provisions  of  the  General  Data  Protection  Regulation  (“GDPR”)  which  took  effect  in  May 2018.  The  GDPR 
significantly increases the level of data protection and imposes a greater compliance burden on companies. In particular, it treats clinical 
data as personal data, requiring us or our subcontractors to implement more extensive procedures in the collection and processing of 
clinical trial data. Furthermore, the GDPR significantly increases the level of sanctions for non-compliance. The European Union data 
protection authorities have the power to impose administrative fines of up to a maximum of €20 million or 4% of our consolidated 
revenues  for  the  preceding  fiscal  year,  whichever  is  higher.  The  GDPR  is  also  supplemented  by  the  provisions  of  the  French  data 
protection act (Law No. 78-17 of  January 6, 1978), in particular in respect of the processing of personal data in the field of healthcare.   

Given the high level of complexity of these laws, and the fact that we do business in regions where regulatory compliance is 
less robust, including in Russia and parts of Asia, there is a risk that we may inadvertently breach some provisions, for example, through 
fraudulent or negligent behavior of individual employees or business partners, our failure to comply with certain formal documentation 
requirements,  or  otherwise.  See  “—  General  Risk  Factors—“Our  results  of  operations  and  financial  condition  could  be  adversely 
affected by the adverse economic, geopolitical and financial environment, and the impact of climate change.” Our success depends, in 
part, on our ability to anticipate these risks and manage these challenges. We have a decentralized international sales organization, and 
this structure may make it more difficult for us to ensure that our international selling operations comply with our global policies and 
procedures. 

Violations of these laws and regulations could result in fines, criminal sanctions against us, our officers or our employees, 
requirements to obtain export licenses, cessation of business activities in sanctioned countries and prohibitions on the conduct of our 
business. Violations of laws and regulations also could result in prohibitions on our ability to offer our products in one or more countries 
and could materially damage our reputation, our brand, our international expansion efforts, our ability to attract and retain employees, 
or our business, results of operations and financial condition. 

We sell our products in many parts of the world and, as a result, our business is affected by fluctuations in currency exchange rates. 

We are exposed to foreign currency exchange rate risk because the mix of currencies in which our costs are denominated is different 
from  the  mix  of  currencies  in  which  we  earn  our  revenue.  In  2023,  60%  of  our  total  costs  of  sales  and  operating  expenses  were 
denominated  in  euro,  while  55%  of  our  revenue  was  denominated  in  currencies  other  than  euro  (primarily  the  U.S.  dollar  and  the 
Japanese yen). Our operating profitability could be materially adversely affected by large fluctuations in the rate of exchange between 
the euro and other currencies. For instance, a decrease in the value of the U.S. dollar or the Japanese yen against the euro would have a 
negative effect on our revenues, which may not be offset by an equal reduction in operating expenses and would therefore negatively 
impact operating profitability. From time to time we enter into foreign exchange forward sale contracts to hedge against fluctuations in 
the exchange rates of the principal foreign currencies in which our receivables are denominated (in particular, the U.S. dollar and the 
Japanese yen), but there can be no assurance that such hedging activities will limit the effect of movements in exchange rates on our 
results of operations. As of December 31, 2023, we had no outstanding hedging instruments. In addition, since any dividends that we 
may declare will be denominated in euro, exchange rate fluctuations will affect the U.S. dollar equivalent of any dividends received by 
holders of ADSs. For more information concerning our exchange rate exposure, see Item 11, “Quantitative and Qualitative Disclosures 
about Market Risk.” 

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Our by-laws and French corporate law contain provisions that may delay or discourage a takeover attempt. 

Provisions  contained  in  our  bylaws  and  French  corporate  law  could  make  it  more  difficult  for  a  third  party  to  acquire  our 
company, even if doing so might be beneficial to its shareholders. In addition, provisions of its bylaws impose various procedural and 
other requirements, which could make it more difficult for shareholders to affect certain corporate actions. These provisions include the 
following:  
• 

under French law, a non-resident of France, as well as any French entity controlled by non-residents of France, may have to 
file a declaration for statistical purposes with the Bank of France (Banque de France) within 20 working days following the 
date of certain direct foreign investments in us, including any purchase of our ADSs. Such filings are required in connection 
with investments exceeding €15,000,000 that lead to the acquisition of at least 10% of our share capital or voting rights or cross 
such 10% threshold;  
under French law, certain investments in a French company relating to certain strategic industries by individuals or entities not 
residents in a Member State of the EU are subject to prior authorization of the Ministry of Economy;  
a merger (i.e., in a French law context, a share for share exchange following which our company would be dissolved into the 
acquiring entity and our shareholders would become shareholders of the acquiring entity) of our company into a company 
incorporated in the European Union would require the approval of the Company's Board of Directors, as well as a two-thirds 
majority of the votes held by the shareholders present, represented by proxy or voting by mail at the relevant meeting;  
a merger of our company into a company incorporated outside of the European Union would require 100% of our shareholders 
to approve it;  
under French law, a cash merger is treated as a share purchase and would require the consent of each participating shareholder;  
our shareholders may in the future grant our Board of Directors broad authorizations to increase our share capital or to issue 
additional ordinary shares or other securities (for example, warrants) to our shareholders, the public or qualified investors, 
including as a possible defense following the launching of a tender offer for our ordinary shares;  
our shareholders have preferential subscription rights proportional to their shareholding in our company on the issuance by us 
of any additional shares or securities giving the right, immediately or in the future, to new shares for cash or a set-off of cash 
debts, which rights may only be waived by the extraordinary general meeting (by a two-thirds majority vote) of our shareholders 
or on an individual basis by each shareholder; 
our  Board  of  Directors  can  only  be  convened  by  its  chair  or,  when  no  Board  meeting  has  been  held  for  more  than  two 
consecutive months, by directors representing at least one-third of the total number of directors;  
our Board of Directors has the right to appoint members to fill a vacancy created by the resignation or death of a member of 
the Board for the remaining duration of such member’s term of office, and subject to the approval by the shareholders of such 
appointment at the next shareholders’ meeting, which prevents shareholders from having the sole right to fill vacancies on our 
Board of Directors;  
approval of at least a majority of the votes held by shareholders present, represented by a proxy, or voting by mail at the relevant 
ordinary shareholders’ general meeting is required to remove members of the Board of Directors with or without cause;  
pursuant to French law, our by-laws, including the sections relating to the number of members of the Board of Directors, and 
election and removal of members of the Board of Directors from office may only be modified by a resolution adopted by two-
thirds of the votes of our shareholders present, represented by a proxy or voting by mail at the meeting.  

• 

• 

• 

• 
• 

• 

• 

• 

• 

• 

The rights of shareholders in companies subject to French corporate law differ in material respects from the rights of shareholders 
of corporations incorporated in the United States. 

We are a French company with limited liability. Our corporate affairs are governed by our by-laws and by the laws governing 
companies  incorporated  in  France.  The  rights  of  shareholders  and  the  responsibilities  of  members  of  our  Board  are  in  many  ways 
different from the rights and obligations of shareholders in companies governed by the laws of U.S. jurisdictions. For example, in the 
performance of its duties, our Board of Directors is required by French law to consider the interests of our company, our shareholders, 
our employees and other stakeholders, rather than solely our shareholders and/or creditors. It is possible that some of these parties will 
have interests that are different from, or in addition to, the interests of our shareholders. 

French law may limit the amount of dividends we are able to distribute, and we do not intend to pay cash dividends for the 
foreseeable future. 

We currently intend to retain our future earnings, if any, to finance the further development and expansion of our business and 
do not intend to pay cash dividends in the foreseeable future. Any future determination to pay dividends will be at the discretion of our 

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Board of Directors and will depend on our financial condition, results of operations, capital requirements, and future agreements and 
financing instruments, business prospects and such other factors as our Board of Directors deems relevant. 

Further, under French law, the determination of whether we have been sufficiently profitable to pay dividends is made based 
on our statutory financial statements prepared and presented in accordance with  applicable French regulations. Therefore, we may be 
more restricted in our ability to declare dividends than companies not based in France. 

We may lose our foreign private issuer status in the future, which could result in significant additional costs and expenses. 

While we currently qualify as a foreign private issuer, the determination of foreign private issuer status is made annually on 
the last business day of an issuer’s most recently completed second fiscal quarter and, accordingly, the next determination will be made 
with  respect  to  us  on  June  30,  2024,  which  would  require  us  to  comply  with  all  of  the  periodic  disclosure  and  current  reporting 
requirements of the Exchange Act applicable to U.S. domestic issuers as of January 1, 2025. We could lose our foreign private issuer 
status  in  the  future  if  we  fail  to  meet  the  requirements  necessary  to  maintain  our  foreign  private  issuer  status  as  of  the  relevant 
determination date. In order to maintain our current status as a foreign private issuer, either (a) a majority of our ordinary shares or ADSs 
must be either directly or indirectly owned of record by non-residents of the United States or (b)(i) a majority of our executive officers 
or directors may not be U.S. citizens or residents, (ii) more than 50% of our assets cannot be located in the United States and (iii) our 
business must not be administered principally inside the United States. If we lost this status, we would be required to comply with the 
Exchange Act reporting and other requirements applicable to U.S. domestic issuers, which are more detailed and extensive than the 
requirements for foreign private issuers and have shorter deadlines, including with respect to annual and quarterly reports. In particular, 
Form  10-Q  requires  quarterly  financial  statements  subject  to  auditor  review.  As  of  December  31,  2023,  approximately  70%  of  our 
outstanding ordinary shares were held by U.S. residents and the other criteria may be triggered in the future to reflect changes in our 
business. 

The  regulatory  and  compliance  obligations  and  costs  to  us  under  U.S.  securities  laws  as  a  U.S.  domestic  issuer  may  be 
significantly more than obligations and costs we currently incur as a foreign private issuer. If we are not a foreign private issuer, we will 
be required to file periodic reports and registration statements on U.S. domestic issuer forms with the SEC, which are more detailed and 
extensive in certain respects than the forms available to a foreign private issuer. We would be required under current SEC rules to modify 
certain of our policies to comply with corporate governance practices associated with U.S. domestic issuers. In addition, we may lose 
our ability to rely upon exemptions from certain corporate governance requirements on U.S. stock exchanges that are available to foreign 
private issuers such as the ones described above and exemptions from procedural requirements related to the solicitation of proxies. 

Judgments of U.S. courts, including those predicated on the civil liability provisions of the federal securities laws of the United States, 
may not be enforceable in French courts. 

An investor in the United States may find it difficult to: 

• 
• 

• 

effect service of process upon or obtain jurisdiction over us or our non-U.S. resident directors and officers in the United States; 
enforce U.S. court judgments based upon the civil liability provisions of the U.S. federal securities laws against us and our non-
U.S. resident directors and officers in France or the United States; or 
bring an original action in a French court to enforce liabilities based upon the U.S. federal securities laws against us and our 
non-U.S. resident directors and officers. 

Risks Relating to Ownership of our Ordinary Shares and the ADSs 

Our securities may be affected by volume fluctuations, and may fluctuate significantly in price, causing investors to lose some or all 
of their investment. 

Our ADSs, each of which represents one ordinary share, are traded on The Nasdaq Global Market. The average daily trading 
volume of our ADSs in 2023 was approximately 96,000, the high and low bid price of our ADSs for the last two fiscal years ended on 
December 31, 2023, and December 31, 2022, was $12.65 and $11.53, and $3.60 and $5.54, respectively. Our ADSs have experienced, 
and are likely to experience in the future, significant price and volume fluctuations, which could adversely affect the market price of our 
ADSs without regard to our operating performance. For example, the average daily trading volume of our ADSs in December 2022 was 
101,126 as opposed to 217,979 for the same period of 2023. The price of our securities and our ADSs in particular, may fluctuate as a 
result of a variety of factors, including changes in our business, operations and prospects, and factors beyond our control, including 
regulatory  considerations,  results  of  clinical  trials  of  our  products  or  those  of  our  competitors,  developments  in  patents  and  other 
proprietary rights, general market and economic conditions and results of operations being below analysts’ or investors’ expectations. 
Any downward pressure on the price of ADSs caused by the sale of ADS’s could also encourage short sales of our ADS by third parties. 

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In a short sale, a prospective seller borrows shares from a shareholder or broker and sells the borrowed shares. The prospective seller 
hopes that the share price will decline, at which time the seller can purchase shares at a lower price for delivery back to the lender. The 
seller profits when the share price declines because it is purchasing shares at a price lower than the sale price of the borrowed shares. 
Such sales could place downward pressure on the price of our ADSs by increasing the number of ADSs being sold, which could further 
contribute to any decline in the market price of our ADSs. 

These  broad  market  and  industry  factors  may  adversely  affect  the  market  price  of  our  ADSs,  regardless  of  our  operating 

performance. If investors invest in our ADSs, investors could lose some or all of their investment. 

In addition, periods of volatility in the market price of a company’s securities often trigger securities class action litigation. 
Any additional litigation, if instituted, causes and could cause us to incur substantial costs and our management resources are and could 
be diverted to defending such litigation, which could adversely affect our financial condition or results of operations. 

Holders of ADSs have fewer rights than shareholders and must act through the Depositary to exercise those rights. 

Holders of ADSs do not have the same rights as shareholders and accordingly, cannot exercise the rights of shareholders against 
us. The Bank of New York Mellon, as Depositary (the “Depositary”), is the registered shareholder of the deposited shares underlying 
the ADSs, and therefore holders of ADSs will generally have to exercise the rights attached to those shares through the Depositary. We 
have used and will continue to use reasonable efforts to request that the Depositary notify the holders of ADSs of upcoming votes and 
ask for voting instructions from them. If a holder fails to return a voting instruction card to the Depositary by the date established by it 
for receipt of such voting instructions, or if the Depositary receives an improperly completed or blank voting instruction card, or if the 
voting instructions included in the voting instruction card are illegible or unclear, then such holder will be deemed to have instructed 
the Depositary to vote its shares and the Depositary shall vote such shares in favor of any resolution proposed or approved by our Board 
of Directors and against any resolution not so proposed or approved. 

If securities or industry analysts do not publish research, or publish inaccurate or unfavorable research, about our business, our 
ADS price and trading volume could decline.  

The trading market for our ADSs will depend, in part, on the research and reports that securities or industry analysts publish 
about us or our business. If one or more of the analysts who cover us downgrade our securities or publish inaccurate or unfavorable 
research about our business, our ADS price would likely decline. In addition, if our operating results fail to meet the expectations of our 
investors or forecasts of research analysts, our ADS price would likely decline. If one or more of these analysts cease coverage of our 
company or fail to publish reports on us regularly, demand for our ADSs could decrease, which might cause our ADS price and trading 
volume to decline.  

We are subject to different corporate disclosure standards that may limit the information available to holders of our ADSs.  

As a foreign private issuer, we are not required to comply with the notice and disclosure requirements under the Exchange Act 
relating to the solicitation of proxies for shareholder meetings. Although we are subject to the periodic reporting requirements of the 
Exchange Act, the periodic disclosure required of foreign private issuers under the Exchange Act is more limited than the periodic 
disclosure required of U.S. issuers. Therefore, there may be less publicly available information about us than is regularly published by 
or about other public companies in the United States. 

Preferential subscription rights may not be available for U.S. persons. 

Under French law, shareholders have preferential rights to subscribe for cash issuances of new shares or other securities giving 
rights to acquire additional shares on a pro rata basis. U.S. holders of our securities may not be able to exercise preferential subscription 
rights for their shares unless a registration statement under the Securities Act is effective with respect to such rights or an exemption 
from the registration requirements imposed by the Securities Act is available. We may, from time to time, issue new shares or other 
securities  giving  rights  to  acquire  additional  shares  (such  as  warrants)  at  a  time  when  no  registration  statement  is  in  effect  and  no 
Securities Act exemption is available. If so, U.S. holders of our securities will be unable to exercise their preferential rights and their 
interests will be diluted. We are under no obligation to file any registration statement in connection with any issuance of new shares or 
other securities. 

For holders of ADSs, the Depositary may make these rights or other distributions available to holders after we instruct it to do 
so and provide it with evidence that it is legal to do so. If we fail to do this and the Depositary determines that it is impractical to sell 
the rights, it may allow these rights to lapse. In that case, the holders of ADSs will receive no value for them. 

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General Risk Factors 

Our  results  of  operations  and  financial  condition  could  be  adversely  affected  by  the  adverse  economic  changes,  geopolitical 
developments, financial changes, and the impact of climate changes.  

As of the date of filing of this report, the global economy remains impacted by geopolitical tensions and instability and, in 
particular, the conflict between Russia and Ukraine and the conflict in the Middle East.  We have little to no business in the Middle East. 

Since February 24, 2022, Russia has engaged in a military conflict against Ukraine. It is difficult to predict the consequences 
and outcomes of such military action, which could lead to significant disruptions, including impacts on the prices and supply of energy 
resources, on purchases from customers who may defer their orders or change their purchase preferences. Should such military conflict 
continue, it may entail instability in financial markets and impact political and economic situations in Europe and worldwide. Russia’s 
military action against Ukraine has led to implementation of sanctions by the United States, the European Union, the United Kingdom, 
Canada, Switzerland, Japan, and other countries against Russia, Belarus, the Crimea Region of Ukraine, the so-called Donetsk People’s 
Republic, and the so-called Luhansk People’s Republic. 

In response to these international sanctions, Russian authorities have also imposed significant currency control and restrictive 
measures. As the situation is evolving, and additional sanctions may be implemented, such new restrictions could adversely affect the 
global economy, prices and energy supply, financial markets, supply chains, and could adversely affect our business, financial condition, 
and results of operations. As we evaluated the impact of such measures on our business, in 2022, we decided to definitively close our 
representative office in Moscow to avoid further difficulties in maintaining a direct administrative and operational activity in Russia. 
Net  sales  in  Russia  are  not  significant  as  they  represented  approximately  1.5%  in  2022  and  0.8%  in  2023  of  our  consolidated 
revenues.  Our sales in Russia are historically subject to significant variation and long purchase order periods.  We have an established 
exclusive distribution agreement with a business partner with significant experience in marketing and distributing medical equipment 
in Russia. This partnership will allow us to continue offering a HIFU solution to Russian patients and to maintain our existing installed 
base in Russia. To date, we have not experienced any material disruptions in our business with Russia, but we cannot predict outcomes 
that such conflict may have on our future results of operations.  

Moreover, uncertain global climate change may result in certain types of more intense and more frequent natural disasters 
including, but not limited to hurricanes, wildfires or flooding or sustained periods of extreme weather. Such extreme disasters could 
imply risks to our facilities and disrupt our supply chain and may cause us to incur additional operational costs. Such intense events may 
also  trigger  internet  security  threats  or  damage  to  global  communication  networks  that  would  harm  our  global  operations  and  our 
customers’ operations. Climate change may also result in new regulatory or legal obligations to address the effects of climate change on 
the environment or the effect of our operations and those of other companies on the environment. Such new obligations could cause 
increased  compliance  costs  to  meet  any  new  regulatory  or  legal  requirements  and  may  adversely  affect  sourcing,  manufacturing 
operations, and the distribution of our products. Such natural disasters could have a material adverse impact on our business, financial 
condition, results of operations, or cash flows.  

We may also be unable to meet the future criteria used by rating agencies in their environmental, social and governance (“ESG”) 
assessments  process,  leading  to  a  downgrading  in  our  rating.  Financial  investments  in  companies  which  perform  well  in  ESG 
assessments are increasingly popular, and major institutional investors have made known their interest in investing in such companies. 
Depending on ESG assessments and on the rapidly changing views on acceptable levels of action across a range of ESG topics from 
investors,  we  may  be  unable  to  meet  society’s  or  investors’  expectations  on  these  matters,  which  may  cause  reputational  harm,  or 
disappoint the expectations of our stakeholders, and we may face increased compliance or other costs and demand for securities issued 
by us and our ability to participate in the debt and equity markets may decrease.  

We may issue additional securities that may be dilutive to our existing shareholders, in view of funding our new developments and 
accelerating our business expansion. 

Our operations have consumed substantial amounts of cash since inception. We expect to use our cash resources to develop 
and further commercialize our products, develop new products, and for working capital and general corporate purposes. We may require 
additional capital to further develop and commercialize our products and to develop new products. In addition, our operating plans may 
change because of many factors that may currently be unknown to us, and we may need to seek additional funds sooner than planned. 

On June 30, 2021, our shareholders adopted resolutions allowing the Board of Directors to issue 2,000,000 new shares under 
the form of subscription options and 200,000 free shares to motivate and reward the teams dedicated to successfully implementing our 
worldwide activities, particularly in the United States. Based on the June 30, 2021, resolutions, a total of 1,357,000 subscription options 

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were granted in 2021, 2022 and 2023, under certain conditions, to the  employees. Based on the June 30, 2021 resolutions, a total of 
101,500 free shares were granted in 2021 and 2022, under certain conditions, to the employees. On June 30, 2022, our shareholders also 
adopted  a  resolution  allowing  the  Board  of  Directors  to  issue  600,000  free  shares  to  incentivize  worldwide  teams  in  charge  of  our 
operations. This new resolution superseded the June 2021 resolution authorizing the issuance of 200,000 free shares, cancelling the 
unused portion of the 2021 resolution. Based on the June 30, 2022 resolution, as of December 31, 2023, a total of 491,500 free shares 
were  granted,  under  certain  conditions,  to  the  employees.  As  of  December  31,  2023  we  have  108,500  free  shares  and  643,000 
subscription options remaining under our existing resolutions. Under French law, only our employees with an employment contract and 
corporate officers, such as the Chief Executive Officer and the Chairman of the Board of Directors (mandataires sociaux) may receive 
free shares. Non-executive directors may not receive free shares. 

On June 30, 2023, our shareholders renewed and extended resolutions allowing the Board of Directors to issue new shares in 
an aggregate maximum amount of 10 million shares in order to meet any fundraising opportunities that may be necessary to finance our 
further developments and to address any potential strategic opportunities for our long-term growth. As of December 31, 2023 no shares 
have been issued related to this resolution.  

We cannot guarantee that future financing will be available in sufficient amounts or on terms acceptable to us, if at all. The 
issuance  of  additional  ordinary  shares,  including  any  additional  ordinary  shares  issuable  pursuant  to  the  exercise  of  preferential 
subscription rights that may not be available to all of our shareholders, would reduce the proportionate ownership and voting power of 
the  then-existing  shareholders.  Moreover,  the  availability  of  additional  capital,  whether  debt  or  equity  from  private  capital  sources 
(including banks) or the public capital markets, fluctuates as our financial condition and industry or market conditions in general change. 
There may be times when the private capital markets and the public debt or equity markets lack sufficient liquidity or when our securities 
cannot be sold at attractive prices, in which case we would not be able to access capital from these sources on favorable terms, if at all. 
We can give no assurance as to the terms or availability of additional capital. 

We  may  acquire  other  companies  or  technologies,  which  could  fail  to  result  in  a  commercial  product  or  net  sales,  divert  our 
management’s  attention,  result  in  additional  dilution  to  our  stockholders  and  otherwise  disrupt  our  operations  and  harm  our 
operating results. 

We may in the future seek to acquire or invest in businesses, applications, or technologies that we believe could complement 
or expand our portfolio, enhance our technical capabilities or otherwise offer growth opportunities. However, we cannot assure that we 
would be able to successfully complete any acquisition we choose to pursue, or that we would be able to successfully integrate any 
acquired business, product or technology in a cost-effective and non-disruptive manner. The pursuit of potential acquisitions may divert 
the  attention  of  management  and  cause  us  to  incur  various  costs  and  expenses  in  identifying,  investigating  and  pursuing  suitable 
acquisitions, whether or not they are consummated. We may not be able to identify desirable acquisition targets or be successful in 
entering into an agreement with any target or obtain the expected benefits of any acquisition or investment. 

To date, the growth of our operations has been largely organic, and we have limited experience in acquiring other businesses 
or technologies. We may not be able to successfully integrate any acquired personnel, operations and technologies, or effectively manage 
the combined business following an acquisition. Acquisitions could also result in dilutive issuances of equity securities, the use of our 
available cash, or the incurrence of debt, which could harm our operating results. In addition, if an acquired business fails to meet our 
expectations, our operating results, business and financial condition may suffer. 

We may in the future be the target of securities class action or other litigation, which could be costly and time consuming to defend. 

In the past, securities class action litigation has often been brought against companies following a decline in the market price 
of their securities. This risk is especially relevant for us because innovative life sciences and medical device companies have experienced 
significant stock price volatility in recent years. 

Any litigation, if instituted, could cause us to incur substantial costs and our management resources may be diverted to 

defending such litigation, which could adversely affect our financial condition or results of operations. 

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Item 4. Information on the Company 

General 

We develop, manufacture, promote and distribute advanced minimally invasive ultrasound technologies for both  diagnosis 
and  treatment  of  urological  disease.  We  have  introduced  the  Focal  One®  Robotic  HIFU  (high-intensity  focused  ultrasound)  system 
around  the  world  including  Europe,  U.S.,  Latin  America,  and  parts  of  Asia.  With  the  addition  of  the  ExactVu™  Micro-Ultrasound 
system, we offer customers a complete solution from diagnosis to treatment of prostate disease. We also produce and distribute systems 
for the treatment of urinary tract stones. These technologies include the Sonolith® i-move lithotripter system based on Extracorporeal 
ShockWave Lithotripsy (ESWL) technology and advanced surgical laser systems.  

History and Development of the Company  

Our legal name is EDAP TMS S.A., and our commercial name is Focal One®. In 2023, we elevated the Focal One brand name 
to further support our growing global sales and marketing activities. This change reflects our focus on our Focal One robotic HIFU 
system and enhances our visibility in targeted markets. 

EDAP TMS S.A. was incorporated on December 3, 1979, as a société anonyme organized under the laws of the Republic of 
France  for  a  duration  of  60 years  from  the  date  of  incorporation.  Our  principal  executive  offices  are  located  at  Parc  d’Activités  la 
Poudrette-  Lamartine,  4/6,  rue  du  Dauphiné,  69120  Vaulx-en-Velin,  France  and  our  telephone  number  is  +33  (0)  4  72  15  31  50. 
Corporation Service Company, located at 251 Little Falls Drive, Wilmington, DE19808-1674, United States, is our agent for service of 
process in the United States. The SEC maintains an Internet site that contains reports, proxy and information statements, and other 
information regarding the Company’s electronic filings with the SEC. Such electronic filings can be found by visiting the SEC website 
at http://www.sec.gov or the Company’s website at http://www.edap-tms.com, section “Investor Relations.” 

In January 2021, U.S. CPT Code Category 1 reimbursement for HIFU became effective. In addition to reimbursement for the 
facility, the CMS established reimbursement for physicians performing ablation of malignant prostate tissue with HIFU in the United 
States. 

In April 2021, we completed a successful public offering of common stock in the form of ADSs that raised gross proceeds of 
$28,012,500 or €23,250,747. We have used most of this funding to further build up our U.S. clinical, sales and marketing infrastructure.  

In June 2021, after completing our capital increase, and in line with our strategy to expand our HIFU activities in the U.S., we 
hired medical technology industry veteran Ryan Rhodes as Chief Executive Officer of EDAP Technomed Inc., the Company’s U.S. 
subsidiary.  

In September 2022, we completed a successful public offering of common stock in the form of ADSs that raised gross proceeds 
of $23,000,003 or €23,913,314. We intend to use the majority of this funding to further expand and continue executing our U.S. Focal 
One growth initiatives while, in parallel, exploring new indications and other market development opportunities. 

On  May  1,  2023,  Ryan  Rhodes  succeeded  Marc  Oczachowski  as  Chief  Executive  Officer  of  the  Company  to  lead  the 

Company’s global strategy and accelerate the Company’s development.  

On January 1, 2024, Ken Mobeck was appointed as Global Chief Financial Officer and François Dietsch was appointed as 
Global  Chief  Accounting  Officer,  to  pursue  ongoing  alignment  in  our  organization  and  enable  the  Company  to  remain  focused  on 
executing our current growth strategy while also increasing our visibility among U.S. investors. 

Reimbursement Update and Clinical Indication Expansion  

On November 1, 2022, the U.S. CMS released its final outpatient prospective payment system (“OPPS”) reimbursement rule 
for calendar year 2023, which became effective on January 1, 2023.  The final rule increased the reimbursement level of Focal One 
Robotic HIFU to an Ambulatory Payment Classification (APC) level 6, similar to surgery, as compared to APC level 5 which was 
previously in place. This represented a 90% increase in reimbursement. On November 1, 2023, the U.S. CMS released its final OPPS 
reimbursement rule for calendar year 2024 maintaining the reimbursement level for HIFU as an APC Level 6 procedure. 

In November 2022, following the completion of a Phase II study evaluating Focal One HIFU as a potential treatment for deep 
infiltrating  endometriosis,  we  received  approval  from  French  authorities  to  initiate  a  Phase  III  randomized,  controlled  clinical  trial 

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evaluating Focal One HIFU as a potential treatment option for such pathology. This study will enroll 60 patients across nine centers in 
France, with 30 patients randomized to each group. The primary efficacy endpoint is acute pelvic pain evolution three months post 
procedure. At the conclusion of the study, patients in the simulated treatment group who received no treatment will be given the option 
to be treated with HIFU. As of December 31, 2023, 57 patients have been included in the follow-up study. 

Business Overview & Strategy 

EDAP  TMS  S.A.  is  a  holding  company  and  is  responsible  for  providing  common  services  to  its  subsidiaries,  including 
preparation and consolidation of the Company’s financial statements, complying with the requirements of various regulatory agencies 
and maintaining the listing of its publicly held securities and, in conjunction with its Board of Directors, directing the overall strategy 
of the Company. 

Our activity is organized in three divisions: HIFU, ESWL and Distribution. Through these three divisions, we develop, produce, 
market and distribute non- invasive medical systems, mainly for diagnosing and treating urological disease. The HIFU division includes 
sales of Focal One, related consumables and services. The ESWL division includes revenues generated by servicing the existing installed 
base of the EDAP family of lithotripters. The Distribution division includes the sale of complementary products such as ExactVu 29 
MHz micro-ultrasound systems, surgical lasers, and other products from third parties.  

Our global strategy is to expand our HIFU activities in the U.S. and worldwide to accelerate Focal One Robotic HIFU adoption. 
We are also focusing our efforts in the development of HIFU for the treatment of other medical conditions beyond prostate disease. We 
are leveraging our Distribution and ESWL divisions to help optimize our global development to further support the expansion of our 
HIFU strategy. 

Our three divisions operate in Europe, the Americas, Asia and the rest of the world. Total net sales for the HIFU division (net 
contributions to total consolidated sales) were €20.6 million, €15.6 million and €9.9 million for 2023, 2022 and 2021, respectively. 
Those sales are generated in Europe, the United States and the rest of the world, excluding certain countries in Asia, such as Japan, 
where our HIFU systems are not approved yet. Total net sales for the ESWL division were €9.9 million, €11.6 million and €11.0 million, 
each for 2023, 2022 and 2021, respectively. Total net sales for the Distribution division were €29.9 million, €27.9 million and €23.1 
million, each for 2023, 2022 and 2021, respectively. 

See Note 29 to our consolidated financial statements for a breakdown of total sales and revenue during the past three fiscal years 

by operating division and Item 5, “Operating and Financial Review and Prospects.” 

HIFU Division 

The HIFU division is engaged in the development, manufacturing and marketing of Focal One robotic systems based on HIFU 
technology for the minimally invasive treatment of urological and other clinical indications. Our HIFU business is cyclical and generally 
linked to lengthy hospital decisions and investment processes. Hence, our quarterly revenues are often impacted and fluctuate according 
to these parameters, generally resulting in higher purchasing activity in the last quarter of the year. The HIFU division contributed €20.6 
million to our consolidated net sales during the fiscal year ended December 31, 2023. 

HIFU Division Business Overview 

As of December 31, 2023, the HIFU division had an active installed base of 107 Focal One systems, including 52 in the U.S.  

The HIFU technology developed by this division uses a high-intensity convergent ultrasound beam generated by high power 
transducers to produce heat. HIFU technology is intended to allow the surgeon to destroy a well-defined area of diseased tissue, without 
damaging surrounding tissue and organs. This treatment option eliminates the need for incisions, transfusions and overnight hospital 
stay while minimizing complications.  The Focal One Robotic HIFU system can also be used for patients who are not candidates for 
conventional surgery or who have failed a radiotherapy treatment regimen. 

In  addition  to  selling  HIFU  systems,  the  HIFU  division  also  records  revenues  driven  from  sales  of  (i) disposables, 

(ii) equipment leases (iii)  Revenue-Per-Procedure (“RPP”) and (iv) equipment service contracts.  

In certain regions of the world, we offer a HIFU mobile treatment option, which provides access to our Focal One HIFU systems 
without requiring hospitals and clinics to make an up-front investment in the equipment. Instead, hospitals and clinics perform treatments 
using these systems and remunerate us on an RPP basis (i.e., based on the number of individual treatments provided). With this model, 

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once the treatment is established in the medical community, a permanent installation may become more attractive, leading to the sale of 
the Focal One system. 

In addition, the HIFU division also generates revenues from net sales of maintenance services associated to our installed Focal 

One HIFU systems.  

HIFU Division Business Strategy 

The HIFU division’s business strategy is to capitalize on its deep expertise in HIFU to achieve long-term growth as a leader in 
the development, manufacturing, marketing and distribution of minimally invasive therapeutic ultrasound systems for urological and 
other indications. The HIFU division believes that minimally invasive treatments using HIFU could provide an alternative to current 
more invasive therapies while reducing costs and lowering morbidity.  The key elements of the HIFU division’s strategy are: 

•  To Provide Minimally Invasive Solutions to Treat Localized Prostate Cancer using HIFU. Building upon our established 
position in the urology market, our HIFU division is striving to become the leading provider of our minimally invasive 
HIFU  treatment  option  for  prostate  cancer.  We  believe  that  there  is  a  large  market  opportunity  due  to  the  increased 
incidence rate linked to the aging male population. Additional screenings combined with increased testing has led to more 
patient awareness about prostate cancer and relevant treatment options. We also believe, for patients that fit certain criteria, 
HIFU could represent an excellent alternative to surgery, external beam radiotherapy, brachytherapy and cryotherapy for 
the  treatment  of  organ-confined  prostate  cancer  without  the  cost,  in-patient  hospitalization  and  adverse  side  effects 
associated with those therapies. With the growing demand for more focused treatments that destroy the tumor only (focal 
therapy)  while  continuously  controlling  the  disease,  HIFU  and  its  focused  approach  is  well  positioned  to  address  this 
market. The HIFU division intends to achieve this through a direct sales network in the U.S and Europe  as well as through 
selected distributors in the rest of the world. Our strategy is to accelerate Focal One Robotic HIFU adoption in the U.S. 
now that the technology has a CPT code and an established level 6 reimbursement. We are currently focused on building 
out our commercial team in order to offer this minimally invasive option to U.S. prostate cancer patients at a broader level 
to expand our market presence worldwide.  Continued investment is key for effective patient and physician education 
through focused communication and training programs. The HIFU division has built strong clinical credibility based on 
clinical articles published in peer-reviewed journals.  

•  Achieve Long-Term Growth by Expanding HIFU Applications Beyond Prostate Cancer. The HIFU division’s long-term 
growth strategy is to apply our HIFU technology in the treatment of other medical conditions beyond prostate cancer. The 
HIFU division is currently developing HIFU for the treatment of endometriosis and is exploring various other applications 
such as benign prostate hyperplasia and conducting clinical research on treatment of cancer in solid organs such as the liver 
and pancreas, where HIFU could provide an alternative to current therapies. In 2023, the HIFU division expenses grew by 
46%  compared  to  2022  on  research  and  development  (“R&D”)  projects  to  develop  HIFU  applications  beyond  prostate 
cancer.  The  division  is  considering  increasing  levels  of  R&D  spending  in  2024  and  future years  to  strengthen  its 
technological leadership in HIFU and expand its application beyond urology.  

HIFU Products 

Currently, we have commercialized Focal One, an image guided, robotic HIFU system dedicated to delivering focal therapy 
for  the  management  of  prostate  cancer.  Focal  One  combines  three  essential  components  to  efficiently  perform  a  focal  treatment  of 
localized prostate cancer: (i) high-quality imaging to localize tumors with the use of imported MRI imaging information combined with 
real-time  ultrasound  imaging,  (ii) high  precision  of  HIFU  treatment  focused  on  the  identified  target  areas  and  (iii)  the  ability  to 
provide immediate feedback on the delivery of treatment utilizing contrast-enhanced ultrasound imaging.  

HIFU Division Patents and Intellectual Property  

As of December 31, 2023, the HIFU division’s patent portfolio contained a total of 33 granted, owned or co-owned patents 
consisting of seven granted patents in the United States, 10 patents in the European Union, eight patents in Japan and eight patents in 
China. These patents belong to 10 groups of patents covering technologies related to therapeutic ultrasound principles, systems and 
associated software. 

Additional  owned  or  co-owned  patent  applications  covering  certain  other  aspects  of  our  HIFU  technology,  including  one 
international  patent  applications  under  the  Patent  Cooperation  Treaty,  two  patent  applications  in  the  United  States,  four  patent 

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applications in the European Union, two patent applications in Japan and two patent applications in China, are currently pending before 
the relevant patent offices.  

Our ongoing research and development objectives are to maintain our leadership position in the management of prostate cancer 
and to extend the HIFU technology to new clinical applications and for future development of new therapeutic ultrasound systems. 
These  research  projects  are  conducted  in  cooperation  and  collaboration  with  the  French  National  Institute  for  Health  and  Medical 
Research (“INSERM”) which gives rise in some cases to the filing of patent applications, followed by the grant of co-owned patents. 
We have entered into license agreements with INSERM related to certain patents co-owned with INSERM whereby we commit to pay 
an amount of royalties to INSERM based on a fixed rate of the net revenues generated from the sales of HIFU systems using co-owned 
patents. Under these agreements, which last for the life of each co-owned patent, we have the exclusive right to the commercial use of 
the co-owned patents, including the right to out-license such commercial rights. We have an option to obtain an exclusive license from 
INSERM relating to other patents co-owned with INSERM. 

Although  we  believe  that  our  HIFU  patents  are  valid  and  should  be  enforceable  against  third  parties  and  that  our  patent 
applications should, if successfully pursued, result in the issuance of additional enforceable patents, there can be no assurance that any 
or all these patents or patent applications, if issued, will provide effective protection for the HIFU division’s proprietary rights in such 
technology. HIFU systems, as they are currently or may in the future be designed, may also be subject to claims of infringement of 
patents  owned  by  third  parties,  which  could  result  in  an  adverse  effect  on  our  ability  to  market  HIFU  systems.  See  Item 3,  “Risk 
Factors—Risks relating to Intellectual Property Rights.” 

HIFU Division Clinical and Regulatory Status 

Clinical and Regulatory Status in Europe 

Based on clinical study results, we obtained a CE Marking for Focal One in June 2013, which allowed us to market the Focal 
One in the European Union and in worldwide territories where CE Marking is required. On March 15, 2023, the European regulation 
N°2023/607 extended the validity of our Focal One CE certificate until December 31, 2028. Ablatherm systems previously placed on 
the market are maintained for use according to applicable regulation. The Focal One is the only HIFU system now being commercialized 
to potential new customers in Europe and territories covered by CE Marking. 

Clinical and Regulatory Status in the United States 

In November 2015, we received 510(k) clearance from the FDA to market Ablatherm Integrated Imaging HIFU in the U.S. for 

the ablation of prostate tissue. In October 2017, we were granted a 510(k) clearance for our Ablatherm Fusion system. 

On June 7, 2018, based on Ablatherm clearance and European pre-market and post-market clinical data, we obtained FDA 

510(k) clearance for our Focal One system. 

Clinical and Regulatory Status in Japan 

We have initiated discussions with the Japanese authorities (PMDA) on the best process to apply to obtain Japanese approval 
for our Focal One system. We will need to conduct a clinical trial in Japan to obtain clearance for the Focal One system. The process of 
requesting approval to market the Focal One in Japan may be long and may never result in the approval to market the Focal One in 
Japan. See Item 3, “Risk Factors—Our future revenue growth and income depend, among other things, on the success of our HIFU 
technology” and “— Our clinical trials related to products using HIFU technology may not be successful, and we may not be able to 
obtain regulatory approvals necessary for commercialization of all of our HIFU products.” 

Clinical and Regulatory Status in China  

We are currently reviewing our regulatory and market access strategy in China. 

Clinical and Regulatory Status in the Rest of the World 

The Focal One system is cleared for distribution in Brazil, Canada, Costa Rica, Ecuador, Hong Kong, Israel, Malaysia, Mexico, 

Morocco, U.K, Russia, Singapore, South Korea Switzerland, Taiwan, and Uruguay. 

See Item 3, “Risk Factors—We operate in a highly regulated industry and our future success depends on government regulatory 

approval of our products, which we may not receive, or which may be delayed for a significant period of time.” 

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HIFU Clinical Developments  

HIFU in Prostate Cancer 

The clinical study initiated in 2015 within the scope of “Forfait Innovation” (the “HIFI” Study) and piloted by the French 
Association of Urology (“AFU”) is aimed at evaluating the reimbursement of HIFU in France. The HIFI Study compares total or sub-
total HIFU vs radical prostatectomy (“RP”) as a first line treatment in grade groups (“GG”) <3 localized prostate cancer or as a salvage 
treatment post radiation. The objectives were to compare oncological efficacy, functional and safety outcomes. The patients’ inclusion 
period closed on September 30, 2019. The 3,328 patients included in the HIFI Study were followed for 30 months ahead of data analysis 
and results publication. During that follow-up period, we pursued patient treatments using HIFU under the specific Forfait Innovation 
coverage process, but these patients were not followed as part of the HIFI Study. In March 2023, the Study Coordinator presented the 
30-month final results of the HIFI Study at the European Association of Urology (“EAU”) congress. Primary endpoint showed a 30-
month Salvage Treatment-Free Survival (“SFTS”) benefit in favor of HIFU. Secondary endpoints showed better continence and erectile 
function outcomes after HIFU. Following the completion and analysis of the HIFI Study submitted to the French National Authority for 
Health (“HAS”), a positive favorable opinion was issued late 2023 to include HIFU as a procedure covered under the national universal 
health, Social Security system ("Sécurité Sociale"). This favorable opinion relates to HIFU as a primary treatment of intermediate risk 
localized prostate cancer as well as a salvage option after failed radiotherapy. Based on this positive opinion from the HAS, the French 
Social  Security  authorities  can  now  use  this  recommendation  for  including  HIFU  procedures  in  its  next  cycle  to  determine  the 
procedure’s reimbursement rate and the timing for when such reimbursement would go into effect. 

In 2017, a clinical study addressing Focal Ablation vs Radical Prostatectomy (“FARP”), sponsored by Oslo University was 
initiated and aimed at comparing focal ablation and robot-assisted radical prostatectomy for treating patients with unilateral clinically 
significant prostate cancer. A total of 213 patients were enrolled and randomized to either arm. Patient inclusion was completed in June 
2021. According to recent abstracts presented by the Principal Investigator at several major scientific meetings, the rate of treatment 
failure after two years post procedure in the focal ablation group was found to be non-inferior to that in the radical prostatectomy group. 
The functional outcomes, in particular the continence rate evaluated with de novo pad use as well as the sexual function evaluated with 
the International Index of Erectile Function shows a statistically significant superiority in favor of HIFU compared to surgery. 

In July 2017, we, together with our academic, scientific and clinical partners, initiated a collaborative project (the “PERFUSE 
Project”) under the “French National Investment Program for the Future”. The overall objective of the PERFUSE Project is two-fold: 
(i) to set-up several clinical studies to assess focal therapy using the Focal One system in view of a better understanding of focal therapy 
in prostate cancer management and, (ii) to prepare a change of paradigm in the treatment of prostate cancer via technical innovations 
such as focal therapy. The whole project was awarded funding of €8 million over five years. We, as a partner of the PERFUSE Project, 
are to receive approximately €1.2 million over the period as a non-refundable grant. As of December 31, 2023, we had received a non-
refundable grant of €1.0 million. 

As part of the PERFUSE Project, several studies were initiated and sponsored by academic partner HCL - Edouard Herriot 
Hospital. In September 2018, a Phase II multi-centric study was launched to evaluate the efficacy and safety of HIFU focal therapy in 
patients with intermediate-risk single-lobed prostate cancer (the “FOCALE” study). 172 patients were included in the FOCALE study 
over 14 centers. The last patient was included in May 2021. Inclusions are now closed, patient follow-up is on-going and last patient 
follow-up visit is scheduled for October 2025. In October 2018, a Phase III, multi-centric, randomized study was initiated aiming at 
evaluating the efficacy of focal HIFU versus active surveillance hence reducing the need for radical treatment for low-risk prostate 
cancer patients (the “HIFUSA” study). As of December 31, 2023, 106 patients have been included within 14 French centers. Patient 
inclusion is now closed. Patient follow-up is on-going and last patient follow-up visit is scheduled for October 2026.  

The majority of academic centers using the Focal One system are collecting data following an Investigational Review Board 
approval in order to continue building clinical evidence and long-term HIFU outcomes. These various sources of clinical data are a basis 
for individual sites to present abstracts at regional, national or international conferences and submit manuscripts for peer-review to 
renown journals and publications. This holds the potential for the FDA, which cleared HIFU for prostate tissue ablation in 2015, to re-
evaluate the technology in the future for a prostate cancer indication. Likewise, health insurance reimbursements on a wider scale are 
also possible with such prospective data collection efforts documenting HIFU data from patients in and out of the U.S. 

HIFU for Potential Treatment of Deep Infiltrating Rectal Endometriosis   

In 2020, we initiated a Phase II multi-center clinical study in France to further investigate the use of Focal One Robotic HIFU 
in the treatment of certain types of deep endometriosis situated in the low rectum. The study was completed in September 2022: a total 
of 60 women were enrolled in the study at four major hospitals in France and assessed over a six-month follow-up period.  The intended 
endpoint was to evaluate the safety and efficacy of HIFU for this pathology. Data from this study have been analyzed and final results 

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on safety and efficacy were presented in France at the Pari(s) Santé Femmes Gynecology Congress in early 2023 as well as in a plenary 
session at the European Society for Gynecological Endoscopy Annual Congress in October 2023 and at the American Association of 
Gynecology Laparoscopists meeting in November 2023.   

In 2021, we initiated a long-term follow-up study aimed at including all the 80 patients treated by HIFU for their Rectovaginal 
endometriosis in the Phase I and II studies. During this study, we will evaluate the quality of life and the symptom levels of the patients 
up to five years after their HIFU treatment. As of December 31, 2023, 57 patients have accepted to be included in the follow-up study.  

In  late  2022,  we  received  approval  from  the  French  authorities  to  initiate  a  Phase  III  randomized,  controlled  clinical  trial 
evaluating Focal One HIFU as a potential treatment for deep infiltrating endometriosis. This study is a level 1 multi-center, double blind, 
randomized, controlled clinical trial. HIFU treatment will be compared to a sham treatment. The study will enroll 60 patients across nine 
centers in France, with 30 patients randomized to each group. The primary efficacy endpoint is acute pelvic pain evolution three months 
post procedure. At the conclusion of the study, patients in the sham group will be offered HIFU treatment. As of December 31, 2023, 
57 patients have been included in the follow-up study. 

HIFU for Potential Treatment of Benign Prostatic Hyperplasia  

In 2021, we initiated a mono-centric Phase I study to investigate the feasibility of Benign Prostatic Hyperplasia (“BPH”) HIFU 
treatment with a Focal One system. A total of nine patients were treated, and the treatment safety was evaluated at three months after 
HIFU treatment. The first patient was included in this study in March 2022. As for December 31, 2023, nine patients have been enrolled 
and treated.  

HIFU for Potential Treatment of Solid Organ Tumor Ablation Within the Pancreas and Liver Tumors 

The Company leveraged the efforts, knowledge and assets resulting from earlier technology developments  for the ablation of 

tissue to further evaluate HIFU technology and approach as a solution for patients with localized tumors of the liver and pancreas.  

As part of a cooperation with Centre Leon Bérard, Lyon, France, we will initiate a phase I-II study to evaluate the safety and 

tolerance of intraoperative HIFU treatment in pancreatic tumors, including 26 patients. 

HIFU Clinical Publications  

To date, clinical results related to our Robotic HIFU systems have been published in renowned peer-reviewed journals. 

Prostate cancer publications  

In January 2021, Dr. Castilho Borges et al. from Institut Mutualiste Montsouris, Paris, published in the Journal of Urology their 
results on 300 patients, a study in which the results compare the impact on functional results (Sexual Function and Urinary Continence) 
in two groups of patients: 195 patients in Focal Treatment (FT) versus 105 patients in the Whole Gland (WGT) Ablation treatment for 
Prostate Cancer. In conclusion, FT is associated with better functional outcomes, with an earlier urinary continence recovery, and better 
sexual function at three and 12 months. Moreover, the morbidity associated with FT is substantially lower than that related to WGT. 

In February 2022, Hong et al., from Seoul National University Bundang Hospital, Korea, published in the Journal of Society 
Urological Oncology their results on their retrospective study on 163 patients who underwent Partial Gland HIFU Ablation (PGA) by 
Focal One with a median follow up period of 17 months. The results concluded that the PGA with HIFU was safe and showed good 
preservation of functional outcomes as well as satisfactory oncological control.  

In October 2022, De Luca et al., from San Luigi Gonzaga University Hospital, Italy published in the Minerva Urology and 
Nephrology journal their results on their prospective study on 100 patients with low to intermediate-risk prostate cancer that received 
customized HIFU ablation by Focal One with 12 months of follow up: 15 patients underwent total ablation, 50 patients hemi-ablation 
and 35 patients focal ablation. Control biopsy at 12 months of the HIFU-treated zone was negative in 80% for total ablation, 84% for 
partial and 80% for focal ablation with in-field reoccurrence being less than 10% after hemi-ablation. Patients had postoperative excellent 
quality of life with lower rate of irritative symptoms and negligible impact on voiding and erectile function scores. 100% of patients that 
received focal and partial HIFU ablation retained potency.  

In December 2022, Jung G, et al., from Seoul National University Bundang Hospital, Korea, published in the journal of Prostate 
International their results on their propensity score-matched retrospective study on 685 patients who underwent PGA using HIFU with 
Focal One (137 patients) versus Robot-Assisted Radical Prostatectomy (548 patients) with a median follow-up period of 22 months. 

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The authors confirmed that PGA HIFU preserves urinary and erectile functions, with a slight/minor loss of efficiency, which remained 
however very satisfactory (80% success rate efficacy). The results concluded that 5.8% underwent salvage treatment with postoperative 
incontinence and erectile dysfunction being more favourable in PGA compared to Robot-Assisted Radical Prostatectomy.  

In July 2023, Mattlet et al, from University of Brussels, Brussels, Belgium published their results in The Prostate Journal from 
a retrospective analysis on 178 patients that underwent HIFU with Ablatherm (2001-2015) and Focal One (2005-2021). 12% of patients 
included in the study received neoadjuvant ADT. Patients received customized ablation based on lesion location with 52% of patients 
receiving hemi-ablation. Treatment free survival and failure free survival were 89% and 98% respectively, at 60 months without Huber 
et al criteria. However, for patients with Huber et al. criteria, 23% of patients had treatment failure at 26 months . Therefore, the Huber 
et al. criteria was found accurate to predict the need for additional treatment. 

In September 2023, Debard C et Al., from CHU de Pellegrin, Bordeaux, France published in the journal of Progrès en urologie 
their results on their retrospective and multicenter study on 137 patients with low- or intermediate-risk localized prostate cancer treated 
with Focal One. 70% of patients had clinical stage T2, 64% had an ISUP score of 2 or 3 on initial biopsies and 61% were treated with 
“targeted” ablation. According to the authors, the selection of patients treated with focal therapy is a key point for the success of the 
technique and the inclusion criteria that varied according to the studies. The authors conclude: “Our results are in agreement with those 
of the literature, seeming to indicate a lower morbidity of the focal treatment by HIFU compared to the radical treatments while offering 
an acceptable oncological control.”  

In  October  2023,  Kaufmann  B  et  al.,  published  in  the  British  Journal  of  Urology  (BJUI)  their  results  on  a  study  aiming 
at assessing the oncological and functional outcomes of HIFU in treating low to intermediate risk prostate cancer a 3-year prospective 
study was undertaken using rigid post-ablation saturation biopsies. Patients with either low (6.6%) or intermediate (93%) risk prostate 
cancer underwent focal ablation around the lesion(s) of interest. All patients had transperineal template saturation biopsy (>20 cores) 
in-conjunction with MRI guided fusion biopsy. Over half the patient underwent follow up biopsy. Failure-Free Survival (PROMIS) and 
Salvage-Free Survival at 36 months was 65% and 81% respectively. They concluded that Focal HIFU treatment for localized prostate 
cancer (“PCa”) shows excellent functional outcomes with half of the patients remaining cancer-free after three years. In-field recurrence 
(GG2 disease or higher) rate is as follows 18%, 18%, and 17% at six, 12, and 36 months, respectively. Urinary and sexual function 
remained un-changed per the Expanded Prostate Cancer Index Composite. In their conclusions, the authors stated that “Whole-gland 
treatment was avoided in 81% of patients. Early follow-up biopsies are crucial to change or continue the treatment modality at the right 
time, while the use of MRI and PSA in detecting PCa recurrence is uncertain.”  

In November 2023, Mala KS, et al., from Berlin Charité University Medicine, Germany, published in the Journal of the Clinical 
Medicine their results on their retrospective study on 57 patients with localized PCa using HIFU with Focal One. HIFU treatment was 
performed as focal, partial, or hemi ablative, depending on the prior histopathology. Out of 26 men that received biopsy eight (15.8%) 
had in-field reoccurrence. The rate of post-HIFU complications was low, at 19.3%. Continence was preserved and erectile function was 
comparatively better than with radical prostatectomy. The study concluded that HIFU as a therapy option for nonmetastatic, significant 
prostate cancer is effective in the short term for carefully selected patients and shows a low risk of adverse events and side effects.  

In November 2023, Rischman P. et al. published in the Progrès en Urologie, their results on salvage HIFU for local recurrence 
after first-line radiotherapy in 531 patients. This HIFI-2 study was developed as part of the “Forfait Innovation” program to evaluate the 
efficacy and safety of HIFU in the salvage treatment of localized PCa after failure of first-line radiotherapy (RT). This is a prospective, 
multicenter, open-label study within the framework of the Forfait Innovation program, promoted by the AFU. Thirty months after post-
RT salvage HIFU, 72% of patients were spared Hormonal Treatment. Pre-therapy PSA and Gleason score data suggest a better outcome 
(up to 85% HT-free survival at 30 months) when, in the presence of biological recurrence after radiotherapy, a recommendation is made 
for earlier management. 

Endometriosis publications  

In September 2020, Philip CA et al, from Croix Rousse Hospital, Lyon, France, published in Ultrasound Obstetric Gynecology 
journal, the results of the treatment of 20 patients with deep recto vaginal endometriosis using Focal One HIFU. This EDAP-sponsored 
study is the first one on the use of HIFU in this indication. The authors reported very promising results with low morbidity and significant 
efficiency on intestinal and gynecological symptoms as well as in the quality of life. 

Pancreas publications  

In December 2021, Cilleros et al. from EDAP and Labtau, INSERM and Centre Leon Bérard, Lyon, published in the journal 
Cancers positive pre-clinical results using intraoperative HIFU ablation of the pancreas in view of assessing the feasibility HIFU in the 

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pancreas under Doppler guidance to treat the pancreatic parenchyma and tissues surrounding the superior mesenteric vessels in vivo in 
an animal model.   

HIFU Division Market Potential 

Prostate cancer is currently the first (in terms of newly diagnosed cases) and second (in terms of number of deaths) as the most 
common form of cancer amongt men in many populations. In the United States, the American Cancer Society estimates the number of 
new prostate cancers to be diagnosed for 2024 to be approximately 299,010, of which approximately 70% are diagnosed with localized 
stage prostate cancer. Additionally, the HIFU division estimates, based on figures provided by the World Health Organization that the 
worldwide incidence of localized prostate cancer is approximately twice this U.S. figure. A more effective diagnostic method for prostate 
cancer, the PSA test, has increased public awareness of the disease in developed countries since its introduction. PSA levels jump sharply 
when cancer is present. Prostate cancer is an age-related disease, and its incidence in developed countries is expected to increase as the 
population ages. 

According to the Focused Ultrasound Society, HIFU has the potential to transform the treatment of a variety of serious medical 
conditions. All indicators point toward the evolution of this platform technology into a robust medical field, including numerous medical 
conditions, including cardiovascular, neurological, urological or women’s health. We decided to focus on developing HIFU for targeted 
medical conditions. The expansion of the use of HIFU to other areas of treatment will require a significant investment in research and 
development, an investment that we intend to accelerate as acceptance of HIFU as a treatment for localized prostate cancer is gaining 
grounds in the medical community. 

The  endorectal  approach  currently  delivered  by  the  Focal  One  Robotic  HIFU  system,  could  benefit  patients  with  rectal 
endometriosis. The European Society of Human Reproduction and Embryology estimates that endometriosis  affects approximately 
10% of women of reproductive age. Among them, 5-12% are affected by digestive endometriosis, of which  90% suffer from infiltration 
of the rectum. As such, we estimate that 1% of the women of reproductive age could possibly benefit from a minimally invasive HIFU 
treatment. 

HIFU Reimbursement Status 

In the United States, following the American Medical Association’s (“AMA”) decision to establish a new Category 1 CPT 
code for the ablation of malignant prostate tissue with transrectal HIFU technology, CMS finalized payment rules for hospitals, facilities, 
and physicians that facilitates coverage and reimbursement, effective January 1, 2021. U.S. private insurers are continuing to evaluate 
and  advance  coverage  and  payment  policies  related  to  HIFU  procedures  for  prostate  cancer  patients.  We  have  engaged  Medical 
Technology Partners (MTP) and Argenta Advisors, two leading reimbursement consultancies, to support us in reimbursement analysis 
and strategies.  

On the hospital payment side, the 2023 final rule upgraded the HIFU procedure from Level 5 Urology Ambulatory Payment 
Classification  (“APC”)  in  2022  to  Level  6  in  2023.  The  2024  final  rule  maintained  the  APC    6  payment  level.  This  translates  into 
reimbursement to a hospital performing a HIFU procedure on a Medicare patient to $8,777 per procedure as a national average, adjusted 
locally based on the wage index, compared to the previous level of approximately $4,500 in 2022. The CMS will continue to update 
payment rates for hospitals on a yearly basis as part of the OPPS Rulemaking. 

On the physician payment side, CMS first established a payment to physicians performing a HIFU procedure in the U.S. in 
2021. The AMA has created a Current Procedure Terminology code and CMS has set the work Relative Value Units for a physician 
performing a HIFU procedure at 17.73. In the 2024 Final Rule of the Physician Fee Schedule, CMS has set the total facility Relative 
Value  Units  (“RVUs”)  at  29.21.  This  translates  to  an  average  payment  of  $956  for  a  urologist  performing  a  HIFU  procedure  on  a 
Medicare patient in a facility setting in 2024. As a reference, a comparable established minimally invasive therapy for prostate cancer, 
cryotherapy, yields 22.84 total facility RVUs, which translates to $748 for the urologist under the same setting and patient conditions in 
2024. A radical prostatectomy would grant the urologist 34.83 total facility RVUs, which translates to a Medicare payment of $1,140, 
or 35.53 total facility RVUs and $1,163 if performed laparoscopically or robotically. Of note, CMS has finalized an 18% reduction for 
the  physician  payment  for  a  robotic  prostatectomy  in  2023  compared  to  2022,  significantly  reducing  the  difference  between  this 
procedure and HIFU in terms of physician payment. 

In  the  European  Union,  there  is  no  harmonized  procedure  for  obtaining  reimbursement  and,  consequently,  we  must  seek 
reimbursement in each Member State. Procedures performed with our HIFU systems are not reimbursed in the European Union except 
in  Italy,  Germany,  the  United  Kingdom  (where  procedures  are  partially  reimbursed  by  either  public  healthcare  systems  or  private 
insurers),  Switzerland  and  France  under  certain  conditions.  In  2014,  the  French  healthcare  government  authorities  announced  the 
reimbursement of prostate cancer treatment procedures using HIFU as part of a specific process (Forfait Innovation) to further validate 

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breakthrough therapies and to accelerate their related reimbursement process based on clinical trials and data registries. As part of the 
Forfait Innovation, patients were included in the HIFI Study sponsored by the French Association of Urology.  Results and analysis of 
the study were submitted to the HAS and a positive favorable opinion was issued late 2023 to include HIFU as a procedure covered 
under the national universal health system. More specially, the favorable opinion relates to HIFU as a primary treatment of intermediate 
risk localized prostate cancer as well as a salvage option after failed radiotherapy. Based on this positive opinion from the HAS, the 
French Social Security authorities can now use this recommendation for including HIFU procedures in its next cycle to determine the 
procedure’s reimbursement rate and the timing for when such reimbursement would go into effect. 

HIFU Competition 

Current therapies for prostate cancer commonly carry side effects that can seriously affect a patient’s quality of life. One of the 
standard treatments for prostate cancer is radical prostatectomy (surgery), which involves the surgical removal of the entire prostate 
gland. Radical prostatectomy may require a hospital stay and additional recovery time, usually with catheterization, and may result in 
urinary incontinence and impotence. Robotic nerve-sparing radical prostatectomy has been developed to reduce the invasiveness of this 
surgery.  However,  this  procedure  is  still  associated  with  the  morbidity  of  surgery  which  requires  ligating,  cutting,  suturing,  and 
dissection of tissue commonly leading to blood loss.  Other therapies for localized prostate cancer include brachytherapy, external beam 
radiation therapy, and cryotherapy. 

Our robotic HIFU systems compete with all current treatments for localized tumors, which include surgery, brachytherapy, 
radiotherapy, and cryotherapy. We believe that HIFU is a cost effective optimal treatment option for qualifying patients seeking to 
manage their cancer with minimal side effects.  

We also believe that Focal One is well positioned to address the growing demand for focal therapy of localized prostate cancer 
as compared to the radical treatments of surgery or radiation. “Focal” treatment (also known as “partial” or “zonal” treatment, as opposed 
to “radical” or “total” treatment) with Focal One provides an effective and accurate ablative treatment while preserving patient quality 
of life. 

Other  companies  are  working  with  HIFU  for  the  minimally  invasive  treatment  of  tumors.  See  Item 3,  “Risk  Factors—
Competition in the markets in which we operate is intense and is expected to increase in the future, and there is a substantial risk our 
products or service offerings could become obsolete or uncompetitive.” 

Certain existing and potential competitors of our HIFU division may have more financial resources to invest in research and 
development,  sales,  marketing,  and  personnel  resources  than  us  and  may  have  more  experience  manufacturing  and  supporting  new 
products. We believe that an important factor in the potential future market for HIFU treatments will be the ability to make substantial 
investments in research and development required to advance the technology beyond the treatment of prostate cancer. These future 
investments are wholly dependent on the successful acceptance of the system for the treatment of prostate cancer. 

Other  companies  working  with  HIFU  technology  for  the  minimally  invasive  treatment  of  tumors  include  Sonablate 
Corporation,  a  U.S.  company  that  markets  the  Sonablate®  system  for  the  ablation  of  prostatic  tissue.  Sonablate  received  de  novo 
clearance  from  the  FDA  for  commercialization  in  the  U.S.  in  October 2015.  Profound  Medical,  a  Canadian  company,  holds  FDA 
clearances for transurethral ultrasound ablation for prostate tissue. Insightec, an Israeli private company has developed a system using 
HIFU technology to treat uterine fibroids, painful bone tumors, brain disorders and ablate prostate tissue; this latter intended use was 
cleared by the FDA in December 2021. Theraclion, a French company licensed by EDAP to use certain of our HIFU patents, is currently 
marketing  the  Echopulse  HIFU  system  to  treat  benign  thyroid  nodules,  benign  breast  masses  and  varicose  veins.  Haifu,  a  Chinese 
company, is developing HIFU products addressing various types of cancers. 

HIFU Division Sales and Distribution of Products 

The HIFU division markets and sells its products through our own direct marketing and sales channels as well as through select 
third-party distributors and agents in several countries. Using our direct subsidiaries or representative offices network, the HIFU division 
maintains a direct marketing and sales force in the United States, France, Germany, Malaysia and South Korea, which currently represent 
its largest HIFU markets. Additionally, the HIFU division markets and sells its products through our network of distribution partners in 
the rest of Europe, Latin America, Middle East, Asia and Southeast Asia. 

The HIFU division’s customers are located worldwide and have included academic, public,  and private hospitals as well as 

urology clinics. No single customer of the HIFU division represents a significant portion of the division’s installed base. 

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The  HIFU  division’s  marketing  efforts  currently  include  the  development  of  marketing  resources,  activities,  and  training 
programs for urologists as well as via traditional, digital  and  social  media programs  educating  patients  on  the  availability  of HIFU 
technology to treat localized prostate cancer.  

ESWL Division  

The ESWL lithotripsy division is engaged in marketing and servicing our installed base of Sonolith lithotripters. The ESWL 

division contributed €9.9 million to our consolidated net sales during the fiscal year ended December 31, 2023. 

ESWL Division Business Overview 

The ESWL division’s business consists of producing and marketing lithotripters for the treatment of urinary tract stones. ESWL 
uses extracorporeal shockwaves, focused at a urinary stone within the human body to fragment it into smaller pieces. This technology 
allows natural elimination of stone fragments and prevents the need for more invasive options including incisions, transfusions, general 
anesthesia, and the potential for related complications. The ESWL division currently markets one lithotripter model: the Sonolith i-move 
and maintains several previous generations of lithotripters that include, but are not limited to, the Sonolith i-sys and Sonolith Praktis. 
As of December 31, 2023, the ESWL division maintained or otherwise serviced 538 Sonolith lithotripters. 

ESWL Division Business Strategy  
The business strategy for the ESWL division is to capitalize on its expertise in ESWL and its position in urology to maintain 

our lithotripsy sale of Sonolith i-move and service activity on our existing installed base of ESWL lithotripters. 

ESWL Division Products 

The ESWL division manufactures its lithotripsy systems, the Sonolith i-move, at our manufacturing facility in Vaulx-en-Velin, 

France. 

The Sonolith i-move relies on electroconductive technology for shockwave generation. The ESWL division’s customers are 
located worldwide and have historically been principally large hospitals, urology clinics and research institutions. The Sonolith i-move 
offers a wide range of configurations to suit various budgets and various local market needs. This technology incorporates the Visio-
Track ultrasound stone localization system: a unique three-dimensional virtual system that uses infrared stereovision proprietary and 
patented technology to guide the treatment robotically. 

The ESWL division also sells disposable accessories for lithotripters and electrodes for the Sonolith line, which need to be 

replaced approximately every ten treatments. 

ESWL Division Patents and Intellectual Property  

As of December 31, 2023, the ESWL division’s patent portfolio includes six granted owned and or co-owned patents consisting 

of one in the United States, four in the European Union and one in Japan. 

These  patents  belong  to  four  groups  of  patents  covering  technologies  relating  to  ESWL  systems  and  associated  software 
capabilities.  The  ESWL  division’s  patents  cover  both  piezoelectric  and  electroconductive  technologies  associated  with  the  ESWL 
generator, localization systems and system design.  

ESWL Division Regulatory Status  

The  Sonolith  i-move  is  cleared  and  available  for  commercial  distribution  in  the European  Union,  Colombia,  Costa  Rica, 
Ecuador, Indonesia, Japan, Malaysia, Mexico, Myanmar, Peru, Russia, Saudi Arabia, Serbia, South Korea, Sudan, Switzerland, Taiwan, 
United Kingdom, United States and Vietnam.  

The ESWL division continues to provide disposables, replacement parts and services for the current installed base of Sonolith 
Praktis, Sonolith Vision and Sonolith i-sys even though we have discontinued the manufacturing of these machines several years ago.  

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ESWL Division Market Potential 

We estimate that roughly 12% of the world population suffers from kidney or ureteric stones during their lifetime. Although 
urinary calculi may be eliminated naturally by the body, natural elimination is frequently accompanied by considerable pain and very 
often by serious complications, such as obstruction and infection of the urinary tract. 

ESWL consists of fragmenting calculi within the body using extracorporeal shockwaves without any surgery. The market for 
lithotripters is mature and has become primarily a replacement and service and maintenance market in most of the world. We believe 
that  companies  with  a  large  installed  base  of  ESWL  lithotripters  can  be  successful  in  maintaining  a  recurring  revenue  stream  from 
maintenance contracts, parts and consumables. We intend to capitalize on our share of the installed base of ESWL systems for this 
recurring revenue.  Several geographical opportunities remain in under-equipped countries and in some countries where the national 
health system strategy is under review for capital equipment at hospitals and clinics. ESWL products are currently facing competition 
from lower priced stone laser systems. To remain competitive, over the past few years we have integrated stone laser products into our 
stone management product portfolio in select markets. 

We  expect  the  ESWL  division  to  continue  to  contribute  to  the  financial  results  with  revenues  from  consumables  and 

maintenance contracts despite the mature nature of this market. See Item 5, “Operating and Financial Review and Prospects.” 

ESWL Division Competition 

The ESWL market is characterized by severe price competition among manufacturers. As a consequence, the average unit price 
of ESWL lithotripters has declined in recent years. The ESWL division expects this trend to continue. See Item 5, “Operating and 
Financial Review and Prospects.” The ESWL division’s major competitors in developed countries are Wolf, Storz Medical and Dornier 
Medtech. 

ESWL Division Sales and Distribution of Products 

The ESWL division markets, sells and services its products through our direct sales and service platform in France, Germany, 
Japan, South Korea, and Malaysia. The ESWL division also markets its products through agents and third-party distributors in several 
other countries. 

The ESWL division’s customers are located worldwide and have historically been mainly public and private hospitals and 
urology clinics. We believe that the division’s customer base provides it with excellent access to the urological community and enables 
to continue marketing its ESWL products under satisfactory conditions. 

No single customer of the ESWL division represents a significant portion of the division’s installed base. The ESWL division’s 

marketing efforts include the organization of training programs for urologists worldwide. 

Distribution Division 

The Distribution division is engaged in the marketing, distribution and servicing of products complementary to the rest of our 
product portfolio such as micro-ultrasound systems, lasers and other medical products from third party manufacturers. The Distribution 
division contributed €29.9 million to our consolidated net sales during the fiscal year ended December 31, 2023. 

Distribution Division Business Strategy 

The Distribution division’s business strategy is to generate revenues from the marketing and distribution of medical devices 
for the minimally invasive diagnosis or treatment of urological disorders and other various clinical indications. These products include 
the ExactVu 29 MHz Micro-ultrasound system and advanced surgical lasers from various companies. The Distribution division also 
generates revenues from system leases, as well as from the sale of disposables, spare parts and maintenance contracts for equipment 
sold under the Distribution division. 

We  have  engaged  in  exclusive  distribution  agreements  with  third  parties  to  distribute  and  service  their  products  in  certain 

territories, under specific conditions. 

The  Distribution  division  strategy  includes  the  distribution  of  products  that  bring  synergies  and  are  complementary  to  our 
existing internally developed technologies. In May 2020, we signed an exclusive worldwide distribution agreement with Exact Imaging 

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Inc. a Canadian company and developer of high-resolution micro-ultrasound imaging technologies. In December 2023, we renewed this 
agreement.  Under the terms of the agreement, we market the ExactVu micro-ultrasound diagnostic systems alongside our Focal One. 
ExactVu Micro-ultrasound technology complements the Focal One Robotic HIFU technology. ExactVu offers advanced technology for 
performing biopsies and diagnosing prostate cancer. By marketing the two technologies, EDAP offers urologists a complete solution 
for focal prostate cancer management, with full autonomy and capabilities from diagnosis to treatment.  

Distribution Division Products 

The Distribution division distributes the ExactVu system. Like Magnetic Resonance Imaging (“MRI”), it allows urologists to 
visualize and locate suspicious regions within the prostate and target biopsies in real time. The ExactVu system also includes FusionVu. 
In cases where an MRI of the prostate is available, FusionVu allows for the quick import, alignment and targeting of MRI-identified 
lesions. After the MRI image is imported via FusionVu, ExactVu’s 70 micron, real-time resolution allows physicians to precisely target 
lesions. 

The Distribution division distributes in France Lumenis® Holmium lasers for Holmium Enucleation of the Prostate  marketed 
by Boston Scientific under an exclusive agreement. Lumenis Pulse™ lasers with Moses™ technology is a patent-protected pulse delivery 
technology that remarkably improves energy transmission, resulting in more efficient lithotripsy and BPH treatments compared to the 
regular laser. Our distribution contract with Boston Scientific expires on December 31, 2024. The Distribution division also exclusively 
markets various Quanta Laser Systems in Japan. Our distribution contract in Japan expires in December 2024.   

The  Distribution  division,  through  our  Japanese  subsidiary,  exclusively  distributes  urology  products  of  Laborie  Medical 
Technologies (“Laborie”), including Urodynamic equipment, Uroflow, and a range of disposable products in Japan. The Distribution 
contract with Laborie expires on March 31, 2024. Laborie is the world leader of Urodynamic systems and disposables which are used 
by  urologists  and  gynecologists  to  diagnose  lower  urinary  tract  functions.  Our  Japanese  subsidiary  also  distributes  X-ray  imaging 
systems for the diagnosis of musculoskeletal pathologies and orthopedic surgical care in Japan on behalf of EOS Imaging. Our Japanese 
also exclusively distributes urology accessories on behalf of Rocamed and Hugemed in Japan. 

Manufacturing 

Our current manufacturing operations consist of assembling medical products in our facility, which is FDA-registered and 
certified under international ISO 13485: 2016 standard and MDSAP program. We manufacture our own products through our operational 
subsidiary, EDAP TMS France. 

We  perform  final  assembly  and  quality  control  processes  and  maintain  production  standards.  We  purchase  most  of  the 
components used in our products from several suppliers, but for some components of our products, we rely on a single source. Most of 
our components are secured by contract or dual sourcing manufacturing strategies. Furthermore, we conduct regular quality audits of 
suppliers’ manufacturing facilities. Our principal suppliers are located in France, Germany, Denmark and the United States. To date, 
our procurement and manufacturing strategy has not led to any material impacts on our ability to deliver systems and services to our 
customers. Management believes that the relationships with our suppliers at the current time are good. 

Suppliers  provide  us  with  some  key  materials  and  components  which  can  expose  us  to  the  risk  of  a  supply  shortage, 
obsolescence or interruption if these suppliers are unable to manufacture our products in line with our quality standards or encounter 
other challenges.  We recently renegotiated a supply agreement with a key supplier of ultrasound components for our HIFU systems as 
prices increased dramatically following a major shift in our supplier’s marketing strategy. We are constantly developing alternative 
options to maintain our product offering, while considering regulatory and cost constraints. We also have experienced difficulties in 
obtaining some materials or components used in our systems, including electronic parts, computers, plastics, mechanical parts due to 
supply shortage directly linked to logistics challenges as well as Asian manufacturing plants’ capacity constraints. In order to address 
these risks, we have put in place safety stock and have modified our order management for long lead time critical components. See Item 
3. “Risk Factors—Worldwide contagious, epidemic diseases may impact our international activities and could have a material adverse 
effect on our business, results of operations and financial condition.”   

Quality and Design Control 

The  manufacturing  operations  of  EDAP  TMS  France  must  comply  with  all  regulations  of  countries  where  we  market  our 
products,  including  the  GMP  regulations  enacted  by  the  FDA,  which  establish  requirements  for  assuring  quality  by  controlling 
components, processes and document traceability and retention, among other things. EDAP TMS France’s facilities are also subject to 
inspections performed by the FDA. EDAP TMS France is ISO 13485: 2016 and MDSAP certified which indicates compliance by EDAP 
TMS France’s manufacturing facilities with international standards for quality assurance, design and manufacturing process control. 

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EDAP TMS France also complies with the applicable requirements that will allow it to affix the CE Marking to certain of its products. 
Our manufacturing site also complies with Taiwanese, Japanese, Canadian, Australian, Brazilian and South Korean regulations, as well 
as with the U.S. Quality System Regulation. See “—Government Regulation—Healthcare Regulation in the United States” and “—
Government Regulation—Healthcare Regulation in the European Union.” 

Organizational Structure 

The following table sets forth the fully consolidated subsidiaries of the Company as of the date of this annual report: 

Name of the Company 
EDAP TMS France SAS 
EDAP Technomed Inc. 
EDAP Technomed Co. Ltd 
EDAP Technomed Sdn Bhd 
EDAP TMS GmbH 

Jurisdiction of  
      Establishment 

France 
   United States    
Japan 
Malaysia 
Germany 

     Percentage Owned(1)   
 100 % 
 100 % 
 100 % 
 100 % 
 100 % 

(1)  Percentage of equity capital owned by EDAP TMS S.A. directly or indirectly through subsidiaries (percentage of capital owned and voting rights are the 

same). 

Property and Equipment 

We have one main facility, which is in Vaulx-en-Velin, near Lyon, France. The premises comprise 4,150 square meters and 
are leased to us under a renewable ten-year commercial lease agreement which became effective on July 1, 2015. At the current time, 
we are still evaluating whether to renew the lease in 2025 or not. We use this facility to manufacture our medical device systems and 
consumables. We believe the terms of the lease reflect current market rates. We are not aware of any environmental issues that could 
affect utilization of the facility.  

In addition, we lease office and/or warehouse facilities in Kuala Lumpur (Malaysia), Flensburg (Germany), Austin, Texas and 
Los Altos, California (U.S.), Seoul (South Korea), Fukuoka, Osaka, Sapporo and Tokyo (Japan). Our representative office in Moscow 
(Russia) was closed in early 2023. 

Government Regulation 

Government regulation in our major markets, particularly the United States, the European Union and Japan, is a significant 
factor in the development and marketing of our products and in our ongoing research and development activities. Our products and 
operations are subject to regulation by the FDA and countries where we market our products.  We must meet the requirements governing 
the design, manufacture, sourcing, testing, certification, packaging, installation, use, and disposal (including recycling) of our products. 
See Item 3, “Risk Factors—Risks Related to Government Regulations.” 

Regulation in the United States 

Our  products  are  regulated  in  the  United  States  by  the  FDA  under  several  statutes  including  the  Federal  Food,  Drug  and 
Cosmetic Act (FDC Act). Pursuant to the FDC Act, the FDA regulates the preclinical and clinical testing, manufacturing, labeling, 
distribution, sale, marketing, advertising and promotion of medical devices in the United States. Medical devices are classified in the 
United  States  into  one  of  three  classes -  Class I, II  or  III -  based  on  the  controls  reasonably  necessary  to  ensure  their  safety  and 
effectiveness. Class I devices are those whose safety and effectiveness can be ensured through general controls, such as establishment 
registration, medical device listing, FDA-mandated CGMP and labeling. Most Class I devices are exempt from premarket notification 
(510(k)).  Class II  devices  are  those  whose  safety  and  effectiveness  can  reasonably  be  ensured  using  general  controls  and  “special 
controls”,  such  as  special  labeling  requirements,  mandatory  performance  standards,  and  post-market  surveillance.  Class II  medical 
devices typically require 510(k) submission and clearance based on a demonstration of substantial equivalence to an identified predicate 
device. A successful 510(k) may also require the submission of clinical data as part of the 510(k) for some Class II devices. For novel 
devices that present low to moderate risk but where there is no suitable predicate device to support a standard 510(k) submission, the 
FDA has what is known as the De Novo process. Class III devices are those that require submission of a pre-market approval (PMA) 
application by the FDA to ensure their safety and effectiveness. The PMA process is expensive and often lengthy, typically requiring 
several years, and may not necessarily result in approval. The manufacturer or the distributor of the device must obtain an IDE approval 
from the FDA before commencing human clinical trials in the United States in support of the PMA. Some newer PMA devices must 

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also go before an advisory committee before FDA approval. Our lithotripsy range of Sonolith i-move products is now classified by the 
FDA as Class II devices. Our Ablatherm and Focal One HIFU devices are also classified as Class II. 

The FDC Act also regulates quality and manufacturing procedures by requiring us to demonstrate and maintain compliance 
with current Quality System Regulations (QSR). We believe our manufacturing facilities follow the requirements of the QSR. There are 
also certain requirements of state, local and foreign governments which must be complied with in the manufacturing and marketing of 
our products. We believe that the manufacturing and quality control procedures we employ meet the requirements of these regulations. 

Advertising and promotional activities in the United States are subject to regulation by the FDA and by the U.S. Federal Trade 

Commission. 

Regulation in the European Union 

In  the  European  Union,  we  annually  perform  ISO  13485:  2016  and  MDSAP  (Australia,  Brazil,  Canada,  Japan,  U.S.) 

certification audits, showing that we comply with standards for quality assurance, manufacturing and design control. 

In 2017, the European Union enacted the new Medical Device Regulation (“MDR”). Manufacturers with currently approved 
medical devices in their portfolio had an initial transition time of three years, i.e. until May 26, 2020, to meet new MDR requirements. 
The transition period was extended to four years, i.e. until May 26, 2021, due to COVID-19 pandemic context. An amendment to modify 
the  transitional  provisions  has  been  adopted.  The  schedule  is  defined  based  on  the  MDR  classification  of  devices  with  a  updated 
application date of December 31, 2028. The extension of the period during which the devices can be placed on the market is subject to 
certain terms and conditions. To benefit from the new provisions, the manufacturer must implement and maintain a Quality Management 
System that complies with MDR requirements before May 26, 2024. This MDR introduces substantial changes to the way medical 
device manufacturers bring their devices to the European market and how they maintain compliance throughout the product’s life cycle. 
This MDR will replace the EU’s current Medical Device Directive (93/42/EEC) (MDD). We are currently updating our organization 
and quality system as well as our product development to be able to handle the MDR enforcement within the expected timelines for our 
existing  devices  ranges  and  the  devices  under  development.  We  have  implemented  regulatory  actions  to  ensure  our  devices  can  be 
marketed in the European and international markets to conform to this MDR, if applicable. 

The MDD and the MDR provide that medical devices that meet certain safety standards must bear a certification of conformity, 
the European Community approval “CE Marking”. Except in limited circumstances, member states of the European Union may not 
prohibit or restrict the sale, free movement or use for its intended purpose of a medical device bearing the CE Marking. Medical devices 
marketed throughout the European Union must comply with the requirement of the MDD and MDR as applicable to bear a CE Marking 
(subject to certain exceptions). 

Pursuant  to  the  MDD  and  MDR,  medical  devices  are  classified  into  different  classes  based  on  their  invasiveness  and  the 
duration of their use. This classification serves as a basis for determining the conformity assessment procedures that apply to medical 
devices that are eligible to receive a CE Mark. The conformity assessment procedures for Class I devices can be carried out, generally, 
under the sole responsibility of the manufacturer, while for devices of other classes, the involvement of a notified body is required. The 
extent of the involvement of such a body in the development and manufacturing of a device varies according to the class under which it 
falls, with Class III devices being subject to the greatest degree of supervision. All of the devices currently marketed by us are Class I, IIa 
and IIb devices. 

Regulation in Japan 

The import and sales of medical devices in Japan is regulated by the Japanese Ministry of Health, Labor and Welfare (MHLW). 
Our Japanese subsidiary has obtained a license as the “Marketing Authorization Holder” as well as specific marketing approvals to 
import and market our products in Japan. Our Japanese subsidiary is also operating as a “Designated Marketing Authorization Holder” 
on behalf of some companies to market their products in the Japanese Territory. The MHLW also administers various national health 
insurance programs to which each Japanese citizen is required to subscribe. These programs cover, among other things, the cost of 
medical devices used in operations. The MHLW establishes a list of reimbursable prices applicable to certain medical devices under the 
national health insurance programs. Until a new device is included in this list,  its costs are not covered by the programs. The Sonolith 
Praktis, the Sonolith Vision, the Sonolith i-sys and the Sonolith i-move are all included on the MHLW’s list for reimbursement. 

Human Capital 

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Overview 

As of December 31, 2023, we had 307 employees. We have never experienced a work stoppage or interruption due to labor 

disputes. We believe our relations with our employees are good. 

Employee Talent and Retention 

Our business and future operating results are dependent upon the continued contributions of our senior management and other 
key personnel with medical device experience. Our ability to continue to attract and retain qualified management, operations, processing, 
marketing, sales, and support personnel for our operations is important to our continued success. 

We have programs and processes in place to help ensure that our compensation, benefits programs, and work environment 
attract and retain such personnel, and we strive to enhance those programs and processes to respond to the increasingly competitive 
market for talent. We also strive to offer competitive equitable pay, comprehensive benefits, and services that retain and meet the varying 
needs of our employees. The main purpose of our equity and cash incentive plans and non-officer incentive plans are to attract, retain, 
motivate, and reward our employees. 

Culture 

Fostering and maintaining a strong and collaborative culture is a key component of our strategy. We also have policies that 
instill  a  commitment  to  ethical  behavior  and  legal  compliance  across  our  company.  Employees  are  encouraged  to  approach  their 
managers  if  they  believe  violations  of  policies  have  occurred.  Employees  may  also  report  any  such  violations  confidentially  and 
anonymously through our whistleblower policy. 

Diversity and Inclusion 

We  believe  that  a  culture  of  diversity  and  inclusion  enables  us  to  create,  develop,  and  fully  leverage  the  strengths  of  our 
workforce to achieve our business objectives. We strive to provide equal opportunity to all applicants and employees, including those 
from diverse backgrounds. We believe that bringing together different perspectives and experiences is fundamental to our future growth 
and success.  

Training and Development 

We  provide  internal  training  and  development  programs  to  employees  globally.  Such  programs  include  leadership 

development, office safety, ethics, and various skill-based training programs. 

Health and Safety 

Protecting the health, safety, and well-being of our employees around the world is a top priority. Throughout the COVID-19 
pandemic, we enhanced our focus on the health and safety of our employees by implementing and enforcing certain COVID-related 
safety protocols. We provided employees with protective equipment, required the wearing of masks, increased cleaning procedures, 
provided cleaning supplies, implemented remote work where possible, enhanced our IT systems to facilitate remote work, and improved 
our  cybersecurity  protocols.  While  a  number  of  these  protocols  were  lessened  or  eliminated  upon  the  waning  of  the  COVID-19 
pandemic, we continue to look for opportunities to provide a safer, healthier, work environment for our employees. 

Item 4A. Unresolved Staff Comments 

None. 

Item 5. Operating and Financial Review and Prospects  

The  following  discussion  of  our  results  of  operations  and  liquidity  and  capital  resources  for  the  fiscal years  ended 
December 31, 2023 and 2022 is based on, and should be read in conjunction with, our consolidated financial statements and the notes 

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thereto included in Item 18, “Financial Statements.” The consolidated financial statements have been prepared in accordance with U.S. 
GAAP. 

The following discussion contains certain forward-looking statements that involve risks and uncertainties. Actual results may 
differ  materially  from  those  contained  in  such  forward-looking  statements.  See  “Cautionary  Statement  on  Forward-Looking 
Information” at the beginning of this annual report. 

Critical Accounting Estimates 

Management has not identified any estimates made in accordance with generally accepted accounting principles that involve a 
significant level of estimation uncertainty and have had or are reasonably likely to have a material impact on the financial condition or 
results of operations of the registrant. 

Operating Results 

Overview 

Our activities are organized into three divisions: HIFU, ESWL and Distribution.  

Total revenues of the Company include sales of our medical devices and sales of disposables (“sales of goods”), sales of RPPs 

and leases, and sales of spare parts and services, all net of commissions, as well as other revenues. 

Sales of goods have historically been comprised of net sales of medical devices (HIFU devices, ESWL lithotripters and other 
third-parties  devices)  and  net  sales  of  disposables  (mostly  Focalpaks  in  the  HIFU  division,  electrodes  in  the  ESWL  division  and 
disposables  from  third-parties’  devices  marketing  by  the  Distribution  division).  The  sale  price  of  our  medical  devices  is  subject  to 
variation based on a number of factors, including market competition, warranties and payment terms. Consequently, a particular sale of 
a medical device may, depending on its terms, result in significant fluctuations in the average unit sale price of the product for a given 
period, which may not be indicative of a market trend. 

Sales of RPP and leases mainly include the revenues recording in the HIFU division from the sale of Focal One treatment 
procedures and from the leasing Focal One devices or treatment probes. We provide Focal One systems to clinics and hospitals for free 
for a limited period, rather than selling the systems. These hospitals and clinics perform treatments using the systems and usually pay 
us based on the number of individual treatments provided. With this business model, the hospital or clinic does not make an initial 
investment until the increase in patient demand justifies the purchase of a HIFU device. Consequently, we are able to make Focal One 
treatments available to a larger number of hospitals and clinics, which we believe should serve to create more long-term interest in the 
product. Compared to the sale of systems, this business model initially generates a smaller, although more predictable stream of revenue 
and, if successful, should lead to more purchases of Focal One systems by hospitals and clinics in the long term. 

Regarding sales of lithotripters as recorded in our ESWL division, we believe that the market for ESWL lithotripters is mature 
and has become primarily a replacement and maintenance market, with intense competition. As a result, we expect total market volumes 
for  our  ESWL  division  to  remain  stable  in  the  foreseeable  future.  In  addition,  following  the  discontinuation  of  our  Sonolith  i-sys 
lithotripter in 2020 and of our developments in lithotripsy, including the development of our Endo-UP platform, our ESWL revenues 
will be mainly stemming from sales of Sonolith i-move lithotripters as well as revenues from sales of maintenance contracts and spare 
parts. 

Revenues  recorded  in  our  Distribution  division  include  sales  of  complementary  products  such  as  lasers,  micro-ultrasound 

systems and other products from third parties, including the associated disposables and maintenance contracts. 

Sales of spare parts and services include revenues arising from maintenance services furnished by us for the installed base of 

ESWL lithotripters, HIFU systems and complementary products from third parties. 

We derive a significant portion of both net sales of medical devices and disposables and net sales of spare parts and services 
from  our  operations  in  Asia,  through  our  wholly-owned  subsidiaries  or  representative  offices  in  Japan  (Edap  Technomed  Co.  Ltd), 
Malaysia  (Edap  Technomed  Sdh  Bhd)  and  South  Korea  (Edap  Technomed  Korea).  Net  sales  derived  from  our  operations  in  Asia 
represented 30% of our total consolidated net sales in 2023. Net sales of goods in Asia represented 33% of such sales in 2023 and 
consisted mainly of sales of urology devices and disposables. Net sales of spare parts, supplies and services in Asia represented 33% of 
such sales in 2023 and related primarily to ESWL lithotripters. We also derive a significant portion of net sales of medical devices and 
disposables from our operations in the U.S., through our wholly owned subsidiary (Edap Technomed. Inc). Net sales derived from our 

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operations in the U.S. represented 28% of our total consolidated net sales in 2023. Net sales of goods in the U.S. represented 29% of 
such  sales  in  2023  and  consisted  mainly  of  sales  of  urology  devices  and  disposables.  See  Note 18  of  our  consolidated  financial 
statements. We sell our products in many parts of the world and, as a result, our business is affected by fluctuations in currency exchange 
rates.  We  are  exposed  to  foreign  currency  exchange  rate  risk  because  the  mix  of  currencies  in  which  our  costs  are  denominated  is 
different from the mix of currencies in which we earn revenues. In 2023, 60% of our costs of sales and research and development, 
selling, marketing and general and administrative expenses were denominated in euro, while 55% of our sales were denominated in 
currencies other than euro (primarily the U.S. Dollar and Japanese yen). Our operating profitability could be materially affected by large 
fluctuations in the rate of exchange between the euro and such other currencies. To minimize our exposure to exchange rate risks, we 
sometimes use certain financial instruments for hedging purposes. See Item 3, “Risk Factors—We sell our products in many parts of the 
world and, as a result, our business is affected by fluctuations in currency exchange rates” and Item 11, “Quantitative and Qualitative 
Disclosures About Market Risk” for a description of the impact of foreign currency fluctuations on our business and results of operations. 

Reserves for slow-moving and obsolete inventory are determined based upon quarterly reviews of all inventory items. Items 
which are not expected to be sold or used in production, based on management’s analysis, are written down to their net realizable value, 
which is their fair market value or zero in the case of spare parts or disposable parts for systems that are no longer in commercial 
production. 

Consolidated research and development expenses include all costs related to the development of new technologies and products 
and  the  enhancement  of  existing  products,  including  the  costs  of  organizing  clinical  trials  and  of  obtaining  patents  and  regulatory 
approvals. We do not capitalize any of our research and development expenses, except for the expenses relating to the production of 
machines to be used in clinical trials and that have alternative future uses as equipment or components for future research projects. 

Consolidated research and development expenses, as described above, amounted to €7.0 million and €4.9 million in 2023 and 
2022, respectively, representing 11.5% and 8.9% of total revenues in 2023 and 2022, respectively. This increase was mainly driven by 
our HIFU development programs and clinical studies. Research and development government grants and tax credits are deducted from 
our  consolidated  research  and  development  expenses  for  amounts  of  €0.6  million  and  €0.8  million  in  2023  and  2022,  respectively. 
Beginning in 2024, management expects the budget for research and development expenses to increase to 11.9% of total revenues, 
which we expect will allow us to maintain our strategy to launch new clinical studies (thus strengthening our clinical credibility), to 
continue  to  focus  our  efforts  on  obtaining  regulatory  approvals  in  Japan  in  particular,  and  to  build  reimbursement  coverage  in  key 
countries and particularly in the U.S., to continue to develop our HIFU product range and to fund projects to expand the use of HIFU 
beyond the treatment of prostate cancer. 

Consolidated selling and marketing expenses amounted to €22.6 million in 2023 and €16.4 million in 2022. The €6.2 million 
or 38.1% increase in selling and marketing expenses from 2022 to 2023 was primarily a result of the implementation of the HIFU 
expansion plan in the U.S. which includes the impact of share-based compensation plans of €1.8 million in 2023 and €1.0 million in 
2022. Beginning in 2024, management expects selling and marketing expenses to increase in connection with the acceleration of HIFU 
adoption in the U.S. 

Consolidated general and administrative expenses increased €7.5 million or 104.6% to €14.6 million in 2023, reflecting the 
impact of the HIFU expansion plan in the U.S., which includes the impact of share-based compensation plans for €2.9 million in 2023 
and non-recurring expenses linked to the leadership succession plan for €3.4 million in 2023, which includes the impact of share-based 
compensation  plan  for  €1.3  million.    Beginning  in  2024,  management  expects  general  and  administrative  expenses  to  increase  in 
connection with the development of the U.S. subsidiary.  

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Fiscal Year Ended December 31, 2023 Compared to Fiscal Year Ended December 31, 2022 

We report our segment information on a “net contribution” basis. See Note 29 to our consolidated financial statements. 

(in millions of euros) 
Total revenues 
Total net sales 

Of which HIFU 
Of which ESWL 
Of which DISTRIBUTION 

Total cost of sales 
Gross profit 
Gross profit as a percentage of total net sales 
Total operating expenses 
Income (loss) from operations 
Net income (loss) 

Total revenues 

2023 

2022 

60.4   
60.4   
20.6   
9.9   
29.9   
(36.0)   
24.4   
 40.40 %   
(44.2)   
(19.8)   
(21.2)   

55.1  
55.1  
15.6  
11.6  
27.9  
(30.9)  
24.2  
 43.90 % 
(28.5)  
(4.3)  
(2.9)  

Our total revenues increased 9.6% from €55.1 million in 2022 to €60.4 million in 2023. 

HIFU division. 

The HIFU division’s total revenues increased by 31.7% from €15.6 million in 2022 to €20.6 million in 2023, reflecting mainly 

the development of equipment sales and treatment-driven revenue in the U.S. 

The HIFU division’s net sales of medical devices increased 39.3% to €9.8 million in 2023, with twenty-one Focal One units 
sold (including fifteen in the U.S.), as compared to €7.0 million, with fifteen Focal One units sold in 2022 (including thirteen in the 
U.S). 

Treatment-driven revenue, which includes net sales of RPP & leases, net sales of disposables and treatments related services, 

increased by 30.0% to €9.1 million in 2023. 

Net sales of HIFU maintenance services increased by 6.9% to €1.8 million in 2023. 

ESWL division. 

The ESWL division’s total revenues decreased 14.3% from €11.6 million in 2022 to €9.9 million in 2023, primarily due to the 

decrease in sale of equipment. 

The ESWL division’s net sales of medical devices decreased 27.7% from €3.9 million in 2022 to €2.8 million in 2023 with 16 

ESWL devices sold in 2023 compared to 22 ESWL units sold in 2022. 

Net sales of ESWL-related consumables, spare parts, supplies, RPP, leasing and services decreased 7.6% from €7.7 million in 

2022 to €7.1 million in 2023 reflecting the mature nature of the market. 

Distribution division. 

The Distribution division’s total revenues increased 7.2% from €27.9 million in 2022 to €29.9 million in 2023, primarily due 

to the increase of consumables and maintenance revenues linked to the development of the installed base. 

The Distribution division’s net sales of medical devices decreased 1.2% from €15.8 million in 2022 to €15.6 million in 2023. 

We sold 46 ExactVu units in 2023, as compared to 47 in 2022. 

Net sales of Distribution-related consumables, spare parts, supplies, leasing and services increased 18.2% from €12.1 million 

in 2022 to €14.4 million in 2023, reflecting the growth of the installed base. 

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Cost of sales. 

Cost of sales increased 16.5% from €30.9 million in 2022 to €36.0 million in 2023, and represented 59.6% as a percentage of 
net sales in 2023, up from 56.1% as a percentage of net sales in 2022. This effect was primarily due to distribution product mix, global 
inflationary price pressure on components which increased manufacturing costs, and continued investments in our U.S. service  and 
clinical application organizations to support HIFU and long-term revenue growth.  

Operating expenses. 

Operating expenses increased 55.4%, or €15.8 million, from €28.5 million in 2022 to €44.2 million in 2023. 

Marketing and sales expenses increased €6.2 million, or 38.1% to €22.6 million in 2023, reflecting the impact of the HIFU 

expansion plan in the U.S., which includes the impact of share-based compensation plans for €0.8 million in 2023. 

Research and development expenses increased 41.5% at €7.0 million in 2023 from €4.9 million in 2022. R&D expenses are 
net of R&D grants and tax credits of €0.6 million in 2023 and €0.8 million in 2022. This increase was mainly driven by the increase in 
research and development activities associated with our HIFU development programs and clinical studies. 

General and administrative expenses increased €7.5 million or 104.6% to €14.6 million in 2023, reflecting the impact of the 
HIFU  expansion  plan  in  the  U.S.,  which  includes  the  impact  of  share-based  compensation  plans  for  €2.9  million  in  2023  and  non-
recurring  expenses  linked  to  the  leadership  succession  plan  for  €3.4  million  in  2023,  which  includes  the  impact  of  share-based 
compensation plan for €1.3 million.  

Operating profit (loss). 

As a result of the factors discussed above, particularly the expansion of our activities in the U.S. to accelerate HIFU adoption, 
we recorded a consolidated operating loss of €19.8 million in 2023, as compared to a consolidated operating loss of €4.3 million in 
2022. 

We realized an operating loss in the HIFU division of €14.8 million in 2023, as compared with an operating loss of €4.9 million 
in 2022, an operating loss in the ESWL division of €0.2 million in 2023, as compared to an operating profit of €0.9 million in 2022, and 
an operating loss in the Distribution division of €0.2 million in 2023, as compared to an operating profit of €2.0 million in 2022. 

Financial (expense) income, net. 

Net financial income was €1.1 million in 2023, compared with a net financial income of €0.2 million in 2022. 

The financial income was mainly generated by short-term deposits. 

Foreign currency exchange gain (loss), net. 

In 2023, we recorded a net foreign currency exchange loss of €1.8 million, mainly due to the variation of the Euro against the 

U.S. Dollar, compared to a gain of €1.9 million in 2022. 

Income taxes. 

Income tax was an expense of €0.6 million in 2023, compared to an expense of 0.8 million in 2022.  

Net income / (loss). 

As a result of the above, we realized a consolidated net loss of €21.2 million in 2023 compared with a consolidated net loss of 

€2.9 million in 2022. 

For comparison between the fiscal year ended December 31, 2022 and the fiscal year ended December 31, 2021, please refer 

to our report on Form 20-F filed with the SEC on April 7, 2023.  

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Effect of Inflation 

In 2022 and 2023, geopolitical instability and other factors have led to higher worldwide inflation leading to a global increase 
in costs. We are constantly addressing this cost increase by mitigating the impact on our margins, in particular by adjusting our prices, 
reducing our costs or implementing counter measures to ensure the minimum residual impact.  

Liquidity and Capital Resources 

Our cash flow has historically been subject to significant fluctuations over the course of any given financial year due to cyclical 
demand for medical devices. Cyclical demand has historically resulted in significant annual and quarterly fluctuations in trade and other 
receivables and inventories, and therefore led to significant variations in working capital requirements and operating cash flows that 
were not necessarily indicative of changes in our business. We believe our working capital is sufficient for our present working capital 
requirements although we have in the past experienced negative cash flows and associated risks to liquidity, and may in the future 
experience the same. Our future capital requirements will depend on many factors including our revenue growth rate, the timing, and 
extent of spending to support further sales and marketing and research and development efforts. Our cash flow situation is described in 
more detail below. 

Material Cash Requirements 

The following table discloses aggregate information about material contractual obligations and periods in which payments were 

due as of December 31, 2023. 

Short-Term Debt 
Long-Term Debt 
Financing Lease Obligations 
Operating Leases Obligations 

Payments Due by Period 
1-

4-

      Total 

 2,466      

    3,551   
 628   
    1,780   

     Less than 1 year      
 2,466      
 1,553   
 201   
 898   

 1,997   
 289   
 725   

 —      
 —   
 83   
 157   

3 years       
 —      

5 years      More than 5 years 
 — 

 55 
 — 

The commitment amounts in the table above are associated with contracts that are enforceable and legally binding and that 
specify  all  significant  terms,  excluding  interest  on  long-term  debt.  Future  events  could  cause  actual  payments  to  differ  from  these 
estimates. 

Long term debts represent a €3.6 million cash requirement as of December 31, 2023 and are mainly related to the two loans 
taken out from French banks, in the form of the loans guaranteed by the French State for a total amount of €4.0 million at inception in 
the context of the Covid-19 pandemic. These loans taken out in August 2020 with initial maturity in August 2021 have been extended 
until August 2026. The amendments provide for reimbursements to be made over four years, beginning in August 2022. 

Operating and Financing leases represent a €2.4 million cash requirement as of December 31, 2023, with a repayment horizon 

up to 2029.  

Cash Flows 

We anticipate that cash flow in future periods will be derived mainly from ongoing operations. As of the date of this annual 
report we do not employ any off-balance sheet financing. Because we anticipate relying principally on cash and cash equivalent balances 

44 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
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to meet our liquidity requirements, a decrease in the demand for our products, or the inability of our customers to meet their financial 
obligations to us due to operating difficulties or adverse market conditions, would reduce the availability of funds to us.  

(in thousands of euros) 
Net cash generated by/(used in) in operating activities 
Net cash generated by/(used in) in investing activities 
Net cash generated by/(used in) in financing activities 
Net effect of exchange rate changes 
Net increase/(decrease) in cash and cash equivalents 
Cash and cash equivalents at the beginning of the year 
Cash and cash equivalents at the end of the year 

2023 
 (14,678)   
 (4,344)   
 (911)   
 268   
 (19,665)   
 63,136   
 43,471   

2022 
 (3,024) 
 (2,378) 
 21,741 
 (388) 
 15,952 
 47,183 
 63,136 

Our cash position as of December 31, 2023 and 2022 was €43.5 million (with no short-term treasury investments) and €63.1 
million (with no short-term treasury investments), respectively. We experienced a decrease in cash and cash equivalent of €19.7 million 
in 2023 and an increase of €16.0 million in 2022. 

In 2023, our negative net cash flow was primarily due to net cash used in operating activities of €14.7 million and in investing 

activities of €4.3 million.  

In 2022, our positive net cash flow was primarily due to net cash generated by financing activities which included net proceeds 
of the offering of common stock in the form of ADSs in September 2022 for €22.0 million. See Item 4, “Information on the Company—
History and Development of the Company”.  

In 2023, net cash used in operating activities was €14.7 million compared with net cash used in operating activities of €3.0 

million in 2022. 

In 2023, net cash used in operating activities reflected principally: 

a net loss of €21.2 million; 
elimination of €9.4 million of net loss without effects on cash, including €1.9 million of depreciation and amortization, €0.4 
million of change in allowances for doubtful accounts & slow-moving inventories and €0.2 million of change in long term 
provisions ; and €6.9 million of non-cash compensation linked to stock-based compensation plans and free shares; and 
an increase in working capital of €2.9 million primarily reflecting the increase in inventory and trade receivables linked to the 
higher level of sales. 

In 2022, net cash used in operating activities reflected principally: 

a net loss of €2.9 million; 
elimination of €4.2 million of net loss without effects on cash, including €1.6 million of depreciation and amortization, €0.1 
million of change in allowances for doubtful accounts & slow-moving inventories and €0.3 million of net capital loss on disposals 
of assets; and €2.1 million of non-cash compensation linked to stock-based compensation plans and free shares; and 
an increase in working capital of €4.3 million primarily reflecting the increase in inventory and trade receivables linked to the 
higher level of sales. 

- 
- 

- 

- 
- 

- 

In 2023, net cash used in investing activities was €4.3 million compared with net cash used in investing activities of €2.4 

million in 2022.  

Net cash used in investing activities of €4.3 million in 2023 reflected mainly: 

- 

- 

- 

investments of €2.6 million in capitalized assets produced by the Company including devices for RPP and lease activity (€0.8 
million), HIFU treatments probes (€1.5 million) and R&D programs (€0.4 million) ;  
investment of €1.2 million in property and equipment (including €0.3 million of laser and ExactVu equipment for demo, €0.7 
million for IT, offices and industrial equipment and €0.1 million for vehicles); and 
investment of €0.5 million in intangible assets (licences and development of IT softwares). 

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Net cash used in investing activities of €2.4 million in 2022 reflected mainly: 

- 

- 

investments of €1.6 million in capitalized assets produced by the Company including devices for RPP activity (€0.3 million) and 
HIFU treatments probes (€1.2 million); and 
investment of €0.6 million in property and equipment (including €0.2 million of laser equipment for demo or RPP, €0.3 million 
for IT and offices equipment and €0.1 million for vehicles). 

In 2023, net cash used in financing activities was €0.9 million compared with net cash generated by financing activities of 

€21.7 million in 2022. 

Net cash used in financing activities of €0.9 million in 2023 reflected principally the net proceeds of €0.3 million from the 
exercise of stock options, the repayments of long-term borrowings and financing lease for €1.8 million and an increase of short-term 
borrowings of €0.7 million. 

Net cash generated by financing activities of €21.7 million in 2022 reflected principally the net proceeds of €22.0 million from 
the  offering  of  common  stock  in  the  form  of  ADSs  in  September  2022  (see  Item 4,  “Information  on  the  Company—History  and 
Development of the Company”), €0.7 million from the exercise of stock options, new long term borrowings for €0.3 million (composed 
of a loan in France to finance HIFU treatment probes), the repayments of long-term borrowings and financing lease for €1.2 million. 

Our policy is that our treasury department should maintain liquidity with the use of short-term borrowings and the minimal use 
of long-term borrowings. The treasury department currently adheres to this objective by using fixed-rate debt, which normally consists 
of long-term borrowing. Currently the short-term debt consists of account receivables factored and for which the Company is supporting 
the  collection  risk.  We  maintain  bank  accounts  for  each  of  our  subsidiaries  in  the  local  currencies  of  each  subsidiary.  The  primary 
currencies in which we maintain balances are the euro, the U.S. dollar and the Japanese yen. To minimize our exposure to exchange rate 
risks,  we  may  use  certain  financial  instruments  for  hedging  purposes  from  time  to  time.  As  of  December 31, 2023,  there  were  no 
outstanding hedging instruments. See Notes 13 and 14 to the consolidated financial statements for further information on our borrowings. 

Recent Accounting Pronouncements 

See  “Note 1.  Summary  of  Significant  Accounting  Policies —1.25  Recent  Accounting  Pronouncements”  of  the  Notes to 
consolidated  financial  statements  for  a  description  of  recent  accounting  pronouncements  including  the  respective  expected  dates  of 
adoption and estimated effects, if any, on our Consolidated Financial Statements. 

Research and Development, Patents and Licenses 

See Item 5, “Operating and Financial Review and Prospects—Operating Results—Overview” and Item 4, “Information on the 
Company—HIFU Division—HIFU Division Patents and Intellectual Property” and “Information on the Company—ESWL Division—
ESWL Division Patents and Intellectual Property.” 

The French government provides tax credits to companies for innovative research and development. This tax credit is calculated 

based on a percentage of eligible research and development costs and it is refundable in cash. 

Off-Balance Sheet Arrangements 

At December 31, 2023, we had no off-balance sheet arrangements. 

Item 6. Directors, Senior Management and Employees 

Senior Management  

The following table sets forth the name, age and position of each of our senior executive officers as of March 15, 2024 (the 
“Senior Management”). The Senior Management listed below have entered into employment contracts with us or our subsidiaries (which 
permit the employee to resign subject to varying notice periods). In addition, in case of a change of control of the Company, or of a 
termination of their employment contract by the Company without cause, the Senior Management are entitled to receive severance 
packages totaling €1.5 million. 

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Name 

Ryan Rhodes  
Age: 62 

Ken Mobeck 
Age: 53 

François Dietsch 
Age: 47 

Position 

Chief Executive Officer of EDAP TMS S.A. 
Member of the Board of Directors 
Chief Executive Officer of EDAP Technomed Inc.  
Mr. Ryan Rhodes was appointed as Chief Executive Officer of the Company in May 
2023. Mr. Rhodes was appointed as a member of the Board of Directors in August 
2023. Mr. Rhodes has over 30 years of leadership experience in market development 
in the medical device industry, including 20 years dedicated to medical robotics.  Prior 
to joining EDAP, Mr. Rhodes served as the Chief Executive Officer of Restoration 
Robotics, a global leader in robotic aesthetic medicine, where he led the company to 
a successful merger with Venus Concept Inc. in 2019.  Prior to Restoration Robotics, 
Mr.  Rhodes  spent  over  13  years  at Intuitive  Surgical,  the  global  leader  in  medical 
robotics, where he was a key architect of the company’s multi-procedure market focus 
and  development  efforts,  including  the  successful  launch  of  the  global  Urology 
franchise.  Prior to Intuitive Surgical, he spent over 11 years in various management 
positions  in  sales,  marketing,  professional  education,  and  market  development 
at Ethicon Inc., a Johnson & Johnson Company.  Mr. Rhodes holds a B.A in Public 
Administration from San Diego State University. 

Chief Financial Officer of EDAP TMS S.A. 
Ken  Mobeck  was  appointed  as  the  Company’s  Chief  Financial  Officer  in  January 
2024. Prior to that position, Mr. Mobeck held the position of Chief Financial Officer 
of  EDAP’s  U.S.  subsidiary  since  joining  the  company  in  December  2022.  Prior  to 
joining  EDAP,  Mr.  Mobeck  served  as  Vice  President  of  Finance  and  Investor 
Relations  at  medical  device  manufacturer  Accuray  Inc.,  a  leading  global  radiation 
therapy  company.  Prior  to  joining  Accuray,  Mr.  Mobeck  served  as  Vice  President, 
Finance with an optical networking leader, Lumentum. Before Lumentum, he spent 
over  two  decades  in  positions  with  increasing  levels  of  responsibility  at  some  of 
Silicon  Valley’s  most  innovative  companies  including  Silicon  Graphics,  Hewlett 
Packard,  KLA  and  Intel  Corporation.  Mr.  Mobeck  holds  an  MBA  and  a  BSC  in 
Finance from the Leavey School of Business at Santa Clara University.  

Chief Accounting Officer of EDAP TMS S.A. 
François  Dietsch  was  appointed  as  the  Company’s  Chief  Accounting  Officer  in 
January 2024. Prior to that position, Mr. Dietsch held the position of Chief Financial 
Officer of the Company since July 2015. Mr. Dietsch joined EDAP in 2005 as Internal 
Audit  and  Consolidation  Manager  and  in  2012  was  promoted  to  Group  Financial 
Control Manager and Finance Manager of EDAP's French subsidiary. Prior to joining 
EDAP he held finance positions at Valeo, a leading global supplier of components and 
systems to the automotive industry. He holds master’s degrees in management and 
Corporate Finance from University of Paris Dauphine. 

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Frédéric Pech 
Age: 55 

Jean-François Bachelard 
Age: 60 

President of EDAP TMS France S.A.S. 
Frédéric Pech joined EDAP TMS France SAS in January 2021, as Chief Operating 
Officer and was appointed as President of EDAP TMS France on May 1, 2023. Prior 
to joining EDAP TMS France, he served as Chief Operating Officer at Metal Global 
Concept,  a  company  specialized  in  the  design  and  manufacturing  of  medical 
instrumentation  containers  for  operating  rooms,  from  2018  to  2021.  Prior  to  this 
position,  he  served  as  Human  Resources  Director,  mainly  in  the  medical  devices 
industry at companies including Stryker, Tornier and Wright Medical, from 2000 to 
2018. Frederic holds a master's degree in accounting, a master's degree in organization 
from  the  CNAM  (Conservatoire  National  des  Arts  et  Métiers),  an  MBA  from  IGS 
Paris (Institut de Gestion Social) and a double degree from EM Lyon business school 
(Certificate  in  Business  Management  and  Executive  Advanced  Management 
program). 

President and Chief Executive Officer of Edaptechnomed Co. Ltd. 
Jean-Francois Bachelard started his career at EDAP TMS Group in 1987 as Service 
Engineer. In 1989, he became Service Manager for Asia Pacific (APAC) area based 
in Tokyo. From 1993 to 1998, he worked for Inamed Corp. as Product Manager France 
(Bioenterics, gastric implants). In 1999, he reintegrated EDAP TMS Group as Area 
Manager Northen Europe and General Manager of EDAP TMS Moscow office. In 
2009, he was appointed President & Chief Executive Officer of Edaptechnomed Co., 
Ltd. (Japan), based in Tokyo. He graduated from Grenoble University with a degree 
in Electrotechnics and Robotics. 

Board of Directors 

The following table sets forth the names and backgrounds of the members of the Board of Directors. On March 29, 2023, the 
Board of Directors decided to separate the roles of Chairman of the Board and Chief Executive Officer as of May 1, 2023, when Mr. 
Rhodes began his term as Chief Executive Officer and Mr. Oczachowski continued serving as Chairman.  

None of the directors has service contracts with the Company or any of its subsidiaries providing for benefits upon termination 
of employment (except for those related to Mr. Rhodes’s current position as Chief Executive Officer, provided under his employment 
agreement). Three of the five Board members are independent within the meaning of Nasdaq Marketplace Rule 5605(2). The mandate 
of our Directors, other than the Chair, was renewed for a new period of six years at the General Meeting of Shareholders held on June 30, 
2020 approving the accounts for the financial year ended December 31, 2019. Their mandate will expire at the end of the ordinary 
general meeting of shareholders, which will approve the accounts for the financial year ended December 31, 2025, held in 2026. The 
Chair’s mandate will expire in 2028. 

Marc Oczachowski  
Age: 54  
Mandate: 6 years  
Appointment: July 10, 2017 
Expiration: 2028 

Chairman of the Board.  
Marc Oczachowski joined EDAP TMS in 1997 as Area Sales Manager. From 2001 to 2004, 
he was General Manager of EDAP Technomed Malaysia. In 2004, he was appointed Chief 
Operating Officer of EDAP TMS based in Lyon, France, and became Chief Executive Officer 
of the Company in 2007. In 2012, he relocated in Austin, Texas (USA), for a five-year period, 
to  manage  U.S.  operations  and  lead  the  FDA  approval  process  of  the  Company’s  HIFU 
devices. On March 25, 2020, he was appointed Chairman of the Board of Directors. In May 
2023,  following  Mr.  Rhodes’  appointment  as  Chief  Executive  Officer,  Mr.  Oczachowski 
continued to serve as Chairman of the Board. Mr. Oczachowski started his career as Area 
Sales  Manager  for  Sodem  Systems,  which  designed  and  manufactured  power  tools  for 
orthopedics.  He  graduated  from  Lyon  I  University  (Molecular  Biology)  and  from  Institut 
Commercial de Lyon, France. 

48 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
  
 
 
 
 
Pierre Beysson was appointed as a member of the Board of Directors in September 2002. 
From 1997 to 2003, Pierre Beysson held the position of Chief Financial Officer of Compagnie 
des  Wagons-Lits  ("CWL"),  the  on-board  train  service  division  of  Accor,  a  French 
multinational  Hotel  and  Business  Services  Group.  Before  CWL,  Pierre  Beysson  held  a 
number of senior financial positions with Nixdorf Computers, Trane (Air Conditioning), AM 
International  (Office  Equipment)  and  FMC  (Petroleum  Equipment).  Pierre  Beysson  was 
trained as a CPA, has auditing experience and holds an MBA from Harvard Business School. 

Marie Meynadier was elected as a member of the Company’s Board of Directors in June 2020. 
Ms.  Meynadier  currently  serves  on  the  boards  of  directors  of  several  medical  technology 
companies in Europe and North America. Ms. Meynadier has been serving as a director of 
Pixium Vision since 2019 and as a director of Alphatec Spine since 2021. From 1999 through 
2018, she served at EOS Imaging as its Chief Executive Officer and led the company through 
a period of rapid worldwide sales growth prior to its sale to Alphatec Holdings in 2021. Prior 
to EOS Imaging, Ms. Meynadier served as the Chief Executive Officer of Biospace Lab, a 
preclinical  imaging  company  she  developed  and  turned  to  profitability.  Ms.  Meynadier 
received a degree in electrical engineering from Sup Télécom, Paris, and her Ph.D. in physics 
from Ecole Normale Supérieure Ulm, Paris. 

Dr. Lance Willsey was appointed as a member of the Board of Directors in December 2023. 
Dr. Lance Willsey, M.S., M.D. is a urologist who has 36 years of private and public board 
experience  focused  in  the  area  of  cancer  diagnostics  and  therapeutics.  He  completed  his 
surgical  and  urology  training  at  the  Massachusetts  General  Hospital  and  additional 
postgraduate  training  in  the  Steele  Lab  Harvard  University  and  the  Dana  Farber  Cancer 
Institute. Dr. Willsey is a founding Partner of Healthcare fund DCF Capital. He also actively 
participated in boards as a Director of Exact Sciences from 1999 to 2009 and of Exelixis from 
1997 to 2023.  He also has extensive experience in corporate governance, having served on 
audit, compensation, finance and scientific advisory committees. Dr. Lance Willsey holds an 
MS and MD from Wayne University.   

Chief Executive Officer. See Ryan Rhodes’ biography above.  

Table of Contents 

Pierre Beysson  
Age: 81 
Mandate: 6 years  
Appointment:  
September 27, 2002  
(renewed in 2014 & 2020) 
Expiration: 2025 

Marie Meynadier  
Age: 62  
Mandate: 6 years  
Appointment: June 30, 2020 
Expiration: 2025 

Lance Willsey  
Age: 62  
Mandate: 6 years  
Appointment: December 6, 2023 
Expiration: 2025 

Ryan Rhodes  
Age: 62  
Mandate: 6 years  
Appointment: August 23, 2023 
Expiration: 2025 

Compensation 

Aggregate  compensation  paid  or  accrued  for  services  in  all  capacities  by  the  Company  and  its  subsidiaries  to  senior 
management and to the Board of Directors as a group (for those individuals in office during the course of the year) for the fiscal year 
2023 was €2,772 thousand including performance bonuses of €301 thousand, benefits in kind of €71 thousand (benefits in kind comprise 
car allowances for senior management) and severance payment of €1,389 thousand. No amount was set aside or accrued by us to provide 
pension, retirement or similar benefits for senior management and to the Board of Directors as a group (for those individuals in office 
during  the  course  of  the  year)  for  the  fiscal year  2023  other  that  the  legal  retirement  indemnity  for  French  senior  executives.  On 
November 8, 2023, the Board of Directors adopted the Company’s Clawback Policy which is filed in exhibit 97.1. For information 
regarding compensation paid in the form of stock options or free shares, see “—Share Ownership” and “Options to Purchase or Subscribe 
for Securities—Free Shares.” 

49 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
 
Table of Contents 

Compensation Committee 

The Compensation Committee is comprised of the following independent members: Mr. Pierre Beysson, Dr. Lance Willsey 
and Ms. Marie Meynadier. The Committee gathers once a year to review the compensation of our Chief Executive Officer and to propose 
to the Board of Directors any changes to the Chief Executive Officer’s compensation. The Chief Executive Officer is not present when 
the Compensation Committee reviews his compensation. The Compensation Committee operates pursuant to a charter. The principal 
duties and responsibilities of our Compensation Committee include, but are not limited to: 

-  Make recommendations and proposals to the Board of Directors regarding compensation programs, including benefits in kind 

and equity compensation, for the Chief Executive Officer and members of the Board of Directors; 

-  Define  methods  used  to  calculate  variable  compensation  and  set  objectives  and  assist  the  Board  of  Directors  in  determining 

whether the objectives have been met for bonuses and other types of equity or non-equity compensation plans; and 

-  Formulate general policies on the granting of equity compensation and recommend to the Board of Directors the granting of 

options and other stock awards thereunder. 

For more information on the missions of our Compensation Committee, please refer to our website www.edaptms.com, under 
the Investor Relations Section, where our Compensation Committee Charter is available. This charter is not incorporated by reference 
in this annual report. 

Audit Committee 

The Board of Directors’ Audit Committee comprises three independent members of the Board: Mr. Pierre Beysson, acting as 
Head  of  the  Audit  Committee  and  financial  expert,  Ms. Marie  Meynadier  and  Dr.  Lance  Willsey.  The  Audit  Committee  operates 
pursuant to a charter. The principal duties and responsibilities of our Audit Committee include, but are not limited to:  

-  Provide assistance to the Board of Directors in fulfilling their oversight responsibility to the shareholders, potential shareholders, 
the  investment  community  and  others  relating  to:  the  integrity  of  our  financial  statements,  our  compliance  with  legal  and 
regulatory requirements, our accounting practices and financial reporting processes, the effectiveness of our disclosure controls 
and procedures and internal control over financial reporting; 

-  Review  the  independent  auditor’s  qualifications,  compensation  and  independence,  and  the  performance  of  our  internal  audit 

function and independent auditors; 

-  Recommend  the  appointment  of  the  independent  auditors  for  consideration  and  approval  by  the  Company’s  shareholders  in 

accordance with French law; 

-  Review and discuss annual financial statements with management and the independent auditors and prepare the Audit Committee 

report, prior to SEC filings, as well as review related press releases; and 

-  Request any officer or employee of the Company or our outside counsel or independent auditor to attend a meeting of the Audit 

Committee or to meet with any members of, or consultants to, the Audit Committee. 

For  more  information  on  the  missions  of  our  Audit  Committee,  please  refer  to  our  website  www.edap-tms.com,  under  the 
Investor Relations Section, where our Audit Committee Charter is available. This charter is not incorporated by reference in this annual 
report.  

Nomination Committee 

The Nomination Committee is comprised of the following independent members: Mr. Pierre Beysson, Ms. Marie Meynadier 
and Dr. Lance Willsey. The Board of Directors recommends director nominees to the Board, which then submit its nominees to the 
shareholders for election. In addition, under specified circumstances and in accordance with French law, shareholders may also submit 
resolutions to the general meeting to appoint directors. The Company’s nominations practice is formalized in a Board resolution.   

The Nomination Committee operates pursuant to a charter, the terms of which apply to the Board of Directors when considering 
director  nominees,  including  in  the  evaluation  of  potential  candidates  and  in  recommendations  to  the  Board  of  Directors  prior  to 
submitting the candidates to the vote of shareholders. The principal duties and responsibilities of our Nomination Committee include, 
but are not limited to: 

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-  Develop and recommend to the Board of Directors appropriate criteria for the selection of individual director candidates (such 
as, independence, industry knowledge, fields of expertise, ability to serve as “financial expert,” leadership, diversity, etc.) and 
executive officers; 

-  Evaluate candidates in light of appropriate criteria and conduct all necessary and appropriate inquiries into the backgrounds and 

qualifications of potential candidates; 

-  Assist the Board of Directors in evaluating director independence, conflicts of interest and re-election of current directors; 
-  Make recommendations to the Board of Directors concerning the size and composition of the Board of Directors in order to 

ensure it has the necessary expertise and diversity; 

-  Make recommendations to the Board of Directors concerning appointees to be selected by the Board of Directors for service on 

its committees or removal of any member of any committee; and 

-  Assist  the  Board  of  Directors  in  ensuring  adequate  succession  planning  for  our  executive  bodies,  in  particular,  through  the 

establishment of a succession plan for the chairman and Chief Executive Officer. 

For more information on the missions of our Nomination Committee, please refer to our website www.edaptms.com, under the 
Investor Relations Section, where our Nomination Committee Charter is available. This charter is not incorporated by reference in this 
annual report. 

Strategic Committee 

The Strategic Committee is comprised of the following members: Ms. Marie Meynadier, independent Director and Head of the 
Committee,  and  Mr. Marc  Oczachowski,  Chairman  of  the  Board.  The  Strategic  Committee  addresses  the  development  and 
implementation of the Company’s strategic plan and the risks associated with such plan. The Strategic Committee operates pursuant to 
a charter. The principal duties and responsibilities of our Strategic Committee also include, but are not limited to: 

-  Assist in the development of EDAP’s strategy, including reviewing and discussing with management the strategic direction and 

initiatives of EDAP and the risks associated with EDAP’s strategy.  

-  Review with management the process for development, approval and modification of EDAP’s strategy and strategic plan.  
-  Assist the management with identifying key issues, options and external developments impacting EDAP’s strategy. Meet with 

management periodically to monitor EDAP’s progress against its strategic goals.  
- 
Ensure the Board is regularly apprised of EDAP’s progress with respect to implementation of any approved strategy.  
-  Regularly review and reassess the adequacy of this charter and recommend any proposed changes to the Board for approval.  
-  Regularly review the Committee's own performance and report the results of such review to the Board.  
- 

Perform such other duties as are necessary or appropriate to further the Committee's purposes, or as the Board may from time to 
time assign to it. 

For more information on the missions of our Strategic Committee, please refer to our website www.edaptms.com, under the 
Investor Relations Section, where our Strategic Committee Charter is available. This charter is not incorporated by reference in this 
annual report.  

Board Diversity Matrix 

Country of Principal Executive Offices: 
Foreign Private Issuer 
Disclosure Prohibited under Home Country Law 

France 
Yes 
Yes 

Board Diversity Matrix 

Total Number of Members 

Gender Identity 

Members 
Demographic Background 
Underrepresented Individual in Home Country Jurisdiction 
LGBTQ+ 
Did Not Disclose Demographic Background 

As of March 28, 2024 
5 
Male 

Female 

As of December 31, 2023 
5 

Female  Male  

1 

4 

1 

4 

5 

5 

51 

 
 
 
 
 
 
 
 
 
 
 
 
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Employees 

As of December 31, 2023, we employed 307 individuals on a full-time basis, as follows: 

Sales &     Manufac-   

  Research   Regula-    Clinical    Adminis-  

France 
Germany 
Japan 
Malaysia 
South Korea 
USA 
Total 

     Marketing      
 25    
 6    
 21    
 2    
 2    
 36    
 92    

turing 

      Service       & Dvpt      
 33    
 —    
 —    
 —    
 —    
 —    
 33    

 24   
 3   
 23   
 3   
 5   
 17   
 75   

 35    
 —    
 —    
 —    
 —    
 —    
 35    

tory 

      Affairs        trative        Total 
 164 
 11 
 55 
 7 
 9 
 61 
 307 

 21    
 2    
 8    
 2    
 2    
 8    
 43    

 15   
 —   
 —   
 —   
 —   
 —   
 15   

 11   
 —   
 3   
 —   
 —   
 —   
 14   

As of December 31, 2022, we employed 264 individuals on a full-time basis, as follows: 

  Sales &  

  Manufac-   

  Research    Regula-    Clinical     Adminis   

     Marketing        turing        Service        & Dvpt      

 tory 

France 
Italy 
Germany 
Japan 
Malaysia 
South Korea 
USA 
Total 

 24    
 —    
 5    
 27    
 1    
 2    
 18    
 77    

 29    
 —    
 —    
 —    
 —    
 —    
 —    
 29    

 26    
 —    
 4    
 20    
 3    
 4    
 11    
 68    

 26    
 —    
 —    
 —    
 —    
 —    
 —    
 26    

      Affairs         trative        Total 
 147 
 — 
 11 
 59 
 6 
 8 
 33 
 264 

 12    
 —    
 —    
 —    
 —    
 —    
 —    
 12    

 21   
 —   
 2   
 9   
 2   
 2   
 4   
 40   

 9   
 —   
 —   
 3   
 —   
 —   
 —   
 12   

As of December 31, 2021, we employed 227 individuals on a full-time basis, as follows: 

Sales & 

     Manufac-      

     Research       Regula-      Clinical       Adminis-      

France 
Italy 
Germany 
Japan 
Malaysia 
South Korea 
USA 
Total 

      Marketing  
 27    
 —    
 5    
 25    
 2    
 2    
 7    
 68    

 turing       Service       & Dvpt       
 21    
 24    
 —    
 —    
 —    
 3    
 —    
 17    
 —    
 3    
 —    
 4    
 —    
 6    
 21    
 57    

 30    
 —    
 —    
 —    
 —    
 —    
 —    
 30    

 tory 

      Affairs  
 9   
 —   
 —   
 —   
 —   
 —   
 —   
 9   

 8   
 —   
 —   
 2   
 —   
 —   
 —   
 10   

 trative        Total 
 136 
 — 
 10 
 50 
 7 
 8 
 16 
 227 

 17    
 —    
 2    
 6    
 2    
 2    
 3    
 32    

Management considers labor relations to be good. Employee benefits are in line with those specified by applicable government 

regulations. 

Share Ownership 

As of March 15, 2024, the total number of shares issued was 37,373,312 with 269,533 shares held as treasury shares, thus 

bringing the total number of shares outstanding to 37,103,779.  

As of March 15, 2024, the Board of Directors and members of the Company’s administrative, supervisory and management 
bodies during 2023 held a total of 1,388,292 shares. The Board of Directors and members of the Company’s administrative, supervisory 
and management bodies during 2023 beneficially own, in the aggregate less than 4% of the Company’s outstanding shares.  

As of March 15, 2024, the members of the Company’s administrative, supervisory and management bodies during 2023 held 
a total of 233,333 free shares and an aggregate of 2,167,500 options to purchase or to subscribe a total of 2,167,500 ordinary shares, 

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with a weighted average exercise price of €8.00 per share. Of these options, 240,000 will expire on April 26, 2026; 65,000 expire on 
April 25, 2027; 35,000 expire on August 29, 2028; 45,000 expire on April 4, 2029; 1,107,500 expire on June 11, 2031; 375,000 expire 
on December 15, 2032; 200,000 expire on May 2, 2033 and 100,000 expire on January 18, 2034.  

Options to Purchase or Subscribe for Securities – Free Shares 

Options 

On February 18, 2016, the shareholders authorized the Board of Directors to grant up to 1,000,000 options to subscribe to 

1,000,000 new shares at a fixed price to be set by the Board of Directors. 

On June 28, 2019, the shareholders authorized the Board of Directors to grant up to a maximum of 358,528 options to purchase 
pre-existing shares at a fixed price to be set by the Board of Directors. All of the shares that may be purchased through the exercise of 
stock options are currently held as treasury stock. On June 28, 2019, the shareholders also authorized the Board of Directors to grant up 
to 1,000,000 options to subscribe to 1,000,000 new shares at a fixed price to be set by the Board of Directors.  

On June 30, 2021, the shareholders authorized the Board of Directors to grant up to 2,000,000 options to subscribe to 2,000,000 

new shares at a fixed price to be set by the Board of Directors and 200,000 free shares.  

On June 30, 2022, the shareholders authorized the Board of Directors to grant up to 600,000 free shares. This new resolution 

superseded the June 30, 2021, resolution, cancelling the unused portion of the 2021 resolution.  

As of March 15, 2024, we had sponsored three stock purchase and subscription option plans open to employees of EDAP TMS 

group and two free share plans. 

On December 31, 2023, the expiration of our stock options contracts was as follows: 

Date of expiration 
April 5, 2026 
April 25, 2026 
May 2, 2026 
May 31, 2026 
August 23, 2026 
September 20, 2026 
November 8, 2026 
December 6, 2026 
April 26, 2027 
August 25, 2028 
April 4, 2029 
June 11, 2031 

Number of  
Options 
 117,000 
 357,000 
 200,000 
 50,000 
 177,000 
 80,000 
 20,000 
 34,000 
 136,080 
 77,500 
 107,500 
 1,244,533 
As of December 31, 2023, a summary of stock option activity to purchase or to subscribe to shares under these plans is as 

follows: 

2023 

2022 

2021 

  Weighted    
   average  
   exercise  
   price  

      Options 

Outstanding on January 1,  
Granted 
Exercised 
Forfeited 
Expired 
Outstanding on December 31,  
Exercisable on December 31,  
Share purchase options available for grant on December 31,     

 2,613,886   
 686,000    
 (55,973)   
 (45,000)   
 —    
    3,198,913    
    1,997,666    
 25,000    

      Options 

(€) 
 5.66  
 8.53   
 4.66   
 7.99   
 —   

 2,408,508   
 571,000    
 (320,622)   
 (45,000)   
 —    
 6.26     2,613,886    
 5.23     1,362,205    
 20,000    

      Options 

  Weighted    
   average 
    exercise 
 price  
(€) 
 4.38   
 1,186,900   
 9.07      1,392,428    
 (150,820)   
 2.14    
 (20,000)   
 5.34    
 —    
 —    
 5.66      2,408,508    
 4.35      1,149,401    
 5,000    

  Weighted  
   average  
   exercise 
 price 
(€) 
 2.81 
 6 
 3 
 4.01 
 — 
 4.38 
 3.25 

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As of December 31, 2023, 643,000 options to subscribe for new shares are available for future grants.  

The following table summarizes information about options to purchase existing shares held by the Company, or to subscribe 

to new shares, as of December 31, 2023: 

Outstanding options 

  Weighted 
 average 

  Weighted    
   average  
   remaining      exercise  
   contractual     price   

   Aggregate   
Intrinsic  
 Value 
(2) 

Fully vested options (1) 
  Weighted   
   average      Aggregate  
 Intrinsic 
   exercise     
Value 
   price 
  -2 

Exercise price (€) 
10.32 
10.10 
9.96 
9.94 
9.32 
7.53 
6.64 
6.41 
6.08 
5.59 
5.18 
4.98 
3.90 
3.22 
2.65 
2.39 
2.39 to 10.32 

      Options 

 20,000   
 200,000   
 117,000   
 395,000   
 50,000   
 177,000   
 20,000   
 100,000   
 80,000   
 1,244,533   
 83,300   
 34,000   
 107,500   
 357,000   
 77,500   
 136,080   
    3,198,913    

 life 

 8.8   
 9.3   
 9.3   
 9.0   
 9.4   
 9.7   
 9.8   
 8.3   
 9.8   
 7.4   
 7.8   
 9.9   
 5.8   
 2.3   
 4.7   
 3.3   
 7.79    

      Options 

(€) 
 7,222   
 10.32   
 38,889   
 10.10   
 26,000   
 9.96   
 131,667   
 9.94   
 9,722   
 9.32   
 —   
 7.53   
 —   
 6.64   
 52,778   
 6.41   
 —   
 6.08   
 1,037,111   
 5.59   
 16,197   
 5.18   
 —   
 4.98   
 107,500   
 3.90   
 357,000   
 3.22   
 77,500   
 2.65   
 2.39   
 136,080   
 0.84      2,700,210      1,997,666    

 —   
 —   
 —   
 —   
 —   
 —   
 —   
 —   
 —   
 —   
 431,494   
 169,320   
 419,250   
 1,149,540   
 205,375   
 325,231   

(€) 
 — 
 10.32   
 — 
 10.10   
 — 
 9.96   
 — 
 9.94   
 — 
 9.32   
 — 
 —   
 — 
 —   
 — 
 6.41   
 — 
 —   
 — 
 5.59   
 83,902 
 5.18   
 — 
 —   
 419,250 
 3.90   
 1,149,540 
 3.22   
 205,375 
 2.65   
 2.39   
 325,231 
 1.09      2,183,298 

(1) 

(2) 

Fully vested options are all exercisable options. On March 29, 2023, the Board of Directors unanimously decided to appoint Ryan Rhodes as the new Chief Executive Officer of the Company, which 

will become effective on May 1, 2023. Marc Oczachowski will continue to serve as Chairman of the Board of the Company. In this context, the Board decided to accelerate the vesting of all unvested 

options granted to Mr. Oczachowski under the 2019 option plans such that these options fully vested and became exercisable on March 29, 2023.  

aggregate intrinsic value represents the total pre-tax intrinsic value, based on the Company’s closing stock price of $10.66 at December 31, 2023, which would have been received by the option holders 

had all in-the-money option holders exercised their options as of that date. 

Free Shares  

On September 28, 2021, 61,500 free shares were granted to certain officers and employees of the Company. On September 28, 
2022, 57,500 free shares vested and became subject to a 12-month holding period. On September 28, 2023, the remaining 4,000 free 
shares fully vested.  

On March 30, 2022, 40,000 free shares were granted to the Chief Executive Officer of the Company. On March 30, 2023 all 

40,000 free shares vested and became subject to a 12-month holding period. 

On November 8, 2022, 291,500 free shares were granted to certain officers and employees of the Company. On November 8, 
2023, 92,881 free shares vested and became subject to a 12-month holding period. As of December 31, 2023, 180,819 free shares remain 
outstanding, and 92,881 shares are still subject to the 12-month holding period. 

On March 29, 2023, 150,000 free shares were granted to the Chief Executive Officer of the Company. On March 29, 2024, all 
150,000 free shares will have been acquired, as long as the conditions set forth in the free share plan are met and will be subject to a 12-
month holding period. 

On May 2, 2023, 50,000 free shares were granted to the President of the French subsidiary EDAP TMS France SAS. On May 
2, 2025, all 50,000 free shares will have vested, as long as the conditions set forth in the free share plan are met and will be subject to a 
12-month holding period. 

See Note 17-5 of the consolidated financial statements.  

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Disclosure of any action to recover erroneously awarded compensation 

Not applicable.  

Item 7. Major Shareholders and Related Party Transactions 

Major Shareholders 

To our knowledge, we are not directly or indirectly owned or controlled by another corporation, by any foreign government, 

or by any other natural or legal person or persons acting severally or jointly. 

On the basis of the notifications received or filed with the SEC, as of March 15, 2024,  (i) Soleus Capital Master Fund, L.P. 
filed a report showing beneficial ownership of 7,226,341 ADSs, representing 19.5% of our outstanding ADSs and (ii) Morgan Stanley 
filed a report showing beneficial ownership of 3,138,680 ADSs, representing 8.5% of our outstanding ADSs, including shared voting 
power over 3,136,680 ADSs and shared dispositive power over 3,138,680 ADSs. There are no arrangements known to us whereby we 
are directly or indirectly owned or controlled by another corporation or government, or by any other natural or legal persons, nor are we 
aware of any arrangement] that may at a later date result in a change of control of the Company. All shares issued by the Company have 
the same voting rights, except the treasury shares held by the Company, which have no voting rights. 

As of March 15, 2024, 37,373,312 shares were issued, including 37,103,779 outstanding and 269,533 treasury shares. As of 
March 15, 2024, there were 37,155,300 ADSs, each representing one Share, all of which were held of record by 20 registered holders 
(including The Depository Trust Company).  

Related Party Transactions 

On August 19, 2019, EDAP Technomed Co. Ltd. (Japan) contracted a loan for 80,000,000 JPY. As a current practice in Japan, 
this  loan  required  a  personal  guarantee  from  the  representative  director,  president  and  CEO  of  the  subsidiary,  Mr. Jean-François 
Bachelard. EDAP TMS S.A., as the parent company, counter-guaranteed this personal loan and agreed to indemnify Mr. Bachelard, in 
an indemnification letter dated September 12, 2019, expiring upon loan maturity date of August 26, 2026. 

On  April 22,  2020,  EDAP  Technomed  Co.  Ltd  (Japan)  contracted  another  loan  for  50,000,000  JPY  requiring  a  personal 
guarantee from the representative director, president and CEO of the subsidiary, Mr. Jean-François Bachelard. EDAP TMS S.A., as the 
parent company, counter-guaranteed this personal loan and agreed to indemnify Mr. Bachelard, in an indemnification letter dated June 2, 
2020, expiring upon loan maturity date of April 2, 2025. 

Interests of Experts and Counsel 

Not applicable. 

Item 8. Financial Information 

Consolidated Financial Statements 

See Item 18, “Financial Statements.” 

Export Sales 

As of December 31, 2023, total consolidated export net sales, which we define as sales made outside of mainland France, were 

€48.4 million, which represented 80% of total net sales. 

As  part  of  our  business,  we  are  engaged  in  sales  and  marketing  activities  with  hospitals,  clinics,  distributors  or  agents  in 
countries on a worldwide basis where we can provide our minimally invasive therapeutic solutions to patients with prostate cancer or 
urinary  stones.  The  following  information  complies  with  the  sub-section  “Disclosure  of  Certain  Activities  Relating  to  Iran”  of  the 
Section 13  of  the  U.S.  Securities  Exchange  Act  of  1934  as  amended:  in  2015  we  honored  warranty  contracts  on  previous  sales  of 
lithotripsy devices to three Iranian public hospitals in order to provide the hospitals with the necessary disposables and services to treat 
patients with kidney stones using our devices. As part of these warranty commitments, we did not invoice any medical equipment to the 
hospitals in 2023 or 2022. 

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Legal Proceedings 

From time to time, we may become involved in legal proceedings or be subject to claims arising in the ordinary course of our 
business. Regardless of the outcome, litigation can have an adverse impact on us because of defense and settlement costs, diversion of 
management resources and other factors. We do not have any legal proceedings outstanding.  

Dividends and Dividend Policy 

The payment and amount of dividends depend on our earnings and financial condition and such other factors that our Board of 
Directors deems relevant. Dividends are subject to recommendation by the Board of Directors and a vote by the shareholders at the 
shareholders’ ordinary general meeting. Dividends, if any, would be paid in euro and, with respect to ADSs, would be converted at the 
then-prevailing exchange rate into U.S. dollars. Holders of ADSs will be entitled to receive payments in respect of dividends on the 
underlying shares in accordance with the Deposit Agreement. 

No dividends were paid with respect to fiscal years 2018 through 2023, and we do not anticipate paying any dividends for the 
foreseeable future. Thereafter, any declaration of dividends on our shares as well as the amount and payment will be determined by 
majority vote of the holders of our shares at an ordinary general meeting, following the recommendation of our Board of Directors. Such 
declaration will depend upon, among other things, future earnings, if any, the operating and financial condition of our business, our 
capital requirements, general business conditions and such other factors as our Board of Directors deems relevant in its recommendation 
to shareholders. 

Significant Changes as of March 15, 2024 

        In order to align EDAP’s organization to build shareholders value and expand its operational and commercial presence in the 
United States, the Company announced on January 2, 2024 the appointment of Ken Mobeck as its Chief Financial Officer and François 
Dietsch as its Chief Accounting Officer. 

On March 4, 2024, EDAP announced that its Focal One platform has been granted Breakthrough Device designation by the 
FDA for the treatment of deep infiltrating endometriosis (DIE). In June 2018, the FDA cleared Focal One Robotic Focal HIFU for the 
ablation of prostatic tissue.  

Item 9. The Offer and Listing 

Description of Securities 

The shares are traded solely in the form of ADSs, each ADS representing one ordinary share. Each ADS may be evidenced by 
an American Depositary Receipt issued by The Bank of New York Mellon, our Depositary. The principal United States trading market 
for the ADSs, which is also the principal trading market for the ADSs overall, is The Nasdaq Global Market of The Nasdaq Stock 
Market, Inc. (“Nasdaq”), on which the ADSs are quoted under the symbol “EDAP.”  

Item 10. Additional Information 

Share Capital 

Not applicable. 

Memorandum and Articles of Association 

Set forth below is a brief summary of significant provisions of our by-laws (or statuts) and applicable French laws. This is not 
a complete description and is qualified in its entirety by reference to our by-laws, a translation of which is provided in Exhibit 1.1 to 
this annual report. Each time they are modified, which can only occur with the approval of a two third majority of the shareholders 
present or represented at a shareholders’ meeting, we file copies of our by-laws with, and such by-laws are publicly available from, the 
Registry of Commerce and Companies in Lyon, France, under number 316 488 204. 

Our corporate affairs are governed by our by-laws and by Book II of the French Commercial Code. 

56 

 
 
 
 
 
 
 
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Our  by-laws  were  updated  on  December  6,  2023  to  reflect  the  latest  increases  in  share  capital  related  to  the  issuance  of 

additional shares following the exercise of options. 

Corporate Purposes 

Pursuant to Article 2 of our by-laws, the corporate purpose of the Company is: 

- 

the taking of financial interests, under whatever form, in all French or foreign groups, companies or businesses which currently 
exist or which may be created in the future, mainly through contribution, subscription or purchasing of stocks or shares, 
obligations or other securities, mergers, holding companies, groups, alliances or partnerships; 
the management of such financial investments; 
the direction, management, control and coordination of its subsidiaries and interests; 
the provision of all administrative, financial, technical or other services; and 

- 
- 
- 
-  generally, all transactions of whatever nature, whether financial, commercial, industrial, civil, relating to property and/or real 

estate, which may be connected directly or indirectly, in whole or in part, to the Company’s purposes or to any similar or related 
purposes which may favor the extension or development of such purpose. 

Board of Directors 

The Board of Directors is currently composed of five members, four of which were appointed by the shareholders for a period 
of six years expiring on the date of the annual general shareholders’ meeting approving the accounts for fiscal year 2025. Mr. Marc 
Oczachowski was appointed as a director of the Company by the shareholders on June 30, 2017, effective July 1, 2017, for a period of 
six years expiring on the date of the annual general shareholders’ meeting approving the accounts for the fiscal year 2022 and has since 
been reappointed by the shareholders on June 30, 2023, for a period of six years expiring on the date of the annual general shareholders’ 
meeting to be held in 2029 to approve the accounts for the fiscal year 2028. He was appointed as Chairman of the Board for the first 
time on March 25, 2020 and reappointed as Chairman on June 30, 2023. See Item 6, “Directors, Senior Management and Employees.” 
A director’s term ends at the end of the ordinary general shareholders’ meeting convened to vote on the accounts of the then-preceding 
fiscal year and held in the year during which the term of such director comes to an end. Directors may be re-elected; a director may also 
be dismissed at any time at the shareholders’ meeting. 

An individual person may not be a member of more than five Boards of Directors or Supervisory Boards in corporations (société 
anonyme) registered in France; directorships held in controlled companies (as defined by Article L.233-16 of the French Commercial 
Code) by the Company are not taken into account. 

In the event of the death or resignation of one or more directors, the Board of Directors may make provisional appointments to 
fill vacancies before the next general shareholders’ meetings, provided that the number of directors still in office is not below the required 
legal minimum of directors (three). These provisional appointments must be ratified by the next ordinary shareholders meeting. Even if 
a provisional appointment is not ratified, resolutions and acts previously approved by the Board of Directors nonetheless remain valid. 

If the number of directors falls below the compulsory legal minimum, the remaining directors must immediately convene an 

ordinary general shareholders’ meeting to reach a full Board of Directors. 

Any director appointed in replacement of another director whose term has not expired remains in office only for the remaining 

duration of the term of his predecessor. 

Our  employees  may  be  appointed  to  serve  as  directors.  Such  employee’s  employment  contract  must  include  actual  work 

obligations. In this case, such employee does not lose the benefit of his/her employment contract. 

The number of directors that have employment contracts with the Company may not exceed one third of the directors then in 

office and in any case, a maximum of five members. 

Pursuant to our by-laws, a director may not be over eighty-five years old. If a director reaches this age limit during his/her term, 

such director is automatically considered to have resigned at the next general shareholders meeting. 

A director cannot borrow money from the Company. 

The Board of Directors determines the direction of our business and supervises its implementation. Within the limits set out by 
the  corporate  purposes  and  the  powers  expressly  granted  by  law  to  the  general  shareholders’  meeting,  the  Board  of  Directors  may 

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deliberate upon our operations and make any decisions in accordance with our business. A director must abstain from voting on matters 
in which the director has an interest. The resolutions passed in a meeting of the Board of Directors are valid only if a quorum of half of 
the directors is reached. Decisions of the Board of Directors are made by a majority vote; in case of a tie, the Chairman of the Board has 
a casting vote. 

French law provides that the functions of Chairman of the Board of Directors and Chief Executive Officer in a French société 
anonyme may be distinct and held by two separate individuals or combined. The choice between these two methods of management 
belongs to the Board of Directors and must be made pursuant to our by-laws and applicable French law. 

The Chairman of the Board 

The Board of Directors must elect one of its members as Chairman of the Board of Directors. The Board of Directors determines 
the duration of the term of the Chairman, which cannot exceed that of his/her tenure as a director. The Board of Directors may revoke 
the  Chairman  at  any  time.  The  Chairman’s  compensation  is  determined  by  the  Board  of  Directors,  upon  recommendation  of  the 
Compensation  Committee.  See  Item 6,  “Directors,  Senior  Management  and  Employees–Compensation  Committee.”  The  Chairman 
represents  the  Board  of  Directors  and  organizes  its  work.  The  Chairman  reports  on  the  Board’s  behalf  to  the  general  shareholders’ 
meeting. The Chairman is responsible for ensuring the proper functioning of our governing bodies and that the Board members have the 
means to perform their duties. 

As with any other director, the Chairman may not be over eighty-five years old. In case the Chairman reaches this age limit 
during his/her tenure, he/she will automatically be considered to have resigned. However, his/her tenure is extended until the next Board 
of Directors meeting, during which his/her successor will be appointed. Subject to the age limit provision, the Chairman of the Board 
may also be re-elected. 

The Chief Executive Officer 

We are managed by an individual elected by the Board of Directors bearing the title of Chief Executive Officer (directeur 
général). On March 31, 2007, the Board of Directors appointed Mr. Marc Oczachowski as Chief Executive Officer and on March 25, 
2020, the Board of Directors decided to combine the roles of Chairman of the Board and Chief Executive Officer, as allowed by the 
Company’s by-laws, and elected Mr. Marc Oczachowski as both the Chairman of the Board of Directors and Chief Executive Officer. 
On March 29, 2023, the Board of Directors decided to separate the roles of Chairman of the Board and Chief Executive Officer, as 
allowed by the Company’s by-laws, and maintained Mr. Marc Oczachowski as the Chairman of the Board of Directors and elected Mr. 
Ryan Rhodes as the Chief Executive Officer for an indefinite term. 

The Chief Executive Officer is vested with the powers to act under all circumstances on behalf of the Company, within the 
limits set out by the Company’s corporate purposes, and subject to the powers expressly granted by the law to the Board of Directors 
and the general shareholders’ meeting. 

The Chief Executive Officer represents the Company with respect to third parties. The Company is bound by any acts of the 
Chief Executive Officer even if they are contrary to corporate purposes, unless it is proven that the third party knew such act exceeded 
the Company’s corporate purposes or could not ignore it in light of the circumstances. Publication of the by-laws alone is not sufficient 
evidence of such knowledge. 

The  Chief  Executive  Officer’s  compensation  is  set  by  the  Board  of  Directors,  upon  recommendation  of  the  Compensation 
Committee.  The  Chief  Executive  Officer  can  be  revoked  at  any  time  by  the  Board  of  Directors.  If  such  termination  is  found  to  be 
unjustified, damages may be allocated to the Chief Executive Officer, except when the Chief Executive Officer is also the Chairman of 
the Board. 

The Chief Executive Officer may not hold another position as Chief Executive Officer or member of a Supervisory Board in a 
corporation (société anonyme) registered in France except when (a) such company is controlled (as referred to in Section L.233-16 of 
the French Commercial Code) by the Company and (b) when this controlled company’s shares are not traded on a regulated market. 

Pursuant to our by-laws, the Chief Executive Officer may not be over seventy years old. In case the Chief Executive Officer 
reaches this age limit during his/her office, he/she is automatically considered to have resigned. However, his/her tenure is extended 
until the next Board of Directors meeting, during which his/her successor must be appointed. 

Pursuant to Section 706-43 of the French Criminal Proceedings Code, the Chief Executive Officer may validly delegate to any 

person he/she chooses the power to represent us in any criminal proceedings that we may face. 

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Provisions With Respect to Directors (French Law)  

Transactions in Which Directors Are Materially Interested 

Under French law, any agreement entered into (directly or through an intermediary) between the Company and any one of the 
members of the Board of Directors that is not entered into (i) in the ordinary course of our business and (ii) under normal conditions, is 
subject to the prior authorization of the Board of Directors with only the disinterested members of the Board of Directors voting. This 
provision applies in particular to any undertaking taken by our Company for the benefit of our Chairman, Chief Executive Officer or his 
delegates (délégués) pursuant to which such persons will or may be granted compensation, benefits or any other advantages as a result 
of the termination of or a change in their offices or following such termination or change. 

The same provision applies to agreements between our Company and another company if one of the members of the Board of 
Directors is the owner, general partner, manager, director, general manager or member of the executive or supervisory board of the other 
company, as well as to agreements in which one of the members of the Board of Directors has an indirect interest. 

In accordance with Article L. 225-38 of the French Commercial Code, each related-party agreement entered into during the 
fiscal year is submitted for approval by our shareholders at the annual general shareholders’ meeting; the interested director (directly or 
through an intermediary), if he/she is a shareholder of the Company, may not take part in the vote and the shares held by the interested 
director are not taken into account for the calculation of the majority vote count.  

Directors’ Compensation 

The aggregate amount of compensation of the Board of Directors is determined at the ordinary general shareholders’ meeting. 
The Board of Directors then divides this aggregate amount among its members by a simple majority vote. In addition, the Board of 
Directors may grant exceptional compensation (rémunérations exceptionnelles) to individual directors on a case-by-case basis for special 
assignments following the procedures described above at “- Transactions in which directors are materially Interested.” The Board of 
Directors may also authorize the reimbursement of travel and accommodation expenses, as well as other expenses incurred by Directors 
in the corporate interest. See also Item 6, “Directors, Senior Management and Employees”.  

Board of Directors’ Borrowing Powers  

All loans or borrowings on behalf of the Company may be decided by the Board of Directors within the limits, if any, imposed 
by the extraordinary meeting of the shareholders. There are currently no limits imposed on the amounts of loans or borrowings that the 
Board of Directors may approve. 

Enforceability of Civil Liabilities (French Law) 

We are a société anonyme, or limited liability corporation, organized under the laws of the Republic of France. The majority 
of our directors reside in the Republic of France. In addition, a substantial portion of our assets are located outside of the United States. 
As a result, it may be difficult for investors: 

• 

• 
• 

• 

to obtain jurisdiction over us or our non-U.S. resident officers and directors in U.S. courts, or obtain evidence in France or 
from French citizen or any individual being resident in France or any officer, representative, agent or employee of a legal 
person having its registered office or an establishment in a territory of France, in actions predicated on the civil liability 
provisions of the U.S. federal securities laws; 
to enforce in U.S. courts judgments obtained in such actions against us or our non-U.S. resident officers and directors; 
to bring an original action in a French court to enforce liabilities based upon the U.S. federal securities laws against us or 
our non-U.S. resident officers or directors; and 
to enforce in U.S. courts against us or our directors in non-U.S. courts, including French courts, judgments of U.S. courts 
predicated upon the civil liability provisions of the U.S. federal securities laws. 

Nevertheless, a final judgment for the payment of money rendered by any federal or state court in the United States based on 
civil  liability,  whether  or  not  predicated  solely  upon  the  U.S. federal  securities  laws,  would  be  recognized  and  enforced  in  France 
provided  that  a  French  judge  considers  that  this  judgment  meets  the  French  legal  requirement  concerning  the  recognition  and  the 
enforcement of foreign judgments and is capable of being immediately enforced in the United States. A French court is therefore likely 
to grant the enforcement of a foreign judgment without a review of the merits of the underlying claim, only if (i) the judgment was 
rendered by a court having jurisdiction over the matter as the dispute is clearly connected to the jurisdiction of such court, the choice of 
the U.S. court was not fraudulent and the French courts did not have exclusive jurisdiction over the matter, (ii) the judgment does not 

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contravene international public policy rules, as applied by French courts, whether such rules pertain to the merits or to the procedure of 
the case, including any defense rights, (iii) the judgment is not tainted with fraud, (iv) the judgment does not conflict with a French 
judgment or a foreign judgment (or an arbitral award) on the same matter which has become effective in France and (v) that judgment 
is enforceable in the jurisdiction of the U.S. court which rendered it. In addition, French law guarantees full compensation for the harm 
suffered but is limited to the actual damages, so the victim does not suffer or benefit from the situation, it being specified that under 
French law, the principle of awarding punitive damages is not, per se, contrary to public order, provided the amount awarded is not 
disproportionate to the harm suffered and the defendant’s breach. 

In addition, French law guarantees full compensation for the harm suffered but is limited to the actual damages, so that the 
victim does not suffer or benefit from the situation, it being specified that under French law, the principle of awarding punitive damages 
is not, per se, contrary to public order, provided the amount awarded is not disproportionate to the harm suffered and the defendant’s 
breach. 

As a result, the enforcement, by U.S. investors, of any judgments obtained in U.S. courts in civil and commercial matters, 
including judgments under the U.S. federal securities law against us or members of our Board of Directors, officers or certain experts 
named herein who are residents of France or countries other than the United States would be subject to the above conditions. 

Finally, there may be doubt as to whether a French court would impose civil liability on us, our directors, our officers or certain 
experts  named  herein  in  an  original  action  predicated  solely  upon  the  U.S.  federal  securities  laws  brought  in  a  court  of  competent 
jurisdiction in France against us or such directors, officers or experts, respectively. 

Listing 

Our ADSs are listed on the Nasdaq Global Market under the symbol “EDAP.” 

Transfer Agent and Registrar 

The transfer agent and registrar for our ADSs is The Bank of New York Mellon. 

Material Contracts 

None.  

Exchange Controls 

Under current French foreign exchange control regulations, there are no limitations on the amount of cash payments that we 
may remit to residents of foreign countries (subject to the absence of any specific decision taken by the government otherwise). Laws 
and regulations concerning foreign exchange controls do require, however, that all payments or transfers of funds made by a French 
resident to a non-resident be handled by an accredited intermediary. There is a reporting obligation to custom officer for transfer of cash 
in banknotes and coins of €10,000 or more carried in, or out of, the European Union. 

Taxation 

Certain Income Tax Considerations  

General 

The following generally summarizes the material French and U.S. federal income tax consequences to U.S. holders (as defined 
below) of purchasing, owning and disposing of ADSs and shares (collectively the “Securities”). This discussion is intended only as a 
descriptive summary and does not purport to be a complete analysis or listing of all potential tax effects of the purchase, ownership or 
disposition of the Securities. All of the following is subject to change. Such changes could apply retroactively and could affect the 
consequences described below. 

This summary does not constitute a legal opinion or tax advice. Holders are urged to consult their own tax advisers 
regarding  the  tax  consequences  of  the  purchase,  ownership  and  disposition  of  Securities  in  light  of  their  particular 
circumstances, including the effect of any U.S. federal, state, local or other national tax laws. 

A  set  of  tax  rules is  applicable  to  French  assets  that  are  held  by  or  in  foreign  trusts.  These  rules provide  inter alia  for  the 
inclusion of trust assets in the settlor’s net assets for purpose of applying the French real estate wealth tax, for the application of French 

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gift and death duties to French assets held in trust, for a specific tax on capital on the French assets of foreign trusts not already subject 
to the French real estate wealth tax and for a number of French tax reporting and disclosure obligations. The following discussion does 
not address the French tax consequences applicable to Securities held in trusts. If Securities are held in trust, the grantor, trustee and 
beneficiary  are  urged  to  consult  their  own  tax  adviser  regarding  the  specific  tax  consequences  of  acquiring,  owning  and  disposing 
of Securities. 

The description of the French and U.S. federal income tax consequences set forth below is based on the laws (including, for 
U.S. federal  income  tax  purposes,  the  Internal  Revenue  Code  of  1986,  as  amended  (the “Code”),  final,  temporary  and  proposed 
U.S. Treasury Regulations promulgated thereunder and administrative and judicial interpretations thereof) in force as of the date of this 
annual report, the Convention Between the Government of the United States of America and the Government of the French Republic 
for the Avoidance of Double Taxation and the Prevention of Fiscal Evasion with Respect to Taxes on Income and Capital of August 31, 
1994 (the “Treaty”), which entered into force on December 30, 1995 (as amended by any subsequent protocols, including the protocol 
of January 13, 2009), and the tax regulations issued by the French tax authorities within the Bulletin Officiel des Finances Publiques-
Impôts (the “Regulations”) in force as of the date of this report. U.S. holders are advised to consult their own tax advisers regarding their 
eligibility  for  Treaty  benefits,  especially  with  regard  to  the  “Limitations  on  Benefits”  provision,  in  light  of  their  own  particular 
circumstances. 

No advance ruling has been obtained with respect to the tax consequences of the acquisition, ownership or disposition of the 
Securities  from  U.S.  tax  authorities.  Thus,  there  can  be  no  assurances  that  one  or  both  of  such  authorities  will  not  take  a  position 
concerning such tax consequences different from that set out herein or that such a position would not be sustained by a court.  

For the purposes of this discussion, a U.S. holder is a beneficial owner of Securities that is (i) an individual who is a U.S. citizen 
or resident for U.S. federal income tax purposes, (ii) a U.S. domestic corporation or certain other entities created or organized in or 
under the laws of the United States or any state thereof, including the District of Columbia, (iii) an estate whose income is subject to 
U.S. federal income tax regardless of its source, or (iv) a trust if (1) a U.S. court can exercise primary supervision over the trust’s 
administration and one or more U.S. persons are authorized to control all substantial decisions of the trust or (2) has a valid election in 
effect under applicable U.S. Treasury Regulations to be treated as a U.S. person for U.S. federal income tax purposes. A non-U.S. holder 
is a person other than a U.S. holder. 

If a partnership holds Securities, the tax treatment of a partner generally will depend upon the status of the partner and the 
activities of the partnership. If a U.S. holder is a partner in a partnership that holds Securities, the holder is urged to consult its own tax 
adviser regarding the specific tax consequences of acquiring, owning and disposing of Securities. 

This discussion is intended only as a general summary and does not purport to be a complete analysis or listing of all potential 
tax effects of the acquisition, ownership or disposition of the Securities to any particular investor, and does not discuss tax considerations 
that  arise  from  rules of  general  application  or  that  are  generally  assumed  to  be  known  by  investors.  The  discussion  applies  only  to 
investors that hold the Securities as capital assets that have the U.S. dollar as their functional currency, that are entitled to Treaty benefits 
under the “Limitation on Benefits” provision contained in the Treaty, and whose ownership of the Securities is not effectively connected 
to a permanent establishment or a fixed base in France. Certain holders (including, but not limited to, U.S. expatriates, partnerships or 
other  entities  classified  as  partnerships  for  U.S. federal  income  tax  purposes,  banks,  insurance  companies,  regulated  investment 
companies, tax-exempt organizations, financial institutions, persons subject to the alternative minimum tax, persons who acquired the 
Securities pursuant to the exercise of employee stock options or otherwise as compensation, persons that own (directly, indirectly or by 
attribution) 5% or more of the Company’s voting stock or 5% or more of the Company’s outstanding share capital, dealers in securities 
or currencies, persons that elect to mark their securities to market for U.S. federal income tax purposes, and persons holding Securities 
as a position in a synthetic security, straddle or conversion transaction) may be subject to special rules not discussed below. Holders of 
Securities are advised to consult their own tax advisers with regard to the application of French tax law and U.S. federal tax law to their 
particular situations, as well as any tax consequences arising under the laws of any state, local or other foreign jurisdiction. 

French Taxes 

Estate and gift taxes and transfer taxes 

In general, a transfer of Securities by gift or by reason of death of a U.S. holder that would otherwise be subject to French gift 
or inheritance tax, respectively, will not be subject to such French tax by reason of the Convention between the Government of the 
United States of America and the Government of the French Republic for the Avoidance of Double Taxation and the Prevention of 
Fiscal Evasion with Respect to Taxes on Estates, Inheritances and Gifts, dated November 24, 1978, unless the donor or the transferor is 
domiciled in France at the time of making the gift or at the time of his or her death, or the Securities were used in, or held for use in, the 
conduct of a business through a permanent establishment or a fixed base in France. 

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Pursuant to Article 235 ter ZD of the French General Tax Code, purchases of certain securities issued by a French company, 
including shares and ADSs, which are listed on a regulated market of the EU or an exchange market formally acknowledged by the 
AMF (in each case within the meaning of the French Monetary and Financial Code) are subject in France to a 0.3% tax on financial 
transactions, or the TFT, provided inter alia that the issuer’s market capitalization exceeds €1.0 billion as of December 1 of the year 
preceding the taxation year. A list of companies whose market capitalization exceeds €1.0 billion as of December 1 of the year preceding 
the  taxation year  within  the  meaning  of  Article 235  ter  ZD  of  the  French  General  Tax  Code  has  been  published  by  the  French  tax 
authorities in its official guidelines on December 20, 2023 (BOI-ANNX-000467-20/12/2023). The Company was not included in such 
list as its market capitalization did not exceed €1.0 billion as at December 1, 2023. Please note that such list may be updated from time 
to time, or may not be published anymore in the future. Furthermore, Nasdaq is not currently acknowledged by the French AMF, but 
this may change in the future. Therefore, purchases of the Securities in 2024 are not subject to the TFT. 

In the case where the TFT is not applicable, transfers of shares issued by a French company which are not listed on a regulated 
or organized market within the meaning of the French Monetary and Financial Code are subject to uncapped registration duties at the 
rate of 0.1% notwithstanding the existence of a written statement (acte). As shares of the Company are not listed, their transfer should 
be subject to uncapped registration duties at the rate of 0.1% notwithstanding the existence of a written agreement (acte). Although the 
official  guidelines  published  by  the  French  tax  authorities  are  silent  on  this  point,  ADSs  should  remain  outside  of  the  scope  of  the 
aforementioned 0.1% registration duties. 

Wealth Tax 

The French wealth tax (impôt de solidarité sur la fortune) has been replaced with a French real estate wealth tax (impôt sur la 
fortune immobilière) with effect from January 1, 2018. French real estate wealth tax applies only to individuals and does not generally 
apply to the Securities if the holder is a U.S. resident, as defined pursuant to the provisions of the Treaty, provided that the individual 
does not own directly or indirectly a shareholding exceeding 10% of the financial rights and voting rights. 

U.S. Taxes 

Ownership of the securities 

Deposits and withdrawals by a U.S. holder of shares in exchange for ADSs will not be taxable events for U.S. federal income 
tax purposes. For U.S. tax purposes, holders of ADSs will be treated as owners of the shares represented by such ADSs. Accordingly, 
the discussion that follows regarding the U.S. federal income tax consequences of acquiring, owning and disposing of shares is equally 
applicable to ADSs. 

Information reporting and backup withholding tax 

Distributions made to holders and proceeds paid from the sale, exchange, redemption or disposal of Securities may be subject 
to information reporting to the Internal Revenue Service. Such payments may be subject to backup withholding taxes unless the holder 
(i) is a corporation or other exempt recipient or (ii) provides a taxpayer identification number and certifies that no loss of exemption 
from backup withholding has occurred. Holders that are not U.S. persons generally are not subject to information reporting or backup 
withholding.  However,  such  a  holder  may  be  required  to  provide  a  certification  of  its  non-U.S. status  in  connection  with  payments 
received within the United States or through a U.S.-related financial intermediary to establish that it is an exempt recipient. Backup 
withholding is not an additional tax. Amounts withheld as backup withholding may be credited against a holder’s U.S. federal income 
tax liability. A holder may obtain a refund of any excess amounts withheld under the backup withholding rules by filing the appropriate 
claim for refund with the Internal Revenue Service and furnishing any required information. 

Foreign asset reporting 

In addition, a U.S. holder that is an individual (and, to the extent provided in future regulations, certain entities), may be subject 
to reporting obligations with respect to shares and ADSs if the aggregate value of these and certain other “specified foreign financial 
assets” exceeds $50,000. If required, this disclosure is made by filing Form 8938 with the U.S. Internal Revenue Service. Significant 
penalties can apply if holders are required to make this disclosure and fail to do so. In addition, a U.S. holder should consider the possible 
obligation to file online a FinCEN Form 114 - Foreign Bank and Financial Accounts Report as a result of holding shares or ADSs. 
Holders are encouraged to consult their U.S. tax advisors with respect to these and other reporting requirements that may apply to their 
acquisition of shares and ADSs. 

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State and local taxes 

In addition to U.S. federal income tax, U.S. holders of Securities may be subject to U.S. state and local taxes with respect to 
such Securities. Holders of Securities are advised to consult their own tax advisers with regard to the application of U.S. state and local 
income tax law to their particular situation. 

ADSs and Shares 

French Taxes 

Taxation of dividends 

Under French law, dividends paid by a French corporation, such as the Company, to corporations which are not domiciled in 
France are generally subject to French withholding tax at a rate of 25% (12.8% for distributions made to individuals, and 15% for 
distributions made to not-for-profit organizations with a head office in a Member State of the European Economic Area which would 
be subject to the tax regime set forth under article 206 paragraph 2 of the French General Tax Code if its head office were located in 
France and which meet the criteria set forth in the Regulations BOI-RPPM-RCM-30-30-10-70-24/12/2019, no 130). Dividends paid by 
a French corporation, such as the Company, towards non-cooperative States or territories, as defined in Article 238-0 A of the French 
General Tax Code, will generally be subject to French withholding tax at a rate of 75%, irrespective of the tax residence of the beneficiary 
of the dividends if the dividends are received in such States or territories; however, eligible U.S. holders entitled to Treaty benefits under 
the “Limitation on Benefits” provision contained in the Treaty who are U.S. residents, as defined pursuant to the provisions of the Treaty 
and who receive dividends in non-cooperative States or territories, will not be subject to this 75% withholding tax rate. 

Under the Treaty, the rate of French withholding tax on dividends paid to an eligible U.S. holder who is a U.S. resident as 
defined  pursuant  to  the  provisions  of  the  Treaty  and  whose  ownership  of  the  shares  or  ADSs  is  not  effectively  connected  with  a 
permanent  establishment  or  fixed  base  that  such  U.S. holder  has  in  France,  is  reduced  to  15%,  or  to  5%  if  such  U.S. holder  is  a 
corporation and owns directly or indirectly at least 10% of the share capital of the issuing company; such U.S. holder may claim a refund 
from the French tax authorities of the amount withheld in excess of the Treaty rates of 15% or 5%, if any. For U.S. holders that are not 
individuals but are U.S. residents, as defined pursuant to the provisions of the Treaty, the requirements for eligibility for Treaty benefits, 
including the reduced 5% or 15% withholding tax rates contained in the “Limitation on Benefits” provision of the Treaty, are subject to 
specific conditions, and certain technical changes were made to these requirements by the protocol of January 13, 2009. U.S. holders 
are advised to consult their own tax advisers regarding their eligibility for Treaty benefits in light of their own particular circumstances. 

Dividends paid to an eligible U.S. holder may immediately be subject to the reduced rates of 5% or 15% provided that such 
holder establishes before the date of payment that it is a U.S. resident under the Treaty by completing and providing the depositary with 
a treaty form (Form 5000). Dividends paid to a U.S. holder that has not filed the Form 5000 before the dividend payment date will be 
subject to French withholding tax at the rate of 25% and then reduced at a later date to 5% or 15%, provided that such holder duly 
completes and provides the French tax authorities with the treaty forms Form 5000 and Form 5001 before December 31 of the second 
calendar year following the year during which the dividend is paid. Pension funds and certain other tax-exempt entities are subject to 
the same general filing requirements as other U.S. holders except that they may have to supply additional documentation evidencing 
their entitlement to these benefits. 

The depositary agrees to use reasonable efforts to follow the procedures established, or that may be established, by the French 
tax authorities (i) to enable eligible U.S. holders to qualify for the reduced withholding tax rate provided by the Treaty, if available at 
the time the dividends are paid, or (ii) to recover any excess French withholding taxes initially withheld or deducted with respect to 
dividends and other distributions to which such U.S. holders may be eligible from the French tax authorities and (iii) to recover any 
other available tax credits. In particular, associated forms (including Form 5000 and Form 5001, together with their instructions), will 
be  made  available  by  the  depositary  to  all  U.S. holders  registered  with  the  depositary,  and  are  also  generally  available  from  the 
U.S. Internal Revenue Service. 

The withholding tax refund, if any, ordinarily is paid within 12 months of filing the applicable French Treasury Form, but not 

before January 15 of the year following the calendar year in which the related dividend is paid. 

Tax on sale or other disposition 

In general, under the Treaty, a U.S. holder who is a U.S. resident for purposes of the Treaty will not be subject to French tax 
on any capital gain from the redemption (other than redemption proceeds characterized as dividends under French domestic law), sale 

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or exchange of shares or ADSs unless the shares or the ADSs form part of the business property of a permanent establishment or fixed 
base that the U.S. holder has in France. Special rules apply to holders who are residents of more than one country. 

U.S. Taxes 

This subsection only addresses certain U.S. federal income tax consequences of ownership of the ADSs or shares to U.S. 
holders. 

Passive Foreign Investment Company Rules 

Unfavorable  U.S.  tax  rules apply  to  companies  that  are  considered  PFICs.  The  Company  will  be  classified  as  a  PFIC  in  a 
particular taxable year if either (a) 75% or more of its gross income is treated as passive income for purposes of the PFIC rules; or (b) the 
average percentage of the value of its assets that produce or are held for the production of passive income is at least 50%. 

Based on the Company’s financial statements and relevant market and shareholder data, the Company believes it was not a 
PFIC with respect to its 2023 taxable year. In addition, based on its current expectations regarding the value and nature of its assets, the 
sources and nature of its income, and relevant market and shareholder data, the Company does not anticipate that it will become a PFIC 
for its 2024 taxable year.] However, as discussed in the Company’s annual reports on Form 20-F filed with respect to certain prior years, 
the Company believes that it was a PFIC in the past. Moreover, because the PFIC determination is made annually and is dependent upon 
a number of factors, some of which are beyond the Company’s control (including whether the Company continues to earn substantial 
amounts of operating income as well as the market composition and value of the Company’s assets), there can be no assurance that the 
Company will not become a PFIC in future years.  

U.S.  holders  that  hold  Securities  at  any  time  during years  when  the  Company  is  a  PFIC  and  do  not  make  certain  U.S.  tax 
elections (a "mark-to-market election" or a "QEF election") will be subject to adverse tax treatment. For instance, such holders will be 
subject to a special tax at ordinary income tax rates on certain dividends that the Company pays and on gains realized on the sale of 
Securities (“excess distributions”) in all subsequent years, even though the Company ceased to qualify as a PFIC. The amount of this 
tax will be increased by an interest charge to compensate for tax deferral, calculated as if the excess distributions had been earned ratably 
over the period the U.S. holder held its Securities. It may be possible, in certain circumstances, for a holder to avoid the application of 
the PFIC rules by making a "deemed sale" election for its taxable year that includes the last day of the Company’s last taxable year 
during which it qualified as a PFIC. The PFIC rules are extremely complex, and holders should consult their own tax advisers regarding 
the possible application of the PFIC rules to their Securities and the desirability and availability of the above elections. 

The remainder of this discussion assumes that the Company is not a PFIC. 

Taxation of dividends 

For U.S. federal income tax purposes, the gross amount of any distribution paid to U.S. holders (that is, the net distribution 
received plus any tax withheld therefrom) will be treated as ordinary dividend income to the extent paid or deemed paid out of the 
current or accumulated earnings and profits of the Company (as determined under U.S. federal income tax principles). Dividends paid 
by the Company will not be eligible for the dividends-received deduction generally allowed to corporate U.S. holders. 

Subject to certain exceptions for short-term and hedged positions, the U.S. dollar amount of dividends received by an individual 
U.S. holder with respect to the ADSs or shares is currently subject to taxation at a maximum rate of 20% if the dividends are “qualified 
dividends”. Dividends paid on the shares or ADSs will be treated as qualified dividends if the issuer is eligible for the benefits of a 
comprehensive income tax treaty with the United States that the Internal Revenue Service has approved for the purposes of the qualified 
dividend rules The Treaty has been approved for the purposes of the qualified dividend rules. Holders of shares and ADSs should consult 
their own tax advisers regarding the availability of the reduced dividend tax rate in light of their own particular circumstances. 

Dividend income received by a U.S. holder with respect to ADSs or shares generally will be treated as foreign source income 
for foreign tax credit purposes. The limitation on foreign taxes eligible for credit is calculated separately with respect to specific classes 
of income. Distributions out of earnings and profits with respect to the ADSs or shares generally will be treated as “passive category” 
income (or, in the case of certain U.S. holders, “general category” income). Subject to certain limitations, French income tax withheld 
in connection with any distribution with respect to the ADSs or shares may be claimed as a credit against the U.S. federal income tax 
liability of a U.S. holder if such U.S. holder elects for that year to credit all foreign income taxes. Alternatively, such French withholding 
tax may be taken as a deduction against taxable income. Foreign tax credits will not be allowed for withholding taxes imposed in respect 
of certain short-term or hedged positions in Securities and may not be allowed in respect of certain arrangements in which a U.S. holder’s 
expected economic profit is insubstantial. The U.S. federal income tax rules governing the availability and computation of foreign tax 

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credits  are  complex.  U.S. holders  should  consult  their  own  tax  advisers  concerning  the  implications  of  these  rules in  light  of  their 
particular circumstances. 

To the extent that an amount received by a U.S. holder exceeds the allocable share of the Company’s current and accumulated 
earnings and profits, such excess will be applied first to reduce such U.S. holder’s tax basis in its shares or ADSs and then, to the extent 
it exceeds the U.S. holder’s tax basis, it will constitute capital gain from a deemed sale or exchange of such shares or ADSs (see “—Tax 
on Sale or Other Disposition”, below). 

The amount of any distribution paid in euros will be equal to the U.S. dollar value of the euro amount distributed, calculated 
by reference to the exchange rate in effect on the date the dividend is received by a U.S. holder of shares (or by the depositary, in the 
case of ADSs) regardless of whether the payment is in fact converted into U.S. dollars on such date. U.S. holders should consult their 
own tax advisers regarding the treatment of foreign currency gain or loss, if any, on any euros received by a U.S. holder that are converted 
into U.S. dollars on a date subsequent to receipt. 

Distributions to holders of additional shares (or ADSs) with respect to their shares (or ADSs) that are made as part of a pro rata 
distribution to all shareholders generally will not be subject to U.S. federal income tax. However, if a U.S. holder has the option to 
receive a distribution in shares (or ADSs) or to receive cash in lieu of such shares (or ADSs), the distribution of shares (or ADSs) will 
be taxable as if the holder had received an amount equal to the fair market value of the distributed shares (or ADSs), and such holder’s 
tax basis in the distributed shares (or ADSs) will be equal to such amount. 

Tax on sale or other disposition 

In general, for U.S. federal income tax purposes, a U.S. holder that sells, exchanges or otherwise disposes of its shares or ADSs 
will recognize capital gain or loss in an amount equal to the U.S. dollar value of the difference between the amount realized for the 
shares or ADSs and the U.S. holder’s adjusted tax basis (determined in U.S. dollars and under U.S. federal income tax rules) in the 
shares or ADSs. Such gain or loss generally will be U.S.-source gain or loss, and will be treated as long-term capital gain or loss if the 
U.S. holder’s holding period in the shares or ADSs exceeds one year at the time of disposition. If the U.S. holder is an individual, any 
capital gain generally will be subject to U.S. federal income tax at preferential rates (currently a maximum of 20%) if specified minimum 
holding periods are met. The deductibility of capital losses is subject to significant limitations. 

Medicare tax 

Certain U.S. holders who are individuals, estates or trusts are required to pay a Medicare tax of 3.8% (in addition to taxes they 
would otherwise be subject to) on their “net investment income” which would include, among other things, dividends and capital gains 
from the shares and ADSs. 

The discussion above is a general summary. It does not cover all tax matters that may be important to you. You should 
consult your tax advisors regarding the application of the U.S. federal tax rules to your particular circumstances, as well as the 
state, local, non-U.S. and other tax consequences to you of the purchase, ownership and disposition of the Securities. 

Dividends and Paying Agents 

Not applicable. 

Statement by Experts 

Not applicable. 

Documents on Display 

We file annual, periodic, and other reports and information with the U.S. Securities and Exchange Commission (the “SEC”). 
These materials, including this annual report and the exhibits hereto, may be inspected and copied at the SEC’s Public Reference Room at 
100  F  Street,  N.E.,  Washington,  D.C.  20549.  The  public  may  obtain  information  on  the  operation  of  the  SEC’s  Public  Reference 
Room by calling the SEC in the United States at +1 800 SEC 0330. Certain of our public filings are also available on the SEC’s website 
at http://www.sec.gov (such documents are not incorporated by reference in this annual report). 

Subsidiary Information 

Not applicable. 

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Table of Contents 

Annual Report to Security Holders 

If we are required to provide an annual report to security holders in response to the requirements of Form 6-K, we will submit 

the annual report to security holders in electronic format in accordance with applicable requirements. 

Item 11. Quantitative and Qualitative Disclosures about Market Risk 

We are exposed to market risk from changes in both foreign currency exchange rates and interest rates. We do not hold or issue 
derivative or other financial instruments. During 2022 and as of December 31, 2023, we had no outstanding foreign exchange sale or 
purchase contracts. 

Exchange Rate Risk 

Revenues and Expenses in Foreign Currencies 

We are exposed to foreign currency exchange rate risk because a significant portion of our costs are denominated in currencies 
other than those in which we earn revenues. In 2023, 60% of our total costs of sales and operating expenses were denominated in euro. 
During  the  same  period,  45%  of  our  net  sales  were  denominated  in  euro,  the  rest  being  denominated  primarily  in  U.S.  dollars  and 
Japanese yen. 

A uniform 10% strengthening in the value of the euro as of December 31, 2023, relative to the U.S. dollar and the Japanese 
yen would have resulted in a decrease  in loss before taxes of approximately €1,118 thousand for the year ended December 31, 2023, 
compared to an increase of approximately €361 thousand for the year ended December 31, 2022. A uniform 10% decrease in the value 
of the euro as of December 31, 2023, relative to the U.S. dollar and the Japanese yen would have resulted in an increase in loss before 
taxes  of  approximately  €1,230  thousand  for  the year  ended  December 31,  2023,  as  compared  to  a  decrease  of  approximately  €397 
thousand for the year ended December 31, 2022. This calculation assumes that the U.S. dollar and Japanese yen exchange rates would 
have changed in the same direction relative to the euro. In addition to the direct effect of changes in exchange rates quantified above, 
changes in exchange rates also affect the volume of sales. 

We regularly assess the exposure of our receivables to fluctuations in the exchange rates of the principal foreign currencies in 
which our sales are denominated (in particular, the U.S. dollar and the Japanese yen) and, from time to time, hedge such exposure by 
entering into forward sale contracts for the amounts denominated in such currencies that we expect to receive from our local subsidiaries. 
As of December 31, 2023, we had no outstanding hedging instruments. 

Financial Instruments and Indebtedness in Foreign Currencies 

Over the past three years, we also had exchange rate exposures with respect to indebtedness and assets denominated in Japanese 
yen  and  U.S.  dollars.  €0.4  million,  €1.0  million  and  €1.2  million  of  our  outstanding  indebtedness  (excluding  lease  obligations)  at 
December 31, 2023, 2022 and 2021, respectively, were denominated in Japanese yen. We had no outstanding indebtedness (excluding 
lease obligations) that were denominated in U.S. dollars at December 31, 2023, 2022 and 2021, respectively. In addition, we had €27.1 
million, €28.8 million and €28.5 million of cash denominated in U.S. dollars at December 31, 2023, 2022 and 2021, respectively, and 
€3.6 million, €3.9 million and €3.6 million of cash denominated in Japanese yen at December 31, 2023, 2022 and 2021, respectively. 

Equity Price Risk 

Not applicable. 

Item 12. Description of Securities Other than Equity Securities 

Debt Securities 

Not applicable. 

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Warrants and Rights 

Not applicable. 

Other Securities 

Not applicable.  

American Depositary Shares 

For general information on our ADSs, please refer to Exhibit 2.3 “Description of securities registered under Section 12 of the 
Exchange Act” of this annual report. 

Fees Payable to ADS Holders 

The Bank of New York Mellon, 240 Greenwich Street, New York, NY 10286, as the Company’s Depositary, currently collects 
its  fees  for  the  delivery  and  surrender  of  ADSs  directly  from  investors  depositing  shares  or  surrendering  ADSs  for  the  purpose  of 
withdrawal or from intermediaries acting for them. 

A deposit agreement among us, the Depositary and the owners and beneficial owners of ADS sets out the ADS holder rights 
as well as the rights and obligations of the Depositary. New York law governs the deposit agreement and the ADSs. A copy of the 
deposit agreement is incorporated by reference as an exhibit to this annual report. 

The Depositary may collect fees for making distributions to investors by deducting those fees from the amounts distributed or 
by  selling  a  portion  of  distributable  property  to  pay  the  fees.  The  Depositary  may  collect  its  annual  fee  for  Depositary  services  by 
deductions from cash distributions or by directly billing investors or by charging the book-entry system accounts of participants acting 
for them. The Depositary may generally refuse to provide fee-attracting services until the fees for those services are paid. 

Fees: 

For:  

$5.00 (or less) per 100 ADSs (or 
portion of 100 ADSs) 

- 

Issuance of ADSs, including issuances resulting from a distribution of shares or rights 
or other property, 

-  Cancellation of ADSs for the purpose of withdrawal, including if the deposit agreement 

terminates. 

$0.02 (or less) per ADS 

-  Any cash distribution to ADS registered holders. 

A fee equivalent to the fee that 
would be payable if securities 
distributed to you had been shares 
and the shares had been deposited 
to issuance of ADSs 

-  Distribution  of  securities  distributed  to  holders  of  deposited  securities  which  are 

distributed by the Depositary to ADS registered holders. 

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Registration or transfer fees 

positary or its agent when you deposit or withdraw shares  

-  Transfer and registration of shares on our share register to or from the name of the De

-  Cable, telex and facsimile transmissions (when expressly provided in the deposit agre

Expenses of the Depositary 
Taxes and other governmental 
charges the Depositary or the 
custodian have to pay on any ADS 
or share underlying an ADS, for 
example, stock transfer taxes, 
stamp duty or withholding taxes 
Any charges incurred by the 
Depositary or its agents for 
servicing the deposited securities 

ement)  

-  Converting foreign currency to U.S. dollars 
-  As necessary  

-  As necessary  

Fees Payable to the Company by the Depositary 

From January 1, 2023 to December 31, 2023, the following amounts were paid by the Depositary to the Company: $90,000 
and $14,540.88 respectively for the administration of the ADR program and for expenses linked to the preparation of our Assembly 
meeting of shareholders and the assistance in identifying shareholders of the Company. 

Item 13. Defaults, Dividend Arrearages and Delinquencies 

PART II 

None. 

Item 14. Material Modifications to the Rights of Security Holders and Use of Proceeds 

Not applicable. 

Item 15. Controls and Procedures 

Disclosure Controls and Procedures 

The Company’s management, with the participation of the Chief Executive Officer and Chief Financial Officer, conducted an 
evaluation,  pursuant  to  Rule 13a-15(e) promulgated  under  the  Securities  Act  of  1934,  as  amended  (the  "Exchange  Act"),  of  the 
effectiveness of our disclosure controls and procedures as of December 31, 2023. Based on this evaluation, the Chief Executive Officer 
and Chief Financial Officer concluded that our disclosure controls and procedures were not effective as of December 31, 2023, because 
of the material weakness described below.  

In response to the identification of the material weakness described below, the Company performed additional analysis and 
other  post-closing  procedures.  Based  upon  the  work  performed,  management  believes  that  the  Company’s  consolidated  financial 
statements for the periods covered by and included in this annual report fairly present in all material respects the Company’s financial 
position, results of operations and cash flows, in conformity with U.S. generally accepted accounting principles. 

Disclosure controls and procedures means controls and other procedures that are designed to ensure that information required 
to be disclosed by us in the reports that we file or submit under the Exchange Act is recorded, processed, summarized and reported, 
within the time periods specified in the SEC’s rules and forms, and that such information required to be disclosed by us in the reports 
that we file or submit under the Exchange Act is accumulated and communicated to our management, including our principal executive 
and principal financial officers, or persons performing similar functions, as appropriate to allow timely decisions regarding required 
disclosures. The Company’s disclosure controls and procedures are designed to provide reasonable, not absolute, assurance that the 
objectives of its disclosure control system are met. Because of inherent limitations in all control systems, no evaluation of controls can 
provide absolute assurance that all control issues, if any, within a company have been detected. 

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Management’s Annual Report on Internal Control Over Financial Reporting  

Management is responsible for establishing and maintaining adequate internal control over financial reporting (as defined in 
Rules 13a 15(f) and 15d 15(f) under the Exchange Act) and for the assessment of the effectiveness of our internal control over financial 
reporting. Internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of 
financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting 
principles. 

The Company’s internal controls over financial reporting include those policies and procedures that: 

•  Pertain to the maintenance of records that in reasonable detail accurately and fairly reflect the transactions and dispositions 

of the assets of the Company; 

•  Provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in 
accordance with generally accepted accounting principles, and that receipts and expenditures of the Company are being 
made only in accordance with authorizations of the Company’s management and directors; and 

•  Provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use or disposition of 

the Company’s assets that could have a material effect on the financial statements. 

Because of inherent limitations, internal controls over financial reporting may not prevent or detect misstatements. Projections 
of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in 
conditions, or that the degree of compliance with the policies or procedures may deteriorate. 

Management assessed the effectiveness of internal control over financial reporting as of December 31, 2023, based upon the 
internal control framework as set forth by the Committee of Sponsoring Organizations of the Treadway Commission (2013 COSO). 
Based  on  management’s  assessment,  management  concluded  that  the  Company’s  internal  control  over  financial  reporting  was  not 
effective as of December 31, 2023, because of the material weakness described below. 

Based on this evaluation, management identified one material weakness with respect to internal control in our U.S. subsidiary, 
Edap Technomed Inc.: an ineffective design and implementation of the subsidiary’s control over the recording of third-party vendor 
invoices. This was due to insufficient resources in the finance department of the subsidiary and IT environment limitations.  

Our management has concluded that, as a result, our internal control over financial reporting was not effective as of December 

31, 2023.  

A material weakness is a deficiency, or combination of deficiencies, in internal control over financial reporting, such that there 
is a reasonable possibility that a material misstatement of our annual or interim financial statements will not be prevented or detected 
on a timely basis. 

Remediation Activities 

In our annual report on Form 20-F for the year ended December 31, 2022, we reported three material weaknesses with respect 
to internal controls in our U.S. subsidiary, Edap Technomed Inc., which were due to insufficient resources in the finance department of 
the subsidiary, leading to inability to perform certain controls. This led to the following material weaknesses at our U.S. subsidiary: 

· 
· 
· 

Ineffective design of the subsidiary’s control over the recording of third-party vendor invoices; 
Deficiencies in the design and implementation of the subsidiary’s controls over the recording of sales invoices; and 
Deficiencies in the design and implementation of the subsidiary’s control over the inventory count. 

As mentioned in our annual report on Form 20-F for the year ended December 31, 2022, we hired a Chief Financial Officer for 
our U.S. subsidiary on December 5, 2022, and hired a person responsible for financial planning and analysis in January 2023. In addition, 
during  2023  we  hired  additional  resources  including  a  Senior  Audit  and  Accounting  Manager  and  designed  and  implemented  new 
controls over the recording of sales invoices and over the inventory count. 

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Management plan for the remediation of the current material weakness  

Despite the remediation actions implemented in 2023 and described above, one of the 2022 material weaknesses related to the 
ineffective  design  and  implementation  of  the  subsidiary’s  control  over  the  recording  of  third-party  vendor  invoices  was  not  fully 
remediated as of December 31, 2023. Due to limited IT systems, manual controls needed to be implemented to address this material 
weakness required additional finance human resources which were added late in the year. 

The material weakness did not result in a material misstatement of the consolidated financial statements for the year ended 
December 31, 2023, or restatement of any prior period previously reported by the Company. However, there is a reasonable possibility 
that a material misstatement of the consolidated financial statements would not have been prevented or detected on a timely basis due 
to the failure in designing and implementing an appropriate control over the recording of third-party vendor invoices, and therefore, our 
management has determined this deficiency constitutes a material weakness. 

In an effort to remediate this remaining material weakness and continue to enhance our overall control environment, we plan 
to hire additional resources in 2024. We are also working at deploying another IT system in our U.S. subsidiary and have hired an IT 
VP Manager to supervise such deployment. We believe this will allow us to remediate this material weakness in the short term. 

Change in Internal Control over Financial Reporting 

Other than the material weakness and remediation activities described above, there were no changes in the Company’s internal 
control over financial reporting during the period covered by this annual report that has materially affected or is reasonably likely to 
materially affect the Company’s internal control over financial reporting. 

Attestation Report of Registered Public Accounting Firm 

The effectiveness of the Company’s internal control over financial reporting as of December 31, 2023, has been audited by 
KPMG S.A., an independent registered public accounting firm, as stated in its report on the Company’s internal control over financial 
reporting included on page F-4 of this annual report. 

Its  report  expresses  an  opinion  that  the  Company  did  not  maintain  effective  internal  control  over  financial  reporting  as  of 

December 31, 2023 because of the effect of the material weakness described above. 

Item 16. [Reserved] 

Item 16A. Audit Committee Financial Expert 

Our Board of Directors has determined that the chair of the Board’s Audit Committee, Mr. Pierre Beysson, an independent 

director, qualifies as an audit committee financial expert. 

Item 16B. Code of Ethics 

We have adopted a code of ethics applicable to our Chief Executive Officer, Chief Financial Officer, principal accounting 
officers and to any persons performing similar functions. The code of ethics is regularly reviewed  and updated as needed.. Our code of 
ethics has been made available on our website at http://www.edap-tms.com. The contents of our website is not incorporated by reference 
or otherwise included in this annual report. You may request a copy of our code of ethics free of charge upon request to Blandine 
Confort, Investor Relations Officer, at bconfort@edap-tms.com. We expect that any amendments to the code of ethics, or any waivers 
of its requirements, will be disclosed on our website. 

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Item 16C. Principal Accountant Fees and Services 

The  following  table  summarizes  the  aggregate  fees  of  our  independent  registered  accounting  firm,  billed  to  us  for  the 
fiscal years  ended  December 31, 2023  and  December 31, 2022  for  audit  and  other  services.  KPMG  S.A.  (“KPMG”)  served  as  the 
Company’s independent registered accounting firm for the fiscal years ended December 31, 2023 and 2022. 

Nature of the Fees 
Audit fees 
Audit-related fees 
Tax fees 
All other fees 
Total 

Fees for  
2023 
(in €) 
 830,000   
 —   
 —   
 —   
 830,000   

Fees for 
2022 
(in €) 
 592,000 
 47,266 
 — 
 — 
 639,266 

As the Company has exceeded certain levels of revenues and balance sheet set under French law, the appointment of a joint-
auditor,  as  well  as  the  production  of  consolidated  accounts  under  International  Financial  Reporting  Standards,  is  required  for  the 
fiscal year 2020 and beyond. On June 30, 2020, the shareholders appointed the audit firm of Agili(3F) as our independent joint-auditors 
starting with the 2020 fiscal year for the audit of the statutory consolidated financial statements prepared in accordance with International 
Financial Reporting Standards. Audit fees billed to us by Agili(3F) for fiscal years ended December 31, 2023 and 2022 are as follows: 

Nature of the Fees 
Audit fees 
Audit-related fees 
Tax fees 
All other fees 
Total 

Audit Fees 

Fees for 
2023 
(in €) 
 30,500   
 —   
 —   
 —   
 30,500   

   Fees for 

2022 
(in €) 
 29,000 
 — 
 — 
 — 
 29,000 

The following services were billed under the category “audit services”: audit of financial statements and services performed in 
relation to legal obligations, including the formulation of audit opinions, consents and reports, domestic and international legal audits. 

Audit-Related Fees 

Audit-related services billed under this category only consist of attestation services related to financial reporting that are not 

required by statute or regulation. 

Pre-approval Policy 

The “Audit and Non-Audit Services Pre-Approval Policy” was approved by our Audit Committee on December 22, 2003 and 
reviewed on November 20, 2012. This requires all services which are to be performed by our external auditors to be pre-approved. Pre-
approval may be in the form of a general pre-approval or as pre-approval on a case-by-case basis. All services to be performed by the 
external auditors were subjected to the above policy and approved in advance. The Audit Committee has been regularly informed of the 
services and the fees to be paid. 

Item 16D. Exemptions from the Listing Standards for Audit Committees 

None. 

Item 16E. Purchases of Equity Securities by the Issuer and Affiliated Purchasers 

None. 

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Item 16F. Change in Registrant’s Certifying Accountant 

Not applicable. 

Item 16G. Corporate Governance Requirements 

Exemptions from Certain Nasdaq Corporate Governance Rules 

EDAP is incorporated under the laws of France, with securities listed on The Nasdaq Global Market in the United States. As a 
foreign  private  issuer  listed  on  Nasdaq,  under  Nasdaq  corporate  governance  requirements,  we  may  follow  French  law  corporate 
governance practices in lieu of following certain Nasdaq corporate governance rules. We summarize below the main practices we follow 
in lieu of Nasdaq corporate governance rules. 

We are exempt from Nasdaq’s quorum requirements applicable to meetings of shareholders. In keeping with French law and 
generally accepted business practices in France, the presence in person or by proxy of shareholders having not less than 20% (in the 
case of an ordinary general meeting or an extraordinary general meeting deciding upon any capital increase by capitalization of reserves) 
or 25% (in the case of an extraordinary general meeting) of the shares is necessary for a quorum. If a quorum is not present at any 
meeting, the meeting is adjourned. Upon recommencement of an adjourned meeting, there is no quorum requirement in the case of an 
ordinary general meeting or an extraordinary general  meeting deciding upon  any  capital  increase by  capitalization of  reserves. The 
presence in person or by proxy of shareholders having not less than 20% of the shares is necessary for a quorum in the case of any other 
type  of  extraordinary  general  meeting.  Therefore,  EDAP  will  not  follow  Nasdaq’s  Listing  Rule  5620(c),  which  provides  that  the 
minimum quorum requirement for a meeting of shareholders is 33 1⁄3% of the outstanding common voting shares of the company. In 
accordance with the provisions of the French Commercial Code, the required majority for the adoption of a decision is a simple majority 
(for an ordinary general meeting of the shareholders) or a two-thirds majority (for an extraordinary general meeting) of the votes cast 
by the shareholders present or represented. 

Under French law, the committees of our Board of Directors are advisory only, and where Nasdaq requirements would vest 
certain decision-making powers with specific committees by delegation (e.g., nominating, compensation or audit committees), our Board 
of Directors is, pursuant to French law the only competent body to take such decisions, albeit taking into account the recommendation 
of the relevant committees. Additionally, under French corporate law, it is the shareholder meeting of the Company that is competent to 
appoint our auditors upon the proposal of our Board of Directors. Our Compensation Committee is composed of four members who 
meet  the  definition  of  independence  contained  in  Nasdaq  Listing  Rule 5602(a) and  is  governed  by  a  charter  which  sets  forth  its 
composition and defines its scope of authority. However, in accordance with French law, the Compensation Committee is not vested 
with the same scope of authority and responsibilities as set out in the Nasdaq Listing Rules. 

On August 26, 2020, the Board of Directors approved the creation of a Strategic Committee to address strategic issues and 

governed by a charter which sets forth its composition and defines its scope of authority. 

Nasdaq rules require shareholder approval in certain circumstances, including in connection with the issuance of shares as part 
of an acquisition of stock or assets of another company (Rule 5635(a)), a company change of control within the meaning of Nasdaq’s 
rules (Rule 5635(b)), when a plan or other equity compensation arrangement is established or materially amended (Rule 5635(c)), and 
in connection with certain issuances involving 20% or more of the ordinary shares or voting power outstanding before the issuance at a 
price lower than a minimum price specified in the Nasdaq rules (Rule 5635(d)). Under French law our shareholders must decide any 
issuance of equity, as a general matter. Such shareholder approval is typically provided by the adoption of authorizing resolutions at the 
Company’s annual shareholders’ meeting at which shareholders approve delegations of authority to the Executive Board to increase the 
Company’s  share  capital  within  specified  parameters,  which  may  include  specified  price  limitations  and/or  specific  or  aggregate 
limitations on the size of the share capital increase. While the Company views such shareholder approvals to be consistent with the 
purpose  of  the  Nasdaq  shareholder  approval  rules,  it  is  not  certain  that  Nasdaq  would  accept  the  Company’s  shareholder-approved 
resolutions as sufficient to satisfy the Nasdaq shareholder approval rules in connection with a specific transaction. Accordingly, we 
follow our French home country practice and obtain shareholder approval for delegations of authority (i) to issue equity to our directors, 
officers and employees, subject to the limitations of such approvals, and (ii) to define the final terms of such transactions (including the 
final terms of any equity compensation plan or arrangements) to our directors, officers and employees. The Company may, from time 
to  time,  ask  for  our  shareholders’  approval  in  respect  of  a  specific  transaction  or  we  may  seek  subsequent  approval  of  an  equity 
compensation arrangement in order to obtain advantageous tax treatment or otherwise. In addition, under French law, we must obtain 
the prior approval of our shareholders before issuing equity or establishing or amending a compensatory plan or arrangement that would 
exceed the limits of the shareholder-granted delegations. 

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Because we are a “foreign private issuer” as described above, our Chief Executive Officer and our Chief Financial Officer issue 
the certifications required by Section 302 and Section 906 of the Sarbanes-Oxley Act of 2002 on an annual basis (with the filing of 
our annual report on Form 20-F) rather than on a quarterly basis as would be the case of a U.S. corporation filing quarterly reports on 
Form 10- Q. 

French  corporate  law  provides  that  the  Board  of  Directors  must  vote  to  approve  a  broadly  defined  range  of  related-party 
transactions (conventions réglementées) between EDAP on the one hand and its directors and Chief Executive Officer on the other hand, 
which  are  then  presented  to  shareholders  for  approval  at  the  next  annual  meeting.  This  legal  safeguard  operates  in  place  of  certain 
provisions of the Nasdaq Listing Rules. 

Item 16H. Mine Safety Disclosure 

Not applicable. 

Item 16I. Disclosure Regarding Foreign Jurisdictions that Prevent Inspections. 

Not applicable. 

Item 16J. Insider Trading Policy 

Not applicable. 

Item 16K. Cybersecurity 

Cybersecurity Risk Management and Strategy 

We have developed and implemented a cybersecurity risk management program designed to safeguard sensitive information 
and  ensure  the  integrity  of  our  operations.  We  have  a  framework  of  policies  and  procedures,  encompassing  governance,  risk 
management, and compliance, to address cybersecurity threats in a manner commensurate with the size and complexity of our operations 
and organizational structures. As part of this program, we address risk linked to network security, data encryption and other measures 
to protect our systems and data from unauthorized access or misuse.  In addition, we also take measures to meet the information security 
standards that our customers require from time-to-time. To protect our systems and information from cybersecurity threats, we use a 
variety of security tools and techniques generally available for entities of our size. 

Our  IT  organization  is  currently  decentralized  by  entity,  whereby  each  entity  is  principally  responsible  for  facilitating  and 

managing our cybersecurity risk management program with respect to such entity.  

Depending on the complexity of our operations for each entity, cybersecurity risk management processes include: 

• 
• 

• 
• 
• 
• 
• 

• 

an incident response plan that ensures detection, mitigation and resolution of cybersecurity incidents; 
risk management criteria that adapt to the specific cybersecurity risk, including feedback from cybersecurity incidents that 
have occurred in the past; 
protocols that protect against specific cybersecurity threats identified by our cyber risk assessments; 
continuous assessments and upgrades of our IT and related systems; 
processes to ensure business continuity and ongoing operations upon the occurrence of a cyber-attack; 
the use of a specialized third-party firm to conduct periodic assessments of our cybersecurity policies and procedures;  
the use of third parties for certain cybersecurity defense measures, including firewalls, antivirus solutions and system back-up 
solutions; 
periodic cyber-awareness campaigns for employees and cybersecurity training for our incident response personnel and senior 
management. 

As part of our strategic evolution and re-organization, we are currently integrating our cybersecurity risk management program 
into our overall enterprise risk management program, to standardize, harmonize and upgrade our processes on a group-wide basis. As 
an illustration, a planned upgrade would be the development of a response to cybersecurity threats associated with EDAP’s use of any 
third-party service provider once we have a higher level of digital integration with other service providers.  

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We have not identified risks from known cybersecurity threats, including as a result of any prior cybersecurity incidents, that 
have materially affected or are reasonably likely to materially affect us, including our operations, business strategy, results of operations, 
or financial condition. See “Item 3.D. Risk Factors—We are exposed to risks related to cybersecurity threats and incidents.” 

Cybersecurity Governance 

Our  board  of  directors  considers  cybersecurity  risk  as  part  of  its  risk  oversight  function  and  has  delegated  to  the  Audit 

Committee oversight of our cybersecurity risk management program.  

Our  Internal  Audit  organization  reports  on  a  quarterly  basis,  on  the  prevention,  detection,  mitigation  and  remediation  of 
cybersecurity incidents to our Senior management team, Audit Committee and Board of Directors depending on the materiality of the 
incident. Materiality is primarily assessed both in terms of criticity of the data and overall amount at risk. In addition to any reports from 
the Audit Committee to our full Board of Directors regarding cybersecurity, the Chairman of the Audit Committee informs and updates 
the full Board of Directors about any significant cybersecurity incidents.  

Our management team, which is led by our Chief Executive Officer and Chief Financial Officer, is responsible for assessing 
and managing material risks from cybersecurity threats. We are in the process of hiring a Vice President of Information Technology 
who will implement our planned group-wide cybersecurity risk management program, as part of our digital strategy.  

Item 17. Financial Statements. 

See Item 18, "Financial Statements." 

Item 18. Financial Statements 

PART III 

The financial statements listed in the Index to Financial Statements are filed as a part of this annual report. 

Item 19. Exhibits 

The exhibits listed in the Index to Exhibits are filed or incorporated by reference as a part of this annual report. 

INDEX TO EXHIBITS 

Pursuant to the rules and regulations of the Securities and Exchange Commission, the Company has filed certain agreements 
as  exhibits  to  this  annual  report  on  Form 20-F.  These  agreements  may  contain  representations  and  warranties  by  the  parties.  These 
representations and warranties have been made solely for the benefit of the other party or parties to such agreements and (i) may be 
intended not as statements of fact, but rather as a way of allocating the risk to one of the parties to such agreements if those statements 
turn out to be inaccurate; (ii) may have been qualified by disclosures that were made to such other party or parties and that either have 
been reflected in the Company’s filings or are not required to be disclosed in those filings; (iii) may apply materiality standards different 
from what may be viewed as material to investors; and (iv) were made only as of the date of such agreements or such other date(s) as 
may be specified in such agreements and are subject to more recent developments. Accordingly, these representations and warranties 
may not describe the Company’s actual state of affairs at the date hereof. 

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Exhibit Description 

Number: 

1.1 

2.1# 

2.2 

2.3 

4.1# 

4.2# 

     By-laws (statuts) of EDAP TMS S.A. as amended as of December 6, 2023 

Form of Amended and Restated Depositary Agreement between EDAP TMS S.A. and The Bank of New York Mellon, as 
depositary  (incorporated  herein  by  reference  to  Exhibit 1.2  to  Form F-6  dated  September 15,  2011,  SEC  File 
No. 333-176843). 

  Form of American Depositary Receipt (included in Exhibit 2.1). 

  Description of securities registered under Section 12 of the Exchange Act  

French  version  of  Commercial  Lease  dated  July 1,  2015  between  Maison  Antoine  Baud  and  EDAP  TMS  France 
(incorporated herein by reference to Exhibit 4.1 to Form 20-F dated April 4, 2016, SEC File No. 000-29374)  

English  language  summary  of  Commercial  Lease  dated  July 1,  2015  between  Maison  Antoine  Baud  and  EDAP  TMS 
France (incorporated herein by reference to Exhibit 4.2 to Form 20-F dated April 4, 2016, SEC File No. 000-29374)   

4.3†# 

  2016 Stock Option Plan on Form S-8 dated April 5, 2017, File Number 333-217160 

4.4†# 

  2019 Stock-Option Subscription Plan on Form S-8 dated June 16, 2021, File Number 333-257142 

4.5†# 

  2019 Stock-Option Purchase Plan on Form S-8 dated June 16, 2021, File Number 333-257142 

4.6†# 

  2021 Free Share Plan on Form S-8 dated September 28, 2021, File Number 333-259857 

4.7†# 

  2021 Share Subscription Option Plan on Form S-8 dated November 18, 2021, File Number 333-261182 

4.8†# 

8.1 

12.1 

12.2 

13.1 

15.1 

97.1 

2022 Free Share Plan on Form S-8 dated November 9, 2022, File Number 333-268265 

List of significant subsidiaries, see “Item 4. Information on the Company — C. Organizational Structure” of this annual 
report on Form 20-F 

Certification by the Principal Executive Officer pursuant to Securities Exchange Rules 13a-14(a) and 15d-14(a), as adopted 
pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. 

Certification by the Principal Financial Officer pursuant to Securities Exchange Rules 13a-14(a) and 15d-14(a), as adopted 
pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. 

Certification by the Principal Executive Officer and Principal Financial Officer pursuant to 18 U.S.C. Section 1350, as 
adopted pursuant to pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. 

  Consent of KPMG. 

  Clawback Policy of EDAP TMS S.A. 

101.INS   

Inline XBRL Instance Document 

101.SCH   

Inline XBRL Taxonomy Extension Schema Document. 

101.CAL  

Inline XBRL Taxonomy Extension Calculation Linkbase Document. 

101.DEF   

Inline XBRL Taxonomy Definition Linkbase Document. 

101.LAB  

Inline XBRL Taxonomy Extension Label Linkbase Document. 

101.PRE   

Inline XBRL Taxonomy Extension Presentation Linkbase Document. 

  Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101) 

104 
†  Indicates a management contract or any compensatory plan, contract or arrangement. 
#  Indicates a document previously filed with the Commission. 

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The registrant hereby certifies that it meets all of the requirements for filing on Form 20-F and that it has duly caused and 

authorized the undersigned to sign this annual report on its behalf. 

SIGNATURES 

Dated: March 28, 2024 

Dated: March 28, 2024 

     EDAP TMS S.A. 

/s/ Ryan Rhodes 

  Ryan Rhodes 
  Chief Executive Officer 

/s/ Ken Mobeck 

  Ken Mobeck 
  Chief Financial Officer 

76 

  
  
 
 
  
 
 
 
  
  
  
 
 
  
 
 
 
  
  
 
 
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INDEX TO FINANCIAL STATEMENTS 

Report of Independent Registered Public Accounting Firm on the Consolidated Financial Statements  
(KPMG S.A., Lyon, France, PCAOB ID 1253) 
Report of Independent Registered Public Accounting Firm on the Internal Control over Financial Reporting 
Consolidated Balance Sheets 
Consolidated Statements of Income (Loss) 
Consolidated Statements of Comprehensive Income (Loss) 
Consolidated Statements of Shareholders’ Equity 
Consolidated Statements of Cash Flows 
Notes to Consolidated Financial Statements 

F-2 
F-4 
F-6 
F-7 
F-8 
F-9 
F-10 
F-11 

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Report of Independent Registered Public Accounting Firm 

To the Shareholders and Board of Directors, 

Opinion on the Consolidated Financial Statements 

We have audited the accompanying consolidated balance sheets of EDAP TMS S.A. and subsidiaries (the Company) as of December 31, 
2023 and 2022, the related consolidated statements of income (loss), comprehensive income (loss), shareholders’ equity, and cash flows 
for each of the years in the three-year period ended December 31, 2023, and the related notes (collectively, the consolidated financial 
statements). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position of the 
Company as of December 31, 2023 and 2022, and the results of its operations and its cash flows for each of the years in the three-year 
period ended December 31, 2023, in conformity with U.S. generally accepted accounting principles. 

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), 
the Company’s internal control over financial reporting as of December 31, 2023, based on criteria established in Internal Control – 
Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission, and our report dated 
March 28, 2024, expressed an adverse opinion on the effectiveness of the Company’s internal control over financial reporting. 

Basis for Opinion 

These consolidated financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion 
on these consolidated financial statements based on our audits. We are a public accounting firm registered with the PCAOB and are 
required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and 
regulations of the Securities and Exchange Commission and the PCAOB. 

We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit 
to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement, whether due to 
error or fraud. Our audits included performing procedures to assess the risks of material misstatement of the consolidated financial 
statements, whether due to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, 
on  a  test  basis,  evidence  regarding  the  amounts  and  disclosures  in  the  consolidated  financial  statements.  Our  audits  also  included 
evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation 
of the consolidated financial statements. We believe that our audits provide a reasonable basis for our opinion. 

Critical Audit Matter 

The critical audit matter communicated below is a matter arising from the current period audit of the consolidated financial statements 
that was communicated or required to be communicated to the audit committee and that: (1) relates to accounts or disclosures that are 
material to the consolidated financial statements and (2) involved our especially challenging, subjective, or complex judgments. The 
communication of a critical audit matter does not alter in any way our opinion on the consolidated financial statements, taken as a whole, 
and we are not, by communicating the critical audit matter below, providing a separate opinion on the critical audit matter or on the 
accounts or disclosures to which it relates. 

Revenue recognition – Identification of distinct performance obligations in multiple-element arrangements related to sales of medical 
devices produced by the Company 

As discussed in Note 1.5 to the consolidated financial statements, the Company’s sale arrangements may contain multiple elements, 
including  medical  devices  produced  by  the  Company,  consumables,  and  services  such  as  maintenance  or  warranty  extensions.  The 
Company identifies goods or services within the contract that constitute distinct performance obligations.  

We identified the identification of distinct performance obligations included in the contracts with customers for the sales of medical 
devices  produced  by  the  Company  as  a  critical  audit  matter,  because  each  customer  contract  is  a  specific  contract,  with  distinct 

F-2 

 
 
 
 
 
 
 
 
 
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performance obligations. Challenging auditor judgment was required in evaluating the impact of the terms and conditions in contracts 
with multiple elements to assess the identification of distinct performance obligations.  

The following are the primary procedures we performed to address this critical audit matter. We evaluated the design and tested the 
operating  effectiveness  of  certain  internal  controls  over  the  Company’s  revenue  recognition  process  related  to  the  identification  of 
distinct performance obligations included in multiple-element arrangements. For certain medical device sales, we obtained and read the 
executed contracts and assessed the Company’s identification of distinct performance obligations. 

Lyon, March 28, 2024 

KPMG S.A. 

Stéphane Gabriel Devin 
Partner 

We have served as the Company’s auditor since 2018. 

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Report of Independent Registered Public Accounting Firm 

To the Shareholders and Board of Directors, 

Opinion on Internal Control Over Financial Reporting 

We have audited EDAP TMS S.A. and subsidiaries’ (the Company) internal control over financial reporting as of December 31, 2023, 
based on criteria established in Internal Control – Integrated Framework (2013) issued by the Committee of Sponsoring Organizations 
of the Treadway Commission. In our opinion, because of the effect of the material weakness, described below, on the achievement of 
the objectives of the control criteria, the Company has not maintained effective internal control over financial reporting as of December 
31,  2023,  based  on  criteria  established  in  Internal  Control  –  Integrated  Framework  (2013)  issued  by  the  Committee  of  Sponsoring 
Organizations of the Treadway Commission. 

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), 
the consolidated balance sheets of the Company as of December 31, 2023 and 2022, the related consolidated statements of income (loss), 
comprehensive income (loss), shareholders’ equity, and cash flows for each of the years in the three-year period ended December 31, 
2023, and the related notes  (collectively, the consolidated financial statements), and our report dated March 28, 2024 expressed an 
unqualified opinion on those consolidated financial statements. 

A material weakness is a deficiency, or a combination of deficiencies, in internal control over financial reporting, such that there is a 
reasonable possibility that a material misstatement of the company’s annual or interim financial statements will not be prevented or 
detected on a timely basis. A material weakness at the Company’s U.S. subsidiary related to an ineffective design and implementation 
of  the  subsidiary's  control  over  the  recording  of  third-party  vendor  invoices  has  been  identified  and  included  in  management’s 
assessment. The material weakness was considered in determining the nature, timing, and extent of audit tests applied in our audit of 
the 2023 consolidated financial statements, and this report does not affect our report on those consolidated financial statements. 

Basis for Opinion  

The Company’s management is responsible for maintaining effective internal control over financial reporting and for its assessment of 
the effectiveness of internal control over financial reporting, included in the accompanying Management’s Annual Report on Internal 
Control Over Financial Reporting. Our responsibility is to express an opinion on the Company’s internal control over financial reporting 
based on our audit. We are a public accounting firm registered with the PCAOB and are required to be independent with respect to the 
Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange 
Commission and the PCAOB. 

We conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to 
obtain reasonable assurance about whether effective internal control over financial reporting was maintained in all material respects. 
Our audit of internal control over financial reporting included obtaining an understanding of internal control over financial reporting, 
assessing the risk that a material weakness exists, and testing and evaluating the design and operating effectiveness of internal control 
based on the assessed risk. Our audit also included performing such other procedures as we considered necessary in the circumstances. 
We believe that our audit provides a reasonable basis for our opinion. 

Definition and Limitations of Internal Control Over Financial Reporting  

A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of 
financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting 
principles.  A  company’s  internal  control  over  financial  reporting  includes  those  policies  and  procedures  that  (1)  pertain  to  the 
maintenance  of  records  that,  in  reasonable  detail,  accurately  and  fairly  reflect  the  transactions  and  dispositions  of  the  assets  of  the 
company; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in 
accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in 

F-4 

 
 
 
 
 
 
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accordance with authorizations of management and directors of the company; and (3) provide reasonable assurance regarding prevention 
or timely detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the 
financial statements. 

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections 
of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in 
conditions, or that the degree of compliance with the policies or procedures may deteriorate. 

Lyon, March 28, 2024 

KPMG S.A. 

Stéphane Gabriel Devin 
Partner 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED BALANCE SHEETS 
As of December 31, 2023 and 2022 
(in thousands of euros unless otherwise noted) 

ASSETS 
Current assets 
Cash and cash equivalents 
Current portion of net trade accounts and notes receivable 
Other receivables 
Inventories 
Other assets, current portion 
Total current assets 
Non-current assets 
Property and equipment, net 
Operating lease right-of-use assets 
Intangible assets, net 
Goodwill 
Deposits and other non-current assets 
Deferred tax assets 
Net Trade accounts and notes receivable, non-current 
Total assets 
LIABILITIES AND SHAREHOLDERS’ EQUITY 
Current liabilities 
Trade accounts and notes payable 
Deferred revenues, current portion 
Social security and other payroll withholdings taxes 
Employee absences compensation 
Income taxes payable 
Other accrued liabilities 
Short-term borrowings 
Current obligations under finance leases 
Current portion of operating lease obligations 
Current portion of long-term debt 
Total current liabilities 
Non-current liabilities 
Deferred revenues, non-current 
Obligations under finance leases 
Operating lease obligations, non-current 
Long-term debt, non-current 
Other long-term liabilities 
Total liabilities 
Shareholders’ equity 

Common stock, €0.13 par value; 37,373,312 shares issued and 37,103,779 shares 
outstanding at December 31, 2023 €0.13 par value 37,197,731 shares issued and 
36,910,925 shares outstanding at December 31, 2022 

Additional paid-in capital 
Retained earnings 
Cumulative other comprehensive loss 
Treasury stock, at cost 269,533 shares at December 31, 2023 and 286,806 shares at 
December 31, 2022 
Total shareholders’ equity 
Total liabilities and shareholders’ equity 

2 
3 
4 
5 
6 

7 
8 
9 
9 

23‑3 
3 

10 
11 

12 
14 
13‑1 
13‑2 
15‑1 

11 
13‑1 
13‑2 
15‑1 
16 

17 
17 

The accompanying notes are an integral part of the consolidated financial statements. 

Notes 

2023 

2022 

 43,471    
 17,858    
 1,380    
 15,112    
 659    
 78,480    

 6,471    
 1,722    
 1,084    
 2,412    
 651    
 729    
 —    
 91,548    

 11,297    
 4,049    
 1,695    
 860    
 77    
 4,506    
 2,466    
 195    
 898    
 1,553    
 27,596    

 643    
 433    
 882    
 1,997    
 3,075    
 34,626    

 63,136 
 13,421 
 1,522 
 11,780 
 660 
 90,518 

 4,200 
 1,784 
 725 
 2,412 
 656 
 829 
 — 
 101,123 

 6,647 
 4,050 
 1,550 
 798 
 219 
 3,873 
 1,846 
 224 
 901 
 1,601 
 21,708 

 264 
 324 
 899 
 3,587 
 2,710 
 29,492 

 4,851    
 120,908    
 (63,549)   
 (4,487)   

 (800)   
 56,922    
 91,548    

 4,776 
 113,952 
 (42,372) 
 (3,829) 

 (897) 
 71,632 
 101,123 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED STATEMENTS OF INCOME (LOSS) 
For the years ended December 31, 2023, 2022 and 2021 
(in thousands of euros except share and per share data) 

Sales of goods 
Sales of RPPs & leases 
Sales of spare parts and services 
Total sales 
Other revenues 
Total revenues 

Cost of goods 
Cost of RPPs & leases 
Cost of spare parts and services 
Total cost of sales 

Gross profit 

Research and development expenses 
Selling and marketing expenses 
General and administrative expenses 

Income (loss) from operations 
Financial (expense) income, net 
Foreign currency exchange gain (loss), net 

Income (loss) before taxes 
Income tax (expense) benefit 
Net income (loss) 
Basic income (loss) per share 
Diluted income (loss) per share 
Basic Weighted average shares outstanding 
Diluted Weighted average shares outstanding 

Note 

18 
19 

20 

21 

22 

23‑1 
23‑2 

24 
24 
24 
24 

2023 
 42,333   
 6,176   
 11,914   
 60,423   
 —   
 60,423   

 (23,302)   
 (4,541)   
 (8,169)   
 (36,012)   

2022 
 38,462   
 5,617   
 11,030   
 55,108   
 —   
 55,108   

 (20,528)   
 (3,387)   
 (7,000)   
 (30,916)   

2021 
 29,040 
 4,968 
 10,052 
 44,060 
 6 
 44,065 

 (16,181) 
 (3,108) 
 (6,354) 
 (25,643) 

 24,411   

 24,193   

 18,422 

 (6,963)   
 (22,626)   
 (14,634)   

 (19,813)   
 1,079   
 (1,799)   

 (4,920)   
 (16,379)   
 (7,152)   

 (4,257)   
 236   
 1,925   

 (3,402) 
 (10,732) 
 (5,900) 

 (1,612) 
 145 
 2,360 

 (20,533)   
 (644)   
 (21,178)   
 (0.57)   
 (0.57)   
 36,996,722   
 36,996,722   

 (2,096)   
 (837)   
 (2,933)   
 (0.09)   
 (0.09)   
 34,392,598   
 34,392,598   

 893 
 (193) 
 700 
 0.02 
 0.02 
 32,129,047 
 32,422,871 

The accompanying notes are an integral part of the consolidated financial statements. 

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CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) 

EDAP TMS S.A. AND SUBSIDIARIES 

For the years ended December 31, 2023, 2022 and 2021 
(in thousands of euros unless otherwise noted) 

Net income (loss) 
Other comprehensive income (loss) : 
Foreign currency translation adjustments 
Provision for retirement indemnities 
Deferred tax for retirement indemnities 
Comprehensive income (loss), net of tax 

2023 
 (21,178)   

2022 
 (2,933)   

2021 

 700 

17‑6 
17‑6 
17‑6 

 (478)   
 (141)   
 (39)   
 (21,836)   

 (596)   
 282    
 73    
 (3,173)   

 (554) 
 77 
 (48) 
 175 

The accompanying notes are an integral part of the consolidated financial statements. 

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CONSOLIDATED STATEMENTS OF SHAREHOLDERS’ EQUITY 

EDAP TMS S.A. AND SUBSIDIARIES 

For the years ended December 31, 2023, 2022 and 2021 
(in thousands of euros unless otherwise noted) 

  Additional   Retained  

Other  

Number 
      of shares 

  Common  
      stock 

paid-in 
      capital 

  Earnings /   comprehensive   Treasury  

      income (loss)       

Balance as of December 31, 2020 
Net (loss) / income 
Translation adjustment 
Stock-based compensation 
Capital increase net of issuance costs of €1,961 thousand 
Treasury stock disposition 
Provision for retirement indemnities 
Deferred tax for retirement indemnities 
Balance as of December 31, 2021 
Net (loss) / income 
Translation adjustment 
Stock-based compensation 
Capital increase net of issuance costs of €1,954 thousand 
Treasury stock disposition 
Provision for retirement indemnities 
Deferred tax for retirement indemnities 
Balance as of December 31, 2022 
Net (loss) / income 
Translation adjustment 
Stock-based compensation 
Capital increase 
Treasury stock disposition 
Provision for retirement indemnities 
Deferred tax for retirement indemnities 
Balance as of December 31, 2023 

 29,165,316   
 —   
 —   
 —   
 4,300,820   
 —   
 —   
 —   
    33,466,136   
 —   
 —   
 —   
 3,444,789   
 —   
 —   
 —   
    36,910,925   
 —   
 —   
 —   
 192,854   
 —   
 —   
 —   
    37,103,779   

 3,830   
 —   
 —   
 —   
 559   
 —   
 —   
 —   
 4,389   
 —   
 —   
 —   
 388   
 —   
 —   
 —   
 4,776   
 —   
 —   
 —   
 74   
 —   
 —   
 —   
 4,851   

 66,548   
 —   
 —   
 1,900   
 21,173   
 —   
 —   
 —   
 89,621   
 —   
 —   
 2,103   
 22,228   
 —   
 —   
 —   
 113,952   
 —   
 —   
 6,865   
 90   
 —   
 —   
 —   
 120,908   

(Loss) 
 (40,139)   
 700   
 —   
 —   
 —   
 —   
 —   
 —   
 (39,439)   
 (2,933)   
 —   
 —   
 —   
 —   
 —   
 —   
 (42,372)   
 (21,178)   
 —   
 —   
 —   
 —   
 —   
 —   
 (63,549)   

 (3,064)   
 —    
 (554)   
 —    
 —    
 —    
 77    
 (48)   
 (3,589)   
 —    
 (596)   
 —    
 —    
 —    
 282    
 73    
 (3,829)   
 —    
 (478)   
 —    
 —    
 —    
 (141)   
 (39)   
 (4,487)   

      Total 

 stock 
 (928)   
 —   
 —   
 —   
 —   
 —   
 —   
 —   
 (928)   
 —   
 —   
 —   
 —   
 31   
 —  
 —   
 (897)   

 26,248 
 700 
 (554) 
 1,900 
 21,732 
 — 
 77 
 (48) 
 50,054 
 (2,933) 
 (596) 
 2,103 
 22,616 
 31 
 282 
 73 
 71,632 
 —     (21,178) 
 (478) 
 —   
 6,865 
 —   
 164 
 —   
 97 
 97   
 (141) 
 —  
 —   
 (39) 
 56,922 
 (800)   

The accompanying notes are an integral part of the consolidated financial statements. 

F-9 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
  
  
  
 
 
  
  
  
  
  
  
  
  
  
  
  
  
  
 
  
 
 
 
Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED STATEMENTS OF CASH FLOWS 
For the years ended December 31, 2023, 2022 and 2021 
(in thousands of euros unless otherwise noted) 

Cash flows from operating activities 
Net income (loss) 
Adjustments to reconcile net income (loss) to net cash generated by (used in) 
operating activities: 
Depreciation and amortization 
Share based compensation 
US Paycheck Protection Program loan Forgiveness 
Change in allowances for doubtful accounts & slow-moving inventories 
Change in long-term provisions 
Net capital loss on disposals of assets 
Deferred tax expense (benefit) 
Operating cash flow before changes in working capital 
Increase/Decrease in operating assets and liabilities: 
Decrease (Increase) in trade accounts and notes and other receivables 
Decrease (Increase) in inventories 
Decrease (Increase) in other assets 
(Decrease) Increase in trade accounts and notes payable 
(Decrease) Increase in accrued expenses, other current liabilities 
Net change in operating assets and liabilities 
Net cash generated by (used in) operating activities 
Cash flows from investing activities: 
Additions to capitalized assets produced by the Company 
Proceeds from sale of leased back assets 
Acquisitions of property and equipment 
Acquisitions of intangible assets 
Decrease (Increase) of other financial assets 
Increase in deposits and guarantees 
Net cash generated by (used in) investing activities 
Cash flow from financing activities: 
Proceeds from capital increase (1) 
Proceeds from stock-option exercise 
Proceeds from long term borrowings, net of financing costs 
Repayment of long term borrowings 
Repayment of obligations under financing leases  
Increase (decrease) in bank overdrafts and short-term borrowings 
Net cash generated by (used in) financing activities 
Net effect of exchange rate changes on cash and cash equivalents 
Net increase (decrease) in cash and cash equivalents 
Cash and cash equivalents at beginning of year 
Cash and cash equivalents at end of year 

2023 

2022 

2021 

 (21,178)   

 (2,933)   

 700 

 1,913   
 6,865   
 —   
 422   
 159   
 1   
 42   
 (11,775)   

 (4,910)   
 (4,212)   
 (12)   
 5,281   
 950   
 (2,903)   
 (14,678)   

 (2,583)   
 —   
 (1,179)   
 (534)   
 1   
 (50)   
 (4,344)   

 —   
 261   
 —   
 (1,586)   
 (242)   
 656   
 (911)   
 268   
 (19,665)   
 63,136   
 43,471   

 1,605   
 2,103   
 —   
 124   
 79   
 266   
 48   
 1,292   

 (1,974)   
 (4,482)   
 (82)   
 1,143   
 1,079   
 (4,316)   
 (3,024)   

 (1,570)   
 —   
 (613)   
 (137)   
 —   
 (58)   
 (2,378)   

 21,960   
 688   
 286   
 (803)   
 (350)   
 (38)   
 21,741   
 (388)   
 15,952   
 47,183   
 63,136   

 1,920 
 1,900 
 (187) 
 363 
 (350) 
 142 
 (563) 
 3,925 

 (103) 
 166 
 (210) 
 (38) 
 706 
 520 
 4,445 

 (1,161) 
 — 
 (393) 
 (92) 
 13 
 (6) 
 (1,638) 

 21,289 
 442 
 1,058 
 (1,401) 
 (406) 
 (717) 
 20,266 
 (585) 
 22,488 
 24,696 
 47,183 

(1) The net proceeds from capital increase of €21,960 thousand relate to the Company’s successful common stock offering in September 2022 and of 

€21,289 thousand relate to the Company’s successful common stock offering in April 2021 – refer to Note 17-1. 

The accompanying notes are an integral part of the consolidated financial statements. 

F-10 

 
 
 
 
 
 
 
 
 
     
     
     
  
     
     
   
  
  
     
     
   
  
  
  
  
  
  
  
  
  
     
     
   
  
  
  
  
  
  
  
  
     
     
   
  
  
  
  
  
  
  
  
     
     
   
  
  
  
  
  
  
  
  
  
  
  
 
Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

1

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES 

1-1     Nature of operations 

EDAP TMS S.A. and its subsidiaries (‘‘the Company’’) are engaged in the development, manufacturing, promotion and 
distribution of advanced minimally-invasive ultrasound technologies for both diagnosis and treatment of urological diseases. We 
have introduced the Focal One® Robotic HIFU (high-intensity focused ultrasound) system around the world including Europe, 
U.S., Latin America, and parts of Asia. With the addition of the ExactVu™ Micro-Ultrasound system, we offer customers a complete 
solution from diagnosis to treatment of prostate disease. The Company also produces and distributes systems for the treatment of 
urinary  tract  stones.  These  technologies  include  the  Sonolith®  i-move  lithotripter  system  based  on  Extracorporeal  ShockWave 
Lithotripsy (ESWL) technology and advanced surgical laser systems. We also derive revenues from the distribution of urodynamics 
products and urology lasers. Net sales consist primarily of direct sales to hospitals and clinics in France and Europe, export sales to 
third-party distributors and agents, and export sales through subsidiaries based in Germany, Italy, the United States and Asia. 

The Company purchases the majority of the components used in its products from a number of suppliers but for some 
components, relies on a single source. Delay would be caused if the supply of these components or other components was interrupted 
and these delays could be extended in certain situations where a component substitution may require regulatory approval. Failure to 
obtain adequate supplies of these components in a timely manner could have a material adverse effect on the Company’s business, 
financial position and results of operations. 

1-2     Basis of preparation 

These consolidated financial statements have been prepared in accordance with accounting principles generally accepted 

in the United States (U.S. GAAP). 

1-3     Management estimates 

The preparation of financial statements in conformity with U.S. generally accepted accounting principles (‘‘U.S. GAAP’’) 
requires management to make estimates and assumptions, such as business plans, stock price volatility, duration of standard warranty 
per market, duration and interest rate of operating leases, price of maintenance contracts used to determine the amount of revenue 
to be deferred and life duration of our range of products. These estimates and assumptions affect the reported amounts of assets and 
liabilities  and  disclosure  of  contingent  assets  and  liabilities  at  the  date  of  the  financial  statements  and  the  reported  amounts  of 
revenues and expenses during the reporting period.  

1-4     Consolidation 

The accompanying consolidated financial statements include the accounts of EDAP TMS S.A. and all its domestic and 
foreign owned subsidiaries after elimination of intercompany balances and transactions. We do not have any significant interests in 
any variable interest entities. 

1-5     Revenue recognition 

The Company’s revenue consists of: 

- Sales of goods (devices and consumables), where invoicing generally takes place upon delivery. Consumables revenues 

included in sales contracts are deferred until delivery. 

- Revenue-per-Procedures (“RPP”) and leases: they comprise (i) revenues on a per treatment basis which are invoiced after 
each treatment, or in advance, or on a periodic basis, (ii) leases of devices, which are generally invoiced on a monthly or quarterly 
basis,  and  (iii)  lease  components  arising  from  multiple-element  arrangements,  where  specific  sales  terms  are  negotiated  in 
accordance with each customer’s individual requirements and which are generally invoiced based on contract terms, 

- Sales of spare parts and services (maintenance, upgrades, mobility and others). Spare parts are invoiced when delivered. 
Regarding services, invoicing is performed either on a subscription basis (in advance or at the end of the period) or when performed. 

Sales of our medical devices and sales of disposables, sales of RPPs and leases, and sales of spare parts and services, are 

all net of commissions. 

F-11 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

The Company invoices its customers based on the billing schedules in its sales arrangements. Payments are generally due 

between one to three months from date of invoice. 

The Company accounts for a contract with a customer when there is a legally enforceable contract between the Company 
and its customer, the rights of the goods or services and their payment terms can be identified, the contract has commercial substance, 
collectability of the contract consideration is probable, it is approved and the parties are committed to their obligations. 

Our sale arrangements may contain multiple elements, including device(s), consumables and services. For these multiple-
element  arrangements,  the  Company  accounts  for  individual  goods  and  services  as  separate  performance  obligations:  (i) if  a 
customer can benefit from the good or service on its own or with other resources that are readily available to the customer, and (ii) if 
they  are  a  distinct  good  or  service  that  is  separately  identifiable  from  other  items  in  the  multiple-element  arrangement. The 
Company’s sale arrangements may include a combination of the following performance obligations: device(s), consumables, leases 
and services (such as, but not limited to, warranty extension). 

For multiple-element arrangements, revenue is allocated to each performance obligation based on its relative standalone 
selling price. Standalone selling prices are based on observable prices at which the Company separately sells the goods or services. 
If a standalone selling price is not directly observable, then the Company estimates the standalone selling price considering market 
conditions and entity-specific factors including, but not limited to, features and functionality of the goods and services, geographies, 
and type of customer. The Company regularly reviews standalone selling prices and updates these estimates as necessary. 

The Company recognizes revenue when the performance obligations are satisfied by transferring control over the goods or 

service to a customer. 

The Company’s revenue consists of the following: 

Sales of goods: 

Sales of goods are and have historically been comprised of sales net of commission of medical devices (ESWL lithotripters 
and HIFU devices) and net sales of disposables (mostly Focalpaks in the HIFU division and electrodes in the ESWL division). Sales 
of goods also includes products such as micro-ultrasound devices, urology lasers and urodynamics devices distributed through our 
agents and third-party distributors. 

For devices and disposables, revenue is recognized when the Company transfers control to the customer (i.e. when the 
customer has the ability to direct the use of, and obtain substantially all of the remaining benefit from, the device or disposables), 
which is generally at the point of delivery, depending on the terms of the arrangement (i.e. when the customer can use the goods to 
provide services or sell or exchange the good), and based on contractual incoterms. Installation-related costs are immaterial in the 
context of the contract with the customer and do not constitute a distinct performance obligation. 

The Company’s sales arrangements do not provide a right of return. The goods are generally covered by a period of one to 
two years standard warranty upon installation depending of the geographic area. Over this standard one to two years period, it is 
considered as an extension of such warranty period and constitutes a distinct performance obligation. The Company also provides 
training associated with the sales of goods; such training-related costs are immaterial in the context of the contract with the customer 
and do not constitute a distinct performance obligation. 

Sales of RPPs and leases: 

Sales of RPP and leases include the revenues from the sale of treatment procedures and from the leasing of machines. For 
RPP, we provide machines to clinics and hospitals for free for a limited period, rather than selling the devices. These hospitals and 
clinics perform treatments using the devices and usually pay us based on the number of individual treatments provided. Revenues 
from leasing of machine are considered as immaterial. 

Revenues related to the sale of treatments invoiced on a ‘‘Revenue-Per-Procedure’’ (‘‘RPP’’) basis are recognized when 
the treatment procedure has been completed. Revenues from devices leased to customers under operating leases are recognized on 
a straight-line basis. 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

Regarding  multiple-element  arrangements  with  a  lease  component,  a  portion  of  the  contract  is  allocated  to  the  lease 
component on the basis of observable market prices applied by the Company for similar devices under operating leases. The lease 
component is recognized on a straight line basis over the contractual period. Other immaterial components under the contract are 
recognized in accordance with their nature. 

Sales of spare parts and services: 

Revenues  related  to  spare  parts  are  recognized  when  spare  parts  are  delivered  to  distributors  who  perform  their  own 
maintenance  services.  Spare  parts  used  in  the  performance  of  EDAP’s  own  maintenance  and  repair  services  are  generally  not 
recognized separately, unless a type of spare part is specifically excluded from the maintenance contract terms. 

Revenues related to Services mainly consist of maintenance contracts which rarely exceed one year and are recognized on 
a straight line basis over the term of the service period as the customer benefits from the service equally throughout the service 
contract  period.  For  services  rendered  when  no  maintenance  contract  is  in  place  or  for  services  not  included  in  the  scope  of  a 
maintenance contract, revenues are recorded when services are performed. 

The Company recognizes revenue for extended warranties included in the multiple-element arrangements as a separate 
performance obligation in Sales of services on a straight-line basis over the extended warranty period. In the majority of countries 
in which the Company operates, the statutory warranty period is one to two years and the extended warranty covers periods beyond 
this statutory period. Standard warranties do not constitute a separate performance obligation. The Company accrues for the warranty 
costs at the time of sale of the device through the multiple-element arrangement. 

Distributors: 

As part of its sale process in countries other than continental France, when the Company does not have a local subsidiary, 
sales of goods to end-customers are performed through agents and distributors. Such agents and distributors are primarily responsible 
for the sales’ process, bear the inventory risk, and are free to determine the sale prices. Sales of goods to agents and distributors are 
recognized when the control is transferred to the related agent or distributor which generally occurs based on contractual incoterms. 

Deferred revenue: 

Deferred revenue for the periods presented primarily relates to service contracts where the service fees are billed up-front, 
generally quarterly or annually, prior to those services having been performed, and consists primarily of billing or cash receipts in 
advance of services due under maintenance contracts or extended warranty contracts. The associated deferred revenue is generally 
recognized ratably over the service period. 

Disaggregation of revenue: 

Disaggregation by primary geographical market, and timing of revenue recognition is reported in Note 18. 

Contract Balances: 

Details on contract liabilities are reported on Note 11. 

The Company applies the practical expedient in paragraph 606-10-50-14 and does not disclose information about remaining 

performance obligations that have original expected durations of one year or less. This relates mainly to maintenance services. 

1-6     Costs of sales 

Costs of sales include all direct product costs, costs related to shipping, handling, duties and importation fees, as well as 
certain indirect costs such as service and supply chain departments expenses. Indirect costs are allocated by type of sales (goods, 
RPP and leases, spare parts and services) using an allocation method determined by management by type of costs and segment 
activities and reviewed on an annual basis. 

F-13 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

1-7     Shipping and handling costs 

Shipping and handling costs are not considered as performance obligations. Shipping and handling costs are recorded as a 

component of cost of sales. 

1-8     Cash equivalents and short term investments 

Cash equivalents are cash investments which are highly liquid and have initial maturities of 90 days or less. 

Cash investments with a maturity higher than 90 days are considered as short-term investments. There is no short-term 

investment at December 31, 2023. 

1-9     Accounts Receivable 

The  Company  maintains  an  allowance  for  doubtful  accounts  for  estimated  losses  inherent  in  its  accounts  receivable 
portfolio. In establishing the required allowance, management considers historical losses adjusted to take into account current market 
conditions and the Company’s customers’ financial condition, the amount of receivables in dispute, and the current receivables 
aging and current payment patterns. The Company reviews its allowance for doubtful accounts quarterly. Past due balances over 
90 days  and  over  a  specified  amount  are  reviewed  individually  for  collectability.  Account  balances  are  charged  off  against  the 
allowance after all means of collection have been exhausted and the potential for recovery is considered remote. Write-offs for 2023 
and 2022 approximated €1 thousand and €640 thousand, respectively. The Company does not have any off-balance-sheet credit 
exposure related to its customers.  

1-10     Inventories 

Inventories  are  valued  at  the  lower  of  cost  and  net  realizable  value.  Cost  is  either  the  manufacturing  cost,  which  is 
principally comprised of components and labor costs for our own manufactured products, or purchase price for urology products 
we  distribute.  Cost  is  determined  on  a  first-in,  first-out  basis  for  components  and  spare  parts  and  by  specific  identification  for 
finished goods (medical devices). The Company establishes reserves for inventory estimated to be obsolete, unmarketable or slow 
moving, first based on a detailed comparison between quantity in inventory and historical consumption and then based on case-by-
case analysis of the difference between the cost of inventory and the related estimated market value. 

1-11     Property and equipment 

Property  and  equipment  is  stated  at  historical  cost,  net  of  accumulated  depreciation  and  impairment.  Depreciation  of 

property and equipment is calculated using the straight-line method over the estimated useful life of the related assets, as follows: 

Leasehold improvements (in years) 
Equipment (in years) 
Furniture, fixtures, fittings and other (in years) 

  10 or lease term if shorter  

 3       
 2   

 — 
 — 

 10 
 10 

Equipment includes industrial equipment and research equipment that has alternative future uses. Equipment also includes 
devices and treatment probes that are manufactured by the Company and leased to customers through operating leases related to 
Revenue-Per-Procedure transactions. This equipment is generally depreciated over a period of five to seven years. 

1-12     Long-lived assets 

The  Company  reviews  the  carrying  value  of  its  long-lived  assets,  including  fixed  assets  and  intangible  assets,  for 
impairment  whenever  events  or  changes  in  circumstances  indicate  that  the  carrying  amount  of  such  assets  may  not  be  fully 
recoverable. Recoverability of long-lived assets is assessed by a comparison of the carrying amount of the assets (or the Group of 
assets, including the asset in question, that represents the lowest level of separately-identifiable cash flows) to the total estimated 
undiscounted cash flows expected to be generated by the asset or group of assets. If the future net undiscounted cash flows is less 
than  the  carrying  amount  of  the  asset  or  group  of  assets,  the  asset  or  group  of  assets  is  considered  impaired  and  an  expense  is 
recognized equal to the amount required to reduce the carrying amount of the asset or group of assets to its then fair value. Fair 
value is determined by discounting the cash flows expected to be generated by the assets, when the quoted market prices are not 
available for the long-lived assets. Estimated future cash flows are based on assumptions and are subject to risk and uncertainty. 

F-14 

 
 
 
 
 
 
 
 
      
 
  
     
  
  
 
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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

1-13     Goodwill and intangible assets 

Goodwill  represents  the  excess  of  purchase  price  over  the  fair  value  of  identifiable  net  assets  of  businesses  acquired. 
Goodwill is not amortized but instead tested annually for impairment or more frequently when events or change in circumstances 
indicate that the assets might be impaired. 

When impairment indicators are identified, the impairment test is performed by comparing the fair value of a reporting unit 
with its carrying amount, including goodwill. An impairment charge should be recognized for the amount by which the carrying 
amount exceeds the reporting unit’s fair value; however, the loss recognized should not exceed the total amount of goodwill allocated 
to that reporting unit. For the purpose of any impairment test, the Company relies upon projections of future undiscounted cash 
flows  and  takes  into  account  assumptions  regarding  the  evolution  of  the  market  and  its  ability  to  successfully  develop  and 
commercialize its products. 

Changes in market conditions could have a major impact on the valuation of these assets and could result in additional 

impairment losses. 

Intangible assets consist primarily of purchased patents relating to lithotripters, purchased licenses, a purchased trade name 
and a purchased trademark. The basis for valuation of these assets is their historical acquisition cost. Amortization of intangible 
assets is calculated by the straight-line method over the shorter of the contractual or estimated useful life of the assets, as follows: 

Patents (in years) 
SAP Licenses (in years) 
Other licenses (in years) 
Trade name and trademark (in years) 

1-14     Treasury Stocks 

 5 
 10 
 5 
 7 

Treasury stock purchases are accounted for at cost. The sale of treasury stocks is accounted for using the first in first out 
method. Gains on the sale or retirement of treasury stocks are accounted for as additional paid-in capital whereas losses on the sale 
or retirement of treasury stock are recorded as additional paid-in capital to the extent that previous net gains from sale or retirement 
of treasury stocks are included therein; otherwise the losses shall be recorded to accumulated benefit (deficit) account. Gains or 
losses from the sale or retirement of treasury stock do not affect reported results of operations. Treasury stocks held by a company 
cannot exceed 10% of the total number of shares issued. 

1-15     Warranty expenses 

The Company provides customers with a warranty for each product sold and accrues warranty expense at time of sale based 
upon historical claims experience. Standard warranty period may vary from 1 year to 2 years depending on the market. The warranty 
expense is incurred at time of accrual and not when paid. Warranty expense amounted to €134 thousand, €112 thousand and €110 
thousand for the years ended December 31, 2023, 2022 and 2021, respectively. 

1-16     Income taxes 

The Company accounts for income taxes in accordance with ASC 740, ‘‘Accounting for Income Taxes’’ Under ASC 740, 
deferred tax assets and liabilities are determined based on differences between the financial reporting and tax basis of assets and 
liabilities and are measured by applying enacted tax rates and laws to taxable years in which such differences are expected to reverse. 
A valuation allowance is established if, based on the weight of available evidence, it is more likely than not that some portion, or 
all of the deferred tax assets, will not be realized. In accordance with ASC740, no provision has been made for income or withholding 
taxes on undistributed earnings of foreign subsidiaries, such undistributed earnings being permanently reinvested. 

Under ASC740, the measurement of a tax position that meets the more-likely-that-not recognition threshold must take into 
consideration  the  amounts  and  probabilities  of  the  outcomes  that  could  be  realized  upon  ultimate  settlement  using  the  facts, 
circumstances and information available at the reporting date. 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

1-17     Research and development costs 

Research and development costs are recorded as an expense in the period in which they are incurred. 

The  French  government  provides  tax  credits  to  companies  for  innovative  research  and  development.  This  tax  credit  is 
calculated based on a percentage of eligible research and development costs and it can be refundable in cash and is not contingent 
on future taxable income. As such, the Company considers the research tax credits as a grant, offsetting research and development 
expenses. 

1-18     Advertising costs 

Advertising  costs  are  recorded  as  an  expense  in  the  period  in  which  they  are  incurred  and  are  included  in  selling  and 
administrative  expenses  in  the  accompanying  consolidated  statements  of  income  (loss).  Advertising  costs  amounted  to  €1,352 
thousand, €929 thousand and €490 thousand for the years ended December 31, 2023, 2022 and 2021, respectively. 

1-19     Foreign currency translation and transactions 

Translation of the financial statements of consolidated companies 

The  reporting  currency  of  EDAP  TMS  S.A.  for  all years  presented  is  the  euro  (€).  The  functional  currency  of  each 
subsidiary is its local currency. In accordance with ASC 830, all accounts in the financial statements are translated into euro from 
the functional currency at the following exchange rates: 

• 
• 
• 
• 

assets and liabilities are translated at year-end exchange rates; 
shareholders’ equity is translated at historical exchange rates (as of the date of contribution); 
statement of income (loss) items are translated at average exchange rates for the year; and 
translation gains and losses are recorded in a separate component of shareholders’ equity. 

Foreign currencies transactions 

Transactions involving foreign currencies are translated into the functional currency using the exchange rate prevailing at 
the time of the transactions. Receivables and payables denominated in foreign currencies are translated at year-end exchange rates. 
The resulting unrealized exchange gains and losses are recorded in the statement of income (loss). 

Presentation in the Statement of Income (loss) 

Aggregate foreign currency transactions gains and losses are disclosed in a single caption in the Statement of Income (loss) 

under section “Foreign currency exchange gain (loss), net”. 

1-20     Earnings per share 

Basic  earnings  per  share  is  computed  by  dividing  income  available  to  common  shareholders  by  the  weighted  average 
number of shares of common stock outstanding for the period. Diluted earnings per share reflects potential dilution that could occur 
if securities or other contracts to issue common stock were exercised or converted into common stock or resulted in the issuance of 
common stock that then shared in the earnings of the Company. The dilutive effects of the Company’s common stock options and 
warrants is determined using the treasury stock method to measure the number of shares that are assumed to have been repurchased 
using the average market price during the period, which is converted from U.S. dollars at the average exchange rate for the period. 

1-21     Derivative instruments 

ASC 815 requires the Company to recognize all of its derivative instruments as either assets or liabilities in the statement 
of financial position at fair value. The accounting for changes in the fair value (i.e., gains or losses) of a derivative instrument 
depends  on  whether  it  has  been  designated  and  qualifies  as  part  of  a  hedging  relationship  and  further,  on  the  type  of  hedging 
relationship. For those derivative instruments that are designated and qualify as hedging instruments, the Company must classify 
the hedging instrument, based upon the exposure being hedged, as fair value hedge, cash flow hedge or a hedge of a net investment 
in a foreign operation. 

F-16 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

Gains and losses from derivative instruments are recorded in the Statement of Income (loss). As of December 31, 2023, 

there are no derivative instruments. 

1-22     Employee stock option and free shares plan 

The accounting for stock-based awards is based on the fair value of the award measured at the grant date. Accordingly, stock-
based  compensation  cost  is  recognized  in  the  consolidated  statements  of  income  (loss)  and  comprehensive  income  (loss)  as  an 
operating expense over the requisite service period. The fair value of stock options is determined using the Black-Scholes option-
pricing model. The Company determines the fair value of stock option awards on the date of grant using assumptions regarding 
expected term, share price volatility over the expected term of the awards, risk-free interest rate, and dividend rate. The fair value 
of free shares is measured using the fair value of the Company's shares as if the free shares were vested and issued on the grant date. 
Forfeited stock-options and free shares are recognized as they occur, in accordance with ASU 2016-09. The Company recognizes 
compensation cost for employee awards with only service conditions that have a graded vesting schedule on a straight-line basis 
over the requisite service period for each separately vesting portion of the award as if the award was, in-substance, multiple awards. 

At December 31, 2023, the Company had three stock-based employee compensation plans and two free shares plans.  

1-23     Warrants 

There are no warrants outstanding at December 31, 2023. 

1-24     Leases 

Leases as a Lessee 

In accordance with ASC 842, Leases, and as from January 1, 2019, the Company classifies all leases at the inception of a 
contract and assess whether the contract is, or contains, a lease. The assessment is based on: (1) whether the contract involves the 
use of a distinct identified asset, (2) whether the company controls the use of the identified asset (e.g. whether the company has the 
right to obtain substantially all of the economic benefits from the use of the asset throughout the period, and whether the company 
has the right to direct the use of the asset). 

Leases are classified as either finance leases or operating leases. Substantially all our operating leases are comprised of 

office space leases, and substantially all our finance leases are comprised of office furniture and technology equipment. 

The Company recognizes a right-of-use (“ROU”) asset and a lease liability at the lease commencement date. The right-of-
use asset is initially measured at cost, which primarily comprises the initial amount of the lease liability, plus any initial direct costs 
incurred, plus prepaid lease payments, less any lease incentives received. All ROU assets are reviewed for impairment. For operating 
leases,  the  lease  liability  is  initially  measured  at  the  present  value  of  the  unpaid  lease  payments  at  lease  commencement  date, 
discounted using the incremental borrowing rate for assets of same duration or characteristics. For finance leases the lease liability 
is initially measured in the same manner and date as for operating leases and is subsequently measured at amortized cost using the 
effective interest method 

For operating leases, the ROU asset is subsequently measured throughout the lease term at the carrying amount of the lease 
liability, plus initial direct costs, plus (minus) any prepaid (accrued) lease payments, less the unamortized balance of lease incentives 
received. Lease expense for lease payments is recognized on a straight-line basis over the lease term. 

For finance leases, the ROU asset is subsequently amortized using the straight-line method from the lease commencement 
date to the earlier of the end of its useful life or the end of the lease term unless the lease transfers ownership of the underlying asset 
to the Company or the Company is reasonably certain to exercise an option to purchase the underlying asset. In those cases, the 
ROU asset is amortized over the useful life of the underlying asset. Amortization of the ROU asset is recognized and presented 
separately from interest expense on the lease liability. 

Lease payments included in the measurement of the lease liability comprise the following: the fixed payments, including 
in-substance fixed payments over the lease term (which includes termination penalties the Company would owe if the lease term 
assumes the Company’s exercise of a termination option), variable lease payments that depend on an index or rate payments for 
optional  renewal  periods  where  it  is  reasonably  certain  the  renewal  period  will  be  exercised,  the  exercise  price  of  an  option  to 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

purchase the underlying asset if the company is reasonably certain to exercise the option, and amounts expected to be payable under 
a Company provided residual value guarantee. The company assesses the discount rate by requesting credit simulation from certain 
banks.  

Variable lease payments associated with the Company’s leases are recognized when the event, activity, or circumstance in 
the lease agreement on which those payments are assessed occurs. Variable lease payments are presented as operating expenses in 
the  Company’s  consolidated  statements  of  income  (loss)  in  the  same  line  item  as  expenses  arising  from  fixed  lease  payments 
(operating leases) or amortization of the ROU asset (finance leases). 

Our real estate leases generally include non-lease maintenance services. The consideration in the contract is allocated to 

the lease and non-lease components based on standalone selling prices. 

Some of our real estate leases contain variable lease payments, including payments based on an index or rate. Variable 
lease payments based on an index or rate are initially measured using the index or rate in effect at lease commencement, and changes 
to index and rate-based variable lease payments are recognized in profit or loss in the period of the change. Variable payments that 
do not depend on an index or rate, such as rental payments based on the use of the underlying asset or property taxes and insurance 
reimbursement,  are  recorded  as  operating  expenses  when  incurred.  Lease  modifications  result  in  remeasurement  of  the  lease 
payments when that modification is not accounted for as a separate contract. 

Lease  expense  for  operating  leases  consists  of  the  lease  payments  plus  any  initial  direct  costs,  primarily  brokerage 
commissions, and is recognized on a straight-line basis over the lease term. Included in lease expense are any variable lease payments 
incurred in the period that were not included in the initial lease liability. Lease expense for finance leases consists of the amortization 
of the right-of-use asset on a straight-line basis over the lease term and interest expense determined on an amortized cost basis. The 
lease payments are allocated between a reduction of the lease liability and interest expense. 

The lease term for all of the Company’s leases includes the non-cancellable period of the lease plus any additional periods 
covered by either a Company option to extend (or not to terminate) the lease that the Company is reasonably certain to exercise, or 
an option to extend (or not to terminate) the lease controlled by the lessor . 

We have elected not to recognize right-of-use assets and lease liabilities for short-term leases that have a term of 12 months 
or less. The effect of short-term leases on our right-of-use asset and lease liability was not material. We have elected not to review 
the classification for expired or existing leases, prior to January 1, 2019. 

Leases as a Lessor: 

A  lessor  shall  classify  a  lease  as  a  sales-type  lease  when  the  lease  meets  any  of  the  following  criteria  at  lease 

commencement: 

•  The lease transfers ownership of the underlying asset to the lessee by the end of the lease term. 
•  The lease grants the lessee an option to purchase the underlying asset that the lessee is reasonably certain to exercise. 
•  The  lease  term  is  for  the  major  part  of  the  remaining  economic  life  of  the  underlying  asset.  However,  if  the 
commencement date falls at or near the end of the economic life of the underlying asset, this criterion shall not be used 
for purposes of classifying the lease. 

•  The present value of the sum of the lease payments and any residual value guaranteed by the lessee that is not already 
reflected in the lease payments in accordance with paragraph 842-10-30-5(f) equals or exceeds substantially all of the 
fair value of the underlying asset. 

•  The underlying asset is of such a specialized nature that it is expected to have no alternative use to the lessor at the end 

of the lease term. 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

When none of the criteria are met: 

A lessor shall classify the lease as either a direct financing lease or an operating lease. A lessor shall classify the lease as 
an operating lease unless both of the following criteria are met, in which case the lessor shall classify the lease as a direct financing 
lease: 

•  The present value of the sum of the lease payments and any residual value guaranteed by the lessee that is not already 
reflected in the lease payments in accordance with paragraph 842-10-30-5(f) and/or any other third party unrelated to 
the lessor equals or exceeds substantially all of the fair value of the underlying asset; 
It is probable that the lessor will collect the lease payments plus any amount necessary to satisfy a residual value 
guarantee. 

• 

1-25     Recent accounting pronouncements 

Recently Adopted Accounting Pronouncements 

As of November 27, 2023, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update 2023-
07 (Segment reporting: Improvements to reportable segment disclosures) that improves disclosures about a public entity’s reportable 
segments and addresses requests from investors and other allocators of capital for additional, more detailed information about a 
reportable segment’s expenses. This Topic provides guidance “on how to report certain information about operating segments in 
complete  sets  of  financial  statements  of  the  public  entity  and  in  condensed  financial  statements  of  interim  periods  issued  to 
shareholders.”  This  standard  is  effective  for  the  Company  in  fiscal  years  beginning  after  December  15,  2023.  The  Company  is 
currently evaluating the impact of this guidance on its Consolidated Financial Statements. 

CASH EQUIVALENTS 

Cash equivalents at December 31, 2023 and 2022 only comprise cash investments which are highly liquid and have initial 

maturities of 90 days or less. 

Total cash and cash equivalents 
Short term investment 
Total cash and cash equivalents 

December 31,  

2023 
 43,471    
 —   
 43,471    

2022 
 63,136 
 — 
 63,136 

Please refer to Note 15-1 – Long-term debt as €567 of indebtedness is pledged in cash position in USD. 

TRADE ACCOUNTS AND NOTES RECEIVABLE, NET 

Trade accounts and notes receivable consist of the following: 

Trade accounts receivable 
Notes receivable 
Less: allowance for doubtful accounts 
Total 
Less current portion 
Total long-term portion 

December 31,  

2023 
 17,186    
 896    
 (224)   
 17,858    
 (17,858)   
 —    

2022 
 12,965 
 617 
 (161) 
 13,421 
 (13,421) 
 — 

Notes receivable usually represent commercial bills of exchange (drafts) with initial maturities of 90 days or less. 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

Bad debt expenses amount to a net cost of €68 thousand, a net cost of €32 thousand and €2 thousand, respectively for 

the years ended December 31, 2023, 2022 and 2021. 

OTHER RECEIVABLES 

Other receivables consist of the following: 

Research and development tax credit receivable from the French State 
Value-added taxes receivable 
Other receivables from Government and public authorities 
Others 
Total 

INVENTORIES 

Components, spare parts 
Work-in-progress 
Finished goods – own manufactured products 
Finished goods – distribution products 
Total gross inventories 
Less: allowance for slow-moving inventory and net realizable value 
Total 

December 31,  

2023 

 411    
 863    
 22    
 84    
 1,380    

2022 

 581 
 894 
 — 
 46 
 1,522 

December 31,  

2023 
 8,973    
 512    
 2,115    
 4,775    
 16,375    
 (1,263)   
 15,112    

2022 
 7,543 
 283 
 1,514 
 3,702 
 13,042 
 (1,262) 
 11,780 

The provision for slow moving inventory relates to components and spare parts. The increase in the allowance for slow 
moving  inventory  (excluding  exchange  rate  impact),  which  are  classified  within  cost  of  sales,  amounted  to  €354  thousand  for 
the year ended December 31, 2023, €93 thousand for the year ended December 31, 2022, and €371 thousand for the year ended 
December 31, 2021. During 2023, we recorded a reversal allowance for slow moving inventory for €301 thousand linked to the 
write-off  of obsolete inventory.

OTHER ASSETS 

Other assets consist of the following: 

Prepaid expenses, current portion 
Total 

Prepaid expenses mainly consist of rental and future congresses and conferences expenses.

December 31,  

2023 

2022 

 659    
 659    

 660 
 660 

PROPERTY AND EQUIPMENT, NET 

Property and equipment consist of Property and equipment purchased or capitalized by the Company and finance leases 

for 2023 and 2022. 

7-1     Property and Equipment, net 

Property and equipment consist of the following: 

Equipment 
Furniture, fixture, and fittings and other 
Total gross value 

December 31,  

2023 
 11,900   
 3,672    
 15,573    

2022 
 9,553 
 3,108 
 12,661 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

Less: accumulated depreciation and amortization 
Total 

 (8,916) 
 3,745 
Depreciation  expense  related  to  property  and  equipment  (inclusive  of  depreciation  expense  on  equipment  leased  to 
customers) amounted to €1,557 thousand, €1,194 thousand and €1,521 thousand for the years ended December 31, 2023, 2022 and 
2021, respectively. 

 (9,686)   
 5,887    

Assets leased to customers: 

Capitalized costs on equipment leased to customers of €885 thousand and €753 thousand are included in property and 
equipment at December 31, 2023 and 2022, respectively. Accumulated amortization of these assets leased to third parties was €207 
thousand and €264 thousand, at December 31, 2023 and 2022, respectively. 

Depreciation expense on equipment leased to customers amounted to €13 thousand, €37 thousand and €40 thousand, for 

the years ended December 31, 2023, 2022 and 2021, respectively. 

7-2     Finance leases 

Finance lease right-of-use assets in 2023 and previous years consist of the following: 

Facilities 
Equipment 
Vehicles and IT equipment 
Total gross value 
Less: accumulated depreciation and amortization 
Total 

December 31,  

2023 

2022 

 242 
 220    
 828    
 1,290    
 705    
 585    

 269 
 220 
 780 
 1,269 
 813 
 455 

Depreciation expense related to finance lease right-of-use assets amounted to €193 thousand, €303 thousand and €275 for 

the years ended December 31, 2023, 2022, 2021, respectively. 

OPERATING LEASE RIGHT-OF-USE ASSETS 

Operating lease right-of-use assets consist of the following: 

Facilities 
Equipment 
Furniture, fixture, and fittings and other 
Total net operating lease right of use 

December 31,  

2023 
 1,534    
 30    
 157    
 1,722    

2022 
 1,536 
 57 
 191 
 1,784 

Operating lease cost amounted to €1,053 thousand and €910 thousand for the years ended December 31, 2023 and 2022, 

respectively. 

Variable  lease  costs  related  to  above  contracts  amounted  to  €243  thousand  and  €152  thousand  for  the years  ended 

December 31, 2023 and 2022, respectively. 

Non-recognized  lease  liabilities  for  short  term  leases  amounted  to  €71  thousand  and  €74  thousand  for  the years  ended 

December 31, 2023 and 2022, respectively.

 GOODWILL AND INTANGIBLE ASSETS 

As discussed in Note 1-13, ASC 350 requires that goodwill not be amortized but instead be tested at least annually for 
impairment, or more frequently when events or change in circumstances indicate that the asset might be impaired, by comparing 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

the carrying value to the fair value of the reporting unit to which they are assigned. The Company considers its ASC 280 operating 
segments — High Intensity Focused Ultrasound (HIFU), Lithotripsy (ESWL) and Distribution services (DIST) — to be its reporting 
units for purposes of testing for impairment. Goodwill amounts to €496 thousand for the ESWL division, €1,271 thousand for the 
DIST division and to €645 thousand for the HIFU division, at December 31, 2023. 

The Company completed the required annual impairment test in the fourth quarter of 2023. To determine the fair value of 
the Company’s reporting units, the Company used the discounted cash flow approach for each of the three reportable units. In all 
three cases, the fair value of the reporting unit was in excess of the reporting unit’s book value, which resulted in no goodwill 
impairment. 

Intangible assets consist of the following: 

Licenses 
Trade name and trademark 
Patents 
Organization costs 
Total gross value 
Accumulated amortization for licenses 
Accumulated amortization for trade name and trademark 
Accumulated amortization for patents 
Accumulated amortization for organization costs 
Less: Total accumulated amortization 
Total 

December 31,  

2023 
 2,119    
 333    
 412    
 225    
 3,089    
 (1,038)   
 (331)   
 (412)   
 (225)   
 (2,005)   
 1,084    

2022 
 1,585 
 370 
 412 
 225 
 2,592 
 (863) 
 (368) 
 (412) 
 (225) 
 (1,868) 
 725 

Amortization  expenses  related  to  intangible  assets  amounted  to  €175  thousand,  €141  thousand  and  €125  thousand,  for 

the years ended December 31, 2023, 2022 and 2021, respectively. 

For the five coming years, the annual estimated amortization expense will consist of the following: 

2024 
2025 
2026 
2027 
2028 
2029 and thereafter 
Total 

TRADE ACCOUNTS AND NOTES PAYABLE 

Trade accounts and notes payable consist of the following: 

Trade accounts payable 
Notes payable 
Total 

      December 31,  

2023 

 205 
 195 
 192 
 175 
 88 
 174 
 1,029 

December 31,  

2023 
 11,236    
 61    
 11,297    

2022 
 6,640 
 7 
 6,647 

Trade accounts payable usually represent invoices with a due date of 90 days or less and invoices to be received. 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

Notes payable represent commercial bills of exchange (drafts) with initial maturities of 90 days or less.

 DEFERRED REVENUES 

Deferred revenues consist of the following: 

Deferred revenues on maintenance contracts 
Deferred revenue on RPP 
Deferred revenue on sale of devices 
Deferred revenue on extension of warranty, included in sales contracts 
Deferred revenue on treatment probe lease and other 
Total 
Less long term portion 
Current portion 

Deferred revenue on extension of warranty will be recognized over the following periods: 

2024 
2025 
2026 
2027 
2028 
2029 and thereafter 
Total 

Changes in deferred revenue on extension of warranty are as follows: 

Balance as of December 31, 2021 
New extension of warranty 
Recognition of revenue 
Balance as of December 31, 2022 
New extension of warranty 
Recognition of revenue 
Balance as of December 31, 2023 

December 31,  

2023 
 1,809 
 492 
 104 
 591 
 1,696 
 4,693 
 (643) 
 4,049 

2022 
 1,803 
 517 
 83 
 535 
 1,376 
 4,314 
 (264) 
 4,050 

      December 31,  

2023 

 224 
 183 
 74 
 46 
 30 
 35 
 591 

Total 

 740 
 162 
 (367) 
 535 
 238 
 (181) 
 591 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

OTHER ACCRUED LIABILITIES 

Other accrued liabilities consist of the following: 

Retirement indemnities 
Provision for warranty costs 
Accruals for payroll and associated taxes 
Conditional government advances 
Value added tax payable 
Advances received from customers 
Provision for Asset Retirement Obligation (Japan) 
Provision for employee termination indemnities (Korea) 
Others 
Total 
Less non-current portion 
Current portion 

December 31,  

2023 
 2,310    
 172    
 2,256    
 463    
 758    
 860    
 91    
 149    
 522    
 7,581    
 (3,075)   
 4,506    

2022 
 2,153 
 162 
 1,848 
 463 
 531 
 861 
 101 
 122 
 340 
 6,583 
 (2,710) 
 3,873 

In  2021,  we  received  conditional  advances  for  €0.5  million  from  Banque  Publique  d’Investissement  for  business 

development programs in China and Africa.  

Grants that relate to expenses we incur for this research program are recognized in the line item “Research and Development 

Expenses” in the period in which the expenses subject to the grants have been incurred (see Note 21). 

Conditional advances as of December 31, 2023, mature as follows: 

2024 
2025 
2026 
2027 
2028 
2029 and thereafter 
Total 

Changes in the provision for warranty costs are as follows: 

Beginning of year 
Amount used during the year 
New warranty expenses 
End of year 
Less current portion 
Long term portion 

LEASE OBLIGATIONS 

13-1     Financing leases 

 111 
 93 
 93 
 86 
 81 
 — 
 463 

2023 

2022 

 162    
 (124)   
 134    
 172    
 (107)   
 65    

 252 
 (202) 
 112 
 162 
 (100) 
 62 

The  Company  leases  certain  of  its  equipment  under  finance  leases.  At  December 31, 2023,  the  corresponding  liability 
associated with this lease equipment amounts to €10 thousand for medical devices and to €617 thousand for vehicles and other IT 
equipment.  

Maturities of finance leases liabilities for the years ended December 31, 2023 and 2022 are as follows: 

F-24 

 
 
 
 
 
 
 
 
 
     
     
     
     
     
     
     
     
     
     
     
     
     
     
 
 
 
 
 
     
  
  
  
  
 
  
 
 
 
 
 
 
 
 
     
     
  
  
  
  
  
  
 
 
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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

2024 
2025 
2026 
2027 
2028 
2029 and thereafter 
Total undiscounted minimum lease payments 
Less: amount representing interest 
Present value of minimum lease payments 
Less: current portion 
Long-term portion 

2023 
2024 
2025 
2026 
2027 
2028 and thereafter 
Total undiscounted minimum lease payments  
Less: amount representing interest 
Present value of minimum lease payments 
Less: current portion 
Long-term portion 

      December 31,  

2023 

 214 
 170 
 134 
 86 
 52 
 2 
 659 
 (33) 
 627 
 (195) 
 433 

      December 31,  

2022 

 234 
 149 
 102 
 63 
 12 
 6 
 566 
 (17) 
 548 
 (224) 
 324 

Interest  paid  under  finance  lease  obligations  was  €7  thousand,  €12  thousand  and  €55  thousand  the years  ended 

December 31, 2023, 2022 and 2021 respectively.  

The weighted average remaining lease term and the weighted average discount rate for finance leases were respectively 

3.75 years and 3.67% at December 31, 2023 and 1.02 years and 1.32% at December 31, 2022. 

13-2     Operating leases 

Maturities of operating lease liabilities consist of the following amounts: 

2024 
2025 
2026 
2027 
2028 
2029 and thereafter 
Total undiscounted minimum lease payments 
Less: current portion 
Long-term portion 

      December 31,  

2023 

 898 
 485 
 240 
 157 
 — 
 — 
 1,780 
 (898) 
 882 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

2023 
2024 
2025 
2026 
2027 
2028 and thereafter 
Total undiscounted minimum lease payments  
Less: current portion 
Long-term portion 

      December 31,  

2022 

 901 
 636 
 238 
 24 
 — 
 — 
 1,799 
 (901) 
 899 

The weighted average remaining lease term and the weighted average discount rate for operating leases were respectively 

2.35 years and 4.98% at December 31, 2023 and 2.18 years and 2.29% at December 31, 2022. 

Total rent expenses under operating leases amounted to €1,017 thousand, €912 thousand and €953 thousand, for the years 
ended December 31, 2023, 2022 and 2021, respectively. These total rent expenses are related to office rentals, office equipment and 
car rentals.

SHORT-TERM BORROWINGS 

As of December 31, 2023 and 2022, short-term borrowings consist mainly of €2,466 thousand and €1,846 thousand of 

factored account receivables and for which the Company maintains the effective control, respectively. 

LONG TERM DEBT 

15-1     Long-term debt: 

France term loan 
Japanese term loan 
Germany term loan 
USA term loan 
Korea term loan 
Malaysia term loan 
Total long term debt 
Less current portion 
Total long-term portion 

December 31,  

2023 
 3,222    
 323    
 —    
 —    
 5   
 —    
 3,551    
 (1,553)   
 1,997    

2022 
 4,593 
 558 
 28 
 — 
 8 
 — 
 5,188 
 (1,601) 
 3,587 

As of December 31, 2023 and 2022, long-term debt in Japan consists of two loans in denominated in Yen and subscribed 

with the following conditions: 

EDAP Technomed Co. Ltd 
EDAP Technomed Co. Ltd 

Initial 
Amount 

Maturity 

  Fixed Interest rate   

Frequency of 
principal payments 

    80,000,000    August 2, 2026   
    50,000,000    April 2, 2025    

 1.98  %   Monthly installment 
 1.8  %   Monthly installment 

As of December 31, 2023 and 2022, long-term debt in France consists of three loans in Euro subscribed in 2020 which 

terms and maturity were amended and a new loan in Euro subscribed in 2021 with the following terms: 

EDAP TMS FRANCE 

      Drown 
Amount 

Maturity 

  Fixed Interest rate   

Frequency of 
principal payments 

    1,066,081    July 1, 2025   

 0.99  %   Monthly installment 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

This loan is pledged against the Company’s cash in USD for an amount equal to the countervalue of the loan in USD. This 
loan constitutes a complete financial package of €1,530,000, of which €1,066,081 were drawn to finance HIFU treatment probes. 
This drawn amount will be reimbursed over three years until July 1, 2025. 

EDAP TMS FRANCE 

Initial 
Amount 

Maturity 

  Fixed Interest rate   

Frequency of 
principal payments 

    2,000,000    July 30, 2026   

 0.73  %   Monthly installment 

This loan is a COVID-related loan guaranteed by the French government entered into in 2020 with an initial one-year 

repayment term subsequently extended to six years. 

EDAP TMS FRANCE 

    2,000,000    August 4, 2026   

 0.73  %   Monthly installment 

Initial 
Amount 

Maturity 

  Fixed Interest rate   

Frequency of 
principal payments 

This  loan,  in  Euro,  is  a  COVID-related  loan  guaranteed  by  the  French  government  in  2020  with  an  initial  one year 

repayment term subsequently extended to six years. 

EDAP TMS FRANCE 

Initial 
Amount 

 72,222   

Maturity 
July 5, 2024 

Fixed Interest rate   

Frequency of 
principal payments 

 0.45  %  Monthly installment 

This loan is related to the acquisition of computer servers. 

As of December 31, 2022, long-term debt in Germany consists of one loan in Euro with the following terms : 

EDAP TMS GMBH 

Initial 

   Amount   
    400,000    April 30, 2023   

Maturity 

  Fixed Interest rate   

 2.40  %   Monthly installment 

Frequency of 
principal payments 

This loan was pledged against an HIFU equipment with a purchase value of €438 thousand. 

15-2     Financial instruments carried at fair value: 

As of December 31, 2023, there are no warrants outstanding. 

Refer to Note 26 for more details on the fair value of other Financial Instruments. 

15-3     Long-term debt maturity: 

Long-term debt carried at amortized cost at December 31, 2023 matures as follows: 

2024 
2025 
2026 
2027 
2028 
2029 and thereafter 
Total 

 1,553 
 1,320 
 677 
 — 
 — 
 — 
 3,551 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

OTHER LONG-TERM LIABILITIES 

Other long-term liabilities consist of the following: 

Provision for retirement indemnities (Japan & France), less current portion 
Provision for employee termination indemnities (Korea) less current portion 
Provision for Asset Retirement Obligation (Japan) less current portion 
Provision for warranty costs, less current portion 
Provision for guarantee given to customer, less curent portion 
Conditional government advances, less current portion 
Accrued interest less current portion 
Total 

December 31,  

2023 
 2,241    
 149    
 91    
 65    
 66   
 463    
 —    
 3,075    

2022 
 1,962 
 122 
 101 
 62 
 — 
 463 
 — 
 2,710 

Provision for asset retirement obligation in Japan is related to subsidiary’s offices and warehouses. 

Pension, post-retirement and post-employment benefits for most of the Company’s employees are sponsored by European 
governments. In addition to government-sponsored plans, subsidiaries in Japan and France have defined benefit retirement plans in 
place.  The  provision  for  retirement  indemnities  at  December 31, 2023  represents  an  accrual  for  lump-sum  retirement  benefit 
payments to be paid at the time an employee retires if  he  or  she is  still present  at  the  Company  at  the  date  of  retirement. This 
provision has been calculated taking into account the estimated payment at retirement (discounted to the current date), turnover and 
salary increases. 

The provision is management’s best estimate based on the following assumptions as of year-end: 

Discount rate 
Salary increase 
Retirement age 
Average retirement remaining service period 

Discount rate 
Salary increase 
Retirement age 
Average retirement remaining service period 

      Retirement indemnities France 

2023 
3.19%   
3.00%   
 65    
 23    

2022 
3.80%   
3.00%   
 65   
 24   

      Retirement indemnities Japan 

2023 
1.30%   
2.50%   
 60    
 14    

2022 
1.30%   
2.50%   
 60   
 14   

The discount rate retained is determined by reference to the high quality rates for AA- rated corporate bonds for a duration 

equivalent to that of the obligations.  

At  December  31,  2023,  the  provision  which  represents  the  projected  benefit  obligation  in  accordance  with  ASC  718 

consists of: 

Non-current liabilities 
Current liabilities 
Total projected benefit obligation 

France 

Japan 

 1,084 

 —    
 1,084    

 1,157 
 70 
 1,227 

At  December  31,  2022,  the  provision  which  represents  the  projected  benefit  obligation  in  accordance  with  ASC  718 

consists of: 

Non-current liabilities 
Current liabilities 
Total projected benefit obligation 

France 

Japan 

 845 
 89    
 934    

 1,117 
 102 
 1,219 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

The Company does not have a funded benefit plan. A detailed reconciliation of pension cost components (in thousands of 

euros) during fiscal year for each of the three years ending December 31, 2023 is as follows: 

France 
Change in benefit obligations: 
Projected Benefit obligations at beginning of year 
Service cost 
Interest cost 
Net loss or (gain) 
Actuarial (gain) or loss 
Amortization of net prior service cost 
Benefits paid 
Projected Benefit obligations at end of year (1) 
Unrecognized actuarial (gain) loss (2) 
Unrecognized prior service cost (2) 

2023 

2022 

2021 

 934   
 67   
 34   
 —   
 66   
 —   
 (17)   
 1,084   
 (146)   
 13   

 1,080    
 84    
 11    
 —    
 (241)   
 —    
 —    
 934    
 (219)   
 14    

 1,111 
 90 
 6 
 — 
 (72) 
 — 
 (56) 
 1,080 
 22 
 16 

(1)  The accumulated benefit obligation was €805 thousand and €701 thousand at December 31, 2023 and 2022 respectively. 
(2)  The amount in accumulated other comprehensive income (loss) to be recognized as components of net periodic benefit costs in 2023 is €133 thousand. 

Japan 
Change in benefit obligations: 
Projected Benefit obligations at beginning of year 
Service cost 
Interest cost 
Amortization of net loss 
Actuarial (gain) / loss 
Benefits paid 
Plan Amendments 
Exchange rate impact 
Projected Benefit obligations at end of year (1) 
Unrecognized actuarial (gain) loss (2) 
Unrecognized prior service cost (2) 

2023 

2022 

2021 

 1,219   
 114   
 13   
 —   
 4   
 (76)   
 74  
 (122)   
 1,227   
 81   
 74   

 1,302    
 112    
 7    
 —    
 (30)   
 (75)   
 —   
 (95)   
 1,219    
 86    
 —    

 1,310 
 120 
 7 
 — 
 — 
 (97) 
 — 
 (39) 
 1,302 
 126 
 — 

(1)  The accumulated benefit obligation was €1,030 thousand and €1,027 thousand at December 31, 2023 and 2022, respectively. 
(2)  The amount in accumulated other comprehensive income (loss) to be recognized as components of net periodic benefit costs in 2023 is €156 thousand. 

The benefits expected to be paid in each of the next five fiscal years, and in the aggregate for the five fiscal years thereafter, 

are detailed in the table below: 

2024 
2025 
2026 
2027 
2028 
2029-2033 

France 

Japan 

 —    
 —    
 129    
 85    
 85    
 408    
 707    

 70 
 152 
 143 
 67 
 46 
 843 
 1,322 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

SHAREHOLDERS’ EQUITY 

17-1     Common stock 

As of December 31, 2023, EDAP TMS S.A.’s common stock consisted of 37,373,312 issued shares fully paid and with a 

par value of €0.13 each. 37,103,779 of the shares were outstanding. 

In September 2022, the Company completed a successful common stock offering and issued 3,066,667 new common shares 
in the form of ADS for $7.50 per share which resulted in gross proceeds of €23,913 thousand. In connection with this offering, the 
Company incurred issuance costs amounting to €1,954 thousand. 

17-2     Pre-emptive subscription rights 

Shareholders have preemptive rights to subscribe on a pro rata basis for additional shares issued by the Company for cash. 
Shareholders  may  waive  such  preemptive  subscription  rights  at  an  extraordinary  general  meeting  of  shareholders  under  certain 
circumstances. Preemptive subscription rights, if not previously waived, are transferable during the subscription period relating to 
a particular offer of shares. 

17-3     Dividend rights 

Dividends  may  be  distributed  from  the  statutory  retained  earnings,  subject  to  the  requirements  of  French  law  and  the 
Company’s by-laws. The Company has not distributed any dividends since its inception as the result of an accumulated statutory 
deficit of 11,962 thousand. Dividend distributions, if any, will be made in euros. The Company has no plans to distribute dividends 
in the foreseeable future. 

17-4     Treasury stock 

As  of  December 31,  2023,  all  269,533  shares  held  as  treasury  stock  consisted  of  (i),  89,243  shares  acquired  between 
August and December 1998 and (ii) 180,290 shares acquired in June and July 2001 for a total of €590 thousand. All treasury stocks 
have been acquired to cover stock purchase options (see Note 17-5). 

17-5     Stock-option and free share plans 

As  of  December 31, 2023,  EDAP  TMS  S.A.  sponsored  three  stock  purchase  and  subscription  option  plans  open  to 

employees of EDAP TMS group: 

On February 18, 2016, the shareholders authorized the Board of Directors to grant up to 1,000,000 options to subscribe to 
1,000,000 new shares at a fixed price to be set by the Board of Directors. Conforming to this stock option plan, the Board of Directors 
granted 575,000 options to subscribe to new shares to certain employees of EDAP TMS on April 26, 2016. The exercise price was 
fixed  at  €3.22  per  share.  Options  were  to  begin  vesting  one year  after  the  date  of  grant  and  all  options  were  fully  vested  as  of 
April 26, 2020 (i.e., four years after the date of grant). The options will expire on April 26, 2026 (i.e., ten years after the date of 
grant) or when employment with the Company ceases, whichever occurs earlier. The total fair value of the options granted under 
this plan was €960 thousand. This non-cash compensation expense was recognized in the Company’s operating expenses over a 
period of 48 months (using the graded vesting method). 

Conforming to this February 18, 2016 stock option plan, the Board of Directors granted 260,000 options to subscribe to 
new shares to certain employees of EDAP TMS on April 25, 2017. The exercise price was fixed at €2.39 per share. Options were 
to begin vesting one year after the date of grant and all options were fully vested as of April 25, 2021 (i.e., four years after the date 
of grant). The options will expire on April 25, 2027 (i.e., ten years after the date of grant) or when employment with the Company 
ceases, whichever occurs earlier. The total fair value of the options granted on April 25, 2017 under this plan was €335 thousand. 
This non-cash compensation expense was recognized in the Company’s operating expenses over a period of 48 months (using the 
graded vesting method). 

Conforming to this February 18, 2016 stock option plan, the Board of Directors granted 165,000 options to subscribe to 
new shares to certain employees of EDAP TMS on August 29, 2018. The exercise price was fixed at €2.65 per share. Options were 
to begin vesting one year after the date of grant and all options were fully vested as of August 29, 2022 (i.e., four years after the 
date of grant). The options will expire on August 29, 2029 (i.e., ten years after the date of grant) or when employment with the 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

Company ceases, whichever occurs earlier. The total fair value of the options granted on August 29, 2018 under this plan was €219 
thousand. This non-cash compensation expense was recognized in the Company’s operating expenses over a period of 48 months 
(using the graded vesting method). 

Conforming to this February 18, 2016 stock option plan, the Board of Directors granted 155,000 options to subscribe to 
new shares to certain employees of EDAP TMS on April 4, 2019. Forfeited options corresponding to employees’ departures were 
re-allocated. The exercise price was fixed at €3.90 per share. Options were to begin vesting one year after the date of grant and all 
options were fully vested as of April 4, 2023 (i.e., four years after the date of grant). The options will expire on April 4, 2029 (i.e., 
ten years after the date of grant) or when employment with the Company ceases, whichever occurs earlier. The total fair value of 
the options granted on April 4, 2019 under this plan was €299 thousand. This non-cash compensation expense is recognized in the 
Company’s operating expenses over a period of 48 months (using the graded vesting method). 

The impact of this February 18, 2016 Plan on operating income, in accordance with ASC 718, was €65 thousand, €25 

thousand and €3 thousand in 2021, 2022 and 2023, respectively. 

Under this 2016 plan, 678,080 options are outstanding and are exercisable at December 31, 2023. 

On June 28, 2019, the shareholders authorized the Board of Directors to grant up to a maximum of 358,528 options to 
purchase pre-existing shares and to grant 1,000,000 options to subscribe to 1,000,000 new shares at a fixed price to be set by the 
Board of Directors. Conforming to this June 28, 2019 stock option plan, the Board of Directors granted 292,428 options to purchase 
pre-existing shares and 1,000,000 options to subscribe to new shares to certain employees of EDAP TMS on June 11, 2021. The 
exercise price was fixed at €5.59 per share. Options were to begin vesting six months after the date of grant and most options will 
be fully vested as of June 11, 2024 (i.e., three years after the date of grant). On March 29, 2023, the vesting of 270,000 of these 
options was accelerated and such options may vest immediately. The options will expire on June 11, 2031 (i.e., ten years after the 
date of grant) or when employment with the Company ceases, whichever occurs earlier. The total fair value of subscription options 
granted on June 11, 2021 under this plan was €681 thousand and the total fair value of purchase options was €2,371 thousand. This 
non-cash compensation expense is recognized in the Company’s operating expenses over a period of 36 months (using the graded 
vesting method). 

The impact of this June 28, 2019 Plan on operating income, in accordance with ASC 718, was €1,484 thousand, €1,104 

thousand and €410 thousand in 2021, 2022 and 2023, respectively. 

Under this 2019 plan, 1,244,533 options are outstanding, of which 1,037,111 are exercisable at December 31, 2023. 

On June 30, 2021, the shareholders authorized the Board of Directors to grant up to a maximum of 2,000,000 options to 
subscribe to 2,000,000 new shares at a fixed price to be set by the Board of Directors. Conforming to this June 30, 2021 stock-
option plan, the Board of Directors granted:  

(i) 

(ii) 

100,000 options to subscribe to new shares to certain employees of EDAP TMS on November 17, 2021. The 
exercise price was fixed at €5.18 per share. Options were to begin vesting six months after the date of grant and 
all options will be fully vested as of November 17, 2024 (i.e., three years after the date of grant). The options will 
expire on November 17, 2031 (i.e., ten years after the date of grant) or when employment with the Company 
ceases, whichever occurs earlier. The total fair value of the options granted on November 17, 2021 under this plan 
was €229 thousand. This non-cash compensation expense is recognized in the Company’s operating expenses 
over a period of 36 months (using the graded vesting method). 

144,000 options to subscribe to new shares to certain employees of EDAP TMS on May 17, 2022. The exercise 
price was fixed at €6.41 per share. Options were to begin vesting six months after the date of grant and all options 
will be fully vested as of May 17, 2025 (i.e., three years after the date of grant). The options will expire on May 
17, 2032 (i.e., ten years after the date of grant) or when employment with the Company ceases, whichever occurs 
earlier. The total fair value of the options granted on May 17, 2022 under this plan was €450 thousand. This non-
cash compensation expense is recognized in the Company’s operating expenses over a period of 36 months (using 
the graded vesting method).  

(iii) 

32,000 options to subscribe to new shares to certain employees of EDAP TMS on November 8, 2022. The exercise 
price was fixed at €10.32 per share. Options were to begin vesting six months after the date of grant and all options 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

(iv) 

(v) 

(vi) 

(vii) 

(viii) 

(ix) 

will be fully vested as of November 8, 2025 (i.e., three years after the date of grant). The options will expire on 
November  8,  2032  (i.e.,  ten years  after  the  date  of  grant)  or  when  employment  with  the  Company  ceases, 
whichever occurs earlier. The total fair value of the options granted on November 8, 2022 under this plan was 
€161 thousand. This non-cash compensation expense was recognized in the Company’s operating expenses over 
a period of 36 months (using the graded vesting method). 

395,000 options to subscribe to new  shares to  certain employees of EDAP TMS  on  December  15, 2022. The 
exercise price was fixed at €9.94 per share. Options were to begin vesting six months after the date of grant and 
all options will be fully vested as of December 15, 2025 (i.e., three years after the date of grant). The options will 
expire  on  December  15,  2032  (i.e.,  ten years  after  the  date  of  grant)  or  when  employment  with  the  Company 
ceases, whichever occurs earlier. The total fair value of the options granted on December 15, 2022 under this plan 
was €1,858 thousand. This non-cash compensation expense is recognized in the Company’s operating expenses 
over a period of 36 months (using the graded vesting method). 

125,000 options to subscribe to new shares to certain employees of EDAP TMS on April 5, 2023. The exercise 
price was fixed at €9.96 per share. Options were to begin vesting six months after the date of grant and all options 
will be fully vested as of April 5, 2026 (i.e., three years after the date of grant). The options will expire on April 
5, 2033 (i.e., ten years after the date of grant) or when employment with the Company ceases, whichever occurs 
earlier. The total fair value of the options granted on April 5, 2023 under this plan was €687 thousand. This non-
cash compensation expense is recognized in the Company’s operating expenses over a period of 36 months (using 
the graded vesting method). 

200,000 options to subscribe to new shares to certain employees of EDAP TMS on May 2, 2023. The exercise 
price was fixed at €10.10 per share. Options were to begin vesting six months after the date of grant and all options 
will be fully vested as of May 2, 2026 (i.e., three years after the date of grant). The options will expire on May 2, 
2033 (i.e., ten years after the date of grant) or when employment with the Company ceases, whichever occurs 
earlier. The total fair value of the options granted on May 2, 2023 under this plan was €1,183 thousand. This non-
cash compensation expense is recognized in the Company’s operating expenses over a period of 36 months (using 
the graded vesting method). 

50,000 options to subscribe to new shares to certain employees of EDAP TMS on May 31, 2023. The exercise 
price was fixed at €9.32 per share. Options were to begin vesting six months after the date of grant and all options 
will be fully vested as of May 31, 2026 (i.e., three years after the date of grant). The options will expire on May 
31, 2033 (i.e., ten years after the date of grant) or when employment with the Company ceases, whichever occurs 
earlier. The total fair value of the options granted on May 31, 2023 under this plan was €270 thousand. This non-
cash compensation expense is recognized in the Company’s operating expenses over a period of 36 months (using 
the graded vesting method). 

177,000 options to subscribe to new shares to certain employees of EDAP TMS on August 23, 2023. The exercise 
price was fixed at €7.53 per share. Options were to begin vesting six months after the date of grant and all options 
will be fully vested as of August 23, 2026 (i.e., three years after the date of grant). The options will expire on 
August 23, 2033 (i.e., ten years after the date of grant) or when employment with the Company ceases, whichever 
occurs earlier. The total fair value of the options granted on August 23, 2023 under this plan was €774 thousand. 
This  non-cash  compensation  expense  is  recognized  in  the  Company’s  operating  expenses  over  a  period  of 
36 months (using the graded vesting method). 

80,000  options  to  subscribe  to  new  shares  to  certain  employees  of  EDAP  TMS  on  September  20,  2023.  The 
exercise price was fixed at €6.08 per share. Options were to begin vesting six months after the date of grant and 
all options will be fully vested as of September 20, 2026 (i.e., three years after the date of grant). The options will 
expire on September 20, 2033 (i.e., ten years after the date of grant) or when employment with the Company 
ceases, whichever occurs earlier. The total fair value of the options granted on September 20, 2023 under this plan 
was €296 thousand. This non-cash compensation expense is recognized in the Company’s operating expenses 
over a period of 36 months (using the graded vesting method). 

(x) 

20,000 options to subscribe to new shares to certain employees of EDAP TMS on November 8, 2023. The exercise 
price was fixed at €6.64 per share. Options were to begin vesting six months after the date of grant and all options 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

will be fully vested as of November 8, 2026 (i.e., three years after the date of grant). The options will expire on 
November  8,  2033  (i.e.,  ten years  after  the  date  of  grant)  or  when  employment  with  the  Company  ceases, 
whichever occurs earlier. The total fair value of the options granted on November 8, 2023 under this plan was €81 
thousand. This non-cash compensation expense is recognized in the Company’s operating expenses over a period 
of 36 months (using the graded vesting method). 

(xi) 

34,000 options to subscribe to new shares to certain employees of EDAP TMS on December 6, 2023. The exercise 
price was fixed at €4.98 per share. Options were to begin vesting six months after the date of grant and all options 
will be fully vested as of December 6, 2026 (i.e., three years after the date of grant). The options will expire on 
December  6,  2033  (i.e.,  ten years  after  the  date  of  grant)  or  when  employment  with  the  Company  ceases, 
whichever occurs earlier. The total fair value of the options granted on December 6, 2023 under this plan was 
€103 thousand. This non-cash compensation expense is recognized in the Company’s operating expenses over a 
period of 36 months (using the graded vesting method). 

The impact of this June 30, 2021, Plan on operating income, in accordance with ASC 718, was €25 thousand, €442 thousand 
and €2,936 thousand in 2021, 2022 and 2023, respectively. 

Under this 2021 plan, 1,276,300 options are outstanding at December 31, 2023 and 282,475 are exercisable. 

Forfeited stock-options are recognized as they occur, in accordance with ASU 2016-09. 

The fair value of each stock option granted during the year is estimated on the date of grant using the Black-Scholes option 

pricing model with the following assumptions: 

Weighted-average expected life (years)  
Expected volatility rates(1) 
Expected dividend yield  
Risk-free interest rate  
Weighted-average exercise price (€) 
Weighted-average fair value of options granted 
during the year (€) 

     Dec-2023      Nov-2023      Sept-2023      Aug-2023      May-2023      May-2023      Apr-2023      

 5.79    

 5.79    

 5.79    
 5.79   
 63.29 %   61.09  %   60.90  %   60.60  %   60.80  %   60.90  %   61.00  % 
 0  % 
 3.39  % 
 9.96    

 0  % 
 3.47  % 
 10.10    

 0  % 
 4.55  % 
 6.64    

 0  % 
 4.55  % 
 6.08    

 0  % 
 4.35  % 
 7.53    

 0  % 
 3.77  % 
 9.32    

 0 % 
 4.16 % 
 4.98   

 5.79    

 5.79    

 5.79    

 3.03   

 4.05    

 3.70    

 4.37    

 5.40    

 5.92    

 5.49    

(1)  Historical volatility calculated over the weighted-average expected life. 

As of December 31, 2023, a summary of stock option activity to purchase or to subscribe to Shares under these plans is as 

follows: 

Outstanding on January 1, 
Granted 
Exercised 
Forfeited 
Expired 
Outstanding on December 31, 
Exercisable on December 31, 
Share purchase options available for grant on 
December 31, 

2023 

2022 

Options  Weighted   

Options  Weighted   

average 
exercice 
price (€) 

 2,613,886 
 686,000 
 (55,973) 
 (45,000) 
 — 
 3,198,913 
 1,997,666 

 5.66    
 8.53    
 4.66    
 7.99    
 —    
 6.26    
 5.23    

 2,408,508 
 571,000 
 (320,622) 
 (45,000) 
 — 
 2,613,886 
 1,362,205 

average 
exercice 
price (€) 

 4.38    
 9.07    
 2.14    
 5.34    
 —    
 5.66    
 4.35    

2021 
Options  Weighted 
average 
exercice 
price (€) 
 2.81 
 5.56 
 2.93 
 4.01 
 — 
 4.38 
 3.25 

 1,186,900 
 1,392,428 
 (150,820) 
 (20,000) 
 — 
 2,408,508 
 1,149,401 

 25,000   

 20,000 

 5,000 

As of December 31, 2023, 643,000 options to subscribe to new shares are available for future grants. 

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EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

The  following  table  summarizes  information  about  options  to  purchase  existing  Shares  held  by  the  Company,  or  to 

subscribe to new Shares, at December 31, 2023: 

Outstanding options 

  Weighted    Weighted   

Fully vested options (1) 

  Weighted   

Exercise price (€) 
10.32 
10.10 
9.96 
9.94 
9.32 
7.53 
6.64 
6.41 
6.08 
5.59 
5.18 
4.98 
3.90 
3.22 
2.65 
2.39 
2.39 to 10.32 

average 
remaining   
contractual  
life 

      Options 

 20,000   
 200,000   
 117,000   
 395,000   
 50,000   
 177,000   
 20,000   
 100,000   
 80,000   
 1,244,533   
 83,300   
 34,000   
 107,500    
 357,000    
 77,500    
 136,080    
 3,198,913    

 8.8   
 9.3   
 9.3   
 9.0   
 9.4   
 9.7   
 9.8   
 8.3   
 9.8   
 7.4   
 7.8   
 9.9   
 5.8    
 2.3    
 4.7    
 3.3    
 7.8    

average 
exercise 
price 
(€) 
 10.32   
 10.10   
 9.96   
 9.94   
 9.32   
 7.53   
 6.64   
 6.41   
 6.08   
 5.59   
 5.18   
 4.98   
 3.90    
 3.22    
 2.65    
 2.39    
 0.84    

Aggregate 
Intrinsic 
Value 
(2) 

      Options 

 —   
 —   
 —   
 —   
 —   
 —   
 —   
 —   
 —   
 —   
 431,494   
 169,320   
 419,250    
 1,149,540    
 205,375    
 325,231    
 2,700,210    

 7,222   
 38,889   
 26,000   
 131,667   
 9,722   
 —   
 —   
 52,778   
 —   
 1,037,111   
 16,197   
 —   
 107,500   
 357,000   
 77,500   
 136,080   
 1,997,666    

average 
exercise 
price 
(€) 
 10.32   
 10.10   
 9.96   
 9.94   
 9.32   
 —   
 —   
 6.41   
 —   
 5.59   
 5.18   
 —   
 3.90   
 3.22   
 2.65   
 2.39   
 1.09    

Aggregate 
Intrinsic 
Value 
(2) 

 — 
 — 
 — 
 — 
 — 
 — 
 — 
 — 
 — 
 — 
 83,902 
 — 
 419,250 
 1,149,540 
 205,375 
 325,231 
 2,183,298 

(1)  Fully vested options are all exercisable options. On March 29, 2023, the Board of Directors unanimously decided to appoint Ryan Rhodes as the new Chief Executive Officer 
of the Company effective on May 1, 2023. Marc Oczachowski would continue to serve as Chairman of the Board of the Company. In this context, the Board decided to 
accelerate the vesting of all unvested options granted to Mr. Oczachowski under the 2019 option plans such that these options fully vested and became exercisable on March 
29, 2023. (Ref. Note 33. Subsequent Events.)  

(2)  The aggregate intrinsic value represents the total pre-tax intrinsic value, based on the Company’s closing stock price of $5.28 at December 31, 2023, which would have been 
received by the option holders had all in-the-money option holders exercised their options as of that date. If closing stock price is under exercise price, then the aggregate 
intrinsic value is not considered.  

A summary of the status of the non-vested options to purchase shares or to subscribe to new shares as of December 31, 

2023, and changes during the three years ended December 31, 2023, is presented below: 

Non-vested at January 1, 2021 
Granted 
Vested 
Forfeited 
Non-vested at December 31, 2021 
Granted 
Vested 
Forfeited 
Non-vested at December 31, 2022 
Granted 
Vested 
Forfeited 
Non-vested at December 31, 2023 

  Weighted average 
  Grant-Date Fair 

      Options 

Value (€) 

 216,250    
 1,392,428    
 (329,571)   
 (20,000)   
 1,259,107    
 571,000   
 (543,426)   
 (35,000)   
 1,251,681    
 686,000   
 (691,434)   
 (45,000)   
 1,201,247    

 1.59 
 2.37 
 2.06 
 1.89 
 2.32 
 4.33 
 2.32 
 2.80 
 2.32 
 4.95 
 3.22 
 3.98 
 4.18 

As of December 31, 2023, there were €2,509 thousand of total unrecognized compensation expenses related to non-vested 

stock-options, over a period of 2.9 years. 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

On June 30, 2021, the shareholders authorized the Board of Directors to grant up to a maximum of 200,000 free shares to 

certain employees. Conforming to this June 30, 2021 authorization, the Board of Directors granted:  

(i) 

(ii) 

61,500  free  shares  to  certain  employees  of  EDAP  TMS  on  September  28,  2021.  Free  shares  shall  be  definitively 
acquired  by  the  relevant  beneficiaries  at  the  end  of  the  vesting  period  (minimum  one  year  period  starting  on  the 
allocation date and ending on the acquisition date, i.e. two years starting on the allocation date). On September 28, 
2022, 57,500 free shares were definitely acquired by French resident beneficiaries. The total fair value of the free 
shares granted on September 28, 2021 under this plan was €340 thousand. This non-cash compensation expense was 
recognized in the Company’s operating expenses upon allocation.  

40,000 free shares to the CEO of EDAP TMS on March 30, 2022. Free shares shall be definitively acquired by the 
relevant beneficiaries at the end of the vesting period (minimum one year period starting on the allocation date and 
ending on the acquisition date, i.e. two years starting on the allocation date). The total fair value of the free shares 
granted on March 30, 2022 under this plan was €259 thousand. This non-cash compensation expense was recognized 
in the Company’s operating expenses upon allocation. 

Under this 2021 plan, no free shares are outstanding at December 31, 2023. 

On June 30, 2022, the shareholders authorized the Board of Directors to grant up to 600,000 free shares. This new resolution 
superseded the June 30, 2021 resolution, cancelling the unused portion of the 2021 resolution. Conforming to this June 30, 2022 
authorization, the Board of Directors granted: 

(i) 

(ii) 

(iii) 

291,500  free  shares  to  certain  employees  of  EDAP  TMS  on  November  8,  2022.  Free  shares  shall  be  definitively 
acquired by the relevant beneficiaries at the end of the vesting period, which begins six months after the date of grant 
and all shares will be fully vested as of November 8, 2025 (i.e. three years after the date of the grant). The total fair 
value  of  the  free  shares  granted  on  November  8,  2022,  under  this  plan  was  €2,963  thousand.  This  non-cash 
compensation  expense  is  recognized  in  the  Company’s  operating  expenses  over  a  period  of  36 months  (using  the 
graded vesting method).  

150,000 free shares to Mr. Marc Oczachowski, Chairman and Chief Executive Officer EDAP TMS on March 29, 
2023. All free shares shall be definitively acquired one year after the date of the grant. All free shares will be subject 
to the required 12-month conservation period following the acquisition of the shares. The total fair value of the free 
shares granted on March 29, 2023 under this plan was €1,542 thousand. This non-cash compensation expense was 
recognized in the Company’s operating expenses upon allocation.  

50,000 free shares to the President of EDAP TMS France, Mr. Frédéric Pech on May 2, 2023. Free shares shall be 
definitively acquired at the end of the vesting period, which begins six months after the date of grant and all shares 
will be fully vested as of May 2, 2026 (i.e. three years after the date of the grant). The total fair value of the free shares 
granted on May 2, 2023, under this plan was €508 thousand. This non-cash compensation expense is recognized in 
the Company’s operating expenses over a period of 36 months (using the graded vesting method).  

 Under this 2022 plan, 273,500 free shares are outstanding at December 31, 2023. 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

17-6    Accumulated other comprehensive income (loss) 

The components of accumulated other comprehensive income (loss) net of tax, for the years ended December 31, 2023, 

and 2022, are as follows: 

  Foreign currency  

translation 
adjustment 

Year Ended December 31, 2023 
Provision for 
retirement indemnities  
(net of tax) 

Beginning balance 
Other comprehensive income (loss) before reclassifications 
Reclassified from accumulated other comprehensive loss 
Net current-period other comprehensive income (loss)  
Ending balance 

 (3,973)      
 —    
 —    
 (478)   
 (4,451)   

 144       
 —    
 —    
 (180)   
 (37)   

Beginning balance 
Other comprehensive income (loss) before reclassifications 
Reclassified from accumulated other comprehensive loss 
Net current-period other comprehensive income (loss)  
Ending balance 

 (3,377)  
 —   
 —   
 (596)  
 (3,973)  

 (212)  
 —   
 —   
 355   
 144    

  Foreign currency  

translation 
adjustment 

Year Ended December 31, 2022 
Provision for 
  retirement indemnities  
(net of tax) 

Total 

 (3,829) 
 — 
 — 
 (658) 
 (4,487) 

Total 

 (3,589) 
 — 
 — 
 (240) 
 (3,829) 

TOTAL SALES 

Amount of net sales derived from our operations in Asia, France, the United States. and other geographical areas, are as 

follows: 

Primary geographical markets (€) 
Asia 
France  
United States  
Others geographical areas 
Total Net Sales 

The amount of net sales is recognized following the timing below: 

Timing of revenue recognition 
Products transferred at a point in time 
Products and services transferred over time 
Total Net Sales 

Year Ended December 31,   
2022 
 17,936   
 10,637   
 15,036   
 11,500   
 55,108   

2023 
 17,841   
 11,999   
 16,717   
 13,865   
 60,423   

2021 
 16,009 
 12,251 
 5,524 
 10,276 
 44,060 

Year Ended December 31,   
2022 
 44,173   
 10,935   
 55,108   

2023 
 48,646   
 11,777   
 60,423   

2021 
 34,552 
 9,508 
 44,060 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

OTHER REVENUES 

Other revenues consist of the following: 

Year Ended December 31,   
2022 

2021 

2023 

Licenses and others 
Total  

 —   
 —   

 —   
 —   

 6 
 6 

In 2021, other revenues mainly consist of sales of a license to Theraclion and training to customers.

COSTS OF SALES 

Costs of sales consist of the following: 

Direct costs of sales 
Indirect costs of sales 
Total costs of sales  

RESEARCH AND DEVELOPMENT EXPENSES 

Research and development expenses consist of the following: 

Gross research and development expenses 
Research Tax Credit 
Grants 
Net Research and development expenses  

2023 

Year Ended December 31,   
2022 
    (22,624)      (19,814)     (16,199) 
    (13,388)      (11,102)   
 (9,443) 
    (36,012)      (30,916)     (25,643) 

2021 

Year Ended December 31,   
2022 
 (5,751)   
 581   
 250   
 (4,920)   

2023 
 (7,596)   
 411   
 222   
 (6,963)   

2021 
 (4,757) 
 617 
 739 
 (3,402) 

In 2023 and 2022, grants consisted mainly of national grants for the assessment and optimization of the focal treatments of 

prostate cancer (Perfuse development project). 

In 2021, grants consisted mainly of national grants for the assessment and optimization of the focal treatments of prostate 
cancer (Perfuse development project) and of a financial impact for the development of innovative imaging solutions for the focal 
treatment of liver cancer (HECAM Development project). Ref. Note 12. 

Research and development costs are expensed as incurred and include amortization of assets, costs of prototypes, salaries, 

benefits and other headcount related costs, contract and other outside service fees, and facilities and overhead costs. 

 FINANCIAL INCOME, NET 

Interest (expense) income, net consists of the following: 

Interest income 
Interest expense 
Paycheck Protection Program loan forgiveness 
Total 

Year Ended December 31,   
      2021 
 10 
 (52) 
 187 
 145 

      2022 
 404 
 (168)   
 —    
 236    

      2023 
 1,311 
 (232)   
 —    
 1,079    

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

INCOME TAXES 

23-1     Income / (Loss) before income taxes 

Income / (loss) before income taxes is comprised of the following: 

France 
Other countries 
Total 

23-2     Income tax (expense)/ benefit 

Income tax (expense)/benefit consists of the following : 

Year Ended December 31,   

2023 

      2022 

 (9,026)   
    (11,507)   
    (20,533)   

 (418)   
 (1,678)   
 (2,096)   

2021 
 869 
 24 
 893 

Year Ended December 31,   
2022 

2021 

2023 

Current income tax expense: 
France 
Other countries 
Sub-total current income tax expense 
Deferred income tax (expense) benefit: 
France 
Other countries 
Sub-total deferred income tax (expense) benefit 
Total 

23-3     Deferred income taxes: 

 (77)   
 (533)   
 (610)   

 3   
 (37)   
 (34)   
 (644)   

 (485)   
 (251)   
 (736)   

 (8)   
 (93)   
 (101)   
 (837)   

 (320) 
 (436) 
 (756) 

 8 
 556 
 563 
 (193) 

Deferred income taxes reflect the impact of temporary differences between the amounts of assets and liabilities reported 
for financial reporting purposes and such amounts as measured in accordance with tax laws. The tax effects of temporary differences 
which give rise to significant deferred tax assets (liabilities) are as follows by nature : 

Net operating loss carry forwards 
Elimination of intercompany profit in inventory 
Elimination of intercompany profit in fixed assets 
Provisions for retirement indemnities 
Capital leases treated as operating leases for tax 
Other items 
Total deferred tax assets 
Total deferred tax liabilities 
Net deferred tax assets 
Valuation allowance for deferred tax assets 
Deferred tax assets (liabilities), net of allowance 

2023 
 16,356 

 689   
 396   
 663   
 10   
 354   
 18,468   
 —   
 18,468   
 (17,739)   
 729   

2022 
 13,793 
 480 
 256 
 658 
 26 
 360 
 15,573 
 — 
 15,573 
 (14,744) 
 829 

Net  operating  loss  carryforwards  available  amount  to  €71,821  thousand  as  of  December 31, 2023,  of  which  €31,284 
thousand  relates  to  EDAP  TMS  SA,  €40,310  thousand  relates  to  Edap  Technomed Inc.  and  €227  thousand  relates  to  Edap 
Technomed Co Ltd Japan. These net operating losses generate deferred tax assets of €16,356 thousand as at December 31, 2023. 
Realization of these tax assets is contingent on future taxable earnings in the applicable tax jurisdictions. As of December 31, 2023, 
€71,594 thousand out of these €71,821 thousand net operating loss carry-forwards have no expiration date but the amount of the net 
operating loss carry-forward, which can be used each year to offset taxable earnings, is limited in all jurisdictions. The remaining 
tax loss carry-forwards expire from years 2023 through 2025. In accordance with ASC 740, a valuation allowance is established if, 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

based on the weight of available evidence, it is more-likely-than-not that some portion or all of the deferred tax asset will not be 
realized. 

23-4     Effective tax income (expense) 

A reconciliation of differences between the statutory French income tax rate and the Company’s effective tax income (loss) 

is as follows: 

Theoretical income tax (expense) benefit at French statutory tax rate 
Income of foreign subsidiaries taxed at different tax rates 
Effect of net operating loss carry-forwards and valuation allowances 
Non-taxable debt fair value variation 
Permanent differences 
Effect of cancellation of intra-group positions 
French business tax included in income tax (CVAE) 
Other 
Effective income tax (expense) benefit 

23-5     Uncertainty in Income Taxes 

2023 
 5,133 
 (546)   
 (4,439)   
 —    
 (263)   
 (476)   
 (74)   
 20    
 (644)   

2022 

 524 
 (174)   
 (643)   
 —    
 (99)   
 (366)   
 (99)   
 20    
 (837)   

2021 
 (237) 
 (95) 
 626 
 — 
 (258) 
 (130) 
 (85) 
 (15) 
 (193) 

According to ASC 740, the Company reviewed the tax positions of each subsidiary. On December 31, 2023 the Company 

believes that there is no significant uncertainty in the Company’s tax positions. 

The Company remains subject to examination by major tax jurisdictions. 

Interest and penalties on income taxes are classified as a component of the provision for income taxes. There were no 

interest or penalties in 2023, 2022 and 2021.

EARNINGS (LOSS) PER SHARE 

Income (loss) available to common shareholders (in Euros) 
Weighted average number of shares for the computation of basic EPS 
Basic EPS (in Euros) 
Effect of dilutive securities 
Weighted average number of shares for the computation of diluted EPS 
Diluted EPS income / (loss) (in Euros) 

Year Ended December 31,   

2023 
  €   (21,177,772)   € 
 36,996,722   

2022 

 (2,933,058)   € 
 34,392,598    

  € 

 (0.57)   € 

 (0.09)   € 

 2,653,050  
 36,996,722  

 2,502,171   
 34,392,598   

  € 

 (0.57)   € 

 (0.09)   € 

2021 
 699,890 
 32,129,047 
 0.02 
 293,824 
 32,422,871 
 0.02 

Diluted EPS income / (loss) available to common shareholders is computed including all dilutive securities that are in the 

money. 

The effects of dilutive securities for the year ended December 31, 2023 and 2022 were excluded from the calculation of 

diluted earnings per share as a net loss was reported in this period.

COMMITMENTS AND CONTINGENCIES 

25-1     Commitments 

The Company currently has commitments regarding its operating leases as described in Note 13-2. 

25-2     Contingencies 

The Company currently has contingencies relating to standard warranties provided to customers for products as described 

in Note 1-15 and Note 12.

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

FAIR VALUE OF FINANCIAL INSTRUMENTS 

The following disclosure of the estimated fair value of financial instruments was made in accordance with the requirements 
of ASC 820 ‘‘Disclosure about fair value of financial instruments’’ and indicates the fair value hierarchy of the valuation techniques 
utilized to determine such fair value. 

ASC 820 defines three levels of inputs that may be used to measure fair value and requires that the assets or liabilities 

carried at fair value be disclosed by the input level under which they were valued. The input levels are defined as follows: 

Level 1: Quoted (unadjusted) prices in active markets for identical assets and liabilities that the reporting entity can access 

at the measurement date. 

Level 2: Inputs other than quoted prices included within Level 1 that are observable for the asset or liability, either directly 

or indirectly. 

Level 3: Unobservable inputs for the asset or liability. 

The recorded amount of cash and cash equivalents, accounts receivable, accounts payable, accrued liabilities and short-
term borrowings are a reasonable estimate of their fair value due to the short-term maturities of these instruments. As of December 
31, 2023 and December 31, 2022, the Company did not have any other asset or liability measured at fair value. 

As of December 31, 2023, the fair value of the Company’s long-term debt was not materially different from the carrying 

value. 

CONCENTRATION OF CREDIT RISK 

Financial instruments, which potentially subject the Company to concentrations of credit risk, consist principally of cash 
and cash equivalents and trade accounts and notes receivable from customers, primarily located in France, Japan and the United 
States. The Company maintains cash deposits with major banks. Management periodically assesses the financial condition of these 
institutions and believes that credit risk is limited. 

The Company has implemented procedures to monitor the creditworthiness of its customers. The Company obtains bank 
guarantees for first time or infrequent unknown customers, and in certain cases obtains insurance against the risk of a payment 
default by the customer. The Company reviewed individual customer balances considering current and historical loss experience 
and general economic conditions in determining the allowance for doubtful accounts receivable of €0.2 million and €0.2 million, 
for the years ended December 31, 2023 and 2022, respectively. 

Actual losses may vary from the current estimates, and any adjustments are reported in earnings in the periods in which 

they become known. 

In 2023, 2022 and 2021, the Company did not generate more than 10% revenue with a single customer.

FOREIGN CURRENCY TRANSACTIONS 

The Company generates a significant percentage of its revenues, and of its operating expenses, in currencies other than the 
euro. The Company’s operating profitability could be materially adversely affected by large fluctuations in the rate of exchange 
between  the  euro  and  such  other  currencies.  The  Company  may  engage  in  foreign  exchange  hedging  activities  when  deemed 
necessary, but there can be no assurance that hedging activities will be offset by the impact of movements in exchange rates on the 
Company’s results of operations. As of December 31, 2023, there were no outstanding hedging instruments. 

SEGMENT INFORMATION 

Our activity is organized into three divisions: HIFU, ESWL (including lithotripsy activities) and Distribution. Through 
these  three  divisions,  we  develop,  produce,  market  and  distribute  minimally  invasive  medical  devices,  mainly  for  urological 
diseases. HIFU division includes sales of Focal One, Ablatherm and related consumables and services, ESWL division includes 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

revenues  generated  by  the  existing  Sonolith  range  of  lithotripters  and,  Distribution  division  includes  the  sale  of  complimentary 
products such as lasers, micro-ultrasound systems and other products from third parties. 

The organization of our activities into three divisions better clarified our vision and enhanced our financial reporting of our 
three  businesses  HIFU,  ESWL  and  Distribution.  This  new  structure  also  allows  for  an  improved  measurement  of  our  business 
progress. 

The  business  in  which  the  Company  operates  is  the  development,  production  and  distribution  of  minimally  invasive 
medical devices, primarily for the treatment of urological diseases. Substantially all revenues result from the sale of medical devices 
and their related license and royalty payments from third parties. The segments derive their revenues from this activity. 

The following tables set forth the key Statement of income (loss) figures, by segment for fiscal years 2023, 2022 and 2021 
and the key balance sheet figures, by segment, for fiscal years 2023, 2022 and 2021. Segment operating profit or loss and segment 
assets are determined in accordance with the same policies as those described in the summary of significant accounting policies and 
they are reviewed by the CODM, who is the CEO. Interest income and expense, current and deferred income taxes are not allocated 
to individual segments. A reconciliation of segment operating profit or loss to consolidated net loss is as follows: 

Segment operating income (loss) 
Financial income (expense), net 
Foreign Currency exchange (losses) gains, net 
Income tax (expense) benefit 
Consolidated net income (loss) 

Year Ended December 31,   
2022 
 (4,257)   
 236    
 1,925    
 (837)   
 (2,933)   

2023 
    (19,813)   
 1,079    
 (1,799)   
 (644)   
    (21,178)   

2021 
 (1,612) 
 145 
 2,360 
 (193) 
 700 

A summary of the Company’s operations by segment is presented below for years ended December 31, 2023, 2022 and 

2021: 

2023 
Sales of goods 
Sales of RPPs & leases 
Sales of spare parts and services 
Total sales 
External other revenues 
Total revenues 
Total COS 
Gross profit 
R&D expenses 
Selling and marketing expenses 
G&A expenses 
Total expenses 
Operating income (loss) from operations 
Total Assets 
Capital expenditures 
Non-current assets 
Goodwill 

      HIFU 

  Division 

      ESWL 
  Division 

      DISTRIB 
  Division 

      Reconciling      
Items 

 13,510    
 4,935    
 2,152    
 20,596    
 —    
 20,596    
 (10,112)   
 10,484    
 (5,755)   
 (13,524)   
 (5,983)   
 (25,262)   
 (14,778)   
 22,443   
 3,577   
 6,516   
 645   

 3,844    
 955    
 5,109    
 9,908    
 —    
 9,908    
 (6,268)   
 3,640    
 (764)   
 (1,636)   
 (1,471)   
 (3,871)   
 (232)   
 12,798   
 288   
 2,105   
 496   

 24,980   
 286   
 4,653   
 29,919   
 —   
 29,919   
 (19,632)  
 10,287   
 (444)  
 (7,466)  
 (2,625)   
 (10,535)   
 (248)   
 31,400   
 479   
 4,448   
 1,271   

 —    
 —    
 —    
 —    
 —    
 —    
 —    
 —    
 —    
 —    
 (4,556)   
 (4,556)   
 (4,556)   
 24,908    
 —    
 —    
 —    

Total 
  consolidated 
 42,333 
 6,176 
 11,914 
 60,423 
 — 
 60,423 
 (36,012) 
 24,411 
 (6,963) 
 (22,626) 
 (14,634) 
 (44,224) 
 (19,813) 
 91,548 
 4,344 
 13,069 
 2,412 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

2022 
Sales of goods 
Sales of RPPs & leases 
Sales of spare parts and services 
Total sales 
External other revenues 
Total revenues 
Total COS 
Gross profit 
R&D expenses 
Selling and marketing expenses 
G&A expenses 
Total expenses 
Operating income (loss) from operations 
Total Assets 
Capital expenditures 
Non-current assets 
Goodwill 

2021 
Sales of goods 
Sales of RPPs & leases 
Sales of spare parts and services 
Total sales 
External other revenues 
Total revenues 
Total COS 
Gross profit 
R&D expenses 
Selling and marketing expenses 
G&A expenses 
Total expenses 
Operating income (loss) from operations 
Total Assets 
Capital expenditures 
Non-current assets 
Goodwill 

VALUATION ACCOUNTS 

Balance as of December 31, 2020 
Charges to costs and expenses 
Deductions: write-off and others 
Balance as of December 31, 2021 
Charges to costs and expenses 
Deductions: write-off and others 
Balance as of December 31, 2022 
Charges to costs and expenses 
Deductions: write-off and others 
Balance as of December 31, 2023 

      HIFU 

  Division 

      ESWL 
  Division 

      DISTRIB 
  Division 

      Reconciling      
Items 

 9,437    
 4,287    
 1,909    
 15,634    
 —    
 15,634    
 (6,788)   
 8,846    
 (3,525)   
 (8,083)   
 (2,131)   
 (13,739)   
 (4,894)   
 16,293   
 1,715   
 4,269   
 645   

 4,880    
 1,058    
 5,630    
 11,568    
 —    
 11,568    
 (6,732)   
 4,836    
 (950)   
 (1,887)   
 (1,077)   
 (3,914)   
 922    
 12,997   
 307   
 2,149   
 496   

 24,145    
 272    
 3,491    
 27,907    
 —    
 27,907    
 (17,396)   
 10,511    
 (444)   
 (6,409)   
 (1,690)   
 (8,543)   
 1,968    
 26,407   
 356   
 4,187   
 1,271   

 —    
 —    
 —    
 —    
 —    
 —    
 —    
 —    
 —    
 —    
 (2,254)   
 (2,254)   
 (2,254)   
 45,426    
 —    
 —    
 —    

      HIFU 

  Division 

      ESWL 
  Division 

      DISTRIB 
  Division 

     Reconciling      
Items 

 4,515   
 3,679   
 1,715   
 9,910   
 6   
 9,915   
 (5,311)   
 4,604   
 (2,238)   
 (3,910)   
 (1,481)   
 (7,630)   
 (3,025)   
 13,597  
 1,234  
 3,689  
 645  

 4,236    
 1,022    
 5,758    
 11,016    
 —    
 11,016    
 (6,080)   
 4,936    
 (835)   
 (2,048)   
 (1,161)   
 (4,043)   
 893    
 13,596   
 141   
 2,185   
 496   

 20,289    
 267    
 2,578    
 23,134    
 —    
 23,134    
 (14,252)   
 8,882    
 (329)   
 (4,774)   
 (1,355)   
 (6,458)   
 2,424    
 25,344   
 261   
 3,971   
 1,271   

 —    
 —    
 —    
 —    
 —    
 —    
 —    
 —    
 —    
 —    
 (1,904)   
 (1,904)   
 (1,904)   
 24,690    
 —    
 —    
 —    

Total 
  consolidated 
 38,462 
 5,617 
 11,030 
 55,108 
 — 
 55,108 
 (30,916) 
 24,193 
 (4,920) 
 (16,379) 
 (7,152) 
 (28,450) 
 (4,257) 
 101,123 
 2,378 
 10,605 
 2,412 

Total 
  consolidated 
 29,040 
 4,968 
 10,052 
 44,060 
 6 
 44,065 
 (25,643) 
 18,422 
 (3,402) 
 (10,732) 
 (5,900) 
 (20,034) 
 (1,612) 
 77,226 
 1,636 
 9,845 
 2,412 

      Allowance        Allowance       

  for deferred    for doubtful    Slow-moving    Warranty 

tax assets 
 15,508 
 346 
 (1,513)   
 14,341 
 1,538 
 (1,135)   
 14,744 
 3,175 
 (180)   

 17,739 

accounts 
 721 
 2 
 19 
 742 
 32 
 (613)   
 161 
 85 
 (21)   
 224 

inventory 
 1,563 
 371 
 (464)   
 1,470 
 93 
 (300)   
 1,262 
 354 
 (353)   
 1,263 

reserve 
 369 
 110 
 (227) 
 252 
 112 
 (202) 
 162 
 134 
 (124) 
 172 

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Table of Contents 

EDAP TMS S.A. AND SUBSIDIARIES 
CONSOLIDATED FINANCIAL STATEMENTS 

(In thousands of euros unless otherwise noted, except per share data) 

SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION 

Interest and income taxes paid are as follows: 

Income taxes paid (refunds received) 
Interest paid 
Interest received 

Non-cash transactions: 

Financing lease obligations incurred 
Operating lease obligations incurred 

Cash paid for amounts included in the measurement of lease liabilities: 

Operating cash flow used in operating leases 
Operating cash flow used in finance leases 
Financing cash flow used in finance leases 

RELATED PARTY TRANSACTIONS 

Year Ended December 31,   
2022 

2021 

2023 

 509   
 265   
 1,311   

 410    
 168    
 403    

 307 
 114 
 10 

Year Ended December 31,   

2023 

 358   
 1,098   

2022 

 162    
 1,162    

2021 

 233 
 674 

Year Ended December 31,   
2022 

2021 

2023 
 1,009    
 7    
 242    

 900   
 12   
 350   

 916 
 18 
 406 

On August 19, 2019, EDAP Technomed Co. Ltd. (Japan) contracted a loan amounting to JPY 80,000,000. As a current 
practice  in  Japan,  this  loan  required  a  personal  warranty  from  the  representative  director,  President  and  CEO  of  the  subsidiary 
Mr. Jean-François  Bachelard.  EDAP  TMS  S.A.,  as  the  parent  company,  counter-warranted  this  personal  loan  and  agreed  to 
indemnify Mr. Bachelard, in an indemnification letter dated September 12, 2019 expiring upon loan maturity date of August 26, 
2026. 

On April 22, 2020, EDAP Technomed Co. Ltd (Japan) contracted another loan amounting to JPY 50,000,000 requiring a 
personal warranty from the representative director, president and CEO of the subsidiary Mr. Jean-François Bachelard. EDAP TMS 
S.A., as the parent company, counter-warranted this personal loan and agreed to indemnify Mr. Bachelard, in an indemnification 
letter dated June 2, 2020, expiring upon loan maturity date of April 2, 2025. 

33— SUBSEQUENT EVENTS 

In  order  to  align  the  Company’s  organization  to  build  shareholders  value  and  expand  its  operational  and  commercial 
presence in the United States, the Company announced on January 2, 2024 the appointment of Ken Mobeck as its Chief Financial 
Officer and François Dietsch as its Chief Accounting Officer. 

On March 4, 2024, EDAP announced that its Focal One platform has been granted Breakthrough Device designation by 
the US Food and Drug Administration (FDA) for the treatment of deep infiltrating endometriosis (DIE). In June 2018, the FDA 
cleared Focal One Robotic Focal HIFU for the ablation of prostatic tissue.  

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ANNUAL REPORT

June 4th, 2024
Dear Fellow Shareholders:

Looking  back,  2023  proved  to  be  a  very  productive  and  successful  year  for  our  company. We  achieved  both 
record revenue and placed a record number of Focal One systems, establishing robotic HIFU as a fast growing 
treatment modality for the management of prostate cancer. We also experienced strong Focal One procedure 
growth, which reflects increasing adoption of robotic HIFU technology, as well as our growing installed base of 
Focal One systems.   
In  parallel  with  our  commercial  success,  we  also  achieved  significant  clinical  and  regulatory  milestones 
throughout  the  year.  In  December,  we  announced  a  positive  opinion  for  reimbursement  from  the  French 
National Authority for Health (HAS) for the treatment of localized prostate cancer with HIFU technology. In July, 
we announced reimbursement approval in Switzerland for the use of HIFU in the treatment of prostate cancer, 
enabling Swiss patients to have greater access to a precise and effective treatment option with the potential of 
fewer side effects. Earlier in 2023, we announced the approval of our ExactVu™ micro-ultrasound biopsy platform 
in Japan, which represents the second largest market for advanced medical device technology in the world. 
We also made significant progress in our clinical pipeline in 2023, highlighted by the progress on our Phase 2 
and Phase 3 clinical trials evaluating Focal One robotic HIFU technology to treat women with deep infiltrating 
endometriosis. Of particular note, FDA recently granted Breakthrough Device designation for Focal One for the 
treatment of deep infiltrating endometriosis, which speaks to the importance of developing new treatment 
approaches for addressing this painful and debilitating condition impacting thousands of women each year. We 
look forward to sharing topline results from the study in the second half of 2024.  
EDAP has also taken steps to ensure that our board and senior leadership continues to evolve as we redefine the 
treatment paradigm for prostate cancer. In December, we appointed Lance Willsey, MD, as a new independent 
director who brings a strong expertise in both urology and prostate cancer. Dr. Willsey also has an accomplished 
background in serving healthcare and cancer focused companies, and in his brief time on the Board, he has 
already made significant contributions to help guide our corporate strategy. More recently, we also announced 
the appointments of two international senior executives, Damien Desmedt and Alexander Fromm, who each 
bring significant commercialization experience in the field of disruptive, robotic capital equipment.   
As previously noted on our first quarter earnings call, this year’s EAU and AUA meetings were major successes 
for  EDAP,  showcasing  the  growing  brand  recognition  for  our  best-in-class  Focal  One  robotic  HIFU  platform. 
A major impact at both of these scientific meetings was the final results from the HIFI study, which provided 
conclusive  clinical  evidence  that  treatment  with  robotic  HIFU  technology  was  at  least  equivalent  to  surgery 
(radical  prostatectomy),  but  with  the  added  benefit  of  improved  functional  outcomes  with  respect  to  both 
erectile  function  and  urinary  continence.  As  results  from  the  HIFI  study  become  more  widely  disseminated 
amongst the urology community, we anticipate seeing a positive impact on the demand for our leading Focal 
One platform.     
Looking ahead in 2024, we believe that, despite the impact from inflation, the U.S. economy still appears to be 
resilient. From our perspective, the current economic backdrop is translating into capital expenditure budgets 
for hospitals and urology practices that are relatively stable, with a modest elongation to some purchasing cycles. 
Nonetheless,  we  believe  a  growing  number  of  hospitals  and  clinics  view  Focal  One  as  a  clinically  necessary, 
strategic investment that will enable urologists to remain at the forefront of prostate cancer management. Based 
on these underlying dynamics, we believe our Focal One pipeline will continue to remain strong throughout 
2024 and beyond, and we remain fully engaged in productive discussions with existing and potentially new 
customers.  
Finally, we would like to acknowledge all of the hard work and dedication of our employees who have helped make 
such important contributions to our ongoing success and growth. We have carefully selected an extraordinary 
group of individuals to both lead and contribute across our Focal One capital and clinical sales teams, and each 
day our relationships with key stakeholders continue to strengthen. We are very excited about our progress and 
what it means for our future.     
I  would  like  to  thank  our  shareholders  for  your  continued  support,  and  I  look  forward  to  sharing  with  you 
additional progress throughout 2024. 

Sincerely,
Ryan Rhodes
Chief Executive Officer 

EDAP TMS S.A. 
Senior Executive Officers

Ryan Rhodes
Chief Executive Officer

Ken Mobeck 
Chief Financial Officer

François Dietsch 
Chief Accounting  Officer

EDAP TMS S.A. 
Board of Directors 

Marc Oczachowski 
Chairman

Pierre Beysson
Director 
Audit Committee Chair

Marie Meynadier 
Director  
Audit Committee

Lance Willsey
Director  
Audit Committee

Ryan Rhodes
Director 
Chief Executive Officer

EDAP TMS S.A. 
Corporate Headquarters

Parc d’Activités - La Poudrette Lamartine
4, Rue du Dauphiné
F 69120 Vaulx-en-Velin - France
Tel : +33 (0)4 72 15 31 50

www.edap-tms.com 
www.hifu-prostate.com 
www.focalone.com 

Blandine Confort 
Director of Legal Affairs
Investor Relations 
Tel : +33 4 72 15 31 50 
bconfort@edap-tms.com

EDAP TMS’s subsidiaries 
Officers

Ryan Rhodes
President & Chief Executive Officer 
EDAP Technomed, Inc. 
Los Altos, CA, USA  
Austin, TX, USA

Frédéric Pech 
President 
EDAP TMS France S.A.S. 
Lyon, France

Judith Johannsen
General Manager 
EDAP TMS GmbH 
Flensburg, Germany

Jean-François Bachelard
Asia Operations Supervisor  
Chief Executive Officer 
EDAP Technomed Co. Ltd 
Tokyo, Japan

Hervé de Soultrait
General Manager 
EDAP Technomed (M) Sdn, Bhd 
Kuala Lumpur, Malaysia

Alex Fromm
General Manager
EDAP Switzerland GmbH
Zurich, Switzerland

EDAP TMS’s Branches 
Officers

Jeon Jon-Hyeon 
General Manager 
EDAP TMS Korea 
Seoul, Korea

ANNUAL
ANNUAL
REPORT
REPORT
2023
2023

ANNUAL
ANNUAL
REPORT
REPORT
2023
2023

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EDAP Technomed, Inc. - 4410 El Camino Real, #50 - Los Altos, CA 94022, USA
____________________
EDAP TMS SA - 4, rue du Dauphiné - PA La Poudrette Lamartine - 69120 Vaulx-en-Velin - FRANCE
____________________
FocalOne.com I www.edap-tms.com I contact@edap-tms.com

EDAP Technomed, Inc. I 4410 El Camino Real, #50 I Los Altos, CA 94022, USA
____________________
EDAP TMS SA I 4, rue du Dauphiné - PA La Poudrette Lamartine - 69120 Vaulx-en-Velin - FRANCE
____________________
FocalOne.com I www.edap-tms.com I contact@edap-tms.com

The Global Leader
in Therapeutic Ultrasound

The Global Leader
in Therapeutic Ultrasound