Masimo
Annual Report 2019

Plain-text annual report

P A T I E N T S A F E T Y T O T H E C O R E 2 0 1 9 A N N U A L R E P O R T S E N I O R M A N A G E M E N T T E A M Joe Kiani Chief Executive Officer & Chairman of the Board Bilal Muhsin Chief Operating Officer Micah Young Executive Vice President & Chief Financial Officer Tom McClenahan Executive Vice President, General Counsel Tao Levy Executive Vice President, Business Development Jon Coleman President, Worldwide Sales, Professional Services & Medical Affairs Yongsam Lee Executive Vice President & Chief Information Officer Anand Sampath Executive Vice President, Operations & Clinical Research Tetsuro Maniwa President, Japan, Greater China & South Korea Stacey Orsat President, EMEA Matthew Anacone Senior Vice President, North America Sales B O A R D O F D I R E C T O R S Joe Kiani Chairman of the Board of Directors Steven J. Barker, MD, PhD H Michael Cohen Sanford Fitch Thomas Harkin Adam Mikkelson Craig Reynolds Julie A. Shimer, PhD P A T I E N T S A F E T Y T O T H E C O R E Letter from the Chairman and CEO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2019 Financial Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Raising the Bar for Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Live to Defeat the Opioid Epidemic with Masimo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Masimo Is Automating Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Why I Believe in Masimo: Q & A with Early Masimo Adopters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Innovation Never Stops: New Product Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 What Patient Safety Means to Me: Employee Spotlight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Integrating OEM Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 A Global Citizen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 2019 Financial Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 L E T T E R F R O M T H E C H A I R M A N A N D C E O Patient Safety Is in Our DNA In 1989, I founded Masimo with an ambitious goal: to solve the “unsolvable” challenge of making pulse oxim- etry accurate and reliable, even during patient motion and low perfusion. At the time, conventional pulse oximetry was plagued by unreliability, delivering inaccurate data and exces- sive false alarms due to patient movement and low per- fusion. Lives were harmed and even lost because con- ventional pulse oximeters failed to accurately monitor those who needed it the most. My dear friend and mentor, Dr. Jeremy Swan, described conventional pulse oximetry as a fair-weather friend. I believed a superior technology——one that would be accurate and reliable during challenging conditions of motion and low perfusion——was possible. In partnership with another dear friend and fellow engineer Mohamed Diab, we set out to make that goal a reality. The Masimo Difference: Signal Extraction Technology® In 1996, Masimo Signal Extraction Technology (SET®) was introduced at the World Congress of Anaesthesi- ologists in Australia. Over time, SET® transformed from a breakthrough technology into the standard of care for monitoring oxygen saturation and pulse rate at top hospitals around the world. Since its launch, more than 100 independent and objective studies have shown that Masimo SET® outperforms other pulse oximetry technol- ogies, providing clinicians with unmatched sensitivity and specificity to make critical patient care decisions.1 The legacy of Masimo SET ® is indelibly tied to enhanced patient safety. As the underlying technology driving many of our solutions, SET® remains as disruptive today as when it launched. Just this past year, we’ve achieved significant accuracy specification improvements with our new line of eco- and patient-friendly RD SET® sensors. And, in line with our unrelenting pursuit of perfecting pulse oximetry for motion, we released Radius PPG™, a tetherless pulse oximetry solution powered by Masimo SET®, providing accurate monitoring for patients on the move. From dramatically reducing the incidence of false alarms and missed true alarms to enabling critical congenital heart disease (CCHD) screening with SET® pulse oxim- etry and helping save newborns’ eyesight, the legacy of Masimo SET® is indelibly tied to enhanced patient safety.  4 5 2019 Highlights Our 30th anniversary, 2019, was a milestone year for Masimo in multiple ways. We grew our product reve- nue by $106 million, achieving 13% product revenue growth on a constant currency basis. 2019 also saw us making significant headway in emerging markets and welcoming many new customers from across the world, resulting in our best year yet for global sales. We believe that 2020 is poised to be a year of momentum for SpHb® adoption as a standard of care, just like SET ®. Moreover, in 2019 we remained true to our commitment to enhancing patient safety by bringing a range of inno- vative products and solutions to market——each designed to make meaningful clinical differences and help clini- cians improve patient outcomes. From Radius PPG, a tetherless, continuous pulse oximetry solution powered by SET®, to Halo ION™, which offers care teams a com- prehensive, personalized, continuous patient score, we are rapidly expanding our portfolio of solutions to match the evolving needs of modern, high-velocity healthcare. Finally, 2019 also brought important new evidence to demonstrate the clinical need for noninvasive, continu- ous hemoglobin (SpHb) monitoring, which, like SET®, is an area of continual innovation at Masimo. While earlier studies showed that SpHb helped clinicians reduce the frequency and volume of unnecessary blood transfusions, both in high- and low-blood-loss surgery, a landmark study conducted in Limoges, France, pub- lished in 2019, reinforces what we have long believed: SpHb has a significant impact on patient outcomes, amounting in that study to a 33% reduction in mortality at 30 days and 29% at 90 days after surgery.2 The evidence is becoming clearer: SpHb monitoring makes a true clinical difference, helping enhance patient safety, improve patient outcomes, and reduce the cost of care. In 2019, we saw an inflection in the adoption of SpHb by hospitals. We believe that 2020 is poised to be a year of momentum for SpHb adoption as a standard of care, just like SET®. While these achievements alone are wonderful news for all of our shareholders, we plan to build on the mo- mentum of 2019 to make 2020 our best year for growth ever——aiming to surpass $1 billion in revenue. The Next Generation of Innovation at Masimo At Masimo, we’ve cultivated a can-do environment populat- ed by dedicated, ethical employees who thrive on passion and curiosity and are committed to the common good. As a mission-based medical technology company, we attract team members who possess the brightest minds and the biggest hearts, and give them a collaborative environment where they have support to develop technologies and solutions that are the best for patient care. Just as we set out three decades ago to perfect pulse oximetry, the next generation of visionary engineers, clinicians, and leaders at Masimo are hard at work addressing the most pressing healthcare technology challenges of the 21st century——each with a profound commitment to enhancing patient safety. They are here, dedicating their considerable talents to our mission, not for prestige or vanity, but in service to the legacy forged by Masimo SET®. I call them the Masimo purists. From tackling the opioid epidemic, to delivering au- tomation solutions that will optimize the continuum of great care, to developing clinically useful wearable and home care devices, these purists are leading the charge into the future of medicine. Please read on to discover how these purists, and the personal motivations that drive their fascination, deter- mination, and commitment to patient safety, are shaping the future of Masimo and our customers and partners—— and why we say we are patient safety to the core.  1Published clinical studies on pulse oximetry and the benefits of Masimo SET® can be found on our website at http://www.masimo.com. Comparative studies include independent and objective studies which are comprised of abstracts presented at scientific meetings and peer-reviewed journal articles. 2Cros et al. J Clin Monit Comput. Aug 2019: 1-9. Joe Kiani Chairman and CEO 6 7 2 0 1 9 F I N A N C I A L H I G H L I G H T S 937.8 936.4 858.3 829.9 790.2 738.2 712.9 674.0 R E V E N U E S In millions of dollars Product revenues Royalty and other revenues 439.0 406.5 405.4 356.4 630.1 599.3 586.6 556.8 547.2 517.4 493.2 464.9 $5.85 $3.49 E A R N I N G S P E R S H A R E Non-recurring litigation settlement $3.45 $3.44 $1.21 $1.05 $1.07 $1.02 $1.30 $2.23 $1.55 $2.36 49.0 2010 32.5 2011 28.3 29.8 29.8 2012 2013 2014 30.8 2015 38.9 2016 52.0 2017 1.4 28.4 2018 2019 2010 2011 2012 2013 2014 2015 1 2016 2017 2018 2019 8 9 F I N A N C I A L R E S U L T S S U M M A R Y 2 0 1 9 T o t a l R e v e n u e s $937,837,000 2 0 1 9 E P S $3.44 1 Included in the FY2016 Historical GAAP Earning Per Share was $3.49 per diluted share related to a $300.0 million litigation settlement agreement, of which $270.0 million was recognized as a gain on the Statement of Operations on December 31, 2016. R A I S I N G T H E B A R F O R P A T I E N T S A F E T Y When you look back over the last 30 years of innovation at Masimo, the profound clin- ical impact of our breakthrough technologies comes clearly into focus. What you see is a correlation be- tween the development of a breakthrough Masimo parameter and improved outcomes. Without a doubt, we’ve helped raise the bar for patient safety, but we ar- en’t done yet. We’ll continue to push the boundaries of monitoring technologies because the evidence has proven what we believed from the start— accurate monitoring enhances patient safety. Joe Kiani | Chief Executive Officer For thirty years, Masimo has empowered clinicians with breakthrough monitoring technologies designed to help them improve patient outcomes. Revisit key highlights from our history to discover how our products have made a clinical difference.  Y T E F A S T N E I T A P R O F R A B E H T G N I S I A R SpHb 20 03 BREAKTHROUGH STUDY Masimo Patient SafetyNet™* Masimo Signal Extraction Technology (SET®) Pulse Oximetry Founding of Masimo 2019 BREAKTHROUGH STUDY Next Generation SedLine® Brain Function Monitoring 2016 BREAKTHROUGH STUDY O3® Cerebral Oximetry rainbow® ORi™† 2003 2010 2014 2016 2019 B R E A K T H R O U G H S T U D Y Cedars-Sinai Medical Center A landmark study links Masimo SET® to reduced retinopathy of prematurity (ROP) in neonatal patients.1 B R E A K T H R O U G H S T U D Y Massachusetts General Hospital A study shows SpHb monitoring helps clinicians optimize blood management.2 B R E A K T H R O U G H S T U D Y Children’s Hospital of Fudan University A study shows Masimo SET®, when combined with clinical assessment, improves critical congenital heart disease (CCHD) screening sensitivity to 93%.3 B R E A K T H R O U G H S T U D Y Dartmouth-Hitchcock Medical Center A study finds continuously monitoring adult patients on a post-surgical floor using Patient SafetyNet with Masimo bedside devices resulted in a 60% reduction in rescue events and a 50% reduction in unplanned transfers to the ICU.4 B R E A K T H R O U G H S T U D Y CHU Limoges A study finds a 33% reduction in mortality at 30 days and 29% at 90 days with the use of SpHb and PVi® as part of a goal-directed therapy protocol.5** 2014 BREAKTHROUGH STUDY Root® Patient Monitoring and Connectivity Platform 2010 BREAKTHROUGH STUDY Additional published clinical studies on Masimo technology can be found on our website at http://www.masimo.com/evidence/featured-studies/feature/. Comparative studies include independent and objective studies, which are comprised of abstracts presented at scientific meetings and peer-reviewed journal articles. 1Chow L.C. et al. Pediatrics. 2003 Feb; 111(2):339-45. 2Ehrenfeld et al. J Blood Disorders Transf. 2014. 5:9. 3Zhao et al. Lancet. 2014 Aug 30;384(9945):747-54. 4McGrath et al. Jt Comm J Qual Patient Saf. 2016;42(7):293- 302. 5Cros et al. J Clin Monit Comput. Aug 2019: 1-9. *The use of the trademark PATIENT SAFETYNET is under license from University HealthSystem Consortium. **Study utilized a goal-directed fluid therapy protocol with PVi in conjunction with a blood transfusion protocol based on SpHb. †ORi has obtained CE Mark. Not available in the US. 1989 1995 2003 2007 2008 2010 2013 2014 2016 2019 10 11 Live to Defeat the Opioid Epidemic with Masimo It’s well known that monitoring with Masimo SET ® can help prevent harm from opioid-induced respiratory depression in hospitals. We want to provide a similar level of safety to opioid users at home. Tom McClenahan Executive Vice President, General Counsel Answering the Call Closing the Gap on Opioid Safety In 2017, the U.S. Department of Health and Human Services (HHS) officially declared the opioid epi- demic a public health emergency. In response, the FDA’s Center for Devic- es and Radiological Health (CDRH) launched an Innovation Challenge to spur the development of medical devices that could help curb the rising death toll. We answered the FDA’s call with a visionary approach that combines hospital-proven pulse oximetry technology with a novel alert system. From more than 250 submissions, Masimo’s was one of eight propos- als selected. We were also granted “Breakthrough Device” status. Since the late 1990s, opioids have been prescribed to a wide variety of patients for many different rea- sons, including postoperative and recovering post-surgical patients and healing at home as well as those with chronic pain. Unfortunately, the last two decades have also shown how addictive opioids can be——with opioid abuse contributing to a grow- ing number of deaths. This worrisome statistic reveals that the opioid epidemic is impacting many different patient groups, in- cluding patients using non-prescrip- tion opioids, such as heroin and fentanyl, and those working through recovery programs. This designation gives us the oppor- tunity to work closely with the FDA to expedite the review process, so our groundbreaking approach is available to help reduce harm as soon as possible. While there are opioid risk mitiga- tion strategies available to offset or lessen the risk of overdose, they leave significant gaps in protection. Current strategies fail to account for one of the most important consid- erations: more than 50% of opioid overdoses occur while a person is alone and vulnerable.1 Though the healthcare industry is actively seeking new approaches to pain management, opioids remain a valuable tool that clinicians rely on to manage and alleviate pain——both in the hospital and at home. For this reason, among others, it is imper- ative to develop new solutions to enhance patient safety outside the boundaries of the hospital. Progress has been made, but major gaps in protection against opioid risks remain. Masimo is leveraging decades of industry-leading mon- itoring expertise to deliver a con- sumer home monitoring solution that helps fill in those gaps.  12 13 Delivering Hospital-proven Systems to the Home Setting Opioids are powerful painkillers, but they are also powerful respiratory depressants. Even when taken as di- rected under the care of physicians, opioids can cause respiratory de- pression (slow or shallow breathing), which lowers blood oxygen to dan- gerous levels, leading to brain injury and death. Respiratory depression is a serious risk for anyone using opi- oids——and a key reason that patients prescribed opioids in the hospital are often continuously monitored for oxy- genation (SpO2) with pulse oximetry. Masimo is leveraging decades of industry-leading monitoring expertise to deliver a consumer home monitoring solution. Masimo Signal Extraction Technolo- gy (SET®) is renowned for reliable, accurate oxygenation monitoring during challenging condi tions of motion and low perfusion. A trusted clinical tool that physicians rely on as an indicator of a patient’s phys- iological status, SET® has demon- strated unmatched sensitivity and specificity, with 3% missed true alarms and 5% false alarms versus 43% and 28%, respectively, with competitor technology.2 With more than 100 independent and objective studies completed since its launch, the clinical benefits of SET®—— including its ability to help care teams reduce the risks associated with opi- oid-induced respiratory depression (OIRD)——have been documented. In particular, a landmark study con- ducted at Dartmouth-Hitchcock Medical Center demonstrated that by implementing continuous pa- tient monitoring with Masimo SET® and a clinician notification system, researchers were able to elimi- nate preventable deaths and brain damage due to opioid overdose in post-surgical wards, as well as re- duce rapid rescue events by 60%, ICU transfers by 50%, and cost by an estimated $1.48 million annually.3-5 The Dartmouth-Hitchcock Medi- cal Center study demonstrates the measureable differ ence that reli- able, continuous monitor ing, cou- pled with a notification sys tem, can have on patient outcomes. In an effort to reduce the harm caused by the opioid epidemic, we are ex panding our leadership be- yond the hospital and into the con- sumer space, so that we can deliver hos pital-proven systems in the home setting directly to all at-risk patients. Masimo SafetyNet*: Opioid Safety Alert System In clinical settings, care teams are trained to respond to alarms and ad- dress possible deterioration before serious complications, such as brain damage or death, occur. However, the home setting is very different. The unmatched sensitivity and spec- ificity of Masimo SET®, in combina- tion with a system that accounts for those who may be alone, is key to delivering the demonstrated ben- efits of pulse oximetry in the home setting. By leveraging similar alert system protocols to those used at Dartmouth-Hitchcock Medical Cen- ter and other leading hospitals, we are bringing hospital-proven solu- tions to the home, enhancing patient safety and, we hope, making a mea- surable impact on the opioid crisis. to enhance safety, Designed Masimo SafetyNet will marry power- ful SET® pulse oximetry technology with a novel alert system. Intended to replicate the responsiveness of hos- pital care teams, Masimo SafetyNet provides crucial opportunities for patients to self-recover or get help when needed. Ideal for anyone us- ing opioids, Masimo SafetyNet will provide a level of safety and accura- cy not available from other wearable devices, fitness trackers, or smart- phone applications.  1ODPRN. Opioid Mortality Surveillance Report. Public Health Ontario. https://www.publichealthon- tario.ca/-/media/documents/opioid-mortality-sur- veillance-report.pdf?la=en. 2Shah et al. J Clin Anesth. 2012;24(5):385-91. 3Taenzer AH et al. Anesthe- siology. 2010:112(2):282-287. 4Taenzer AH et al. Anesthesia Patient Safety Foundation Newsletter. 2012. Available at: http://www.apsf.org/newsletters/ html/2012/spring/01_postop.htm. 5McGrath et al. Jt Comm J Qual Patient Saf. 2016;42(7):293-302. *Masimo SafetyNet pending FDA clearance. Product not available. R/IR D I G I T I Z E D , F I L T E R E D , A N D N O R M A L I Z E D R / I R (Conventional Pulse Oximetry) D S T ® Adaptive Filter F S T ® S S T ™ Adaptive Filter M S T ™ E V A L U A T I O N A N D A N A L Y S I S P O S T P R O C E S S O R M A S I M O S E T ® D S T 9 7 % 0 50% 66% 97% 100% Conventional pulse oximetry uses the standard red-over-infrared algorithm to provide SpO2, while Masimo SET® includes four additional algorithms, running in parallel. These algorithms distinguish between the arterial signal and non-arterial and venous signal noise–—during motion and low perfusion–— by identifying and isolating the non-arterial and venous noise SpO2 components (left peak, shown in blue) from the true arterial SpO2 components (right peak, shown in red) in the signal. 14 15 M a s i m o I s 97 74 15 7.0 20 4.0 A u t o m a t i n g C a r e Healthcare needs more than scalable, flexible connectivity solutions. My team is at the forefront of invention and innovation at Masimo, working to provide a platform for potential advancements such as centralized device control, decision support, and closed- loop management. We believe that by supplying advanced connectivity solutions, combined with best-in-class approaches, our automation platform will help clinicians reduce manual steps and procedures—leading to enhanced patient safety and improved patient outcomes. Omar Ahmed | Vice President, Software Engineering The Masimo Difference: Signal Extraction Technology Masimo Signal Extraction Tech- nology (SET®) is used to monitor more than 700 million patients ev- ery year.1 The primary pulse ox imetry at 9 of the 10 hospitals that top the 2019-20 U.S. News and World Report Best Hospitals Honor Roll, SET® is re- nowned for accuracy and reliability, even in challenging conditions of motion and low perfusion.2 As the foundation of Masimo moni- toring devices, SET® provides clini- cians with quality patient data. Lead- ing hos pitals and clinicians choose SET® because they know that with more accurate patient data, fewer false alarms, and more true alarms, they can focus on what truly matters: de livering excellent, evidence-based patient care. With the rainbow® Pulse CO-Oxime- ter®, Masimo combines the power of SET® with the ability to monitor additional advanced parameters, in- cluding Total Hemoglobin (SpHb), Perfusion Index (Pi), Pleth Variability Index (PVi), Methemoglobin (SpMet®), Carboxyhemoglobin (SpCO®), and Acoustic Respiration Rate (RRa®)—— increasing the amount of continuous, noninvasive patient data available to clinicians to support informed care decisions. Masimo is automating care by mar- rying the undisputed power of SET® and rainbow® Pulse CO-Oximeters with powerful automation features, including expanded connectivity and in teroperability solutions and a variety of novel devices and systems. This unique combination provides clinicians and care teams with an abundance of accurate, noninva- sive, continuous patient data along- side advanced automation features to improve workflow efficiencies. Combined, our approach to auto- mating care is helping clinicians de- liver great care while also optimizing the continuum of care. Automating Care to Enhance Patient Safety As more patient information be- comes available to clinicians through continuous monitoring, new oppor- tunities to enhance the care experi- ence for both the clinician and the patient abound. We are addressing these opportu- nities with a range of automation solutions poised to revolutionize not only the kind of patient data that can be collected and moved throughout the continuum of care, but also how that information can be used to em- power clinicians to deliver superior, evidence-based care. Automating care benefits patients and clinicians in many ways. To un- derstand the specific benefits for each, it is imperative to outline our approach to automation. Continuously Monitor Advanced Parameters At the core of our approach to automating care is our ability to accurately monitor multiple ad- vanced patient parameters. With the Root Patient Monitoring and Connectivity Platform, clinicians are able to centralize noninvasive tech- nologies usually found on multiple separate devices in one comprehen- including advanced sive monitor, rainbow SET® measurements, brain function monitoring, regional oxime- try, blood pressure, temperature, and capnography——all on an easy-to-in- terpret, customizable display. Further, Root serves as a connectivi- ty hub, drawing in patient data from connected Masimo and third-party devices and automating the elec- tronic charting of this rich, compre- hensive stream in electronic medical records (EMR). By reducing the need to manually document and copy data, the chance of transcription er- rors is minimized, helping clinicians focus their full attention on deliv- ering evidence-based care rather than documentation.  16 17 I R I S C O N N E C T I V I T Y A C R O S S T H E C O N T I N U U M O F C A R E Iris Gateway® Admissions, Discharges and Transfers (ADT) Electronic Medical Records (EMR) Continuously Monitor Advanced Patient Parameters Centralize Patient Data to Streamline Workflows Root Patient Monitoring and Connectivity Platform Designed to Transform Care UniView™ Intelligent Display for Next-Generation Data Aggregation and Alarm Visualization Third-party Devices Anesthesia Anesthesia Machine Machine Infusion Pump Pump Monitor Patient Monitor Ventilator Ventilator Iris Analytics™ Hospital-wide Patient Reporting Patient SafetyNet Supplemental Remote Monitoring and Clinician Alarm Notification Use Patient Data to Inform Management Decisions Replica™ Mobile Application for Supplemental Remote Monitoring and Clinician Alarm Notification Masimo is firmly committed to the flow of open data and, with our scalable, flexible automation solutions, we adapt our advanced connectivity tools to meet the needs of each hospital’s unique device and network infrastructure. at home via Doctella™, we are ex- panding what it means to provide great care. And we are far from done. As we look forward, only one thing is certain: we are committed to au- tomating care for the benefit of cli- nicians and patients alike——and will pursue any avenue that drives us closer to that goal.  1Estimate: Masimo data on file. 2http://health.usnews. com/health-care/best-hospitals/articles/best-hospitals- honor-roll-and-overview. In addition to robust continuous monitoring capabilities, Root offers a versatile spot-check interface that streamlines data input at the bed- side, automating vital signs work- flows and the calculation of early warning scores (EWS). With easy-to- follow prompts, cold-spot data queueing, and intuitive data push capabilities, care teams can more easily collect quality data and trans- fer it upstream for use by clinicians throughout the hospital and beyond. Iris Connectivity Across the Continuum of Care The Iris® platform enables connec- tivity across the continuum of care by seamlessly funneling all the data collected at the bedside——including third-party devices——into hospital IT systems, promoting connectivity and interoperability through stan- dards-based protocols. Masimo is firmly committed to the flow of open data and, with our scalable, flexible automation solutions, we adapt our advanced connectivity tools to meet the needs of each hospital’s unique device and network infrastructure. By breaking down data siloes and automating how patient information is collected and transferred, clini- cians and care teams have access to high quality, comprehensive infor- mation about patient status through- out the hospital——helping reduce variability in bedside care and en- hance patient safety and comfort. Transforming Patient Data into Actionable Insights Automating care at Masimo is more than accurate patient monitoring and patient data management. To maximize the use of quality patient data, our state-of-the-art devices and systems are designed to dis- play that data in meaningful ways to support care team workflows and enhance patient safety. For example, Patient SafetyNet is a supplemental remote monitoring and clinician notification system that displays near real-time infor- mation from connected Masimo and third-party devices at a central station. Combined with Replica, these alarms and alerts travel from bedside devices to a clinician’s tab- let or smartphone. In turn, Halo ION maximizes the value of quality patient data col- lected at the bedside. Specifically, Halo ION aggregates trend data from multiple physiologic parame- ters into a single, continuous score for each patient. Configured ac- cording to hospital policy, and dis- played and dynamically updated at Patient SafetyNet central view stations and on Replica mobile de- vices, Halo ION allows clinicians to leverage patient data to support workflow and resource allocation. Combined, the Masimo approach to automating care offers clinicians the ability to leverage quality data to deliver evidence-based care across the continuum. For patients, this approach helps ensure en- hanced care at the bedside and a more consistent care experience. The Relentless Pursuit of Innovation At Masimo, innovation is a way of life. Nowhere is this more evident than in our efforts to automate care. In ear- ly 2020, we acquired NantHealth’s Connected Care business (formerly iSirona™), bolstering Masimo’s con- nectivity solutions with DCX™ de- vice connectivity software (formerly known as DeviceConX™), VCX™ pa- tient vitals software (formerly known as VitalsConX™), and the HBox® connectivity hub. These connectiv- ity assets will help us expand and strengthen our automation solutions by promoting the free, open flow of patient data across even more sys- tems and devices. By recognizing the value of open data and scalable automation solu- tions that allow more patients to be continuously monitored on the general floor, during transport, or Transform Patient Data into Actionable Insights 18 19 W H Y I B E L I E V E I N M A S I M O Q & A w i t h E a r l y M a s i m o A d o p t e r s From the beginning, a devoted group of respected clinicians and medical authorities has fiercely advocated for Masimo technology to be made accessible to practioners everywhere. Their support and scholarship have been integral to the successful adoption of Masimo monitoring technologies around the globe. We recently asked four of these early adopters for their candid opinions on why they believe in Masimo technology. Round Table Participants Mitchell Goldstein, MD Professor of Pediatrics, Loma Linda University School of Medicine Director, Neonatal ECMO Program Division of Neonatology, Department of Pediatrics Loma Linda University Children’s Hospital, Loma Linda, California Augusto Sola, MD, FAAP Vice President, Medical Affairs, Neonatology, Masimo Medical Director, Iberoamerican Society of Neonatology André Denault, MD, PhD, ABIM-CCM, FRCPC, FASE, FCCS Professor of Anesthesiology and Critical Care Department of Anesthesiology, Critical Care Division Montréal Heart Institute and Centre Hospitalier de l’Université de Montréal Université de Montréal, Montréal, Quebec, Canada Michael A.E. Ramsay, MD, FRCA Chairman, Department of Anesthesiology and Pain Management, Baylor University Medical Center, and President of Baylor Scott & White Research Institute, Dallas, Texas Chairman, Patient Safety Movement Foundation Question: Thank you for your participation. As early adopters, you have a unique outlook on the value of Masimo tech- nologies—both for the clinician and the patient. From a clinical perspec- tive, how do Masimo technologies improve patient safety? Dr. Goldstein: Masimo technologies define patient safety. What I mean by that is that Ma- simo builds robust products that can be trusted when the patient is coding and nothing else is working. In my patient population, fragile neo- nates, who have low perfusion, high motion, and multiple confounding interfering extrinsic signals, reliable pulse oximetry was not achievable before Masimo. Without Masimo, patient safety would just be a theory. Dr. Sola: As a clinical neonatologist for over four decades, I have witnessed several, but not many, technological advancements that have been truly useful in improving the safety of new- borns. Masimo pulse oximetry is one. Years ago, in a landmark study pub- lished in Pediatrics, I showed that se- vere retinopathy of prematurity (ROP) and blindness in preterm babies was much more prevalent than commonly thought but that with the implementa- tion of Masimo Signal Extraction Tech- nology (SET®), from the time of birth, rates of ROP decreased significantly.1 This technology has improved patient safety——particularly in helping to avoid the many types of damage that excessive oxygen can cause. It’s the main reason that, following the ROP study, I chose to join Masimo. It’s critical to educate others about how pulse oximetry can improve patient outcomes. Some of the adverse effects of excess oxygen are very serious, not only for children, but also for pregnant women, their fetuses, and even adults. Going forward, the ability to monitor the oxygenation of the neonatal brain will significantly benefit efforts to avoid central nervous system hypoxia and hyperoxia. Dr. Denault: We started using SedLine in our insti- tution, a cardiac center seeing 2,000 cases a year, in 2017. Before then, we were skeptical about processed EEG monitors and only used near-infrared spectroscopy (beginning in 2002). At first, we were quite surprised by how differently our patients respond- ed to anesthesia and how often we observed over-sedation. We have since significantly reduced our use of intraoperative anesthesia agents. For me, the major role of SedLine is to personalize my anesthesia regimen and avoid burst suppression from overdosing, which by itself can lead to unnecessary complications. Dr. Ramsay: Masimo provides innovative, accurate noninvasive technology that gives clinically relevant, real-time informa- tion that improves patient safety and treatment. Masimo has delivered technology that is needed to detect vital sign changes at a time interven- tion can be made and before harm can occur. For example, Masimo technology helps to prevent blindness in pre- mature infants, reduce unnecessary blood transfusions in major surgeries, and support precise anesthesia in enhanced recovery programs. Finally, Masimo technology can help reduce harm from opioid-induced respiratory depression through early detection. By aggregating patient data collected in the ICU, clinicians can quickly identify deterioration in a patient at a time when an intervention can be made to prevent harm. Question: What made you an advocate for Masimo and how does the compa- ny’s mission align with your own? Dr. Goldstein: Masimo gave me 2020 equipment back in the 1990s. I am passionate about doing everything I can to save the most fragile neonates. Masimo helps me do my job and more. When I have had a question, a suggestion, a thought, or just needed to discuss an issue regarding patient care, Masimo wanted to hear from me. Unlike other companies in the field, Masimo listened. Dr. Sola: Before SET®, SpO2 monitors had significant false alarms and false readings. The original innovation by Masimo gave me the opportunity to improve the care delivered in the centers I directed, and subsequently, in many centers around the world. I have devoted most of my profes- sional life to two issues: The first is education. The second is finding original ways to improve the quality of infant care, to decrease morbidity, and to improve survival without mor- bidities or sequelae. Masimo, in the field of noninvasive monitoring, has shown a permanent commitment to both. Dr. Denault: Masimo brings technologies togeth- er and continually evaluates and improves their products. The ability to combine SedLine with O3 and other noninvasive technology is really unique and valuable. Dr. Ramsay: Masimo, as a company, is very re- sponsive to physician needs and also to patient safety needs. Their focus on patient safety has resulted in very positive results. The reliability of their devices has reduced patient harm and made our hospitals safer places to be as a patient. Question: What are your thoughts on the next generation of Masimo technologies (i.e. automating care, advanced non- invasive technologies, wearable and home care solutions, etc.)? How do you envision them improving patient safety? Dr. Goldstein: With Masimo, innovative technol- ogy will carry information back to providers like me reliably, just in time, and without false positives, helping me extend my ability to monitor my patients and save more lives. Dr. Sola: For noninvasive technologies in neo- natal care, I believe the implementa- tion of SpHb will lead to less expo- sure from blood transfusion, but also lead to more appropriate transfusion. In addition, I believe the implemen- tation of O3 in neonates will play a major role in helping clinicians avoid practices that can neg atively impact the developing brain. Dr. Denault: I hope to see more technologies that improve patient care become univer- sally adopted, just as pulse oximetry and bedside ultrasound have been. I also hope to see, eventually, more technology that is environmentally responsible and affordable. Dr. Ramsay: No patient should be categorized as a “Failure to Rescue.” This must be made a major quality issue and eliminated. Nearly every major event is preceded by a change in vital signs. Finally, more major surgery is being done in an outpatient setting and Masimo technology will enable home monitoring with the ability to wirelessly transmit to caregivers’ smart phones when anomalies are detected, and at a time when an intervention can be made.  1Chow L.C., Wright K.W., Sola A.; CSMC Oxygen Adminis- tration Study Group. Pediatrics. 2003 Feb;111(2):339-45. 20 21 Inno vation Ne ve r Stops   Rad iu s PPG At Masimo, innovation is a way of life. It drives us to think differently and pursue new ideas. That’s why, when I look at the list of 2019 product highlights, I’m incredibly proud of our achievements. They prove that our relentless drive for innovation is contributing to better patient care — both in the hospital and at home. Bilal Muhsin | Chief Operating Officer Tetherless Radius PPG pulse oximetry represents a significant breakthrough in patient monitoring, providing industry-leading Masimo SET® Measure-through Motion and Low Perfusion™ technology without a cabled connection to a monitor——allowing patients to move about freely and comfortably while remaining continuously and reliably monitored. Featuring a feather-weight sensor with an adjustable wrist strap, each Radius PPG single- patient-use sensor provides four days of battery life. Multiple sensor types are available to support a variety of patient populations. Designed to improve patient comfort and convenience while enhancing clinical workflows and efficiency, Radius PPG is suitable for use anywhere patients can benefit from mobility. 22 23  Halo ION  Do ct el la Halo ION aggregates trend data from multiple physio- logic parameters into a single, continuous score for each patient, configured according to hospital policy and dis- played and dynamically updated at Patient SafetyNet central view stations and on Replica mobile devices. By displaying the relative contribution of each parameter to the score, Halo ION provides a tool to help clinicians bet- ter assess possible causes of patient deterioration. Doctella is a secure, cloud-based patient engagement and remote home care automation platform. Using intu- itive, customizable CarePrograms, home device data ag- gregation, and a web-based provider dashboard, Doctel- la provides a complete end-to-end home care solution, allowing clinicians to create, relay, and manage treatment plans, patient schedules, and patient data flow. 24 25  Pathway ™  O3 Pathway, a newborn oxygenation visualization mode for Root, provides clinicians with a way to visualize a hospital’s recommended resuscitation protocol for a newborn’s oxygen saturation (SpO2) while continuously monitoring SpO2 and pulse rate (PR) during the first ten minutes after birth. Pathway is intended to help streamline clinician workflow and improve protocol adherence during this critical period. O3 Regional Oximetry is now indicated for use on neonatal patients in the U.S. With this expansion, the benefits of monitoring with O3 are now avail- able to patients of all ages in the U.S. and beyond. 26 27 W H A T P A T I E N T S A F E T Y M E A N S T O M E At the core of Masimo is a network of dedicated employees committed to enhancing patient safety. Their hard work and unwavering commitment drives us closer to reaching our goals every day. In honor of our 30th anni- versary, we asked employees at all lev- els of our organization to tell us what patient safety means to them and why they have dedicated their working lives to improving patient outcomes and reducing the cost of care. M I S S I O N S T A T E M E N T Improving patient outcomes and reducing the cost of care.® G U I D I N G P R I N C I P L E S Remain faithful to your promises and responsibilities. Thrive on fascination and accomplishment and not greed and power. Strive to make each year better than the year before, both personally and for the team. Make each day as fun as possible. Do what is best for patient care. Clockwise from top: Valery G. Telfort, Austin Pike, Julie Jin-Cesana, Michelle Hahn, Faisal Kashif, David Todd, and Crystal Wei. Not pictured: Elisa Mulet and Andrea Walters. 28 “I appreciate Masimo’s mission in par- ticular for its use of present progres- sive verbs, ‘improving’ and ‘reducing.’ This is a reminder that we aren’t solely focused on an end goal, but instead on continuously striving for an ideal. It’s the enduring effort that is im- portant to me.” A U S T I N P I K E Senior Mechanical Engineer “I feel a particularly strong connec- tion to two of our guiding princi- ples, ‘Do what is best for patient care’ and ‘Strive to make each year better than the year before, both personally and for the team.’ These principles align with my desire to make a positive impact on the lives of those in need. At Masimo, I have the opportunity, every day, to work toward our shared goal of enhanc- ing patient safety and improving patient outcomes, and that is deep- ly important to me.” C R Y S T A L W E I Senior Manager, Project Management “Every superhero fan knows the say- ing, ‘With great power comes great responsibility.’ At Masimo, we say, ‘Thrive on fascination and accom- plishment and not greed and pow- er.’ For me, this means that I must do what is best for patient care at all stages of the product development cycle by continuously calibrating our moral and ethical compass to safeguard inalienable human rights.” “Many people ask me, why Masimo? Throughout the 10 years that I have worked at Masimo, my answer re- mains the same: our commitment to improving healthcare and patient safety. I love working for an organi- zation where it is very clear that this mission drives all of us on a daily ba- sis. I want to ensure I do my part and leave healthcare in a better place for my family, friends, and loved ones. We all have someone who is impacted by healthcare. I am driven to do what is best for patients, who as we all know are ultimately some- one’s family.” M I C H E L L E H A H N Area Vice President, West, Sales “I want to know that when my co-workers, friends, and loved ones go to a hospital using Masimo, they will be monitored with the best technology money can buy. I know every single Masimo team member takes pride in their work and would not allow a low-quality product to leave the building.” E L I S A M U L E T Senior Legal Administrator “For me, patient safety means saving lives through developing innovative technology, upholding the highest standards, and delivering the best solutions for patient care. I share Masimo’s mission and value being part of a bigger cause and movement dedicated to improving patient care.” V A L E R Y G . T E L F O R T Vice President, Engineering J U L I E J I N - C E S A N A Vice President, Worldwide Tax “20 years ago, my father nearly lost his eyesight. Thanks to a new treat- ment, they were able to prolong his vision. It was at that point, when I saw how medical technology could make a difference, that I decided I wanted to be part of something that positively impacts the lives of pa- tients and their families, just as it had mine—–and that’s when I discovered Masimo. Masimo technology not only helps save lives and improve patient outcomes, every day, but it also makes a difference in the lives of patients’ loved ones, too.” A N D R E A W A L T E R S Area Vice President, Northeast, Sales “Patient safety means getting the best products and services into the hands of doctors who are respon- sible for saving the lives of people who may be going through the most difficult time of their lives. I believe that our products help doctors make better decisions based on trustworthy data.” D A V I D T O D D Senior Manager, IT Systems “I have always been strongly re- solved to contribute to patient care, and have made my career decisions based on this motivation, opting to use my background for advanc- ing noninvasive patient monitoring, which I find more meaningful than other applications of engineering. I believe that passion is the most im- portant factor in our pursuits, and I share Masimo’s passion for saving and improving people’s lives. These shared values make me proud to be a part of the Masimo family.” F A I S A L K A S H I F Director of Engineering 29 S E L E C T P A R T N E R S Integrating Masimo Technology into Leading Multi-parameter Monitors Masimo technologies are integrated into more than 200 third-party monitors from 90 leading brands. Masimo SET® is more often inte- grated than any other pulse oximetry technology. In addition, many of our original equipment manufacturer (OEM) partners are enhancing the capabilities of their monitoring solutions by integrating rainbow® measurements and other advanced Masimo technologies, including NomoLine capnography solutions. NomoLine® ISA™ Capno Module S E L E C T P A R T N E R S MX-7™ Low power rainbow® OEM board MSX™ Very low power SET® OEM board 30 31 DIGICAREA G L O B A L C I T I Z E N H E A D Q U A R T E R S Corporate Headquarters 52 Discovery Irvine, CA 92618, USA Tel: 949 297 7000 I N T E R N A T I O N A L O P E R A T I O N S International Headquarters Puits-Godet 10 2000 Neuchâtel Switzerland Tel: +41 32 720 1111 R & D C E N T E R S 52 Discovery Irvine, CA 92618, USA 25 Sagamore Park Rd, Hudson, NH 03051, USA 1021 West Hastings Street Unit 500 Vancouver, BC V6E 0C3, Canada 430 W. 5th St. #800 Panama City, FL 32401, USA Svärdvägen 15, 182 33 Danderyd, Sweden M A N U F A C T U R I N G C E N T E R S U .S . Manufacturing 15776 Laguna Canyon Rd, Irvine, CA 92618, USA Mexico Manufacturing Industrial Vallera De Mexicali, S.A. de C.V. Calzada Del Oro No. 2001 Modulo-6, Mexicali, 21395, Mexico Industrial Vallera de Mexicali S.A. de C.V. Calle José López Portillo, 104-A, Parque Industrial, Código Postal 83455, San Luis Rio Colorado, Sonora, Mexico Sweden Manufacturing Svärdvägen 15, 182 33 Danderyd, Sweden C O U N T R Y O F F I C E S Asia Pacific 31 Ubi Road 1, #04-05 Singapore 408694 Tel: +65-6521-6700 G L O B A L R E A C H As a global company, Masimo employs over 5,500 people worldwide and maintains operations in North America, Europe, Latin America, the Middle East, Asia, and Australia. Australia Suite 5.04, Level 5 Avaya House, 123 Epping Road North Ryde, NSW 2113, Australia Tel: 1300 627466 Austria Masimo Österreich GmbH Mariahilfer Straße 136 1150 Wien, Austria Tel: +43 (0)1 533 7361 Brazil Rua Gal. Fernando Vasconcellos Cavalcanti de Albuquerque, 80 Salas 402 e 404 Bloco A Cotia - SP, Brazil, 06711-020 Tel: + 55 11 3149 8181 Canada 1021 West Hastings Street Unit 500 Vancouver, BC V6E 0C3, Canada Tel: 1-888-336-0043 China Unit 4905, Office Tower of Raffles City, No. 268 Xizang Road(M), Huangpu District, Shanghai 200001 P.R.C. Tel: +86 (21) 6378 8998 Masimo’s mission and guiding principles ar- en’t restricted by borders; we are focused on ensuring global access to the technologies and health- care that we’d want for our own loved ones. We are proud of the customer relationships we have built and the patients we reached internationally in 2019, yet there are still five billion people in this world who don’t have access to safe surgery. In 2020, we will pursue all possible opportunities to do what is right for every pa- tient, everywhere, and to make a difference in all peoples’ lives. Patient safety, love, dignity, and respect for all is a goal we must never stop pursuing. Stacey Orsat | President, EMEA R&D Center Manufacturing Centers Country Offices Masimo Distributors Masimo OEM Partners Masimo Capnography OEMs Dubai DSO-DDP-Office-A4-401-407-408 Dubai Silicon Oasis Dubai – UAE Tel: +971 50 929 7 939 France Celtic Parc - Le Bois des Côtes 304 Route Nationale 6 69760 Limonest, France Tel: +33 (0) 4 72 17 93 70 Germany Niederlassung, Deutschland Lindberghstr 11, 82178 Puchheim, Germany Tel: +49 89 800 65 899-0 Hong Kong 22/F Unit 6, Tower 1, Millennium City 1 No. 388 Kwun Tong Road Kwun Tong, Kowloon, Hong Kong Tel: +852-2326-3011 India 1 Floor, Billor’s Pladium, No. 19/3 Cunningham Road, Bengaluru-560052, Karnataka, India Tel: +91 80 453 88888 Italy Via Domenico Scarlatti 30, 20124 Milano, Italy Tel: +39 02 4507 6308 Japan Shinjuku Front Tower, 24F2-21-1 Kitashinjuku, Shinjuku-ku, Tokyo, 169-0074, Japan Tel: +(81) 3-3868-5201 Korea Platinum Tower 2F, Seochodae-ro 398, Seochu-gu, Seoul, South Korea Tel: +82 2 597 4900 Latin America Paseo de la Reforma 404, Piso 6-602 Edificio Moncayo, Col. Juárez México, D.F. 06600, Delegación Cuauhtémoc Tel: +52 5511-2799 Netherlands Hart van Brabantlaan 12-14-16 5038 JL Tilburg, Netherlands Tel: +31 135 832 479 Poland Plac Kontytucji 5/17, 00-657 Warszawa, Poland Tel: +48 510 036 367 Saudi Arabia King Khalid Road, The Walk Unit no. 15 Riyadh, Kingdom of Saudi Arabia Tel +966 558 866 513 Spain Ronda de Poniente, 12 2F 28760 Tres Cantos, Madrid, Spain Tel: +34 91 8049734 Turkey Mustafa Kemal Mah. 2125. Sok Kolbay Is Merkezi C Blok No. 6/10 Cankaya / Ankara, Turkey Tel: +90 312 219 54 38 United Kingdom Matrix House, Basing View Basingstoke-Hampshire RG21 4DZ, U.K. Tel: +44 (0)1256 479988 T H I R D P A R T I E S Masimo Distributors Masimo OEMS Masimo Capnography OEMS 32 33 F I N A N C I A L P E R F O R M A N C E A S S E T S • L I A B I L I T I E S A N D S T O C K H O L D E R S ’ E Q U I T Y • R E V E N U E Condensed Consolidated Balance Sheets (unaudited, in thousands) A S S E T S Current assets Cash and cash equivalents Short-term investments Trade accounts receivable, net of allowance for doubtful accounts Inventories Other current assets Total current assets Lease receivable, non-current Deferred costs and other contract assets Property and equipment, net Intangible assets, net Goodwill Deferred tax assets Other non-current assets Total assets December 28, 2019 December 29, 2018 $567,687 120,000 132,433 115,871 60,071 996,062 49,936 16,214 219,552 27,251 22,350 35,972 28,791 $552,490 — 109,629 94,732 32,426 789,277 — 122,906 165,972 27,924 23,297 21,210 4,232 $1,396,128 $1,154,818 L I A B I L I T I E S A N D S T O C K H O L D E R S ’ E Q U I T Y December 28, 2019 December 29, 2018 Current liabilities Accounts payable Accrued compensation Deferred revenue and other contract-related liabilities, current Other current liabilities Total current liabilities Other non-current liabilities Total liabilities Commitments and contingencies Stockholders’ equity Preferred stock Common stock Treasury stock Additional paid-in capital Accumulated other comprehensive loss Retained earnings Total stockholders’ equity $54,548 54,705 25,939 37,027 172,219 56,035 228,254 — 54 (526,580) 600,624 (6,718) 1,100,494 1,167,874 $40,388 49,486 32,054 24,627 146,555 39,198 185,753 — 53 (489,026) 533,164 (6,199) 931,073 969,065 Total liabilities and stockholders’ equity $1,396,128 $1,154,818 Condensed Consolidated Statements of Operations (unaudited, in thousands, except per share amounts) R E V E N U E Product Royalty and other revenue Total revenue Cost of goods sold Gross profit Operating expenses: Selling, general, and administrative Research and development Litigation settlement, award and/or defense costs Total operating expenses Operating income Non-operating income Income before provision for income taxes Provision for income taxes Net income Net income per share: Basic Diluted Weighted-average shares used in per share calculations: Basic Diluted Year ended December 28, 2019 Year ended December 29, 2018 $936,408 1,429 937,837 308,665 629,172 314,661 93,295 — 407,956 221,216 12,950 234,166 37,950 $829,874 28,415 858,289 283,397 574,892 285,417 81,006 425 366,848 208,044 5,732 213,776 20,233 $196,216 $193,543 $3.67 $3.44 53,434 57,100 $3.70 $3.45 52,296 56,039 34 35 F I N A N C I A L P E R F O R M A N C E C A S H F L O W S Condensed Consolidated Statements of Cash Flows (unaudited, in thousands) Cash flows from operating activities: Net income Adjustments to reconcile net income to net cash provided by operating activities: Depreciation and amortization Stock-based compensation Loss on disposal of equipment, intangibles and other assets Provision (benefit) for doubtful accounts Benefit for amount due from former foreign agent Benefit from deferred income taxes Changes in operating assets and liabilities: (Increase) decrease in trade accounts receivable Increase in inventories (Increase) decrease in other current assets Increase in lease receivable, net Decrease (increase) in deferred costs and other contract assets (Increase) decrease in other non-current assets Increase in accounts payable Increase in accrued compensation Increase in deferred revenue and other contract-related liabilities Increase (decrease) in income taxes payable Increase in accrued liabilities Increase (decrease) in other non-current liabilities Net cash provided by operating activities Year ended December 28, 2019 Year ended December 29, 2018 $196,216 $193,543 23,487 39,233 357 687 — (5,965) (23,580) (21,257) (8,536) (11,958) 3,308 (226) 9,934 5,338 7,739 4,079 746 2,038 221,640 21,127 27,417 949 (439) (2,016) (8,274) 10,826 (1,885) 3,843 — (17,935) 407 5,211 10,195 1,420 (1,208) 3,923 (7,577) 239,527 Condensed Consolidated Statements of Cash Flows (unaudited, in thousands) Cash flows from investing activities: Purchases of short-term investments Purchases of property and equipment Increase in intangible assets (Purchases of) proceeds from strategic investments Business acquisition, net of cash acquired Net cash used in investing activities Cash flows from financing activities: Proceeds from issuance of common stock Repurchases of common stock Other Net cash provided by (used in) financing activities Effect of foreign currency exchange rates on cash Net increase in cash, cash equivalents and restricted cash Cash, cash equivalents and restricted cash at beginning of period Year ended December 28, 2019 Year ended December 29, 2018 (120,000) (68,375) (4,117) (5,189) — (197,681) 28,339 (37,555) (123) (9,339) 814 15,434 552,641 — (17,126) (5,557) 453 (3,922) (26,152) 44,748 (18,478) (490) 25,780 (1,997) 237,158 315,483 Cash, cash equivalents and restricted cash at end of period $568,075 $ 552,641 36 37 F O R W A R D – L O O K I N G S T A T E M E N T S All statements other than statements of historical facts management; product liability claims exposure; a included in this annual report that address activities, failure to obtain expected returns from the amount of events or developments that we expect, believe, or intangible assets we have recorded; the maintenance anticipate will or may occur in the future are forward- of our brand; the amount and type of equity awards looking statements. Forward-looking statements that we may grant to employees and service providers include statements which are predictive in nature, in the future; our ongoing litigation and related which depend upon or refer to future events or matters; and other factors discussed in the “Risk conditions, or which include words such as “expects,” Factors” section of our most recent periodic reports “anticipates,” “intends,” “plans,” “believes,” “estimates” filed with the Securities and Exchange Commission or the negative of these words or other similar terms (“SEC”), including our most recent Annual Report or expressions that concern our expectations, strategy, on Form 10-K, Quarterly Reports on Form 10-Q and plans or intentions. These forward-looking statements Current Reports on Form 8-K, all of which you may are based on management’s current expectations obtain for free on the SEC’s website at www.sec.gov. and beliefs and are subject to uncertainties and Although we believe that the expectations reflected factors, all of which are difficult to predict and many of in our forward-looking statements are reasonable, which are beyond our control and could cause actual we do not know whether our expectations will prove results to differ materially and adversely from those correct. You are cautioned not to place undue reliance described in the forward-looking statements. These on these forward-looking statements, which speak risks include, but are not limited to, those related only as of the date hereof, even if subsequently made to: our dependence on Masimo SET®, products and available by us on our website or otherwise. We do not technologies for substantially all of our revenue; any undertake any obligation to update, amend or clarify failure in protecting our intellectual property; exposure these forward-looking statements, whether as a result to competitors’ assertions of intellectual property of new information, future events or otherwise, except claims; the highly competitive nature of the markets as may be required under applicable securities laws. in which we sell our products and technologies; any failure to continue developing innovative products and technologies; the lack of acceptance of any of our NOTE REGARDING THIS ANNUAL REPORT Please note that this annual report does not constitute current or future products and technologies; obtaining our “annual report to security holders” for purposes of regulatory approval of our current and future products the requirements of the SEC. For a copy of our annual and technologies; the risk that the implementation report to security holders required under Rule 14a-3 of of our international realignment will not continue to Regulation 14A of the Securities Exchange Act of 1934, as produce anticipated operational and financial benefits, amended, please refer to our Annual Report on Form 10-K including a continued lower effective tax rate; the loss for the fiscal year ended December 28, 2019, which you of our customers; the failure to retain and recruit senior may obtain for free on the SEC‘s website at www.sec.gov. 38 M A S I M O • 5 2 D I S C O V E R Y • I R V I N E , C A 9 2 6 1 8 • T E L : 9 4 9 2 9 7 7 0 0 0 © 2020 Masimo, SET, rainbow, rainbow SET, RD SET, DCX, DeviceConX, Doctella, DST, Halo ION, HBox, Iris, Iris Analytics, Iris Gateway, ISA, iSirona, Masimo SafetyNet, Measure-through Motion and Low Perfusion, MST, MSX, MX-7, NomoLine, O3, Oxygen Reserve Index, ORi, Pathway, Pulse CO-Oximeter, PVi, Radius-PPG, Replica, Root, RRa, SedLine, Signal Extraction Technology, SpCO, SpHb, SpMet, SpOC, SST, UniView, VCX, VitalsConX, and Improving patient outcomes and reducing the cost of care are trademarks, registered trademarks, or service marks of Masimo Corporation. All other products, logos, or company names mentioned herein may be trademarks and/or registered trademarks of their respective companies. REGULATORY NOTICE Not all Masimo features and/or products included in this Annual Report are available in all markets . 61129/PLM-11616A-0320 

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