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ResMed

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FY2001 Annual Report · ResMed
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healthy
sleep

for a healthy

e
f
i
l

annual report 2001

Innovators in Sleep and Respiratory Medicine

ResMed's Mission Statement

Continue  global  leadership  in  sleep  medicine  based  on  innovative  technology  advancing  the  diagnosis,
treatment, and management of sleep-disordered breathing. 

Corporate Aims and Objectives

ResMed is a leading developer, manufacturer, and marketer of products for the diagnosis and management
of  sleep-disordered  breathing.  ResMed  operates  through  direct  offices  in  the  United  States,  the  United
Kingdom,  Switzerland,  Sweden,  Singapore,  New  Zealand,  Netherlands,  Malaysia,  Germany,  France,
Australia, and Austria and through a network of distributors in over 47 other countries. 

ResMed  is  committed  to  advancing  innovative  technology  in  sleep  and  respiratory  medicine  and
commercializing innovative products that incorporate these technologies on a global basis. In reaching its
goals, ResMed will at all times act ethically in dealing with both customers and employees. 

Contents

1 business overview

2 financial summary

4 2001 highlights

5 chairman’s report

11 strategic review

14 medical advisory board

19 operations review

23 shareholders’ information

24 ten-year financial summary

26 board of directors

Cover: healthy sleep for a healthy life

You  can’t  be  healthy  unless  your  sleep  is  healthy.  The  vital  role  that  sleep  plays  in  good  health  and
well-being is only now being recognized. Sleep is just as important as physical fitness and good nutrition.  

Statements contained in this Annual Report, which are not historical facts, including any projections regarding future opportunities in current and
new markets, are “forward-looking” statements as contemplated by the Private Securities Litigation Reform Act of 1995. Such forward-looking
statements  are  subject  to  risks  and  uncertainties,  which  could  cause  actual  results  to  differ  materially  from  those  projected  or  implied  in  the
forward-looking  statements.  Such  risks  and  uncertainties  are  more  fully  discussed  in  the  Company’s  Annual  Report  on  Form  10-K  for  its  most
recent fiscal year.

Sometimes I’d fall

asleep at work

Often I would

feel exhausted

business overview

1

ResMed  is  a  leading  developer,  manufacturer,  and
marketer of innovative products for diagnosing, treating,
and  managing  sleep-disordered  breathing  (SDB).    SDB
includes  obstructive  sleep  apnea  (OSA)  and  related
respiratory disorders that occur during sleep.

ResMed employs approximately 950 people in ten regions
and  distributes  to  over  60  countries.  In  fiscal  2001,
ResMed sales were $155 million, and operating cash flow
was  $30  million.  The  company  has  a  history  of  solid
financial  performance.  Since  listing  in  June  1995,
ResMed  has  met  or  exceeded  First  Call  Consensus
earnings per share estimates for 25 consecutive quarters
and has maintained a growth rate in excess of 30% per
annum in revenues and net income (excluding recent MAP
acquisition charges). 

Since formation in 1989, the company has maintained its
focus on the under-penetrated but strongly growing SDB
market. Led by a strong, experienced management team
and  Medical  Advisory  Board,  ResMed  has  undertaken  a
productive research and product development effort and
significant geographic expansion. These factors, together
with increased awareness of SDB as an important health
concern, have fueled the company's rapid growth. 

In  February  2001,  ResMed  acquired  MAP  Medizin-
Technologie  GmbH.  MAP  is  the  leading  German
designer, manufacturer, and distributor of medical devices
for the diagnosis and treatment of SDB, with a particular
focus  on  OSA.  This  acquisition  enhances  the  company's
position  in  Europe,  particularly  in  Germany,  the  second
largest market worldwide for OSA products.

The SDB market

The  market  for  SDB  therapies  is  large  and  relatively
undeveloped. In its "Wake Up America" report to Congress
in  1993,  the  National  Commission  on  Sleep  Disorders
Research  estimated  that  approximately  40  million
individuals  in  the  United  States  suffer  from  chronic
disorders of sleep and wakefulness, such as sleep apnea,
insomnia, and narcolepsy.

SDB  is  an  umbrella  term  that  encompasses  all
physiological processes that cause detrimental breathing
patterns  during  sleep.  Manifestations  of  SDB  include
OSA,  central  sleep  apnea  (CSA),  and  hypoventilation
syndromes  that  occur  during  sleep.  Hypoventilation
syndromes are generally associated with obesity, chronic
obstructive  pulmonary  disease  (COPD),  neuromuscular
disease, and upper airway resistance changes. 

Waking up to sleep

While  the  importance  of  good  nutrition  and  physical
fitness has long been recognized, the vital role that sleep
plays  in  good  health  is  only  now  being  acknowledged.
The consequences of SDB can severely affect health and
mortality, yet awareness among primary care physicians is
low.  As  a  result,  patients  often  find  themselves  receiving
treatment  for  other  conditions  when  the  cause  of  their
symptoms originates in their sleep.

Treating SDB as part of disease management in a range
of  diseases  is  of  primary  importance.  Several  recent
studies  have  shown  that  SDB  is  strongly  associated  with
hypertension, the leading risk factor for the development
of  both  stroke  and  congestive  heart  failure  (CHF).  In
addition,  over  60%  of  post-stroke  patients  and  50%  or
more of patients with CHF have SDB. 

The risk of developing hypertension,
a major risk factor for cardiovascular
and cerebrovascular disease, is two
to three times higher in patients 
with OSA.
Peppard et al. New England Journal 
of Medicine May 2000

financial summary

Net revenue

$M

Income

$M

*after MAP
acquisition costs of
$18.2M

Income from operations
Income before income taxes
Net income

3

Assets and shareholders’ equity

Net income per common share and equivalent

$M

$

#

Shareholders’ equity
Assets

#Gross assets include $61M of assets due to MAP acquisition. Shareholders’
equity is net of $18.2M of costs associated with MAP acquisition.

*after MAP
acquisition costs
of $18.2M

2001 highlights

August 2000
Listed by Fortune magazine as one of the 100 Fastest Growing Companies in the US for second consecutive year.

October 2000
Listed by Forbes magazine as one of the 200 Best Small Companies in America for fourth consecutive year. Ranked #34.

November 2000
ResMed Chairman Peter Farrell received AT&T International Business Leadership Award 2000 from the San Diego World
Trade Center. 

January 2001
Ranked #1 Medical Products Company by Investor's Business Daily.  
Embletta Portable Diagnostic System (PDS) introduced.

February 2001
Acquired MAP Medizin-Technologie GmbH, Munich, Germany. 

June 2001
Issued $180 million through private placement of convertible subordinated notes due 2006.

July 2001
Listed  by  Fortune  Small  Business magazine  as  one  of  America's  100  Fastest  Growing  Small  Business  Companies. 
Ranked #30.

August 2001
Listed by Business Week as one of the 100 Hottest-Growth Companies for the third consecutive year. Ranked #31.

Above: MAP executives Harald Vögele, Stefan Madaus, and Caspar Stauffenberg

5

chairman’s report

It is with distinct pleasure that I write the Chairman's report
for  fiscal  2001,  our  12th  year  of  operations.  We  had  a
great year in 2000. In fact we have had a great decade,
and  our  success  in  fiscal  2001  in  growing  our  sleep
business  as  profitably  as  we  did  should  provide
considerable encouragement to all ResMed shareholders
and staff as we go forward. The company grew 34% at the
top  line  to  finish  with  net  revenues  of  $155.2  million;
excluding  acquisitions  costs,  we  also  grew  34%  at  the
bottom  line  to  a  net  income  of  $29.9  million,  while
maintaining a gross margin of 67.5%. Earnings per share,
again  exclusive  of  acquisitions,  was  $0.89  on  a  fully-
diluted basis compared to $0.69 per share in fiscal 2000,
an increase of 29%. An excellent performance.

In addition, the ratio of net income to revenues at 19.3%
was virtually identical to the 19.2% we achieved in fiscal
2000. And, very encouragingly, we finished the year with
days  sales  outstanding  of  60  days,  due  primarily  to
increased efforts, which were focused on US receivables.
Several new products were also released during the year,
and one of the real success stories was our Ultra Mirage
nasal  mask  interface  which,  although  only  released  into
the  US  market  in  the  June  2000  quarter,  became  the
second  most  popular  medical  product  in  HomeCare's
catalog in terms of requests for literature and information.
In short, we had another excellent year, and once again 

I would like to acknowledge the dedication and teamwork
of  my  colleagues,  particularly  ResMed's  sales  and
marketing  executives  who  grew  their  respective  revenue
lines  as  well  as  they  did.  I  will  now  highlight  further
milestones and then address what I see, in the near-term
crystal ball, for sleep-disordered breathing (SDB).

One of the major commercial steps we took during fiscal
2001  was  the  purchase  of  MAP  Medizin-Technologie
GmbH (MAP), a private SDB company based in Munich,
Germany.  The  total  purchase  price,  including  legal,
accounting,  and  other  expenses  associated  with  the
transaction,  was  approximately  $70  million,  or  about
three times MAP's revenue base. The June 2001 quarter
was our first full quarter with MAP on board; our top-line
growth  was  an  impressive  49%,  quarter  on  year-ago
quarter; even without MAP our revenue growth was still an
impressive 31%, in line with our expectations.

We are very pleased with the MAP acquisition, which was
finalized  in  February  of  this  year;  we  are  meeting  our
goals to reduce expenses, particularly with the closure of
MAP's money-losing French operations, and we are also
meeting revenue growth expectations. One of the reasons
for  this  is  the  excellent  cooperation  of  MAP's  senior
management:    Dr  Stefan  Madaus,  Harald  Vogele,  and
Caspar Stauffenberg; we appreciate their support. In the

g o o d        

n u t r i t i o n

h e a l t h y
s l e e p

The triumvirate of health 
proposed by Dr. William C. Dement,

Director, Stanford Sleep Disorders Clinic and
Research Center, Stanford University, USA

p h y s i c a l

f i t n e s s

March  quarter,  we  wrote  off  $17.7  million  of  in-process
MAP R&D and took a restructuring charge of $0.6 million
to  close  MAP's  French  operation;  the  closure  was
completed  in  June  2001.  This  reduced  ResMed's  net
income  for  fiscal  2001  to  $11.6  million  or  $0.35  per
share on a fully diluted basis. 

In order to pay for MAP, and to provide funds for future
initiatives, we completed a $180 million convertible bond
issue,  including  $30  million  in  over-allotment.  The
offering was ably managed by Merrill Lynch and Deutsche
Bank  with  the  further  help  of  William  Blair  &  Co.,
Macquarie Bank, and UBS Warburg. The five-year bond
offering  was  keenly  priced  with  a  coupon  rate  of  4%,  a
three-year  makewhole  call  at  150%  of  the  conversion
price and a 20% share premium for the conversion price;
the  conversion  price  ended  up  at  $60.60  based  on  a
closing share price of $50.50, at the time of the offering.
Our goal was to place at least 50% of the bonds outside
the US market and to do it efficiently with minimal share
price impact. Our goals were more than met: the offering
was  completed  in  three  days  on  three  continents;  the
share price fell only 2% during the marketing phase; and
non-US placement was over 55%. The $30 million green
shoe was booked in July and is, therefore, not reflected in

the  accompanying  balance  sheet.  The  successful
convertible  bond  issue  allowed  us  to  pay  off  all  of  the
MAP  debt  and  has  left  us  with  close  to  $130  million  in
cash  and  marketable  securities  to  provide  us  with  on-
going financial flexibility.

For the past two years, I have referred to the triumvirate of
health proposed by Stanford's Dr. William C. Dement. At
the risk of sounding like a broken record, I emphasize its
importance once again. Sleep is equally important to our
physical  well-being  as  adequate  nutrition  and  physical
activity.  And  this  message  is  finally  being  heard.  At
the  University  of
Harvard  Medical  School  and 
Pennsylvania Medical School, separate divisions of sleep
medicine  have  been  set  up.  In  addition,  the  worldwide
public health concern with the level of untreated SDB, and
its major manifestation, obstructive sleep apnea (OSA), is
alive  but  perhaps  not  so  well;  the  rate  of  diagnosis  and
treatment  still  lags  incidence,  so  the  problem  is  getting
worse rather than better. Even without a full-court press,
the  global  market  is  growing  at  around  20%;  however,
this growth in treatment initiation is nowhere near enough
to deal with an issue which was described over eight years
ago in a New England Journal of Medicine editorial (April,
1993)  as  a  major  public  health  problem  on  a  level

Michael Massie, age 42, was already suffering from high blood
pressure and a stress related illness when he had a stroke in July
1999.  He  spent  the  following  year  in  a  rehabilitation  ward
learning how to walk, talk, and look after himself.

Night staff in the ward observed that Michael snored loudly and
stopped  breathing  for  long  periods  of  time  while  asleep.  He
would  wake  suddenly  with  a  fright  and  on  occasion  became
agitated.  During  the  day,  he  was  very  sleepy  and  reluctant  to
take part in therapy.

At the time, research into sleep apnea was being undertaken in
the  ward.  Michael  was  diagnosed  with  OSA  and  started  on  a
ResMed AutoSet T while hospitalized. His drowsiness decreased
significantly,  and  he  was  more  able  to  engage  in  his
rehabilitation therapy.

Michael's health is now stable, and he lives at home with family
and community support.

equivalent to that of tobacco smoking. So what needs to
be done? As I have stated before, the major problem is
still one of raising public and physician awareness to the
dangers  of  untreated  SDB  because  of  its  profound
connection  with  hypertension,  the  concomitant  risk  of
premature death, and the deleterious impact of untreated
SDB on quality of life.

The number one risk factor for both stroke and congestive
heart  failure  (CHF)  is  hypertension.  And  it  is  well  to
remember that heart disease is the number one killer and
the third most important cause of morbidity, while stroke
is the number three cause of death and the number one
cause of morbidity. Given these statistics, and the fact that
SDB  has  been  variously  estimated  as  being  prevalent  in
50% to 80% of CHF and stroke sufferers, it is a sine qua
non that these patients be diagnosed and treated for their
SDB.  This  is  not  only  because  of  the  stated  impact  of
untreated  SDB  on  quality  of  life,  but  because  of  the
serious cardiovascular consequences of having combined
SDB  and  hypertension  coupled  with  a  serious  co-
morbidity, such as stroke or CHF. The latter circumstances
will  almost  certainly  result  in  an  early  exit  from  life's
freeway  for  these  patients.  It  is,  therefore,  vital  that  the
medical  community  (particularly  stroke  neurologists,

7

Michael Massie
stroke victim, Australia

cardiologists, and rehabilitation physicians) be alerted to
the  issue  of  untreated  SDB  and  its  grossly  deleterious
consequences. I will come back to this theme.

it 

is 

that  patients  with
imperative 
Furthermore, 
neuromuscular  and  motor  neurone  diseases  as  well  as
chronic  obstructive  pulmonary  disease  (COPD)  also  be
tested  for  SDB/OSA.  Specifically,  patients  with  COPD,
muscular dystrophy, kyphoscoliosis, multiple sclerosis, and
amyotrophic  lateral  sclerosis  (ALS)  often  have  horrific
sleep architecture, due to both their disease and the fact
that  a  lot  of  them  have  concomitant  SDB;  the  diagnosis
of  the  latter  is  hugely  important  to  both  the  morbidity
and  mortality  of  people  with  these  disease  states.
Unfortunately,  the  progress  being  made  in  addressing
these  problems  is  way  too  gradual,  but  the  medical
literature  is  beginning  to  alert  the  wider  medical
community to the importance of the issue.

We  continue  to  make  excellent  progress  with  respect  to
both  CHF  and  stroke  and  the  clinical  connection  with
SDB. Oxford has just completed a randomized controlled
trial (RCT) of 30 patients treated with ResMed's AutoSet CS
against  sham  treatment.  We  eagerly  await  their  results.
And  in  another  large  RCT,  shortly  to  be  published  in 

Walter Pfeffer
heart failure patient, Germany

Eighteen years ago, heart illness forced 50-year-old Walter to retire from his job
because he could no longer cope with the physical demands. Then a few years
ago he started to suffer from severe fatigue during the day, which finally made
it impossible for him even to chat with friends without repeatedly and abruptly
falling  fast  asleep.  Having  less  and  less  energy  and  motivation,  increased
problems  concentrating,  and  cognitive  difficulties  as  well,  he  became
increasingly  reclusive.  He  completely  abandoned  his  hobbies  and  no  longer
went on holiday.

About one year ago Walter went to see a doctor about his heart condition and
was assessed for sleep disorders for the first time. The study revealed that he
suffered from Cheyne-Stokes respiration during sleep.

Walter started therapy using ResMed's AutoSet CS, which rapidly improved his
quality of life. The fatigue symptoms during the day improved dramatically and
his general state of health stabilized so much that in recent months Walter has
been  able  to  take  part  in  light  recreational  sports  again  and  has  already
planned his next holiday.

The Lancet, the Oxford group has shown that nasal CPAP
significantly lowers blood pressure, in an intention to treat
study,  and  the  effect  was  even  more  pronounced  when
subjects were on antihypertensive therapy. In addition, we
now  have  over  150  CHF  patients  on  AutoSet  CS  in
Europe.  We  continue  to  learn  as  we  initiate  further
treatment  of  CHF  patients  with  AutoSet  CS.  Very
encouraging  sets  of  results  have  been  obtained  in
Germany on small numbers of patients. For example, over
three to six months in compliant CHF patients, it has been
observed  that  maximum  oxygen  uptake,  six  minute  walk
and  left  ventricular  ejection  fractions  have  significantly
improved,  in  some  cases  by  in  excess  of  30%.  We  look
forward  to  receiving  further  feedback  as  these  studies
progress. In addition, we have begun a prospective FDA
trial  on  CHF  patients  using  AutoSet  CS,  compared  with
conventional oxygen therapy, at six sites across the US. It
is early days, but we remain optimistic about the potential. 

On  the  stroke  front  progress  continues,  albeit  at  a
somewhat  slow  pace.  There  is  certainly  interest  by
neurologists in the SDB space; for example, ResMed, in its
relationship  with  the  US  National  Stroke  Association
(NSA), sponsored a two-hour seminar on SDB and stroke
at  the  annual  NSA  meeting  held  last  September  in

Toronto. Nearly 6% of the total neurologists in the United
States  attended  this  session;  we  are  running  a  similar
seminar this August at the annual NSA meeting to be held
in  San  Diego.  We  expect  even  more  interest  by  stroke
neurologists in SDB, and it is our hope that there will soon
be a subsequent substantial increase in both the diagnosis
and  treatment  of  SDB  in  stroke  patients.  What  we  have
learned thus far is that treating patients in the acute phase
of stroke is difficult and it seems as though diagnosis and
treatment in the rehabilitation phase may make the most
sense,  at  least  in  this  initial  phase  of  our  work.  At  the
moment we are actively working on some strategic alliances
to address this problem. 

What we can say is that the data we have seen thus far
suggests  that  the  best  current  basis  for  the  treatment  of
SDB/OSA  in  both  stroke  and  CHF  is  with  ResMed's
devices.  These  products  incorporate  our  patented
autotitrating  algorithms  (in  AutoSet  T  and  AutoSet  CS)
coupled with ResMed's mask interfaces. Furthermore, it is
important  to  recognize  that  very  sick  patients  cannot  be
easily handled by conventional sleep labs, either patients
can't  be  easily  moved  from  the  ward  or  rehabilitation
facility to a sleep lab, or the sleep lab is not capable of
dealing  with  patients  with  such  co-morbidities.  In  short,

9

As a cardiologist, I know the importance of
aggressive treatment of sleep apnea. And as
a patient, I know the difficulty in maximizing 
patient compliance due to uncomfortable masks,
loud machines, and unnecessarily high pressures.
I have tried many CPAP machines, and the ResMed
AutoSet T is simply the "Lexus of the line": it is 
quiet, comfortable, and easy to use. I recommend
it to my patients.
AD,  Cardiologist, Michigan, US

This is certainly one area where it is high time to wake up
to sleep.

One  of  the  real  challenges  I  alluded  to  was  the
unfortunate ignorance in the wider community concerning
the  importance  of  diagnosing  and  treating  SDB.  The
major continuing issue here is one of education. However,
when  the  horses  of  SDB  finally  bolt  from  the  barn,  as  is
widely  expected,  the  sleep  community  runs  the  risk  of
being virtually overwhelmed by SDB patients. What is to
be done? There's no question that current sleep labs will
be  buried  under  the  increased  diagnostic  load,  since
many sleep centers currently have long waitlists. It would
seem  that  the  paradigm  needs  to  drastically  change  to
address  the  overwhelming  prevalence  and  incidence  of
SDB.  Legitimate  concerns  have  been  raised  about  the
specificity and sensitivity of home sleep diagnostic testing.
I believe that these concerns are currently minor ones for
two  reasons.  First,  technology  has  evolved  to  the  point
where  the  concerns  of  specificity  and  sensitivity  are
probably  more  imaginary  than  real;  second,  much
cheaper and less sophisticated diagnostic technology can
be  used  when  a  sleep  physician  is  involved  in  the
equation,  since  trained  sleep  physicians  take  a  sleep
history  and  use  their  clinical  judgement  in  conjunction
with the diagnostic sleep test. On top of this, the use of
nasal CPAP for SDB is extraordinarily effective and does
little harm if there were to be some unlikely false positives,
assuming  sleep-trained  personnel  remain  involved.  In
short, in this instance diagnostic certainty is not needed.
In  this  context,  let  me  refer  to  a  very  apropos editorial,
which  Dr.  Michael  Coppola,  a  member  of  ResMed's

Embletta portable diagnostic system

the  sleep  lab  needs  to  be  taken  to  the  bedside.  In  this
case, our portable sleep lab is Flaga's Embletta PDS. This
device is a highly specific and sensitive nine-channel sleep
diagnostic  system  with  excellent  software  (Somnologica
3.0) and great portability. We look forward to progressing
our global stroke and CHF initiatives.

Another  area  of  great  concern,  which  was  recently
highlighted  in  the  British  medical  journal  Thorax,  is  the
danger of serious motor vehicle accidents in patients with
undiagnosed  OSA.  There  are  now  several  dozen
publications  in  the  peer-reviewed  literature  emphasizing
the  severe  dangers  of  individuals  who  drive  while  sleep
deprived from untreated sleep apnea. There is little doubt
that  this  is  a  major  public  health  issue;  data  in  the
literature indicate that the frequency of traffic accidents in
untreated  sleep  apnea  sufferers  varies  from  a  factor  of
three to 12 times the normal accident rate, depending upon
the study. The good news is that when the apnea is treated
successfully with nasal continuous positive airway pressure
(CPAP),  the  frequency  of  traffic  accidents,  in  compliant
OSA  sufferers,  is  completely  normalized.  Insurers  and
motor  vehicle  authorities,  among  others,  need  to  start
seriously  addressing  the  carnage  and  the  cost  on  the
nations' roads due to unrecognized sleep apnea sufferers. 

be  the  overseer  of  home-based  studies;  certainly  the
engagement of sleep labs in home testing would go a long
way to addressing such a serious public health challenge.

ResMed  is  now  approaching  1000  employees.  Almost
50% of this year's additional staff was the 180 employees
we  gained  from  our  MAP  acquisition;  the  rest  of  the
additions  were  to  handle  our  continuing  growth  in  all
global  markets.  We  have  added  four  further  record
quarters  during  the  last  fiscal  year  so  that  ResMed  has
now managed a run of 25 quarters of record revenue and
net  income  since  we  went  public  in  June  1995.  This
welcome  performance  was  due  to  the  efforts  of  all
employees;  we  welcome  the  new  additions  and  thank
both  our  new  and  old  staff  for  their  commitment  and
teamwork.  I  would  also  like  to  thank  members  of  the
Board of Directors for their input and support. 

The Board was also delighted to welcome Dr. Christopher
Bartlett,  Professor  of  Business  Administration  at  Harvard
Business  School.  Chris  is  already  making  his  Board
presence felt in terms of helping the company address its
strategic organizational needs as ResMed's global growth
continues. Significant thanks are also due to our Medical
Advisory Board whose input continues to be highly valued
and regarded.

Once more ResMed was named by Forbes as one of the
200  Best  Small  Companies  in  America;  in  addition,
ResMed was named by both Business Week, for the third
consecutive  year,  and  Fortune  Small  Business in  their
respective top 100 high growth business performers lists.
We welcome this continuing recognition.

Finally,  I  would  like  to  thank  our  shareholders  for  their
support  during  this  past  fiscal  year.  We  continue  to
examine a number of strategic growth opportunities where
we believe our particular knowledge of sleep-disordered
breathing could add significant value.

We  will  also  continue  to  try  to  wake  people  up  to  the
importance of healthy sleep. It is our ongoing mission.

Medical  Advisory  Board,  alerted  me  to  earlier  this  year
and which was published in the New England Journal of
Medicine and  authored  by  Dr.  Jerome  Kassirer  (NEJM
320, 1489 (1989)). Let me quote Dr. Kassirer:

Excessive testing has many causes, besides the quest for
diagnostic  certainty.  Some  are  a  function  of  the  forces
imposed  on  the  physician  by  our  system  of  patient
care–for example, pressure from peers and supervisors,
the  convenience  with  which  tests  are  ordered,  the
demands of the patient or family, and the desire to avoid
malpractice  claims.  Others  stem  from  physicians'
personal  practices  and  whims–among  them,  curiosity
about  test  results,  ignorance  of  the  characteristics  of
tests, financial motives, and irrational and ossified habits.

Kassirer continued:

therapy 

is  high 

How should we handle uncertainty?  To a large degree,
the  level  of  diagnostic  certainty  needed  in  decision-
making  is  a  function  of  the  characteristics  of  available
therapies.  When  a  specific 
in
effectiveness and low in risk, one can tolerate substantial
diagnostic  uncertainty  (and  therefore  avoid  having  to
carry  out  many  tests)–not  only  because  the  treatment
cures  the  disease,  but  also  because  it  will  cause  little
harm  to  patients  who  do  not  have  the  disease.  By
contrast,  any  therapy  that  is  not  highly  effective  or  that
produces  considerable  morbidity  must  be  given  only
when the level of diagnostic uncertainty is minimal.

Dr Kassirer makes points that we believe the wider sleep
community  needs  to  consider  in  the  context  of
undiagnosed  SDB/OSA  being  a  major  public  health
problem  that  is  not  being  adequately  addressed  by  the
current  modus  operandi.  In  short,  how  one  should
address a disease with a prevalence of almost 10% of the
population  is  a  very  thorny  issue  deserving  of  serious
debate. However, there is movement at the station. Todd
Eiken, RPSGT, a sleep technologist who oversees a sleep
center in Minnesota, is an advocate of home sleep studies
done  under  the  auspices  of  the  sleep  lab;  he  had
previously  started  a  home  sleep-monitoring  program
when  he  worked  for  a  sleep  center  in  Alabama.  His
concern  is  that  sleep  labs  can't  possibly  handle  the
needed  load  in  the  time  available  and  that  labs  should
take the initiative on home sleep testing. To quote him:

The  sleep  community  as  a  whole  should  be  the
innovators and determine how home sleep testing should
be used; there are benefits for everyone.

It seems logical that home testing will occur and it should be
overseen by sleep-trained personnel. The sleep lab ought to

strategic review

ResMed’s S6 CPAP device
and Ultra Mirage Mask

positive airway pressure therapy. At June 30, ResMed had
over  400  patents  granted  or  pending  and  over  100
registered designs worldwide. Up to 8% of revenues have
been invested in research and development. 

Expand  geographic  presence. ResMed  sells  its
products  in  over  60  countries  to  sleep  clinics,  home
healthcare dealers, and third-party payers. The company
intends  to  increase  sales  and  marketing  efforts  in  its
principal  markets  as  well  as  expand  its  presence  in  new
geographic regions. 

78% of long-distance truck drivers
have Obstructive Sleep Apnea.
Stoohs et al. Chest May 1995

Increase  public  and  clinical  awareness. ResMed
intends to continue the expansion of promotional activities
to increase awareness of SDB. These promotional activities
target the population with a predisposition to SDB as well
as  primary  care  physicians  and  specialists,  such  as
pulmonologists, cardiologists, and neurologists. In addition,
the  company  also  targets  patient  advocacy  groups,
including  the  US  National  Sleep  Foundation,  the  US

People with sleep apnea are 15 times more
likely to be involved in a traffic accident.
Horstmann et al. Sleep 2000

ResMed  believes  that  the  SDB  market  will  continue  to
grow  due  to  a  number  of  factors.  These  factors  include
increasing  awareness  of  OSA  and  improved  under-
standing of the role of SDB treatment in the management
of  cardiovascular  disease.  Areas  of  focus  within
cardiovascular disease include hypertension, stroke, and
congestive  heart  failure.  The  company's  strategy  for
expanding  business  operations  and  capitalizing  on  the
growth  of  the  SDB  market  consists  of  the  following
key elements.

to  ongoing 

is  committed 

Continue  product  development  and  innovation.
ResMed 
in
developing  products  for  the  diagnosis  and  treatment  of
SDB.  The  company  has  been  a  leading  innovator  of
products designed to more effectively treat sleep apnea,
increase patient comfort, and encourage compliance with

innovation 

13

Susana Lopez puts the finishing
touches to a ResMed S6 CPAP

ResMed's acquisition of MAP, the market leader in Germany,
has  deepened  the  company's  presence  in  Europe.  The
combination  of  MAP  and  ResMed  Germany  makes
ResMed the largest sleep company in Germany, which has
the  second  largest  SDB  market  in  the  world.    MAP's
strengths  in  research  and  development,  sales  and
marketing,  and  local  distribution  complement  those 
of  ResMed  and  will  strengthen  ResMed's  market
leadership position throughout Europe. The acquisition of
MAP  represents  a  significant  step  forward  in  ResMed's
global strategy.

National  Stroke  Association, 
the  American  Heart
Association, and the Australian National Stroke Foundation.

Expand  into  new  clinical  applications. ResMed
continually  seeks  to  identify  new  applications  of  its
technology  for  significant  unmet  medical  needs.  The
relations  with
company  maintains  close  working 
prominent physicians to assist this process.

Leverage  the  experience  of  our  management
team and Medical Advisory Board. ResMed's senior
management team has extensive experience in the field of
SDB  and  in  the  medical  device  industry  in  general.  The
Medical Advisory Board is comprised of experts in the field
of SDB, including Dr. Colin Sullivan, the inventor of nasal
CPAP  for  the  treatment  of  OSA.  ResMed  intends  to
continue leveraging the experience and expertise of these
individuals,  maintaining  its  innovative  approach  to
developing  products,  and  increasing  awareness  of  the
serious medical problems caused by untreated SDB.

Innovation, application, awareness, and
presence in 2001

In  fiscal  2001,  ResMed  focused  significant  attention  on
increasing  its  presence  in  Europe  and  expanding  its
presence in the SDB market around the world.

medical advisory board

Terence M. Davidson,
MD, FACS, is Professor of
Surgery in the Division of
Otolaryngology–Head
and Neck Surgery at the
University of California,
San Diego, School of
Medicine. He is Section
Chief of Head and Neck
Surgery at the Veterans
Administration, San
Diego Healthcare 
System and Associate
Dean for Continuing
Medical Education at 
the University of
California San Diego. 
He is also Director of the
UCSD Head and Neck
Surgery Sleep Clinic in 
La Jolla, CA.

Neil J. Douglas,
MD, FRCP, is Professor of
Respiratory and Sleep
Medicine, University of
Edinburgh, an Honorary
Consultant Physician,
Royal Infirmary of
Edinburgh, and Director
of the Scottish National
Sleep Laboratory. He is
Vice President of the
Royal College of
Physicians of Edinburgh
and Chairman of the
British Sleep Foundation.
He is a past Chairman of
the British Sleep Society
and past Secretary of the
British Thoracic Society.
He has published over
200 papers on breathing
during sleep.

Nicholas Hill,
MD, is Professor of
Medicine at Brown
University and Director
of Critical Care Services
at Rhode Island Hospital
and Pulmonary Medicine
at the Miriam Hospital,
both in Providence. He is
a Fellow of the American
College of Chest
Physicians and a member
of the Planning
Committee for the
American Thoracic
Society. His main
research interests are in
the acute and chronic
applications of non-
invasive positive pressure
ventilation for treating
lung disease.

Claudio Bassetti,
MD, is a leader in
studying the implications
of SDB on stroke and is
Head of the Neurology
Clinic and Vice-
Chairman of the
Neurology Department at
the University Hospital,
Zurich. Dr. Bassetti is a
member of the American
Academy of Neurology,
the American Sleep
Disorders Association,
and the scientific
committee of the
European Sleep Research
Society (ESRS). He is also
a member of several
Swiss medical boards
and sits on the editorial
boards of Sleep
Medicine, European
Neurology, and Swiss
Archives of Neurology
and Psychiatry. He has
produced over 100
publications.
(photo not available)

Michael Coppola,
MD, is a leading
pulmonary, critical care
and sleep disorders
physician in private
practice in Massachusetts.
He is an attending
physician at Baystate
Medical Center and
Mercy Hospital in
Springfield, MA, and a
Fellow of the American
College of Chest
Physicians. He is
Chairman of the
Massachusetts Sleep
Breathing Disorders
Society. He is also the
Medical Director of
Winmar Diagnostics, a
sleep-disordered
breathing specialty
company, and Associate
Clinical Professor of
Medicine at Tufts
University School of
Medicine.

15

Barry J. Make,
MD, is Director,
Emphysema Center
and Pulmonary
Rehabilitation National
Jewish Medical and
Research Center and
Professor of Pulmonary
Sciences and Critical
Care Medicine of the
University of Colorado
School of Medicine. He
has served on
numerous national and
international
committees for
respiratory and
cardiovascular
diseases. His research
and clinical work has
resulted in a large
number of publications
on mechanisms,
treatment, and
rehabilitation of chronic
respiratory disease.
(photo not available)

Colin Sullivan,
MD, PhD, FRACP, FAA is
Chairman of the MAB
and inventor of nasal
CPAP for the treatment
of OSA. He is Professor
of Medicine and
Director of the David
Read Research
Laboratory and
Australian Centre for
Advanced Medical
Technology at the
Sydney University
Medical School. He
established the Centre
for Respiratory Failure
and Sleep Disorders at
the Royal Prince Alfred
Hospital, the Pediatric
Sleep laboratories at the
New Children's Hospital,
and Sydney Children's
Hospital. Dr. Sullivan is
a Fellow of the Royal
Australian College of
Physicians and
Australian Academy of
Science. He has
continued to contribute
to ResMed's innovation,
product development,
and clinical testing.

J. Woodrow Weiss,
MD, is Associate
Professor of Medicine
and Co-Chairman of
the Division of Sleep
Medicine at Harvard
Medical School as well
as Chief, Pulmonary &
Critical Care Medicine,
Beth Israel Deaconess
Medical Center, Boston
MA. Dr. Weiss is an
internationally
recognized researcher
in sleep disorders
medicine.

Helmut Teschler,
MD, is Associate
Professor and Head of
the Department of
Respiratory Medicine
and Sleep Medicine,
Ruhrlandklinik, Medical
Faculty, University of
Essen, Germany. He is
a Fellow of each of the
following Associations:
German Pneumology
Society, American
Thoracic Society,
European Respiratory
Society, and American
Sleep Disorders
Association. He is an
internationally
recognized researcher
in respiratory medicine
and sleep disorders
medicine.

B. Tucker Woodson,
MD, FACS, is Associate
Professor of
Otolaryngology and
Communication
Sciences at the Medical
College of Wisconsin,
a Diplomat of the
American Academy of
Sleep Medicine, and a
Fellow of the American
Academy of
Otolaryngology–Head
and Neck Surgery and
the American College
of Surgeons. Dr.
Woodson is the
Director of the Medical
College of
Wisconsin/Froedert
Memorial Lutheran
Hospital Center for
Sleep.  He also sits on
multiple committees for
the American Academy
of Sleep Medicine and
American Academy of
Otolaryngology.

1 
Normally during sleep
the muscles that
control the tongue and
soft palate, hold the
airway open.

3 
If these muscles relax too
much, the airway can
become blocked, 
preventing breathing.

This is an obstructive apnea.

2 
If these muscles relax, the
airway narrows, causing
snoring and breathing
difficulties.

SDB explained

Obstructive sleep apnea (OSA). The upper airway has
no rigid support and is held open by active contraction of
upper airway muscles. Normally during deep sleep, these
muscles relax and the upper airway narrows slightly. People
with narrow upper airways and poor muscle tone, however,
are  prone  to  temporary  upper  airway  collapses  during
sleep.  A complete collapse is called an obstructive apnea,
and  a  partial  obstruction  is  referred  to  as  a  hypopnea.
These  breathing  irregularities  result  in  lowering  of  blood
oxygen concentration, causing the central nervous system
to react to the lack of oxygen or increased carbon dioxide
and  signal  the  body  to  respond.  Typically,  the  individual
subconsciously  arouses  from  sleep,  opening  the  upper
airway.  After  a  few  gasping  breaths,  the  individual  slips
back into sleep, and the process begins again.

Sleep  fragmentation  and  the  loss  of  the  deeper  levels  of
sleep  caused  by  OSA  can  lead  to  excessive  daytime
sleepiness, reduced cognitive function (including memory
loss and lack of concentration), depression, and irritability.
OSA sufferers also experience increases in heart rate and
elevations of blood pressure. Several studies indicate that
the oxygen desaturation, increased heart rate, and elevated

blood  pressure  caused  by  OSA  may  be  associated  with
increased  risk  of  cardiovascular  morbidity  and  mortality
due to angina, stroke, and heart attack.  Patients with OSA
have been shown to have impaired daytime performance
in  a  variety  of  cognitive  functions,  including  problem
solving,  response  speed,  and  visual  motor  coordination.
Studies have also linked OSA to increased occurrence of
traffic and workplace accidents.

Generally,  an  individual  seeking  treatment  for  the
symptoms of OSA is referred by a general practitioner to
a specialist for further evaluation.  The diagnosis of OSA
typically  involves  monitoring  the  patient  during  sleep.
During  the  testing,  the  respiratory  parameters  and  sleep
patterns are monitored along with other vital signs such as
blood  pressure,  heart  rate,  and  blood  oxygen  levels.
These  tests  allow  sleep  clinicians  to  detect  any  sleep
disturbances  such  as  apneas,  hypopneas,  or  sub-
conscious awakenings.  

The number of sleep clinics in the US alone has expanded
from 100 in 1985 to over 2000 today. Almost 10% of the
general  adult  population  suffers  from  sleep  disorders.
Despite  the  high  prevalence,  very  few  of  those  affected
have been clinically diagnosed.  Healthcare professionals
are  often  unable  to  diagnose  OSA  because  they  are
unaware  that  such  non-specific  symptoms  as  fatigue,
snoring, and irritability are characteristic of OSA.

17

Lynn Sawyer
obstructive sleep apnea patient, Australia

Sixty-three-year-old  Lynn  Sawyer  only  discovered  he  had  sleep  apnea  two
months  ago  after  telling  his  cardiologist  how  tired  and  washed  out  he  was
feeling. Even after heart surgery, Lynn knew things were not right. A very active
man all his life, Lynn was extremely tired all the time.  Often he couldn’t even
stay awake at the dinner table. After a quick trip down the corridor from the
cardiologist’s rooms to the sleep physician, Lynn’s life changed for the better.
He was diagnosed with obstructive sleep apnea.

“I  spent  a  night  in  a  sleep  laboratory,  hooked  up  with  leads  and  wires.  The
physician showed me two graphs of my sleep that demonstrated clearly how
many times I was waking up throughout the night.

“He then sent me back to the sleep lab for a second night, this time on a CPAP
machine. The difference was amazing!  I literally leapt out of bed. I could feel
the difference immediately.

“Now I’m a new man. I bounce out of bed. I feel great and have more energy
and stamina,” says Lynn.

While  OSA  has  been  diagnosed  in  a  broad  cross-
section  of  the  population,  it  seems  predominant
among  obese,  middle-aged  men  and  those  who
smoke,  consume  alcohol  in  excess,  or  use  muscle-
relaxing drugs.  In addition, patients being treated for
certain other conditions, including those undergoing
dialysis treatment or suffering from diabetes, may be
medically predisposed to OSA.

The risk of motor vehicle crashes due
to OSA is removed when patients are
treated with CPAP.
C. F. George. Thorax 2001

Positive  airway  pressure  therapy  for  OSA
patients.  Continuous  positive  airway  pressure
(CPAP)  provides  a  non-invasive  means  of  treating
OSA.  Dr. Colin Sullivan, the Chairman of ResMed's
Medical Advisory Board, invented nasal CPAP as a
treatment for OSA in 1980.  Today, use of CPAP is
generally  acknowledged  as  the  most  effective  and
least invasive therapy for managing OSA.  

During CPAP treatment, a patient sleeps with a nasal
or  full  face  mask  connected  to  a  small,  portable
airflow  generator  that  delivers  room  air  at  a

continuous  positive  pressure.  The  flow  generator
supplies  just  enough  positive  air  pressure  to  prevent
the  upper  airway  from  collapsing.  Positive  airway
pressure applied in this manner acts like an "air splint"
to keep the upper airway open and unobstructed.

ResMed's  S6  range  of  CPAP  systems  has  three
models  to  suit  different  patient  needs  and  is
renowned for its small, elegant casing, extremely low
noise, light weight, and exceptional reliability.

Positive airway pressure therapy and SDB in
stroke  patients.  Positive  airway  pressure  therapy
has evolved in recent years with the introduction of
ResMed's AutoSet T. AutoSet T automatically adjusts
the amount of pressure to suit the patient’s needs as
they  vary  throughout  the  night  due  to  sleep  stage
and  body  position.  This  form  of  customized
treatment delivers lower mean pressures and is more
comfortable  than  conventional  CPAP.  AutoSet T
adapts to patients' needs as they vary from one night
to the next over time. This means AutoSet T can be
considered appropriate for treating SDB in patients
who  undergo  dynamic  changes  in  the  severity  of
their OSA over time.

AutoSet T technology enables continuous tailoring of
treatment and logging of clinical data so that patients

need  not  undergo  additional  titration  studies  as  their
pressure requirements change. Clinicians can gather 200
days of compliance data and 30 days of efficacy data to
monitor and help patients through rehabilitation.  ResMed
has commenced trials for diagnosis and treatment of OSA
in  stroke  and  congestive  heart  failure  patients  with  the
AutoSet T at a limited number of key sites around the world.
Moving forward, ResMed intends to further investigate the
presence of SDB in patients with hypertension, stroke, and
congestive heart failure.

Over 60% of stroke patients have SDB.
Bassetti et al. Sleep 1999

Positive airway pressure therapy for CHF patients.
Around 60% of patients with congestive heart failure (CHF)
have  SDB.  Of  these,  36%  manifest  a  serious  condition
known as Cheyne-Stokes respiration (CSR), 12% manifest
OSA, and the rest manifest a combination of central and
obstructive  abnormal  breathing  (Lipkin  et  al.  Lancet Aug
1999).  With  CSR,  also  known  as  periodic  breathing,  the
patient's  breathing  continuously  cycles  between  under-
breathing (may stop altogether) and over-breathing.

ResMed's new AutoSet CS (not available for sale in the US,
but  currently  undergoing  FDA  trials)  is  an  automatically
adjusting device designed to treat CSR, CSA, and OSA.
The device automatically adjusts pressure on a breath-by-
breath  basis,  delivering  varying  degrees  of  ventilatory
assistance  to  stabilize  breathing  and  reduce  CSR.  The
AutoSet  CS  responds  to  the  dynamic  nature  of  these
patients' disease states and recovery needs.  The device is
fully portable and has a number of features designed to
improve patient comfort and compliance. Trials are showing
that  the  AutoSet  CS  provides  better  control  of  CSR  than
other forms of respiratory therapy. In Germany, about 150
CHF patients have been treated with the AutoSet CS, and
the initial results are extremely promising.

Positive  airway  pressure  therapy  for  COPD
patients. COPD (chronic obstructive pulmonary disease)
is a group of diseases, the most common being chronic
bronchitis and emphysema. The common characteristic of
COPD is obstruction to the airflow in and out of the lungs.
People with COPD may eventually require supplementary
oxygen and rely on mechanical ventilatory assistance. 

ResMed's  VPAP  devices  deliver  bilevel  therapy,  which
involves two pressure levels: a higher level for inspiration
and  a  lower  level  for  expiration.  Bilevel  therapy  is
recommended for some OSA patients and for a range of
COPD  patients  who  require  breathing  assistance.
ResMed  manufactures  five  VPAP  models  for  home,
hospital, and acute care environments.

Innovation–the way forward. Positive airway pressure
is not a cure but a therapy for managing SDB, and it must
be used on a daily basis as long as treatment is required.
Patient compliance has been a major factor in the efficacy
of  positive  airway  pressure  treatment.  Early  generations
of  CPAP  units  provided  limited  patient  comfort  and
convenience.  Patients  experienced  soreness  from  the
repeated use of poorly fitting nasal masks and had difficulty
falling  asleep  with  the  CPAP  device  operating  at  the
prescribed  pressure.  In  recent  years,  product  innovations
have improved patient comfort and compliance.

Innovative products and features include more comfortable
mask systems; delay timers, which gradually increase air
pressure  to  allow  the  patient  to  fall  asleep  more  easily;
autotitrating  systems  such  as  AutoSet  T;  and  heated
humidification  systems,  such  as  ResMed’s  HumidAire,
which  makes  the  air  from  a  CPAP  system  more
comfortable to breathe.

Following  the  innovative  Bubble  Cushion  technology
released  in  1991,  ResMed  released  the  Mirage  Mask  in
1997. The Mirage Mask uses the air from the flow generator
to  create  a  more  comfortable  and  better  seal.  In  1999,
ResMed launched the Mirage Full Face Mask, which provides
an  effective  method  of  applying  mechanical  ventilatory
assistance  and  can  be  used  to  address  mouth  leak  in
conventional bilevel or CPAP therapy. In 2000, the company
released the Ultra Mirage Mask, the next generation of the
Mirage  nasal  mask.  It  has  been  well  received  by  both
clinicians  and  patients.  Now  the  company  is  releasing  the
next generation of the Mirage Full Face Mask.

In  2001,  ResMed  began  distributing  the  Embletta  PDS
(portable  diagnostic  system),  a  fully  portable  diagnostic
system used to screen for SDB in sleep clinics, hospitals,
and  patients'  homes.  This  portable  system  gives  sleep
clinics  and  specialists  the  means  to  expand  their
capabilities and increase patient throughput.

operations review

AutoSet T product training at ResMed Germany

Product development 

ResMed  has  a  strong  record  of  innovation  in  the  sleep
market. In 1989, ResMed introduced its first nasal CPAP
device.  Since  then  the  company  has  been  committed  to
an  ongoing  program  of  product  advancement  and
development.  Current  product  development  efforts  are
focused  on  both  improving  current  products  and
expanding  into  new  product  applications.  In  the  three
fiscal  years  ended  June  30,  2001,  2000,  and  1999,
ResMed 
invested  $11,146,000,  $8,499,000,  and
$6,542,000 respectively, on research and development.

ResMed's  mask  systems  are  excellent  examples  of  the
company's  commitment 
to  product  development.
ResMed's  engineers  have  integrated  their  research  and
development  efforts  with  feedback  from  patients  and
professionals  to  maintain  a  constant  evolution  of  quality
and comfort in mask systems. ResMed's Mirage family of
masks is among the most popular in the world.

Manufacturing

ResMed's  principal  manufacturing  facility  is  located  in
Sydney,  Australia.  Sydney  operations  consist  primarily  of
research,  development,  testing,  manufacturing,  and
assembling of flow generators, masks, and accessories.

The  newly  acquired  MAP  German  manufacturing
operation is based in Munich. The products are primarily
flow  generators  that  have  been  developed  by  a  small,
internal  team.  The  manufacturing  process  consists  of
major  sub-assemblies  produced  externally  by  sub-
contractors.  Final  assembly  and  testing  of  finished
products is performed in-house.

Sales and marketing

ResMed currently markets its products in over 60 countries
using  a  network  of  distributors,  independent  manu-
facturers'  representatives,  and  a  direct  sales  force.
ResMed attempts to tailor its marketing approach to each
regional market, based on local awareness of SDB as a
health  problem,  physician  referral  patterns,  consumer
preferences, and local reimbursement policies.

North  America  and  Latin  America.  In  the  United
States,  sales  and  marketing  activities  are  conducted
through  a  field  sales  organization  made  up  of  regional
territory representatives, program development specialists,
diagnostic system specialists, regional sales directors, and
independent manufacturers' representatives. 

ResMed also promotes and markets its products directly to
sleep  clinics.  Patients  who  are  diagnosed  with  OSA  and
prescribed  CPAP  treatment  are  typically  referred  by  the

21

World Class

Manufacturing

techniques

improve

efficiency on

the ResMed 

S6 CPAP line

diagnosing sleep clinic to a home healthcare dealer to fill
the  prescription.  The  home  healthcare  dealer,  in
consultation  with  the  referring  physician,  will  assist  the
patient in selecting the equipment, fit the patient with the
appropriate mask and set the flow generator pressure to
the prescribed level.

Canadian  and  Latin  American  sales  are  conducted
through independent distributors. Sales in North America
and Latin America accounted for 52%, 54%, and 57% of
net  revenues  for  the  fiscal  years  ended  June  30,  2001,
2000, and 1999, respectively. 

Europe.  ResMed  markets  its  products  in  all  major
European  countries.  The  company  has  wholly  owned
subsidiaries in the United Kingdom, Switzerland, Sweden,
Germany,  France,  and  Austria,  and  uses  independent
distributors  to  sell  products  in  other  areas  of  Europe.
Distributors  are  selected  in  each  country  based  on  their
knowledge of respiratory medicine and a commitment to
SDB  therapy.  In  subsidiaries,  a  local  senior  manager  is
responsible  for  direct  national  sales.  MAP  conducts  its
sales efforts through a direct sales force and subsidiaries
in Germany, Austria, the Netherlands and Switzerland.

ResMed’s  Executive  Vice  President  is  responsible  for
coordination of all European activities and, in conjunction
with local management, the direct sales activity in Europe.

Sales  in  Europe  accounted  for  39%,  35%,  and  34%  of
net  revenues  for  the  fiscal  years  ended  June  30,  2001,
2000, and 1999, respectively. 

Asia Pacific/rest of world. Marketing in Australia and
the rest of the world is the responsibility of the Executive
Vice President. Sales in Australia and the rest of the world
accounted for 9%, 11%, and 9% of net revenues for the
fiscal  years  ended  June  30,  2001,  2000,  and  1999,
respectively.

Strategic  partnerships.  In  addition  to  internal  sales
efforts, ResMed works with the following organizations to
promote public and clinical awareness of SDB and OSA:

US  National  Stroke  Association  and  Australian
National  Stroke  Foundation. ResMed  has  developed
strategic alliances with the US National Stroke Association
and the Australian National Stroke Foundation to increase
awareness about the high prevalence of SDB in the stroke
survivor  population.  ResMed  is  working  on  a  number  of
programs, including a symposium on stroke and SDB at
this year's North American Stroke Meeting.

American Heart Association. ResMed is working with the
Western Affiliates of the American Heart Association on a
number  of  local  programs  to  increase  awareness  and
education about SDB. 

Physiotherapist Julie Skelton fits a patient with a ResMed
Mirage Mask at Cedar Court Healthsouth Rehabilitation
Hospital, Melbourne, Australia

US National Sleep Foundation. The US National Sleep
Foundation  is  a  nonprofit  organization  dedicated  to
improving public health and safety by raising the level of
awareness and education toward sleep related programs
and  research.  ResMed  has  been  an  active  corporate
partner and has supported the National Sleep Foundation
for a number of years.

ResMed  believes  that  its  affiliations  and  continued  work
with these organizations raises the awareness of SDB as a
significant health concern. 

Cedar Court Healthsouth Rehabilitation Hospital.
Cedar Court, in Melbourne, Australia, is set to open one
of  the  first  dedicated  on-site  sleep  clinics  within  the
rehabilitation environment. ResMed is sponsoring one of
the  two  beds;  both  beds  will  be  fitted  with  a  ResMed
Embla sleep recorder as well as an AutoSet T. ResMed will
capitalize  on  this  experience  in  its  endeavor  to  globally
expand the rehabilitation OSA market.

People 

As  of  June  30,  2001,  ResMed  had  approximately  950
employees, of which approximately 37% were employed in
warehousing  and  manufacturing,  14%  in  research  and

development,  29%  in  sales  and  marketing,  and  20%  in
administration and information technology. The company's
employees and consultants are primarily based in Australia,
Germany, the United States, Europe, and Asia Pacific.

Properties 

ResMed  owns  its  principal  executive  offices  and  US
distribution  center,  a  144,000  square-foot  (13,378
square-meter)  facility  located  in  Poway,  California,  just
outside San Diego. Primary manufacturing operations are
situated  in  Sydney,  Australia,  a  120,000  square-foot
(11,148  square-meter)  facility  also  owned  by  ResMed.
Sales  and  warehousing  facilities  are  leased  in  Oxford,
England;  Mönchengladbach,  Germany;  Lyon,  France;
Trollhättan, Sweden; and Singapore.

MAP's principal offices are located in Munich, Germany,
in  a  44,000  square-foot  (4,088  square-meter)  leased
facility. MAP's subsidiaries also lease sales and warehouse
facilities  in  Lyss,  Switzerland;  Villach,  Austria;  and
s'Hertogenbosch, Netherlands.

shareholders’ information

ten year financial summary

Year ended June 30

In thousands, except per share data

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

Net revenues

155,156

115,615

88,627

66,519

49,180

34,562

23,501

13,857

7,650

3,356

Income from operations

44,269*

33,138

25,255

17,363

8,327

3,595

2,787

1,289

637

Income before income taxes

45,541*

34,166

24,577

16,112

11,087

6,561

3,781

1,831

1,205

Net income

Basic EPS

Diluted EPS

29,857*

22,226

16,102

10,611

7,465

4,503

2,833

1,232

0.96*

0.89*

0.74

0.69

0.55

0.52

0.37

0.35

0.26

0.26

0.16

0.16

0.19

0.16

0.10

0.09

846

0.09

0.06

(95)

315

315

0.04

0.02

* Numbers after MAP acquisition are: Income from operations 26,042; Income before income taxes 27,314; Net income 11,630; Basic EPS 0.37; Diluted EPS 0.35

Annual meeting of shareholders

Form 10-K

The  annual  meeting  of  shareholders  will  be  held  on
Monday, November 5, 2001, at 4.00pm at ResMed Inc.,
14040 Danielson St, Poway, CA, USA.

Market for the company's common stock
and related shareholders’ matters

The company's shares are traded on the New York Stock
Exchange  (primary  listing)  and  the  Australian  Stock
Exchange  under  the  symbol  RMD.  Prior  to  September
1999, ResMed was listed on the NASDAQ-AMEX national
stock  market  under  the  symbol  RESM.  The  company
began trading on the Nasdaq market on June 2, 1995.

The company does not intend to pay cash dividends with
respect to its common stock in the foreseeable future. High
and low closing sale price information for the company's
common stock for the applicable quarters is shown below.

2001

2000

High

Low

High

Low

Quarter One

38.38

24.63

17.19

11.82

Quarter Two

41.50

25.50

23.13

12.75

Quarter Three

47.00

36.65

39.62

20.34

Quarter Four

57.68

37.91

38.06

22.00

Copies of the ResMed Inc. annual report on Form 10-K, as
filed  with  the  Securities  and  Exchange  Commission,  are
available upon request without charge. Please address written
requests to Walter Flicker, Corporate Secretary, ResMed Inc.,
14040 Danielson St, Poway, CA 92064-6857 USA.

Shareholder and investor inquiries

ResMed  has  a  World  Wide  Web  site  containing  details
about the company, its products, SDB, and information for
sleep  professionals,  as  well  as  the  latest  company  news
releases.  You can visit the web site at www.resmed.com.

To  directly  receive  copies  of  company  news  and  other
investor  information,  please  contact  Walter  Flicker,
Corporate  Secretary,  ResMed  Inc.,  14040  Danielson  St,
Poway, CA 92064-6857 USA.  
Tel: +1 858 746 2400; Fax: +1 858 746 2830; 
E-mail: InvestorRelations@ResMed.com.

Security  analysts  and  institutional  investors  are  invited  to
contact Adrian M. Smith, Vice President, Finance, ResMed
Inc., Tel: +61 2 9886 5000 or Walter Flicker, Corporate
Secretary, ResMed Inc.
Tel +1 858 746 2400 or 1800 424 0737 (US only). 

As at June 30

25

In thousands

2001

2000

1999

1998

1997

1996

1995

1994

1993

1992

Working capital

144,272

47,550

32,529

32,759

34,395

30,844

27,354

5,010

2,589

1,501

Long-term debt

150,000 

-

-

-

274

578

787

386

163

218

Shareholders’ equity

100,366 

93,972

71,647

50,773

44,625

38,986

28,867

5,630

2,895

1,689

Total assets

288,090 

115,594

89,889

64,618

54,895

47,299

35,313

9,608

5,173

2,886

Transfer agent and registrar

Inquiries regarding transfer requirements, lost certificates,
and changes of address should be directed to either of the
following:

(2) pursuant to an exemption from, or in a transaction not
subject to, the registration requirements of the Securities
Act and any other applicable securities laws.

Legal counsel

American Stock Transfer and Trust Company, 40 Wall
Street, New York, NY 10005. Tel: +1 718 921 8275.

Latham and Watkins, 650 Town Center Drive, Suite
2000, Costa Mesa, CA 92626 USA.

Computershare, Level 3, 60 Carrington Street,
Sydney NSW 2000. Tel: +61 2 8234 5000.

Independent auditors

KPMG Peat Marwick LLP, 750B Street, Suite 3000,
San Diego, CA 92101 USA.

Convertible notes inquiries

The  indenture  trustee  for  the  notes  is  American  Stock
Transfer and Trust Company. Inquiries regarding the notes
should be directed to American Stock Transfer and Trust
Company,  40  Wall  Street,  New  York,  NY  10005. 
Tel: +1 718 921 8275.

The  notes  and  the  common  stock  issuable  upon
conversion  of  the  notes  (the  "Securities")  have  not  been
registered  under  the  Securities  Act  or  any  other  state  or
foreign  securities  laws.  Thus,  unless  and  until  they  are
registered under the Securities Act, the securities may not
be offered, sold, pledged, or otherwise transferred except
(1) in compliance with the registration requirements of the
Securities Act and all other applicable securities laws, or

board of directors

Chairman of the Board

Directors

Peter C. Farrell

President, Chief
Executive Officer,
ResMed, Inc.

Christopher A.
Bartlett 

Donagh
McCarthy

Gary W. 
Pace

Professor of
Business
Administration and
Chair, Program for
Global Leadership,
Harvard Business
School

President, CEO
and Chairman of
the Board of
Protiveris Inc., a
startup Biotech
company based in
Rockville, Maryland

President and
Chief Executive
Officer, RTP
Pharma Inc. (a
biopharmaceutical
research
corporation)

Christopher G.
Roberts

Executive Vice
President,
ResMed, Inc.

Michael A.
Quinn

CEO of
international
venture fund.
Formerly CEO of
a medical device
company and
co-founder of NYSE
listed environmental
company

Senior Executives

Mark Abourizk
Michael Berthon-Jones
Don Darkin
David D'Cruz
Norman DeWitt
Robert Douglas
Walter Flicker
Robert Frater
Elliott Glick
Steve Hyde
Curt Kenyon
Brett Lenthall
Stefan Madaus
William Nicklin
Alain Perséguers
Ron Richard
Klaus Schindhelm
Joerg Schneider
Adrian Smith
Deirdre Stewart
Jonathan Wright

Vice President, Intellectual Property and Legal Affairs (Asia Pacific)
Vice President, Clinical Research
Vice President, Product Development
Vice President, Quality Assurance and Regulatory Affairs
General Counsel
Vice President, Corporate Marketing
Corporate Secretary
Vice President, Innovation
Vice President, US Operations
Vice President, Technology Ventures
Vice President, US Sales & Marketing 
Vice President, Information Systems
Chief Executive, MAP
Vice President, Manufacturing
Chief Executive, Southern Europe
Vice President, US Marketing 
Vice President, Global Operations 
Chief Executive, ResMed Germany
Vice President, Finance and Chief Financial Officer
Vice President, New Business Development and Clinical Education and Training
Vice President, Global New Business

27

2000 – 1992 highlights

Business
00 Begins trading on the New York Stock Exchange (NYSE); secondary listing of common stock on the Australian Stock
Exchange (ASX); 2-for-1 stock split; enters into partnership with US National Stroke Association; purchases business
activities of Swedish distributor Einar Egnell AB

99 Acquires holding in Flaga hf becoming distributor of Embla sleep diagnostic equipment in US and selected other countries

98 Construction of new Australian premises begins; 3-year agreement signed with Invacare Corp. for distribution of

selected products in the US; 2-for-1 stock split 

97 Liquid silicone manufacturing assets of TQR Pty Ltd acquired; awarded $2 million competitive Government R & D Grant;
NSW State Government offers financial assistance for the expansion of Sydney manufacturing plant; Singaporean and
Malaysian distributor Innovmedics acquired and ResMed Singapore Pte Ltd established for direct distribution in SE Asia

96 German distributor Priess Med Technik purchased and ResMed Priess GmbH & Co established in Germany; business 

activities of French distributor Premium Medical S.A.R.L. purchased and ResMed SA established in France

95 Company name changed to ResMed; lists on NASDAQ, raising US$24 million

94 ResCare group incorporates as Delaware Corporation

93 Nomura Jafco invests

92 Medtronic distribution agreement terminated; direct distribution to USA market

Products
00 ResMed S6 CPAP system; Ultra Mirage Mask; enhanced AutoSet T; enhanced VPAP; AutoScan; Embla sleep recorder

99 AutoSet T & AutoSet PDS devices; Mirage Full Face Mask; Mirage Disposable Full Face Mask; ResControl

98 AutoSet Clinical II device; AutoSet Portable II Plus device; VPAP II ST-A & VPAP MAX bilevel devices

97 AutoSet Portable II device; HumidAire active humidifier; Mirage Mask; SCAN 2.0; UCU 2

96 Comfort device; ResCap II headgear; VPAP II bilevel device

95 Alert CPAP device; AutoSet Portable device; Modular Mask frame; Pediatric CPAP device; SCAN software; 

SULLIVAN V CPAP device; UCU (Universal Control Unit)

94 AutoSet Clinical device; Infant Mask; SmartStart; SULLIVAN IV CPAP device; VPAP bilevel device

93 Bubble Mask - Series 3; Constant CPAP (Germany); ResCap headgear; SULLIVAN III CPAP device

92 HC100 active humidifier

Awards
00 Ranked 58 in Business Week as one of the 100 Hottest-Growth Companies ($25m to $500m annual sales) in the U.S;

wins two Australian Technology Awards for excellence, the first in the Development of Biotechnology, Pharmaceutical
Technology and Medical Instrumentation and the second in the globalization of technology pioneered in Australia;
ranked in Forbes Magazine in the 200 Best Small Companies in America for fourth year in a row

99 Ranked 67 by Business Week as one of the 100 Hottest-Growth Companies ($25m to $500m annual sales) in the
US; ranked 94 by Fortune as one of America's Fastest-Growing Companies; ranked 27 by Forbes Magazine in the
200 Best Small Companies in America

98 Dr. Peter Farrell named San Diego's Entrepreneur of the Year in Health Sciences; Ranked 63 by Forbes Magazine in
the 200 Best Small Companies in America; wins NSW Exporter of the Year Award across all industry categories

97 Dr. Peter Farrell receives David Dewhurst Award for significant contributions to biomedical engineering; named by

Deloitte & Touche as one of the Technology Fast 500 (received again in 1998); ranked 172 by Forbes Magazine in
the 200 Best Small Companies in America; Australian Venture Capital Award (Best Expansion Phase Investee
Company category)

95 Australian State Exporter of the Year Award
92 Austrade Exporter of the Year Awards Finalist

AutoScan, AutoSet, AutoSet CS, AutoSet T, AutoView, Bubble Cushion, Bubble Mask, HumidAire, Mirage, ResCap, ResControl, ResMed, SCAN, SmartStart, S6,
SULLIVAN, Ultra Mirage, VPAP, and VPAP MAX are trademarks of ResMed Ltd.

Now I can drive for hours

I feel twenty

years old again

Germany 
ResMed GmbH & Co. KG 
Rudolfstraße 10 
D-41068 Mönchengladbach
Germany 
Telefon: +49 02161 / 3521-0 
Telefax: +49 02161 / 3521-299 
reception@resmed.de 

MAP GmbH & Co KG
Fraunhoferstrasse 16
D-82152 Martinsried, Germany
Telefon: +49 89 89518-6
Telefax: +49 89 89518-714
info.de@map-med.com
www.map-med.com

France
ResMed SA
Parc de la Bandonnière
2 rue Maurice Audibert 69800 
Saint Priest, France 
Tel: +33 (4) 37 251 251 
Fax: +33 (4) 37 251 260
reception@resmed.fr

Australia
ResMed Ltd
97 Waterloo Road
North Ryde NSW 2113
Australia
Tel: +61 (2) 9886 5000
or 1 800 658 189
Fax: +61 (2) 9878 0120
reception@resmed.com.au

Global Offices

World Headquarters
ResMed Inc.
14040 Danielson St 
Poway CA 92064-6857 USA
Tel: +1 (858) 746 2400 
or 1 800 424 0737
Fax: +1 (858) 746 2900 
usreception@resmed.com

United States
ResMed Corp
14040 Danielson St 
Poway CA 92064-6857 USA
Tel: +1 (858) 746 2400 
or 1 800 424 0737
Fax: +1 (858) 746 2900 
usreception@resmed.com

United Kingdom
ResMed (UK) Limited
67B Milton Park
Abingdon Oxon OX14 4RX UK
Tel: +44 (1235) 862 997
Fax: +44 (1235) 831 336
reception@resmed.co.uk 

Sweden
ResMed Sweden AB 
Industrigatan 2 
461 37 Trollhättan Sweden 
Tel: +46 520 420 110 
Fax: +46 520 397 15
reception@resmed.se

Singapore
ResMed Singapore Pte Ltd
57 Ubi Ave 1
#07-09 Ubi Centre Singapore 408936 
Tel: +65 284 7177
Fax: +65 284 7787 
reception@resmed.com.sg

New Zealand
ResMed NZ Ltd
PO Box 51-048
Pakuranga Auckland New Zealand
Tel: +0800 737 633 (NZ toll free)
Fax: +0800 737 634 (NZ toll free)
reception@resmed.com.au

Malaysia
ResMed Malaysia Sdn Bhd 
Suite E-10-20, Plaza Mon’t Kiara
No.2, Jalan 1/70C, Mon’t Kiara
50480 Kuala Lumpur  Malaysia 
Tel: +60 (3) 6201 7177
Fax: +60 (3) 6201 2177
reception@resmed.com.my

Japan
ResMed KK
Nihonbashi Hisamatsu Bldg., 4F
2-28-1 Nihonbashi-Hamacho
Chuo-Ku
Tokyo 103-0007
Japan
Tel:  +81 (3) 3662 5056
Fax: +81 (3) 3662 5040