Morning, ladies and gentlemen, and welcome to this presentation. My name is Einar Bonnevie. I'm the CFO of CSAM, and I'm sitting here together with Sverre Flatby, the CEO of CSAM. We have just acquired a new company, made a new acquisition this time over Carmona. I'm happy to share that information with you and to be here together with you, Sverre.
Thank you, Einar. I would like to go through the background first, because I need to remind you how we became the leading player in the Nordics. It's actually just because of this type of a transaction that we have made today, and we focused on eHealth specialized software, and that has been a strategy that has been successful. Today's transaction is part of that plan, and I think it's important to have that in mind. Also, we'll compare with a couple of other business areas we have to see how we're actually going to grow further. Most importantly, when we acquire new companies, it's the same here.
We are always focusing on systems or data that is extremely relevant, for the quality of healthcare and, in the end, for the patients. I think especially now, today's transaction is also an add-on, that takes care of data, in our current business areas, and they are important, not only to big healthcare providers, but the users there that handles the patients, but ultimately also the patient. Then again, we of course, we run an eHealth business, and the business is, structured like this. I'm not going to go through, our business areas today, but obviously, having had seven of those, over time and created most of them through M&As, of course, it's relevant for you to see this, when we make new transactions.
Today's transaction is related to our smallest business area at the moment, Health Analytics. After the transaction, it's no longer the smallest one, and that's, you know, how it goes. I would also like to later on go through and compare the way we do this in other areas just so you understand how we're going to grow further. Let me go through specifically the acquisition, and I guess, Einar, maybe you could just summarize this, the numbers and the transaction details.
Absolutely. With great pleasure. When we acquired MedSciNet last year, we said that this acquisition was our first entry into the domain of Health Analytics, and that this was the first, but not necessarily the last. Now here we are, a little more than half a year later, and we're doing the second acquisition within this very exciting space. You see that the way the multiples are around the same as we have been paying in the past. We are settling the transaction SEK 20 million in cash. Carmona last year showed numbers of just above SEK 13 million in sales, and the forecast this year is around SEK 16 million in sales.
This really also, you know, manifests the position that CSAM has in the Nordics within Health Analytics, absolutely, you know, dominating in the Swedish market. Same kind of structure. This is a software company. Carmona is a software company. A huge part of the income is recurring by nature. This is also a very, you know, fast growing area. We expect that the organic growth will be supported by this acquisition. Also the technology here is tried and tested, been in use for many years.
We are absolutely have high hopes for this one, and it fits very well, both you know, strategically, financially, and also technology-wise into our portfolio. Yes, Sverre.
Yes. Let me just explain what it is. It's similar to MedSciNet which we acquired in May last year, and that also constructed our Health Analytics business area last year. But here the product composition, there are more products here than the quality registers, but most of it is related to quality registers, which are extremely important tools for healthcare providers, researchers. I think this is a good thing for us. It's also a SaaS-based, cloud-based platform. More and more of our business, of course, is going that way, which is also shown in our recurring revenue business. Also, there are important customers. We have complementary products, add-on products that we can use.
We have common customers from before, like Karolinska. We've had Karolinska as a customer for more than 12 years. Also, there's a number of quality registers within several clinical disciplines, which is also good news for a company like CSAM that are highly specialized. We're focusing on different types of products within our specialized areas, and they obviously also can use and connect to these types of products. In a sense, it's synergies in many ways here. If you look at the initial synergies here, of course, put together we are now being dominant especially in Sweden, but also in the Nordics. To put these together, it gives us other opportunities.
Also, if you look at our structure, the slide I showed you a few minutes ago, we have different specialized branches. Within all of these, there are relevant things that we can add with these registers and also connect them, integrate them with these. We feed data between both ways, actually, and that makes a future that I think is important to healthcare and of course, obviously a good business for CSAM.
Also this platform, as I mentioned, has other types of functionalities, but one that is a growing area at the moment would be the outcome measurements, because patient outcome is obviously the whole point with healthcare and more and more, especially high quality and big healthcare providers, they would like to measure the outcome of their treatment processes. We have tools there as well as part of the platform here. Of course, since these type of functionalities are add-ons, it will again give us the possibility to sell to current customers and to add functionalities across different areas, which is a good thing for us when it comes to added SaaS income in the next years.
Of course, we explained many times for those who follow us, our buy, integrate and build process also gives us synergies, obviously, where we can share sales, marketing, and work more efficient, share quality management, certification aspects, et cetera. All in all, we are looking at this transaction as a very successful start, together with our previous acquisition and now with Health Analytics, about the double size as it had, is a very good start. I would like to use a couple of minutes to explain why we are doing it this way, because it's not only, as you can see from our other business area, Public Safety, which is completely different and something else, but we have the same methodology, the same approach within all our areas.
In 2015 we acquired our first step within public safety to grow. We've used those six, seven years to create a business that are more than 10 times bigger. I think this, as long as you focus on these highly specialized type of software, this is a very good way to grow. It is predictable. It's a lot of recurring revenue streams. Also, of course, you can systematically through our buy, integrate and build methodology make sure that we can increase the margins when we acquire new companies over time. If you see what we've done today, we are doing exactly the same actually. We had nothing in 2021. We acquired MedSciNet in 2021.
We are acquiring Carmona today and put together a fantastic team, good products, platforms, SaaS based, cloud based, and I think the growth, going forward, will be based on the same methodology as you can see on the line above, with public safety. This is really CSAM's playbook. Today marks a start when it comes to further growth of our Health Analytics area, which is a growing area in healthcare itself. What is buy, integrate and build? Because that applies to Carmona as well. We're using the same 24 months as we always do to make sure that we properly analyze the business, take over the right elements when it comes to accounting, invoicing and structuring all these types of governance processes.
Altogether the M&A one, after three months we will have a structured takeover, making sure that everybody is taken care of, customers, employees, that we have a good process there the first three months. Then we have these margin expansion milestones, which are extremely important. There we will work together with a team, not only between the Health Analytics today and the added Carmona team, but also with the others in CSAM to secure either increased income or reduced cost or a combination of that. This is the same. I think also here it's important for those of you who follow us that this is how we do it with every acquisition. That means we now have five ongoing acquisitions.
The first one that we acquired, New Year's Eve, 2020-2021, is about to be finished while the others still are ongoing integration projects. I think this picture should give you the possibility to understand how the complete business will develop when we are doing acquisitions, including the fact that you dilute your margins as you acquire companies that don't have the EBITDA that is our target margin 30%. This is how we do it.
Carmona, we're going to do the same, not something else, which I think will be a good thing for the new team and also for the business. I always summarized after these acquisitions the last years, this is how we do it. I think we have done exactly what we said we're going to do, become the leading Nordic player. We increased through acquisitions, and we're going to focus on acquisition also with customers outside the Nordics. I think so far, there is no other companies that has chosen specifically the strategy we have.
At the moment, we feel quite unique, and we have the ability to stay ambitious, and we're going to grow and be a notable player in Europe and in the world. As you see, we have come somewhere already, and this is a good thing that we are more and more diversified, not only inside the Nordics, mirroring the Nordics, when it comes to size, but also the increase of customers outside the Nordics. It's diversifying our business very well. All in all, we think that we deliver exactly what we say we're going to do when it comes to growth, and further growth internationally as well.
Having said that, Einar, maybe you could summarize the way you normally do look at what we have come and achieved so far and what we're gonna do next.
We are going to do more of the same. When we IPO'd, we had sales of approximately NOK 200 million. We said we plan to grow approximately 40% per annum. We have done exactly that. What is ahead of us? More of the same, really. We will continue to grow organically as fast as possible and then strategically through selected mergers and acquisitions. Our aim is still to reach NOK 1 billion in sales within 2025, and we are so far moving ahead according to plan. That is same message as before. It hasn't changed, so we'll just soldier on. We will have a Q&A session. We have received a couple of questions already.
You can continue to write them in as we address them. So just type in your questions, and we will take them in turn. Before we move into the Q&A session, remember to subscribe to our newsletter, and then you will be the first to know all the juicy news from CSAM. All right. Shall we move into the Q&A session, Sverre?
Sure.
Okay. The first question here is regarding the M&A pipeline. People are interested in M&A. The question is, can you comment on the M&A pipeline for 2022? What can you say and what can you not say?
Yeah, that's a very good question. The answer is really no. On the other hand, of course, there's an obvious fact that CSAM was created in 2005, based on overview over 3,000 clinical systems. We created already then a database, an overview over the vendors. We've been monitoring the market for many, many years, and obviously we have dialogue with companies for many, many years. Many of the acquisitions we have been dialogues going on for years, and some are jumping in more like a coincidence. That is a volume that is there all the time. However, we cannot disclose the number of targets or the size, et cetera.
What I can say, though, is that we've said the last six years we're going to grow, except for the year where we IPO'd, we're going to grow about 40% annually through acquisitions, and that we always have had a pipeline warm enough to support that growth. I will just say we've done that for the last five years. We're going to continue to do it next five years, and we feel comfortable that the pipeline will support that. That, I can say.
That you can say. That you just did. Right. There is another question here, and that is related to the economics of Carmona. The question is, can you give some insight into the underlying economics of Carmona churn profile and NRR, I assume, is referring to net retention rate, the inverse of churn, so to speak. What I can say about the economics is that this is a company, you know, very, very typical for the companies that we have acquired and that we do acquire. They are typically small. This company, Carmona, about the same size as MedSciNet that we acquired last year.
I think what we observe is that they, you know, great people, great products, great contracts, but it's hard to, you know, really achieve superior economic performance with that size. Size matters. Now we combine them. Together, you know, Carmona and MedSciNet is like a SEK 30 million business. Again, we started with MedSciNet. We are continuing with Carmona, not necessarily stopping there. The other economics like churn, same thing here, very sticky business, same churn profile, same retention rate. This is very typical, you know, in CSAM terms or eHealth terms, so to speak. Sticky business, we aim to improve it and to grow it. Okay.
Another question here, this one I believe is for you, Sverre, and that is, how many competitors remain in quality registers in Sweden?
Well, there are many small ones. There are not so many big ones, but if you summarize the combination now of Carmona and MedSciNet that now comprises our Health Analytics business, it will be the dominant one, so. You have a few others, but then again, even very small ones, like SEK 1 million annual and stuff like which are highly specialized. You have very small ones, but you have a couple of the same size-ish as our current Health Analytics business. That's still a competition in Sweden. We have more than the Swedish market here, obviously.
We have Nordic installations and also in the U.K., and also the possibility to offer this to our international customers. In our heads, the competition, it's not that important in a specific country because the growth here is also based on a diversified set of contracts outside the Nordics as well. In summary, yes, there are competition, but as you know, competition organically is not that critical given the fact that most of these systems, SaaS business are recurring revenues over years. They, you know, the competitors have their customers, and we have our customers, and that is the very strong position, not only for us, but also for competitors. That is why we acquire companies. That's the way to grow, and that's the successful thing we've done today with Carmona.
Okay. Thank you, Sverre. Another question here from EP that also relates to the economics and the financials of Carmona. It says that when we acquired MedSciNet, they reported an EBITDA margin of approximately 8%. Is it the same for Carmona? Yes, it is around the same, actually a little less, so you know, around 5%. These companies, great talents, great products, they are surfing around, you know, breakeven or breakeven plus. So that is where they are, as simple as that. All right. Another question from Herman here. I think this one is for you, Sverre. What concrete parameters do you look at when prioritizing M&A targets if the opportunities are many? Many they are indeed. So what on earth are we prioritizing, Sverre?
Yeah, that's a good question. It's a very good question, actually, because there are a lot of companies out there, as I mentioned, also smaller ones, bigger ones. The whole point in our history has been the Triple C strategy, customer, code, competence. In that order, because we need to have customers that have recurring revenue streams over time. We have always thought if there are good software and code, the C number two here, in production, and it's been there for many years, that gives recurring revenue for many years ahead as well. The combination of the first two Cs obviously is critical in such processes. Also the last C, the competence part.
Of course, many of those specialized companies have people that are experts, and obviously, we get experts on board at the same time, and that's always the case with Carmona. Good teams with experience over years, in addition to the customer code aspect, that is the main part, actually. We have seen many companies that does that the opposite way, a lot of consulting rather than recurring revenue streams, et cetera. We try to avoid that type, instead focus on software companies with a viable position.
Okay. Another question from EP here is either Eddie Palmgren or Elvis Presley, one of the two. How challenging is it to expand MedSciNet/Carmona organically outside of Sweden?
That is also a very good question. It's really not that complicated. It's actually much easier than many of our other specialized areas. Why is that? Well, many of our areas have extremely complicated relations with processes inside the complex clinical areas. That makes the implementation process very complex. However, when it comes to quality registers like this on a cloud and SaaS platform, obviously the organic growth process, it's easier. You can sell something, implement something easier than these larger implementation and integrations inside the complex areas. In that sense, it's actually easier from that point of view.
That's also what we think it's going to be, not only because we see that we can grow internationally standalone on Health Analytics, but because we have these valuable installations. For instance, with almost all hospitals in the Nordics having our systems, we see that there are added value for customers, and so with our customers outside the Nordics. We're looking at a very good future here when it comes to organic growth in the area of Health Analytics.
Okay, thank you, Sverre. To you out there, if you have any more questions, just type them in, and we'll address them. Another question here that is very interesting. How long have we been following Carmona and been in contact with them, and why are they selling now? What do you think, Sverre? Why are they selling now?
Yeah, since you have been negotiating with them, you should probably answer that question. The good thing and the first thing, obviously, we have followed that market for a long time, so, it's not a new thing for us. On the other hand, how did this actually happen now? That is always the fact that, you know, it takes two to tango, so we have to find the right time. We were approached just before Christmas actually, that a more strategic discussion could move forward. This specific transaction has actually happened like a quick added M&A a bit outside our pipeline, actually.
It was a big good thing for us, and also I think for the owners of previous owners of Carmona. Since you negotiated, you could probably answer that question. What about the owners?
You know, they had several owners, and I think this is a good deal for both parties. CSAM is a good home for the people and for the technology and for the customers. Again, it's challenging to be, you know, small to mid-size. Size matters in this business. A good deal for both parties. Okay. This one is definitely for you, Sverre. It says, "Happy Birthday, Sverre." It's actually your birthday today. It is.
Yeah.
Congratulations with the acquisition of Carmona. That is the birthday present to you. We can see that the payment for Carmona is in cash. I don't know if that was a question, but yes, I can confirm that Sverre is having his birthday today. Yes, check. I can also confirm that the settlement is in cash. It is like you see, 20 million SEK, nothing further. No earn-out, no deferred payment, nothing else. This is it. The transaction is closed and paid and settled today. Okay, no more birthday things for you, Sverre. Another one is it possible. It's from Herman. Is it possible to give more color on the cost ramp-up in Q4? What kind of return you expect on those investments?
That really relates back to the presentation we had last week on Friday with the Q4 and the increased cost base. Maybe you can explain why we are ramping up. Why are we hiring? Why are we increasing the costs?
Sure. It's a good question, and I respect the view on that, the Q4 numbers and our increased salary and recruitment cost. However, it's important when we do acquisitions like we do and grow fast, obviously with the 40% annually, which is the plan to reach SEK 1 billion. To do that, we had to increase the management capacity, for instance, HR director and also other management resources. Also, we had to ramp up on different areas that grow a bit faster than normal due to business contracts happening during the year.
One thing is, I mentioned within our Blood Management area that not only the SEK 100 million contract in Denmark itself, but on the back of that contract, there is a lot of customers that want those new functionalities we deliver to Denmark. To do that, when we get a queue, we obviously have to rearrange the delivery setup. That means we have to have more people that in parallel can handle that type of deliveries, which are complex, goes over time, many months, sometimes even a year. To do that, we had to start recruiting many people, actually about 20 people. Not only for the Blood Management, but also deliveries on other areas.
Specifically this quarter, the Q4 we passed recently, we also have activities within public safety that requires recruitment as well. The summary of that in our head is not a negative Q4 . Quite the opposite. It is a deliberate business decision to make sure that we can satisfy the customers, take the growth based on the order backlog. That is simply most of what you see of one-off costs in the Q4 .
Well, thank you, Sverre. There's another question following up here, which I think is a very good question, and I think it's also relevant to what you just said, why we are ramping up. That relates to the fact that there are now five companies in the integration phase, in the bid phase. A question is, with five companies being in integration phase, have we now reached our bandwidth for M&A integrations? Very relevant question. What do you think, Sverre? Have we? How does this pertain to. You just said that we are, you know, reorganizing and focusing more on the business areas. What consequences does the reorganization, the ramping up, have for our bandwidth and ability to take on more M&A objects?
I think now we have reached a point in our organization where we are more and more focusing on these business areas as businesses. They're not separate, but they have separate leaders that actually focus on the results and the growth. They also have another task, and that is integration. Meaning that CSAM has been a successful acquirer for over 10 years, that we actually have also people in the operations that handles that separately inside each business area. That means we could easily, as we did in 2021, that is proven. We did two acquisitions within Public Safety in 2021. If we can do two within one segment, we can do that in the others. It's more to come. If there's more coming on, it's not a bandwidth problem.
That means, whether there are 10 in parallel or five in parallel, it's not a problem in our current structure.
What you're saying there is that integration phase will be managed by Camilla in MedSciNet, so they will act as one unified team.
Exactly. That is the whole point because she knows she's the manager of that area, she knows the area, and she's also been working with us for a long enough time to understand the BIB process, so she can take the responsibility for that. Einar fulfills the contract, sign it, and when we deliver it to the integration, it's not a generic management thing, it's a specific thing for the leader of that business area. That will work, and looking forward to see the results of that.
Actually, I do. I sign it and pay it.
Yeah.
Thank you for the presence. All right. There's a last question here from Pippi. I guess she's Swedish, and it's in two stages. It says, "Can you comment if the founders will continue in the company and if there are incentives for them and other key people so that they do not leave the company?" So you can start on that one, Sverre, and I can fill in if necessary.
Yeah. The point is, I think every time we have done acquisitions over the last 10 years, we've had the same principles that, you know, these targets are different all the time. Sometimes the owners are retiring, sometimes they wanna stay on, and we've done both. When it comes to the model, incentive model, we have chosen early on that we will only have one type of incentive, and that is actually our shares. Many of our employees have acquired shares in the company, and it's the same shares that everybody else has, even you as our investors. That is a very, very simple model, and we stick to that model, and it will be the same here. There's no differences.
I think we don't wanna force people to stay in CSAM. We think we have created a company that is a good acquirer, and people will stay if they wanna stay. If they not want to stay, they will leave. So far, the churn, when you talk about churn on the income side, Einar, is the same when it comes to our our employees. We have a very low churn, and that is a good thing. We stick to that philosophy.
Yep, we stick to that philosophy. I can say that, you know, all employees in Carmona will join us and continue to work for us and the key people. We think they will look forward to coming to a new home. Okay. This last question, again, if you have any more questions, type them in as we address this one. The last question here, you said that the deal was not in your pipeline. Are you targeting larger acquisitions there? Just a comment on the pipeline. It was of course, I mean, we knew of the company. We had knowledge of Carmona, so it was on the list.
I think it's fair to say, and as you did, Sverre, that it advanced, you know, faster than originally planned because of, you know, different events. Then the question, if there are larger acquisitions out there, what can we not say about that one, Sverre?
Well, that was what I tried to explain with the comparison with Public Safety, which we started at 0, acquired something with SEK 15 million, now getting over SEK 150 million in 2022. I think we will do the same with all the business areas. That is the strategy. Of course, in our list, we have a lot of smaller companies, some mid-size, some even bigger. Of course, it's a time for everything. Yes, there are bigger players in that database as well. That's not a secret. Pipeline is pipeline. We are not publishing the pipeline with the type of companies and size. That's what I can say today.
That is what we can say today. All right. As you saw, you know, since we IPO'd, we have done five acquisitions. I think we have proven that we have the ability and the will to continue with acquisitions. Remember, if you look at the Q4 report and you look at the cash position, you see that we are in a good position. We absolutely do have dry gunpowder, so we can continue, and we will continue to do meaningful acquisitions. Okay. Another question came up here, and that was regarding the M&A capacity. What is the M&A capacity going forward, given no additional equity funding? I think I just, you know, addressed that.
Again, we have almost NOK 300 million on the balance sheet, so we absolutely have a war chest. Of course, it is not limitless, but we can continue as we do. The capacity financially is absolutely there. That said, there are other opportunities as well that we can use. At least for the short to medium term, we can absolutely continue to do what we have been doing. Okay. As I can see, we can leave it five seconds. As I can see, no more. Oh, here comes another one. Another one from Herwin. This is relating to the M&A strategy.
Since the M&A strategy is indefinite, would it be meaningful to report underlying EBITDA for fully integrated businesses? I can address that one. I can see the reasoning behind that. Again, it's about how to measure and to make sure that you measure absolutely what you want to measure. Keep in mind that there are some, you know, common services as well in CSAM. We wanna make sure that when we report something, it must be correct, it must be meaningful, it must be repeatable and scalable. What we have said is that we will indeed focus on reporting and measurements. We will, for a start to report organic growth.
For the Q1 report, 2022, we will, you know, try to increase the granularity of the reporting. I think I'll leave it at that. Correct and relevant reporting to investors is, of course, of a very high priority. Okay. 11:40. I think we will round it off here if no more questions. Ladies and gentlemen, thank you very much for watching. Thank you for tuning in. Have a real nice rest of your day.