From what I understand, the Irish company buys the units outright and does the monitoring themselves with no recurring revenue to MDHI.
MDHI has made it very clear that domestically they are in the business of selling their monitoring services and the Medipendant itself is free. The only way there is an up-front fee for the unit itself is if the purchase price includes the monitoring service for some period of time. Costco sales are structured this way. When a medipendant is purchased through Costco there is an upfront fee that includes shipping and 6 month's monitoring service from MDHI. Costco gets their money from the initial fee, MDHI gets the balance for the included monitoring then and MDHI keeps all the revenue from extending the monitoring service. If the unit fails for the initial user at any time--even if it is 10 years later--MDHI replaces the unit for free.
Any upfront charges from security system alarm companies that offer the medipendant as their medical alarm are for installation and set up. They may get a % of the recurring revenue or they may just want to be able to offer full coverage to their customers. I would guess that the full advertised mdhi monitoring fee is paid to the alarm company and then MDHI's discounted fee for a volume re-seller is forwarded to MDHI.