CARECLOUD, INC. The following is a discussion of our condensed consolidated financial condition and results of operations for the three and six months endedJune 30, 2021 and 2020, and other factors that are expected to affect our prospective financial condition. The following discussion and analysis should be read together with our Condensed Consolidated Financial Statements and related notes beginning on page 4 of this Quarterly Report on Form 10-Q. Some of the statements set forth in this section are forward-looking statements relating to our future results of operations. Our actual results may vary from the results anticipated by these statements. Please see "Forward-Looking Statements" on page 2 of this Quarterly Report on Form 10-Q. COVID-19 Pandemic InDecember 2019 , a novel strain of coronavirus, SARS-CoV-2, was reported to have surfaced inWuhan, China . Since then, SARS-CoV-2, and the resulting disease COVID-19, has spread to most countries, and all 50 states withinthe United States . InMarch 2020 , theWorld Health Organization declared the COVID-19 outbreak a pandemic. Further, the former President ofthe United States declared the COVID-19 pandemic a national emergency, invoking powers under the Stafford Act, the legislation that directs federal emergency disaster response, and under the Defense Production Act, the legislation that facilitates the production of goods and services necessary for national security and for other purposes. Numerous governmental jurisdictions, including theState of New Jersey where we maintain our principal executive offices, and those in which many of ourU.S. and international offices are based, have imposed, and others in the future may impose, "shelter-in-place" orders, quarantines, executive orders and similar government orders and restrictions for their residents to control the spread of COVID-19. Most states and the federal government, including theState of New Jersey , together with foreign jurisdictions in which we have operations centers, have declared a state of emergency related to the spread of COVID-19. While the COVID-19 pandemic did not materially adversely affect the Company's consolidated financial results and operations during the six months endedJune 30, 2021 , economic and health conditions inthe United States and across most of the globe continue to change. The Company has expanded its telehealth operations, which is an alternative to office visits. However, not all physicians are using telehealth and not to the same extent as previous office visits. The COVID-19 pandemic is affecting the Company's operations in 2021, and may continue to do so indefinitely thereafter. The pandemic may have an impact on the Company's business, operations, and financial results and conditions, directly and indirectly, including, without limitation, impacts on the health of the Company's management and employees, its operations, marketing and sales activities, and on the overall economy. The spread of the virus did not adversely affect the health and availability of our employees and staff. The scope and nature of these impacts, most of which are beyond the Company's control, continue to evolve and the outcomes are uncertain. Due to the above circumstances and as described generally in this Quarterly Report on Form 10-Q, the Company's consolidated results of operations for the three and six months endedJune 30, 2021 are not necessarily indicative of the results to be expected for the full fiscal year. The Company is not aware of any certain event or circumstance that would require an update to its estimates or judgements or a revision of the carrying value of its assets or liabilities as of the date of issuance of this Quarterly Report on Form 10-Q. These estimates could change in the future as new information about future developments is obtained. Management cannot predict the full impact of the COVID-19 pandemic on the Company's consolidated operations nor on economic conditions generally, including the effects on patient visits. The ultimate extent of the effects of the COVID-19 pandemic on the Company is highly uncertain and will depend on highly unpredictable factors such as the ultimate geographic spread of the disease, the severity of the disease, the duration of outbreak, and the effectiveness of any further developments globally and nationally. The Company will actively monitor the situation and take further action that is in the best interest of our employees, customers, partners, and stockholders. 27 OverviewCareCloud, Inc. ("CareCloud" and together with its consolidated subsidiaries, the "Company", "we", "us" and/or "our") is a healthcare information technology company that provides a full suite of proprietary cloud-based solutions, together with related business services, to healthcare providers and hospitals throughoutthe United States . Our Software-as-a-Service ("SaaS") platform includes revenue cycle management ("RCM"), practice management ("PM"), electronic health record ("EHR"), business intelligence, telehealth, patient experience management ("PXM") solutions and complementary software tools and business services for high-performance medical groups and health systems.
At a high level, these solutions can be categorized as follows:
? Technology-enabled business solutions, which are often bundled but are
occasionally provided individually, including:
? EHRs, which are easy to use, integrated with our business services or offered
as Software-as-a-Service ("SaaS") solutions, and allow our healthcare
provider clients to deliver better patient care, document their clinical
visits effectively and thus potentially qualify for government incentives,
reduce documentation errors and reduce paperwork;
? PM software and related tools, which support our clients' day-to-day business
operations and workflows;
?
assist patients and healthcare providers in the provision of healthcare
services;
? Telehealth solutions, which allow healthcare providers to conduct remote
patient visits;
? Healthcare claims clearinghouse, which enables our clients to electronically
scrub and submit claims to, and process payments from, insurance companies;
? Business intelligence, customized applications, interfaces and a variety of
other technology solutions that support our healthcare clients; and
? RCM services, which include end-to-end medical billing, eligibility,
analytics, and related services, all of which can often be provided either
with our technology platform or through a third-party system.
? Professional services consisting of application and advisory services, revenue
cycle services, data analytic services and educational training services.
? Medical practice management services are provided to medical practices. In this
service model, we provide the medical practice with appropriate facilities,
equipment, supplies, support services, nurses and administrative support staff.
We also provide management, bill-paying and financial advisory services.
Our solutions enable clients to increase financial and operational performance, streamline clinical workflows, get better insight through data, and make better business and clinical decisions, resulting in improvement in patient care and collections while reducing administrative burdens and operating costs. The modernization of the healthcare industry is transforming nearly every aspect of a healthcare organization from policy to providers; clinical care to member services, devices to data, and ultimately the quality of the patient's experience as a healthcare consumer. We create elegant, user-friendly applications that solve many of the challenges facing healthcare organizations. We partner with organizations to develop customized, best-in-class solutions to solve their specific challenges while ensuring they also meet future regulatory and organizational requirements and market demands. We are able to deliver our industry-leading solutions at very competitive prices because we leverage a combination of our proprietary software, which automates our workflows and increases efficiency, together with our team of approximately 700 experienced health industry experts throughoutthe United States . These experts are supported by our highly educated and specialized offshore workforce of approximately 3,300 team members at labor costs that we believe are approximately one-tenth the cost of comparableU.S. employees. Our unique business model also allowed us to become a leading consolidator in our industry sector, gaining us a reputation for acquiring and positively transforming distressed competitors into profitable operations ofCareCloud . Adoption of our technology-enabled business solutions typically requires little or no upfront expenditure by a client. Additionally, for most of our solutions and customers, our financial performance is linked directly to the financial performance of our clients, as the vast majority of our revenues are based on a percentage of our clients' collections. The fees we charge for our complete, integrated, end-to-end solution are very competitive and among the lowest in the industry. We estimate that we currently provide services to more than 40,000 providers, (which we define as physicians, nurses, nurse practitioners, physician assistants and other clinical staff that render bills for their services) practicing in approximately 2,600 independent medical practices and hospitals representing 80 specialties and subspecialties in 50 states. In addition, we serve approximately 200 clients which are not medical practices, but are primarily service organizationswho serve the healthcare community. The foregoing numbers include clients leveraging any of our products or services, and are based, in part, upon estimates where the precise number of practices or providers is unknown. 28
We service clients ranging from small practices, consisting of one to ten providers, to large practices with over 2,000 providers operating in multiple states, to community hospitals.
OnJanuary 8, 2020 , through a merger with a subsidiary, the Company acquiredCareCloud Corporation , aDelaware corporation which was subsequently renamedCareCloud Health, Inc ("CCH"), which has developed a highly acclaimed cloud-based platform including EHR, PM and patient experience capabilities. The Company paid$11.9 million in cash, assumed a working capital deficiency of approximately$5.1 million and issued 760,000 shares of the Company's Series A Preferred Stock and two million warrants for the purchase of the Company's common stock at prices of$7.50 for two years and$10.00 per share for three years. OnJune 16, 2020 , the Company purchased all of the issued and outstanding capital stock ofMeridian Billing Management Co. and its affiliateOrigin Holdings, Inc. (collectively "Meridian" and sometimes referred to as "Meridian Medical Management"), a former GE Healthcare IT company that delivers advanced healthcare information technology solutions and services. The Company paid$11.9 million in cash, issued 200,000 shares of the Company's Series A Preferred Stock and warrants to purchase 2,250,000 of the Company's common stock with an exercise price per share of$7.50 for two years and assumed Meridian's negative working capital and certain long-term lease liabilities where the space is either not being utilized or will be vacated shortly, with an aggregate value of approximately$4.8 million . OnJune 1, 2021 ,CareCloud Acquisition Corp ("CAC"), a wholly-owned subsidiary entered into an Asset and Stock Purchase Agreement (the "Purchase Agreement") withMedMatica Consulting Associates, Inc. , ("MedMatica") whereby CAC purchased the assets of MedMatica and the stock of its wholly-owned subsidiarySanta Rosa Staffing, Inc. ("SRS"). MedMatica and SRS provide a broad range of specialty consulting services to hospitals and large healthcare groups, including certain consulting services related to healthcare IT applications services and implementations, practice management, and revenue cycle management. The total consideration paid at closing was$10 million in cash, net of$1.5 million of escrow withheld. A working capital adjustment of approximately$3.8 million was also paid at closing. The Purchase Agreement provides that if during the 18-month period commencing onJune 1, 2021 ("the "Earn-Out Period"), CAC's EBITDA and revenue targets are achieved, then CAC shall pay an earn-out up to a maximum of$8 million (the "Base Earn-Out"). If during the Earn-Out Period, CAC's additional and increased EBITDA and revenue targets are achieved, then CAC shall pay an additional earn-out, up to a maximum of$5 million (the "Additional Earn-Out", collectively, with the Base Earn-Out, the "Earn-Out"). CAC will have the right to offset the Earn-Out against any claim for which CAC is entitled to indemnification under the Purchase Agreement and against damages for breaches by the seller of the non-competition and non-solicitation provisions in the Purchase Agreement. Our offshore operations in the Pakistan Offices andSri Lanka accounted for approximately 11% of total expenses for both the six months endedJune 30, 2021 and 2020. A significant portion of those foreign expenses were personnel-related costs (approximately 80% for both the six months endedJune 30, 2021 and 2020). Because personnel-related costs are significantly lower inPakistan andSri Lanka than in theU.S. and many other offshore locations, we believe our offshore operations give us a competitive advantage over many industry participants. We are able to achieve significant cost reductions and leverage technology to reduce manual work and strategically transition a portion of the remaining manual tasks to our highly-specialized, cost-efficient team in theU.S. , the Pakistan Offices andSri Lanka . Key Performance Measures
We consider numerous factors in assessing our performance. Key performance measures used by management, including adjusted EBITDA, adjusted operating income, adjusted operating margin, adjusted net income and adjusted net income per share, are non-GAAP financial measures, which we believe better enable management and investors to analyze and compare the underlying business results from period to period.
These non-GAAP financial measures should not be considered in isolation, or as a substitute for or superior to, financial measures calculated in accordance with accounting principles generally accepted inthe United States of America ("GAAP"). Moreover, these non-GAAP financial measures have limitations in that they do not reflect all the items associated with the operations of our business as determined in accordance with GAAP. We compensate for these limitations by analyzing current and future results on a GAAP basis as well as a non-GAAP basis, and we provide reconciliations from the most directly comparable GAAP financial measures to the non-GAAP financial measures. Our non-GAAP financial measures may not be comparable to similarly titled measures of other companies. Other companies, including companies in our industry, may calculate similarly titled non-GAAP financial measures differently than we do, limiting the usefulness of those measures for comparative purposes. Adjusted EBITDA, adjusted operating income, adjusted operating margin, adjusted net income and adjusted net income per share provide an alternative view of performance used by management and we believe that an investor's understanding of our performance is enhanced by disclosing these adjusted performance measures. 29
Adjusted EBITDA excludes the following elements which are included in GAAP net income (loss):
? Income tax expense (benefit) or the cash requirements to pay our taxes; ? Interest expense, or the cash requirements necessary to service interest on
principal payments, on our debt; ? Foreign currency gains and losses and other non-operating expenditures; ? Stock-based compensation expense includes cash-settled awards and the related
taxes, based on changes in the stock price; ? Depreciation and amortization charges; ? Integration costs, such as severance amounts paid to employees from acquired
businesses, and transaction costs, such as brokerage fees, pre-acquisition
accounting costs and legal fees and exit costs related to contractual
agreements; and ? Impairment and unoccupied lease charges.
Set forth below is a presentation of our adjusted EBITDA for the three and six
months ended
Three Months Ended Six Months Ended
June 30, June 30,
2021 2020 2021 2020
($ in thousands)
Net revenue $ 34,065 $ 19,579 $ 63,834 $ 41,446
GAAP net loss (227 ) (4,792 ) (2,191 ) (7,294 )
Provision (benefit) for income taxes 213 (74 ) 212 (44 ) Net interest expense 113 142 177 222 Foreign exchange loss / other expense (146 ) 111 97 (313 ) Stock-based compensation expense 1,735 1,881 3,002 3,188 Depreciation and amortization 3,128 2,405 5,959 3,738 Transaction and integration costs 617 455 849 1,100 Impairment and unoccupied lease charges 223 63 1,241 361 Adjusted EBITDA$ 5,656 $ 191 $ 9,346 $ 958
Adjusted operating income and adjusted operating margin exclude the following elements which are included in GAAP operating income (loss):
? Stock-based compensation expense includes cash-settled awards and the related
taxes, based on changes in the stock price; ? Amortization of purchased intangible assets; ? Integration costs, such as severance amounts paid to employees from acquired
businesses, and transaction costs, such as brokerage fees, pre-acquisition
accounting costs and legal fees and exit costs related to contractual
agreements; and ? Impairment and unoccupied lease charges. Set forth below is a presentation of our adjusted operating income and adjusted operating margin, which represents adjusted operating income as a percentage of net revenue, for the three and six months endedJune 30, 2021 and 2020: Three Months Ended Six Months Ended June 30, June 30, 2021 2020 2021 2020 ($ in thousands) Net revenue$ 34,065 $ 19,579 $ 63,834 $ 41,446 GAAP net loss (227 ) (4,792 ) (2,191 ) (7,294 ) Provision (benefit) for income taxes 213 (74 ) 212 (44 ) Net interest expense 113 142 177 222 Other expense (income) - net (205 ) 114 15 (331 ) GAAP operating loss (106 ) (4,610 ) (1,787 ) (7,447 ) GAAP operating margin (0.3 )% (23.5 )% (2.8 )% (18.0 )%
Stock-based compensation expense 1,735 1,881 3,002 3,188 Amortization of purchased intangible assets 2,175 2,046 4,311 3,061 Transaction and integration costs 617 455 849 1,100 Impairment and unoccupied lease charges 223 63 1,241 361
Non-GAAP adjusted operating income
13.6 % (0.8 )% 11.9 % 0.6 %
Adjusted net income and adjusted net income per share exclude the following elements which are included in GAAP net income (loss):
? Foreign currency gains and losses and other non-operating expenditures; ? Stock-based compensation expense includes cash-settled awards and the related
taxes, based on changes in the stock price; ? Amortization of purchased intangible assets; ? Integration costs, such as severance amounts paid to employees from acquired
businesses, and transaction costs, such as brokerage fees, pre-acquisition
accounting costs and legal fees and exit costs related to contractual
agreements;
? Impairment and unoccupied lease charges; and ? Income tax expense (benefit) resulting from the amortization of goodwill
related to our acquisitions.
30 No tax effect has been provided in computing non-GAAP adjusted net income and non-GAAP adjusted net income per share as the Company has sufficient carry forward net operating losses to offset the applicable income taxes. The following table shows our reconciliation of GAAP net loss to non-GAAP adjusted net income for the three and six months endedJune 30, 2021 and 2020: Three Months Ended Six Months Ended June 30, June 30, 2021 2020 2021 2020 ($ in thousands) GAAP net loss$ (227 ) $ (4,792 ) $ (2,191 ) $ (7,294 ) Foreign exchange loss / other expense (146 ) 111 97 (313 )
Stock-based compensation expense 1,735 1,881 3,002 3,188 Amortization of purchased intangible assets 2,175 2,046 4,311 3,061 Transaction and integration costs 617 455 849 1,100 Impairment and unoccupied lease charges 223 63 1,241 361 Income tax expense (benefit) related to goodwill 163 (115 ) 127 (100 ) Non-GAAP adjusted net income$ 4,540 $ (351 ) $ 7,436 $ 3
Set forth below is a reconciliation of our GAAP net loss attributable to common shareholders, per share to our non-GAAP adjusted net income per share:
Three Months Ended Six Months Ended
June 30, June 30,
2021 2020 2021 2020
GAAP net loss attributable to
common shareholders, per share $ (0.27 ) $ (0.65 ) $ (0.63 ) $ (1.07 )
Impact of preferred stock dividend 0.25 0.27 0.48 0.48
Net loss per end-of-period share (0.02 ) (0.38 ) (0.15 ) (0.59 ) Foreign exchange loss / other expense (0.01 ) 0.01 0.01 (0.03 )
Stock-based compensation expense 0.12 0.15 0.21 0.26 Amortization of purchased intangible assets 0.15 0.15 0.30 0.25 Transaction and integration costs 0.04 0.04 0.06 0.09 Impairment and unoccupied lease charges 0.02 0.01 0.07 0.03 Income tax expense (benefit) related to goodwill 0.01 (0.01 ) 0.01 (0.01 ) Non-GAAP adjusted earnings per share$ 0.31 $ (0.03 ) $ 0.51 $ 0.00 End-of-period common shares 14,611,606 12,454,691 14,611,606 12,454,691 In-the-money warrants and outstanding unvested RSUs 2,628,747 4,295,561 2,628,747 4,295,561 Total fully diluted shares 17,240,353 16,750,252 17,240,353 16,750,252 Non-GAAP adjusted diluted earnings per share$ 0.26 $ (0.02 ) $ 0.43 $ 0.00 For purposes of determining non-GAAP adjusted earnings per share, the Company used the number of common shares outstanding at the end ofJune 30, 2021 and 2020. Non-GAAP adjusted diluted earnings per share was computed using an as-converted method and includes warrants that are in-the-money as of that date as well as outstanding unvested RSUs. Non-GAAP adjusted earnings per share and non-GAAP adjusted diluted earnings per share do not take into account dividends paid on Preferred Stock. No tax effect has been provided in computing non-GAAP adjusted earnings per share and non-GAAP adjusted diluted earnings per share as the Company has sufficient carry forward net operating losses to offset the
applicable income taxes. Key Metrics In addition to the line items in our condensed consolidated financial statements, we regularly review the following metrics. We believe information on these metrics is useful for investors to understand the underlying trends in our business. 31 Providers and Practices Served: As ofJune 30, 2021 , we provided services to an estimated universe of more than 40,000 providers (which we define as physicians, nurses, nurse practitioners, physician assistants and other clinical staff that render bills for their services), representing approximately 2,600 independent medical practices and hospitals. In addition, we served approximately 200 clientswho were not medical practices, but are service organizationswho serve the healthcare community. The foregoing numbers include clients leveraging any of our products or services and are based in part upon estimates in cases where the precise number of practices or providers is unknown. Sources of Revenue Revenue: We primarily derive our revenues from subscription-based technology-enabled business solutions, reported in our Healthcare IT segment, which are typically billed as a percentage of payments collected by our customers. This fee includes RCM, as well as the ability to use our EHR, practice management system and other software as part of the bundled fee. These solutions accounted for approximately 80% and 83% of our revenues during the three months endedJune 30, 2021 and 2020, respectively, and 83% and 82% for the six months endedJune 30, 2021 and 2020, respectively. Other Healthcare IT services, including printing and mailing operations, group purchasing and professional services, represented approximately 12% and 5% of revenues for the three months endedJune 30, 2021 and 2020, respectively, and 8% and 5% for the six months endedJune 30, 2021 and 2020, respectively.
We earned approximately 8% and 12% of our revenue from medical practice
management services during the three months ended
Operating Expenses Direct Operating Costs. Direct operating cost consists primarily of salaries and benefits related to personnelwho provide services to our customers, claims processing costs, costs to operate the three managed practices, including facility lease costs, supplies, insurance and other direct costs related to our services. Costs associated with the implementation of new customers are expensed as incurred. The reported amounts of direct operating costs do not include depreciation and amortization, which are broken out separately in the condensed consolidated statements of operations.
Selling and Marketing Expense. Selling and marketing expense consists primarily of compensation and benefits, commissions, travel and advertising expenses.
General and Administrative Expense. General and administrative expense consists primarily of personnel-related expense for administrative employees, including compensation, benefits, travel, facility lease costs and insurance, software license fees and outside professional fees.
Research and Development Expense. Research and development expense consists primarily of personnel-related costs and third-party contractor costs.
Contingent Consideration. Contingent consideration represents the portion of consideration payable to the sellers of some of our acquisitions, the amount of which is based on the achievement of defined performance measures contained in the purchase agreements. Contingent consideration is adjusted to fair value at the end of each reporting period. Depreciation and Amortization Expense. Depreciation expense is charged using the straight-line method over the estimated lives of the assets ranging from three to five years. Amortization expense is charged on either an accelerated or on a straight-line basis over a period of three or four years for most intangible assets acquired in connection with acquisitions including those intangibles related to the group purchasing services. Amortization expense related to the value of our medical practice management clients is amortized on a straight-line basis over a period of twelve years.
Impairment and Unoccupied Lease Charges. Impairment charges represent charges recorded for a leased facility no longer being used by the Company and a non-cancellable vendor contract where the services are no longer being used.
32 Unoccupied lease charges represent the portion of lease and related costs for vacant space not being utilized by the Company. The Company is marketing both the unused facility and the unused space for sub-lease. Interest and Other Income (Expense). Interest expense consists primarily of interest costs related to our line of credit, term loans and amounts due in connection with acquisitions, offset by interest income. Other income (expense) results primarily from foreign currency transaction gains (losses) and income earned from temporary cash investments. Income Tax. In preparing our condensed consolidated financial statements, we estimate income taxes in each of the jurisdictions in which we operate. This process involves estimating actual current tax exposure together with assessing temporary differences resulting from differing treatment of items for tax and financial reporting purposes. These differences result in deferred income tax assets and liabilities. Although the Company is forecasting a return to profitability, it incurred losses historically and there is uncertainty regarding futureU.S. taxable income, which makes realization of a deferred tax asset difficult to support in accordance with ASC 740. Accordingly, a valuation allowance has been recorded against all deferred tax assets as ofJune 30 ,
2021 andDecember 31, 2020 .
Critical Accounting Policies and Estimates
The critical accounting policies and estimates used in the preparation of our condensed consolidated financial statements that we believe affect our more significant judgments and estimates used in the preparation of our condensed consolidated financial statements presented in this Report are described in Management's Discussion and Analysis of Financial Condition and Results of Operations and in the Notes to the consolidated financial statements included in our Annual Report on Form 10-K for the year endedDecember 31, 2020 .
Leases:
We determine if an arrangement is a lease at inception. Operating leases are
included in operating lease right-of-use ("ROU") assets, operating lease
liability (current portion) and operating lease liability (noncurrent portion)
in the condensed consolidated balance sheets at June 30, 2021 and December 31,
2020 . The Company does not have any finance leases.
ROU assets represent our right to use an underlying asset for the lease term and
lease liabilities represent our obligation to make lease payments arising from
the lease. ROU assets and liabilities are recognized at the lease commencement
date based on the estimated present value of lease payments over the lease term.
We use our estimated incremental borrowing rates, which are derived from
information available at the lease commencement date, in determining the present
value of lease payments. We give consideration to bank financing arrangements,
geographical location and collateralization of assets when calculating our
incremental borrowing rates.
Our lease term includes options to extend the lease when it is reasonably
certain that we will exercise that option. Leases with a term of less than 12
months are not recorded in the condensed consolidated balance sheet. Our lease
agreements do not contain any residual value guarantees. For real estate leases,
we account for the leased and non-leased components as a single lease component.
Some leases include escalation clauses and termination options that are factored
into the determination of the future lease payments when appropriate.
Capitalized software costs:
All of our software is considered internal use for accounting purposes, as we do not market or sell our software. As a result, we capitalize certain costs associated with the creation of internally-developed software for internal use. The total of these costs is recorded in Intangible assets - net in our condensed consolidated balance sheets. We capitalized costs incurred during the application development stage related to our internal use software. Costs incurred during the application development phase are capitalized only when we believe it is probable that the development will result in new or additional functionality. The types of costs capitalized during the application development phase consist of employee compensation, employee benefits and employee stock- based compensation. Costs related to the preliminary project stage and post-implementation activities are expensed as incurred. Capitalized internal-use software is amortized on a straight-line basis over its estimated useful life when the asset has been placed in service for general availability. 33 Significant judgments related to internally-developed software include determining whether it is probable that projects will result in new or additional functionality; concluding on when the application development phase starts and ends; and deciding which costs, especially employee compensation costs, should be capitalized. Additionally, there is judgment applied to the useful lives of capitalized software; we have concluded that the useful lives for capitalized internally-developed software is three years. Company management employs its best estimates and assumptions in determining the appropriateness of the judgments noted above on a project-by-project basis during initial capitalization as well as subsequent measurement. While we believe that our approach to estimates and judgments is reasonable, actual results could differ, and such differences could lead to an increase or decrease in expense.
As of
There have been no material changes in our critical accounting policies and estimates from those described in the Management's Discussion and Analysis of Financial Condition and Results of Operations, included in our Annual Report on Form 10-K for the year endedDecember 31, 2020 , filed with theSEC onFebruary 25, 2021 . Results of Operations
The following table sets forth our consolidated results of operations as a percentage of total revenue for the periods shown:
Three Months Ended Six Months Ended
June 30, June 30,
2021 2020 2021 2020
Net revenue 100.0 % 100.0 % 100.0 % 100.0 %
Operating expenses:
Direct operating costs 60.3 % 64.1 % 60.5 % 63.0 %
Selling and marketing 6.5 % 8.3 % 6.4 % 7.7 %
General and administrative 18.4 % 27.5 % 18.6 % 26.5 %
Research and development 5.3 % 11.0 % 6.0 % 10.8 %
Depreciation and amortization 9.2 % 12.3 % 9.3 % 9.0 %Impairment and unoccupied lease charges 0.7 % 0.3 %
1.9 % 0.9 % Total operating expenses 100.4 % 123.5 % 102.7 % 117.9 % Operating loss (0.4 )% (23.5 )% (2.7 )% (17.9 )% Interest expense - net 0.3 % 0.7 % 0.3 % 0.5 % Other income (expense) - net 0.6 % (0.6 )% (0.0 )% 0.8 % Loss before income taxes (0.1 )% (24.8 )% (3.0 )% (17.6 )%
Income tax provision (benefit) 0.6 % (0.4 )%
0.3 % (0.1 )% Net loss (0.7 )% (24.4 )% (3.3 )% (17.5 )% 34
Comparison of the three and six months ended
Three Months Ended Six Months Ended
June 30, Change June 30, Change
2021 2021 Amount Percent 2021 2020 Amount Percent
($ in thousands)
Net revenue$ 34,065 $ 19,579 $ 14,486 74 % $
63,834$ 41,446 $ 22,388 54 % Net Revenue. Net revenue of$34.1 million and$63.8 million for the three and six months endedJune 30, 2021 , respectively increased by$14.5 million or 74% and$22.4 million or 54% from net revenue of$19.6 million and$41.4 million for the three and six months endedJune 30, 2020 . Revenue for the three and six months endedJune 30, 2021 includes approximately$21.3 million and$38.5 million from customers acquired in the medSR, CCH and Meridian acquisitions. Revenue for the three and six months endedJune 30, 2021 includes$27.1 million and$53.0 million relating to technology-enabled business solutions,$3.5 million and$4.1 million related to professional services and$3.0 million and$5.7 million for medical practice management services. Three Months Ended Six Months Ended June 30, Change June 30, Change 2021 2020 Amount Percent 2021 2020 Amount Percent ($ in thousands) Direct operating costs$ 20,534 $ 12,557 $ 7,977 64 %$ 38,595 $ 26,123 $ 12,472 48 % Selling and marketing 2,204 1,625 579 36 % 4,094 3,206 888 28 % General and administrative 6,269 5,393 876 16 %
11,893 10,986 907 8 % Research and development 1,813 2,146 (333 ) (16 )% 3,839 4,479 (640 ) (14 )% Depreciation 533 288 245 85 % 994 562 432 77 % Amortization 2,595 2,117 478 23 % 4,965 3,176 1,789 56 %
Impairment and unoccupied lease charges 223 63 160 254 % 1,241 361 880 244 % Total operating expenses$ 34,171 $ 24,189 $ 9,982 41 %$ 65,621 $ 48,893 $ 16,728 34 % Direct Operating Costs. Direct operating costs of$20.5 million and$38.6 million for the three and six months endedJune 30, 2021 increased by$8.0 million or 64% and$12.5 million or 48% compared to direct operating costs of$12.6 million and$26.1 million for the three and six months endedJune 30, 2020 . During the three and six months endedJune 30, 2021 , salary costs increased by$4.8 million and$8.4 million , and outsourcing and processing costs increased by$2.5 million and$3.4 million , respectively. The increase in the costs for the three and six months endedJune 30, 2021 were primarily related to the CCH, Meridian and medSR acquisitions. Selling and Marketing Expense. Selling and marketing expense of$2.2 million and$4.1 million for the three and six months endedJune 30, 2021 increased by$579,000 or 36% and$888,000 or 28% from selling and marketing expense of$1.6 million and$3.2 million for the three and six months endedJune 30, 2020 . The increase was primarily related to additional emphasis on sales and marketing activities which began as a result of the CCH acquisition. General and Administrative Expense. General and administrative expense of$6.3 million and$11.9 million for the three and six months endedJune 30, 2021 increased by$876,000 or 16% and$907,000 or 8% compared to the same period in 2020. The increase in general and administrative expense was primarily related to the CCH, Meridian and medSR acquisitions. Research and Development Expense. Research and development expense of$1.8 million and$3.8 million for the three and six months endedJune 30, 2021 decreased by$333,000 and$640,000 from research and development expense of$2.1 million and$4.5 million for the three and six months endedJune 30, 2020 . The decrease primarily represented additional capitalization of software costs. During the three and six months endedJune 30, 2021 , the Company capitalized approximately$1.7 million and$3.3 million of development costs in connection with its internal-use software, respectively. Depreciation. Depreciation of$533,000 and$994,000 for the three and six months endedJune 30, 2021 increased by$245,000 or 85% and$432,000 or 77% from the depreciation of$288,000 and$562,000 for the three and six months endedJune 30, 2020 , primarily due to the property and equipment acquired as part of the MedMatica, CCH and Meridian acquisitions. 35
Amortization Expense. Amortization expense of$2.6 million and$5.0 million for the three and six months endedJune 30, 2021 , respectively increased by$478,000 or 23% and$1.8 million or 56% from amortization expense of$2.1 million and$3.2 million for the three and six months endedJune 30, 2020 . The increase was primarily related to the intangible assets acquired from the MedMatica, CCH
and
Meridian acquisitions.
Impairment and Unoccupied Lease Charges. Impairment charges represent charges
recorded for a leased facility no longer being used by the Company and the
impairment of a vendor contract assumed in the CCH acquisition where the
provided services are no longer being used by the Company. Unoccupied lease
charges represent the portion of lease and related costs for space not being
utilized by the Company. The Company is marketing both the unused facility and
the unused space for sub-lease.
Three Months Ended Six Months Ended
June 30, Change June 30, Change
2021 2020 Amount Percent 2021 2020 Amount Percent
($ in thousands)
Interest income $ 2 $ 4 $ (2 ) (50 )% $ 6 $ 42 $ (36 ) (86 )%
Interest expense (115 ) (146 ) 31 21 % (183 ) (264 ) 81 31 %
Other income (expense)
- net 205 (114 ) 319 280 % (15 ) 331 (346 ) (105 )%
Income tax expense
(benefit) provision 213 (74 ) (287 ) (388 )% 212 (44 ) (256 ) (582 )%
Interest Income. Interest income of$2,000 and$6,000 for the three and six months endedJune 30, 2021 , respectively, decreased by$2,000 or 50% and$36,000 or 86% from interest income of$4,000 and$42,000 for the three and six months endedJune 30, 2020 , respectively. The interest income represents interest earned on temporary cash investments. Interest Expense. Interest expense of$115,000 and$183,000 for the three and six months endedJune 30, 2021 , respectively, decreased by$31,000 or 21% and$81,000 or 31% from interest expense of$146,000 and$264,000 for the three and six months endedJune 30, 2020 , respectively. Interest expense includes the amortization of deferred financing costs, which was$71,000 and$96,000 during the six months endedJune 30, 2021 and 2020, respectively. Other Income (Expense) - net. Other income (expense) - net was$205,000 and ($15,000 ) for the three and six months endedJune 30, 2021 , respectively compared to other income (expense) - net of ($114,000 ) and$331,000 for the three and six months endedJune 30, 2020 , respectively. Other income (expense) primarily represents foreign currency transaction gains and other expense primarily represents foreign currency transaction losses. These transaction gains and losses result from revaluing intercompany accounts whenever the exchange rate varies and are recorded in the condensed consolidated statements of operations. Income Tax Provision. The provision for income taxes was$213,000 and$212,000 for the three and six months endedJune 30, 2021 , respectively compared to income tax benefits of$74,000 and$44,000 for the three and six months endedJune 30, 2020 , respectively. As a result of the Company incurring a tax loss for 2021 and 2020, which has an indefinite life under the current Federal tax rules, the federal deferred tax liability was offset against the federal net operating loss to the extent allowable in 2021 and 2020. The current income tax provision for the three and six months endedJune 30, 2021 was approximately$51,000 and$86,000 and primarily relates to state minimum taxes and foreign income taxes. The Company has incurred cumulative losses historically and there is uncertainty regarding futureU.S. taxable income, which makes realization of a deferred tax losses difficult to support in accordance with ASC 740. Accordingly, a valuation allowance was recorded against all deferred tax assets atJune 30, 2021 and
December 31, 2020 . 36
Liquidity and Capital Resources
Borrowings under the SVB facility are based on 200% of repeatable revenue, reduced by an annualized attrition rate as defined in the agreement. As ofJune 30, 2021 ,$5.0 million was drawn on the SVB facility which was fully repaid
inJuly 2021 . During the three and six months endedJune 30, 2021 , there was positive cash flow from operations of approximately$1.1 million and$2.1 million , respectively. As ofJune 30, 2021 , the Company had approximately$9.5 million in cash with$5.0 million drawn on its line of credit, and positive working capital of$8.0 million . The line of credit was fully repaid inJuly 2021 . During April andJuly 2020 , the Company sold 1,932,000 shares of its Series A Preferred Stock and received net proceeds of approximately$44.6 million , after issuance expenses. A portion of these proceeds was used to fully repay the line of credit outstanding atMarch 31 andJune 30, 2020 . During the first quarter of 2021, 858,000 warrants for common stock issued to Midcap Funding as part of the consideration for the Meridian acquisition were exercised at an exercise price of$7.50 per warrant. The Company received net proceeds of approximately$6.4 million .
During
The following table summarizes our cash flows for the periods presented:
Three Months Ended June 30, Six Months Ended June 30, Change
2021 2020 2021 2020 Amount Percent
($ in thousands)
Net cash provided by (used in)
operating activities $ 1,123 $ 955 $ 2,081 $ (2,928 ) $ 5,009 171 %
Net cash used in investing
activities (14,780 ) (13,122 ) (16,999 ) (27,155 ) 10,156 37 %
Net cash provided by financing
activities 2,434 16,249 3,591 23,058 (19,467 ) (84 )%
Effect of exchange rate changes
on cash (270 ) 55 (96 ) (437 ) 341 78 %
Net (decrease) increase in cash
and restricted cash $ (11,493 ) $ 4,137 $ (11,423 ) $ (7,462 ) $ (3,961 ) (53 )%
The loss before income taxes was$14,000 and$2.0 million for the three and six months endedJune 30, 2021 , respectively, which included$3.1 million and$6.0 million of non-cash depreciation and amortization, respectively. The loss before income taxes for the three and six months endedJune 30, 2020 was$4.9 million and$7.3 million , respectively, which included$2.4 million and$3.7 million of non-cash depreciation and amortization, respectively. During 2021, the Company paid approximately$4.2 million in cash to resolve a civil investigation for which one of the subsidiaries it acquired in 2020 has been subject to sinceJuly 2018 . Of this amount,$4.0 million came from escrowed shares of preferred stock that the Company held that were subsequently cancelled. Operating Activities Cash provided by operating activities was$2.1 million for the six months endedJune 30, 2021 and cash used by operations was$2.9 million during the six months endedJune 30, 2020 . During both the three and six months endedJune 30, 2021 , approximately$4.2 million of cash from operations was used to settle a pre-existing contingent liability from the CCH acquisition, which resulted in an equivalent reduction in the value of consideration paid. The decrease in the net loss of$5.1 million for the six months endedJune 30, 2021 as compared to the same period in 2020 was accompanied by the following changes in non-cash items: an increase in depreciation and amortization expense of$2.5 million , a decrease in stock-based compensation expense of$186,000 , a change in the provision (benefit) for deferred income taxes of$226,000 and a decrease in interest accretion of$43,000 . The net change in operating assets and liabilities was$6.9 million . Accounts payable, accrued compensation and accrued expenses decreased by$6.1 million for the six months endedJune 30, 2021 compared to a decrease of$5.6 million for the six months endedJune 30, 2020 as the Company paid past due amounts which existed at the time of the CCH and Meridian acquisitions. Accounts receivable increased by$1.7 million for the six months endedJune 30, 2021 compared with a decrease of$1.6 million for the six months endedJune 30, 2020 . For the six months endedJune 30, 2021 and 2020, the change in the lease liabilities is
included in this amount. 37 Investing Activities Capital expenditures were$1.5 million and$817,000 for the six months endedJune 30, 2021 and 2020, respectively. The capital expenditures for the six months endedJune 30, 2021 and 2020 primarily represented computer equipment purchased and leasehold improvements for the Pakistan Offices. Software development costs of$3.3 million and$2.6 million for the six months endedJune 30, 2021 and 2020, respectively, were capitalized in connection with the development of software for providing technology-enabled business solutions. Financing Activities
Cash provided by financing activities during the six months endedJune 30, 2021 and 2020, was$3.6 million and$23.1 million , respectively. The Company received$6.4 million from the exercise of common stock warrants,$1.4 million from the sale of common stock and$5.0 million from the line of credit during the six months endedJune 30, 2021 . Cash used in financing activities during the six months endedJune 30, 2021 included$7.2 million of preferred stock dividends,$391,000 of repayments for debt obligations and$1.6 million of tax withholding obligations paid in connection with stock awards issued to employees. Cash used in financing activities for the six months endedJune 30, 2020 included$4.5 million of preferred stock dividends,$186,000 of repayment for debt obligations and$1.0 million of tax withholding obligations paid in connection with stock awards issued to employees.
Contractual Obligations and Commitments
We have contractual obligations under our line of credit. We also maintain
operating leases for property and certain office equipment. We were in
compliance with all SVB covenants as of
Off-Balance Sheet Arrangements
As ofJune 30, 2021 , and 2020, we did not have any relationships with unconsolidated entities or financial partnerships, such as entities often referred to as structured finance or special-purpose entities, which would have been established for the purpose of facilitating off-balance sheet arrangements or other contractually narrow or limited purposes. During 2020, aNew Jersey corporation, talkMD Clinicians, PA ("talkMD"), was formed by the wife of the Executive Chairman,who is a licensed physician, to provide telehealth services. talkMD was determined to be a variable interest entity ("VIE") for financial reporting purposes because the entity will be controlled by the Company. As ofJune 30, 2021 , talkMD had not yet commenced operations or had any transactions or agreements with the Company or otherwise. We do not engage in off-balance sheet financing arrangements.
© Edgar Online, source
