HealthStream : 2017 Annual Report

2017 LETTER TO SHAREHOLDERS

FINANCIAL HIGHLIGHTS

Year Ended December 31,		2017		2016
(In thousands, except per share amounts)
Statement of Income Data:
Revenues	$	247,662	$	225,974
Operating costs and expenses		237,862		220,407
Operating income		9,800		5,567
Other income, net		733		581
Income before income taxes		10,533		6,148
Income tax provision		529		2,393
Net income	$	10,004	$	3,755
Net income per share:
Basic	$	0.31	$	0.12
Diluted	$	0.31	$	0.12
Weighted average shares of common stock outstanding:
Basic		31,861		31,721
Diluted		32,196		32,068
Income before interest, taxes, share-based compensation,
depreciation and amortization ("Adjusted EBITDA"(1)):
Net income	$	10,004	$	3,755
Interest, income taxes, share-based compensation, depreciation and amortization		27,925		26,096
Adjusted EBITDA	$	37,929	$	29,851

1. In order to better assess the Company's financial results, management believes that income before interest, income taxes, share-based compensation, depreciation and amortization ("Adjusted EBITDA") is a useful measure for evaluating the operating performance of the Company at this stage in its life cycle because adjusted EBITDA reflects net income adjusted for non-cash and non-operating items. We believe that Adjusted EBITDA is also useful to many investors to assess the Company's results from current operations. Adjusted EBITDA is a non-GAAP financial measure and should not be considered as a measure of financial performance under generally accepted accounting principles. Because adjusted EBITDA is not a measurement determined in accordance with generally accepted accounting principles, it is susceptible to varying calculations. Accordingly, adjusted EBITDA, as presented, may not be comparable to other similarly titled measures of other companies.

Year Ended December 31,		2017	2016
(In thousands)
Balance Sheet Data:
Cash and cash equivalents	$	84,768	$ 49,634
Investments in marketable securities		46,350	53,540
Accounts receivable, net		40,849	44,805
Goodwill and intangible assets		179,114	188,129
Working capital		98,662	82,467
Total assets		411,074	396,000
Deferred revenue - current and noncurrent		75,256	76,401
Shareholders' equity		300,170	286,108

TOTAL REVENUES

(in $ millions)
2013								132.3
2014										170.7
2015												209.0
2016													226.0	247.7
2017
0	20	40	60	80	100	120	140	160	180	200	220	240	260

DIRECTORS

Robert A. Frist, Jr.	Frank E. Gordon
Chief Executive Officer, President, and	Managing Partner
Chairman of the Board of Directors	Crofton Capital
HealthStream, Inc.	Michael Shmerling
Jeffrey L. McLaren	Chairman
Chief Executive Officer	Clearbrook Holdings Corporation
Medaxion, Inc.	Dale W. Polley
Thompson S. Dent	Past President and Vice Chairman
Chairman and Chief Executive Officer	First American Corporation
Urgent Team	C. Martin Harris, M.D.
Chairman
Re:Cognition Health	Associate Vice President of the Health Enterprise
William W. Stead, M.D.	Chief Business Officer
Dell Medical School
Chief Strategy Officer	The University of Texas at Austin
Vanderbilt University Medical Center	Deborah Taylor Tate, J.D.
Linda E. Rebrovick	Former Commissioner
Senior Client Partner	Federal Communications Commission
Morgan Samuels	Director
	State of Tennessee /Administrative Office of the Courts

EXECUTIVE OFFICERS

Robert A. Frist, Jr.

Chief Executive Officer, President, and Chairman of

the Board of Directors

J. Edward Pearson

Chief Operating Officer and Senior Vice President

Gerard M. Hayden, Jr.

Chief Financial Officer and Senior Vice President

Michael M. Collier

General Counsel and Senior Vice President

Jeffrey S. Doster

Chief Information Officer and Senior Vice President

Jeffrey D. Cunningham

Chief Technology Officer and Senior Vice President

Michael J. Sousa

President, Provider Solutions and Senior Vice President

LETTER TO SHAREHOLDERS

Since we became a public company almost 18 years ago, the healthcare industry has experienced extraordinary change-but one thing remains constant: every patient is important and deserves the best possible care. To that end, healthcare organizations are using HealthStream's solutions to develop and maintain a knowledgeable, highly skilled workforce to deliver patient care. I continue to be inspired by what our customers are achieving with HealthStream-and I am even more excited about the opportunities ahead of us.

Our 2017 financial performance was solid. Year-end results for 2017 included annual revenues of $247.7 million, up 10 percent over 2016 revenues. Operating income for 2017 was $9.8 million, up 76 percent over 2016. Adjusted EBITDA (earnings before interest, income taxes, share-based compensation, depreciation, and amortization) also improved significantly in 2017 compared to 2016. These full-year results are based on all three business segments that comprised the Company during 2017, which included Workforce Development Solutions, Provider Solutions, and Patient Experience Solutions.

HealthStream ended 2017 well capitalized with a cash and marketable securities balance of $131.1 million and full availability of our $50 million line of credit-which remains untapped. This strong capital position allows us to utilize multiple strategies for creating shareholder value, such as developing and launching new products and pursuing an active M&A pipeline.

Our target market is a workforce of approximately

8.5 million healthcare professionals, which includes approximately 5.2 million employees working in the nation's acute-care hospitals and 3.3 million employees in the post-acute care market. By combining the capabilities of our enterprise workforce development platform with leading content and superior data and analytics, we are equipping healthcare organizations with powerful solutions to optimize the impact of their workforce in delivering outstanding patient-centered care. Every day, we help our customers meet compliance requirements, develop their clinical workforce, improve resuscitation outcomes, manage revenue cycles, and ensure that their workforce maintains all required credentials.

HealthStream is focused on delivering innovative solutions that drive positive outcomes in healthcare- and we are increasingly seeing that happen. Our recently launched Nurse Residency Pathway™ solution, for example, is a unique, blended learning program that closes the academic-to-practice gap for nurses, optimizing safe, quality patient care and retention rates. During a pilot of this new solution at a large health system, new nurses reported a 52 percent increase in their confidence levels and nurse turnover was reduced by 12 percent, which is less than half of the industry average.

HealthStream's enterprise workforce development solutions include a wide range of healthcare-specific applications, such as the HealthStream Learning Center™, HealthStream Performance Center™, and HealthStream Competency Center™, along with several complementary applications like Checklist Management™ and COI- Smart™. At year-end 2017, approximately 4.77 million employees of United States healthcare organizations subscribed to HealthStream's workforce platform applications through their respective organizations.

Along with multiple workforce applications on our platform, we have amassed an ecosystem of over 100 healthcare industry partners, which include highly regarded professional medical and nursing associations as well as best-in-class content providers. In 2017, some of our new industry partners included: the Association of Women's Health, Obstetrics, and Neonatal Nurses (AWHONN); Duke University Schools of Nursing and Medicine; VitalSims; and the Association of Clinical Research Professionals (ACRP); among others.

Our industry partners are increasingly beginning to incorporate HealthStream's core technologies into their initial thinking and development plans as they consider what is now possible for their products by leveraging our powerful network, its data and benchmarking opportunities. EBSCO Health, for example, adapted its prestigious Clinical Skills Development Program to take advantage of HealthStream's Checklist Management application, thereby reaching hundreds of thousands of healthcare professionals that subscribe and use Checklist Management in their respective healthcare organizations.

As a leading provider of healthcare training and development solutions, HealthStream is uniquely positioned to bring choice and competition to the

market on behalf of the thousands of hospitals and health systems that we serve on a daily basis. We have brought a wide selection of training options to customers, including, for example, two of the top three leading brands in clinical skills development. We firmly believe that such an approach benefits our customers, our industry partners, and the Company.

In contrast to our current "marketplace approach" where we aim to offer multiple, competing product/ solution options for customers, our historical practice has been to select one partner only for a specific solution area. We did this for over a decade for our resuscitation solutions that we offered through a partnership with Laerdal Medical A/S ("Laerdal"). In June 2017, Laerdal provided notice that they do not intend to continue their existing agreements for sales of HeartCode and Resuscitation Quality Improvement (RQI) products or enter into new agreements with us in relation to these products. Our agreements to sell these products remain in effect through December 31, 2018 and we are prohibited from selling substantially similar products to HeartCode and RQI during that time.

Beginning in 2019, we believe that we will be well positioned to introduce choices for highly effective resuscitation solutions to our customers. HealthStream is fully committed to making the next 10 years a period of great improvement in the quality of resuscitation. We firmly believe disruptive resuscitation technologies and innovation should drive quality up and cost down for our healthcare customers-and we are excited about several newly contracted partners that are helping us get ready to do that in early 2019.

HealthStream's Provider Solutions business now serves over 2,400 hospitals and over 1,000 medical groups, making us the leading credentialing, privileging, and enrollment company in the United States. In January 2018, we introduced "Verity, a HealthStream Company™" as the name of our newly formed business that combined our Echo and Morrisey businesses. Echo was formed in September 2015 as a combination of HealthStream's previous acquisitions of HealthLine Systems and SyMed Development, while Morrisey Associates was acquired in August 2016. As we introduced the new name for our Provider Solutions business, Verity, we simultaneously launched our

SaaS-based provider credentialing, privileging, and enrollment solutions, which is also named Verity™. Our Verity offering combines the best platform, content, data, services, and community to deliver a foundational source of truth for healthcare organizations.

In February 2018, HealthStream divested its Patient Experience business to Press Ganey Associates for $65.5 million in cash. We expect after-tax cash proceeds of approximately $50.0 million, $6.55 million of which is subject to an indemnification escrow under the terms of the purchase agreement with Press Ganey Associates. The proceeds received from this transaction provided an ideal opportunity for HealthStream to return value directly to its shareholders. Accordingly, the Board of Directors declared a $1.00 per common share special cash dividend to shareholders of record on March 6, 2018, which was paid on April 3, 2018.

Looking forward, we intend to continue growing HealthStream organically by increasing our customer base and expanding the number of solutions provided to existing accounts. We may also pursue Company growth by utilizing a portion of our cash position and/or common stock to acquire or invest in opportunities arising from our M&A pipeline while we, at the same time, continue to invest in the integration and enhancement of new products and capabilities for our customers.

In closing, I want to thank you, our shareholders, for your continued commitment and support of HealthStream. I, along with the rest of the management team, believe that HealthStream is achieving its vision to improve the quality of healthcare by assessing and developing the people who deliver care. We will continue to put forth our best efforts to the task of producing superior results for you.

Sincerely,

Robert A. Frist, Jr.

Chairman and Chief Executive Officer