Computer Programs and Systems Annual Report 2023

FY2023 Annual Report · Computer Programs and Systems

Loading PDF…

2 0 2 3 A N N U A L R E P O R T

Clear the way for care.

COMPANY PROFILE
We are a trusted partner to more than 1,500 healthcare organizations with a broad range of technology-first solutions
that address the unique needs and challenges of diverse communities, promoting equitable access to quality care and
fostering positive outcomes. TruBridge has over four decades of experience in connecting providers, patients and
communities with innovative data-driven solutions that create real value by supporting both the financial and clinical side
of healthcare delivery. Our industry leading HFMA Peer Reviewed® suite of revenue cycle management (RCM) offerings
combine unparalleled visibility and transparency to enhance productivity and support the financial health of healthcare
organizations across all care settings. We support efficient patient care with electronic health record (EHR) product
offerings that successfully integrate data between care settings. Above all, we believe in the power of community and
encourage collaboration, connection, and empowerment with our customers. We clear the way for care. For more
information, please visit www.trubridge.com.

ANNUAL MEETING
The annual meeting of stockholders will be held Thursday, May 9, 2024, at 8:00 a.m. Central Time in a virtual format only via
the internet at www.proxydocs.com/TBRG.

FINANCIAL HIGHLIGHTS

(In thousands, except per share data)

Revenues:
RCM
EHR
Patient engagement
Total sales revenues
Total cost of revenue
Operating income (loss)
Total other expense

Income (loss) before taxes

Provision (benefit) for income taxes
Net income (loss)
Net income (loss) per common share—basic and diluted
Weighted average shares outstanding
Basic
Diluted

Year Ended December 31,

2023

2022

$ 193,929
138,063
7,443
339,435
175,868
(42,604)
(11,776)
(54,380)
(8,591)
(45,789)
(3.15)

$
$

$ 179,870
139,823
6,955
326,648
166,541
22,783
(4,702)
18,081
2,214
15,867
1.08

14,187
14,187

14,356
14,356

5
3
4

9
3
3
$

8
4
6

6
2
3
$

9
2
6

0
8
2
$

4
3
6

4
7
2
$

8
8
4

4
6
2
$

)
s
d
n
a
s
u
o
h
t

$
(

s
e
u
n
e
v
e
R

8
6
4

0
2
$

0
3
4

8
1
$

7
6
8

5
1
$

6
4
2

4
1
$

)
s
d
n
a
s
u
o
h
t

$
(

e
m
o
c
n

t
e
N

)
9
8
7

5
4
(
$

e
r
a
h
S
r
e
P
s
g
n

n
r
a
E
d
e
t
u

l
i

3
4

1
$

6
2

1
$

8
0

1
$

8
9

0
$

)
5
1

3
(
$

19 20 21 22 23

TO OUR SHAREHOLDERS:

We are pleased to report to our shareholders for the first time under our new company name, TruBridge.

This name change reflects our transformation journey over the past two years, with a goal to align our
products and services more effectively with market demand and pursue a more comprehensive go-to-
market strategy under one brand. We believe the TruBridge name represents the tangible benefits
that our solutions provide in today’s dynamic healthcare market and more accurately reflects our current
strategic focus and planned growth trajectory. Our vision is to Clear the Way for Care by leveraging
our collective knowledge and experience to pursue a strategy that supports providers and creates value
for our shareholders.

For over four decades, TruBridge has been at the forefront of helping clients across all care settings to
drive improved financial health and support more efficient care delivery. We are proud of our long-standing
reputation as a trusted partner to healthcare providers, helping them navigate through changing economic
dynamics, shifting regulations, alternative payment models and ongoing pressure to improve the quality
of care. As one company, TruBridge is collectively focused on bridging gaps in healthcare through the
timely delivery of solutions that solve real problems in the communities we serve. With a singular focus on
addressing the technology needs of today’s complex healthcare environment, TruBridge will continue to
deliver our industry-leading suite of revenue cycle management (RCM) offerings and utilize data-driven
tools and insights that deliver workflow efficiencies and remove distractions. Importantly, we will build upon
the legacy created by CPSI and our electronic health record (EHR) business to support more efficient care
delivery in small, rural community hospitals and clinics. Above all, we remain steadfast in our commitment to
offer the same exceptional support and high-touch service that our valued clients have come to expect.

Our results for the year reflect a challenging market environment in our core hospital client base. Hospitals,
especially those with fewer than 100 beds, faced tremendous cost pressures, primarily labor-related, leading
many to pause or delay any non-clinical spending, including the decision to implement new technology
solutions or outsource their RCM services. While we have also extended our target market for our RCM
solutions to larger hospitals of 100 to 400 beds, we often faced a longer decision-making process due to the
complexities of multiple decision makers. As a result, our overall RCM sales and cross-selling opportunities did
not match the pace we expected. Nevertheless, based on our consistent high-touch communications with
our market, we are confident providers will ultimately decide to transition to an outsourced model and look to
trusted partners like TruBridge. In the meantime, we have made operational adjustments to support our core
business and improve the efficiency of our own operations to ensure we will be in a strong position to take
advantage of future opportunities as they arise.

Despite the challenges we faced in 2023, we were pleased to finish the year with a solid fourth quarter top
line performance, providing positive growth momentum as we enter 2024. Annual revenues for the year
were $339.4 million compared with $326.6 million in 2022. These results were led by our RCM business
with revenues increasing by 7.8 percent to $193.9 million in 2023 compared to $179.9 million for 2022. For

the year, RCM represented 57.1 percent of total revenue, our EHR business accounted for 40.7 percent and
our Patient Engagement business rounded out the remaining 2.2 percent. Total bookings for 2023 were
$85.1 million compared with $89.4 million in 2022. While we experienced a slower than expected pace in
cross-selling opportunities for most of the year, we were encouraged to see both sequential and year-over-
year improvement in the fourth quarter. Additionally, our current pipeline indicates there are more potential
opportunities that we expect to lead to improved deal flow in 2024.

We believe that our efforts over the past year to realign our sales team and strengthen client relationships
with a higher level of consultation will support higher sales, especially as market conditions improve.
Importantly, we have an experienced sales staff that clearly understands the demands placed on hospitals
and the associated financial dynamics of their revenue cycle needs. Providers are looking for ways to improve
their financial performance and offer the most effective delivery of healthcare services, but they are often
understaffed and unable to focus on non-clinical operations. In addition, the value-based care model has
created more complexity around reimbursement, especially for smaller hospitals with limited administrative
resources to navigate the revenue cycle.

Importantly, our solutions are backed by a high level of ongoing support that fosters strong relationships,
and we are fortunate to have a loyal customer base of over 1,500 healthcare providers who will continue to
benefit from the unmatched value proposition that is synonymous with the TruBridge brand. For 2023, our
client retention rate was approximately 95 percent, consistent with recent years, and we remain laser focused
on improving our retention level with a high-touch strategy for our clients. As a trusted business partner, we
will continue to leverage these relationships to drive opportunities for cross-selling RCM and other TruBridge
offerings both within our traditional EHR customer base as well as expanding sales outside our network.
As healthcare organizations increasingly look to outsource their RCM process, TruBridge is a trusted name
that brings the right experience and expertise to meet their needs, with access to innovative solutions that
enhance their performance. We take the burden away with our industry-leading HFMA Peer-Reviewed® suite
of RCM offerings.

In 2023, we continued to pursue a global workforce strategy to support our business more effectively as we
have faced a shortage of qualified domestic labor resources. Additionally, moving more of our RCM resources
offshore presents a meaningful opportunity for cost savings in our core business. To support this strategy, in
October 2023, we acquired Viewgol, an offshore provider of ambulatory RCM analytics and complementary
outsourcing services. The addition of this direct offshore presence supports our objective to ensure our RCM
offerings remain affordable, profitable, and scalable. Having a globalized workforce in-house rather than solely
relying on third-party partners ensures a more consistent level of support, which is critical to maintaining the
same quality of service for our clients. In addition to gaining improved access to global resources and potential
margin expansion, Viewgol is focused on the ambulatory setting, creating additional market opportunities for
TruBridge and diversifying our RCM business. As we continue to ramp up our global capacity over the course
of 2024, we expect to capture meaningful synergies by utilizing Viewgol’s existing offshore infrastructure.
Longer term, our goal is to achieve a workforce comprised of 70 percent offshore and 30 percent U.S.-based
support.

As part of our ongoing business transformation, following the end of 2023, we announced the divestiture
of our subsidiary, American HealthTech, Inc., or AHT, a leading provider of EHR solutions to the post-acute
care market, to PointClickCare. Based in Toronto, Canada, PointClickCare is a leading healthcare technology
platform serving long-term and post-acute care providers, primarily skilled nursing facilities, across North
America. We believe PointClickCare is an ideal partner for our former AHT clients due to PointClickCare’s
high level of service and exclusive focus on delivering EHR solutions for the post-acute care market.
PointClickCare and AHT share similar cultures and values, making this an ideal fit for AHT clients and
employees. We are confident this transaction will benefit post-acute care clients and support their
objective to deliver the highest quality of care.

Following the completion of this transaction, we entered a referral partnership whereby PointClickCare will
exclusively refer TruBridge’s RCM solution to their skilled nursing home clients. This post-acute care market
remains under penetrated, however, we believe that skilled nursing home facilities will ultimately need to
outsource part or all of the RCM process to drive efficiencies and improve financial health. Leveraging our
tenure and experience, this partnership will provide a clear choice for a trusted RCM partner in TruBridge.

Our RCM solution is key to our future growth, as we continue to believe more healthcare organizations will
increasingly look to outsource part or all of their RCM process. As a trusted business partner, providers
benefit from our industry-leading products and services that streamline business operations for consistent
revenue and cash flow, assess and augment staffing needs, automate claims management, prepare for value-
based reimbursement, and improve the patient experience. We remain committed to supporting providers
across the care continuum with our proven RCM, EHR and Patient Engagement solutions that improve the
financial health of healthcare organizations, enhance the delivery of quality care, and promote engagement
between providers and patients. Our focus on innovation is a key differentiator for TruBridge, with products
that use real-time data to drive efficiency, enhance care delivery and support better patient outcomes. Our
Patient Engagement solution allows patients to securely access healthcare records over mobile devices
and computers, with live support for portal-related needs and convenient features like online bill pay. By
connecting providers and patients with the information and tools they need to advance patient care, we
help our clients achieve a wide range of clinical and business objectives.

While we faced many challenges over the past year, we also made significant progress in our transformation
journey. Looking forward to 2024 and beyond, we remain focused on execution and operational excellence as
we strive to extend our market reach. As TruBridge, we have a strong value proposition and a more focused
strategy that leverages our experience and expertise to drive favorable outcomes. We will continue to drive
collaboration, innovation and growth as we help our valued clients respond to both the opportunities and
challenges of today’s healthcare marketplace. Above all, we are a healthcare solutions company with the
critical tools our clients need to support both the financial and clinical side of healthcare delivery. We remain
steadfast in our mission to help communities thrive and promote equitable access to quality healthcare for
all. We are grateful for the support of our global workforce of over 3,000 people who share this mission and
continue to work hard every day to earn the trust of our valued clients. We also acknowledge the unwavering
support of our Board of Directors and executive management team for their leadership and guidance
throughout this journey. Together, we will Clear the Way for Care as we pursue a strategic direction that
delivers greater value to the communities we serve and our shareholders.

Sincerely,

Chris L. Fowler
President and Chief Executive Officer

This page intentionally left blank.

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549

FORM 10-K

☒

☐

ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT OF 1934

FOR THE FISCAL YEAR ENDED December 31, 2023

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT OF 1934

FOR THE TRANSITION PERIOD FROM TO .

Commission file number: 000-49796
TruBridge, Inc.
(Exact Name of Registrant as Specified in Its Charter)

Delaware
(State or Other Jurisdiction of
Incorporation or Organization)

54 St. Emanuel Street, Mobile, Alabama

(Address of Principal Executive Offices)

74-3032373
(I.R.S. Employer
Identification No.)

36602
(Zip Code)

(251) 639-8100
(Registrant’s telephone number, including area code)
Securities registered pursuant to Section 12(b) of the Act:

Title of each class
Common Stock, par value $.001 per share

Trading symbol

TBRG

Name of each exchange on which registered
The NASDAQ Stock Market LLC

Securities registered pursuant to Section 12(g) of the Act:
None

Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ¨ No x

Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ¨ No x
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act

of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to
such filing requirements for the past 90 days. Yes x No ¨

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to

Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to
submit such files). Yes x No ¨

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting
company, or an emerging growth company. See the definitions of "large accelerated filer," accelerated filer,” "smaller reporting company," and
"emerging growth company" in Rule 12b-2 of the Exchange Act. (Check one):

Accelerated filer

Smaller reporting company

ý
☐

Large accelerated filer

Non-accelerated filer

¨
☐

Emerging Growth Company
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any
new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ¨
Indicate by check mark whether the registrant has filed a report on and attestation to its management's assessment of the effectiveness of its internal
control of financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that
prepared or issued its audit report. ☒
If securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the financial statement of the registrant included in the
filing reflect the correction of an error to previously issued financial statements. ☐
Indicate by check mark whether any of those error corrections are restatement that required a recovery analysis of incentive-based compensation
received by any of the registrant's executive officers during the relevant recovery period pursuant to §240.10D-1(b). ¨

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act). Yes ☐ No x
The aggregate market value of common stock held by non-affiliates of the registrant at June 30, 2023 was $358,665,532.
As of March 11, 2024, the registrant had outstanding 14,507,776 shares of its common stock.

DOCUMENTS INCORPORATED BY REFERENCE IN THIS FORM 10-K:

Portions of the definitive Proxy Statement for the 2024 Annual Meeting of Stockholders are incorporated by reference into Part III of this report to the
extent described herein.

Item No.

Special Note Regarding Forward-Looking Statements

Page No.

TABLE OF
CONTENTS

1A.
1B.
1C.
2
3
4

6
7

7A.
8
9

9A.
9B.
9C.

10
11
12

13
14

PART I
Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Industry Dynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Our Products and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Software Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Product Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
System Implementation and Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Clients, Sales and Marketing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Backlog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Competition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Information Security and Privacy Practices . . . . . . . . . . . . . . . . . . . . . . . .
Intellectual Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Material Government Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Human Capital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Executive Officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Company Web Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unresolved Staff Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cybersecurity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Legal Proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mine Safety Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART II

Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer
Purchases of Equity Securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Management’s Discussion and Analysis of Financial Condition and Results of
Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Quantitative and Qualitative Disclosures about Market Risk . . . . . . . . . . . . . . . . . . . .
Financial Statements and Supplementary Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Changes in and Disagreements with Accountants on Accounting and Financial
Disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Controls and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Disclosure Regarding Foreign Jurisdictions that Prevent Inspections . . . . . . . . . . . . . .

PART III
Directors, Executive Officers and Corporate Governance . . . . . . . . . . . . . . . . . . . . . . .
Executive Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Security Ownership of Certain Beneficial Owners and Management and Related
Stockholder Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Certain Relationships and Related Transactions, and Director Independence . . . . . . . .
Principal Accountant Fees and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6
6
6
8
9
13
13
13
14
15
16
17
17
19
18
20
21
22
42
42
43
44
44

45
46

46
62
63

104
104
105
105

106
106

107
107
107

15 . . . . . . . . . . . . . Exhibits and Financial Statement Schedules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16 . . . . . . . . . . . . . Form 10-K Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SIGNATURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

108
108
108

Portions of the definitive Proxy Statement for the 2024 Annual Meeting of Stockholders are incorporated by
reference into Part III of this report to the extent described herein.

PART IV

SPECIAL NOTE REGARDING FORWARD LOOKING STATEMENTS

This Annual Report on Form 10-K contains forward-looking statements within the meaning of the "safe harbor" provisions of
the Private Securities Litigation Reform Act of 1995. These forward-looking statements can be identified generally by the use
of forward-looking terminology and words such as "expects," "anticipates," "estimates," "believes," "predicts," "intends,"
"plans," "potential," "may," "continue," "should," "will" and words of comparable meaning. Without limiting the generality of
the preceding statement, all statements in this Annual Report relating to estimated and projected earnings, margins, costs,
expenditures, cash flows, growth rates and future financial results are forward-looking statements. We caution investors that
any such forward-looking statements are only predictions and are not guarantees of future performance. Certain risks,
uncertainties and other factors may cause actual results to differ materially from those projected in the forward-looking
statements. The following is a summary of the principal risks that could adversely affect our business, financial condition,
results of operations and cash flows.

Risks Related to Our Industry

•
•

saturation of our target market and hospital consolidations;
unfavorable economic or market conditions that may cause a decline in spending for information technology and
services;
significant legislative and regulatory uncertainty in the healthcare industry;
exposure to liability for failure to comply with regulatory requirements;

Risks Related to Our Business

•
•
•
•
•
•
•
•

•

•
•
•

transition to a subscription-based recurring revenue model and modernization of our technology;
competition with companies that have greater financial, technical and marketing resources than we have;
potential future acquisitions that may be expensive, time consuming, and subject to other inherent risks;
our ability to attract and retain qualified personnel;
disruption from periodic restructuring of our sales force;
slower than anticipated development of the market for RCM services;
our potential inability to manage our growth in the new markets we may enter;
our operations could be significantly disrupted if we do not effectively implement a new enterprise resource planning
software solution;
exposure to numerous and often conflicting laws, regulations, policies, standards or other requirements through our
international business activities;
potential litigation against us and investigations;
our use of offshore third-party resources;
competitive and litigation risk related to the use of artificial intelligence;

Risks Related to Our Products and Services

•
•
•
•
•
•
•
•
•
•
•
•
•

potential failure to develop new products or enhance current products that keep pace with market demands;
exposure to claims if our products fail to provide accurate and timely information for clinical decision-making;
exposure to claims for breaches of security and viruses in our systems;
undetected errors or problems in new products or enhancements;
our potential inability to convince customers to migrate to current or future releases of our products;
failure to maintain our margins and service rates;
increase in the percentage of total revenues represented by service revenues, which have lower margins;
exposure to liability in the event we provide inaccurate claims data to payors;
exposure to liability claims arising out of the licensing of our software and provision of services;
dependence on licenses of rights, products and services from third parties;
a failure to protect our intellectual property rights;
exposure to significant license fees or damages for intellectual property infringement;
service interruptions resulting from loss of power and/or telecommunications capabilities;

Risks Related to Our Indebtedness

•
•
•
•
•

our potential inability to secure additional financing on favorable terms to meet our future capital needs;
substantial indebtedness that may adversely affect our business operations;
our ability to incur substantially more debt;
pressures on cash flow to service our outstanding debt;
restrictive terms of our credit agreement on our current and future operations;

Risks Related to Our Common Stock and Other General Risks

•
•
•
•
•
•
•
•
•

changes in and interpretations of financial accounting matters that govern the measurement of our performance;
the potential for our goodwill or intangible assets to become impaired;
quarterly fluctuations in our financial results due to various factors;
volatility in our stock price;
failure to maintain effective internal control over financial reporting;
inherent limitations in our internal control over financial reporting;
vulnerability to significant damage from natural disasters;
exposure to market risk related to interest rate changes; and
potential material adverse effects due to macroeconomic conditions.

For more information about the risks described above and other risks affecting us, see "Risk Factors" beginning on page 22 of
this Annual Report. We also caution investors that the forward-looking information described herein represents our outlook
only as of this date, and we undertake no obligation to update or revise any forward-looking statements to reflect events or
developments after the date of this Annual Report.

ITEM 1.

BUSINESS

Overview

PART I

Founded in 1979, TruBridge, Inc. (“TruBridge” or the “Company”) is a leading provider of healthcare solutions and services
for community hospitals, their clinics and other healthcare systems. Previously named Computer Programs and Systems, Inc.,
the Company changed its name to TruBridge, Inc. on March 4, 2024 in a Company-wide rebranding and legal entity
consolidation. TruBridge is a trusted partner to more than 1,500 healthcare organizations with a broad range of technology-first
solutions that address the unique needs and challenges of diverse communities, promoting equitable access to quality care and
fostering positive outcomes. TruBridge has over four decades of experience in connecting providers, patients and communities
with innovative data-driven solutions that create real value by supporting both the financial and clinical side of healthcare
delivery. Our industry leading HFMA Peer Reviewed® suite of revenue cycle management (RCM) offerings combine
unparalleled visibility and transparency to enhance productivity and support the financial health of healthcare organizations
across all care settings. We support efficient patient care with electronic health record (EHR) product offerings that
successfully integrate data between care settings. Above all, we believe in the power of community and encourage
collaboration, connection, and empowerment with our customers. We clear the way for care.

The Company’s legal structure includes TruBridge, Inc., the parent company, with Viewgol, LLC ("Viewgol"), iNetXperts,
Corp. d/b/a Get Real Health, Healthcare Resource Group, Inc. ("HRG"), and Healthland Holding Inc. as its wholly-owned
subsidiaries. The Company operates its business in three operating segments, which are also our reportable segments: RCM,
EHR, and Patient Engagement. These segments contribute towards the combined focus of improving the health of the
communities we serve as follows:

•

The RCM reporting segment focuses on providing a complete RCM solution for all care settings, regardless of their
primary healthcare information solutions provider along with business management, consulting, managed IT services,
analytics and business intelligence.

The EHR segment provides comprehensive acute care solutions and related services for community hospitals, and their
physician clinics.

The Patient Engagement segment offers comprehensive patient engagement and empowerment technology solutions to
improve patient outcomes and engagement strategies with care providers.

Our companies currently support community hospitals and other healthcare systems with a geographically diverse patient mix
within the domestic community healthcare market. Our target market for our RCM, EHR, and Patient Engagement solutions
includes community hospitals with fewer than 400 acute care beds, and their clinics, as well as independent or small to medium
sized chains of skilled nursing facilities. Approximately 98% of our acute care hospital EHR customer base is comprised of
hospitals with fewer than 100 beds. As of January 16, 2024, we have divested our post-acute care EHR business, American
HealthTech, Inc., to PointClickCare Technologies USA Corp. During 2023, we generated revenues of $339.4 million from the
sale of our products and services.

In October 2023, the Company closed its acquisition of Viewgol, LLC ("Viewgol"), a provider of ambulatory RCM analytics
and complementary outsourcing services, for a purchase price is $36 million in cash, with an additional earnout of up to
approximately $31.5 million based on achieving certain objectives post-closing.

See Note 18 to the consolidated financial statements included herein for additional information on our three reportable
segments.

Industry Dynamics

The healthcare industry is the largest industry in the United States economy, comprising approximately 17.3% of the U.S. gross
domestic product in 2022 according to the Centers for Medicare and Medicaid Services ("CMS"). CMS estimates that national
health spending is projected to grow at an average annual rate of 5.4% through 2031 and will reach $7.0 trillion in 2031.

Hospital expenditures grew by 2.2% to approximately $1.5 trillion in 2022, slower than the 4.5% growth rate in 2021.
According to the American Hospital Association’s AHA Hospital Statistics, 2022 Edition, there are approximately 4,600
community hospitals in the United States that are in our target market of hospitals with fewer than 400 beds, with
approximately 2,900 of those having fewer than 100 acute care beds. In addition, there is a market of small specialty hospitals
that focus on discrete medical areas such as surgery, rehabilitation and long-term acute care.

The healthcare industry is constantly challenged by changing economic dynamics, increased regulation and pressure to improve
the quality of care. These factors create an environment of escalating costs of care which, because of their heavy reliance on
Medicare and Medicaid programs, our hospital clients have limited ability to recover through reimbursement changes.
However, we believe healthcare providers can successfully address these issues with the help of our advanced medical
information systems, including our RCM solutions and our suite of complementary services. Specific examples of the
challenges and opportunities facing healthcare providers include the following:

Changing Economic Dynamics

The healthcare industry is heavily influenced by legislative and regulatory initiatives of the federal and state governments.
These initiatives have a particularly significant impact on our customer base, as community hospitals generate a significant
portion of their revenues from beneficiaries of the Medicare and Medicaid programs. Consequently, even small changes in
federal and state programs have a disproportionate effect on community hospitals as compared to larger facilities where greater
portions of their revenues are generated from beneficiaries of private insurance programs.

Medicare and Medicaid funding and reimbursements fluctuate annually and, with projected growth in healthcare costs, will
continue to be scrutinized as the federal and state governments attempt to control the costs and growth of the program. As the
federal government seeks to further limit deficit spending in the future due to fiscal restraints, it will likely continue to place
constraints on healthcare spending programs such as Medicare and Medicaid matching grants, which will place further cost
pressures on hospitals and other healthcare providers. Further reductions in reimbursements from these programs could lead to
hospitals postponing expenditures on information technology and may motivate hospitals to revisit long-held cost structures,
which could positively impact demand for RCM and other services.

While legislative and regulatory initiatives are placing significant pressure on the related reimbursements, community hospitals
are also faced with likely increased demand for Medicare and Medicaid services. Medicare Advantage enrollment in rural
communities has grown by nearly 50% from 2019 through 2023. The challenges posed by this dual-threat are complicated by
the shift away from volume-based reimbursement towards value-based reimbursement, linking reimbursement to quality
measurements and outcomes. The increasing prevalence of high deductible health plans and value-based reimbursement
models is transforming domestic healthcare delivery into a more patient-centric experience. This transformation brings about
new and increased data needs, resulting in additional regulatory demands for data that patients find useful in decision-making.
These new regulatory demands increase regulatory risks and compliance burdens for TruBridge and our clients, but also pose
opportunities for TruBridge to provide additional value-added products and services to our target market.

To compete in the continually changing healthcare environment, providers are increasingly using technology in order to help
maximize the efficiency of their business practices, to assist in enhancing patient care, and to maintain the privacy and security
of patient information. Healthcare providers are placing increased demands on their information systems to accomplish these
tasks. We believe that information systems must facilitate management of patient information across administrative, financial
and clinical tasks and must also effectively interface with a variety of payor organizations within the increasingly complex
reimbursement environment.

The American Recovery and Reinvestment Act of 2009

In 2009, the U.S. federal government enacted the American Recovery and Reinvestment Act (the “ARRA”), which included the
Health Information Technology for Economic and Clinical Health Act (“HITECH”). HITECH authorized the EHR incentive
program, which provided significant incentive funding to physicians and hospitals that have adopted and are appropriately
using technology such as our EHR solutions. The end result of the ARRA has been to accelerate the adoption of EHR
technology nationwide, significantly increasing industry-wide penetration rates and our penetration rates within our existing
customer base for our current menu of applications. As a result, the revenue opportunities for new customer additions have
greatly diminished, as have our opportunities for add-on sales to existing customers.

Continued Push for Improved Patient Care

With the increased pressure to improve the quality of healthcare and reduce costs, there is a general shift towards value-based
reimbursement, which increases the demand for information technology solutions for clinical decision support. This migration
toward clinical decision support solutions is further supported by the ARRA.

In the face of decreasing revenue and increasing pressure to improve patient care, healthcare providers are in need of
management tools and related services that (1) increase efficiency in the delivery of healthcare services, (2) reduce medical
errors, (3) effectively track the cost of delivering services so that those costs can be properly managed and (4) increase the
speed and rate of reimbursement. A hospital’s failure to adequately invest in a modern medical information system could result

in fewer patient referrals, cost inefficiencies, lower than expected reimbursement, increased malpractice risk and possible
regulatory infractions. Additionally, we believe that the industry will continue to increase its utilization of third party services
that contribute to the achievement of these and other objectives necessary for success in the current environment. We believe
these dynamics should allow for future revenue growth for both our information technology solutions and our complementary
suite of services.

COVID-19 Pandemic

The healthcare industry continues to deal with the lingering effects of the COVID-19 pandemic, including financial disruptions
and critical labor shortages. Looking beyond 2023, we believe there will be continued pressure on hospital staffing, creating
greater demand for automation and machine learning to allow staff to focus on patient care. Payors are experiencing staffing
issues, similar to hospitals, which is causing delays in authorizations, denials and extended processing times for appeals. As a
result of these issues and pressures, we expect ongoing and continued growth in demand for our RCM and related services.

The pandemic has also heightened patient interest and demand for digital engagement. While purchasing demand for digital
patient engagement solutions in the United States has not yet fully materialized, we believe healthcare leaders will embrace the
digital acceleration, identifying new channels to connect with patients and strengthen the patient experience over the next few
years. Our digital front door technology helps create efficiencies and patient engagement that lead to greater patient connections
and improved care. We also expect to see continued health care policy legislation focused on patients, like pricing transparency
and the No Surprises Act, which is intended to address unexpected gaps in insurance coverage that result in “surprise medical
bills” when patients unknowingly obtain medical services (such as emergency services) from out-of-network providers.

Strategy
Our primary objectives are to increase the market share of our RCM solutions and services, maintain a strong retention rate
within our EHR client base while pursuing competitive and vulnerable EHR replacement opportunities, and further establish
our position as a leading provider of patient engagement solutions. The acquisition of Viewgol, whose operations are almost
entirely focused on the ambulatory setting, creates additional market expansion opportunities, and diversifies our RCM
business. These objectives are all in support of our corporate strategy, centered around the following components:

Core Growth

Our core growth initiatives include cross-selling RCM solutions and services into our existing sizeable EHR client base and
expanding our RCM market share with sales to new community hospitals and larger health systems.

Over the course of our more than 45-year history, we have developed a significant customer base of community hospitals. This
customer base is our most valuable asset, providing not only the critical mass necessary to scale our development, client support
and service resources to meet the evolving needs of our customers, but also serving as fertile ground for our cross-selling efforts
for additional value-added solutions and services. Chief among our cross-sell opportunities is RCM, where we utilize our
industry-leading RCM services and solutions to improve the financial health of our EHR clients by improving cash flow metrics
in the face of the myriad cost and reimbursement challenges facing healthcare organizations. Our operational expertise and
technology tools provide proven results in improving claim acceptance rates, accelerating payments from third party payors,
and increasing private pay collections.

Margin Optimization

These efforts support the core growth efforts as we routinely seek, find and execute on initiatives that modernize our business,
increasing our efficiency and resulting in cost savings, and thereby allowing us to reinvest in additional growth opportunities
and enabling better positioning on pricing elasticity.

Chief among our margin optimization initiatives are parallel workstreams dedicated to (1) standardizing and streamlining
existing workflows by leveraging automation to improve both the accuracy and efficiency of our services, and (2)
systematically leveraging offshore resources to mitigate the high costs and disruption risks associated with single-source talent
markets. Talent availability has proven to be a significant challenge for our mostly-domestic customer base, and our
nationwide reach does little to mitigate this nationwide dilemma. With talent scarcity a real risk and prospects for growth that
require significant scale, the successful execution of our growth prospects requires both broadening our talent pool beyond the
domestic market and ensuring talent resources are put to their highest and best use.

Digital Innovation

In addition to our core growth and margin optimization initiatives is a focus on identifying new innovation and larger adjacency
opportunities, driven by demand for patient engagement, industry insights, reporting and analytics technology.

As today's patients and providers have a more collaborative approach to healthcare, our patient engagement offerings provide a
secure ecosystem that supports home care, clinicians, and the patients they serve by providing tools and analytics to provide a
complete view of patients' health and improve health outcomes. In addition to supporting improved care, our patient
engagement platform provides financial benefits to providers and hospital systems through increased revenue opportunities and
digital transformation of workflows to fill staffing gaps. This platform gives healthcare providers the insights and tools they
need to provide efficient, cost-effective care as they collaborate with today's growing population of engaged patients.

Underpinning each of the three components to our strategy is a capital allocation strategy designed to afford the flexibility
necessary to be adaptive and opportunistic with future investment decisions. Such flexibility is necessary if we are to continue
to bring timely products and services to a rapidly changing healthcare landscape. We serve the needs of multiple stakeholder
groups as customers benefit from the related products and services, our employees benefit from expanded opportunities for
development, and our stockholders benefit from the increasing diversity in revenue sources.

Our Products and Services

RCM

We offer RCM services which can be grouped into the following categories:

•

Revenue Cycle Management Products. Our RCM solutions empower providers and caregivers in hospitals, healthcare
systems, clinics and skilled nursing organizations to accelerate their revenue cycle through a suite of comprehensive,
web-based solutions designed to improve financial operations and staff productivity and increase reimbursement. Our
RCM products include the following offerings:

◦

Patient Liability Estimates. Improve patient satisfaction, maximize point-of-service collections, and equip staff
with the ability to provide transparent pricing with the Patient Liability Estimate module.

Eligibility Verification. Reduce claim denials and carrier rejections by performing on-demand eligibility look-
ups, assuring the care provided is covered.

Claim Scrubbing and Submission. A powerful claim management solution for submitting, validating, and
processing a healthcare facility’s claims with ease and with a high quality of edits.

Remittance Management. Remittance advice can be effortlessly gathered and managed with the Electronic
Remittance Advice Retrieval and Remittance Management modules, simplifying workflow and involvement.

Denial/Audit Management. Equips healthcare facilities with the tools necessary to combat denied and audited
claims, assisting organizations in recovering lost revenue.

Contract Management. Allows healthcare facilities to take control over complex healthcare contracts by
prospectively pricing every claim submitted to payers, retrospectively pricing every remittance to ensure proper
payment was received, and modeling proposed contract terms during payer negotiations.

•

Revenue Cycle Management Services. Our RCM services span a healthcare enterprise’s revenue cycle and provide
clients with a strong alternative to in-house operations. These services leverage our deep service and technology
experience and are designed to allow clients to streamline their administrative staffing while improving operational
efficiencies. Our RCM services include the following service offerings: Accounts Receivable Management, Private
Pay Service, Medical Coding, Revenue Cycle Consulting, and other additional Insurance and Patient Billing Services.

•

Consulting and Business Management Services. Our consulting and business management services are designed to
help healthcare organizations by assessing their needs, setting goals, and creating an action plan to achieve those goals,
and, if needed, implementing the action plan. Many of our professional consultants have decades of experience and all
are skilled in adopting new technologies, redesigning processes, educating staff, and providing interim or on-going
management services. Our consulting and business management services include the following service offerings:
Consulting, Business Intelligence, Staffing, and Administrative.

• Managed IT Services. Our managed IT services provide a range of services designed to meet the IT needs of

community healthcare enterprises. The pace of technological change can be overwhelming. Our services allow clients
to affordably maintain an advanced IT infrastructure, meet regulatory requirements, and reduce risk. Our managed IT
services include the following service offerings: Cloud Services, Backup and Recovery, Collaboration and
Connectivity, Security Services, Systems Management, and Help Desk.

•

Encoder Solutions. Our encoder technology and services support the hospital, consulting and payer markets. Our
encoder solution is known for its knowledge-based coding methodology, which presents coding guidance and
references at the point of coding, helping to improve coding accuracy and productivity.

EHR

Acute Care Software Systems

We offer healthcare IT solutions designed to cater to the specific needs of community hospital organizations under the software
solution platform TruBridge EHR.

TruBridge EHR

Within TruBridge EHR, we offer a full array of software applications using one fully integrated system designed to
streamline the flow of information to the primary functional areas of community hospitals. We intend to continue to
enhance our existing software applications and develop new applications as required by evolving industry standards and
the changing needs of our clients. Pursuant to our client support agreements, we provide our clients with software
enhancements and upgrades periodically on a when-and-if-available basis. See "Acute Care Support and Maintenance
Services." These enhancements enable each client, regardless of its original installation date, to have the benefit of our
most advanced products available. Our software applications within TruBridge EHR

•

provide automated processes that improve clinical workflow and support clinical decision-making;

allow healthcare providers to efficiently input and easily access the most current patient medical data in order
to improve quality of care and patient safety;

integrate clinical, financial and patient information to promote efficient use of time and resources, while
eliminating dependence on paper medical records;

provide tools that permit healthcare organizations to analyze past performance, model new plans for the future
and measure and monitor the effectiveness of those plans;

provide for rapid and cost-effective implementation, whether through the installation of an in-house system or
through our Software as a Service ("SaaS") services; and

increase the flow of information by replacing centralized data over which there is limited control with broad-
based, secure access by clinical and administrative personnel to data relevant to their functional areas.

Our software applications within Trubridge EHR are grouped for support purposes according to the following general
functional categories described below:

•

Patient Management. Our patient management software enables a hospital to identify a patient at any point in
the healthcare delivery system and to collect and maintain patient information throughout the entire process of
patient care on an enterprise-wide basis. The TruBridge EHR single database structure permits authorized
hospital personnel to simultaneously access appropriate portions of a patient’s record from any point on the
system. Our patient management software applications include: Registration, Patient Accounting, Health
Information Management, Patient Index, Enterprise Wide Scheduling, Contract Management, and Quality
Improvement.

•

Financial Accounting. Our financial accounting software provides a variety of business office applications
designed to efficiently track and coordinate information needed for managerial decision-making. Our
financial accounting software applications include: Executive Information System, General Ledger, Accounts
Payable, Payroll/Personnel, Time and Attendance, Electronic Direct Deposits, Human Resources, Budgeting,
Fixed Assets, and Materials Management.

Clinical. Our clinical software automates record keeping and reporting for many clinical functions including
laboratory, radiology, physical therapy, respiratory care and pharmacy. These products eliminate tedious
paperwork, calculations and written documentation while allowing for easy retrieval of patient data and
statistics. Our clinical software applications include: Laboratory Information Systems, Laboratory Instrument
Interfaces, Radiology Information Systems, ImageLink Picture Archiving and Communication System
(PACS), Physical Therapy and Respiratory Care, and Pharmacy.

Patient Care. Our patient care applications allow hospitals to create computerized "patient files" in place of
the traditional paper file systems. This software enables physicians, nurses and other hospital staff to improve
the quality of patient care through increased access to patient information, assistance with projected care
requirements and feedback regarding patient needs. Our software also addresses current safety initiatives in
the healthcare industry such as the transition from written prescriptions and physician orders to computerized
physician order entry. Our patient care software applications include: Order Entry/Results Reporting, Point-
of-Care System, Patient Acuity, ChartLink®, Computerized Physician Order Entry (CPOE), Medication
Verification, Resident Assessment Instruments, Thrive Provider EHR, Outreach Client Access, Electronic
Forms, Physician Documentation, and Emergency Department System.

Enterprise Applications. We provide software applications that support the products described above and are
useful to all areas of the hospital. These applications include: ad hoc reporting, automatic batch and real-time
system backups, an integrated fax system, archival data repository, document scanning and Microsoft Office
integration, and an Application Portal.

Centriq

Centriq is a web-based acute-care EHR platform. We are discontinuing support and services of the Centriq platform as of
December 31, 2024. A large number of clients that used Centriq have already migrated to the TruBridge EHR platform.

Acute Care Support and Maintenance Services

After EHR installation, we provide software application support, hardware maintenance, continuing education and related
services pursuant to a support agreement using our collaborative support model. The following describes services provided to
customers using the TruBridge EHR:

• Total System Support. We believe the quality of continuing customer support is one of the most critical
considerations in the selection of an information system provider. We provide hardware, technical and
software support for all aspects of our system, which gives us the flexibility to take the necessary course of
action to resolve any issue. Unlike our competitors who use third-party services for hardware and software
support, we provide a single, convenient and efficient resource for all of our customers’ system support needs.
In order to minimize the impact of a system problem, we train our customer service personnel to be
technically proficient, courteous and prompt. Because a properly functioning information system is crucial to
a hospital’s operations, our support teams are available 24 hours per day to assist customers with any problem
that may arise. Customers can also use the Internet to directly access our support system.

• National Client Conference. All of our customers have the opportunity to attend our annual National Client
Conference. TruBridge hosts this conference to provide educational sessions, product demonstrations, and
one-on-one time with application experts. The conference also allows important time for networking among
customers and TruBridge staff across all business platforms. The in-person conference was held in Orlando,
Florida from April 30 to May 3, 2023. The 2024 in-person conference will be held during April in Las Vegas,
Nevada.

• Continuing Education. Effective learning tools are a key factor in successful EHR adoption and allowing

clients to get the most out of a software investment. Therefore, ongoing learning and training is a cornerstone
to our “total solution” and a key competitive differentiator. Our ongoing learning and training offerings also
address some of the unique needs of community hospitals - limited resources and staff with cross-department

responsibilities and budget and time constraints - all of which require a customized approach to learning and
training. To meet these needs, we offer customers online content that can be accessed at any time, scheduled
online interactive classroom presentations, on-campus training at our facilities, educational sessions during
user group conferences, and scheduled regional training sessions.

• Software Releases. We are committed to providing our customers with software and technology solutions that
will continue to meet their information system needs. To accomplish this purpose, we continually work to
enhance and improve our application programs. As part of this effort, for each customer covered under our
general support agreement, we provide software updates as they become available at no additional cost. We
design these enhancements to be seamlessly integrated into each customer’s existing system. The benefit of
these enhancements is that each customer, regardless of its original installation date, uses the most advanced
software available. Through this process, we can keep our customers up-to-date with the latest operational
innovations in the healthcare industry as well as with changing governmental regulatory requirements.
Another benefit of this "one system" concept is that our customer service teams can be more effective in
responding to customer needs because they maintain a complete understanding of and familiarity with the one
system that all customers use.

Purchasing a new information technology system requires the expenditure of a substantial amount of capital

and other resources, and many customers are concerned that these systems will become obsolete as
technology changes. Our periodic product updates eliminate our customers’ concerns about system
obsolescence. We believe providing this benefit is a strong incentive for potential customers to select our
products over the products of our competitors.

• Hardware Replacement. As part of our general support agreements, we are also committed to promptly

replacing malfunctioning system hardware in order to minimize the effect of operational interruptions. By
offering replacements of all hardware used in our system, we believe we are better able to meet and address
all of the information technology needs of our customers.

• Cloud Electronic Health Record (Cloud EHR). We offer Cloud EHR services to customers via remote access
telecommunications. Cloud EHR is a SaaS configuration and is a monthly subscription to access and use
application software maintained by TruBridge in a cloud environment. Under this configuration, a customer is
able to obtain access to an advanced EHR without a significant initial capital outlay. We store and maintain
all Cloud EHR customers’ critical patient and administrative data. These customers access this information
remotely through direct telecommunications connections.

• Forms and Supplies. In addition to our support services, we offer our customers the standard and customized
forms that they need for their patient and financial records, as well as the supplies necessary to support the
operation of their server and peripheral equipment. Furnishing these forms and supplies helps us to achieve
our objective of being a one-source solution for a hospital’s complete healthcare information system
requirements.

•

Public Cloud Infrastructure – In 2021, we formed a strategic partnership with Microsoft for Azure cloud
hosting and infrastructure services, with the end-goal of migrating all existing internal and client data to
Azure’s public cloud and utilizing the related infrastructure solutions to enhance both internal and client-
facing processes and services. The eventual migration to Azure, which began during 2022 and continued
through 2023, will benefit customers by removing the burden of maintaining their own on-premise
infrastructure while the underlying applications will operate with higher availability and stability, reducing
unexpected downtime. This modernized infrastructure will open the door to future innovations and data
access as well.

Post-acute Care Software Systems, Support and Maintenance Services

The Company entered into the post-acute care market with the acquisition of American HealthTech, Inc. ("AHT") in January
2016. Our comprehensive, long-term care management solutions in 2023 included care management and financial and
enterprise management, backed by ongoing training and support to ensure that clients can maximize their software investment.
Our post-acute care EHR business line was comprised solely of AHT and was disposed of in January 2024.

Patient Engagement

Our patient engagement offering is a comprehensive digital front door platform that both improves outcomes and promotes
patient engagement through the following tools:

•

InstantPHR. Our interactive portal is designed to serve all patient populations and health organizations' needs. Ideal for
chronic disease management, maintaining wellness goals, and meeting federal mandates, this solution is flexible
enough to grow and change as industry trends dictate. InstantPHR can be integrated into nearly any existing EHR
system to improve care and outcomes for individuals and professionals alike.

CHBase™. This powerful tool funnels data from multiple sources into one platform. Patients have the ability to
contribute data from their favorite apps and home health devices and combine it with clinical data from providers. This
combined data can then be pulled into patient-oriented health applications or population health management and
customer analytics. This process makes data comprehensive and relevant, thus maximizing its value to the entire care
circle. Additionally, innovators have the capability to create, develop and connect other systems and applications
through the CHBase APIs.

For additional details on our products, service, and support offerings, visit www.trubridge.com.

For the results of operations by segment, refer to Note 18 of the consolidated financial statements included herein.

Software Development

The healthcare information technology industry is characterized by rapid technological change requiring us to continually make
investments to update, enhance and improve our products and services. Software development costs are accounted for in
accordance with ASC 350-40, Internal-Use Software. Under ASC 350-40, software development costs related to preliminary
project activities and post-implementation and maintenance activities are expensed as incurred. We capitalize direct costs
related to application development activities that are probable to result in additional functionality. Capitalized costs are
amortized on a straight-line basis over five years. We test for impairment whenever events or changes in circumstances that
could impact recoverability occur.

Total product development expenses included in our consolidated results of operations were approximately $37.2 million, $31.9
million and $32.8 million during the years ended December 31, 2023, 2022 and 2021, respectively. We capitalized software
development costs of approximately $23.1 million, $19.1 million and $9.4 million during the years ended December 31, 2023,
2022 and 2021, respectively.

See Note 5 to the consolidated financial statements included herein for additional information on software development costs.

Product Strategy

We have built an enterprise-wide center of excellence for both our product and technology strategy. This organization utilizes
market research and interviews with clients, patients and healthcare subject matter experts, as well as extensive data
surrounding our solutions to ensure our technology is meeting our client’s needs.

Accessibility, scalability and usability serve as our critical product pillars, with recent investments in modern user experiences
and improved workflows designed to address all three. For example:

•

Through data normalization efforts and the creation of both a unified clinical interoperability solution with our TruBridge
Unify product technology and a modern data lakehouse solution for financial insights through TruBridge Analytics, we
have accelerated the pace of innovation, allowing our customers to recognize this value.

By deploying solutions such as robotic process automation, we continuously strive to optimize user workflows for our
clinical and financial solutions, increasing efficiencies and delivering modern user experiences.

By investing in new patient engagement and communication solutions, we have improved staff, provider and patient
interactions and increased patient participation in their healthcare experience.

System Implementation and Training

Conversion Services. When a client purchases or leases one of our systems, we convert their existing data to the new system.
Our knowledge of hospital data processing, in conjunction with extensive in-house technical expertise, allows us to accomplish

this task in a cost effective manner. When we install a new system, the data conversion has already occurred so that the system
is immediately operational. Our goal is for each client to be productive on day one in order to eliminate time and money wasted
on the costly and inefficient task of maintaining the same data on parallel systems. Our services also relieve the hospital staff of
the time-consuming burden of data conversion. The conversion process is the initial phase of our long-term partnership and
overall client experience.

Training. In order to integrate the new system and to ensure its success, we spend approximately sixteen weeks providing
individualized training remotely and on-site at the go-live. We provide hardware and software application training for all
hospital users, including staff members and healthcare providers, during all hospital shifts. We employ nurses, medical
technicians, and providers along with our technical training staff in order to help us communicate more effectively with our
clients during the training process. This training phase is also part of the overall client experience that is provided to all of our
clients.

Clients, Sales and Marketing

Target Markets

The target market for our RCM product and services extends beyond hospitals of less than 100 beds, where we have historically
focused our EHR efforts. We are acutely focused on our vision of selling our RCM solution to both our existing customer base,
as well as to hospitals of 400 beds or under in the United States. There are approximately 4,600 of these hospitals with fewer
than 400 beds.

Our strategy to grow our RCM business is centered around leveraging our established sales relationships within our substantial
EHR customer base in order to cross sell RCM services. In addition, we target hospitals that use competitor EHRs and
upmarket larger hospitals and health systems that manage their RCM operations in-house. The hospitals are under increasing
financial pressure caused by fluctuating patient volumes, increasing self-pay accounts, and the lingering impact of the
COVID-19 pandemic.

A core initiative to our growth plan is to maintain a strong retention rate across our EHR base and pursue conservative growth
of new EHR clients, as they are critical to driving cross-sales of our RCM solutions. We target hospitals under 100 beds in the
United States that we believe are currently using a vendor that we have determined is vulnerable based on a variety of factors.
Our goal in the ambulatory market is to aggressively target physician practices in those communities where the local hospital is
a current TruBridge client.

The target market for our acute care EHR systems consists of community hospitals with fewer than 200 acute care beds, with a
primary focus on hospitals with fewer than 100 acute care beds. In the United States, there are approximately 3,800 community
hospitals with fewer than 200 acute care beds, with approximately 2,900 having fewer than 100 acute care beds. In addition, we
market our products to small specialty hospitals in the United States that focus on discrete medical areas such as behavioral
health, surgery, rehabilitation and long-term acute care. Approximately 98% of our existing acute care clients are hospitals with
fewer than 100 acute care beds.

Our patient engagement efforts continue to focus on growing the number of registered patient users with existing clients in the
international market while also initiating penetration of the domestic market. We target hospitals in the U.S. that use competitor
EHRs, including upmarket larger hospitals and health systems that support multiple EHRs and data sources around affiliated
providers and practices. The target market for our domestic launch is acute care EHR systems of community hospitals that are
part of a hospital system. In the United States, there are approximately 3,400 community hospitals that fall into this category.
The target market for our engagement solution also includes government healthcare and health information exchanges focused
on leveraging technology to drive efficient care delivery in addition to citizen portal initiatives.

The following table presents our revenues generated from clients located within the U.S. ("Domestic") and all foreign countries,
in total ("International").

(In thousands)
Sales revenues:

Domestic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
International(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Year ended December 31,

2023

2022

2021

333,048 $

320,443 $

6,387
339,435 $

6,205
326,648 $

274,521

6,108
280,629

(1) International sales revenues are related to the Caribbean nation of St. Maarten, the islands of Turks and Caicos, the British
Overseas Territory of Anguilla, Canada, England, Australia, the United Arab Emirates and the Netherlands.

Sales Staff

We have dedicated sales organizations in all three business units: RCM, EHR, and patient engagement. Many of our sales
personnel are hired from within the Company and have previous experience in client support roles. We believe this experience
positions them to more effectively sell our products and services within our target markets. We have also added some talent
from outside the Company, creating a depth of experience we believe will enhance the effectiveness of the teams. Our sales
organizations are generally divided into four areas: sales management, new client sales, existing client sales and sales support
staff. New client sales staff are typically organized based on geographic territories. Our sales representatives who sell to
existing clients have assigned clients within their territory, which is also geographically based. Some sales representatives in
our services areas are assigned specifically to cross-sell services into our acute care EHR client base. A significant portion of
the compensation for all sales personnel is commission based except for administrative support staff.

Marketing Strategy

Our marketing strategy positions TruBridge as a healthcare solutions company that supports providers in their efforts to deliver
the best care possible for their communities. Through a suite of innovation products, collaborative services and tools, we help
clients eliminate the financial and operational obstacles holding them back and lay the foundation for lasting success. We are a
healthcare solutions company and we clear the way for care.

With regard to our RCM solutions, we will continue to leverage our proven track record of success in accounts receivable
management and private pay collections for community healthcare providers. With the increasing complexity of reimbursement
requirements and a global shift in healthcare towards an increase in patient financial responsibility, the ability of our services
business to bring expertise and best practice operational efficiencies to bear is a significant competitive advantage. In consulting
services, the added complexity brought about by the transition to the ICD-10 code set, a standard transaction code set for
diagnostic purposes under HIPAA, has created a significant demand for our coding services. Our strategy is to cross sell our
RCM solutions into our loyal EHR customer base as we prioritize strengthening our client relationships. At the same time, we
target the 400 bed and less hospital market outside of our EHR client network, which hospitals have a need to improve revenue
cycles and address staffing issues.

Our EHR software and services address providers across the care continuum, with a primary focus on the community healthcare
market. Our ability to connect patients to care providers within their community and across communities through our own
products and interoperability development, including our membership in the CommonWell Health Alliance, sets us apart from
other competitors in our market. Our goal is to position ourselves as partners to community healthcare providers as they move
to a more proactive care model based on the use of data analytics and patient engagement tools.

Our strategy to grow our patient engagement business is centered around leveraging our established customer relationships
within our substantial partner ecosystem for continued sales around licensing and professional services. In addition, we target
hospitals that use competitor EHRs, including upmarket larger hospitals and health systems that support multiple EHRs and
data sources around affiliated providers and practices. A core initiative to our growth plan is to maintain a strong retention rate
of this client base and pursue rapid growth of new clients domestically.

Backlog

Backlog consists of revenues we reasonably expect to recognize over the next twelve months under existing contracts. The
revenues to be recognized may relate to a combination of one-time fees for system sales and recurring fees for support and
maintenance and RCM services. As of December 31, 2023, we had a twelve-month backlog of approximately $9 million in

connection with non-recurring system purchases and approximately $328 million in connection with recurring payments under
support and maintenance and RCM services. As of December 31, 2022, we had a twelve-month backlog of approximately $6
million in connection with non-recurring system purchases and approximately $322 million in connection with recurring
payments under support and maintenance and RCM services.

Competition

The market for our products and services is competitive, and we expect additional competition from established and emerging
companies in the future. Our market is characterized by rapidly changing technology, global shifts in the healthcare system,
evolving user needs and impactful regulatory and reimbursement changes. We believe the principal competitive factors that
hospitals, clinics and post-acute care providers consider when choosing between us and our competitors are:

•

perceived level of product and system security;

product features, functionality and performance;

range of services offered;

level of client service and satisfaction;

ease of integration and speed of implementation;

product price;

cost of services offered;

results of services engagements;

knowledge of the healthcare industry;

training provided;

sales and marketing efforts; and

company reputation.

We believe that we compete favorably with our competitors on these factors. Our principal competitors for RCM solutions
include RelayHealth Corp, SSI Group, LLC, Quadax Inc., Change Healthcare Holdings, Inc., Availity, LLC, Waystar
Technologies, Inc., and Navicure, Inc. Our principal competitors in the business management, consulting and managed IT
services market are Resolution Health, Inc., The Outsource Group Inc., Patient Focus, Inc., Xtend Healthcare Inc., Ensemble
Health Partners, and nThrive, Inc. These companies all focus on providing services to the healthcare market, and the services
they offer are comparable in scope to the competing services we offer. Secondary competitors in the RCM space include ARx
LLC, Citadel Outsource Group LLC, Patient Matters, LLC, KIWI-TEK, LLC, and Aviacode Inc. The primary competitors for
our encoder solutions include 3M, Nuance and Optum.

Our principal competitors in the acute care EHR market are Oracle Cerner Corporation, Medical Information Technology, Inc.
("Meditech"), and MEDHOST, Inc. These companies compete with us directly in our target market of small and midsize
hospitals. They offer comparable products and systems that address the needs of hospitals in the markets we serve. Our
secondary competitors in the acute care EHR market include N. Harris Computer Corporation and Epic Systems Corporation.
These companies are significantly larger than we are, and they typically sell their products and services to larger hospitals
outside of our target market. However, they will sometimes compete with us directly or, more commonly, when a larger health
system who uses a system from one of these companies will offer it to a smaller hospital as part of a merger or alliance.

We also face competition from providers of practice management systems, general decision support and database systems and
other segment-specific applications. Any of these companies as well as other technology or healthcare companies could decide
at any time to specifically target hospitals within our target market.

Our principal competitors in the patient engagement market include Relay Health, Get Well Network/Healthloop, Apollo Care
Connect, Bridge Patient Portal, eClinicalWorks Patient Portal, Influence Health, and InteliChart.

Health Information Security and Privacy Practices

Health Insurance Portability and Accountability Act (“HIPAA”) is a federal law governing the use, disclosure, transmission and
storage of certain individually identifiable health information, referred to as "protected health information," and that was
enacted for the purpose of, among other things, protecting the privacy and security of protected health information. As directed
by HIPAA, the Department of Health and Human Services (the "DHHS") has promulgated standards and rules for certain
electronic health transactions, code sets, data security, unique identification numbers and privacy of protected health
information. HIPAA and the standards promulgated by DHHS apply to certain health plans, healthcare clearinghouses and
healthcare providers (referred to as "covered entities"), which includes our hospital and post-acute care clients. The Health
Information Technology for Economic and Clinical Health Act (the "HITECH Act") and its implementing regulations published
in January 2013 significantly expand HIPAA by extending privacy and security standards to "business associates" of healthcare
providers that are covered entities. Under the HITECH Act, business associates are required to establish administrative,
physical and technical safeguards and are subject to direct penalties for violations. Certain of our services frequently require us
to act as a healthcare clearinghouse and/or a business associate to the hospitals and post-acute care clients that we serve. As a
result, we are covered by the patient privacy and security standards of HIPAA and subject to oversight by DHHS. We believe
that we have taken all necessary steps to comply with HIPAA, as it applies to us as a business associate, but it is important to
note that DHHS could, at any time in the future, adopt new rules or modify existing rules in a manner that could require us to
change our systems or operations.

Protecting individually identifiable health information and other sensitive data is a critical and essential function of TruBridge’s
operations and its software solutions. A variety of industry-standard approaches that meet or exceed regulatory requirements
such as HIPAA and HITECH are employed. In order to avoid unauthorized access for the life span of this data, diverse methods
of identification, authentication, authorization and encryption are utilized at various points throughout the operating system,
application software and hardware. These methods and processes are shared amongst servers and other end-user devices and are
complemented by change management processes and tools, which allow the software change control cycle to be a formal,
defined process.

In addition to HIPAA, many states have enacted patient confidentiality laws that protect against the unauthorized disclosure of
confidential medical information, with many others adopting or considering further legislation in this area, including privacy
safeguards, security standards, and data security breach notification requirements. Such state laws, if more stringent than
HIPAA requirements, are not preempted by the federal requirements, and we must comply with them even though they may be
subject to different interpretations by various courts and other governmental authorities. For example, the California
Confidentiality of Medical Information Act has several standards that go beyond those set forth under HIPAA and its
regulations.

The collection, use, storage, disclosure, transfer, or other processing of any personal data regarding individuals in the European
Union, including personal health data, is subject to the European Union’s General Data Protection Directive (“GDPR”), which
became effective in May 2018. The GDPR is wide-ranging in scope and imposes numerous requirements on companies that
process personal data, including requirements relating to processing health and other sensitive data, obtaining consent of the
individuals to whom the personal data relates, providing information to individuals regarding data processing activities,
implementing safeguards to protect the security and confidentiality of personal data, providing notification of data breaches,
and taking certain measures when engaging third-party processors. The GDPR also imposes strict rules on the transfer of
personal data to countries outside the European Union, including the United States, and permits data protection authorities to
impose large penalties for violations of the GDPR, including potential fines of up to €20 million or 4% of annual global
revenues, whichever is greater. The GDPR also confers a private right of action on data subjects and consumer associations to
lodge complaints with supervisory authorities, seek judicial remedies, and obtain compensation for damages resulting from
violations of the GDPR.

Intellectual Property

We regard some aspects of our internal operations, software and documentation as proprietary, and rely primarily on a
combination of contract and trade secret laws to protect our proprietary information. We believe, because of the rapid pace of
technological change in the computer software industry, trade secret and copyright protection is less significant than factors
such as the knowledge, ability and experience of our employees, frequent software product enhancements and the timeliness
and quality of our support services. The source code for our proprietary software is protected as a trade secret. We enter into
confidentiality or license agreements with our vendors, consultants and clients, and control access to and distribution of our
software, documentation and other proprietary information. We cannot guarantee that these protections will be adequate or that
our competitors will not independently develop technologies that are substantially equivalent or superior to our technology.

The Company endeavors to protect its intellectual property rights and maintain certain trademarks, trade names, service marks
and other intellectual property rights, including Clear the Way for Care, TruBridge, MyCareCorner, and others. Trademark and
service mark registrations must generally be renewed every five to ten years and we renew the registration of trademarks that
we deem to have continuing value to our business.

We do not believe our software products or other TruBridge proprietary rights infringe on the property rights of third parties.
However, we cannot guarantee that third parties will not assert infringement claims against us with respect to current or future
software products or that any such assertion may not require us to enter into royalty arrangements or result in costly litigation.

Human Capital

As of December 31, 2023, we had 3,219 employees. Most of our employees are remote, with the remaining employees located
at our offices in Alabama, Mississippi, Pennsylvania, Washington, and Minnesota. None of our employees are covered by a
collective bargaining agreement or are represented by a labor union with respect to his or her employment with us. We have not
experienced any work stoppages and we consider our relations with our employees to be good.

We seek to attract, develop, and retain top talent in order to deliver a one-of-a-kind service experience while fully leveraging
the strengths of our workforce to exceed customer expectations and meet our growth objectives. By improving the employee
experience, we also improve the ability to support our customers and protect the long-term interests of our stockholders. To that
end, we strive to foster an engaged, purpose-driven culture where employees have an opportunity to achieve professional
success.

Diversity, Equity and Inclusion

We are committed to creating a welcoming and inclusive environment, where everyone is inspired to be the best they can be
and feels empowered to openly express opinions and ideas that help drive innovation, progress, and excellence. We eagerly
promote our relentless commitment to creating an inclusive and respectful culture across our family of companies. We are
steadfast in our responsibility to embrace the diversity of all people and demonstrate our values – collaborative, dependable,
proactive, empathetic and agile - with an unwavering focus on those essential to the Company achieving sustainable and
meaningful growth. We have a long-standing commitment to equal employment opportunity ("EEO"), as evidenced by the
Company’s EEO policy.

As part of our commitment the Company launched our Inclusion, Diversity, Equity Alliance ("Team IDEA") in 2020, an
employee-led council with executive sponsorship that is focused on strengthening company-wide engagement on diversity,
equity and inclusion, providing learning opportunities for our employees, and helping to identify areas for improvement and
monitor progress against these initiatives. The mission of the Team IDEA Diversity Council is to promote and champion
diversity, inclusion, equity, and global understanding throughout TruBridge to enable employee engagement and strong
business performance. The council members do this by sharing their diverse perspectives and advising management to help
shape and implement TruBridge’s DEI strategy. We are steadfast in our responsibility to embrace the diversity of all people and
demonstrate our values – embracing the fun, daring to explore, getting after greatness, doing the right thing, and putting people
first – with an unwavering focus on those essential to TruBridge achieving sustainable and meaningful growth.

Now, more than ever, we are committed to listening with open hearts and leading with empathy — toward each other, toward
our customers and toward our healthcare communities. We continue to invite our leaders, board, clients, and community
leaders, along with our chief people officer, to advise us along this journey.

Compensation and Benefits

We compensate employees with competitive wages and benefit and wellness programs designed to meet employee needs. Our
compensation program is designed to recognize our employees' contributions to service excellence and business results. We use
a combination of fixed and variable pay including base salary, bonus, commissions and merit increases which vary across the
Company. In addition, as part of our incentive plan for executives and certain employees, we provide stock-based compensation
to attract, retain and motivate our key leaders. For further information concerning our equity incentive plans, see Note 9, Stock-
based Compensation and Equity.

As the success of our employees is fundamentally connected to the well-being of our people, our benefit and wellness programs
focus on four key pillars: physical, emotional, financial, and social well-being. We offer a wide array of benefits including
comprehensive health and welfare insurances that reflect a 74% participation rate. Included is a 401(k) plan with employer-
match, generous time-off, company paid short term disability, basic life insurance, parental leave policy that pays 6 weeks to
those adding to their family, identity theft insurance, and financial planning support. We provide emotional well-being services

through our medical carrier, Neuro580, and associated Employee Assistance Program. Our financial education tools offer
employees resources to reach their personal financial goals. In addition, our newly added Pay it Forward (ETO donation)
program has gathered donations from 179 employees totaling over 6,000 hours of donated time. This program has helped 86
employees by granting them time off during personal or family medical crises.

We continue to partner with our employees, including our people leaders to understand how we can better support their health
and wellness while allowing them to be their true and authentic selves at work every day.

Development

Our goal is to promote the growth of our people through the provision of opportunities to cultivate talent, measurement of
performance in their current role, and identification of candidates for new roles within the Company. In 2023 we did this
through (1) a focus on developing our leaders, (2) increasing our people’s access to quality content, and (3) improving the
overall experience we provide to our learners. Accelerate 2.0 pushed the first 105 People Leaders through a customized
Leadership Development program guiding them on how to lead themselves, the business, and the Company. We upgraded our
content library to enable our employees access to over 30,000 new modules from over 150 publishers across a variety of core
themes. Through automation and governance revisions we increased the accuracy of our learning data and reduced barriers
between our people and the opportunities they seek.

To gauge an individual's ability to impact growth, we began installation of a performance architecture that better ties individual
financial reward to the individual’s contribution towards our present and future success as a Company. This includes setting
goals throughout the year, allowing people to evaluate progress against those goals, and gaining feedback from our people
leaders. Inherent in the execution of this process is an aim to recognize differentiation in individual performance levels and
incentivize accordingly. The balance of perspective on short and long-term performance paired with individualized
compensation is intended to promote sustained evolution and retention of our talent base.

Employee Recruitment

Our key talent philosophy is to develop talent from within and supplement with external hires. This approach has yielded a deep
understanding of our business, vision, products, services and clients among our employee base, while adding new employees
and ideas in support of our continuous improvement mindset. We continue to focus on working in a predominantly remote
environment, which supports our efforts to expand our internal talent and welcome employees from diverse backgrounds and
geographies, creating deeper team collaboration and a more engaging client experience. Our recruitment team uses internal and
external resources to recruit diverse, highly skilled and talented workers, and we encourage employee referrals for open
positions. The acquisition of Viewgol will bring a global perspective to hiring in 2024. Expanding our global footprint will
assist in diversifying our talent sources to scale our people practices.

Communication and Engagement

Given the geographic diversity of our workforce, we use multiple modalities in our communication efforts. Our email and the
employee hotline have been bolstered by weekly all-employee communications. Additionally, leaders participate in monthly
business updates that facilitate awareness of current business initiatives, progress and results. These meetings encourage cross-
functional collaboration and help ensure that our teams are not working in silos. These efforts have supported our ability to
deliver a more consistent message across all our constituencies and thereby improve employee engagement.

Material Government Regulations

Our business operations are subject to various federal, state and international laws, and our products and services are governed
by a number of rules and regulations. For example, we are affected by the following regulations:

•

As discussed above, the HIPAA security and privacy standards affect our claims transmission services, since those
services must be structured and provided in a way that supports our clients’ HIPAA compliance obligations, and
GDPR is applicable to certain of our activities conducted from an establishment in the EU and our operations that are
targeting clients and activities within the EU.

The United States Food and Drug Administration (the “FDA”) has determined that certain of our solutions, such as our
ImageLink® and Blood Administration ® products, are medical devices that are actively regulated under the Federal
Food, Drug and Cosmetic Act, as amended.

•

The use of our solutions by physicians for electronic prescribing and electronic routing of prescriptions via the
Surescripts network to pharmacies is governed by federal and state laws. States have differing regulations that govern
the electronic transmission of certain prescriptions and prescription requirements.

The federal Anti-Kickback Statute (“AKS”) (See 42 U.S.C. § 1320a-7b) is a criminal statute that prohibits the
exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business
reimbursable by federal health care programs. The CMS has stated that kickbacks have led to overutilization and
increased costs of healthcare services, corruption of medical decision making, steering patients away from valid
services or therapies and unfair, non-competitive service delivery. Certain of our products and services may be
reimbursed by federal healthcare programs such that referrals of business for such products and services may
implicate, or have the appearance of implicating, the AKS. Examples of prohibited kickbacks include receiving
financial incentives such as discounts or gifts for referrals. Possible penalties for violating the AKS include fines of up
to $25,000 per violation, up to five years in jail, and exclusion from Medicare and Medicaid care program business.

Although there is no assurance that existing or future government laws, rules and other regulations applicable to our operations,
products or services will not have a material adverse effect on our capital expenditures, results of operations and competitive
position, we do not currently anticipate materially increased expenditures in response to government regulations or future
material impacts to our results or competitiveness. These regulations and related risks are described in more detail below under
“Risk Factors” beginning on page 22 of this Annual Report.

Executive Officers

Set forth below is a list of the current executive officers of TruBridge and a brief explanation of each individual’s principal
employment during the last five years.

Christopher L. Fowler – President and Chief Executive Officer. Christopher L. Fowler, age 48, was appointed as our
President and Chief Executive Officer, and a member of the Board of Directors on July 1, 2022. Mr. Fowler began his career
with TruBridge in May 2000 as a Software Support Representative and later as a manager of Financial Software Services. From
August 2004 until March 2008, Mr. Fowler served as Assistant Director and Director of Business Management Services. Mr.
Fowler served as TruBridge’s Vice President – Business Management Services from March 2008 until the formation of
TruBridge in January 2018, after which time he served as its President. He then served as Chief Operating Officer of the
Company from November 2015 through June 2022.

David A. Dye – Chief Operating Officer. David A. Dye, age 54, was appointed as our Chief Operating Officer on October 10,
2022. Mr. Dye previously served as our Chief Growth Officer since November 2015 and Chief Financial Officer, Secretary and
Treasurer from June 2010 until November 2015. Mr. Dye served as our President and Chief Executive Officer from July 1999
to May 2006. He was first elected as a director in March 2002 and served as our Chairman of the Board from May 2006 until
April 2019. Mr. Dye began his career with TruBridge in May 1990 as a Financial Software Support Representative and served
in various capacities until July 1999. Mr. Dye served as a director of Bulow Biotech Prosthetics, LLC, a company
headquartered in Nashville, Tennessee that operates prosthetic clinics in the Southeastern United States, from July 2006 until
October 2018.

Vinay Bassi – Chief Financial Officer, Secretary and Treasurer. Vinay Bassi, age 53, was appointed as our Chief Financial
Officer, Secretary and Treasurer in January 1, 2024. Prior to joining TruBridge, Mr. Bassi served as Chief Financial Officer for
the Audience Measurement division at Nielsen Holdings plc and held various finance and corporate development positions in
that company since 2016. Prior to joining Nielsen in 2016, Mr. Bassi worked in corporate development at Avaya Inc. from 2004
to 2016. He began his career as an Auditor at PricewaterhouseCoopers LLP and spent time at Standard and Poor's and
Citigroup.

Dawn M. Severance - Chief Sales Officer. Dawn M. Severance, age 54, was appointed as our Chief Sales Officer in
November 2022 after serving as Senior Vice President of Sales for TruBridge since January 2021. Ms. Severance joined
TruBridge as part of the Healthland acquisition in 2016 where she served as Vice President of Sales. Ms. Severance served as
Regional Vice President of Sales for TruBridge from 2016 to May 2019 and as Vice President of Sales for TruBridge from May
2019 to January 2021.

Kevin Plessner - General Counsel. Kevin Plessner, age 41, was appointed as our General Counsel in January 2022. Mr.
Plessner joined TruBridge as part of the Get Real Health acquisition in 2019. He served as General Counsel at Get Real Health
from 2013 until the 2019 acquisition, at which point he became Corporate Counsel at TruBridge.

Wes D. Cronkite - Chief Technology and Innovation Officer. Wes D. Cronkite, age 41, was appointed as our Chief
Innovation Officer in May 2021 and then was appointed Chief Technology and Innovation Officer in November 2022. Prior to
joining TruBridge, Mr. Cronkite served as Senior Vice President of Innovation at BrightSpring Health from August 2018 until
April 2021. He also held various healthcare technology leadership roles at nThrive (formerly MedAssets) from March 2010
through August 2019, including Senior Vice President of Internal Analytics, Vice President of Strategic Initiatives, and Vice
President of System Strategy and Operations.

Company Web Site

The Company maintains a web site at http://www.trubridge.com. The Company makes available on its web site, free of charge,
its Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, and all amendments to
those reports, as soon as it is reasonably practicable after such material is electronically filed with the Securities and Exchange
Commission. The Company is not including the information contained on or available through its web site as a part of, or
incorporating such information into, this Annual Report on Form 10-K.

ITEM 1A.

RISK FACTORS

These are not the only risks and uncertainties that we face. Our business, financial condition, operating results, and stock price
can be materially and adversely affected by a number of factors, whether currently known or unknown, including, but not
limited to, those described below. Any one or more of such factors could directly or indirectly cause our actual financial
condition and operating results to vary materially from our past or anticipated future financial condition or operating results.

RISKS RELATED TO OUR INDUSTRY

There are a limited number of hospitals in our target market. Saturation or consolidation in the healthcare industry could
result in the loss of existing clients, a reduction in our potential client base and downward pressure on the prices of our
products and services.

The limited number of hospitals with fewer than 200 acute care beds in our general target market for our acute care product and
service offerings has resulted in an ever narrowing market for new system installations and add-on sales which could materially
and adversely impact our business, financial condition and operating results.

Our primary objectives are to increase the market share of our RCM services, aggressively pursue competitive and vulnerable
EHR replacement opportunities, and differentiate our products and services on a client experience basis that enables us to sell a
broader set of services into a loyal base of clients that are our advocates. Although we have formulated strategic responses for
capitalizing on each of the identified opportunities, there is no guarantee that such responses will ultimately prove successful.
Additionally, to the extent that these opportunities fail to develop or develop more slowly than expected, our business, financial
condition and operating results could be materially and adversely impacted.

Furthermore, many healthcare providers have consolidated to create larger healthcare delivery enterprises with greater market
power. If this consolidation continues, we could lose existing clients and could experience a decrease in the number of potential
purchasers of our products and services. The loss of existing and potential clients due to industry consolidation could cause our
revenue growth rate to decline.

Economic, market and other factors may cause a decline in spending for information technology and services by our current
and prospective clients which may result in less demand for our products, lower prices and, consequently, lower revenues
and a lower revenue growth rate.

The purchase of our information system involves a significant financial commitment by our clients. At the same time, the
healthcare industry faces significant financial pressures that could adversely affect overall spending on healthcare information
technology and services. To the extent spending for healthcare information technology and services declines or increases slower
than we anticipate, demand for our products and services, as well as the prices we charge, could be adversely affected.
Accordingly, we cannot assure you that we will be able to increase or maintain our revenues or our revenue growth rate.

There is significant uncertainty in the healthcare industry, both as a result of recently enacted legislation and changing
government regulation, which may have a material adverse impact on the businesses of our hospital clients and ultimately
on our business, financial condition and results of operations.

The healthcare industry is subject to changing political, economic and regulatory influences that may affect the procurement
processes and operation of healthcare facilities, including our hospital clients. During the past decade, the healthcare industry
has been subject to increased legislation and regulation of, among other things, reimbursement rates, payment programs,
information technology programs and certain capital expenditures (collectively, the "Health Reform Laws").

The Health Reform Laws contain various provisions which impact us and our clients. Some of these provisions have a positive
impact, by expanding the use of electronic health records in certain federal programs, for example, while others, such as
reductions in reimbursement for certain types of providers, have a negative impact due to fewer available resources. The
continued increase in fraud and abuse penalties is expected to adversely affect participants in the healthcare sector, including us.

Among other things, the Health Reform Laws provide for the expansion of Medicaid eligibility, mandate material changes to
the delivery of healthcare services and reduce the reimbursement paid for such services in order to generate savings in the
Medicare program. The Health Reform Laws also modify certain payment systems to encourage more cost-effective, quality-
based care and a reduction of inefficiencies and waste, including through various tools to address fraud and abuse.

The Health Reform Laws will continue to affect hospitals differently depending upon the populations they serve and their payor
mix. Our target market of community hospitals typically serve higher uninsured populations than larger urban hospitals and rely

more heavily on Medicare and Medicaid for reimbursement. It remains to be seen whether the increase in the insured
population for community hospitals will be sufficient to offset actual and proposed additional cuts in Medicare and Medicaid
reimbursements contained in the Health Reform Laws.

The Health Reform Laws are leading to significant changes in the healthcare system, but the full impact of the legislation and of
further statutory and regulatory actions to reform healthcare on our business is unknown. As a result, there can be no assurances
that the legislation will not adversely impact either our operational results or the manner in which we operate our business. We
believe some healthcare industry participants have reduced their investments or postponed investment decisions, including
investments in our solutions and services.

Cost-containment measures instituted by healthcare providers as a result of regulatory reform or otherwise could result in a
reduced allocation of capital funds. Such a reduction could have an adverse effect on our ability to sell our systems and related
services. Although the Biden administration promises to prioritize public health by fortifying and expanding implementation of
such laws and legislation, we cannot predict what effect, if any, such additional proposals or healthcare reforms might have on
our business, financial condition and results of operations.

As existing regulations mature and become better defined, we anticipate that these regulations will continue to directly affect
certain of our products and services, but we cannot fully predict the effect at this time. We have taken steps to modify our
products, services and internal practices as necessary to facilitate our compliance with the regulations, but there can be no
assurance that we will be able to do so in a timely or complete manner. Achieving compliance with these regulations could be
costly and distract management’s attention and divert other company resources, and any noncompliance by us could result in
civil and criminal penalties.

The healthcare industry is heavily regulated at the local, state and federal levels. Our failure to comply with regulatory
requirements could create liability for us, result in adverse publicity and negatively affect our business.

The healthcare industry is heavily regulated and is constantly evolving due to the changing political, legislative and regulatory
landscapes. In some instances, the impact of these regulations on our business is direct to the extent that we are subject to these
laws and regulations ourselves. However, these regulations also impact our business indirectly as, in a number of
circumstances, our solutions, devices and services must be capable of being used by our clients in a way that complies with
those laws and regulations, even though we may not be directly regulated by the specific healthcare laws and regulations. There
is a significant number of wide-ranging regulations, including regulations in the areas of healthcare fraud, e-prescribing, claims
processing and transmission, medical devices, the security and privacy of patient data, the ARRA meaningful use program,
patient access rights and interoperability standards, that may be directly or indirectly applicable to our operations and
relationships or the business practices of our clients. Specific areas that are subject to increased regulation include, but are not
limited to, the following:

Healthcare Fraud. Federal and state governments continue to enhance regulation of and increase their scrutiny over practices
potentially involving healthcare fraud, waste and abuse by healthcare providers whose services are reimbursed by Medicare,
Medicaid and other government healthcare programs. Our healthcare provider clients are subject to laws and regulations
regarding fraud and abuse that, among other things, prohibit the direct or indirect payment or receipt of any remuneration for
patient referrals, or arranging for or recommending referrals or other business paid for in whole or in part by these federal or
state healthcare programs. Federal enforcement personnel have substantial funding, powers and remedies to pursue suspected or
perceived fraud and abuse. The effect of this government regulation on our clients is difficult to predict. Many of the
regulations applicable to our clients and that may be applicable to us, including those relating to marketing incentives offered in
connection with medical device sales may be interpreted or applied by a prosecutorial, regulatory or judicial authority in a
manner that could broaden their applicability to us or require our clients to make changes in their operations or the way in
which they deal with us. If such laws and regulations are determined to be applicable to us and if we fail to comply with any
applicable laws and regulations, we could be subject to civil and criminal penalties, sanctions or other liabilities, including
exclusion from government healthcare programs, which could have a material adverse effect on our business, results of
operations and financial condition. Even an unsuccessful challenge by a regulatory or prosecutorial authority of our activities
could result in adverse publicity, could require a costly response from us and could adversely affect our business, results of
operations and financial condition.

E-Prescribing. The use of our solutions by physicians for electronic prescribing and electronic routing of prescriptions via the
Surescripts network to pharmacies is governed by federal and state laws. States have differing regulations that govern the
electronic transmission of certain prescriptions and prescription requirements. Standards adopted by the National Council for
Prescription Drug Programs and regulations adopted by the CMS related to "EPrescribing and the Prescription Drug Program"
set forth implementation standards for the transmission of electronic prescriptions. These standards are detailed and broad, and

cover not only routing transactions between prescribers and pharmacies, but also electronic eligibility, formulary and benefits
inquiries. In general, regulations in this area can be burdensome and evolve regularly, meaning that any potential benefits to our
clients from utilizing such solutions and services may be superseded by a newly-promulgated regulation that adversely affects
our business model. Our efforts to provide solutions that enable our clients to comply with these regulations could be time
consuming and expensive.

Claims Processing and Transmission. Our system electronically transmits medical claims by physicians to patients’ payors for
immediate approval and reimbursement. In addition, we offer business management services that include the manual and
electronic processing and submission of medical claims by healthcare providers to patients’ payors for approval and
reimbursement. Federal and state laws provide that it is a violation for any person to submit, or cause to be submitted, a claim to
any payor, including, without limitation, Medicare, Medicaid and all private health plans and managed care plans, seeking
payment for any service or product that overbills or bills for items that have not been provided to the patient. We have in place
policies and procedures that we believe assure that all claims that are transmitted by our system and through our services are
accurate and complete, provided that the information given to us by our clients is also accurate and complete. If, however, we
do not follow those procedures and policies, or they are not sufficient to prevent inaccurate claims from being submitted, we
could be subject to substantial liability including, but not limited to, civil and criminal liability. Additionally, any such failure of
our billing and collection services to comply with these laws and regulations could adversely affect demand for our services and
could force us to expend significant capital, research and development, and other resources to address the failure.

Where we are permitted to do so, we calculate charges for our billing and collection services based on a percentage of the
collections that our clients receive as a result of our services. To the extent that violations or liability for violations of these laws
and regulations require intent, it may be alleged that this percentage calculation provides us or our employees with incentive to
commit or overlook fraud or abuse in connection with submission and payment of reimbursement claims. CMS has stated that it
is concerned that percentage-based billing services may encourage billing companies to commit or to overlook fraudulent or
abusive practices.

A portion of our business involves billing Medicare claims on behalf of our clients. In an effort to combat fraudulent Medicare
claims, the federal government offers rewards for reporting of Medicare fraud which could encourage others to subject us to a
charge of fraudulent claims, including charges that are ultimately proved to be without merit.

As discussed below, the HIPAA security and privacy standards also affect our claims transmission services, since those services
must be structured and provided in a way that supports our clients’ HIPAA compliance obligations.

Regulation of Medical Devices. The United States FDA has determined that certain of our solutions, such as our ImageLink®
and Blood Administration® products, are medical devices that are actively regulated under the Federal Food, Drug and
Cosmetic Act, as amended. If other of our solutions are deemed to be actively regulated medical devices by the FDA, we could
be subject to extensive requirements governing pre- and post-marketing activities including registration of the applicable
manufacturing facility and software and hardware products, application of detailed record-keeping and manufacturing
standards, application of the medical device excise tax, and FDA approval or clearance prior to marketing. Complying with
these medical device regulations is time consuming and expensive, and our marketing and other sales activities could be subject
to unanticipated and significant delays. Further, it is possible that the FDA may become more active in regulating software and
medical devices that are used in the healthcare industry. If we are unable to obtain the required regulatory approvals for any
such software or medical devices, our short- to long-term business plans for these solutions or medical devices could be delayed
or canceled and we could face FDA refusal to grant pre-market clearance or approval of products; withdrawal of existing
clearances and approvals; fines, injunctions or civil penalties; recalls or product corrections; production suspensions; and
criminal prosecution. FDA regulation of our products could increase our operating costs, delay or prevent the marketing of new
or existing products, and adversely affect our revenue growth.

Security and Privacy of Patient Information. Federal, state and local laws regulate the privacy and security of patient records
and the circumstances under which those records may be released. These regulations govern both the disclosure and use of
confidential patient medical record information and require the users of such information to implement specified security and
privacy measures. United States regulations currently in place governing electronic health data transmissions continue to evolve
and are often unclear and difficult to apply.

In the United States, HIPAA regulations require national standards for some types of electronic health information transactions
and the data elements used in those transactions, security standards to ensure the integrity and confidentiality of health
information, and standards to protect the privacy of individually identifiable health information. Covered entities under HIPAA,
which include healthcare organizations such as our clients, and our claims processing, transmission and submission services,
are required to comply with the privacy standards, transaction regulations and security regulations. Moreover, HITECH and

associated regulatory requirements extend many of the HIPAA obligations, formerly imposed only upon covered entities, to
business associates as well. As a business associate of our clients who are covered entities, we are in most instances already
contractually required to ensure compliance with the HIPAA regulations as they pertain to the handling of covered client data.
However, the extension of these HIPAA obligations to business associates by law has created a direct liability risk related to the
privacy and security of individually identifiable health information.

Evolving HIPAA and HITECH-related laws or regulations could restrict the ability of our clients to obtain, use or disseminate
patient information. This could adversely affect demand for our solutions and devices if they are not re-designed in a timely
manner in order to meet the requirements of any new interpretations or regulations that seek to protect the privacy and security
of patient data or enable our clients to execute new or modified healthcare transactions. We may need to expend additional
capital and software development and other resources to modify our solutions to address these evolving data security and
privacy issues. Furthermore, our failure to maintain the confidentiality of sensitive personal information in accordance with the
applicable regulatory requirements could damage our reputation and expose us to claims, fines and penalties.

Federal and state statutes and regulations have granted broad enforcement powers to regulatory agencies to investigate and
enforce compliance with these privacy and security laws and regulations. Federal and state enforcement personnel have
substantial funding, powers and remedies to pursue suspected or perceived violations. If we fail to comply with any applicable
laws or regulations, we could be subject to civil penalties, sanctions or other liability. Enforcement investigations, even if
meritless, could have a negative impact on our reputation, cause us to lose existing clients or limit our ability to attract new
clients.

ARRA Meaningful Use Program. The ARRA initially required "meaningful use of certified electronic health record technology"
by healthcare providers by 2015 in order to receive limited incentive payments and to avoid related reduced reimbursement
rates for Medicare claims. Related standards and specifications are subject to interpretation by the entities designated to certify
such technology. While a combination of our solutions has been certified as meeting stage one, stage two, and stage three
standards for certified electronic health record technology, the regulatory standards to achieve certification will continue to
evolve over time. We may incur increased development costs and delays in delivering solutions if we need to upgrade our
software or healthcare devices to be in compliance with these varying and evolving standards. In addition, further delays in
interpreting these standards may result in postponement or cancellation of our clients’ decisions to purchase our software
solutions. If our software solutions are not compliant with these evolving standards, our market position and sales could be
impaired and we may have to invest significantly in changes to our software solutions.

Interoperability Standards. Our clients are concerned with and often require that our software and systems be interoperable
with other third party healthcare information technology systems. Market forces or governmental or regulatory authorities could
create software interoperability standards that would apply to our software and systems, and if our software and systems are not
consistent with those standards, we could be forced to incur substantial additional development costs. For example, the
HITECH Act contains interoperability standards that healthcare providers are required to adhere to in order to receive stimulus
funds from the federal government under the ARRA. Compliance with these and related standards is becoming a competitive
requirement and, although a combination of our solutions has been certified as meeting all such required interoperability
standards to date, maintaining such compliance with these varying and evolving rules may result in increased development
costs and delays in upgrading our client software and systems. To the extent these rules are narrowly construed, subsequently
changed or supplemented, or that we are delayed in achieving certification under these evolving rules for applicable products,
our clients may postpone or cancel their decisions to purchase or implement our software and systems.

As it relates specifically to interoperability, we are a member of CommonWell Health Alliance ("CommonWell"), a not-for-
profit trade association comprised of healthcare information technology vendors devoted to the notion that patient data should
be safely, securely and immediately available to patients and healthcare providers to support better care delivery, regardless of
where that care occurs. CommonWell is committed to fostering standards that make this possible, and to having healthcare
information technology companies embed these capabilities natively and cost effectively into their EHR systems. Despite our
membership in CommonWell, there is no guarantee that we will successfully manage the interoperability of our software and
systems with third-party health IT providers.

Patient Access Rights. In March 2020, the Office of National Coordinator for Health Information Technology ("ONC") of the
U.S. Department of Health and Human Services ("HHS") released the "21st Century Cures Act: Interoperablity, Information
Blocking, and the ONC Health IT Certification Program, Final Rule." The rule implements several of the key interoperability
provisions included in the 21st Century Cures Act. Specifically, it calls on developers of certified EHRs and health IT products
to adopt standardized APIs, which will help allow individuals to securely and easily access structured and unstructured EHI
formats using smartphones and other mobile devices. This provision and others included in the final rule create a potentially
lengthy list of certification and maintenance of certification requirements that developers of EHRs and other health IT products

have to meet in order to maintain approved federal government certification status. Meeting and maintaining this certification
status could require additional development costs.

The ONC rule also implements the information blocking provisions of the 21st Century Cures Act, including identifying
reasonable and necessary activities that do not constitute information blocking. Under the 21st Century Cures Act, the HHS has
the regulatory authority to investigate and assess civil monetary penalties of up to $1,000,000 against health IT developers and/
or providers found to be guilty of "information blocking." This new oversight and authority to investigate claims of information
blocking creates significant risks for us and our clients and could potentially create substantial new compliance costs. The
HHS may impose penalties for information blocking that has occurred after September 1, 2023, and the ONC and the HHS
proposed a rule on November 1, 2023 listing certain disincentives for actors that conduct information blocking.

Standards for Submission of Healthcare Claims. CMS requires all providers, payors, clearinghouses and billing services to
utilize patient codes for reporting medical diagnosis and inpatient procedures, referred to as ICD-10 codes when submitting
claims for payment. ICD-10 codes affect medical diagnosis and inpatient procedure coding for everyone covered by HIPAA,
not just those who submit Medicare or Medicaid claims. Claims for services must use ICD-10 codes for medical diagnosis and
inpatient procedures or they will not be paid. While we have successfully implemented the use of ICD-10 codes within our
products and services since their initial mandate in 2015, the possibility exists for similar future mandates by CMS. If our
products and services do not accommodate CMS mandates at any future date, clients may cease to use those products and
services that are not compliant and may choose alternative vendors and products that are compliant. This could adversely
impact future revenues.

RISKS RELATED TO OUR BUSINESS

Our strategy to transition to a subscription-based recurring revenue model and continued modernization of our technology
may adversely affect our near-term revenue growth and results of operations.

As we transition more of our offerings to leverage cloud technologies, we may incur disruption and be less competitive as we
transition existing clients to new product offerings, which could impact revenue and profitability. We believe we must continue
to dedicate a significant amount of resources to our research and development efforts to maintain our competitive position, and
oftentimes, successful investments require several years before generating significant revenue. We expect our ongoing shift
from a software license model to a subscription-based services revenue model to create a recurring revenue stream that is more
predictable. The transition, however, creates changes related to the timing of revenue recognition compared to historical
patterns. We also incur certain expenses associated with the infrastructures of our cloud-based offerings in advance of our
ability to recognize the revenues associated with these offerings, which may adversely affect our near-term reported revenues,
results of operations, and cash flows. A decline in renewals of recurring revenue offerings in any period may not be
immediately reflected in our results for that period but may result in a decline in our revenue and results of operations in future
periods.

Competition with companies that have greater financial, technical and marketing resources than we have could result in a
loss of clients and/or a lowering of prices for our products, causing a decrease in our revenues and/or market share.

Our principal competitors in the business management, consulting and managed IT services market are Resolution Health, Inc.,
The Outsource Group Inc., Patient Focus, Inc., Xtend Healthcare Inc., Ensemble Health Partners, and nThrive, Inc. All of these
companies provide one or more of the services we offer, with their primary focus being on providing business management
services to the healthcare market. The services they offer are comparable in scope to the competing services we offer.
Secondary competitors include ARx LLC, Citadel Outsource Group LLC, Patient Matters, LLC, KIWI-TEK, LLC, and
Aviacode Inc. Our principal competitors for RCM solutions include RelayHealth Corp, SSI Group, LLC, Quadax Inc., Change
Healthcare Holdings, Inc., Availity, LLC, and Navicure, Inc. TruCode's primary competitors include 3M, Nuance and Optum.

Our principal competitors in the acute EHR market are Cerner Corporation, Medical Information Technology, Inc.
("Meditech"), and MEDHOST, Inc. These companies compete with us directly in our target market of small and midsize
hospitals. They offer products and systems that are comparable to our solutions and address the needs of hospitals in the
markets we serve.

Our secondary competitors in the acute care EHR market include N. Harris Computer Corporation and Epic Systems
Corporation. These companies are significantly larger than we are, and they typically sell their products and services to larger
hospitals outside of our target market. However, they will sometimes compete with us directly or, more commonly, a larger
health system who uses a system provided by one of these competitors will offer it to a smaller hospital as part of a merger or
alliance.

We also face competition from providers of practice management systems, general decision support and database systems, and
other segment-specific applications. Any of these companies, as well as other technology or healthcare companies could decide
at any time to specifically target hospitals within our target market.

A number of existing and potential competitors are more established than we are and have greater name recognition and
financial, technical and marketing resources. Products of our competitors may have better performance, lower prices and
broader market acceptance than our products. We expect increased competition that could cause us to lose clients, lower our
prices to remain competitive and, consequently, experience lower revenues, revenue growth and profit margins.

We recently completed the acquisitions of TruCode, HRG and Viewgol, and we may engage in future acquisitions. Such
strategic acquisitions may be expensive, time consuming, and subject to other inherent risks which may jeopardize our
ability to realize anticipated benefits.

We may acquire additional businesses, technologies and products if we determine that these additional businesses, technologies
and products are likely to serve our strategic goals. Acquisitions have inherent risks, which may have a material adverse effect
on our business, financial condition, operating results or prospects, including, but not limited to the following:

•

significant acquisition and integration costs;

failure to achieve projected synergies and performance targets;

potentially dilutive issuances of our securities, the incurrence of debt and contingent liabilities and amortization
expenses related to intangible assets with indefinite useful lives, which could adversely affect our results of operations
and financial condition;

using cash as acquisition currency may adversely affect interest or investment income, which may in turn adversely
affect our earnings and/or earnings per share;

difficulty in fully or effectively integrating the acquired technologies, software products, services, business practices or
personnel, which would prevent us from realizing the intended benefits of the acquisition;

failure to maintain uniform standard controls, policies and procedures across acquired businesses;

difficulty in predicting and responding to issues related to product transition such as development, distribution and
client support;

the possible adverse effect of such acquisitions on existing relationships with third party partners and suppliers of
technologies and services;

the possibility that staff or clients of the acquired companies might not accept new ownership and may transition to
different technologies or attempt to renegotiate contract terms or relationships, including maintenance or support
agreements;

the assumption of known and unknown liabilities;

the possibility that the due diligence process in any such acquisition may not completely identify material issues
associated with product quality, product architecture, product development, intellectual property issues, key personnel
issues or legal and financial contingencies, including any deficiencies in internal controls and procedures and the costs
associated with remedying such deficiencies;

difficulty in entering geographic and/or business markets in which we have no or limited prior experience;

diversion of management’s attention from other business concerns; and

the possibility that acquired assets become impaired, requiring us to take a charge to earnings which could be
significant.

A failure to successfully integrate acquired businesses or technology in a timely manner could, for any of these reasons, have an
adverse effect on our financial condition and results of operations. As a result, we may not be able to realize the expected

benefits that we seek to achieve from the acquisitions, which could also affect our ability to service our debt obligations. In
addition, we may be required to spend additional time or money on integration that otherwise would be spent on the
development and expansion of our business.

If we are unable to attract and retain qualified personnel, our business and operating results will suffer.

Our client service and support is a key component of our business. Most of our hospital clients have small information
technology staffs, and they depend on us to service and support their systems. Future difficulty in attracting, training and
retaining capable client service and support personnel could cause a decrease in the overall quality of our client service and
support. That decrease would have a negative effect on client satisfaction which could cause us to lose existing clients and
could have an adverse effect on our new client sales. The loss of clients due to inadequate client service and support would
negatively impact our ability to continue to grow our business.

We periodically have restructured our sales force, which can be disruptive.

We continue to rely heavily on our direct sales force. Periodically, we have restructured or made other adjustments to our sales
force in response to factors such as product changes, geographical coverage and other internal considerations. Change in the
structures of the sales force and sales force management can result in temporary lack of focus and reduced productivity that
may affect revenues in one or more quarters. Future restructuring of our sales force could occur, and if so we may again
experience the adverse transition issues associated with such restructuring.

The markets for our RCM service offering may develop more slowly than we expect.

Our success depends, in part, on the willingness of healthcare organizations to implement integrated solutions for the areas in
which we provide services. Some organizations may be reluctant or unwilling to implement our solutions for a number of
reasons, including failure to perceive the need for improved revenue cycle operations, lack of knowledge about the potential
benefits our solutions provide, concerns over the cost of using an external solution, or as a result of investments or planned
investments in internally developed solutions, choosing to continue to rely on their own internal resources.

If we are unable to manage our growth in the new markets we may enter, our business and financial results could suffer.

Our future financial results will depend in part on our ability to profitably manage our business in new markets that we may
enter. We are engaging in the strategic identification of, and competition for, growth and expansion opportunities in new
markets or offerings. In order to successfully execute on these future initiatives, we will need to, among other things, manage
changing business conditions and develop expertise in areas outside of our business's traditional core competencies. Difficulties
in managing future growth in new markets could have a significant negative impact on our business, financial condition and
results of operations.

We are currently in the process of implementing a new enterprise resource planning (“ERP”) software solution. If we do not
effectively implement this project, or any future associated updates, our operations could be significantly disrupted.

We are in the process of implementing of a new ERP software solution. This project requires us to migrate and reconfigure all
of our current system processes, transactions, data and controls to a new cloud-based platform and is expected to have a
significant impact on our business processes, sales pipeline management, customer relationship management, financial
reporting, information systems and internal controls. This implementation process is expected to require significant change
management, meaningful investment in capital and personnel resources and coordination of software and system providers and
internal business teams. We may experience difficulties as we manage these changes and transition to this new ERP solution,
including loss or corruption of data, delayed sales, delayed financial reporting, decreases in productivity as our personnel
implement and become familiar with the new systems and processes, unanticipated expenses (including increased costs of
implementation and costs of conducting business) and lost revenue. Once implemented, this cloud-based ERP solution will be
eligible for periodic updates from the vendor. Although we will conduct design validations and user testing, these updates may
cause delays in transacting our business due to system challenges, limitations in functionality, inadequate change management
or process deficiencies in the production and use of the system. Difficulties in implementing this new ERP solution or the
related quarterly updates could disrupt our operations, divert management’s attention from key strategic initiatives and have an
adverse effect on our results of operations, financial condition and cash flows.

Our international business activities and processes expose us to numerous and often conflicting laws, regulations, policies,
standards or other requirements, and to risks that could harm our business, financial condition and results of operations.

Our subsidiary, Get Real Health, sells patient engagement technology to hospital systems and government agencies in Canada,
Australia, England, the United Arab Emirates and the Netherlands, directly and through resellers, and we have had limited sales
of EHR software to government agencies in Canada and the Caribbean. Our subsidiary, Viewgol, provides RCM analytics and
complementary outsourcing services in India. Our business in these countries is subject to numerous risks inherent in
international business operations. Among others, these risks include:

•

data protection and privacy regulations regarding access by government authorities to customer, partner, or employee
data;

data residency requirements (the requirement to store certain data only in and, in some cases, also to access such data
only from within a certain jurisdiction);

conflict and overlap among tax regimes;

possible tax constraints impeding business operations in certain countries;

expenses associated with the localization of our products and compliance with local regulatory requirements;

discriminatory or conflicting fiscal policies;

operational difficulties in countries with a high corruption perception index;

difficulties enforcing intellectual property and contractual rights in certain jurisdictions;

country-specific software certification requirements;

the difficulty of managing and staffing our international operations and the increased travel, infrastructure and legal
compliance costs associated with multiple international locations;

differing labor and employment regulations, especially where foreign labor laws are more advantageous to employees
as compared to the U.S.;

compliance with various industry standards; and

• market volatilities or workforce restrictions due to changing laws and regulations resulting from political decisions

(e.g. Brexit, government elections).

As we expand into new countries and markets, these risks could intensify. The application of the respective local laws and
regulations to our business is sometimes unclear, subject to change over time, and often conflicting among jurisdictions.
Additionally, these laws and government approaches to enforcement are continuing to change and evolve, just as our products
and services continually evolve. Compliance with these varying laws and regulations could involve significant costs or require
changes in products or business practices. Non-compliance could result in the imposition of penalties or cessation of orders due
to alleged non-compliant activity. We do not believe we have engaged in any activities sanctionable under these laws and
regulations, but governmental authorities could use considerable discretion in applying these statutes and any imposition of
sanctions against us could be material. One or more of these factors could have an adverse effect on our operations globally or
in one or more countries or regions, which could have an adverse effect on our business, financial condition and results of
operations.

We face the risks and uncertainties that are associated with investigations and litigation against us, which may adversely
impact our marketing, distract management and have a negative impact upon our business, results of operations and
financial condition.

We face the risks associated with litigation concerning the operation of our business. For example, companies in our industry,
including many of our competitors, have been subject to litigation based on allegations of patent infringement or other
violations of intellectual property rights. In particular, patent holding companies often engage in litigation to seek to monetize
patents that they have obtained. As the number of competitors, patents and patent holding companies in our industry increases,
the functionality of our products and services expands, and we enter into new geographies and markets, the number of
intellectual property rights-related actions against us is likely to continue to increase. The uncertainty associated with
substantial unresolved litigation may have an adverse effect on our business. In particular, such litigation could impair our
relationships with existing clients and our ability to obtain new clients. Defending such litigation may result in a diversion of
management's time and attention away from business operations, which could have an adverse effect on our business, results of
operations and financial condition. Such litigation may also have the effect of discouraging potential acquirers from bidding for
us or reducing the consideration such acquirers would otherwise be willing to pay in connection with an acquisition.

There can be no assurance that such litigation will not result in liability in excess of our insurance coverage, that our insurance
will cover such claims or that appropriate insurance will continue to be available to us in the future at commercially reasonable
rates.

Investigations may lead to future requests for information and ultimately the assertion of claims or the commencement of legal
proceedings against us, which themselves may lead to material fines, penalties or other material liabilities. In addition, our
responses to these and any future requests require time and effort, which can result in additional cost to us. Given the highly-
regulated nature of our industry, we have been and may, from time to time, be subject to subpoenas, requests for information, or
investigations from various government agencies.

Our use of offshore labor resources could expose us to risks that could have a material adverse effect on our operating costs.

Our reliance on an international workforce exposes us to business disruptions caused by the political and economic
environment in those regions. Terrorist attacks and acts of violence or war may directly affect our workforce or contribute to
general instability. Our global business services operations require us to comply with local laws and regulatory requirements,
which are complex and of which we may not always be aware, and expose us to foreign currency exchange rate risk. Our global
business services operations may also subject us to trade restrictions, reduced or inadequate protection for intellectual property
rights, security breaches, and public health events, including the COVID-19 pandemic and other factors which may adversely
affect our business. Negative developments in any of these areas could increase our operating costs or otherwise harm our
business. In addition, local laws and customs in countries in which we contract with third-party partners may differ from those
in the U.S. For example, it may be a local custom for businesses to engage in practices that are prohibited by our internal
policies and procedures or U.S. laws and regulations applicable to us, such as the Foreign Corrupt Practices Act ("FCPA"). The
FCPA generally prohibits U.S. companies from giving or offering money, gifts, or anything of value to a foreign official to
obtain or retain business and requires businesses to make and keep accurate books and records and a system of internal
accounting controls. We cannot guarantee that our employees, contractors, and agents will comply with all of our FCPA
compliance policies and procedures. If we or our employees, contractors, or agents fail to comply with the requirements of the
FCPA or similar legislation, government authorities in the U.S. and elsewhere could seek to impose civil or criminal fines and
penalties which could have a material adverse effect on our business, operating results, and financial condition.

Offshore outsourcing is a politically sensitive topic in the U.S. For example, various organizations and public figures in the
United States have expressed concern about a perceived association between offshore outsourcing providers and the loss of jobs
in the U.S. Current or prospective customers may elect to perform such RCM services themselves or may be discouraged from
transferring these services from onshore to offshore providers to avoid negative perceptions that may be associated with using
an offshore provider. Any slowdown or reversal of existing industry trends towards offshore outsourcing, and the resulting need
to relocate aspects of our services from our global business services operations to the U.S., where operating costs are higher,
would increase the cost of delivering our services.

We utilize artificial intelligence, which could expose us to liability or adversely affect our business, especially if we are
unable to compete effectively with others in adopting artificial intelligence.

We utilize artificial intelligence, including generative artificial intelligence, machine learning, and similar tools and
technologies that collect, aggregate, analyze, or generate data or other materials or content (collectively, “AI”) in connection
with our business. There are significant risks involved in using AI and no assurance can be provided that our use of AI will

enhance our products or services, produce the intended results, or keep pace with our competitors. For example, AI algorithms
may be flawed, insufficient, of poor quality, rely upon incorrect or inaccurate data, reflect unwanted forms of bias, or contain
other errors or inadequacies, any of which may not be easily detectable; AI has been known to produce false or “hallucinatory”
inferences or outputs; our use of AI can present ethical issues and may subject us to new or heightened legal, regulatory, ethical,
or other challenges; and inappropriate or controversial data practices by developers and end-users, or other factors adversely
affecting public opinion of AI, could impair the acceptance of AI solutions, including those incorporated in our products and
services. If the AI tools that we use are deficient, inaccurate, or controversial, we could incur operational inefficiencies,
competitive harm, legal liability, brand or reputational harm, or other adverse impacts on our business and financial results. If
we do not have sufficient rights to use the data or other material or content on which the AI tools we use rely, we also may
incur liability through the violation of applicable laws and regulations, third-party intellectual property, data privacy, or other
rights, or contracts to which we are a party.

In addition, AI regulation is rapidly evolving worldwide as legislators and regulators increasingly focus on these powerful
emerging technologies. The technologies underlying AI and its uses are subject to a variety of laws and regulations, including
intellectual property, data privacy and security, consumer protection, competition, and equal opportunity laws, and are expected
to be subject to increased regulation and new laws or new applications of existing laws and regulations. AI is the subject of
ongoing review by various U.S. governmental and regulatory agencies, and various U.S. states and other foreign jurisdictions
are applying, or are considering applying, their platform moderation, data privacy, and security laws and regulations to AI or
are considering general legal frameworks for AI. We may not be able to anticipate how to respond to these rapidly evolving
frameworks, and we may need to expend resources to adjust our operations or offerings in certain jurisdictions if the legal
frameworks are inconsistent across jurisdictions. Furthermore, because AI technology itself is highly complex and rapidly
developing, it is not possible to predict all of the legal, operational, or technological risks that may arise relating to the use of
AI.

RISKS RELATED TO OUR PRODUCTS AND SERVICES

Our failure to develop new products or enhance current products in response to market demands could adversely impact our
competitive position and require substantial capital resources to correct.

The needs of hospitals in our target market are subject to rapid change due to government regulation, trends in clinical care
practices and technological advancements. As a result of these changes, our products may quickly become obsolete or less
competitive. New product introductions and enhancements by our competitors that more effectively or timely respond to
changing industry needs may weaken our competitive position.

We continually redesign and enhance our products to incorporate new technologies and adapt our products to ever-changing
hardware and software platforms. Often we face difficult choices regarding which new technologies to adopt. If we fail to
anticipate or respond adequately to technological advancements, or experience significant delays in product development or
introduction, our competitive position could be negatively affected. Moreover, our failure to offer products acceptable to our
target market could require us to make significant capital investments and incur higher operating costs to redesign our products,
which could negatively affect our financial condition and operating results.

Our products assist clinical decision-making and related care by capturing, maintaining and reporting relevant patient data.
If our products fail to provide accurate and timely information, our clients could assert claims against us that could result in
substantial cost to us, harm our reputation in the industry and cause demand for our products to decline.

We provide products that assist clinical decision-making and related care by capturing, maintaining and reporting relevant
patient data. Our products could fail or produce inaccurate results due to a variety of reasons, including unexpected service
disruptions, mechanical error, product flaws, faulty installation and/or human error during the initial data conversion. If our
products fail to provide accurate and timely information, clients and/or patients could sue us to hold us responsible for losses
they incur from these errors. These lawsuits, regardless of merit or outcome, could result in substantial cost to us, divert
management’s attention from operations and decrease market acceptance of our products. We attempt to limit by contract our
liability for damages arising from negligence, errors or mistakes. Despite this precaution, such contract provisions may not be
enforceable or may not otherwise protect us from liability for damages. We maintain general liability insurance coverage,
including coverage for errors or omissions. However, this coverage may not be sufficient to cover one or more large claims
against us or otherwise continue to be available on terms acceptable to us. In addition, the insurer could disclaim coverage as to
any future claim.

Breaches of security and viruses in our systems could result in client claims against us and harm to our reputation causing
us to incur expenses and/or lose clients.

In the course of our business operations, we compile and transmit confidential information, including patient health
information. We have included security features in our systems that are intended to protect the privacy and integrity of this
information. Despite the existence of these security features, our system may experience break-ins and similar disruptive
problems that could jeopardize the security of information stored in and transmitted through the information technology
networks of our clients. In addition, the other systems with which we may interface, such as the Internet and related systems,
may be vulnerable to security breaches, viruses, programming errors or similar disruptive problems. Based on the size of our
company, the industry in which we operate, and the overall percentage of impacted companies in the same or similar industry, it
is probable there will be attempts to breach our security. Healthcare information has become a prime target for attackers based
on the value of the information and, therefore, has the potential to increase the risk of us experiencing a cyber attack.

Our systems have experienced various immaterial breaches in the past, including ransomware, denial-of-service, malware, and
phishing. Also, our business partners have experienced security breaches, which is disruptive for our customers. While these
events have not had an adverse impact on our business or financial condition, security breaches such as these could have a
material adverse effect on our financial condition, as, (a) clients could sue us for breaches of security involving our system due
to the sensitivity of the medical information we compile and transmit; (b) actual or perceived security breaches in our system
could harm the market perception of our products which could cause us to lose existing and prospective clients; and (c) the
effect of security breaches and related issues could disrupt our ability to perform certain key business functions and could
potentially reduce demand for our products and services. Accordingly, we have expended significant resources toward
establishing and enhancing the security of our related infrastructures and we have enhanced our cybersecurity risk management
program and disclosure controls and procedures, as discussed under "Business - Our Products and Services." However, no
assurance can be given that these efforts will be sufficient to protect against a breach or other cybersecurity incident. Also,
maintaining and enhancing our infrastructure security may require us to expend significant capital in the future.

Our networks have been, and likely will continue to be, subject to Distributed Denial of Service ("DDoS") attacks. Recent
industry experience has demonstrated that DDoS attacks continue to grow in size and sophistication and have the ability to
widely disrupt services. In recent years, the size of DDoS attacks has grown rapidly. While we have adopted mitigation
techniques, procedures and strategies to defend against DDoS attacks, there can be no assurance that we will be able to defend
against every attack, especially as the attacks increase in size and sophistication. Any attack, even if only partially successful,
could disrupt our networks, increase response time, negatively impact our ability to meet our service level obligations, and
generally impede our ability to provide reliable service to our customers and the broader internet community.

Recently, there have been reports of disruptions in billing and data systems in healthcare (e.g., the cybersecurity incident
affecting Change Healthcare). Such cybersecurity events which materially disrupt the healthcare system upon which our
business relies could adversely affect our business if such disruption is widespread and continues for an extended period of
time. Cyber incidents could also include the use of AI to launch more automated, targeted and coordinated attacks on targets.

New products that we introduce or enhancements to our existing products may contain undetected errors or problems that
could affect client satisfaction and cause a decrease in revenues.

Highly complex software products such as ours sometimes contain undetected errors or failures when first introduced or when
updates and new versions are released. Tests of our products may not detect bugs or errors because it is difficult to simulate our
clients’ wide variety of computing environments. Despite extensive testing, from time to time we have discovered defects or
errors in our products. Defects or errors discovered in our products could cause delays in product introductions and shipments
and unexpected service disruptions, result in increased costs and diversion of development resources, require design
modifications, decrease market acceptance or client satisfaction with our products, cause a loss of revenue, result in legal
actions by our clients and cause increased insurance costs.

We may not be successful in convincing customers to migrate to current or future releases of our products, which may lead
to reduced services and maintenance revenues and less future business from existing customers.

Our customers may not be willing to incur the costs or invest the resources necessary to complete upgrades to current or future
releases of our products. This may lead to our loss of services and maintenance revenues and future business from customers
that continue to operate prior versions of our products or choose to no longer use our products.

Failure to maintain our margins and service rates for implementation services could have a material adverse effect on our
operating performance and financial condition.

A significant portion of our revenues is derived from implementation services. If we fail to scope our implementation projects
correctly, our services margins may suffer. We bill for implementation services predominately on an hourly or daily basis (time
and materials) and sometimes under fixed price contracts, and we generally recognize revenue from those services as we
perform the work. If we are not able to maintain the current service rates for our time and materials implementation services,
without corresponding cost reductions, or if the percentage of fixed price contracts increases and we underestimate the costs of
our fixed price contracts, our operating performance may suffer. The rates we charge for our implementation services depend
on a number of factors, including the following:

•

perceptions of our ability to add value through our implementation services;

complexity of services performed;

competition;

pricing policies of our competitors and of systems integrators;

the use of globally sourced, lower-cost service delivery capabilities within our industry; and

economic, political and market conditions.

Services revenues carry lower gross margins than license revenues and an overall increase in services revenues as a
percentage of total revenues could have an adverse impact on our business.

Because our service revenues have lower gross margins than do our license revenues, an increase in the percentage of total
revenues represented by service revenues could have a detrimental impact on our overall gross margins and could adversely
affect operating results.

We may be subject to liability in the event we provide inaccurate claims data to payors.

We offer electronic claims submission services as part of our business management services. While we have implemented
certain product features designed to maximize the accuracy and completeness of claims submissions, these features may not be
sufficient to prevent inaccurate claims data from being submitted to payors. Should inaccurate claims data be submitted to
payors, we may be subject to liability claims.

We may experience liability claims arising out of the licensing of our software and provision of services.

Our agreements normally contain provisions designed to limit our exposure to potential liability claims and generally exclude
consequential and other forms of extraordinary damages. However, these provisions could be rendered ineffective, invalid or
unenforceable by unfavorable judicial decisions or by federal, state, local or foreign laws or ordinances. For example, we may
not be able to avoid or limit liability for disputes relating to product performance or the provision of services. If a claim against
us were to be successful, we may be required to incur significant expense and pay substantial damages, including consequential
or punitive damages, which could have a material adverse effect on our business, operating results and financial condition.
Even if we prevail in contesting such a claim, the accompanying publicity could adversely affect the demand for our products
and services.

We also rely on certain technology that we license from third parties, including software that is integrated with our internally
developed software. Although these third parties generally indemnify us against claims that their technology infringes on the
proprietary rights of others, such indemnification is not always available for all types of intellectual property. Often such third-
party indemnifiers are not well capitalized and may not be able to indemnify us in the event that their technology infringes on
the proprietary rights of others. As a result, we may face substantial exposure if technology we license from a third party
infringes on another party’s proprietary rights. Defending such infringement claims, regardless of their validity, could result in
significant cost and diversion of resources.

We are dependent on our licenses of rights, products and services from third parties, disruptions of which may cause us to
discontinue, delay or reduce product shipments.

We are increasingly dependent upon licenses for some of the technology used in our products as well as other products and
services from third-party vendors, and the costs of these licenses have increased in recent years. Most of these arrangements can

be continued/renewed only by mutual consent and may be terminated for any number of reasons. We may not be able to
continue using the technology, products or services made available to us under these arrangements on commercially reasonable
terms or at all. As a result, we may have to discontinue, delay or reduce product shipments or services provided until we can
obtain equivalent technology or services. Most of our third-party licenses are non-exclusive. Our competitors may obtain the
right to use any of the business elements covered by these arrangements and use these elements to compete directly with us. In
addition, if our vendors choose to discontinue providing their technology, products or services in the future or are unsuccessful
in their continued research and development efforts, we may not be able to modify or adapt our own products. The operation of
our products would be impaired if errors occur in third party technology or content that we incorporate, and we may incur
additional costs to repair or replace the defective technology or content. It may be difficult for us to correct any errors in third
party products because the products are not within our control.

Because we believe that proprietary rights are material to our success, misappropriation of these rights could limit our
ability to compete effectively and adversely affect our financial condition.

We are heavily dependent on the maintenance and protection of our intellectual property and we rely largely on a combination
of confidentiality provisions in our client agreements, employee nondisclosure agreements, trademark and trade secret laws and
other measures to protect our intellectual property. Additionally, our software is not patented or copyrighted. Although we
attempt to control access to our intellectual property, unauthorized persons may attempt to copy or otherwise use our
intellectual property. There can be no assurance that the legal protections and precautions we take will be adequate to prevent
misappropriation of our technology or that competitors will not independently develop technologies equivalent or superior to
ours. Monitoring unauthorized use of our intellectual property is difficult, and the steps we have taken may not prevent
unauthorized use. If our competitors gain access to our intellectual property, our competitive position in the industry could be
damaged. An inability to compete effectively could cause us to lose existing and potential clients and experience lower
revenues, revenue growth and profit margins. Third parties could obtain patents that may require us to negotiate licenses to
conduct our business, and the required licenses may not be available on reasonable terms or at all. We also rely on
nondisclosure agreements with certain employees, and we cannot be certain that these agreements will not be breached or that
we will have adequate remedies for any breach.

If we are deemed to infringe on the intellectual property rights of third parties, we could incur unanticipated expense and be
prevented from providing our products and services if we cannot obtain licenses to these rights on commercially acceptable
terms.

We do not believe that our operations or products infringe on the intellectual property rights of others. However, there can be
no assurance that others will not assert infringement or trade secret claims against us with respect to our current or future
products. Many participants in the technology industry have an increasing number of patents and patent applications and have
frequently demonstrated a readiness to take legal action based on allegations of patent and other intellectual property
infringement. Further, as the number and functionality of our products increase, we believe we may become increasingly
subject to the risk of infringement claims. If infringement claims are brought against us, these assertions could distract
management. We may have to spend a significant amount of money and time to defend or settle those claims. In addition,
claims against third parties from which we purchase software could adversely affect our ability to access third-party software
for our systems.

If we were found to infringe on the intellectual property rights of others, we could be forced to pay significant license fees or
damages for infringement. If we were unable to obtain licenses to these rights on commercially acceptable terms, we would be
required to discontinue the sale of our products that contain the infringing technology. Our clients would also be required to
discontinue the use of those products. We are unable to insure against this risk on an economically feasible basis. Even if we
were to prevail in an infringement lawsuit, the accompanying publicity could adversely impact the demand for our products.
Under some circumstances, we agree to indemnify our clients for some types of infringement claims that may arise from the use
of our products.

Interruptions in our power supply and/or telecommunications capabilities could disrupt our operations, cause us to lose
revenues and/or increase our expenses.

We currently have backup generators to be used as alternative sources of power in the event of a loss of power to our facilities.
If these generators were to fail during any power outage, we would be temporarily unable to continue operations at our
facilities. This would have adverse consequences for our clients who depend on us for system support, business management,
and managed IT and professional services. Any such interruption in operations at our facilities could damage our reputation,
harm our ability to retain existing clients and obtain new clients, and result in lost revenue and increased insurance and other
operating costs.

We also have clients for whom we store and maintain computer servers containing critical patient and administrative data.
Those clients access this data remotely through telecommunications lines. If our power generators fail during any power outage
or if our telecommunications lines are severed or impaired for any reason, those clients would be unable to access their mission
critical data causing an interruption in their operations. In such event our remote access clients and/or their patients could seek
to hold us responsible for any losses. We would also potentially lose those clients, and our reputation could be harmed.

RISKS RELATED TO OUR INDEBTEDNESS

Volatility in and disruption to the global capital and credit markets and tightened lending standards may adversely affect our
ability to access credit in the future, the cost of any credit obtained in the future, and the financial soundness of our clients
and our business.

Domestic and international events have frequently resulted in volatility and disruption to the global capital and credit markets,
often adversely affecting the availability, terms and cost of credit. Although we believe that our operating cash flow and
financial assets will give us the ability to meet our financing needs for the foreseeable future, there can be no assurance that the
volatility and disruption in the global capital and credit markets will not impair our liquidity or increase the costs of any future
borrowing.

Our business could also be negatively impacted to the extent that our hospital clients continue to face tight capital and credit
markets and other disruptions resulting from the deteriorating macroeconomic conditions or cuts in Medicare and Medicaid
funding. Hospitals may modify, delay or cancel plans to purchase our software systems or services. Additionally, if hospitals’
operating and financial performance deteriorates, or if they are unable to make scheduled payments or obtain credit, they may
not be able to pay, or may delay payment of, accounts receivable owed to us. Any inability of clients to pay us for our products
and services may adversely affect our earnings and cash flow.

Tightened lending standards and the absence of third-party credit has resulted in many of our hospital clients seeking financing
arrangements from us to purchase our software systems and services. These financing arrangements impact our short-term
operating cash flow and cash available. Should the requests for these financing arrangements continue or increase, our business
could be negatively impacted by our inability to finance these arrangements. In addition, the absence of credit could negatively
impact our existing financing receivables should our clients with financing arrangements be unable to meet their obligations.

Our substantial indebtedness may adversely affect our available cash flow and our ability to operate our business, remain in
compliance with debt covenants and make payments on our indebtedness.

As of December 31, 2023, we had approximately $199.6 million in principal amount of indebtedness, which includes $63.9
million under our term loan facility and $135.7 million borrowed under our revolving credit facility. We also had $24.3 million
of unused commitments under our revolving credit facility as of December 31, 2023.

Our substantial indebtedness increases the possibility that we may be unable to generate cash sufficient to pay, when due, the
principal of, interest on or other amounts due in respect of our indebtedness. Our substantial indebtedness, combined with our
other financial obligations and contractual commitments, could have important consequences. For example, it could:

• make it more difficult for us to satisfy our obligations with respect to our indebtedness, and any failure to comply with
the obligations under any of our debt instruments, including restrictive covenants, could result in an event of default
under such instruments;

• make us more vulnerable to adverse changes in general economic, industry and competitive conditions and adverse

changes in government regulation;

•

require us to dedicate a substantial portion of our cash flow from operations to payments on our indebtedness, thereby
reducing the availability of our cash flow to fund working capital, capital expenditures, acquisitions and other general
corporate purposes;

limit our flexibility in planning for, or reacting to, changes in our business and the industry in which we operate;

place us at a competitive disadvantage compared to our competitors that are less highly leveraged and therefore able to
take advantage of opportunities that our indebtedness prevents us from exploiting; and

limit our ability to borrow additional amounts for working capital, capital expenditures, acquisitions, debt service
requirements, execution of our business strategy or other purposes.

Any of the above listed factors could have a material adverse effect on our business, prospects, results of operations and
financial condition. Furthermore, our interest expense could increase if interest rates increase because our debt bears interest at
floating rates, which could adversely affect our cash flows. If we do not have sufficient earnings to service our debt, we may be
required to refinance all or part of our existing debt, sell assets, borrow more money or sell securities, none of which we can
guarantee we will be able to do.

In addition, the credit agreement governing our term loan facility and revolving credit facility contains restrictive covenants that
limit our ability to engage in activities that may be in our long-term best interests. See "The terms of the credit agreement
governing our term loan facility and revolving credit facility may restrict our current and future operations, particularly our
ability to respond to changes in our business or to take certain actions."

Despite our current indebtedness levels, we and our subsidiaries may still be able to incur substantially more debt, which
could exacerbate the risks associated with our substantial leverage.

We and our subsidiaries may be able to incur substantial additional indebtedness in the future, including secured indebtedness.
Although the credit agreement governing our term loan facility and revolving credit facility contains restrictions on the
incurrence of additional indebtedness, these restrictions are subject to a number of significant qualifications and exceptions, and
the indebtedness incurred in compliance with these restrictions could be substantial. If new debt is added to our or our
subsidiaries’ current debt levels, the related risks that we face would be increased.

To service our indebtedness, we will require a significant amount of cash. Our ability to generate cash depends on many
factors beyond our control, and any failure to meet our debt service obligations could have a material adverse effect on our
business, prospects, results of operations and financial condition.

Our ability to pay interest on and principal of our debt obligations principally depends upon our operating performance. As a
result, prevailing economic conditions and financial, business and other factors, many of which are beyond our control, will
affect our ability to make these payments.

If we do not generate sufficient cash flow from operations to satisfy our debt service obligations, we may have to undertake
alternative financing plans, such as refinancing or restructuring our indebtedness, selling assets, reducing or delaying capital
investments or capital expenditures or seeking to raise additional capital. Our ability to restructure or refinance our debt, if at
all, will depend on the condition of the capital markets and our financial condition at such time. Any refinancing of our debt
could be at higher interest rates and may require us to comply with more onerous covenants, which could further restrict our
business operations. In addition, the terms of existing or future debt instruments may restrict us from adopting some of these
alternatives. Our inability to generate sufficient cash flow to satisfy our debt service obligations, or to refinance our obligations
at all or on commercially reasonable terms, could affect our ability to satisfy our debt obligations and have a material adverse
effect on our business, prospects, results of operations and financial condition.

The terms of the credit agreement governing our term loan facility and revolving credit facility may restrict our current and
future operations, particularly our ability to respond to changes in our business or to take certain actions.

Our term loan facility and revolving credit facility contain, and any future indebtedness of ours would likely contain, a number
of restrictive covenants that impose significant operating restrictions, including restrictions on our ability to engage in acts that
may be in our best long-term interests.

The credit agreement governing our term loan facility and revolving credit facility includes covenants restricting, among other
things, our ability to:

•

incur additional debt;

incur liens and encumbrances;

pay dividends on our equity securities or payments to redeem, repurchase or retire our equity securities;

enter into restrictive agreements;

• make investments, loans and acquisitions;

• merge or consolidate with any other person;

•

dispose of assets;

•

enter into sale and leaseback transactions;

engage in transactions with our affiliates; and

• materially alter the business we conduct.

The operating restrictions and covenants in these debt agreements and any future financing agreements may adversely affect our
ability to finance future operations or capital needs or to engage in other business activities. The credit agreement requires
compliance with a consolidated net leverage ratio test and a fixed charge coverage ratio test. On March 10, 2023, the calculation
of the fixed charge coverage ratio was amended to specifically exclude from the definition of fixed charges the Company's
share repurchases conducted during the third and fourth quarters of 2022. As of September 30, 2023, we were not in
compliance with the fixed charge coverage ratio required by the credit agreement. On November 8, 2023, the Company and the
subsidiary guarantors entered into a Waiver with Regions Bank, as administrative agent, and various other lenders, which
provided for a waiver of this failure as an event of default. Similarly, we were not in compliance with this ratio as of December
31, 2023, and we received another waiver of this failure as an event of default pursuant to the Fourth Amendment to the credit
agreement entered into by the parties on February 29, 2024. Any failure by us to comply with this or another covenant in the
future may result in an event of default. There can be no assurance that we will be able to continue to comply with this covenant
or obtain amendments to avoid future covenant violations, or that such amendments will be available on commercially
acceptable terms.

Our ability to comply with these covenants may be affected by events beyond our control, and any material deviations from our
forecasts could require us to seek waivers or amendments of covenants, alternative sources of financing or reductions in
expenditures. In addition, the outstanding indebtedness under our term loan facility and revolving credit facility is, subject to
certain exceptions, secured by security interests in substantially all of our and the subsidiary guarantors’ tangible and intangible
assets (subject to certain exceptions). A breach of any of the restrictive covenants in the credit agreement governing our term
loan facility and revolving credit facility would result in a default, and our lenders may elect to declare all outstanding
borrowings, together with accrued interest and other fees, to be immediately due and payable, or enforce and foreclose on their
security interest and liquidate some or all of such pledged assets. The lenders under our term loan facility and revolving credit
facility also have the right in these circumstances to terminate any commitments they have to provide further borrowings.

RISKS RELATED TO OUR COMMON STOCK AND OTHER GENERAL RISKS

We are subject to changes in and interpretations of financial accounting matters that govern the measurement of our
performance, one or more of which could adversely affect our business, financial condition, cash flows, revenue and results
of operations.

Based on our reading and interpretations of relevant guidance, principles or concepts issued by, among other authorities, the
American Institute of Certified Public Accountants, the Financial Accounting Standards Board and the Securities and Exchange
Commission, we believe revenue received pursuant to our current sales and licensing contract terms and business arrangements
have been properly recognized. However, there continue to be issued interpretations and guidance for applying the relevant
standards to a wide range of sales and licensing contract terms and business arrangements that are prevalent in the software
industry. Future interpretations or changes by the regulators of existing accounting standards, including Financial Accounting
Standards Board ("FASB") Accounting Standards Codification ("ASC") Topic 606, Revenue from Contracts with Customers, or
changes in our business practices could result in changes in our revenue recognition and/or other accounting policies and
practices that could adversely affect our business, financial condition, cash flows, revenue and results of operations.

We may be required to record additional significant charges to earnings if our goodwill or intangible assets become
impaired.

We are required under U.S. generally accepted accounting principles ("U.S. GAAP") to test our goodwill for impairment
annually or more frequently if indicators for potential impairment exist. Indicators that are considered include significant
changes in performance relative to expected operating results, significant changes in the use of the assets, significant negative
industry, or economic trends, or a significant decline in the Company's stock price and/or market capitalization for a sustained
period of time. In addition, we periodically review our intangible assets for impairment when events or changes in
circumstances indicate that the carrying value may not be recoverable. Factors that may be considered a change in
circumstances indicating that the carrying value of our intangible assets may not be recoverable include slower growth rates, the
loss of significant clients, or divestiture of a business or asset for less than its carrying value. We may be required to record a
significant charge to earnings in our consolidated financial statements during the period in which any impairment of our
goodwill or intangible assets is determined. We recorded a goodwill impairment charge of $35.9 million in the fourth quarter of
2023, $21.9 million of which was associated with our Post-acute care EHR reporting unit, $6.4 million of which was associated

with our Acute care EHR reporting unit and $7.6 million of which was associated with our Patient Engagement reporting unit.
These impairment charges had a significant negative effect on our consolidated net income for the year ended December 31,
2023. We subsequently sold our Post-acute care EHR business in January 2024. The Company is currently finalizing the
accounting for the sale but does not expect a material gain or loss to be recorded in 2024 since the related asset impairments
were recorded in 2023.

Exclusive of our Post-acute care EHR reporting unit, which was disposed of in January 2024, we have remaining goodwill of
$171.9 million as of December 31, 2023. Any future impairment charges could have a material adverse impact on our results of
operations. There are inherent uncertainties in management's estimates, judgments and assumptions used in assessing
recoverability of goodwill and intangible assets. Any changes in key assumptions, including failure to meet business plans, a
deterioration in the market, or other unanticipated events and circumstances, may affect the accuracy or validity of such
estimates and could potentially result in an impairment charge.

The unpredictability of our quarterly operating results may cause us to fail to meet revenues or earnings expectations which
could cause the price of our common stock to fluctuate or decline.

There is no assurance that consistent quarterly growth in our business will occur. Our quarterly revenues may fluctuate and may
be difficult to forecast for a variety of reasons. For example, prospective clients often take significant time evaluating our
system and related services before making a purchase decision. Moreover, a prospective client who has placed an order for our
system could decide to cancel that order or postpone installation of the ordered system. If a prospective client delays or cancels
a scheduled system installation during any quarter, we may not be able to schedule a substitute system installation during that
quarter. The amount of revenues that would have been generated from that installation will be postponed or lost. The possibility
of delays or cancellations of scheduled system installations could cause our quarterly revenues to fluctuate.

The following factors may also affect demand for our products and services and cause our quarterly revenues to fluctuate:

•

changes in client budgets and purchasing priorities;

the ability of our clients to obtain financing for the purchase of our products;

the financial stability of our clients;

the specific mix of software, hardware and services in orders from clients;

the timing of new product announcements and product introductions by us and our competitors;

• market acceptance of new products, product enhancements and services from us and our competitors;

•

product and price competition;

our success in expanding our sales and marketing programs;

the availability and cost of system components;

delay of revenue recognition to future quarters due to an increase in the sales of our remote access SaaS services;

the length of sales cycles and installation processes;

changes in revenue recognition or other accounting guidelines employed by us and/or established by the Financial
Accounting Standards Board or other rulemaking bodies;

accounting policies concerning the timing of recognition of revenue;

personnel changes; and

general market and economic factors.

Variations in our quarterly revenues may adversely affect our operating results. In each fiscal quarter, our expense levels,
operating costs and hiring plans are based on projections of future revenues and are relatively fixed. Because a significant
percentage of our expenses are relatively fixed, a variation in the timing of systems sales, implementations and installations can
cause significant variations in operating results from quarter to quarter. As a result, we believe that interim period-to-period
comparisons of our results of operations are not necessarily meaningful and should not be relied upon as indications of future

performance. Further, our historical operating results are not necessarily indicative of future performance for any particular
period.

Due to all of the foregoing factors, it is possible that our operating results may be below the expectations of securities analysts
and investors. In such event, the price of our common stock would likely be adversely affected.

Our common stock price has periodically experienced significant volatility, which could result in substantial losses for
investors purchasing shares of our common stock and in litigation against us.

Volatility may be caused by a number of factors including but not limited to:

•

actual or anticipated quarterly variations in operating results;

rumors about our performance, software solutions, or merger and acquisition activity;

changes in expectations of future financial performance or changes in estimates of securities analysts;

governmental regulatory action;

healthcare reform measures;

client relationship developments;

purchases or sales of Company stock;

changes occurring in the markets in general;

• macroeconomic conditions, both nationally and internationally; and

•

other factors, many of which are beyond our control.

Furthermore, the stock market in general, and the market for software, healthcare and high technology companies in particular,
has experienced significant volatility in recent years that often has been unrelated to the operating performance of particular
companies. These broad market and industry fluctuations may adversely affect the trading price of our common stock,
regardless of actual operating performance.

Moreover, in the past, securities class action litigation has often been brought against a company following periods of volatility
in the market price of its securities. We may in the future be the target of similar litigation. Securities litigation could result in
substantial costs and divert management’s attention and resources.

If we fail to maintain effective internal control over financial reporting, this may adversely affect investor confidence in our
company and, as a result, the value of our common stock.

We are required under Section 404 of the Sarbanes-Oxley Act to furnish a report by management on the effectiveness of our
internal control over financial reporting and to include a report by our independent auditors attesting to such effectiveness. Any
failure by us to maintain effective internal control over financial reporting could adversely affect our ability to report accurately
our financial condition or results of operations.

As reported in our Quarterly Report on Form 10-Q for the period ended September 30, 2023, we identified a material weakness
in our internal control over financial reporting in the third quarter of 2023, as our controls over debt covenant monitoring and
compliance were not operating with sufficient precision and timeliness. As of December 31, 2023, this weakness had been
remediated with more robust and timely review controls over the related covenant calculations.

If we are unable to maintain effective internal control over financial reporting, or if our independent auditors determine that we
have any additional material weaknesses in our internal control over financial reporting, we could lose investor confidence in
the accuracy and completeness of our financial reports, the market price of our common stock could decline, and we could be
subject to sanctions or investigations by the Securities and Exchange Commission (“SEC”) or other regulatory authorities.
Failure to remedy any material weakness in our internal control over financial reporting, or to implement or maintain other
effective control systems required of public companies, also could restrict our future access to the capital markets.

As a result of the inherent limitations in our internal control over financial reporting, misstatements due to error or fraud
may occur and not be detected.

Our disclosure controls and procedures are designed to provide reasonable assurance that information required to be disclosed
by us in reports we file with or submit to the SEC under the Securities Exchange Act of 1934 (“Exchange Act”) is accumulated
and communicated to management and recorded, processed, summarized, and reported within the time periods specified in SEC
rules and forms. We believe that any disclosure controls and procedures or internal controls and procedures, no matter how well
conceived and operated, can provide only reasonable, not absolute, assurance that the objectives of the control system are met.
These inherent limitations include the realities that judgments in decision-making can be faulty and that breakdowns can occur
because of simple error or mistake. In addition, controls can be circumvented by the individual acts of some persons, by
collusion of two or more people, or by an unauthorized override of the controls.

Most of our facilities are located in an area vulnerable to hurricanes and tropical storms, and the occurrence of a severe
hurricane, similar storm or other natural disaster could cause damage to our facilities and equipment, which could require
us to cease or limit our operations.

A significant portion of our facilities and employees are located within 30 miles of the coast of the Gulf of Mexico. Our
facilities are vulnerable to significant damage or destruction from hurricanes and tropical storms. Such disasters may become
more frequent and/or severe as the result of climate change. We are also vulnerable to damage from other types of disasters,
including tornadoes, fires, floods and similar events. If any disaster were to occur, our ability to conduct business at our
facilities could be seriously impaired or completely destroyed. This would have adverse consequences for our clients who
depend on us for system support or business management, consulting and managed IT services. Also, the servers of clients who
use our remote access services could be damaged or destroyed in any such disaster. This would have potentially devastating
consequences to those clients. Although we have an emergency recovery plan, including back-up systems in remote locations,
there can be no assurance that this plan will effectively prevent the interruption of our business due to a natural disaster.
Furthermore, the insurance we maintain may not be adequate to cover our losses resulting from any natural disaster or other
business interruption. Moreover, we could be affected by climate change and other environmental issues to the extent such
issues adversely affect the general economy, adversely impact our supply chain or increase the costs of supplies needed for our
operations, or otherwise result in disruptions impacting the communities in which our facilities are located.

We are exposed to market risk related to interest rate changes.

We are exposed to market risk related to changes in interest rates as a result of the floating interest rates applicable to the
outstanding debt under our term loan facility and revolving credit facility. The interest rate for the outstanding debt under our
term loan facility and revolving credit facility as of December 31, 2023 was 8.48%. Each of our credit facilities continues to
bear interest at a rate per annum equal to an applicable margin plus, at our option, either (1) the Adjusted Secured Overnight
Financing Rate ("SOFR") rate for the relevant interest period, subject to a floor of 0.50%, (2) an alternate base rate determined
by reference to the greater of (a) the prime lending rate of Regions, (b) the federal funds rate for the relevant interest period plus
one half of one percent per annum and (c) the one month SOFR rate, subject to the aforementioned floor, plus one percent per
annum, or (3) a combination of (1) and (2). The applicable margin for SOFR loans and the letter of credit fee ranges from 1.8%
to 3.0%. The applicable margin for base rate loans ranges from 0.8% to 2.0%, in each case based on the Company's
consolidated net leverage ratio. A one hundred basis point change in interest rate on our borrowings outstanding as of
December 31, 2023 would result in a change in interest expense of approximately $2.0 million annually.

Macroeconomic conditions could have a materially adverse impact on our business, financial condition, or results of
operations.

In recent months, record levels of inflation have resulted in significant volatility and disruptions in the global economy. In
response to rising inflation, central banks, including the United States Federal Reserve, have tightened their monetary policies
and raised interest rates, and such measures may continue if there is a period of sustained heightened inflation. Higher interest
rates and volatility in financial markets could lead to additional economic uncertainty or recession. Increased inflation rates
have increased our and our suppliers’ operating costs, including labor costs. There is no assurance that we will be able to
promptly increase our pricing to offset our increased costs in a higher inflationary environment, or that our operations will not
be materially impacted by rising inflation and its broader effect on the markets in which we operate in the future. Impacts from
inflationary pressures could be more pronounced and materially adversely impact aspects of our business where revenue
streams and costs commitments are linked to contractual agreements that extend into the future, as we may not be able to
quickly or easily adjust pricing, reduce costs, or implement countermeasures. We are unable to predict the impact of efforts by
central banks and federal, state, and local governments to combat elevated levels of inflation. If their efforts to create downward
pressure on inflation are too aggressive, they may lead to a recession. Alternatively, if they are insufficient or are not sustained
long enough to bring inflation to lower, more acceptable levels, our customers’ ability or willingness to spend on healthcare
information technology may be impacted for a prolonged period of time. If a recession occurs, economies weaken, or
inflationary trends continue, our business and operating results could be materially adversely affected.

Moreover, a potential U.S. federal government shutdown resulting from budgetary decisions, a prolonged continuing resolution,
breach of the federal debt ceiling, or a potential U.S. sovereign default and the uncertainty surrounding the 2024 U.S.
presidential election may increase uncertainty and volatility in the global economy and financial markets. Weak economic
conditions or significant uncertainty regarding the stability of financial markets related to stock market volatility, inflation,
recession, changes in tariffs, trade agreements or governmental fiscal, monetary and tax policies, among others, could adversely
impact our business, financial condition and operating results.

ITEM 1B.

UNRESOLVED STAFF COMMENTS

None.

ITEM 1C.

CYBERSECURITY

Our business operations, including the provision of the products and services described above, involve the compilation and
transmission of confidential information, including patient health information. We also collect and store other sensitive data
such as credit card, insurance, and other information. We have included security features in our systems that are intended to
protect the privacy and integrity of this information, but our systems may be vulnerable to security breaches, viruses,
programming errors and other similar disruptive problems.

The Board of Directors is responsible for exercising oversight of management’s identification of, and planning for, the material
risks facing the Company, and we believe our risk management policies and procedures are adequate to ensure that relevant
information about cybersecurity risks and incidents is appropriately reported and disclosed. In October 2017, the Board
authorized the formation of a Cybersecurity Committee, which is now known as the Governance, Risk & Compliance (“GRC”)
Committee. Our cybersecurity risk management process, which are discussed in greater detail below, are led by the GRC
Committee. The GRC Committee is currently comprised of the Chief Technology and Innovation Officer, Chief Financial
Officer, General Manager of TruBridge, General Manager of EHR, General Manager of Patient Engagement, Corporate
Security Officer, and General Counsel and Corporate Compliance Officer. The GRC Committee generally meets weekly, and
has a formal meeting quarterly, to discuss the primary security and compliance-related risks currently facing the Company,
including cybersecurity risks. The General Counsel and Corporate Compliance Officer then provides updates to the Board at
each regular quarterly meeting. Annually, the full Board participates in cybersecurity training and discusses the internal incident
management process with the GRC Committee.

In October 2020, the Board created the Innovation and Technology Committee to aid the Board in its duties to assess and
oversee the management of risks in the areas of information technology, information and data security, cybersecurity, disaster
recovery, data privacy and business continuity. This committee oversees the GRC Committee’s activities relating to information
technology and cybersecurity matters, and seeks to enhance communication and coordination of efforts between the Board and
management in these areas. The members of the Innovation and Technology Committee monitor the prevention, mitigation,
detection, and remediation of cybersecurity incidents through their management of and participation in the cybersecurity risk
management process described below, including the operation of our incident response plan.

Additionally, we have a Security Operations Center ("SOC") to oversee several initiatives designed to improve our
cybersecurity protection, readiness and response. The Company partnered with a third party to provide Security as a Service
("SECaaS") to assist our internal SOC in reducing the likelihood and impact of a cybersecurity attack. The SOC oversees
penetration testing, vulnerability scanning, intrusion prevention, endpoint and insider threat detection, log management and
other cybersecurity-related projects. The Company also consulted with third parties to achieve ISO 27001 certification related
to information security management, which was achieved starting in 2020 and maintained every year since.

Our SOC team members have over 35 years of combined work experience in various roles involving managing information
security, developing cybersecurity strategy, implementing effective information and cybersecurity programs, and developing
and overseeing programs and policies related to various areas, including incident response, eDiscovery, forensic investigations,
log analysis, malware analysis, risk management, physical security, and enterprise security operations, as well as several
relevant degrees and certifications, including Masters degrees in Cybersecurity and Information Assurance, Bachelors degrees
in Information Technology, BS Information Systems and Cybersecurity, Certified Information Systems Security Professional,
Certified Ethical Hacker, Computer Hacking Forensic Investigator, A+, Network+, Security+, MS Sentinel, a Degree in
forensic science and others being worked on. Prior work experience, knowledge, skills, or background for the SOC team
include: law enforcement, DoD contractor work in cybersecurity, heavy involvement in numerous large scale intrusion
investigations, published author of an Intrusion Analysis book, presentations at numerous conferences focused on
cybersecurity, hundreds of forensic analysis cases, prior employment by other companies as cybersecurity/SOC analysts, and
continuous on the job training

We have a cybersecurity-specific risk assessment process, which helps identify our cybersecurity threat risks by comparing our
process to industry standards and best practices standards set by the National Institute of Standards and Technology (“NIST”)
and the International Organization for Standardization (“ISO”), as well as by engaging experts to attempt to infiltrate our

information systems, as such term is defined in Item 106(a) of Regulation S-K. Our cybersecurity program includes controls
designed to identify, protect against, detect, respond to and recover from information and cybersecurity incidents, as such term
is defined in Item 106(a) of Regulation S-K, and to provide for the availability of critical data and systems and to maintain
regulatory compliance. These controls include the following activities:

a.
b.
c.

closely monitor emerging data protection laws and implement changes to our processes designed to comply;
conduct annual customer data handling and use requirements training for all our employees;
conduct annual cybersecurity management and incident training for employees involved in our systems and processes
that handle sensitive data;
conduct regular phishing email simulations for all employees and all contractors with access to corporate email
systems to enhance awareness and responsiveness to such possible threats;
through policy, practice and contract (as applicable), require employees, as well as third-parties who provide services
on our behalf, to protect customer information and data;
run tabletop exercises to simulate a response to a cybersecurity incident and use the findings to improve our processes
and technologies;
leverage the NIST and ISO incident handling frameworks to help us identify, protect, detect, respond, and recover
when there is an actual or potential cybersecurity incident; and

h. maintain multiple layers of controls, including embedding security into our technology investments.

We perform periodic internal and third-party assessments to test our cybersecurity controls and regularly evaluate our policies
and procedures surrounding our handling and control of personal data and the systems we have in place to help protect us from
cybersecurity or personal data breaches, and we perform periodic internal and third-party assessments to test our controls and to
help us identify areas for continued focus, improvement, and/or compliance. An example of the assessment we use is the ISO
27001 assessment that was implemented started in 2020. Our team is continually evaluating our technology vendors and tools
to ensure that we are managing evolving threats to the best of our ability.

Our processes also address cybersecurity threat risks associated with our use of third-party service providers, including those in
our supply chain or who have access to our customer and employee data or our systems. Third-party risks are included within
our enterprise risk management program, as well as our cybersecurity-specific risk identification program, both of which are
discussed above. In addition, cybersecurity considerations affect the selection and oversight of our third-party service providers.
We perform diligence on third-parties that have access to our systems, data or facilities that house such systems or data, and
continually monitor cybersecurity threat risks identified through such diligence. Additionally, we generally require those third
parties that could introduce significant cybersecurity risk to us to agree by contract to manage their cybersecurity risks in
specified ways, and to agree to be subject to cybersecurity audits, which we conduct as appropriate. Finally, all users employed
by or contracted to the Company are required to complete annual cybersecurity education and training, which includes
identifying suspicious emails, internet threats, telecommunication threats and ransomware.

We describe whether and how risks from identified cybersecurity threats, including as a result of any previous cybersecurity
incidents, have materially affected or are reasonably likely to materially affect us, including our business strategy, results of
operations, or financial condition, under the heading “Breaches of security and viruses in our systems could result in client
claims against us and harm to our reputation causing us to incur expenses and/or lose clients” included as part of our risk
factor disclosures at Item 1A of this Annual Report on Form 10-K,which disclosure is incorporated by reference herein.
Although we maintain cybersecurity insurance to reduce potential financial losses that may stem from cybersecurity incidents,
the costs related to cybersecurity threats or disruptions may not be full insured.

ITEM 2.

PROPERTIES

On April 5, 2021, the Company relocated its principal executive office pursuant to a sublease for 20,093 square feet of office
space in downtown Mobile, Alabama. Our corporate campus is located on approximately 16.5 acres in Mobile, Alabama and
includes approximately 135,500 square feet of office space. Our main campus building consists of approximately 66,000 square
feet of office and warehouse space. We also have eleven additional smaller campus buildings consisting of approximately 6,000
square feet of office space each and an additional campus building consisting of approximately 3,500 square feet. The Company
also owns 11.3 acres of undeveloped real property adjacent to our corporate campus.

We lease the remainder of our facilities in various locations in the United States, including: Mobile, Alabama; Pottsville,
Pennsylvania; Glenwood, Minnesota; Ridgeland, Mississippi; Spokane, Washington and Rockville, Maryland. The terms of

these leases generally range in length from one to twelve years, and all of the leases contain options to incrementally extend the
lease period.

During 2023, the Company terminated its lease agreement for approximately 12,500 square feet of office space in Plymouth,
Minnesota.

ITEM 3.

LEGAL PROCEEDINGS

From time to time, we have been and may again become involved in legal proceedings arising in the ordinary course of our
business. We are not presently a party to any litigation or legal proceedings that we believe to be material and we are not aware
of any pending or threatened litigation against us that we believe could have a material adverse effect on our business, operating
results, financial condition or cash flows. See Note 16 – Commitments and Contingencies included in the notes to our audited
financial statements included elsewhere in the Annual Report on Form 10-K.

ITEM 4.

MINE SAFETY DISCLOSURES

Not applicable.

ITEM 5.

MARKET FOR REGISTRANT’S COMMON EQUITY, RELATED STOCKHOLDER MATTERS
AND ISSUER PURCHASES OF EQUITY SECURITIES

PART II

Market for TruBridge Common Stock

As of March 11, 2024, there were approximately 77 registered holders of our common stock, as provided to us by our transfer
agent. This number does not include the number of beneficial owners whose shares are held in “street” names by broker-dealers
and other institutions who hold shares on behalf of their clients. As of March 11, 2024, there were 14,507,776 shares of
common stock outstanding.

TruBridge’s common stock is listed on the NASDAQ Global Select Market under the symbol "TBRG." Prior to March 4, 2024,
TruBridge's common stock was listed under the symbol “CPSI.”

Dividends

On September 4, 2020, our Board of Directors opted to indefinitely suspend all quarterly dividends. The indefinite suspension
of quarterly dividends was concurrent with the authorization of a stock repurchase program, aligning with the Company's
capital allocation strategy that prioritizes flexibility to allow for more opportunistic uses of capital. Our Board of Directors will
take into account such matters as general business conditions, capital needs, our financial results, available liquidity and such
other factors as our Board of Directors may deem relevant in future dividend declarations. Additionally, the terms of our Credit
Agreement restrict our ability to pay dividends and make share repurchases. See Item 7, Management’s Discussion and
Analysis of Financial Condition and Results of Operations, “Liquidity and Capital Resources-Credit Agreement” included
herein.

Purchases of Equity Securities

The following table summarizes our repurchase of equity securities during the three months ended December 31, 2023:

Period

Total Number
of Shares
Purchased

Average Price
Paid per Share

Total Number
of Shares
Purchased as
Part of Publicly
Announced
Plans or
Programs (a)

Approximate
Dollar Value of
Shares That
May Yet Be
Purchased
Under the Plans
or Programs (a)

October 1, 2023 - October 31, 2023 . . . . . . . . . .

November 1, 2023 - November 30, 2023 . . . . . .

December 1, 2023 - December 31, 2023 . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

— $

—

— $

16,471,896

— $

16,471,896

—

(a) On September 4, 2020, our Board of Directors approved a stock repurchase program under which we may repurchase
up to $30.0 million of our common stock through September 3, 2022. On July 27, 2022, the Board of Directors
extended the expiration date of the stock repurchase program to September 4, 2024. Any future stock repurchase
transactions may be made through open market purchases, privately-negotiated transactions, or otherwise in
compliance with Rule 10b-18 under the securities Exchange Act of 1934, as amended.

ITEM 6.

[Reserved]

ITEM 7.

MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS
OF OPERATIONS

You should read the following discussion of our financial condition and results of operations in conjunction with the "Selected
Financial Data" and our financial statements and the related notes included elsewhere in this Annual Report. This discussion
and analysis contains forward-looking statements that involve risks, uncertainties and assumptions. Our actual results may
differ materially from those anticipated in these forward-looking statements as a result of many factors, including but not
limited to those set forth under "Risk Factors" and elsewhere in this Annual Report.

Background

During much of the Company's history, our strategy, operations, and financial results have been largely associated with
developments in the electronic health record ("EHR") industry. With the rapid maturity of the EHR industry and the increasing
prevalence of and demand for outsourced revenue cycle management ("RCM") services and complementary solutions, we've
seen our strategy, operations, and financial results naturally evolve to become more heavily associated with RCM, with RCM
revenues comprising 57% of our consolidated revenue for 2023. In recognition of this significant shift in strategic focus,
Computer Programs and Systems, Inc. changed its corporate name to TruBridge, Inc. on March 4, 2024. Contemporaneous
with this name change, the former wholly-owned subsidiaries Evident, LLC, TruBridge, LLC, and TruCode, LLC were merged
into the parent company, while the former wholly-owned subsidiary Rycan Technologies, Inc. was merged into its parent and
another wholly-owned subsidiary, Healthland Holding Inc. With these changes, the Company's remaining legal structure
includes TruBridge, Inc., the parent company, with Viewgol, LLC ("Viewgol"), iNetXperts, Corp. d/b/a Get Real Health,
Healthcare Resource Group, Inc. ("HRG"), and Healthland Holding Inc. as its wholly-owned subsidiaries.

Founded in 1979, TruBridge is a leading provider of healthcare services and solutions for community hospitals, their clinics and
other healthcare systems. Our combined companies are focused on helping improve the health of the communities we serve,
connecting communities for a better patient care experience, and improving the financial operations of our customers.

The Company operates its business in three operating segments, which are also our reportable segments: RCM, EHR, and
Patient Engagement. These reporting segments contribute towards the combined focus of improving the health of the
communities we serve as follows:

•

The RCM reporting segment focuses on providing business management, consulting, and managed IT services along
with a complete RCM solution for all care settings, regardless of their primary healthcare information solutions
provider.

The EHR segment provides comprehensive acute care EHR solutions and related services for community hospitals and
their physician clinics. Prior to our sale of American HealthTech, Inc. in January 2024, our EHR segment also
provided post-acute care EHR solutions and related services for skilled nursing and assisted living facilities.

The Patient Engagement segment offers comprehensive patient engagement and empowerment technology solutions to
improve patient outcomes and engagement strategies with care providers.

See Note 18 to the consolidated financial statements included herein for additional information on our three reportable
segments.

Management Overview

Strategy

Our core strategy is to achieve meaningful long-term revenue growth by cross-selling RCM services into our existing EHR
customer base, expanding RCM market share with sales to new community hospitals and larger health systems, and pursuing

competitive EHR takeaway opportunities. We may also seek to grow through acquisitions of businesses, technologies or
products if we determine that such acquisitions are likely to help us meet our strategic goals.

Our growth strategy is heavily dependent on our ability to cross-sell RCM services to our Acute Care EHR customer base. As
such, retention of our existing Acute Care EHR customers is a key component of our long-term growth strategy by protecting
this base of potential RCM customers, while at the same time serving as a leading indicator of our market position and stability
of revenues and cash flows.

We determine retention rates by reference to the amount of beginning-of-period Acute Care EHR recurring revenues that have
not been lost due to customer attrition from our production environment customer base. Production environment customers are
those that are using our applications to document live patient encounters, as opposed to legacy environment customers that have
view-only access to historical patient records. Since 2019, these retention rates have consistently remained in the mid-to-high
90th percentile ranges. Specifically, we achieved retention rates of 98.2% and 94.9% in 2021 and 2022, respectively, decreasing
to 92.1% in 2023, as EHR product consolidation has led to an increase in attrition from our non-flagship products (retention for
our flagship EHR product was approximately 95.2% in 2023). We have increased customer retention efforts by enhancing
support services, investing in tooling and instrumentation to proactively monitor for potential disruptions, and deploying in-
application experience software that delivers application-specific insights while using our products.

As we pursue meaningful long-term revenue growth by leveraging RCM as a growth agent, we are placing ever-increasing
value in further developing our already significant recurring revenue base to further stabilize our revenues and cash flows. As
such, maintaining and growing recurring revenues are key components of our long-term growth strategy, aided by the
aforementioned focus on customer retention. This includes a renewed focus on driving demand for subscriptions for our
existing technology solutions and expanding the footprint for RCM services beyond our EHR customer base.

While the combination of revenue growth and operating leverage is expected to result in increased margin realization, we also
look to increase margins through specific cost containment measures where appropriate as we continue to leverage
opportunities for greater operating efficiencies. However, in the immediate future, we anticipate incremental margin pressure
from the continued client transition from perpetual license arrangements to “Software as a Service” ("SaaS") arrangements as
described below.

Industry Dynamics

Turbulence in the U.S. and worldwide economies and financial markets impacts almost all industries. While the healthcare
industry is not immune to economic cycles, we believe it is more significantly affected by U.S. regulatory and national health
initiatives. In recent years, there have been significant changes to provider reimbursement by the U.S. federal government,
followed by commercial payers and state governments. There is increasing pressure on healthcare organizations to reduce costs
and increase quality while replacing the fee-for-service reimbursement model in part by enrolling in an advanced payment
model that incentivizes high-quality, cost effective-care via value-based reimbursement. This pressure could further encourage
adoption of healthcare IT and increase demand for business management, consulting, and managed IT services, as the future
success of these healthcare providers is greatly dependent upon their ability to engage patient populations and to coordinate
patient care across a multitude of settings, while optimizing operating efficiency along the way.

Additionally, healthcare organizations with a large dependency on Medicare and Medicaid populations, such as community
hospitals, have been affected by the challenging financial condition of the federal government and many state governments and
government programs. Accordingly, we recognize that prospective hospital clients often do not have the necessary capital to
make investments in information technology while those with the necessary capital have become more selective in their
investments. Despite these challenges, we believe healthcare IT will be an area of continued investment due to its unique
potential to improve safety and efficiency and reduce costs while meeting current and future regulatory, compliance and
government reimbursement requirements.

EHR License Model Preferences

Much of the variability in our periodic revenues and profitability has been and will continue to be due to changing demand for
different license models for our technology solutions, with variability in operating cash flows further impacted by the financing
decisions within those license models. Our technology solutions are generally deployed in one of two license models: (1)
perpetual licenses, for which the related revenue is recognized effectively upon installation, and (2) “Software as a Service” or
“SaaS” arrangements, including our Cloud Electronic Health Record (“Cloud EHR”) offering, which generally result in revenue
being recognized monthly as the services are provided over the term of the arrangement.

The overwhelming majority of our historical EHR installations have been under a perpetual license model, but new customer
demand has dramatically shifted towards a SaaS license model in the past several years. SaaS license models made up only 12%
of annual new acute care EHR installations in 2018, increasing to 100% during 2022 and 2023. These SaaS offerings are
attractive to our clients because this configuration allows them to obtain access to advanced software products without a
significant initial capital outlay. We expect this trend to continue for the foreseeable future, with the resulting impact on the
Company’s financial statements being reduced EHR revenues in the period of installation in exchange for increased recurring
periodic revenues (reflected in EHR revenues) over the term of the SaaS arrangement. This naturally places downward pressure
on short-term revenue growth and profitability metrics, but benefits long-term revenue growth and profitability which, in our
view, is consistent with our goal of delivering long-term shareholder value.

For customers electing to purchase our technology solutions under a traditional perpetual license, we have historically made
financing arrangements available on a case-by-case basis, depending on the various aspects of the proposed contract and
customer attributes. These financing arrangements have comprised the majority of our perpetual license installations over the
past several years, and include short-term payment plans and longer-term lease financing through us or third-party financing
companies. The aforementioned shift in customer preference towards SaaS arrangements has significantly reduced the
frequency of new financing arrangements for customer purchases under a perpetual license. When combined with scheduled
payments on existing financing arrangements, the reduced frequency of new financing arrangements has resulted in a
substantial reduction in financing receivables during 2023.

For those perpetual license clients not seeking a financing arrangement, the payment schedule of the typical contract is
structured to provide for a scheduling deposit due at contract signing, with the remainder of the contracted fees due at various
stages of the installation process (delivery of hardware, installation of software and commencement of training, and satisfactory
completion of a monthly accounting cycle or end-of-month operation by each respective application, as applicable).

Margin Optimization Efforts

Our core growth strategy includes margin optimization by identifying opportunities to further improve our cost structure by
executing against initiatives related to organizational realignment, expanded use of offshore resources and the use of automation
to increase the efficiency and value of our associates' efforts.

Initial organizational realignment efforts began during 2021, when we committed to a reduction in force intended to more
effectively align our resources with business priorities. Other related initiatives include our ongoing implementation of the
Scaled Agile Framework® throughout our EHR product development, implementation and support functions to enhance
cohesion, time-to-market and customer satisfaction. This framework is a set of organization and workflow patterns intended to
guide enterprises in scaling lean and agile practices and promote alignment, collaboration, and delivery across large numbers of
agile teams.

The remaining margin optimization initiatives of expanded utilization of offshore resources and automation have commenced
and, to date, have provided meaningful efficiencies to our operations, particularly within RCM. As a service organization,
RCM's cost structure is heavily dependent upon human capital, subjecting it to the complexities and risks associated with this
resource. Chief among these complexities and risks is the ever-present pressure of wage inflation, which has recently become a
reality as national and international economies recover from the economic downturn caused by the COVID-19 pandemic and
has compelled the Company to make compensation adjustments that are outside of historical norms. Prior to our October 2023
acquisition of Viewgol, we were solely reliant upon third-party partnerships for offshore resources, increasing both the
execution risk of this initiative and the related cost of scaling this labor force. With Viewgol as a subsidiary, we have greatly
enhanced our control over the resource availability for this initiative and we expect to achieve meaningful per-unit cost
efficiencies. However, in the near-term, we expect to see additional pressure on margins due to the integration and ramp-up of
Viewgol.

We believe that our efforts towards margin optimization are well-timed, enabling a rapid response to actual or expected wage
inflation in order to preserve RCM profitability, but we cannot guarantee that these efforts will fully eliminate any related
margin deterioration.

In addition to wage inflation, we are a party to contracts with certain third-party suppliers and vendors that allow for annual
price adjustments indexed to inflation. While we continually seek to proactively manage controllable expenses, inflationary
pressure on costs has led to, and could lead to, erosion of margins.

2023 Financial Overview

In the fourth quarter of 2022, the Company made a number of changes to its organizational structure and management system to
align the Company's operating model to its strategic initiatives. With these changes the Company revised its reportable
segments to RCM, EHR, and Patient Engagement, but this realignment of the Company's reportable segments did not impact its
consolidated financial statements. Throughout this discussion, prior-year results have been recast to conform with the change in
reportable segments noted above.

We generated revenues of $339.4 million from the sale of our products and services during 2023, compared to $326.6 million
during 2022, an increase of 4% that is due to the combination of inorganic growth through our recent acquisitions of HRG and
Viewgol and organic growth as RCM solutions continue to gain traction in the domestic healthcare landscape. Despite this
increase in revenues, net income (loss) decreased by $61.7 million to a net loss of $45.8 million during 2023, compared to net
income of $15.9 million during 2022. Heavily impacting our results for 2023 were (i) $35.9 million of goodwill impairment
charges related to our divestiture of American HealthTech, Inc., the impact of deteriorating macroeconomic conditions and
moderated assumptions regarding growth expectations and eventual margin achievement on the fair values of our Acute care
EHR and Patient Engagement reporting units; (ii) $2.3 million of impairment charges related to trademark intangible assets
resulting from our March 2024 name change and corporate rebranding initiative (see Note 12 - Intangible Assets and Goodwill
for further information); (iii) $17.7 million of incremental severance and other nonrecurring charges resulting from various
restructuring and acquisition initiatives; and (iv) $6.2 million of incremental interest expense driven by the combined factors of
an increasing interest rate environment and acquisition-fueled increases in debt. Corresponding to this decreased profitability,
net cash provided by operating activities decreased by $31.3 million, from $32.4 million provided by operations during 2022 to
$1.1 million provided by operations for 2023.

Results of Operations

The following table sets forth certain items included in our results of operations for each of the three years in the period ended
December 31, 2023, expressed as a percentage of our total revenues for these periods:

(In thousands)
INCOME DATA:
Revenues:

2023

Year ended December 31,
2022

2021

Amount

% Sales

Amount

% Sales

Amount

% Sales

RCM . . . . . . . . . . . . . . . . . . . . . . . . $ 193,929
138,063
EHR . . . . . . . . . . . . . . . . . . . . . . . . .
7,443
Patient engagement . . . . . . . . . . . . .
339,435
Total revenues . . . . . . . . . . . . . . . . . .
Expenses

Costs of revenue (exclusive of
amortization and depreciation)

RCM . . . . . . . . . . . . . . . . . . . . . . .
EHR . . . . . . . . . . . . . . . . . . . . . . .
Patient engagement . . . . . . . . . . . .

Total costs of revenue (exclusive of
amortization and depreciation) . . . . .
Product development . . . . . . . . . . . .
Sales and marketing . . . . . . . . . . . .
General and administrative . . . . . . .
Amortization . . . . . . . . . . . . . . . . . .

Depreciation . . . . . . . . . . . . . . . . . .

Goodwill impairment . . . . . . . . . . .
Trademark impairment . . . . . . . . . .
Total expenses . . . . . . . . . . . . . . . . . .
Operating income (loss) . . . . . . . . . .
Other income (expense): . . . . . . . . . .
Other income . . . . . . . . . . . . . . . . .
Gain on contingent consideration . .
Loss on extinguishment of debt . . .
Interest expense . . . . . . . . . . . . . . . .
Total other income (expense) . . . . . .
Income (loss) before taxes . . . . . . . . .
Provision (benefit) for income taxes .
Net income (loss) . . . . . . . . . . . . . . . . $

110,192
62,048
3,628

175,868
37,246
28,049
76,153

24,522

1,946
35,913
2,342
382,039
(42,604)

745
—
—
(12,521)
(11,776)
(54,380)
(8,591)
(45,789)

2023 Compared to 2022

Revenues

57.1 % $ 179,870
139,823
40.7 %
2.2 %
6,955
326,648
100.0 %

55.1 % $ 131,242
143,109
42.8 %
6,278
2.1 %
280,629
100.0 %

46.8 %
51.0 %
2.2 %
100.0 %

32.5 %
18.3 %
1.1 %

51.8 %
11.0 %
8.3 %
22.4 %

97,024
65,661
3,856

166,541
31,898
27,131
54,965

29.7 %
20.1 %
1.2 %

51.0 %
9.8 %
8.3 %
16.8 %

66,015
66,698
3,068

135,781
32,809
21,978
48,481

7.2 %

20,887

6.4 %

14,717

0.6 %
10.6 %
0.7 %
112.6 %
(12.6) %

2,443
—
—
303,865
22,783

0.2 %
— %
— %
(3.7) %
(3.5) %
(16.0) %
(2.5) %
(13.5) % $

1,178
565
(125)
(6,320)
(4,702)
18,081
2,214
15,867

0.7 %
— %
— %
93.0 %
7.0 %

2,156
—
—
255,922
24,707

0.4 %
0.2 %
— %
(1.9) %
(1.4) %
5.5 %
0.7 %
4.9 % $

1,529
—
—
(3,160)
(1,631)
23,076
4,646
18,430

23.5 %
23.8 %
1.1 %

48.4 %
11.7 %
7.8 %
17.3 %

5.2 %

0.8 %
— %
— %
91.2 %
8.8 %

0.5 %
— %
— %
(1.1) %
(0.6) %
8.2 %
1.7 %
6.6 %

Total revenues for the year ended December 31, 2023 increased by $12.8 million, or 4%, compared to the year ended
December 31, 2022.

RCM revenues increased by $14.1 million, or 8%, compared to 2022, as acquisition-fueled growth from our March 2022
acquisition of HRG and our October 2023 acquisition of Viewgol added to the organic growth of our RCM offerings.

EHR revenues decreased by $1.8 million, or 1%, from the year ended December 31, 2022, and were comprised of the following
for the years ended December 31, 2023 and 2022:

(In thousands)
Recurring EHR revenues (1)

Year ended December 31,

2023

2022

Acute Care EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Post-acute Care EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total recurring EHR revenues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111,276 $
14,712
125,988

109,340
15,384
124,724

Non-recurring EHR revenues (2)

Acute Care EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Post-acute Care EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total non-recurring EHR revenues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total EHR revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
(1) Mostly comprised of support and maintenance, third-party subscriptions, and SaaS revenues.
(2) Mostly comprised of installation revenues from the sale of our acute and post-acute care EHR solutions and related
applications under a perpetual (non-subscription) licensing model.

10,657
1,418
12,075
138,063 $

13,138
1,961
15,099
139,823

Recurring EHR revenues increased by $1.3 million, or 1%, in 2023 compared to 2022. Although customer attrition during
2023 resulted in a decrease in Post-acute care EHR recurring revenues of $0.7 million, or 4%, Acute Care EHR recurring
revenues increased by $1.9 million, or 2%, as continued efforts to emphasize SaaS arrangements have led to the accumulation
of significant sources of recurring revenue.

Non-recurring EHR revenues decreased by $3.0 million, or 20%, compared to 2022. The consequence of our continued focus
on increasing recurring revenues has been the de-emphasizing of nonrecurring, perpetual license sales.

EHR revenues for 2023 included $16.1 million in revenues from American HealthTech, Inc. which the Company sold in
January 2024. See Note 19 – Subsequent Events to the consolidated financial statements included herein for more information.

Patient Engagement revenues increased by $0.5 million, or 7%, compared to 2022 as delivery of certain services formerly
provided by our Acute Care EHR segment are now the responsibility of our Patient Engagement segment, with the related
revenues and direct costs now reflected in our Patient Engagement segment's results.

Costs of Revenue (exclusive of amortization and depreciation)

Total costs of revenue (exclusive of amortization and depreciation) increased by $9.3 million compared to 2022. As a
percentage of total revenues, costs of revenue (exclusive of amortization and depreciation) increased slightly to 52% during
2023 compared to 51% during 2022.

Costs associated with our RCM revenues increased by $13.2 million, or 14%, compared to 2022. This increase has primarily
been driven by our recent acquisitions of HRG and Viewgol and the aforementioned necessary responses to domestic labor
market challenges, which have increased the costs associated with our people-intensive service offerings. Additionally, (i)
revenue growth during 2023 has largely come from lower margin revenue streams; (ii) during 2023 we experienced the loss of a
single large customer with a margin profile well beyond our typical customer margin profile; and (iii) we faced increased costs
during 2023 associated with enhancing our compliance function within the RCM business unit to accommodate scale.

Costs associated with our EHR revenues decreased by $3.6 million, or 6%, compared to 2022, primarily as our ongoing
implementation of the Scaled Agile Framework® resulted in job displacement for a number of our employees.

Costs associated with our Patient Engagement revenues were effectively flat, decreasing by $0.2 million compared to 2022.

Product Development

Sales and Marketing

Sales and marketing costs increased by $0.9 million, or 3%, compared to 2022 as the restructuring of our sales force in early
2023 resulted in a significant expansion of related resources.

General and Administrative

General and administrative expenses increased by $21.2 million, or 39%, compared to 2022. Our ongoing implementation of
the Scaled Agile Framework® resulted in job displacement for a number of our employees, resulting in an $8.9 million increase
in related non-recurring severance costs. Other non-recurring charges increased by $8.8 million, largely as the result of
acquisition-related activity and lease termination costs related to our efforts to right-size our real estate footprint.

Amortization & Depreciation

Combined amortization and depreciation expense increased by $3.1 million, or 13%, as increasing capitalized software
development asset balances resulted in an increase in the related amortization.

Trademark & Goodwill Impairment

Our combined impairment charges related to trademark intangibles and goodwill were $38.3 million in 2023, with none in
2022. Trademark impairment charges of $2.3 million were recorded as our recently-completed corporate name change and
rebranding initiative resulted in the near abandonment of previously-recognized trademark assets. Total goodwill impairment
charges of $35.9 million resulted from the combination of: (i) a $21.9 million impairment charge related to our Post-acute care
EHR business unit, as we adjusted the carrying value of the reporting unit to align with the agreed-upon eventual sales price;
(ii) a $6.4 million impairment charge related to our Acute Care EHR business unit as the combined pressures of an increase in
the related discount rate and moderated assumptions regarding eventual margin achievement lowered the estimated fair value of
the reporting unit; and (iii) a $7.6 million impairment charge related to our Patient Engagement reporting unit as our growth
expectations for this reporting unit have moderated significantly as the related pipelines have been slow to develop.

Total Other Income (Expense)

Total other income (expense) increased to expense of $11.8 million during 2023 compared to expense of $4.7 million during
2022. A rising interest rate environment and a higher level of funded debt caused a $6.2 million increase in interest expense.
Additionally, during 2022, $0.6 million of the original $2.5 million contingent consideration estimated in determining the
TruCode purchase price was reversed as updated estimates of TruCode's earnings over the earnout period were less than
estimated on the date of acquisition.

Income (Loss) Before Taxes

As a result of the foregoing factors, income (loss) before taxes decreased to a loss of $54.4 million in 2023, compared to
income of $18.1 million in 2022.

Provision (Benefit) for Income Taxes

Our effective income tax rates for 2023 and 2022 were 16% and 12%, respectively. Our effective tax rate for 2023 was
significantly impacted by the non-deductible nature of our goodwill impairment charges and the changing relationship between
net income or loss and research and development tax credits, which accumulate as benefits even in years with loss positions
such as 2023. Our effective tax rate for 2022 was impacted by the non-taxable nature of our recorded gain on contingent
consideration, which served to reduce the year's effective tax rate by 2.2%.

Net Income (Loss)

Net income (loss) for 2023 decreased by $61.7 million to a loss of $45.8 million, or a loss of $3.15 per basic and diluted share,
compared with income of $15.9 million, or $1.08 per basic and diluted share, for 2022.

Supplemental Segment Information

Our reportable segments have been determined in accordance with ASC 280 - Segment Reporting. We have three reportable
operating segments: RCM, EHR, and Patient Engagement. We evaluate each of our three operating segments based on segment
revenues and segment adjusted EBITDA.

8 %

(1) %

7 %

(30) %

2 %

93 %

Adjusted EBITDA consists of GAAP net income (loss) as reported and adjusts for (i) deferred revenue purchase accounting
adjustments arising from purchase allocation adjustments related to business acquisitions; (ii) depreciation expense; (iii)
amortization of software development costs; (iv) amortization of acquisition-related intangible assets; (v) stock-based
compensation; (vi) severance and other non-recurring charges; (vii) interest expense and other, net; (viii) impairment of
goodwill; (ix) impairment of trademark intangibles; (x) (gain) loss on contingent consideration; and (xi) the provision (benefit)
for income taxes. The segment measurements provided to and evaluated by the chief operating decision makers ("CODM") are
described in Note 18 to the condensed consolidated financial statements. These results should be considered in addition to, and
not as a substitute for, results reported in accordance with GAAP.

The following table presents a summary of the revenues and adjusted EBITDA of our three operating segments for the years
ended December 31, 2023 and 2022.

(In thousands)
Revenues by segment:

Year Ended December 31,

Change

2023

2022

RCM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 193,929 $ 179,870 $
EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

138,063

139,823

Patient engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,443

6,955

14,059

(1,760)

488

Adjusted EBITDA by segment:

RCM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(124)

(1,827)

Segment Revenues

24,800 $

35,219 $

(10,419)

22,900

22,507

393

1,703

Refer to the corresponding discussion of revenues for each of our reportable segments previously provided under the Revenues
heading of this Management's Discussion and Analysis. There are no intersegment revenues to be eliminated in computing
segment revenue.

Segment Adjusted EBITDA - Year Ended December 31, 2023 Compared with Year Ended December 31, 2022

RCM adjusted EBITDA decreased by $10.4 million, or 30%, compared to 2022. While revenues have increased by $14
million, or 8%, this growth has been met with an increase in costs of revenue (exclusive of amortization and depreciation) of
$13.2 million, or 14%, primarily due to upward pressure on costs associated with our people-intensive service offerings. This
direct-labor headwind was compounded by expanding operating expenses driven by the aforementioned product development
costs related to our strategy to migrate to the public cloud and general and administrative costs related to our ongoing
implementation of the Scaled Agile Framework®.

EHR adjusted EBITDA increased by $0.4 million, or 2%. Although revenues decreased by $1.8 million, or 1%, the ongoing
implementation of the Scaled Agile Framework® resulted in job displacement for a number of our employees, thereby
benefiting the segment's profitability.

Patient Engagement adjusted EBITDA increased by $1.7 million, or 93%, as the previously-discussed improved revenue
performance worked in tandem with reduced operating expenses to result in improved adjusted EBITDA.

2022 Compared to 2021

Revenues

Total revenues for the year ended December 31, 2022 increased by $46.0 million, or 16%, compared to the year ended
December 31, 2021.

RCM revenues increased by $48.6 million, or 37%, compared to 2021 due to acquisition-fueled growth and organic growth of
our revenue cycle service offerings. TruCode, acquired in May 2021, contributed $13.8 million of revenue during 2022,
compared to only $7.4 million during 2021, which reflected only eight months of activity. Our acquisition of HRG in March
2022 provided further inorganic growth, contributing an estimated $34.1 million of revenue during 2022. Organic revenue
growth materialized in 2022 as our hospital clients operate in an environment typified by rising costs and increased complexity
and are increasingly seeking to alleviate themselves of the ever-increasing administrative burden of operating their own
business office functions. This increasing demand for services, coupled with the positive impact of improving hospital patient
volumes on RCM revenues, resulted in organic revenue growth of $8.1 million, or 7% in 2022.

EHR revenues decreased by $3.3 million, or 2%, from the year ended December 31, 2021, and were comprised of the following
for the years ended December 31, 2022 and 2021:

(In thousands)
Recurring EHR revenues (1)

Year ended December 31,

2022

2021

109,340 $
15,384
124,724

108,440
16,472
124,912

Non-recurring EHR revenues (2)

13,138
1,961
15,099
139,823 $

16,939
1,258
18,197
143,109

Recurring EHR revenues remained essentially flat with a $0.2 million, or 0.2%, decrease in 2022 compared to 2021. Acute
Care EHR recurring revenues increased by $0.9 million, or 1%, as recent efforts to emphasize SaaS arrangements have led to
the accumulation of significant sources of recurring revenue, albeit at the expense of non-recurring revenue. Post-acute care
EHR recurring revenues decreased by $1.1 million, or 7%, primarily due to the loss of certain significant customers during
early 2022.

Non-recurring EHR revenues decreased by $3.1 million, or 17%, compared to 2021. Acute Care EHR non-recurring revenues
decreased by $3.8 million, or 22%, compared to 2021, due mostly to a decrease in the number of perpetual license installations
of our Acute Care EHR solutions. We installed our Acute Care EHR solutions at nineteen new hospital clients during 2022 (all
of which were under a SaaS arrangements resulting in revenue being recognized ratably over the contract term) compared to
seventeen new hospital clients during 2021 (ten under a SaaS arrangement). Post-acute care EHR non-recurring revenues
increased by $0.7 million, or 56%, compared to 2021 due to a temporarily beneficial shift in license mix.

Patient Engagement revenues increased by $0.7 million, or 11%, compared to 2021 as escalating demand for patient
engagement solutions continues to propel organic growth for Get Real Health's products and services.

Costs of Revenue (exclusive of amortization and depreciation)

Total costs of revenue (exclusive of amortization and depreciation) increased by $30.8 million compared to 2021. As a
percentage of total revenues, costs of revenues (exclusive of amortization and depreciation) increased to 51% of revenues
during 2022 from 48% during 2021.

Costs associated with our RCM revenues increased by $31.0 million, or 47%, in 2022, primarily driven by our recent
acquisitions of TruCode and HRG. The remaining cost increases for RCM are organic in nature, caused by resource expansion
necessitated by the growing customer base and improved patient volumes.

Costs associated with our EHR revenues decreased by $1.0 million, or 2%, in 2022, primarily driven by decreasing costs related
to third-party content. These costs scale with overall customer counts, which contracted moderately during 2022.

Costs associated with our Patient Engagement revenues increased by $0.8 million, or 26%, compared to 2021. Increased labor
costs related to investments aimed at aggressively addressing increasing demand for patient engagement solutions comprised
the majority of the increase.

Product Development

Product development expenses consist primarily of compensation and other employee-related costs (including stock-based
compensation) and infrastructure costs incurred, but not capitalized, for new product development and product enhancements.
Product development costs decreased by $0.9 million, or 3%, as a $5.6 million increase in product development labor
capitalization costs (pursuant to the previously disclosed change in our method of estimating the labor costs incurred in
developing software assets requiring capitalization under ASC 350-40, Internal Use Software) was offset by increased costs
related to our strategy to migrate to a public cloud environment. In addition, our recent acquisitions of TruCode and HRG
resulted in a combined $1.9 million of product development expenses during 2022 compared to only $0.8 million in 2021.

Sales and Marketing

Sales and marketing costs increased by $5.2 million, or 23%, compared to 2021. 2022 marked the return of our in-person
National Client Conference, which had migrated to virtual-only since the onset of the COVID-19 pandemic, resulting in
incremental expense of $1.1 million. Resource expansion resulted in a $1.3 million increase in payroll costs and an improved
sales environment resulted in a $0.6 million increase in commission expenses. Similarly, travel costs have increased by $0.3
million as travel patterns return to pre-COVID levels. Marketing program costs increased by $0.7 million due to more
aggressive marketing of our solutions and services combined with specific campaigns to increase brand awareness for our
portfolio of companies. In addition, our recent acquisitions of TruCode and HRG resulted in a combined increase in sales and
marketing expense of $1.5 million in 2022, compared to only $0.4 million of additional sales and marketing expenses during
2021.

General and Administrative

General and administrative expenses increased by $6.5 million, or 13%, compared to 2021, mostly due to volatility in employee
health claims coupled with an expanding employee base that resulted in a $4.1 million increase in employee benefits cost. In
addition, our commitment to improving the employee experience and becoming an employer of choice resulted in a $1.9
million increase in human resources cost. Lastly, our recent acquisitions of TruCode and HRG resulted in a combined increase
in general and administrative expenses of $2.9 million in 2022, compared to only $1.1 million of additional general and
administrative expenses during 2021. Partially offsetting this aggregate $7.8 million increase in employee benefits, human
resources, and acquisition-related costs was a $1.6 million decrease in bad debt expense due to generally improved collections
experience and the lack of any severe collectability determinations for customers with large receivables balances.

Amortization & Depreciation

Combined amortization and depreciation expense increased by $6.5 million, or 38%, in 2022 primarily due to the amortization
of intangibles acquired in the TruCode and HRG acquisitions and increased amortization of capitalized software development
costs resulting from increases in the related capitalized software development asset balances.

Total Other Income (Expense)

Total other income (expense) increased to expense of $4.7 million during 2022 compared to expense of $1.6 million during
2021. A rising interest rate environment and a higher level of funded debt caused a $3.2 million increase in interest expense,
which was partially offset by a $0.6 million gain on contingent consideration. During 2022, $0.6 million of the original $2.5
million contingent consideration estimated in determining the TruCode purchase price was reversed as TruCode's earnings over
the earnout period were less than estimated on the date of acquisition.

Income Before Taxes

As a result of the foregoing factors, income before taxes decreased to $18.1 million in 2022, compared to $23.1 million in 2021.

Provision for Income Taxes

Our effective income tax rates for 2022 and 2021 were 12% and 20%, respectively. Lowered provision-to-return adjustments
resulted in an incremental 3.5% decrease in our effective tax rate for 2022 compared to 2021, while the tax-free gain on
contingent consideration and increased Work Opportunity Tax Credits resulted in an incremental decrease in our effective tax
rate of 2.2% for 2022 compared to 2021.

Net Income

Net income for 2022 decreased by $2.6 million to $15.9 million, or $1.08 per basic and diluted share, compared with $18.4
million, or $1.26 per basic and diluted share, for 2021.

Supplemental Segment Information

The following table presents a summary of the revenues and adjusted EBITDA of our three operating segments for the years
ended December 31, 2022 and 2021.

(In thousands)
Revenues by segment:

Year Ended December 31,

Change

2022

2021

RCM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 179,870 $ 131,242 $
EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

143,109

139,823

Patient engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6,955

6,278

48,628

(3,286)

677

Adjusted EBITDA by segment:

Patient engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1,827)

(2,093)

Segment Revenues

35,219 $

28,265 $

6,954

22,507

26,505

(3,998)

266

37 %

(2) %

11 %

25 %

(15) %

13 %

Segment Adjusted EBITDA - Year Ended December 31, 2022 Compared with Year Ended December 31, 2021

RCM adjusted EBITDA increased by $7.0 million, or 25%, compared to 2021. Revenue growth of 37% was partially offset by
a 47% increase in costs of revenues (exclusive of amortization and depreciation), as growth materialized from lower-margin,
resource-intensive service lines. This direct labor headwind combined with expanded operating expenses to limit adjusted
EBITDA growth despite this dramatic increase in revenues.

EHR adjusted EBITDA decreased by $4.0 million, or 15%, mostly due to the aforementioned decrease in revenues.

Patient Engagement adjusted EBITDA increased by $0.3 million, mostly due to the aforementioned increase in revenues.

Liquidity and Capital Resources

Sources of Liquidity

As of December 31, 2023, our principal sources of liquidity consisted of cash and cash equivalents of $3.8 million and our
remaining borrowing capacity under the revolving credit facility of $24.3 million, compared to $7.0 million of cash and cash
equivalents and $86.3 million of remaining borrowing capacity under the revolving credit facility as of December 31, 2022. In
January 2016, we entered into a syndicated credit agreement which provided for a $125 million term loan facility and a $50
million revolving credit facility. On June 16, 2020, we entered into an Amended and Restated Credit Agreement that increased
the aggregate principal amount of our credit facilities to $185 million, which included a $75 million term loan facility and a
$110 million revolving credit facility. On May 2, 2022, we entered into a First Amendment to the Amended Restated Credit
Agreement that further increased the aggregate principal amount of our credit facilities to $230 million, which included a $70
million term loan facility and a $160 million revolving credit facility.

As of December 31, 2023, we had $199.6 million in principal amount of indebtedness outstanding under the credit facilities.
We believe that our cash and cash equivalents of $3.8 million as of December 31, 2023, our future operating cash flows, and
our remaining borrowing capacity under the revolving credit facility of $24.3 million as of December 31, 2023, taken together,
provide adequate resources to fund ongoing cash requirements for the next twelve months and beyond. We cannot provide
assurance that our actual cash requirements will not be greater than we expect as of the date of filing of this Annual Report on
Form 10-K. If sources of liquidity are not available or if we cannot generate sufficient cash flow from operations during the
next twelve months, we may be required to obtain additional sources of funds through additional operational improvements,
capital market transactions, asset sales or financing from third parties, a combination thereof or otherwise. We cannot provide
assurance that these additional sources of funds will be available or, if available, would have reasonable terms. Aside from
normal operating cash requirements, obligations under our Credit Agreement (as discussed below) and operating leases, and
opportunistic uses of capital in share repurchases and business acquisition transactions, we do not have any material cash
commitments or planned cash commitments. Although the Company currently has no obligations related to planned
acquisitions, the Company's strategy includes the potential for future acquisitions, which may be funded through draws on the
credit facilities or the use of the other sources of liquidity described above.

Operating Cash Flow Activities

Net cash provided by operating activities decreased by $31.3 million from $32.4 million for 2022 to $1.1 million for 2023, as
the Company’s net income (loss) decreased by $61.7 million. The Company's net income excluding the significant non-cash
expenses of amortization, depreciation, and impairment charges decreased by $20.2 million, mostly as significant restructuring
events (such as our ongoing implementation of the Scaled Agile Framework® and related mid-year 2023 Voluntary Early
Retirement Program) and acquisition activity (such as our October 2023 acquisition of Viewgol) resulted in incremental
nonrecurring expenses of $17.7 million, as well as increased interest on the credit facility. This reduction in profit was met with
detrimental changes in working capital as (i) net cash inflows related to financing receivables decreased by $3.5 million as we
continue to work down receivable balances from previous years' transactions, and (ii) the timing of income tax payments
resulted in a net $0.9 million cash outflow for 2023 compared to a net $3.9 million inflow for 2022. Significant cash outflows
related to nonrecurring transactions and restructuring events had a significant impact on 2023 cash flows. As the cash effects of
these events subside, the Company expects to have sufficient cash flow to satisfy ongoing obligations.

Investing Cash Flow Activities

Net cash used in investing activities decreased from $62.7 million during 2022 to $60.1 million during 2023. Most notably, we
completed our $36.7 million acquisition of Viewgol during the fourth quarter of 2023. We completed our $43.4 million
acquisition of HRG during the first quarter of 2022. Conversely, cash outflows related to capitalized software development
efforts increased from $19.1 million in 2022 to $23.1 million in 2023 as our workload mix has shifted away from addressing
deficiencies in legacy code related to existing applications towards adding features and functionalities to our cloud-native
solutions and increased development efforts related to non-customer-facing, internal-use software.

Financing Cash Flow Activities

During 2023, our financing activities were a net source of cash in the amount of $55.9 million, as $67.0 million in borrowings
from our revolving line of credit (most of which was used to fund our acquisition of Viewgol, with related transaction
expenses), were partially offset by long-term debt principal payments of $8.5 million and $2.6 million used to repurchase shares
of our common stock, which are treated as treasury stock. During 2022, our financing activities were a net source of cash in the
amount of $25.9 million, as $48.0 million in borrowings from our revolving line of credit, used to fund our acquisition of HRG,
with cash outflows mostly comprised of long-term debt principal payments of $8.9 million and $11.9 million used to repurchase
shares of our common stock.

On September 4, 2020, our Board of Directors approved a stock repurchase program to repurchase up to $30.0 million in
aggregate amount of the Company's outstanding shares of common stock through open market purchases, privately-negotiated
transactions, or otherwise in compliance with Rule 10b-18 under the Securities Exchange Act of 1934, as amended. On July 27,
2022, our Board of Directors extended the expiration of the stock repurchase program to September 4, 2024. These shares may
be purchased from time to time throughout the duration of the stock repurchase program depending upon market conditions.
Our ability to repurchase shares is subject to compliance with the terms of our Amended and Restated Credit Agreement.
Concurrent with the authorization of this stock repurchase program, the Board of Directors opted to indefinitely suspend all
quarterly dividends.

Credit Agreement

As of December 31, 2023, we had $63.9 million in principal amount outstanding under the term loan facility and $135.7 million
in principal amount outstanding under the revolving credit facility. Each of our credit facilities continues to bear interest at a
rate per annum equal to an applicable margin plus, at our option, either (1) the Adjusted SOFR rate for the relevant interest
period, subject to a floor of 0.50%, (2) an alternate base rate determined by reference to the greater of (a) the prime lending rate
of Regions, (b) the federal funds rate for the relevant interest period plus one half of one percent per annum and (c) the one
month SOFR rate, subject to the aforementioned floor, plus one percent per annum, or (3) a combination of (1) and (2). The
applicable margin for SOFR loans and the letter of credit fee ranges from 1.8% to 3.0%. The applicable margin for base rate
loans ranges from 0.8% to 2.0%, in each case based on the Company's consolidated net leverage ratio.

Principal payments with respect to the term loan facility are due on the last day of each fiscal quarter beginning June 30, 2022,
with quarterly principal payments of approximately $0.9 million through March 31, 2027, with maturity on May 2, 2027 or
such earlier date as the obligations under the Amended and Restated Credit Agreement, as amended by the First Amendment,
become due and payable pursuant to the terms of such agreement. Any principal outstanding under the revolving credit facility
is due and payable on the maturity date.

Our credit facilities are secured pursuant to the Amended and Restated Credit Agreement, dated as of June 16, 2020, among the
parties identified as obligors therein and Regions, as collateral agent, on a first priority basis by a security interest in
substantially all of the tangible and intangible assets (subject to certain exceptions) of the Company and certain subsidiaries of
the Company, as guarantors (collectively, the “Subsidiary Guarantors”), including certain registered intellectual property and
the capital stock of certain of the Company’s direct and indirect subsidiaries. Our obligations under the Amended and Restated
Credit Agreement are also guaranteed by the Subsidiary Guarantors.

The First Amendment provides incremental facility capacity of $75 million, subject to certain conditions. The Amended and
Restated Credit Agreement, as amended by the First Amendment, includes a number of restrictive covenants that, among other
things and in each case subject to certain exceptions and baskets, impose operating and financial restrictions on the Company
and the Subsidiary Guarantors, including the ability to incur additional debt; incur liens and encumbrances; make certain
restricted payments, including paying dividends on the Company's equity securities or payments to redeem, repurchase, or retire
the Company's equity securities (which are subject to our compliance, on a pro forma basis to give effect to the restricted
payment, with the fixed charge coverage ratio and consolidated net leverage ratio described below); enter into certain restrictive
agreements; make investments, loans and acquisitions; merge or consolidate with any other person; dispose of assets; enter into
sale and leaseback transactions; engage in transactions with affiliates; and materially alter the business we conduct. The First
Amendment required the Company to maintain a minimum fixed charge coverage ratio of 1.25:1.00 throughout the duration of
such agreement. Under the First Amendment, the Company is required to comply with a maximum consolidated net leverage
ratio of 3.50:1.00. Further, under the First Amendment, in connection with any acquisition by the Company exceeding $25
million, the Company may elect to increase the maximum permitted consolidated net leverage ratio for the fiscal quarter in
which the acquisition occurs and each of the following three fiscal quarters by 0.50:1.00 above the otherwise permitted
maximum. If the consolidated net leverage ratio is less than 2.50:1.00, there is no limit on the amount of incremental facilities.
The Amended and Restated Credit Agreement also contains customary representations and warranties, affirmative covenants
and events of default. On March 10, 2023, the calculation of the fixed charge coverage ratio was amended to specifically
exclude from the definition of fixed charges the Company's share repurchases conducted during the third and fourth quarters of
2022.
As of September 30, 2023, we were not in compliance with the fixed charge coverage ratio required by the Amended and
Restated Credit Agreement. On November 8, 2023, the Company and the subsidiary guarantors entered into a Waiver with
Regions Bank, as administrative agent, and various other lenders, which provided for a one-time waiver of this failure as an
event of default. As of December 31, 2023, the Company was similarly not in compliance with the fixed charge coverage ratio
required by the Amended and Restated Credit Agreement and a one-time waiver was provided in conjunction with the Fourth
Amendment described below. On January 16, 2024, the definition of "Consolidated EBITDA" under the Amended and Restated
Credit Agreement was modified to allow for more cost exclusions related to acquisitions and other nonrecurring events and to
release American HealthTech, Inc. ("AHT") from its obligations as a Subsidiary Guarantor in connection with the closing of
our sale of AHT. On February 29, 2024, the definition of “Consolidated EBITDA” was further amended, pursuant to the Fourth
Amendment to the Amended and Restated Credit Agreement. The Fourth Amendment decreased the required consolidated
fixed charge coverage ratio from 1.25:1.00 to 1.15:1.00 for each fiscal quarter ending March 31, 2024 through and including
December 31, 2024.

Any failure by us to comply with this or another covenant in the future may result in an event of default. There can be no
assurance that we will be able to continue to comply with this covenant or obtain amendments to avoid future covenant
violations, or that such amendments will be available on commercially acceptable terms.

The First Amendment removed the requirement that the Company mandatorily prepay the credit facilities with excess cash flow
generated during the prior fiscal year. The Company is permitted to voluntarily prepay the credit facilities at any time without
penalty, subject to customary “breakage” costs with respect to prepayments of SOFR rate loans made on a day other than the
last day of any applicable interest period.

Bookings

Bookings is a key operational metric used by management to assess the relative success of our sales generation efforts, and
were as follows for the years ended December 31, 2023 and 2022, respectively:

(In thousands)
RCM(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
EHR(2)
Patient engagement (1)
Total Bookings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2023

2022

48,986 $

33,143

2,973

85,102 $

48,065

38,152

3,188

89,405

(1) Generally calculated as the total contract price (for non-recurring, project-related amounts) and annualized contract value
(for recurring amounts).
(2) Generally calculated as the total contract price (for system sales) including annualized contract value (for support) for
perpetual license system sales and total contract price for SaaS sales.

RCM bookings were effectively flat for 2023, increasing only $0.9 million, or 2%, compared to 2022. Net-new bookings
increased by $3.4 million, or 23%, while cross-sell bookings decreased by $3.5 million, or 12%, experiencing
uncharacteristically high volatility as the pace of prospective sales decisions slowed. With the relative strength in net-new
bookings effectively offset by declining cross-sell bookings, bookings for our Encoder product proved the difference in the
year-to-year comparison, increasing by $1.1 million.

EHR bookings during 2023 decreased by $5.0 million, or 13%, compared to 2022, primarily due to a challenging decision
environment for new Acute Care EHR system arrangements, including lower volumes for migration opportunities from Centriq
(acquired in our 2016 acquisition of HHI) to Thrive, our flagship hospital EHR product.

Bookings for our nascent Patient Engagement business unit were effectively flat, decreasing by $0.2 million during 2023
compared to 2022.

Bookings represent our sales activity during the periods reported above. The amount and volume of pending contracts at the end
of the period is described under “Business – Backlog.” Some of the contracts in our backlog are subject to modification or
cancellation at the convenience of the customer, or for default in the event that we are unable to perform under the contract.
There can be no assurance that our bookings or backlog will result in actual revenue in any particular period, or at all, or that
any contract included in backlog will be profitable.

Critical Accounting Policies and Estimates

General

Our discussion and analysis of our financial condition and results of operations are based on our financial statements, which
have been prepared in accordance with accounting principles generally accepted in the United States of America. We are
required to make some estimates and judgments that affect the preparation of these financial statements. We base our estimates
on historical experience and on various other assumptions that we believe to be reasonable under the circumstances, but actual
results may differ from these estimates under different assumptions or conditions.

Revenue Recognition

Revenue is recognized upon transfer of control of promised products or services to clients in an amount that reflects the
consideration we expect to receive in exchange for those products and services. We enter into contracts that can include various
combinations of products and services, which are generally distinct and accounted for as separate performance obligations. The
Company employs the 5-step revenue recognition model under ASC 606, Revenue from Contracts with Customers, to: (1)
identify the contract with the client, (2) identify the performance obligations in the contract, (3) determine the transaction price,
(4) allocate the transaction price to the performance obligations in the contract, and (5) recognize revenue when (or as) the
entity satisfies a performance obligation. Refer to Note 2 to the consolidated financial statements included herein for further
discussion regarding our revenue recognition policies and significant judgments involved in our application of ASC 606.
Although we believe that our approach to estimates and judgments regarding revenue recognition is reasonable, actual results
could differ and we may be exposed to increases or decreases in revenue that could be material.

Allowance for Credit Losses

Trade accounts receivable are stated at the amount the Company expects to collect and do not bear interest. The collectability of
trade receivable balances is regularly evaluated based on a combination of factors such as customer credit-worthiness, past
transaction history with the customer, current economic industry trends and changes in customer payment patterns, resulting in
the establishment of general reserves. Additionally, if it is determined that a customer will be unable to fully meet its financial
obligation, such as in the case of a bankruptcy filing or other material event impacting its business, a specific allowance for
credit losses may be recorded to reduce the related receivable to the amount expected to be recovered. Refer to Note 11 of the
consolidated financial statements included herein for a detailed discussion about our credit loss accounting policy related to
trade accounts receivable.

The Company has sold information and patient care systems to certain healthcare providers under short-term payment plans and
sales-type leases. The Company establishes an allowance for credit losses for these financing receivables based on the historical
level of customer defaults under such financing arrangements. Additionally, if it is determined that a customer will be unable to
meet its financial obligation, such as in the case of a bankruptcy filing or other material event impacting its business, a specific
allowances may be recorded to reduce the related receivable to the amount expected to be recovered.

Although we believe that that our approach to estimates and judgments regarding our allowance for credit losses is reasonable,
actual results could differ and we may be exposed to increases or decreases in required allowances that could be material.

Business Combinations, including Purchased Intangible Assets

The Company accounts for business combinations at fair value. Acquisition costs are expensed as incurred and recorded in
general and administrative expenses. Measurement period adjustments relate to adjustments to the fair value of assets acquired
and liabilities assumed based on information that we should have known at the time of acquisition. All changes to purchase
accounting that do not qualify as measurement period adjustments are included in current period earnings.

The fair value amount assigned to an intangible asset is based on an exit price from a market participant’s viewpoint, and
utilizes data such as discounted cash flow analysis and replacement cost models. We review acquired intangible assets for
impairment whenever events or changes in circumstances indicate that the carrying amount of such assets may not be
recoverable.

Goodwill is recorded as the difference, if any, between the aggregate consideration paid for an acquisition and the fair value of
the identifiable net tangible and intangible assets acquired. Goodwill is not amortized but is evaluated for impairment annually
or more frequently if indicators of impairment are present or changes in circumstances suggest that impairment may exist. We
test annually for impairment as of October 1.

As part of our annual goodwill impairment test, we first assess qualitative factors to determine whether it is more likely than not
that the fair value of a reporting unit is less than its carrying amount. If we conclude that it is more likely than not that the fair
value of a reporting unit is less than its carrying amount, we conduct a quantitative goodwill impairment assessment which
compares the fair value of the reporting unit with its carrying amount, including goodwill. If the carrying amount of the
reporting unit exceeds its fair value, an impairment charge is recognized for the amount by which the carrying amount exceeds
that reporting unit's fair value. If the fair value of the reporting unit exceeds its carrying amount, the goodwill of the reporting
unit is not considered to be impaired.

Critical estimates in valuing certain intangible assets and the fair value of the reporting unit during goodwill impairment tests
include, but are not limited to, identifying reporting units, historical and projected customer retention rates, anticipated growth
in revenue from the acquired customers, and expected future cash outflows.

Significant judgments in testing goodwill for impairment also include assigning assets and liabilities to the reporting unit and
determining the fair value of each reporting unit based on management’s best estimates and assumptions, as well as other
information compiled by management, including valuations that utilize customary valuation procedures and techniques.

Management’s best estimates and assumptions are employed in determining the appropriateness of these assumptions as of the
acquisition date and for each subsequent period.

Future business and economic conditions, as well as differences actually related to any of the assumptions, could materially
affect the financial statements through impairment of goodwill or intangible assets, and acceleration of the amortization period
of the purchased intangible assets, which are finite-lived assets.

As of October 1, 2023, the date of our most recent impairment test, the estimated fair value for our RCM reporting unit was
substantially in excess of its carrying value, exceeding its carrying value by 48%. The estimated fair values of our Post-acute
care EHR, Acute care EHR, and Patient Engagement reporting units were each below their respective carrying values, resulting
in goodwill impairment charges of $2.2 million, $6.4 million, and $7.6 million, respectively. During the fourth quarter of 2023,
the decision to accept an offer for the sale of AHT that was well below the related reporting unit’s carrying value was
considered a triggering event requiring reassessment of the Post-acute care EHR reporting unit’s goodwill, resulting in an
additional goodwill impairment charge of $19.7 million. Further, management considered the continued decrease in the
Company’s market capitalization since our most recent quantitative analysis dated October 1, 2023 to be a triggering event
warranting a further quantitative goodwill impairment analysis as of December 31, 2023. As a result of this updated
quantitative goodwill impairment analysis, management concluded that there was no further impairment to goodwill.

Software Development Costs

Software development costs are accounted for in accordance with ASC 350-40, Internal-Use Software. Under ASC 350-40,
software development costs related to preliminary project activities and post-implementation and maintenance activities are
expensed as incurred. We capitalize direct costs related to application development activities that are probable to result in
additional functionality. Capitalized costs are amortized on a straight-line basis over five years. We test for impairment
whenever events or changes in circumstances that could impact recoverability occur.

Estimates

The Company uses estimates to record certain other transactions and liabilities. These estimates are generally based on
management’s best judgment, past experience, and utilization of third party services such as actuarial and other expert services.
Because these estimates are subjective and variable, actual results could differ significantly from these estimates. Significant
estimates included in our financial statements include those for reserves related to uncertain tax positions, bad debt and credit
allowances, legal liability exposure or lack thereof, accrued expenses, and (prior to 2023) self-insurance reserves under our
health insurance plan.

Quantitative and Qualitative Disclosures about Market and Interest Rate Risk

Our exposure to market risk relates primarily to the potential fluctuations in the Secured Overnight Financing Rate ("SOFR")
which replaced the British Bankers Association London Interbank Offered Rate ("LIBOR") as the new benchmark interest rate
for our credit facilities. We had $199.6 million of outstanding borrowings under our credit facilities with Regions Bank at
December 31, 2023. The term loan facility and revolving credit facility bear interest at a rate per annum equal to an applicable
margin plus, at our option, either (1) the Adjusted SOFR rate for the relevant interest period, subject to a floor of 0.5%, (2) an
alternate base rate determined by reference to the greatest of (a) the prime lending rate of Regions, (b) the federal funds rate for
the relevant interest period plus one half of one percent per annum and (c) the one month SOFR rate, subject to the
aforementioned floor, plus one percent per annum, or (3) a combination of (1) and (2). Accordingly, we are exposed to
fluctuations in interest rates on borrowings under our credit facilities. A one hundred basis point change in interest rate on our
borrowings outstanding as of December 31, 2023 would result in a change in interest expense of approximately $2.0 million
annually.

We did not have investments as of December 31, 2023. We do not currently utilize derivative financial instruments to manage
our interest rate risks.

Recent Accounting Pronouncements

There were no new accounting standards required to be adopted in 2023 that had a material impact on our consolidated
financial statements, and we do not believe that any recently issued but not yet effective accounting standards, if adopted,
would have a material impact on our consolidated financial statements.

ITEM 7A.

QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

The information required by this Item is contained in Item 7 herein under the heading "Quantitative and Qualitative Disclosures
about Market and Interest Rate Risk."

ITEM 8.

FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA

Index to Financial Statements

Management’s Report on Internal Control Over Financial Reporting

Report of Grant Thornton LLP, Independent Registered Public Accounting Firm, (PCAOB ID Number
248) on Internal Control Over Financial Reporting

Report of Grant Thornton LLP, Independent Registered Public Accounting Firm, on Consolidated
Financial Statements

Consolidated Balance Sheets — December 31, 2023 and 2022

Consolidated Statements of Operations — Years ended December 31, 2023, 2022 and 2021

Consolidated Statements of Stockholders’ Equity — Years ended December 31, 2023, 2022 and 2021

Consolidated Statements of Cash Flows — Years ended December 31, 2023, 2022 and 2021

Notes to Consolidated Financial Statements

Index to Financial Statement Schedules

Schedule II — Valuation and Qualifying Accounts

All other schedules to the financial statements required by Article 9 of Regulation S-X are not
applicable and therefore have been omitted.

Page

104

MANAGEMENT’S REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING

Management is responsible for establishing and maintaining adequate internal control over financial reporting as defined in
Rule 13a-15(f) under the Securities Exchange Act of 1934. TruBridge, Inc.’s ("TruBridge") internal control over financial
reporting is designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of
financial statements for external purposes in accordance with generally accepted accounting principles. TruBridge’s internal
control over financial reporting includes those policies and procedures that:

(i) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and
dispositions of the assets of TruBridge;

(ii) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial
statements in accordance with generally accepted accounting principles, and that receipts and expenditures of
TruBridge are being made only in accordance with authorizations of management and directors of TruBridge; and

(iii) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use or
disposition of TruBridge’s assets that could have a material effect on the financial statements.

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also,
projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate
because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

Management assessed the effectiveness of TruBridge’s internal control over financial reporting as of December 31, 2023. In
making this assessment, management used the criteria set forth by the Committee of Sponsoring Organizations of the Treadway
Commission (“COSO”) in Internal Control-Integrated Framework (2013).

Based on our assessment and those criteria, management believes that TruBridge maintained effective control over financial
reporting as of December 31, 2023.

We excluded Viewgol, LLC ("Viewgol"), which was included in our consolidated financial statements, from our assessment of
internal control over financial reporting as of December 31, 2023 because it was acquired by the Company in a purchase
business combination on October 16, 2023. The acquired business of Viewgol excluded from our assessment represented
approximately 9% of the Company's total assets as of December 31, 2023 and approximately 1% of the Company's
consolidated total revenues for the year ended December 31, 2023.

The independent registered public accounting firm, Grant Thornton LLP, has audited the consolidated financial statements of
the Company as of and for the year ended December 31, 2023, and has also issued its report on the effectiveness of the
Company’s internal control over financial reporting included in this report on page 65.

REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

Board of Directors and Stockholders
TruBridge, Inc.:

Opinion on internal control over financial reporting
We have audited the internal control over financial reporting of TruBridge, Inc. (formerly known as Computer Programs and
Systems, Inc.) (a Delaware corporation) and subsidiaries (the “Company”) as of December 31, 2023, based on criteria
established in the 2013 Internal Control—Integrated Framework issued by the Committee of Sponsoring Organizations of the
Treadway Commission (“COSO”). In our opinion, the Company maintained, in all material respects, effective internal control
over financial reporting as of December 31, 2023, based on criteria established in the 2013 Internal Control—Integrated
Framework issued by COSO.

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States)
(“PCAOB”), the consolidated financial statements of the Company as of and for the year ended December 31, 2023, and our
report dated March 15, 2024 expressed an unqualified opinion on those financial statements.

Basis for opinion
The Company’s management is responsible for maintaining effective internal control over financial reporting and for its
assessment of the effectiveness of internal control over financial reporting, included in the accompanying Management’s Report
on Internal Control over Financial Reporting ("Management's Report"). Our responsibility is to express an opinion on the
Company’s internal control over financial reporting based on our audit. We are a public accounting firm registered with the
PCAOB and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and
the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.

We conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the
audit to obtain reasonable assurance about whether effective internal control over financial reporting was maintained in all
material respects. Our audit included obtaining an understanding of internal control over financial reporting, assessing the risk
that a material weakness exists, testing and evaluating the design and operating effectiveness of internal control based on the
assessed risk, and performing such other procedures as we considered necessary in the circumstances. We believe that our audit
provides a reasonable basis for our opinion.

Our audit of, and opinion on, the Company's internal control over financial reporting does not include the internal control over
financial reporting of Viewgol, LLC (“Viewgol”), a wholly-owned subsidiary whose financial statements reflect total assets and
revenues constituting 9% and 1%, respectively, of the related consolidated financial statement amounts as of and for the year
ended December 31, 2023. As indicated in Management's Report, Viewgol was acquired during 2023. Management's assertion
on the effectiveness of the Company's internal control over financial reporting excluded internal control over financial reporting
of Viewgol.

Definition and limitations of internal control over financial reporting
A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the
reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally
accepted accounting principles. A company’s internal control over financial reporting includes those policies and procedures
that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and
dispositions of the assets of the company; (2) provide reasonable assurance that transactions are recorded as necessary to permit
preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and
expenditures of the company are being made only in accordance with authorizations of management and directors of the
company; and (3) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or
disposition of the company’s assets that could have a material effect on the financial statements.

/s/ GRANT THORNTON LLP

Atlanta, Georgia
March 15, 2024

REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

Board of Directors and Stockholders
TruBridge, Inc.:

Opinion on the financial statements
We have audited the accompanying consolidated balance sheets of TruBridge, Inc. (formerly known as Computer Programs and
Systems, Inc.) (a Delaware corporation) and subsidiaries (the “Company”) as of December 31, 2023 and 2022, the related
consolidated statements of operations, stockholders’ equity, and cash flows for each of the three years in the period ended
December 31, 2023, and the related notes and financial statement schedule included under item 15(a) (collectively referred to as
the “financial statements”). In our opinion, the financial statements present fairly, in all material respects, the financial position
of the Company as of December 31, 2023 and 2022, and the results of its operations and its cash flows for each of the three
years in the period ended December 31, 2023, in conformity with accounting principles generally accepted in the United States
of America.

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States)
(“PCAOB”), the Company’s internal control over financial reporting as of December 31, 2023, based on criteria established in
the 2013 Internal Control—Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway
Commission (“COSO”), and our report dated March 15, 2024 expressed an unqualified opinion.

Basis for opinion
These financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion on
the Company’s financial statements based on our audits. We are a public accounting firm registered with the PCAOB and are
required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable
rules and regulations of the Securities and Exchange Commission and the PCAOB.

We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the
audit to obtain reasonable assurance about whether the financial statements are free of material misstatement, whether due to
error or fraud. Our audits included performing procedures to assess the risks of material misstatement of the financial
statements, whether due to error or fraud, and performing procedures that respond to those risks. Such procedures included
examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. Our audits also included
evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall
presentation of the financial statements. We believe that our audits provide a reasonable basis for our opinion.

Critical audit matter
The critical audit matter communicated below is a matter arising from the current period audit of the financial statements that
was communicated or required to be communicated to the audit committee and that: (1) relates to accounts or disclosures that
are material to the financial statements and (2) involved our especially challenging, subjective, or complex judgement. The
communication of critical audit matters does not alter in any way our opinion on the financial statements, taken as a whole, and
we are not, by communicating the critical audit matter below, providing a separate opinion on the critical audit matter or on the
accounts or disclosures to which it relates.

Goodwill Impairment Assessment
As described further in Notes 2 and 12 to the financial statements, management evaluates goodwill for impairment on an annual
basis as of October 1, or more frequently if impairment indicators exist, at the reporting unit level. Management estimated the
fair values of its reporting units using a combination of the income and market approaches. The determination of the fair value
of the reporting units requires management to make significant estimates and assumptions related to forecasts of future
revenues, gross margin, EBITDA, and discount rates. We identified the goodwill impairment assessment of the Acute Care
EHR, Post-acute Care EHR, Patient Engagement, and RCM reporting units as a critical audit matter.

The principal considerations for our determination that the goodwill impairment assessment of the Acute Care EHR, Post-acute
Care EHR, Patient Engagement, and RCM reporting units is a critical audit matter is that changes in the assumptions related to
forecasts of future revenues, gross margin, EBITDA, and discount rates could materially affect the determination of the fair
value of the reporting unit, the amount of any goodwill impairment charge, or both. Management utilized significant judgment
when estimating the fair value and carrying value of the reporting units. In turn, auditing management’s judgments regarding
forecasts of future revenues, gross margin, EBITDA, and the discount rates applied, involved a high degree of subjectivity due
to the estimation uncertainty of management’s significant judgments.

Our audit procedures related to the goodwill impairment assessment of the Acute Care EHR, Post-acute Care EHR, Patient
Engagement, and RCM reporting units included the following, among others:

• We evaluated the design and tested the operating effectiveness of controls relating to the goodwill impairment

assessment of the Acute Care EHR, Post-acute Care EHR, Patient Engagement, and RCM reporting units, including
the controls over determination of the fair values of the reporting units.

• We tested management's process for determining the fair value and carrying value of the Acute Care EHR, Post-acute
Care EHR, Patient Engagement, and RCM reporting units. This included evaluating the appropriateness of the
valuation methods, testing the completeness, accuracy, and relevance of data used by management, and evaluating the
reasonableness of management's significant assumptions, which included forecasted revenues, gross margin, and
EBITDA. We tested whether these forecasts were reasonable and consistent with historical performance, third-party
market data, and other evidence obtained in other areas of the audit.

• We tested the Company's discounted cash flow models for the Acute Care EHR, Post-acute Care EHR, Patient

Engagement, and RCM reporting units with the assistance of valuation specialists, including the reasonableness of the
utilized discount rate.

• We tested the Company's use of the market approach with the assistance of valuation specialists, including the

reasonableness of the selected multiples.

/s/ GRANT THORNTON LLP

We have served as the Company’s auditor since 2004.

Atlanta, Georgia
March 15, 2024

TRUBRIDGE, INC.
CONSOLIDATED BALANCE SHEETS
(In thousands, except per share data)

December 31,
2023

December 31,
2022

Assets

Current assets:

Cash and cash equivalents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Accounts receivable, net of allowance for credit losses of $3,631 and $2,854,
respectively . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Financing receivables, current portion, net (net of allowance for expected credit
losses of $319 and $223, respectively) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Inventories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prepaid income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prepaid expenses and other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Assets of held for sale disposal group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total current assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Property and equipment, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Software development costs, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Operating lease assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Financing receivables, net of current portion (net of allowance for expected credit
losses of $97 and $326, respectively) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other assets, net of current portion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Intangible assets, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Goodwill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Liabilities and Stockholders’ Equity

Current liabilities:

Accounts payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Current portion of long-term debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Accrued vacation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other accrued liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Liabilities of held for sale disposal group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total current liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Long-term debt, net of current portion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Operating lease liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Deferred tax liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Stockholders’ equity:

3,848 $

6,951

59,723

51,311

3,997
475
1,628
15,807
25,977
111,455
8,974
39,139
5,192

1,226
7,314
89,213
171,909
434,422 $

10,133 $
3,141
8,677
5,410
19,892
977
48,230
195,270
3,074
1,230
247,804

4,474
784
701
10,338
—
74,559
9,884
27,257
7,567

3,312
8,131
102,000
198,253
430,963

7,035
3,141
11,590
6,214
16,475
—
44,455
136,388
5,651
12,758
199,252

Common stock, $0.001 par value per share; 30,000 shares authorized; 15,121
shares issued at December 31, 2023 and 14,913 shares issued at December 31,
2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Additional paid-in capital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Retained earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Treasury stock, 572 shares at December 31, 2023 and 483 shares at December 31,
2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total stockholders’ equity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total liabilities and stockholders’ equity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

15
195,546
8,132

(17,075)
186,618
434,422 $

15
192,275
53,921

(14,500)
231,711
430,963

The accompanying notes are an integral part of these consolidated financial statements.

TRUBRIDGE, INC.
CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except per share data)

Revenues:

RCM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patient engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total revenues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Expenses:
Costs of revenue (exclusive of amortization and depreciation):

RCM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Patient engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total costs of revenue (exclusive of amortization and depreciation) . . . . . .
Product development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sales and marketing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
General and administrative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amortization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Goodwill impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trademark impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Operating income (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other income (expense):

Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gain on contingent consideration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Loss on extinguishment of debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total other income (expense) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Income (loss) before taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Provision (benefit) for income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net income (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Net income (loss) per share - basic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Net income (loss) per share - diluted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Weighted average shares outstanding used in per common share
computations:

Year ended December 31,
2022

2021

2023

193,929 $
138,063
7,443
339,435

179,870 $
139,823
6,955
326,648

131,242
143,109
6,278
280,629

110,192
62,048
3,628
175,868
37,246
28,049
76,153
24,522
1,946
35,913
2,342
382,039
(42,604)

745
—
—

(12,521)
(11,776)
(54,380)
(8,591)
(45,789) $
(3.15) $
(3.15) $

97,024
65,661
3,856
166,541
31,898
27,131
54,965
20,887
2,443
—
—
303,865
22,783

1,178
565
(125)
(6,320)
(4,702)
18,081
2,214
15,867 $
1.08 $
1.08 $

66,015
66,698
3,068
135,781
32,809
21,978
48,481
14,717
2,156
—
—
255,922
24,707

1,529
—
—
(3,160)
(1,631)
23,076
4,646
18,430
1.26
1.26

Basic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Diluted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14,187
14,187

14,356
14,356

14,290
14,318

The accompanying notes are an integral part of these consolidated financial statements.

TRUBRIDGE, INC.
CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY
(In thousands)

Balance at December 31, 2020 . . . . . . . . . . .
Net income . . . . . . . . . . . . . . . . . . . . . . . . . .
Issuance of restricted stock . . . . . . . . . . . . . .
Forfeiture of restricted stock . . . . . . . . . . . .
Stock-based compensation . . . . . . . . . . . . . .
Treasury stock purchases . . . . . . . . . . . . . . .
Balance at December 31, 2021 . . . . . . . . . . .
Net income . . . . . . . . . . . . . . . . . . . . . . . . . .
Exercise of stock option . . . . . . . . . . . . . . . .
Issuance of restricted stock . . . . . . . . . . . . . .
Forfeiture of restricted stock . . . . . . . . . . . .
Stock-based compensation . . . . . . . . . . . . . .
Treasury stock purchases . . . . . . . . . . . . . . .
Balance at December 31, 2022 . . . . . . . . . . .
Net income (loss) . . . . . . . . . . . . . . . . . . . . .
Issuance of restricted stock . . . . . . . . . . . . . .
Forfeiture of restricted stock . . . . . . . . . . . .
Stock-based compensation . . . . . . . . . . . . . .
Treasury stock purchases . . . . . . . . . . . . . . .
Balance at December 31, 2023 . . . . . . . . . . .

Common
Shares
14,511 $
—
229

(6)
—
—
14,734 $
—
4
189
(14)
—
—
14,913 $
—
210

(2)
—
—
15,121 $

Common
Stock

Additional
Paid-in
Capital

Total
Stockholders’
Equity

Retained
Earnings

—
—
—
5,457
—

18,430
—
—
—
—

Treasury
Stock
(1,261) $ 200,000
15 $ 181,622 $ 19,624 $
—
18,430
—
—
—
—
—
—
—
—
5,457
—
(1,315)
(1,315)
—
(2,576) $ 222,572
15 $ 187,079 $ 38,054 $
15,867
15,867
—
23
—
—
—
—
—
—
—
—
5,173
—
—
—
(11,924)
—
15 $ 192,275 $ 53,921 $ (14,500) $ 231,711
—
(45,789)
—
—
—
—
—
—
—
—
3,271
—
(2,575)
—
(2,575)
8,132 $ (17,075) $ 186,618
15 $ 195,546 $

—
23
—
—
5,173
—

—
—
—
3,271
—

—
—
—
—
—

—
—
—
—

(11,924)

(45,789)

The accompanying notes are an integral part of these consolidated financial statements.

TRUBRIDGE, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)

Operating Activities
Net income (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Adjustments to net income (loss):

Provision for bad debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Deferred taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Stock based compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amortization of acquisition-related intangibles . . . . . . . . . . . . . . . . . . .
Amortization of software development costs . . . . . . . . . . . . . . . . . . . . .
Amortization of deferred finance costs . . . . . . . . . . . . . . . . . . . . . . . . .
Gain on contingent consideration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Goodwill impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trademark impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Loss on extinguishment of debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Loss on disposal of property and equipment . . . . . . . . . . . . . . . . . . . . .
Non-cash operating lease costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Changes in operating assets and liabilities (net of acquired assets and
liabilities):

Accounts receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Financing receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Inventories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prepaid expenses and other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Accounts payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Operating lease liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prepaid income taxes/income taxes payable . . . . . . . . . . . . . . . . . . . . .
Net cash provided by operating activities . . . . . . . . . . . . . . . . . . . . . . . . . . .
Investing Activities
Purchases of property and equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Purchase of business, net of cash received . . . . . . . . . . . . . . . . . . . . . . . . . .
Investment in software development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net cash used in investing activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Financing Activities
Proceeds from long-term debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Payments of long-term debt principal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Proceeds from revolving line of credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Payments of revolving line of credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Payments of contingent consideration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Proceeds from exercise of stock options . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Treasury stock purchases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net cash provided by financing activities . . . . . . . . . . . . . . . . . . . . . . . . . . .
Decrease in cash and cash equivalents . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cash and cash equivalents at beginning of year . . . . . . . . . . . . . . . . . . . . . .
Cash and cash equivalents at end of year . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Continued on following page.

Year ended December 31,
2022

2021

2023

(45,789) $

15,867 $

18,430

1,920
(11,305)
3,271
1,946
16,426
8,096
359
—
35,913
2,342
—
117
1,602

(11,319)
2,659
309
(4,554)
3,075
(2,913)
(2,063)
1,894
(927)
1,059

(346)
(36,705)
(23,059)
(60,110)

—
(3,500)
67,023
(5,000)
—
—
(2,575)
55,948
(3,103)
6,951
3,848 $

992
(6,688)
5,173
2,443
17,403
3,484
332
(565)
—
—
125
—
2,166

(12,428)
6,144
71
(2,930)
(1,429)
61
(2,019)
275
3,898
32,375

(270)
(43,364)
(19,097)
(62,731)

575
(3,563)
48,000
(5,300)
(1,935)
23

(11,924)
25,876
(4,480)
11,431
6,951 $

2,592
3,502
5,457
2,156
13,786
931
293
—
—
—
—
313
1,753

(3,204)
8,098
229
(3,914)
(615)
2,099
(1,753)
401
(2,810)
47,744

(920)
(59,634)
(9,365)
(69,919)

—
(3,750)
61,000
(35,000)
—
—
(1,315)
20,935
(1,240)
12,671
11,431

TRUBRIDGE, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS - (Continued)
(In thousands)

Year ended December 31,
2022

2023

2021

Supplemental disclosure of cash flow information:
Cash paid for interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Cash paid for income taxes, net of refund . . . . . . . . . . . . . . . . . . . . . . . . . . . $

9,298 $
3,659 $

5,863 $
4,765 $

2,817
3,503

The accompanying notes are an integral part of these consolidated financial statements.

TRUBRIDGE, INC.
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
DECEMBER 31, 2023

NATURE OF OPERATIONS

•

The Revenue Cycle Management (“RCM”) reporting segment focuses on providing a complete RCM solution for all
care settings, regardless of their primary healthcare information solutions provider along with business management,
consulting, managed IT services, analytics and business intelligence.

The electronic health record (“EHR”) segment provides comprehensive acute care solutions and related services for
community hospitals and their physician clinics. AHT is one of the nation’s largest providers of post-acute care EHR
solutions and services for post-acute care facilities. In January 2024, the Company disposed of its interest in AHT,
refer to Note 19 – Subsequent Events for more information.

The Patient Engagement segment offers comprehensive patient engagement and empowerment technology solutions to
improve patient outcomes and engagement strategies with care providers.

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Principles of Consolidation

The consolidated financial statements of TruBridge include the accounts of the Company and its wholly-owned
subsidiaries. All significant intercompany balances and transactions have been eliminated.

The Company has no items of other comprehensive income (loss) in any period presented. Therefore, as presented in the
Company's statements of operations, net income (loss) equals comprehensive income (loss).

Cash and Cash Equivalents

Cash and cash equivalents can include time deposits and certificates of deposit with original maturities of three months or
less that are highly liquid and readily convertible to a known amount of cash. These assets are stated at cost, which
approximates market value, due to their short duration or liquid nature.

Change in Useful Lives of Intangible Assets

In accordance with its policy, the Company reviews the estimated useful lives of its intangible assets on an ongoing basis.
This review indicated that the actual lives of certain developed technology were shorter than the estimated useful lives used
for amortization purposes in the Company's financial statements. As a result, effective January 1, 2021, the Company
changed its estimates of the useful lives of certain developed technology to better reflect the estimated periods during
which these assets will remain in service. The remaining useful life of certain developed technology that was 3.25 years at
January 1, 2021 was reduced to 2 years, while the remaining useful life of certain developed technology that was 4.25 years
was reduced to 3 years. The effect of this change was to increase 2021 amortization expense by approximately $1.0 million
and decrease 2021 net income and basic and diluted earnings per share by $0.8 million and $0.06, respectively.

Presentation

Commencing with the fourth quarter of 2022, the Company realigned its reporting structure due to certain organizational
changes. As a result, the Company changed its three reportable segments from (i) TruBridge, (ii) Acute Care EHR, and (iii)
Post-acute care EHR to (i) RCM, (ii) EHR, and (iii) Patient Engagement. All prior segment information has been recast to
reflect the Company's new segment structure and current period presentation. Refer to Note 18 - Segment Reporting for
more information.

Additional changes to the presentation of amounts within our condensed consolidated statements of income are as follows:

•

During the first quarter of 2023, we identified certain costs related to the implementation of our cloud strategy and
our security operations center that were recorded within the caption "Costs of revenue (exclusive of amortization
and depreciation) - EHR" on our condensed consolidated statements of operations, that we determined do not
solely contribute to the production of EHR products and services, but support the overall business. Consequently,
effective January 1, 2023, certain costs related to the implementation of our cloud strategy, which were formerly
included within the caption "Costs of revenue (exclusive of amortization and depreciation) - EHR," have been
recorded as components of "Product development" expenses. In addition, certain costs related to the Company's
security operations center, which were formerly included within the caption "Costs of revenue (exclusive of
amortization and depreciation) - EHR," have been recorded as components of "General and administrative"
expenses. Additionally, immaterial travel costs were reclassified from within the caption "Costs of revenue
(exclusive of amortization and depreciation) - RCM" to "Product development" expenses. Amounts presented for
the years ended December 31, 2022 and 2021 have been reclassified to conform to the current presentation.

In addition, during the first quarter of 2023, we refined our operating expense allocation methodology to more
accurately distribute the appropriate share of costs among operating segments. Amounts presented for the years
ended December 31, 2022 and 2021 have been reclassified and are reflective of the current operating expense
methodology in order to conform to the current presentation.

During the third quarter of 2023, we changed the presentation of certain costs previously recorded within the
expense captions of "Product development" and "General and administrative" to better comply with the disclosure
requirements of Staff Accounting Bulletin Topic 11.B., Miscellaneous Disclosure: Depreciation and Depletion
Excluded from Cost of Sales. These changes are summarized as follows:

◦

Amortization expense associated with capitalized software development costs, previously recorded
within the expense caption of "Product development," has been combined with amounts previously
recorded within the expense caption "Amortization of acquisition-related intangibles" and reflected in a
newly-presented expense caption of "Amortization."

Depreciation expense previously recorded within the expense caption of "General and administrative"
has been reclassified within the newly-presented expense caption of "Depreciation."

The expense caption previously labelled as "Costs of sales" has been renamed "Costs of revenue
(exclusive of amortization and depreciation)," with the previously reported reference to "Gross profit"
removed from the current presentation.

The following table provides the amounts reclassified and the impact of applying the current operating expense allocation
methodology for the years ended December 31, 2022 and 2021.

December 31, 2022

As previously
reported

Re-
classifications

As
reclassified

Impact of
operating
expense
allocations

As currently
reported

(in thousands)
Costs of revenue (exclusive of
amortization and depreciation)

RCM . . . . . . . . . . . . . . . . . . . . . . $

97,010 $

14 $

97,024 $

— $

EHR . . . . . . . . . . . . . . . . . . . . . . .

71,347

(3,054)

68,293

(2,632)

Other expenses

Product development . . . . . . . . .

General and administrative . . . . .
Amortization of acquisition-
related intangibles . . . . . . . . . . . .

Amortization . . . . . . . . . . . . . . . .

Depreciation . . . . . . . . . . . . . . . .

30,926

56,192

(1,660)

(1,227)

17,403

(17,403)

—

20,887

2,443

29,266

54,965

—

20,887

2,443

2,632

—

97,024

65,661

31,898

54,965

—

20,887

2,443

December 31, 2021

As previously
reported

Re-
classifications

As
reclassified

Impact of
operating
expense
allocations

As currently
reported

(in thousands)
Costs of revenue (exclusive of
amortization and depreciation)

RCM . . . . . . . . . . . . . . . . . . . . . . $

66,015 $

— $

66,015 $

— $

EHR . . . . . . . . . . . . . . . . . . . . . . .

70,664

(1,049)

69,615

(2,917)

Other expenses

Product development . . . . . . . . .

General and administrative . . . . .
Amortization of acquisition-
related intangibles . . . . . . . . . . . .
Amortization . . . . . . . . . . . . . . . .
Depreciation . . . . . . . . . . . . . . . .

30,389

50,022

13,786
—
—

(497)

(1,541)

(13,786)
14,717
2,156

29,892

48,481

—
14,717
2,156

2,917

—

—
—
—

66,015

66,698

32,809

48,481

—
14,717
2,156

Accounts Receivable and Allowance for Credit Losses

Trade accounts receivable are stated at the amount the Company expects to collect and do not bear interest. The Company
establishes a general allowance for credit losses based on collections history. In the case of a bankruptcy filing or other
similar event indicating the collectability of specific customer accounts is no longer probable, a specific allowance for
credit losses may be recorded to reduce the related receivable to the amount expected to be recovered.

Financing Receivables

Financing receivables are comprised of short-term payment plans and sales-type leases. Short-term payment plans are
stated at the amount the Company expects to collect and do not bear interest. Sales-type leases are initially recorded at the
present value of the related minimum lease payments.

An allowance for credit losses has been established for our financing receivables based on the historical level of customer
defaults under such arrangements. In the case of a bankruptcy filing or other similar event indicating the collectability of
specific customer accounts is no longer probable, a specific reserve may be recorded to reduce the related receivable to the
amount expected to be recovered. Customer payments are considered past due if a scheduled payment is not received

within contractually agreed upon terms, with amounts reclassified to accounts receivable when they become due. As a
result, we evaluate the credit quality of our financing receivables on an ongoing basis utilizing an aging of receivables and
write-offs, customer collection experience, the customer’s financial condition and known risk characteristics impacting the
respective customer base, as well as existing economic conditions, to determine if any further allowance is necessary.
Amounts are specifically charged off once all available means of collection have been exhausted.

Inventories

Inventories are stated at lower of cost or net realizable value using the average cost method. The Company’s inventories are
comprised of computer equipment, forms and supplies.

Property and Equipment

Property and equipment is recorded at cost, less accumulated depreciation. Additions and improvements to property and
equipment that materially increase productive capacity or extend the life of an asset are capitalized. Maintenance, repairs
and minor renewals are expensed as incurred. Upon retirement or other disposition of such assets, the related costs and
accumulated depreciation are removed from the respective accounts and any resulting gain or loss is included in the results
of operations.

Depreciation expense is computed using the straight-line method over the asset’s useful life, which is generally 5 years for
computer equipment, furniture, and fixtures and 30 years for buildings. Leasehold improvements are depreciated over the
shorter of the asset’s useful life or the remaining lease term. The Company reviews for the possible impairment of long-
lived assets whenever events or changes in circumstances indicate that the carrying amount of an asset may not be
recoverable. Depreciation expense is reported in the consolidated statements of operations as a component of costs of sales
and operating expenses.

Business Combinations

We apply business combination accounting when we acquire a business. Business combinations are accounted for at fair
value. The associated acquisition costs are expensed as incurred and recorded in general and administrative expenses;
restructuring costs associated with a business combination are expensed as incurred; contingent consideration is measured
at fair value at the acquisition date, with changes in fair value after the acquisition date affecting earnings; changes in
deferred tax asset valuation allowances and income tax uncertainties after the measurement period affect income tax
expense; and goodwill is determined as the excess of the fair value of the consideration conveyed in the acquisition over
the fair value of the net assets acquired. The accounting for business combinations requires estimates and judgments as to
expectations for future cash flows of the acquired business, and the allocation of those cash flows to identifiable intangible
assets, in determining the estimated fair value for assets and liabilities acquired. The fair values assigned to tangible and
intangible assets acquired and liabilities assumed, are based on management's estimates and assumptions, including
valuations that utilize customary valuation procedures and techniques. If the actual results differ from the estimates and
judgments used in these estimates, the amounts recorded in the financial statements could result in a possible impairment of
the intangible assets and goodwill, or require acceleration of the amortization expense of finite-lived intangible assets. The
results of the acquired businesses' operations are included in the Consolidated Statements of Operations of the combined
entity beginning on the date of the acquisition. We have applied this acquisition method to the transactions described in
Note 3 - Business Combinations.

Goodwill

Goodwill is recorded as the difference, if any, between the aggregate consideration paid for an acquisition and the fair
value of the identifiable net tangible and intangible assets acquired. Goodwill is not amortized but is evaluated for
impairment annually or more frequently if indicators of impairment are present or changes in circumstances suggest that
impairment may exist. We test annually for impairment as of October 1.

As part of our annual goodwill impairment test, we first assess qualitative factors to determine whether it is more likely
than not that the fair value of a reporting unit is less than its carrying amount. If we conclude that it is more likely than not
that the fair value of a reporting unit is less than its carrying amount, we conduct a quantitative goodwill impairment
assessment, which compares the fair value of the reporting unit with its carrying amount, including goodwill. If the
carrying amount of the reporting unit exceeds its fair value, an impairment charge is recognized for the amount by which
the carrying amount exceeds the total amount of goodwill allocated to that reporting unit. If the fair value of the reporting
unit exceeds its carrying amount, the goodwill of the reporting unit is not considered to be impaired.

Our reporting units assessed for impairment of goodwill include: RCM (formerly the “TruBridge” reporting unit), Acute
Care EHR, Post-acute care EHR (comprised solely of AHT, which was disposed in January 2024), and Patient Engagement
(formerly a component of our former “TruBridge” reporting unit). We did not identify any events or circumstances that
would require interim goodwill impairment testing prior to October 1, 2023. Based on our assessment as of October 1,
2023, we determined that there was no impairment of goodwill for our RCM reporting unit. However, quantitative
evaluations of the fair values of each of our remaining three reporting units, using a combination of the income and market
valuation approaches, resulted in impairment conclusions as follows:

•

Our Acute Care EHR reporting unit was assessed goodwill impairment charges of $6.4 million due to
deteriorating market conditions, the related impact to the cost of capital, and lowered expectations regarding long-
term margin potential.

Our Post-acute care EHR reporting unit was assessed goodwill impairment charges of $2.2 million due to
deteriorating market conditions, the related impact to the cost of capital, and revised expectations regarding the
long-term persistence of elevated customer attrition levels.

Our Patient Engagement reporting unit was assessed goodwill impairment charges of $7.6 million due to
deteriorating market conditions, the related impact to the cost of capital, and revised expectations regarding long-
term growth prospects as sales pipelines have been stubborn to develop to the robust levels previously anticipated.

During the fourth quarter of 2023, the decision to accept an offer for the sale of AHT that was well below the related
reporting unit’s carrying value was considered a triggering event requiring reassessment of the reporting unit’s goodwill,
resulting in an additional goodwill impairment charge of $19.7 million. Lastly, management considered the continued
decrease in the Company’s market capitalization since our most recent quantitative analysis dated October 1, 2023 to be a
triggering event warranting a further quantitative goodwill impairment analysis as of December 31, 2023. As a result of
this updated quantitative goodwill impairment analysis as of December 31, 2023, management concluded that there was no
further impairment to goodwill.

We determined there was no impairment to goodwill as of December 31, 2022 or 2021.

Purchased Intangible Assets

Purchased intangible assets are acquired in connection with a business acquisition, and are amortized over their estimated
useful lives based on the pattern of economic benefit expected from each asset. We concluded for certain purchased
intangible assets that the pattern of economic benefit approximated the straight-line method, and therefore, the use of the
straight-line method was appropriate, as the majority of the cash flows will be recognized ratably over the estimated useful
lives and there is no degradation of the cash flows over time.

We assess the recoverability of intangible assets whenever events or changes in circumstances indicate that the carrying
amount of the asset may not be recoverable. The carrying amount is not recoverable if it exceeds the undiscounted sum of
cash flows expected to result from the use and eventual disposition of the asset. If the asset is not recoverable, the
impairment loss is measured by the excess of the asset's carrying amount over its fair value. During the fourth quarter of
2023, the Company committed to the Company-wide rebranding and legal entity consolidation initiative that culminated in
the change of the Company’s corporate name to “TruBridge, Inc.” on March 4, 2024. As a result of this initiative, it was
expected that certain of the Company’s brand names and related trademarks would cease to be used, resulting in total
trademark impairment recorded during the year ended December 31, 2023 of $2.3 million. Of the total trademark
impairment charge, $1.0 million is derived from our RCM segment, $1.2 million is derived from our EHR segment, and
$0.1 million is derived from our Patient Engagement segment.

We determined there was no impairment to purchased intangible assets as of December 31, 2022 or 2021.

Revenue Recognition

Revenue is recognized net of shipping charges and any taxes collected from clients, which are subsequently remitted to
governmental authorities.

•

Revenue Cycle Management

Our RCM business unit provides an array of business processing services ("BPS") consisting of accounts
receivable management, private pay services, insurance services, medical coding, electronic billing, statement
processing, payroll processing, and contract management. Fees are recognized over the period of the client
contractual relationship as the services are performed based on the stand-alone selling price ("SSP"), net of
discounts. SSP for BPS services is determined based on observable stand-alone selling prices. Fees for many of
these services are invoiced, and revenue recognized accordingly, based on the volume of transactions or a
percentage of client accounts receivable collections. Payment is due monthly for BPS with certain amounts
varying based on utilization and/or volumes.

Our RCM business unit also provides professional IT services. Revenue from professional IT services is
recognized as the services are performed based on SSP, which is determined by observable stand-alone selling
prices. Payment is due monthly as services are performed.

Lastly, our RCM business unit also provides certain software solutions and related support under Software as a
Service ("SaaS") arrangements and time-based software licenses. Revenue from SaaS arrangements is
recognized in a manner consistent with SaaS arrangements for EHR software, as discussed below. Revenue
from time-based software licenses is recognized upon delivery to the client (“point in time”) and revenue from
non-license components (i.e., support) is recognized ratably over the respective contract term (“over time”).
SSP for time-based licenses is determined using the residual approach, while the non-license component is
based on cost plus reasonable margin.

•

Electronic Health Records

The Company enters into contractual obligations to sell perpetual software licenses, installation, conversion, and
related training services, software application support, hardware, and hardware maintenance services to acute
care community hospitals and post-acute providers.

•

Non-recurring Revenues

•

Perpetual software licenses and installation, conversion, and related training services are not
considered separate and distinct performance obligations due to the proprietary nature of our software
and are, therefore, accounted for as a single performance obligation on a module-by-module basis.
Revenue is recognized as each module's implementation is completed based on the module's SSP, net
of discounts. We determine each module's SSP using the residual method. Fees for licenses and
installation, conversion, and related training services are typically due in three installments: (1) at
placement of order, (2) upon installation of software and commencement of training, and (3) upon
satisfactory completion of monthly accounting cycle or end-of-month operation by application and as
applicable for each application. Often, short-term and/or long-term financing arrangements are
provided for software implementations; refer to Note 11 - Financing Receivables for further
information. EHR implementations include a system warranty that terminates thirty days from the
software go-live date, the date which the client begins using the system in a live environment.

Hardware revenue is recognized separately from software licenses at the point in time it is delivered to
the client. The SSP of hardware is cost plus a reasonable margin and revenue is recognized on a gross
basis. Payment is generally due upon delivery of the hardware to the client. Standard manufacturer
warranties apply to hardware.

•

Recurring Revenues

•

Software application support and hardware maintenance services sold with software licenses and
hardware are separate and distinct performance obligations. Revenue for support and maintenance
services is recognized based on SSP, which is the renewal price, ratably over the life of the contract,
which is generally three to five years. Payment is due monthly for support and maintenance services
provided.

•

Subscriptions to third-party content revenue is recognized as a separate performance obligation ratably
over the subscription term based on SSP, which is cost plus a reasonable margin, and revenue is
recognized on a gross basis. Payment is due monthly for subscriptions to third party content.

SaaS arrangements for EHR software and related conversion and training services are considered a
single performance obligation. Revenue is recognized on a monthly basis as the SaaS service is
provided to the client over the contract term. Payment is due monthly for SaaS services provided.

Refer to Note 18 of the consolidated financial statements for further information, including revenue by
client base (acute care or post-acute care) bifurcated by recurring and non-recurring revenue.

•

Patient Engagement

The Company enters into contractual obligations to sell perpetual and term-based software licenses,
implementation and customization professional services, and software application support services to a variety
of healthcare organizations including hospital systems, health ministries, and government and non-profit
organizations.

•

Non-recurring Revenues

•

Perpetual software licenses are sold only to one re-seller client and are considered a separate and
distinct performance obligation. Revenue is recognized at the point in time perpetual licenses are
delivered to the client, which occurs at the time of sale. The SSP of perpetual licenses is directly
observable. Payment is generally due upon delivery of licenses.

Implementation and customization services are considered a separate and distinct performance
obligation. Revenue is recognized over time based on SSP, which is generally directly observable.
Payment for professional services is typically due in two installments: (1) upon signature of the
agreement and (2) upon customer acceptance of the delivered services.

•

Recurring Revenues

•

Term-based software licenses are considered a separate and distinct performance obligation. Revenue
is recognized based on SSP, which is directly observable, at the point in time the term-based licenses
are delivered to the client or upon annual renewal. Payment is generally due upon delivery of licenses
or upon annual renewal.

Software application support services sold with software licenses are separate and distinct performance
obligations. The related revenues are recognized based on SSP, which is the renewal price, ratably
over the life of the contract, which is generally three to five years. Payment is generally due for the
full amount of annual support fees at the beginning of an annual license term.

Refer to Note 18 of the consolidated financial statements for further information.

•

Deferred Revenue

Deferred revenue represents amounts invoiced to clients for which the services under contract have not been
completed and revenue has not been recognized, including annual renewals of certain software subscriptions
and customer deposits for implementations to be performed at a later date. Revenue is recognized ratably over
the life of the software subscriptions as services are provided and at the point-in-time when implementations
have been completed.

The following table details deferred revenue for the years ended December 31, 2023 and 2022, included in the
consolidated balance sheets:

(In thousands)

For years ended December 31,

2023

2022

Beginning balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Deferred revenue recorded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11,590

17,192

Less deferred revenue recognized as revenue . . . . . . . . . . . . . . . . . . . . . . . . .

(20,105)

11,529

25,579

(25,518)

Ending balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

8,677

11,590

The deferred revenue recorded for the years ended December 31, 2023 and 2022 is comprised primarily of the
annual renewals of certain software subscriptions billed during the first quarter of each year and deposits
collected for future EHR installations. The deferred revenue recognized as revenue during the years ended
December 31, 2023 and 2022 is comprised primarily of the periodic recognition of annual renewals that were
deferred until earned and deposits for future EHR installations that were deferred until earned.

•

Costs to Obtain and Fulfill a Contract with a Customer

Costs to obtain a contract include the commission costs related to SaaS and RCM arrangements, which are
capitalized and amortized ratably over the expected life of the customer. As a practical expedient, we generally
recognize the incremental costs of obtaining a contract as an expense when incurred if the amortization period
of the asset would have been one year or less. Costs to obtain a contract are expensed within sales and
marketing expenses in the accompanying consolidated statements of operations.

Contract fulfillment costs related to the implementation of SaaS arrangements are capitalized and amortized
ratably over the expected life of the customer. Costs to fulfill contracts consist of the payroll costs for the
implementation of SaaS arrangements, including time for training, conversion, and installation that is necessary
for the software to be utilized. Contract fulfillment costs are expensed within the caption "Electronic health
record - Cost of sales" in the accompanying consolidated statements of operations.

Costs to obtain and fulfill contracts related to SaaS and RCM arrangements are included within the "Prepaid
expenses and other" and "Other assets, net of current portion" line items on our consolidated balance sheets.

The following table details costs to obtain and fulfill contracts with customers for the years ended December 31,
2023 and 2022, included in the consolidated balance sheets:

(In thousands)
Beginning balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Costs to obtain and fulfill contracts capitalized . . . . . . . . . . . . . . . . . . . . . . . . . .
Less costs to obtain and fulfill contracts recognized as expense . . . . . . . . . . . . .
Ending balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

2023

2022

11,577 $
7,390
(5,852)
13,115 $

7,312
11,361
(7,096)
11,577

For years ended December 31,

•

Significant Judgments

Our contracts with clients often include promises to transfer multiple products and services. Determining
whether products and services are considered distinct performance obligations that should be accounted for
separately versus together may require significant judgment.

Judgment is required to determine SSP for each distinct performance obligation. We use observable SSP for
items that are sold on a stand-alone basis to similarly situated clients at unit prices within a sufficiently narrow
range. For performance obligations that are sold to different clients for a broad range of amounts, or for
performance obligations that are never sold on a stand-alone basis, the residual method in determining SSP is
applied and requires significant judgment.

Allocating the transaction price, including estimating SSP of promised goods and services for contracts with
discounts or variable consideration, may require significant judgment. Due to the short time frame of the
implementation cycle, discount allocation is immaterial as revenue is recognized net of discounts within the
same reporting period. In scenarios where the Company enters into a contract that includes both a software

license and BPS or other services that are charged based on volume of services rendered, the Company allocates
variable amounts entirely to a distinct good or service. The terms of the variable payment relate specifically to
the entity’s efforts to satisfy that performance obligation.

Significant judgment is required in determining the expected life of a customer relationship, which is the
amortization period for costs to obtain and fulfill a contract that have been capitalized. The Company
determined that the expected life of the customer relationship is not materially different from the initial contract
term based on the characteristics of the SaaS offering.

•

Remaining Performance Obligations

Disclosures regarding remaining performance obligations are not considered material as the overwhelming
majority of the Company's remaining performance obligations either (a) are related to contracts with an
expected duration of one year or less, or (b) exhibit revenue recognition in the amount to which the Company
has the right to invoice.

Although we believe that our approach to estimates and judgments regarding revenue recognition is reasonable, actual
results could differ, and we may be exposed to increases or decreases in revenue that could be material.

Stock-Based Compensation

The Company accounts for stock-based compensation according to the provisions of ASC 718, Compensation – Stock
Compensation, which establishes accounting for stock-based awards exchanged for employee services. Accordingly, stock-
based compensation cost is measured at the grant date based on the fair value of the award, and is recognized as an expense
over the employee’s or non-employee director’s requisite service period.

Software Development Costs

Our software solutions are offered to our clients through SaaS delivery models, traditional perpetual licenses, and term
licenses. Development costs associated with the solutions offered exclusively through a SaaS model are accounted for in
accordance with ASC 350-40, Internal Use Software. All other client solution development costs are accounted for in
accordance with ASC 985-20, Costs of Software to be Sold, Leased, or Marketed.

Under ASC 350-40, software development costs related to preliminary project activities and post-implementation and
maintenance activities are expensed as incurred. We capitalize direct costs related to application development activities
that are probable to result in additional functionality. Capitalized costs are amortized on a straight-line basis over five
years. We test for impairment whenever events or changes in circumstances that could impact recoverability occur.

Under ASC 985-20, software development costs incurred in creating computer software solutions are expensed until
technological feasibility has been established upon completion of a detailed program design or, in the absence of a detailed
program design, upon completion of a product design and working model of the software product. Thereafter, all software
development costs incurred through the software’s general release date are capitalized and subsequently recorded at the
lower of amortized cost or net realizable value. Capitalized costs are amortized based on the current and expected future
revenue for each software solution with minimum annual amortization equal to the straight-line amortization over the
estimated economic life of the solution, which is estimated to be five years.

See Note 5 to the consolidated financial statements for further information relating to our software development costs.

Income Taxes

We account for income taxes in accordance with ASC 740, Accounting for Income Taxes. Under this topic, deferred
income taxes are determined utilizing the asset and liability approach. This method gives consideration to the future tax
consequences associated with differences between financial accounting and tax bases of assets and liabilities. The effect on
the deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the
enactment date. We recognize interest and penalties accrued related to unrecognized tax benefits in the consolidated
statements of operations as a component of the provision for income taxes.

We also make a provision for uncertain income tax positions in accordance with the ASC 740, Accounting for Income
Taxes. These provisions require that a tax position taken in a tax return be recognized in the financial statements when it is
more likely than not (i.e., a likelihood of more than fifty percent) that the position would be sustained upon examination by

tax authorities. A recognized tax position is then measured at the largest amount of benefit that is greater than fifty percent
likely of being realized upon settlement. The topic also requires that changes in judgment that result in subsequent
recognition, derecognition, or change in a measurement date of a tax position taken in a prior annual period (including any
related interest and penalties) be recognized as a discrete item in the interim period in which the change occurs.

Valuation allowances are recorded when, in the opinion of management, it is more likely than not that all or a portion of the
deferred tax assets will not be realized. These valuation allowances can be impacted by changes in tax laws, changes to
statutory tax rates, and future taxable income, and are based on our judgment, estimates, and assumptions.

Use of Estimates

The preparation of financial statements in conformity with U.S. GAAP requires that management make estimates and
assumptions that affect the reported amounts of assets and liabilities, the disclosures of contingent assets and liabilities at
the date of the financial statements, and the reported revenues and expenses during the reporting periods. Actual results
could differ from those estimates.

Segment Reporting

Operating segments are identified as components of an enterprise about which separate discrete financial information is
evaluated by the chief operating decision maker, which we refer to as the "CODM", or decision-making group in assessing
performance and making decisions regarding resource allocation. The Company has prepared operating segment
information based on the manner in which management disaggregates the Company's operations for making internal
operating decisions. For more information, see Note 18 - Segment Reporting.

New Accounting Standards Adopted in 2023

There were no new accounting standards required to be adopted in 2023 that would have a material impact on our
consolidated financial statements.

New Accounting Standards Yet to be Adopted

We do not believe that any recently issued but not yet effective accounting standards, if adopted, would have a material
impact on our consolidated financial statements.

3. BUSINESS COMBINATIONS

Acquisition of Viewgol, LLC

On October 16, 2023, we acquired all of the assets and liabilities of Viewgol, LLC (“Viewgol”), a Delaware limited
liability company, pursuant to a Securities Purchase Agreement dated October 16, 2023. Based in Frisco, Texas, Viewgol
is a provider of ambulatory RCM analytics and complementary outsourcing services with an extensive offshore presence
we intend to leverage and grow to accommodate the growing demand for RCM services by our pre-existing acute care
customers.

Consideration for the acquisition included cash (net of cash of the acquired entity) of $36.7 million (inclusive of seller's
transaction expenses). Also included in the acquisition consideration were contingent earnout payments of (i) up to
$21.5 million based on the Viewgol business achieving earnings before interest, taxes, depreciation, and amortization
(“EBITDA”) of $6.0 million or more during fiscal year 2024 (the “EBITDA Earnout Amount”), and (ii) up to
$10.0 million based on the number of productive agents the Viewgol business hires in India in fiscal year 2024 (the
“Offshore Earnout Amount”); provided, however, that none of the Offshore Earnout Amounts may be earned if the
EBITDA Earnout Amount’s minimum EBITDA threshold of $6.0 million is not achieved during fiscal 2024. During 2023,
we incurred approximately $4.7 million of pre-tax acquisition expenses in our consolidated statements of operations.

Our acquisition of Viewgol was treated as a purchase in accordance with ASC 805, Business Combinations, which requires
allocation of the purchase price to the estimated fair values of assets and liabilities acquired in the transaction. Our
allocation of the purchase price was based on management's judgment after evaluating several factors, including a
valuation assessment.

The allocation of the purchase price paid for Viewgol was as follows:

(In thousands)

Purchase Price
Allocation

Acquired cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Accounts receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prepaid expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Property and equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intangible assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Goodwill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accounts payable and accrued liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contingent consideration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,449

2,233

132

1,112

17,720

17,263

(711)

(1,044)

Net assets acquired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

38,154

The intangible assets in the table above are being amortized on a straight-line basis over their estimated useful lives. The
amortization is included in amortization of acquisition-related intangibles in our consolidated statements of operations.

The fair value measurements of tangible and intangible assets and liabilities (including those related to contingent
consideration) were based on significant inputs not observable in the market and thus represent Level 3 measurements
within the fair value measurement hierarchy (see Note 17 - Fair Value). Level 3 inputs included, among others, discount
rates that we estimated would be used by a market participant in valuing these assets and liabilities, projections of revenues
and cash flows, client attrition rates and market comparables.

Our consolidated statement of operations for the year ended December 31, 2023 includes revenues and earnings of
approximately $3.8 million and $0.3 million, respectively, attributed to the acquired business since the October 16, 2023
acquisition date.

The following unaudited pro forma revenue, net income and earnings per share amounts for the years ended December 31,
2023 and 2022 give effect to the Viewgol acquisition as if it had been completed on January 1, 2022. The pro forma
financial information is presented for illustrative purposes only and is not necessarily indicative of what the operating
results actually would have been during the periods presented had the Viewgol acquisition been completed on January 1,
2022. In addition, the unaudited pro forma financial information does not purport to project future operating results. The
pro forma information does not fully reflect: (1) any anticipated synergies (or costs to achieve synergies) or (2) the impact
of non-recurring items directly related to the Viewgol acquisition.

(In thousands, except per share data, unaudited)

Year Ended December 31,

2023

2022

Pro forma revenues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

351,731 $

338,009

Pro forma net income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

(47,735) $

15,536

Pro forma diluted earnings per share . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

(3.36) $

1.10

Pro forma net income was calculated by adjusting the results for the applicable period to reflect (i) the additional
amortization that would have been charged assuming the fair value adjustments to intangible assets had been applied on
January 1, 2022 and (ii) the pro forma adjustment to interest expense as a result of utilizing revolver debt to finance the
acquisition.

Acquisition of Healthcare Resource Group

On March 1, 2022, we acquired all of the assets and liabilities of Healthcare Resource Group, Inc., a Washington
corporation ("HRG"), pursuant to a Stock Purchase Agreement dated March 1, 2022. Based in Spokane, Washington, HRG
is a leading provider of customized RCM solutions and consulting services that enable hospitals and clinics to improve
efficiency, profitability, and patient satisfaction.

Consideration for the acquisition included cash (net of cash of the acquired entity) of $43.6 million (inclusive of seller's
transaction expenses). During 2022, we incurred approximately $1.2 million of pre-tax acquisition costs in connection with
the acquisition of HRG. Acquisition costs are included in general and administrative expenses in our consolidated
statements of operations.

Our acquisition of HRG was treated as a purchase in accordance with ASC 805, Business Combinations, which requires
allocation of the purchase price to the estimated fair values of assets and liabilities acquired in the transaction. Our
allocation of the purchase price was based on management's judgment after evaluating several factors, including a
valuation assessment.

The allocation of the purchase price paid for HRG was as follows:

(In thousands)

Purchase Price
Allocation

Acquired cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Accounts receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prepaid expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Property and equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intangible assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operating lease assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Goodwill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accounts payable and accrued liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deferred taxes, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operating lease liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,989

5,655

398

467

24,200

1,315

20,750

(2,403)

(5,565)

(1,315)

Net assets acquired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

47,564

The fair value measurements of tangible and intangible assets and liabilities were based on significant inputs not
observable in the market and thus represent Level 3 measurements within the fair value measurement hierarchy (see Note
17 - Fair Value). Level 3 inputs included, among others, discount rates that we estimated would be used by a market
participant in valuing these assets and liabilities, projections of revenues and cash flows, client attrition rates and market
comparables.

Acquisition of TruCode

On May 12, 2021, we acquired all of the assets and liabilities of TruCode LLC, a Virginia limited liability company
("TruCode"), pursuant to a Stock Purchase Agreement dated May 12, 2021. Based in Alpharetta, Georgia, TruCode
provides configurable, knowledge-based software that gives coders, clinical documentation improvement specialists and
auditors the flexibility to code according to their knowledge, preferences and experience. The cloud-based medical coding
solution is bundled with our RCM solutions and services to enhance revenue cycle performance for healthcare
organizations of all sizes.

Consideration for the acquisition included cash (net of cash of the acquired entity) of $59.9 million (inclusive of seller's
transaction expenses), plus a contingent earnout payment of up to $15.0 million tied to TruCode's EBITDA (subject to
certain pro-forma adjustments) for the twelve- month period concluding on the anniversary date of the acquisition. During
2022, the related contingent earnout payment was finalized and paid to the former shareholders of TruCode in the amount
of $1.9 million. During 2021, we incurred approximately $0.9 million of pre-tax acquisition costs in connection with the
acquisition of TruCode. Acquisition costs are included in general and administrative expenses in our consolidated
statements of operations.

Our acquisition of TruCode was treated as a purchase in accordance with ASC 805, Business Combinations, which requires
allocation of the purchase price to the estimated fair values of assets and liabilities acquired in the transaction. Our

allocation of the purchase price was based on management's judgment after evaluating several factors, including a
valuation assessment.

The allocation of the purchase price paid for TruCode was as follows:

(In thousands)

Purchase Price
Allocation

Acquired cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

4,249

Accounts receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prepaid expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intangible assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Goodwill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accounts payable and accrued liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contingent consideration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

924

37,300

27,287

(1,840)

(2,500)

(1,300)

Net assets acquired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

64,122

PROPERTY AND EQUIPMENT

Property and equipment were comprised of the following at December 31, 2023 and 2022:

(In thousands)
Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Buildings and improvements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Computer equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Leasehold improvements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Office furniture and fixtures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Automobiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less: accumulated depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Property and equipment, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

2023

2022

2,848 $
8,481
10,104
631
586
18
22,668
(13,694)
8,974 $

2,848
8,320
8,228
783
1,008
18
21,205
(11,321)
9,884

SOFTWARE DEVELOPMENT

Software development costs are accounted for in accordance with ASC 350-40, Internal-Use Software and ASC 985-20,
Costs of Software to be Sold, Leased, or Marketed. We capitalize incurred labor costs for software development from the
time the preliminary project phase is completed until the software is available for general release. Research and
development costs and other computer software maintenance costs related to software development are expensed as
incurred. We estimate the useful life of our capitalized software and amortize its value on a straight-line basis over that
estimated life, which is estimated to be five years. If the actual useful life of the asset is determined to be shorter than our
estimated useful life, we will amortize the remaining book value over the remaining useful life, or the asset may be deemed
to be impaired and, accordingly, a write-down of the value of the asset may be recorded as a charge to earnings.
Amortization begins when the related features are placed in service.

Software development costs, net was comprised of the following at December 31, 2023 and 2022:

(In thousands)
Software development costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

2023

2022

51,349

31,789

Less: accumulated amortization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(12,210)

(4,532)

Software development costs, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

39,139

27,257

OTHER ACCRUED LIABILITIES

Other accrued liabilities were comprised of the following at December 31, 2023 and 2022:

(In thousands)
Salaries and benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Severance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Commissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Self-insurance reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contingent consideration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Operating lease liabilities, current portion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other accrued liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

2023

2022

5,194 $
5,806
1,185
—
1,044
4,859
1,804
19,892 $

8,430
2,504
1,280
1,358
—
840
2,063
16,475

NET INCOME PER SHARE

The Company presents basic and diluted earnings per share ("EPS") data for its common stock. Basic EPS is calculated by
dividing the net income (loss) attributable to stockholders of the Company by the weighted average number of shares of
common stock outstanding during the period. Diluted EPS is determined by adjusting the net income attributable to
stockholders of the Company and the weighted average number of shares of common stock outstanding during the period
for the effects of all dilutive potential common shares, including awards under stock-based compensation arrangements.

The Company's unvested restricted stock awards (see Note 9) are considered participating securities under ASC 260,
Earnings Per Share, because they entitle holders to non-forfeitable rights to dividends until the awards vest or are forfeited.
When a company has a security that qualifies as a "participating security," the Codification requires the use of the two-class
method when computing basic EPS. The two-class method is an earnings allocation formula that determines EPS for each
class of common stock and participating security according to dividends declared (or accumulated) and participation rights
in undistributed earnings. In determining the amount of net income to allocate to common stockholders, income is allocated
to both common stock and participating securities based on their respective weighted average shares outstanding for the
period, with net income attributable to common stockholders ultimately equaling net income less net income attributable to
participating securities. Diluted EPS for the Company's common stock is computed using the more dilutive of the two-class
method or the treasury stock method.

The following is a calculation of the basic and diluted EPS for the Company's common stock, including a reconciliation
between net income and net income attributable to common stockholders for the years ended December 31, 2023, 2022,
and 2021:

(In thousands, except for per share data)

2023

2022

2021

Basic EPS

Numerator

Net income (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

(45,789) $

15,867 $

18,430

Less: Net income (loss) attributable to participating securities . . . . . . . .

1,030

(311)

(409)

Net income (loss) attributable to common stockholders . . . . . . . . . . . . . $

(44,759) $

15,556 $

18,021

Denominator

Weighted average shares outstanding used in basic per common share
computations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14,187

14,356

Basic EPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

(3.15) $

1.08 $

14,290

1.26

Diluted EPS

Numerator

Net income (loss) attributable to common stockholders for diluted EPS . $

(44,759) $

15,556 $

18,021

Denominator

Weighted average shares outstanding used in basic per common share
computations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14,187

14,356

14,290

Weighted average effect of dilutive securities:

Performance share awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Weighted average shares outstanding used in diluted per common share
computations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

—

14,187

14,356

14,318

1.26

Diluted EPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

(3.15) $

1.08 $

INCOME TAXES

The Company accounts for income taxes in accordance with ASC 740, Accounting for Income Taxes. These provisions
require a company to determine whether it is more likely than not that a tax position will be sustained upon examination
based on the technical merits of the position. If the more-likely-than-not threshold is met, a company must measure the tax
position to determine the amount to recognize in the financial statements. The Company did not have any material
unrecognized tax positions as of December 31, 2023 and 2022.

The federal returns for tax years 2020 through 2022 remain open to examination, and the tax years 2019 through 2022
remain open to examination by certain other taxing jurisdictions to which the Company is subject. Additional years may be
open to the extent attributes are being carried forward to an open year.

Deferred income taxes arise from the temporary differences in the recognition of income and expenses for tax purposes. A
valuation allowance is established when the Company believes that it is more likely than not that some portion of its
deferred tax assets will not be realized.

Deferred tax assets and liabilities were comprised of the following at December 31, 2023 and 2022:

(In thousands)
Deferred tax assets:

Accounts receivable and financing receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Stock-based compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Research expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Accrued severance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Right of use asset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net operating loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Deferred tax assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Less: Valuation allowance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total deferred tax assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Deferred tax liabilities:

Intangible assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Accrued liabilities and other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fixed assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Right of use liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total deferred tax liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Total net deferred tax liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

2023

2022

871 $

1,275
367
16,496
890
952
2,770
3,656
27,277
604
26,673 $

14,477 $
12,127
254
1,045 $
27,903 $
(1,230) $

877
1,909
1,002
9,779
490
1,848
814
3,738
20,457
604
19,853

20,941
9,259
527
1,884
32,611
(12,758)

Under the Tax Cuts and Jobs Act, Internal Revenue Code ("IRC") Section 174 amended the federal tax treatment of
research or experimental expenditures paid or incurred during the tax year, which allowed for expensing of such costs in
the year incurred for federal income tax purposes. Effective for the 2022 tax year, taxpayers are required to capitalize and
amortize specified research or experimental expenditures over a five-year period. As a result of the change to IRC Section
174, a deferred tax asset of $9.8 million was recorded for the tax year ended December 31, 2022.

Significant components of the income tax (benefit) provision for the years ended December 31, 2023, 2022 and 2021 were
as follows:

(In thousands)
Current provision:

2023

2022

2021

Federal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,392 $
322

6,482 $
2,420

Deferred provision:

Federal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total income tax (benefit) provision . . . . . . . . . . . . . . . . . . . . . . . . . . $

(8,884)
(2,421)
(8,591) $

(4,769)
(1,919)
2,214 $

731
413

3,331
171
4,646

The difference between income taxes at the U.S. federal statutory income tax rate of 21% for the years ended December 31,
2023, 2022 and 2021, and those reported in the consolidated statements of operations for the years ended December 31,
2023, 2022 and 2021 are as follows:

(In thousands)
Income taxes at U.S. federal statutory rate . . . . . . . . . . . . . . . . . . . . . . $
Provision-to-return adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
State income tax, net of federal tax effect . . . . . . . . . . . . . . . . . . . . . . .
Tax credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contingent consideration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Goodwill impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Stock-based compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Non-deductible compensation - 162(m) . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total income tax (benefit) provision . . . . . . . . . . . . . . . . . . . . . . . . . . $

2023

2022

2021

(11,420) $
(999)
(2,157)
(2,481)
—
7,542
65
15
844
(8,591) $

3,797 $
(539)
428
(1,254)
(406)
—
(112)
306

(6)
2,214 $

4,846
117
509
(1,274)
—
—
(74)
510
12
4,646

Our effective tax rates for the years ended December 31, 2023, 2022 and 2021 were 16%, 12% and 20% respectively. Our
effective tax rate for 2023 was significantly impacted by the non-deductible nature of our goodwill impairment charges and
the changing relationship between net income or loss and research and development tax credits, which accumulate as
benefits even in years with loss positions such as 2023. Our effective tax rate for 2022 was impacted by the non-taxable
nature of our recorded gain on contingent consideration, which served to reduce the year's effective tax rate by 2.2%, while
lowered provision-to-return adjustments resulted in an incremental 3.5% decrease in our effective tax rate for 2022
compared to 2021.

We have federal net operating loss carryforwards related to the acquisitions of Healthland Holding Inc. ("HHI") and Get
Real Health of $3.4 million, $5.9 million, and $7.9 million for the years ending December 31, 2023, 2022, and 2021,
respectively, which expire at various dates from 2027 to 2036. We have state net operating loss carryforwards related to the
acquisitions of HHI and Get Real Health and normal business operations of $68.2 million, $39.8 million, and $29.9 million
for the years ending December 31, 2023, 2022, and 2021, respectively, which expire at various dates from 2024 to 2043.

Realization of deferred tax assets associated with the state net operating loss carryforwards is dependent upon generating
sufficient taxable income prior to their expiration. We believe it is more likely than not that the benefit from certain state
NOL carryforwards associated with the acquisition of Get Real Health will not be realized. In recognition of this risk, we
have provided a valuation allowance on the deferred tax assets related to these state NOL carryforwards of $0.6 million
after both December 31, 2023 and 2022, respectively.

STOCK-BASED COMPENSATION AND EQUITY

The Company's stock-based compensation awards are in the form of restricted stock and performance share awards granted
pursuant to the Company's Amended and Restated 2019 Incentive Plan (the "Plan"). Stock-based compensation cost is
measured at the grant date based on the fair value of the award, and is recognized as an expense over the employee’s or
non-employee director’s requisite service period. As of December 31, 2023, there was a total of 805,771 shares of common
stock reserved under the Plan for issuance under future share-based payment arrangements.

The following table details total stock-based compensation expense for the years ended December 31, 2023, 2022 and
2021, included in the consolidated statements of operations:
(In thousands)
Costs of sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Operating expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pre-tax stock-based compensation expense . . . . . . . . . . . . . . . . . . . . .
Less: income tax effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net (after tax) stock-based compensation expense . . . . . . . . . . . . . . . . $

4,364
5,173
(1,086)
4,087 $

2,526
3,271
(687)
2,584 $

990
4,467
5,457
(1,146)
4,311

745 $

809 $

2022

2023

2021

As of December 31, 2023, there was $6.3 million of unrecognized compensation cost related to unvested or unearned, as
applicable, stock-based compensation arrangements granted under the Plan, which is expected to be recognized over a
weighted-average period of 1.9 years.

Restricted Stock

The Company grants restricted stock to executive officers, certain key employees and non-employee directors under the
Plan with the fair value of the awards representing the fair value of the common stock on the date the restricted stock is
granted. Shares of restricted stock generally vest in equal annual installments over the applicable vesting period, which
ranges from one to three years. The Company records expenses for these grants on a straight-line basis over the applicable
vesting periods.

A summary of restricted stock activity (including shares of restricted stock issued pursuant to the settlement of
performance share awards) under the Plan during the years ended December 31, 2023, 2022 and 2021 is as follows:

Unvested stock outstanding at January 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Granted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vested . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Forfeited . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unvested stock outstanding at December 31, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Granted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vested . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Forfeited . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unvested stock outstanding at December 31, 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Granted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vested . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Forfeited . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unvested stock outstanding at December 31, 2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Performance Share Awards

Weighted-
Average
Grant-Date
Fair Value

412,967 $

153,700

(245,455)

(6,329)

314,883 $

161,375

(181,405)

(13,692)

281,161 $

210,351

(145,529)

(2,668)

343,315 $

28.87

31.22

29.16

29.10

29.79

34.22

29.79

31.66

32.24

26.44

31.35

29.23

29.08

The Company grants performance share awards to executive officers and certain key employees under the Plan, with the
number of shares of common stock earned and issuable under each award determined at the end of a three-year
performance period, based on the Company's achievement of performance goals predetermined by the Compensation
Committee of the Board of Directors at the time of grant. These performance share awards include a modifier to the total
number of shares earned based on the Company's total shareholder return ("TSR") compared to a small-cap stock market
index. If certain levels of the performance objective are met, the award results in the issuance of shares of common stock
corresponding to such level. Performance share awards that result in the issuance of shares of common stock are not
subject to time-based vesting at the conclusion of the three-year performance period.

In the event that the Company's financial performance meets the predetermined targets for the performance objectives of
the performance share awards, the Company will issue each award recipient the number of shares of common stock equal
to the target award specified in the individual's underlying performance share award agreement. In the event the financial
results of the Company exceed the predetermined targets, additional shares up to the maximum award may be issued. In the
event the financial results of the Company fall below the predetermined targets, a reduced number of shares may be issued.
If the financial results of the Company fall below the threshold performance levels, no shares will be issued. The total
number of shares issued for the performance share award may be increased, decreased, or unchanged based on the TSR
modifier described above.

The recipients of performance share awards do not receive dividends or possess voting rights during the performance
period and, accordingly, the fair value of the performance share awards is the quoted market value of TruBridge's common
stock on the grant date less the present value of the expected dividends not received during the relevant period. The TSR
modifier applicable to the performance share awards is considered a market condition and therefore is reflected in the grant
date fair value of the award. A Monte Carlo simulation has been used to account for this market condition in the grant date
fair value of the award.

Expense related to performance share awards is recognized using ratable straight-line amortization over the three-year
performance period. In the event the Company determines it is no longer probable that the minimum performance level will
be achieved, all previously recognized compensation expense related to the applicable awards is reversed in the period such
a determination is made.

A summary of performance share award activity under the Plan for the years ended December 31, 2023, 2022 and 2021, is
as follows, based on the target award amounts set forth in the performance share award agreements:

Weighted-
Average
Grant-Date
Fair Value

Performance share awards outstanding at January 1, 2021 . . . . . . . . . . . . . . . . . . . . . . .

Granted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Forfeited or unearned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vested and issued . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Performance share awards outstanding at December 31, 2021 . . . . . . . . . . . . . . . . . . . .

Granted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Forfeited or unearned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Performance share awards converted to restricted stock . . . . . . . . . . . . . . . . . . . . . . . . .

Performance share awards outstanding at December 31, 2022 . . . . . . . . . . . . . . . . . . . .

Granted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Forfeited or unearned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vested and issued . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

252,852 $

93,444

(20,373)

(75,971)

249,952 $

101,799

(72,059)

(27,317)

252,375 $

122,071

(100,655)

—

Performance share awards outstanding at December 31, 2023 . . . . . . . . . . . . . . . . . . . .

273,791 $

29.27

31.26

29.92

30.50

29.59

37.98

32.74

31.75

31.84

31.21

27.46

—

33.17

Stock Repurchases

On September 4, 2020, our Board of Directors approved a stock repurchase program under which we may repurchase up to
$30.0 million of our common stock through September 3, 2022. On July 27, 2022, the Board of Directors extended the
expiration date of the stock repurchase program to September 4, 2024. During 2023, we repurchased 49,789 shares. The
approximate value of shares that may yet be repurchased under the stock repurchase program was $16.5 million as of
December 31, 2023. Any future stock repurchase transactions may be made through open market purchases, privately-
negotiated transactions, or otherwise in compliance with Rule 10b-18 under the Securities Exchange Act of 1934, as
amended. Any repurchase activity will depend on many factors, such as the availability of shares of our common stock,
general market conditions, the trading price of our common stock, alternative uses for capital, the Company's financial
performance, compliance with the terms of our Amended and Restated Credit Agreement and other factors. Concurrent
with the authorization of this stock repurchase program, the Board of Directors opted to indefinitely suspend all quarterly
dividends.

10.

CONCENTRATION OF CREDIT RISK

Financial instruments, which potentially subject the Company to concentration of credit risk, consist principally of
temporary cash investments and trade receivables (including financing receivables). The Company places its temporary
cash investments with credit-worthy, high-quality financial institutions.

The Company’s customer base is concentrated in the healthcare industry. Customers are primarily located throughout the
United States. The Company requires no collateral or other security to support customer trade receivables. An allowance
for credit losses for trade receivables and an allowance for credit losses for financing receivables have been established for
potential credit losses based on historical collection experience.

The Company maintains its cash and cash equivalents in bank deposit accounts, which, at times, may exceed federally
insured limits. The Company has not experienced any losses in such accounts and does not believe it is exposed to any
significant credit risk on cash and cash equivalents.

11.

FINANCING RECEIVABLES

Short-Term Payment Plans

The Company provides fixed monthly payment arrangements ("short-term payment plans") over terms ranging from three
to twelve months for certain add-on software installations. As a practical expedient, we do not adjust the amount of
consideration recognized as revenue for the financing component as unearned income when we expect payment within one
year or less. These receivables, included in the current portion of financing receivables, were comprised of the following on
December 31, 2023 and 2022:

(In thousands)
Short-term payment plans, gross . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Less: allowance for credit losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Short-term payment plans, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

2023

2022

788 $
(39)
749 $

330
(16)
314

Long-Term Financing Arrangements

Additionally, the Company provides financing for purchases of its information and patient care systems to certain
healthcare providers under long-term financing arrangements expiring in various years through 2028. Under long-term
financing arrangements, the transaction price is adjusted by a discount rate that reflects market conditions and that would
be used for a separate financing transaction between the Company and licensee at contract inception, and takes into account
the credit characteristics of the licensee and market interest rates as of the date of the agreement. As such, the amount of
fixed fee revenue recognized at the beginning of the license term will be reduced by the calculated financing component.
As payments are received from the licensee, the Company recognizes a portion of the financing component as interest
income, reported as other income in the consolidated statements of operations. These receivables typically have terms from
two to seven years.

The decrease in long-term financing arrangement balances during 2023 is primarily a result of the continued evolution of
customer licensing preferences. Although the overwhelming majority of our historical EHR installations prior to 2019 were
made under a perpetual license model, the dramatic shift in customer preferences to a SaaS license model began during
2019 with 49% of the year's new acute care EHR installations being performed in a SaaS model, compared to only 12% in
2018. The shift in customer preference toward a SaaS model has since continued, with SaaS installations representing
approximately 63% of new acute care EHR installations in 2021, 100% in 2022 and 100% in 2023. Due to the nature of the
revenue recognition requirements for SaaS arrangements coupled with recurring monthly payments, these arrangements do
not give rise to long-term financing arrangements.

The components of these receivables were as follows on December 31, 2023 and 2022:

(In thousands)
Long-term financing arrangements, gross . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Less: allowance for credit losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Less: unearned income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Long-term financing arrangements, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

2023

2022

5,212 $
(377)
(361)
4,474 $

8,683
(533)
(678)
7,472

Future minimum payments to be received subsequent to December 31, 2023 are as follows:

(In thousands)
2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
2025 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2026 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2027 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2028 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Thereafter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total minimum payments to be received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Less: allowance for credit losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Less: unearned income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Receivables, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

3,157
1,793
178
40
36
8
5,212
(377)
(361)
4,474

Credit Quality of Financing Receivables and Allowance for Credit Losses

The following table is a roll-forward of the allowance for financing credit losses for the years ended December 31, 2023
and 2022:

(In thousands)
December 31, 2023 . . . . . . . . . . . . $
December 31, 2022 . . . . . . . . . . . . $

Beginning
Balance

Provision

Charge-offs

Recoveries

Ending
Balance

549 $
722 $

(133) $
(211) $

— $
38 $

— $
— $

416
549

The Company’s financing receivables are comprised of a single portfolio segment, as the balances are all derived from
short-term payment plan arrangements and long-term financing arrangements within our target market of community
hospitals. The Company evaluates the credit quality of its financing receivables based on a combination of factors,
including, but not limited to, customer collection experience, economic conditions, the customer’s financial condition, and
known risk characteristics impacting the respective customer base of community hospitals, the most notable of which relate
to enacted and potential changes in Medicare and Medicaid reimbursement rates as community hospitals typically generate
a significant portion of their revenues and related cash flows from beneficiaries of these programs. In addition to specific
account identification, the Company utilizes historical collection experience to establish the allowance for credit losses.
Financing receivables are written off only after the Company has exhausted all collection efforts.

Customer payments are considered past due if a scheduled payment is not received within contractually agreed upon terms.
To facilitate customer collection and credit monitoring efforts, financing receivable amounts are invoiced and reclassified
to trade accounts receivable when they become due, with all invoiced amounts placed on nonaccrual status. As a result, all
past due amounts related to the Company’s financing receivables are included in trade accounts receivable in the
accompanying consolidated balance sheets. The following is an analysis of the age of financing receivables amounts
(excluding short-term payment plans) that have been reclassified to trade accounts receivable and were past due as of
December 31, 2023 and 2022:

(In thousands)
December 31, 2023 . . . . . . . . . . . . . . . . . . . . . . . . . . $
December 31, 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . $

1 to 90 Days
Past Due

91 to 180 Days
Past Due

181 + Days
Past Due

Total
Past Due

857 $
1,086 $

231 $
278 $

323 $
283 $

1,411
1,647

From time to time, the Company may agree to alternative payment terms outside of the terms of the original financing
receivable agreement due to customer difficulties in achieving the original terms. In general, such alternative payment
arrangements do not result in a re-aging of the related receivables. Rather, payments pursuant to any alternative payment
arrangements are applied to the already outstanding invoices beginning with the oldest outstanding invoices as the
payments are received.

Because amounts are reclassified to trade accounts receivable when they become due, there are no past due amounts
included within the financing receivables or the financing receivables, current portion, net amounts in the accompanying
consolidated balance sheets.

The Company utilizes an aging of trade accounts receivable as the primary credit quality indicator for its financing
receivables, which is facilitated by the reclassification of customer payment amounts to trade accounts receivable when
they become due. The table below categorizes customer financing receivable balances (excluding short term payment
plans), none of which are considered past due, based on the age of the oldest payment outstanding that has been reclassified
to trade accounts receivable:

(In thousands)
Stratification of uninvoiced client financing receivables based on aging of related trade
accounts receivable:

December 31,
2023

December 31,
2022

Uninvoiced client financing receivables related to trade accounts receivable that
are 1 to 90 Days Past Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Uninvoiced client financing receivables related to trade accounts receivable that
are 91 to 180 Days Past Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Uninvoiced client financing receivables related to trade accounts receivable that
are 181+ Days Past Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total uninvoiced client financing receivables balances of clients with a trade accounts
receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Total uninvoiced client financing receivables of clients with no related trade accounts
receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total financing receivables with contractual maturities of one year or less . . . . . . . . . .

Less: allowance for credit losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total financing receivables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

1,068 $

3,876

1,720

965

1,369

1,894

3,753 $

7,139

1,098

788

(416)

5,223 $

866

330

(549)

7,786

12.

INTANGIBLE ASSETS AND GOODWILL

Our purchased definite-lived intangible assets as of December 31, 2023 and 2022 are summarized as follows:

Total

December 31, 2023

(In thousands)

Customer
Relationships

Trademark

Developed
Technology

Non-compete
Agreements

Total

Gross carrying amount, beginning
of period . . . . . . . . . . . . . . . . . . . . . . $

Intangible assets acquired . . . . . . . .

Accumulated amortization . . . . . . .

Accumulated impairment . . . . . . . . .
Held for sale . . . . . . . . . . . . . . . . . . .

Net intangible assets as of
December 31, 2023 . . . . . . . . . . . $

Weighted average remaining years
of useful life . . . . . . . . . . . . . . . . . . .

132,170 $

12,320 $

40,800 $

1,400 $

186,690

16,100

(63,686)

—
(8,735)

—

(6,974)

(2,342)
(3,004)

1,400

(29,934)

—
—

220

17,720

(522)

(101,116)

—
—

(2,342)
(11,739)

75,849 $

— $

12,266 $

1,098 $

89,213

December 31, 2022

(In thousands)

Customer
Relationships

Trademark

Developed
Technology

Non-compete
Agreements

Total

Gross carrying amount, beginning
of period . . . . . . . . . . . . . . . . . . . . . $

112,570 $

12,320 $

37,600 $

— $

162,490

Intangible assets acquired . . . . . . . .

Accumulated amortization . . . . . . . .

19,600

(52,371)

—

(6,076)

3,200

(26,010)

1,400

(233)

24,200

(84,690)

Net intangible assets as of
December 31, 2022 . . . . . . . . . . . $

79,799 $

6,244 $

14,790 $

1,167 $

102,000

During the fourth quarter of 2023, the Company committed to the Company-wide rebranding and legal entity consolidation
initiative that culminated in the change of the Company’s corporate name to “TruBridge, Inc.” on March 4, 2024. As a
result of this initiative, it was expected that certain of the Company’s brand names and related trademarks would cease to
be used, resulting in total trademark impairment recorded during the year ended December 31, 2023 of $2.3 million. Of
the total trademark impairment charge, $1.0 million is derived from our RCM segment, $1.2 million is derived from our
EHR segment, and $0.1 million is derived from our Patient Engagement segment.

The following table represents the remaining amortization of definite-lived intangible assets as of December 31, 2023:

(In thousands)

For the year ended December 31,

2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

2025 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2026 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2027 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2028 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Due thereafter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

12,506

12,191

11,516

10,496

10,203

32,301

89,213

The following table sets forth the change in the carrying amount of goodwill by segment for the years ended December 31,
2023, 2022, and 2021:

(In thousands)

RCM

EHR

Patient
engagement

Total

Balance as of December 31, 2021 . . . . . . . . . . . . . . . . . . . . $

41,281 $

126,665 $

9,767 $

177,713

Goodwill acquired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Balance as of December 31, 2022 . . . . . . . . . . . . . . . . . . . .

Goodwill acquired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Goodwill impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Held for sale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20,540

61,821

17,263

—

20,540

126,665

9,767

198,253

—

(28,307)

(7,694)

—

(7,606)

17,263

(35,913)

(7,694)

Balance as of December 31, 2023 . . . . . . . . . . . . . . . . . . . . $

79,084 $

90,664 $

2,161 $

171,909

Our reporting units assessed for impairment of goodwill include: RCM (formerly the “TruBridge” reporting unit), Acute
Care EHR, Post-acute care EHR (comprised solely of AHT, which was disposed in January 2024), and Patient Engagement
(formerly a component of our former “TruBridge” reporting unit). We did not identify any events or circumstances that
would require interim goodwill impairment testing prior to October 1, 2023. Based on our quantitative assessment as of
October 1, 2023, we determined that there was no impairment of goodwill for our RCM reporting unit. However,
quantitative evaluations of the fair values of each of our remaining three reporting units, using a combination of the income
and market valuation approaches, resulted in impairment conclusions as follows:

•

Our Acute Care EHR reporting unit was assessed goodwill impairment charges of $6.4 million due to deteriorating
market conditions, the related impact to the cost of capital, and lowered expectations regarding long-term margin
potential.

Our Post-acute care EHR reporting unit was assessed goodwill impairment charges of $2.2 million due to deteriorating
market conditions, the related impact to the cost of capital, and revised expectations regarding the long-term
persistence of elevated customer attrition levels.

Our Patient Engagement reporting unit was assessed goodwill impairment charges of $7.6 million due to deteriorating
market conditions, the related impact to the cost of capital, and revised expectations regarding long-term growth
prospects as sales pipelines have been stubborn to develop to the robust levels previously anticipated.

this updated quantitative goodwill impairment analysis, management concluded that there was no further impairment to
goodwill.

We determined there was no impairment to goodwill as of December 31, 2022 or 2021.

13.

LONG-TERM DEBT

Long-term debt was comprised of the following at December 31, 2023 and 2022:

(In thousands)

December 31, 2023

December 31, 2022

Term loan facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

63,875

Revolving credit facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Debt obligations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less: debt issuance costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Debt obligation, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less: current portion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

135,723

199,598

(1,187)

198,411

(3,141)

Long-term debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

195,270

67,375

73,700

141,075

(1,546)

139,529

(3,141)

136,388

As of December 31, 2023, the carrying value of debt approximates the fair value due to the variable interest rate which
reflects market rates. The interest rate for the outstanding debt under our term loan facility and revolving credit facility as
of December 31, 2023 was 8.48%.

Credit Agreement

In conjunction with our acquisition of Healthland Holding Inc. in January 2016, we entered into a syndicated credit
agreement with Regions Bank ("Regions") serving as administrative agent, which provided for a $125 million term loan
facility and a $50 million revolving credit facility. On June 16, 2020, we entered into an Amended and Restated Credit
Agreement that increased the aggregate principal amount of our credit facilities to $185 million, including a $75 million
term loan facility and a $110 million revolving credit facility. On May 2, 2022, we entered into a First Amendment (the
"First Amendment") to the Amended and Restated Credit Agreement, that increased the aggregate principal amount of our
credit facilities to $230 million, which includes a $70 million term loan facility and a $160 million revolving credit facility.
In addition, the interest rate provisions of the First Amendment reflect the transition from the London Interbank Offered
Rate ("LIBOR") to the Secured Overnight Financing Rate ("SOFR") as the new benchmark interest rate for each loan.

Each of our credit facilities continues to bear interest at a rate per annum equal to an applicable margin plus, at our option,
either (1) the Adjusted SOFR rate for the relevant interest period, subject to a floor of 0.50%, (2) an alternate base rate
determined by reference to the greater of (a) the prime lending rate of Regions, (b) the federal funds rate for the relevant
interest period plus one half of one percent per annum and (c) the one month SOFR rate, subject to the aforementioned
floor, plus one percent per annum, or (3) a combination of (1) and (2). The applicable margin for SOFR loans and the
letter of credit fee ranges from 1.8% to 3.0%. The applicable margin range for base rate loans ranges from 0.8% to 2.0%, in
each case based on the Company's consolidated net leverage ratio.

Principal payments with respect to the term loan facility are due on the last day of each fiscal quarter beginning June 30,
2022, with quarterly principal payments of approximately $0.9 million through March 31, 2027, with maturity on May 2,
2027 or such earlier date as the obligations under the Amended and Restated Credit Agreement, as amended by the First
Amendment, become due and payable pursuant to the terms of such agreement. Any principal outstanding under the
revolving credit facility is due and payable on the maturity date.

Anticipated annual future maturities of the term loan facility and revolving credit facility are as follows as of December 31,
2023:

2026 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2027 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thereafter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,500

189,098

—

199,598

Our credit facilities are secured pursuant to the Amended and Restated Credit Agreement, dated as of June 16, 2020,
among the parties identified as obligors therein and Regions, as collateral agent, on a first priority basis by a security
interest in substantially all of the tangible and intangible assets (subject to certain exceptions) of the Company and certain
subsidiaries of the Company, as guarantors (collectively, the “Subsidiary Guarantors”), including certain registered
intellectual property and the capital stock of certain of the Company’s direct and indirect subsidiaries. Our obligations
under the Amended and Restated Credit Agreement are also guaranteed by the Subsidiary Guarantors.

As of September 30, 2023, we were not in compliance with the fixed charge coverage ratio required by the Amended and
Restated Credit Agreement. On November 8, 2023, the Company and the subsidiary guarantors entered into a Waiver with
Regions Bank, as administrative agent, and various other lenders, which provided for a one-time waiver of this failure as an
event of default. As of December 31, 2023, the Company was similarly not in compliance with the fixed charge coverage
ratio required by the Amended and Restated Credit Agreement, and a one-time waiver was provided in conjunction with
the Fourth Amendment to the Amended and Restated Credit Agreement. Any failure by us to comply with this or another
covenant in the future may result in an event of default. There can be no assurance that we will be able to continue to
comply with this covenant or obtain amendments to avoid future covenant violations, or that such amendments will be
available on commercially acceptable terms.

The First Amendment removed the requirement that the Company mandatorily prepay the credit facilities with excess cash
flow generated during the prior fiscal year. The Company is permitted to voluntarily prepay the credit facilities at any time
without penalty, subject to customary “breakage” costs with respect to prepayments of SOFR rate loans made on a day
other than the last day of any applicable interest period.

See Note 19 - Subsequent Events for disclosures related to the Third and Fourth Amendments to the Amended and
Restated Credit Agreement, effective January 16, 2024 and February 29, 2024, respectively.

14.

BENEFIT PLANS

In January 1994, the Company adopted the CPSI 401(k) Retirement Plan that covers all eligible employees of the
Company. The plan allows eligible employees to contribute up to 60% of their pre-tax earnings up to the statutory limit
prescribed by the Internal Revenue Service. The Company matches a discretionary amount determined by the Board of
Directors. The Company contributed approximately $3.8 million, $3.5 million, and $3.2 million to the plan for the years
ended December 31, 2023, 2022 and 2021, respectively.

15.

OPERATING LEASES

The Company leases office space in various locations in Alabama, Pennsylvania, Minnesota, Maryland, Mississippi and
Washington. These leases have terms expiring from 2024 through 2030 but do contain optional extension terms. Leases
with an initial term of 12 months or less are not recorded on the balance sheet. We recognize lease expense on a straight-
line basis over the lease term.

On July 28, 2021, the Company terminated its lease agreement for approximately 45,000 square feet of office space in
Fairhope, Alabama. Pursuant to a Termination of Lease Agreement dated July 28, 2021, the Company paid $0.9 million to
the landlord as consideration for the early termination. In connection with the lease termination, the Company
derecognized the assets and liabilities associated with the operating lease and recorded a $0.3 million loss on the disposal
of leasehold improvements. On April 30, 2023, the company terminated its lease agreement for approximately 12,500
square feet of office space in Plymouth, Minnesota. Pursuant to a Termination of Lease Agreement dated April 18, 2023,
the Company paid $1.1 million to the landlord as consideration for the early termination. In connection with the lease
termination, the Company derecognized the assets and liabilities associated with the operating lease and recorded a
$0.1 million loss on the disposal of leasehold improvement.

Supplemental balance sheet information related to operating leases is as follows:

(In thousands)

Operating lease assets:

December 31,
2023

Operating lease assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

5,192

Operating lease liabilities:

Other accrued liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operating lease liabilities, net of current portion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total operating lease liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

1,804

3,074

4,878

Weighted average remaining lease term in years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Weighted average discount rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2%

Because our leases do not provide an implicit rate, we use our incremental borrowing rate based on the information
available at the lease commencement date in determining the present value of lease payments. We used the incremental
borrowing rate on January 1, 2019, for operating leases that commenced prior to that date.

The future minimum lease payments payable under these operating leases subsequent to December 31, 2023 are as follows:

(In thousands)
2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
2025 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2026 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2027 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2028 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Thereafter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total lease payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Less imputed interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

1,804
1,063
1,025
706
462
231
5,291
(413)
4,878

Total rent expense for the years ended December 31, 2023, 2022, and 2021 was $1.8 million, $2.2 million, and
$1.8 million, respectively.

Total cash paid for amounts included in the measurement of lease liabilities within operating cash flows from operating
leases for the year ended December 31, 2023, 2022, and 2021 was $1.8 million, $2.2 million, and $1.8 million,
respectively.

16.

COMMITMENTS AND CONTINGENCIES

From time to time, the Company is involved in routine litigation that arises in the ordinary course of business. Management
does not believe it is reasonably possible that such matters will have a material adverse effect on the Company’s financial
statements. The Company recorded a liability of $1.0 million related to contingent consideration for Viewgol's former
equity holders as of December 31, 2023.

17.

FAIR VALUE

ASC 820, Fair Value Measurements and Disclosures, establishes a framework for measuring fair value and expands
financial statement disclosures about fair value measurements. Fair value is the price that would be received to sell an asset
or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an
orderly transaction between market participants at the measurement date. The Codification topic does not require any new
fair value measurements, but rather applies to all other accounting pronouncements that require or permit fair value
measurements. The Codification topic requires that assets and liabilities carried at fair value be classified and disclosed in
one of the following three categories:

Level 1: Quoted market prices in active markets for identical assets or liabilities.

Level 2: Observable market-based inputs or unobservable inputs that are corroborated by market data.

Level 3: Unobservable inputs that are not corroborated by market data.

As of December 31, 2023, we measured the fair value of contingent consideration that represents the potential earnout
incentive for Viewgol’s former equity holders. We estimated the fair value of the contingent consideration based on the
probability of Viewgol meeting EBITDA targets (subject to certain pro-forma adjustments). We did not have any other
instruments that required fair value measurement as of December 31, 2023.

The following table summarizes the carrying amount and fair value of the contingent consideration at December 31, 2023:

Fair Value at December 31, 2023 Using

Carrying
Amount at
12/31/23

Quoted Price in
Active Markets
for Identical
Assets (Level 1)

Significant Other
Observable
Inputs (Level 2)

Significant
Unobservable
Inputs (Level 3)

(In thousands)

Description

Contingent consideration . $

Total . . . . . . . . . . . . . . . . . $

1,044 $

— $

1,044

As of December 31, 2022, we did not have any instruments that required fair value measurement.

18. SEGMENT REPORTING

Our chief operating decision makers ("CODM") previously utilized the following three operating segments, "Acute Care
EHR", "Post-acute care EHR" and "TruBridge". However, in the fourth quarter of 2022, the Company made a number of
changes to its organizational structure and management system to better align the Company's operating model to its
strategic initiatives. As a result of these changes, the Company revised its operating segments. The new operating and
reportable segments, based on our three distinct business units with unique market dynamics and opportunities, are RCM,
EHR, and "Patient Engagement". These segments represent the components of the Company for which separate financial
information is available that is utilized on a regular basis by the CODM in assessing segment performance and in allocating
the Company's resources. Management evaluates the performance of the segments based on revenues and adjusted
EBITDA. The Company previously evaluated the performance of the segments based on segment gross profit.
Management believes adjusted EBITDA is a useful measure to assess the performance and liquidity of the Company as it
provides meaningful operating results by excluding the effects of expenses that are not reflective of its operating business
performance. Our CODM group is comprised of the Chief Executive Officer, Chief Operating Officer, and Chief Financial
Officer. Accounting policies for each of the reportable segments are the same as those used on a consolidated basis. The
segment disclosures below for the years ended December 31, 2022, and 2021 have been recast to conform to the current
year presentation.

Adjusted EBITDA consists of GAAP net income (loss) as reported and adjusts for (i) deferred revenue purchase
accounting adjustments arising from purchase allocation adjustments related to business acquisitions; (ii) depreciation
expense; (iii) amortization of software development costs; (iv) amortization of acquisition-related intangible assets; (v)
stock-based compensation; (vi) severance and other non-recurring charges; (vii) interest expense and other, net; (viii)
impairment of goodwill; (ix) impairment of trademark intangibles; (x) gain on contingent consideration; and (xi) the
provision (benefit) for income taxes. There are no intersegment revenues to be eliminated in computing segment revenue.

The following table presents a summary of the revenues and adjusted EBITDA of our three operating segments for the
years ended December 31, 2023, 2022, and 2021:

(In thousands)

Revenues:

Year Ended December 31,

2023

2022

2021

RCM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

193,929

179,870

131,242

EHR

Recurring revenue

Acute Care EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Post-acute Care EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Total recurring EHR revenues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-recurring revenue

Acute Care EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Post-acute Care EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Total non-recurring EHR revenues . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111,276

14,712

125,988

10,657
1,418

12,075

$
$

Total EHR revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

138,063

Patient engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,443

$
$

109,340

15,384

124,724

13,138
1,961

15,099

139,823

6,955

108,440

16,472

124,912

16,939
1,258

18,197

143,109

6,278

Total revenues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

339,435

326,648

280,629

Adjusted EBITDA by Segment:

RCM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24,800

22,900

(124)

35,219

22,507

(1,827)

28,265

26,505

(2,093)

Total adjusted EBITDA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

47,576

55,899

52,677

100

The following table reconciles net income to adjusted EBITDA:

(In thousands)

Year Ended December 31,

2023

2022

2021

Net income (loss), as reported . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

(45,789) $

15,867

18,430

Deferred revenue and other acquisition-related adjustments . . . . . . . . .

Depreciation expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amortization of software development costs . . . . . . . . . . . . . . . . . . . . .

Amortization of acquisition-related intangibles . . . . . . . . . . . . . . . . . . .

Stock-based compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Severance and other non-recurring charges . . . . . . . . . . . . . . . . . . . . . .

Interest expense and other, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Impairment of goodwill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Impairment of trademark intangibles . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gain on contingent consideration . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

—

1,946

8,096

16,426

3,271

22,186

11,776

35,913

2,342

—

Provision (benefit) for income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . .

(8,591)

109

2,443

3,484

17,403

5,173

4,504

5,267

—

(565)

2,214

747

2,156

931

13,786

5,457

4,892

1,632

—

4,646

Total adjusted EBITDA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

47,576

55,899

52,677

19.

SUBSEQUENT EVENTS

Sale of American HealthTech, Inc.

On January 16, 2024, we entered into a Stock Purchase Agreement (the “Purchase Agreement”), by and among the
Company, PointClickCare Technologies USA Corp., a Delaware corporation (“Buyer”), Healthland Inc., a Minnesota
corporation and an indirect, wholly-owned subsidiary of the Company (“Healthland” and, together with the Company, the
“Seller Parties”) and American HealthTech, Inc., a Mississippi corporation (“AHT”). The Transaction (hereinafter defined)
also closed on January 16, 2024. Under the Purchase Agreement, Buyer purchased from Healthland all of the issued and
outstanding capital stock of AHT (the “Transaction”), with AHT becoming a wholly-owned subsidiary of Buyer. Prior to
this transaction, results for AHT were reported within our EHR operating segment.

The Purchase Agreement provides for an aggregate purchase price (the “Purchase Price”) of $25 million (the “Base Cash
Consideration”), subject to adjustments based on working capital, cash, indebtedness and transaction expenses of American
HealthTech. Additionally, pursuant to the Purchase Agreement, a total of approximately $3.75 million was withheld from
the Base Cash Consideration at the closing and deposited by Buyer into various escrow accounts with an escrow agent,
including $2.5 million as a general indemnity escrow and $1 million as a special indemnity escrow. Based upon the
adjustments and the various escrow holdbacks, Buyer paid a net amount of approximately $21.41 million to Healthland at
the closing. The Purchase Price is subject to a post-closing true-up. In connection with the closing of the Transaction,
Buyer has provided offers of employment to certain key employees of the Company that primarily supported AHT’s
business.

The Purchase Agreement contains customary representations, warranties and covenants. The representations and warranties
made by the Seller Parties to Buyer cover a broad range of items related to, among other things, the business and financial
condition of AHT. Subject to certain exceptions and limitations, the Seller Parties have agreed to indemnify Buyer for
certain breaches of representations, warranties and covenants and certain other enumerated items. Such limitations on the
Seller Parties’ indemnification obligations are subject to various exceptions for certain fundamental representations, tax
representations, special representations, and fraud. Subject to certain exceptions and limitations, Buyer has likewise agreed
to indemnify the Seller Parties for certain breaches of representations, warranties and covenants and certain other
enumerated items.

The company is currently finalizing the accounting for the sale but does not expect a material gain or loss to be recorded.
The accompanying consolidated balance sheet as of December 31, 2023 includes amounts related to this Transaction under
the captions "Assets of held for sale disposal group" and "Liabilities of held for sale disposal group", the details of which
are as follows as of December 31, 2023:

101

(In thousands)

Assets of held for sale disposal group

Accounts receivable, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

3,087

Financing receivables , net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prepaid expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Software costs, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intangibles, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Goodwill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Liabilities of held for sale disposal group

Accounts payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Other accrued liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deferred tax liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

3,386

11,739

7,694

25,977

178

576

223

977

Credit Facility Third Amendment

On January 16, 2024, the Company entered into a Third Amendment (the “Third Amendment”) to the Amended and
Restated Credit Agreement, dated as of June 16, 2020 (as amended, the “Credit Agreement”), by and among the Company;
certain subsidiaries of the Company, as guarantors (collectively, the “Subsidiary Guarantors”); Regions Bank, as
administrative agent and collateral agent; and various other lenders from time to time. Capitalized terms used but not
defined herein shall have the meanings ascribed to them in the Credit Agreement.

The Third Amendment modified the term “Consolidated EBITDA” to provide that the following amounts will be added
back to Consolidated Net Income: (i) the reasonably expected value of all earn-out consideration in connection with any
Permitted Acquisition, provided that the aggregate amount of fees and out-of-pocket expenses incurred in connection with
anticipated Permitted Acquisitions which are not consummated during any period of four fiscal quarters ending on or after
the Closing Date will not exceed the greater of $7 million and 10% of Consolidated EBITDA; (ii) any fees, costs or
expenses related to the implementation of cost savings, operating expense reductions and synergies related to Permitted
Acquisitions, restructurings and other initiatives; and (iii) costs and expenses related to the previously disclosed U.S.
Securities and Exchange Commission investigation that occurred during the fiscal year ended December 31, 2023, in an
aggregate amount not to exceed $1.25 million. Additionally, the Third Amendment (y) removed from the maximum
aggregate amount of fees and expenses that can be added back to Consolidated Net Income any losses resulting from any
Asset Sales or Involuntary Disposition and (z) increased the maximum amount of fees and expenses that can be added back
to Consolidated Net Income related to savings initiatives, Equity Transactions, the incurrence of Indebtedness and
amendments to the Credit Documents from 10% to 15% of Consolidated EBITDA (determined prior to giving effect to
such adjustments).

The Company’s obligations under the Credit Agreement continue to be secured pursuant to the Amended and Restated
Pledge and Security Agreement, dated as of June 16, 2020, by and among the parties identified as Obligors therein and
Regions Bank, as collateral agent, on a first priority basis by a security interest in substantially all of the tangible and
intangible personal assets (subject to certain exceptions) of the Company and the Subsidiary Guarantors, including certain
registered intellectual property and the capital stock of certain of the Company’s direct and indirect subsidiaries. The
Company’s obligations under the Credit Agreement also continue to be guaranteed by the Subsidiary Guarantors,
excluding American HealthTech, which has been released from its obligations as a Subsidiary Guarantor in connection
with the closing of the Transaction.

Credit Facility Fourth Amendment

On February 29, 2024, the Company entered into a Fourth Amendment (the “Fourth Amendment”) to the Credit
Agreement, by and among the Company; the Subsidiary Guarantors; the Administrative Agent; and various other lenders.
Capitalized terms used but not defined herein shall have the meanings ascribed to them in the Credit Agreement.

102

The Fourth Amendment modified the term “Consolidated EBITDA” to provide that the additional following amounts will
be added back to Consolidated Net Income: (i) costs and expenses related to the voluntary early retirement program during
the fiscal year ending December 31, 2023; and (ii) fees, costs and expenses in categories identified to the Administrative
Agent to the extent incurred during the fiscal year ending December 31, 2024, in an aggregate amount not to exceed
$7.25 million. Additionally, the modified definition of “Consolidated EBITDA” limits the amount of pro forma “run rate”
cost savings, operating expense reductions and synergies (collectively, “Savings”) related to the Viewgol Acquisition that
can be added back to Consolidated Net Income to an aggregate amount not to exceed $6.6 million; however, Savings
related to the Viewgol Acquisition are not subject to the cap of 15% of Consolidated EBITDA that otherwise applies to
Savings related to Permitted Acquisitions, restructurings or cost savings initiatives.

Finally, the Consolidated Fixed Charge Coverage Ratio covenant was decreased from 1.25:1.00 to 1.15:1.00 for each fiscal
quarter ending March 31, 2024 through and including December 31, 2024. As of December 31, 2023, the Company was
not in compliance with the Consolidated Fixed Charge Coverage Ratio required by the Credit Agreement, and the Fourth
Amendment provides for a one-time waiver of this failure as an event of default.

Corporate Name Change and Rebranding

The Company changed its corporate name to “TruBridge, Inc.” on March 4, 2024. Contemporaneous with this name
change, the former wholly-owned subsidiaries Evident, LLC, TruBridge, LLC, and TruCode, LLC were merged into the
parent company, while the former wholly-owned subsidiary Rycan Technologies, Inc. was merged into its parent and
another wholly-owned subsidiary, Healthland Holding Inc. With these changes, the Company's remaining legal structure
includes TruBridge, Inc., the parent company, with Viewgol, LLC ("Viewgol"), iNetXperts, Corp. d/b/a Get Real Health,
Healthcare Resource Group, Inc. ("HRG"), and Healthland Holding Inc. as its wholly-owned subsidiaries.

103

SCHEDULE II
TRUBRIDGE, INC.
VALUATION AND QUALIFYING ACCOUNTS
(In thousands)

Description
Allowance for credit losses deducted
from accounts receivable in the balance
sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Balance at
beginning of
period

Additions
charged to cost
and expenses (1)

Deductions (2)

Balance at end
of period

2021 $
2022 $
2023 $

1,701 $
1,826 $
2,854 $

2,111 $
1,203 $
2,053 $

(1,986) $
(175) $
(879) $

1,826
2,854
4,028

(1) Adjustments to allowance for change in estimates.
(2) Uncollectible accounts written off, net of recoveries.

Description
Allowance for credit losses deducted
from financing receivables in the
balance sheet . . . . . . . . . . . . . . . . . . . . .

Balance at
beginning of
period

Additions
charged to cost
and expenses (1)

Deductions (2)

Balance at end
of period

2021 $
2022 $
2023 $

1,489 $
722 $
549 $

481 $
(211) $
(133) $

(1,248) $
38 $
— $

722
549
416

(1) Adjustments to allowance for change in estimates.
(2) Uncollectible accounts written off, net of recoveries.

ITEM 9.

None.

CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND
FINANCIAL DISCLOSURE

ITEM 9A.

CONTROLS AND PROCEDURES.

Evaluation of Disclosure Controls and Procedures

We maintain disclosure controls and procedures that are designed to provide reasonable assurance that the information required
to be disclosed by us in reports that we file or submit under the Securities Exchange Act of 1934, as amended (the "Exchange
Act"), is recorded, processed, summarized and reported within the time periods specified in the rules and forms promulgated by
the Securities and Exchange Commission, and that such information is accumulated and communicated to our management,
including our Chief Executive Officer and Chief Financial Officer, as appropriate to allow timely decisions regarding required
disclosure. Because of the inherent limitations to the effectiveness of any system of disclosure controls and procedures, no
evaluation of disclosure controls and procedures can provide absolute assurance that all control issues and instances of fraud, if
any, within a company have been prevented or detected on a timely basis. Even disclosure controls and procedures determined
to be effective can only provide reasonable assurance that their objectives are achieved.

As of the end of the period covered by this report, we carried out an evaluation, under the supervision and with the participation
of our management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of the design and
operation of our disclosure controls and procedures (as defined in Exchange Act Rule 13a-15(e)) pursuant to Rule 13a-15 of the
Exchange Act. Based upon that evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our
disclosure controls and procedures are effective at the reasonable assurance level.

Changes in Internal Control over Financial Reporting

On October 16, 2023, we acquired Viewgol, LLC (“Viewgol”), as further described in Note 3 to the consolidated financial
statements. We continue to integrate policies, processes, people, technology and operations for our combined operations, and
will continue to evaluate the impact of any related changes to internal controls over financial reporting during the fiscal year.

104

As reported in our Quarter Report on Form 10-Q for the period ended September 30, 2023, we identified a material weakness in
our internal control over financial reporting, as our controls over debt covenant monitoring and compliance were not operating
with sufficient precision and timeliness. As of December 31, 2023, this weakness had been remediated with more robust and
timely review controls around the related covenant calculations. Other than the remediation of this previously identified
material weakness, there were no changes in the Company’s internal control over financing reporting (as defined in Exchange
Act Rule 13a-15(f)) during the quarter ended December 31, 2023 that have materially affected, or are reasonably likely to
materially affect, the Company’s internal control over financial reporting.

Management’s Annual Report on Internal Control Over Financial Reporting

This report is included in Item 8 on page 64 and is incorporated herein by reference.

Report of Independent Registered Public Accounting Firm on Internal Control Over Financial Reporting

This report is included in Item 8 on page 65 and is incorporated herein by reference.

ITEM 9B.

OTHER INFORMATION.

(a) None.

(b) Rule 10b5-1 Trading Arrangements

From time to time, members of the Company's Board of Directors and officers of the Company may enter into Rule 10b5-1
trading plans, which allow for the purchase or sale of common stock under pre-established terms at times when directors and
officers might otherwise be prevented from trading under insider trading laws or because of self-imposed blackout periods.
Such trading plans are intended to satisfy the affirmative defense conditions of Rule 10b5-1(c) under the Exchange Act and
comply with the Company's insider trading policy. During the three months ended December 31, 2023, none of the Company’s
directors or officers adopted or terminated a “Rule 10b5-1 trading arrangement” or a “non-Rule 10b5-1 trading arrangement,”
as each term is defined in Item 408 of Regulation S-K.

ITEM 9C.

DISCLOSURE REGARDING FOREIGN JURISDICTIONS THAT PREVENT INSPECTIONS.

None.

105

ITEM 10.

DIRECTORS, EXECUTIVE OFFICERS AND CORPORATE GOVERNANCE

PART III

We have adopted a Code of Business Conduct and Ethics applicable to all of our directors, officers (including our Chief
Executive Officer and senior financial officers) and employees which also includes a separate code of ethics with additional
guidelines and responsibilities applicable to our Chief Executive Officer and senior financial officers, known as the Code of
Ethics for CEO and Senior Financial Officers. Copies of the Code of Business Conduct and Ethics and the Code of Ethics for
CEO and Senior Financial Officers are available on TruBridge’s web site at www.trubridge.com in the "Corporate Information"
section under "Corporate Governance."

Other information required by this Item regarding executive officers is included in Part I of this Form 10-K under the caption
"Executive Officers" in accordance with Instruction 3 to Paragraph (b) of Item 401 of Regulation S-K.

Other information required by this Item is incorporated by reference pursuant to General Instruction G(3) of Form 10-K from
TruBridge’s definitive Proxy Statement for the 2024 Annual Meeting of Stockholders (the "2024 Proxy Statement") to be filed
with the Securities and Exchange Commission pursuant to Regulation 14A.

ITEM 11.

EXECUTIVE COMPENSATION

The information required by this Item is incorporated by reference pursuant to General Instruction G(3) of Form 10-K from the
2024 Proxy Statement to be filed with the Securities and Exchange Commission pursuant to Regulation 14A.

106

ITEM 12.

SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND
RELATED STOCKHOLDER MATTERS

Securities Authorized for Issuance Under Equity Compensation Plans

The following table summarizes the securities that have been authorized for issuance as of December 31, 2023 under our
Amended and Restated 2019 Incentive Plan (the “2019 Plan”), which was previously approved by our stockholders. The 2019
Plan is described in Note 9 to the consolidated financial statements included in Item 8 to this Form 10-K.

Number of
securities to be
issued upon
exercise of
outstanding
options, warrants
and rights
(a)
273,791 (1)

None

273,791 (1)

Weighted-average
exercise price of
outstanding
options, warrants
and rights

(b)
N/A

None

N/A

Number of securities
remaining available for
future issuance under
equity compensation
plans (excluding
securities reflected in
column (a))
(c)
805,771 (2)

None

805,771 (2)

Plan Category
Equity compensation plans approved by stockholders . .
Equity compensation plans not approved by
stockholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1) Represents 273,791 target performance share awards outstanding under the 2019 Plan as of December 31, 2023. The
number of shares of common stock earned and issuable under each performance share award will be determined at the end of a
three-year performance period, based on the Company's achievement of performance goals predetermined by the Compensation
Committee of the Board of Directors. Does not include 343,315 time-based restricted stock awards outstanding under the 2019
Plan as of December 31, 2023.

(2) Represents shares of common stock issuable pursuant to the 2019 Plan, assuming maximum payout of performance share
awards outstanding as of December 31, 2023.

The additional information required by this Item is incorporated by reference pursuant to General Instruction G(3) of Form 10-
K from the 2024 Proxy Statement to be filed with the Securities and Exchange Commission pursuant to Regulation 14A.

ITEM 13.

CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS, AND DIRECTOR
INDEPENDENCE

ITEM 14.

PRINCIPAL ACCOUNTANT FEES AND SERVICES

107

ITEM 15.

EXHIBITS AND FINANCIAL STATEMENT SCHEDULES

PART IV

(a)(1) and (2) and (c) – Financial Statements and Financial Statement Schedules.

Financial Statements: The Financial Statements and related Financial Statements Schedule of TruBridge are included herein in
Part II, Item 8.

(a)(3) and (b) – Exhibits.

The exhibits listed on the Exhibit Index beginning on page 110 of this Annual Report on Form 10-K are filed herewith or are
incorporated herein by reference.

ITEM 16.
None.

FORM 10-K SUMMARY

SIGNATURES

Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this
report to be signed on its behalf by the undersigned, thereunto duly authorized, on this the 15th day of March, 2024.

TRUBRIDGE, INC.

By:

/s/ Christopher L. Fowler

Christopher L. Fowler

President and Chief Executive Officer

Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been signed below by the following
persons on behalf of the registrant and in the capacities and on the dates indicated.

108

Name

/s/ Christopher L. Fowler
Christopher L. Fowler

/s/ Vinay Bassi
Vinay Bassi

/s/ David A. Dye
David A. Dye

/s/ Lance Park
Lance Park

/s/ Glenn P. Tobin
Glenn P. Tobin

/s/ Mark V. Anquillare
Mark V. Anquillare
/s/ Regina M. Benjamin
Regina M. Benjamin

/s/ Christopher T. Hjelm
Christopher T. Hjelm

/s/ Charles P. Huffman
Charles P. Huffman

/s/ Denise W. Warren
Denise W. Warren

Title

Date

President, Chief Executive Officer and Director

March 15, 2024

(principal executive officer)

Chief Financial Officer, Treasurer and Secretary

March 15, 2024

(principal financial officer)

Chief Operating Officer and Director

March 15, 2024

Vice President – Finance and Controller

(principal accounting officer)

Chairperson of the Board

Director

March 15, 2024

109

This page intentionally left blank.

DIRECTORS AND OFFICERS

Board of Directors

Glenn P. Tobin, Ph.D.
Chairman
Retired Executive
Vice President
The Advisory Board Company

Chris L. Fowler
President and Chief
Executive Officer
TruBridge, Inc.

David A. Dye
Chief Operating Officer
TruBridge, Inc.

Mark V. Anquillare
Retired President and
Chief Operating Officer
Verisk Analytics

Officers

Regina Benjamin, MD
Chief Executive Officer
Bayou La Batre Rural Health Clinic

Christopher L. Fowler
President and
Chief Executive Officer

Christopher T. Hjelm
Retired Executive Vice President
and Chief Information Officer
The Kroger Company

Charles P. Huffman
Retired Executive Vice President
and Chief Financial Officer
EnergySouth, Inc.

Denise Warren
Retired Executive Vice President
and Chief Operating Officer
WakeMed Health & Hospitals

David A. Dye
Chief Operating Officer

Vinay Bassi
Chief Financial Officer

Dawn M. Severance
Chief Sales Officer

Kevin Plessner
General Counsel

Wes D. Cronkite
Chief Technology and
Innovation Officer

Stock Performance Graph
The following graph sets forth the cumulative total return (assuming reinvestment of dividends) to our stockholders
during the period beginning December 31, 2018, and ending on December 31, 2023, compared to an overall stock
market index (S&P 500 Index) and the S&P 600 Health Care Equipment & Services Index.

$350

$250

$200

$150

$100

$50

12/18

12/19

TruBridge, Inc.

12/20

S&P 500

12/21

12/22

12/23

S&P 600 Health Care Equipment & Services

TruBridge, Inc.
S&P 500
S&P 600 Health Care Equipment & Services

$ 100.00
$ 100.00
$ 100.00

$ 106.79
$ 131.49
$ 113.20

$ 109.83
$ 155.68
$ 140.30

$ 119.89
$ 200.37
$ 154.71

$ 111.38
$ 164.08
$ 119.49

$ 45.83
$ 207.21
$ 116.51

12/18

12/19

12/20

12/21

12/22

12/23

*$100 invested on 12/31/18 in stock or index, including reinvestment of dividends. Fiscal year ending December 31.

CORPORATE DATA

Independent Registered Public Accounting Firm
Grant Thornton LLP
1100 Peachtree Street, Suite 1200
Atlanta, GA 30309

Transfer Agent
Computershare
462 South 4th Street, Suite 1600
Louisville, KY 40202
Shareholder Services: (800) 736-3001
www.computershare.com

Legal Counsel
Maynard Nexsen PC
1901 Sixth Avenue North, Suite 1700
Birmingham, AL 35203-2618
(205) 254-1000
www.maynardnexsen.com

Corporate Headquarters
TruBridge, Inc.
54 St. Emanuel Street
Mobile, AL 36602
(251) 639-8100
www.trubridge.com

Common Stock
TruBridge, Inc.’s common stock is traded on The
NASDAQ Stock Market’s Global Select Market under
the symbol “TBRG.”

54 St. Emanuel Street
Mobile, Alabama 36602