You should read the following discussion of our financial condition and results of operations in conjunction with our financial statements and the related notes and other financial information included elsewhere in this Annual Report on Form 10-K ("Form 10-K").
The following discussion and analysis also includes discussion of certain non-GAAP financial measures. For a description and reconciliation of the non-GAAP measures discussed in this section, see "Non-GAAP Financial Measures" below.
This Form 10-K contains "forward-looking statements". These statements are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Forward-looking statements are neither historical facts nor assurances of future performance. Instead, they are based on our current beliefs, expectations and assumptions regarding the future of our business, future plans and strategies and other future conditions. Such forward-looking statements may include, without limitation, statements about future opportunities for us and our products and services, our future operations, financial or operating results, anticipated business levels, future earnings, planned activities, anticipated growth, market opportunities, strategies, competitions and other expectations and targets for future periods. In some cases, you can identify forward-looking statements because they contain words such as "anticipate," "believe," "estimate," "expect," "intend," "may," "predict," "project," "target," "potential," "seek," "will," "would," "could," "should," continue," contemplate," "plan" and other words and terms of similar meaning. Forward-looking statements are subject to known and unknown risks and uncertainties, many of which may be beyond our control. We caution you that forward-looking statements are not guarantees of future performance or outcomes and that actual performance and outcomes may differ materially from those made in or suggested by the forward-looking statements contained in this Form 10-K. In addition, even if our results of operations, financial condition and cash flows, and the development of the markets in which we operate, are consistent with the forward-looking statements contained in this Form 10-K, those results or developments may not be indicative of results or developments in subsequent periods. New factors emerge from time to time that may cause our business not to develop as we expect, and it is not possible for us to predict all of them. Factors that could cause actual results and outcomes to differ from those reflected in forward-looking statements include, among others, the following: our ability to retain our existing clients or attract new clients, and sell additional solutions and services to our clients; our dependence on a small number of clients for a substantial portion of our total revenue; limitations of our clients' growth prospects, and the failure of the size of the total addressable markets in which we compete or expect that we may compete in the future to grow at rates currently expected; our ability to achieve or maintain profitability; Federal reductions in Medicare Advantage funding; significant consolidation in the healthcare industry, and decisions by clients to perform internally some of the same solutions or services we offer; the limited operating history we have with certain of our solutions; a failure to deliver high-quality member management services to our clients' members; the competition we face from healthcare services and technology companies; risks related to acquisitions of other businesses or technologies and other significant transactions; increases in labor costs, including due to changing minimum wage laws, and an overall tightening of the labor market; the long and unpredictable sales and integration cycles for our solutions; an economic downturn or volatility, including as a result of the ongoing COVID-19 pandemic; our ability to achieve market acceptance of new or updated solutions and services; our reliance on third parties for certain components of our business; significant fluctuations in our quarterly results of operations due to seasonality; our ability to achieve or maintain adequate utilization and suitable billing rates for our consultants, and our ability to deliver our services to our clients; recent and future developments in the Medicare Advantage market or the healthcare industry generally, including with respect to changing laws and regulations; our ability to comply with applicable laws, regulations and standards relating to data privacy and security; security breaches or incidents, failures and other disruptions of the information technology systems used in our business operations and of the sensitive information we collect, process, transmit, use and store; disruptions in service, and other software and systems failures, affecting us and our vendors; our ability to obtain, maintain, protect and enforce our intellectual property and proprietary rights; our ability to operate our business without infringing, misappropriating or otherwise violating the intellectual property or proprietary rights of third parties; our substantial indebtedness, and the restrictions imposed by our indebtedness on our subsidiaries; identified material weaknesses in our internal control over financial reporting and a failure to remediate these material weaknesses, and the effectiveness of our internal control over financial reporting; and the significant influence our principal stockholder, TPG, has over us. For a further discussion of these and other factors that could impact our future results, performance or transactions, see Part I, Item 1A "Risk Factors" of this Form 10-K and our other filings with theSecurities and Exchange Commission ("SEC"). Given these uncertainties, you should not place undue reliance on these forward-looking statements. Moreover, we operate in a very competitive and rapidly changing environment, and new risks emerge from time to time. It is not possible for us to predict all risks, nor can we assess the impact of all factors on our business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in any forward-looking statements we may make. In light of these risks, uncertainties and assumptions, the future events and trends discussed in this Form 10-K may not occur and actual results could differ materially and adversely from those anticipated or implied in the forward-looking statements. 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addition, statements that "we believe" and similar statements reflect our beliefs and opinions on the relevant subject. These statements are based upon information available to us as of the date of this Form 10-K, and, while we believe such information forms a reasonable basis for such statements, such information may be limited or incomplete, and our statements should not be read to indicate that we have conducted an exhaustive inquiry into, or review of, all potentially available relevant information. We qualify all of the forward-looking statements in this Form 10-K by these cautionary statements. Except as required by law, we undertake no obligation to publicly update any forward-looking statements, whether as a result of new information, future events or otherwise. Overview The Company is a leading healthcare platform that utilizes technology and processes to improve government-sponsored health plans, including Medicare Advantage ("MA") plans. We help health plans to grow membership and revenue as well as operate more effectively and efficiently. We are a trusted solutions-oriented partner to payors and deliver purpose-built technology and services to enhance our clients' mission-critical workflows. Our solutions address health plan needs, including product development and sales, member experience management, clinical management, core operations, business intelligence and analytics. Leveraging our technology and expert advisory services, we serve as a unified and integrated extension of our clients' core health plan operations. Our proprietary, modular technology and end-to-end solutions replace or supplement our clients' existing systems and processes, enabling us to help health plans attract and retain members, improve revenue accuracy, drive cost savings, facilitate regulatory compliance, and enhance operational effectiveness. Since our inception, we have created and continuously refined our technology solutions to best serve government-sponsored health plans. Our clients are primarily MA plans, Medicare Part D plans ("PDP"), includingEmployer Group Waiver plans, and pharmacy benefit managers ("PBM"). As ofDecember 31, 2021 , our solutions managed over 3.5 million MA members and 1.6 million PDP members. Additionally, our value-based analytics, which are powered by our 35 million member data set, provided actionable insights for nearly 7.3 million MA members in 2021. We foster long-term collaborative partnerships as evidenced by our average relationship with our top 10 clients of over eight years, and we serve as a partner to nine of the nation's top 10 MA payors by lives covered, in each case as ofDecember 31, 2021 . We believe that we have significant opportunity to grow within our existing client base as the majority of our clients currently subscribe to only a subset of our overall solutions and services. Moreover, we believe we have significant opportunity to grow by winning new clients in the MA market, by selling more products to our existing clients, by expanding into adjacent markets such as Medicaid and commercial insurance, and through complementary strategic acquisitions.
Our clients face significant and constantly evolving challenges managing their Medicare health plans:
•Increasingly Competitive Environment for Medicare Plans: Effective benefit design and sales are critical to retaining and growing members during the Medicare annual enrollment period. Once members are enrolled in a plan, effective member engagement and supplemental benefits administration are paramount to ensuring strong satisfaction and retention. Moreover, the proliferation of value-based reimbursement models such as MA requires effective member management and broad ecosystem coordination, which fall outside the core competencies of many health plans. •Compliance withCenters for Medicare and Medicaid Services ("CMS") Requirements: Constantly evolving CMS and client requirements result in hundreds of modifications per year that inhibit the operational effectiveness and capabilities of health plans. Our purpose-built government sector technology platform addresses these constantly evolving requirements. •Complex and Highly Regulated Medicare Market: Many health plans enter the government plan market by simply adapting their existing systems designed for the commercial insurance market. As a result, the technology they employ often lacks the sophistication and design needed to effectively maintain and administer benefits tailored for the complex and highly regulated Medicare market. Health plans increasingly recognize the need for specialized solutions like ours to help them overcome these challenges and drive superior performance. We believe our proprietary technology and processes facilitate member engagement, health plan growth, and operational efficiencies. We operate in two segments: Technology Enabled Solutions ("TES") in which we provide technology and support solutions to our clients, and Advisory Services ("Advisory") in which we provide project-based consulting services led by our long-tenured subject matter experts. Our TES segment was approximately 84% of our consolidated revenue and our Advisory segment was approximately 16% for the year endedDecember 31, 2021 . We believe that our combination of technology and advisory solutions gives us a competitive advantage in the government-sponsored health plan market. Our Technology Enabled 59
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Solutions and Advisory teams collaborate effectively to combine a strong technology platform with deep domain expertise to deliver best-in-class solutions to our clients. Furthermore, we leverage the Advisory team's industry expertise to identify new opportunities as well as cross-sell our solutions within existing clients.
We have a highly predictable and recurring revenue model with strong cash flow from operations. We typically charge a recurring subscription or per-member fee or a re-occurring utilization-based fee, which, coupled with our long-term contracts and strong client retention, has historically provided us with strong revenue visibility into estimated future revenue. Our Technology Enabled Solutions business historically has been highly predictable as most of our revenue in any given year is under contract or otherwise visible by the beginning of that year due to the contract structures we employ.
For more information on our business, see Part I, Item 1 "Business" of this Form 10-K.
Initial Public Offering OnJune 18, 2021 , we closed the initial public offering ("IPO") of our common stock through an underwritten sale of 13,333,334 shares of our common stock at a price of$14.00 per share. In the offering, we sold 11,666,667 shares and a selling stockholder sold 1,666,667 shares. The aggregate net proceeds to us from the offering, after deducting underwriting discounts and commissions and other offering expenses payable by us, were approximately$146.1 million . We used approximately$131.5 million of the net proceeds from the IPO to repay outstanding indebtedness under our First Lien Credit Agreement (as amended, the "Credit Agreement"). We did not receive any of the proceeds from the sale by the selling stockholder. Key Factors Affecting Our Performance Our results of operations and financial condition have been, and will continue to be, affected by several factors that present significant opportunities for us but can also pose risks and challenges, including those discussed below and in the section of this Form 10-K titled "Risk Factors."
Continued Growth of Medicare Advantage Market
We primarily operate within the government-sponsored health plan market, supporting government-sponsored health plans and PBMs with healthcare-specific, compliant member support solutions. Our solutions and services are primarily tailored to the Medicare Advantage market, which has grown significantly in recent years. Data from theU.S. government and third-party industry participants forecast that this growth will continue for the foreseeable future, driven largely by demographic trends inthe United States where an increasingly large share of the adultU.S. population will become eligible for Medicare, as well as an increasing tendency of individuals to opt into Medicare Advantage plans versus traditional Medicare plans. MA enrollment grew by a 7% compound annual growth rate from 2015 to 2020 and is expected to grow at that same 7% growth rate from 2020 to 2025. In addition, MA enrollment as a percentage of total Medicare enrollment is expected to grow from 38.7% in 2020 to 46.5% in 2025. Within our core Medicare Advantage market, we estimate the total addressable opportunity for our technologies and services to be approximately$77 billion . Because we have designed our platform to bring purpose-built, technology enabled solutions for government-sponsored health plans, in particular Medicare Advantage plans, we believe we are well positioned to capitalize on the anticipated growth of the Medicare Advantage market.
Client Retention and Expansion of Existing Relationships
We foster long-term, collaborative partnerships as evidenced by our average relationship with our top 10 clients of over eight years as ofDecember 31, 2021 . As ofDecember 31, 2021 , we served 169 clients, including nine of the nation's top 10 payors. The value we deliver to our clients is demonstrated though our high Gross Dollar Retention ("GDR"), which was 99%, 98%, and 99% in 2021, 2020, and 2019, respectively. 2019 is based on the Successor period fromJune 13, 2019 toDecember 31, 2019 and the Predecessor period fromJanuary 1, 2019 toSeptember 3, 2019 . Our ability to increase revenue depends, in part, on our ability to retain our existing clients and expand our relationships with these clients by selling additional solutions and services to them. Our ability to retain our clients is dependent on several variables, including our ability to support their growth and our ability to positively engage with their members. Because we offer a flexible and comprehensive technology platform that covers end-to-end payor workflows to address a wide variety of health plan and member needs, we have been able to retain existing clients and successfully expand these relationships over time. As a result of an increasingly competitive landscape, we have had clients not renew their contracts with us. We believe, however, that the superior outcomes we have delivered to clients combined with the flexibility of our platform will enable us to continue to grow our existing relationships. Our Advisory segment complements our Technology Enabled Solutions segment and the insights of our subject matter experts provide us 60
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with unique perspectives into marketplace opportunities for our Technology Enabled Solutions segment. In addition, we often forge strong relationships with key decision makers at our clients as a result of the work our Advisory segment performs.
Expansion of Existing and New Solutions and Services
We believe we have significant remaining opportunity to continue our growth within our existing client base. For example, approximately 60% of our technology enabled solutions client base uses only one of our three core technology enabled solutions as ofDecember 31, 2021 . Additionally, approximately 46% of our clients use only Advisory services as ofDecember 31, 2021 , and currently utilize none of our TES solutions. We estimate we have a$10.0 billion directly addressable opportunity in our existing client base with the technology solutions we offer today. Given the C-suite relationships we have in our Advisory business, we believe our existing client base continues to be a significant channel in which to sell both our existing technologies and any additional solutions or services. We have historically had an exceptional track record of growth within existing clients as evidenced through our high Net Dollar Retention ("NDR") of 117%, 135%, and 142% in 2021, 2020, and 2019, respectively. 2019 is based on the Successor period fromJune 13, 2019 toDecember 31, 2019 and the Predecessor period fromJanuary 1, 2019 toSeptember 3, 2019 . In addition, we are constantly expanding the solutions and services we offer through internal innovation and through strategic acquisitions in order to keep pace with changes in the government-sponsored health plan market, including the anticipated continued growth of Medicare Advantage and the increasing tendency of health plans to outsource core and non-core health plan functions to third-party partners such as us. These factors have enabled us to deliver additional functionality over time, and we are always evaluating new markets for opportunities to deploy our broad set of solutions and services. We believe our demonstrated ability to provide purpose-built, technology enabled solutions and advisory to participants in this market and our track record of enhancing operational efficiencies, facilitating regulatory compliance and delivering a high-quality member experience positions us well to serve as a high value-add strategic partner to our existing and prospective client base.
Seasonality
We typically generate outsized revenue in the fourth quarter primarily due to increased member utilization of supplemental benefits within our TES segment. The supplemental benefit programs, including products, we support may include an in-year roll-over provision, in which benefits not used during the calendar year accumulate and are available for members to use prior to the end of the following calendar year. Similarly, we typically incur outsized expenses in the fourth quarter, driven by the increased member utilization of supplemental benefits described above, as well as increased costs related to our advanced plan administration solutions, which are within our TES segment, for managing the Medicare annual election period. As part of these expenses, we also experience seasonal employee hiring practices primarily from September through December in connection with the Medicare annual enrollment period, which typically results in the hiring of a significant number of full-time employees on a temporary basis.
Investments in Growth and Technology
We continue to invest in growth by expanding our suite of solutions both organically and through strategic acquisition. Achievement of our growth strategy will require additional investments and result in higher expenses incurred and ongoing capital expenditures, particularly in developing new solutions and successfully cross-selling and upselling additional solutions and services to current clients. Developing new solutions can be time and resource intensive, and it can take a significant amount of time and investment to contract with clients, provide them with new technology offerings and have those technology offerings implemented to begin to generate revenue for us. This may increase our costs for one or more periods before we begin generating revenue from new or expanded solutions or services utilized by our clients. We will continue to invest in our technology platform and human resources to enable our clients to further optimize their health plan offerings and improve their operating efficiency.
Client Concentration
We have developed long-term relationships with our clients and typically enter into multi-year contracts covering multiple products. For example, we have an average relationship with our top 10 clients of over eight years as ofDecember 31, 2021 . For the year endedDecember 31, 2021 , our two largest clients, when aggregating all the solutions and services utilized by such clients across separate contracts with multiple product delivery solutions, represented 27.8% and 18.9% of our total revenue, respectively, or collectively 46.7% of our total revenue during this period. Consequently, the loss of all or a portion of revenue from any of our largest clients or the renegotiation of any of our largest client contracts could adversely impact our results of operations and cash flows. See "Risk Factors- Our client base is highly concentrated and we currently depend on a small number of clients for a substantial portion of our total revenue, and this concentration exposes us disproportionately to effects 61
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from altered contracts with these clients". While we have client concentration, our longest client relationships are among our two largest clients at 16 years and 10 years as ofDecember 31, 2021 , respectively, and we generally have long-term contracts with our other clients as well. In addition, we have many different contractual relationships with, and provide many different solutions to, each of our top clients. The multiple solutions we provide to our clients, the length of our contracts and the established long-term relationships we have developed with our top clients reduces the overall risk of concentration to our business. COVID-19 Pandemic COVID-19 was declared a global pandemic by theWorld Health Organization onMarch 11, 2020 . Governments at the national, state, and local level in theU.S. , and globally, have implemented varying measures in an effort to contain the virus, including social distancing, travel restrictions, border closures, limitations on public gatherings of people, work from home and supply chain logistical changes. While some of these actions have eased, escalating transmission rates (including of the Delta and Omicron variants of COVID-19), uneven vaccination and vaccination booster rates and further governmental guidance and orders may result in having to reimplement certain of these measures or implementing new and additional ones. The spread of COVID-19 has also caused significant volatility inUnited States and international markets and has had and continues to have widespread, rapidly evolving and unpredictable impacts on global society, economies, financial markets and business practices. Our operations have been impacted by COVID-19 sinceMarch 2020 . During March andApril 2020 , we obtained approval from our clients for a work-at-home model, though not all required our approval, and transitioned most of our employees to the home environment so that they could work more safely. COVID-19 created a hardship for many of our employees. We worked during 2020 to care for our employees by periodically implementing temporary premium pay and temporary paid sick leave programs which provided additional financial resources for our employees, as well as partial pay for those employeeswho contracted the virus or had to care for a family memberwho was affected. We also had provided compensation to employeeswho worked with us for more than six months so that they can take time off to be vaccinated. In addition, we increased cleaning protocols throughout our facilities. Certain of these measures have resulted in increased costs. Due to significant volatility to the markets, as well as business and supply chain disruptions, we incurred several additional expenses due to the COVID-19 pandemic, including the following: •Higher Pricing from Vendors and Higher Shipping Costs: We experienced higher costs to procure certain products included in the formulary available to Medicare members. The price increases were due to supply chain disruptions and product shortages caused by the COVID-19 pandemic. We quantified the pricing increase by comparing the pre-pandemic prices for high demand products directly attributable to the COVID-19 pandemic (e.g., masks and other similar high demand products) to the prices to procure such products during the pandemic. Further, we incurred additional costs due to expedited shipping fees as a result of new inventory management practices put into place due to supply chain disruptions and delays caused by COVID-19 in order to fulfill product demand.
•Sick Pay, Premium Pay and
•Wages to Accommodate Social Distancing: In order to meet the annual enrollment and quarterly volume requirements while properly socially distancing team memberswho were required to work in-person at our distribution facilities, we decreased the number of agents per training session and held training sessions up to eight weeks in advance of normal requirements, creating an extended training program with costs incremental to a standard operating training schedule. In addition, individuals working at our distribution centers to fulfill product delivery requirements were required to social distance and, as a result, we were required to add shifts and increased headcount to accomplish the same productivity as experienced prior to the COVID-19 pandemic under our normal operations. We quantified the incremental cost attributable to the modified staffing put into place due to COVID-19 by comparing the cost of our standard staffing with our actual incurred costs due to the changes. •Work-at-Home Training: In response to the COVID-19 pandemic, we held work-at-home remote training. To accomplish this transition, hourly new hire employees were required to receive training regarding at-home information technology ("IT") and telephony equipment setup. We paid the hourly new hire employees four hours for these efforts at their regular hourly wage rate and applicable fringe benefit rate. •IT Expenses: Additional temporary IT resources were retained, and overtime hours were incurred, for existing IT resources, in order to implement the new remote working environment designed in response to the COVID-19 pandemic. 62
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•Janitorial Costs: Due to the onset of the COVID-19 pandemic, we implemented an enhanced sanitation policy. The enhanced sanitation policy included special deep cleaning sessions in areas contacted by employeeswho had tested positive for COVID-19 and enhanced sanitation sessions through our facilities compared to the sanitation methods used prior to the COVID-19 pandemic. See "Non-GAAP Financial Measures" for amounts related to the additional expenses due to the COVID-19 pandemic (Cost of COVID-19). These expenses are not expected to be an adjustment in the calculation of Adjusted EBITDA after 2021. The full extent to which the COVID-19 pandemic and the various responses to the COVID-19 pandemic will impact our business, operations or financial condition continues to depend on numerous evolving factors that we may not be able to accurately predict, including, but not limited to, the duration, severity and scope of the COVID-19 pandemic (including due to new variants such as Delta and Omicron); actions by governmental entities, businesses and individuals that have been and continue to be taken in response to the pandemic; the effect on our clients and demand by clients, clients and our clients' members for and ability to pay for our solutions and services; and disruptions or restrictions on our employees' ability to work and travel. The impact of these factors and others on our suppliers and clients could persist for some time after governments ease their restrictions and after the overall number of COVID-19 cases inthe United States decreases. We may continue to experience higher than usual costs as a result of COVID-19 for the foreseeable future. Key Business and Operating Metrics We regularly review financial and operating metrics, including the following key metrics, to evaluate our business, measure our performance and manage our operations, including by identifying trends affecting our business, formulating business plans and making strategic decisions. We believe that non-GAAP and operational measures provide an additional way of viewing aspects of our operations that, when viewed together with our GAAP results, provide a more complete understanding of our results of operations and the factors and trends affecting our business. These non-GAAP financial measures are also used by our management to evaluate financial results and to plan and forecast future periods. Non-GAAP financial measures should be considered a supplement to, and not a substitute for, or superior to, the corresponding measures calculated in accordance with GAAP. Non-GAAP financial measures used by us may differ from the non-GAAP measures used by other companies, including our competitors. See "Non-GAAP Financial Measures" for additional information on non-GAAP financial measures and a reconciliation of non-GAAP financial measures to their most comparable GAAP measures.
Segment Revenue
We evaluate the performance of each of our operating segments based on segment revenue. We continue to see rapid growth in our Technology Enabled Solutions segment driven by both existing and new clients. Within our existing client base, we benefit from both increased volume driven by growth in the membership of our existing clients as well as incremental implementations of new solutions for both existing and new clients. Advisory revenue was negatively impacted in 2020 by COVID-19 as our health plan clients closed their offices, which impacted the ability of our advisory team to meet in person with health plan clients as was customary prior to the COVID-19 pandemic. 63
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[[Image Removed: cnvy-20211231_g7.gif]] We generated$338 million in net revenues for the year endedDecember 31, 2021 , as compared to$283 million for the year endedDecember 31, 2020 . The increase of$54.7 million reflects growth of 19.3%. We generated$80 million and$141 million in net revenues for the Successor period and Predecessor period, respectively. Revenue in our Technology Enabled Solutions segment was$285 million ,$241 million ,$66 million and$110 million for the year endedDecember 31, 2021 , the year endedDecember 31, 2020 , the Successor period, and the Predecessor period, respectively. Revenue in our Advisory Services segment was$53 million ,$42 million ,$14 million and$31 million for the year endedDecember 31, 2021 , the year endedDecember 31, 2020 , the Successor period, and the Predecessor period, respectively.
Net (Loss) Income, EBITDA and Adjusted EBITDA
In addition to net (loss) income and net cash provided by (used in) operating activities, EBITDA and Adjusted EBITDA are key measures we use to assess our financial performance and are also used for internal planning and forecasting purposes. EBITDA and Adjusted EBITDA are non-GAAP financial measures. We define EBITDA as net income (loss) less income (loss) from discontinued operations adjusted for interest, net, income tax expense (benefit), and depreciation and amortization expense. We define Adjusted EBITDA as EBITDA further adjusted for certain items of a significant or unusual nature, including but not limited to, change in fair value contingent consideration, COVID-19 cost impacts, non-cash stock compensation, transaction related costs, acquisition bonus expense, loss on extinguishment of debt, director and officer prior act liability insurance policy and other costs. Other includes costs such as contract termination fees, management and board of directors fees, and arrangement fees paid to TPG in connection with obtaining the incremental term loans. We believe EBITDA and Adjusted EBITDA provide investors with useful information because such metrics offer a consistent and comparable overview of our operations across historical financial periods. In evaluating EBITDA and Adjusted EBITDA, you should be aware that in the future we may incur expenses similar to those eliminated in the presentation. We had a net loss of$10.0 million for the year endedDecember 31, 2021 , net loss of$6.5 million for the year endedDecember 31, 2020 , net loss of$16.8 million for the Successor period and net income of$3.6 million for the Predecessor period. We generated$69.2 million in Adjusted EBITDA for the year endedDecember 31, 2021 . We generated$51.5 million ,$14.0 million , and$27.5 million in Adjusted EBITDA for the year endedDecember 31, 2020 , the Successor period, and the Predecessor period, respectively.
See "Non-GAAP Financial Measures" for additional information and a reconciliation of net (loss) income to EBITDA and Adjusted EBITDA.
We also use the following operating metrics on an annual basis to evaluate our performance: Technology Client Gross Dollar Retention, TechnologyNet Dollar Retention, and Advisory Revenue per Headcount. 64
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Technology Client Gross Dollar Retention
We use Technology GDR to measure the performance of existing solutions on an existing client basis and believe it is useful to investors, as it represents the gross retention of our existing client engagements on a revenue retention basis. Technology Annual Contracted Revenue ("ACR") at the beginning of the fiscal period is equal to the prior year total revenue for our reported Technology Enabled Solutions segment. For example, as ofDecember 31, 2020 , revenue from the Technology Enabled Solutions segment was$241.3 million which equals the 2021 Beginning Technology ACR. GDR is calculated by taking our ACR, which represents the annual revenue generated from the performance of our technology solutions as contracted by our clients, at the beginning of the fiscal period, and deducting from ACR the client attrition during the fiscal period. The difference is Technology Client Gross Retention. We then divide Technology Client Gross Retention by Beginning Technology ACR to calculate GDR. We have typically experienced a high client revenue retention rate as our solutions are deeply embedded in our clients' core operations and difficult to replace. Our calculation of GDR may differ from similarly titled metrics presented by other companies. For the years endedDecember 31, 2021 , 2020, and 2019 our GDR was 99%, 98%, and 99%, respectively. 2019 is based on the Successor period fromJune 13, 2019 toDecember 31, 2019 and the Predecessor period fromJanuary 1, 2019 toSeptember 3, 2019 . A reconciliation of ACR to Technology GDR is set forth below. For the Years Ended December 31, $ in millions 2021 2020 2019 Beginning Technology ACR$ 241 $ 176 $ 124 (-) Attrition (1) (3) (1) Technology Client Gross Retention$ 240 $ 173 $ 123 Technology Client Gross Dollar Retention (GDR) 99 %
98 % 99 %
Technology Net Dollar Retention
We use Technology Net Dollar Retention ("NDR") to measure the performance rate on a revenue retention basis of existing clients in total and before new client wins by adding cross-sell and upsell initiatives to GDR. NDR is calculated by taking Technology Client Gross Retention and adding existing client cross-sell (the additional solutions provided to existing clients) and net upsell (increased volume from current engagements with existing clients) to Technology GDR. We then divide Technology Net Retention by Beginning Technology ACR to calculate NDR, which represents the net retention of existing client engagements. While we believe NDR, in combination with other metrics, is useful to investors as an indicator of our near-term future revenue opportunity, it is not intended to be used as a projection of future revenue. Our calculation of NDR may differ from similarly titled metrics presented by other companies. For the years endedDecember 31, 2021 , 2020, and 2019, our NDR was 117%, 135%, and 142%, respectively. 2019 is based on the Successor period fromJune 13, 2019 toDecember 31, 2019 and the Predecessor period fromJanuary 1, 2019 toSeptember 3, 2019 . For the Years Ended December 31, $ in millions 2021 2020 2019 Technology Client Gross Retention$ 240 $ 174 $ 123 (+) Cross-sell, (+) Net Upsell 44 65 52 Technology Net Retention$ 284 $ 239 $ 175 Technology Net Dollar Retention (NDR) 117 %
135 % 142 %
Advisory Revenue per Headcount
We use Advisory Revenue per Headcount to evaluate the revenue generation of our Advisory Services segment. We calculate Advisory Revenue per Headcount by dividing Advisory revenue by the total headcount in our Advisory segment. Headcount is calculated based on the average headcount during the calendar year. We have typically had high revenue per Advisory employee, demonstrating the efficiency of the Advisory segment. Our calculation of Advisory Revenue per Headcount may differ from similarly titled metrics by other companies. For the years endedDecember 31, 2021 , 2020, and 2019, we had Advisory Revenue per Headcount of$0.43 million ,$0.32 million , and$0.40 million , respectively. 2019 is based on the Successor period fromJune 13, 2019 toDecember 31, 2019 and the Predecessor period fromJanuary 1, 2019 toSeptember 3, 2019 . 65
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Table of Contents For the Years Ended December 31, $ in millions 2021 2020 2019 Advisory Services Revenue$ 52,977 $ 41,578 $ 44,691 Advisory Services Headcount 123 130 113 Advisory Services Revenue per Headcount$ 0.43 $ 0.32 $ 0.40 Non-GAAP Financial Measures We present our financial results in accordance with GAAP. However, we use certain non-GAAP financial measures to supplement financial information presented on a GAAP basis. We believe that excluding certain items from our GAAP results allows management to better understand our consolidated financial performance from period to period and better project our future consolidated financial performance as forecasts are developed at a level of detail different from that used to prepare GAAP-based financial measures. Moreover, we believe these non-GAAP financial measures provide investors with useful information to help them evaluate our operating results by facilitating an enhanced understanding of our operating performance and enabling them to make more meaningful period to period comparisons. In particular, we use EBITDA and Adjusted EBITDA to assess our financial performance and also for internal planning and forecasting purposes. We believe EBITDA and Adjusted EBITDA provide investors with useful information because such metrics offer a consistent and comparable overview of our operations across historical financial periods. In evaluating EBITDA and Adjusted EBITDA, you should be aware that in the future we may incur expenses similar to those eliminated in the presentation. Non-GAAP measures should be considered as a supplement to, and not as a substitute for, or superior to, the corresponding measures calculated in accordance with GAAP. There are limitations to the use of the non-GAAP financial measures presented in this Form 10-K. For example, our non-GAAP financial measures may not be comparable to similarly titled measures of other companies. Other companies, including companies in our industry, may calculate non-GAAP financial measures differently than we do, limiting the usefulness of those measures for comparative purposes. The non-GAAP financial measures we present are not meant to be considered as indicators of performance in isolation from or as a substitute for measures prepared in accordance with GAAP, and should be read only in conjunction with financial information presented on a GAAP basis. Reconciliations of each of EBITDA and Adjusted EBITDA to the most directly comparable GAAP financial measure, net income (loss), are presented below. We encourage you to review our financial information in its entirety, not to rely on any single financial measure and to view the reconciliations in conjunction with the presentation of the non-GAAP financial measures for each of the periods presented. In future periods, we may exclude such items, may incur income and expenses similar to these excluded items, and include other expenses, costs, and non-recurring items. The tables below provide reconciliations of EBITDA and Adjusted EBITDA to net income (loss) on a consolidated basis for the periods indicated. We define EBITDA as net income (loss) less income (loss) from discontinued operations adjusted for interest, net, income tax expense (benefit), and depreciation and amortization expense. We define Adjusted EBITDA as EBITDA further adjusted for certain items of a significant or unusual nature, including but not limited to, change in fair value contingent consideration, COVID-19 cost impacts, non-cash stock compensation, transaction related costs, acquisition bonus expense, loss on extinguishment of debt, director and officer prior act liability insurance policy and other costs. Other includes costs such as contract termination fees, management and board of directors fees, and arrangement fees paid to TPG in connection with obtaining the incremental term loans. In addition, we measure the performance of our individual segments using Segment Adjusted EBITDA. Segment Adjusted EBITDA is the financial measure by which management allocates resources and analyzes the performance of the reportable segments. The main difference between Segment Adjusted EBITDA and Adjusted EBITDA is that Segment Adjusted EBITDA includes add backs for sales and use tax, lower consultant utilization due to COVID-19, executive recruitment and severance costs, certain revenue adjustments, contract termination costs, and severance.
The following table presents a reconciliation of net income (loss) to EBITDA and Adjusted EBITDA for the periods presented:
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Table of Contents Period from Period from January Inception to 1, 2019 to September Years Ended December 31, December 31, 2019 3, 2019 (in thousands) 2021 2020 (Successor) (Predecessor) Net income (loss)$ (9,978) $ (6,462) $ (16,826) $ 3,649 Less income (loss) from discontinued operations, net of tax - 36 73 (696) Net income (loss) from continuing operations (9,978) (6,498) (16,899) 4,345 Interest, net 17,294 18,853 5,762 6,213 Income tax expense (benefit) (619) (1,904) (858) (23,288) Depreciation and amortization expense 30,480 28,032 9,188 13,359 EBITDA 37,177 38,483 (2,807) 629 Change in fair value of contingent consideration(1) 96 (10,770) - 19,671 Cost of Covid-19(2) 3,827 10,174 - - Non-cash stock compensation expense(3) 4,380 6,682 - 300 Transaction related costs(4) 5,894 3,949 14,784 2,511 Acquisition bonus expense - HealthScape and Pareto acquisition(5) 667 1,989 1,663 3,685 Loss on extinguishment of debt(6) 5,015 - 385 - Director and officer prior act liability insurance policy(7) 7,861 - - - Other(8) 4,316 986 - 666 Adjusted EBITDA$ 69,233 $ 51,493 $ 14,025 $ 27,462 ________________________ (1)Change in fair value of contingent consideration is composed of two components: earn-out liability and holdback liability. The earn-out liability resulted from theHealthScape Advisors, LLC ("HealthScape Advisors ") andPareto Intelligence, LLC ("Pareto Intelligence") acquisition that closed onNovember 16, 2018 . The holdback liability resulted from the merger with TPG that closed onSeptember 4, 2019 . The earn-out liability and holdback liability were re-measured to fair value at each reporting date until the contingency was resolved. During the year endedDecember 31, 2021 , we made a final payment of$13.1 million related to the holdback liability and a$7.5 million final payment related to the earn-out liability due toHealthScape Advisors . (2)Due to significant volatility to the markets, as well as business and supply chain disruptions, we incurred several additional expenses due to the COVID-19 pandemic. Expenses incurred include the following:$0 and$3.2 million for early hire of employees due to social distancing and work at home protocols for the years endedDecember 31, 2021 , and 2020, respectively;$2.3 million and$2.9 million for higher pricing from vendors due to supply chain disruptions, product shortages and increases in shipping costs for the years endedDecember 31, 2021 , and 2020, respectively;$0.8 million and$2.8 million for higher employee costs due to hazard pay for our employees, enhanced sick pay due to illness and quarantine protocols for the years endedDecember 31, 2021 , and 2020, respectively;$0.5 million and$0.7 million for COVID-19 training, overtime, temporary resources, and IT costs due to the change in the work environment for the years endedDecember 31, 2021 and 2020, respectively; and$0.2 million and$0.5 million for janitorial costs due to enhanced COVID-19 protocols for the years endedDecember 31, 2021 and 2020, respectively. These expenses are not expected to be an adjustment in the calculation of Adjusted EBITDA after 2021.
These expenses are included in Cost of services and Cost of products on our statements of operations and comprehensive (loss) income. See "Key Factors Affecting Our Performance - COVID-19 Pandemic" for additional information related to these expenses.
(3)Represents non-cash stock-based compensation expense in connection with the stock awards that have been granted to employees and non-employees. The expense is included in Selling, general and administrative expenses on our statements of operations and comprehensive income (loss).
(4)Transaction related costs primarily consist of public company readiness costs, expenses for corporate development, such as mergers and acquisitions activity, and due diligence costs.
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(5)In conjunction with theHealthScape Advisors and Pareto Intelligence acquisitions, the previous shareholders set aside funds for an incentive compensation plan for employeeswho remained post acquisition. The costs were expensed on a monthly basis and funded through an escrow account which was established on the closing date and was included in restricted cash on our consolidated balance sheets. The expense is included in Selling, general and administrative expenses on our statements of operations and comprehensive income (loss).
(6)The loss on extinguishment of debt was recognized for the prepayment of outstanding indebtedness.
(7)In connection with the IPO, we made a$7.9 million one-time payment on a 3-year director and officer prior act liability insurance policy. We deemed this policy to be a retroactive insurance policy and in accordance with ASC 720-20-25, "Retrospective Contracts", we expensed the premium of$7.9 million inJune 2021 . (8)Other includes other individual adjustments related to legal fees associated with obtaining the incremental loans, contract termination costs assessed upon the early termination of a facility lease, severance costs incurred as a result of eliminating certain positions, management service agreement termination fee, management fees and professional fees for assistance in the implementation of ASC 606. All costs are included in Selling, general and administrative expenses on our statements of operations and comprehensive income (loss).
Components of Results of Operations
Revenue
We generate revenue from contracts with our clients within our two operating segments: Technology Enabled Solutions and Advisory Services.
Through our Technology Enabled Solutions segment, we primarily provide technology solutions and services to assist our clients with workflows across product development, member experience, clinical management, core operations, business intelligence, and analytics. Through our Advisory Services segment, we provide fixed or variable fee arrangements to assist clients in the design and management of government and commercial health plans. Our revenue includes both product revenue and service arrangements. Products revenue consists of technology enabled solutions for supplemental benefits to members through their Medicare Advantage plans. These include supplemental benefit products, administration, fulfillment, and shipment of eligible product, as well as catalog development and distribution. Revenue is derived from supplemental benefit membership, supplemental benefit dollars, and member utilization of the benefits.
Services revenue consists of:
•Technology-based Medicare plan administration services including eligibility and enrollment processing, member services, premium billing and payment processing, reconciliation and other related services. Our solutions are primarily priced on recurring per member per month fees, annual software license fees, and transaction-based fees. •Value based payment assurance solutions, including payment tools and data analytics, that improve revenue accuracy and gaps in quality, clinical care, and compliance. Our value-based solutions are primarily priced on an annual subscription fee, shared savings or fee-based engagement. Advisory (consulting) services that support health plan operations and drive business model evolution. Our Advisory services are priced on a fixed-fee or time and materials basis.
Operating Expenses
Costs of products consist of the value of supplemental benefit products, shipping and handling costs to acquire and to deliver the product to our clients; personnel costs including salaries, wages, overtime, benefits; facility costs and overhead allocation covering information technology, telecommunications costs, and other costs specifically identified to the shipment of our products.
Costs of services consist of all costs directly attributable to service revenue generation activities as outlined in contracts with our clients. Our largest components in costs of services are personnel costs, including salaries, wages, overtime, benefits, and discretionary bonus; facility costs and overhead allocation covering information technology, telecommunications costs, and other costs needed in the delivery of our services.
Selling, general and administrative expenses ("SG&A") include corporate management and governance functions comprised of general management, legal, accounting, financial reporting, human resource, sales, marketing, and other costs not
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directly associated with revenue generation activities, including those involved with developing new service offerings. SG&A includes salaries, bonuses, and related benefits. SG&A also includes all general operating expenses, including, but not limited to, rent and occupancy costs for non-revenue generating activities, telecommunications costs, information technology infrastructure, and operations costs, including software licensing costs, advertising and marketing expenses, insurance expenses, professional services and consulting expenses.
Depreciation and amortization includes depreciation expense of property and equipment, including leasehold improvements, computer equipment, furniture and fixtures and software and amortization expense of capitalized internal-use software and software development costs, customer relationships, acquired software and certain trade names.
Transaction related costs primarily consist of professional services incurred in connection with public company readiness costs, expenses for corporate development such as mergers and acquisitions activity and due diligence costs.
Change in fair value of contingent consideration is composed of two components: earn-out liability and holdback liability. The earn-out liability resulted from theHealthScape Advisors and Pareto Intelligence acquisition that closed onNovember 16, 2018 . The holdback liability resulted from the merger with TPG that closed onSeptember 4, 2019 . The earn-out liability and holdback liability were re-measured to fair value at each reporting date until the contingency was resolved. During the year endedDecember 31, 2021 , we made a final payment of$13.1 million related to the holdback liability and a$7.5 million final payment related to the earn-out liability due toHealthScape Advisors .
Other Income (Expense)
Other Income (expense) is primarily composed of:
•Interest income. Interest income consists of interest on cash and cash equivalents.
•Interest expense. Interest expense consists of accrued interest and related payments on our outstanding term loans and revolving loans, as well as the amortization of debt issuance costs associated with our debt. Interest expense also includes interest on our sales tax accrual.
•Loss on extinguishment of debt. Loss on extinguishment of debt includes unamortized financing costs and a prepayment premium in connection with the prepayment of outstanding indebtedness.
Factors Affecting the Comparability of Our Results of Operations
Set forth below is a brief discussion of the key factors impacting the comparability of our results of operations.
The Merger
Convey Health Solutions Holdings, Inc. ("Convey") (formerly known asCannes Holding Parent, Inc. andConvey Holding Parent, Inc. ) was formed onJune 13, 2019 ("Inception") for the purpose of acquiringConvey Health Solutions, Inc. ("CHS"). OnSeptember 4, 2019 ,Cannes Parent, Inc. ("Cannes"), a direct subsidiary of Convey, entered into an agreement to acquire all of the outstanding stock of CHS through the merger ofCannes Merger Sub, Inc. ("Merger Sub") andConvey Health Parent, Inc. ("Parent") (the "Merger") with Parent surviving as a direct subsidiary of Cannes. The Merger principally occurred through an investment fromTPG Cannes Aggregation, L.P. , which is primarily funded by partners ofTPG Partners VIII, L.P. andTPG Healthcare Partners, L.P. or any parallel fund or their alternative investment vehicles (collectively, "TPG").
The Merger was accounted for in accordance with the
The period fromJanuary 1, 2019 toSeptember 3, 2019 reflects the historical financial information for Parent and its subsidiaries prior to the closing of the Merger ("Predecessor"). The period from Inception toDecember 31, 2019 and the years endedDecember 31, 2020 , and 2021, reflects the historical financial information for Convey and its subsidiaries ("Successor"). The Predecessor and Successor consolidated financial information presented herein is not comparable due to the impacts of the Merger including the application of acquisition accounting in the Successor financial statements as ofSeptember 4, 2019 . Where applicable, a black line separates the Successor and Predecessor periods to highlight the lack of comparability.
Public Company Costs
We incur additional costs associated with operating as a public company that we
did not incur as a private company (which we were prior to
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relations, and other expenses. The Sarbanes-Oxley Act of 2002, as amended, as well as rules adopted by theSEC and national securities exchanges, requires public companies to implement specified corporate governance practices that are inapplicable to a private company. These additional rules and regulations, as well as others associated with being a public company, have increased our legal, regulatory, financial and insurance compliance costs and made some activities more time consuming and costly.
Results of Operations
Comparison of the Years Ended
The following table sets forth our results of operations for the periods indicated: Years Ended December 31, Change 2021 2020 $ % Net revenues: Services$ 177,575 $ 147,191 $ 30,384 21 % Products 160,021 135,723 24,298 18 % Net revenues 337,596 282,914 54,682 19 % Operating expenses: Cost of services 92,241 84,144 8,097 10 % Cost of products 103,080 87,153 15,927 18 % Selling, general and administrative 94,093 79,955 14,138 18 % Depreciation and amortization 30,480 28,032 2,448 9 % Transaction related costs 5,894 3,949 1,945 49 % Change in fair value of contingent consideration 96 (10,770) 10,866 (101) % Total operating expenses 325,884 272,463 53,421 20 % Operating income 11,712 10,451 1,261 12 % Other income (expense): Interest income 18 7 11 157 % Loss on extinguishment of debt (5,015) - (5,015) 100 % Interest expense (17,312) (18,860) 1,548 (8) % Total other expense, net (22,309) (18,853) (3,456) 18 % Loss from continuing operations before income taxes (10,597) (8,402) (2,195) 26 % Income tax benefit 619 1,904 (1,285) (67) % Net loss from continuing operations (9,978) (6,498) (3,480) 54 % Income from discontinued operations, net of tax - 36 (36) (100) % Net loss$ (9,978) $ (6,462) $ (3,516) 54 % Net Revenues Services Revenue Services revenue was$177.6 million and$147.2 million for the years endedDecember 31, 2021 , andDecember 31, 2020 , respectively. The$30.4 million increase is driven by$19.0 million attributable to our Technology Enabled Solutions segment largely due to increased support to our existing clients; and$11.4 million attributable to our Advisory Services segment due to strong sales, higher consultant utilization, and stronger demand.
Products Revenue
Products revenue was$160.0 million and$135.7 million for the years endedDecember 31, 2021 , andDecember 31, 2020 , respectively. The increase of$24.3 million in products revenue was primarily attributable to an increase in the total benefit amount provided by our health plan clients and an increase in total members. 70
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Table of Contents Operating Expenses Cost of Services Cost of services was$92.2 million and$84.1 million for the years endedDecember 31, 2021 , andDecember 31, 2020 , respectively. The increase of$8.1 million is primarily attributable to higher staffing levels to handle increased support to our existing clients and state-mandated increases in the minimum wage.
Cost of Products
Cost of products was$103.1 million and$87.2 million for the years endedDecember 31, 2021 , andDecember 31, 2020 , respectively. The increase of$15.9 million was attributable to the additional costs incurred to service the growth in new members, higher labor costs due to certain state-mandated increases in the minimum wage and higher product costs as a result of increased pricing from suppliers driven by supply chain disruptions.
Selling, General and Administrative
Selling, general and administrative was$94.1 million and$80.0 million for the years endedDecember 31, 2021 , andDecember 31, 2020 , respectively. The increase of$14.1 million was primarily due to a$7.9 million one-time payment on a 3-year director and officer prior act liability insurance policy in connection with the IPO. We deemed this policy to be a retroactive insurance policy and in accordance with ASC 720-20-25, "Retrospective Contracts", we expensed the premium of$7.9 million inJune 2021 . In addition, the increase was due to: (i) higher management fees for TPG as a result of the one-time termination fee of the management service agreement and the fee to arrange the 2021 incremental loan and theJuly 2021 amendment to the Credit Agreement, and (ii) higher personnel costs due to additional resources to support being a public company.
Depreciation and Amortization
Depreciation and amortization was$30.5 million and$28.0 million for the years endedDecember 31, 2021 , andDecember 31, 2020 , respectively. The increase of$2.4 million in depreciation and amortization expense is due to the addition of property and equipment and capitalization of software development costs.
Transaction Related Costs
Transaction related costs were$5.9 million and$3.9 million for the years endedDecember 31, 2021 , andDecember 31, 2020 , respectively. The increase of$1.9 million in transaction related costs is due to costs associated with the public company readiness and professional fees incurred for due diligence in connection with an acquisition completed inFebruary 2022 . See Note 19. Subsequent Events, to our consolidated financial statements in this Form 10-K for additional information.
Change in Fair Value of Contingent Consideration
Change in fair value of contingent consideration liability was an increase of$0.1 million and a reduction of$10.8 million for the years endedDecember 31, 2021 andDecember 31, 2020 , respectively. A decrease of$10.9 million , was due to the re-measurement in 2020 of the earn-out liability related to theHealthScape Advisors and Pareto Intelligence acquisitions and the holdback liabilities related to the TPG acquisition.
Other Income (Expense)
Interest Income
Interest income consists primarily of bank interest and was de minimis for the periods presented.
Loss on extinguishment of debt
The loss on extinguishment of debt of$5.0 million was recognized for the prepayment of outstanding indebtedness. The Company used approximately$131.5 million of the net proceeds from the IPO to repay outstanding indebtedness under its credit agreement. The loss included unamortized financing costs of$3.4 million and prepayment premium of$1.6 million .
Interest Expense
Interest expense was$17.3 million and$18.9 million for the years endedDecember 31, 2021 , andDecember 31, 2020 , respectively. The decrease of$1.5 million was primarily due to: (i) lower interest expense incurred as a result of a reduction of 71
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the sales tax liability, (ii) the prepayment of outstanding indebtedness and (iii) the impact of lower interest rates due to theJuly 2021 amendment to the Credit Agreement. The Company used approximately$131.5 million of the net proceeds from the IPO to repay outstanding indebtedness under its credit agreement.
Segment Information
Our reportable segments have been determined in accordance with Accounting Standards Codification Topic 280, Segment Reporting. We have two reportable segments: Technology Enabled Solutions and Advisory Services. We evaluate the performance of each of our two operating segments based on segment revenue and Segment Adjusted EBITDA. Segment Adjusted EBITDA represents each segment's earnings before interest, tax, depreciation and amortization and is further adjusted to exclude certain items of a significant or unusual nature, including but not limited to, COVID-19 cost impacts, sales and use tax, non-cash stock compensation, transaction related costs, acquisition bonus expense, loss on extinguishment of debt, director and officer prior act liability insurance policy, and other costs. Other includes costs such as contract termination fees, management and board of directors fees, and costs associated with obtaining the incremental term loans.
See Note 18. Segment Information, to our consolidated financial statements in this Form 10-K the notes accompanying our consolidated financial statements.
The segment measurements provided to and evaluated by the chief operating decision maker group are described in the notes to our financial statements. These results should be considered in addition to, and not as a substitute for, results reported in accordance with GAAP. For the Years Ended December 31, Change (in thousands) 2021 2020 $ % Revenue
Technology Enabled Solutions
18 % Advisory Services 52,977 41,578 11,399 27 % Total$ 337,596 $ 282,914 $ 54,682 19 % Segment Adjusted EBITDA Technology Enabled Solutions$ 69,214 $ 66,043 $ 3,171 5 % Advisory Services 16,232 8,204 8,028 98 % Total$ 85,446 $ 74,247 $ 11,199 15 % Segment Revenues Technology Enabled Solutions revenue was$284.6 million and$241.3 million for the years endedDecember 31, 2021 , and 2020, respectively. The increase of$43.3 million was mainly driven by: (i)$19.0 million of health plan management, software services and data analytics revenues primarily due to membership growth, and (ii)$24.3 million of product revenue as a result of an increase in the total benefit amount utilized by health plan members and increase in members. Advisory revenue was$53.0 million and$41.6 million for the years endedDecember 31, 2021 , and 2020, respectively. The increase of$11.4 million was driven by higher demand for our consulting services and higher consultant utilization compared to the prior year which was more negatively impacted by COVID-19. Segment Adjusted EBITDA Technology Enabled Solutions Segment Adjusted EBITDA was$69.2 million and$66.0 million for the years endedDecember 31, 2021 , and 2020, respectively. The increase of$3.2 million was primarily due to the flow through of increased revenue offset in part by higher personnel costs to ensure service levels, certain state-mandated increases in the minimum wage and higher product costs as a result of increased pricing from suppliers. Advisory Services Segment Adjusted EBITDA was$16.2 million and$8.2 million for the years endedDecember 31, 2021 , and 2020, respectively. The increase of$8.0 million was attributable to flow through of consulting services demand and higher utilization of our consultants. 72
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Year Ended
Supplemental Pro Forma Financial Information for the Year Ended
2019 To facilitate comparability, the following table below sets forth our unaudited pro forma condensed, combined, and consolidated statements of operations for the year endedDecember 31, 2019 . The pro forma financial information gives pro forma effect to the Merger in accordance with Article 11 of Regulation S-X, as amended, as if it had occurred onJanuary 1, 2019 ("Pro Forma Basis"). The pro forma results for the year endedDecember 31, 2019 includes (i) the additional depreciation and amortization resulting from the adjustments to the value of property and equipment and intangible assets resulting from purchase accounting, (ii) the additional amortization of the estimated adjustment to decrease the assumed deferred revenue obligations to fair value that would have been charged assuming the acquisition occurred onJanuary 1, 2019 , together with the consequential tax effects. The pro forma results also include interest expense associated with debt used to fund the acquisitions and adjustments to exclude interest expense from debt extinguished in the Merger. The pro forma results do not include any anticipated synergies or other expected benefits of the acquisitions. The pro forma information does not purport to be indicative of what our results of operations would have been if the Merger had in fact occurred at the beginning of the period presented and is not intended to be a projection of our future results of operations. Transaction expenses are included within the pro forma results. The following table sets forth our results of operations for the periods indicated: For the Years Ended December 31, Change 2019 Pro Forma (in thousands) 2020 Basis (unaudited) $ % Net revenues: Services$ 147,191 $ 143,378 $ 3,813 3 % Products 135,723 77,555 58,168 75 % Net revenues 282,914 220,933 61,981 28 % Operating expenses: Cost of services 84,144 77,040 7,104 9 % Cost of products 87,153 47,051 40,102 85 % Selling, general and administrative 79,955 62,274 17,681 28 % Depreciation and amortization 28,032 27,307 725 3 % Transaction related costs 3,949 17,295 (13,346) (77 %) Change in fair value of contingent consideration (10,770) 19,671 (30,441) (155 %) Total operating expenses 272,463 250,638 21,825 9 % Operating income (loss) 10,451 (29,705) 40,156 (135 %) Other expense: Interest income 7 - 7 100 % Interest expense (18,860) (17,599) (1,261) 7 % Total other expense, net (18,853) (17,599) (1,254) 7 % Loss from continuing operations before income taxes (8,402) (47,304) 38,902 (82 %) Income tax benefit 1,904 27,113 (25,209) (93 %) Net loss from continuing operations (6,498) (20,191) 13,693 (68 %) Income (loss) from discontinued operations, net of tax 36 (624) 660 (106 %) Net loss$ (6,462) $ (20,815) $ 14,353 (69 %) We generated$282.9 million ,$80.4 million , and$140.7 million in revenue for the year endedDecember 31, 2020 , the Successor period and the Predecessor period, respectively. Revenues were$282.9 million for the year endedDecember 31, 2020 as compared to$220.9 million for the year endedDecember 31, 2019 on a Pro Forma Basis. The increase of$61.9 million from the year endedDecember 31, 2019 on a Pro Forma Basis to the year endedDecember 31, 2020 reflects growth of 28.1%. We had net (loss) income of$(6.5) million ,$(16.8) million and$3.6 million for the year endedDecember 31, 2020 , the Successor period and the Predecessor period, respectively. The net loss was$(6.5) million for the year endedDecember 31, 2020 as compared to$(20.8) million for the year endedDecember 31, 2019 on a Pro Forma Basis. The decrease of 73
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Net Revenues
Services Revenue
Services revenue was$147.2 million ,$51.2 million , and$92.4 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. Services revenue was$147.2 million for the year endedDecember 31, 2020 as compared to$143.6 million for the year endedDecember 31, 2019 on a Pro Forma Basis. The increase in services revenue was primarily attributable to an increase in our Technology Enabled Solutions segment. Increases in services revenue attributable to our Technology Enabled Solutions segment were largely offset by the effects of COVID-19 on our business, resulting in elongated sales cycles, temporary decrease in demand, and slower implementation of solutions, as well as a reduction in billable hours in our Advisory segment. Products Revenues Products revenue was$135.7 million ,$29.3 million , and$48.3 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. Products revenue was$135.7 million for the year endedDecember 31, 2020 as compared to$77.6 million for the year endedDecember 31, 2019 on a Pro Forma Basis. The increase in products revenue was primarily attributable to an increase in the total benefit amount provided by our health plan clients plus an increased utilization by members.
See further analysis in "Segment Information" below.
Operating Expenses
Cost of Services
Cost of services was$84.1 million ,$28.8 million , and$48.2 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. Cost of services was$84.1 million for the year endedDecember 31, 2020 as compared to$77.0 million for the year endedDecember 31, 2019 on a Pro Forma Basis. The increase was primarily attributable to labor costs, which increased due to certain state-mandated increases in the minimum wage. In addition, labor costs were impacted by COVID-19, through premium pay, additional sick pay, and early hire of employees due to social distancing and work at home orders, additional training, over-time, and the use of additional temporary resources. Cost of Products Cost of products was$87.2 million ,$17.8 million , and$29.2 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. Cost of products was$87.2 million for the year endedDecember 31, 2020 as compared to$47.1 million for the year endedDecember 31, 2019 on a Pro Forma Basis. The increase was attributable to the additional costs incurred to service the growth in new members, including costs incurred in providing current product availability information to members, additional labor costs to develop and implement technology enhancements, as well as higher staffing levels to handle increased interactions with members. In addition, the negative impact of COVID-19 resulted in higher pricing from vendors due to supply chain disruptions, product shortages, and increases in shipping costs. Further, labor costs increased due to certain state-mandated increases in the minimum wage. In addition, labor costs were impacted by COVID-19, through premium pay, additional sick pay, and early hire of employees due to social distancing and work at home orders, additional training, over-time, and the use of additional temporary resources.
Selling, General, and Administrative
Selling, general, and administrative was$80.0 million ,$21.8 million , and$40.5 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. Selling, general, and administrative was$80.0 million for the year endedDecember 31, 2020 as compared to$62.3 million for the year endedDecember 31, 2019 on a Pro Forma Basis. The increase was primarily due to additional resources to support growth, including investments in IT and additional costs to support our IPO.
Depreciation and Amortization
Depreciation and amortization was
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year endedDecember 31, 2020 as compared to$27.3 million for the year endedDecember 31, 2019 on a Pro Forma Basis. On a Pro Forma Basis, the increase in depreciation and amortization expense is due to the addition of property and equipment and capitalization of software development costs.
Transaction Related Costs
Transaction related costs were$3.9 million ,$14.8 million , and$2.5 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. Transaction related costs were$3.9 million for the year endedDecember 31, 2020 as compared to$17.3 million for the year endedDecember 31, 2019 on a Pro Forma Basis. Transaction related costs for the year endedDecember 31, 2020 , of which$2.4 million are due to costs associated with the preparation of our IPO, and$1.5 million for corporate development such as mergers and acquisitions activity that did not proceed. Transaction related costs for the year endedDecember 31, 2019 on a Pro Forma Basis were primarily due to costs incurred of$16.1 million , which includes buyer and seller costs, related to the TPG acquisition, and$1.2 million of expenses for corporate development such as mergers and acquisitions activity that did not proceed.
Change in Fair Value of Contingent Consideration
Change in fair value of contingent consideration liability was a reduction of$10.8 million and an increase of$19.7 million for the year endedDecember 31, 2020 and for the Predecessor period, respectively. There was no change in fair value of contingent consideration for the Successor period. A decrease of$30.4 million or 154.8% was due to the re-measurement at year end of the earn-out liability related to theHealthScape Advisors and Pareto Intelligence acquisitions and the holdback liabilities related to the TPG acquisition. The movement for the contingent consideration liability for the year endedDecember 31, 2020 was driven by the Pareto Intelligence earn-out payment targets ultimately not being met, partly due to the impact of COVID-19. This resulted in a$21.1 million reduction in earn-out liabilities and an increase of$10.3 million to the holdback liabilities owed toConvey Health's previous shareholders. The movement of the contingent consideration liability for the Predecessor period arose due to management reassessing the estimate of the earn-out liability. Other Income (Expense) Interest Income
Interest income consists primarily of bank interest and was de Minimis for the periods presented.
Interest Expense Interest expense was$18.9 million ,$5.8 million , and$6.2 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. Interest expense was$18.9 million for the year endedDecember 31, 2020 as compared to$17.6 million for the year endedDecember 31, 2019 on a Pro Forma Basis. The increase was due to net incremental borrowings under our credit facility. Interest expense for the Term Facility was$16.7 million ,$5.4 million and$5.7 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. Amortization of debt issuance costs for the Term Facility, included in interest expense, was$0.9 million ,$0.2 million and$0.3 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. The increase was due to net incremental borrowings under our credit facility.
Interest expense for the revolving credit facility was
All other interest expense for the year ended
Segment Information
Our reportable segments have been determined in accordance with Accounting Standards Codification Topic 280, Segment Reporting. We have two reportable segments: Technology Enabled Solutions and Advisory Services. We evaluate the performance of each of our two operating segments based on segment revenue and Segment Adjusted EBITDA. 75
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Segment Adjusted EBITDA represents each segment's earnings before interest, tax, depreciation and amortization and is further adjusted for certain items of income and expense, including but not limited to, the change in fair value of contingent consideration, COVID-19 related costs, non-cash stock compensation expense, transaction costs associated with the Merger, acquisition bonus expenses incurred in connection with the acquisitions ofHealthScape Advisors and Pareto Intelligence, legal fees related to increase loan facility, certain contract termination costs, certain severance costs, certain management fees, sales and use tax paid on behalf of clients, other sales adjustments, and ASC Topic 606, Revenue from Contracts with Customers ("ASC 606") implementation costs.
See Note 18. Segment Information, to our consolidated financial statements in this Form 10-K.
Compared to Adjusted EBITDA, Segment Adjusted EBITDA includes addbacks for sales and use tax, lower consultant utilization due to COVID-19, executive recruitment and severance costs, certain revenue adjustments, contract termination costs, severance, and professional fees incurred in the implementation of ASC 606.
The segment measurements provided to and evaluated by the chief operating decision maker group are described in the notes to the audited consolidated financial statements. These results should be considered in addition to, and not as a substitute for, results reported in accordance with GAAP.
For the year ended Successor Predecessor 2019 December 31, 2020 2019 Period Period (in thousands) Revenue Technology Enabled Solutions $ 241,336$ 66,530 $ 109,932 Advisory Services 41,578 13,885 30,806 Total $ 282,914$ 80,415 $ 140,738 Segment Adjusted EBITDA Technology Enabled Solutions $ 66,043$ 14,881 $ 29,205 Advisory Services 8,204 1,445 6,073 Total $ 74,247$ 16,326 $ 35,278 Segment Revenues Technology Enabled Solutions revenue was$241.3 million ,$66.5 million , and$109.9 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. The increase was primarily due to approximately$65.0 million of upsell and cross sell revenue, offset by$2.8 million of client attrition and the adverse impact of COVID-19. Advisory revenue was$41.6 million ,$13.9 million , and$30.8 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. The$3.1 million decrease was driven by reduced demand for our consulting services as a result of COVID-19.
Segment Adjusted EBITDA
The Technology Enabled Solutions portion of Segment Adjusted EBITDA was$66.0 million ,$14.9 million , and$29.2 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. The$21.9 million increase in Segment Adjusted EBITDA was primarily due to the flow through of increased revenue. The primary reconciling items for the Technology Enabled Solutions portion of Segment Adjusted EBITDA, outside of depreciation and amortization, interest expense and tax, are changes in the fair value of contingent consideration, sales tax, transaction bonuses and COVID-19 addbacks. The change in the fair value of contingent consideration result in a reduction to Segment Adjusted EBITDA of$10.7 million inDecember 31, 2020 , no adjustment for the Successor Period and an add back of$10.3 million , for the Predecessor period, respectively. The changes were driven by the movement of the contingent consideration and the holdback liability estimates in relation to the acquisition of Pareto Intelligence. The increase to Segment Adjusted EBITDA for sales and use tax was$8.2 million ,$1.9 million and$3.1 million for the year endedDecember 31, 2020 , Successor period and Predecessor period, respectively. The primary driver for the increase in sales and use tax is due to increased sales and client sales mix. The add back for transaction bonuses was$0.5 million ,$0.5 million and$1.1 million for the year endedDecember 31, 2020 , Successor and Predecessor respectively. For the year endedDecember 31, 2020 a COVID-19 add back of$10.2 million was included in Segment Adjusted EBITDA. No such adjustment is made for the 76
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Successor or Predecessor period, respectively. The COVID-19 cost adjustment includes the early hire of employees due to social distancing and work at home protocols; higher pricing from vendors due to supply chain disruptions, product shortages and increases in shipping costs; higher employee costs due to hazard pay for our employees, enhanced sick pay due to illness and quarantine protocols; IT costs due to the change in the work environment; and janitorial costs due to enhanced COVID-19 protocols. The Advisory portion of Segment Adjusted EBITDA was$8.2 million ,$1.4 million , and$6.1 million for the year endedDecember 31, 2020 , for the Successor period and for the Predecessor period, respectively. Segment Adjusted EBITDA was essentially the same year over year due to reductions in operating expenses in conjunction with the reductions in revenue due to COVID-19. The primary reconciling items for the Advisory Services portion of Segment Adjusted EBITDA, outside of depreciation and amortization, interest expense and tax, are changes in the fair value of contingent consideration, transaction bonuses and lower consultant utilization due to COVID-19. The change in the fair value of contingent consideration result in a reduction to EBITDA of$0.1 million inDecember 31, 2020 , no adjustment for the Successor Period and an add back of$9.4 million , for the Predecessor period, respectively. The changes were driven by the movement of the contingent consideration and the holdback liability estimates in relation to the acquisition ofHealthScape Advisors . The add back for transaction bonuses was$1.4 million ,$1.1 million and$2.6 million for the year endedDecember 31, 2020 , Successor and Predecessor respectively. For the year endedDecember 31, 2020 a cost adjustment as a result of lower consultant utilization due to COVID-19 of$2.0 million was included in Segment Adjusted EBITDA. No such adjustment is made for the Successor or Predecessor period, respectively. The utilization adjustment reflects decreased productivity for the Advisory segment caused by the COVID-19 pandemic. The average utilization for consultants from January throughJune 2019 and from March throughDecember 2019 was higher than the average utilization during the corresponding periods in 2020. The difference in utilization was attributable to the disruption caused by the COVID-19 pandemic. 77
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Quarterly Results of Operations The following table sets forth unaudited statement of operations data for each of the quarters presented. The quarterly statement of operations data was prepared on the same basis as our annual consolidated financial statements. In our opinion, this financial information includes all normal and recurring adjustments considered necessary for a fair statement of such financial information. The historical results presented below are not necessarily indicative of financial results to be achieved in future periods. This information should be read together with our consolidated financial statements and the related notes. For the Three Months Ended (unaudited) December 31, September 30, March 30, December 31, September 30, March 30, (in thousands) 2021 2021 June 30, 2021 2021 2020 2020 June 30, 2020 2020 Net revenues: Services$ 47,573 $ 44,191 $ 42,284 $ 43,527 $ 42,377 $ 37,207 $ 33,123 $ 34,484 Products 49,733 38,220 32,964 39,104 44,704 32,321 28,439 30,259 Net revenues 97,306 82,411 75,248 82,631 87,081 69,528 61,562 64,743 Operating expenses: Costs of services(1) 26,442 20,993 20,785 24,021 24,425 20,077 20,067 19,575 Cost of products(1) 30,033 24,221 22,299 26,527 26,510 21,226 18,429 20,988 Selling, general and administrative 23,109 21,296 29,589 20,099 21,068 18,784 18,983 21,120 Depreciation and amortization 7,812 7,473 7,823 7,372 7,323 6,918 6,949 6,842 Transaction related costs 2,924 328 1,556 1,086 3,672 80 52 145 Change in fair value of contingent consideration - - 96 - (10,770) - - - Total operating expenses 90,320 74,311 82,148 79,105 72,228 67,085 64,480 68,670 Operating income (loss) 6,986 8,100 (6,900) 3,526 14,853 2,443 (2,918) (3,927) Other income (expense): Interest income 18 - - - - - 1 6 Loss on extinguishment of debt - - (5,015) - - - - - Interest expense (2,168) (3,283) (6,394) (5,467) (5,381) (4,561) (4,648) (4,270) Total other (expense) income (2,150) (3,283) (11,409) (5,467) (5,381) (4,561) (4,646) (4,264) Income (loss) from continuing operations before income taxes 4,836 4,817 (18,309) (1,941) 9,472 (2,118) (7,564) (8,191) Income tax (expense) benefit (4,423) (1,131) 5,166 1,007 (1,368) 472 1,537 1,263 Net income (loss) from continuing operations 413 3,686 (13,143) (934) 8,104 (1,646) (6,027) (6,928) Income (loss) from discontinued operations, net of tax - - - - - (7) 7 36 Net income (loss)$ 413 $ 3,686 $ (13,143) $ (934) $ 8,104 $ (1,652) $ (6,020) $ (6,892)
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(1)Excludes amortization of intangible assets and depreciation, which are separately stated below.
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Table of Contents Liquidity and Capital Resources Overview Our primary sources of liquidity are our existing cash and cash equivalents, cash provided by operating activities and borrowings available under our Credit Agreement. As ofDecember 31, 2021 , we had unrestricted cash and cash equivalents of$38.8 million , and as ofDecember 31, 2021 , our total indebtedness was$192.6 million . We are a holding company that transacts substantially all of our business through our operating subsidiaries. Consequently, our ability to pay dividends to stockholders, meet debt payment obligations, and pay taxes and operating expenses is largely dependent on dividends or other distributions from our subsidiaries, whose ability to pay such distributions to us is restricted, subject to certain exceptions, pursuant to the terms of the Credit Agreement. Covenants contained in the Credit Agreement may restrict our operating subsidiaries from issuing dividends and other distributions to us. See Note 9. Credit Facility to our consolidated financial statements in this Form 10-K for additional information regarding our credit facilities. Our principal liquidity needs have been, and we expect them to continue to be, working capital and general corporate needs, debt service, capital expenditures and potential acquisitions. Our capital expenditures for property and equipment to support growth in the business were$6.4 million and$5.2 million for the years endedDecember 31, 2021 and 2020, respectively, and$1.4 million and$9.8 million for the Successor period and for the Predecessor period, respectively. Additional expenditures for software development were$5.9 million and$4.4 million for the years endedDecember 31, 2021 , and 2020, respectively, and$2.1 million and$2.5 million for the Successor period and for the Predecessor period, respectively. We believe that our primary sources of liquidity, including our cash and cash equivalents, cash provided by operating activities and borrowing capacity under our Credit Agreement, will be sufficient to meet our liquidity needs for at least the next 12 months. We anticipate that to the extent that we require additional liquidity, it will be funded through the incurrence of additional indebtedness, the issuance of additional equity, or a combination thereof. We cannot assure you that we will be able to obtain this additional liquidity on reasonable terms, or at all. Additionally, our liquidity and our ability to meet our obligations and fund our capital requirements are also dependent on our future financial performance, which is subject to general economic, financial, and other factors that are beyond our control. See "Risk Factors."
Year Ended
Cash Flows Information
The following table presents a summary of cash flows for the periods presented: For the year ended For the year December 31, ended December (in thousands) 2021 31, 2020 Net cash (used in) provided by operating activities$ (2,315) $ 31,563 Net cash used in investing activities$ (12,329) $ (13,272) Net cash provided by financing activities$ 4,413 $ 9,429 Operating Activities
Net cash (used in) provided by operating activities for the year ended
Net loss was$10.0 million for the year endedDecember 31, 2021 , as compared to$6.5 million for the year endedDecember 31, 2020 . The net loss for the year endedDecember 31, 2021 included$7.9 million for director and officer prior acts insurance premium,$5.0 million of expense related to theJune 2021 extinguishment of debt and$2.3 million related to the one-time termination of a management service agreement with TPG. Non-cash items were$40.9 million for the year endedDecember 31, 2021 , as compared to$23.7 million for the year endedDecember 31, 2020 . The effect of changes in operating assets and liabilities was a cash decrease of$33.3 million for the year endedDecember 31, 2021 , as compared to a cash increase of$14.3 million for the year endedDecember 31, 2020 . The most significant drivers contributing to this net decrease of$47.6 million relate to the following:
•Final contingent consideration payments of
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•A net decrease related to accounts payable and accrued expenses of
Investing Activities
Net cash used in investing activities for the year endedDecember 31, 2021 , was$12.3 million compared to$13.3 million for the year endedDecember 31, 2020 . Net cash used in investing activities for both 2021 and 2020, was primarily attributable to expenditures for property and equipment and software development.
Financing Activities
Net cash provided by financing activities for the year endedDecember 31, 2021 , was$4.4 million compared to$9.4 million for the year endedDecember 31, 2020 . During the year endedDecember 31, 2021 , net cash provided by financing activities was primarily attributable to net IPO proceeds of$146.1 million , net proceeds from issuance of debt of$75.9 million , and proceeds from the exercise of vested stock options of$1.4 million , offset in part by$74.5 million special dividend paid inFebruary 2021 ,$133.9 million repayment of term loans and associated prepayment premiums, and$10.3 million contingent consideration payments related to the holdback liability associated with the TPG and the earn-out liability associated withHealthScape Advisors . During the year endedDecember 31, 2020 , net cash provided by financing activities was primarily attributable to net proceeds from issuance of debt of$23.9 million offset in part by$2.4 million repayment of term loan, and$11.9 million contingent consideration payments related to the earn-out liability associated withHealthScape Advisors and Pareto Intelligence.
Year Ended
Cash Flows Information
The following table presents a summary of cash flows for the periods presented: Period from Period from For the year ended Inception to January 1, 2019 to December 31, 2020 December 31, 2019 September 3, 2019 (in thousands) (Successor) (Predecessor) Net cash provided by (used in) operating activities $ 31,563 $ (14,391) $ 25,247 Net cash used in investing activities $ (13,272) $ (629,850) $ (12,287) Net cash provided by (used in) financing activities $ 9,429 $ 665,566 $ (1,329) Operating Activities
Net cash provided by (used in) operating activities for the year ended
Net loss was$(6.5) million for the year endedDecember 31, 2020 , as compared to$(16.8) million for the Successor period and net income of$3.6 million for the Predecessor period. The decrease in net loss was primarily due to a decrease in transaction related costs and growth in our service and product revenues, partially offset by an increase in operating expenses to support the growth in the business. Non-cash items were$23.7 million for the year endedDecember 31, 2020 as compared to$8.7 million for the Successor period and$10.1 million for the Predecessor period. The increase in non-cash items was primarily driven by a$6.4 million increase in share-based compensation, a$4.7 million increase in amortization associated with an increase in intangible assets due to the TPG acquisition, and a$22.2 million decrease in deferred income tax benefit, which was partially offset by a$30.4 million decrease for the change in fair value of contingent consideration. The effect of changes in operating assets and liabilities was a cash increase of$14.3 million for the year endedDecember 31, 2020 , as compared to a cash decrease of$6.3 million for the Successor period and increase of$11.5 million for the Predecessor period. The most significant drivers contributing to this net increase of$9.1 million relates to the following:
•A decrease related to accounts receivable of
•An increase related to inventory of
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•A net increase related to accounts payable and accrued expenses of$11.1 million primarily due to timing of payments. The increase in accounts payable and accrued expenses was$29.7 million for the year endedDecember 31, 2020 , as compared to$6.0 million for the Successor period and$12.6 million for the Predecessor period. Investing Activities Net cash used in investing activities for the year endedDecember 31, 2020 was$13.3 million compared to$629.9 million for the Successor period and$12.3 million for the Predecessor period. The use of the$629.9 million from the Successor period was primarily due to the cash used to fund the TPG acquisition.
Financing Activities
Net cash provided by (used in) financing activities for the year endedDecember 31, 2020 was$9.4 million compared to$665.6 million for the Successor period and($1.3) million for the Predecessor period. The use of$665.6 million for the Successor period was primarily driven by proceeds received from the issuance of$225.0 million of debt and$447.4 million in proceeds received associated with our acquisition capitalization. The inflow of$9.4 million for 2020 was primarily driven by$25.0 million of proceeds received from the issuance of debt offset by a contingent consideration payment of$11.9 million . 81
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Contractual Obligations and Commitments The following table summarizes our contractual obligations as ofDecember 31, 2021 . The principal commitments consisted of obligations under outstanding operating leases for office facilities, capital leases related to copy machines, our long-term debt, and purchase commitments. The amount of the obligations presented in the following table summarizes as ofDecember 31, 2021 , the commitments to settle contractual obligations in cash for the periods presented. Payments Due by Period Less than 1 More than (in thousands) Total year 1-3 Years 4-5 Years 5 years Operating lease obligations$ 37,914 $ 8,762 $ 15,129 $ 7,803 $ 6,220 Capital lease obligations 1,084 529 473 82 - Long-term debt obligations(1) 192,631 - - 192,631 - Purchase commitments 5,208 5,208 - - - Total contractual obligations$ 236,837 $ 14,499 $ 15,602 $ 200,516 $ 6,220 ________________________
(1)Includes the term loan under our Credit Agreement.
Off-Balance Sheet Arrangements
During the periods presented we did not have any off-balance sheet arrangements,
as defined in Regulation S-K promulgated by the
Critical Accounting Policies and Use of Estimates The discussion and analysis of our financial condition and results of operations is based upon our consolidated financial statements, which have been prepared in accordance with GAAP. The preparation of our financial statements requires us to make judgments, estimates, and assumptions that affect the reported amounts of assets, liabilities, income, and expenses and related disclosures of contingent assets and liabilities. We base these estimates on our historical experience and various other assumptions that we believe to be reasonable under the circumstances. Actual results experienced may vary materially and adversely from our estimates. Revisions to estimates are recognized prospectively. We believe the following critical accounting policies could potentially produce materially different results if we were to change underlying assumptions, estimates, or judgments. See Note 2. Summary of Significant Accounting Policies to our consolidated financial statements in this Form 10-K for a summary of our significant accounting policies.
Revenue Recognition
We recognize revenue under ASC 606. We recognize revenue when our customer obtains control of promised goods or services, in an amount that reflects the consideration that the entity expects to receive in exchange for those goods or services. To determine revenue recognition for contracts that are within the scope of the standard, we perform the following five steps:
1) Identify the contract(s) with a customer
A contract with a customer exists when (i) we enter into an enforceable contract with the customer that defines each party's rights regarding the goods or services to be transferred and identifies the payment terms related to these goods or services, (ii) the contract has commercial substance, and (iii) we determine that collection of substantially all consideration for goods or services that are transferred is probable based on the customer's intent and ability to pay the promised consideration. We apply judgment in determining the customer's ability and intention to pay. Our customary business practice is to enter into legally enforceable written contracts with our customers. The majority of our contracts are governed by a master agreement between us and the customer, which sets forth the general terms and conditions of any individual contract between the parties, which is then supplemented by any of the following: software as a service agreement, statement of work, project task orders, or purchase orders. The supplement specifies the different goods and services, the associated prices, and any additional terms for an individual contract. Multiple contracts with a single counterparty entered into at the same time are evaluated to determine if the contracts should be combined and accounted for as a single contract. Typical payment terms are net 30 days.
2) Identify the performance obligations in the contract
Performance obligations promised in a contract are identified based on the goods or services that will be transferred to the customer that are both capable of being distinct, whereby the customer can benefit from the goods or services either on its own 82
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or together with other resources that are readily available from third parties or from us, and are distinct in the context of the contract, whereby the transfer of the goods or services is separately identifiable from other promises in the contract. To the extent a contract includes multiple promised goods or services, we must apply judgment to determine whether promised goods or services are capable of being distinct and are distinct in the context of the contract. If these criteria are not met the promised goods or services are accounted for as a combined performance obligation. No customer can take possession of our software in the ordinary course of business, nor is it feasible for a customer to contract with a third party to host the software or for a customer to host the software. Therefore, our license arrangements are accounted for as service obligations, rather than the transfer of intellectual property.
The Company is generally acting as a principal in each arrangement and, thus, recognizes revenue on a gross basis.
3) Determine the transaction price
The transaction price is determined based on the consideration to which we will be entitled in exchange for transferring goods or services to the customer. We assess the timing of transfer of goods and services to the customer as compared to the timing of payments to determine whether a significant financing component exists. As a practical expedient, we do not assess the existence of a significant financing component when the difference between payment and transfer of deliverables is a year or less, which is the case in most of our customer contracts. The primary purpose of our invoicing terms is not to receive or provide financing from or to customers. To the extent the transaction price includes variable consideration, we estimate the amount of variable consideration when it is required. Typically, outside of our supplemental benefit products, we do not provide our customers with any right of return. We do not constrain the contract price as it is probable that there will not be a significant revenue reversal due to a return.
4) Allocate the transaction price to the performance obligations in the contract
If the contract contains a single performance obligation, the entire transaction price is allocated to the single performance obligation. However, if a series of distinct goods or services that are substantially the same qualifies as a single performance obligation in a contract with variable consideration, we must determine if the variable consideration is attributable to the entire contract or to a specific part of the contract. We allocate the variable amount to one or more distinct performance obligations or to one or more distinct services that forms a part of a single performance obligation, when the payment terms of the variable amount relate solely to our efforts to satisfy that distinct performance obligation and it results in an allocation that is consistent with the overall allocation objective of ASC 606. Where variable revenue exists in connection with providing a series of substantially similar services to our customers, we do not estimate variable revenue at the inception of a contract but recognize revenue as services are provided which typically aligns with billing. Contracts that contain multiple performance obligations require an allocation of the transaction price to each performance obligation based on a relative standalone selling price ("SSP") unless the transaction price is variable and meets the criteria to be allocated entirely to a performance obligation or to a distinct good or service that forms part of a single performance obligation. We determine SSP based on the price at which the performance obligation is sold separately. If the SSP is not observable through past transactions, we estimate the SSP using an expected cost-plus-a-margin approach.
5) Recognize revenue when (or as) the entity satisfies a performance obligation
We satisfy performance obligations either over time or at a point in time depending on the nature of the underlying promise. Revenue is recognized at the time the related performance obligation is satisfied by transferring a promised good or service to a customer.
Accounting Policy Elections and Practical Expedients
We have elected to exclude from the measurement of the transaction price all taxes (e.g., sales, use, value-added) assessed by government authorities and collected from a customer. Therefore, revenue is recognized net of such taxes. We contract with customers to deliver and ship tangible products within the normal course of business, such as supplemental benefit products. The control of the products transfers to the customer, in most cases, free on board (FOB) shipping point. We have elected to use the practical expedient allowed under ASC 606 to account for shipping and handling activities that occur after the customer has obtained control of a promised good as fulfillment costs rather than as an additional promised service and, therefore, we do not allocate a portion of the transaction price to a shipping service obligation. We record as revenue any amounts billed to customers for shipping and handling costs and record as cost of revenue the actual shipping costs incurred. 83
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In accordance with ASC 606, if an entity has a right to consideration from a customer in an amount that corresponds directly with the value to the customer of the entity's performance completed to date, the entity may recognize revenue in the amount to which the entity has a right to invoice ("right-to-invoice" practical expedient). We have elected to utilize this expedient on supplemental benefit products shipped and advisory services that are not based on a fixed fee. Our standard contract terms allow for the reimbursement by a customer for certain travel expenses necessary to provide on-site services to the customer. Such reimbursed travel expenses are reported on a gross basis. Since such reimbursed travel expenses do not represent a distinct good or service nor incremental value provided to a customer, a performance obligation is deemed not to exist. Where the "right-to invoice" practical expedient is being applied to variable consideration any client pass-thru charges related to the consulting services performance obligations are also treated under the "right-to-invoice" practical expedient.
Share-based Compensation Policy
Compensation expense related to stock option awards granted to certain employees and non-employee directors is based on the fair value of the awards on the grant date. If the service inception date precedes the grant date, accrual of compensation cost for periods before the grant date is based on the fair value of the award at the reporting date. In the period in which the grant date occurs, cumulative compensation cost is adjusted to reflect the cumulative effect of measuring compensation cost based on fair value at the grant date rather than the fair value previously used at the service inception date or any subsequent reporting date. Forfeitures are recorded as they occur. We elected to recognize compensation cost related to time-vested options with graded vesting features on a straight-line basis over the requisite service period. Compensation cost related to performance-vesting option, where a performance condition or a market condition that affects vesting exists, is recognized over the shortest of the explicit, implicit, or defined service periods. Compensation cost is adjusted depending on whether or not the performance condition is achieved. If the performance condition is probable or becomes probable of being achieved, the full fair value of the award (i.e., without regard for the market condition) is recognized. If the performance condition is not probable of being achieved, then compensation cost for the value of the award incorporating the market condition is recognized. We estimate the fair value of the stock option awards on the date of grant using the Black-Scholes Merton model and/or the Monte-Carlo simulation model. Prior to the IPO, in order to estimate the equity value of the enterprise to determine the fair value of our common units, we used a combination of the market approach and the income approach. For the market approach, we utilized the Guideline Company Method by selecting certain companies that we considered to be the most comparable to us in terms of size, growth, profitability, risk and return on investment, among others. We then used these guideline companies to develop relevant market multiples and ratios. The market multiples and ratios were applied to our financial projections based on assumptions at the time of the valuation in order to estimate our total enterprise value. Since there was not an active market for our common units, a discount for lack of marketability was then applied to the resulting value. For the income approach, we performed discounted cash flow analyses utilizing projected cash flows, which were discounted to the present value in order to arrive at an enterprise value. The key assumptions used in the income approach include management's financial projections which are based on highly subjective assumptions as of the date of valuation, a discount rate and a long-term growth rate. The fair value of options without a market condition are valued using the Black-Scholes Merton model. The fair value of options with a market condition are valued using the Monte-Carlo simulation model. Option valuation models, including the Black-Scholes Merton model and Monte-Carlo simulation model, require the input of certain assumptions that involve judgment. Changes in the input assumptions can materially affect the fair value estimates and, ultimately, how much we recognize as stock-based compensation expense. The fair value of the options granted during the year are estimated on the date of the grant using the historical volatility of the common stock of other companies in the same industry over a period of time commensurate with the expected term of the options awarded. We use the simplified method for estimating the expected term of the options since we have limited historical experience to estimate expected term behavior. We estimate the risk-free interest rate based onU.S. Treasury note rates for the expected term. We do not intend to pay dividends on our common shares, therefore, the dividend yield percentage is zero. Following our IPO inJune 2021 , equity awards have been issued to certain employees in the form of restricted stock units ("RSUs") and/or stock options. The grant date fair value of RSUs is based on the closing stock price of our common stock on the date of grant and is recognized as stock-based compensation expense over the vesting period. The grant date fair value of stock options is measured using a Black-Scholes Merton model and is recognized as stock-based compensation expense over the vesting period. Long-Term Incentive ("LTI") awards vest upon satisfaction of a return on investment from a liquidity event as determined by our Board of Directors at its sole discretion, subject to the participant's continued employment or service. The LTI awards therefore have a market condition with an associated implicit performance condition. Settlement of the award can be made, as determined by the Board of Directors at its sole discretion, (i) in cash, (ii) common stock, or (iii) in other property acceptable to 84
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the Board of Directors. The LTIs are treated as liability-based awards under ASC Topic 718, Compensation - Stock Compensation ("ASC 718"). As the LTI awards are liability-classified, the award is measured for fair value on the grant date. The fair value of the award is re-measured each reporting period until the award is settled. The Company will recognize compensation expense for the LTIs upon the liquidity event occurring.
Goodwill represents the fair value of acquired businesses in excess of the fair value of the individually identified net assets acquired.Goodwill is not amortized but is tested for impairment annually or whenever indications of impairment exist. Impairment exists when the carrying amount, including goodwill, of the reporting unit exceeds its fair value, resulting in an impairment charge for this excess (not to exceed the carrying amount of the goodwill). Our annual impairment testing date isOctober 1 . We can elect to qualitatively assess goodwill for impairment if it is more likely than not that the fair value of a reporting unit exceeds its carrying value. For purposes of the goodwill impairment test, we have determined our business operates in four reporting units:Advanced Plan Administration ,Supplemental Benefit Administration , Value Based Payment Assurance, and Advisory Services.Advanced Plan Administration ,Supplemental Benefit Administration , and Value Based Payment Assurance reporting units form part of the Technology Enabled Solutions reporting segment. A qualitative assessment considers macroeconomic and other industry-specific factors, such as trends in short-term and long-term interest rates and the ability to access capital, and company specific factors such as trends in revenue generating activities, and merger or acquisition activity. If we elect to bypass qualitatively assessing goodwill, or it is not more likely than not that the fair value of a reporting unit exceeds its carrying value, management estimates the fair values of each of our reporting units mentioned above and compares it to their carrying values. Evaluation of goodwill for impairment requires judgment, including the identification of reporting units, assignment of assets, liabilities and goodwill to reporting units and determination of the fair value of each reporting unit. We estimate the fair value of our reporting units using a combination of an income approach, utilizing a discounted cash flow analysis, and a market approach, using market multiples. Under the income approach, we estimate projected future cash flows, the timing of such cash flows and long-term growth rates, and determine the appropriate discount rate that reflects the risk inherent in the projected future cash flows. The discount rate used is based on a market participant weighted-average cost of capital and may be adjusted for the relevant risk associated with business-specific characteristics and the uncertainty related to the reporting unit's ability to execute on the projected future cash flows. Under the market approach, we estimate fair value based on market multiples of revenues and earnings derived from comparable publicly-traded companies with characteristics similar to the reporting unit. The estimates used to calculate the fair value of a reporting unit change from year to year based on operating results, market conditions and other factors. Changes in these estimates and assumptions could materially affect the determination of fair value for each reporting unit.
Based on our most recent evaluation of goodwill performed on
Income Taxes
Income tax expense includes federal, state, and foreign taxes and is based on reported income before income taxes. We recognize deferred tax assets and liabilities based on the differences between the financial statement carrying amounts and the tax basis of assets and liabilities. The deferred tax assets and liabilities are determined based on the enacted tax rates expected to apply in the periods in which the deferred tax assets or liabilities are anticipated to be settled or realized. We regularly review our deferred tax assets for recoverability and establish a valuation allowance if it is more likely than not that some portion, or all, of a deferred tax asset will not be realized. The determination as to whether a deferred tax asset will be realized is made on a jurisdictional basis and is based on the evaluation of positive and negative evidence. This evidence includes historical taxable income, projected future taxable income, the expected timing of the reversal of existing temporary differences and the implementation of tax planning strategies. We recognize the tax benefit from uncertain tax positions only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized from uncertain tax positions are measured at the largest amount of benefit that is greater than fifty percent likely of being realized upon ultimate settlement. No tax benefits are recognized for positions that do not meet this threshold. Interest related to uncertain tax positions is recognized as part of the provision for income taxes and is accrued beginning in the period that such 85
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interest would be applicable under relevant tax law until such time that the related tax benefits are recognized. See Note 13. Taxes to our consolidated financial statements in this Form 10-K for additional information.
Determining the consolidated provision for income tax expense, deferred income tax assets (and related valuation allowance, if any) and liabilities requires significant judgment. We are required to calculate and provide for income taxes in each of the jurisdictions where we operate. Changes in the geographic mix of income before taxes or estimated level of annual pre-tax income can affect our overall effective income tax rate. The consolidated provision for income taxes may change period to period based on changes in facts and circumstances, such as settlements of income tax audits.
Contingent Consideration
We recognized an earn-out liability in connection with the
The initial fair value of the earn-out liability was determined by employing a Monte-Carlo simulation model. The underlying simulated variable was adjusted revenue discounted by the market price of risk embedded in the revenue metrics. The revenue volatility estimate was based on a study of historical asset volatility and implied volatility for a set of comparable public companies, adjusted by our operating leverage. The earn-out payments were calculated based on simulated revenue metrics and payment thresholds as set forth in theHealthScape Advisors and Pareto Intelligence purchase agreement. The calculated payments were further discounted back to present value using cost of debt reflecting our credit risk. The fair value of the earn-out liability at each reporting date subsequent to the acquisition was measured using a probability weighted approach. Any change in fair value was recognized in the consolidated statements of operations and comprehensive (loss) income. In connection with the Merger, we recognized a holdback liability, which represented contingent consideration. See Note 4. Acquisitions to our consolidated financial statements in this Form 10-K for additional information. The initial fair value of the holdback liabilities and at each subsequent reporting date was measured using a probability weighted approach. Any change in fair value was recognized in the consolidated statements of operations and comprehensive (loss) income. During the year endedDecember 31, 2021 , we made a final payment of$13 million related to the holdback liability and a$7.5 million final payment related to the earn-out liability due toHealthScape Advisors . Recent Accounting Pronouncements
See Note 2. Summary of Significant Accounting Policies, to our consolidated financial statements in this Form 10-K for more information.
Emerging Growth Company Status Pursuant to the JOBS Act, an emerging growth company is provided the option to adopt new or revised accounting standards that may be issued by FASB or theSEC either (i) within the same periods as those otherwise applicable to non-emerging growth companies or (ii) within the same time periods as private companies. We intend to take advantage of the exemption for complying with new or revised accounting standards within the same time periods as private companies. Accordingly, the information contained herein may be different than the information you receive from other public companies. We also intend to take advantage of some of the reduced regulatory and reporting requirements of emerging growth companies pursuant to the JOBS Act so long as we qualify as an emerging growth company, including, but not limited to, not being required to comply with the auditor attestation requirements of Section 404(b) of the Sarbanes-Oxley Act, reduced disclosure obligations regarding executive compensation and exemptions from the requirements of holding non-binding advisory votes on executive compensation and golden parachute payments.
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