HEALTHSTREAM INC Item 1A Risk Factors We believe that the risks and uncertainties described below and elsewhere in this document are the principal material risks facing the Company as of the date of this report |
In the future, we may become subject to additional risks that are not currently known to us |
Our business, financial condition or results of operations could be materially adversely affected by any of the following risks and by any unknown risks |
The trading price of our common stock could decline due to any of the following risks or any unknown risks |
We may be unable to effectively implement our growth strategy which could have an adverse effect on our business and competitive position in the industry |
Our business strategy includes increasing our market share and presence through sales to new customers, transitioning existing customers, further penetration and additional sales to existing customers and introductions of new products and services |
Some of the risks that we may encounter in implementing our growth strategy include: • expenses, delays and difficulties of identifying and integrating new products or services into our existing organization; • inability to leverage our operational and financial systems sufficient to support our growth; • inability to generate sufficient revenue from new products to offset investment costs; and • inability to effectively identify, manage and exploit existing and emerging market opportunities |
If any of these risks are realized, our business could suffer |
We may be unable to effectively identify, complete or integrate the operations of future acquisitions |
As part of our growth strategy, we are actively reviewing possible acquisitions that complement or enhance our business |
We may not be able to identify, complete or integrate the operations of future acquisitions |
In addition, if we finance acquisitions by issuing equity securities, our existing shareholders may be diluted which could affect the market price of our stock |
As a result, if we fail to properly evaluate and execute acquisitions and investments, our business prospects may be seriously harmed |
Some of the risks that we may encounter in implementing our acquisition strategy include: • expenses, delays or difficulties of identifying and integrating acquired companies into our organization; • inability to retain personnel associated with acquisitions; • diversion of management’s attention from daily operations; and • inability to generate sufficient revenues from acquisitions to offset acquisition costs |
Certain revenue components are subject to significant fluctuations |
As revenues from our subscription business continue to increase, a larger portion of our revenues will be predictable; however, quarterly performance may be more subject to fluctuations associated with our project based products and services, which generally relates to our pharmaceutical and medical device customers as well as healthcare organization customers who use our survey and research services |
The pharmaceutical and medical device business is generally associated with recurring customer relationships, however services are generally specific and relate to product launches or training events that may vary from year to year |
The magnitude of such contracts 9 _________________________________________________________________ [65]Table of Contents may vary widely |
Our survey and research services are typically contracted by healthcare organizations for multi-year terms, but the frequency and timing of survey cycles can vary from quarter to quarter |
Our sales cycle is lengthy and can vary widely |
The period from our initial contact with a potential customer and the first purchase of our solution by the customer typically ranges from three to nine months, and in some cases has extended much further |
The range in the sales cycle can be impacted by factors including an increasing trend towards more formal requests for proposals (RFP’s) process, and more competition within our space, as well as formal budget timelines which impact timing of purchases by target customers |
This, in turn, makes it more difficult to predict quarterly financial performance |
We may not be able to maintain our competitive position against current and potential competitors, especially those with significantly greater financial, marketing, technical and other resources |
Several of our competitors have longer operating histories and significantly greater financial, technical, marketing and other resources than we do |
We encounter direct competition from both large and small e-learning companies focused on training and continuing education in the healthcare industry |
We also face competition from larger survey and research companies |
We believe we maintain a competitive advantage against our competitors with the comprehensive array of products and services we offer |
If our competitors were to offer a complete e-learning solution to the healthcare industry, our competitive position could be adversely affected |
These companies may be able to respond more quickly than we are to new or changing opportunities, technologies, standards or customer requirements |
Further, most of our customer agreements are for shorter terms ranging from one to three years, with no obligation to renew |
The short terms of these agreements allow customers to more easily shift to one of our competitors |
Growth in courseware subscription revenues depend, in part, on our obtaining proper distribution rights from our content partners |
Most of our agreements with content providers are for initial terms of two to three years |
The content partners may choose not to renew their agreements with us or may terminate the agreements early if we do not fulfill our contractual obligations |
If a significant number of our content providers terminate or fail to renew their agreements with us on acceptable terms, it could result in a reduction in the number of courses we are able to distribute and decreased revenues |
Most of our agreements with our content partners are also non-exclusive, and our competitors also offer, or could offer, training and continuing education content that is similar to or the same as ours |
If publishers and authors, including our current content partners, offer information to users or our competitors on more favorable terms than those offered to us or increase our license fees, our competitive position and our profit margins and prospects could be harmed |
In addition, the failure by our content partners to deliver high-quality content and to revise their content in response to user demand and evolving healthcare advances and trends could result in user dissatisfaction and inhibit our ability to attract and retain subscribers of our courseware offerings |
We may not be able to develop enhancements to our existing products and services or achieve widespread acceptance of new features or keep pace with technological developments |
Our revenue growth is expected to be generated through sales to new customers as well as increasing sales of additional courseware subscriptions and other products and services to existing customers |
Our identification of additional features, content, products and services may not result in timely development of complementary products |
In addition, the success of certain new products and services may be dependent on continued growth in our base of Internet-based customers or adoption of new methodology by new customers |
Because healthcare training continues to change and evolve, we may be unable to accurately predict and develop features, content and other products to address the needs of the healthcare industry |
If new products, features, or content are not accepted by new or existing customers, we may not be able to recover the cost of this development and our business will be harmed |
Continued growth of our Internet-based customer population is dependent on our ability to continue to provide relevant products and services in a timely manner |
The success of our business will depend on our ability to continue providing our products and services as well as enhancing our courseware, product and service offerings that address the needs of healthcare organizations |
Within the healthcare industry, our customer channels are focused on two segments: healthcare organizations and pharmaceutical/ medical device companies |
We rely on spending within these two segments and our business may suffer if financial pressures cause our potential or existing customers to cut back on our services |
There are several economic factors that have had an impact on the nation’s approximately 5cmam000 acute care hospitals |
Some of these factors include labor costs, which as recently as 2002 constituted 40 percent of 2002 hospital revenues, according to the Centers for Medicare and Medicaid (CMS), with half of that allocated for staffing nurses |
Also, the reduced Medicare payment increases that resulted from the Balanced Budget Act of 1997 and the lower payments that most hospitals accepted from managed care companies in the last several years have both had an adverse financial effect on the hospital segment |
These financial pressures, along with several major hospital defaults and bankruptcies, have resulted in limited access to capital for some hospitals |
As HealthStream’s target market within the healthcare industry, hospitals’ financial pressures are salient in achieving our business objectives |
10 _________________________________________________________________ [66]Table of Contents Financial analysts generally believe that medical device companies enjoy higher revenues and earnings growth, relative to their medical supply company counterparts, although they’re considered more volatile |
The medical device industry is highly concentrated; the largest two percent of the 6cmam000 US medical device firms account for nearly half of the industry’s sales, according to the CMS In addition, relatively short product life cycles for medical devices make the management and marketing strategies particularly crucial in this segment |
These economic factors contribute to the volatility of this customer channel for HealthStream |
The top ten pharmaceutical companies account for 60 percent of US drug sales, with the top company owning a ten percent market share of the US pharmaceutical market in 2001, according to CMS Successful research and development is the key driver for long-term growth, yet this may be held constant or reduced during profit crunches—like that experienced by some companies as the patent expires on their blockbuster drugs |
Both branded and generic pharmaceutical companies fiercely litigate intellectually property and, as a result, may experience adverse financial consequences |
Over the past few years, pharmaceutical companies experienced a significant increase in public scrutiny with respect to product development, testing and introductions in certain specific treatment areas |
Continued restrictions or further extending the testing and product launch cycle could have a negative impact on our sales to and revenues from pharmaceutical companies |
As one of our two customer channels, these characteristics of the pharmaceutical and medical device segment could have an impact on HealthStream |
Our product and service offerings include third party technology, the loss of which could materially harm our business |
Errors in third party software or our inability to license this software in the future could increase our costs and decrease our revenues |
We use some licensed third party technology components in our products |
Future licenses to this technology may not be available to us on commercially reasonable terms, or at all |
The loss of or inability to obtain or maintain any of these technology licenses could result in delays in the introduction of new products or could force us to discontinue offering portions of our learning management solutions until equivalent technology, if available, is identified, licensed and integrated |
The operation of our products would be impaired if errors occur in the third party software that we incorporate, and we may incur additional costs to repair or replace the defective software |
It may be difficult for us to correct any errors in third party software because the software is not within our control |
Accordingly, our revenue could decrease and our costs could increase in the event of any errors in this technology |
Furthermore, we may become subject to legal claims related to licensed technology based on product liability, infringement of intellectual property or other legal theories |
Financial Risks A significant portion of our revenue is generated from a relatively small number of customers |
We provide our Internet-based training and education services and our survey and research services to HCA, Inc |
(HCA) under separate agreements |
During 2005, we derived approximately 14prca, or dlra3dtta9 million, of our net revenues from HCA Our agreement with HCA for our Internet-based training and education services was automatically renewed under the terms of the existing agreement, but may be terminated by either party upon forty-five days notice to the other party |
We are in discussions regarding a revised multi-year agreement with HCA Our survey and research services agreement with HCA expires in December 2007 |
We also derive a significant portion of our revenues from a relatively small number of customers |
A termination of our agreements with HCA or several of our other significant customers or a failure by HCA or other significant customers to renew their contracts on favorable terms, or at all, would have a material adverse effect on our business |
As the percentage of our business that is subject to renewal continues to increase, those renewals have a more significant impact on our revenue and operating results |
For the year ended December 31, 2005, approximately sixty percent of our net revenues were derived from our Internet-based subscription products |
Our Internet-based HLC customers have no obligation to renew their subscriptions for our products or services after the expiration of the initial subscription period and in fact, some customers have elected not to renew their subscription |
In addition, our customers may renew at a lower pricing or activity level |
During the year ended December 31, 2005, we renewed 89prca of the annual contract value up for renewal and 92prca of the subscribers which were up for renewal |
The number of accounts up for renewal will continue to increase during and after 2006 |
Because a significant portion of our customer contracts are still operating under their original agreements or have only renewed one time, we do not have sufficient historical data to accurately predict future customer renewal rates |
Our customers’ renewal rates may decline or fluctuate as a result of a number of factors, including their dissatisfaction with our service |
If we are unable to renew a substantial portion of the contracts that are up for renewal or maintain our pricing, our revenues could be adversely affected, which would have a material adverse affect on our results of operations and financial position |
In addition, much of our live event activity is of a recurring and somewhat predictable nature, however, we do not have any long term contracts that obligate these customers beyond their current contract terms |
Contracts for our survey and research services typically range from one to three years in length, and customers are not obligated to renew their contract with us after their contract expires |
If our customers do not renew their arrangements for our service, or if their activity levels decline, our revenue may decline and our business will suffer |
11 _________________________________________________________________ [67]Table of Contents Our future success also depends in part on our ability to sell additional features or enhanced offerings of our services to our current customers |
This may require increasingly sophisticated and costly sales efforts that require targeting, contact with, or approval by our customer’s senior management |
The timing of our revenue recognition from sales activity is dependent upon achievement of certain events or performance milestones, and our inability to accurately predict them will harm our operating results |
Our ability to record revenues is dependent upon several factors including the transfer of customer-specific information such as unique subscriber IDs, which are required for us to implement customers on our Internet-based learning platform |
Accordingly, if customers do not provide us with the specified information in a timely manner, our ability to recognize revenues will be delayed, which could adversely impact our operating results |
In addition, completion and acceptance by our customers of developed content and courseware must be achieved, survey responses must be received, and utilization of courseware is required in connection with subscription Internet-based learning products and commercial support arrangements for us to recognize revenues |
As we noted above, while we have been successful in achieving growth in our subscription based revenues, our project based revenues have and may continue to be subject to significant fluctuations |
Because we recognize revenue from subscriptions for our products and services over the term of the subscription period, downturns or upturns in sales may not be immediately reflected in our operating results |
We recognize a large portion of our revenue from customers monthly over the terms of their subscription agreements, which are typically one to three years, although terms can range from less than one to up to five years |
As a result, much of the revenue we report in each quarter is related to subscription agreements entered into during previous quarters |
Consequently, a decline in new or renewed subscriptions in any one quarter will not necessarily be fully reflected in the revenue in that quarter and will negatively affect our revenue in future quarters |
In addition, we may be unable to adjust our cost structure to reflect these reduced revenues |
Accordingly, the effect of significant downturns in sales and market acceptance of our products and services may not be fully reflected in our results of operations until future periods |
Additionally, our subscription model also makes it difficult for us to rapidly increase our revenue through additional sales in any period, as revenue from new customers must be recognized over the applicable subscription term |
We may not be able to meet our strategic business objectives unless we obtain additional financing, which may not be available to us on favorable terms or at all |
Our current cash reserves and results of operations are expected to be sufficient to meet our cash requirements through at least 2006 |
However, we may need to raise additional funds in order to: • develop new, or enhance existing, services or products; • respond to competitive pressures; • finance working capital requirements; • sustain content and development relationships; or • acquire complementary businesses, technology, content or products |
At December 31, 2005, we had approximately dlra12dtta2 million in cash, cash equivalents, restricted cash, investments in marketable securities and related interest receivable |
We expect to incur up to dlra3dtta5 million of capital expenditures and content purchases during 2006 to support our business |
We are actively reviewing possible business acquisitions that would complement our products and services |
We may not have adequate cash and investments to consummate one or more acquisitions |
We cannot assure you that additional financing will be available on terms favorable to us, or at all |
If adequate funds are not available or are not available on acceptable terms, our ability to fund expansion, take advantage of available opportunities, develop or enhance services or products or otherwise respond to competitive pressures would be significantly limited |
If we raise additional funds by issuing equity or convertible debt securities, the percentage ownership of our shareholders may be reduced |
Our relatively short operating history may prevent us from forecasting our results of operations accurately |
As a result of our relatively short operating history and lack of sustained success in executing our growth strategy, we do not have historical financial data for a significant number of periods upon which to forecast quarterly revenues and results of operations |
We believe that period-to-period comparisons of our operating results are not necessarily meaningful and should not be relied upon as indicators of future performance |
In addition, our operating results may vary substantially |
This variability may be the result of differences in levels of sales activity, introductions of new products and services, and the related revenue recognition for our various products and services |
In one or more future quarters, our results of operations may fall below recent operating trends or the expectations of securities analysts and investors, and the trading price of our common stock may decline |
12 _________________________________________________________________ [68]Table of Contents We have significant goodwill and identifiable intangible assets recorded on our balance sheet that may be subject to impairment losses that would reduce our reported assets and earnings |
As of December 31, 2005, our balance sheet included goodwill of dlra10dtta3 million and identifiable intangible assets of dlra3dtta3 million |
Economic, legal, regulatory, competitive, contractual, and other factors may affect the carrying value of goodwill and identifiable intangible assets in the future |
If any of these factors impair the value of these assets, accounting rules require us to reduce their carrying value and recognize an impairment charge, which would reduce our reported assets and earnings in the period an impairment is recognized |
The market price of our common stock is likely to be volatile and could be subject to significant fluctuations in response to factors such as the following, some of which are beyond our control: quarterly variations in our operating results; operating results that vary from the expectations of securities analysts and investors; changes in expectations as to our future financial performance; changes in market valuations of other online service companies; future sales of our common stock; stock market price and volume fluctuations; general political and economic conditions, such as a recession or war or terrorist attacks or interest rate or currency rate fluctuations; and other risk factors described in this Form 10-K Moreover, our stock is thinly traded, and we have a relatively small public float |
These factors may adversely affect the market price of our common stock |
In addition, the market prices for stocks of many Internet related and technology companies have historically experienced significant price fluctuations that in some cases appear to bear no relationship to the operating performance of these companies |
Risks Related to Sales, Marketing and Competition We continue to refine our pricing and our products and services and cannot predict whether the ongoing changes will be accepted |
We cannot predict whether our current pricing and products and services, or any ongoing refinements we make will be accepted by our existing customer base or by prospective customers |
If our customers and potential customers decide not to accept our current or future pricing or product and service offerings, it could have a material adverse effect on our business |
Risks Related to Operations We may be unable to adequately develop our systems, processes and support in a manner that will enable us to meet the demand for our services |
We have provided our online products and services since 1999 and continue to develop our ability to provide our courseware and learning management systems on both a subscription and transactional basis over the Internet |
Our future success will depend on our ability to effectively develop the infrastructure, including additional hardware and software, and implement the services, including customer support, necessary to meet the demand for our services |
Our inability from time to time to successfully develop the necessary systems and implement the necessary services on a timely basis has resulted in our customers experiencing some delays or interruptions in their service |
Such delays or interruptions may cause customers to become dissatisfied with our service and move to competing providers of traditional and online training and education services |
If this happens, our revenues could be adversely affected, which would have a material adverse effect on our financial condition |
Our business operations could be significantly disrupted if we lose members of, or fail to integrate, our management team |
Our future performance is substantially dependent on the continued services of our management team and our ability to retain and motivate them |
In March 2006, our senior vice president of sales and marketing left the Company |
The loss of the services of any of our officers or senior managers could harm our business, as we may not be able to find suitable replacements |
We do not have employment agreements with any of our key personnel, other than our chief executive officer, and we do not maintain any “key person” life insurance policies |
Our future success will depend on our ability to attract, train, retain and motivate other highly skilled technical, managerial, marketing and customer support personnel |
Competition for these personnel is intense, especially for developers, Web designers and sales personnel, and we may be unable to successfully attract sufficiently qualified personnel |
We have experienced difficulty in the past hiring qualified personnel in a timely manner for these positions |
The pool of qualified technical personnel, in particular, is limited in Nashville, Tennessee, which is where our headquarters are located |
We will need to maintain the size of our staff to support our anticipated growth, without compromising the quality of our offerings or customer service |
Our inability to locate, hire, integrate and retain qualified personnel in sufficient numbers may reduce the quality of our services |
We must continue to upgrade our technology infrastructure, both hardware and software, to effectively meet demand for our services |
We must continue to add hardware and enhance software to accommodate the increased courseware in our library and increased use of our platform |
In order to make timely decisions about hardware and software enhancements, we must be able to accurately forecast the growth in demand for our services |
This growth in demand for our services is difficult to forecast and the potential audience for our services is large |
If we are unable to increase the data storage and processing capacity of our systems at least as fast as the growth in demand, our systems may become unstable and our customers may encounter delays or disruptions in their service |
Unscheduled downtime could harm our business and also could discourage current and potential customers and reduce future revenues |
Our network infrastructure and computer systems and software may fail |
An unexpected event like a telecommunications failure, fire, flood, earthquake, or other catastrophic loss at our Internet service providers’ facilities or at our on-site data facility could cause the loss of critical data and prevent us from offering our products and services |
Our business interruption insurance may not adequately compensate us for losses that may occur |
In addition, we rely on third parties to securely store our archived data, house our Web server and network systems and connect us to the Internet |
While our service providers have planned for certain contingencies, the failure by any of these third parties to provide these services satisfactorily and our inability to find suitable replacements would impair our ability to access archives and operate our systems and software |
We may lose users and lose revenues if our security measures fail |
If the security measures that we use to protect personal information are ineffective, we may lose users of our services, which could reduce our revenues |
We rely on security and authentication technology licensed from third parties |
With this technology, we perform real-time credit card authorization and verification |
We cannot predict whether these security measures could be circumvented by new technological developments |
In addition, our software, databases and servers may be vulnerable to computer viruses, physical or electronic break-ins and similar disruptions |
We may need to spend significant resources to protect against security breaches or to alleviate problems caused by any breaches |
We cannot assure that we can prevent all security breaches |
Risks Related to Government Regulation, Content and Intellectual Property Government regulation may require us to change the way we do business |
The laws and regulations that govern our business change rapidly |
The United States government and the governments of states and foreign countries have attempted to regulate activities on the Internet |
Evolving areas of law that are relevant to our business include privacy law, proposed encryption laws, content regulation and sales and use tax laws and regulations |
Because of this rapidly evolving and uncertain regulatory environment, we cannot predict how these laws and regulations might affect our business |
In addition, these uncertainties make it difficult to ensure compliance with the laws and regulations governing the Internet |
These laws and regulations could harm us by subjecting us to liability or forcing us to change how we do business |
See “Business — Government Regulation of the Internet and the Healthcare Industry” for a more complete discussion of these laws and regulations |
Any reduction or change in the regulation of continuing education and training in the healthcare industry may adversely affect our business |
Our business model is dependent in part on required training and continuing education for healthcare professionals and other healthcare workers resulting from regulations of state and Federal agencies, state licensing boards and professional organizations |
Any change in these regulations that reduce the requirements for continuing education and training for the healthcare industry could harm our business |
14 _________________________________________________________________ [70]Table of Contents In addition, our business with pharmaceutical and medical device manufacturers is predicated on our ability to maintain accreditation status with organizations such as the ACCME, ANCC, American Council for Pharmaceutical Education (ACPE) and others |
The failure to maintain status as an accredited provider could result in a detrimental effect on our business |
New regulations may reduce our business activity with pharmaceutical and medical device customers |
These guidelines collectively identify three areas of risks for pharmaceutical and medical device companies and recommends certain best practices to be included in a compliance plan designed to avoid the risk of federal healthcare program abuse |
The guidance highlighted a number of arrangements that have the potential to trigger fraud and abuse violations, including educational grants |
The Company follows the rules and guidelines provided by the ACCME, ANCC and other continuing education accrediting bodies to ensure that its continuing education programming is free from commercial bias and consistent with the OIG guidance |
The majority of the Company’s accredited continuing education programming is funded by educational grants from our pharmaceutical and medical device customers |
There is no assurance that our pharmaceutical and medical device customers will continue to provide educational grants consistent with past practices |
To the extent that our customers curtail or restructure their business practices, it could have a material adverse impact on the Company’s revenues, results of operations, and financial position |
We may be liable to third parties for content that is available from our online library |
We may be liable to third parties for the content in our online library if the text, graphics, software or other content in our library violates copyright, trademark, or other intellectual property rights, our content partners violate their contractual obligations to others by providing content to our library or the content does not conform to accepted standards of care in the healthcare profession |
We attempt to minimize these types of liabilities by requiring representations and warranties relating to our content partners’ ownership of the rights to distribute as well as the accuracy of their content |
We also take necessary measures to review this content ourselves |
Although our agreements with our content partners contain provisions providing for indemnification by the content providers in the event of inaccurate content, we cannot assure you that our content partners will have the financial resources to meet this obligation |
Alleged liability could harm our business by damaging our reputation, requiring us to incur legal costs in defense, exposing us to awards of damages and costs and diverting management’s attention away from our business |
See “Business — Intellectual Property and Other Proprietary Rights” for a more complete discussion of the potential effects of this liability on our business |
Protection of certain proprietary trademarks and domain names may be difficult and costly |
Despite protection of certain proprietary trademarks and domain names, a third-party could, without authorization, copy or otherwise appropriate our content or other information from our database |
Our agreements with employees, consultants and others who participate in development activities could be breached |
We may not have adequate remedies for any breach, and our trade secrets may otherwise become known or independently developed by competitors |
In addition, the laws of some foreign countries do not protect our proprietary rights to the same extent as the laws of the United States, and effective copyright, trademark and trade secret protection may not be available in those jurisdictions |
We currently hold several domain names |
The legal status of intellectual property on the Internet is currently subject to various uncertainties |
The current system for registering, allocating and managing domain names has been the subject of litigation and proposed regulatory reform |
Additionally, legislative proposals have been made by the federal government that would afford broad protection to owners of databases of information, such as stock quotes |
This protection of databases already exists in the European Union |
There have been substantial amounts of litigation in the computer and online industries regarding intellectual property assets |
Third-parties may claim infringement by us with respect to current and future products, trademarks or other proprietary rights, and we may counterclaim against such parties in such actions |
Any such claims or counterclaims could be time-consuming, result in costly litigation, divert management’s attention, cause product release delays, require us to redesign our products or require us to enter into royalty or licensing agreements, any of which could have a material adverse effect upon our business, financial condition and operating results |
Such royalty and licensing agreements may not be available on terms acceptable to us, if at all |
We may be unable to protect our intellectual property, and we may be liable for infringing the intellectual property rights of others |
Our business could be harmed if unauthorized parties infringe upon or misappropriate our proprietary systems, content, services or other information |
Our efforts to protect our intellectual property through copyright, trademarks and other controls may not be adequate |
In the future, litigation may be necessary to enforce our intellectual property rights or to determine the validity and scope of the proprietary rights of others, which could be time consuming and costly |
Intellectual property infringement claims could be made against us as the number of our competitors grows |
These claims, even if not meritorious, could be expensive and divert our attention from operating our company |
In addition, if we become liable to third parties for infringing their intellectual property rights, we could be required to pay a substantial damage award and develop comparable non-infringing intellectual property, to obtain a license or to cease providing the content or services that contain the infringing intellectual property |
We may be unable to develop non-infringing intellectual property or obtain a license on commercially reasonable terms, if at all |