The formulary revision process considers manufacturer rebates, payments from drug manufacturers for low placement on PBM Pharmacy Benefit Manager formularies, along with average cvs health store in california price AWPdrug availability, and bulk discounts when choosing at which co-pay a brand name drug should be placed. Jn cares forpatients annually through a national network of more than 85 locations as well as the largest home infusion network cs the United States. I'm already a fan, gealth show this again. Review the Patch Community Guidelines. Subscribe to Patch's new newsletter to be the first to know about open houses, new listings and carefirst jew. The update comes after at least eight deaths are said to have occurred since then. Bloomberg -- Oil steadied as traders looked to a revival in Chinese demand this year after data showed that the economy fared better than expected last quarter, with further clues on the outlook to come in an OPEC analysis.
In many cases, these state laws are not preempted by the HIPAA Privacy Standards and may be subject to interpretation by various courts and other governmental authorities.
Further, the U. Congress and a number of states have considered or are considering prohibitions or limitations on the disclosure of medical or other information to individuals or entities located outside of the United States. Banking and Financial Services Industry. The banking and financial services industry is subject to numerous laws, regulations and industry standards, some of which may impact our operations and subject us, our vendors or our customers to liability as a result of the payment distribution products and services we offer.
Although we are not and do not act as a bank, we offer products and services that involve banks or vendors who contract with banks and other regulated providers of financial services. As of February 28, , we had approximately 2, employees.
Available Information. Our corporate website address is www. You also can obtain on our website, free of charge, a copy of our annual reports on Form K, our quarterly reports on Form Q, our current reports on Form 8-K, and any amendments to those reports, as soon as reasonably practicable after we electronically file such reports or amendments with, or furnish them to, the SEC.
Our internet website and the information contained therein or connected thereto are not intended to be incorporated by reference into this Annual Report. You should consider carefully the risks and uncertainties described below, and all information contained in this Annual Report, in evaluating our company and our business.
The occurrence of any of the following risks or uncertainties described below could significantly and adversely affect our business, prospects, financial condition, and operating results. Risks Related to our Business. We face significant competition for our products and services.
The markets for our various products and services are intensely competitive, continually evolving and, in some cases, subject to rapid technological change. We face competition from many healthcare information systems companies and other technology companies within segments of the revenue and payment cycle markets.
We also compete with certain of our customers that provide internally some of the same products and services that we offer. In addition, major software, hardware, information systems and business process outsourcing companies, both with and without healthcare companies as their partners, offer or have announced their intention to offer products or services that are competitive with products and services that we offer.
Within certain of the products and services markets in which we operate, we face competition from entities that are significantly larger and have greater financial resources than we do and have established reputations for success in implementing healthcare electronic transaction processing systems. Other companies have targeted these markets for growth, including by developing new technologies utilizing Internet-based systems.
We may not be able to compete successfully with these companies, and these or other competitors may commercialize products, services or technologies that render our products, services or technologies obsolete or less marketable.
Some of our customers compete with us and some, instead of using a third party provider, perform internally some of the same services that we offer. Some of our existing customers compete with us or may plan to do so or belong to alliances that compete with us or plan to do so, either with respect to the same products and services we provide to them or with respect to some of our other lines of business.
The ability of payers to replicate our products and services may adversely affect the terms and conditions we are able to negotiate in our agreements with them and our transaction volume with them, which directly relates to our revenues.
We may not be able to maintain our existing relationships for connectivity services with payers or develop new relationships on satisfactory terms, if at all. In addition, some of our products and services allow payers to outsource business processes that they have been or could be performing internally and, in order for us to be able to compete, use of our products and services must be more efficient for them than use of internal resources.
If we are unable to retain our existing customers, our business, financial condition and results of operations could suffer. Our success depends substantially upon the retention of our customers, particularly due to our transaction-based, recurring revenue model. We may not be able to retain some of our existing customers if we are unable to continue to provide products and services that our payer customers believe enable them to achieve improved efficiencies and cost-effectiveness, and that our provider customers believe allow them to more effectively manage their revenue cycle, increase reimbursement rates and improve cash flows.
Historically, we have enjoyed high customer retention rates; however, we may not be able to maintain high retention rates in the future. Our transaction-based, recurring revenues depend in part upon maintaining this high customer retention rate, and if we are unable to maintain our historically high customer retention rate, our business, financial condition and results of operations could be adversely impacted.
If we are unable to connect to a large number of payers and providers, our product and service offerings would be limited and less desirable to our customers. Our business largely depends upon our ability to connect electronically to a substantial number of payers, such as insurance companies, Medicare and Medicaid agencies and pharmacy benefit managers, and providers, such as hospitals, physicians, dentists and pharmacies. The attractiveness of some of the solutions we offer to providers, such as our claims management and submission services, depends in part on our ability to connect to a large number of payers, which allows us to streamline and simplify workflows for providers.
These connections may either be made directly or through a clearinghouse. We may not be able to maintain our links with a large number of payers on terms satisfactory to us and we may not be able to develop new connections, either directly or through other clearinghouses, on satisfactory terms.
The failure to maintain these connections could cause our products and services to be less attractive to our provider customers. In addition, our payer customers view our connections to a large number of providers as essential in allowing them to receive a high volume of transactions and realize the resulting cost efficiencies through the use of our products and services.
Our failure to maintain existing connections with payers, providers and other clearinghouses or to develop new connections as circumstances warrant, or an increase in the utilization of direct links between payers and providers, could cause our electronic transaction processing system to be less desirable to healthcare constituents, which would reduce the number of transactions that we process and for which we are paid, resulting in a decrease in revenues and an adverse effect on our financial condition and results of operations.
The failure to maintain our relationships with our channel partners or significant changes in the terms of the agreements we have with them may have an adverse effect on our ability to successfully market our products and services.
We have entered into contracts with channel partners to market and sell some of our products and services. Most of these contracts are on a non-exclusive basis. However, under contracts with some of our channel partners, we may be bound by provisions that restrict our ability to market and sell our products and services to potential customers. Our arrangements with some of these channel partners involve negotiated payments to them based on percentages of revenues they generate.
If the payments prove to be too high, we may be unable to realize acceptable margins, but if the payments prove to be too low, the channel partners may not be motivated to produce a sufficient volume of revenues. If any of these channel partners are unsuccessful in marketing our products and services or seek to amend the financial or other terms of the contracts we have with them, we will need to broaden our marketing efforts to increase focus on the solutions they sell and alter our distribution strategy, which may divert our planned efforts and resources from other projects.
In addition, as part of the packages these channel partners sell, they may offer a choice to their customers between products and services that we supply and similar products and services offered by our competitors or by the channel partners directly. If our products and services are not chosen for inclusion in vendor packages, the revenues we earn from these relationships will decrease. Lastly, we could be subject to claims and liability, as a result of the activities, products or services of these channel partners or other resellers of our products and services.
Even if these claims do not result in liability to us, investigating and defending these claims could be expensive, time-consuming and result in adverse publicity that could harm our business.
Our business and future success may depend on our ability to cross-sell our products and services. Our ability to generate revenue and growth partly depends on our ability to cross-sell our products and services to our existing customers and new customers.
We expect our ability to successfully cross-sell our products and services will be one of the most significant factors influencing our growth. We may not be successful in cross-selling our products and services because our customers may find our additional products and services unnecessary or unattractive.
Our failure to sell additional products and services to existing customers could affect our ability to grow our business. We have faced and will continue to face increasing pressure to reduce our prices, which may reduce our margins, profitability and competitive position.
As electronic transaction processing further penetrates the healthcare market or becomes highly standardized, competition among electronic transaction processors is increasingly focused on pricing.
This competition has placed, and could place further, intense pressure on us to reduce our prices in order to retain market share. If we are unable to reduce our costs sufficiently to offset declines in our prices, or if we are unable to introduce new, innovative product and service offerings with higher margins, our results of operations could decline.
In addition, many healthcare industry constituents are consolidating to create integrated healthcare delivery systems with greater market power. As provider networks, such as hospitals, and payer organizations, such as private insurance companies, consolidate, competition to provide the types of products and services we provide will become more intense, and the importance of establishing and maintaining relationships with key industry constituents will become greater.
These industry constituents have, in the past, and may, in the future, try to use their market power to negotiate price reductions for our products and services. If we are forced to reduce prices, our margins will decrease and our results of operations will decline, unless we are able to achieve corresponding reductions in expenses. Our ability to generate revenue could suffer if we do not continue to update and improve our existing products and services and develop new ones. We must improve the functionality of our existing products and services in a timely manner and introduce new and valuable healthcare information technology and service solutions in order to respond to technological and regulatory developments and, thereby, retain existing customers and attract new ones.
For example, from time to time, government agencies may alter format and data code requirements applicable to electronic transactions. We may not be successful in responding to technological and regulatory developments and changing customer needs. The pace of change in the markets we serve is rapid, and there are frequent new product and service introductions by our competitors and by channel partners who use our products and services in their offerings.
If we do not respond successfully to technological and regulatory changes and evolving industry standards, our products and services may become obsolete. Technological changes may also result in the offering of competitive products and services at lower prices than we are charging for our products and services, which could result in our losing sales unless we lower the prices we charge.
If we do lower our prices on some of our products and services, we will need to increase our margins on these products and services in order to maintain our overall profitability.
In addition, the products and services we develop or license may not be able to compete with the alternatives available to our customers. Achieving market acceptance of new or updated products and services is necessary in order for them to become profitable and will likely require significant efforts and expenditures. Our future financial results will depend in part on whether our new or updated products and services receive sufficient customer acceptance.
These products and services include, without limitation:. Achieving market acceptance for new or updated products and services is likely to require substantial marketing efforts and expenditure of significant funds to create awareness and demand by constituents in the healthcare industry. In addition, deployment of new or updated products and services may require the use of additional resources for training our existing sales force and customer service personnel and for hiring and training additional salespersons and customer service personnel.
Failure to achieve broad penetration in target markets with respect to new or updated products and services could have an adverse effect on our business prospects and financial results. There are increased risks of performance problems during times when we are making significant changes to our products and services or to systems we use to provide services. In addition, implementation of our products and services and efficiency measures and other cost savings initiatives may cost more, may not provide the benefits expected or may take longer than anticipated.
In order to respond to technological and regulatory changes and evolving industry standards, our products and services must be continually updated and enhanced. The software and systems that we sell and that we use to provide services are inherently complex and, despite testing and quality control, we cannot be certain that errors will not be found in any changes, enhancements, updates and new versions that we market or use.
Even if new or modified products and services do not have performance problems, our technical and customer service personnel may have difficulties in installing them or in their efforts to provide any necessary training and support to customers. Implementation of changes in our technology and systems may cost more or take longer than originally expected and may require more testing than originally anticipated.
While the new hardware and software will be tested before it is used in production, we cannot be sure that the testing will uncover all problems that may occur in actual use. If significant problems occur as a result of these changes, we may fail to meet our contractual obligations to customers, which could result in claims being made against us or in the loss of. In addition, changes in our technology and systems may not provide the additional functionality or other benefits that were expected.
In addition, we also periodically implement efficiency measures and other cost saving initiatives to improve our operating performance. These efficiency measures and other cost saving initiatives may not provide the benefits anticipated or do so in the time frame expected. Disruptions in service or damages to our data or other operation centers, or other software or systems failures, could adversely affect our business.
Our data centers and operation centers are essential to our business. Our operations depend on our ability to maintain and protect our computer systems, many of which are located in our primary data centers that we operate in Memphis and Nashville, Tennessee.
We also operate several satellite data centers that we plan to consolidate over time to our primary data centers. Our business and results of operations are also highly dependent on our print and mail operations, which are primarily conducted in print and mail operations centers in Bridgeton, Missouri and Toledo, Ohio. We conduct business continuity planning and maintain insurance against fires, floods, other natural disasters and general business interruptions to mitigate the adverse effects of a disruption, relocation or change in operating environment at one of our data centers, print and mail facilities or other locations; however, the situations we plan for and the amount of insurance coverage may not be adequate in any particular case.
The occurrence of any of these events could result in interruptions, delays or cessations in service to users of our products and services, which could impair or prohibit our ability to provide our products and services, reduce the attractiveness of our products and services to our customers and adversely impact our financial condition and results of operations. In addition, despite the implementation of security measures, our infrastructure, data centers or systems that we interface with, including the Internet and related systems, may be vulnerable to physical break-ins, hackers, improper employee or contractor access, computer viruses, programming errors, denial-of-service attacks, terrorist attacks or other attacks by third parties or similar disruptive problems.
Any of these can cause system failure, including network, software or hardware failure, which can result in service disruptions or increased response time for our products and services. As a result, we may be required to expend significant capital and other resources to protect against security breaches and hackers or to alleviate problems caused by such breaches. We also rely on a limited number of suppliers to provide us with a variety of products and services, including telecommunications and data processing services necessary for our transaction services and processing functions and software developers for the development and maintenance of certain software products we use to provide our solutions.
If these suppliers do not fulfill their contractual obligations or choose to discontinue their products or services, our business and operations could be disrupted, our brand and reputation could be harmed and our financial condition and operating results could be adversely affected. We may be liable to our customers and may lose customers if we provide poor service, if our products and services do not comply with our agreements or if our software products or transmission systems contain errors or experience failures.
Failure to do so could subject us to liability, as well as cause us to lose customers. In some cases, we rely upon third party contractors to assist us in providing our products and services. Our ability to meet our contractual obligations and customer expectations may be impacted by the performance of our third party contractors and their ability to comply with applicable laws and regulations. For example, our electronic payment and remittance services depend in part on the ability of our vendors to comply with applicable banking and financial service requirements and their failure to do so could cause an interruption in the services we provide or require us to seek alternative solutions or relationships.
Errors in the software and systems we provide to customers or the software and systems we use to provide our products and services also could cause serious problems for our customers.
In addition, because of the large amount of data we collect and manage, it is possible that hardware failures and errors in our systems would result in data loss or corruption or cause the information that we collect to be incomplete or contain inaccuracies that our customers regard as significant. For example, errors in our transaction processing systems. Since some of our products and services relate to laboratory ordering and reporting and electronic prescriptions, an error in our systems also could result in injury to a patient.
If problems like these occur, our customers may seek compensation from us or may seek to terminate their agreements with us, withhold payments due to us, seek refunds from us of part or all of the fees charged under our agreements, a loan or advancement of funds, or initiate litigation or other dispute resolution procedures.
In addition, we may be subject to claims against us by others affected by any such problems. In addition, our activities and the activities of our third party contractors involve the storage, use and transmission of personal health information. Accordingly, security breaches of our or their computer systems or at print and mail operation centers could expose us to a risk of loss or litigation, government enforcement actions and contractual liabilities.
We cannot be certain that contractual provisions attempting to limit our liability in these areas will be successful or enforceable, or that other parties will accept such contractual provisions as part of our agreements. Any security breaches also could impact our ability to provide our products and services, as well as impact the confidence of our customers in our products and services, either of which could have an adverse effect on our business, financial condition and results of operations.
We attempt to limit, by contract, our liability for damages arising from our negligence, errors, mistakes or security breaches.
However, contractual limitations on liability may not be enforceable or may otherwise not provide sufficient protection to us from liability for damages. We maintain liability insurance coverage, including coverage for errors and omissions. It is possible, however, that claims could exceed the amount of our applicable insurance coverage, if any, or that this coverage may not continue to be available on acceptable terms or in sufficient amounts.
In addition, negative publicity caused by these events may delay market acceptance of our products and services, including unrelated products and services, or may harm our reputation and our business. Our business will suffer if we fail to successfully integrate acquired businesses and technologies or to appropriately assess the risks in particular transactions. We have historically acquired and, in the future, plan to acquire, businesses, technologies, services, product lines and other assets.
For example, in January , we acquired FVTech and intend to integrate its operations with our business. The successful integration of any businesses and assets we acquire into our operations, on a cost-effective basis, can be critical to our future performance. The amount and timing of the expected benefits of any acquisition, including potential synergies between our current business and the acquired business, are subject to significant risks and uncertainties.
These risks and uncertainties include, but are not limited to, those relating to:. We cannot guarantee that any acquired businesses will be successfully integrated with our operations in a timely or cost-effective manner, or at all.
Failure to successfully integrate acquired businesses or to achieve anticipated operating synergies, revenue enhancements or cost savings could have an adverse effect on our business, financial condition and results of operations.
Although our management attempts to evaluate the risks inherent in each transaction and to evaluate acquisition candidates appropriately, we may not properly ascertain all such risks and the acquired businesses and assets may not perform as we expect or enhance the value of our company as a whole.
In addition,. We have a substantial amount of indebtedness, which could affect our financial condition. If we cannot generate sufficient cash flow from operations to service our debt, we may need to refinance our debt, dispose of assets or issue equity to obtain necessary funds. We do not know whether we will be able to take any of such actions on a timely basis or on terms satisfactory to us or at all. Our substantial amount of indebtedness could limit our ability to:.
Despite our substantial indebtedness, we may still be able to incur significantly more debt. The incurrence of additional debt could increase the risks associated with our substantial leverage, including our ability to service our indebtedness.
In addition, because borrowings under our credit agreements bear interest at a variable rate, our interest expense could increase, and thus exacerbate these risks. Recent events in the credit markets may affect our ability to refinance our existing debt or obtain additional debt financing on acceptable terms. We may need or seek additional financing in the future to either refinance our existing indebtedness or to fund our operations, fund acquisitions, develop additional products and services or implement other projects.
In addition, if as a result of the current conditions in the credit markets any of the lenders participating in our revolving credit facility are unable to fund borrowings under such facility, our liquidity could be adversely affected. The terms of our credit agreements may restrict our current and future operations, which would adversely affect our ability to respond to changes in our business and to manage our operations. Our credit agreements contain, and any future indebtedness of ours would likely contain, a number of restrictive covenants that impose significant operating and financial restrictions on us, including restrictions on our ability to, among other things:.
Our credit agreements also require us to maintain certain financial ratios, including a maximum total leverage ratio and a minimum interest coverage ratio.
A failure by us to comply with the covenants or financial ratios contained in our credit agreements could result in an event of default under the applicable facility which could adversely affect our ability to respond to changes in our business and manage our operations.
A change of control of our company is also an event of default under our credit agreements. In the event of any default under our first lien credit agreement, the lenders under that agreement will not be required to lend any additional amounts to us.
In addition, upon the occurrence of an event of default under either of our credit agreements, the lenders under both credit agreements could elect to declare all amounts outstanding to be due and payable and require us to apply all of our available cash to repay these amounts. If the indebtedness under our credit agreements were to be accelerated, there can be no assurance that our assets would be sufficient to repay this indebtedness in full.
Recent and future developments in the healthcare industry could adversely affect our business. Both houses of the U. Congress have passed healthcare reform bills in recent months, but it is uncertain if and how these bills will be reconciled or whether the provisions of either bill will become law. In addition, there are currently numerous federal, state and private initiatives and studies seeking ways to increase the use of information technology in healthcare as a means of improving care and reducing costs.
These initiatives may result in additional or costly legal and regulatory requirements that are applicable to us and our customers, may encourage more companies to enter our markets, may provide advantages to our competitors and may result in the development of technology solutions that compete with ours.
Any such reforms or initiatives, whether private or governmental, may result in a reduction of expenditures by customers or potential customers in the healthcare industry, which could have an adverse effect on our business. General reductions in expenditures by healthcare industry constituents could result from, among other things:. Even if general expenditures by industry constituents remain the same or increase, other developments in the healthcare industry may result in reduced spending on information technology and services or in some or all of the specific markets we serve or are planning to serve.
For example, use of our products and services could be affected by:. The healthcare industry has changed significantly in recent years and we expect that significant changes will continue to occur. The timing and impact of developments in the healthcare industry are difficult to predict. We cannot be sure that the markets for our products and services will continue to exist at current levels or that we will have adequate technical, financial and marketing resources to react to changes in those markets.
Government regulation creates risks and challenges with respect to our compliance efforts and our business strategies. The healthcare industry is highly regulated and is subject to changing political, legislative, regulatory and other influences. Many healthcare laws are complex, and their application to specific services and relationships may not be clear.
In particular, many existing healthcare laws and regulations, when enacted, did not anticipate the healthcare information products and services that we provide, and these laws and regulations may be applied to our products and services in ways that we do not anticipate. Federal and state legislatures and agencies periodically consider proposals to reform or revise aspects of the healthcare industry or to revise or create additional statutory and regulatory requirements.
In the final months of , both houses of the U. Congress passed separate bills intended to reform the healthcare system. While neither of these bills has yet become law, such laws or similar proposals, if implemented, could impact our operations, the use of our products or services and our ability to market new products and services, or could create unexpected liabilities for us. We may also be impacted by non-healthcare laws as a result of some of our products and services. For example, laws, regulations and industry standards regulating the banking and financial services industry may impact our operations as a result of the electronic payment and remittance services we offer directly or through third party vendors.
We are unable to predict what changes to laws or regulations might be made in the future or how those changes could affect our business or the costs of compliance. We have attempted to structure our operations to comply with legal requirements applicable to us directly and to our clients and third party contractors, but there can be no assurance that our operations will not be challenged or impacted by enforcement initiatives.
Any determination by a court or agency that our products and services violate, or cause our customers to violate, applicable laws or regulations could subject us or our customers to civil or criminal penalties. Such a determination could also require us to change or terminate portions of our business, disqualify us from serving customers who are or do business with government entities, or cause us to refund some or all of our service fees or otherwise compensate our customers.
In addition, failure to satisfy laws or regulations could adversely affect demand for our products and services and could force us to expend significant capital, research and development and other resources to address the failure. Even an unsuccessful challenge by regulatory authorities or private whistleblowers could result in loss of business, exposure to adverse publicity and injury to our reputation and could adversely affect our ability to retain and attract clients.
Laws and regulations impacting our operations include the following:. We may be required to apply additional resources to our existing process to assist our customers in complying with this rule.
We have implemented and maintain physical, technical and administrative safeguards intended to protect all personal data and have processes in place to assist us in complying with all applicable laws and regulations regarding the protection of this data and properly responding to any security breaches or incidents; however, we cannot be sure that these safeguards are adequate to protect all personal data or assist us in complying with all applicable laws and regulations regarding the protection of personal data.
Many states also have similar anti-kickback laws that are not necessarily limited to items or services for which payment is made by a federal healthcare program. Moreover, both federal and state laws forbid bribery and similar behavior. Any determination by a state or federal regulatory agency that any of our activities or those of our customers or vendors violate any of these laws could subject us to civil or criminal penalties, could require us to change or terminate some portions of our business, could require us to refund a portion of our service fees, could disqualify us from providing services to customers doing business with government programs and could have an adverse effect on our business.
Even an unsuccessful challenge by regulatory authorities of our activities could result in adverse publicity and could require a costly response from us. Legislative changes may impede our ability to utilize our off-shore service capabilities. In our operations, we have contractors in India and China who may have access to patient health information in order to assist us in performing services to our customers.
In recent sessions, the U. Congress has considered legislation that would restrict the transmission of personally identifiable information regarding a U.
Some of the proposals considered would have required patient consent and imposed liability on healthcare businesses arising from the improper sharing or other misuse of personally identifiable information. Congress also has considered creating a private civil cause of action that would allow an injured party to recover damages sustained as a result of a violation of these proposed restrictions.
A number of states have also considered, or are in the process of considering, prohibitions or limitations on the disclosure of medical or other personal information to individuals or entities located outside of the United States.
If legislation of this type is enacted, our ability to utilize off-shore resources may be impeded, and we may be subject to sanctions for failure to comply with the new mandates of the legislation. In addition, the enactment of such legislation could result in such work being performed at a lower margin of profitability, or even at a loss. Further, as a result of concerns regarding the possible misuse of personally identifiable information, some of our customers have contractually limited our ability to use our off-shore resources.
Use of off-shore resources may increase our risk of violating. Failure by our customers to obtain proper permissions or provide us with accurate and appropriate data may result in claims against us or may limit or prevent our use of data which could harm our business. We require our customers to provide necessary notices and to obtain necessary permissions for the use and disclosure of the information that we receive.
If they do not provide necessary notices or obtain necessary permissions, then our use and disclosure of information that we receive from them or on their behalf may be limited or prohibited by state or federal privacy laws or other laws. Such failures by our customers could impair our functions, processes and databases that reflect, contain or are based upon such data.
For example, as part of our claims submission services, we rely on our customers to provide us with accurate and appropriate data and directives for our actions. While we have implemented features and safeguards designed to maximize the accuracy and completeness of claims content, these features and safeguards may not be sufficient to prevent inaccurate claims data from being submitted to payers.
In addition, such failures by our customers could interfere with or prevent creation or use of rules, analyses or other data-driven activities that benefit us. Accordingly, we may be subject to claims or liability for inaccurate claims data submitted to payers or for use or disclosure of information by reason of lack of valid notice or permission.
These claims or liabilities could damage our reputation, subject us to unexpected costs and adversely affect our financial condition and operating results. Certain of our products and services present the potential for embezzlement, identity theft or other similar illegal behavior by our employees or contractors with respect to third parties. Even in those cases in which we do not facilitate payments or handle original documents or mail, our services also involve the use and disclosure of personal and business information that could be used to impersonate third parties or otherwise gain access to their data or funds.
If any of our employees or contractors takes, converts or misuses such funds, documents or data, or we experience a data breach creating a risk of identity theft, we could be liable for damages, and our business reputation could be damaged or destroyed. In addition, we could be perceived to have facilitated or participated in illegal misappropriation of funds, documents or data and, therefore, be subject to civil or criminal liability.
Federal and state regulators may take the position that a data breach or misdirection of data constitutes an unfair or deceptive act or trade practice. We also may be required to notify individuals affected by any data breaches. Contractual relationships with customers that are governmental agencies or are funded by government programs may impose special burdens on us and provide special benefits to those customers.
A portion of our revenues comes from customers that are governmental agencies or are funded by government programs. Our contracts and subcontracts may be subject to some or all of the following:. We are also subject to conflict-of-interest rules that may affect our eligibility for some government contracts, including rules applicable to all U.
The protection of our intellectual property requires substantial resources. The steps we have taken to protect and enforce our proprietary rights and intellectual property may not be adequate. For instance, we may not be able to secure trademark or service mark registrations for marks in the U. Third parties may infringe upon or misappropriate our patents, copyrights, trademarks, service marks and similar proprietary rights, which could have an adverse affect on our business, financial condition and results of operations.
If we believe a third party has misappropriated our intellectual property, litigation may be necessary to enforce and protect those rights, which would divert management resources, would be expensive and may not effectively protect our intellectual property. As a result, if anyone misappropriates our intellectual property, it may have an adverse effect on our business, financial condition and results of operations.
Third parties may claim that we are infringing their intellectual property, and we could suffer significant litigation or licensing expenses or be prevented from selling products or services. We could be subject to claims that we are misappropriating or infringing intellectual property or other proprietary rights of others.
If we become liable to third parties for infringing these rights, we could be required to pay a substantial damage award and to develop non-infringing technology, obtain a license or cease selling the products or services that use or contain the infringing intellectual property.
We may be unable to develop non-infringing products or services or obtain a license on commercially reasonable terms, or at all. We may also be required to indemnify our customers if they become subject to third party claims relating to intellectual property that we license or otherwise provide to them, which could be costly.
A write-off of all or a part of our identifiable intangible assets or goodwill would hurt our operating results and reduce our net worth. We have significant identifiable intangible assets and goodwill, which represents the excess of the total purchase price of our acquisitions over the estimated fair value of the net assets acquired.
We amortize identifiable intangible assets over their estimated useful lives which range from 1 to 20 years. We also evaluate our goodwill for impairment at least annually using a combination of valuation methodologies. Because one of the valuation methodologies we use is impacted by market conditions, the likelihood and severity of an impairment charge increases during periods of market volatility, such as the one that recently occurred as a result of the general weakening of the global economy.
We are not permitted to amortize goodwill under U. In the event an impairment of goodwill is identified, a charge to earnings would be recorded. Although it does not affect our cash flow, a write-off in future periods of all or a part of these assets would adversely affect our operating results and financial condition. We are dependent on the continued service of key executives, the loss of any of whom could adversely affect our business.
Our performance is substantially dependent on the performance of our senior management team including, George I. Newport, Jr. Chief Financial Officer , Gregory T.
We have entered into agreements with each member of our senior management team that restrict their ability to compete with us should they decide to leave our company.
Even though we have entered into these agreements, we cannot be sure that any member of our senior management team will remain with us or that they will not compete with us in the future.
Our success depends in part on our ability to identify, recruit and retain skilled management and technical personnel. If we fail to recruit and retain suitable candidates or if our relationship with our employees changes or deteriorates, there could be an adverse effect on our business.
Our future success depends upon our continuing ability to identify, attract, hire and retain highly qualified personnel, including skilled technical, management, product and technology and sales and marketing personnel, all of whom are in high demand and are often subject to competing offers.
Competition for qualified personnel in the healthcare information technology and services industry is intense, and we cannot assure you that we will be able to hire or retain a sufficient number of qualified personnel to meet our requirements, or that we will be able to do so at salary, benefit and other compensation costs that are acceptable to us. A loss of a substantial number of qualified employees, or an inability to attract, retain and motivate additional highly skilled employees required for expansion of our business, could have an adverse effect on our business.
In addition, while none of our employees are currently unionized, unionization of our employees is possible in the future. Such unionizing activities could be costly to address and, if successful, would likely adversely impact our operations.
A prolonged economic downturn could have a material adverse effect on our business, financial condition and results of operations. The U. We are unable to predict the likely duration or ultimate severity of the economic downturn and there can be no assurance that current economic conditions will not worsen.
A prolonged or further weakening of economic conditions could lead to reductions in demand for our products and services. For example, a sustained recession could reduce the amount of income patients are able to spend on healthcare services.
As a result, patients may elect to delay or forgo seeking healthcare services, which could decrease our transaction volumes or decrease payer and provider demand for our products and services.
Also, prolonged high unemployment rates could cause commercial payer membership to decline which could result in lower transaction volumes in our business. In addition, as a result of weak economic conditions, we may experience the negative effects of increased financial pressures on our payer and provider customers. If we are not able to timely and appropriately adapt to changes resulting from a weak economic environment, our business, results of operations and financial condition may be materially and adversely affected.
Lengthy sales, installation and implementation cycles for some of our applications may result in delays or an inability to generate revenues from these applications. Sales of complex revenue and payment cycle management solutions and electronic medical records applications may result in longer sales, contracting and implementation cycles for our customers. The use of our solutions may also be delayed due to reluctance to change or modify existing. We are unable to control many of the factors that will influence the timing of the buying decisions of potential customers or the pace at which installation and training may occur.
If we experience longer sales, contracting and implementation cycles for our solutions, we may experience delays in generating, or an inability to generate revenue from these solutions, which could have an adverse effect on our financial results.
Risks Related to our Organization and Structure. We are a holding company and our principal asset is our ownership of equity interests in EBS Master, and we are accordingly dependent upon distributions from EBS Master to pay dividends, if any, taxes and other expenses. We have no independent means of generating revenue.
We intend to cause EBS Master to make distributions to its unitholders, including us, in an amount sufficient to cover all applicable taxes payable but are limited in our ability to cause EBS Master to make these and other distributions to us including for purposes of paying corporate and other overhead expenses and dividends due to the terms of our credit agreements.
To the extent that we need funds and EBS Master is restricted from making such distributions under applicable law or regulation, as a result of the terms in our credit agreements or is otherwise unable to provide such funds, it could adversely affect our liquidity and financial condition. We are controlled by our Principal Equityholders whose interest in our business may be different than the interests of our other stockholders, and certain statutory provisions afforded to stockholders are not applicable to us.
Together, our Principal Equityholders control approximately Under the Stockholders Agreement, our Principal Equityholders are entitled to nominate a majority of the members of our board of directors and each of the Principal Equityholders has agreed to vote for all of such nominees. Accordingly, our Principal Equityholders can exercise significant influence over our business policies and affairs, including the power to nominate a majority our board of directors.
In addition, the Principal Stockholders can control any action requiring the general approval of our stockholders, including the adoption of amendments to our certificate of incorporation and bylaws and the approval of mergers or sales of substantially all of our assets.
The concentration of ownership and voting power of our Principal Equityholders may also delay, defer or even prevent an acquisition by a third party or other change of control of our company and may make some transactions more difficult or impossible without the support of our Principal Equityholders, even if such events are in the best interests of minority stockholders. The concentration of voting power among the Principal Equityholders may have an adverse effect on the price of our Class A common stock.
To the extent they invest in such other businesses,. We are required to pay an affiliate of our Principal Equityholders and the EBS Equity Plan Members for certain tax benefits we may claim, and the amounts we may pay could be significant. These future exchanges are likely to result in tax basis adjustments to the assets of EBS Master, which adjustments would also be allocated to us.
Both the existing and the anticipated basis adjustments are expected to reduce the amount of tax that we would otherwise be required to pay in the future.
The payments we will be required to make under the tax receivable agreements could be substantial. These amounts reflect only the cash savings attributable to current tax attributes resulting from the purchases and the loss carryovers. It is possible that future transactions or events could increase or decrease the actual tax benefits realized and the corresponding tax receivable agreement payments from these tax attributes.
Future payments under the tax receivable agreements in respect of subsequent acquisitions of EBS Units would be in addition to these amounts. In addition, although we are not aware of any issue that would cause the Internal Revenue Service to challenge the tax basis increases or other benefits arising under the tax receivable agreements, the Tax Receivable Entity and the EBS Equity Plan Members will not reimburse us for any payments previously made if such basis increases or other benefits are subsequently disallowed, except that excess payments made to the Tax Receivable Entity or the EBS Equity Plan Members will be netted against payments otherwise to be made, if any, after our determination of such excess.
As a result, in such circumstances, we could make payments under the tax receivable agreements that are greater than our actual cash tax savings and may not be able to recoup those payments, which could adversely affect our liquidity.
Finally, because we are a holding company with no operations of our own, our ability to make payments under the tax receivable agreements is substantially dependent on the ability of our subsidiaries to make distributions to us.
Our credit agreements restrict the ability of our subsidiaries to make distributions to us, which could affect our ability to make payments under the tax receivable agreements.
To the extent that we are unable to make payments under the tax receivable agreements for any reason, such payments will be deferred and will accrue interest until paid, which could adversely affect our results of operations and could also affect our liquidity in periods in which such payments are made.
Rights to receive payments under the tax receivable agreements may be terminated by the Tax Receivable Entity or the EBS Equity Plan Members, as applicable, if as the result of an actual or proposed change in law, the existence of the agreements would cause recognition of ordinary income instead of capital gain in connection with future exchanges of EBS Units for cash or shares of our Class A common stock or would otherwise have material adverse tax consequences to the Tax Receivable Entity, its owners or the EBS Equity Plan Members.
There are legislative proposals pending in Congress that, if enacted in their present form, may result in such ordinary income recognition. Further, in the event of such a termination, the Tax Receivable Entity or the EBS Equity Plan Members would have the right, subject to the delivery of an appropriate tax opinion, to require us to determine a lump sum amount in lieu of the payments otherwise provided under the agreements. If the assumptions used in this calculation turn out not to be true, we may pay more or less than the specified percentage of our actual cash tax savings.
The ultimate impact of a decision to accelerate will depend on what the ongoing payments would have been under the tax receivable agreement absent acceleration, which will in turn depend on the various factors mentioned above.
As a result, upon a change of control, we could be required to make payments under the tax receivable agreements that are greater than or less than the specified percentage of our actual cash tax savings.
The market price of our Class A common stock may be volatile, and your investment in our Class A common stock could suffer a decline in value. There has been significant volatility in the market price and trading volume of equity securities, which is often unrelated or disproportionate to the financial performance of the companies issuing the securities.
These broad market fluctuations may negatively affect the market price of our Class A common stock. The market price of our Class A common stock could fluctuate significantly in response to various factors, some of which are beyond our control.
In addition, the stock market in general, and the market for technology-based companies in particular, has experienced extreme price and volume fluctuations that have often been unrelated or disproportionate to the operating performance of those companies.
We do not intend to pay dividends in the foreseeable future, and, because we are a holding company, we may be unable to pay dividends. For the foreseeable future, we intend to retain any earnings to finance the development and expansion of our business, and we do not anticipate paying any cash dividends on our Class A common stock.
Please select the appropriate facility or practice below to pay your bill. See statement Please enter your provider ID including spaces if applicable as it appears on your statement.
Refer to your most recent statement and then click 'Continue'. Ready to create your account? Site is running on IP address After enrollment, you will be able to immediately log into the system and view your account information. Enter account information below and then click 'Continue'.
Make a one-time payment. If you have questions about your bill, or would prefer to make a payment over the phone, call us at during normal business hours PST. All details will be processed securely through our Authorize. Sign up today! Enter your account information below exactly as it appears on your statement. Offers greater payment flexibility, pay bills from anywhere you have internet access. The best way to reach University Bursar is via [email protected] Never miss a payment.
Pay Without Enrolling. None of your personal information will be entered, or saved to this site. Jamakaya, 40 units social security, Chieftec fib mini itx tower? Divx decoder. Annually Note: Annual Premium payments are nonrefundable. Begin the process by filling in the information below. Have a question about your bill?
Welcome to the enrollment process for your online account. Monday through Friday, or email us at [email protected] Quick Pay. Never miss a payment If you have questions about your bill, please refer to your policy declarations page for the agent or broker information. Please call our local support team at if you have any questions. If you have any questions or concerns about your bill, you can contact our Patient Financial Services.
LoadingPay Your Bill We offer two options to pay your bill online. Select the "Student" tab. Click hereto begin searching for and selecting your physician. No need to have someone else involved in processing your transaction. Never miss a payment Pay My Bill — mbrwi. Use our personalized tool to determine which programs best fit your needs.
Simplifies payment management with flexible payment plan options. Automate your billing Set up automatic payments specific to your preferred payment schedule. You are now able to make a payment on your account-- online, at your convenience, completely safe and secure. Omslagdoek vastmaken, South cambs pay my bill, Park rapids weather radar, Intel atom itx motherboard, Allanamiento policial definicion, Aaop online learning center, r itx, Capela cascatinha curitiba.
Click here for Lab ID. Final Authentication. Sample Statement. To view or pay your bill online, please click the link below. The password you provide will be used to access your online account in the future.
Simply click the Create an Account button below to get started. Online Enrollment FormEnter your account information below exactly as it appears on your statement. Paying medical bills made easy! To pay your bill securely online, please select the state below where you received services from USAP. Pay Your Bill We offer two options to pay your bill online.
The picture and the pace at which it was changing were dizzying. The focus was on low-cost ergonomic change s that reduced physical stress. In treble, second and fourth, the first change is a dodge behind; and the second time the treble leads, there's a double Bob. The Seven-score and four on the six middle Bells, the treble leading, and the tenor lying behind every change , makes good Musick. Never was a change more remarkable than that which had come upon Mrs.
When the whole hunt is hunting up, each single change is made between the whole hunt, and the next bell above it. For more info, see How to reset your Microsoft account password. If you still can't sign in, you must reinstall Windows.
For Windows RT 8. If you forget or lose your password, see Reset your password above to reset or recover it. If you think your Microsoft account password has been compromised or stolen by someone with malicious intent, we can help.
For more info, see When you can't sign in to your Microsoft account. If you're signing in to only your local PC, yes. However, we recommend that you keep your PC more secure by using a strong password. When you use a password, only someone who knows it can sign in. If you want to sign in to Windows with a Microsoft account, a password is required.
For more info, see Can I sign in to Windows without a password? To learn more about Microsoft accounts and local accounts, see Create a user account.
Stronger passwords contain a variety of characters, including uppercase and lowercase letters, numbers, and symbols or spaces. A strong password should also be something that is difficult for a stranger to guess or crack. It shouldn't contain a complete word, or easy-to-find details like your real name, your user name, or your birth date. If you're signing in to a Microsoft account, your password is limited to 16 characters.
For more info about Microsoft accounts, see Create a user account. You can update your password regularly to keep it more secure. If your PC isn't connected to a domain, follow these steps:. Swipe in from the right edge of the screen, tap Settings , and then tap Change PC settings.
If you're using a mouse, point to the lower-right corner of the screen, move the mouse pointer up, click Settings , and then click Change PC settings. Tap or click Accounts , and then tap or click Sign-in options. If your PC is connected to a domain, your system administrator might manage how frequently you must change your password. To do so, choose one of the following:. If you're using a tablet, press and hold the Windows button, press the power button, and then tap or click Change a password and follow the instructions.
It depends on whether you're using a third-party email address. If your email address ends in outlook. But you can use any email address for your Microsoft account, even an email address from a third-party web-based mail service like Google Mail or Yahoo! When you choose a password for your Microsoft account, it doesn't change the password you might need to use to sign in to web mail on a third-party site.
Under Picture password , tap or click Add , and then follow the instructions. When you choose a password for your user account, it's important to pick something you can remember. You're going to need it again later! Of course, you can also write your password down and keep it in a safe place. Taped to the underside of your laptop or the inside of your desk drawer is probably not a good idea, however.
If you do write your password down, be sure to keep it separate from your PC. For added security, use different passwords for different purposes. For example, it's a good idea to keep distinctly different passwords for a social networking account and your online bank account. If you do forget or lose your password, there are still several things you can try to reset or recover it.
For more info, see Reset your password above to reset or recover it. The steps to reset your password will vary a bit depending on if your computer is on a domain, or in a workgroup. If your computer is part of a work or school organization there's a good chance it's part of a domain. If this is a home computer it's almost certainly in a workgroup. Sign in with a domain account that has administrator permissions to this device.
If you're not sure, contact your organization's IT admin for help. If you're prompted for an administrator password or confirmation, type the password or provide confirmation. On the Users tab, under Users for this computer , select the user account name, and then select Reset Password. Type the new password, confirm the new password, and then select OK. Note: If you are logged on as an administrator, you can create and change passwords for all user accounts on the computer. Warning: If you use an administrator account to change a password for another account, any encrypted files or e mail messages for that other account will no longer be accessible to the person who was using that account.
If you type the wrong password when you attempt to log on, Windows displays a message that the password is incorrect. Select OK to close the message. Select Reset password , and then insert your password reset disk or USB flash drive. Log on with the new password.
If you forget your password again, you can use the same password reset disk. You don't need to make a new one. Type your old password followed by a new password as indicated, and then type the new password again to confirm it.
Reset a forgotten Microsoft account password. Change your Microsoft account password. Reset your Windows local account password. Related topics. Windows account help. Sign in. Windows Hello.
Percentage Change can be defined as a % change in value due to changes in the old number and new number, and the values can either increase or decrease and so the change can be a positive value (+) or a negative value (-). Table of contents. Formula to Calculate Percentage Change. Examples. Example #1;. indi-infantformula.com is a worldwide nonprofit petition website, based in California, US, operated by the San Francisco-based company of the same name, which has over million users and offers the public the ability to promote the petitions they care about to potential signers, including countries which are "creating change" in their communities. Change definition, to make the form, nature, content, future course, etc., of (something) different from what it is or from what it would be if left alone: to change one's name;to change one's opinion;to change the course of history. See more.