CareCloud, Inc. 10-K

Item 9A. Controls and Procedures Evaluation of Disclosure Controls and Procedures Our management, with the participation of our Chief Executive Officer and Chief Financial Officer, based on the Internal Control-Integrated Framework (2013 framework) issued by the Committee of Sponsoring Organizations of the Treadway Commission (“COSO”), evaluated the effectiveness of our disclosure controls and procedures as of December 31, 2022 as required by Rules 13a-15(b) and 15d-15(b) of the Exchange Act. The term “disclosure controls and procedures,” as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act, means controls and other procedures of a company that are designed to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is recorded, processed, summarized and reported, within the time periods specified in the SEC’s rules and forms. Disclosure controls and procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is accumulated and communicated to the Company’s management, including its principal executive and principal financial officers, to allow timely decisions regarding required disclosure. Management recognizes that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving their objectives and management necessarily applies its judgment in evaluating the cost-benefit relationship of possible controls and procedures. Based on the evaluation of our disclosure controls and procedures, as of December 31, 2022, our Chief Executive Officer and Chief Financial Officer concluded that, as of such date, our disclosure controls and procedures were effective. Our management, including our Chief Executive Officer and Chief Financial Officer, has concluded that the consolidated financial statements in this Annual Report on Form 10-K fairly present, in all material respects, our consolidated financial condition, results of operations and cash flows for the periods presented in accordance with U.S. generally accepted accounting principles. Management’s Report on Internal Control over Financial Reporting Our management is responsible for establishing and maintaining adequate internal control over financial reporting, as such term is defined in Rule 13a-15(f) and 15d-15(f) of the Exchange Act. Internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external reporting purposes in accordance with generally accepted accounting principles. Internal control over financial reporting includes those policies and procedures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of our assets; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that our receipts and expenditures are being made only in accordance with authorizations of our management; and (3) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of our assets that could have a material effect on the financial statements. Management is required to base its assessment on the effectiveness of our internal control over financial reporting on a suitable, recognized control framework. Management has utilized the criteria established in COSO to evaluate the effectiveness of internal control over financial reporting. A material weakness is a deficiency, or a combination of deficiencies, in internal control over financial reporting such that there is a reasonable possibility that a material misstatement of the Company’s annual or interim financial statements will not be prevented or detected on a timely basis. Our management has performed its assessment according to the guidelines established by COSO. Our management concluded that as of December 31, 2022, the Company’s internal control over financial reporting was effective. Management has performed analysis and procedures in preparing our consolidated financial statements. We have concluded that our consolidated financial statements fairly present, in all material respects, our financial condition, results of operations and cash flows at and for the periods presented. Because of its inherent limitations, our internal controls over financial reporting provide reasonable, not absolute, assurance that the financial statements and notes thereto are free of material error. In addition, no internal control structure can provide absolute assurance that all instances of fraud have been detected. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies and procedures may deteriorate. This Annual Report does not include an attestation report of the Company’s registered public accounting firm regarding internal control over financial reporting. Management’s report was not subject to attestation by the Company’s registered public accounting firm pursuant to the rules of the SEC that permit the Company to provide only management’s report in this Annual Report on Form 10-K. 52 Changes in Internal Control over Financial Reporting During the period January 1, 2022 through December 31, 2022, we implemented and tested changes to our internal control over financial reporting related to our remediation efforts described below. During the fourth quarter of 2022, there were no changes in our internal control over financial reporting (as defined in Rule 13a-15(f) of the Exchange Act) that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting. Remediation of a Material Weakness in Internal Control Over Financial Reporting During the year ended December 31, 2021, we concluded that we had a material weakness in internal control over financial reporting, specifically related to the completeness and accuracy of key inputs related to non-routine transactions as described in Item 9A of our Annual Report on Form 10-K for the fiscal year ended December 31, 2021. To address the material weakness, during the year ended December 31, 2022, we designed and implemented enhancements to our processes and controls to verify the completeness and accuracy of key inputs related to non-routine transactions by requiring more detailed reviews by experienced staff and increased communication among our personnel and third party professionals with whom we consult regarding such transactions. Based on the cumulative changes implemented, as well as management’s evaluation of the design and operating effectiveness of the new controls, management has concluded that the material weakness, related to the completeness and accuracy of key inputs related to non-routine transactions has been remediated as of December 31, 2022. Item 9B. Other Information None. Item 9C. Disclosure Regarding Foreign Jurisdictions that Prevent Inspection Not applicable. PART III Item 10. Directors, Executive Officers and Corporate Governance Information required by this item will be included in our definitive Proxy Statement for the 2023 Meeting of Shareholders which will be filed within 120 days of the end of our fiscal year ended December 31, 2022 (“2023 Proxy Statement”) and is incorporated herein by reference. Item 11. Executive Compensation Information required by this item will be included in the 2023 Proxy Statement and is incorporated herein by reference. Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters Information required by this item will be included in the 2023 Proxy Statement and is incorporated herein by reference. Item 13. Certain Relationships and Related Transactions, and Director Independence Information required by this item will be included in the 2023 Proxy Statement and is incorporated herein by reference. Item 14. Principal Accountant Fees and Services Information required by this item will be included in the 2023 Proxy Statement and is incorporated herein by reference. 53 PART IV Item 15. Exhibits and Financial Statement Schedules (a) The following documents are filed as part of this Annual Report on Form 10-K: (1) Financial Statements (i) Consolidated Balance Sheets as of December 31, 2022 and 2021 (ii) Consolidated Statements of Operations for the years ended December 31, 2022 and 2021 (iii) Consolidated Statements of Comprehensive Income for the years ended December 31, 2022 and 2021 (iv) Consolidated Statements of Shareholders’ Equity for the years ended December 31, 2022 and 2021 (v) Consolidated Statements of Cash Flows for the years ended December 31, 2022 and 2021 (vi) Notes to Consolidated Financial Statements (2) Financial Statement Schedules There are no Financial Statement Schedules filed as part of this Annual Report on Form 10-K, as the required information is not applicable or is included in the Notes to Consolidated Financial Statements. (b) Exhibit Index: Exhibit Number Description 2.1 Assignment Agreement dated October 3, 2016, by and between the Company, The Prudential Insurance Company of America, and Prudential Retirement Insurance and Annuity Company (filed as Exhibit 10.1 to the Company’s Form 8-K filed on October 5, 2016, and incorporated herein by reference). 2.2 Strict Foreclosure Agreement dated October 3, 2016, by and between MTBC Acquisition, Corp., MediGain, LLC and Millennium Practice Management Associates, LLC (filed as Exhibit 10.2 to the Company’s Form 8-K filed on October 5, 2016, and incorporated herein by reference). 2.3 Transition Services Agreement dated October 3, 2016, by and between MTBC Acquisition, Corp., MediGain, LLC and Millennium Practice Management Associates, LLC (filed as Exhibit 10.3 to the Company’s Form 8-K filed on October 5, 2016, and incorporated herein by reference). 2.4 First Amendment to Assignment Agreement dated January 3, 2017, by and between the Company, The Prudential Insurance Company of America, and Prudential Retirement Insurance and Annuity Company (filed as Exhibit 2.1 to the Company’s Form 8-K filed on January 6, 2017, and incorporated herein by reference). 2.5 Second Amendment to Assignment Agreement dated January 23, 2017, by and between the Company, The Prudential Insurance Company of America, and Prudential Retirement Insurance and Annuity Company (filed as Exhibit 2.1 to the Company’s Form 8-K filed on January 24, 2017, and incorporated herein by reference). 2.6 Asset Purchase Agreement dated June 25, 2018, by and between MTBC, and Orion Healthcorp, Inc. (filed as Exhibit 10.1 to the Company’s Form 8-K filed on July 2, 2018, and incorporated herein by reference). 2.7 Transition Services Agreement dated June 25, 2018, by and between MTBC, and Orion Healthcorp, Inc. (filed as Exhibit 2.29 to the Company’s Form S-1 filed on September 25, 2018, and incorporated herein by reference). 2.8 Asset Purchase Agreement dated March 27, 2019, by and between MTBC-Med, Inc., and Etransmedia Technology, Inc., et. al. (filed as Exhibit 10.1 to the Company’s Form 8-K filed on March 28, 2019, and incorporated herein by reference). 54 2.9 Amended and Restated Asset Purchase Agreement dated April 3, 2019, by and between MTBC-Med, Inc., and Etransmedia Technology, Inc., et. al. (filed as Exhibit 10.1 to the Company’s Form 8-K filed on April 4, 2019, and incorporated herein by reference). 2.10 Agreement and Plan of Merger by and among MTBC, Inc., MTBC Merger Sub, Inc., CareCloud Corporation and Runway Growth Credit Fund Inc., as the Seller’s representative dated January 8, 2020 (filed as Exhibit 2.1 to the Company’s Form 8-K filed on January 8, 2020, and incorporated herein by reference). 2.11 Escrow Agreement dated January 8, 2020 by and among MTBC, Inc., Runway Growth Credit Fund., Inc. and TD Bank (filed as Exhibit 10.17 to the Company’s Form 10-K filed on February 28, 2020, and incorporated herein by reference). 2.12 Stock Purchase Agreement dated June 16, 2020 by and among MTBC, Inc., Origin Holdings, Inc., Meridian Billing Management Co., Origin Holdings, Inc., and GMM II Holdings, LLC, (filed as Exhibit 2.1 to the Company’s Form 8-K on June 17, 2020, and incorporated herein by reference). 2.13 Asset and Stock Purchase Agreement by and among CareCloud Acquisition. Corp., MedMatica Consulting Associates, Inc., and Jerold Howell dated June 1, 2021 (filed as Exhibit 2.1 to the Company’s Form 8-K filed on June 2, 2021, and incorporated herein by reference). 2.14 Non-Competition and Non-Solicitation Agreement by and among Santa Rosa Consulting, Inc., SureTest Holdings, LLC, Laura O’Toole, Mark Scruggs, Raleigh Brewer, Thomas Watford, and CareCloud Acquisition, Corp., dated June 1, 2021 (filed as Exhibit 2.2 to the Company’s Form 8-K filed on June 2, 2021, and incorporated herein by reference). 2.15 Transition Services Agreement by and among CareCloud Acquisition, Corp., MedMatica Consulting Associates, Inc., and Jerold Howell, dated June 1, 2021 (filed as Exhibit 2.3 to the Company’s Form 8-K filed on June 2, 2021 and incorporated herein by reference). 3.1 Amended and Restated Certificate of Incorporation of the Company dated April 4, 2014 (filed as Exhibit 3.1 to the Company’s Form S-1 filed on September 25, 2018 and incorporated herein by reference). 3.2 Certificate of Amendment of Certificate of Incorporation of the Company dated June 28, 2016 (filed as Exhibit 3.2 to the Company’s Form S-1 filed on September 25, 2018 and incorporated herein by reference). 3.3 Certificate of Amendment of Amended and Restated Certificate of Incorporation of the Company dated June 18, 2018 (filed as Exhibit 3.6 to the Company’s Form S-1 filed on September 25, 2018 and incorporated herein by reference). 3.4 Certificate of Amendment of Amended and Restated Certificate of Incorporation of the Company dated February 6, 2019 (filed as Exhibit 3.1 to the Company’s Form 8-K filed on February 7, 2019 and incorporated herein by reference). 3.5 Certificate of Amendment of Amended and Restated Certificate of Incorporation of the Company dated June 25, 2019 (filed as Exhibit 3.1 to the Company’s Form 8-K filed on June 25, 2019 and incorporated herein by reference). 3.6 Certificate of Amendment of Amended and Restated Certificate of Incorporation of the Company dated February 26, 2021 (filed as Exhibit 3.1 to the Company’s Form 8-K filed on March 29, 2021 and incorporated herein by reference). 3.7 Certificate of Amendment to Amended and Restated Certificate of Incorporation of the Company dated June 16, 2022 (filed as Exhibit 3.6 to the Company’s Form 8-K/A filed on June 17, 2022 and incorporated herein by reference). 3.8 Certificate of Correction to Certificate of Amendment to Amended and Restated Certificate of Incorporation (filed as Exhibit 3.1 to the Company’s Form 8-K/A filed June 17, 2022 and incorporated herein by reference). 55 3.9 Amended and Restated Certificate of Designations, Preferences and Rights of 11% Series A Cumulative Redeemable Perpetual Preferred Stock dated July 6, 2016 (filed as Exhibit 3.3 to the Company’s Form S-1 filed on September 25, 2018, and incorporated herein by reference). 3.10 First Amendment to Amended and Restated Certificate of Designations, Preferences and Rights of 11% Series A Cumulative Redeemable Perpetual Preferred Stock dated September 15, 2017 (filed as Exhibit 3.4 to the Company’s Form S-1 filed on September 25, 2018, and incorporated herein by reference). 3.11 Second Amendment to Amended and Restated Certificate of Designations, Preferences and Rights of 11% Series A Cumulative Redeemable Perpetual Preferred Stock dated March 23, 2018 (filed as Exhibit 3.5 to the Company’s Form S-1 filed on September 25, 2018, and incorporated herein by reference). 3.12 Third Amendment to Amended and Restated Certificate of Designations, Preferences and Rights of 11% Series A Cumulative Redeemable Perpetual Preferred Stock dated September 25, 2018 (filed as Exhibit 3.7 to the Company’s Form S-1 filed on September 25, 2018, and incorporated herein by reference). 3.13 Fourth Amendment to Amended and Restated Certificate of Designations, Preferences and Rights of 11% Series A Cumulative Redeemable Perpetual Preferred Stock dated January 9, 2020 (filed as Exhibit 3.1 to the Company’s Form 8-K filed on January 28, 2020, and incorporated herein by reference). 3.14 Fifth Amendment to Amended and Restated Certificate of Designations, Preferences and Rights of 11% Series A Cumulative Redeemable Perpetual Preferred Stock dated May 19, 2020 (filed as Exhibit 3.2 to the Company’s Form 8-K filed on May 21, 2020, and incorporated herein by reference). 3.15 Sixth Amendment to Amended and Restated Certificate of Designations, Preferences and Rights of 11% Series A Cumulative Redeemable Perpetual Preferred Stock dated July 9, 2020 (filed as Exhibit 3.1 to the Company’s Form 8-K filed on July 9, 2020, and incorporated herein by reference). 3.16 Seventh Amendment to Amended and Restated Certificate of Designations, Preferences and Rights of 11% Series A Cumulative Redeemable Perpetual Preferred Stock (filed as exhibit 3.1 to the Company’s Form 8-K filed January 31, 2022 and incorporated herein by reference). 3.17 Certificate of Correction to Eighth Amendment to Amended and Restated Certificate of Designations, Preferences and Rights of 11% Series A Cumulative Redeemable Perpetual Preferred Stock (filed as Exhibit 3.2 to the Company’s Form 8-K/A filed June 17, 2022 and incorporated herein by reference). 3.18 Eighth Amendment to Amended and Restated Certificate of Designations, Preferences and Rights of 11% Series A Cumulative Redeemable Perpetual Preferred Stock dated June 15, 2022 (filed as Exhibit 3.4 to the Company’s Form 8-K/A filed June 17, 2022 and incorporated herein by reference). 3.19 Certificate of Designations, Preferences and Rights of 8.75% Series B Cumulative Redeemable Perpetual Preferred Stock (filed as exhibit 3.2 to the Company’s Form 8-K filed January 31, 2022 and incorporated herein by reference). 3.20 Certificate of Correction to First Amendment to Certificate of Designations, Preferences and Rights of 8.75% Series B Cumulative Redeemable Perpetual Preferred Stock (filed as Exhibit 3.3 to the Company’s Form 8-K/A filed June 17, 2022 and incorporated herein by reference). 3.21 First Amendment to Certificate of Designations, Preferences and Rights of 8.75% Series B Cumulative Redeemable Perpetual Preferred Stock dated June 15, 2022 (filed as Exhibit 3.5 to the Company’s Form 8-K/A filed June 17, 2022 and incorporated herein by reference). 3.22 Amended and Restated By-laws of the Company (filed as Exhibit 3.2 to the Company’s Amendment No. 1 to Form S-1 filed on April 7, 2014, and incorporated herein by reference). 56 4.1 Form of common stock certificate of the Company (filed as Exhibit 4.1 to Amendment No. 2 to the Company’s Form S-1 filed on May 7, 2014, and incorporated herein by reference). 4.2 Form of stock certificate of the 11% Series A Cumulative Redeemable Perpetual Preferred Stock (filed as Exhibit 4.2 to Amendment No. 2 to the Company’s Form S-1 on October 19, 2015, and incorporated herein by reference). 4.3 Form of stock certificate of the 8.75% Series B Cumulative Redeemable Perpetual Preferred Stock (filed as Exhibit 4.3 to the Company’s Form 8-A on January 31, 2022 and incorporated herein by reference). 4.4 Warrant to Purchase Stock dated as of October 13, 2017 issued by the Company to Silicon Valley Bank (filed as Exhibit 10.2 to the Company’s Form 8-K filed on October 16, 2017, and incorporated herein by reference). 4.5 Warrant to Purchase Stock issued by the Company on September 20, 2018 to Silicon Valley Bank (filed as Exhibit 10.2 to the Company’s Form 8-K filed on September 20, 2018, and incorporated herein by reference). 4.6 Warrant to Purchase Stock issued by the Company on January 8, 2020 to Runway Growth Credit Fund Inc. (filed as Exhibit 4.5 to the Company’s Form 10-K filed on February 28, 2020, and incorporated herein by reference). 4.7 Warrant to Purchase Stock issued by the Company on January 8, 2020 to Runway Growth Credit Fund Inc. (filed as Exhibit 4.6 to the Company’s Form 10-K filed on February 28, 2020, and incorporated herein by reference). 4.8 Form of Warrant to Purchase Stock issued by the Company on June 16, 2020 with respect to the Meridian transaction (filed as Exhibit 4.7 to the Company’s Form S-1 filed on August 20, 2020, and incorporated herein by reference). 4.9 Description of Securities Registered Pursuant to Section 12 of the Securities Exchange Act of 1934. 10.1 Form of Indemnification Agreement between the Company and each of its directors and executive officers (filed as Exhibit 10.1 to Amendment No. 2 to the Company’s Form S-1 filed on May 7, 2014, and incorporated herein by reference). 10.2 * Amended and Restated Equity Incentive Plan of the Company (filed as Appendix B to the Company’s Proxy Statement on Schedule 14A filed on February 10, 2017, and incorporated herein by reference). 10.3 * First Amendment to the Amended and Restated Equity Incentive Plan of the Company (filed as Exhibit 10.16 to the Company’s Form 10-Q filed on August 8, 2018, and incorporated herein by reference). 10.4* Second Amendment to MTBC, Inc. Amended and Restated Equity Incentive Plan (filed as Exhibit 3.1 to the Company’s Form 8-K filed on May 21, 2020, and incorporated herein by reference). 10.5 * Form of Restricted Stock Unit Agreement under Amended and Restated Equity Incentive Plan (filed as Exhibit 10.3 to Amendment No. 1 to the Company’s Form S-1 filed on April 7, 2014, and incorporated herein by reference). 10.6 * Third Amendment to Amended and Restated Equity Incentive Plan (filed as Exhibit 3.1 to the Company’s Form 8-K filed on June 9, 2022, and incorporated herein by reference). 10.7 * Form of Restricted Stock Award Agreement under the Amended and Restated Equity Incentive Plan (filed as Exhibit 10.12 to the Company’s Form 10-K filed on March 24, 2016, and incorporated herein by reference). 10.8 Lease between Company and Mahmud Haq with respect to offices located at 7 Clyde Road, Somerset, NJ 08873 (filed as Exhibit 10.4 to the Company’s Form S-1 filed on December 20, 2013, and incorporated herein by reference). 10.9 * Employment Agreement between the Company and Mahmud Haq dated as of May 1, 2018 (filed as Exhibit 10.1 to the Company’s Form 8-K filed on May 7, 2018, and incorporated herein by reference). 57 10.10 * Employment Agreement between the Company and A. Hadi Chaudhry dated as of March 23, 2021 (filed as Exhibit 10.2 to the Company’s Form 8-K filed on March 24, 2021, and incorporated herein by reference). 10.11 * Employment Agreement between the Company and Bill Korn dated as of May 1, 2018 (filed as Exhibit 10.4 to the Company’s Form 8-K filed on May 7, 2018, and incorporated herein by reference). 10.12 Loan and Security Agreement dated as of October 13, 2017 between Medical Transcription Billing, Corp., MTBC Acquisition, Corp. and Silicon Valley Bank (filed as Exhibit 10.1 to the Company’s Form 8-K filed on October 16, 2017, and incorporated herein by reference). 10.13 Joinder and First Loan Modification Agreement dated as of September 20, 2018 between Medical Transcription Billing, Corp., MTBC Acquisition, Corp., MTBC Health, Inc. and MTBC Practice Management, Corp. and Silicon Valley Bank (filed as Exhibit 10.1 to the Company’s Form 8-K filed on September 20, 2018, and incorporated herein by reference). 10.14 Second Loan Modification Agreement dated November 15, 2019, by and between the Company and SVB (filed as Exhibit 1.1 to the Company’s Form 8-K filed on November 21, 2019, and incorporated herein by reference). 10.15 Joinder and Third Loan Modification Agreement dated as of February 28, 2020 between MTBC, Inc., MTBC Acquisition Corp., MTBC Health, Inc. and MTBC Practice Management Corp., MTBC-Med, Inc., CareCloud Corporation and Silicon Valley Bank (filed as Exhibit 10.16 to the Company’s Form 10-K filed on February 28, 2020, and incorporated herein by reference). 10.16 Joinder and Fourth Loan Modification Agreement dated September 21, 2020, by and between the Company and SVB (filed as Exhibit 1.1 to the Company’s Form 8-K filed on September 25, 2020, and incorporated herein by reference). 10.17 Joinder and Fifth Loan Modification Agreement dated September 21, 2021, by and between the Company and SVB (filed as Exhibit 10.1 to the Company’s Form 8-K filed on September 22, 2021 and incorporated herein by reference). 10.18 Underwriting Agreement dated January 28, 2022 by and between the Company and B. Riley FBR, Inc. as representative of several underwriters named therein (filed as Exhibit 1.1 to the Company’s Form 8-K filed on January 31, 2022, and incorporated herein by reference). 10.19 Sixth Loan Modification Agreement dated January 27, 2022, by and between the Company and SVB (filed as Exhibit 10.19 to the Company’s Form 10-Q filed on May 9, 2022 and incorporated herein by reference). 10.20 At Market Issuance Sales Agreement dated February 14, 2022 by and between CareCloud, Inc. and B. Riley Securities, Inc. (filed as Exhibit 1.1 to the Company’s Form 8-K filed on February 14, 2022 and incorporated herein by reference). 10.21 Seventh Loan Modification Agreement dated February 17, 2023, by and between the Company and SVB (filed as Exhibit 10.1 to the Company’s Form 8-K filed on February 21, 2023 and incorporated herein by reference). 10.22 Consulting Agreement dated June 3, 2022 by and between the Company and Hill City Advisors, LLC. 10.23 Amendment to Consulting Agreement dated February 16, 2023 by and between the Company and Hill City Advisors, LLC. 21.1 List of subsidiaries. 23.1 Consent of Grant Thornton LLP. 31.1 Certification of the Company’s Principal Executive Officer pursuant to Exchange Act Rules 13a-14(a)/15d-14(a), of the Securities Exchange Act of 1934, as amended. 31.2 Certification of the Company’s Principal Financial Officer pursuant to Exchange Act Rules 13a-14(a)/15d-14(a), of the Securities Exchange Act of 1934, as amended. 58 32.1 Certification of the Company’s Chief Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. 32.2 Certification of the Company’s Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. 101.INS Inline XBRL Instance 101.SCH Inline XBRL Taxonomy Extension Schema 101.CAL Inline XBRL Taxonomy Extension Calculation Linkbase 101.LAB Inline XBRL Taxonomy Extension Label Linkbase 101.PRE Inline XBRL Taxonomy Extension Presentation Linkbase 101.DEF Inline XBRL Taxonomy Extension Definition Linkbase 104 Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101). * Indicates management contract or compensatory plan or arrangement. The certifications on Exhibit 32 hereto are deemed not “filed” for purposes of Section 18 of the Securities and Exchange Act of 1934, as amended, or otherwise subject to the liability of that Section. Such certifications will not be deemed incorporated by reference into any filing under the Securities Act or the Exchange Act. 59 Signatures Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized. CareCloud, Inc. By: /s/ A. Hadi Chaudhry A. Hadi Chaudhry Chief Executive Officer Date: March 2, 2023 By: /s/ Bill Korn Bill Korn Chief Financial Officer Date: March 2, 2023 Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been signed below by the following persons on behalf of the Registrant and in the capacities and on the dates indicated: Signature Title Date /s/ Mahmud Haq March 2, 2023 Mahmud Haq Executive Chairman and Director /s/ A. Hadi Chaudhry March 2, 2023 A. Hadi Chaudhry Principal Executive Officer, President and Director /s/ Bill Korn March 2, 2023 Bill Korn Principal Financial Officer /s/ Norman Roth March 2, 2023 Norman Roth Principal Accounting Officer /s/ Anne Busquet March 2, 2023 Anne Busquet Director /s/ John N. Daly March 2, 2023 John N. Daly Director /s/ Cameron Munter March 2, 2023 Cameron Munter Director /s/ Lawrence Sharnak March 2, 2023 Lawrence Sharnak Director /s/ Stephen Snyder March 2, 2023 Stephen Snyder Director 60 Index to Consolidated Financial Statements Report of Independent Registered Public Accounting Firm Grant Thornton, LLP (PCAOB ID Number 248 ) F-2 Consolidated Balance Sheets as of December 31, 2022 and 2021 F-4 Consolidated Statements of Operations for the years ended December 31, 2022 and 2021 F-5 Consolidated Statements of Comprehensive Income for the years ended December 31, 2022 and 2021 F-6 Consolidated Statements of Shareholders’ Equity for the years ended December 31, 2022 and 2021 F-7 Consolidated Statements of Cash Flows for the years ended December 31, 2022 and 2021 F-8 Notes to Consolidated Financial Statements F-9 F- 1 REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM Board of Directors and Shareholders CareCloud, Inc. Opinion on the financial statements We have audited the accompanying consolidated balance sheets of CareCloud, Inc. (a Delaware corporation) and subsidiaries (the “Company”) as of December 31, 2022 and 2021, the related consolidated statements of operations, comprehensive income, changes in shareholders’ equity, and cash flows for each of the two years in the period ended December 31, 2022, and the related notes (collectively referred to as the “financial statements”). In our opinion, the financial statements present fairly, in all material respects, the financial position of the Company as of December 31, 2022 and 2021, and the results of its operations and its cash flows for each of the two years in the period ended December 31, 2022, in conformity with accounting principles generally accepted in the United States of America. Basis for opinion These financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion on the Company’s financial statements based on our audits. We are a public accounting firm registered with the Public Company Accounting Oversight Board (United States) (“PCAOB”) and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB. We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement, whether due to error or fraud. The Company is not required to have, nor were we engaged to perform, an audit of its internal control over financial reporting. As part of our audits we are required to obtain an understanding of internal control over financial reporting but not for the purpose of expressing an opinion on the effectiveness of the Company’s internal control over financial reporting. Accordingly, we express no such opinion. Our audits included performing procedures to assess the risks of material misstatement of the financial statements, whether due to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. Our audits also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that our audits provide a reasonable basis for our opinion. F- 2 Critical audit matter The critical audit matter communicated below is a matter arising from the current period audit of the financial statements that was communicated or required to be communicated to the audit committee and that: (1) relates to accounts or disclosures that are material to the financial statements and (2) involved our especially challenging, subjective, or complex judgments. The communication of critical audit matters does not alter in any way our opinion on the financial statements, taken as a whole, and we are not, by communicating the critical audit matter below, providing a separate opinion on the critical audit matter or on the accounts or disclosures to which it relates. Goodwill Impairment Assessment- Healthcare IT Reporting Unit As described further in Notes 2 and 4 of the consolidated financial statements, the Company performed a goodwill impairment assessment as of October 31, 2022, the date of its annual impairment test, on one of its reporting units, Healthcare IT (HIT). We identified the Company’s goodwill impairment assessment over the HIT reporting unit as a critical audit matter. The principal considerations for our determination that goodwill impairment assessment is a critical audit matter are the significant management estimates and judgements related to forecasts of expected future cash flows required to estimate the HIT reporting unit’s fair value. Management’s significant estimates and judgements include the determination of the discount rate, revenue growth rates, operating margins, and long-term growth rate. Auditing these estimates requires a high degree of auditor judgement, including the use of professionals with specialized skills and knowledge. Our audit procedures related to the goodwill impairment assessment included the following, among others: ● We assessed the design and implementation of management controls around the determination of inputs used in the quantitative impairment test. ● We assessed management’s ability to forecast by comparing historical projections to actual results and comparing current forecasted projections to historical trends, industry data, and underlying business strategies. ● We evaluated managements revenue growth rates, operating margins, and cash flows for consistency with relevant historical data, recent changes in the business, and external industry data and forecasts. ● With the assistance of our valuation professionals with specialized skills and knowledge, we evaluated the valuation methodologies, inputs, and assumptions utilized by management, including the long-term growth rate and discount rate. ● We performed sensitivity analyses on the long-term growth rate and discount rate used to evaluate the impact that changes in these assumptions have on management’s conclusion. /s/ GRANT THORNTON LLP We have served as the Company’s auditor since 2015. Iselin, New Jersey March 2, 2023 F- 3 CARECLOUD, INC. CONSOLIDATED BALANCE SHEETS AS OF DECEMBER 31, 2022 AND 2021 ($ in thousands, except share and per share amounts) December 31, December 31, 2022 2021 ASSETS Current assets: Cash $ 12,299 $ 9,340 Restricted cash - 1,000 Accounts receivable - net 14,773 17,006 Contract asset 4,399 4,725 Inventory 381 503 Current assets - related party 16 13 Prepaid expenses and other current assets 2,785 2,972 Total current assets 34,653 35,559 Property and equipment - net 5,056 5,404 Operating lease right-of-use assets 4,921 6,940 Intangible assets - net 29,520 30,778 Goodwill 61,186 61,186 Other assets 838 981 TOTAL ASSETS $ 136,174 $ 140,848 LIABILITIES AND SHAREHOLDERS’ EQUITY Current liabilities: Accounts payable $ 5,681 $ 5,948 Accrued compensation 4,248 4,251 Accrued expenses 4,432 5,091 Operating lease liability (current portion) 2,273 3,963 Deferred revenue (current portion) 1,386 1,085 Deferred payroll taxes - 934 Notes payable (current portion) 319 344 Contingent consideration (current portion) - 3,090 Dividend payable 4,059 3,856 Consideration payable - 1,000 Total current liabilities 22,398 29,562 Notes payable 13 20 Borrowings under line of credit 8,000 8,000 Operating lease liability 3,207 4,545 Deferred revenue 342 341 Deferred tax liability 525 449 Total liabilities 34,485 42,917 COMMITMENTS AND CONTINGENCIES (NOTE 11) - - SHAREHOLDERS’ EQUITY: Preferred stock, $ 0.001 par value - authorized 7,000,000 shares. Series A, issued and outstanding 4,526,231 and 5,299,227 shares at December 31, 2022 and December 31, 2021, respectively. Series B, issued and outstanding 1,344,128 shares at December 31, 2022 6 5 Common stock, $ 0.001 par value - authorized 35,000,000 shares. Issued 15,970,204 and 15,657,641 shares at December 31, 2022 and December 31, 2021, respectively. Outstanding 15,229,405 and 14,916,842 shares at December 31, 2022 and December 31, 2021, respectively 16 16 Additional paid-in capital 130,987 131,379 Accumulated deficit ( 25,621 ) ( 31,053 ) Accumulated other comprehensive loss ( 3,037 ) ( 1,754 ) Less: 740,799 common shares held in treasury, at cost at December 31, 2022 and December 31, 2021 ( 662 ) ( 662 ) Total shareholders’ equity 101,689 97,931 TOTAL LIABILITIES AND SHAREHOLDERS’ EQUITY $ 136,174 $ 140,848 See notes to consolidated financial statements. F- 4 CARECLOUD, INC. CONSOLIDATED STATEMENTS OF OPERATIONS FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021 ($ in thousands, except share and per share amounts) December 31, 2022 2021 NET REVENUE $ 138,826 $ 139,599 OPERATING EXPENSES: Direct operating costs 84,434 86,918 Selling and marketing 9,788 8,786 General and administrative 23,820 24,273 Research and development 4,401 4,408 Change in contingent consideration ( 3,090 ) ( 2,515 ) Depreciation and amortization 11,725 12,195 Net loss on lease termination, impairment and unoccupied lease charges 1,138 2,005 Total operating expenses 132,216 136,070 OPERATING INCOME 6,610 3,529 OPERATING INCOME (LOSS) 6,610 3,529 OTHER: Interest income 41 15 Interest expense ( 405 ) ( 455 ) Other expense - net ( 637 ) ( 96 ) INCOME BEFORE PROVISION FOR INCOME TAXES 5,609 2,993 Income tax provision 177 157 NET INCOME $ 5,432 $ 2,836 Preferred stock dividend 15,517 14,052 NET LOSS ATTRIBUTABLE TO COMMON SHAREHOLDERS $ ( 10,085 ) $ ( 11,216 ) Net loss per common share: basic and diluted $ ( 0.67 ) $ ( 0.77 ) Weighted-average common shares used to compute basic and diluted loss per share 15,109,587 14,541,061 See notes to consolidated financial statements. F- 5 CARECLOUD, INC. CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021 ($ in thousands) December 31, 2022 2021 NET INCOME $ 5,432 $ 2,836 OTHER COMPREHENSIVE LOSS, NET OF TAX Foreign currency translation adjustment (a) (a) ( 1,283 ) ( 750 ) COMPREHENSIVE INCOME $ 4,149 $ 2,086 (a) No tax effect has been recorded as the Company recorded a valuation allowance against the tax benefit from its foreign currency translation adjustments. See notes to consolidated financial statements. F- 6 CARECLOUD, INC. CONSOLIDATED STATEMENTS OF SHAREHOLDERS’ EQUITY FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021 ($ in thousands, except for number of shares) Shares Amount Shares Amount Shares Amount Capital Deficit Loss Stock Equity Preferred Stock Series A Preferred Stock Series B Common Stock Additional Paid-in Accumulated Accumulated Other Comprehensive Treasury (Common) Total Shareholders’ Shares Amount Shares Amount Shares Amount Capital Deficit Loss Stock Equity Balance - January 1, 2022 5,299,227 $ 5 - $ - 15,657,641 $ 16 $ 131,379 $ ( 31,053 ) $ ( 1,754 ) $ ( 662 ) $ 97,931 Net income - - - - - - - 5,432 - - 5,432 Foreign currency translation adjustment - - - - - - - - ( 1,283 ) - ( 1,283 ) Issuance of stock under the equity incentive plan 27,004 - 19,270 - 303,491 - - - - - - Redemption of Series A Preferred Stock ( 800,000 ) - - - - - ( 20,005 ) - - - ( 20,005 ) Exercise of common stock warrants - - - - 9,072 - - - - - - Issuance of Series B Preferred Stock - - 1,324,858 1 - - 30,900 - - - 30,901 Stock issuance costs - - - - - - ( 32 ) - - - ( 32 ) Stock-based compensation, net of cash settlements - - - - - - 4,262 - - - 4,262 Preferred stock dividends - - - - - - ( 15,517 ) - - - ( 15,517 ) Balance - December 31, 2022 4,526,231 $ 5 1,344,128 $ 1 15,970,204 $ 16 $ 130,987 $ ( 25,621 ) $ ( 3,037 ) $ ( 662 ) $ 101,689 Balance - January 1, 2021 5,475,279 $ 5 - $ - 14,121,044 $ 14 $ 136,781 $ ( 33,889 ) $ ( 1,004 ) $ ( 662 ) $ 101,245 Balance 5,475,279 $ 5 - $ - 14,121,044 $ 14 $ 136,781 $ ( 33,889 ) $ ( 1,004 ) $ ( 662 ) $ 101,245 Net income - - - - - - - 2,836 - - 2,836 Foreign currency translation adjustment - - - - - - - - ( 750 ) - ( 750 ) Issuance of stock under the equity incentive plan 39,770 - - - 332,208 - - - - - - Cancellation of shares held in escrow ( 215,822 ) - - - - - - - - - - Settlement of contingent liability - - - - - - ( 4,000 ) - - - ( 4,000 ) Sale of common stock - - - - 346,389 1 2,730 - - - 2,731 Exercise of common stock warrants - - - - 858,000 1 6,434 - - - 6,435 Stock-based compensation, net of cash settlements - - - - - - 3,486 - - - 3,486 Preferred stock dividends - - - - - - ( 14,052 ) - - - ( 14,052 ) Balance - December 31, 2021 5,299,227 $ 5 - $ - 15,657,641 $ 16 $ 131,379 $ ( 31,053 ) $ ( 1,754 ) $ ( 662 ) $ 97,931 Balance 5,299,227 $ 5 - $ - 15,657,641 $ 16 $ 131,379 $ ( 31,053 ) $ ( 1,754 ) $ ( 662 ) $ 97,931 For all years presented, the preferred stock dividends were paid monthly at the rate of $2.75 and $2.19 for Series A and Series B, respectively, per share per annum. See notes to consolidated financial statements. F- 7 CARECLOUD, INC. CONSOLIDATED STATEMENTS OF CASH FLOWS FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021 ($ in thousands) 2022 2021 OPERATING ACTIVITIES: Net income $ 5,432 $ 2,836 Adjustments to reconcile net income to net cash provided by operating activities: Depreciation and amortization 12,318 12,676 Lease amortization 3,286 3,574 Deferred revenue 302 ( 72 ) Provision for doubtful accounts 740 890 Provision for deferred income taxes 76 289 Foreign exchange loss (gain) 610 ( 16 ) Interest accretion 596 857 Loss on sale of assets - 172 Stock-based compensation expense 4,914 5,396 Change in contingent consideration ( 3,090 ) ( 2,515 ) Adjustment of goodwill - 36 Changes in operating assets and liabilities, net of businesses acquired: Accounts receivable 1,493 ( 620 ) Contract asset 326 ( 620 ) Inventory 122 ( 104 ) Other assets 619 921 Accounts payable and other liabilities ( 6,593 ) ( 10,366 ) Net cash provided by operating activities 21,151 13,334 INVESTING ACTIVITIES: Purchases of property and equipment ( 2,588 ) ( 2,928 ) Capitalized software ( 9,179 ) ( 7,636 ) Cash paid for acquisition (net) - ( 12,582 ) Net cash used in investing activities ( 11,767 ) ( 23,146 ) FINANCING ACTIVITIES: Preferred stock dividends paid ( 15,314 ) ( 14,437 ) Settlement of contingent obligation ( 1,000 ) - Settlement of tax withholding obligations on stock issued to employees ( 1,197 ) ( 2,123 ) Repayments of notes payable ( 1,003 ) ( 1,045 ) Financing and stock issuance costs ( 32 ) ( 80 ) Proceeds from exercise of warrants - 6,435 Proceeds from issuance of Series B Preferred Stock, net of expenses 30,901 - Proceeds from issuance of common stock, net of expenses - 2,731 Redemption of Series A Preferred Stock ( 20,005 ) - Proceeds from line of credit 25,500 26,000 Repayment of line of credit ( 25,500 ) ( 18,000 ) Net cash used in financing activities ( 7,650 ) ( 519 ) EFFECT OF EXCHANGE RATE CHANGES ON CASH 225 ( 254 ) NET INCREASE (DECREASE) IN CASH AND RESTRICTED CASH 1,959 ( 10,585 ) CASH AND RESTRICTED CASH - Beginning of the year 10,340 20,925 CASH AND RESTRICTED CASH - End of the year $ 12,299 $ 10,340 SUPPLEMENTAL NONCASH INVESTING AND FINANCING ACTIVITIES: Preferred stock cancelled in connection with an acquisition $ - $ ( 4,000 ) Contingent consideration at fair value at acquisition date $ - $ 5,605 Dividends declared, not paid $ 4,059 $ 3,856 Purchase of prepaid insurance with assumption of note $ 695 $ 967 SUPPLEMENTAL INFORMATION - Cash paid during the year for: Income taxes $ 153 $ 282 Interest $ 162 $ 103 See notes to consolidated financial statements. F- 8 CARECLOUD, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021 1. ORGANIZATION AND BUSINESS CareCloud, Inc., (together with its consolidated subsidiaries, “CareCloud,” the “Company,” “we,” “us” and/or “our”) is a healthcare information technology company that provides a full suite of proprietary cloud-based solutions, related business services, to healthcare providers and hospitals throughout the United States. The Company’s integrated services are designed to help customers increase revenues, streamline workflows and make better business and clinical decisions, while reducing administrative burdens and operating costs. Our Software-as-a-Service (“SaaS”) platform includes revenue cycle management (“RCM”), practice management (“PM”), electronic health records (“EHR”), business intelligence, telehealth, patient experience management (“PXM”) solutions and complementary software tools and business services for high-performance medical groups and health systems. CareCloud has its corporate offices in Somerset, New Jersey and maintains client support teams throughout the U.S., and offshore offices in Pakistan and Azad Jammu and Kashmir, a region administered by Pakistan (the “Pakistan Offices”), and in Sri Lanka. CareCloud was founded in 1999 under the name Medical Transcription Billing, Corp. and incorporated under the laws of the State of Delaware in 2001. In 2004, the Company formed MTBC Private Limited (“MTBC Pvt. Ltd.”), a 99.9 % majority-owned subsidiary of CareCloud based in Pakistan. The remaining 0.1 % of the shares of MTBC Pvt. Ltd. is equally owned by the founder and Executive Chairman of CareCloud and a local employee who is also a director of this entity. In 2016, the Company formed MTBC Acquisition Corp. (“MAC”), a Delaware corporation, in connection with its acquisition of substantially all of the assets of MediGain, LLC and its subsidiary, Millennium Practice Management Associates, LLC (together “MediGain”). MAC has a wholly owned subsidiary in Sri Lanka, RCM MediGain Colombo, Pvt. Ltd. In May 2018, the Company formed CareCloud Practice Management, Corp. (“CPM”), a Delaware corporation, to operate the medical practice management business acquired from Orion Healthcorp. In January 2020, the Company purchased CareCloud Corporation, a company whose name we took. That company is now known as CareCloud Health, Inc. (“CCH”). In June 2020, the Company purchased Meridian Billing Management Co. and its affiliate Origin Holdings, Inc. (collectively “Meridian” and sometimes referred to as “Meridian Medical Management”). Both companies were subsequently merged and the surviving company was renamed Meridian Medical Management, Inc. During March 2021, the Company formed a new wholly-owned subsidiary, CareCloud Acquisition, Corp. (“CAC”). In June 2021, CAC purchased certain assets and assumed certain liabilities of MedMatica Consulting Associates Inc., (“MedMatica”) and purchased the stock of Santa Rosa Staffing, Inc. (“SRS”). The assets and liabilities of MedMatica were merged into SRS and the company was renamed medSR, Inc. (“medSR”). See Note 3. Effective April 1, 2022, the Company formed MTBC Bagh Private Limited (“MTBC Bagh Pvt. Ltd.”), a 99.8 % majority-owned subsidiary of CareCloud based in Azad Jammu and Kashmir, a region administered by Pakistan. The remaining 0.2 % of the shares of MTBC Bagh Pvt. Ltd. is equally owned by the founder and Executive Chairman of CareCloud and the same director/employee as noted above. 2. SIGNIFICANT ACCOUNTING POLICIES Principles of Consolidation — The accompanying consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) and include the operating results and financial condition of CareCloud, its wholly-owned subsidiaries, MAC, CPM, its majority-owned subsidiary MTBC Pvt. Ltd, majority-owned subsidiary MTBC Bagh Pvt. Ltd, CCH (since January 2020), Meridian Medical Management (since June 2020), medSR (since June 2021) and the subsidiary in Sri Lanka. The non-controlling interests of MTBC Pvt. Ltd. and MTBC Bagh Pvt. Ltd. are inconsequential to the consolidated financial statements. All intercompany accounts and transactions have been eliminated in consolidation. F- 9 Segment Reporting — The Company views its operations as comprising two operating segments, Healthcare IT and Medical Practice Management. The chief operating decision maker (“CODM”) monitors and reviews financial information at these segment levels for assessing operating results and the allocation of resources. Use of Estimates — The preparation of consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the consolidated financial statements, as well as the reported amounts of revenues and expenses during the reporting period. Significant estimates and assumptions made by management include, but are not limited to: (1) impairment of long-lived assets, (2) depreciable lives of assets, (3) allowance for doubtful accounts, (4) contingent consideration, (5) estimates of variable consideration related to the contract asset, (6) fair value of identifiable purchased tangible and intangible assets, including determination of expected customer life, (7) stock-based compensation, and (8) estimating lease terms and incremental borrowing rates. Actual results could significantly differ from those estimates. Revenue Recognition — We derive revenue from five primary sources: (1) technology-enabled business solutions including revenue cycle management, (2) professional services, (3) printing and mailing services, (4) group purchasing services and (5) medical practice management services. All of our revenue arrangements are based on contracts with customers. Most of our contracts with customers contain single performance obligations, although certain contracts do contain multiple performance obligations where we perform more than one service for the same customer. We account for individual performance obligations separately if they are distinct within the context of the contract. For contracts where we provide multiple services such as where we perform multiple ancillary services, each service represents its own performance obligation. Selling or transaction prices are based on the contractual prices for each service at its stand-alone selling price. A five-step approach is applied in the recognition of revenue under ASC 606: (1) identify the contract with a customer, (2) identify the performance obligations in the contract, (3) determine the transaction price, (4) allocate the transaction price to the performance obligations in the contract, and (5) recognize revenue when we satisfy a performance obligation. Although we believe that our approach to estimates and judgments is reasonable, actual results could differ, and we may be exposed to increases or decreases in revenue that could be material. Our estimates of variable consideration may prove to be inaccurate, in which case we may have understated or overstated the revenue recognized in a reporting period. The amount of variable consideration recognized to date that remains subject to estimation is included within the contract asset within the consolidated balance sheet. Payment of invoices is due as specified in the underlying customer agreement, typically 30 days from the invoice date, which occurs on the date of transfer of control of the services to the customer. Since payment terms are less than a year, we have elected the practical expedient and do not assess whether a customer contract has a significant financing component. The Company’s revenue arrangements generally do not include a general right of refund for services provided (See Note 9, Revenue, for additional information). Direct Operating Costs — Direct operating costs consist primarily of salaries and benefits related to personnel who provide services to clients and at our managed medical practices, claims processing costs, medical supplies at our managed practices and other direct costs related to the Company’s services. Costs associated with the implementation of new clients are expensed as incurred. The reported amounts of direct operating costs include allocated amounts for rent expense and overhead costs. Selling and Marketing Expenses — Selling and marketing expenses consist primarily of compensation and benefits, travel and advertising expenses and are expensed as incurred. The Company incurred approximately $ 4.5 million and $ 3.9 million of advertising costs for the years ended December 31, 2022 and 2021, respectively. Research and Development Expenses — Research and development expenses consist primarily of personnel-related costs incurred performing market research, analyzing proposed products and developing new products. F- 10 Internal-Use Software Costs — The Company capitalizes certain development costs incurred in connection with its internal-use software. Costs incurred in the preliminary stages of development are expensed as incurred. Once an application has reached the development stage, internal and external costs, if direct, are capitalized until the software is substantially complete and ready for its intended use. Capitalization ceases upon completion of all substantial testing. The Company also capitalizes costs related to specific upgrades and enhancements when it is probable that the expenditures will result in additional functionality. Capitalized costs are recorded as part of intangible assets in the accompanying consolidated balance sheets. Maintenance and training costs are expensed as incurred. Internal use software is amortized on a straight line basis over its estimated useful life, generally three years. Management evaluates the useful lives of these assets on an annual basis and tests for impairment whenever events or changes in circumstances occur that could impact the recoverability of these assets. During the years ended December 31, 2022 and 2021, the Company capitalized approximately $ 9.2 million and $ 7.6 million, respectively, primarily consisting of salaries and payroll-related costs of employees and consultants who devoted time to the development of internal-use software projects. Accounts Receivable — Accounts receivable are stated at their net realizable value. Accounts receivable are presented on the consolidated balance sheet net of an allowance for doubtful accounts, which is established based on reviews of the accounts receivable aging, an assessment of the customers’ history and current creditworthiness and the probability of collection. Accounts are written off when it is determined that collection of the outstanding balance is no longer probable. The movement in the allowance for doubtful accounts for the years ended December 31, 2022 and 2021 was as follows: SCHEDULE OF ALLOWANCE FOR DOUBTFUL ACCOUNTS Year Ended December 31, 2022 2021 ($ in thousands) Beginning balance $ 537 $ 522 Provision 740 890 Recoveries/adjustments 313 69 Write-offs ( 767 ) ( 944 ) Ending balance $ 823 $ 537 Property and Equipment — Property and equipment are stated at cost, less accumulated depreciation. Depreciation is calculated using the straight-line basis over the estimated useful lives of the assets ranging from three to five years. Ordinary maintenance and repairs are expensed as incurred. Depreciation for computers is calculated over three years, while the remaining assets (except leasehold improvements) are depreciated over five years. The Company amortizes leasehold improvements over the lesser of the lease term or the remaining economic life of those assets. Generally, the lease term is the base lease term plus certain renewal option periods for which renewal is reasonably certain and for which failure to exercise the renewal option would result in an economic penalty to the Company. Intangible Assets — Intangible assets include customer relationships, covenants not-to-compete acquired in connection with acquisitions, software purchase and development costs and trademarks acquired. Amortization for intangible assets related to revenue cycle management is recorded primarily using the double declining balance method over three to four years. Amortization for intangible assets related to the group purchasing organization and medical practice management is recorded on a straight line basis over four and twelve years, respectively. Evaluation of Long-Lived Assets — The Company reviews its long-lived assets for impairment whenever changes in circumstances indicate that the carrying value of an asset may not be recoverable. If the sum of undiscounted expected future cash flows is less than the carrying amount of the asset group, the Company will recognize an impairment loss based on the fair value of the asset. There was no impairment of internal-use software costs, intangible assets or property and equipment during the years ended December 31, 2022 and 2021, other than the impairment recorded on right-of-use (“ROU”) assets of approximately $ 68,000 for the year ended December 31, 2021. In addition, during the year ended December 31, 2021, the Company recorded approximately $ 774,000 of impairment charges on a vendor contract. Goodwill — Goodwill consists of the excess of the purchase price over the fair value of identifiable net assets of businesses acquired. The Company tests goodwill for impairment annually as of October 31 st , referred to as the annual test date. The goodwill impairment test for the Healthcare IT segment is performed using the discounted cash flow approach. Conditions that could trigger a more frequent impairment assessment include, but are not limited to, a significant adverse change to the Company in certain agreements, significant underperformance relative to historical or projected future operating results, loss of customer relationships, an economic downturn in customers’ industries, or increased competition. Impairment testing for goodwill is performed at the reporting-unit level. The Company has determined that its business consists of two operating segments and two reporting units. No impairment charges were recorded during the years ended December 31, 2022 or 2021. F- 11 Treasury Stock — Treasury stock is recorded at cost and represents shares repurchased by the Company. No shares were repurchased or issued from treasury stock during the years ended December 31, 2022 and 2021. Stock-Based Compensation — The Company recognizes compensation for all share-based payments granted based on the grant date fair value. Compensation expense is generally recognized on a straight-line basis over the vesting period. The Company does not estimate forfeitures in recognizing the expense for share-based payments, as historical forfeiture rates have not been significant. For restricted stock units (“RSUs”) classified as equity, the market price of our common stock on the date of grant is used in recording the fair value of the award. For RSUs classified as a liability, the earned amount is marked to market based on the end-of-period common stock price. Business Combinations — The Company accounts for business combinations under the provisions of ASC 805, Business Combinations , which requires that the acquisition method of accounting be used for all business combinations. Assets acquired and liabilities assumed are recorded at the date of acquisition at their respective fair values. ASC 805 also specifies criteria that intangible assets acquired in a business combination must be recognized and reported apart from goodwill. Goodwill represents the excess purchase price over the fair value of the tangible net assets and intangible assets acquired in a business combination. Acquisition-related expenses are recognized separately from the business combinations and are expensed as incurred. If the business combination provides for contingent consideration, the Company records the contingent consideration at fair value at the acquisition date with changes in the fair value recorded through earnings. Acquisition costs are expensed as incurred. During the year ended December 31, 2021, the Company incurred approximately $ 316,000 of professional fees related to the medSR acquisition discussed in Note 3, which are included in general and administrative expenses in the consolidated statements of operations. Income Taxes — The Company accounts for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements. Under this method, deferred tax assets and liabilities are determined based on the differences between the financial statements and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. The effect of a change in tax rates on deferred tax assets and liabilities is recognized in operations in the period that includes the enactment date. The Company records net deferred tax assets to the extent that these assets will more likely than not be realized. All available positive and negative evidence is considered in making such a determination, including future reversals of existing taxable temporary differences, projected future taxable income, tax planning strategies, and results of recent operations. A valuation allowance would be recorded to reduce deferred income tax assets when it is determined that it is more likely than not that the Company would not be able to realize its deferred income tax assets in the future in excess of their net recorded amount. The Company records uncertain tax positions on the basis of a two-step process whereby (1) the Company determines whether it is more likely than not that the tax positions will be sustained based on the technical merits of the position and (2) for those tax positions that meet the more-likely-than-not recognition threshold, the Company recognizes the largest amount of tax benefit that is greater than 50 percent likely to be realized upon ultimate settlement with the related tax authority. At December 31, 2022 and 2021, the Company did not have any uncertain tax positions that required recognition. Interest and penalties related to uncertain tax positions are recognized in income tax expense. For the years ended December 31, 2022 and 2021, the Company did not recognize any penalties or interest related to unrecognized tax benefits in its consolidated financial statements. Dividends — Dividends are recorded when declared by the Company’s Board of Directors. The Board of Directors has declared monthly dividends on the Series A and Series B Preferred Stock through February 2023. Preferred Stock dividends are charged against paid in capital because the Company does not have sufficient retained earnings. The Company is prohibited from paying dividends on its common stock without the prior written consent of its lender, Silicon Valley Bank (“SVB”). Deferred Revenue — Deferred revenue primarily consists of payments received in advance of the revenue recognition criteria being met. Deferred revenue includes certain deferred implementation services fees that are recognized as revenue ratably over the longer of the life of the agreement or the estimated expected customer life, which is currently estimated to be three years. Deferred revenue that will be recognized during the succeeding 12-month period is recorded as current deferred revenue and the remaining portion is recorded as non-current. At the time of customer termination, any unrecognized service fees associated with implementation services are recognized as revenue. F- 12 Fair Value Measurements — ASC 820, Fair Value Measurement , requires the disclosure of fair value information about financial instruments, whether or not recognized in the balance sheet, for which it is practicable to estimate that value. The Company follows a fair value measurement hierarchy to measure financial instruments. The fair value of the Company’s financial instruments is measured using inputs from the three levels of the fair value hierarchy as follows: Level 1 — Inputs are unadjusted quoted market prices in active markets for identical assets or liabilities that the Company has the ability to access at the measurement date. Level 2 — Inputs are directly or indirectly observable, which include quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets or liabilities in markets that are not active, inputs other than quoted prices that are observable for the asset or liability and inputs that are derived principally from or corroborated by observable market data by correlation or other means. Level 3 — Inputs are unobservable inputs that are used to measure fair value to the extent observable inputs are not available. The Company’s contingent consideration is a Level 3 liability and is measured at fair value at the end of each reporting period. The Company has certain financial instruments that are not measured at fair value on a recurring basis. These financial instruments are subject to fair value adjustments only in certain circumstances and include cash, accounts receivable, accounts payable and accrued expenses, borrowings under term loans and line of credit, and notes payable. Due to the short term nature of these financial instruments and that the borrowings bear interest at prevailing market rates, the carrying value approximates the fair value. Foreign Currency Translation — The financial statements of the Company’s foreign subsidiaries are translated from their functional currency into U.S. dollars, the Company’s functional currency. All foreign currency assets and liabilities are translated at the period-end exchange rate, and all revenue and expenses are translated at transaction date exchange rates. The effects of translating the financial statements of the foreign subsidiaries into U.S. dollars are reported as a cumulative translation adjustment, a separate component of accumulated other comprehensive loss in the consolidated statements of shareholders’ equity, except for transactions related to the intercompany receivable for which transaction adjustments are recorded in the consolidated statements of operations as they are not deemed to be permanently reinvested. Foreign currency transaction gains/losses are reported as a component of other expense – net in the consolidated statements of operations and amounted to losses of approximately $ 610,000 and gains of $ 16,000 for the years ended December 31, 2022 and 2021, respectively. Net Loss on Lease Termination, Impairment and Unoccupied Lease Charges — Net loss on lease termination represents the write-off of leasehold improvements as the result of early lease terminations. Impairment charges represent charges recorded for leased facilities no longer being used by the Company. Unoccupied lease charges represent the portion of lease and related costs for that portion of the space that is vacated and not being utilized by the Company. The Company was able to turn back to the landlord one of the unused facilities effective January 1, 2022. Recent Accounting Pronouncements — From time to time, new accounting pronouncements are issued by the Financial Accounting Standards Board (“FASB”) and are adopted by us as of the specified effective date. Unless otherwise discussed, we believe that the impact of recently adopted and recently issued accounting pronouncements will not have a material impact on our consolidated financial position, results of operations and cash flows. In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses: Measurement of Credit Losses on Financial Instruments. The guidance in Accounting Standards Update (“ASU”) 2016-13 replaces the incurred loss impairment methodology under current GAAP. The new impairment model requires immediate recognition of estimated credit losses expected to occur for most financial assets and certain other instruments. It will apply to all entities. For trade receivables, loans and held-to-maturity debt securities, entities will be required to estimate lifetime expected credit losses. This may result in the earlier recognition of credit losses. In November 2019, the FASB issued ASU No. 2019-10, which delays this standard’s effective date for SEC smaller reporting companies to the fiscal years beginning on or after December 15, 2022. The Company determined that this update will not have a material impact on the consolidated financial statements upon adoption on January 1, 2023. F- 13 In December 2019, the FASB issued ASU 2019-12, Simplifying the Accounting for Income Taxes . This ASU simplifies accounting for income taxes to reduce complexity in the accounting standards. The amendments consist of the removal of certain exceptions to the general principles of ASC 740 and some additional simplifications. The amendments are not required to be implemented until 2021 for public entities. The Company adopted this guidance effective January 1, 2021. There was no impact on the consolidated financial statements as a result of this standard. In 2020, the FASB issued ASU 2020-04 to simplify the accounting for contract modifications made to replace LIBOR or other reference rates that are expected to be discontinued because of reference rate reform. The guidance provides optional expedients and exceptions for applying U.S. GAAP to these contract modifications if certain criteria are met. The optional expedients and exceptions can be applied to contract modifications made until December 31, 2022. There was no impact on the consolidated financial statements as a result of this standard. In August 2020, the FASB issued ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40). This ASU simplifies the accounting for certain financial instruments with characteristics of liabilities and equity, including convertible instruments and contracts on an entity’s own equity. The Company adopted this guidance effective January 1, 2022. There was no impact on the consolidated financial statements as a result of this standard. In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805) – Accounting for Contract Assets and Contract Liabilities from Contracts with Customers. The amendments in this update require acquiring entities to apply Topic 606 to recognize and measure contract assets and contract liabilities in a business combination. The amendments are effective for public business entities for fiscal years beginning after December 15, 2022. The Company determined that this update will not have a significant impact on the consolidated financial statements. 3. ACQUISITION 2021 Acquisition On June 1, 2021, CAC entered into an Asset and Stock Purchase Agreement (“Purchase Agreement”) with MedMatica and its sole shareholder. Pursuant to the Purchase Agreement, CAC acquired (i) all of the issued and outstanding capital stock of SRS, a Delaware corporation, and (ii) all of the MedMatica assets that were used in MedMatica’s and SRS’ business. Certain MedMatica liabilities were also assumed under the Purchase Agreement. The total cash consideration was $ 10 million plus a working capital adjustment of approximately $ 3.8 million. The Purchase Agreement also provided that if during the 18-month period commencing on June 1, 2021 (the “Earn-Out Period”), certain EBITDA and revenue targets with respect to the assets and capital stock purchased under the Purchase Agreement were achieved, then CAC would pay MedMatica an earn-out up to a maximum of $ 8 million. Further, if during the Earn-Out Period, certain additional and increased EBITDA and revenue targets with respect to the assets and capital stock purchased under the Purchase Agreement were achieved, then CAC would pay MedMatica an additional earn-out, up to a maximum of $ 5 million. At the end of the Earn-Out period, it was determined that no amounts were due to the seller. MedMatica and SRS are in the business of providing a broad range of specialty consulting services to hospitals and large healthcare groups, including certain consulting services related to healthcare IT application services and implementations, medical practice management, and revenue cycle management. The acquisition has been accounted for as a business combination. A summary of the total consideration is as follows: SUMMARY OF TOTAL CONSIDERATION ON BUSINESS CONSIDERATION medSR Purchase Price ($ in thousands) Cash $ 12,261 Amounts held in escrow 1,571 Contingent consideration 5,605 Total purchase price $ 19,437 F- 14 The Company engaged a third party valuation specialist to assist the Company in valuing the assets acquired and liabilities assumed from MedMatica. The following table summarizes the purchase price allocation. The Company finalized the purchase price allocation during the fourth quarter of 2021. The purchase price allocation for medSR is summarized as follows: SCHEDULE OF ASSETS ACQUIRED AND LIABILITIES ASSUMED ($ in thousands) Accounts receivable $ 2,696 Receivable from seller 227 Prepaid expenses 102 Unbilled receivables 2,491 Property and equipment 84 Customer relationships 3,100 Acquired backlog 490 Goodwill 11,931 Accounts payable ( 539 ) Accrued expenses & compensation ( 1,125 ) Deferred revenue ( 20 ) Total purchase price allocation $ 19,437 The acquired accounts receivable was recorded at fair value, which represents amounts that have subsequently been paid or were expected to be paid by clients. The fair value of customer relationships was based on the estimated discounted cash flows generated by these intangibles. The goodwill represents the Company’s ability to have an expanded local presence in additional markets and operational synergies that we expect to achieve that would not be available to other market participants. The goodwill from this acquisition is deductible ratably for income tax purposes over fifteen years. The purchase agreement provides that if revenue and EBITDA over the next 18 months exceeds certain specified amounts, there will be an earn-out payment to the seller equal to such excess, up to $ 13 million. It was estimated that the probable payment was approximately $ 5.6 million as of the acquisition date and this amount was recorded as part of the purchase price allocation as contingent consideration. At December 31, 2021, the Company determined that the fair value of the contingent consideration was approximately $ 3.1 million, based in part on the actual operating results since the acquisition. At the end of the 18-month period, it was determined that no earn-out payment was due to the seller and accordingly, there was no contingent consideration recorded as of December 31, 2022. The difference in the contingent consideration between December 31, 2022 and December 31, 2021 has been recorded as a change in contingent consideration in the consolidated statements of operations. As part of the acquisition, $ 1.5 million of the purchase price was held in escrow, which represented $ 500,000 to be paid upon the achievement of agreed-upon revenue and backlog milestones, and the balance to be held for up to 18 months to satisfy certain indemnification obligations. During the third quarter of 2021, the initial portion of the escrow was settled whereby $ 250,000 was paid to the seller and $ 250,000 was offset against the working capital adjustment. An additional $ 71,000 that was held in escrow was also paid. Approximately $ 12.3 million in cash was paid at closing. The balance of $ 1 .0 million escrow is included in consideration payable and restricted cash in the consolidated balance sheet at December 31, 2021. During the quarter ended December 31, 2022, $ 1 .0 million was paid to the seller settling the remaining portion of the escrow. The weighted-average amortization period of the acquired intangible assets is approximately three years . Revenue earned as a result of the medSR acquisition was approximately $ 29.7 million and $ 15.9 million for the years ended December 31, 2022 and 2021, respectively. The medSR acquisition added additional clients to the Company’s customer base and, similar to previous acquisitions, broadened the Company’s presence in the healthcare information technology industry through expansion of its customer base and by increasing available customer relationship resources and specialized trained staff. F- 15 Pro forma financial information (Unaudited) The unaudited pro forma information below represents the consolidated results of operations as if the medSR acquisition occurred on January 1, 2021. The pro forma information has been included for comparative purposes and is not indicative of results of operations that the Company would have had if the acquisition occurred on the above date, nor is it necessarily indicative of future results. The unaudited pro forma information reflects material, non-recurring pro forma adjustments directly attributable to the business combination. The difference between the actual revenue and the pro forma revenue is approximately $ 17.8 million of additional revenue primarily recorded by medSR for the year ended December 31, 2021 and reflected as a pro forma adjustment below. Other differences arise from amortizing purchased intangibles using the double declining balance method. SCHEDULE OF BUSINESS ACQUISITION PRO FORMA INFORMATION Year Ended December 31, 2021 ($ in thousands, except per share amounts) Total revenue $ 157,390 Net income $ 3,753 Net loss attributable to common shareholders $ ( 10,299 ) Net loss per common share $ ( 0.71 ) Net loss per common share $ ( 0.71 ) 4. GOODWILL AND INTANGIBLE ASSETS – NET Goodwill consists of the excess of the purchase price over the fair value of identifiable net assets of businesses acquired. The following is the summary of the changes to the carrying amount of goodwill for the years ended December 31, 2022 and 2021: SCHEDULE OF INTANGIBLE ASSETS AND GOODWILL Year Ended December 31, 2022 2021 ($ in thousands) Beginning gross balance $ 61,186 $ 49,291 Acquisition, net of adjustments - 11,895 Ending gross balance $ 61,186 $ 61,186 At December 31, 2022, and 2021, approximately $ 90,000 of goodwill was allocated to the Medical Practice Management segment and the balance was allocated to the Healthcare IT segment. F- 16 Below is a summary of intangible asset activity for the years ended December 31, 2022 and 2021: SCHEDULE OF FINITE - LIVED INTANGIBLE ASSETS Customer Capitalized Other Intangible Relationships Software Assets Total ($ in thousands) COST Balance, January 1, 2022 $ 47,597 $ 13,196 $ 9,632 $ 70,425 Additions - 9,160 19 9,179 Translation loss - ( 809 ) - ( 809 ) Allocation from 2021 acquisition 3,100 - 490 3,590 Balance, December 31, 2022 $ 47,597 $ 21,547 $ 9,651 $ 78,795 Useful lives 3 - 12 years 3 years 3 years ACCUMULATED AMORTIZATION Balance, January 1, 2022 $ 33,851 $ 1,591 $ 4,205 $ 39,647 Amortization expense 5,672 3,341 615 9,628 Balance, December 31, 2022 39,523 4,932 4,820 49,275 Net book value $ 8,074 $ 16,615 $ 4,831 $ 29,520 COST Balance, January 1, 2021 $ 44,497 $ 5,760 $ 9,142 $ 59,399 Additions - 7,636 - 7,636 Translation loss - ( 200 ) - ( 200 ) Allocation from 2021 acquisition 3,100 - 490 3,590 Balance, December 31, 2021 $ 47,597 $ 13,196 $ 9,632 $ 70,425 Useful lives 3 - 12 years 3 years 3 years ACCUMULATED AMORTIZATION Balance, January 1, 2021 $ 26,008 $ 245 $ 3,168 $ 29,421 Amortization expense 7,843 1,346 1,037 10,226 Balance, December 31, 2021 33,851 1,591 4,205 39,647 Net book value $ 13,746 $ 11,605 $ 5,427 $ 30,778 The amount for capitalized software represents payroll and development costs incurred for internally developed software. Other intangible assets primarily represent non-compete agreements, purchased and acquired software and trademarks. Amortization expense was approximately $ 9.8 million and $ 10.3 million for the years ended December 31, 2022 and 2021, respectively. The weighted-average amortization period is three years . As of December 31, 2022, future amortization expense scheduled to be expensed is as follows: SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS, FUTURE AMORTIZATION EXPENSE Years ending December 31, ($ in thousands) 2023 $ 13,632 2024 8,873 2025 5,665 2026 300 2027 300 Thereafter 750 Total $ 29,520 F- 17 5. PROPERTY AND EQUIPMENT Property and equipment consisted of the following: SCHEDULE OF PROPERTY AND EQUIPMENT December 31, 2022 2021 ($ in thousands) Computer equipment $ 5,831 $ 5,558 Office furniture and equipment 1,990 1,868 Transportation equipment 1,099 1,087 Leasehold improvements 3,460 1,623 Assets not placed in service 72 1,682 Total property and equipment 12,452 11,818 Less accumulated depreciation ( 7,396 ) ( 6,414 ) Property and equipment – net $ 5,056 $ 5,404 Depreciation expense was approximately $ 2.0 million and $ 1.9 million for the years ended December 31, 2022 and 2021, respectively. 6. CONCENTRATIONS Financial Risks — As of December 31, 2022 and 2021, the Company held cash of approximately $ 1.8 million and $ 1.7 million, respectively, in the name of its subsidiaries, at banks in Pakistan and Sri Lanka. The banking systems in these countries do not provide deposit insurance coverage. Additionally, from time to time, the Company maintains cash balances at financial institutions in the United States in excess of federal insurance limits. The Company has not experienced any losses on such accounts. Concentrations of credit risk with respect to trade accounts receivable are managed by periodic credit evaluations of customers. The Company does not require collateral for outstanding trade accounts receivable. As of December 31, 2022, two customers each individually accounted for approximately 6 % of accounts receivable. As of December 31, 2021, two customers each individually accounted for approximately 5 % of accounts receivable, respectively. During the years ended December 31, 2022 and 2021, there was one customer with sales of approximately 7 % and 9 % of total revenue, respectively. Geographical Risks — The Company’s offices in Islamabad and Bagh, Pakistan, and Colombo, Sri Lanka conduct significant back-office operations for the Company. The Company has no revenue earned outside of the United States. The office in Bagh is located in a different territory of Pakistan from the Islamabad office known as Azad Jammu and Kashmir. The Bagh office was opened in 2009 for the purpose of providing operational support and operating as a backup to the Islamabad office. The Company’s operations outside the United States are subject to special considerations and significant risks not typically associated with companies in the United States. The Company’s business, financial condition and results of operations may be influenced by the political, economic, and legal environment in the countries in which it operates and by the general state of these countries’ economies. The Company’s results may be adversely affected by, among other things, changes in governmental policies with respect to laws and regulations, changes in local countries’ telecommunications industries, regulatory rules and policies, anti-inflationary measures, currency conversion and remittance, and rates and methods of taxation. F- 18 Carrying amounts of net assets located outside the United States were approximately $ 8.5 million and $ 7.2 million as of December 31, 2022 and 2021, respectively. These balances exclude net intercompany receivables of approximately $ 1.0 million and $ 4.1 million as of December 31, 2022 and 2021, respectively. The following is a summary of the net assets located outside the United States as of December 31, 2022 and 2021: SCHEDULE OF CONCENTRATION OF RISK, BY GEOGRAPHICAL RISKS FACTOR 2022 2021 December 31, 2022 2021 ($ in thousands) Current assets $ 2,306 $ 2,189 Non-current assets 7,890 6,736 Assets 10,196 8,925 Current liabilities ( 1,500 ) ( 1,575 ) Non-current liabilities ( 224 ) ( 153 ) Net assets $ 8,472 $ 7,197 7. NET LOSS PER COMMON SHARE The following table reconciles the weighted-average shares outstanding for basic and diluted net loss per common share for the years ended December 31, 2022 and 2021: SCHEDULE OF LOSSES PER SHARE, BASIC AND DILUTED 2022 2021 Year Ended December 31, 2022 2021 ($ in thousands, except share and per share amounts) Basic and Diluted: Net loss attributable to common shareholders $ ( 10,085 ) $ ( 11,216 ) Weighted-average common shares used to compute basic and diluted loss per share 15,109,587 14,541,061 Net loss attributable to common shareholders per share - basic and diluted $ ( 0.67 ) $ ( 0.77 ) At December 31, 2022, the 598,245 unvested restricted stock units (“RSUs”) as discussed in Note 15 and 1,128,489 unexercised warrants expiring between January 2023 and September 2023 with exercise prices between $ 5.00 and $ 10.00 have been excluded from the above calculations as they were anti-dilutive. At December 31, 2021, the 331,039 unvested equity RSUs and 3,152,140 unexercised warrants have been excluded from the above calculations as they were anti-dilutive. Vested RSUs, vested restricted shares and exercised warrants have been included in the above calculations. 8. DEBT SVB — During October 2017, the Company opened a revolving line of credit from Silicon Valley Bank (“SVB”) under a three-year agreement which replaced the previous credit facility from Opus. The SVB credit facility is a secured revolving line of credit where borrowings are based on a formula of 200 % of repeatable revenue adjusted by an annualized attrition rate as defined in the credit agreement. During the third quarter of 2018, the credit line was increased from $ 5 million to $ 10 million and the term was extended for an additional year. During the third quarter of 2021, the credit line was further increased to $ 20 million and the term was extended for another year. During February 2023, the line of credit was increased to $ 25 million and the term was extended for two years. (See Note 20). At both December 31, 2022 and 2021, there were $ 8 million of borrowings under the credit facility. Interest on the SVB revolving line of credit is currently charged at the prime rate plus 1.50 % . There is also a fee of one-half of 1% annually for the unused portion of the credit line . The debt is secured by all of the Company’s domestic assets and 65 % of the shares in its offshore subsidiaries. Future acquisitions are subject to approval by SVB. In connection with the original SVB debt agreement, the Company paid SVB approximately $ 50,000 of fees upfront and issued warrants for SVB to purchase 125,000 shares of its common stock, and committed to pay an annual anniversary fee of $ 50,000 a year. Based on the terms in the original SVB credit agreement, these warrants had a strike price equal to $ 3.92 . They had a five -year exercise window and net exercise rights, and were valued at $ 3.12 per warrant. These warrants were exercised during 2022. As a result of the revision in the SVB credit line, which increased the credit line from $ 5 million to $ 10 million and reduced the interest rate by 25 basis points, the Company paid approximately $ 50,000 of fees upfront and issued an additional 28,489 warrants, with a strike price equal to $ 5.26 , a five-year exercise window and net exercise rights. The additional warrants were valued at $ 3.58 per warrant. The SVB credit agreement contains various covenants and conditions governing the revolving line of credit including a current annual fee of $ 100,000 . These covenants include a minimum level of adjusted EBITDA and a minimum liquidity ratio. At December 31, 2022 and 2021, the Company was in compliance with all covenants. F- 19 During September 2021, the agreement with SVB was modified to include CAC and medSR as borrowers. During January 2022, the agreement with SVB was modified to allow the Company to issue Series B Preferred Stock and pay monthly dividends on this stock, to use a portion of the offering proceeds to redeem a portion of the Series A Preferred Stock that is outstanding and to allow for the potential exchange of shares of Series A Preferred Stock for Series B Preferred Stock. During September 2021, the agreement with SVB was modified to include CAC and medSR as borrowers. Vehicle Financing Notes — The Company financed certain vehicle purchases both in the United States and in Pakistan. The vehicle financing notes have three to six year terms and were issued at current market rates. Insurance Financing — The Company finances certain insurance purchases over the term of the policy life. The interest rate charged is 4.55 % . Maturities of the outstanding notes payable and other obligations as of December 31, 2022 are as follows: SCHEDULE OF MATURITIES OF LONG-TERM DEBT Years ending December 31 Line of Credit* Vehicle Financing Notes Insurance Financing Total ($ in thousands) 2023 $ - $ 7 $ 312 $ 319 2024 - 5 - 5 2025 8,000 5 - 8,005 2026 - 3 - 3 Total $ 8,000 $ 20 $ 312 $ 8,332 * The line of credit was repaid after the year-end. 9. REVENUE Introduction The Company accounts for revenue in accordance with ASC 606, Revenue from Contracts with Customers . All revenue is recognized as our performance obligations are satisfied. A performance obligation is a promise in a contract to transfer a distinct good or service to a customer, and is the unit of account under ASC 606. The Company recognizes revenue when the revenue cycle management services begin on the medical billing claims, which is generally upon receipt of the claim from the provider. For many services the Company recognizes revenue as a percent of the amount the customer collects on the medical billing claims. The Company’s software is utilized at the time the provider sees the patient, and the Company estimates the value of the consideration it will earn over the remaining contractual period as our services are provided and recognizes the fees over the term; this estimation involves predicting the amounts our clients will ultimately collect associated with the services they provided. Certain significant estimates, such as payment-to-charge ratios, effective billing rates and the estimated contractual payment periods are required to measure revenue cycle management revenue under the new standard. Most of our current contracts with customers contain a single performance obligation. For contracts where we provide multiple services, such as where we perform multiple ancillary services, each service represents its own performance obligation. The standalone selling prices are based on the contractual price for the service. We apply the portfolio approach as permitted by ASC 606 as a practical expedient to contracts with similar characteristics and we use estimates and assumptions when accounting for those portfolios. Our contracts generally include standard commercial payment terms. We have no significant obligations for refunds, warranties or similar obligations and our revenue does not include taxes collected from our customers. F- 20 Disaggregation of Revenue from Contracts with Customers We derive revenue from five primary sources: (1) Technology-enabled business solutions, (2) professional services, (3) printing and mailing services, (4) group purchasing services and (5) medical practice management services. The following table represents a disaggregation of revenue for the years ended December 31, 2022 and 2021: SCHEDULE OF DISAGGREGATION OF REVENUE 2022 2021 Year Ended December 31, 2022 2021 ($ in thousands) Healthcare IT: Technology-enabled business solutions $ 88,140 $ 105,531 Professional services 33,984 19,044 Printing and mailing services 2,207 1,538 Group purchasing services 945 967 Medical Practice Management: Medical practice management services 13,550 12,519 Total $ 138,826 $ 139,599 Revenues $ 138,826 $ 139,599 Technology-enabled business solutions: Revenue derived on an on-going basis from our technology-enabled solutions, which typically includes revenue cycle management services, is billed as a percentage of payments collected by our customers. The fee for our services often includes the ability to use our EHR and practice management software as well as RCM as part of the bundled fee. Technology-assisted revenue cycle management services are the recurring process of submitting and following up on claims with health insurance companies in order for the healthcare providers to receive payment for the services they rendered. The Company typically invoices customers on a monthly basis based on the actual collections received by its customers and the agreed-upon rate in the sales contract. The fee for these services typically includes use of practice management software and related tools (on a SaaS basis), electronic health records (on a SaaS basis), medical billing services and use of mobile health solutions. We consider the services to be one performance obligation since the promises are not distinct in the context of the contract. The performance obligation consists of a series of distinct services that are substantially the same and have the same periodic pattern of transfer to our customers. In many cases, our clients may terminate their agreements with 90 days’ notice without cause, thereby limiting the term in which we have enforceable rights and obligations, although this time period can vary between clients. Our payment terms are normally net 30 days. Although our contracts typically have stated terms of one or more years, under ASC 606 our contracts are considered month-to-month and accordingly, there is no financing component. For the majority of our revenue cycle management contracts, the total transaction price is variable because our obligation is to process an unknown quantity of claims, as and when requested by our customers over the contract period. When a contract includes variable consideration, we evaluate the estimate of the variable consideration to determine whether the estimate needs to be constrained; therefore, we include variable consideration in the transaction price only to the extent that it is probable that a significant reversal of the amount of cumulative revenue recognized will not occur when the uncertainty associated with variable consideration is subsequently resolved. Estimates to determine variable consideration such as payment to charge ratios, effective billing rates, and the estimated contractual payment periods are updated at each reporting date. Revenue is recognized over the performance period using the input method. Our proprietary, cloud-based practice management application automates the labor-intensive workflow of a medical office in a unified and streamlined SaaS platform. The Company has a large number of clients who utilize the Company’s practice management software, electronic health records software, patient experience management solutions, business intelligence software and/or robotic process automation software on a SaaS basis, but who do not utilize the Company’s revenue cycle management services. SaaS fees may be fixed based on the number of providers, or may be variable. F- 21 The medical billing clearinghouse service takes claim information from customers, checks the claims for errors and sends this information electronically to insurance companies. The Company invoices customers on a monthly basis based on the number of claims submitted and the agreed-upon rate in the agreement. This service is provided to medical practices and providers to medical practices who are not revenue cycle management customers. The performance obligation is satisfied once the relevant submissions are completed. Additional services such as coding and transcription are rendered in connection with the delivery of revenue cycle management and related medical services. The Company invoices customers monthly, based on the actual amount of services performed at the agreed-upon rate in the contract. These services are only offered to revenue cycle management customers. These services do not represent a material right because the services are optional to the customer and customers electing these services are charged the same price for those services as if they were on a standalone basis. Each individual coding or transcription transaction processed represents a performance obligation, which is satisfied over time as that individual service is rendered. Digital health services: Our digital health services, which began generating revenue in 2022, include chronic care management, where a care manager has remote visits with patients with one or more chronic conditions under the supervision of a physician who is our client. It also includes remote patient monitoring where our system monitors recordings from FDA approved internet connected devices. These devices record patient trends and alerts the physician to changes which might trigger the need for additional follow-up visits. The performance obligation for chronic care management is satisfied at a point in time once the patient receives the services. The performance obligation for remote patient monitoring is satisfied over time as the patient receives the services. The revenue for these services for the year ended December 31, 2022 was not material. Professional services: Our professional services include an extensive set of services including EHR vendor-agnostic optimization and activation, project management, IT transformation consulting, process improvement, training, education and staffing for large healthcare organizations including health systems and hospitals. The performance obligation is satisfied over time using the input method. The revenue is recorded on a monthly basis as the professional services are rendered. Printing and mailing services: The Company provides printing and mailing services for both revenue cycle management customers and a non- revenue cycle management customer, and invoices on a monthly basis based on the number of prints, the agreed-upon rate per print and the postage incurred. The performance obligation is satisfied once the printing and mailing is completed. Group purchasing services: The Company provides group purchasing services which enable medical providers to purchase various vaccines directly from selected pharmaceutical companies at a discounted price. Currently, there are approximately 4,000 medical providers who are members of the program. Revenue is recognized as the vaccine shipments are made to the medical providers. Fees from the pharmaceutical companies are paid either quarterly or annually and the Company adjusts its revenue accrual at the time of payment. The Company makes significant judgments regarding the variable consideration which we expect to be entitled to for the group purchasing services which includes the anticipated shipments to the members enrolled in the program, anticipated volumes of purchases made by the members, and the changes in the number of members. The amounts recorded are constrained by estimates of decreases in shipments and loss of members to avoid a significant revenue reversal in the subsequent period. The only performance obligation is to provide the pharmaceutical companies with the medical providers who want to become members in order to purchase vaccines. The performance obligation is satisfied once the medical provider agrees to purchase a specific quantity of vaccines and the medical provider’s information is forwarded to the vaccine suppliers. The Company records a contract asset for revenue earned and not paid as the ultimate payment is conditioned on achieving certain volume thresholds. F- 22 For all of the above revenue streams other than group purchasing services, revenue is recognized over time, which is typically one month or less, which closely matches the point in time that the customer simultaneously receives and consumes the benefits provided by the Company. For the group purchasing services, revenue is recognized at a point in time. Each service is substantially the same and has the same periodic pattern of transfer to the customer. Each of the services provided above is considered a separate performance obligation. Medical practice management services: The Company also provides medical practice management services under long-term management service agreements to three medical practices. We provide the medical practices with the nurses, administrative support, facilities, supplies, equipment, marketing, RCM, accounting, and other non-clinical services needed to efficiently operate their practices. Revenue is recognized as the services are provided to the medical practices. Revenue recorded in the consolidated statements of operations represents the reimbursement of costs paid by the Company for the practices and the management fee earned each month for managing the practice. The management fee is based on either a fixed fee or a percentage of the net operating income. The Company assumes all financial risk for the performance of the managed medical practices. Revenue is impacted by the amount of the costs incurred by the practices and their operating income. The gross billing of the practices is impacted by billing rates, changes in current procedural terminology code reimbursement and collection trends which in turn impacts the management fee that the Company is entitled to. Billing rates are reviewed at least annually and adjusted based on current insurer reimbursement practices. The performance obligation is satisfied as the management services are provided. Our contracts for medical practice management services have approximately an additional 16 years remaining and are only cancellable under very limited circumstances. The Company receives a management fee each month for managing the day-to-day business operations of each medical group as a fixed fee or a percentage payment of the net operating income which is included in revenue in the consolidated statements of operations. Our medical practice management services obligations consist of a series of distinct services that are substantially the same and have the same periodic pattern of transfer to our customers. Revenue is recognized over time, however for reporting and convenience purposes, the management fee is computed at each month end. Information about contract balances: As of December 31, 2022, the estimated revenue expected to be recognized in the future related to the remaining revenue cycle management performance obligations outstanding was approximately $ 4 million. We expect to recognize substantially all of the revenue for the remaining performance obligations over the next three months . Approximately $ 371,000 of the contract asset represents revenue earned, not paid, from the group purchasing services. Amounts that we are entitled to collect under the applicable contract are recorded as accounts receivable. Invoicing is performed at the end of each month when the services have been provided. The contract asset includes our right to payment for services already transferred to a customer when the right to payment is conditional on something other than the passage of time. For example, contracts for revenue cycle management services where we recognize revenue over time but do not have a contractual right to payment until the customer receives payment of their claim from the insurance provider. The contract asset also includes the revenue accrued, not received, for the group purchasing services. Changes in the contract asset are recorded as adjustments to net revenue. The changes primarily result from providing services to revenue cycle management customers that result in additional consideration and are offset by our right to payment for services becoming unconditional and changes in the revenue accrued for the group purchasing services. The contract asset for our group purchasing services is reduced when we receive payments from vaccine manufacturers and is increased for revenue earned, not received. The opening and closing balances of the Company’s accounts receivable, contract asset and deferred revenue are as follows: SCHEDULE OF ACCOUNTS RECEIVABLE, CONTRACT ASSET AND DEFERRED REVENUE Accounts Receivable, Net Contract Asset Deferred Revenue (current) Deferred Revenue (long term) ($ in thousands) Balance as of January 1, 2022 $ 17,006 $ 4,725 $ 1,085 $ 341 medSR acquisition (Decrease) increase, net ( 2,233 ) ( 326 ) 301 1 Balance as of December 31, 2022 $ 14,773 $ 4,399 $ 1,386 $ 342 Balance as of January 1, 2021 $ 12,089 $ 4,105 $ 1,173 $ 305 Beginning Balance $ 12,089 $ 4,105 $ 1,173 $ 305 medSR acquisition 5,187 - 20 - (Decrease) increase, net ( 270 ) 620 ( 108 ) 36 Balance as of December 31, 2021 $ 17,006 $ 4,725 $ 1,085 $ 341 Ending Balance $ 17,006 $ 4,725 $ 1,085 $ 341 F- 23 Deferred commissions: Our sales incentive plans include commissions payable to employees and third parties at the time of the initial contract execution that are capitalized as incremental costs to obtain a contract. The capitalized commissions are amortized over the period the related services are transferred. As we do not offer commissions on contract renewals, we have determined the amortization period to be the estimated client life, which is three years. Deferred commissions were approximately $ 643,000 and $ 931,000 at December 31, 2022 and 2021, respectively, and are included in the other assets amounts in the consolidated balance sheets. 10. SHAREHOLDERS’ EQUITY Treasury stock The Board of Directors of the Company previously approved common stock repurchase programs. The last program expired January 25, 2017 . As a result of these stock repurchases, the Company has 740,799 common shares held as treasury stock at an aggregate cost of $ 662,000 . Common stock The Company has the right to sell up to $ 50 million of its common stock using an “at-the-market” facility (“ATM”). The underwriter receives 3 % of the gross proceeds. During the year ended December 31, 2022, no shares of common stock were issued under this ATM. During the year ended December 31, 2021, the Company sold 346,389 shares of common stock under its ATM and received net proceeds of approximately $ 2.7 million. Holders of our common stock are entitled to one vote for each share held on all matters properly submitted to a vote of shareholders on which holders of common stock are entitled to vote. Holders of common stocks are entitled to receive dividends only at times and amounts as determined by the Board of Directors. The common stock is not entitled to pre-emptive rights, and is not subject to conversion, redemption or sinking fund provisions. The common stock is listed on the Nasdaq Global Market under the trading symbol “CCLD.” Preferred stock The Company has seven million authorized shares of preferred stock of which 5,360,000 have been designated as Series A shares and the balance have been designated as Series B shares. The Company has the right to sell up to $ 35 million of its Series B Preferred Stock using an ATM facility. The underwriter receives 3 % of the gross proceeds. During the year ended December 31, 2022, the Company sold 1,324,858 of shares of Series B Preferred Stock and received net proceeds of approximately $ 30.9 million. This includes 224,048 shares sold under the Company’s ATM. On March 18, 2022, the Company used a portion of the proceeds from selling Series B Preferred Stock to redeem 800,000 shares of Series A Preferred Stock for $ 25.00 per share, plus all accrued and unpaid dividends to, but not including, the redemption date. During the year ended December 31, 2021, the Company cancelled 215,822 shares of Series A Preferred Stock that were held in escrow from the CCH acquisition as the matters related to the escrow were settled in cash. Since November 4, 2020, the Company may redeem, at its option, the Series A Preferred Stock, in whole or in part, at a cash redemption price of $ 25.00 per share, plus all accrued and unpaid dividends to, but not including, the redemption date. The Series A Preferred Stock has no stated maturity, is not subject to any sinking fund or other mandatory redemption, and is not convertible into or exchangeable for any of the Company’s other securities. Holders of the Series A Preferred Stock have no voting rights except for limited voting rights if dividends payable on the Series A Preferred Stock are in arrears for eighteen or more consecutive or non-consecutive monthly dividend periods. If the Company were to liquidate, dissolve or wind up, the holders of the Series A Preferred Stock will have the right to receive $ 25.00 per share, plus any accumulated and unpaid dividends to, but not including, the date of payment, before any payment is made to the holders of the common stock. The Series A Preferred Stock is listed on the Nasdaq Global Market under the trading symbol “CCLDP.” Commencing on February 15, 2024 and prior to February 15, 2025, we may redeem, at our option, the Series B Preferred Stock, in whole or in part, at a cash redemption price of $ 25.75 per share, plus all accrued and unpaid dividends to, but not including, the redemption date. On or after February 15, 2025 and prior to February 15, 2026, we may redeem, at our option, the Series B Preferred Stock, in whole or in part, at a cash redemption price of $ 25.50 per share, plus all accrued and unpaid dividends to, but not including, the redemption date. On or after February 15, 2026 and prior to February 15, 2027, we may redeem, at our option, the Series B Preferred Stock, in whole or in part, at a cash redemption price of $ 25.25 per share, plus all accrued and unpaid dividends to, but not including, the redemption date. On or after February 15, 2027, we may redeem, at our option, the Series B Preferred Stock, in whole or in part, at a cash redemption price of $ 25.00 per share, plus all accrued and unpaid dividends to, but not including, the redemption date. The Series B Preferred Stock is listed on the Nasdaq Global Market under the trading symbol “CCLDO.” F- 24 Dividends on the Series A and Series B Preferred Stock of $ 2.75 and $ 2.19 , respectively, annually per share are cumulative from the date of issue and are payable each month when, as and if declared by the Company’s Board of Directors. As of December 31, 2022, the Board of Directors has declared monthly dividends on the Series A and Series B Preferred Stock payable through February 2023. Warrants The Company has issued 6,603,489 warrants for its common stock, of which 1,128,489 remained outstanding at December 31, 2022. The outstanding warrants consist of 1,000,000 warrants at a $ 10.00 exercise price which expired in January 2023 , 100,000 warrants at a $ 5.00 exercise price which will expire in July 2023 , and 28,489 warrants at a $ 5.26 exercise price which will expire in September 2023 . During the years ended December 31, 2022 and 2021, 125,000 and 858,000 warrants, respectively, were exercised at a $ 3.92 and $ 7.50 exercise price for total proceeds of approximately $ 6,435,000 in 2021. The warrants exercised in 2022 were a cashless exercise. The Company incurs common and preferred stock offering costs which consist principally of professional fees, primarily legal and accounting, and other costs such as printing and registration costs. In connection with the 2022 and 2021 equity offerings, the Company incurred approximately $ 2.3 million and $ 223,000 , respectively, of such costs, excluding underwriting commissions and placement agent fees which are recorded in additional paid-in capital in the consolidated balance sheets. 11. COMMITMENTS AND CONTINGENCIES Legal Proceedings — On December 9, 2022, an arbitrator rendered a decision in favor of MTBC Acquisition Corp. (“MAC”) and dismissed the claims brought against MAC by Randolph Pain Relief and Wellness Center (“RPRWC”), determining that RPRWC failed to prove any breach of the applicable billing services agreement and failed to prove that any alleged damages were due. RPRWC has until April 5, 2023 to file a summary action in Superior Court of New Jersey should it seek to have the decision overturned. RPRWC was a client of Millennium Practice Management Associates, Inc. (“MPMA”), a subsidiary of MediGain, Inc., whose assets were purchased by MAC on October 3, 2016, after RPRWC terminated its billing services agreement with MPMA. After MAC’s purchase of MediGain’s assets, RPRWC demanded an arbitration proceeding against CareCloud and MAC before the American Arbitration Association for damages they alleged were caused by MPMA prior to the asset purchase. On May 30, 2018, the Superior Court of New Jersey, Chancery Division, Somerset County (the “Chancery Court”) denied CareCloud’s and MAC’s request to enjoin the arbitration proceeding demanded by RPRWC. CareCloud and MAC filed an appeal of the Chancery Court’s decision with the New Jersey Superior Court, Appellate Division. The Chancery Court stayed the arbitration pending the appeal. On appeal, CareCloud and MAC contended they were never party to the billing services agreement giving rise to the arbitration claim, did not assume the obligations of MPMA under such agreement, and any agreement to arbitrate disputes arising under such agreement did not apply to CareCloud or MAC as RPRWC terminated the agreement before the applicable asset purchase agreement took effect. On April 23, 2019, the Appellate Division affirmed in part and reversed in part the Chancery Court’s order. The Appellate Division upheld the portion of the Chancery Court’s order requiring MAC to participate in the arbitration based on the Chancery Court’s finding that MAC had assumed MPMA’s contractual responsibilities. The Appellate Division, however, reversed the Chancery Court’s order requiring CareCloud to participate in the arbitration on the grounds that insufficient facts had been provided by RPRWC from which the court could conclude CareCloud was required to participate in the arbitration and remanded the matter back to the Chancery Court for further proceedings. On February 6, 2020, the Chancery Court held that CareCloud cannot be compelled to participate in the arbitration. On March 25, 2020, the Chancery Court lifted the stay of arbitration relative to RPRWC and MAC. In its arbitration demand, RPRWC alleged that MPMA, a subsidiary of MediGain, LLC, breached the terms of the billing services agreement the parties had entered into and sought compensatory damages of $ 6.6 million and costs. F- 25 During the discovery phase of the arbitration, RPRWC served expert reports whereby RPRWC’s expert alleged that damages were estimated to be in the range of $ 9.8 million to $ 10.8 million. MAC served an expert report refuting the alleged damages. In the event RPRWC files a summary action, MAC will continue to vigorously defend against RPRWC’s claim. It remains that since MAC is not a significant subsidiary of CareCloud pursuant to Rule 1-02(w) of Regulation S-X and CareCloud is not a party to this proceeding, we do not expect any outcome to have a material impact on the Company’s consolidated financial statements. From time to time, we may become involved in other legal proceedings arising in the ordinary course of our business. Including the proceeding described above, we are not presently a party to any legal proceedings that, in the opinion of our management, would individually or taken together have a material adverse effect on our business, consolidated results of operations, financial position or cash flows of the Company. 12. LEASES We determine if an arrangement is a lease at inception. We have operating leases for office and temporary living space as well as for some office equipment. Operating leases are included in operating lease ROU assets, current operating lease liability and non-current operating lease liability in our consolidated balance sheets as of December 31, 2022 and 2021. The Company does not have any finance leases. ROU assets represent our right to use an underlying asset for the lease term and lease liabilities represent our obligation to make lease payments arising from the lease. ROU assets and liabilities are recognized at the lease commencement date based on the estimated present value of the lease payments over the lease term. As most of our leases do not provide an implicit rate, we use our estimated incremental borrowing rates, which are derived from information available at the lease commencement date, in determining the present value of lease payments. We give consideration to our bank financing arrangements, geographical location and collateralization of assets when calculating our incremental borrowing rates. Our lease terms include options to extend the lease when it is reasonably certain that we will exercise that option. Leases with a term of less than 12 months are not recorded in the consolidated balance sheets . Our lease agreements do not contain any residual value guarantees. For real estate leases, we account for the lease and non-lease components as a single lease component. Some leases include escalation clauses and termination options that are factored in the determination of the lease payments when appropriate. If a lease is modified after the effective date, the operating lease ROU asset and liability is re-measured using the current incremental borrowing rate. There were no lease modifications during the years ended December 31, 2022 and 2021. The anticipated renewal for one lease was reassessed, resulting in an increase in ROU assets and liabilities of approximately $ 150,000 . We review our incremental borrowing rate for our portfolio of leases on a quarterly basis. During the years ended December 31, 2022 and 2021, there were approximately $ 1.0 million and $ 959,000 , respectively, of unoccupied lease charges for two of the Company’s facilities. During the year ended December 31, 2021, the Company recorded approximately $ 775,000 of impairment charges on a vendor contract and recorded a lease impairment of approximately $ 68,000 since the Company is no longer using certain leased facilities. There was no lease impairment recorded for the year ended December 31, 2022. During the year ended December 31, 2022, there was a gain on lease termination of approximately $ 105,000 . Additionally, a facility lease was terminated in conjunction with the Company ceasing its document storage services resulting in additional costs of approximately $ 203,000 . These amounts are included in net loss on lease terminations, impairment and unoccupied lease charges in the consolidated statements of operations. During the year ended December 31, 2021, the Company decided to terminate one of its leases in Pakistan which expired as of the end of the year. The Company did not renew this lease and consolidated its employees into the remaining facilities. As a result of the termination, the Company incurred a loss of approximately $ 18,000 which has been included in net loss on lease termination, impairment and unoccupied lease charges in the consolidated statements of operations. F- 26 Lease expense is included in direct operating costs and general and administrative expenses in the consolidated statements of operations based on the nature of the expense. As of December 31, 2022, we had 31 leased properties, five in Medical Practice Management and 26 in Healthcare IT, with the remaining terms ranging from less than one year to thirteen years. Our lease terms are determined taking into account lease renewal options, the Company’s anticipated operating plans and leases that are on a month-to-month basis. We also have some related party leases – see Note 13. The components of lease expense were as follows: SCHEDULE OF LEASE EXPENSE 2022 2021 Year Ended December 31, 2022 2021 ($ in thousands) Operating lease cost $ 3,714 $ 4,232 Short-term lease cost 92 54 Variable lease cost 29 31 Total - net lease cost $ 3,835 $ 4,317 Short-term lease cost represents leases that were not capitalized as the lease term as of the later of January 1, 2022 or the beginning of the lease was less than 12 months. Variable lease costs include utilities, real estate taxes and common area maintenance costs. Supplemental balance sheet information related to leases was as follows: SCHEDULE OF SUPPLEMENTAL BALANCE SHEET INFORMATION RELATED TO LEASES December 31, 2022 December 31, 2021 ($ in thousands) Operating leases: Operating lease ROU assets, net $ 4,921 $ 6,940 Current operating lease liabilities $ 2,273 $ 3,963 Operating lease liability (current portion) $ 2,273 $ 3,963 Non-current operating lease liabilities 3,207 4,545 Operating lease liability 3,207 4,545 Total operating lease liabilities $ 5,480 $ 8,508 Operating leases: ROU assets $ 8,293 $ 10,535 Asset lease expense ( 3,286 ) ( 3,574 ) Foreign exchange loss ( 86 ) ( 21 ) ROU assets, net $ 4,921 $ 6,940 Operating lease right-of-use assets $ 4,921 $ 6,940 Weighted average remaining lease term (in years): Operating leases 5.1 4.3 Weighted average discount rate: Operating leases 7.9 % 6.8 % Weighted average discount rate: Operating leases 7.9 % 6.8 % F- 27 Supplemental cash flow and other information related to leases was as follows: SCHEDULE OF SUPPLEMENTAL CASH FLOW AND OTHER INFORMATION RELATED TO LEASES 2022 2021 Year Ended December 31, 2022 2021 ($ in thousands) Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 4,743 $ 5,351 ROU assets obtained in exchange for lease liabilities: Operating leases, excluding impairments and terminations $ 1,569 $ 2,790 Maturities of lease liabilities are as follows: SCHEDULE OF MATURITIES OF LEASE LIABILITIES Operating leases - Years ending December 31, ($ in thousands) 2023 $ 2,613 2024 1,333 2025 821 2026 286 2027 231 Thereafter 1,637 Total lease payments 6,921 Less: imputed interest ( 1,441 ) Total lease obligations 5,480 Less: current obligations ( 2,273 ) Long-term lease obligations $ 3,207 13. RELATED PARTIES The Company had sales to a related party, a physician who is the wife of the Executive Chairman. Revenues from this customer were approximately $ 58,000 for the year ended December 31, 2022 and approximately $ 23,000 for the year ended December 31, 2021. As of December 31, 2022 and 2021, the accounts receivable balance due from this customer was approximately $ 10,000 and $ 3,000 respectively, and is included in accounts receivable - net in the consolidated balance sheets. The Company leases its corporate offices in New Jersey, its temporary housing for its foreign visitors, a storage facility, its backup operations center in Bagh, Pakistan and an apartment for temporary housing in Dubai, the UAE, from the Executive Chairman. The related party rent expense for the years ended December 31, 2022 and 2021 was approximately $ 198,000 and $ 186,000 , respectively, and is included in direct operating costs and general and administrative expense in the consolidated statements of operations. During the years ended December 31, 2022 and 2021, the Company spent approximately $ 941,000 and $ 2 .0 million, respectively, to upgrade the related party leased facilities. Current assets-related party in the consolidated balance sheets includes security deposits related to the leases of the Company’s corporate offices in the amount of approximately $ 16,000 and $ 13,000 for the years ended December 31, 2022 and 2021, respectively. On October 15, 2021, the Company entered into a one-year lease agreement with the Executive Chairman for an apartment for temporary housing in Dubai. This agreement was renewed in 2022 for an additional year. Included in the ROU asset at December 31, 2022 is approximately $ 467,000 applicable to the related party leases. Included in the current and non-current operating lease liability at December 31, 2022 is approximately $ 158,000 and $ 301,000 , respectively, applicable to the related party leases. Included in the ROU asset at December 31, 2021 is approximately $ 483,000 applicable to the related party leases. Included in the current and non-current operating lease liability at December 31, 2021 is approximately $ 174,000 and $ 305,000 , respectively, applicable to the related party leases. During June 2022, the Company entered into a one-year consulting agreement with an entity owned and controlled by one of its non-independent directors whereby the director received 10,000 shares of Series B Preferred Stock in exchange for assisting the Company to identify and acquire additional companies, including performing due diligence. The payment was capitalized and is being amortized over the service period. The amortization is recorded as stock compensation in General and Administrative expense in the 2022 consolidated statement of operations. In addition, the Company may make additional payments under the agreement for any successful acquisitions by the Company based on the purchase price of the transaction. No such additional payments were made in 2022. During February 2023, the agreement was amended and extended through December 2024 whereby the director received 14,000 shares of Series B Preferred Stock in February 2023 and will receive an additional 14,000 shares in January 2024. All such shares of the Series B Preferred Stock are or will be issued in accordance with the Company’s Amended and Restated Equity Incentive Plan. In addition to the extension of the consulting agreement, the amendment provides that any transaction fees due will be offset against the last two above payments before any amounts are due to the director. F- 28 During 2020, a New Jersey corporation, talkMD Clinicians, PA (“talkMD”), was formed by the wife of the Executive Chairman, who is a licensed physician, to provide telehealth services. talkMD was determined to be a variable interest entity (“VIE”) for financial reporting purposes because the entity will be controlled by the Company. As of December 31, 2022, talkMD had not yet commenced operations. Cumulatively, the Company has paid approximately $ 4,000 on behalf of talkMD for income taxes. The Company was a party to a nonexclusive aircraft dry lease agreement with Kashmir Air, Inc. (“KAI”), which was owned by the Executive Chairman. The Company recorded an expense of approximately $ 80,000 for the year ended December 31, 2021. The lease for the aircraft was renewed as of April 1, 2021 and terminated on August 31, 2021. As a result of the lease termination, the Company incurred a loss of approximately $ 185,000 which was included in the net loss on lease termination, impairment and unoccupied lease charges in the December 31, 2021 consolidated statement of operations. As of December 31, 2021, the Company had no liability outstanding to KAI. 14. EMPLOYEE BENEFIT PLANS The Company has qualified 401(k) plans covering all U.S. employees who have completed one month of service. The plans provide for matching contributions by the Company for employees of the Company and most U.S. subsidiaries, although there is no match for CPM employees. Employer contributions to the plans for the years ended December 31, 2022 and 2021 were approximately $ 549,000 and $ 697,000 , respectively. Additionally, the Company has a defined contribution retirement plan covering all employees located in our Pakistan Offices who have completed three months of service. The plan provides for monthly contributions by the Company which are equal to 10% of qualified employees’ basic monthly compensation . The Company’s contributions for the years ended December 31, 2022 and 2021 were approximately $ 329,000 and $ 479,000 , respectively. The Company maintains a defined contribution retirement plan covering all employees in Sri Lanka. The employee and employer contribute 8 % and 12 % , respectively, of the employee’s gross salary. The Company’s contribution for the years ended December 31, 2022 and 2021 was approximately $ 22,000 and $ 35,000 , respectively. The contributions are required to be deposited with the Employees’ Provident Fund Organization, a government owned entity. 15. STOCK-BASED COMPENSATION In April 2014, the Company adopted the Medical Transcription Billing, Corp. 2014 Equity Incentive Plan (the “Original Plan”), reserving a total of 1,351,000 shares of common stock for grants to employees, officers, directors and consultants. On April 14, 2017, the Original Plan was amended and restated whereby an additional 1,500,000 shares of common stock and 100,000 shares of Series A Preferred Stock were added to the plan for future issuance (the “A&R Plan”). During 2018, an additional 200,000 shares of Series A Preferred Stock were added to the A&R Plan for future issuance. In May 2020, an additional 2,000,000 shares of common stock and an additional 300,000 shares of Series A Preferred Stock were added to the A&R Plan for future issuance. During 2022, an additional 1,000,000 shares of common stock and 200,000 shares of Series B Preferred Stock were added to the A&R Plan for future issuance. As of December 31, 2022, 1,498,492 shares of common stock and 33,769 and 100,000 shares of Series A and Series B Preferred Stock, respectively, are available for grant. Permissible awards include incentive stock options, non-statutory stock options, stock appreciation rights, restricted stock, RSUs, performance stock and cash-settled awards and other stock-based awards in the discretion of the Compensation Committee of the Board of Directors including unrestricted stock grants. The equity based RSUs contain a provision in which the units shall immediately vest and become converted into common shares at the rate of one common share per RSU, immediately after a change in control, as defined in the award agreement. Common stock During 2021, 628,361 RSUs of common stock were granted to employees and independent contractors to vest at different dates during the years 2021 through 2023. Included therein were 44,000 RSUs of common stock granted over two years equally to the four outside members of the Board of Directors with 25 % of the shares vesting every six months. F- 29 During 2022, 777,715 RSUs of common stock were granted to employees and independent contractors to vest at different dates during the years 2022 through 2024. Included therein were 80,000 shares of common stock granted over two years equally to the four outside members of the Board of Directors with 25 % of the shares vesting every six months. During December 2022, it was agreed that certain bonuses to employees of medSR that were originally going to be paid in cash will be paid in common stock. The change of paying the bonuses in common stock resulted in approximately 135,000 shares being issued in February 2023. This change resulted in approximately $ 404,000 of stock compensation expense, which offset the amounts previously accrued. The following table summarizes the RSU and restricted stock transactions related to the common and Preferred Stock under the A&R Plan for the years ended December 31, 2022 and 2021: DISCLOSURE OF SHARE-BASED COMPENSATION ARRANGEMENTS BY SHARE-BASED PAYMENT AWARD Common Stock Series A Preferred Stock Series B Preferred Stock Outstanding and unvested shares at January 1, 2022 418,039 34,000 - Granted 777,715 8,644 100,000 Vested ( 465,455 ) ( 42,644 ) ( 19,538 ) Forfeited ( 84,824 ) - - Outstanding and unvested shares at December 31, 2022 645,475 - 80,462 Outstanding and unvested shares at January 1, 2021 382,435 44,000 - Granted 628,361 50,010 - Vested ( 491,025 ) ( 60,010 ) - Forfeited ( 101,732 ) - - Outstanding and unvested shares at December 31, 2021 418,039 34,000 - As of December 31, 2022 and 2021, there was approximately $ 1.4 million and $ 3.7 million, respectively, of total unrecognized compensation cost related to the common stock RSUs classified as equity that will be expensed through 2024. As of December 31, 2022, there was approximately $ 557,000 of total unrecognized compensation cost related to the Series B Preferred Stock RSUs classified as equity that will be expensed through 2023. There was no unrecognized compensation cost related to the Series A Preferred Stock RSUs for both the years ended December 31, 2022 and 2021. Of the total outstanding and unvested common stock RSUs at December 31, 2022 and 2021, 598,245 and 331,039 RSUs, respectively, are classified as equity and 47,230 and 87,000 RSUs, respectively, are classified as a liability. For both 2022 and 2021, all of the Preferred Stock RSUs are classified as equity. The following table summarizes the share activity during the years ended December 31, 2022 and 2021 and the amount of common and preferred shares available for grant at December 31, 2022 and 2021: SCHEDULE OF SHARE-BASED COMPENSATION, RESTRICTED STOCK UNITS AWARD ACTIVITY Common Stock Series A Preferred Stock Series B Preferred Stock Shares available for grant at January 1, 2022 1,191,383 320,065 - Shares added to the Plan 1,000,000 - 200,000 RSUs granted ( 777,715 ) ( 8,644 ) ( 100,000 ) Shares redesignated as Series B - ( 277,652 ) - RSUs forfeited 84,824 - - Shares available for grant at December 31, 2022 1,498,492 33,769 100,000 Shares available for grant at January 1, 2021 1,718,012 370,075 - RSUs granted ( 628,361 ) ( 50,010 ) - RSUs forfeited 101,732 - - Shares available for grant at December 31, 2021 1,191,383 320,065 - The liability for the cash-settled awards and accrued payroll taxes on equity awards was approximately $ 1.0 million at both December 31, 2022 and 2021, and is included in accrued compensation in the consolidated balance sheets. During the years ended December 31, 2022 and 2021, approximately $ 105,000 and $ 97,000 , respectively, was paid in connection with the cash-settled awards. F- 30 Series A Preferred Stock In 2021, the Compensation Committee approved executive bonuses to be paid in 34,000 shares of Series A Preferred Stock with the final number of shares and the amount based on specified performance criteria being achieved during 2021. Also in 2021, 16,010 shares of Series A Preferred Stock were granted as performance bonuses and in lieu of sales commissions. Stock-based compensation expense recorded during 2021 for these awards was approximately $ 1.5 million, based on the fair value of the Series A Preferred Shares on the grant date. During January 2022, the Compensation Committee determined that the financial objectives were attained and all of the performance bonus shares were issued. Series B Preferred Stock In February 2022, the Compensation Committee approved executive bonuses to be paid in 34,000 shares of Series B Preferred Stock, with the number of shares and the amount based on specified criteria being achieved during the year 2022. During February 2023, the Compensation Committee determined that the financial objectives were attained and all of the performance bonus shares were issued. Stock-based compensation expense The Company recognizes compensation expense on a straight-line basis over the total requisite service period for the entire award. For stock awards classified as equity the market price of our common stock or our Series A and Series B Preferred Stock on the date of grant is used in recording the fair value of the award and includes the related taxes. For stock awards classified as a liability, the earned amount is marked to market based on the end of period common stock price. The weighted average grant date fair value of the common stock price in connection with the RSUs classified as equity was $ 4.27 and $ 9.16 for the years ended December 31, 2022 and 2021, respectively. The weighted average grant date fair value of the Series A Preferred Stock in connection with the RSUs was $ 26.69 and $ 28.52 for the years ended December 31, 2022 and 2021, respectively, and for the Series B Preferred Stock it was $ 25.24 for the year ended December 31, 2022. The following table summarizes the components of stock-based compensation expense for the years ended December 31, 2022 and 2021: SCHEDULE OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS Stock-based compensation included in the consolidated statements of operations: Year Ended December 31, 2022 2021 ($ in thousands) Direct operating costs $ 1,047 $ 1,142 General and administrative 2,598 3,302 Research and development 245 268 Selling and marketing 1,024 684 Total stock-based compensation expense $ 4,914 $ 5,396 16. INCOME TAXES For the years ended December 31, 2022 and 2021, the Company estimated its income tax provision based upon the annual pre-tax income or loss. Although the Company reported GAAP earnings in 2021 and 2022, it incurred losses historically and there is uncertainty regarding future U.S. taxable income, which makes realization of a deferred tax asset difficult to support in accordance with ASC 740. Accordingly, a valuation allowance has been recorded against all federal and state deferred tax assets as of December 31, 2022 and December 31, 2021, with the exception of a net deferred tax liability relating to the amortization of intangibles for tax purposes. F- 31 The annual adjusted earnings and profits of our foreign affiliates pass through to the U.S. as federal and state taxable income under the Global Intangible Low-Taxed Income (“GILTI”) regime. For the tax years ended December 31, 2022 and 2021, the net GILTI from our foreign affiliates was absorbed against our current year U.S. consolidated loss. For state tax purposes, the Company’s foreign earnings may be taxable depending on each individual state’s legislative stance on the recent tax reform legislation. The activity in the deferred tax valuation allowance was as follows for the years ended December 31, 2022 and 2021: SCHEDULE OF DEFERRED TAX VALUATION ALLOWANCE Year Ended December 31, 2022 2021 ($ in thousands) Beginning balance $ 86,728 $ 89,994 Current year valuation allowance increase (decrease) 5,363 ( 3,266 ) Ending balance $ 92,091 $ 86,728 The income (loss) before tax for financial reporting purposes during the years ended December 31, 2022 and 2021 consisted of the following: SCHEDULE OF INCOME BEFORE INCOME TAX, DOMESTIC AND FOREIGN Year Ended December 31, 2022 2021 ($ in thousands) United States $ 6,137 $ 1,048 Foreign ( 528 ) 1,945 Total $ 5,609 $ 2,993 The provision (benefit) for income taxes for the years ended December 31, 2022 and 2021 consisted of the following: SCHEDULE OF COMPONENTS OF INCOME TAX EXPENSE (BENEFIT) Year Ended December 31, 2022 2021 ($ in thousands) Current: Federal $ - $ ( 285 ) State 80 148 Foreign 21 5 101 ( 132 ) Deferred: Federal 63 190 State 13 99 76 289 Total income tax provision $ 177 $ 157 F- 32 The components of the Company’s deferred income taxes as of December 31, 2022 and 2021 are as follows: SCHEDULE OF DEFERRED TAX ASSETS AND LIABILITIES December 31, December 31, 2022 2021 ($ in thousands) Deferred tax assets: Allowance for doubtful accounts $ 221 $ 138 Deferred revenue 97 89 Property and intangible assets 2,213 2,422 State net operating loss (“NOL”) carryforwards 27,262 20,466 Federal net operating loss (“NOL”) carryforwards 57,179 57,602 Section 163(j) interest limitation 2,525 2,413 Stock based compensation 173 714 ASC 842 - ROU asset ( 1,243 ) ( 996 ) Prepaid commissions ( 253 ) ( 213 ) Cumulative balance translation adjustment 819 469 Section 267 limitation 7 7 Deferred payroll taxes - 155 Credit carryovers 2,498 2,498 ASC 842 - Lease liability 1,386 1,398 Accrued compensation 171 272 Other 69 59 Valuation allowance ( 92,091 ) ( 86,728 ) Total deferred tax assets 1,033 765 Deferred tax liabilities: Goodwill amortization ( 1,558 ) ( 1,214 ) Net deferred tax liability $ ( 525 ) $ ( 449 ) Deferred income tax balances reflect the effects of temporary differences between the carrying amounts of assets and liabilities and their tax bases, as well as from net operating loss carryforwards. Deferred income tax assets represent amounts available to reduce income taxes payable on taxable income in future years. The Company has recorded goodwill as a result of its acquisitions. Goodwill is generally not amortized for financial reporting purposes. For tax purposes, goodwill from asset acquisitions is tax deductible and amortized over 15 years. As such, deferred income tax expense and a deferred tax liability arise as a result of the tax-deductibility of this indefinitely lived asset (also known as a naked credit). The resulting deferred tax liability, which is expected to continue to increase over the amortization period, will have an indefinite life. As a result of the Company having indefinite life net operating losses under the recent tax reform legislation, the federal deferred tax liability resulting from the amortization of goodwill was offset against these indefinite federal operating net loss deferred tax assets to the extent allowable. The remaining deferred tax liability could remain on the Company’s consolidated balance sheet indefinitely unless there is an impairment of goodwill (for financial reporting purposes) or a portion of the business is sold. Due to the fact that the aforementioned deferred tax liability could have an indefinite life, it is not netted against the Company’s deferred tax assets when determining the required valuation allowance in accordance with ASC 740 guidelines. Doing so would result in the understatement of the valuation allowance and related deferred income tax expense. F- 33 A reconciliation of the federal statutory income tax rate ( 21 % ) for 2022 and 2021 to the Company’s effective income tax rate (determined in dollars) for the years ended December 31, 2022 and 2021 is as follows: SCHEDULE OF EFFECTIVE INCOME TAX RATE RECONCILIATION Year Ended December 31, 2022 2021 ($ in thousands) Federal provision at statutory rate $ 1,178 $ 629 Increase (decrease) in income taxes resulting from: State tax expense, net of federal benefit 77 178 Non-deductible items 20 85 Impact of foreign operations ( 137 ) ( 561 ) Subpart F GILTI inclusion 62 317 Stock based compensation 239 ( 399 ) Change in contingent consideration ( 649 ) - NOL carryback - ( 230 ) Deferred true-up 858 550 Valuation allowance ( 1,471 ) ( 412 ) Total income tax provision $ 177 $ 157 At December 31, 2022 and 2021, the Company did not record any uncertain tax positions based on the technical merits. Therefore, a tabular roll forward was excluded and there has been no accrued interest and penalties. The Company is subject to taxation in the United States, various states, Pakistan and Sri Lanka. As of December 31, 2022, all tax years since 2014 remain open to examination due to the carryover of unused net operating losses and tax credits in the United States by major taxing jurisdictions in which the Company is subject to tax. For the first six months of 2022, the Pakistan Federal Board of Revenue allowed a 100 % tax credit against earnings from IT activities, which precludes the Pakistan subsidiaries from being subject to income taxes. A new tax became effective July 1, 2022, whereby IT companies are subject to a 0.25% tax deducted at the source on receipts received from foreign sources with no further tax being due . It is the Company’s policy that any assessed penalties and interest on uncertain tax positions would be charged to income tax expense. The former Pakistan tax credit and foreign receipts tax does not have a significant impact on the Company’s effective tax rate as all of its earnings in Pakistan have been fully included in the U.S. federal tax rate reconciliation at 21 % for 2022 and 2021. The Pakistan statutory corporate tax rate is 29 % before consideration of the aforementioned tax credit and the foreign receipts tax. As of December 31, 2022, the Company has a total federal NOL carry forward of approximately $ 273 million of which approximately $ 199 million will expire between 2034 and 2037, and the balance of approximately $ 74 million has an indefinite life. Out of the total federal NOL carry forward, approximately $ 238 million is from the CareCloud and Meridian acquisitions and is subject to the federal Section 382 NOL annual usage limitations. The Company has state NOL carry forwards of approximately $ 211 million, of which $ 86 million relates to the State of New Jersey. These NOLs expire between 2034 and 2041. The Company has a full valuation allowance on its deferred tax assets in the U.S. which results in there being no U.S. deferred tax assets or liabilities recorded on the consolidated balance sheets, other than the deferred tax liability related to the amortization of goodwill. 17. OTHER EXPENSE – NET Other expense - net for the years ended December 31, 2022 and 2021 consisted of the following: SCHEDULE OF OTHER (EXPENSE) INCOME - NET Year Ended December 31, 2022 2021 ($ in thousands) Foreign exchange (losses) gains $ ( 610 ) $ 16 Other expense ( 27 ) ( 112 ) Other expense - net $ ( 637 ) $ ( 96 ) Foreign currency transaction gains and losses primarily result from transactions in foreign currencies other than the functional currency. These transaction gains and losses are recorded in the consolidated statements of operations related to the recurring measurement and settlement of such transactions. F- 34 18. SEGMENT REPORTING The Company’s Chief Executive Officer and Executive Chairman serve as the CODM, organize the Company, manage resource allocations and measure performance among two operating and reportable segments: (i) Healthcare IT and (ii) Medical Practice Management. The Healthcare IT segment includes technology-assisted revenue cycle management, SaaS solutions and other services. The Medical Practice Management segment includes the management of three medical practices. Each segment is considered a reporting unit. The CODM evaluates financial performance of the business units on the basis of revenue and direct operating costs excluding unallocated amounts, which are mainly corporate overhead costs. Our CODM does not evaluate operating segments using asset or liability information. The accounting policies of the segments are the same as those disclosed in the summary of significant accounting policies. The following tables present revenues, operating expenses and operating income (loss) by reportable segment for the years ended December 31, 2022 and 2021: SCHEDULE OF REVENUES, OPERATING EXPENSES AND OPERATING INCOME (LOSS) BY REPORTABLE SEGMENT Healthcare IT Medical Practice Management Unallocated Corporate Expenses Total Year Ended December 31, 2022 ($ in thousands) Healthcare IT Medical Practice Management Unallocated Corporate Expenses Total Net revenue $ 125,276 $ 13,550 $ - $ 138,826 Operating expenses: Direct operating costs 73,702 10,732 - 84,434 Selling and marketing 9,760 28 - 9,788 General and administrative 12,558 1,802 9,460 23,820 Research and development 4,401 - - 4,401 Change in contingent consideration ( 3,090 ) - - ( 3,090 ) Depreciation and amortization 11,368 357 - 11,725 Net loss on lease termination and unoccupied lease charges 1,138 - - 1,138 Total operating expenses 109,837 12,919 9,460 132,216 Operating income (loss) $ 15,439 $ 631 $ ( 9,460 ) $ 6,610 Healthcare IT Medical Practice Management Unallocated Corporate Expenses Total Year Ended December 31, 2021 ($ in thousands) Healthcare IT Medical Practice Management Unallocated Corporate Expenses Total Net revenue $ 127,080 $ 12,519 $ - $ 139,599 Operating expenses: Direct operating costs 76,981 9,937 - 86,918 Selling and marketing 8,755 31 - 8,786 General and administrative 13,910 2,080 8,283 24,273 Research and development 4,408 - - 4,408 Change in contingent consideration ( 2,515 ) - - ( 2,515 ) Depreciation and amortization 11,854 341 - 12,195 Net loss on lease termination, impairment and unoccupied lease charges 2,005 - - 2,005 Total operating expenses 115,398 12,389 8,283 136,070 Operating income (loss) $ 11,682 $ 130 $ ( 8,283 ) $ 3,529 F- 35 19. FAIR VALUE OF FINANCIAL INSTRUMENTS Fair value measurements are based upon observable and unobservable inputs. Observable inputs reflect market data obtained from independent sources, while unobservable inputs reflect our view of market participant assumptions in the absence of observable market information. We utilize valuation techniques that maximize the use of observable inputs and minimize the use of unobservable inputs. The fair values of assets and liabilities required to be measured at fair value are categorized based upon the level of judgement associated with the inputs used to measure their value in one of the following three categories: Level 1: Inputs are unadjusted quoted prices in active markets for identical assets or liabilities. We held no Level 1 financial instruments at December 31, 2022 or December 31, 2021. Level 2: Quoted prices for similar instruments in active markets with inputs that are observable, either directly or indirectly. Our Level 2 financial instruments include notes payable which are carried at cost and approximate fair value since the interest rates being charged approximate market rates. Level 3: Unobservable inputs are significant to the fair value of the asset or liability, and include situations where there is little, if any, market activity for the asset or liability. Our Level 3 instruments include the fair value of contingent consideration related to completed acquisitions. The fair value at December 31, 2021 is based on discounted cash flow analysis reflecting the likelihood of achieving specified performance measure or events and captures the contractual nature of the contingencies, the passage of time and the associated discount rate. As of December 31, 2021, the contingent consideration was valued using a Monte Carlo simulation model. There was no contingent consideration recorded at December 31, 2022. The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3): SCHEDULE OF FAIR VALUE, LIABILITIES MEASURED ON RECURRING BASIS, UNOBSERVABLE INPUT RECONCILIATION Fair Value Measurement at Reporting Date Using Significant Unobservable Inputs, Level 3 Year Ended December 31, 2022 2021 ($ in thousands) Balance - January 1, $ 3,090 $ - Acquisitions - 5,605 Change in fair value ( 3,090 ) ( 2,515 ) Payments - - Balance - December 31, $ - $ 3,090 20. SUBSEQUENT EVENTS During February 2023, SVB increased the Company’s line of credit to $ 25 million and extended the term of the agreement for two additional years. The financial covenants were also slightly modified for 2023 and subsequent years. Subsequent to December 31, 2022, the Company sold approximately 60,000 shares of Series B Preferred Stock via an “at-the-market” offering, raising net proceeds of approximately $ 1.5 million. F- 36