HEALTHSTREAM INC 10-K

Item 9A. Controls and Procedures Evaluation of Disclosure Controls and Procedures HealthStream’s chief executive officer and principal financial officer have reviewed and evaluated the effectiveness of the Company’s disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) promulgated under the Securities Exchange Act of 1934 (the Exchange Act)) as of December 31, 2023. Based on that evaluation, the chief executive officer and principal financial officer have concluded that HealthStream’s disclosure controls and procedures were effective to ensure that the information required to be disclosed by the Company in the reports the Company files or submits under the Exchange Act is recorded, processed, summarized, and reported within the time periods specified in the Securities and Exchange Commission’s rules and forms, and the information required to be disclosed in the reports the Company files or submits under the Exchange Act was accumulated and communicated to the Company’s management, including its principal executive and principal financial officer, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure. Management ’ s Annual Report on Internal Control over Financial Reporting Our management is responsible for establishing and maintaining adequate internal control over financial reporting as defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act, and for assessing the effectiveness of internal control over financial reporting. The Company’s internal control over financial reporting is designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with GAAP. The Company’s internal control over financial reporting includes those policies and procedures that: (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the Company; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with GAAP, and that receipts and expenditures of the Company are being made only in accordance with authorizations of management and directors of the Company; and (3) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the Company’s assets that could have a material effect on the financial statements. Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate. Management assessed the effectiveness of the Company’s internal control over financial reporting as of December 31, 2023. In making this assessment, management used the criteria set forth by the Committee of Sponsoring Organizations of the Treadway Commission in Internal Control-Integrated Framework (2013 Framework). Management’s assessment included an evaluation of the design of our internal control over financial reporting and testing of the operational effectiveness of our internal control over financial reporting. Management believes that, as of December 31, 2023, the Company’s internal control over financial reporting was effective based on those criteria. The Company’s independent registered public accounting firm, Ernst & Young LLP, has issued an audit report on the Company’s internal control over financial reporting, which appears in Item 8 of this Annual Report on Form 10-K. 62 Table of Contents Changes in Internal Control over Financial Reporting There were no changes in HealthStream’s internal control over financial reporting that occurred during the fourth quarter of 2023 that have materially affected, or that are reasonably likely to materially affect, HealthStream’s internal control over financial reporting. Item 9B. Other Information None . Without limiting the generality of the foregoing, during the three months ended December 31, 2023, no director or officer of the Company adopted or terminated any “Rule 10b5 - 1 trading arrangement,” or any “non-Rule 10b - 5 trading arrangement,” as such terms are defined in Item 408 (a) of Regulation S-K. Item 9C. Disclosure Regarding Foreign Jurisdictions that Prevent Inspections None. 63 Table of Contents PART III Item 10. Directors, Executive Officers and Corporate Governance Information required by Item 10 of Part III is incorporated by reference from the information to be contained in our proxy statement for the 2024 Annual Meeting of Shareholders (2024 Proxy Statement) that the Company will file with the Securities and Exchange Commission within 120 days of the end of the fiscal year to which this report relates. Pursuant to General Instruction G(3), certain information concerning executive officers of the Company is included in Part I of this Form 10-K, under the caption Information about our Executive Officers. Item 11. Executive Compensation Information required by Item 11 of Part III is incorporated by reference from the information to be contained in the Company’s 2024 Proxy Statement. Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters Information required by Item 12 of Part III is incorporated by reference from the information to be contained in the Company’s 2024 Proxy Statement. Item 13. Certain Relationships and Related Transactions, and Director Independence Information required by Item 13 of Part III is incorporated by reference from the information to be contained in the Company’s 2024 Proxy Statement. Item 14. Principal Accounting Fees and Services Information required by Item 14 of Part III is incorporated by reference from the information to be contained in the Company’s 2024 Proxy Statement. 64 Table of Contents PART IV Item 15. Exhibits, Financial Statement Schedules (a)(1) Financial Statements Reference is made to the financial statements included in Item 8 to this Report on Form 10-K. (a)(2) Financial Statement Schedules All schedules are omitted because they are not applicable or the required information is shown in the Consolidated Financial Statements or the notes thereto. (a)(3) Exhibits Number Description 2.2 (1) Equity Purchase Agreement, dated November 25, 2020, by and among HSTM Max Holdings, Inc., Change Healthcare Holdings, LLC, Change Healthcare Technologies, LLC and Change Healthcare Ireland Limited. 3.1* Fourth Amended and Restated Charter of HealthStream, Inc. 3.2 (2) Third Amended and Restated Bylaws of HealthStream, Inc. 4.1* Form of certificate representing the common stock, no par value per share, of HealthStream, Inc. 4.2* Reference is made to Exhibits 3.1 and 3.2 . 4.3 (3) Description of Capital Stock of HealthStream, Inc. 10.1 Form of Indemnification Agreement 10.2 Contribution Agreement dated as of December 29, 2021 between HealthStream, Inc. and Robert A. Frist, Jr. 10.3 Executive Employment Agreement, dated July 21, 2005, between HealthStream, Inc. and Robert A. Frist, Jr. 10.4 (6) Revolving Credit Agreement, dated November 24, 2014, by and among HealthStream, Inc., the several banks and other financial institutions and lenders from time to time party thereto and SunTrust Bank, as administrative agent, issuing bank, and swingline lender 10.5 Summary of Director and Executive Officer Compensation 10.6 Letter Agreement, dated as of February 20, 2023, between HealthStream, Inc. and Michael Sousa. 10.7 HealthStream, Inc. 2023 Cash Incentive Bonus Plan 10.8 Form of HealthStream, Inc. Restricted Share Unit Agreement (Time Based) under 2022 Omnibus Incentive Plan 10.9 2016 Omnibus Incentive Plan. 10.10 Form of HealthStream, Inc. Restricted Share Unit Agreement (Officers) under 2016 Omnibus Incentive Plan. 10.11 Form of HealthStream, Inc. Restricted Share Unit Agreement (Non-Employee Director) under 2016 Omnibus Incentive Plan. 10.12 (10) Lease Agreement, dated April 3, 2017, by and between HealthStream, Inc. and Capitol View Joint Venture. 10.13 (11) First Amendment to Revolving Credit Agreement, dated November 13, 2017, by and between HealthStream, Inc. and SunTrust Bank. 10.14 (12) Second Amendment to Revolving Credit Agreement, dated as of December 31, 2018, by and between HealthStream, Inc. and SunTrust Bank. 10.15 (13) Third Amendment to Revolving Credit Agreement, dated as of October 28, 2020, by and between HealthStream, Inc. and SunTrust Bank. 10.16 Form of HealthStream, Inc. Restricted Share Unit Agreement (Performance) under 2016 Omnibus Incentive Plan between HealthStream, Inc. and J. Edward Pearson 10.17 Form of HealthStream, Inc. Restricted Share Unit Agreement (Performance) under 2016 Omnibus Incentive Plan between HealthStream, Inc. and Michael Sousa 10.18 Form of HealthStream, Inc. Non-Qualified Stock Option Agreement under 2016 Omnibus Incentive Plan. 10.19 Form of HealthStream, Inc. Restricted Share Unit Agreement (Performance) under 2016 Omnibus Incentive Plan 10.20 Form of HealthStream, Inc. Restricted Share Unit Agreement (Performance) which were contingent upon approval of 2022 Omnibus Incentive Plan 10.21 Form of HealthStream, Inc. Restricted Share Unit Agreement (Time Based) which were contingent upon approval of 2022 Omnibus Incentive Plan 10.22 HealthStream, Inc. 2022 Omnibus Incentive Plan 10.23 Form of HealthStream, Inc. Restricted Share Unit Agreement (Non-Employee Director) under 2022 Omnibus Incentive Plan. 10.24 Form of HealthStream, Inc. Restricted Share Unit Agreement (Performance) under 2022 Omnibus Incentive Plan 10.25 (20) Amended and Restated Credit Agreement, dated October 6, 2023, by and among the several banks and other financial institutions and lenders from time to time party thereto and Truist Bank, as administrative agent 21.1 Subsidiaries of HealthStream, Inc. 23.1 Consent of Independent Registered Public Accounting Firm 31.1 Certification of the Chief Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 31.2 Certification of the Chief Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 65 Table of Contents 32.1 Certification Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002 32.2 Certification Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002 97 HealthStream, Inc. Amended and Restated Compensation Recoupment Policy 101.1 INS XBRL Instance Document - the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document. 101.1 SCH Inline XBRL Taxonomy Extension Schema 101.1 CAL Inline XBRL Taxonomy Extension Calculation Linkbase 101.1 DEF Inline XBRL Taxonomy Extension Definition Linkbase 101.1 LAB Inline XBRL Taxonomy Extension Label Linkbase 101.1 PRE Inline XBRL Taxonomy Extension Presentation Linkbase 104 Cover Page Interactive Data File (formatted in Inline XBRL and included in Exhibit 101.1) * Incorporated by reference to Registrant’s Registration Statement on Form S-1, as amended (Reg. No. 333-88939). Management contract or compensatory plan or arrangement (1) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated November 30, 2020. (2) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated October 23, 2023. (3) Incorporated by reference from exhibit filed on our Annual Report on Form 10-K, for the year ended December 31, 2019, filed with the SEC on February 26, 2020. (4) Incorporated by reference from exhibit filed on our Annual Report on Form 10-K, for the year ended December 31, 2021, filed with the SEC on February 28, 2022. (5) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated July 25, 2005. (6) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated November 25, 2014. (7) Incorporated by reference from exhibit filed on our Quarterly Report on Form 10-Q, for the quarterly period ended March 31, 2023, filed with the SEC on April 27, 2023. (8) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated May 31, 2016. (9) Incorporated by reference from exhibit filed on our Quarterly Report on Form 10-Q, for the quarterly period ended March 31, 2017, filed with the SEC on May 1, 2017. (10) Incorporated by reference from exhibit filed on our Quarterly Report on Form 10-Q, for the quarterly period ended June 30, 2017, filed with the SEC on July 31, 2017. (11) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated November 14, 2017. (12) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated January 2, 2019. (13) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated October 28, 2020. (14) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated May 16, 2018. (15) Incorporated by reference from exhibit filed on our Annual Report on Form 10-K, for the year ended December 31, 2020, filed with the SEC on February 26, 2021. (16) Incorporated by reference from exhibit filed on our Quarterly Report on Form 10-Q, for the quarterly period ended March 31, 2022, filed with the SEC on April 28, 2022. (17) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated May 31, 2022. (18) Incorporated by reference from exhibit filed on our Quarterly Report on Form 10-Q, for the quarterly period ended June 30, 2023, filed with the SEC on July 27, 2023. (19) Incorporated by reference from exhibit filed on our Annual Report on Form 10-K, for the year ended December 31, 2022, filed with the SEC on February 28, 2023. (20) Incorporated by reference from exhibit filed on our Current Report on Form 8-K, dated October 6, 2023. Item 16. Form 10-K Summary None. 66 Table of Contents SIGNATURES Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized on this 26th day of February 2024. HEALTHSTREAM, INC. By: /s/ ROBERT A. FRIST, JR. Robert A. Frist, Jr. Chief Executive Officer Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been signed by the following persons on behalf of the registrant and in the capacities and on the dates indicated: Signature Title(s) Date /s/ ROBERT A. FRIST, JR. Chief Executive Officer and February 26, 2024 Robert A. Frist, Jr. Chairman (Principal Executive Officer) /s/ SCOTT A. ROBERTS Chief Financial Officer and Senior Vice President February 26, 2024 Scott A. Roberts (Principal Financial and Accounting Officer) /s/ THOMPSON DENT Director February 26, 2024 Thompson Dent /s/ FRANK GORDON Director February 26, 2024 Frank Gordon /s/ TERRY ALLISON RAPPUHN Director February 26, 2024 Terry Allison Rappuhn /s/ JEFFREY L. MCLAREN Director February 26, 2024 Jeffrey L. McLaren /s/ LINDA REBROVICK Director February 26, 2024 Linda Rebrovick /s/ ALEX JAHANGIR Director February 26, 2024 Alex Jahangir /s/ WILLIAM STEAD Director February 26, 2024 William Stead /s/ DEBORAH TAYLOR TATE Director February 26, 2024 Deborah Taylor Tate 67