What changed in this filing

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Item 1. Business

2025-02-28 compared with 2024-02-26 · 79 added, 82 removed, 280 unchanged (37% of the section changed)

OVERVIEW AND HISTORY

HealthStream’s focus is and has always been on improving the quality of healthcare through the development of the dedicated individuals who deliver care.

HealthStream’s focus is and has always been on improving the quality of healthcare through the development and support of the dedicated individuals who deliver care.

Like healthcare itself, our mission remains constant, but how we accomplish that mission continues to evolve and improve over time.

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dynamic engagement models;

artificial intelligence (AI) driven clinical assessments;

artificial intelligence and machine learning (AI/ML) driven clinical assessments;

physical-based simulations;

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HealthStream’s success in offering the largest, most diverse ecosystem of workforce solutions in healthcare has made it a thought leader and barometer of innovation for the industry.

From its roots in originating online learning for healthcare organizations to the Company's more recent release of "Jane AI," the first AI-driven clinical assessment application, HealthStream continues to believe that the key to quality patient care lies in the people who deliver care.

From its roots in originating online learning for healthcare organizations to the Company's more recent release of "Competency Suite" the first AI/ML-driven clinical competency development system, HealthStream continues to believe that the key to quality patient care lies in the people who deliver care.

To that end, we are solely dedicated to providing solutions for the healthcare workforce and for those about to enter it.

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It began providing its SaaS-based workforce solutions in 1999, its provider solutions in 2012, and launched the hStream technology platform in 2018.

Since January 2023, the Company’s operations have been streamlined around a consolidated, enterprise approach such that, beginning January 1, 2023, the Company ceased having two reportable business segments (Workforce Solutions and Provider Solutions).

As such, since January 1, 2023, the Company has had a single reportable segment and presents financial information on a single segment basis.

Since January 2023, the Company’s operations have been streamlined around a consolidated, enterprise approach such that the Company ceased having two reportable business segments (Workforce Solutions and Provider Solutions).

As such, beginning January 1, 2023, the Company has had a single reportable segment and presents financial information on a single segment basis.

HealthStream is headquartered in Nashville, Tennessee and had 1,083 full-time and 10 part-time employees as of December 31, 2024.

INDUSTRY BACKGROUND

According to the Centers for Medicare & Medicaid Services (CMS), spending in the healthcare industry reached nearly $4.5 trillion in 2022, or 17.3% of the U.S.

According to the Centers for Medicare & Medicaid Services (CMS), spending in the healthcare industry reached over $4.9 trillion in 2023, or 17.6% of the U.S.

gross domestic product.

The growth in 2022, which was an increase of 4.1% over the prior year, reflected growth in Medicaid and private health insurance spending that was partially offset by continued declines in supplemental funding by the federal government associated with the COVID-19 pandemic.

Hospital care expenditures in 2022 accounted for approximately 30% of the $4.5 trillion industry.

While hospital spending increased 2.2% in 2022 to reach nearly $1.4 trillion, the rate of increase was slightly lower in 2022 (4.5%) compared to the prior year due to a slower growth in hospital prices and a decline in hospital days and discharges.

According to the Bureau of Labor Statistics, as of January 2024, approximately 22 million professionals are employed in the healthcare and social services segment of the domestic economy, with approximately 5.4 million employed in acute-care hospitals and, according to CMS, approximately 5.9 million employed in healthcare organizations throughout the continuum of care, the primary target markets for our products.

(Organizations in the continuum of care employ approximately 2.2 million employees in ambulatory centers, approximately 2.8 million employees in post-acute care facilities, and over 0.9 million employees in health & human services facilities.)

The growth in 2023 was an increase of 4.6% over the prior year and reflected growth in non-price factors, such as increased use and intensity of healthcare goods and services, influencing strong growth in both Medicare and private health insurance spending.

Hospital care expenditures reached over $1.5 trillion in 2023 accounting for over 30% of the $4.9 trillion healthcare industry.

Hospital care expenditures increased 10.4% over 2022, driven by strong growth in spending for hospital care by all major payors and the factors discussed above.

According to the Bureau of Labor Statistics, as of January 2024, approximately 22 million professionals are employed in the healthcare and social assistance sector of the domestic economy, with approximately 5.4 million employed in acute-care hospitals and, according to CMS, approximately 5.9 million employed in other healthcare organizations throughout the continuum of care, the primary target markets for our products.

Organizations in the continuum of care employ approximately 2.2 million employees in post-acute care facilities and over 0.9 million employees in health and human services facilities.

All of the approximately 5.65 million hospital-based healthcare professionals that work in the nation’s approximately 6,100 inpatient hospitals that are registered with Medicare are required by federal and state mandates and accrediting bodies to complete training in a number of areas.

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Staffing shortages have also increased the need for facility-based workforce development as well as additional assessment and competency-based training.

An ongoing nursing shortage, for example, is resulting in skill gaps and rising costs.

Employment of registered nurses is projected to grow 6% from 2022 to 2032, faster than the average for all occupations, according to the U.S.

Bureau of Labor Statistics.

The ongoing nursing shortage, for example, is resulting in skill gaps and rising costs.

According to the National Center for Health Workforce Analysis (2024), there is a projected 10% shortage of registered nurses (RNs) in 2027.

By 2037, the shortage projected is 6%, a shortage of 207,980 full-time equivalent RNs.

We believe that offering training and education and other engagement solutions for hospital personnel is increasingly being utilized as a retention and recruitment incentive.

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Provider data management has become more complex and arduous for healthcare organizations.

Spurred by The Joint Commission Medical Staff standards and other regulatory requirements, credentialing and privileging has been transformed from a periodic review to a continuous, evidence-driven analysis of professional competency and provider performance.

This transformation requires ongoing, automatic monitoring of licenses, sanctions, and exclusions, as well as expanding the scope of review at initial credentialing and re-credentialing.

Credentialing and privileging is now a continuous, evidence-driven analysis of professional competency and provider performance that requires automatic monitoring of licenses, sanctions, and exclusions, as well as a broad scope of review at initial credentialing and re-credentialing.

In addition, provider enrollment processes have compounded in difficulty.

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Healthcare organizations continue to operate under ongoing pressure to reduce costs as a result of actual and potential reductions in reimbursement rates and increased focus on cost containment consistent with participation of patients in managed care programs, among other factors.

In addition, many care settings, including hospitals, surgery centers, telehealth companies, outpatient centers, and skilled nursing facilities, may continue to experience rising operating costs, coupled with increased pressure to measure and report on the outcomes of the dollars spent on training.

In addition, many care settings, including hospitals, surgery centers, telehealth companies, outpatient centers, and skilled nursing facilities, have experienced and may continue to experience rising operating costs and increased pressure to measure and report on the outcomes of the dollars spent on training.

Our products and services are designed to meet these needs by reducing healthcare organizations’ costs of training while improving learning outcomes, enhancing reporting capabilities, and supporting customers’ business objectives.

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HealthStream’s solutions are provided to a wide range of customers within the healthcare industry.

All of our solutions are powered by our hStream technology platform, which enables activity across HealthStream's diverse ecosystem of solutions.

At December 31, 2023, HealthStream had contracts with customers for approximately 5.79 million subscriptions to hStream, compared to 5.54 million subscriptions as of December 31, 2022.

Under our One HealthStream approach, the hStream technology platform benefits both customers and partners.

Our underlying solutions are comprised primarily of SaaS, subscription-based applications that are used by healthcare organizations to meet a broad range of their workforce development needs around learning, clinical development, credentialing, and scheduling.

Nursing schools, nursing students, as well as individual healthcare professionals are also beginning to utilize our training and education solutions.

Our numerous content libraries allow customers to subscribe to a wide array of courseware, which includes content from leading healthcare and nursing associations, medical and healthcare publishers, and other content providers.

Our scheduling solutions provide customers with real-time visibility into clinical staff scheduling that enables them to optimize their workforce, reduce costs, and improve care.

Our flagship credentialing, privileging, and enrollment solution, CredentialStream, provides customers an intuitive, modern user experience with a continual stream of enhancements, evidence-based content, and curated data, all which provides healthcare organizations with tools to support the provider lifecycle management from recruiting, application submission, verification of licensure and other credentials, privileging, appointments by credentialing committees, enrollment, network, management, onboarding, and performance evaluations of providers.

Our SaaS-based credentialing, privileging, and enrollment solution, CredentialStream, provides customers an intuitive, modern user experience, evidence-based content, and curated data, all which provides healthcare organizations with tools to support the provider lifecycle management from recruiting, application submission, verification of licensure and other credentials, privileging, appointments by credentialing committees, enrollment, network, management, onboarding, and performance evaluations of providers.

Pricing for hStream and HealthStream’s products is primarily subscription-based, with fees based on the number of subscriptions, solutions provided, and other factors.

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Each application on our platform has its own value.

Examples of individual applications that are offered on our platform include applications for performance appraisal, competency management, disclosure management, clinical competency, assessment, development, simulation-based education, clinical rotation and onboarding management, quality management, scheduling, and industry training.

BUSINESS ACQUISITIONS

As part of our overall growth strategy, we evaluate opportunities for mergers and acquisitions, and since the beginning of 2022, we have completed two acquisitions.

As part of our overall growth strategy, we evaluate opportunities for mergers and acquisitions, and since the beginning of 2022, we have completed four acquisitions.

In May 2022, we acquired the remaining ownership interest (representing approximately 82% of the outstanding equity interests) of CloudCME, LLC (CloudCME), and in December 2022, we acquired substantially all of the assets of Electronic Education Documentation System (d/b/a eeds) (eeds).

For additional information regarding acquisitions, please see Note 8 of the Consolidated Financial Statements and “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in Part II, Item 7 of this Form 10-K.

We provide our solutions to customers across a broad range of individuals and entities within the healthcare industry, including private, not-for-profit, and government entities, as well as pharmaceutical and medical device companies.

More recently, HealthStream has begun to market and sell its solutions to nursing schools and students as well.

In October and November 2024, we acquired substantially all of the assets of Total Clinical Placement System (d/b/a TCPS) (TCPS) and The Clinical Hub, Inc.

(d/b/a The Clinical Hub) (The Clinical Hub), respectively.

For additional information regarding acquisitions, please see Note 8 to the Consolidated Financial Statements included elsewhere in this report.

We derive a substantial portion of our revenues from a relatively small number of customers that are healthcare providers.

However, during the year ended December 31, 2023, no single customer accounted for 10% or more of our annual revenue.

However, during the year ended December 31, 2024, no single customer accounted for 10 percent or more of our annual revenue.

SALES AND MARKETING

We market our products and services primarily through our direct sales teams, who are located throughout the United States.

We market our products and services primarily through our direct sales teams, who are located throughout the United States and who reach out to a wide range of healthcare organizations throughout the full continuum of care.

HealthStream has also expanded its e-commerce sales capabilities, building on its existing sales channels and establishing new online sales channels.

This has enabled the Company to begin extending beyond its traditional business-to-business sales model to also include functionality to support sales made directly to healthcare professionals and students, including those direct sales that can be made by the buyer.

We conduct a variety of marketing programs to promote our products and services, including via our hStream content marketplace, user groups, trade shows, social media, Internet promotion and demonstrations, digital marketing campaigns, public relations, distribution of product-specific literature, direct mail, advertising, and in partnership with third parties.

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Our software applications, servers, and network infrastructure that deliver our services are hosted by a combination of third-party data center providers and cloud-based infrastructure.

We maintain fully redundant disaster recovery data centers that are located in geographically separate locations.

We maintain redundant disaster recovery data centers that are located in geographically separate locations.

Our technology equipment is maintained in secure, limited access environments, supported by redundant power, environmental conditioning, and network connectivity.

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Cybersecurity .

In addition to the competing healthcare education delivery methods in the industry, we also have direct competitors.

A number of companies offer competitive learning, scheduling, and credentialing solutions, some of which are focused on multiple industries and some of which are focused on the healthcare industry.

We compete with companies such as Cornerstone OnDemand, Ultimate Kronos Group, Oracle, SAP, Infor, and Workday, which provide their services to multiple industries, including healthcare.

We compete with companies such as Cornerstone OnDemand, Ultimate Kronos Group, Degreed, Oracle, SAP, Infor, and Workday, which provide their services to multiple industries, including healthcare.

We also compete with companies that are dedicated to, or have operating units focused on healthcare, such as Relias Learning, RLDatix, Symplr, Verisys, MD-Staff, AMN Healthcare, as well as with an array of smaller companies.

We believe our hStream technology platform and the interoperability it has begun to enable provides us a competitive advantage by facilitating education, training, assessment, engagement, scheduling, credentialing, privileging, validation, and development for healthcare professionals through a wide assortment of content, functionality, and applications.

We also believe that our hStream platform technology is beginning to accelerate the scope and quality of our products, capability to connect medical staff credentialing with provider enrollment, and innovative new predictive analytics, all of which we believe provide us with a competitive advantage.

We also believe that our hStream platform technology is accelerating the scope and quality of our products, has the capability to connect medical staff credentialing with provider enrollment, and provide innovative predictive analytics, all of which we believe provide us with a competitive advantage.

We believe that the principal competitive factors affecting the marketing of our solutions to the healthcare industry include:

our hStream technology platform, which combines SaaS-based capabilities and certain Platform-as-a-Service (PaaS) capabilities to help capture, track, manage, and report on activities, such as learning, performance, scheduling, credentialing, and privileging across various modalities, and provides interoperability with external systems such as HRIS and other systems utilized by our customers;

our hStream technology platform, which combines SaaS-based capabilities and certain Platform-as-a-Service (PaaS) capabilities to help capture, track, manage, and report on activities, such as learning, performance, scheduling, credentialing, and privileging across various modalities, provides interoperability with external systems such as HRIS and other systems utilized by our customers;

scope and variety of Internet-based solutions available, including, without limitation, learning and education, clinical, GRC, resuscitation, revenue cycle, talent management, scheduling, credentialing, and privileging solutions;

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Privacy and Security Laws.

Federal, state, and foreign privacy and security laws and regulations restricting the collection, use, retention, deletion, security, disclosure, and other processing of personal information limit our ability to collect information or use and disclose the information in our databases or that we derive from other sources to generate revenues.

Federal, state, and foreign privacy and security laws and regulations governing the collection, use, retention, deletion, security, disclosure, and other processing of personal information limit our ability to collect information or use and disclose the information in our databases or that we derive from other sources to generate revenues.

These laws and regulations are rapidly evolving and could have an adverse effect on our operations.

For example, various states have passed privacy laws that impose restrictive requirements on the use and disclosure of personal information, some of which were recently enacted and will be implemented over the course of 2024.

Moreover, additional states have been considering similar legislation, and privacy laws have been proposed at the federal level as well.

Additionally, we have expanded our business in recent years into new markets and jurisdictions (including foreign jurisdictions), which may subject our business to additional privacy and data protections laws and regulations, such as the Family Educational Rights and Privacy Act (FERPA), the Canadian Personal Information Protection and Electronic Documents Act, the New Zealand Privacy Act 2020, the Australia Privacy Act 1988, and the European Union’s General Data Protection Regulation.

For example, various states have passed privacy laws that restrict the use and disclosure of personal information, some of which were recently enacted and will be implemented over the course of 2025.

Additional states are considering similar legislation, and privacy laws have been proposed at the federal level as well.

We have expanded our business in recent years into new markets and jurisdictions (including foreign jurisdictions), which may subject our business to additional privacy and data protections laws and regulations, such as the Family Educational Rights and Privacy Act (FERPA), the Canadian Personal Information Protection and Electronic Documents Act, the New Zealand Privacy Act 2020, the Australia Privacy Act 1988, and the European Union’s General Data Protection Regulation.

Many of the data privacy requirements in foreign jurisdictions are more stringent than those imposed by the U.S.

federal and state governments.

The significant differences among various privacy and security laws introduces complexity in our compliance efforts.

The significant differences among various privacy and security laws introduce complexity in our compliance efforts.

It may be costly to implement measures (such as certain security requirements, contracting terms, assessments, and registrations with authorities) that are designed to comply with new legal requirements, changes to existing legal requirements, or legal requirements in jurisdictions into which we have recently expanded or are planning to expand.

The obligations and requirements applicable to companies under these laws and regulations are subject to uncertainty in how they may be interpreted by government authorities and regulators.

We may be audited or subject to an investigation by a federal, state, or foreign regulator regarding our compliance with privacy and security laws and regulations.

If the Company is determined by a regulator or court to fail to comply with such laws and regulations, the Company may become subject to penalties and the Company’s business and reputation could be negatively impacted.

We may be audited or subject to an investigation by a federal, state, or foreign regulator regarding our compliance with privacy and security laws and regulations and may incur substantial costs as a result.

If a court or other governmental authority determines the Company has failed to comply with such laws and regulations, the Company may become subject to penalties, and the Company’s business and reputation could be negatively impacted.

Content Regulation and Artificial Intelligence.

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These include laws relating to obscenity, indecency, libel, and defamation.

We could be liable if content created, stored, or delivered by us is determined to be in violation of these laws and regulations.

In addition, various jurisdictions (both in the U.S.

and in foreign jurisdictions) have enacted and/or are considering laws and regulations applicable to the use of artificial intelligence and machine learning applications and tools, particularly on the use of artificial intelligence to facilitate healthcare, education, employment, or hiring decisions.

We could be liable if content we create, store, or deliver is determined to be in violation of these laws and regulations.

In addition, various U.S.

and foreign jurisdictions have enacted and/or are considering laws and regulations applicable to the use of AI/ML applications and tools, particularly on the use of AI to facilitate healthcare, education, employment, or hiring decisions.

Any failure to comply with those laws and regulations may result in the Company being subject to fines, penalties, or negative publicity.

Information Security Accountability Regulation.

As a HIPAA business associate of certain of our customers, we are required to report certain breaches of protected health information to our customers, who must in turn notify affected individuals, the U.S.

As a HIPAA business associate of certain of our customers, we are required to report breaches of protected health information to our customers, who must in turn notify affected individuals, the U.S.

Department of Health and Human Services (HHS) and/or other governmental agencies, and, in certain situations, the media.

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OSHA regulations require certain employers to provide training to certain employees to minimize the risk of injury from various potential workplace hazards.

Employers in the healthcare industry may be required to provide training with respect to various topics, including, but not limited to, blood borne pathogens exposure control, laboratory safety, and tuberculosis infection control.

OSHA regulations further require employers to keep records of their employees’ completion of training with respect to these workplace hazards, as applicable.

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The Joint Commission accreditation and certification standards require employers in the healthcare industry to provide certain workplace safety and patient interaction training to employees.

Training required by The Joint Commission may include programs on infection control, patient bill of rights, radiation safety, and incident reporting.

Training required by The Joint Commission may include programs on infection control, patient bill of rights, medication safety, radiation safety, and incident reporting.

Healthcare organizations are required to provide and document training on these topics to receive accreditation from The Joint Commission.

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We are recognized as an accredited provider of CME for physicians by the ACCME.

Centers for Medicare & Medicaid Services (CMS).

The CMS National Quality Strategy is focused on ensuring that all persons receive equitable, high-quality, and value-based care, with an emphasis on shaping a health care system that incorporates quality and safety as foundational components to delivering value as part of the overall care journey.

The goals of the initiative include:

embedding quality into the care journey;

advancing health equity;

promoting safety;

embracing the digital age;

ensuring resilience to adapt to future challenges and emergencies;

incentivizing innovation and technology;

and increasing alignment across CMS, its partners, and stakeholders.

Value-based purchasing (VBP), which links payment more directly to the quality of care provided, is a strategy that aims to transform the current payment system by rewarding providers for delivering high quality, efficient clinical care.

Through a number of public reporting programs, demonstration projects, pilot programs, and other initiatives, some voluntary and some mandatory, CMS has launched VBP initiatives in various settings, including hospitals, physician offices, nursing homes, home health services, and dialysis facilities.

Through its “Meaningful Measures” initiative, CMS identifies priorities for quality measurement and improvement.

The framework is intended to improve patient outcomes while also reducing burdens on providers.

Centers for Medicare & Medicaid Services (CMS) Quality Efforts.

CMS is increasingly focused on arrangements, which generally aim to hold providers accountable for delivering high quality, efficient clinical care in part by tying provider reimbursement to patient outcomes or related measures.

Through a number of public reporting programs, demonstration projects, pilot programs, and other initiatives, some voluntary and some mandatory, CMS has implemented value-based care programs for various provider-types, including hospitals, physician offices, nursing homes, home health providers, and dialysis facilities.

CMS promotes innovation and modernization of quality measures, which are central to value-based care, through its Meaningful Measures Initiative.

Interoperability Initiatives.

CMS interoperability programs encourage eligible professionals, eligible hospitals, and critical access hospitals to adopt electronic health record (EHR) technology by imposing payment reductions for failure to demonstrate meaningful use of certified EHR technology.

Providers that meaningfully use an EHR system may reap benefits such as reduction in errors, availability of records and data, reminders and alerts, clinical decision support, and e-prescribing/refill automation.

Further, the 21st Century Cures Act and implementing regulations promote interoperability and the exchange of patient health information through a number of requirements including a ban on information blocking by healthcare providers, health IT developers, and certain other entities.

EHR technology can be used to reduce errors, increase the availability of records and data, and provide reminders, alerts, clinical decision support, and e-prescribing/refill automation.

Further, healthcare providers and industry participants are subject to a growing number of requirements intended to promote interoperability and the exchange of patient health information.

For example, under the 21st Century Cures Act, healthcare providers, health IT developers, and certain other entities are subject to information blocking restrictions.

Information blocking is generally defined as engaging in activities that are likely to interfere with the access, exchange, or use of electronic health information, subject to limited exceptions.

Violations may result in penalties or other significant disincentives.

Allied Disciplines.

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In addition, the AMA has established its own code of ethics that provides standards of conduct for physicians, addressing professional-self regulation and including a policy regarding Gifts to Physicians from Industry .

Some continuing education organizations issue standards applicable to our services.

For example, we comply with the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education to ensure that our CME and CNE activities are evidence-based, designed to improve patient care and/or community health, and are free from commercial influence.

Some continuing education organizations issue related standards applicable to our services.

We follow all standards/criteria/guidelines set-forth by ACCME, ANCC, and other continuing education organizations regarding the regulation of educational program sponsorship and support.

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Therefore, any information that promotes the use of pharmaceutical or medical device products that is presented with our services is subject to the FDA and FTC requirements and regulatory oversight including criminal, civil, and administrative actions.

We believe that banner advertisements, sponsorship links, and any educational programs we may present with our services, even if we lack independent editorial control over it, could be subject to FDA or FTC regulation.

While the FDA and the FTC place the principal burden of compliance with advertising and promotional regulations on the advertiser, if the FDA or FTC finds that any regulated information presented with our services violates FDA or FTC regulations, they may take regulatory action against us or the advertiser or sponsor of that information.

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At the current time, our compliance with environmental legal requirements, including legal requirements relating to climate change, does not have a material effect on our capital expenditures, financial results, or operations, and we did not incur material capital expenditures with respect to environmental matters during the year ended December 31, 2024.

However, it is possible that future environmental-related developments may impact us, including as a result of climate change and/or legal requirements associated with the transition to a lower carbon economy in a manner that we are currently unable to predict.

However, future environmental-related developments may impact us, including as a result of climate change and/or legal requirements associated with the transition to a lower carbon economy in a manner that we are currently unable to predict.

INTELLECTUAL PROPERTY AND OTHER PROPRIETARY RIGHTS

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and use measures designed to control access to our software, documentation, and other proprietary information.

We own federal trademark and service mark registrations for several marks, including, without limitation “HEALTHSTREAM”, “HEALTHSTREAM LEARNING CENTER”, "HSTREAM", "JANE", “HEALTHSTREAM EPORTFOLIO”, and “COMPLYQ”.

We own federal trademark and service mark registrations for several marks, including, without limitation “HEALTHSTREAM”, "HSTREAM", “HEALTHSTREAM LEARNING CENTER”, "CREDENTIALSTREAM", "JANE", “HEALTHSTREAM EPORTFOLIO”, and “COMPLYQ”.

We also have obtained registration of the “HEALTHSTREAM” mark in certain other countries.

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The Company operates under a hybrid work policy that allows employees to work remotely if they so choose and if the scope of their job duties is suitable for remote work.

As of December 31, 2023, approximately 48% of employees worked within a commutable distance from one of the Company's three offices, while the remaining 52% did not.

As of December 31, 2024, approximately 39% of employees worked within a commutable distance from one of the Company's two offices, while the remaining 61% did not.

HealthStream’s culture is both exemplified and driven by our Constitution, which is a living document and the lens through which we endeavor to view and shape our actions.

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Our Constitution is available on our website on the Investor Relations page.

This and other information on our website is not a part of this Annual Report on Form 10-K and is not incorporated by reference herein.

This and other information on our website are not a part of this Annual Report on Form 10-K and is not incorporated by reference herein.

HealthStream is committed to recruiting, maintaining, and growing a diverse, equitable, and inclusive workforce that helps us live our Constitutional values as we strive to achieve positive results for our shareholders, employees, customers, and community.

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Chief Executive Officer and Chairman of the Board of Directors

Executive Vice President, Corporate Strategy and Development

Executive Vice President, Corporate Strategy, Development, and Operations

Michael Sousa *

Executive Vice President, Enterprise Applications

Executive Vice President, Workforce Solutions

Executive Vice President, Enterprise Workforce Platform

Senior Vice President and Chief Financial Officer

Senior Vice President and Chief Technology Officer

Senior Vice President, Workforce Development Solutions

Scott McQuigg

Senior Vice President, Digital & Network Development

Senior Vice President, Platform Solutions

Scott Fenstermacher

Senior Vice President, Sales

* As previously announced in the Company's Form 8-K filed February 24, 2025, Michael Sousa will be resigning from his position as EVP, Enterprise Applications effective March 31, 2025.

Frist, Jr., one of our co-founders, has served as our chief executive officer and chairman of the board of directors since 1990.

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Collier joined the Company in August 2011 as vice president and general counsel, began serving as the vice president of business development and general counsel shortly thereafter, was promoted to senior vice president in July 2017, and was promoted to executive vice president, corporate strategy and development in April 2022.

As of February 2025, Mr.

Collier was promoted to executive vice president, corporate strategy, development, and operations.

From August 2011 through the end of 2022, Mr.

Collier also served as the Company’s Corporate Secretary.

He graduated with bachelors and masters degrees in Philosophy and Religion from University of Tennessee-Knoxville and earned a Juris Doctorate (J.D.) from University of California, Berkeley – School of Law.

He graduated with both a Bachelor of Arts and Master of Arts in Philosophy and Religion from University of Tennessee-Knoxville and earned a Juris Doctorate (J.D.) from University of California, Berkeley – School of Law.

Michael Sousa joined the Company in October 2004 and served as senior vice president of sales from January 2010 to June 2014.

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He earned a Bachelor of Science degree from Boston College and a Master of Business Administration from Boston University.

Coady joined the Company in January 2014 and served as associate vice president and subsequently vice president and general manager of clinical development solutions from June 2015 to November 2018.

In November 2018, she was promoted to senior vice president and general manager of clinical solutions.

As of February 2025, Ms.

Coady was promoted to executive vice president, workforce solutions.

She earned a Bachelor of Science in Nursing degree from Université de Moncton.

Kevin O’Hara joined the Company in January 2021 as senior vice president and general manager of platform solutions and was promoted in August 2024 to senior vice president of Platform Solutions and Product Strategy.

As of February 2025, Mr.

O’Hara was promoted to executive vice president, Enterprise Workforce Platform.

Prior to joining the Company, he served as chief product officer for Caresyntax for one year and as chief executive officer for Syus, a predecessor entity, for eight years.

He earned a Bachelor of Arts in Public Policy Studies and a J.D.

from Vanderbilt University.

Roberts joined the Company in January 2002 and served as vice president of accounting and finance beginning in January 2015, following service in multiple positions to which he was promoted.

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He earned a Bachelor of Science in Computer Science from University of North Texas.

Coady joined the Company in January 2014 and served as associate vice president and subsequently vice president and general manager of clinical development solutions from June 2015 to November 2018.

In November 2018, she was promoted to senior vice president and general manager of clinical solutions.

Coady currently serves as senior vice president of workforce development solutions.

She earned a Bachelor of Science in Nursing degree from Université de Moncton.

Scott McQuigg joined the Company in January 2019 as senior vice president of hStream solutions and then served as general manager of scheduling solutions.

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Before this role, he co-founded and served as chief executive officer of HealthLeaders.

Kevin O’Hara joined the Company in January 2021 as senior vice president and general manager of platform solutions and currently serves as senior vice president of platform solutions.

Prior to joining the Company, he served as chief product officer for Caresyntax for one year and as chief executive officer for Syus, a predecessor entity, for eight years.

He earned a Bachelor of Arts in Public Policy Studies and a J.D.

from Vanderbilt University.

Scott Fenstermacher joined the Company in 2012 and served as vice president of sales beginning in 2017 and was promoted to senior vice president of sales in January 2021.

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Compared sentence by sentence after normalising whitespace, quotation marks, case and digits, so re-formatting and restated figures do not read as changed language. Wording changes appear as one removal and one addition. The current filing and the prior one are authoritative.

What changed 10-K

Item 1. Business