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Risks Related to our Business
−Removed: We could be negatively impacted by the recent Coronavirus or “
+Added: We could be negatively impacted by the Coronavirus or “
COVID-19 ”
outbreak or other similar outbreaks.
−Removed: The outbreak of COVID-19 has been recognized as a global pandemic by the World Health Organization.
−Removed: Federal, state, local and foreign governments have restricted travel and business operations and recommended or imposed social distancing and isolation mandates.
−Removed: These measures have severely restricted economic activity around the world.
−Removed: These events have had and may continue to have adverse effects on our business in a number of respects.
−Removed: The outbreak of COVID-19 has significantly increased economic and demand uncertainty. 
−Removed: The current outbreak and continued spread of COVID-19 and associated government mandates and recommendations have resulted in an economic slowdown and a global recession. 
−Removed: Although the impact on our healthcare clients has varied, the restrictions on movement outside of individuals’
−Removed: homes has resulted in significantly decreased demand for elective healthcare services, which are a large source of revenue for healthcare providers. These circumstances have resulted in many of our clients experiencing decreased revenues, contracting margins, and cash losses. 
+Added: The outbreak of COVID-19, and the associated responses, have impacted our business in a variety of ways.
+Added: Governments have implemented business and travel restrictions and recommended social distancing and other guidelines.
+Added: Many businesses, including many of our clients, have de-emphasized external business opportunities and restricted in-person meetings while shifting their attention toward addressing COVID-19 planning, business disruptions, higher costs, and revenue shortfalls.
+Added: Although the impact on our healthcare clients has varied, many of our clients have experienced decreased revenues, contracting margins, and cash losses. 
Some clients’
−Removed: cost reducing measures have included and could continue to include reducing or eliminating the services they purchase from us. While these circumstances did not significantly impact our financial position or results of operations in 2020, the negative impact could continue to increase. 
+Added: cost reducing measures have included and could continue to include reducing or eliminating the services they purchase from us. While these circumstances did not significantly impact our financial position or results of operations in 2020 and 2021, the negative impact could continue to increase. 
We rely on third-party service providers and business partners, for services or supplies that are critical to providing our clients’
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These third parties are also subject to risks and uncertainties related to the COVID-19 pandemic, which may interfere with their ability to provide their services in a timely manner and in accordance with the agreed-upon terms or our agreements, which could interfere with our ability to operate our business.
−Removed: The COVID-19 pandemic may also have legal or regulatory impacts that have an impact on our business and operations.
−Removed: Historically CMS required certain healthcare organizations to periodically assess, through surveys or related methodologies, the performance of the care they provide.
−Removed: Many of these organizations use our services to comply with this regulatory requirement.
−Removed: However, as a result of the COVID-19 pandemic CMS has suspended the requirement for healthcare organizations to perform these assessments, and some clients have suspended or reduced these services, and others may do so.
−Removed: In addition, the vast majority of our workforce has been working remotely since March 2020.
−Removed: Historically we have relied on national travel as part of our sales efforts, but as a result of the pandemic we have placed an indefinite hold on all company related travel.
+Added: At NRC, the vast majority of our associates are working remotely, and to date we have been capable of providing our services without significant disruption.
+Added: We have made our facilities available for associates to return to work effective July 1, 2021 at their discretion.
+Added: Historically, we have relied on national travel as part of our sales efforts, but as a result of the pandemic we had placed a temporary hold on all company related travel.
+Added: We modified our travel policy and limited travel did resume in the third quarter of 2021.
To date, we are still capable of providing our services without interruption and without significant changes to our internal control over financial reporting.
−Removed: However, an extended period of associates working remotely and restrictions on travel may interfere with our ability to conduct business, including our ability to sell our products or develop new products.
−Removed: Furthermore, COVID-19 has negatively impacted the proper functioning of financial and capital markets, foreign currency exchange rates, and interest rates.
−Removed: In particular, the continued spread of COVID-19 has led to disruption and volatility in the global capital markets which increases the cost of capital and adversely impacts access to capital.
−Removed: If we need to seek additional liquidity in response to some of the economic and business impacts of COVID-19, these circumstances could increase our cost of capital or limit the extent to which capital is available to us.
−Removed: The impact of the COVID-19 pandemic (or any future pandemic or similar event) on our business will depend on a variety of factors, including the duration and spread of the outbreak in the United States and Canada, the associated government and industry mandates and practices, the economic and regulatory impacts on our clients and the markets in which we operate, the policies we implement, and the response of our associates and clients to these factors, all of  which are difficult to predict.
−Removed: We may need to develop or adapt to new ways of doing business that challenge our leadership, our associate training, our human resources, and our business practices, and we cannot assure you that we will be successful in doing so.
−Removed: The short and long-term costs associated with these potential changes are difficult to quantify. 
−Removed: For these and other reasons, the outbreak and associated responses have negatively affected and are expected to continue to affect our business, and the impact could be material.
+Added: However, we may need to develop or adapt to new ways of doing business that challenge our leadership, our associate training, our human resources, and our business practices, and we cannot assure you that we will be successful in doing so.
+Added: The short and long-term costs associated with these potential changes are difficult to quantify.
+Added: For these and other reasons, the outbreak and associated responses could negatively affect our business, and the impact could be material.
+Added: To the extent the COVID-19 pandemic adversely affects the Company’s business, results of operations, financial condition and stock price, it may also have the effect of heightening many of the other risks described in this Part I, Item 1A of this Form 10-K.
We depend on contract renewals, including retention of key clients, for a large share of our revenue and our operating results could be adversely affected.
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Our primary competitors among such specialty firms include Press Ganey, which we believe has significantly higher annual revenue than us, and three or four other firms that we believe have lower annual revenue than us.
−Removed: To a certain degree, we currently compete with, and anticipate that in the future we may increasingly compete with, (1) market research firms and technology solutions which provide survey-based, general market research or Voice of the Customer Feedback capabilities and (2) firms that provide services or products that complement healthcare performance assessments, such as healthcare software or information systems.
+Added: We also compete with market research firms and technology solutions which provide survey-based, general market research or voice of the customer feedback capabilities and firms that provide services or products that complement healthcare performance assessments, such as healthcare software or information systems.
Although only a few of these competitors have offered specific services that compete directly with our services, many of these competitors have substantially greater financial, information gathering, and marketing resources than us and could decide to increase their resource commitments to our market.
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However, over the years Mr.
−Removed: Hays, for estate planning purposes, gifted and/or transferred almost all of his directly owned shares to two trusts for the benefit of his family, The K/I/E Trust under agreement dated October 24, 2018 and the Amandla MK Trust (collectively the “Trusts”).
+Added: Hays, for estate planning purposes, gifted and/or transferred almost all of his directly owned shares to trusts for the benefit of his family.
+Added: Currently, the principal holders of shares previously owned by Mr.
+Added: Hays are the Common Property Trust and the Amandla MK Trust (collectively the “Trusts”).
As of February 25, 2022, approximately 42.6% of our outstanding common stock was owned by the Trusts and approximately 52.4% of our outstanding common stock was held by the Trusts and other entities owned or controlled by members of Mr.
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Any of these factors, among others, may result in changes in the trading volume and/or market price of our common stock.
−Removed: Following periods of volatility in the market price of our securities, shareholders have often filed securities class-action lawsuits.
−Removed: Our involvement in a class-action lawsuit would result in substantial legal fees and divert our senior management’s attention from operating our business, which could harm our business and net income.
+Added: Following periods of volatility in the market price of securities, shareholders have often filed securities class-action lawsuits.
+Added: Our involvement in a class-action lawsuit would result in substantial legal fees and divert our senior management’s attention from operating our business, which could harm our business and net income.
General Risk Factors
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We cannot assure you that we will be able to recruit, retain and motivate a sufficient number of qualified personnel to compete successfully.
+Added: Like many other companies, we experienced higher attrition rates in 2021.
+Added: We may incur higher costs to attract, train and retain these associates.
+Added: Attrition in our sales and service areas can also impact our ability to retain and attract new business.
+Added: We may need to develop or adapt to new ways of doing business that challenge our leadership, our associate training, our human resources, and our business practices, and we cannot assure you that we will be successful in doing so.
+Added: The short and long-term costs associated with these potential changes are difficult to quantify. 
Failure to comply with public company regulations could adversely impact our profitability.
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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.