UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, D.C. 20549

FORM 10-Q


☒			QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended March 31, ~~2020~~2021


☐			TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from to

Commission file number: 000-49796

COMPUTER PROGRAMS AND SYSTEMS, INC.

(Exact Name of Registrant as Specified in Its Charter)


Delaware						74-3032373
(State or Other Jurisdiction of Incorporation or Organization)						(I.R.S. Employer Identification No.)

~~6600 Wall~~54 St. Emanuel Street, Mobile, Alabama						~~36695~~36602
(Address of Principal Executive Offices)						(Zip Code)

(251) 639-8100

(Registrant’s Telephone Number, Including Area Code)

~~N/A~~

6600 Wall Street Mobile, Alabama 36695

(Former Name, Former Address and Former Fiscal Year, if Changed Since Last Report)

Securities registered pursuant to Section 12(b) of the Act:


Title of each class	Trading symbol	Name of each exchange on which registered
Common Stock, par value $.001 per share	CPSI	The NASDAQ Stock Market LLC

Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ý No ¨

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ý No ¨

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of "large accelerated filer," "accelerated filer," "smaller reporting company," and "emerging growth company" in Rule 12b-2 of the Exchange Act.

Large accelerated filer

Accelerated filer

Non-accelerated filer

Smaller reporting company

☐

Emerging growth company

☐

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ý

As of May ~~1, 2020,~~7, 2021, there were ~~14,512,105~~14,728,829 shares of the issuer’s common stock outstanding.

COMPUTER PROGRAMS AND SYSTEMS, INC.

Quarterly Report on Form 10-Q

(For the three months ended March 31, ~~2020)~~2021)

TABLE OF CONTENTS

PART I. FINANCIAL INFORMATION

Item 1.

Financial Statements

Condensed Consolidated Balance Sheets (Unaudited) – March 31 3 1 , 20202 201 and December 31, ~~201~~20 920

Condensed Consolidated Statements of Income (Unaudited) – Three Months Ended March 313 1 , 20202 201 and 20 1 920

Condensed Consolidated Statement of Stockholders’ Equity (Unaudited) – Three Months Ended March 3 1 , 20202 201 and ~~201~~20 920

Condensed Consolidated Statements of Cash Flows (Unaudited) – Three Months Ended March 31 3 1 , 20202 201 and ~~201~~2 90 20

Notes to Condensed Consolidated Financial Statements (Unaudited)

Item 2.

Management’s Discussion and Analysis of Financial Condition and Results of Operations

Item 3.

Quantitative and Qualitative Disclosures about Market Risk

3335

Item 4.

Controls and Procedures

3335

PART II. OTHER INFORMATION

Item 1.

Item 1A.

Item 2.

Unregistered Sales of Equity Securities and Use of Proceeds

Item 3.

Defaults Upon Senior Securities

3637

Item 4.

Mine Safety Disclosures

Item 5.

Item 6.

PART I

FINANCIAL INFORMATION


Item 1.			Financial Statements.

COMPUTER PROGRAMS AND SYSTEMS, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

(In thousands, except per share data)

(Unaudited)


		March 31, 2020		December 31, 2019			March 31, 2021		December 31, 2020
Assets	Assets					Assets
Current assets:	Current assets:					Current assets:
Cash and cash equivalents	Cash and cash equivalents	$	4,280	$	7,357	Cash and cash equivalents	$	18,016	$	12,671
Accounts receivable (net of allowance for expected credit losses of $2,064 and $2,078, respectively)		38,241		38,819
Financing receivables, current portion, net (net of allowance for expected credit losses of $165 and $165, respectively)		12,175		12,032
Accounts receivable (net of allowance for expected credit losses of $2,088 and $1,701, respectively)						Accounts receivable (net of allowance for expected credit losses of $2,088 and $1,701, respectively)	33,793		32,414
Financing receivables, current portion, net (net of allowance for expected credit losses of $486 and $541, respectively)						Financing receivables, current portion, net (net of allowance for expected credit losses of $486 and $541, respectively)	9,710		10,821
Inventories	Inventories	1,365		1,426		Inventories	1,342		1,084
Prepaid income taxes	Prepaid income taxes	1,208		1,337		Prepaid income taxes	2,188		1,789
Prepaid expenses and other	Prepaid expenses and other	6,606		5,861		Prepaid expenses and other	7,833		8,365
Total current assets	Total current assets	63,875		66,832		Total current assets	72,882		67,144
Property and equipment, net	Property and equipment, net	13,294		11,593		Property and equipment, net	13,079		13,139
Software development costs, net	Software development costs, net	883		—		Software development costs, net	4,009		3,210
Operating lease assets	Operating lease assets	7,522		7,800		Operating lease assets	9,030		6,610
Financing receivables, net of current portion (net of allowance for expected credit losses of $3,140 and $2,806, respectively)		17,794		18,267
Financing receivables, net of current portion (net of allowance for expected credit losses of $891 and $948, respectively)						Financing receivables, net of current portion (net of allowance for expected credit losses of $891 and $948, respectively)	10,460		11,477
Other assets, net of current portion	Other assets, net of current portion	2,105		1,771		Other assets, net of current portion	2,998		2,787
Intangible assets, net	Intangible assets, net	80,244		83,110		Intangible assets, net	68,632		71,689
Goodwill	Goodwill	150,216		150,216		Goodwill	150,216		150,216

Total assets	Total assets	$	335,933	$	339,589	Total assets	$	331,306	$	326,272
Liabilities and Stockholders’ Equity	Liabilities and Stockholders’ Equity					Liabilities and Stockholders’ Equity
Current liabilities:	Current liabilities:					Current liabilities:
Accounts payable	Accounts payable	$	9,010	$	8,804	Accounts payable	$	6,742	$	7,716
Current portion of long-term debt	Current portion of long-term debt	8,430		8,430		Current portion of long-term debt	3,457		3,457
Deferred revenue	Deferred revenue	7,807		8,628		Deferred revenue	8,833		8,130
Accrued vacation	Accrued vacation	4,649		4,301		Accrued vacation	5,306		5,353

Other accrued liabilities	Other accrued liabilities	8,714		11,767		Other accrued liabilities	16,394		12,786
Total current liabilities	Total current liabilities	38,610		41,930		Total current liabilities	40,732		37,442
Long-term debt, net of current portion	Long-term debt, net of current portion	93,325		99,433		Long-term debt, net of current portion	67,496		73,360
Operating lease liabilities, net of current portion	Operating lease liabilities, net of current portion	5,950		6,256		Operating lease liabilities, net of current portion	7,527		5,092
Deferred tax liabilities	Deferred tax liabilities	8,688		7,623		Deferred tax liabilities	11,436		10,378
Total liabilities	Total liabilities	146,573		155,242		Total liabilities	127,191		126,272
Stockholders’ equity:	Stockholders’ equity:					Stockholders’ equity:
Common stock, $0.001 par value; 30,000 shares authorized; 14,512 and 14,356 shares issued and outstanding, respectively		15		14
Common stock, $0.001 par value; 30,000 shares authorized; 14,715 and 14,511 shares issued and outstanding, respectively						Common stock, $0.001 par value; 30,000 shares authorized; 14,715 and 14,511 shares issued and outstanding, respectively	15		15
Additional paid-in capital	Additional paid-in capital	176,975		174,618		Additional paid-in capital	182,656		181,622

Retained earnings	Retained earnings	12,370		9,715		Retained earnings	23,768		19,624
Treasury stock, 80 shares and 47 shares, respectively						Treasury stock, 80 shares and 47 shares, respectively	(2,324)		(1,261)
Total stockholders’ equity	Total stockholders’ equity	189,360		184,347		Total stockholders’ equity	204,115		200,000
Total liabilities and stockholders’ equity	Total liabilities and stockholders’ equity	$	335,933	$	339,589	Total liabilities and stockholders’ equity	$	331,306	$	326,272

The accompanying notes are an integral part of these condensed consolidated financial statements.

COMPUTER PROGRAMS AND SYSTEMS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF INCOME

(In thousands, except per share data)

(Unaudited)


		Three Months Ended March 31,					Three Months Ended March 31,
		2020		2019			2021		2020
Sales revenues:	Sales revenues:					Sales revenues:
System sales and support	System sales and support	$	41,186	$	43,247	System sales and support	$	36,366	$	41,186
TruBridge	TruBridge	28,571		25,894		TruBridge	31,639		28,571
Total sales revenues	Total sales revenues	69,757		69,141		Total sales revenues	68,005		69,757
Costs of sales:	Costs of sales:					Costs of sales:
System sales and support	System sales and support	18,587		18,337		System sales and support	17,376		18,587
TruBridge	TruBridge	15,057		13,689		TruBridge	15,779		15,057
Total costs of sales	Total costs of sales	33,644		32,026		Total costs of sales	33,155		33,644
Gross profit	Gross profit	36,113		37,115		Gross profit	34,850		36,113
Operating expenses:	Operating expenses:					Operating expenses:
Product development	Product development	8,271		9,228		Product development	8,429		8,271
Sales and marketing	Sales and marketing	6,997		7,492		Sales and marketing	5,301		6,997
General and administrative	General and administrative	11,847		11,824		General and administrative	13,149		11,847
Amortization of acquisition-related intangibles	Amortization of acquisition-related intangibles	2,866		2,523		Amortization of acquisition-related intangibles	3,057		2,866
Total operating expenses	Total operating expenses	29,981		31,067		Total operating expenses	29,936		29,981
Operating income	Operating income	6,132		6,048		Operating income	4,914		6,132
Other income (expense):	Other income (expense):					Other income (expense):
Other income	Other income	362		248		Other income	814		362

Interest expense	Interest expense	(1,179)		(1,804)		Interest expense	(627)		(1,179)
Total other income (expense)	Total other income (expense)	(817)		(1,556)		Total other income (expense)	187		(817)
Income before taxes	Income before taxes	5,315		4,492		Income before taxes	5,101		5,315
Provision for income taxes	Provision for income taxes	1,225		1,048		Provision for income taxes	957		1,225
Net income	Net income	$	4,090	$	3,444	Net income	$	4,144	$	4,090
Net income per common share—basic	Net income per common share—basic	$	0.28	$	0.24	Net income per common share—basic	$	0.29	$	0.28
Net income per common share—diluted	Net income per common share—diluted	$	0.28	$	0.24	Net income per common share—diluted	$	0.28	$	0.28
Weighted average shares outstanding used in per common share computations:	Weighted average shares outstanding used in per common share computations:					Weighted average shares outstanding used in per common share computations:
Basic	Basic	13,904		13,656		Basic	14,159		13,904
Diluted	Diluted	13,904		13,656		Diluted	14,221		13,904
Dividends declared per common share	Dividends declared per common share	$	0.10	$	0.10	Dividends declared per common share	$	0	$	0.10

The accompanying notes are an integral part of these condensed consolidated financial statements.

COMPUTER PROGRAMS AND SYSTEMS, INC.

CONDENSED CONSOLIDATED STATEMENT OF STOCKHOLDERS’ EQUITY

(In thousands)

(Unaudited)


		Common Stock					Additional Paid-in-Capital					Retained Earnings (Accumulated Deficit)				Total Stockholders’ Equity			Common Stock								Additional Paid-in-Capital						Retained Earnings			Treasury Stock				Total Stockholders’ Equity
																										Common Stock									Treasury Stock			Total Stockholders’ Equity
		Shares	Amount																			Shares						Amount				Retained Earnings									Treasury Stock

Balance at December 31, 2019		14,356	$	14	$	174,618				$	9,715						$	184,347
Three Months Ended March 31, 2021 and 2020:														Three Months Ended March 31, 2021 and 2020:
Balance at December 31, 2020														Balance at December 31, 2020	14,511						$	15			$	181,622					$					19,624			$	(1,261)		$	200,000
Net income	Net income	—	—		—			4,090				4,090		Net income	—				—				—						4,144						—			4,144

Issuance of restricted stock	Issuance of restricted stock	156	1		(1)			—				—		Issuance of restricted stock	210				—				—						—				—			—
Forfeiture of restricted stock														Forfeiture of restricted stock	(6)				—				—						—				—			—
Stock-based compensation	Stock-based compensation	—	—		2,358			—				2,358		Stock-based compensation	—				—				1,034						—				—			1,034
Dividends		—	—		—			(1,435)				(1,435)
Balance at March 31, 2020		14,512	$	15	$	176,975		$	12,370			$	189,360
Treasury stock acquired														Treasury stock acquired	—				—				—						—				(1,063)			(1,063)

Balance at December 31, 2018		14,083	$	14	$	164,793		$	(5,024)			$	159,783
Balance at March 31, 2021														Balance at March 31, 2021	14,715				$	15			$	182,656					$	23,768			$	(2,324)		$	204,115

Balance at December 31, 2019														Balance at December 31, 2019	14,356				$	14			$	174,618					$	9,715			$	0		$	184,347
Net income	Net income	—	—		—			3,444				3,444		Net income	—				—				—						4,090				—			4,090

Issuance of restricted stock	Issuance of restricted stock	273	—		—			—				—		Issuance of restricted stock	156				1				(1)						—				—			—

Stock-based compensation	Stock-based compensation	—	—		2,436			—				2,436		Stock-based compensation	—				—				2,358						—				—			2,358
Dividends	Dividends	—	—		—			(1,422)				(1,422)		Dividends	—				—				—						(1,435)				—			(1,435)
Balance at March 31, 2019		14,356	$	14	$	167,229		$	(3,002)			$	164,241
Balance at March 31, 2020														Balance at March 31, 2020	14,512				$	15			$	176,975					$	12,370			$	0		$	189,360

The accompanying notes are an integral part of these condensed consolidated financial statements.

COMPUTER PROGRAMS AND SYSTEMS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(In thousands)

(Unaudited)


		Three Months Ended March 31,							Three Months Ended March 31,
		2020		2019			2021		2020
Operating Activities:	Operating Activities:					Operating Activities:
Net income	Net income	$	4,090	$	3,444	Net income	$	4,144	$	4,090
Adjustments to net income:	Adjustments to net income:					Adjustments to net income:
Provision for bad debt		999		1,207
Provision for credit losses						Provision for credit losses	938		999
Deferred taxes	Deferred taxes	1,065		854		Deferred taxes	1,058		1,065
Stock-based compensation	Stock-based compensation	2,358		2,436		Stock-based compensation	1,034		2,358
Depreciation	Depreciation	420		361		Depreciation	553		420
Amortization of acquisition-related intangibles	Amortization of acquisition-related intangibles	2,866		2,523		Amortization of acquisition-related intangibles	3,057		2,866
Amortization of software development costs	Amortization of software development costs	38		—		Amortization of software development costs	73		38
Amortization of deferred finance costs	Amortization of deferred finance costs	86		86		Amortization of deferred finance costs	73		86

Changes in operating assets and liabilities:	Changes in operating assets and liabilities:					Changes in operating assets and liabilities:
Accounts receivable	Accounts receivable	(88)		(156)		Accounts receivable	(2,183)		(88)
Financing receivables	Financing receivables	(4)		183		Financing receivables	1,994		(4)
Inventories	Inventories	62		(251)		Inventories	(258)		62
Prepaid expenses and other	Prepaid expenses and other	(1,079)		(772)		Prepaid expenses and other	321		(1,079)
Accounts payable	Accounts payable	206		1,239		Accounts payable	(974)		206
Deferred revenue	Deferred revenue	(821)		698		Deferred revenue	703		(821)
Other liabilities	Other liabilities	(2,732)		(3,808)		Other liabilities	3,576		(2,732)
Prepaid income taxes/income taxes payable		128		(156)
(Prepaid income taxes)/income taxes payable						(Prepaid income taxes)/income taxes payable	(399)		128
Net cash provided by operating activities	Net cash provided by operating activities	7,594		7,888		Net cash provided by operating activities	13,710		7,594
Investing Activities:	Investing Activities:					Investing Activities:

Investment in software development	Investment in software development	(921)		—		Investment in software development	(872)		(921)
Purchase of property and equipment	Purchase of property and equipment	(2,120)		(473)		Purchase of property and equipment	(493)		(2,120)
Net cash used in investing activities	Net cash used in investing activities	(3,041)		(473)		Net cash used in investing activities	(1,365)		(3,041)
Financing Activities:	Financing Activities:					Financing Activities:
Dividends paid	Dividends paid	(1,435)		(1,422)		Dividends paid	0		(1,435)

Payments of long-term debt principal	Payments of long-term debt principal	(2,195)		(7,110)		Payments of long-term debt principal	(937)		(2,195)
Payments of contingent consideration		—		(206)

Payments of revolving line of credit	Payments of revolving line of credit	(4,000)		—		Payments of revolving line of credit	(5,000)		(4,000)

Treasury stock purchases						Treasury stock purchases	(1,063)		0
Net cash used in financing activities	Net cash used in financing activities	(7,630)		(8,738)		Net cash used in financing activities	(7,000)		(7,630)
Decrease in cash and cash equivalents		(3,077)		(1,323)
Increase (decrease) in cash and cash equivalents						Increase (decrease) in cash and cash equivalents	5,345		(3,077)
Cash and cash equivalents at beginning of period	Cash and cash equivalents at beginning of period	7,357		5,732		Cash and cash equivalents at beginning of period	12,671		7,357
Cash and cash equivalents at end of period	Cash and cash equivalents at end of period	$	4,280	$	4,409	Cash and cash equivalents at end of period	$	18,016	$	4,280
Supplemental disclosure of cash flow information:	Supplemental disclosure of cash flow information:					Supplemental disclosure of cash flow information:
Cash paid for interest	Cash paid for interest	$	1,093	$	1,289	Cash paid for interest	$	554	$	1,093
Cash paid for income taxes, net of refund	Cash paid for income taxes, net of refund	$	31	$	350	Cash paid for income taxes, net of refund	$	298	$	31
The accompanying notes are an integral part of these condensed consolidated financial statements.	The accompanying notes are an integral part of these condensed consolidated financial statements.									The accompanying notes are an integral part of these condensed consolidated financial statements.

COMPUTER PROGRAMS AND SYSTEMS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

1. BASIS OF PRESENTATION

Basis of Presentation

The accompanying unaudited condensed consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (the "SEC") and include all adjustments that, in the opinion of management, are necessary for a fair presentation of the results of the periods presented. All such adjustments are considered of a normal recurring nature. Quarterly results of operations are not necessarily indicative of annual results.

Certain footnote disclosures normally included in financial statements prepared in accordance with accounting principles generally accepted in the United States of America ("U.S. GAAP") have been condensed or omitted. The condensed consolidated balance sheet as of December 31, ~~2019~~2020 was derived from the audited consolidated balance sheet at that date. These unaudited condensed consolidated financial statements should be read in conjunction with the audited financial statements of Computer Programs and Systems, Inc. ("CPSI" or the "Company") for the year ended December 31, ~~2019~~2020 and the notes thereto contained in the Company’s Annual Report on Form 10-K for the year ended December 31, ~~2019.~~2020.

Principles of Consolidation

The condensed consolidated financial statements of CPSI include the accounts of TruBridge, LLC ("TruBridge"), Evident, LLC ("Evident"), Healthland Holding Inc. ("HHI"), and iNetXperts, Corp. d/b/a Get Real Health ("Get Real Health"), all of which are wholly-owned subsidiaries of CPSI. The accounts of HHI include those of its wholly-owned subsidiaries, Healthland Inc. ("Healthland"), Rycan Technologies, Inc. ("Rycan"), and American HealthTech, Inc. ("AHT"). All significant intercompany balances and transactions have been eliminated.

2. RECENT ACCOUNTING PRONOUNCEMENTS

New Accounting Standards Adopted in ~~2020~~2021

~~In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13,~~ ~~Financial Instruments-Credit Losses~~, which requires the measurement of all expected credit losses for financial assets held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. WeThere were no new accounting standards required to be adopted ~~this guidance as of January 1, 2020. Adoption of the standard did not~~in 2021 that would have a material impact on our consolidated financial statements.

New Accounting Standards Yet to be Adopted

We do not believe that any other recently issued but not yet effective accounting standards, if adopted, would have a material impact on our consolidated financial statements.

3. REVENUE RECOGNITION

Revenue is recognized upon transfer of control of promised products or services to clients in an amount that reflects the consideration we expect to receive in exchange for those products and services. We enter into contracts that can include various combinations of products and services, which are generally distinct and accounted for as separate performance obligations. The Company employs the 5-step revenue recognition model under Accounting Standards Codification ("ASC") 606, Revenue from Contracts with Customers, to: (1) identify the contract with the client, (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 (or as) the entity satisfies a performance obligation.

Revenue is recognized net of shipping charges and any taxes collected from clients, which are subsequently remitted to governmental authorities.

System Sales and Support

The Company enters into contractual obligations to sell perpetual software licenses, installation, conversion, training, hardware and software application support and hardware maintenance services to acute care and post-acute care community hospitals.

Non-recurring Revenues

•Perpetual software licenses, installation, conversion, and related training are not considered separate and distinct performance obligations due to the proprietary nature of our software and are, therefore, accounted for as a single performance obligation on a module-by-module basis. Revenue is recognized as each module's implementation is completed based on the module's stand-alone selling price ("SSP"), net of discounts. Fees for licenses, installation, conversion, and related training are typically due in three installments: (1) at placement of order, (2) upon installation of software and commencement of training, and (3) upon satisfactory completion of monthly accounting cycle or end-of-month operation by application and as applicable for each application. Often, short-term and/or long-term financing arrangements are provided for software implementations; refer to Note 1110 - Financing Receivables for further information. Electronic health records ("EHR") implementations include a system warranty that terminates thirty days from the software go-live date, the date on which the client begins using the system in a live environment.

•Hardware revenue is recognized separately from software licenses at the point in time it is delivered to the client. The SSP of hardware is cost plus a reasonable margin. Payment is generally due upon delivery of the hardware to the client. Standard manufacturer warranties apply to hardware.

Recurring Revenues

•Software application support and hardware maintenance services sold with software licenses and hardware are separate and distinct performance obligations. Revenue for support and maintenance services is recognized based on SSP, which is the renewal price, ratably over the life of the contract, which is generally three to five years. Payment is due monthly for support services provided.

•Subscriptions to third party content revenue is recognized as a separate performance obligation ratably over the subscription term based on SSP, which is cost plus a reasonable margin. Payment is due monthly for subscriptions to third party content.

•Software as a Service ("SaaS") arrangements for EHR software and related conversion and training services are considered a single performance obligation. Revenue is recognized on a monthly basis as the SaaS service is provided to the client over the contract term. Payment is due monthly for SaaS services provided.

Refer to Note 1716 - Segment Reporting, for further information, including revenue by client base (acute care or post-acute care) bifurcated by recurring and non-recurring revenue.

TruBridge

TruBridge provides an array of business processing services ("BPS") consisting of accounts receivable management, private pay services, insurance services, medical coding, electronic billing, statement processing, payroll processing, and contract management. Fees are recognized over the period of the client contractual relationship as the services are performed based on the SSP, net of discounts. Fees for many of these services are invoiced, and revenue recognized accordingly, based on the volume of transactions or a percentage of client accounts receivable collections. Payment is due monthly for BPS with certain amounts varying based on utilization and/or volumes.

TruBridge also provides professional IT services. Revenue from professional IT services is recognized as the services are performed based on SSP. Payment is due monthly as services are performed.

Deferred Revenue

Deferred revenue represents amounts invoiced to clients for which the services under contract have not been completed and revenue has not been recognized, including annual renewals of certain software subscriptions and customer deposits for implementations to be performed at a later date. Revenue is recognized ratably over the life of the software subscriptions as services are provided and at the point-in-time when implementations have been completed.

The following table details deferred revenue for the three months ended March 31, ~~2020~~2021 and ~~2019,~~2020, included in the condensed consolidated balance sheets:


(In thousands)	(In thousands)	Three Months Ended March 31, 2020		Three Months Ended March 31, 2019		(In thousands)	Three Months Ended March 31, 2021		Three Months Ended March 31, 2020
Beginning balance	Beginning balance	$	8,628	$	10,201	Beginning balance	$	8,130	$	8,628
Deferred revenue recorded	Deferred revenue recorded	6,194		6,530		Deferred revenue recorded	5,847		6,194

Less deferred revenue recognized as revenue	Less deferred revenue recognized as revenue	(7,015)		(5,832)		Less deferred revenue recognized as revenue	(5,144)		(7,015)
Ending balance	Ending balance	$	7,807	$	10,899	Ending balance	$	8,833	$	7,807

The deferred revenue recorded during the three months ended March 31, ~~2020~~2021 is comprised primarily of the annual renewals of certain software subscriptions billed during the first quarter of each year and deposits collected for future EHR installations. The deferred revenue recognized as revenue during the three months ended March 31, ~~2020~~2021 and ~~2019~~2020 is comprised primarily of the periodic recognition of annual renewals that were deferred until earned and deposits for future EHR installations that were deferred until earned.

Costs to Obtain and Fulfill a Contract with a Customer

Costs to obtain a contract include the commission costs related to SaaS licensing agreements, which are capitalized and amortized ratably over the expected life of the customer. As a practical expedient, we generally recognize the incremental costs of obtaining a contract as an expense when incurred if the amortization period of the asset would have been one year or less, with the exception of commissions generated from TruBridge sales. TruBridge commissions, which are paid up to twelve months in advance of services performed, are capitalized and amortized over the prepayment period. Costs to obtain a contract are expensed within sales and marketing expenses in the accompanying condensed consolidated statements of income.

Contract fulfillment costs related to the implementation of SaaS arrangements are capitalized and amortized ratably over the expected life of the customer. Costs to fulfill contracts consist of the payroll costs for the implementation of SaaS arrangements, including time for training, conversion and installation that is necessary for the software to be utilized. Contract fulfillment costs are expensed within the caption "System sales and support - Cost of ~~sales."~~sales" in the accompanying condensed consolidated statements of income.

Costs to obtain and fulfill contracts related to SaaS arrangements are included within the "Prepaid expenses and other" and "Other assets, net of current portion" line items on our condensed consolidated balance sheets.

The following table details costs to obtain and fulfill contracts with customers for the three months ended March 31, ~~2020~~2021 and ~~2019,~~2020, included in the condensed consolidated balance sheets:


(In thousands)	(In thousands)	Three Months Ended March 31, 2020		Three Months Ended March 31, 2019		(In thousands)	Three Months Ended March 31, 2021		Three Months Ended March 31, 2020
Beginning balance	Beginning balance	$	4,440	$	3,017	Beginning balance	$	5,992	$	4,440
Costs to obtain and fulfill contracts capitalized	Costs to obtain and fulfill contracts capitalized	1,888		1,922		Costs to obtain and fulfill contracts capitalized	1,836		1,888
Less costs to obtain and fulfill contracts recognized as expense	Less costs to obtain and fulfill contracts recognized as expense	(1,285)		(1,134)		Less costs to obtain and fulfill contracts recognized as expense	(1,475)		(1,285)
Ending balance	Ending balance	$	5,043	$	3,805	Ending balance	$	6,353	$	5,043

Remaining Performance Obligations

Disclosures regarding remaining performance obligations are not considered material as the overwhelming majority of the Company's remaining performance obligations either (a) are related to contracts with an expected duration of one year or less, or (b) exhibit revenue recognition in the amount to which the Company has the right to invoice.

~~4. BUSINESS COMBINATION~~

~~Acquisition of Get Real Health~~

On May 3, 2019, we acquired all of the assets and liabilities of iNetXperts, Corp., a Maryland corporation doing business as Get Real Health (“Get Real Health”), pursuant to a Stock Purchase Agreement dated April 23, 2019, as amended on May 2, 2019. Based in Rockville, Maryland, Get Real Health delivers technology solutions to improve patient outcomes and engagement strategies with care providers.

Consideration for the acquisition included cash (net of cash of the acquired entity) of $10.8 million (inclusive of seller's transaction expenses), plus a contingent earnout payment of up to $14.0 million tied to Get Real Health's earnings before interest, tax, depreciation, and amortization ("EBITDA") (subject to certain pro-forma adjustments) for 2019. As of December 31, 2019, the $5.0 million contingent consideration estimated in the allocation of purchase price paid was fully reversed as Get Real Health's earnings did not achieve the required level for earnout payment. During 2019, we incurred approximately $0.6 million of pre-tax acquisition costs in connection with the acquisition of Get Real Health. Acquisition costs are included in general and administrative expenses in our consolidated statements of income.

~~Our acquisition of Get Real Health was treated as a purchase in accordance with ASC 805,~~ ~~Business Combinations~~, which requires allocation of the purchase price to the estimated fair values of assets and liabilities acquired in the transaction. Our allocation of the purchase price was based on management's judgment after evaluating several factors, including a valuation assessment.

~~The allocation of the purchase price paid for Get Real Health was as follows:~~9


~~(In thousands)~~	~~Purchase Price Allocation~~
~~Acquired cash~~	$	~~159~~
~~Accounts receivable~~	~~364~~

~~Prepaid expenses~~	~~107~~
~~Property and equipment~~	~~365~~
~~Operating lease asset~~	~~1,285~~
~~Intangible assets~~	~~7,890~~
~~Goodwill~~	~~9,767~~
~~Accounts payable and accrued liabilities~~	~~(594)~~
~~Deferred taxes, net~~	~~(1,736)~~
~~Operating lease liability~~	~~(1,285)~~
~~Contingent consideration~~	~~(5,000)~~
~~Deferred revenue~~	~~(430)~~
~~Net assets acquired~~	$	~~10,892~~

The intangible assets in the table above are being amortized on a straight-line basis over their estimated useful lives. The amortization is included in amortization of acquisition-related intangibles in our condensed consolidated statements of income.

The fair value measurements of tangible and intangible assets and liabilities were based on significant inputs not observable in the market and thus represent Level 3 measurements within the fair value measurement hierarchy (see Note 16 - Fair Value). Level 3 inputs included, among others, discount rates that we estimated would be used by a market participant in valuing these assets and liabilities, projections of revenues and cash flows, client attrition rates and market comparables.

5.4. PROPERTY AND EQUIPMENT

Property and equipment, net was comprised of the following at March 31, ~~2020~~2021 and December 31, ~~2019:~~2020:


(In thousands)	(In thousands)	March 31, 2020		December 31, 2019		(In thousands)	March 31, 2021		December 31, 2020
Land	Land	$	2,848	$	2,848	Land	$	2,848	$	2,848
Buildings and improvements	Buildings and improvements	8,039		8,039		Buildings and improvements	8,538		8,242

Computer equipment	Computer equipment	6,131		4,011		Computer equipment	7,342		7,144
Leasehold improvements	Leasehold improvements	1,712		1,712		Leasehold improvements	1,283		1,283
Office furniture and fixtures	Office furniture and fixtures	2,018		2,018		Office furniture and fixtures	829		829
Automobiles	Automobiles	18		18		Automobiles	18		18
Property and equipment, gross	Property and equipment, gross	20,766		18,646		Property and equipment, gross	20,858		20,364
Less: accumulated depreciation	Less: accumulated depreciation	(7,472)		(7,053)		Less: accumulated depreciation	(7,779)		(7,225)
Property and equipment, net	Property and equipment, net	$	13,294	$	11,593	Property and equipment, net	$	13,079	$	13,139

6.5. SOFTWARE DEVELOPMENT

Software development costs are accounted for in accordance with ASC 350-40, Internal-Use Software. We capitalize incurred labor costs for software development from the time the preliminary project phase is completed until the software is available for general release. Research and development costs and other computer software maintenance costs related to software development are expensed as incurred. We estimate the useful life of our capitalized software and amortize its value on a straight-line basis over that estimated life, which is estimated to be five years. IfWe evaluate capitalized software development costs for impairment when there is an indication that the ~~actual life is shorter than our estimated~~ useful life ~~we will amortize~~has changed or that the ~~remaining book value over the remaining useful life or the asset~~unamortized costs may not be ~~deemed to be impaired and, accordingly, a~~recoverable. A write-down of the value of the asset may be recorded as a charge to earnings. Upon the software's availability for general release, we commence amortization of the capitalized software costs on a module-by-module basis.

Software development, net was comprised of the following at March 31, ~~2020~~2021 and December 31, ~~2019:~~2020:


~~(In thousands)~~	~~March 31, 2020~~		~~December 31, 2019~~
~~Software development costs~~	$	~~921~~	$	—
~~Less: accumulated amortization~~	~~(38)~~		—
~~Software development costs, net~~	$	~~883~~	$	—


(In thousands)	March 31, 2021		December 31, 2020
Software development costs	$	4,200	$	3,328
Less: accumulated amortization	(191)		(118)
Software development costs, net	$	4,009	$	3,210

7.6. OTHER ACCRUED LIABILITIES

Other accrued liabilities was comprised of the following at March 31, ~~2020~~2021 and December 31, ~~2019:~~2020:


(In thousands)	(In thousands)	March 31, 2020		December 31, 2019		(In thousands)	March 31, 2021		December 31, 2020
Salaries and benefits	Salaries and benefits	$	4,052	$	6,946	Salaries and benefits	$	9,891	$	7,876
Severance	Severance	128		329		Severance	1,644		25
Commissions	Commissions	1,153		1,037		Commissions	844		1,040
Self-insurance reserves	Self-insurance reserves	1,214		1,382		Self-insurance reserves	1,929		1,776

Other	Other	595		529		Other	583		551
Operating lease liabilities, current portion	Operating lease liabilities, current portion	1,572		1,544		Operating lease liabilities, current portion	1,503		1,518
Other accrued liabilities	Other accrued liabilities	$	8,714	$	11,767	Other accrued liabilities	$	16,394	$	12,786

8.7. NET INCOME PER SHARE

The Company presents basic and diluted earnings per share ("EPS") data for its common stock. Basic EPS is calculated by dividing the net income attributable to stockholders of the Company by the weighted average number of shares of common stock outstanding during the period. Diluted EPS is determined by adjusting the net income attributable to stockholders of the Company and the weighted average number of shares of common stock outstanding during the period for the effects of all dilutive potential common shares, including awards under stock-based compensation arrangements.

The Company's unvested restricted stock awards (see Note ~~10)~~9) are considered participating securities under ~~FASB Codification topic,~~ASC 260, Earnings Per Share, because they entitle holders to non-forfeitable rights to dividends until the awards vest or are forfeited. When a company has a security that qualifies as a "participating security," the Codification requires the use of the two-class method when computing basic EPS. The two-class method is an earnings allocation formula that determines EPS for each class of common stock and participating security according to dividends declared (or accumulated) and participation rights in undistributed earnings. In determining the amount of net income to allocate to common stockholders, income is allocated to both common stock and participating securities based on their respective weighted average shares outstanding for the period, with net income attributable to common stockholders ultimately equaling net income less net income attributable to participating securities. Diluted EPS for the Company's common stock is computed using the more dilutive of the two-class method or the treasury stock method.

The following is a calculation of the basic and diluted EPS for the Company's common stock, including a reconciliation between net income and net income attributable to common stockholders:


		Three Months Ended March 31,					Three Months Ended March 31,
(In thousands, except per share data)	(In thousands, except per share data)	2020		2019		(In thousands, except per share data)	2021		2020
Net income	Net income	$	4,090	$	3,444	Net income	$	4,144	$	4,090
Less: Net income attributable to participating securities	Less: Net income attributable to participating securities	(134)		(130)		Less: Net income attributable to participating securities	(103)		(134)
Net income attributable to common stockholders	Net income attributable to common stockholders	$	3,956	$	3,314	Net income attributable to common stockholders	$	4,041	$	3,956

Weighted average shares outstanding used in basic per common share computations	Weighted average shares outstanding used in basic per common share computations	13,904		13,656		Weighted average shares outstanding used in basic per common share computations	14,159		13,904
Add: Dilutive potential common shares	Add: Dilutive potential common shares	—		—		Add: Dilutive potential common shares	62		0
Weighted average shares outstanding used in diluted per common share computations	Weighted average shares outstanding used in diluted per common share computations	13,904		13,656		Weighted average shares outstanding used in diluted per common share computations	14,221		13,904

Basic EPS	Basic EPS	$	0.28	$	0.24	Basic EPS	$	0.29	$	0.28
Diluted EPS	Diluted EPS	$	0.28	$	0.24	Diluted EPS	$	0.28	$	0.28

During ~~2018,~~ 2019, 2020, and ~~2020,~~2021, performance share awards were granted to certain executive officers and key employees of the Company that will result in the issuance of ~~time-vesting restricted~~common stock if the predefined performance criteria are met. The awards provide for an aggregate target of ~~252,852~~249,952 shares, ~~none~~ of which 62,267 have been included in the calculation of diluted EPS for the three months ended March 31, ~~2020~~2021. The remaining 187,685 shares have been excluded from the calculation of diluted EPS because the related threshold award performance levels have not been achieved as of March 31, ~~2020.~~2021. See Note 109 - Stock-Based Compensation and Equity for more information.

9.8. INCOME TAXES

The Company determines the tax provision for interim periods using an estimate of our annual effective tax rate, adjusted for discrete items, if any, that are taken into account in the relevant period. Each quarter we update our estimate of the annual effective tax rate, and if our estimated tax rate changes, we make a cumulative adjustment.

Our effective tax rate for the three months ended March 31, 2021 decreased to 18.8% from 23.0% for the three months ended March 31, 2020, ~~and 2019, was~~primarily as a result of the tax consequences of stock-based compensation. Specifically, excess tax benefits resulting from restricted stock vesting benefited our effective tax rate by 1.6% during the first quarter of 2021. Comparatively, the first quarter of 2020 experienced a tax ~~expense of 23%.~~benefit shortfall resulting from restricted stock vesting that increased our effective tax rate by 2.4% for the period.

~~10.~~

9. STOCK-BASED COMPENSATION AND EQUITY

Stock-based compensation expense is measured at the grant date based on the fair value of the award, and is recognized as an expense over the employee's or non-employee director's requisite service period.

The following table details total stock-based compensation expense for the three months ended March 31, ~~2020~~2021 and ~~2019,~~2020, included in the condensed consolidated statements of income:


		Three Months Ended March 31,					Three Months Ended March 31,
(In thousands)	(In thousands)	2020		2019		(In thousands)	2021		2020
Costs of sales	Costs of sales	$	528	$	531	Costs of sales	$	213	$	528
Operating expenses	Operating expenses	1,830		1,905		Operating expenses	821		1,830
Pre-tax stock-based compensation expense	Pre-tax stock-based compensation expense	2,358		2,436		Pre-tax stock-based compensation expense	1,034		2,358
Less: income tax effect	Less: income tax effect	(519)		(536)		Less: income tax effect	(227)		(519)
Net stock-based compensation expense	Net stock-based compensation expense	$	1,839	$	1,900	Net stock-based compensation expense	$	807	$	1,839

The Company's stock-based compensation awards are in the form of restricted stock and performance share awards granted pursuant to the Company's ~~2012 Restricted Stock Plan for Non-Employee Directors,~~ Amended and Restated 2014 Incentive Plan and 2019 Incentive Plan, as amended (the "Plans"). As of March 31, ~~2020,~~2021, there was ~~$13.6~~$11.1 million of unrecognized compensation expense related to unvested stock-based compensation arrangements granted under the Plans, which is expected to be recognized over a weighted-average period of ~~2.0~~2.4 years.

Restricted Stock

The Company grants restricted stock to executive officers, certain key employees and non-employee directors under the Plans with the fair value of the awards representing the fair value of the common stock on the date the restricted stock is granted. Shares of restricted stock generally vest in equal annual installments over the applicable vesting period, which ranges from one to three years. The Company records expenses for these grants on a straight-line basis over the applicable vesting periods. Shares of restricted stock ~~may~~have also bebeen issued pursuant to the settlement of performance share awards with one-year performance periods, for which the Company records expenses in the manner described in the "Performance Share Awards" section below. Although no such one-year performance share awards were granted during the quarter ended March 31, 2021, shares issued pursuant to past one-year performance share awards are still subject to vesting.

A summary of restricted stock activity (including shares of restricted stock issued pursuant to the settlement of performance share awards) under the Plans during the three months ended March 31, ~~2020~~2021 and ~~2019~~2020 is as follows:


		Three Months Ended March 31, 2020				Three Months Ended March 31, 2019						Three Months Ended March 31, 2021			Three Months Ended March 31, 2020
		Shares	Weighted-Average Grant Date Fair Value Per Share		Shares	Weighted-Average Grant Date Fair Value Per Share			Shares	Weighted-Average Grant Date Fair Value Per Share		Shares	Weighted-Average Grant Date Fair Value Per Share
Unvested restricted stock outstanding at beginning of period	Unvested restricted stock outstanding at beginning of period	525,859	$	30.51	475,132	$	32.00	Unvested restricted stock outstanding at beginning of period	412,967	$	28.87	525,859	$	30.51
Granted	Granted	136,771	26.16		133,936	30.89		Granted	134,314	31.26		136,771	26.16
Performance share awards settled through the issuance of restricted stock	Performance share awards settled through the issuance of restricted stock	19,678	30.15		138,566	29.80		Performance share awards settled through the issuance of restricted stock	0	0		19,678	30.15
Vested	Vested	(202,468)	30.20		(143,945)	33.81		Vested	(245,455)	29.16		(202,468)	30.20

Forfeited								Forfeited	(6,329)	29.10		0	0
Unvested restricted stock outstanding at end of period	Unvested restricted stock outstanding at end of period	479,840	$	29.39	603,689	$	30.82	Unvested restricted stock outstanding at end of period	295,497	$	29.71	479,840	$	29.39

Performance Share Awards

The Company granted performance share awards to executive officers and certain key employees under the Amended and Restated 2014 Incentive Plan prior to 2019 and under the 2019 Incentive Plan beginning in 2019. The number of shares of common stock earned and issuable under each award is determined at the end of a one-year or three-year performance period, based on the Company's achievement of performance goals predetermined by the Compensation Committee of the Board of Directors at the time of grant. The three-year performance share awards include a modifier to the total number of shares earned based on the Company's total shareholder return ("TSR") compared to an industry index. If certain levels of the performance objective are met, the award results in the issuance of shares of restricted stock or common stock corresponding to such level. One-year performance share awards are then subject to time-based vesting pursuant to which the shares of restricted stock vest in equal annual installments over the applicable vesting period, which is generally three years. Three-year performance share awards that result in the issuance of shares of common stock are not subject to time-based vesting at the conclusion of the three-year performance period.

In the event that the Company's financial performance meets the predetermined targets for the performance objectives of the one-year and three-year performance share awards, the Company will issue each award recipient the number of shares of restricted stock or common stock, as applicable, equal to the target award specified in the individual's underlying performance share award agreement. In the event the financial results of the Company exceed the predetermined targets, additional shares up to the maximum award may be issued. In the event the financial results of the Company fall below the predetermined targets, a reduced number of shares may be issued. If the financial results of the Company fall below the threshold performance levels, no shares will be issued. The total number of shares issued for the three-year performance share award may be increased, decreased, or unchanged based on the TSR modifier described above.

The recipients of performance share awards do not receive dividends or possess voting rights during the performance period and, accordingly, the fair value of the one-year and three-year performance share awards is the quoted market value of CPSI's common stock on the grant date less the present value of the expected dividends not received during the relevant period. The TSR modifier applicable to the three-year performance share awards is considered a market condition and therefore is reflected in the grant date fair value of the award. A Monte Carlo simulation has been used to account for this market condition in the grant date fair value of the award.

Expense of one-year performance share awards is recognized using the accelerated attribution (graded vesting) method over the period beginning on the date the Company determines that it is probable that the performance criteria will be achieved and ending on the last day of the vesting period for the restricted stock issued in satisfaction of such awards. Expense of three-year performance share awards is recognized using ratable straight-line amortization over the three-year performance period. In the event the Company determines it is no longer probable that the minimum performance level will be achieved, all previously recognized compensation expense related to the applicable awards is reversed in the period such a determination is made.

A summary of performance share award activity under the Plans during the three months ended March 31, ~~2020~~2021 and ~~2019~~2020 is as follows, based on the target award amounts set forth in the performance share award agreements:


		Three Months Ended March 31, 2020				Three Months Ended March 31, 2019						Three Months Ended March 31, 2021			Three Months Ended March 31, 2020
		Shares	Weighted-Average Grant Date Fair Value Per Share		Shares	Weighted-Average Grant Date Fair Value Per Share			Shares	Weighted-Average Grant Date Fair Value Per Share		Shares	Weighted-Average Grant Date Fair Value Per Share
Performance share awards outstanding at beginning of period	Performance share awards outstanding at beginning of period	200,709	$	30.75	184,776	$	30.15	Performance share awards outstanding at beginning of period	252,852	$	29.27	200,709	$	30.75
Granted	Granted	107,298	26.96		—	—		Granted	93,444	31.26		107,298	26.96
Adjusted for actual performance, net of forfeitures	Adjusted for actual performance, net of forfeitures	(35,477)	30.15		46,176	29.80		Adjusted for actual performance, net of forfeitures	(20,373)	29.92		(35,477)	30.15
Performance share awards settled through the issuance of restricted stock	Performance share awards settled through the issuance of restricted stock	(19,678)	30.15		(138,566)	29.80		Performance share awards settled through the issuance of restricted stock	(75,971)	30.50		(19,678)	30.15
Performance share awards outstanding at end of period	Performance share awards outstanding at end of period	252,852	$	29.27	92,386	$	30.50	Performance share awards outstanding at end of period	249,952	$	29.59	252,852	$	29.27

Stock Repurchases

On September 4, 2020, our Board of Directors approved a stock repurchase program under which we may repurchase up to $30.0 million of our common stock through September 3, 2022. We repurchased 12,056 shares during the three months ended March 31, 2021 and 0 shares during the three months ended March 31, 2020. The approximate dollar value of shares that may yet be repurchased under the stock repurchase program was $28.3 million as of March 31, 2021. Any future stock repurchase transactions may be made through open market purchases, privately-negotiated transactions, or otherwise in compliance with Rule 10b-18 under the Securities Exchange Act of 1934, as amended. Any repurchase activity will depend on many factors, such as the availability of shares of our common stock, general market conditions, the trading price of our common stock, alternative uses for capital, the Company’s financial performance, compliance with the terms of our Amended and Restated Credit Agreement and other factors. Concurrent with the authorization of this stock repurchase program, the Board of Directors opted to indefinitely suspend all quarterly dividends.

In addition to shares repurchased under the approved stock repurchase program, we purchased 21,444 shares during the three months ended March 31, 2021 to fund required tax withholding related to the vesting of restricted stock. Shares withheld to cover required tax withholdings related to the vesting of restricted stock do not reduce our total share repurchase authority.

~~11.~~10. FINANCING RECEIVABLES

Short-Term Payment Plans

The Company provides fixed monthly payment arrangements ("short-term payment plans") over terms ranging from three to twelve months for meaningful use stage three and other add-on software installations. As a practical expedient, we do not adjust the amount of consideration recognized as revenue for the financing component as unearned income when we expect payment within one year or less. These receivables, included in the current portion of financing receivables, were comprised of the following at March 31, ~~2020~~2021 and December 31, ~~2019:~~2020:


(In thousands)	(In thousands)	March 31, 2020		December 31, 2019		(In thousands)	March 31, 2021		December 31, 2020
Short-term payment plans, gross	Short-term payment plans, gross	$	2,356	$	2,361	Short-term payment plans, gross	$	929	$	1,973
Less: allowance for losses	Less: allowance for losses	(165)		(165)		Less: allowance for losses	(46)		(99)
Short-term payment plans, net	Short-term payment plans, net	$	2,191	$	2,196	Short-term payment plans, net	$	883	$	1,874

Long-Term Financing Arrangements

Additionally, the Company provides financing for purchases of its information and patient care systems to certain healthcare providers under long-term financing arrangements expiring in various years through 2026. Under long-term financing arrangements, the transaction price is adjusted by a discount rate that reflects market conditions that would be used for a separate financing transaction between the Company and licensee at contract inception, and takes into account the credit characteristics of the licensee and market interest rates as of the date of the agreement. As such, the amount of fixed fee revenue recognized at the beginning of the license term will be reduced by the calculated financing component. As payments are received from the licensee, the Company recognizes a portion of the financing component as interest income, reported as other income in the condensed consolidated statements of income. These receivables typically have terms from two to seven years.

The components of these receivables were as follows at March 31, ~~2020~~2021 and December 31, ~~2019:~~2020:


(In thousands)	(In thousands)	March 31, 2020		December 31, 2019		(In thousands)	March 31, 2021		December 31, 2020
Long-term financing arrangements, gross	Long-term financing arrangements, gross	$	34,328	$	34,483	Long-term financing arrangements, gross	$	22,696	$	24,082
Less: allowance for expected credit losses	Less: allowance for expected credit losses	(3,140)		(2,806)		Less: allowance for expected credit losses	(1,331)		(1,390)
Less: unearned income	Less: unearned income	(3,410)		(3,574)		Less: unearned income	(2,078)		(2,268)
Long-term financing arrangements, net	Long-term financing arrangements, net	$	27,778	$	28,103	Long-term financing arrangements, net	$	19,287	$	20,424

Future minimum payments to be received subsequent to March 31, ~~2020~~2021 are as follows:


(In thousands)	(In thousands)			(In thousands)
Years Ending December 31,	Years Ending December 31,			Years Ending December 31,
2020		$	9,427
2021	2021	10,806		2021	$	7,893
2022	2022	6,896		2022	6,737
2023	2023	4,038		2023	4,278
2024	2024	2,403		2024	2,670
2025				2025	1,106
Thereafter	Thereafter	758		Thereafter	12
Total minimum payments to be received	Total minimum payments to be received	34,328		Total minimum payments to be received	22,696
Less: allowance for expected credit losses	Less: allowance for expected credit losses	(3,140)		Less: allowance for expected credit losses	(1,331)
Less: unearned income	Less: unearned income	(3,410)		Less: unearned income	(2,078)
Receivables, net	Receivables, net	$	27,778	Receivables, net	$	19,287

Credit Quality of Financing Receivables and Allowance for Expected Credit Losses

The following table is a roll-forward of the allowance for expected credit losses for the three months ended March 31, ~~2020~~2021 and year ended December 31, ~~2019:~~2020:

(In thousands) Balance at Beginning of Period Provision Charge-offs Recoveries Balance at End of Period
March 31, 2020 $ 2,971 $ 334 $ — $ — $ 3,305
December 31, 2019 $ 2,567 $ 970 $ (566) $ — $ 2,971


(In thousands)	Balance at Beginning of Period		Provision		Charge-offs		Recoveries		Balance at End of Period
March 31, 2021	$	1,489	$	134	$	(246)	$	0	$	1,377
December 31, 2020	$	2,971	$	1,632	$	(3,114)	$	0	$	1,489

The Company’s financing receivables are comprised of a single portfolio segment, as the balances are all derived from short-term payment plan arrangements and long-term financing arrangements within our target market of community hospitals. The Company evaluates the credit quality of its financing receivables based on a combination of factors, including, but not limited to, customer collection experience, current and future economic conditions, the customer’s financial condition, and known risk characteristics impacting the respective customer base of community hospitals, the most notable of which relate to enacted and potential changes in Medicare and Medicaid reimbursement rates as community hospitals typically generate a significant portion of their revenues and related cash flows from beneficiaries of these programs. In addition to specific account identification, the Company utilizes historical collection experience to establish the allowance for expected credit losses. Financing receivables are written off only after the Company has exhausted all collection efforts.

Customer payments are considered past due if a scheduled payment is not received within contractually agreed upon terms. To facilitate customer collection and credit monitoring efforts, financing receivable amounts are invoiced and reclassified to trade accounts receivable when they become due, with all invoiced amounts placed on nonaccrual status. As a result, all past due amounts related to the Company’s financing receivables are included in trade accounts receivable in the accompanying condensed consolidated balance sheets. The following is an analysis of the age of financing receivables amounts (excluding short-term payment plans) that have been reclassified to trade accounts receivable and were past due as of March 31, ~~2020~~2021 and December 31, ~~2019:~~2020:

(In thousands) 1 to 90 Days Past Due 91 to 180 Days Past Due 181 + Days Past Due Total Past Due
March 31, 2020 $ 1,401 $ 352 $ 257 $ 2,010
December 31, 2019 $ 1,480 $ 150 $ 207 $ 1,837


(In thousands)	1 to 90 Days Past Due		91 to 180 Days Past Due		181 + Days Past Due		Total Past Due
March 31, 2021	$	917	$	229	$	841	$	1,987
December 31, 2020	$	1,270	$	227	$	672	$	2,169

From time to time, the Company may agree to alternative payment terms outside of the terms of the original financing receivable agreement due to customer difficulties in achieving the original terms. In general, such alternative payment arrangements do not result in a re-aging of the related receivables. Rather, payments pursuant to any alternative payment arrangements are applied to the already outstanding invoices beginning with the oldest outstanding invoices as the payments are received.

Because amounts are reclassified to trade accounts receivable when they become due, there are no past due amounts included within financing receivables, current portion, net or financing receivables, net of current portion in the accompanying condensed consolidated balance sheets.

The Company utilizes an aging of trade accounts receivable as the primary credit quality indicator for its financing receivables, which is facilitated by the reclassification of customer payment amounts to trade accounts receivable when they become due. The table below categorizes customer financing receivable balances (excluding short-term payment plans) based on the age of the oldest payment outstanding that has been reclassified to trade accounts receivable:


(In thousands)	(In thousands)	March 31, 2020		December 31, 2019		(In thousands)	March 31, 2021		December 31, 2020
Stratification of uninvoiced client financing receivables based on aging of related trade accounts receivable:	Stratification of uninvoiced client financing receivables based on aging of related trade accounts receivable:					Stratification of uninvoiced client financing receivables based on aging of related trade accounts receivable:
Uninvoiced client financing receivables related to trade accounts receivable that are 1 to 90 Days Past Due	Uninvoiced client financing receivables related to trade accounts receivable that are 1 to 90 Days Past Due	$	15,705	$	18,015	Uninvoiced client financing receivables related to trade accounts receivable that are 1 to 90 Days Past Due	$	12,051	$	11,719
Uninvoiced client financing receivables related to trade accounts receivable that are 91 to 180 Days Past Due	Uninvoiced client financing receivables related to trade accounts receivable that are 91 to 180 Days Past Due	2,893		2,136		Uninvoiced client financing receivables related to trade accounts receivable that are 91 to 180 Days Past Due	644		1,092
Uninvoiced client financing receivables related to trade accounts receivable that are 181 + Days Past Due	Uninvoiced client financing receivables related to trade accounts receivable that are 181 + Days Past Due	3,455		1,972		Uninvoiced client financing receivables related to trade accounts receivable that are 181 + Days Past Due	1,075		2,668
Total uninvoiced client financing receivables balances of clients with a trade accounts receivable	Total uninvoiced client financing receivables balances of clients with a trade accounts receivable	$	22,053	$	22,123	Total uninvoiced client financing receivables balances of clients with a trade accounts receivable	$	13,770	$	15,479
Total uninvoiced client financing receivables of clients with no related trade accounts receivable	Total uninvoiced client financing receivables of clients with no related trade accounts receivable	8,865		8,786		Total uninvoiced client financing receivables of clients with no related trade accounts receivable	6,848		6,335
Total financing receivables with contractual maturities of one year or less	Total financing receivables with contractual maturities of one year or less	2,356		2,361		Total financing receivables with contractual maturities of one year or less	929		1,973
Less: allowance for expected credit losses	Less: allowance for expected credit losses	(3,305)		(2,971)		Less: allowance for expected credit losses	(1,377)		(1,489)
Total financing receivables	Total financing receivables	$	29,969	$	30,299	Total financing receivables	$	20,170	$	22,298

~~12.~~

11. INTANGIBLE ASSETS AND GOODWILL

Our purchased definite-lived intangible assets as of March 31, ~~2020~~2021 and December 31, ~~2019~~2020 are summarized as follows:

(In thousands) Customer Relationships Trademark Developed Technology Total
Gross carrying amount as of December 31, 2018 $ 82,300 $ 10,900 $ 24,100 $ 117,300
Intangible assets acquired for year ended December 31, 2019 2,070 220 5,600 7,890
Accumulated amortization as of December 31, 2019 (26,456) (3,449) (12,175) (42,080)
Net intangible assets as of December 31, 2019 $ 57,914 $ 7,671 $ 17,525 $ 83,110
Gross carrying amount as of March 31, 2020 $ 84,370 $ 11,120 $ 29,700 $ 125,190
Net intangible assets as of December 31, 2019 57,914 7,671 17,525 83,110
Amortization expenses as of March 31, 2020 (1,800) (212) (854) (2,866)
Net intangible assets as of March 31, 2020 $ 56,114 $ 7,459 $ 16,671 $ 80,244
Weighted average remaining years of useful life 9 12 5 9





	March 31, 2021
(In thousands)	Customer Relationships		Trademark		Developed Technology		Total
Gross carrying amount, beginning of period	$	84,370	$	11,120	$	29,700	125,190

Accumulated amortization	(35,346)		(4,509)		(16,703)		(56,558)
Net intangible assets as of March 31, 2021	$	49,024	$	6,611	$	12,997	$	68,632
Weighted average remaining years of useful life	8		12		4		8

	December 31, 2020
(In thousands)	Customer Relationships		Trademark		Developed Technology		Total
Gross carrying amount, beginning of period	$	84,370	$	11,120	$	29,700	$	125,190

Accumulated amortization	(33,612)		(4,297)		(15,592)		(53,501)
Net intangible assets as of December 31, 2020	$	50,758	$	6,823	$	14,108	$	71,689

The following table represents the remaining amortization of definite-lived intangible assets as of March 31, ~~2020:~~2021:


(In thousands)	(In thousands)			(In thousands)
For the year ended December 31,	For the year ended December 31,			For the year ended December 31,
2020		$	8,555
2021	2021	11,003		2021	$	8,974
2022	2022	10,904		2022	11,932
2022		10,904
2023				2023	10,044
2024	2024	9,681		2024	8,510
2025				2025	8,194
Thereafter	Thereafter	29,197		Thereafter	20,978
Total	Total	$	80,244	Total	$	68,632

The following table sets forth the change in the carrying amount of goodwill by segment for the three months ended March 31, ~~2020:~~2021:

(In thousands) Acute Care EHR Post-acute Care EHR TruBridge Total
Balance as of December 31, 2019 $ 97,095 $ 29,570 $ 23,551 $ 150,216
Balance as of March 31, 2020 $ 97,095 $ 29,570 $ 23,551 $ 150,216


(In thousands)	Acute Care EHR		Post-acute Care EHR		TruBridge		Total
Balance as of December 31, 2020	$	97,095	$	29,570	$	23,551	$	150,216


Balance as of March 31, 2021	$	97,095	$	29,570	$	23,551	$	150,216

Goodwill is evaluated for impairment annually on October 1, or more frequently if indicators of impairment are present or changes in circumstances suggest that impairment may exist.

~~13.~~

12. LONG-TERM DEBT

Long-term debt was comprised of the following at March 31, ~~2020~~2021 and December 31, ~~2019:~~2020:

(In thousands) March 31, 2020 December 31, 2019
Term loan facility $ 86,630 $ 88,823
Revolving credit facility 16,000 20,000
Debt obligations 102,630 108,823
Less: unamortized debt issuance costs (875) (960)
Debt obligation, net 101,755 107,863
Less: current portion (8,430) (8,430)
Long-term debt $ 93,325 $ 99,433


(In thousands)	March 31, 2021		December 31, 2020
Term loan facility	$	72,188	$	73,125
Revolving credit facility	0		5,000

Debt obligations	72,188		78,125
Less: unamortized debt issuance costs	(1,235)		(1,308)
Debt obligation, net	70,953		76,817
Less: current portion	(3,457)		(3,457)
Long-term debt	$	67,496	$	73,360

As of March 31, ~~2020,~~2021, the carrying value of debt approximated the fair value due to the variable interest rate, which reflected the market rate.

Credit Agreement

In conjunction with our acquisition of HHI in January 2016, we entered into a syndicated credit agreement with Regions Bank ("Regions") serving as administrative agent, which provided for a $125 million term loan facility and a $50 million revolving credit facility. On ~~February 8, 2018,~~June 16, 2020, we entered into ~~a Third Amendment to the credit agreement~~an Amended and Restated Credit Agreement that increased the aggregate principal amount of our credit facilities ~~from $162 million~~ to ~~$167~~$185 million, which includes a ~~$117~~$75 million term loan facility and a ~~$50~~$110 million revolving credit facility.

Each of our credit facilities continues to bear interest at a rate per annum equal to an applicable margin plus, at our option, either (1) the Adjusted LIBOR rate for the relevant interest period, subject to a floor of 0.50%, (2) an alternate base rate determined by reference to the greater of (a) the prime lending rate of Regions, (b) the federal funds rate for the relevant interest period plus one half of one percent per annum and (c) the one month LIBOR rate, subject to the aforementioned floor, plus 1 percent per annum, or (3) a combination of (1) and (2). The applicable margin range for LIBOR loans and the letter of credit fee ranges from ~~2.0%~~1.8% to ~~3.5%~~3.0%. The applicable margin range for base rate loans ranges from ~~1.0%~~0.8% to ~~2.5%~~2.0%, in each case based on the Company's consolidated net leverage ratio.

Principal payments with respect to the term loan facility are due on the last day of each fiscal quarter beginning ~~December 31, 2017,~~September 30, 2020, with quarterly principal payments of approximately ~~$1.5~~$0.9 million through ~~September~~June 30, ~~2019,~~2022, approximately ~~$2.2~~$1.4 million through ~~September~~June 30, ~~2021~~2024 and approximately ~~$2.9~~$1.9 million through ~~September 30, 2022,~~March 31, 2025, with maturity on ~~October 13, 2022~~June 16, 2025 or such earlier date as the obligations under the ~~credit agreement~~Amended and Restated Credit Agreement become due and payable pursuant to the terms of ~~the credit~~such agreement. Any principal outstanding under the revolving credit facility is due and payable on the maturity date.

Anticipated annual future maturities of the term loan facility and revolving credit facility are as follows as of March 31, ~~2020:~~2021:


(In thousands)	(In thousands)			(In thousands)
2020		$	6,581
2021	2021	9,506		2021	$	2,813
2022	2022	86,543		2022	4,687
2023	2023	—		2023	5,625
2024	2024	—		2024	6,563
2025				2025	52,500
Thereafter	Thereafter	—		Thereafter	0
		$	102,630		$	72,188

intellectual property and the capital stock of certain of the Company’s direct and indirect subsidiaries. Our obligations under the ~~credit agreement~~Amended and Restated Credit Agreement are also guaranteed by the Subsidiary Guarantors.

The ~~credit agreement, as amended by the Third Amendment,~~Amended and Restated Credit Agreement provides incremental facility capacity of $50 million, subject to certain conditions. The ~~credit agreement~~Amended and Restated Credit Agreement includes a number of restrictive covenants that, among other things and in each case subject to certain exceptions and baskets, impose operating and financial restrictions on the Company and the Subsidiary Guarantors, including the ability to incur additional debt; incur liens and encumbrances; make certain restricted payments, including paying dividends on the Company's equity securities or payments to redeem, repurchase or retire the Company's equity securities (which are subject to our compliance, on a pro forma basis to give effect to the restricted payment, with the fixed charge coverage ratio and consolidated net leverage ratio described below); enter into certain restrictive agreements; make investments, loans and acquisitions; merge or consolidate with any other person; dispose of assets; enter into sale and leaseback transactions; engage in transactions with affiliates; and materially alter the business we conduct. The ~~credit agreement~~Amended and Restated Credit Agreement requires the Company to maintain a minimum fixed charge coverage ratio of 1.25:1.00 throughout the duration of such agreement. Under the ~~credit agreement,~~Amended and Restated Credit Agreement, the Company is required to comply with a maximum consolidated net leverage ratio of 3.50:1.00. The ~~credit agreement~~Amended and Restated Credit Agreement also contains customary representations and warranties, affirmative covenants and events of default. We believe that we were in compliance with the covenants contained in ~~the credit~~such agreement as of March 31, ~~2020.~~

2021.

The ~~credit agreement~~Amended and Restated Credit Agreement requires the Company to mandatorily prepay the credit facilities with 50% of excess cash flow (minus certain specified other payments). This mandatory prepayment requirement is applicable only if the Company's consolidated net leverage ratio exceeds 2.50:1.00. The Company is permitted to voluntarily prepay the credit facilities at any time without penalty, subject to customary “breakage” costs with respect to prepayments of LIBOR rate loans made on a day other than the last day of any applicable interest period. ~~The~~An excess cash flow ~~mandatory~~ prepayment ~~requirement under the credit agreement resulted in a $7.0 million prepayment on the term loan facility during the first quarter of 2019~~ related to excess cash flow generated ~~by the Company~~ during ~~2018. An excess cash flow prepayment~~2020 was not required during the first quarter of ~~2020.~~2021.

~~14.~~13. OPERATING LEASES

The Company leases office space in various locations in Alabama, Louisiana, Pennsylvania, Minnesota, Maryland, and Mississippi. These leases have terms expiring from ~~2020~~2021 through 2030 but do contain optional extension terms. Leases with an initial term of 12 months or less are not recorded on the balance sheet; we recognize lease expense for these leases on a straight-line basis over the lease term.

Supplemental balance sheet information related to operating leases was as follows:


(In thousands)	March 31, ~~2020~~ 2021
Operating lease ~~assets:~~assets
Operating lease assets	$	~~7,522~~9,030
Operating lease ~~liabilities:~~liabilities
Other accrued liabilities	$	~~1,572~~1,503
Operating lease liabilities, net of current portion	~~5,950~~7,527
Total operating lease liabilities	$	~~7,522~~9,030
Weighted average remaining lease term in years	76
Weighted average discount rate	~~5.1%~~4.6%

Because our leases do not provide an implicit rate, we use our incremental borrowing rate based on the information available at the lease commencement date in determining the present value of lease payments. We used the incremental borrowing rate on January 1, 2019, for operating leases that commenced prior to that date.

The future minimum lease payments payable under these operating leases subsequent to March 31, ~~2020~~2021 are as follows:


(In thousands)	(In thousands)			(In thousands)
2020		$	1,177
2021	2021	1,518		2021	$	1,503
2022	2022	1,436		2022	1,943
2023	2023	1,363		2023	1,872
2024	2024	980		2024	1,469
2025				2025	1,202
Thereafter	Thereafter	2,383		Thereafter	2,340
Total lease payments	Total lease payments	8,857		Total lease payments	10,329
Less imputed interest	Less imputed interest	(1,335)		Less imputed interest	(1,299)
Total	Total	$	7,522	Total	$	9,030

Total ~~rent~~lease expense for both the three months ended March 31, ~~2020~~2021 and ~~2019~~2020 was $0.4 ~~million and $0.6 million, respectively.~~million.

Total cash paid for amounts included in the measurement of lease liabilities within operating cash flows from operating leases for the three months ended March 31, ~~2020~~2021 was $0.4 million.

~~15.~~14. COMMITMENTS AND CONTINGENCIES

From time to time, the Company is involved in routine litigation that arises in the ordinary course of business. Management does not believe it is reasonably possible that such matters will have a material adverse effect on the Company’s financial statements.

~~16.~~15. FAIR VALUE

FASB Codification topic, Fair Value Measurements and Disclosures, establishes a framework for measuring fair value and expands financial statement disclosures about fair value measurements. Fair value is the price that would be received to sell an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants at the measurement date. The Codification does not require any new fair value measurements, but rather applies to all other accounting pronouncements that require or permit fair value measurements. The Codification requires that assets and liabilities carried at fair value be classified and disclosed in one of the following three categories:

Level 1: Quoted market prices in active markets for identical assets or liabilities.

Level 2: Observable market-based inputs or unobservable inputs that are corroborated by market data.

Level 3: Unobservable inputs that are not corroborated by market data.

As of March 31, ~~2020~~2021 and December 31, ~~2019,~~2020, we did not have any instruments that require fair value measurement.

~~17.~~

16. SEGMENT REPORTING

Our chief operating decision makers ("CODM") utilize 3 operating segments, "Acute Care EHR," "Post-acute Care EHR" and "TruBridge," based on our ~~three~~3 distinct business units with unique market dynamics and opportunities. Revenues and cost of sales are primarily derived from the provision of services and sales of our proprietary software, and our CODM assess the performance of these ~~three~~3 segments at the gross profit level. Operating expenses and items such as interest, income tax, capital expenditures and total assets are managed at a consolidated level and thus are not included in our operating segment disclosures. Our CODM group is comprised of the Chief Executive Officer, Chief Growth Officer, Chief Operating Officer, and Chief Financial Officer. Accounting policies for each of the reportable segments are the same as those used on a consolidated basis.

The following table presents a summary of the revenues and gross profits of our ~~three~~3 operating segments for the three months ended March 31, ~~2020~~2021 and ~~2019:~~2020:


		Three Months Ended March 31,							Three Months Ended March 31,
(In thousands)	(In thousands)	2020		2019		(In thousands)	2021		2020
Revenues:	Revenues:					Revenues:
Acute Care EHR	Acute Care EHR					Acute Care EHR
Recurring revenue	Recurring revenue	$	26,438	$	27,389	Recurring revenue	$	27,210	$	26,438
Non-recurring revenue	Non-recurring revenue	10,077		10,059		Non-recurring revenue	4,680		10,077
Total Acute Care EHR revenue	Total Acute Care EHR revenue	36,515		37,448		Total Acute Care EHR revenue	31,890		36,515
Post-acute Care EHR	Post-acute Care EHR					Post-acute Care EHR
Recurring revenue	Recurring revenue	4,134		4,478		Recurring revenue	4,222		4,134
Non-recurring revenue	Non-recurring revenue	537		1,321		Non-recurring revenue	254		537
Total Post-acute Care EHR revenue	Total Post-acute Care EHR revenue	4,671		5,799		Total Post-acute Care EHR revenue	4,476		4,671
TruBridge	TruBridge	28,571		25,894		TruBridge	31,639		28,571
Total revenues	Total revenues	$	69,757	$	69,141	Total revenues	$	68,005	$	69,757

Cost of sales:	Cost of sales:					Cost of sales:
Acute Care EHR	Acute Care EHR	$	17,259	$	17,066	Acute Care EHR	$	16,212	$	17,259
Post-acute Care EHR	Post-acute Care EHR	1,328		1,271		Post-acute Care EHR	1,164		1,328
TruBridge	TruBridge	15,057		13,689		TruBridge	15,779		15,057
Total cost of sales	Total cost of sales	$	33,644	$	32,026	Total cost of sales	$	33,155	$	33,644

Gross profit:	Gross profit:					Gross profit:
Acute Care EHR	Acute Care EHR	$	19,256	$	20,382	Acute Care EHR	$	15,678	$	19,256
Post-acute Care EHR	Post-acute Care EHR	3,343		4,528		Post-acute Care EHR	3,312		3,343
TruBridge	TruBridge	13,514		12,205		TruBridge	15,860		13,514
Total gross profit	Total gross profit	$	36,113	$	37,115	Total gross profit	$	34,850	$	36,113

Corporate operating expenses	Corporate operating expenses	$	(29,981)	$	(31,067)	Corporate operating expenses	$	(29,936)	$	(29,981)
Other income	Other income	362		248		Other income	814		362

Interest expense	Interest expense	(1,179)		(1,804)		Interest expense	(627)		(1,179)
Income before taxes	Income before taxes	$	5,315	$	4,492	Income before taxes	$	5,101	$	5,315

~~18.~~

17. SUBSEQUENT EVENTS

~~Dividends~~

On ~~May~~April 5, 2021, the Company relocated its principal executive office pursuant to a sublease for 20,093 square feet of office space in downtown Mobile, Alabama, which sublease was signed in February 2021.

18. COVID-19 PANDEMIC

In December 2019, a novel coronavirus disease (“COVID-19”) was reported and in January 2020, the ~~Company announced~~World Health Organization (“WHO”) declared it a ~~dividend for~~Public Health Emergency of International Concern. In February 2020, the ~~second quarter~~WHO raised its assessment of ~~2020~~the COVID-19 threat from high to very high at a global level due to the continued increase in the ~~amount~~number of ~~$0.10 per share, payable on May 29,~~cases and affected countries, and in March 2020, ~~to stockholders of record~~the WHO characterized COVID-19 as a pandemic and the President of the ~~close of business on May 15, 2020.~~United States declared the COVID-19 outbreak a national emergency.

~~COVID-19~~

The COVID-19 pandemic has caused, and is continuing to cause, severe economic, market and other disruptions to the U.S. and global economies. Although the pandemic had a muted impact on our results for the first quarter of 2020, ~~and financial condition as of March 31, 2020,~~ the Company began experiencing increasingly adverse business conditions beginning in the latter half of March ~~and~~2020 through the date of this ~~report.~~report, including our results of operations for the first quarter of 2021. Most notably:

•Travel restrictions and social distancing protocols have created an additional challenge to our on-site implementation and sales teams. Although we have shown success with remote implementation models and our sales representatives are engaging in remote contact with existing customers and prospects, ~~we expect~~ these restrictions and protocols are expected to continue to have an incrementally negative impact on implementation revenues and new sales generation.

•~~Patient~~Although patient volumes at our client hospitals have largely recovered from the severe declines in such volumes experienced ~~a severe decline from historical levels.~~during much of 2020, there can be no guarantee as to the permanence of this recovery. As the overwhelming majority of TruBridge revenues are directly or indirectly correlated with client patient volumes, ~~we expect~~any further reduction in these ~~reduced~~ patient volumes tomay negatively impact our related revenues.

•Although we have experienced no notable disruption to our operating cash flows through the date of this report, we currently expect that the aforementioned limitations on travel and decreased client patient volumes will ultimately result in decreased cash collections from our customers as long as these conditions persist. These decreases in cash collections could be further negatively impacted by the amount and extent to which the pandemic impacts the financial condition and liquidity of our customers.

Despite these adverse business conditions, the pandemic has had a muted impact on our financial condition as of March 31, 2021.

At this time, the Company is uncertain of the potential full magnitude or duration of the business and economic impacts from the unprecedented public health efforts to contain and combat the spread of COVID-19, and while the extent to which the COVID-19 pandemic ~~impacts~~continues to impact the Company’s results will depend on future developments, the outbreak could result in a material impact to the Company’s future financial position, results of operations, cash flows and liquidity.


Item 2.			Management’s Discussion and Analysis of Financial Condition and Results of Operations.

You should read the following discussion and analysis of our financial condition and results of operations together with the unaudited condensed consolidated financial statements and related notes appearing elsewhere herein.

This discussion and analysis contains forward-looking statements within the meaning of the "safe harbor" provisions of the Private Securities Litigation Reform Act of 1995. These forward-looking statements can be identified generally by the use of forward-looking terminology and words such as "expects," "anticipates," "estimates," "believes," "predicts," "intends," "plans," "potential," "may," "continue," "should," "will" and words of comparable meaning. Without limiting the generality of the preceding statement, all statements in this report relating to estimated and projected earnings, margins, costs, expenditures, cash flows, growth rates and future financial results are forward-looking statements. We caution investors that any such forward-looking statements are only predictions and are not guarantees of future performance. Certain risks, uncertainties and other factors may cause actual results to differ materially from those projected in the forward-looking statements. Such factors may include:

Risks Related to Our Industry

•the ~~impact of~~ongoing COVID-19 pandemic and related economic ~~disruptions could materially affect our revenue, gross margin and income, as well as our financial position and/or liquidity;~~disruption;

•saturation of our target market and hospital consolidations;

•~~changes~~unfavorable economic or market conditions that may cause a decline in ~~customer purchasing priorities, capital expenditures and demand~~spending for information technology ~~systems;~~and services;

•~~overall business~~significant legislative and ~~economic conditions affecting~~regulatory uncertainty in the healthcare ~~industry, including the effects of the federal healthcare reform legislation enacted in 2010, and implementing regulations, on the businesses of our hospital customers;~~industry;

•government regulation of our products and services and the healthcare and health insurance industries, including changes in healthcare policy affecting Medicare and Medicaid reimbursement rates and qualifying technological standards;exposure to liability for failure to comply with regulatory requirements;

Risks Related to Our Business

•competition with companies that have greater financial, technical and marketing resources than we have;

•potential future acquisitions that may be expensive, time consuming, and subject to other inherent ~~risks which may jeopardize our ability to realize anticipated benefits;~~risks;

•our ability to attract and retain qualified client service and support personnel;

•~~failure~~disruption from periodic restructuring of our sales force;

•our potential inability to ~~properly~~ manage our growth in the new markets we may enter;

•exposure to numerous and often conflicting laws, regulations, policies, standards or other requirements through our international business ~~activities and processes;~~activities;

•potential litigation against us;

Risks Related to Our Products and Services

•potential failure to develop new ~~technology and~~ products ~~in response to~~or enhance current products that keep pace with market demands;

•~~failure of~~exposure to claims if our products fail to ~~function properly resulting in claims~~provide accurate and timely information for ~~medical and other losses;~~clinical decision-making;

•exposure to claims for breaches of security and viruses in our ~~systems resulting in customer claims against us and harm to our reputation;~~systems;

•~~failure to maintain customer satisfaction through new product releases free of~~ undetected errors or ~~problems;~~problems in new products or enhancements;

•~~failure~~our potential inability to convince customers to migrate to current or future releases of our products;

•failure to maintain our margins and service ~~rates for implementation services;~~rates;

•~~potential~~increase in the percentage of total revenues represented by service revenues, which have lower gross margins;

•exposure to liability in the event we provide inaccurate claims data to payors;

•exposure to liability claims arising out of the licensing of our software and provision of ~~services and our dependency~~services;

•dependence on ~~our~~ licenses of rights, products and services from third parties;

•~~misappropriation of~~a failure to protect our intellectual property ~~rights and potential intellectual property claims and litigation against us;~~rights;

•~~interruptions in our power supply and/~~exposure to significant license fees or ~~telecommunications capabilities, including those caused by natural disaster;~~

•~~general economic conditions, including changes in the financial and credit markets that may affect the availability and cost of credit to us or our customers;~~damages for intellectual property infringement;

•~~our substantial indebtedness, and our ability~~service interruptions resulting from loss of power and/or telecommunications capabilities;

Risks Related to ~~incur additional indebtedness in the future;~~Our Indebtedness

•our potential inability to ~~generate sufficient cash in order~~secure additional financing on favorable terms to meet our ~~debt service obligations;~~future capital needs;

•~~restrictions~~substantial indebtedness that may adversely affect our business operations;

•our ability to incur substantially more debt;

•pressures on cash flow to service our outstanding debt;

•restrictive terms of our credit agreement on our current and future ~~operations because of the terms of our senior secured credit facilities;~~operations;

•
~~market risks related~~

Risks Related to ~~interest rate changes;~~Our Common Stock and Other General Risks

•changes in and interpretations of financial accounting ~~principles generally accepted in~~matters that govern the ~~United States~~measurement of ~~America; and~~our performance;

•~~significant charges to earnings if~~the potential for our goodwill or intangible assets to become impaired; ~~and~~

•quarterly fluctuations in ~~quarterly~~our financial ~~performance~~results due to ~~among other factors, timing~~various factors;

•volatility in our stock price;

•failure to maintain effective internal control over financial reporting;

•lack of ~~customer installations.~~employment or non-competition agreements with most of our key personnel;

•inherent limitations in our internal control over financial reporting;

•vulnerability to significant damage from natural disasters; and

•exposure to market risk related to interest rate changes.

Additional information concerning these and other factors that could cause differences between forward-looking statements and future actual results is discussed under the heading "Risk Factors" in our Annual Report on Form 10-K for the year ended December 31, ~~2019.~~2020.

Background

CPSI is a leading provider of healthcare solutions and services for community hospitals and other healthcare systems and post-acute care facilities. Founded in 1979, CPSI offers its products and services through four companies - Evident, LLC ("Evident"), TruBridge, LLC ("TruBridge"), American HealthTech, Inc. ("AHT"), and iNetXperts, Corp. d/b/a Get Real Health ("Get Real Health"). These combined companies are focused on improving the health of the communities we serve, connecting communities for a better patient care experience, and improving the financial operations of our clients. The individual contributions of each of these companies towards this combined focus are as follows:

•Evident, which makes up our Acute Care EHR reporting segment, provides comprehensive acute care electronic health record ("EHR") solutions, Thrive and Centriq, and related services for community hospitals and their physician clinics.

•AHT, which makes up our Post-acute Care EHR reporting segment, provides a comprehensive post-acute care EHR solution and related services for skilled nursing and assisted living facilities.

•TruBridge, our third reporting segment, focuses on providing business management, consulting, and managed IT services along with its complete revenue cycle management ("RCM") solution for all care settings, regardless of their primary healthcare information solutions provider.

•Get Real Health, included within our TruBridge segment, delivers technology solutions to improve patient outcomes and engagement strategies with care providers.

Our companies currently support ~~approximately~~ ~~800~~ acute care facilities and ~~approximately 3,300~~ post-acute care facilities with a geographically diverse customer mix within the domestic community healthcare market. Our ~~clients primarily consist of~~target market for our acute care solutions includes community hospitals with fewer than 200 acute care ~~beds,~~beds. Our primary focus within this defined target market is on hospitals with ~~hospitals having~~ fewer than 100 beds, ~~comprising~~which comprise approximately 98% of our acute care hospital EHR client base. The target market for our post-acute care solutions consists of approximately 15,500 skilled nursing facilities that are either independently owned or part of a larger management group with multiple facilities. Our target market for our TruBridge services includes community hospitals with fewer than 600 acute care beds.

See Note 1716 to the condensed consolidated financial statements included herein for additional information on our three reportable segments.

Management Overview

Through much of our history, our strategy has been to achieve meaningful long-term revenue growth through sales of healthcare IT systems and related services to existing and new clients within our target market. Prospectively, our ability to continue to realize long-term revenue growth is largely dependent on our ability to sell new and additional products and services to our existing customer base, including cross-selling opportunities presented between our operating segments, Acute Care EHR, Post-acute Care EHR, and TruBridge. Chief among these cross-selling opportunities is the ability to continue to sell TruBridge services into our Acute Care EHR customer base.As a result, retention of existing Acute Care EHR customers is a key component of our long-term growth strategy by protecting this base of potential ~~cross-sell~~TruBridge customers, while at the same time serving as a leading indicator of our market position and stability of revenues and cash flows.

We determine retention rates by reference to the amount of beginning-of-period Acute Care EHR recurring revenues that have been lost due to customer attrition from our production environment customer base.Production environment customers are those that are using our applications to document live patient encounters, as opposed to legacy environment customers that have view-only access to historical patient records. Historically, these retention rates had consistently remained in the mid-to-high

~~Additionally,~~24

90th percentile ranges.However, fiscal years 2017 through 2019 saw retention rates decrease to the low 90th percentile ranges due to, among other factors, (i) post-acquisition customer concerns regarding our long-term commitment to the Centriq platform, acquired in January 2016, (ii) an intensified competitive market, primarily due to aggressive pricing and marketing by a highly disruptive new entrant into the Acute Care EHR marketplace, and (iii) the announced sunset of the Classic platform, also acquired in January 2016.During 2020 and through the first quarter of 2021, retention rates returned to the mid-90th percentile ranges, as (i) the lingering effects of the Centriq acquisition continue to abate, (ii) the competitive environment continues to normalize as the aforementioned disruptive new entrant into this market has since departed the market altogether, and (iii) the Classic platform was sunset in the fourth quarter of 2019, with all related customers having either changed EHR vendors or migrated to one of our EHR solutions.

As we consider the long-term growth prospects of our business, we are seeking to further stabilize our revenues and cash flows and leverage TruBridge services as a growth ~~agent in light of a relatively mature EHR marketplace.~~agent. As a result, we are placing ever-increasing value in further developing our already significant recurring revenue base. As such,

maintaining and growing recurring revenues are ~~additional~~ key components of our long-term growth strategy, aided by the aforementioned focus on customer ~~retention, and~~retention. This includes a renewed focus on driving demand for subscriptions for our existing technology solutions and expanding the footprint for TruBridge services beyond our EHR customer base.

During 2020, we took pause and engaged a top-tier international consulting firm to assess our company-wide growth strategy. The outcome of this eight-week effort was the confirmation of our current strategy of cross-selling TruBridge into the existing EHR base, expanding TruBridge market share with sales to new community and larger health systems, and pursuing competitive EHR takeaway opportunities in the acute and post-acute markets. We may also seek to grow through acquisitions of businesses, technologies or products if we determine that such acquisitions are likely to help us meet our strategic goals.

Our business model is designed such that, as revenue growth materializes, earnings and profitability growth are naturally bolstered through the increased margin realization afforded us by operating leverage. Once a hospital has installed our solutions, we continue to provide support services to the customer on a continuing basis and make available to the customer our broad portfolio of business management, consulting, and managed IT services, all of which contribute to recurring revenue growth. The provision of these recurring revenue services typically requires fewer resources than the initial system installation, resulting in increased overall gross margins and operating margins. We also look to increase margins through cost containment measures where appropriate as we continue to leverage opportunities for greater operating ~~efficiencies of~~efficiencies. However, in the ~~combined entity.~~immediate future, we anticipate incremental margin pressure from the continued client transition from perpetual license arrangements to “Software as a Service” arrangements as described below.

Turbulence in the U.S. and worldwide economies and financial markets impacts almost all industries. While the healthcare industry is not immune to economic cycles, we believe it is more significantly affected by U.S. regulatory and national health initiatives than by the economic cycles of our economy. Additionally, healthcare organizations with a large dependency on Medicare and Medicaid populations, such as community hospitals, have been affected by the challenging financial condition of the federal government and many state governments and government programs. Accordingly, we recognize that prospective hospital clients often do not have the necessary capital to make investments in information technology. Additionally, in response to these challenges, hospitals have become more selective regarding where they invest capital, resulting in a focus on strategic spending that generates a return on their investment. Despite these challenges, we believe healthcare information technology is often viewed as more strategically beneficial to hospitals than other possible purchases because the technology also plays an important role in healthcare by improving safety and efficiency and reducing costs. Additionally, we believe most hospitals recognize that they must invest in healthcare information technology to meet current and future regulatory, compliance and government reimbursement requirements.

In recent years, there have been significant changes to provider reimbursement by the U.S. federal government, followed by commercial payers and state governments. There is increasing pressure on healthcare organizations to reduce costs and increase quality while replacing fee-for-service in part by enrolling in an advanced payment ~~model.~~model that incentivizes high-quality, cost effective-care via value-based reimbursement. This pressure could further encourage adoption of healthcare IT and increase demand for business management, consulting, and managed IT services, as the future success of these healthcare providers is greatly dependent upon their ability to engage patient populations and to coordinate patient care across a multitude of settings, while optimizing operating efficiency along the way.

Much of the variability in our periodic revenues and profitability has been and will continue to be due to changing demand for different license models for our technology solutions, with variability in operating cash flows further impacted by the financing decisions within those license models. Our technology solutions are generally deployed in one of two license models: (1) perpetual licenses, for which the related revenue is recognized effectively upon installation, and (2) “Software as a Service” or “SaaS” arrangements, including our Cloud Electronic Health Record (“Cloud EHR”) offering, which generally result in revenue being recognized monthly as the services are provided over the term of the arrangement.

Although the overwhelming majority of our historical installations have been under a perpetual license model, ~~2019 marked a~~the dramatic shift in customer preferences into a SaaS license model continued in 2020, with ~~43%~~68% of the ~~year’s~~year's new acute care EHR installations being performed in a SaaS model, compared to 43% in 2019 and only 12% in 2018. These SaaS offerings are becoming increasingly attractive to our clients because this configuration allows them to obtain access to advanced software products without a significant initial capital outlay. We expect this trend to continue for the foreseeable future, with the resulting impact on the Company’s financial statements being reduced system sales revenues in the period of installation in exchange for increased recurring periodic revenues (reflected in system sales and support revenues) over the term of the SaaS arrangement. This naturally places downward pressure on short-term revenue growth and profitability metrics, but benefits long-term revenue growth and profitability which, in our view, is consistent with our goal of delivering long-term shareholder value.

For customers electing to purchase our technology solutions under a perpetual license, we have historically made financing arrangements available on a case-by-case basis, depending on the various aspects of the proposed contract and customer attributes. These financing arrangements continue to comprise the majority of our perpetual license installations, and include short-term payment plans and longer-term lease financing through us or third-party financing companies. During 2018, total financing receivables increased dramatically and had a significant impact on operating cash flows. This increase in financing arrangements was primarily due to two reasons. First, meaningful use stage 3 (“MU3”) installations are primarily financed through short-term payment plans and demand for such installations increased significantly in late 2017. Second, competitor financing options, primarily through accounts receivable management collections and Cloud EHR arrangements, have applied pressure to reduce initial customer capital investment requirements for new EHR installations, leading to the offering of long-term lease options. In 2019, we experienced a modest reduction in total financing receivables due to the natural exhaustion of the MU3 opportunity and the aforementioned dramatic shift in license preferences towards SaaS arrangements,

the former of which also resulted in a positive impact to operating cash flows. ~~We expect~~A more substantial reduction in total financing receivables ~~to continue to decrease during~~occurred in 2020 ~~with a corresponding beneficial impact to operating cash flows, as~~and has continued into the ~~trends related to MU3 purchases and SaaS arrangements continue.~~first quarter of 2021.

For those perpetual license clients not seeking a financing arrangement, the payment schedule of the typical contract is structured to provide for a scheduling deposit due at contract signing, with the remainder of the contracted fees due at various stages of the installation process (delivery of hardware, installation of software and commencement of training, and satisfactory completion of a monthly accounting cycle or end-of-month operation by each respective application, as applicable).

~~In May 2019,~~On February 1, 2021, we committed to a reduction in force that resulted in the termination of approximately 1.0% of our workforce (21 employees). The reduction in force is a component of a broader strategic review of the Company's operations that is intended to more effectively align our resources with business priorities. Substantially all of the employees impacted by the reduction in force exited the Company ~~closed its acquisition~~in the first quarter of ~~Get Real Health. Based~~2021. The Company estimates that it will incur expenses of approximately $2.7 million related to the reduction in ~~Rockville, Maryland, Get Real Health delivers technology solutions~~force, of which approximately $2.1 million was incurred in the first quarter of 2021, with the remaining expenses to ~~improve patient outcomes~~be incurred during the remainder of 2021. These expenses consist of one-time termination benefits to the affected employees, including but not limited to severance payments, healthcare benefits, and ~~engagement strategies with care providers. Through this acquisition,~~payments for accrued vacation time. The Company expects to pay for the expenses from cash flow from operations and does not expect to incur any debt. After the reduction in force is fully implemented, the Company ~~strengthened its position~~expects to realize approximately $3.9 million in ~~community healthcare by offering three new comprehensive patient engagement and empowerment solutions that are offered by Get Real Health.~~annual savings compared to prior expense levels.

COVID-19

The continuing impacts of COVID-19 and related economic conditions on the Company’s results are highly uncertain and outside the Company’s control. The scope, duration and magnitude of the direct and indirect effects of COVID-19 ~~are evolving rapidly~~continue to evolve in ways that are difficult or impossible to anticipate. In addition, because COVID-19 did not begin to affect the Company’s financial results until late in the first quarter of 2020, its impact on the Company’s results in the first quarter of 2020 is not indicative of its impact on the Company’s results for the remainder of 2020. For additional information on the risks posed by COVID-19, see “The impact of COVID-19 and related economic disruptions could materially affect our revenue, gross margin and income, as well as our financial position and/or liquidity" included in “Part II-Item 1A-Risks Factors” in this Quarterly Report on Form 10-Q.

As a result of COVID-19, community hospital patient volume in the United States and other countries around the world have rapidly deteriorated. ~~The~~Although recent operational metrics indicate promising signs that these patient volumes are improving, the persistence of the pandemic and the unprecedented nature of the resulting challenges it has imposed on national and global healthcare and economic systems are likely to continue to negatively impact patient volumes and make uncertain the exact path to recovery for community hospitals. These decreased levels of our hospital clients' patient volumes have negatively impacted, and will continue to negatively impact, our revenues, gross margins, and income for our TruBridge service offerings. ~~We also expect that~~Additionally, new EHR system installations have been, and will continue to be, negatively impacted by restrictive travel and social distancing protocols. The Company began to experience this impact in March 2020, ~~and expects it to persist and be more significant~~which increased in significance during the second quarter of 2020. Gradual signs of improvements started in the ~~second~~third quarter of 2020 and ~~third quarters~~have continued through the fourth quarter of ~~2020.~~2020 and the first quarter of 2021. The Company expects these impacts to continue for the ~~remainder of 2020 and beyond,~~forseeable future, but the degree of the impact will depend on the ability of our community hospital clients to return to normal

operations and patient volume. We believe that COVID-19 has impacted, and will continue to impact, our business results in the following additional areas:

•Bookings – A decline in new business and add-on bookings as certain client purchasing decisions and projects are delayed to focus on treating patients, procuring necessary medical supplies, and managing their organization through this crisis. This decline in bookings ~~flow through to~~eventually results in reduced backlog and lower subsequent revenue.

•TruBridge Revenues - Decreased levels of patient volume within our community hospital client base will negatively impact our revenues for our TruBridge service offerings as the overwhelming majority of TruBridge revenues are directly or indirectly correlated with client patient volumes. This decline in revenues will have a negative impact on gross margins and income.

•Associate productivity – A decline in associate productivity, primarily for our implementation personnel, as a large amount of work is typically done at client sites, which is being impacted by travel restrictions and our clients’ focus on the pandemic. Our clients’ focus on the pandemic has also led to pauses on existing projects and postponed start dates for others, which translates into lower implementation revenues, gross margin and income. We are mitigating this by doing more work remotely than we have in the past, but we cannot fully offset the negative impact.

•Travel – Associate travel restrictions reduce client-related travel, which reduces reimbursed travel revenues and lowers our costs of sales as a percent of revenues. Such restrictions also reduce non-reimbursable travel, which lowers operating expenses.

•Cash collections – A delay in client cash collections due to COVID-19’s impact on national reimbursement processes, and client focus on managing their own organizations’ liquidity during this time, could impact our cash collections. The federal government has allocated unprecedented resources specifically designed to assist healthcare providers with their operating and capital needs during the pandemic, allocating a total of $175 billion through the Coronavirus Aid,

Relief, and Economic Security (CARES) Act Provider Relief Fund. Further, $10 billion has been specifically targeted for rural providers, which is of particular interest to our client base, which is comprised mostly of non-urban community hospitals. Of this $10 billion, the average rural hospital iswas expected to receive a total of approximately $3.6 million in direct financial relief. While these funds certainly help mitigate the financial pressures our clients face, the clinical and operational challenges remain immense and are likely to cause certain of our customers to more aggressively manage cash resources in order to preserve liquidity, resulting in uncharacteristic aging of our trade accounts receivable. ~~This~~Additionally, the aforementioned decrease in community hospital patient volumes has had, and will continue to have, a negative impact on TruBridge billings for services and resulting revenues. These factors would translate to lower cash flows from operating activities. Lower cash flows from operating activities may impact how we execute under our capital allocation strategy and may adversely affect our financial condition.

Results of Operations

During the three months ended March 31, ~~2020,~~2021, we generated revenues of ~~$69.8~~$68.0 million from the sale of our products and services, compared to ~~$69.1~~$69.8 million million during the three months ended March 31, ~~2019, an increase~~2020, a decrease of 1%3% that is primarily attributed to ~~continued TruBridge~~decreased non-recurring revenues from our Acute Care EHR segment due to the aforementioned shift in customer preference towards SaaS arrangements and the impact of COVID-19 on client ~~growth. We view sales of TruBridge solutions within our existing EHR client base as our leading performance indicator.~~purchasing and implementation plans. Our net income for the three months ended March 31, ~~2020~~2021, increased by ~~$0.6~~$0.1 million to $4.1 million from the three months ended March 31, ~~2019,~~2020, primarily as the aforementioned revenue declines have been offset by corresponding decreases in operating expenses, costs of ~~result of~~sales, and tax expense, as well as decreased interest expense arising from our long-term debt ~~interest.~~obligations. Net cash provided by operating activities ~~decreased slightly~~increased by ~~$0.3~~$6.1 million, ~~during the three months ended March 31, 2019 to~~from $7.6 million during the three months ended March 31, 2020 to $13.7 million during the three months ended March 30, 2021, primarily due to cash advantageous changes in working capital.

The following table sets forth certain items included in our results of operations for the three months ended March 31, ~~2020~~2021 and ~~2019,~~2020, expressed as a percentage of our total revenues for these periods:


		Three Months Ended March 31,															Three Months Ended March 31,
		2020						2019							2021				2020
(In thousands)	(In thousands)	Amount		% Sales		Amount		% Sales		(In thousands)	Amount		% Sales		Amount		% Sales
INCOME DATA:	INCOME DATA:									INCOME DATA:
Sales revenues:	Sales revenues:									Sales revenues:
System sales and support:	System sales and support:									System sales and support:
Acute Care EHR	Acute Care EHR	$	36,515	52.3	%	$	37,448	54.2	%	Acute Care EHR	$	31,890	46.9	%	$	36,515	52.3	%
Post-acute Care EHR	Post-acute Care EHR	4,671		6.7	%	5,799		8.4	%	Post-acute Care EHR	4,476		6.6	%	4,671		6.7	%
Total System sales and support	Total System sales and support	41,186		59.0	%	43,247		62.5	%	Total System sales and support	36,366		53.5	%	41,186		59.0	%
TruBridge	TruBridge	28,571		41.0	%	25,894		37.5	%	TruBridge	31,639		46.5	%	28,571		41.0	%
Total sales revenues	Total sales revenues	69,757		100.0	%	69,141		100.0	%	Total sales revenues	68,005		100.0	%	69,757		100.0	%
Costs of sales:	Costs of sales:									Costs of sales:
System sales and support:	System sales and support:									System sales and support:
Acute Care EHR	Acute Care EHR	17,259		24.7	%	17,066		24.7	%	Acute Care EHR	16,212		23.8	%	17,259		24.7	%
Post-acute Care EHR	Post-acute Care EHR	1,328		1.9	%	1,271		1.8	%	Post-acute Care EHR	1,164		1.7	%	1,328		1.9	%
Total System sales and support	Total System sales and support	18,587		26.6	%	18,337		26.5	%	Total System sales and support	17,376		25.6	%	18,587		26.6	%
TruBridge	TruBridge	15,057		21.6	%	13,689		19.8	%	TruBridge	15,779		23.2	%	15,057		21.6	%
Total costs of sales	Total costs of sales	33,644		48.2	%	32,026		46.3	%	Total costs of sales	33,155		48.8	%	33,644		48.2	%
Gross profit	Gross profit	36,113		51.8	%	37,115		53.7	%	Gross profit	34,850		51.2	%	36,113		51.8	%
Operating expenses:	Operating expenses:									Operating expenses:
Product development	Product development	8,271		11.9	%	9,228		13.3	%	Product development	8,429		12.4	%	8,271		11.9	%
Sales and marketing	Sales and marketing	6,997		10.0	%	7,492		10.8	%	Sales and marketing	5,301		7.8	%	6,997		10.0	%
General and administrative	General and administrative	11,847		17.0	%	11,824		17.1	%	General and administrative	13,149		19.3	%	11,847		17.0	%
Amortization of acquisition-related intangibles	Amortization of acquisition-related intangibles	2,866		4.1	%	2,523		3.6	%	Amortization of acquisition-related intangibles	3,057		4.5	%	2,866		4.1	%
Total operating expenses	Total operating expenses	29,981		43.0	%	31,067		44.9	%	Total operating expenses	29,936		44.0	%	29,981		43.0	%
Operating income	Operating income	6,132		8.8	%	6,048		8.7	%	Operating income	4,914		7.2	%	6,132		8.8	%
Other income (expense):	Other income (expense):									Other income (expense):
Other income	Other income	362		0.5	%	248		0.4	%	Other income	814		1.2	%	362		0.5	%

Interest expense	Interest expense	(1,179)		(1.7)	%	(1,804)		(2.6)	%	Interest expense	(627)		(0.9)	%	(1,179)		(1.7)	%
Total other income (expense)	Total other income (expense)	(817)		(1.2)	%	(1,556)		(2.3)	%	Total other income (expense)	187		0.3	%	(817)		(1.2)	%
Income before taxes	Income before taxes	5,315		7.6	%	4,492		6.5	%	Income before taxes	5,101		7.5	%	5,315		7.6	%
Provision for income taxes	Provision for income taxes	1,225		1.8	%	1,048		1.5	%	Provision for income taxes	957		1.4	%	1,225		1.8	%
Net income	Net income	$	4,090	5.9	%	$	3,444	5.0	%	Net income	$	4,144	6.1	%	$	4,090	5.9	%

Three Months Ended March 31, ~~2020~~2021 Compared with Three Months Ended March 31, ~~2019~~2020

~~Revenues.~~ Revenues

Total revenues for the three months ended March 31, ~~2020 increased~~2021 decreased by ~~$0.6~~$1.8 million, or 1%approximately 3%, compared to the three months ended March 31, ~~2019.~~2020.

System sales and support revenues decreased by ~~$2.1~~$4.8 million, or 5%12%, compared to the first quarter of ~~2019.~~2020. System sales and support revenues were comprised of the following during the respective periods:


		Three Months Ended March 31,							Three Months Ended March 31,
(In thousands)	(In thousands)	2020		2019		(In thousands)	2021		2020
Recurring system sales and support revenues⁽¹⁾	Recurring system sales and support revenues⁽¹⁾					Recurring system sales and support revenues (1)
Acute Care EHR	Acute Care EHR	$	26,438	$	27,389	Acute Care EHR	$	27,210	$	26,438
Post-acute Care EHR	Post-acute Care EHR	4,134		4,478		Post-acute Care EHR	4,222		4,134
Total recurring system sales and support revenues	Total recurring system sales and support revenues	30,572		31,867		Total recurring system sales and support revenues	31,432		30,572
Non-recurring system sales and support revenues ⁽²⁾	Non-recurring system sales and support revenues ⁽²⁾					Non-recurring system sales and support revenues (2)
Acute Care EHR	Acute Care EHR	10,077		10,059		Acute Care EHR	4,680		10,077
Post-acute Care EHR	Post-acute Care EHR	537		1,321		Post-acute Care EHR	254		537
Total non-recurring system sales and support revenues	Total non-recurring system sales and support revenues	10,614		11,380		Total non-recurring system sales and support revenues	4,934		10,614
Total system sales and support revenue	Total system sales and support revenue	$	41,186	$	43,247	Total system sales and support revenue	$	36,366	$	41,186

⁽¹⁾ Mostly comprised of support and maintenance, third-party subscriptions, and SaaS revenues.	⁽¹⁾ Mostly comprised of support and maintenance, third-party subscriptions, and SaaS revenues.									(1) Mostly comprised of support and maintenance, third-party subscriptions, and SaaS revenues.

⁽²⁾ Mostly comprised of installation revenues from the sale of our acute care and post-acute care EHR solutions and related applications under a perpetual (non-subscription) licensing model.	⁽²⁾ Mostly comprised of installation revenues from the sale of our acute care and post-acute care EHR solutions and related applications under a perpetual (non-subscription) licensing model.									(2) Mostly comprised of installation revenues from the sale of our acute care and post-acute care EHR solutions and related applications under a perpetual (non-subscription) licensing model.

Recurring system sales and support revenues ~~decreased~~increased by ~~$1.3~~$0.9 million, or 4%3%, compared to the first quarter of ~~2019.~~2020. Acute Care EHR recurring revenues ~~decreased~~increased by ~~$1.0~~$0.8 million, or 3%, as attrition from the Thrive and Centriq customer base ~~outweighed new Thrive~~has normalized to more historical levels and our SaaS customer ~~growth and additional support fees.~~base has continued to grow, strengthening recurring revenues. Post-acute Care EHR recurring revenues ~~decreased~~increased by ~~$0.3~~$0.1 million, or 8%2%, ~~due to~~as attrition ~~attributed to an aggressive competitive environment~~has stabilized as we continue to make technological improvements to the AHT product line.

Non-recurring system sales and support revenues decreased by ~~$0.8~~$5.7 million, or ~~7%.~~54%, compared to the first quarter of 2020. Acute Care EHR non-recurring revenues ~~were relatively flat.~~ decreased by $5.4 million, or 54%. We installed our Acute Care EHR solutions at ~~nine~~five new hospital clients during the first quarter of ~~2020 (eight~~2021 (two of which were under a SaaS arrangement, resulting in revenue being recognized ratably over the contract term) compared to ~~five~~nine new hospital clients during the first quarter of ~~2019 (one~~2020 (eight under a SaaS arrangement). ~~Acute Care EHR revenues from~~Despite this increase in non-SaaS new ~~system~~customer implementations, ~~increased by $3.0 million, but were primarily offset by a $2.4 million decrease in MU3 installation revenue as~~ the ~~2019 year-end deadline for compliance has passed. In addition, other add-on sales and~~related non-recurring ~~revenue decreased by $0.6 million.~~ ~~Non-recurring Post-acute Care EHR~~ revenues decreased ~~by $0.8 million, or 59%, in~~as the first quarter of 2020 ~~as installation bookings have weakened as we continue our ongoing product releases~~benefited from a high volume of late-installing applications for non-SaaS implementations that went live in prior periods. Comparatively, the continued shift in customer preference towards SaaS arrangements and ~~efforts to make technological improvements to~~ the ~~AHT product line.~~continuing impacts of COVID-19 on client purchasing and implementation plans has decreased the opportunities for such follow-on revenue activities for recent implementations.

TruBridge revenues increased by ~~10%,~~$3.1 million, or ~~$2.7 million,~~11%, compared to the first quarter of ~~2019.~~2020. Our hospital clients operate in an environment typified by rising costs and increased complexity and are increasingly seeking to alleviate themselves of the ever-increasing administrative burden of operating their own business office functions. Most notably, an expanded customer base for our accounts receivable management services resulted in a revenue increase of ~~$1.1~~$1.9 million, or 18%. Additionally, revenue from our insurance services division increased by $0.8 million, or 10%, and revenue from medical coding services increased by $0.3 million, or 12%. Additionally, continued increasing demand for hosting services resulted in an increase of $0.3 million, or 11%, in our IT management services revenues. Get Real Health, which was acquired during the second quarter of 2019, contributed $1.3 million to TruBridge revenue during the first quarter of 2020.

Costs of Sales.

Total costs of sales ~~increased~~decreased by ~~5%,~~$0.5 million, or ~~$1.6 million,~~1%, compared to the first quarter of ~~2019.~~2020. As a percentage of total revenues, costs of sales ~~were~~increased slightly to 49% of revenues in the first quarter of 2021 compared to 48% of revenues in the first quarter of 2020, ~~compared to 46%~~as the decrease in revenue outpaced the decrease in costs of ~~revenues in the first quarter of 2019.~~sales.

Costs of Acute Care EHR system sales and support ~~increased~~decreased by ~~$0.2~~$1.0 million, or 1%6%, compared to the first quarter of ~~2019,~~2020, primarily due to ~~increases~~travel costs savings of ~~$0.4~~approximately $0.9 million ~~in third-party software costs and $0.5 million in travel and other costs~~ due to ~~increased installation activity. These increases were partially offset by a decrease~~the impact of ~~$0.3 million in payroll and $0.4 million in hardware costs. Gross~~COVID-19 on associate travel. The gross margin on Acute Care EHR system sales and support decreased to 49% in the first quarter of 2021, compared to 53% in the first quarter of 2020 ~~compared to 54%~~as the aforementioned decrease in non-recurring revenues outpaced the ~~first quarter~~related decrease in cost of ~~2019.~~sales.

Costs of Post-acute Care EHR system sales and support ~~increased~~decreased by ~~$0.1~~$0.2 million, or 4%12%, compared to the first quarter of ~~2019, as we had incremental increases in payroll~~2020, primarily due to reduced third party software costs combined with reduced hardware costs and ~~hardware.~~improved personnel efficiency. The gross margin on Post-acute Care EHR system sales and support ~~decreased~~increased to 74% in the first quarter of 2021, compared to 72% in the first quarter of 2020, ~~compared~~as growth in recurring revenues worked in tandem with cost efficiencies to ~~78% in the first quarter of 2019.~~

increase margins.

Our costs associated with TruBridge sales and support increased by ~~10%,~~$0.7 million, or ~~$1.4 million,~~5%, compared to the first quarter of ~~2019. The primary driver was~~2020, primarily due to a ~~payroll~~$0.5 million, or 97%, increase ~~of $1.1 million as demand for our ARMs service increases. Get Real Health, acquired~~ in temporary labor costs necessary to support the ~~second quarter of 2019, contributed $0.3 million in TruBridge costs of sales during the first quarter of 2020.~~growing revenue base. The gross margin on these services ~~remained flat at 47%~~increased to 50% in the first quarter of 2021, compared to 47% during the first quarter of 2020, ~~and 2019.~~as the growing recurring revenue base worked in tandem with operational efficiencies to increase margins.

Product ~~Development.~~ Development

Product development expenses consist primarily of compensation and other employee-related costs (including stock-based compensation) and infrastructure costs incurred, but not capitalized, for new product development and product enhancements. Product development costs ~~decreased~~increased by ~~$1.0~~$0.2 million, or ~~10%~~2%, compared to the first quarter of ~~2019, primarily due to~~2020, with the primary driver being a ~~decrease~~$0.3 million, or 4%, increase in payroll ~~of $0.5 million, with an additional $0.9 million of payroll capitalized for software development. Get Real Health contributed $0.6 million in expenses during the first quarter of 2020.~~costs resulting primarily from annual compensation adjustments.

Sales and ~~Marketing.~~Marketing

Sales and marketing ~~expenses~~costs decreased by ~~7%,~~$1.7 million, or ~~$0.5 million,~~24%, compared to the first quarter of ~~2019, primarily due to decreases~~2020. The aforementioned reduction-in-force combined with reduced revenues resulted in payroll ~~costs~~and commission expenses decreasing a combined $1.0 million, while travel restrictions related to COVID-19 resulted in a $0.3 million decrease in travel costs. Finally, stock compensation expense decreased by $0.4 million, due mostly to lowered expectations regarding eventual achievement of ~~$0.1 million, travel costs of $0.2 million, and general marketing spend of $0.2 million. Get Real Health contributed $0.1 million in sales and marketing costs during the first quarter of 2020.~~targets associated with our long-term performance share awards.

General and ~~Administrative.~~Administrative

General and administrative expenses ~~remained flat~~increased by $1.3 million, or 11% , compared to the first quarter of ~~2019. Most notably, we saw a $1.0~~2020, mostly due to $2.1 million ~~decrease~~ in ~~non-recurring transaction-related~~reduction-in-force-related severance costs ~~resulting from the the GRH acquisition and other strategic initiatives which we incurred during~~in the first quarter of ~~2019. These costs were primarily offset by~~2021 combined with an increase of ~~$0.7~~$0.5 million in costs associated with health benefits offered to our employees through our self-insured health plans. These increases were partially offset by decreases in employee ~~health costs, along with $0.4 million contributed by Get Real Health in general~~retirement plan, legal and ~~administrative costs during the first quarter of 2020.~~accounting, and stock-based compensation expenses.

Amortization of Acquisition-Related ~~Intangibles.~~ Intangibles

Amortization expense associated with acquisition-related intangible assets increased by ~~$0.3~~$0.2 million, or 7%, compared to the first quarter of ~~2019,~~2020, due to changes in estimates regarding the ~~inclusion~~remaining useful lives of ~~Get Real Health intangibles.~~certain of our acquired intangible assets.

Total Operating ~~Expenses.~~ Expenses

Total operating expenses remained flat at $30.0 million for the first quarter of 2021 and the first quarter of 2020. As a percentage of total revenues, total operating expenses ~~decreased~~increased to ~~43%~~44% of revenues in the first quarter of ~~2020,~~2021, compared to ~~45%~~43% in the first quarter of ~~2019.~~2020.

Total Other Income (Expense).

Total other income (expense) ~~decreased from expense~~improved to income of ~~$1.6~~$0.2 million during the first quarter of ~~2019~~2021 compared to expense of $0.8 million during the first quarter of ~~2020, primarily as~~2020. The combined effects of a decreasing interest rate environment and lowered amounts outstanding under our long-term debt ~~and accompanying~~facilities resulted in a $0.6 million decrease in related interest ~~rate have both decreased from the first quarter of 2019.~~expense.

Income Before ~~Taxes.~~ Taxes

As a result of the foregoing factors, income before taxes ~~increased~~decreased by ~~$0.8~~$0.2 million, compared to the first quarter of ~~2019.~~2020.

Provision for Income ~~Taxes.~~ Taxes

Net Income.

Net income for the three months ended March 31, ~~2020~~2021 increased by ~~$0.6~~less than $0.1 million to $4.1 million, or ~~$0.28~~$0.29 per basic and $0.28 per diluted share, compared with net income of ~~$3.4~~$4.1 million, or ~~$0.24~~$0.28 per basic and diluted share, for the three months ended March 31, ~~2019.~~2020. Net income represented 6% of revenue for both the three months ended March 31, ~~2020, compared to 5% of revenue for~~2021 and the three months ended March 31, ~~2019.~~2020.

Liquidity and Capital Resources

The Company’s liquidity and capital resources were not materially impacted by COVID-19 and related economic conditions during the ~~first quarter of 2020.~~three months ended March 31, 2021. For further discussion regarding the potential future impacts of COVID-19 and related economic conditions on the Company’s liquidity and capital resources, see “COVID-19” in this Management's Discussion and Analysis of Financial Condition and Results of Operations and ~~“Part II-Item 1A-Risk~~Part I, "Item 1A. Risk Factors” ~~below.~~in our Annual Report on Form 10-K for the year ended December 31, 2020.

Sources of Liquidity

As of March 31, ~~2020,~~2021, our principal sources of liquidity consisted of cash and cash equivalents of ~~$4.3~~$18.0 million and our remaining borrowing capacity under the revolving credit facility of ~~$34.0~~$110.0 million, compared to ~~$7.4~~$12.7 million of cash and cash equivalents and ~~$30.0~~$105.0 million of remaining borrowing capacity under the revolving credit facility as of December 31, ~~2019.~~2020. In conjunction with our acquisition of HHI in January 2016, we entered into ~~the~~a syndicated credit agreement which provided for a $125 million term loan facility and a $50 million revolving credit facility. On ~~February 8, 2018, the Company~~June 16, 2020, we entered into ~~the Third Amendment to the credit agreement to increase~~an Amended and Restated Credit Agreement that increased the aggregate principal amount of ~~the~~our credit facilities ~~from $162 million~~ to ~~$167~~$185 million, which includes a ~~$117~~$75 million term loan facility and a ~~$50~~$110 million revolving credit facility.

As of March 31, ~~2020,~~2021, we had ~~$102.6~~$72.2 million in principal amount of indebtedness outstanding under the credit facilities. We believe that our cash and cash equivalents of ~~$4.3~~$18.0 million as of March 31, ~~2020,~~2021, the future operating cash flows of the combined entity, and our remaining borrowing capacity under the revolving credit facility of ~~$34.0~~$110.0 million as of March 31,

~~2020,~~ 2021, taken together, provide adequate resources to fund ongoing cash requirements for the next twelve months. We cannot provide assurance that our actual cash requirements will not be greater than we expect as of the date of filing of this Form 10-Q. If sources of liquidity are not available or if we cannot generate sufficient cash flow from operations during the next twelve months, we may be required to obtain additional sources of funds through additional operational improvements, capital market transactions, asset sales or financing from third parties, a combination thereof or otherwise. We cannot provide assurance that these additional sources of funds will be available or, if available, would have reasonable terms.

Operating Cash Flow Activities

Net cash provided by operating activities ~~decreased~~increased by ~~$0.3~~$6.1 million from ~~$7.9 million provided by operations for the three months ended March 31, 2019 to~~ $7.6 million provided by operations for the three months ended March 31, ~~2020.~~2020 to $13.7 million provided by operations for the three months ended March 31, 2021. The ~~decrease~~increase in cash flows provided ~~from~~by operations is primarily due to advantageous changes in working capital, ~~partially offset by greater net income during the first three months of 2020. Working capital~~which was a net use of cash during the first three months of ~~2019~~2020 in the amount of ~~$3.0~~$4.3 million, compared to a net ~~use~~inflow of cash during the first three months of ~~2020~~2021 in the amount of ~~$4.3~~$2.8 million.

Investing Cash Flow Activities

Net cash used in investing activities ~~increased~~decreased by ~~$2.6~~$1.7 million, with ~~$3.0~~$1.4 million used in the three months ended March 31, ~~2020~~2021 compared to ~~$0.5~~$3.0 million used during the three months ended March 31, ~~2019. The~~2020. Cash outflows for purchases of property and equipment decreased from $2.1 million in the first three months of 2020 ~~included $0.9~~to $0.5 million ~~in capitalized software development costs compared to none~~ during the first three months of ~~2019.We do not anticipate~~2021. The decrease is mostly due to the ~~need for significant~~addition of a West Coast data center to enhance our remote hosting capabilities in 2020 without similar capital expenditures during the ~~remainder~~first three months of ~~2020.~~2021.

Financing Cash Flow Activities

During the three months ended March 31, ~~2020,~~2021, our financing activities used net cash of ~~$7.6~~$7.0 million, as we paid a net ~~$6.2~~$5.9 million in long-term debt principal and ~~declared and paid dividends in the amount~~used $1.1 million to repurchase shares of $1.4 million. During the three months ended March 31, 2019, we made a $7.0 million prepayment on the term loan facility in accordance with the excess cash flow mandatory prepayment requirements of the credit agreement.our common stock, which are treated as treasury stock. Financing cash flow activities used ~~$8.7~~$7.6 million during the three months ended March 31, ~~2019,~~2020, primarily due to ~~$7.1~~$6.2 million net paid in long-term debt principal and $1.4 million cash paid in dividends.

~~We believe that paying dividends is an effective way~~On September 4, 2020, our Board of ~~providing an investment return~~Directors approved a stock repurchase program to ~~our stockholders and~~repurchase up to $30 million in aggregate amount of the Company's outstanding shares of common stock through open market purchases, privately-negotiated transactions, or otherwise in compliance with Rule 10b-18 under the Securities Exchange Act of 1934, as amended. These shares may be purchased from time to time over a ~~beneficial use of our cash. However, the declaration of dividends by CPSI~~two-year period depending upon market conditions. Our ability to repurchase shares is subject to compliance with the terms of our Amended and Restated Credit ~~Agreement and~~Agreement. Concurrent with the ~~discretion~~authorization of our Board of Directors, which may decide to change or terminate the Company's dividend policy at any time. Our Board of Directors will continue to take into account such matters as general business conditions, capital needs, our financial results and other such factorsthis stock repurchase program, the Board of Directors ~~may deem relevant.~~opted to indefinitely suspend all quarterly dividends.

Credit Agreement

As of March 31, ~~2020,~~2021, we had ~~$86.6~~$72.2 million in principal amount outstanding under the term loan facility and ~~$16.0 million in~~no principal amount outstanding under the revolving credit facility. Each of ~~the~~our credit facilities continues to bear interest at a rate per annum equal to an applicable margin plus, at our option, either (1) the Adjusted LIBOR rate for the relevant interest period, subject to a floor of 0.50%, (2) an alternate base rate determined by reference to the greater of (a) the prime lending rate of Regions, (b) the federal funds rate for the relevant interest period plus one half of one percent per annum and (c) the one month LIBOR rate, subject to the aforementioned floor, plus one percent per annum, or (3) a combination of (1) and (2). The applicable margin range for LIBOR loans and the letter of credit fee ranges from ~~2.0%~~1.8% to ~~3.5%~~3.0%. The applicable margin range for base rate loans ranges from ~~1.0%~~0.8% to ~~2.5%~~2.0%, in each case based on the Company's consolidated net leverage ratio.

Our credit facilities are secured pursuant to aan Amended and Restated Pledge and Security Agreement, dated ~~January 8, 2016,~~June 16, 2020, among the parties identified as obligors therein and Regions, as collateral agent, on a first priority basis by a security interest in substantially all of the tangible and intangible assets (subject to certain exceptions) of the Company and certain subsidiaries of the Company, as guarantors (collectively, the “Subsidiary Guarantors”), including certain registered intellectual property and the capital stock of certain of the Company’s direct and indirect subsidiaries. Our obligations under the ~~credit agreement~~Amended and Restated Credit Agreement are also guaranteed by the Subsidiary Guarantors.

Backlog

Backlog consists of revenues we reasonably expect to recognize over the next twelve months under all existing contracts, including those with remaining performance obligations that have original expected durations of one year or less and those with fees that are variable in which we estimate future revenues. The revenues to be recognized may relate to a combination of one-time fees for system sales and recurring fees for support and maintenance and TruBridge services. As of March 31, 2021, we had a twelve-month backlog of approximately $9 million in connection with non-recurring system purchases and approximately $249 million in connection with recurring payments under support and maintenance, Cloud EHR contracts, and TruBridge services. As of March 31, 2020, we had a twelve-month backlog of approximately $12 million in connection with non-recurring system purchases and approximately $234 million in connection with recurring payments under support and maintenance ~~Cloud EHR contracts,~~ and TruBridge services. As of March 31, 2019, we had a twelve-month backlog of approximately $17 million in connection with non-recurring system purchases and approximately $227 million in connection with recurring payments under support and maintenance and TruBridge services.

Bookings

Bookings is a key operational metric used by management to assess the relative success of our sales generation efforts, and were as follows for the three months ended March 31, ~~2020~~2021 and ~~2019:~~2020:


		Three Months Ended March 31,							Three Months Ended March 31,
(In thousands)	(In thousands)	2020		2019		(In thousands)	2021		2020
System sales and support ⁽¹⁾	System sales and support ⁽¹⁾					System sales and support (1)
Acute Care EHR	Acute Care EHR	$	8,919	$	8,285	Acute Care EHR	$	5,442	$	8,919
Post-acute Care EHR	Post-acute Care EHR	913		1,431		Post-acute Care EHR	648		913
Total system sales and support	Total system sales and support	9,832		9,716		Total system sales and support	6,090		9,832

TruBridge⁽²⁾	TruBridge⁽²⁾	9,511		4,228		TruBridge (2)	2,687		9,511

Total bookings	Total bookings	$	19,343	$	13,944	Total bookings	$	8,777	$	19,343

⁽¹⁾ Generally calculated as the total contract price (for system sales) and annualized contract value (for support).	⁽¹⁾ Generally calculated as the total contract price (for system sales) and annualized contract value (for support).									(1) Generally calculated as the total contract price (for system sales) and annualized contract value (for support).
⁽²⁾ Generally calculated as the total contract price (for non-recurring, project-related amounts) and annualized contract value (for recurring amounts).	⁽²⁾ Generally calculated as the total contract price (for non-recurring, project-related amounts) and annualized contract value (for recurring amounts).									(2) Generally calculated as the total contract price (for non-recurring, project-related amounts) and annualized contract value (for recurring amounts).

~~Acute Care EHR bookings in the first quarter~~Bookings for each of ~~2020 increased by $0.6 million, or 8%, over the first quarter of 2019, mostly propelled by increased demand for new EHR installations. Acute Care EHR new installation bookings increased $2.2~~

~~million compared to the first three months of 2019. This increase was partially offset by a $0.5 million decrease in MU3 related add-on sales and a $1.1 million decrease in other EHR add-on sales~~our operating segments experienced significant decreases compared to the first quarter of ~~2019.~~

2020, with Acute Care EHR bookings decreasing $3.5 million, or 39%, Post-acute Care EHR bookings indecreasing $0.3 million, or 29%, and TruBridge bookings decreasing $6.8 million, or 72%. Sales activities during the first quarter of ~~2020 decreased by $0.5 million, or 36%,~~2021 suffered from ~~the first quarter~~a number of ~~2019~~incremental headwinds, chief among them being (a) COVID-19 related distractions, including increased infection rates for certain geographies and widespread focus on eventual vaccine rollouts, (b) reorganization transitions related to our February 2021 reduction-in-force, and (c) lower-value regulatory purchases disproportionately dominated sales discussions and resources. We view these incremental headwinds as ~~bookings have weakened as we continue our ongoing product releases~~being temporary delays in decision-making and ~~efforts to make technological improvements to the AHT product line.~~not reflective of a diminished overall market opportunity.

TruBridge bookings in the first quarter of 2020 increased by $5.3 million, or 125%, over the first quarter of 2019, mostly due to our recently-introduced initiative to expand our TruBridge footprint outside of our traditional EHR customer base, resulting in significant client wins.

Off-Balance Sheet Arrangements

We had no off-balance sheet arrangements, as defined by Item 303(a)(4) of SEC Regulation S-K, as of March 31, ~~2020.~~2021.

Critical Accounting Policies and Estimates

Our Management Discussion and Analysis is based upon our condensed consolidated financial statements, which have been prepared in accordance with U.S. GAAP. The preparation of these financial statements requires us to make subjective or complex judgments that may affect the reported financial condition and results of operations. We base our estimates on historical experience and other assumptions that we believe to be reasonable under the circumstances, the results of which form the basis for making judgments about the reported values of assets, liabilities, revenues, expenses and other financial amounts that are not readily apparent from other sources. Actual results may differ from these estimates and these estimates may differ under different assumptions or conditions. We continually evaluate the information used to make these estimates as our business and the economic environment changes.

In our Annual Report on Form 10-K for the year ended December 31, ~~2019,~~2020, we identified our critical accounting polices related to revenue recognition, allowance for ~~doubtful accounts, allowance for~~ credit losses, estimates, and ~~estimates.~~business combinations, including purchased intangible assets. There have been no significant changes to these critical accounting policies during the three months ended March 31, ~~2020.~~2021.


Item 3.			Quantitative and Qualitative Disclosures about Market Risk.

Our exposure to market risk relates primarily to the potential change in the British Bankers Association London Interbank Offered Rate ("LIBOR"). We had ~~$102.6~~$72.2 million of outstanding borrowings under our credit facilities with Regions Bank at March 31, ~~2020.~~2021. The term loan facility and revolving credit facility bear interest at a rate per annum equal to an applicable margin plus, at our option, either (1) the Adjusted LIBOR rate for the relevant interest period, subject to a floor of 0.50%, (2) an alternate base rate determined by reference to the ~~greatest~~greater of (a) the prime lending rate of Regions, (b) the federal funds rate for the relevant interest period plus one half of one percent per annum and (c) the one month LIBOR rate, subject to the aforementioned floor, plus one percent per annum, or (3) a combination of (1) and (2). Accordingly, we are exposed to fluctuations in interest rates on borrowings under the credit facilities. A one hundred basis point change in interest rate on our borrowings outstanding as of March 31, ~~2020~~2021 would result in a change in interest expense of approximately ~~$1.0~~$0.7 million annually.

We did not have investments and do not utilize derivative financial instruments to manage our interest rate risks.


Item 4.			Controls and Procedures.

Evaluation of Disclosure Controls and Procedures

We maintain disclosure controls and procedures that are designed to provide reasonable assurance that the information required to be disclosed by us in reports that we file or submit under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), is recorded, processed, summarized and reported within the time periods specified in the rules and forms promulgated by the Securities and Exchange Commission, and that such information is accumulated and communicated to our management, including our Chief Executive Officer and Chief Financial Officer, as appropriate to allow timely decisions regarding required disclosure. Because of the inherent limitations to the effectiveness of any system of disclosure controls and procedures, no evaluation of disclosure controls and procedures can provide absolute assurance that all control issues and instances of fraud, if any, with a company have been prevented or detected on a timely basis. Even disclosure controls and procedures determined to be effective can only provide reasonable assurance that their objectives are achieved.

As of the end of the period covered by this report, we carried out an evaluation, under the supervision and with the participation of our management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of the design and operation of our disclosure controls and procedures (as defined in Exchange Act Rule 13a-15(e)) pursuant to Rule 13a-15 of the Exchange Act. Based upon that evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures are effective at the reasonable assurance level.

Changes in Internal Control over Financial Reporting

There were no changes in the Company’s internal control over financial reporting (as defined in Exchange Act Rule 13a-15(f)) during the quarter ended March 31, ~~2020~~2021 that have materially affected, or are reasonably likely to materially affect, the Company’s internal control over financial reporting.

PART II

OTHER INFORMATION


Item 1.			Legal Proceedings.

From time to time, we are involved in routine litigation that arises in the ordinary course of business. We are not currently involved in any claims outside the ordinary course of business that are material to our financial condition or results of operations.


Item 1A.			Risk Factors.

In addition to the other information set forth in this report, you should carefully consider the factors discussed in Part I, "Item 1A. Risk Factors" in our Annual Report on Form 10-K for the year ended December 31, ~~2019,~~2020, which could materially affect our business, financial condition or future results. The risks described in our Annual Report on Form 10-K are not the only risks facing our Company. Additional risks and uncertainties not currently known to us or that we currently deem immaterial also may materially adversely affect our business, financial condition or operating results. ~~Other than as described below, there~~There have been no material changes to the risk factors disclosed in Part ~~I-Item 1A of the Company’s 2019 Annual Report.~~

~~The impact of COVID-19 and related economic disruptions could materially affect our revenue, gross margin and income, as well as our financial position and/or liquidity.~~

Beginning in March 2020, the global pandemic related to the novel coronavirus COVID-19 began to impact the global economy and our results of operations. Because of the size and breadth of this pandemic, all of the direct and indirect consequences of COVID-19 are not yet known and may not emerge for some time. Risks presented by the ongoing effects of COVID-19 include the following:

•~~Revenues, Gross Margins and Income.~~ We expect that the impact of COVID-19 on our community hospital client base, and the related decrease in patient volumes, will negatively impact our variable revenues, gross margins and income driven by collection volume. We also expect that new EHR system installations will be negatively impacted by restrictive travel and social distancing protocols. We began to experience this impact in March 2020 and expect it to persist and be more significant in the second and third quarters of 2020. The Company expects these impacts to continue for the remainder of 2020 and beyond, but the degree of the impact will depend on the ability of our community hospital clients to return to normal operations and patient volume. In addition, although we have experienced no notable disruption to our operating cash flows through the date of this report, we currently expect that the aforementioned limitations on travel and decreased client patient volumes will ultimately result in decreased cash collections from our customers as long as these conditions persist. For further discussion, see “~~Failure to maintain our margins and services rates for implementation services could have a material adverse effect on our operating performance and financial conditions”~~ ~~in the risk factors discussed~~1, "Item 1A. Risk Factors" in our Annual Report on Form ~~10-K for the year ended December 31, 2019.~~10-K.

•~~Adverse Legislative and/or Regulatory Action.~~ ~~Federal, state and local government actions to address and contain the impact of COVID-19 may adversely affect us. For further discussion, see “~~There is significant uncertainty in the healthcare industry, both as a result of recently enacted legislation and changing government regulation, which may have a material adverse impact on the businesses of our hospital clients and ultimately on our business, financial condition and results of operations~~” in the risk factors discussed in our Annual Report on Form 10-K for the year ended December 31, 2019.~~

•~~Operational Disruptions and Heightened Cybersecurity Risks.~~ Our operations could be disrupted if key members of our senior management or a significant percentage of our workforce or the workforce of our client community hospitals are unable to work because of illness, government directives or otherwise. Having shifted to remote working arrangements, we also face a heightened risk of cybersecurity attacks or data security incidents and are more dependent on the internet and telecommunications access and capabilities. For further discussion, see “~~Breaches of security and viruses in our systems could result in client claims against us and harm to our reputation causing us to~~

~~incur expenses and/or lose clients” in the risk factors discussed in our Annual Report on Form 10-K for the year ended December 31, 2019.~~

The extent to which the COVID-19 pandemic will impact our financial condition and results of operations will depend on future developments, which are highly uncertain and difficult to predict, including, but not limited to, the duration and spread of the pandemic, its severity, the actions to contain the virus or treat its impact, and how quickly and to what extent normal economic and operating conditions can resume. Even after the COVID-19 pandemic has subsided, we may experience material adverse impacts to our business as a result of the global or U.S. economic impact and any recession that has occurred or may occur in the future. There are no comparable recent events that provided guidance as to effect the COVID-19 pandemic may have, and, as a result, the ultimate impact of the pandemic on our operations and financial results is highly uncertain and subject to change.

Additionally, concerns over the economic impact of the COVID-19 pandemic have caused extreme volatility in financial and other capital markets which has and may continue to adversely impact our stock price and may adversely impact our ability to access capital, at all or on reasonable terms. To the extent the COVID-19 pandemic adversely affects our business and financial results, it may also have the effect of heightening many of the other risks described under “Risk Factors” in the Annual Report on Form 10-K for the year ended December 31, 2019.


Item 2.			Unregistered Sales of Equity Securities and Use of Proceeds.

~~Not Applicable.~~

Repurchases of Equity Securities

The following table provides information about our repurchases of common stock during the three months ended March 31, 2021:


Period	Total Number of Shares Purchased(1)	Average Price Paid per Share		Total Number of Shares Purchased as Part of Publicly Announced Plans or Programs(2)	Approximate Dollar Value of Shares That May Yet Be Purchased Under the Plans or Programs(3)
Beginning of Period					$	28,695,292
January 1, 2021 - January 31, 2021	7,251	$	28.83	7,251	28,486,244
February 1, 2021 - February 28, 2021	6,289	29.69		4,055	28,365,734
March 1, 2021 - March 31, 2021	19,960	30.77		750	$	28,343,267
Total	33,500	$	30.15	12,056
(1) We purchased 21,444 shares during the three months ended March 31, 2021 that were not made pursuant to our previously announced stock repurchase program, but were purchased to fund required tax withholding related to the vesting of restricted stock. Shares withheld to cover required tax withholdings related to the vesting of restricted stock do not reduce our total share repurchase authority.
(2) Shares purchased during the three months ended March 31, 2021 pursuant to our previously announced stock repurchase program.
(3) On September 4, 2020, our Board of Directors approved a stock repurchase program under which we may repurchase up to $30.0 million of our common stock through September 3, 2022. Any future stock repurchase transactions may be made through open market purchases, privately-negotiated transactions, or otherwise in compliance with Rule 10b-18 under the Securities Exchange Ace of 1934, as amended.


Item 3.			Defaults Upon Senior Securities.

Not applicable.


Item 4.			Mine Safety Disclosures.

Not applicable.


Item 5.			Other Information.

~~None.~~

On February 22, 2021, CPSI entered into a sublease agreement (the “Sublease”) with Red Square, LP (the “Sublandlord”) in order to sublease a portion of a building in Mobile, Alabama that will house our principal executive office. The subleased portion of the building consists of a two-story office building in downtown Mobile with approximately 20,093 square feet of office space (the “Leased Office”). The Sublease term begins on April 1, 2021 and ends on June 5, 2024. CPSI will pay base rent of $37,937 per month. The Sublandlord is leasing the Leased Office from Central Optical, LLC (the “Landlord”) pursuant to a lease agreement (the “Master Lease”). The Landlord consented to the Sublease. The terms of the Master Lease are incorporated into the Sublease. The Sublandlord will remain responsible for paying certain maintenance items, taxes and the Landlord’s insurance expense as required under the Master Lease. CPSI is responsible for all other costs and obligations required of the Sublandlord under the Master Lease, and is responsible for all utilities for the Leased Office. The Sublandlord will leave the Leased Office with the items of furniture, fixtures and equipment (“FF&E”) listed in an attachment to the Sublease. At the expiration of the Sublease, the parties will negotiate for the sale of the FF&E to CPSI at a mutually agreeable price.

On March 1, 2021, CPSI entered into a lease agreement (the “New Lease”) with the Landlord to continue leasing the Leased Office from the Landlord upon the expiration of the Master Lease. The New Lease term will begin on June 6, 2024 and end on May 31, 2027. CPSI will pay base rent of $34,959 per month. In addition to the base rent, CPSI will be responsible for paying certain expenses of the Landlord related to the Leased Office, including insurance, and will be responsible for all costs of maintenance (other than the roof and exterior walls), taxes and utilities for the Leased Office.

The foregoing description of the Sublease and the New Lease is only a summary, does not purport to be complete and is qualified in its entirety by reference to, and should be read in conjunction with, the complete text of the Sublease and the New Lease, which are filed as Exhibits 10.1 and 10.2, respectively, to this Quarterly Report on Form 10-Q and incorporated herein by reference.


Item 6.			Exhibits.


3.1		Certificate of Incorporation (filed as Exhibit 3.4 to CPSI’s Registration Statement on Form S-1 (Registration No. 333-84726) and incorporated herein by reference)

3.2		Amended and Restated Bylaws (filed as Exhibit 3 to CPSI’s Current Report on Form 8-K dated October 28, 2013 and incorporated herein by reference)

3.3		Amendment to Amended and Restated Bylaws (filed as Exhibit 3.1 to CPSI's Current Report on Form 8-K dated January 22, 2019 and incorporated herein by reference)

10.1			~~Form of Non-Employee Director Restricted Stock Award~~Sublease Agreement, ~~Under the 2019 Incentive Plan~~dated February 22,2021, between CPSI and Red Square, LLC
10.2	Commercial Lease Agreement, dated March 1, 2021, between CPSI and Central Optical, LLC

~~31.1~~ 10.3	Amended Commission Program for Troy D. Rosser (2020)
31.1	Certification of the Chief Executive Officer pursuant to Rule 13a-14(a), as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

31.2		Certification of the Chief Financial Officer pursuant to Rule 13a-14(a), as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

32.1		Certifications of the Chief Executive Officer and 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		Interactive Data Files for CPSI’s Form 10-Q for the period ended March 31, ~~2020~~2021

SIGNATURES

Pursuant to the requirements 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.

COMPUTER PROGRAMS AND SYSTEMS, INC.

May ~~5, 2020~~10, 2021

By:

/s/ J. Boyd Douglas

J. Boyd Douglas

President and Chief Executive Officer

May ~~5, 2020~~10, 2021

By:

/s/ Matt J. Chambless

Matt J. Chambless

Chief Financial Officer