UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 10-Q

(Mark One)

☒	Quarterly Report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934

For the quarterly period ended June 30, ~~2022~~2023

☐	Transition Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934

Commission File No.: 000-27701

HealthStream, Inc.

(Exact name of registrant as specified in its charter)

Tennessee	62-1443555
(State or other jurisdiction of incorporation or organization)	(I.R.S. Employer Identification No.)

500 11th Avenue North, Suite 1000,
Nashville, Tennessee	37203
(Address of principal executive offices)	(Zip Code)

(615) 301-3100

(Registrant's telephone number, including area code)

Title of each class	Trading Symbol(s)	Name of each exchange on which registered
Common Stock (Par Value $0.00)	HSTM	Nasdaq Global Select Market

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 ☒ 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 ☒ 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 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 ☒

As of July ~~25, 2022,~~24, 2023, there were ~~30,569,790~~30,686,568 shares of the registrant’s common stock outstanding.

Table of Contents

	*June 30,*			*December 31,*		*June 30,*			*December 31,*
	*2022*			*2021*		*2023*			*2022*
ASSETS
Current assets:
Cash and cash equivalents	$	37,216		$	46,905	$	25,805		$	46,023
Marketable securities		2,000			5,041		30,158			7,885
Accounts receivable, net of allowance for doubtful accounts of $699 and $853 at June 30, 2022 and December 31, 2021, respectively		28,744			30,308
Accounts receivable, net of allowance for doubtful accounts of $625 and $544 at June 30, 2023 and December 31, 2022, respectively							35,010			36,730
Accounts receivable - unbilled		6,157			4,612		5,869			5,980
Prepaid royalties, net of amortization		9,677			9,155		9,881			9,071
Other prepaid expenses and other current assets		11,539			10,824		11,290			8,688
Total current assets		95,333			106,845		118,013			114,377

Property and equipment, net of accumulated depreciation of $20,183 and $17,999 at June 30, 2022 and December 31, 2021, respectively		16,477			17,950
Capitalized software development, net of accumulated amortization of $95,206 and $86,097 at June 30, 2022 and December 31, 2021, respectively		34,509			32,412
Property and equipment, net of accumulated depreciation of $22,364 and $20,280 at June 30, 2023 and December 31, 2022, respectively							14,461			15,483
Capitalized software development, net of accumulated amortization of $115,618 and $105,025 at June 30, 2023 and December 31, 2022, respectively							38,950			37,118
Operating lease right of use assets, net		23,964			25,168		21,477			22,759
Goodwill		187,919			182,501		191,346			192,398
Customer-related intangibles, net of accumulated amortization of $50,036 and $45,615 at June 30, 2022 and December 31, 2021, respectively		66,333			68,803
Other intangible assets, net of accumulated amortization of $19,574 and $16,752 at June 30, 2022 and December 31, 2021, respectively		20,436			20,402
Customer-related intangibles, net of accumulated amortization of $52,807 and $48,552 at June 30, 2023 and December 31, 2022, respectively							58,925			61,269
Other intangible assets, net of accumulated amortization of $15,936 and $12,818 at June 30, 2023 and December 31, 2022, respectively							16,439			20,284
Deferred tax assets		601			601		383			383
Deferred commissions		25,174			24,012		28,709			28,344
Non-marketable equity investments		5,994			7,043		4,277			4,518
Other assets		964			1,016		494			808
Total assets	$	477,704		$	486,753	$	493,474		$	497,741

LIABILITIES AND SHAREHOLDERS’ EQUITY
Current liabilities:
Accounts payable and accrued expenses	$	18,353		$	21,497	$	22,147		$	32,301
Accrued royalties		4,695			5,037		5,236			5,443
Deferred revenue		81,866			73,816		81,768			79,469
Total current liabilities		104,914			100,350		109,151			117,213

Deferred tax liabilities		18,677			18,146		17,480			17,996
Deferred revenue, noncurrent		1,151			1,583		2,256			2,937
Operating lease liability, noncurrent		24,771			26,178		21,801			23,321
Other long term liabilities		1,459			1,477
Other long-term liabilities							2,167			2,210
Commitments and contingencies

Shareholders’ equity:
Common stock, no par value, 75,000 shares authorized; 30,570 and 31,327 shares issued and outstanding at June 30, 2022 and December 31, 2021, respectively		253,036			270,791
Common stock, no par value, 75,000 shares authorized; 30,686 and 30,579 shares issued and outstanding at June 30, 2023 and December 31, 2022, respectively							256,073			254,832
Retained earnings		74,098			68,122		85,435			80,213
Accumulated other comprehensive (loss) income		(402	)		106
Accumulated other comprehensive loss							(889	)		(981	)
Total shareholders’ equity		326,732			339,019		340,619			334,064
Total liabilities and shareholders’ equity	$	477,704		$	486,753	$	493,474		$	497,741

See accompanying Notes to the unaudited Condensed Consolidated Financial Statements.

	*Six Months Ended June 30,*						*Six Months Ended June 30,*
	*2022*			*2021*			*2023*			*2022*
OPERATING ACTIVITIES:
Net income	$	5,976		$	4,732		$	6,756		$	5,976
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization		18,742			18,302			20,148			18,742
Stock-based compensation		1,691			1,398			2,038			1,691
Amortization of deferred commissions		5,029			4,509			5,464			5,029
Provision for credit losses		444			3			371			444
Deferred income taxes		1,089			1,751			(490	)		1,089
Gain on sale of fixed assets		(25	)		0			—			(25	)
Loss on non-marketable equity investments		500			133			241			500
Non-cash paid time off expense		0			(1,011	)
Change in fair value of non-marketable equity investments		(943	)		0			—			(943	)
Other		37			60			(342	)		37
Changes in operating assets and liabilities:
Accounts and unbilled receivables		(2	)		12,247			1,460			(2	)
Prepaid royalties		(521	)		(1,032	)		(810	)		(521	)
Other prepaid expenses and other current assets		(651	)		590			(2,408	)		(651	)
Deferred commissions		(6,192	)		(6,612	)		(5,830	)		(6,192	)
Other assets		52			(168	)		315			52
Accounts payable and accrued expenses		(2,644	)		(6,041	)		(2,835	)		(2,644	)
Accrued royalties		(342	)		(2,798	)		(207	)		(342	)
Deferred revenue		5,741			(1,739	)		1,618			5,741
Net cash provided by operating activities		27,981			24,324			25,489			27,981

INVESTING ACTIVITIES:
Business combinations, net of cash acquired		(4,009	)		(731	)		(6,621	)		(4,009	)
Proceeds from maturities of marketable securities		5,025			9,731			10,000			5,025
Purchases of marketable securities		(2,024	)		(5,205	)		(31,983	)		(2,024	)
Payments to acquire non-marketable equity investments		0			(1,750	)
Payments associated with capitalized software development		(11,817	)		(10,277	)		(13,309	)		(11,817	)
Proceeds from sale of fixed assets		26			0			—			26
Purchases of property and equipment		(1,181	)		(2,407	)		(1,382	)		(1,181	)
Net cash used in investing activities		(13,980	)		(10,639	)		(43,295	)		(13,980	)

FINANCING ACTIVITIES:
Taxes paid related to net settlement of equity awards		(498	)		(399	)		(797	)		(498	)
Repurchases of common stock		(23,137	)		0			—			(23,137	)
Payment of cash dividends		0			(12	)		(1,534	)		—
Net cash used in financing activities		(23,635	)		(411	)		(2,331	)		(23,635	)

Effect of exchange rate changes on cash and cash equivalents		(55	)		(48	)		(81	)		(55	)
Net (decrease) increase in cash and cash equivalents		(9,689	)		13,226
Net decrease in cash and cash equivalents								(20,218	)		(9,689	)
Cash and cash equivalents at beginning of period		46,905			36,566			46,023			46,905
Cash and cash equivalents at end of period	$	37,216		$	49,792		$	25,805		$	37,216

See accompanying Notes to the unaudited Condensed Consolidated Financial Statements.

HealthStream provides primarily Software-as-a-Service (SaaS) based applications for healthcare organizations—all designed to improve business and clinical outcomes by supporting the people who deliver patient care. We are focused on helping healthcare organizations meet their ongoing clinical development, talent management, training, education, assessment, competency management, safety and compliance, scheduling, and provider credentialing, privileging, and enrollment needs. The Company is organized and operated according to our One HealthStream approach, with our hStream technology platform at the center of that approach. Increasingly, SaaS based applications in our diverse ecosystem of solutions utilize our proprietary hStream technology platform to enhance their value proposition by creating interoperability with and among other applications. As used in this Report, “HealthStream,” “Company,” “we,” “us,” and “our” mean HealthStream, Inc. and its subsidiaries unless the context indicates otherwise.

The accompanying unaudited Condensed Consolidated Financial Statements have been prepared in accordance with accounting principles generally accepted in the United States (“US GAAP”) for interim financial information and with the instructions to Form 10‑Q and Article 10 of Regulation S‑X. Accordingly, condensed consolidated financial statements do not include all of the information and footnotes required by US GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair presentation have been included. All intercompany transactions have been eliminated in consolidation. Operating results for the three and six months ended June 30, ~~2022~~2023 are not necessarily indicative of the results that may be expected for the year ending December 31, ~~2022.~~2023.

The Condensed Consolidated Balance Sheet at December 31, ~~2021~~2022 was derived from the audited Consolidated Financial Statements at that date but does not include all of the information and footnotes required by US GAAP for a complete set of financial statements. For further information, refer to the Consolidated Financial Statements and Notes thereto for the year ended December 31, ~~2021~~2022 (included in the Company's Annual Report on Form 10-K, filed with the Securities and Exchange Commission on February 28, ~~2022)~~2023).

Our business is managed and organized around a single platform strategy, also referred to as our One HealthStream approach. At the center of this single platform strategy is our hStream technology platform. By facilitating interoperability among our applications, as well as third party applications, we believe that our hStream technology platform is allowing stand-alone applications to leverage each other to more efficiently and effectively empower our customers to manage their business and improve their outcomes.

As indicated in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022, filed on February 28, 2023, the Company reached an inflection point in its efforts to operate according to its single platform strategy, One HealthStream. Since January 1, 2023, the Company’s business has been organized and managed around a consolidated, enterprise approach, including with regard to technology, operations, accounting, internal reporting (including the nature of information reviewed by our key decision maker), organization structure, compensation, performance assessment, and resource allocation.

As the result of these developments, the Company determined that Workforce Solutions and Provider Solutions were no longer separate operating segments or separate reportable segments as of January 1, 2023, such that the Company would no longer present two reportable segments for periods beginning on and after this date. As such, since January 1, 2023, the Company has had a single reportable segment, such that the Company is presenting historical financial information on a single segment basis in this Quarterly Report on Form 10-Q for the three and six months ended June 30, 2023. For purposes of reporting historical 2022 results in this Quarterly Report on Form 10-Q, we are reporting comparable performance on a consolidated basis unless otherwise indicated.

In ~~October 2021,~~ ~~the Financial Accounting Standards Board issued Accounting Standards Update ("ASU")~~ ~~2021~~-08,~~Business Combinations (Topic~~~~805~~~~): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers.~~ The new guidance requires contract assets and contract liabilities acquired in a business combination to be recognized and measured by the acquirer on the acquisition date in accordance with Accounting Standards Codification ("ASC") ~~606~~,~~Revenue from Contracts with Customers~~, as if it had originated the contracts. This approach differs from the previous requirement to measure contract assets and contract liabilities acquired in a business combination at fair value. The standard will be effective for the ~~first~~ ~~interim period within annual reporting periods beginning after~~ ~~December 15, 2022~~ ~~and early adoption is permitted. The Company early adopted this ASU on~~ ~~January 1, 2022,~~ ~~and the impact of the new standard will depend on the magnitude of future acquisitions but has~~ ~~not~~ ~~had a material impact to date. The standard will~~ ~~not~~ ~~impact contract assets or liabilities from business combinations that occurred prior to the adoption date.~~

Revenues are recognized when control of the promised goods or services is transferred to the customer in an amount that reflects the consideration the Company expects to be entitled in exchange for transferring those goods or services.

The following table represents revenues disaggregated by revenue source (in thousands). Sales taxes are excluded from revenues.

months ended June 30, 2023 and 2022, the Company recognized $0.2 million and $0.4 million in impairment losses on receivables and contract assets arising from the Company's contracts with customers, respectively. For both the six months ended June 30, ~~2022~~2023 and ~~2021~~2022, the Company recognized $0.4 million ~~and $3,000~~ in impairment losses on receivables and contract assets arising from the Company’s contracts with ~~customers, respectively.~~

Deferred revenue represents contract liabilities that are recorded when cash payments are received or are due in advance of our satisfaction of performance obligations. During the three months ended June 30, ~~2022~~2023 and ~~2021~~2022, we recognized revenues of approximately ~~$40.0~~$43.6 million and ~~$40.5~~$40.0 million, respectively, from amounts included in deferred revenue at the beginning of the respective periods. During the six months ended June 30, ~~2022~~2023 and ~~2021~~2022,, we recognized revenues of approximately $62.1 million and $56.0 million, ~~and $52.2 million of revenue~~respectively, from amounts included in deferred ~~revenues~~revenue at the beginning of the respective periods. As of June 30, ~~2022~~2023, approximately ~~$455~~$511 million of revenue is expected to be recognized from remaining performance obligations under contracts with customers. We expect to recognize revenue related to approximately ~~46%~~44% of these remaining performance obligations over the next 12 months, with the remaining amounts recognized thereafter.

Sales commissions earned by our sales force are considered incremental and recoverable costs of obtaining a contract with a customer. ~~Under ASC~~ ~~606,~~ costs to acquire contracts with customers, such as the initial sales commission payment and associated payroll taxes, are capitalized in the period a customer contract is entered into and are amortized consistent with the transfer of the goods or services to the customer over the expected period of benefit. Capitalized contract costs are included in deferred commissions in the accompanying Condensed Consolidated Balance Sheets. The expected period of benefit is the contract term, except when the capitalized commission is expected to provide economic benefit to the Company for a period longer than the contract term, such as for new customer or incremental sales where renewals are expected and renewal commissions are ~~not~~ ~~commensurate with initial commissions. Non-commensurate commissions are amortized over the greater of the contract term or technological obsolescence period of approximately~~ ~~three~~ ~~years.~~ The Company recorded amortization of deferred commissions of approximately ~~$2.5~~$2.8 million and ~~$2.4~~$2.5 million for the three months ended June 30, ~~2022~~2023 and ~~2021~~2022, and ~~$5.0~~$5.5 million and ~~$4.5~~$5.0 million for the six months ended June 30, ~~2022~~2023 and ~~2021~~2022,, respectively, which is included in sales and marketing expenses in the accompanying Condensed Consolidated Statements of Income.

Income taxes are accounted for using the asset and liability method, whereby deferred tax assets and liabilities are determined based on the temporary differences between the financial statement and tax bases of assets and liabilities measured at tax rates that will be in effect for the year in which the differences are expected to affect taxable income.

The Company computes its interim period provision for income taxes by applying the estimated annual effective tax rate to year-to-date pretax income or loss and adjusts the provision for discrete tax items recorded in the period. During the three months ended June 30, ~~2022~~2023 and ~~2021~~2022, the Company recorded a provision for income taxes of approximately ~~$0.5~~$0.4 million and ~~$0.9~~$0.5 million, respectively. During the six months ended June 30, ~~2022~~2023 and ~~2021~~2022,, the Company recorded a provision for income taxes of ~~$1.4~~$0.9 million and ~~$1.8~~$1.4 million, respectively. The Company’s effective tax rate was ~~19%~~12% and ~~28%~~19% for the six months ended June 30, ~~2022~~2023 and ~~2021~~2022, respectively. The Company’s effective tax rate primarily reflects the statutory corporate income tax rate, the net effect of state taxes, foreign income taxes, and the effect of various permanent tax differences. The Company recognizes excess tax benefits and tax deficiencies associated with stock-based awards as a component of its provision for income taxes. During the six months ended June 30, 2023, the Company recorded discrete tax benefits of $0.5 million, which consisted primarily of tax benefits associated with changes in state apportionment rules in Tennessee upon the enactment of the Tennessee Works Tax Act, in the amount of $0.6 million, and stock-based awards, in the amount of $0.1 million, partially offset by $0.2 million of discrete tax expense related to reserves for uncertain tax positions. During the six months ended June 30, 2022, the Company recorded discrete tax benefits of $0.1 million, which consisted primarily of a $0.2 million tax benefit associated with a nontaxable gain of $0.9 million recognized from the change in fair value of our previously held minority interest in CloudCME, LLC. This tax benefit was partially offset by $0.1 million of excess tax deficiencies associated with stock-based awards.

On February 20, 2023, the Company's Board of Directors ("Board") approved a dividend policy, marking the first quarterly cash dividend policy adopted by the Company ("Dividend Policy"). During the six months ended June 30, ~~2021~~2023, , the ~~Company recorded discrete tax expense~~Board declared the following quarterly dividends under the Dividend Policy:

Additionally, on July 24, 2023, the Board approved the Company’s third quarterly cash dividend of ~~$0.2 million related~~$0.025 per share, payable on September 29,2023 to ~~purchase accounting adjustments and the impact~~holders of ~~a state tax rate change enacted during the period.~~

The Company has stock awards outstanding under its 2016 Omnibus Incentive Plan and 2022 Omnibus Incentive Plan. ~~The~~ ~~2022~~ ~~Omnibus Incentive Plan was approved at the annual meeting of shareholders held on~~ ~~May 26, 2022.~~ The Company accounts for its stock-based compensation plans using the fair-value based method for costs related to share-based payments, including restricted share units (“RSUs”) and stock options. During the six months ended June 30, 2023, the Company issued 72,923 RSUs subject to service-based time vesting, with a weighted average grant date fair value of $25.36 per share, measured based on the closing fair market value of the Company's stock on the date of the grant. During the six months ended June 30, 2022, the Company ~~issued~~approved the grant of 137,055 RSUs subject to service-based time vesting, with a weighted average grant date fair value of $20.27 per share, measured based on the closing fair market value of the ~~Company's~~Company’s stock on the date of ~~the~~ grant.

During the six months ended June 30, ~~2021~~2023, the Company issued 122,686 RSUs subject to service-based time vesting with a weighted average grant date fair value of $23.16 per share, measured based on the closing fair market value of the Company’s stock on the date of grant.

~~During~~ ~~2018~~, ~~the Company~~ granted ~~70,000~~138,000 performance-based RSUs, the vesting of which occurs over a five-year period and is contingent upon continued service and achieving certain performance criteria established by the Compensation Committee on an annual ~~basis.~~basis in increments of 15%, 20%, 20%, 20%, and 25% based on performance in 2023,2024,2025,2026, and 2027, respectively. The performance criteria ~~and measurement date~~ for the ~~final 21,000~~first-year tranche, or 20,700 of these performance-based RSUs, is based on ~~2022~~2023 adjusted ~~EBITDA and~~EBITDA. The measurement date for these 20,700 performance-based RSUs was established during the ~~six~~first ~~months ended~~quarter of ~~June~~ ~~30,~~~~2022~~2023 with a grant date fair value of ~~$20.32~~$26.25 per share, measured based on the closing fair market value of the Company's stock on the date the performance criteria was established.

~~NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)~~ yet been determined and will be established on an annual basis in 2024,2025,2026, and 2027, as applicable; therefore, the measurement date for these remaining 117,300 performance-based RSUs cannot be determined until the performance criteria have been established.

During the six months ended June 30, 2022, ~~30,~~~~2022,~~the Company ~~issued~~granted 91,042 performance-based RSUs, the vesting of which occurs over a five-year period and is contingent upon continued service and achieving certain performance criteria established by the Compensation Committee on an annual basis in increments of 15%, 20%, 20%, 20%, and 25% based on performance in 2022, 2023, 2024, 2025, and 2026, respectively. The performance criteria for the ~~first~~second-year tranche, or ~~13,654~~18,210 of these performance-based RSUs, is based on ~~2022~~2023 adjusted EBITDA. The measurement date for these ~~13,654~~18,210 performance-based RSUs was established during the ~~six~~first ~~months ended~~quarter of ~~June 30, 2022~~ 2023with a grant date fair value of ~~$20.29~~$26.25 per share, measured based on the closing fair market value of the Company's stock on the date the performance criteria was ~~established or, in the case of the portion of such performance-based RSUs which were granted contingent upon the approval of the~~ ~~2022~~ ~~Omnibus Incentive Plan by the Company's shareholders, the date the~~ ~~2022~~ ~~Omnibus Incentive Plan was approved by shareholders of the Company.~~established. The performance criteria for the remaining ~~77,388~~59,178 performance-based RSUs has not yet been determined and will be established on an annual basis in ~~2023,~~2024, 2025, and 2026, as applicable; therefore, the measurement date for these remaining ~~77,388~~59,178 performance-based RSUs cannot be determined until the performance criteria have been established.

Total stock-based compensation expense recognized in the Condensed Consolidated Statements of Income is as follows (in thousands):

On ~~November 30, 2021~~, the Company's Board of Directors authorized a share repurchase program to repurchase up to $20.0 million of the Company's outstanding shares of common stock. This share repurchase program concluded on ~~March 8, 2022~~, when the maximum dollar amount authorized under the program was expended. Under this program, the Company repurchased a total of 853,023 shares through open market purchases at an aggregate value of $20.0 million, reflecting an average price per share of $23.45 (excluding the cost of broker commissions). During the ~~six~~ ~~months ended~~ ~~June~~ ~~30,~~~~2022~~, the Company repurchased 649,739 shares pursuant to this share repurchase program at an aggregate fair value of $14.9 million, based on an average price per share of $22.92 (excluding the cost of broker commissions).

On ~~March 14, 2022,~~ the Company's Board of Directors approved an expansion of the Company's share repurchase program by authorizing the repurchase of up to an additional $10.0 million of the Company's outstanding shares of common stock. The share repurchase expansion program is scheduled to terminate on the earlier of ~~March 13, 2023,~~ ~~or when the maximum dollar amount has been expended. During the~~ ~~three~~ ~~months ended~~ ~~June~~ ~~30,~~~~2022,~~ the Company repurchased 159,403 shares pursuant to this share repurchase program at an aggregate fair value of $3.1 million, based on an average price per share of $19.70 (excluding the cost of broker commissions). During the ~~six~~ ~~months ended~~ ~~June 30, 2022~~~~, the Company repurchased 402,050 shares at an aggregate fair value of $8.1 million, reflecting an average price per share of $20.19 (excluding the cost of broker commissions).~~NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

Basic earnings per share is computed by dividing the net income available to common shareholders for the period by the weighted average number of common shares outstanding during the period. Diluted earnings per share is computed by dividing the net income available to common shareholders for the period by the weighted average number of potentially dilutive common and common equivalent shares outstanding during the period. Common equivalent shares are composed of incremental common shares issuable upon the exercise of stock options and RSUs subject to vesting. The dilutive effect of common equivalent shares is included in diluted earnings per share by application of the treasury stock method. The total number of common equivalent shares excluded from the calculations of diluted earnings per share, due to their anti-dilutive effect or contingent performance conditions, was approximately ~~228,000~~225,000 and ~~111,000~~228,000 for the three months ended June 30, ~~2022~~2023 and ~~2021~~2022, respectively, and ~~223,000~~246,000 and ~~130,000~~223,000 for the six months ended June 30, ~~2022~~2023 and ~~2021~~2022,, respectively.

The following table sets forth the computation of basic and diluted earnings per share (in thousands, except per share data):

The fair value of marketable securities, which were all classified as available for sale and which the Company does not intend to sell nor will the Company be required to sell prior to recovery of their amortized cost basis, included the following (in thousands):

The carrying amounts reported in the Condensed Consolidated Balance Sheets approximate ~~the~~ fair value based on quoted market prices or alternative pricing sources and models utilizing market observable inputs. As of June 30, ~~2022~~2023, the Company did not recognize any allowance for credit impairments on its available for sale debt securities. All investments in marketable securities are classified as current assets on the Condensed Consolidated Balance Sheets because the underlying securities mature within one year from the balance sheet date.

On ~~May~~ ~~18,~~~~2022~~, the Company acquired the remaining ownership interest (representing approximately 82% of the outstanding equity interests) of CloudCME, LLC ("CloudCME"), a Nashville-based healthcare technology company offering a SaaS-based application for managing all aspects of continuing education (CME/CE) within a healthcare organization, for approximately $4.0 million in cash and $4.1 million in shares of HealthStream's common stock issued through a private placement at closing. The Company previously held a minority interest in CloudCME of approximately 18%. Of the purchase price paid at closing, $0.3 million is being held in escrow for a period of time following the closing to serve as a source of recovery for certain potential indemnification claims by the Company. Acquisition-related transaction costs were $0.1 million. The acquisition is ~~not~~ considered material to the Company’s financial statements. The Company accounted for the acquisition as a business combination and has allocated the purchase consideration based on management’s estimates of fair value. Net assets acquired were $9.6 million. Based on the fair value of assets acquired and liabilities assumed, including intangible assets of $5.1 million, goodwill of $5.6 million was established. The results of operations for CloudCME are included in the Company’s Consolidated Financial Statements from the date of acquisition and are included in the Workforce Solutions segment.

The Company provides services to healthcare organizations and other members within the healthcare industry. The Company’s services are focused on the delivery of workforce training, certification, assessment, development, and scheduling products and services (Workforce Solutions) and provider credentialing, privileging, call center, and enrollment products and services (Provider Solutions).

The Company measures segment performance based on operating income before income taxes and prior to the allocation of certain corporate overhead expenses, interest income, interest expense, gains and losses from equity investments, and depreciation. The Unallocated component below includes corporate functions, such as accounting, human resources, legal, investor relations, information systems, administrative and executive personnel, depreciation, a portion of amortization, and certain other expenses, which are ~~not~~ ~~currently allocated in measuring segment performance. The following is the Company’s business segment information (in thousands).~~

On December 31, 2022, the Company acquired substantially all of the assets of Electronic Education Documentation System, LLC (d/b/a eeds) ("eeds"), an Asheville, North Carolina-based healthcare technology company offering a SaaS-based continuing education (CME/CE) management system for healthcare organizations, for approximately $6.6 million in cash, reflecting customary purchase price adjustments made to the purchase price paid of $7.0 million. After the filing of the Company’s Annual Report on Form 10-K for the year ended December 31, 2022 on February 28, 2023, the Company received an updated valuation report for the acquisition from a third-party valuation firm. Based on the results of that valuation report, the Company has estimated the fair value of the customer relationships, developed technology, non-compete, and trade name intangible assets to be $2.6 million, $1.9 million, $0.2 million, and $0.1 million, respectively. As a result, the fair value of the customer relationships and non-compete intangible assets were increased by $2.0 million and $0.1 million during the six months ended June 30, 2023, respectively, while the developed technology and trade name intangible assets were decreased by $0.8 million and $20,000 during the six months ended June 30, 2023, respectively, due to this new information, with a corresponding decrease to goodwill of $1.3 million for the net change in the fair value of identifiable intangible assets.

On October 28, 2020, the Company entered into a Third Amendment to Revolving Credit Agreement ("Revolving Credit Facility"), amending the Revolving Credit Facility dated as of November 24, 2014 with Truist Bank, successor by merger to SunTrust Bank ("Truist"), extending the maturity date to October 28, 2023. Under the Revolving Credit Facility, the Company may borrow up to $65.0 million, which includes a $5.0 million swing line sub-facility and a $5.0 million letter of credit sub-facility, as well as an accordion feature that allows the Company to increase the Revolving Credit Facility by a total of up to $25.0 million, subject to securing additional commitments from existing lenders or new lending institutions.

At the Company’s election, the borrowings under the Revolving Credit Facility bear interest at either (1) a rate per annum equal to the highest of Truist’s prime rate or 0.5% in excess of the Federal Funds Rate or 1.0% in excess of one-month LIBOR (the "Base Rate"), plus an applicable margin, or (2) the one, two, three, or six-month per annum LIBOR for deposits in the applicable currency (the "Eurocurrency Rate"), as selected by the Company, plus an applicable margin. The applicable margin for Eurocurrency Rate loans depends on the Company’s funded debt leverage ratio and varies from 1.50% to 1.75%. The applicable margin for Base Rate loans depends on the Company’s funded debt leverage ratio and varies from 0.50% to 0.75%. Commitment fees and letter of credit fees are also payable under the Revolving Credit Facility. Principal is payable in full at maturity on October 28, 2023, and there are no scheduled principal payments prior to maturity. The Company is required to pay a commitment fee ranging between 20 and 30 basis points per annum of the average daily unused portion of the Revolving Credit Facility, depending on the Company’s funded debt leverage ratio. The obligations under the Revolving Credit Facility are guaranteed by each of the Company’s subsidiaries. As of June 30, 2023, the LIBOR interest rate benchmark has been phased out, triggering a Benchmark Transition Event as defined by the Company's Revolving Credit Facility. Accordingly, should the Company elect to borrow from its Revolving Credit Facility, LIBOR will be replaced with the Benchmark Replacement (as defined by the Revolving Credit Facility) for purposes of calculating an interest rate and the Revolving Credit Facility will be amended to reflect the same; until such Benchmark Replacement is implemented, loans requested by the Company under the Revolving Credit Facility must be made as Base Rate loans, as described above.

The purpose of the Revolving Credit Facility is for general working capital needs, permitted acquisitions (as defined in the Revolving Credit Facility), and for stock repurchase and/or redemption transactions that the Company may authorize.

The Revolving Credit Facility contains certain covenants that, among other things, restrict additional indebtedness, liens and encumbrances, changes to the character of the Company’s business, acquisitions, asset dispositions, mergers and consolidations, sale or discount of receivables, creation or acquisitions of additional subsidiaries, and other matters customarily restricted in such agreements.

In addition, the Revolving Credit Facility requires the Company to meet certain financial tests, including, without limitation:

As of June 30, ~~2022~~2023, the Company was in compliance with all covenants. There were 0no balances outstanding on the Revolving Credit Facility as of or during the three and six months ended June 30, ~~2022~~2023.

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

You should read the following discussion and analysis in conjunction with our Condensed Consolidated Financial Statements and related Notes included elsewhere in this report and our audited Consolidated Financial Statements and the Notes thereto for the year ended December 31, ~~2021,~~2022, appearing in our Annual Report on Form 10-K that was filed with the Securities and Exchange Commission (“SEC”) on February 28, ~~2022~~2023 (the ~~“2021~~“2022 Form 10-K”). Statements contained in this Quarterly Report on Form 10-Q that are not historical facts are forward-looking statements that the Company intends to be covered by the safe harbor provisions for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995. Statements that are predictive in nature, that depend on or refer to future events or conditions, or that include words such as “anticipates,” “believes,” “could,” “estimates,” “expects,” “intends,” “may,” “plans,” “potential,” “predicts,” “projects,” “should,” “will,” “would,” and similar expressions are forward-looking statements.

The Company cautions that forward-looking statements involve known and unknown risks, uncertainties, and other factors that may cause actual results, performance, or achievements to be materially different from any future results, performance, or achievements expressed or implied by the forward-looking statements. Forward-looking statements reflect our current views with respect to future events and are based on assumptions and subject to risks and uncertainties. Given these uncertainties, you should not place undue reliance on these forward-looking statements.

In evaluating any forward-looking statement, you should specifically consider the information regarding forward-looking statements set forth above and the risks set forth under the caption Part I, Item 1A. Risk Factors in our ~~2021~~2022 Form 10-K and other disclosures in our ~~2021~~2022 Form 10-K, earnings releases, and other filings with the SEC from time to time, as well as other cautionary statements contained elsewhere in this report, including our critical accounting policies and estimates as discussed in this report and our ~~2021~~2022 Form 10-K. We undertake no obligation to update or revise any forward-looking statements. You should read this report and the documents that we reference in this report and have filed as exhibits to this report completely and with the understanding that our actual future results may be materially different from what we currently expect.

HealthStream provides primarily SaaS based applications for healthcare organizations—all designed to improve business and clinical outcomes by supporting the people who deliver patient care. We are focused on helping healthcare organizations meet their ongoing clinical development, talent management, training, education, assessment, competency management, safety and compliance, scheduling, and provider credentialing, privileging, and enrollment needs.

~~We are in the process of more completely unifying the Company under~~Our business is managed and organized around a single platform strategy, ~~that will serve~~also referred to as our One HealthStream approach. At the ~~foundation for the entire enterprise.~~center of this single platform strategy is our hStream technology platform. By ~~enabling~~facilitating interoperability among our applications, ~~through a common technology platform known~~ as ~~hStream,~~well as third party applications, we believe that our hStream technology platform is allowing stand-alone applications ~~which already provide a powerful value proposition, will begin~~ to leverage each other to more efficiently and effectively empower our customers to manage their ~~organizations~~business and improve their outcomes.

As ~~we continue~~indicated in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022, filed on February 28, 2023, the Company has reached an inflection point in its efforts to ~~achieve this goal~~operate according to its One HealthStream approach. Since January 1, 2023, the Company’s business has been organized and managed around a consolidated, enterprise approach, including with regard to technology, operations, accounting, internal reporting (including the nature of ~~orienting multiple applications in relation to a single technology platform, distinctions between~~information reviewed by our ~~current reporting segments~~key decision maker), organization structure, compensation, performance assessment, and resource allocation.

As the result of these developments, the Company determined that Workforce Solutions and Provider Solutions ~~may become less applicable,~~were no longer separate operating segments or ~~even obsolete,~~separate reportable segments as of January 1, 2023, such that the Company would no longer present two reportable segments for periods beginning on and after this date. As such, since January 1, 2023, the Company has had a single reportable segment, such that the Company is presenting historical financial information on a single segment basis in ~~terms of how we operate~~this Quarterly Report on Form 10-Q for the three and report on the Company's business. At the current time, what we characterize and report on as Workforce Solutions products are used by healthcare organizations to meet a broad range of their clinical development, learning and performance, certification, scheduling, safety and compliance, and competency assessment needs. Provider Solutions products are used by healthcare organizations for provider credentialing, privileging, and enrollment needs. HealthStream’s primary customers include healthcare organizations and other participants in the healthcare industry.six months ended June 30, 2023.

Significant financial metrics for the second quarter of ~~2022~~2023 are set forth in the bullets below.

~~While~~The impact of the COVID-19 pandemic ~~persists and remains a~~continues to cause of uncertainty and potential economic volatility, ~~public health conditions related~~including with regard to ~~the pandemic have generally stabilized at the current time in the United States,~~our healthcare customers and our business. However, the impact of the pandemic itself on ~~general~~public health and economic conditions ~~in the United States appears to~~has significantly lessened and conditions have decreased. As the inflow of COVID patients with respect to healthcare organizations has become more manageable, certain areas of our business, such as our compliance and learning solutions, have begun to return to and, in some cases, even eclipse pre-pandemic norms. However, other parts of our business have continued to be negatively impacted by the ongoing impacts of the pandemic as well as current economic conditions. One of the more pronounced after-effects for our healthcare customers involves staffing challenges, including labor shortages and increased labor and staffing costs. In some instances, we believe that the pressures associated with these challenges continue to result in delayed sales for certain of our products, particularly those that are more elective in nature. However, we have recently begun to observe an increase in sales engagement with customers through both in-person and virtual meetings when compared to the height of the pandemic. Ultimately, we believe that our product offerings are well-positioned to help our healthcare customers successfully manage issues associated with onboarding, training, developing, engaging, and retaining employees—nurses in particular—and we remain dedicated to helping our customers overcome the challenges associated with the pandemic and ongoing economic conditions.

~~During~~normalized since the height of the pandemic ~~including~~ in 2020 and 2021, ~~we experienced delayed and reduced bookings and renewals due~~potentially to the ~~pandemic. Given that we sell multiple year subscriptions~~point of reaching an endemic stage.

Our business is focused on providing solutions to healthcare organizations, and as such the pandemic’s adverse impact on healthcare organizations has resulted in an adverse impact on our solutions, the revenue impact of lost or delayed sales in a given period generally does not manifest until future periods, just as the revenue we recognize in a given period is generally the result of sales from a prior period.Company. We believe that ~~the delay in bookings from the height of~~certain developments related to the pandemic negatively impacted our ~~revenue growth~~business in ~~the first half of 2022,~~2021 and to a lesser extent ~~will~~in 2022 and the six months ended June 30, 2023. In particular, sales cycles in 2021 and 2022 were delayed or postponed such that declines in sales bookings by customers over this period resulted in a negative impact to revenue and earnings in 2022 and the six months ended June 30, 2023 and may continue to ~~negatively~~result in a negative impact ~~our~~(to a lesser extent) to revenue ~~at least through the third quarter~~and earnings for a portion of ~~2022 and potentially throughout~~ the remainder of ~~the year. However, we also experienced increased bookings~~2023. Earlier in the ~~first half~~pandemic, such impacts on our healthcare organization customers were more frequently associated with the need to focus on providing critical care to pandemic victims and the negative economic impact many of ~~2022,~~our healthcare organization customers experienced from being forced to temporarily reduce or discontinue services, like elective surgeries, from which ~~we believe will begin~~they derive revenue. More recently, such impacts on healthcare customers appear to ~~benefit revenue that we will recognize~~be associated with the cessation of or significant reduction in governmental funds such customers have received or anticipate receiving through earlier federal stimulus and relief measures, including the Public Health Emergency Fund, the Paycheck Protection Program, and the Provider Relief Fund.

Macroeconomic conditions in the ~~latter half~~U.S. continue to be challenging in various respects, including as the result of ~~2022.~~

~~In addition, the U.S. economy has been experiencing various challenges, including recessionary concerns,~~ ongoing ~~inflation, significant~~inflationary pressures, elevated interest rate levels, disruptions to global supply networks, ~~and~~ challenging labor market ~~conditions.~~conditions, and potential instability in the banking system. Such negative macroeconomic conditions have adversely affected, and may continue to adversely affect, us and our customers in the healthcare industry. In ~~this regard,~~particular, we have ~~recently~~ experienced, and believe that ~~many~~some of our customers have experienced, increased labor, supply chain, capital, and other expenditures associated with current inflationary ~~pressures. These conditions impacting the U.S. economy~~pressures and our customers in the healthcare industry may adversely impact our business and results of operations. However, as discussed above, we also believe that our product offerings are well positioned to help customers mitigate some of the negative impacts otherwise associated with current labor ~~challenges as we continue to fulfill our vision of improving healthcare by developing the people who provide care.~~market conditions.

Our management utilizes the following financial and non-financial metrics in connection with managing our business.

As previously disclosed, the Company approved a consolidation program involving the elimination of 33 job roles during the first quarter of 2023, many of which job roles were duplicative as a result of several areas of consolidation. In connection with these job reductions, we incurred severance charges in the amount of $1.0 million during the three months ended March 31, 2023. In addition, while these job reductions were completed during the three months ended March 31, 2023, we incurred related severance charges in the amount of $0.1 million during the three months ended June 30, 2023, and expect to incur additional related severance charges in the aggregate amount of up to $40,000 during the remainder of 2023.

The Company’s Condensed Consolidated Financial Statements are prepared in accordance with US GAAP. These accounting principles require us to make certain estimates, judgments, and assumptions during the preparation of our Financial Statements. We believe the estimates, judgments, and assumptions upon which we rely are reasonable based upon information available to us at the time they are made. These estimates, judgments, and assumptions can affect the reported amounts of assets and liabilities as of the date of the Financial Statements, as well as the reported amounts of revenues and expenses during the periods presented and related disclosures. To the extent there are material differences between these estimates, judgments, or assumptions and actual results, our Financial Statements will be affected.

The accounting policies and estimates that we believe are the most critical in fully understanding and evaluating our reported financial results include the following:

In many cases, the accounting treatment of a particular transaction is specifically dictated by US GAAP and does not require management’s judgment in its application. There are also areas where management’s judgment in selecting among available alternatives would not produce a materially different result. See Notes to the Consolidated Financial Statements in our ~~2021~~2022 Form 10-K and the Notes to the Condensed Consolidated Financial Statements herein which contain additional information regarding our accounting policies and other disclosures required by US GAAP. There have been no changes in our critical accounting policies and estimates from those reported in our ~~2021~~2022 Form 10-K.

Three Months Ended June 30, ~~2022~~2023 Compared to Three Months Ended June 30, ~~2021~~2022

Revenues, net. Revenues increased approximately ~~$0.8~~$3.6 million, or 1%5%, to $69.2 million for the three months ended June 30, 2023 from $65.6 million for the three months ended June 30, ~~2022~~2022. The revenue growth was attributable to growth in several product categories, including $0.8 million, or 1%, of contributions from ~~$64.8~~our recent acquisitions. Subscription revenues increased $4.1 million, ~~for the three months ended June 30, 2021.~~or 6%, but were partially offset by $0.5 million of declines from professional services revenues.

A comparison of revenues by ~~business segment~~revenue source is as follows (in thousands):

Revenues for Workforce Solutions increased $0.3 million, or 1%, to $52.5 million for the three months ended June 30, 2022, from $52.2 million for the three months ended June 30, 2021. The Workforce Solutions segment experienced growth in several product categories, including contributions from recent acquisitions, partially offset by declines from the legacy resuscitation business of $0.9 million, as well as lower installed software license sales from the legacy portion of our Scheduling application suite.

Revenues for Provider Solutions increased $0.5 million, or 4%, to $13.2 million for the three months ended June 30, 2022, from $12.7 million for the three months ended June 30, 2021. Revenue growth was primarily attributable to new subscription revenues.

Cost of Revenues (excluding Depreciation and Amortization). Cost of revenues ~~decreased $0.5~~increased $1.4 million, or 2%6%, to $23.6 million for the three months ended June 30, 2023, from $22.2 million for the three months ended June 30, ~~2022, from $22.7 million for the three months ended June 30, 2021.~~2022. Cost of revenues as a percentage of revenues ~~was~~were 34% ~~and 35%~~ for both the three months ended June 30, ~~2022~~2023 and ~~2021, respectively.~~

Cost of revenues for Workforce Solutions decreased $1.0 million to $17.7 million for the three months ended June 30, 2022, compared to the prior year period and approximated 34% and 36% of revenues for Workforce Solutions for the three months ended June 30, 2022 and 2021, respectively. The decrease is primarily attributable to a lower royalties payable by us related to legacy resuscitation products, consistent with the reduction in these revenues. Cost of revenues for Provider Solutions increased $0.5 million to $4.5 million for the three months ended June 30, 2022, compared to the prior year period and approximated 34% and 31% of Provider Solutions revenues for the three months ended June 30, 2022 and 2021, respectively.2022. The increase in ~~amount~~expense is primarily associated with ~~an increase in personnel,~~higher costs for royalties and cloud hosting, as well as increased contract labor and software ~~costs during the three months ended June 30, 2022.~~expenses.

Product Development. Product development expenses increased ~~$0.3~~$0.4 million, or 2%4%, to $11.0 million for the three months ended June 30, 2023, from $10.6 million for the three months ended June 30, ~~2022, from $10.3 million for the three months ended June 30, 2021.~~2022. Product development expenses as a percentage of revenues were 16% for both the three months ended June 30, ~~2022~~2023 and ~~2021.~~

~~Product development expenses for Workforce Solutions decreased $8,000~~2022. The increase in expense is primarily due to $8.8 million for the three months ended June 30, 2022, compared to the prior year period and approximated 17% of revenues for Workforce Solutions for both the three months ended June 30, 2022 and 2021. Personnel expenses andincreased personnel costs, contract labor, and software costs, ~~increased over the prior year, but~~which were partially offset by an increase in labor capitalized for internally developed software. Product development expenses for Provider Solutions increased $0.3 million to $1.8 million for the three months ended June 30, 2022, compared to the prior year period and approximated 13% and 12% of revenues for Provider Solutions for the three months ended June 30, 2022 and 2021, respectively. The increase in product development expenses is primarily due to an increase in personnel costs compared to the prior year period.

Sales and Marketing. Sales and marketing expenses, including personnel costs, increased ~~$1.4~~$0.4 million, or ~~15%~~4%, to $11.3 million for the three months ended June 30, 2023, from $10.9 million for the three months ended June 30, ~~2022, from $9.5 million for the three months ended June 30, 2021.~~2022. Sales and marketing expenses were ~~17%~~16% and ~~15%~~17% of revenues for the three months ended June 30, ~~2022~~2023 and ~~2021, respectively.~~

~~Sales and marketing expenses for Workforce Solutions increased $1.3 million to $8.8 million for the three months ended June 30,~~ 2022, ~~compared to the prior year period and approximated 17% and 14% of revenues for Workforce Solutions for the three months ended June 30, 2022 and 2021,~~ respectively. The increase in expense is primarily due to increases in ~~personnel expenses, contract labor, marketing expenses, travel expense, and~~ sales commissions. Sales and marketing expenses for Provider Solutions increased $0.2 million to $1.8 million for the three months ended June 30, 2022, compared to the prior year period and approximated 14% and 13% of revenues for Provider Solutions for the three months ended June 30, 2022 and 2021, respectively. The increase is primarily due to an increasecommissions, which were partially offset by a decrease in personnel expenses, increased software costs, the return of travel expense, and increased sales commissions. The unallocated corporate portion of sales and marketing expenses decreased $0.1 million to $0.3 million for the three months ended June 30, 2022, compared to the prior year period, primarily due to a reduction in personnel costs andgeneral marketing expenses.

Other General and Administrative Expenses. Other general and administrative expenses decreased ~~$0.2~~$0.5 million, or 2%5%, to $9.1 million for the three months ended June 30, 2023, from $9.6 million for the three months ended June 30, ~~2022, from $9.8 million for the three months ended June 30, 2021.~~2022. Other general and administrative expenses were 13% and 15% of ~~revenues for both the three months ended June 30, 2022 and 2021.~~

Other general and administrative expenses for Workforce Solutions decreased $0.5 million to $2.5 million for the three months ended June 30, 2022, compared to the prior year period and approximated 5% and 6% of Workforce Solutions revenues for the three months ended June 30, ~~2022~~2023 and ~~2021,~~2022, respectively. The decrease is primarily due to ~~reductions in facilities costs associated with closing certain leased satellite offices~~lower bad debt expense, general office expenses, professional service fees, and a decrease in contract labor. Other general and administrative expenses for Provider Solutions increased $0.1 million to $1.0 million for the three months ended June 30, 2022, compared to the prior year period and approximated 7% of Provider Solutions revenues for both the three months ended June 30, 2022 and 2021. The unallocated corporate portion of other general and administrative expenses increased $0.2 million to $6.1 million for the three months ended June 30, 2022, compared to the prior year period primarily due to increases in software ~~expense and employee recruitment~~ expenses.

Depreciation and Amortization. Depreciation and amortization expense increased ~~$0.3~~$0.8 million, or 3%9%, to $10.2 million for the three months ended June 30, 2023, from $9.4 million for the three months ended June 30, ~~2022, from $9.1 million for the three months ended June 30, 2021.~~2022. This increase is primarily a result of an increase in amortization associated with capitalized software.

Other Income, ~~(Loss),~~ Net. Other income, ~~(loss),~~ net was ~~income of~~$0.5 million for the three months ended June 30, 2023, compared to $0.7 million for the three months ended June 30, ~~2022, compared to a loss~~2022. The decrease is primarily the result of ~~$65,000 for~~the $0.9 million gain recorded during the three months ended June 30, ~~2021. The increase is primarily a result of the $0.9 million gain recorded~~2022 due to the change in fair value of our previously held minority interest in CloudCME, LLC that was remeasured upon acquiring the remaining ownership interest of CloudCME during such period, partially offset by an increase in interest income earned on cash and investments during the three months ended June 30, ~~2022.~~2023.

Income Tax Provision. The Company recorded a provision for income taxes of $0.4 million for the three months ended June 30, 2023, compared to $0.5 million for the three months ended June 30, ~~2022, compared to $0.9 million~~2022. The Company’s effective tax rate was 8% for the three months ended June 30, ~~2021. The Company’s effective tax rate was~~2023, compared to 15% for the three months ended June 30, ~~2022, compared to 27% for the three months ended June 30, 2021.~~2022. The Company’s effective tax rate primarily reflects the statutory corporate income tax rate, the net effect of state taxes, foreign income taxes, the effect of various permanent tax differences, and recognition of discrete tax items. During the three months ended June 30, 2023, the Company recorded discrete tax benefits of $0.5 million, which consisted primarily of tax benefits in the amount of $0.6 million resulting from changes in apportionment rules in Tennessee upon the enactment of the Tennessee Works Tax Act, partially offset by $0.1 million of discrete tax expense related to reserves for uncertain tax positions. During the three months ended June 30, 2022, the Company recorded discrete tax benefits of $0.2 million, which consisted primarily of a $0.2 million tax benefit associated with a nontaxable gain of $0.9 million recognized from the change in fair value of our previously held minority interest in CloudCME, ~~LLC.~~LLC as noted above.

Net Income. Net income was ~~$3.1~~$4.1 million and ~~$2.4~~$3.1 million for the three months ended June 30, ~~2022~~2023 and ~~2021,~~2022, respectively. Earnings per share (EPS) ~~was $0.10~~were $0.13 per share (diluted) and ~~$0.08~~$0.10 per share (diluted) for the three months ended June 30, ~~2022~~2023 and ~~2021,~~2022, respectively.

Adjusted EBITDA was $15.3 million for the three months ended June 30, 2023, compared to $13.1 million for the three months ended June 30, ~~2022, compared to $14.5 million for the three months ended June 30, 2021.~~2022. See “Reconciliation of Non-GAAP Financial Measures” below for our reconciliation of adjusted EBITDA to the most directly comparable ~~measures~~measure under US GAAP and disclosure regarding why we believe adjusted EBITDA provides useful information to investors.

Six Months Ended June 30, ~~2022~~2023 Compared to Six Months Ended June 30, ~~2021~~2022

Revenues, net. Revenues increased approximately ~~$2.7~~$7.1 million, or 2%5%, to $138.1 million for the six months ended June 30, 2023, from $131.0 million for the six months ended June 30, ~~2022~~2022. The revenue growth was attributable to growth in several product categories, including contributions from ~~$128.3~~our recent acquisitions. Subscription revenues increased $8.0 million, ~~for the six months ended June 30, 2021.~~or 6%, but were partially offset by $0.9 million of declines from professional services revenues.

A comparison of revenues by ~~business segment~~revenue source is as follows (in thousands):

Revenues for Workforce Solutions increased $1.1 million, or 1%, over the first six months of 2021. Contributions from recent acquisitions and growth in other workforce solutions more than offset the expected decline in revenues from legacy resuscitation products of $2.6 million.

~~Revenues for Provider Solutions increased $1.6 million, or 6%, over the first six months of 2021. Revenue growth was primarily attributable to new subscription revenues.~~

Cost of Revenues (excluding Depreciation and Amortization). Cost of revenues ~~decreased $1.3~~increased $3.2 million, or 3%7%, to $47.4 million for the six months ended June 30, 2023, from $44.2 million for the six months ended June 30, ~~2022, from $45.5 million for the six months ended June 30, 2021.~~2022. Cost of revenues as a percentage of revenues ~~was~~were 34% ~~and 35%~~ for both the six months ended June 30, ~~2022~~2023 and ~~2021, respectively.~~

Cost of revenues for Workforce Solutions decreased $2.2 million to $35.3 million and approximated 34% and 36% of revenues for Workforce Solutions for the six months ended June 30, 2022 and 2021, respectively. The decrease in amount is primarily attributable to a lower royalties payable by us related to legacy resuscitation products, consistent with the reduction in these revenues. Cost of revenues for Provider Solutions increased $0.9 million to $8.9 million and approximated 34% and 32% of Provider Solutions revenues for the six months ended June 30, 2022 and 2021, respectively.2022. The increase in ~~amount~~expense is primarily associated with ~~an increase in~~ personnel costs, including severance costs associated with the elimination of 33 job roles as part of the consolidation of HealthStream's business under a single platform strategy. In addition, we experienced higher costs for royalties, cloud hosting, contract labor, and software ~~expense during the six months ended June 30, 2022.~~expenses.

Product Development. Product development expenses increased ~~$1.1~~$1.7 million, or 6%8%, to $22.7 million for the six months ended June 30, 2023, from $21.0 million for the six months ended June 30, ~~2022 from $19.9 million for the six months ended June 30, 2021.~~2022. Product development expenses as a percentage of revenues were 16% ~~and 15% of revenues~~ for both the six months ended June 30, ~~2022~~2023 and ~~2021, respectively.~~

Product development expenses for Workforce Solutions increased $0.6 million to $17.7 million and approximated 17% and 16% of revenues for Workforce Solutions for the six months ended June 30, 2022 and 2021, respectively.2022. The increase in expense is primarily ~~associated with~~due to increased personnel costs, including severance costs as noted above, and an increase in ~~personnel costs, partially related to recent acquisitions, and~~ contract labor, which ~~was~~were partially offset by an increase in labor capitalized for internally developed software. Additionally, the six months ended June 30, 2021 included a non-recurring, non-cash benefit related to the reduction of paid time off ("PTO") expense as a result of modifications to the Company's PTO policy. Product development expenses for Provider Solutions increased $0.5 million to $3.3 million and approximated 13% and 11% of revenues for Provider Solutions for the six months ended June 30, 2022 and 2021, respectively. The increase is primarily due to an increase in personnel costs.

Sales and Marketing. Sales and marketing expenses, including personnel costs, increased ~~$2.8~~$1.7 million, or ~~15%~~8%, to $23.0 million for the six months ended June 30, 2023, from $21.3 million for the six months ended June 30, ~~2022 from $18.5 million for the six months ended June 30, 2021.~~2022. Sales and marketing expenses were ~~16%~~17% and ~~14%~~16% of revenues for the six months ended June 30, ~~2022~~2023 and ~~2021, respectively.~~

~~Sales and marketing expenses for Workforce Solutions increased $2.6 million to $17.2 million and approximated 16% and 14% of revenues for Workforce Solutions for the six months ended June 30,~~ 2022, ~~and 2021,~~ respectively. The increase is primarily ~~associated with increases in personnel costs, sales commissions, travel, and marketing expenses. Sales and marketing expenses for Provider Solutions increased $0.4 million~~due to ~~$3.6 million and approximated 13% of revenues for Provider Solutions for both the six months ended June 30, 2022 and 2021. The increase in amount is a result of~~ increased personnel costs, ~~software~~including severance costs as noted above, as well as higher sales commissions and travel ~~and sales commissions. The unallocated portion of sales and marketing expenses decreased $0.2 million to $0.5 million compared to the prior year period primarily due to~~costs, which were partially offset by a decrease in ~~personnel costs and~~general marketing expenses.

Other General and Administrative Expenses. Other general and administrative expenses decreased ~~$0.6~~$0.8 million, or 3%4%, to $17.9 million for the six months ended June 30, 2023, from $18.8 million for the six months ended June 30, ~~2022 from $19.4 million for the six months ended June 30, 2021.~~2022. Other general and administrative expenses ~~as a percentage of revenues~~ were ~~14%~~13% and ~~15%~~14% of revenues for the six months ended June 30, ~~2022~~2023 and ~~2021, respectively.~~

Other general and administrative expenses for Workforce Solutions decreased $1.5 million to $4.6 million and approximated 4% and 6% of revenues for Workforce Solutions for the six months ended June 30, 2022, ~~and 2021,~~ respectively. The decrease is primarily due to ~~reductions in facilities costs associated with closing certain leased satellite offices,~~ lower ~~transition~~employee recruitment and onboarding expenses, professional service ~~costs associated with prior acquisitions, including with regard to the end of our transition services agreement with Change Healthcare,~~fees, software expenses, and general office expenses, which related to our acquisition of the Scheduling and Capacity Management business, and a decrease in contract labor. Other general and administrative expenses for Provider Solutions increased $0.3 million to $1.9 million and approximated 7% of revenues for Provider Solutions for both the six months ended June 30, 2022 and 2021. Thewere partially offset by an increase in amount is primarily due to increased personnel costs. The unallocated corporate portion of other general and administrative expenses increased $0.6 million to $12.3 million compared to the first six months of 2021 primarily due to increased employee recruitment expenses as well as software expenses over the prior year period.stock-based compensation.

Depreciation and Amortization. Depreciation and amortization expense increased ~~$0.4~~$1.4 million, or 2%7%, to $20.1 million for the six months ended June 30, 2023, from $18.7 million for the six months ended June 30, ~~2022, from $18.3 million for the six months ended June 30, 2021.~~2022. This increase is primarily a result of an increase in amortization associated with capitalized ~~software.~~software, partially offset by lower depreciation expense.

Other Income, ~~(Loss),~~ Net. Other income, ~~(loss),~~ net was ~~income of~~$0.7 million for the six months ended June 30, 2023, compared to $0.4 million for the six months ended June 30, ~~2022, compared to a loss~~2022. The increase is primarily the result of ~~$0.2 million for~~an increase in interest income earned on cash and investments during the six months ended June 30, ~~2021. The increase is primarily~~2023 compared to the prior year period coupled with a ~~result of~~reduction in losses recorded on equity method investments, partially offset by the $0.9 million gain recorded due to the change in fair value of our previously held minority interest in CloudCME, LLC during the six months ended June 30, 2022 that was remeasured upon acquiring the remaining ownership interest of CloudCME, ~~during the six months ended June 30, 2022.~~LLC such 2022 period.

Income Tax Provision. The Company recorded a provision for income taxes of ~~$1.4 million and $1.8~~$0.9 million for the six months ended June 30, ~~2022 and 2021, respectively.~~2023, compared to $1.4 million the six months ended June 30, 2022. The Company’s effective tax rate was 12% for the six months ended June 30, 2023, compared to 19% for the six months ended June 30, ~~2022, compared to 28% for the six months ended June 30, 2021.~~2022. The Company’s effective tax rate primarily reflects the statutory corporate income tax rate, the net effect of state taxes, foreign income taxes, the effect of various permanent tax differences, and recognition of discrete tax items. During the six months ended June 30, 2023, the Company recorded discrete tax benefits of $0.5 million, which consisted primarily of tax benefits in the amount of $0.6 million resulting from changes in apportionment rules in Tennessee upon the enactment of the Tennessee Works Tax Act, and stock-based awards, in the amount of $0.1 million, partially offset by $0.2 million of discrete tax expense related to reserves for uncertain tax positions. During the six months ended June 30, 2022, the Company recorded discrete tax benefits of $0.1 million, which consisted primarily of a $0.2 million tax benefit associated with a nontaxable gain of $0.9 million recognized from the change in fair value of our previously held minority interest in CloudCME, ~~LLC.~~LLC as noted above. This tax benefit was partially offset by $0.1 million of excess tax deficiencies associated with stock-based awards. During the six months ended June 30, 2021, the Company recorded discrete tax expense a $0.2 million primarily related to purchase accounting adjustments and the impact of a state tax rate change enacted during the period.

Net Income. Net income was ~~approximately $6.0~~$6.8 million and ~~$4.7~~$6.0 million for the six months ended June 30, ~~2022~~2023 and ~~2021,~~2022, respectively. Earnings per share (EPS) ~~was $0.19~~were $0.22 per share (diluted) and ~~$0.15~~$0.19 per share (diluted) for the six months ended June 30, ~~2022~~2023 and ~~2021,~~2022, respectively.

Adjusted EBITDA ~~decreased $1.0~~was $29.1 million for the six months ended June 30, 2023, compared to $27.1 million for the six months ended June 30, ~~2022, compared to $28.1 million for the six months ended June 30, 2021. This decrease resulted from the factors mentioned above.~~2022. See “Reconciliation of Non-GAAP Financial Measures” below for our reconciliation of ~~Adjusted~~adjusted EBITDA to the most directly comparable measure under US ~~GAAP.~~GAAP and disclosure regarding why we believe adjusted EBITDA provides useful information to investors.

This Quarterly Report on Form 10-Q presents adjusted EBITDA, which is a non-GAAP financial measure used by management in analyzing our financial results and ongoing operational performance.

In order to better assess the Company’s financial results, management believes that net income excluding the impact of the deferred revenue write-downs associated with fair value accounting for acquired businesses (as discussed in greater detail below) and before interest, income taxes, stock-based compensation, depreciation and amortization, and changes in fair value of, including gains (losses) on the sale of, non-marketable equity investments ~~and the de-recognition of non-cash expense resulting from the paid time off expense reduction in the first quarter of 2021~~ (“adjusted EBITDA”) is a useful measure for evaluating the operating performance of the Company because adjusted EBITDA reflects net income adjusted for certain GAAP accounting, non-cash, ~~and~~and/or non-operating items which may not, in any such case, fully reflect the underlying operating performance of our business. We also believe that adjusted EBITDA is useful to ~~many~~ investors to assess the Company’s ongoing operating performance and to compare the Company’s operating performance between periods. Additionally, short-term cash incentive bonuses and ~~certain~~ performance-based equity awards are based on the achievement of adjusted EBITDA (as defined in applicable bonus and equity grant documentation) targets.

As noted above, the definition of adjusted EBITDA includes an adjustment for the impact of the deferred revenue write-downs associated with fair value accounting for acquired businesses. Prior to the Company early adopting ASU 2021-08 effective January 1, 2022, following the completion of any acquisition by the Company, the Company was required to record the acquired deferred revenue at fair value as defined in GAAP, which typically resulted in a write-down of the acquired deferred revenue. When the Company was required to record a write-down of deferred revenue, it resulted in lower recognized revenue, operating income, and net income in subsequent periods. Revenue for any such acquired business was deferred and was typically recognized over a one-to-two year period following the completion of any particular acquisition, so our GAAP revenues for this one-to-two year period would not reflect the full amount of revenues that would have been reported if the acquired deferred revenue was not written down to fair value. Management believes that including an adjustment in the definition of adjusted EBITDA for the impact of the deferred write-downs associated with fair value accounting for businesses acquired prior to the January 1, 2022 effective date of the Company's adoption of ASU 2021-08 provides useful information to investors because the deferred revenue write-down recognized in periods after an acquisition may, given the nature of this non-cash accounting impact, cause our GAAP financial results during such periods to not fully reflect our underlying operating performance and thus adjusting for this amount may assist in comparing the Company’s results of operations between periods. Following the adoption of ASU 2021-08, contracts acquired in an acquisition completed on or after January 1, 2022 ~~will be~~are measured as if the Company had originated the contract (rather than the contract being measured at fair value) such that, for such acquisitions, the Company ~~will~~ no longer ~~record~~records deferred revenue write-downs associated with acquired businesses (for acquisitions completed prior to January 1, 2022, the Company ~~will continue~~continues to record deferred revenue write-downs associated with fair value accounting for periods on and after January 1, 2022 consistent with past practice). At the current time, the Company intends to continue to include an adjustment in the definition of adjusted EBITDA for the impact of deferred revenue write-downs from business acquired prior to January 1, 2022 given the ongoing impact of such deferred revenue on our financial results.

Adjusted EBITDA is a non-GAAP financial measure and should not be considered as a measure of financial performance under GAAP. Because adjusted EBITDA is not a measurement determined in accordance with GAAP, adjusted EBITDA is susceptible to varying calculations. Accordingly, adjusted EBITDA, as presented, may not be comparable to other similarly titled measures of other companies and has limitations as an analytical ~~tools.~~tool.

A reconciliation of adjusted EBITDA to the most directly comparable GAAP measure is set forth below (in thousands).

Net cash provided by operating activities ~~increased~~decreased by ~~$3.7~~$2.5 million to $25.5 million during the six months ended June 30, 2023, from $28.0 million during the six months ended June 30, ~~2022, from $24.3~~2022. The decrease in net cash provided by operating activities is primarily due to $2.6 million of income tax payments made during the six months ended June 30, ~~2021. This increase was primarily due~~2023 compared to ~~lower royalties paid by us compared to~~$0.4 million in the prior year ~~period and was partially offset by lower cash receipts and increased labor costs.~~period. Our days sales outstanding ("DSO") ~~was~~increased to 50 days for the second quarter of 2023 from 45 days for the second quarter of 2022 ~~compared~~due to ~~43 days for the second quarter of 2021.~~certain customers delaying payments longer than usual. The Company calculates DSO by dividing the average accounts receivable balance for the quarter by average daily revenues for the quarter. The Company’s primary sources of cash were receipts generated from the sales of our products and services. The primary uses of cash to fund operations included personnel expenses, sales commissions, royalty payments, payments for contract labor and other direct expenses associated with delivery of our products and services, income tax payments, and general corporate expenses.

Net cash used in investing activities was $43.3 million for the six months ended June 30, 2023, compared to $14.0 million for the six months ended June 30, ~~2022, compared to $10.6 million for~~2022. During the six months ended June 30, ~~2021.~~2023, the Company spent $6.6 million for the acquisition of substantially all of the assets of Electronic Education Documentation System, LLC ("eeds") (note: the eeds acquisition was consummated on December 31, 2022, but was funded in January 2023 such that the purchase price for eeds impacted net cash used in investing activities during the six months ended June 30, 2023), invested in marketable securities of $32.0 million, made payments for capitalized software development of $13.3 million, and purchased property and equipment of $1.4 million. These uses of cash were partially offset by $10.0 million in maturities of marketable securities. During the six months ended June 30, 2022, the Company spent $3.9 million to acquire the remaining ownership interest in CloudCME on a net cash basis and spent $62,000 related to post-closing adjustments for prior acquisitions for a net cash outflow of $4.0 million for business combinations, invested in marketable securities of $2.0 million, made payments for capitalized software development of $11.8 million, and purchased property and equipment of $1.2 million. These uses of cash were partially offset by $5.0 million in maturities of marketable securities. During the six months ended June 30, 2021, the Company spent $2.0 million to acquire ComplyALIGN and on a net cash basis received $1.3 million of proceeds upon settling post-closing adjustments related to ANSOS and ShiftWizard acquisitions for a net cash outflow of $0.7 million for business combinations, invested in marketable securities of $5.2 million, made payments for capitalized software development of $10.3 million, purchased property and equipment of $2.4 million, and invested $1.8 million in non-marketable equity investments. These uses of cash were partially offset by $9.7 million in maturities of marketable securities.

Net cash used in financing activities was approximately $2.3 million for the six months ended June 30, 2023, compared to $23.6 million for the six months ended June 30, ~~2022, compared to $0.4 million~~2022. The uses of cash for the six months ended June 30, ~~2021.~~2023 included $1.5 million for the payment of cash dividends and $0.8 million for the payment of employee payroll taxes in relation to the vesting of restricted share units. The uses of cash for the six months ended June 30, 2022 included $23.1 million for repurchases of common stock and $0.5 million for the payment of employee payroll taxes in relation to the vesting of restricted share units. ~~The uses of cash for the six months ended June 30, 2021 primarily included $0.4 million for the payment of employee payroll taxes in relation to the vesting of restricted share units.~~

Our balance sheet reflects positive working capital of $8.9 million at June 30, 2023, compared to negative working capital of ~~$9.6 million at June 30, 2022, compared to positive working capital of $6.5~~$2.8 million at December 31, ~~2021.~~2022. The ~~decrease~~increase in working capital is primarily a result of ~~a reduction~~an increase in cash and cash equivalents and marketable securities in the aggregate, despite the use of cash to fund the acquisition of ~~CloudCME, repurchases of common stock and an increase~~eeds, which resulted in ~~deferred revenue.~~a corresponding decrease in accrued liabilities. The Company’s primary source of liquidity as of June 30, ~~2022~~2023 was ~~$37.2~~$25.8 million of cash and cash equivalents and ~~$2.0~~$30.2 million of marketable securities. The Company also has a $65.0 million revolving credit facility, all of which was available for additional borrowing at June 30, ~~2022.~~2023. The revolving credit facility expires on October 28, 2023, unless earlier renewed or amended.

On November 30, 2021, the ~~Company's Board of Directors authorized~~Company announced a share repurchase program approved by the Company’s Board of Directors under which the Company was authorized to ~~repurchase~~purchase up to $20.0 million of ~~the Company's outstanding shares of~~its common stock. ~~The~~This share repurchase program concluded on March 8, 2022, when the maximum dollar amount authorized under the program was expended. Under this program, the Company repurchased a total of 853,023 shares in open market purchases at an aggregate value of $20.0 million, reflecting an average price per share of $23.45 (excluding the cost of broker commissions). During the ~~six~~three months ended ~~June 30,~~March 31, 2022 the Company repurchased 649,739 shares of common stock pursuant to this share repurchase program at an aggregate fair value of $14.9 million, ~~based on~~reflecting an average price per share of $22.92 (excluding the cost of broker commissions).

On March 14, 2022, the ~~Company's~~ Board ~~of Directors~~ approved an expansion of the Company's share repurchase program by authorizing the repurchase of up to an additional $10.0 million of the Company's outstanding shares of common stock. The share repurchase program ~~is scheduled to terminate~~expired on ~~the earlier of~~ March 13, 2023, ~~or when~~and no repurchases occurred during the ~~maximum dollar amount has been expended. During the six~~three months ended ~~June 30, 2022,~~March 31, 2023. Under this program, the Company repurchased a total of 402,050 shares ~~pursuant to this share repurchase program~~ at an aggregate fair value of $8.1 million, based on an average price per share of $20.19 (excluding the cost of broker commissions), including 242,647 shares purchased during the three months ended March 31, 2022, at an aggregate fair value of $5.0 million, based on an average per share price of $20.52 (excluding the cost of broker commissions). We may elect in the future to adopt a new share repurchase program.

On February 20, 2023, we announced that our Board approved a dividend policy under which we intend to pay quarterly cash dividends on our common stock, at an initial rate of $0.025 per share per fiscal quarter. We also announced that our Board declared the initial quarterly dividend under the new policy in the amount of $0.025 per share, which was paid on April 28, 2023 to the holders of record of all of the issued and outstanding shares of common stock as of the close of business on April 17, 2023. This marked the first quarterly cash dividend policy adopted by the Company. On April 24, 2023, the Board approved the Company's second quarterly cash dividend of $0.025 per share, which was paid on June 23, 2023 to holders of record on June 12, 2023. On July 24, 2023, the Board approved the Company's third quarterly cash dividend of $0.025 per share, payable on September 29, 2023 to holders of record on September 18, 2023. Further, the Company intends to declare and pay one more quarterly cash dividend in 2023. The dividend policy and the declaration and payment of each quarterly cash dividend will be subject to our Board’s continuing determination that the policy and the declaration and payment of dividends thereunder are in the best interests of our stockholders and are in compliance with applicable law and our credit agreement. Our Board retains the power to modify, suspend, or cancel the dividend policy and quarterly dividends thereunder in any manner and at any time that our Board may deem necessary or appropriate.

We believe that our existing cash and cash equivalents, marketable securities, cash generated from operations, and available borrowings under our revolving credit facility will be sufficient to meet anticipated working capital needs, new product development, dividend payments, and capital expenditures for at least the next 12 months and for the foreseeable future thereafter.

In addition, the Company’s growth strategy includes acquiring businesses or making strategic investments in businesses that complement or enhance our business. It is anticipated that future acquisitions or strategic investments, if any, would be effected through cash consideration, stock consideration, or a combination of both. The issuance of our stock as consideration for an acquisition or to raise additional capital could have a dilutive effect on earnings per share and could adversely affect our stock price. Our revolving credit facility contains financial covenants and availability calculations designed to set a maximum leverage ratio of outstanding debt to adjusted EBITDA and an interest coverage ratio of adjusted EBITDA to interest expense. Therefore, the maximum borrowings against our revolving credit facility would be dependent on the covenant calculations at the time of borrowing. As of June 30, ~~2022,~~2023, we were in compliance with all covenants. There can be no assurance that amounts available for borrowing under our revolving credit facility will be sufficient to consummate any possible acquisitions, and we cannot ~~assure you~~provide assurance that if we need additional financing that it will be available on terms favorable to us, or at all. Failure to generate sufficient cash flow from operations or raise additional capital when required in sufficient amounts and on terms acceptable to us could harm our business, financial condition, and results of operations.

The Company is exposed to market risk from changes in interest rates, foreign currency risk, and investment risk. We do not have any commodity price risk.

As of June 30, ~~2022,~~2023, and during the three and six months then ended, the Company had no outstanding debt. We may become subject to interest rate market risk associated with any future borrowings under our revolving credit facility. The interest rate under the revolving credit facility varies depending on the interest rate option selected by the Company plus a margin determined in accordance with a pricing grid. We are also exposed to market risk with respect to our cash and investment balances, which approximated ~~$39.2~~$56.0 million at June 30, ~~2022.~~2023. Assuming a hypothetical 10% decrease in interest rates for invested balances, interest income from cash and investments would decrease on an annualized basis by approximately ~~$6,000.~~$0.2 million.

We have foreign currency risks related to our revenue and operating expenses denominated in currencies other than the US dollar, including Canadian dollar, New Zealand dollar, and Australian dollar. Increases or decreases in our foreign-denominated revenue from movements in foreign exchange rates are often partially offset by the corresponding increases or decreases in our foreign-denominated operating expenses.

To the extent that our international operations grow, our risks associated with fluctuation in currency rates will become greater, and we will continue to assess our approach to managing this risk. In addition, currency fluctuations or a weakening US dollar can increase the costs of our international operations. To date, we have not entered into any foreign currency hedging contracts although we may do so in the future.

The Company’s investment policy and strategy is focused on investing in highly rated securities with the objective of minimizing the potential risk of principal loss. The Company’s policy limits the amount of credit exposure to any single issuer and sets limits on the average portfolio maturity.

We have an investment portfolio that includes strategic investments in privately held companies, which primarily include early-stage companies. We primarily invest in healthcare technology companies that we believe can help expand our ecosystem. We may continue to make these types of strategic investments as opportunities arise that we find attractive. We may experience additional volatility to our Consolidated Financial Statements due to changes in market prices, observable price changes, and impairments to our strategic investments. These changes could be material based on market conditions and events.

The above market risk discussion and the estimated amounts presented are forward-looking statements of market risk assuming the occurrence of certain adverse market conditions. Actual results in the future may differ materially from those projected as a result of actual developments in the market.

HealthStream’s chief executive officer and principal financial officer have reviewed and evaluated the effectiveness of the Company’s disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) promulgated under the Securities Exchange Act of 1934 (the “Exchange Act”)) as of the end of the period covered by this Quarterly Report. Based on that evaluation, the chief executive officer and principal financial officer have concluded that HealthStream’s disclosure controls and procedures were effective to ensure that the information required to be disclosed by the Company in the reports the Company files or submits under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms, and the information required to be disclosed in the reports the Company files or submits under the Exchange Act was accumulated and communicated to the Company’s management, including its chief executive officer and principal financial officer, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure.

There was no change in HealthStream’s internal control over financial reporting that occurred during the second quarter of ~~2022~~2023 that has materially affected, or that is reasonably likely to materially affect, HealthStream’s internal control over financial reporting.

There have been no material changes to the risk factors previously disclosed in the ~~2021~~2022 Form 10-K.

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

~~In connection with~~None. Without limiting the ~~Company’s acquisition~~generality of the ~~remaining ownership interest of CloudCME as set forth above,~~foregoing, the Company ~~issued 208,567~~did not purchase any shares of ~~the Company’s~~ common stock ~~at the closing of such acquisition on May 18, 2022, which shares had a value of $4.1 million at the closing. These shares were issued to CloudCME's founder Karl Wilkens as partial payment~~ of the purchase price to Mr. Wilkens in exchange for his ownership interest as noted above. These shares were issued in a private placement in reliance upon the exemption set forth in Section 4(a)(2) of the Securities Act.

~~On March 14, 2022, the~~ Company announced an expansion of the share repurchase program authorized by the Company’s Board of Directors under which the Company may purchase up to an additional $10.0 million of its common stock. Pursuant to this authorization, repurchases may be made in the open market, including under a Rule 105b-1 plan, through privately negotiated transactions, or otherwise. Under this program, during the first six months of 2022 the Company repurchased 402,050 shares at an aggregate fair value of $8.1 million, reflecting an average price per share of $20.19 (excluding the cost of broker commissions). In addition, any future repurchases under the authorization will be subject to prevailing market conditions, liquidity and cash flow considerations, applicable securities laws requirements (including under Rule 10b-18 and Rule 10b5-1 of the Securities Exchange Act of 1934, as applicable), and other factors. The share repurchase program is scheduled to terminate on the earlier of March 13, 2023 or when the maximum dollar amount has been expended.

~~The table below sets forth activity under the stock repurchase plan for~~ the three months ended June 30, ~~2022.~~2023.

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.

		Page Number
Part I.	Financial Information	1
Item 1.	Financial Statements	1
	Condensed Consolidated Balance Sheets (Unaudited) – June 30, ~~2022~~2023 and December 31, ~~2021~~2022	1
	Condensed Consolidated Statements of Income (Unaudited) – Three and Six Months ended June 30, ~~2022~~2023 and ~~2021~~2022	2
	Condensed Consolidated Statements of Comprehensive Income (Unaudited) – Three and Six Months ended June 30, ~~2022~~2023 and ~~2021~~2022	3
	Condensed Consolidated Statement of Shareholders' Equity (Unaudited) – Three and Six Months ended June 30, ~~2022~~2023 and ~~2021~~2022	4
	Condensed Consolidated Statements of Cash Flows (Unaudited) – Six Months ended June 30, ~~2022~~2023 and ~~2021~~2022	5
	Notes to Condensed Consolidated Financial Statements (Unaudited)	6
Item 2.	Management's Discussion and Analysis of Financial Condition and Results of Operations	11
Item 3.	Quantitative and Qualitative Disclosures about Market Risk	1920
Item 4.	Controls and Procedures	1921
Part II.	Other Information	2021
Item 1A.	Risk Factors	2021
Item 6.	Exhibits	21
	SIGNATURE	22

	*Three Months Ended*					*Six Months Ended*					*Three Months Ended*				*Six Months Ended*
	*June 30, 2022*		*June 30, 2021*			*June 30, 2022*		*June 30, 2021*			*June 30, 2023*		*June 30, 2022*		*June 30, 2023*		*June 30, 2022*
Revenues, net	$	65,638	$	64,816		$	131,005	$	128,284		$	69,198	$	65,638	$	138,144	$	131,005
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)		22,234		22,657			44,232		45,518			23,567		22,234		47,424		44,232
Product development		10,583		10,336			20,995		19,861			11,031		10,583		22,711		20,995
Sales and marketing		10,869		9,462			21,287		18,481			11,307		10,869		23,035		21,287
Other general and administrative expenses		9,579		9,781			18,760		19,391			9,063		9,579		17,927		18,760
Depreciation and amortization		9,420		9,149			18,742		18,302			10,222		9,420		20,148		18,742
Total operating costs and expenses		62,685		61,385			124,016		121,553			65,190		62,685		131,245		124,016

Operating income		2,953		3,431			6,989		6,731			4,008		2,953		6,899		6,989

Other income (loss), net		679		(65	)		402		(152	)
Other income, net												492		679		742		402

Income before income tax provision		3,632		3,366			7,391		6,579			4,500		3,632		7,641		7,391
Income tax provision		549		925			1,415		1,847			367		549		885		1,415
Net income	$	3,083	$	2,441		$	5,976	$	4,732		$	4,133	$	3,083	$	6,756	$	5,976

Net income per share:
Basic	$	0.10	$	0.08		$	0.19	$	0.15		$	0.13	$	0.10	$	0.22	$	0.19
Diluted	$	0.10	$	0.08		$	0.19	$	0.15		$	0.13	$	0.10	$	0.22	$	0.19

Weighted average shares of common stock outstanding:
Basic		30,491		31,553			30,723		31,528			30,684		30,491		30,638		30,723
Diluted		30,512		31,616			30,744		31,571			30,775		30,512		30,717		30,744
Dividends declared per share											$	0.025	$	—	$	0.050	$	—

	*Three Months Ended*					*Six Months Ended*					*Three Months Ended*						*Six Months Ended*
	*June 30, 2022*			*June 30, 2021*		*June 30, 2022*			*June 30, 2021*		*June 30, 2023*			*June 30, 2022*			*June 30, 2023*			*June 30, 2022*
Net income	$	3,083		$	2,441	$	5,976		$	4,732	$	4,133		$	3,083		$	6,756		$	5,976

Other comprehensive income, net of taxes:
Other comprehensive income (loss), net of taxes:
Foreign currency translation adjustments		(782	)		347		(505	)		577		177			(782	)		144			(505	)
Unrealized gain (loss) on marketable securities		2			4		(3	)		8
Total other comprehensive (loss) income		(780	)		351		(508	)		585
Unrealized (loss) gain on marketable securities												(50	)		2			(52	)		(3	)
Total other comprehensive income (loss)												127			(780	)		92			(508	)
Comprehensive income	$	2,303		$	2,792	$	5,468		$	5,317	$	4,260		$	2,303		$	6,848		$	5,468

	*Six Months Ended June 30, 2022*														*Six Months Ended June 30, 2023*
	*Common Stock*						*Retained*		*Accumulated Other Comprehensive*			*Total Shareholders’*			*Common Stock*					*Retained*			*Accumulated Other Comprehensive*			*Total Shareholders’*
	*Shares*			*Amount*			*Earnings*		*Income (Loss)*			*Equity*			*Shares*		*Amount*			*Earnings*			*Loss*			*Equity*
Balance at December 31, 2021		31,327		$	270,791		$	68,122	$	106		$	339,019
Balance at December 31, 2022																30,579	$	254,832		$	80,213		$	(981	)	$	334,064
Net income																—		—			2,623			—			2,623
Comprehensive loss																—		—			—			(35	)		(35	)
Dividends declared on common stock ($0.025 per share)																—					(767	)					(767	)
Stock-based compensation																—		945			—			—			945
Common stock issued under stock plans, net of shares withheld for employee taxes																103		(791	)		—			—			(791	)
Balance at March 31, 2023																30,682	$	254,986		$	82,069		$	(1,016	)	$	336,039
Net income		—			0			2,893		0			2,893			—		—			4,133			—			4,133
Comprehensive income		—			0			0		272			272			—		—			—			127			127
Dividends declared on common stock ($0.025 per share)																—		—			(767	)		—			(767	)
Stock-based compensation		—			774			0		0			774			—		1,093			—			—			1,093
Common stock issued under stock plans, net of shares withheld for employee taxes		83			(497	)		0		0			(497	)		4		(6	)		—			—			(6	)
Repurchase of common stock		(892	)		(19,889	)		0		0			(19,889	)
Balance at March 31, 2022		30,518		$	251,179		$	71,015	$	378		$	322,572
Net income		—			0			3,083		0			3,083
Comprehensive loss		—			0			0		(780	)		(780	)
Issuance of common stock in acquisition		209			4,084			0		0			4,084
Stock-based compensation		—			917			0		0			917
Common stock issued under stock plans, net of shares withheld for employee taxes		2			(1	)		0		0			(1	)
Repurchase of common stock		(159	)		(3,143	)		0		0			(3,143	)
Balance at June 30, 2022		30,570		$	253,036		$	74,098	$	(402	)	$	326,732
Balance at June 30, 2023																30,686	$	256,073		$	85,435		$	(889	)	$	340,619

	*Six Months Ended June 30, 2021*												*Six Months Ended June 30, 2022*
	*Common Stock*					*Retained*		*Accumulated Other Comprehensive*		*Total Shareholders’*			*Common Stock*						*Retained*		*Accumulated Other Comprehensive*			*Total Shareholders’*
	*Shares*		*Amount*			*Earnings*		*Income*		*Equity*			*Shares*			*Amount*			*Earnings*		*Income (Loss)*			*Equity*
Balance at December 31, 2020		31,493	$	271,784		$	62,277	$	1	$	334,062
Balance at December 31, 2021														31,327		$	270,791		$	68,122	$	106		$	339,019
Net income		—		0			2,291		0		2,291			—			—			2,893		—			2,893
Comprehensive income		—		0			0		234		234			—			—			—		272			272
Stock-based compensation		—		616			0		0		616			—			774			—		—			774
Common stock issued under stock plans, net of shares withheld for employee taxes		60		(399	)		0		0		(399	)		83			(497	)		—		—			(497	)
Balance at March 31, 2021		31,553	$	272,001		$	64,569	$	235	$	336,805
Repurchase of common stock														(892	)		(19,889	)		—		—			(19,889	)
Balance at March 31, 2022														30,518		$	251,179		$	71,015	$	378		$	322,572
Net income		—		0			2,441		0		2,441			—			—			3,083		—			3,083
Comprehensive income		—		0			0		351		351
Comprehensive loss														—			—			—		(780	)		(780	)
Issuance of common stock in acquisition														209			4,084			—		—			4,084
Stock-based compensation		—		782			0		0		782			—			917			—		—			917
Common stock issued under stock plans, net of shares withheld for employee taxes		1		0			0		0		0			2			(1	)		—		—			(1	)
Balance at June 30, 2021		31,554	$	272,783		$	67,010	$	586	$	340,379
Repurchase of common stock														(159	)		(3,143	)		—		—			(3,143	)
Balance at June 30, 2022														30,570		$	253,036		$	74,098	$	(402	)	$	326,732

	*Three Months Ended June 30, 2022*						*Six Months Ended June 30, 2022*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*		*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	50,971	$	11,500	$	62,471	$	101,524	$	23,022	$	124,546
Professional services		1,503		1,664		3,167		2,989		3,470		6,459
Total revenues, net	$	52,474	$	13,164	$	65,638	$	104,513	$	26,492	$	131,005

	*Three Months Ended June 30, 2021*						*Six Months Ended June 30, 2021*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*		*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	50,740	$	10,905	$	61,645	$	100,511	$	21,502	$	122,013
Professional services		1,418		1,753		3,171		2,894		3,377		6,271
Total revenues, net	$	52,158	$	12,658	$	64,816	$	103,405	$	24,879	$	128,284

	*Three Months Ended June 30,*				*Six Months Ended June 30,*
	*2023*		*2022*		*2023*		*2022*
Subscription services	$	66,506	$	62,471	$	132,521	$	124,546
Professional services		2,692		3,167		5,623		6,459
Total revenues, net	$	69,198	$	65,638	$	138,144	$	131,005

Dividend Payment Date	Dividend Declaration Date	Dividend Per Share		Record Date	Cash Outlay
April 28, 2023	February 20, 2023	$	0.025	April 17, 2023	$	767,000
June 23, 2023	April 24, 2023		0.025	June 12, 2023		767,000
Total dividends		$	0.050		$	1,534,000

	*June 30, 2022*
	*Adjusted Cost*		*Unrealized Gains*		*Unrealized Losses*			*Fair Value*
Level 2:
Corporate debt securities	$	2,005	$	0	$	(5	)	$	2,000
Total	$	2,005	$	0	$	(5	)	$	2,000

	*December 31, 2021*
	*Adjusted Cost*		*Unrealized Gains*		*Unrealized Losses*			*Fair Value*
Level 2:
Corporate debt securities	$	5,043	$	0	$	(2	)	$	5,041
Total	$	5,043	$	0	$	(2	)	$	5,041

	*December 31, 2022*
	*Adjusted Cost*		*Unrealized Gains*		*Unrealized Losses*		*Fair Value*
Level 2:
U.S. treasury securities	$	7,882	$	3	$	—	$	7,885
Total	$	7,882	$	3	$	—	$	7,885

	*Three Months Ended June 30,*						*Six Months Ended June 30,*
Revenues, net:	*2022*			*2021*			*2022*			*2021*
Workforce Solutions	$	52,474		$	52,158		$	104,513		$	103,405
Provider Solutions		13,164			12,658			26,492			24,879
Total revenues, net	$	65,638		$	64,816		$	131,005		$	128,284
Operating income:
Workforce Solutions	$	8,767		$	9,222		$	18,153		$	18,249
Provider Solutions		1,702			2,166			4,013			4,221
Unallocated		(7,516	)		(7,957	)		(15,177	)		(15,739	)
Total operating income	$	2,953		$	3,431		$	6,989		$	6,731

Segment assets *	*June 30, 2022*		*December 31, 2021*
Workforce Solutions	$	266,200	$	258,864
Provider Solutions		133,399		137,008
Unallocated		78,105		90,881
Total assets	$	477,704	$	486,753

	Three Months Ended June 30,
Revenues by Business Segment:	2022			2021			Percentage Change
Workforce Solutions	$	52,474		$	52,158			1	%
Provider Solutions		13,164			12,658			4	%
Total revenues, net	$	65,638		$	64,816			1	%

% of Revenues
Workforce Solutions		80	%		80	%
Provider Solutions		20	%		20	%

	Three Months Ended June 30,
	2023			2022			Percentage Change
Subscription services	$	66,506		$	62,471			6	%
Professional services		2,692			3,167			-15	%
Total revenues, net	$	69,198		$	65,638			5	%

% of Revenues
Subscription services		96	%		95	%
Professional services		4	%		5	%

	Six Months Ended June 30,
Revenues by Business Segment:	2022			2021			Percentage Change
Workforce Solutions	$	104,513		$	103,405			1	%
Provider Solutions		26,492			24,879			6	%
Total revenues, net	$	131,005		$	128,284			2	%

% of Revenues
Workforce Solutions		80	%		81	%
Provider Solutions		20	%		19	%

Period	(a) Total number of shares (or units) purchased		(b) Average price paid per share (or unit)(1)		(c) Total number of shares (or units) purchased as part of publicly announced plans or programs		(d) Maximum number (or approximate dollar value) of shares (or units) that may yet be purchased under the plans or programs
Month #1 (April 1 - April 30)		126,765	$	19.88		126,765	$	2,500,020
Month #2 (May 1 - May 31)		26,722		18.98		26,722		1,992,953
Month #3 (June 1 - June 30)		5,916		18.98		5,916		1,880,642
Total		159,403	$	19.70		159,403	$	1,880,642

10.1 ~~(1)~~	Form of HealthStream, Inc. Restricted Share Unit Agreement (Non-Employee Director) under 2022 Omnibus Incentive Plan
31.1	Certification of the Chief Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
31.2	Certification of the Principal Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
32.1	Certification Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002
32.2	Certification Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002
101.1 INS	Inline XBRL Instance Document – The instant document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
101.1 SCH	Inline XBRL Taxonomy Extension Schema
101.1 CAL	Inline XBRL Taxonomy Extension Calculation Linkbase
101.1 DEF	Inline XBRL Taxonomy Extension Definition Linkbase
101.1 LAB	Inline XBRL Taxonomy Extension Label Linkbase
101.1 PRE	Inline XBRL Taxonomy Extension Presentation Linkbase
104	The cover page from the Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, ~~2022,~~2023, has been formatted in Inline XBRL
	Management contract of compensatory plan or arrangement
~~(1)~~	~~Incorporated by reference from exhibit 10.1 filed on our Current Report on Form 8-K dated May 31, 2022.~~

	HEALTHSTREAM, INC.

July ~~28, 2022~~27, 2023	By:	/s/ Scott A. Roberts
		Scott A. Roberts
		Chief Financial Officer