0001437749-22-004615 | 10-K | XBRL Viewer

Segment assets include accounts and unbilled receivables, prepaid royalties, prepaid and other current assets, other assets, capitalized software development, deferred commissions, certain property and equipment, and intangible assets. Cash and cash equivalents, marketable securities, non-marketable equity investments, and certain ROU assets are not allocated to individual segments and are included within Unallocated. A significant portion of property and equipment assets are included within Unallocated.

Consolidated Balance Sheets (Parentheticals) - USD ($) shares in Thousands, $ / shares in Thousands, $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Accounts receivable, allowance for doubtful accounts	$ 853	$ 549
Accumulated amortization on property and equipment	17,999	19,237
Accumulated amortization on capitalized software development	86,097	70,516
Accumulated amortization on intangible assets	$ 62,367	$ 47,471
Common stock, shares authorized (in shares)	75,000	75,000
Common stock, shares issued (in shares)	31,327	31,493
Common stock, shares outstanding (in shares)	31,327	31,493
Common stock, par value (in dollars per share)	$ 0	$ 0
Customer-Related Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 45,615	$ 36,723
Other Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 16,752	$ 10,748

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Revenues, net	$ 256,712	$ 244,826	$ 254,112
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)	91,033	89,332	103,890
Product development	41,659	32,305	29,109
Sales and marketing	39,457	35,297	37,945
Other general and administrative expenses	39,695	41,885	40,579
Depreciation and amortization	36,813	30,189	27,869
Total operating costs and expenses	248,657	229,008	239,392
Operating income	8,055	15,818	14,720
Other (loss) income, net	(289)	2,005	3,209
Income from continuing operations before income tax provision	7,766	17,823	17,929
Income tax provision	1,921	3,732	3,733
Income from continuing operations	5,845	14,091	14,196
Discontinued operations
Gain on sale of discontinued operations	0	0	2,053
Income tax provision	0	0	479
Income from discontinued operations	0	0	1,574
Net income	$ 5,845	$ 14,091	$ 15,770
Net income per share – basic:
Continuing operations, basic (in dollars per share)	$ 0.19	$ 0.44	$ 0.44
Discontinued operations, basic (in dollars per share)	0	0	0.05
Net income per share - basic (in dollars per share)	0.19	0.44	0.49
Net income per share - diluted:
Continuing operations (in dollars per share)	0.18	0.44	0.44
Discontinued operations (in dollars per share)	0	0	0.05
Net income per share - diluted (in dollars per share)	$ 0.18	$ 0.44	$ 0.49
Weighted average shares of common stock outstanding:
Basic (in shares)	31,534	31,960	32,372
Diluted (in shares)	31,618	31,989	32,428

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Net income	$ 5,845	$ 14,091	$ 15,770
Other comprehensive income, net of taxes:
Foreign currency translation adjustments	99	6	2
Unrealized gain (loss) on marketable securities	6	(9)	25
Total other comprehensive income	105	(3)	27
Comprehensive income	$ 5,950	$ 14,088	$ 15,797

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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+ Details

Consolidated Statements of Shareholders' Equity - USD ($) shares in Thousands, $ in Thousands	Common Stock Including Additional Paid in Capital [Member]	Retained Earnings [Member]	AOCI Attributable to Parent [Member]	Total
Balance (in shares) at Dec. 31, 2018	32,325
Balance at Dec. 31, 2018	$ 286,597	$ 32,373	$ (23)	$ 318,947
Net income	0	15,770	0	15,770
Comprehensive income (loss)	$ 0	0	27	27
Stock donated to Company (held in treasury) (in shares)	(86)
Stock donated to Company (held in treasury)	$ (86)	0	0	0
Stock-based compensation	$ 4,244	0	0	4,244
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	140
Common stock issued under stock plans, net of shares withheld for employee taxes	$ (820)	0	0	(820)
Balance (in shares) at Dec. 31, 2019	32,379
Balance at Dec. 31, 2019	$ 290,021	48,143	4	338,168
Net income	0	14,091	0	14,091
Comprehensive income (loss)	0	0	(3)	(3)
Stock-based compensation	$ 2,217	0	0	2,217
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	71
Common stock issued under stock plans, net of shares withheld for employee taxes	$ (435)	0	0	(435)
Dividend forfeitures on unvested equity awards	$ 0	43	0	43
Repurchase of common stock (in shares)	(957)
Repurchase of common stock	$ (20,019)	0	0	$ (20,019)
Balance (in shares) at Dec. 31, 2020	31,493			31,500
Balance at Dec. 31, 2020	$ 271,784	62,277	1	$ 334,062
Net income	0	5,845	0	5,845
Comprehensive income (loss)	$ 0	0	105	105
Stock donated to Company (held in treasury) (in shares)	(94)
Stock donated to Company (held in treasury)	$ 0	0	0	0
Stock-based compensation	$ 5,303	0	0	5,303
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	131
Common stock issued under stock plans, net of shares withheld for employee taxes	$ (1,182)	0	0	(1,182)
Repurchase of common stock (in shares)	(203)
Repurchase of common stock	$ (5,114)	0	0	$ (5,114)
Balance (in shares) at Dec. 31, 2021	31,327			31,300
Balance at Dec. 31, 2021	$ 270,791	$ 68,122	$ 106	$ 339,019

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
OPERATING ACTIVITIES:
Net income	$ 5,845	$ 14,091	$ 15,770
Income from discontinued operations	0	0	(1,574)
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	36,813	30,189	27,869
Stock-based compensation	5,303	2,217	4,244
Amortization of deferred commissions	9,169	8,768	8,305
Provision for credit losses	723	274	211
Deferred income taxes	1,539	4,295	2,167
Loss on disposal of fixed assets	21	0	0
Loss (gain) on equity method investments	462	51	(64)
Non-cash paid time off expense	(1,011)	0	0
Non-cash royalty expense	0	(3,440)	0
Change in fair value of non-marketable equity investments	(279)	(1,181)	0
Other	184	347	(72)
Changes in operating assets and liabilities:
Accounts and unbilled receivables	(10,344)	2,992	(11,605)
Prepaid royalties	416	2,397	1,698
Other prepaid expenses and other current assets	1,772	(2,985)	4,862
Deferred commissions	(13,274)	(11,030)	(9,479)
Other assets	52	(112)	(42)
Accounts payable and accrued expenses	(4,329)	1,124	1,098
Accrued royalties	(3,772)	(4,672)	979
Deferred revenue	(7,593)	(1,467)	(1,920)
Net cash provided by operating activities	42,385	35,874	65,657
INVESTING ACTIVITIES:
Business combinations, net of cash acquired	(4,705)	(121,342)	(27,018)
Proceeds from sale of discontinued operations, net of tax	0	0	6,070
Proceeds from maturities of marketable securities	9,931	77,120	80,589
Proceeds from sales of marketable securities	0	15,051	0
Purchases of marketable securities	(5,223)	(61,179)	(87,328)
Proceeds from sale of property and equipment	0	0	15
Proceeds from sale of non-marketable equity investments	1,370	0	0
Payments to acquire non-marketable equity investments	(1,750)	(1,257)	(3,342)
Payments associated with capitalized software development	(21,929)	(16,815)	(14,513)
Purchases of property and equipment	(3,417)	(1,988)	(21,997)
Net cash used in investing activities	(25,723)	(110,410)	(67,524)
FINANCING ACTIVITIES:
Proceeds from exercise of stock options	0	0	214
Taxes paid related to net settlement of equity awards	(1,182)	(435)	(1,034)
Payment of earn-out related to prior acquisitions	0	0	(38)
Repurchases of common stock	(5,008)	(20,019)	0
Payment of cash dividends	(19)	(40)	(58)
Net cash used in financing activities	(6,209)	(20,494)	(916)
Effect of exchange rate changes on cash and cash equivalents	(114)	58	0
Net increase (decrease) in cash and cash equivalents	10,339	(94,972)	(2,783)
Cash and cash equivalents at beginning of period	36,566	131,538	134,321
Cash and cash equivalents at end of period	46,905	36,566	131,538
SUPPLEMENTAL CASH FLOW INFORMATION:
Interest paid	132	96	101
Income taxes (refunded) paid	(92)	877	630
Non-cash additions to property and equipment	0	0	31
Non-cash additions to non-marketable equity investments	$ 0	$ 1,300	$ 0

Note 1 - Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Significant Accounting Policies [Text Block]

1. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Description of Business

HealthStream, Inc. (the Company) was incorporated in 1990 as a Tennessee corporation and is headquartered in Nashville, Tennessee. The Company reports financial results based on two reportable segments: Workforce Solutions and Provider Solutions. Workforce Solutions products help meet the ongoing training, certification, assessment, development, and scheduling needs of the healthcare workforce; they are primarily delivered via a software-as-a-service (SaaS) model and are sold on a subscription basis. Provider Solutions products offer healthcare organizations software applications for administering and tracking provider credentialing, privileging, and enrollment activities.

On February 12, 2018, the Company divested its Patient Experience (PX) business to Press Ganey Associates (Press Ganey) for $65.2 million in cash (after giving effect to the post-closing working capital adjustment). This sale of the PX business resulted in the divestiture of the Company’s patient experience solutions business segment. The results of operations for PX are presented as discontinued operations within the Notes to Consolidated Financial Statements herein.

Recognition of Revenue

In accordance with Accounting Standards Codification (ASC) Topic 606, Revenue from Contracts with Customer, the Company's 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.

Revenue is recognized based on the following five step model:

•

Identification of the contract with a customer

•

Identification of the performance obligations in the contract

•

Determination of the transaction price

•

Allocation of the transaction price to the performance obligations in the contract

•

Recognition of revenue when, or as, the Company satisfies a performance obligation

Subscription revenues primarily consist of fees in consideration of providing customers access to one or more of our SaaS-based solutions and/or courseware subscriptions, as well as fees related to licensing agreements, all of which include routine customer support and technology enhancements. Revenue is generally recognized over time during the contract term beginning when the service is made available to the customer. Subscription contracts are generally non-cancelable, one to five years in length, and billed annually, semi-annually, quarterly, or monthly in advance.

Professional services revenues primarily consist of fees for implementation and onboarding services, consulting, and training. The majority of our professional services contracts are billed in advance based on a fixed price basis, and revenue is recognized over time as the services are performed. For both subscription services and professional services, the time between billing the customer and when performance obligations are satisfied is generally not significant.

Our contracts with customers often contain promises for multiple goods and services. For these contracts, the Company accounts for the promised goods and services in its contracts as separate performance obligations if they are distinct. The contract price, which represents transaction price when the contract reflects a fixed fee arrangement, or management’s estimate of variable consideration including application of the constraint when the contract does not have a fixed fee, is allocated to the separate performance obligations on a relative standalone selling price basis. We generally determine standalone selling prices based on the standard list price for each product, taking into consideration certain factors, including contract length and the number of subscriptions within the contract.

We receive payments from customers based on billing schedules established in our contracts. Accounts receivable - unbilled represent contract assets related to our conditional right to consideration for subscription and professional services contracts where performance has occurred under the contract. Accounts receivable are primarily comprised of trade receivables that are recorded at the invoice amount, net of an allowance for credit losses, when the right to consideration becomes unconditional.

Deferred revenue represents contract liabilities that are recorded when cash payments are received or are due in advance of our satisfaction of performance obligations.

Basis of Presentation

The Consolidated Financial Statements include the accounts of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions have been eliminated in consolidation.

Use of Estimates

The Consolidated Financial Statements are prepared in accordance with United States generally accepted accounting principles. These accounting principles require management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. Actual results could differ from those estimates and such differences could be material to the Consolidated Financial Statements.

Cash Equivalents

The Company considers cash equivalents to be unrestricted, highly liquid investments with initial maturities of less than three months.

Marketable Securities

Marketable securities are classified as available for sale and are stated at fair market value, with the unrealized gains and losses, net of tax, reported in other accumulated comprehensive income (loss) on the accompanying Consolidated Balance Sheets. Realized gains and losses and declines in market value judged to be other than temporary on investments in marketable securities are included in other income, net on the accompanying Consolidated Statements of Income. The cost of securities sold is based on the specific identification method. Interest and dividends on securities classified as available for sale are included in other income, net on the accompanying Consolidated Statements of Income. Premiums and discounts are amortized over the life of the related available for sale security as an adjustment to the yield using the effective interest method.

Deferred Commissions

Deferred commissions represent incremental costs to acquire contracts with customers, such as the initial sales commission payment and associated payroll taxes, which are capitalized and amortized consistent with the transfer of the goods or services to the customer over the expected period of benefit. Capitalized contract costs are included under the caption deferred commissions in the accompanying 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 three years.

Prepaid Royalties

Prepaid royalties represent advance payments to business partners under revenue sharing arrangements for which the Company sells and delivers such partner products to its customers. Royalties are typically paid in advance at the commencement of the subscription period or periodically throughout the subscription period, such as in quarterly, bi-annual, or annual installments. Royalty payments are amortized over the term of the underlying subscription contracts, which generally range from one to five years, in order to match the direct royalty costs to the same period the subscription revenue is recognized. Amortization of prepaid royalties is included under the caption cost of revenues (excluding depreciation and amortization) in the accompanying Consolidated Statements of Income.

Allowance for Credit Losses

The Company estimates its allowance for credit losses based on its historical collection experience, a review in each period of the status of the then-outstanding accounts receivable, and external market factors. Uncollectible receivables are written-off in the period management believes it has exhausted its ability to collect payment from the customer. Expected credit losses are recorded under the caption "Other general and administrative expenses" in the accompanying Consolidated Statements of Income.

Changes in the allowance for credit losses and the amounts charged to bad debt expense for the years ended December 31 were as follows (in thousands):

	*Allowance Balance at Beginning of Period*		*Charged to Costs and Expenses*		*Write-offs*			*Allowance Balance at End of Period*
2021	$	549	$	723	$	(419	)	$	853
2020		843		274		(568	)		549
2019		1,161		211		(529	)		843

Capitalized Software Development

Capitalized software development is stated on the basis of cost and is presented net of accumulated amortization. The Company capitalizes costs incurred during the software development phase for projects when such costs are material. These assets are generally amortized using the straight-line method over three years. The Company capitalized $21.4 million and $17.9 million during 2021 and 2020, respectively. Amortization of capitalized software development was $15.6 million, $12.7 million, and $11.0 million during 2021, 2020, and 2019, respectively. Maintenance and operating costs are expensed as incurred. As of December 31, 2021 and 2020, there were no capitalized software development costs for external computer software developed for resale.

Fair Value Measurements

Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in the principal or most advantageous market in an orderly transaction between market participants at the measurement date. The fair value hierarchy prioritizes the inputs to valuation techniques used in measuring fair value. There are three levels to the fair value hierarchy based on the reliability of inputs, as follows:

Level 1 – Observable inputs that reflect quoted prices (unadjusted) for identical assets or liabilities in active markets.

Level 2 – Inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly.

Level 3 – Unobservable inputs in which little or no market data exists, therefore requiring the Company to develop its own assumptions.

The Company evaluates assets and liabilities subject to fair value measurements on a recurring basis to determine the appropriate level at which to classify them for each reporting period. This determination may require significant judgments to be made by the Company. At December 31, 2021 and 2020, our assets measured at fair value on a recurring basis consisted of marketable securities, which are classified as available for sale (see Note 4 – Marketable Securities).

Property and Equipment

Property and equipment are stated on the basis of cost. Depreciation is provided on the straight-line method over the following estimated useful lives, except for leasehold improvements, which are amortized over the shorter of the estimated useful life or their respective lease term.

	*Years*
Furniture and fixtures		5 - 7
Equipment		3

Goodwill and Intangible Assets

Goodwill represents the excess of purchase price in a business combination over the fair value of the net identifiable assets acquired, including intangible assets. The Company estimates fair values of intangible assets using the income and cost methods, which are based on management’s estimates and assumptions. The carrying amount of our goodwill is evaluated for impairment at least annually during the fourth quarter and whenever events or changes in facts or circumstances indicate that impairment may exist. In accordance with ASC 350, Intangibles – Goodwill and Other, companies may opt to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount. A qualitative assessment includes factors such as financial performance, industry and market metrics, and other factors affecting the reporting unit. If this assessment concludes that it is more likely than not that the fair value of a reporting unit exceeds its carrying value, then goodwill is not considered impaired and no further impairment testing is required. Conversely, if the qualitative assessment concludes that it is more likely than not that the fair value of a reporting unit is less than its carrying value, we must then compare the fair value of the reporting unit to its carrying value. The Company determines fair value of the reporting units using both income and market-based models. These models require the use of various assumptions relating to cash flow projections, growth rates, discount rates, and terminal value calculations. There were no goodwill impairments identified or recorded for the years ended December 31, 2021, 2020, or 2019.

As of December 31, 2021, intangible assets include customer relationships, internally developed technology, non-competition agreements, and trade names. Intangible assets that are considered to have definite useful lives are being amortized on a straight-line basis over periods ranging between one and eighteen years. The weighted average amortization period for definite lived intangible assets as of December 31, 2021 was 11.3 years. Intangible assets considered to have indefinite useful lives are evaluated for impairment at least annually during the fourth quarter, and all intangible assets are reviewed for impairment whenever events or changes in facts or circumstances indicate that the carrying amount of the assets may not be recoverable. There were no intangible asset impairments identified or recorded for the years ended December 31, 2021, 2020, or 2019.

Long-Lived Assets

Long-lived assets to be held for use are reviewed for events or changes in facts and circumstances, both internally and externally, which may indicate that an impairment of long-lived assets held for use is present. The Company measures any impairment using observable market values or discounted future cash flows from the related long-lived assets. The cash flow estimates and discount rates incorporate management’s best estimates, using appropriate and customary assumptions and projections at the date of evaluation. Management periodically evaluates whether the carrying value of long-lived assets, including intangible assets, property and equipment, capitalized software development, deferred commissions, and other assets will be recoverable. There were no long-lived asset impairments identified or recorded for the years ended December 31, 2021, 2020, or 2019.

Non-Marketable Equity Investments

Non-marketable equity investments in limited liability companies with specific ownership accounts for each investor not resulting in a controlling financial interest are accounted for using the equity method of accounting. Non-marketable equity investments of preferred stock in corporations that do not result in a controlling financial interest are accounted for using the measurement alternative for equity investments that do not have readily determinable fair values. ASU 2016-01, Financial Instruments – Overall (Subtopic 825-10) requires equity investments (except those accounted for under the equity method of accounting or those that result in consolidation of the investee) to be measured at fair value with changes in fair value recognized in net income. The fair value of non-marketable equity investments is not estimated if there are no identified events or changes in circumstances that may have a significant adverse effect on the fair value of the investment. The proportionate share of income or loss from equity method investments and any changes in fair value of investments accounted for using the measurement alternative are recorded under the caption other income, net in the accompanying Consolidated Statements of Income.

Financial Instruments

The Company has various financial instruments, including cash and cash equivalents, accounts receivable, accounts receivable-unbilled, accounts payable, and accrued liabilities. The carrying amounts of these financial instruments approximate fair value because of the short-term maturity or short-term nature of such instruments. The Company also has marketable securities, which are recorded at approximate fair value based on quoted market prices or alternative pricing sources (see Note 4 – Marketable Securities) and non-marketable equity investments, which are recorded under the equity method or under the measurement alternative (see Note 17 - Non-Marketable Equity Investments).

Advertising

The Company expenses the costs of advertising as incurred. Advertising expense for the years ended December 31, 2021, 2020, and 2019 was $1.9 million, $1.1 million, and $0.8 million, respectively, and is included under the caption sales and marketing expense in the accompanying Consolidated Statements of Income.

Shipping and Handling Costs

Shipping and handling costs that are associated with our products and services are included under the caption cost of revenues (excluding depreciation and amortization) in the accompanying Consolidated Statements of Income.

Income Taxes

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. Management evaluates all available evidence, both positive and negative, to determine whether, based on the weight of that evidence, a valuation allowance is needed. Future realization of the tax benefit of an existing deductible temporary difference or carryforward ultimately depends on the existence of sufficient taxable income of the appropriate character within the carryback or carryforward period available under the tax law. There are four possible sources of taxable income that may be available under the tax law to realize a tax benefit for deductible temporary differences and carryforwards: 1) future reversals of existing taxable temporary differences, 2) future taxable income exclusive of reversing temporary differences and carryforwards, 3) taxable income in prior carryback year(s) if carryback is permitted under the tax law, and 4) tax-planning strategies that would, if necessary, be implemented to realize deductible temporary differences or carryforwards prior to their expiration. Management reviews the realizability of its deferred tax assets each reporting period to identify whether any significant changes in circumstances or assumptions have occurred that could materially affect the realizability of deferred tax assets. As of December 31, 2021, the Company had established a valuation allowance of $2.0 million for the portion of its net deferred tax assets that are not more likely than not expected to be realized. The Company accounts for income tax uncertainties using a more-likely-than-not recognition threshold based on the technical merits of the tax position taken. Tax positions that meet the more-likely-than-not recognition threshold are measured in order to determine the tax benefit to be recognized in the financial statements.

Earnings per Share

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 for the period by the weighted average number of 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 restricted share units subject to vesting. The dilutive effect of common equivalent shares is included in diluted earnings per share by application of the treasury stock method. Common equivalent shares that have an anti-dilutive effect on diluted net income per share were excluded from the calculation of diluted weighted average shares outstanding for the years ended December 31, 2021, 2020, and 2019.

Concentrations of Credit Risk and Significant Customers

The Company’s credit risks relate primarily to cash and cash equivalents, marketable securities, and accounts receivable. The Company places its temporary excess cash in high quality, short-term money market instruments. At times, such investments may be in excess of the FDIC insurance limits. Marketable securities consist primarily of investment grade corporate debt securities.

The Company sells its products and services to various companies in the healthcare industry that are primarily located in the United States. Customer credit worthiness evaluations are performed on an as-needed basis, and the Company generally requires no collateral from customers. An allowance for doubtful accounts is maintained for potentially uncollectible accounts receivable. The Company did not have any single customer representing over 10% of net revenues or accounts receivable during 2021, 2020, or 2019.

Stock-Based Compensation

As of December 31, 2021, the Company maintained one stock-based compensation plan under which awards are outstanding, as described in Note 11. The Company accounts for stock-based compensation using the fair-value based method for costs related to share-based payments, including stock options and restricted share units. The Company uses the Black Scholes option pricing model for calculating the fair value of option awards issued under its stock-based compensation plan. The Company measures compensation cost of restricted share units based on the closing fair market value of the Company’s stock on the date of grant. Stock-based compensation cost is measured at the grant date, based on the fair value of the award that is ultimately expected to vest, and is recognized as an expense over the requisite service period. The Company recognizes tax benefits or deficiencies from stock-based compensation if an excess tax benefit or deficiency is realized. Excess tax benefits and deficiencies are reflected in the Consolidated Statements of Income as a component of the provision for income taxes when realized.

Leases

The Company has several non-cancelable agreements to lease office space. For leases with a lease term greater than 12 months, the Company recognizes a right-of-use (ROU) asset and a lease liability on the balance sheet at the lease commencement date. Lease liabilities and their corresponding right-of-use assets are recorded based on the present value of the future lease payments over the expected lease term.

The Company does not have any lease contracts that contain: (1) an option to extend that the Company is reasonably certain to exercise, (2) an option to terminate that the Company is reasonably certain not to exercise, or (3) an option to extend (or not to terminate) in which exercise of the option is controlled by the lessor. Additionally, the Company does not have any leases with residual value guarantees or material restrictive covenants. Most of the Company’s lease agreements contain provisions for escalating rent payments over the terms of the leases, which escalations are either fixed within the contract or are variable based on the consumer price index.

The Company’s leases do not contain readily determinable implicit discount rates, and as such the Company must use its incremental borrowing rate to discount the future lease payments based on information available at lease commencement. The incremental borrowing rate was estimated by determining the rate of interest that the Company would have to pay to borrow on a collateralized basis over a similar term an amount equal to the lease payments in a similar economic environment.

Foreign Currency

The functional currency for the Company’s subsidiaries is determined based on the primary economic environment in which the subsidiary operates. The Company translates the assets and liabilities of its non-U.S. dollar functional currency subsidiaries into U.S. dollars using exchange rates in effect at the end of each period. Revenues and expenses for these subsidiaries are translated using rates that approximate those in effect during the period. Gains and losses from these translations are recognized as cumulative translation adjustment included in accumulated other comprehensive income in the Consolidated Balance Sheets.

Recently Issued Accounting Pronouncements Not Yet Adopted

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 606, Revenue from Contracts with Customers, as if it had originated the contracts. This approach differs from the current 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 will early adopt this ASU on January 1, 2022 and the adoption impact of the new standard will depend on the magnitude of future acquisitions. The standard will not impact contract assets or liabilities from business combinations occurring prior to the adoption date.

Note 2 - Shareholders' Equity

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Stockholders' Equity Note Disclosure [Text Block]

2. SHAREHOLDERS’ EQUITY

Common Stock

The Company is authorized to issue up to 75 million shares of common stock. The number of common shares issued and outstanding as of December 31, 2021 and 2020 was 31.3 million and 31.5 million, respectively.

Preferred Stock

The Company is authorized to issue up to 10 million shares of preferred stock in one or more series, having the relative voting powers, designations, preferences, rights and qualifications, limitations or restrictions, and other terms as the Board of Directors may fix in providing for the issuance of such series, without any vote or action of the shareholders.

Share Repurchase Plan

On March 13, 2020, the Company’s Board of Directors authorized a share repurchase program to repurchase up to $30.0 million of outstanding shares of common stock. The share repurchase program terminated on March 12, 2021. During the year ended December 31, 2020, the Company repurchased 957,367 shares pursuant to this share repurchase program at an aggregate fair value of $20.0 million, based on an average price per share of $20.89 (excluding the cost of broker commissions). No repurchases occurred under this share repurchase program during the year ended December 31, 2021.

On November 30, 2021, the Company’s Board of Directors authorized a share repurchase program to repurchase up to $20.0 million of outstanding shares of common stock. The share repurchase program will terminate on the earlier of November 29, 2022 or when the maximum dollar amount has been expended. During the year ended December 31, 2021, the Company repurchased 203,284 shares pursuant to this share repurchase program at an aggregate fair value of $5.1 million, based on an average price per share of $25.14 (excluding the cost of broker commissions).

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

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+ Details

Note 3 - Earnings Per Share

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Earnings Per Share [Text Block]

3. EARNINGS PER SHARE

The following table sets forth the computation of basic and diluted earnings per share for the three years ended December 31, 2021 (in thousands, except per share amounts):

	*Year Ended December 31,*
	*2021*		*2020*		*2019*
Numerator:
Income from continuing operations	$	5,845	$	14,091	$	14,196
Income from discontinued operations		—		—		1,574
Net income	$	5,845	$	14,091	$	15,770
Denominator:
Weighted-average shares outstanding		31,534		31,960		32,372
Effect of dilutive shares		84		29		56
Weighted-average diluted shares		31,618		31,989		32,428

Net income per share – basic:
Continuing operations	$	0.19	$	0.44	$	0.44
Discontinued operations		—		-		0.05
Net income per share - basic	$	0.19	$	0.44	$	0.49

Net income per share – diluted:
Continuing operations	$	0.18	$	0.44	$	0.44
Discontinued operations		—		—		0.05
Net income per share - diluted	$	0.18	$	0.44	$	0.49

Potentially dilutive shares representing 78,000, 122,000, and 93,000 shares of common stock for the years ended December 31, 2021, 2020, and 2019, respectively, were excluded from the calculation of diluted earnings per share because their effect would have been anti-dilutive.

Note 4 - Marketable Securities

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block]

4. MARKETABLE SECURITIES

At December 31, 2021 and 2020, the fair value of marketable securities, which were all classified as available for sale, included the following (in thousands):

	*December 31, 2021*
	*Adjusted Cost*		*Unrealized Gains*		*Unrealized Losses*			*Fair Value*		*Cash and Cash Equivalents*		*Current Marketable Securities*
Cash	$	46,905	$	—	$	—		$	46,905	$	46,905	$	—
Level 2:
Corporate debt securities		5,043		—		(2	)		5,041		—		5,041
Total	$	51,948	$	—	$	(2	)	$	51,946	$	46,905	$	5,041

	*December 31, 2020*
	*Adjusted Cost*		*Unrealized Gains*		*Unrealized Losses*			*Fair Value*		*Cash and Cash Equivalents*		*Current Marketable Securities*
Cash	$	31,558	$	—	$	—		$	31,558	$	31,558	$	—
Level 2:
Time deposits		10,021		—		—			10,021		5,008		5,013
Corporate debt securities		4,923		—		(8	)		4,915		—		4,915
Total	$	46,502	$	—	$	(8	)	$	46,494	$	36,566	$	9,928

The carrying amounts of the marketable securities reported in the Consolidated Balance Sheets approximate fair value based on quoted market prices or alternative pricing sources and models utilizing market observable inputs. As of December 31, 2021, the Company does not consider any of its marketable securities to be other than temporarily impaired. During the years ended December 31, 2021 and 2020, the Company did not reclassify any items out of accumulated other comprehensive income to net income. All investments in marketable securities are classified as a current asset on the Consolidated Balance Sheet because the underlying securities mature within one year from the balance sheet date.

Note 5 - Revenue Recognition and Sales Commissions

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Revenue from Contract with Customer [Text Block]

5. REVENUE RECOGNITION AND SALES COMMISSIONS

Revenue Recognition

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 included in continuing operations disaggregated by revenue source for the years ended December 31, 2021, 2020, and 2019 (in thousands). Sales taxes are excluded from revenues.

	*Year Ended December 31, 2021*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	199,676	$	43,941	$	243,617
Professional services		5,767		7,328		13,095
Total revenues, net	$	205,443	$	51,269	$	256,712

	*Year Ended December 31, 2020*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	193,673	$	40,237	$	233,910
Professional services		3,914		7,002		10,916
Total revenues, net	$	197,587	$	47,239	$	244,826

	*Year Ended December 31, 2019*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	202,479	$	38,022	$	240,501
Professional services		6,120		7,491		13,611
Total revenues, net	$	208,599	$	45,513	$	254,112

For the years ended December 31, 2021 and 2020, we recognized $0.7 million and $0.3 million, respectively, in impairment losses on receivables and contract assets arising from the Company’s contracts with customers.

During the years ended December 31, 2021, 2020, and 2019, we recognized revenues of $62.3 million, $64.5 million, and $64.7 million from amounts included in deferred revenue at the beginning of the respective period. As of December 31, 2021, $451 million of revenue is expected to be recognized from remaining performance obligations under contracts with customers. We expect to recognize revenue on approximately 47% of these remaining performance obligations over the 12 months ending December 31, 2022, with the remaining amounts recognized thereafter.

Sales Commissions

Sales commissions earned by our sales employees 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, whereas subsequent sales commission payments which require a substantive performance condition of the employee are expensed ratably through the payment date. 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 $9.2 million, $8.8 million, and $8.3 million for the years ended December 31, 2021, 2020 and 2019, which is included in sales and marketing expenses in the accompanying Consolidated Statements of Income.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Note 6 - Property and Equipment

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Property, Plant and Equipment Disclosure [Text Block]

6. PROPERTY AND EQUIPMENT

Property and equipment consist of the following (in thousands):

	*December 31,*
	*2021*			*2020*
Equipment	$	15,987		$	21,401
Leasehold improvements		14,937			14,980
Furniture and fixtures		5,025			5,074
Gross property and equipment		35,949			41,455
Accumulated depreciation and amortization		(17,999	)		(19,237	)
Property and equipment, net	$	17,950		$	22,218

Depreciation of property and equipment totaled $6.3 million, $6.9 million, and $7.3 million for the years ended December 31, 2021, 2020, and 2019, respectively.

Note 7 - Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Goodwill and Intangible Assets Disclosure [Text Block]

7. GOODWILL AND INTANGIBLE ASSETS

The changes in the carrying amount of goodwill for the years ended December 31, 2021 and 2020 are as follows (in thousands):

	*Workforce Solutions*		*Provider Solutions*		*Total*
Balance at January 1, 2021	$	104,016	$	74,424	$	178,440
Acquisition of ComplyALIGN		945		—		945
Acquisition of Rievent		1,707		—		1,707
Post-closing adjustment for ANSOS		1,183		—		1,183
Effect of exchange rate changes		226		—		226
Balance at December 31, 2021	$	108,077	$	74,424	$	182,501

	*Workforce Solutions*		*Provider Solutions*		*Total*
Balance at January 1, 2020	$	27,776	$	74,420	$	102,196
Acquisition of NurseGrid		21,085		—		21,085
Acquisition of ShiftWizard		19,307		—		19,307
Acquisition of ANSOS		35,258		—		35,258
Acquisition of myClinicalExchange		590		—		590
Post-closing adjustment for CredentialMyDoc		—		4		4
Balance at December 31, 2020	$	104,016	$	74,424	$	178,440

Intangible assets other than goodwill that are considered to have finite useful lives include customer-related intangibles consisting of customer relationships, which are amortized over their estimated useful lives ranging from five to eighteen years, and other intangible assets consisting of developed technology, non-competition agreements, and trade names, which are amortized over their estimated useful lives ranging from one to ten years. The Company also recorded an indefinite lived intangible for a trade name valued at $0.7 million. Amortization of intangible assets was $14.9 million, $10.5 million, and $9.6 million for the years ended December 31, 2021, 2020, and 2019, respectively.

Identifiable intangible assets are comprised of the following (in thousands):

	*As of December 31, 2021*							*As of December 31, 2020*
	*Gross Amount*		*Accumulated Amortization*			*Net*		*Gross Amount*		*Accumulated Amortization*			*Net*
Customer related	$	114,418	$	(45,615	)	$	68,803	$	113,650	$	(36,723	)	$	76,927
Other		37,154		(16,752	)		20,402		34,536		(10,748	)		23,788
Total	$	151,572	$	(62,367	)	$	89,205	$	148,186	$	(47,471	)	$	100,715

The expected future annual amortization expense for the years ending December 31, is as follows (in thousands):

2022	$	14,181
2023		13,519
2024		12,021
2025		11,300
2026		8,215
Thereafter		29,269
Total	$	88,505

Note 8 - Business Combinations

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Business Combination Disclosure [Text Block]

8. BUSINESS COMBINATIONS

NurseGrid

On March 9, 2020, the Company acquired all of the outstanding stock of HcT2 Co. dba NurseGrid (NurseGrid), a Portland, Oregon-based healthcare technology company offering NurseGrid Mobile and its corollary application for nurse managers, NurseGrid Enterprise, for net cash consideration of approximately $21.5 million, after giving effect to the post-closing working capital adjustment. The Company accounted for this transaction as a business combination achieved in stages which required the Company to remeasure its previously existing minority ownership interest held in NurseGrid, which was accounted for as a non-marketable equity investment measured using the fair value alternative, to fair value at the acquisition date based on the total enterprise value, adjusting for a control premium. The fair value of the Company’s interest in NurseGrid was $3.6 million at closing, resulting in a gain of $1.2 million, recorded as a change in fair value of non-marketable equity investments in the Company’s Condensed Consolidated Statements of Income. Additionally, the Company’s previously recorded non-marketable equity investment in NurseGrid was de-recognized from the Company’s Condensed Consolidated Balance Sheet during the same period. Acquisition-related transaction costs were $0.2 million. The financial results of NurseGrid have been included in the Workforce Solutions segment from March 9, 2020.

A summary of the purchase price is as follows (in thousands):

Cash paid at closing	$	25,485
Post-closing adjustment, net of cash received		33
Cash acquired		(4,064	)
Net consideration paid		21,454
Fair value of existing equity interest in NurseGrid		3,623
Net consideration paid	$	25,077

The following table summarizes the fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands):

Accounts and unbilled receivable, net	$	92
Prepaid and other current assets		155
Operating lease right-of-use assets		50
Deferred tax assets		2,121
Goodwill		21,085
Intangible assets		1,845
Accounts payable and accrued liabilities		(143	)
Deferred revenue		(78	)
Operating lease liabilities		(50	)
Net assets acquired	$	25,077

The excess of purchase price over the fair values of net tangible and intangible assets is recorded as goodwill. The fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. The primary intangible assets acquired were developed technology and trade name. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. The fair value estimate for trade name intangible asset included significant assumptions in the prospective financial information, such as projected revenues, royalty rate, and the discount rate. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. The goodwill balance is primarily attributed to the assembled workforce, future market opportunities to engage and support the NurseGrid Mobile user community, and expected synergies from integrating NurseGrid with other combined functional areas within the Company. The goodwill balance is not deductible for U.S. income tax purposes. The net tangible assets include deferred revenue, which was adjusted down from a book value at the acquisition date of $157,000 to an estimated fair value of $78,000. The $79,000 write-down of deferred revenue will result in lower revenues than would have otherwise been recognized for such services.

The following table sets forth the components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands):

	*Fair value*		*Useful life (in years)*
Customer relationships	$	35		8
Developed technology		1,110		5
Trade name		700	Indefinite
Total intangible assets	$	1,845

Pro forma results of operations have not been presented as the impact of the acquisition is not material to the Company's financial results.

ShiftWizard

On October 12, 2020, the Company acquired all of the outstanding stock of ShiftWizard, Inc. (ShiftWizard) a Raleigh, North Carolina-based healthcare technology company offering a SaaS-based solution that integrates key workforce management capabilities, including scheduling, productivity, and forecasting. The consideration paid for ShiftWizard consisted of $30.5 million in cash after giving effect to the post-closing working capital adjustment. Acquisition-related transaction costs were $0.3 million. The financial results of ShiftWizard have been included in the Workforce Solutions segment from October 12, 2020.

The following table summarizes the fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands):

Cash	$	1,091
Accounts and unbilled receivable, net		1,038
Prepaid assets		106
Operating lease right-of-use assets		183
Property and equipment		50
Indemnification assets		464
Goodwill		19,307
Intangible asset		12,660
Accounts payable and accrued liabilities		(600	)
Deferred revenue		(1,601	)
Deferred tax liability		(1,559	)
Operating lease liabilities		(183	)
Indemnification liability		(464	)
Net assets acquired	$	30,492

The excess of purchase price over the fair values of net tangible and intangible assets is recorded as goodwill. The fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. Included in the assets and liabilities is an indemnification asset and liability of $0.5 million associated with a Paycheck Protection Program loan pending forgiveness as of the acquisition date that was subsequently forgiven. The primary intangible assets acquired were customer relationships and developed technology. The fair value estimate for customer relationships intangible asset included significant assumptions in the prospective financial information, such as revenue growth, customer attrition, EBITDA margin, and the discount rate. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. The goodwill balance is primarily attributed to the assembled workforce, additional market opportunities from offering ShiftWizard products, and expected synergies from integrating ShiftWizard with other products or other combined functional areas within the Company. The goodwill balance is not deductible for U.S. income tax purposes. The net tangible assets include deferred revenue, which was adjusted down from a book value at the acquisition date of $2.7 million to an estimated fair value of $1.6 million. The $1.1 million write-down of deferred revenue will result in lower revenues than would have otherwise been recognized for such services.

The following table sets forth the components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands):

	*Fair Value*		*Useful life (in years)*
Customer relationships	$	7,800		18
Developed technology		4,050		5
Non-compete		580		1 - 5
Trade name		230		5
Total intangible assets subject to amortization	$	12,660

The following unaudited pro forma financial information summarizes the results of operations of the Company and ShiftWizard as though the companies were combined as of January 1, 2019 (in thousands, except per share data):

	*Year Ended December 31,*
	*2021*		*2020*		*2019*
Total revenues	$	257,291	$	248,306	$	257,042
Income from continuing operations	$	6,352	$	13,056	$	11,604
Net income	$	6,352	$	13,056	$	13,178
Net income per share - basic	$	0.20	$	0.41	$	0.41
Net income per share - diluted	$	0.20	$	0.41	$	0.41

These unaudited pro forma combined results of operations include certain adjustments arising from the acquisition, such as amortization of intangible assets, depreciation of property and equipment, and fair value adjustments of acquired deferred revenue balances. The unaudited pro forma combined results of operations is for informational purposes only and is not indicative of what the Company’s results of operations would have been had the transaction occurred at the beginning of the earliest period presented or to project the Company’s results of operations in any future period.

ANSOS Staff Scheduling application

On December 2, 2020, the Company acquired all of the equity interests of Change Healthcare’s staff scheduling business, consisting of the ANSOS Staff Scheduling application and related products (ANSOS). The consideration paid for ANSOS was $66.4 million in cash, after giving effect to the post-closing working capital adjustment. Acquisition-related transaction costs were $1.2 million. The financial results of ANSOS have been included in the Workforce Solutions segment from December 2, 2020.

The following table summarizes the fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands):

Cash	$	1,599
Accounts and unbilled receivable, net		11,017
Prepaid assets		233
Operating lease right-of-use assets		888
Property and equipment		66
Deferred tax assets		1,191
Goodwill		36,440
Intangible assets		32,440
Accounts payable and accrued liabilities		(1,776	)
Deferred revenue		(13,873	)
Operating lease liabilities		(888	)
Deferred tax liability		(889	)
Net assets acquired	$	66,448

The excess of purchase price over the fair values of net tangible and intangible assets is recorded as goodwill. The fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. During the year ended December 31, 2021, the Company made adjustments to accounts receivable, deferred revenue, indemnification asset, uncertain tax position liability, accounts payable and accrued liabilities, and deferred tax assets based on updated information obtained since our preliminary estimates were made. As a result of these items, coupled with the impact of the post-closing working capital adjustment, the Company recorded a measurement period adjustment which increased goodwill by $1.2 million. The measurement period adjustment had no effect on current or prior period earnings. The primary intangible assets acquired were customer relationships and developed technology. The fair value estimate for customer relationships intangible asset included significant assumptions regarding prospective financial information with respect to the acquisition, including with respect to revenue growth, customer attrition, EBITDA margin, and the discount rate. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. The goodwill balance is primarily attributed to the assembled workforce, additional market opportunities from offering ANSOS products, and expected synergies from integrating ANSOS with other products or other combined functional areas within the Company.

The goodwill balance is deductible for U.S. income tax purposes. The net tangible assets include deferred revenue, which was adjusted down from a book value at the acquisition date of $17.2 million to an estimated fair value of $13.9 million. The $3.3 million write-down of deferred revenue will result in lower revenues than would have otherwise been recognized for such services.

The following table sets forth the components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands):

	*Fair Value*		*Useful life (in years)*
Customer relationships	$	21,100		11 - 14
Developed technology		9,800		5
Trade name		1,540		10
Total intangible assets subject to amortization	$	32,440

The following unaudited pro forma financial information summarizes the results of operations of the Company and ANSOS as though the companies were combined as of January 1, 2019 (in thousands, except per share data):

	*Year Ended December 31,*
	*2021*		*2020*		*2019*
Total revenues	$	259,451	$	270,246	$	278,491
Income from continuing operations	$	8,072	$	18,861	$	16,534
Net income	$	8,072	$	18,861	$	18,108
Net income per share - basic	$	0.26	$	0.59	$	0.56
Net income per share - diluted	$	0.26	$	0.59	$	0.56

Other Business Combinations

On December 10, 2020, the Company acquired substantially all of the assets of myClinicalExchange, LLC, a Denver, Colorado-based information technologies company offering a SaaS-based solution that allows healthcare organizations to track, manage, and report the intern and clinical rotation educational requirements of medical, nursing, and allied healthcare students, as well as host required documentation for medical residents. The consideration paid for myClinicalExchange consisted of $4.4 million in cash. 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. The results of operations for myClinicalExchange are included in the Company’s Consolidated Financial Statements from the date of acquisition and are included in the Workforce Solutions segment.

On January 19, 2021, the Company acquired the issued and outstanding equity of ProcessDATA, Ltd. (d/b/a ComplyALIGN and HospitalPORTAL) ("ComplyALIGN"), a Chicago, Illinois-based healthcare technology company offering SaaS-based policy management system for healthcare organizations, for $2.0 million in cash. 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. The results of operations for ComplyALIGN are included in the Company’s Consolidated Financial Statements from the date of acquisition and are included in the Workforce Solutions segment.

On December 1, 2021, the Company acquired substantially all of the assets of Rievent Technologies, LLC ("Rievent"), a Virginia Beach, Virginia-based healthcare technology company offering a SaaS-based continuing education (CME/CE) management and delivery application, branded Rievent, which supports publishers, professional associations, healthcare insurance companies, and healthcare providers, for $4.0 million in cash. Of the purchase price paid at closing, $0.4 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. The results of operations for Rievent are included in the Company’s Consolidated Financial Statements from the date of acquisition and are included in the Workforce Solutions segment.

Note 9 - Business Segments

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Segment Reporting Disclosure [Text Block]

9. BUSINESS SEGMENTS

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, information systems, investor relations, 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 as of and for the years ended December 31, 2021, 2020, and 2019 (in thousands).

Revenues, net:	*2021*		*2020*		*2019*
Workforce Solutions	$	205,443	$	197,587	$	208,599
Provider Solutions		51,269		47,239		45,513
Total revenues, net	$	256,712	$	244,826	$	254,112

Operating income:	*2021*			*2020*			*2019*
Workforce Solutions	$	31,736		$	41,622		$	40,296
Provider Solutions		7,915			4,678			5,384
Unallocated		(31,596	)		(30,482	)		(30,960	)
Total operating income	$	8,055		$	15,818		$	14,720

	Assets*				*Purchases of long-lived assets*						*Depreciation and amortization*
	*2021*		*2020*		*2021*		*2020*		*2019*		*2021*		*2020*		*2019*
Workforce Solutions	$	258,864	$	270,924	$	17,831	$	17,586	$	14,972	$	20,616	$	12,930	$	10,813
Provider Solutions		137,008		140,490		4,719		2,849		2,959		9,861		10,311		9,757
Unallocated		90,881		88,899		892		573		13,602		6,336		6,948		7,299
Total	$	486,753	$	500,313	$	23,442	$	21,008	$	31,533	$	36,813	$	30,189	$	27,869

* Segment assets include accounts and unbilled receivables, prepaid royalties, prepaid and other current assets, other assets, capitalized software development, deferred commissions, certain property and equipment, and intangible assets. Cash and cash equivalents, marketable securities, non-marketable equity investments, and certain ROU assets are not allocated to individual segments and are included within Unallocated. A significant portion of property and equipment assets are included within Unallocated.

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

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+ Details

Note 10 - Income Taxes

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Income Tax Disclosure [Text Block]

10. INCOME TAXES

Components of earnings before income taxes are as follows (in thousands):

	*Year Ended December 31,*
	*2021*			*2020*		*2019*
United States	$	8,006		$	17,719	$	17,929
Foreign		(240	)		104		—
Earnings before income taxes	$	7,766		$	17,823	$	17,929

The provision for income taxes is comprised of the following (in thousands):

	*Year Ended December 31,*
	*2021*			*2020*			*2019*
Current federal	$	5		$	(1,022	)	$	233
Current state		406			387			634
Current foreign		(29	)		71			—
Deferred federal		926			3,830			2,717
Deferred state		699			467			149
Deferred foreign		(86	)		(1	)		—
Provision for income taxes	$	1,921		$	3,732		$	3,733

A reconciliation of income taxes at the statutory federal income tax rate to the provision for income taxes included in the accompanying Consolidated Statements of Income is as follows (in thousands):

	*Year Ended December 31,*
	*2021*			*2020*			*2019*
Federal tax provision at the statutory rate	$	1,631		$	3,743		$	3,765
State income tax provision, net of federal benefit		1,297			787			895
Tax credits		(717	)		(745	)		(614	)
Change in valuation allowance		(272	)		4			(247	)
Impact of foreign operations		(18	)		7			—
Stock compensation		(1	)		27			(117	)
Other		1			(91	)		51
Provision for income taxes	$	1,921		$	3,732		$	3,733

Management periodically assesses the realizability of its deferred tax assets, and to the extent that a recovery is not likely, a valuation allowance is established to reduce the deferred tax asset to the amount estimated to be recoverable. At December 31, 2021, the Company has a valuation allowance of $2.0 million recorded against deferred tax assets for state net operating losses and certain foreign deferred tax assets.

As of December 31, 2021, the Company had federal, state, and foreign net operating loss carryforwards of $19.1 million, $26.3 million, and $8.8 million, respectively. Certain losses have an indefinite carryforward period, while other loss carryforwards will expire in years 2031 through 2041. A portion of the net operating loss carryforwards are subject to annual limitations under Internal Revenue Code Section 382. The annual limitations could result in the expiration of net operating loss and tax credit carryforwards before they are fully utilized. The Company is subject to income taxation at the federal, foreign, and various state levels. We are under examination by the Internal Revenue Service for the 2018 tax year. The Company is no longer subject to U.S. federal tax examinations for tax years before 2018, and with few exceptions, the Company is not subject to examination by foreign or state tax authorities for tax years which ended before 2018. Loss carryforwards and credit carryforwards generated or utilized in years earlier than 2018 are also subject to examination and adjustment.

A reconciliation of the beginning and ending liability for gross unrecognized tax benefits are as follows (in thousands):

	*December 31,*
	*2021*			*2020*
Balance at beginning of year	$	962		$	317
Additions for tax positions of prior years		—			645
Reductions for tax positions of prior years		(662	)		—
Balance at end of year	$	300		$	962

The Company recognized $7,000 and $20,000 for interest and penalties related to unrecognized tax benefits within the provision for income taxes during the years ended December 31, 2021 and 2020. Unrecognized tax benefits included tax positions of $300,000 and $317,000 for the years ended December 31, 2021 and 2020, respectively, that if recognized would impact the Company’s effective tax rate.

Deferred federal and state income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes. Significant components of deferred tax assets and deferred tax liabilities are as follows (in thousands):

	*December 31,*
	*2021*			*2020*
Deferred tax assets:
Allowance for credit losses	$	222		$	143
Accrued liabilities		1,827			1,927
Lease liability		7,548			8,356
Tax credits		518			119
Stock-based compensation		901			691
Deferred revenue		570			3,244
Basis difference on investments		300			395
Net operating loss carryforwards		7,210			3,692
Total deferred tax assets		19,096			18,567
Less: Valuation allowance		(2,011	)		(550	)
Deferred tax assets, net of valuation allowance		17,085			18,017
Deferred tax liabilities:
Deductible goodwill		4,906			2,614
Nondeductible intangible assets		3,422			3,752
Right of use assets		6,523			7,378
Prepaid assets		8,269			6,986
Capitalized software development		8,484			6,989
Depreciation		3,026			3,846
Total deferred tax liabilities		34,630			31,565

Net deferred tax liabilities	$	17,545		$	13,548

The Company realized $1,000 of excess tax expense related to stock-based awards during the year ended December 31, 2021, which was reflected in the statement of income as a component of the provision for income taxes.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

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+ Details

Note 11 - Stock-based Compensation

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Share-based Payment Arrangement [Text Block]

11. STOCK-BASED COMPENSATION

Stock Incentive Plan

The Company has outstanding stock-based awards under its 2016 Omnibus Incentive Plan (2016 Plan). The 2016 Plan authorizes the grant of options, restricted share units (RSUs), or other forms of stock-based compensation to employees, officers, directors, and others, and such grants must be approved by the Compensation Committee of the Board of Directors. The 2016 Plan allows the Compensation Committee of the Board of Directors to determine the vesting period and parameters of each grant. The vesting period of the options and RSUs granted has historically included annual vesting over a period of up to four years, generally beginning one year after the grant date. As of December 31, 2021, 259,000 shares of common stock were available to be granted under the 2016 Plan.

Stock Option Activity

A summary of activity and various other information relative to stock options for the year ended December 31, 2021 is presented in the tables below (in thousands, except exercise price).

			*Weighted-*
	*Common*		*Average*		*Aggregate*
	*Shares*		*Exercise Price*		*Intrinsic Value*
Outstanding at beginning of period		90	$	20.34
Granted		—		—
Exercised		—		—
Expired		—		—
Forfeited		—		—
Outstanding at end of period		90	$	20.34	$	542
Exercisable at end of period		14	$	20.34	$	81

Other information relative to option activity during the three years ended December 31, 2021 is as follows (in thousands):

	*2021*		*2020*		*2019*
Total intrinsic value of stock options exercised	$	—	$	—	$	277
Cash proceeds from exercise of stock options	$	—	$	—	$	214

The aggregate intrinsic value for stock options in the table above represents the total difference between the Company’s closing stock price on December 31, 2021 (the last trading day of the year) of $26.36 per share and the option exercise price, multiplied by the number of in-the money options as of December 31, 2021. The weighted average remaining contractual term of options outstanding at December 31, 2021 was 9 years.

Restricted Share Unit Activity

A summary of activity relative to RSUs for the year ended December 31, 2021 is as follows (in thousands, except weighted average grant date fair value):

				*Weighted-*
	*Number of*			*Average Grant Date*		*Aggregate*
	*RSU’s*			*Fair Value*		*Intrinsic Value*
Outstanding at beginning of period		299		$	24.95
Granted		173			24.09
Vested		(92	)		24.82
Forfeited		(15	)		24.57
Outstanding at end of period		365		$	24.59	$	9,626

The aggregate fair value of RSUs that vested during the year ended December 31, 2021 and 2020, as of the respective vesting dates, was $2.3 million and $2.2 million, respectively. A portion of RSUs that vested in 2021 and 2020 were net-share settled such that the Company withheld shares with value equivalent to the employees’ minimum statutory obligation for the applicable income and other employment taxes and remitted the cash to the appropriate taxing authorities. The total shares withheld for RSUs during 2021 and 2020 were 20,000 and 19,000, respectively, and were based on the value of the RSUs on their respective settlement dates as determined by the Company’s closing stock price. Total payments related to RSUs for the employees’ tax obligations to taxing authorities were $0.5 million in 2021, $0.4 million in 2020, and $0.4 million in 2019, and are reflected as a financing activity within the Consolidated Statements of Cash Flows.

Stock-Based Compensation

Total stock-based compensation expense, which is recorded in our Consolidated Statements of Income, recorded for the years ended December 31, is as follows (in thousands):

	*Years Ended December 31,*
	*2021*		*2020*		*2019*
Cost of revenues (excluding depreciation and amortization)	$	944	$	41	$	699
Product development		1,164		363		956
Sales and marketing		759		199		614
Other general and administrative		2,436		1,614		1,975
Total stock-based compensation expense	$	5,303	$	2,217	$	4,244

The Company amortizes the fair value of all stock-based awards, net of estimated forfeitures, on a straight-line basis over the requisite service period, which generally is the vesting period. As of December 31, 2021, total unrecognized compensation expense related to non-vested stock options and RSUs was $5.6 million, net of estimated forfeitures, with a weighted average expense recognition period remaining of 2.7 years. The Company realized $1,000 of excess tax expense related to stock-based awards during the year ended December 31, 2021, which was reflected in the Consolidated Statement of Income as a component of the provision for income taxes.

Stock-based compensation cost for RSUs is measured based on the closing fair market value of the Company’s stock on the date of grant. Stock-based compensation cost for stock options is estimated at the grant date based on the fair value calculated using the Black-Scholes method.

Stock Awards

During December 2021, the Company’s Chief Executive Officer, Robert A. Frist, Jr., contributed 86,494 of his personally owned shares of HealthStream, Inc. common stock (valued at $2.25 million) to the Company, without any consideration paid to him, for the benefit of the Company’s employees. In connection therewith, effective December 29, 2021 the Company approved the award of 86,494 fully vested shares of common stock to over 1,000 employees of the Company under the HealthStream, Inc. 2016 Omnibus Incentive Plan. These shares were issued in December 2021. As required by ASC Topic 718, Compensation – Stock Compensation, ("ASC 718") the Company recognized $2.25 million of stock-based compensation expense for these stock awards during the three months ended December 31, 2021 based on the closing fair market value of the Company’s stock on the date of the Company’s approval of these grants. Total payments related to the employees’ tax obligations to taxing authorities for these stock awards were $0.7 million and are reflected as a financing activity within the Consolidated Statement of Cash Flows for 2021. In addition, the employer taxes and expenses associated with these grants were $0.2 million and were recorded as an expense during December 2021. Mr. Frist contributed an additional 7,113 of his personally owned shares to cover these costs. The receipt of shares from Mr. Frist and in connection with the withholding of shares as set forth above are presented on the Company’s Statement of Shareholders’ Equity in a similar manner as a share repurchase (i.e., reduction of outstanding shares).

During June 2019, Mr. Frist contributed 78,520 of his personally owned shares of HealthStream, Inc. common stock (valued at $2.0 million) to the Company, without any consideration paid to him, for the benefit of the Company’s employees. In connection therewith, effective June 26, 2019 the Company approved the award of 78,520 fully vested shares of common stock to approximately 820 employees of the Company under the HealthStream, Inc. 2016 Omnibus Incentive Plan. These shares were issued in July 2019. As required by ASC Topic 718, the Company recognized $2.0 million of stock-based compensation expense for these stock awards during the three months ended June 30, 2019 based on the closing fair market value of the Company’s stock on the date of the Company’s approval of these grants. Total payments related to the employees’ tax obligations to taxing authorities for these stock awards were $0.6 million and are reflected as a financing activity within the Consolidated Statement of Cash Flows for 2019. In addition, the employer taxes and expenses associated with these grants were $0.2 million and were recorded as an expense during June 2019. Mr. Frist contributed an additional 7,852 of his personally owned shares to cover these costs. The receipt of shares from Mr. Frist and in connection with the withholding of shares as set forth above are presented on the Company’s Statement of Shareholders’ Equity in a similar manner as a share repurchase (i.e., reduction of outstanding shares).

Note 12 - Employee Benefit Plan

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Retirement Benefits [Text Block]

12. EMPLOYEE BENEFIT PLAN

401(k) Plan

The Company has a defined-contribution employee benefit plan (401(k) Plan) incorporating provisions of Section 401(k) of the Internal Revenue Code. Employees must have attained the age of 21 and have completed thirty days of service to be eligible to participate in the 401(k) Plan. Under the provisions of the 401(k) Plan, a plan member may make contributions, on a tax-deferred basis, subject to IRS limitations. The Company elected to provide eligible employees with matching contributions totaling $2.0 million, $1.2 million, and $1.4 million for the years ended December 31, 2021, 2020, and 2019, respectively.

- Definition

The entire disclosure for retirement benefits.

+ References

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+ Details

Note 13 - Discontinued Operations

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Disposal Groups, Including Discontinued Operations, Disclosure [Text Block]

13. DISCONTINUED OPERATIONS

On February 12, 2018, the Company divested its PX business to Press Ganey for $65.2 million in cash (after giving effect to the post-closing working capital adjustment), resulting in a gain, net of tax, of $20.5 million, of which $19.0 million was recorded during the year ended December 31, 2018 and $1.5 million was recorded during the year ended December 31, 2019. This sale of the PX business resulted in the divestiture of the Company’s patient experience solutions business segment. The Company has classified the results of its PX business segment as discontinued operations in its Consolidated Statements of Income for all periods presented.

Note 14 - Debt

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Debt Disclosure [Text Block]

14. DEBT

At December 31, 2021 and 2020, the Company had no debt outstanding.

Revolving Credit Facility

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. The Amendment also increased the capacity under the Revolving Credit Facility to $65.0 million, which continues to include 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. In addition, the Amendment, among other things, (i) increased the basket for dividends to $65.0 million so long as the pro forma leverage ratio is less than or equal to 1.50:1.00 and the Company has minimum liquidity of $30.0 million, (ii) increased the basket for permitted minority owned investments to $20.0 million, (iii) added a LIBOR floor of 0.50%, and (iv) adjusted the applicable margin. 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.

The purpose of the Revolving Credit Facility is for general working capital needs, permitted acquisitions (as defined in the Loan Agreement), 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:

•

a funded debt leverage ratio (consolidated debt/consolidated EBITDA) of not greater than 3.0 to 1.0; and

•

an interest coverage ratio (consolidated EBITDA/consolidated interest expense) of not less than 3.0 to 1.0.

As of December 31, 2021, the Company was in compliance with all covenants. There were no balances outstanding on the Revolving Credit Facility as of December 31, 2021 and there were no borrowings under the Revolving Credit Facility during the year ended December 31, 2021.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

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+ Details

Note 15 - Leases

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Lessee, Operating Leases [Text Block]

15. LEASES

The Company’s operating lease expense as presented in other general and administrative expense in the Consolidated Statements of Income was $5.5 million, $4.8 million, and $4.9 million for the twelve months ended December 31, 2021, 2020, and 2019, respectively. Cash paid for amounts included in the measurement of operating lease liabilities was $5.3 million and $4.9 million for the year ended December 31, 2021 and December 31, 2020, respectively. As of December 31, 2021, the weighted-average remaining lease term was 8.9 years, and the weighted-average incremental borrowing rate was 6%. As of December 31, 2021, the Company did not have any leases that have not yet commenced.

The table below presents the lease-related assets and liabilities recorded on the Consolidated Balance Sheets as of December 31, 2021 and 2020 (in thousands).

		*Year Ended December 31,*
		*2021*		*2020*
Assets	*Classification*
Operating lease right-of-use assets	Operating lease right of use assets, net	$	25,168	$	28,081
Total leased assets		$	25,168	$	28,081
Liabilities
Operating lease liabilities, current	Accounts payable and accrued expenses	$	2,928	$	3,390
Operating lease liabilities, noncurrent	Operating lease liability, noncurrent		26,178		28,479
Total operating lease liabilities		$	29,106	$	31,869

The table below presents the maturities of lease liabilities under non-cancellable leases as of December 31, 2021 (in thousands).

2022	$	4,495
2023		4,422
2024		4,457
2025		4,022
2026		3,650
Thereafter		17,000
Total undiscounted lease payments	$	38,046
Less imputed interest		8,940
Total lease liabilities	$	29,106

Note 16 - Litigation

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Commitments and Contingencies Disclosure [Text Block]

16. LITIGATION

In connection with its business, the Company is from time to time involved in various legal actions. The litigation process is inherently uncertain, and it is possible that the resolution of such matters might have a material adverse effect upon the financial condition and/or results of operations of the Company. However, in the opinion of the Company’s management, matters currently pending or threatened against the Company are not expected to have a material adverse effect on the financial position or results of operations of the Company.

Note 17 - Non-marketable Equity Investments

12 Months Ended

Dec. 31, 2021

Notes to Financial Statements

Non-marketable Equity Investments Disclosure [Text Block]

17. NON-MARKETABLE EQUITY INVESTMENTS

The aggregate carrying amount of non-marketable equity investments accounted for using the measurement alternative for equity investments that do not have readily determinable fair values was $2.8 million and $3.9 million for the years ended December 31, 2021 and 2020, respectively, which carrying value we evaluate for impairment at each reporting period. During the year ended December 31, 2021, the Company recorded a $0.3 million upward adjustment to the carrying value of a non-marketable equity investment due to a change in fair value based on the consideration received upon the sale of the investment. During the year ended December 31, 2020, the Company recorded a $1.2 million upward adjustment to the carrying value of our non-marketable equity investment in NurseGrid due to a change in fair value based on the consideration paid upon the Company’s acquisition of NurseGrid on March 9, 2020 (see Note 8). Cumulatively, the Company has recorded $0.2 million in upward adjustments to the carrying value of non-marketable equity investments. Such is the combination of cumulative upward adjustments of $1.5 million offset by cumulative downward adjustments of $1.3 million. Cumulatively, the Company has recorded $1.3 million in reductions to the carrying value of non-marketable equity investments due to downward changes in fair value based on observable prices from orderly transactions for similar investments made in the investee. The fair value of non-marketable equity investments is not estimated if there are no identified events or changes in circumstances that may have a significant adverse effect on the fair value of the investment.

Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Business Description [Policy Text Block]

Description of Business

Revenue from Contract with Customer [Policy Text Block]

Recognition of Revenue

Revenue is recognized based on the following five step model:

•

Identification of the contract with a customer

•

Identification of the performance obligations in the contract

•

Determination of the transaction price

•

Allocation of the transaction price to the performance obligations in the contract

•

Recognition of revenue when, or as, the Company satisfies a performance obligation

Deferred revenue represents contract liabilities that are recorded when cash payments are received or are due in advance of our satisfaction of performance obligations.

Basis of Accounting, Policy [Policy Text Block]

Basis of Presentation

The Consolidated Financial Statements include the accounts of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions have been eliminated in consolidation.

Use of Estimates, Policy [Policy Text Block]

Use of Estimates

Cash and Cash Equivalents, Policy [Policy Text Block]

Cash Equivalents

The Company considers cash equivalents to be unrestricted, highly liquid investments with initial maturities of less than three months.

Marketable Securities, Policy [Policy Text Block]

Marketable Securities

Revenue from Contract with Customer Commissions Policy [Policy Text Block]

Deferred Commissions

Deferred Charges, Policy [Policy Text Block]

Prepaid Royalties

Receivables, Trade and Other Accounts Receivable, Allowance for Doubtful Accounts, Policy [Policy Text Block]

Allowance for Credit Losses

Changes in the allowance for credit losses and the amounts charged to bad debt expense for the years ended December 31 were as follows (in thousands):

	*Allowance Balance at Beginning of Period*		*Charged to Costs and Expenses*		*Write-offs*			*Allowance Balance at End of Period*
2021	$	549	$	723	$	(419	)	$	853
2020		843		274		(568	)		549
2019		1,161		211		(529	)		843

Research, Development, and Computer Software, Policy [Policy Text Block]

Capitalized Software Development

Fair Value Measurement, Policy [Policy Text Block]

Fair Value Measurements

Level 1 – Observable inputs that reflect quoted prices (unadjusted) for identical assets or liabilities in active markets.

Level 2 – Inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly.

Level 3 – Unobservable inputs in which little or no market data exists, therefore requiring the Company to develop its own assumptions.

Property, Plant and Equipment, Policy [Policy Text Block]

Property and Equipment

	*Years*
Furniture and fixtures		5 - 7
Equipment		3

Goodwill and Intangible Assets, Policy [Policy Text Block]

Goodwill and Intangible Assets

Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]

Long-Lived Assets

Equity Securities without Readily Determinable Fair Value [Policy Text Block]

Non-Marketable Equity Investments

Fair Value of Financial Instruments, Policy [Policy Text Block]

Financial Instruments

Advertising Cost [Policy Text Block]

Advertising

Shipping and Handling Costs Policy [Policy Text Block]

Shipping and Handling Costs

Income Tax, Policy [Policy Text Block]

Income Taxes

Earnings Per Share, Policy [Policy Text Block]

Earnings per Share

Concentration Risk, Credit Risk, Policy [Policy Text Block]

Concentrations of Credit Risk and Significant Customers

Share-based Payment Arrangement [Policy Text Block]

Stock-Based Compensation

Lessee, Leases [Policy Text Block]

Leases

Foreign Currency Transactions and Translations Policy [Policy Text Block]

Foreign Currency

New Accounting Pronouncements, Policy [Policy Text Block]

Recently Issued Accounting Pronouncements Not Yet Adopted

Note 1 - Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Financing Receivable, Allowance for Credit Loss [Table Text Block]

	*Allowance Balance at Beginning of Period*		*Charged to Costs and Expenses*		*Write-offs*			*Allowance Balance at End of Period*
2021	$	549	$	723	$	(419	)	$	853
2020		843		274		(568	)		549
2019		1,161		211		(529	)		843

Property Plant and Equipment Useful Lives [Table Text Block]

	*Years*
Furniture and fixtures		5 - 7
Equipment		3

Note 3 - Earnings Per Share (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]

	*Year Ended December 31,*
	*2021*		*2020*		*2019*
Numerator:
Income from continuing operations	$	5,845	$	14,091	$	14,196
Income from discontinued operations		—		—		1,574
Net income	$	5,845	$	14,091	$	15,770
Denominator:
Weighted-average shares outstanding		31,534		31,960		32,372
Effect of dilutive shares		84		29		56
Weighted-average diluted shares		31,618		31,989		32,428

Net income per share – basic:
Continuing operations	$	0.19	$	0.44	$	0.44
Discontinued operations		—		-		0.05
Net income per share - basic	$	0.19	$	0.44	$	0.49

Net income per share – diluted:
Continuing operations	$	0.18	$	0.44	$	0.44
Discontinued operations		—		—		0.05
Net income per share - diluted	$	0.18	$	0.44	$	0.49

Note 4 - Marketable Securities (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Debt Securities, Available-for-sale [Table Text Block]

	*December 31, 2021*
	*Adjusted Cost*		*Unrealized Gains*		*Unrealized Losses*			*Fair Value*		*Cash and Cash Equivalents*		*Current Marketable Securities*
Cash	$	46,905	$	—	$	—		$	46,905	$	46,905	$	—
Level 2:
Corporate debt securities		5,043		—		(2	)		5,041		—		5,041
Total	$	51,948	$	—	$	(2	)	$	51,946	$	46,905	$	5,041

	*December 31, 2020*
	*Adjusted Cost*		*Unrealized Gains*		*Unrealized Losses*			*Fair Value*		*Cash and Cash Equivalents*		*Current Marketable Securities*
Cash	$	31,558	$	—	$	—		$	31,558	$	31,558	$	—
Level 2:
Time deposits		10,021		—		—			10,021		5,008		5,013
Corporate debt securities		4,923		—		(8	)		4,915		—		4,915
Total	$	46,502	$	—	$	(8	)	$	46,494	$	36,566	$	9,928

Note 5 - Revenue Recognition and Sales Commissions (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Disaggregation of Revenue [Table Text Block]

	*Year Ended December 31, 2021*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	199,676	$	43,941	$	243,617
Professional services		5,767		7,328		13,095
Total revenues, net	$	205,443	$	51,269	$	256,712

	*Year Ended December 31, 2020*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	193,673	$	40,237	$	233,910
Professional services		3,914		7,002		10,916
Total revenues, net	$	197,587	$	47,239	$	244,826

	*Year Ended December 31, 2019*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	202,479	$	38,022	$	240,501
Professional services		6,120		7,491		13,611
Total revenues, net	$	208,599	$	45,513	$	254,112

Note 6 - Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Property, Plant and Equipment [Table Text Block]

	*December 31,*
	*2021*			*2020*
Equipment	$	15,987		$	21,401
Leasehold improvements		14,937			14,980
Furniture and fixtures		5,025			5,074
Gross property and equipment		35,949			41,455
Accumulated depreciation and amortization		(17,999	)		(19,237	)
Property and equipment, net	$	17,950		$	22,218

Note 7 - Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Schedule of Goodwill [Table Text Block]

	*Workforce Solutions*		*Provider Solutions*		*Total*
Balance at January 1, 2021	$	104,016	$	74,424	$	178,440
Acquisition of ComplyALIGN		945		—		945
Acquisition of Rievent		1,707		—		1,707
Post-closing adjustment for ANSOS		1,183		—		1,183
Effect of exchange rate changes		226		—		226
Balance at December 31, 2021	$	108,077	$	74,424	$	182,501

	*Workforce Solutions*		*Provider Solutions*		*Total*
Balance at January 1, 2020	$	27,776	$	74,420	$	102,196
Acquisition of NurseGrid		21,085		—		21,085
Acquisition of ShiftWizard		19,307		—		19,307
Acquisition of ANSOS		35,258		—		35,258
Acquisition of myClinicalExchange		590		—		590
Post-closing adjustment for CredentialMyDoc		—		4		4
Balance at December 31, 2020	$	104,016	$	74,424	$	178,440

Schedule of Finite-Lived Intangible Assets [Table Text Block]

	*As of December 31, 2021*							*As of December 31, 2020*
	*Gross Amount*		*Accumulated Amortization*			*Net*		*Gross Amount*		*Accumulated Amortization*			*Net*
Customer related	$	114,418	$	(45,615	)	$	68,803	$	113,650	$	(36,723	)	$	76,927
Other		37,154		(16,752	)		20,402		34,536		(10,748	)		23,788
Total	$	151,572	$	(62,367	)	$	89,205	$	148,186	$	(47,471	)	$	100,715

Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block]

2022	$	14,181
2023		13,519
2024		12,021
2025		11,300
2026		8,215
Thereafter		29,269
Total	$	88,505

Note 8 - Business Combinations (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Schedule of Business Acquisitions, by Acquisition [Table Text Block]

Cash paid at closing	$	25,485
Post-closing adjustment, net of cash received		33
Cash acquired		(4,064	)
Net consideration paid		21,454
Fair value of existing equity interest in NurseGrid		3,623
Net consideration paid	$	25,077

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed [Table Text Block]

Accounts and unbilled receivable, net	$	92
Prepaid and other current assets		155
Operating lease right-of-use assets		50
Deferred tax assets		2,121
Goodwill		21,085
Intangible assets		1,845
Accounts payable and accrued liabilities		(143	)
Deferred revenue		(78	)
Operating lease liabilities		(50	)
Net assets acquired	$	25,077

Cash	$	1,091
Accounts and unbilled receivable, net		1,038
Prepaid assets		106
Operating lease right-of-use assets		183
Property and equipment		50
Indemnification assets		464
Goodwill		19,307
Intangible asset		12,660
Accounts payable and accrued liabilities		(600	)
Deferred revenue		(1,601	)
Deferred tax liability		(1,559	)
Operating lease liabilities		(183	)
Indemnification liability		(464	)
Net assets acquired	$	30,492

Cash	$	1,599
Accounts and unbilled receivable, net		11,017
Prepaid assets		233
Operating lease right-of-use assets		888
Property and equipment		66
Deferred tax assets		1,191
Goodwill		36,440
Intangible assets		32,440
Accounts payable and accrued liabilities		(1,776	)
Deferred revenue		(13,873	)
Operating lease liabilities		(888	)
Deferred tax liability		(889	)
Net assets acquired	$	66,448

Schedule of Finite-Lived Intangible Assets Acquired as Part of Business Combination [Table Text Block]

	*Fair value*		*Useful life (in years)*
Customer relationships	$	35		8
Developed technology		1,110		5
Trade name		700	Indefinite
Total intangible assets	$	1,845

	*Fair Value*		*Useful life (in years)*
Customer relationships	$	7,800		18
Developed technology		4,050		5
Non-compete		580		1 - 5
Trade name		230		5
Total intangible assets subject to amortization	$	12,660

	*Fair Value*		*Useful life (in years)*
Customer relationships	$	21,100		11 - 14
Developed technology		9,800		5
Trade name		1,540		10
Total intangible assets subject to amortization	$	32,440

Business Acquisition, Pro Forma Information [Table Text Block]

	*Year Ended December 31,*
	*2021*		*2020*		*2019*
Total revenues	$	257,291	$	248,306	$	257,042
Income from continuing operations	$	6,352	$	13,056	$	11,604
Net income	$	6,352	$	13,056	$	13,178
Net income per share - basic	$	0.20	$	0.41	$	0.41
Net income per share - diluted	$	0.20	$	0.41	$	0.41

	*Year Ended December 31,*
	*2021*		*2020*		*2019*
Total revenues	$	259,451	$	270,246	$	278,491
Income from continuing operations	$	8,072	$	18,861	$	16,534
Net income	$	8,072	$	18,861	$	18,108
Net income per share - basic	$	0.26	$	0.59	$	0.56
Net income per share - diluted	$	0.26	$	0.59	$	0.56

Note 9 - Business Segments (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Reconciliation of Revenue and Operating Profit Loss from Segments to Consolidated [Table Text Block]

Revenues, net:	*2021*		*2020*		*2019*
Workforce Solutions	$	205,443	$	197,587	$	208,599
Provider Solutions		51,269		47,239		45,513
Total revenues, net	$	256,712	$	244,826	$	254,112

Operating income:	*2021*			*2020*			*2019*
Workforce Solutions	$	31,736		$	41,622		$	40,296
Provider Solutions		7,915			4,678			5,384
Unallocated		(31,596	)		(30,482	)		(30,960	)
Total operating income	$	8,055		$	15,818		$	14,720

Reconciliation of Assets from Segment to Consolidated [Table Text Block]

	Assets*				*Purchases of long-lived assets*						*Depreciation and amortization*
	*2021*		*2020*		*2021*		*2020*		*2019*		*2021*		*2020*		*2019*
Workforce Solutions	$	258,864	$	270,924	$	17,831	$	17,586	$	14,972	$	20,616	$	12,930	$	10,813
Provider Solutions		137,008		140,490		4,719		2,849		2,959		9,861		10,311		9,757
Unallocated		90,881		88,899		892		573		13,602		6,336		6,948		7,299
Total	$	486,753	$	500,313	$	23,442	$	21,008	$	31,533	$	36,813	$	30,189	$	27,869

Note 10 - Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Schedule of Income before Income Tax, Domestic and Foreign [Table Text Block]

	*Year Ended December 31,*
	*2021*			*2020*		*2019*
United States	$	8,006		$	17,719	$	17,929
Foreign		(240	)		104		—
Earnings before income taxes	$	7,766		$	17,823	$	17,929

Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]

	*Year Ended December 31,*
	*2021*			*2020*			*2019*
Current federal	$	5		$	(1,022	)	$	233
Current state		406			387			634
Current foreign		(29	)		71			—
Deferred federal		926			3,830			2,717
Deferred state		699			467			149
Deferred foreign		(86	)		(1	)		—
Provision for income taxes	$	1,921		$	3,732		$	3,733

Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]

	*Year Ended December 31,*
	*2021*			*2020*			*2019*
Federal tax provision at the statutory rate	$	1,631		$	3,743		$	3,765
State income tax provision, net of federal benefit		1,297			787			895
Tax credits		(717	)		(745	)		(614	)
Change in valuation allowance		(272	)		4			(247	)
Impact of foreign operations		(18	)		7			—
Stock compensation		(1	)		27			(117	)
Other		1			(91	)		51
Provision for income taxes	$	1,921		$	3,732		$	3,733

Summary of Income Tax Contingencies [Table Text Block]

	*December 31,*
	*2021*			*2020*
Balance at beginning of year	$	962		$	317
Additions for tax positions of prior years		—			645
Reductions for tax positions of prior years		(662	)		—
Balance at end of year	$	300		$	962

Schedule of Deferred Tax Assets and Liabilities [Table Text Block]

	*December 31,*
	*2021*			*2020*
Deferred tax assets:
Allowance for credit losses	$	222		$	143
Accrued liabilities		1,827			1,927
Lease liability		7,548			8,356
Tax credits		518			119
Stock-based compensation		901			691
Deferred revenue		570			3,244
Basis difference on investments		300			395
Net operating loss carryforwards		7,210			3,692
Total deferred tax assets		19,096			18,567
Less: Valuation allowance		(2,011	)		(550	)
Deferred tax assets, net of valuation allowance		17,085			18,017
Deferred tax liabilities:
Deductible goodwill		4,906			2,614
Nondeductible intangible assets		3,422			3,752
Right of use assets		6,523			7,378
Prepaid assets		8,269			6,986
Capitalized software development		8,484			6,989
Depreciation		3,026			3,846
Total deferred tax liabilities		34,630			31,565

Net deferred tax liabilities	$	17,545		$	13,548

Note 11 - Stock-based Compensation (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Share-based Payment Arrangement, Option, Activity [Table Text Block]

			*Weighted-*
	*Common*		*Average*		*Aggregate*
	*Shares*		*Exercise Price*		*Intrinsic Value*
Outstanding at beginning of period		90	$	20.34
Granted		—		—
Exercised		—		—
Expired		—		—
Forfeited		—		—
Outstanding at end of period		90	$	20.34	$	542
Exercisable at end of period		14	$	20.34	$	81

Schedule of Share Based Compensation Additional Stock Options Activity [Table Text Block]

	*2021*		*2020*		*2019*
Total intrinsic value of stock options exercised	$	—	$	—	$	277
Cash proceeds from exercise of stock options	$	—	$	—	$	214

Share-based Payment Arrangement, Restricted Stock Unit, Activity [Table Text Block]

				*Weighted-*
	*Number of*			*Average Grant Date*		*Aggregate*
	*RSU’s*			*Fair Value*		*Intrinsic Value*
Outstanding at beginning of period		299		$	24.95
Granted		173			24.09
Vested		(92	)		24.82
Forfeited		(15	)		24.57
Outstanding at end of period		365		$	24.59	$	9,626

Share-based Payment Arrangement, Expensed and Capitalized, Amount [Table Text Block]

	*Years Ended December 31,*
	*2021*		*2020*		*2019*
Cost of revenues (excluding depreciation and amortization)	$	944	$	41	$	699
Product development		1,164		363		956
Sales and marketing		759		199		614
Other general and administrative		2,436		1,614		1,975
Total stock-based compensation expense	$	5,303	$	2,217	$	4,244

Note 15 - Leases (Tables)

12 Months Ended

Dec. 31, 2021

Notes Tables

Lessee, Operating Lease, Assets and Liabilities [Table Text Block]

		*Year Ended December 31,*
		*2021*		*2020*
Assets	*Classification*
Operating lease right-of-use assets	Operating lease right of use assets, net	$	25,168	$	28,081
Total leased assets		$	25,168	$	28,081
Liabilities
Operating lease liabilities, current	Accounts payable and accrued expenses	$	2,928	$	3,390
Operating lease liabilities, noncurrent	Operating lease liability, noncurrent		26,178		28,479
Total operating lease liabilities		$	29,106	$	31,869

Lessee, Operating Lease, Liability, Maturity [Table Text Block]

2022	$	4,495
2023		4,422
2024		4,457
2025		4,022
2026		3,650
Thereafter		17,000
Total undiscounted lease payments	$	38,046
Less imputed interest		8,940
Total lease liabilities	$	29,106

Note 1 - Summary of Significant Accounting Policies (Details Textual) $ in Thousands		12 Months Ended
	Feb. 12, 2018 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Number of Operating Segments		2
Capitalized Software Development Amortization Period (Year)		3 years
Capitalized Computer Software, Gross		$ 21,400	$ 17,900
Capitalized Computer Software, Amortization		15,600	12,700	$ 11,000
Capitalized Software Development Costs for Software Sold to Customers		0	0
Impairment of Intangible Assets, Finite-lived		0	0	0
Impairment, Long-Lived Asset, Held-for-Use, Total		$ 0	0	0
Number of Possible Sources of Taxable Income		4
Deferred Tax Assets, Valuation Allowance, Total		$ 2,011	550
Number of Stock Based Compensation Plans		1
Selling and Marketing Expense [Member]
Advertising Expense		$ 1,900	$ 1,100	$ 800
Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)		1 year
Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)		18 years
Weighted Average [Member]
Finite-Lived Intangible Asset, Useful Life (Year)		11 years 3 months 18 days
Patient Experience Solution [Member]
Proceeds from Divestiture of Businesses	$ 65,200

Note 1 - Summary of Significant Accounting Policies - Changes in the Allowance for Doubtful Accounts and the Amounts Charged to Bad Debt Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Allowance balance	$ 549	$ 843	$ 1,161
Accounts Receivable, Credit Loss Expense (Reversal)	723	274	211
Write-offs	(419)	(568)	(529)
Allowance balance	$ 853	$ 549	$ 843

Note 1 - Summary of Significant Accounting Policies - Estimated Useful Lives of Property and Equipment (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Property and equipment, estimated useful lives (Year)		3 years
Minimum [Member]
Property and equipment, estimated useful lives (Year)	5 years
Maximum [Member]
Property and equipment, estimated useful lives (Year)			7 years

Note 2 - Shareholders' Equity (Details Textual) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Nov. 30, 2021	Mar. 13, 2020
Common Stock, Shares Authorized (in shares)	75,000,000	75,000,000
Common Stock, Shares, Outstanding, Ending Balance (in shares)	31,300,000	31,500,000
Common Stock, Shares, Issued, Total (in shares)	31,327,000	31,493,000
Preferred Stock, Shares Authorized (in shares)	10,000,000
Stock Repurchased During Period, Value	$ 5,114	$ 20,019
March 2020 Share Repurchase Program [Member]
Stock Repurchase Program, Authorized Amount				$ 30,000
Stock Repurchased During Period, Shares (in shares)	0	957,367
Stock Repurchased During Period, Value		$ 20,000
Stock Repurchased Average Price per Share (in dollars per share)		$ 20.89
November 2021 Share Repurchase Program [Member]
Stock Repurchase Program, Authorized Amount			$ 20,000
Stock Repurchased During Period, Shares (in shares)	203,284
Stock Repurchased During Period, Value	$ 5,100
Stock Repurchased Average Price per Share (in dollars per share)	$ 25.14

Note 3 - Earnings Per Share (Details Textual) - shares	12 Months Ended
Note 3 - Earnings Per Share (Details Textual) - shares	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares)	78,000	122,000	93,000

Note 3 - Earnings Per Share - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income from continuing operations	$ 5,845	$ 14,091	$ 14,196
Income from discontinued operations	0	0	1,574
Net income	$ 5,845	$ 14,091	$ 15,770
Weighted-average shares outstanding (in shares)	31,534	31,960	32,372
Effect of dilutive shares (in shares)	84	29	56
Weighted-average diluted shares (in shares)	31,618	31,989	32,428
Net income per share – basic:
Continuing operations (in dollars per share)	$ 0.19	$ 0.44	$ 0.44
Discontinued operations (in dollars per share)	0	0	0.05
Net income per share - basic (in dollars per share)	0.19	0.44	0.49
Net income per share - diluted:
Continuing operations (in dollars per share)	0.18	0.44	0.44
Discontinued operations (in dollars per share)	0	0	0.05
Net income per share - diluted (in dollars per share)	$ 0.18	$ 0.44	$ 0.49

Note 4 - Marketable Securities - Fair Value of Available for Sale Marketable Securities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Adjusted Cost	$ 51,948	$ 46,502
Unrealized Gains	0	0
Unrealized Losses	(2)	(8)
Fair Value	51,946	46,494
Cash and Cash Equivalents	46,905	36,566
Current Marketable Securities	5,041	9,928
Cash [Member]
Adjusted Cost	46,905	31,558
Unrealized Gains	0	0
Unrealized Losses	0	0
Fair Value	46,905	31,558
Cash and Cash Equivalents	46,905	31,558
Current Marketable Securities	0	0
Corporate Debt Securities [Member] \| Fair Value, Inputs, Level 2 [Member]
Adjusted Cost	5,043	4,923
Unrealized Gains	0	0
Unrealized Losses	(2)	(8)
Fair Value	5,041	4,915
Cash and Cash Equivalents	0	0
Current Marketable Securities	$ 5,041	4,915
Bank Time Deposits [Member] \| Fair Value, Inputs, Level 2 [Member]
Adjusted Cost		10,021
Unrealized Gains		0
Unrealized Losses		0
Fair Value		10,021
Cash and Cash Equivalents		5,008
Current Marketable Securities		$ 5,013

Note 5 - Revenue Recognition and Sales Commissions 1 (Details Textual) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounts Receivable, Credit Loss Expense (Reversal)	$ 723	$ 274	$ 211
Contract with Customer, Liability, Revenue Recognized	62,300	64,500	64,700
Revenue, Remaining Performance Obligation, Amount	$ 451,000
Revenue, Remaining Performance Obligation, Percentage	47.00%
Sales Commissions, Amortization Term (Year)	3 years
Amortization of Deferred Sales Commissions	$ 9,169	8,768	$ 8,305
Customer Contracts [Member]
Accounts Receivable, Credit Loss Expense (Reversal)	$ 700	$ 300

Note 5 - Revenue Recognition and Sales Commissions 2 (Details Textual)	Dec. 31, 2021
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Period (Month)	12 months

Note 5 - Revenue Recognition and Sales Commissions - Revenues Disaggregated By Revenue Source (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Revenues	$ 256,712	$ 244,826	$ 254,112
Subscription Services [Member]
Revenues	243,617	233,910	240,501
Professional Services [Member]
Revenues	13,095	10,916	13,611
Healthstream Workforce Solutions [Member]
Revenues	205,443	197,587	208,599
Healthstream Workforce Solutions [Member] \| Subscription Services [Member]
Revenues	199,676	193,673	202,479
Healthstream Workforce Solutions [Member] \| Professional Services [Member]
Revenues	5,767	3,914	6,120
Healthstream Provider Solutions [Member]
Revenues	51,269	47,239	45,513
Healthstream Provider Solutions [Member] \| Subscription Services [Member]
Revenues	43,941	40,237	38,022
Healthstream Provider Solutions [Member] \| Professional Services [Member]
Revenues	$ 7,328	$ 7,002	$ 7,491

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9031-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9038-108599

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 4
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130543-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 42
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9054-108599

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 5
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130545-203045

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Note 6 - Property and Equipment (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Depreciation, Total	$ 6.3	$ 6.9	$ 7.3

Note 6 - Property and Equipment - Summary of Property and Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Property, plant and equipment	$ 35,949	$ 41,455
Accumulated depreciation and amortization	(17,999)	(19,237)
Property and equipment, net	17,950	22,218
Equipment [Member]
Property, plant and equipment	15,987	21,401
Leasehold Improvements [Member]
Property, plant and equipment	14,937	14,980
Furniture and Fixtures [Member]
Property, plant and equipment	$ 5,025	$ 5,074

Note 7 - Goodwill and Intangible Assets (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Indefinite-lived Intangible Assets (Excluding Goodwill), Ending Balance	$ 0.7
Amortization of Intangible Assets, Total	$ 14.9	$ 10.5	$ 9.6
Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	1 year
Minimum [Member] \| Customer Relationships [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	5 years
Minimum [Member] \| Other Intangible Assets [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	1 year
Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	18 years
Maximum [Member] \| Customer Relationships [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	18 years
Maximum [Member] \| Other Intangible Assets [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	10 years

Note 7 - Goodwill and Intangible Assets - Changes in Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Balance	$ 178,440	$ 102,196
Effect of exchange rate changes	226
Balance	182,501	178,440
ComplyALIGN [Member]
Goodwill, Acquired	945
Nurse Grid [Member]
Goodwill, Acquired		21,085
Rievent Technologies [Member]
Goodwill, Acquired	1,707
ShiftWizard [Member]
Goodwill, Acquired		19,307
ANSOS [Member]
Goodwill, Acquired		35,258
Post-closing adjustment for ANSOS	1,183
MyClinicalExchange [Member]
Goodwill, Acquired		590
Credential My Doc [Member]
Post-closing adjustment for ANSOS		4
Healthstream Workforce Solutions [Member]
Balance	104,016	27,776
Effect of exchange rate changes	226
Balance	108,077	104,016
Healthstream Workforce Solutions [Member] \| ComplyALIGN [Member]
Goodwill, Acquired	945
Healthstream Workforce Solutions [Member] \| Nurse Grid [Member]
Goodwill, Acquired		21,085
Healthstream Workforce Solutions [Member] \| Rievent Technologies [Member]
Goodwill, Acquired	1,707
Healthstream Workforce Solutions [Member] \| ShiftWizard [Member]
Goodwill, Acquired		19,307
Healthstream Workforce Solutions [Member] \| ANSOS [Member]
Goodwill, Acquired		35,258
Post-closing adjustment for ANSOS	1,183
Healthstream Workforce Solutions [Member] \| MyClinicalExchange [Member]
Goodwill, Acquired		590
Healthstream Workforce Solutions [Member] \| Credential My Doc [Member]
Post-closing adjustment for ANSOS		0
Healthstream Provider Solutions [Member]
Balance	74,424	74,420
Effect of exchange rate changes	0
Balance	74,424	74,424
Healthstream Provider Solutions [Member] \| ComplyALIGN [Member]
Goodwill, Acquired	0
Healthstream Provider Solutions [Member] \| Nurse Grid [Member]
Goodwill, Acquired		0
Healthstream Provider Solutions [Member] \| Rievent Technologies [Member]
Goodwill, Acquired	0
Healthstream Provider Solutions [Member] \| ShiftWizard [Member]
Goodwill, Acquired		0
Healthstream Provider Solutions [Member] \| ANSOS [Member]
Goodwill, Acquired		0
Post-closing adjustment for ANSOS	$ 0
Healthstream Provider Solutions [Member] \| MyClinicalExchange [Member]
Goodwill, Acquired		0
Healthstream Provider Solutions [Member] \| Credential My Doc [Member]
Post-closing adjustment for ANSOS		$ 4

Note 7 - Goodwill and Intangible Assets - Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Gross Amount	$ 151,572	$ 148,186
Accumulated Amortization	(62,367)	(47,471)
Net	89,205	100,715
Customer Relationships [Member]
Gross Amount	114,418	113,650
Accumulated Amortization	(45,615)	(36,723)
Net	68,803	76,927
Other Intangible Assets [Member]
Gross Amount	37,154	34,536
Accumulated Amortization	(16,752)	(10,748)
Net	$ 20,402	$ 23,788

Note 7 - Goodwill and Intangible Assets - Expected Annual Amortization Expense (Details) $ in Thousands	Dec. 31, 2021 USD ($)
2022	$ 14,181
2023	13,519
2024	12,021
2025	11,300
2026	8,215
Thereafter	29,269
Total	$ 88,505

Note 8 - Business Combinations (Details Textual) - USD ($)							3 Months Ended	12 Months Ended
	Dec. 01, 2021	Jan. 19, 2021	Dec. 10, 2020	Dec. 02, 2020	Oct. 12, 2020	Mar. 09, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Payments to Acquire Businesses, Net of Cash Acquired, Total								$ 4,705,000	$ 121,342,000	$ 27,018,000
Nurse Grid [Member]
Payments to Acquire Businesses, Net of Cash Acquired, Total						$ 21,500,000
Business Combination, Step Acquisition, Equity Interest in Acquiree, Fair Value						3,623,000
Business Combination, Step Acquisition, Equity Interest in Acquiree, Remeasurement Gain							$ 1,200,000
Business Acquisition, Transaction Costs						200,000
Deferred Revenue Included in Net Tangible Assets, Book Value						157,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Deferred Revenue						78,000
Write-down of Deferred Revenue						79,000
Payments to Acquire Businesses, Gross						$ 25,485,000
ShiftWizard [Member]
Payments to Acquire Businesses, Net of Cash Acquired, Total					$ 30,500,000
Business Acquisition, Transaction Costs					300,000
Deferred Revenue Included in Net Tangible Assets, Book Value					2,700,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Deferred Revenue					1,601,000
Write-down of Deferred Revenue					1,100,000
Business Combination, Indemnification Asset and Liability, Related to Paycheck Protection, Program Loan as of Acquisition Date					$ 500,000
ANSOS Staff Scheduling Application [Member]
Payments to Acquire Businesses, Net of Cash Acquired, Total				$ 66,400,000
Business Acquisition, Transaction Costs				1,200,000
Deferred Revenue Included in Net Tangible Assets, Book Value				17,200,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Deferred Revenue				13,873,000
Write-down of Deferred Revenue				3,300,000
Goodwill, Purchase Accounting Adjustments				$ 1,200,000
MyClinicalExchange [Member]
Business Acquisition, Transaction Costs			$ 100,000
Payments to Acquire Businesses, Gross			$ 4,400,000
ProcessDATA, Limited [Member]
Business Acquisition, Transaction Costs		$ 100,000
Payments to Acquire Businesses, Gross		$ 2,000,000.0
Rievent Technologies [Member]
Business Acquisition, Transaction Costs	$ 100,000
Payments to Acquire Businesses, Gross	4,000,000.0
Escrow Deposit	$ 400,000

Note 8 - Business Combinations - Summary of Purchase Price (Details) - Nurse Grid [Member] $ in Thousands	Mar. 09, 2020 USD ($)
Cash paid at closing	$ 25,485
Post-closing adjustment, net of cash received	33
Cash acquired	(4,064)
Net consideration paid	21,454
Fair value of existing equity interest in NurseGrid	3,623
Net consideration paid	$ 25,077

Note 8 - Business Combinations - Summary of Preliminary Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020	Dec. 02, 2020	Oct. 12, 2020	Mar. 09, 2020	Dec. 31, 2019
Goodwill	$ 182,501,000	$ 178,440,000				$ 102,196,000
Intangible assets			$ 32,440,000
Intangible asset			32,440,000
Deferred tax liability			(889,000)
Deferred tax liability			(889,000)
Nurse Grid [Member]
Accounts and unbilled receivable, net					$ 92,000
Prepaid and other current assets					155,000
Operating lease right-of-use assets					50,000
Deferred tax assets					2,121,000
Goodwill					21,085,000
Intangible assets					1,845,000
Accounts payable and accrued liabilities					(143,000)
Deferred revenue					(78,000)
Operating lease liabilities					(50,000)
Net assets acquired					25,077,000
Prepaid assets					155,000
Intangible asset					$ 1,845,000
ShiftWizard [Member]
Accounts and unbilled receivable, net				$ 1,038,000
Prepaid and other current assets				106,000
Operating lease right-of-use assets				183,000
Goodwill				19,307,000
Intangible assets				12,660,000
Accounts payable and accrued liabilities				(600,000)
Deferred revenue				(1,601,000)
Operating lease liabilities				(183,000)
Net assets acquired				30,492,000
Cash				1,091,000
Prepaid assets				106,000
Property and equipment				50,000
Indemnification assets				464,000
Intangible asset				12,660,000
Deferred tax liability				(1,559,000)
Indemnification liability				(464,000)
Cash				1,091,000
Property and equipment				50,000
Deferred tax liability				$ (1,559,000)
ANSOS Staff Scheduling Application [Member]
Accounts and unbilled receivable, net			11,017,000
Prepaid and other current assets			233,000
Operating lease right-of-use assets			888,000
Deferred tax assets			1,191,000
Goodwill			36,440,000
Intangible assets			32,440,000
Accounts payable and accrued liabilities			(1,776,000)
Deferred revenue			(13,873,000)
Operating lease liabilities			(888,000)
Net assets acquired			66,448,000
Cash			1,599,000
Prepaid assets			233,000
Property and equipment			66,000
Intangible asset			32,440,000
Cash			1,599,000
Property and equipment			$ 66,000

Note 8 - Business Combinations - Summary of Components of Identifiable Intangible Assets and Estimated Useful Lives (Details) - USD ($) $ in Thousands	Dec. 02, 2020	Oct. 12, 2020	Mar. 09, 2020
Intangible asset	$ 32,440
Intangible assets	32,440
Nurse Grid [Member]
Intangible asset			$ 1,845
Intangible assets			1,845
Nurse Grid [Member] \| Trade Names [Member]
Intangible assets, fair value			700
Nurse Grid [Member] \| Customer Relationships [Member]
Intangible asset			$ 35
Intangible assets, useful life (Year)			8 years
Intangible assets			$ 35
Nurse Grid [Member] \| Developed Technology Rights [Member]
Intangible asset			$ 1,110
Intangible assets, useful life (Year)			5 years
Intangible assets			$ 1,110
ShiftWizard [Member]
Intangible asset		$ 12,660
Intangible assets		12,660
ShiftWizard [Member] \| Customer Relationships [Member]
Intangible asset		$ 7,800
Intangible assets, useful life (Year)		18 years
Intangible assets		$ 7,800
ShiftWizard [Member] \| Developed Technology Rights [Member]
Intangible asset		$ 4,050
Intangible assets, useful life (Year)		5 years
Intangible assets		$ 4,050
ShiftWizard [Member] \| Noncompete Agreements [Member]
Intangible asset		580
Intangible assets		$ 580
ShiftWizard [Member] \| Noncompete Agreements [Member] \| Minimum [Member]
Intangible assets, useful life (Year)		1 year
ShiftWizard [Member] \| Noncompete Agreements [Member] \| Maximum [Member]
Intangible assets, useful life (Year)		5 years
ShiftWizard [Member] \| Trade Name [Member]
Intangible asset		$ 230
Intangible assets, useful life (Year)		5 years
Intangible assets		$ 230
ANSOS Staff Scheduling Application [Member]
Intangible asset	32,440
Intangible assets	32,440
ANSOS Staff Scheduling Application [Member] \| Customer Relationships [Member]
Intangible asset	21,100
Intangible assets	$ 21,100
ANSOS Staff Scheduling Application [Member] \| Customer Relationships [Member] \| Minimum [Member]
Intangible assets, useful life (Year)	11 years
ANSOS Staff Scheduling Application [Member] \| Customer Relationships [Member] \| Maximum [Member]
Intangible assets, useful life (Year)	14 years
ANSOS Staff Scheduling Application [Member] \| Developed Technology Rights [Member]
Intangible asset	$ 9,800
Intangible assets, useful life (Year)	5 years
Intangible assets	$ 9,800
ANSOS Staff Scheduling Application [Member] \| Trade Name [Member]
Intangible asset	$ 1,540
Intangible assets, useful life (Year)	10 years
Intangible assets	$ 1,540

Note 8 - Business Combinations - Summary of Unaudited Pro Forma Financial Information (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
ShiftWizard [Member]
Total revenues	$ 257,291	$ 248,306	$ 257,042
Income from continuing operations	6,352	13,056	11,604
Net income	$ 6,352	$ 13,056	$ 13,178
Net income per share - basic (in dollars per share)	$ 0.20	$ 0.41	$ 0.41
Net income per share - diluted (in dollars per share)	$ 0.20	$ 0.41	$ 0.41
ANSOS Staff Scheduling Application [Member]
Total revenues	$ 259,451	$ 270,246	$ 278,491
Income from continuing operations	8,072	18,861	16,534
Net income	$ 8,072	$ 18,861	$ 18,108
Net income per share - basic (in dollars per share)	$ 0.26	$ 0.59	$ 0.56
Net income per share - diluted (in dollars per share)	$ 0.26	$ 0.59	$ 0.56

Note 9 - Business Segments - Business Segment Information Based on Net Revenues and Operating Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Revenues, net	$ 256,712	$ 244,826	$ 254,112
Operating income	8,055	15,818	14,720
Segment Reconciling Items [Member]
Operating income	(31,596)	(30,482)	(30,960)
Healthstream Workforce Solutions [Member]
Revenues, net	205,443	197,587	208,599
Healthstream Workforce Solutions [Member] \| Operating Segments [Member]
Revenues, net	205,443	197,587	208,599
Operating income	31,736	41,622	40,296
Healthstream Provider Solutions [Member]
Revenues, net	51,269	47,239	45,513
Healthstream Provider Solutions [Member] \| Operating Segments [Member]
Revenues, net	51,269	47,239	45,513
Operating income	$ 7,915	$ 4,678	$ 5,384

- Definition

+ References

+ Details

Note 9 - Business Segments - Business Segment Information Based on Assets (Details) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2021

Dec. 31, 2020

Dec. 31, 2019

Assets

^[1]

$ 486,753

$ 500,313

Purchase and long-lived assets

23,442

21,008

$ 31,533

Depreciation and amortization

36,813

30,189

27,869

Segment Reconciling Items [Member]

Assets

^[1]

90,881

88,899

Purchase and long-lived assets

892

573

13,602

Depreciation and amortization

6,336

6,948

7,299

Healthstream Workforce Solutions [Member] | Operating Segments [Member]

Assets

^[1]

258,864

270,924

Purchase and long-lived assets

17,831

17,586

14,972

Depreciation and amortization

20,616

12,930

10,813

Healthstream Provider Solutions [Member] | Operating Segments [Member]

Assets

^[1]

137,008

140,490

Purchase and long-lived assets

4,719

2,849

2,959

Depreciation and amortization

$ 9,861

$ 10,311

$ 9,757

[1]

- Definition

Sum of the carrying amounts as of the balance sheet date of all assets that are recognized. Assets are probable future economic benefits obtained or controlled by an entity as a result of past transactions or events.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 210
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-03(11))
-URI http://asc.fasb.org/extlink&oid=120398452&loc=d3e534808-122878

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 852
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-Section 55
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-URI http://asc.fasb.org/extlink&oid=84165509&loc=d3e56426-112766

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(iii)(A))
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Topic 470
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Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Topic 944
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-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-03(a)(12))
-URI http://asc.fasb.org/extlink&oid=120400017&loc=d3e572229-122910

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
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-URI http://asc.fasb.org/extlink&oid=124433192&loc=SL2890621-112765

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 1A
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Paragraph 1
-Subparagraph (SX 210.4-08(g)(1)(ii))
-URI http://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
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Reference 14: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-URI http://asc.fasb.org/extlink&oid=123596393&loc=d3e14064-108612

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 10
-Section S99
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-Subparagraph (SX 210.13-02(a)(4)(iii)(B))
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Reference 17: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
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Reference 19: http://www.xbrl.org/2003/role/disclosureRef
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Reference 20: http://www.xbrl.org/2003/role/disclosureRef
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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
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Reference 22: http://www.xbrl.org/2003/role/disclosureRef
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Reference 23: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

+ Details

Note 10 - Income Taxes (Details Textual) - USD ($)	12 Months Ended
Note 10 - Income Taxes (Details Textual) - USD ($)	Dec. 31, 2021	Dec. 31, 2020
Deferred Tax Assets, Valuation Allowance, Total	$ 2,011,000	$ 550,000
Unrecognized Tax Benefits, Income Tax Penalties and Interest Expense, Total	7,000	20,000
Unrecognized Tax Benefits that Would Impact Effective Tax Rate	300,000	$ 317,000
Employee Service Share-based Compensation, Tax Benefit Expense from Exercise of Stock Options	1,000
Domestic Tax Authority [Member]
Operating Loss Carryforwards, Total	$ 19,100,000
Domestic Tax Authority [Member] \| Internal Revenue Service (IRS) [Member]
Income Tax Examination, Year under Examination	2018
State and Local Jurisdiction [Member]
Operating Loss Carryforwards, Total	$ 26,300,000
Foreign Tax Authority [Member]
Operating Loss Carryforwards, Total	$ 8,800,000

Note 10 - Income Taxes - Schedule of Components of Earnings Before Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
United States	$ 8,006	$ 17,719	$ 17,929
Foreign	(240)	104	0
Earnings before income taxes	$ 7,766	$ 17,823	$ 17,929

Note 10 - Income Taxes - Summary of Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Current federal	$ 5	$ (1,022)	$ 233
Current state	406	387	634
Current foreign	(29)	71	0
Deferred federal	926	3,830	2,717
Deferred state	699	467	149
Deferred foreign	(86)	(1)	0
Provision for income taxes	$ 1,921	$ 3,732	$ 3,733

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Note 10 - Income Taxes - Reconciliation of Income Taxes at the Statutory Federal Income Tax Rate to the Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Federal tax provision at the statutory rate	$ 1,631	$ 3,743	$ 3,765
State income tax provision, net of federal benefit	1,297	787	895
Tax credits	(717)	(745)	(614)
Change in valuation allowance	(272)	4	(247)
Impact of foreign operations	(18)	7	0
Stock compensation	(1)	27	(117)
Other	1	(91)	51
Provision for income taxes	$ 1,921	$ 3,732	$ 3,733

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Note 10 - Income Taxes - Reconciliation of the Beginning and Ending Liability for Gross Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Balance	$ 962	$ 317
Additions for tax positions of prior years	0	645
Reductions for tax positions of prior years	(662)
Balance at end of year	$ 300	$ 962

Note 10 - Income Taxes - Significant Components of Deferred Tax Assets and Deferred Tax Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred tax assets:
Allowance for credit losses	$ 222	$ 143
Accrued liabilities	1,827	1,927
Lease liability	7,548	8,356
Tax credits	518	119
Stock-based compensation	901	691
Deferred revenue	570	3,244
Basis difference on investments	300	395
Net operating loss carryforwards	7,210	3,692
Total deferred tax assets	19,096	18,567
Less: Valuation allowance	(2,011)	(550)
Deferred tax assets, net of valuation allowance	17,085	18,017
Deferred tax liabilities:
Deductible goodwill	4,906	2,614
Nondeductible intangible assets	3,422	3,752
Right of use assets	6,523	7,378
Prepaid assets	8,269	6,986
Capitalized software development	8,484	6,989
Depreciation	3,026	3,846
Total deferred tax liabilities	34,630	31,565
Net deferred tax liabilities	$ 17,545	$ 13,548

Note 11 - Stock-based Compensation (Details Textual)	1 Months Ended			3 Months Ended		12 Months Ended
Note 11 - Stock-based Compensation (Details Textual)	Dec. 31, 2021 USD ($) $ / shares shares	Jul. 31, 2019 shares	Jun. 30, 2019 USD ($) shares	Dec. 31, 2021 USD ($) $ / shares shares	Jun. 30, 2019 USD ($)	Dec. 31, 2021 USD ($) $ / shares shares	Dec. 31, 2020 USD ($) shares	Dec. 31, 2019 USD ($)
Payment, Tax Withholding, Share-based Payment Arrangement						$ 1,182,000	$ 435,000	$ 1,034,000
Employee Service Share-based Compensation, Tax Benefit Expense from Exercise of Stock Options						1,000
Share-based Payment Arrangement, Expense						5,303,000	$ 2,217,000	4,244,000
Share-based Payment Arrangement, Expensed and Capitalized, Amount, Total			$ 200,000			$ 200,000
Chief Executive Officer [Member]
Stock Redeemed or Called During Period, Shares (in shares) \| shares	86,494		78,520
Stock Redeemed or Called During Period, Value	$ 2,250,000		$ 2,000,000.0
Additional Stock Redeemed or Called During Period, Shares (in shares) \| shares			7,852			7,113
Stock Options And Restricted Stock Units [Member]
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount, Total	$ 5,600,000			$ 5,600,000		$ 5,600,000
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)						2 years 8 months 12 days
Employee Service Share-based Compensation, Tax Benefit Expense from Exercise of Stock Options						$ 1,000
The 2016 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period (Year)						4 years
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant (in shares) \| shares	259,000			259,000		259,000
Share Price (in dollars per share) \| $ / shares	$ 26.36			$ 26.36		$ 26.36
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Remaining Contractual Term (Year)						9 years
Restricted Stock, Shares Issued Net of Shares for Tax Withholdings (in shares) \| shares						20,000	19,000
The 2016 Plan [Member] \| Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period, Fair Value						$ 2,300,000
Payment, Tax Withholding, Share-based Payment Arrangement						500,000		400,000
The 2016 Plan [Member] \| Restricted Stock Units (RSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period, Fair Value							$ 2,200,000
Payment, Tax Withholding, Share-based Payment Arrangement							$ 400,000
The 2016 Omnibus Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Vested, Number of Shares (in shares) \| shares	86,494	78,520
Number of Employees Awarded Fully Vested Shares	1,000	820
Share-based Payment Arrangement, Expense				$ 2,250,000	$ 2,000,000.0
Payments Related to Tax Withholding for Share Based Compensation for Stock Awards						$ 700,000		$ 600,000

Note 11 - Stock Based Compensation - Stock Option Activity (Details) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($) $ / shares shares
Outstanding, Shares (in shares) \| shares	90
Outstanding, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Granted, Shares (in shares) \| shares	0
Granted, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Exercised, Shares (in shares) \| shares	0
Exercised, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Expired, Shares (in shares) \| shares	0
Expired, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Forfeited, Shares (in shares) \| shares	0
Forfeited, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Outstanding, Shares (in shares) \| shares	90
Outstanding, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Outstanding, Aggregate intrinsic value \| $	$ 542
Exercisable, Shares (in shares) \| shares	14
Exercisable, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Exercisable, Aggregate intrinsic value \| $	$ 81

Note 11 - Stock Based Compensation - Other Information Relative to Option Activity (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Total intrinsic value of stock options exercised	$ 0	$ 0	$ 277
Cash proceeds from exercise of stock options	$ 0	$ 0	$ 214

Note 11 - Stock Based Compensation - RSUs Activities (Details) - Restricted Stock Units (RSUs) [Member] $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($) $ / shares shares
Outstanding, shares (in shares) \| shares	299
Outstanding, Weighted average grant date fair value (in dollars per share) \| $ / shares	$ 24.95
Granted, shares (in shares) \| shares	173
Granted, Weighted average grant date fair value (in dollars per share) \| $ / shares	$ 24.09
Vested, shares (in shares) \| shares	(92)
Vested, Weighted average grant date fair value (in dollars per share) \| $ / shares	$ 24.82
Forfeited, shares (in shares) \| shares	(15)
Forfeited, Weighted average grant date fair value (in dollars per share) \| $ / shares	$ 24.57
Outstanding, shares (in shares) \| shares	365
Outstanding, Weighted average grant date fair value (in dollars per share) \| $ / shares	$ 24.59
Outstanding, aggregate intrinsic value \| $	$ 9,626

Note 11 - Stock Based Compensation - Stock Based Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
stock based compensation expense	$ 5,303	$ 2,217	$ 4,244
Cost of Sales [Member]
stock based compensation expense	944	41	699
Product Development [Member]
stock based compensation expense	1,164	363	956
Selling and Marketing Expense [Member]
stock based compensation expense	759	199	614
General and Administrative Expense [Member]
stock based compensation expense	$ 2,436	$ 1,614	$ 1,975

Note 12 - Employee Benefit Plan (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Defined Contribution Plan, Employer Discretionary Contribution Amount	$ 2.0	$ 1.2	$ 1.4

Note 13 - Discontinued Operations (Details Textual) - Patient Experience Solutions [Member] - USD ($) $ in Millions		12 Months Ended
	Feb. 12, 2018	Dec. 31, 2019	Dec. 31, 2018
Proceeds from Divestiture of Businesses	$ 65.2
Gain (Loss) on Disposition of Business	$ 20.5	$ 1.5	$ 19.0

Note 14 - Debt (Details Textual) $ in Thousands	Oct. 28, 2020 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Long-term Debt, Gross		$ 0	$ 0
Revolving Credit Facility [Member] \| Truist Bank [Member]
Debt Instrument, Covenant, Maximum Funded Debt Leverage Ratio	3.0
Debt Instrument, Covenant, Interest Coverage Ratio	3.0
Long-term Line of Credit, Total		$ 0	$ 0
Revolving Credit Facility [Member] \| Truist Bank [Member] \| Minimum [Member]
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage	20.00%
Revolving Credit Facility [Member] \| Truist Bank [Member] \| Maximum [Member]
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage	30.00%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 65,000
Line of Credit Facility, Increased Facility Size Due to Accordion Feature	25,000
Line of Credit Facility, Increase Basket for Dividend	$ 65,000
Leverage Ratio	1.50
Minimum Liquidity Amount	$ 30,000
Minority Owned Investment	$ 20,000
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate	0.50%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Fed Funds Effective Rate Overnight Index Swap Rate [Member]
Debt Instrument, Basis Spread on Variable Rate	0.50%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Base Rate [Member]
Debt Instrument, Basis Spread on Variable Rate	1.00%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Base Rate [Member] \| Minimum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	0.50%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Base Rate [Member] \| Maximum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	0.75%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Eurodollar [Member] \| Minimum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	1.50%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Eurodollar [Member] \| Maximum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	1.75%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Swing Line Subfacility [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 5,000
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Letter of Credit Subfacility [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 5,000

Note 15 - Leases (Details Textual) - USD ($) $ in Millions	12 Months Ended
Note 15 - Leases (Details Textual) - USD ($) $ in Millions	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Operating Lease, Cost	$ 5.5	$ 4.8	$ 4.9
Operating Lease, Payments	$ 5.3	$ 4.9
Operating Lease, Weighted Average Remaining Lease Term (Year)	8 years 10 months 24 days
Operating Lease, Weighted Average Discount Rate, Percent	6.00%

Note 15 - Leases - Lease-related Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Operating lease right of use assets, net	$ 25,168	$ 28,081
Operating lease liability, non-current	26,178	28,479
Total operating lease liabilities	29,106	31,869
Accounts Payable and Accrued Liabilities [Member]
Operating lease liabilities, current	$ 2,928	$ 3,390

Note 15 - Leases - Maturities of Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
2022	$ 4,495
2023	4,422
2024	4,457
2025	4,022
2026	3,650
Thereafter	17,000
Total undiscounted lease payments	38,046
Less imputed interest	8,940
Total lease liabilities	$ 29,106	$ 31,869

Note 17 - Non-marketable Equity Investments (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Equity Securities without Readily Determinable Fair Value, Amount	$ 2.8	$ 3.9
Equity Securities without Readily Determinable Fair Value, Upward Price Adjustment, Cumulative Amount	1.5
Equity Securities without Readily Determinable Fair Value, Upward Price Adjustment, Annual Amount	0.2
Equity Securities without Readily Determinable Fair Value, Downward Price Adjustment, Cumulative Amount	1.3
Equity Securities without Readily Determinable Fair Value, Impairment Loss, Cumulative Amount	1.3
Nurse Grid [Member]
Equity Securities without Readily Determinable Fair Value, Upward Price Adjustment, Cumulative Amount	$ 0.3	$ 1.2

Note 11 - Stock Based Compensation - Stock Option Activity (Details) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($) $ / shares shares
Outstanding, Shares (in shares) \| shares	90
Outstanding, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Granted, Shares (in shares) \| shares	0
Granted, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Exercised, Shares (in shares) \| shares	0
Exercised, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Expired, Shares (in shares) \| shares	0
Expired, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Forfeited, Shares (in shares) \| shares	0
Forfeited, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Outstanding, Shares (in shares) \| shares	90
Outstanding, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Outstanding, Aggregate intrinsic value \| $	$ 542
Exercisable, Shares (in shares) \| shares	14
Exercisable, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Exercisable, Aggregate intrinsic value \| $	$ 81