FinanceLooker

Excrept from filing document 2024-02-29

The aggregate market value of the voting and non voting common equity held by non affiliates of the registrant was approximately 926 1 million as of the last business day of the registrant s most recently completed second fiscal quarter based upon the closing sale price on The Nasdaq Global Select Market reported for such date Excludes an aggregate of 7 428 455 shares of the registrant s common stock held as of such date by officers directors and stockholders that the registrant has concluded are or were affiliates of the registrant Exclusion of such shares should not be construed to indicate that the holder of any such shares possesses the power direct or indirect to direct or cause the direction of the management or policies of the registrant or that such person is controlled by or under common control with the registrant
Part III incorporates information by reference from the registrant s definitive proxy statement to be filed with the Securities and Exchange Commission pursuant to Regulation 14A not later than 120 days after the end of the fiscal year covered by this Annual Report on Form 10 K in connection with the registrant s 2024 Annual Meeting of Stockholders
This Annual Report on Form 10 K contains forward looking statements about us and our industry that involve substantial risks and uncertainties All statements other than statements of historical facts contained in this Annual Report on Form 10 K are forward looking statements In some cases you can identify forward looking statements because they contain words such as anticipate believe contemplate continue could estimate expect intend may plan potential predict project should target will or would or the negative of these words or other similar terms or expressions Forward looking statements include information related to our financial performance and possible or assumed future results of operations and expenses our outlook business strategies and plans business environment market size product capabilities timing of new product releases the impact of our focus areas and key initiatives and potential future growth Forward looking statements include all statements that are not historical facts
You should not rely on forward looking statements as predictions of future events We have based the forward looking statements contained in this Annual Report on Form 10 K primarily on our current expectations and projections about future events and trends that we believe may affect our business financial condition and operating results The outcome of the events described in these forward looking statements is subject to risks uncertainties and other factors described in the section titled Risk Factors and elsewhere in this Annual Report on Form 10 K Moreover we operate in a very competitive and rapidly changing environment New risks and uncertainties emerge from time to time and it is not possible for us to predict all risks and uncertainties that could have an impact on the forward looking statements contained in this Annual Report on Form 10 K The results events and circumstances reflected in the forward looking statements may not be achieved or occur and actual results events or circumstances could differ materially from those described in the forward looking statements
In addition statements that we believe and similar statements reflect our beliefs and opinions on the relevant subject These statements are based on information available to us as of the date of this Annual Report on Form 10 K While we believe that such information provides a reasonable basis for these statements that information may be limited or incomplete Our statements should not be read to indicate that we have conducted an exhaustive inquiry into or review of all relevant information These statements are inherently uncertain and investors are cautioned not to unduly rely on these statements
The forward looking statements made in this Annual Report on Form 10 K relate only to events as of the date on which the statements are made We undertake no obligation to update any forward looking statements made in this Annual Report on Form 10 K to reflect events or circumstances after the date of this Annual Report on Form 10 K or to reflect new information or the occurrence of unanticipated events except as required by law We may not actually achieve the plans intentions or expectations disclosed in our forward looking statements and you should not place undue reliance on our forward looking statements Our forward looking statements do not reflect the potential impact of any future acquisitions mergers dispositions joint ventures or investments we may make
Investing in our securities involves a high degree of risk Below is a summary of material factors that make an investment in our securities speculative or risky Importantly this summary does not address all of the risks that we face Additional discussion of the risks summarized in this risk factor summary as well as other risks that we face can be found under the heading Item 1A
We derive a significant portion of our revenue from our largest customers The loss of any of these customers or renegotiation of any of our contracts with these customers could negatively impact our results
Our business results of operations and financial condition may fluctuate on a quarterly and annual basis which may result in a decline in our stock price if such fluctuations result in a failure to meet any projections that we may provide or the expectations of securities analysts or investors
Our sales cycle can be long and unpredictable and requires considerable time and expense As a result our sales revenue and cash flows are difficult to predict and may vary substantially from period to period which may cause our results of operations to fluctuate significantly
Certain of our operating results and financial metrics may be difficult to predict as a result of seasonality and due to the fact that a portion of our revenue is subject to the achievement of performance metrics and healthcare cost savings
If we are unable to attract integrate and retain additional qualified personnel especially for Accolade Care Advocates clinical including primary care physicians and medical specialists and various product and technology roles our business could be adversely affected
We have and may again in the future acquire other companies or technologies which could divert our management s attention result in dilution to our stockholders and otherwise disrupt our operations and we may have difficulty integrating any such acquisitions successfully or realizing the anticipated benefits therefrom any of which could have an adverse effect on our business financial condition and results of operations
We may face intense competition which could limit our ability to maintain or expand market share within our industry and if we do not maintain or expand our market share our business and operating results will be harmed
Macroeconomic factors including inflation and geopolitical risk may result in decreases to the workforces of or benefits spending by our customers which would impact our operational and financial performance
At Accolade we envision a world where every person can live their healthiest life a concept that encompasses physical emotional financial and professional wellness Our mission is to empower people through expertise empathy and technology to make the best decisions for their health and well being
Accolade enables our members to receive the right healthcare for their individual needs We call it Personalized Healthcare Accolade solutions are personal data driven and value based to provide a healthcare experience that helps people better understand navigate and utilize the healthcare system and workplace benefits Our customers are primarily employers that deploy Accolade solutions in order to provide employees and their families our members a single place to turn for their health healthcare and benefits needs We also offer expert medical opinion services to commercial customers which includes employers health plans and governmental entities and virtual primary care and mental health support both directly to consumers and to commercial customers Our innovative platform which we call our True Health Engine combines open cloud based intelligent technology with multimodal support from a team of empathetic and knowledgeable Accolade Care Advocates and clinicians including registered nurses physician medical directors pharmacists behavioral health specialists women s health specialists case management specialists expert medical opinion providers and primary care physicians We leverage our integrated capabilities connectivity with providers and the broader healthcare ecosystem and longitudinal data to engage across the entire member population rather than focusing solely on high cost claimants or those with chronic conditions Our goal is to build trusted relationships with our members that ultimately position us to deliver personalized recommendations and interventions We believe that our True Health Engine dramatically improves the member experience encourages better health outcomes and lowers costs for both our members and our customers
The U S healthcare system is complex and places significant strain on consumers who struggle to effectively use their healthcare and benefits make informed decisions about their health and navigate the fragmented network of providers and third party benefit programs Healthcare consumers face challenges finding providers and scheduling appointments physicians oftentimes do not have complete data to understand the longitudinal needs of each patient and access to appropriate care and the quality of available care varies widely based on a number of reasons commonly referred to as Health Equity including economic social and geographic Collectively we refer to these challenges as the Physician Gap We designed our solutions to close this Physician Gap by following a clinical model that emphasizes both contextual and concordant care healthcare that takes into account a person s lifelong healthcare experience delivered by a team of people who understand their individual need This approach also takes into account the numerous social determinants of health such as social economic race and geographic barriers that impact the quality and accessibility of healthcare Healthcare payors including managed care companies the government employers and consumers face significant and rising costs For large employers in particular the direct costs are substantial the total annual employer cost for healthcare is estimated at more than 10 000 per employee Employers also bear indirect costs in the form of absenteeism decreased productivity and diminished morale all potentially intensified during times when their employees are forced to work remotely due to threats to public health Despite the significant and growing spend on care health outcomes are not improving and misaligned incentives among key constituents thwart meaningful change A suboptimal consumer experience persists
We believe the most effective way to improve health outcomes and control cost is to close the Physician Gap and help consumers make better data driven healthcare and benefits related decisions Based on this belief we have developed a differentiated platform to support and influence consumer decision making that is built on a foundation of mission driven people and purpose built technology
Our Accolade Care Advocates are highly trained professionals enabled by advanced data and technology who develop trusted ongoing relationships with our members and serve as their personal contact for all issues related to healthcare and benefits
Our clinicians include registered nurses physician medical directors pharmacists behavioral health specialists women s health specialists case management specialists expert medical opinion providers and primary care physicians
Our technology platform was designed to deliver highly personalized member experiences at scale leveraging data and machine learning to derive actionable insights optimize our care teams workflows and accelerate the pace of our innovation We ingest and link disparate data points to Accolade generated data to create a 360 degree member view which our Accolade Care Advocates and clinicians access in our purpose built member CRM tool InView Our secure open technology platform supports our continuous innovation and the development of additional capabilities to benefit our members
In addition to Accolade s owned solutions we have assembled a roster of high quality partners whose condition specific solutions are complementary to our services and deliver additional value to our members and customers The Trusted Partner Ecosystem encompasses partnerships in areas that we believe matter to our customers because medical spend in them is high such as diabetes or musculoskeletal care and or having services related to them is viewed favorably in terms of attracting and retaining talent e g fertility care LGBTQIA affirming care Accolade vets Trusted Partners along clinical data security financial and operational dimensions Ultimately customers can streamline selection procurement and implementation when working with our Trusted Partners We believe what sets our Trusted Partner Ecosystem apart from other point solution marketplaces is that we enable a set of integrated features that support incremental appropriate utilization of the Trusted Partners services
Through trusted ongoing engagement we can meaningfully influence member decisions and help increase valuable healthcare utilization e g primary care visits prescription refills and reduce wasteful healthcare utilization e g unnecessary emergency room visits hospital readmissions excessive inpatient stays We further enhance the member experience by educating members on relevant available benefits such as wellness programs and telemedicine In raising awareness of these benefits and seamlessly integrating them into our platform we can significantly increase their utilization rates
Our investments in a scalable technology platform have enabled us to acquire complementary services and implement a multi offering strategy that meets the diverse needs of our existing and prospective customers Buyers of our offerings have varying priorities and appetites for change to their existing health and benefits packages and we have therefore developed a solutions portfolio that is designed to support a range of capabilities and services for employers of all sizes
member population to have a sustainable impact on health outcomes and cost This stands in contrast to the historic industry norm of engaging only the highest cost sickest patients with the most complex needs To do this we have built a platform to engage with each customer s eligible member population build trusted relationships with members and leverage those relationships to deliver important healthcare interventions when they matter the most
Our engagement model integrates human touch with a proprietary technology platform to encourage better outcomes for our members While the right mix of experience and skills is critical all care team members must demonstrate empathy to be hired and maintain it to be retained
We are engaged by employers to solve real issues around the design coordination and utilization of their employee benefits programs Because we help their employees live their healthiest lives our customers view us as a strategic partner that can provide population health insights and help them manage healthcare benefit costs and complexity
Our offerings are built on an open cloud based intelligent platform designed to deliver a highly personalized member experience Our platform is built for scale architected to deliver repeatable results and high service levels at a sustainable cost to serve and leverages extensive data ingestion capabilities and artificial intelligence to derive predictive analytics deliver targeted population health insights and recommend the right care intervention for our members at the right time
As of February 29 2024 we had over 1 200 commercial customers that collectively purchase access to our solutions for more than 14 million members We principally generate revenue from our customers on a recurring PMPM fee basis with contracts generally three years in length which together provide us with significant revenue visibility Our ability to deliver significant and measurable return on investment for our customers in the form of improved clinical and financial outcomes has led to a gross dollar retention of 89 87 and 98 for the fiscal years ended February 28 29 2024 2023 and 2022 respectively
We believe there is a substantial opportunity to further grow our customer base in our large and under penetrated market that includes thousands of self and fully insured employers in the United States Our sales and marketing team draws on advanced demand generation strategies to reach and educate the market about our offerings and increase the opportunities to grow our customer base We maintain a cohort of highly referenceable customers in support of new customer acquisition
By delivering measurable outcomes to our customers we can achieve strong customer retention which enables us to expand and deepen these relationships Our expert medical opinion and virtual primary care offerings complement our advocacy solutions and can be sold as standalone solutions or provide cross sell opportunities to drive incremental revenue As we build upon our trusted partner status with these customers we have the opportunity to cross sell our additional capabilities as well as services offered by our ecosystem partners
We have made significant investments in our technology platform to expand our capabilities with respect to how we engage with our members and deliver our solutions and care interventions By leveraging our technology in areas such as machine learning and artificial intelligence predictive analytics and multimodal communication we believe we can generate more efficiencies in our operating model while simultaneously improving our ability to deliver better health outcomes and lower costs for both our members and our customers
We are constantly innovating to enhance our model and develop new offerings including our recently introduced Accolade Care and Accolade Connect Our ability to act as a trusted advisor to our members and customers positions us to identify new opportunities for additional offerings that can meet their existing and emerging needs
We see significant additional opportunity in adjacent markets including expanding with government sponsored health plans such as TRICARE Medicare Advantage and Managed Medicaid as well as traditional Medicare and Medicaid along with those administered by Veterans Affairs Our technology platform and broad range of healthcare services is also enabling us to expand our opportunities with health plans including their individual and family plans and fully insured commercial customers Our focus and experience in the navigation and coordination of benefits and healthcare coupled with our technology investments position us to take advantage of emerging healthcare trends surrounding care coordination and value based care initiatives We believe that we can leverage our existing platform and scalable solutions to successfully expand into these markets
We have historically integrated new and complementary capabilities into our offerings by forming strategic partnerships and other relationships with third parties We believe our partners choose us because of our entrepreneurial and collaborative culture dedication to continuous innovation and track record of exceptionally high member engagement rates We develop and maintain partnerships with a number of healthcare companies to offer our customers a broader range of services and our members a more seamless healthcare experience on the back of the core Accolade engagement model These partnerships include
Condition specific point solutions that leverage our distribution infrastructure to connect with more employer customers and a member engagement model to connect with more qualified participants These partners interventions enhance the positive impact that we have on members health and customers spend by serving as extensions of our clinical model and
Technology partners including vendors which specialize in artificial intelligence whose capabilities augment our own and chronic and clinical solutions providers such as Virta Health Sword Health Hinge Health Lyra Health Employer Direct Healthcare Carrum Health and FOLX
We believe health outcomes are improved and overall healthcare spend is lowered when personalized care guidance and coordination are effectively delivered Our clinical philosophy governs the ways we help members as they contemplate and consume care Increasing healthcare spend is a lagging indicator of the need for support our engagement model seeks to engage all members regardless of healthcare spend or the complexity of medical needs and support them as early as possible in their care journeys
We have developed a continuum of offerings to address the market s varied perspectives on how best to improve healthcare and benefits utilization along with buyers varying appetites for change All of our offerings have been built on the same technology stack meaning each is capable of fully leveraging our integrated platform combining people and technology to deliver value to our customers We can unpack and combine our capabilities into differentiated bundles while maintaining scale and efficiency by operating on a single platform
We offer our solutions as standalone or bundled offerings combining the capabilities of Accolade s historical navigation and advocacy solutions with our primary care mental health and expert medical opinion services augmented by artificial intelligence machine learning and data driven recommendations Our offerings include
Plus and Connect A benefits navigation and care solution designed to work with our customers existing benefits ecosystem incorporating elements of all Accolade solutions including Advocacy Accolade Expert MD Accolade Care and the Accolade partner ecosystem Different offering configurations may also include member services provider services and an expanded set of clinical programs that address case and disease management to maximize member engagement and return on investment
Trusted Partner Ecosystem In addition to Accolade s owned solutions we have assembled a roster of high quality partners whose condition specific solutions are complementary to our services and capable of delivering additional value to our members and customers or capabilities that meet specific customer needs
With great conviction that technology can help scale and optimize the Accolade engagement model we began making substantial investments to create an industry leading open cloud based platform in 2016 This technology platform built utilizing artificial intelligence microservices and data analytics enables us to deliver personalized experiences to our full member population throughout their healthcare journeys We have established a highly experienced Product Technology organization that has extensive experience in machine learning artificial intelligence data science engineering and product management
In order to fuel our machine learning processes we have made a concerted effort to source what we view as a massive powerful and differentiated data set We pair Accolade data encounter and activation history conditions medications procedures barriers to care assessment responses care plans with the data we ingest from
With this combination of data we are able to apply machine learning tactics to generate predictive insights about our members For example we calculate various scores for members that quantify their relationship with us overall health status and their propensity to take a desired action These scoring techniques inform recommended actions for our Accolade Care Advocates and clinicians that are surfaced to InView as well as recommendations delivered directly to our members as part of our activation capabilities and or self service
We employ a multipronged go to market strategy to drive adoption of our solutions We have strategically curated our offerings portfolio to ensure we have a compelling value proposition at an appropriate price point that resonates with each specific customer segment
We principally sell our solutions through our direct salesforce and distribution agreements with healthcare industry third parties such as large and regional health plans and governmental entities We have invested meaningfully in creating a scaled and focused team to capture new customer growth opportunities across different customer sizes verticals and geographies Our field sales professionals are organized by account size region and existing versus prospective customers This organizational structure enables us to deliver context specific tailored messaging that resonates with each customer segment Our sales team possesses deep domain expertise in health benefits management and boasts long term relationships with key decision makers within our prospective customer organizations We also have a sales team solely focused on our health plan distribution relationships We believe the effectiveness of our sales organization is evidenced by growing adoption of our platform by large strategic customers as well as more recent traction with enterprise and mid market customers where we see meaningful additional revenue opportunity
Our customer success team provides strategic insights point solutions recommendations and day to day account support to our customers The team is focused on deepening existing customer relationships and cross selling new offerings where appropriate This organization is comprised of dedicated customer support teams to serve each customer s specific needs and also focuses on deepening existing customer relationships through sales of our new offerings
We selectively form partnerships to further drive customer acquisition and adoption of our personalized technology enabled solutions platform For example in 2022 we announced partnerships with Blue Shield of California and Priority Health to provide our services as part of their employer focused virtual first health plan offerings These relationships allow us to reach a wider customer audience through regionally focused organizations
We generate customer leads accelerate sales opportunities and drive brand awareness through our marketing programs Our marketing programs target benefits and finance executives senior business leaders health professionals brokers consultants third party administrators and suppliers
In addition to our direct sales organization we maintain relationships with a range of third parties including brokers benefits consultants third party administrators and Trusted Partner Ecosystem These partners supplement our direct sales force and help sell our offerings into select end markets by way of warm introductions and advice as we field prospective customers requests for proposals We have developed strong relationships with our partners and have a well established reputation within our partner community We proactively educate our partners on our solutions and value proposition to ensure we are appropriately represented to prospective customers
We believe no single competitor offers a similarly comprehensive platform combining personalized technology enabled solutions with highly trained professionals However we have experienced and expect to continue to experience competition from a number of companies including those who are well established and may have greater resources and
those who may become meaningful competitors in the future Our competitors generally fall into two categories large health plans that provide member and provider services and traditional advocacy and navigation companies such as Quantum Health and Included Health We believe the primary competitive factors for our industry include
While certain of our competitors may have greater resources recognition larger customer bases or longer standing offerings we believe that we compete favorably against our competitors based on these criteria We believe that our platform dramatically improves member experience encourages better health outcomes and lower costs for both our members and our customers As our market grows and continues to evolve through technology or regulatory driven changes we expect it will continue to attract interest from existing larger companies who may be able to invest more resources in solutions development and sales and marketing while leveraging their existing relationships as well as interest from new entrants who could introduce new solutions
We believe that our intellectual property rights are valuable and important to our business We rely on trademarks patents copyrights trade secrets intellectual property assignment agreements confidentiality procedures nondisclosure agreements and employee nondisclosure and invention assignment agreements to establish and protect our proprietary rights
These intellectual property rights and procedures may not prevent others from creating a competitive technology platform or otherwise competing with us We may be unable to obtain maintain and enforce the intellectual property rights on which our business depends and assertions by third parties that we violate their intellectual property rights could have a material adverse effect on our business financial condition and results of operations
We continually review our product and technology efforts to assess the existence and patentability of new intellectual property and have been granted several patents in the United States and may prosecute additional patent applications in the future We have several registered trademarks in the United States
Numerous state federal local and foreign laws and regulations govern the collection dissemination use privacy confidentiality security availability integrity and other processing of personal or sensitive data including protected
health information PHI and personally identifiable information PII These laws and regulations include the Health Insurance Portability and Accountability Act HIPAA as amended by the Health Information Technology for Economic and Clinical Health Act HITECH the Federal Trade Commission Act the Telephone Consumer Protection Act of 1991 TCPA the Controlling the Assault of Non Solicited Pornography and Marketing Act of 2003 CAN SPAM and the California Consumer Privacy Act of 2018 CCPA as amended by the California Privacy Rights Act CPRA In addition several states within the United States have enacted or proposed data privacy laws including Virginia Colorado Utah and Connecticut Additionally we are or may become subject to various U S federal and state consumer protection laws which require us to publish statements that accurately and fairly describe how we handle personal data and choices individuals may have about the way we handle their personal data
For example HIPAA establishes a set of national privacy and security standards for the protection of PHI by health plans healthcare clearinghouses and certain healthcare providers referred to as covered entities and individuals and entities that perform services for them which involve the use or disclosure of individually identifiable health information known as business associates and their subcontractors We are considered a business associate under HIPAA As such we could be subject to periodic audits for compliance with the HIPAA Privacy and Security Standards by the U S Department of Health and Human Services HHS and our customers HIPAA also implemented the use of standard transaction code sets and standard identifiers that covered entities must use when submitting or receiving certain electronic healthcare transactions including activities associated with the billing and collection of healthcare claims HIPAA imposes mandatory penalties for certain violations However a single breach incident can result in violations of multiple standards HIPAA also authorizes state attorneys general to file suit on behalf of their residents Courts may award damages costs and attorneys fees related to violations of HIPAA in such cases While HIPAA does not create a private right of action allowing individuals to sue us in civil court for violations of HIPAA its standards have been used as the basis for duty of care in state civil suits such as those for negligence or recklessness in the misuse or breach of PHI
In addition HHS is required under HIPAA to establish a methodology whereby harmed individuals who were the victims of breaches of unsecured PHI may receive a percentage of the Civil Monetary Penalty fine paid by the violator which is yet to be publicly proposed or implemented HIPAA further requires that patients be notified of any unauthorized acquisition access use or disclosure of their unsecured PHI that compromises the privacy or security of such information with certain exceptions related to unintentional or inadvertent use or disclosure by employees or authorized individuals HIPAA specifies that such notifications must be made without unreasonable delay and within a certain time period after discovery of the breach Depending on the number of patients affected by a breach it may be required to be reported to HHS without unreasonable delay and HHS will post the name of the breaching entity on its public web site Breaches affecting a certain number of patients in the same state or jurisdiction must also be reported to the local media For breaches affecting smaller numbers of patients the covered entity must record it in a log and notify HHS at least annually
Likewise the CCPA creates individual privacy rights for consumers and places increased privacy and security obligations on entities handling personal data of consumers or households The CCPA imposes obligations on covered companies to provide specific disclosures related to a company s collection use and disclosure of personal data and to respond to certain requests from California residents related to their personal data The CPRA effective January 1 2023 expands the CCPA by giving California residents the ability to limit use of certain sensitive personal data establishing restrictions on personal data retention expanding the types of data breaches that are subject to the CCPA s private right of action and establishing a new California Privacy Protection Agency to implement and enforce the new law
There are numerous other federal state and foreign laws and regulations that protect the confidentiality privacy availability integrity and security of PHI and other types of PII These laws and regulations in many cases are more restrictive than and may not be preempted by HIPAA and its implementing rules These laws and regulations are often uncertain contradictory and subject to changed or differing interpretations and we expect new laws rules and regulations regarding privacy data protection and information security to be proposed and enacted in the future
Foreign data privacy and security laws including but not limited to the EU General Data Protection Regulation EU GDPR and the UK GDPR impose significant and complex compliance obligations on entities that are subject to those laws As one example the EU GDPR applies to any company established in the European Economic Area EEA and to companies established outside the EEA that process personal data in connection with the offering of goods or services to data subjects in the EEA or the monitoring of the behavior of data subjects in the EEA
Our business activities are subject to a complex set of regulations and rigorous enforcement including by the Food and Drug Administration FDA U S Department of Justice HHS Office of the Inspector General and Office of Civil Rights and numerous other federal and state governmental authorities In addition our employees consultants and
commercial partners may engage in misconduct or other improper activities including non compliance with regulatory standards and requirements Federal and state healthcare laws and regulations that may affect our ability to conduct business include
HIPAA as amended by HITECH and its implementing regulations which impose certain requirements relating to the privacy security and transmission of protected health information on certain healthcare providers health plans and healthcare clearinghouses their business associates as well as their covered subcontractors that access or otherwise process individually identifiable health information on their behalf HIPAA also created criminal liability for knowingly and willfully falsifying or concealing a material fact or making a materially false statement in connection with the delivery of or payment for healthcare benefits items or services
the federal Anti Kickback Statute which prohibits among other things any person from knowingly and willfully offering soliciting receiving or providing remuneration directly or indirectly in exchange for or to induce either the referral of an individual for or the purchase order or recommendation of any good or service for which payment may be made under federal healthcare programs such as the CMS programs including Medicare and Medicaid
the federal civil false claims laws including the federal False Claims Act and civil monetary penalties laws which prohibit among other things individuals or entities from knowingly presenting or causing to be presented false claims or knowingly using false statements to obtain payment from the federal government
the federal Physician Payments Sunshine Act or Open Payments created under the Patient Protection and Affordable Care Act as amended by the Health Care and Education Affordability Reconciliation Act collectively the Affordable Care Act and its implementing regulations which requires manufacturers of drugs medical devices biologicals and medical supplies for which payment is available under Medicare Medicaid or the Children s Health Insurance Program to report annually to CMS information related to payments or other transfers of value made to physicians defined to include doctors dentists optometrists podiatrists and chiropractors other healthcare professionals such as physician assistants and nurse practitioners and teaching hospitals as well as ownership and investment interests held by physicians and their immediate family members
Federal Food Drug and Cosmetic Act FDCA which requires among other things manufacturers of medical devices including certain software technology companies to comply with requirements related to pre market clearances approved labeling medical device adverse event reporting and on going post market monitoring and quality assurance
state law equivalents of each of the above federal laws such as anti kickback and false claims laws which may apply to items or services reimbursed by any third party payor including commercial insurers and
federal and state laws and regulations regarding i the corporate practice of medicine and other health care professions the provision of management or administrative services in connection with practice of medicine and other health care professions employment of professionals by non professionals professional fee splitting ii professional licensing and standards of professional conduct iii the provision of telemedicine telehealth or other health care services including medical record retention requirements and iv the billing submission or collection of claims or payments for healthcare services
The Affordable Care Act among other things amended the intent requirement of the federal Anti Kickback Statute and criminal healthcare fraud statutes A person or entity no longer needs to have actual knowledge of this statute or specific intent to violate it In addition the Affordable Care Act provides that the government may assert that a claim including items or services resulting from a violation of the federal Anti Kickback Statute constitutes a false or fraudulent claim for purposes of the federal False Claims Act Further our operations may subject us to various laws relating to the licensure and corporate practice of a health care profession These laws in particular vary greatly by state and are subject to broad interpretations by regulators
Because of the breadth of these laws and the narrowness of available statutory and regulatory exemptions it is possible that some of our activities could be subject to challenge under one or more of such laws Any action brought against us for violations of these laws or regulations even if successfully defended could cause us to incur significant legal expenses and divert our management s attention from the operation of our business We may be subject to private qui tam actions brought by individual whistleblowers on behalf of the federal or state governments with potential liability under the federal False Claims Act including mandatory treble damages and significant per claim penalties
If our operations are found to be in violation of any of the federal or state laws described above or any other current or future fraud and abuse or other healthcare laws and regulations that apply to us we may be subject to penalties including significant criminal civil and administrative penalties damages and fines disgorgement additional reporting requirements and oversight if we become subject to a corporate integrity agreement or similar agreement to resolve allegations of noncompliance with these laws imprisonment and exclusion from participation in government programs such as Medicare and Medicaid as well as contractual damages curtailment of our business activities and reputational harm
Additionally in the United States and some foreign jurisdictions there have been and continue to be several legislative and regulatory changes and proposed reforms of the healthcare system in an effort to contain costs improve quality and expand access to care including the proposed modification to some of the aforementioned laws We expect there to continue to be a number of healthcare related legislative initiatives that may significantly affect the healthcare industry These reform initiatives may among other things result in modifications to the aforementioned laws and or the implementation of new laws affecting the healthcare industry
Our employees are critical to our success We share our mission with the dedicated and passionate people that we employ and our culture is a driving factor in our ability to attract and retain top talent We foster a culture of transparency and alignment whereby we educate our employees on how their contributions each day drive us toward the achievement of our mission We work together to solve complex problems and we strive to do well and do good
Our Board of Directors and Board committees provide oversight on certain human capital matters including our Inclusion and Diversity programs and initiatives and are updated periodically by our executive management and our People and Culture team Our People and Culture team is principally tasked with identifying and recruiting a highly skilled empathetic and diverse workforce aligned with our mission of changing healthcare and supporting our members and customers Diversity and inclusion inclusive of pay equity is a focus of our human capital management programs as is enabling high levels of employee engagement and professional development and advancement
We regularly conduct anonymous surveys to seek feedback from our employees on a variety of topics including but not limited to their engagement with and joy in their roles whether they intend to remain at the company confidence in company leadership career growth opportunities and improvements on how we can make the company a more desirable place to work and grow The results are shared with our employees and reviewed by senior leadership who analyze areas of progress or deterioration and prioritize actions and activities in response to such survey results
As of February 29 2024 we had a workforce of approximately 2 400 people Our employee groups are comprised as follows Front Line Care Product and Technology Field Operations including sales and marketing Solutions and Growth and General and Administration roles We also supplement our workforce with contractors and consultants depending on business need
Our largest group of employees is our front line care team including our Accolade Care Advocates and clinicians who serve our members and customers who are highly trained professionals who develop trusted relationships with our members and serve as their primary and ongoing point of contact for myriad issues related to healthcare and benefits as part of our services We employ individuals who demonstrate empathy and problem solving skills and we hire from diverse professional backgrounds including social work teaching customer care and benefits Our Accolade Care Advocates are trained in our proprietary engagement approach and leverage our integrated technology platform to provide data informed personalized health and benefits support to members in friendly straightforward terms Our clinicians include registered nurses physician medical directors pharmacists behavioral health specialists and women s health specialists and have
deep expertise across a wide variety of specializations Our nurses work with our other clinicians to help members demystify their care needs through personalized evidence based and data driven protocols
Our two largest offices and co headquarters locations are located in Seattle Washington and Plymouth Meeting Pennsylvania We also have concentrations of employees in various cities throughout the United States and Prague Czech Republic as well as a number of employees who work from home in various states None of our employees is represented by a labor union We have not experienced any work stoppages and we consider our relations with our employees to be good
We seek to retain our employees through appropriate incentives The principal purposes of our equity and cash incentive plans are to attract retain and reward personnel through the granting of stock based and cash based compensation awards in order to increase stockholder value and the success of our company by motivating such individuals to perform to the best of their abilities and achieve our objectives Our Board of Directors and particularly our Compensation Committee in consultation with executive management and our People and Culture team are responsible for reviewing our total rewards packages including compensation and health and welfare benefits
Various employee assistance and health related programs to provide our employees access to important health resources including telehealth mental health programs expert medical opinion family planning and the Accolade for Accolade program that enables our employees to receive the Accolade service
We were formed under the laws of the state of Delaware in January 2007 under the name Accretive Care LLC and we converted to a Delaware corporation under the name Accolade Inc in June 2010 Our principal executive offices are located at 1201 Third Avenue Suite 1700 Seattle WA 98101 and we have co headquarters at 660 West Germantown Pike Suite 500 Plymouth Meeting PA 19462 Our telephone number is 206 926 8100 Our website address is www accolade com
Our Annual Report on Form 10 K Quarterly Reports on Form 10 Q and Current Reports on Form 8 K and amendments to those reports are available free of charge on our website at http www accolade com Information found on or accessible through our website is not part of and is not incorporated into this Annual Report on Form 10 K These reports are posted as soon as reasonably practicable after we file them electronically with the SEC at http www sec gov
You should consider carefully the risks and uncertainties described below together with all of the other information in this Annual Report on Form 10 K including the section titled Management s Discussion and Analysis of Financial Condition and Results of Operations and our consolidated financial statements and related notes Our business results of operations financial condition and prospects could also be harmed by risks and uncertainties that are not presently known to us or that we currently believe are not material If any of the risks actually occur our business results of operations financial condition and prospects could be materially and adversely affected Unless otherwise indicated references in these risk factors to our business being harmed will include harm to our business reputation brand financial condition results of operations and prospects In such event the market price of our common stock could decline
We have incurred net losses in most periods since our inception and continue to have an accumulated deficit We expect our costs will increase substantially in the foreseeable future and our losses will continue as we expect to invest significant additional funds towards growing our business and as we continue to invest in increasing our customer base expanding our operations hiring additional employees and developing future offerings These efforts may prove more expensive than we currently anticipate and we may not succeed in increasing our revenue sufficiently to offset these higher expenses We are unable to accurately predict when or if we will be able to achieve profitability Even if we achieve profitability in the future we may not be able to sustain profitability in subsequent periods To date we have financed our operations principally from the sale of our equity revenue from sales of our offerings and the incurrence of indebtedness Our cash flow from operations was negative for each of the last three fiscal years and we may not generate positive cash flow from operations in any given period If we are not able to achieve or maintain positive cash flow in the long term we may require additional financing which may not be available on favorable terms or at all and or which may be dilutive to our stockholders If we are unable to successfully address these risks and challenges as we encounter them our business may be harmed Our failure to achieve or maintain profitability or positive cash flow could negatively impact the value of our common stock
We derive a significant portion of our revenue from our largest customers The loss of any of these customers or renegotiation of any of our contracts with these customers could negatively impact our results
Historically we have relied on a limited number of customers for a significant portion of our revenue The loss of any of our largest customers or the renegotiation of any of our largest customer contracts has in the past and could in the future adversely affect our results of operations The loss of a significant customer if we are not able to replace such revenue from other existing or new customers could harm our business and our financial results We typically enter into three year contracts with our customers and certain of these contracts including existing contracts with some of our largest customers are terminable for convenience by our customers after an initial period and a notice period has passed In the ordinary course of business including in connection with renewals or extensions of these agreements we engage in active discussions and renegotiations with our customers in respect of the solutions we provide and the terms of our customer agreements including our fees In addition as our customers businesses respond to market dynamics and financial pressures and as our customers make decisions with respect to the health and other benefits they provide to their employees our customers may seek to renegotiate or terminate their agreements with us or may stage competitive request for proposal processes any of which could result in the loss or reduced profitability of such customers agreements with us Macroeconomic factors including heightened inflation and geopolitical tension may affect our customers desire to renew their contracts If customers undergo layoffs or reductions in force then our membership numbers would result in a reduction in our base and variable fee per member per month PMPM and reduce our revenues In addition there is substantial uncertainty about further disruption due to macroeconomic factors including heightened inflation and geopolitical tension Any of these and other macroeconomic factors could result in reductions to the fees and changes to the scope of offerings contemplated by our original customer contracts and consequently could negatively impact our business Because we rely on a limited number of customers for a significant portion of our revenue delayed payments by a few of our largest customers could result in a reduction in and greater volatility of our free cash flow and available cash We also depend on the creditworthiness of these customers If the financial condition of one or more of our largest customers declines our credit risk could increase Should one or more of our largest customers declare bankruptcy it could adversely affect the collectability of our accounts receivable and affect our bad debt reserves net income free cash flow and available cash
Our business results of operations and financial condition may fluctuate on a quarterly and annual basis which may result in a decline in our stock price if such fluctuations result in a failure to meet any projections that we may provide or the expectations of securities analysts or investors
Our operating results have in the past and could in the future vary significantly from quarter to quarter and year to year and may fail to match our past performance our projections or the expectations of securities analysts because of a variety of factors many of which are outside of our control and as a result should not be relied upon as an indicator of future performance As a result we may not be able to accurately forecast our operating results and growth rate Any of these events could cause the market price of our common stock to fluctuate Factors that may contribute to the variability of our operating results include
political economic and social instability including terrorist activities the ongoing conflict between Ukraine and Russia conflicts in the Middle East and outbreaks of public health threats such as coronavirus influenza or other highly communicable diseases or viruses and any disruption these events may cause to the global economy and
The impact of one or more of the foregoing and other factors may cause our operating results to vary significantly As such we believe that quarter to quarter and year to year comparisons of our operating results may not be meaningful and should not be relied upon as an indication of future performance
Our sales cycle can be long and unpredictable and requires considerable time and expense As a result our sales revenue and cash flows are difficult to predict and may vary substantially from period to period which may cause our results of operations to fluctuate significantly
The timing of our sales revenue and cash flows is difficult to predict because of the length and unpredictability of our sales cycle The sales cycle for our solutions from initial contact to launch varies widely by potential customer Some of our potential customers especially in the case of our prospective strategic and enterprise customers undertake a significant and prolonged evaluation process including to determine whether our solutions meet the specific needs of their group health plan employee benefits programs corporate budgets and other goals which frequently involves evaluation of not only our solutions but also an evaluation of other available solutions Such evaluations have in the past resulted in extended sales cycles that due to changes in corporate objectives leadership involved in the selection process and other factors may result in delayed or suspended decision making in awarding the sale In addition our sales cycle may become more lengthy and difficult as a result of macroeconomic factors including heightened inflation and geopolitical tension During the sales cycle we expend significant time and money on sales and marketing activities which lowers our operating margins particularly if no sale occurs For example there may be unexpected delays in a potential customer s internal procurement processes which involve intensive financial operational and security reviews and for which our solutions represent a significant purchase In addition the significance and timing of our offering enhancements and the introduction of new products by our competitors may also affect our potential customers purchases For all of these reasons it is difficult to predict whether a sale will be completed the particular period in which a sale will be completed or the period in which revenue from a sale will be recognized
We believe there are significant seasonal factors that may cause us to record higher revenue in some quarters compared with others We believe this variability is largely due to our focus on the healthcare industry For example with respect to our customers in particular our customers with contract years commencing at the beginning of a calendar year we record a disproportionate amount of revenue from such customers during the fourth quarter of our fiscal year relative to the first three quarters of our fiscal year This timing is caused in part by the measurement achievement and associated revenue recognition of performance metrics and healthcare costs savings components of certain of our customer contracts during the fourth quarter of each fiscal year Our growth rate and the impact of acquisitions over the last several years may have made seasonal fluctuations more difficult to detect If our rate of growth slows over time seasonal or cyclical variations in our operations may become more pronounced and our business may be harmed
We price the majority of our services based upon a PMPM fee times the number of eligible members typically with a portion of the PMPM fee fixed base PMPM fee and the remainder of the fee variable variable PMPM fee Revenue from variable PMPM fees can be earned through either or a combination of the achievement of certain performance metrics or the realization of healthcare savings resulting from the utilization of our services Although we have typically achieved these performance metrics and realization in savings of healthcare spend resulting in our earning over 90 of the aggregate maximum potential revenue under our customer contracts measured on the corresponding calendar year basis in fiscal years 2024 2023 and 2022 our revenue and financial results in the future may be variable based on whether we earn this performance based revenue For example lower healthcare utilization could result in lower
engagement with Accolade services than expected and put our ability to meet certain performance metrics at risk In addition since our customers typically pay the full PMPM fee in advance on a periodic basis any required refund as a result of our failure to earn the performance based revenue could have a negative impact on cash flows Under U S generally accepted accounting principles GAAP we recognize revenue when control of the promised services is transferred to our customers in an amount that reflects the consideration to which we expect to be entitled in exchange for those services The majority of the fees we earn are considered to be variable consideration under GAAP We typically invoice our customers on a periodic basis for the base PMPM fees and variable PMPM fees in advance of performing the services and these advances are classified as deferred revenue on our consolidated balance sheet until such time that the associated revenue can be recognized Due to the need for us to satisfy performance metrics and healthcare savings requirements deferred revenue at any particular date may not be representative of actual revenue for any current or future period
We have experienced and may continue to experience growth and organizational change which has placed and may continue to place significant demands on our management operational and financial resources including the need to hire new employees to support our growth We believe that our mission driven culture has been an important contributor to our success which we believe fosters empathy innovation teamwork and passion for providing high levels of customer satisfaction and member engagement If we fail to successfully integrate develop and motivate new employees it could harm our mission driven culture Any failure to preserve our culture could also negatively affect our ability to retain and recruit personnel maintain our performance or execute on our business strategy
In addition from time to time we implement organizational changes to pursue greater efficiency and realign our business and strategic priorities For example during the year ended February 28 2023 we initiated several measures to accelerate the integration of recent acquisitions through strategic reductions in our workforce including increasing hiring in lower cost regions to support our growth scale and profitability objectives Additional risks associated with the continuing impact of the organizational changes include employee attrition beyond our intended reduction and adverse effects on employee morale diversion of management attention adverse effects to our reputation as an employer which could make it more difficult for us to hire new employees in the future and potential failure or delays to meet operational and growth targets due to the loss of qualified employees If we do not realize the expected benefits of our organizational changes on a timely basis or at all our business results of operations and financial condition could be adversely affected
To manage our current and anticipated future growth and organizational change effectively we must also continue to maintain and may need to enhance our information technology infrastructure and financial and accounting systems and controls as well as manage expanded operations in geographically distributed locations which will place additional demands on our resources and operations Failure to manage our growth and organizational change effectively could lead us to over invest or under invest in technology and operations result in weaknesses in our infrastructure systems or controls give rise to operational mistakes losses or loss of productivity or business opportunities reduce customer or member satisfaction limit our ability to respond to competitive pressures and result in loss of team members and reduced productivity of remaining team members Our growth and organization change could require significant capital expenditures and may divert financial resources and management attention from other projects such as the development of new or enhanced solutions or the acquisition of suitable businesses or technologies If our management is unable to effectively manage our growth and organizational change our expenses may increase more than expected our revenue could decline or may grow more slowly than expected and we may be unable to implement our business strategy
If we are unable to attract integrate and retain additional qualified personnel especially for Accolade Care Advocates clinical including primary care physicians and medical specialists and various product and technology roles our business could be adversely affected
Our future success depends in part on our ability to identify attract integrate and retain empathetic and knowledgeable Accolade Care Advocates and clinicians as well as highly qualified and motivated product developers and engineers who embody our mission driven culture We seek to employ Accolade Care Advocates and clinicians who demonstrate empathy and problem solving skills and hire from diverse professional backgrounds including social work teaching customer care and benefits Our Accolade Expert MD service relies on the attraction of and engagement with medical specialists to support its business operations and PlushCare via the associated medical practices seeks to engage high quality primary care physicians We have from time to time in the past experienced and may in the future experience difficulty in hiring and retaining employees with appropriate qualifications In addition we may experience employee turnover as a result of our organizational changes Qualified individuals in the regions where we have offices are in high demand and we may incur significant costs to attract them For example the market for software engineers in the Seattle
area is particularly competitive In addition with a current shortage of certain qualified nurses in many areas of the United States competition for the hiring of these professionals remains intense Similarly with the expansion of adoption of telehealth generally and specifically virtual primary care competition remains intense for qualified primary care physicians We compete for qualified individuals with numerous other companies many of whom have greater financial and other resources than we do In addition in the future we may experiment with different staffing and scheduling models to help attract and retain qualified personnel including hiring more individuals who work remotely incorporating more flexible work schedules or deploying a temporary workforce If we fail to effectively manage our hiring needs or successfully integrate new hires our employee morale and retention could suffer Any of these events could also adversely affect our customer and member satisfaction and harm our business
Attracting integrating and retaining personnel will require us to invest in and commit significant financial operational and management resources to grow and change in these areas without undermining the mission driven culture that has been critical to our growth so far For example newly hired Accolade Care Advocates and clinicians require significant training and in many cases take significant time before they achieve full productivity We train Accolade Care Advocates and clinicians in our proprietary engagement approach and integrated technology platform to provide data informed personalized health and benefit support to members in friendly straightforward terms This new hire training process lasts approximately one month including classroom sessions and supervised live call training If we do not achieve the benefits anticipated from these investments or if the realization of these benefits is delayed our results of operations may be adversely affected and our reputation could suffer
We may also incur significant costs to attract and retain qualified personnel including significant expenditures related to salaries and benefits and compensation expenses related to equity awards and we may lose new employees to our competitors or other companies before we realize the benefit of our investment in recruiting and training them Additionally we have granted certain but not all of our employees equity based awards under our equity incentive plans and expect to continue this practice However if we do not grant equity awards or if we reduce the value of the equity awards we grant we may not be able to attract and retain key personnel Volatility in the price of our common stock underlying equity awards may adversely affect our ability to attract or retain key personnel If we grant more equity awards to attract and retain key personnel the expenses associated with such additional equity awards could affect our results of operations
Further as of February 29 2024 approximately 50 of our U S based labor force is hourly employees including Accolade Care Advocates and certain clinicians who are paid wage rates that currently are above the applicable U S federal and state minimum wage requirements These employees are classified as non exempt and overtime eligible under U S federal and state law If we fail to effectively manage these hourly employees then we may face claims alleging violations of wage and hour employment laws including claims of back wages unpaid overtime pay and missed meal and rest periods Any such employee litigation could be attempted on a class or representative basis Such litigation can be expensive and time consuming regardless of whether the claims against us are valid or whether we are ultimately determined to be liable and could divert management s attention from our business We also could be adversely affected by negative publicity litigation costs resulting from the defense of these claims and the diversion of time and resources from our operations Our employees could also unionize or any of our employees could engage in a strike work stoppage or other slowdown that would adversely affect our operations and could result in higher labor costs which would harm our business
Annually and upon the identification of a triggering event management is required to perform an evaluation of the recoverability of goodwill Triggering events potentially warranting an interim goodwill impairment test include among other factors declines in historical or projected revenue operating income or cash flows and sustained declines in our stock price or market capitalization considered both in absolute terms and relative to peers As a result of sustained decreases in our stock price and market capitalization we conducted an impairment test of our goodwill and intangible assets as of May 31 2022 As a result of this testing we recorded a non cash goodwill impairment charge of 299 7 million during the first quarter of fiscal 2023 No impairments were recorded to goodwill or intangible assets during the year ended February 29 2024 We cannot predict if or when additional future goodwill impairments may occur Additional goodwill impairments could have material adverse effects on our operating income net assets or our cost of or access to capital which could harm our business See Note 4 to our consolidated financial statements for more details
We may face intense competition which could limit our ability to maintain or expand market share within our industry and if we do not maintain or expand our market share our business and operating results will be harmed
The market for our offerings is underpenetrated competitive and characterized by rapidly evolving technology standards customer and member needs and the frequent introduction of new products and services Our competitors range from smaller niche companies to large well financed health plans As costs fall and technology improves increased market saturation may change the competitive landscape in favor of competitors with greater scale than we currently possess We compete on the basis of several factors including level of member engagement ability to influence members to improve health and financial incomes customer and member satisfaction and price Some of our competitors have greater name recognition longer operating histories and significantly greater resources than we do As a result our competitors may be able to respond more quickly and effectively than we can to new or changing opportunities technologies standards or customer requirements
In addition to new niche vendors who offer stand alone products and services we also face competition from health plans which may have existing systems in place with customers in our target market These competitors may now or in the future offer or promise products or services similar to ours and offer ease of integration with existing systems which may leverage existing customer and vendor relationships
In addition current and potential competitors have established and may in the future establish cooperative relationships with vendors of complementary products our Trusted Partner Ecosystem or other third parties technologies or services to increase the availability of their products to the marketplace For example our current competitors may persuade our Trusted Partner Ecosystem suppliers to terminate their relationship with us and engage exclusively with our competitors Accordingly new competitors or alliances may emerge that have greater market share larger customer bases more widely adopted proprietary technologies greater marketing expertise greater financial resources and larger sales forces than we have which could put us at a competitive disadvantage Further in light of these advantages even if our offerings are more effective than the product or service offerings of our competitors current or potential customers might accept competitive products and services in lieu of purchasing our solutions
Our partners including our suppliers in our Trusted Partner Ecosystem could become our competitors by offering similar services Some of our partners may begin to offer services in the same or similar manner as we do For example a supplier included in our Trusted Partner Ecosystem may expand their business model from a point solution into an engagement model similar to ours Although there are many potential opportunities for and applications of these services our partners may seek opportunities or target new customers in areas that may overlap with those that we have chosen to pursue In such cases we may potentially compete against our partners Competition from our partners may adversely affect our business and results from operations In addition some of the terms of our partner relationships may include exclusivity or other restrictive clauses Any agreements with partners that include exclusivity or other restrictive provisions may limit our ability to partner with or provide services to potential customers or other third parties which could harm our business
We also compete on the basis of price We may be subject to pricing pressures as a result of among other things competition within the industry practices of managed care organizations government action and financial stress experienced by our customers Many customers stage regular request for proposal processes as a matter of procurement policy which enables competitors to bid aggressively to try to capture such customers business and such competitors may submit bids incorporating pricing or other terms that we are unable or unwilling to match If our pricing experiences significant downward pressure our business will be less profitable and our results of operations will be adversely affected We cannot be certain that we will be able to retain our current customers or expand our customer base in this competitive environment If we do not retain current customers or expand our customer base or if we have to renegotiate existing contracts our business will be harmed
Moreover we expect that competition will continue to increase as a result of consolidation in both the healthcare information technology and healthcare industries If one or more of our competitors or potential competitors were to merge or partner with another of our competitors or one of the suppliers in our Trusted Partner Ecosystem the change in the competitive landscape could also adversely affect our ability to compete effectively and could harm our business In addition as the healthcare industry consolidates competition to provide services to this segment will become more intense These healthcare industry participants may try to use their market power to negotiate price reductions for our existing and future offerings If we reduce our prices because of consolidation in the healthcare industry our revenue would decrease which could harm our business
The growth of our business relies in part on the growth and success of our customers and the number of members with access to our offerings which are difficult to predict and are affected by factors outside of our control
We enter into agreements with our customers under which our fees are generally dependent upon the number of their employees enrolled in in scope health plans and those employees enrolled dependents each month If the number of members covered by one or more of our customers health and other benefits programs were to decline such decrease would lead to a decrease in our revenue Any reductions in headcount for our customers may result in a decrease in our revenue Some of our fees are also subject to credits if certain performance criteria are not met which in some cases depend on the behavior of our members such as their continued engagement with our existing and future offerings and other factors outside of our control The recognition of a portion of our revenue is subject to achievement of performance metrics and healthcare cost savings and may not be representative of revenue for future periods In addition some of our customers members may request to opt out of our service which could cause our customers to only pay for those members that have not opted out and as a result may result in usage based pricing which could lead to a decrease in revenue from that customer and harm our business
We are continually executing on growth initiatives strategies and operating plans designed to enhance our business and extend our existing and future offerings to address evolving needs For example we developed add on offerings that target specific challenges faced by our customers including the Trusted Partner Ecosystem The anticipated benefits from these efforts are based on several assumptions that may prove to be inaccurate Moreover we may not be able to successfully complete these growth initiatives strategies and operating plans and realize all of the benefits including growth targets and cost savings that we expect to achieve or it may be more costly to do so than we anticipate A variety of risks could cause us not to realize some or all of the expected benefits These risks include among others delays in the anticipated timing of activities related to such growth initiatives strategies and operating plans increased difficulty and cost in implementing these efforts including difficulties in complying with new regulatory requirements the incurrence of other unexpected costs associated with operating our business and lack of acceptance by our customers Moreover our continued implementation of these programs may disrupt our operations and performance As a result we cannot guarantee that we will realize these benefits If for any reason the benefits we realize are less than our estimates or the implementation of these growth initiatives strategies and operating plans adversely affect our operations or cost more or take longer to effectuate than we expect or if our assumptions prove inaccurate our business may be harmed
We have and may again in the future acquire other companies or technologies which could divert our management s attention result in dilution to our stockholders and otherwise disrupt our operations and we may have difficulty integrating any such acquisitions successfully or realizing the anticipated benefits therefrom any of which could have an adverse effect on our business financial condition and results of operations
We have and may again in the future seek to acquire or invest in businesses applications services or technologies that we believe could complement or expand our existing and future offerings enhance our technical capabilities or otherwise offer growth opportunities The pursuit of potential acquisitions may divert the attention of management and cause us to incur various expenses in identifying investigating and pursuing suitable acquisitions whether or not they are consummated In addition we have limited experience in acquiring other businesses and may have difficulty integrating acquired businesses If we acquire additional businesses we may not be able to integrate the acquired operations and technologies successfully or effectively manage the combined business following the acquisition Integration may prove to be difficult due to the necessity of integrating personnel with disparate business backgrounds and who are accustomed to different corporate cultures
We may issue equity securities or incur indebtedness to pay for any such acquisition or investment which could adversely affect our business results of operations or financial condition Any such issuances of additional capital stock may cause stockholders to experience significant dilution of their ownership interests and the per share value of our common stock to decline In addition a significant portion of the purchase price of any companies we acquire may be allocated to acquired goodwill and other intangible assets which must be assessed for impairment annually and upon the identification of a triggering event such as sustained declines in our stock price or market capitalization In the future if our acquisitions do not yield expected returns we may be required to incur charges to our results of operations based on this impairment assessment process which could adversely affect our results of operations
If we do not continue to innovate and provide offerings that are useful to customers and members that achieve and maintain market acceptance we may not remain competitive and our revenue and results of operations could suffer
Our success depends on our ability to keep pace with technological developments satisfy increasingly sophisticated customer and member requirements and achieve and maintain market acceptance on our existing and future offerings in the rapidly evolving market for healthcare and benefits in the United States In addition market acceptance and adoption of our existing and future offerings depend on the acceptance by employers payors health plans and government entities as to the distinct features cost savings and other perceived benefits of our existing and future offerings as compared to competitive solutions Our competitors are constantly developing products and services that may become more efficient or appealing to our customers or members As a result we must continue to invest significant resources in research and development in order to enhance our existing offerings and introduce new offerings that customers and members will want while offering our existing and future offerings at competitive prices If we are unable to predict customer and member preferences or industry changes or if we are unable to modify our existing and future offerings on a timely or cost effective basis we may lose customers If we are not successful in demonstrating to existing and potential customers the benefits of our existing and future offerings or if we are not able to achieve the support of employers healthcare providers and insurance carriers for our existing and future offerings our revenue may decline or we may fail to increase our revenue in line with our forecasts Our results of operations also would suffer if our innovations are not responsive to the needs of our customers and members are not timed to match the corresponding market opportunity or are not effectively brought to market including as the result of delayed releases or releases that are ineffective or have errors or defects
The growth of our business and future success relies in part on our partnerships and other relationships with third parties and our business could be harmed if we fail to maintain or expand these relationships
We selectively form partnerships and engage with numerous third parties including brokers agents benefits consultants carriers third party administrators suppliers in our Trusted Partner Ecosystem and co marketing and co selling partners to grow our customer base and adoption of our offerings We may fail to retain and expand these partnerships and other third party relationships for various reasons and any such failure could harm our relationship with our customers our reputation and brand our prospects and our business
In order to grow our business we anticipate that we will continue to depend on our relationships with our partners As we seek to form additional partnerships and other third party relationships it is uncertain whether these efforts will be successful or that these relationships will result in increased customer or member use of our solutions or increased revenue In the event that we are unable to effectively utilize maintain and expand these partnerships and other third party relationships our revenue growth could slow Additionally our partnerships and other third party relationships may demand or demand greater referral fees or commissions
Our success depends in part on the skills working relationships and continued services of Rajeev Singh Chief Executive Officer other senior management team members and other key personnel We do not currently maintain key person insurance on the lives of any of our key personnel From time to time there may be changes in our senior management team resulting from the hiring or departure of executives which could disrupt our business The replacement of one or more of our executive officers or other key employees would likely involve significant time and costs and may significantly delay or prevent the achievement of our business objectives
While we have entered into offer letters or employment agreements with certain of our executive officers all of our employees are at will employees and their employment can be terminated by us or them at any time for any reason and without notice subject in certain cases to severance payment rights In order to retain valuable employees in addition to salary and cash incentives we may provide equity awards that vest over time or based on performance The value to employees of equity awards that vest over time or based on performance will be significantly affected by movements in our stock price that are beyond our control and may at any time be insufficient to counteract offers from other organizations The departure of key personnel could adversely affect the conduct of our business In such event we would be required to hire other personnel to manage and operate our business and there can be no assurance that we would be able to employ a suitable replacement for the departing individual or that a replacement could be hired on terms that are favorable to us In addition volatility or lack of performance in our stock price may affect our ability to attract and retain replacements should key personnel depart If we are not able to retain our key personnel our business could be harmed
We believe that maintaining and enhancing our reputation and brand recognition is critical to our relationships with our existing customers and partners including suppliers in our Trusted Partner Ecosystem and to our ability to attract new customers and partners The promotion of our brand may require us to make substantial investments and we anticipate that as our market becomes increasingly competitive these marketing initiatives may become increasingly difficult and expensive Brand promotion and marketing activities may not be successful or yield increased revenue and to the extent that these activities yield increased revenue the increased revenue may not offset the expenses we incur and our results of operations could be harmed In addition any factor that diminishes our reputation or that of our management including failing to meet the expectations of customers members and partners and failure to maintain high quality support could harm our reputation and brand and make it substantially more difficult for us to attract new customers and Trusted Partner Ecosystem suppliers or form new partnerships Additionally the performance of third parties with whom we have a relationship including suppliers in our Trusted Partner Ecosystem may also affect our brand and reputation particularly if our customers and members do not have a positive experience with suppliers in our Trusted Partner Ecosystem or other third parties In addition our sales process is highly dependent on the reputation of our offerings and business and on positive recommendations from our existing customers If we do not successfully maintain and enhance our reputation and brand recognition our business may not grow and we could lose our relationships with existing and prospective customers which would harm our business
Our customers and members depend on our support to assist members with their healthcare and other benefits needs We may be unable to accurately predict our members demand for services or respond quickly enough to accommodate short term increases in customer or member demand for services Increased customer or member demand for services without a corresponding increase in productivity or revenue could increase costs and adversely affect our operating results Any failure to maintain high quality support or a market perception that we do not maintain high quality support could adversely affect our reputation our ability to sell our solutions to existing and prospective customers our relationships with third parties and our ability to form new partnerships and our business and operating results
If our existing customers do not continue to renew their contracts with us renew at lower fee levels decline to purchase additional offerings from us or terminate their contracts for convenience our business could be harmed
We expect to derive a significant portion of our revenue from the renewal of existing customers contracts and sales of additional solutions to existing customers As part of our growth strategy for instance we are recently focused on expanding our solutions among current customers Achieving a high customer retention rate and selling additional
applications and solutions are critical to our future business revenue growth and results of operations Factors that may affect our retention rate and our ability to sell additional applications and solutions include the following
We typically enter into contracts with our customers with a stated initial term of three years and various termination rights which if invoked may cause such contracts to be terminated before the term expires For example after a specified period certain of these contracts are terminable for convenience by our customers after a notice period has passed including existing contracts with some of our largest customers Macroeconomic factors including heightened inflation and geopolitical tension may affect our customers desire to renew their contracts or even if they do renew if they undergo layoffs or reductions in force then our membership numbers would decrease which would reduce our revenues If any of our contracts with our customers is terminated we may not be able to recover all fees due under the terminated contract which may adversely affect our operating results Should any of our customers terminate their relationship with us after implementation of our solutions has begun we not only would lose our time effort and resources invested in that implementation but also we would have lost the opportunity to leverage those resources to build a relationship with other customers over that same period of time Our customers may negotiate terms less advantageous to us upon renewal which may reduce our revenue from these customers and may decrease our annual revenue Mergers and acquisitions involving our customers have in the past and may in the future lead to non renewal or termination of our contracts with those customers or by the acquiring or combining companies If our customers fail to renew their contracts renew their contracts upon less favorable terms or at lower fee levels or fail to purchase new solutions from us our revenue may decline or our future revenue growth may be constrained
The healthcare industry is rapidly evolving and the market for technology enabled solutions that empower healthcare consumers is relatively immature and unproven If we are not successful in promoting the benefits of our existing and future offerings our growth may be limited
The market for our solutions is subject to rapid and significant changes The market for technology enabled solutions that empower healthcare consumers is characterized by rapid technological change new product and service introductions increasing consumer financial responsibility consumerism and engagement and the entrance of non traditional competitors In addition there may be a limited time opportunity to achieve and maintain a significant share of this market due in part to the rapidly evolving nature of the healthcare and technology industries and the substantial resources available to our existing and potential competitors The market for technology enabled solutions that empower healthcare consumers is relatively new and unproven and it is uncertain whether this market will achieve and sustain high levels of demand and market adoption In order to remain competitive we are continually involved in a number of projects to compete with new market entrants by developing new offerings growing our customer base and expanding into adjacent markets For example the Accolade Trusted Partner Ecosystem solutions are examples of add on offerings we have deployed to complement our traditional offerings and generate additional value to our customers These projects carry risks such as cost overruns delays in delivery performance problems and lack of acceptance by our customers If we cannot adapt to rapidly evolving industry standards technology and increasingly sophisticated customers and their employees our existing technology could become undesirable obsolete or harm our reputation
We must continue to invest significant resources in our personnel and technology in a timely and cost effective manner in order to enhance our existing offerings and introduce new offerings that existing customers and potential new customers will want If our new or modified offerings are not responsive to the preferences of customers and their employees emerging industry standards or regulatory changes are not appropriately timed with market opportunity or are not effectively brought to market we may lose existing customers or be unable to obtain new customers and our results of operations may suffer
Our success also depends to a substantial extent on the ability of our existing and future offerings to increase member engagement and our ability to demonstrate the value of our existing and future offerings to customers If our existing customers do not recognize or acknowledge the benefits of our existing and future offerings or our offerings do not increase member engagement then the market for our solutions might not develop at all or it might develop more slowly
than we expect either of which could adversely affect our operating results In addition we have limited insight into trends that might develop and affect our business which could lead to errors in our predicting and reacting to relevant business legal and regulatory trends and healthcare reform If any of these events occur it could harm our business
Our marketing efforts for the direct to consumer virtual primary care portion of our business may not be successful or may become more expensive either of which could increase our costs and adversely affect our business financial condition results of operations and cash flows
Direct to consumer virtual primary care and mental health support represents a material portion of our overall business We spend significant resources marketing this service We rely on relationships for our direct to consumer virtual business with a wide variety of third parties including Internet search providers such as Google social networking platforms such as Facebook Internet advertising networks co registration partners retailers distributors television advertising agencies and direct marketers to source new members and to promote or distribute our services and products In addition in connection with the launch of new services or products for our direct to consumer virtual primary care and mental health support business we may spend a significant amount of resources on marketing If our marketing activities are inefficient or unsuccessful if important third party relationships or marketing strategies such as Internet search engine marketing and search engine optimization become more expensive or unavailable or are suspended modified or terminated for any reason including without limitation resulting from a change in consumer sentiment or laws rules or regulations regarding the use of web advertising technologies such as cookies or other tracking technologies if there is an increase in the proportion of consumers visiting our websites or purchasing our services by way of marketing channels with higher marketing costs as compared to channels that have lower or no associated marketing costs or if our marketing efforts do not result in our services being prominently ranked in Internet search listings our business financial condition results of operations and cash flows could be materially and adversely impacted
Our business entails the risk of liability claims against us and we have been and may in the future become subject to litigation Claims against us may be asserted by or on behalf of a variety of parties including our customers our members vendors of our customers government agencies our current or former employees or our stockholders Some of these claims may result in significant defense costs and potentially significant judgments against us We carry professional liability insurance in amounts that we believe are appropriate in light of the risks attendant to our business but successful claims could result in substantial damage awards that exceed the limits of our insurance coverage In addition any determination that certain non medical services are acting in the capacity of a healthcare provider or exercising undue influence or control over a healthcare provider may subject us to claims not covered by our professional liability insurance coverage or could result in significant sanctions against us and our clinicians additional compliance requirements expense and liability to us If our medical care services are found to cause harm to an individual or otherwise constitute malpractice we may be subject to claims exceeding our coverage limits and cause reputational harm If we make errors in the billing and the coding for such services we may be subject to claims exceeding our coverage limits and cause reputational harm In addition professional liability insurance is expensive and insurance premiums may increase significantly in the future particularly as we expand our solutions As a result adequate professional liability insurance may not be available to us or to our partners in the future at acceptable costs or at all We cannot be certain of the ultimate outcomes of any claims that may arise in the future Resolution of some of these types of matters against us may result in our having to pay significant fines judgments or settlements which if uninsured or if the fines judgments and settlements exceed insured levels could adversely impact our earnings and cash flows thereby harming our business and per share trading price of our common stock For example fines or assessments could be levied against us under domestic or foreign data privacy laws such as HIPAA the GDPR or the CCPA or under authority of privacy enforcing governmental entities such as the FTC or the U S Department of Health and Human Services HHS or as a result of private actions such as class actions based on data breaches or based on private rights of action such as that contained in the CCPA Certain litigation or the resolution of certain litigation may affect the availability or cost of some of our insurance coverage which could adversely impact our results of operations and cash flows expose us to increased risks that would be uninsured and adversely impact our ability to attract directors and officers In addition such litigation could result in increased scrutiny by government authorities having authority over our business such as the FTC the HHS Office for Civil Rights OCR and state attorneys general
If our information technology systems or data or those of third parties upon which we rely are or were compromised we could experience adverse consequences resulting from such compromise including but not limited to regulatory investigations or actions litigation fines and penalties disruptions of our business operations reputational harm loss of revenue or profits loss of customers or sales and other adverse consequences
In the ordinary course of our business we may collect store use and disclose collectively process proprietary confidential and sensitive information including personal data such as health related data intellectual property and trade secrets We manage and maintain our technology platform and data utilizing a combination of on site systems mobile applications managed data center systems and cloud based computing center systems We are highly dependent on information technology networks mobile applications and systems including the Internet to securely process transmit and store this critical information We utilize third party service providers including business associates as defined under HIPAA for important aspects of the collection storage and transmission of customer and member information and other confidential and sensitive information and therefore rely on third parties to manage functions that have material cybersecurity risks Our technology platform also utilizes artificial intelligence AI and machine learning ML technology to provide services and this technology may be susceptible to cybersecurity threats as PHI PII and other confidential and sensitive information may be integrated into the platform Because of the sensitivity of the PHI other PII and other confidential information we and our service providers process the security of our technology platform and other aspects of our solutions including those provided or facilitated by our third party service providers are important to our operations and business strategy While we use various information security techniques and tools designed to secure our platforms and require our third party service providers to adhere to substantially similar standards our ability to monitor these third parties cybersecurity practices is limited and these third parties may not have adequate information security measures in place
Cyberattacks malicious Internet based activity online and offline fraud and similar activities threaten the confidentiality integrity and availability of our sensitive information and information technology systems and those of the third parties upon which we rely These threats are prevalent continue to increase and are increasingly difficult to detect These threats come from a variety of sources including traditional computer hackers threat actors hacktivists organized criminal threat actors personnel such as through theft or misuse sophisticated nation states and nation state supported actors Some actors now engage and are expected to continue to engage in cyberattacks including without limitation nation state actors for geopolitical reasons and in conjunction with military conflicts and defense activities We and the third parties upon which we rely may be subject to a variety of evolving threats including but not limited to social engineering attacks including through phishing attacks malicious code such as computer viruses and worms malware including as a result of advanced persistent threat intrusions denial of service attacks such as credential stuffing credential harvesting personnel misconduct or error ransomware attacks supply chain attacks software bugs system disruptions shutdowns or unauthorized disclosure or modifications of confidential information server malfunctions software or hardware failures loss of data or other information technology assets adware telecommunications failures and other similar threats
Ransomware attacks including by organized criminal threat actors nation states and nation state supported actors are becoming increasingly prevalent and severe and can lead to significant interruptions in our operations loss of data and income reputational harm and diversion of funds Extortion payments may alleviate the negative impact of a ransomware attack but we may be unwilling or unable to make such payments due to for example applicable laws or regulations prohibiting such payments Similarly supply chain attacks have increased in frequency and severity and we cannot guarantee that third parties and infrastructure in our supply chain or our third party partners supply chains have not been compromised or that they do not contain exploitable defects or bugs that could result in a breach of or disruption to our information technology systems including our services or the third party information technology systems that support us and our services Our hybrid workforce poses increased risks to our information technology systems and data as many of our employees work from home on at least a partial schedule and utilize network connections computers and devices outside our premises or network while at home in transit or in public locations Future or past business transactions such as acquisitions or integrations could expose us to additional cybersecurity risks and vulnerabilities as our systems could be negatively affected by vulnerabilities present in acquired or integrated entities systems and technologies Furthermore we may discover security issues that were not found during due diligence of such acquired or integrated entities and it may be difficult to integrate companies into our information technology environment and security program
Any of the previously identified or similar threats could cause a security incident or other interruption A security incident or other interruption could result in unauthorized unlawful or accidental acquisition modification destruction loss alteration encryption disclosure of or access to data A security incident or other interruption could disrupt our ability and that of third parties upon whom we rely to provide our services
We may expend significant resources or modify our business activities in an effort to protect against security incidents Certain data privacy and security obligations may require us to implement and maintain specific security
measures industry standards or reasonable security measures to protect our information technology systems and data We take certain administrative physical and technological safeguards to address these risks such as by requiring outsourcing subcontractors and partners including suppliers in our Trusted Partner Ecosystem who handle customer and member information for us to enter into agreements that contractually obligate those subcontractors and partners to comply with applicable privacy laws such as HIPAA and otherwise use reasonable efforts to safeguard PHI other PII and other sensitive information For those subcontractors and partners who handle PHI on our behalf we enter into business associate agreements as required by HIPAA Measures taken to protect our systems those of our subcontractors and partners or the PHI other PII or other sensitive information we our subcontractors or our partners process or maintain may not adequately protect us from the risks associated with the collection storage and transmission of such information
There can be no assurance that the security measures we have implemented to protect against security incidents and help protect confidential and other sensitive information including PHI and PII will be effective We may be unable to detect vulnerabilities in our information technology systems or remediate them in a timely manner or without adversely impacting or interrupting our operations Such vulnerabilities could be exploited because such threats and techniques change frequently are often sophisticated in nature and may not be detected until after a security incident has occurred These vulnerabilities may pose material risks to our business Further we may experience delays in developing and deploying remedial measures designed to address any such identified vulnerabilities In addition security incidents and other inappropriate access to or acquisition or processing of information can be difficult to detect or may occur outside of our network such as in our supply chain or at our customers or suppliers in our Trusted Partner Ecosystem and any delay in identifying or responding to such incidents or in providing any notification of such incidents may lead to increased harm Any such breach or interruption of our systems or the systems of any of our third party information technology partners could compromise our networks or data security processes and sensitive information could be inaccessible or could be accessed by unauthorized parties publicly disclosed lost or stolen Any such interruption in access improper access disclosure or other loss of information could result in legal claims or proceedings liability under laws and regulations that govern protections of personal information Despite our efforts to identify and address vulnerabilities in our information technology systems including our products our efforts may not be successful
Applicable data privacy and security obligations may require us to notify relevant stakeholders of security incidents Such disclosures are costly and the disclosures or the failure to comply with such requirements could lead to adverse consequences If we or a third party upon whom we rely experience a security incident or are perceived to have experienced a security incident we may experience adverse consequences These consequences may include government enforcement actions for example investigations fines penalties audits and inspections additional reporting requirements and or oversight restrictions on processing data including personal data litigation including class claims indemnification obligations negative publicity harm to our reputation monetary fund diversions interruptions in our operations including availability of data financial loss and other similar harms Security incidents and attendant consequences may cause customers to stop using our services deter new customers from using our services and negatively impact our ability to grow and operate our business
Our contracts may not contain limitations of liability and even where they do there can be no assurance that limitations of liability in our contracts are sufficient to protect us from liabilities damages or claims related to our data privacy and security obligations We maintain insurance covering certain security and privacy damages and claim expenses but may not carry insurance or maintain coverage sufficient to compensate for all liability and in any event insurance coverage would not address the reputational damage that could result from a security incident We cannot be sure that such coverage will continue to be available on commercially reasonable terms or at all or that such coverage will pay future claims Additionally our contracts may not contain limitations of liability and even where they do there can be no assurance that limitations of liability in our contracts are sufficient to protect us from liabilities damages or claims related to our data privacy and security obligations
If we fail to provide accurate and timely information or if our personnel including Accolade Care Advocates and clinicians our content or any other element of our existing and future offerings is associated with faulty administrative or clinical decisions or treatment we could have liability to customers or members which could adversely affect our results of operations
Our Accolade Care Advocates and clinicians our member web portal and our mobile application all use our technology platform to support our members in making healthcare and benefits related decisions In addition our Accolade Care Advocates and clinicians use our technology platform to help guide interactions with members Our technology platform applies AI and ML tactics to generate predictive insights about our members which are then translated into recommended interventions for our Accolade Care Advocates and clinicians and used to enhance our member self service capabilities Our services including personalized recommendations and interventions center around engagement with our members to provide members with better understanding of their benefits assist with access to care and provide options for choosing quality providers and care For example our Accolade Care Advocates can leverage our technology platform to
provide quotes to a member about that member s healthcare benefits including in network services balance billing or claims quotes If we fail to provide accurate and timely information regarding these benefits or if the data generated by our technology platform including the artificial intelligence and machine learning components are inaccurate fail or are subject to security incidents this could lead to claims against us that could result in substantial costs to us or cause demand for our solutions to decline If our Accolade Care Advocates clinicians or technology platform guide people to care settings and providers resulting in faulty clinical decisions or treatment then our customers or our members could assert claims against us that could result in substantial costs to us harm our reputation in the industry and cause demand for our existing and future offerings to decline For example our nurses have access to extensive intelligence on provider quality and cost which allows them to present various options to members when they are selecting a primary care physician or specialist If the member relies on this provider recommendation and that provider subsequently makes faulty clinical decisions or treatment recommendations we could be subject to claims by such member In addition if our Accolade Care Advocates or clinicians make recommendations outside of our standard protocol that result in faulty clinical decisions or treatments then our customers or our members could assert claims against us
The assertion of such claims and ensuing litigation regardless of its outcome could result in substantial cost to us divert management s attention from operations damage our reputation and decrease market acceptance of our existing and future offerings We maintain general liability and professional liability insurance coverage but this coverage may not continue to be available on acceptable terms may not be available in sufficient amounts to cover one or more large claims against us or may not provide coverage if our Accolade Care Advocates or clinicians were to engage in the unlicensed practice of medicine In addition the insurer might disclaim coverage as to any future claim One or more large claims could exceed our available insurance coverage Adequate professional liability insurance may not be available to our clinicians or to us in the future at acceptable costs or at all Any claims made against us that are not fully covered by insurance could be costly to defend against result in substantial damage awards against us and divert the attention of our management and our providers from our operations which may harm our business In addition any claims may adversely affect our business or reputation
We also provide a service that allows members to access board certified national specialists across the country for second opinion consultations in a real time video call or by phone in order to provide the member with a rapid second opinion on their medical condition enabling the member to better understand a diagnosis and treatment options to help them make more informed decisions on their healthcare regarding significant and high cost care decisions While we believe that these specialists do not create a physician patient relationship with the member and are not practicing medicine in these engagements if the information provided is not accurate or timely we could incur liability which could adversely affect our operations
We also act as a managed service provider to several medical practices that provide virtual primary care and mental health support to individuals The physicians employed by or contracted with PlushCare of California or other PlushCare associated medical practices could misdiagnose or treat a patient and or the services and technology provided by PlushCare to the medical practices could malfunction which could cause us to incur liability which could adversely affect our operations
Concerns relating to the responsible use of new and evolving technologies such as AI in our products and services may result in reputational or financial harm and liability and may cause us to incur costs to resolve such issues Various federal and state level legislation may impact the use of evolving technologies such as AI We are increasingly building AI capabilities into our products and services Such legislation and or industry or customer resistance to the use of AI due to emerging legal social and ethical issues presents risks and challenges that could affect its adoption and therefore our business and ability to scale If we implement and use AI in a manner that violates such legislation including various privacy and discrimination laws customer policies or causes direct harm to our members we may experience brand or reputational harm competitive harm or legal liability Complying with multiple regulations from different jurisdictions related to AI including any U S regulation adopted in response to the Biden administration s Executive Order on AI could increase our cost of doing business may change the way that we operate in certain jurisdictions or may impede our ability to offer certain products and services in certain jurisdictions if we are unable to comply with regulations Changes in AI related regulation could disproportionately impact and disadvantage us as we expand our deployment of AI and require us to change our business practices which may negatively impact our financial results Our failure to address concerns and regulation relating to the responsible use of AI by us or our third party service providers could undermine public confidence in AI and slow adoption of AI in our products and services or cause reputational or financial harm
We rely on Internet infrastructure bandwidth providers data center providers other third parties and our own systems for providing solutions to our customers and any failure or interruption in the services provided by these third parties or our own systems could expose us to litigation and negatively impact our relationships with customers adversely affecting our brand and our business
Our ability to deliver our solutions is dependent on the development and maintenance of the infrastructure of the Internet and other telecommunications services by third parties We currently host our technology platform serve our customers and members and support our operations primarily using third party data centers and telecommunications solutions including cloud infrastructure services such as Amazon Web Services AWS and Google Cloud We also use a third party call center for off hours clinical support We do not have control over the operations of the facilities of our data and call center providers AWS or Google Cloud These facilities are vulnerable to damage or interruption from earthquakes hurricanes floods fires cyber security attacks terrorist attacks power losses telecommunications failures and similar events The occurrence of a natural disaster or an act of terrorism a decision to close the facilities without adequate notice or other unanticipated problems could result in lengthy interruptions in our solution The facilities also could be subject to break ins computer viruses sabotage intentional acts of vandalism and other misconduct Any errors failures interruptions or delays experienced in connection with these third party technologies and information services or our own systems could negatively impact our relationships with customers and adversely affect our business and could expose us to third party liabilities
For some of these services we may not maintain redundant systems or facilities Our technology platform s continuing and uninterrupted performance is critical to our success Members may become dissatisfied by any system failure that interrupts our ability to provide our solutions to them We may not be able to easily switch our AWS and Google Cloud operations to another cloud service provider if there are disruptions or interference with our use of AWS or Google Cloud Sustained or repeated system failures would reduce the attractiveness of our technology platform to customers and members and result in contract terminations thereby reducing revenue Moreover negative publicity arising from these types of disruptions could damage our reputation and may adversely impact use of our existing and future offerings We may not carry sufficient business interruption insurance to compensate us for losses that may occur as a result of any events that cause interruptions in our service Neither our third party data and call center providers nor AWS or Google Cloud have an obligation to renew their agreements with us on commercially reasonable terms or at all If we are unable to renew our agreements with these providers on commercially reasonable terms if our agreements with our providers are prematurely terminated or if in the future we add additional data or call center providers or cloud service providers we may experience costs or downtime in connection with the transfer to or the addition of new providers If these providers were to increase the cost of their services we may have to increase the price of our existing and future offerings and our business may be harmed
The market for private health insurance in the United States is evolving and as our customers are primarily employers that deploy our offerings to employees and their families our future financial performance will depend in part on the growth in this market Changes and developments in the health insurance system in the United States could reduce demand for our existing and future offerings and harm our business For example there has been an ongoing national debate relating to the healthcare reimbursement system in the United States Some elected officials have introduced proposals that would create a new single payor national health insurance program for all United States residents others have proposed more incremental approaches such as creating a new public health insurance plan option as a supplement to private sources of coverage In the event that laws regulations or rules that eliminate or reduce private sources of health insurance or require such benefits to be taxable are adopted the subsequent impact on the workplace benefits provided by our customers may in turn have an adverse effect on our business and results of operations
In addition changes in laws or regulations regarding the Employee Retirement Income Security Act of 1974 ERISA changes in state insurance laws or other changes in laws could materially impact the self insured employer healthcare and benefits markets or the markets in which our other existing or potential customers procure and provide benefits
Our existing and future offerings as well as our business activities including our relationships with our commercial partners and customers are or may be in the future subject to a complex set of regulations and rigorous enforcement including by the HHS Office of the Inspector General and Office of Civil Rights U S Food and Drug Administration FDA U S Department of Justice and numerous other federal and state governmental authorities Our employees consultants and commercial partners may engage in misconduct or other improper activities including non compliance with regulatory standards and requirements Certain aspects of our business model may also trigger scrutiny under healthcare and related laws Federal and state healthcare and related laws and regulations that may now or in the future affect our ability to conduct business include
laws that regulate how businesses operate online including measures relating to privacy and data security and how such information is communicated to customers a under the FTC s unfair and deceptive trade practice authority from the FTC Act and the FTC breach notification rule b under the OCR s investigative powers regulating HIPAA and c from state attorneys general under state consumer protection laws and data privacy laws including without limitation changes in laws rules and regulations related to the use of cookies and tracking technologies on the internet
federal and state laws governing i the corporate practice of medicine and other healthcare professions and related fee splitting laws including the provision of management or administrative services in connection with practice of medicine and other health care professions employment of professionals by non professionals ii professional licensing and standards of professional conduct iii the provision of telemedicine telehealth or other health care services including medical record retention requirements and iv the billing submission or collection of claims or payments for healthcare services
the federal Anti Kickback Statute which prohibits among other things any person from knowingly and willfully offering soliciting receiving or providing remuneration directly or indirectly in exchange for or to induce either the referral of an individual for or the purchase order or recommendation of any good or service for which payment may be made under federal healthcare programs such as the Centers for Medicare and Medicaid Services CMS programs including Medicare and Medicaid
the federal civil false claims laws including the federal False Claims Act and federal Civil Monetary Penalties Law which prohibit among other things individuals or entities from knowingly presenting or causing to be presented false claims or knowingly using false statements to obtain payment from the federal government
the federal Physician Payments Sunshine Act or Open Payments created under the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act collectively the Affordable Care Act and its implementing regulations which requires certain manufacturers of drugs medical devices biologicals and medical supplies for which payment is available under Medicare Medicaid or the Children s Health Insurance Program to report annually to CMS information related to payments or other transfers of value made to physicians defined to include doctors dentists optometrists podiatrists and chiropractors certain other healthcare professionals e g physician assistants and nurse practitioners and teaching hospitals as well as ownership and investment interests held by physicians and their immediate family members and
state law equivalents of each of the above federal laws such as anti kickback and false claims laws which may apply to items or services reimbursed by any third party payor including commercial insurers
The Affordable Care Act among other things amended the intent requirement of the federal Anti Kickback Statute and criminal healthcare fraud statutes A person or entity no longer needs to have actual knowledge of this statute or specific intent to violate it In addition the Affordable Care Act provides that the government may assert that a claim including items or services resulting from a violation of the federal Anti Kickback Statute constitutes a false or fraudulent claim for purposes of the federal False Claims Act
Because of the breadth of these laws and the narrowness of available statutory and regulatory exemptions it is possible that some of our activities could be subject to challenge under one or more of such laws For example there is a risk that regulatory authorities in some states may find that certain of our contractual relationships with healthcare providers are in violation of state anti kickback corporate practice of health care professions or fee splitting laws Any
action brought against us for violations of these laws or regulations even if successfully defended could cause us to incur significant legal expenses and divert our management s attention from the operation of our business We may be subject to private qui tam actions brought by individual whistleblowers on behalf of the federal or state governments with potential liability under the federal False Claims Act including mandatory treble damages and significant per claim penalties
Although we have adopted policies and procedures designed to comply with these laws and regulations and conduct internal reviews of our compliance with these laws our compliance is also subject to governmental review The growth of our business and sales organization may increase the potential of violating these laws or our internal policies and procedures The risk of our being found in violation of these or other laws and regulations is further increased by the fact that many have not been fully interpreted by the regulatory authorities or the courts and their provisions are open to a variety of interpretations Any action brought against us for violation of these or other laws or regulations even if we successfully defend against it could cause us to incur significant legal expenses and divert our management s attention from the operation of our business If our operations are found to be in violation of any of the federal state and foreign laws described above or any other current or future fraud and abuse or other healthcare laws and regulations that apply to us we may be subject to penalties including significant criminal civil and administrative penalties damages and fines disgorgement additional reporting requirements and oversight if we become subject to a corporate integrity agreement or similar agreement to resolve allegations of noncompliance with these laws imprisonment for individuals and exclusion from participation in government programs such as Medicare and Medicaid as well as contractual damages and reputational harm We could also be required to curtail or cease our operations Any of the foregoing consequences could seriously harm our business and our financial results
In our virtual care business we are dependent on our relationships with affiliated professional entities which we do not own to provide physician services and our business would be adversely affected if those relationships were disrupted or if our arrangements with our providers or our members are found to violate state laws prohibiting the corporate practice of medicine or fee splitting
The laws of many states including states in which our members are located prohibit us from exercising control over the medical judgments or decisions of physicians and from engaging in certain financial arrangements such as splitting professional fees with physicians These laws and their interpretations vary from state to state and are enforced by state courts and regulatory authorities each with broad discretion and are subject to change and to evolving interpretations by state boards of medicine and state attorneys general among others We enter into agreements with professional associations PlushCare of California Inc a California professional corporation and others which enter into contracts with our providers pursuant to which they render professional medical services In addition we enter into contracts with our members to deliver professional services in exchange for fees These contracts include management services agreements with our affiliated physician organizations pursuant to which the physician organizations reserve exclusive control and responsibility for all aspects of the practice of medicine and the delivery of medical services Although we seek to substantially comply with applicable state prohibitions on the corporate practice of medicine and fee splitting changes in or subsequent interpretations of the corporate practice of medicine laws could circumscribe our business operations and state officials who administer these laws or other third parties may successfully challenge our existing organization and contractual arrangements If such a claim were successful we could be subject to civil and criminal penalties and could be required to restructure or terminate the applicable contractual arrangements A determination that these arrangements violate state statutes or our inability to successfully restructure our relationships with our providers to comply with these statutes could eliminate our ability to acquire members located in certain states from the market for our services which would have a materially adverse effect on our business financial condition and results of operations State corporate practice of medicine doctrines also often impose penalties on physician themselves for aiding the corporate practice of medicine which could discourage physicians from participating in our network of providers
We do not own PlushCare of California Inc a California professional corporation or other medical groups with which we contract These medical groups are 100 physician owned and independent The professional corporations with which we contract are owned by Dr James Wantuck one of our affiliated providers and the professional corporations are owned by physicians licensed in their respective states While we expect that these relationships will continue we cannot guarantee that they will A material change in our relationship with the medical groups that support our virtual care services whether resulting from a dispute among the entities a change in government regulation or the loss of these affiliations could impair our ability to provide services to our members and could have a material adverse effect on our business financial condition and results of operations In addition the arrangement in which we have entered to comply with state corporate practice of medicine doctrines could subject us to additional scrutiny by federal and state regulatory bodies regarding federal and state fraud and abuse laws Any scrutiny investigation or litigation with regard to such arrangements with the medical groups could have a material adverse effect on our business financial condition and results of operations
We are subject to stringent and evolving U S and foreign laws regulations rules contractual obligations policies and other obligations related to data privacy and security Our actual or perceived failure to comply with such obligations could lead to regulatory investigations or actions litigation fines and penalties disruptions of our business operations reputational harm loss of revenue or profits loss of customers or sales and other adverse business consequences
In the ordinary course of business we process personal data and other sensitive information including proprietary and confidential business information trade secrets intellectual property sensitive third party information personal data benefit plan eligibility information and health information including medical claims and other health records Our data processing activities subject us to numerous data privacy and security obligations such as various laws regulations guidance industry standards external and internal privacy and security policies contracts and other obligations that govern the processing of personal data by us and third parties who may process data on our behalf
In the United States state federal and local governments have enacted numerous data privacy and security laws including data breach notification laws personal data privacy laws consumer protection laws e g Section 5 of the Federal Trade Commission Act and state consumer protection laws regulating unfair or deceptive trade practices and other applicable laws e g wiretapping laws These laws and regulations include HIPAA which establishes a set of national privacy and security standards for the protection of PHI by health plans healthcare clearinghouses and certain healthcare providers referred to as covered entities and individuals and entities that perform services for them which involve the use or disclosure of individually identifiable health information known as business associates and their subcontractors As a healthcare technology company we are considered a business associate under HIPAA and our associated medical practices are considered HIPAA covered entities As such we execute business associate agreements with our customers subcontractors and suppliers in our Trusted Partner Ecosystem HIPAA requires covered entities and business associates such as us and their covered subcontractors to develop and maintain policies and procedures with respect to PHI that is used or disclosed including the adoption of administrative physical and technical safeguards to protect such information
Some of our business activities require that we or our partners obtain permissions consistent with HIPAA to provide certain marketing and data aggregation services as well as those activities that require the creation and use of de identified information We may also require large sets of de identified information to enable us to continue to develop and enhance our data and analytics platform If we or our partners are unable to secure these rights or if there is a future change in law we may face limitations on the use of PHI and our ability to provide marketing services and use de identified information which could harm our business or subject us to potential government actions or penalties Also there are ongoing public policy discussions regarding whether the standards for de identified anonymous or pseudonomized health information are sufficient and the risk of re identification sufficiently small to adequately protect patient privacy These discussions may lead to further restrictions on the use of such information or create additional regulatory burdens There can be no assurance that these initiatives or future initiatives will not adversely affect our ability to access and use data or to develop or market current or future services
In addition we could be subject to periodic audits for compliance with the HIPAA Privacy and Security Standards by HHS and our customers HIPAA also implemented the use of standard transaction code sets and standard identifiers that covered entities must use when submitting or receiving certain electronic healthcare transactions including activities associated with the billing and collection of healthcare claims HIPAA imposes mandatory penalties for certain violations and a single breach incident can result in violations of multiple standards HIPAA also authorizes state attorneys general to file suit on behalf of their residents Courts may award damages costs and attorneys fees related to violations of HIPAA in such cases While HIPAA does not create a private right of action allowing individuals to sue us in civil court for violations of HIPAA its standards have been used as the basis for duty of care in state civil suits such as those for negligence or recklessness in the misuse or breach of PHI
In addition to HIPAA CAN SPAM and the TCPA impose specific requirements on communications with customers For example the TCPA imposes various consumer consent requirements and other restrictions on certain telemarketing activity and other communications with consumers by phone fax or text message TCPA violations can result in significant financial penalties including penalties or criminal fines imposed by the Federal Communications Commission FCC or fines of up to 1 500 per violation imposed through private litigation or by state authorities Furthermore the CCPA applies to personal information of consumers business representatives and employees and requires businesses to provide specific disclosures in privacy notices and honor requests from California residents to exercise certain privacy rights The CCPA provides for civil penalties of up to 7 500 per violation and allows private litigants affected by certain data breaches to recover significant statutory damages In addition the CPRA effective January 1 2023 expands the CCPA by adding a new right for individuals to correct their personal information and establishing a new California Privacy Protection Agency to implement and enforce the CPRA Other states have enacted data privacy laws including Virginia Colorado Utah and Connecticut all of which become effective in 2023 Additionally several states and localities have enacted measures related to the use of AI and ML in products and services
Outside the United States an increasing number of laws regulations and industry standards apply to data privacy and security In Canada the Personal Information Protection and Electronic Documents Act PIPEDA and various related provincial laws as well as Canada s Anti Spam Legislation CASL may apply to our operations Additionally the EU GDPR and the UK GDPR impose strict requirements for processing the personal data of individuals For example under the EU GDPR government regulators may impose temporary or definitive bans on data processing as well as fines of up to 20 million euros or 4 of annual global revenue whichever is greater Further individuals classes of data subjects or consumer protection organizations authorized at law to represent their interests may initiate private litigation related to our processing of their personal data Furthermore in Europe there is a proposed regulation related to AI and ML that if adopted could impose onerous obligations related to the use of AI related systems We may have to change our business practices to comply with such obligations In addition to data privacy and security laws we may be contractually subject to data privacy and security obligations including industry standards adopted by industry groups and may become subject to new data privacy and security obligations in the future Certain privacy laws such as the GDPR and the CCPA also require our customers to impose specific contractual restrictions on their service providers
Additionally regulators are increasingly scrutinizing companies that process children s data Numerous laws regulations and legally binding codes such as the Children s Online Privacy Protection Act COPPA California s Age Appropriate Design Code effective July 2024 the CCPA and CPRA other U S state comprehensive privacy laws the EU and UK GDPR and the UK Age Appropriate Design Code impose various obligations on companies that process children s data including by requiring certain consents to process such data and extending certain rights to children and their parents with respect to that data Some of these obligations have wide ranging applications including for services that do not intentionally target child users defined in some circumstances as a user under the age of 18 years old Additionally under various privacy laws and other obligations we may be required to obtain certain consents to process personal data Our inability or failure to do so could result in adverse consequences
In the ordinary course of business we may transfer personal data from Europe and other jurisdictions to the United States or other countries Europe and other jurisdictions have enacted laws requiring data to be localized or limiting the transfer of personal data to other countries In particular the EEA and the UK have significantly restricted the transfer of personal data to the United States and other countries whose privacy laws it believes are inadequate Other jurisdictions may adopt similarly stringent interpretations of their data localization and cross border data transfer laws Although there are currently various mechanisms that may be used to transfer personal data from the EEA and UK to the United States in compliance with law such as the EEA and UK s standard contractual clauses these mechanisms are subject to legal challenges and there is no assurance that we can satisfy or rely on these measures to lawfully transfer personal data to the United States
If there is no lawful manner for us to transfer personal data from the EEA the UK or other jurisdictions to the United States or if the requirements for a legally compliant transfer are too onerous we may face significant adverse consequences including the interruption or degradation of our operations the need to relocate part of or all of our business or data processing activities to other jurisdictions at significant expense increased exposure to regulatory actions substantial fines and penalties the inability to transfer data and work with partners vendors and other third parties and injunctions against processing or transferring personal data necessary to operate our business Additionally companies that transfer personal data out of the EEA and UK to other jurisdictions particularly to the United States are subject to increased scrutiny from regulators individual litigants and activist groups Some European regulators have ordered certain companies to suspend or permanently cease certain transfers out of Europe for allegedly violating the GDPR s cross border data transfer limitations Inability to transfer personal data from the EEA Switzerland or UK to the United States or elsewhere may restrict our activities in those jurisdictions and limit our ability to provide our products and services in those jurisdictions Our response to these requirements globally may not meet the expectations of individual customers affected data subjects or other stakeholders which could reduce the demand for our services Some customers or other service providers may respond to these evolving laws and regulations by asking us to make certain privacy or data related contractual commitments that we are unable or unwilling to make This could lead to the loss of current or prospective customers or other business relationships
Obligations related to data privacy and security are quickly changing becoming increasingly stringent and creating regulatory uncertainty This complex dynamic legal landscape regarding data privacy and security creates significant compliance issues for us and our customers and potentially exposes us to additional expense adverse publicity and liability Additionally these obligations may be subject to differing applications and interpretations which may be inconsistent or in conflict among jurisdictions Preparing for and complying with these obligations requires us to devote significant resources including without limitation financial and time related resources These obligations may
necessitate changes to our information technologies systems and practices and to those of any third parties that process personal data on our behalf In addition these obligations may require us to change our business model
Although we endeavor to comply with all applicable data privacy and security obligations we may at times fail or be perceived to have failed to do so Moreover despite our efforts our personnel or third parties upon whom we rely may fail to comply with such obligations which could negatively impact our business operations and compliance posture For example any failure by a third party processor to comply with applicable law regulations or contractual obligations could result in adverse effects including inability to operate our business and proceedings against us by governmental entities or others If we fail or are perceived to have failed to address or comply with data privacy and security obligations we could face significant consequences These consequences may include but are not limited to government enforcement actions e g investigations fines penalties audits inspections and similar litigation including class related claims additional reporting requirements and or oversight bans on processing personal data orders to destroy or not use personal data and imprisonment of company officials While we are unaware of regulatory audits investigations or actions relating to our privacy practices various entities in the healthcare technology industry including the PlushCare medical practices have received and responded to a compliance review from the U S Department of Health and Human Services Office for Civil Rights OCR related to the utilization of digital website trackers such as Meta s Pixel The compliance review is focused on whether the use of such trackers collects and discloses protected health information for visitors to a healthcare related website to third parties such as Meta and Google
In addition to data privacy and security laws we are contractually subject to industry standards adopted by industry groups and may become subject to such obligations in the future For example if we are subject to the Payment Card Industry Data Security Standard PCI DSS the PCI DSS requires companies to adopt certain measures to ensure the security of cardholder information including using and maintaining firewalls adopting proper password protections for certain devices and software and restricting data access Noncompliance with PCI DSS can result in penalties ranging from 5 000 to 100 000 per month by credit card companies litigation damage to our reputation and revenue losses We also rely on vendors to process payment card data who may be subject to PCI DSS and our business may be negatively affected if our vendors are fined or suffer other consequences as a result of PCI DSS noncompliance We also publish statements to our customers and members that describe how we handle and protect PHI and personal data for example through our privacy policies connected with our website mobile applications and other digital tools If federal or state regulatory authorities such as the FTC or state attorneys general or private litigants consider any portion of these statements to be untrue deficient lacking in transparency deceptive unfair or misrepresentative of our practices we may be subject to claims of deceptive practices which could lead to significant liabilities and consequences including costs of responding to investigations defending against litigation settling claims and complying with regulatory or court orders
Any of the foregoing consequences could have a material adverse effect on our reputation business and our financial condition including but not limited to interruptions or stoppages in our business operations interruptions or stoppages of data collection needed to train our algorithms inability to process personal data or to operate in certain jurisdictions limited ability to develop or commercialize our products expenditure of time and resources to defend any claim or inquiry adverse publicity or revision or restructuring of our operations Furthermore the costs of compliance with and other burdens imposed by the laws regulations and policies that are applicable to the businesses of our customers may limit the use and adoption of and reduce the overall demand for our existing and future offerings Any of the foregoing consequences could harm our business
Our employment and use of nurses physician medical directors and our other clinicians and our engagement of physicians may subject us to state and other licensing and regulatory risks For example there may be restrictions on the ability of our employed and contracted clinicians to provide services to our members residing in states outside of the state or states in which such clinicians are licensed or registered The services provided by our clinicians may be subject to review by state or other regulatory bodies In addition any activities conducted by our clinicians that are in violation of practice rules could subject us to fines or other penalties While we do not believe that we provide medical care or establish patient relationships with our members our clinicians could be found to be in violation of applicable laws Further in March 2021 we acquired 2nd MD which provides a service that allows members to access board certified national specialists across the country for second opinion consultations in a real time video call or by phone This provides the member with a rapid second opinion on their medical condition enabling the member to better understand a diagnosis and treatment options which helps them make more informed decisions on their healthcare regarding significant and high cost care decisions We believe that these experts do not create a physician patient relationship with the member and are not practicing medicine but state medical boards may disagree with our position which could result in significant liability and may require the restructuring of such operations Our associated medical practices employ and engage clinicians as permitted under state law and maintain physician patient relationships with members Further if one of our clinicians is
found to be acting outside the scope of their professional license or otherwise violated the applicable state s practice laws such activity could result in disciplinary action against the clinician by the applicable licensing agency The definition of what constitutes the practice of medicine nursing or other health professions varies by state
In addition there is a risk that we may be found in violation of the prohibition of the corporate practice of a health profession under certain state laws which may result in the imposition of civil or criminal penalties Certain states prevent corporations from being licensed as practitioners and prohibit physicians from practicing medicine in partnership with non physicians such as business corporations Activities other than those directly related to the delivery of healthcare may be considered an element of the practice of medicine in certain states These laws which vary by state may also prevent the sharing of professional services income with non professional or business interests Any determination that we are acting in the capacity as a healthcare provider exercising undue influence or control over a healthcare provider or impermissibly sharing fees with a healthcare provider may result in significant sanctions against us and our clinicians including civil and criminal penalties and fines additional compliance requirements expense and liability to us and require us to change or terminate some portions of our contractual arrangements or business
In a regulatory climate that is uncertain our operations may be subject to direct and indirect adoption expansion or reinterpretation of various laws and regulations Compliance with these future laws and regulations may require us to change our practices at an undeterminable and possibly significant initial monetary and annual expense These additional monetary expenditures may increase future overhead which could harm our business For example since the Affordable Care Act was enacted there have been executive judicial and Congressional challenges to certain aspects of the law For example President Trump signed several Executive Orders and other directives designed to delay the implementation of certain provisions of the Affordable Care Act or otherwise circumvent some of the requirements for health insurance mandated by the Affordable Care Act Concurrently prior sessions of Congress considered legislation to repeal or repeal and replace all or part of the Affordable Care Act While Congress has not passed comprehensive repeal legislation several bills affecting the implementation of certain taxes under the Affordable Care Act have been signed into law The Tax Cuts and Jobs Act of 2017 Tax Act included a provision which repealed effective January 1 2019 the tax based shared responsibility payment imposed by the Affordable Care Act on certain individuals who fail to maintain qualifying health coverage for all or part of a year that is commonly referred to as the individual mandate
The Bipartisan Budget Act of 2018 among other things amended the Affordable Care Act effective January 1 2019 to close the coverage gap in most Medicare drug plans commonly referred to as the donut hole In addition the 2020 federal spending package permanently eliminated effective January 1 2020 the Cadillac tax on high cost employer sponsored health coverage and medical device tax that were mandated by the Affordable Care Act and effective January 1 2021 also eliminated the health insurer tax On June 17 2021 the U S Supreme Court dismissed a challenge on procedural grounds that argued the Affordable Care Act is unconstitutional in its entirety because the individual mandate was repealed by Congress Further prior to the U S Supreme Court ruling on January 28 2021 President Biden issued an executive order that initiated a special enrollment period for purposes of obtaining health insurance coverage through the Affordable Care Act marketplace which began on February 15 2021 and remained open through August 15 2021 The executive order also instructed certain governmental agencies to review and reconsider their existing policies and rules that limit access to healthcare including among others reexamining Medicaid demonstration projects and waiver programs that include work requirements and policies that create unnecessary barriers to obtaining access to health insurance coverage through Medicaid or the Affordable Care Act In addition on August 16 2022 President Biden signed the Inflation Reduction Act of 2022 IRA into law which among other things extends enhanced subsidies for individuals purchasing health insurance coverage in the Affordable Care Act marketplaces through plan year 2025 The IRA also eliminates the donut hole under the Medicare Part D program beginning in 2025 by significantly lowering the beneficiary maximum out of pocket cost and creating a new manufacturer discount program It is possible that the Affordable Care Act will be subject to judicial or Congressional challenges in the future It is unclear how any such challenges and any additional healthcare reform measures of the Biden administration will impact the Affordable Care Act We continue to evaluate the potential impact of such healthcare reform measures on our business
There could be laws and regulations applicable to our business that we have not identified or that if changed may be costly to us and we cannot predict all the ways in which implementation of such laws and regulations may affect us In the states in which we operate we believe we are in compliance with all applicable material regulations but due to the uncertain regulatory environment certain states may determine that we are in violation of their laws and regulations In the event that we must remedy such violations we may be required to modify our existing and future offerings and solutions in such states in a manner that undermines our existing and future offerings attractiveness to partners customers or members we may become subject to fines or other penalties or if we determine that the requirements to operate in compliance in such states are overly burdensome we may elect to terminate our operations in such states In each case our revenue may decline and our business financial condition and results of operations could be adversely affected
Additionally the introduction of new solutions may require us to comply with additional yet undetermined laws and regulations Compliance may require obtaining appropriate state medical board licenses or certificates increasing our security measures and expending additional resources to monitor developments in applicable rules and ensure compliance The failure to adequately comply with these future laws and regulations may delay or possibly prevent our existing and future offerings from being offered to partners customers and members which could significantly harm our business Further we expect that additional healthcare reform measures will be adopted in the future which could impact our business In
Several federal laws are designed to protect consumers from various types and modes of marketing HIPAA prohibits certain types of marketing to individuals using PHI except for certain treatment and healthcare operations including communications made to describe a health related product or service or payment for such product or service that is provided by or included in a plan of benefits Our solutions may be subject to review by OCR and deemed in violation of HIPAA which could subject us to significant fines or other penalties In addition the TCPA is a federal statute that protects consumers from unwanted telephone calls and faxes Since its inception the TCPA s purview has extended to text messages sent to consumers We may communicate with and perform outreach to members through multiple modes of communication including phone email and secure messaging We must ensure that our solutions that leverage telephone and secure messaging comply with TCPA regulations and agency guidance While we strive to adhere to strict policies and procedures the FCC as the agency that implements and enforces the TCPA may disagree with our interpretation of the TCPA and subject us to penalties and other consequences for noncompliance Determination by a court or regulatory agency that our solutions violate the TCPA could subject us to civil penalties could invalidate all or portions of some of our customer contracts could require us to change or terminate some portions of our offerings could require us to refund portions of our fees and could have an adverse effect on our business Even an unsuccessful challenge by consumers or regulatory authorities of our activities could result in adverse publicity and could require a costly response from us Other laws focus on unsolicited email such as the CAN SPAM Act which establishes requirements for the transmission of commercial email messages and specifies penalties for unsolicited commercial email messages that follow a recipient s opt out request or deceive the receiving consumer
In addition some of our marketing activities require that we obtain permissions consistent with HIPAA and applicable state health information privacy laws If we are unable to secure such permissions or if there is a future change in law we may face limitations on the use of such information which may harm our business
Our direct to consumer virtual care business leverages revenue from member subscriptions which if we do not comply with various state and federal laws relating to the collection of auto renewing subscription fees could result in significant liability or reputational harm and in turn a material adverse effect on our member base and revenue
Various state and federal laws require disclosures to be made to consumers prior to collecting periodic subscription fees that will automatically renew without further action by the consumer One such example is the California Automatic Renewal Law California ARL pursuant to which PlushCare Inc and PlushCare of California were recently sued by a purported class
that PlushCare violated the California ARL by failing to provide adequate disclosures to members In fiscal 2024 we agreed to and paid a settlement of 3 7 million which was partially reimbursed through third party insurance and remaining indemnification from selling shareholders of PlushCare Inc
Direct to consumer virtual care represents a material portion of our overall business If we are required to change our automatically renewing subscription fee practices our business financial condition results of operations and cash flows could be materially and adversely impacted
There is a risk that our existing and future offerings including the operational technical component of our business model such as our decision support software incorporating machine learning meet the definition of a medical device under the FDCA Medical devices are subject to extensive regulation by the FDA under the FDCA Under the FDCA medical devices include any instrument apparatus machine contrivance or other similar or related articles that is intended for use in the diagnosis of disease or other conditions or in the cure mitigation treatment or prevention of disease FDA regulations govern among other things product development testing manufacture packaging labeling storage clearance or approval advertising and promotion sales and distribution and import and export
Failure to appropriately seek FDA approval or noncompliance with applicable FDA requirements can result in among other things public warning letters fines injunctions civil penalties recall or seizure of products total or partial suspension of production failure of the FDA to grant marketing approvals withdrawal of marketing approvals a recommendation by the FDA to disallow us from entering into government contracts and criminal prosecutions The FDA also has the authority to request repair replace or refund of the cost of any device
Taxing authorities may successfully assert that we should have collected or in the future should collect sales and use value added or similar taxes and we could be subject to liability with respect to past or future sales which could adversely affect our results of operations
We do not collect sales and use value added and similar taxes in all jurisdictions in which we have sales based on our understanding that such taxes are not applicable Sales and use value added and similar tax laws and rates vary greatly by jurisdiction Certain jurisdictions in which we do not collect such taxes may assert that such taxes are applicable or jurisdictions in which we collect sales tax may assert that we have under collected sales tax either of which could result in tax assessments penalties and interest and we may be required to collect such taxes in the future Although our customer contracts typically provide that our customers must pay all applicable sales and similar taxes our customers may be reluctant to pay back taxes and associated interest and penalties or we may determine that it would not be commercially feasible to seek reimbursement from such customers in which event any such tax assessments penalties and interest or future requirements may adversely affect our results of operations
As of February 29 2024 we had U S federal net operating loss carryforwards NOLs of 501 6 million and state NOLs of 448 5 million Under the Tax Act as modified by the Coronavirus Aid Relief and Economic Security Act CARES Act unused NOLs for the tax year ended February 28 2018 and prior tax years will carry forward to offset future taxable income if any until such unused losses expire Unused losses generated in tax years beginning after December 31 2017 which would be our tax year ended February 28 2018 and thereafter pursuant to the Tax Act will not expire and may be carried forward indefinitely but will only be deductible in the case of NOLs arising in taxable years ending after 2020 to the extent of 80 of current year taxable income in any given year It is uncertain if and to what extent various states will conform to the Tax Act as modified by the CARES Act As a result if we earn net taxable income in future years our NOLs arising in tax years ended February 28 2018 and earlier may expire prior to being used and our NOLs generated in later tax years will be subject to a percentage limitation Under Sections 382 and 383 of the Code if a corporation undergoes an ownership change the corporation s ability to use its pre change NOLs and other tax attributes and to offset its post change income and taxes may be limited In general an ownership change occurs if there is a cumulative change in our ownership by 5 stockholders that exceed 50 percentage points over a rolling three year period Our existing NOLs may be subject to limitations arising from previous ownership changes and if we undergo an ownership change in connection with or after our initial public offering or as a result of future events our ability to utilize NOLs could be further limited by Section 382 of the Code Future changes in our stock ownership some of which are outside of our control could result in an ownership change under Section 382 of the Code The existing NOLs of one of our subsidiaries may be subject to limitations arising from ownership changes prior to or in connection with their acquisition by us Furthermore our ability to utilize NOLs of companies that we may acquire in the future may be subject to limitations There is also a risk that due to regulatory changes such as suspensions on the use of NOLs or other unforeseen reasons our existing NOLs could expire or otherwise be unavailable to reduce future income tax liabilities including for state tax purposes For these reasons we may not be able to utilize some portion of our NOLs none of which are currently reflected on our balance sheet even if we attain profitability
Our intellectual property includes our processes methodologies algorithms applications technology platform software code website content user interfaces graphics registered and unregistered copyrights trademarks trade dress databases domain names and patents and patent applications We believe that our intellectual property is an essential asset of our business If we do not adequately protect our intellectual property our brand and reputation could be harmed and competitors may be able to use our technologies and erode or negate any competitive advantage we may have which could harm our business negatively affect our position in the marketplace limit our ability to commercialize our technology and delay or render impossible our achievement of profitability A failure to protect our intellectual property in a cost effective and meaningful manner could have a material adverse effect on our ability to compete We regard the protection of our trade secrets copyrights trademarks trade dress databases domain names and patents as critical to our success
We strive to protect our intellectual property rights by relying on federal state and common law rights and other rights provided under foreign laws These laws are subject to change at any time and could further restrict our ability to protect or enforce our intellectual property rights In addition the existing laws of certain foreign countries in which we operate may not protect our intellectual property rights to the same extent as do the laws of the United States
We generally enter into confidentiality and invention assignment agreements with our employees and contractors and confidentiality agreements with other parties with whom we conduct business in order to limit access to and disclosure and use of our proprietary information However we may not be successful in executing these agreements with every party who has access to our confidential information or contributes to the development of our intellectual property
The agreements that we execute may be breached and we may not have adequate remedies for any such breach These contractual arrangements and the other steps we have taken to protect our intellectual property may not prevent the misappropriation of our intellectual property or deter independent development of similar intellectual property by others
Obtaining and maintaining effective intellectual property rights is expensive including the costs of monitoring unauthorized use of our intellectual property and defending our rights We make business decisions about when to seek patent protection for a particular technology and when to rely upon trade secret protection and the approach we select may ultimately prove to be inadequate We strive to protect certain of our intellectual property rights through filing applications for trademarks patents and domain names in a number of jurisdictions a process that is expensive and may not be successful in all jurisdictions However there is no assurance that any resulting patents or other intellectual property rights will adequately protect our intellectual property or provide us with any competitive advantages Moreover we cannot guarantee that any of our pending patent or trademark applications will issue or be approved Even where we have intellectual property rights they may later be found to be unenforceable or have a limited scope of enforceability In addition we may not seek to pursue such protection in every jurisdiction The United States Patent and Trademark Office also requires compliance with a number of procedural documentary fee payment and other similar provisions during the patent application process and after a patent has issued Noncompliance with such requirements and processes may result in abandonment or lapse of the patent or patent application resulting in partial or complete loss of patent rights in the relevant jurisdiction In such an event our competitors might be able to develop and commercialize substantially similar and competing applications which would harm our business
We believe it is important to maintain protect and enhance our brands Accordingly we pursue the registration of domain names and our trademarks and service marks in the United States Third parties may challenge our use of our trademarks oppose our trademark applications or otherwise impede our efforts to protect our intellectual property in certain jurisdictions In the event that we are unable to register our trademarks in certain jurisdictions we could be forced to rebrand our solutions which would result in loss of brand recognition and could require us to devote resources to advertising and marketing new brands Our competitors and others could also attempt to capitalize on our brand recognition by using domain names or business names similar to ours Domain names similar to ours have been registered in the United States and elsewhere We may be unable to prevent third parties from acquiring or using domain names and other trademarks that infringe on are similar to or otherwise decrease the value of our brands trademarks or service marks We also may incur significant costs in enforcing our trademarks against those who attempt to imitate our brand and other valuable trademarks and service marks
In order to protect our intellectual property rights we may be required to spend significant resources to monitor and protect these rights We may not be able to detect infringement or unauthorized use of our intellectual property rights and defending or enforcing our intellectual property rights even if successfully detected prosecuted enjoined or remedied could result in the expenditure of significant financial and managerial resources Litigation has in the past and may be necessary in the future to enforce our intellectual property rights protect our proprietary rights or determine the validity and scope of proprietary rights claimed by others Any litigation of this nature regardless of outcome or merit could result in substantial costs and diversion of management and technical resources any of which could harm our business Furthermore our efforts to enforce our intellectual property rights may be met with defenses counterclaims countersuits and adversarial proceedings such as oppositions inter partes review post grant review re examination or other post issuance proceedings that attack the validity and enforceability of our intellectual property rights An adverse determination of any litigation proceedings could put our patents at risk of being invalidated or interpreted narrowly and could put our related pending patent applications at risk of not issuing Further because of the substantial amount of discovery required in connection with intellectual property litigation there is a risk that some of our confidential or sensitive information could be compromised by disclosure in the event of litigation In addition during the course of litigation there could be public announcements of the results of hearings motions or other interim proceedings or developments If securities analysts or investors perceive these results to be negative it could have a substantial adverse effect on the price of our common stock If we fail to maintain protect and enhance our intellectual property rights our business may be harmed and the market price of our common stock could decline
Our competitors also may independently develop similar technology that does not infringe on or misappropriate our intellectual property rights The laws of some foreign countries may not be as protective of intellectual property rights as those in the United States and mechanisms for enforcement of intellectual property rights may be inadequate Effective patent trademark copyright and trade secret protection may not be available to us in every country in which our solutions or technology are developed Further legal standards relating to the validity enforceability and scope of protection of intellectual property rights are uncertain The laws in the United States and elsewhere change rapidly and any future changes could adversely affect us and our intellectual property Our failure to meaningfully protect our intellectual property could result in competitors offering solutions that incorporate our most technologically advanced features which could seriously reduce demand for existing and future offerings
Third parties may initiate legal proceedings alleging that we are infringing or otherwise violating their intellectual property rights the outcome of which would be uncertain and could harm our business
Our success depends in part on our ability to develop and commercialize our offerings and use our proprietary technology without infringing the intellectual property or proprietary rights of third parties Intellectual property disputes can be costly to defend and may cause our business operating results and financial condition to suffer As the market for healthcare in the United States expands and more patents are issued the risk increases that there may be patents issued to third parties that relate to our offerings and technology of which we are not aware or that we must challenge to continue our operations as currently contemplated Whether merited or not we may face allegations that we our partners our licensees or parties indemnified by us have infringed or otherwise violated the patents trademarks copyrights or other intellectual property rights of third parties Such claims may be made by competitors seeking to obtain a competitive advantage or by other parties
Additionally in recent years individuals and groups have begun purchasing intellectual property assets for the purpose of making claims of infringement and attempting to extract settlements from companies like ours We may also face allegations that our employees have misappropriated the intellectual property or proprietary rights of their former employers or other third parties We have in the past initiated and it may in the future be necessary for us to initiate litigation to defend ourselves in order to determine the scope enforceability and validity of third party intellectual property or proprietary rights or to establish our respective rights Regardless of whether claims that we are infringing patents or other intellectual property rights have merit such claims can be time consuming divert management s attention and financial resources and can be costly to evaluate and defend Results of any such litigation are difficult to predict and may require us to stop commercializing or using our solutions or technology obtain licenses modify our solutions and technology while we develop non infringing substitutes or incur substantial damages settlement costs or face a temporary or permanent injunction prohibiting us from marketing or providing the affected solutions If we require a third party license it may not be available on reasonable terms or at all and we may have to pay substantial royalties upfront fees or grant cross licenses to intellectual property rights for our solutions We may also have to redesign our solutions so that they do not infringe third party intellectual property rights which may not be possible or may require substantial monetary expenditures and time during which our technology and solutions may not be available for commercialization or use Even if we have an agreement to indemnify us against such costs the indemnifying party may be unable to uphold its contractual obligations If we cannot or do not obtain a third party license to the infringed technology license the technology on reasonable terms or obtain similar technology from another source our revenue and earnings could be adversely impacted
From time to time we have been and may be subject to legal proceedings and claims in the ordinary course of business with respect to intellectual property Some third parties may be able to sustain the costs of complex litigation more effectively than we can because they have substantially greater resources Even if resolved in our favor litigation or other legal proceedings relating to intellectual property claims may cause us to incur significant expenses and could distract our technical and management personnel from their normal responsibilities In addition there could be public announcements of the results of hearings motions or other interim proceedings or developments and if securities analysts or investors perceive these results to be negative it could have a material adverse effect on the price of our common stock Moreover any uncertainties resulting from the initiation and continuation of any legal proceedings could have a material adverse effect on our ability to raise the funds necessary to continue our operations Assertions by third parties that we violate their intellectual property rights could therefore harm our business
We use open source software in connection with our existing and future offerings Some of these licenses contain requirements that we make available source code for modifications or derivative works we create based upon the open source software and that we license such modifications or derivative works under the terms of a particular open source license or other license granting third parties certain rights of further use By the terms of certain open source licenses we
could be required to release the source code of our proprietary software and to make our proprietary software available under open source licenses if we combine and or distribute our proprietary software with open source software in certain manners Although we monitor our use of open source software we cannot be sure that all open source software is reviewed prior to use in our proprietary software that our programmers have not incorporated open source software into our proprietary software or that they will not do so in the future Additionally the terms of many open source licenses to which we are subject have not been interpreted by U S or foreign courts
There is a risk that open source software licenses could be construed in a manner that imposes unanticipated conditions or restrictions on our ability to provide our existing and future offerings to our customers and members In addition the terms of open source software licenses may require us to provide software that we develop using such open source software to others including our competitors on unfavorable license terms As a result of our current or future use of open source software we may face claims or litigation be required to release our proprietary source code pay damages for breach of contract re engineer our technology discontinue sales in the event re engineering cannot be accomplished on a timely basis or take other remedial action that may divert resources away from our development efforts any of which could harm our business
Our business depends in part on data provided to us by among other sources health plans benefits administrators data warehouses electronic data interchange EDI transaction data providers and suppliers in our Trusted Partner Ecosystem Any errors or defects in any third party data or other technology could result in errors in our existing and future offerings that could harm our business and damage our reputation and cause losses in revenue and we could be required to spend significant amounts of additional resources to fix any problems In addition certain of our offerings including Accolade Total Care and Accolade Total Health and Benefits depend on maintaining our data and analytics technology platform which is populated with data provided by third parties While our existing agreements with these data providers have multiple year terms these providers could become our competitors in the future Any loss of the right to use of data provided by any health plan providers benefits administrators or other entities that provide us data could result in delays in producing or delivering our solutions until equivalent data other technology or intellectual property is identified and integrated which delays could harm our business In this situation we would be required to either redesign our solutions to function with technology data or intellectual property available from other parties or to develop these components ourselves which would result in increased costs Furthermore we might be forced to limit the features available in our existing or future offerings If we fail to maintain or renegotiate any of these technology or intellectual property licenses we could face significant delays and diversion of resources in attempting to develop similar or replacement offerings or to license and integrate a functional equivalent of the technology or intellectual property The occurrence of any of these events may harm our business
In addition some of our business activities require that we obtain permissions consistent with HIPAA to provide certain marketing and data aggregation solutions as well as those activities that require the creation and use of de identified information We also require large sets of de identified information to enable us to continue to develop and enhance our data and analytics platform If we are unable to secure these rights or if there is a future change in law we may face limitations on the use of PHI and our ability to use de identified information that could harm our business There is also a risk that we may fail to properly de identify PHI and or PII under applicable state laws some of which impose different standards for de identification than those imposed by HIPAA
We have in the past experienced a material weakness in our internal controls over financial reporting and if we experience additional material weaknesses in the future or if we otherwise fail to maintain an effective system of disclosure controls and internal control over financial reporting our ability to produce timely and accurate financial statements or comply with applicable regulations could be impaired
As a public company we are subject to the reporting requirements of the Securities Exchange Act of 1934 as amended the Exchange Act the Sarbanes Oxley Act and the rules and regulations of the applicable listing standards of the Nasdaq Stock Market Nasdaq The Sarbanes Oxley Act requires among other things that we maintain effective disclosure controls and procedures and internal control over financial reporting We have developed and refined our disclosure controls and other procedures that are designed to ensure that information required to be disclosed by us in the reports that we file with the SEC is recorded processed summarized and reported within the time periods specified in SEC rules and forms and that information required to be disclosed in reports under the Exchange Act is accumulated and communicated to our principal executive and financial officers If any of our controls and systems do not perform as
expected we may experience material weaknesses in our controls It is possible that our current controls and any new controls that we develop may become inadequate in the future because of changes in conditions in our business
Any failure to develop or maintain effective controls or any difficulties encountered in their implementation or improvement could harm our results of operations or cause us to fail to meet our reporting obligations and may result in a restatement of our financial statements for prior periods Any failure to implement and maintain effective internal control over financial reporting also could adversely affect the results of periodic management evaluations and annual independent registered public accounting firm attestation reports regarding the effectiveness of our internal control over financial reporting that we will eventually be required to include in our periodic reports that will be filed with the SEC Ineffective disclosure controls and procedures and further ineffective internal control over financial reporting could also cause investors to lose confidence in our reported financial and other information which would likely have a negative effect on the trading price of our common stock In addition if we are unable to continue to meet these requirements we may not be able to remain listed on Nasdaq We are required to comply with the SEC rules that implement Section 404 of the Sarbanes Oxley Act and are required to make a formal assessment of the effectiveness of our internal control over financial reporting for that purpose We are required to provide an annual management report on the effectiveness of our internal control over financial reporting and our independent registered public accounting firm is also required to formally attest to the effectiveness of our internal control over financial reporting Our independent registered public accounting firm may issue reports that are adverse in the event it is not satisfied with the level at which our internal control over financial reporting is documented designed or operating or if it is not satisfied with our remediation of any identified material weaknesses Any failure to maintain effective disclosure controls and internal control over financial reporting could have an adverse effect on our business and results of operations and could cause a decline in the price of our common stock
Sales of a substantial number of shares of our common stock in the public market or the perception that such sales could occur could adversely affect the market price of our common stock and may make it more difficult for you to sell your common stock at a time and price that you deem appropriate
Moreover we have in the past and may in the future grant rights to some of our stockholders that require us to register the resale of our common stock or other securities on behalf of these stockholders and or facilitate public offerings of our securities held by these stockholders including in connection with potential future acquisition or capital raising transactions
In order to support the growth of our business we may need to incur additional indebtedness under our current credit facility or seek capital through new equity or debt financings which sources of additional capital may not be available to us on acceptable terms or at all
Our operations have consumed substantial amounts of cash since inception and we intend to continue to make significant investments to support our business growth respond to business challenges or opportunities develop new applications and solutions enhance our existing solutions enhance our operating infrastructure and potentially acquire complementary businesses and technologies Our future capital requirements may be significantly different from our current estimates and will depend on many factors including the need to
Accordingly we may need to engage in equity or debt financings to secure additional funds Additional financing may not be available on terms favorable to us or at all If we raise additional funds through further issuances of equity or convertible debt securities our existing stockholders could suffer significant dilution and any new equity securities we issue could have rights preferences and privileges superior to those of holders of our common stock Any debt financing
secured by us in the future could involve additional restrictive covenants relating to our capital raising activities and other financial and operational matters which may make it more difficult for us to obtain additional capital and to pursue business opportunities including potential acquisitions In addition during times of economic instability it has been difficult for many companies to obtain financing in the public markets or to obtain debt financing and we may not be able to obtain additional financing on commercially reasonable terms if at all If we are unable to obtain adequate financing or financing on terms satisfactory to us it could harm our business
If securities or industry analysts publish reports that are interpreted negatively by the investment community or publish negative or inaccurate research reports about our business our share price and trading volume could decline
The trading market for our common stock depends to some extent on the research and reports that securities or industry analysts publish about us or our business We do not have any control over these analysts or the information contained in their reports Securities and industry analysts may cease to publish research on our business or publish negative coverage If one or more analysts commence coverage of us and publish research reports that are interpreted negatively by the investment community or have a negative tone regarding our business financial condition operating performance industry or end markets or downgrade our common stock our share price could decline In addition if a significant number of these analysts ceases coverage of our company or fails to regularly publish reports about us we could lose visibility in the financial markets which could cause our share price or trading volume to decline
Anti takeover provisions in our charter documents and under Delaware law could make an acquisition of us more difficult limit attempts by our stockholders to replace or remove our current management and may limit the market price of our common stock
Provisions in our amended and restated certificate of incorporation and amended and restated bylaws may have the effect of rendering more difficult delaying or preventing a change of control or changes in our management Among other things our amended and restated certificate of incorporation and amended and restated bylaws include provisions
authorizing blank check preferred stock which could be issued by our board of directors without stockholder approval and may contain voting liquidation dividend and other rights superior to our common stock
requiring the approval of our board of directors or the holders of at least 66 of our outstanding shares of capital stock to amend our amended and restated bylaws and certain provisions of our amended and restated certificate of incorporation
These provisions may frustrate or prevent any attempts by our stockholders to replace or remove our current management by making it more difficult for stockholders to replace members of our board of directors which is responsible for appointing the members of our management In addition institutional stockholder representative groups stockholder activists and others may disagree with our corporate governance provisions or other practices including anti takeover provisions such as those listed above We generally will consider recommendations of institutional stockholder representative groups but we will make decisions based on what our board and management believe to be in the best long
Finally because we are incorporated in Delaware we are governed by the provisions of Section 203 of the Delaware General Corporation Law which generally prohibits a Delaware corporation from engaging in any of a broad range of business combinations with any interested stockholder for a period of three years following the date on which the stockholder became an interested stockholder
Any of the foregoing provisions could limit the price that investors might be willing to pay in the future for shares of our common stock and they could deter potential acquirers of our company thereby reducing the likelihood that you would receive a premium for your shares of our common stock in an acquisition
Our amended and restated certificate of incorporation provides that the Court of Chancery of the State of Delaware and to the extent enforceable the federal district courts of the United States of America will be the exclusive forum for substantially all disputes between us and our stockholders which could limit our stockholders ability to obtain a favorable judicial forum for disputes with us or our directors officers or employees
Our amended and restated certificate of incorporation provides that the Court of Chancery of the State of Delaware and to the extent enforceable the federal district courts of the United States of America will be the exclusive forum for the following types of actions or proceedings under Delaware statutory or common law
This provision would not apply to suits brought to enforce a duty or liability created by the Securities Act or the Exchange Act or any claim for which the U S federal courts have exclusive jurisdiction Our amended and restated certificate of incorporation will provide that the federal district courts of the United States of America will be the exclusive forum for resolving any complaint asserting a cause of action arising under the Securities Act
These exclusive forum provisions may limit a stockholder s ability to bring a claim in a judicial forum that it finds favorable for disputes with us or our directors officers or other employees which may discourage lawsuits against us and our directors officers and other employees If any other court of competent jurisdiction were to find either exclusive forum provision in our amended and restated certificate of incorporation to be inapplicable or unenforceable we may incur additional costs associated with resolving the dispute in other jurisdictions which could seriously harm our business For example the Court of Chancery of the State of Delaware determined that a provision stating that U S federal district courts are the exclusive forum for resolving any complaint asserting a cause of action arising under the Securities Act is not enforceable However this decision was recently reviewed and ultimately overturned by the Delaware Supreme Court in March 2020
We expect to issue additional capital stock in the future that will result in dilution to all other stockholders We expect to grant equity awards to employees directors and consultants under our stock incentive plans We also may raise capital through equity financings in the future As part of our business strategy we may acquire or make investments in complementary
The terms of our existing credit agreement with Comerica Bank and the related collateral documents contain and any future indebtedness would likely contain a number of restrictive covenants that impose significant operating and financial restrictions on us including restrictions on our ability and the ability of our subsidiaries to take actions that may be in our best interests including among others disposing of assets entering into change of control transactions mergers or acquisitions incurring additional indebtedness granting liens on our assets declaring and paying dividends and agreeing to do any of the foregoing These agreements require us to satisfy a specified minimum liquidity level at all times and to achieve certain minimum covenant revenue as defined on a trailing six month basis Our ability to meet financial covenants can be affected by events beyond our control including as a result of economic downturns and we may not be able to continue to meet these covenants A breach of any of these covenants or the occurrence of other events including a material adverse effect specified in these agreements and or the related collateral documents would result in an event of default under such agreements Upon the occurrence of an event of default Comerica Bank as administrative agent for the revolving lenders could elect to declare all amounts outstanding if any under the credit agreement to be immediately due and payable and terminate all commitments to extend further credit If we were unable to repay those amounts Comerica Bank as administrative agent for the revolving lenders could proceed against the collateral granted to them to secure such indebtedness We have pledged substantially all of our assets as collateral under the loan documents If Comerica Bank as administrative agent for the revolving lenders accelerates the repayment of borrowings if any we may not have sufficient funds to repay our existing debt
Our ability to pay our debt when due or to refinance our indebtedness including the 0 50 Convertible Senior Notes due 2026 issued in March 2021 the Notes depends on our future performance which is subject to economic financial competitive and other factors beyond our control Our business may not generate cash flow from operations in the future sufficient to service our debt and make necessary capital expenditures In most instances it is at our discretion to settle the Notes for cash or the distribution of common stock however any required repurchase of the Notes for cash as a result of a fundamental change would lower our current cash on hand such that we would not have those funds available for us in our business If we are unable to generate such cash flow we may be required to adopt one or more alternatives such as selling assets restructuring debt or obtaining additional equity capital on terms that may be onerous or highly dilutive Our ability to refinance our indebtedness will depend on the capital markets and our financial condition at such time We may not be able to engage in any of these activities or engage in these activities on desirable terms which could result in a default on our debt obligations
We and our subsidiaries may incur substantial additional debt in the future subject to the restrictions contained in our future debt instruments some of which may be secured debt We are not restricted under the terms of the indenture governing the Notes from incurring additional debt securing existing or future debt recapitalizing our debt or taking a number of other actions that could have the effect of diminishing our ability to make payments on the Notes when due Furthermore the indenture prohibits us from engaging in certain mergers or acquisitions unless among other things the surviving entity assumes our obligations under the Notes and the indenture These and other provisions in the indenture could deter or prevent a third party from acquiring us even when the acquisition may be favorable to holders of the Notes
The conversion of some or all of the Notes would dilute the ownership interests of existing stockholders to the extent we satisfy our conversion obligation by delivering shares of our common stock upon any conversion of such Notes Our Notes may become in the future convertible at the option of their holders under certain circumstances If holders of our Notes elect to convert their notes we may settle our conversion obligation by delivering to them a significant number of shares of our common stock which would cause dilution to our existing stockholders In addition the existence of the Notes may encourage short selling by market participants because the conversion of the Notes could be used to satisfy short positions or anticipated conversion of the Notes into shares of our common stock could depress the price of our common stock
In addition in connection with the issuance of the Notes we entered into capped call transactions with certain financial institutions Option Counterparties The capped call transactions are expected generally to reduce the potential dilution to our common stock upon any conversion or settlement of the Notes and or offset any cash payments we are required to make in excess of the principal amount of converted Notes as the case may be with such reduction and or offset subject to a cap From time to time the Option Counterparties or their respective affiliates may modify their hedge positions by entering into or unwinding various derivative transactions with respect to our common stock and or purchasing or selling our common stock or other securities of ours in secondary market transactions prior to the maturity of the Notes This activity could cause a decrease in the market price of our common stock
New income sales use or other tax laws statutes rules regulations or ordinances could be enacted at any time which could adversely affect our business operations and financial performance Further existing tax laws statutes rules regulations or ordinances could be interpreted changed modified or applied adversely to us For example the Tax Act the CARES Act and the IRA enacted many significant changes to the U S tax laws Future guidance from the Internal Revenue Service and other tax authorities with respect to such legislation may affect us and certain aspects of the Tax Act could be repealed or modified in future legislation Changes in corporate tax rates the realization of net deferred tax assets relating to our U S operations and the deductibility of expenses under the Tax Act or future tax reform legislation could have a material impact on the value of our deferred tax assets could result in significant one time charges in the current or future taxable years and could increase our future U S tax expense The foregoing items as well as any other future changes in tax laws could have a material adverse effect on our business cash flow financial condition or results of operations In addition it is uncertain if and to what extent various states will conform to the Tax Act the CARES Act the IRA or any newly enacted federal tax legislation
Unstable market and economic conditions including adverse developments affecting the financial services industry such as actual events or concerns involving liquidity defaults or non performance by financial institutions or transactional counterparties may have serious adverse consequences on our business financial condition results of operations and stock price
The global credit and financial markets have recently experienced extreme volatility and disruptions including severely diminished liquidity and credit availability increased interest rates inflationary pressures declines in consumer confidence declines in economic growth increases in unemployment rates and uncertainty about economic stability The financial markets and global economy may also be adversely affected by the current or anticipated impact of military conflict including the conflict between Russia and Ukraine conflicts in the Middle East terrorism or other geopolitical events Sanctions imposed by the United States and other countries in response to such conflicts including the ones in Ukraine and the Middle East may also adversely impact the financial markets and the global economy and any economic countermeasures by affected countries and others could exacerbate market and economic instability There can be no assurance that further deterioration in the credit and financial markets and confidence in economic conditions will not occur Our general business strategy may be adversely affected by any such economic downturn volatile business environment or continued unpredictable and unstable market conditions If the current equity and credit markets deteriorate it may make any necessary debt or equity financing more difficult more costly and more dilutive Failure to secure any necessary financing in a timely manner and on favorable terms could have a material adverse effect on our growth strategy financial performance and stock price and could require us to delay or abandon critical development plans Accordingly there is a risk that one or more of our customers current service providers or other partners may be adversely impacted by or may not survive an economic downturn which could directly affect our ability to attain our operating goals on schedule and on budget
In addition actual events involving limited liquidity defaults non performance or other adverse developments that affect financial institutions transactional counterparties or other companies in the financial services industry or the financial services industry generally or concerns or rumors about any events of these kinds or other similar risks have in the past and may in the future lead to market wide liquidity problems If any of our lenders or counterparties to any such instruments were to be placed into receivership we may be unable to access such funds
We regularly maintain cash balances at third party financial institutions in excess of the FDIC insurance limit Although we assess our banking relationships as we believe necessary or appropriate our access to funding sources and other credit arrangements in amounts adequate to finance or capitalize our current and projected future business operations could be significantly impaired by factors that affect us the financial institutions with which we have arrangements
directly or the financial services industry or economy in general These factors could include among others events such as liquidity constraints or failures the ability to perform obligations under various types of financial credit or liquidity agreements or arrangements disruptions or instability in the financial services industry or financial markets or concerns or negative expectations about the prospects for companies in the financial services industry These factors could involve financial institutions or financial services industry companies with which we have financial or business relationships but could also include factors involving financial markets or the financial services industry generally
In addition investor concerns regarding the U S or international financial systems could result in less favorable commercial financing terms including higher interest rates or costs and tighter financial and operating covenants or systemic limitations on access to credit and liquidity sources thereby making it more difficult for us to acquire financing on acceptable terms or at all
Natural or man made disasters events outside our reasonable control and other similar events may significantly disrupt our operations and negatively impact our business financial condition and results of operations
Our offices third party data and call centers or cloud infrastructure services may be harmed or rendered inoperable by natural or man made disasters including earthquakes power outages fires floods nuclear disasters pandemics acts of terrorism or other criminal activities or other events or business continuity problems outside our reasonable control such as a general and widespread failure of the Internet or telecommunications or outbreaks of public health threats such as coronavirus influenza or other highly communicable diseases or viruses which may render it difficult or impossible for us to operate our business for some period of time Any disruptions in our operations related to the repair or replacement of our offices third party data and call centers or cloud infrastructure services could negatively impact our business and results of operations and harm our reputation Insurance may not be sufficient to compensate for losses that may occur Any such losses or damages could harm our business
We have incurred and will incur increased costs and demands upon management as a result of complying with the laws and regulations affecting public companies which could adversely affect our business results of operations and financial condition
As a public company we are subject to the reporting requirements of the Securities Exchange Act of 1934 as amended the Exchange Act the listing standards of the Nasdaq Stock Market Nasdaq and other applicable securities rules and regulations We expect that the requirements of these rules and regulations will continue to increase our legal accounting and financial compliance costs make some activities more difficult time consuming and costly and place significant strain on our personnel systems and resources For example the Exchange Act requires among other things that we file annual quarterly and current reports with respect to our business and results of operations As a result of the complexity involved in complying with the rules and regulations applicable to public companies our management s attention may be diverted from other business concerns which could harm our business results of operations and financial condition Although we have already hired additional employees and engaged outside consultants to assist us in complying with these requirements we will need to hire more employees in the future or may need to engage additional outside consultants which will increase our operating expenses In addition changing laws regulations and standards relating to corporate governance and public disclosure are creating uncertainty for public companies increasing legal and financial compliance costs and making some activities more time consuming These laws regulations and standards are subject to varying interpretations in many cases due to their lack of specificity and as a result their application in practice may evolve over time as new guidance is provided by regulatory and governing bodies These factors could result in continuing uncertainty regarding compliance matters and higher costs necessitated by ongoing revisions to disclosure and governance practices We intend to invest substantial resources to comply with evolving laws regulations and standards and this investment may result in increased general and administrative expenses and a diversion of management s time and attention from business operations to compliance activities If our efforts to comply with new laws regulations and standards differ from the activities intended by regulatory or governing bodies due to ambiguities related to their application and practice regulatory authorities may initiate legal proceedings against us and our business may be harmed As a result of disclosure of information in our public company filings our business and financial condition will become more visible which may result in pricing pressure from customers or an increased risk of threatened or actual litigation including by competitors and other third parties If such claims are successful our business and results of operations could be harmed and even if the claims do not result in litigation or are resolved in our favor these claims and the time and resources necessary to resolve them could divert the resources of our management and harm our business results of operations and financial condition
Our stock price has been volatile since our initial public offering and it is likely that the trading price of our common stock may fluctuate substantially depending on a number of factors including those described in this Risk Factors section many of which are beyond our control and may not be related to our operating performance These fluctuations could cause you to lose all or part of your investment in our common stock Factors that could cause fluctuations in the trading price of our common stock include the following
failure of securities analysts to initiate or maintain coverage of us changes in financial estimates by securities analysts who follow our company or our failure to meet these estimates or the expectations of investors
that you may obtain for your shares of our common stock An inactive market may also impair our ability to raise capital to continue to fund operations by selling shares of our common stock and may impair our ability to acquire or make investments in complementary companies products or technologies by using shares of our common stock as consideration
In addition if the market for healthcare technology stocks or the stock market in general experiences a loss of investor confidence the trading price of our common stock could decline for reasons unrelated to our business financial condition or results of operations The trading price of our common stock might also decline in reaction to events that affect other companies in our industry even if these events do not directly affect us In the past following periods of volatility in the trading price of a company s securities securities class action litigation has often been brought against that company If our stock price is volatile we may become the target of securities litigation Securities litigation could result in substantial costs and divert our management s attention and resources from our business This could harm our business
We believe cybersecurity is critical to our mission to help every person live their healthiest life Our customers members partners and employees trust Accolade to maintain a secure environment for their health information We process and maintain sensitive data on our customers and members in the form of PHI and PII and we maintain intellectual property of our solutions and PII of our employees Because of the sensitivity of this data we are subject to various cybersecurity threats that could adversely affect our business customers and members through impacts to the confidentiality integrity and availability of our systems
As part of our enterprise risk management ERM program we maintain a cybersecurity program in an effort to reduce the risk of a breach of our systems or information Our cybersecurity program includes policies and controls which are regularly reviewed through internal assessments We have an active HITRUST certification for our expert medical opinion offering and Service Organization Control SOC 2 Type II security compliance reports that are issued by third party entities for our other offerings We have controls in place intended to assess our cybersecurity readiness and prevent unauthorized access to our critical systems including for example vulnerability scanning of our systems detection and blocking of potentially malicious email multifactor authentication and security review of our vendors We also actively engage with the law enforcement community industry groups and key vendors to maintain awareness of the evolving threat environment We have a documented cybersecurity response plan for identification and assessment of cybersecurity incidents including an escalation process for management to assess the materiality of an incident
Despite our cybersecurity program we cannot guarantee that we will not be subject to a material cybersecurity incident For a description of the risks from cybersecurity threats that may materially affect the Company and how they may do so see Item 1A Risk Factors included elsewhere in this Annual Report on Form 10 K As of the date of this Annual Report we have determined that there have been no cybersecurity incidents which materially impacted our business financial condition or results of operations
Our board of directors maintains oversight of our risk management and the audit committee of our board of directors maintains primary responsibility related to overseeing our cybersecurity risk One member of our audit committee has experience in cybersecurity and provides perspective regularly We maintain a cybersecurity program to identify assess and manage our cybersecurity threats that is led by our Chief Information Security Officer CISO and General Counsel Chief Compliance Officer These individuals regularly engage with the audit committee and other members of senior management to discuss cybersecurity risks
We have co headquarters in Seattle Washington at 1201 Third Avenue Suite 1700 Seattle WA 98101 and Plymouth Meeting Pennsylvania at 660 West Germantown Pike Suite 500 Plymouth Meeting PA 19462 Our Seattle headquarters is leased pursuant to a lease that expires in 2030 Our Plymouth Meeting headquarters is leased pursuant to a lease that expires in 2027 We also have offices located in Houston Texas San Francisco California El Paso Texas and Prague Czech Republic pursuant to leases that expire at various dates through 2031 We believe that our properties are
generally suitable to meet our needs for the foreseeable future In addition to the extent we require additional space in the future we believe that it would be readily available on commercially reasonable terms
Our common stock is listed on the Nasdaq Global Select Market under the symbol ACCD Trading began on our common stock on July 2 2020 Prior to that time there was no public market for our common stock There were 184 stockholders of record as of February 29 2024 Certain shares are held in street name and accordingly the number of beneficial owners of such shares is not known or included in the foregoing number
We have never declared or paid cash dividends on our capital stock We currently intend to retain all available funds and future earnings if any to fund the development and expansion of our business and we do not anticipate paying any cash dividends in the foreseeable future Our ability to pay dividends on our common stock is restricted by our credit facility See Management s Discussion and Analysis of Financial Condition and Results of Operations Liquidity and Capital Resources Any future determination regarding the declaration and payment of dividends if any will be at the discretion of our board of directors subject to applicable laws and will depend on then existing conditions including our financial condition operating results contractual restrictions capital requirements business prospects and other factors our board of directors may deem relevant
The following graph shows the cumulative total stockholder return on our common stock compared with the Nasdaq Composite Index and the Nasdaq Health Care Index The comparison begins on July 2 2020 the date on which our common stock first began trading on the Nasdaq Global Select Market and assumes an initial investment of 100
The information under Stock Performance Graph is not deemed filed with the Securities and Exchange Commission and is not to be incorporated by reference in any filing of Accolade Inc under the Securities Act of 1933 as amended or the Securities Exchange Act of 1934 as amended whether made before or after the date of this Annual Report on Form 10 K and irrespective of any general incorporation language in those filings
The following discussion and analysis of our financial condition and results of our operations should be read together with our consolidated financial statements including the related notes thereto appearing at the end of this filing The following discussion contains forward looking statements Actual results may differ significantly from those projected in the forward looking statements Factors that might cause future results to differ materially from those projected in the forward looking statements include but are not limited to those discussed in the sections titled
Discussion and analysis of our fiscal year 2022 as well as the year over year comparison of our fiscal 2023 financial performance to fiscal 2022 have been omitted from this section and may be found under the heading
in the Annual Report on Form 10 K for the fiscal year ended February 28 2023 and filed with the Securities and Exchange Commission the SEC on April 28 2023 Our fiscal year ends on the last day of February and our fiscal quarters end on May 31 August 31 November 30 and the last day of February
We provide an advocacy led nationwide care delivery service comprised of personalized technology enabled solutions that help people better understand navigate and utilize the healthcare system and their workplace benefits Our customers are primarily employers that deploy Accolade solutions in order to provide employees and their families our members a single place to turn for their health healthcare and benefits needs We also offer expert medical opinion services to commercial customers which includes employers health plans and governmental entities and virtual primary care and mental health therapy both directly to consumers and to commercial customers Our innovative platform combines open cloud based intelligent technology with multimodal support from a team of empathetic and knowledgeable Accolade Care Advocates and clinicians including primary care physicians registered nurses physician medical directors pharmacists behavioral health specialists women s health specialists case management specialists and expert medical opinion providers We leverage our integrated capabilities connectivity with providers and the broader healthcare ecosystem and longitudinal data to engage across the entire member population rather than focusing solely on high cost claimants or those with chronic conditions Our goal is to build trusted relationships with our members that ultimately position us to deliver personalized recommendations and interventions We believe that our platform dramatically improves the member experience encourages better health outcomes and lowers costs for both our members and our customers
We offer our solutions as standalone or bundled offerings Our solution portfolio combines the capabilities of Accolade s historical navigation and advocacy solutions with our primary care mental health and expert medical opinion services augmented by artificial intelligence machine learning and data driven recommendations Our offerings include
Plus and Connect A benefits navigation and care solution designed to work with our customers existing benefits ecosystem incorporating elements of all Accolade solutions including Advocacy Accolade Expert MD Accolade Care and the Accolade partner ecosystem Different offering configurations may also include member services provider services and an expanded set of clinical programs that address case and disease management to maximize member engagement and return on investment
Trusted Partner Ecosystem In addition to Accolade s owned solutions we have assembled a roster of high quality partners whose condition specific solutions are complementary to our services and capable of delivering additional value to our members and customers or capabilities that meet specific customer needs
We were founded in 2007 and launched our initial offering in 2009 We have seen significant growth in recent years since the changes to our executive management team in 2015 and the subsequent investments we have made in product technology sales and distribution As of February 29 2024 we had over 1 200 commercial customers comprising more than 14 million members Our customers represent a diversified set of industries including technology financial
services healthcare manufacturing transportation education retail and the public sector Additionally as of February 29 2024 we had more than 150 000 consumers subscribed to virtual primary care services through our PlushCare solution
For the fiscal years ended February 28 29 2024 and 2023 our total revenue was 414 3 million and 363 1 million respectively representing 14 year over year growth for fiscal 2024 compared to fiscal 2023 For the fiscal years ended February 28 29 2024 and 2023 our net losses were 99 8 million and 459 7 million respectively Net loss for the fiscal year ended February 28 2023 included a goodwill impairment charge of 299 7 million due to sustained decreases in our stock price and market capitalization in the first quarter of fiscal 2023 Refer to the section below under Critical Accounting Policies and Estimates titled Accounting for Goodwill and Other Intangible Assets and Note 4 to our consolidated financial statements for more details
We provide our solutions primarily to employers that deploy Accolade offerings to our members and to consumers who directly purchase our PlushCare virtual primary care services We earn revenue from providing personalized health guidance solutions expert medical opinion services and virtual primary care services to the members of our commercial customers health plans and to members of fully insured plans offered via health insurance companies Our advocacy solutions are priced based on a recurring per member per month PMPM fee typically consisting of both a base fee and a performance based fee component As a result generally a portion of our potential revenue is variable subject to our achievement of performance metrics and the realization of savings in healthcare spend by our customers resulting from the utilization of our solutions We typically achieve a substantial portion of the contractual performance metrics and realization in savings of healthcare spend We also provide expert medical opinion services which are typically charged on a PMPM or case rate basis and virtual primary care services which are typically priced on a fee per visit basis for consumers and a visit fee basis or PMPM plus visit fee basis for commercial customers
The primary cost of delivering our service includes the personnel costs of Accolade Care Advocates and clinicians including registered nurses physician medical directors pharmacists behavioral health specialists women s health specialists case management specialists expert medical opinion providers and primary care physicians as well as software and tools for telephony workforce management business analytics allocated overhead costs and other expenses related to delivery and implementation of our solutions As we support more customers with an increasing number of members over time we expect that our support costs per member will decline due to economies of scale and improved operational efficiencies driven by continued enhancements of our technology platform and capabilities We have experienced and expect to continue to achieve operational efficiencies realized from continued enhancements of our technology platform and capabilities
We employ a multipronged go to market strategy to increase adoption of our solutions to new and existing customers We principally sell our solutions through our direct salesforce which is stratified by account size i e strategic more than 35 000 employees enterprise 5 000 to 35 000 employees and mid market 500 to 5 000 employees region and existing versus prospective customer Our sales team possesses deep domain expertise in health benefits management and brings substantial experience selling to key decision makers within our current and prospective customer organizations human resource officers CFOs benefits executives consultants and brokers We believe the effectiveness of our sales organization is evidenced by growing adoption of our platform by large strategic customers recent traction with enterprise and mid market customers and demonstrated demand for add on offerings from existing customers
We have chosen to invest significantly in growing our customer base and plan to continue both adding new customers and expanding our relationships with existing customers which we believe will allow us to increase margins over time When a customer renews their contract or purchases additional solutions or enhancements the value realized from that customer increases because we generally do not incur significant incremental acquisition or implementation costs for the renewal or expansion We believe that as our customer base grows and a higher percentage of our revenue is attributable to renewals and upsells or cross sells to existing customers relative to acquisition of new customers associated sales and marketing expenses and other upfront costs will decrease as a percentage of revenue
In addition we have strategically curated our offering portfolio to ensure we have a compelling value proposition at an appropriate price point that resonates with each identified customer segment Based on our experience the opportunity to cross sell is meaningfully enhanced once a customer has been on boarded onto our platform and has benefited from a measurable and compelling return on their investment Our customer success team provides strategic insights point solution recommendations and day to day account support to our customers They are focused on existing customer retention cross sell and upsell
We maintain relationships with a range of third parties including brokers agents benefits consultants carriers third party administrators suppliers in our Trusted Partner Ecosystem and co marketing and co selling partners These third parties provide an important source of referrals for our sales organization We also selectively form strategic alliances to further drive customer acquisition and adoption of our solutions We believe the breadth of our go to market and distribution strategy enables us to reach customers of nearly every size and across markets
We have demonstrated a consistent track record of product and technology innovation over time as evidenced by continuous improvement of our platform and new offerings This innovation is driven by feedback we receive from our customers industry experts and the market generally Our technology platform has enabled us to unbundle aspects of our core navigation capability to create various offerings for our customers while integrating capabilities from our recent acquisitions to deliver our Personalized Healthcare solution that combines our core navigation with expert medical consultations and virtual primary care Our investments in product and technology have been focused on increasing the value we provide via our personalized member health guidance solutions and expanding the market segments we can serve with a portfolio of offerings and associated price points
While macroeconomic factors including inflation and geopolitical risk have not had a material adverse impact on our financial condition and results of operations to date the future impact of these factors on our operational and financial performance will depend on certain developments including U S unemployment and economic growth changes in interest rates impact on our customers and our sales cycles impact on our marketing efforts and any decreases of workforce or benefits spending by our customers all of which are uncertain and cannot be predicted Changing macroeconomic factors may affect our customers desire to renew their contracts If our customers undergo layoffs or reductions in force our membership numbers would decrease which would reduce our revenues We may experience increased member attrition to the extent our existing customers reduce their respective workforces in response to changes in economic conditions Any layoffs or reductions in employee headcounts by our commercial customers would result in a reduction in our base and variable PMPM fees When customer headcount reductions occur we may not experience the impact of changes to our customers headcounts immediately because employees that are on furlough or are receiving continued health coverage pursuant to COBRA may still have access to our services during such periods and would be included in our member count
We believe our value proposition resonates with a broad audience of employers Disruptions to traditional care consumption ignited by the COVID 19 pandemic have reinforced the need for navigation services and that projected increases in healthcare costs due to some combination of complications stemming from neglected conditions pent up demand for elective services and strain on individuals mental health prompt the need for solutions such as ours that bend the cost curve and improve health outcomes by driving good utilization up and wasteful utilization down
We measure our performance through several metrics including but not limited to customer satisfaction member engagement and care advocate availability As gauged by these core performance metrics service levels have been high and member engagement and satisfaction have remained strong
We believe there is a substantial opportunity to further grow our customer base in our large and under penetrated market through our sales and marketing strategy Across our existing customer base and as we acquire new customers we intend to expand and deepen these relationships As we build trust through our proven model we seek to cross sell our Accolade Expert MD and Accolade Care solutions as well as Accolade partner ecosystem programs We plan to continue to invest in sales and marketing in order to grow our customer base and increase sales to existing customers Any investments we make in our sales and marketing organization will occur in advance of experiencing any benefits from such investments so it may be difficult for us to determine if we are efficiently allocating our resources in these areas
We are constantly innovating to enhance our model and develop new offerings Our ability to act as a trusted advisor to our members and customers positions us to identify new opportunities for additional offerings that can meet their
existing and emerging needs Our open technology platform also allows us to efficiently add and integrate new offerings and applications on top of our existing technology stack that target specific challenges faced by our customers
In most of our contracts a portion of our potential fee is variable subject to our achievement of performance metrics and the realization of savings in healthcare spend by our customers resulting from the utilization of our solutions and thus we might record higher revenue in some quarters compared to others Examples of performance metrics included in our customer contracts are achievement of specified member engagement levels member satisfaction levels and various operational metrics Although we have earned over 90 of the aggregate maximum potential revenue under our contracts measured on the corresponding calendar year basis in fiscal years 2024 and 2023 our revenue and financial results in the future may vary as a result of our ability to earn this performance based revenue In addition because our customers typically pay both the base PMPM fees and variable PMPM fees in advance on a periodic basis any required refund as a result of our failure to earn the performance based revenue could have a negative impact on cash flows
Significant investments in our technology platform have enhanced our capabilities with respect to how we engage with our members and deliver our solutions and care interventions By leveraging our technology in areas such as machine learning predictive analytics and multimodal communication we believe we can generate more efficiencies in our operating model while simultaneously improving our ability to deliver better health outcomes and lower costs for both our members and our customers We will continue to invest in our technology platform to empower our Accolade Care Advocates our clinicians and our members to further improve and optimize efficiencies in our operating model However our investments in our technology platform may be more expensive or take longer to develop than we expect and may not result in operational efficiencies
There are seasonal factors that may cause us to record higher revenue in some quarters compared with others We have historically recorded a disproportionate amount of revenue during the fourth quarter of our fiscal year relative to the first three quarters of our fiscal year This timing is caused in part by the measurement achievement and associated revenue recognition of performance metrics and healthcare costs savings components of certain of our customer contracts during the fourth quarter of each fiscal year Additionally services launch on January 1 for the majority of our commercial customer contracts which is during our fiscal fourth quarter While we believe we have visibility into the seasonality of our business our rapid growth rate and acquisitions over the last several years have made seasonal fluctuations more difficult to detect
We believe ACV provides investors with useful information on period to period performance as evaluated by management comparison with our past financial performance and a view toward potential future financial performance To calculate ACV we treat each type of contract as detailed below
ACV for advocacy customers represents the annualized value of our in force contracts as of the measurement date including base contractual revenue and the amount of performance based variable revenue we expect to realize in the following fiscal year based on the number of members as of the measurement date and using a straight line averaging of PMPM fees over the lives of the contracts ACV also includes expert medical opinion and commercial virtual primary care
customers Pricing for these customers is either PMPM or per case visit For contracts with PMPM pricing we calculate ACV as the number of members multiplied by the applicable annualized rate For contracts with case visit rate pricing we calculate ACV as the expected usage during the following fiscal year multiplied by the applicable per case visit rate We do not include any consumer subscription revenue or consumer virtual primary care visit fees in ACV as these arrangements are generally terminable within 30 days by the consumer
Over the past two complete fiscal years we have realized in excess of 90 of the maximum contract value across our book of business The ACV amounts included above reflect approximately 95 of the total revenue opportunity consistent with the percentages realized in recent years We also include the expected revenue share to be earned from ecosystem product partner arrangements
As required by GAAP we recognize performance based revenue over the term of the applicable contract In some cases especially with regard to revenue associated with the realization of healthcare cost savings revenue may be recognized in a fiscal period later than the period in which the required metric was achieved Conversely a fiscal period s revenue may include the recognition of revenue related to the achievement in prior periods of performance metrics and healthcare cost savings For purposes of calculating ACV we assume that all customer contracts expiring during the following fiscal year will renew on the same terms
Our ability to increase revenue depends in large part on our ability to retain our existing customers and their associated ACV We monitor GDR specifically as it relates to our employer customers as our employer customers represent our primary strategic focus We calculate GDR for a period by starting with the sum of ACV from all employer customers as of the beginning of such period beginning period ACV we then subtract the ACV associated with terminated employer customers during the period and divide the result by the beginning of period ACV
We operate our business through a single reportable segment We operate on a fiscal year ending at the end of February of each year and our fiscal quarters end on May 31 August 31 November 30 and the last day of February
We earn revenue from providing personalized health guidance solutions advocacy expert medical opinion and virtual primary care services to the members of our commercial customers health plans and to members of fully insured plans offered via health insurance companies Access fees for these services are priced primarily using a recurring PMPM fee typically with a portion of the fee calculated as the product of a fixed rate times the number of members and a variable PMPM fee calculated as the product of a variable rate times the number of members The fees associated with variable PMPM charges are earned through the achievement of performance metrics and or the realization of healthcare cost savings resulting from use of our services We also earn revenue from providing virtual primary care services directly to consumers on a monthly or yearly fixed fee subscription basis Our expert medical opinion and virtual primary care services typically also include a variable rate charged based on utilization for commercial customers i e case rate or fee per visit As a result a portion of our total potential fee is typically variable subject to our achievement of performance metrics the realization of savings in healthcare spend by our customers resulting from the utilization of our solutions and the number of eligible members during the respective period
Our cost of revenue excluding depreciation and amortization consists primarily of personnel costs including salaries wages bonuses stock based compensation expense and benefits as well as software and tools for telephony workforce management business analytics allocated overhead costs certain member outreach costs and other expenses related to delivery and implementation of our personalized technology enabled solutions expert medical opinion services and virtual primary care services We expect cost of revenue excluding depreciation and amortization to increase along with revenue growth over time but decrease as a percentage of revenue
Product and technology expenses include costs to build new offerings add new features to our existing solutions and to manage operate and ensure the reliability and scalability of our existing technology platform Product and technology expenses consist of personnel expenses including salaries bonuses stock based compensation expense and benefits for employees and contractors for our engineering product and design teams and
allocated overhead costs as well as costs of software and tools for business analytics data management and IT applications that are not directly associated with delivery of our solutions to customers Over time we expect product and technology expenses to decrease as a percentage of revenue
Sales and marketing expenses consist of personnel expenses including sales commissions for our direct sales force and our market and business development workforce as well as digital marketing costs promotional costs customer conferences public relations other marketing events and allocated overhead costs Sales and marketing expenses also include advertising and digital media costs associated with our efforts to acquire new consumer customers and build awareness for our direct to consumer offering Personnel expenses include salaries bonuses stock based compensation expense and benefits for employees and contractors We expect sales and marketing expense to increase in absolute dollars but remain relatively stable as a percentage of revenue over time
General and administrative expenses consist of personnel expenses and related expenses for our executive finance and accounting human resources legal and corporate organizations Personnel expenses include salaries bonuses stock based compensation expense and benefits for employees and contractors In addition general and administrative expenses include external legal accounting and other professional fees as well as tools for financial and human capital management and allocated overhead costs Over time we expect general and administrative expenses to decrease as a percentage of revenue
Depreciation and amortization expenses are primarily attributable to our capital investments and consist of fixed asset depreciation amortization of intangibles considered to have definite lives and amortization of capitalized internal use software costs
Revenue increased 51 2 million or 14 to 414 3 million for the fiscal year ended February 29 2024 referred to as fiscal 2024 as compared to 363 1 million for the fiscal year ended February 28 2023 referred to as fiscal 2023 The increase was attributable to revenues derived from growth in the number of customers served and higher utilization of our services during fiscal 2024 as compared to the prior year Revenue from usage based fees increased 34 8 million or 44 to 113 8 million for fiscal 2024 as compared to 79 0 million for fiscal 2023 Revenue from access fees increased 16 3 million or 6 to 300 5 million for fiscal 2024 as compared to 284 1 million for fiscal 2023 The increase in access fee revenue reflects revenues associated with new customers partially offset by the loss of a significant customer which represented 22 8 million of revenue in the prior year
Cost of revenue excluding depreciation and amortization increased 23 3 million or 12 to 222 2 million for fiscal 2024 as compared to 198 9 million for fiscal 2023 The increase was attributable primarily to 19 6 million in increased personnel and related costs to serve the customer base 5 0 million in increased costs associated with third party services and solutions from trusted suppliers partially offset by 2 1 million in decreased member outreach costs reflecting leverage of technology driven efficiencies in order to digitize member outreach programs
Product and technology expense decreased 2 2 million or 2 to 99 2 million for fiscal 2024 as compared to 101 3 million for fiscal 2023 The decrease was primarily driven by 6 3 million in decreased personnel and related costs which included a 2 0 million decrease in severance costs associated with workforce realignment actions taken by management The decrease was also driven by 2 5 million in higher capitalized software development costs associated with expanding our product offering features and scalability of our technology platform and was partially offset by 5 0 million in increased stock based compensa
Sales and marketing expense increased 1 0 million or 1 to 100 1 million for fiscal 2024 as compared to 99 1 million for fiscal 2023 The increase was primarily driven by 12 0 million in marketing programs and consumer customer acquisition costs partially offset by 8 7 million in decreased personnel and related costs which included 2 1 million of decreased severance costs associated with workforce realignment actions taken by management and 3 0 million in decreased stock based compensation expense
General and administrative expense decreased 19 1 million or 24 to 62 1 million for fiscal 2024 as compared to 81 2 million for fiscal 2023 The decrease was primarily due to 13 2 million in decreased stock based compensation expense 5 5 million in decreased personnel and related costs which included 1 7 million of decreased severance costs associated with workforce realignment actions taken by management and 1 2 million in decreased acquisition and integration related charges partially offset by 1 6 million increased software costs related to growth in the business and tool expansion
Depreciation and amortization expense decreased 1 2 million or 3 to 45 2 million for fiscal 2024 as compared to 46 4 million for fiscal 2023 The decrease was primarily due to certain intangible assets becoming fully amortized during fiscal 2024
Interest income net increased 5 7 million or 2 234 to 6 0 million for fiscal 2024 as compared to 0 3 million for fiscal 2023 The increase was primarily due to an additional 5 4 million of interest income generated from our cash and cash equivalents during fiscal 2024 as compared to fiscal 2023 primarily due to higher market interest rates
Other income expense net increased 9 9 million or 66 307 to 9 9 million for fiscal 2024 as compared to 0 0 million for fiscal 2023 The increase was primarily due to a net gain of 9 3 million on the repurchase and cancellation of convertible notes during fiscal 2024 compared to the prior year period
Adjusted Gross Profit is a non GAAP financial measure that we define as revenue less cost of revenue excluding depreciation and amortization and excluding stock based compensation and severance costs We define Adjusted Gross Margin as our Adjusted Gross Profit divided by our revenue We expect Adjusted Gross Margin to continue to improve over time to the extent that we are able to gain efficiencies through technology and successfully cross sell and upsell our current and future offerings However our ability to improve Adjusted Gross Margin over time is not guaranteed and will be impacted by the factors affecting our performance discussed above and the risks outlined in the section titled Risk Factors We believe Adjusted Gross Profit and Adjusted Gross Margin are useful to investors as they eliminate the impact of certain non cash expenses and allow a direct comparison of these measures between periods without the impact of non cash expenses and certain other nonrecurring operating expenses
Adjusted EBITDA is a non GAAP financial measure that we define as net income loss adjusted to exclude interest expense income net income tax expense benefit depreciation and amortization stock based compensation acquisition and integration related costs goodwill impairment change in fair value of contingent consideration severance costs and other expense income Severance costs include severance payments related to the realignment of our resources Other expense income includes debt extinguishment gain or loss and foreign exchange gain or loss We believe Adjusted EBITDA provides investors with useful information on period to period performance as evaluated by management and comparison with our past financial performance We believe Adjusted EBITDA is useful in evaluating our operating performance compared to that of other companies in our industry as this measure generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance
Adjusted Gross Profit Adjusted Gross Margin and Adjusted EBITDA have certain limitations including that they exclude the impact of certain non cash charges such as depreciation and amortization whereas underlying assets may need to be replaced and result in cash capital expenditures and stock based compensation expense which is a recurring charge These non GAAP financial measures may also not be comparable to similarly titled measures of other companies because they may not calculate such measures in the same manner limiting their usefulness as comparative measures In evaluating these non GAAP financial measures you should be aware that in the future we expect to incur expenses similar to the adjustments in this presentation Our presentation of non GAAP financial measures should not be construed as an inference that our future results will be unaffected by these expenses or any unusual or nonrecurring items When evaluating our performance you should consider these non GAAP financial measures alongside other financial performance measures
including the most directly comparable GAAP measures set forth in the reconciliation tables below and our other GAAP results The following table presents for the periods indicated the calculation of our Adjusted Gross Profit and Adjusted Gross Margin
GAAP gross margin for fiscal 2024 increased to 38 3 from 36 5 for fiscal 2023 Adjusted Gross Margin for fiscal 2024 increased to 47 6 from 46 8 for fiscal 2023 The increases in GAAP gross margin and Adjusted Gross Margin were driven primarily by cost efficiencies resulting from initiatives to optimize staffing costs and service delivery by leveraging technology to automate elements of service delivery and member experience processes and by hiring certain roles in lower cost geographies
We had cash and cash equivalents of 185 7 million and marketable securities of 51 3 million as of February 29 2024 totaling an aggregate of 237 0 million of cash cash equivalents and marketable securities
three months Marketable securities are comprised of U S government debt commercial paper and U S agency debt with original maturities greater than three months Management believes the Company s cash cash equivalents and marketable securities plus customer revenues and advances and available borrowings under its debt facility are sufficient to fund its operations through at least the next 12 months from the issuance of this Annual Report on Form 10 K
In March 2021 we issued an aggregate of 287 5 million principal amount of 0 50 Convertible Senior Notes due 2026 the Notes including the exercise in full by the initial purchasers of their option to purchase up to an additional 37 5 million aggregate principal amount of the Notes pursuant to an Indenture dated as of March 29 2021 the Indenture between us and U S Bank National Association as trustee During the year ended February 29 2024 we entered into separate privately negotiated transactions with certain holders of the Notes to repurchase 76 5 million aggregate principal amount of the Notes for an aggregate cash repurchase price of 66 2 million We subsequently cancelled the repurchased Notes After the cancellation 211 0 million aggregate principal amount of the Notes remained outstanding The Notes bear interest at a rate of 0 50 per annum payable semiannually in arrears on April 1 and October 1 of each year beginning on October 1 2021 The Notes mature on April 1 2026 unless earlier converted redeemed or repurchased The Notes are convertible into cash shares of our common stock or a combination of cash and shares of our common stock at our election
We currently have a revolving credit facility 2019 Revolver which we entered into in July 2019 The 2019 Revolver provides for a senior secured revolving line of credit in the amount of up to 80 0 million with borrowing availability subject to certain monthly recurring revenue calculations The interest rate on any outstanding borrowings are at the Bloomberg Short Term Bank Yield Index rate BSBY plus 350 basis points or Base Rate as defined plus 250 basis points with the BSBY rate and Base Rate subject to minimum levels subject to certain floors and interest payments are to be made in installments of one two or three months as chosen by us We also have outstanding letters of credit to serve as office landlord security deposits in the amount of 1 2 million These letters of credit are secured through the revolving credit facility and reduce our borrowing capacity The capacity of the revolving credit facility was 72 6 million as of February 29 2024 On July 19 2022 we entered into an amendment to extend the term until July 19 2024 documented the transition from the prior LIBOR interest rate index to the BSBY rate and established new minimum covenant revenue targets The term will automatically be extended to July 19 2025 if we have at least 200 0 million in consolidated net cash as of May 31 2024
We were in compliance with all such applicable covenants as of February 29 2024 and believe we are in compliance as of the date of this Annual Report on Form 10 K We do not expect to need to draw on the 2019 Revolver but our access to draw on the 2019 Revolver could be limited in the future if we do not have enough monthly recurring revenues to cover the borrowing availability calculations
As of February 29 2024 our material cash requirements from known contractual and other obligations which we expect to fund through available cash future cash generated from operations and our existing financing arrangements are as follows
We have entered into certain arrangements that include obligations to make significant future purchases The majority of these purchases are not expected to be made over the next 12 months See Note 14 to our consolidated financial statements for more details
In addition to the above our material cash requirements also include compensation and benefits expenses for our employees severance for terminated employees expenses for software and third party services and other miscellaneous expenses
Net cash used in operating activities decreased by 24 5 million to 16 2 million during fiscal 2024 from 40 7 million during fiscal 2023 primarily due to increased performance of the business including growth in revenues and gross profit which combined with certain measures we initiated in fiscal 2023 through strategic reductions in the Company s workforce resulted in a reduction in cash used in operating activities
Net cash used in investing activities increased by 56 4 million to 63 6 million during fiscal 2024 from 7 2 million during fiscal 2023 primarily due to 51 1 million of cash invested in marketable securities
Net cash provided used by financing activities decreased by 58 7 million to 55 6 million during fiscal 2024 from 3 2 million during fiscal 2023 primarily due to 65 8 million paid to repurchase convertible notes partially offset by 5 0 million in increased proceeds from stock option exercises
Our consolidated financial statements are prepared in accordance with U S GAAP The preparation of these consolidated financial statements requires us to make estimates and assumptions that affect the reported amounts of assets liabilities revenue and expenses as well as related disclosures We evaluate our estimates and assumptions on an ongoing basis Our estimates are based on historical experience and various other assumptions that we believe to be reasonable under the circumstances Our actual results could differ from these estimates
We define our critical accounting policies as those accounting principles that require us to make subjective estimates and judgments about matters that are uncertain and are likely to have a material impact on our financial condition and results of operations as well as the specific manner in which we apply those principles Our significant accounting policies are more fully described in Note 2 to our consolidated financial statements located elsewhere in this Annual Report on Form 10 K We have listed below our critical accounting estimates that we believe to have the greatest potential impact on our consolidated financial statements Historically our assumptions judgments and estimates relative to our critical accounting estimates have not differed materially from actual results
We generate revenue by providing customers access to our advocacy expert medical opinion and virtual primary care services as well as through usage of our expert medical opinion and virtual primary care services Contracts with customers that include expert medical opinion or virtual primary care services may contain either an access fee a usage based fee or both
At contract inception we assess the type of services being provided and assess the performance obligations in the contract The transaction price is allocated to the separate performance obligations on a relative standalone selling price basis We determine the standalone selling prices based on overall pricing objectives taking into consideration market conditions and other factors using an expected cost plus margin approach We considered the variable consideration allocation exception in ASC 606 and concluded that such exception for allocating variable consideration to distinct performance obligations or distinct time periods within a series was not met primarily due to variability in per member per month PMPM pricing
The majority of fees earned by us is considered to be variable consideration due to both the uncertainty regarding the total number of members consultations or visits for which we will invoice the customer as well as the variable PMPM fees that are dependent upon the achievement of performance metrics and or healthcare cost savings Performance metrics are measured monthly quarterly or annually and with respect to the achievement of healthcare cost savings targets annually typically measured on a calendar year basis Accordingly at contract inception and on an ongoing basis as part of our estimate of the transaction price we determine whether any such fees should be constrained and we include the estimated consideration for those fees to the extent it is probable that a significant reversal of cumulative revenue recognized will not occur and is therefore considered to be unconstrained On an ongoing basis we reassess our estimates for variable consideration which can change based upon our assessment of the achievement of performance metrics and healthcare cost savings as well as the number of members consultations or visits
We generate revenue primarily from contracts with customers to access our advocacy expert medical opinion and virtual primary care services We price access fees primarily using a recurring PMPM fee typically with a portion of the fee calculated as the product of a fixed rate times the number of members fixed PMPM fee plus a variable PMPM fee calculated as the product of a variable rate times the number of members variable PMPM fee The fees associated with the variable PMPM fee can be earned through the achievement of performance metrics and or the realization of healthcare cost savings resulting from the use of our services Collectively the fixed PMPM fee and variable PMPM fee are referred to as the total PMPM fee Our PMPM pricing varies by contract In certain contracts the maximum total PMPM fee varies during the contract term total PMPM rate increases or decreases annually while in other contracts the total PMPM maximum fee is consistent over the term yet the fixed and variable portions vary For example in certain contracts the fixed PMPM fee increases on an annual basis while the variable PMPM fee decreases on an annual basis resulting in the same total PMPM fee throughout the term of the contract The PMPM fees for expert medical opinion and virtual primary care services may be tiered based upon the customer s utilization
Access to our services represents a single stand ready performance obligation Our contracts include stand ready services to provide eligible participants with access to our services and to perform an unspecified quantity of interactions with members during the contract period Accordingly our services are generally viewed as stand ready performance obligations comprised of a series of distinct daily services that are substantially the same and have the same pattern of transfer Generally we satisfy these performance obligations over time and recognize revenue related to our services as the services are provided using a measure of progress based upon the actual number of members eligible for the service during the respective period as a percentage of the estimated members expected to be eligible for the service over the term of the contract We believe a measure of progress based on the number of members is the most appropriate measurement of control of the services being transferred to the customer as the amount of internal resources necessary to stand ready is directly correlated to the number of members who can use the services
For the majority of expert medical opinion services we satisfy these performance obligations over time and recognize revenue in the amount of consideration for which we have the right to invoice using the as invoiced practical
expedient Access fees also include access to our virtual primary care services sold directly to consumers on a monthly or yearly fixed fee subscription basis For these services we satisfy these stand ready performance obligations over time and recognize revenue ratably over the subscription period
We also generate revenue when members use the expert medical opinion and virtual primary care services that are billed based on usage Many but not all contracts with customers contain usage based fees For any usage based fees we satisfy these performance obligations over time and recognize revenue in the amount of consideration for which we have the right to invoice using the as invoiced practical expedient for any consultations or visits sold to commercial customers as well as any non insured consultations or visits related to virtual primary care services sold directly to consumers For any consultations or visits that are paid through insurance claims we recognize revenue as the consultations and visits occur in an amount that reflects the consideration that is expected based upon then current prices and historical experience from insurance payors In prior periods the Company referred to usage based fees as utilization based fees
We estimate the fair value of our stock options using the Black Scholes option pricing model This requires the input of subjective assumptions including the fair value of our underlying common stock prior to our IPO the expected term of stock options the expected volatility of the price of our common stock risk free interest rates and the expected dividend yield of our common stock the most critical of which prior to our IPO was the estimated fair value of common stock The assumptions used in our option pricing model represent our best estimates These estimates involve inherent uncertainties and the application of management s judgment If factors change and different assumptions are used our stock based compensation expense could be materially different in the future The resulting fair value net of actual forfeitures is recognized on a straight line basis over the period during which an employee is required to provide service in exchange for the award
Prior to our IPO our board of directors periodically estimated the fair value of the Company s common stock considering among other things contemporaneous valuations of our preferred and common stock prepared by an unrelated third party valuation firm in accordance with the guidance provided by the American Institute of Certified Public Accountants 2013 Practice Aid Valuation of Privately Held Company Equity Securities Issues as Compensation Since the closing of the IPO our board of directors has determined the per share fair value of the Company s common stock based on the closing price as reported by the Nasdaq Global Select Market on the date of grant
Since a public market for our common stock did not exist prior to our IPO in July 2020 and therefore we do not have an extensive trading history of our common stock we estimated the expected volatility based on the volatility of similar publicly held entities guideline companies over a period equivalent to the expected term of the awards In evaluating the similarity of guideline companies to us we considered factors such as industry stage of life cycle size and financial leverage We intend to continue to consistently apply this process using the same or similar guideline companies to estimate the expected volatility until sufficient historical information regarding the volatility of the share price of our common stock becomes available
Goodwill represents the excess of the cost of an acquired business over the fair value of the identifiable tangible and intangible assets acquired and liabilities assumed in a business combination For the purposes of impairment testing we have determined that we have one reporting unit We perform a qualitative assessment to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount If that is the case we perform a quantitative impairment test We test our goodwill for impairment on an annual basis in the fourth quarter of each fiscal year or more frequently whenever an event or change in circumstances indicates that the asset may be impaired In performing our evaluation we assess qualitative factors such as overall financial performance of our reporting unit anticipated changes in industry and market structure and the competitive and regulatory environment
During the three months ended November 30 2023 the Company determined that the decline in the price of its stock which resulted in a corresponding decline in market capitalization constituted a triggering event The Company evaluated whether changes in the Company s market capitalization indicated that the carrying value of goodwill was impaired As a result of this evaluation the Company determined that there was no impairment as of November 30 2023 The Company also performed its annual evaluation of the recoverability of goodwill during the fourth quarter and concluded that there was no impairment
As a result of sustained decreases in our stock price and market capitalization we conducted an impairment test of our goodwill as of May 31 2022 As a result of this testing we recorded a 299 7 million non cash goodwill impairment charge equivalent to 4 20 per basic and diluted share during the year ended February 28 2023 Our May 31 2022 goodwill impairment test reflected an allocation of 70 and 30 between the income and market based approaches respectively We believe the 70 weighting to the income based approach is appropriate as it more directly reflects our future growth and profitability expectations Significant inputs into the valuation models included the discount rate revenue market multiples and estimated future cash flows We used a discount rate of 11 and guideline peer group and public transaction revenue multiples between 1 1x and 1 8x current and forward looking revenues in the goodwill impairment test
While we cannot predict if or when additional future goodwill impairments may occur additional goodwill impairments could have material adverse effects on our operating income net assets and or our cost of or access to capital
We assess the realizability of our long lived assets and related intangible assets other than goodwill quarterly or sooner should events or changes in circumstances indicate the carrying values of such assets may not be recoverable We consider the following factors important in determining when to perform an impairment review significant under performance of a business or product line relative to budget shifts in business strategies which affect the continued uses of the assets significant negative industry or economic trends and the results of past impairment reviews When such events or changes in circumstances occur we assess recoverability of these assets
We assess recoverability of these assets by comparing the carrying amounts to the future undiscounted cash flows the assets are expected to generate If impairment indicators were present based on our undiscounted cash flow models which include assumptions regarding projected cash flows we would perform a discounted cash flow analysis to assess impairments on long lived assets Variances in these assumptions could have a significant impact on our conclusion as to whether an asset is impaired or the amount of any impairment charge Impairment charges if any result in situations where any fair values of these assets are less than their carrying values
In addition to our recoverability assessments we routinely review the remaining estimated useful lives of our long lived assets Any reduction in the useful life assumption will result in increased depreciation and amortization expense in the quarter when such determinations are made as well as in subsequent quarters
We will continue to evaluate the values of our long lived assets in accordance with applicable accounting rules As changes in business conditions and our assumptions occur we may be required to record impairment charges
We had cash and cash equivalents of 185 7 million and marketable securities of 51 3 million as of February 29 2024 totaling an aggregate of 237 0 million of cash cash equivalents and marketable securities as of February 29 2024 and we had cash and cash equivalents of 321 1 million as of February 28 2023 Our cash equivalents are comprised primarily of cash and money market accounts held at banks and U S treasury bills with
maturities of less than three months Our marketable securities are comprised of U S government debt commercial paper and U S agency debt with original maturities greater than three months Due to the short term nature of these instruments we believe that we do not have any material exposure to changes in the fair value of our investment portfolio as a result of changes in interest rates Declines in interest rates however would reduce future interest income
In addition our 2019 Revolver has a variable interest rate which if drawn upon would subject us to risks associated with changes in that interest rate During fiscal 2024 we had no borrowings under the 2019 Revolver
We have in the past and may in the future be exposed to foreign currency exchange risks in the ordinary course of our business but that exposure is not currently material to our business or results of operations
We maintain disclosure controls and procedures as defined in Rules 13a 15 e and Rule 15d 15 e under the Exchange Act that are designed to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is recorded processed summarized and reported within the time periods specified in the SEC s rules and forms Disclosure controls and procedures include without limitation controls and procedures designed to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is accumulated and communicated to our management including our principal executive and principal financial officers as appropriate to allow timely decisions regarding required disclosure
Our management with the participation of our Chief Executive Officer and Chief Financial Officer evaluated the effectiveness of our disclosure controls and procedures as of February 29 2024 Based on the evaluation of our disclosure controls and procedures as of February 29 2024 our Chief Executive Officer and Chief Financial Officer concluded that as of such date our disclosure controls and procedures were effective at the reasonable assurance level
Our management is responsible for establishing and maintaining adequate internal control over financial reporting as defined in Rules 13a 15 f and 15d 15 f of the Exchange Act Our internal control system is designed to provide reasonable assurance regarding the preparation and fair presentation of external financial statements in accordance with U S generally accepted accounting principles
Our management including our Chief Executive Officer and our Chief Financial Officer assessed the effectiveness of our internal control over financial reporting as of February 29 2024 In making this assessment management used the criteria set forth by the Committee of Sponsoring Organizations of the Treadway Commission COSO in
Based on this assessment management including our Chief Executive Officer and our Chief Financial Officer concluded that we maintained effective internal control over financial reporting as of February 29 2024
KPMG LLP the Company s independent registered public accounting firm was appointed by the Board of Directors and ratified by our Company s stockholders to render an opinion regarding our internal control over financial reporting which appears below
There was no change in our internal control over financial reporting identified in connection with the evaluation required by Rules 13a 15 d and 15d 15 d of the Exchange Act that occurred during the quarter ended February 29 2024 that has materially affected or is reasonably likely to materially affect our internal control over financial reporting
issued by the Committee of Sponsoring Organizations of the Treadway Commission In our opinion the Company maintained in all material respects effective internal control over financial reporting as of February 29 2024 based on criteria established in
We also have audited in accordance with the standards of the Public Company Accounting Oversight Board United States PCAOB the consolidated balance sheets of the Company as of February 29 2024 and February 28 2023 the related consolidated statements of operations and comprehensive loss stockholders equity deficit and cash flows for each of the years in the three year period ended February 29 2024 and the related notes collectively the consolidated financial statements and our report dated April 25 2024 expressed an unqualified opinion on those consolidated financial statements
The Company s management is responsible for maintaining effective internal control over financial reporting and for its assessment of the effectiveness of internal control over financial reporting included in the accompanying Management s Report on Internal Control Over Financial Reporting Our responsibility is to express an opinion on the Company s internal control over financial reporting based on our audit We are a public accounting firm registered with the PCAOB and are required to be independent with respect to the Company in accordance with the U S federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB
We conducted our audit in accordance with the standards of the PCAOB Those standards require that we plan and perform the audit to obtain reasonable assurance about whether effective internal control over financial reporting was maintained in all material respects Our audit of internal control over financial reporting included obtaining an understanding of internal control over financial reporting assessing the risk that a material weakness exists and testing and evaluating the design and operating effectiveness of internal control based on the assessed risk Our audit also included performing such other procedures as we considered necessary in the circumstances We believe that our audit provides a reasonable basis for our opinion
A company s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles A company s internal control over financial reporting includes those policies and procedures that 1 pertain to the maintenance of records that in reasonable detail accurately and fairly reflect the transactions and dispositions of the assets of the company 2 provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company and 3 provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition use or disposition of the company s assets that could have a material effect on the financial statements
Because of its inherent limitations internal control over financial reporting may not prevent or detect misstatements Also projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions or that the degree of compliance with the policies or procedures may deteriorate
On February 12 2024 Stephen Barnes our Chief Financial Officer adopted a trading plan intended to satisfy the affirmative defense conditions under Rule 10b5 1 c of the Securities Exchange Act of 1934 as amended the Exchange Act The plan is for the exercise of up to 78 000 non qualified stock options and the sale of the number of shares of common stock as is necessary to cover exercise costs fees and tax withholding obligations incurred in connection with the exercise the Sell to Cover Shares The plan terminates on the earlier of 1 the date all non qualified stock options under the plan are exercised and related Sell to Cover Shares are sold and 2 December 13 2024
On February 22 2024 Colin McHugh our Chief Accounting Officer adopted a trading plan intended to satisfy the affirmative defense conditions under Rule 10b5 1 c of the Exchange Act The plan is for the sale of up to 15 602 shares of our common stock The plan terminates on the earlier of 1 the date all shares under the plan are sold and 2 July 12 2024
On February 26 2024 Richard Eskew our Executive Vice President General Counsel and Chief Compliance Officer adopted a trading plan intended to satisfy the affirmative defense conditions under Rule 10b5 1 c of the Exchange Act The plan is for 1 the sale of up to 6 474 shares of our common stock in amounts determined in accordance with a formula set forth in the plan 2 the exercise and sale of stock options up to 18 925 shares and 3 the exercise of up to options up to 30 250 shares The plan terminates on the earlier of the date all the shares under the plan are sold or exercised as applicable and November 22 2024
The information required by Part III is omitted from this report because we will file a definitive proxy statement within 120 days after the end of our fiscal year pursuant to Regulation 14A for our 2024 Annual Meeting of Stockholders or the 2024 Proxy Statement and the information to be included in the 2024 Proxy Statement is incorporated herein by reference
The information required by this item is incorporated by reference to the information set forth in the sections titled Executive Compensation Compensation Discussion and Analysis and Director Compensation in our 2024 Proxy Statement
The information required by this item is incorporated by reference to the information set forth in the sections titled Equity Compensation Plan Information and Security Ownership of Certain Beneficial Owners and Management in our 2024 Proxy Statement
The information required by this item is incorporated by reference to the information set forth in the sections titled Transactions With Related Persons and Information Regarding the Board and Corporate Governance Board Independence in our 2024 Proxy Statement
The information required by this item is incorporated by reference to the information set forth in the sections titled Proposal 3 Ratification of Selection of Independent Registered Public Accounting Firm Principal Accountant Fees and Services in our 2024 Proxy Statement
All financial statement schedules have been omitted because of the absence of conditions under which they are required or because the required information where material is shown in the financial statements financial notes or supplementary financial information
The list of exhibits filed with this Annual Report on Form 10 K is set forth in the Exhibit Index preceding the signature page and is incorporated herein by reference or filed with this Annual Report on Form 10 K in each case as indicated herein numbered in accordance with Item 601 of Regulation S K
We have omitted schedules and similar attachments to the subject agreement pursuant to Item 601 of Regulation S K We will furnish a copy of any omitted schedule or similar attachment to the Securities and Exchange Commission upon request
Portions of this exhibit have been omitted in accordance with Item 601 b 10 of Regulation S K We will furnish a copy of any omitted schedule or similar attachment to the Securities and Exchange Commission upon request
or otherwise subject to the liability of that section nor shall it be deemed incorporated by reference into any filing under the Securities Act of 1933 as amended or the Securities Exchange Act of 1934 as amended whether made before or after the date of this Form 10 K irrespective of any general incorporation language contained in such filing
Pursuant to the requirements of Section 13 or 15 d of the Securities Exchange Act of 1934 the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized in the City of Seattle State of Washington on April 25 2024
KNOW ALL PERSONS BY THESE PRESENTS that each person whose signature appears below constitutes and appoints Rajeev Singh and Stephen Barnes and each one of them as his or her true and lawful attorneys in fact and agents with full power of substitution and resubstitution for him or her and in their name place and stead in any and all capacities to sign any and all amendments to this Annual Report on Form 10 K and to file the same with all exhibits thereto and
documents in connection therewith with the Securities and Exchange Commission granting unto said attorneys in fact and agents and each of them full power and authority to do and perform each and every act and thing requisite and necessary to be done in connection therewith as fully to all intents and purposes as he or she might or could do in person hereby ratifying and confirming all that said attorneys in fact and agents or any of them or his or her substitute or substitutes may lawfully do or cause to be done by virtue hereof
We have audited the accompanying consolidated balance sheets of Accolade Inc and subsidiaries the Company as of February 29 2024 and February 28 2023 the related consolidated statements of operations and comprehensive loss stockholders equity deficit and cash flows for each of the years in the three year period ended February 29 2024 and the related notes collectively the consolidated financial statements In our opinion the consolidated financial statements present fairly in all material respects the financial position of the Company as of February 29 2024 and February 28 2023 and the results of its operations and its cash flows for each of the years in the three year period ended February 29 2024 in conformity with U S generally accepted accounting principles
We also have audited in accordance with the standards of the Public Company Accounting Oversight Board United States PCAOB the Company s internal control over financial reporting as of February 29 2024 based on criteria established in
issued by the Committee of Sponsoring Organizations of the Treadway Commission and our report dated April 25 2024 expressed an unqualified opinion on the effectiveness of the Company s internal control over financial reporting
These consolidated financial statements are the responsibility of the Company s management Our responsibility is to express an opinion on these consolidated financial statements based on our audits We are a public accounting firm registered with the PCAOB and are required to be independent with respect to the Company in accordance with the U S federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB
We conducted our audits in accordance with the standards of the PCAOB Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement whether due to error or fraud Our audits included performing procedures to assess the risks of material misstatement of the consolidated financial statements whether due to error or fraud and performing procedures that respond to those risks Such procedures included examining on a test basis evidence regarding the amounts and disclosures in the consolidated financial statements Our audits also included evaluating the accounting principles used and significant estimates made by management as well as evaluating the overall presentation of the consolidated financial statements We believe that our audits provide a reasonable basis for our opinion
The critical audit matter communicated below is a matter arising from the current period audit of the consolidated financial statements that was communicated or required to be communicated to the audit committee and that 1 relates to accounts or disclosures that are material to the consolidated financial statements and 2 involved our especially challenging subjective or complex judgments The communication of a critical audit matter does not alter in any way our opinion on the consolidated financial statements taken as a whole and we are not by communicating the critical audit matter below providing a separate opinion on the critical audit matter or on the accounts or disclosures to which it relates
As discussed in Note 2 l to the consolidated financial statements the Company generates revenue by providing customers access to its advocacy expert medical opinion and virtual primary care services as well as through usage of its expert medical opinion and virtual primary care services The Company s revenue includes multiple revenue streams and certain aspects of the Company s processes and information technology IT systems differ among the revenue streams As discussed in Note 3 the Company recorded 414 292 thousand of revenue for the year ended
We identified the evaluation of the sufficiency of audit evidence over revenue as a critical audit matter Evaluating the sufficiency of audit evidence required a high degree of subjective auditor judgment and specialized skills and knowledge due to the number of revenue streams with unique revenue processes and IT applications involved This
The following are the primary procedures we performed to address this critical audit matter We applied auditor judgment to determine the nature and extent of procedures to be performed over revenue For each revenue stream where procedures were performed we evaluated the design and tested the operating effectiveness of certain internal controls related to the revenue process including IT related controls We involved IT professionals with specialized skills and knowledge who assisted in testing certain general IT and application controls used by the Company in its revenue processes For a sample of transactions we assessed the recorded revenue by comparing the amounts recognized to underlying documentation We evaluated the sufficiency of the audit evidence obtained over revenue by assessing the results of procedures performed
Accolade Inc Accolade or together with its subsidiaries the Company provides an advocacy led nationwide care delivery service comprised of personalized technology enabled solutions that help people better understand navigate and utilize the healthcare system and their workplace benefits The Company s customers are primarily employers that deploy Accolade solutions in order to provide employees and their families the members a single place to turn for their health healthcare and benefits needs The Company also offers expert medical opinion services to commercial customers which includes employers health plans and governmental entities and virtual primary care both directly to consumers and to commercial customers These services are designed to improve the member experience encourage better healthcare outcomes and lower costs for both members and customers Accolade is co headquartered in Seattle Washington and Plymouth Meeting Pennsylvania
The Company has incurred net losses and cumulative negative cash flows from operations since inception To date the Company s operations have been funded by capital raised from investors debt facilities and revenues in the normal course of business Management believes that the Company s cash and cash equivalents plus customer revenues and advances and available borrowings under its debt facility are sufficient to fund its operations through at least the next 12 months from the issuance of these consolidated financial statements Additional financing may be required for the Company to successfully implement its long term strategy There can be no assurance that additional financing if needed can be obtained on terms acceptable to the Company
Accolade s consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America U S GAAP and include the Company s accounts and those of the Company s wholly owned subsidiaries All significant intercompany balances and transactions have been eliminated in consolidation
The Company has various administrative service agreements ASA with professional medical corporations established in California Illinois Wyoming and New Jersey PC The PCs employ or contract with medical providers who provide services via the Company s technology platform The ASAs are evergreen and are terminable by the parties for breach or bankruptcy Through the ASAs the Company provides non clinical administrative services to the PCs and manages the economic activities that most significantly affect PCs The PCs retain control over the provision of medical services and the PC s clinical personnel
the Company is considered the PC s primary beneficiary because the Company has the power to direct the activities that most significantly impact the VIE s economic performance and absorbs the residual benefits and losses from the VIE s operations Consequently the Company consolidates the operations of the PCs PC assets were 31 148 as of February 29 2024 which consisted primarily of amounts receivable from PlushCare Inc PC liabilities were 15 276 as of February 29 2024 and consisted primarily of amounts due to Accolade Inc and accrued compensation
The PCs and the Company are independent entities and as such creditors of the PCs do not have recourse against the Company in the event of default by the PCs Additionally the PCs non cash assets are available to the Company to satisfy obligations or for other corporate purposes
The preparation of consolidated financial statements in conformity with U S GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities including the fair value of assets acquired and liabilities assumed for business combinations unbilled revenues and deferred revenues certain accrued expenses stock based compensation assessment of the useful life and recoverability of long lived assets income taxes disclosure of contingent assets and liabilities at the date of the consolidated financial statements assessment of the recoverability of goodwill and the reported amounts of revenues and expenses during the reporting period To the extent there are material differences between these estimates judgments or assumptions and actual results the Company s financial statements will be affected
The carrying value of the Company s financial instruments including cash equivalents marketable securities accounts receivable unbilled revenue other current assets accounts payable and accrued expenses approximates fair value due to the short term nature of those instruments
The Company measures financial assets and liabilities at fair value at each reporting period using a fair value hierarchy that requires the use of observable inputs and minimizes the use of unobservable inputs The Company defines fair value as the price that would be received from selling an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date Fair value is estimated by applying the following hierarchy which prioritizes the inputs used to measure fair value into three levels and bases the categorization within the hierarchy upon the lowest level of input that is available and significant to the fair value measurement
Level 2 Observable inputs other than quoted prices in active markets for identical assets and liabilities quoted prices for identical or similar assets or liabilities in inactive markets or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities
Cash and cash equivalents is comprised of cash in banks and highly liquid investments including U S treasury bills purchased with an original maturity of three months or less Cash equivalents consist of investments in money market funds for which the carrying amount approximates fair value due to the short maturities of these instruments
The Company classifies its marketable securities as available for sale which include securities with original maturities of greater than three months These securities are carried at fair market value and unrealized gains and losses are recorded to accumulated other comprehensive loss Premiums and discounts are amortized or accreted over the life of the related available for sale security as an adjustment to yield
Accounts receivable are recorded at the invoiced amount and do not bear interest The Company does not have any off balance sheet credit exposure related to its customers The Company records unbilled revenue for services performed on contracts for amounts not yet billed to customers
Costs related to software acquired developed or modified solely to meet the Company s internal requirements including tools that enable the Company s employees to interact with members and their providers with no substantive plans to market such software at the time of development are capitalized Costs incurred during the preliminary planning and evaluation stage of the project and during the post implementation operational stage are expensed as incurred Costs related to minor upgrades minor enhancements and maintenance activities are expensed as incurred Costs incurred during the application development stage of the project are capitalized Internal use software is included in property and equipment and is amortized on a straight line basis over 3 years
For the fiscal years ended February 28 29 2024 2023 and 2022 the Company capitalized 6 938 5 709 and 1 096 respectively for internal use software Amortization expense related to capitalized internal use software during the fiscal years ended February 28 29 2024 2023 and 2022 was 2 761 1 196 and 2 387 respectively
The Company reviews long lived assets such as property and equipment and finite lived intangibles for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to estimated undiscounted future cash flows expected to be generated by the asset If the carrying amount of an asset exceeds its estimated undiscounted future cash flows then an impairment charge is recognized for the amount by which the carrying value of the asset exceeds the fair value of the asset There were no long lived asset impairment charges recorded during the fiscal years ended February 28 29 2024 2023 and 2022
The Company has acquired intangible assets through various acquisitions Intangible assets are recorded at fair value on the date of acquisition and are subject to amortization over the estimated useful lives of each asset Estimates of fair value and useful lives are based on historical factors current circumstances and the experience and judgment of management Estimates and assumptions used to value intangible assets are evaluated by management on an ongoing basis
Goodwill is the excess of the cost of an acquired entity over the net amounts assigned to tangible and intangible assets acquired and liabilities assumed Goodwill is not amortized but is subject to evaluations of its recoverability annually and upon the identification of a triggering event The Company has a single reporting unit and all goodwill relates to that reporting unit
The Company performs an impairment analysis of goodwill on an annual basis in the fourth quarter of each fiscal year or more frequently if changes in circumstances or the occurrence of events suggest that an impairment exists If the fair value of the reporting unit is less than its carrying value an impairment loss is recorded A goodwill impairment loss was recorded during the first quarter of fiscal 2023 See Note 4 for further information The Company did not recognize a goodwill impairment charge in the fiscal year ended February 29 2024
The Company generates revenue by providing customers access to its advocacy expert medical opinion and virtual primary care services as well as through usage of its expert medical opinion and virtual primary care services Contracts with customers that include expert medical opinion or virtual primary care services may contain either an access fee a usage based fee or both
the Company recognizes revenue when control of the promised services is transferred to its customers in an amount that reflects the consideration to which it expects to be entitled in exchange for those services Accordingly the Company determines revenue recognition through the following steps
At contract inception the Company assesses the type of services being provided and assesses the performance obligations in the contract The transaction price is allocated to the separate performance obligations on a relative standalone selling price basis The Company determines the standalone selling prices based on overall pricing objectives taking into consideration market conditions and other factors using an expected cost plus margin approach The Company considered the variable consideration allocation exception in ASC 606 for its advocacy contracts and concluded that such exception for allocating variable consideration to distinct performance obligations or distinct time periods within a series was not met primarily due to variability in its per member per month PMPM pricing
The majority of fees earned by the Company are considered to be variable consideration due to both the uncertainty regarding the total number of members consultations or visits for which the Company will invoice the customer as well as the variable PMPM fees that are dependent upon the achievement of performance metrics and or healthcare cost savings Performance metrics are measured monthly quarterly or annually and with respect to the achievement of healthcare cost savings targets annually typically measured on a calendar year basis Accordingly at contract inception and on an ongoing basis as part of the Company s estimate of the transaction price the Company determines whether any such fees should be constrained and the Company includes the estimated consideration for those fees to the extent that it is probable that a significant reversal of cumulative revenue recognized will not occur and is therefore considered to be unconstrained Consideration related to the Company s achievement of healthcare cost savings is typically constrained until the end of the applicable calendar year due to uncertainty related to factors outside of the Company s control Consideration related to other performance metrics is typically not constrained based on the Company s prior success of achieving such metrics On an ongoing basis the Company reassesses its estimates for variable consideration which can change based upon its assessment of the achievement of performance metrics and healthcare cost savings as well as the number of members consultations or visits
The Company generates revenue primarily from contracts with customers to access the Company s advocacy expert medical opinion and virtual primary care services The Company prices access fees primarily using a recurring PMPM fee typically with a portion of the fee calculated as the product of a fixed rate times the number of members fixed PMPM fee plus a variable PMPM fee calculated as the product of a variable rate times the number of members variable PMPM fee The fees associated with the variable PMPM fee can be earned through the achievement of performance metrics and or the realization of healthcare cost savings resulting from use of the Company s services Collectively the fixed PMPM fee and variable PMPM fee are referred to as the total PMPM fee The Company s PMPM pricing varies by contract In certain contracts the maximum total PMPM fee varies during the contract term total PMPM rate increases or decreases annually while in other contracts the total PMPM maximum fee is consistent over the term yet the fixed and variable portions vary For example in certain contracts the fixed PMPM fee increases on an annual basis while the variable PMPM fee decreases on an annual basis resulting in the same total PMPM fee throughout the term of the contract
Access to the Company s services represent a single stand ready performance obligation The Company s contracts include stand ready services to provide eligible participants with access to the Company s services and to perform an unspecified quantity of interactions with members during the contract period Accordingly the Company s services are generally viewed as stand ready performance obligations comprised of a series of distinct daily services that are substantially the same and have the same pattern of transfer For advocacy services the Company satisfies these performance obligations over time and recognizes revenue related to its services as the services are provided using a measure of progress based upon the actual number of members eligible for the service during the respective period as a percentage of the estimated members expected to be eligible for the service over the term of the contract The Company believes a measure of progress based on the number of members is the most appropriate measurement of control of the services being transferred to the customer as the amount of internal resources necessary to stand ready is directly correlated to the number of members who can use the services
For the majority of expert medical opinion services the Company satisfies these performance obligations over time and recognizes revenue in the amount of consideration for which it has the right to invoice using the as invoiced practical expedient Access fees also include access to the Company s virtual primary care services sold directly to consumers on a monthly or yearly fixed fee subscription basis For these services the Company satisfies these stand ready performance obligations over time and recognizes revenue ratably over the subscription period
The Company also generates revenue when members use the expert medical opinion and virtual primary care services that are billed based on usage Many but not all contracts with customers contain usage based fees For any usage based fees the Company satisfies these performance obligations over time and recognizes revenue in the amount of consideration for which it has the right to invoice using the as invoiced practical expedient for any consultations or visits sold to commercial customers as well as any non insured consultations or visits related to virtual primary care services sold directly to consumers For any consultations or visits that are paid through insurance claims the Company recognizes revenue as the consultations and visits occur in an amount that reflects the consideration that is expected based upon then current prices and historical experience from insurance payors In prior periods the Company referred to usage based fees as utilization based fees
The Company typically invoices its customers in advance of the services performed on a monthly or quarterly basis and the amount invoiced typically represents the maximum total PMPM fee for the estimated number of eligible members over the applicable invoice period The total PMPM fee covers the stand ready services in the Company s typical contracts i e the performance obligations are not separately priced or invoiced The maximum total PMPM fee that is invoiced includes both the fixed PMPM fee and the variable PMPM fee related to the performance metrics and or the realization of healthcare cost savings that can be achieved during the period These fees are classified as deferred revenue on the Company s consolidated balance sheet until such time that revenue can be recognized In the event the Company fails to satisfy any of the performance metrics and or realization of healthcare cost savings that are billed in advance the Company will refund the applicable portion of the fee or offset the amount against a future invoice These amounts are included in due to customers on the Company s consolidated balance sheet The Company s accounts receivable represent rights to consideration that are unconditional
Financial instruments that potentially subject the Company to credit risk consist principally of cash cash equivalents and marketable securities The Company maintains its cash primarily with domestic financial institutions of high credit quality which may exceed federal deposit insurance corporation limits The Company invests its cash equivalents in highly rated money market funds and U S treasury bills with original maturities of three months or less Marketable securities are comprised of U S government debt commercial paper and U S agency debt with original maturities greater than three months The Company believes it is not exposed to any significant credit risk on cash cash equivalents and marketable securities and performs periodic evaluations of the credit standing of such institutions
The Company recognizes compensation cost for awards to employees nonemployee directors consultants and advisors based on the grant date fair value of stock based awards on a straight line basis over the period during which an award holder is required to provide service in exchange for the award The Company estimates the fair value of each employee stock option on the date of grant using the Black Scholes option pricing model
Cost of revenue excluding depreciation and amortization consists primarily of personnel costs including salaries wages overtime bonuses stock based compensation expense and benefits as well as software and tools for telephony business analytics allocated overhead costs and other expenses related to delivery and implementation of the Company s personalized technology enabled solutions
Product and technology expenses consist of personnel expenses including salaries bonuses stock based compensation expense and benefits for employees and contractors for engineering product and design teams and allocated overhead costs as well as costs of software and tools for business analytics data management and IT applications that are not directly associated with delivery of the Company s solutions to customers
The provision for income taxes was determined using the asset and liability approach of accounting for income taxes Under this approach deferred taxes represent the future tax consequences expected to occur when the reported amounts of assets and liabilities are recovered or paid The provision for income taxes represents income taxes paid or payable for the current year plus the change in deferred taxes during the period Deferred taxes result from differences between the financial and tax basis of the Company s assets and liabilities and are adjusted for changes in tax rates and tax laws when changes are enacted Valuation allowances are recorded to reduce deferred tax assets when it is more likely than not that a tax benefit will not be realized Deferred tax assets and liabilities are measured using enacted tax rates applicable in the years in which they are expected to be recovered or settled The effect on deferred tax assets and liabilities of a change in tax law is recognized in income in the period that includes the enactment date
In evaluating the ability to realize deferred tax assets the Company relies on taxable income in prior carryback years the future reversals of existing taxable temporary differences future taxable income and tax planning strategies
the Company does not recognize a tax benefit for a tax position in its financial statements unless it has concluded that it is more likely than not that the benefit will be sustained on audit by the taxing authority based solely on the technical merits of the associated tax position and that the amount of tax benefit recognized is measured at the largest amount of the tax benefit that in the Company s judgment is greater than 50 likely to be realized U S GAAP requires the evaluation of tax positions taken or expected to be taken in the course of preparing tax returns to determine whether the tax positions will more likely than not be sustained by the Company upon challenge by the applicable tax authority Tax positions not deemed to meet the more likely than not threshold and that would result in a tax benefit or expense to the Company would be recorded as a tax benefit or expense in the current period A reconciliation is not provided herein as the beginning and ending amounts of unrecognized benefits are 0 with no additions reductions or settlements during the year Tax years 2010 through present remain subject to examination by the U S and state taxing authorities
The Company s chief operating decision maker its Chief Executive Officer reviews the financial information presented on a consolidated basis for purposes of allocating resources and evaluating its financial performance Accordingly the Company has determined that it operates in a single reportable segment
Whenever the Company enters into a new arrangement it determines at the inception date whether the arrangement is or contains a lease This determination generally depends on whether the arrangement conveys to the Company the right to control the use of an explicitly or implicitly identified asset for a period of time in exchange for consideration Control of an underlying asset is conveyed to the Company if the Company obtains the right to direct the use of and obtain substantially all the economic benefits from the use of the underlying asset
For each lease the Company then determines the lease term the present value of lease payments and the classification of the lease as either an operating or finance lease The Company has elected for all of its leases to not separate lease and non lease components The lease term is the period of the lease not cancellable by the Company together with periods covered by i renewal options the Company is reasonably certain to exercise ii termination options the Company is reasonably certain not to exercise and iii renewal or termination options that are controlled by the lessor
Lease payments Lease payments included in the measurement of the lease asset or liability comprise the following fixed payments including in substance fixed payments and the exercise price of a lessee option to purchase the underlying asset if the lessee is reasonably certain to exercise
Discount rate the discount rate is determined based on information available to the Company upon the commencement of the lease Lessees are required to use the rate implicit in the lease whenever such rate is readily available however as the implicit rate in the Company s leases is generally not readily determinable the Company generally uses the incremental borrowing rate it would have to pay to borrow an amount equal to the lease payments on a collateralized basis over a timeframe similar to the lease term
In making the determination of whether a lease is an operating lease or a finance lease the Company considers the lease term in relation to the economic life of the leased asset the present value of lease payments in relation to the fair value of the leased asset and certain other factors including the lessee s and lessor s rights obligations and economic incentives over the term of the lease
The Company does not recognize leases with an initial term of 12 months or less on its consolidated balance sheets and recognizes these payments in the consolidated statements of operations on a straight line basis over the lease term Certain leases contain variable payments which are based on usage or operating costs such as utilities and maintenance These payments are not included in the measurement of the lease liability or corresponding right of use asset due to the uncertainty of the payment amount and are recorded as lease expense in the period incurred
In November 2023 the Financial Accounting Standards Board FASB issued Accounting Standards Update ASU 2023 07 Segment Reporting Topic 280 The new standard requires enhanced disclosures about significant segment expenses and other segment items and requires companies to disclose all annual disclosures about segments in interim periods The new standard also permits companies to disclose more than one measure of segment profit or loss requires disclosure of the title and position of the Chief Operating Decision Maker and requires companies with a single reportable segment to provide all disclosures required by Topic 280 The new standard is effective for fiscal years beginning after December 15 2023 and interim periods within fiscal years beginning after December 15 2024 Early adoption is permitted and companies are required to apply the ASU retrospectively to all periods presented The Company is currently evaluating the impact that the adoption of this standard will have on its financial statements and related disclosures
In December 2023 the FASB issued ASU 2023 09 Income Taxes Topic 740 Improvements to Income Tax Disclosures which requires expanding disclosures of an entity s income tax rate reconciliation and income taxes paid The new standard is effective for annual periods beginning after December 15 2024 and early adoption is permitted Upon adoption this standard will result in additional required disclosures being included in the Company s consolidated financial statements The Company is currently evaluating the impact that the adoption of this standard will have on its financial statements and related disclosures
The expected revenue includes variable fee estimates for access fee revenue during the non cancellable term of the Company s contracts The expected revenue does not include amounts of variable consideration that are constrained direct to consumer revenues and usage based revenues
Significant changes to the contract liability balances during the fiscal years ended February 28 29 2024 and 2023 were the result of revenue recognized and net cash received During the fiscal years ended February 28 29 2024 and 2023 changes in the deferred revenue balances were the result of recognized revenue of 34 941 and 30 567 respectively that were included in deferred revenue In addition significant changes to the contract asset balances during the fiscal years ended February 28 29 2024 and 2023 were the result of revenue recognized and transfers to accounts receivable Contract assets relating to unbilled revenue are transferred to accounts receivable when the right to consideration becomes unconditional
Revenue related to performance obligations satisfied in prior periods that was recognized during the years ended February 28 29 2024 and 2023 was 5 142 and 3 768 respectively These changes in amounts were primarily due to the inclusion of consideration that was previously constrained related to the Company s achievement of healthcare cost savings
The Company capitalizes sales commissions paid to internal sales personnel that are both incremental to the acquisition of customer contracts and recoverable These costs are recorded as deferred contract acquisition costs in the accompanying consolidated balance sheets The Company capitalized commission costs of 3 913 and 6 016 for the years ended February 28 29 2024 and 2023 respectively The Company defers costs based on its sales compensation plans only if the commissions are incremental and would not have occurred absent the customer contract Payments to direct sales personnel are typically made upon signature of the contract The Company does not pay commissions on contract renewals
Deferred commissions paid on the initial acquisition of a contract are amortized ratably over an estimated period of benefit of five years which is the estimated customer life The Company determined the period of amortization for deferred commissions by taking into consideration current customer contract terms historical customer retention and other factors Amortization is included in sales and marketing expenses in the accompanying consolidated statements of operations and totaled 3 950 2 695 and 2 080 for the fiscal years ended February 28 29 2024 2023 and 2022 respectively The Company periodically reviews deferred contract acquisition costs to determine whether events or changes in circumstances have occurred that could impact the estimated period of benefit There were no impairment losses recorded during the periods presented
For certain customer contracts the Company may incur direct and incremental costs related to customer set up and implementation The Company recorded deferred implementation costs of 1 645 and 1 303 for the fiscal years ended February 28 29 2024 and 2023 respectively These implementation costs are deferred and amortized over the expected useful life of the Company s customers which is five years Amortization is included in cost of revenues in the Company s consolidated statements of operations and totaled 1 486 1 002 and 865 for the fiscal years ended February 28 29 2024 2023 and 2022 respectively
Annually and upon the identification of a triggering event management is required to perform an evaluation of the recoverability of goodwill Triggering events potentially warranting an interim goodwill impairment test include among other factors declines in historical or projected revenue operating income or cash flows and sustained declines in the Company s stock price or market capitalization considered both in absolute terms and relative to peers During the three months ended November 30 2023 the Company determined that the decline in the price of its stock which resulted in a corresponding decline in market capitalization constituted a triggering event The Company evaluated whether changes in the Company s market capitalization indicated that the carrying value of goodwill was impaired As a result of this evaluation the Company determined that there was no impairment as of November 30 2023 The Company also performed its annual evaluation of the recoverability of goodwill during the fourth quarter and concluded that there was no impairment
No impairments were recorded to goodwill or intangible assets during the year ended February 29 2024 During the year ended February 28 2023 as a result of sustained decreases in the Company s stock price and market capitalization the Company conducted an impairment test of its goodwill and intangible assets as of May 31 2022 As a result of this testing the Company recorded a non cash goodwill impairment charge of 299 705 equivalent to 4 20 per basic and diluted share for the year ended February 28 2023 during the first quarter of fiscal 2023
The Company s May 31 2022 goodwill impairment test reflected an allocation of 70 and 30 between income and market based approaches respectively The Company believes the 70 weighting to the income based approach is appropriate as it more directly reflects its future growth and profitability expectations Significant inputs into the valuation models included the discount rate revenue market multiples and estimated future cash flows Management used a discount rate of 11 and guideline peer group and public transaction revenue multiples between 1 1x and 1 8x current and forward looking revenues in the goodwill impairment test
While management cannot predict if or when additional future goodwill impairments may occur additional goodwill impairments could have material adverse effects on the Company s operating income net assets and or the Company s cost of or access to capital
Topic 842 on February 28 2022 with an effective date of adoption of March 1 2021 using the modified retrospective approach The Company has operating leases for offices and certain equipment under non cancelable leases in the United States and Czech Republic These leases have
The estimated fair value of the convertible senior notes Note 9 was 180 841 as of February 29 2024 based on quoted market prices of the Company s instrument in markets that are not active and are classified as Level 2 within the fair value hierarchy Considerable judgment is necessary to interpret the market data and develop an estimate of the fair value Accordingly the estimate is not necessarily indicative of the amount at which this instrument could be purchased sold or settled
In March 2021 the Company completed a private convertible note offering pursuant to an Indenture dated as of March 29 2021 between the Company and U S Bank National Association as trustee the Indenture and issued 287 500 of 0 50 Convertible Senior Notes due 2026 the Notes that mature in April 2026 unless earlier converted redeemed or
repurchased The Notes bear interest at a rate of 0 50 per annum payable semiannually in arrears on April 1 and October 1 of each year beginning on October 1 2021 and are convertible into cash shares of the Company s common stock or a combination of cash and shares of common stock at the Company s election The Company incurred costs of 8 428 in connection with the Notes and the capped calls of which 8 368 was allocated to the Notes and recorded as a debt discount and 60 was allocated to the capped call and recorded directly to additional paid in capital Net proceeds from the issuance of Notes were 279 132 and the Company used 34 443 of the net proceeds to pay the costs of the capped call transactions described below
Pursuant to the terms of the Notes a holder may convert all or any portion of its Notes at its option at any time prior to October 1 2025 and only under the following circumstances 1 during any fiscal quarter commencing after the fiscal quarter ending on August 31 2021 if the last reported sale price of the Company s common stock for at least 20 trading days during a period of 30 consecutive trading days ending on and including the last trading day of the immediately preceding fiscal quarter is greater than or equal to 130 of the conversion price on each applicable trading day 2 during the five business day period after any ten consecutive trading day period the measurement period in which the trading price as defined in the Indenture per 1 principal amount of Notes for each trading day of the measurement period was less than 98 of the product of the last reported sale price of the Company s common stock and the conversion rate on each such trading day 3 if the Company calls such Notes for redemption at any time prior to the close of business on the scheduled trading day immediately preceding the redemption date but only with respect to the Notes called or deemed called for redemption or 4 upon the occurrence of specified corporate events On or after October 1 2025 until the close of business on the second scheduled trading day immediately preceding the maturity date holders may convert all or any portion of their Notes at any time regardless of the foregoing circumstances
The initial conversion rate is 19 8088 shares of the Company s common stock per 1 principal amount of Notes equivalent to an initial conversion price of approximately 50 48 per share of the Company s common stock The conversion rate is subject to adjustment in some events but will not be adjusted for any accrued and unpaid interest In addition following certain corporate events that occur prior to the maturity date or if the Company delivers a notice of redemption the Company will in certain circumstances increase the conversion rate for a holder who elects to convert its Notes in connection with such a corporate event or convert its Notes called or deemed called for redemption in connection with such notice of redemption as the case may be
The Company was not able to redeem the Notes prior to April 6 2024 On or after April 6 2024 the Company may redeem for cash all or any portion of the Notes subject to the partial redemption limitation set forth in the Indenture at its option if the last reported sale price of the Company s common stock has been at least 130 of the conversion price then in effect for at least 20 trading days including the trading day immediately preceding the date on which the Company provides notice of redemption during any 30 consecutive trading day period ending on and including the trading day immediately preceding the date on which the Company provides notice of redemption at a redemption price equal to 100 of the principal amount of the Notes to be redeemed plus accrued and unpaid interest to but excluding the redemption date No sinking fund is provided for the Notes
Upon a fundamental change as defined in the Indenture holders may subject to certain exceptions require the Company to purchase their Notes in whole or in part for cash at a price equal to the principal amount of the Notes to be purchased plus accrued and unpaid interest if any to but excluding the fundamental change repurchase date as defined in the Indenture In addition upon a Make Whole Fundamental Change as defined in the Indenture the Company will under certain circumstances increase the applicable conversion rate for a holder that elects to convert its Notes in connection with such Make Whole Fundamental Change
Under the Indenture the Notes may be accelerated upon the occurrence of certain customary events of default If certain bankruptcy and insolvency related events of default with respect to the Company occur the principal of and accrued and unpaid interest on all of the then outstanding Notes shall automatically become due and payable The Indenture provides that the sole remedy for an event of default relating to certain failures by the Company to comply with reporting covenants including timely filings consists exclusively of the right to receive additional interest on the Notes
As of February 29 2024 none of the conditions of the Notes to early convert had been met The Notes are the Company s senior unsecured obligations that rank senior in right of payment to the Company s future indebtedness that is expressly subordinated to the Notes rank equally in right of payment with the Company s future senior unsecured indebtedness that is not so subordinated effectively subordinated to the Company s existing and future secured indebtedness to the extent of the value of the collateral securing such indebtedness and structurally subordinated to all existing and future indebtedness and other liabilities including trade payables and preferred equity to the extent the Company is not a holder thereof of the Company s subsidiaries The Notes contain both affirmative and negative covenants As of February 29 2024 the Company was in compliance with all covenants in the Notes
The Company concluded the Notes are accounted for as debt with no bifurcation of the embedded conversion feature Transaction costs were recorded as a direct deduction from the related debt liability in the consolidated balance sheet and are amortized to interest expense using the effective interest method over the term of the Notes The effective interest rate for the Notes is 1 1
During the year ended February 29 2024 the Company entered into separate privately negotiated transactions with certain holders of the Notes to repurchase 76 459 aggregate principal amount of the Notes for an aggregate cash repurchase price of 66 163 including third party costs of 355 the Repurchases Following the Repurchases the Company cancelled the repurchased Notes The repurchase and cancellation of the Notes was accounted for as a debt extinguishment and the resulting gain of 9 268 net of related unamortized issuance costs of 1 078 and accrued interest of 50 that were written off has been recorded within other income expense on the condensed consolidated statement of operations After the cancellation 211 041 aggregate principal amount of the Notes remained outstanding
For the years ended February 28 29 2024 2023 and 2022 the Company recorded interest expense of 2 869 3 094 and 2 857 respectively of which 1 540 1 657 and 1 534 respectively was associated with the amortization of the debt discount
Concurrent with the pricing of the Notes the Company entered into privately negotiated capped call transactions with two of the initial purchasers and or their respective affiliates and another financial institution the Option Counterparties The capped call transactions are expected to offset the potential dilution to Accolade s common stock as a result of any conversion of Notes with such offset subject to a cap initially equal to 76 20 which represented a premium of 100 over the last reported sale price of the Company s common stock on March 24 2021 The capped call transactions are separate transactions entered into by the Company with the Option Counterparties and are not part of the terms of the Notes
As the capped call options are both legally detachable and separately exercisable from the Notes the Company accounts for the capped call options separately from the Notes The capped call options are indexed to the Company s own common stock and classified in stockholders equity As such the premiums paid for the capped call options were included as a net reduction to additional paid in capital in the consolidated balance sheet
During July 2019 the Company entered into a revolving credit facility as amended the 2019 Revolver with a syndicate of two banks Under the 2019 Revolver the Company has the capacity to borrow up to 80 000 on a revolving facility Availability of borrowings on the 2019 Revolver is calculated as a multiple of the Company s eligible monthly recurring revenues as defined in the 2019 Revolver As of February 29 2024 the Company had outstanding letters of credit to serve as office landlord security deposits in the amount of 1 208 which are secured through the revolving credit facility and reduce our borrowing capacity The capacity of the revolving credit facility was 72 613 as of February 29 2024 No amounts were outstanding as of February 29 2024
The 2019 Revolver term ends on July 19 2024 The interest rate on the outstanding borrowings are at the Bloomberg Short Term Bank Yield Index BSBY rate plus 350 basis points or Base Rate as defined plus 250 basis points with the BSBY rate and Base Rate subject to minimum levels Interest payments are to be made in installments of one two or three months as chosen by the Company
The Company incurred lender and third party fees when entering into the 2019 Revolver all of which were deferred at the onset of the facility and have been fully amortized During the years ended February 28 29 2024 2023
and 2022 the Company recorded interest expense of 203 203 and 296 respectively related to the revolving credit facility of which 0 0 and 93 respectively related to the amortization of deferred financing fees
On July 19 2022 the Company entered into an amendment to the 2019 Revolver which extended the term until July 19 2024 documented the transition from the LIBOR interest rate index to the BSBY rate and established new minimum covenant revenue targets The term will automatically be extended to July 19 2025 if the Company has at least 200 000 in consolidated net cash as of May 31 2024
In addition to the letters of credit outstanding under the 2019 Revolver the Company had letters of credit outstanding as of February 29 2024 to serve as office landlord security deposits in the amount of 1 407 The Company provided a payment guarantee which restricts the use of the Company s cash in this amount These letters of credit expire on June 30 2024
In July 2020 the Company adopted the 2020 Equity Incentive Plan the Incentive Plan which authorized the Company to grant up to 4 300 000 shares of common stock to eligible employees directors and consultants to the Company in the form of stock options restricted stock units and other various equity awards including any shares subject to stock options or other awards granted under the Company s prior stock option plan that expire or terminate for any reason other than being exercised in full or are cancelled in accordance with the terms of the prior stock option plan The Incentive Plan also includes an annual evergreen increase and the amount terms of grants and exercisability provisions are determined by the board of directors The term of an award may be up to 10 years and options generally vest over four years with one quarter of an award vesting one year after grant and the remainder vesting on a monthly basis over three years As of February 29 2024 there was a total of 12 135 039 shares of common stock authorized for issuance under the Incentive Plan of which 1 447 521 were available for future grants
The Company recognizes stock based compensation based on the grant date fair value of the awards and recognizes that cost using the straight line method over the requisite service period of the award The fair value of options which vest in accordance with service schedules is estimated on the date of grant using the Black Scholes option pricing model Prior to the Company s IPO in July 2020 the absence of an active market for the Company s common stock required it to estimate the fair value of the Company s common stock for purposes of granting stock options and for determining stock based compensation expense for the periods presented The Company obtained contemporaneous third party valuations to assist in determining the estimated fair value of its common stock These contemporaneous third party valuations used the methodologies approaches and assumptions consistent with the American Institute of Certified Public Accountants Practice Guide
Expected volatilities are based on historical volatilities of comparable companies The expected term of the options is based on the simplified method outlined in the SEC Staff accounting guidance under which the Company estimates the term as the average of the option s contractual term and the option s weighted average vesting period The risk free rate represents the yield on U S Treasury bonds with maturity equal to the expected term of the granted option The Company accounts for
During the years ended February 28 29 2024 2023 and 2022 the Company recognized 7 188 11 798 and 10 374 respectively of compensation expense related to stock options The Company did not capitalize any stock based compensation expense to deferred costs for the years ended February 28 29 2024 2023 and 2022 The weighted average grant date fair value for stock options granted during the years ended February 28 29 2024 2023 and 2022 was 9 22 5 10 and 28 59 respectively The fair value of the Company s option grants is estimated at the grant date using the Black Scholes option pricing model based on the following assumptions
The aggregate intrinsic value of stock options exercised was 7 820 1 801 and 29 964 for the years ended February 28 29 2024 2023 and 2022 respectively As of February 29 2024 approximately 5 036 of unrecognized compensation expense related to stock options is expected to be recognized over a weighted average period of 1 1 years
In connection with the acquisition of PlushCare Inc PlushCare on June 9 2021 the Company assumed all stock options that were awarded under the PlushCare Plan and that were outstanding as of the closing of the acquisition These options were converted into options to purchase the Company s common stock at a ratio determined in the purchase agreement The Company has no intent to grant any further options under the PlushCare Plan beyond the options granted
For the years ended February 28 29 2024 2023 and 2022 the Company recognized 2 335 4 367 and 4 161 respectively in compensation expense related to PlushCare stock options As of February 29 2024 approximately 212 of unrecognized compensation expense related to PlushCare stock options is expected to be recognized over a weighted average period of 0 7 years The aggregate intrinsic value of stock options exercised was 1 027 1 127 and 1 596 for the years ended February 28 29 2024 2023 and 2022 respectively
Time based restricted stock units have generally been subject to a vesting period of two to four years For two year grants one eighth of an award generally vests quarterly for the first year after the grant with the remainder vesting ratably on a monthly basis over the subsequent year For three year grants one third of an award generally vests one year after grant with the remainder vesting ratably on a monthly basis over the subsequent two years For four year grants one quarter of an award generally vests one year after grant and the remainder vests ratably on a monthly basis over the subsequent three years
For the years ended February 28 29 2024 2023 and 2022 the Company recognized 35 449 32 356 and 23 309 respectively in restricted stock unit compensation expense with 56 932 remaining of total unrecognized compensation costs related to these awards as of February 29 2024 The total unrecognized costs are expected to be recognized over a weighted average term of 2 0 years The weighted average grant date fair value of restricted stock units granted during the years ended February 28 29 2024 2023 and 2022 was 12 22 8 76 and 44 40 respectively
In connection with the PlushCare acquisition the agreement provided for the issuance of time based restricted stock units for 64 694 shares of common stock to existing PlushCare shareholders upon the achievement of the contingent consideration revenue milestones During the second quarter of fiscal 2023 57 124 of these restricted stock units were issued These restricted stock units are included in the table above
During fiscal 2023 performance based restricted stock units were approved to be issued as part of the Company s fiscal 2023 corporate bonus program In association with the Company s fiscal 2023 corporate bonus payout 747 687 fully vested RSUs were issued in May 2023 During the year ended February 28 2023 the Company recorded 4 663 in stock based compensation expense related to these performance based restricted stock units
During the year ended February 29 2024 the Company granted performance stock units PSUs to the Company s named executive officers These PSUs will vest after the fiscal year ending February 28 2026 based on achievement of performance metrics for revenue Adjusted EBITDA and Gross Dollar Retention for each of the fiscal years 2024 2025 and 2026 Stock based compensation costs associated with these PSUs are reassessed each reporting period based on estimated performance achievement The number of PSUs that will be issued to executive officers at the end of the performance period will be between 0 and 200 of the grant based on the actual achievement of performance metrics
Expense for these awards is recognized using graded amortization For the year ended February 29 2024 the Company recognized 281 in PSU expense related to these awards with 3 972 remaining total unrecognized compensation costs related to these awards as of February 29 2024 The total unrecognized costs are expected to be recognized over a weighted average term of 2 3 years The weighted average grant date fair value of PSUs granted during the year ended February 29 2024 was 12 23
Under the ESPP eligible employees can purchase the Company s common stock through accumulated payroll deductions at such times as are established by the compensation committee Eligible employees may purchase the Company s common stock at 85 of the lower of the fair market value of the Company s common stock on the first day of the offering period or on the last day of the offering period Eligible employees may contribute up to 15 of their eligible compensation Under the ESPP a participant may not accrue rights to purchase more than 25 000 worth of the Company s common stock for each calendar year in which such right is outstanding
therefore the ESPP is a compensatory plan under this guidance Accordingly share based compensation expense is determined based on the option s grant date fair value as estimated by applying the Black Scholes option pricing model and is recognized over the withholding period The Company recognized share based compensation expense of 1 506 1 332 and 1 749 during the years ended February 28 29 2024 2023 and 2022 respectively related to the ESPP
During the years ended February 28 29 2024 2023 and 2022 employees who elected to participate in the ESPP purchased a total of 512 235 560 345 and 140 838 shares of common stock respectively resulting in cash proceeds to the Company of 3 579 2 927 and 4 309 respectively An additional 1 263 has been withheld via employee payroll deductions who have opted to participate in the next stock purchase plan period ending May 2024
the acquisition of Innovation Specialists LLC d b a 2nd MD 2nd MD on March 3 2021 several 2nd MD individuals entered into agreements with the Company whereby these individuals are eligible to receive an aggregate of 608 332 shares that required continued employment with the Company These shares are excluded from the above restricted stock units table Included in the 608 332 shares are 281 531 shares that were also contingent upon the achievement of the contingent consideration milestones These shares are considered compensatory in the post business combination periods due to the additional service requirement for these individuals These shares vested 50 on the first anniversary of the acquisition date and 50 on the second anniversary of acquisition date As a result of the achievement of certain revenue milestones the contingent consideration milestones a total of 256 418 of the eligible 281 531 shares were issued to such shareholders As of February 29 2024 there were no unvested shares outstanding The Company recognized stock based compensation expense of 4 015 and 23 138 during the years ended February 28 2023 and 2022 respectively including 8 981 of accelerated expense related to certain separation and transition agreements entered into during fiscal 2022
the acquisition of PlushCare certain PlushCare individuals entered into agreements with the Company whereby these individuals are eligible to receive an aggregate of 806 161 shares that require continued employment with the Company These shares are excluded from the above restricted stock units table These shares are considered compensatory in the post business combination p
eriods due to the additional service requirement for these individuals One third of these shares vested on the first anniversary of the acquisition date one third vested on the second anniversary of acquisition date and one third will vest on the third anniversary of the acquisition date As of February 29 2024 there were 268 720 unvested shares outstanding with a grant date fair value of 52 52 per share The Company recognized stock based compensation expe
se of 14 182 14 113 and 10 208 during the years ended February 28 29 2024 2023 and 2022 respectively The unamortized compensation expense of 3 905 will be recognized over a weighted average remaining period of 0 3 years
The Company sponsors a defined contribution retirement plan named the Accolade Inc 401 k Plan 401 k Plan Under the 401 k Plan eligible employees may contribute up to the maximum allowed by law Eligible employees are eligible for Company matching contributions on the first quarter following their one year anniversary date which are dollar for dollar up to 3 5 of an employee s eligible compensation up to 100 in annual compensation Employer contributions are vested over a period of four years of service The 401 k Plan includes an employer discretionary profit sharing contribution feature to allow the Company to make a contribution to eligible employees 401 k Plan accounts Profit sharing contributions are vested over a period of four years of service The Company incurred expenses related to matching contributions totaling 2 903 3 231 and 2 278 for the years ended February 28 29 2024 2023 and 2022 respectively which were funded subsequent to each respective year end
Income tax expense benefit for the fiscal years ended February 28 29 2024 2023 and 2022 differ from the U S statutory income tax rate primarily due to changes in valuation allowances state income taxes goodwill impairment and stock based compensation
The tax expense for the year ended February 29 2024 primarily relates to the profitability of the PCs and the Company s foreign subsidiary The tax benefit for the year ended February 28 2023 relates to the partial release of the reversal of the deferred tax liability associated with the basis difference in goodwill from the 2nd MD acquisition The goodwill impairment recorded in the first quarter of fiscal 2023 required the Company to reverse that deferred tax liability in the amount of 3 899 and recognize a tax benefit during the year ended February 28 2023
Deferred 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 for income tax purposes The Company makes significant judgments regarding the realizability of its deferred tax assets principally net operating losses The carrying value of deferred tax assets is based on the Company s assessment that it is more likely than not that the Company will realize these
Deferred tax liabilities are included in other noncurrent liabilities on the consolidated balance sheet Net operating loss NOL carryforwards amounted to 501 600 and 453 323 for U S federal and 448 518 and 402 376 for U S states at February 28 29 2024 and 2023 respectively These NOL carryforwards related to the 2010 through current 2022 tax periods At
none of the NOL carryforwards were subject to expiration until 2030 The NOL carryforwards expiring in years 2030 through 2037 make up 61 189 of the recorded deferred tax asset The remaining deferred tax asset relating to NOL carryforwards of 64 782 have an indefinite expiration In addition to NOL carryforwards research and development tax credit carryforwards amounted to 432 for U S federal and U S states at
These tax credit carryforwards will expire in 2036 Under Section 382 of the Internal Revenue Code the yearly utilization of a corporation s NOL carryforwards may be limited following a change in ownership of greater than 50 by value over a three year period The yearly limitation is based on the value of the corporation immediately before the ownership change multiplied by the federal long term tax exempt rate If a loss is not utilized in a year after an ownership change that yearly limit is carried forward to future years for the balance of the NOL carryforward period As of
Management assesses the available positive and negative evidence to estimate if a valuation allowance is required to be recorded against existing deferred tax assets The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible Management considers the scheduled reversal of deferred tax liabilities projected future taxable income and tax planning strategies in making this assessment Based upon the Company s brief operating history and the net losses incurred since inception management does not believe that it is more likely than not that the Company will realize the benefits of these deductible differences in the U S As a result a full valuation allowance has been provided at
U S income and foreign withholding taxes have not been recognized on the excess of the amount for financial reporting over tax basis of the investments in foreign subsidiaries that is indefinitely reinvested outside the U S The foreign subsidiary is identified as a branch for U S tax purposes and therefore a gross temporary difference for investment basis differences is not applicable
The Company had no material accrual for uncertain tax positions or interest or penalties related to income taxes on the Company s consolidated balance sheets at February 28 29 2024 and 2023 and has not recognized any material uncertain tax positions or interest and or penalties related to income taxes in the consolidated statement of operations for the years ended February 28 29 2024 2023 and 2022
As the Company has reported net losses for each of the periods presented all potentially dilutive securities are antidilutive The following potential outstanding shares of common stock were excluded from the computation of diluted net loss per common share for the periods presented because including them would have been antidilutive
The Company is involved in various claims inquiries and legal actions arising in the ordinary course of business In the opinion of management the ultimate disposition of these matters is not expected to have a material adverse effect on the Company s financial position or liquidity
was filed in the United States District Court for the Northern District of California against the Company s wholly owned subsidiary PlushCare Inc The complaint as amended alleges that certain of PlushCare s subscription payment practices violate California and other state automatic renewal laws and the Federal Electronic Funds Transfer Act among other claims arising from allegations that PlushCare failed to provide adequate disclosures to members The lawsuit seeks restitution of subscription fees statutory damages for each violation subject to trebling reasonable attorneys fees and injunctive relief Under the terms of the agreement to purchase PlushCare the selling shareholders will indemnify Accolade for losses related to this matter subject to a cap The parties agreed to a settlement for 3 700 The court issued a final approval and final judgment in July 2023 The Company paid the settlement in full in September 2023 pursuant to the terms of the court approved settlement The Company has been reimbursed by third party insurance for a majority of the liability and the remainder of the liability was subject to indemnification and reimbursement from cash and stock escrows set up as part of the Company s acquisition of PlushCare which was settled in the fourth quarter of fiscal 2024
Certain officers of the Company have employment agreements providing for severance continuation of benefits and other specified rights in the event of termination without cause including in the event of a change of control of the Company as defined in the agreements
The Company has minimum required purchase commitments of 40 323 pursuant to an agreement primarily related to cloud computing services Portions of the total purchase commitment are required to be met prior to the end of each contract year September 30 in each of fiscal years 2023 through 2027 If total purchases in a contract year do not meet the portion of the commitment required for that year the shortfall must be prepaid and can be used for future purchases through September 30 2027 As of February 29 2024 the Company has remaining future purchase commitments under this agreement of 22 588
During the year ended February 28 2023 the Company initiated certain measures to accelerate the integration of recent acquisitions through strategic reductions in the Company s workforce including increasing hiring in lower cost regions to support its growth scale and profitability objectives As a result severance expense was recorded for the impacted employees

Company Name	Accolade, Inc. Vist SEC web-site
Category	SERVICES-BUSINESS SERVICES, NEC
Trading Symbol	ACCD