TIDMCHT

RNS Number : 9676S

Constellation Healthcare Tech, Inc

23 March 2016

THIS ANNOUNCEMENT AND THE INFORMATION CONTAINED HEREIN IS RESTRICTED AND IS NOT FOR RELEASE, PUBLICATION OR DISTRIBUTION, IN WHOLE OR IN PART, DIRECTLY OR INDIRECTLY, IN, INTO OR FROM THE UNITED STATES, AUSTRALIA, CANADA, JAPAN, SOUTH AFRICA OR ANY OTHER JURISDICTION IN WHICH SUCH RELEASE, PUBLICATION OR DISTRIBUTION WOULD BE UNLAWFUL.

23 March 2016

Constellation Healthcare Technologies, Inc.

("Constellation Healthcare Technologies", "CHT", "Company" or the "Group")

Preliminary Announcement of Final Results for the Year Ended 31(st) December 2015

Key Performance Indicators

 
                                    FY- 2015      FY - 2014 
 -----------------------  ------  ------------  ------------ 
 REVENUE                   +40%    $76.7   *     $54.6   * 
-----------------------   ------  ------  ----  ------  ---- 
 Income from 
  Operations               +76%    $19.2   25%   $10.9   20% 
-----------------------   ------  ------  ----  ------  ---- 
 Profit Before 
 Tax                       +356%   $11.4   15%    $2.5   5% 
-----------------------   ------  ------  ----  ------  ---- 
 EBITDA                    +68%    $23.9   31%   $14.2   26% 
-----------------------   ------  ------  ----  ------  ---- 
 RCM Revenue               +76%    $50.1   65%   $28.4   52% 
-----------------------   ------  ------  ----  ------  ---- 
 RCM EBITDA                +115%   $16.1   21%    $7.5   14% 
-----------------------   ------  ------  ----  ------  ---- 
 CASH FROM OPERATIONS      +91%    $15.5   20%    $8.1   15% 
------------------------  ------  ------  ----  ------  ---- 
 
 

* % of FY15 revenue

All amounts USD$M

Highlights

   --     Revenue Increased by 40% to $76.7M ($54.6M in 2014) 
   --     Cash from Operations increased by 91% to $15.5M ($8.1M in 2014 ) 
   --     9000+ US Physicians being currently serviced 
   --     RCM business revenue increased by 76% to $50.1M ($28.4M in 2014) 
   --     RCM EBITA increased by 115% to $16.1M ($7.5M in 2014) 
   --     8.8% organic growth in RCM business 
   --     Appointment of Sir Rodney Aldridge as Non-Executive Director and Sam Zaharis as CFO 

-- Three successful acquisitions and integration to the CHT platform during the year; Physicians Practice Plus Inc. (PPP), Phoenix Healthcare, LLC ("Phoenix") and Northstar First Health, LLC ("NorthStar")

Paul Parmar, Chief Executive Officer of Constellation Healthcare Technologies, commented, "CHT enjoyed a successful year across all metrics. We increased our revenue base and more importantly, significantly increased our profitability for the year. Our acquisition and integration strategy is proven and we are quickly becoming one of the largest healthcare and technology services businesses in the U.S, serving the billing requirements of 9,000+ doctors."

Enquiries:

 
 Constellation Healthcare             c/o Redleaf Communications 
  Technologies                                    +44 (0)20 7382 
  Paul Parmar, Chief Executive                              4730 
  Officer / 
  Sotirios 'Sam' Zaharis, Chief 
  Financial Officer 
 Redleaf Communications -                         +44 (0)20 7382 
  PR adviser                                                4730 
  Charlie Geller / Harriet           constellation@redleafpr.com 
  Lynch 
 finnCap - Nominated Adviser 
  and Joint Broker 
  Julian Blunt / Scott Mathieson 
  - corporate finance 
  Simon Johnson - corporate                       +44 (0)20 7220 
  broking                                                   0568 
 Stifel Nicholas Europe Limited 
  - Joint Broker                                  +44 (0)20 7710 
  Jonathan Senior / Ben Maddison                            7600 
 

Chief Executive's Review

The Company is always evaluating new acquisitions and we spend significant time and resources micro analysing potential deals. The acquisitions we do make must meet very strict and immovable criteria. Only once this is met can we be confident that we can achieve the value accretion we require.

Given the strict criteria for making acquisitions it was very pleasing to complete three accretive transactions in the year. In March, we acquired PPP for a maximum cash consideration of up to $20 million. PPP is a New York-based collection of Revenue Cycle Management businesses for healthcare providers. In September, we also acquired NorthStar for a maximum consideration of $18M and Phoenix for $14M.

NorthStar is a New Jersey based RCM business, and we expect to collect an additional $170m annually from doctors as a result of this acquisition. Phoenix is a New Jersey based group of RCM businesses, which also has a national clearing house operating in the worker's compensation and automobile claims processing vertical for healthcare providers. These complementary businesses added a number of new areas of expertise to CHT.

In December of last year we also returned to the equity market to raise GBP30m (approximately $45.5m) to fund further acquisitions. This fundraising closed shortly after the New Year and enabled us to acquire MDRX Medical Billing, LLC ("MDRX") in February 2016 for an initial consideration of $28.0 million. MDRX is a US based healthcare service provider primarily operating in the billing practice management and healthcare consulting space. MDRX has a nationwide presence and added approximately 3,500 doctors to the CHT platform. The majority of these doctors are from large sized hospital based groups.

The acquisition of MDRX means that CHT is now working with doctors in new territories, including Alabama, Louisiana, New Mexico and Utah. As a result of this transaction CHT is also now collecting approximately $2 billion annually for physicians across the US. The three acquisitions completed by CHT during the year together with the acquisition of MDRX after the year-end means that the Company now has 9,000+ physicians on its platform in the US.

Following the fundraise and the acquisition of MDRX, CHT has approximately $15.5M in the bank to fund additional acquisitions during 2016. In the meantime this money leaves the group net debt free (excluding deferred consideration) on a proforma basis.

CHT also grew organically and secured a number of new contracts in the year, including four new contracts in April. These four contracts were expected to see CHT collect approximately $136 million in billings annually on behalf of nearly 400 new doctors, resulting in approximately $6 - 7 million in annual revenue and approximately $2 - 3 million in annual EBITA.

Getting M&A right is just one part of the equation. CHT has also focused on getting the right team in place. CHT appointed Sir Rodney Aldridge as a non-executive director in July 2015. Sir Rodney is a shareholder and we believe his experience of acquiring and operating businesses will be invaluable. In addition, Sam Zaharis joined as our President and Chief Financial Officer in July. Sam brings a wealth of operational experience to our business and a proven track record in both M&A and, importantly, the successful integration of those businesses.

Financial Performance

The financial results for 2015 demonstrate that our unique business model is working successfully. CHT's revenues increased by 40.5% to $76.7M compared with the same period last year and EBITA increased by 63.3% from $14.2M in 2014 to $23.9M in 2015. The core Orion business is going from strength to strength and the other acquired businesses (NEMS, PPP, NorthStar, Phoenix and MDRX) are performing well.

Conversion of operating profit into cash flow was robust, demonstrating the cash generative nature of our business model. Cash Generated from operations increased by 91% from $8.1M in 2014 to $15.5M in 2015. Strong cash generation enabled us to invest significantly in capital expenditure. We continue to build efficiencies through better technology including workflow automation, business analytics, business intelligence, automated data transfer tools and the management of operations using various KPI's. The enabling software products, i.e. workflow automation, business intelligence and data extraction tools have reached a significant maturity in terms of their functionalities. We expect very little development and mostly maintenance expense going forward. The quality and cost of our operations, enabled by these proprietary technologies, continues to be superior to our competition and forms a fundamental part of our strategy.

Strategy

CHT is focused on acquiring healthcare service businesses across the U.S and improving revenue generation and profitability by utilizing CHT's proprietary technology. This is coupled with our efficient processing operation to give CHT a competitive edge. Organic growth is also a key driver going forward. CHT continues to increase the number of doctors using its platform and as of December 2015, it has over 10,000 independent practicing and hospital/contracting Physicians groups using its various service offerings. We expect that number will continue to grow this year and next.

Outlook

The U.S healthcare system remains complex while the number of people who continue to receive healthcare insurance and utilize the system continuously increases. This provides an excellent back drop for CHT to operate in and consolidate the sector in a major way.

Paul Parmar

Chief Executive Officer

Constellation Healthcare Technologies

CONSTELLATION HEALTHCARE TECHNOLOGIES, INC. AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS FOR YEAR ENDED DECEMBER 31, 2015

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Consolidated Balance Sheets

 
                                                       December                       December 
                                                       31, 2015                       31, 2014 
                                      -------------------------  ----------------------------- 
 
  Current assets 
   Cash and cash equivalents                        $ 2,516,379                   $ 18,136,336 
   Accounts receivable, net                          15,060,632                      8,601,001 
   Inventory                                            249,433                        382,745 
   Prepaid expenses and other 
    current assets                                      605,744                        663,644 
   Deferred finance costs                               409,455                        329,894 
   Deferred tax asset                                   252,000                        252,000 
                                      -------------------------  ----------------------------- 
   Total current assets                              19,093,643                     28,365,620 
                                      -------------------------  ----------------------------- 
 
  Property and equipment, net                         9,546,085                      4,170,363 
                                      -------------------------  ----------------------------- 
 
  Other long-term assets 
   Intangible assets, excluding 
    goodwill                                         35,263,534                     15,419,629 
   Goodwill                                          37,982,340                     13,722,379 
   Deferred tax asset                                 5,596,995                      4,018,178 
   Deferred finance costs                               307,088                        577,309 
   Deferred offering costs                               60,202                              - 
   Other assets, net                                    278,156                        223,796 
                                      -------------------------  ----------------------------- 
   Total other long-term assets                      79,488,315                     33,961,291 
   Total assets                                   $ 108,128,043                   $ 66,497,274 
                                      =========================  ============================= 
 
  Current liabilities 
   Accounts payable                                 $ 4,496,760                    $ 3,024,679 
   Accrued expenses                                   4,423,110                      1,823,586 
   Income taxes payable                               2,832,298                      1,271,858 
   Current portion of capital 
    lease obligation                                      2,172                         29,107 
   Current portion of long-term 
    debt                                             11,579,428                      4,631,771 
   Current portion of contingent 
    consideration                                             -                        638,700 
   Payable to Sellers                                 1,967,141                              - 
   Total current liabilities                         25,300,909                     11,419,701 
                                      -------------------------  ----------------------------- 
 
  Long-term liabilities 
   Long-term debt, net of 
    current portion                                   3,342,921                     16,327,108 
   Contingent consideration                          10,453,631                              - 
   Deferred rent liability                              605,149                        532,349 
   Deferred tax liability                             7,510,042                      4,156,491 
   Total long-term liabilities                       21,911,743                     21,015,948 
                                      -------------------------  ----------------------------- 
 
  Commitments and Contingencies 
 
  Stockholders' equity (deficit) 
   Common stock, par value 
    $0.0001; 150,000,000 shares 
    authorized at December 
    31, 2015 and 111,226,912 
    shares authorized at December 
    31, 2014; 64,990,623 shares 
    issued and outstanding 
    at December 31, 2015 and 
    55,615,056 shares issued 
    and outstanding at December 
    31, 2014.                                             6,500                          5,562 
   Additional paid-in capital                        49,163,637                     29,488,953 
   Retained earnings                                 11,575,405                      4,567,110 
   Accumulated other comprehensive 
    loss                                               (79,519)                              - 
 
   Total stockholders' equity 
    (deficit)                                        60,666,023                     34,061,625 
   Non-controlling interest 
    in consolidated entity                              249,368                              - 
   Total liabilities and 
    stockholders' equity (deficit)                $ 108,128,043                   $ 66,497,274 
                                      =========================  ============================= 
 

Consolidated Statements of Operations

 
                                                 Year ended                      Year ended 
                                       -----------------------------  ------------------------------- 
                                                  December                        December 
                                                   31, 2015                        31, 2014 
                                       -----------------------------  ------------------------------- 
 
  Revenues                                              $ 76,735,069                     $ 54,605,827 
                                       -----------------------------  ------------------------------- 
 
  Operating expenses: 
    Salaries and benefits                                 21,465,227                       17,334,464 
    Facility rent and related 
     costs                                                 3,318,017                        2,538,546 
    Depreciation                                           1,327,392                        1,363,293 
    Amortization                                           3,378,174                        1,887,247 
    Professional and consulting 
     fees                                                 15,629,191                       10,139,620 
    Insurance                                                444,081                          651,211 
    Provision for doubtful 
     accounts                                                733,764                          427,643 
    Vaccines and medical 
     supplies                                              4,417,260                        4,371,464 
    Office and computer 
     supplies                                                232,443                          288,622 
    Postage and courier                                    1,807,249                        1,891,431 
    Other                                                  4,783,213                        2,728,127 
   Total operating expenses                               57,536,011                       43,621,668 
                                       -----------------------------  ------------------------------- 
  Income from operations                                  19,199,058                       10,984,159 
                                       -----------------------------  ------------------------------- 
 
  Other income (expenses): 
    Interest expense                                     (2,579,398)                      (3,035,955) 
    Change in fair value 
     of contingent consideration                         (1,075,899)                                - 
    Fees paid to debt providers                                    -                      (2,164,089) 
    Debt related expenses                                          -                      (3,213,194) 
    Other expense, net                                   (4,192,337)                         (44,997) 
                                       -----------------------------  ------------------------------- 
   Total other income (expenses), 
    net                                                  (7,847,634)                      (8,458,235) 
                                       -----------------------------  ------------------------------- 
 
  Income before provision for 
   income taxes                                           11,351,424                        2,525,924 
 
   Provision for income taxes                              4,392,347                          888,071 
                                       -----------------------------  ------------------------------- 
 
  Net income                                             $ 6,959,077                      $ 1,637,853 
                                       =============================  =============================== 
  Loss from consolidated entity 
   attributable to non-controlling 
   interest                                                 (49,217)                                - 
 
  Net Income attributable to 
   the company                                             7,008,294                        1,637,853 
 
  Other Comprehensive Loss, 
   net of tax 
   Foreign currency translation 
    adjustments                                             (79,519)                                - 
  Other Comprehensive Loss                                  (79,519) 
 
  Comprehensive Income                                   $ 6,928,775                      $ 1,637,853 
                                       =============================  =============================== 
 
  Income per common shares 
    Basic 
    Common Stock                                              $ 0.11                           $ 0.45 
   Diluted 

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   Common Stock                                               $ 0.11                           $ 0.45 
 
 Weighted average number of 
  shares for basic 
    Common Stock                                          61,061,591                        3,657,815 
 Weighted average number of 
  shares for Diluted 
    Common Stock                                          61,061,591                        3,657,815 
 

Consolidated Statements of Cash Flows

 
                                                         Year ended                      Year ended 
                                              -------------------------------  ----------------------------- 
                                                     December 31, 2015               December 31, 2014 
                                              -------------------------------  ----------------------------- 
Cash Flow from operating activities: 
 Net Income                                                       $ 6,928,775                    $ 1,637,853 
 Adjustments to reconcile net income 
  to net cash provided by operating 
  activities: 
  Provision for doubtful accounts                                     733,764                        427,643 
  Depreciation                                                      1,327,392                      1,363,293 
  Amortization                                                      3,378,174                      1,887,247 
  Deferred Tax                                                      1,761,921                      (208,282) 
  Provision for taxes                                               2,630,426                      1,096,353 
  Change in fair value of contingent 
  consideration                                                     1,075,899                              - 
  Foreign currency exchange loss                                       39,498                              - 
  Conversion of PIK interest to principal                                   -                         54,708 
  Amortization of deferred finance fees                               363,044                      1,759,984 
   Debt related expenses paid by parent                                     -                      2,905,000 
   Loss from consolidated entity 
   attributable to non-controlling interest                          (49,217)                              - 
  Changes in operating assets and 
  liabilities: 
   Accounts receivable                                            (5,279,143)                    (3,346,577) 
   Inventory                                                          133,314                       (42,755) 
   Prepaid expenses and other assets                                   57,900                        632,530 
   Deferred offering cost                                            (60,202)                              - 
   Other assets                                                      (54,360)                            624 
   Accounts payable, accrued expenses                               5,895,190                       (12,456) 
   Income tax payable                                             (2,893,572)                              - 
   Change in fair value of contingent 
   consideration                                                    (537,199)                              - 
   Other liabilities                                                        -                       (97,000) 
Net cash provided by operating activities                          15,451,604                      8,058,164 
                                              -------------------------------  ----------------------------- 
 
Cash flows from investing activities 
 Cash outlay for property and equipment                           (6,703,114)                       (68,662) 
 Cash acquired from acquisition                                             -                         11,900 
 Development of software tool                                     (3,078,701)                    (4,960,714) 
 Net deposits to restricted cash                                            -                         97,000 
 Capital Paid for Acquisition                                    (34,650,000)                              - 
Net cash used in investing activities                            (44,431,815)                    (4,920,476) 
                                              -------------------------------  ----------------------------- 
 
Cash flows from financing activities 
 Payments of capital lease obligations                               (26,935)                       (21,174) 
 Borrowings on line of credit                                               -                              - 
 Payments on line of credit                                                 -                      (500,000) 
 Payments on long term loan                                       (6,036,530)                   (24,072,889) 
 Net proceeds from long term debt                                           -                     23,000,000 
 Cash outlay for deferred finance costs                             (172,384)                      (414,541) 
 Distribution to parent                                                     -                    (4,389,756) 
 Dividends paid                                                     (176,390)                              - 
 Contribution from parent                                           1,000,000                      3,910,350 
 Proceeds from sale of stock, net of related 
  fees                                                             18,852,012                     13,466,231 
Net cash provided by financing activities                          13,439,773                     10,978,222 
                                              -------------------------------  ----------------------------- 
 
Effect of exchange rate changes in cash                              (79,519)                              - 
Net increase in cash and cash equivalents                        (15,619,957)                     14,115,910 
 
Cash and cash equivalents, beginning of 
 period                                                            18,136,336                      4,020,426 
Cash and cash equivalents, end of period                          $ 2,516,379                   $ 18,136,336 
                                              ===============================  ============================= 
 
 
                                                   Year ended                         Year ended 
                                         -----------------------------  ------------------------------------ 
                                                    December                           December 
                                                     31, 2015                          31, 2014 
                                         -----------------------------  ------------------------------------ 
 Supplemental Cash Flow Information 
  Cash Paid for interest                                   $ 2,579,398                           $ 2,931,240 
  Cash Paid for Income Taxes                                 1,050,000                                     - 
 
 Supplemental Schedule of Non-Cash 
 Investing and Financing Activities 
  Notes payable issued for accrued 
   interest                                                        $ -                             $ 162,716 
 

YEAR ENDED DECEMBER 31, 2015

 
                                       Common Stock 
                     ----------------------------------------------- 
                           Shares                     Amount                    Paid-in                     Retained                      Accumulated                   Non-controlling                  Total 
                                                                                 Capital                    Earnings                          other                         interest 
                                                                                                                                          comprehensive                  in consolidated 
                                                                                                                                              loss                           entity 
                     -----------------       -----------------------       -----------------       -------------------------       -------------------------       -------------------------       ----------------- 
  Balances, January 
   1, 2014                       1,000    $                        1    $         16,214,070    $                  2,929,257    $                          -    $                          -    $         19,143,328 
  Proceeds from 
   sale 
   of stock, net of 
   related 
   fees                     55,614,056                         5,561              13,460,670                               -                               -                               -              13,466,231 
  Distributions to 
   parent                            -                             -             (4,389,756)                               -                               -                               -             (4,389,756) 
  Contribution from 
   parent                            -                             -               3,910,350                               -                               -                               -               3,910,350 
 
   Deal fees and 
   deferred 
   financing fees 
   paid 
   by parent                         -                             -               4,623,315                               -                               -                               -               4,623,315 
  Effect of push 
   down 
   accounting                        -                             -             (4,329,696)                               -                               -                               -             (4,329,696) 
  Net income for 

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   2014                              -                             -                       -                       1,637,853                               -                               -               1,637,853 
                     -----------------       -----------------------       -----------------       -------------------------       -------------------------       -------------------------       ----------------- 
  Balances, 
   December 
   31, 2014                 55,615,056    $                    5,562    $         29,488,953    $                  4,567,110    $                          -    $                          -    $         34,061,625 
                     =================       =======================       =================       =========================       =========================       =========================       ================= 
 
  Proceeds from 
   sale 
   of stock, net of 
   related 
   fees                      9,375,567    $                      938    $         18,851,074    $                          -    $                          -    $                          -    $         18,852,012 
  Contribution from 
   parent                            -                             -               1,000,000                               -                               -                               -               1,000,000 
  Dividends Paid                     -                             -               (176,390)                               -                               -                               -               (176,390) 
  Other 
   Comprehensive 
   Loss                              -                             -                       -                               -                        (79,519)                               -                (79,519) 
  Non-controlling 
   interest 
   in consolidated 
   entity                            -                             -                       -                               -                               -                         298,585                 298,585 
  Net income for 
   2015                              -                             -                       -                       7,008,295                               -                        (49,217)               6,959,078 
  Balances, 
   December 
   31, 2015                 64,990,623    $                    6,500    $         49,163,637    $                 11,575,405    $                   (79,519)    $                    249,368    $         60,915,391 
                     =================       =======================       =================       =========================       =========================       =========================       ================= 
 
   1.       Segment reporting information 
 
                                             Year ended                           Year ended 
                                               December                            December 
                                               31, 2015                            31, 2014 
                                ------------------------------------  --------------------------------- 
 Revenue Cycle Management 
 Revenues                                               $ 50,131,907                       $ 28,425,915 
 Depreciation, Depletion 
  and Amortization                                         3,769,051                          2,249,960 
 Operating Income before 
  Depreciation & Amortization                             16,145,524                          7,549,170 
 
 GP & Corporate 
 Revenues                                                  7,666,437                          7,048,604 
 Depreciation, Depletion 
  and Amortization                                           930,444                            991,481 
 Operating Income before 
  Depreciation & Amortization                              6,338,577                          5,179,558 
 
 Practice Management: 
 Revenues                                                 18,936,725                         19,131,308 
 Depreciation, Depletion 
  and Amortization                                             6,071                              9,099 
 Operating Income before 
  Depreciation & Amortization                              1,420,523                          1,505,971 
 

Corporate expenses that are incurred for the company's general administration have not been apportioned to other business segments. These costs are grouped under General Purchasing and Corporate segment.

The operating segments are identified and reported on the basis of internal reports about components of the group that are regularly reviewed by the Management Board to assess the performance of the segments.

The group's internal management reporting is structured primarily on the basis of the market segments in which the 3 operating segments - Revenue Cycle Management, Practice Management and General Purchasing (GP) & Corporate - operate.

Management assesses the performance of segments based on the measures of revenue and earnings before depreciation, interest and taxes (EBDIT), whereby the EBDIT measure includes allocations of expenses from supporting functions within the group.

Company runs shared services for each of its three segments. All resources, who form part of general management & administration, HR, finance and accounting, IT, call center are part of shared services that are used by one or more segments and have been included in the reallocation.

Such allocations have been determined by the best management estimates based on number of resources served, volume of transactions processed and or relevant measures that reflect the level of benefits of these functions to each of the operating segments. As the 3 operating segments serve only external customers, there is no inter-segment revenue. Interest income and expenses and tax are not allocated to the segments. There is no measure of segment (non-current) assets and/or liabilities provided to the Management Board.

Reconciliation of reportable segment revenues and profit to the consolidated totals

 
                                                Year ended                            Year ended 
                                               December 31,                            December 
                                                   2015                                31, 2014 
                                  -------------------------------------  ----------------------------------- 
 Total Revenues for 
  reportable segments                                      $ 76,735,069                         $ 54,605,827 
 Total Consolidated 
  revenues                                                 $ 76,735,069                         $ 54,605,827 
                                  =====================================  =================================== 
 
 Operating profit before 
  depreciation and amortization 
  for reportable segments                                  $ 23,904,624                         $ 14,234,699 
 Depreciation & amortization                                (4,705,566)                          (3,250,540) 
 Interest expense                                           (2,216,354)                          (3,035,955) 
 Contingent consideration 
  adjustment                                                (1,075,899)                                    - 
 Fees paid to debt providers                                          -                          (2,164,089) 
 Amortization of deferred 
  finance fees                                                (363,044)                          (3,213,194) 
 Other income (expense), 
  net                                                       (4,192,337)                             (44,997) 
 Provision for income 
  taxes                                                     (4,392,347)                            (888,071) 
  Net income (loss)                                         $ 6,959,077                          $ 1,637,853 
                                  =====================================  =================================== 
 
   2.       Intangible Assets, excluding Goodwill, net 

Intangible assets, excluding goodwill, net consist of the following at December 31, 2015 and 2014:

 
                                             December                          December 
                                             31, 2015                          31, 2014 
                        -----------------------------  -------------------------------- 
 Software tool - work 
  in progress                            $ 17,083,401                       $ 7,056,043 
 Client relationships                      11,862,138                         8,380,000 
 Management service 
  agreements                                2,000,000                         2,000,000 
 Group Purchasing 
  agreements                                  600,000                           600,000 
 Trade Name                                 3,349,536                           220,000 
 Non-Compete                                6,598,047                            15,000 
                        -----------------------------  -------------------------------- 
                                           41,493,122                        18,271,043 
 Less accumulated 
  amortization                            (6,229,588)                       (2,851,414) 
                        -----------------------------  -------------------------------- 
 Net amount                              $ 35,263,534                      $ 15,419,629 
                        -----------------------------  -------------------------------- 
 

Estimated future annual amortization of our identifiable intangible assets is as follows:

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