MOUNT LAUREL, N.J.,
Nov. 11, 2010 /PRNewswire-FirstCall/
-- MedQuist Inc., (Nasdaq: MEDQ) a leading provider of integrated
clinical documentation solutions for the U.S. healthcare industry
announced its financial results for the third quarter ended
September 30, 2010.
Third Quarter Highlights:
- Revenue increased by 34.0% to $102.9
million compared to $76.8
million for the same quarter in the prior year due primarily
to the incremental volumes of the acquired Spheris
operations.
- Realized third quarter cost savings from the Spheris
acquisition of $4.0 million and on
track to achieve $7.0 million for
fourth quarter, or annualized savings of $28.0 million.
- Adjusted EBITDA increased 56.8% to $21.5 million, or 20.9% of net revenues versus
17.8% for the same quarter in the prior year, reflecting the
benefits of realized synergies from the Spheris acquisition,
increased technology utilization, and expanded offshore
production. (For more information regarding Adjusted EBITDA and
our use of this non-GAAP financial measure, please refer to the
section titled "Use of non-GAAP Financial Information").
- This is the first quarter reflecting the full impact of the
results of Spheris, acquired April 22,
2010.
"We are pleased with our operating performance for the third
quarter of 2010," said CEO Peter
Masanotti. "Our net revenues increased 34.0% during the
third quarter compared to the same period in the prior year, due
largely to third quarter of 2010 being the first full quarter that
included the impact of the Spheris acquisition. Historical
Spheris volumes had been declining prior to our acquisition of this
business, and although we believe we have stabilized these volumes,
the carryover impact of historical losses may impact us in future
periods. Our increases in revenues were partially offset by
the impact of pricing and lower non-core maintenance service
revenues.
"We increased Adjusted EBITDA by 56.8% over the prior year same
quarter despite an increasingly competitive market environment as
the Spheris acquisition helped expand our customer base and
provided continuing opportunities to realize operating
efficiencies. We continue to see improvements to our operating
margins as a result of efficiencies gained through use of our
speech recognition technologies and expanded use of offshore labor.
We are also pleased with the results of integration efforts
from the Spheris acquisition and expect that the majority of the
synergies associated with this acquisition will be realized by
mid-year 2011."
Third Quarter Results
Net revenues increased $26.1
million, or 34.0%, to $102.9
million for the three months ended September 30, 2010 compared with $76.8 million for the three months ended
September 30, 2009. The acquisition
of Spheris contributed $32.8 million
in net revenues for the three months ended September 30, 2010 versus the same period in the
prior year. This increase was offset by a decrease in legacy
maintenance services revenues which were $4.1 million and $5.1
million for the three months ended September 30, 2010 and 2009, respectively.
Current year net revenues were also unfavorably impacted by
effects of lower average pricing realized for our transcription
services.
As a percentage of net revenues, cost of revenues decreased to
66.5% for the three months ended September
30, 2010 from 68.7% for the same period in 2009. This
improvement was achieved through leveraging speech recognition
technologies and increased offshore production as well as overhead
savings realized as a result of the Spheris integration efforts.
Our use of speech recognition technology increased from 59%
of our volume in the third quarter of 2009 to 72% of our volume
during the third quarter of 2010. Additionally, expanded
utilization of our offshore resources enabled us to increase our
offshore production from 21% of our volume to 34% of our volume
over this same period.
Total operating costs and expenses increased by 30.5% to
$89.6 million during the third
quarter from $68.7 million in the
prior year comparable period primarily due to the inclusion of
incremental direct costs of revenues associated with the
acquisition of Spheris and $0.8
million of acquisition related costs. Amortization
expense increased by $1.9 million
during the current year period versus the same comparable period in
the prior year primarily due to amortization of acquired intangible
assets associated with the acquisition of Spheris. Also
included in the third quarter results were legal proceedings and
settlement expenses and restructuring charges in the amounts of
$0.6 million and $0.5 million, respectively.
Adjusted EBITDA for the third quarter of 2010 improved to 20.9%
of net revenues versus 17.8% for the same period in the prior year.
The Company's improved operating performance during the third
quarter of 2010 reflects substantial progress on operating
initiatives related to leveraging technology and offshore
production resources as well as the Company's progress in
successfully integrating the Spheris acquisition. The impact
of cost savings and synergies which we have implemented since the
Spheris acquisition are expected to yield $7.0 million of cost savings in the fourth
quarter of 2010 representing an annualized savings of $28.0 million. Of these savings
$4.0 million were realized during the
quarter ended September 30, 2010.
Net income for the third quarter of 2010 was $9.0 million or $0.24 per diluted share compared to $9.7 million and $0.26 per diluted share reported in the prior
year comparable period.
Year-To-Date Results
Net revenues increased $41.2
million, or 17.7%, to $274.4
million for the nine months ended September 30, 2010 compared with $233.3 million for the nine months ended
September 30, 2009. The acquisition
of Spheris contributed $58.2 million
in net revenues for the nine months ended September 30, 2010 versus the same period in the
prior year. This increase was offset by a decrease in legacy
maintenance services revenues which were $12.9 million and $16.0
million for the nine months ended September 30, 2010 and 2009, respectively.
Current year net revenues were also unfavorably impacted by
effects of lower average pricing of transcription service
revenues.
As a percentage of net revenues, cost of revenues decreased to
67.5% for the nine months ended September
30, 2010 from 67.7% for the same period in 2009. This
improvement was achieved through leveraging speech recognition
technologies and increased offshore production as well as overhead
savings realized as a result of the Spheris integration efforts.
The increase in cost of revenues versus the prior year period
was primarily due to direct incremental costs associated with the
incremental Spheris volumes as well as a nonrecurring $1.2 million credit during 2009 related to
medical claims costs, which also impacted prior year margin
percentages.
Total operating costs and expenses increased by 14.9% to
$249.2 million for the nine-month
period ended September 30, 2010 from
$216.9 million in the prior year
comparable period primarily due to the inclusion of incremental
direct costs of revenues associated with the acquisition of Spheris
and $6.5 million of acquisition
related costs. Amortization expense increased by $3.7 million during the current year period
versus the same comparable period in the prior year primarily due
to amortization of acquired intangible assets associated with the
acquisition of Spheris. Also included for the nine-month
period ended September 30, 2010 were
legal proceedings and settlement expenses and restructuring charges
in the amount of $2.8 million and
$1.4 million, respectively.
Adjusted EBITDA as a percentage of net revenues was 18.8% for
the nine months ended September 30,
2010 versus 17.1% for the same prior year period. The
Company's improved operating performance during the nine months
ended September 30, 2010 reflects
substantial progress in operating initiatives related to leveraging
technology and offshore production resources as well as the
Company's progress in successfully integrating the Spheris
acquisition.
Net income for the nine-months ended September 30, 2010 was $17.2 million or $0.46 per diluted share compared to $17.4 million and $0.46 per diluted share for the prior year
comparable period.
In addition to the United States generally accepted
accounting principles, or GAAP, results provided throughout this
document, MedQuist has provided Adjusted EBITDA data that
is a non-GAAP financial measure. Adjusted EBITDA is Net income
excluding taxes, interest, equity in income of an affiliated
company, depreciation, amortization, cost of legal proceedings and
settlements, acquisition related charges, restructuring charges and
certain non-recurring accrual reversals.
Management believes that this non-GAAP financial measure used to
manage the business may provide our investors with useful
information in addition to the GAAP financial measures presented
here. The tables attached to this press release include a
reconciliation of this non-GAAP financial measure to the most
directly comparable GAAP financial measure and a description of why
we believe the non-GAAP financial measure is useful to
investors.
Subsequent Events
As previously announced, on October 14,
2010, the Company completed a refinancing program whereby
the Company secured $310.0 million of
financing, consisting of a $225.0
million senior secured credit facility, which includes a
$200.0 million term loan and an
undrawn $25.0 million revolving
credit facility, and $85.0 million
aggregate principal amount of senior subordinated notes. The
proceeds were used to repay debt incurred related to prior
acquisitions and to pay a special cash dividend of $4.70 per share of common stock to the Company's
shareholders.
In October 2010, MedQuist sold its
ownership of A-Life Medical Inc. ("A-Life") in return for cash
consideration of $23.8 million.
We anticipate recognition of a gain on the sale of
approximately $9.6 million and to
receive approximately $19.1 million
of cash from the sale during November of 2010 and the residual
during 2012. MedQuist's investment in A-Life has been
accounted for under the equity method and therefore the sale does
not impact either revenues or Adjusted EBITDA. Upon receipt
of our cash from the A-life sale, we expect to have approximately
$40.0 million in cash and
approximately $285.0 million in
debt.
On October 18, 2010, CBaySystems
Holdings Limited ("CBay Holdings"), the parent of CBay, Inc, the
holder of 69.5% of the outstanding common stock of MedQuist, filed
a registration statement on Form S-1 with the U.S. Securities and
Exchange Commission ("SEC") relating to a proposed public offering
of its common stock in the United
States. CBay Holdings also filed a registration statement on
Form S-4 with the SEC relating to a proposed exchange offer
pursuant to which CBay Holdings expects to offer to exchange shares
of CBay Holdings common stock for outstanding shares of
MedQuist common stock. MedQuist will not be a party to the proposed
exchange offer. On September 30,
2010, certain of MedQuist's noncontrolling shareholders
entered into an exchange agreement (the "MedQuist Exchange") with
CBay Holdings, pursuant to which those shareholders will receive
4.2459 CBay Holdings shares of common stock for each MedQuist share
of common stock, subject to certain adjustments relating to the
level of MedQuist's net debt at closing of the MedQuist Exchange,
and will enter into a stockholders agreement with CBay Holdings
that, among other things, provides them with registration rights
and contains provisions regarding their voting in the election of
CBay Holdings' directors. The closing under the MedQuist Exchange
is conditioned upon the listing of CBay Holdings' shares on the
NASDAQ Stock Market the completion of the proposed public offering
by CBay Holdings in the United
States by January 31, 2011,
the reincorporation of CBay Holdings as a Delaware corporation and other conditions.
MedQuist is not a party to the MedQuist Exchange.
Forward-Looking Statements
This report contains forward-looking statements that are based
on current expectations, estimates, forecasts and projections about
us, the industry in which we operate and other matters, as well as
management's beliefs and assumptions and other statements regarding
matters that are not historical facts. These statements include, in
particular, statements about our plans, strategies and prospects.
For example, when we use words such as "projects," "expects,"
"anticipates," "intends," "plans," "believes," "seeks,"
"estimates," "should," "would," "could," "will," "opportunity,"
"potential" or "may," variations of such words or other words that
convey uncertainty of future events or outcomes, we are making
forward-looking statements within the meaning of Section 27A of the
Securities Act of 1933 and Section 21E of the Securities Exchange
Act of 1934. These statements are only predictions and, as such,
are not guarantees of future performance and involve risks,
uncertainties and assumptions that are difficult to predict. For a
discussion of these risks, uncertainties and assumptions, any of
which could cause our actual results to differ from those contained
in the forward-looking statement, see the section
of MedQuist's Annual Report on Form 10-K for the year
ended December 31, 2009, entitled "Risk Factors" and
discussions of potential risks and uncertainties in MedQuist's
subsequent filings with the Securities and Exchange
Commission.
MedQuist
Inc. and Subsidiaries
|
|
Consolidated
Statements of Operations
|
|
(In
thousands, except per share amounts)
|
|
Unaudited
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three months
ended
|
|
Nine months
ended
|
|
|
|
|
September
30,
|
|
September
30,
|
|
|
|
|
2010
|
|
2009
|
|
2010
|
|
2009
|
|
|
|
|
|
|
|
|
|
|
|
|
Net revenues
|
$ 102,933
|
|
$ 76,836
|
|
$ 274,442
|
|
$ 233,251
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating costs and
expenses:
|
|
|
|
|
|
|
|
|
|
Cost of revenues
|
68,427
|
|
52,768
|
|
185,350
|
|
157,993
|
|
|
Selling, general and
administrative
|
9,352
|
|
7,930
|
|
28,169
|
|
25,819
|
|
|
Research and
development
|
3,681
|
|
2,439
|
|
9,274
|
|
7,235
|
|
|
Depreciation
|
2,822
|
|
2,197
|
|
7,518
|
|
7,418
|
|
|
Amortization of intangible
assets
|
3,394
|
|
1,518
|
|
8,229
|
|
4,533
|
|
|
Cost of legal proceedings and
settlements
|
631
|
|
1,382
|
|
2,783
|
|
13,440
|
|
|
Acquisition and integration
related charges
|
842
|
|
-
|
|
6,501
|
|
-
|
|
|
Restructuring charges
|
495
|
|
481
|
|
1,425
|
|
481
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total operating costs and
expenses
|
89,644
|
|
68,715
|
|
249,249
|
|
216,919
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating income
|
13,289
|
|
8,121
|
|
25,193
|
|
16,332
|
|
|
|
|
|
|
|
|
|
|
|
|
Equity in income of affiliated
company
|
70
|
|
2,154
|
|
616
|
|
2,582
|
|
Interest income
(expense)
|
(2,927)
|
|
(29)
|
|
(6,706)
|
|
36
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income
taxes
|
10,432
|
|
10,246
|
|
19,103
|
|
18,950
|
|
|
|
|
|
|
|
|
|
|
|
|
Income tax provision
|
1,461
|
|
542
|
|
1,908
|
|
1,556
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
$ 8,971
|
|
$ 9,704
|
|
$ 17,195
|
|
$ 17,394
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income per share:
|
|
|
|
|
|
|
|
|
|
Basic
|
$
0.24
|
|
$ 0.26
|
|
$
0.46
|
|
$
0.46
|
|
|
Diluted
|
$
0.24
|
|
$ 0.26
|
|
$
0.46
|
|
$
0.46
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average shares
outstanding:
|
|
|
|
|
|
|
|
|
|
Basic
|
37,556
|
|
37,556
|
|
37,556
|
|
37,556
|
|
|
Diluted
|
37,556
|
|
37,560
|
|
37,556
|
|
37,556
|
|
|
|
|
|
|
|
|
|
|
|
MedQuist
Inc. and Subsidiaries
|
|
Consolidated
Balance Sheets
|
|
(In
thousands)
|
|
Unaudited
|
|
|
|
|
|
|
|
|
|
September
30,
|
|
December
31,
|
|
|
|
2010
|
|
2009
|
|
Assets
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
Cash and cash
equivalents
|
|
$ 21,894
|
|
$ 25,216
|
|
|
Accounts receivable, net of
allowance of $3,305 and $3,159, respectively
|
|
65,026
|
|
43,627
|
|
|
Income tax receivable
|
|
35
|
|
772
|
|
|
Other current assets
|
|
9,311
|
|
4,940
|
|
|
|
Total current assets
|
|
96,266
|
|
74,555
|
|
|
|
|
|
|
|
|
Property and equipment,
net
|
|
14,975
|
|
11,772
|
|
Goodwill
|
|
88,951
|
|
40,813
|
|
Other intangible assets,
net
|
|
81,984
|
|
36,307
|
|
Deferred income taxes
|
|
1,525
|
|
1,396
|
|
Other assets
|
|
14,788
|
|
9,818
|
|
|
|
|
|
|
|
|
|
|
Total assets
|
|
$ 298,489
|
|
$ 174,661
|
|
|
|
|
|
|
|
|
Liabilities and Shareholders'
Equity
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
Current portion of long term
debt (subsequently refinanced)
|
|
$ 25,000
|
|
$
-
|
|
|
Accounts payable
|
|
6,275
|
|
8,687
|
|
|
Accrued expenses
|
|
24,374
|
|
21,490
|
|
|
Accrued compensation
|
|
17,133
|
|
12,432
|
|
|
Current portion of lease
obligations
|
|
1,229
|
|
-
|
|
|
Related party payable
|
|
6,681
|
|
1,362
|
|
|
Deferred revenue
|
|
10,762
|
|
10,854
|
|
|
|
Total current
liabilities
|
|
91,454
|
|
54,825
|
|
Long term debt (subsequently
refinanced)
|
|
68,898
|
|
|
|
Deferred income taxes
|
|
5,419
|
|
3,240
|
|
Other non-current
liabilities
|
|
874
|
|
1,848
|
|
|
|
|
|
|
|
|
Commitments and
contingencies
|
|
|
|
|
|
Shareholders' equity:
|
|
|
|
|
|
|
Common stock - no par value;
authorized 60,000 shares;
|
|
|
|
|
|
|
37,556 and 37,556 shares issued
and outstanding, respectively
|
|
237,993
|
|
237,848
|
|
|
Accumulated deficit
|
|
(108,659)
|
|
(125,854)
|
|
|
Accumulated other comprehensive
income
|
|
2,510
|
|
2,754
|
|
|
|
|
|
|
|
|
|
|
Total shareholders'
equity
|
|
131,844
|
|
114,748
|
|
|
|
|
|
|
|
|
|
|
Total liabilities and
shareholders' equity
|
|
$ 298,489
|
|
$ 174,661
|
|
|
|
|
|
|
|
|
MedQuist
Inc. and Subsidiaries
|
|
Consolidated
Statements of Cash Flows
|
|
(In
thousands)
|
|
Unaudited
|
|
|
|
|
|
|
|
|
|
Nine months
ended
|
|
|
|
September
30,
|
|
|
|
2010
|
|
2009
|
|
Operating
activities:
|
|
|
|
|
|
Net income
|
|
$ 17,195
|
|
$ 17,394
|
|
Adjustments to reconcile
net income to cash provided by operating activities:
|
|
|
|
|
|
Depreciation and
amortization
|
|
15,747
|
|
11,951
|
|
Equity in income of
affiliated company
|
|
(616)
|
|
(2,582)
|
|
Deferred income
taxes
|
|
2,021
|
|
662
|
|
Stock option
expense
|
|
145
|
|
144
|
|
Noncash interest
expense
|
|
328
|
|
-
|
|
Provision for doubtful
accounts
|
|
1,571
|
|
230
|
|
Loss on disposal of
property and equipment
|
|
-
|
|
27
|
|
Changes in operating
assets and liabilities:
|
|
|
|
|
|
Accounts
receivable
|
|
(554)
|
|
6,847
|
|
Income tax
receivable
|
|
733
|
|
(50)
|
|
Other current
assets
|
|
(1,216)
|
|
3,467
|
|
Other non-current
assets
|
|
869
|
|
(34)
|
|
Accounts
payable
|
|
1,129
|
|
(351)
|
|
Accrued expenses and
Related party payable
|
|
(6,910)
|
|
(3,744)
|
|
Accrued
compensation
|
|
878
|
|
2,959
|
|
Deferred
revenue
|
|
(170)
|
|
(4,107)
|
|
Other non-current
liabilities
|
|
(1,056)
|
|
168
|
|
Net cash provided by operating
activities
|
|
$ 30,094
|
|
$ 32,981
|
|
|
|
|
|
|
|
Investing
activities:
|
|
|
|
|
|
Purchase of property and
equipment
|
|
(3,793)
|
|
(3,603)
|
|
Capitalized
software
|
|
(3,806)
|
|
(1,846)
|
|
Investment in affiliated
company
|
|
-
|
|
(852)
|
|
Acquisitions, net of cash
acquired
|
|
(98,661)
|
|
-
|
|
Net cash used in investing
activities
|
|
(106,260)
|
|
(6,301)
|
|
|
|
|
|
|
|
Financing
activities:
|
|
|
|
|
|
Borrowing on credit
line
|
|
100,000
|
|
-
|
|
Repayment of
debt
|
|
(20,000)
|
|
-
|
|
Dividends paid
|
|
-
|
|
(49,949)
|
|
Debt issuance
costs
|
|
(7,031)
|
|
(1,171)
|
|
Payments on lease
obligations
|
|
(129)
|
|
-
|
|
Net cash provided by (used in)
financing activities
|
|
72,840
|
|
(51,120)
|
|
|
|
|
|
|
|
Effect of exchange rate
changes
|
|
4
|
|
199
|
|
|
|
|
|
|
|
Net decrease in cash and cash
equivalents
|
|
(3,322)
|
|
(24,241)
|
|
|
|
|
|
|
|
Cash and cash equivalents -
beginning of period
|
|
25,216
|
|
39,918
|
|
|
|
|
|
|
|
Cash and cash equivalents - end
of period
|
|
$ 21,894
|
|
$ 15,677
|
|
|
|
|
|
|
|
Supplemental cash flow
information:
|
|
|
|
|
|
|
|
|
|
|
|
Cash paid for income
taxes
|
|
$
(318)
|
|
$
241
|
|
Accommodation payments paid with
credits
|
|
$
-
|
|
$
103
|
|
Noncash debt incurred in
connection with the Spheris acquisition
|
|
$ 13,570
|
|
$
-
|
|
|
|
|
|
|
MedQuist
Inc. and Subsidiaries
|
|
Reconciliation of GAAP financial
measures to the non-GAAP measures
|
|
Adjusted
EBITDA
|
|
(In
thousands)
|
|
Unaudited
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three months
ended
|
|
Nine months
ended
|
|
|
September
30,
|
|
September
30,
|
|
|
2010
|
|
2009
|
|
2010
|
|
2009
|
|
|
|
|
|
|
|
|
|
|
Net income
|
$ 8,971
|
|
$ 9,704
|
|
$ 17,195
|
|
$ 17,394
|
|
|
|
|
|
|
|
|
|
|
Add: Income tax
provision
|
1,461
|
|
542
|
|
1,908
|
|
1,556
|
|
|
|
|
|
|
|
|
|
|
Add (Less): Interest expense
(income)
|
2,927
|
|
29
|
|
6,706
|
|
(36)
|
|
|
|
|
|
|
|
|
|
|
Add: Depreciation
|
2,822
|
|
2,197
|
|
7,518
|
|
7,418
|
|
|
|
|
|
|
|
|
|
|
Add: Amortization of intangible
assets
|
3,394
|
|
1,518
|
|
8,229
|
|
4,533
|
|
|
|
|
|
|
|
|
|
|
Add: Restructuring
charges
|
495
|
|
481
|
|
1,425
|
|
481
|
|
|
|
|
|
|
|
|
|
|
Add: Acquisition and integration
related charges
|
842
|
|
-
|
|
6,501
|
|
-
|
|
|
|
|
|
|
|
|
|
|
Add: Cost of legal proceedings
and settlements
|
631
|
|
1,382
|
|
2,783
|
|
13,440
|
|
|
|
|
|
|
|
|
|
|
Less: Accrual
reversals
|
-
|
|
-
|
|
-
|
|
(2,254)
|
|
|
|
|
|
|
|
|
|
|
Less: Equity in income of
affiliated company
|
(70)
|
|
(2,154)
|
|
(616)
|
|
(2,582)
|
|
|
|
|
|
|
|
|
|
|
Adjusted EBITDA
|
$ 21,473
|
|
$ 13,699
|
|
$ 51,649
|
|
$ 39,950
|
|
|
|
|
|
|
|
|
|
|
Adjusted EBITDA as a % of Net
revenue
|
20.9%
|
|
17.8%
|
|
18.8%
|
|
17.1%
|
|
|
|
|
|
|
|
|
|
The impact of cost savings and synergies resulting from the
Spheris acquisition, which we have implemented since the Spheris
acquisition are expected to yield $7.0
million of cost savings in the fourth quarter of 2010
representing an annualized savings of $28.0
million. Of these savings $4.0
million were realized during the three months ended
September 30, 2010 and $4.9 million were realized in the nine months
ended September 30, 2010.
Adjusted EBITDA is a financial measure not computed in
accordance with United States
generally accepted accounting principles, or GAAP. The Company
believes that this non-GAAP measure, when presented in conjunction
with comparable GAAP measures, is useful to both management and
investors in analyzing the Company's ongoing business and operating
performance. The Company believes that providing the non-GAAP
information to investors, in addition to the GAAP presentation,
allows investors to view the Company's financial results in the way
that management views financial results. Management believes
Adjusted EBITDA is useful as supplemental measures of the Company's
financial results because it removes costs not related to the
Company's operating performance. Management believes that Adjusted
EBITDA should be considered in addition to, but not as a substitute
for items presented in accordance with GAAP that are presented in
this press release. A reconciliation of Net income to Adjusted
EBITDA is provided above.
SOURCE MedQuist Inc.