form10q.htm


UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

FORM 10-Q
 
x
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES
EXCHANGE ACT OF 1934
 
For the quarterly period ended March 31, 2011
 
o
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
 
For the transition period from                    to                   
 
Commission file number 001–33006

MERGE HEALTHCARE INCORPORATED
(Exact name of Registrant as specified in its charter)
 
Delaware
 
39–1600938
(State or other jurisdiction
of incorporation or organization)
 
(I. R. S. Employer
Identification No.)
 
200 East Randolph Street, 24th Floor
Chicago, Illinois  60601-6436
 (Address of principal executive offices, including zip code)
(Registrant’s telephone number, including area code) (312) 565-6868
 
Indicate by check mark whether the Registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the Registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.  Yes xNo o
 
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).  Yes oNo o
 
Indicate by check mark whether the Registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company. See the definitions of “large accelerated filer”, “accelerated filer” and “smaller reporting company” in Rule 12b–2 of the Exchange Act.
 
Large accelerated filero
Non-accelerated filer¨
Accelerated filerx
Smaller reporting company o
 
Indicate by check mark whether the Registrant is a shell company (as defined in Rule 12b–2 of the Act).  Yes o    No x
 
The number of shares outstanding of the Registrant’s common stock, par value $0.01 per share, as of May 2, 2011:  84,272,059



 
 

 
 
INDEX
 
       
Page
   
PART I – FINANCIAL INFORMATION
   
Item 1.
   
1
     
1
     
2
     
3
     
4
     
5
     
6
Item 2.
   
17
Item 3.
   
22
Item 4.
   
23
   
PART II – OTHER INFORMATION
   
Item 1.
   
24
Item 1A.
   
25
Item 2.   Unregistered Sales of Equity Securities and Use of Proceeds   25
Item 6.
   
25
     
27
     
27
     
27
 
 
 


PART I – FINANCIAL INFORMATION
 
Item 1.
 
MERGE HEALTHCARE INCORPORATED AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
(Unaudited)
 (In thousands, except for share data)
 
ASSETS
 
March 31,
2011
   
December 31,
2010
 
Current assets:
           
Cash and cash equivalents, including restricted cash of $847 and $1,647 at March 31, 2011and December 31, 2010, respectively
  $ 47,736     $ 41,029  
Accounts receivable, net of allowance for doubtful accounts and sales returns of $1,750 and $1,322 at March 31, 2011 and December 31, 2010, respectively
    54,418       53,254  
Inventory
    3,612       3,486  
Prepaid expenses
    3,223       4,191  
Deferred income taxes
    2,545       2,545  
Other current assets
    13,705       9,336  
Total current assets
    125,239       113,841  
Property and equipment:
               
Computer equipment
    8,976       9,859  
Office equipment
    1,945       2,007  
Leasehold improvements
    1,151       1,055  
      12,072       12,921  
Less accumulated depreciation
    7,172       7,149  
Net property and equipment
    4,900       5,772  
Purchased and developed software, net of accumulated amortization of $11,250 and $9,811 at March 31, 2011 and December 31, 2010, respectively
    25,120       26,619  
Other intangible assets, net of accumulated amortization of $11,023 and $8,419 at March 31, 2011 and December 31, 2010, respectively
    47,043       48,957  
Goodwill
    170,079       169,533  
Deferred income taxes
    16,394       17,006  
Other assets
    12,748       14,660  
Total assets
  $ 401,523     $ 396,388  
LIABILITIES AND SHAREHOLDERS' EQUITY
               
Current liabilities:
               
Accounts payable
  $ 20,433     $ 18,370  
Interest payable
    9,792       3,917  
Accrued wages
    4,371       4,304  
Restructuring accrual
    1,225       1,707  
Other accrued liabilities
    6,874       6,875  
Deferred revenue
    45,877       49,876  
Total current liabilities
    88,572       85,049  
Notes payable, net of unamortized discount
    195,292       195,077  
Deferred revenue
    5,814       3,809  
Income taxes payable
    5,683       5,683  
Other
    1,683       1,964  
Total liabilities
    297,044       291,582  
Shareholders' equity:
               
Series A Non-voting Preferred Stock, $0.01 par value: 50,000 shares authorized; 41,750 shares issued and outstanding at March 31, 2011 and December 31, 2010, respectively.  Aggregate liquidation preference:  $54,275 at March 31, 2011 and December 31, 2010, respectively.
    41,750       41,750  
Common stock, $0.01 par value: 150,000,000 shares authorized: 84,259,176 shares and 83,258,123shares issued and outstanding at March 31, 2011 and December 31, 2010, respectively
    843       833  
Common stock subscribed, 12,883 shares and 991,053 shares at March 31, 2011 and December 31, 2010, respectively
    60       3,323  
Additional paid-in capital
    531,515       527,228  
Accumulated deficit
    (471,461 )     (469,872 )
Accumulated other comprehensive income
    1,772       1,544  
Total shareholders' equity
    104,479       104,806  
Total liabilities and shareholders' equity
  $ 401,523     $ 396,388  
 
See accompanying notes to unaudited condensed consolidated financial statements.
 
 
1


MERGE HEALTHCARE INCORPORATED AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(Unaudited)
(in thousands, except for share and per share data)
 
   
Three Months Ended
March 31,
 
   
2011
   
2010
 
Net sales:
           
Software and other
  $ 18,671     $ 9,365  
Professional services
    8,400       3,745  
Maintenance and EDI
    25,601       6,860  
Total net sales
    52,672       19,970  
Cost of sales:
               
Software and other
    6,577       704  
Professional services
    5,063       2,997  
Maintenance and EDI
    7,964       1,497  
Depreciation and amortization
    2,499       1,218  
Total cost of sales
    22,103       6,416  
Gross margin
    30,569       13,554  
Operating costs and expenses:
               
Sales and marketing
    8,693       2,819  
Product research and development
    6,752       3,256  
General and administrative
    6,590       3,851  
Acquisition-related expenses
    104       5,938  
Restructuring and other expenses
    (36 )     -  
Depreciation and amortization
    2,650       840  
Total operating costs and expenses
    24,753       16,704  
Operating income (loss)
    5,816       (3,150 )
Other income (expense):
               
Interest expense
    (6,360 )     (5 )
Interest income
    6       15  
Other, net
    (206 )     36  
Total other income (expense)
    (6,560 )     46  
Loss before income taxes
    (744 )     (3,104 )
Income tax expense
    845       48  
Net loss
    (1,589 )     (3,152 )
Less:  preferred stock dividends
    1,566       -  
Net loss available to common shareholders
  $ (3,155 )   $ (3,152 )
Net loss per share - basic
  $ (0.04 )   $ (0.04 )
Weighted average number of common shares outstanding - basic
    84,208,907       74,801,177  
Net loss per share - diluted
  $ (0.04 )   $ (0.04 )
Weighted average number of common shares outstanding - diluted
    84,208,907       74,801,177  
 
See accompanying notes to unaudited condensed consolidated financial statements.
 
 
2

 
MERGE HEALTHCARE INCORPORATED AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(Unaudited)
(in thousands)
 
   
Three Months Ended
March 31,
 
   
2011
   
2010
 
Cash flows from operating activities:
           
Net loss
  $ (1,589 )   $ (3,152 )
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
               
Depreciation and amortization
    5,149       2,058  
Share-based compensation
    1,062       354  
Change in contingent consideration for acquisitions
    -       165  
Amortization of notes payable issuance costs & discount
    569       -  
Provision for doubtful accounts receivable and sales returns, net of recoveries
    428       55  
Deferred income taxes
    612       -  
Changes in operating assets and liabilities, net of effects of acquisitions:
               
Accounts receivable
    (2,015 )     (3,574 )
Inventory
    (126 )     (20 )
Prepaid expenses
    934       (72 )
Accounts payable
    1,863       694  
Accrued wages
    (20 )     (70 )
Restructuring accrual
    (613 )     (408 )
Deferred revenue
    (2,335 )     849  
Accrued interest and other liabilities
    5,584       (324 )
Other
    (2,602 )     (1,157 )
Net cash provided by (used in) operating activities
    6,901       (4,602 )
Cash flows from investing activities:
               
Cash paid for acquisitions, net of cash acquired
    -       (1,350 )
Purchases of property, equipment, and leasehold improvements
    (284 )     (555 )
Change in restricted cash
    800       42  
Preferred stock deposits in escrow
    -       (25,700 )
Net cash provided by (used in) investing activities
    516       (27,563 )
Cash flows from financing activities:
               
Note and stock issuance costs paid
    -       (1,551 )
Proceeds from exercise of stock options and employee stock purchase plan
    90       31  
Principal payments on capital leases
    -       (57 )
Preferred stock deposits
    -       30,000  
Net cash provided by financing activities
    90       28,423  
Net increase (decrease) in cash and cash equivalents
    7,507       (3,742 )
Cash and cash equivalents (net of restricted cash), beginning of period (1)
    39,382       19,062  
Cash and cash equivalents (net of restricted cash), end of period (2)
  $ 46,889     $ 15,320  
                 
Supplemental Disclosures of Cash Flow Information:
               
Cash paid for interest
  $ 1     $ 5  
Cash paid for income taxes, net of refunds
    (6 )     56  
 
(1)
Net of restricted cash of $1,647 and $559 at December 31, 2010 and 2009, respectively.
(2)
Net of restricted cash of $847 and $517 at March 31, 2011 and 2010, respectively.
 
See accompanying notes to unaudited condensed consolidated financial statements.
 
 
3


MERGE HEALTHCARE INCORPORATED AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENT OF SHAREHOLDERS’ EQUITY
(Unaudited)
(in thousands, except for share and per share data)

   
Preferred Stock
   
Common Stock
         
Accumulated
       
                                       
Additional
         
Other
   
Total
 
   
Shares
   
Issued
   
Shares
   
Subscribed
   
Shares
   
Issued
   
Paid–in
   
Accumulated
   
Comprehensive
   
Shareholders’
 
   
Issued
   
Amount
   
Subscribed
   
Amount
   
Issued
   
Amount
   
Capital
   
Deficit
   
Income
   
Equity
 
Balance at December 31, 2010
    41,750     $ 41,750       991,053     $ 3,323       83,258,123     $ 833     $ 527,228     $ (469,872 )   $ 1,544     $ 104,806  
Stock issued under ESPP
    -       -       (3,469 )     2       16,352       -       58       -       -       60  
Exercise of stock options
    -       -       -       -       10,000       -       30       -       -       30  
Share-based compensation expense
    -       -       -       -       -       -       1,062       -       -       1,062  
Shares issued for acquisitions
    -       -       (974,701 )     (3,265 )     974,701       10       3,137       -       -       (118 )
Net loss
    -       -       -       -       -       -       -       (1,589 )     -       (1,589 )
Other comprehensive income
    -       -       -       -       -       -       -       -       228       228  
Balance at March 31, 2011
    41,750     $ 41,750       12,883     $ 60       84,259,176     $ 843     $ 531,515     $ (471,461 )   $ 1,772     $ 104,479  
 
See accompanying notes to unaudited condensed consolidated financial statements.
 
 
4

 
MERGE HEALTHCARE INCORPORATED AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
(Unaudited)
(in thousands)
   
Three Months Ended
March 31,
 
   
2011
   
2010
 
Net loss
  $ (1,589 )   $ (3,152 )
Translation adjustment
    (20 )     -  
Unrealized gain (loss) on marketable security, net of taxes
    248       (13 )
Comprehensive loss
  $ (1,361 )   $ (3,165 )
 
See accompanying notes to unaudited condensed consolidated financial statements.
 
 
5


Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
 
(1)         
Basis of Presentation and Significant Accounting Policies
 
The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with the rules and regulations of the Securities and Exchange Commission (SEC) for reporting on Form 10-Q. Accordingly, certain information and notes required by United States of America generally accepted accounting principles (GAAP) for annual financial statements are not included herein. These interim statements should be read in conjunction with the consolidated financial statements and notes thereto included in the Annual Report on Form 10-K for the year ended December 31, 2010 of Merge Healthcare Incorporated, a Delaware corporation, and its subsidiaries and affiliates (which we sometimes refer to collectively as Merge, we, us or our).
 
Principles of Consolidation
 
Our unaudited condensed consolidated financial statements reflect all adjustments, which are, in the opinion of management, necessary for a fair presentation of our financial position and results of operations.  Such adjustments are of a normal recurring nature, unless otherwise noted.  The results of operations for the three month period ended March 31, 2011 are not necessarily indicative of the results to be expected for any future period.
 
Our unaudited condensed consolidated financial statements are prepared in accordance with GAAP. These accounting principles require us to make certain estimates, judgments and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. We believe that the estimates, judgments and assumptions are reasonable, based on information available at the time they are made. Actual results could differ materially from those estimates.
 
(2)         
Other Current Assets and Other Accrued Liabilities
 
Other current assets consist primarily of revenue recognized that has not yet been billed to a customer, taxes receivable and other non-trade receivables, all of which are due within the next twelve months.  The balances are comprised of the following as of March 31, 2011 and December 31, 2010:
 
   
Balance at March 31, 2011
   
Balance at December 31, 2010
 
Revenue recognized in excess of billings
  $ 12,734     $ 8,337  
Taxes receivable
    16       848  
Other non-trade receivables
    955       151  
    $ 13,705     $ 9,336  
 
Other accrued liabilities consist primarily of leases payable, deferred tax liability, accrued taxes and other non-trade payables, all of which are due within the next twelve months.  The balances are comprised of the following as of March 31, 2011 and December 31, 2010:
 
   
Balance at March 31, 2011
   
Balance at December 31, 2010
 
Leases payable
  $ 543     $ 679  
Deferred tax liability
    732       732  
Accrued taxes
    1,382       1,296  
Other current liabilities
    4,217       4,168  
    $ 6,874     $ 6,875  
 
 
6

 
Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
 
 (3)        
Goodwill and Other Intangible Assets
 
Goodwill
 
The changes in carrying amount of goodwill for the three months ended March 31, 2011, are as follows:
 
   
Total
 
Balance at December 31, 2010
  $ 169,533  
Adjustments to acquisitions
    546  
Balance at March 31, 2011
  $ 170,079  
 
Other Intangible Assets
 
Our intangible assets subject to amortization are summarized as of March 31, 2011 as follows:
 
   
Weighted
Average
Remaining Amortization
Period (Years)
   
Gross Carrying
Amount
   
Accumulated
Amortization
 
Purchased software
    6.2     $ 34,545     $ (10,067 )
Capitalized software
    3.4       1,825       (1,183 )
Customer relationships
    8.5       42,226       (6,958 )
Backlog
    3.8       8,110       (3,178 )
Trade names
    10.0       4,590       (468 )
Non-competes
    6.0       3,140       (419 )
Total
          $ 94,436     $ (22,273 )
 
In the quarter ended March, 31, 2011, we decreased the gross carrying amount of purchased software by $61 and increased the carrying amount of customer relationships, trade names and non-competes by $591, $60 and $40, respectively, related to the finalization of accounting for insignificant acquisitions completed in the fourth quarter of 2010.  
 
Our purchased and capitalized software assets are measured at fair value on a non-recurring basis using Level 3 inputs (as defined in Note 4).  In calculating potential impairment losses, we evaluate the expected future benefit of the assets using undiscounted cash flow techniques.  
 
Estimated aggregate amortization expense for our intangible assets, which become fully amortized in 2022, is as follows:
 
For the remaining 9 months of the year ended:
2011
  $ 10,709  
For the year ended December 31:
2012
    12,457  
 
2013
    11,507  
 
2014
    10,407  
 
2015
    8,171  
 
Thereafter
    18,912  
 
Total
  $ 72,163  
 
 
7

 
Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
 
Amortization expense for the three months ended March 31, 2011 and 2010 is set forth in the following table:
 
   
Three Months Ended
March 31,
 
   
2011
   
2010
 
Amortization included in cost of sales:
           
Purchased software
  $ 1,384     $ 862  
Capitalized software
    53       129  
Backlog
    936       -  
Total
    2,373       991  
                 
Amortization included in operating expenses:
               
Customer relationships
    1,421       404  
Trade names
    124       10  
Non-competes
    124       -  
Total
    1,669       414  
Total amortization
  $ 4,042     $ 1,405  
 
(4)         
Fair Value Measurement
 
Our financial instruments include cash and cash equivalents, accounts receivable, marketable and non-marketable securities, accounts payable, notes payable, and certain accrued liabilities.  The carrying amounts of our cash and cash equivalents (which are comprised primarily of deposit and overnight sweep accounts), accounts receivable, accounts payable, and certain accrued liabilities approximate fair value due to the short maturity of these instruments.  The carrying amount of our marketable equity security is based on the quoted price of the security in an active market.  The estimated fair values of the non-marketable equity securities have been determined from information obtained from independent valuations and management estimates.  The carrying value of our notes payable approximates fair value due to the interest rates and terms approximating those available to the company for similar obligations.
 
We use a three-tier value hierarchy to prioritize the inputs used in measuring fair value of our financial assets and liabilities.  These tiers include: Level 1, defined as observable inputs such as quoted prices in active markets; Level 2, defined as inputs other than quoted prices in active markets that are directly or indirectly observable; and Level 3, defined as unobservable inputs in which little or no market data exists, therefore, requiring us to develop our own assumptions.  
 
We also consider additional information in estimating fair value when the volume and level of activity for the asset or liability have significantly decreased, or circumstances indicate a transaction is not suitable for fair value measurement.  
 
Non-Current Investments
 
At March 31, 2011, we held certain securities in a publicly traded entity and private companies which are classified within other assets on our condensed consolidated balance sheet.  The investment in the publicly traded equity security, over which we do not exert significant influence, is classified as “available-for-sale” and reported at fair value on a recurring basis.  Unrealized gains and losses are reported within the accumulated other comprehensive income component of shareholders’ equity.  The investments in equity securities of private companies, over which we do not exert significant influence, are classified as Level 3 investments and are reported at cost or fair value, if an other-than-temporary loss has been determined.  Any loss due to impairment in value is recorded when such loss occurs.  We performed the evaluation of our Level 3 investments as of March 31, 2011, and concluded that there was no significant change in their fair value.
 
The following table sets forth the change in the fair value of our Level 1 publicly traded equity security:
 
 
8

 
Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
 
Rollforward of Level 1 Investment
 
Three Months Ended
March 31,
 
   
2011
   
2010
 
Balance at January 1
  $ 55     $ 110  
Unrealized gain (loss)
    283       (13 )
Balance at March 31
  $ 338     $ 97  
 
Unrealized gains or losses on our Level 1 available-for-sale (publicly traded) security, as well as foreign currency translation adjustments, are components of accumulated other comprehensive income as set forth in the following table:
 
   
March 31, 2011
   
December 31, 2010
 
Cumulative translation adjustment
  $ 1,916     $ 1,936  
Unrealized loss on available-for-sale security, net of taxes
    (144 )     (392 )
Total accumulated other comprehensive income
  $ 1,772     $ 1,544  
 
(5)         
Restructuring
 
The following table sets forth the activity in the three months ended March 31, 2011, related to restructuring activities taken in prior years:
 
   
Employee Termination Costs
   
Contract Exit Costs
 
Relocation
   
Total
 
Balance at December 31, 2010
  $ 449     $ 1,698     $ 42     $ 2,189  
Adjustments to expense
    (10 )     -       (25 )     (35 )
Payments
    -       (578 )     -       (578 )
Balance at March 31, 2011
  $ 439     $ 1,120     $ 17     $ 1,576  
 
As of March 31, 2011, $1,225 of the remaining balance was recorded in the restructuring accrual in current liabilities, with the remainder recorded in other long term liabilities.  
 
(6)         
Debt
 
In April 2010, we issued $200,000 of Senior Secured Notes (Notes) at 97.266% of the principal amount, which bear interest at 11.75% of principal (payable on May 1st and November 1st of each year) and will mature on May 1, 2015.  The Notes were offered in a private placement pursuant to Rule 144A and Regulation S under the Securities Act of 1933, as amended.  In connection with the Notes, we incurred issuance costs of $9,015 (which are recorded in other assets on the condensed consolidated balance sheet as of March 31, 2011).  These issuance costs are recorded as a long-term asset and amortized over the life of the Notes using the effective interest method.  In the three months ended March 31, 2011, we recorded $6,443 of interest expense related to the Notes, including $354 and $215 in amortization of debt issuance costs and debt discount, respectively.
 
(7)         
Shareholders’ Equity
 
In the three months ended March 31, 2011, we recorded a cumulative dividend of $1,566 related to our outstanding preferred stock.  This dividend is reflected as a reduction of net income available to common shareholders in our condensed statement of operations.
 
In the three months ended March 31, 2011, we issued 974,701 shares as partial consideration for an insignificant acquisition which was completed in the fourth quarter of 2010.  These shares had been recorded as common stock subscribed as of December 31, 2010.
 
(8)         
Share-Based Compensation
 
The following table summarizes share-based compensation expense recognized during the periods indicated:
 
 
9

 
Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
 
   
Three Months Ended
March 31,
 
   
2011
   
2010
 
Share-based compensation expense included in the statement of operations:                
Professional services cost of sales
  $ 10     $ 6  
Maintenance and EDI cost of sales
    28       -  
Sales and marketing
    587       83  
Product research and development
    (8 )     62  
General and administrative
    445       203  
Total   $ 1,062     $ 354  
 
Stock option activity in the three months ended March 31, 2011 is set forth in the following table:
 
   
Number of
 
   
Options
 
Options outstanding, December 31, 2010
    7,959,110  
Options granted
    1,175,000  
Options exercised
    (10,000 )
Options forfeited and expired
    (50,342 )
Options outstanding, March 31, 2011
    9,073,768  
         
Options exercisable, March 31, 2011
    3,009,064  
 
As of March 31, 2011, there was approximately $9,512 of unrecognized compensation cost related to stock options that may be recognized in future periods.
 
(9)         
Commitments and Contingencies
 
On June 1, 2009, Merge Healthcare was sued in the Milwaukee County Circuit Court, State of Wisconsin, by William C. Mortimore and David M. Noshay with respect to the separation of Mortimore’s and Noshay’s employment and our subsequent refusal to indemnify them with respect to litigation related to their service as officers of Merge.  The plaintiffs allege that we breached their employment agreements, unreasonably refused their requests for indemnification and breached other covenants of good faith and fair dealing.  The plaintiffs seek indemnification and unspecified monetary damages.  Discovery in this case is on-going.  On April 6, 2011, the Milwaukee County Circuit Court rendered a decision in which it concluded that Merge and Mortimore entered into an oral employment contract on or about June 15, 2006, but did not make any decision as to damages, which would be addressed in a later phase of the litigation.  We have retained litigation counsel and intend to continue to vigorously defend this action, including an evaluation of the Company’s rights to an appeal from the court’s April 6, 2011 decision and Order.
 
In January 2010, a purported stockholder class action complaint was filed in the Superior Court of Suffolk County, Massachusetts in connection with AMICAS Inc.’s (AMICAS) proposed acquisition by Thoma Bravo, LLC (the “Thoma Bravo Merger”).  A second similar action was filed in the same court in February 2010 and consolidated with the first action.  In March 2010, because AMICAS had terminated the Thoma Bravo Merger and agreed to be acquired by us, the court dismissed the plaintiffs’ claims as moot.  Subsequently, counsel for the plaintiffs filed an application for approximately $5,000 of attorneys’ fees for its work on this case, which fee petition AMICAS opposed.  We retained litigation counsel to defend against the fee petition.  On December 23, 2010, the court awarded plaintiffs approximately $3,200 in attorneys’ fees and costs.  AMICAS has filed a notice of appeal from this judgment, and the plaintiffs have cross-appealed.  We previously tendered the defense in this matter to our appropriate insurers, who have provided coverage against the claims asserted against AMICAS.  After receipt of the court’s attorneys’ fee award decision, the applicable insurer denied policy coverage for approximately $2,500 of the fee award.  We do not believe that the insurer’s denial has merit and have retained counsel to contest it.  We will vigorously assert all of our rights under our applicable insurance policies, which we believe cover the claims and expenses incurred by AMICAS or us in connection with the fee award.  However, an adverse outcome could negatively impact our financial condition.
 
 
10

 
Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
 
On February 1, 2010, Merge filed a complaint against its former CEO, Richard Linden, and its former CFO, Scott Veech, in the U.S. District for the Eastern District of Wisconsin, seeking a declaration that we do not have to indemnify either Linden or Veech for liabilities they incurred in connection with SEC investigation and enforcement actions and various securities fraud and shareholder derivative litigation.  Merge also seeks to recover from both defendants all costs incurred by Merge associated with defending Linden and Veech in those prior actions.  On October 15, 2010, the court concluded that it did not have subject matter jurisdiction over Merge’s claims and dismissed the claims in their entirety.  The court rendered no opinion on the merits of Merge’s claims. Merge is evaluating its further options with respect to the Scott Veech matter in Wisconsin state court.  On February 8, 2011, Merge filed a complaint against its former CEO, Richard Linden, in the U.S. District Court for the Eastern District of Wisconsin captioned Merge Healthcare Incorporated v. Richard Linden, Case no. 11-CV-001541.  On May 4, 2011, Merge and Linden entered into a confidential settlement agreement resolving all claims against Mr. Linden and through which Linden agreed to issue a statement of regret and apology to Merge’s Board of Directors and reimburse Merge for a portion of the Company’s legal fees to defend Linden in prior legal actions. Merge believes that it has numerous meritorious claims against Mr. Veech and will continue to pursue these claims, which have not been affected by the settlement with Mr. Linden.
 
In August, 2010, Merge Healthcare was sued in the Northern District of Texas by the court-appointed receiver for Stanford International Bank, Ltd.  The receiver alleges that Merge was a recipient of a fraudulent conveyance as a result of a Ponzi scheme orchestrated by Robert Stanford and Stanford International Bank, Ltd. (SIBL).  Merge is not alleged to have participated in the Ponzi scheme.  The receiver’s claims arise from the failed acquisition of Emageon, Inc. (Emageon) by Health Systems Solutions, Inc. (HSS) an affiliate of SIBL in February 2009, which resulted in the payment of a $9,000 break-up fee by HSS, which payment is alleged to have been financed by SIBL.  Merge subsequently acquired Emageon as part of our AMICAS acquisition.  The complaint seeks to recover the $9,000 payment to Emageon, plus interest, costs, and attorneys’ fees.  We have retained litigation counsel and intend to vigorously defend this action.  We have filed a motion to dismiss the complaint.  That motion has been fully briefed, and we are awaiting a decision from the court.  However, an adverse outcome could negatively impact our operating results and financial condition.
 
In addition to the matters discussed above, we are, from time to time, parties to legal proceedings, lawsuits and other claims incident to our business activities.  Such matters may include, among other things, assertions of contract breach or intellectual property infringement, claims for indemnity arising in the course of our business and claims by persons whose employment has been terminated.  Such matters are subject to many uncertainties and outcomes are not predictable.  We are unable to estimate the ultimate aggregate amount of monetary liability, amounts which may be covered by insurance or recoverable from third parties, or the financial impact with respect to these matters as of the date of this report.
 
Guarantees
 
As a result of the acquisition of AMICAS, we assumed a guarantee to a lender on behalf of a customer.  At March 31, 2011, the balance outstanding on the loan was approximately $805.  As the customer makes loan payments to the lender, the guarantee is reduced.
 
 (10)      
Transactions with Related Party
 
Effective January 1, 2009, we entered into a consulting agreement with Merrick RIS, LLC (Merrick), an affiliate of Merrick Ventures, LLC (Merrick Ventures).  We amended the agreement effective January 1, 2010 to extend the term through December 31, 2011, and modify the payment terms from a flat fee arrangement per quarter to a per transaction or success based arrangement.  Michael W. Ferro, Jr. and trusts for the benefit of Mr. Ferro’s family members beneficially own a majority of the equity interest in Merrick Ventures.  Mr. Ferro, who is the Chairman of our Board of Directors, also serves as the Chairman and Chief Executive Officer of Merrick Ventures.  Accordingly, Mr. Ferro indirectly owns or controls all of the shares owned by Merrick.  As of March 31, 2011, Merrick and its affiliates owned approximately 37.7% of our common stock.  
 
 
11

 
Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
 
We paid $304 and zero to Merrick for such services and recognized $94 and $250 in expenses in the three month periods ended March 31, 2011 and 2010, respectively.  As of March 31, 2011 and 2010, we have $94 and $253, respectively, recorded in accounts payable covering all obligations under this agreement.
 
On April 1, 2010, we entered into a Securities Purchase Agreement with Merrick, under which Merrick subscribed to purchase 10,000 shares of Series A Non-Voting Preferred Stock, par value $0.01 per share (Series A Preferred Stock) and 1,800,000 shares of common stock for an aggregate purchase price of $10,000, under the same terms and conditions as other investors.
 
Merrick also purchased, at the same purchase price per note as the other investors in the offering, $5.0 million of the $200.0 million aggregate principal amount of Notes that we issued on April 28, 2010 to complete our acquisition of AMICAS.
 
(11)       
Income Taxes
 
We are subject to tax in multiple jurisdictions and record income tax expense on an interim basis using an estimated annual effective tax rate.  The estimated annual effective tax rate is modified to exclude the effect of losses for those jurisdictions where the tax benefit cannot be recognized and a separate estimated annual tax rate is required.  Items discrete to a specific quarter are reflected in tax expense for that interim period.  A valuation allowance is established when necessary to reduce deferred tax assets to the amount more-likely-than-not to be realized.  Further limitations may apply to deferred tax assets if ownership changes occur.  There was no material change in unrecognized tax benefits in the three month period ended March 31, 2011.  Within the next twelve months we estimate that unrecognized tax benefits will decrease by approximately $4,119 due to statute expirations.
 
(12)       
Earnings Per Share Available to Common Shareholders
 
Basic and diluted net earnings or loss per share are computed by dividing earnings or loss available to common shareholders by the weighted average number of shares of common stock outstanding.  Earnings or loss available to common shareholders is computed as net income or loss less the 15% cumulative annual compounding dividend earned by preferred shareholders in the respective periods.  The computation of earnings or loss available to common shareholders is presented in our condensed consolidated statements of operations.  Diluted earnings per share includes the dilution that could occur based on outstanding restricted stock awards and the potential exercise of stock options, except for stock options with an exercise price of more than the average market price of our common stock, as such exercise would be anti-dilutive.  The following table sets forth the computation of basic and diluted earnings per share for the periods indicated:
 
   
Three Months Ended
March 31,
 
   
2011
   
2010
 
Numerator:
           
Net loss available to common shareholders
  $ (3,155 )   $ (3,152 )
Denominator:
               
Weighted average number of shares of Common Stock  outstanding - basic
    84,208,907        74,801,177   
Denominator for net loss per share - diluted
    84,208,907       74,801,177  
Net loss per share - basic
  $ (0.04 )   $ (0.04 )
Net loss per share - diluted
  $ (0.04 )   $ (0.04 )
 
In the three months ended March 31, 2011 and 2010, options to purchase 1,273,768 and 1,980,467 shares of our common stock, respectively, had exercise prices greater than the average market price of our common stock, and, therefore, are not considered in the above calculations of diluted net loss per share.
 
As a result of the losses in the three months ended March 31, 2011 and 2010, incremental shares from the assumed conversion of employee stock options and restricted stock awards totaling 7,800,000 and 1,280,452 shares, respectively, have been excluded from the calculation of diluted loss per share as their inclusion would have been anti-dilutive.
 
 
12

 
Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
 
 (13)      
Guarantor Subsidiaries
 
The obligations under the Notes are fully and unconditionally guaranteed, jointly and severally, by all of our current and future 100% owned domestic restricted subsidiaries (Guarantors).  No other subsidiaries guarantee the Notes.  The Notes and guarantees are secured by a first-priority lien on certain collateral which comprises substantially all of the Parent and Guarantors’ tangible and intangible assets, subject to certain exceptions.  The following tables present the balance sheets, statements of operations and statements of cash flows of the Parent, Guarantor and Non-Guarantor entities along with the eliminations necessary to arrive at the information on a consolidated basis.
 
 General corporate expenses, including public company costs, certain amortization, corporate administration costs, acquisition-related expenses and net interest expense are included in the results of the Parent.
 
CONDENSED CONSOLIDATING BALANCE SHEET
 
     
March 31, 2011
 
     
Parent
   
Guarantors
   
Non-Guarantors
   
Eliminations
   
Consolidated
 
  ASSETS                              
Current assets:
                                       
Cash and cash equivalents (including restricted cash)
  $ 14,658     $ 27,945     $ 5,133     $ -     $ 47,736  
Accounts receivable, net
    -       48,486       5,932       -       54,418  
Intercompany receivables
    6,213       14,118       741       (21,072 )     -  
Other current assets
    600       18,157       4,328       -       23,085  
Total current assets
    21,471        108,706        16,134        (21,072  )     125,239   
Net property and equipment
    142        4,173        585              4,900   
Purchased and developed software, net
    240        24,153        727         -       25,120   
Other intangible assets, net
    158        46,081        804              47,043  
Goodwill     -       168,800       1,279       -       170,079  
Investment in and advances to subsidiaries
    285,439       633       -       (286,072 )     -  
Other assets     13,261       6,996       11,764       (2,879 )     29,142  
Total assets
  $ 320,711     $ 359,542     $ 31,293     $ (310,023 )   $ 401,523  
 LIABILITIES AND SHAREHOLDERS' EQUITY                                        
Current liabilities:
                                       
Accounts payable
  $ 1,706     $ 16,426     $ 2,301     $ -     $ 20,433  
Deferred revenue
    -       43,085       2,792       -       45,877  
Intercompany payables
    -       5,931       25,238       (31,169 )     -  
Other accrued liabilities
    10,672       10,608       982       -       22,262  
Total current liabilities
                                       
Notes payable
    195,292       -       -       -       195,292  
Other long-term liabilities
    8,562       6,556       941       (2,879 )     13,180  
Total liabilities     216,232       82,606       32,254       (34,048 )     297,044  
Total shareholders' equity     104,479       276,936       (961 )     (275,975 )     104,479  
Total liabilities and shareholders' equity    $ 320,711      $ 359,542      $ 31,293      $ (310,023 )    $ 401,523  
 
 
13

 
Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
          
CONDENSED CONSOLIDATING BALANCE SHEET
 
   
December 31, 2010
 
   
Parent
   
Guarantors
   
Non-Guarantors
   
Eliminations
   
Consolidated
 
 
ASSETS
                             
Current assets:
       
 
                   
Cash and cash equivalents (including restricted cash)
  $ 870     $ 35,877     $ 4,282     $ -     $ 41,029  
    Accounts receivable, net     -       48,201       5,053       -       53,254  
Intercompany receivables
    14,170       14,168       961       (29,299 )     -  
    Other current assets     791       14,844       3,923       -       19,558  
Total current assets
    15,831       113,090       14,219       (29,299 )     113,841  
Net property and equipment
    156       4,949       667       -       5,772  
Purchased and developed software, net
    601       25,210       808       -       26,619  
Other intangible assets, net
    395       48,053       509       -       48,957  
Goodwill
    -       167,957       1,576       -       169,533  
Investment in and advances to subsidiaries
    284,893       1,830       -       (286,723 )     -  
Other assets
    13,615       8,829       12,101       (2,879 )     31,666  
Total assets
  $ 315,491     $ 369,918     $ 29,880     $ (318,901 )   $ 396,388  
  LIABILITIES AND SHAREHOLDERS' EQUITY
 
                               
Current liabilities:
                                       
   Accounts payable   $ 2,054     $ 14,155     $ 2,161     $ -     $ 18,370  
   Deferred revenue     -       48,216       1,660       -       49,876  
    Intercompany payables     -       13,767       25,580       (39,347 )     -  
    Other accrued liabilities
    4,965       10,902       936       -       16,803  
Total current liabilities
    7,019       87,040       30,337       (39,347 )     85,049  
    Notes payable     195,077       -       -       -       195,077  
    Other long-term liabilities     8,589       4,885       861       (2,879 )     11,456  
Total liabilities
    210,685       91,925       31,198       (42,226 )     291,582  
Total shareholders' equity
    104,806       277,993       (1,318 )     (276,675 )     104,806  
Total liabilities and shareholders' equity
  $ 315,491     $ 369,918     $ 29,880     $ (318,901 )   $ 396,388  
 
 
CONDENSED CONSOLIDATING STATEMENT OF OPERATIONS
 
  
 
Three Months Ended March 31, 2011
 
   
Parent
   
Guarantor
   
Non-Guarantor
   
Eliminations
   
Consolidated
 
Net sales
  $ -     $ 47,425     $ 5,247     $ -     $ 52,672  
Cost of sales
    -       20,760       1,343       -       22,103  
Gross margin
    -       26,665       3,904       -       30,569  
 Selling, research and development, general and  administrative expenses
    1,817       17,297       2,921       -       22,035  
 Acquisition-related expenses
    104       -       -       -       104  
 Restructuring and other expenses
    -       (36 )     -       -       (36 )
 Depreciation and amortization
    156       2,379       115       -       2,650  
Total operating costs and expenses
    2,077       19,640       3,036       -       24,753  
Operating income (loss)
    (2,077 )     7,025       868       -       5,816  
 Equity in net income of subsidiaries
    6,983       (812 )     -       (6,171 )     -  
 Other, net
    (6,405 )     (118 )     (37 )     -       (6,560 )
Other income (expense)
    578       (930 )     (37 )     (6,171 )     (6,560 )
Income (loss) before income taxes
    (1,499 )     6,095       831       (6,171 )     (744 )
Income tax expense
    90       177       578       -       845  
Net income (loss)
  $ (1,589 )   $ 5,918     $ 253     $ (6,171 )   $ (1,589 )
 
14

 
Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
 
CONDENSED CONSOLIDATING STATEMENT OF OPERATIONS
 
  
 
Three Months Ended March 31, 2010
 
  
 
Parent
   
Guarantor
   
Non-Guarantor
   
Eliminations
   
Consolidated
 
Net sales
  $ -     $ 13,985     $ 5,985     $ -     $ 19,970  
Cost of sales
    -       5,265       1,151       -       6,416  
Gross margin
    -       8,720       4,834       -       13,554  
Selling, research and development, general and and administrative expenses
    191       7,592       2,143       -       9,926  
Acquisition-related expenses
    5,938       -       -       -       5,938  
Depreciation and amortization
    217       540       83       -       840  
Total operating costs and expenses
    6,346       8,132       2,226       -       16,704  
Operating income (loss)
    (6,346 )     588       2,608       -       (3,150 )
Equity in net income of subsidiaries
    3,111       (59 )     -       (3,052 )     -  
Other, net
    97       (4 )     (47 )     -       46  
Other income (expense)
    3,208       (63 )     (47 )     (3,052 )     46  
Income (loss) before income taxes
    (3,138 )     525       2,561       (3,052 )     (3,104 )
Income tax expense
    14       14       20       -       48  
Net income (loss)
  $ (3,152 )   $ 511     $ 2,541     $ (3,052 )   $ (3,152 )
 
 
CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS
 
   
Three Months Ended March 31, 2011
 
   
Parent
   
Guarantor
   
Non-Guarantor
   
Eliminations
   
Consolidated
 
Cash flows from operating activities:
                             
Net income (loss)
  $ (1,589 )   $ 5,918     $ 253     $ (6,171 )   $ (1,589 )
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
                                       
Deferred income taxes
    -       -       612       -       612  
Depreciation and amortization
    340       4,572       237       -       5,149  
Share-based compensation
    389       650       23       -       1,062  
Amortization of notes payable issuance costs and discount
    569       -       -       -       569  
Provision for doubtful accounts receivable and sales returns, net of recoveries
    -       391       37       -       428  
Net change in assets and liabilities (net of effects of acquisitions)
    4,967       (10,157 )     (311 )     6,171       670  
Net cash provided by operating activities
    4,676       1,374       851       -       6,901  
Cash flows from investing activities:
                                       
Purchases of property, equipment, and leasehold improvements
    -       (284 )     -       -       (284 )
Intercompany advances
    -       (9,022 )     -       9,022       -  
Change in restricted cash
    -       800       -       -       800  
Net cash used in investing activities
    -       (8,506 )     -       9,022       516  
Cash flows from financing activities:
                                       
Intercompany advances
    9,022       -       -       (9,022 )     -  
Proceeds from exercise of options and employee stock purchase plan
    90       -       -       -       90  
Net cash provided by financing activities
    9,112       -       -       (9,022 )     90  
Net increase (decrease) in cash and cash equivalents
    13,788       (7,132 )     851       -       7,507  
Cash and cash equivalents (net of restricted cash), beginning of period
    186       34,914       4,282       -       39,382 (1)
Cash and cash equivalents (net of restricted cash), end of period
  $ 13,974     $ 27,782     $ 5,133     $ -     $ 46,889 (2)
 
(1)Net of restricted cash of $1,647 at December 31, 2010
(2) Net of restricted cash of $847 at March 31, 2011
 
 
15

 
Merge Healthcare Incorporated and Subsidiaries
Notes to Condensed Consolidated Financial Statements
(Unaudited and in thousands, except for share and per share data)
 
CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

   
Three Months Ended March 31, 2010
 
   
Parent
   
Guarantor
   
Non-Guarantor
   
Eliminations
   
Consolidated
 
Cash flows from operating activities:
                             
Net income (loss)
  $ (3,152 )   $ 511     $ 2,541     $ (3,052 )   $ (3,152 )
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
                                       
Depreciation and amortization
    218       1,485       355       -       2,058  
Share-based compensation
    114       175       65       -       354  
Change in contingent consideration for acquisitions
    -       165       -       -       165  
Provision for doubtful accounts receivable and sales returns, net of recoveries
            (58 )     113       -       55  
Net change in assets and liabilities (net of effects of acquisitions)
    (4,783 )     442       (2,793 )     3,052       (4,082 )
Net cash provided by (used in) operating activities
    (7,603 )     2,720       281       -       (4,602 )
Cash flows from investing activities:
                                       
Cash paid for acquisitions, net of cash acquired
    -       (1,350 )     -       -       (1,350 )
Purchases of property, equipment, and leasehold improvements
    -       (442 )     (113 )     -       (555 )
Intercompany advances
    1,193       -       -       (1,193 )     -  
Change in restricted cash
    -       42       -       -       42  
Preferred stock deposits in escrow
    (25,700 )     -       -       -       (25,700 )
Net cash used in investing activities
    (24,507 )     (1,750 )     (113 )     (1,193 )     (27,563 )
Cash flows from financing activities:
                                       
Intercompany advances
    -       200       (1,393 )     1,193       -  
Note and stock issuance costs paid
    (1,551 )     -       -       -       (1,551 )
Proceeds from exercise of stock options and employee stock purchase plan
    31       -       -       -       31  
Principal payments on capital leases
    -       (57 )     -       -       (57 )
Preferred stock deposits
    30,000       -       -       -       30,000  
Net cash provided by (used in) financing activities
    28,480       143       (1,393 )     1,193       28,423  
Net increase (decrease) in cash and cash equivalents
    (3,630 )     1,113       (1,225 )     -       (3,742 )
Cash and cash equivalents (net of restricted cash), beginning of period
    5,113       8,792       5,157       -       19,062  (1)
Cash and cash equivalents (net of restricted cash), end of period
  $ 1,483     $ 9,905     $ 3,932     $ -     $ 15,320  (2)

(1)  Net of restricted cash of $559 at December 31, 2009.
(2)  Net of restricted cash of $517 at March 31, 2010.
 
 
(14)       
Recent Accounting Pronouncements
 
There were no recent pronouncements that have had or may have a significant effect on our financial condition or results of operation.  We do not discuss recent pronouncements that are not anticipated to have an impact on or are unrelated to our financial condition, results of operations, or related disclosures.
 
 
16

 
Item 2.
 
Cautionary Note Regarding Forward-Looking Statements
 
The discussion below contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act, and Section 21E of the Exchange Act.  We have used words such as “believes,” “intends,” “anticipates,” “expects” and similar expressions to identify forward-looking statements.  These statements are based on information currently available to us and are subject to a number of risks and uncertainties that may cause our actual results of operations, financial condition, cash flows, performance, business prospects and opportunities and the timing of certain events to differ materially from those expressed in, or implied by, these statements.  These risks, uncertainties and other factors include, without limitation, those matters discussed in Item 1A of Part I of our Annual Report on Form 10-K for the year ended December 31, 2010.  Except as expressly required by the federal securities laws, we undertake no obligation to update such factors or to publicly announce the results of any of the forward-looking statements contained herein to reflect future events, developments, or changed circumstances, or for any other reason.  The following discussion should be read in conjunction with our consolidated financial statements and notes thereto appearing in our Annual Report on Form 10-K and Item 1A, “Risk Factors” for the year ended December 31, 2010.
 
Management’s Discussion and Analysis is presented in the following order:
 
   
·       Overview
  
·       Results of Operations
    
·       Liquidity and Capital Resources
        
·       Material Off Balance Sheet Arrangements
     
·       Critical Accounting Policies
 
 
Overview
 
Our solutions are designed to help solve some of the toughest challenges in health information exchange today, such as the incorporation of medical images and diagnostic information into broader healthcare IT applications, the interoperability of proprietary software solutions, advanced clinical tools like computer aided detection (CAD), the profitability of outpatient imaging practices in the face of declining reimbursement and the ability to improve the efficiency and cost effectiveness of our customers’ businesses.  Our proven ability to innovate has driven consistent expansion of solutions and services and entry into new markets.  We also look to expand through strategic acquisitions that will allow us to further expand our addressable market and customer base.  
 
We primarily generate revenue from the sale of perpetual software licenses, upgrading and/or renewing those licenses, hardware, professional services and maintenance.  Except for maintenance, these contract elements comprise the majority of non-recurring revenue.  Our backlog of non-recurring revenue was approximately $42.3 million as of March 31, 2011.  Maintenance, which we renew annually with our customer base, is the primary component of recurring revenues.  Recurring revenue also includes software licenses sold through contracts that are annually renewed and recognized ratably over the annual period and recorded as software revenue, revenues derived from SaaS offerings which are recorded as professional services revenue and Electronic Data Interchange (EDI) revenues which are recognized based on monthly transactional volumes.  During the first quarter of 2011, recurring revenue was approximately 65% of total net sales.  
 
Our solutions optimize processes for healthcare organizations ranging in size from single-doctor practices to health systems, for the sponsors of clinical trials, for the medical device industry, for the healthcare commerce system and for consumers of healthcare. These solutions are licensed by more than 1,500 hospitals; 4,000 clinics and labs, 250 OEM customers and 70% of the top pharmaceutical companies. We believe that we have an opportunity to grow revenues by expanding our solution footprint in existing customers, as only a small percent currently have more than one of our solutions.  With the benefit of a broad customer base and several product lines undergoing ongoing innovation, we also believe that we are well-positioned to continue to leverage technologies into new segments where customers see value.  For example, as the push for Meaningful Use incentives drives adoption of Electronic Health Records, we envision this will create significant demand for our vendor-neutral archiving and iConnect access platforms to image enable those newly deployed systems. In order to take advantage of these opportunities, we began aggressively hiring sales and marketing personnel in the fourth quarter of 2010.  We continue these hiring efforts today.
 
 
17

 
Results of Operations
 
The following have significantly impacted the results of operations for the periods discussed herein:
 
 
·
During 2010, we expanded our product offerings through the acquisition of AMICAS, Inc. (AMICAS), an image and information management solutions provider, which we acquired on April 28, 2010 as well as five other acquisitions.  As a result of the timing of the completion of the acquisition of AMICAS, the comparability of the results of operations in the three months ended March 31, 2011 differ significantly from the same period in 2010.  In addition, in the three months ended March 31, 2010, we incurred $5.9 million in acquisition related expenses associated with the acquisition of AMICAS.  
 
 
·
We issued $200.0 million of Senior Secured Notes (Notes) in April 2010 as part of the financing for the acquisition of AMICAS.  The Notes were issued at 97.266% of the principal amount, are due in 2015 and bear interest at 11.75% of principal (payable on May 1st and November 1st of each year).  In connection with the Notes, we incurred issuance costs of $9.0 million.  The three months ended March 31, 2011 include three months of interest expense and amortization of the original issuance discount and costs of the Notes, while 2010 has no such expenses.
 
Three Months Ended March 31, 2011 Compared to the Three Months Ended March 31, 2010
 
The following table sets forth selected, summarized, unaudited, consolidated financial data for the periods indicated, as well as comparative data showing increases and decreases between the periods.  All amounts, except percentages, are in thousands.
 
 
18

 
   
Three Months Ended March 31,
   
Change
 
   
2011
   
%
(1)     2010    
%
(1)         $   %
                                         
Net sales:
                                       
Software and other
  $ 18,671       35.4 %   $ 9,365       46.9 %   $ 9,306       99.4 %
Professional services
    8,400       15.9 %     3,745       18.8 %     4,655       124.3 %
Maintenance and EDI
    25,601       48.6 %     6,860       34.4 %     18,741       273.2 %
Total net sales
    52,672       100.0 %     19,970       100.0 %     32,702       163.8 %
Cost of sales:
                                               
Software and other
    6,577       35.2 %     704       7.5 %     5,873       834.2 %
Professional services
    5,063       60.3 %     2,997       80.0 %     2,066       68.9 %
Maintenance and EDI
    7,964       31.1 %     1,497       21.8 %     6,467       432.0 %
Depreciation and amortization
    2,499       4.7 %     1,218       6.1 %     1,281       105.2 %
Total cost of sales
    22,103       42.0 %     6,416       32.1 %     15,687       244.5 %
Total gross margin
    30,569       58.0 %     13,554       67.9 %     17,015       125.5 %
                                                 
Gross margin by net sales category (3)
                                               
Software and other
    12,094       64.8 %     8,661       92.5 %     3,433       39.6 %
Professional services
    3,337       39.7 %     748       20.0 %     2,589       346.1 %
Maintenance and EDI
    17,637       68.9 %     5,363       78.2 %     12,274       228.9 %
                                                 
Operating expenses:
                                               
Sales and marketing
    8,693       16.5 %     2,819       14.1 %     5,874       208.4 %
Product research and development
    6,752       12.8 %     3,256       16.3 %     3,496       107.4 %
General and administrative
    6,590       12.5 %     3,851       19.3 %     2,739       71.1 %
Acquisition-related expenses
    104       0.2 %     5,938       29.7 %     (5,834 )     -98.2 %
Restructuring and other expenses
    (36 )     -0.1 %     -       0.0 %     (36 )  
NM
(2)
Depreciation and amortization
    2,650       5.0 %     840       4.2 %     1,810       215.5 %
Total operating costs and expenses
    24,753       47.0 %     16,704       83.6 %     8,049       48.2 %
Operating income (loss)
    5,816       11.0 %     (3,150 )     -15.8 %     8,966       -284.6 %
Other income (expense), net
    (6,560 )     -12.5 %     46       0.2 %     (6,606 )  
NM
(2)
Loss before income taxes
    (744 )     -1.4 %     (3,104 )     -15.5 %     2,360       -76.0 %
Income tax expense
    845       1.6 %     48       0.2 %     797    
NM
(2)
Net loss
    (1,589 )     -3.0 %     (3,152 )     -15.8 %     1,563       -49.6 %
Less:  preferred stock dividends
    1,566       3.0 %     -       0.0 %     -    
NM
(2)
Net loss available to common shareholders
  $ (3,155 )     -6.0 %   $ (3,152 )     -15.8 %   $ (3 )     0.1 %
 
 
(1)
Percentages are of total net sales, except for cost of sales and gross margin, which are based upon related net sales.
 
(2)
NM denotes percentage is not meaningful.
 
(3)
Depreciation and amortization expenses are excluded from these gross margin calculations.
 
Net Sales
 
Software and Other Sales.  Total software and other sales in 2011 were $18.7 million, an increase of $9.3 million, or 99.4%, from $9.4 million in 2010, primarily due to sales arising from the acquisition of AMICAS.  We anticipate that the revenue recognized from software and other sales may vary significantly on a quarterly basis.
 
Professional Services Sales.  Total professional services sales in 2011 were $8.4 million, an increase of $4.7 million, or 124.3%, from $3.7 million in 2010, primarily due to sales arising from the acquisition of AMICAS.  
 
Maintenance and EDI Sales.  Total maintenance and EDI sales in 2011 were $25.6 million, an increase of $18.7 million, or 273.2%, from $6.9 million in 2010 due to sales arising from the acquisition of AMICAS.
 
Gross Margin
 
Gross Margin – Software and Other Sales. Gross margin on software and other sales was $12.1 million in 2011, an increase of $3.4 million, or 39.6%, from $8.7 million in 2010.  Gross margin as a percentage of software and other sales decreased to 64.8% in 2011 from 92.5% in 2010, due to an increase in hardware sales, which are at lower margins than software only sales, as a result of the acquisition of AMICAS.  Hardware sales were 28% of software and other sales in 2011 compared to 5% in 2010.  We expect gross margin on software and other sales to fluctuate depending on the mix of sales among our products.
 
 
19

 
Gross Margin – Professional Service Sales. Gross margin on professional service sales was $3.3 million in 2011, an increase of $2.6 million, or 346.1%, from $0.7 million in 2010.  Gross margin as a percentage of professional service sales increased to 39.7% in 2011 from 20.0% in 2010, primarily due to an increase in the billable utilization of our professional services resources.  As the majority of professional services costs are fixed, we expect gross margins going forward to fluctuate depending on billable utilization of these resources.
 
Gross Margin – Maintenance and EDI Sales. Gross margin on maintenance and EDI sales was $17.6 million in 2011, an increase of $12.3 million, or 228.9%, from $5.3 million in 2010.  Gross margin as a percentage of maintenance and EDI sales decreased to 68.9% in 2011 from 78.2% in 2010, primarily due to the impact of the AMICAS acquisition, which included more third party maintenance costs.  Further, EDI margins are typically lower than that of maintenance.  
 
Depreciation and Amortization.  Depreciation and amortization expense increased $1.3 million, or 105.2%, to $2.5 million in 2011 from $1.2 million in 2010, primarily due to the acquisition of AMICAS.
 
Sales and Marketing
 
Sales and marketing expense increased $5.9 million, or 208.4%, to $8.7 million in 2011 from $2.8 million in 2010, primarily due to the acquisition of AMICAS. As a percentage of net sales, sales and marketing expense increased by 2.4% to 16.5% as a result of our investments in these functions to allow us to meet our sales goals.  We expect that our quarterly sales and marketing expenses will continue to increase in 2011 as we invest further in these functions.
 
Product Research and Development
 
Product research and development expense increased $3.5 million, or 107.4%, to $6.8 million in 2011 from $3.3 million in 2010, primarily due to the acquisition of AMICAS.  As a percentage of net sales, product research and development decreased by 3.5% to 12.8% as we were able to leverage our innovation efforts.  We expect that our quarterly product research and development expense will increase in 2011 as we invest and grow these functions to allow us to innovate and expand our product solution capabilities.
 
General and Administrative
 
General and administrative expense increased $2.7 million, or 71.1%, to $6.6 million in 2011 from $3.9 million in 2010, primarily due to the acquisition of AMICAS.  As a percentage of net sales, general and administrative expenses decreased by 6.8% to 12.5% as a result of the cost saving initiatives which were implemented in connection with the acquisition of AMICAS.  We expect to leverage our current level of general and administrative operations during 2011.
 
Depreciation and Amortization
 
Depreciation and amortization expense increased $1.8 million, or 215.5%, to $2.6 million in 2011 from $0.8 million in 2010, due to depreciation and amortization on fixed assets and intangible assets acquired from AMICAS.  
 
Other Income (Expense), Net
 
Net other expense increased $6.6 million in 2011, primarily due to $6.5 million of interest expense and amortization of issuance costs and note discount associated with our $200.0 million Notes issued to fund the AMICAS acquisition.
 
Income Tax Expense
 
In 2011, we recorded income tax expense of $0.8 million, resulting in an effective tax rate of (113.6%) compared to (1.5%) of income tax expense recorded in 2010.   The effective tax rate for 2011 differs significantly from the statutory rate primarily due to non-cash income tax expense being recorded for profitable foreign operations that cannot be offset by unprofitable U.S. domestic operations requiring a full valuation allowance.  The effective tax rate for 2010 differed from the statutory rate primarily due to the effect of changes in valuation allowances in both our primary foreign and domestic tax jurisdictions.  Our expected effective income tax rate is volatile and may move up or down with changes in, among other items, operating income and the results of changes in tax laws and regulations of the U.S. and the foreign jurisdictions in which we operate.
 
 
20

 
 
Liquidity and Capital Resources
 
Our cash and cash equivalents were $47.7 million at March 31, 2011, an increase of approximately $6.7 million, or 16.3%, from our balance of $41.0 million at December 31, 2010.  In addition, our working capital was $36.7 million at March 31, 2011, an increase of $7.9 million from our working capital of $28.8 million at December 31, 2010.
 
The change in cash and cash equivalents during the three month periods ended March 31, 2011and 2010 is attributed to the following factors:
 
   
Three Months Ended March 31,
 
   
2011
   
2010
 
       ( unaudited)  
   
(amounts in millions)
 
Cash received from (paid for):
           
Acquisitions
  $ -     $ (1.4 )
Restructuring initiatives
    (0.6 )     (0.4 )
Acquisition related costs
    (0.4 )     (4.9 )
Preferred stock deposits, net of escrow
    -       4.3  
Debt and equity issuance costs
    -       (1.6 )
Property and equipment purchases
    (0.3 )     (0.6 )
Settlements with former officers
    (0.9 )     -  
Core business operations
    8.9       0.8  
Increase (decrease) in cash
  $ 6.7     $ (3.8 )
 
Operating Cash Flows
 
Cash provided by operating activities was $6.9 million in 2011, compared to cash used in operating activities of $4.6 million in 2010.  The net loss in 2011 of $1.6 million includes non-cash expenses of $7.2 million and interest expense from our Notes of $5.9 million, which is not payable until May 2011.  In addition, the timing between the recording of acquisition-related and restructuring costs and payments thereof impacted operating cash flows.  
 
In addition to the payments related to restructuring initiatives as noted in the table above, we have remaining payments as of March 31, 2011 of $1.6 million.  DSO, based on pro forma revenues, was 91 days in the first quarter of 2011 compared to a quarterly average of 99 days in 2010.    
 
Contractual Obligations
 
Total outstanding commitments as of March 31, 2011 (in thousands), were as follows:
 
          Payment due by period  
Contractual Obligations
 
Total
   
Less than
 1 Year
   
1-3 Years
   
3-5Years
   
More than
 5 Years
 
Operating leases
  $ 22,317     $ 4,509     $ 5,560     $ 3,135     $ 9,113  
Capital leases (including interest)
    56       54       2       -       -  
Notes payable (Including interest)
    305,750       23,500       47,000       235,250       -  
Total
  $ 328,123     $ 28,063     $ 52,562     $ 238,385     $ 9,113  
 
The above obligations include lease payments, net of contractually committed sub-lease income of $0.2 million, $0.4 million, zero and zero in the respective periods indicated, involving facilities that we use and those we have either ceased to use or previously abandoned.  
 
Except for restricted cash of $0.8 million (primarily letters-of-credit related to our leased facilities) and a $0.8 million guarantee to a lender on behalf of a customer of ours at March 31, 2011, we do not have any other significant long-term obligations, contractual obligations, lines of credit, standby letters of credit, guarantees, standby repurchase obligations or other commercial commitments.
 
 
21

 
General
 
We believe our current cash and cash equivalent balances will be sufficient to meet our operating, financing and capital requirements through at least the next 12 months, including interest payments due under the Notes.  However, any projections of future cash inflows and outflows are subject to uncertainty.  In the event that it is necessary to raise additional capital to meet our short term or long term liquidity needs, such capital may be raised through additional debt, equity offerings or sale of certain assets.  If we raise additional funds through the issuance of equity, equity-related or debt securities, such securities may have rights, preferences or privileges senior to those of our common stock.  Furthermore, the number of shares of any new equity or equity-related securities that may be issued may result in significant dilution to existing shareholders.  In addition, the issuance of debt securities could increase the liquidity risk or perceived liquidity risk that we face.  We cannot, however, be certain that additional financing, or funds from asset sales, will be available on acceptable terms.  If adequate funds are not available or are not available on acceptable terms, we will likely not be able to take advantage of opportunities, develop or enhance services or products or respond to competitive pressures.  Any projections of future cash inflows and outflows are subject to uncertainty.  In particular, our uses of cash in 2011 and beyond will depend on a variety of factors such as the costs to implement our business strategy, the amount of cash that we are required to devote to defend and address any regulatory proceedings, and potential merger and acquisition activities. 
 
For a more detailed description of risks and uncertainties that may affect our liquidity, see Item 1A., “Risk Factors” in our Annual Report on Form 10-K for the year ended December 31, 2010.
 
Material Off Balance Sheet Arrangements
 
We have no material off balance sheet arrangements.
 
Critical Accounting Policies
 
Our discussion and analysis of our financial condition and results of operations are based upon our unaudited condensed consolidated financial statements, which have been prepared in accordance with accounting principles generally accepted in the United States.  The preparation of these condensed consolidated financial statements requires our management to make estimates and judgments that affect the reported amounts of assets, liabilities, revenues and expenses, and related disclosure of contingent assets and liabilities.  On an ongoing basis, our management evaluates these estimates.  We base our estimates and judgments on our experience, our current knowledge (including terms of existing contracts), our beliefs of what could occur in the future, our observation of trends in the industry, information provided by our customers and information available from other sources.  Actual results may differ materially from these estimates.
 
We have identified the following accounting policies and estimates as those that we believe are most critical to our financial condition and results of operations and that require management’s most subjective and complex judgments in estimating the effect of inherent uncertainties: revenue recognition, allowance for sales returns and doubtful accounts, intangible assets and goodwill, share-based compensation expense, income taxes, guarantees and loss contingencies.  There have been no significant changes in the quarterly period ended March 31, 2011 in our method of application of these critical accounting policies.  For a complete description of our critical accounting policies, please refer to Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations – Critical Accounting Policies” in our Annual Report on Form 10-K for the year ended December 31, 2010.
 
Item 3.
 
Interest Rate Risk
 
Our cash and cash equivalents are exposed to financial market risk due to fluctuations in interest rates, which may affect our interest income.  As of March 31, 2011, our cash and cash equivalents included money market funds and short term deposits totaling $47.7 million, and earned interest at a weighted average rate of approximately 0.2%.  The value of the principal amounts is equal to the fair value for these instruments.  Due to the relative short-term nature of our investment portfolio, our interest income is vulnerable to changes in short-term interest rates.  At current investment levels, our results of operations would vary by approximately $0.5 million on an annual basis for every 100 basis point change in our weighted average short-term interest rate.  We do not use our portfolio for trading or other speculative purposes.
 
Foreign Currency Exchange Risk
 
We have sales and expenses in Canada, China and Europe that are denominated in currencies other than the U.S. dollar and, as a result, have exposure to foreign currency exchange risk.  In the event our exposure to foreign currency exchange risk increases to levels that we do not deem acceptable, we may choose to hedge those exposures.  We did not enter into any derivative financial instruments to hedge such exposures in 2011 or 2010.
 
 
22

 
Item 4.
 
Disclosure Controls and Procedures
 
We evaluated the effectiveness of the design and operation of our disclosure controls and procedures, which were designed to provide resonable assurance of achieving their objectives, as of March 31, 2011, as required by Rule 13a-15 of the Exchange Act.  This evaluation was carried out under the supervision and with the participation of our management, including our principal executive officer and principal financial officer.  Based on this evaluation, our principal executive officer and principal financial officer have concluded that, as of  March 31, 2011, our disclosure controls and procedures were effective at the reasonable assurance level to ensure (1) that information required to be disclosed by us in the reports we file or submit under the Exchange Act is recorded, processed, summarized and reported, within the time periods specified in the SEC’s rules and forms, and (2) information required to be disclosed by us in our reports that we file or submit under the Exchange Act is accumulated and communicated to our management, including our principal executive officer and principal financial officer, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure.
 
Changes in Internal Control Over Financial Reporting
 
There were no changes with respect to our internal control over financial reporting that materially affected, or are reasonably likely to materially affect, our internal control over financial reporting in the quarterly period ended March 31, 2011.
 
 
23


PART II – OTHER INFORMATION
 
Item 1.
 
On June 1, 2009, Merge Healthcare was sued in the Milwaukee County Circuit Court, State of Wisconsin, by William C. Mortimore and David M. Noshay with respect to the separation of Mortimore’s and Noshay’s employment and our subsequent refusal to indemnify them with respect to litigation related to their service as officers of Merge.  The plaintiffs allege that we breached their employment agreements, unreasonably refused their requests for indemnification and breached other covenants of good faith and fair dealing.  The plaintiffs seek indemnification and unspecified monetary damages.  Discovery in this case is on-going.  On April 6, 2011, the Milwaukee County Circuit Court rendered a decision in which it concluded that Merge and Mortimore entered into an oral employment contract on or about June 15, 2006, but did not make any decision as to damages, which would be addressed in a later phase of the litigation.  We have retained litigation counsel and intend to continue to vigorously defend this action, including an evaluation of the Company’s rights to an appeal from the court’s April 6, 2011 decision and Order.
 
In January 2010, a purported stockholder class action complaint was filed in the Superior Court of Suffolk County, Massachusetts in connection with AMICAS’ proposed acquisition by Thoma Bravo, LLC (the “Thoma Bravo Merger”).  A second similar action was filed in the same court in February 2010 and consolidated with the first action.  In March 2010, because AMICAS had terminated the Thoma Bravo Merger and agreed to be acquired by us, the court dismissed the plaintiffs’ claims as moot.  Subsequently, counsel for the plaintiffs filed an application for approximately $5.0 million of attorneys’ fees for its work on this case, which fee petition AMICAS opposed.  We retained litigation counsel to defend against the fee petition.  On December 23, 2010, the court awarded plaintiffs approximately $3.2 million in attorneys’ fees and costs.  AMICAS has filed a notice of appeal from this judgment, and the plaintiffs have cross-appealed.  We previously tendered the defense in this matter to our appropriate insurers, who have provided coverage against the claims asserted against AMICAS.  After receipt of the court’s attorneys’ fee award decision, the applicable insurer denied policy coverage for approximately $2.5 million of the fee award.  We do not believe that the insurer’s denial has merit and have retained counsel to contest it.  We will vigorously assert all of our rights under our applicable insurance policies, which we believe cover the claims and expenses incurred by AMICAS or us in connection with the fee award.  However, an adverse outcome could negatively impact our financial condition.
 
On February 1, 2010, Merge filed a complaint against its former CEO, Richard Linden and its former CFO, Scott Veech, in the U.S. District for the Eastern District of Wisconsin, seeking a declaration that we do not have to indemnify either Linden or Veech for liabilities they incurred in connection with SEC investigation and enforcement actions and various securities fraud and shareholder derivative litigation.  Merge also seeks to recover from both defendants all costs incurred by Merge associated with defending Linden and Veech in those prior actions.  On October 15, 2010, the court concluded that it did not have subject matter jurisdiction over Merge’s claims and dismissed the claims in their entirety.  The court rendered no opinion on the merits of Merge’s claims. Merge is evaluating its further options with respect to the Scott Veech matter in Wisconsin state court.  On February 8, 2011, Merge filed a complaint against its former CEO, Richard Linden, in the U.S. District Court for the Eastern District of Wisconsin captioned Merge Healthcare Incorporated v. Richard Linden, Case no. 11-CV-001541.  On May 4, 2011, Merge and Linden entered into a confidential settlement agreement resolving all claims against Mr. Linden and through which Linden agreed to issue a statement of regret and apology to Merge’s Board of Directors and reimburse Merge for a portion of the Company’s legal fees to defend Linden in prior legal actions. Merge believes that it has numerous meritorious claims against Mr. Veech and will continue to pursue these claims, which have not been affected by the settlement with Mr. Linden.
 
In August, 2010, Merge Healthcare was sued in the Northern District of Texas by the court-appointed receiver for Stanford International Bank, Ltd.  The receiver alleges that Merge was a recipient of a fraudulent conveyance as a result of a Ponzi scheme orchestrated by Robert Stanford and Stanford International Bank, Ltd. (SIBL).  Merge is not alleged to have participated in the Ponzi scheme.  The receiver’s claims arise from the failed acquisition of Emageon, Inc. (Emageon) by Health Systems Solutions, Inc. (HSS) an affiliate of SIBL in February 2009, which resulted in the payment of a $9.0 million break-up fee by HSS, which payment is alleged to have been financed by SIBL.  Merge subsequently acquired Emageon as part of our AMICAS acquisition.  The complaint seeks to recover the $9.0 million payment to Emageon, plus interest, costs, and attorneys’ fees.  We have retained litigation counsel and intend to vigorously defend this action.  We have filed a motion to dismiss the complaint.  That motion has been fully briefed, and we are awaiting a decision from the court.  However, an adverse outcome could negatively impact our operating results and financial condition.
 
 
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In addition to the matters discussed above, we are, from time to time, parties to legal proceedings, lawsuits and other claims incident to our business activities.  Such matters may include, among other things, assertions of contract breach or intellectual property infringement, claims for indemnity arising in the course of our business and claims by persons whose employment has been terminated.  Such matters are subject to many uncertainties and outcomes are not predictable.  We are unable to estimate the ultimate aggregate amount of monetary liability, amounts which may be covered by insurance or recoverable from third parties, or the financial impact with respect to these matters as of the date of this report.
 
Item 1A.
 
Our operations and financial results are subject to various risks and uncertainties that could adversely affect our business, financial condition, results of operations, and the market price for our common stock.  Part I, Item 1A, “Risk Factors” of our Annual Report on Form 10-K for the year ended December 31, 2010 includes a detailed discussion of these factors and these factors have not changed materially from those included in the Form 10-K.
 
See also the discussions in Part I, Item 2, “Managements Discussion and Analysis of Financial Condition and Results of Operations - Liquidity and Capital Resources” and Part I, Item 4, “Controls and Procedures” in this Quarterly Report on Form 10-Q.
 
Item 2.
Unregistered Sales of Equity Securities and Use of Proceeds
 
In the three months ended March 31, 2011, we issued 974,701 shares as partial consideration for an insignificant acquisition which was completed in the fourth quarter of 2010.  These shares had been recorded as common stock subscribed as of December 31, 2010.  Further information about this transaction can be found in our Current Report on Form 8-K dated January 6, 2011.
 
Item 6.
 
(a)  Exhibits
 See Exhibit Index
 
 
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SIGNATURES
 
Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
 
 
Registrant:
   
 
MERGE HEALTHCARE INCORPORATED
   
May 5, 2011
By:
/s/ Jeffery A. Surges
   
Jeffery A. Surges
   
Chief Executive Officer
   
(principal executive officer)
 
May 5, 2011
By:
/s/ Justin C. Dearborn
   
Justin C. Dearborn
   
President and Chief Financial Officer
   
(principal financial officer)
 
 
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EXHIBIT INDEX
 
 
 
 
 
 
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