e10vq

-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, POM9pX0T+MPUuxygrT31IQj5G6peeBXKdTsy7EkIf7Dnt9I0jxwl79mdexE/g1kY Y5TZSjZdXaDUjWrStuqWXA== 0000950123-10-047366.txt : 20100510 0000950123-10-047366.hdr.sgml : 20100510 20100510173012 ACCESSION NUMBER: 0000950123-10-047366 CONFORMED SUBMISSION TYPE: 10-Q PUBLIC DOCUMENT COUNT: 9 CONFORMED PERIOD OF REPORT: 20100331 FILED AS OF DATE: 20100510 DATE AS OF CHANGE: 20100510 FILER: COMPANY DATA: COMPANY CONFORMED NAME: MEDQUIST INC CENTRAL INDEX KEY: 0000884497 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374] IRS NUMBER: 222531298 STATE OF INCORPORATION: NJ FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 10-Q SEC ACT: 1934 Act SEC FILE NUMBER: 001-13326 FILM NUMBER: 10817840 BUSINESS ADDRESS: STREET 1: 1000 BISHOPS GATE BLVD STREET 2: SUITE 300 CITY: MOUNT LAUREL STATE: NJ ZIP: 08054-4632 BUSINESS PHONE: 8568108000 MAIL ADDRESS: STREET 1: 1000 BISHOPS GATE BLVD STREET 2: SUITE 300 CITY: MOUNT LAUREL STATE: NJ ZIP: 08054-4632 10-Q 1 w78445e10vq.htm FORM 10-Q e10vq

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

Form 10-Q

(Mark One)


þ		QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended March 31, 2010.


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: 001-13326

MEDQUIST INC.

(Exact name of registrant as specified in its charter)


New Jersey		22-2531298
(State or other jurisdiction of		(I.R.S. Employer
incorporation or organization)		Identification No.)

1000 BISHOPS GATE BOULEVARD
SUITE 300
MOUNT LAUREL, NEW JERSEY		08054-4632
(Address of principal executive offices)		(Zip Code)

(856) 206-4000
(Registrant’s telephone number, including area code)

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 þ No 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 o No 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. (Check one):


Large accelerated filer o	Accelerated filer þ	Non-accelerated filer o	Smaller reporting company o
		(Do not check if a smaller reporting company)

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes o No þ

The number of registrant’s shares of common stock, no par value, outstanding as of May 5, 2010 was 37,555,893.

MEDQUIST INC.
INDEX


		Page
PART I. FINANCIAL INFORMATION		1
Item 1. Financial Statements		1
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations		11
Item 4. Controls and Procedures		20

PART II. OTHER INFORMATION		21

Item 1. Legal Proceedings		21
Item 1A. Risk Factors		23
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds		23
Item 3. Defaults Upon Senior Securities		23
Item 5. Other Information		23
Item 6. Exhibits		23
EX-10.4
EX-10.5
EX-31.1
EX-31.2
EX-32.1
EX-32.2

PART I. FINANCIAL INFORMATION

Item 1. Financial Statements

MedQuist Inc. and Subsidiaries
Consolidated Statements of Operations
(In thousands, except per share amounts)
Unaudited


	Three months ended
	March 31,
	2010			2009
Net revenues	$	73,981		$	78,944


Operating costs and expenses:
Cost of revenues		49,833			53,868
Selling, general and administrative		8,797			9,438
Research and development		2,281			2,416
Depreciation		1,910			2,552
Amortization of intangible assets		1,820			1,511
Cost of legal proceedings and settlements		1,043			1,924
Acquisition related charges		894			—
Restructuring charges		60			—


Total operating costs and expenses		66,638			71,709


Operating income		7,343			7,235

Equity in income of affiliated company		514			72
Interest income (expense), net		(146	)		46


Income before income taxes		7,711			7,353

Income tax provision		367			499


Net income	$	7,344		$	6,854


Net income per share:
Basic	$	0.20		$	0.18

Diluted	$	0.20		$	0.18


Weighted average shares outstanding:
Basic		37,556			37,556

Diluted		37,556			37,556

The accompanying notes are an integral part of these consolidated financial statements.

MedQuist Inc. and Subsidiaries
Consolidated Balance Sheets
(In thousands)
Unaudited


	March 31,			December 31,
	2010			2009
Assets
Current assets:
Cash and cash equivalents	$	21,726		$	25,216
Accounts receivable, net of allowance of $2,984 and $3,159, respectively		43,897			43,627
Income tax receivable		283			772
Other current assets		5,299			4,940

Total current assets		71,205			74,555

Property and equipment, net		10,758			11,772
Goodwill		40,723			40,813
Other intangible assets, net		36,032			36,307
Deferred income taxes		1,312			1,396
Other assets		17,769			9,818


Total assets	$	177,799		$	174,661


Liabilities and Shareholders’ Equity
Current liabilities:
Accounts payable	$	7,544		$	8,687
Accrued expenses		22,634			22,848
Accrued compensation		10,495			12,432
Deferred income taxes		4			4
Deferred revenue		10,112			10,854

Total current liabilities		50,789			54,825

Deferred income taxes		3,424			3,240
Other non-current liabilities		1,745			1,848


Commitments and contingencies (Note 8)

Shareholders’ equity:
Common stock — no par value; authorized 60,000 shares; 37,556 and 37,556 shares issued and outstanding, respectively		237,896			237,848
Accumulated deficit		(118,510	)		(125,854	)
Accumulated other comprehensive income		2,455			2,754


Total shareholders’ equity		121,841			114,748


Total liabilities and shareholders’ equity	$	177,799		$	174,661

The accompanying notes are an integral part of these consolidated financial statements.

MedQuist Inc. and Subsidiaries
Consolidated Statements of Cash Flows
(In thousands)
Unaudited


	Three months ended
	March 31,
	2010			2009
Operating activities:
Net income	$	7,344		$	6,854
Adjustments to reconcile net income to cash provided by operating activities:
Depreciation and amortization		3,730			4,063
Equity in income of affiliated company		(514	)		(72	)
Deferred income tax provision		182			309
Stock option expense		48			48
Provision for (recovery of) doubtful accounts		779			(105	)
Loss on disposal of property and equipment		—			24

Changes in operating assets and liabilities:
Accounts receivable		(1,035	)		3,920
Income tax receivable		483			(20	)
Other current assets		(166	)		923
Other non-current assets		65			(18	)
Accounts payable		(819	)		392
Accrued expenses		(482	)		(1,739	)
Accrued compensation		(1,938	)		930
Deferred revenue		(766	)		(1,424	)
Other non-current liabilities		(84	)		63

Net cash provided by operating activities	$	6,827		$	14,148


Investing activities:
Purchase of property and equipment		(1,737	)		(1,393	)
Capitalized software		(925	)		(766	)
Deposit for Spheris Acquisition		(7,500	)		—

Net cash used in investing activities		(10,162	)		(2,159	)


Financing activities:
Debt issuance costs		(195	)		—

Net cash used in financing activities		(195	)		—


Effect of exchange rate changes		40			(53	)


Net increase (decrease) in cash and cash equivalents		(3,490	)		11,936


Cash and cash equivalents — beginning of period		25,216			39,918


Cash and cash equivalents — end of period	$	21,726		$	51,854


Supplemental cash flow information:

Cash paid (recovered) for income taxes	$	(695	)	$	(131	)

Accommodation payments paid with credits	$	—		$	61

The accompanying notes are an integral part of these consolidated financial statements.

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

1. Basis of Presentation

The consolidated financial statements and footnotes thereto are unaudited. Certain information and footnote disclosures normally included in financial statements prepared in accordance with U.S. generally accepted accounting principles (GAAP) have been omitted pursuant to such rules and regulations although we believe that the disclosures are adequate to make the information presented not misleading. The consolidated financial statements include our accounts and the accounts of all of our wholly-owned subsidiaries. All significant inter-company accounts and transactions have been eliminated in consolidation.

These statements reflect all normal recurring adjustments that, in the opinion of management, are necessary for the fair presentation of our results of operation, financial position and cash flows. Interim results are not necessarily indicative of results for a full year. The information in this Form 10-Q should be read in conjunction with our 2009 Annual Report on Form 10-K for the year ended December 31, 2009 filed with the Securities and Exchange Commission (SEC) on March 12, 2010.

Recent Developments On April 22, 2010, we and our majority shareholder, CBay Inc. (together with us, the Purchasers), completed the acquisition (the Acquisition) of substantially all of the assets of Spheris, Inc. (Spheris) and certain of its affiliates (collectively with Spheris, the Sellers), pursuant to the terms of the Stock and Asset Purchase Agreement (the Agreement) entered into between the Purchasers and Sellers on April 15, 2010. See Note 11 for a description of the transaction.

Recent Accounting Pronouncements

In September 2009, the Financial Accounting Standards Board (FASB) ratified two consensuses affecting revenue recognition:

The first consensus, Revenue Recognition—Multiple-Element Arrangements, sets forth requirements that must be met for an entity to recognize revenue from the sale of a delivered item that is part of a multiple-element arrangement when other items have not yet been delivered. One of those current requirements is that there be objective and reliable evidence of the standalone selling price of the undelivered items, which must be supported by either vendor-specific objective evidence (VSOE) or third-party evidence (TPE).

This consensus eliminates the requirement that all undelivered elements have VSOE or TPE before an entity can recognize the portion of an overall arrangement fee that is attributable to items that already have been delivered. In the absence of VSOE or TPE of the standalone selling price for one or more delivered or undelivered elements in a multiple-element arrangement, entities will be required to estimate the selling prices of those elements. The overall arrangement fee will be allocated to each element (both delivered and undelivered items) based on their relative selling prices, regardless of whether those selling prices are evidenced by VSOE or TPE or are based on the entity’s estimated selling price. Application of the “residual method” of allocating an overall arrangement fee between delivered and undelivered elements will no longer be permitted.

The second consensus, Software-Revenue Recognition, addresses the accounting for transactions involving software to exclude from its scope tangible products that contain both software and non-software and not-software components that function together to deliver a products functionality.

The consensuses are effective prospectively for revenue arrangements entered into or materially modified in fiscal years beginning on or after June 15, 2010. We are evaluating the potential impact of these requirements on our financial statements.

2. Comprehensive income

Comprehensive income was as follows:


	Three months ended March 31,
	2010			2009
Net income	$	7,344		$	6,854
Foreign currency translation adjustment		(299	)		(265	)

Comprehensive income	$	7,045		$	6,589

3. Net Income per Share

Basic net income per share is computed by dividing net income by the weighted average number of shares outstanding during each period. Diluted net income per share is computed by dividing net income by the weighted average shares outstanding, as adjusted for the dilutive effect of common stock equivalents, which consist only of stock options, using the treasury stock method.

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

The following table reflects the weighted average shares outstanding used to compute basic and diluted net income per share:


	Three months ended March 31,
	2010		2009
Net income	$	7,344	$	6,854

Weighted average shares outstanding:
Basic		37,556		37,556
Effect of dilutive shares		—		—

Diluted		37,556		37,556

Net income per share:
Basic	$	0.20	$	0.18
Diluted	$	0.20	$	0.18

For the three months ended March 31, 2010 and 2009, 1,152 and 1,582 options, respectively, were excluded from the computation of diluted earnings per share as the options’ exercise price was greater than the average market price of the common stock during the respective period.

4. Accrued Expenses

Accrued expenses consisted of the following:


	March 31, 2010		December 31, 2009
Customer accommodations	$	11,477	$	11,635
Other (no item exceeds 5% of current liabilities)		11,157		11,213

Total accrued expenses	$	22,634	$	22,848

In November 2003, one of our employees raised allegations that we had engaged in improper billing practices. In response, our board of directors undertook an independent review of these allegations (Review). In response to our customers’ concern over the public disclosure of certain findings from the Review, we made the decision in the fourth quarter of 2005 to take action to try to avoid litigation and preserve and solidify our customer business relationships by offering a financial accommodation to certain of our customers.

In connection with our decision to offer financial accommodations to certain of our customers (Accommodation Customers), we analyzed our historical billing information and the available report-level data (Management’s Billing Assessment) to develop individualized accommodation offers to be made to Accommodation Customers (Accommodation Analysis). Based on the Accommodation Analysis, our board of directors authorized management to make cash or credit accommodation offers to Accommodation Customers in the aggregate amount of $75,818. By accepting our accommodation offer, the customer agreed, among other things, to release us from any and all claims and liability regarding the billing related issues. We are unable to predict how many customers, if any, may accept the outstanding accommodation offers on the terms proposed by us, nor are we able to predict the timing of the acceptance of any outstanding accommodation offers. Until any offers are accepted, we may withdraw or modify the terms of the accommodation program or any outstanding offers at any time. In addition, we are unable to predict how many future offers, if made, will be accepted on the terms proposed by us. We regularly evaluate whether to proceed with, modify or withdraw the accommodation program or any outstanding offers.

The following is a summary of the financial statement activity related to the customer accommodation.


	Three months ended			Year ended
	March 31, 2010			December 31, 2009
Beginning balance	$	11,635		$	12,055
Payments and other adjustments		(158	)		(317	)
Credits		—			(103	)

Ending balance	$	11,477		$	11,635

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

2009 Restructuring Plan

During the third and fourth quarters of 2009, as a result of management’s continued planned process improvement and technology development investments we committed to an exit and disposal plan which includes projected employee severance for planned reduction in headcount. Because of plan development in late 2009 and execution of the plan over multiple quarters in 2009 and 2010, not all personnel affected by the plan know of the plan or its impact. The plan includes costs of $2.5 million for employee severance and $0.4 million for vacating operating leases. The table below reflects the financial statement activity related to the 2009 restructuring plan:


	Three Months Ended			Year Ended
	March 31, 2010			December 31, 2009
Beginning balance	$	2,064		$	—
Charge		60			2,810
Cash paid		(495	)		(746	)

Ending balance	$	1,629		$	2,064

The charge for the three months ended March 31, 2010 reflected costs related to vacating facilities.

5. Cost of Legal Proceedings and Settlements

The following is a summary of the amounts recorded as Cost of legal proceedings and settlements, in the accompanying consolidated statements of operations:


	Three months ended March 31,
	2010		2009
Legal fees	$	1,043	$	1,894
Other professional fees		—		30

Total	$	1,043	$	1,924

Other professional fees represent document search and retrieval costs.

6. Income Taxes

Our consolidated income tax expense consists principally of an increase in deferred tax liabilities related to goodwill amortization deductions for income tax purposes during the applicable period as well as state and foreign income taxes. We recorded a valuation allowance to reduce our net deferred tax assets to an amount that is more likely than not to be realized in future years.

We expect that our consolidated income tax expense for the year ended December 31, 2010, similar to the year ended December 31, 2009, will consist principally of an increase in deferred tax liabilities related to goodwill amortization deductions for income tax purposes during the applicable year as well as state and foreign income taxes. We regularly assess the future realization of deferred taxes and whether the valuation allowance against the majority of domestic deferred tax assets is still warranted. To the extent sufficient positive evidence, including past results and future projections, exists to benefit all or part of these benefits, the valuation allowance will be released accordingly.

We classify penalties and interest related to uncertain tax positions as part of income tax expense. There were no material changes to our uncertain tax positions, including penalties and interest for the three months ended March 31, 2010.

7. Credit Agreement

In August 2009, we entered into a five-year $25 million revolving credit agreement (the Wells Fargo Credit Agreement) with Wells Fargo Foothill, LLC. Subject to certain terms and conditions, the Wells Fargo Credit Agreement provided committed revolving funding through August 2014 and included an option whereby we could increase our maximum credit to $40 million. The amount available for borrowings was based upon a percentage of eligible accounts receivable. At March 31, 2010, $21.0 million was available

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

under the Wells Fargo Credit Agreement. At March 31, 2010 and December 31, 2009, there were no borrowings outstanding under the Wells Fargo Credit Agreement.

The Wells Fargo Credit Agreement terminated April 22, 2010 when we acquired substantially all of the assets of Spheris, Inc. and entered into a credit agreement with General Electric Capital Corporation, CapitalSource Bank, and Fifth Third Bank, as described in Note 11. Pursuant to its terms, we paid a fee of $576 to terminate the Wells Fargo Credit Agreement.

8. Commitments and Contingencies

Customer Litigation

Kaiser Litigation

On June 6, 2008, plaintiffs Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals, The Permanente Medical Group, Inc., Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and Kaiser Foundation Health Plan of Colorado (collectively, Kaiser) filed suit against MedQuist Inc. and MedQuist Transcriptions, Ltd. (collectively, MedQuist) in the Superior Court of the State of California in and for the County of Alameda. The action is entitled Foundation Health Plan Inc., et al v. MedQuist Inc. et al., Case No. CV-078-03425 PJH. The complaint asserts five causes of action, for common law fraud, breach of contract, violation of California Business and Professions Code section 17200, unjust enrichment, and a demand for an accounting. More specifically, Kaiser alleges that we fraudulently inflated the payable units of measure in medical transcription reports generated by us for Kaiser pursuant to the contracts between the parties. The damages alleged in the complaint include an estimated $7 million in compensatory damages, as well as punitive damages, attorneys’ fees and costs, and injunctive relief. We contend that we did not breach the contracts with Kaiser, or commit the fraud alleged, and we intend to defend the suit vigorously. The parties participated in private mediation on July 24, 2008, but the case was not settled. We removed the case to the United States District Court for the Northern District of California, and we filed motions to dismiss Kaiser’s complaint and to transfer venue of the case to the United Stated District Court for the District of New Jersey. Kaiser stipulated to transfer, and the case was transferred to the United States District Court for the District of New Jersey on or about August 26, 2008

The parties exchanged initial disclosures on October 6, 2008 and appeared before the court for an initial scheduling conference on October 14, 2008. Kaiser’s initial disclosures claim damages, including compensatory damages, punitive damages, and prejudgment interest, in excess of $12 million. Following the scheduling conference, the court ordered the parties to mediation. The parties participated in court-ordered mediation on February 27, 2009 but the case was not settled. The court heard argument on our motion to dismiss on March 19, 2009. On April 8, 2009, the court entered an order denying our motion to dismiss, except that our motion to dismiss plaintiffs’ claim under the fraudulent prong of the California Unfair Competition Law was granted. The court issued a scheduling order on April 17, 2009, setting a pretrial schedule. We filed our answer to plaintiff’s complaint on April 23, 2009.

Kaiser served an initial set of discovery requests on May 7, 2009. On May 20, 2009, the court temporarily stayed discovery to address allegations of ethical misconduct by Kaiser’s trial counsel, Greenberg Traurig, LLP. On July 1, 2009, the court granted us leave to conduct limited written discovery regarding Greenberg Traurig’s alleged ethical misconduct and continued the temporary stay of all other discovery. On July 14, 2009, we moved for sanctions against Greenberg Traurig for breach of the New Jersey Rules of Professional Conduct, and we moved to stay the litigation pending resolution of the motion for sanctions. Discovery is presently stayed pending resolution of our motion to stay. No hearing date has been set for any of the pending motions. On February 24, 2010, the court granted our motion to stay pending resolution of the motion for sanctions and entered a scheduling order setting oral arguments on the pending motion for sanctions for March 16, 2010. On March 31, 2010, the court granted our motion to disqualify Greenberg Traurig as counsel for Kaiser. In its order, the court gave Kaiser until May 31, 2010 to obtain new counsel and set an in-person status conference for June 9, 2010.

Kahn Putative Class Action

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

Burlington County. In the action, plaintiff purports to bring the action on his own behalf and on behalf of all current holders of our common stock. The original complaint alleged that defendants breached their fiduciary duties of good faith, fair dealing, loyalty, and due care by purportedly agreeing to and initiating a process for our sale or a change of control transaction which will allegedly cause harm to plaintiff and members of the putative class. Plaintiff sought damages in an unspecified amount, plus costs and interest, a judgment declaring that defendants breached their fiduciary duties and that any proposed transactions regarding our sale or change of control are void, an injunction preventing our sale or any change of control transaction that is not entirely fair to the class, an order directing us to appoint three independent directors to our board of directors, and attorneys’ fees and expenses.

On June 12, 2008, plaintiff filed an amended class action complaint against us, eight of our current and former directors, and Philips in the Superior Court of New Jersey, Chancery Division. In the amended complaint, plaintiff alleged that our current and former directors breached their fiduciary duties of good faith, fair dealing, loyalty, and due care by not providing our public shareholders with the opportunity to decide whether they wanted to participate in a share purchase offer with non-party CBaySystems Holdings Ltd. (CBaySystems Holdings) that would have allowed the public shareholders to sell their shares of our common stock for an amount above market price. Plaintiff further alleged that CBaySystems Holdings made the share purchase offer to Philips and that Philips breached its fiduciary duties by accepting CBaySystems Holdings’ offer. Based on these allegations, plaintiff sought declaratory, injunctive, and monetary relief from all defendants. Plaintiff claimed that we were only named as a party to the litigation for purposes of injunctive relief.

On July 14, 2008, we moved to dismiss plaintiff’s amended class action complaint, arguing (1) that plaintiff’s amended class action complaint did not allege that we engaged in any wrongdoing which supported a breach of fiduciary duty claim and (2) that a breach of fiduciary duty claim is not legally cognizable against a corporation. Plaintiff filed an opposition to our motion to dismiss on July 21, 2008.

On November 21, 2008, the Court granted our motion and the motions filed by the other defendants and dismissed plaintiff’s amended class action complaint with prejudice. On December 31, 2008, plaintiff filed an appeal of the trial court’s dismissal order with the New Jersey Appellate Division. Thereafter, the parties briefed all the issues raised in plaintiff’s appeal. In our opposition brief, we opposed all the arguments plaintiff raised with respect to the dismissal of the claims against us.

On September 24, 2009, the Appellate Division held oral argument on the issues that are the subject of plaintiff’s appeal. We are now waiting for the Appellate Division to issue a decision.

Reseller Arbitration Demand

On October 1, 2007, we received from counsel to nine current and former resellers of our products (Claimants), a copy of an arbitration demand filed by the Claimants, initiating an arbitration proceeding styled Diskriter, Inc., Electronic Office Systems, Inc., Milner Voice & Data, Inc., Nelson Systems, Inc., NEO Voice and Communications, Inc., Office Business Systems, Inc., Roach-Reid Office Systems, Inc., Stiles Office Systems, Inc., and Travis Voice and Data, Inc. v. MedQuist Inc. and MedQuist Transcriptions, Ltd. (collectively MedQuist) (filed on September 27, 2007, AAA, 30-118-Y-00839-07). The arbitration demand purports to set forth claims for breach of contract; breach of covenant of good faith and fair dealing; promissory estoppel; misrepresentation; and tortious interference with contractual relations. The Claimants allege that we breached our written agreements with the Claimants by: (i) failing to provide reasonable training, technical support, and other services; (ii) using the Claimants’ confidential information to compete against the Claimants; (iii) directly competing with the Claimants’ territories; and (iv) failing to make new products available to the Claimants. In addition, the Claimants allege that we made false oral representations that we: (i) would provide new product, opportunities and support to the Claimants; (ii) were committed to continuing to use Claimants; (iii) did not intend to create our own sales force with respect to the Claimants’ territory; and (iv) would stay out of Claimants’ territories and would not attempt to take over the Claimants business and relationships with the Claimants’ customers and end-users. The Claimants assert that they are seeking damages in excess of $24.3 million. We also moved to dismiss MedQuist Inc. as a party to the arbitration since MedQuist Inc. is not a party to the Claimants’ agreements, and accordingly, has never agreed to arbitration. The AAA initially agreed to rule on these matters, but then decided to defer a ruling to the panel of arbitrators selected pursuant to the parties’ agreements (Panel). In response, we informed the Panel that a court, not the Panel, should rule on these issues. When it appeared that the Panel would rule on these issues, we initiated a lawsuit in the Superior Court of DeKalb County (the Court) and requested an injunction enjoining the Panel from deciding these issues. The Court denied the request, and indicated that a new motion could be filed if the Panel’s ruling was adverse to MedQuist Inc. or MedQuist Transcriptions, Ltd. On May 6, 2008, the Panel dismissed MedQuist Inc. as a party, but ruled against our opposition to a consolidated arbitration. We asked the Court to stay the arbitration in order to review that decision. The Court initially granted the stay, but later lifted the stay. The Court did not make any substantive rulings regarding consolidation, and in fact, left that

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

decision and others to the assigned judge, who was unable to hear those motions. Accordingly, until further order of the Court, the arbitration will proceed forward.

We filed an answer and counterclaim in the arbitration, which generally denied liability. In the lawsuit, the defendants filed a motion to dismiss alleging that our complaint failed to state an actionable claim for relief. On July 25, 2008, we filed our response which opposed the motion to dismiss in all respects. On September 10, 2008, the Court heard argument on defendants’ motion to dismiss. The Court did not issue a decision, but rather, took the matter under advisement.

During discovery in the arbitration, Claimants repeatedly modified the individual damage claims and asserted two alternative damage theories. Claimants did not specify what the two alternative damage theories were, but stated that they were seeking alternative damage amounts for each Claimant. The Panel issued a Revised Scheduling Order, which tentatively scheduled the arbitration to begin in February 2010.

On March 31, 2010, the parties entered into a Settlement Agreement and Release pursuant to which we paid the Claimants $500 on April 1, 2010 to resolve all claims. Under the Settlement Agreement and Release, (i) the parties exchanged mutual releases, (ii) the arbitration and related state court litigation were dismissed with prejudice and (iii) we did not admit to any liability or wrongdoing. We accrued the entire amount of this settlement as of December 31, 2009.

SEC Investigations of Former Officers

With respect to our historical billing practices, the SEC is pursuing civil litigation against our former chief financial officer, whose employment with us ended in July 2004. Pursuant to our bylaws, we have indemnification obligations for the legal fees for our former chief financial officer. In February 2010, one of our current employees, who was our former controller but who does not currently serve in a senior management or financial reporting oversight role, reached a settlement with the SEC in connection with the civil litigation that the SEC had brought against him in connection with our historical billing practices.

9. Related Party Transactions

From time to time, we enter into transactions in the normal course of business with related parties. Since August 6, 2008, CBaySystems Holdings and affiliated entities own approximately 69.5% ownership interest in MedQuist. The Audit Committee of our board of directors has been charged with the responsibility of approving or ratifying all related party transactions. In any situation where the Audit Committee sees fit to do so, any related party transaction, is presented to disinterested members of our board of directors for approval or ratification. All of the agreements with CBay Systems & Services, Inc. and CBay Inc. described below have been reviewed and approved by our Audit Committee.

On April 3, 2009, we entered into a transcription services agreement (Transcription Services Agreement) with CBay Systems, pursuant to which we outsource certain medical transcription services to CBay Systems. The Transcription Services Agreement will expire on April 16, 2012 unless sooner terminated by either party. Under the Transcription Services Agreement, we pay CBay Systems a per line fee based on each transcribed line of text processed and the specific type of service provided. CBay Systems will perform its services using our DocQment Enterprise Platform and will be held to certain performance standards and quality guidelines set forth in the agreement. The specific services to be performed will be set forth in order forms delivered by us to CBay Systems from time to time during the term of the Transcription Services Agreement. For the three months ended March 31, 2010 and 2009, we incurred expenses of $3,634 and $0, respectively, which were recorded in Cost of revenues. The Transcription Services Agreement terminated by agreement of the parties on March 9, 2010 when we entered into the Sales & Services Agreement with CBay Systems referenced immediately below.

On March 9, 2010, we entered into the Sales & Services Agreement with CBay Systems, pursuant to which we outsource certain medical transcription services to CBay Systems. Under the Sales & Services Agreement, CBay Systems has discontinued its new customer marketing efforts for transcription services to hospitals in North America and has become the exclusive supplier to us of Asian based transcription production services, which are either performed directly by CBay Systems or through a network of third party suppliers managed by CBay Systems. Under the Sales & Services Agreement, we pay CBay Systems a per line fee based on each transcribed line of text processed and the specific type of service provided. The Sales & Services Agreement will expire on March 10, 2015, and thereafter shall automatically renew for two additional five year terms, unless either party provides the other with written notice of its election to terminate the agreement at the end of the initial term or at the end of a renewal term, provided such notice is provided to the other party, not earlier than 12 months nor less than six months prior to the end of the initial term or the

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

applicable renewal term. Either we or CBay may terminate the Sales & Services Agreement if the other party materially breaches any term of the agreement, or in the event CBay Systems and its affiliates (other than us or our subsidiaries) cease to control, directly or indirectly, the power to vote at least thirty percent (30%) of our issued and outstanding common equity. For the three months ended March 31, 2010 and 2009, we recorded cost of revenues of $1,272 and $0, respectively.

On March 31, 2009, we entered into a transcription services subcontracting agreement (Subcontracting Agreement) with CBay Systems, pursuant to which CBay Systems will subcontract certain medical transcription, editing and related services to us. Under the Subcontracting Agreement, we will provide the medical transcription, editing and related services to CBay Systems using labor located within the United States using our DocQment Enterprise Platform. The specific services to be performed will be set forth in order forms delivered by CBay Systems to us from time to time during the term of the Subcontracting Agreement. We will receive 98% of the net monthly fees collected by CBay Systems from its customers for the services provided by us. For the three months ended March 31, 2010 and 2009, we recorded revenue of $531 and $0 under the terms of the Subcontracting agreement.

On September 19, 2009, we entered into a services agreement (Management Services Agreement) with CBay Inc. (CBay), a wholly-owned subsidiary of CBay Systems, pursuant to which certain senior executives and directors of CBay render to us, upon the request of our Chief Executive Officer, certain advisory and consulting services in relation to the affairs of us and our subsidiaries. The Management Services Agreement will remain in effect until the earliest to occur of (i) December 31, 2009, if either party gives notice of termination of the Services Agreement to the other party no later than December 1, 2009, (ii) the end of any calendar quarter subsequent to December 31, 2009, if either party gives notice of termination of the Services Agreement to the other party no later than thirty (30) days prior to the end of such calendar quarter, (iii) such time as CBay or its affiliates (other than the us and our subsidiaries) control, directly or indirectly, the power to vote less than thirty percent (30%) of the issued and outstanding common equity of the MedQuist, and (iv) such earlier date as we and CBay may mutually agree upon in writing. The Management Services Agreement provides that, in consideration of the management services rendered by CBay to us since July 1, 2009 and to be rendered by CBay to us pursuant to the Management Services Agreement, we will pay CBay a quarterly services fee equal to $350, which shall be payable in arrears. For the three months ended March 31, 2010 and 2009, we incurred services expenses with CBay Inc. of $350 and $0, respectively, which has been recorded in Selling, general and administrative expense.

As of March 31, 2010 and December 31, 2009, Accounts payable and Accrued expenses included $363 and $1,362, respectively, for amounts due to CBay. As of March 31, 2010 and December 31, 2009, Accounts receivable included $396 and $710, respectively, for amounts due from CBay Systems.

10. Investment in A-Life Medical, Inc. (A-Life)

We have an investment in A-Life of $9,378 and $8,864 as of March 31, 2010 and December 31, 2009. Our investment is accounted for under the equity method as we owned approximately 32% of the outstanding ownership as of March 31, 2010 and December 31, 2009. During the quarter ended March 31, 2010, A-Life recorded a change in estimate related to its purchase accounting of an acquisition. Our share of the impact from the change in estimate was approximately $440 which is included in the Equity in income of affiliated company. Our investment in A-Life is included in Other Assets in the accompanying consolidated balance sheets.

11. Subsequent Events

On April 22, 2010, we and our majority shareholder, CBay Inc. (together with us, the Purchasers), completed the acquisition (the Acquisition) of substantially all of the assets of Spheris, Inc. (Spheris) and certain of its affiliates (collectively with Spheris, the Sellers), pursuant to the terms of the Stock and Asset Purchase Agreement (the Agreement) entered into between the Purchasers and Sellers on April 15, 2010. The purchase price for the assets was approximately $116.3 million, consisting of approximately $98.8 million of cash, and the issuance of a promissory note in the principal amount of $17.5 million (the Subordinated Promissory Note). Included in Other Assets in the accompanying consolidated balance sheets as of March 31, 2010, is a deposit of $7.5 million related to the Acquisition.

In connection with the Acquisition, MedQuist Inc., together with MedQuist Transcriptions, Ltd. (MedQuist Transcriptions), a wholly-owned subsidiary (collectively, the Loan Parties) entered into a Credit Agreement (the GE Credit Agreement) with General Electric Capital Corporation, CapitalSource Bank, and Fifth Third Bank. The GE Credit Agreement provides for up to $100 million in senior secured credit facilities, consisting of a $50 million term loan, and a revolving credit facility of up to $50 million. The credit facilities are secured by a first priority lien on substantially all of the property of the Loan Parties. The term loan is repayable in equal quarterly installments of $5 million starting on October 1, 2010, with the balance payable 2.5 years from the date of closing (or, if certain convertible senior notes of CBay are called or otherwise become due and payable prior to such date, such earlier date). The

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

interest rate is Prime plus 3.25% (currently an interest rate of 6.50%) and is payable monthly. We may also structure borrowings as Eurodollar loans with an interest rate based on LIBOR rates. We may prepay the loan with certain prepayment penalties. Mandatory prepayments are required when we generate excess cash flows as defined under the agreement. The Term Loan maturity date is the earlier of October 22, 2012 or the date on which certain CBay notes are called or otherwise become due and payable. Maximum borrowings under the Revolving Loan are the lower of a percentage of eligible accounts receivable or $50 million. The interest rate is Prime plus 3% (currently an interest rate of 6.25%) and is payable monthly with a scheduled termination date of April 22, 2014.

To complete closing of the transactions, the entire facility amount of $100 million was utilized. Amounts borrowed under the GE Credit Agreement bear interest at a rate selected by MedQuist Transcriptions equal to the Base Rate or the Eurodollar Rate (each as defined in the GE Credit Agreement) plus a margin, all as more fully set forth in the GE Credit Agreement.

Both the Term Loan and the Revolving Loan contain usual and customary financial covenants, including covenants relating to reporting and notification, payment of indebtedness, taxes and other obligations, and compliance with applicable laws. There are also financial covenants, which include a Minimum Consolidated Fixed Charge Coverage Ratio, and a Maximum Consolidated Senior Leverage Ratio and a Maximum Consolidated Total Leverage Ratio and Minimum Liquidity, as defined. The GE Credit Agreement also imposes certain customary limitations and requirements on us with respect to the incurrence of indebtedness and liens, investments, mergers, acquisitions and dispositions of assets. Amounts due under the GE Credit Agreement may be accelerated upon an Event of Default (as defined in the GE Credit Agreement), including failure to comply with obligations under the credit agreement, bankruptcy or insolvency, and termination of certain material agreements.

The Subordinated Promissory Note was entered into with Spheris, Inc. The loan matures in five years from the date of the closing with provisions for prepayment at discounted amounts, ranging from 77.5% of the principal if paid within six months, 87.5% from six to nine months, 97.5% from nine to twelve months, 102.0% by year two, 101.0% by year three and 100.0% thereafter.

The note bears interest at 8.0% for the first six months, 9.0% from six to nine months, and 12.5% thereafter of which 2.5% may be paid by increasing the principal amount. Payments of interest are made semi-annually on each six month anniversary of the Spheris transaction.

When we entered into the GE Credit Agreement, we terminated our five-year $25 million revolving credit agreement with Wells Fargo Foothill, LLC dated August 31, 2009. Pursuant to its terms, we paid Wells Fargo a fee of $576 to terminate the Wells Fargo agreement.

On May 4, 2010, the audit committee of our board of directors approved the payment of a $1.5 million success-based fee to S A C Private Capital Group, LLC (SAC) in connection with the work of SAC to help us with the Acquisition.


Item 2.		*Management’s Discussion and Analysis of Financial Condition and Results of Operations*

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 (Securities Act) and Section 21E of the Securities Exchange Act of 1934 (Exchange Act). Our forward-looking statements are subject to risks and uncertainties. Actual events or results may differ materially from the results anticipated in these forward-looking statements as a result of a variety of factors. While it is impossible to identify all such factors, factors that could cause actual results to differ materially from those estimated by us include:

•		each of the factors discussed in Item 1A, Risk Factors, of this report as well as risks discussed elsewhere in this report;

•		each of the matters discussed in Part II, Item 1, Legal Proceedings;

•		our ability to recruit and retain qualified medical transcriptionists (MTs) and other employees;

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

•		changes in law, including, without limitation, the impact HIPAA will have on our business;

•		the impact of our new services and products on the demand for our existing services and products;

•		our increased dependence on speech recognition technology, which we license, but do not own;

•		our current dependence on medical transcription for a significant portion of our technology-enabled clinical documentation services;

•		our ability to expand our customer base;

•		infringement on the proprietary rights of others;

•		our ability to diversify into other businesses;

•		our increased dependence on CBay Systems & Services, Inc. as the exclusive provider of medical transcription performed in Asia, the current location of all our medical transcription and medical editing work performed outside of North America;

•		our ability to effectively integrate the newly-acquired business and operations of Spheris;

•		the effectiveness of Spheris’ internal controls, which we are in the process of evaluating;

•		competitive pricing and service feature pressures in the clinical documentation industry and our response to those pressures;

•		our ability to operate the business given our restrictions under the GE Credit Agreement;

•		difficulties relating to our significant management turnover; and

•		general conditions in the economy and capital markets.

These and other risks and uncertainties that could affect our actual results are discussed in this report and in our other filings with the SEC.

Although we believe that the expectations reflected in the forward-looking statements are reasonable, we cannot guarantee future results, events, levels of activity, performance, or achievements. We do not assume responsibility for the accuracy and completeness of the forward-looking statements other than as required by applicable law. We do not undertake any duty to update any of the forward-looking statements after the date of this report to conform them to actual results, except as required by the federal securities laws.

You should read this section in combination with the section entitled Management’s Discussion and Analysis of Financial Condition and Results of Operations for the year ended December 31, 2009, included in our Annual Report on Form 10-K for the year ended December 31, 2009.

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

Executive Overview

We are a leading provider of technology-enabled clinical documentation services. We offer health systems, hospitals, and group medical practices integrated solutions for voice capture, speech recognition, medical transcription, document management and clinical documentation improvement using natural language processing, as well as coding services. Our solutions are designed to facilitate electronic access to clinical information by healthcare providers and to improve overall revenue cycle performance and adoption of the Electronic Health Record (EHR). We perform our services utilizing the DocQment^tm Enterprise Platform (DEP), our proprietary clinical documentation workflow management system. We believe our services and enterprise technology solutions — including mobile voice capture devices, speech recognition technologies, Web-based workflow platforms, and global network of medical transcriptionists (MTs) and medical editors (MEs) — enable to improve patient care, increase physician satisfaction and lower operational costs while facilitating their migration toward increased adoption and utilization of the EHR.

Significant developments in the clinical documentation industry include:

	•		A shortage of qualified domestic medical transcriptionists (MTs) and medical editors (MEs) has increased the demand for offshore medical transcription services by healthcare providers. This demand for qualified MTs and MEs, combined with budgetary pressures experienced by healthcare providers nationwide, has also caused many more healthcare providers to evaluate and consider the use of offshore medical transcription services.

	•		Several low cost providers have emerged and aggressively moved into our market offering medical transcription services (performed both domestically and offshore) at prices significantly below our traditional price point. While we believe the market for outsourced medical transcription continues to expand, the growing acceptance of utilizing offshore labor by healthcare providers has further increased the competitive environment in the medical transcription industry.

	•		Technological advances including speech recognition products reduce the length of time required to transcribe medical reports, in turn reducing the overall cost of medical transcription services.

	•		Growing market penetration of EHR and certain other technologies have eliminated or shortened the length of certain work types produced through transcription.

Although we remain the leading provider of medical transcription services in the U.S., we experience competition from many other providers at the local, regional and national level. The medical transcription industry remains highly fragmented, with hundreds of small companies in the U.S. performing medical transcription services.

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

We believe the outsourced portion of the medical transcription services market will increase due in part to the majority of healthcare providers seeking the following:

	•		Reductions in overhead and other administrative costs;

	•		Improvements in the quality and delivery speed of transcribed medical reports;

	•		Access to leading technologies, such as speech recognition technology, without development and investment risk;

	•		Implementation and management of a medical transcription system tailored to the providers’ specific requirements;

	•		Access to skilled MTs and MEs;

	•		Solutions for compliance with governmental and industry mandated privacy and security requirements; and

	•		Product offerings that interface with EHR initiatives.

We evaluate our operating results based upon the following factors:

	•		Revenues;

	•		Operating income;

	•		Net income per share;

	•		Adjusted earnings before interest, taxes, depreciation and amortization;

	•		Net cash provided by operating activities; and

	•		Days sales outstanding.

Our goal is to execute our strategy to yield growth in net revenues, operating income, cash flow and net income per share.

Network and information systems, the Internet and other technologies are critical to our business activities. Substantially all of our transcription services are dependent upon the use of network and information systems, including the use of our DocQment™ Enterprise Platform (DEP) and our license to use speech recognition secured from a third party. If information systems including the Internet or our DEP are disrupted, we could face a significant disruption of services provided to our customers. We have periodically experienced short term outages with our DEP, which have not significantly disrupted our business and we have an active disaster recovery program in place for our information systems and our DEP.

Critical Accounting Policies, Judgments and Estimates

Management’s Discussion and Analysis (MD&A) is based in part upon our consolidated financial statements, which have been prepared in accordance with generally accepted accounting principles in the U.S. (GAAP). We believe there are several accounting policies that are critical to understanding our historical and future performance, as these policies affect the reported amounts of revenues and other significant areas that involve management’s judgments and estimates. These critical accounting policies and estimates have been discussed with our audit committee.

The preparation of our consolidated financial statements requires us to make estimates and judgments that affect our reported amounts of assets, liabilities, expenses and related disclosure of contingent liabilities. On an ongoing basis, we evaluate these estimates and judgments. We base these estimates on historical experience and on various other assumptions that are believed to be reasonable at such time, the results of which form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other independent sources. Actual results may ultimately differ from these estimates. While there are a number of accounting policies, methods and estimates affecting our consolidated financial statements as addressed in Note 1 to our consolidated financial statements, areas that are particularly significant and critical include:

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

Valuation of Long-Lived and Other Intangible Assets and Goodwill: In connection with acquisitions, we allocate portions of the purchase price to tangible and intangible assets, consisting primarily of acquired technologies, and customer relationships, based on independent appraisals received after each acquisition, with the remainder allocated to goodwill. We assess the realizability of goodwill and intangible assets with indefinite useful lives at least annually, or sooner if events or changes in circumstances indicate that the carrying amount may not be recoverable. We have determined that the reporting unit level is our sole operating segment.

We review our long-lived assets, including amortizable intangibles, for impairment when events indicate that their carrying amount may not be recoverable. When we determine that one or more impairment indicators are present for an asset, we compare the carrying amount of the asset to net future undiscounted cash flows that the asset is expected to generate. If the carrying amount of the asset is greater than the net future undiscounted cash flows that the asset is expected to generate, we then compare the fair value to the book value of the asset. If the fair value is less than the book value, we recognize an impairment loss. The impairment loss is the excess of the carrying amount of the asset over its fair value.

Some of the events that we consider as impairment indicators for our long-lived assets, including goodwill, are:

	•		our net book value compared to our fair value;

	•		significant adverse economic and industry trends;

	•		significant decrease in the market value of the asset;

	•		the extent that we use an asset or changes in the manner that we use it;

	•		significant changes to the asset since we acquired it; and

	•		other changes in circumstances that potentially indicate all or a portion of the company will be sold.

Deferred income taxes. Deferred tax assets represent future tax benefits that we expect to be able to apply against future taxable income or that will result in future net operating losses that we can carry forward to use against future taxable earnings. Our ability to utilize the deferred tax assets is dependent upon our ability to generate future taxable income. To the extent that we believe it is more likely than not that all or a portion of the deferred tax asset will not be utilized, we record a valuation allowance against that asset. In making that determination we consider all positive and negative evidence and give stronger consideration to evidence that is objective in nature.

Commitments and contingencies. We routinely evaluate claims and other potential litigation to determine if a liability should be recorded in the event it is probable that we will incur a loss and can estimate the amount of such loss.

Revenue recognition. We recognize medical transcription services revenues when there is persuasive evidence that an arrangement exists, the price is fixed or determinable, services have been rendered and collectability is reasonably assured. These services are recorded using contracted rates and are net of estimates for customer credits. Historically, our estimates have been adequate. If actual results are higher or lower than our estimates, we would have to adjust our estimates and financial statements in future periods.

We recognize the remainder of our revenues from the sale and implementation of voice-capture and document management products including software and implementation, training and maintenance services related to these products. The application of the accounting guidelines requires judgment regarding the timing of the recognition of these revenues including: (i) whether a software arrangement includes multiple elements, and if so, whether vendor-specific objective evidence of fair value exists for those elements; (ii) whether customizations or modifications of the software are significant; and (iii) whether collection of the software fee is probable.

Additionally, for certain contracts we recognize revenues using the percentage-of-completion method. Percentage-of-completion accounting involves estimates of the total costs to be incurred over the duration of the project.

Accounts receivable and allowance for doubtful accounts. Accounts receivable are recorded at the invoiced amount and do not bear interest. The carrying value of accounts receivable approximates fair value. The allowance for doubtful accounts is our best estimate of potential losses resulting from the inability of our customers to make required payments due. This allowance is used to state trade receivables at estimated net realizable value.

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

We estimate uncollectible amounts based upon our historical write-off experience, current customer receivable balances, aging of customer receivable balances, the customer’s financial condition and current economic conditions. Historically, our estimates have been adequate to provide for our accounts receivable exposure.

Additionally, we enter into medical transcription service contracts that may contain provisions for performance penalties in the event we do not meet certain required service levels, primarily related to turnaround time on transcribed reports. We reduce revenues for any such performance penalties and service level credits incurred and have included an estimate of such penalties and credits in our allowance for uncollectible accounts.

We recognize product revenues for sales to end-user customers and resellers upon passage of title if all other revenue recognition criteria have been met. End-user customers generally do not have a right of return. We provide certain of our resellers and distributors with limited rights of return of our products. We reduce revenues for rights to return our product based upon our historical experience and have included an estimate of such credits in our allowance for uncollectible accounts.

Customer Accommodation Program. In response to customers’ concerns regarding historical billing matters, we established a plan to offer financial accommodations to certain of our customers during 2005 and 2006 and recorded the related liability. In 2008 we reached an agreement on customer litigation resolving all claims by the named parties. Since then we have not made additional offers.

We are unable to predict how many customers, if any, may accept the outstanding accommodation offers on the terms proposed by us, nor are we able to predict the timing of the acceptance (or rejection) of any outstanding accommodation offers. Until any offers are accepted, we may withdraw or modify the terms of the accommodation program or any outstanding offers at any time. In addition, we are unable to predict how many future offers, if made, will be accepted on the terms proposed by us. We regularly evaluate whether to proceed with, modify or withdraw the accommodation program or any outstanding offers.

Basis of Presentation

Sources of Revenues

We derive revenues primarily from providing medical transcription services to health systems, hospitals and large group medical practices. Our customers are generally charged a rate times the volume of work that we transcribe or edit. In the clinical documentation workflow, we provide, in addition to medical transcription technology and services, maintenance services, digital dictation, speech recognition and electronic signature services.

Cost of Revenues

Cost of revenues includes compensation of our U.S.-based employee MTs and our subcontractor MTs, other production costs (primarily related to operational and production management, quality assurance, quality control and customer and field service personnel), and telecommunication and facility costs. Cost of revenues also includes the direct cost of technology products sold to customers. MT costs are directly related to medical transcription revenues and are based on lines transcribed or edited multiplied by a specific rate.

Selling, General and Administrative (SG&A)

Our SG&A expenses include marketing and sales costs, accounting costs, information technology costs, professional fees, corporate facility costs, corporate payroll and benefits expenses.

Research and Development (R&D)

Our R&D expenses consist primarily of personnel and related costs, including salaries and employee benefits for software engineers and consulting fees paid to independent consultants who provide software engineering services to us. To date, our R&D efforts have been devoted to new products and services offerings and increases in features and functionality of our existing products and services.

Depreciation and Amortization

Depreciation is calculated on a straight-line basis over the estimated useful lives of the assets which range from two to seven years for furniture, equipment and software, and the lesser of the lease term or estimated useful life for leasehold improvements. Intangible assets are being amortized using the straight-line method over their estimated useful lives which range from three to 20 years.

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

Legal Matters

Cost of legal proceedings and settlements includes settlement of claims, ongoing litigation, and associated legal and other professional fees incurred.

Consolidated Results of Operations

The following tables set forth our consolidated results of operations for the periods indicated below:

Comparison of Three Months Ended March 31, 2010 and 2009


	Three Months Ended March 31,
	2010						2009
				% of Net					% of Net
($ in thousands)	Amount			Revenues			Amount		Revenues			$ Change			% Change
Net revenues	$	73,981			100.0	%	$	78,944		100.0	%	$	(4,963	)		(6.3	%)


Operating costs and expenses:
Cost of revenues		49,833			67.4	%		53,868		68.2	%		(4,035	)		(7.5	%)
Selling, general and administrative		8,797			11.9	%		9,438		12.0	%		(641	)		(6.8	%)
Research and development		2,281			3.1	%		2,416		3.1	%		(135	)		(5.6	%)
Depreciation		1,910			2.6	%		2,552		3.2	%		(642	)		(25.2	%)
Amortization of intangible assets		1,820			2.5	%		1,511		1.9	%		309			20.5	%
Cost of legal proceedings and settlements		1,043			1.4	%		1,924		2.4	%		(881	)		(45.8	%)
Acquisition related charges		894			1.2	%		—		—			894			n.a.
Restructuring charges		60			0.1	%		—		—			60			n.a.


Total operating costs and expenses		66,638			90.1	%		71,709		90.8	%		(5,071	)		(7.1	%)


Operating income		7,343			9.9	%		7,235		9.2	%		108			1.5	%

Equity in income of affiliated company		514			0.7	%		72		0.1	%		442			613.9	%
Interest income (expense), net		(146	)		(0.2	%)		46		0.1	%		(192	)		(417.4	%)


Income before income taxes		7,711			10.4	%		7,353		9.3	%		358			4.9	%

Income tax provision		367			0.5	%		499		0.6	%		(132	)		(26.5	%)


Net income	$	7,344			9.9	%	$	6,854		8.7	%	$	490			7.1	%

Net revenues

Net revenues decreased $5.0 million, or 6.3%, to $74.0 million for the three months ended March 31, 2010 compared with $78.9 million for the three months ended March 31, 2009. Transcription volumes increased during the first quarter relative to the prior period, while average prices for transcription declined and the migration from legacy products reduced the need for maintenance services.

Cost of revenues

Cost of revenues decreased $4.0 million, or 7.5% to $49.8 million for the three months ended March 31, 2010 compared with $53.9 million for the three months ended March 31, 2009. This decrease was attributable primarily to:

	•		reduced transcription costs of $1.9 million related to our increased use of speech recognition technology, which reduces the payroll costs associated with the production of revenues and an increase in the use of outsourced medical transcription volumes to our international labor partners;

	•		reduced costs of $2.8 million resulting from headcount reductions taken in 2009 to better align our overhead costs with our lower revenue levels; offset by

	•		an increase of $0.7 million due to a one-time benefit in the 2009 period for the release of a prior period reserve.

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

As a percentage of net revenues, cost of revenues decreased to 67.4% for the three months ended March 31, 2010 from 68.2% for the same period in 2009 for the reasons stated above. We expect to continue to increase our use of outsourced medical transcription volumes to our international labor partners.

Selling, general and administrative

SG&A expenses decreased $0.6 million, or 6.8% to $8.8 million for the three months ended March 31, 2010 compared with $9.4 million for the three months ended March 31, 2009. This decrease was attributable to a decrease of $0.5 million of consulting fees, a decrease of $0.2 million in legal fees, a reduction in audit fees of $0.2 million, a decrease of $0.1 million for building rent, and a decrease in all other SG&A expense of $0.1 million, offset by an increase in bad debt expense of $0.5 million. SG&A expense in the three month period ended March 31, 2010 as a percentage of net revenues was 11.9% compared with 12.0% for the same period in 2009.

Research & development

R&D expenses decreased $0.1 million, or 5.6%, to $2.3 million for the three months ended March 31, 2010 compared with $2.4 million for the three months ended March 31, 2009. This decrease was related to a decrease of $0.1 million for maintenance contracts with third party vendors. R&D expenses as a percentage of net revenues were 3.1% for the three months ended March 31, 2010 and March 31, 2009.

Depreciation

Depreciation expense decreased $0.6 million, or 25.2% to $1.9 million for the three months ended March 31, 2010 compared with $2.6 million for the three months ended March 31, 2009. This decrease was primarily the result of reduced capital spending in 2009. Depreciation expense as a percentage of net revenues was 2.6% for the three months ended March 30, 2010 compared with 3.2% for the same period in 2009.

Amortization

Amortization expense increased $0.3 million, or 20.5%, to $1.8 million for the three months ended March 31, 2010 compared with $1.5 million for the three months ended March 31, 2009. This increase was primarily the result of amortization expense associated with software development projects which were completed in 2009. Amortization expense as a percentage of net revenues was 2.5% for the three months ended March 31, 2010 compared with 1.9% for the same period in 2009.

Cost of legal proceedings and settlements

Costs of legal proceedings and settlements decreased $0.9 million, or 45.8%, to $1.0 million for the three months ended March 31, 2010 compared with $1.9 million for the three months ended March 31, 2009. In 2009, we incurred $0.9 million in legal fees regarding a patent claim.

Equity in income of affiliated company

Equity in income of affiliated company increased $0.4 million to $0.5 million for the three months ended March 31, 2010 compared with $0.1 million for the three months ended March 31, 2009. A-Life recorded a change in estimate related to its purchase accounting of an acquisition. Our share of the impact from the change in estimate was approximately $0.4 million.

Income tax provision

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

Liquidity and Capital Resources

As of March 31, 2010, we had working capital of $20.4 million compared with $19.7 million as of December 31, 2009. Our principal sources of liquidity include cash generated from operations, available cash on hand and our former credit facility with Wells Fargo. Cash and cash equivalents declined $3.5 million to $21.7 million as of March 31, 2010, from $25.2 million as of December 31, 2009. This decrease included cash provided by operating activities of $6.8 million offset by cash used to purchase property and equipment of $1.7 million, cash used for software development activities and other investments of $8.4 million, and cash used of $0.2 million for fees and expenses related to obtainment of our new GE Credit Agreement. See Note 11 to our consolidated financial statements.

We believe our existing cash, cash equivalents, and cash to be generated from operations, if any, will be sufficient to finance our operations for the foreseeable future. However, if we fail to generate adequate cash flows from operations in the future, due to an unexpected decline in our net revenues, or due to increased cash expenditures in excess of the net revenues generated, then our cash balances may not be sufficient to fund our continuing operations without obtaining additional debt or equity. There are no assurances that sufficient funding from external sources will be available to us on acceptable terms, if at all. For instance, we may have increased cash expenditures relating to the defense and resolution of the civil litigation matters.

Subsequent Events

On April 22, 2010, we and our majority shareholder, CBay Inc., completed the acquisition of substantially all of the assets of Spheris, Inc. and certain of its affiliates, pursuant to the terms of the Stock and Asset Purchase Agreement entered into between the Purchasers and Sellers on April 15, 2010. The purchase price for the assets was approximately $116.3 million, consisting of approximately $98.8 million of cash, and the issuance of a promissory note in the principal amount of $17.5 million (the Subordinated Promissory Note). Included in Other Assets as of March 31, 2010, is a deposit of $7.5 million related to the Acquisition.

In connection with the Acquisition, MedQuist Inc., together with MedQuist Transcriptions, Ltd., a wholly-owned subsidiary entered into a Credit Agreement with General Electric Capital Corporation, CapitalSource Bank, and Fifth Third Bank. The GE Credit Agreement provides for up to $100 million in senior secured credit facilities, consisting of a $50 million term loan, and a revolving credit facility of up to $50 million. The credit facilities are secured by a first priority lien on substantially all of the property of the Loan Parties. The term loan is repayable in equal quarterly installments of $5 million starting on October 1, 2010, with the balance payable 2.5 years from the date of closing (or, if certain convertible senior notes of CBay are called or otherwise become due and payable prior to such date, such earlier date). The interest rate is Prime plus 3.25% (currently an interest rate of 6.50%) and is payable monthly. We may also structure borrowings as Eurodollar loans with an interest rate based on LIBOR rates. We may prepay the loan with certain prepayment penalties. Mandatory prepayments are required when we generate excess cash flows as defined under the agreement. The Term Loan maturity date is the earlier of October 22, 2012 or the date on which certain CBay notes are called or otherwise become due and payable. Maximum borrowings under the Revolving Loan are the lower of a percentage of eligible accounts receivable of $50 million. The interest rate is Prime plus 3% (currently an interest rate of 6.25%) and is payable monthly with a scheduled termination date of April 22, 2014.

MedQuist Inc. & Subsidiaries
Notes to Consolidated Financial Statements
(In thousands, except for per share amounts)
Unaudited

Off-Balance Sheet Arrangements

We are not involved in any off-balance sheet arrangements that have or are reasonably likely to have a material current or future impact on our financial condition, changes in financial condition, revenues or expenses, results of operations, liquidity, capital expenditures, or capital resources.

Item 4. Controls and Procedures

Evaluation of Disclosure Controls and Procedures

Our management team, under the supervision and with the participation of our principal executive officer and our principal financial officer, evaluated the effectiveness of the design and operation of our disclosure controls and procedures as such term is defined under Rule 13a-15(e) promulgated under the Exchange Act, as of the last day of the fiscal period covered by this report, March 31, 2010. The term disclosure controls and procedures means our controls and other procedures that are designed to ensure that information required to be disclosed by us in the reports that 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. Disclosure controls and procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed by us in the reports that we file or submit under the Exchange Act is accumulated and communicated to management, including our principal executive and principal financial officer, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure. Based on this evaluation, our principal executive officer and our principal financial officer concluded that, as of March 31, 2010, our disclosure controls and procedures were effective at a reasonable assurance level.

Changes in Internal Control Over Financial Reporting

There have been no changes in our internal control over financial reporting during the fiscal quarter ended March 31, 2010 that materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

PART II. OTHER INFORMATION

Item 1. Legal Proceedings

Customer Litigation

Kaiser Litigation

Kaiser served an initial set of discovery requests on May 7, 2009. On May 20, 2009, the court temporarily stayed discovery to address allegations of ethical misconduct by Kaiser’s trial counsel, Greenberg Traurig, LLP. On July 1, 2009, the court granted us leave to conduct limited written discovery regarding Greenberg Traurig’s alleged ethical misconduct and continued the temporary stay of all other discovery. On July 14, 2009, we moved for sanctions against Greenberg Traurig for breach of the New Jersey Rules of Professional Conduct, and we moved to stay the litigation pending resolution of the motion for sanctions. Discovery is presently stayed pending resolution of our motion to stay. No hearing date has been set for any of the pending motions. On February 24, 2010, the court granted our motion to stay pending resolution of the motion for sanctions and entered a scheduling order setting oral arguments on the pending motion for sanctions for March 16, 2010. On March 31, 2010 the court granted our motion to disqualify Greenberg Traurig as counsel for Kaiser. In its order, the court gave Kaiser until May 31, 2010 to obtain new counsel and set an in-person status conference for June 9, 2010.

Kahn Putative Class Action

On January 22, 2008, Alan R. Kahn, one of our shareholders, filed a shareholder putative class action lawsuit against us, Koninklijke Philips Electronics N.V. (Philips), our former majority shareholder, and four of our former non-independent directors, Clement Revetti, Jr., Stephen H. Rusckowski, Gregory M. Sebasky and Scott Weisenhoff. The action, entitled Alan R. Kahn v. Stephen H. Rusckowski, et al., Docket No. BUR-C-000007-08, was venued in the Superior Court of New Jersey, Chancery Division, Burlington County. In the action, plaintiff purports to bring the action on his own behalf and on behalf of all current holders of our common stock. The original complaint alleged that defendants breached their fiduciary duties of good faith, fair dealing, loyalty, and due care by purportedly agreeing to and initiating a process for our sale or a change of control transaction which will allegedly cause harm to plaintiff and members of the putative class. Plaintiff sought damages in an unspecified amount, plus costs and interest, a judgment declaring that defendants breached their fiduciary duties and that any proposed transactions regarding our sale or change of control are void, an injunction preventing our sale or any change of control transaction that is not entirely fair to the class, an order directing us to appoint three independent directors to our board of directors, and attorneys’ fees and expenses.

shareholders with the opportunity to decide whether they wanted to participate in a share purchase offer with non-party CBaySystems Holdings Ltd. (CBaySystems Holdings) that would have allowed the public shareholders to sell their shares of our common stock for an amount above market price. Plaintiff further alleged that CBaySystems Holdings made the share purchase offer to Philips and that Philips breached its fiduciary duties by accepting CBaySystems Holdings’ offer. Based on these allegations, plaintiff sought declaratory, injunctive, and monetary relief from all defendants. Plaintiff claimed that we were only named as a party to the litigation for purposes of injunctive relief.

On September 24, 2009, the Appellate Division held oral argument on the issues that are the subject of plaintiff’s appeal. We are now waiting for the Appellate Division to issue a decision.

Reseller Arbitration Demand

arbitration and related state court litigation were dismissed with prejudice and (iii) we did not admit to any liability or wrongdoing. We accrued the entire amount of this settlement as of December 31, 2009.

SEC Investigations of Former Officers

With respect to our historical billing practices, the Securities and Exchange Commission (SEC) is pursuing civil litigation against our former chief financial officer, whose employment with us ended in July 2004. Pursuant to our bylaws, we have indemnification obligations for the legal fees for our former chief financial officer. In February 2010, one of our current employees, who was our former controller but who does not currently serve in a senior management or financial reporting oversight role, reached a settlement with the SEC in connection with the civil litigation that the SEC had brought against him in connection with our historical billing practices.

Item 1A. Risk Factors

Excluding the updates discussed below, there have been no other material changes to the risk factors discussed in Part I, “Item 1A. Risk Factors,” in our Annual Report on Form 10-K for the year ended December 31, 2009 (“Form 10-K”). You should carefully consider the risks described in our Form 10-K, which could materially affect our business, financial condition or future results. The risks described in our Form 10-K are not the only risks we face. Additional risks and uncertainties not currently known to us or that we currently deem to be immaterial also may materially adversely affect our business, financial condition, and/or operating results. If any of the risks actually occur, our business, financial condition, and/or results of operations could be negatively affected.

We have reviewed the risk factors previously disclosed in our Form 10-K and have the following revisions:

The risk fact in our Form 10-K for the year ended December 31, 2009 which is entitled – “We may pursue future transactions, including the proposed acquisition of certain assets of Spheris Inc., which could require us to incur debt and assume contingent liabilities and expenses, and we may not be able to effectively integrate new operations.” — is hereby amended and restated as follows:

We may pursue future transactions, which could require us to incur debt and assume contingent liabilities and expenses, and we may not be able to effectively integrate new operations.

A significant portion of our historical growth has occurred through transactions, and we may pursue transactions in the future. Transactions involve risks that the combined businesses will not perform in accordance with expectations and that business judgments concerning the value, strengths and weaknesses of the combined businesses will prove incorrect. We cannot guarantee that if we decide to pursue other future transactions, we will be able to identify attractive opportunities or successfully integrate such other future businesses or assets with our existing business. In addition, we cannot guarantee the ability to retain customers of such other future businesses or assets we acquire. Future transactions may involve high costs and may result in the incurrence of debt, contingent liabilities, interest expense, amortization expense or periodic impairment charges related to goodwill and other intangible assets as well as significant charges relating to integration costs.

We cannot guarantee that we will be able to successfully integrate any future transaction with our existing business or that any combined businesses will be profitable. The successful integration of new businesses depends on our ability to manage these new businesses effectively. The successful integration of future transactions may also require substantial attention from our senior management and the management of the combined businesses, which could decrease the time that they have to service and attract customers. In addition, because we may actively pursue a number of opportunities simultaneously, we may encounter unforeseen expenses, complications and delays, including difficulties in employing sufficient staff and maintaining operational and management oversight. Our inability to complete the integration of any future transaction with our existing business in a timely and orderly manner could reduce our net revenues and negatively impact our results of operations.

We have also added the following additional risk factors to the Form 10-K:

We may not be able to effectively integrate the operation of Spheris Inc. and the internal controls of Spheris Inc. may not be effective.

We cannot guarantee that we will be able to identify attractive opportunities or successfully integrate Spheris with our existing business. In addition, we cannot guarantee the ability to retain customers of Spheris. The successful integration with Spheris depends on our ability to manage the operations and business of Spheris effectively and will require substantial attention from our senior management, which could decrease the time that they have to service and attract customers. Our inability to complete the integration of Spheris with our existing business in a timely and orderly manner could reduce our net revenues and negatively impact our results of operations. In addition, the internal controls of Spheris, which we are in the process of evaluating, may not be effective.

Our ability to operate the business given our restrictions under the GE Credit Agreement.

Our significant indebtedness could adversely affect our ability to raise additional capital to fund our business, harm our ability to react to changes in the economy or our business and prevent us from fulfilling our obligations under our indebtedness, including under our GE Credit Agreement and the Subordinated Promissory Note. The GE Credit Agreement contains usual and customary financial covenants, including covenants relating to reporting and notification, payment of indebtedness, taxes and other obligations, and compliance with applicable laws. There are also financial covenants, which include a Minimum Consolidated Fixed Charge Coverage Ratio, and a Maximum Consolidated Senior Leverage Ratio and a Maximum Consolidated Total Leverage Ratio and Minimum Liquidity, as defined in the GE Credit Agreement. Amounts due under the GE Credit Agreement may be accelerated upon an Event of Default (as defined in the GE Credit Agreement), including failure to comply with obligations under the credit agreement, bankruptcy or insolvency, and termination of certain material agreements;

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds

None.

Item 3. Defaults Upon Senior Securities

None.

Item 5. Other Information

None.

Item 6. Exhibits

(a) Exhibits


No.		Description
10.1⁽¹⁾		Stock and Asset Purchase Agreement, dated February 2, 2010, between Spheris Holding II, Inc., Spheris Inc., Spheris Operations LLC, Vianeta Communications, Spheris Leasing LLC, Spheris Canada Inc., CBay Inc. and MedQuist Inc.

10.2⁽²⁾		Stock and Asset Purchase Agreement, dated April 15, 2010, between Spheris Holding II, Inc., Spheris Inc., Spheris Operations LLC, Vianeta Communications, Spheris Leasing LLC, Spheris Canada Inc., CBay Inc. and MedQuist Inc.

10.3⁽³⁾		Credit Agreement dated as April 22, 2010 among MedQuist Transcriptions, Ltd. as Borrower, MedQuist Inc. as Holdings, the Lenders and L/C Issuers party thereto, and General Electric Capital Corporation as Administrative Agent and Collateral Agent, CapitalSource Bank as Syndication Agent, and Fifth Third Bank as Documentation Agent.

10.4		MedQuist Transcriptions, Ltd. Subordinated Promissory Note dated April 22, 2010

10.5(#)		Sales & Services Agreement dated March 9, 2010 by and between MedQuist, Inc. and CBay Systems & Services, Inc.


No.		Description
31.1		Certification of Chief Executive Officer required by Rule 13a-14(a) or Rule 15d-14(a) of the Securities Exchange Act of 1934, as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

31.2		Certification of Chief Financial Officer required by Rule 13a-14(a) or Rule 15d-14(a) of the Securities Exchange Act of 1934, as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

32.1		Certification of Chief Executive Officer pursuant to 18 U.S.C. 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

32.2		Certification of Chief Financial Officer pursuant to 18 U.S.C. 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002


#		Portions of this Exhibit are omitted and filed separately with the Secretary of the SEC pursuant to a request for confidential treatment that has been filed with the SEC.

(1)		Incorporated by reference to our Current Report on Form 8-K filed with the SEC on February 4, 2010.

(2)		Incorporated by reference to our Current Report on Form 8-K filed with the SEC on April 21, 2010.

(3)		Incorporated by reference to our Current Report on Form 8-K filed with the SEC on April 28, 2010.

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.


	MEDQUIST INC.
Date: May 10, 2010	/s/ Peter Masanotti
	Peter Masanotti
	President and Chief Executive Officer (Principal Executive Officer)


Date: May 10, 2010	/s/ Dominick Golio
	Dominick Golio
	Chief Financial Officer (Principal Financial Officer)

Exhibit Index


No.		Description
10.4		MedQuist Transcriptions, Ltd. Subordinated Promissory Note dated April 22, 2010Sales & Services Agreement dated March 9, 2010 by and between MedQuist, Inc. and CBay Systems & Services, Inc.

10.5(#)		Sales & Services Agreement dated March 9, 2010 by and between MedQuist, Inc. and CBay Systems & Services, Inc.

31.1		Certification of Chief Executive Officer required by Rule 13a-14(a) or Rule 15d-14(a) of the Securities Exchange Act of 1934, as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

31.2		Certification of Chief Financial Officer required by Rule 13a-14(a) or Rule 15d-14(a) of the Securities Exchange Act of 1934, as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

32.1		Certification of Chief Executive Officer pursuant to 18 U.S.C. 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

32.2		Certification of Chief Financial Officer pursuant to 18 U.S.C. 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002


#		Portions of this Exhibit are omitted and filed separately with the Secretary of the SEC pursuant to a request for confidential treatment that has been filed with the SEC.

EX-10.4 2 w78445exv10w4.htm EX-10.4 exv10w4

Exhibit 10.4

THE ISSUANCE AND SALE OF THIS SUBORDINATED PROMISSORY NOTE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR QUALIFIED UNDER APPLICABLE STATE SECURITIES LAWS AND MAY NOT BE SOLD OR OTHERWISE TRANSFERRED EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT OR AN EXEMPTION FROM REGISTRATION, UNDER THE SECURITIES ACT OF 1933.

THIS SUBORDINATED PROMISSORY NOTE AND THE RIGHTS AND OBLIGATIONS EVIDENCED HEREBY ARE SUBORDINATE IN THE MANNER AND TO THE EXTENT SET FORTH IN SECTION 9 BELOW, AND EACH HOLDER OF THIS SUBORDINATED PROMISSORY NOTE, BY ITS ACCEPTANCE HEREOF, IRREVOCABLY AGREES TO BE BOUND BY THE PROVISIONS CONTAINED IN SECTION 9 BELOW.

SUBORDINATED PROMISSORY NOTE

MEDQUIST TRANSCRIPTIONS, LTD.


$17,500,000.00		New York, New York April 22, 2010

FOR VALUE RECEIVED, the undersigned MEDQUIST TRANSCRIPTIONS, LTD., a New Jersey corporation (the “Maker”), promises to pay to the order of Spheris Inc. (“Spheris”), a Delaware corporation (together with its successors and assigns, transferees and any permitted holder of this Note from time to time, or any portion hereof, hereinafter, the “Holder”), or to such other account pursuant to such other wiring instruction as the Holder may from time to time designate in writing, the original principal amount of SEVENTEEN MILLION FIVE HUNDRED THOUSAND AND 00/100 DOLLARS ($17,500,000.00) (the “Original Principal Amount”), together with interest thereon and all other amounts payable to the Holder under this note (this “Note”), pursuant to the terms and conditions herein. This Note has been executed and delivered pursuant to and in accordance with the terms and conditions of the Stock and Asset Purchase Agreement, dated as of April 15, 2010 (the “Purchase Agreement”), by and among Spheris Holding II, Inc., Spheris Inc., Spheris Operations LLC, Vianeta Communications, Spheris Leasing LLC, Spheris Canada Inc., CBay Inc. and MedQuist Inc. The Maker’s payment and other obligations under this Note are guaranteed (each, a “Guarantee”) by MedQuist Inc., a Delaware corporation (“Holdings”), and the other guarantors (the “Subsidiary Guarantors,” and, together with Holdings, the “Guarantors”) as provided in Appendix 1 hereto.

1. Definitions. Capitalized terms used here and not otherwise defined in this Note shall have the meanings ascribed to them in the Purchase Agreement. In addition, the following terms, as used herein, have the following meanings:

(a) “Agent” shall have the meaning ascribed to it in the Senior Secured Credit Agreement.

(b) “Applicable Law” means the law in effect, from time to time, applicable to the transaction evidenced by this Note which lawfully permits the receipt, contracting for, charging and collection of the highest permissible lawful, non-usurious rate of interest on this Note and the transactions evidenced hereby, and arising in connection herewith, including laws of the State of New York and, to the extent controlling, the federal laws of the United States of America.

(c) “Applicable Rate” shall mean the following: from Closing through six months following Closing, 8.00% per annum. From six months following Closing through nine months following Closing, 9.00% per annum. From nine months following Closing through the rest of the Term, 12.50% per annum (up to 2.5% of which may be paid by increasing the Principal Amount in accordance with Section 2 hereof).

(d) “Business Day” shall mean any day other than Saturday, Sunday or other day on which commercial banks in the State of New York are authorized or required by law or execute order to remain closed.

(e) “Capitalized Lease Obligations” means, as to any Person, the obligations of such Person under a lease that are required to be classified and accounted for as capital lease obligations under GAAP and, for purposes of this definition, the amount of such obligations at any date shall be the capitalized amount of such obligations at such date, determined in accordance with GAAP.

(f) “Capital Stock” means (i) with respect to any Person that is a corporation, any and all shares, interests, participations or other equivalents (however designated and whether or not voting) of corporate stock, including each class of Common Stock and Preferred Stock, of such Person and (ii) with respect to any Person that is not a corporation, any and all partnership or other equity interests of such Person.

(g) “Common Stock” of any Person means any and all shares, interests or other participations in, and other equivalents (however designated and whether voting or non-voting) of such Person’s common stock, whether outstanding on the date of this Note or issued after date of this Note, and includes, without limitation, all series and classes of such common stock.

(h) “Consolidated EBITDA” shall have the meaning provided in the Senior Secured Credit Agreement in effect on the date of this Note.

(i) “Currency Agreement” means any foreign exchange contract, currency swap agreement, futures contract, option contract or other similar agreement or arrangement designed to protect Holdings, the Maker and their subsidiaries against fluctuations in currency values.

(j) “Disqualified Capital Stock” means with respect to any Person, any Capital Stock which by its terms (or by the terms of any security into which it is convertible or for which it is exchangeable at the option of the holder) or upon the happening of any event: (i) matures or is mandatorily redeemable (other than redeemable only for Capital Stock of such Person which is not itself Disqualified Capital Stock) pursuant to a sinking fund obligation or

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otherwise; (ii) is convertible or exchangeable at the option of the holder for Indebtedness or Disqualified Capital Stock (excluding Capital Stock which is convertible or exchangeable solely at the option of Holdings, the Maker or their subsidiaries); or (iii) is mandatorily redeemable or must be purchased upon the occurrence of certain events or otherwise, in whole or in part; in each case on or prior to (a) the final maturity date of this Note or (b) the date on which there is no Note outstanding.

(k) “GAAP” means generally accepted accounting principles set forth in the opinions and pronouncements of the Accounting Principles Board of the American Institute of Certified Public Accountants and statements and pronouncements of the Financial Accounting Standards Board or in such other statements by such other entity as may be approved by a significant segment of the accounting profession of the United States of America, as in effect as of date of this Note. All ratios and computations based on GAAP contained in this Note will be computed in conformity with GAAP, except as expressly provided in this Note.

(l) “Indebtedness” means with respect to any Person, without duplication: (i) all Obligations of such Person for borrowed money; (ii) all Obligations of such Person evidenced by bonds, debentures, notes or other similar instruments; (iii) all Capitalized Lease Obligations of such Person; (iv) all Obligations of such Person issued or assumed as the deferred and unpaid purchase price of property, all conditional sale obligations and all Obligations under any title retention agreement (but excluding trade accounts payable and other accrued liabilities arising in the ordinary course of business); (v) all Obligations for the reimbursement of any obligor on any letter of credit, banker’s acceptance or similar credit transaction (including reimbursement obligations with respect thereto except to the extent such reimbursement obligation relates to a trade payable and such obligation is satisfied within 30 days of incurrence); (vi) guarantees and other contingent obligations in respect of Indebtedness of other Persons referred to in clauses (i) through (v) above and clause (viii) below; (vii) all Obligations of any other Person of the type referred to in clauses (i) through (vi) which are secured by any Lien on any property or asset of such Person whether or not such Indebtedness is assumed by such Person, the amount of such Obligation being deemed to be the lesser of the fair market value of such property or asset at such date of determination and the amount of the Obligation so secured; (viii) all Obligations under Currency Agreements and Interest Swap Obligations of such Person (the amount of any such obligations to be equal at any time to the termination value, as determined in good faith by the Company’s Board of Directors, which determination will be conclusive, of such agreement or arrangement giving rise to such obligation that would be payable by such Person at such time); and (ix) all Disqualified Capital Stock issued by such Person with the amount of Indebtedness represented by such Disqualified Capital Stock being equal to the greater of its voluntary or involuntary liquidation preference and its maximum fixed repurchase price or, with respect to any subsidiary of Holdings or the Maker that is not a Guarantor of this Note, any Preferred Stock (but excluding, in each case, accrued dividends, if any).

(m) “Interest Swap Obligations” means the obligations of any Person pursuant to any arrangement with any other Person, whereby directly or indirectly, such Person is entitled to receive from time to time periodic payments calculated by applying either a floating or a fixed rate of interest on a stated notional amount in exchange for periodic payments made by such other Person calculated by applying a fixed or a floating rate of interest on the same notional

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amount and shall include, without limitation, interest rate swaps, caps, floors, collars and similar agreements.

(n) “Lenders” shall have the meaning ascribed to it in the Senior Secured Credit Agreement.

(o) “Lien” means any lien, mortgage, deed of trust, pledge, security interest, charge or encumbrance of any kind (including any conditional sale or other title retention agreement, any lease in the nature thereof and any agreement to give any security interest).

(p) “Maximum Rate” means, on any day, the maximum lawful non-usurious rate of interest (if any) which, under Applicable Law, the Holder is permitted or authorized to contract for, charge, collect, receive, reserve or take from or of the Maker on the indebtedness evidenced by this Note from time to time in effect, including changes in such Maximum Rate attributable to changes under Applicable Law which permit a greater rate of interest to be contracted for, charged, collected, received, reserved or taken as of the effective dates of the respective changes.

(q) “Obligations” means all obligations for principal, premium, interest, penalties, fees, indemnifications, reimbursements, damages and other liabilities payable under the documentation governing any Indebtedness.

(r) “Paid in Full” means the full irrevocable and indefeasible payment in cash, in immediately available funds, of all the Senior Debt (whether or not any of the Senior Debt shall have been voided, disallowed or subordinated pursuant to any provision of the Bankruptcy Code, any applicable state fraudulent conveyance law, any other law in connection with an insolvency proceeding or otherwise) and the termination of all commitments of the Lenders to make loans and other extensions of credit to or for the benefit of the Borrowers pursuant to the terms of the Senior Secured Credit Agreement. The expressions “prior payment in full”, “payment in full”, “paid or satisfied in full” and “paid in full” (whether or not such expressions are capitalized) and other similar phrases shall have correlative meanings.

(s) “Person” means an individual, partnership, corporation, limited liability company, unincorporated organization, trust or joint venture, or a governmental agency or political subdivision thereof.

(t) “Preferred Stock” of any Person means any Capital Stock of such Person that has preferential rights to any other Capital Stock of such Person with respect to dividends or redemptions or upon liquidation or dissolution of such Person, over shares of Capital Stock of any other class of such Person.

(u) “Principal Amount” shall mean the Original Principal Amount (i) as decreased from time to time by the amount of any prepayments, if any, pursuant to Section 5, to the extent applied to principal and (ii) as increased from time to time by any Additional Principal Amounts pursuant to Section 2.

(v) “Securities Act” means the Securities Act of 1933, as amended.

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(w) “Senior Debt” means the Obligations (as such term is defined in the Senior Secured Credit Agreement) and all other Indebtedness, obligations and other liabilities of the Maker or its affiliates now or hereafter existing in favor of the Lenders, the L/C Issuers (as defined in the Senior Secured Credit Agreement) and Agent under the Senior Secured Credit Agreement (in each case, as amended, restated, supplemented or otherwise modified from time to time), whether for principal (including, without limitation, protective advances and overadvances), interest (including interest accruing subsequent to the filing of any petition initiating any insolvency proceeding, whether or not a claim for such interest is allowed in any such proceeding), premiums, indemnities, fees, costs, expenses (including, without limitation, auditor, legal and other professional fees, costs and expenses, and including, without limitation, fees, costs and expenses accruing subsequent to the filing of any petition initiating insolvency proceeding, whether or not a claim for such fees, costs and expenses is allowed in any such proceeding), or otherwise, in each case whether now existing or hereafter arising, direct or indirect, absolute or contingent, joint or several, secured or unsecured, matured or unmatured, monetary or nonmonetary, liquidated or unliquidated, acquired outright, conditionally or as collateral security from another, and all extensions, renewals, refundings, replacements and modifications of any of the foregoing; provided, however, that the aggregate principal amount of all Senior Debt shall not exceed $115,000,000 at any one time outstanding.

(x) “Senior Default” means any “Event of Default” as defined in the Senior Secured Credit Agreement.

(y) “Senior Secured Credit Agreement” means that certain Credit Agreement, entered into by and among the Maker, MedQuist Inc., the Lenders, the L/C Issuers (as defined in that agreement), and General Electric Capital Corporation as administrative agent and collateral agent, dated as of April 22, 2010, as amended, restated, supplemented, amended and restated, refinanced or otherwise modified from time to time.

(z) “Significant Subsidiary,” with respect to any Person, means any subsidiary of such Person that satisfies the criteria for a “significant subsidiary” set forth in Rule 1-02(w) of Regulation S-X under the Securities Act.

(aa) “Subordinated Debt” means all Obligations arising with respect to this Note and all guarantees of such Obligations.

2. Payments. Payments of interest on this Note shall be made semi-annually, on each six-month anniversary following the date of the closing of the acquisition of substantially all of the assets of Spheris by the Maker (the “Closing”) as contemplated in the Purchase Agreement. Interest shall accrue on the Principal Amount at the Applicable Rate, payable in cash semi-annually in arrears on each six month anniversary of the Closing Date or, if such day is not a Business Day, on the next succeeding Business Day (the “Interest Payment Date”). All payments of interest hereunder shall be computed on the basis of a 360-day year and the number of days elapsed (including the first day but excluding the last day). Notwithstanding anything herein to the contrary, from and after the nine month anniversary of the Closing Date, at the option of the Maker, in lieu of being paid in cash, an amount of interest representing 2.5% per annum applied to the Principal Amount may be added to the outstanding principal amount (such additional principal amount from time to time being the “Additional Principal Amount”) and, in

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such event, shall be deemed to have been paid in the form of Additional Principal Amounts, and the cash payment of interest for such period shall be correspondingly reduced. Any Additional Principal Amount shall accrue interest from the Interest Payment Date on which such Additional Principal Amount was issued. The Maker shall pay interest on overdue principal and interest at the Applicable Rate plus 1.00% per annum, which interest shall be paid by adding Additional Principal Amount.

3. Future Guarantors. Promptly after a subsidiary of the Maker guarantees the Senior Secured Credit Agreement, the Maker shall cause such subsidiary also to guarantee this Note on the same basis as the other Guarantors.

4. Term. This Note shall mature on the date that is 5 years (the “Term”) from the date of the Closing, or the next succeeding Business Day if such day is not a Business Day.

5. Prepayment. This Note shall be prepayable at the option of the Maker. Such prepayments shall be applied first, to accrued and unpaid interest, and second, to remaining payments of the Principal Amount. To prepay this Note, the Maker shall pay to the Holder an amount equal to the outstanding Principal Amount at such time, multiplied by the percentage rate (the “Applicable Percentage”) from the table below corresponding to the date of such payoff, plus accrued and unpaid interest. In each case, the dates set forth below shall be either such date, or the next succeeding Business Day if such date is not a Business Day.


	Applicable
Date of Payoff	Percentage
The date of Closing through and including the date that is 6 months following Closing		77.5	%
Following the date that is 6 months following Closing through and including the date that is 9 months following Closing		87.5	%
Following the date that is 9 months following Closing through and including the date that is one year following Closing		97.5	%
Following the date that is one year following Closing through and including the date that is two years following Closing		102.0	%
Following the date that is two years following Closing through and including the date that is three years following Closing		101.0	%
Following the date that is three years following Closing and thereafter		100.0	%

6. Security. This Note shall be an unsecured obligation of the Maker, and the Guarantees shall be unsecured obligations of the Guarantors.

7. Covenants. (i) Each of Holdings and the Maker covenants and agrees that, until all obligations evidenced by, and provided for in, this Note are fully, finally and indefeasibly paid:

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(a) Payment of Notes. The Maker shall pay or cause to be paid the principal amount and interest on this Note on the dates and in the manner provided herein.

(b) Compliance Certificate. Holdings and the Maker shall each deliver to the Holder an officers’ certificate within 90 days after the end of each fiscal year stating that a review of the activities of Holdings, the Maker and their subsidiaries during the preceding fiscal year has been made under the supervision of the signing officers with a view to determining whether Holdings and the Maker have kept, observed, performed and fulfilled its obligations under this Note, and further stating that, as to each such officer signing such certificate, that to the best of his or her knowledge Holdings and the Maker have kept, observed, performed and fulfilled each and every covenant contained in this Note and are not in default in the performance or observance of any of the terms, provisions and conditions of this Note (or, if a default or Event of Default shall have occurred, describing all such defaults or Events of Default of which he or she may have knowledge and what action the Maker is taking or proposes to take with respect thereto) and that to the best of his or her knowledge no event has occurred and remains in existence by reason of which payments on account of the principal of or interest, if any, on this Note is prohibited or if such event has occurred, a description of the event and what action Holdings or the Maker is taking or proposes to take with respect thereto. For purposes of this paragraph, such compliance shall be determined without regard to any period of grace or requirement of notice provided under this Note.

(c) Total Leverage Ratio. As of the end of each Fiscal Quarter, Holdings shall not have a ratio of (x) Consolidated Total Debt (as defined in the Senior Secured Credit Agreement in effect on the date of this Note) to (y) Consolidated EBITDA for the last period of four consecutive Fiscal Quarters ending on or before such date that is greater than 2:00:1.00 for any Fiscal Quarter ending after the date hereof.

(d) Conduct of Business. Holdings and the Maker shall not, and shall not permit any of their subsidiaries to, engage in any material line of businesses a majority of whose revenues are not derived from businesses that are the same or reasonably similar, complementary, ancillary or related to, or a reasonable extension, development or expansion of, the businesses in which Holdings, the Maker and their subsidiaries are engaged on the date hereof except as otherwise permitted under the Senior Secured Credit Agreement.

(e) Corporate Existence. Holdings and the Maker shall preserve and maintain (i) their corporate existence, and the corporate, partnership or other existence of each of their subsidiaries, in accordance with the respective organizational documents of Holdings, the Maker and their subsidiaries, and (ii) the rights (charter and statutory), licenses and franchises of Holdings, the Maker and their subsidiaries, in each case, except as otherwise permitted under the Senior Secured Credit Facility.

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(f) No Senior Subordinated Debt. Each of Holdings, the Maker and the Guarantors shall not incur or suffer to exist Indebtedness that is senior in right of payment to this Note or such Person’s Guarantee, as the case may be, and subordinate in right of payment to any other Indebtedness such Person; provided that the foregoing does not prohibit subordination of Liens among holders of Senior Debt.

(ii) Each of Holdings and the Maker covenants and agrees that:

(a) Exchange Notes. Subject to the execution of the indenture as described in Section 7(ii)(b), the Maker shall exchange this Note for one or more notes (the “Exchange Notes”), of like principal amount (in the aggregate) to this Note, to be governed by the indenture described in Section 7(ii)(b).

(b) Indenture. The Maker and Holder shall negotiate in good faith and use all commercially reasonable efforts to enter into, and Maker shall, and shall cause each of the Guarantors to, enter into, within 30 days of the Closing, an indenture (the “New Indenture”), in form and substance reasonably satisfactory to the Maker and the Holder, governing the Exchange Notes, with Wells Fargo Bank, N.A., as trustee, or such other trustee acceptable to the Maker and the Holder, which shall contain, among other things, the (A) covenants listed on Annex A hereto (the “Listed Covenants”) (applicable to Holdings (as the “Company” for such purposes), the Maker and the Guarantors); provided that (1) the Listed Covenants shall have terms that are customary and no more restrictive than those contained in either (a) the Indenture (the “Spheris Indenture”), dated as of December 22, 2004, by and among Spheris Inc., the guarantors party thereto and The Bank of New York, as trustee, governing the 11% Senior Subordinated Notes due 2012 of Spheris Inc. or (b) the Senior Secured Credit Agreement and (2) the Total Leverage Ratio shall be the only financial maintenance covenant, (B) events of default and other provisions that are customary and no more restrictive than those contained in either the Spheris Indenture or the Senior Secured Credit Agreement and (C) guarantees of the Exchange Notes on the terms described herein under “Guarantee”.

The Maker and Holder agree that the covenant to act in good faith and use commercially reasonable efforts shall not require that Maker agree to any provision that is prohibited by the definition of “Permitted Junior Capital” (as defined in the Senior Secured Credit Agreement (as in effect on the date hereof)).

8. Events of Default; Acceleration. If any one or more of the following events (each an “Event of Default”) shall occur for any reason whatsoever (and whether such occurrence shall be voluntary or involuntary or come about or be effected by operation of law or pursuant to or in compliance with any judgment, decree or order of any court or any order, rule or regulation of any Governmental Authority):

(a) if default shall be made in the due and punctual payment of the principal of or premium on, if any, interest on or other amounts payable on account of this Note, when and

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as the same shall become due and payable, whether at maturity or by acceleration or declaration or otherwise, and, in the case of interest, such failure continues for ten (10) Business Days (it being agreed that interest shall continue to accrue on all such unpaid amounts until such payment is made);

(b) if default shall be made in the performance or observance in any other covenant, agreement or provision contained in this Note and such default shall continue for 30 Business Days after written notice thereof is provided to the Maker;

(c) the failure to pay at final stated maturity (giving effect to any applicable grace periods and any extensions thereof) the principal amount of any Indebtedness of Holdings, the Maker or any Significant Subsidiary of Holdings, or the acceleration of the final stated maturity of any such Indebtedness, if the aggregate principal amount of such Indebtedness, together with the principal amount of any other such Indebtedness, whether such Indebtedness now exists, or is created after the date of this Note, in default for failure to pay principal at final maturity or which has been accelerated, aggregates $5.0 million or more at any time;

(d) one or more judgments in an aggregate amount in excess of $5.0 million (excluding amounts adequately covered by insurance payable to Holdings or any of its subsidiaries, to the extent the relevant insurer has not denied coverage therefor) shall have been rendered against Holdings, the Maker or any of Holdings’ Significant Subsidiaries or group of Holdings’ subsidiaries that, taken together (as of the latest audited consolidated financial statements for Holdings, the Maker and the subsidiaries), would constitute a Significant Subsidiary, and such judgments remain undischarged, unpaid or unstayed for a period of 60 days after such judgment or judgments become final and non-appealable;

(e) if Holdings, the Maker or any of Holdings’ Significant Subsidiaries or a group of Holdings’ subsidiaries that, taken together (as of the latest audited consolidated financial statements for Holdings, the Company and their subsidiaries) would constitute a Significant Subsidiary, shall file a petition or seek relief under or take advantage of any insolvency law; make an assignment for the benefit of its creditors; commence a proceeding for the appointment of a receiver, trustee, liquidator, custodian or conservator of itself or of the whole or substantially all of its property; file a petition or an answer to a petition under any chapter of the Bankruptcy Code or file a petition or seek relief under or take advantage of any other similar law or statute of the United States of America, any state thereof or any foreign country; or

(f) if a court of competent jurisdiction shall enter an order, judgment or decree appointing or authorizing a receiver, trustee, liquidator, custodian or conservator of Holdings, the Maker or any of Holdings’ Significant Subsidiaries or a group of Holdings’ subsidiaries that, taken together (as of the latest audited consolidated financial statements for Holdings, the Maker and their subsidiaries) would constitute a Significant Subsidiary, or of the whole or substantially all of any of their property, or enter an order for relief against Holdings, the Maker or any of Holdings’ Significant Subsidiaries or a group of Holdings’ subsidiaries that, taken together (as of the latest audited consolidated financial statements for Holdings, the Maker and their subsidiaries) would constitute a Significant Subsidiary, in any case commenced under any chapter of the Bankruptcy Code or grant relief under any other similar law or statute of the

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United States of America, any state thereof or any foreign country; or if, under the provisions of any law for the relief or aid of debtors, a court of competent jurisdiction or a receiver, trustee, liquidator, custodian or conservator shall assume custody or control or take possession of Holdings, the Maker or any of Holdings’ Significant Subsidiaries or a group of Holdings’ subsidiaries that, taken together (as of the latest audited consolidated financial statements for Holdings, the Maker and their subsidiaries) would constitute a Significant Subsidiary, or of the whole or substantially all of their property; or if there is commenced against Holdings, the Maker or any of Holdings’ Significant Subsidiaries or a group of Holdings’ subsidiaries that, taken together (as of the latest audited consolidated financial statements for Holdings, the Maker and their subsidiaries) would constitute a Significant Subsidiary, any proceeding for any of the foregoing relief or if a petition is filed against Holdings, the Maker or any of Holdings’ Significant Subsidiaries or a group of Holdings’ subsidiaries that, taken together (as of the latest audited consolidated financial statements for Holdings, the Maker and their subsidiaries) would constitute a Significant Subsidiary, under any chapter of the Bankruptcy Code or under any other similar law or statute of the United States of America or any state thereof or any foreign country and such proceeding or petition remains undismissed for a period of sixty (60) days; or if Holdings, the Maker or any Significant Subsidiary consents to, approves of or acquiesces in any such proceeding or petition;

then, upon the occurrence of any Event of Default, the unpaid Principal Amount of, and accrued and unpaid interest on, this Note shall automatically become immediately due and payable, together with all other amounts payable under this Note, without presentment, demand, protest, notice of intent to accelerate, notice of acceleration or further notice of any kind, all of which are hereby expressly waived by the Maker.

9. Subordination. Notwithstanding anything to the contrary set forth in this Note, this Note is subordinated to Senior Debt to the extent and in the manner set forth in this Section 9. For the avoidance of doubt, this Note is not subordinated to any instrument or Indebtedness other than Senior Debt.

(a) No payment or distribution of any kind, whether direct or indirect (by set-off, recoupment or otherwise) and whether in cash, securities or other property, shall be made on account of any Subordinated Debt, or in respect of any redemption, retirement, purchase or other acquisition of any Subordinated Debt, by or for the account of Maker or any guarantor, at any time during which any Senior Debt shall be outstanding or any commitment to extend Senior Debt exists, other than (a) any increases to the principal amount owing under this Note resulting from the compounding of interest or the payment of interest in kind rather than in cash, (b) to the extent no Senior Default has occurred and is continuing, regularly scheduled payments of interest at a rate not to exceed 10% per annum; provided, however, with respect to clauses (a) and (b), the total interest rate per annum on this Note does not exceed 12.5% per annum, (c) prepayments of principal of this Note to the extent permitted pursuant to and made in accordance with clause (ii) of Section 8.6 of the Senior Secured Credit Agreement and (d) payment of principal on this Note at its stated maturity date so long as no Senior Default has occurred and is continuing or the maturity date of the Senior Debt was extended beyond the maturity date of this Note.

(b) In the event of any payment or distribution of assets of the Maker of any kind or character, whether in cash, property, or securities, upon the dissolution, winding up, or total or

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partial liquidation or reorganization, readjustment, arrangement, or similar proceeding relating to such Maker or its property, whether voluntary or involuntary, or in bankruptcy, insolvency, receivership, arrangement or similar proceedings or upon an assignment for the benefit of creditors, or upon any other marshaling or composition of the assets and liabilities of such Maker (each, a “Proceeding”), or event described in 8(d) or 8(e) of this Note or otherwise: (x) all amounts owing on account of the Senior Debt shall first be Paid in Full before any payment of the Subordinated Debt is made and (y) any payment to which the Holder would be entitled (but for the provisions hereof) shall be paid or delivered by the trustee in bankruptcy, receiver, assignee for the benefit of creditors, or other liquidating agent making such payment or distribution to the Agent directly, for application to the payment of the Senior Debt until all Senior Debt shall have been Paid in Full.

(i) the Agent is hereby irrevocably authorized and empowered (in its own name or in the name of the Maker, the Holder or otherwise), but shall have not obligation, to demand, sue for, collect and receive every payment or distribution referred to in clause (b) and give acquaintance therefore and to file claims and proofs of claim and take such other action as it may deem necessary or advisable for the exercise or enforcement of any of the rights or interests of holders of Senior Debt; and

(ii) Holder shall duly and promptly take any or all of the following actions as the Agent may request: (A) to collect the Subordinated Debt for the account of the holders of the Senior Debt and to file appropriate claims or proofs of claim in respect of the Subordinated Debt, (B) to execute and deliver to such Agent such powers of attorney, assignments, or other instruments as such Agent may request in order to enable Agent to enforce any and all claims with respect to, and any security interests and other liens securing payment of, the Subordinated Debt, or (C) to collect and receive any and all payments or distributions which may be payable or deliverable upon or with respect to the Subordinated Debt.

(d) Until all the Senior Debt shall have been Paid in Full, no Holder shall:

(i) accelerate, make demand, or otherwise make due and payable prior to the original due date thereof any Note or bring suit or institute any other actions or proceeding to enforce its rights or interest in respect of the obligations of the Maker or the Guarantors;

(ii) exercise any rights to set-offs and counterclaims in respect of any indebtedness, liabilities or obligations of the Maker or the Guarantors, or

(iii) commence, or cause to be commenced, or join with any creditor in commencing any insolvency proceeding against the Maker or the Guarantors; or

(iv) exercise any other rights or remedies against the Maker or the Guarantors;

provided, however, that the Holder may accelerate and make demand against all obligations of, or enforce or exercise any or all rights and remedies, or commence or

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petition for any such action or proceedings, against, the Maker after a period of 180 days has elapsed since the date on which the Holder has delivered to the Agent written notice of an Event of Default (the “Standstill Period”); provided, further, however, that the Holder may (A) upon any acceleration of any Senior Debt, accelerate and make demand against all obligations of any entity against whom such Senior Debt has been accelerated during the Standstill Period and (B) after the stated maturity of this Note, make demand against all obligations of, or enforce or exercise any or all rights and remedies, or commence or petition for any such action or proceedings, against, the Maker. Notwithstanding the foregoing, the Holder may file a proof of claim against the Maker or any of the Guarantors in connection with an insolvency proceeding of the Maker or any Guarantor.

(e) In the event that, notwithstanding the foregoing, any payment or distribution of assets of Maker or any guarantor of any kind or character, whether direct or indirect (by set-off, recoupment or otherwise) and whether in cash, property or securities, shall be received by the Holder on account of the Subordinated Debt in violation of the provisions of this Note and before all Senior Debt is paid in full in cash, such payment or distribution shall be received and held in trust by the Holder for the benefit of the holders of Senior Debt, or their designated representative, ratably according to the respective amounts of Senior Debt held or represented by each, to the extent necessary to cause all such Senior Debt to be Paid in Full.

(f) If at any time hereafter, the Holder obtains any judgment against Maker in respect of any Subordinated Debt, such judgment shall be subject to the subordination provisions of this Note and the rights of the holders of Senior Debt to the same extent as such rights apply to Subordinated Debt under this Note.

(g) The provisions of this Section 9 shall continue to be effective or be reinstated, as the case may be, if at any time any payment in respect of any Senior Debt is rescinded or must otherwise be returned by any holders of Senior Debt (including, without limitation, in the event of a Proceeding), all as though such payment had not been made. Without limitation to the foregoing, in the event that any Senior Debt is avoided, disallowed or subordinated pursuant to Section 548 of the U.S. Bankruptcy Code or any applicable state fraudulent conveyance laws, whether asserted directly or under Section 544 of the U.S. Bankruptcy Code, the provisions of this Section 9 shall continue to be effective or be reinstated, as the case may be.

(h) Agent is hereby authorized to demand specific performance of the subordination provisions contained herein, whether or not Maker shall have complied with any of the provisions hereof applicable to it, at any time when Holder shall have failed to comply with any of the provisions of this Agreement applicable to it. Holder hereby irrevocably waives any defense based on the adequacy of a remedy at law, which might be asserted as a bar to such remedy of specific performance.

(i) All rights and interests of the holders of Senior Debt hereunder, and all agreements and obligations of the Holder, or Maker hereunder, shall remain in full force and effect irrespective of:

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(i) any lack of validity or enforceability of the Senior Secured Credit Agreement, this Note (as defined in the Senior Secured Credit Agreement) or any other Loan Document (as defined in the Senior Secured Credit Agreement);

(ii) any change in the time, manner or place of payment of, or in any other term of, all or any of the Senior Debt, or any other amendment or waiver of or any consent to any departure from the Senior Secured Credit Agreement or any other Loan Document (as defined in the Senior Secured Credit Agreement), including, without limitation, any increase in the Senior Debt resulting from the extension of additional credit to Maker or otherwise:

(iii) any taking, exchange, release or non-perfection of any collateral, or any taking, release or amendment or waiver of or consent to departure from any guaranty, for all or any part of the Senior Debt;

(iv) any manner of application of collateral, or proceeds thereof, to all or any of the Senior Debt, or any manner of sale or other disposition of any collateral for all or any of the Senior Debt or any other assets of any Borrower;

(v) the grant of any adjustment, indulgence or forbearance, or compromise with, Maker with respect to the Senior Debt;

(vi) any change, restructuring or termination of the structure or existence of the Maker; or

(vii) any other circumstance which might otherwise constitute a defense available to, or a discharge of, the Maker or any Holder.

(j) Each of Maker and Holder hereby waives promptness, diligence, notice of acceptance and any other notice with respect to any of the Senior Debt and this clause 9 and any requirement that Agent or any Lender protect, secure, perfect or insure any security interest or lien on the any property subject thereto or exhaust any right to taken any action against Maker or any other person or entity or any collateral.

(k) This Note and all other instruments (and all replacements thereof) evidencing the Subordinated Debt or any part thereof shall be inscribed with a legend conspicuously indicating that the payment thereof is subordinated to the payment of Senior Debt pursuant to the provisions of this Section 9.

(l) This Section 9 shall constitute a continuing offer to all Persons who become holders of, or continue to hold, Senior Debt; and such holders are made obligees hereunder and any one or more of them, or their designated representative, may enforce such provisions, and all such holders shall be deemed to have relied thereon. The subordination effected by this Section 9 is a continuing subordination, and the Holder unconditionally waives notice of the incurring of any Senior Debt or any part thereof and reliance by any holders of Senior Debt upon the subordination contained herein. The Holder acknowledges and agrees that the foregoing subordination provisions are, and are intended to be, an inducement to and a consideration of the holders of Senior Debt, whether such Senior Debt was created or acquired before or after the

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incurrence or creation of any Subordinated Debt and whether such holders of Senior Debt are now known or hereafter become known, and each holder of Senior Debt shall be deemed conclusively to have relied upon such subordination provisions in acquiring and holding, or in continuing to hold, such Senior Debt and shall be entitled to enforce the provisions of this Section 9 directly as if it were a party to this Note. No right of any present or future holders of Senior Debt to enforce subordination provisions contained in this Section 9 shall at any time be prejudiced or impaired by any act or failure to act on the part of Maker or by any noncompliance by Maker with the terms of this Note.

10. Notices. Any notice or communication must be given in writing or delivered in person, or by overnight courier, or by facsimile addressed as follows:


Holder:	Spheris Inc.
	9009 Carothers Parkway, Suite C-3
	Franklin, Tennessee 37067
	Attention:	Chief Executive Officer and
		General Counsel
	Facsimile:	(615) 261-1792

With a copy to:	Willkie Farr & Gallagher LLP
	787 Seventh Avenue
	New York, New York 10019
	Attention:	Michael J. Kelly, Esq.
		Mark A. Cognetti, Esq.

Maker:	MedQuist Transcriptions, Ltd.
	1000 Bishops Gate Boulevard, Suite 300
	Mount Laurel, New Jersey 08054
	Attention:	Mark Sullivan, General Counsel
	Facsimile:	(856) 206-4211

With a copy to:	Wachtell, Lipton, Rosen & Katz
	51 West 52nd Street
	New York, New York 10019
	Attention:	Richard G. Mason, Esq.
		Andrew J. Nussbaum, Esq.
		Gordon S. Moodie, Esq.
	Facsimile:	(212) 403-2000

Any such notice or communication is effective (x) when received, if delivered in person or by facsimile or (y) on the next Business Day, if delivered by overnight courier.

11. No Waiver. The Holder shall not by any act, delay, omission or otherwise be deemed to have amended, modified, supplemented, waived, extended, discharged or terminated any of its rights or remedies, except by an amendment, modification, supplement, waiver, extension, discharge or termination in writing and signed by the appropriate parties, as

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may be applicable. All rights and remedies of the Holder under the terms of this Note and applicable statutes or rules of law shall be cumulative, and may be exercised successively or concurrently. The Maker agrees that there are no defenses, equities or setoffs with respect to the obligations set forth herein.

12. Compliance With Applicable Law. It is the intent of Holder and Maker in the execution and performance of this Note to remain in strict compliance with Applicable Law from time to time in effect. In furtherance thereof, the Holder and the Maker stipulate and agree that none of the terms and provisions contained in this Note shall ever be construed to create a contract to pay for the use, forbearance or detention of money with interest at a rate or in an amount in excess of the Maximum Rate or maximum amount of interest permitted or allowed to be contracted for, charged, received, taken or reserved under Applicable Law. For purposes of this Note, “interest” shall include the aggregate of all amounts which constitute or are deemed to constitute interest under Applicable Law which are contracted for, taken, charged, reserved, received or paid under this Note. The Maker shall never be required to pay unearned interest and shall never be required to pay interest at a rate or in an amount in excess of the Maximum Rate or maximum amount of interest that may be lawfully contracted for, charged, received, taken or reserved under Applicable Law, and the provisions of this paragraph shall control over all other provisions of this Note, which may be in actual or apparent conflict herewith. If the maturity of this Note is accelerated for any reason, or if under any other contingency the interest effective rate or amount of interest which would otherwise be payable under this Note would exceed the Maximum Rate or maximum amount of interest Holder is permitted or allowed by Applicable Law to charge, contract for, take, reserve or receive, or in the event Holder shall charge, contract for, take, reserve or receive monies that are deemed to constitute interest which would, in the absence of this provision, increase the effective interest rate or amount of interest payable under this Note to a rate or amount in excess of that permitted or allowed to be charged, contracted for, taken, reserved or received under Applicable Law then in effect, then the principal amount of this Note or the amount of interest which would otherwise be payable under this Note, or both, shall be reduced to the amount allowed under Applicable Law as now or hereinafter construed by the courts having jurisdiction, and all such monies so charged, contracted for, taken, reserved or received that are deemed to constitute interest in excess of the Maximum Rate or maximum amount of interest permitted by Applicable Law shall immediately be returned to or credited to the account of the Maker upon such determination. The Holder and the Maker further stipulate and agree that, without limitation of the foregoing, all calculations of the rate or amount of interest contracted for, charged, taken, reserved or received under this Note which are made for the purpose of determining whether such rate or amount exceeds the Maximum Rate, shall be made to the extent not prohibited by Applicable Law, by amortizing, prorating, allocating and spreading during the period of the full stated term of this Note, all interest hereon at any time contracted for, charged, taken, reserved or received from the Maker or otherwise by the Holder.

13. General. This Note was negotiated in New York, and made by the Maker and accepted by the Holder in the State of New York, and the proceeds of this Note were disbursed from New York, which State the parties agree has a substantial relationship to the parties and to the underlying transaction embodied hereby, and in all respects (including, without limitation, matters of construction, validity and performance), this Note and the obligations arising hereunder shall be governed by, and construed in accordance with, the laws of the State of New

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York applicable to contracts made and performed in such State and any applicable law of the United States of America.

ANY LEGAL SUIT, ACTION OR PROCEEDING AGAINST THE HOLDER OR THE MAKER ARISING OUT OF OR RELATING TO THIS NOTE SHALL BE INSTITUTED IN (A) WITH RESPECT TO A SUIT, ACTION OR PROCEEDING INITIATED IN CONNECTION WITH SECTION 7(ii) OF THIS NOTE PRIOR TO THE EXECUTION OF THE INDENTURE, THE U.S. BANKRUPTCY COURT FOR THE DISTRICT OF DELAWARE AND (B) WITH RESPECT TO ALL OTHER MATTERS, ANY FEDERAL OR STATE COURT IN NEW YORK, NEW YORK. HOLDINGS AND THE MAKER, AND BY ACCEPTANCE OF THIS NOTE, THE HOLDER, HEREBY (i) IRREVOCABLY WAIVES, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, ANY OBJECTION WHICH IT MAY NOW OR HEREAFTER HAVE TO THE LAYING OF VENUE OF ANY SUCH SUIT, ACTION OR PROCEEDING BROUGHT IN SUCH A COURT AND ANY CLAIM THAT ANY SUCH PROCEEDING BROUGHT IN SUCH A COURT HAS BEEN BROUGHT IN AN INCONVENIENT FORUM, AND (ii) IRREVOCABLY SUBMITS TO THE JURISDICTION OF ANY SUCH COURT IN ANY SUIT, ACTION OR PROCEEDING.

THE MAKER AND, BY ACCEPTANCE HEREOF, THE HOLDER, TO THE FULLEST EXTENT THAT EACH MAY LAWFULLY DO SO, WAIVE TRIAL BY JURY IN ANY ACTION OR PROCEEDING (INCLUDING, WITHOUT LIMITATION, ANY TORT ACTION), BROUGHT BY EITHER PARTY HERETO WITH RESPECT TO THIS NOTE.

14. Subject to applicable law, Spheris may transfer this Note (or portions thereof) to any holders of Spheris claims pursuant to a plan (the “Spheris Plan”) of reorganization or liquidation under Chapter 11 of Title 11 of the United States Code. In case this Note or any portion thereof is to be transferred to any such parties, Holdings and the Maker agree to use all commercially reasonable efforts to facilitate such transfer, so long as such transfer does not require registration under the Securities Act.

[Signature page follows]

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IN WITNESS WHEREOF, the Maker, Holdings and the Guarantors have caused this Note to be executed as of the day and year first above written.


MAKER:

	MEDQUIST TRANSCRIPTIONS, LTD.

	By:	/s/ Mark R. Sullivan
	Name:	Mark R. Sullivan
	Title:	General Counsel

HOLDINGS:

	MEDQUIST INC.

	By:	/s/ Mark R. Sullivan
	Name:	Mark R. Sullivan
	Title:	General Counsel

GUARANTORS:

	MEDQUIST IP LLC

	By:	/s/ Mark R. Sullivan
	Name:	Mark R. Sullivan
	Title:	President

	MEDQUIST CM LLC

	By:	/s/ Mark R. Sullivan
	Name:	Mark R. Sullivan
	Title:	President

	MEDQUIST OF DELAWARE, INC.

	By:	/s/ Mark R. Sullivan
	Name:	Mark R. Sullivan
	Title:	Secretary


Agreed and Accepted:

SPHERIS, INC.

By:	/s/ Robert L. Butler

	Name:	Robert L. Butler
	Title:	Chief Restructuring Officer

GUARANTEE

1. Each of Guarantors hereby unconditionally and irrevocably guarantees, jointly and severally, to each Holder and its successors and assigns (a) the full and punctual payment of principal of and premium, if any, and interest, on the attached Subordinated Promissory Note of MedQuist Transcriptions, Ltd. (the “Maker”), dated April 22, 2010 (the “Note”) when due, whether at maturity, by acceleration, by redemption or otherwise and (b) the full and punctual payment and performance within applicable grace periods of all other Obligations of the Maker under the Note whether for fees, expenses, indemnification or otherwise under the Note (all the foregoing being hereinafter collectively called the “Guaranteed Obligations”). Capitalized terms used but not otherwise defined in this Guarantee shall have the meanings given them in the Note.

2. Each Guarantor further agrees that the Guaranteed Obligations may be extended or renewed, in whole or in part, without notice or further assent from each such Guarantor and that such Guarantor will remain bound under this Guarantee notwithstanding any extension or renewal of any Guaranteed Obligation.

3. Each Guarantor waives presentation to, demand of, payment from and protest to the Maker of any of the Guaranteed Obligations and also waives notice of protest for nonpayment. Each Guarantor waives notice of any default under the Notes or the Guaranteed Obligations. The obligations of each Guarantor hereunder shall not be affected by (a) the failure of any Holder to assert any claim or demand or to enforce any right or remedy against the Maker or any other Person under the Note or any other agreement or otherwise; (b) any extension or renewal of the Note or any other agreement; (c) any rescission, waiver, amendment or modification of any of the terms or provisions of the Note or any other agreement; (d) the release of any security held by any Holder for the Guaranteed Obligations or any Guarantor; (e) the failure of any Holder to exercise any right or remedy against any other guarantor of the Guaranteed Obligations; or (f) any change in the ownership of such Guarantor.

4. Each Guarantor hereby waives any right to which it may be entitled to have its obligations hereunder divided among the Guarantors, such that such Guarantor’s obligations would be less than the full amount claimed. Each Guarantor hereby waives any right to which it may be entitled to have the assets of the Maker first be used and depleted as payment of the Maker’s or such Guarantor’s obligations hereunder prior to any amounts being claimed from or paid by such Guarantor hereunder. Each Guarantor hereby waives any right to which it may be entitled to require that the Maker be sued prior to an action being initiated against such Guarantor.

5. Each Guarantor further agrees that its Guarantee herein constitutes a guarantee of payment, performance and compliance when due (and not a guarantee of collection) and waives any right to require that any resort be had by any Holder to any security held for payment of the Guaranteed Obligations.

6. Each Guarantee is, to the extent and in the manner set forth in Section 9 of the Note, subordinated and subject in right of payment to the prior payment in full of the principal of

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and premium, if any, and interest and other Senior Debt of the Guarantor giving such Guarantee; and each Guarantee is made subject to such provisions of the Note.

7. Except as expressly set forth in Section 11 of this Guarantee, the obligations of each Guarantor hereunder shall not be subject to any reduction, limitation, impairment or termination for any reason, including any claim of waiver, release, surrender, alteration or compromise, and shall not be subject to any defense of setoff, counterclaim, recoupment or termination whatsoever or by reason of the invalidity, illegality or unenforceability of the Guaranteed Obligations or otherwise. Without limiting the generality of the foregoing, the obligations of each Guarantor herein shall not be discharged or impaired or otherwise affected by the failure of any Holder to assert any claim or demand or to enforce any remedy under the Note or any other agreement, by any waiver or modification of any thereof, by any default, failure or delay, willful or otherwise, in the performance of the obligations, or by any other act or thing or omission or delay to do any other act or thing which may or might in any manner or to any extent vary the risk of such Guarantor or would otherwise operate as a discharge of such Guarantor as a matter of law or equity.

8. Each Guarantor further agrees that its Guarantee herein shall continue to be effective or be reinstated, as the case may be, if at any time payment, or any part thereof, of principal of or interest on any Guaranteed Obligation is rescinded or must otherwise be restored by any Holder upon the bankruptcy or reorganization of the Maker or otherwise.

9. In furtherance of the foregoing and not in limitation of any other right which any Holder has at law or in equity against any Guarantor by virtue hereof, upon the failure of the Maker to pay the principal of or interest on any Guaranteed Obligation when and as the same shall become due, whether at maturity, by acceleration, by redemption or otherwise, or to perform or comply with any other Guaranteed Obligation, each Guarantor hereby promises to and shall, upon receipt of written demand by the Holder, forthwith pay, or cause to be paid, in cash, to the Holder an amount equal to the sum of (1) the unpaid principal amount of such Guaranteed Obligations and (2) accrued and unpaid interest on such Guaranteed Obligations (but only to the extent not prohibited by applicable law).

10. Each Guarantor agrees that it shall not be entitled to any right of subrogation in relation to the Holder in respect of any Guaranteed Obligations guaranteed hereby until payment in full in cash of all Guaranteed Obligations and all obligations to which the Guaranteed Obligations are subordinated as provided in Section 9 of the Note. Each Guarantor further agrees that, as between it, on the one hand, and the Holder, on the other hand, (x) the maturity of the Guaranteed Obligations may be accelerated as provided in the Note for the purposes of such Guarantor’s Guarantee herein, notwithstanding any stay, injunction or other prohibition preventing such acceleration in respect of the Guaranteed Obligations guaranteed hereby, and (y) in the event of any declaration of acceleration of such Guaranteed Obligations as provided in Section 8 of the Note, such Guaranteed Obligations (whether or not due and payable) shall forthwith become due and payable by such Guarantor for the purposes of this Guarantee. Each Guarantor also agrees to pay any and all costs and expenses (including reasonable attorneys’ fees and expenses) incurred by any Holder in enforcing any rights under this Guarantee.

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11. Any term or provision of the Note to the contrary notwithstanding, the maximum aggregate amount of the Guaranteed Obligations guaranteed hereunder by any Guarantor shall not exceed the maximum amount that can be hereby guaranteed without rendering the Note and the Guarantee, as it relates to such Guarantor, void or voidable under applicable law relating to solvency, fraudulent conveyance or fraudulent transfer, prohibited distributions to shareholders or similar laws affecting the rights of creditors generally.

12. Each Guarantor that makes a payment under its Guarantee shall be entitled upon payment in full in cash of all Guaranteed Obligations to a contribution from each other Guarantor in an amount equal to such other Guarantor’s pro rata portion of such payment based on the respective net assets of all the Guarantors at the time of such payment determined in accordance with GAAP.

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Annex A

The following are the Listed Covenants:

	•		Offer to Purchase by Application of Net Proceeds Offer Amount;

	•		Payment of Notes;

	•		Maintenance of Office or Agency;

	•		Reports (to be satisfied with current public reporting of Holdings if the Notes are guaranteed by Holdings in accordance with Rule 3-10(d) of Regulation S-X);

	•		Compliance Certificate;

	•		Stay, Extension and Usury Laws;

	•		Restricted Payments;

	•		Dividend and Other Payment Restrictions Affecting Subsidiaries;

	•		Incurrence of Indebtedness (to permit Senior Debt of up to $115 million);

	•		Asset Sales;

	•		Transactions with Affiliates;

	•		Liens (to permit liens to secure the Senior Debt up to $115 million);

	•		Conduct of Business;

	•		Corporate Existence;

	•		Offer to Repurchase upon Change of Control;

	•		No Senior Subordinated Debt;

	•		Future Guarantees by Domestic Subsidiaries;

	•		Limitation on Preferred Stock of Restricted Subsidiaries;

	•		Consolidated Leverage Ratio (as set forth in Section 7(i)(c) of the Note); and

	•		Merger, Consolidation or Sale of Assets.

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EX-10.5 3 w78445exv10w5.htm EX-10.5 exv10w5

Exhibit 10.5

Portions of this exhibit were omitted and filed separately with the Secretary of the Securities and Exchange Commission (the “Commission”) pursuant to an application for confidential treatment filed with the Commission pursuant to Rule 24b-2 under the Securities Exchange Act of 1934. Such portions are marked by a series of asterisks.

SALES AND SERVICES AGREEMENT

This Sales and Services Agreement (the “Agreement”) dated as of March 09, 2010 is by and between MedQuist Transcriptions, Ltd., a New Jersey corporation (together with its successors, “MedQuist” or the “Company”), and CBay Systems & Services Inc., a Delaware corporation (“CBay”).

RECITALS

WHEREAS, CBay, the Company and their Affiliates have entered into several intercompany agreements relating to sales and operational support, including (i) the Transcription Services Agreement, dated as of April 3, 2009, by and between the Company and CBay, pursuant to which the Company outsources certain medical transcription services to CBay (such agreement, as amended from time to time prior to the date hereof, the “TSA”), (ii) the Subcontracting Agreement, dated as of March 31, 2009, by and between MedQuist and CBay, pursuant to which CBay subcontracts certain medical transcription, editing and related services to MedQuist (as such agreement may be amended from time to time, the “Subcontracting Agreement”), and (iii) the CBayScribe Marketing Agreement, dated as of October 1, 2009, by and between MedQuist and CBay, pursuant to which the Company markets CBay’s CBayScribe products and services (as such agreement may be amended from time to time, the “CBayScribe Marketing Agreement”);

WHEREAS, CBay and the Company recognize that the success of their relationship will depend upon the mutual commitment and cooperation of both parties; and

WHEREAS, CBay and the Company desire to terminate the TSA and enter into a more comprehensive intercompany agreement whereby (i) CBay would discontinue its New Customer marketing efforts for Transcription Services to Hospitals in North America and (ii) CBay would become the exclusive supplier to the Company of Indian or Asian based transcription production services (either directly or through a network of third party suppliers (“ILPs”)).

NOW, THEREFORE, in consideration of the mutual promises hereinafter set forth and for other good and valuable consideration, and upon the terms and conditions contained herein, the parties agree as follows:

ARTICLE I

DEFINITIONS

1.1 Definitions. In this Agreement, and in the Schedules attached to this Agreement, the following terms, whether used in the singular or plural, shall have the respective meanings set forth below:

(a) “Administrative Safeguards” shall mean administrative actions, policies and procedures to manage the selection, development, implementation and maintenance


*******		- Material has been omitted and filed separately with the Commission.

of security measures to protect EPHI and to manage the conduct of CBay’s workforce in relation to the production of that information as defined in 45 CFR §164.304.

(b) “Affiliate” shall mean any individual or entity directly or indirectly controlling, controlled by or under common control with, a party to this Agreement. For purposes of this Agreement, (i) the direct or indirect ownership of over fifty percent (50%) of the outstanding voting securities of an entity, or the right to receive over fifty percent (50%) of the profits or earnings of an entity, or (ii) the power to direct or cause the direction of the management or policies of a Person, whether through the ownership of voting securities, by contract or otherwise, shall be deemed to constitute control. For purposes of this definition, S.A.C. Private Capital Group, LLC shall not be deemed to be an Affiliate of CBay or the Company.

(d) “Confidential Information” shall mean all non-public information of a confidential or proprietary nature (whether or not specifically labeled or identified as “confidential”), in any form or medium, that relates to the business, products, financial condition, services or research or development of either of the parties under this Agreement and each of its Affiliates, suppliers, distributors, customers, independent contractors or other business relations, including all trade secrets, know-how, compilations of data and analyses, techniques, systems, formulae, recipes, research, records, reports, manuals, documentation, models, data and data bases relating thereto; inventions, innovations, improvements, developments, methods, designs, analyses, drawings, reports and all similar or related information.

(e) “Contribution Margin” shall mean Revenues less the sum of Direct Production Costs and Indirect Production Costs.

(f) “Contribution Ratio” shall mean 20% of Revenues.

(g) “Dictation” shall mean the audio dictated by a physician and recorded on digital media as a computer digital audio file for conversion from voice into text or data.

(h) “Direct Production Costs” shall mean the sum of (i) direct personnel costs (i.e., wages, bonuses, fringe benefits and other employee related costs) for employees directly involved in the provision of Transcription Services to MedQuist pursuant to this Agreement (i.e., transcriptionists and first level quality assurance personnel), (ii) production related telecommunication costs and other direct production expenses (i.e., third party production fees, royalty or license fees and other expenses incurred directly as a result of Transcription Services related production activities on behalf of MedQuist pursuant to this Agreement), and (iii) any costs incurred by CBay under Section 3.4(e). For purposes hereof, Direct Production Costs shall mean solely those costs included in the general ledger accounts listed on Schedule H hereto.


*******		- Material has been omitted and filed separately with the Commission.

(i) “Effective Date” shall mean the date this Agreement is executed by the parties below following approval by the respective boards of directors (or any committee of the board charged with such approval) of the parties.

(j) “EPHI” shall mean Electronic Protected Health Information as that term is defined by 45 CFR §164.513.

(k) “HIPAA” shall mean the Health Insurance Portability and Accountability Act of 1996.

(l) “Hospital” shall mean a hospital, clinic or other institution that provides inpatient or outpatient medical, surgical, or psychiatric care and treatment for the sick or the injured which either (i) has inpatient beds or (ii) is directly related to or connected to a hospital, clinic or other institution that has inpatient beds.

(m) “Implementation Period” shall mean the 60 day period beginning the first day that CBay transcribes or edits a live dictated report of a new client or new client work type.

(n) “Indirect Production Costs” shall mean the total of all allocations of Indirect Production Costs for each production facility and support function involved in the provision of Transcription Services to MedQuist. The allocation of said costs shall be determined for each facility in India at which transcription services are performed by CBay for MedQuist by multiplying (i) the sum of (x) indirect personnel costs (i.e., wages, bonuses, fringe benefits and other employee related costs) for employees indirectly involved in the provision of Transcription Services to MedQuist pursuant to this Agreement (i.e., second level quality assurance, supervisory, management and other production related personnel) at such facility, and (y) other indirect production expenses (i.e., rental expenses, utility expenses, customer penalties and other expenses incurred indirectly as a result of and related to the provision of Transcription Services to MedQuist pursuant to this Agreement) at such facility by (ii) a ratio, the numerator of which is the Volume of Transcription Services performed for MedQuist hereunder at such facility and the denominator of which is CBay’s total volume of Transcription Services performed at such facility. The allocation of Indirect Production Costs other than those at the production facility shall be based upon a ratio of the Volume of Transcription Services performed for MedQuist hereunder to the total volume of all Transcription Services (or such other volume as may be appropriate for that specific support function). For purposes hereof, Indirect Production Costs shall mean solely those costs expended in India and included in the general ledger accounts listed on Schedule H hereto.

(o) “Laws” shall mean all applicable federal, municipal, state, local or foreign statutes or laws, and shall be deemed also to refer to all rules and regulations promulgated thereunder, by any applicable regulatory authority or otherwise, unless context requires otherwise. Any reference to a particular law or regulation will be interpreted to include any revision of or successor to such statute, law, rule or regulation regardless of how it is numbered or classified.


*******		- Material has been omitted and filed separately with the Commission.

(p) “Line” shall mean *******

(q) “MedQuist Audit Committee” shall mean the Audit Committee of the Board of Directors of MedQuist Inc.

(r) “New Customer” shall mean a customer or prospective customer that is not a Current Customer.

(s) “Non-Client Ready Services” shall mean Transcription Services for which the Threshold QA Volume is *******.

(t) “PHI” shall mean Protected Health Information as defined in 45 CFR §164.501.

(u) “Physician Practice” shall mean a medical practice comprised of one or more physicians organized to provide patient care services, but which practice is not part of a Hospital.

(v) “Profit Sharing Amount” shall mean the excess of the Contribution Margin over the Contribution Ratio.

(w) “Revenue Cycle Management” shall mean the activities of Mirrus Systems, AMS Plus, and other operations responsible for billing, coding, or collections.

(x) “Revenues” shall mean the gross revenues received by CBay from MedQuist for the provision of Transcription Services hereunder.

(y) “Rupee Exchange Rate” shall mean the number of Indian Rupees that can be purchased for one U.S. Dollar, as reported by The Wall Street Journal on the date in question.

(z) “Technical Safeguards” shall mean the technology and the policy and procedures for its use that protect EPHI and control access to it as defined in 45 CFR §164.304.

(aa) “Term” shall mean the period of time commencing on the Effective Date and ending on the Expiration Date.

(bb) “Transcript” shall mean the document or computer file resulting from the conversion of Dictation into text or data.


*******		- Material has been omitted and filed separately with the Commission.

(cc) “Transcription Services” shall mean the transcription and/or editing services that result in the conversion of physician Dictation into Transcript.

(dd) “Volume” shall mean the volume of Transcription Services provided to MedQuist hereunder.

ARTICLE II

COORDINATED SALES AND MARKETING EFFORTS

2.1 CBay Discontinues Certain Marketing Efforts. From and after the Effective Date until the Expiration Date, except as otherwise agreed upon in writing by MedQuist (following approval by the MedQuist Audit Committee) and CBay on a case-by-case basis, CBay will cease any New Customer sales efforts for Transcription Services to Hospitals in North America. For the avoidance of doubt, the limitation in the previous sentence will not restrict CBay from the following activities:

(a) Current Customer Relationships with Hospitals. Maintaining, developing and growing its relationships with current Hospital customers set forth on Schedule A (the “Current Customers Schedule”), including their Affiliates and existing, new, or subsequently acquired facilities of such persons (collectively, “Current Customers”) and servicing and providing additional work types/services for such Current Customers, including the Company’s products and services set forth on Schedule B (the “Current Products and Services Schedule”).

(b) Other Market Segments. Prospecting for New Customers in any other market segment, including, but not limited to, the Physician Practice market segment.

(c) Other Product/Service Categories. Selling any product/service, other than Transcription Services, to any Hospital, including but not limited to, Revenue Cycle Management products/services.

(d) Current Pipeline. Servicing and continuing its sales efforts to the Hospitals actively being pursued as of the date of this Agreement (“Current Pipeline Customers”), set forth on Schedule C (the “Current Pipeline Customers Schedule”), for twelve (12) months after the Effective Date. Unless the parties mutually agree to extend this twelve (12) month period (which agreement in the case of MedQuist will require the approval of the MedQuist Audit Committee), CBay will discontinue its sales efforts to any Hospitals that have not become customers as of twelve (12) months after the Effective Date.

2.2 Marketing of Transcription Services. During the Term of this Agreement, the Company will use its commercially reasonable efforts to sell and market Transcription Services to Hospitals in North America other than Current Customers and Current Pipeline Customers. With CBay’s express written consent, the Company may sell and market Transcription Services to any Current Customer, Current Pipeline Customer or facilities acquired by either Current


*******		- Material has been omitted and filed separately with the Commission.

Customers or Current Pipeline Customers. CBay will provide the Company with such marketing assistance, technical information and other cooperation as is reasonably requested by the Company in connection with its marketing efforts.

2.3 General Exceptions. Notwithstanding anything contained in this Agreement, neither CBay nor MedQuist or their Affiliates shall be prohibited or restricted from acquiring, holding or investing in, directly or indirectly through any of its Affiliates, securities of an entity engaged in any business after the Effective Date, including the medical transcription business, the Hospital sector, and/or the Physician Practice market. The provisions of this Agreement will apply to any entity acquired after the Effective Date of this Agreement, unless the parties mutually agree otherwise (which agreement in the case of MedQuist will require the approval of the MedQuist Audit Committee).

2.4 Group Purchasing Order Contracts. During the Term of this Agreement, CBay will cooperate with the Company to transfer, to the fullest extent permissible, the rights and benefits under CBay’s Group Purchasing Order (“GPO”) contracts set forth on Schedule D (the “GPO Contracts Schedule”) to the Company in order to allow MedQuist to market its products and services solely to New Customers that are Hospitals covered by such GPO contracts. If any such GPO contract cannot be transferred, CBay shall provide or cause to be provided all commercially reasonable assistance to the Company (not including the payment of any consideration) reasonably requested by the Company to secure any lawful and commercially reasonable arrangement reasonably proposed by the Company under which the Company shall obtain (without infringing upon the legal rights of any third party) the economic claims, rights and benefits under such GPO contract and shall assume any related economic burden with respect to such GPO contract. If any such GPO contract cannot be transferred, and CBay cannot facilitate MedQuist’s beneficial use of any such GPO contract pursuant to the previous sentence, then CBay shall contract for sales under such GPO contract and engage the Company to provide Transcription Services thereunder pursuant to the Subcontracting Agreement.

ARTICLE III

OFFSHORE TRANSCRIPTION SERVICES

3.1 Termination of the TSA. The TSA is hereby terminated and superseded in its entirety by this Agreement, other than with respect to the payment of any fees or penalties for services provided under the TSA through the date of termination and Section 5.5 and Article VIII thereof, which provisions shall survive such termination and not be superseded solely with respect to services provided under the TSA through the date of termination.

3.2 Exclusive Vendor Relationship. As of the Effective Date, until the Agreement is terminated or this provision ceases to be applicable in accordance with Sections 5.5 or 7.5 hereof, CBay shall be the Company’s exclusive provider of Indian or Asian Transcription Services, except as otherwise agreed upon in writing by MedQuist and CBay on a case-by-case basis, MedQuist will cease to directly or indirectly (except through CBay) purchase Indian or Asian Transcription Services from any person or entity other than CBay or perform Indian or Asian Transcription Services itself except pursuant to the Company’s International Labor Partner (“MQ ILP”) Vendor Contracts for Indian or Asian Transcription Services set forth on Schedule E


*******		- Material has been omitted and filed separately with the Commission.

(“ILP Contracts”) prior to their assignment to CBay pursuant to Section 3.3. CBay shall provide the Indian or Asian Transcription Services at substantially the same level of quality as CBay provides similar services to its other clients, but in no event less than the standards customary in the industry.

3.3 MedQuist’s Current International Labor Partner Vendor Contracts. As of the Effective Date the Company will take commercially reasonable measures to obtain consent, if required, for the assignment of the ILP Contracts from each MQ ILP. The Company will assign to CBay, and CBay will assume, each of the Company’s ILP Contracts in order to allow CBay to perform initially the necessary Indian or Asian Transcription Services for the Company promptly following its receipt of the consent of the MQ ILP party to such ILP Contract of such assignment. For purposes of clarity, following such assignment, CBay shall be solely responsible to MedQuist for the performance of all Indian and Asian Transcription Services and all other obligations under such ILP Contract and such services shall be deemed to be performed by or on behalf of CBay. Following the assignment of an ILP Contract, CBay shall have the right to amend, modify, terminate and replace ILP Contracts and vendors in its discretion, and MedQuist will not be entitled to any discounts, rebates, reductions in price or penalties under the ILP Contracts (except to the extent set forth in Section 3.4(h)). If any ILP does not consent to the assignment of its ILP Contract, the Company shall provide or cause to be provided all commercially reasonable assistance to CBay (not including the payment of any consideration) reasonably requested by CBay to secure such consent or cooperate with CBay (at CBay’s expense for any out-of pocket expenses) in any lawful and commercially reasonable arrangement reasonably proposed by CBay under which CBay shall obtain (without infringing upon the legal rights of any third party) the economic claims, rights and benefits under such ILP contract and shall assume any related economic burden with respect to such ILP contract.

3.4 Pricing; Profit Sharing.

(a) ILP Contracts. With respect to any ILP Contract that is assigned to CBay, following such assignment, for Non-Client Ready Services performed under such ILP Contracts, CBay will bill the Company, and the Company agrees to pay CBay, the amount required to be paid for services under the ILP Contract at the rates in effect as of the Effective Date as set forth in Schedule E, regardless of the date of actual transfer of the ILP Contract or the date CBay begins or ceases to provide services under such contract (the “ILP Contract Rate”). For Client Ready Services performed under such ILP Contracts, CBay will bill the Company, and the Company agrees to pay CBay, the ILP Contract Rate plus *******. Upon termination of an ILP Contract in accordance with its terms, CBay will be paid the Services Fee under clause (b).

(b) Services Fee. For Indian or Asian Transcription Services provided by CBay other than through the ILP Contracts assigned to CBay, CBay will be paid at the rates set forth in Schedule F (the “Services Fee Schedule”) (subject to changes for currency fluctuation as described below) (the “Services Fee”). Notwithstanding anything herein to the contrary, in no event shall the Services Fee net of impact of amounts received by the Company pursuant to the Profit Sharing pursuant to Section 3.4(i) be greater than the fee charged by CBay to any other customer to whom it is providing substantially similar Transcription Services.


*******		- Material has been omitted and filed separately with the Commission.

(i) Invoicing. An invoice for Service Fees will be generated by CBay twice each month and payment is due within thirty (30) calendar days after the Company’s receipt of the invoice and any other contractual reporting obligations of CBay due during the applicable billing period.

(c) Currency Fluctuation. If the average Rupee Exchange Rate during any three month period following the Effective Date (such rate, the “Adjusted Rupee Exchange Rate”) is 5% higher or lower than the average Rupee Exchange Rate during the twelve (12) month period immediately preceding the Effective Date (such rate, the “Baseline Rupee Exchange Rate”), the prices charged by CBay for its Indian or Asian Transcription Services under this Agreement shall be adjusted upwards or downwards, as the case may be, by a factor equivalent to the ratio of the Baseline Rupee Exchange Rate to the Adjusted Rupee Exchange Rate. The most recent date on which such a modification occurs shall be deemed the “Exchange Rate Price Modification Date.” Once the prices have been modified pursuant to this paragraph, the first sentence of this paragraph shall be applied by replacing the words “Effective Date” with the words “Exchange Rate Price Modification Date” and adjustments may be made thereafter as set forth above.

(d) Additional Costs. If the Company requests a material change in the scope of the Transcription Services provided by CBay (including without limitation accelerated TAT times (2 hours instead of 12 hours) or significantly more nighttime work), and CBay informs the Company that such changes would increase CBay’s production costs over the costs that would be incurred if there were no material change in the scope of Transcription Services provided by CBay, then, in any such case, the expected additional costs, as specified in a new increased cost per line rate, shall have to be identified and agreed to by the Company before CBay begins performance of the Transcription Services incorporating the requested changes. If the Company agrees to the additional production costs resulting from the changes requested by the Company, as specified in a new increased cost per line rate, the Company shall thereafter pay CBay the increased per line rate. If the Company does not agree to the additional production costs resulting from the changes requested by the Company, as reflected in a specified increased cost per line rate, CBay will not perform the requested changes and the per line rate will remain constant. The parties shall work in good faith to minimize the amount of any cost increases resulting from material changes in the scope of the Transcription Services requested by the Company.

(e) CBay assumes all Taxes, Duties, Delivery and Installation Fees. CBay assumes responsibility for all excise, sales, use and similar taxes, export or import duties and shipment, and delivery or installation fees.

(f) Uncollected Services Fee. To the extent the Company cannot pay, or cause to be paid, the Services Fee for any reason, including by reason of any prohibition on such payment pursuant to any applicable law or the terms of any debt financing of the Company or its subsidiaries, the payment by the Company or any of its subsidiaries to CBay of the Services Fee will be payable immediately on the earlier of (i) the first date on which the payment of such deferred Services Fee is no longer prohibited by law or


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under any contract applicable to the Company and the Company is otherwise able to make such payment or cause such payment to be made, and (ii) total or partial liquidation, dissolution or winding up of the Company. Notwithstanding anything to the contrary herein, under any applicable law or under any contract applicable to the Company or its subsidiaries, any forbearance of collection of the Services Fee by CBay shall not be deemed to be a subordination of such payments to any other person, entity or creditor of the Company or its subsidiaries. Any installment of the Services Fee not paid on the scheduled due date will bear interest at an annual rate of six percent (6%), compounded quarterly, from the date due until paid.

(g) Disputed Services Fee. In the event that any invoiced amount is disputed by the Company, the Company shall deliver written notice of such disputed amount to CBay within thirty (30) calendar days after the date the invoice is due. Upon receipt of written notice of a billing dispute, CBay and Company shall promptly exchange any backup or other information reasonably necessary to support the correctness of any disputed amount. The parties shall thereafter have thirty (30) calendar days (“Invoice Review Period”) in which to examine such information, and to the extent such information substantiates payment, reductions or credits in the applicable invoice, such will be applied promptly. Thereafter, if CBay and the Company are unable to reach an agreement as to any remaining disputed amount, CBay and the Company shall immediately enter into good faith negotiations to resolve any remaining dispute, provided that in the case of MedQuist any resolution shall require the approval of the MedQuist Audit Committee. In the event the parties are unable to resolve such dispute within fifteen (15) calendar days after the end of the Invoice Review Period, the dispute shall be settled pursuant to the provisions of Section 11.12 of this Agreement.

(h) Penalties. The Company shall receive from CBay reimbursement for any actual penalties paid (whether in cash or by credit against future services) by the Company to its customers for Transcription Services performed either directly or indirectly (through an ILP Contract) by CBay which due to CBay’s action or inaction fail to meet the Quality Assurance or Turnaround Time performance requirements (as those terms are defined in the underlying contracts with the Company’s customers) under the contracts with such customers.

(i) On a monthly basis, the Company shall submit to CBay any and all invoices, if any, for penalties paid by the Company to a customer due to CBay’s action or inaction as explained above.

(ii) CBay shall have 20 days to object to the Company’s conclusion that CBay’s action or inaction caused the Company to incur a penalty to its customer. If CBay objects, the parties will discuss the objection and try to resolve any disagreement in good faith (provided that in the case of MedQuist any resolution shall require the approval of the MedQuist Audit Committee), failing which the matter shall be submitted to binding arbitration in accordance with Section 11.12. If CBay does not object or the objection is resolved, then within 10 days thereafter CBay shall pay to the Company an amount in cash equal to the sum of the penalties paid by the Customer and submitted as invoices to CBay


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under paragraph (i) above; provided that if CBay does not object to the full amount of the penalty, then CBay shall within 10 days of receipt of the invoice pay to the Company an amount in cash equal to the portion of the penalties as to which CBay is not objecting. Any penalties not paid on the due date set forth in this paragraph (ii) will bear interest at an annual rate of six percent (6%), compounded quarterly, from the date due until paid.

(i) Profit Sharing. The Company shall be entitled to 50% of CBay’s Profit Sharing Amount (the “Company’s Share”) in each Fiscal Year of CBay. Within 60 days after the close of each Fiscal Year of CBay, the calculation of the Company’s Share will be reviewed as part of the annual audit and CBay shall prepare and submit to the Company a certificate, signed by CBay’s chief financial officer, specifying in reasonable detail the relevant calculation of the Revenues, Direct Production Costs, Indirect Production Costs and Profit Sharing Amount related to CBay’s Indian or Asian Transcription Services performed for the Company; and the results of its operations and cash flow for the relevant transactions, together with payment of the Company’s Share as set forth in the certificate. The Company shall have 21 days to object to the calculation set forth in the certificate. If the Company objects, the parties will discuss the objection and try to resolve any disagreement in good faith (which resolution in the case of MedQuist will require the approval of the MedQuist Audit Committee), failing which the matter shall be submitted to binding arbitration in accordance with Section 11.12. If the Company has objected to the calculation, then within 10 days following resolution of the objection, CBay shall pay to the Company (or the Company shall pay to CBay, as the case may be) an amount in cash equal to the difference, if any, between the Company’s Share as finally resolved and the Company’s Share as set forth in the certificate and previously paid.

(i) Example. By way of example only, if CBay earns $10 million in Revenue from Transcription Services sold to the Company, and $3 million in Contribution Margin on such services, the Company would be entitled to a payment of $500,000 according to the following calculations. Contribution Margin in excess of the Contribution Ratio would equal $3 million less $2 million (20% Contribution Ratio on $10 million in Transcription Services Revenues), or $1 million of which 50%, or $500,000, would be paid to the Company.

3.5 Excess Quality Assurance Expense. The Company shall have the right to charge, and CBay shall pay, an amount equal to the Excess Quality Assurance Expense as explained in Schedule F.

3.6 Books of Account. Appropriate records and books of account of CBay’s transactions with, and the provision of services to, the Company under this Agreement shall be maintained by CBay in accordance with GAAP consistently applied. Such records and books of account shall at all times be maintained at such place of business of CBay as shall have been notified to the Company. The books of account and the records of CBay shall be audited as of the end of each Fiscal Year by its independent auditors. All such records shall be maintained during the Term of this Agreement, or such longer period as may be required by relevant Law.


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3.7 Inspection Rights of the Company. The Company, and any accountants, attorneys, financial advisers and other representatives of the Company, may, from time to time at the Company’s sole expense, visit and inspect the properties of CBay, examine (and make copies and extracts of) CBay’s books, records and documents solely for purposes of confirming the calculation of Revenues, Direct Production Costs, Indirect Production Costs, Contribution Margin, the Profit Sharing Amount and the Company’s Share related to the Indian or Asian Transcription Services provided by CBay to the Company under this Agreement, and may discuss those transactions with its officers, employees and independent accountants, all at such reasonable times as the Company may request on reasonable notice.

3.8 Other Information. Upon the reasonable request of the Company, CBay shall, to the extent reasonably practicable without interfering unduly with the ongoing operation and management of CBay’s business and without imposing any significant expense or cost on CBay, prepare and furnish, or cause to be prepared and furnished, to the Company, as soon as practicable following such request, any additional financial or operating information or reports as are so reasonably requested by the Company, related to determining Revenues, Direct Production Costs, Indirect Production Costs, Contribution Margin, the Profit Sharing Amount and the Company’s Share.

ARTICLE IV

REPRESENTATIONS, WARRANTIES AND COVENANTS

4.1 CBay represents and warrants that it is fully authorized to enter into this Agreement and that its entry into this Agreement does not violate any contractual obligation it owes to a third party.

4.2 CBay shall provide any operational, technical, production and quality assurance support to reasonably meet the sales and operations requirements of the Company. However, should any such request on the part of the Company require travel by individuals or entities who assist CBay in fulfilling its obligations under this Agreement from their home station, the Company shall be responsible for all such travel, lodging and related expenses of these individuals or entities to the extent such expenses are submitted and approved by the Company prior to the expense being incurred by CBay.

4.3 The Company and CBay agree that they shall designate operational, sales, and administrative personnel as points of contact, and each party shall maintain appropriate levels of communication as required to fulfill their obligations under this Agreement.

4.4 CBay represents and warrants that no individuals or entities shall assist CBay in fulfilling CBay’s obligations and duties under this Agreement unless those individuals or entities: (a) are employees of CBay, its Affiliates and other entities (“Covered Entities”) set forth in Schedule G attached hereto, as modified pursuant to the mutual written consent of MedQuist and CBay (the “Covered Entities Schedule”), or employees of Covered Entities; (b) if located outside of the United States, perform all services in connection with this Agreement in a secure site and shall not at any time perform Transcription Services remotely or outside of CBay’s premises or the Covered Entities’ premises designated for performance of Transcription


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Services; (c) will in all cases have executed and as such present to the Company upon the Company’s reasonable request such business agreements, HIPAA confidentiality agreements, employee verifications and other similar documentation as may be required by the Company; and (d) perform all services pursuant to this Agreement in full compliance with the terms of the Company’s “International Labor Vendor Standards and Safeguards for HIPAA Compliance” (as more fully defined and expressly limited in Section 5.5 herein) and any written modifications of such presented to CBay during the Term of this Agreement. CBay further represents and warrants that it shall not subcontract or assign any Transcription Services, duties or obligations under this Agreement in the absence of the prior written authorization from the Company.

ARTICLE V

HIPAA COMPLIANCE

5.1 CBay, for itself and on behalf of the Covered Entities, will:

(a) Not use or further disclose any PHI other than as permitted or required by this Agreement or as required by law;

(b) Report to the Company’s Corporate Director of Information Privacy and Security any use or disclosure of the PHI not provided for by this Agreement within forty-eight (48) hours of becoming aware of the unauthorized use or disclosure;

(c) Have procedures in place for mitigating, to the maximum extent practicable, any deleterious effects from the use or disclosure of PHI in a manner contrary to this Agreement;

(d) Ensure that any individuals or entities who assist CBay in fulfilling its obligations under this Agreement agree, in writing, to substantially the same restrictions and conditions that apply to CBay with respect to such PHI. CBay shall obtain reasonable assurances from any such individuals or entities that: (i) the information being disclosed will be held confidentially and used or further disclosed only as required by law, (ii) the individuals or entities will use the appropriate Administrative and Technical Safeguards to prevent the unauthorized use or disclosure of the PHI and EPHI; and (iii) the individuals or entities will immediately notify CBay of any instance of a breach of any of the PHI terms set forth herein;

(e) Ensure that all individuals and entities who assist CBay in fulfilling its obligations under the Agreement are or shall be appropriately informed of the terms of this Agreement and are under a legal obligation, by contract or otherwise, sufficient to enable each individual and entity to fully comply with all provisions of this Agreement. CBay will ensure that all individuals and entities who assist CBay in fulfilling its obligations under this Agreement are educated on the Company’s privacy and security policies (as further defined in Section 5.5 herein) and that sanctions are imposed for non-compliance with those policies and procedures. CBay will also ensure that all individuals and entities who assist CBay in fulfilling its obligations under the Agreement have signed Protected Health Information Confidentiality Agreements;


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(f) Make available to the Company such information as the Company may require to fulfill the Company’s obligations to provide access to, provide a copy of, and account for disclosures with respect to PHI pursuant to HIPAA and the HIPAA Regulations, including, but not limited to, 45 CFR §164.524 and §164.528;

(g) Make the Company’s PHI available as the Company may require to fulfill the Company’s obligations to amend PHI pursuant to HIPAA and the HIPAA Regulations, including but not limited to 45 CFR §164.526. CBay shall, as directed by the Company, incorporate any amendments to the Company’s PHI into copies of such PHI maintained by CBay;

(h) Make available the information required to provide an accounting of disclosures in accordance with 45 CFR §164.528;

(i) Make its internal practices, books, and records relating to the use and disclosure of PHI received from, or created or received by CBay on behalf of, the Company available to the Secretary of the U.S. Department of Health and Human Services for purposes of determining the Company’s or a Company customer’s compliance with HIPAA;

(j) Upon termination or expiration of the Agreement, or any time during the Term of this Agreement, with respect to PHI that CBay maintains in any form, recorded on any medium or stored in any storage system, including PHI retained or stored by individuals and entities who assist CBay in fulfilling its obligations under the Agreement, at the Company’s direction and if feasible, return to the Company or destroy all such PHI. A senior officer of CBay shall certify in writing to the Company, within thirty (30) days after termination or other expiration of the Agreement, that all PHI has been returned or disposed of as provided above and that CBay no longer retains any such Protected Health Information in any form;

(k) If return or destruction of PHI is infeasible, notify the Company in writing within thirty (30) days after termination or other expiration of the Agreement. Such notification shall include: (i) a statement that CBay has determined that it is infeasible to return or destroy the PHI in its possession; and (ii) the specific reasons for such determination. In addition to providing such notification, CBay shall certify within such thirty (30) day period that it will, and will require individuals and entities who assist CBay in fulfilling its obligations under the Agreement to, extend any and all protections, limitations and restrictions contained in this Agreement to any PHI retained after termination of the Agreement and to limit any further uses and/or disclosures to those purposes that make the return or destruction of the PHI infeasible;

(l) Implement Administrative and Technical Safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of EPHI that CBay creates, receives, maintains or transmits on behalf of the Company;


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(m) Report to the Company’s Director of Information Privacy and Security within forty eight (48) hours any “security incident” of which it becomes aware, as such term is defined in the HIPAA Security Rule;

(n) Ensure that any individuals and entities who assist CBay in fulfilling its obligations under the Agreement to whom CBay provides EPHI agree in writing, to implement reasonable and appropriate safeguards to protect EPHI as required herein; and

(o) Upon request, provide to the Company a list of names of any individuals or entities used to outsource the Company’s transcription and evidence of written assurances from those individuals or entities (as required in 5.1 (d)) that they will agree to substantially the same restrictions and conditions that apply to CBay with respect to such PHI.

5.2 CBay, in its capacity as Business Associate (as that term is defined in the HIPAA Regulations) to the Company, shall be permitted to use and disclose PHI in a manner that would not violate the requirements of the HIPAA Regulations as follows: (a) for the proper management and administration of CBay; (b) to carry out the legal responsibilities of CBay and to fulfill CBay’s duties and responsibilities under this Agreement including in part disclosure to individuals and entities who assist CBay in fulfilling its obligations under the Agreement; and (c) to provide data aggregation services relating to the health care operations of the Company.

5.3 CBay acknowledges that the Company is not conveying any right or title in the PHI to CBay.

5.4 Notwithstanding anything to the contrary set forth herein, CBay shall indemnify, defend and hold harmless the Company and any of the Company’s directors, officers, employees and agents from and against any claim, liability, or expense (including reasonable attorneys’ fees), arising out of or relating to any non-permitted use or disclosure of PHI or EPHI or other breach of this Article V by CBay or any individuals and entities who assist CBay in fulfilling CBay’s obligations under the Agreement.

5.5 Following the execution of this Agreement, CBay shall at all times comply in all material respects with the terms of the Company’s International Labor Vendor Standard and Safeguards for HIPAA Compliance and any written modifications of such presented to CBay during the Term of this Agreement (the “Company HIPAA Compliance Standards”). The Company shall give CBay five (5) business days to consider and accept any modifications to the Company HIPAA Compliance Standards, and if CBay does not object to such modifications within the aforementioned time period, then such modifications shall be considered accepted by CBay and incorporated by reference. To the extent that CBay objects to any modification of the Company HIPAA Compliance Standards, the parties will discuss in good faith the negotiation of mutually acceptable terms. However, should the parties not be able to reach agreement of the modifications within ten (10) days, the Company shall have the right to, at its option, (i) submit such disagreement to binding arbitration in accordance with Section 11.12, or (ii) terminate this Agreement. Subject to the provisions of Section 7.6, such termination shall be effective immediately or at such other date as specified in the notice of termination. The Company HIPAA Compliance Standards shall be hereby incorporated by reference into this Agreement


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and the most current version has been supplied by the Company along with the fully executed Agreement. The Company shall be permitted at any time, at the Company’s sole cost and expense, reasonable access to and the ability to examine all information, in any form, which is necessary or appropriate (as determined by the Company in its sole discretion) to review CBay’s compliance with the Company HIPAA Compliance Standards (an “HIPAA Audit”). In the event that the Company in its sole discretion determines as a result of an HIPAA Audit that CBay is not in material compliance with the Company HIPAA Compliance Standards (a “Negative Finding”), and notwithstanding anything herein to the contrary, (a) CBay shall promptly pay to the Company, as liquidated damages and not as a penalty, (i) all costs and expenses associated with the HIPAA Audit, and (ii) all costs and expenses incurred by the Company in connection with any liability, loss, damage (including, without limitation, special, exemplary, punitive, consequential or incidental damages), penalty, claim or cause of action relating directly or indirectly to the Negative Finding including, without limitation, reasonable attorney’s fees; and (b) subject to the provisions of Section 7.6, the Agreement shall be terminated effective immediately upon written notice from the Company to CBay and, upon such termination, CBay shall immediately return to the Company all Confidential Information (including, without limitation, all PHI) in its possession or in the possession of any individuals and entities who assist CBay in fulfilling its obligations under the Agreement.

ARTICLE VI

INTELLECTUAL PROPERTY MATTERS

6.1 Any and all designs, artwork, logos, graphics, video, text, data code and other proprietary or confidential materials supplied by the Company to CBay in connection with this Agreement (the “Company Content”) shall remain the sole and exclusive property of the Company. No copyrights, patents, trademarks or other Intellectual Property rights shall be transferred from the Company to CBay with respect to any of the Company Content. However, the Company hereby grants to CBay a worldwide, non-exclusive, unlimited fully paid-up license to use, copy, modify, enhance, create derivative works of and otherwise use the Company Content in any manner reasonably necessary in connection with the performance of the Transcription Services hereunder (the “Company Content License”).

6.2 Nothing in this Agreement shall be construed to grant to CBay any right to or interest in any trademark, trade name, trade dress, service mark, copyright, patent, trade secret or know-how (“Intellectual Property”) owned or asserted to be owned by the Company. CBay’s use of the Intellectual Property shall be limited to the performance of the Transcription Services as contemplated hereby. Any other use of the Intellectual Property shall constitute an infringement thereof and/or a violation of the Company’s rights resulting in irreparable injury to the Company and entitling the Company to immediate injunctive relief and to any other remedies at law or equity.

6.3 Any and all designs, artwork, logos, graphics, video, text, data code and other proprietary or confidential materials supplied by CBay to the Company in connection with this Agreement (the “CBay Content”) shall remain the sole and exclusive property of CBay. No copyrights, patents, trademarks or other Intellectual Property rights shall be transferred from CBay to the Company with respect to any of the CBay Content. However, CBay hereby grants to


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the Company a worldwide, non-exclusive, unlimited fully paid-up license to use, copy, modify, enhance, create derivative works of and otherwise use the CBay Content in any manner reasonably necessary in connection with the performance of the Transcription Services hereunder (the “CBay Content License”).

6.4 Nothing in this Agreement shall be construed to grant to the Company any right to or interest in any Intellectual Property owned or asserted to be owned by CBay. Any use of such Intellectual Property shall constitute an infringement thereof and/or a violation of CBay’s rights resulting in irreparable injury to CBay and entitling CBay to immediate injunctive relief and to any other remedies at law or equity.

6.5 Application Service Provider License.

(a) Through the use of software applications (the “Applications”) hosted on the DEP and made available by means of the Internet, CBay shall have the ability to access the DEP for the purpose of providing the Transcription Services described herein. Subject to the terms and conditions set forth herein, the Company hereby grants to CBay for the Term of this Agreement a non-transferable, non-exclusive limited right of access to, and use of, the Applications solely for the purposes of performing the Transcription Services hereunder. From time to time, the Company may require the agreement to and acknowledgement of an end-user license, terms and conditions and/or other agreements prior to CBay accessing the Applications.

(b) With respect to its use of the Applications, CBay, at its own cost and expense, shall: (i) not permit any individual or entity, other than authorized individuals and entities under this Agreement, to use or gain access to the Applications; (ii) provide reasonable security devices to protect against unauthorized usage; (iii) not adapt the Applications in any way or use it to create a derivative work (other than reports that are transcribed or edited using the Applications); and (iv) not remove, obscure, hinder or alter the Company’s (or any other third party’s) proprietary notices, trademarks, or other proprietary rights notices affixed to or contained in the Applications.

(c) The Applications are the exclusive property of the Company and/or the Company’s licensors, which shall retain all right, title and interest in and to the Applications, including, without limitation, the Intellectual Property rights and any other rights under United States and international copyright, patent, trademark, trade secret or other law. CBay may not use the Applications for the benefit of any third parties or allow access to the Applications by any third party, except as otherwise explicitly authorized hereunder.

(d) CBay has developed and may continue to develop proprietary software tools (the “Tools”) to enhance the productivity of its workforce, and/or better meet HIPAA compliance requirements. CBay may at its sole discretion share these Tools with the Company. Should the Company use these Tools, either with or without compensation to CBay, the Company warrants it will not share these Tools with any third party without the specific written permission of CBay.


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ARTICLE VII

TERM

7.1 Term. This Agreement shall be effective on the Effective Date and continue until the fifth anniversary of the Effective Date (the “Expiration Date”), unless sooner terminated by the parties in accordance with Section 5.5 or this Article VII.

7.2 Termination for Material Breach. Either party may terminate this Agreement or the provision of any Service if the other party materially breaches any term of this Agreement immediately after providing written notice of termination to the other party and, in the event of termination due to a material breach that is curable, after providing not less than 20 days to cure such breach as specified in such notice.

7.3 Termination Upon Change of Control. In the event CBay and its Affiliates (other than the Company and its subsidiaries) cease to control, directly or indirectly, the power to vote at least thirty percent (30%) of the issued and outstanding common equity of the Company, the Company or CBay may elect to terminate this Agreement.

7.4 Renewal. After the initial Term of this Agreement, the Term of this Agreement shall automatically renew for two additional five year terms, unless, not earlier than 12 months nor less than six months prior thereto, either party provides the other with written notice of its election to terminate this Agreement on the next Expiration Date.

7.5 Selective Termination by Either Party. Notwithstanding the foregoing, (i) CBay may, in its sole discretion, terminate Section 3.2 of this Agreement and allow the Company to contract with CBay on a non-exclusive basis, and seek new providers of Indian or Asian Transcription Services, and (ii) the Company may, in its sole discretion (following approval by the MedQuist Audit Committee), terminate Section 2.1 of this Agreement and allow CBay to market to New Customer Hospitals.

7.6 Post-Termination Transcription Services. In the event either CBay or the Company elects to terminate this Agreement pursuant to Sections 5.5, 7.2 or 7.3 as the case may be, or in the event either the Company or CBay elects not to renew this Agreement pursuant to Section 7.4 hereof, then CBay shall continue to perform Transcription Services hereunder for a period of up to one year to allow the Company to transition the Transcription Services being provided hereunder to other providers, and the Company shall use commercially reasonable efforts to transition such services as promptly as reasonably practicable.

ARTICLE VIII

INDEMNIFICATION AND INSURANCE

8.1 Indemnification Obligations.

(a) CBay hereby indemnifies and holds the Company harmless from and against any and all liability, loss, damage, claim or cause of action, and expenses connected therewith, including, without limitation, reasonable attorney’s fees and


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expenses, to the extent such damage (i) is caused directly or indirectly by CBay, its employees or agents in the performance of CBay’s obligations hereunder and (ii) results in costs incurred or liability by the Company to any of its customers.

(b) The Company hereby indemnifies and holds CBay harmless from and against any and all liability, loss, damage, claim or cause of action, and expenses connected therewith, including, without limitation, reasonable attorney’s fees and expenses, to the extent such damage (i) is caused directly or indirectly by the Company, its employees or agents in the performance of the Company’s obligations hereunder and (ii) results in costs incurred or liability by CBay to any of its customers (other than the Company).

8.2 Insurance. CBay represents and warrants that during the Term of this Agreement, it shall maintain the types and amounts of insurance set forth below:

(a) General liability insurance, including contractual liability coverage of all of CBay’s obligations under this Agreement and products liability/completed operations coverage in such amounts and covering such risks and liabilities as are in accordance with normal industry practice.

(b) Such insurance shall be evidenced by a certificate of insurance which shall provide that the Company shall receive thirty (30) days’ prior written notice of cancellation or material change of such policy.

ARTICLE IX

CONFIDENTIALITY

9.1 Confidentiality. CBay and the Company acknowledge that Confidential Information is to be considered highly confidential. Each party shall use Confidential Information disclosed to it by or on behalf of the other party only for the purposes contemplated by this Agreement and shall not disclose such Confidential Information to any third party without the prior written consent of the disclosing party. The foregoing obligations shall survive the expiration or termination of this Agreement for a period of five (5) years. These obligations shall not apply to Confidential Information that:

(a) Is known by the receiving party in connection with providing services under this Agreement at the time of its receipt, and not through a prior disclosure by the disclosing party, as documented by business records;

(b) Is published at the time of disclosure, or thereafter becomes published or otherwise part of the public domain without breach of this Agreement by the receiving party;


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(d) Is developed by the receiving party independently of Confidential Information or other information received from the disclosing party and such independent development is properly documented by the receiving party; or

(e) Is required to be disclosed by law or court order, provided that notice is promptly delivered to the other party in order to provide an opportunity to seek a protective order or other similar order with respect to such Confidential Information and thereafter discloses only the minimum information required to be disclosed in order to comply with the request, whether or not a protective order or other similar order is obtained by the other party.

Nothing herein shall be interpreted to prohibit the Company from publishing the results of its studies in accordance with industry practices.

ARTICLE X

MUTUAL COMMITMENTS

10.1 Executive Committee Formation. Both parties commit to the formation of an Executive Committee that is responsible for the effective coordination of the coordinated sales and marketing efforts, offshore Transcription Services activities and for the making of any decisions under or related to this Agreement. The Executive Committee shall consist of equal numbers of members appointed by CBay and by MedQuist, provided that the persons appointed by MedQuist shall have no position with CBay or any of its Affiliates (other than the Company). The Executive Committee shall meet at least once a month by telephone or in person. CBay and the Company shall deliver to the Executive Committee such financial and other information regarding the delivery of Transcription Services hereunder as the Executive Committee or any of its members may request.

10.2 CBay’s Reduction of Costs. CBay commits to use its best efforts to reduce its Direct Production Costs and Indirect Production Costs through improved productivity, better use of technology, and other methods as it, in it sole discretion but in consultation with the Executive Committee, deems appropriate so as to strive to optimize its Contribution Margin and as such to maximize the profit sharing payments to MedQuist under Section 3.4(i).

10.3 CBay’s Reporting of Financial and Operational Data. CBay commits to use its best efforts to provide complete financial and operational data about the Transcription Services provided to the Company, including but not limited to, monthly financial statements showing Revenues, Direct Production Costs, Indirect Production Costs, Contribution Margin, other expenses and productivity. CBay shall use reasonable efforts to inform the Executive Committee prior to switching any MedQuist customer from an ILP currently performing Transcription Services for such customer, it being acknowledged and agreed that any such determination shall be made by CBay in its sole discretion.

10.4 MedQuist’s Maintenance and Enhancement of Systems. MedQuist commits to use its best efforts to maintain and enhance its system platforms and technology (including but not


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limited to DEP) to support continuing improvement in operational performance and reduction in Direct Production Costs and Indirect Production Costs of CBay.

10.5 MedQuist’s Option to Determine Volume. MedQuist shall have the sole right to determine the volume of Transcription Services performed in India and Asia (subject to the limitations of this Agreement) and to withdraw Indian and Asian Transcription Services volume as it determines in its sole discretion necessary to address quality or performance issues.

ARTICLE XI

GENERAL PROVISIONS

11.1 Notices. Wherever provision is made in this Agreement for the giving of any notice, such notice shall be in writing and shall be deemed to have been duly given if mailed by first class United States mail, postage prepaid, addressed to the party entitled to receive the same or delivered personally to such party at the address specified below, or if delivered personally, sent by facsimile transmission or sent by overnight courier. All notices shall be given,

if to CBay, to:

2661 Riva Rd Building 800
Annapolis, MD 21401
Attention: President
Facsimile: 410-266-9409

with a copy (which shall not constitute notice) to:

Simpson Thacher & Bartlett LLP
1999 Avenue of the Stars, 29th Floor
Los Angeles, California 90067
Attention: Daniel Clivner
Facsimile: (310) 407-7502

if to the Company, to:

1000 Bishops Gate Boulevard, Suite 300
Mt. Laurel, NJ 08054
Attention: Chief Executive Officer
Facsimile: (856) 206-4215

with copies which shall not constitute notice to:

General Counsel
MedQuist Inc.
1000 Bishops Gate Boulevard, Suite 300
Mt. Laurel, NJ 08054


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Facsimile: (856) 206-4215

Chairman of the Audit Committee
MedQuist Inc.
1000 Bishops Gate Boulevard, Suite 300
Mt. Laurel, NJ 08054
Facsimile: (856) 206-4215

and

Fulbright & Jaworski L.L.P.
666 Fifth Avenue
New York, New York 10103
Attention: Paul Jacobs
Facsimile: (212) 318-3400

or to such other address, in any such case, as any party hereto shall have last designated by notice to the other parties. Notice shall be deemed to have been given on the day that it is so delivered personally or sent by facsimile transmission and the appropriate confirmation received or, if sent by overnight courier, shall be deemed to have been given one day after delivery to the courier company, or if mailed, three days following the date on which such notice was so mailed.

11.2 Assignment. This Agreement and the rights and duties hereunder shall be binding upon and inure to the benefit of the successors and assigns of each of the parties hereto, but shall not be assignable or delegable by any party without the prior written consent of the other party.

11.3 Waivers. Any waiver by CBay or the Company of any breach of or failure to comply with any provision of this Agreement by the other party shall be in writing and shall not be construed as, or constitute, a continuing waiver of such provision, or a waiver of any other breach of, or failure to comply with, any other provision of this Agreement.

11.4 Compliance with Laws. The parties agree to comply with all Laws applicable to the performance of their obligations hereunder.

11.5 Governing Law. This Agreement shall be governed by, and construed and interpreted in accordance with, the laws of the State of New Jersey without giving effect to any conflicts of law principles.

11.6 Third Parties. Nothing herein is intended or shall be construed to confer upon or give to any person other than the parties hereto, any rights or remedies under or by reason of this Agreement.

11.7 Entire Agreement; Amendment. This Agreement sets forth the entire agreement of the parties with respect to the subject matter hereof and supersedes any prior oral agreement with respect thereto. This Agreement may not be amended orally but only by an instrument in writing duly executed by the parties. Nothing in this Agreement is intended to amend or modify


*******		- Material has been omitted and filed separately with the Commission.

the Subcontracting Agreement or the CBayScribe Marketing Agreement, each of which shall remain in effect in accordance with its respective terms.

11.8 Headings. The headings of the Articles and Sections of this Agreement are inserted for convenience of reference only and shall not be deemed to constitute a part hereof.

11.9 Counterparts. This Agreement may be executed in any number of counterparts, all of which taken together constitute one and the same instrument, and any of the parties hereto may execute this Agreement by signing any such counterpart.

11.10 Force Majeure. Neither party shall be liable for any failure of, or delay in the performance of, its obligations hereunder for the period that such failure or delay is due to earthquake, flood, fire or similar acts of God, terrorism, public enemy, civil unrest, riots, strikes or general labor disputes, or any other cause beyond such party’s reasonable control.

11.11 Severability. If any provision of this Agreement is declared invalid or unenforceable by a court of competent jurisdiction, the validity or enforceability of any other provision of this Agreement shall not be affected.

11.12 Injunctive Relief and Resolution of Disputes.

(a) Injunctive Relief. The parties to this Agreement acknowledge and agree that remedies at law are inadequate in the event of any breach or threatened breach by any party of its agreements and obligations as set forth in this Agreement. Notwithstanding Sections 11.12(b) — (d), in addition to any other remedy which may be available, the non-breaching party shall be entitled to petition for injunctive and/or other equitable relief restraining the breach or threatened breach of the provisions and/or obligations in this Agreement.

(b) If any dispute or controversy shall arise between the parties as to any matter arising out of or in connection with this Agreement or the transactions contemplated hereby, the parties shall attempt in good faith to resolve such dispute or controversy by mutual agreement. If such dispute or controversy cannot be so resolved, it shall be resolved solely by binding arbitration in accordance with the provisions of Section 11.12(c).

(c) In the event that any such dispute or controversy cannot be resolved in accordance with the provisions of the first sentence of Section 11.12(b), such dispute or controversy shall be finally settled by binding arbitration in New Jersey under the Commercial Rules of the American Arbitration Association then in effect by one or more arbitrators appointed in accordance with such rules. The decision of such arbitrator(s) shall be final and binding, and shall not be subject to appeal. Each party shall bear its own fees and expenses incurred in connection with the arbitration, and shall share equally the costs of the arbitrator(s), provided that the arbitrator may in its discretion require that the non-prevailing party pay all or a portion of the fees and expenses of the prevailing party.


*******		- Material has been omitted and filed separately with the Commission.

(d) Each of the parties hereto hereby irrevocably and unconditionally: (i) submits for itself and its property in any legal action or proceeding seeking injunctive relief, enforcing the arbitration provision set forth in Section 11.12(c), or for recognition and enforcement of any judgment in respect thereof or any arbitral award rendered with respect hereto in accordance with Section 11.12(c), to the non-exclusive general jurisdiction of the courts of the State of New Jersey and of the United States of America sitting in the District of the State of New Jersey; (ii) consents that any such action or proceeding may be brought in such courts and waives any objection that it may now or hereafter have to the venue of any such action or proceeding in any such court or that such action or proceeding was brought in an inconvenient court and agrees not to plead or claim the same; (iii) agrees that service of process in any such action or proceeding may be effected by mailing a copy thereof by registered or certified mail (or any substantially similar form of mail), postage prepaid, to its address set forth in Section 11.1 hereof; and (iv) agrees that nothing herein shall affect the right to effect service of process in any other manner permitted by law.

[REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]


*******		- Material has been omitted and filed separately with the Commission.

IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized officers as of the day and year first above written.


MEDQUIST TRANSCRIPTIONS, LTD.		CBAY SYSTEMS & SERVICES INC.

By:		By:
	Name:		Name:
	Title:		Title:


*******		- Material has been omitted and filed separately with the Commission.

SCHEDULE A

CBay Current Customers Schedule

*******


*******		- Material has been omitted and filed separately with the Commission.

*******


*******		- Material has been omitted and filed separately with the Commission.

SCHEDULE B

Current MedQuist Products and Services

•

DocQment Enterprise Platform (“DEP”): MedQuist’s web based dictation and transcription management system. Within DEP are the following applications:

	o		DocQmanage™: Included application which enables customer to manage authorized users, set-up business processes and report on Client data derived as a result of using the DEP.

	o		DocQscribe™: Included application that provides an Internet-based, password-controlled typing and editing user interface which will allow authorized users to listen to Voice Files through streaming audio delivered to their desktops, transcribe or edit reports from Voice Files, and return completed reports to Vendor for post-transcription processing through DocQmanage™ and onward distribution to customer.

	o		File Storage: Included application that allows for the accessing of reports via DocQmanage™ for up to three hundred sixty-five (365) days following completed transcription. Voice Files can be accessed via DocQmanage™ for up to thirty (30) days following dictation. Admission, Discharge and Transfer (“ADT”) can be accessed via DocQscribe™ for up to ninety (90) days following the date the ADT message was received into the DocQmanage™ database.

	o		DocQspeech™: Optional application pursuant to which MedQuist can provide Automated Speech Recognition to customer. DocQspeech™ is a speech recognition process based on the integration of the SpeechMagic^TM engine with the DEP and provides speech recognized reports and associated Voice Files to a medical editor for correction.

	o		DocQsign™: Optional application pursuant to which MedQuist can provide electronic signature services to the customer. DocQsign^TMis the physician approval and signature application within the DEP.

	o		VoiceQ™: Optional application pursuant to which MedQuist can provide a recording system for use over telephone lines. MedQuist will publish domestic, toll-free U.S. telephone numbers assigned to customer. MedQuist and Customer will agree on greetings and voice server configurations to be used by authorized Customer dictators

•		DocQvoice™ - captures voice through a variety of devices: toll-free 800 number for call-in dictation, handhelds and premise-based dictation systems,

•		DocQroute™: distribution engine that facilitates complex printing rules, faxing and uploading to HIS systems,

•		CodeRunner w/ CAC: packages a third-party computer-assisted coding program (CAC) with our CodeRunner coding workflow software to deliver a Web-based product to manage the coding enterprise

•		Coding Services

•		MedQuist Performance Monitor (MPM): Reporting tool that provides detailed reports and business analytics, reports, graphs, to monitor and optimize the clinical documentation process.

•		DEP on an Application Services basis

•		SpeechQ™ for Radiology

•		SpeechQ™ for General Medicine


*******		- Material has been omitted and filed separately with the Commission.

SCHEDULE C

Current Pipeline Customers Schedule

*******


*******		- Material has been omitted and filed separately with the Commission.

Note: To the extent that (i) a CBay Pipeline Customer listed above is, as of the Effective Date, currently serviced by MedQuist or in the MedQuist sales pipeline, (ii) a portion of any of a CBay Pipeline Customer listed above is not serviced by CBay as of the Effective Date, or (iii) a CBay Pipeline Customer listed above has sent out, or sends out, an RFP (Request for Proposal), MedQuist, without the prior written consent of CBay, may pursue a sales opportunity or retention efforts for any such CBay Pipeline Customer currently serviced by MedQuist or in MedQuist’s pipeline, portions of such CBay Pipeline Customer not serviced by CBay or CBay Pipeline Customer that has sent out or sends out an RFP


*******		- Material has been omitted and filed separately with the Commission.

SCHEDULE D

GPO Contracts Schedule

*******


*******		- Material has been omitted and filed separately with the Commission.

SCHEDULE E

ILP Contracts Schedule

1.		Accentia Technologies, Ltd. Agreement by and between MedQuist Transcriptions, Ltd. and Accentia Technologies, Ltd. effective March 24, 2009, as amended by Amendment No.1 effective July 2, 2009.

2.		Decipher Intime Transcriptions Private Limited. Agreement by and between MedQuist Transcriptions, Ltd. and Decipher Intime Transcriptions Private Limited effective March 23, 2009.

3.		Gemini Bay Consulting Ltd. Agreement by and between MedQuist Transcriptions, Ltd. and Gemini Bay Consulting Ltd. effective March 23, 2009


*******		- Material has been omitted and filed separately with the Commission.

SCHEDULE F

Services Fee Schedule


		Price
Type of		Non-Client	Price
Service	Service Descriptions	Ready	Client Ready
A	Transcription performed by CBay’s transcriptionists for Company Customers located in the United States of America	*******	*******
B	Transcription performed using the Company’s Automated Speech Recognition application (with editing performed by CBay) for Company Customers located in the United States of America	*******	*******

CBay shall identify to the Company, the specific Company customers for whom CBay is able to supply Client Ready Transcription Services. The Company shall designate to CBay in writing which of the Company customers identified by CBay that the Company wishes CBay to provide Client Ready Transcription Services. CBay shall be paid at the rates set forth above for Client and Non-Client Ready Services.

The Threshold QA Volume for Client Ready Services shall be *******. The Threshold QA Volume for Non-Client Ready Services shall be *******.

During the Implementation Period, CBay shall have the right to route up to ******* of the Transcribed lines to the Company’s quality assurance without incurring a charge back for quality assurance services; provided, however, that there shall be no Implementation Period with respect to any MedQuist customer that CBay elects to switch from an ILP currently performing Transcription Services for such customer to CBay.

After the Implementation Period, in the event that CBay routes transcription volume during any billing period in excess of the applicable QA Threshold, the Company shall apply a charge back at the actual domestic quality assurance cost per line for all lines in every report routed to Company quality assurance resources above the QA Threshold (the “QA Credit”). This domestic quality assurance cost per line will initially be set at ******* and shall be adjusted annually to reflect the Company’s average domestic quality assurance cost per line during the prior calendar year.

The Company shall invoice CBay monthly for the applicable QA Credit, and shall have the right to offset the amount of a QA Credit, if any, against invoices due by MedQuist to CBay under this Agreement.

If MedQuist, in its reasonable judgment, determines in accordance with existing custom and practice and after notification to the Executive Committee, that the performance by CBay of Transcription Services for a MedQuist customer is not meeting the quality standards necessary for the customer’s satisfaction or specified in MedQuist’s contract with such customer, MedQuist


*******		- Material has been omitted and filed separately with the Commission.

shall have the right, at its sole option, to elect to perform some or all of the quality assurance work for such customer while MedQuist and the Executive Committee work to address and remedy the performance issues. If MedQuist elects to perform any portion of such quality assurance work, (A) MedQuist shall notify CBay and shall be entitled to the QA Credit for such work as set forth on this Schedule F and (B) an issues resolution committee reporting to the Executive Committee with representatives from MedQuist and CBay will be immediately convened, with an objective of resolving the quality assurance performance issues as soon as possible. The issues resolution committee shall report to the Executive Committee in no less than 30 day intervals following MedQuist’s election to perform such quality assurance work.

The parties hereto shall negotiate in good faith a resolution to any issues that may arise in the future under the Internal Revenue Code and applicable state tax laws in respect of this Agreement.


*******		- Material has been omitted and filed separately with the Commission.

SCHEDULE G

The Covered Entities Schedule

Shaster
Technology Center,S-3,
Technocrats Industrial Estate,
Balanagar, Hyderabad — 500 037

DHS
102, Jivan Silkmill Compound,
Opp Sakinaka Telephone Exchange ,
Sakinaka, Mumbai 400072

Saral
22 New York Tower A,
Sarkhej-Gandhinagar Highway,
Thaltej, Ahmedabad, PIN code number 380054

Insignia
10, Sir Theagaraya Road,
T.Nagar, Chennai, India.600 017

Rtec
A-53, T.T.C. Industrial Area,
M.I.D.C. Near. Nelco Bus Stand,
Mahape, Navi Mumbai India – 400705

Gokul
2nd Floor, Panchvati Plaza,
Deshmukh Road,
Tilakwadi, Belgaum-590006

Lake
159 Sarjapura Road,
1st Block
Koramangala, Bangalore, Karnataka – 560034

Sharp Info Solutions Pvt. Ltd.
SF. No. 3300/2(B)2
Sitra Road, Sharp Nager
Kalappatti, Coimbatore – 641 035


*******		- Material has been omitted and filed separately with the Commission.

SCHEDULE H

General Ledger Accounts


Direct Costs	G/L Accounts	Allocation to MQ
Direct Personnel Costs including Transcription Labor and 1st Level QA Labor (wages, bonuses, incentives, fringe benefits etc)	4310001 to 4340001,4110001& 4110002	Direct or allocated based upon production volume
Direct Cost of Non-Captive production (P Center Cost)	41200045
Telecommunication costs	4510001 to 4510004
Royalty License, Taxes and Other Fees	4660001 to 4660002,4632001 to 4632002
Indirect Costs	G/L Accounts	Allocation to MQ
Indirect Personnel Costs for Indirect Labor within the Production Facilities as well as Corporate QA and Audit Labor, Production Management, Production Supervision, and Scheduling and Purchasing Labor (wages, bonuses, incentives, fringe benefits etc)	4310001 to 4340001

Rental and Utility expenses within Production Facilities	4631001,4631002,4520001 to 4520008,4631003

Travel, Transportation, Entertainment and Meal Expenses	4710001 to 4730003	Allocated based on production volume except for costs where a different allocation method is more appropriate — for example some allocations are based on MQ seats to total seats at production centers.
Customer Penalties (as incurred and charged by MQ)	41200001
Professional and Other Fees of Production Facilities	4610001 to 4610003 ,4640001 to 4640004
Maintenance and Repairs	4650001 to 4650003
Other Indirect costs	4100001 to 4100004,4510001 to 4510004,4530001 to 4530005 and 4620001 to 4620003


Notes

a.		MQ production is currently carried out at all captive production facilities. Of these CTU4,CTU5,CTU7,CKAR-DSK and CTS are fully dedicated to MQ production.

b.		MQ work is carried out in a secured, enclosed environment with access controls and restrictions. G&A costs are therefore allocated on seat basis

c.		The current account codes, groups etc could change in the event of software upgradation, integration, account code streamlining etc. These are ongoing activities.


*******		- Material has been omitted and filed separately with the Commission.

Example of Direct Labor Cost Allocation:

The transcriptionist labor costs (wages, bonuses, fringe benefits, and incentives) for individuals or facilities that are identifiable and dedicated to production work for MedQuist would be charged to MedQuist production volumes. However, such costs for individuals or facilities that are performing transcription for both MedQuist and other customers, will be allocated between MedQuist and the other customers based upon the most direct method possible or based upon a ratio of MedQuist volume to total production volume. An example follows:

	•		If labor costs at the CTU4 facility was $500,000 and all production volume from CTU4 is for MQ, the labor cost pool charged to MQ would be $500,000

	•		If labor costs at Ckar was $400,000 and it could not be allocated more directly (either by individual or work group) and MQ accounted for 60% of the total production at Ckar, then 60% of the cost or $240,000 would be allocated to MQ.


*******		- Material has been omitted and filed separately with the Commission.

EXHIBIT 1


*******		- Material has been omitted and filed separately with the Commission.

EXHIBIT 1

DecHexCharDecHexCharDecHexCharDecHexChar —— —— —— —

0 00 Null 32 20 Space 64 40 @ 96 60 -

1 01 Start of heading 33 21 65 41 A 97 61 a

2 02 Start of text 34 22 “ 66 42 B 98 62 ta

3 03 End of text 35 23 # 67 43 C 99 63 c

4 04 End of transmit 36 24 S 68 44 D 100 64 d

5 05 Enquiry 37 25% 69 45 E 101 65 e

6 06 Acknowledge 38 26 £ 70 46 F 102 66 f

7 07 Audible bell 39 27 ‘ 71 47 G 103 67 g

8 08 Backspace 40 28 (72 48 H 104 68 h

9 09 Horizontal tab 41 29) 73 49 I 105 69 i

10 OALinefeed 42 2A * 74 4AJ 106 6Aj

11 OBVertical tab 43 2B + 75 4EK 107 6Bk

12 OCFormfeed 44 2C, 76 4CL 108 6C 1

13 ODCarriage return 45 2D •- 77 4DH 109 6Dm

14 OEShift out 46 2E . 78 4EN 110 6En

15 OFShift in 47 2F / 79 4F 0 111 6Fo

16 10 Data link escape 48 30 0 80 50 P 112 70 p

17 11 Device contrail 49 31 1 81 51 Q 113 71 q

18 12 Device control 2 50 32 2 82 52 R 114 72 r

19 13 Device control 3 51 33 3 83 53 S 115 73 s

20 14 Device control 4 52 34 4 84 54 T 116 74 t

21 15 Neg. acknowledge 53 35 5 85 55 U 117 75 u

22 16 Synchronous idle 54 36 6 86 56 V 118 76 v

23 17 End trans, block 55 37 7 87 57 W 119 77 w

24 18 Cancel 56 38 8 88 58 X 120 78 x

25 19 End of medium 57 39 9 89 59 Y 121 79 y

26 1ASubstitution 58 3A : 90 5AZ 122 7Az

27 IBEscape 59 3B ; 91 SB [ 123 7B {

28 1CFile separator 60 3C < 92 5C \ 124 7C |

29 IDGroup separator 61 3D = 93 5D ] 125 7D }

30 IERecord separator 62 3E > 94 5E A 126 7E ~

31 IFUnit separator 63 3F 7 95 5F 127 7F

******* — Material has been omitted and filed separately with the Commission.


*******		- Material has been omitted and filed separately with the Commission.

DecHexCharDecHexCharDecHexCharDecHexChar —— —— —— —

128 80 C, 160 AOa 192 CO L 224 EOa

129 81 u 161 Ali 193 Cl -1- 225 ElB

130 82 e 162 A2 6 194 C2 T 226 E2 T

131 83 a 163 A3 u 195 C3 |- 227 E3 n

132 84 a 164 A4 n 196 C4 — 228 E4 Z

133 85 a 165 ASN 197 C5 -f 229 E5 a

134 86 a 166 A6 a 198 C6 |= 230 E6 y.

135 87 c 167 A7 ° 199 C7 |f- 231 E7 T

136 88 e 168 A8 c 200 C8 It 232 E8 *

137 89 e 169 A9 r- 201 C9 |j= 233 E9 (»>

138 8Ae 170 AA -, 202 CA =t 234 EA Q

139 SBl 171 AEH 203 CB =n= 235 EB 5

140 8Cl 172 ACli 204 CC ||= 236 EC «

141 8Di 173 ADi 205 CD = 237 ED 0

142 8EA 174 AE « 206 CE | 238 EE n

143 8FA 175 AF » 207 CF === 239 EFn

144 90 E 176 bo ; 208 DO - 240 FO =

145 91 £ 177 Bl 209 Dl =p 241 Fl ±

146 92 8. 178 B2 B 210 D2 T 242 F2 2

147 93 6 179 B3 | 211 D3 IL 243 F3 ^

148 94 o 180 B4 -| 212 D4 1= 244 F4 [

149 95 6 181 B5 =| 213 D5 p 245 F5 J

150 96 u 182 B6 | 214 D6 ,,- 246 F6 t

151 97 u 183 B7 -n 215 D7 f 247 F7 *

152 98 y 184 B8 =] 216 D8 =)= 248 F8

153 99 6 185 B9 =|| 217 D9 J 249 F9 •

154 9AU 186 BA || 218 DA r 250 FA •

155 9B * 187 BB =n 219 DB | 251 FBV

156 9C £ 188 BC =J 220 DC H 252 FC *

157 9D ¥ 189 BD •” 221 DD | 253 FD *

158 9E £ 190 BEJ 222 DE | 254 FE •

159 9F f 191 BF -, 223 DF • 255 FF

******* — Material has been omitted and filed separately with the Commission.

EX-31.1 4 w78445exv31w1.htm EX-31.1 exv31w1

Exhibit 31.1

I, Peter Masanotti, certify that:

1. I have reviewed this quarterly report on Form 10-Q of MedQuist Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

	(a)		Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

	(b)		Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

	(c)		Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

	(d)		Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

	(a)		All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

	(b)		Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.



By:	/s/ Peter Masanotti
	Name:	Peter Masanotti
	Title:	President and Chief Executive Officer

Dated: May 10, 2010

EX-31.2 5 w78445exv31w2.htm EX-31.2 exv31w2

Exhibit 31.2

I, Dominick Golio, certify that:

1. I have reviewed this quarterly report on Form 10-Q of MedQuist Inc.;

	(a)		Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

	(b)		Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

	(c)		Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

	(d)		Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

	(a)		All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

	(b)		Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.



By:	/s/ Dominick Golio
	Name:	Dominick Golio
	Title:	Chief Financial Officer

Dated: May 10, 2010

EX-32.1 6 w78445exv32w1.htm EX-32.1 exv32w1

Exhibit 32.1

CERTIFICATION PURSUANT TO
18 U.S.C. SECTION 1350,
AS ADOPTED PURSUANT TO
SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the quarterly report of MedQuist Inc. (the “Company”) on Form 10-Q for the fiscal quarter ended March 31, 2010 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Peter Masanotti, President and Chief Executive Officer of the Company, certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that:

(1) The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.



	/s/ Peter Masanotti
	Peter Masanotti
	President and Chief Executive Officer

Date: May 10, 2010

EX-32.2 7 w78445exv32w2.htm EX-32.2 exv32w2

Exhibit 32.2

CERTIFICATION PURSUANT TO
18 U.S.C. SECTION 1350,
AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the quarterly report of MedQuist Inc. (the “Company”) on Form 10-Q for the fiscal quarter ended March 31, 2010 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Dominick Golio, Chief Financial Officer of the Company, certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that:

(1) The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.



	/s/ Dominick Golio
	Dominick Golio
	Chief Financial Officer

Date: May 10, 2010

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