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Eye Care Leaders Chapter 11 Deep Dive

How insurance fraud dragged an unconventional software rollup into Chapter 11

Welcome to the 137th Pari Passu newsletter.

Today, we’re looking at a different kind of software bankruptcy in which the core business wasn’t the problem, but the funding model was. EyeCare Leaders was sponsor-backed, but not by a PE firm. Instead, the company was funded through insider loans from life insurers controlled by Greg Lindberg, a now-convicted insurance mogul. When those insurers were placed into rehabilitation in 2019, the company lost access to capital and spent the next four years slowly unraveling. 

This deep dive explores how the provider of electronic health record software to over 8,000 eye-care practices files for bankruptcy with no third-party debt. We’ll walk through the regulatory landslide that froze its capital structure, the critical mistakes that followed, and the insider-backed DIP financing and 363 sale that returned ECL to the insurers that created the mess in the first place. 

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Eye Care Leaders Overview

Eye Care Leaders (ECL) was founded as a one-stop shop, providing software solutions for optometry and ophthalmology (eye-care) practices. The company was born as a rollup-style strategy by Greg Lindberg, a North Carolina insurance tycoon. Lindberg used Global Growth (f.k.a. Eli Global), which had no limited partners and was funded with capital from his insurance businesses via “intercompany loans”, to buy up software providers in a fragmented eye-care software market. Some of Lindberg’s insurance companies included Colorado Bankers Life Insurance Co., Bankers Life Insurance Co., and Southland National Insurance Corp. Lindberg made dozens of acquisitions during the 2010s in spaces such as healthcare, software, education, and finance. The ECL umbrella was specifically comprised of software offerings for Optometrists and Ophthalmologists [1]. 

To quickly clarify, Optometrists (ODs) examine, diagnose, and treat patients' eyes; they are who you’d think of as a general eye doctor, treating general vision problems and prescribing things like glasses and contacts. On the other hand, ophthalmologists (DOs) are medical doctors who treat complex eye diseases and perform eye surgeries. You’d typically find ODs in retail optical chains, private offices, clinics, and select large retailers. You’d find DOs in hospitals, surgery centers, and specialty clinics. While ECL served both ODs and DOs, ophthalmologist practices, which are more lucrative customers, accounted for the majority of ECL's revenue.

The company’s software portfolio featured notable names, including iMedicWare (ophthalmology software), My Vision Express (optometry software), and Alta (revenue cycle management software). Collectively, these three products accounted for roughly 62% of ECL’s annual revenue. The company offers cloud-based electronic health records (EHR), practice management, revenue cycle management, and some consulting services. The table below details all of ECL’s offerings [2]. 

Figure 1: ECL Segments as % of Annual Revenue [2]

ECL’s primary offerings were software and revenue cycle management (RCM) services. The software segment was split between electronic health records (EHR) and practice management (PM), with PM usually being bundled with EHR, creating a full-suite software platform. 

Electronic Health Records (EHR): ECL’s cloud-based EHR system was designed to replace paper charts and on-site servers. EHR software stores and manages clinical data such as exam notes, diagnoses, surgical plans, imaging results, etc. ECL’s EHR offerings, with IMedicWare (IMW) and My Vision Express (MVE) being the two largest, presented themselves as secure cloud-based alternatives. ECL charged monthly license fees per provider for access to the software, along with support services and updates. The company charged much more for iMedicWare ($3500 for IMW vs $300 for MVE per provider per month) as software for DOs must be more technical, supporting surgery, imaging, and complex charting [1]. 

Practice Management (PM): ECL also offered PM software to assist with the day-to-day operations of eye-care practices. PM includes things like appointment scheduling, patient check-ins, insurance verification, and coding. In healthcare, coding is the process of attaching specific billing codes to services provided. ECL typically bundled the PM services with its staple EHR offerings [1]. This strategy lowered churn, as practices would struggle to switch software providers when so heavily integrated with ECL products. 

Revenue Cycle Management (RCM): Alta Billing was ECL’s primary RCM company. Unlike other offerings, the company’s RCM segment was service-based, allowing Alta to provide billing services for the practice from claim creation to reimbursement. The revenue cycle in healthcare is quite complex, and it’s good to have a baseline understanding of the process, so let’s simply outline the different steps. First, after a patient visits, clinical staff assign the standardized codes we mentioned above. Procedure codes determine what treatment was provided, and diagnosis codes determine why it was provided. These codes create a claim, which is submitted to the patient’s insurance provider. The insurer then approves, denies, or partially reimburses the claim. Alta handled this entire process for its RCM clients, for fees of roughly 6% of clients' net collections [1]. 

ECL grew rapidly to serve over 8,000 ophthalmology and optometry practices, roughly a third of the U.S. eye-care market by location count. Additionally, ECL managed records for over 25 million patients at its peak [1]. While ECL’s financials are not public, we can use some information available to estimate its peak run-rate annual revenue. In the class action suit against ECL, which we’ll cover momentarily, the numbers in the table below were reported:

Figure 2: Hypothetical Run-Rate Software Revenue [2]

As seen above, we can estimate licensing revenue from ECL’s EHR and PM bundling services to be roughly $90mm. We also know that licensing revenues of ~$90mm made up 82% of the company’s revenue, so we can estimate total revenue to be roughly $110mm ($90mm / 82%), which includes $20mm from ECL’s other service-based segments, such as Alta billing. This $110mm number provides perspective into the revenue decline ECL would experience in the coming years. It also shows how critical the iMedicWare segment was to ECL’s business model, making up roughly 65% of total revenue ($72mm / $110mm). 

Lindberg’s acquisition strategy initially proved effective, allowing ECL to gain a substantial market share in the eye-care software space. However, amidst regulatory issues with Lindberg’s insurance companies, ECL began making some lethal mistakes. After losing access to new capital, the company started aggressive cost-cutting measures, including layoffs of key engineers. These measures made the company more prone to ransomware attacks and data outages while also slowing development. As a result, ECL lost a number of customers, and margins shrank significantly. Let’s dive into this series of events, starting with the 2019 insurance collapse.   

In 2019, Greg Lindberg was charged with bribery for attempting to influence North Carolina’s insurance commissioner. Lindberg offered political donations in exchange for looser oversight of his insurance companies, which directly violated regulations [3]. 

We must remember how insurance companies operate to understand the rules Lindberg sidestepped. Insurance companies collect premiums from policyholders and invest the funds to earn returns. Later, if the policy is triggered, insurance companies must pay out claims to policyholders. The insurer’s simple goal is to earn more money from premiums and returns than it has to pay out in claims (read our Insurance Breakdown for a great, in-depth explanation). One key component of this strategy is that insurance law requires firms to invest premiums prudently and conservatively to protect policyholders. This aims to prevent insurance firms from losing money in high-risk assets and being unable to pay out to policyholders. Insurance companies typically invest in low-risk, liquid assets such as government bonds, investment-grade corporate bonds, etc. 

Right away, it’s pretty clear why Lindberg didn’t want the North Carolina Department of Insurance (NCDOI) looking into his portfolio of insurance companies. His investments in risky, private companies, totaling over $2bn of intercompany loans to various affiliates (Lindberg’s Global Growth had invested in an array of companies beyond just ECL), clearly violated the National Association of Insurance Companies (NAIC) Model Law that guides investment [4]. Initially, the NCDOI limited investments in affiliates to 40%, but this was later reduced to 10% [5]. It was reported that Lindberg’s affiliate investments reached over 50% at one point [14]. Assuming this 50% number, Lindberg’s insurance companies held assets of $4bn ($2bn / 50%), $2bn of which were intercompany loans to companies like ECL, while they legally can’t invest more than $400mm ($4bn x 10%). Lindberg was now clearly over the 10% limit and attempted to influence the NCDOI commissioner via bribery. 

Lindberg was later convicted of bribery in 2020. Around the same time, the NCDOI placed Lindberg’s insurance companies into rehabilitation, citing risky investment practices [1]. For an insurance company, rehabilitation is not bankruptcy, but it is close. In rehabilitation, the state’s insurance commissioner, or a court-appointed rehabilitator, is given complete control of the company to stabilize the firm and protect policyholders [6]. Mike Causey, NCDOI Commissioner, acted on behalf of the state as rehabilitator in Lindberg’s case. The court ruled that the affiliated investments must repay a massive $1.2 billion of debt owed to the insurers. This was meant to lower the risk of Lindberg’s investment portfolio. If repaid, the risky intercompany loan receivables would be replaced with cash to be invested in high-grade assets. This also meant that ECL no longer had access to sponsor funds from Global Growth (Lindberg’s conglomerate investment entity). 

The impact of insurance rehabilitation on ECL was twofold. First, the company faced a significant liability in the form of repayment to Lindberg’s insurers. However, the obligation wasn’t immediately enforced and didn’t trigger any defaults for ECL. The second, primary impact was the loss of access to new capital. Since the insurance companies were now under the control of the NCDOI, they’d no longer provide any funding to ECL. Additionally, ECL wouldn’t be able to raise third-party debt as regulators would almost always block it, unless it directly benefited insurance policyholders. The regulatory liability, coupled with the cutoff to funding, seriously strained liquidity, and ECL would begin cost-cutting measures, starting with substantial layoffs. 

Workforce Layoffs 

In 2020 and 2021, management began laying off core software developers and replacing them with “lower-skilled, lower-cost engineers” [2]. Following these layoffs, ECL underwent very little new product development post-2021. Instead, the company spent time patching software bugs and addressing client concerns. It was also anecdotally reported that the company began releasing software updates without prior adequate testing, further causing outages and crashes [9]. Additionally, the coding by the new engineering team was so out of touch with ECL’s foundational coding that it caused severe development issues with four of ECL’s earlier platforms: myIntegrity, IOPW, Keymed, and PennMed. These problems got so bad that the four platforms would lose their certified electronic health record technology (CEHRT ) status [2]. Eventually, ECL decided to scrap these platforms altogether, as noted in Figure 1 above. In a field like software, where innovation is key to success, ECL fell into a trap of maintenance and would begin to lose the market share it had built up over the years. Additionally, its skeleton workforce would be poorly positioned for future data breaches. 

Ransomware Attacks and Data Breaches

Shortly after laying off essential employees, ECL was hit by a ransomware attack that knocked out its EHR systems for days in the Spring of 2021. Providers that used any EHR platforms were suddenly unable to access patient charts or any other stored data. This effectively paralyzed the eye-care practices that relied on ECL’s EHR platforms. One ophthalmology clinic reported systems being down for an entire week and being forced to use pen and paper charts to continue operations. Additionally, the practice reported permanently losing a week’s worth of data [7]. While this was happening, ECL’s support team told clients that the outages were merely technical issues and would be solved shortly [1]. 

Later, in December 2021, ECL suffered one of the most significant data breaches of the year, in which over 3 million patients’ information was compromised. Once again, practices also permanently lost data. Once again, ECL miscommunicated the issue, assuring providers that no data was compromised and services would be back shortly. ECL also failed to notify end-patient victims of the data breaches, leaving the affected practices to do so themselves [7]. 

These outages impacted ECL on multiple fronts. The most significant factor was the clear breach of client trust that followed the deliberate miscommunication of ECL’s outages. ECL quickly lost 20% of its customer base, and topline revenue would shrink by 35% over three years, from $47.6mm in 2020 to $31mm in 2023. Additionally, the company would spend enormous amounts of cash fixing its platforms, lowering EBITDA from $18.8mm in 2020 (40% margin) to $2.5mm in 2023 (8% margin) [1]. 

For a software company, customer losses are especially damaging due to a fixed cost structure. Unlike a retailer, where COGS tends to fluctuate with sales volumes, software companies incur substantial costs building out software platforms. These costs don’t go away when customers leave. Rather, ECL experienced a direct hit to its bottom line. The $16.3mm ($18.8mm - $2.5mm) decrease in EBITDA almost directly mirrors the $16.6mm ($47.6mm - $31mm) decrease in revenue from 2020 to 2023.

In addition to the direct financial impacts, ECL would also be subject to its own legal battle in the form of a class action lawsuit against the company. While ECL’s EHR platforms were down, the company continued to charge providers for its service, which violated contract terms. In ECL’s license agreement, the company agreed to reduce fees if software uptime fell below 95%. It also agreed to fix outages within 72 hours of being reported. ECL failed to meet both of these promises, and the ensuing lawsuit cited the fee agreement below: 

Figure 3: Outage Fee Agreement [2]

The Physician Settlement Class, made up of IMW, MCI, and MVE clients, claimed aggregate overcharge (the amount ECL charged providers above its contractual rate) damages of $5.3mm. This comprised a $4.2mm overcharge for IMW, $420,000 for MCI, and $698,000 for MVE. In 2023, ECL would agree to settle for $4.25mm, putting further pressure on the company. 

AWS Contract

Following the ransomware attacks and data breaches, ECL looked to move data from leased servers to more secure Amazon Web Services (AWS) data centers. In early 2022, the company entered a 5-year lease agreement with AWS. However, this agreement ended up being another driver of ECL’s downfall. The company states that this agreement was made with the assumption that ECL would continue growing its nine different software platforms. As we know from above, this was not the case, as ECL would lose a significant portion of its clients and discontinue four legacy software platforms. Unfortunately for ECL, the AWS contract was made up of two components: monthly usage fees and a minimum spend requirement. The unrealistic assumptions that prior management had made resulted in an unreasonably high minimum spend requirement that the company could not lower per the agreement. The AWS contract required monthly payments of approximately $980,000 per month, consistently costing the company 20% of revenue, which is double the industry average of 10% [2]. Attempting to suspend the agreement would effectively kill ECL, as AWS now hosts all of its platforms, so this agreement became another liquidity-straining factor. 

 Chapter 11 Bankruptcy

The Lindberg legal scandal, workforce layoffs, class action suit, and AWS contract occurred as a cascading series of events, culminating in ECL filing for Chapter 11 bankruptcy on January 16,  2024, in the Northern District of Texas. ECL filed with little to no third-party debt, and the nearest insider debt maturity was in 2029. Instead, the ultimate driver of ECL’s bankruptcy was the inability to pay its recurring essential expenses, mainly the AWS contract. 

While no specific cash-on-hand information is unavailable, we know that ECL burned through cash quickly following its customer losses. In 2023, ECL reported EBITDA of $2.5mm. The company also had a roughly $6mm interest expense on its loan from a Lindberg affiliate and ECL was also paying roughly $11.8mm ($980,000 x 12) per year on its AWS contract. This massive, unavoidable expense, combined with significant customer losses, shrunk 2023 EBITDA to just $2.5mm (an 87% decrease from 2020). Not including capital expenditures (undisclosed), the $6mm interest expense alone put ECL in the red, burning at least $3.5mm of cash in 2023, while not being able to raise any new capital.

In the first-day declaration, ECL noted that it was unable to pay its AWS contract for a number of months and accrued a significant past-due payable (amount not disclosed). This caught up with ECL when AWS began threatening to suspend its services if ECL did not pay. ECL likely did not have cash-on-hand to pay AWS back. Additionally, the company would be unable to finance the payment by raising new funds because of the abovementioned regulatory restrictions. This left ECL in a very tough spot. In late 2023, AWS stated that if ECL did not resolve the payable by January 16, 2024, AWS would suspend services [2]. This would effectively destroy ECL as its entire EHR platform was hosted on AWS servers, so suspension was not an option. The last resort available to ECL was Chapter 11 bankruptcy. 

In Chapter 11, ECL immediately received protection via the automatic stay, which prevents collections, lawsuits, and contract enforcement actions after the company files. The automatic stay prevented AWS from suspending the essential ECL contract. With this in mind, the filing date of January 16, 2024 was not coincidental, but rather a last resort for ECL. 

Filing for Chapter 11 is also significant because the jurisdiction of the Federal Bankruptcy Court trumps that of the State of North Carolina and the rehabilitation process. This provided two notable benefits to ECL. 

First, since ECL was now a debtor in possession after filing, it was entitled to receive new money DIP financing from a Colorado Bankers Life Insurance Company, Lindberg affiliate, even though the previous rehabilitator would have likely prohibited it out of court due to a conflict of interest. As ECL was strapped for cash, this provided the necessary funds to continue operations, avoiding a platform shutdown, which would further harm client practices. 

Additionally, ECL was free to explore a 363 sale process, selling all assets free and clear of liens, claims, and interests [link to credit bid writeup]. This was beyond important to ECL, as the company was previously unable to pursue a sale because it would require the consent of the rehabilitation agent. However, ECL’s assets now belonged to the bankruptcy estate, overseen by the Federal Bankruptcy Court in the Southern District of Texas, so the company was free to explore a sale. 

Sale Process

On February 23, 2024, the court approved a series of orders outlining bidding procedures, deadlines, and a stalking horse bidder. Create Capital Partners was the stalking horse bidder, with an $11mm bid, and was entitled to breakup fees of 3% along with expense reimbursement. However, Create would be outbid by Colorado Bankers Life Insurance (CBLI), which submitted a $14.5mm bid. CBLI credit bid using the remaining $6.05mm of the DIP facility outstanding. It also used $8.45mm of cash. After paying out a $200,000 exit fee, a $580,000 breakup fee, and a $250,000 investment banker fee, total sale proceeds were roughly $7.87mm [8]. 

While it may seem odd that CBLI, a Lindberg affiliate, can buy back ECL, it is legal under the Bankruptcy Code. Insiders can bid as long as they follow the standard sale process and act in good faith. While Lindberg, on behalf of CBLI and the other insurers, committed fraud by deliberately sidestepping the affiliate investment cap, putting policyholders at risk (and trying to bribe his way out of it), that fraud was entirely outside the auction process. The key here is that the Chapter 11 process is not meant to punish CBLI for insurance fraud, but to deliver the most value to creditors. Another important note is that Lindberg no longer controlled CLBI, as it was in rehabilitation and controlled by the North Carolina Department of Insurance. In this case, CBLI’s bid was over 30% higher than the original bid, providing more value to the entire capital structure. 

Creditor Recoveries

Figure 4: Proposed Recoveries Under the Sale [7]

The chart above shows ECL’s capital structure at the time of filing. The only secured debt was the loan from GHTG Investment (a Lindberg Affiliate), which the debtor referred to as “The Purported Prepetition Lenders”, for $118.1mm maturing in June 2029 [2]. However, the debtors would quickly commence an adversary proceeding, arguing that the debt is undersecured (meaning the true value of its lien is not $118.1mm) or possibly invalid because of the insider nature and circumstances surrounding its issuance [11]. 

While this adversary proceeding might seem odd, especially considering GHTG is an insider creditor, we must remember that ECL is now a debtor-in-possession with the legal obligation to act in the best interest of the estate as a whole, which includes other creditors. These duties involve scrutinizing insider transactions, especially in this case, when GHTG’s claim could potentially eat up all sale proceeds. See the text below, which summarizes Section 1107 of the bankruptcy code, outlining the duties of a debtor in possession. 

“These duties, set forth in the Bankruptcy Code and Federal Rules of Bankruptcy Procedure, include accounting for property, examining and objecting to claims, and filing informational reports as required by the court and the U.S. trustee or bankruptcy administrator” [12]

Examining and objecting to claims means challenging the validity of certain debts and/or liens, even if that debt comes from an insider. By challenging GHTG’s claim, ECL acted in the best interest of all creditors, not just its affiliates, fulfilling its duties as a debtor in possession. 

Considering the total sale price was $14.5mm, we can infer that the GHTG’s lien, which was on substantially all of ECL’s assets, was undersecured and worth far less than the original $118mm. The $100mm decrease in value is massive, but not surprising given the downward trajectory of ECL. Remember that the company was losing significant customers due to outages and poor customer service, causing EBITDA to shrink by 87% from $18.8mm in 2020 to $2.5mm in 2023. This erosion in value also tells us that the rest of the claim would be treated as an unsecured deficiency claim, representing the upper $134mm range of general unsecured claims shown in Figure 4. This means that if GHTG’s entire claim was valid, but undersecured, unsecured claims would total $134mm, diluting recoveries for other unsecured creditors. 

Beyond this, the company reported secured claims of $665,000-$6.6mm and general unsecured claims of between $10.1mm and $134mm. Let’s go over what each of them likely consisted of:

Other Secured Claims:

The other secured claims class was likely comprised of miscellaneous creditors with specific claims who filed Uniform Commercial Code-1 (UCC-1) statements. For example, if ECL had specifically financed the purchase of some IT hardware, the debt would likely be secured via a purchase-money security interest (PMSI), giving the lender the right to repossess the purchased IT hardware. Unlike the GHTG claim, these liens were likely valid, specific, and perfected, which is why they were projected to receive a 100% recovery, regardless of the claim size, which was projected between $665,000 and $6.6mm. 

General Unsecured Claims:

General unsecured claims likely included accounts payable to third-party vendors, damages from rejected leases and terminated contracts, and claims from eye-care practices affected by outages. The reason total unsecured claims in Figure 4 range so widely, from $10.1mm to $134mm, is the potential deficiency claim tied to the GHTG loan. Since GHTG’s $118.1mm loan was secured by substantially all of ECL’s assets, which were later sold for just $14.5mm, most of that claim is almost certainly undersecured and could end up in the unsecured pool.

While ECL’s case is still being litigated, the best-case scenario for non-GHTG unsecured creditors is if the entire GHTG claim is recharacterized as equity. That means the court could determine it wasn’t a loan at all if, for example, it lacked a clear maturity date, enforceable repayment terms, or arms-length conditions. While rare, courts have done this before in cases like SubMicron [13], and it would eliminate GHTG from sharing in any recoveries.

If that happened, the remaining general unsecured creditors would share in the estate’s sale proceeds after the $665,000 to $6.6mm in “other secured claims” are paid. That leaves roughly $1.4mm to $7.2 mm for unsecured creditors, resulting in a recovery of 15% to 60%, depending on how large the secured claims end up..

Lindberg and ECL Today

As of May 2025, Greg Lindberg is in federal custody awaiting sentencing. While his bribery conviction was overturned on appeal, he faced new indictments in 2023 relating to the entire $2bn insurance scheme. In November 2024, Lindberg pleaded guilty to the entire scheme, which also involved the “forgiveness” of $125mm of loans from his insurance companies to himself. Lindberg could face a maximum prison sentence of 10 years, and a sentencing date has not yet been set [15]. 

ECL, which has rebranded to Slightview Software,  continues to operate under Colorado Bankers Life Insurance (the auction's winning bidder) ownership, maintaining  key platform offerings, such as iMedicWare and My Vision Express. In terms of the class action suit relating to ECL’s health record outages, the reorganized entity established a $4.07mm settlement fund to pay out patients and providers. Additional payouts will depend on insurance claims from ECL’s cyber liability insurance [10]. 

ECL Analysis and Takeaways

What makes EyeCare Leaders one of the most unusual software bankruptcies in recent years isn’t the ransomware attacks, destructive layoffs, or unprofitable contracts. Instead, it is the combination of fraud, insider creditors, and insurance law that resulted in a company being sold back to a Lindberg affiliate. 

This case highlights how a very non-traditional capital structure can influence half a decade of distress. ECL was initially funded via insurance premiums illegally funneled into the company, clearly breaching insurance investment mandates. Because of this, the state of North Carolina took over, preventing any more capital from being injected into the business. While the company’s downfall stemmed from both regulatory influence and other operational challenges, some may argue that the company would have never laid off workers, poorly handled ransomware attacks, or entered the AWS at such poor terms if it wasn’t already suffering from a cutoff of funding. Ultimately, one stakeholder will end up losing. Ultimately, ECL was just a fraction of Global Growth’s holdings, and the state of North Carolina aimed to remedy Lindberg’s entire fraud scheme, arguably putting provider clients at risk. 

The ECL case also showcases the limitations of state-led regulatory processes when federal bankruptcy is at play. After Lindberg’s insurance companies were placed into rehabilitation, the companies (and their affiliate investments) would effectively be blocked from raising new capital, exploring sale transactions, or looking into other restructuring alternatives without first gaining state approval. However, the Chapter 11 filing changed things. Now that the process was under federal jurisdiction, ECL was entitled to its rights under the bankruptcy code, particularly Section 363. And while CBLI was an insider, it still had the right to bid (with credit) under the bankruptcy code, outbidding a third-party stalking horse bidder for control of ECL. The lesson to be had from ECL is that, ultimately, who’s in charge is just as important as operational health. 

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