Employee Wellness: Two Parts Perspiration, One Part PersistenceWith employee health affecting bottom lines, organizations need to support preemptive initiatives that encourage both personal wellness and quantifiable results. Here’s how we are addressing this major challenge.

KEEP CHALLENGING October 2014

Executive Summary

Between January and June this year, 127 Cognizant employees could

have walked halfway to the moon. Their cumulative footsteps covered

half of the 238,000-mile distance — and they’re still walking.

This group has taken nearly 200 million steps as part of iCommit2Fit,

an innovative wellness improvement program that we designed and

piloted for our associates in five U.S. locations. The voluntary program

combines personal commitment, technology, incentives and coaching.

At the close of the six-month pilot, virtually all of our participants have

substantially increased and sustained their physical activity levels while

losing weight and seeing significant improvements in their Body Mass

Index (BMI) ratios.

What sets iCommit2Fit apart is the personalized, one-to-one coaching

deployed to help associates outfitted with Fitbit® wearable smart

bands to monitor their physical activity, with the goal of improving

their wellness. While wearable smart bands like Fitbit are all the rage,

they are no wellness elixir.1 The reason? While great at automating data

collection without any human intervention, the current generation of

devices can’t instruct users on ways to increase their physical activity

today or tomorrow, much less next week or month. The bottom line: to

EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 3

improve their wellness, humans need the counsel and encouragement of

fellow carbon-based beings to increase their physical activity, improve

their nutrition and adopt healthier lifestyles.

In fact, our findings show that participants who attended the coaching

sessions without fail recorded activity levels and weight loss that were

almost 75% higher than the levels for participants who missed coaching

sessions. Equipped with the knowledge gained from this pilot, we are set

to expand the program to 1,400 more employees across the U.S.

This whitepaper shares the lessons we learned from the pilot program

and our ideas for improving the wellness of our associates so that other

enterprises can improve their wellness initiatives. Doing so is a matter

of health for both employees and employers, alike. Consider that the

medical costs associated with obesity are estimated at $190.2 billion

per year, or 20.6% of national health expenditures.2 Employers offering

health insurance bear a portion of these costs and have a stake in

helping employees lead more active, healthier lifestyles.

4 KEEP CHALLENGING October 2014

iCommit2Fit in ActionWhen designing iCommit2Fit, we hypothesized that proactive, personalized and technologically savvy support was necessary to help individuals embrace and sustain behaviors that improve health and prevent or alleviate chronic health conditions. The healthcare industry is already measuring “patient activation” rates as a way of predicting which individuals will consume more healthcare services and/or succeed in managing their existing health conditions.3

We solicited voluntary applications for iCommit2Fit from five Cognizant facilities across the U.S., located in the South, Southwest, Midwest and Southeast. Applicants were reviewed for any pre-existing health conditions that could preclude their par-ticipation; those selected were equipped with a Fitbit activity tracker.

From an iCommit2Fit participant’s perspective, the requirements were simple: wear the activity tracker to capture daily steps walked; log food intake in a daily digital diary; upload data on a weekly basis; and participate in weekly coaching sessions via telephone (see Figure 1). On the back-end, we used the data capture and person-alized coaching capabilities of our HealthActivate patient engagement platform to administer the program (see sidebar, page 7).

Figure 1

All participants reported their pre-program daily “step” baseline. Based on that measure, each participant’s coach set a daily step goal for the first month of the program. If a participant easily met or exceeded that goal, the coach would increase it.

Devices were synchronized with participants’ smartphones or laptop dongles, then uploaded directly from Fitbit to the Cognizant HealthActivate portal. Laptops equipped with the Fitbit software were available at several office locations for use

Daily foodlogging

Periodicwebinars

Weekly nutritione-mails

Daily step goals

Weekly stepcount upload

via activity monitor

Portal/Personal Coach

Weekly virtualmeeting with coach

iCommit2Fit Data Flows

by participants without smartphones or with data synchronization issues. To ensure consistent and accurate results across all participants, we disabled the manual data entry feature. Thus, all step counts came from the devices; none were estimated by participants.

In addition to weekly phone-based coaching sessions, participants received per-sonalized e-mails with observations and advice from coaches. If a participant was meeting step goals but not losing the desired weight, a coach might examine the food log and note an abundance of fried or fatty foods and suggest alternatives.

Four Times around the Earth During the pilot — which ran from January 2014 to June 2014 — the 127 participants cumulatively took almost 200 million steps, or approximately 100,000 miles. To put this into perspective, the circumference of the earth is almost 25,000 miles. The participants also cumulatively lost three-quarters of a ton of weight.

The iCommit2Fit participants started out at a higher weekly step average than the Cognizant corporate benchmark, the U.S. average and the Fitbit user average (see Figure 2). From January to June, participants increased their weekly step counts from an average baseline of 36,500 across all groups to 75,000, an improvement of 105% and more than twice the American daily step average. Participants doubled their own baseline steps as well as the average American baseline steps, while consistently attaining 10,000 steps per day, as recommended by the American Heart Association, and reaching 30 minutes of moderate physical activity per day as recom-mended by the U.S. Surgeon General.

All participants improved their step counts, with the largest percentage increases achieved in the Overweight and Obese 1 and 2 BMI categories, indicating much greater activity by those participants (see Figure 3, next page). BMI reduction is a critically important metric; for example, the risk rate of acquiring chronic diseases increases substantially as people go from Overweight to Obese 1, and from Obese 1 to Obese 2. Members of the Obese 1 and Obese 2 categories in the 41 to 50 age range posted the greatest weight loss by percentage (see Figure 4, next page).

EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 5

30K

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50K

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Fitbit Average

iCommit2Fit Average

U.S. AverageCognizant Baseline

JAN. FEB. MARCH APRIL MAY JUNE

Average Daily Steps Comparison

Figure 2

From January to June, participants increased their weekly step counts from an average baseline of 36,500 across all groups to 75,000, an improvement of 105% and more than twice the American daily step average.

6 KEEP CHALLENGING October 2014

0

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OVERWEIGHT OBESE 1 OBESE 2

The weight loss significantly reduced BMI measures in all of our participants, with the greatest reductions coming in the Obese 1 and 2 categories (see Figure 5, next page). These indi-viduals recorded the lowest baseline step counts of all program participants.

The BMI reductions enabled nearly 27% of our participants to move to new BMI categories. Thirteen participants who began the program in the “Obese 2” category lost enough weight to improve to the Obese 1 category (see Figure 6, page 8). Nineteen people reduced their BMI enough to move from the Obese 1 category to Overweight.

The BMI improvements among participants in the Overweight and Obese categories, coupled with their increased step counts, suggest that these individuals made significant lifestyle changes.

Further, our data indicates that the support structure underlying iCommit2Fit was a significant influence on those results.

The Coaching DifferenceNot surprisingly, the participants who followed all the program requirements — weekly step goals, daily food logging and weekly coach meetings — saw the greatest average weight loss, or 20 pounds. Conversely, those with the lowest compliance rates lost about five pounds on average.

Personalized weekly coaching had a strong impact on participant results.

Roughly 15% of participants who had 100% coaching compliance — that is, they did not miss a single coaching session — took 54% more steps and lost twice as much weight as those who had 95% coaching compliance rates. They took 70% more steps than those with the lowest compliance rate and lost three times as much weight (see Figures 7 and 8, pages 9 and 10, respectively).

In other words, participants with 95% compliance rates missed only two of 23 meetings, yet lost only half the weight and took slightly more than half the steps of those who made it to all their coaching sessions. Similarly, the group with the lowest compliance rates missed about three meetings, lost only about a quarter of the weight and took only about 30% of the steps of those in the 100% group (see Figure 9, page 10).

Average Step Gain by BMI Category

Average Weight Loss by BMI Category

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Figure 3

Figure 4

The BMI reductions enabled nearly 27% of our participants to move to new BMI categories.

EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 7

These results signal to us the value and impact of the personalized and consistent expert coaching underlying iCommit2Fit. They also complement studies showing that workplace health programs tailored to an individual’s personal goals can lead to increases of up to 35% in the amount of time a person will spend in physical activity.4

Healthy OptimismOur initial pilot program was not long enough in duration or large enough in participant numbers to draw conclusions about the impact of increased activity and weight loss on employee productivity or health claim costs. However, we are optimistic about achieving positive results. For instance, greater activity and improved BMI should contribute to reduced healthcare costs. It is estimated that obesity-related productivity losses cost employers $225.9 billion per year, with an obese employee costing employers an additional $460 to $2,500 in medical care and sick days over the average annual individual healthcare cost of $3,000 per person.5

Roughly 15% of participants who had 100% coaching compliance took 54% more steps and lost twice as much weight as those who had 95% coaching compliance rates.

Figure 5

23.5 22.8

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4138.3

= BASE BMI = BMI June 2014

NORMAL OVERWEIGHT OBESE 1 OBESE 2

0

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Improvement by BMI Weight Category

Cognizant’s Connected Health Solution

The HealthActivate platform combines “bring your own health device” (BYOhD) data collection capabilities with analytics and virtual and live coaching to offer a next-generation care management platform. The platform accepts data from virtually any BYOhD that an individual might use, from an activity tracker to an in-home blood sugar testing device to a wireless scale.

Our analytics engine reviews this data and alerts coaches to any anomalies requiring intervention. Some interventions are automatic and virtual, such as an instant message or e-mail; at other times, coaches (who are trained nurses) will call the individual to find out why a medicine dosage was missed or to determine whether a sudden weight gain indicates a serious problem. The platform helps indi-viduals on the cusp of chronic conditions to become healthier and enables partici-pants who are managing diabetes, heart conditions, etc. to do so more effectively and avoid acute care episodes.

Quick Take

JAN. JUNE

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30Obese 2

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43 43

Moved toObese 2

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1

23

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19

8 KEEP CHALLENGING October 2014

But as noted by the American Heart Association, regular exercise, such as 10,000 daily steps, reduces coronary heart disease in women by 30% to 40%, while moderately active people see their stroke risk reduced by 20% and highly active people by 27%.6 We are hopeful that participants will see improved health as they continue their steps, while we closely monitor the impact of greater employee wellness on health costs as we expand the program.

Lessons LearnedWhile we are very pleased with the results of the first phase of iCommit2Fit, the pilot participants taught us a variety of lessons and raised issues that we hope to address in the expanded program.

• Device details. It is critical to use a reliable activity tracker that also largely automates the data upload process. We selected the Fitbit, both for these capa-bilities and its name recognition. It is important to have extra devices on hand: When a tracker was lost or stopped working for any reason, participant activity quickly dropped.

As iCommit2Fit grows, we will watch for more advanced devices that can track a wider range of physical activities and convert them to a meaningful measure. Potential exercise movement to capture includes swimming, weight-lifting, yoga, etc. As participants become more fit, they might be more likely to participate in activities that our activity tracker cannot capture.

Figure 6

BMI Category Changes

Nineteen people reduced their BMI enough to move from the Obese 1 category to Overweight, while

two participants went to Normal from Obese 1.

EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 9

The Criticality of BMI-based Weight Categories

The Body Mass Index (BMI) is a mathematical formula that uses an individual’s height and weight to evaluate whether he or she is at a healthy weight. A BMI of 18.5 to 24.9 is

considered healthy, while a reading of 25 to 29.9 is considered overweight. Research-ers and clinicians divide obesity into three categories: Class I (30–34.9), Class

II (35–39.9) and Class III (40). Class III is further divided into super-obesity (BMI 50–59) and super-super obesity (BMI 60+).10

What we found in our pilot program is that as participants lose weight and begin to transfer from one BMI category to the next, it is crucial for them to realize that meeting their goal is not enough; they must sustain it. One way that we work to ensure goal maintenance is through

high-intensity interval training. We believe that when coaches encourage individuals to increase the intensity of their workouts, it poses a new and

different challenge to the participants and results in a sustainable loss.

Research has found that people on diets typically lose 5% to 10% of their starting weight in the first six months. However, at least one- to two-thirds of people on diets regain more weight than they lost within four or five years, and the true number may well be significantly higher.11 This is why we extended our pilot from three to six months and hope to extend the program indefinitely in the future.

Quick Take

• Going beyond step counts. We will also explore whether and how to incorporate other wellness activities into the pro-gram to help participants maintain their weight loss. To ac-complish this, we will actively track the wearable industry as devices become more mature and are able to capture activities beyond steps. Many smaller companies are be-ginning to engineer devices that capture body-weight ex-ercises (i.e., push-ups, squats and crunches), swimming, strength-training and other activities. As devices become more mature and able to track additional activities beyond walking and running, our coaches will be further trained in exercise therapy to offer a wider array of services.

• Limits of the BMI. While the BMI is widely used as a measure, it is only a mathematical estimate of a person’s weight catego-ry and cannot take into account body fat percentage or bone structure. A person weighing 145 lbs and measuring 5’8” in height could be very fit — or they could be carrying more body fat than muscle mass (see above sidebar).

Changes in body fat percentage would be a more accurate measure of wellness, but obtaining this reading is more intrusive and resource-intensive. Home health devices that offer body fat measurement could be evaluated.

• The incentive effect. We experimented with three types of incentives: individual, worksite-based and team-based. Individuals could earn congratulatory e-mails, color bands for their trackers, hoodies and custom t-shirts, all of which were designed to appeal to goal-oriented but noncompetitive participants.

Figure 7

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10 KEEP CHALLENGING October 2014

Worksite challenges involved seeing which site teams recorded the highest compliance rates in terms of step counts, food logging and coaching. Winners were treated to a lunch during program-related webinars.

Finally, several weeks into the program, we randomly selected participants to form teams across the five pilot locations. To score points for their teams, members had to complete their daily food log, meet their weekly step goals and complete their weekly coach meeting. Missing even one of these activities would reduce the team’s overall score.

Certain teams proved especially competitive, so members would drop out rather than hurt the team by leaving an activity incomplete. We will examine our scoring procedures and communication to ensure that the formation of teams enhances the iCommit2Fit support system.

• Data sharing. Participants, especially in the various challenges, want to know how their performance compared with others. Due to priva-cy restrictions of HIPAA and PHI, the data that can be shared with par-ticipants is highly restricted. When members of the five-member teams witnessed a dip in their cumulative score, some wanted to know which team member caused the average to be lowered. However, because protecting privacy is of utmost importance, we have utilized safeguards to ensure par-

ticipants’ data is only reviewed by Cognizant health coaches and those administering incentives. To help

As iCommit2Fit grows, we will watch for more advanced devices that can track a wider range of physical activities and convert them to a meaningful measure.

Figure 9

87%Meeting

participation

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Figure 8

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Impact of Weekly Coach Meetings on Steps Taken

the cause while remaining compliant with regula-tory restrictions, we created a Fitbit Community in the Fitbit portal, where users could opt-in to share as much information as they were comfortable sharing.

• Attrition happens. Our program attrition rate was about 18% (or 25% if we include the 11 participants who never synched their devices with the portal), which is lower than the typical 30% annual attrition rate that health clubs experience.7 We enrolled 150 participants (18 individuals joined after a few early participants bowed out), of whom 127 were still active six months later. While some partici-pants dropped out due to medical conditions or injury, oth-ers left the program after changing jobs.

• Climate matters. The onset of very hot summer weather in some of the locations had a definite impact on results. In one location, weather advisories recommended not walk-ing outside until after 10:00 p.m. On the flip side, locations in the Midwest and North experienced a harsher than nor-mal winter in early 2014, with the polar vortex impacting outdoor activities. It is important for coaches and par-ticipants to identify alternate walking venues and tactics ahead of time, such as in malls or other indoor sites.

Empowering Employees for Personal Wellness

“Five little lights changed my life,” says Jacqui Bennion, one of the 150 participants in our iCom-mit2Fit wellness pilot program. After six months of watching her Fitbit wristband display the signal that she had reached her daily goal of 12,000 steps, Bennion feels more fit, has gained better control over her diabetes and has made “a complete change” in her lifestyle. “The program is about so much more than weight loss; it’s about getting healthy,” she said.

“Getting healthy” similarly was the driver behind Kathy Martin’s participation in the program. “I have six grandkids and two more on the way,” Martin said. “I want to be there for them — but I have a tendency to give up in an instant. With iCommit2Fit, I had a support team, goals to make and motivation.”

“The accountability the program offered was most important to me,” says Scott Seeliger. “Seeing that information — the activity and food log — on a daily basis was a big motivator to reaching my goals.”

Motivation with a Personal TouchThe personalized support provided by iCommit2Fit coaches was especially important for Bennion and Martin. Bennion’s coach worked with her to set up appropriate calorie counts and eating styles to maintain steady blood sugar levels. Martin gained so much energy that she tried running a portion of her daily 1.5-mile walk — and promptly hurt her knee. She and her coach found alternative ways to remain active, such as doing upper-body work.

“My coach was my motivator,” Martin says. “It’s easy to start when someone’s watching, and my coach was huge in that role.”

Bennion enjoyed competing against friends during the iCommit2Fit team challenges, an aspect of the program that Seeliger also cited as a big motivator. “I am a competitive person and definitely liked the challenge of being able to win prizes,” he said.

Whether through coaching or competition, the motivation worked: Seeliger used a local skywalk system as well as nighttime walks in 10° F weather to log his 12,000 daily steps. Bennion turned to

an indoor trampoline rebounder and a local air-conditioned Walmart to beat the 113° F heat, and Martin walked around her kitchen island to avoid subzero wind chills.

Committed to WellnessAll three report much improved health and energy. Martin is no longer winded by walking up a short flight of steps in her house; Bennion has improved blood sugar numbers; and Seeliger dropped 45 pounds. Each said they expect their education about healthier food choices to have a lasting effect on their wellness. “Logging the value of everything you put in your mouth makes a big difference,” Bennion said. “I was not going to log French fries.”

Family members of participants also saw side benefits. Martin’s husband lost 20 pounds because of the changes to her cooking style, and Seeliger’s family’s diet has also changed. “I have 8-year-old twins, and it was just so important for them to be exposed to healthier behavior,” Seeliger said.

Although the pilot ended in June, Bennion, Martin and Seeliger have all continued their daily steps and more. “I have so much more energy than I did eight months ago,” Bennion said. With her improved endurance, she is starting to move into more intense interval training and planking exercises. Seeliger has started the Couch-to-5K™ running program.

“We don’t just sit on the couch anymore: we find other things to do,” said Martin, who estimates her family’s tele-vision-viewing went from as much as eight hours a day to just two hours a week. The

“other things” include yard chores, fixing old cars and remodeling a property.

“It’s been fabulous,” she said. “I know I’m in a better place because of iCommit2Fit.”

Quick Take

EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 11

Spreading the Success of iCommit2FitThe basic principles behind the success of iCommit2Fit are transferable to other settings. Voluntary participation and a good activity-tracking device are the basic prerequisites. Our results indicate that personalized expert coaching to constantly challenge participants is the mandatory component that enables participants to achieve significant activity gains and weight loss.

We were fortunate to have access to our HealthActivate platform and its coaching resources (see sidebar, page 11). Other companies could turn to third-parties for similar services. Health insurers and large healthcare systems are increasing-ly investing in wellness and patient care programs that could offer some of the features we built into iCommit2Fit.

Factors to consider in program selection include the ability of the service provider to:

• Offer high-quality, clinically trained coaches who can tailor advice and recom-mendations to participants.

• Manage administrative aspects, from enrollment through technical support, through tabulating results for incentives or internal use.

• Support data transmissions from potentially a variety of personal health devices, which currently do not adhere to a data standard.

• Protect participant privacy.

Studies show that employees increasingly will pay for larger shares of their health costs, whether as co-pays in employer-sponsored coverage or when selecting their own health plans through employer-defined benefits contributions.8 Programs such as iCommit2Fit potentially can help employees reduce their need for expensive healthcare services. This development could benefit employers, too.

One way to determine whether to invest in a program like iCommit2Fit is to look at aggregate, non-personal employee health data and calculate what percentage of health claims are arising from “lifestyle” conditions, from diabetes to heart disease. It is also worth noting that one review of more than a dozen employer wellness programs indicated average savings of $358 through reduced health costs per employee per year, while costing the employer $144 per employee per year. For every dollar an employer spent on its program, it saved $3.37.9

Our expansion of iCommit2Fit this coming fall is not just about good health for our employees; it is also about ensuring that our business is fit and productive, too. We are proud of our iCommit2Fit participants and their hard work and look forward to logging many more steps from them.

Footnotes1 Matt Clinch, “Wearable Smart Bands Set for 350% Growth in 2014,” CNBC, Feb. 12,

2014, http://www.cnbc.com/id/101410507#.

2 “Obesity Accounts for 21 percent of U.S. Health Care Costs, Study Finds,” Science-Daily, April 9, 2012, http://www.sciencedaily.com/releases/2012/04/120409103247.htm.

3 Julia James, “Patient Engagement,” Health Affairs, Feb. 14, 2013, http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86.

4 “Workplace Health Promotion,” Centers for Disease Control and Prevention, http://www.cdc.gov/workplacehealthpromotion/implementation/topics/physical-activity.html.

12 KEEP CHALLENGING October 2014

EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 13

5 “The Price of Inactivity,” American Heart Association, http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/The-Price-of-Inactivity_UCM_307974_Article.jsp.

6 “Physical Activity Improves Quality of Life,” American Heart Association, http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/Physical-activity-improves-quality-of-life_UCM_307977_Article.jsp.

7 Heather Rascher, “Battling Attrition: A Study in Improving Member Retention at Health Club Facilities,” Sports Economics Perspectives, Issue 3, http://www.sportsec-onomics.com/Images/PDF/SE_Perspectivevol3.pdf.

8 “Aon Hewitt 2013 HealthCare Survey,” Aon, 2013, page 7, http://www.aon.com/ attachments/human-capital-consulting/2013_Health_Care_Survey.pdf.

9 Katherine Baicker, David Cutler, Zirui Song, “Workplace Wellness Programs Can Generate Savings,” Health Affairs, February 2010, Vol. 29, No. 2, pp 304-311, http://content.healthaffairs.org/content/29/2/304.full#ref-22.

10 “Why Use BMI?” Harvard School of Public Health, http://www.hsph.harvard.edu/obe-sity-prevention-source/obesity-definition/obesity-definition-full-story/#references.

11 Stuart Wolpert, “Dieting Does Not Work, UCLA Researchers Report,” UCLA, April 3, 2007, http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA-Research-ers-7832.

About the AuthorsNiresh Terence Sivathasan is a Manager within Cognizant’s Business Process Services (BPS) Strategic Operations’ group. During his four-year tenure, he has engaged in various due diligences and contracting initiatives, and was a part of the program team of one of Cognizant’s largest BPS clients. Niresh is the program manager for iCommit2Fit and oversees all aspects of the program. He earned his B.A. from the University of Texas and a Juris doctorate from the University of Oklahoma College of Law. Additionally, he is licensed to practice law in Texas. Niresh has a passion for wellness after overcoming his own weight struggles. He altered his lifestyle to become more physically active and competes in local charity races, soccer and ice hockey. He can be reached at Niresh.Sivathasan@cognizant.com | LinkedIn: www.linkedin.com/pub/niresh-sivathasan/3/27/592 | Google+: plus.google.com/s/niresh%20sivathasan

Dr. Anthony Nguyen is Cognizant’s Chief Medical Officer. He led the development of the coaching protocols and oversaw all clinical aspects of the pilot. Anthony is part of the Global Clinical Services teams and is responsible for furthering Cognizant’s role in helping our clinical partners run better and run different. Anthony graduated magna cum laude from University of CA, Irvine, and received his M.D. at Tufts School of Medicine. He is board-certified in internal medicine. Anthony’s passion in wellness stems from his medical education, as well as his dedication to surfing at a high level. Anthony can be reached at Anthony.Nguyen@cognizant.com | LinkedIn: www.linkedin.com/in/anguyenmd

AcknowledgmentsThe authors would like to acknowledge Gajen Kandiah, Executive Vice-President of Cognizant’s Business Process Services Business Unit, for his vision and contribu-tions to this white paper.

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About CognizantCognizant (NASDAQ: CTSH) is a leading provider of informa-tion technology, consulting, and business process outsourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered in Teaneck, New Jer-sey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise, and a global, collaborative workforce that embod-ies the future of work. With over 75 development and delivery centers worldwide and approximately 187,400 employees as of June 30, 2014, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world. Visit us online at www.cognizant.com or follow us on Twitter: Cognizant.