EXACT SCIENCES CORP, 10-K filed on 2/22/2022
Annual Report
v3.22.0.1
Cover Page - USD ($)
12 Months Ended
Dec. 31, 2021
Feb. 21, 2022
Jun. 30, 2021
Cover [Abstract]      
Document Type 10-K    
Document Annual Report true    
Document Period End Date Dec. 31, 2021    
Current Fiscal Year End Date --12-31    
Document Transition Report false    
Entity File Number 001-35092    
Entity Registrant Name EXACT SCIENCES CORPORATION    
Entity Incorporation, State or Country Code DE    
Entity Address, Address Line One 5505 Endeavor Lane    
Entity Address, City or Town Madison    
Entity Address, State or Province WI    
Entity Tax Identification Number 02-0478229    
Entity Address, Postal Zip Code 53719    
City Area Code 608    
Local Phone Number 284‑5700    
Title of 12(b) Security Common Stock, $0.01 Par Value    
Trading Symbol EXAS    
Security Exchange Name NASDAQ    
Entity Well-known Seasoned Issuer Yes    
Entity Voluntary Filers No    
Entity Current Reporting Status Yes    
Entity Interactive Data Current Yes    
Entity Filer Category Large Accelerated Filer    
Entity Small Business false    
Entity Emerging Growth Company false    
ICFR Auditor Attestation Flag true    
Entity Shell Company false    
Entity Public Float     $ 21,211,910,456
Entity Common Stock, Shares Outstanding   174,116,598  
Documents Incorporated by Reference The registrant intends to file a definitive proxy statement pursuant to Regulation 14A within 120 days after the end of the fiscal year ended December 31, 2021. Portions of such proxy statement are incorporated by reference into Part III of this Form 10‑K.    
Entity Central Index Key 0001124140    
Amendment Flag false    
Document Fiscal Year Focus 2021    
Document Fiscal Period Focus FY    
v3.22.0.1
Audit Information
12 Months Ended
Dec. 31, 2021
Dec. 31, 2019
Audit Information [Abstract]    
Auditor Firm ID 238 243
Auditor Name PricewaterhouseCoopers LLP BDO USA, LLP
Auditor Location Chicago, Illinois Madison, Wisconsin
v3.22.0.1
Consolidated Balance Sheets - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Current assets:    
Cash and cash equivalents $ 315,471 $ 1,491,288
Marketable securities 715,005 348,699
Accounts receivable, net 216,645 233,185
Inventory 104,994 92,265
Prepaid expenses and other current assets 74,122 33,157
Total current assets 1,426,237 2,198,594
Long-term assets:    
Property, plant and equipment, net 580,248 451,986
Operating lease right-of-use assets 174,225 125,947
Goodwill 2,335,172 1,237,672
Intangible assets, net 2,094,411 847,123
Other long-term assets, net 74,591 63,770
Total assets 6,684,884 4,925,092
Current liabilities:    
Accounts payable 67,829 35,709
Accrued liabilities 398,556 233,604
Operating lease liabilities, current portion 19,710 11,483
Convertible notes, net, current portion 0 312,715
Debt, current portion 0 1,319
Other current liabilities 30,973 38,265
Total current liabilities 517,068 633,095
Convertible notes, net, less current portion 2,180,232 1,861,685
Long-term debt, less current portion 0 22,342
Other long-term liabilities 417,782 51,342
Operating lease liabilities, less current portion 182,166 121,075
Total liabilities 3,297,248 2,689,539
Commitments and contingencies
Stockholders’ equity:    
Preferred stock, $0.01 par value Authorized—5,000,000 shares issued and outstanding—no shares at December 31, 2021 and December 31, 2020 0 0
Common stock, $0.01 par value Authorized—400,000,000 shares issued and outstanding—173,674,067 and 159,423,410 shares at December 31, 2021 and December 31, 2020 1,738 1,595
Additional paid-in capital 6,028,861 4,279,327
Accumulated other comprehensive income (loss) (1,443) 526
Accumulated deficit (2,641,520) (2,045,895)
Total stockholders’ equity 3,387,636 2,235,553
Total liabilities and stockholders’ equity $ 6,684,884 $ 4,925,092
v3.22.0.1
Consolidated Balance Sheets (Parenthetical) - $ / shares
Dec. 31, 2021
Dec. 31, 2020
Statement of Financial Position [Abstract]    
Preferred stock, par value (in dollars per share) $ 0.01 $ 0.01
Preferred stock, authorized shares (in shares) 5,000,000 5,000,000
Preferred stock, issued shares (in shares) 0 0
Preferred stock, outstanding shares (in shares) 0 0
Common stock, par value (in dollars per share) $ 0.01 $ 0.01
Common stock, authorized shares (in shares) 400,000,000 400,000,000
Common stock, issued shares (in shares) 173,674,067 159,423,410
Common stock, outstanding shares (in shares) 173,674,067 159,423,410
v3.22.0.1
Consolidated Statements of Operations - USD ($)
shares in Thousands, $ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Income Statement [Abstract]      
Revenue $ 1,767,087 $ 1,491,391 $ 876,293
Operating expenses:      
Cost of sales (exclusive of amortization of acquired intangible assets) 458,757 354,324 216,717
Research and development 385,646 554,052 139,694
Sales and marketing 861,889 589,919 385,176
General and administrative 801,262 481,393 352,453
Amortization of acquired intangible assets 95,001 93,398 16,035
Intangible asset impairment charge 20,210 209,666 0
Total operating expenses 2,622,765 2,282,752 1,110,075
Other operating income 0 23,665 0
Loss from operations (855,678) (767,696) (233,782)
Other income (expense)      
Investment income, net 31,778 6,574 26,530
Interest expense (18,606) (67,941) (199,192)
Total other income (expense) 13,172 (61,367) (172,662)
Net loss before tax (842,506) (829,063) (406,444)
Income tax benefit 246,881 5,458 193,354
Net loss $ (595,625) $ (823,605) $ (213,090)
Net loss per share - basic (in dollars per share) $ (3.48) $ (5.45) $ (1.62)
Net loss per share - diluted (in dollars per share) $ (3.48) $ (5.45) $ (1.62)
Weighted average common shares outstanding - basic (in shares) 171,348 151,137 131,257
Weighted average common shares outstanding - diluted (in shares) 171,348 151,137 131,257
v3.22.0.1
Consolidated Statements of Comprehensive Loss - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Statement of Comprehensive Income [Abstract]      
Net loss $ (595,625) $ (823,605) $ (213,090)
Other comprehensive loss:      
Unrealized gain (loss) on available-for-sale investments (2,162) 771 1,322
Foreign currency adjustment 23 25 0
Comprehensive loss, before tax (597,764) (822,809) (211,768)
Income tax expense related to items of other comprehensive loss 170 (170) 0
Comprehensive loss, net of tax $ (597,594) $ (822,979) $ (211,768)
v3.22.0.1
Consolidated Statements of Stockholders’ Equity - USD ($)
$ in Thousands
Total
Common Stock
Additional Paid In Capital
Accumulated Other Comprehensive Income (Loss)
Accumulated Deficit
Beginning balance (in shares) at Dec. 31, 2018   123,192,540      
Beginning balance at Dec. 31, 2018 $ 447,258 $ 1,232 $ 1,456,648 $ (1,422) $ (1,009,200)
Increase (Decrease) in Stockholders' Equity          
Shares issued to settle convertible notes (in shares) 2,159,716 2,159,716      
Shares issued to settle convertible notes $ 182,435 $ 22 182,413    
Exercise of common stock options (in shares)   641,925      
Exercise of common stock options 8,787 $ 6 8,781    
Issuance of common stock to fund the Company's 401(k) match (in shares)   86,532      
Issuance of common stock to fund the Company's 401(k) match 7,409 $ 1 7,408    
Compensation expense related to issuance of stock options and restricted stock awards (in shares)   4,322,366      
Compensation expense related to issuance of stock options and restricted stock awards 108,483 $ 43 108,440    
Purchase of employee stock purchase plan shares (in shares)   176,458      
Purchase of employee stock purchase plan shares $ 8,396 $ 2 8,394    
Issuance of common stock to fund business combinations (in shares) 17,046,159 17,046,159      
Issuance of common stock for business combinations and asset acquisitions $ 1,407,080 $ 171 1,406,909    
Stock issuance costs (441)   (441)    
Net loss (213,090)       (213,090)
Accumulated other comprehensive income (loss) 1,322     1,322  
Ending balance (in shares) at Dec. 31, 2019   147,625,696      
Ending balance at Dec. 31, 2019 $ 1,957,639 $ 1,477 3,178,552 (100) (1,222,290)
Increase (Decrease) in Stockholders' Equity          
Shares issued to settle convertible notes (in shares) 2,159,716        
Exercise of common stock options (in shares)   702,907      
Exercise of common stock options $ 27,077 $ 7 27,070    
Issuance of common stock to fund the Company's 401(k) match (in shares)   136,559      
Issuance of common stock to fund the Company's 401(k) match 12,007 $ 1 12,006    
Compensation expense related to issuance of stock options and restricted stock awards (in shares)   1,665,408      
Compensation expense related to issuance of stock options and restricted stock awards 152,906 $ 17 152,889    
Purchase of employee stock purchase plan shares (in shares)   301,064      
Purchase of employee stock purchase plan shares $ 18,355 $ 3 18,352    
Issuance of common stock to fund business combinations (in shares) 386,293 386,293      
Issuance of common stock for business combinations and asset acquisitions $ 28,847 $ 4 28,843    
Issuance of common stock for registered direct offering (in shares)   8,605,483      
Issuance of common stock for registered direct offering 861,701 $ 86 861,615    
Stock issuance costs 0        
Net loss (823,605)       (823,605)
Accumulated other comprehensive income (loss) $ 626     626  
Ending balance (in shares) at Dec. 31, 2020 159,423,410 159,423,410      
Ending balance at Dec. 31, 2020 $ 2,235,553 $ 1,595 4,279,327 526 (2,045,895)
Increase (Decrease) in Stockholders' Equity          
Shares issued to settle convertible notes (in shares) 2,159,716        
Conversion of convertible notes, net of tax (in shares)   580      
Conversion of convertible notes, net of tax $ 43   43    
Exercise of common stock options (in shares) 1,295,400 1,295,104      
Exercise of common stock options $ 14,437 $ 13 14,424    
Issuance of common stock to fund the Company's 401(k) match (in shares)   162,606      
Issuance of common stock to fund the Company's 401(k) match 22,934 $ 2 22,932    
Compensation expense related to issuance of stock options and restricted stock awards (in shares)   1,879,169      
Compensation expense related to issuance of stock options and restricted stock awards 334,023 $ 19 334,004    
Purchase of employee stock purchase plan shares (in shares)   331,769      
Purchase of employee stock purchase plan shares $ 23,070 $ 3 23,067    
Issuance of common stock to fund business combinations (in shares) 10,581,429 10,581,429      
Issuance of common stock for business combinations and asset acquisitions $ 1,355,170 $ 106 1,355,064    
Net loss (595,625)       (595,625)
Accumulated other comprehensive income (loss) $ (1,969)     (1,969)  
Ending balance (in shares) at Dec. 31, 2021 173,674,067 173,674,067      
Ending balance at Dec. 31, 2021 $ 3,387,636 $ 1,738 $ 6,028,861 $ (1,443) $ (2,641,520)
v3.22.0.1
Consolidated Statements of Stockholders Equity (Parenthetical) - $ / shares
Dec. 31, 2021
Dec. 31, 2020
Statement of Financial Position [Abstract]    
Common stock, par value (in dollars per share) $ 0.01 $ 0.01
v3.22.0.1
Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Cash flows from operating activities:      
Net loss $ (595,625) $ (823,605) $ (213,090)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:      
Depreciation and amortization 85,345 69,964 34,212
Loss on disposal of property, plant and equipment 1,055 2,470 1,394
Unrealized (gain) loss on equity investments 1,492 (1,179) 207
Deferred tax benefit (253,169) (6,748) (193,605)
Stock-based compensation 253,063 152,906 108,483
Post-combination expense for acceleration of unvested equity 80,960 0 0
Realized gain on preferred stock investment (30,500) 0 0
Loss on settlement of convertible notes 0 50,819 187,698
Amortization of deferred financing costs, convertible note debt discount and issuance costs, and other liabilities 6,683 1,546 (1,758)
Accretion (Amortization) of discount (premium) on short-term investments 4,618 1,549 (3,102)
Amortization of acquired intangible assets 95,001 93,398 16,035
Asset acquisition IPR&D expense 85,337 412,568 0
Intangible asset impairment charge 20,210 209,666 0
Remeasurement of contingent consideration 6,360 (323) 0
Non-cash lease expense 25,825 15,720 5,427
Changes in assets and liabilities, net of effects of acquisition:      
Accounts receivable, net 25,150 (100,526) (27,633)
Inventory, net (9,221) (30,310) (19,041)
Operating lease liabilities (16,685) (8,784) (4,114)
Accounts payable and accrued liabilities 169,800 55,165 3,469
Other assets and liabilities (57,935) 42,186 (6,237)
Net cash provided by (used in) operating activities (102,236) 136,482 (111,655)
Cash flows from investing activities:      
Purchases of marketable securities (1,164,050) (1,089,953) (634,117)
Maturities of marketable securities 794,322 886,675 1,657,204
Purchases of property, plant and equipment (135,766) (65,078) (172,654)
Investment in privately held companies (18,044) (15,947) 0
Business combination, net of cash acquired (499,730) (6,658) (973,861)
Asset acquisitions, net of cash acquired (58,073) (411,421) 0
Other investing activities (744) 345 (1,000)
Net cash used in investing activities (1,082,085) (702,037) (124,428)
Cash flows from financing activities:      
Proceeds from issuance of convertible notes, net 0 1,125,547 729,477
Proceeds from exercise of common stock options 14,437 27,077 8,787
Proceeds from sale of common stock, net of issuance costs 0 861,701 0
Proceeds in connection with the Company's employee stock purchase plan 23,070 18,355 8,396
Payments on settlement of convertible notes 0 (150,054) (493,356)
Payments on construction loan (23,749) (1,250) 0
Other financing activities (5,286) (1,755) (123)
Net cash provided by financing activities 8,472 1,879,621 253,181
Effects of exchange rate changes on cash and cash equivalents 23 0 0
Net increase (decrease) in cash, cash equivalents and restricted cash (1,175,826) 1,314,066 17,098
Cash, cash equivalents and restricted cash at the beginning of period 1,491,594 177,528 160,430
Cash, cash equivalents and restricted cash at the end of period 315,768 1,491,594 177,528
Supplemental disclosure of non-cash investing and financing activities:      
Property, plant and equipment acquired but not paid 33,177 2,685 10,265
Unrealized (loss) gain on available-for-sale investments (2,162) 771 1,322
Issuance of 162,606, 136,559, and 86,532 shares of common stock to fund the Company’s 401(k) matching contribution for 2020, 2019, and 2018, respectively 22,934 12,007 7,409
Issuance of 2,159,716 shares of common stock upon settlement of convertible notes 0 0 (182,435)
Issuance of 10,581,429, 386,293, and 17,046,159 shares of common stock in 2021, 2020, and 2019, respectively, for business combination (1,355,170) (28,847) (1,407,080)
Business acquisition contingent consideration liability 350,348 0 0
Supplemental disclosure of cash flow information:      
Interest paid $ 10,735 $ 9,384 $ 5,128
v3.22.0.1
Consolidated Statements of Cash Flows (Parenthetical) - shares
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Statement of Cash Flows [Abstract]      
Issuance of shares of common stock to fund the Company's 401(k) matching contribution (in shares) 162,606 136,559 86,532
Shares issued to settle convertible notes (in shares) 2,159,716 2,159,716 2,159,716
Issuance of common stock to fund business combinations (in shares) 10,581,429 386,293 17,046,159
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
12 Months Ended
Dec. 31, 2021
Accounting Policies [Abstract]  
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Business
Exact Sciences Corporation (together with its subsidiaries, “Exact,” or the “Company”) was incorporated in February 1995. Exact is a leading global cancer diagnostics company. It has developed some of the most impactful tests in cancer screening and diagnostics, including Cologuard® and Oncotype DX®. Exact is currently working on the development of additional tests, with the goal of bringing new innovative cancer tests to patients throughout the world.
Basis of Presentation and Principles of Consolidation
The accompanying consolidated financial statements include the accounts of Exact Sciences Corporation and those of its wholly-owned subsidiaries and variable interest entities. All intercompany transactions and balances have been eliminated upon consolidation.
Use of Estimates
The preparation of the consolidated financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Critical accounting policies are those that affect the Company's financial statements materially and involve difficult, subjective or complex judgments by management, and actual results could differ from those estimates. These estimates include revenue recognition, valuation of intangible assets and goodwill, and accounting for income taxes among others.
The spread of the coronavirus (“COVID-19”) has affected many segments of the global economy, including the cancer screening and diagnostics industry. The Company assessed certain accounting matters that generally require consideration of forecasted financial information in context with the information reasonably available to the Company and the unknown future impacts of COVID-19 as of December 31, 2021 and through the date of the filing of this Annual Report on Form 10-K. The accounting matters assessed included, but were not limited to, the Company’s allowance for doubtful accounts and credit losses, marketable and non-marketable investments, software, and the carrying value of the goodwill and other long-lived assets. The Company’s future assessment of the magnitude and duration of COVID-19, as well as other factors, could result in additional material impacts to the Company’s consolidated financial statements in future reporting periods.
The pandemic and related precautionary measures began to materially disrupt the Company's operations in March 2020 and may continue to disrupt the business for an unknown period of time. As a result, the pandemic had a significant impact on the Company's revenues and operating results.
The ultimate impact of COVID-19 depends on factors beyond the Company’s knowledge or control, including the duration and severity of the outbreak, as well as third-party actions taken to contain its spread and mitigate its public health effects. As a result, the Company is unable to estimate the extent to which COVID-19 will negatively impact its financial results or liquidity.
Cash and Cash Equivalents
The Company considers cash on hand, demand deposits in a bank, money market funds, and all highly liquid investments with an original maturity of 90 days or less to be cash and cash equivalents.
Marketable Securities
Management determines the appropriate classification of debt securities at the time of purchase and re-evaluates such designation as of each balance sheet date. Debt securities carried at amortized cost are classified as held-to-maturity when the Company has the positive intent and ability to hold the securities to maturity. Debt securities not classified as held-to-maturity are classified as available-for-sale. Available-for-sale securities are carried at fair value. The unrealized gains and losses, net of tax, on the Company's debt securities are reported in other comprehensive income. Marketable equity securities are measured at fair value and the unrealized gains and losses, net of tax, are recognized in other income (expense) in the consolidated
statements of operations. The amortized cost of debt securities in this category is adjusted for amortization of premiums and accretion of discounts to maturity computed under the effective interest rate method. Such amortization is included in investment income, net. Realized gains and losses and declines in value as a result of credit losses on available-for-sale securities are included in the consolidated statements of operations as investment income, net. The cost of securities sold is based on the specific identification method. Interest and dividends on securities classified as available-for-sale are included in the consolidated statements of operations as investment income, net.
The Company’s investment policy limits investments to certain types of instruments issued by institutions with investment grade credit ratings and places restrictions on maturities and concentration by type and issuer. Investments in which the Company has the ability and intent, if necessary, to liquidate in order to support its current operations (including those with a contractual term greater than one year from the date of purchase) are classified as current.
The Company periodically evaluates its available-for-sale debt securities in unrealized loss positions to determine whether any impairment is a result of a credit loss or other factors. This evaluation includes, but is not limited to, significant quantitative and qualitative assessments and estimates regarding credit ratings, significance of a security’s loss position, adverse conditions specifically related to the security, and the payment structure of the security.
Allowance for Doubtful Accounts
The Company estimates an allowance for doubtful accounts against accounts receivable using historical collection trends, aging of accounts, current and future implications surrounding the ability to collect such as economic conditions, and regulatory changes. The allowance for doubtful accounts is evaluated on a regular basis and adjusted when trends, significant events, or other substantive evidence indicate that expected collections will be less than applicable accrual rates. At December 31, 2021 and 2020, the allowance for doubtful accounts recorded was not material to the Company's consolidated balance sheets. For the years ended December 31, 2021, 2020 and 2019, there was an immaterial amount of bad debt expense written off against the allowance and charged to operating expense.
Inventory
Inventory is stated at the lower of cost or net realizable value. The Company determines the cost of inventory using the first-in, first out method (“FIFO”). The Company estimates the recoverability of inventory by reference to internal estimates of future demands and product life cycles, including expiration. The Company periodically analyzes its inventory levels to identify inventory that may expire prior to expected sale, no longer meet quality specifications, or has a cost basis in excess of its estimated realizable value and records a charge to cost of sales for such inventory as appropriate.
Direct and indirect manufacturing costs incurred during process validation with probable future economic benefit are capitalized. Validation costs incurred for other research and development activities, which are not permitted to be sold, have been expensed to research and development in the Company’s consolidated statements of operations.
Property, Plant and Equipment
Property, plant and equipment are stated at cost and depreciated using the straight-line method over the assets’ estimated useful lives. Land is stated at cost and does not depreciate. Additions and improvements are capitalized, including direct and indirect costs incurred to validate equipment and bring to working conditions. Revalidation costs, including maintenance and repairs are expensed when incurred.
Software Development Costs
Costs related to internal use software, including hosted arrangements, are incurred in three stages: the preliminary project stage, the application development stage, and the post-implementation stage. Costs incurred during the preliminary project and post-implementation stages are expensed as incurred. Costs incurred during the application development stage that meet the criteria for capitalization are capitalized and amortized, when the software is ready for its intended use, using the straight‑line basis over the estimated useful life of the software, or the duration of the hosting agreement.
Investments in Privately Held Companies
The Company determines whether its investments in privately held companies are debt or equity based on their characteristics, in accordance with the applicable accounting guidance for such investments. The Company also evaluates the investee to determine if the entity is a variable interest entity (“VIE”) and, if so, whether the Company is the primary beneficiary of the VIE, in order to determine whether consolidation of the VIE is required. If consolidation is not required and the Company does not have voting control of the entity, the investment is evaluated to determine if the equity method of accounting should be applied. The equity method applies to investments in common stock or in substance common stock where the Company exercises significant influence over the investee.
Investments in privately held companies determined to be equity securities are accounted for as non-marketable securities. The Company adjusts the carrying value of its non-marketable equity securities for changes from observable transactions for identical or similar investments of the same issuer, less impairment. All gains and losses on non-marketable equity securities, realized and unrealized, are recognized in investment income, net in the consolidated statements of operations.
Investments in privately held companies determined to be debt securities are accounted for as available-for-sale or held-to-maturity securities, in accordance with the applicable accounting guidance for such investments.
Derivative Financial Instruments
The Company hedges a portion of its foreign currency exposures related to outstanding monetary assets and liabilities using foreign currency forward contracts. The foreign currency forward contracts are included in prepaid expenses and other current assets or in accrued liabilities in the consolidated balance sheets, depending on the contracts’ net position. These contracts are not designated as hedges, and as a result, changes in their fair value are recorded in other income (expense) in the consolidated statements of operations.
Business Combinations and Asset Acquisitions
Business Combinations are accounted for under the acquisition method in accordance with Accounting Standards Codification (“ASC”) 805, Business Combinations. The acquisition method requires identifiable assets acquired and liabilities assumed and any non-controlling interest in the business acquired be recognized and measured at fair value on the acquisition date, which is the date that the acquirer obtains control of the acquired business. The amount by which the fair value of consideration transferred as the purchase price exceeds the net fair value of assets acquired and liabilities assumed is recorded as goodwill. Acquisitions that do not meet the definition of a business combination under ASC 805 are accounted for as asset acquisitions. Asset acquisitions are accounted for by allocating the cost of the acquisition to the individual assets acquired and liabilities assumed on a relative fair value basis. Goodwill is not recognized in an asset acquisition with any consideration in excess of net assets acquired allocated to acquired assets on a relative fair value basis. Transaction costs are expensed in a business combination and are considered a component of the cost of the acquisition in an asset acquisition.
Intangible Assets
Purchased intangible assets are recorded at fair value. The Company uses a discounted cash flow model to value intangible assets. The discounted cash flow model requires assumptions about the timing and amount of future net cash flows, risk, the cost of capital, terminal values and market participants.
Patent costs are capitalized as incurred, only if the Company determines that there is some probable future economic benefit derived from the transaction. A capitalized patent is amortized over its estimated useful life, beginning when such patent is approved. Capitalized patent costs are expensed upon disapproval, upon a decision by the Company to no longer pursue the patent or when the related intellectual property is either sold or deemed to be no longer of value to the Company. The Company determined that all patent costs incurred during the years ended December 31, 2021, 2020 and 2019 should be expensed and not capitalized as the future economic benefit derived from the patent costs incurred cannot be determined.
Acquired In-process Research and Development ("IPR&D")
Acquired IPR&D represents the fair value assigned to research and development assets that have not reached technological feasibility. The value assigned to acquired IPR&D is determined by estimating the costs to develop the acquired technology into commercially viable products, estimating the resulting revenues from the projects and discounting the net cash flows to present value. The revenues and cost projections used to value acquired IPR&D are, as applicable, reduced based on the probability of success. IPR&D projects acquired in a business combination that are not complete are capitalized and accounted for as indefinite-lived intangible assets until completion or abandonment of the related research and development ("R&D") efforts. Upon successful completion of the project, the capitalized amount is amortized over its estimated useful life. If a project is abandoned, all remaining capitalized amounts are written off immediately. There are often major risks and uncertainties associated with IPR&D projects as the Company is required to obtain regulatory approvals in order to be able to market the resulting products. Such approvals require completing clinical trials that demonstrate the products effectiveness. Consequently, the eventual realized value of the IPR&D project may vary from its fair value at the date of acquisition, and IPR&D impairment charges may occur in future periods.
Capitalized IPR&D projects are tested for impairment annually and whenever events or changes in circumstances indicate that the carrying amount may not be recoverable. The Company considers various factors for potential impairment, including the current legal and regulatory environment, current and future strategic initiatives and the competitive landscape. Adverse clinical trial results, significant delays in obtaining marketing approval, the inability to bring a product to market and the introduction or advancement of competitors' products could result in partial or full impairment of the related intangible assets.
Contingent Consideration
Certain of the Company’s business combinations involve potential payment of future consideration that is contingent upon the achievement of certain regulatory and product development milestones being achieved. The Company records contingent consideration at fair value at the date of acquisition based on the consideration expected to be transferred, estimated as the probability-weighted future cash flows, discounted back to present value. The fair value of contingent consideration is measured using projected probabilities of success, projected payment dates, present value-factors, and projected revenues (for revenue-based considerations). Changes in probabilities of success, present-value factors, and projected payment dates may result in adjustments to the fair value measurements. Contingent consideration is remeasured each reporting period using Level 3 inputs, and the change in fair value, including accretion for the passage of time, is recognized as income or expense within general and administrative expenses on the Company’s consolidated statements of operations. Contingent consideration payments made soon after the acquisition date are classified as investing activities in the consolidated statements of cash flows. Contingent consideration payments not made soon after the acquisition date that are related to the acquisition date fair value are reported as financing activities in the consolidated statements of cash flows, and amounts paid in excess of the original acquisition date fair value are reported as operating activities in the consolidated statements of cash flows.
Goodwill
The Company evaluates goodwill for possible impairment in accordance with ASC 350 on an annual basis during the fourth quarter, or more frequently if events or changes in circumstances indicate that the carrying amount of such assets may not be recoverable. Qualitative factors considered in this assessment include industry and market conditions, overall financial performance, and other relevant events and factors affecting the Company's business. Based on the qualitative assessment, if it is determined that the fair value of goodwill is more likely than not to be less than its carrying amount, the fair value of a reporting unit will be calculated and compared with its carrying amount and an impairment charge will be recognized for the amount that the carrying value exceeds the fair value.
Impairment of Long-Lived Assets
The Company evaluates the fair value of long-lived assets, which include property, plant and equipment, finite-lived intangible assets, and investments in privately held companies, for impairment whenever events or changes in circumstances indicate that the carrying amounts of the assets may not be fully recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to future undiscounted net cash flows expected to be generated by the asset. If such assets are considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the assets exceeds the fair value of the assets. Assets to be disposed of are reported at the lower of the carrying amount or fair value less costs to sell.
Accounting for Government Assistance
There is no GAAP that specifically addresses the accounting by business entities for government assistance and tax credits. Absent authoritative accounting standards, interpretative guidance issued and commonly applied by financial statement preparers allows for the selection of accounting policies amongst acceptable alternatives. Based on the facts and circumstances of the government assistance and tax credits received by the Company as discussed below, the Company determined it most appropriate to account for the these transactions by analogy to International Accounting Standards 20 (“IAS 20”), Accounting for Government Grants and Disclosure of Government Assistance. IAS 20 permits for the recognition in earnings either separately under a general heading such as other income, or as a reduction of the related expenses.
In April 2020, the Company received $23.7 million from the United States Department of Health and Human Services (“HHS”) as a distribution from the Public Health and Social Services Emergency Fund provided for in the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”). The fund payments are grants, not loans, and HHS will not require repayment provided the funds are utilized to offset expenses incurred to address COVID-19 or to replace lost revenues. The Company accepted the terms and conditions of the grant in May 2020 and recognized the entire $23.7 million during the year ended December 31, 2020, due to lost revenue attributable to COVID-19. The Company has elected to recognize government grant income separately to present a clearer distinction in its consolidated financial statements between its operating income and the amount of income resulting from the CARES Act grant received. The Company believes this presentation method promotes greater comparability amongst all periods presented. Accordingly, the $23.7 million grant recognized during the year ended December 31, 2020 was reflected in other operating income in the consolidated statement of operations and as an operating activity in the consolidated statement of cash flows.
In December 2021 the Company entered into an amended agreement with the Wisconsin Economic Development Corporation (“WEDC”) to earn refundable tax credits on the condition of certain capital investment and job creation requirements. The Company has elected to recognize the tax credits as a reduction of the related expenses, as they are earned through the performance of the Company’s ongoing operating activities.
Net Loss Per Share
Basic net loss per common share was determined by dividing net loss applicable to common stockholders by the weighted average common shares outstanding during the period. Basic and diluted net loss per share is the same because all outstanding common stock equivalents have been excluded, as they are anti-dilutive as a result of the Company’s losses.
The following potentially issuable common shares were not included in the computation of diluted net loss per share because they would have an anti-dilutive effect due to net losses for each period:
December 31,
(In thousands)202120202019
Shares issuable in connection with acquisitions45 157 — 
Shares issuable upon exercise of stock options2,284 2,231 2,700 
Shares issuable upon the release of restricted stock awards4,321 3,968 3,801 
Shares issuable upon the release of performance share units878 619 583 
Shares issuable upon conversion of convertible notes20,309 20,309 12,196 
27,837 27,284 19,280 
Accounting for Stock-Based Compensation
The Company requires all share-based payments to employees, including grants of employee stock options, restricted stock, restricted stock units, shares purchased under an employee stock purchase plan (if certain parameters are not met), and performance share units to be recognized in the financial statements based on their grant date fair values. Forfeitures of any share-based awards are recognized as they occur.
The fair values and recognition of the Company's share-based payment awards are determined as follows:
The fair value of each service-based option award is estimated on the date of grant using the Black-Scholes option-pricing model. The Black-Scholes pricing model utilizes the following assumptions:
Expected Term—Expected life of an option award is the average length of time over which the Company expects employees will exercise their options, which is based on historical experience with similar grants.
Expected Volatility—Expected volatility is based on the Company’s historical stock volatility data over the expected term of the awards.
Risk-Free Interest Rate—The Company bases the risk-free interest rate on the implied yield currently available on U.S. Treasury zero-coupon issues with an equivalent expected term.
The estimated fair value of these awards is recognized to expense using the straight-line method over the expected term.
The fair value of service-based awards for each restricted stock unit award is determined on the date of grant using the closing stock price on that day. The estimated fair value of these awards is recognized to expense using the straight-line method over the vesting period.
The fair value of performance-based equity awards is determined on the date of grant using the closing stock price on that day. The expense recognized each period is also dependent on the probability of what performance conditions will be met which is determined by management's evaluation of internal and external factors. Determining the appropriate amount to expense based on the anticipated achievement of the stated goals requires judgment, including forecasting future financial results. The estimate of the timing of the expense recognition is revised periodically based on the probability of achieving the goals and adjustments are made as appropriate. The cumulative impact of any revision is reflected in the period of the change. If the financial performance targets and operational milestones are not achieved, the award would not vest resulting in no stock-based compensation being recognized and any previously recognized stock-based compensation expense being reversed.
Research and Development Costs
Research and development costs are expensed as incurred. These expenses include the costs of the Company's proprietary research and development efforts, as well as costs of IPR&D projects acquired as part of an asset acquisition that have no alternative future use. Upfront and milestone payments due to third parties in connection with research and development collaborations prior to regulatory approval are expensed as incurred. Milestone payments due to third parties upon, or subsequent to, regulatory approval are capitalized and amortized into research and development costs over the shorter of the remaining license or product patent life, when there are no corresponding revenues related to the license or product. Nonrefundable advance payments for goods and services that will be used in future research and development activities are expensed when the activity has been performed or when the goods have been received, rather than when the payment is made.
The Company incurred research and development expenses of $385.6 million, $554.1 million, and $139.7 million during the years ended December 31, 2021, 2020, and 2019, respectively, including IPR&D of $85.3 million and $412.6 million that was acquired in asset acquisitions that had no alternative future use during the years ended December 31, 2021 and 2020, respectively. The value of the acquired IPR&D that was expensed was determined by identifying those acquired specific IPR&D projects that would be continued and which (a) were incomplete and (b) had no alternative future use. Acquired IPR&D assets that are acquired in an asset acquisition and which have no alternative future use are classified as an investing cash outflow in the consolidated statements of cash flows.
Advertising Costs
The Company expenses the costs of media advertising at the time the advertising takes place. The Company expensed approximately $144.0 million, $97.6 million, and $90.5 million of media advertising during the years ended December 31, 2021, 2020, and 2019, respectively, which is recorded in sales and marketing expenses on the Company's consolidated statements of operations.
Fair Value Measurements
The Financial Accounting Standards Board (“FASB”) has issued authoritative guidance that requires fair value to be based on the assumptions market participants would use when pricing an asset or liability and establishes a fair value hierarchy that prioritizes the information used to develop those assumptions. Under that standard, fair value measurements are separately disclosed by level within the fair value hierarchy. The fair value hierarchy establishes and prioritizes the inputs used to measure fair value that maximizes the use of observable inputs and minimizes the use of unobservable inputs. Observable inputs are inputs that reflect the assumptions that market participants would use in pricing the asset or liability developed based on market data obtained from sources independent of the Company. Unobservable inputs are inputs that reflect the Company’s assumptions about the assumptions market participants would use in pricing the asset or liability developed based on the best information available in the circumstances.
Leases
The Company acts as lessee in its lease agreements, which include operating leases for corporate offices, laboratory space, warehouse space, vehicles and certain laboratory and office equipment, and finance leases for certain equipment and vehicles.
The Company determines whether an arrangement is, or contains, a lease at inception. At the beginning of fiscal year 2019, the company adopted ASC 842. The Company records the present value of lease payments as right-of-use (“ROU”) assets and lease liabilities on the consolidated balance sheets. ROU assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent an obligation to make lease payments based on the present value of lease payments over the lease term. Classification of lease liabilities as either current or non-current is based on the expected timing of payments due under the Company’s obligations.
As most of the Company’s leases do not provide an implicit interest rate, the Company uses its incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. The incremental borrowing rate is the rate of interest that a lessee would have to pay to borrow on a collateralized basis over a similar term and at an amount equal to the lease payments in a similar economic environment. The Company calculates its incremental borrowing rates for specific lease terms, used to discount future lease payments, as a function of the US. Treasury rate and an indicative Moody's rating for operating leases or finance leases.
The ROU asset also consists of any lease incentives received. The lease terms used to calculate the ROU asset and related lease liability include options to extend or terminate the lease when it is reasonably certain that the Company will exercise that option. “Reasonably certain” is assessed internally based on economic, industry, company, strategic and contractual factors. The leases have remaining lease terms of 1 year to 15 years, some of which include options to extend the lease for up to 10 years, and some of which include options to terminate the lease within 1 year. Operating lease expense and amortization of finance lease ROU assets are recognized on a straight-line basis over the lease term as an operating expense. Finance lease interest expense is recorded as interest expense on the Company’s consolidated statements of operations.
The Company accounts for leases acquired in business combinations by measuring the lease liability at the present value of the remaining lease payments as if the acquired lease were a new lease for the Company. This measurement includes recognition of a lease intangible for any below-market terms present in the leases acquired. The below-market lease intangible is included in the ROU asset on the consolidated balance sheets and are amortized over the remaining lease term. The Company has not acquired any leases with above-market terms.
The Company has taken advantage of certain practical expedients offered to registrants at adoption of ASC 842. The Company does not apply the recognition requirements of ASC 842 to short-term leases. Instead, those lease payments are recognized in profit or loss on a straight-line basis over the lease term. Further, as a practical expedient, all lease contracts are accounted for as one single lease component, as opposed to separating lease and non-lease components to allocate the consideration within a single lease contract.
Revenue Recognition
Revenues are recognized when the satisfaction of the performance obligation occurs, in an amount that reflects the consideration the Company expects to collect in exchange for those services. The Company’s revenue is primarily generated by its laboratory testing services utilizing its Cologuard, Oncotype DX, and COVID-19 tests. The services are completed upon release of a patient’s test result to the ordering healthcare provider. To determine revenue recognition for the arrangements that
the Company determines are within the scope of ASC 606, Revenue from Contracts with Customers, the Company performs the following five steps: (1) identify the contract(s) with a customer, (2) identify the performance obligations in the contract, (3) determine the transaction price, (4) allocate the transaction price to the performance obligations in the contract and (5) recognize revenue when (or as) the entity satisfies a performance obligation.
The key aspects considered by the Company include the following:
Contracts—The Company’s customer is primarily the patient, but the Company does not enter into a formal reimbursement contract with a patient. The Company establishes a contract with a patient in accordance with other customary business practices, which is the point in time an order is received from a provider and a patient specimen has been returned to the laboratory for testing. Payment terms are a function of a patient’s existing insurance benefits, including the impact of coverage decisions with Center for Medicare & Medicaid Services (“CMS”) and applicable reimbursement contracts established between the Company and payers. However, when a patient is considered self-pay, the Company requires payment from the patient prior to the commencement of the Company’s performance obligations. The Company’s consideration can be deemed variable or fixed depending on the structure of specific payer contracts, and the Company considers collection of such consideration to be probable to the extent that it is unconstrained.
Under the Company’s Laboratory Service Agreements (“LSA”) and Laboratory Reference Agreements (“LRA”) the Company contracts with a direct bill payer who is the customer for an agreed upon amount of laboratory testing services for a specified amount of time at a fixed reimbursement rate, and certain of the Company’s agreements obligate the customer to pay for testing services prior to result.
Performance obligations—A performance obligation is a promise in a contract to transfer a distinct good or service (or a bundle of goods or services) to the customer.  The Company’s contracts have a single performance obligation, which is satisfied upon rendering of services, which culminates in the release of a patient’s test result to the ordering healthcare provider. Or, in the context of some of the Company’s agreements, the satisfaction of the performance obligation occurs when a specimen sample is not returned to the laboratory for processing before the end of the allotted testing window. The Company elects the practical expedient related to the disclosure of unsatisfied performance obligations, as the duration of time between providing testing supplies, the receipt of a sample, and the release of a test result to the ordering healthcare provider is far less than one year.
Transaction price—The transaction price is the amount of consideration that the Company expects to collect in exchange for transferring promised goods or services to a customer, excluding amounts collected on behalf of third parties (for example, some sales taxes). The consideration expected to be collected from a contract with a customer may include fixed amounts, variable amounts, or both.
Fixed consideration is derived from the Company’s LSA, LRA, and direct bill payer contracts that exist between the Company and the direct bill payers. The contracted reimbursement rate is deemed to be fixed as the Company expects to fully collect all amounts billed under these relationships. Variable consideration is primarily derived from payer and patient billing and can result due to several factors such as the amount of contractual adjustments, any patient co-payments, deductibles or patient adherence incentives, the existence of secondary payers, and claim denials.
The Company estimates the amount of variable consideration using the expected value method, which represents the sum of probability-weighted amounts in a range of possible consideration amounts. When estimating the amount of variable consideration, the Company considers several factors, such as historical collections experience, patient insurance eligibility and payer reimbursement contracts.
The Company limits the amount of variable consideration included in the transaction price to the unconstrained portion of such consideration. In other words, the Company recognizes revenue up to the amount of variable consideration that is not subject to a significant reversal until additional information is obtained or the uncertainty associated with the additional payments or refunds is subsequently resolved. Differences between original estimates and subsequent revisions, including final settlements, represent changes in the estimate of variable consideration and are included in the period in which such revisions are made.
The Company monitors its estimates of transaction price to depict conditions that exist at each reporting date. If the Company subsequently determines that it will collect more or less consideration than it originally estimated for a contract with a patient, it will account for the change as an increase or decrease in the estimate of the transaction price (i.e., an upward or downward revenue adjustment) in the period identified.
When the Company does not have significant historical experience or that experience has limited predictive value, the constraint over estimates of variable consideration may result in no revenue being recognized upon completion of the performance obligations associated with the Company's tests, with recognition, generally occurring at the date of cash receipt.
Allocate transaction price—The transaction price is allocated entirely to the performance obligation contained within the contract with a customer.
Point in time recognition—The Company’s single performance obligation is satisfied at a point in time. That point in time is defined as the date the Company releases a result to the ordering healthcare provider, or, in the context of some of the Company's agreements, that point in time could be the date the allotted testing window ends if a specimen sample is not returned to the laboratory for processing. The point in time in which revenue is recognized by the Company signifies fulfillment of the performance obligation to the patient or direct bill payer.
Contract Balances—The timing of revenue recognition, billings and cash collections results in billed accounts receivable and deferred revenue on the consolidated balance sheets. Generally, billing occurs subsequent to the release of a patient’s test result to the ordering healthcare provider, resulting in an account receivable. However, the Company sometimes receives advance payment from a patient or a direct bill payer before a test result is completed, resulting in deferred revenue. The deferred revenue recorded is recognized as revenue at the point in time results are released to the patient’s healthcare provider. Or, in the context of some of the Company’s agreements, the satisfaction of the performance obligation occurs when a specimen sample is not returned to the laboratory for processing before the end of the allotted testing window.
Practical Expedients—The Company does not adjust the transaction price for the effects of a significant financing component, as at contract inception, the Company expects the collection cycle to be one year or less.
The Company expenses sales commissions when incurred because the amortization period would have been one year or less. These costs are recorded within sales and marketing expenses in the Company’s consolidated statements of operations.
The Company incurs certain other costs that are incurred regardless of whether a contract is obtained. Such costs are primarily related to legal services and patient communications (e.g. adherence reminder letters). These costs are expensed as incurred and recorded within general and administrative expenses in the Company’s consolidated statements of operations.
Foreign Currency Transactions
The functional currency for most of the Company’s international subsidiaries is the U.S. dollar. In these instances where the functional currency differs from the local currency, monetary assets and liabilities are remeasured at the current period-end exchange rate, while non-monetary assets and liabilities are remeasured at the historical rate. The gains and losses as a result of exchange rate adjustments of these subsidiaries are recognized in the consolidated statements of operations. Net foreign currency transaction gains or losses were not material to the consolidated statements of operations for the periods presented.
For the Company's international subsidiaries where the functional currency is other than the U.S. dollar, assets and liabilities are translated into the U.S. dollar at the current period-end exchange rate. Revenue and expense items are translated at the average exchange rates for the period. The cumulative adjustments resulting from the translation of the financial statements into the U.S. dollar are included in the Company's consolidated balance sheet as a component of accumulated other comprehensive income (loss).
Concentration of Credit Risk
Financial instruments that subject the Company to credit risk consist of cash, cash equivalents and marketable securities. As of December 31, 2021, the Company had cash and cash equivalents deposited in financial institutions in which the balances exceed the federal government agency insured limit of $250,000 by approximately $234.9 million. The Company has not experienced any losses in such accounts and management believes it is not exposed to any significant credit risk.
Through December 31, 2021, the Company’s revenues have been primarily derived from the sale of Cologuard, Oncotype DX, and COVID-19 tests. The following is a breakdown of revenue and accounts receivable from major payers:
% Revenue for the years ended December 31,% Accounts Receivable at December 31,
Major Payer202120202019202120202019
Centers for Medicare and Medicaid Services20%21%29%11%14%19%
UnitedHealthcare11%10%13%8%7%7%
State of Wisconsin8%12%—%9%22%—%
Tax Positions
A valuation allowance to reduce the deferred tax assets is reported if, based on the weight of the evidence, it is more likely than not that some portion or all of the deferred tax assets will not be realized. The Company has incurred significant losses since its inception and due to the uncertainty of the amount and timing of future taxable income, the Company has determined that a $262.2 million and $293.4 million valuation allowance at December 31, 2021 and 2020 is necessary to reduce the tax assets to the amount that is more likely than not to be realized. The change in valuation allowance as of December 31, 2021 and 2020 was a decrease of $31.2 million and an increase of $98.0 million, respectively. An income tax benefit of $246.9 million was recorded primarily as a result of the change in the deferred tax asset valuation allowance resulting from the acquisition of Thrive Earlier Detection Corporation (“Thrive”). Due to the existence of the valuation allowance, future changes in the Company's unrecognized tax benefits will not impact the Company's effective tax rate.
Recent Accounting Pronouncements
Recently Adopted Accounting Pronouncements
In August 2020, The FASB issued Accounting Standards Update (“ASU”) No. 2020-06, Debt – Debt with Conversion and Other Options (subtopic 470-20) and Derivatives and Hedging – Contracts in Entity’s Own Equity (Subtopic 815-40). This update simplifies the accounting for convertible debt instruments by removing the beneficial conversion and cash conversion separation models for convertible instruments. Under the update, the embedded conversion features are no longer separated from the host contract for convertible instruments with conversion features that are not required to be accounted for as derivatives or that do not result in substantial premiums accounted for as paid-in capital. The update also amends the accounting for certain contracts in an entity’s own equity that are currently accounted for as derivatives because of specific settlement provisions. In addition, ASU 2020-06 requires the application of the if-converted method for calculating diluted earnings per share and the treasury stock method will no longer be available. This standard may be adopted through either a modified retrospective method of transition or a full retrospective method of transition. The amendments in this update are effective for fiscal years beginning after December 15, 2021, including interim periods within those fiscal years. Early adoption is permitted, but no earlier than fiscal years beginning after December 15, 2020.
The Company adopted the standard on January 1, 2021 through application of the full retrospective method of transition. This method of adoption was applied to enhance comparability between the periods presented in the Company’s financial statements. The Company applied the standard to convertible notes outstanding as of the date of the first offering of the Company’s outstanding convertible notes as discussed in Note 10.
The Company’s convertible debt instruments are now accounted for as a single liability measured at its amortized cost. The notes are no longer bifurcated between debt and equity, rather accounted for entirely as debt at face value net of any discount or premium and issuance costs. Interest expense is comprised of (1) cash interest payments, (2) amortization of any debt discounts or premiums based on the original offering, and (3) amortization of any debt issuance costs. Gain or loss on extinguishment of convertible notes is calculated as the difference between the (i) fair value of the consideration transferred and (ii) the sum of the carrying value of the debt at the time of repurchase.
As of January 1, 2019, the cumulative effect of adoption resulted in an increase in the net carrying amount of convertible notes, net, of $233.7 million, a decrease in additional-paid-in-capital of $260.2 million, a decrease in accumulated deficit of $26.6 million, and an increase to net deferred tax assets of $55.7 million offset by a corresponding increase of $55.7 million in the valuation allowance. For the year ended December 31, 2019, interest expense in the consolidated statement of operations increased by $137.7 million as a result of a decrease in amortization of debt discounts, premiums, and issuance costs of $39.5
million, which was offset by an increase in loss on extinguishment of $177.1 million in connection with the extinguishment of $493.4 million face value of the 2025 Notes. Income tax benefit increased by $8.5 million and net loss per share, basic and diluted, increased by $0.98 per share. For the year ended December 31, 2020, interest expense in the condensed consolidated statement of operations decreased by $28.1 million as a result of a decrease in amortization of debt discounts, premiums, and issuance costs of $70.9 million, which was offset by an increase in loss on extinguishment of $42.8 million in connection with the extinguishment of $100.0 million face value of the 2025 Notes. Income tax benefit decreased by $3.1 million and net loss per share, basic and diluted, decreased by $0.17 per share.
In November 2021, the FASB issued ASU No. 2021-10, Government Assistance (Topic 832). This update requires certain annual disclosures about transactions with a government that are accounted for by applying a grant or contribution model by analogy. The amendments in this update are effective for fiscal years beginning after December 15, 2021. Early application of the amendments is permitted. The Company early adopted these disclosure requirements and applied them to its disclosure of the WEDC tax credits earned during fiscal year 2021 and the funding received as part of the CARES Act in 2020.
Recently Issued Accounting Pronouncements Not Yet Adopted
In October 2021, The FASB issued ASU No. 2021-08, Business Combinations (Topic 805). This update requires that an entity (acquirer) recognize and measure contract assets and contract liabilities acquired in a business combination in accordance with ASC 606. This differs from the current requirement to measure contract assets and contract liabilities acquired in a business combination at fair value. The amendments in this update should be applied prospectively, and are effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption is permitted, Including adoption in an interim period. This ASU will only impact the Company if it acquires another entity through a business combination.
Guarantees and Indemnifications
The Company, as permitted under Delaware law and in accordance with its bylaws, indemnifies its officers and directors for certain events or occurrences, subject to certain limits, while the officer or director is or was serving at the Company’s request in such capacity. The term of the indemnification period is for the officer’s or director’s lifetime. The maximum amount of potential future indemnification is unlimited; however, the Company has a directors and officers insurance policy that limits its exposure and may enable it to recover a portion of any future amounts paid. The Company believes the fair value of these indemnification agreements is minimal. Accordingly, the Company has not recorded any liabilities for these agreements as of December 31, 2021 and 2020.
Reclassifications
Certain prior year amounts have been reclassified to conform to the current year presentation in the consolidated financial statements and accompanying notes to the consolidated financial statements.
v3.22.0.1
REVENUE
12 Months Ended
Dec. 31, 2021
Revenue from Contract with Customer [Abstract]  
REVENUE REVENUE
 The following table presents the Company's revenues disaggregated by revenue source:
Year Ended December 31,
(In thousands)202120202019
Screening
Medicare Parts B & C$438,646 $365,471 $404,331 
Commercial569,944 409,671 368,006 
Other53,718 39,925 37,783 
Total Screening1,062,308 815,067 810,120 
Precision Oncology
Medicare Parts B & C$195,069 $157,166 $24,325 
Commercial189,198 186,043 29,976 
International109,913 77,484 11,444 
Other67,496 19,800 428 
Total Precision Oncology561,676 440,493 66,173 
COVID-19 Testing$143,103 $235,831 $— 
Total$1,767,087 $1,491,391 $876,293 
Screening revenue primarily includes laboratory service revenue from the Cologuard test while Precision Oncology revenue primarily includes laboratory service revenue from global Oncotype products.
The downward adjustment to revenue from changes in transaction price on tests completed in the prior year was $11.8 million for the year ended December 31, 2021 and revenue recognized from changes in transaction price on tests completed in the prior year was $9.6 million and $9.9 million for the years ended December 31, 2020 and 2019, respectively.
The Company had deferred revenue of $1.0 million and $25.0 million as of December 31, 2021 and 2020, respectively. As of December 31, 2020, $24.2 million of the Company’s deferred revenue balance is a result of the billing terms pursuant to the existing COVID-19 LSAs with customers. Deferred revenue is reported in other current liabilities in the Company’s consolidated balance sheets.
Revenue recognized for the years ended December 31, 2021 and 2020, which was included in the deferred revenue balance at the beginning of each period was $24.6 million and $0.2 million, respectively. Of the $24.6 million of revenue recognized for the year ended December 31, 2021, which was included in the deferred revenue balance at the beginning of the period, $24.2 million related to COVID-19 testing.
v3.22.0.1
MARKETABLE SECURITIES
12 Months Ended
Dec. 31, 2021
Cash and Cash Equivalents [Abstract]  
MARKETABLE SECURITIES MARKETABLE SECURITIES
The following table sets forth the Company’s cash, cash equivalents, restricted cash, and marketable securities at December 31, 2021 and 2020:
December 31,
(In thousands)20212020
Cash, cash equivalents, and restricted cash
Cash and money market$247,335 $901,294 
Cash equivalents68,136 589,994 
Restricted cash (1)297 306 
Total cash, cash equivalents and restricted cash315,768 1,491,594 
Marketable securities
Available-for-sale debt securities$711,669 $347,178 
Equity securities3,336 1,521 
Total marketable securities715,005 348,699 
Total cash and cash equivalents, restricted cash and marketable securities$1,030,773 $1,840,293 
_________________________________
(1) Restricted cash is included in other long-term assets on the consolidated balance sheets.
Available-for-sale debt securities at December 31, 2021 consisted of the following:
(In thousands)Amortized CostGains in Accumulated Other Comprehensive Income (Loss) (1)Losses in Accumulated Other Comprehensive Income (Loss) (1)Estimated Fair Value
Cash equivalents
U.S. government agency securities$3,543 $— $— $3,543 
Commercial paper64,593 — — 64,593 
Total cash equivalents68,136 — — 68,136 
Marketable securities
Corporate bonds$313,634 $13 $(493)$313,154 
U.S. government agency securities250,793 — (873)249,920 
Asset backed securities94,565 (107)94,460 
Certificates of deposit47,147 (10)47,139 
Commercial paper6,996 — — 6,996 
Total marketable securities713,135 17 (1,483)711,669 
Total available-for-sale debt securities$781,271 $17 $(1,483)$779,805 
_________________________________
(1) Gains and losses in accumulated other comprehensive income (loss) ("AOCI") are reported before tax impact.
Available-for-sale debt securities at December 31, 2020 consisted of the following:
(In thousands)Amortized CostGains in Accumulated Other Comprehensive Income (Loss) (1)Losses in Accumulated Other Comprehensive Income (Loss) (1)Estimated Fair Value
Cash equivalents
U.S. government agency securities$589,986 $$— $589,994 
Total cash equivalents589,986 — 589,994 
Marketable securities
Corporate bonds$132,301 $612 $— $132,913 
U.S. government agency securities207,119 52 — 207,171 
Asset backed securities7,070 24 — 7,094 
Total marketable securities346,490 688 — 347,178 
Total available-for-sale debt securities$936,476 $696 $— $937,172 
_________________________________
(1) Gains and losses in AOCI are reported before tax impact.
The following table summarizes contractual underlying maturities of the Company’s available-for-sale debt securities at December 31, 2021:
Due one year or lessDue after one year through five years
(In thousands)CostFair ValueCostFair Value
Cash equivalents
Commercial paper$64,593 $64,593 $— $— 
U.S. government agency securities3,543 3,543 — — 
Total cash equivalents68,136 68,136 — — 
Marketable securities
U.S. government agency securities$48,113 $48,046 $202,680 $201,874 
Corporate bonds180,114 180,008 133,520 133,146 
Asset backed securities— — 94,565 94,460 
Certificates of deposit47,147 47,139 — — 
Commercial paper6,996 6,996 — — 
Total marketable securities282,370 282,189 430,765 429,480 
Total available-for-sale securities$350,506 $350,325 $430,765 $429,480 
The following table summarizes the gross unrealized losses and fair values of available-for-sale debt securities in an unrealized loss position as of December 31, 2021, aggregated by investment category and length of time those individual securities have been in a continuous unrealized loss position:
Less than 12 months12 months or greaterTotal
(In thousands)Fair ValueGross Unrealized LossFair ValueGross Unrealized LossFair ValueGross Unrealized Loss
Marketable securities
Corporate bonds$299,448 $(493)$— $— $299,448 $(493)
U.S. government agency securities249,921 (873)— — 249,921 (873)
Asset backed securities89,990 (107)— — 89,990 (107)
Certificates of deposit24,137 (10)— — 24,137 (10)
Total available-for-sale securities$663,496 $(1,483)$— $— $663,496 $(1,483)
There were no available-for-sale debt securities in an unrealized loss position as of December 31, 2020.
The Company evaluates investments that are in an unrealized loss position for impairment as a result of credit loss. It was determined that no credit losses exist as of December 31, 2021 and 2020 because the change in market value for those securities in an unrealized loss position has resulted from fluctuating interest rates rather than a deterioration of the credit worthiness of the issuers.
The gains and losses recorded are included in investment income, net in the Company’s consolidated statements of operations. The gains and losses recorded on available-for-sale debt securities and equity securities were not significant for the years ended December 31, 2021, 2020, and 2019.
v3.22.0.1
INVENTORY
12 Months Ended
Dec. 31, 2021
Inventory Disclosure [Abstract]  
INVENTORY INVENTORY
Inventory consisted of the following:
December 31,
(In thousands)20212020
Raw materials$51,321 $43,083 
Semi-finished and finished goods53,673 49,182 
Total inventory$104,994 $92,265 
v3.22.0.1
PROPERTY, PLANT AND EQUIPMENT
12 Months Ended
Dec. 31, 2021
Property, Plant and Equipment [Abstract]  
PROPERTY, PLANT AND EQUIPMENT PROPERTY, PLANT AND EQUIPMENT
The carrying value and estimated useful lives of property, plant and equipment are as follows:
December 31,
(In thousands)Estimated Useful Life20212020
Property, plant and equipment
Landn/a$4,716 $4,466 
Leasehold and building improvements(1)147,083 117,865 
Land improvements15 years5,206 4,864 
Buildings
30 - 40 years
210,560 200,980 
Computer equipment and computer software3 years109,119 75,519 
Laboratory equipment
3 - 10 years
189,748 142,110 
Furniture and fixtures
3 - 10 years
28,293 24,968 
Assets under constructionn/a100,339 18,751 
Property, plant and equipment, at cost795,064 589,523 
Accumulated depreciation(214,816)(137,537)
Property, plant and equipment, net$580,248 $451,986 
_________________________________
(1) Lesser of remaining lease term, building life, or estimated useful life.
Depreciation expense for the years ended December 31, 2021, 2020, and 2019 was $85.3 million, $70.0 million, and $34.2 million, respectively.
At December 31, 2021, the Company had $100.3 million of assets under construction, which consisted of $41.5 million in buildings under construction, $27.6 million in leasehold improvements, $19.8 million in laboratory equipment under construction, $10.6 million of capitalized costs related to software projects, $0.6 million in land improvements, and $0.2 million in furniture and fixtures. Depreciation will begin on these assets once they are placed into service upon completion in 2022 and 2023.
v3.22.0.1
INTANGIBLE ASSETS AND GOODWILL
12 Months Ended
Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]  
INTANGIBLE ASSETS AND GOODWILL INTANGIBLE ASSETS AND GOODWILL
Intangible Assets
The following table summarizes the net-book-value and estimated remaining life of the Company's intangible assets as of December 31, 2021:
(In thousands)Weighted Average Remaining Life (Years)CostAccumulated AmortizationNet Balance at December 31, 2021
Finite-lived intangible assets
Trade name13.4$104,700 $(13,554)$91,146 
Customer relationships9.66,700 (1,577)5,123 
Patents and licenses3.610,942 (6,763)4,178 
Supply agreement5.42,295 (101)2,194 
Acquired developed technology8.6918,171 (176,402)741,769 
Total finite-lived intangible assets1,042,808 (198,397)844,411 
In-process research and developmentn/a1,250,000 — 1,250,000 
Total intangible assets$2,292,808 $(198,397)$2,094,411 
The following table summarizes the net-book-value and estimated remaining life of the Company’s intangible assets as of December 31, 2020:
(In thousands)Weighted Average Remaining Life (Years)CostAccumulated AmortizationNet Balance at December 31, 2020
Finite-lived intangible assets
Trade name14.9$100,700 $(7,258)$93,442 
Customer relationships12.82,700 (404)2,296 
Patents3.710,441 (5,422)5,019 
Supply agreement6.530,000 (4,527)25,473 
Acquired developed technology9.0814,171 (93,278)720,893 
Total intangible assets$958,012 $(110,889)$847,123 
As of December 31, 2021, the estimated future amortization expense associated with the Company’s finite-lived intangible assets for each of the five succeeding fiscal years is as follows:
(In thousands)
2022$98,614 
202398,611 
202498,277 
202597,230 
202696,169 
Thereafter355,510 
$844,411 
The Company’s acquired intangible assets are being amortized on a straight-line basis over the estimated useful life.
During the third quarter of 2021 and in connection with the preparation of the financial statements included in the Company's Form 10-Q for the period ended September 30, 2021, the Company recorded a non-cash, pre-tax impairment loss of $20.2 million related to the supply agreement intangible asset that was initially recorded as part of the combination with Genomic Health due to lower than anticipated performance of the underlying product. The Company utilized the income approach to measure the fair value of the supply agreement, which involves significant unobservable inputs (Level 3 inputs). The impairment is recorded in intangible asset impairment charge in the consolidated statement of operations for the year ended December 31, 2021.
During the third quarter of 2020, the Company began discussions with Biocartis regarding the termination of its agreements with Biocartis related to the development of an in vitro diagnostic (“IVD”) version of the Oncotype DX Breast Recurrence Score® test. As a result, and in connection with the preparation of the financial statements included in the Company's Form 10-Q for the period ended September 30, 2020, the Company recorded a non-cash, pre-tax impairment loss of $200.0 million related to the in-process research and development intangible asset that was initially recorded as part of the combination with Genomic Health. The impairment is recorded in intangible asset impairment charge in the consolidated statement of operations for the year ended December 31, 2020. The agreements with Biocartis were terminated in November 2020.
During the third quarter of 2020, the Company abandoned certain research and development assets acquired in 2017 through an asset purchase agreement with Armune Biosciences, Inc. These assets were expected to complement the Company’s product pipeline and were expected to have alternative future uses at the time of acquisition; however, due to changes in strategic priorities and efforts during the third quarter of 2020, these assets are no longer expected to be utilized to advance the Company’s product pipeline. As a result, and in connection with the preparation of the financial statements included in the Company's Form 10-Q for the period ended September 30, 2020, the Company wrote-off the gross cost basis of the intangible asset of $12.2 million and accumulated amortization of $2.5 million as of September 30, 2020. This write-off resulted in a non-cash, pre-tax impairment loss of $9.7 million, which is recorded in intangible asset impairment charge in the consolidated statement of operations for the year ended December 31, 2020.
There were no impairment losses for the year ended December 31, 2019.
Goodwill
The change in the carrying amount of goodwill for the years ended December 31, 2021 and 2020 is as follows:
(In thousands)
Balance, January 1, 2020 (1)$1,203,197 
Paradigm & Viomics acquisition30,431 
Genomic Health acquisition adjustment (2)
4,044 
Balance, December 31, 20201,237,672 
Thrive acquisition948,105 
Ashion acquisition56,758 
PreventionGenetics acquisition92,637 
Balance, December 31, 2021$2,335,172 
_________________________________
(1) The beginning balance represents the goodwill acquired from the acquisitions of Sampleminded, Inc., Biomatrica, Inc., and Genomic Health between 2017 and 2019 totaling $2.0 million, $15.3 million, and $1.19 billion, respectively.
(2) The Company recognized a measurement period adjustment to goodwill related to an increase in Genomic Health's pre-acquisition deferred tax liability due to finalization of certain income-tax related items.
There were no impairment losses for the years ended December 31, 2021, 2020, and 2019.
v3.22.0.1
FAIR VALUE MEASUREMENTS
12 Months Ended
Dec. 31, 2021
Fair Value Disclosures [Abstract]  
FAIR VALUE MEASUREMENTS FAIR VALUE MEASUREMENTS
The three levels of the fair value hierarchy established are as follows:
Level 1    Quoted prices (unadjusted) in active markets for identical assets or liabilities that the Company has the ability to access as of the reporting date. Active markets are those in which transactions for the asset or liability occur in sufficient frequency and volume to provide pricing information on an ongoing basis.
Level 2    Pricing inputs other than quoted prices in active markets included in Level 1, which are either directly or indirectly observable as of the reporting date. These include quoted prices for similar assets or liabilities in active markets and quoted prices for identical or similar assets or liabilities in markets that are not active.
Level 3    Unobservable inputs that reflect the Company’s assumptions about the assumptions that market participants would use in pricing the asset or liability. Unobservable inputs shall be used to measure fair value to the extent that observable inputs are not available.
The following table presents the Company’s fair value measurements as of December 31, 2021 along with the level within the fair value hierarchy in which the fair value measurements, in their entirety, fall.
(In thousands)Fair value at December 31, 2021Quoted Prices in Active Markets for Identical Assets (Level 1)Significant Other Observable Inputs (Level 2)Significant Unobservable Inputs (Level 3)
Cash, cash equivalents, and restricted cash
Cash and money market$247,335 $247,335 $— $— 
Commercial paper64,593 — 64,593 — 
U.S. government agency securities3,543 — 3,543 — 
Restricted cash297 297 — — 
Marketable securities
Corporate bonds$313,154 $— $313,154 $— 
U.S. government agency securities249,920 — 249,920 — 
Asset backed securities94,460 — 94,460 — 
Certificates of deposit47,139 — 47,139 — 
Commercial paper6,996 — 6,996 — 
Equity securities3,336 3,336 — — 
Non-marketable securities$3,090 $— $— $3,090 
Liabilities
Contingent consideration$(359,021)$— $— $(359,021)
Total$674,842 $250,968 $779,805 $(355,931)
The following table presents the Company’s fair value measurements as of December 31, 2020 along with the level within the fair value hierarchy in which the fair value measurements, in their entirety, fall.
(In thousands)Fair Value at December 31, 2020Quoted Prices in Active Markets for Identical Assets (Level 1)Significant Other Observable Inputs (Level 2)Significant Unobservable Inputs (Level 3)
Cash and cash equivalents
Cash and money market$901,294 $901,294 $— $— 
U.S. government agency securities589,994 — 589,994 — 
Restricted cash306 306 — — 
Marketable securities
Corporate bonds$132,913 $— $132,913 $— 
Asset backed securities7,094 — 7,094 — 
U.S. government agency securities207,171 — 207,171 — 
Equity securities1,521 1,521 — — 
Liabilities
Contingent consideration$(2,477)$— $— $(2,477)
Total$1,837,816 $903,121 $937,172 $(2,477)
The equity securities held as of December 31, 2021 were subject to a short-term lock-up restriction after they were obtained in the second quarter of 2021, and the fair value was previously discounted from the observable market prices of the similar unrestricted equity securities, which the Company classified as a Level 2 investment. The lock-up restriction ended during the fourth quarter of 2021, and the equity securities are classified as a Level 1 investment as of December 31, 2021. There was no change in valuation techniques or transfers between fair value measurement levels during the year ended December 31, 2020. The fair value of Level 2 instruments classified as cash equivalents and marketable debt securities are valued using a third-party pricing agency where the valuation is based on observable inputs including pricing for similar assets and other observable market factors.
Contingent Consideration
The fair value of contingent consideration as of December 31, 2021 and 2020 was $359.0 million and $2.5 million, respectively, which was recorded in other long-term liabilities in the condensed consolidated balance sheets.
The following table provides a reconciliation of the beginning and ending balances of contingent consideration:
(In thousands)Contingent consideration
Balance, January 1, 2020 (1)
$(2,879)
Changes in fair value325 
Payments77 
Balance, December 31, 2020
(2,477)
Purchase price contingent consideration (2)(350,348)
Changes in fair value(6,359)
Payments163 
Balance, December 31, 2021
$(359,021)
_________________________________
(1) The change in fair value of the contingent consideration liability during the year ended December 31, 2019 was not material to the consolidated financial statements.
(2) The increase in the contingent consideration liability is due to the contingent consideration associated with the acquisitions of Ashion Analytics, LLC (“Ashion”) and Thrive. Refer to Note 19 for further information.
This fair value measurement of contingent consideration is categorized as a Level 3 liability, as the measurement amount is based primarily on significant inputs not observable in the market.
The fair value of the contingent consideration liability recorded related to regulatory and product development milestones associated with the Thrive and Ashion acquisitions was $357.8 million as of December 31, 2021. The Company evaluates the fair value of the regulatory and product development contingent consideration liabilities using the probability-weighted scenario based discounted cash flow model, which is consistent with the initial measurement of the expected contingent consideration liabilities. Probabilities of success are applied to each potential scenario and the resulting values are discounted using a rate that considers a present-value factor. The passage of time in addition to changes in projected milestone achievement timing, present-value factor, the degree of achievement if applicable, and probabilities of success may result in adjustments to the fair value measurement. The fair value measurements of contingent consideration for which a liability is recorded include significant unobservable inputs. As of December 31, 2021, the fair value of the contingent consideration liability recorded related to regulatory and product development milestones was determined using a weighted average probability of success of 90.5% and a weighted average present-value factor of 2.3%. The projected fiscal year of payment range is from 2024 to 2027. Unobservable inputs were weighted by the relative fair value of the contingent consideration liability.
The fair value of the contingent consideration earnout liability related to certain revenue milestones associated with the Biomatrica acquisition was $1.2 million as of December 31, 2021. The revenue milestone associated with the Ashion acquisition is not expected to be achieved and therefore no liability has been recorded for this milestone.
Non-Marketable Equity Investments
As of December 31, 2021 and 2020, the aggregate carrying amounts of the Company’s non-marketable equity securities without readily determinable fair values were $25.3 million and $28.3 million, respectively, which are classified as a component of other long-term assets in the Company’s consolidated balance sheets. There have been no downward or upward adjustments made on these investments since initial recognition.
The Company has committed capital to venture capital investment funds (the “Funds”) of $17.5 million, of which $16.0 million remained callable through 2033 as of December 31, 2021. The aggregate carrying amount of the Funds, which are classified as a component of other long-term assets in the Company's consolidated balance sheets, were $1.5 million and $0.8 million as of December 31, 2021 and 2020, respectively.
Derivative Financial Instruments
As of December 31, 2021 and 2020, the Company had open foreign currency forward contracts with notional amounts of $46.7 million and $22.4 million, respectively. The Company's foreign exchange derivative instruments are classified as Level 2 within the fair value hierarchy as they are valued using inputs that are observable in the market or can be derived principally from or corroborated by observable market data. The fair value of the foreign currency forward contracts was zero at December 31, 2021 and 2020, and there were no gains or losses recorded for the years ended December 31, 2021 and 2020.
v3.22.0.1
ACCRUED LIABILITIES
12 Months Ended
Dec. 31, 2021
Payables and Accruals [Abstract]  
ACCRUED LIABILITIES ACCRUED LIABILITIES
Accrued liabilities at December 31, 2021 and 2020 consisted of the following:
December 31,
(In thousands)20212020
Compensation$183,517 $124,654 
Pfizer Promotion Agreement related costs91,436 46,937 
Professional fees50,077 36,203 
Other32,116 13,064 
Assets under construction22,611 2,118 
Research and trial related expenses15,534 6,111 
Licenses3,265 4,517 
$398,556 $233,604 
v3.22.0.1
LONG-TERM DEBT
12 Months Ended
Dec. 31, 2021
Debt Disclosure [Abstract]  
LONG-TERM DEBT LONG-TERM DEBT
Construction Loan Agreement
During December 2017, the Company entered into a loan agreement with Fifth Third Bank (formerly MB Financial Bank, N.A.) (the “Construction Loan Agreement”), which provided the Company with a non-revolving construction loan (the “Construction Loan”) of $25.6 million. The Company used the Construction Loan proceeds to finance the construction of an additional clinical laboratory and related facilities in Madison, Wisconsin. The Construction Loan was collateralized by the additional clinical laboratory and related facilities.
In November 2021, the Company entered into a revolving loan agreement (the “Revolving Loan Agreement”) with PNC Bank, National Association (“PNC”). As part of the Revolving Loan Agreement, the Company agreed to repay in full all outstanding debt owed to Fifth Third Bank under the Construction Loan Agreement, and as of December 31, 2021, the remaining outstanding balance had been fully repaid in connection with the termination of the Construction Loan Agreement.
Prior to the repayment, the Construction Loan Agreement bore interest at a rate equal to the sum of the 1-month LIBOR rate plus 2.25%. Regular monthly payments were interest-only for the first 24 months, with further payments based on a 20-year amortization schedule. Amounts borrowed pursuant to the Construction Loan Agreement could be prepaid at any time without penalty, and the maturity date of the Construction Loan Agreement would have been December 10, 2022.
In November 2017, Fifth Third Bank, on behalf of the Company, issued an Irrevocable Standby Letter of Credit in the amount of $0.6 million in favor of the City of Madison, Wisconsin (the “City Letter of Credit”). The City Letter of Credit was deemed to have been issued pursuant to the Construction Loan Agreement. The amount of the City Letter of Credit reduced, dollar for dollar, the amount available for borrowing under the Construction Loan Agreement.
As a condition to Fifth Third’s initial advance of loan proceeds under the Construction Loan Agreement, the Company was required to first invest at least $16.4 million of its own cash into the construction project. The Company fulfilled its required initial investment and made its first draw on the Construction Loan in June 2018. In December 2019, the Company began making monthly payments towards the outstanding principal balance plus accrued interest. As of December 31, 2020, the outstanding balance was $23.8 million from the Construction Loan, including $0.7 million of interest incurred, which was accrued for as an interest reserve and represents a portion of the loan balance. The Company capitalized the $0.7 million of interest to the construction project. The Company incurred approximately $0.2 million of debt issuance costs related to the Construction Loan, which were recorded as a direct deduction from the liability. The debt issuance costs were being amortized over the life of the Construction Loan, and any unamortized issuance costs were recorded as a loss as of the date of the repayment of the loan in November 2021.
The carrying amount of the Construction Loan approximated fair value due to the short maturity of this instrument. The Construction Loan was privately held with no public market for this debt and therefore was classified as a Level 3 fair value measurement. The change in the fair value during the years ended December 31, 2021 and December 31, 2020 was due to payments made on the loan resulting in a decrease in the liability.
Revolving Loan Agreement
During November 2021, the Company entered into the Revolving Loan Agreement with PNC. The Revolving Loan Agreement provides the Company with a revolving line of credit of up to $150.0 million (the “Revolver”). The Revolver is collateralized by the Company’s marketable securities held by PNC, which must continue to maintain a minimum market value of $150.0 million. The Revolver is available for general working capital purposes and all other lawful corporate purposes. In addition, the Company may request, in lieu of cash advances, letters of credit with an aggregate stated amount outstanding not to exceed $20.0 million. The availability of advances under the line of credit will be reduced by the stated amount of each letter of credit issued and outstanding.
Borrowings under the Revolving Loan Agreement accrue interest at an annual rate equal to the sum of the daily Bloomberg Short-Term Bank Yield Index Rate plus the applicable margin of 0.60%. Loans under the Revolving Loan Agreement may be prepaid at any time without penalty. The Revolver’s maturity date is November 5, 2023.
The Company has agreed in the Revolving Loan Agreement to various financial covenants, and as of December 31, 2021, the Company is in compliance with all covenants.
During the fourth quarter of 2021, PNC issued a letter of credit of $2.9 million, which reduced the amount available for cash advances under the line of credit to $147.1 million as of December 31, 2021. As of December 31, 2021, the Company has not drawn funds from, nor are any amounts outstanding under, the Revolving Loan Agreement.
Tax Increment Financing Loan Agreements
The Company entered into two separate Tax Increment Financing Loan Agreements (“TIFs”) in February 2019 and June 2019 with the City of Madison, Wisconsin. The TIFs provide for $4.6 million of financing in the aggregate. In return for the loans, the Company is obligated to create and maintain 500 full-time jobs over a five-year period, starting on the date of occupancy of the buildings constructed. In the event that the job creation goals are not met, the Company would be required to pay a penalty.
The Company records the earned financial incentives as the full-time equivalent positions are filled. The amount earned is recorded as a liability and amortized as a reduction of operating expenses over a two-year period, which is the timeframe when the TIFs will be repaid through property taxes.
As of December 31, 2019, the Company had earned and received payment of the full $4.6 million from the City of Madison, and the corresponding liability became fully amortized in October 2020. In May 2021 the City of Madison confirmed that the Company had repaid the TIFs in full and released the Company from the loans and the related property liens.
v3.22.0.1
CONVERTIBLE NOTES
12 Months Ended
Dec. 31, 2021
CONVERTIBLE DEBT  
CONVERTIBLE NOTES CONVERTIBLE NOTES
Convertible note obligations included in the consolidated balance sheet consisted of the following as of December 31, 2021:
Fair Value (2)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%
$1,150,000 $(18,826)$1,131,174 $1,139,650 2
2027 Convertible notes - 0.375%
747,500 (11,691)735,809 771,794 2
2025 Convertible notes - 1.000% (1)
315,005 (1,756)313,249 415,473 2
Convertible note obligations included in the consolidated balance sheet consisted of the following as of December 31, 2020:
Fair Value (2)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%
$1,150,000 $(21,879)$1,128,121 $1,526,625 2
2027 Convertible notes - 0.375%
747,500 (13,937)733,563 992,306 2
2025 Convertible notes - 1.000% (1)
315,049 (2,333)312,716 601,744 2
____________________________
(1) Based on the Company's share price on the trading days leading up to December 31, 2020 and through the third quarter of 2021, holders of the 2025 Convertible Notes had the right to convert their debentures beginning on January 1, 2021 and ending on December 31, 2021. As a result, the 2025 Convertible Notes were included within convertible notes, net, current portion on the consolidated balance sheet as of December 31, 2020. Some holders did convert their debentures, resulting in a decrease of the principal amount of the 2025 Convertible Notes. As of December 31, 2021, the 2025 Convertible Notes are not convertible and included within long-term convertible notes, net on the consolidated balance sheet.
(2) The fair values are based on observable market prices for this debt, which is traded in less active markets and therefore is classified as a Level 2 fair value measurement.
Issuances and Settlements
In January 2018, the Company issued and sold $690.0 million in aggregate principal amount of 1.0% Convertible Notes (the “January 2025 Notes”) with a maturity date of January 15, 2025. The January 2025 Notes accrue interest at a fixed rate of 1.0% per year, payable semi-annually in arrears on January 15 and July 15 of each year, beginning on July 15, 2018. The net proceeds from the issuance of the January 2025 Notes were approximately $671.1 million, after deducting underwriting discounts and commissions and the offering expenses payable by the Company.
In June 2018, the Company issued and sold an additional $218.5 million in aggregate principal amount of 1.0% Convertible Notes (the “June 2025 Notes”). The June 2025 Notes were issued under the same indenture pursuant to which the Company previously issued the January 2025 Notes (the “Indenture”). The January 2025 Notes and the June 2025 Notes (collectively, the “2025 Notes”) have identical terms (including the same January 15, 2025 maturity date) and are treated as a single series of securities. The net proceeds from the issuance of the June 2025 Notes were approximately $225.3 million, after deducting underwriting discounts and commissions and the offering expenses payable by the Company.
In March 2019, the Company issued and sold $747.5 million in aggregate principal amount of 0.375% Convertible Notes (the “2027 Notes”) with a maturity date of March 15, 2027. The 2027 Notes accrue interest at a fixed rate of 0.375% per year, payable semi-annually in arrears on March 15 and September 15 of each year, beginning on September 15, 2019. The net proceeds from the issuance of the 2027 Notes were approximately $729.5 million, after deducting underwriting discounts and commissions and the offering expenses payable by the Company.
The Company utilized a portion of the proceeds from the issuance of the 2027 Notes to settle a portion of the 2025 Notes in privately negotiated transactions. In March 2019, the Company used cash of $494.1 million and an aggregate of 2.2 million shares of the Company’s common stock valued at $182.4 million for total consideration of $676.5 million to settle $493.4 million of the 2025 Notes, of which $0.7 million was used to pay off interest accrued on the 2025 Notes. The transaction resulted in a loss on settlement of convertible notes of $187.7 million, which is reflected in interest expense in the Company’s consolidated statement of operations. The loss represents the difference between (i) the fair value of the consideration transferred and (ii) the carrying value of the debt at the time of repurchase.
In February 2020, the Company issued and sold $1.15 billion in aggregate principal amount of 0.375% Convertible Notes (the “2028 Notes” and, collectively with the 2025 Notes and the 2027 Notes, the “Notes”) with a maturity date of March 1, 2028. The 2028 Notes accrue interest at a fixed rate of 0.375% per year, payable semi-annually in arrears on March 1 and September 1 of each year, beginning on September 1, 2020. The net proceeds from the issuance of the 2028 Notes were approximately $1.13 billion, after deducting underwriting discounts and commissions and the offering expenses payable by the Company.
In February 2020, the Company used $150.1 million of the proceeds from the issuance of the 2028 Notes to settle $100.0 million of the 2025 Notes, of which $0.1 million was used to pay off interest accrued on the 2025 Notes. The transaction resulted in a loss on settlement of convertible notes of $50.8 million, which is recorded in interest expense in the Company’s consolidated statement of operations. The loss represents the difference between (i) the fair value of the consideration transferred and (ii) the carrying value of the debt at the time of repurchase.
Summary of Conversion Features
Until the six-months immediately preceding the maturity date of the applicable series of Notes, each series of Notes is convertible only upon the occurrence of certain events and during certain periods, as set forth in the Indentures filed at the time of the original offerings. On or after the date that is six-months immediately preceding the maturity date of the applicable series of Notes until the close of business on the second scheduled trading day immediately preceding the maturity date, holders may convert such Notes at any time. The Notes will be convertible into cash, shares of the Company’s common stock (plus, if applicable, cash in lieu of any fractional share), or a combination of cash and shares of the Company’s common stock, at the Company’s election.
It is the Company’s intent and policy to settle all conversions through combination settlement. The initial conversion rate is 13.26, 8.96, and 8.21 shares of common stock per $1,000 principal amount for the 2025 Notes, 2027 Notes, and 2028 Notes, respectively, which is equivalent to an initial conversion price of approximately $75.43, $111.66, and $121.84 per share of the Company’s common stock for the 2025 Notes, 2027 Notes, and 2028 Notes, respectively. The 2025 Notes, 2027 Notes, and 2028 Notes may be convertible in up to 4.2 million, 6.7 million, and 9.4 million shares, respectively. The conversion rate is subject to adjustment upon the occurrence of certain specified events as set forth in the Indentures filed at the time of the original offerings but will not be adjusted for accrued and unpaid interest. In addition, holders of the Notes who convert their Notes in connection with a “make-whole fundamental change” (as defined in the Indenture), will, under certain circumstances, be entitled to an increase in the conversion rate.
If the Company undergoes a “fundamental change” (as defined in the Indenture), holders of the Notes may require the Company to repurchase for cash all or part of their Notes at a repurchase price equal to 100% of the principal amount of the Notes to be repurchased, plus accrued and unpaid interest.
Based on the closing price of the Company's common stock of $77.83 on December 31, 2021, the if-converted values on the Company's 2025 Notes exceed the principal amount by $10.0 million and the if-converted values of the 2027 Notes and 2028 Notes do not exceed the principal amount.
Ranking of Convertible Notes
The Notes are the Company’s senior unsecured obligations and (i) rank senior in right of payment to all of its future indebtedness that is expressly subordinated in right of payment to the Notes; (ii) rank equal in right of payment to each outstanding series thereof and to all of the Company’s future liabilities that are not so subordinated, unsecured indebtedness; (iii) are effectively junior to all of the Company's existing and future secured indebtedness and other secured obligations, to the extent of the value of the assets securing that indebtedness and other secured obligations; and (iv) are structurally subordinated to all indebtedness and other liabilities of the Company’s subsidiaries.
Issuance costs are amortized to interest expense over the term of the Notes. The following table summarizes the original issuance costs at the time of issuance for each set of Notes:
(In thousands)
January 2025 Notes$10,284 
June 2025 Notes7,362 
2027 Notes14,285 
2028 Notes24,453 
The Notes do not contain any financial or operating covenants or any restrictions on the payment of dividends, the issuance of other indebtedness or the issuance or repurchase of securities by the Company.
Interest expense includes the following:
Year Ended December 31,
(In thousands)202120202019
Debt issuance costs amortization$5,727 $5,303 $2,891 
Debt discount amortization147 131 (131)
Loss on settlement of convertible notes— 50,819 187,698 
Coupon interest expense10,266 9,631 6,611 
Total interest expense on convertible notes16,140 65,884 197,069 
Other interest expense2,466 2,057 2,123 
Total interest expense$18,606 $67,941 $199,192 
The effective interest rates on the 2025 Notes, 2027 Notes, and 2028 Notes for the year ended December 31, 2021 were 1.18%, 0.68%, and 0.64%, respectively. The effective interest rates on the 2025 Notes, 2027 Notes, and 2028 Notes for the year ended December 31, 2020 were 1.20%, 0.68%, and 0.54%, respectively. The effective interest rates on the 2025 Notes and 2027 Notes for the year ended December 31, 2019 were 1.27% and 0.55%, respectively. The remaining period over which the unamortized debt discount will be recognized as non-cash interest expense is 3.04 years, 5.21 years, and 6.17 years for the 2025 Notes, 2027 Notes and 2028 Notes, respectively.
v3.22.0.1
LICENSE AND COLLABORATION AGREEMENTS
12 Months Ended
Dec. 31, 2021
LICENSE AGREEMENTS [Abstract]  
LICENSE AND COLLABORATION AGREEMENTS LICENSE AND COLLABORATION AGREEMENTS 
The Company licenses certain technologies that are, or may be, incorporated into its technology under several license agreements, as well as the rights to commercialize certain diagnostic tests through collaboration agreements. Generally, the license agreements require the Company to pay single-digit royalties based on net revenues received using the technologies and may require minimum royalty amounts, milestone payments, or maintenance fees.
Mayo
In June 2009, the Company entered into a license agreement with the Mayo Foundation for Medical Education and Research (“Mayo”). The Company’s license agreement with Mayo was most recently amended and restated in September 2020. Under the license agreement, Mayo granted the Company an exclusive, worldwide license to certain Mayo patents and patent applications, as well as a non-exclusive, worldwide license with regard to certain Mayo know-how. The scope of the license covers any screening, surveillance or diagnostic test or tool for use in connection with any type of cancer, pre-cancer, disease or condition. 
The licensed Mayo patents and patent applications contain both method and composition claims that relate to sample processing, analytical testing and data analysis associated with nucleic acid screening for cancers and other diseases. The jurisdictions covered by these patents and patent applications include the U.S., Australia, Canada, the European Union, China, Japan and Korea. Under the license agreement, the Company assumed the obligation and expense of prosecuting and maintaining the licensed Mayo patents and is obligated to make commercially reasonable efforts to bring to market products using the licensed Mayo intellectual property.
Pursuant to the Company’s agreement with Mayo, the Company is required to pay Mayo a single-digit royalty on the Company’s net sales of current and future products using the licensed Mayo intellectual property each year during the term of the Mayo agreement.
In addition to the royalties described above, the Company is required to pay Mayo cash of $0.2 million, $0.8 million and $2.0 million upon each product using the licensed Mayo intellectual property reaching $5.0 million, $20.0 million and $50.0 million in cumulative net sales, respectively.
As part of the most recent amendment, the Company agreed to pay Mayo an additional $6.3 million, payable in five equal annual installments, through 2024. The annual installments are recorded in research and development expenses in the Company's consolidated statements of operations.
The license agreement will remain in effect, unless earlier terminated by the parties in accordance with the agreement, until the last of the licensed patents expires in 2039 (or later, if certain licensed patent applications are issued). However, if the Company is still using the licensed Mayo know-how or certain Mayo-provided biological specimens or their derivatives on such expiration date, the term shall continue until the earlier of the date the Company stops using such know-how and materials and the date that is five years after the last licensed patent expires. The license agreement contains customary termination provisions and permits Mayo to terminate the license agreement if the Company sues Mayo or its affiliates, other than any such suit claiming an uncured material breach by Mayo of the license agreement.
In addition to granting the Company a license to the covered Mayo intellectual property, Mayo provides the Company with product development and research and development assistance pursuant to the license agreement and other collaborative arrangements. In September 2020, Mayo also agreed to make available certain personnel to provide such assistance through January 2025. In connection with this collaboration, the Company incurred charges of $5.0 million, $3.9 million, and $4.8 million for the years ended December 31, 2021, 2020, and 2019, respectively. The charges incurred in connection with this collaboration are recorded in research and development expenses in the Company's consolidated statements of operations.
Biocartis
In September 2017, Genomic Health entered into an exclusive license and development agreement with Biocartis, a molecular diagnostics company based in Belgium, to develop and commercialize an IVD version of the Oncotype DX Breast Recurrence Score test on the Biocartis Idylla platform. Under the terms of the license and development agreement, the Company had an exclusive, worldwide, royalty-bearing license to develop and commercialize an IVD version of the Oncotype DX Breast Recurrence Score test on the Biocartis Idylla platform, and certain options to expand the collaboration.
In October 2020, the Company and Biocartis agreed to terminate all agreements between them with a mutual release. As part of the termination, the Company made a payment of $12.0 million and returned certain equipment to Biocartis. The remaining net book value of the equipment was previously written off when it was determined that the agreement with Biocartis would be terminated. The termination payment and equipment write-off are both recorded in general and administrative expenses on the Company's consolidated statement of operations.
Johns Hopkins University (“JHU”)
Through the acquisition of Thrive, the Company acquired a worldwide exclusive license agreement with JHU for use of several JHU patents and licensed know-how. The license is designed to enable the Company to leverage JHU proprietary data in the development and commercialization of a blood-based, multi-cancer early detection test. The agreement terms include single-digit sales-based royalties and sales-based milestone payments of $10.0 million, $15.0 million, and $20.0 million upon achieving calendar year licensed product revenue using JHU proprietary data of $0.50 billion, $1.00 billion, and $1.50 billion, respectively.
v3.22.0.1
PFIZER PROMOTION AGREEMENT
12 Months Ended
Dec. 31, 2021
PFIZER PROMOTION AGREEMENT  
PFIZER PROMOTION AGREEMENT PFIZER PROMOTION AGREEMENTIn August 2018, the Company entered into a Promotion Agreement (the “Original Promotion Agreement”) with Pfizer, Inc. (“Pfizer”), which was amended and restated in October 2020 (the “Restated Promotion Agreement”). The Restated Promotion Agreement extended the relationship between the Company and Pfizer and restructured the manner in which the Company compensated Pfizer for promotion of the Cologuard test through a service fee, and provision of certain other sales and marketing services related to the Cologuard test. The Restated Promotion Agreement included fixed and performance-related fees, some of which retroactively went into effect on April 1, 2020. In November 2021, the Company and Pfizer entered into an amendment to the Restated Promotion Agreement (the “November 2021 Amendment”), which provides that after November 30, 2021, Pfizer will no longer promote the Cologuard test to healthcare providers. The November 2021 Amendment provides that the Company will pay Pfizer a total of $35.9 million in three installments during the second, third, and fourth quarters of 2022. The November 2021 Amendment eliminates the Company's obligation to pay Pfizer royalties or other fees except for certain media fees, advertising fees, and any detail fees owed to Pfizer for promoting the Cologuard test prior to November 30, 2021. The $35.9 million fee incurred as a result of the November 2021 Amendment was recognized in full during the fourth quarter of 2021. All payments to Pfizer are recorded in sales and marketing expenses in the Company's consolidated statements of operations.Under the Original Promotion Agreement, the service fee was calculated based on incremental gross profits over specified baselines during the term. Under the Restated Promotion Agreement (and prior to giving effect to the November 2021 Amendment), the service fee provided a fee-for-service model that included certain fixed fees and performance-related bonuses. The performance-related bonuses were contingent upon the achievement of certain annual performance criteria with any applicable expense being recognized ratably upon achievement of the payment becoming probable. The Company incurred charges of $81.3 million, $51.2 million, and $68.5 million for the service fee during the years ended December 31, 2021, 2020 and 2019, respectively. The Company incurred charges of $121.0 million, $85.3 million, and $68.9 million for promotion, sales and marketing services performed by Pfizer on behalf of the Company during the years ended December 31, 2021, 2020 and 2019, respectively.
v3.22.0.1
STOCKHOLDERS' EQUITY
12 Months Ended
Dec. 31, 2021
Equity [Abstract]  
STOCKHOLDERS' EQUITY STOCKHOLDERS' EQUITY
Amendment to Certificate of Incorporation
In July 2020, the Company filed a Certificate of Amendment (the “Certificate of Amendment”) to its Sixth Amended and Restated Certificate of Incorporation with the Secretary of State of the State of Delaware to increase the number of authorized shares of the Company’s common stock from 200 million to 400 million shares. The Certificate of Amendment was approved by the Company’s stockholders at the Company’s 2020 annual meeting in July 2020.
PreventionGenetics LLC (“PreventionGenetics”) Acquisition Stock Issuance
In December 2021, the Company completed its acquisition of PreventionGenetics. In connection with the acquisition, which is further described in Note 19, the Company issued 1.1 million shares of the Company's common stock that had a fair value of $84.2 million.
Ashion Acquisition Stock Issuance
In April 2021, the Company completed its acquisition of Ashion. In connection with the acquisition, which is further described in Note 19, the Company issued 0.1 million shares of the Company's common stock that had a fair value of $16.2 million.
Thrive Acquisition Stock Issuance
In January 2021, the Company completed its acquisition of Thrive. In connection with the acquisition, which is further described in Note 19, the Company issued 9.3 million shares of the Company's common stock that had a fair value of $1.19 billion.
Targeted Digital Sequencing (“TARDIS”) License Acquisition Stock Issuance
In January 2021, the Company acquired a worldwide exclusive license to the TARDIS technology from The Translational Genomics Research Institute (“TGen”), which is further described in Note 19. As part of the consideration transferred, the Company issued 0.2 million shares of the Company's common stock that had a fair value of $27.3 million.
Registered Direct Offering
In October 2020, the Company entered into securities purchase agreements with a limited number of institutional investors for the registered direct offering of 8.6 million shares of common stock at a price of $101.00 per share. The Company received, in the aggregate, approximately $861.7 million of net proceeds from the offering, after deducting $7.5 million for the offering expenses and other stock issuance costs paid by the Company.
Paradigm Diagnostics, Inc. ("Paradigm") and Viomics, Inc. ("Viomics") Acquisition Stock Issuance
In March 2020, the Company completed the acquisitions of Paradigm and Viomics. The purchase price for these acquisitions consisted of cash and stock with a fair value of $40.4 million. Of the $40.4 million purchase price, $32.2 million is expected to be settled through the issuance of 0.4 million shares of common stock. Of the $32.2 million that will be settled through the issuance of common stock, $28.8 million was issued as of December 31, 2021, and the remainder was withheld and may become issuable as additional merger consideration subject to the terms and conditions of the acquisition agreements.
Changes in Accumulated Other Comprehensive Income (Loss)
The amount recognized in AOCI for the years ended December 31, 2021, 2020 and 2019 were as follows:
(In thousands)Cumulative Translation AdjustmentUnrealized Gain (Loss) on SecuritiesAccumulated Other Comprehensive Income (Loss)
Balance at January 1, 2019$(25)$(1,397)$(1,422)
Other comprehensive income (loss) before reclassifications— 681 681 
Amounts reclassified from accumulated other comprehensive income (loss)— 641 641 
Net current period change in accumulated other comprehensive income (loss) (1)— 1,322 1,322 
Balance at December 31, 2019$(25)$(75)$(100)
Other comprehensive income (loss) before reclassifications— 771 771 
Amounts reclassified from accumulated other comprehensive income (loss)25 — 25 
Net current period change in accumulated other comprehensive income (loss)25 771 796 
Income tax expense related to items of other comprehensive income (loss)— (170)(170)
Balance at December 31, 2020$— $526 $526 
Other comprehensive income (loss) before reclassifications23 (1,648)(1,625)
Amounts reclassified from accumulated other comprehensive income (loss)— (514)(514)
Net current period change in accumulated other comprehensive income (loss)23 (2,162)(2,139)
Income tax expense related to items of other comprehensive income (loss)— 170 170 
Balance at December 31, 2021$23 $(1,466)$(1,443)
_________________________________
(1) There was no tax impact from the amounts recognized in AOCI for the year ended December 31, 2019.
Amounts reclassified from accumulated other comprehensive income (loss) for the years ended December 31, 2021, 2020 and 2019 were as follows:
Year Ended December 31,
Details about AOCI Components (In thousands)Affected Line Item in the
Statements of Operations
202120202019
Change in value of available-for-sale investments
Sales and maturities of available-for-sale investmentsInvestment income$(514)$— $641 
Foreign currency adjustmentGeneral and administrative— 25 — 
Total reclassifications$(514)$25 $641 
v3.22.0.1
STOCK-BASED COMPENSATION
12 Months Ended
Dec. 31, 2021
Share-based Payment Arrangement [Abstract]  
STOCK-BASED COMPENSATION STOCK-BASED COMPENSATION
Stock-Based Compensation Plans
The Company maintains the following plans for which awards were granted from or had shares outstanding in 2021: the 2010 Omnibus Long-Term Incentive Plan (As Amended and Restated Effective July 27, 2017), the 2019 Omnibus Long-Term Incentive Plan, the 2010 Employee Stock Purchase Plan, and the 2016 Inducement Award Plan. These plans are collectively referred to as the “Stock Plans”.
The Stock Plans are administered by the Human Capital Committee of the Company’s Board of Directors. The 2019 Omnibus Long-Term Incentive Plan provides that upon an acquisition of the Company, all equity will accelerate by a period of one year. In addition, upon the termination of an employee without cause or for good reason prior to the first anniversary of the completion of the acquisition, all equity awards then outstanding under the respective plan held by that employee will immediately vest.
2019 Omnibus Long-Term Incentive Plan. The Company adopted the 2019 Omnibus Long-Term Incentive Plan (the “2019 Stock Plan”) on July 25, 2019 to grant share-based awards to employees, officers, directors, consultants and advisors. Awards granted under the 2019 Stock Plan may include incentive stock options, as defined under the Internal Revenue Code, non-qualified options, restricted stock awards and other stock awards in amounts and with terms and conditions determined by the human capital committee of the Company’s Board of Directors, subject to the provisions of the 2019 Stock Plan. The 2019 Stock Plan will expire on July 25, 2029 and after such date no further awards may be granted under the plan. Options granted under the 2019 Stock Plan expire ten years from the date of grant. Grants made from the 2019 Stock Plan generally vest over a period of three to four years. At December 31, 2021, options to purchase 395,584 shares were outstanding under the 2019 Stock Plan and 3,573,014 shares of restricted stock and restricted stock units were outstanding. At December 31, 2021, there were 8,491,176 shares available for future grant under the 2019 Stock Plan.
2010 Omnibus Long-Term Incentive Plan.  The Company adopted the 2010 Omnibus Long-Term Incentive Plan (the “2010 Stock Plan”) on July 16, 2010 to grant share-based awards to employees, officers, directors, consultants and advisors. Awards granted under the 2010 Stock Plan may include incentive stock options, as defined under the Internal Revenue Code, non-qualified options, restricted stock awards and other stock awards in amounts and with terms and conditions determined by the human capital committee of the Company’s Board of Directors, subject to the provisions of the 2010 Stock Plan. The 2010 Stock Plan expired on July 16, 2020 and after such date no further awards may be granted under the plan. Options granted under the 2010 Stock Plan expire ten years from the date of grant. Grants made from the 2010 Stock Plan generally vest over a period of three to four years. At December 31, 2021, options to purchase 1,474,505 shares were outstanding under the 2010 Stock Plan and 1,230,807 shares of restricted stock and restricted stock units were outstanding. At December 31, 2021, there were no shares available for future grant under the 2010 Stock Plan.
2016 Inducement Award Plan.  The Company adopted the 2016 Inducement Award Plan (the “2016 Inducement Plan”) on January 25, 2016 to grant share-based awards to employees who were not previously an employee of the Company or any of its Subsidiaries. Awards granted under the 2016 Inducement Plan may include grant incentive stock options, as defined under the Internal Revenue Code, non-qualified options, restricted stock awards and other stock awards in amounts and with terms and conditions determined by the Human Capital committee of the Company’s Board of Directors, subject to the provisions of the 2016 Inducement Plan. The 2016 Inducement Plan expired on July 27, 2017, and after such date no further awards could be granted under the plan. Options granted under the 2016 Inducement Plan expire ten years from the date of grant. Grants made from the 2016 Inducement Plan generally vest over a period of three to four years. At December 31, 2021, there were no shares of restricted stock and restricted stock units outstanding under the 2016 Inducement Award Plan. At December 31, 2021, there were no shares available for future grant under the 2016 Inducement Plan.
2010 Employee Stock Purchase Plan.  The 2010 Employee Stock Purchase Plan (the “2010 Purchase Plan”) was adopted by the Company on July 16, 2010 to provide participating employees the right to purchase shares of common stock at a discount through a series of offering periods. The 2010 Purchase Plan will expire on October 31, 2030. The Company’s stockholders approved amendments to the 2010 Employee Stock Purchase Plan to increase the number of shares available for purchase thereunder by 500,000 shares and 2,000,000 shares on July 24, 2014 and July 28, 2016, respectively. At December 31, 2021, there were 427,246 shares of common stock available for purchase by participating employees under the 2010 Purchase Plan.
Generally, all employees whose customary employment is more than 20 hours per week and more than five months in any calendar year are eligible to participate in the 2010 Purchase Plan. Participating employees authorize an amount, between 1% and 15% of the employee’s compensation, to be deducted from the employee’s pay during the offering period. On the last day of the offering period, the employee is deemed to have exercised the employee’s option to purchase shares of Company common stock, at the option exercise price, to the extent of accumulated payroll deductions. Under the terms of the 2010 Purchase Plan, the option exercise price is an amount equal to 85% of the fair market value, as defined under the 2010 Purchase Plan, and no employee can purchase more than $25,000 of Company common stock under the 2010 Purchase Plan in any calendar year. Rights granted under the 2010 Purchase Plan terminate upon an employee’s voluntary withdrawal from the 2010 Purchase Plan at any time or upon termination of employment. At December 31, 2021, there were 2,372,754 cumulative shares issued under the 2010 Purchase Plan.
Stock-Based Compensation Expense
The Company records stock-based compensation expense in connection with the amortization of restricted stock and restricted stock unit awards (“RSUs”), stock purchase rights granted under the Company’s employee stock purchase plan and stock options granted to employees, non-employee consultants and non-employee directors. A summary of non-cash stock-based compensation expense by expense category included in the Company's consolidated statements of operations for the years ended December 31, 2021, 2020, and 2019 is as follows:
Year Ended December 31,
(In thousands)
202120202019
Cost of sales
$16,835 $12,852 $5,799 
Research and development
49,723 19,976 17,196 
General and administrative
216,952 75,999 64,222 
Sales and marketing
55,716 44,079 21,266 
Total stock-based compensation
$339,226 $152,906 $108,483 
As of December 31, 2021, there was approximately $368.5 million of expected total unrecognized compensation cost related to non-vested share-based compensation arrangements granted under all equity compensation plans. The Company expects to recognize that cost over a weighted average period of 2.40 years.
In connection with the acquisition of Thrive, the Company accelerated the vesting of shares of previously unvested stock options and restricted stock units for employees with qualifying termination events. During the year ended December 31, 2021, the Company accelerated 139,096 shares of previously unvested stock options and 58,171 shares of previously unvested restricted stock awards and restricted stock units and recorded $19.0 million of non-cash stock-based compensation for the accelerated awards. As further discussed in Note 19, the Company also recorded $86.2 million in stock-based compensation related to accelerated vesting of awards held by Thrive employees in connection with the acquisition.
In connection with the combination with Genomic Health, the Company accelerated the vesting of shares of previously unvested stock options and restricted stock units for employees with qualifying termination events. During the year ended December 31, 2020, the Company accelerated 83,593 shares of previously unvested stock options and 93,770 shares of previously unvested restricted stock units and recorded $9.7 million of non-cash stock-based compensation for the accelerated awards. During the year ended December 31, 2019, the Company accelerated 364,281 shares of previously unvested stock options and 70,138 shares of previously unvested restricted stock units and recorded $21.6 million of non-cash stock-based compensation for the accelerated awards. There was an immaterial amount of accelerated unvested stock options and restricted stock during the year ended December 31, 2021.
Stock Options
The Company determines the fair value of each service-based option award on the date of grant using the Black-Scholes option-pricing model, which utilizes several key assumptions which are disclosed in the following table:
Year Ended December 31
202120202019
Option Plan Shares
Risk-free interest rates(1)
1.26% - 1.47%
2.54% - 2.59%
Expected term (in years)(1)
6.15
6.28
Expected volatility(1)
65.67% - 65.71%
64.95% - 64.99%
Dividend yield(1)0%0%
_________________________________
(1) The Company did not grant stock options under its 2010 Omnibus Long-Term Incentive Plan or 2019 Omnibus Long-Term Incentive Plan during the period.
A summary of stock option activity under the Stock Plans is as follows:
OptionsSharesWeighted Average Exercise Price (1)Weighted Average Remaining Contractual Term (Years)Aggregate Intrinsic Value (2)
(Aggregate intrinsic value in thousands)
Outstanding, January 1, 2021
2,231,059 $39.67 6.0
Granted— — 
Assumed through acquisition1,393,748 5.51 
Exercised(1,295,400)11.17 
Forfeited(45,131)56.66 
Outstanding, December 31, 2021
2,284,276 $34.65 5.5$107,586 
Vested and expected to vest, December 31, 2021
2,284,276 $34.65 5.5$107,586 
Exercisable, December 31, 2021
1,780,838 $25.59 4.8$96,789 
_________________________________
(1) The weighted average grant date fair value of options granted during the years ended December 31, 2020 and 2019 was $58.57 and $57.11, respectively.
(2) The total intrinsic value of options exercised during the years ended December 31, 2021, 2020, and 2019 was $155.8 million, $40.6 million, and $52.0 million, respectively, determined as of the date of exercise.
The Company received approximately $14.4 million, $27.1 million, and $8.8 million from stock option exercises during the years ended December 31, 2021, 2020 and 2019, respectively.
Restricted Stock and Restricted Stock Units
The fair value of restricted stock and restricted stock units is determined on the date of grant using the closing stock price on that day.
A summary of restricted stock and restricted stock unit activity is as follows:
Restricted SharesWeighted Average Grant Date Fair Value (2)
Outstanding, January 1, 2021
3,968,214 $79.38 
Granted2,333,213 129.16
Assumed through acquisition242,123 127.79
Released (1)(1,697,643)73.18
Forfeited(524,997)101.20
Outstanding, December 31, 2021
4,320,910 $108.84 
_________________________________
(1) The fair value of restricted stock units vested and converted to shares of the Company's common stock was $219.4 million, $152.4 million, and $173.8 million for the years ended December 31, 2021, 2020, and 2019, respectively.
(2) The weighted average grant date fair value of the restricted stock units granted during the years ended December 31, 2020 and 2019 was $92.55 and $93.20, respectively.
Performance Share Units
The Company has issued performance-based equity awards to certain employees which vest upon the achievement of certain performance goals, including financial performance targets and operational milestones.
In June 2020 and December 2020, the Company modified certain of the operational milestones and financial performance targets, respectively, within the outstanding performance-based equity awards, which were not deemed to have an impact on vesting and no incremental stock-based compensation expense was recorded for the year ended December 31, 2021. This modification impacted awards held by 36 employees.
A summary of performance share unit activity is as follows:
Performance Share Units (2)Weighted Average Grant Date Fair Value (3)
Outstanding, January 1, 2021618,515 $93.22 
Granted270,665 138.09 
Released (1)— — 
Forfeited(11,066)83.15 
Outstanding, December 31, 2021878,114 $107.18 
_________________________________
(1) The fair value of performance share units vested and converted to shares of the Company's common stock was $183.8 million for the year ended December 31, 2019. There were no performance share units vested and converted to shares of the Company's common stock during the years ended December 31, 2021 and 2020.
(2) The performance share units listed above assumes attainment of maximum payout rates as set forth in the performance criteria. Applying actual or expected payout rates, the number of outstanding performance share units as of December 31, 2021 was 45,312.
(3) The weighted average grant date fair value of the performance share units granted during the years ended December 31, 2020 and 2019 was $90.17 and $93.40, respectively.
Employee Stock Purchase Plan ("ESPP")
A summary of ESPP activity is as follows:
Year Ended December 31,
(in thousands, except share and per share amounts)202120202019
Shares issued under the 2010 Purchase Plan331,769301,064176,458
Cash received under the 2010 Purchase Plan$23,070 $18,355 $8,396 
Weighted average fair value per share of stock purchase rights granted during the period$34.93 $32.57 $29.21 
The 331,769 shares issued during the year ended December 31, 2021 were as follows:
Offering period ended
Number of Shares
Weighted Average price per Share
April 30, 2021173,717 $69.31 
November 1, 2021158,052 $69.71 
The fair value of ESPP shares is based on the assumptions in the following table:
Year Ended December 31,
202120202019
ESPP Shares
Risk-free interest rates
0.04% - 0.16%
0.11% - 0.20%
1.60% - 2.40%
Expected term (in years)
0.5 - 2
0.5 - 2
0.4 - 2
Expected volatility
43.00% - 68.51%
61.59% - 89.00%
43.20% - 57.60%
Dividend yield0%0%0%
Shares Reserved for Issuance
The Company has reserved shares of its authorized common stock for issuance pursuant to its employee stock purchase and equity plans, including all outstanding stock option grants noted above at December 31, 2021, as follows:
Shares reserved for issuance
2019 Stock Plan8,491,176 
2010 Purchase Plan
427,246 
8,918,422 
v3.22.0.1
COMMITMENTS AND CONTINGENCIES
12 Months Ended
Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]  
COMMITMENTS AND CONTINGENCIES COMMITMENTS AND CONTINGENCIES
Leases
The components of lease expense were as follows:
Year Ended December 31,
(In thousands)202120202019
Finance lease cost
Amortization of right-of-use assets$5,731 $1,935 $27 
Interest on lease liabilities1,018 383 
Operating lease cost31,730 22,551 9,200 
Short-term lease cost628 356 219 
Variable lease cost5,212 2,703 896 
Total lease Cost$44,319 $27,928 $10,344 
Supplemental disclosure of cash flow information related to the Company's cash and non-cash activities with its leases are as follows:
Year Ended December 31,
(In thousands)202120202019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases$27,461$17,531$9,641
Operating cash flows from finance leases9383811
Finance cash flows from finance leases5,2901,75615
Non-cash investing and financing activities:
Right-of-use assets obtained in exchange for new operating lease liabilities (1)74,36913,26151,030
Right-of-use assets obtained in exchange for new finance lease liabilities5,46020,349237
Weighted-average remaining lease term - operating leases (in years)8.338.759.80
Weighted-average remaining lease term - finance leases (in years)2.953.681.20
Weighted-average discount rate - operating leases6.11 %6.80 %6.80 %
Weighted-average discount rate - finance leases5.36 %5.67 %5.60 %
_________________________________
(1) For the year ended December 31, 2021, this includes right-of-use assets acquired as part of the business combinations described in Note 19 of $39.6 million. For the year ended December 31, 2019, this includes right-of-use assets obtained from the initial adoption of ASC 842 of $17.9 million.
As of December 31, 2021 and 2020, the Company’s right-of-use assets from operating leases are $174.2 million and $125.9 million, respectively, which are reported in operating lease right-of-use assets in the Company’s consolidated balance sheet. As of December 31, 2021, the Company has outstanding operating lease obligations of $201.9 million, of which $19.7 million is reported in operating lease liabilities, current portion and $182.2 million is reported in operating lease liabilities, less current portion in the Company’s consolidated balance sheet. As of December 31, 2020, the Company had outstanding operating lease obligations of $132.6 million, of which $11.5 million is reported in operating lease liabilities, current portion and $121.1 million is reported in operating lease liabilities, less current portion in the Company’s consolidated balance sheet.
As of December 31, 2021 and 2020, the Company’s right-of-use assets from finance leases are $18.2 million and $18.6 million, respectively, which are reported in other long-term assets, net in the Company’s consolidated balance sheets. As of December 31, 2021, the Company has outstanding finance lease obligations of $18.7 million, of which $6.2 million is reported in other current liabilities and $12.5 million is reported in other long-term liabilities in the Company’s consolidated balance sheets. As of December 31, 2020, the Company had outstanding finance lease obligations of $18.7 million, of which $4.7 million is reported in other current liabilities and $14.0 million is reported in other long-term liabilities in the Company’s consolidated balance sheets.
Maturities of operating lease liabilities on an annual basis as of December 31, 2021 were as follows:
(In thousands)
2022$30,706 
202331,793 
202432,209 
202530,446 
202629,890 
Thereafter106,967 
Total minimum lease payments262,011 
Imputed interest(60,135)
Total$201,876 
Maturities of finance lease liabilities on an annual basis as of December 31, 2021 were as follows (amounts in thousands):
(In thousands)
2022$7,040
20236,930
20245,253
2025911
202651
Thereafter
Total minimum lease payments20,185
Imputed interest(1,449)
Total$18,736
Legal Matters
The Company records reserves and accrues costs for certain legal proceedings and regulatory matters to the extent that it determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. While such reserves and accrued costs reflect the Company’s best estimate of the probable loss for such matters, the recorded amounts may differ materially from the actual amount of any such losses. In some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal and regulatory proceedings, which may be exacerbated by various factors, including but not limited to, they may involve indeterminate claims for monetary damages or may involve fines, penalties or punitive damages; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; involve a large number of parties, claimants or regulatory bodies; are in the early stages of the proceedings; involve a number of separate proceedings and/or a wide range of potential outcomes; or result in a change of business practices.
As of the date of this Annual Report on Form 10-K, amounts accrued for legal proceedings and regulatory matters were not material except for the amounts accrued related to the Medicare Date of Service Rule Investigation (the “DOS Rule Investigation”) discussed below. However, it is possible that in a particular quarter or annual period the Company’s financial condition, results of operations, cash flow and/or liquidity could be materially adversely affected by an ultimate unfavorable resolution of, or development in, legal and/or regulatory proceedings, including as described below. Except for the proceedings discussed below, the Company believes that the ultimate outcome of any of the regulatory and legal proceedings that are currently pending against it should not have a material adverse effect on financial condition, results of operations, cash flow or liquidity.
The Company is currently responding to civil investigative demands and administrative subpoenas issued pursuant to the Health Insurance Portability and Accountability Act of 1996 by the United States Department of Justice (“DOJ”) concerning Genomic Health’s compliance with the Medicare Date of Service billing regulations. The Company has been cooperating with these inquiries and has produced documents in response thereto.
During the second quarter of 2021, as part of ongoing discussions between the DOJ and the Company regarding the DOS Rule Investigation, the DOJ presented an estimate of civil damages in the amount of $48.2 million relating to alleged non-compliance with the Medicare Date of Service billing regulations from 2007 to 2020. The civil damages estimate does not include potential treble damages, civil or criminal penalties or other remedies that the DOJ could seek against the Company. Based on the Company’s review and analysis of the DOJ presentation, ongoing discussions held with the DOJ, the civil damages estimate, and range of potential exposure, the Company recorded an accrual of approximately $10 million for the year ended December 31, 2021.
As noted above, litigation outcomes are difficult to predict, and the estimation of probable losses requires an analysis of multiple possible outcomes that often depend on judgments about potential actions by third parties. Accordingly, the recorded accrual of approximately $10 million for the year ended December 31, 2021 is based on several factors, considerations, and judgments, and the ultimate resolution of this matter could result in a loss in excess of the recorded accrual.
On June 24, 2019, Niles Rosen M.D. filed a sealed ex parte qui tam lawsuit against the Company in the United States District Court for the Middle District of Florida, that alleged a violation of the Federal Anti-Kickback Statute and False Claims Act for offering gift cards to patients in exchange for returning the Cologuard screening test (the “Qui Tam Suit”). Dr. Rosen seeks on behalf of the U.S. government and himself an award of civil penalties, treble damages and fees and costs. On February 25, 2020, the Company received a civil investigative demand by the DOJ related to the Company’s gift card program. The Company produced documents in response thereto. On March 25, 2021, the DOJ filed a notice of its election to decline intervention in the Qui Tam Suit. This election does not prevent Dr. Rosen from continuing the Qui Tam Suit. On April 12, 2021, Dr. Rosen filed an amended complaint against the Company, alleging violations of the Federal Anti-Kickback Statute and False Claims Act. The Company first learned of the Qui Tam Suit and the DOJ’s election to decline intervention in July 2021. The Company intends to vigorously defend itself against Dr. Rosen's claims and seek, among other things, the Company’s attorneys' fees and costs incurred in defending this action. Although the Company denies Dr. Rosen's allegations and believes that it has meritorious defenses to his False Claims Act claims, neither the outcome of the litigation nor can a reasonable estimate or an estimated range of loss associated with the litigation be determined at this time.
Adverse outcomes from the DOS Rule Investigation and the Qui Tam Suit could include the Company being required to pay treble damages, incur civil and criminal penalties, paying attorneys’ fees, entering into a corporate integrity agreement, being excluded from participation in government healthcare programs, including Medicare and Medicaid, and other adverse actions that could materially affect the Company’s business, financial condition, and results of operation.
In connection with the Company's combination with Genomic Health, on June 22, 2020, Suzanne Flannery, a purported former stockholder of Genomic Health, filed a Verified Individual and Class Action Complaint in the Delaware Court of Chancery, captioned Flannery v. Genomic Health, Inc., et al., C.A. No. 2020-0492. Flannery amended her complaint on November 23, 2020. The amended complaint asserted individual and class action claims, including: (i) a violation of 8 Del. C. § 203 by Genomic Health, Exact Sciences and a purported controlling group of former Genomic Health stockholders; (ii) conversion by Genomic Health, Exact Sciences and Spring Acquisition Corp.; (iii) breach of fiduciary duty by Genomic Health's former directors; (iv) breach of fiduciary duty by the purported controlling group; and (v) aiding and abetting breach of fiduciary duty against Exact Sciences, Spring Acquisition and Goldman Sachs & Co. LLC, Genomic Health's financial advisor in the combination. The amended complaint sought, among other things, declaratory relief, unspecified monetary damages and attorneys' fees and costs. All defendants moved to dismiss the amended complaint. Oral argument on defendants’ motions to dismiss the amended complaint occurred in May 2021, and in September 2021 the case was officially dismissed by the court.
v3.22.0.1
EMPLOYEE BENEFIT PLAN
12 Months Ended
Dec. 31, 2021
Retirement Benefits [Abstract]  
EMPLOYEE BENEFIT PLAN EMPLOYEE BENEFIT PLAN
The Company maintains a qualified 401(k) retirement savings plan for Exact Sciences employees (the "401(k) Plan"). The Company also maintains additional retirement savings plans that are acquired as a result of business combinations. These plans are maintained for a period of time before being merged into the 401(k) Plan. Under the terms of the 401(k) Plan, participants may elect to defer a portion of their compensation into the 401(k) Plan, subject to certain limitations. Company matching contributions may be made at the discretion of the Board of Directors.
The Company’s Board of Directors approved 401(k) Plan matching contributions for the years ended December 31, 2021, 2020 and 2019 in the form of Company common stock equal to 100% up to 6% of the participant’s eligible compensation for that year. The Company recorded compensation expense of approximately $30.0 million, $22.8 million, and $12.5 million, respectively, in the statements of operations for the years ended December 31, 2021, 2020 and 2019.
v3.22.0.1
NEW MARKET TAX CREDIT
12 Months Ended
Dec. 31, 2021
NEW MARKET TAX CREDIT  
NEW MARKET TAX CREDIT NEW MARKET TAX CREDIT
During the fourth quarter of 2014, the Company received approximately $2.4 million in net proceeds from financing agreements related to working capital and capital improvements at one of its Madison, Wisconsin facilities. This financing arrangement was structured with an unrelated third-party financial institution (the “Investor”), an investment fund, and its majority owned community development entity in connection with the Company’s participation in transactions qualified under the federal New Markets Tax Credit (“NMTC”) program, pursuant to Section 45D of the Internal Revenue Code of 1986, as amended. Through its participation in this program, the Company has secured low interest financing and the potential for future debt forgiveness related to certain of the Company's Madison, Wisconsin facilities. The Company was required to be in compliance through December 2021 with various regulations and contractual provisions that apply to the NMTC arrangement. Noncompliance with applicable requirements could have resulted in the Investor’s projected tax benefits not being realized and, therefore, require the Company to indemnify the Investor for any loss or recapture of NMTC related to the financing until such time as the recapture provisions have expired under the applicable statute of limitations.
The Investor and its majority owned community development entity were considered Variable Interest Entities (“VIEs”) and the Company was the primary beneficiary of the VIEs. This conclusion was reached based on the following:
the ongoing activities of the VIEs—collecting and remitting interest and fees and NMTC compliance—were all considered in the initial design and are not expected to significantly affect performance throughout the life of the VIE;
contractual arrangements obligate the Company to comply with NMTC rules and regulations and provide various other guarantees to the Investor and community development entity;
the Investor lacks a material interest in the underlying economics of the project; and
the Company is obligated to absorb losses of the VIEs.
Because the Company was the primary beneficiary of the VIEs, they were included in the Company's consolidated financial statements as of December 31, 2020. There are no other assets, liabilities or transactions in these VIEs outside of the financing transactions executed as part of the NMTC arrangement. The $2.4 million was recorded in other long-term liabilities on the Company's balance sheet. The benefit of this net $2.4 million contribution was recognized as a decrease in expenses, included in cost of sales, as the Company amortized the contribution liability over the seven-year compliance period as it was being earned through the Company's on-going compliance with the conditions of the NMTC program. The seven-year term ended in December 2021, at which point the Company entered into a loan forgiveness agreement with the Investor, which forgives, cancels, and terminates the debt from the original financing agreements. As of December 31, 2021, there are no outstanding balances related to the NMTC financing agreements.
v3.22.0.1
WISCONSIN ECONOMIC DEVELOPMENT TAX CREDITS
12 Months Ended
Dec. 31, 2021
WISCONSIN ECONOMIC DEVELOPMENT TAX CREDITS.  
WISCONSIN ECONOMIC DEVELOPMENT TAX CREDITS WISCONSIN ECONOMIC DEVELOPMENT TAX CREDITSDuring February 2015, the Company entered into an agreement with the WEDC (“Original WEDC Agreement”) to earn $9.0 million in refundable tax credits on the condition that the Company expends $26.3 million in capital investments and establishes and maintains 758 full-time positions over a seven-year period. 
During December 2021, the Company amended its agreement with the WEDC (“Amended WEDC Agreement”) to earn an additional $18.5 million in refundable tax credits on the condition that the Company expends $350.0 million in capital investments and establishes and maintains 1,300 additional full-time positions over a five-year period. The capital investment credits are earned at a rate of 10% of eligible capital investments up to a maximum of $7.0 million, while the jobs creation credits are earned annually pursuant to the agreement.
The tax credits earned are first applied against the tax liability otherwise due, and if there is no such liability present, the claim for tax credits will be reimbursed in cash to the Company. The maximum amount of the refundable tax credit to be earned for each year is fixed, and the Company earns the credits by meeting certain capital investment and job creation thresholds over the term of the agreement. Should the Company earn and receive the job creation tax credits but not maintain those full-time positions through the end of the agreement, the Company may be required to pay those credits back to the WEDC.
Under the Original WEDC Agreement, the Company recorded the earned tax credits as job creation and capital investments occurred. The tax credits earned from capital investment are being recognized as an offset to depreciation expense over the expected life of the acquired capital assets. The tax credits earned related to job creation were recognized as an offset to operational expenses through December 31, 2020.
As of December 31, 2021, the Company has earned all $9.0 million of the refundable tax credits and has received payment of $7.5 million from the WEDC under the Original WEDC Agreement. The unpaid portion is $1.5 million, which is reported in prepaid expenses and other current assets, reflecting when collection of the refundable tax benefits is expected to occur. 
During the years ended December 31, 2020 and 2019, the Company recognized $2.2 million and $2.4 million, respectively, of the tax credits earned as a reduction of operating expenses.
Under the Amended WEDC Agreement, the Company records the earned tax credits as job creation and capital investments occurs. The tax credits earned from capital investment are recognized as a reduction to capital expenditures at the time the costs are incurred, and then as an offset to depreciation expense over the expected life of the acquired capital assets. The tax credits earned related to job creation are recognized as an offset to operational expenses in the period in which the credits are earned. The credits recognized will be required to be repaid if the Company does not maintain minimum cumulative job requirements.
As of December 31, 2021, the Company has earned $8.0 million of the refundable tax credits under the Amended WEDC Agreement. The unpaid portion is $8.0 million as of December 31, 2021, of which $1.7 million is reported in prepaid expenses and other current assets and $6.3 million is reported in other long-term assets, reflecting when collection of the refundable tax credits is expected to occur. 
During the year ended December 31, 2021, the Company recorded $7.0 million as a reduction to capital expenditures and $1.0 million as a reduction to operational expenses for the credits earned for capital investments and job creation, respectively.
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS
12 Months Ended
Dec. 31, 2021
Business Combination and Asset Acquisition [Abstract]  
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS BUSINESS COMBINATIONS AND ASSET ACQUISITIONS
Business Combinations
PreventionGenetics LLC
On December 31, 2021, the Company completed the acquisition (the “PreventionGenetics Acquisition”) of all of the outstanding equity interests of PreventionGenetics, LLC. The PreventionGenetics Acquisition provided the Company a Clinical Laboratory Improvement Amendments (“CLIA”) certified and College of American Pathologist (“CAP”) accredited sequencing lab based in Marshfield, Wisconsin. PreventionGenetics provides more than 5,000 predefined genetic tests for nearly all clinically relevant genes, additional custom panels, and comprehensive germline, whole exome (“PGxome®”), and whole genome (“PGnome®”) sequencing tests. The Company has included the financial results of PreventionGenetics in the consolidated financial statements from the date of the combination.
The combination date fair value of the consideration transferred for PreventionGenetics was approximately $185.5 million, which consisted of the following:
(In thousands)
Cash$101,255
Common stock issued84,252
Total purchase price$185,507
The fair value of the 1,070,410 common shares issued as part of consideration transferred was determined on the basis of the average of the high and low market price of the Company's shares on the acquisition date, which was $78.71.
Of the total $101.3 million of consideration to be settled through the payment of cash, $85.8 million was paid as of December 31, 2021. The remaining $15.5 million represents withheld cash consideration that will be used to cover working capital adjustments or seller claims, if any, that arise following the completion of the acquisition. The withheld cash consideration will be held by the Company until settlement and was recorded in other current liabilities in the consolidated balance sheet.
The following table summarizes the preliminary estimated fair values of the assets acquired and liabilities assumed at the acquisition date.
(In thousands)
Cash and cash equivalents$1,574
Accounts receivable6,261
Inventory1,697
Prepaid expenses and other current assets30
Property, plant and equipment12,793
Developed technology65,000
Customer relationships4,000
Trade name4,000
Total identifiable assets acquired95,355
Accounts payable(1,493)
Accrued liabilities(992)
Total liabilities assumed(2,485)
Net identifiable assets acquired92,870
Goodwill92,637
Net assets acquired$185,507
Developed technology represents purchased technology that had reached technological feasibility and for which PreventionGenetics had substantially completed development as of the date of combination. The developed technology is associated with PreventionGenetics’ ability to perform next-generation sequencing and use its developed software solutions and infrastructure to report on the sequencing process. The fair value of the developed technology has been determined using the income approach multi-period excess earnings method, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, margin, obsolescence factor, and discount rate. The developed technology intangible is amortized on a straight-line basis over its estimated useful life of 13 years.
Customer relationships represent agreements and relationships with existing PreventionGenetics customers. The fair value of customer relationships has been determined using the excess earnings distributor model, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, margin, attrition rate, and discount rate. The customer relationship intangible is amortized on a straight-line basis over its estimated useful life of 9 years.
Trade names represent the value associated with the PreventionGenetics trade name in the market. The fair value of trade names has been determined using the relief-from-royalty method, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, royalty rate, and discount rate. The trade name intangible is amortized on a straight-line basis over its estimated useful life of 4 years.
The calculation of the excess of the purchase price over the estimated fair value of the tangible net assets and intangible assets acquired was recorded to goodwill, which is primarily attributed to the acquired workforce’s genetic sequencing, informatics, and counseling expertise, as well as expected sales force synergies. The total goodwill related to this combination is deductible for tax purposes.
The total purchase price allocation is preliminary and based upon estimates and assumptions that are subject to change within the measurement period as additional information for the estimates is obtained. The measurement period remains open pending the completion of valuation procedures related to certain acquired assets and liabilities assumed, primarily in connection with the intangible assets.
Pro forma impact and results of operations disclosures have not been included due to immateriality.
During 2021, the Company incurred $2.7 million of acquisition-related costs recorded in general and administrative expenses in the consolidated statement of operations. These costs include fees associated with financial, legal, accounting and other advisors incurred to complete the merger.
Ashion Analytics, LLC
On April 14, 2021, the Company completed the acquisition (“Ashion Acquisition”) of all of the outstanding equity interests of Ashion Analytics, LLC from PMed Management, LLC (“PMed”), which is a subsidiary of TGen. The Ashion Acquisition provided the Company a CLIA-certified and CAP-accredited sequencing lab based in Phoenix, Arizona. Ashion developed GEM ExTra®, a comprehensive genomic cancer test, and provides access to whole exome, matched germline, and transcriptome sequencing capabilities. The Company has included the financial results of Ashion in the consolidated financial statements from the date of the combination.
The combination date fair value of the consideration transferred for Ashion was approximately $110.0 million, which consisted of the following:
(In thousands)
Cash$74,775
Common stock issued16,224
Contingent consideration19,000
Total purchase price$109,999
The fair value of the 125,444 common shares issued as part of consideration transferred was determined on the basis of the average of the high and low market price of the Company's shares on the acquisition date, which was $129.33.
The contingent consideration arrangement requires the Company to pay $20.0 million of additional cash consideration to PMed upon the Company’s commercial launch, on or before the tenth anniversary of the Ashion Acquisition, of a test for minimal residual disease (“MRD”) detection and/or treatment (the “Commercial Launch Milestone”). The fair value of the Commercial Launch Milestone at the acquisition date was $19.0 million. The contingent consideration arrangement also requires the Company to pay $30.0 million of additional cash upon the Company’s achievement, on or before the fifth anniversary of the Ashion Acquisition, of cumulative revenues from MRD products of $500.0 million (the “MRD Product Revenue Milestone”). No value was ascribed to the MRD Product Revenue Milestone based on probability assessments as of the acquisition date. The fair value of the Commercial Launch Milestone and MRD Product Revenue Milestone was estimated using a probability-weighted scenario based discounted cash flow model. This fair value measurement is based on significant inputs not observable in the market and thus represents a Level 3 measurement as defined in ASC 820. The key assumptions are described in Note 7.
The following table summarizes the preliminary estimated fair values of the assets acquired and liabilities assumed at the acquisition date.
(In thousands)
Cash and cash equivalents$2,474
Accounts receivable2,349
Inventory1,811
Prepaid expenses and other current assets425
Property, plant and equipment9,947
Operating lease right-of-use assets548
Developed technology39,000
Total identifiable assets acquired56,554
Accounts payable(1,477)
Accrued liabilities(1,190)
Operating lease liabilities, current portion(343)
Other current liabilities(98)
Operating lease liabilities, less current portion(205)
Total liabilities assumed(3,313)
Net identifiable assets acquired53,241
Goodwill56,758
Net assets acquired$109,999
The Company recorded $39.0 million of identifiable intangible assets related to the developed technology associated with GEM ExTra. Developed technology represents purchased technology that had reached technological feasibility and for which Ashion had substantially completed development as of the date of combination. The fair value of the developed technology has been determined using the income approach multi-period excess earnings method, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, margin, and required rate of return and tax rate. Cash flows were discounted to their present value as of the closing date. Developed technology is amortized on a straight-line basis over its estimated useful life of 13 years.
The calculation of the excess of the purchase price over the estimated fair value of the tangible net assets and intangible assets acquired was recorded to goodwill, which is primarily attributed to the acquired workforce expertise, the capabilities in the advancement of creating and launching new products, including an MRD product, and expected sales force synergies related to the developed technology. The total goodwill related to this combination is deductible for tax purposes.
The total purchase price allocation is preliminary and based upon estimates and assumptions that are subject to change within the measurement period as additional information for the estimates is obtained. The measurement period remains open pending the completion of valuation procedures related to certain acquired assets and liabilities assumed, primarily in connection with the developed technology intangible asset.
Pro forma impact and results of operations disclosures have not been included due to immateriality.
During the year ended December 31, 2021, the Company incurred $1.6 million of acquisition-related costs recorded in general and administrative expenses in the consolidated statement of operations. These costs include fees associated with financial, legal, accounting and other advisors incurred to complete the merger.
Thrive Earlier Detection Corporation
On January 5, 2021, the Company completed the acquisition (“Thrive Merger”) of all of the outstanding capital stock of Thrive Earlier Detection Corporation. Thrive, headquartered in Cambridge, Massachusetts, is a healthcare company dedicated to incorporating earlier cancer detection into routine medical care. The Company expects that combining Thrive's early-stage multi-cancer early detection test with the Company’s scientific platform, clinical organization, and commercial infrastructure will bring an accurate blood-based, multi-cancer early detection test to patients faster. The Company has included the financial results of Thrive in the consolidated financial statements from the date of the combination.
The combination date fair value of the consideration transferred for Thrive was approximately $2.19 billion, which consisted of the following:
(In thousands)
Common stock issued$1,175,431
Cash584,996
Contingent consideration331,348
Fair value of replaced equity awards52,245
Previously held equity investment fair value43,034
Total purchase price$2,187,054
The Company issued 9,323,266 common shares that had a fair value of $1.19 billion based on the average of the high and low market price of the Company's shares on the acquisition date, which was $127.79. Of the total consideration for common stock issued, $1.18 billion was allocated to the purchase consideration and $16.0 million was recorded as compensation within general and administrative expenses in the consolidated statement of operations on the acquisition date due to accelerated vesting of legacy Thrive restricted stock awards (“RSA”) and RSU awards in connection with the acquisition.
The Company paid $590.2 million in cash on the acquisition date. Of the total consideration for cash, $585.0 million was allocated to the purchase consideration and $5.2 million was recorded as compensation within general and administrative expenses on the acquisition date due to accelerated vesting of legacy Thrive RSU and restricted stock awards (“RSA”) that were cash-settled in connection with the acquisition.
The contingent consideration arrangement requires the Company to pay up to $450.0 million of additional cash consideration to Thrive’s former shareholders upon the achievement of two discrete events, U.S. Food and Drug Administration (“FDA”) approval and CMS coverage, for $150.0 million and up to $300.0 million, respectively. The fair value of the contingent consideration arrangement at the acquisition date was $352.0 million. The fair value of the contingent consideration was estimated using a probability-weighted scenario based discounted cash flow model. This fair value measurement is based on significant inputs not observable in the market and thus represents a Level 3 measurement as defined in ASC 820. The key assumptions are described in Note 7. Of the total fair value of the contingent consideration, $331.3 million was allocated to the consideration transferred, $6.4 million was allocated to the Company’s previous ownership interest in Thrive, and $14.3 million was deemed compensatory as participation is dependent on replaced unvested equity awards vesting which requires future service. Compensation expense related to the milestones could be up to $18.2 million undiscounted and will be recognized in the future once probable and payable.
The Company replaced unvested stock options, RSUs, and RSAs and vested stock options with a combination-date fair value of $197.0 million. Of the total consideration for replaced equity awards, $52.2 million was allocated to the consideration transferred and $144.8 million was deemed compensatory as it was attributable to post acquisition vesting. Of the total compensation related to replaced awards, $65.0 million was expensed on the acquisition date due to accelerated vesting of stock options in connection with the acquisition and $79.8 million relates to future services and will be expensed over the remaining service periods of the unvested stock options, RSUs, and RSAs on a straight-line basis. Including expense recognized for accelerated vesting of RSUs and RSAs described above, total expected stock-based compensation expense is $166.0 million, of which $86.2 million was recognized immediately to general and administrative expenses in the consolidated statement of operations due to accelerated vesting.
The fair value of the stock options assumed by the Company was determined using the Black-Scholes option pricing model. The fair value of the RSA and RSUs assumed by the Company was determined based on the average of the high and low market price of the Company's shares on the acquisition date. The share conversion ratio of 0.06216 was applied to convert Thrive’s outstanding equity awards for Thrive’s common stock into equity awards for shares of the Company’s common stock.
The fair value of options assumed were based on the assumptions in the following table:
Option Plan Shares Assumed
Risk-free interest rates
0.11% - 0.12%
Expected term (in years)
1.26 - 1.57
Expected volatility
65.54% - 71.00%
Dividend yield
0%
Weighted average fair value per share of options assumed
$109.74 - $124.89
The Company previously held a preferred stock investment of $12.5 million in Thrive and recognized a gain of approximately $30.5 million on the transaction within investment income (expense), net on the Company’s consolidated statement of operations, which represented the adjustment of the Company’s historical investment to the acquisition date fair value. The fair value of the Company’s previous ownership in Thrive was determined based on the pro-rata share payout applied to the Company’s interest combined with the fair value of the Company’s share of the contingent consideration arrangement, as discussed above.
The purchase price was allocated to the underlying assets acquired and liabilities assumed based upon their estimated fair values as follows:
(In thousands)Preliminary Allocation
January 5, 2021
Measurement Period AdjustmentsFinal Allocation
December 31, 2021
Cash and cash equivalents$241,748$$241,748
Prepaid expenses and other current assets3,9393,939
Property, plant and equipment29,97729,977
Operating lease right-of-use assets39,02739,027
Other long-term assets6767
In-process research and development (IPR&D)1,250,0001,250,000
Total identifiable assets acquired 1,564,7581,564,758
Accounts payable(3,222)(3,222)
Accrued liabilities (6,218)(1,862)(8,080)
Operating lease liabilities, current portion(2,980)(2,980)
Operating lease liabilities, less current portion(38,622)(38,622)
Deferred tax liability(272,905)(272,905)
Total liabilities assumed (323,947)(1,862)(325,809)
Net identifiable assets acquired 1,240,811(1,862)1,238,949
Goodwill946,2431,862948,105
Net assets acquired $2,187,054$$2,187,054
IPR&D represents the fair value assigned to research and development assets that have not reached technological feasibility. The primary basis for determining technological feasibility of these projects is obtaining regulatory approval to market the underlying product and expected commercial release. The amounts capitalized are accounted for as indefinite-lived intangible assets, subject to impairment testing, until completion or abandonment of the research and development efforts associated with the projects. The Company recorded $1.25 billion of IPR&D related to a project associated with the development of an FDA approved blood-based, multi-cancer early detection test. The IPR&D asset was valued using the multiple-period excess earnings method approach, which involves significant unobservable inputs (Level 3 inputs). These inputs include inputs such as projected revenues, gross margin, required rate of return, tax rate, probability of commercial success, and obsolescence factor.
The calculation of the excess of the purchase price over the estimated fair value of the tangible net assets and intangible assets acquired was recorded to goodwill, which is primarily attributed to the research and development workforce expertise, next generation sequencing capabilities, and expected synergies. The total goodwill related to this combination is not deductible for tax purposes.
The net loss before tax of Thrive included in the Company’s consolidated statement of operations from the combination date of January 5, 2021 to December 31, 2021 was $255.0 million.
The following unaudited pro forma financial information summarizes the combined results of operations for the Company and Thrive, as though the companies were combined as of the beginning of January 1, 2020.
Year Ended December 31,
(In thousands)20212020
Total revenues$1,767,087 $1,491,391 
Net loss before tax$(761,337)$(1,014,352)
The unaudited pro forma financial information for all periods presented above has been calculated after adjusting the results of Thrive to reflect the business combination accounting effects resulting from this combination. The Company incurred $86.2 million of stock-based compensation expense related to accelerated vesting in connection with the acquisition, $13.5 million of stock-based compensation expense related to accelerated vesting for employees with qualifying termination events, and $10.3 million of transaction costs incurred to execute the acquisition during the first quarter of 2021. These expenses are included in general and administrative expenses on the consolidated statement of operations for the year ended December 31, 2021 and are reflected in pro forma earnings for the year ended December 31, 2020 in the table above. The Company recorded a realized gain of $30.5 million during the first quarter of 2021 in investment income (expense), net on the Company’s consolidated statement of operations relating to the Company’s pre-acquisition investment in Thrive. This gain has been reduced to $7.6 million due to the Company’s smaller ownership interest in Thrive on January 1, 2020, and is reflected in pro forma earnings for the year ended December 31, 2020 in the table above. The Company recorded a remeasurement of contingent consideration of $7.2 million related to Thrive in general and administrative expenses in the consolidated statement of operations for the year ended December 31, 2021. This expense is reflected in the year ended December 31, 2020 in the table above. The historical consolidated financial statements have been adjusted in the unaudited pro forma combined financial information to give effect to pro forma events that are directly attributable to the business combination and factually supportable. The unaudited pro forma financial information is for informational purposes only and is not indicative of the results of operations that would have been achieved if the combination had taken place as of January 1, 2020.
During the year ended December 31, 2021, the Company incurred $10.3 million of acquisition-related costs recorded in general and administrative expenses in the consolidated statement of operations. These costs include fees associated with financial, legal, accounting and other advisors incurred to complete the merger.
In connection with acquisition-related severances, the Company recorded $19.0 million of expense related to vesting of previously unvested equity awards and $3.9 million of additional benefit charges for the year ended December 31, 2021.
Paradigm Diagnostics, Inc. and Viomics, Inc.
On March 3, 2020, the Company acquired all of the outstanding capital stock of Paradigm Diagnostics, Inc. and Viomics, Inc., two related party companies of one another headquartered in Phoenix, Arizona, in transactions that are deemed to be a single business combination in accordance with ASC 805, Business Combinations, (“the Paradigm Acquisition”). Paradigm provides comprehensive genomic-based profiling tests that assist in the diagnosis and therapy recommendations for late-stage cancer. Viomics provides a platform for identification of biomarkers.
The Company entered into this acquisition to enhance its product portfolio in cancer diagnostics and to enhance its capabilities for biomarker identification.
The acquisition date fair value of the consideration to be transferred for Paradigm and Viomics was $40.4 million, which consists of $32.2 million payable in shares of the Company’s common stock and $8.2 million which was settled through a cash payment. Of the $32.2 million to be settled through the issuance of common stock, $28.8 million was issued as of December 31, 2021 and December 31, 2020, and the remaining $3.4 million, which was withheld and may become payable as additional merger consideration, is included in other current liabilities in the consolidated balance sheet as of December 31, 2021. The purchase price was allocated to the underlying assets acquired and liabilities assumed based upon their estimated fair values as follows:
(In thousands)Preliminary Allocation
March 3, 2020
Measurement Period AdjustmentsFinal Allocation
March 3, 2021
Net operating assets$6,133 $(760)$5,373 
Goodwill29,695 736 30,431 
Developed technology7,800 — 7,800 
Net operating liabilities(3,123)(80)(3,203)
Total purchase price$40,505 $(104)$40,401 
The fair value of identifiable intangible assets has been determined using the income approach, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, margin, weighted average cost of capital and tax rate.
Developed technology represents purchased technology that had reached technological feasibility and for which development had been completed as of the acquisition date. Fair value was determined using future discounted cash flows related to the projected income stream of the developed technology for a discrete projection period. Cash flows were discounted to their present value as of the closing date. Developed technology is amortized on a straight-line basis over its estimated useful life of 15 years.
The calculation of the excess of the purchase price over the estimated fair value of the tangible net assets and intangible assets acquired was recorded to goodwill, which is primarily attributed to the assembled workforce and expected synergies. The total goodwill related to this acquisition is not deductible for tax purposes.
The Company agreed to issue to the previous investors in Viomics equity interests with an acquisition-date fair value of up to $8.4 million in Viomics, vesting over 4 years based on certain retention arrangements. Payment is contingent upon continued employment with the Company over the four year vesting period and is recognized as stock-based compensation expense in general and administrative expense in the consolidated statement of operations.
Genomic Health, Inc.
On November 8, 2019, the Company acquired all of the outstanding capital stock of Genomic Health, Inc. Genomic Health, headquartered in Redwood City, California, provides genomic-based diagnostic tests that address both the overtreatment and optimal treatment of early and late stage cancer. The Company entered into this combination to create a leading global cancer diagnostics company and provide a robust platform for continued growth. The Company has included the financial results of Genomic Health in the consolidated financial statements from the date of the combination.
The combination date fair value of the consideration transferred for Genomic Health was approximately $2.47 billion, which consisted of the following:
(In thousands)
Cash$1,061,489 
Common stock issued1,389,266 
Fair value of replacement stock options and restricted stock awards17,813 
Total purchase price$2,468,568 
The fair value of the common stock issued as part of consideration was determined on the basis of the closing market price of the Company's shares at the acquisition date. The fair value of the stock options assumed by the Company was determined using the Black-Scholes option pricing model. The share conversion ratio of 0.76534 was applied to convert Genomic Health’s outstanding equity awards for Genomic Health’s common stock into equity awards for shares of the Company’s common stock.
The fair value of options assumed were based on the assumptions in the following table:
Option Plan Shares Assumed
Risk-free interest rates
0.88% - 2.90%
Expected term (in years)
3.28 - 6.73
Expected volatility
63.54% - 69.09%
Dividend yield0%
Weighted average fair value per share of options assumed
$45.75 - $57.44
During 2019, the Company incurred $22.5 million of acquisition-related costs recorded in general and administrative expense. These costs include fees associated with financial, legal, accounting and other advisors incurred to complete the combination.
In connection with the combination, the Company decided to terminate certain Genomic Health executives in the fourth quarter of 2019 and recorded $32.1 million in severance benefits charges.
The amounts of revenue and net loss before tax of Genomic Health included in the Company’s consolidated statement of operations from the combination date of November 8, 2019 to December 31, 2019.
(In thousands)2019
Total revenues$66,174 
Net loss before tax$(40,446)
The following unaudited pro forma financial information summarized the combined results of operations for the Company and Genomic Health, as though the companies were combined as of January 1, 2018.
(In thousands)2019
Total revenues$1,266,591 
Net loss before tax$(389,795)
The unaudited pro forma financial information for the period presented above has been calculated after adjusting the results of Genomic Health to reflect the business combination accounting effects resulting from this combination, including the amortization expense from acquired intangible assets and the stock-based compensation expense for unvested stock options and restricted stock awards assumed as though the combination occurred as of January 1, 2018. The historical consolidated financial statements have been adjusted in the unaudited pro forma combined financial information to give effect to pro forma events that are directly attributable to the business combination and factually supportable. The unaudited pro forma financial information is for informational purposes only and is not indicative of the results of operations that would have been achieved if the combination had taken place as of January 1, 2018.
As described in Note 15, the Company identified a pre-acquisition contingency relating to the DOJ investigation. The Company assigned a fair value estimate of zero to this pre-acquisition contingency. Subsequent to the Company's final determination of the pre-acquisition contingency’s estimated value, changes to this estimate could have a material impact on the Company's results of operations and financial position. As of December 31, 2021, the Company has accrued approximately $10 million related to this investigation.
Asset Acquisitions
PFS Genomics Inc.
On May 3, 2021, the Company acquired 90% of the outstanding capital stock of PFS Genomics Inc. (“PFS”). On June 23, 2021, the Company completed the acquisition of the remaining 10% interest in PFS. The Company paid cash of $33.6 million for 100% of the outstanding capital stock in PFS. PFS is a healthcare company focused on personalizing treatment for breast cancer patients to improve outcomes and reduce unnecessary treatment. The Company expects this acquisition to expand its ability to help guide early-stage breast cancer treatment through individualized radiotherapy treatment decisions.
The transaction was treated as an asset acquisition under GAAP because substantially all of the fair value of the gross assets acquired were deemed to be associated with the acquired technology.
The assets acquired and liabilities assumed were substantially comprised of the IPR&D asset as shown in the table below. The IPR&D asset acquired was recorded to research and development expense in the consolidated statement of operations immediately after acquisition as the asset was deemed to be incomplete and had no alternative future use at the time of acquisition.
The Company accounted for the acquisition in accordance with the accounting standards codification guidance for business combinations, whereby the total purchase price was allocated to the acquired net tangible and intangible assets based on their estimated fair values as of the closing date.
Acquisition related costs were not material in this asset acquisition.
The following table summarizes the allocation of the purchase price to the fair values assigned to the assets acquired and liabilities assumed:
(In thousands)
Consideration
Cash paid for acquisition of PFS Genomics outstanding shares$33,569
Assets acquired and liabilities assumed
Cash496
IPR&D asset33,074
Other assets and liabilities(1)
Net assets acquired$33,569
TARDIS License Agreement
On January 11, 2021, the Company entered into a worldwide exclusive license to the proprietary TARDIS technology from TGen, an affiliate of City of Hope. Under the agreement, the Company acquired a royalty-free, worldwide exclusive license to proprietary TARDIS patents and know-how. The Company intends to develop and commercialize the TARDIS technology as a minimal residual disease test. The Company accounted for this transaction as an asset acquisition. In connection with the asset acquisition, the Company paid upfront fair value consideration of $52.3 million comprised of $25.0 million in cash and issuance of 0.2 million shares of common stock valued at $27.3 million based on the average of the high and low market price of the Company’s shares on the acquisition date. In addition, the Company is obligated to make milestone payments to TGen of $10.0 million and $35.0 million upon achieving cumulative product revenue related to MRD detection and/or treatment totaling $100.0 million and $250.0 million, respectively. These payments are contingent upon achievement of these cumulative revenues on or before December 31, 2030. The upfront consideration was recorded to research and development expense in the consolidated statement of operations immediately after acquisition as the asset was deemed to be incomplete and had no alternative future use at the time of acquisition. The Company will record the sales milestones once achievement is deemed probable. No acquisition related costs were incurred in this asset acquisition during the year ended December 31, 2021.
Base Genomics, Limited
On October 26, 2020, The Company acquired all of the outstanding capital stock of Base Genomics, Limited (“Base Genomics”) in a cash transaction totaling $416.5 million. Base Genomics, headquartered in Oxford, England, exclusively licenses from Ludwig a non-bisulfite technology for the detection of methylated DNA and other epigenetic modifications. This technology (“TAPS”) simultaneously generates both genetic and epigenetic information at base resolution. TAPS overcomes the issues of the current gold standard for DNA methylation detection of bisulfite sequencing. The Company has included the financial results of Base Genomics in the consolidated statements from the date of the acquisition and not disclosed separately due to immateriality. Pro forma disclosures have not been included due to immateriality.
While the acquisition was treated legally as a merger of the two entities, for accounting purposes, the transaction was treated as an asset acquisition under GAAP because substantially all of the fair value of the gross assets acquired were deemed to be associated with the TAPS technology.
The assets and liabilities acquired in the merger were recorded at fair value as determined as of October 26, 2020, and were substantially comprised of the TAPS IPR&D asset as shown in the table below. The Company incurred approximately $4.6 million of direct transaction costs during 2020 associated with this acquisition. These acquisition-related transaction costs were capitalized to the acquired tangible and intangible assets based on their estimated fair values as of the closing date. The IPR&D asset acquired was recorded to research and development expense in the consolidated statement of operations immediately after acquisition as the asset was deemed to be incomplete and had no alternative future use at the time of acquisition.
The Company accounted for the merger in accordance with the accounting standards codification guidance for business combinations, whereby the total purchase price was allocated to the acquired net tangible and intangible assets based on their estimated fair values as of the closing date.
The following table summarizes the total consideration for the acquisition and the value of assets acquired and liabilities assumed as of October 26, 2020, the Merger closing date. These values are based on internal Company and independent external third-party valuations:
(In thousands)
Consideration
Cash paid for acquisition of Base Genomics outstanding shares$416,525 
Transaction costs4,600 
Total consideration421,125 
Assets acquired and liabilities assumed
Cash9,704 
IPR&D asset412,568 
Other assets and liabilities(1,147)
Net assets acquired$421,125 
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS BUSINESS COMBINATIONS AND ASSET ACQUISITIONS
Business Combinations
PreventionGenetics LLC
On December 31, 2021, the Company completed the acquisition (the “PreventionGenetics Acquisition”) of all of the outstanding equity interests of PreventionGenetics, LLC. The PreventionGenetics Acquisition provided the Company a Clinical Laboratory Improvement Amendments (“CLIA”) certified and College of American Pathologist (“CAP”) accredited sequencing lab based in Marshfield, Wisconsin. PreventionGenetics provides more than 5,000 predefined genetic tests for nearly all clinically relevant genes, additional custom panels, and comprehensive germline, whole exome (“PGxome®”), and whole genome (“PGnome®”) sequencing tests. The Company has included the financial results of PreventionGenetics in the consolidated financial statements from the date of the combination.
The combination date fair value of the consideration transferred for PreventionGenetics was approximately $185.5 million, which consisted of the following:
(In thousands)
Cash$101,255
Common stock issued84,252
Total purchase price$185,507
The fair value of the 1,070,410 common shares issued as part of consideration transferred was determined on the basis of the average of the high and low market price of the Company's shares on the acquisition date, which was $78.71.
Of the total $101.3 million of consideration to be settled through the payment of cash, $85.8 million was paid as of December 31, 2021. The remaining $15.5 million represents withheld cash consideration that will be used to cover working capital adjustments or seller claims, if any, that arise following the completion of the acquisition. The withheld cash consideration will be held by the Company until settlement and was recorded in other current liabilities in the consolidated balance sheet.
The following table summarizes the preliminary estimated fair values of the assets acquired and liabilities assumed at the acquisition date.
(In thousands)
Cash and cash equivalents$1,574
Accounts receivable6,261
Inventory1,697
Prepaid expenses and other current assets30
Property, plant and equipment12,793
Developed technology65,000
Customer relationships4,000
Trade name4,000
Total identifiable assets acquired95,355
Accounts payable(1,493)
Accrued liabilities(992)
Total liabilities assumed(2,485)
Net identifiable assets acquired92,870
Goodwill92,637
Net assets acquired$185,507
Developed technology represents purchased technology that had reached technological feasibility and for which PreventionGenetics had substantially completed development as of the date of combination. The developed technology is associated with PreventionGenetics’ ability to perform next-generation sequencing and use its developed software solutions and infrastructure to report on the sequencing process. The fair value of the developed technology has been determined using the income approach multi-period excess earnings method, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, margin, obsolescence factor, and discount rate. The developed technology intangible is amortized on a straight-line basis over its estimated useful life of 13 years.
Customer relationships represent agreements and relationships with existing PreventionGenetics customers. The fair value of customer relationships has been determined using the excess earnings distributor model, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, margin, attrition rate, and discount rate. The customer relationship intangible is amortized on a straight-line basis over its estimated useful life of 9 years.
Trade names represent the value associated with the PreventionGenetics trade name in the market. The fair value of trade names has been determined using the relief-from-royalty method, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, royalty rate, and discount rate. The trade name intangible is amortized on a straight-line basis over its estimated useful life of 4 years.
The calculation of the excess of the purchase price over the estimated fair value of the tangible net assets and intangible assets acquired was recorded to goodwill, which is primarily attributed to the acquired workforce’s genetic sequencing, informatics, and counseling expertise, as well as expected sales force synergies. The total goodwill related to this combination is deductible for tax purposes.
The total purchase price allocation is preliminary and based upon estimates and assumptions that are subject to change within the measurement period as additional information for the estimates is obtained. The measurement period remains open pending the completion of valuation procedures related to certain acquired assets and liabilities assumed, primarily in connection with the intangible assets.
Pro forma impact and results of operations disclosures have not been included due to immateriality.
During 2021, the Company incurred $2.7 million of acquisition-related costs recorded in general and administrative expenses in the consolidated statement of operations. These costs include fees associated with financial, legal, accounting and other advisors incurred to complete the merger.
Ashion Analytics, LLC
On April 14, 2021, the Company completed the acquisition (“Ashion Acquisition”) of all of the outstanding equity interests of Ashion Analytics, LLC from PMed Management, LLC (“PMed”), which is a subsidiary of TGen. The Ashion Acquisition provided the Company a CLIA-certified and CAP-accredited sequencing lab based in Phoenix, Arizona. Ashion developed GEM ExTra®, a comprehensive genomic cancer test, and provides access to whole exome, matched germline, and transcriptome sequencing capabilities. The Company has included the financial results of Ashion in the consolidated financial statements from the date of the combination.
The combination date fair value of the consideration transferred for Ashion was approximately $110.0 million, which consisted of the following:
(In thousands)
Cash$74,775
Common stock issued16,224
Contingent consideration19,000
Total purchase price$109,999
The fair value of the 125,444 common shares issued as part of consideration transferred was determined on the basis of the average of the high and low market price of the Company's shares on the acquisition date, which was $129.33.
The contingent consideration arrangement requires the Company to pay $20.0 million of additional cash consideration to PMed upon the Company’s commercial launch, on or before the tenth anniversary of the Ashion Acquisition, of a test for minimal residual disease (“MRD”) detection and/or treatment (the “Commercial Launch Milestone”). The fair value of the Commercial Launch Milestone at the acquisition date was $19.0 million. The contingent consideration arrangement also requires the Company to pay $30.0 million of additional cash upon the Company’s achievement, on or before the fifth anniversary of the Ashion Acquisition, of cumulative revenues from MRD products of $500.0 million (the “MRD Product Revenue Milestone”). No value was ascribed to the MRD Product Revenue Milestone based on probability assessments as of the acquisition date. The fair value of the Commercial Launch Milestone and MRD Product Revenue Milestone was estimated using a probability-weighted scenario based discounted cash flow model. This fair value measurement is based on significant inputs not observable in the market and thus represents a Level 3 measurement as defined in ASC 820. The key assumptions are described in Note 7.
The following table summarizes the preliminary estimated fair values of the assets acquired and liabilities assumed at the acquisition date.
(In thousands)
Cash and cash equivalents$2,474
Accounts receivable2,349
Inventory1,811
Prepaid expenses and other current assets425
Property, plant and equipment9,947
Operating lease right-of-use assets548
Developed technology39,000
Total identifiable assets acquired56,554
Accounts payable(1,477)
Accrued liabilities(1,190)
Operating lease liabilities, current portion(343)
Other current liabilities(98)
Operating lease liabilities, less current portion(205)
Total liabilities assumed(3,313)
Net identifiable assets acquired53,241
Goodwill56,758
Net assets acquired$109,999
The Company recorded $39.0 million of identifiable intangible assets related to the developed technology associated with GEM ExTra. Developed technology represents purchased technology that had reached technological feasibility and for which Ashion had substantially completed development as of the date of combination. The fair value of the developed technology has been determined using the income approach multi-period excess earnings method, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, margin, and required rate of return and tax rate. Cash flows were discounted to their present value as of the closing date. Developed technology is amortized on a straight-line basis over its estimated useful life of 13 years.
The calculation of the excess of the purchase price over the estimated fair value of the tangible net assets and intangible assets acquired was recorded to goodwill, which is primarily attributed to the acquired workforce expertise, the capabilities in the advancement of creating and launching new products, including an MRD product, and expected sales force synergies related to the developed technology. The total goodwill related to this combination is deductible for tax purposes.
The total purchase price allocation is preliminary and based upon estimates and assumptions that are subject to change within the measurement period as additional information for the estimates is obtained. The measurement period remains open pending the completion of valuation procedures related to certain acquired assets and liabilities assumed, primarily in connection with the developed technology intangible asset.
Pro forma impact and results of operations disclosures have not been included due to immateriality.
During the year ended December 31, 2021, the Company incurred $1.6 million of acquisition-related costs recorded in general and administrative expenses in the consolidated statement of operations. These costs include fees associated with financial, legal, accounting and other advisors incurred to complete the merger.
Thrive Earlier Detection Corporation
On January 5, 2021, the Company completed the acquisition (“Thrive Merger”) of all of the outstanding capital stock of Thrive Earlier Detection Corporation. Thrive, headquartered in Cambridge, Massachusetts, is a healthcare company dedicated to incorporating earlier cancer detection into routine medical care. The Company expects that combining Thrive's early-stage multi-cancer early detection test with the Company’s scientific platform, clinical organization, and commercial infrastructure will bring an accurate blood-based, multi-cancer early detection test to patients faster. The Company has included the financial results of Thrive in the consolidated financial statements from the date of the combination.
The combination date fair value of the consideration transferred for Thrive was approximately $2.19 billion, which consisted of the following:
(In thousands)
Common stock issued$1,175,431
Cash584,996
Contingent consideration331,348
Fair value of replaced equity awards52,245
Previously held equity investment fair value43,034
Total purchase price$2,187,054
The Company issued 9,323,266 common shares that had a fair value of $1.19 billion based on the average of the high and low market price of the Company's shares on the acquisition date, which was $127.79. Of the total consideration for common stock issued, $1.18 billion was allocated to the purchase consideration and $16.0 million was recorded as compensation within general and administrative expenses in the consolidated statement of operations on the acquisition date due to accelerated vesting of legacy Thrive restricted stock awards (“RSA”) and RSU awards in connection with the acquisition.
The Company paid $590.2 million in cash on the acquisition date. Of the total consideration for cash, $585.0 million was allocated to the purchase consideration and $5.2 million was recorded as compensation within general and administrative expenses on the acquisition date due to accelerated vesting of legacy Thrive RSU and restricted stock awards (“RSA”) that were cash-settled in connection with the acquisition.
The contingent consideration arrangement requires the Company to pay up to $450.0 million of additional cash consideration to Thrive’s former shareholders upon the achievement of two discrete events, U.S. Food and Drug Administration (“FDA”) approval and CMS coverage, for $150.0 million and up to $300.0 million, respectively. The fair value of the contingent consideration arrangement at the acquisition date was $352.0 million. The fair value of the contingent consideration was estimated using a probability-weighted scenario based discounted cash flow model. This fair value measurement is based on significant inputs not observable in the market and thus represents a Level 3 measurement as defined in ASC 820. The key assumptions are described in Note 7. Of the total fair value of the contingent consideration, $331.3 million was allocated to the consideration transferred, $6.4 million was allocated to the Company’s previous ownership interest in Thrive, and $14.3 million was deemed compensatory as participation is dependent on replaced unvested equity awards vesting which requires future service. Compensation expense related to the milestones could be up to $18.2 million undiscounted and will be recognized in the future once probable and payable.
The Company replaced unvested stock options, RSUs, and RSAs and vested stock options with a combination-date fair value of $197.0 million. Of the total consideration for replaced equity awards, $52.2 million was allocated to the consideration transferred and $144.8 million was deemed compensatory as it was attributable to post acquisition vesting. Of the total compensation related to replaced awards, $65.0 million was expensed on the acquisition date due to accelerated vesting of stock options in connection with the acquisition and $79.8 million relates to future services and will be expensed over the remaining service periods of the unvested stock options, RSUs, and RSAs on a straight-line basis. Including expense recognized for accelerated vesting of RSUs and RSAs described above, total expected stock-based compensation expense is $166.0 million, of which $86.2 million was recognized immediately to general and administrative expenses in the consolidated statement of operations due to accelerated vesting.
The fair value of the stock options assumed by the Company was determined using the Black-Scholes option pricing model. The fair value of the RSA and RSUs assumed by the Company was determined based on the average of the high and low market price of the Company's shares on the acquisition date. The share conversion ratio of 0.06216 was applied to convert Thrive’s outstanding equity awards for Thrive’s common stock into equity awards for shares of the Company’s common stock.
The fair value of options assumed were based on the assumptions in the following table:
Option Plan Shares Assumed
Risk-free interest rates
0.11% - 0.12%
Expected term (in years)
1.26 - 1.57
Expected volatility
65.54% - 71.00%
Dividend yield
0%
Weighted average fair value per share of options assumed
$109.74 - $124.89
The Company previously held a preferred stock investment of $12.5 million in Thrive and recognized a gain of approximately $30.5 million on the transaction within investment income (expense), net on the Company’s consolidated statement of operations, which represented the adjustment of the Company’s historical investment to the acquisition date fair value. The fair value of the Company’s previous ownership in Thrive was determined based on the pro-rata share payout applied to the Company’s interest combined with the fair value of the Company’s share of the contingent consideration arrangement, as discussed above.
The purchase price was allocated to the underlying assets acquired and liabilities assumed based upon their estimated fair values as follows:
(In thousands)Preliminary Allocation
January 5, 2021
Measurement Period AdjustmentsFinal Allocation
December 31, 2021
Cash and cash equivalents$241,748$$241,748
Prepaid expenses and other current assets3,9393,939
Property, plant and equipment29,97729,977
Operating lease right-of-use assets39,02739,027
Other long-term assets6767
In-process research and development (IPR&D)1,250,0001,250,000
Total identifiable assets acquired 1,564,7581,564,758
Accounts payable(3,222)(3,222)
Accrued liabilities (6,218)(1,862)(8,080)
Operating lease liabilities, current portion(2,980)(2,980)
Operating lease liabilities, less current portion(38,622)(38,622)
Deferred tax liability(272,905)(272,905)
Total liabilities assumed (323,947)(1,862)(325,809)
Net identifiable assets acquired 1,240,811(1,862)1,238,949
Goodwill946,2431,862948,105
Net assets acquired $2,187,054$$2,187,054
IPR&D represents the fair value assigned to research and development assets that have not reached technological feasibility. The primary basis for determining technological feasibility of these projects is obtaining regulatory approval to market the underlying product and expected commercial release. The amounts capitalized are accounted for as indefinite-lived intangible assets, subject to impairment testing, until completion or abandonment of the research and development efforts associated with the projects. The Company recorded $1.25 billion of IPR&D related to a project associated with the development of an FDA approved blood-based, multi-cancer early detection test. The IPR&D asset was valued using the multiple-period excess earnings method approach, which involves significant unobservable inputs (Level 3 inputs). These inputs include inputs such as projected revenues, gross margin, required rate of return, tax rate, probability of commercial success, and obsolescence factor.
The calculation of the excess of the purchase price over the estimated fair value of the tangible net assets and intangible assets acquired was recorded to goodwill, which is primarily attributed to the research and development workforce expertise, next generation sequencing capabilities, and expected synergies. The total goodwill related to this combination is not deductible for tax purposes.
The net loss before tax of Thrive included in the Company’s consolidated statement of operations from the combination date of January 5, 2021 to December 31, 2021 was $255.0 million.
The following unaudited pro forma financial information summarizes the combined results of operations for the Company and Thrive, as though the companies were combined as of the beginning of January 1, 2020.
Year Ended December 31,
(In thousands)20212020
Total revenues$1,767,087 $1,491,391 
Net loss before tax$(761,337)$(1,014,352)
The unaudited pro forma financial information for all periods presented above has been calculated after adjusting the results of Thrive to reflect the business combination accounting effects resulting from this combination. The Company incurred $86.2 million of stock-based compensation expense related to accelerated vesting in connection with the acquisition, $13.5 million of stock-based compensation expense related to accelerated vesting for employees with qualifying termination events, and $10.3 million of transaction costs incurred to execute the acquisition during the first quarter of 2021. These expenses are included in general and administrative expenses on the consolidated statement of operations for the year ended December 31, 2021 and are reflected in pro forma earnings for the year ended December 31, 2020 in the table above. The Company recorded a realized gain of $30.5 million during the first quarter of 2021 in investment income (expense), net on the Company’s consolidated statement of operations relating to the Company’s pre-acquisition investment in Thrive. This gain has been reduced to $7.6 million due to the Company’s smaller ownership interest in Thrive on January 1, 2020, and is reflected in pro forma earnings for the year ended December 31, 2020 in the table above. The Company recorded a remeasurement of contingent consideration of $7.2 million related to Thrive in general and administrative expenses in the consolidated statement of operations for the year ended December 31, 2021. This expense is reflected in the year ended December 31, 2020 in the table above. The historical consolidated financial statements have been adjusted in the unaudited pro forma combined financial information to give effect to pro forma events that are directly attributable to the business combination and factually supportable. The unaudited pro forma financial information is for informational purposes only and is not indicative of the results of operations that would have been achieved if the combination had taken place as of January 1, 2020.
During the year ended December 31, 2021, the Company incurred $10.3 million of acquisition-related costs recorded in general and administrative expenses in the consolidated statement of operations. These costs include fees associated with financial, legal, accounting and other advisors incurred to complete the merger.
In connection with acquisition-related severances, the Company recorded $19.0 million of expense related to vesting of previously unvested equity awards and $3.9 million of additional benefit charges for the year ended December 31, 2021.
Paradigm Diagnostics, Inc. and Viomics, Inc.
On March 3, 2020, the Company acquired all of the outstanding capital stock of Paradigm Diagnostics, Inc. and Viomics, Inc., two related party companies of one another headquartered in Phoenix, Arizona, in transactions that are deemed to be a single business combination in accordance with ASC 805, Business Combinations, (“the Paradigm Acquisition”). Paradigm provides comprehensive genomic-based profiling tests that assist in the diagnosis and therapy recommendations for late-stage cancer. Viomics provides a platform for identification of biomarkers.
The Company entered into this acquisition to enhance its product portfolio in cancer diagnostics and to enhance its capabilities for biomarker identification.
The acquisition date fair value of the consideration to be transferred for Paradigm and Viomics was $40.4 million, which consists of $32.2 million payable in shares of the Company’s common stock and $8.2 million which was settled through a cash payment. Of the $32.2 million to be settled through the issuance of common stock, $28.8 million was issued as of December 31, 2021 and December 31, 2020, and the remaining $3.4 million, which was withheld and may become payable as additional merger consideration, is included in other current liabilities in the consolidated balance sheet as of December 31, 2021. The purchase price was allocated to the underlying assets acquired and liabilities assumed based upon their estimated fair values as follows:
(In thousands)Preliminary Allocation
March 3, 2020
Measurement Period AdjustmentsFinal Allocation
March 3, 2021
Net operating assets$6,133 $(760)$5,373 
Goodwill29,695 736 30,431 
Developed technology7,800 — 7,800 
Net operating liabilities(3,123)(80)(3,203)
Total purchase price$40,505 $(104)$40,401 
The fair value of identifiable intangible assets has been determined using the income approach, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, margin, weighted average cost of capital and tax rate.
Developed technology represents purchased technology that had reached technological feasibility and for which development had been completed as of the acquisition date. Fair value was determined using future discounted cash flows related to the projected income stream of the developed technology for a discrete projection period. Cash flows were discounted to their present value as of the closing date. Developed technology is amortized on a straight-line basis over its estimated useful life of 15 years.
The calculation of the excess of the purchase price over the estimated fair value of the tangible net assets and intangible assets acquired was recorded to goodwill, which is primarily attributed to the assembled workforce and expected synergies. The total goodwill related to this acquisition is not deductible for tax purposes.
The Company agreed to issue to the previous investors in Viomics equity interests with an acquisition-date fair value of up to $8.4 million in Viomics, vesting over 4 years based on certain retention arrangements. Payment is contingent upon continued employment with the Company over the four year vesting period and is recognized as stock-based compensation expense in general and administrative expense in the consolidated statement of operations.
Genomic Health, Inc.
On November 8, 2019, the Company acquired all of the outstanding capital stock of Genomic Health, Inc. Genomic Health, headquartered in Redwood City, California, provides genomic-based diagnostic tests that address both the overtreatment and optimal treatment of early and late stage cancer. The Company entered into this combination to create a leading global cancer diagnostics company and provide a robust platform for continued growth. The Company has included the financial results of Genomic Health in the consolidated financial statements from the date of the combination.
The combination date fair value of the consideration transferred for Genomic Health was approximately $2.47 billion, which consisted of the following:
(In thousands)
Cash$1,061,489 
Common stock issued1,389,266 
Fair value of replacement stock options and restricted stock awards17,813 
Total purchase price$2,468,568 
The fair value of the common stock issued as part of consideration was determined on the basis of the closing market price of the Company's shares at the acquisition date. The fair value of the stock options assumed by the Company was determined using the Black-Scholes option pricing model. The share conversion ratio of 0.76534 was applied to convert Genomic Health’s outstanding equity awards for Genomic Health’s common stock into equity awards for shares of the Company’s common stock.
The fair value of options assumed were based on the assumptions in the following table:
Option Plan Shares Assumed
Risk-free interest rates
0.88% - 2.90%
Expected term (in years)
3.28 - 6.73
Expected volatility
63.54% - 69.09%
Dividend yield0%
Weighted average fair value per share of options assumed
$45.75 - $57.44
During 2019, the Company incurred $22.5 million of acquisition-related costs recorded in general and administrative expense. These costs include fees associated with financial, legal, accounting and other advisors incurred to complete the combination.
In connection with the combination, the Company decided to terminate certain Genomic Health executives in the fourth quarter of 2019 and recorded $32.1 million in severance benefits charges.
The amounts of revenue and net loss before tax of Genomic Health included in the Company’s consolidated statement of operations from the combination date of November 8, 2019 to December 31, 2019.
(In thousands)2019
Total revenues$66,174 
Net loss before tax$(40,446)
The following unaudited pro forma financial information summarized the combined results of operations for the Company and Genomic Health, as though the companies were combined as of January 1, 2018.
(In thousands)2019
Total revenues$1,266,591 
Net loss before tax$(389,795)
The unaudited pro forma financial information for the period presented above has been calculated after adjusting the results of Genomic Health to reflect the business combination accounting effects resulting from this combination, including the amortization expense from acquired intangible assets and the stock-based compensation expense for unvested stock options and restricted stock awards assumed as though the combination occurred as of January 1, 2018. The historical consolidated financial statements have been adjusted in the unaudited pro forma combined financial information to give effect to pro forma events that are directly attributable to the business combination and factually supportable. The unaudited pro forma financial information is for informational purposes only and is not indicative of the results of operations that would have been achieved if the combination had taken place as of January 1, 2018.
As described in Note 15, the Company identified a pre-acquisition contingency relating to the DOJ investigation. The Company assigned a fair value estimate of zero to this pre-acquisition contingency. Subsequent to the Company's final determination of the pre-acquisition contingency’s estimated value, changes to this estimate could have a material impact on the Company's results of operations and financial position. As of December 31, 2021, the Company has accrued approximately $10 million related to this investigation.
Asset Acquisitions
PFS Genomics Inc.
On May 3, 2021, the Company acquired 90% of the outstanding capital stock of PFS Genomics Inc. (“PFS”). On June 23, 2021, the Company completed the acquisition of the remaining 10% interest in PFS. The Company paid cash of $33.6 million for 100% of the outstanding capital stock in PFS. PFS is a healthcare company focused on personalizing treatment for breast cancer patients to improve outcomes and reduce unnecessary treatment. The Company expects this acquisition to expand its ability to help guide early-stage breast cancer treatment through individualized radiotherapy treatment decisions.
The transaction was treated as an asset acquisition under GAAP because substantially all of the fair value of the gross assets acquired were deemed to be associated with the acquired technology.
The assets acquired and liabilities assumed were substantially comprised of the IPR&D asset as shown in the table below. The IPR&D asset acquired was recorded to research and development expense in the consolidated statement of operations immediately after acquisition as the asset was deemed to be incomplete and had no alternative future use at the time of acquisition.
The Company accounted for the acquisition in accordance with the accounting standards codification guidance for business combinations, whereby the total purchase price was allocated to the acquired net tangible and intangible assets based on their estimated fair values as of the closing date.
Acquisition related costs were not material in this asset acquisition.
The following table summarizes the allocation of the purchase price to the fair values assigned to the assets acquired and liabilities assumed:
(In thousands)
Consideration
Cash paid for acquisition of PFS Genomics outstanding shares$33,569
Assets acquired and liabilities assumed
Cash496
IPR&D asset33,074
Other assets and liabilities(1)
Net assets acquired$33,569
TARDIS License Agreement
On January 11, 2021, the Company entered into a worldwide exclusive license to the proprietary TARDIS technology from TGen, an affiliate of City of Hope. Under the agreement, the Company acquired a royalty-free, worldwide exclusive license to proprietary TARDIS patents and know-how. The Company intends to develop and commercialize the TARDIS technology as a minimal residual disease test. The Company accounted for this transaction as an asset acquisition. In connection with the asset acquisition, the Company paid upfront fair value consideration of $52.3 million comprised of $25.0 million in cash and issuance of 0.2 million shares of common stock valued at $27.3 million based on the average of the high and low market price of the Company’s shares on the acquisition date. In addition, the Company is obligated to make milestone payments to TGen of $10.0 million and $35.0 million upon achieving cumulative product revenue related to MRD detection and/or treatment totaling $100.0 million and $250.0 million, respectively. These payments are contingent upon achievement of these cumulative revenues on or before December 31, 2030. The upfront consideration was recorded to research and development expense in the consolidated statement of operations immediately after acquisition as the asset was deemed to be incomplete and had no alternative future use at the time of acquisition. The Company will record the sales milestones once achievement is deemed probable. No acquisition related costs were incurred in this asset acquisition during the year ended December 31, 2021.
Base Genomics, Limited
On October 26, 2020, The Company acquired all of the outstanding capital stock of Base Genomics, Limited (“Base Genomics”) in a cash transaction totaling $416.5 million. Base Genomics, headquartered in Oxford, England, exclusively licenses from Ludwig a non-bisulfite technology for the detection of methylated DNA and other epigenetic modifications. This technology (“TAPS”) simultaneously generates both genetic and epigenetic information at base resolution. TAPS overcomes the issues of the current gold standard for DNA methylation detection of bisulfite sequencing. The Company has included the financial results of Base Genomics in the consolidated statements from the date of the acquisition and not disclosed separately due to immateriality. Pro forma disclosures have not been included due to immateriality.
While the acquisition was treated legally as a merger of the two entities, for accounting purposes, the transaction was treated as an asset acquisition under GAAP because substantially all of the fair value of the gross assets acquired were deemed to be associated with the TAPS technology.
The assets and liabilities acquired in the merger were recorded at fair value as determined as of October 26, 2020, and were substantially comprised of the TAPS IPR&D asset as shown in the table below. The Company incurred approximately $4.6 million of direct transaction costs during 2020 associated with this acquisition. These acquisition-related transaction costs were capitalized to the acquired tangible and intangible assets based on their estimated fair values as of the closing date. The IPR&D asset acquired was recorded to research and development expense in the consolidated statement of operations immediately after acquisition as the asset was deemed to be incomplete and had no alternative future use at the time of acquisition.
The Company accounted for the merger in accordance with the accounting standards codification guidance for business combinations, whereby the total purchase price was allocated to the acquired net tangible and intangible assets based on their estimated fair values as of the closing date.
The following table summarizes the total consideration for the acquisition and the value of assets acquired and liabilities assumed as of October 26, 2020, the Merger closing date. These values are based on internal Company and independent external third-party valuations:
(In thousands)
Consideration
Cash paid for acquisition of Base Genomics outstanding shares$416,525 
Transaction costs4,600 
Total consideration421,125 
Assets acquired and liabilities assumed
Cash9,704 
IPR&D asset412,568 
Other assets and liabilities(1,147)
Net assets acquired$421,125 
v3.22.0.1
SEGMENT INFORMATION
12 Months Ended
Dec. 31, 2021
Segment Reporting [Abstract]  
SEGMENT INFORMATION SEGMENT INFORMATION
Management determined that the Company functions as a single operating segment, and thus reports as a single reportable segment. This operating segment is focused on the development and global commercialization of clinical laboratory services allowing healthcare providers and patients to make individualized treatment decisions. Management assessed the discrete financial information routinely reviewed by the Company's Chief Operating Decision Maker, its President and Chief Executive Officer, to monitor the Company's operating performance and support decisions regarding allocation of resources to its operations. Performance is continuously monitored at the consolidated level to timely identify deviations from expected results.
The following table summarizes total revenue from customers by geographic region. Product revenues are attributed to countries based on ship-to location.
Year Ended December 31,
(In thousands)202120202019
United States$1,657,174 $1,413,907 $864,849 
Outside of United States109,913 77,484 11,444 
Total revenues$1,767,087 $1,491,391 $876,293 
Long-lived assets located in countries outside of the United States are not significant.
v3.22.0.1
INCOME TAXES
12 Months Ended
Dec. 31, 2021
Income Tax Disclosure [Abstract]  
INCOME TAXES INCOME TAXESUnder financial accounting standards, deferred tax assets or liabilities are computed based on the differences between the financial statement and income tax bases of assets and liabilities using the enacted tax rates. Deferred income tax expense or benefit represents the change in the deferred tax assets or liabilities from period to period. At December 31, 2021, the Company had federal net operating loss, state net operating loss, and foreign net operating loss carryforwards of approximately $2.15 billion, $1.04 billion, and $15.9 million, respectively for financial reporting purposes, which may be used to offset future taxable income. The Tax Cuts and Jobs Act (H.R. 1) of 2017 limits the deduction for net operating losses to 80% of current year taxable income and provides for an indefinite carryover period for federal net operating losses. Both provisions are applicable for losses arising in tax years beginning after December 31, 2017. As of December 31, 2021 the Company has $1.32 billion of federal net operating loss carryovers incurred after December 31, 2017 with an unlimited carryover period and $835.6 million of federal net operating loss carryovers expiring at various dates through 2041. State and foreign net operating loss carryovers expire at various dates through 2041. All net operating loss carryforwards are subject to review and possible adjustment by federal, state and foreign taxing jurisdictions. The Company also had federal and state research tax credit carryforwards of $63.0 million and $39.8 million, respectively which may be used to offset future income tax liability. The federal credit carryforwards expire at various dates through 2041 and are subject to review and possible adjustment by the Internal Revenue Service. The state credit carryforwards expire at various dates through 2036 with the exception of $23.5 million of California
research and development tax credits that have an indefinite carryforward period. All state tax credits are subject to review and possible adjustment by local tax jurisdictions. In the event of a change of ownership, the federal and state net operating loss and research and development tax credit carryforwards may be subject to annual limitations provided by the Internal Revenue Code and similar state provisions.
Income (loss) before provision for taxes consisted of the following:
Year Ended December 31,
(In thousands)202120202019
Income (loss) before income taxes:
Domestic$(801,536)$(423,025)$(405,425)
Foreign(40,970)(406,038)(1,019)
Total income (loss) before income taxes$(842,506)$(829,063)$(406,444)
The expense (benefit) for income taxes consists of:
Year Ended December 31,
(In thousands)202120202019
Current expense (benefit):
Federal$— $(3)$— 
State1,388 802 314 
Foreign4,898 933 (63)
Deferred tax expense (benefit):
Federal(222,693)(3,050)(173,521)
State(30,528)(4,260)(20,099)
Foreign54 120 15 
Total income tax expense (benefit)$(246,881)$(5,458)$(193,354)
The Company recorded an income tax benefit for the year ended December 31, 2021 of $246.9 million primarily as a result of the change in the deferred tax asset valuation allowance resulting from the Thrive Merger.
The components of the net deferred tax asset with the approximate income tax effect of each type of carryforward, credit and temporary differences are as follows:
December 31,
(In thousands)20212020
Deferred tax assets:
Operating loss carryforwards$516,344 $369,642 
Tax credit carryforwards72,959 64,760 
Compensation related differences74,127 48,349 
Lease liabilities48,201 31,938 
Capitalized research and development23,035 — 
Other temporary differences20,087 6,136 
Tax assets before valuation allowance754,753 520,825 
Less - Valuation allowance(262,238)(293,397)
Total deferred tax assets492,515 227,428 
Deferred tax liabilities
Amortization$(464,748)$(197,847)
Property, plant and equipment(4,756)(4,580)
Lease assets(45,781)(30,312)
Other temporary differences(6,012)(3,995)
Total deferred tax liabilities(521,297)(236,734)
Net deferred tax liabilities$(28,782)$(9,306)
A valuation allowance to reduce the deferred tax assets is reported if, based on the weight of the evidence, it is more likely than not that some portion or all of the deferred tax assets will not be realized. The Company has incurred significant losses since its inception and due to the uncertainty of the amount and timing of future taxable income and the realization of deferred tax liabilities, management has determined that a valuation allowance of $262.2 million and $293.4 million at December 31, 2021 and 2020, respectively, is necessary to reduce the tax assets to the amount that is more likely than not to be realized. Given the future limitations on and expiration of certain federal and state deferred tax assets, the recording of a valuation allowance resulted in a deferred tax liability of approximately $28.8 million remaining at the end of 2021, which is included in other long-term liabilities on the Company's consolidated balance sheet. The overall change in valuation allowance for December 31, 2021 and 2020 was a decrease of $31.2 million and an increase of $98.0 million, respectively.
Activity associated with the Company's valuation allowance is as follows:
December 31,
(In thousands)202120202019
Balance as of January 1, $(293,397)$(195,401)$(265,587)
Valuation allowances established(206,574)(94,589)(113,522)
Changes to existing valuation allowances(1,500)2,151 (22)
Acquisition and purchase accounting239,233 (5,558)183,730 
Balance as of December 31,$(262,238)$(293,397)$(195,401)
During the year ended December 31, 2021, the Company recorded an increase to the valuation allowance of $206.6 million primarily related to losses from continuing operations. Offsetting the increase, the Company recorded a decrease to the valuation allowance of $239.2 million related to the Thrive Merger offset against goodwill.
During the year ended December 31, 2020, the Company recorded an increase to the valuation allowance of $94.6 million primarily related to losses from continuing operations. Additionally, the Company recorded an increase to the valuation allowance of $5.6 million related to the Genomic Health combination offset against goodwill.
During the year ended December 31, 2019, the Company recorded an increase to the valuation allowance of $113.5 million primarily related to losses from continuing operations. Additionally, the Company recorded a decrease to the valuation allowance of $183.7 million related to the Genomic Health combination offset against goodwill.
The effective tax rate differs from the statutory tax rate due to the following:
December 31,
202120202019
U.S. Federal statutory rate21.0 %21.0 %21.0 %
State taxes3.6 1.7 3.4 
Federal and state tax rate changes(0.3)— 0.1 
Foreign tax rate differential(0.6)(1.0)0.4 
Acquired IPR&D asset expense(0.8)(9.4)— 
Research and development tax credits0.7 1.6 0.7 
Stock-based compensation expense1.1 1.1 14.6 
Non-deductible executive compensation(0.2)(0.8)(2.7)
Transaction costs(0.1)(0.1)(0.5)
Loss on extinguishment - convertible notes— — (9.2)
Other adjustments1.2 (2.2)(0.5)
Valuation allowance3.7 (11.3)20.2 
Effective tax rate29.3 %0.6 %47.5 %
For the year ended December 31, 2021, the Company recognized an income tax benefit, representing an effective tax rate of 29.3%. The difference between the expected statutory federal tax rate of 21.0% and the effective tax rate of 29.3% for the year ended December 31, 2021, was primarily attributable to an income tax benefit of $239.2 million recorded as a result of a change in the deferred tax asset valuation allowance resulting from the Thrive Merger.
For the year ended December 31, 2020, the Company recognized an income tax benefit, representing an effective tax rate of 0.6%. The difference between the expected statutory federal tax rate of 21.0% and the effective tax rate of 0.6% for the year ended December 31, 2020, was primarily attributable to the valuation allowance established against the Company's current period losses generated and the non-deductible IPR&D expense related to the Base Genomics acquisition.
For the year ended December 31, 2019, the Company recognized an income tax benefit, representing an effective tax rate of 47.5%. The difference between the expected statutory federal tax rate of 21.0% and the effective tax rate of 47.5% for the year ended December 31, 2019, was primarily attributable to an income tax benefit of $193.6 million recorded as a result of a change in the deferred tax asset valuation allowance resulting from the Genomic Health combination, as well as excess tax benefits on vested stock-based compensation awards.
The Company had unrecognized tax benefits related to federal and state research and development tax credits of $21.8 million, $16.6 million, and $10.3 million as of December 31, 2021, 2020, and 2019, respectively. These amounts have been recorded as a reduction to the Company's deferred tax asset, if recognized they would not have an impact on the effective tax rate due to the existing valuation allowance. Certain of the Company's unrecognized tax benefits could change due to activities of various tax authorities, including possible settlement of audits, or through normal expiration of various statutes of limitations. The Company does not expect a material change in unrecognized tax benefits in the next twelve months.
The following is a tabular reconciliation of the amounts of unrecognized tax benefits:
December 31,
(In thousands)202120202019
January 1,$16,629 $10,276 $1,926 
Increase due to current year tax positions5,363 3,600 2,142 
Increase due to prior year tax positions— 2,753 6,208 
Decrease due to prior year tax positions(212)— — 
Settlements— — — 
December 31,$21,780 $16,629 $10,276 
As of December 31, 2021, due to the carryforward of unutilized net operating losses and research and development credits, the Company is subject to U.S. federal income tax examinations for the tax years 2002 through 2021, and to state income tax examinations for the tax years 2002 through 2021. There were no interest or penalties related to income taxes that have been accrued or recognized as of and for the years ended December 31, 2021, 2020 and 2019.
v3.22.0.1
QUARTERLY RESULTS OF OPERATIONS (UNAUDITED)
12 Months Ended
Dec. 31, 2021
Quarterly Financial Information Disclosure [Abstract]  
QUARTERLY RESULTS OF OPERATIONS (UNAUDITED) QUARTERLY RESULTS OF OPERATIONS (UNAUDITED)
The following table sets forth unaudited quarterly statements of operations data for each of the eight quarters ended December 31, 2021 and 2020. In the opinion of management, this information has been prepared on the same basis as the audited consolidated financial statements and contains all adjustments, consisting only of normal recurring adjustments, considered necessary for a fair statement of the unaudited quarterly results for the periods presented. The quarterly data should be read in conjunction with the Company’s audited consolidated financial statements and the notes to the consolidated financial statements appearing elsewhere in this Form 10-K.
Quarter Ended
March 31,June 30,September 30,December 31,
(Amounts in thousands, except per share data)
2021
Revenue$402,077 $434,819 $456,379 $473,812 
Cost of sales (exclusive of amortization of acquired intangible assets)109,993 113,968 115,738 119,058 
Amortization of acquired intangible assets (1)20,555 21,188 21,214 21,216 
Gross profit271,529 299,663 319,427 333,538 
Operating expenses, net (2)572,070 471,327 481,450 554,988 
Interest income and interest expense26,572 (1,223)(8,773)(3,404)
Income tax benefit (expense)242,805 (4,025)3,858 4,243 
Net loss$(31,164)$(176,912)$(166,938)$(220,611)
Net loss per share—basic and diluted$(0.18)$(1.03)$(0.97)$(1.28)
Weighted average common shares outstanding—basic and diluted169,434 171,494 171,978 172,446 
2020
Revenue$347,821 $268,868 $408,363 $466,339 
Cost of sales (exclusive of amortization of acquired intangible assets)81,606 77,892 95,061 99,765 
Amortization of acquired intangible assets (1)20,464 20,555 20,555 20,553 
Gross profit245,751 170,421 292,747 346,021 
Operating expenses (2)328,124 237,430 496,082 761,000 
Interest income and interest expense (3)(54,507)(1,388)(1,955)(3,517)
Income tax benefit (3)2,237 305 2,752 164 
Net loss$(134,643)$(68,092)$(202,538)$(418,332)
Net loss per share—basic and diluted$(0.91)$(0.45)$(1.35)$(2.67)
Weighted average common shares outstanding—basic and diluted148,151 149,727 150,155 156,470 
_________________________________
(1) Includes only amortization of acquired intangible assets identified as developed technology assets through purchase accounting transactions, which otherwise would have been allocated to cost of sales.
(2) Consists of research and development, sales and marketing, general and administrative, and amortization of acquired intangible assets excluding acquired developed technology, which is included in the gross profit calculation above. This also includes intangible asset impairment charges and funding received as part of the CARES Act in the second quarter of 2020. Refer to Note 6 for further discussion on the intangible asset impairment charges recorded in the third quarters of 2020 and 2021. Refer to Note 1 for further discussion on the funding received as part of the CARES Act in the second quarter of 2020.
(3) As a result of the adoption of ASU 2020-06, Debt - Debt with Conversion and Other Options (subtopic 470-20) and Derivatives and Hedging - Contracts in Entity's Own Equity (Subtopic 815-40), using the full retrospective method of adoption, the balances for interest expense and income tax benefit have been restated. Refer to Note 1 for further discussion on the adoption of this ASU.
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)
12 Months Ended
Dec. 31, 2021
Accounting Policies [Abstract]  
Business BusinessExact Sciences Corporation (together with its subsidiaries, “Exact,” or the “Company”) was incorporated in February 1995. Exact is a leading global cancer diagnostics company. It has developed some of the most impactful tests in cancer screening and diagnostics, including Cologuard® and Oncotype DX®. Exact is currently working on the development of additional tests, with the goal of bringing new innovative cancer tests to patients throughout the world.
Basis of Presentation and Principles of Consolidation
Basis of Presentation and Principles of Consolidation
The accompanying consolidated financial statements include the accounts of Exact Sciences Corporation and those of its wholly-owned subsidiaries and variable interest entities. All intercompany transactions and balances have been eliminated upon consolidation.
Use of Estimates
Use of Estimates
The preparation of the consolidated financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Critical accounting policies are those that affect the Company's financial statements materially and involve difficult, subjective or complex judgments by management, and actual results could differ from those estimates. These estimates include revenue recognition, valuation of intangible assets and goodwill, and accounting for income taxes among others.
The spread of the coronavirus (“COVID-19”) has affected many segments of the global economy, including the cancer screening and diagnostics industry. The Company assessed certain accounting matters that generally require consideration of forecasted financial information in context with the information reasonably available to the Company and the unknown future impacts of COVID-19 as of December 31, 2021 and through the date of the filing of this Annual Report on Form 10-K. The accounting matters assessed included, but were not limited to, the Company’s allowance for doubtful accounts and credit losses, marketable and non-marketable investments, software, and the carrying value of the goodwill and other long-lived assets. The Company’s future assessment of the magnitude and duration of COVID-19, as well as other factors, could result in additional material impacts to the Company’s consolidated financial statements in future reporting periods.
The pandemic and related precautionary measures began to materially disrupt the Company's operations in March 2020 and may continue to disrupt the business for an unknown period of time. As a result, the pandemic had a significant impact on the Company's revenues and operating results.
The ultimate impact of COVID-19 depends on factors beyond the Company’s knowledge or control, including the duration and severity of the outbreak, as well as third-party actions taken to contain its spread and mitigate its public health effects. As a result, the Company is unable to estimate the extent to which COVID-19 will negatively impact its financial results or liquidity.
Cash and Cash Equivalents Cash and Cash EquivalentsThe Company considers cash on hand, demand deposits in a bank, money market funds, and all highly liquid investments with an original maturity of 90 days or less to be cash and cash equivalents.
Marketable Securities
Marketable Securities
Management determines the appropriate classification of debt securities at the time of purchase and re-evaluates such designation as of each balance sheet date. Debt securities carried at amortized cost are classified as held-to-maturity when the Company has the positive intent and ability to hold the securities to maturity. Debt securities not classified as held-to-maturity are classified as available-for-sale. Available-for-sale securities are carried at fair value. The unrealized gains and losses, net of tax, on the Company's debt securities are reported in other comprehensive income. Marketable equity securities are measured at fair value and the unrealized gains and losses, net of tax, are recognized in other income (expense) in the consolidated
statements of operations. The amortized cost of debt securities in this category is adjusted for amortization of premiums and accretion of discounts to maturity computed under the effective interest rate method. Such amortization is included in investment income, net. Realized gains and losses and declines in value as a result of credit losses on available-for-sale securities are included in the consolidated statements of operations as investment income, net. The cost of securities sold is based on the specific identification method. Interest and dividends on securities classified as available-for-sale are included in the consolidated statements of operations as investment income, net.
The Company’s investment policy limits investments to certain types of instruments issued by institutions with investment grade credit ratings and places restrictions on maturities and concentration by type and issuer. Investments in which the Company has the ability and intent, if necessary, to liquidate in order to support its current operations (including those with a contractual term greater than one year from the date of purchase) are classified as current.
The Company periodically evaluates its available-for-sale debt securities in unrealized loss positions to determine whether any impairment is a result of a credit loss or other factors. This evaluation includes, but is not limited to, significant quantitative and qualitative assessments and estimates regarding credit ratings, significance of a security’s loss position, adverse conditions specifically related to the security, and the payment structure of the security.
Allowance for Doubtful Accounts Allowance for Doubtful AccountsThe Company estimates an allowance for doubtful accounts against accounts receivable using historical collection trends, aging of accounts, current and future implications surrounding the ability to collect such as economic conditions, and regulatory changes. The allowance for doubtful accounts is evaluated on a regular basis and adjusted when trends, significant events, or other substantive evidence indicate that expected collections will be less than applicable accrual rates.
Inventory
Inventory
Inventory is stated at the lower of cost or net realizable value. The Company determines the cost of inventory using the first-in, first out method (“FIFO”). The Company estimates the recoverability of inventory by reference to internal estimates of future demands and product life cycles, including expiration. The Company periodically analyzes its inventory levels to identify inventory that may expire prior to expected sale, no longer meet quality specifications, or has a cost basis in excess of its estimated realizable value and records a charge to cost of sales for such inventory as appropriate.
Direct and indirect manufacturing costs incurred during process validation with probable future economic benefit are capitalized. Validation costs incurred for other research and development activities, which are not permitted to be sold, have been expensed to research and development in the Company’s consolidated statements of operations.
Property, Plant and Equipment Property, Plant and EquipmentProperty, plant and equipment are stated at cost and depreciated using the straight-line method over the assets’ estimated useful lives. Land is stated at cost and does not depreciate. Additions and improvements are capitalized, including direct and indirect costs incurred to validate equipment and bring to working conditions. Revalidation costs, including maintenance and repairs are expensed when incurred.
Software Development Costs
Software Development Costs
Costs related to internal use software, including hosted arrangements, are incurred in three stages: the preliminary project stage, the application development stage, and the post-implementation stage. Costs incurred during the preliminary project and post-implementation stages are expensed as incurred. Costs incurred during the application development stage that meet the criteria for capitalization are capitalized and amortized, when the software is ready for its intended use, using the straight‑line basis over the estimated useful life of the software, or the duration of the hosting agreement.
Investments in Privately Held Companies
Investments in Privately Held Companies
The Company determines whether its investments in privately held companies are debt or equity based on their characteristics, in accordance with the applicable accounting guidance for such investments. The Company also evaluates the investee to determine if the entity is a variable interest entity (“VIE”) and, if so, whether the Company is the primary beneficiary of the VIE, in order to determine whether consolidation of the VIE is required. If consolidation is not required and the Company does not have voting control of the entity, the investment is evaluated to determine if the equity method of accounting should be applied. The equity method applies to investments in common stock or in substance common stock where the Company exercises significant influence over the investee.
Investments in privately held companies determined to be equity securities are accounted for as non-marketable securities. The Company adjusts the carrying value of its non-marketable equity securities for changes from observable transactions for identical or similar investments of the same issuer, less impairment. All gains and losses on non-marketable equity securities, realized and unrealized, are recognized in investment income, net in the consolidated statements of operations.
Investments in privately held companies determined to be debt securities are accounted for as available-for-sale or held-to-maturity securities, in accordance with the applicable accounting guidance for such investments.
Derivative Financial Instruments Derivative Financial InstrumentsThe Company hedges a portion of its foreign currency exposures related to outstanding monetary assets and liabilities using foreign currency forward contracts. The foreign currency forward contracts are included in prepaid expenses and other current assets or in accrued liabilities in the consolidated balance sheets, depending on the contracts’ net position. These contracts are not designated as hedges, and as a result, changes in their fair value are recorded in other income (expense) in the consolidated statements of operations.
Business Combinations and Asset Acquisitions Business Combinations and Asset AcquisitionsBusiness Combinations are accounted for under the acquisition method in accordance with Accounting Standards Codification (“ASC”) 805, Business Combinations. The acquisition method requires identifiable assets acquired and liabilities assumed and any non-controlling interest in the business acquired be recognized and measured at fair value on the acquisition date, which is the date that the acquirer obtains control of the acquired business. The amount by which the fair value of consideration transferred as the purchase price exceeds the net fair value of assets acquired and liabilities assumed is recorded as goodwill. Acquisitions that do not meet the definition of a business combination under ASC 805 are accounted for as asset acquisitions. Asset acquisitions are accounted for by allocating the cost of the acquisition to the individual assets acquired and liabilities assumed on a relative fair value basis. Goodwill is not recognized in an asset acquisition with any consideration in excess of net assets acquired allocated to acquired assets on a relative fair value basis. Transaction costs are expensed in a business combination and are considered a component of the cost of the acquisition in an asset acquisition.
Intangible Assets
Intangible Assets
Purchased intangible assets are recorded at fair value. The Company uses a discounted cash flow model to value intangible assets. The discounted cash flow model requires assumptions about the timing and amount of future net cash flows, risk, the cost of capital, terminal values and market participants.
Patent costs are capitalized as incurred, only if the Company determines that there is some probable future economic benefit derived from the transaction. A capitalized patent is amortized over its estimated useful life, beginning when such patent is approved. Capitalized patent costs are expensed upon disapproval, upon a decision by the Company to no longer pursue the patent or when the related intellectual property is either sold or deemed to be no longer of value to the Company. The Company determined that all patent costs incurred during the years ended December 31, 2021, 2020 and 2019 should be expensed and not capitalized as the future economic benefit derived from the patent costs incurred cannot be determined.
Acquired In-process Research and Development (IPR&D)
Acquired In-process Research and Development ("IPR&D")
Acquired IPR&D represents the fair value assigned to research and development assets that have not reached technological feasibility. The value assigned to acquired IPR&D is determined by estimating the costs to develop the acquired technology into commercially viable products, estimating the resulting revenues from the projects and discounting the net cash flows to present value. The revenues and cost projections used to value acquired IPR&D are, as applicable, reduced based on the probability of success. IPR&D projects acquired in a business combination that are not complete are capitalized and accounted for as indefinite-lived intangible assets until completion or abandonment of the related research and development ("R&D") efforts. Upon successful completion of the project, the capitalized amount is amortized over its estimated useful life. If a project is abandoned, all remaining capitalized amounts are written off immediately. There are often major risks and uncertainties associated with IPR&D projects as the Company is required to obtain regulatory approvals in order to be able to market the resulting products. Such approvals require completing clinical trials that demonstrate the products effectiveness. Consequently, the eventual realized value of the IPR&D project may vary from its fair value at the date of acquisition, and IPR&D impairment charges may occur in future periods.
Capitalized IPR&D projects are tested for impairment annually and whenever events or changes in circumstances indicate that the carrying amount may not be recoverable. The Company considers various factors for potential impairment, including the current legal and regulatory environment, current and future strategic initiatives and the competitive landscape. Adverse clinical trial results, significant delays in obtaining marketing approval, the inability to bring a product to market and the introduction or advancement of competitors' products could result in partial or full impairment of the related intangible assets.
Contingent Consideration
Contingent Consideration
Certain of the Company’s business combinations involve potential payment of future consideration that is contingent upon the achievement of certain regulatory and product development milestones being achieved. The Company records contingent consideration at fair value at the date of acquisition based on the consideration expected to be transferred, estimated as the probability-weighted future cash flows, discounted back to present value. The fair value of contingent consideration is measured using projected probabilities of success, projected payment dates, present value-factors, and projected revenues (for revenue-based considerations). Changes in probabilities of success, present-value factors, and projected payment dates may result in adjustments to the fair value measurements. Contingent consideration is remeasured each reporting period using Level 3 inputs, and the change in fair value, including accretion for the passage of time, is recognized as income or expense within general and administrative expenses on the Company’s consolidated statements of operations. Contingent consideration payments made soon after the acquisition date are classified as investing activities in the consolidated statements of cash flows. Contingent consideration payments not made soon after the acquisition date that are related to the acquisition date fair value are reported as financing activities in the consolidated statements of cash flows, and amounts paid in excess of the original acquisition date fair value are reported as operating activities in the consolidated statements of cash flows.
Goodwill GoodwillThe Company evaluates goodwill for possible impairment in accordance with ASC 350 on an annual basis during the fourth quarter, or more frequently if events or changes in circumstances indicate that the carrying amount of such assets may not be recoverable. Qualitative factors considered in this assessment include industry and market conditions, overall financial performance, and other relevant events and factors affecting the Company's business. Based on the qualitative assessment, if it is determined that the fair value of goodwill is more likely than not to be less than its carrying amount, the fair value of a reporting unit will be calculated and compared with its carrying amount and an impairment charge will be recognized for the amount that the carrying value exceeds the fair value.
Impairment of Long-Lived Assets Impairment of Long-Lived AssetsThe Company evaluates the fair value of long-lived assets, which include property, plant and equipment, finite-lived intangible assets, and investments in privately held companies, for impairment whenever events or changes in circumstances indicate that the carrying amounts of the assets may not be fully recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to future undiscounted net cash flows expected to be generated by the asset. If such assets are considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the assets exceeds the fair value of the assets. Assets to be disposed of are reported at the lower of the carrying amount or fair value less costs to sell.
Net Loss Per Share
Net Loss Per Share
Basic net loss per common share was determined by dividing net loss applicable to common stockholders by the weighted average common shares outstanding during the period. Basic and diluted net loss per share is the same because all outstanding common stock equivalents have been excluded, as they are anti-dilutive as a result of the Company’s losses.
Accounting for Stock-Based Compensation
Accounting for Stock-Based Compensation
The Company requires all share-based payments to employees, including grants of employee stock options, restricted stock, restricted stock units, shares purchased under an employee stock purchase plan (if certain parameters are not met), and performance share units to be recognized in the financial statements based on their grant date fair values. Forfeitures of any share-based awards are recognized as they occur.
The fair values and recognition of the Company's share-based payment awards are determined as follows:
The fair value of each service-based option award is estimated on the date of grant using the Black-Scholes option-pricing model. The Black-Scholes pricing model utilizes the following assumptions:
Expected Term—Expected life of an option award is the average length of time over which the Company expects employees will exercise their options, which is based on historical experience with similar grants.
Expected Volatility—Expected volatility is based on the Company’s historical stock volatility data over the expected term of the awards.
Risk-Free Interest Rate—The Company bases the risk-free interest rate on the implied yield currently available on U.S. Treasury zero-coupon issues with an equivalent expected term.
The estimated fair value of these awards is recognized to expense using the straight-line method over the expected term.
Research and Development Costs
Research and Development Costs
Research and development costs are expensed as incurred. These expenses include the costs of the Company's proprietary research and development efforts, as well as costs of IPR&D projects acquired as part of an asset acquisition that have no alternative future use. Upfront and milestone payments due to third parties in connection with research and development collaborations prior to regulatory approval are expensed as incurred. Milestone payments due to third parties upon, or subsequent to, regulatory approval are capitalized and amortized into research and development costs over the shorter of the remaining license or product patent life, when there are no corresponding revenues related to the license or product. Nonrefundable advance payments for goods and services that will be used in future research and development activities are expensed when the activity has been performed or when the goods have been received, rather than when the payment is made.
The Company incurred research and development expenses of $385.6 million, $554.1 million, and $139.7 million during the years ended December 31, 2021, 2020, and 2019, respectively, including IPR&D of $85.3 million and $412.6 million that was acquired in asset acquisitions that had no alternative future use during the years ended December 31, 2021 and 2020, respectively. The value of the acquired IPR&D that was expensed was determined by identifying those acquired specific IPR&D projects that would be continued and which (a) were incomplete and (b) had no alternative future use. Acquired IPR&D assets that are acquired in an asset acquisition and which have no alternative future use are classified as an investing cash outflow in the consolidated statements of cash flows.
Advertising Costs
Advertising Costs
The Company expenses the costs of media advertising at the time the advertising takes place. The Company expensed approximately $144.0 million, $97.6 million, and $90.5 million of media advertising during the years ended December 31, 2021, 2020, and 2019, respectively, which is recorded in sales and marketing expenses on the Company's consolidated statements of operations.
Fair Value Measurements
Fair Value Measurements
The Financial Accounting Standards Board (“FASB”) has issued authoritative guidance that requires fair value to be based on the assumptions market participants would use when pricing an asset or liability and establishes a fair value hierarchy that prioritizes the information used to develop those assumptions. Under that standard, fair value measurements are separately disclosed by level within the fair value hierarchy. The fair value hierarchy establishes and prioritizes the inputs used to measure fair value that maximizes the use of observable inputs and minimizes the use of unobservable inputs. Observable inputs are inputs that reflect the assumptions that market participants would use in pricing the asset or liability developed based on market data obtained from sources independent of the Company. Unobservable inputs are inputs that reflect the Company’s assumptions about the assumptions market participants would use in pricing the asset or liability developed based on the best information available in the circumstances.
Leases
Leases
The Company acts as lessee in its lease agreements, which include operating leases for corporate offices, laboratory space, warehouse space, vehicles and certain laboratory and office equipment, and finance leases for certain equipment and vehicles.
The Company determines whether an arrangement is, or contains, a lease at inception. At the beginning of fiscal year 2019, the company adopted ASC 842. The Company records the present value of lease payments as right-of-use (“ROU”) assets and lease liabilities on the consolidated balance sheets. ROU assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent an obligation to make lease payments based on the present value of lease payments over the lease term. Classification of lease liabilities as either current or non-current is based on the expected timing of payments due under the Company’s obligations.
As most of the Company’s leases do not provide an implicit interest rate, the Company uses its incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. The incremental borrowing rate is the rate of interest that a lessee would have to pay to borrow on a collateralized basis over a similar term and at an amount equal to the lease payments in a similar economic environment. The Company calculates its incremental borrowing rates for specific lease terms, used to discount future lease payments, as a function of the US. Treasury rate and an indicative Moody's rating for operating leases or finance leases.
The ROU asset also consists of any lease incentives received. The lease terms used to calculate the ROU asset and related lease liability include options to extend or terminate the lease when it is reasonably certain that the Company will exercise that option. “Reasonably certain” is assessed internally based on economic, industry, company, strategic and contractual factors. The leases have remaining lease terms of 1 year to 15 years, some of which include options to extend the lease for up to 10 years, and some of which include options to terminate the lease within 1 year. Operating lease expense and amortization of finance lease ROU assets are recognized on a straight-line basis over the lease term as an operating expense. Finance lease interest expense is recorded as interest expense on the Company’s consolidated statements of operations.
The Company accounts for leases acquired in business combinations by measuring the lease liability at the present value of the remaining lease payments as if the acquired lease were a new lease for the Company. This measurement includes recognition of a lease intangible for any below-market terms present in the leases acquired. The below-market lease intangible is included in the ROU asset on the consolidated balance sheets and are amortized over the remaining lease term. The Company has not acquired any leases with above-market terms.
The Company has taken advantage of certain practical expedients offered to registrants at adoption of ASC 842. The Company does not apply the recognition requirements of ASC 842 to short-term leases. Instead, those lease payments are recognized in profit or loss on a straight-line basis over the lease term. Further, as a practical expedient, all lease contracts are accounted for as one single lease component, as opposed to separating lease and non-lease components to allocate the consideration within a single lease contract.
Revenue Recognition
Revenue Recognition
Revenues are recognized when the satisfaction of the performance obligation occurs, in an amount that reflects the consideration the Company expects to collect in exchange for those services. The Company’s revenue is primarily generated by its laboratory testing services utilizing its Cologuard, Oncotype DX, and COVID-19 tests. The services are completed upon release of a patient’s test result to the ordering healthcare provider. To determine revenue recognition for the arrangements that
the Company determines are within the scope of ASC 606, Revenue from Contracts with Customers, the Company performs the following five steps: (1) identify the contract(s) with a customer, (2) identify the performance obligations in the contract, (3) determine the transaction price, (4) allocate the transaction price to the performance obligations in the contract and (5) recognize revenue when (or as) the entity satisfies a performance obligation.
The key aspects considered by the Company include the following:
Contracts—The Company’s customer is primarily the patient, but the Company does not enter into a formal reimbursement contract with a patient. The Company establishes a contract with a patient in accordance with other customary business practices, which is the point in time an order is received from a provider and a patient specimen has been returned to the laboratory for testing. Payment terms are a function of a patient’s existing insurance benefits, including the impact of coverage decisions with Center for Medicare & Medicaid Services (“CMS”) and applicable reimbursement contracts established between the Company and payers. However, when a patient is considered self-pay, the Company requires payment from the patient prior to the commencement of the Company’s performance obligations. The Company’s consideration can be deemed variable or fixed depending on the structure of specific payer contracts, and the Company considers collection of such consideration to be probable to the extent that it is unconstrained.
Under the Company’s Laboratory Service Agreements (“LSA”) and Laboratory Reference Agreements (“LRA”) the Company contracts with a direct bill payer who is the customer for an agreed upon amount of laboratory testing services for a specified amount of time at a fixed reimbursement rate, and certain of the Company’s agreements obligate the customer to pay for testing services prior to result.
Performance obligations—A performance obligation is a promise in a contract to transfer a distinct good or service (or a bundle of goods or services) to the customer.  The Company’s contracts have a single performance obligation, which is satisfied upon rendering of services, which culminates in the release of a patient’s test result to the ordering healthcare provider. Or, in the context of some of the Company’s agreements, the satisfaction of the performance obligation occurs when a specimen sample is not returned to the laboratory for processing before the end of the allotted testing window. The Company elects the practical expedient related to the disclosure of unsatisfied performance obligations, as the duration of time between providing testing supplies, the receipt of a sample, and the release of a test result to the ordering healthcare provider is far less than one year.
Transaction price—The transaction price is the amount of consideration that the Company expects to collect in exchange for transferring promised goods or services to a customer, excluding amounts collected on behalf of third parties (for example, some sales taxes). The consideration expected to be collected from a contract with a customer may include fixed amounts, variable amounts, or both.
Fixed consideration is derived from the Company’s LSA, LRA, and direct bill payer contracts that exist between the Company and the direct bill payers. The contracted reimbursement rate is deemed to be fixed as the Company expects to fully collect all amounts billed under these relationships. Variable consideration is primarily derived from payer and patient billing and can result due to several factors such as the amount of contractual adjustments, any patient co-payments, deductibles or patient adherence incentives, the existence of secondary payers, and claim denials.
The Company estimates the amount of variable consideration using the expected value method, which represents the sum of probability-weighted amounts in a range of possible consideration amounts. When estimating the amount of variable consideration, the Company considers several factors, such as historical collections experience, patient insurance eligibility and payer reimbursement contracts.
The Company limits the amount of variable consideration included in the transaction price to the unconstrained portion of such consideration. In other words, the Company recognizes revenue up to the amount of variable consideration that is not subject to a significant reversal until additional information is obtained or the uncertainty associated with the additional payments or refunds is subsequently resolved. Differences between original estimates and subsequent revisions, including final settlements, represent changes in the estimate of variable consideration and are included in the period in which such revisions are made.
The Company monitors its estimates of transaction price to depict conditions that exist at each reporting date. If the Company subsequently determines that it will collect more or less consideration than it originally estimated for a contract with a patient, it will account for the change as an increase or decrease in the estimate of the transaction price (i.e., an upward or downward revenue adjustment) in the period identified.
When the Company does not have significant historical experience or that experience has limited predictive value, the constraint over estimates of variable consideration may result in no revenue being recognized upon completion of the performance obligations associated with the Company's tests, with recognition, generally occurring at the date of cash receipt.
Allocate transaction price—The transaction price is allocated entirely to the performance obligation contained within the contract with a customer.
Point in time recognition—The Company’s single performance obligation is satisfied at a point in time. That point in time is defined as the date the Company releases a result to the ordering healthcare provider, or, in the context of some of the Company's agreements, that point in time could be the date the allotted testing window ends if a specimen sample is not returned to the laboratory for processing. The point in time in which revenue is recognized by the Company signifies fulfillment of the performance obligation to the patient or direct bill payer.
Contract Balances—The timing of revenue recognition, billings and cash collections results in billed accounts receivable and deferred revenue on the consolidated balance sheets. Generally, billing occurs subsequent to the release of a patient’s test result to the ordering healthcare provider, resulting in an account receivable. However, the Company sometimes receives advance payment from a patient or a direct bill payer before a test result is completed, resulting in deferred revenue. The deferred revenue recorded is recognized as revenue at the point in time results are released to the patient’s healthcare provider. Or, in the context of some of the Company’s agreements, the satisfaction of the performance obligation occurs when a specimen sample is not returned to the laboratory for processing before the end of the allotted testing window.
Practical Expedients—The Company does not adjust the transaction price for the effects of a significant financing component, as at contract inception, the Company expects the collection cycle to be one year or less.
The Company expenses sales commissions when incurred because the amortization period would have been one year or less. These costs are recorded within sales and marketing expenses in the Company’s consolidated statements of operations.
The Company incurs certain other costs that are incurred regardless of whether a contract is obtained. Such costs are primarily related to legal services and patient communications (e.g. adherence reminder letters). These costs are expensed as incurred and recorded within general and administrative expenses in the Company’s consolidated statements of operations.
Foreign Currency Transactions
Foreign Currency Transactions
The functional currency for most of the Company’s international subsidiaries is the U.S. dollar. In these instances where the functional currency differs from the local currency, monetary assets and liabilities are remeasured at the current period-end exchange rate, while non-monetary assets and liabilities are remeasured at the historical rate. The gains and losses as a result of exchange rate adjustments of these subsidiaries are recognized in the consolidated statements of operations. Net foreign currency transaction gains or losses were not material to the consolidated statements of operations for the periods presented.
For the Company's international subsidiaries where the functional currency is other than the U.S. dollar, assets and liabilities are translated into the U.S. dollar at the current period-end exchange rate. Revenue and expense items are translated at the average exchange rates for the period. The cumulative adjustments resulting from the translation of the financial statements into the U.S. dollar are included in the Company's consolidated balance sheet as a component of accumulated other comprehensive income (loss).
Concentration of Credit Risk
Concentration of Credit Risk
Financial instruments that subject the Company to credit risk consist of cash, cash equivalents and marketable securities. As of December 31, 2021, the Company had cash and cash equivalents deposited in financial institutions in which the balances exceed the federal government agency insured limit of $250,000 by approximately $234.9 million. The Company has not experienced any losses in such accounts and management believes it is not exposed to any significant credit risk.
Tax Positions
Tax Positions
A valuation allowance to reduce the deferred tax assets is reported if, based on the weight of the evidence, it is more likely than not that some portion or all of the deferred tax assets will not be realized. The Company has incurred significant losses since its inception and due to the uncertainty of the amount and timing of future taxable income, the Company has determined that a $262.2 million and $293.4 million valuation allowance at December 31, 2021 and 2020 is necessary to reduce the tax assets to the amount that is more likely than not to be realized. The change in valuation allowance as of December 31, 2021 and 2020 was a decrease of $31.2 million and an increase of $98.0 million, respectively. An income tax benefit of $246.9 million was recorded primarily as a result of the change in the deferred tax asset valuation allowance resulting from the acquisition of Thrive Earlier Detection Corporation (“Thrive”). Due to the existence of the valuation allowance, future changes in the Company's unrecognized tax benefits will not impact the Company's effective tax rate.
Recent Accounting Pronouncements
Recent Accounting Pronouncements
Recently Adopted Accounting Pronouncements
In August 2020, The FASB issued Accounting Standards Update (“ASU”) No. 2020-06, Debt – Debt with Conversion and Other Options (subtopic 470-20) and Derivatives and Hedging – Contracts in Entity’s Own Equity (Subtopic 815-40). This update simplifies the accounting for convertible debt instruments by removing the beneficial conversion and cash conversion separation models for convertible instruments. Under the update, the embedded conversion features are no longer separated from the host contract for convertible instruments with conversion features that are not required to be accounted for as derivatives or that do not result in substantial premiums accounted for as paid-in capital. The update also amends the accounting for certain contracts in an entity’s own equity that are currently accounted for as derivatives because of specific settlement provisions. In addition, ASU 2020-06 requires the application of the if-converted method for calculating diluted earnings per share and the treasury stock method will no longer be available. This standard may be adopted through either a modified retrospective method of transition or a full retrospective method of transition. The amendments in this update are effective for fiscal years beginning after December 15, 2021, including interim periods within those fiscal years. Early adoption is permitted, but no earlier than fiscal years beginning after December 15, 2020.
The Company adopted the standard on January 1, 2021 through application of the full retrospective method of transition. This method of adoption was applied to enhance comparability between the periods presented in the Company’s financial statements. The Company applied the standard to convertible notes outstanding as of the date of the first offering of the Company’s outstanding convertible notes as discussed in Note 10.
The Company’s convertible debt instruments are now accounted for as a single liability measured at its amortized cost. The notes are no longer bifurcated between debt and equity, rather accounted for entirely as debt at face value net of any discount or premium and issuance costs. Interest expense is comprised of (1) cash interest payments, (2) amortization of any debt discounts or premiums based on the original offering, and (3) amortization of any debt issuance costs. Gain or loss on extinguishment of convertible notes is calculated as the difference between the (i) fair value of the consideration transferred and (ii) the sum of the carrying value of the debt at the time of repurchase.
As of January 1, 2019, the cumulative effect of adoption resulted in an increase in the net carrying amount of convertible notes, net, of $233.7 million, a decrease in additional-paid-in-capital of $260.2 million, a decrease in accumulated deficit of $26.6 million, and an increase to net deferred tax assets of $55.7 million offset by a corresponding increase of $55.7 million in the valuation allowance. For the year ended December 31, 2019, interest expense in the consolidated statement of operations increased by $137.7 million as a result of a decrease in amortization of debt discounts, premiums, and issuance costs of $39.5
million, which was offset by an increase in loss on extinguishment of $177.1 million in connection with the extinguishment of $493.4 million face value of the 2025 Notes. Income tax benefit increased by $8.5 million and net loss per share, basic and diluted, increased by $0.98 per share. For the year ended December 31, 2020, interest expense in the condensed consolidated statement of operations decreased by $28.1 million as a result of a decrease in amortization of debt discounts, premiums, and issuance costs of $70.9 million, which was offset by an increase in loss on extinguishment of $42.8 million in connection with the extinguishment of $100.0 million face value of the 2025 Notes. Income tax benefit decreased by $3.1 million and net loss per share, basic and diluted, decreased by $0.17 per share.
In November 2021, the FASB issued ASU No. 2021-10, Government Assistance (Topic 832). This update requires certain annual disclosures about transactions with a government that are accounted for by applying a grant or contribution model by analogy. The amendments in this update are effective for fiscal years beginning after December 15, 2021. Early application of the amendments is permitted. The Company early adopted these disclosure requirements and applied them to its disclosure of the WEDC tax credits earned during fiscal year 2021 and the funding received as part of the CARES Act in 2020.
Recently Issued Accounting Pronouncements Not Yet Adopted
In October 2021, The FASB issued ASU No. 2021-08, Business Combinations (Topic 805). This update requires that an entity (acquirer) recognize and measure contract assets and contract liabilities acquired in a business combination in accordance with ASC 606. This differs from the current requirement to measure contract assets and contract liabilities acquired in a business combination at fair value. The amendments in this update should be applied prospectively, and are effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption is permitted, Including adoption in an interim period. This ASU will only impact the Company if it acquires another entity through a business combination.
Guarantees and Indemnifications
Guarantees and Indemnifications
The Company, as permitted under Delaware law and in accordance with its bylaws, indemnifies its officers and directors for certain events or occurrences, subject to certain limits, while the officer or director is or was serving at the Company’s request in such capacity. The term of the indemnification period is for the officer’s or director’s lifetime. The maximum amount of potential future indemnification is unlimited; however, the Company has a directors and officers insurance policy that limits its exposure and may enable it to recover a portion of any future amounts paid. The Company believes the fair value of these indemnification agreements is minimal. Accordingly, the Company has not recorded any liabilities for these agreements as of December 31, 2021 and 2020.
Reclassifications
Reclassifications
Certain prior year amounts have been reclassified to conform to the current year presentation in the consolidated financial statements and accompanying notes to the consolidated financial statements.
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)
12 Months Ended
Dec. 31, 2021
Accounting Policies [Abstract]  
Schedule of potentially issuable common shares not included in the computation of diluted net loss per share because they would have an anti-dilutive effect
The following potentially issuable common shares were not included in the computation of diluted net loss per share because they would have an anti-dilutive effect due to net losses for each period:
December 31,
(In thousands)202120202019
Shares issuable in connection with acquisitions45 157 — 
Shares issuable upon exercise of stock options2,284 2,231 2,700 
Shares issuable upon the release of restricted stock awards4,321 3,968 3,801 
Shares issuable upon the release of performance share units878 619 583 
Shares issuable upon conversion of convertible notes20,309 20,309 12,196 
27,837 27,284 19,280 
Schedules of concentration of risk The following is a breakdown of revenue and accounts receivable from major payers:
% Revenue for the years ended December 31,% Accounts Receivable at December 31,
Major Payer202120202019202120202019
Centers for Medicare and Medicaid Services20%21%29%11%14%19%
UnitedHealthcare11%10%13%8%7%7%
State of Wisconsin8%12%—%9%22%—%
v3.22.0.1
REVENUE (Tables)
12 Months Ended
Dec. 31, 2021
Revenue from Contract with Customer [Abstract]  
Schedule of disaggregation by revenue source The following table presents the Company's revenues disaggregated by revenue source:
Year Ended December 31,
(In thousands)202120202019
Screening
Medicare Parts B & C$438,646 $365,471 $404,331 
Commercial569,944 409,671 368,006 
Other53,718 39,925 37,783 
Total Screening1,062,308 815,067 810,120 
Precision Oncology
Medicare Parts B & C$195,069 $157,166 $24,325 
Commercial189,198 186,043 29,976 
International109,913 77,484 11,444 
Other67,496 19,800 428 
Total Precision Oncology561,676 440,493 66,173 
COVID-19 Testing$143,103 $235,831 $— 
Total$1,767,087 $1,491,391 $876,293 
v3.22.0.1
MARKETABLE SECURITIES (Tables)
12 Months Ended
Dec. 31, 2021
Cash and Cash Equivalents [Abstract]  
Schedule of cash and cash equivalents
The following table sets forth the Company’s cash, cash equivalents, restricted cash, and marketable securities at December 31, 2021 and 2020:
December 31,
(In thousands)20212020
Cash, cash equivalents, and restricted cash
Cash and money market$247,335 $901,294 
Cash equivalents68,136 589,994 
Restricted cash (1)297 306 
Total cash, cash equivalents and restricted cash315,768 1,491,594 
Marketable securities
Available-for-sale debt securities$711,669 $347,178 
Equity securities3,336 1,521 
Total marketable securities715,005 348,699 
Total cash and cash equivalents, restricted cash and marketable securities$1,030,773 $1,840,293 
_________________________________
(1) Restricted cash is included in other long-term assets on the consolidated balance sheets.
Schedule of restricted cash and cash equivalents
The following table sets forth the Company’s cash, cash equivalents, restricted cash, and marketable securities at December 31, 2021 and 2020:
December 31,
(In thousands)20212020
Cash, cash equivalents, and restricted cash
Cash and money market$247,335 $901,294 
Cash equivalents68,136 589,994 
Restricted cash (1)297 306 
Total cash, cash equivalents and restricted cash315,768 1,491,594 
Marketable securities
Available-for-sale debt securities$711,669 $347,178 
Equity securities3,336 1,521 
Total marketable securities715,005 348,699 
Total cash and cash equivalents, restricted cash and marketable securities$1,030,773 $1,840,293 
_________________________________
(1) Restricted cash is included in other long-term assets on the consolidated balance sheets.
Schedule of available-for-sale securities
Available-for-sale debt securities at December 31, 2021 consisted of the following:
(In thousands)Amortized CostGains in Accumulated Other Comprehensive Income (Loss) (1)Losses in Accumulated Other Comprehensive Income (Loss) (1)Estimated Fair Value
Cash equivalents
U.S. government agency securities$3,543 $— $— $3,543 
Commercial paper64,593 — — 64,593 
Total cash equivalents68,136 — — 68,136 
Marketable securities
Corporate bonds$313,634 $13 $(493)$313,154 
U.S. government agency securities250,793 — (873)249,920 
Asset backed securities94,565 (107)94,460 
Certificates of deposit47,147 (10)47,139 
Commercial paper6,996 — — 6,996 
Total marketable securities713,135 17 (1,483)711,669 
Total available-for-sale debt securities$781,271 $17 $(1,483)$779,805 
_________________________________
(1) Gains and losses in accumulated other comprehensive income (loss) ("AOCI") are reported before tax impact.
Available-for-sale debt securities at December 31, 2020 consisted of the following:
(In thousands)Amortized CostGains in Accumulated Other Comprehensive Income (Loss) (1)Losses in Accumulated Other Comprehensive Income (Loss) (1)Estimated Fair Value
Cash equivalents
U.S. government agency securities$589,986 $$— $589,994 
Total cash equivalents589,986 — 589,994 
Marketable securities
Corporate bonds$132,301 $612 $— $132,913 
U.S. government agency securities207,119 52 — 207,171 
Asset backed securities7,070 24 — 7,094 
Total marketable securities346,490 688 — 347,178 
Total available-for-sale debt securities$936,476 $696 $— $937,172 
_________________________________
(1) Gains and losses in AOCI are reported before tax impact.
Schedule of contractual maturities of available-for-sale investments
The following table summarizes contractual underlying maturities of the Company’s available-for-sale debt securities at December 31, 2021:
Due one year or lessDue after one year through five years
(In thousands)CostFair ValueCostFair Value
Cash equivalents
Commercial paper$64,593 $64,593 $— $— 
U.S. government agency securities3,543 3,543 — — 
Total cash equivalents68,136 68,136 — — 
Marketable securities
U.S. government agency securities$48,113 $48,046 $202,680 $201,874 
Corporate bonds180,114 180,008 133,520 133,146 
Asset backed securities— — 94,565 94,460 
Certificates of deposit47,147 47,139 — — 
Commercial paper6,996 6,996 — — 
Total marketable securities282,370 282,189 430,765 429,480 
Total available-for-sale securities$350,506 $350,325 $430,765 $429,480 
Schedule of gross unrealized losses and fair values of investments in an unrealized loss position
The following table summarizes the gross unrealized losses and fair values of available-for-sale debt securities in an unrealized loss position as of December 31, 2021, aggregated by investment category and length of time those individual securities have been in a continuous unrealized loss position:
Less than 12 months12 months or greaterTotal
(In thousands)Fair ValueGross Unrealized LossFair ValueGross Unrealized LossFair ValueGross Unrealized Loss
Marketable securities
Corporate bonds$299,448 $(493)$— $— $299,448 $(493)
U.S. government agency securities249,921 (873)— — 249,921 (873)
Asset backed securities89,990 (107)— — 89,990 (107)
Certificates of deposit24,137 (10)— — 24,137 (10)
Total available-for-sale securities$663,496 $(1,483)$— $— $663,496 $(1,483)
v3.22.0.1
INVENTORY (Tables)
12 Months Ended
Dec. 31, 2021
Inventory Disclosure [Abstract]  
Schedule of inventory
Inventory consisted of the following:
December 31,
(In thousands)20212020
Raw materials$51,321 $43,083 
Semi-finished and finished goods53,673 49,182 
Total inventory$104,994 $92,265 
v3.22.0.1
PROPERTY, PLANT, AND EQUIPMENT (Tables)
12 Months Ended
Dec. 31, 2021
Property, Plant and Equipment [Abstract]  
Schedule of property, plant and equipment, net
The carrying value and estimated useful lives of property, plant and equipment are as follows:
December 31,
(In thousands)Estimated Useful Life20212020
Property, plant and equipment
Landn/a$4,716 $4,466 
Leasehold and building improvements(1)147,083 117,865 
Land improvements15 years5,206 4,864 
Buildings
30 - 40 years
210,560 200,980 
Computer equipment and computer software3 years109,119 75,519 
Laboratory equipment
3 - 10 years
189,748 142,110 
Furniture and fixtures
3 - 10 years
28,293 24,968 
Assets under constructionn/a100,339 18,751 
Property, plant and equipment, at cost795,064 589,523 
Accumulated depreciation(214,816)(137,537)
Property, plant and equipment, net$580,248 $451,986 
_________________________________
(1) Lesser of remaining lease term, building life, or estimated useful life.
v3.22.0.1
INTANGIBLE ASSETS AND GOODWILL (Tables)
12 Months Ended
Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of net-book value and estimated remaining life and finite lived intangible assets
The following table summarizes the net-book-value and estimated remaining life of the Company's intangible assets as of December 31, 2021:
(In thousands)Weighted Average Remaining Life (Years)CostAccumulated AmortizationNet Balance at December 31, 2021
Finite-lived intangible assets
Trade name13.4$104,700 $(13,554)$91,146 
Customer relationships9.66,700 (1,577)5,123 
Patents and licenses3.610,942 (6,763)4,178 
Supply agreement5.42,295 (101)2,194 
Acquired developed technology8.6918,171 (176,402)741,769 
Total finite-lived intangible assets1,042,808 (198,397)844,411 
In-process research and developmentn/a1,250,000 — 1,250,000 
Total intangible assets$2,292,808 $(198,397)$2,094,411 
The following table summarizes the net-book-value and estimated remaining life of the Company’s intangible assets as of December 31, 2020:
(In thousands)Weighted Average Remaining Life (Years)CostAccumulated AmortizationNet Balance at December 31, 2020
Finite-lived intangible assets
Trade name14.9$100,700 $(7,258)$93,442 
Customer relationships12.82,700 (404)2,296 
Patents3.710,441 (5,422)5,019 
Supply agreement6.530,000 (4,527)25,473 
Acquired developed technology9.0814,171 (93,278)720,893 
Total intangible assets$958,012 $(110,889)$847,123 
Schedule of estimated future amortization expense, intangible assets
As of December 31, 2021, the estimated future amortization expense associated with the Company’s finite-lived intangible assets for each of the five succeeding fiscal years is as follows:
(In thousands)
2022$98,614 
202398,611 
202498,277 
202597,230 
202696,169 
Thereafter355,510 
$844,411 
Schedule of carrying amount of goodwill
The change in the carrying amount of goodwill for the years ended December 31, 2021 and 2020 is as follows:
(In thousands)
Balance, January 1, 2020 (1)$1,203,197 
Paradigm & Viomics acquisition30,431 
Genomic Health acquisition adjustment (2)
4,044 
Balance, December 31, 20201,237,672 
Thrive acquisition948,105 
Ashion acquisition56,758 
PreventionGenetics acquisition92,637 
Balance, December 31, 2021$2,335,172 
_________________________________
(1) The beginning balance represents the goodwill acquired from the acquisitions of Sampleminded, Inc., Biomatrica, Inc., and Genomic Health between 2017 and 2019 totaling $2.0 million, $15.3 million, and $1.19 billion, respectively.
(2) The Company recognized a measurement period adjustment to goodwill related to an increase in Genomic Health's pre-acquisition deferred tax liability due to finalization of certain income-tax related items.
v3.22.0.1
FAIR VALUE MEASUREMENTS (Tables)
12 Months Ended
Dec. 31, 2021
Fair Value Disclosures [Abstract]  
Schedule of fair value measurements along with the level within the fair value hierarchy in which the fair value measurements fall
The following table presents the Company’s fair value measurements as of December 31, 2021 along with the level within the fair value hierarchy in which the fair value measurements, in their entirety, fall.
(In thousands)Fair value at December 31, 2021Quoted Prices in Active Markets for Identical Assets (Level 1)Significant Other Observable Inputs (Level 2)Significant Unobservable Inputs (Level 3)
Cash, cash equivalents, and restricted cash
Cash and money market$247,335 $247,335 $— $— 
Commercial paper64,593 — 64,593 — 
U.S. government agency securities3,543 — 3,543 — 
Restricted cash297 297 — — 
Marketable securities
Corporate bonds$313,154 $— $313,154 $— 
U.S. government agency securities249,920 — 249,920 — 
Asset backed securities94,460 — 94,460 — 
Certificates of deposit47,139 — 47,139 — 
Commercial paper6,996 — 6,996 — 
Equity securities3,336 3,336 — — 
Non-marketable securities$3,090 $— $— $3,090 
Liabilities
Contingent consideration$(359,021)$— $— $(359,021)
Total$674,842 $250,968 $779,805 $(355,931)
The following table presents the Company’s fair value measurements as of December 31, 2020 along with the level within the fair value hierarchy in which the fair value measurements, in their entirety, fall.
(In thousands)Fair Value at December 31, 2020Quoted Prices in Active Markets for Identical Assets (Level 1)Significant Other Observable Inputs (Level 2)Significant Unobservable Inputs (Level 3)
Cash and cash equivalents
Cash and money market$901,294 $901,294 $— $— 
U.S. government agency securities589,994 — 589,994 — 
Restricted cash306 306 — — 
Marketable securities
Corporate bonds$132,913 $— $132,913 $— 
Asset backed securities7,094 — 7,094 — 
U.S. government agency securities207,171 — 207,171 — 
Equity securities1,521 1,521 — — 
Liabilities
Contingent consideration$(2,477)$— $— $(2,477)
Total$1,837,816 $903,121 $937,172 $(2,477)
Schedule of fair value of contingent consideration
The following table provides a reconciliation of the beginning and ending balances of contingent consideration:
(In thousands)Contingent consideration
Balance, January 1, 2020 (1)
$(2,879)
Changes in fair value325 
Payments77 
Balance, December 31, 2020
(2,477)
Purchase price contingent consideration (2)(350,348)
Changes in fair value(6,359)
Payments163 
Balance, December 31, 2021
$(359,021)
_________________________________
(1) The change in fair value of the contingent consideration liability during the year ended December 31, 2019 was not material to the consolidated financial statements.
(2) The increase in the contingent consideration liability is due to the contingent consideration associated with the acquisitions of Ashion Analytics, LLC (“Ashion”) and Thrive. Refer to Note 19 for further information.
v3.22.0.1
ACCRUED LIABILITIES (Tables)
12 Months Ended
Dec. 31, 2021
Payables and Accruals [Abstract]  
Schedule of accrued expenses
Accrued liabilities at December 31, 2021 and 2020 consisted of the following:
December 31,
(In thousands)20212020
Compensation$183,517 $124,654 
Pfizer Promotion Agreement related costs91,436 46,937 
Professional fees50,077 36,203 
Other32,116 13,064 
Assets under construction22,611 2,118 
Research and trial related expenses15,534 6,111 
Licenses3,265 4,517 
$398,556 $233,604 
v3.22.0.1
CONVERTIBLE NOTES (Tables)
12 Months Ended
Dec. 31, 2021
CONVERTIBLE DEBT  
Schedule of debt, net of discounts and deferred financing costs
Convertible note obligations included in the consolidated balance sheet consisted of the following as of December 31, 2021:
Fair Value (2)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%
$1,150,000 $(18,826)$1,131,174 $1,139,650 2
2027 Convertible notes - 0.375%
747,500 (11,691)735,809 771,794 2
2025 Convertible notes - 1.000% (1)
315,005 (1,756)313,249 415,473 2
Convertible note obligations included in the consolidated balance sheet consisted of the following as of December 31, 2020:
Fair Value (2)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%
$1,150,000 $(21,879)$1,128,121 $1,526,625 2
2027 Convertible notes - 0.375%
747,500 (13,937)733,563 992,306 2
2025 Convertible notes - 1.000% (1)
315,049 (2,333)312,716 601,744 2
____________________________
(1) Based on the Company's share price on the trading days leading up to December 31, 2020 and through the third quarter of 2021, holders of the 2025 Convertible Notes had the right to convert their debentures beginning on January 1, 2021 and ending on December 31, 2021. As a result, the 2025 Convertible Notes were included within convertible notes, net, current portion on the consolidated balance sheet as of December 31, 2020. Some holders did convert their debentures, resulting in a decrease of the principal amount of the 2025 Convertible Notes. As of December 31, 2021, the 2025 Convertible Notes are not convertible and included within long-term convertible notes, net on the consolidated balance sheet.
(2) The fair values are based on observable market prices for this debt, which is traded in less active markets and therefore is classified as a Level 2 fair value measurement.
Schedule of Allocation of Transaction Costs Related to Convertible Debt The following table summarizes the original issuance costs at the time of issuance for each set of Notes:
(In thousands)
January 2025 Notes$10,284 
June 2025 Notes7,362 
2027 Notes14,285 
2028 Notes24,453 
Schedule of Interest Expense
Interest expense includes the following:
Year Ended December 31,
(In thousands)202120202019
Debt issuance costs amortization$5,727 $5,303 $2,891 
Debt discount amortization147 131 (131)
Loss on settlement of convertible notes— 50,819 187,698 
Coupon interest expense10,266 9,631 6,611 
Total interest expense on convertible notes16,140 65,884 197,069 
Other interest expense2,466 2,057 2,123 
Total interest expense$18,606 $67,941 $199,192 
v3.22.0.1
STOCKHOLDERS' EQUITY (Tables)
12 Months Ended
Dec. 31, 2021
Equity [Abstract]  
Schedule of amounts recognized in accumulated other comprehensive income (loss) (AOCI)
The amount recognized in AOCI for the years ended December 31, 2021, 2020 and 2019 were as follows:
(In thousands)Cumulative Translation AdjustmentUnrealized Gain (Loss) on SecuritiesAccumulated Other Comprehensive Income (Loss)
Balance at January 1, 2019$(25)$(1,397)$(1,422)
Other comprehensive income (loss) before reclassifications— 681 681 
Amounts reclassified from accumulated other comprehensive income (loss)— 641 641 
Net current period change in accumulated other comprehensive income (loss) (1)— 1,322 1,322 
Balance at December 31, 2019$(25)$(75)$(100)
Other comprehensive income (loss) before reclassifications— 771 771 
Amounts reclassified from accumulated other comprehensive income (loss)25 — 25 
Net current period change in accumulated other comprehensive income (loss)25 771 796 
Income tax expense related to items of other comprehensive income (loss)— (170)(170)
Balance at December 31, 2020$— $526 $526 
Other comprehensive income (loss) before reclassifications23 (1,648)(1,625)
Amounts reclassified from accumulated other comprehensive income (loss)— (514)(514)
Net current period change in accumulated other comprehensive income (loss)23 (2,162)(2,139)
Income tax expense related to items of other comprehensive income (loss)— 170 170 
Balance at December 31, 2021$23 $(1,466)$(1,443)
_________________________________
(1) There was no tax impact from the amounts recognized in AOCI for the year ended December 31, 2019.
Schedule of amounts reclassified from accumulated other comprehensive income (loss)
Amounts reclassified from accumulated other comprehensive income (loss) for the years ended December 31, 2021, 2020 and 2019 were as follows:
Year Ended December 31,
Details about AOCI Components (In thousands)Affected Line Item in the
Statements of Operations
202120202019
Change in value of available-for-sale investments
Sales and maturities of available-for-sale investmentsInvestment income$(514)$— $641 
Foreign currency adjustmentGeneral and administrative— 25 — 
Total reclassifications$(514)$25 $641 
v3.22.0.1
STOCK-BASED COMPENSATION (Tables)
12 Months Ended
Dec. 31, 2021
Share-based Payment Arrangement [Abstract]  
Schedule of non-cash stock-based compensation expense by department A summary of non-cash stock-based compensation expense by expense category included in the Company's consolidated statements of operations for the years ended December 31, 2021, 2020, and 2019 is as follows:
Year Ended December 31,
(In thousands)
202120202019
Cost of sales
$16,835 $12,852 $5,799 
Research and development
49,723 19,976 17,196 
General and administrative
216,952 75,999 64,222 
Sales and marketing
55,716 44,079 21,266 
Total stock-based compensation
$339,226 $152,906 $108,483 
Schedule of valuation assumptions
The Company determines the fair value of each service-based option award on the date of grant using the Black-Scholes option-pricing model, which utilizes several key assumptions which are disclosed in the following table:
Year Ended December 31
202120202019
Option Plan Shares
Risk-free interest rates(1)
1.26% - 1.47%
2.54% - 2.59%
Expected term (in years)(1)
6.15
6.28
Expected volatility(1)
65.67% - 65.71%
64.95% - 64.99%
Dividend yield(1)0%0%
_________________________________
(1) The Company did not grant stock options under its 2010 Omnibus Long-Term Incentive Plan or 2019 Omnibus Long-Term Incentive Plan during the period.
The fair value of ESPP shares is based on the assumptions in the following table:
Year Ended December 31,
202120202019
ESPP Shares
Risk-free interest rates
0.04% - 0.16%
0.11% - 0.20%
1.60% - 2.40%
Expected term (in years)
0.5 - 2
0.5 - 2
0.4 - 2
Expected volatility
43.00% - 68.51%
61.59% - 89.00%
43.20% - 57.60%
Dividend yield0%0%0%
Summary of stock option activity under the Stock Plans
A summary of stock option activity under the Stock Plans is as follows:
OptionsSharesWeighted Average Exercise Price (1)Weighted Average Remaining Contractual Term (Years)Aggregate Intrinsic Value (2)
(Aggregate intrinsic value in thousands)
Outstanding, January 1, 2021
2,231,059 $39.67 6.0
Granted— — 
Assumed through acquisition1,393,748 5.51 
Exercised(1,295,400)11.17 
Forfeited(45,131)56.66 
Outstanding, December 31, 2021
2,284,276 $34.65 5.5$107,586 
Vested and expected to vest, December 31, 2021
2,284,276 $34.65 5.5$107,586 
Exercisable, December 31, 2021
1,780,838 $25.59 4.8$96,789 
_________________________________
(1) The weighted average grant date fair value of options granted during the years ended December 31, 2020 and 2019 was $58.57 and $57.11, respectively.
(2) The total intrinsic value of options exercised during the years ended December 31, 2021, 2020, and 2019 was $155.8 million, $40.6 million, and $52.0 million, respectively, determined as of the date of exercise.
Summary of restricted stock and restricted stock unit activity under the Stock Plans
A summary of restricted stock and restricted stock unit activity is as follows:
Restricted SharesWeighted Average Grant Date Fair Value (2)
Outstanding, January 1, 2021
3,968,214 $79.38 
Granted2,333,213 129.16
Assumed through acquisition242,123 127.79
Released (1)(1,697,643)73.18
Forfeited(524,997)101.20
Outstanding, December 31, 2021
4,320,910 $108.84 
_________________________________
(1) The fair value of restricted stock units vested and converted to shares of the Company's common stock was $219.4 million, $152.4 million, and $173.8 million for the years ended December 31, 2021, 2020, and 2019, respectively.
(2) The weighted average grant date fair value of the restricted stock units granted during the years ended December 31, 2020 and 2019 was $92.55 and $93.20, respectively.
Share-based Payment Arrangement, Performance Shares, Activity
A summary of performance share unit activity is as follows:
Performance Share Units (2)Weighted Average Grant Date Fair Value (3)
Outstanding, January 1, 2021618,515 $93.22 
Granted270,665 138.09 
Released (1)— — 
Forfeited(11,066)83.15 
Outstanding, December 31, 2021878,114 $107.18 
_________________________________
(1) The fair value of performance share units vested and converted to shares of the Company's common stock was $183.8 million for the year ended December 31, 2019. There were no performance share units vested and converted to shares of the Company's common stock during the years ended December 31, 2021 and 2020.
(2) The performance share units listed above assumes attainment of maximum payout rates as set forth in the performance criteria. Applying actual or expected payout rates, the number of outstanding performance share units as of December 31, 2021 was 45,312.
(3) The weighted average grant date fair value of the performance share units granted during the years ended December 31, 2020 and 2019 was $90.17 and $93.40, respectively.
Schedule of shares of common stock issued
A summary of ESPP activity is as follows:
Year Ended December 31,
(in thousands, except share and per share amounts)202120202019
Shares issued under the 2010 Purchase Plan331,769301,064176,458
Cash received under the 2010 Purchase Plan$23,070 $18,355 $8,396 
Weighted average fair value per share of stock purchase rights granted during the period$34.93 $32.57 $29.21 
Schedule of Common Stock Issued
The 331,769 shares issued during the year ended December 31, 2021 were as follows:
Offering period ended
Number of Shares
Weighted Average price per Share
April 30, 2021173,717 $69.31 
November 1, 2021158,052 $69.71 
Summary of shares of authorized common stock reserved for issuance
The Company has reserved shares of its authorized common stock for issuance pursuant to its employee stock purchase and equity plans, including all outstanding stock option grants noted above at December 31, 2021, as follows:
Shares reserved for issuance
2019 Stock Plan8,491,176 
2010 Purchase Plan
427,246 
8,918,422 
v3.22.0.1
COMMITMENTS AND CONTINGENCIES (Tables)
12 Months Ended
Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]  
Components of lease expense
The components of lease expense were as follows:
Year Ended December 31,
(In thousands)202120202019
Finance lease cost
Amortization of right-of-use assets$5,731 $1,935 $27 
Interest on lease liabilities1,018 383 
Operating lease cost31,730 22,551 9,200 
Short-term lease cost628 356 219 
Variable lease cost5,212 2,703 896 
Total lease Cost$44,319 $27,928 $10,344 
Supplemental disclosure of cash flow information related to the Company's cash and non-cash activities with its leases are as follows:
Year Ended December 31,
(In thousands)202120202019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases$27,461$17,531$9,641
Operating cash flows from finance leases9383811
Finance cash flows from finance leases5,2901,75615
Non-cash investing and financing activities:
Right-of-use assets obtained in exchange for new operating lease liabilities (1)74,36913,26151,030
Right-of-use assets obtained in exchange for new finance lease liabilities5,46020,349237
Weighted-average remaining lease term - operating leases (in years)8.338.759.80
Weighted-average remaining lease term - finance leases (in years)2.953.681.20
Weighted-average discount rate - operating leases6.11 %6.80 %6.80 %
Weighted-average discount rate - finance leases5.36 %5.67 %5.60 %
_________________________________
(1) For the year ended December 31, 2021, this includes right-of-use assets acquired as part of the business combinations described in Note 19 of $39.6 million. For the year ended December 31, 2019, this includes right-of-use assets obtained from the initial adoption of ASC 842 of $17.9 million.
Operating lease maturity
Maturities of operating lease liabilities on an annual basis as of December 31, 2021 were as follows:
(In thousands)
2022$30,706 
202331,793 
202432,209 
202530,446 
202629,890 
Thereafter106,967 
Total minimum lease payments262,011 
Imputed interest(60,135)
Total$201,876 
Finance lease maturity
Maturities of finance lease liabilities on an annual basis as of December 31, 2021 were as follows (amounts in thousands):
(In thousands)
2022$7,040
20236,930
20245,253
2025911
202651
Thereafter
Total minimum lease payments20,185
Imputed interest(1,449)
Total$18,736
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS (Tables)
12 Months Ended
Dec. 31, 2021
Business Combination and Asset Acquisition [Abstract]  
Schedule of business acquisitions, by acquisition
The combination date fair value of the consideration transferred for PreventionGenetics was approximately $185.5 million, which consisted of the following:
(In thousands)
Cash$101,255
Common stock issued84,252
Total purchase price$185,507
The combination date fair value of the consideration transferred for Ashion was approximately $110.0 million, which consisted of the following:
(In thousands)
Cash$74,775
Common stock issued16,224
Contingent consideration19,000
Total purchase price$109,999
The combination date fair value of the consideration transferred for Thrive was approximately $2.19 billion, which consisted of the following:
(In thousands)
Common stock issued$1,175,431
Cash584,996
Contingent consideration331,348
Fair value of replaced equity awards52,245
Previously held equity investment fair value43,034
Total purchase price$2,187,054
Schedule of allocated to the underlying assets acquired and liabilities assumed
The following table summarizes the preliminary estimated fair values of the assets acquired and liabilities assumed at the acquisition date.
(In thousands)
Cash and cash equivalents$1,574
Accounts receivable6,261
Inventory1,697
Prepaid expenses and other current assets30
Property, plant and equipment12,793
Developed technology65,000
Customer relationships4,000
Trade name4,000
Total identifiable assets acquired95,355
Accounts payable(1,493)
Accrued liabilities(992)
Total liabilities assumed(2,485)
Net identifiable assets acquired92,870
Goodwill92,637
Net assets acquired$185,507
The following table summarizes the preliminary estimated fair values of the assets acquired and liabilities assumed at the acquisition date.
(In thousands)
Cash and cash equivalents$2,474
Accounts receivable2,349
Inventory1,811
Prepaid expenses and other current assets425
Property, plant and equipment9,947
Operating lease right-of-use assets548
Developed technology39,000
Total identifiable assets acquired56,554
Accounts payable(1,477)
Accrued liabilities(1,190)
Operating lease liabilities, current portion(343)
Other current liabilities(98)
Operating lease liabilities, less current portion(205)
Total liabilities assumed(3,313)
Net identifiable assets acquired53,241
Goodwill56,758
Net assets acquired$109,999
The purchase price was allocated to the underlying assets acquired and liabilities assumed based upon their estimated fair values as follows:
(In thousands)Preliminary Allocation
January 5, 2021
Measurement Period AdjustmentsFinal Allocation
December 31, 2021
Cash and cash equivalents$241,748$$241,748
Prepaid expenses and other current assets3,9393,939
Property, plant and equipment29,97729,977
Operating lease right-of-use assets39,02739,027
Other long-term assets6767
In-process research and development (IPR&D)1,250,0001,250,000
Total identifiable assets acquired 1,564,7581,564,758
Accounts payable(3,222)(3,222)
Accrued liabilities (6,218)(1,862)(8,080)
Operating lease liabilities, current portion(2,980)(2,980)
Operating lease liabilities, less current portion(38,622)(38,622)
Deferred tax liability(272,905)(272,905)
Total liabilities assumed (323,947)(1,862)(325,809)
Net identifiable assets acquired 1,240,811(1,862)1,238,949
Goodwill946,2431,862948,105
Net assets acquired $2,187,054$$2,187,054
The purchase price was allocated to the underlying assets acquired and liabilities assumed based upon their estimated fair values as follows:
(In thousands)Preliminary Allocation
March 3, 2020
Measurement Period AdjustmentsFinal Allocation
March 3, 2021
Net operating assets$6,133 $(760)$5,373 
Goodwill29,695 736 30,431 
Developed technology7,800 — 7,800 
Net operating liabilities(3,123)(80)(3,203)
Total purchase price$40,505 $(104)$40,401 
The combination date fair value of the consideration transferred for Genomic Health was approximately $2.47 billion, which consisted of the following:
(In thousands)
Cash$1,061,489 
Common stock issued1,389,266 
Fair value of replacement stock options and restricted stock awards17,813 
Total purchase price$2,468,568 
The following table summarizes the allocation of the purchase price to the fair values assigned to the assets acquired and liabilities assumed:
(In thousands)
Consideration
Cash paid for acquisition of PFS Genomics outstanding shares$33,569
Assets acquired and liabilities assumed
Cash496
IPR&D asset33,074
Other assets and liabilities(1)
Net assets acquired$33,569
The following table summarizes the total consideration for the acquisition and the value of assets acquired and liabilities assumed as of October 26, 2020, the Merger closing date. These values are based on internal Company and independent external third-party valuations:
(In thousands)
Consideration
Cash paid for acquisition of Base Genomics outstanding shares$416,525 
Transaction costs4,600 
Total consideration421,125 
Assets acquired and liabilities assumed
Cash9,704 
IPR&D asset412,568 
Other assets and liabilities(1,147)
Net assets acquired$421,125 
Schedule of share-based payment award, stock options, valuation assumptions
The fair value of options assumed were based on the assumptions in the following table:
Option Plan Shares Assumed
Risk-free interest rates
0.11% - 0.12%
Expected term (in years)
1.26 - 1.57
Expected volatility
65.54% - 71.00%
Dividend yield
0%
Weighted average fair value per share of options assumed
$109.74 - $124.89
The fair value of options assumed were based on the assumptions in the following table:
Option Plan Shares Assumed
Risk-free interest rates
0.88% - 2.90%
Expected term (in years)
3.28 - 6.73
Expected volatility
63.54% - 69.09%
Dividend yield0%
Weighted average fair value per share of options assumed
$45.75 - $57.44
Business combination, pro forma information
The following unaudited pro forma financial information summarizes the combined results of operations for the Company and Thrive, as though the companies were combined as of the beginning of January 1, 2020.
Year Ended December 31,
(In thousands)20212020
Total revenues$1,767,087 $1,491,391 
Net loss before tax$(761,337)$(1,014,352)
The amounts of revenue and net loss before tax of Genomic Health included in the Company’s consolidated statement of operations from the combination date of November 8, 2019 to December 31, 2019.
(In thousands)2019
Total revenues$66,174 
Net loss before tax$(40,446)
The following unaudited pro forma financial information summarized the combined results of operations for the Company and Genomic Health, as though the companies were combined as of January 1, 2018.
(In thousands)2019
Total revenues$1,266,591 
Net loss before tax$(389,795)
v3.22.0.1
SEGMENT INFORMATION (Tables)
12 Months Ended
Dec. 31, 2021
Segment Reporting [Abstract]  
Revenue from external customers by geographic areas
The following table summarizes total revenue from customers by geographic region. Product revenues are attributed to countries based on ship-to location.
Year Ended December 31,
(In thousands)202120202019
United States$1,657,174 $1,413,907 $864,849 
Outside of United States109,913 77,484 11,444 
Total revenues$1,767,087 $1,491,391 $876,293 
v3.22.0.1
INCOME TAXES (Tables)
12 Months Ended
Dec. 31, 2021
Income Tax Disclosure [Abstract]  
Schedule of income before income tax, domestic and foreign
Income (loss) before provision for taxes consisted of the following:
Year Ended December 31,
(In thousands)202120202019
Income (loss) before income taxes:
Domestic$(801,536)$(423,025)$(405,425)
Foreign(40,970)(406,038)(1,019)
Total income (loss) before income taxes$(842,506)$(829,063)$(406,444)
Schedule of expense (benefit) for income taxes
The expense (benefit) for income taxes consists of:
Year Ended December 31,
(In thousands)202120202019
Current expense (benefit):
Federal$— $(3)$— 
State1,388 802 314 
Foreign4,898 933 (63)
Deferred tax expense (benefit):
Federal(222,693)(3,050)(173,521)
State(30,528)(4,260)(20,099)
Foreign54 120 15 
Total income tax expense (benefit)$(246,881)$(5,458)$(193,354)
Schedule of components of the net deferred tax asset
The components of the net deferred tax asset with the approximate income tax effect of each type of carryforward, credit and temporary differences are as follows:
December 31,
(In thousands)20212020
Deferred tax assets:
Operating loss carryforwards$516,344 $369,642 
Tax credit carryforwards72,959 64,760 
Compensation related differences74,127 48,349 
Lease liabilities48,201 31,938 
Capitalized research and development23,035 — 
Other temporary differences20,087 6,136 
Tax assets before valuation allowance754,753 520,825 
Less - Valuation allowance(262,238)(293,397)
Total deferred tax assets492,515 227,428 
Deferred tax liabilities
Amortization$(464,748)$(197,847)
Property, plant and equipment(4,756)(4,580)
Lease assets(45,781)(30,312)
Other temporary differences(6,012)(3,995)
Total deferred tax liabilities(521,297)(236,734)
Net deferred tax liabilities$(28,782)$(9,306)
Summary of valuation allowance
Activity associated with the Company's valuation allowance is as follows:
December 31,
(In thousands)202120202019
Balance as of January 1, $(293,397)$(195,401)$(265,587)
Valuation allowances established(206,574)(94,589)(113,522)
Changes to existing valuation allowances(1,500)2,151 (22)
Acquisition and purchase accounting239,233 (5,558)183,730 
Balance as of December 31,$(262,238)$(293,397)$(195,401)
Schedule of differences between the effective income tax rate and the statutory tax rate
The effective tax rate differs from the statutory tax rate due to the following:
December 31,
202120202019
U.S. Federal statutory rate21.0 %21.0 %21.0 %
State taxes3.6 1.7 3.4 
Federal and state tax rate changes(0.3)— 0.1 
Foreign tax rate differential(0.6)(1.0)0.4 
Acquired IPR&D asset expense(0.8)(9.4)— 
Research and development tax credits0.7 1.6 0.7 
Stock-based compensation expense1.1 1.1 14.6 
Non-deductible executive compensation(0.2)(0.8)(2.7)
Transaction costs(0.1)(0.1)(0.5)
Loss on extinguishment - convertible notes— — (9.2)
Other adjustments1.2 (2.2)(0.5)
Valuation allowance3.7 (11.3)20.2 
Effective tax rate29.3 %0.6 %47.5 %
Schedule of unrecognized tax benefits
The following is a tabular reconciliation of the amounts of unrecognized tax benefits:
December 31,
(In thousands)202120202019
January 1,$16,629 $10,276 $1,926 
Increase due to current year tax positions5,363 3,600 2,142 
Increase due to prior year tax positions— 2,753 6,208 
Decrease due to prior year tax positions(212)— — 
Settlements— — — 
December 31,$21,780 $16,629 $10,276 
v3.22.0.1
QUARTERLY RESULTS OF OPERATIONS (UNAUDITED) (Tables)
12 Months Ended
Dec. 31, 2021
Quarterly Financial Information Disclosure [Abstract]  
Schedule of quarterly statement of operations
The following table sets forth unaudited quarterly statements of operations data for each of the eight quarters ended December 31, 2021 and 2020. In the opinion of management, this information has been prepared on the same basis as the audited consolidated financial statements and contains all adjustments, consisting only of normal recurring adjustments, considered necessary for a fair statement of the unaudited quarterly results for the periods presented. The quarterly data should be read in conjunction with the Company’s audited consolidated financial statements and the notes to the consolidated financial statements appearing elsewhere in this Form 10-K.
Quarter Ended
March 31,June 30,September 30,December 31,
(Amounts in thousands, except per share data)
2021
Revenue$402,077 $434,819 $456,379 $473,812 
Cost of sales (exclusive of amortization of acquired intangible assets)109,993 113,968 115,738 119,058 
Amortization of acquired intangible assets (1)20,555 21,188 21,214 21,216 
Gross profit271,529 299,663 319,427 333,538 
Operating expenses, net (2)572,070 471,327 481,450 554,988 
Interest income and interest expense26,572 (1,223)(8,773)(3,404)
Income tax benefit (expense)242,805 (4,025)3,858 4,243 
Net loss$(31,164)$(176,912)$(166,938)$(220,611)
Net loss per share—basic and diluted$(0.18)$(1.03)$(0.97)$(1.28)
Weighted average common shares outstanding—basic and diluted169,434 171,494 171,978 172,446 
2020
Revenue$347,821 $268,868 $408,363 $466,339 
Cost of sales (exclusive of amortization of acquired intangible assets)81,606 77,892 95,061 99,765 
Amortization of acquired intangible assets (1)20,464 20,555 20,555 20,553 
Gross profit245,751 170,421 292,747 346,021 
Operating expenses (2)328,124 237,430 496,082 761,000 
Interest income and interest expense (3)(54,507)(1,388)(1,955)(3,517)
Income tax benefit (3)2,237 305 2,752 164 
Net loss$(134,643)$(68,092)$(202,538)$(418,332)
Net loss per share—basic and diluted$(0.91)$(0.45)$(1.35)$(2.67)
Weighted average common shares outstanding—basic and diluted148,151 149,727 150,155 156,470 
_________________________________
(1) Includes only amortization of acquired intangible assets identified as developed technology assets through purchase accounting transactions, which otherwise would have been allocated to cost of sales.
(2) Consists of research and development, sales and marketing, general and administrative, and amortization of acquired intangible assets excluding acquired developed technology, which is included in the gross profit calculation above. This also includes intangible asset impairment charges and funding received as part of the CARES Act in the second quarter of 2020. Refer to Note 6 for further discussion on the intangible asset impairment charges recorded in the third quarters of 2020 and 2021. Refer to Note 1 for further discussion on the funding received as part of the CARES Act in the second quarter of 2020.
(3) As a result of the adoption of ASU 2020-06, Debt - Debt with Conversion and Other Options (subtopic 470-20) and Derivatives and Hedging - Contracts in Entity's Own Equity (Subtopic 815-40), using the full retrospective method of adoption, the balances for interest expense and income tax benefit have been restated. Refer to Note 1 for further discussion on the adoption of this ASU.
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Use of Estimates (Details) - USD ($)
$ in Millions
1 Months Ended 12 Months Ended
Apr. 30, 2020
Dec. 31, 2020
Accounting Policies [Abstract]    
CARES Act, grant payment received $ 23.7 $ 23.7
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Net Loss Per Share (Details) - shares
shares in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Common shares not included in the computation of diluted net loss per share      
Antidilutive shares (in shares) 27,837 27,284 19,280
Shares issuable in connection with acquisitions      
Common shares not included in the computation of diluted net loss per share      
Antidilutive shares (in shares) 45 157 0
Shares issuable upon exercise of stock options      
Common shares not included in the computation of diluted net loss per share      
Antidilutive shares (in shares) 2,284 2,231 2,700
Shares issuable upon the release of restricted stock awards      
Common shares not included in the computation of diluted net loss per share      
Antidilutive shares (in shares) 4,321 3,968 3,801
Shares issuable upon the release of performance share units      
Common shares not included in the computation of diluted net loss per share      
Antidilutive shares (in shares) 878 619 583
Shares issuable upon conversion of convertible notes      
Common shares not included in the computation of diluted net loss per share      
Antidilutive shares (in shares) 20,309 20,309 12,196
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Research and Development Costs (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Accounting Policies [Abstract]      
Research and development $ 385,646 $ 554,052 $ 139,694
Asset acquisition IPR&D expense $ 85,337 $ 412,568 $ 0
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Advertising Costs (Details) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Accounting Policies [Abstract]      
Advertising expense $ 144.0 $ 97.6 $ 90.5
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Leases (Details)
12 Months Ended
Dec. 31, 2021
Lessee, Lease, Description [Line Items]  
Operating lease, term extension 10 years
Operating lease, termination period 1 year
Minimum  
Lessee, Lease, Description [Line Items]  
Operating lease, remaining lease term 1 year
Maximum  
Lessee, Lease, Description [Line Items]  
Operating lease, remaining lease term 15 years
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Concentration of Credit Risk (Details) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Concentration of Credit Risk      
Cash, uninsured amount $ 234.9    
Revenue | Customer Concentration Risk | Centers for Medicare and Medicaid Services      
Concentration of Credit Risk      
Concentration risk (as a percent) 20.00% 21.00% 29.00%
Revenue | Customer Concentration Risk | UnitedHealthcare      
Concentration of Credit Risk      
Concentration risk (as a percent) 11.00% 10.00% 13.00%
Revenue | Customer Concentration Risk | State of Wisconsin      
Concentration of Credit Risk      
Concentration risk (as a percent) 8.00% 12.00% 0.00%
Accounts Receivable | Customer Concentration Risk | Centers for Medicare and Medicaid Services      
Concentration of Credit Risk      
Concentration risk (as a percent) 11.00% 14.00% 19.00%
Accounts Receivable | Customer Concentration Risk | UnitedHealthcare      
Concentration of Credit Risk      
Concentration risk (as a percent) 8.00% 7.00% 7.00%
Accounts Receivable | Customer Concentration Risk | State of Wisconsin      
Concentration of Credit Risk      
Concentration risk (as a percent) 9.00% 22.00% 0.00%
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Tax Positions (Details) - USD ($)
$ in Thousands
3 Months Ended 12 Months Ended
Dec. 31, 2021
Sep. 30, 2021
Jun. 30, 2021
Mar. 31, 2021
Dec. 31, 2020
Sep. 30, 2020
Jun. 30, 2020
Mar. 31, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Accounting Policies [Abstract]                      
Deferred tax asset valuation allowance $ 262,238       $ 293,397       $ 262,238 $ 293,397  
Increase (decrease) in valuation allowance                 (31,200) 98,000  
Income tax benefit $ 4,243 $ 3,858 $ (4,025) $ 242,805 $ 164 $ 2,752 $ 305 $ 2,237 $ 246,881 $ 5,458 $ 193,354
v3.22.0.1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Recent Accounting Pronouncements (Details) - USD ($)
$ / shares in Units, $ in Thousands
1 Months Ended 3 Months Ended 12 Months Ended
Feb. 29, 2020
Mar. 31, 2019
Dec. 31, 2021
Sep. 30, 2021
Jun. 30, 2021
Mar. 31, 2021
Dec. 31, 2020
Sep. 30, 2020
Jun. 30, 2020
Mar. 31, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
New Accounting Pronouncements or Change in Accounting Principle [Line Items]                            
Stockholders' equity     $ 3,387,636       $ 2,235,553       $ 3,387,636 $ 2,235,553 $ 1,957,639 $ 447,258
Deferred tax asset valuation allowance     262,238       293,397       262,238 293,397    
Decrease in amortization debt discount                     (6,683) (1,546) 1,758  
Loss on extinguishment of debt $ 50,800                   0 50,819 187,698  
Tax expense (benefit)     $ (4,243) $ (3,858) $ 4,025 $ (242,805) $ (164) $ (2,752) $ (305) $ (2,237) $ (246,881) $ (5,458) $ (193,354)  
Increase (decrease) in net loss per share (in usd per share)     $ (1.28) $ (0.97) $ (1.03) $ (0.18) $ (2.67) $ (1.35) $ (0.45) $ (0.91) $ (3.48) $ (5.45) $ (1.62)  
Increase (decrease) in net loss per share (in usd per share)     $ (1.28) $ (0.97) $ (1.03) $ (0.18) $ (2.67) $ (1.35) $ (0.45) $ (0.91) $ (3.48) $ (5.45) $ (1.62)  
2025 Convertible notes                            
New Accounting Pronouncements or Change in Accounting Principle [Line Items]                            
Loss on extinguishment of debt   $ 187,700                        
Repayments of debt   $ 493,400                        
Additional Paid In Capital                            
New Accounting Pronouncements or Change in Accounting Principle [Line Items]                            
Stockholders' equity     $ 6,028,861       $ 4,279,327       $ 6,028,861 $ 4,279,327 $ 3,178,552 1,456,648
Accumulated Deficit                            
New Accounting Pronouncements or Change in Accounting Principle [Line Items]                            
Stockholders' equity     (2,641,520)       (2,045,895)       (2,641,520) (2,045,895) (1,222,290) (1,009,200)
2025 Convertible notes                            
New Accounting Pronouncements or Change in Accounting Principle [Line Items]                            
Convertible notes     $ 313,249       $ 312,716       $ 313,249 312,716    
Loss on extinguishment of debt                       42,800 177,100  
Extinguishment of debt, amount                       100,000    
Cumulative Effect, Period of Adoption, Adjustment                            
New Accounting Pronouncements or Change in Accounting Principle [Line Items]                            
Convertible notes                           233,700
Deferred tax assets, net                           55,700
Deferred tax asset valuation allowance                           55,700
Interest income (expense)                       28,100 137,700  
Decrease in amortization debt discount                       70,900 39,500  
Tax expense (benefit)                       $ (3,100) $ 8,500  
Increase (decrease) in net loss per share (in usd per share)                       $ (0.17) $ 0.98  
Increase (decrease) in net loss per share (in usd per share)                       $ (0.17) $ 0.98  
Cumulative Effect, Period of Adoption, Adjustment | Additional Paid In Capital                            
New Accounting Pronouncements or Change in Accounting Principle [Line Items]                            
Stockholders' equity                           (260,200)
Cumulative Effect, Period of Adoption, Adjustment | Accumulated Deficit                            
New Accounting Pronouncements or Change in Accounting Principle [Line Items]                            
Stockholders' equity                           $ 26,600
v3.22.0.1
REVENUE - Schedule of Disaggregation of Revenue (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Disaggregation of Revenue [Line Items]      
Revenue recognized $ 1,767,087 $ 1,491,391 $ 876,293
Screening      
Disaggregation of Revenue [Line Items]      
Revenue recognized 1,062,308 815,067 810,120
Screening | Medicare Parts B & C      
Disaggregation of Revenue [Line Items]      
Revenue recognized 438,646 365,471 404,331
Screening | Commercial      
Disaggregation of Revenue [Line Items]      
Revenue recognized 569,944 409,671 368,006
Screening | Other      
Disaggregation of Revenue [Line Items]      
Revenue recognized 53,718 39,925 37,783
Precision Oncology      
Disaggregation of Revenue [Line Items]      
Revenue recognized 561,676 440,493 66,173
Precision Oncology | Medicare Parts B & C      
Disaggregation of Revenue [Line Items]      
Revenue recognized 195,069 157,166 24,325
Precision Oncology | Commercial      
Disaggregation of Revenue [Line Items]      
Revenue recognized 189,198 186,043 29,976
Precision Oncology | Other      
Disaggregation of Revenue [Line Items]      
Revenue recognized 67,496 19,800 428
Precision Oncology | International      
Disaggregation of Revenue [Line Items]      
Revenue recognized 109,913 77,484 11,444
COVID-19 Testing      
Disaggregation of Revenue [Line Items]      
Revenue recognized $ 143,103 $ 235,831 $ 0
v3.22.0.1
REVENUE - Narrative (Details) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Disaggregation of Revenue [Line Items]      
Deferred revenue $ 1.0 $ 25.0  
Deferred revenue, revenue recognized during period 24.6 0.2  
COVID-19      
Disaggregation of Revenue [Line Items]      
Deferred revenue   24.2  
Deferred revenue, revenue recognized during period 24.2    
Variable consideration      
Disaggregation of Revenue [Line Items]      
Revenue recognized from changes in transaction price $ 11.8 $ 9.6 $ 9.9
v3.22.0.1
MARKETABLE SECURITIES - Schedule of Cash and Cash Equivalents (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Marketable Securities [Line Items]    
Cash and cash equivalents, and restricted cash $ 315,768 $ 1,491,594
Available-for-sale debt securities 779,805 937,172
Equity securities 3,336 1,521
Total marketable securities 715,005 348,699
Total cash and cash equivalents, restricted cash and marketable securities 1,030,773 1,840,293
Cash equivalents    
Marketable Securities [Line Items]    
Cash and cash equivalents, and restricted cash 68,136 589,994
Available-for-sale debt securities 68,136 589,994
Marketable securities    
Marketable Securities [Line Items]    
Available-for-sale debt securities 711,669 347,178
Cash and money market    
Marketable Securities [Line Items]    
Cash and cash equivalents, and restricted cash 247,335 901,294
Restricted cash    
Marketable Securities [Line Items]    
Cash and cash equivalents, and restricted cash $ 297 $ 306
v3.22.0.1
MARKETABLE SECURITIES - Schedule of Available For Sale Securities (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Available-for-sale securities    
Amortized Cost $ 781,271 $ 936,476
Gains in Accumulated Other Comprehensive Income (Loss) 17 696
Losses in Accumulated Other Comprehensive Income (Loss) (1,483) 0
Estimated Fair Value 779,805 937,172
Cash equivalents    
Available-for-sale securities    
Amortized Cost 68,136 589,986
Gains in Accumulated Other Comprehensive Income (Loss) 0 8
Losses in Accumulated Other Comprehensive Income (Loss) 0 0
Estimated Fair Value 68,136 589,994
Marketable securities    
Available-for-sale securities    
Amortized Cost 713,135 346,490
Gains in Accumulated Other Comprehensive Income (Loss) 17 688
Losses in Accumulated Other Comprehensive Income (Loss) (1,483) 0
Estimated Fair Value 711,669 347,178
U.S. government agency securities | Cash equivalents    
Available-for-sale securities    
Amortized Cost 3,543 589,986
Gains in Accumulated Other Comprehensive Income (Loss) 0 8
Losses in Accumulated Other Comprehensive Income (Loss) 0 0
Estimated Fair Value 3,543 589,994
U.S. government agency securities | Marketable securities    
Available-for-sale securities    
Amortized Cost 250,793 207,119
Gains in Accumulated Other Comprehensive Income (Loss) 0 52
Losses in Accumulated Other Comprehensive Income (Loss) (873) 0
Estimated Fair Value 249,920 207,171
Commercial paper | Cash equivalents    
Available-for-sale securities    
Amortized Cost 64,593  
Gains in Accumulated Other Comprehensive Income (Loss) 0  
Losses in Accumulated Other Comprehensive Income (Loss) 0  
Estimated Fair Value 64,593  
Corporate bonds | Marketable securities    
Available-for-sale securities    
Amortized Cost 313,634 132,301
Gains in Accumulated Other Comprehensive Income (Loss) 13 612
Losses in Accumulated Other Comprehensive Income (Loss) (493) 0
Estimated Fair Value 313,154 132,913
Asset backed securities | Marketable securities    
Available-for-sale securities    
Amortized Cost 94,565 7,070
Gains in Accumulated Other Comprehensive Income (Loss) 2 24
Losses in Accumulated Other Comprehensive Income (Loss) (107) 0
Estimated Fair Value 94,460 $ 7,094
Certificates of deposit | Marketable securities    
Available-for-sale securities    
Amortized Cost 47,147  
Gains in Accumulated Other Comprehensive Income (Loss) 2  
Losses in Accumulated Other Comprehensive Income (Loss) (10)  
Estimated Fair Value 47,139  
Commercial paper, not included with cash equivalents | Marketable securities    
Available-for-sale securities    
Amortized Cost 6,996  
Gains in Accumulated Other Comprehensive Income (Loss) 0  
Losses in Accumulated Other Comprehensive Income (Loss) 0  
Estimated Fair Value $ 6,996  
v3.22.0.1
MARKETABLE SECURITIES - Schedule of Underlying Maturities of AFS Securities (Details)
$ in Thousands
Dec. 31, 2021
USD ($)
Available-for-sale securities  
Due in one year or less, Cost $ 350,506
Due in one year or less, Fair Value 350,325
Due after one year through four years, Cost 430,765
Due after one year through four years, Fair Value 429,480
Cash equivalents  
Available-for-sale securities  
Due in one year or less, Cost 68,136
Due in one year or less, Fair Value 68,136
Due after one year through four years, Cost 0
Due after one year through four years, Fair Value 0
Cash equivalents | Commercial paper  
Available-for-sale securities  
Due in one year or less, Cost 64,593
Due in one year or less, Fair Value 64,593
Due after one year through four years, Cost 0
Due after one year through four years, Fair Value 0
Cash equivalents | U.S. government agency securities  
Available-for-sale securities  
Due in one year or less, Cost 3,543
Due in one year or less, Fair Value 3,543
Due after one year through four years, Cost 0
Due after one year through four years, Fair Value 0
Marketable securities  
Available-for-sale securities  
Due in one year or less, Cost 282,370
Due in one year or less, Fair Value 282,189
Due after one year through four years, Cost 430,765
Due after one year through four years, Fair Value 429,480
Marketable securities | Commercial paper  
Available-for-sale securities  
Due in one year or less, Cost 6,996
Due in one year or less, Fair Value 6,996
Due after one year through four years, Cost 0
Due after one year through four years, Fair Value 0
Marketable securities | U.S. government agency securities  
Available-for-sale securities  
Due in one year or less, Cost 48,113
Due in one year or less, Fair Value 48,046
Due after one year through four years, Cost 202,680
Due after one year through four years, Fair Value 201,874
Marketable securities | Corporate bonds  
Available-for-sale securities  
Due in one year or less, Cost 180,114
Due in one year or less, Fair Value 180,008
Due after one year through four years, Cost 133,520
Due after one year through four years, Fair Value 133,146
Marketable securities | Asset backed securities  
Available-for-sale securities  
Due in one year or less, Cost 0
Due in one year or less, Fair Value 0
Due after one year through four years, Cost 94,565
Due after one year through four years, Fair Value 94,460
Marketable securities | Certificates of deposit  
Available-for-sale securities  
Due in one year or less, Cost 47,147
Due in one year or less, Fair Value 47,139
Due after one year through four years, Cost 0
Due after one year through four years, Fair Value $ 0
v3.22.0.1
MARKETABLE SECURITIES - Schedule of Gross Unrealized Losses And Fair Value of Available For Sale Securities (Details)
$ in Thousands
Dec. 31, 2021
USD ($)
Marketable Securities [Line Items]  
Total fair value of available-for-sale securities in a continuous unrealized loss position for less than twelve months $ 663,496
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position for less than twelve months (1,483)
Debt securities, available-for-sale, continuous unrealized loss position, 12 months or greater 0
Debt securities, available-for-sale, continuous unrealized loss position, 12 months or greater, accumulated loss 0
Total fair value of available-for-sale securities in a continuous unrealized loss position 663,496
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position (1,483)
Marketable securities | Corporate bonds  
Marketable Securities [Line Items]  
Total fair value of available-for-sale securities in a continuous unrealized loss position for less than twelve months 299,448
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position for less than twelve months (493)
Debt securities, available-for-sale, continuous unrealized loss position, 12 months or greater 0
Debt securities, available-for-sale, continuous unrealized loss position, 12 months or greater, accumulated loss 0
Total fair value of available-for-sale securities in a continuous unrealized loss position 299,448
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position (493)
Marketable securities | U.S. government agency securities  
Marketable Securities [Line Items]  
Total fair value of available-for-sale securities in a continuous unrealized loss position for less than twelve months 249,921
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position for less than twelve months (873)
Debt securities, available-for-sale, continuous unrealized loss position, 12 months or greater 0
Debt securities, available-for-sale, continuous unrealized loss position, 12 months or greater, accumulated loss 0
Total fair value of available-for-sale securities in a continuous unrealized loss position 249,921
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position (873)
Marketable securities | Asset backed securities  
Marketable Securities [Line Items]  
Total fair value of available-for-sale securities in a continuous unrealized loss position for less than twelve months 89,990
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position for less than twelve months (107)
Debt securities, available-for-sale, continuous unrealized loss position, 12 months or greater 0
Debt securities, available-for-sale, continuous unrealized loss position, 12 months or greater, accumulated loss 0
Total fair value of available-for-sale securities in a continuous unrealized loss position 89,990
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position (107)
Marketable securities | Certificates of deposit  
Marketable Securities [Line Items]  
Total fair value of available-for-sale securities in a continuous unrealized loss position for less than twelve months 24,137
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position for less than twelve months (10)
Debt securities, available-for-sale, continuous unrealized loss position, 12 months or greater 0
Debt securities, available-for-sale, continuous unrealized loss position, 12 months or greater, accumulated loss 0
Total fair value of available-for-sale securities in a continuous unrealized loss position 24,137
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position $ (10)
v3.22.0.1
INVENTORY (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Inventory Disclosure [Abstract]    
Raw materials $ 51,321 $ 43,083
Semi-finished and finished goods 53,673 49,182
Inventory $ 104,994 $ 92,265
v3.22.0.1
PROPERTY, PLANT AND EQUIPMENT - Schedule of Estimated Useful Lives (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Property, plant and equipment    
Property, plant and equipment, at cost $ 795,064 $ 589,523
Accumulated depreciation (214,816) (137,537)
Property, plant and equipment, net 580,248 451,986
Land    
Property, plant and equipment    
Property, plant and equipment, at cost 4,716 4,466
Leasehold and building improvements    
Property, plant and equipment    
Property, plant and equipment, at cost $ 147,083 117,865
Land improvements    
Property, plant and equipment    
Estimated Useful Life 15 years  
Property, plant and equipment, at cost $ 5,206 4,864
Buildings    
Property, plant and equipment    
Property, plant and equipment, at cost $ 210,560 200,980
Buildings | Minimum    
Property, plant and equipment    
Estimated Useful Life 30 years  
Buildings | Maximum    
Property, plant and equipment    
Estimated Useful Life 40 years  
Computer equipment and computer software    
Property, plant and equipment    
Estimated Useful Life 3 years  
Property, plant and equipment, at cost $ 109,119 75,519
Laboratory equipment    
Property, plant and equipment    
Property, plant and equipment, at cost $ 189,748 142,110
Laboratory equipment | Minimum    
Property, plant and equipment    
Estimated Useful Life 3 years  
Laboratory equipment | Maximum    
Property, plant and equipment    
Estimated Useful Life 10 years  
Furniture and fixtures    
Property, plant and equipment    
Property, plant and equipment, at cost $ 28,293 24,968
Furniture and fixtures | Minimum    
Property, plant and equipment    
Estimated Useful Life 3 years  
Furniture and fixtures | Maximum    
Property, plant and equipment    
Estimated Useful Life 10 years  
Assets under construction    
Property, plant and equipment    
Property, plant and equipment, at cost $ 100,339 $ 18,751
v3.22.0.1
PROPERTY, PLANT AND EQUIPMENT - Narrative (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Property, plant and equipment      
Depreciation $ 85,300 $ 70,000 $ 34,200
Property, plant and equipment, gross 795,064 589,523  
Assets under construction      
Property, plant and equipment      
Property, plant and equipment, gross 100,339 18,751  
Buildings under construction      
Property, plant and equipment      
Assets under construction 41,500    
Leasehold improvements      
Property, plant and equipment      
Assets under construction 27,600    
Laboratory equipment      
Property, plant and equipment      
Property, plant and equipment, gross 189,748 142,110  
Assets under construction 19,800    
Software projects      
Property, plant and equipment      
Assets under construction 10,600    
Land improvements      
Property, plant and equipment      
Property, plant and equipment, gross 5,206 4,864  
Assets under construction 600    
Furniture and fixtures      
Property, plant and equipment      
Property, plant and equipment, gross 28,293 $ 24,968  
Assets under construction $ 200    
v3.22.0.1
INTANGIBLE ASSETS AND GOODWILL - Schedule of Finite Lived Intangible Assets Net Balances and Weighted Average Useful Lives (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]    
Finite-lived intangible assets, gross $ 1,042,808 $ 958,012
Less: Accumulated amortization (198,397) (110,889)
Finite-lived intangible assets, net 844,411 847,123
Indefinite-lived intangible assets 1,250,000  
Finite-lived and indefinite-lived intangible assets, gross 2,292,808  
Finite-lived and indefinite-lived intangible assets, net $ 2,094,411 $ 847,123
Trade name    
Finite-Lived Intangible Assets [Line Items]    
Weighted Average Remaining Life (Years) 13 years 4 months 24 days 14 years 10 months 24 days
Finite-lived intangible assets, gross $ 104,700 $ 100,700
Less: Accumulated amortization (13,554) (7,258)
Finite-lived intangible assets, net $ 91,146 $ 93,442
Customer relationships    
Finite-Lived Intangible Assets [Line Items]    
Weighted Average Remaining Life (Years) 9 years 7 months 6 days 12 years 9 months 18 days
Finite-lived intangible assets, gross $ 6,700 $ 2,700
Less: Accumulated amortization (1,577) (404)
Finite-lived intangible assets, net $ 5,123 $ 2,296
Patents and licenses    
Finite-Lived Intangible Assets [Line Items]    
Weighted Average Remaining Life (Years) 3 years 7 months 6 days 3 years 8 months 12 days
Finite-lived intangible assets, gross $ 10,942 $ 10,441
Less: Accumulated amortization (6,763) (5,422)
Finite-lived intangible assets, net $ 4,178 $ 5,019
Supply agreement    
Finite-Lived Intangible Assets [Line Items]    
Weighted Average Remaining Life (Years) 5 years 4 months 24 days 6 years 6 months
Finite-lived intangible assets, gross $ 2,295 $ 30,000
Less: Accumulated amortization (101) (4,527)
Finite-lived intangible assets, net $ 2,194 $ 25,473
Acquired developed technology    
Finite-Lived Intangible Assets [Line Items]    
Weighted Average Remaining Life (Years) 8 years 7 months 6 days 9 years
Finite-lived intangible assets, gross $ 918,171 $ 814,171
Less: Accumulated amortization (176,402) (93,278)
Finite-lived intangible assets, net $ 741,769 $ 720,893
v3.22.0.1
INTANGIBLE ASSETS AND GOODWILL - Schedule of Future Amortization Expense (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]    
2022 $ 98,614  
2023 98,611  
2024 98,277  
2025 97,230  
2026 96,169  
Thereafter 355,510  
Finite-lived intangible assets, net $ 844,411 $ 847,123
v3.22.0.1
INTANGIBLE ASSETS AND GOODWILL - Narrative (Details) - USD ($)
3 Months Ended 9 Months Ended 12 Months Ended
Sep. 30, 2021
Sep. 30, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]          
Intangible asset impairment charge         $ 0
Finite-lived intangible assets, gross     $ 1,042,808,000 $ 958,012,000  
Finite-lived intangible assets, accumulated amortization     198,397,000 110,889,000  
Goodwill, impairment loss     $ 0 0 $ 0
In Process Research and Development [Member]          
Finite-Lived Intangible Assets [Line Items]          
Intangible asset impairment charge $ 20,200,000        
In Process Research and Development [Member] | Armune Biosciences Agreement          
Finite-Lived Intangible Assets [Line Items]          
Intangible asset impairment charge       $ 9,700,000  
Finite-lived intangible assets, gross   $ 12,200,000      
Finite-lived intangible assets, accumulated amortization   2,500,000      
In Process Research and Development [Member] | Biocartis Agreement          
Finite-Lived Intangible Assets [Line Items]          
Intangible asset impairment charge   $ 200,000,000      
v3.22.0.1
INTANGIBLE ASSETS AND GOODWILL - Schedule of Changes in Goodwill (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Apr. 14, 2021
Jan. 05, 2021
Mar. 03, 2020
Dec. 31, 2018
Dec. 31, 2017
Carrying amount of goodwill              
Beginning of the period $ 1,237,672 $ 1,203,197          
Ending of the period 2,335,172 1,237,672          
Goodwill 2,335,172 1,237,672          
Paradigm & Viomics              
Carrying amount of goodwill              
Acquisition   30,431          
Ending of the period 30,431            
Goodwill 30,431       $ 29,695    
Genomic Health Inc              
Carrying amount of goodwill              
Beginning of the period   1,190,000          
Genomic Health acquisition adjustment   $ 4,044          
Goodwill              
Thrive              
Carrying amount of goodwill              
Acquisition 948,105            
Ending of the period 948,105            
Goodwill 948,105     $ 946,243      
Ashion Analytics              
Carrying amount of goodwill              
Acquisition 56,758            
Goodwill     $ 56,758        
Sampleminded Inc              
Carrying amount of goodwill              
Goodwill             $ 2,000
Biomatrica, Inc              
Carrying amount of goodwill              
Goodwill           $ 15,300  
PreventionGenetics              
Carrying amount of goodwill              
Acquisition 92,637            
Ending of the period 92,637            
Goodwill $ 92,637            
v3.22.0.1
FAIR VALUE MEASUREMENTS - Schedule of Fair Value (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Fair value measurements    
Cash and cash equivalents, and restricted cash $ 315,768 $ 1,491,594
Estimated Fair Value 779,805 937,172
Equity securities 3,336 1,521
Restricted cash    
Fair value measurements    
Cash and cash equivalents, and restricted cash 297 306
Fair Value, Recurring    
Fair value measurements    
Equity securities 3,336 1,521
Non-marketable securities 3,090  
Contingent consideration (359,021) (2,477)
Total 674,842 1,837,816
Fair Value, Recurring | Corporate bonds    
Fair value measurements    
Estimated Fair Value 313,154 132,913
Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Estimated Fair Value 249,920 207,171
Fair Value, Recurring | Asset backed securities    
Fair value measurements    
Estimated Fair Value 94,460 7,094
Fair Value, Recurring | Certificates of deposit    
Fair value measurements    
Estimated Fair Value 47,139  
Fair Value, Recurring | Commercial paper    
Fair value measurements    
Estimated Fair Value 6,996  
Fair Value, Recurring | Cash and money market    
Fair value measurements    
Cash and cash equivalents, and restricted cash 247,335 901,294
Fair Value, Recurring | Commercial paper    
Fair value measurements    
Cash and cash equivalents, and restricted cash 64,593  
Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Cash and cash equivalents, and restricted cash 3,543 589,994
Fair Value, Recurring | Restricted cash    
Fair value measurements    
Cash and cash equivalents, and restricted cash 297 306
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring    
Fair value measurements    
Equity securities 3,336 1,521
Non-marketable securities 0  
Contingent consideration 0 0
Total 250,968 903,121
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Corporate bonds    
Fair value measurements    
Estimated Fair Value 0 0
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Estimated Fair Value 0 0
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Asset backed securities    
Fair value measurements    
Estimated Fair Value 0 0
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Certificates of deposit    
Fair value measurements    
Estimated Fair Value 0  
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Estimated Fair Value 0  
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Cash and money market    
Fair value measurements    
Cash and cash equivalents, and restricted cash 247,335 901,294
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Cash and cash equivalents, and restricted cash 0  
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Cash and cash equivalents, and restricted cash 0 0
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Restricted cash    
Fair value measurements    
Cash and cash equivalents, and restricted cash 297 306
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring    
Fair value measurements    
Equity securities 0 0
Non-marketable securities 0  
Contingent consideration 0 0
Total 779,805 937,172
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Corporate bonds    
Fair value measurements    
Estimated Fair Value 313,154 132,913
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Estimated Fair Value 249,920 207,171
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Asset backed securities    
Fair value measurements    
Estimated Fair Value 94,460 7,094
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Certificates of deposit    
Fair value measurements    
Estimated Fair Value 47,139  
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Estimated Fair Value 6,996  
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Cash and money market    
Fair value measurements    
Cash and cash equivalents, and restricted cash 0 0
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Cash and cash equivalents, and restricted cash 64,593  
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Cash and cash equivalents, and restricted cash 3,543 589,994
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Restricted cash    
Fair value measurements    
Cash and cash equivalents, and restricted cash 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring    
Fair value measurements    
Equity securities 0 0
Non-marketable securities 3,090  
Contingent consideration (359,021) (2,477)
Total (355,931) (2,477)
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Corporate bonds    
Fair value measurements    
Estimated Fair Value 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Estimated Fair Value 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Asset backed securities    
Fair value measurements    
Estimated Fair Value 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Certificates of deposit    
Fair value measurements    
Estimated Fair Value 0  
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Estimated Fair Value 0  
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Cash and money market    
Fair value measurements    
Cash and cash equivalents, and restricted cash 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Cash and cash equivalents, and restricted cash 0  
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Cash and cash equivalents, and restricted cash 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Restricted cash    
Fair value measurements    
Cash and cash equivalents, and restricted cash $ 0 $ 0
v3.22.0.1
FAIR VALUE MEASUREMENTS - Narrative (Details)
$ in Thousands
12 Months Ended
Dec. 31, 2021
USD ($)
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]      
Contingent consideration, liability $ 359,021 $ 2,477 $ 2,879
Venture Capital Investment Fund      
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]      
Investment owned, fair value 1,500 800  
Committed capital 17,500    
Committed capital callable $ 16,000    
Weighted Average | Product Development and Other Milestone-based Payments | Measurement Input, Probability of Success      
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]      
Contingent consideration liability, measurement input 0.905    
Weighted Average | Product Development and Other Milestone-based Payments | Measurement Input, Present-value Factor      
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]      
Contingent consideration liability, measurement input 0.023    
Foreign Exchange Forward      
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]      
Derivative, notional amount $ 46,700 22,400  
Fair Value, Nonrecurring      
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]      
Investment owned, fair value 25,300 $ 28,300  
Thrive and Ashion | Fair Value      
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]      
Contingent consideration, liability 357,800    
Biomatrica, Inc | Revenue and Other Performance-based Payments      
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]      
Contingent consideration, liability $ 1,200    
v3.22.0.1
FAIR VALUE MEASUREMENTS - Fair Value of Contingent Consideration (Details) - USD ($)
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Fair Value Disclosures [Abstract]      
Beginning balance $ (2,477,000) $ (2,879,000)  
Changes in fair value (6,359,000) 325,000 $ 0
Payments 163,000 77,000  
Purchase price contingent consideration (350,348,000) 0 0
Ending balance $ (359,021,000) $ (2,477,000) $ (2,879,000)
v3.22.0.1
ACCRUED LIABILITIES (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Payables and Accruals [Abstract]    
Compensation $ 183,517 $ 124,654
Pfizer Promotion Agreement related costs 91,436 46,937
Professional fees 50,077 36,203
Other 32,116 13,064
Assets under construction 22,611 2,118
Research and trial related expenses 15,534 6,111
Licenses 3,265 4,517
Accrued liabilities $ 398,556 $ 233,604
v3.22.0.1
LONG-TERM DEBT - Narrative (Details)
1 Months Ended 3 Months Ended 12 Months Ended
Nov. 30, 2021
USD ($)
Dec. 31, 2021
USD ($)
Dec. 31, 2021
USD ($)
position
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Dec. 31, 2017
USD ($)
Nov. 30, 2017
USD ($)
Long-term debt              
Time frame when amount will be repaid through property taxes     2 years        
Construction Loans              
Long-term debt              
Face amount           $ 25,600,000  
Amortization period     20 years        
Initial investment   $ 16,400,000 $ 16,400,000        
Long-term construction loan       $ 23,800,000      
Interest costs incurred       700,000      
Interest costs capitalized       $ 700,000      
Debt issuance costs           $ 200,000  
Construction Loans | 1-month LIBOR              
Long-term debt              
Variable rate     2.25%        
Interest-only payment, period     24 months        
Construction Loans | City Letter of Credit              
Long-term debt              
Borrowing capacity             $ 600,000
Tax Increment Financing Loan Agreements              
Long-term debt              
Face amount   4,600,000 $ 4,600,000   $ 4,600,000    
Number of jobs required to create and maintain | position     500        
Term     5 years        
Line of Credit | City Letter of Credit | Revolver              
Long-term debt              
Proceeds from lines of credit   2,900,000          
Line of Credit | Revolving Credit Facility | Revolver              
Long-term debt              
Borrowing capacity $ 150,000,000            
Debt instrument, covenant, collateral minimum market value 150,000,000            
Debt instrument, covenant, maximum outstanding cash advances threshold $ 20,000,000            
Remaining borrowing capacity   $ 147,100,000 $ 147,100,000        
Line of Credit | Revolving Credit Facility | Daily Bloomberg Short-Term Bank Yield Index Rate | Revolver              
Long-term debt              
Variable rate 0.60%            
v3.22.0.1
CONVERTIBLE NOTES - Schedule of Convertible Notes (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Feb. 29, 2020
Mar. 31, 2019
Jun. 30, 2018
2028 Convertible notes          
Long-term debt          
Coupon interest rate 0.375% 0.375% 0.375%    
Principal Amount $ 1,150,000 $ 1,150,000      
Unamortized Debt Discount and Issuance Costs (18,826) (21,879)      
Net Carrying Amount 1,131,174 1,128,121      
2028 Convertible notes | Significant Other Observable Inputs (Level 2) | Fair Value          
Long-term debt          
Amount $ 1,139,650 $ 1,526,625      
2027 Convertible notes          
Long-term debt          
Coupon interest rate 0.375% 0.375%   0.375%  
Principal Amount $ 747,500 $ 747,500      
Unamortized Debt Discount and Issuance Costs (11,691) (13,937)      
Net Carrying Amount 735,809 733,563      
2027 Convertible notes | Significant Other Observable Inputs (Level 2) | Fair Value          
Long-term debt          
Amount $ 771,794 $ 992,306      
2025 Convertible notes          
Long-term debt          
Coupon interest rate 1.00% 1.00%     1.00%
Principal Amount $ 315,005 $ 315,049      
Unamortized Debt Discount and Issuance Costs (1,756) (2,333)      
Net Carrying Amount 313,249 312,716      
2025 Convertible notes | Significant Other Observable Inputs (Level 2) | Fair Value          
Long-term debt          
Amount $ 415,473 $ 601,744      
v3.22.0.1
CONVERTIBLE NOTES - Issuances and Settlements (Details) - USD ($)
shares in Millions
1 Months Ended 12 Months Ended
Feb. 29, 2020
Mar. 31, 2019
Jun. 30, 2018
Jan. 31, 2018
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Debt Instrument [Line Items]              
Net proceeds from issuance         $ 0 $ 1,125,547,000 $ 729,477,000
Value of stock after conversion of convertible notes             182,435,000
Loss on extinguishment of debt $ 50,800,000       $ 0 $ 50,819,000 187,698,000
2025 Convertible notes              
Debt Instrument [Line Items]              
Stock issued in conversion of convertible notes (in shares)   2.2          
Value of stock after conversion of convertible notes   $ 182,400,000          
Repayments of convertible debt in cash and by issuance of shares   676,500,000          
Repayments of debt   493,400,000          
Accrued interest on notes   700,000          
Loss on extinguishment of debt   187,700,000          
2025 Convertible notes              
Debt Instrument [Line Items]              
Face amount     $ 218,500,000 $ 690,000,000      
Interest rate (as a percent)     1.00%   1.00% 1.00%  
Net proceeds from issuance     $ 225,300,000 $ 671,100,000      
Repayments of convertible debt 150,100,000            
Accrued interest on notes 100,000            
Loss on extinguishment of debt           $ 42,800,000 $ 177,100,000
Amount settled 100,000,000            
2027 Convertible notes              
Debt Instrument [Line Items]              
Face amount   $ 747,500,000          
Interest rate (as a percent)   0.375%     0.375% 0.375%  
Net proceeds from issuance   $ 729,500,000          
2027 Convertible notes | 2025 Convertible notes              
Debt Instrument [Line Items]              
Repayments of convertible debt   $ 494,100,000          
2028 Convertible notes              
Debt Instrument [Line Items]              
Face amount $ 1,150,000,000            
Interest rate (as a percent) 0.375%       0.375% 0.375%  
Net proceeds from issuance $ 1,130,000,000            
v3.22.0.1
CONVERTIBLE NOTES - Summary of Conversion Features (Details)
$ / shares in Units, shares in Millions, $ in Millions
12 Months Ended
Dec. 31, 2021
USD ($)
shares
$ / shares
Debt Instrument [Line Items]  
Repurchase price, as percentage of principal amount, if company undergoes change of control 100
Shares issued, price per share (in usd per share) $ 77.83
2025 Convertible notes  
Debt Instrument [Line Items]  
Conversion rate, number of shares to be issued per $1,000 of principal amount 13.26
Conversion price per share of common stock (in usd per share) $ 75.43
Convertible debt, if converted (in shares) | shares 4.2
If-converted value in excess of principal | $ $ 10.0
2027 Convertible notes  
Debt Instrument [Line Items]  
Conversion rate, number of shares to be issued per $1,000 of principal amount 8.96
Conversion price per share of common stock (in usd per share) $ 111.66
Convertible debt, if converted (in shares) | shares 6.7
2028 Convertible notes  
Debt Instrument [Line Items]  
Conversion rate, number of shares to be issued per $1,000 of principal amount 8.21
Conversion price per share of common stock (in usd per share) $ 121.84
Convertible debt, if converted (in shares) | shares 9.4
v3.22.0.1
CONVERTIBLE NOTES - Ranking of Convertible Notes (Details)
$ in Thousands
12 Months Ended
Dec. 31, 2021
USD ($)
January 2025 Notes  
Debt Instrument [Line Items]  
Total transaction costs $ 10,284
June 2025 Notes  
Debt Instrument [Line Items]  
Total transaction costs 7,362
2027 Convertible notes  
Debt Instrument [Line Items]  
Total transaction costs 14,285
2028 Convertible notes  
Debt Instrument [Line Items]  
Total transaction costs $ 24,453
v3.22.0.1
CONVERTIBLE NOTES - Schedule of Interest Expense (Details) - USD ($)
$ in Thousands
1 Months Ended 12 Months Ended
Feb. 29, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Debt Instrument [Line Items]        
Debt issuance costs amortization   $ 5,727 $ 5,303 $ 2,891
Debt discount amortization   147 131 (131)
Loss on settlement of convertible notes $ 50,800 0 50,819 187,698
Coupon interest expense   10,266 9,631 6,611
Total interest expense on convertible notes   16,140 65,884 197,069
Other interest expense   2,466 2,057 2,123
Total interest expense   $ 18,606 67,941 199,192
2025 Convertible notes        
Debt Instrument [Line Items]        
Loss on settlement of convertible notes     $ 42,800 $ 177,100
Effective interest rate   1.18% 1.20% 1.27%
Convertible debt, remaining discount amortization period   3 years 14 days    
2027 Convertible notes        
Debt Instrument [Line Items]        
Effective interest rate   0.68% 0.68% 0.55%
Convertible debt, remaining discount amortization period   5 years 2 months 15 days    
2028 Convertible notes        
Debt Instrument [Line Items]        
Effective interest rate   0.64% 0.54%  
Convertible debt, remaining discount amortization period   6 years 2 months 1 day    
v3.22.0.1
LICENSE AND COLLABORATION AGREEMENTS - Mayo (Details)
$ in Thousands
1 Months Ended 12 Months Ended
Oct. 31, 2017
USD ($)
installment
Dec. 31, 2021
USD ($)
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]        
Research and development   $ 385,646 $ 554,052 $ 139,694
Licensing Agreements | Mayo        
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]        
License fees payable in five annual installments $ 6,300      
Number of annual installments in which license fees are payable | installment 5      
Time period after the last licensed patent expires that the license agreement will remain in effect   5 years    
Licensing Agreements | Mayo | Sales Milestone Range One        
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]        
Amount agreed to be paid upon reaching the specified amount of net sales $ 200      
Net sales of a licensed product 5,000      
Licensing Agreements | Mayo | Sales Milestone Range Two        
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]        
Amount agreed to be paid upon reaching the specified amount of net sales 800      
Net sales of a licensed product 20,000      
Licensing Agreements | Mayo | Sales Milestone Range Three        
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]        
Amount agreed to be paid upon reaching the specified amount of net sales 2,000      
Net sales of a licensed product $ 50,000      
Licensing Agreements | Mayo        
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]        
Research and development   $ 5,000 $ 3,900 $ 4,800
v3.22.0.1
LICENSE AND COLLABORATION AGREEMENTS - Biocartis (Details)
$ in Millions
1 Months Ended
Oct. 31, 2020
USD ($)
Biocartis N.V. | Licensing Agreements  
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]  
Early contract termination payment $ 12.0
v3.22.0.1
LICENSE AND COLLABORATION AGREEMENTS - Johns Hopkins University (Details) - Thrive - Licensing Agreements - USD ($)
$ in Millions
Jan. 05, 2021
Dec. 31, 2021
Sales Milestone Range One    
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]    
Payments contingent on milestones   $ 10.0
Net sales of a licensed product $ 500.0  
Sales Milestone Range Three    
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]    
Payments contingent on milestones   20.0
Net sales of a licensed product 1,500.0  
Sales Milestone Range Two    
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]    
Payments contingent on milestones   $ 15.0
Net sales of a licensed product $ 1,000.0  
v3.22.0.1
PFIZER PROMOTION AGREEMENT (Details) - Manufactured Product, Other - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Nov. 30, 2021
Pfizer Inc        
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]        
Contract termination fee       $ 35.9
Pfizer Inc        
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]        
Service fee based on incremental gross profits over specified baselines and royalties $ 81.3 $ 51.2 $ 68.5  
Charges for promotion, sales and marketing $ 121.0 $ 85.3 $ 68.9  
v3.22.0.1
STOCKHOLDERS' EQUITY - Narrative (Details) - USD ($)
$ / shares in Units, $ in Thousands
1 Months Ended 12 Months Ended
Dec. 31, 2021
Apr. 14, 2021
Jan. 11, 2021
Jan. 05, 2021
Dec. 31, 2021
Apr. 30, 2021
Jan. 31, 2021
Oct. 31, 2020
Mar. 31, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Jul. 01, 2020
Jun. 30, 2020
Subsidiary or Equity Method Investee [Line Items]                            
Common stock, authorized shares (in shares) 400,000,000       400,000,000         400,000,000 400,000,000   400,000,000 200,000,000
Sale of stock, number of shares issued in transaction (in shares)               8,600,000            
Sale of stock, price per share (in usd per share)               $ 101.00            
Sale of stock, consideration received on transaction               $ 861,700            
Underwriting discount and other stock issuance costs               $ 7,500            
Stock issued during period, value, acquisitions                   $ 1,355,170 $ 28,847 $ 1,407,080    
Issuance of common stock to fund business combinations (in shares)                 400,000 10,581,429 386,293 17,046,159    
TARDIS Technology                            
Subsidiary or Equity Method Investee [Line Items]                            
Payments to acquire productive assets (in shares)     200,000                      
Stock issued to acquire productive assets, value     $ 27,300                      
PreventionGenetics                            
Subsidiary or Equity Method Investee [Line Items]                            
Equity issued to acquire business (in shares)         1,070,410                  
Fair value of stock issued in acquisition $ 84,200       $ 84,200         $ 84,200        
Business combination, consideration transferred 185,507                          
Common stock issued 84,252                          
Ashion Analytics                            
Subsidiary or Equity Method Investee [Line Items]                            
Equity issued to acquire business (in shares)   125,444       100,000                
Fair value of stock issued in acquisition           $ 16,200                
Business combination, consideration transferred   $ 109,999                        
Common stock issued   $ 16,224                        
Thrive                            
Subsidiary or Equity Method Investee [Line Items]                            
Equity issued to acquire business (in shares)       9,323,266     9,300,000              
Fair value of stock issued in acquisition       $ 1,190,000     $ 1,190,000              
Business combination, consideration transferred       2,187,054                    
Common stock issued       $ 1,175,431                    
Paradigm & Viomics                            
Subsidiary or Equity Method Investee [Line Items]                            
Business combination, consideration transferred                 $ 40,400          
Stock issued during period, value, acquisitions                 $ 32,200          
Common stock issued $ 28,800                          
v3.22.0.1
STOCKHOLDERS' EQUITY - Schedule of OCI (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
AOCI Attributable to Parent, Net of Tax [Roll Forward]      
Beginning balance $ 2,235,553 $ 1,957,639 $ 447,258
Other comprehensive income (loss) before reclassifications (1,625) 771 681
Amounts reclassified from accumulated other comprehensive income (loss) (514) 25 641
Net current period change in accumulated other comprehensive income (loss) (2,139) 796 1,322
Income tax expense related to items of other comprehensive income (loss) 170 (170)  
Ending balance 3,387,636 2,235,553 1,957,639
Accumulated Other Comprehensive Income (Loss)      
AOCI Attributable to Parent, Net of Tax [Roll Forward]      
Beginning balance 526 (100) (1,422)
Ending balance (1,443) 526 (100)
Cumulative Translation Adjustment      
AOCI Attributable to Parent, Net of Tax [Roll Forward]      
Beginning balance 0 (25) (25)
Other comprehensive income (loss) before reclassifications 23 0 0
Amounts reclassified from accumulated other comprehensive income (loss) 0 25 0
Net current period change in accumulated other comprehensive income (loss) 23 25 0
Income tax expense related to items of other comprehensive income (loss) 0 0  
Ending balance 23 0 (25)
Unrealized Gain (Loss) on Securities      
AOCI Attributable to Parent, Net of Tax [Roll Forward]      
Beginning balance 526 (75) (1,397)
Other comprehensive income (loss) before reclassifications (1,648) 771 681
Amounts reclassified from accumulated other comprehensive income (loss) (514) 0 641
Net current period change in accumulated other comprehensive income (loss) (2,162) 771 1,322
Income tax expense related to items of other comprehensive income (loss) 170 (170)  
Ending balance $ (1,466) $ 526 $ (75)
v3.22.0.1
STOCKHOLDERS' EQUITY - Schedule of amounts reclassified from AOCI (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Changes in Accumulated Other Comprehensive Income (Loss)      
General and administrative $ (801,262) $ (481,393) $ (352,453)
Total reclassifications (514) 25 641
Reclassification Out Of Accumulated Other Comprehensive Income | Unrealized Gain (Loss) on Securities      
Changes in Accumulated Other Comprehensive Income (Loss)      
Investment income, net (514) 0 641
Reclassification Out Of Accumulated Other Comprehensive Income | Cumulative Translation Adjustment      
Changes in Accumulated Other Comprehensive Income (Loss)      
General and administrative $ 0 $ 25 $ 0
v3.22.0.1
STOCK-BASED COMPENSATION - Stock-Based Compensation Plans (Details)
12 Months Ended 138 Months Ended
Jul. 28, 2016
shares
Jul. 24, 2014
shares
Dec. 31, 2021
USD ($)
item
shares
Dec. 31, 2021
shares
Dec. 31, 2020
shares
Stock-based compensation          
Period by which all options to purchase common stock will accelerate upon an acquisition of the company     1 year    
Shares outstanding (in shares)     2,284,276 2,284,276 2,231,059
Shares available for future grant (in shares)     8,918,422 8,918,422  
Omnibus Long Term Incentive Plan 2019          
Stock-based compensation          
Further grants or awards after termination of plan (in shares)     0    
Shares available for future grant (in shares)     8,491,176 8,491,176  
Omnibus Long Term Incentive Plan 2019 | Minimum          
Stock-based compensation          
Vesting period     3 years    
Omnibus Long Term Incentive Plan 2019 | Maximum          
Stock-based compensation          
Vesting period     4 years    
Omnibus Long Term Incentive Plan 2019 | Stock Options          
Stock-based compensation          
Expiration period from the date of grant     10 years    
Shares outstanding (in shares)     395,584 395,584  
Omnibus Long Term Incentive Plan 2019 | Restricted Stock          
Stock-based compensation          
Shares outstanding (in shares)     3,573,014 3,573,014  
Omnibus Long Term Incentive Plan 2010          
Stock-based compensation          
Further grants or awards after termination of plan (in shares)     0    
Shares available for future grant (in shares)     0 0  
Omnibus Long Term Incentive Plan 2010 | Minimum          
Stock-based compensation          
Vesting period     3 years    
Omnibus Long Term Incentive Plan 2010 | Maximum          
Stock-based compensation          
Vesting period     4 years    
Omnibus Long Term Incentive Plan 2010 | Stock Options          
Stock-based compensation          
Expiration period from the date of grant     10 years    
Shares outstanding (in shares)     1,474,505 1,474,505  
Omnibus Long Term Incentive Plan 2010 | Restricted Stock          
Stock-based compensation          
Shares outstanding (in shares)     1,230,807 1,230,807  
2016 Inducement Award Plan          
Stock-based compensation          
Further grants or awards after termination of plan (in shares)     0    
Expiration period from the date of grant     10 years    
Shares available for future grant (in shares)     0 0  
2016 Inducement Award Plan | Minimum          
Stock-based compensation          
Vesting period     3 years    
2016 Inducement Award Plan | Maximum          
Stock-based compensation          
Vesting period     4 years    
2016 Inducement Award Plan | Restricted Stock          
Stock-based compensation          
Shares outstanding (in shares)     0 0  
Employee Stock Purchase Plan 2010          
Stock-based compensation          
Shares available for future grant (in shares)     427,246 427,246  
Increase in number of shares reserved for issuance (in shares) 2,000,000 500,000      
Option exercise price, expressed as a percentage of fair market value     85.00%    
Maximum value of shares that an employee is permitted to purchase | $     $ 25,000    
Number of shares (in shares)     331,769 2,372,754  
Employee Stock Purchase Plan 2010 | Minimum          
Stock-based compensation          
Number of hours per week of customary employment required to participate in the plan | item     20    
Number of months of customary employment required to participate in the plan     5 months    
Percentage of employee's compensation to be deducted from the employee's pay     1.00%    
Employee Stock Purchase Plan 2010 | Maximum          
Stock-based compensation          
Percentage of employee's compensation to be deducted from the employee's pay     15.00%    
v3.22.0.1
STOCK-BASED COMPENSATION - Stock-Based Compensation Expense (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Stock-based compensation expense      
Stock-based compensation expense $ 339,226 $ 152,906 $ 108,483
Cost of sales      
Stock-based compensation expense      
Stock-based compensation expense 16,835 12,852 5,799
Research and development      
Stock-based compensation expense      
Stock-based compensation expense 49,723 19,976 17,196
General and administrative      
Stock-based compensation expense      
Stock-based compensation expense 216,952 75,999 64,222
Sales and marketing      
Stock-based compensation expense      
Stock-based compensation expense $ 55,716 $ 44,079 $ 21,266
v3.22.0.1
STOCK-BASED COMPENSATION - Stock-Based Compensation Additional Information (Details) - USD ($)
$ in Thousands
3 Months Ended 12 Months Ended
Jan. 05, 2021
Mar. 31, 2021
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Stock-based compensation          
Unrecognized compensation cost     $ 368,500    
Weighted average period for recognition of unrecognized compensation cost     2 years 4 months 24 days    
Stock-based compensation     $ 253,063 $ 152,906 $ 108,483
Thrive          
Stock-based compensation          
Stock-based compensation     19,000    
Non-cash stock-based compensation expense $ 65,000        
Thrive | General and administrative          
Stock-based compensation          
Non-cash stock-based compensation expense   $ 86,200 $ 86,200    
Stock Options | Thrive          
Stock-based compensation          
Accelerated vesting (in shares)     139,096    
Stock Options | Genomic Health Inc          
Stock-based compensation          
Accelerated vesting (in shares)       83,593 364,281
Restricted Shares and RSUs | Thrive          
Stock-based compensation          
Accelerated vesting (in shares)     58,171    
Restricted Shares and RSUs | Genomic Health Inc          
Stock-based compensation          
Accelerated vesting (in shares)       93,770 70,138
Non-cash stock-based compensation expense       $ 9,700 $ 21,600
v3.22.0.1
STOCK-BASED COMPENSATION - Schedule of Fair Value of Options and ESPP (Details) - shares
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Valuation assumptions      
Granted (in shares) 0    
Stock Options      
Valuation assumptions      
Risk-free interest rates, minimum   1.26% 2.54%
Risk-free interest rates, maximum   1.47% 2.59%
Expected term (in years)   6 years 1 month 24 days 6 years 3 months 10 days
Expected volatility, minimum (as a percent)   65.67% 64.95%
Expected volatility, maximum (as a percent)   65.71% 64.99%
Dividend yield   0.00% 0.00%
Employee Stock      
Valuation assumptions      
Risk-free interest rates, minimum 0.04% 0.11% 1.60%
Risk-free interest rates, maximum 0.16% 0.20% 2.40%
Expected volatility, minimum (as a percent) 43.00% 61.59% 43.20%
Expected volatility, maximum (as a percent) 68.51% 89.00% 57.60%
Dividend yield 0.00% 0.00% 0.00%
Minimum | Employee Stock      
Valuation assumptions      
Expected term (in years) 6 months 6 months 4 months 24 days
Maximum | Employee Stock      
Valuation assumptions      
Expected term (in years) 2 years 2 years 2 years
v3.22.0.1
STOCK-BASED COMPENSATION - Stock Option, Restricted Stock, and Performance Shares (Details)
12 Months Ended
Dec. 31, 2021
USD ($)
employees
$ / shares
shares
Dec. 31, 2020
USD ($)
$ / shares
shares
Dec. 31, 2019
USD ($)
$ / shares
Shares      
Outstanding at the beginning of the period (in shares) | shares 2,231,059    
Granted (in shares) | shares 0    
Assumed through acquisition (in shares) | shares 1,393,748    
Exercised (in shares) | shares (1,295,400)    
Forfeited (in shares) | shares (45,131)    
Outstanding at the end of the period (in shares) | shares 2,284,276 2,231,059  
Vested and expected to vest (in shares) | shares 2,284,276    
Exercisable at the end of the period (in shares) | shares 1,780,838    
Weighted Average Exercise Price      
Outstanding at the beginning of the period (in dollars per share) | $ / shares $ 39.67    
Granted (in dollars per share) | $ / shares 0    
Assumed through acquisition (in dollars per share) | $ / shares 5.51    
Exercised (in dollars per share) | $ / shares 11.17    
Forfeited (in dollars per share) | $ / shares 56.66    
Outstanding at the end of the period (in dollars per share) | $ / shares 34.65 $ 39.67  
Vested and expected to vest (in dollars per share) | $ / shares 34.65    
Exercisable at the end of the period (in dollars per share) | $ / shares $ 25.59    
Weighted Average Remaining Contractual Term      
Outstanding at the end of the period 5 years 6 months 6 years  
Vested and expected to vest at end of period 5 years 6 months    
Exercisable at the end of the period 4 years 9 months 18 days    
Aggregate Intrinsic Value      
Outstanding at the end of the period | $ $ 107,586,000    
Vested and expected to vest at the end of the period | $ 107,586,000    
Exercisable at the end of the period | $ 96,789,000    
Additional disclosures      
Total intrinsic value of options exercised | $ 155,800,000 $ 40,600,000 $ 52,000,000
Proceeds from stock option exercises | $ $ 14,400,000 $ 27,100,000 $ 8,800,000
Weighted Average Grant Date Fair Value      
Number of employees impacted by change in operational milestones | employees 36    
Restricted Shares and RSUs      
Restricted Shares and Performance Shares      
Outstanding at the beginning of the period (in shares) | shares 3,968,214    
Granted (in shares) | shares 2,333,213    
Assumed through acquisition (in shares) | shares 242,123    
Released (in shares) | shares (1,697,643)    
Forfeited (in shares) | shares (524,997)    
Outstanding at the end of the period (in shares) | shares 4,320,910 3,968,214  
Weighted Average Grant Date Fair Value      
Outstanding at the beginning of the period (in dollars per share) | $ / shares $ 79.38    
Granted (in dollars per share) | $ / shares 129.16 $ 92.55 $ 93.20
Assumed through acquisition (in dollars per share) | $ / shares 127.79    
Released (in dollars per share) | $ / shares 73.18    
Forfeited (in dollars per share) | $ / shares 101.20    
Outstanding at the end of the period (in dollars per share) | $ / shares $ 108.84 $ 79.38  
Fair value of equity instruments other than options | $ $ 219,400,000 $ 152,400,000 $ 173,800,000
Performance Shares      
Restricted Shares and Performance Shares      
Outstanding at the beginning of the period (in shares) | shares 618,515    
Granted (in shares) | shares 270,665    
Released (in shares) | shares 0    
Forfeited (in shares) | shares (11,066)    
Outstanding at the end of the period (in shares) | shares 878,114 618,515  
Weighted Average Grant Date Fair Value      
Outstanding at the beginning of the period (in dollars per share) | $ / shares $ 93.22    
Granted (in dollars per share) | $ / shares 138.09 $ 90.17 $ 93.40
Released (in dollars per share) | $ / shares 0    
Forfeited (in dollars per share) | $ / shares 83.15    
Outstanding at the end of the period (in dollars per share) | $ / shares $ 107.18 $ 93.22  
Fair value of equity instruments other than options | $ $ 0 $ 0 $ 183,800,000
Number of outstanding performance share units (in shares) | shares 45,312    
Stock Options      
Additional disclosures      
Weighted average fair value per share of options granted during the period (in dollars per share) | $ / shares   $ 58.57 $ 57.11
v3.22.0.1
STOCK-BASED COMPENSATION - Issuance of Stock Under ESPP (Details) - Employee Stock Purchase Plan 2010 - USD ($)
$ / shares in Units, $ in Thousands
12 Months Ended 138 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2021
Stock-based compensation        
Stock issued under the Company's stock purchase plan (in shares) 331,769     2,372,754
Employee Stock        
Stock-based compensation        
Stock issued under the Company's stock purchase plan (in shares) 331,769 301,064 176,458  
Cash received under the 2010 Purchase Plan $ 23,070 $ 18,355 $ 8,396  
Weighted average fair value per share of options granted during the period (in dollars per share) $ 34.93 $ 32.57 $ 29.21  
v3.22.0.1
STOCK-BASED COMPENSATION - Schedule of Share Issued During Period (Details) - Employee Stock Purchase Plan 2010 - $ / shares
12 Months Ended 138 Months Ended
Nov. 01, 2021
Apr. 30, 2021
Dec. 31, 2021
Dec. 31, 2021
Stock-based compensation        
Stock issued under the Company's stock purchase plan (in shares)     331,769 2,372,754
Offering Period End Date One        
Stock-based compensation        
Stock issued under the Company's stock purchase plan (in shares)   173,717    
Weighted average price per share (in dollars per share)   $ 69.31    
Offering Period End Date Two        
Stock-based compensation        
Stock issued under the Company's stock purchase plan (in shares) 158,052      
Weighted average price per share (in dollars per share) $ 69.71      
v3.22.0.1
STOCK-BASED COMPENSATION - Shares Reserved for Issuance (Details)
Dec. 31, 2021
shares
Shares reserved for issuance  
Shares reserved for issuance (in shares) 8,918,422
Employee Stock Purchase Plan 2019  
Shares reserved for issuance  
Shares reserved for issuance (in shares) 8,491,176
Employee Stock Purchase Plan 2010  
Shares reserved for issuance  
Shares reserved for issuance (in shares) 427,246
v3.22.0.1
COMMITMENTS AND CONTINGENCIES - Lease Expense (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Finance lease cost      
Amortization of right-of-use assets $ 5,731 $ 1,935 $ 27
Interest on lease liabilities 1,018 383 2
Operating lease cost 31,730 22,551 9,200
Short-term lease cost 628 356 219
Variable lease cost 5,212 2,703 896
Total lease Cost $ 44,319 $ 27,928 $ 10,344
v3.22.0.1
COMMITMENTS AND CONTINGENCIES - Supplemental Disclosure of Cash Flow Information (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:      
Operating cash flows from operating leases $ 27,461 $ 17,531 $ 9,641
Operating cash flows from finance leases 938 381 1
Finance cash flows from finance leases 5,290 1,756 15
Non-cash investing and financing activities:      
Right-of-use assets obtained in exchange for new operating lease liabilities 74,369 13,261 51,030
Right-of-use assets obtained in exchange for new finance lease liabilities $ 5,460 $ 20,349 $ 237
Weighted-average remaining lease term - operating leases (in years) 8 years 3 months 29 days 8 years 9 months 9 years 9 months 18 days
Weighted-average remaining lease term - finance leases (in years) 2 years 11 months 12 days 3 years 8 months 4 days 1 year 2 months 12 days
Weighted-average discount rate - operating leases 6.11% 6.80% 6.80%
Weighted-average discount rate - finance leases 5.36% 5.67% 5.60%
ASU 2016-02      
Non-cash investing and financing activities:      
Right-of-use assets obtained in exchange for new operating lease liabilities $ 39,600   $ 17,900
v3.22.0.1
COMMITMENTS AND CONTINGENCIES - Additional Information (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Commitments and Contingencies Disclosure [Abstract]    
Recognition of ROU assets $ 174,225 $ 125,947
Recognition of lease liabilities 201,876 132,600
Operating lease liability, current 19,710 11,483
Operating lease liability, noncurrent 182,166 121,075
Finance lease, right-of-use asset $ 18,200 $ 18,600
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List] Other long-term assets, net Other long-term assets, net
Finance lease obligations $ 18,736 $ 18,700
Finance lease liability, current $ 6,200 $ 4,700
Finance Lease, Liability, Current, Statement of Financial Position [Extensible List] Other current liabilities Other current liabilities
Finance lease liability, noncurrent $ 12,500 $ 14,000
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List] Other long-term liabilities Other long-term liabilities
v3.22.0.1
COMMITMENTS AND CONTINGENCIES - Schedule of Maturities on Operating Lease Liabilities (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Operating Leases, Future Minimum Payments Due, Fiscal Year Maturity [Abstract]    
2022 $ 30,706  
2023 31,793  
2024 32,209  
2025 30,446  
2026 29,890  
Thereafter 106,967  
Total minimum lease payments 262,011  
Imputed interest (60,135)  
Total $ 201,876 $ 132,600
v3.22.0.1
COMMITMENTS AND CONTINGENCIES - Schedule of Maturities on Finance Lease Liabilities (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Finance Leases, Future Minimum Payments Due, Fiscal Year Maturity [Abstract]    
2022 $ 7,040  
2023 6,930  
2024 5,253  
2025 911  
2026 51  
Thereafter 0  
Total minimum lease payments 20,185  
Imputed interest (1,449)  
Total $ 18,736 $ 18,700
v3.22.0.1
COMMITMENTS AND CONTINGENCIES - Legal Matters (Details) - DOS Rule Investigation - USD ($)
$ in Millions
Dec. 31, 2021
Jun. 30, 2021
Lessee, Lease, Description [Line Items]    
Estimated litigation liability   $ 48.2
Loss contingency accrual $ 10.0  
v3.22.0.1
EMPLOYEE BENEFIT PLAN (Details) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Retirement Benefits [Abstract]      
Matching contribution by employer 100.00% 100.00% 100.00%
Percentage of participant's salary matched by employer 6.00% 6.00% 6.00%
Compensation expense in connection with the 401 (k) Plan $ 30.0 $ 22.8 $ 12.5
v3.22.0.1
NEW MARKET TAX CREDIT (Details) - New Market Tax Credit Program
$ in Millions
3 Months Ended 12 Months Ended
Dec. 31, 2014
USD ($)
facility
Dec. 31, 2021
Disclosures related to New Market Tax Credit    
Net proceeds received from financing arrangements | $ $ 2.4  
Number of facilities receiving working capital and capital improvements from financing agreements | facility 1  
Financing Arrangement, Compliance Period   7 years
v3.22.0.1
WISCONSIN ECONOMIC DEVELOPMENT TAX CREDIT (Details)
$ in Millions
1 Months Ended 12 Months Ended
Dec. 31, 2021
USD ($)
position
Feb. 28, 2015
USD ($)
position
Dec. 31, 2021
USD ($)
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Wisconsin Economic Development Tax Credit Agreement          
Agreements          
Refundable tax credits earned   $ 9.0 $ 9.0    
Capital investment expenditures over specified period, requirement to earn the refundable tax credits   $ 26.3      
Full-time positions that must be created over a specified time period to earn the refundable tax credits | position   758      
Period over which the capital investment expenditures must be incurred and the creation of full-time positions must be completed   7 years      
Refundable tax credit received     7.5    
Refundable tax credit receivable $ 1.5   1.5    
Amortization of tax credits       $ 2.2 $ 2.4
Amended Wisconsin Economic Development Tax Credit Agreement          
Agreements          
Refundable tax credits earned 18.5   8.0    
Capital investment expenditures over specified period, requirement to earn the refundable tax credits $ 350.0   350.0    
Full-time positions that must be created over a specified time period to earn the refundable tax credits | position 1,300        
Period over which the capital investment expenditures must be incurred and the creation of full-time positions must be completed 5 years        
Credit earning rate 10.00%        
Maximum credits to earn $ 7.0        
Refundable tax credit receivable 8.0   8.0    
Amended Wisconsin Economic Development Tax Credit Agreement | Capital Expenditures          
Agreements          
Amortization of tax credits     7.0    
Amended Wisconsin Economic Development Tax Credit Agreement | Operating Expense          
Agreements          
Amortization of tax credits     1.0    
Amended Wisconsin Economic Development Tax Credit Agreement | Prepaid expenses and other current assets          
Agreements          
Refundable tax credit receivable 1.7   1.7    
Amended Wisconsin Economic Development Tax Credit Agreement | Other long-term assets          
Agreements          
Refundable tax credit receivable $ 6.3   $ 6.3    
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Business Combinations Textual (Details)
$ / shares in Units, $ in Thousands
1 Months Ended 2 Months Ended 3 Months Ended 12 Months Ended
Dec. 31, 2021
USD ($)
test
$ / shares
Apr. 14, 2021
USD ($)
$ / shares
shares
Jan. 05, 2021
USD ($)
$ / shares
shares
Mar. 03, 2020
USD ($)
Nov. 08, 2019
USD ($)
Dec. 31, 2021
USD ($)
$ / shares
shares
Apr. 30, 2021
USD ($)
shares
Jan. 31, 2021
USD ($)
shares
Mar. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Mar. 31, 2021
USD ($)
Dec. 31, 2019
USD ($)
Dec. 31, 2021
USD ($)
$ / shares
Dec. 31, 2021
USD ($)
$ / shares
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Acquisition                                
Shares issued, price per share (in usd per share) | $ / shares $ 77.83         $ 77.83             $ 77.83 $ 77.83    
Contingent consideration, liability $ 359,021         $ 359,021       $ 2,879   $ 2,879 $ 359,021 $ 359,021 $ 2,477 $ 2,879
Stock-based compensation expense                         339,226   152,906 108,483
Business combination, equity interest in acquiree, remeasurement gain                         30,500   0 0
Remeasurement of contingent consideration                         6,360   (323) 0
Stock-based compensation                         253,063   152,906 108,483
Stock issued during period, value, acquisitions                         1,355,170   28,847 1,407,080
Consideration transferred, net of cash acquired                         $ 499,730   $ 6,658 973,861
Equity interests issued or issuable to previous investors       $ 8,400                        
Acquired developed technology                                
Acquisition                                
Weighted Average Remaining Life (Years)                         8 years 7 months 6 days   9 years  
Customer relationships                                
Acquisition                                
Weighted Average Remaining Life (Years)                         9 years 7 months 6 days   12 years 9 months 18 days  
Trade name                                
Acquisition                                
Weighted Average Remaining Life (Years)                         13 years 4 months 24 days   14 years 10 months 24 days  
Thrive                                
Acquisition                                
Investment owned, fair value     $ 12,500                          
Business combination, equity interest in acquiree, remeasurement gain                     $ 7,600          
Remeasurement of contingent consideration                         $ 7,200      
General and administrative                                
Acquisition                                
Stock-based compensation expense                         $ 216,952   $ 75,999 64,222
Investment Income | Thrive                                
Acquisition                                
Business combination, equity interest in acquiree, remeasurement gain                     30,500          
PreventionGenetics                                
Acquisition                                
Number of tests provided | test 5,000                              
Business combination, consideration transferred $ 185,507                              
Equity issued to acquire business (in shares) | shares           1,070,410                    
Shares issued, price per share (in usd per share) | $ / shares $ 78.71         $ 78.71             $ 78.71 $ 78.71    
Cash $ 101,255                              
Business combination, cash withheld 15,500         $ 15,500             $ 15,500 $ 15,500    
Acquisition related costs 2,700                              
Fair value of stock issued in acquisition 84,200         84,200             84,200 84,200    
Common stock issued 84,252                              
PreventionGenetics | Payment 1                                
Acquisition                                
Cash $ 85,800                              
PreventionGenetics | Acquired developed technology                                
Acquisition                                
Weighted-average remaining useful life of finite-lived intangible asset (in years) 13 years                              
Intangible assets $ 65,000         65,000             65,000 65,000    
PreventionGenetics | Customer relationships                                
Acquisition                                
Weighted-average remaining useful life of finite-lived intangible asset (in years) 9 years                              
Intangible assets $ 4,000         4,000             4,000 4,000    
PreventionGenetics | Trade name                                
Acquisition                                
Weighted-average remaining useful life of finite-lived intangible asset (in years) 4 years                              
Intangible assets $ 4,000         4,000             4,000 4,000    
Ashion Analytics                                
Acquisition                                
Business combination, consideration transferred   $ 109,999                            
Equity issued to acquire business (in shares) | shares   125,444         100,000                  
Shares issued, price per share (in usd per share) | $ / shares   $ 129.33                            
Cash   $ 74,775                            
Weighted-average remaining useful life of finite-lived intangible asset (in years)   13 years                            
Acquisition related costs   $ 1,600                            
Intangible assets   39,000                            
Fair value of stock issued in acquisition             $ 16,200                  
Common stock issued   16,224                            
Ashion Analytics | Commercial Launch Milestone                                
Acquisition                                
Additional cash consideration to be paid   20,000                            
Contingent consideration, liability   19,000                            
Ashion Analytics | MRD Product Revenue Milestone                                
Acquisition                                
Contingent consideration, liability   30,000                            
Revenue milestone   $ 500,000                            
Thrive                                
Acquisition                                
Business combination, consideration transferred     $ 2,187,054                          
Equity issued to acquire business (in shares) | shares     9,323,266         9,300,000                
Shares issued, price per share (in usd per share) | $ / shares     $ 127.79                          
Cash     $ 584,996                          
Acquisition related costs                     10,300   10,300      
Contingent consideration, liability     450,000                          
Fair value of stock issued in acquisition     1,190,000         $ 1,190,000                
Common stock issued     1,175,431                          
Payments to acquire businesses and accelerated vesting of awards     590,200                          
Stock-based compensation expense     166,000                          
Compensation consideration assumed     197,000                          
Compensation consideration assumed and allocated to consideration transferred     52,200                          
Compensation consideration assumed and deemed compensatory     144,800                          
Non-cash stock-based compensation expense     65,000                          
Share based compensation, costs not yet recognized     $ 79,800                          
Share conversion ratio     0.06216                          
Business combination, pro forma loss                           255,000    
Stock-based compensation                         19,000      
Additional benefit charges                         3,900      
Thrive | Employees with Qualifying Termination Events                                
Acquisition                                
Non-cash stock-based compensation expense                     13,500          
Thrive | Fair Value                                
Acquisition                                
Contingent consideration, liability     $ 352,000                          
Thrive | General and administrative                                
Acquisition                                
Incremental share based compensation expense     16,000                          
Stock-based compensation expense     5,200                          
Non-cash stock-based compensation expense                     $ 86,200   86,200      
Thrive | FDA Approval                                
Acquisition                                
Contingent consideration, liability     150,000                          
Thrive | CSM Coverage                                
Acquisition                                
Contingent consideration, liability     300,000                          
Thrive | Allocated to Consideration Transferred | Fair Value                                
Acquisition                                
Contingent consideration, liability     331,300                          
Thrive | Allocated to Previous Ownership Interest | Fair Value                                
Acquisition                                
Contingent consideration, liability     6,400                          
Thrive | Allocated to Compensation | Fair Value                                
Acquisition                                
Contingent consideration, liability     14,300                          
Thrive | Compensation Expense                                
Acquisition                                
Contingent payment obligations     $ 18,200                          
Paradigm & Viomics                                
Acquisition                                
Business combination, consideration transferred                 $ 40,400              
Intangible assets 7,800     $ 7,800   7,800             7,800 7,800    
Common stock issued 28,800                              
Stock issued during period, value, acquisitions                 32,200              
Consideration transferred, net of cash acquired                 $ 8,200              
Amount of shares held for future issuance $ 3,400         $ 3,400             $ 3,400 $ 3,400    
Equity interests issued or issuable to previous investors, vesting period       4 years                        
Paradigm & Viomics | Acquired developed technology                                
Acquisition                                
Weighted Average Remaining Life (Years)       15 years                        
Genomic Health Inc                                
Acquisition                                
Business combination, consideration transferred         $ 2,468,568                      
Cash         1,061,489                      
Acquisition related costs                               $ 22,500
Common stock issued         $ 1,389,266                      
Share conversion ratio         0.76534                      
Business combination, pro forma loss                   $ 40,446            
Severance benefits expense                       $ 32,100        
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Consideration Transferred for PreventionGenetics LLC (Details) - PreventionGenetics
$ in Thousands
Dec. 31, 2021
USD ($)
Acquisition  
Cash $ 101,255
Common stock issued 84,252
Total purchase price $ 185,507
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Assets Acquired and Liabilities Assumed, PreventionGenetics LLC (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Acquisition      
Goodwill $ 2,335,172 $ 1,237,672 $ 1,203,197
PreventionGenetics      
Acquisition      
Cash and cash equivalents 1,574    
Accounts receivable 6,261    
Inventory 1,697    
Prepaid expenses and other current assets 30    
Property, plant and equipment 12,793    
Net operating assets 95,355    
Accounts payable (1,493)    
Accrued liabilities (992)    
Net operating liabilities (2,485)    
Net assets acquired 92,870    
Goodwill 92,637    
Net assets acquired 185,507    
PreventionGenetics | Acquired developed technology      
Acquisition      
Intangible assets 65,000    
PreventionGenetics | Customer relationships      
Acquisition      
Intangible assets 4,000    
PreventionGenetics | Trade name      
Acquisition      
Intangible assets $ 4,000    
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Consideration Transferred for Ashion Analytics (Details) - Ashion Analytics
$ in Thousands
Apr. 14, 2021
USD ($)
Acquisition  
Cash $ 74,775
Common stock issued 16,224
Contingent consideration 19,000
Total purchase price $ 109,999
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Assets Acquired and Liabilities Assumed, Ashion Analytics (Details) - USD ($)
$ in Thousands
Dec. 31, 2021
Apr. 14, 2021
Dec. 31, 2020
Dec. 31, 2019
Acquisition        
Goodwill $ 2,335,172   $ 1,237,672 $ 1,203,197
Ashion Analytics        
Acquisition        
Cash and cash equivalents   $ 2,474    
Accounts receivable   2,349    
Inventory   1,811    
Prepaid expenses and other current assets   425    
Property, plant and equipment   9,947    
Operating lease right-of-use assets   548    
Developed technology   39,000    
Total identifiable assets acquired   56,554    
Accounts payable   (1,477)    
Accrued liabilities   (1,190)    
Operating lease liabilities, current portion   (343)    
Other current liabilities   (98)    
Operating lease liabilities, less current portion   (205)    
Total liabilities assumed   (3,313)    
Net assets acquired   53,241    
Goodwill   56,758    
Net assets acquired   $ 109,999    
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Consideration Transferred, Thrive (Details) - Thrive
$ in Thousands
Jan. 05, 2021
USD ($)
Acquisition  
Common stock issued $ 1,175,431
Cash 584,996
Liabilities incurred 331,348
Fair value of replaced equity awards 52,245
Previously held equity investment fair value 43,034
Total purchase price $ 2,187,054
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Assumptions on Fair Value of Options Assumed (Details) - Options - $ / shares
Jan. 05, 2021
Nov. 08, 2019
Thrive    
Acquisition    
Risk-free interest rates, minimum 0.11%  
Risk-free interest rates, maximum 0.12%  
Expected volatility, minimum (as a percent) 65.54%  
Expected volatility, maximum (as a percent) 71.00%  
Dividend yield 0.00%  
Genomic Health Inc    
Acquisition    
Risk-free interest rates, minimum   0.88%
Risk-free interest rates, maximum   2.90%
Expected volatility, minimum (as a percent)   63.54%
Expected volatility, maximum (as a percent)   69.09%
Dividend yield   0.00%
Minimum | Thrive    
Acquisition    
Expected term (in years) 1 year 3 months 3 days  
Weighted average fair value per share of options granted during the period (in dollars per share) $ 109.74  
Minimum | Genomic Health Inc    
Acquisition    
Expected term (in years)   3 years 3 months 10 days
Weighted average fair value per share of options granted during the period (in dollars per share)   $ 45.75
Maximum | Thrive    
Acquisition    
Expected term (in years) 1 year 6 months 25 days  
Weighted average fair value per share of options granted during the period (in dollars per share) $ 124.89  
Maximum | Genomic Health Inc    
Acquisition    
Expected term (in years)   6 years 8 months 23 days
Weighted average fair value per share of options granted during the period (in dollars per share)   $ 57.44
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Assets Acquired and Liabilities Assumed, Thrive (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Jan. 05, 2021
Dec. 31, 2020
Dec. 31, 2019
Acquisition        
Goodwill $ 2,335,172   $ 1,237,672 $ 1,203,197
Thrive        
Acquisition        
Cash and cash equivalents 241,748 $ 241,748    
Prepaid expenses and other current assets 3,939 3,939    
Property, plant and equipment 29,977 29,977    
Operating lease right-of-use assets 39,027 39,027    
Other long-term assets 67 67    
In-process research and development (IPR&D) 1,250,000 1,250,000    
Total identifiable assets acquired 1,564,758 1,564,758    
Accounts payable (3,222) (3,222)    
Accrued liabilities (8,080) (6,218)    
Operating lease liabilities, current portion (2,980) (2,980)    
Operating lease liabilities, less current portion (38,622) (38,622)    
Deferred tax liability (272,905) (272,905)    
Total liabilities assumed (325,809) (323,947)    
Net assets acquired 1,238,949 1,240,811    
Goodwill 948,105 946,243    
Net assets acquired 2,187,054 $ 2,187,054    
Measurement Period Adjustments        
Cash and cash equivalents 0      
Prepaid expenses and other current assets 0      
Property, plant and equipment 0      
Operating lease right-of-use assets 0      
Other long-term assets 0      
In-process research and development (IPR&D) 0      
Total identifiable assets acquired 0      
Accounts payable 0      
Accrued liabilities (1,862)      
Operating lease liabilities, current portion 0      
Operating lease liabilities, less current portion 0      
Deferred tax liability 0      
Net operating liabilities (1,862)      
Net identifiable assets acquired (1,862)      
Goodwill 1,862      
Net assets acquired $ 0      
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Pro Forma Thrive Information (Details) - Thrive - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Acquisition    
Total revenues $ 1,767,087 $ 1,491,391
Net loss before tax $ (761,337) $ (1,014,352)
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Assets Acquired and Liabilities Assumed From Paradigm Diagnostics Acquisition (Details) - USD ($)
$ in Thousands
10 Months Ended
Dec. 31, 2020
Dec. 31, 2021
Mar. 03, 2020
Dec. 31, 2019
Acquisition        
Goodwill $ 1,237,672 $ 2,335,172   $ 1,203,197
Paradigm & Viomics        
Acquisition        
Net operating assets   5,373 $ 6,133  
Goodwill   30,431 29,695  
Developed technology   7,800 7,800  
Net operating liabilities   (3,203) (3,123)  
Net assets acquired   $ 40,401 $ 40,505  
Measurement Period Adjustments        
Net operating assets (760)      
Goodwill 736      
Developed technology 0      
Net operating liabilities (80)      
Total purchase price $ (104)      
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Consideration Transferred for Genomic Health, Inc (Details) - Genomic Health Inc
$ in Thousands
Nov. 08, 2019
USD ($)
Acquisition  
Cash $ 1,061,489
Common stock issued 1,389,266
Fair value of replaced equity awards 17,813
Total purchase price $ 2,468,568
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Pro Forma Genomic Health Inc Information (Details) - Genomic Health Inc - USD ($)
$ in Thousands
2 Months Ended 12 Months Ended
Dec. 31, 2019
Dec. 31, 2019
Acquisition    
Total revenues $ 66,174  
Net loss before tax $ (40,446)  
Total revenues   $ 1,266,591
Net loss before tax   $ (389,795)
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Asset Acquisitions Textual (Details) - USD ($)
$ in Thousands, shares in Millions
1 Months Ended
Jun. 23, 2021
Jan. 11, 2021
Jan. 31, 2021
May 03, 2021
PFS Genomics        
Acquisition        
Percent of equity acquired 10.00%     90.00%
Business combination, consideration transferred $ 33,569      
Equity interest in acquiree after subsequent acquisition 100.00%      
TARDIS Technology        
Acquisition        
Asset acquisition, consideration transferred   $ 52,300    
Payments to acquire productive assets   $ 25,000    
Payments to acquire productive assets (in shares)   0.2    
Stock issued to acquire productive assets, value   $ 27,300    
Sales Milestone Range One | TARDIS Technology        
Acquisition        
Payments contingent on milestones   10,000    
Net sales of a licensed product     $ 100,000  
Sales Milestone Range Two | TARDIS Technology        
Acquisition        
Payments contingent on milestones   $ 35,000    
Net sales of a licensed product     $ 250,000  
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Assets Acquired and Liabilities Assumed, PFS Genomics (Details) - PFS Genomics
$ in Thousands
Jun. 23, 2021
USD ($)
Acquisition  
Cash paid for acquisition of PFS Genomics outstanding shares $ 33,569
Cash 496
Intangible assets 33,074
Other assets and liabilities (1)
Net assets acquired $ 33,569
v3.22.0.1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Assets Acquired and Liabilities Assumed Base Genomics (Details) - USD ($)
$ in Thousands
12 Months Ended
Oct. 26, 2020
Dec. 31, 2020
Business Combination and Asset Acquisition [Abstract]    
Cash paid for acquisition of Base Genomics outstanding shares $ 416,525  
Transaction costs 4,600 $ 4,600
Total consideration 421,125  
Cash 9,704  
IPR&D asset 412,568  
Other assets and liabilities (1,147)  
Net assets acquired $ 421,125  
v3.22.0.1
SEGMENT INFORMATION (Details) - USD ($)
$ in Thousands
3 Months Ended 12 Months Ended
Dec. 31, 2021
Sep. 30, 2021
Jun. 30, 2021
Mar. 31, 2021
Dec. 31, 2020
Sep. 30, 2020
Jun. 30, 2020
Mar. 31, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Segment Reporting Information [Line Items]                      
Revenue $ 473,812 $ 456,379 $ 434,819 $ 402,077 $ 466,339 $ 408,363 $ 268,868 $ 347,821 $ 1,767,087 $ 1,491,391 $ 876,293
United States                      
Segment Reporting Information [Line Items]                      
Revenue                 1,657,174 1,413,907 864,849
Outside of United States                      
Segment Reporting Information [Line Items]                      
Revenue                 $ 109,913 $ 77,484 $ 11,444
v3.22.0.1
INCOME TAXES - Narrative (Details) - USD ($)
3 Months Ended 12 Months Ended
Dec. 31, 2021
Sep. 30, 2021
Jun. 30, 2021
Mar. 31, 2021
Dec. 31, 2020
Sep. 30, 2020
Jun. 30, 2020
Mar. 31, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Operating Loss Carryforwards [Line Items]                      
Income tax benefit $ 4,243,000 $ 3,858,000 $ (4,025,000) $ 242,805,000 $ 164,000 $ 2,752,000 $ 305,000 $ 2,237,000 $ 246,881,000 $ 5,458,000 $ 193,354,000
Deferred tax asset valuation allowance 262,238,000       293,397,000       262,238,000 293,397,000  
Deferred tax liability 28,782,000       9,306,000       28,782,000 9,306,000  
Increase (decrease) in valuation allowance                 $ (31,200,000) $ 98,000,000  
Effective tax rate                 29.30% 0.60% 47.50%
Unrecognized tax benefit that would impact effective tax rate 21,800,000       16,600,000       $ 21,800,000 $ 16,600,000 $ 10,300,000
Accrued interest or penalties 0       $ 0       0 0 0
Recognized interest or penalties                 0 0 0
Genomic Health Inc                      
Operating Loss Carryforwards [Line Items]                      
Income tax benefit                   (193,600,000)  
Deferred tax asset                      
Operating Loss Carryforwards [Line Items]                      
Valuation allowances established                 206,574,000 94,589,000 113,522,000
Acquisition and purchase accounting                 239,233,000 (5,558,000) 183,730,000
Deferred tax asset | Thrive                      
Operating Loss Carryforwards [Line Items]                      
Acquisition and purchase accounting                 239,200,000    
Deferred tax asset | Genomic Health Inc                      
Operating Loss Carryforwards [Line Items]                      
Acquisition and purchase accounting                   $ (5,600,000) $ 183,700,000
Federal                      
Operating Loss Carryforwards [Line Items]                      
Operating loss carryforwards 2,150,000,000               2,150,000,000    
Operating loss carryforwards with no expiration date 1,320,000,000               1,320,000,000    
Operating loss carryforwards with expiration date 835,600,000               835,600,000    
Federal | Research                      
Operating Loss Carryforwards [Line Items]                      
Tax credit carryforwards 63,000,000               63,000,000    
State                      
Operating Loss Carryforwards [Line Items]                      
Operating loss carryforwards 1,040,000,000.00               1,040,000,000.00    
State | Research                      
Operating Loss Carryforwards [Line Items]                      
Tax credit carryforwards 39,800,000               39,800,000    
State | Research | California                      
Operating Loss Carryforwards [Line Items]                      
Tax credit carryforwards 23,500,000               23,500,000    
Foreign                      
Operating Loss Carryforwards [Line Items]                      
Operating loss carryforwards $ 15,900,000               $ 15,900,000    
v3.22.0.1
INCOME TAXES - Income (Loss) Before Income Taxes, Domestic and Foreign (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Income Tax Disclosure [Abstract]      
Domestic $ (801,536) $ (423,025) $ (405,425)
Foreign (40,970) (406,038) (1,019)
Net loss before tax $ (842,506) $ (829,063) $ (406,444)
v3.22.0.1
INCOME TAXES - Additional Information (Details) - USD ($)
$ in Thousands
3 Months Ended 12 Months Ended
Dec. 31, 2021
Sep. 30, 2021
Jun. 30, 2021
Mar. 31, 2021
Dec. 31, 2020
Sep. 30, 2020
Jun. 30, 2020
Mar. 31, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Expense (benefit) for income taxes                      
Total income tax expense (benefit) $ (4,243) $ (3,858) $ 4,025 $ (242,805) $ (164) $ (2,752) $ (305) $ (2,237) $ (246,881) $ (5,458) $ (193,354)
Deferred tax assets:                      
Operating loss carryforwards 516,344       369,642       516,344 369,642  
Tax credit carryforwards 72,959       64,760       72,959 64,760  
Compensation related differences 74,127       48,349       74,127 48,349  
Lease liabilities 48,201       31,938       48,201 31,938  
Capitalized research and development 23,035       0       23,035 0  
Other temporary differences 20,087       6,136       20,087 6,136  
Tax assets before valuation allowance 754,753       520,825       754,753 520,825  
Less - Valuation allowance (262,238)       (293,397)       (262,238) (293,397)  
Total deferred tax assets 492,515       227,428       492,515 227,428  
Deferred tax liabilities                      
Amortization (464,748)       (197,847)       (464,748) (197,847)  
Property, plant and equipment (4,756)       (4,580)       (4,756) (4,580)  
Lease assets (45,781)       (30,312)       (45,781) (30,312)  
Other temporary differences (6,012)       (3,995)       (6,012) (3,995)  
Total deferred tax liabilities (521,297)       (236,734)       (521,297) (236,734)  
Net deferred tax liabilities (28,782)       (9,306)       $ (28,782) $ (9,306)  
Differences between the effective income tax rate and the statutory tax rate                      
U.S. Federal statutory rate                 21.00% 21.00% 21.00%
State taxes                 3.60% 1.70% 3.40%
Federal and state tax rate changes                 (0.30%) 0.00% 0.10%
Foreign tax rate differential                 (0.60%) (1.00%) 0.40%
Acquired IPR&D asset expense                 (0.80%) (9.40%) 0.00%
Research and development tax credits                 0.70% 1.60% 0.70%
Stock-based compensation expense                 1.10% 1.10% 14.60%
Non-deductible executive compensation                 (0.20%) (0.80%) (2.70%)
Transaction costs                 (0.10%) (0.10%) (0.50%)
Loss on extinguishment - convertible notes                 0.00% 0.00% (9.20%)
Other adjustments                 1.20% (2.20%) (0.50%)
Valuation allowance                 3.70% (11.30%) 20.20%
Effective tax rate                 29.30% 0.60% 47.50%
Reconciliation of the amounts of unrecognized tax benefits                      
Beginning of the period       $ 16,629       $ 10,276 $ 16,629 $ 10,276 $ 1,926
Increase due to current year tax positions                 5,363 3,600 2,142
Increase due to prior year tax positions                 0 2,753 6,208
Decrease due to prior year tax positions                 (212) 0 0
Settlements                 0 0 0
Ending of the period $ 21,780       $ 16,629       21,780 16,629 10,276
Federal                      
Expense (benefit) for income taxes                      
Current expense (benefit):                 0 (3) 0
Deferred tax expense (benefit):                 (222,693) (3,050) (173,521)
State                      
Expense (benefit) for income taxes                      
Current expense (benefit):                 1,388 802 314
Deferred tax expense (benefit):                 (30,528) (4,260) (20,099)
Foreign                      
Expense (benefit) for income taxes                      
Current expense (benefit):                 4,898 933 (63)
Deferred tax expense (benefit):                 $ 54 $ 120 $ 15
v3.22.0.1
INCOME TAXES - Deferred Tax Asset, Valuation Allowance RollForward (Details) - Deferred tax asset - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
SEC Schedule, 12-09, Valuation and Qualifying Accounts Disclosure [Line Items]      
Beginning balance $ (293,397) $ (195,401) $ (265,587)
Valuation allowances established (206,574) (94,589) (113,522)
Changes to existing valuation allowances (1,500) 2,151 (22)
Acquisition and purchase accounting 239,233 (5,558) 183,730
Ending balance $ (262,238) $ (293,397) $ (195,401)
v3.22.0.1
QUARTERLY RESULTS OF OPERATIONS (UNAUDITED) (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Thousands
3 Months Ended 12 Months Ended
Dec. 31, 2021
Sep. 30, 2021
Jun. 30, 2021
Mar. 31, 2021
Dec. 31, 2020
Sep. 30, 2020
Jun. 30, 2020
Mar. 31, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Quarterly Financial Information Disclosure [Abstract]                      
Revenue $ 473,812 $ 456,379 $ 434,819 $ 402,077 $ 466,339 $ 408,363 $ 268,868 $ 347,821 $ 1,767,087 $ 1,491,391 $ 876,293
Cost of sales (exclusive of amortization of acquired intangible assets) 119,058 115,738 113,968 109,993 99,765 95,061 77,892 81,606 458,757 354,324 216,717
Amortization of acquired intangible assets 21,216 21,214 21,188 20,555 20,553 20,555 20,555 20,464      
Gross profit 333,538 319,427 299,663 271,529 346,021 292,747 170,421 245,751      
Operating expenses 554,988 481,450 471,327 572,070 761,000 496,082 237,430 328,124      
Interest income and interest expense (3,404) (8,773) (1,223) 26,572 (3,517) (1,955) (1,388) (54,507) 13,172 (61,367) (172,662)
Income tax benefit 4,243 3,858 (4,025) 242,805 164 2,752 305 2,237 246,881 5,458 193,354
Net loss $ (220,611) $ (166,938) $ (176,912) $ (31,164) $ (418,332) $ (202,538) $ (68,092) $ (134,643) $ (595,625) $ (823,605) $ (213,090)
Net loss per share - basic (in dollars per share) $ (1.28) $ (0.97) $ (1.03) $ (0.18) $ (2.67) $ (1.35) $ (0.45) $ (0.91) $ (3.48) $ (5.45) $ (1.62)
Net loss per share - diluted (in dollars per share) $ (1.28) $ (0.97) $ (1.03) $ (0.18) $ (2.67) $ (1.35) $ (0.45) $ (0.91) $ (3.48) $ (5.45) $ (1.62)
Weighted average common shares outstanding - basic (in shares) 172,446 171,978 171,494 169,434 156,470 150,155 149,727 148,151 171,348 151,137 131,257
Weighted average common shares outstanding - diluted (in shares) 172,446 171,978 171,494 169,434 156,470 150,155 149,727 148,151 171,348 151,137 131,257