Table of Contents

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended September 30, 20202021
OR
☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
Commission File Number: 001-35092
EXACT SCIENCES CORPORATION
(Exact name of registrant as specified in its charter)
Delaware02-0478229
(State or other jurisdiction of
incorporation or organization)
(I.R.S. Employer
Identification Number)

5505 Endeavor Lane, Madison WI53719
(Address of principal executive offices)(Zip Code)
(608) 535-8815 (Registrant’s telephone number, including area code)
Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading Symbol(s)Name of each exchange on which registered
Common Stock, $0.01 par value per shareEXASThe Nasdaq Stock Market LLC
Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes  No 
Indicate by check mark whether the registrant has submitted electronically, if any, every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes No
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large accelerated filerAccelerated filer 
Non-accelerated filerSmaller reporting company 
Emerging growth company
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes  No 
As of October 26, 2020,November 1, 2021, the registrant had 150,424,035172,318,821 shares of common stock outstanding.



EXACT SCIENCES CORPORATION
INDEX
Page
Number

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Table of Contents
EXACT SCIENCES CORPORATION
Condensed Consolidated Balance Sheets
(Amounts in thousands, except share data - unaudited)
Part I — Financial Information​Information

September 30,
2020
December 31,
2019
September 30, 2021December 31, 2020
ASSETSASSETSASSETS
Current Assets:Current Assets:Current Assets:
Cash and cash equivalentsCash and cash equivalents$806,678 $177,254 Cash and cash equivalents$273,779 $1,491,288 
Marketable securitiesMarketable securities476,324 146,401 Marketable securities944,688 348,699 
Accounts receivable, netAccounts receivable, net206,606 130,667 Accounts receivable, net249,572 233,185 
InventoryInventory80,427 61,724 Inventory95,167 92,265 
Prepaid expenses and other current assetsPrepaid expenses and other current assets36,592 40,913 Prepaid expenses and other current assets52,385 33,157 
Total current assetsTotal current assets1,606,627 556,959 Total current assets1,615,591 2,198,594 
Long-term Assets:Long-term Assets:Long-term Assets:
Property, plant and equipment, netProperty, plant and equipment, net456,455 455,325 Property, plant and equipment, net524,200 451,986 
Operating lease right-of-use assetsOperating lease right-of-use assets129,837 126,444 Operating lease right-of-use assets167,911 125,947 
GoodwillGoodwill1,237,672 1,203,197 Goodwill2,242,535 1,237,672 
Intangible assets, netIntangible assets, net871,660 1,143,550 Intangible assets, net2,044,958 847,123 
Other long-term assets, netOther long-term assets, net52,119 20,293 Other long-term assets, net59,241 63,770 
Total assetsTotal assets$4,354,370 $3,505,768 Total assets$6,654,436 $4,925,092 
LIABILITIES AND STOCKHOLDERS’ EQUITYLIABILITIES AND STOCKHOLDERS’ EQUITYLIABILITIES AND STOCKHOLDERS’ EQUITY
Current Liabilities:Current Liabilities:Current Liabilities:
Accounts payableAccounts payable$26,061 $25,973 Accounts payable$41,717 $35,709 
Accrued liabilitiesAccrued liabilities182,945 193,329 Accrued liabilities304,714 233,604 
Operating lease liabilities, current portionOperating lease liabilities, current portion10,746 7,891 Operating lease liabilities, current portion19,220 11,483 
Debt, current portionDebt, current portion1,319 834 Debt, current portion1,319 1,319 
Convertible notes, net, current portionConvertible notes, net, current portion313,104 312,716 
Other current liabilitiesOther current liabilities31,761 8,467 Other current liabilities30,157 38,265 
Total current liabilitiesTotal current liabilities252,832 236,494 Total current liabilities710,231 633,096 
Long-term Liabilities:Long-term Liabilities:Long-term Liabilities:
Convertible notes, net1,554,967 803,605 
Convertible notes, net, less current portionConvertible notes, net, less current portion1,865,647 1,861,685 
Long-term debt, less current portionLong-term debt, less current portion22,643 24,032 Long-term debt, less current portion21,438 22,342 
Other long-term liabilitiesOther long-term liabilities62,821 34,911 Other long-term liabilities436,580 51,342 
Operating lease liabilities, less current portionOperating lease liabilities, less current portion124,007 118,665 Operating lease liabilities, less current portion162,950 121,075 
Total liabilitiesTotal liabilities2,017,270 1,217,707 Total liabilities3,196,846 2,689,540 
Commitments and contingencies
Commitments and contingencies (Note 14)Commitments and contingencies (Note 14)00
Stockholders’ Equity:Stockholders’ Equity:Stockholders’ Equity:
Preferred stock, $0.01 par value Authorized—5,000,000 shares issued and outstanding—0 shares at September 30, 2020 and December 31, 2019
Common stock, $0.01 par value Authorized—400,000,000 shares issued and outstanding—150,373,486 and 147,625,696 shares at September 30, 2020 and December 31, 20191,505 1,477 
Preferred stock, $0.01 par value Authorized—5,000,000 shares issued and outstanding—no shares at September 30, 2021 and December 31, 2020Preferred stock, $0.01 par value Authorized—5,000,000 shares issued and outstanding—no shares at September 30, 2021 and December 31, 2020— — 
Common stock, $0.01 par value Authorized—400,000,000 shares issued and outstanding—172,242,798 and 159,423,410 shares at September 30, 2021 and December 31, 2020Common stock, $0.01 par value Authorized—400,000,000 shares issued and outstanding—172,242,798 and 159,423,410 shares at September 30, 2021 and December 31, 20201,723 1,595 
Additional paid-in capitalAdditional paid-in capital3,865,990 3,406,440 Additional paid-in capital5,876,644 4,279,327 
Accumulated other comprehensive income (loss)1,084 (100)
Accumulated other comprehensive incomeAccumulated other comprehensive income133 526 
Accumulated deficitAccumulated deficit(1,531,479)(1,119,756)Accumulated deficit(2,420,910)(2,045,896)
Total stockholders’ equityTotal stockholders’ equity2,337,100 2,288,061 Total stockholders’ equity3,457,590 2,235,552 
Total liabilities and stockholders’ equityTotal liabilities and stockholders’ equity$4,354,370 $3,505,768 Total liabilities and stockholders’ equity$6,654,436 $4,925,092 
The accompanying notes are an integral part of these condensed consolidated financial statements.
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EXACT SCIENCES CORPORATION
Condensed Consolidated Statements of Operations
(Amounts in thousands, except per share data - unaudited)

Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Three Months Ended September 30,Nine Months Ended September 30,
2021202020212020
RevenueRevenue$408,363 $218,805 $1,025,052 $580,718 Revenue$456,379 $408,363 $1,293,275 $1,025,052 
Operating expensesOperating expensesOperating expenses
Cost of sales (exclusive of amortization of acquired intangible assets)Cost of sales (exclusive of amortization of acquired intangible assets)95,061 52,335 254,559 146,301 Cost of sales (exclusive of amortization of acquired intangible assets)115,738 95,061 339,699 254,559 
Research and developmentResearch and development31,471 34,714 107,653 96,471 Research and development75,356 31,471 297,158 107,653 
Sales and marketingSales and marketing136,481 86,196 423,092 265,325 Sales and marketing196,617 136,481 577,585 423,092 
General and administrativeGeneral and administrative115,589 80,538 336,265 208,067 General and administrative186,541 115,589 621,897 336,265 
Amortization of acquired intangible assetsAmortization of acquired intangible assets23,430 748 70,199 2,256 Amortization of acquired intangible assets23,940 23,430 70,954 70,199 
Intangible asset impairment chargeIntangible asset impairment charge209,666 209,666 Intangible asset impairment charge20,210 209,666 20,210 209,666 
Total operating expensesTotal operating expenses611,698 254,531 1,401,434 718,420 Total operating expenses618,402 611,698 1,927,503 1,401,434 
Other operating incomeOther operating income23,665 Other operating income— — — 23,665 
Loss from operationsLoss from operations(203,335)(35,726)(352,717)(137,702)Loss from operations(162,023)(203,335)(634,228)(352,717)
Other income (expense)Other income (expense)Other income (expense)
Investment income, net2,523 9,093 5,532 23,417 
Investment income (expense), netInvestment income (expense), net(4,093)2,523 30,524 5,532 
Interest expenseInterest expense(23,582)(13,209)(71,647)(47,911)Interest expense(4,680)(4,478)(13,948)(63,382)
Total other income (expense)Total other income (expense)(21,059)(4,116)(66,115)(24,494)Total other income (expense)(8,773)(1,955)16,576 (57,850)
Net loss before taxNet loss before tax(224,394)(39,842)(418,832)(162,196)Net loss before tax(170,796)(205,290)(617,652)(410,567)
Income tax benefit (expense)4,510 (683)7,109 230 
Income tax benefitIncome tax benefit3,858 2,752 242,638 5,294 
Net lossNet loss$(219,884)$(40,525)$(411,723)$(161,966)Net loss$(166,938)$(202,538)$(375,014)$(405,273)
Net loss per share—basic and dilutedNet loss per share—basic and diluted$(1.46)$(0.31)$(2.76)$(1.26)Net loss per share—basic and diluted$(0.97)$(1.35)$(2.19)$(2.71)
Weighted average common shares outstanding—basic and dilutedWeighted average common shares outstanding—basic and diluted150,155 129,567 149,346 128,344 Weighted average common shares outstanding—basic and diluted171,978 150,155 170,978149,346
The accompanying notes are an integral part of these condensed consolidated financial statements.
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EXACT SCIENCES CORPORATION
Condensed Consolidated Statements of Comprehensive Loss
(Amounts in thousands - unaudited)

Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Three Months Ended September 30,Nine Months Ended September 30,
2021202020212020
Net lossNet loss$(219,884)$(40,525)$(411,723)$(161,966)Net loss$(166,938)$(202,538)$(375,014)$(405,273)
Other comprehensive loss, before tax:
Unrealized gain on available-for-sale investments(405)(2,697)1,159 1,431 
Other comprehensive income (loss), before tax:Other comprehensive income (loss), before tax:
Unrealized gain (loss) on available-for-sale investmentsUnrealized gain (loss) on available-for-sale investments66 (405)(563)1,159 
Foreign currency adjustmentForeign currency adjustment25 Foreign currency adjustment— — — 25 
Comprehensive loss, before taxComprehensive loss, before tax(220,289)(43,222)(410,539)(160,535)Comprehensive loss, before tax(166,872)(202,943)(375,577)(404,089)
Income tax expense related to items of other comprehensive lossIncome tax expense related to items of other comprehensive loss643 (341)Income tax expense related to items of other comprehensive loss— — 170 — 
Comprehensive loss, net of taxComprehensive loss, net of tax$(220,289)$(42,579)$(410,539)$(160,876)Comprehensive loss, net of tax$(166,872)$(202,943)$(375,407)$(404,089)
The accompanying notes are an integral part of these condensed consolidated financial statements.
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EXACT SCIENCES CORPORATION
Condensed Consolidated Statements of Stockholders’ Equity
(Amounts in thousands, except share data - unaudited)

Common StockAdditional
Paid-In
Capital
Other
Comprehensive
Income (Loss)
Accumulated
Deficit​
Total
Stockholders’
Equity
Number of
Shares
$0.01
Par Value
Balance, January 1, 2020147,625,696 $1,477 $3,406,440 $(100)$(1,119,756)$2,288,061 
Equity component of convertible notes, net of tax and issuance costs— — 346,641 — — 346,641 
Settlement of convertible notes, net of tax— — (64,199)— — (64,199)
Common StockAdditional
Paid-In
Capital
Accumulated Other
Comprehensive
Income (Loss)
Accumulated
Deficit
Total
Stockholders’
Equity
Number of
Shares
$0.01
Par Value
Balance, January 1, 2021Balance, January 1, 2021159,423,410 $1,595 $4,279,327 $526 $(2,045,896)$2,235,552 
Conversion of convertible notes, net of taxConversion of convertible notes, net of tax344 — 26 — — 26 
Exercise of common stock optionsExercise of common stock options160,286 4,298 — — 4,300 Exercise of common stock options967,107 10 8,749 — — 8,759 
Issuance of common stock to fund the Company’s 2019 401(k) match136,559 12,006 — — 12,007 
Issuance of common stock to fund the Company’s 2020 401(k) matchIssuance of common stock to fund the Company’s 2020 401(k) match162,606 22,932 — — 22,934 
Compensation expense related to issuance of stock options and restricted stock awardsCompensation expense related to issuance of stock options and restricted stock awards1,141,376 11 29,549 — — 29,560 Compensation expense related to issuance of stock options and restricted stock awards1,355,435 13 158,239 — — 158,252 
Issuance of common stock for business combinations382,947 28,593 — — 28,597 
Issuance of common stock for business combination and asset acquisitionIssuance of common stock for business combination and asset acquisition9,384,410 94 1,254,704 — — 1,254,798 
Net lossNet loss— — — — (105,697)(105,697)Net loss— — — — (31,164)(31,164)
Accumulated other comprehensive loss— — — (1,617)— (1,617)
Balance, March 31, 2020149,446,864 $1,495 $3,763,328 $(1,717)$(1,225,453)$2,537,653 
Exercise of common stock options208,434 6,636 — — 6,638 
Compensation expense related to issuance of stock options and restricted stock awards157,579 40,037 — — 40,039 
Purchase of employee stock purchase plan shares167,921 9,797 — — 9,799 
Net loss— — — — (86,142)(86,142)
Accumulated other comprehensive income— — — 3,206 — 3,206 
Balance, June 30, 2020149,980,798 $1,501 $3,819,798 $1,489 $(1,311,595)$2,511,193 
Other comprehensive lossOther comprehensive loss— — — (162)— (162)
Balance, March 31, 2021Balance, March 31, 2021171,293,312 $1,714 $5,723,977 $364 $(2,077,060)$3,648,995 
Conversion of convertible notes, net of taxConversion of convertible notes, net of tax197 — 14 — — 14 
Exercise of common stock optionsExercise of common stock options140,145 4,469 — — 4,470 Exercise of common stock options140,478 2,857 — — 2,858 
Compensation expense related to issuance of stock options and restricted stock awardsCompensation expense related to issuance of stock options and restricted stock awards249,197 41,474 — — 41,476 Compensation expense related to issuance of stock options and restricted stock awards121,575 56,283 — — 56,285 
Issuance of common stock for business combinationsIssuance of common stock for business combinations3,346 249 — — 250 Issuance of common stock for business combinations126,026 16,119 — — 16,120 
Purchase of employee stock purchase plan sharesPurchase of employee stock purchase plan shares173,717 12,036 — — 12,038 
Net lossNet loss— — — — (219,884)(219,884)Net loss— — — — (176,912)(176,912)
Accumulated other comprehensive loss— — — (405)— (405)
Balance, September 30, 2020150,373,486 $1,505 $3,865,990 $1,084 $(1,531,479)$2,337,100 
Other comprehensive lossOther comprehensive loss— — — (297)— (297)
Balance, June 30, 2021Balance, June 30, 2021171,855,305 $1,720 $5,811,286 $67 $(2,253,972)$3,559,101 
Conversion of convertible notes, net of taxConversion of convertible notes, net of tax39 — — — 
Exercise of common stock optionsExercise of common stock options100,474 1,754 — — 1,755 
Compensation expense related to issuance of stock options and restricted stock awardsCompensation expense related to issuance of stock options and restricted stock awards286,980 63,601 — — 63,603 
Net lossNet loss— — — — (166,938)(166,938)
Other comprehensive incomeOther comprehensive income— — — 66 — 66 
Balance, September 30, 2021Balance, September 30, 2021172,242,798 $1,723 $5,876,644 $133 $(2,420,910)$3,457,590 
The accompanying notes are an integral part of these condensed consolidated financial statements.

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EXACT SCIENCES CORPORATION
Condensed Consolidated Statements of Stockholders’ Equity
(Amounts in thousands, except share data - unaudited)
Common StockAdditional Paid-In CapitalOther
Comprehensive
Income (Loss)
Accumulated
Deficit​
Total
Stockholders’
Equity
Number of
Shares
$0.01
Par Value
Balance, January 1, 2019123,192,540 $1,232 $1,716,894 $(1,422)$(1,035,763)$680,941 
Equity component of convertible notes, net of tax and issuance costs— — 268,390 — — 268,390 
Shares issued to settle convertible notes2,158,991 22 182,413 — — 182,435 
Settlement of convertible notes— — (300,768)— — (300,768)
Exercise of common stock options235,278 3,648 — — 3,650 
Issuance of common stock to fund the Company’s 2018 401(k) match86,532 7,408 — — 7,409 
Compensation expense related to issuance of stock options and restricted stock awards3,410,481 35 16,131 — — 16,166 
Net loss— — — — (82,939)(82,939)
Accumulated other comprehensive income— — — 1,656 — 1,656 
Balance, March 31, 2019129,083,822 $1,292 $1,894,116 $234 $(1,118,702)$776,940 
Equity component of convertible notes, net of issuance costs— — (22)— — (22)
Exercise of common stock options78,793 1,347 — — 1,348 
Compensation expense related to issuance of stock options and restricted stock awards104,845 20,142 — — 20,143 
Purchase of employee stock purchase plan shares93,588 4,136 — — 4,137 
Net loss— — — — (38,502)(38,502)
Accumulated other comprehensive income— — — 1,488 — 1,488 
Balance, June 30, 2019129,361,048 $1,295 $1,919,719 $1,722 $(1,157,204)$765,532 
Settlement of convertible notes26 — — — 
Exercise of common stock options178,628 1,389 — — 1,391 
Compensation expense related to issuance of stock options and restricted stock awards278,180 24,346 — — 24,348 
Purchase of employee stock purchase plan shares— — — — 
Stock issuance costs— — (409)— — (409)
Net loss— — — — (40,525)(40,525)
Accumulated other comprehensive loss— — — (2,054)— (2,054)
Balance, September 30, 2019129,817,885 $1,299 $1,945,046 $(332)$(1,197,729)$748,284 
Common StockAdditional Paid-In CapitalAccumulated Other
Comprehensive
Income (Loss)
Accumulated
Deficit
Total
Stockholders’
Equity
Number of
Shares
$0.01
Par Value
Balance, January 1, 2020147,625,696 $1,477 $3,178,552 $(100)$(1,222,290)$1,957,639 
Exercise of common stock options160,286 4,298 — — 4,300 
Issuance of common stock to fund the Company’s 2019 401(k) match136,559 12,006 — — 12,007 
Compensation expense related to issuance of stock options and restricted stock awards1,141,376 11 29,549 — — 29,560 
Issuance of common stock for business combinations382,947 28,593 — — 28,597 
Net loss— — — — (134,643)(134,643)
Other comprehensive loss— — — (1,617)— (1,617)
Balance, March 31, 2020149,446,864 $1,495 $3,252,998 $(1,717)$(1,356,933)$1,895,843 
Exercise of common stock options208,434 6,636 — — 6,638 
Compensation expense related to issuance of stock options and restricted stock awards157,579 40,037 — — 40,039 
Purchase of employee stock purchase plan shares167,921 9,797 — — 9,799 
Net loss— — — — (68,092)(68,092)
Other comprehensive income— — — 3,206 — 3,206 
Balance, June 30, 2020149,980,798 $1,501 $3,309,468 $1,489 $(1,425,025)$1,887,433 
Exercise of common stock options140,145 4,469 — — 4,470 
Compensation expense related to issuance of stock options and restricted stock awards249,197 41,474 — — 41,476 
Issuance of common stock for business combinations3,346 249 — — 250 
Net loss— — — — (202,538)(202,538)
Other comprehensive loss— — — (405)— (405)
Balance, September 30, 2020150,373,486 $1,505 $3,355,660 $1,084 $(1,627,563)$1,730,686 
The accompanying notes are an integral part of these condensed consolidated financial statements.
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EXACT SCIENCES CORPORATION
Condensed Consolidated Statements of Cash Flows
(Amounts in thousands - unaudited)

Nine Months Ended September 30,
20202019
Cash flows from operating activities:
Net loss$(411,723)$(161,966)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization53,345 21,920 
Loss on disposal of property, plant and equipment930 880 
Unrealized gain on equity investments(1,183)
Deferred tax benefit(7,976)(341)
Stock-based compensation111,075 60,657 
Loss on settlement of convertible notes7,954 10,558 
Amortization of convertible note debt discount and issuance costs55,222 30,778 
Amortization of deferred financing costs and other liabilities(3,614)(2,421)
Amortization of premium on short-term investments1,040 (6,229)
Amortization of acquired intangible assets70,199 2,256 
Intangible asset impairment charge209,666 
Non-cash lease expense11,041 2,681 
Changes in assets and liabilities:
Accounts receivable, net(73,642)(36,871)
Inventory, net(18,472)(14,525)
Operating lease liabilities(6,135)(2,628)
Accounts payable and accrued liabilities(7,608)16,279 
Other assets and liabilities34,959 (7,382)
Net cash provided by (used in) operating activities25,078 (86,354)
Cash flows from investing activities:
Purchases of marketable securities(890,012)(604,129)
Maturities and sales of marketable securities559,907 1,449,330 
Purchases of property, plant and equipment(47,782)(130,970)
Business combination, net of cash acquired(6,658)
Investments in privately held companies(10,610)
Other investing activities(244)(530)
Net cash provided by (used in) investing activities(395,399)713,701 
Cash flows from financing activities:
Proceeds from issuance of convertible notes, net1,125,547 729,477 
Proceeds from exercise of common stock options15,408 6,389 
Proceeds in connection with the Company’s employee stock purchase plan9,799 4,137 
Payments on settlement of convertible notes(150,054)(493,356)
Other financing activities(938)(90)
Net cash provided by financing activities999,762 246,557 
Net increase in cash, cash equivalents and restricted cash629,441 873,904 
Cash, cash equivalents and restricted cash, beginning of period177,528 160,430 
Cash, cash equivalents and restricted cash, end of period$806,969 $1,034,334 


Nine Months Ended September 30,
20212020
Cash flows from operating activities:
Net loss$(375,014)$(405,273)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization64,267 53,345 
Loss on disposal of property, plant and equipment928 930 
Unrealized (gain) loss on equity investments1,937 (1,183)
Deferred tax benefit(248,716)(6,161)
Stock-based compensation197,180 111,075 
Post-combination expense for acceleration of unvested equity80,960 — 
Realized gain on preferred stock investment(30,500)— 
Loss on settlement of convertible notes— 50,819 
Amortization of deferred financing costs, convertible note debt discount and issuance costs, and other liabilities4,948 340 
Amortization of premium on short-term investments3,265 1,040 
Amortization of acquired intangible assets70,954 70,199 
Intangible asset impairment charge20,210 209,666 
Asset acquisition IPR&D expense85,337 — 
Remeasurement of contingent consideration10,986 — 
Non-cash lease expense18,347 11,041 
Changes in assets and liabilities:
Accounts receivable, net(14,038)(73,642)
Inventory, net(1,091)(18,472)
Operating lease liabilities(11,834)(6,135)
Accounts payable and accrued liabilities64,344 (7,608)
Other assets and liabilities(20,134)35,097 
Net cash provided by (used in) operating activities(77,664)25,078 
Cash flows from investing activities:
Purchases of marketable securities(1,021,557)(890,012)
Maturities and sales of marketable securities424,830 559,907 
Purchases of property, plant and equipment(76,374)(48,371)
Business combination, net of cash acquired(415,549)(6,658)
Asset acquisition(58,073)— 
Investments in privately held companies(13,555)(10,610)
Other investing activities(244)345 
Net cash used in investing activities(1,160,522)(395,399)
Cash flows from financing activities:
Proceeds from issuance of convertible notes, net— 1,125,547 
Proceeds from exercise of common stock options13,372 15,408 
Proceeds in connection with the Company’s employee stock purchase plan12,038 9,799 
Payments on settlement of convertible notes— (150,054)
Other financing activities(4,742)(938)
Net cash provided by financing activities20,668 999,762 
Net increase (decrease) in cash, cash equivalents and restricted cash(1,217,518)629,441 
Cash, cash equivalents and restricted cash, beginning of period1,491,594 177,528 
Cash, cash equivalents and restricted cash, end of period$274,076 $806,969 
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EXACT SCIENCES CORPORATION
Condensed Consolidated Statements of Cash Flows
(Amounts in thousands - unaudited)
Nine Months Ended September 30,
20202019
Supplemental disclosure of non-cash investing and financing activities
Property, plant and equipment acquired but not paid$7,209 $16,933 
Unrealized gain on available-for-sale investments, before tax$1,159 $1,431 
Issuance of 136,559 and 86,535 shares of common stock to fund the Company’s 401(k) matching contribution for 2019 and 2018, respectively$12,007 $7,409 
Issuance of 2,159,017 shares of common stock upon settlement of convertible notes$$182,435 
Retirement of equity component of convertible notes settled$(64,199)$(300,768)
Issuance of 386,293 shares for business combination$28,847 $
Supplemental disclosure of cash flow information:
Interest paid$9,239 $4,944 
Nine Months Ended September 30,
20212020
Supplemental disclosure of non-cash investing and financing activities
Property, plant and equipment acquired but not paid$21,110 $7,209 
Unrealized gain (loss) on available-for-sale investments, before tax$(563)$1,159 
Issuance of 162,606 and 136,559 shares of common stock to fund the Company’s 401(k) matching contribution for 2020 and 2019, respectively$22,934 $12,007 
Issuance of 9,510,436 and 382,947 shares of common stock for business combinations and asset acquisition for 2021 and 2020, respectively$1,270,918 $28,847 
Business combination contingent consideration liability$350,348 $— 
Supplemental disclosure of cash flow information:
Interest paid$10,685 $9,239 
The accompanying notes are an integral part of these condensed consolidated financial statements.
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)

(1) 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 brands in cancer screening and diagnostics, including Cologuard® and Oncotype DX®. Exact is currently working on the development of additional tests, for other types of cancer, with the goal of bringing new, innovative cancer tests to patients throughout the world.
Basis of Presentation and Principles of Consolidation
The accompanying condensed consolidated financial statements, which include the accounts of Exact Sciences Corporation and those of its wholly owned subsidiaries and variable interest entities, are unaudited and have been prepared on a basis substantially consistent with the Company’s audited financial statements and notes as of and for the year ended December 31, 20192020 included in the Company’s Annual Report on Form 10-K (the “2019“2020 Form 10-K”). All intercompany transactions and balances have been eliminated upon consolidation. These condensed consolidated financial statements are prepared in conformity with accounting principles generally accepted in the United States of America (“GAAP”) and follow the requirements of the Securities and Exchange Commission (“SEC”) for interim reporting. In the opinion of management, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting only of adjustments of a normal and recurring nature) considered necessary for a fair statement of its financial position, operating results and cash flows for the periods presented. The condensed consolidated balance sheet at December 31, 20192020 has been derived from audited financial statements, but does not contain all of the footnote disclosures from the 20192020 Form 10-K. The results of the Company’s operations for any interim period are not necessarily indicative of the results of the Company’s operations for any other interim period or for a full fiscal year. The statements should be read in conjunction with the audited financial statements and related notes included in the 20192020 Form 10-K.
Use of Estimates
The preparation of the condensed consolidated financial statements in conformity with 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 convertible notes, valuation of intangible assets and goodwill, and accounting for income taxes among others. The Company’s critical accounting policies and estimates are explained further in the notes to the condensed consolidated financial statements in this Quarterly Report and the 20192020 Form 10-K.

The spread of the coronavirus (“COVID-19”) has affected many segments of the global economy, including the cancer screening and diagnostics industry. The COVID-19 outbreak, which the World Health Organization has classified as a pandemic, has prompted governments and regulatory bodies throughout the world to enact broad precautionary measures, including “stay-at-home” orders, restrictions on the performance of “non-essential” services, public gatherings and travel. Health systems, including key markets where the Company operates, have been, or may be, overwhelmed with high volumes of patients suffering from COVID-19. Even in areas where “stay-at-home” restrictions have been lifted and the number of cases of COVID-19 has declined, many individuals remain cautious about resuming activities such as preventive-care medical visits. Medical practices continue to be cautious about allowing individuals, such as sales representatives, into their offices. Many individuals continue to work from home rather from an office setting. The Company cannot forecast when the COVID-19 pandemic will end or the extent to which practices that have emerged during the pandemic will continue once it subsides.

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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
The extent to which COVID-19 impacts the Company’s business and financial results will depend on numerous evolving factors including, but not limited to: the magnitude and duration of COVID-19, the extent to which it will impact worldwide macroeconomic conditions including interest rates, employment rates and health insurance coverage, the speed of the anticipated recovery, access to capital markets, and governmental and business reactions to the pandemic. 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 September 30, 20202021 and through the date of the filing of this Quarterly Report on Form 10-Q. The accounting matters assessed included, but were not limited to, the Company’s allowance for doubtful accounts and credit losses, equity 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 impacted the Company's revenues and operating results for the three and nine months ended September 30, 2021.
Despite the Company’s efforts, theThe 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.
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Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”)EXACT SCIENCES CORPORATION
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 CARES Act. The fund payments are grants, not loans, and HHS will not require repayment provided the funds are utilizedNotes 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 duringCondensed Consolidated Financial Statements
(Unaudited)
Significant Accounting Policies
During the nine months ended September 30, 2021, there were no changes to the Company’s significant accounting policies as described in the Company’s Annual Report on Form 10-K for the year ended December 31, 2020, dueexcept as described in the Recently Adopted Accounting Pronouncements section below.
Reclassifications
Certain prior year amounts have been reclassified to lost revenue attributableconform to COVID-19, which is reflected in other operating incomethe current year presentation in the condensed consolidated statementfinancial statements and accompanying notes to the condensed consolidated financial statements.
Recent Accounting Pronouncements
Recently Adopted Accounting Pronouncements
In August 2020, The Financial Accounting Standards Board 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 operations. 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 cannot predictadopted the extent to which it might receive any additional funds to be paid out under the Provider Relief Fund, and to what extent the financial impact of receiving such funds might offset the broad implicationsstandard on January 1, 2021 through application of the COVID-19 pandemic, which include increasesfull retrospective method of transition. This method of adoption was applied to enhance comparability between the periods presented in the Company’s costs and lost revenues.

Cash and Cash Equivalentsfinancial 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 9.
The Company considersCompany’s convertible debt instruments will be 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 hand, demand deposits in bank, money market funds,the original offering, and all highly liquid investments with an original maturity(3) amortization of 90 daysany debt issuance costs. Gain or less to be cashloss on extinguishment of convertible notes is calculated as the difference between the (i) fair value of the consideration transferred and cash equivalents.
Marketable Securities
Management determines(ii) the appropriate classificationsum of the carrying value of the 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 condensed 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 straight-line 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 condensed 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 condensed consolidated statements of operations as investment income, net.

repurchase.
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
The Company’s investment policy limits investmentsAs of January 1, 2019, the cumulative effect of adoption resulted in a decrease in additional-paid-in-capital of $260.2 million, a decrease in accumulated deficit of $26.6 million, and an increase to certain typesnet deferred tax assets of instruments issued$55.7 million offset by institutions with investment grade credit ratingsa corresponding increase of $55.7 million in the valuation allowance. As of January 1, 2020, the cumulative effect of adoption resulted in a decrease in additional-paid-in-capital of $227.8 million, an increase in accumulated deficit of $102.6 million, and places restrictions on maturitiesan increase to the net deferred tax assets of $83.2 million offset by a corresponding increase of $74.7 million in the valuation allowance resulting in a net decrease of $8.5 million in recorded deferred tax liabilities. As of December 31, 2020, the cumulative effect of adoption resulted in an increase in the net carrying amount of convertible notes, net, current portion of $57.3 million and concentrationconvertible notes, net, less current portion of $540.9 million, a decrease in additional-paid-in-capital of $510.3 million, an increase in accumulated deficit of $77.7 million, and an increase to net deferred tax assets of $146.0 million offset by type and issuer. Investmentsa corresponding increase of $135.8 million in which the Company hasvaluation allowance resulting in a net decrease of $10.2 million in recorded deferred tax liabilities. For the ability and intent, if necessary, to liquidate,three months ended September 30, 2020, interest expense in order to support its currentthe condensed consolidated statement of operations (including those with a contractual term greater than one year from the date of purchase), are classifieddecreased by $19.1 million 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 creditdecrease in amortization of debt discounts, premiums, and issuance costs, income tax benefit decreased by $1.8 million and net loss or other factors. This evaluation includes, but is not limited to, significant quantitativeper share, basic 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 September 30, 2020 and December 31, 2019, the allowance for doubtful accounts recorded was not material to the Company’s condensed consolidated balance sheets.diluted, decreased by $0.12 per share. For the three and nine months ended September 30, 2020, interest expense in the condensed consolidated statement of operations decreased by $8.3 million as a result of a decrease in amortization of debt discounts, premiums, and 2019, thereissuance costs of $51.2 million, which was offset by an immaterial amountincrease in loss on extinguishment of bad debt expense written off against$42.9 million in connection with the allowanceextinguishment of $100.0 million face value of 2025 Notes. Income tax benefit decreased by $1.8 million and chargednet loss per share, basic and diluted, increased by $0.04 per share.
Net Loss Per Share
Basic net loss per common share was determined by dividing net loss applicable to operating expense.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.
InventoryThe 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:
Inventory is stated at
September 30,
(In thousands)20212020
Shares issuable in connection with acquisitions (1)45 157 
Shares issuable upon exercise of stock options2,380 2,429 
Shares issuable upon the release of restricted stock awards4,306 4,035 
Shares issuable upon the release of performance share units863 619 
Shares issuable upon conversion of convertible notes20,309 20,309 
27,903 27,549 
______________
(1)During the lowerthird quarter of cost or net realizable value. The Company determines2021, shares were issued related to holdback amounts on the costpreviously closed acquisition of inventory using the first-in, first out methodViomics, Inc. (“FIFO”Viomics”). The Company estimatesremaining issuable shares relate to the recoverabilitypreviously closed acquisition of inventoryParadigm Diagnostics, Inc. (“Paradigm”).

(2) REVENUE
The Company’s revenue is primarily generated by referenceits 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 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 condensed consolidated statements of operations.
Inventory consisted of the following:
(In thousands)September 30,
2020
December 31,
2019
Raw materials$33,842 $24,958 
Semi-finished and finished goods46,585 36,766 
Total inventory$80,427 $61,724 
ordering healthcare provider.
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
Property, PlantDisaggregation of Revenue
The following table presents the Company’s revenues disaggregated by revenue source:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2021202020212020
Screening
Medicare Parts B & C$116,088 $98,847 $329,034 $256,589 
Commercial151,245 106,002 419,268 280,451 
Other13,045 9,774 36,341 28,367 
Total Screening280,378 214,623 784,643 565,407 
Precision Oncology
Medicare Parts B & C$51,607 $33,945 $142,428 $114,973 
Commercial42,844 37,402 145,821 137,212 
International27,229 16,243 80,133 56,227 
Other23,732 3,989 44,246 14,493 
Total Precision Oncology145,412 91,579 412,628 322,905 
COVID-19 Testing$30,589 $102,161 $96,004 $136,740 
Total$456,379 $408,363 $1,293,275 $1,025,052 
Screening revenue primarily includes laboratory service revenue from the Cologuard test while Precision Oncology revenue primarily includes laboratory service revenue from global Oncotype DX products.
The downward adjustment to revenue from changes in transaction price was $0.2 million for the three months ended September 30, 2021 and Equipmentrevenue recognized from changes in transaction price was $0.5 million for the three months ended September 30, 2020. The downward adjustment to revenue from changes in transaction price was $13.2 million for the nine months ended September 30, 2021 and revenue recognized from changes in transaction price was $9.1 million for the nine months ended September 30, 2020. At each reporting period end, the Company conducts an analysis of the estimates used to calculate the transaction price to determine whether any new information available impacts those estimates made in prior reporting periods.
​Property,Deferred revenue balances are reported in other current liabilities in the Company’s condensed consolidated balance sheets and were $18.7 million and $25.0 million as of September 30, 2021 and December 31, 2020, respectively. As of September 30, 2021, $17.8 million of the Company’s deferred revenue balance is a result of the billing terms pursuant to the existing COVID-19 laboratory service agreements (“LSAs”) with customers.
Revenue recognized for the three months ended September 30, 2021 and 2020, which was included in the deferred revenue balance at the beginning of each period, was $0.2 million and $5,000, respectively. Of the $0.2 million of revenue recognized for the three months ended September 30, 2021, which was included in the deferred revenue balance at the beginning of the period, $0.1 million related to COVID-19 testing. Revenue recognized for the nine months ended September 30, 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 nine months ended September 30, 2021, which was included in the deferred revenue balance at the beginning of the period, $24.3 million related to COVID-19 testing.

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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
(3) MARKETABLE SECURITIES
The following table sets forth the Company’s cash, cash equivalents, restricted cash, and marketable securities at September 30, 2021 and December 31, 2020:
(In thousands)September 30, 2021December 31, 2020
Cash, cash equivalents, and restricted cash
Cash and money market$273,779 $901,294 
Cash equivalents— 589,994 
Restricted cash297 306 
Total cash, cash equivalents, and restricted cash274,076 1,491,594 
Marketable securities
Available-for-sale debt securities941,620 347,178 
Equity securities3,068 1,521 
Total marketable securities944,688 348,699 
Total cash and cash equivalents, restricted cash and marketable securities$1,218,764 $1,840,293 
Available-for-sale debt securities at September 30, 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
Marketable securities
Corporate bonds$368,662 $213 $(43)$368,832 
U.S. government agency securities276,146 19 (84)276,081 
Certificates of deposit175,508 35 (1)175,542 
Commercial paper10,000 — 10,001 
Asset backed securities111,171 11 (18)111,164 
Total available-for-sale securities$941,487 $279 $(146)$941,620 
______________
(1)Gains and losses in accumulated other comprehensive income (loss) (“AOCI”) are reported before tax impact.
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
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
U.S. government agency securities207,119 52 — 207,171 
Asset backed securities7,070 24 — 7,094 
Corporate bonds132,301 612 — 132,913 
Total marketable securities346,490 688 — 347,178 
Total available-for-sale 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 September 30, 2021:
Due one year or lessDue after one year through five years
(In thousands)CostFair ValueCostFair Value
Marketable securities
U.S. government agency securities$7,049 $7,067 $269,097 $269,014 
Corporate bonds235,977 236,101 132,685 132,731 
Certificates of deposit175,508 175,542 — — 
Asset backed securities— — 111,171 111,164 
Commercial paper10,000 10,001 — — 
Total$428,534 $428,711 $512,953 $512,909 
The following table summarizes the gross unrealized losses and fair values of available-for-sale debt securities in an unrealized loss position as of September 30, 2021, aggregated by investment category and length of time that individual securities have been in a continuous unrealized loss position:
Less than one yearOne year or greaterTotal
(In thousands)Fair ValueGross Unrealized LossFair ValueGross Unrealized LossFair ValueGross Unrealized Loss
Marketable securities
Corporate bonds$155,043 $(43)$— $— $155,043 $(43)
Certificates of deposit15,650 (1)— — 15,650 (1)
Asset backed securities81,478 (18)— — 81,478 (18)
U.S. government agency securities259,019 (84)— — 259,019 (84)
Total available-for-sale securities$511,190 $(146)$— $— $511,190 $(146)
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 September 30, 2021 and December 31, 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 realized gain recorded on available-for-sale debt securities was not material to the condensed consolidated statements of income for the three and nine months ended September 30, 2021 and 2020.
The Company recorded a loss of $4.5 million and $1.9 million from its equity securities for the three and nine months ended September 30, 2021 as compared to a gain of $33,000 and a loss of $0.3 million for the three and nine months ended September 30, 2020.
The gains and losses recorded are included in investment income (expense), net in the Company’s condensed consolidated statements of operations.

(4) INVENTORY
Inventory consisted of the following:
(In thousands)September 30, 2021December 31, 2020
Raw materials$47,971 $43,083 
Semi-finished and finished goods47,196 49,182 
Total inventory$95,167 $92,265 

(5) PROPERTY, PLANT AND EQUIPMENT
The carrying value and estimated useful lives of property, plant and equipment are stated at cost and depreciated using the straight-line method over the assets’as follows:
(In thousands)Estimated Useful LifeSeptember 30, 2021December 31, 2020
Property, plant and equipment
Landn/a$4,466 $4,466 
Leasehold and building improvements(1)142,025 117,865 
Land improvements15 years4,894 4,864 
Buildings30 - 40 years201,040 200,980 
Computer equipment and computer software3 years99,889 75,417 
Laboratory equipment3 - 10 years175,393 142,110 
Furniture and fixtures3 - 10 years27,593 24,968 
Assets under constructionn/a64,187 18,854 
Property, plant and equipment, at cost719,487 589,524 
Accumulated depreciation(195,287)(137,538)
Property, plant and equipment, net$524,200 $451,986 
______________
(1)Lesser of remaining lease term, building life, or estimated useful lives. Land is stated at costlife.
Depreciation expense for the three months ended September 30, 2021 and does not depreciate. Additions2020 was $22.3 million and improvements are capitalized, including direct$19.7 million, respectively. Depreciation expense for the nine months ended September 30, 2021 and indirect costs incurred to validate2020 was $64.3 million and $53.3 million, respectively.
At September 30, 2021, the Company had $64.2 million of assets under construction which consisted of $11.8 million in laboratory equipment, and bring it to working conditions. Revalidation costs, including maintenance and repairs are expensed when incurred.
Software Development Costs
Costs$40.6 million related to internal usebuilding and leasehold improvements, $11.6 million in capitalized costs related to software including hosting arrangements,projects, and $0.2 million related to land improvements. Depreciation will begin on these assets once they are incurred in 3 stages:placed into service upon completion between 2021 and 2023.
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)

(6) INTANGIBLE ASSETS AND GOODWILL
Intangible Assets
The following table summarizes the preliminary project stage,net-book-value and estimated remaining life of the application development stage,Company’s intangible assets as of September 30, 2021:
(In thousands)Weighted Average Remaining Life (Years)Gross Carrying AmountAccumulated Amortization
Net Balance at
September 30, 2021
Finite-lived intangible assets
Trade name14.1$100,700 $(11,980)$88,720 
Customer relationships12.02,700 (539)2,161 
Patents3.010,442 (6,427)4,015 
Acquired developed technology8.4853,171 (155,404)697,767 
Supply agreements5.72,295 — 2,295 
Total finite-lived intangible assets969,308 (174,350)794,958 
In-process research and developmentn/a1,250,000 — 1,250,000 
Total intangible assets$2,219,308 $(174,350)$2,044,958 
The following table summarizes the net-book-value and estimated remaining life of the post-implementation stage. Costs incurred duringCompany’s intangible assets as of December 31, 2020:
(In thousands)Weighted Average Remaining Life (Years)Gross Carrying AmountAccumulated Amortization
Net 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 
Acquired developed technology9.0814,171 (93,278)720,893 
Supply agreements6.530,000 (4,527)25,473 
Total intangible assets$958,012 $(110,889)$847,123 
As of September 30, 2021, the preliminary project and post-implementation stagesestimated 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)
2021 (remaining three months)$23,053 
202292,205 
202392,202 
202491,868 
202590,820 
Thereafter404,810 
$794,958 
The Company’s acquired intangible assets are expensed as incurred. Costs incurred during the application development stage that meet the criteria for capitalization are capitalized andbeing amortized when the software is ready for its intended use, using theon a straight-line basis over the estimated useful lifelife.
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
During the third quarter of 2021 and in connection with the preparation of the software, orfinancial statements, the durationCompany 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 hosting agreement.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 condensed consolidated statement of operations for the three and nine months ended September 30, 2021.
InvestmentsDuring 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 Privately Held Companiesvitro 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 condensed consolidated statement of operations for the three and nine months ended September 30, 2020.
During the third quarter of 2020, the Company abandoned certain research and development assets acquired through an asset purchase agreement with Armune Biosciences, Inc. in 2017. 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 condensed consolidated statement of operations for the three and nine months ended September 30, 2020.
Goodwill
The Company determines whether its investmentschange in privately held companies are debt or equity based on their characteristics, in accordance with the applicable accounting guidancecarrying amount of goodwill for such investments. the periods ended September 30, 2021 and December 31, 2020 is as follows:
(In thousands)
Balance, January 1, 2020$1,203,197 
Paradigm & Viomics acquisition30,431 
Genomic Health acquisition adjustment (1)4,044 
Balance, December 31, 2020$1,237,672 
Thrive acquisition948,105 
Ashion Acquisition56,758 
Balance September 30, 2021$2,242,535 
______________
(1)The Company also evaluatesrecognized 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 investee to determine ifthree and nine months ended September 30, 2021 and 2020.

(7) FAIR VALUE MEASUREMENTS
The three levels of the entity is a variable interest entity (“VIE”) and, if so, whetherfair value hierarchy established are as follows:
Level 1    Quoted prices (unadjusted) in active markets for identical assets or liabilities that the Company ishas the primary beneficiaryability to access as of the VIE,reporting date. Active markets are those in orderwhich transactions for the asset or liability occur in sufficient frequency and volume to determine whether consolidationprovide pricing information on an ongoing basis.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 VIE is required. If consolidation is not requiredreporting date. These include quoted prices for similar assets or liabilities in active markets 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 transactionsquoted prices for identical or similar investmentsassets 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 September 30, 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 September 30, 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$273,779 $273,779 $— $— 
Restricted cash297 297 — — 
Marketable securities
Corporate bonds368,832 — 368,832 — 
Certificates of deposit175,542 — 175,542 — 
Commercial paper10,001 — 10,001 — 
U.S. government agency securities276,081 — 276,081 — 
Asset backed securities111,164 — 111,164 — 
Equity securities (1)3,068 — 3,068 — 
Non-marketable securities2,540 — — 2,540 
Liabilities
Contingent consideration(363,647)— — (363,647)
Total$857,657 $274,076 $944,688 $(361,107)
______________
(1)The equity securities held are classified as Level 2 as they are subject to a short-term lock-up restriction and have been discounted from the observable market prices of the same issuer, less impairment. All gainssimilar unrestricted equity securities.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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
U.S. government agency securities207,171 — 207,171 — 
Corporate bonds132,913 — 132,913 — 
Asset backed securities7,094 — 7,094 — 
Equity securities1,521 1,521 — — 
Liabilities
Contingent consideration(2,477)— — (2,477)
Total$1,837,816 $903,121 $937,172 $(2,477)
There have been no changes in valuation techniques or transfers between fair value measurement levels during the periods ended September 30, 2021 and lossesDecember 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 non-marketableobservable inputs including pricing for similar assets and other observable market factors. The Company’s marketable equity securities, realizedsecurity investment in Biocartis held as of December 31, 2020 was classified as a Level 1 instrument prior to being sold in the first quarter of 2021.
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 unrealized, areproduct revenue milestones being achieved. A liability is recorded for the estimated fair value of the contingent consideration on the acquisition date. The fair value of the contingent consideration is remeasured at each reporting period, and the change in fair value is recognized in investment income, net inwithin general and administrative expenses on the Company’s condensed consolidated statements of operations.
InvestmentsThe fair value of contingent consideration as of September 30, 2021 and December 31, 2020 was $363.6 million and $2.5 million, respectively, which was recorded in privately held companiesother 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
Beginning balance, January 1, 2021$2,477 
Purchase price contingent consideration (1)350,348 
Changes in fair value10,986 
Payments(164)
Ending balance, September 30, 2021$363,647 
______________
(1)The increase in the contingent consideration liability is due to the contingent consideration associated with the acquisitions of Ashion Analytics, LLC (“Ashion”) and Thrive Earlier Detection Corporation (“Thrive”). Refer to Note 17 for further information.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 $361.3 million as of September 30, 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 September 30, 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 2.0%. 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 $2.3 million as of September 30, 2021. The revenue milestone associated with the Ashion acquisition is not expected to be debtachieved and therefore no liability has been recorded for this milestone.
Non-Marketable Equity Investments
As of September 30, 2021 and December 31, 2020, the aggregate carrying amounts of the Company’s non-marketable equity securities without readily determinable fair values were $22.7 million and $29.1 million, respectively, which are accounted forclassified as available-for-salea component of other long-term assets in the Company’s condensed consolidated balance sheets. There have been no downward or held-to-maturity securities, in accordance with the applicable accounting guidance for such investments.​upward adjustments made on these investments since initial recognition.
DerivativeRecent Accounting Pronouncements
Recently Adopted Accounting Pronouncements
In August 2020, The Financial InstrumentsAccounting Standards Board 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 hedges a portionadopted the standard on January 1, 2021 through application of its foreign currency exposures relatedthe full retrospective method of transition. This method of adoption was applied 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 liabilitiesenhance comparability between the periods presented in the condensed consolidated balance sheets, dependingCompany’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 9.
The Company’s convertible debt instruments will be 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 contracts’ net position. These contracts are not designatedoriginal offering, and (3) amortization of any debt issuance costs. Gain or loss on extinguishment of convertible notes is calculated as hedges, and as a result, changes in their fair value are recorded in other income (expense) in the condensed consolidated statements of operations. There were 0 gains or losses recorded fordifference between the three and nine months ended September 30, 2020 and 2019. As of September 30, 2020 and December 31, 2019, the Company had open foreign currency forward contracts with notional amounts of $18.2 million and $17.9 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(i) fair value of the foreign currency forward contracts was 0consideration transferred and (ii) the sum of the carrying value of the debt at September 30, 2020 and December 31, 2019.the time of repurchase.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Intangible Assets
Purchased intangibleAs of January 1, 2019, the cumulative effect of adoption resulted in 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 areof $55.7 million offset by a corresponding increase of $55.7 million in the valuation allowance. As of January 1, 2020, the cumulative effect of adoption resulted in a decrease in additional-paid-in-capital of $227.8 million, an increase in accumulated deficit of $102.6 million, and an increase to the net deferred tax assets of $83.2 million offset by a corresponding increase of $74.7 million in the valuation allowance resulting in a net decrease of $8.5 million in recorded at fair value. The Company uses a discounted cash flow model to value intangible assets. The discounted cash flow model requires assumptions aboutdeferred tax liabilities. As of December 31, 2020, the timing andcumulative effect of adoption resulted in an increase in the net carrying amount of futureconvertible notes, net, cash flows, risk,current portion of $57.3 million and convertible notes, net, less current portion of $540.9 million, a decrease in additional-paid-in-capital of $510.3 million, an increase in accumulated deficit of $77.7 million, and an increase to net deferred tax assets of $146.0 million offset by a corresponding increase of $135.8 million in the costvaluation allowance resulting in a net decrease 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$10.2 million in recorded deferred tax liabilities. For the three months ended September 30, 2020, interest expense in the condensed consolidated statement of operations decreased by $19.1 million as a result of a decrease in amortization of debt discounts, premiums, and issuance costs, income tax benefit decreased by $1.8 million and net loss per share, basic and diluted, decreased by $0.12 per share. For the nine months ended September 30, 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 acquiredinterest expense 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 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 we are 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.
Goodwill​
The Company evaluates goodwill for possible impairment in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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. Refer to Note 5 for discussion of the impairment charges recorded during the nine months ended September 30, 2020.
Fair Value Measurements
The 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.
Convertible Notes
The Company accounts for convertible notes that may be settled in cash or equity upon conversion by separating the liability and equity components of the instruments in a manner that reflects the Company’s nonconvertible debt borrowing rate. The Company determines the carrying amount of the liability component of the convertible notes by using assumptions that market participants would use in pricing a debt instrument, including market interest rates, credit standing, yield curves and volatilities. Determining the fair value of the debt component requires the use of accounting estimates and assumptions. These estimates and assumptions are judgmental in nature and could have a significant impact on the determination of the debt component, and the associated non-cash interest expense.
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 Topic 842. The Company records the present value of lease payments as right-of-use (“ROU”) assets and lease liabilities on the condensed consolidated balance sheets. ROU assets representstatement of operations decreased by $8.3 million as a result of a decrease in amortization of debt discounts, premiums, and issuance costs of $51.2 million, which was offset by an increase in loss on extinguishment of $42.9 million in connection with 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 presentextinguishment of $100.0 million face 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 term2025 Notes. Income tax benefit decreased by $1.8 million and at an amount equal to the lease payments in a similar economic environment. In order to determine the appropriate incremental borrowing rates, the Company has used a number of factors including the credit rating,net loss per share, basic and the lease term. Certain vehicle leases include variable lease payments that depend on an index or rate. Those lease payments are initially measured using the index or rate at the lease commencement date.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 condensed consolidated statements of operations.
The Company accounts for leases acquired in business combinationsdiluted, increased 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 condensed 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.$0.04 per share.
Net Loss Per Share​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:
September 30,
September 30,
(In thousands)(In thousands)20202019(In thousands)20212020
Shares issuable in connection with acquisitions(1)Shares issuable in connection with acquisitions(1)157 Shares issuable in connection with acquisitions(1)45 157 
Shares issuable upon exercise of stock optionsShares issuable upon exercise of stock options2,429 2,199 Shares issuable upon exercise of stock options2,380 2,429 
Shares issuable upon the release of restricted stock awardsShares issuable upon the release of restricted stock awards4,654 3,902 Shares issuable upon the release of restricted stock awards4,306 4,035 
Shares issuable upon the release of performance share unitsShares issuable upon the release of performance share units863 619 
Shares issuable upon conversion of convertible notesShares issuable upon conversion of convertible notes20,309 12,197 Shares issuable upon conversion of convertible notes20,309 20,309 
27,549 18,298 
27,903 27,549 
Accounting______________
(1)During the third quarter of 2021, shares were issued related to holdback amounts on the previously closed acquisition of Viomics, Inc. (“Viomics”). The remaining issuable shares relate to the previously closed acquisition of Paradigm Diagnostics, Inc. (“Paradigm”).

(2) REVENUE
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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Disaggregation of Revenue
The following table presents the Company’s revenues disaggregated by revenue source:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2021202020212020
Screening
Medicare Parts B & C$116,088 $98,847 $329,034 $256,589 
Commercial151,245 106,002 419,268 280,451 
Other13,045 9,774 36,341 28,367 
Total Screening280,378 214,623 784,643 565,407 
Precision Oncology
Medicare Parts B & C$51,607 $33,945 $142,428 $114,973 
Commercial42,844 37,402 145,821 137,212 
International27,229 16,243 80,133 56,227 
Other23,732 3,989 44,246 14,493 
Total Precision Oncology145,412 91,579 412,628 322,905 
COVID-19 Testing$30,589 $102,161 $96,004 $136,740 
Total$456,379 $408,363 $1,293,275 $1,025,052 
Screening revenue primarily includes laboratory service revenue from the Cologuard test while Precision Oncology revenue primarily includes laboratory service revenue from global Oncotype DX products.
The downward adjustment to revenue from changes in transaction price was $0.2 million for Stock-Based Compensationthe three months ended September 30, 2021 and revenue recognized from changes in transaction price was $0.5 million for the three months ended September 30, 2020. The downward adjustment to revenue from changes in transaction price was $13.2 million for the nine months ended September 30, 2021 and revenue recognized from changes in transaction price was $9.1 million for the nine months ended September 30, 2020. At each reporting period end, the Company conducts an analysis of the estimates used to calculate the transaction price to determine whether any new information available impacts those estimates made in prior reporting periods.
Deferred revenue balances are reported in other current liabilities in the Company’s condensed consolidated balance sheets and were $18.7 million and $25.0 million as of September 30, 2021 and December 31, 2020, respectively. As of September 30, 2021, $17.8 million of the Company’s deferred revenue balance is a result of the billing terms pursuant to the existing COVID-19 laboratory service agreements (“LSAs”) with customers.
Revenue recognized for the three months ended September 30, 2021 and 2020, which was included in the deferred revenue balance at the beginning of each period, was $0.2 million and $5,000, respectively. Of the $0.2 million of revenue recognized for the three months ended September 30, 2021, which was included in the deferred revenue balance at the beginning of the period, $0.1 million related to COVID-19 testing. Revenue recognized for the nine months ended September 30, 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 nine months ended September 30, 2021, which was included in the deferred revenue balance at the beginning of the period, $24.3 million related to COVID-19 testing.

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Notes to Condensed Consolidated Financial Statements
(Unaudited)
(3) MARKETABLE SECURITIES
The following table sets forth the Company’s cash, cash equivalents, restricted cash, and marketable securities at September 30, 2021 and December 31, 2020:
(In thousands)September 30, 2021December 31, 2020
Cash, cash equivalents, and restricted cash
Cash and money market$273,779 $901,294 
Cash equivalents— 589,994 
Restricted cash297 306 
Total cash, cash equivalents, and restricted cash274,076 1,491,594 
Marketable securities
Available-for-sale debt securities941,620 347,178 
Equity securities3,068 1,521 
Total marketable securities944,688 348,699 
Total cash and cash equivalents, restricted cash and marketable securities$1,218,764 $1,840,293 
Available-for-sale debt securities at September 30, 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
Marketable securities
Corporate bonds$368,662 $213 $(43)$368,832 
U.S. government agency securities276,146 19 (84)276,081 
Certificates of deposit175,508 35 (1)175,542 
Commercial paper10,000 — 10,001 
Asset backed securities111,171 11 (18)111,164 
Total available-for-sale securities$941,487 $279 $(146)$941,620 
______________
(1)Gains and losses in accumulated other comprehensive income (loss) (“AOCI”) are reported before tax impact.
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
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
U.S. government agency securities207,119 52 — 207,171 
Asset backed securities7,070 24 — 7,094 
Corporate bonds132,301 612 — 132,913 
Total marketable securities346,490 688 — 347,178 
Total available-for-sale 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 September 30, 2021:
Due one year or lessDue after one year through five years
(In thousands)CostFair ValueCostFair Value
Marketable securities
U.S. government agency securities$7,049 $7,067 $269,097 $269,014 
Corporate bonds235,977 236,101 132,685 132,731 
Certificates of deposit175,508 175,542 — — 
Asset backed securities— — 111,171 111,164 
Commercial paper10,000 10,001 — — 
Total$428,534 $428,711 $512,953 $512,909 
The following table summarizes the gross unrealized losses and fair values of available-for-sale debt securities in an unrealized loss position as of September 30, 2021, aggregated by investment category and length of time that individual securities have been in a continuous unrealized loss position:
Less than one yearOne year or greaterTotal
(In thousands)Fair ValueGross Unrealized LossFair ValueGross Unrealized LossFair ValueGross Unrealized Loss
Marketable securities
Corporate bonds$155,043 $(43)$— $— $155,043 $(43)
Certificates of deposit15,650 (1)— — 15,650 (1)
Asset backed securities81,478 (18)— — 81,478 (18)
U.S. government agency securities259,019 (84)— — 259,019 (84)
Total available-for-sale securities$511,190 $(146)$— $— $511,190 $(146)
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
The Company requires all share-based paymentsevaluates 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 September 30, 2021 and December 31, 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 realized gain recorded on available-for-sale debt securities was not material to employees, including grantsthe condensed consolidated statements of employee stock options, restricted stock, restricted stock unitsincome for the three and shares purchased under an employee stock purchase plan (if certain parametersnine months ended September 30, 2021 and 2020.
The Company recorded a loss of $4.5 million and $1.9 million from its equity securities for the three and nine months ended September 30, 2021 as compared to a gain of $33,000 and a loss of $0.3 million for the three and nine months ended September 30, 2020.
The gains and losses recorded are not met)included in investment income (expense), to be recognizednet in the financialCompany’s condensed consolidated statements basedof operations.

(4) INVENTORY
Inventory consisted of the following:
(In thousands)September 30, 2021December 31, 2020
Raw materials$47,971 $43,083 
Semi-finished and finished goods47,196 49,182 
Total inventory$95,167 $92,265 

(5) PROPERTY, PLANT AND EQUIPMENT
The carrying value and estimated useful lives of property, plant and equipment are as follows:
(In thousands)Estimated Useful LifeSeptember 30, 2021December 31, 2020
Property, plant and equipment
Landn/a$4,466 $4,466 
Leasehold and building improvements(1)142,025 117,865 
Land improvements15 years4,894 4,864 
Buildings30 - 40 years201,040 200,980 
Computer equipment and computer software3 years99,889 75,417 
Laboratory equipment3 - 10 years175,393 142,110 
Furniture and fixtures3 - 10 years27,593 24,968 
Assets under constructionn/a64,187 18,854 
Property, plant and equipment, at cost719,487 589,524 
Accumulated depreciation(195,287)(137,538)
Property, plant and equipment, net$524,200 $451,986 
______________
(1)Lesser of remaining lease term, building life, or estimated useful life.
Depreciation expense for the three months ended September 30, 2021 and 2020 was $22.3 million and $19.7 million, respectively. Depreciation expense for the nine months ended September 30, 2021 and 2020 was $64.3 million and $53.3 million, respectively.
At September 30, 2021, the Company had $64.2 million of assets under construction which consisted of $11.8 million in laboratory equipment, $40.6 million related to building and leasehold improvements, $11.6 million in capitalized costs related to software projects, and $0.2 million related to land improvements. Depreciation will begin on their grant date fair values. Forfeitures of any share-based awardsthese assets once they are recognized as they occur. ​placed into service upon completion between 2021 and 2023.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Revenue Recognition​
Revenues are recognized when
(6) INTANGIBLE ASSETS AND GOODWILL
Intangible Assets
The following table summarizes the satisfactionnet-book-value and estimated remaining life of the performance obligation occurs,Company’s intangible assets as of September 30, 2021:
(In thousands)Weighted Average Remaining Life (Years)Gross Carrying AmountAccumulated Amortization
Net Balance at
September 30, 2021
Finite-lived intangible assets
Trade name14.1$100,700 $(11,980)$88,720 
Customer relationships12.02,700 (539)2,161 
Patents3.010,442 (6,427)4,015 
Acquired developed technology8.4853,171 (155,404)697,767 
Supply agreements5.72,295 — 2,295 
Total finite-lived intangible assets969,308 (174,350)794,958 
In-process research and developmentn/a1,250,000 — 1,250,000 
Total intangible assets$2,219,308 $(174,350)$2,044,958 
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)Gross Carrying AmountAccumulated Amortization
Net 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 
Acquired developed technology9.0814,171 (93,278)720,893 
Supply agreements6.530,000 (4,527)25,473 
Total intangible assets$958,012 $(110,889)$847,123 
As of September 30, 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)
2021 (remaining three months)$23,053 
202292,205 
202392,202 
202491,868 
202590,820 
Thereafter404,810 
$794,958 
The Company’s acquired intangible assets are being amortized on a straight-line basis over the estimated useful life.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
During the third quarter of 2021 and in an amount that reflectsconnection with the considerationpreparation of the financial statements, the Company expectsrecorded a non-cash, pre-tax impairment loss of $20.2 million related to collectthe 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 exchange for those services. To determine revenue recognitionintangible asset impairment charge in the condensed consolidated statement of operations for the arrangementsthree and nine months ended September 30, 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 condensed consolidated statement of operations for the three and nine months ended September 30, 2020.
During the third quarter of 2020, the Company abandoned certain research and development assets acquired through an asset purchase agreement with Armune Biosciences, Inc. in 2017. 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 condensed consolidated statement of operations for the three and nine months ended September 30, 2020.
Goodwill
The change in the carrying amount of goodwill for the periods ended September 30, 2021 and December 31, 2020 is as follows:
(In thousands)
Balance, January 1, 2020$1,203,197 
Paradigm & Viomics acquisition30,431 
Genomic Health acquisition adjustment (1)4,044 
Balance, December 31, 2020$1,237,672 
Thrive acquisition948,105 
Ashion Acquisition56,758 
Balance September 30, 2021$2,242,535 
______________
(1)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 three and nine months ended September 30, 2021 and 2020.

(7) 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 determineshas 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 September 30, 2021 along with the level within the scopefair value hierarchy in which the fair value measurements, in their entirety, fall.
(In thousands)Fair Value at September 30, 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$273,779 $273,779 $— $— 
Restricted cash297 297 — — 
Marketable securities
Corporate bonds368,832 — 368,832 — 
Certificates of deposit175,542 — 175,542 — 
Commercial paper10,001 — 10,001 — 
U.S. government agency securities276,081 — 276,081 — 
Asset backed securities111,164 — 111,164 — 
Equity securities (1)3,068 — 3,068 — 
Non-marketable securities2,540 — — 2,540 
Liabilities
Contingent consideration(363,647)— — (363,647)
Total$857,657 $274,076 $944,688 $(361,107)
______________
(1)The equity securities held are classified as Level 2 as they are subject to a short-term lock-up restriction and have been discounted from the observable market prices of FASB ASC Topic 606, Revenue from Contractsthe similar unrestricted equity securities.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
The following table presents the Company’s fair value measurements as of December 31, 2020 along with Customers, the Company performslevel within the following five steps: (1) identifyfair value hierarchy in which the contract(s) withfair 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
U.S. government agency securities207,171 — 207,171 — 
Corporate bonds132,913 — 132,913 — 
Asset backed securities7,094 — 7,094 — 
Equity securities1,521 1,521 — — 
Liabilities
Contingent consideration(2,477)— — (2,477)
Total$1,837,816 $903,121 $937,172 $(2,477)
There have been no changes in valuation techniques or transfers between fair value measurement levels during the periods ended September 30, 2021 and December 31, 2020. The fair value of Level 2 instruments classified as cash equivalents and marketable debt securities are valued using a customer, (2) identifythird-party pricing agency where the performance obligationsvaluation is based on observable inputs including pricing for similar assets and other observable market factors. The Company’s marketable equity security investment in Biocartis held as of December 31, 2020 was classified as a Level 1 instrument prior to being sold 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. See Note 2 for further discussion.first quarter of 2021.
Foreign Currency TransactionsContingent Consideration
Prior to 2019,Certain of the Company’s international subsidiaries’ functional currency wasbusiness combinations involve potential payment of future consideration that is contingent upon the local currencyachievement of certain regulatory and assetsproduct revenue milestones being achieved. A liability is recorded for the estimated fair value of the contingent consideration on the acquisition date. The fair value of the contingent consideration is remeasured at each reporting period, and liabilities were translated into U.S. dollars at the period-end exchange rate or historical rates, as appropriate. Condensedchange in fair value is recognized within general and administrative expenses on the Company’s condensed consolidated statements of operations were translated at average exchange ratesoperations.
The fair value of contingent consideration as of September 30, 2021 and December 31, 2020 was $363.6 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
Beginning balance, January 1, 2021$2,477 
Purchase price contingent consideration (1)350,348 
Changes in fair value10,986 
Payments(164)
Ending balance, September 30, 2021$363,647 
______________
(1)The increase in the contingent consideration liability is due to the contingent consideration associated with the acquisitions of Ashion Analytics, LLC (“Ashion”) and Thrive Earlier Detection Corporation (“Thrive”). Refer to Note 17 for further information.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
This fair value measurement of contingent consideration is categorized as a Level 3 liability, as the period,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 $361.3 million as of September 30, 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 cumulative translation adjustments resulting fromvalues are discounted using a rate that considers a present-value factor. The passage of time in addition to changes in exchange ratesprojected 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 September 30, 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 2.0%. The projected fiscal year of payment range is from 2024 to 2027. Unobservable inputs were includedweighted 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 $2.3 million as of September 30, 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 September 30, 2021 and December 31, 2020, the aggregate carrying amounts of the Company’s non-marketable equity securities without readily determinable fair values were $22.7 million and $29.1 million, respectively, which are classified as a component of other long-term assets in the Company’s condensed consolidated balance sheet as a component of additional paid-in capital. In 2019 and 2020, the Company’s international subsidiaries use the U.S. dollar as the functional currency, resulting in the Company not being subject to gains and losses from foreign currency translation of the subsidiary financial statements. The Company recognizes gains and losses from foreign currency transactions in the condensed consolidated statements of operations. Net foreign currency transaction gains or losses were not material to the condensed consolidated statements of operations for the periods presented.
Reclassifications
Certain prior year amountssheets. There have been reclassified to conform to the current year presentation in the condensed consolidated financial statements and accompanying notes to the condensed consolidated financial statements including the amortization of acquired intangible assets, which is now presented as a separate line itemno downward or upward adjustments made on the Company's condensed consolidated statements of operations and was previously included in cost of sales, research and development, and general and administrative expenses. Due to these reclassifications, the Company is no longer presenting gross margin on the Company's condensed consolidated statements of operations.investments since initial recognition.
Recent Accounting Pronouncements
Recently Adopted Accounting Pronouncements
In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments-Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. The updated guidance requires companies to measure all expected credit losses for financial instruments held at the reporting date based on historical experience, current conditions, and reasonable supportable forecasts. This replaces the existing incurred loss model and is applicable to the measurement of credit losses on financial assets, including trade receivables. The updates also require available-for-sale debt security credit losses to be recognized as allowances rather than a reduction in amortized cost. The guidance was adopted by the Company on January 1, 2020. The requirements of the ASU did not result in the recognition of a material allowance for current expected credit losses, as the Company’s analysis of collectability looks at historical experience as well as current and future implications surrounding the ability to collect. Adoption of the updated guidance did not have a material impact on the Company’s condensed consolidated financial statements.
In April 2019, the FASB issued ASU 2019-04, Codification Improvements to Topic 326, Financial Instruments –Credit Losses, Topic 815, Derivatives and Hedging, and Topic 825, Financial Instruments. The updated guidance provides clarity regarding measurement of securities without readily determinable fair values. The guidance was adopted on January 1, 2020 and did not have a material impact on the Company's condensed consolidated financial statements.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
In August 2018, the FASB issued ASU 2018-15, Intangibles –Goodwill and Other –Internal-Use Software (Subtopic 350-40). The update provided guidance for evaluating the accounting for fees paid by a customer in a cloud computing arrangement that is a service contract. The guidance was adopted on a prospective basis, beginning on January 1, 2020 and it did not have a material impact on the Company's condensed consolidated financial statements.
In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820); Disclosure Framework -Changes to the Disclosure Requirements for Fair Value Measurement. The guidance provided an update to the disclosure requirements for fair value measurements under the scope of ASC 820. The updates were adopted on January 1, 2020 and did not have a material impact on the Company’s condensed consolidated financial statements.
In November 2018, the FASB issued ASU 2018-18, Collaborative Arrangements (Topic 808). The update provided additional guidance regarding the interaction between Topic 808 on Collaborative Arrangements and Topic 606 on Revenue Recognition. The guidance was adopted on January 1, 2020 and did not have a material impact on the Company's condensed consolidated financial statements.
In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes. The update simplifies the accounting for income taxes through removing exceptions related to certain intraperiod allocations and deferred tax liabilities; clarifying guidance primarily related to evaluating the step-up tax basis for goodwill in a business combination; and reflecting enacted changes in tax laws or rates in the annual effective tax rate. The amended guidance is effective for interim and annual periods in 2021, however early adoption is permitted. The guidance was early adopted on January 1, 2020 and did not have a material impact on the Company’s condensed consolidated financial statements.
In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. The updated guidance provides optional expedients for applying the requirements of certain topics in the codification for contracts that are modified because of reference rate reform. In addition to the optional expedients, the update includes a general principle that permits an entity to consider contract modifications due to reference rate reform to be an event that does not require contract remeasurement at the modification date or reassessment of a previous accounting determination. The updated guidance is effective for all entities as of March 12, 2020 and through December 31, 2022. The Company adopted the guidance upon issuance on March 12, 2020. There was no impact on the Company's condensed consolidated financial statements.
Recently Issued Accounting Pronouncements Not Yet Adopted
In August 2020, The Financial Accounting Standards Board issued ASUAccounting 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 new guidance modifies how particular convertible instrumentsapplication of the if-converted method for calculating diluted earnings per share and certain contracts thatthe treasury stock method will no longer be available. This standard may be settled in cashadopted through either a modified retrospective method of transition or shares impact the computationa full retrospective method of diluted EPS.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 is currently evaluatingadopted the impactstandard on January 1, 2021 through application of this guidance on its consolidatedthe 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 9.
The Company’s convertible debt instruments will be 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
As of January 1, 2019, the cumulative effect of adoption resulted in 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. As of January 1, 2020, the cumulative effect of adoption resulted in a decrease in additional-paid-in-capital of $227.8 million, an increase in accumulated deficit of $102.6 million, and an increase to the net deferred tax assets of $83.2 million offset by a corresponding increase of $74.7 million in the valuation allowance resulting in a net decrease of $8.5 million in recorded deferred tax liabilities. As of December 31, 2020, the cumulative effect of adoption resulted in an increase in the net carrying amount of convertible notes, net, current portion of $57.3 million and convertible notes, net, less current portion of $540.9 million, a decrease in additional-paid-in-capital of $510.3 million, an increase in accumulated deficit of $77.7 million, and an increase to net deferred tax assets of $146.0 million offset by a corresponding increase of $135.8 million in the valuation allowance resulting in a net decrease of $10.2 million in recorded deferred tax liabilities. For the three months ended September 30, 2020, interest expense in the condensed consolidated statement of operations decreased by $19.1 million as a result of a decrease in amortization of debt discounts, premiums, and issuance costs, income tax benefit decreased by $1.8 million and net loss per share, basic and diluted, decreased by $0.12 per share. For the nine months ended September 30, 2020, interest expense in the condensed consolidated statement of operations decreased by $8.3 million as a result of a decrease in amortization of debt discounts, premiums, and issuance costs of $51.2 million, which was offset by an increase in loss on extinguishment of $42.9 million in connection with the extinguishment of $100.0 million face value of 2025 Notes. Income tax benefit decreased by $1.8 million and net loss per share, basic and diluted, increased by $0.04 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.
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:
September 30,
(In thousands)20212020
Shares issuable in connection with acquisitions (1)45 157 
Shares issuable upon exercise of stock options2,380 2,429 
Shares issuable upon the release of restricted stock awards4,306 4,035 
Shares issuable upon the release of performance share units863 619 
Shares issuable upon conversion of convertible notes20,309 20,309 
27,903 27,549 
______________
(1)During the third quarter of 2021, shares were issued related to holdback amounts on the previously closed acquisition of Viomics, Inc. (“Viomics”). The remaining issuable shares relate to the previously closed acquisition of Paradigm Diagnostics, Inc. (“Paradigm”).

(2) REVENUE
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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
The core principle of ASC 606 is that the Company recognizes revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the Company expects to collect in exchange for those goods or services. The Company recognizes revenues from its products in accordance with that core principle, and 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 an order is received for a patient with no active insurance or insurance that does not cover the Company’s testing services, 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 LSAs 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 LSAs, 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 specimen 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 who assume the downstream patient billing. 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 third party 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
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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. Revenue recognized from changes in transaction prices was $0.5 million and $1.2 million for the three months ended September 30, 2020 and 2019, respectively. Revenue recognized from changes in transaction prices was $9.1 million and $4.6 million for the nine months ended September 30, 2020 and 2019, respectively.
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 release 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 LSAs, 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.
Disaggregation of Revenue
The following table presents the Company’s revenues disaggregated by revenue source:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2020201920202019
Screening
Medicare Parts B & C$98,847 $108,617 $256,589 $295,103 
Commercial106,002 99,352 280,451 261,521 
Other9,774 10,836 28,367 24,094 
Total Screening214,623 218,805 565,407 580,718 
Precision Oncology
Medicare Parts B & C$33,945 $$114,973 $
Commercial37,402 137,212 
International16,243 56,227 
Other3,989 14,493 
Total Precision Oncology91,579 322,905 
COVID-19 Testing$102,161 $$136,740 $
Total$408,363 $218,805 $1,025,052 $580,718 
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2021202020212020
Screening
Medicare Parts B & C$116,088 $98,847 $329,034 $256,589 
Commercial151,245 106,002 419,268 280,451 
Other13,045 9,774 36,341 28,367 
Total Screening280,378 214,623 784,643 565,407 
Precision Oncology
Medicare Parts B & C$51,607 $33,945 $142,428 $114,973 
Commercial42,844 37,402 145,821 137,212 
International27,229 16,243 80,133 56,227 
Other23,732 3,989 44,246 14,493 
Total Precision Oncology145,412 91,579 412,628 322,905 
COVID-19 Testing$30,589 $102,161 $96,004 $136,740 
Total$456,379 $408,363 $1,293,275 $1,025,052 
Screening revenue primarily includes laboratory service revenue from the Cologuard test while Precision Oncology revenue primarily includes laboratory service revenue from global Oncotype DX products.
Contract Balances
The timing ofdownward adjustment to revenue recognition, billingsfrom changes in transaction price was $0.2 million for the three months ended September 30, 2021 and cash collections resultsrevenue recognized from changes in billed accounts receivabletransaction price was $0.5 million for the three months ended September 30, 2020. The downward adjustment to revenue from changes in transaction price was $13.2 million for the nine months ended September 30, 2021 and deferred revenue onrecognized from changes in transaction price was $9.1 million for the condensed 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,nine months ended September 30, 2020. At each reporting period end, 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 someconducts an analysis of the Company’s LSAs,estimates used to calculate the satisfaction of the performance obligation occurs when a specimen sample is not returnedtransaction price to the laboratory for processing before the end of the allotted testing window.determine whether any new information available impacts those estimates made in prior reporting periods.
Deferred revenue balances are reported in other current liabilities in the Company’s condensed consolidated balance sheets and were $22.4$18.7 million and $0.6$25.0 million as of September 30, 20202021 and December 31, 2019,2020, respectively. As of September 30, 2020, $21.82021, $17.8 million of the Company’s deferred revenue balance is a result of the billing terms pursuant to the existing COVID-19 LSAslaboratory service agreements (“LSAs”) with customers.
Revenue recognized for the three months ended September 30, 20202021 and 2019, which was included in the deferred revenue balance at the beginning of each period was $5,000 and $0.2 million, respectively. Revenue recognized for the nine months ended September 30, 2020, and 2019, which was included in the deferred revenue balance at the beginning of each period, was $0.2 million and $0.5$5,000, respectively. Of the $0.2 million respectively.
Practical Expedients
The Company does not adjust the transaction priceof revenue recognized 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 expensesthree months ended September 30, 2021, which was included in the Company’s condensed consolidated statementsdeferred revenue balance at the beginning of operations.
The Company incurs certain other costs that are incurred regardless of whether a contract is obtained. Such costs are primarilythe period, $0.1 million related to legal servicesCOVID-19 testing. Revenue recognized for the nine months ended September 30, 2021 and patient communications (e.g. adherence reminder letters). These costs are expensed as incurred and recorded within general and administrative expenses2020, which was included in the Company’s condensed consolidated statementsdeferred revenue balance at the beginning of operations.each period, was $24.6 million and $0.2 million, respectively. Of the $24.6 million of revenue recognized for the nine months ended September 30, 2021, which was included in the deferred revenue balance at the beginning of the period, $24.3 million related to COVID-19 testing.

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Notes to Condensed Consolidated Financial Statements
(Unaudited)
(3) MARKETABLE SECURITIES
The following table sets forth the Company’s cash, cash equivalents, restricted cash, and marketable securities at September 30, 20202021 and December 31, 2019:2020:
(In thousands)September 30, 2020December 31, 2019
Cash, cash equivalents, and restricted cash
Cash and money market$456,701 $146,932 
Cash equivalents349,977 30,322 
Restricted cash (1)291 274 
Total cash, cash equivalents, and restricted cash806,969 177,528 
Marketable securities
Available-for-sale debt securities474,906 144,685 
Equity securities1,418 1,716 
Total marketable securities476,324 146,401 
Total cash and cash equivalents, restricted cash and marketable securities$1,283,293 $323,929 
______________
(1)Restricted cash is included in other long-term assets on the condensed consolidated balance sheets. There was no restricted cash at September 30, 2019.
(In thousands)September 30, 2021December 31, 2020
Cash, cash equivalents, and restricted cash
Cash and money market$273,779 $901,294 
Cash equivalents— 589,994 
Restricted cash297 306 
Total cash, cash equivalents, and restricted cash274,076 1,491,594 
Marketable securities
Available-for-sale debt securities941,620 347,178 
Equity securities3,068 1,521 
Total marketable securities944,688 348,699 
Total cash and cash equivalents, restricted cash and marketable securities$1,218,764 $1,840,293 
Available-for-sale debt securities at September 30, 20202021 consisted of the following:
(In thousands)(In thousands)Amortized CostGains in Accumulated
Other Comprehensive
Income (Loss)
Losses in Accumulated
Other Comprehensive
Income (Loss)
Estimated Fair
Value
(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$349,975 $$$349,977 
Total cash equivalents349,975 349,977 
Marketable securitiesMarketable securitiesMarketable securities
Corporate bondsCorporate bonds191,651 970 192,621 Corporate bonds$368,662 $213 $(43)$368,832 
U.S. government agency securitiesU.S. government agency securities257,102 60 257,162 U.S. government agency securities276,146 19 (84)276,081 
Certificates of depositCertificates of deposit10,000 10,001 Certificates of deposit175,508 35 (1)175,542 
Commercial paperCommercial paper10,000 — 10,001 
Asset backed securitiesAsset backed securities15,071 51 15,122 Asset backed securities111,171 11 (18)111,164 
Total marketable securities473,824 1,082 474,906 
Total available-for-sale securitiesTotal available-for-sale securities$823,799 $1,084 $$824,883 Total available-for-sale securities$941,487 $279 $(146)$941,620 
______________
(1)Gains and losses in accumulated other comprehensive income (loss) (“AOCI”) are reported before tax impact.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)

Available-for-sale debt securities at December 31, 20192020 consisted of the following:
(In thousands)(In thousands)Amortized CostGains in Accumulated
Other Comprehensive
Income (Loss)
Losses in Accumulated
Other Comprehensive
Income (Loss)
Estimated Fair Value(In thousands)Amortized CostGains in Accumulated
Other Comprehensive
Income (Loss) (1)
Losses in Accumulated
Other Comprehensive
Income (Loss) (1)
Estimated Fair Value
Cash equivalentsCash equivalentsCash equivalents
U.S. government agency securitiesU.S. government agency securities$30,320 $$$30,322 U.S. government agency securities$589,986 $$— $589,994 
Total cash equivalentsTotal cash equivalents30,320 30,322 Total cash equivalents589,986 — 589,994 
Marketable securitiesMarketable securitiesMarketable securities
U.S. government agency securitiesU.S. government agency securities140,745 10 (73)140,682 U.S. government agency securities207,119 52 — 207,171 
Asset backed securitiesAsset backed securities7,070 24 — 7,094 
Corporate bondsCorporate bonds4,017 (14)4,003 Corporate bonds132,301 612 — 132,913 
Total marketable securitiesTotal marketable securities144,762 10 (87)144,685 Total marketable securities346,490 688 — 347,178 
Total available-for-sale securitiesTotal available-for-sale securities$175,082 $12 $(87)$175,007 Total available-for-sale 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 September 30, 2020:​2021:
Due one year or lessDue after one year through four years
Due one year or lessDue after one year through five years
(In thousands)(In thousands)CostFair ValueCostFair Value(In thousands)CostFair ValueCostFair Value
Cash equivalents
U.S. government agency securities$349,975 $349,977 $ $ 
Total cash equivalents349,975 349,977   
Marketable securitiesMarketable securitiesMarketable securities
U.S. government agency securitiesU.S. government agency securities249,943 249,949 7,159 7,213 U.S. government agency securities$7,049 $7,067 $269,097 $269,014 
Corporate bondsCorporate bonds148,903 149,409 42,748 43,212 Corporate bonds235,977 236,101 132,685 132,731 
Certificates of depositCertificates of deposit10,000 10,001 Certificates of deposit175,508 175,542 — — 
Asset backed securitiesAsset backed securities15,071 15,122 Asset backed securities— — 111,171 111,164 
Total marketable securities408,846 409,359 64,978 65,547 
Commercial paperCommercial paper10,000 10,001 — — 
TotalTotal$758,821 $759,336 $64,978 $65,547 Total$428,534 $428,711 $512,953 $512,909 
The following table summarizes the gross unrealized losses and fair values of available-for-sale debt securities in an unrealized loss position as of September 30, 2020,2021, aggregated by investment category and length of time that individual securities have been in a continuous unrealized loss position:
Less than one yearOne year or greaterTotal
(In thousands)Fair ValueGross Unrealized LossFair ValueGross Unrealized LossFair ValueGross Unrealized Loss (1)
Cash equivalents
U.S. government agency securities$49,996 $$$$49,996 $
Total cash equivalents49,996 49,996 
Marketable securities
U.S. government agency securities24,994 24,994 
Total marketable securities24,994 24,994 
Total available-for-sale securities$74,990 $$$$74,990 $
______________
(1)Available-for-sale debt securities in an unrealized loss position are insignificant as of September 30, 2020.
Less than one yearOne year or greaterTotal
(In thousands)Fair ValueGross Unrealized LossFair ValueGross Unrealized LossFair ValueGross Unrealized Loss
Marketable securities
Corporate bonds$155,043 $(43)$— $— $155,043 $(43)
Certificates of deposit15,650 (1)— — 15,650 (1)
Asset backed securities81,478 (18)— — 81,478 (18)
U.S. government agency securities259,019 (84)— — 259,019 (84)
Total available-for-sale securities$511,190 $(146)$— $— $511,190 $(146)
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
The Company evaluates investments including investments in privately-held companies, 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 September 30, 20202021 and December 31, 20192020, 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 Company recorded a realized gain recorded on available-for-sale debt securities was not material to the condensed consolidated statements of $1,000 and $3.1 millionincome for the three months ended September 30, 2020 and 2019, respectively, net of insignificant realized losses. The Company recorded a realized gain on available-for-sale debt securities of $0.1 million and $3.3 million for the nine months ended September 30, 20202021 and 2019, respectively, net of insignificant realized losses.

2020.
The Company recorded a gain of $33,000 and a loss of $0.3$4.5 million and $1.9 million from its equity securities for the three and nine months ended September 30, 20202021 as compared to 0a gain orof $33,000 and a loss of $0.3 million for the three and nine months ended September 30, 2019.

2020.
The gains and losses recorded are included in investment income (expense), net in the Company’s condensed consolidated statements of operations.

(4) INVENTORY
Inventory consisted of the following:
(In thousands)September 30, 2021December 31, 2020
Raw materials$47,971 $43,083 
Semi-finished and finished goods47,196 49,182 
Total inventory$95,167 $92,265 

(5) PROPERTY, PLANT AND EQUIPMENT
The carrying value and estimated useful lives of property, plant and equipment are as follows:
(In thousands)(In thousands)Estimated
Useful Life
September 30,
2020
December 31,
2019
(In thousands)Estimated Useful LifeSeptember 30, 2021December 31, 2020
Property, plant and equipmentProperty, plant and equipmentProperty, plant and equipment
LandLandn/a$4,466 $4,466 Landn/a$4,466 $4,466 
Leasehold and building improvementsLeasehold and building improvements(1)113,153 80,352 Leasehold and building improvements(1)142,025 117,865 
Land improvementsLand improvements15 years3,222 1,766 Land improvements15 years4,894 4,864 
BuildingsBuildings30 - 40 years200,141 112,815 Buildings30 - 40 years201,040 200,980 
Computer equipment and computer softwareComputer equipment and computer software3 years78,350 65,323 Computer equipment and computer software3 years99,889 75,417 
Laboratory equipmentLaboratory equipment3 - 10 years136,462 104,008 Laboratory equipment3 - 10 years175,393 142,110 
Furniture and fixturesFurniture and fixtures3 - 10 years23,950 14,539 Furniture and fixtures3 - 10 years27,593 24,968 
Assets under constructionAssets under constructionn/a26,472 149,687 Assets under constructionn/a64,187 18,854 
Property, plant and equipment, at costProperty, plant and equipment, at cost586,216 532,956 Property, plant and equipment, at cost719,487 589,524 
Accumulated depreciationAccumulated depreciation(129,761)(77,631)Accumulated depreciation(195,287)(137,538)
Property, plant and equipment, netProperty, plant and equipment, net$456,455 $455,325 Property, plant and equipment, net$524,200 $451,986 
______________
(1)Lesser of remaining lease term, building life, or estimated useful life.
Depreciation expense for the three months ended September 30, 2021 and 2020 and 2019 was $19.5$22.3 million and $8.4$19.7 million, respectively. Depreciation expense for the nine months ended September 30, 2021 and 2020 and 2019 was $52.9$64.3 million and $21.8$53.3 million, respectively.
At September 30, 2020,2021, the Company had $26.5$64.2 million of assets under construction which consisted of $9.7$11.8 million in laboratory equipment, $8.4$40.6 million ofrelated to building and leasehold improvements, $7.9$11.6 million in capitalized costs related to software projects, and $0.5$0.2 million related to furniture and fixtures.land improvements. Depreciation will begin on these assets once they are placed into service. The Company expects to incur an additional $2.0 million to complete the laboratory equipment, $13.3 million to complete the building projectsservice upon completion between 2021 and leasehold improvements, $3.6 million to complete the software projects, and minimal costs to complete the furniture and fixtures. These projects are expected to be completed throughout 2020 and 2021.

2023.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
(5)
(6) 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 September 30, 2020:​2021:
(In thousands)(In thousands)Weighted Average
Remaining
Life (Years)
CostAccumulated AmortizationNet Balance at September 30, 2020(In thousands)Weighted Average Remaining Life (Years)Gross Carrying AmountAccumulated Amortization
Net Balance at
September 30, 2021
Finite-lived intangible assetsFinite-lived intangible assetsFinite-lived intangible assets
Trade nameTrade name15.2$100,700 $(5,683)$95,017 Trade name14.1$100,700 $(11,980)$88,720 
Customer relationshipsCustomer relationships13.12,700 (359)2,341 Customer relationships12.02,700 (539)2,161 
PatentsPatents4.010,441 (5,089)5,352 Patents3.010,442 (6,427)4,015 
Acquired developed technologyAcquired developed technology9.2814,171 (73,022)741,149 Acquired developed technology8.4853,171 (155,404)697,767 
Supply agreementsSupply agreements6.830,000 (3,538)26,462 Supply agreements5.72,295 — 2,295 
Internally developed technology2.41,883 (750)1,133 
Total finite-lived intangible assetsTotal finite-lived intangible assets959,895 (88,441)871,454 Total finite-lived intangible assets969,308 (174,350)794,958 
Internally developed technology in processn/a206 — 206 
In-process research and developmentIn-process research and developmentn/a1,250,000 — 1,250,000 
Total intangible assetsTotal intangible assets$960,101 $(88,441)$871,660 Total intangible assets$2,219,308 $(174,350)$2,044,958 
The following table summarizes the net-book-value and estimated remaining life of the Company’s intangible assets as of December 31, 2019:​2020:
(In thousands)Weighted Average
Remaining
Life (Years)
CostAccumulated AmortizationNet Balance at December 31, 2019
Finite-lived intangible assets
Trade name15.9$100,700 $(961)$99,739 
Customer relationships13.62,700 (224)2,476 
Patents8.822,690 (5,974)16,716 
Acquired developed technology9.9806,371 (12,345)794,026 
Supply agreements7.530,000 (571)29,429 
Internally developed technology2.51,229 (336)893 
Total finite-lived intangible assets963,690 (20,411)943,279 
In-process research and developmentn/a200,000 — 200,000 
Internally developed technology in processn/a271 — 271 
Total intangible assets$1,163,961 $(20,411)$1,143,550 
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
(In thousands)Weighted Average Remaining Life (Years)Gross Carrying AmountAccumulated Amortization
Net 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 
Acquired developed technology9.0814,171 (93,278)720,893 
Supply agreements6.530,000 (4,527)25,473 
Total intangible assets$958,012 $(110,889)$847,123 
As of September 30, 2020,2021, 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)(In thousands)(In thousands)
2020$23,357 
202193,322 
2021 (remaining three months)2021 (remaining three months)$23,053 
2022202293,116 202292,205 
2023202392,812 202392,202 
2024202492,421 202491,868 
2025202590,820 
ThereafterThereafter476,426 Thereafter404,810 
$871,454 
$794,958 
The Company’s acquired intangible assets are being amortized on a straight-line basis over the estimated useful life.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
During the third quarter of 2021 and in connection with the preparation of the financial statements, 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 amortization expenseCompany 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 from thesein intangible assets is reportedasset impairment charge in amortization of acquired intangible assets on the condensed consolidated statementsstatement of operations.operations for the three and nine months ended September 30, 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 ScoreScore® 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 condensed consolidated statement of operations for the three and nine months ended September 30, 2020. See Note 7 for additional information on Biocartis.
During the third quarter of 2020, the Company abandoned certain research and development assets acquired through an asset purchase agreement with Armune Biosciences, Inc. in 2017. 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 condensed consolidated statement of operations for the three and nine months ended September 30, 2020.
There were 0 impairment losses for the three and nine months ended September 30, 2019.
Goodwill
As a result of the acquisition of Paradigm Diagnostics, Inc. (“Paradigm”) and Viomics, Inc. (“Viomics”) in March 2020, the Company recognized goodwill of $30.4 million, which includes an immaterial post-acquisition adjustment to goodwill in the second quarter of 2020. Refer to the Company’s 2019 10-K for further discussion on goodwill recorded from previous business combinations.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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. Due to the impact of COVID-19 on the Company’s operations, the Company performed a qualitative assessment of goodwill to determine if an event indicating impairment was present. No such indicators were identified as of September 30, 2020. There were 0 impairment losses for the periods ended September 30, 2020 and September 30, 2019. During the nine months ended September 30, 2020, the Company recognized a measurement period adjustment to goodwill of $4.0 million related to an increase in Genomic Health’s pre-acquisition deferred tax liability due to finalization of certain income-tax related items.
The change in the carrying amount of goodwill for the periods ended September 30, 20202021 and December 31, 20192020 is as follows:
(In thousands)
Balance, January 1, 20192020$17,279 
Genomic Health acquisition1,185,918 
Balance, December 31, 20191,203,197 
Paradigm & Viomics acquisition30,431 
Genomic Health acquisition adjustment (1)4,044 
Balance, September 30,December 31, 2020$1,237,672 
Thrive acquisition948,105 
Ashion Acquisition56,758 
Balance September 30, 2021$2,242,535 
______________
(1)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 three and nine months ended September 30, 2021 and 2020.

(6)(7) 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 September 30, 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 September 30, 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$273,779 $273,779 $— $— 
Restricted cash297 297 — — 
Marketable securities
Corporate bonds368,832 — 368,832 — 
Certificates of deposit175,542 — 175,542 — 
Commercial paper10,001 — 10,001 — 
U.S. government agency securities276,081 — 276,081 — 
Asset backed securities111,164 — 111,164 — 
Equity securities (1)3,068 — 3,068 — 
Non-marketable securities2,540 — — 2,540 
Liabilities
Contingent consideration(363,647)— — (363,647)
Total$857,657 $274,076 $944,688 $(361,107)
______________
(1)The equity securities held are classified as Level 2 as they are subject to a short-term lock-up restriction and have been discounted from the observable market prices of the similar unrestricted equity securities.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
(In thousands)Fair Value at September 30,
2020
Quoted 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$456,701 $456,701 $$
U.S. government agency securities349,977 349,977 
Restricted cash291 291 
Marketable securities
Corporate bonds192,621 192,621 
U.S. government agency securities257,162 257,162 
Certificates of deposit10,001 10,001 
Asset backed securities15,122 15,122 
Equity Securities1,418 1,418 
Liabilities
Contingent consideration(2,638)(2,638)
Total$1,280,655 $458,410 $824,883 $(2,638)
The following table presents the Company’s fair value measurements as of December 31, 2019 along with the level within the fair value hierarchy in which the fair value measurements in their entirety fall.​
(In thousands)(In thousands)Fair Value at December 31,
2019
Quoted Prices
in Active
Markets for
Identical Assets
(Level 1)
Significant
Other
Observable
Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
(In thousands)Fair Value at December 31, 2020Quoted Prices
in Active Markets
for Identical Assets
(Level 1)
Significant Other
Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Cash and cash equivalentsCash and cash equivalentsCash and cash equivalents
Cash and money marketCash and money market$146,932 $146,932 $$Cash and money market$901,294 $901,294 $— $— 
U.S. government agency securitiesU.S. government agency securities30,322 30,322 U.S. government agency securities589,994 — 589,994 — 
Restricted cashRestricted cash274 274 Restricted cash306 306 — — 
Marketable securitiesMarketable securitiesMarketable securities
U.S. government agency securitiesU.S. government agency securities140,682 140,682 U.S. government agency securities207,171 — 207,171 — 
Corporate bondsCorporate bonds4,003 4,003 Corporate bonds132,913 — 132,913 — 
Asset backed securitiesAsset backed securities7,094 — 7,094 — 
Equity securitiesEquity securities1,716 1,716 Equity securities1,521 1,521 — — 
LiabilitiesLiabilitiesLiabilities
Contingent considerationContingent consideration(2,879)(2,879)Contingent consideration(2,477)— — (2,477)
TotalTotal$321,050 $148,922 $175,007 $(2,879)Total$1,837,816 $903,121 $937,172 $(2,477)
There have been no changes in valuation techniques or transfers between fair value measurement levels during the periods ended September 30, 20202021 and December 31, 2019.2020. 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. The Company’s marketable equity security investment in Biocartis isheld as of December 31, 2020 was classified as a Level 1 instrument. See Note 7 for additional information on Biocartis. ​
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
Contingent Consideration
In connection withCertain of the Biomatrica Acquisition, a contingent earn-out liability was created to account for an additional $20.0 million in contingentCompany’s business combinations involve potential payment of future consideration that could be earned basedis contingent upon the achievement of certain regulatory and product revenue milestones being met. achieved. A liability is recorded for the estimated fair value of the contingent consideration on the acquisition date. The fair value of the contingent consideration is remeasured at each reporting period, and the change in fair value is recognized within general and administrative expenses on the Company’s condensed consolidated statements of operations.
The fair value of contingent consideration as of September 30, 2021 and December 31, 2020 was $363.6 million and $2.5 million, respectively, which was recorded in other long-term liabilities in the condensed consolidated balance sheets.
The following table provides a roll-forwardreconciliation of the fair valuesbeginning and ending balances of the contingent consideration, which includes Level 3 measurements:consideration:
(In thousands)Contingent considerationConsideration
Balance,Beginning balance, January 1, 20202021$(2,879)2,477 
Purchase price contingent consideration (1)350,348 
Changes in fair value
Gains (losses) recognized in earnings010,986 
Payments241 (164)
Balance,Ending balance, September 30, 20202021$(2,638)363,647 
As of September 30, 2020, the fair value of______________
(1)The increase in the contingent earn-outconsideration liability is classified as a componentdue to the contingent consideration associated with the acquisitions of other long-term liabilities in the Company’s condensed consolidated balance sheet.Ashion Analytics, LLC (“Ashion”) and Thrive Earlier Detection Corporation (“Thrive”). Refer to Note 17 for further information.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
This fair value measurement of contingent consideration related to the Biomatrica acquisition wasis 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 $361.3 million as of September 30, 2021. The Company evaluates the fair value of expectedthe regulatory and product development contingent consideration and the corresponding liability each annual reporting periodliabilities using the Monte Carlo Method,probability-weighted scenario based discounted cash flow model, which is consistent with the initial measurement of the expected Biomatrica Acquisition earn-out liability. The Company estimates projections during the earn-out period utilizing various potential pay-out scenarios.contingent consideration liabilities. Probabilities wereof success are applied to each potential scenario and the resulting values wereare discounted using a rate that considers weighted average costa present-value factor. The passage of capital as well as a specific risk premium associated withtime in addition to changes in projected milestone achievement timing, present-value factor, the riskinessdegree of the earn-out itself, the related projections,achievement if applicable, and the overall business.
Non-Marketable Equity Investment
The Company has non-marketable equity investments which are initially recorded at the estimated fair value based on observable transactions. The Company has concluded it is not a primary beneficiary with regardsprobabilities of success may result in adjustments to these investments and does not have the ability to exercise significant influence over the investees and thus has not consolidated the investees pursuant to the requirements of ASC 810, Consolidation. The Company will continue to assess its investments and future commitments to the investees and to the extent its relationship with the investees change and whether such change may require consolidation of the investees in future periods. The Company remeasures the fair value only when an observable transaction occurs during the period that would suggestmeasurement. The fair value measurements of contingent consideration for which a change in the carrying value of the investment.liability is recorded include significant unobservable inputs. As of September 30, 20202021, 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 2.0%. 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 $2.3 million as of September 30, 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 September 30, 2021 and December 31, 2019,2020, the Company hadaggregate carrying amounts of the Company’s non-marketable equity investments of $23.9securities without readily determinable fair values were $22.7 million and $11.8$29.1 million, respectively, which are classified as a component of other long-term assets in the Company’s condensed consolidated balance sheets. There have been no downward or upward adjustments made on these investments since initial recognition.
Derivative Financial Instruments
As of September 30, 2021 and December 31, 2020, the balance primarily consistsCompany had open foreign currency forward contracts with notional amounts of $29.5 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 Company’s preferred stock investments in 18,258,838 shares of Epic Sciencesforeign currency forward contracts was zero at September 30, 2021 and 5,025,764 shares of Thrive Earlier Detection Corp. (“Thrive”) of $10.8 million and $12.5 million, respectively. As of December 31, 2019,2020, and there were no gains or losses recorded for the balance consists of the Company’s preferred stock investments in Epic Sciencesthree and Thrive Earlier Detection Corp. (“Thrive”) of $10.8 million and $1.0 million, respectively.

The Company purchased 4.0 million shares of Series B Preferred Stock of Thrive for $10.0 million in July 2020. The Company previously held a $1.0 million investment in the Series A Preferred Stock of Thrive, which does not have a readily determinable fair value and therefore, the Company elected the measurement alternative. The rights and obligations of the Series B Preferred Stock are generally the same as the Series A Preferred Stock previously held indicating that the transactions are identical or similar investments. As a result, the Company recorded an unrealized gain of $1.5 million during the threenine months ended September 30, 2020 in investment income, net on the Company’s condensed consolidated statement of operations to revalue the Company’s initial investment to the value of the Series B Preferred Stock, which was the most recent observable transaction.2021 and 2020.

(8) 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 provides 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 is collateralized by the additional clinical laboratory and related facilities.
Pursuant to the Construction Loan Agreement, funds drawn will bear interest at a rate equal to the sum of the 1-month LIBOR rate plus 2.25 percent. Regular monthly payments are 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 may be prepaid at any time without penalty. The maturity date of the Construction Loan Agreement is 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 is deemed to have been issued pursuant to the Construction Loan Agreement. The amount of the City Letter of Credit will reduce, dollar for dollar, the amount available for borrowing under the Construction Loan Agreement.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
There have beenAs a condition to Fifth Third Bank’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 September 30, 2021 and December 31, 2020, the outstanding balance was $22.8 million and $23.8 million, respectively, from the Construction Loan, including $0.7 million of interest incurred, which is 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 are recorded as a direct deduction from the liability. The debt issuance costs are being amortized over the life of the Construction Loan.
The carrying amount of the Construction Loan approximates fair value due to the short maturity of this instrument. The Construction Loan is privately held with no other observable transactionspublic market for this debt and therefore is classified as a Level 3 fair value measurement. The change in the fair value during the three and nine months ended September 30, 2021 was due to payments made on the loan resulting in a decrease in the liability.
The Construction Loan Agreement was amended effective June 30, 2020 to include a financial covenant to maintain a minimum liquidity of $250 million and 2019.remove the minimum tangible net worth covenant. As of September 30, 2021, the Company is in compliance with the covenant included in the amended agreement.
Fair Value of Long-Term Debt and Convertible Notes​Tax Increment Financing Loan Agreements
The Company measuresentered into 2 separate Tax Increment Financing Loan Agreements (“TIFs”) in February 2019 and June 2019 with the fair valueCity of its convertible notesMadison, 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 long-term debt for disclosure purposes. 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 lien.

(9) CONVERTIBLE NOTES
Convertible note obligations included in the condensed consolidated balance sheet consisted of the following table summarizesas of September 30, 2021:
Fair Value (2)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%$1,150,000 $(19,596)$1,130,404 $1,222,968 2
2027 Convertible notes - 0.375%747,500 (12,257)735,243 834,285 2
2025 Convertible notes - 1.000% (1)315,005 (1,901)313,104 455,204 2
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
Convertible note obligations included in the Company’s outstanding convertible notes and long-term debt:​condensed consolidated balance sheet consisted of the following as of December 31, 2020:
September 30, 2020December 31, 2019
(In thousands)Carrying Amount (1)Fair ValueCarrying Amount (1)Fair Value
2028 Convertible notes (2)$796,463 $1,251,085 $$
2027 Convertible notes (2)506,294 881,631 483,909 843,741 
2025 Convertible notes (2)252,210 494,627 319,696 592,482 
Construction loan (3)23,962 23,962 24,866 24,866 
Fair Value (2)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%$1,150,000 $(21,878)$1,128,122 $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)The carrying amounts presentedBased on the Company’s share price on the days leading up to September 30, 2021 and December 31, 2020, holders of the 2025 Convertible Notes have the right to convert their debentures. As a result, the 2025 Convertible Notes are included within convertible notes, net, of debt discounts and debt issuance costs (see Note 12 and Note 15 ofcurrent portion on the condensed consolidated financial statements for further information).​balance sheets. Some holders did convert their debentures, resulting in a decrease of the principal amount of the 2025 Convertible Notes.
(2)The fair values are based on observable market prices for this debt, which is traded in active markets and therefore is classified as a Level 2 fair value measurement. A
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 accumulated deficit in the Company’s condensed consolidated balance sheets. 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 settled inapproximately $1.13 billion, after deducting underwriting discounts and commissions and the offering expenses payable by the Company.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
In February 2020, resultingthe 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 decreaseloss on settlement of convertible notes of $50.8 million, which is recorded in interest expense in the liability.​Company’s condensed 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.
(3)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 carryingNotes 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 construction loan approximates fair value dueNotes to be repurchased, plus accrued and unpaid interest.
Based on the closing price of the Company’s common stock of $95.45 on September 30, 2021, the if-converted values on the Company’s 2025 Notes exceed the principal amount by $83.6 million and 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 short-term natureNotes; (ii) rank equal in right of this instrument.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 construction loan is privately held with no public marketfollowing table summarizes the original issuance costs at the time of issuance for this debt and therefore is classified as a Level 3 fair value measurement. each set of Notes:
(In thousands)
January 2025 Notes$10,284 
June 2025 Notes7,362 
2027 Notes14,285 
2028 Notes24,453 
The change in the fair value was due to payments madeNotes do not contain any financial or operating covenants or any restrictions on the loan resulting in a decrease inpayment of dividends, the liability.issuance of other indebtedness or the issuance or repurchase of securities by the Company.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Interest expense includes the following:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2021202020212020
Debt issuance costs amortization$1,444 $1,443 $4,284 $3,860 
Debt discount amortization37 37 110 94 
Loss on settlement of convertible notes— — — 50,819 
Coupon interest expense2,566 2,567 7,699 7,065 
Total interest expense on convertible notes4,047 4,047 12,093 61,838 
Other interest expense633 431 1,855 1,544 
Total interest expense$4,680 $4,478 $13,948 $63,382 
The effective interest rates on the 2025 Notes, 2027 Notes, and 2028 Notes for the three months ended September 30, 2021 and 2020 were 1.18%, 0.68%, and 0.64% and 1.18%, 0.68%, and 0.64%, respectively. The effective interest rates on the 2025 Notes, 2027 Notes, and 2028 Notes for the nine months ended September 30, 2021 and 2020 were 1.18%, 0.67%, and 0.64% and 1.21%, 0.68%, and 0.63%, respectively. The remaining period over which the unamortized debt discount will be recognized as non-cash interest expense is 3.30, 5.46, and 6.42 years for the 2025 Notes, 2027 Notes, and 2028 Notes, respectively.

(7)(10) 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 low single-digit royalties based on net revenues received using the technologies and may require minimum royalty amounts or maintenance fees.
Mayo
In June 2009 the Company entered into a license agreement with 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Pursuant to the Company’s agreement with Mayo, the Company is required to pay Mayo a low-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.
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 Company paid Mayo the first annual installment of $1.3 millioninstallments are recorded in research and development expenses in the third quarterCompany’s condensed consolidated statements of 2020 and will make all subsequent annual payments in the first quarteroperations.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 20372038 (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 $0.9$1.3 million and $1.0$0.9 million for the three months ended September 30, 20202021 and 2019,2020, respectively. The Company incurred charges of $2.8$3.5 million and $3.6$2.8 million for the nine months ended September 30, 20202021 and 2019,2020, respectively. The charges incurred in connection with this collaboration are recorded in research and development expenses in the Company’s condensed consolidated statements of operations.
Epic SciencesJohns Hopkins University (“JHU”)
In June 2016, Genomic Health (nowThrough the acquisition of Thrive, the Company acquired a wholly-owned subsidiary of the Company) entered into a collaborationworldwide exclusive license agreement with Epic Sciences, which was supersededJHU for use of several JHU patents and replaced in March 2019 by alicensed know-how. The license agreement and laboratory services agreement with Epic Sciences, under which Genomic Health was granted exclusive distribution rightsis designed to commercialize Epic Sciences’ AR-V7 Nucleus Detect testenable the Company to leverage JHU proprietary data in the United States, which is marketed as Oncotype DX AR-V7 Nucleus Detect. The Company has primary responsibility, in accordance with applicable lawsdevelopment and regulations, for marketing and promoting the test, order fulfillment, billing and collectionscommercialization of receivables, claims appeals, customer support, and providing and maintaining order management systems for the test. Epic Sciences is responsible for performing all tests, performing studies including analytic and clinical validation studies, and seeking Medicare coverage and a Medicare payment rate from the CMS for theblood-based, multi-cancer early detection test. The licenseagreement terms include single-digit sales-based royalties and laboratory service agreement has a termsales-based milestone payments of ten years from June 2016, unless terminated earlier under certain circumstances. The Oncotype DX AR-V7 Nucleus Detect test became commercially available in February 2018. The Company recognizes revenues for the test performed under this arrangement$10.0 million, $15.0 million, $20.0 million upon achieving calendar year licensed product revenue using JHU proprietary data of $0.50 billion, $1.00 billion, and Epic Sciences receives a fee per test performed that represents the fair market value for the testing services they perform.
Biocartis N.V.
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 has 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 an option to expand the collaboration to include additional tests in oncology and urology. The Company has primary responsibility for developing, validating and obtaining regulatory authorizations and registrations for IVD Oncotype DX tests to be performed on the Idylla platform. The Company is also responsible for manufacturing and commercialization activities with respect to such tests.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Pursuant to the license and development agreement, Genomic Health recorded a one-time upfront license and option fee of $3.2 million. In December 2017, Genomic Health purchased 270,000 ordinary shares of Biocartis, a public company listed on the Euronext exchange, for a total cost of $4.0 million. This investment was subject to a lock-up agreement that expired in December 2018. The investment has been recognized at fair value, which the Company estimated to be $1.4 million and $1.7 million as of September 30, 2020 and December 31, 2019, respectively, and is included in marketable securities on the Company's condensed consolidated balance sheets.
Under a November 2018 addendum to the license and development agreement, the Company exercised its option to expand the collaboration to include tests in urology and obtained a right of first refusal to add a test for the non-invasive detection of prostate cancer in a pre-biopsy setting.
Additional terms of the license and development agreement and the addendum include the Company’s obligation to pay Biocartis (i) an aggregate of €2.5 million in cash upon achievement of certain milestones, (ii) €2.0 million for the expansion of the collaboration to include additional tests in oncology, and (iii) certain royalties based primarily on the future sales volumes of the Company’s tests performed on the Idylla platform.
The Company is currently in discussions with Biocartis to terminate the agreements. The outcome of these discussions is not determinable at this time. Refer to Note 5 for further information regarding Biocartis.$1.50 billion, respectively.

(8)(11) PFIZER PROMOTION AGREEMENT
In 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 extends the relationship between the Company and Pfizer and restructures the manner in which the Company compensates Pfizer for promotion of the Cologuard test through a service fee, and provision of certain other sales and marketing services related to Cologuard.the Cologuard test. The Restated Promotion Agreement also includes additional fixed and performance-related fees, some of which retroactively gowent into effect on April 1, 2020. All payments to Pfizer are recorded in sales and marketing expenses in the Company’s condensed 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, the service fee provides a fee-for-service model that includes certain fixed fees and performance-related bonuses. The performance-related bonuses are 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 $15.8$16.8 million and $18.0 million for the service fee for the three months ended September 30, 2021 and 2020, respectively. The Company incurred charges of $63.6 million and $39.7 million for the service fee for the nine months ended September 30, 2021 and 2020, respectively. The Company incurred charges of $30.2 million and $15.8 million for promotion, sales and marketing services performed by Pfizer on behalf of the Company during the three months ended September 30, 20202021 and 2019,2020, respectively. The Company incurred charges of $57.6$88.0 million and $49.8$56.3 million for promotion, sales and marketing services performed by Pfizer on behalf of the Company during the nine months ended September 30, 2021 and 2020, respectively. During 2022, and 2019, respectively. Undercontingent upon the Original Promotion Agreement,achievement of certain Cologuard test revenue metrics during 2021, the service fee was calculatedCompany will pay Pfizer a royalty based on incremental gross profits over specified baselines during the term. The Company incurred charges of $16.0 million and $54.5 million for this service fee during the three and nine months ended September 30, 2019. Under the Restated Promotion Agreement, the service fee was reviseda low single-digit royalty rate applied to a fee-for-service model, and includes certain fixed fees and performance-related bonuses. The Company incurred charges of $18.0 million and $37.5 million for the service fee during the three and nine months ended September 30, 2020. The Company will also pay Pfizer royalties foractual 2022 Cologuard related revenues over specified thresholds during the last year of the term of the Restated Promotion Agreement.test revenues. The term of the Restated Promotion Agreement runs through December 31, 2022.

(12) STOCKHOLDERS’ EQUITY
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 17, the Company issued 0.1 million common shares that had a fair value of $16.2 million.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
(9) 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.
Convertible Notes SettlementThrive Acquisition Stock Issuance
In March 2019,January 2021, the Company used cashcompleted its acquisition of $494.1Thrive. In connection with the acquisition, which is further described in Note 17, the Company issued 9.3 million and an aggregatecommon shares that had a fair value 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 convertible notes. Refer to Note 15 for further discussion of this settlement transaction.$1.19 billion.
Genomic Health CombinationTargeted Digital Sequencing (“TARDIS”) License Acquisition Stock Issuance
In November 2019,January 2021, the Company completedacquired a worldwide exclusive license to the combination with Genomic HealthTARDIS technology from The Translational Genomics Research Institute (“TGen”), which is further described in a cash and stock transaction valued at $2.5 billion. Of the $2.5 billion purchase price, $1.4 billion was settled through the issuance of 17.0 million shares of common stock. The Company incurred $0.4 million in stock issuance costs asNote 17. As part of the transaction. Refer to Note 16 for further discussion of the consideration transferred, as partthe Company issued 0.2 million shares that had a fair value of the combination with Genomic Health.$27.3 million.
Paradigm Diagnostics, Inc. and Viomics, Inc. 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 valued atwith 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 September 30, 2020,2021, and the remainder was withheld and may become issuable as additional merger consideration on June 3, 2021 subject to the terms and conditions of the acquisition agreements.
Changes in Accumulated Other Comprehensive Income (Loss)
The amount recognized in accumulated other comprehensive income (loss) (“AOCI”)AOCI for the nine months ended September 30, 2021 were as follows:
(In thousands)Unrealized
Gain (Loss)
on Marketable
Securities
Accumulated
Other
Comprehensive
Income (Loss)
Balance at December 31, 2020$526 $526 
Other comprehensive loss before reclassifications(292)(292)
Amounts reclassified from accumulated other comprehensive loss(271)(271)
Net current period change in accumulated other comprehensive loss, before tax(563)(563)
Income tax expense related to items of other comprehensive income170 170 
Balance at September 30, 2021$133 $133 
The amounts recognized in AOCI for the nine months ended September 30, 2020 were as follows:
(In thousands)(In thousands)Foreign
Currency
Translation
Adjustments
Unrealized
Gain (Loss)
on Marketable
Securities
Accumulated
Other
Comprehensive
Income (Loss)
(In thousands)Foreign
Currency
Translation
Adjustments
Unrealized
Gain (Loss)
on Marketable
Securities (1)
Accumulated
Other
Comprehensive
Income (Loss)
Balance at December 31, 2019Balance at December 31, 2019$(25)$(75)$(100)Balance at December 31, 2019$(25)$(75)$(100)
Other comprehensive income (loss) before reclassifications1,159 1,159 
Other comprehensive loss before reclassificationsOther comprehensive loss before reclassifications— 1,159 1,159 
Amounts reclassified from accumulated other comprehensive lossAmounts reclassified from accumulated other comprehensive loss25 25 Amounts reclassified from accumulated other comprehensive loss25 — 25 
Net current period change in accumulated other comprehensive loss25 1,159 1,184 
Net current period change in accumulated other comprehensive loss, before taxNet current period change in accumulated other comprehensive loss, before tax25 1,159 1,184 
Balance at September 30, 2020Balance at September 30, 2020$$1,084 $1,084 Balance at September 30, 2020$— $1,084 $1,084 
______________
(1)There was no tax impact from the amounts recognized in AOCI for the three and nine months ended September 30, 2020.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
The amounts recognized in AOCI for the nine months ended September 30, 2019 were as follows:
(In thousands)Foreign
Currency
Translation
Adjustments
Unrealized
Gain (Loss)
on Marketable
Securities
Accumulated
Other
Comprehensive
Income (Loss)
Balance at December 31, 2018$(25)$(1,397)$(1,422)
Other comprehensive loss before reclassifications815 815 
Amounts reclassified from accumulated other comprehensive loss616 616 
Net current period change in accumulated other comprehensive loss, before tax1,431 1,431 
Income tax expense related to items of other comprehensive income(341)(341)
Balance at September 30, 2019$(25)$(307)$(332)
Amounts reclassified from AOCI for the nine months ended September 30, 20202021 and 20192020 were as follows:
Affected Line Item in the
Statements of Operations
Nine Months Ended September 30,
Affected Line Item in the
Statements of Operations
Nine Months Ended September 30,
Details about AOCI Components (In thousands)Details about AOCI Components (In thousands)Affected Line Item in the
Statements of Operations
20202019Details about AOCI Components (In thousands)Affected Line Item in the
Statements of Operations
20212020
Change in value of available-for-sale investmentsChange in value of available-for-sale investmentsChange in value of available-for-sale investments
Sales and maturities of available-for-sale investmentsSales and maturities of available-for-sale investmentsInvestment income, net$$616 Sales and maturities of available-for-sale investmentsInvestment income (expense), net$(271)$— 
Foreign currency adjustmentForeign currency adjustmentGeneral and administrative25 Foreign currency adjustmentGeneral and administrative— 25 
Total reclassificationsTotal reclassifications$25 $616 Total reclassifications$(271)$25 

(10)(13) STOCK-BASED COMPENSATION
Stock-Based Compensation Plans
The Company maintains 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 and the 2000 Stock Option and Incentive Plan (collectively, the “Stock Plans”).
Stock-Based Compensation ExpenseConstruction 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 provides 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 is collateralized by the additional clinical laboratory and related facilities.
Pursuant to the Construction Loan Agreement, funds drawn will bear interest at a rate equal to the sum of the 1-month LIBOR rate plus 2.25 percent. Regular monthly payments are 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 may be prepaid at any time without penalty. The maturity date of the Construction Loan Agreement is 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 is deemed to have been issued pursuant to the Construction Loan Agreement. The amount of the City Letter of Credit will reduce, dollar for dollar, the amount available for borrowing under the Construction Loan Agreement.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
As a condition to Fifth Third Bank’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 September 30, 2021 and December 31, 2020, the outstanding balance was $22.8 million and $23.8 million, respectively, from the Construction Loan, including $0.7 million of interest incurred, which is 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 are recorded as a direct deduction from the liability. The debt issuance costs are being amortized over the life of the Construction Loan.
The Company records stock-based compensation expensecarrying amount of the Construction Loan approximates fair value due to the short maturity of this instrument. The Construction Loan is privately held with no public market for this debt and therefore is classified as a Level 3 fair value measurement. The change 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. The Company recorded $41.5 million and $24.3 million in stock-based compensation expensefair value during the three months ended September 30, 2020 and 2019, respectively. The Company recorded $111.1 million and $60.7 million in stock-based compensation expense during the nine months ended September 30, 2021 was due to payments made on the loan resulting in a decrease in the liability.
The Construction Loan Agreement was amended effective June 30, 2020 to include a financial covenant to maintain a minimum liquidity of $250 million and remove the minimum tangible net worth covenant. As of September 30, 2021, the Company is in compliance with the covenant included in the amended agreement.
Tax Increment Financing Loan Agreements
The Company entered into 2 separate Tax Increment Financing Loan Agreements (“TIFs”) in February 2019 respectively.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 lien.

(9) CONVERTIBLE NOTES
Convertible note obligations included in the condensed consolidated balance sheet consisted of the following as of September 30, 2021:
Fair Value (2)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%$1,150,000 $(19,596)$1,130,404 $1,222,968 2
2027 Convertible notes - 0.375%747,500 (12,257)735,243 834,285 2
2025 Convertible notes - 1.000% (1)315,005 (1,901)313,104 455,204 2
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Convertible note obligations included in the condensed 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 $(21,878)$1,128,122 $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 days leading up to September 30, 2021 and December 31, 2020, holders of the 2025 Convertible Notes have the right to convert their debentures. As a result, the 2025 Convertible Notes are included within convertible notes, net, current portion on the condensed consolidated balance sheets. Some holders did convert their debentures, resulting in a decrease of the principal amount of the 2025 Convertible Notes.
(2)The fair values are based on observable market prices for this debt, which is traded in active markets and therefore is classified as a Level 2 fair value measurement.
Issuances and Settlements
In FebruaryJanuary 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 performance-based equity awardsand 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 certain employeessettle 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 vest upon the achievement of certain performance goals, including financial performance targets and operational milestones. Determining the appropriate amount$0.7 million was used to expense basedpay off interest accrued on the anticipated achievement2025 Notes. The transaction resulted in a loss on settlement of the stated goals requires judgment, including forecasting future financial results. The estimateconvertible notes 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$187.7 million, which is reflected in accumulated deficit in the periodCompany’s condensed consolidated balance sheets. The loss represents the difference between (i) the fair value of the change. Ifconsideration transferred and (ii) the financial performance targetscarrying value of the debt at the time of repurchase.
In February 2020, the Company issued and operational milestones are not achieved,sold $1.15 billion in aggregate principal amount of 0.375% Convertible Notes (the “2028 Notes” and, collectively with the award would not vest, so no compensation cost would be recognized2025 Notes and any previously recognized stock-based compensation expense would be reversed.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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
In JuneFebruary 2020, the Company modified certainused $150.1 million of the operational milestones withinproceeds from the outstanding performance-based equity awards,issuance of the 2028 Notes to settle $100.0 million of the 2025 Notes, of which were not deemed$0.1 million was used to have an impactpay off interest accrued on vestingthe 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 condensed consolidated statement of operations. The loss represents the difference between (i) the fair value of the consideration transferred and 0 incremental stock-based compensation expense was recorded(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 three2025 Notes, 2027 Notes, and nine months ended2028 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 $95.45 on September 30, 2020. This modification impacted awards held2021, the if-converted values on the Company’s 2025 Notes exceed the principal amount by 36 employees.
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 three and nine months ended September 30, 2020, the Company accelerated 0 shares and 43,480 shares of previously unvested stock options, respectively, and 9,786 shares and 38,600 shares of previously unvested restricted stock units, respectively, and recognized the additional non-cash stock-based compensation expense of $0.3$83.6 million and $4.2 million, respectively, for the accelerated awards.2027 Notes and 2028 Notes do not exceed the principal amount.
As a resultRanking of workforce reductionsConvertible Notes
The Notes are the Company’s senior unsecured obligations and (i) rank senior in April 2020 dueright of payment to all of its future indebtedness that is expressly subordinated in right of payment to the COVID-19 pandemic, the Company accelerated the vestingNotes; (ii) rank equal in right of previously unvested stock optionspayment to each outstanding series thereof and restricted stock units for employees that were terminated. The Company accelerated 708 shares of previously unvested stock options and 33,123 shares of previously unvested restricted stock units, and recognized the additional non-cash stock-based compensation expense of $1.8 million for the accelerated awards.
In connection with the termination in August 2020 of two former Genomic Health employees, the Company accelerated the vesting of 34,619 shares of previously unvested stock options and 6,836 shares of previously unvested restricted stock units as a resultto all of the former employees experiencing a deemed “qualifying termination” under the termsCompany’s future liabilities that are not so subordinated, unsecured indebtedness; (iii) are effectively junior to all of the merger agreement betweenCompany’s existing and future secured indebtedness and other secured obligations, to the Companyextent of the value of the assets securing that indebtedness and Genomic Health. Duringother 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Interest expense includes the following:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2021202020212020
Debt issuance costs amortization$1,444 $1,443 $4,284 $3,860 
Debt discount amortization37 37 110 94 
Loss on settlement of convertible notes— — — 50,819 
Coupon interest expense2,566 2,567 7,699 7,065 
Total interest expense on convertible notes4,047 4,047 12,093 61,838 
Other interest expense633 431 1,855 1,544 
Total interest expense$4,680 $4,478 $13,948 $63,382 
The effective interest rates on the 2025 Notes, 2027 Notes, and 2028 Notes for the three months ended September 30, 2021 and 2020 were 1.18%, 0.68%, and 0.64% and 1.18%, 0.68%, and 0.64%, respectively. The effective interest rates on the Company recorded non-cash stock-based compensation of $1.6 million2025 Notes, 2027 Notes, and 2028 Notes for the accelerated awards.nine months ended September 30, 2021 and 2020 were 1.18%, 0.67%, and 0.64% and 1.21%, 0.68%, and 0.63%, respectively. The previously unvested stock optionsremaining period over which the unamortized debt discount will be recognized as non-cash interest expense is 3.30, 5.46, and restricted stock units were converted awards held by6.42 years for the former employees prior2025 Notes, 2027 Notes, and 2028 Notes, respectively.

(10) 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 combination with Genomic Health in November 2019.
In addition, the former employees held awards that were granted subsequent to the combination with Genomic Health that were modified as part of severancelicense agreements withrequire the Company to vest upon separation from service.pay low single-digit royalties based on net revenues received using the technologies and may require minimum royalty amounts or maintenance fees.
Mayo
In June 2009 the Company entered into a license agreement with Mayo Foundation for Medical Education and Research (“Mayo”). The former employees will continueCompany’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 provide consulting servicescertain 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 for a fixed period, but those services were determined to be non-substantive, and therefore the unvested restricted stock units, excluding certain awards that were cancelled pursuant to the severance agreements, were fully expensed in the third quarter of 2020. 36,250 shares of previously unvested restricted stock units were expensed, andCompany’s agreement with Mayo, the Company recognized the additional non-cash stock-based compensation expense of $2.4 million in the third quarter of 2020.
Determining Fair Value
Valuation and Recognition – The fair value of each service-based option award is estimated on the date of grant using the Black-Scholes option-pricing model. 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 recognizedrequired to expense using the straight-line method over the vesting period. For awards that vest whenpay Mayo a performance condition is achieved, the Company performs an evaluation of internal and external factors to determine the number of shares that are most likely to vest based on the probability of what performance conditions will be met. 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 life of a market measure-based award is based on the applicable performance period.
Expected Volatility - Expected volatility is basedlow-single-digit royalty on the Company’s historical stock volatility data overnet sales of current and future products using the expectedlicensed Mayo intellectual property each year during the term of the awards.Mayo agreement.
Risk-Free Interest Rate -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 Company basesannual installments are recorded in research and development expenses in the risk-free interest rate on the implied yield currently available on U.S. Treasury zero-coupon issues with an equivalent expected term.
Forfeitures - The Company recognizes forfeitures as they occur.Company’s condensed consolidated statements of operations.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
The fair valuelicense agreement will remain in effect, unless earlier terminated by the parties in accordance with the agreement, until the last of each optionthe licensed patents expires in 2038 (or later, if certain licensed patent applications are issued). However, if the Company is basedstill using the licensed Mayo know-how or certain Mayo-provided biological specimens or their derivatives on such expiration date, the assumptionsterm 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 $1.3 million and $0.9 million for the three months ended September 30, 2021 and 2020, respectively. The Company incurred charges of $3.5 million and $2.8 million for the nine months ended September 30, 2021 and 2020, respectively. The charges incurred in connection with this collaboration are recorded in research and development expenses in the following table:Company’s condensed consolidated statements of operations.
Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Option Plan Shares
Risk-free interest rates(1)(1)0.11% - 1.47%2.54% - 2.59%
Expected term (in years)(1)(1)0.25 - 6.156.28
Expected volatility(1)(1)44.19% - 77.51%64.95% - 65.00%
Dividend yield(1)(1)0%0%
Weighted average fair value per share of options granted during the period(1)(1)$58.57$57.11
ESPP Shares
Risk-free interest rates(2)(2)0.12% - 0.2%2.31% - 2.44%
Expected term (in years)(2)(2)0.5 - 20.5 - 2
Expected volatility(2)(2)63.7% - 89.0%55.0% - 58.0%
Dividend yield(2)(2)0%0%
Weighted average fair value per share of stock purchase rights granted during the period(2)(2)$30.60$35.91
Johns Hopkins University (“JHU”)
______________
(1)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 did not grant options under its 2010 Omnibus Long-Term Incentive Plan or 2019 Omnibus Long-Term Incentive Plan duringto leverage JHU proprietary data in the period indicated.​
(2)development and commercialization of a blood-based, multi-cancer early detection test. The Company did not issue stock purchase rights under its 2010 Employee Stock Purchase Plan during the period indicated.agreement terms include single-digit sales-based royalties and sales-based milestone payments of $10.0 million, $15.0 million, $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.

Stock Option, Restricted Stock,
(11) PFIZER PROMOTION AGREEMENT
In August 2018, the Company entered into a Promotion Agreement (the “Original Promotion Agreement”) with Pfizer Inc. (“Pfizer”), which was amended and Restricted Stock Unit Activityrestated in October 2020 (the “Restated Promotion Agreement”). The Restated Promotion Agreement extends the relationship between the Company and Pfizer and restructures the manner in which the Company compensates 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 includes fixed and performance-related fees, some of which retroactively went into effect on April 1, 2020. All payments to Pfizer are recorded in sales and marketing expenses in the Company’s condensed consolidated statements of operations.
A summaryUnder 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, the service fee provides a fee-for-service model that includes certain fixed fees and performance-related bonuses. The performance-related bonuses are contingent upon the achievement of stock option activity undercertain annual performance criteria with any applicable expense being recognized ratably upon achievement of the Stock Planspayment becoming probable. The Company incurred charges of $16.8 million and $18.0 million for the service fee for the three months ended September 30, 2021 and 2020, respectively. The Company incurred charges of $63.6 million and $39.7 million for the service fee for the nine months ended September 30, 2021 and 2020, respectively. The Company incurred charges of $30.2 million and $15.8 million for promotion, sales and marketing services performed by Pfizer on behalf of the Company during the three months ended September 30, 2021 and 2020, respectively. The Company incurred charges of $88.0 million and $56.3 million for promotion, sales and marketing services performed by Pfizer on behalf of the Company during the nine months ended September 30, 2021 and 2020, is as follows:
OptionsSharesWeighted
Average
Exercise
Price
Weighted
Average
Remaining
Contractual
Term(Years)
Aggregate
Intrinsic
Value(1)
(Aggregate intrinsic value in thousands)
Outstanding, January 1, 20202,700,293 $34.01 6.7
Granted309,143 97.66 
Exercised(509,335)30.34 
Forfeited(71,364)82.76 
Outstanding, September 30, 20202,428,737 $41.45 6.3$146,939 
Exercisable, September 30, 20201,577,785 $26.96 5.4$118,314 
______________respectively. During 2022, and contingent upon the achievement of certain Cologuard test revenue metrics during 2021, the Company will pay Pfizer a royalty based on a low single-digit royalty rate applied to actual 2022 Cologuard test revenues. The term of the Restated Promotion Agreement runs through December 31, 2022.
(1)
The total intrinsic
(12) STOCKHOLDERS’ EQUITY
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 17, the Company issued 0.1 million common shares that had a fair value of options exercised during the nine months ended September 30, 2020 and 2019 was $29.0 million and $41.7 million, respectively, determined as of the date of exercise.$16.2 million.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
A summaryThrive Acquisition Stock Issuance
In January 2021, the Company completed its acquisition of restrictedThrive. In connection with the acquisition, which is further described in Note 17, the Company issued 9.3 million common shares 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 17. As part of the consideration transferred, the Company issued 0.2 million shares that had a fair value of $27.3 million.
Paradigm Diagnostics, Inc. and Viomics, Inc. 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 September 30, 2021, and restricted stock unit activity under the Stock Plans duringremainder 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 nine months ended September 30, 2021 were as follows:
(In thousands)Unrealized
Gain (Loss)
on Marketable
Securities
Accumulated
Other
Comprehensive
Income (Loss)
Balance at December 31, 2020$526 $526 
Other comprehensive loss before reclassifications(292)(292)
Amounts reclassified from accumulated other comprehensive loss(271)(271)
Net current period change in accumulated other comprehensive loss, before tax(563)(563)
Income tax expense related to items of other comprehensive income170 170 
Balance at September 30, 2021$133 $133 
The amounts recognized in AOCI for the nine months ended September 30, 2020 iswere as follows:
Restricted
Shares and RSUs
Weighted
Average Grant
Date Fair Value
Outstanding, January 1, 20204,384,005 $63.41 
Granted2,166,913 90.94 
Released(1,615,545)48.97 
Forfeited(280,899)80.67 
Outstanding, September 30, 20204,654,474 $80.10 
(In thousands)Foreign
Currency
Translation
Adjustments
Unrealized
Gain (Loss)
on Marketable
Securities (1)
Accumulated
Other
Comprehensive
Income (Loss)
Balance at December 31, 2019$(25)$(75)$(100)
Other comprehensive loss before reclassifications— 1,159 1,159 
Amounts reclassified from accumulated other comprehensive loss25 — 25 
Net current period change in accumulated other comprehensive loss, before tax25 1,159 1,184 
Balance at September 30, 2020$— $1,084 $1,084 
As of______________
(1)There was no tax impact from the amounts recognized in AOCI for the three and nine months ended September 30, 2020, there was $285.2 million of 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 2.8 years.

(11) 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 1 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. The Company is 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 result 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 Company does not anticipate any credit recapture will be required in connection with this financing arrangement.
The Investor and its majority owned community development entity are considered Variable Interest Entities (“VIEs”) and the Company is 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 is the primary beneficiary of the VIEs, they have been included in the consolidated financial statements. There are no other assets, liabilities or transactions in these VIEs outside of the financing transactions executed as part of the NMTC arrangement.

2020.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
(12) DEBTAmounts reclassified from AOCI for the nine months ended September 30, 2021 and 2020 were as follows:
Affected Line Item in the
Statements of Operations
Nine Months Ended September 30,
Details about AOCI Components (In thousands)20212020
Change in value of available-for-sale investments
Sales and maturities of available-for-sale investmentsInvestment income (expense), net$(271)$— 
Foreign currency adjustmentGeneral and administrative— 25 
Total reclassifications$(271)$25 

(13) STOCK-BASED COMPENSATION
Stock-Based Compensation Plans
The Company maintains 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 (collectively, the “Stock Plans”).
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 provides the Company with a non-revolving construction loan (the “Construction Loan”) of $25.6 million. The Company is usingused the Construction Loan proceeds to finance the construction of an additional clinical laboratory and related facilities in Madison, Wisconsin. The Construction Loan is collateralized by the additional clinical laboratory and related facilities.
Pursuant to the Construction Loan Agreement, funds drawn will bear interest at a rate equal to the sum of the 1-month LIBOR rate plus 2.25 percent. Regular monthly payments are 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 may be prepaid at any time without penalty. The maturity date of the Construction Loan Agreement is 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 is deemed to have been issued pursuant to the Construction Loan Agreement. The amount of the City Letter of Credit will reduce, dollar for dollar, the amount available for borrowing under the Construction Loan Agreement.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
As a condition to Fifth Third’sThird Bank’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 September 30, 20202021 and December 31, 2019,2020, the outstanding balance was $24.1$22.8 million and $25.0$23.8 million, respectively, from the Construction Loan, including $0.7 million of interest incurred, which is 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 are recorded as a direct deduction from the liability. The debt issuance costs are being amortized over the life of the Construction Loan.
The carrying amount of the Construction Loan approximates fair value due to the short maturity of this instrument. The Construction Loan is privately held with no public market for this debt and therefore is classified as a Level 3 fair value measurement. The change in the fair value during the three and nine months ended September 30, 2021 was due to payments made on the loan resulting in a decrease in the liability.
The Construction Loan Agreement was amended effective June 30, 2020 to include a financial covenant to maintain a minimum liquidity of $250 million and remove the minimum tangible net worth covenant. As of September 30, 2020,2021, the Company is in compliance with the covenant included in the amended agreement.
Tax Increment Financing Loan Agreements
The Company entered into 2 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.
By the endAs of December 31, 2019, the Company had earned and received payment of the full $4.6 million from the City of Madison. AsMadison, 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 lien.

(9) CONVERTIBLE NOTES
Convertible note obligations included in the condensed consolidated balance sheet consisted of the following as of September 30, 2020 and December 31, 2019, the Company has recorded a liability of $ $0.3 million and $2.7 million, respectively, in other current liabilities on the Company’s condensed consolidated balance sheets, reflecting when the expected benefit of the financial benefits amortization will reduce future operating expenses.2021:

Fair Value (2)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%$1,150,000 $(19,596)$1,130,404 $1,222,968 2
2027 Convertible notes - 0.375%747,500 (12,257)735,243 834,285 2
2025 Convertible notes - 1.000% (1)315,005 (1,901)313,104 455,204 2
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Convertible note obligations included in the condensed 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 $(21,878)$1,128,122 $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 days leading up to September 30, 2021 and December 31, 2020, holders of the 2025 Convertible Notes have the right to convert their debentures. As a result, the 2025 Convertible Notes are included within convertible notes, net, current portion on the condensed consolidated balance sheets. Some holders did convert their debentures, resulting in a decrease of the principal amount of the 2025 Convertible Notes.
(2)The fair values are based on observable market prices for this debt, which is traded in 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 accumulated deficit in the Company’s condensed consolidated balance sheets. 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 condensed 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 $95.45 on September 30, 2021, the if-converted values on the Company’s 2025 Notes exceed the principal amount by $83.6 million and 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Interest expense includes the following:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2021202020212020
Debt issuance costs amortization$1,444 $1,443 $4,284 $3,860 
Debt discount amortization37 37 110 94 
Loss on settlement of convertible notes— — — 50,819 
Coupon interest expense2,566 2,567 7,699 7,065 
Total interest expense on convertible notes4,047 4,047 12,093 61,838 
Other interest expense633 431 1,855 1,544 
Total interest expense$4,680 $4,478 $13,948 $63,382 
The effective interest rates on the 2025 Notes, 2027 Notes, and 2028 Notes for the three months ended September 30, 2021 and 2020 were 1.18%, 0.68%, and 0.64% and 1.18%, 0.68%, and 0.64%, respectively. The effective interest rates on the 2025 Notes, 2027 Notes, and 2028 Notes for the nine months ended September 30, 2021 and 2020 were 1.18%, 0.67%, and 0.64% and 1.21%, 0.68%, and 0.63%, respectively. The remaining period over which the unamortized debt discount will be recognized as non-cash interest expense is 3.30, 5.46, and 6.42 years for the 2025 Notes, 2027 Notes, and 2028 Notes, respectively.

(10) 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 low single-digit royalties based on net revenues received using the technologies and may require minimum royalty amounts or maintenance fees.
Mayo
In June 2009 the Company entered into a license agreement with 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 low-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.
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 condensed consolidated statements of operations.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 2038 (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 $1.3 million and $0.9 million for the three months ended September 30, 2021 and 2020, respectively. The Company incurred charges of $3.5 million and $2.8 million for the nine months ended September 30, 2021 and 2020, respectively. The charges incurred in connection with this collaboration are recorded in research and development expenses in the Company’s condensed consolidated statements 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, $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.

(11) PFIZER PROMOTION AGREEMENT
In 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 extends the relationship between the Company and Pfizer and restructures the manner in which the Company compensates 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 includes fixed and performance-related fees, some of which retroactively went into effect on April 1, 2020. All payments to Pfizer are recorded in sales and marketing expenses in the Company’s condensed 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, the service fee provides a fee-for-service model that includes certain fixed fees and performance-related bonuses. The performance-related bonuses are 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 $16.8 million and $18.0 million for the service fee for the three months ended September 30, 2021 and 2020, respectively. The Company incurred charges of $63.6 million and $39.7 million for the service fee for the nine months ended September 30, 2021 and 2020, respectively. The Company incurred charges of $30.2 million and $15.8 million for promotion, sales and marketing services performed by Pfizer on behalf of the Company during the three months ended September 30, 2021 and 2020, respectively. The Company incurred charges of $88.0 million and $56.3 million for promotion, sales and marketing services performed by Pfizer on behalf of the Company during the nine months ended September 30, 2021 and 2020, respectively. During 2022, and contingent upon the achievement of certain Cologuard test revenue metrics during 2021, the Company will pay Pfizer a royalty based on a low single-digit royalty rate applied to actual 2022 Cologuard test revenues. The term of the Restated Promotion Agreement runs through December 31, 2022.

(12) STOCKHOLDERS’ EQUITY
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 17, the Company issued 0.1 million common shares that had a fair value of $16.2 million.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 17, the Company issued 9.3 million common shares 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 17. As part of the consideration transferred, the Company issued 0.2 million shares that had a fair value of $27.3 million.
Paradigm Diagnostics, Inc. and Viomics, Inc. 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 September 30, 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 nine months ended September 30, 2021 were as follows:
(In thousands)Unrealized
Gain (Loss)
on Marketable
Securities
Accumulated
Other
Comprehensive
Income (Loss)
Balance at December 31, 2020$526 $526 
Other comprehensive loss before reclassifications(292)(292)
Amounts reclassified from accumulated other comprehensive loss(271)(271)
Net current period change in accumulated other comprehensive loss, before tax(563)(563)
Income tax expense related to items of other comprehensive income170 170 
Balance at September 30, 2021$133 $133 
The amounts recognized in AOCI for the nine months ended September 30, 2020 were as follows:
(In thousands)Foreign
Currency
Translation
Adjustments
Unrealized
Gain (Loss)
on Marketable
Securities (1)
Accumulated
Other
Comprehensive
Income (Loss)
Balance at December 31, 2019$(25)$(75)$(100)
Other comprehensive loss before reclassifications— 1,159 1,159 
Amounts reclassified from accumulated other comprehensive loss25 — 25 
Net current period change in accumulated other comprehensive loss, before tax25 1,159 1,184 
Balance at September 30, 2020$— $1,084 $1,084 
______________
(1)There was no tax impact from the amounts recognized in AOCI for the three and nine months ended September 30, 2020.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Amounts reclassified from AOCI for the nine months ended September 30, 2021 and 2020 were as follows:
Affected Line Item in the
Statements of Operations
Nine Months Ended September 30,
Details about AOCI Components (In thousands)20212020
Change in value of available-for-sale investments
Sales and maturities of available-for-sale investmentsInvestment income (expense), net$(271)$— 
Foreign currency adjustmentGeneral and administrative— 25 
Total reclassifications$(271)$25 

(13) STOCK-BASED COMPENSATION
Stock-Based Compensation Plans
The Company maintains 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 (collectively, the “Stock Plans”).
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. The Company recorded $63.6 million and $41.5 million in stock-based compensation expense during the three months ended September 30, 2021 and 2020, respectively. The Company recorded $283.3 million and $111.1 million in stock-based compensation expense during the nine months ended September 30, 2021 and 2020, respectively.
As of September 30, 2021, there was $401.6 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 2.8 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 three months ended September 30, 2021, the Company accelerated 34,167 shares of previously unvested stock options and 24,865 shares of previously unvested restricted stock awards and restricted stock units and recorded $4.5 million of non-cash stock-based compensation for the accelerated awards. During the nine months ended September 30, 2021, the Company accelerated 138,163 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 17, 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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:
Three Months Ended September 30,Nine Months Ended September 30,
2021202020212020
Option Plan Shares
Risk-free interest rates(1)(1)(1)0.11% - 1.47%
Expected term (in years)(1)(1)(1)0.25 - 6.15
Expected volatility(1)(1)(1)44.19% - 77.51%
Dividend yield(1)(1)(1)—%
______________
(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, 20212,231,059 $39.67 6.0
Granted— — 
Assumed through acquisition1,393,748 5.51 
Exercised(1,208,355)11.09 
Forfeited(36,909)62.85 
Outstanding, September 30, 20212,379,543 $33.81 5.6$147,337 
Vested and expected to vest, September 30, 20212,379,543 $33.81 5.6$147,337 
Exercisable, September 30, 20211,816,492 $25.17 4.9$127,826 
______________
(1)The weighted average grant date fair value of options granted during the nine months ended September 30, 2020 was $58.57.
(2)The total intrinsic value of options exercised during the nine months ended September 30, 2021 and 2020 was $148.8 million and $29.0 million, respectively, determined as of the date of exercise.
The Company received approximately $13.4 million and $15.4 million from stock option exercises during the nine months ended September 30, 2021 and 2020, 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
A summary of restricted stock and restricted stock unit activity during the nine months ended September 30, 2021 is as follows:
Restricted stock and restricted stock unitsSharesWeighted
Average Grant
Date Fair Value (2)
Outstanding, January 1, 20213,968,214 $79.50 
Granted2,084,705 133.80 
Assumed through acquisition242,123 127.79 
Released (1)(1,582,760)72.28 
Forfeited(406,201)99.94 
Outstanding, September 30, 20214,306,081 $109.23 
______________
(1)The fair value of restricted stock units vested and converted to shares of the Company’s common stock was $114.4 million and $79.1 million during the nine months ended September 30, 2021 and 2020, respectively.
(2)The weighted average grant date fair value of the restricted stock units granted during the nine months ended September 30, 2020 was $90.95.
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.
A summary of performance share-based compensation arrangements granted under all equity compensation unit activity is as follows:
Performance share unitsShares (1)Weighted
Average Grant
Date Fair Value (2)
Outstanding, January 1, 2021618,515 $93.22 
Granted253,120 140.96 
Released— — 
Forfeited(8,991)68.23 
Outstanding, September 30, 2021862,644 $107.49 
______________
(1)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 September 30, 2021 was 249,695.
(2)The weighted average grant date fair value of the performance share units granted during the nine months ended September 30, 2020 was $90.17.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Employee Stock Purchase Plan (“ESPP”)
The fair value of ESPP shares is based on the assumptions in the following table:
Three Months Ended September 30,Nine Months Ended September 30,
2021202020212020
ESPP Shares
Risk-free interest rates(1)(1)0.04% - 0.16%0.12% - 0.20%
Expected term (in years)(1)(1)0.5 - 20.5 - 2
Expected volatility(1)(1)48.38% - 68.51%63.67% - 89.04%
Dividend yield(1)(1)—%—%
______________
(1)The Company did not issue stock purchase rights under its 2010 Employee Stock Purchase Plan during the three months ended September 30, 2021 and 2020, respectively.

(14) COMMITMENTS AND CONTINGENCIES
Leases
Supplemental disclosure of cash flow information related to the Company’s cash and non-cash activities with its leases are as follows:
Nine Months Ended September 30, 2020Nine Months Ended September 30,
(In thousands)(In thousands)20202019(In thousands)20212020
Cash paid for amounts included in the measurement of lease liabilities:Cash paid for amounts included in the measurement of lease liabilities:Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leasesOperating cash flows from operating leases$12,827 $3,744 Operating cash flows from operating leases$19,835$12,827
Operating cash flows from finance leasesOperating cash flows from finance leases125 Operating cash flows from finance leases723125
Finance cash flows from finance leasesFinance cash flows from finance leases620 Finance cash flows from finance leases3,805620
Non-cash investing and financing activities:Non-cash investing and financing activities:Non-cash investing and financing activities:
Right-of-use assets obtained in exchange for new operating lease liabilities (1)Right-of-use assets obtained in exchange for new operating lease liabilities (1)13,662 20,147 Right-of-use assets obtained in exchange for new operating lease liabilities (1)60,48013,662
Right-of-use assets obtained in exchange for new finance lease liabilitiesRight-of-use assets obtained in exchange for new finance lease liabilities17,420 Right-of-use assets obtained in exchange for new finance lease liabilities4,29617,420
Weighted-average remaining lease term - operating leases (in years)Weighted-average remaining lease term - operating leases (in years)8.148.95
Weighted-average remaining lease term - finance leases (in years)Weighted-average remaining lease term - finance leases (in years)3.133.86
Weighted-average discount rate - operating leasesWeighted-average discount rate - operating leases6.28 %6.83 %
Weighted-average discount rate - finance leasesWeighted-average discount rate - finance leases5.42 %5.87 %
___________________________
(1)For the nine months ended September 30, 2019,2021, this includes right-of-use assets obtained fromacquired as part of the initial adoptionbusiness combinations described in Note 17 of ASC 842 of approximately $17.9$39.6 million.
As of September 30, 20202021 and December 31, 2019,2020, the Company’s right-of-use assets from operating leases are $129.8$167.9 million and $126.4$125.9 million, respectively, which are reported in operating lease right-of-use assets in the Company’s condensed consolidated balance sheets. As of September 30, 2020,2021, the Company has outstanding operating lease obligations of $134.7$182.2 million, of which $10.7$19.2 million is reported in operating lease liabilities, current portion and $124.0$163.0 million is reported in operating lease liabilities, less current portion in the Company’s condensed consolidated balance sheets. As of December 31, 2019,2020, the Company had outstanding operating lease obligations of $126.6$132.6 million, of which $7.9$11.5 million is reported in operating lease liabilities, current portion and $118.7$121.1 million is reported in operating lease liabilities, less current portion in the Company’s condensed consolidated balance sheets. The Company calculates its incremental borrowing rates for specific lease terms, used to discount future lease payments, as a function of the U.S. Treasury rate and an indicative Moody’s rating for operating leases. The Company’s weighted average discount rate and weighted average lease term remaining on operating lease liabilities is approximately 6.83% and 8.95 years, respectively.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
As of September 30, 20202021 and December 31, 2019,2020, the Company’s right-of-use assets from finance leases are $16.9$18.7 million and $0.3$18.6 million, respectively, which are reported in other long-term assets, net in the Company’s condensed consolidated balance sheets. As of September 30, 2020,2021, the Company has outstanding finance lease obligations of $16.9$19.1 million, of which $4.0$5.9 million is reported in other current liabilities and $12.9$13.2 million is reported in other long-term liabilities in the Company’s condensed consolidated balance sheets. As of December 31, 2019,2020, the Company had outstanding finance lease obligations of $0.2$18.7 million, of which $32,000$4.7 million is reported in other current liabilities and $0.2$14.0 million is reported in other long-term liabilities in the Company’s condensed consolidated balance sheets. The Company calculates its incremental borrowing rates for specific lease terms, used to discount future lease payments, as a function of the U.S. Treasury rate and an indicative Moody’s rating for finance leases.
The Company’s weighted average discount rateCompany executed a lease agreement for a new facility in La Jolla, California, which the Company is expecting to commence in the fourth quarter of 2021. The Company anticipates that it will recognize $22.9 million in operating lease right-of-use assets and weighted average lease term remaining on finance$22.9 million in operating lease liabilities is approximately 5.87% and 3.86 years,in the condensed consolidated balance sheet, respectively, upon commencement of the lease.
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 Quarterly Report on Form 10-Q, 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 initiatedand administrative subpoenas issued pursuant to the Health Insurance Portability and Accountability Act of 1996 by the United States Department of Justice (“DOJ”) concerning (1) 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 and (2) allegationsfrom 2007 to 2020. The civil damages estimate does not include potential treble damages, civil or criminal penalties or other remedies that the Company offered or gave gift cards to patients in exchange for returningDOJ could seek against the Cologuard screening test, in violationCompany. Based on the Company’s review and analysis of the Federal Anti-Kickback StatuteDOJ presentation, civil damages estimate, and False Claims Act. Therange of potential exposure, the Company hasrecorded an accrual of approximately $10 million for the three and nine months ended September 30, 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 three and nine months ended September 30, 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
been cooperating with these inquiresOn 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 hasFalse 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 these investigationsthe 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'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 and adversely affect the Company'sCompany’s business, financial condition, and results of operation.
The DOJ's investigations are still in process and the scope and outcome of the investigations is not determinable at this time. Refer to the Company’s 2019 Form 10-K for additional information onIn connection with the Company's fair value determination of the pre-acquisition loss contingency related to thecombination with Genomic Health, investigation. There can be no assurance that any settlement, resolution, oron 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 asserts 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 seeks, among other outcome of these matters during any subsequent reporting period will not have a material adverse effectthings, 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 Company’s results of operations or cash flows for that period or onamended complaint occurred in May 2021, and in September 2021 the Company’s financial position.​case was officially dismissed by the court.

(14)(15) 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 1 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. The Company is 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 result 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 Company does not anticipate any credit recapture will be required in connection with this financing arrangement.
The Investor and its majority owned community development entity are considered Variable Interest Entities (“VIEs”) and the Company is 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Because the Company is the primary beneficiary of the VIEs, they have been included in the consolidated financial statements. There are no other assets, liabilities or transactions in these VIEs outside of the financing transactions executed as part of the NMTC arrangement.

(16) WISCONSIN ECONOMIC DEVELOPMENT TAX CREDITS
During the first quarter of 2015, the Company entered into an agreement with the Wisconsin Economic Development Corporation (“WEDC”) 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. 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 seven-year period. 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.
The Company records the earned tax credits as job creation and capital investments occur. The amount of tax credits earned is recorded as a liability and amortized as a reduction of operating expenses over the expected period of benefit. The tax credits earned from capital investment are recognized 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 over the life of the agreement, as the Company is required to maintain the minimum level of full-time positions through the seven-year period.
As of September 30, 2020,2021, the Company has earned all $9.0 million of the refundable tax credits and has received payment of $5.9$7.5 million from the WEDC. The unpaid portion is $3.1$1.5 million, of which $1.6 million is reported in prepaid expenses and other current assets and $1.5 million is reported in other long-term assets, reflecting when collection of the refundable tax credits is expected to occur. As of September 30, 2021 and December 31, 2020, the Company also has recorded a $0.5 millioncorresponding liability, in other current liabilities, which reflectsreflected when the expected benefit of the tax credit amortization willwould reduce future operating expenses.​expenses, has been fully amortized.
During the three and nine months ended September 30, 2020, the Company amortized $0.6 million and $1.7 million, respectively, of the tax credits earned as a reduction of operating expenses. During the three and nine months ended September 30, 2019, the Company amortized $0.6 million and $1.8 million, respectively, of the tax credits earned as a reduction of operating expenses.

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(17) BUSINESS COMBINATIONS AND ASSET ACQUISITIONS

Business Combinations
TableAshion Analytics, LLC
On April 14, 2021, the Company completed the acquisition (“Ashion Acquisition”) of Contents
EXACT SCIENCES CORPORATION
Notesall of the outstanding equity interests of Ashion from PMed Management, LLC (“PMed”), which is a subsidiary of TGen. The Ashion Acquisition provided the Company a Clinical Laboratory Improvement Amendments (“CLIA”) certified and College of American Pathologists (“CAP”) accredited sequencing lab based in Phoenix, Arizona. Ashion developed GEMExTra®, a comprehensive genomic cancer test, and provides access to Condensed Consolidated Financial Statements
(Unaudited)
(15) CONVERTIBLE NOTES
Convertible note obligationswhole exome, matched germline, and transcriptome sequencing capabilities. The Company has included the financial results of Ashion in the condensed consolidated balance sheetsfinancial 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)Coupon Interest RateEffective Interest
Rate
Fair Value of Liability Component at
Issuance (1)
September 30, 2020December 31, 2019
2028 Convertible notes0.375%5.2%$790,608 $1,150,000 $
2027 Convertible notes0.375%6.3%472,501 747,500 747,500 
2025 Convertible notes1.000%6.0%227,103 315,049 415,049 
Total Convertible notes2,212,549 1,162,549 
Less: Debt discount (2)(628,820)(342,463)
Less: Debt issuance costs (3)(28,762)(16,481)
Net convertible debt$1,554,967 $803,605 
(In thousands)
Cash$74,775
Common stock issued16,224
Contingent consideration19,000
Total purchase price$109,999
______________
(1)As each of the convertible instruments may be settled in cash upon conversion, for accounting purposes, they were separated into a liability component and an equity component. The amount allocated to the equity component is the difference between the principal value of the instrument and the fair value of the liability component at issuance. The resulting debt discount is being amortized to interest expense at the respective effective interest rate over the contractual term of the debt. A portion of the 2025 Convertible Notes have been extinguished or converted. The fair value of the liability component at issuance reflected above represents125,444 common shares issued as part of consideration transferred was determined on the liability value at issuance for the applicable portionbasis of the 2025 Notes which remain outstanding at September 30, 2020. The fair valueaverage of the liability componenthigh and low market price of the 2025 Notes at issuanceCompany's shares on the acquisition date, which was $654.8 million with the equity component being $267.9 million.
(2)The unamortized discount consists of the following:​
(In thousands)September 30, 2020December 31, 2019
2028 Convertible notes$337,968 $
2027 Convertible notes232,038 253,340 
2025 Convertible notes58,814 89,123 
Total unamortized discount$628,820 $342,463 
(3)Debt issuance costs consists of the following:​
(In thousands)September 30, 2020December 31, 2019
2028 Convertible notes$15,569 $
2027 Convertible notes9,168 10,251 
2025 Convertible notes4,025 6,230 
Total debt issuance costs$28,762 $16,481 
$129.33.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
Issuances and Settlements​
In January 2018,The contingent consideration arrangement requires the Company issued and sold $690.0to pay $20.0 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 arrearsadditional cash consideration to PMed upon the Company’s commercial launch, on January 15 and July 15 of each year, beginning on July 15, 2018. The net proceeds fromor before the issuancetenth anniversary 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 amountAshion Acquisition, of 1.0% Convertible Notesa test for minimal residual disease (“MRD”) detection and/or treatment (the “June 2025 Notes”“Commercial Launch Milestone”). 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 will be 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 $375.0 million was allocated to the liability component, $300.8 million was allocated to the equity component, and $0.7 million was used to pay off interest accrued on the 2025 Notes. The consideration transferred was allocated to the liability and equity components of the 2025 Notes using the equivalent rate that reflected the borrowing rate for a similar non-convertible debt instrument immediately prior to settlement. The transaction resulted in a loss on settlement of convertible notes of $10.6 million, which is recorded in interest expense in the Company’s condensed consolidated statement of operations. The loss represents the difference between (i) the fair value of the liability component and (ii)Commercial Launch Milestone at the sumacquisition 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 carryingAshion 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 debt component and any unamortized debt issuance costs at the time of repurchase.
In February 2020, the Company issued and sold $1,150.0 million 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.acquisition date. 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 $1,125.6 million, 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 $85.5 million was allocated to the liability component, $64.2 million, net of a tax impact of $0.3 million, was allocated to the equity component, and $0.1 million was used to pay off interest accrued on the 2025 Notes. The consideration transferred was allocated to the liability and equity components of the 2025 Notes using the equivalent rate that reflected the borrowing rate for a similar non-convertible debt instrument immediately prior to settlement. The transaction resulted in a loss on settlement of convertible notes of $8.0 million, which is recorded in interest expense in the Company’s condensed consolidated statement of operations. The loss represents the difference between (i) the fair value of the liability componentCommercial Launch Milestone and (ii)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 summarket and thus represents a Level 3 measurement as defined in Accounting Standards Codification (“ASC”) 820. The key assumptions are described in Note 7.
The following table summarizes the estimated fair values of the carryingassets 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 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 identifiable assets acquired$53,241
Goodwill56,758
Net assets acquired$109,999
The Company recorded $39.0 million of identifiable intangible assets related to the developed technology associated with GEMExTra. 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 debt componentdeveloped 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 any unamortized debt issuance costs atrequired rate of return and tax rate. Cash flows were discounted to their present value as of the timeclosing date. Developed technology is amortized on a straight-line basis over its estimated useful life of repurchase.​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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
SummaryThe 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 Conversion Features​valuation procedures related to certain acquired assets and liabilities assumed, primarily in connection with the developed technology intangible asset.
UntilPro forma impact and results of operations disclosures have not been included due to immateriality.
During the six-months immediately precedingnine months ended September 30, 2021, the maturityCompany incurred $1.6 million of acquisition-related costs recorded in general and administrative expenses in the condensed consolidated statement of operations, respectively. 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. 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 screening test, CancerSEEK, with the Company’s scientific platform, clinical organization and commercial infrastructure will establish the Company as a leading competitor in blood-based, multi-cancer early detection. The Company has included the financial results of Thrive in the consolidated financial statements from the date of the applicable seriescombination.
The combination date fair value of Notes, each seriesthe consideration transferred for Thrive was approximately $2.19 billion, which consisted of Notes is convertible only upon the occurrencefollowing:
(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 certain events$1.19 billion based on the average of the high and during certain periods,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 set forthcompensation within general and administrative expenses in the Indentures. The Notes will be convertible into cash, sharescondensed consolidated statement 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. On or after the date that is six-months immediately preceding the maturity date of the applicable series of Notes until the close of businessoperations on the second scheduled trading day immediately preceding the maturityacquisition date holders may convert such Notes at any time.
It is the Company’s intentdue to accelerated vesting of legacy Thrive restricted stock awards (“RSA”) 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 conversion rate is subject to adjustment upon the occurrence of certain specified events but will not be adjusted for accrued and unpaid interest. In addition, holders of the Notes who convert their NotesRSU awards in connection with a “make-whole fundamental change” (as definedthe acquisition.
The Company paid $590.2 million in cash on the Indenture), will, under certain circumstances, be entitledacquisition date. Of the total consideration for cash, $585.0 million was allocated to an increasethe 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 RSA awards that were cash-settled in connection with the conversion rate.​acquisition.
If the Company undergoes a “fundamental change” (as defined in the Indenture), holders of the Notes may requireThe contingent consideration arrangement requires the Company to repurchasepay 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 Centers 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 our common stock of $101.95 on September 30, 2020, the if-converted values on our 2025 Notes exceed the principal amount by $110.8Medicare & Medicaid Services (“CMS”) coverage, for $150.0 million and the 2027 Notes and 2028 Notes do not exceed the principal amount.​
Ranking of Convertible Notes
up to $300.0 million, respectively. 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; equal in right of payment to all of the Company’s future liabilities that are not so subordinated, unsecured indebtedness; (ii) are effectively junior to all of our existing and future secured indebtedness and other secured obligations, to the extent of thefair value of the assets securing that indebtedness and other secured obligations; and (iii) are structurally subordinated to all indebtedness and other liabilitiescontingent consideration arrangement at the acquisition date was $352.0 million. The fair value of the Company’s subsidiaries.​
Whilecontingent 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 Notesmarket and thus represents a Level 3 measurement as defined in ASC 820. The key assumptions are currently classified ondescribed 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 condensed consolidated balance sheets at September 30, 2020previous ownership interest in Thrive, and $14.3 million was deemed compensatory as long-term,participation is dependent on replaced unvested equity awards vesting which requires future service. Compensation expense related to the future convertibility and resulting balance sheet classification of this liability willmilestones could be monitored at each quarterly reporting dateup to $18.2 million undiscounted and will be analyzed dependent upon market prices ofrecognized in the Company’s common stock during the prescribed measurement periods. In the event that the holders of the Notes have the election to convert the Notes at any time during the prescribed measurement period, the Notes would then be considered a current obligationfuture once probable and classified as such.​payable.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
The Company allocatesreplaced unvested stock options, RSUs, and RSAs and vested stock options with a combination-date fair value of $197.0 million. Of the total transaction costsconsideration 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 condensed 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 rates0.11% - 0.12%
Expected term (in years)1.26 - 1.57
Expected volatility65.54% - 71.00%
Dividend yield—%
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 condensed 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.
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Notes to the liability and equity components based on their relative values. Transaction costs attributable to the liability component are amortized to interest expense over the term of the Notes, and transaction costs attributable to the equity component are netted with the equity component in stockholders’ equity. Condensed Consolidated Financial Statements
(Unaudited)
The following table summarizes the originalestimated fair values of the assets acquired and liabilities assumed at the acquisition date:
(In thousands)Preliminary Allocation
January 5, 2021
Measurement Period AdjustmentsAllocation as of September 30, 2021
Cash and cash equivalents$241,748$$241,748
Prepaid expenses and other current assets3,9393,939
Property, plant and equipment29,97729,977
Operating lease right-of-use assets39,02739,027
Other long-term assets6767
In-process research and development (IPR&D)1,250,0001,250,000
Total identifiable assets acquired$1,564,758$$1,564,758
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 screening 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 projected sales, margin, required rate of return and tax rate, as well as estimates of achievement probability and timing related to the royalty and milestone obligations due to JHU, as described in Note 10.
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 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 IPR&D asset, as well as finalization of the pre-combination income tax returns.
The net loss before tax of Thrive included in the Company’s condensed consolidated statement of operations from the combination date of January 5, 2021 to September 30, 2021 was $219.6 million. The net loss before tax of Thrive included in the Company’s condensed consolidated statement of operations for the three months ended September 30, 2021 was $39.6 million.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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.
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2021202020212020
Total revenues$456,379 $408,363 $1,293,275 $1,025,052 
Net loss before tax(170,797)(224,860)(536,253)(575,981)
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 atincurred to execute the timeacquisition during the first quarter of issuance2021. These expenses are included in general and administrative expenses on the condensed consolidated statement of operations for each setthe nine months ended September 30, 2021 and are reflected in pro forma earnings for the nine months ended September 30, 2020 in the table above. The Company recorded a realized gain of Notes and$30.5 million during the respective allocationfirst quarter of 2021 in investment income (expense), net on the Company’s condensed consolidated statement of operations relating to the liabilityCompany’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 equity components:
(In thousands)January 2025 NotesJune 2025 Notes2027 Notes2028 Notes
Transaction costs allocated to:
Liability component$13,569 $5,052 $11,395 $16,811 
Equity component5,340 2,311 6,632 7,642 
Total transaction costs$18,909 $7,363 $18,027 $24,453 
is reflected in pro forma earnings for the nine months ended September 30, 2020 in the table above. The Notes do not contain any financial or operating covenants or any restrictions onCompany recorded a remeasurement of contingent consideration of $10.5 million related to Thrive in general and administrative expenses in the paymentcondensed consolidated statement of dividends,operations for the issuance of other indebtedness or the issuance or repurchase of securities by the Company.​
Interest expense includes the following:​
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2020201920202019
Debt issuance costs amortization$1,123 $658 $3,084 $1,989 
Debt discount amortization19,461 10,322 52,138 28,789 
Loss on settlement of convertible notes7,954 10,558 
Coupon interest expense2,567 1,739 7,065 5,585 
Total interest expense on convertible notes23,151 12,719 70,241 46,921 
Other interest expense431 490 1,406 990 
Total interest expense$23,582 $13,209 $71,647 $47,911 
The remaining period over which the unamortized debt discount will be recognized as non-cash interestnine months ended September 30, 2021. This expense is 7.42, 6.46,reflected in the nine months ended September 30, 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 4.30 yearsfactually 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 nine months ended September 30, 2021, the Company incurred $10.3 million of acquisition-related costs recorded in general and administrative expenses in the condensed 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 $4.5 million of expense related to vesting of previously unvested equity awards and $1.2 million of additional benefit charges for the 2028 Notes, 2027 Notes,three months ended September 30, 2021. The Company recorded $19.0 million of expense related to vesting of previously unvested equity awards and 2025 Notes, respectively.

(16) BUSINESS COMBINATIONS$3.9 million of additional benefit charges for the nine months ended September 30, 2021.
Paradigm Diagnostics, Inc. and Viomics, Inc.
On March 3, 2020, the Company acquired all of the outstanding capital stock of Paradigm and Viomics, two related party companies of one another headquartered in Phoenix, Arizona, in transactions that arewere 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.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 September 30, 2020,2021, 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 condensed consolidated balance sheet as of September 30, 2020.2021. The purchase price was allocated to the underlying assets acquired and liabilities assumed based upon their estimated fair values at the date of acquisition as follows:
(In thousands)
Net operating assets$5,373 
Goodwill30,431 
Developed technology7,800 
Net operating liabilities(3,203)
Total purchase price$40,401 
(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 measurement period adjustments primarily related to accounts receivable valuation and working capital adjustments.
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 condensed consolidated statement of operations.
The partial year results from the operations of Paradigm and Viomics are included in the Company’s condensed consolidated financial statements and not disclosed separately due to immateriality. Pro forma disclosures have not been included due to immateriality.Asset Acquisitions
Genomic Health,PFS Genomics Inc.
On November 8, 2019,May 3, 2021, the Company acquired all90% of the outstanding capital stock of Genomic Health. Genomic Health, headquarteredPFS Genomics Inc. (“PFS”). On June 23, 2021, the Company completed the acquisition of the remaining 10% interest in Redwood City, California, provides genomic-based diagnostic tests that address bothPFS. The Company paid cash of $33.6 million for 100% of the overtreatmentoutstanding capital stock in PFS. PFS is a healthcare company focused on personalizing treatment for breast cancer patients to improve outcomes and optimalreduce unnecessary treatment. The Company expects this acquisition to expand its ability to help guide early-stage breast cancer treatment of early and late stage cancer.through individualized radiotherapy treatment decisions.
The Company entered into this combination to create a leading global cancer diagnostics company and provide a robust platform for continued growth. This combination provides the Company with a commercial presence in more than 90 countries in which the combined company expects to continue to increase adoptiontransaction was treated as an asset acquisition under GAAP because substantially all of current tests, and to bring new innovative cancer tests to patients around the world.
Refer to the Company’s 2019 10-K for detailed disclosures on the combination, including the fair value of the consideration transferred, purchase price allocation,gross assets acquired were deemed to be associated with the acquired technology.
The assets acquired and goodwill and intangible assets identifiedliabilities assumed were substantially comprised of the IPR&D asset as shown in the transaction. Duringtable below. The IPR&D asset acquired was recorded to research and development expense in the period ended September 30, 2020, there werecondensed consolidated statement of operations immediately after acquisition as the asset was deemed to be incomplete and had no material changes toalternative future use at the purchase price allocation.time of acquisition.
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Notes to Condensed Consolidated Financial Statements
(Unaudited)
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 condensed 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 three and nine months ended September 30, 2021.

(17)(18) 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.
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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
The following table summarizes total revenue from customers by geographic region. Product revenues are attributed to countries based on ship-to location.
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)(In thousands)2020201920202019(In thousands)2021202020212020
United StatesUnited States$392,120 $218,805 $968,825 $580,718 United States$429,150 $392,120 $1,213,142 $968,825 
Outside of United StatesOutside of United States16,243 56,227 Outside of United States27,229 16,243 80,133 56,227 
Total revenuesTotal revenues$408,363 $218,805 $1,025,052 $580,718 Total revenues$456,379 $408,363 $1,293,275 $1,025,052 
Long-lived assets located in countries outside of the United States are not significant.

(18)(19) INCOME TAXES
The Company recorded an income tax benefit of $4.5$3.9 million and an expense of $0.7$2.8 million for the three months ended September 30, 20202021 and 2019,2020, respectively. The Company recorded an income tax benefit of $7.1$242.6 million and $0.2$5.3 million for the nine months ended September 30, 20202021 and 2019,2020, respectively. The Company’s income tax benefitexpense recorded during the three and nine months ended September 30, 2020,2021 is primarily related to foreign tax expense, as well as the future limitations on and expiration of certain Federal and State deferred tax assets. AsThe Company’s income tax benefit recorded during the nine months ended September 30, 2021 is primarily related to an income tax benefit of $239.2 million recorded as a result of these limitations, the recording of achange in the deferred tax asset valuation allowance resulted in aresulting from the Thrive Merger. A deferred tax liability of approximately $21.5$32.7 million remainingwas recorded as of September 30, 2020,2021, which is included in other long-term liabilities on the Company’s condensed consolidated balance sheet. The Company’s income tax benefit recorded during the nine months ended September 30, 2019 was primarily related to the intraperiod tax allocation rules that required the Company to allocate the provision for income taxes between continuing operations and other categories of earnings. The Company continues to maintain a full valuation allowance against its deferred tax assets based on management’s determination that it is more likely than not the benefit will not be realized.
The Company had $14.4$17.7 million and $10.2$16.6 million of unrecognized tax benefits at September 30, 20202021 and December 31, 2019,2020, 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 anticipateexpect a material change to itsin unrecognized tax benefits overin the next 12 months that would affect its effective tax rate. Unrecognized tax benefits may change duringtwelve months.
As of September 30, 2021, due to the next 12 months for items that arise incarryforward of unutilized net operating losses and research and development credits, the ordinary course of business.
Accrued interest and penalties related to unrecognized tax benefits are recognized as part of the Company’s income tax provision in its condensed consolidated statements of operations. The Company is subject to U.S. federal income tax examinations for the tax years 2001 through 2020,2021, and to state income tax examinations for the tax years 20032001 through 2020, and for the years 2014 through 2020 in foreign jurisdictions.2021. No interest or penalties related to income taxes have been accrued or recognized as of September 30, 2021.

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EXACT SCIENCES CORPORATION
Notes to Condensed Consolidated Financial Statements
(Unaudited)
(19) SUBSEQUENT EVENTS
In October 2020, the Company and Pfizer entered into an Amended and Restated Cologuard Promotion Agreement (the “Restated Agreement”), which modifies, and amends and restates in its entirety, the Promotion Agreement effective August 2018. The term of the Restated Agreement runs until December 31, 2022. The Restated Agreement extends the relationship between the Company and Pfizer and restructures the manner in which the Company compensates Pfizer for promotion of Cologuard and provision of certain other sales and marketing services related to Cologuard. The Company agreed to pay Pfizer specified amounts for each instance Pfizer promotes Cologuard to a healthcare provider that is eligible to prescribe Cologuard, which includes a one-time lump sum payment for the promotion of Cologuard between April 1, 2020 and September 30, 2020. The Company also agreed to pay Pfizer certain bonuses during 2020 and 2021, certain quarterly fees in 2020 and 2021, and a one-time fee in connection with Pfizer securing certain media and advertising for Cologuard for 2022. During the last year of the term of the Restated Agreement, the Company agreed to pay Pfizer a royalty based on Cologuard revenues over a specified threshold. See Note 8 for further discussion on the Promotion Agreement with Pfizer.
On October 26, 2020, the Company acquired all of the outstanding capital stock of Base Genomics Limited, headquartered in Cambridge, England, for $410.0 million in cash, net of cash received and certain other adjustments. This acquisition was funded with cash on hand and is expected to enhance the Company’s efforts in multi-cancer and colorectal cancer screening, as well as other cancers across the continuum.
On October 26, 2020, the Company entered into a definitive agreement and plan of merger (the “Thrive Merger Agreement”) with Thrive Earlier Detection Corporation (“Thrive”), which contemplates that, among other things, Thrive will be merged with and into one of the Company’s wholly owned subsidiaries, with the Company’s previously existing subsidiary surviving. Thrive is a healthcare company dedicated to incorporating earlier cancer detection into routine medical care. The Company expects that combining Thrive’s early-stage screening test, CancerSEEK, with the Company’s scientific platform, clinical organization and commercial infrastructure will establish the Company as a leading competitor in blood-based, multi-cancer screening. Under the terms of the Thrive Merger Agreement, Thrive will receive total consideration of $2.2 billion, of which $1.7 billion would be payable at closing, comprised of 35% in cash and 65% in the Company’s common stock. An additional $450.0 million would be payable in cash based upon the achievement of certain milestones related to the development and commercialization of a blood-based, multi-cancer screening test. The Thrive merger was approved by the Company’s board of directors and the board of directors and stockholders of Thrive. The Company currently expects the Thrive merger to close during the first quarter of 2021, subject to customary closing conditions and regulatory approvals.
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Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations​Operations
The following discussion of our financial condition and results of operations should be read in conjunction with the condensed consolidated financial statements and the related notes thereto included elsewhere in this Quarterly Report on Form 10-Q and the audited financial statements and notes thereto and Management’s Discussion and Analysis of Financial Condition and Results of Operations included in our Annual Report on Form 10-K for the year ended December 31, 2019,2020, which has been filed with the SEC (the “2019“2020 Form 10-K”).
Forward-Looking Statements​Statements
This Quarterly Report on Form 10-Q contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, that are intended to be covered by the “safe harbor” created by those sections. Forward-looking statements, which are based on certain assumptions and describe our future plans, strategies and expectations, can generally be identified by the use of forward-looking terms such as “believe,” “expect,” “may,” “will,” “should,” “would,” “could,” “seek,” “intend,” “plan,” “goal,” “project,” “estimate,” “anticipate” or other comparable terms. All statements other than statements of historical facts included in this Quarterly Report on Form 10-Q regarding our strategies, prospects, expectations, financial condition, operations, costs, plans objectives and the pending acquisition of Thrive Earlier Detection Corporation (“Thrive”)objectives are forward-looking statements. Examples of forward-looking statements include, among others, statements we make regarding expected future operating results, anticipated results ofresults; our sales, marketingstrategies, positioning, resources, capabilities and patient adherence efforts, expectations concerning payer reimbursement, the anticipated results of our product development efforts,for future events or performance; and the anticipated benefits of the pending acquisition of Thrive,our acquisitions, including estimated synergies and other financial impacts, and the expected timing of completion of the transaction.impacts. Forward-looking statements are neither historical facts nor assurances of future performance or events. Instead, they are based only on current beliefs, expectations and assumptions regarding the future of our business, future plans and strategies, projections, anticipated events and trends, the economy and other future conditions. Because forward-looking statements relate to the future, they are subject to inherent uncertainties, risks and changes in circumstances that are difficult to predict and many of which are outside of our control. Actual results, conditions and events may differ materially from those indicated in the forward-looking statements. Therefore, you should not rely on any of these forward-looking statements. Important factors that could cause actual results, conditions and events to differ materially from those indicated in the forward-looking statements include, among others, the following: uncertainties associated with the coronavirus (COVID-19)(“COVID-19”) pandemic, including its possible effects on our operations, including our supply chain and clinical studies, and the demand for our cancer and COVID-19 testing products and services; our ability to efficiently and flexibly manage our business amid uncertainties related to COVID-19; our ability to successfully and profitably market our products and services; our ability to realize the benefits of our recently hired sales representatives and our promotion agreement with Pfizer;the acceptance of our products and services by patients and healthcare providers; our ability to meet demand for our products and services; the success of our efforts to facilitate patient access to Cologuard via telehealth; the willingness of health insurance companies and other payers to cover our products and services and adequately reimburse us for such products and services; the amount and nature of competition for our products and services; the effects of the adoption, modification or repeal of any law, rule, order, interpretation or policy relating to the healthcare system, including without limitation as a result of any judicial, executive or legislative action;action affecting us or the effects of changes in pricing, coverage and reimbursement for our products and services, including without limitation as a result of the Protecting Access to Medicare Act of 2014;healthcare system; recommendations, guidelines and quality metrics issued by various organizations such as the U.S. Preventive Services Task Force, the American Society of Clinical Oncology, the American Cancer Society, and the National Committee for Quality Assurance regarding cancer screening or our products and services; our ability to successfully develop new products and services and assess potential market opportunities; our ability to effectively enter into and utilize strategic partnerships such as through our Restated Promotion Agreement with Pfizer, Inc., and acquisitions; our success establishing and maintaining collaborative, licensing and supplier arrangements; our ability to obtain and the ability of Thrive and Base Genomics Limited (“Base”), to maintain regulatory approvals and comply with applicable regulations; our ability to manage an international business and our expectations regarding our international expansion and opportunities; the potential effects of foreign currency exchange rate fluctuations and our efforts to hedge such effects; the possibility that the anticipated benefits from our business acquisitions (including the pending acquisition of Thrive and recent acquisition of Base) cannotwill not be realized in full or at all or may take longer to realize than expected; the possibility that costs or difficulties related to the integration of acquired businesses’ (including Thrive’s and Base’s) operations will be greater than expected and the possibility of disruptions tothat integration efforts will disrupt our business during integration efforts and strain on management time and resources; the outcome of any litigation, government investigations, enforcement actions or other legal proceedings; theproceedings, including in connection with acquisitions; our ability of the
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Company and Thrive to receive the required the required regulatory approvals for the pending merger and to satisfy the conditions to the closing of the transaction on a timely basis or at all; the occurrence of events that may give rise to a right of one or both of the Company and Thrive to terminate the merger agreement; possible negative effects of the announcement or the consummation of the pending acquisition of Thrive or recent acquisition of Base on the market price of our common stock and/or on our and/or Thrive’s or Base’s respective businesses, financial conditions, results of operations and financial performance; significant transaction costs and/or unknown liabilities; risks associated with contracts containing consent and/or other provisions that may be triggered by the pending acquisition of Thrive or the recent acquisition of Base; risks associated with potential transaction-related litigation; the ability of Thrive, Base and the combined company to retain and hire key personnel; and the otherpersonnel, including employees at businesses we acquire. The risks included above are not exhaustive. Other important risks and uncertainties are described in the Risk Factors and in Management’s Discussion and Analysis of Financial Condition and Results of Operations sections of the 20192020 Form 10-K and subsequently filed Quarterly Reports on Form 10-Q. You are further cautioned not to place undue reliance upon any such forward-looking statements, which speak only as of the date made. Except as otherwise required by the federal securities laws, we undertake no obligation to publicly update any forward-looking statement, whether written or oral, that may be made from time to time, whether as a result of new information, future developments or otherwise.
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Overview
Exact Sciences Corporation (together with its subsidiaries, “Exact,” “we,” “us,” “our” or the “Company”) is a leading global cancer diagnostics company. We have developed some of the most impactful brands in cancer diagnostics, and we are currently working on the development of additional tests, for other types of cancer, with the goal of bringing new innovative cancer tests to patients throughout the world.
Acquisitions
Refer to Note 17 of our condensed consolidated financial statements included in this Quarterly Report on Form 10-Q for full discussion of acquisitions completed during the year.
Our Cologuard Test
Colorectal cancer is the second leading cause of cancer deaths in the United States (“U.S.”) and the leading cause of cancer deaths in the U.S.United States among non-smokers. In 2020 in the U.S.United States there are projectedwas estimated to be approximately 148,000 new cases of colorectal cancer and 53,000 deaths from colorectal cancer. It is widely accepted that colorectal cancer is among the most preventable, yet least prevented cancers.
Our CologuardCologuard® test is a non-invasive stool-based DNA (“sDNA”) screening test that utilizes a multi-target approach to detect DNA and hemoglobin biomarkers associated with colorectal cancer and pre-cancer. Upon approval by the U.S. Food and Drug Administration (“FDA”) in August 2014, our Cologuard test became the first and only FDA-approved sDNA non-invasive colorectal cancer screening test. Our Cologuard test is now indicated for average risk adults 45 years of age and older.
Our original premarket approval submission to the FDA for Cologuard included the results of our pivotal DeeP-C clinical trial that had over 10,000 patients enrolled at 90 sites in the U.S. and Canada. The results of our DeeP-C clinical trial for Cologuard were published in the New England Journal of Medicine in April 2014. The peer-reviewed study, “Multi-target Stool DNA Testing for Colorectal-Cancer Screening,” highlighted the performance of Cologuard in the trial population:​
Cancer Sensitivity: 92%
Stage I and II Cancer Sensitivity: 94%
High-Grade Dysplasia Sensitivity: 69%
Specificity: 87%​​
Our Oncotype DX Tests
With our Oncotype IQ Genomic Intelligence Platform we are applyingWe apply our world-class scientific and commercial expertise and infrastructure to lead the translation of clinical and genomic data into clinically actionable results for treatment planning throughout the cancer patient'spatient’s journey, from diagnosis to treatment selection and monitoring. Our Oncotype IQ Genomic Intelligence Platform is currently comprised oftests include our flagship line of Oncotype DXDX® gene expression tests for breast, prostate and colon cancer, as well as Oncotype DX AR-V7 Nucleus Detect® test, a liquid-based test for advanced stage prostate cancer.
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We believe our Oncotype DX tests provide information that hasIn October 2020, we announced the following benefits:
Improved Qualityintroduction of Treatment Decisions. We believe our approach to genomic-based cancer analysis improves the quality of cancer treatment decisions by providing an individualized analysis of each patient’s tumor that is correlated to clinical outcome, rather than solely using subjective, anatomic and qualitative factors to determine treatments. Our Oncotype DX tests for breast cancer, Ductal Carcinoma in Situ (“DCIS”), prostate cancer, and colon cancer have been analytically and clinically validated in multiple published studies. The Recurrence Score® results from our tests have been demonstrated to classify patients into recurrence risk categories different than classifications based primarily on clinical and pathologic features. Additionally, multiple decision impact studies conducted worldwide consistently show that the Recurrence Score result changes treatment decisions in more than 30% of patients. As a result, we believe our tests enable patients and healthcare providers to make more informed decisions about the risks and benefits of various treatments, and consequently design an individualized treatment plan.
Improved Health Economics of Cancer Care. We believe that improving the quality of treatment decisions can result in significant economic benefits. The results of a number of clinical studies have demonstrated that by using the Oncotype DX Breast Recurrence Score®MAPTM Pan-Cancer Tissue (“Oncotype MAP”) test, physicians andwhich is a rapid, comprehensive tumor profiling panel that aids therapy selection for patients can better evaluate treatment options, such as whether a patient willwith advanced, metastatic, refractory, or will not benefit from chemotherapy. Patients are benefited when (1) those who aren’t likely to benefit from chemotherapy avoid it and the associated chemotoxicities and (2) those who are likely to benefit from chemotherapy receive it resulting in reduced incidence of distant recurrences. These better clinical outcomes increase survival rates and also save the patient as well as the healthcare system significant costs.recurrent cancer.
International Business Background and Products
Prior to our combination with Genomic Health, we did not have international revenue. We now commercialize our Oncotype DX tests internationally through employees in Canada, Japan and six European countries, as well as through exclusive distribution agreements. We have provided our Oncotype DX tests in more than 90 countries outside of the United States. We do not offer our Cologuard test or COVID-19 testing outside of the U.S.United States.
Inclusion
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Table of our products in guidelines and quality measures will be critical to our international success. The Oncotype DX breast cancer test is recognized in international guidelines issued by the St. Gallen International Breast Cancer Expert Panel and European Society for Medical Oncology and has been included in certain guidelines and recommendations in England, Germany and Japan. We have obtained coverage for our invasive breast cancer test outside of the U.S., including coverage for certain patients in Canada, France, Spain, Germany, Italy, Ireland, Israel, Saudi Arabia, Switzerland, and the United Kingdom. We expect that broadening coverage and reimbursement for our Oncotype DX tests outside of the United States will take years.Contents
Pipeline Research and Development
Our research and development efforts are focused on developing new products and enhancing existing products to address new cancer areas and expand the clinical utility and addressable patient populations for our existing tests. These development efforts may lead to a variety of possible new products, including risk assessment, screening and prevention, early disease diagnosis, adjuvant and/or neoadjuvant disease treatment, metastatic disease treatment selection and patient monitoring.
In October 2020 we announced the introduction of the Oncotype MAP™ Pan-Cancer Tissue test (“Oncotype MAP” test). The Oncotype MAP test is a rapid, comprehensive tumor profiling panel that aids therapy selection for patients with advanced, metastatic, refractory, or recurrent cancer. The Oncotype MAP test utilizes next generation sequencing and immunohistochemistry to provide in-depth insights into genomic alterations in hundreds of cancer-related genes. The Oncotype MAP test report supports clinical decision making by showing actionable biomarkers associated with more than 100 evidence-based therapies, over 45 combination therapies, and more than 650 active clinical trial associations. The identification of these biomarkers helps to inform treatment options for a breadth of solid tumor types.
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Through our collaboration with Mayo Foundation for Medical Education and Research, we have successfully performed validation studies on multiple types of cancer using tissue, blood and other samples. In September 2020, Mayo agreed to make available certain personnel to provide us product development and research and development assistance through January 2025. We are currently focusing our research and development efforts on building a pipeline of potential future products and services with a focus on improving Cologuard's performance characteristics and on developing blood or other fluid-based (“liquid biopsy”) tests. We expect to advance liquid biopsy through biomarker discovery and validation in tissue, blood, or other fluids.
fluids and to leverage recent business development activities to accelerate our leadership in earlier cancer detection and treatment guidance. We are pursuing the following opportunities:
Colon Cancer Screening. We are seeking opportunities to improve upon Cologuard’sour Cologuard test’s performance characteristics. In October 2019, we and Mayo presented at the American College of Gastroenterology’s 2019 Annual Scientific Meeting findings from a blinded-case control study showing enhanced colorectal cancer and advanced adenoma detection using newly discovered methylation biomarkers and hemoglobin.biomarkers. To establish the performance of the novelan enhanced multi-target stool DNA test, in November 2019, we launched the BLUE-C study, a multi-center, prospective study. We expect to enroll more than 10,000 patients 40 years of age and older in theour multi-center, prospective BLUE-C study. The timing of any such enhancements to our Cologuard test is unknown and would be subject to FDA approval. We are also working to develop a blood-based screening test for colorectal cancer.
Multi-Cancer ScreeningEarly Detection (“MCED”) Test Development. We are currently seeking to develop a blood-based, multi-cancer screeningMCED test. In September 2020,January 2021, we reported that togethercompleted the acquisition of Thrive Earlier Detection Corporation (“Thrive”), a healthcare company dedicated to developing a blood-based, MCED test. An early version of Thrive’s test has achieved promising results in a 10,000-patient, prospective, interventional study detecting 10 different types of cancer, including seven with Mayo we have identified methylation markersno current recommended screening guidelines, with very few false positives. We intend to combine Thrive's expertise with our scientific capabilities, clinical organization and commercial infrastructure to establish us as a 97% average accuracyleading competitor in identifying cancers in tissue and blood. We also presented results from an internal study using these markers on blood samples that demonstrated 86% sensitivity at 95% specificity when looking at six different cancers.blood-based, multi-cancer early detection.
Hepatocellular Carcinoma (HCC) Test Development. We are currently seeking to developdeveloping a blood-based biomarker test to serve as an alternative to ultrasound and alpha-fetoprotein (“AFP”) for use in HCC testing. HCC is the most common type of liver cancer. Our goal is to developprovide a patient-friendly test that performs better than the current standardguideline-recommended testing options. In August 2021, the performance of care. In November 2019, we releasedour OncoguardTM Liver liquid biopsy test was published in the results of a 443-patient study which demonstrated 80%peer-reviewed journal Clinical Gastroenterology and Hepatology. The test delivers 82% early-stage sensitivity and an overall 88% sensitivity for HCC at 90%87% specificity with a novel combination of six blood-based biomarkers for HCC. The study also showed 71% sensitivity for early stage HCC at 90% specificity. The study compared performance to the AFP test, which demonstrated 45% sensitivity at 90% specificity for early stage HCC. Our test was made available on a limited basis beginning in the second quarter of 2021.
Minimal Residual Disease (“MRD”) Test Development. In January 2021 we acquired an exclusive license to The Translational Genomics Research Institute (“TGen”) proprietary Targeted Digital Sequencing (“TARDIS”) technology. We are currently seeking to utilize this compelling and technically distinct approach to develop a test to detect small amounts of tumor DNA that may remain in patients’ blood after they have undergone initial treatment. In a study published in Science Translational Medicine, TARDIS demonstrated high accuracy in assessing molecular response and residual disease during neoadjuvant therapy to treat breast cancer. TARDIS achieved up to 100-fold improvement beyond the current limit of circulating tumor DNA detection. We intend to expand our precision oncology business to become a leader in minimal residual disease testing, which will leverage our existing foundation to deliver better solutions to patients navigating cancer.
Development Studies for Oncotype DX Products. We may also conduct or fund clinical studies that could support additional opportunities for our Oncotype DX products. For example, we are exploring clinical studies to expand the use of genomic testing to address additional populations, including higher-risk patients.
Coronavirus (“COVID-19”) PandemicWe may also use a number of other technologies across various development programs and product implementations. While early-stage cancer continues to be our main focus, we believe we also have an opportunity to expand our business further along the patient’s cancer journey, both through our research and development process and strategic collaborations.
The spreadResearch and development, which includes our clinical study programs, accounts for a material portion of COVID-19 has affected many segments of the global economy, including theour operating expenses. As we seek to enhance our current product portfolio and expand our product pipeline by developing additional cancer screening and diagnostics industry. The COVID-19 outbreak, which the World Health Organization has classified as a pandemic, has prompted governmentsdiagnostic tests, we expect that our research and regulatory bodies throughout the world to enact broad precautionary measures, including “stay at home” orders, restrictions on the performance of “non-essential” services, public gatherings and travel. Health systems, including in key markets where we operate, have been, or may be, overwhelmed with high volumes of patients suffering from COVID-19. The territories in which we market, sell, distribute and perform our tests are attempting to address the COVID-19 pandemic in varying ways, including stay-at-home orders, temporarily closing businesses, restricting gatherings, restricting travel, and mandating social distancing and face coverings. Certain jurisdictions have begun re-opening only to return to restrictions due to increases in new COVID-19 cases. Even in the absence of legal restrictions, businesses and individuals may voluntarilydevelopment expenditures will continue to limit in-person interactions and practice social distancing, and such behaviors may continue beyond the formal end of the pandemic, The level and nature of the disruption caused by COVID-19 is unpredictable, may be cyclical and long-lasting and may vary from location to location.
The pandemic and related precautionary measures began to materially disrupt our business in March 2020 and may continue to disrupt our business for an unknown period of time. As a result, we anticipate significant impact to our 2020 operating results, including our revenues, margins, and cash utilization, among other measures.increase.
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Beginning in March 2020, we undertook temporary precautionary measures intended to help minimize the risk of the virus to our employees, including temporarily requiring most employees to work remotely; suspending field-based, face-to-face interactions by our sales force; requiring on-site employees to undergo COVID-19 testing, wear personal protective equipment (including face masks or shields) and maintain social distancing; pausing all non-essential travel worldwide for our employees; and limiting employee attendance at industry events and in-person work-related meetings, to the extent those events and meetings are continuing. Our commercial partner for Cologuard, Pfizer, Inc. (“Pfizer”), took similar precautions, including suspending face-to-face interactions between sales representatives and healthcare providers.
We expect to adjust our precautionary measures at our various locations based on local recovery levels and applicable governmental regulations. For example, a portion of the Company’s and Pfizer’s sales force has recommenced field-based interactions, although access to healthcare providers remains limited and the resumption of normal activities is expected to be gradual. Our business could be negatively affected if we take excessive, ineffective or inadequate precautions.
Due to social distancing, stay-at-home orders, and other actions taken in response to COVID-19, there has been a significant and widespread decline in standard wellness visits and preventive services. That decline negatively impacted Cologuard test orders during the second quarter of 2020 in our Screening business, notwithstanding the availability of alternative ordering channels such as telehealth. During the third quarter, orders have recovered to pre-pandemic levels.
The Precision Oncology business started to see weakening underlying conditions in April 2020 because of COVID-19, more notably in the U.S. prostate business and in certain international geographies. The widespread decrease in preventive services, including mammograms and prostate cancer screenings, negatively impacted Precision Oncology test volumes beginning in May 2020 and continuing throughout the third quarter of 2020 due to the typical lag between cancer screening and genomic test ordering.
Despite our efforts, the ultimate impact of COVID-19 depends on factors beyond our knowledge or control, including the duration and severity of the outbreak, third-party actions taken to contain its spread and mitigate its public health effects and the extent to which behavioral changes resulting from the pandemic continue even after it ends.
COVID-19 Testing Business
In late March 2020, we began providing COVID-19 testing. The U.S. Food and Drug Administration (FDA) has granted us Emergency Use Authorization to test for SARS-CoV-2, the virus that causes COVID-19, in upper respiratory samples. We have partnered with various customers, including the State of Wisconsin Department of Health Services, to administer testing. Customers are responsible for employing trained personnel to collect specimens. Specimens are sent to our laboratory in Madison, Wisconsin, where we run the assay in our laboratories and provide test results to ordering providers. In light of the uncertainty surrounding the COVID-19 pandemic, we intend to periodically reassess our COVID-19 testing business. Although we expect that demand for our COVID-19 testing services will decline over time as the pandemic abates, as discussed below, demand for these services remained relatively strong during the quarter ended September 30, 2021, in part due to increased COVID-19 cases in certain areas of the country during the quarter.
20202021 Priorities
Our top priorities for 2021 are to (1) get more people tested, (2) advance new solutions, and (3) enhance our customer experience.
Get More People Tested
We are committed to delivering critical answers to patients by getting more people tested with our Cologuard and Oncotype tests. Depending on the course of the COVID-19 pandemic, we expect to continue to provide COVID-19 testing.
Advance New Solutions
In 2021, we are focused on advancing new solutions to provide answers to patients throughout their cancer journeys. We plan to continue investing in ongoing and additional clinical trials to support our product development efforts in enhancing existing products. We also plan to bring new products to patients and providers as further discussed in the Pipeline Research and Development section above.
Enhance Our Customer Experience
Another priority for 2021 is to enhance our customer experience. To establish long-term relationships with patients and providers, we plan to improve customer communications and create new ways to personalize their experiences. Our goal is to become the cancer diagnostic provider of choice for providers and patients.
Results of Operations
The spread of COVID-19 has affected many segments of the global economy, including the cancer screening and diagnostics industry. The pandemic and related precautionary measures have materially disrupted our business since March 2020 and have significantly impacted, and may continue to impact, our testing volumes, revenues, margins and cash utilization, among other measures. The level and nature of the disruption caused by COVID-19 is unpredictable, may be cyclical and long-lasting and may vary from location to location. As a result of COVID-19 and its impact to our business,the pandemic, we have re-prioritized our goals for 2020 with a focus on serving patients who continue to needprovide COVID-19 testing, the healthcare services we provide while aligningrevenue from which has partially offset the pandemic’s impact on our cost structure with the anticipated lower sales volumesScreening and revenues. Our top priorities for 2020 are (1) get people tested, (2) take care of our customers, and (3) preserve financial strength.
Get People Tested
Business continuity plans are in place at all of our sites to help sustain operations and ensure continuity of services for patients during this unprecedented time. Despite the COVID-19 pandemic, many people still need to be screened for colorectal cancer, and treated for breast, colon, and prostate cancers. Our lab facilities presently remain operational so that we can continue to process results of our Cologuard, Oncotype DX and COVID-19 tests.
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Take Care of our CustomersPrecision Oncology testing revenue.
Due to social distancing, stay-at-home orders, and other actions taken in response to COVID-19, there has beenwas a significant and widespread decline in standard wellness visits and preventive services.services beginning at the end of the first quarter of 2020. We have takentook steps to limit exposure to COVID-19 based on recommendations from government and health agencies, including limiting field-based, face-to-face interactions by our sales force. The pandemic negatively impacted both our Screening and Precision Oncology businesses in 2020. We began to see orders recovering towards the end of 2020 to near pre-pandemic levels.
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While Cologuard test orders have increased from the early pandemic lows, the growth has been slower than expected due to continuing restrictions on patients’ and our and Pfizer Inc.’s (“Pfizer”) sales team thatrepresentatives’ access to healthcare provider offices and additional outbreaks of COVID-19 and its variants during 2021, which further diminished access to healthcare provider offices. Our Cologuard test is not engaged in face-to-face interactions will serve healthcare providers via telephonepromotionally responsive, and online technologies until it is safepreventive health and wellness visits continue to return to the field and practices allow representatives back in their offices.
Preserve Financial Strength
In order to minimize the adverse impacts to our business and operations anticipated during 2020be deprioritized due to the risk of COVID-19. The COVID-19 pandemic has also reduced well-patient access to healthcare providers, which has contributed to, and may continue to contribute to, delays to clinical studies that are critical to the launch of future products and services. Even after the pandemic subsides, some healthcare providers and health systems may limit the extent and type of sales representatives’ access to their facilities and personnel. We have not seen the impact to our Precision Oncology business as it relates to the COVID-19 variants like we have with our Cologuard test. This is mostly due to the fact that patients are already diagnosed with cancer and there is greater urgency to access healthcare providers and our Oncotype tests. We could see a delayed impact in our Precision Oncology business from the COVID-19 variants if patients deprioritize preventive services, including mammograms and prostate cancer screening.
Although health and safety precautions loosened in many jurisdictions during the quarter ended June 30, 2021 as the number of COVID-19 cases began to decline and vaccination rates increased, beginning in Aprillate July 2021, COVID-19 cases, including cases associated with the highly contagious delta variant, increased significantly in the United States. With the recent resurgence of COVID-19 cases, mask mandates, social-distancing, and other protective measures were reinstated in many parts of the country. Although infection rates have begun to fall in some parts of the country, cases are continuing to climb in other regions, and public health officials and medical professionals have warned that COVID-19 cases may spike again nationally, particularly if vaccination rates do not quickly increase or if additional, potent disease variants emerge. It is unclear how long any future resurgences may last, how severe they may be, and what safety measures governments may impose in response. It is also unclear how long individuals will remain cautious about resuming activities such as preventive-care medical visits or how long medical practices will remain cautious about allowing individuals, such as sales representatives, into their offices.
In September 2021, we completed an expedited hiring process and onboarded approximately 400 former Pfizer sales representatives to increase adoption of our Cologuard test and our pipeline of innovative screening tests. Prior to late August 2021, when Pfizer announced a decrease in the number of sales positions supporting its Internal Medicine therapeutic area, these employees had been promoting our Cologuard test under our promotion agreement with Pfizer (the “Promotion Agreement”).
We are uncertain how many or what type of sales details Pfizer’s sales representatives will contribute during the remainder of 2021 and beyond. In October 2020, we initiated proactive measuresamended and restated our Promotion Agreement with Pfizer to, achieve cost savings. Actionsamong other things, address changes to the operational landscape resulting from the COVID-19 pandemic, and we took included a temporary reduction of base pay for our executive officers and other employees, a reductionare in the annual retainer payableprocess of discussing further amendments to the Promotion Agreement. Those discussions could result in material changes to the Promotion Agreement. If we are unable to manage our boardrelationships with Pfizer and Pfizer’s sales representatives, or if we or Pfizer fail to optimally or effectively promote, market and sell our Cologuard test, our results of directors,operation could be adversely affected.
We have adjusted, and a reductionexpect to continue to adjust, our COVID-19 precautionary measures at our various locations based on local recovery levels and applicable governmental regulations. During the third quarter of quarterly sales commissions. We implemented a workforce reduction, involuntary furloughs, work schedule reductions, as well as a voluntary furlough program. Additionally,2021, we reduced investments in marketingannounced that anyone working onsite at an Exact Sciences’ U.S. facility and other promotional activities, paused certain clinical trial activities, reduced travel and professional services, and delayed or terminated certain capital projects. We also saw a reduction in certain volume based cost of goods sold expenses consistent with the reduction in revenue. These actions have contributed to significant cost savings in 2020 during the nine months ended September 30, 2020.
Recent Events
On October 26, 2020, we enteredanyone going into a definitive agreement and plan of merger (“Thrive Merger Agreement”) with Thrive, which we currently expecthealthcare setting to be completedperform their job in the firstU.S. must be fully vaccinated. As part of this announcement, we provided information to help educate and encourage our employees to receive the COVID-19 vaccination. We have also authorized more employees to work on-site and expect more teams to return onsite in the fourth quarter of 2021. On October 26, 2020,Our business could be negatively affected if we acquired all oftake excessive, ineffective or inadequate precautions.
We continue to plan for future growth through investing in our existing operations and through the outstanding stock of Base (“Base Merger Agreement”). Refer to Note 19acquisitions further discussed in our condensed consolidated financial statements included in this Quarterly Report for additional information.
Results of Operations​on Form 10-Q.
We have generated significant losses since inception and, as of September 30, 2020,2021, we had an accumulated deficit of approximately $1.5$2.42 billion. We expect to continue to incur losses for the near future, and it is possible we may never achieve profitability. As mentioned in further detail above, the COVID-19 outbreak has had an adverse impact on our operations beginning in March 2020. While we have seen recovery in our Screening and Precision Oncology businesses, the impact
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Revenue. Our revenue is primarily generated by our laboratory testing services from our Cologuard, Oncotype, DX and COVID-19 tests. Our Screening revenue, which primarily includes laboratory service revenue from our Cologuard test, was $280.4 million and $214.6 million for the three months ended September 30, 2021 and 2020, respectively. Screening revenue was $784.6 million and $565.4 million for nine months ended September 30, 2021 and 2020, respectively. The increase for the three and nine months ended September 30, 2021 was primarily due to an increase in the number of completed Cologuard tests, partially offset by a decrease in transaction price as discussed below. Relative recovery from the COVID-19 pandemic and increases in electronic ordering rates, screening of patients in the 45 to 49 age group, and screening of patients that previously completed a Cologuard test contributed to the increase in completed Cologuard tests for the three and nine months ended September 30, 2021. Our Precision Oncology revenue, which primarily includes laboratory service revenue from our global Oncotype products, was $145.4 million and $91.6 million for the three months ended September 30, 2021 and 2020, respectively. Precision Oncology revenue was $412.6 million and $322.9 million for the nine months ended September 30, 2021 and 2020, respectively. The increase for the three and nine months ended September 30, 2021 was primarily due to an increase in the number of completed Oncotype tests. In the third quarter of 2020, Oncotype test revenue was negatively impacted as a result of the COVID-19 pandemic. During the third quarter of 2021, we saw an increase in Oncotype DX breast test orders, both domestically and internationally. Additionally, in 2021 we had revenue from new products as a result of our recent acquisitions that we did not have for the three and nine months ended September 30, 2020. For the three months ended September 30, 2021 and 2020, and 2019, we also generated Screening revenue from our COVID-19 testing of $214.6$30.6 million and $218.8$102.2 million, respectively. For the nine months ended September 30, 20202021 and 2019, we generated Screening revenue of $565.4 million and $580.7 million, respectively. Screening includes laboratory service revenue from Cologuard and revenue from Biomatrica products. For the three months ended September 30, 2020, we generated Precision Oncology revenue of $91.6 million. For the nine months ended September 30, 2020, we generated Precision Oncology revenue of $322.9 million. Precision Oncology includes laboratory service revenue from global Oncotype DXour COVID-19 testing of $96.0 million and Paradigm products. For$136.7 million, respectively.
During the three and nine months ended September 30, 2020,2021, we also generated $102.2recorded a downward adjustment to revenue of $0.2 million and $136.7$13.2 million, respectively, in revenueon completed tests from the prior year after identifying a lower realized reimbursement rate on a portion of our COVID-19 testing.
For the three and nine months ended September 30, 2020, our Screening and Precision Oncology testing service revenue was adversely impacted by the effects of the COVID-19 outbreak. In response to the pandemic, we are conducting COVID-19 testing, which has served as additional revenue outside our normal Screening and Precision Oncologylaboratory testing services. This change in transaction price is primarily driven by certain prior claims not being submitted to insurance timely. We are working to address these issues, and are more broadly working on improvements to our billing systems to prevent recurrence. Pursuant to our contracts with payers and standards within the industry, claims submitted outside of specified timeframes may not be reimbursed. Successful reimbursement for our laboratory testing services will continue to depend on our ability to execute our order to cash operations efficiently. At each reporting period-end, we monitor our estimates of transaction price to ensure reflection of conditions that exist at each reporting date, and while we strive to restrict volatility in our realized reimbursement rates, changes in transaction price can occur.
Our cost structure. Our selling, general and administrative expenses consist primarily of non-research personnel salaries, office expenses, professional fees, sales and marketing expenses incurred in support of our commercialization efforts and non-cash stock-based compensation.
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Cost of sales includes costs related to inventory production and usage, shipment of collection kits and tissue samples, royalties and the cost of services to process tests and provide results to healthcare providers.
We expect that gross marginrevenue and cost of sales for our services will continue to fluctuate and be affected by the test volume of our products, our operating efficiencies, patient adherence rates, payer mix, the levels of reimbursement, and payment patterns of payers and patients.
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Cost of sales (exclusive of amortization of acquired intangible assets). Cost of sales (exclusive of amortization of acquired intangible assets) increased to $115.7 million for the three months ended September 30, 2021 compared to $95.1 million for the three months ended September 30, 2020 from $52.32020. Cost of sales (exclusive of amortization of acquired intangible assets) increased to $339.7 million for the threenine months ended September 30, 2019. Cost of sales increased2021 compared to $254.6 million for the nine months ended September 30, 2020 from $146.3 million for the nine months ended September 30, 2019.2020. The increase in cost of sales is primarily due to an increase in production costs, incurred on our Precision Oncologywhich is a direct result of an increase in completed Cologuard and Oncotype tests. The increase was partially offset by a reduction in the number of COVID-19 tests due to the completion of the combination with Genomic Health in November 2019 and costs incurred from our COVID testing.completed year over year.
Three Months Ended September 30,Three Months Ended September 30,
Amounts in millionsAmounts in millions20202019ChangeAmounts in millions20212020Change
Production costsProduction costs$51.4 $36.5 $14.9 Production costs$63.9 $51.4 $12.5 
Personnel expensesPersonnel expenses26.8 9.4 17.4 Personnel expenses31.7 26.8 4.9 
Facility and support servicesFacility and support services13.3 4.9 8.4 Facility and support services15.7 13.3 2.4 
Stock-based compensationStock-based compensation3.5 1.4 2.1 Stock-based compensation4.3 3.5 0.8 
Other cost of sales expensesOther cost of sales expenses0.1 0.1 — Other cost of sales expenses0.1 0.1 — 
Total cost of sales expenseTotal cost of sales expense$95.1 $52.3 $42.8 Total cost of sales expense$115.7 $95.1 $20.6 

Nine Months Ended September 30,
Amounts in millions20202019Change
Production costs$134.3 $103.4 $30.9 
Personnel expenses72.5 25.7 46.8 
Facility and support services38.2 13.2 25.0 
Stock-based compensation9.3 3.9 5.4 
Other cost of sales expenses0.3 0.1 0.2 
Total cost of sales expense$254.6 $146.3 $108.3 
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Nine Months Ended September 30,
Amounts in millions20212020Change
Production costs$188.8 $134.3 $54.5 
Personnel expenses92.4 72.5 19.9 
Facility and support services44.9 38.2 6.7 
Stock-based compensation12.8 9.3 3.5 
Other cost of sales expenses0.8 0.3 0.5 
Total cost of sales expense$339.7 $254.6 $85.1 
Research and development expensesexpenses. . Research and development expenses decreasedincreased to $75.4 million for the three months ended September 30, 2021 compared to $31.5 million for the three months ended September 30, 2020 compared2020. Research and development expenses increased to $34.7$297.2 million for the threenine months ended September 30, 2019. Research and development expenses increased2021 compared to $107.7 million for the nine months ended September 30, 2020. The increase for the three and nine months ended September 30, 2021 is primarily a result of the acquisition of Thrive in January 2021, which resulted in increased direct research and development expenses, as well as an increase in personnel and stock-based compensation expenses due to the increase in headcount. We also saw an increase in clinical trial related expenses, which were driven by the BLUE-C study as enrollment increased in 2021 following a slowdown in 2020 compareddue to $96.5 million forthe COVID-19 pandemic and cost cutting measures that we put in place. Specific to the nine months ended September 30, 2019. The decrease during the three months ended September 30, 2020 was primarily due to a reduction of certain2021, direct research and development costsexpenses increased year over year due to the cost saving measures and the timing of certain expenditures as a resultour acquisition of the COVID-19 pandemic.license to the TARDIS technology in January 2021 and our acquisition of PFS Genomics in May 2021, which resulted in an expense of $52.3 million and $33.1 million upon acquisition, respectively. The increase during the nine months ended September 30, 2020 was primarily due to an increaseacquisitions are further described in personnel related costs as a resultNote 17 of the combination with Genomic Healthour condensed consolidated financial statements included in November 2019, which was partially offset by a reduction in of certain direct research and development costs as discussed above.​this Quarterly Report on Form 10-Q.
Three Months Ended September 30,
Amounts in millions20202019Change
Personnel expenses$13.1 $7.9 $5.2 
Direct research and development7.3 16.4 (9.1)
Stock-based compensation5.0 6.9 (1.9)
Facility and support services5.0 1.2 3.8 
Professional fees0.6 1.8 (1.2)
Other research and development0.5 0.5 — 
Total research and development expenses$31.5 $34.7 $(3.2)

Nine Months Ended September 30,Three Months Ended September 30,
Amounts in millionsAmounts in millions20202019ChangeAmounts in millions20212020Change
Personnel expensesPersonnel expenses$45.2 $23.7 $21.5 Personnel expenses$25.1 $13.1 $12.0 
Direct research and developmentDirect research and development32.4 51.3 (18.9)Direct research and development28.7 7.4 21.3 
Stock-based compensationStock-based compensation14.6 12.9 1.7 Stock-based compensation12.2 5.0 7.2 
Facility and support servicesFacility and support services11.1 3.3 7.8 Facility and support services6.4 5.0 1.4 
Professional feesProfessional fees2.3 3.9 (1.6)Professional fees1.7 0.5 1.2 
Other research and developmentOther research and development2.1 1.4 0.7 Other research and development1.3 0.5 0.8 
Total research and development expensesTotal research and development expenses$107.7 $96.5 $11.2 Total research and development expenses$75.4 $31.5 $43.9 
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Nine Months Ended September 30,
Amounts in millions20212020Change
Technology acquisition$85.3 $— $85.3 
Personnel expenses69.7 45.2 24.5 
Direct research and development74.9 32.4 42.5 
Stock-based compensation39.3 14.6 24.7 
Facility and support services18.8 11.1 7.7 
Professional fees4.7 2.4 2.3 
Other research and development4.5 2.0 2.5 
Total research and development expenses$297.2 $107.7 $189.5 
General and administrative expensesexpenses. . General and administrative expenses increased to $186.5 million for the three months ended September 30, 2021 compared to $115.6 million for the three months ended September 30, 2020 compared2020. General and administrative expenses increased to $80.5$621.9 million for the threenine months ended September 30, 2019. General and administrative expenses increased2021 compared to $336.3 million for the nine months ended September 30, 2020 compared to $208.1 million for the nine months ended September 30, 2019.2020. The increase in general and administrative expenses was in part due to $10.2 million and $141.4 million in acquisition and integration related costs incurred during the three and nine months ended September 30, 2021 as part of our acquisitions completed during the year, which primarily consists of integration related tostock-based compensation and professional and legal fees incurred. The acquisition and integration related costs also include the operationsremeasurement of Genomic Health beingthe contingent consideration liabilities recorded from our acquisitions, which are included in other general and administrative expenses. The contingent consideration liability is further discussed in Note 7 of our results after the completion of the combinationcondensed consolidated financial statements included in November 2019,this Quarterly Report on Form 10-Q. Personnel expenses and stock-based compensation also increased due to an overall increase in headcount information technologyto prepare for future growth in our operations and customer care center costsfrom our recent acquisitions. Due to support the growthCOVID-19 pandemic and the protective measures put in place in the first half of 2020, we experienced lower spend in our personnel and professional fees. As our business began to recover in the third quarter of 2020, personnel expenses and stock-based compensation increased due to additional headcount. These factors account for a portion of the Company.increase that we see for the three and nine months ended September 30, 2021 when compared to the prior year.
Three Months Ended September 30,Three Months Ended September 30,
Amounts in millionsAmounts in millions20202019ChangeAmounts in millions20212020Change
Stock-based compensationStock-based compensation$32.4 $21.5 $10.9 
Personnel expensesPersonnel expenses$53.7 $29.2 $24.5 Personnel expenses79.3 53.7 25.6 
Professional and legal feesProfessional and legal fees15.9 20.1 (4.2)Professional and legal fees34.1 15.9 18.2 
Stock-based compensation21.5 11.1 10.4 
Facility and support servicesFacility and support services13.4 16.1 (2.7)Facility and support services25.7 13.4 12.3 
Other general and administrativeOther general and administrative11.1 4.0 7.1 Other general and administrative15.0 11.1 3.9 
Total general and administrative expensesTotal general and administrative expenses$115.6 $80.5 $35.1 Total general and administrative expenses$186.5 $115.6 $70.9 

Nine Months Ended September 30,Nine Months Ended September 30,
Amounts in millionsAmounts in millions20202019ChangeAmounts in millions20212020Change
Stock-based compensationStock-based compensation$189.6 $54.8 $134.8 
Personnel expensesPersonnel expenses$159.3 $85.9 $73.4 Personnel expenses225.5 159.3 66.2 
Professional and legal feesProfessional and legal fees52.9 39.4 13.5 Professional and legal fees99.2 52.9 46.3 
Stock-based compensation54.8 29.6 25.2 
Facility and support servicesFacility and support services42.4 42.0 0.4 Facility and support services60.8 42.4 18.4 
Other general and administrativeOther general and administrative26.9 11.2 15.7 Other general and administrative46.8 26.9 19.9 
Total general and administrative expensesTotal general and administrative expenses$336.3 $208.1 $128.2 Total general and administrative expenses$621.9 $336.3 $285.6 
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Sales and marketing expenses. Sales and marketing expenses increased to $196.6 million for the three months ended September 30, 2021 compared to $136.5 million for the three months ended September 30, 2020 compared2020. Sales and marketing expenses increased to $86.2$577.6 million for the threenine months ended September 30, 2019. Sales and marketing expenses increased2021 compared to $423.1 million for the nine months ended September 30, 2020 compared to $265.3 million for the nine months ended September 30, 2019.2020. The increase in sales and marketing expenses was primarily due to an increase in direct marketing spend to support the future growth of our products and increased personnel expenses and stock-based compensation as a result of additional sales and marketing personnel,an increase in headcount including the Precision Oncology team added followingapproximately 400 former Pfizer sales representatives that were onboarded in the completionthird quarter of 2021. In addition, professional fees increased during the Genomic Health combinationthree and nine months ended September 30, 2021 primarily due to an increase in November 2019,costs incurred related to our Promotion Agreement with Pfizer during the second and third quarters of 2021 as compared to 2020, which was partially offset by a reduction in advertising and marketing spendwere reduced due to cost saving measures as a result of the COVID-19 pandemic.
Three Months Ended September 30,Three Months Ended September 30,
Amounts in millionsAmounts in millions20202019ChangeAmounts in millions20212020Change
Personnel expensesPersonnel expenses$67.4 $37.7 $29.7 Personnel expenses$92.3 $67.4 $24.9 
Direct marketing costs and professional fees26.9 23.0 3.9 
Direct marketing costsDirect marketing costs48.0 26.9 21.1 
Professional and legal feesProfessional and legal fees19.5 19.6 (0.1)Professional and legal fees23.0 19.5 3.5 
Facility and support servicesFacility and support services10.5 0.8 9.7 Facility and support services16.7 10.5 6.2 
Stock-based compensationStock-based compensation11.5 4.9 6.6 Stock-based compensation14.7 11.5 3.2 
Other sales and marketing expensesOther sales and marketing expenses0.7 0.2 0.5 Other sales and marketing expenses1.9 0.7 1.2 
Total sales and marketing expensesTotal sales and marketing expenses$136.5 $86.2 $50.3 Total sales and marketing expenses$196.6 $136.5 $60.1 

Nine Months Ended September 30,Nine Months Ended September 30,
Amounts in millionsAmounts in millions20202019ChangeAmounts in millions20212020Change
Personnel expensesPersonnel expenses$209.0 $111.0 $98.0 Personnel expenses$264.3 $209.0 $55.3 
Direct marketing costs and professional fees90.0 68.9 21.1 
Direct marketing costsDirect marketing costs136.5 90.0 46.5 
Professional and legal feesProfessional and legal fees56.9 68.5 (11.6)Professional and legal fees81.5 56.9 24.6 
Facility and support servicesFacility and support services33.4 2.4 31.0 Facility and support services50.0 33.4 16.6 
Stock-based compensationStock-based compensation32.4 14.3 18.1 Stock-based compensation41.6 32.4 9.2 
Other sales and marketing expensesOther sales and marketing expenses1.4 0.2 1.2 Other sales and marketing expenses3.7 1.4 2.3 
Total sales and marketing expensesTotal sales and marketing expenses$423.1 $265.3 $157.8 Total sales and marketing expenses$577.6 $423.1 $154.5 
Amortization of acquired intangible assets. Amortization of acquired intangible assets increased to $23.9 million for the three months ended September 30, 2021 compared to $23.4 million for the three months ended September 30, 2020 compared to $0.7 million for the three months ended September 30, 2019.2020. Amortization of acquired intangible assets increased to $71.0 million for the nine months ended September 30, 2021 compared to $70.2 million for the nine months ended September 30, 2020 compared to $2.3 million for the nine months ended September 30, 2019.2020. The increase in amortization of acquired intangible assets was primarily due to the Genomic Health combination.amortization of intangible assets acquired as part of our acquisition of Ashion Analytics, LLC.
Intangible asset impairment charge.Intangible asset impairment charge wasdecreased to $20.2 million for the three and nine months ended September 30, 2021 compared to $209.7 million for the three and nine months ended September 30, 2020 compared to zero for2020. The impairment recorded during the three and nine months ended September 30, 2019.2021 relates to the impairment of the supply agreement intangible asset acquired as part of the combination with Genomic Health. The impairment recorded during the three and nine months ended September 30, 2020 primarily relates to the impairment of the in-process research and development intangible asset acquired as part of the combination with Genomic Health.
Other operating income.Other operating income increaseddecreased to zero for the three and nine months ended September 30, 2021 compared to zero and $23.7 million for the three and nine months ended September 30, 2020, compared to zero for the nine months ended September 30, 2019.respectively. The income generated during the three and nine months ended September 30, 2020 represents the funding received under the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) Provider Relief Fund, which was accepted from the Department of Health & Human Services in May 2020.
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Investment income (expense), net. Investment income (expense), net decreased to an expense of $4.1 million for the three months ended September 30, 2021 compared to income of $2.5 million for the three months ended September 30, 2020 compared2020. Investment income (expense), net increased to $9.1$30.5 million for the threenine months ended September 30, 2019. Investment income, net decreased2021 compared to $5.5 million for the nine months ended September 30, 2020 compared2020. The decrease in investment income (expense), net for the three months ended September 30, 2021 was primarily due to $23.4 millionlosses recorded on our equity securities. The increase in investment income, net for the nine months ended September 30, 2019. The decrease in investment income, net2021 was primarily due to a decreasethe realized gain of $30.5 million that was recorded on our preferred stock investment in realized gains generated fromThrive at closing in January 2021, which represented the saleadjustment to our historical investment to its fair value prior to our acquisition of marketable securities and a decreaseThrive. Our acquisition of Thrive is further described in the average rateNote 17 of returnour condensed consolidated financial statements included in this Quarterly Report on investments due to an decrease in market interest rates and a lower average balance in marketable securities for the nine months ended September 30, 2020 when compared to the same period in 2019.​Form 10-Q.
Interest expense. Interest expense increased to $23.6$4.7 million for the three months ended September 30, 20202021 compared to $13.2$4.5 million for the three months ended September 30, 2019. Interest expense increased to $71.6 million for the nine months ended September 30, 2020 compared to $47.9 million for the nine months ended September 30, 2019. The increase is primarily due to the issuance of additional convertible notes in February 2020, which was partially offset by lower interest rates on the convertible notes issued in February 2020. Interest expense recorded from our outstanding convertible notes totaled $23.2$4.0 million and $12.7 million during each of the three months ended September 30, 20202021 and 2019, respectively. Of the interest2020. Interest expense recorded on outstanding convertible notesdecreased to $13.9 million for the threenine months ended September 30, 2020 and 2019, $20.62021 compared to $63.4 million and $11.0 million of interest expense relates to amortization of debt discount and debt issuance costs, respectively.for the nine months ended September 30, 2020. Interest expense recorded from our outstanding convertible notes totaled $62.3$12.1 million and $36.4$61.8 million during the nine months ended September 30, 20202021 and 2019,2020, respectively. Of the interest expense recorded on our outstanding convertible notes for the nine months ended September 30, 2020, and 2019, $55.2$50.8 million and $30.8 million of interest expense relates to amortization of debt discount and debt issuance costs, respectively. The remaining interest expense recorded on outstanding convertible notes relatesis due to the stated interest that is paid out in cash. In addition to the interest expense recordedloss on outstanding convertible notes, an additional $8.0 million and $10.6 million was recorded during the nine months ended September 30, 2020 and 2019, respectively, as a result of the settlement of convertible notes. The convertible notes are further described in Note 159 of our condensed consolidated financial statements included in this Quarterly Report. The remainingReport on Form 10-Q. In addition, we recognized an immaterial amount of interest expense relating to stated interest expense on our construction loan and finance leases for the three and nine months ended September 30, 20202021 and 2019, relates to the stated interest on our construction loan.​2020.
Income tax benefit (expense).benefit. Income tax benefit increased to $4.5$3.9 million for the three months ended September 30, 20202021 compared to an expense of $0.7$2.8 million for the three months ended September 30, 2019.2020. Income tax benefit increased to $7.1$242.6 million for the nine months ended September 30, 20202021 compared to $0.2$5.3 million for the nine months ended September 30, 2019.2020. This increase in income tax benefit is primarily due to future limitations on and expirationan income tax benefit of certain Federal and State$239.2 million recorded during the nine months ended September 30, 2021, as a result of the change in the deferred tax assets.asset valuation allowance resulting from the acquisition of Thrive.
Liquidity and Capital Resources​Resources
We have financed our operations since inception primarily through public offerings of our common stock and convertible debt and through revenue generated by the sale of the Cologuard, and since the completion of our Genomic Health combination, of Oncotype DX tests.laboratory testing services. As of September 30, 2020,2021, we had approximately $806.7$273.8 million in unrestricted cash and cash equivalents and approximately $476.3$944.7 million in marketable securities.
The majority of our investments in marketable securities consist of fixed income investments, and all are deemed available-for-sale. The objectives of this portfolio are to provide liquidity and safety of principal while striving to achieve the highest rate of return. Our 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.
Net cash provided byused in operating activities was $77.7 million for the nine months ended September 30, 2021 compared to cash provided by operations of $25.1 million for the nine months ended September 30, 2020 compared to cash use of $86.4 million for the nine months ended September 30, 2019.2020. The increase in cash provided byused in operating activities for the nine months ended September 30, 20202021 was primarily due to thean increase in cash payments made related to expenses necessary to process our tests and an increase in operating expenses to prepare for future growth of our operations. This was partially offset by an increase in revenue, which was driven by an increase in completed Cologuard and reductionOncotype tests.
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Net cash used in investing activities was $1.16 billion for the nine months ended September 30, 2021 compared to cash use of $395.4 million for the nine months ended September 30, 2020 compared to cash provided of $713.7 million for the nine months ended September 30, 2019.2020. The increase in cash used in investing activities for the nine months ended September 30, 20202021 compared to the same period in 20192020 was primarily the result of the timing of purchases, sales, and maturities of marketable securities. Excluding the impact
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of purchases, sales, and maturities of marketable securities, net cash used in investing activities was $563.8 million for the nine months ended September 30, 2021 compared to $65.3 million for the nine months ended September 30, 2020 compared to $131.52020. Cash use consisted primarily of our acquisition of Thrive of $343.2 million, our acquisition of Ashion of $72.3 million, our asset acquisition of PFS Genomics of $33.1 million, and our TARDIS license asset acquisition of $25.0 million, purchases of property and equipment of $76.4 million, and investments in privately held companies of $13.6 million for the nine months ended September 30, 2019.2021. Cash use primarily consisted primarily of purchasespurchase of property and equipment of $47.8$48.4 million, and $131.0 million for the nine months ended September 30, 2020 and 2019, respectively, investments in privately held companies of $10.6 million, and an acquisitionbusiness combinations of $6.7 million. There were also minimal purchases of intangible assets duringmillion for the nine months ended September 30, 2020 and 2019.2020.
Net cash provided by financing activities was $20.7 million for the nine months ended September 30, 2021 compared to $999.8 million for the nine months ended September 30, 2020 compared to $246.62020. The cash provided by financing activities during the nine months ended September 30, 2021 consisted of proceeds of $13.4 million from the exercise of stock options and $12.0 million in connection with our employee stock purchase plan, which was partially offset by cash outflows of $4.7 million for other financing activities. The cash provided by financing activities for the nine months ended September 30, 2019. During2020 was primarily the nine months ended September 30, 2020, we received net cashresult of $1,125.5 millionproceeds of $1.13 billion from theour issuance of Convertible Notes with a maturity date of March 1, 2028 (the “2028 Notes”), and we used $150.1 million of cash to settle Convertible Notes with an original maturity date of January 15, 2025 (the “2025 Notes”). The cash provided by financing activities for the nine months ended September 30, 2019 was primarily the result of proceeds of $729.5 million from our issuance of Convertible Notes with a maturity date of March 15, 2027 (the “2027 Notes”, and, collectively with the 2025 Notes and 2028 Notes, the “Notes”), and we used $493.4 million of cash to settle a portion of the 2025 Notes. In addition, during the nine months ended September 30, 2020 we received proceeds of $15.4 million from the exercise of stock options and $9.8 million fromin connection with our employee stock purchase plan.
As described above, on October 26, 2020, we entered into the Base Merger Agreement, under which we acquired Base in a cash transaction valued at approximately $410.0 million.
As described above, on October 26, 2020, we entered into the Thrive Merger Agreement, under which we agreed to acquire Thrive in a cash and stock transaction valued at approximately $2.2 billion, of which $1.7 billion would be payable at closing. We currently expect the merger will be completed in the first quarter of 2021, subject to customary closing conditions and regulatory approvals. We anticipate that cash of approximately $0.6 billion will be required to pay the aggregate cash portion of the merger consideration.
We expect that cash and cash equivalents and marketable securities on hand at September 30, 20202021 will be sufficient to fund the cash portion of the purchase price to be paid in connection with the Thrive and Base acquisitions as well as our current operations for at least the next twelve months based on current operating plans. However, we may need to raise additional capital to fully fund our current strategic plan, which includes successfully commercializing our Cologuard test and Oncotype DXproducts and developing a pipeline of future products. Additionally, we may enter into transactions to acquire other businesses, products, services, or technologies as part of our strategic plan. If we are unable to obtain sufficient additional funds to enable us to fund our operations through the completion of such plan, our results of operations and financial condition would be materially adversely affected, and we may be required to delay the implementation of our plan and otherwise scale back our operations. Even if we successfully raise sufficient funds to complete our plan, there is no certainty that we cannot assure that our business will ever generatebe successful in generating sufficient cash flow from operations or achieving and maintaining profitable operations in the future to become profitable.​
The spread of COVID-19 and measuresenable us to prevent further spread, have significantly disruptedmeet our business, and may continue to disrupt our business for an unknown period of time. The full impact of the outbreak is uncertain at this time and continues to evolve globally. We do not yet know the extent to which COVID-19 will negatively impact our financial results or liquidity. The outbreak has disrupted our operations,obligations as well as the operations and behaviors of healthcare providers, patients and suppliers. Depending on how healthcare providers, patients and suppliers are adversely impacted by the pandemic, as well as the overall duration and severity of the pandemic and changes in behavior that continue even after the pandemic, our liquidity could be materially and adversely affected. Management continues to monitor and assess the evolving developments with respect to COVID-19.they come due.
A table reflecting certain of our specified contractual obligations as of December 31, 20192020 was provided in the Management’s Discussion and Analysis of Financial Condition and Results of Operation of our 20192020 Form 10-K. During the nine months ended September 30, 2020, we issued $1,150.0 million in aggregate principal amount of 0.375% Convertible Notes that will mature on March 1, 2028. The holders of the Notes may convert prior to September 1, 2027 only under certain circumstances and may convert at any time after September 1, 2027. The 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. Of the cash received upon issuance of the 2028 Notes, approximately $150.1 million was used to repay a portion of the outstanding principal balance and accrued interest of the 2025 Notes held by certain Noteholders. Upon repayment of such portion of the outstanding principal balance
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of the 2025 Notes, there was $315.0 million in aggregate principal balance remaining under the 2025 Notes. See Note 15 of the condensed consolidated financial statements included in this Quarterly Report for further details. With the exception of this item, thereThere were no material changes outside the ordinary course of our business in our specified contractual obligations during the nine months ended September 30, 2020.​2021.
Critical Accounting Policies and Estimates​Estimates
Management’s discussion and analysis of our financial condition and results of operations is based on our condensed consolidated financial statements, which have been prepared in accordance with accounting principles generally accepted in the United StatesU.S. (“GAAP”). The preparation of these financial statements requires us to make estimates and assumptions that affect the amounts reported amounts of assets and liabilities and the disclosure of contingent assets and liabilities at the date of thein our condensed consolidated financial statements as well as the reported revenues and expenses during the reporting periods.accompanying notes. On an ongoing basis, we evaluate our estimates and judgments, including those related to revenue recognition, tax positions and stock-based compensation.judgments. We base our estimates on historical experience and on various other factors that are believed to be appropriate under the circumstances, the results of which form the basis for making judgments about the carrying value of assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates under different assumptions or conditions.
OurWhile our significant accounting policies are more fully described in Note 1 of our financial statements included in our 20192020 Form 10-K, as well as our Management’s Discussion and Analysis of Financial Condition and Results of Operations on our 20192020 Form 10-K. There10-K, we believe that the following accounting policies and judgments are most critical to aid in fully understanding and evaluating our reported financial results. Other than the adoption of Accounting Standards Update 2020-06 fully discussed in Note 9 of our condensed consolidated financial statements in this Quarterly Report on Form 10-Q, there have not been any significant changes to our critical accounting policies and estimates during the nine months ended September 30, 2020.​2021.
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Revenue Recognition. Revenues are recognized when control of the promised services are transferredwe release a result to the patient’sordering healthcare provider, in an amount that reflects the consideration we expect to collect in exchange for those services. The amount of revenue we recognize is based on the established billing rates less contractual and other adjustments, which yields the constrainedunconstrained amount that we expect to ultimately collect. We determine the amount we expect to ultimately collect, on a per-payer or per-agreement basis, using historical collections, established reimbursement rates and other adjustments. The expected amount is typically lower than, if applicable, the agreed-upon reimbursement amount due to several factors, such as the amount of any patient co-payments, out-of-network payers, the existence of secondary payers and claim denials. The consideration derived from our contracts is fixed when we contract with a direct bill payer who assumes the downstream patient billing.payer. Our ability to collect is not contingent on the customer’s ability to collect through their downstream billing efforts.
In the case of some of our laboratory service agreements (“LSAs”) with various organizations, the right to bill and collect exists prior to the receipt of a specimen and release of a test result to the ordering healthcare provider, which results in deferred revenue. The deferred revenue balance is generally relieved upon the release of the applicable patient’s test result to the ordering healthcare provider the date a non-conforming specimen is received, or as of the date the customer has surpassed the window of time in which they are able to exercise their rights for testing services. We believe these points in time represent our fulfillment of our obligations to the customer.
The quality of our billing operations, most notably those activities that relate to obtaining the correct information in order to bill effectively for services provided, directly impacts the collectability of our receivables and revenue estimates. As such, we continually assess the state of our order to cash cycle foroperations in order to identify areas of risk and opportunity as we believe adequate operations support our abilitythat allow us to appropriately estimate receivables and revenue. Upon ultimate collection, the aggregate amount received from payers and patients where reimbursement was estimated is compared to previous collection estimates and, if necessary, the contractual allowancetransaction price is adjusted. Finally, should we later determine the judgments underlying estimated collections change, our financial results could be negatively impacted in future quarters.
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Convertible Notes. We account for convertible debt instruments that may be settled in cash or equity upon conversion by separating the liabilityBusiness Combinations and equity components of the instruments in a manner that reflects our nonconvertible debt borrowing rate. In February 2020 we issued the 2028 Notes of $1,150.0 million in aggregate principal amount of 0.375% Convertible Notes with a maturity date of March 1, 2028. As part of that issuance, we settled approximately $100.0 million in outstanding 2025 Notes. We determined the carrying amount of the liability component of the 2028 Notes by using assumptions that market participants would use in pricing a debt instrument, including market interest rates, credit standing, yield curves and volatilities. Determining the fair value of the debt component requires the use of accounting estimates and assumptions. These estimates and assumptions are judgmental in nature and could have a significant impact on the determination of the debt component, and the associated non-cash interest expense.​
For the February 2020 offering, we allocated $346.6 million, net of tax, to the equity component of the convertible debt instrument. That equity component is treated as a discount on the liability component of the Notes, which is amortized over the eight-year term of the 2028 Notes using the effective interest rate method. In addition, debt issuance costs related to the 2028 Notes was $24.4 million. We allocated the costs to the liability and equity components of the 2028 Notes based on their relative values. The debt issuance costs allocated to the liability component are being amortized over the life of the 2028 Notes as additional non-cash interest expense. The transaction costs allocated to the equity component are netted with the equity component of the convertible debt instrument in stockholders’ equity.​
Business Combinations.Asset Acquisitions. Business Combinations are accounted for under the acquisition method in accordance with ASCAccounting 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 the ASC 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.
In March 2020, we recognized goodwill of $30.4 million from the acquisitions of Paradigm and Viomics. We evaluate goodwill impairment on an annual basis or more frequently should an event or change in circumstance occur that indicates that the carrying amount is in excess of the fair value. Refer to Note 5 and Note 16 of the condensed consolidated financial statements included in this Quarterly Report for further discussion of the goodwill recorded.
Impairment of Long-Lived Assets. We evaluate the fair value of long-lived assets, which include property, plant and equipment, 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.
During the third quarter, we recorded an impairment loss of $200.0 million related to the in-process research and development intangible asset acquired as part of the business combination with Genomic Health and an impairment loss of $9.7 million relating to the abandonment of certain research and development efforts using intangible assets acquired as part of an asset purchase agreement with Armune Biosciences, Inc. The determination to record these impairment charges was made in connection with the preparation of the financial statements as of September 30, 2020. Refer to Note 5 of the condensed consolidated financial statements included in this Quarterly Report for further discussion on the impairment charges recorded. ​
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Recent Accounting Pronouncements​Pronouncements
See Note 1 in the Notes to Condensed Consolidated Financial Statements for the discussion of Recent Accounting Pronouncements.
Off-Balance Sheet Arrangements​Arrangements
As of September 30, 2020,2021, we had no off-balance sheet arrangements.

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Item 3. Quantitative and Qualitative Disclosures About Market Risk​Risk
Interest Rate Risk
Our exposure to market risk is principally confined to our cash, cash equivalents and marketable securities. We invest our cash, cash equivalents, and marketable securities in securities of the U.S. governments and its agencies and in investment-grade, highly liquid investments consisting of commercial paper, bank certificates of deposit, and corporate bonds, which as of September 30, 20202021 and December 31, 20192020 were classified as available-for-sale. We place our cash, cash equivalents, restricted cash, and marketable securities with high-quality financial institutions, limit the amount of credit exposure to any one institution, and have established investment guidelines relative to diversification and maturities designed to maintain safety and liquidity.
Based on a hypothetical ten percent adverse movement in interest rates, the potential losses in future earnings, fair value of risk-sensitive financial instruments, and cash flows are immaterial, although the actual effects may differ materially from the hypothetical analysis. While we believe our cash, cash equivalents, restricted cash, and marketable securities do not contain excessive risk, we cannot provide absolute assurance that, in the future, our investments will not be subject to adverse changes in market value. In addition, we maintain significant amounts of cash, cash equivalents, restricted cash, and marketable securities at one or more financial institutions that are in excess of federally insured limits. Given the potential instability of financial institutions, we cannot provide assurance that we will not experience losses on these deposits. We do not utilize interest rate hedging agreements or other interest rate derivative instruments.
A hypothetical ten percent change in interest rates would not have a material adverse impact on our future operating results or cash flows. All of our significant interest-bearing liabilities bear interest at fixed rates and therefore are not subject to fluctuations in market interest rates; however, because these interest rates are fixed, we may be paying a higher interest rate, relative to market, in the future if circumstances change.
Foreign Currency Risk
Substantially all of our revenues are recognized in U.S. dollars, although a growing percentagesmall portion is denominated in foreign currency as we continue to expand into markets outside of the U.S. Certain expenses related to our international activities are payable in foreign currencies. As a result, factors such as changes in foreign currency exchange rates or weak economic conditions in foreign markets will affect our financial results.
Prior to 2019, the functional currency for each of our international subsidiaries was its local currency. For 2019 our international subsidiaries use the U.S. dollar as the functional currency, resulting in us not being subject to gains and losses from foreign currency translation of the subsidiary financial statements. In September 2017, Genomic Health (now a wholly owned subsidiary) started enteringWe enter into forward contracts to mitigate the impact of adverse movements in foreign exchange rates related to the re-measurement of monetary assets and liabilities and hedge our foreign currency exchange rate exposure. As of September 30, 2020,2021, we had open foreign currency forward contracts with notional amounts of $18.2$29.5 million. Although the impact of currency fluctuations on our financial results has been immaterial in the past, there can be no guarantee that the impact of currency fluctuations related to our international activities will not be material in the future.

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Item 4. Controls and Procedures​Procedures
As of the end of the period covered by this report, we carried out an evaluation, under the supervision and with the participation of our management, including our principal executive officer and our principal financial officer, of the effectiveness of our disclosure controls and procedures, as defined in Rule 13a-15(e) promulgated under the Securities Exchange Act of 1934, as amended (the “Exchange Act”). Based upon that evaluation, our principal executive officer and our principal financial officer concluded that, as of September 30, 2020,2021, our disclosure controls and procedures were effective. Disclosure controls and procedures enable us to record, process, summarize and report information required to be included in our Exchange Act filings within the required time period. Our disclosure controls and procedures include controls and procedures designed to ensure that information required to be disclosed by us in the periodic reports filed with the SEC is accumulated and communicated to our management, including our principal executive, financial and accounting officers, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure.
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In November 2019, the CompanyJanuary 2021, we acquired all of the outstanding capital stock of Genomic HealthThrive (see Note 16 to17 of the accompanying condensed consolidated financial statements for additional information). As of September 30, 2020,2021, management is in the process of evaluating and integrating the internal controls of Genomic HealthThrive into the Company’sour existing operations. Other than the controls enhanced or implemented to integrate the Genomic HealthThrive business, there have been no significant changes in the Company’s internal controlscontrol over financial reporting during the quarter ended September 30, 20202021 that have materially affected, or are reasonably likely to materially affect, the Company’sour internal controlscontrol over financial reporting.
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Part II - Other Information
Item 1. Legal Proceedings​Proceedings
From time to time we are a party to various legal proceedings arising in the ordinary course of our business. Legal proceedings, including litigation, government investigations and enforcement actions could result in material costs, occupy significant management resources and entail civil and criminal penalties.
We are currently responding The information called for by this item is incorporated by reference to civil investigative demands initiated by the United States Department of Justice (“DOJ”) concerning (1) Genomic Health’s compliance with the Medicare Date of Service billing regulations and (2) allegations that we offered or gave gift cards to patientsinformation in exchange for returning the Cologuard screening test, in violationNote 14 of the Federal Anti-Kickback Statute and False Claims Act. We have been cooperating with these inquires and have produced documentsNotes to Condensed Consolidated Financial Statements included in response thereto. Adverse outcomes from these investigations could include our being required to pay treble damages, incur civil and criminal penalties, paying attorney’s 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 and adversely affect our business, financial condition and resultsPart I of operations.

In connection with our combination with Genomic Health,this Quarterly Report 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. The complaint asserts individual and class action claims, including: (i) a violation of 8 Del. C. § 203 by Genomic Health's former directors; (ii) conversion by Genomic Health, Exact and Spring Acquisition Corp.; (iii) breach of fiduciary duty by Genomic Health's former directors; (iv) breach of fiduciary duty by a purported controlling group of former Genomic Health stockholders comprised of funds managed by former Genomic Health directors, Julian Baker and Felix Baker; and (v) aiding and abetting breach of fiduciary duty against Exact, Spring Acquisition and Goldman Sachs & Co. LLC, Genomic Health's financial advisor in the combination. The complaint seeks, among other things, declaratory relief, unspecified monetary damages and attorneys' fees and costs. All defendants intend to move to dismiss the complaint.Form 10-Q.

Item 1A. Risk Factors​Factors
We operate in a rapidly changing environment that involves a number of risks that could materially affect our business, financial condition or future results, some of which are beyond our control. In addition to the other information set forth in this report, the risks and uncertainties that we believe are most important for you to consider are discussed in Part I, “Item 1A. Risk Factors” in the 20192020 Form 10-K and in Part II, “Item 1A. Risk Factors” in our subsequently filed Quarterly Reports on Form 10-Q. Other than the factors set forth below, there have been no material changes to the risk factors described in the 20192020 Form 10-K10-K.
We may be unable to realize the anticipated benefits of our newly hired sales representatives or our Pfizer Promotion Agreement.
In September 2021, we completed an expedited hiring process and onboarded approximately 400 former Pfizer sales representatives. Prior to late August 2021, when Pfizer announced a decrease in subsequently filed Quarterly Reportsthe number of sales positions supporting its Internal Medicine therapeutic area, these employees had been promoting our Cologuard test under the Promotion Agreement between Exact Sciences and Pfizer. The newly hired representatives increased the size of our primary care field sales team to more than 850 representatives.
Certain risks may exist that may prevent us from realizing the anticipated benefits of our newly hired sales representatives, including, among others:
We may encounter potential unknown liabilities or unforeseen increased expenses or delays in connection with the integration of the new representatives into our workforce and their deployment into the field;
Cultural and other differences between Pfizer and us could delay or prevent the successful integration and subsequent retention of these new sales personnel;
Healthcare providers may be more reluctant to allocate time for meetings with Exact sales representatives offering a more limited product portfolio as compared to the product portfolio offered by those representatives when at Pfizer;
Our management’s attention may be diverted by the integration and deployment process;
Precautionary measures taken in response to the COVID-19 pandemic, together with changing policies at healthcare providers offices and hospitals, may limit our sales representatives’ interactions with healthcare providers for an unknown period of time; and
Depending on Form 10-Q.the course of the COVID-19 pandemic, we may need to once again withdraw all or a portion of our sales representatives from the field.
If we are unable to successfully realize the anticipated benefits of our new sales personnel, our business and operating results could be harmed.
For the Promotion Agreement to be successful, we will need to effectively coordinate sales and marketing activities among our and Pfizer’s teams. We are in discussions with Pfizer that could result in material changes to our relationship with Pfizer. Pfizer continues to promote our Cologuard test under the Promotion Agreement through a smaller sales team, but the changing dynamics of our and Pfizer’s sales teams may reduce or otherwise alter the benefits of the Promotion Agreement. We are uncertain how many or what type of sales details Pfizer’s sales representatives will contribute during the fourth quarter of 2021 and beyond.

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The COVID-19 outbreak has and may further materially and adversely affect our business and financial results.
The COVID-19 outbreak, which the World Health Organization has classified as a pandemic, together with related precautionary measures, began tohas materially disruptdisrupted our business insince March 2020 and may continue to disrupt our business for an unknown period of time. COVID-19 has significantly impacted, and may continue to significantly impact, our operating results including our revenues, margins, and cash utilization, among other measures. The territories in which we market, sell, distribute and perform our tests are attemptinghave attempted to address the COVID-19 pandemic in varying ways, including stay-at-home orders, temporarily closing businesses, restricting gatherings, restricting travel, and mandating social distancing and face coverings. Certain jurisdictions have begun re-opening only to return to restrictions due to increases in new COVID-19 cases. EvenAlthough health and safety precautions loosened in areas where “stay-at-home” restrictions have been lifted andmany jurisdictions over the past several months as the number of COVID-19 cases declined and vaccination rates increased, beginning in early July 2021, COVID-19 cases, including cases associated with the highly contagious delta variant, have increased significantly in the United States. Although, infection rates have begun to fall in some parts of the country, cases are continuing to climb in other regions, and public health officials and medical professionals have warned that COVID-19 has declined,cases may spike again nationally, particularly if vaccination rates do not quickly increase or if additional, potent disease variants emerge. It is unclear how long any resurgence will last, how severe it will be, and what safety measures governments will impose in response to it. Mask mandates, social-distancing, travel restrictions and stay-at-home orders are in force in many areas of the country and could be reinstated elsewhere. Even before the recent increase in cases, many individuals remainremained cautious about resuming activities such as preventive-care medical visits. Medicalvisits and many medical practices continue to beremained cautious about allowing individuals, such as sales representatives, into their offices. Many individuals continue to work from home rather from an office setting. The level and nature of the disruption caused by COVID-19 is unpredictable, may be cyclical and long-lasting and may vary from location to location. As a result, we anticipate significant impact to at least our 2020 operating results, including our revenues, margins, and cash utilization, among other measures.
Beginning in March 2020, we undertook temporary precautionary measures intended to help minimize the risk of the virus to our employees, including requiring most employees to work remotely; suspending field-based, face-to-face interactions by our sales force; requiring on-site employees to undergo COVID-19 testing, wear personal protective equipment (including face masks or shields) and maintain social distancing; pausing all non-essential travel worldwide for our employees; and limiting employee attendance at industry events and in-person work-related meetings, to the extent those events and meetings are continuing. Our commercial partner for Cologuard, Pfizer, Inc. (“Pfizer”), took similar precautions, including suspending face-to-face interactions between sales representatives and healthcare providers.
We expect to adjust our precautionary measures at our various locations based on local recovery levels and applicable governmental regulations. For example, a portion of the Company’s and Pfizer’s sales force has recommenced field-based interactions, although access to healthcare providers remains limited and the resumption of normal activities is expected to be gradual. Our business could be negatively affected if we take excessive, ineffective or inadequate precautions.
The COVID-19 pandemic has materially impacted our business, and may continue to impact our business for an unknown period of time. Such impacts may include the following:
Both our and Pfizer’s sales teams have been, and for an extended period of time may continue to be, limited in their in-person interactions with healthcare providers, and therefore, also limited in their ability to engage in various types of healthcare provider education activities as contemplated by our and Pfizer’s Cologuard promotion agreement; while we amended and restated our promotion agreement with Pfizer to, among other things, address changes to the operational landscape resulting from the COVID-19 pandemic, our expectations regarding the duration, severity and effects of the pandemic may prove inaccurate, and we may not realize the expected benefits from this agreement;Promotion Agreement;
Healthcare providers or patients have canceled or delayed scheduling, and for an extended period of time may continue to cancel or delay scheduling, standard wellness visits and other non-emergency appointments and procedures (including mammograms and prostate cancer screenings), contributing to a decline in orders for our products or services;
Restrictions on travel, commerce and shipping may prevent patients and pathologists from shipping samples to our clinical laboratories;
Pandemic-related supply chain disruptions (whether caused by restrictions, congestion, or slowdowns in shipping or logistics, increases in demand for certain goods used on our operations, or otherwise) may hinder, or even force us to suspend, operations at some or all of our clinical laboratories;
Illnesses, quarantines, financial hardships, restrictions on travel, commerce and shipping, or other consequences of the pandemic, may disrupt our supply chain or other business relationships, and we or other parties may assert rights under force majeure clauses to excuse performance;
We have experienced, and for an extended period of time may continue to experience, reduced volumes at our clinical laboratories and we may need to suspend operations at some or all of our clinical laboratories;
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We have taken,Our efforts to manage our operations through a volatile and cyclical pandemic, which efforts may take additional,include cost cutting measures, which may hinder our efforts to commercialize our products or delay the development of future products and services. We might not realize all of the cost savings we expect to achieve as a result of those efforts;services;
We and our partners have postponed or cancelled clinical studies, which may delay or prevent our launch of future products and services;services and increase the opportunity for competitors to develop products and services that compete with ours;
Our workforce much of which has been asked to work remotely in an effort to reduce the spread of COVID-19, may be infected by the virus or otherwise distracted;
A combination of factors, including infection from the virus, supply shortfalls or disruptions, and inability to obtain or maintain equipment, could increase our operating expenses and adversely affect our lab capacity and our ability to meet the demand for our testing services. In Marchservices;
We have adjusted, and expect to continue to adjust, our precautionary measures at our various locations based on our perception of 2020local recovery levels and applicable governmental regulations; our business could be negatively affected if we began offering a COVID-19 test and by devoting lab capacity and supplies to that test, we may experience capacity limitations and supply shortfalls that adversely affect our ability to provide Cologuard and other tests that may generate more revenue and higher profits;take excessive, ineffective or inadequate precautions; and
We may inaccurately estimate the duration or severity of the COVID-19 pandemic, which could cause us to misalign our staffing, spending, activities and precautionary measures with market current or future market conditions.
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Despite our efforts, the ultimate impact of COVID-19 depends on factors beyond our knowledge or control, including the duration and severity of the outbreak, third-party actions taken to contain its spread and mitigate its public health effects and short- and long-term changes in the behaviors of medical professionals and patients resulting from the pandemic.
We heavily rely upon certain suppliers, including suppliers that are the sole source of certain products; the loss or interruption of supply from our suppliers could have a disruptive effect on our business.
We purchase certain supplies from third-party suppliers and manufacturers. In some cases, due to the unique attributes of products that are incorporated into our tests, we maintain either a single-source supplier relationship or a very limited set of supplier relationships. Certain of our third-party suppliers possess exclusive intellectual property or otherwise may be the only party with the rights or expertise to provide us critical supplies. These third parties are independent entities subject to their own unique operational, regulatory compliance, and financial risks that are outside our control. These third parties may not be willing to enter or renew long-term supply arrangements with us or continue to supply us at all. Additionally, they may not perform their obligations in a timely and cost-effective manner and they may be unwilling or unable to increase production capacity commensurate with demand for our tests or future products or services. Our relationships with suppliers may also be negatively affected by general supply chain material shortages worldwide, as suppliers struggle to keep pace with demand and manage their own supply chains.
We may become dependent on additional single- or limited-source suppliers, or become increasingly dependent on existing suppliers, as we expand and develop our product and service pipeline. For example, our Oncotype MAP and GEMExTra® tests are currently only validated to be performed on Illumina’s sequencing platform and we are not aware of any other platform that we could use in the anticipated economic consequencesnear future as a commercially viable alternative. Further, Illumina may become the sole supplier of certain equipment and reagents necessary for future tests we may develop, including MCED, minimal residual disease, and recurrence monitoring tests. We currently procure Illumina equipment and reagents on a purchase order basis, without any long-term supply agreement. In August 2021, Illumina completed its acquisition of GRAIL, which is commercializing a MCED test against which certain of our planned tests would compete. Illumina’s ownership of GRAIL could incentivize Illumina to offer its sequencing products in a manner that advantages GRAIL over us and other competitors, including the potential that Illumina may be unwilling or unable to supply, or commit to supplying, us with sequencing equipment and reagents on commercially acceptable terms, or at all. Although Illumina has made an irrevocable standing offer to supply any customer with its sequencing products on certain terms, that offer may not provide pricing or other terms necessary for us or others to successfully compete against GRAIL, including outside of the U.S. Although we expect to continue our efforts to validate alternative sequencing platforms on which we could run our Oncotype MAP or GEMExTra tests or other future tests in a commercially viable manner, we may expend considerable time and efforts, endure delays to our test development and commercialization timelines, and be ultimately unsuccessful in our efforts to validate alternatives. Even if we validate an alternative sequencing platform, we may become substantially dependent on the supplier of that platform.
Similarly, as an additional example, we rely on Hamilton Company to provide us laboratory equipment and related supplies (such as racking and pipette tips) necessary to perform certain critical DNA analysis steps in our clinical laboratory tests, including our Cologuard, Oncotype DX and COVID-19 tests. Although other companies may offer viable alternative platforms, we have invested significant capital, time and expertise to procure Hamilton machines and to optimize their use in our tests. Industry demand for Hamilton supplies has increased significantly since the onset of the COVID-19 pandemic, and although we have adverselya long-term supply agreement with Hamilton, it is possible that Hamilton could become unable or unwilling to continue to provide us with certain equipment and supplies on commercially acceptable terms, if at all. Hamilton may require us to exclusively use Hamilton consumables and components in connection with certain Hamilton laboratory equipment. Therefore, if our access to certain Hamilton consumables and components became impacted, financial markets, resulting in high share price volatility, reduced market liquidity,we may need to completely replace the Hamilton platform. Validating alternative vendors’ offerings could be expensive, time-consuming, and substantial declines inunsuccessful. Further, because our Cologuard test is regulated by the market pricesFDA, we may also need FDA clearance or approval to replace certain Hamilton equipment and supplies with another vendor’s offerings. FDA approval or clearance may entail extensive new clinical and material costs and delays and may be ultimately unsuccessful.
The loss of a critical supplier, the securitiesfailure to perform by a critical supplier, the deterioration of many publicly traded companies. Volatileour relationship with a critical supplier or declining markets for equitiesany unilateral modification to the contractual terms under which we are supplied materials could have a disruptive effect on our business, and could adversely affect our ability to raise capital when needed through the saleresults of sharesoperations for an extended period of common stock or other equity or equity-linked securities. If these market conditions persist when and if we need to raise capital, andtime, particularly if we are ablerequired to sell shares of our common stock under then prevailing market conditions, we might have to accept lower prices for our shares and issue a larger number of shares than might have been the case under better market conditions, resulting in significant dilution of the interests of our stockholders.
We currently offer COVID-19 testing, but there can be no assurance that we will continue to be able to successfully offer, perform or generate revenues from the test.
In late March 2020, we began providing COIVD-19 testing. The U.S. Food and Drug Administration (FDA) has granted us Emergency Use Authorization to test for SARS-CoV-2, the virus that causes COVID-19, in upper respiratory samples.
While we have entered into a limited number of contracts to provide COVID-19 testing and expect to pursue additional contracts, there can be no assurance that our efforts to offer and perform COVID-19 testing will be successful. The success of our test, our ability to continue to generate revenues from COVID-19 testing, and our ability to generate profits from COVID-19 testing will depend on a variety of factors, including:
the level of demand for COVID-19 testing, the price we are able to charge for performing the test, and the length of time for which that demand persists;
the availability of COVID-19 testing, from other laboratories;
acceptance of our COVID-19 testing in the medical community;
the emergence of other forms of COVID-19 testing (including antigen and antibody screening tests) and other sample collection methods, which healthcare providers and patients may prefer to our test;
the period of time for which the FDA will permit us to offer COVID-19 testing undervalidate an Emergency Use Authorization;
our ability to maintain regulatory approvals to perform and market COVID-19 testing and to respond to any changes in regulatory requirements;
the potential for supply disruptions and our reliance on certain single-source suppliers;
the potential for disruption in the delivery of patient samples to our laboratories;alternative supplier.
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Our results of operations can be adversely affected by labor shortages, turnover and labor cost increases.
Labor is a significant component of operating our business. A number of factors may adversely affect the capacity of our laboratorieslabor force available to satisfy bothus or increase labor costs, including high employment levels, federal unemployment subsidies, including unemployment benefits offered in response to the COVID-19 testingpandemic, increased wages offered by other employers, vaccine mandates and other testing demands;
the extentgovernment regulations and our responses thereto. As more employers offer remote work, we may have more difficulty recruiting for jobs that require on-site attendance, such as certain clinical laboratory and sales roles. Although we have not experienced any material labor shortage to whichdate, we choosehave recently observed an overall tightening and increasingly competitive labor market. A sustained labor shortage or increased turnover rates within our employee base, caused by COVID-19 or as a result of general macroeconomic factors, could lead to allocate limited laboratory capacity, suppliesincreased costs, such as increased overtime or financial incentives to meet demand and other resourcesincreased wage rates to areas of our business other than COVID-19 testing;
the complexity of billing for,attract and collecting revenue for, our test;
healthcare providerretain employees, and patient compliance with instructions for performing the nasal swab and providing samples to our laboratories;
could negatively affect our ability to maintain laboratory operations during the COVID-19 pandemicefficiently operate our clinical laboratories and to perform the test accurately and punctually; and
the ease of use of our ordering and reporting process.
Additionally, we have previously only offered cancer screening and diagnostic tests. The addition of COVID-19 testing may divert resources and distract management’s attention from other projects that may be more profitable or strategic.overall business. If we are unable to successfully provide COVID-19 testing while continuing to operate our existing Screeninghire and Precision Oncology business, our resultsretain employees capable of operations, financial position and reputation may suffer.
Our business is subject to complex and evolving laws, as well as customer and patient expectations, regarding data privacy, protection and security.
The interpretation and application of consumer, health related and data protection laws in the U.S., Europe and elsewhere are often uncertain, contradictory and in flux. In order to mitigate concerns about overseas data transfers and to comply with provisions of the GDPR and its predecessor regulations, we self-certified with the Department of Commerce for compliance with the U.S.-E.U. Privacy Shield. However, on July 16, 2020, the Court of Justice of the European Union rendered its judgment in Data Protection Commissioner v. Facebook Ireland, invalidating the U.S.-E.U. Privacy Shield program. Although we expect to implement other measures to ensure compliance with the GDPR, the changing legal landscape could cause us to incur substantial costs or change our operations and compliance procedures, all of which may adversely affect our business.
If we fail to comply with the GDPR and other applicable data privacy, protection and security laws,performing at a high-level, or if mitigation measures we failmay take to satisfy customer or patient concerns regarding data handling, werespond to a decrease in labor availability have unintended negative effects, our business could be subject to government enforcement actions, private litigation, civiladversely affected. An overall labor shortage, lack of skilled labor, increased turnover or criminal penalties, reduced orders and adverse publicity.
Our failure to successfully completelabor inflation, caused by COVID-19 or integrate acquisitions, including our recently announced acquisition of Thrive, in the expected timeframes, or to realize all or any part of the anticipated benefits of such acquisitions, may adversely affect our results of operations..
We undertake acquisition activities from time to time. In November 2019, we completed the acquisition of Genomic Health, Inc., and in March 2020, we completed the acquisitions of Paradigm Diagnostics, Inc. and Viomics, Inc. On October 27, 2020, we announced our entry into the Thrive Merger Agreement and our acquisition of Base. Certain risks may exist as a result of these and other acquisition activities, including, among others, that:
general macroeconomic factors, could have a failure to complete the merger with Thrive, including due to the inability to receive the required regulatory approvals, the occurrence of events that may give rise to the right of one or both of us and Thrive to terminate the Thrive Merger Agreement, a ruling or judgment by a government authority enjoining or prohibiting the Thrive merger, or the failure of us or Thrive to satisfy another closing condition outside ofmaterial adverse impact on our control, could negatively impact our stock price and our future business and financial results;operating results.
we will incur substantial expenses, andWe may encounter potential unknown liabilities and unforeseen increased expenses, delaysbe a party to litigation in the normal course of business or unfavorable conditions, in connection with the closing of the Thrive merger and other business acquisitions, including our acquisition of Base, whether or not such acquisitions are completed, and the subsequent integration, reducing our cash available for operations and other uses;
the pendency of the Thrive merger or other acquisitionsotherwise, which could adversely affect our business and operations, including by diverting significant focus of managementfinancial position.
From time to time, we are a party to or otherwise involved in legal proceedings, claims and government investigations and other resourceslegal matters, both inside and limitingoutside the United States, arising in the ordinary course of our abilitybusiness or otherwise. We are currently involved in various legal proceedings and claims that have not yet been fully resolved, and additional claims may arise in the future. Legal proceedings can be complex and take many months, or even years, to execute certain business strategies;
reach resolution, with the final outcome depending on a number of variables, some of which are not within our control. Litigation is subject to significant uncertainty and may be expensive, time-consuming, and disruptive to our operations. Although we will vigorously defend ourselves in such legal proceedings, their ultimate resolution and potential financial and other impacts on us are uncertain. For these and other reasons, we may be unablechoose to successfully integratesettle legal proceedings and claims, regardless of their actual merit. If a legal proceeding is resolved against us, it could result in significant compensatory damages, and in certain circumstances punitive or trebled damages, disgorgement of revenue or profits, remedial corporate measures or injunctive relief imposed on us. If our existing insurance does not cover the acquired businesses into our business;
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we may lose key employees;
we may encounter potential unknown liabilities and unforeseen risks associated with contracts containing consent and/damages awarded, or if other provisions that may be triggered by the acquisitions;
we may be unable to realize the anticipated benefits of the acquisitionsresolution or do so within the anticipated timeframe;
our future results will suffer if we do not effectively manage our expanded operations; and
the market price of our common stock may declineactions taken as a result of the acquisitions.
In the future, we may enter into transactionsa legal proceeding were to acquire other businesses, products, services or technologies. Because we have only made a limited number of acquisitions to date,restrain our ability to do so successfullyoperate, our financial position, results of operations or cash flows could be materially adversely affected. In addition, legal proceedings, and any adverse resolution thereof, can result in adverse publicity and damage to our reputation, which could adversely impact our business.
The amounts we record for legal contingencies can result from a complex series of judgments about future events and uncertainties and can rely heavily on estimates and assumptions. While we have accrued for certain potential legal liabilities, there is unproven. If we do identify suitable candidates, we mayno guarantee that additional costs will not be ableincurred beyond the amounts accrued. Additional information regarding certain legal matters in which we are involved can be found in Note 14 to make such acquisitions on favorable terms or at all. Any acquisitions we make may not strengthen our competitive position, and these transactions may be viewed negatively by investors, healthcare providers, patients and others. In addition to the risks outlined above, we may decide to incur debtCondensed Consolidated Financial Statements in connection with an acquisition or issue our common stock or other securities to the stockholders of the acquired company, which would reduce the percentage ownership of our existing stockholders. We cannot predict the number, timing or size of future acquisitions or the effect that any such transactions might have on our operating results.Part I, Item 1.

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
In January 2020, we entered into an amendment to a services and license agreement with Mayo Foundation for Medical Education and Research (“Mayo”) relating to medical officer services provided by certain Mayo employees. As part of the agreement, in July 2020 we issued Mayo 4,984 shares of restricted stock.
We believe that the offer and sale of the securities referenced were exempt from registration under the Securities Act of 1933 (the “Securities Act”) by virtue of Section 4(a)(2) of the Securities Act and/or Regulation D promulgated thereunder as transactions not involving any public offering. Use of this exemption is based on the following facts:
Neither we nor any person acting on our behalf solicited any offer to buy or sell securities by any form of general solicitation or advertising.
At the time of the purchase, Mayo was an accredited investor, as defined in Rule 501(a) of the Securities Act.
Mayo has had access to information regarding Exact and is knowledgeable about us and our business affairs.Not applicable.

Item 3. Defaults Upon Senior Securities​Securities
Not applicable.

Item 4. Mine Safety Disclosures
Not applicable.

Item 5. Other Information​Information
On October 23, 2020, we notified The Nasdaq Stock Market (“Nasdaq”) of an inadvertent noncompliance with Nasdaq Listing Rule 5605(c) (“Rule 5605(c)”), which prohibits members of a listed company’s audit committee from receiving, directly or indirectly, consulting fees of any amount. During the time period from July 25, 2019, to October 22, 2020, Pierre Jacquet, a member of our board of directors, served as a member of our Audit and Finance Committee. Mr. Jacquet is Vice Chairman, Global Healthcare Managing Director at L.E.K. Consulting, a global management consulting firm that we have engaged from time to time to perform strategic consulting services for theNot applicable.
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Company. We made payments to L.E.K. Consulting of $359,231 during the period in which Mr. Jacquet served on our Audit and Finance Committee in 2019 and $506,234 during the period in which Mr. Jacquet served on our Audit and Finance Committee in 2020. Mr. Jacquet did not provide the consulting services to the Company and did not receive any direct compensation related thereto. Once it was determined that the payments to L.E.K. Consulting were deemed indirect consulting fees to Mr. Jacquet under Rule 5605(c) by virtue of its requirement that members of a listed company’s audit committee meet the criteria for independence set forth in Rule 10A-3(b)(1) under the Securities Exchange Act of 1934 (the “Exchange Act”), we promptly corrected the non-compliance. Daniel Levangie, who our board of directors has determined meets the criteria for independence required by Rule 5605(c), succeeded Mr. Jacquet as a member of the Audit and Finance Committee on October 22, 2020.
The notification to Nasdaq was made in accordance with Nasdaq Rule 5625, which requires a company with common securities listed on Nasdaq to report any noncompliance of Nasdaq’s Rule 5600 Series. This report shall not constitute an admission that the inadvertent noncompliance reported herein is material.
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Item 6. Exhibits​Exhibits
The following documents are filed as part of this Form 10-Q.
Exhibit
Number
Exhibit DescriptionFiled
with
This
Report
Incorporated
by Reference
herein from
Form or
Schedule
Filing
Date
SEC File /
Registration
Number
Sixth Amended and Restated Certificate of Incorporation of the RegistrantS-1 (Exhibit 3.3)12/4/2000333-48812
Amendment to Sixth Amended and Restated Certificate of Incorporation of the Registrant8-K (Exhibit 3.1)7/24/2020001-35092
FourthFifth Amended and Restated By-Laws of the Registrant8-K (Exhibit 3.1)1/31/2020001-35092
Second Amended and Restated License Agreement, effective January 31, 2020, by and between Mayo Foundation for Medical Education and Research and the Registrant *X
Amended and Restated Cologuard Promotion Agreement by and between the Registrant and Pfizer, Inc.8-K
(Exhibit 10.1)
10/7/20203/3/2021001-35092
Certification Pursuant to Rule 13(a)-14(a) or Rule 15d-14(a) of Securities Exchange Act of 1934X
Certification Pursuant to Rule 13(a)-14(a) or Rule 15d-14(a) of Securities Exchange Act of 1934X
Certification Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002X
101The following materials from the Quarterly Report on Form 10-Q of Exact Sciences Corporation for the quarter ended September 30, 20202021 filed on October 27, 2020,November 2, 2021, formatted in Inline eXtensible Business Reporting Language (“iXBRL”): (i) Condensed Consolidated Balance Sheets, (ii) Condensed Consolidated Statements of Operations, (iii) Condensed Consolidated Statement of Changes in Stockholders’ Equity, (iv) Condensed Consolidated Statements of Cash Flows and (v) related notes to these financial statementsX
104The cover page from our Quarterly Report for the period ended September 30, 2020,2021, filed with the Securities and Exchange Commission on October 27, 2020,November 2, 2021, is formatted in Inline Extensible Business Reporting Language (“iXBRL”)X
______________​
*Confidential portions of this exhibit, indicated by asterisks, have been omitted.​
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SIGNATURES​SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
EXACT SCIENCES CORPORATION
Date: October 27, 2020November 2, 2021By:/s/ Kevin T. Conroy
Kevin T. Conroy
President and Chief Executive Officer
(Principal Executive Officer)
Date: October 27, 2020November 2, 2021By:/s/ Jeffrey T. Elliott
Jeffrey T. Elliott
Executive Vice President, Chief Financial Officer and Chief Operating Officer
(Principal Financial and Accounting Officer)

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