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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

FORM 10-K
(Mark One)
ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the fiscal year ended December 31, 20192021
OR
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from                  to
Commission File No. 000-33043
OMNICELL, INC.
(Exact name of Registrantregistrant as specified in its charter)
Delaware94-3166458
(State or other jurisdiction of
incorporation or organization)
(IRS Employer
Identification No.)
590 East Middlefield Road
Mountain View, CA 94043
(Address of registrant’s principal executive offices, including zip code)

(650) 251-6100
(Registrant’s telephone number, including area code)
Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading SymbolName of each exchange on which registered
Common Stock, $0.001 par valueOMCLNASDAQ Global Select Market
Securities registered pursuant to Section 12(g) of the Act: None
Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ý    No o
Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes o    No ý
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 ý    No o
Indicate by check mark whether the registrant has submitted electronically 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 and post such files). Yes ý    No o
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or 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 filerNon-accelerated filerSmaller reporting companyEmerging 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. o
Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal controls over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or issued its audit report. ☒
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes     No ý


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The aggregate market value of the registrant’s common stock, $0.001 par value, held by non-affiliates of the registrant as of June 28, 201930, 2021 was $3.5$6.5 billion (based upon the closing sales price of such stock as reported on the NASDAQ Global Select Market on such date) which excludes an aggregate of 540,177594,469 shares of the registrant’s common stock held by officers, directors and affiliated stockholders. For purposes of determining whether a stockholder was an affiliate of the registrant at June 28, 2019,30, 2021, the registrant has assumed that a stockholder was an affiliate of the registrant at June 28, 201930, 2021 if such stockholder


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(i) beneficially owned 10% or more of the registrant’s common stock and/or (ii) was affiliated with an executive officer or director of the registrant at June 28, 2019.30, 2021. Exclusion of such shares should not be construed to indicate that any such person possesses the power, direct or indirect, to direct or cause the direction of the management or policies of the registrant or that such person is controlled by or under common control with the registrant.
As of February 20, 2020,18, 2022, there were 42,465,81444,421,377 shares of the registrant’s common stock, $0.001 par value, outstanding.
DOCUMENTS INCORPORATED BY REFERENCE
Portions of the registrant’s definitive Proxy Statement for the 20202022 Annual Meeting of Stockholders to be filed with the United States Securities and Exchange Commission pursuant to Regulation 14A not later than 120 days after the end of the fiscal year covered by this Form 10-K are incorporated by reference in Part III, Items 10-14 of this Form 10-K.



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OMNICELL, INC.
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FORWARD-LOOKING STATEMENTS AND FACTORS THAT MAY AFFECT FUTURE RESULTS
This annual reportAnnual Report on Form 10-K contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act of 1933, as amended (the "Securities Act"“Securities Act”), and Section 21E of the Securities Exchange Act of 1934, as amended (the "Exchange Act"“Exchange Act”). The forward-looking statements are contained throughout this reportAnnual Report including in the sections entitled “Risk Factors” and “Management’s Discussion and Analysis of Financial Condition and Results of Operations.” Forward-looking statements include, but are not limited to, statements about:
our expectations about the continuing impact of the ongoing COVID-19 pandemic on our workforce and operations (including new variants of the virus) and associated efforts to contain the spread of the pandemic, as well as the continuing impacts on our customers and suppliers, and the anticipated continuing effects of the COVID-19 pandemic and associated containment measures on our business, financial condition, liquidity, and results of operations;
our expectations regarding our future sales pipeline and product bookings;
the extent and timing of future revenues, including the amounts of our current backlog;
the size or growth of our market or market share;
our beliefs about drivers of demand for our solutions, market opportunities in certain product categories, and continued expansion in these product categories, as well as our belief that our technology, services, and solutions within these categories position us well to address the needs of retail, acute, and post-acute pharmacy providers;
our abilityexpectation to continue to acquire companies, businesses, products, or technologies on commercially reasonable terms and integrate such acquisitions effectively;technologies;
our goal of advancing our platform with new product introductions annually;introductions;
our abilitygoal to deliver on the autonomous pharmacyAutonomous Pharmacy vision, as well as our plan to integrate our current offerings and technologies on a cloud infrastructure and invest in broadening our solutions across certain key areas as we execute on this vision;
continued investment in the autonomous pharmacyAutonomous Pharmacy vision, our beliefs about the anticipated benefits of such investments, and our expectations regarding continued growth in current and future subscription and cloud-based offerings as we execute on this vision;
our belief that our solutions and vision for fully autonomous medication management are strongly aligned with long-term trends in the healthcare market and well-positioned to address the evolving needs of the healthcare institutions;
planned new products and services;
the bookings, revenue, and margin opportunities presented by new products, emerging marketsservices, and international markets;
our ability to secure adequate supplies of raw materials and components utilized in the manufacture of our products of a quality that we require and at acceptable prices;
our ability to align our cost structure and headcount with our current business expectations;
the bookings, revenues, non-GAAP EBITDA, non-GAAP operating marginsmargin, or non-GAAP earnings per share goals we may set;
the outcome of any legal proceedings to which we are a party;
our projected target long-term revenues and revenue growth rate,rates, long-term non-GAAP operating margins,margin targets, long-term non-GAAP EBITDA margin targets, and free cash flow conversion;
our ability to protect our intellectual property and operate our business without infringing the intellectual property rights of others;
the expected impacts of new accounting standards or changes to existing accounting standards;
our expected future uses of cash, including our expected uses for the remaining proceeds of our convertible senior notes, and the sufficiency of our sources of funding; and
our expectations about the operational and financial impact of the outbreak of the coronavirus first identified in Wuhan, China on our business; and
our ability to generate cash from operations and our estimates regarding the sufficiency of our cash resources.
In some cases, you can identify forward-looking statements by terms such as “anticipates,” “believes,” “could,” “estimates,” “expects,” “intends,” “seeks,” “may,” “plans,” “potential,” “predicts,” “projects,” “should,” “will,” “would”“would,” and variations of these terms and similar expressions. Forward-looking statements are based on our current expectations and assumptions, and are subject to known and unknown risks and uncertainties, many of which are beyond our control, which may cause our actual results, performance, or achievements to be materially different from those expressed or implied in the forward-looking statements. Such risks and uncertainties include those described throughout this Annual Report, including in
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uncertainties include those described throughout this annual report, including in Part I - Section 1A. “Risk Factors” and Part II - Item 7. "Management's“Management’s Discussion and Analysis of Financial Condition and Results of Operations"Operations” below. Given these risks and uncertainties, you should not place undue reliance on these forward-looking statements. You should carefully read this annual reportAnnual Report and the documents that we reference in this annual reportAnnual Report and have filed as exhibits, as well as other documents we file with, or furnish to, the U.S. Securities and Exchange Commission (“SEC”) from time to time, with the Securities and Exchange Commission, with the understanding that our actual future results may be materially different from what we expect. The forward-looking statements in this annual reportAnnual Report represent our estimates and assumptions only as of the date of this annual report.Annual Report. Except as required by law, we assume no obligation to update any forward-looking statements publicly, or to update the reasons actual results could differ materially from those expressed or implied in any forward-looking statements, even if new information becomes available in the future.
Other Information
All references in this reportAnnual Report to “Omnicell,” “our,” “us,” “we,” or the “Company”“the Company” collectively refer to Omnicell, Inc., a Delaware corporation, and its subsidiaries. The term “Omnicell, Inc.,” refers only to Omnicell, Inc., excluding its subsidiaries.
We own various registered and unregistered trademarks and service marks used in our business, including the following registered and unregistered markssome of which appear in this report:Annual Report, including Omnicell®, the Omnicell logo, OmniCenter®, SafetyStock®, SinglePointe®, OnDemand®, SureMed®, AccuFlex®, Detect-Rx®, Time My Meds®, Pharmacy Line®, Connect-Rx®, MedCarousel®, ROBOT-Rx®, Performance CenterTM, and AcuDose-RxTM. This reportAnnual Report may also includesinclude the trademarks and service marks of other companies. All otherSuch trademarks and service marks used in this report are the marks of their respective holders.owners.
Information posted on or accessible through websites referenced in this Annual Report is not incorporated by reference or otherwise included in this Annual Report, and any references to these websites are intended to be inactive textual references only.
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PART I
ITEM 1.    BUSINESS
Overview
We areOmnicell, a leading provider of medication management automation solutions and adherence tools for healthcare systems and pharmacies. Our solutions support the vision of a fully autonomous pharmacy, a roadmap designed to improve patient outcomes and operational efficiencies through a fully automated, medication management infrastructure. Our goal is to transformleader in transforming the pharmacy care delivery model, through automation designedis committed to replace manual, error-prone processes, combinedelevating the role of pharmacy within healthcare and transforming medication management as an essential component of care delivery. We are doing so with intelligencean industry-leading comprehensive intelligent infrastructure, bringing together technology, analytics, and expert services offerings, thatto equip and empower pharmacists and pharmacies to focus on clinical care rather than administrative tasks. This intelligent infrastructure provides the critical foundation for realizing the industry vision of the Autonomous Pharmacy, a vision defined by pharmacy leaders for improving operational efficiencies and ultimately targeting zero-error medication management.
Medication management solutions are helpingsome of the most utilized solutions in healthcare. According to a 2018 survey conducted by the Centers for Disease Control and Prevention, drugs are prescribed in approximately 69% of physician appointments and approximately 80% of hospital emergency room visits. With close to 160,000 of our customersdevices installed in hospitals around the globe, dispensing close to 5 million doses daily, and over 2 million users, we believe we play a critical role in day-to-day pharmacy operations.
Many pharmacy leaders utilize our intelligent infrastructure to harness the power of data and analytics, as well as leverage our expertise in medication management to deliver intelligent business insights.improved patient outcomes.
In 2019, a group of pharmacy leaders published a definition of the autonomous pharmacy, articulating specific objectives and targeted outcomes to progress towards the fully autonomous pharmacy, along with a framework outlining the path to achieving it through defined levels of automation. This vision, along with its supporting framework, has become the industry’s North Star for elevating the role of pharmacy within healthcare. Through our medication management automation platform that spans the continuum of care, we are advancingbelieve Omnicell provides the vision forintelligent infrastructure necessary to advance the autonomous pharmacy.Autonomous Pharmacy and reach the industry vision. By developing and delivering a combination of automation, intelligence,technology, analytics, and expert services to be powered byutilizing a cloud datasingle, cloud-based platform, we believe we are helping towill empower healthcare and pharmacy providers to focus on clinical, rather than administrative, tasks.increase healthcare value and improve patient outcomes.
Over 6,000 facilitiesWe believe our robust customer base and channel within the pharmacy care market creates a network of insights and understandings that enable us to bring new solutions and innovations to market. Facilities worldwide use our automation and analytics solutions to help increase operational efficiency, reduce medication errors, deliver actionable intelligence, and improve patient safety. More than 40,000 institutionalInstitutional and retail pharmacies across North America, and the United Kingdom, Germany, and Australia leverage our innovative medication adherence and population health solutions to improve patient engagement and adherence to prescriptions, helping to reduce costly hospital readmissions.
We believe our committed customer base and strategic planning, along with a broad portfolio of products and services, combined with innovation, alignaligns us with the long-term trends of the healthcare market to manage patients across the continuum of care while helping to control costs and improve patient outcomes.
Operating Segments
We previously operated and reported our business in two segments: Automation and Analytics, and Medication Adherence. In an effort to deliver on the strategic vision of the autonomous pharmacy and address industry changes including the continuing consolidation of healthcare systems, rising pharmaceutical costs, and increased scrutiny on controlled substances, we initiated a company-wide organizational realignment in the fourth quarter of 2018 to centrally manage our business operations, including the development and marketing of all of our products, sales and distribution, supply chain and inventory management, as well as regulatory and quality functions. As a result of this organizational realignment, we now operate and report our business as one segment.
Business Strategy
We are committed to being the care provider’sproviders’ and retail pharmacies’ most trusted partner and executing on the industry vision of the autonomous pharmacyAutonomous Pharmacy by developing and delivering automation, intelligence,an intelligent medication management infrastructure composed of devices, digital workflows, analytics, and services designed to transformexperts, all powered by the pharmacy care delivery model, helping to dramatically improve outcomes and lower costs for our healthcare partners.cloud. We believe there are significant challenges facing the pharmacy practice today including, but not limited to, labor shortages, medication errors, drug shortages, medication loss due to drug diversion, significant medication waste and expiration costs, a high level of manual steps in the medication management process, complexity around compliance requirements, high pharmacy employee turnover rates affecting tenure and expertise, hospitalizations from adverse drug events in outpatient settings, high variability in outcomes, and limited inventory visibility. We believe that these significant challenges to the pharmacy practice drive the demand for increased digitization, visibility, and insights that our solutions enable, and represent large market opportunities in three productfour market categories:
Point of Care. As a market leader, we expect to continue expansion of this product category as customers increase use of our dispensing systems in more areas within their hospitals. In addition, weWe are early inmore than halfway through the replacement, upgrade, and expansion cycle of older models of automated dispensing systems with our XT Series automated dispensing systems within our own customer base, which we believe is a significant market opportunity and we expect to continue to focus on furtheropportunity. We have been successful penetrating markets through competitive conversion.conversions and expect this success to continue. We also believe there is an opportunity for us to define a new standard of care for dispensing systems in perioperative settings. We believe our current portfolio within the Point of Care market and new innovation and services will continue to drive improved outcomes and lower costs for our customers.
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Central Pharmacy. This market represents the beginning of the medication management process in Acute Care Settings,acute care settings, and, we believe, the next big automation opportunity to replace high volumes of manual and repetitive processes whichthat are common in the pharmacypharmacies today. Manual processes are prone to significant errors, and products such as IVX Workflow, our IV sterile compounding solutionsSterile Compounding Service (including IV robotics), and our Central Pharmacy Dispensing Service (including the XR2 Automated Central Pharmacy systemSystem), automate these manual processes and are designed to reduce the risk of error for our healthcare partners. Because automation adoption in the Central Pharmacy is still nascent, we believe that the adoption of solutions will be accelerated by bundling those solutions with technology-enabled services that are designed to deliver specific outcomes and leverage intelligence across the enterprise for more actionable insights, and are expected to reduce administrative burden, allowing clinicians to operate at the top of their license. We think that these bundled solutions are becoming more critical than ever as health systems appear to face increasing labor shortages and supply chain disruption following the COVID-19 pandemic. Additionally, we believe new products, innovations and innovationour expertise in the Central Pharmacy market create opportunities to replace prior generation Central Pharmacy robotics, especially when combining those robotics with carousels and carousels.technology-enabled services to increase the percentage of medication managed through the intelligent infrastructure.
Specialty Pharmacy and 340B Program. We believe that health systems will invest in more revenue generating activities that improve patient outcomes, and pharmacy will be at the center with specialty pharmacies and the 340B Drug Pricing Program.
Studies have shown that specialty medications represent over 50% of the country’s total spending on retail, mail-order, and provider-administered drugs. Used for treatment of complex conditions, these medications often require intensive patient management and specialized workflows for dispensing and care coordination. Specialty pharmacies serve as the connection between patients, prescribing physicians, and payors to ensure streamlined access and adherence to these specialty drugs, helping to maintain continuity of care throughout the process, and are expected to improve margin and profitability for the health system. The Central Pharmacy also representsnewly acquired ReCept Holdings, Inc. (“ReCept”) solution provides implementation and managed services for health systems and other provider organizations to optimize their specialty pharmacy programs and the related pharmaceutical aspects of patient care.
The 340B market is targeted to covered entities participating in Section 340B of the Public Health Services Act. The Public Health Services Act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to healthcare organizations that care for many uninsured and low-income patients and creates a complex compliance environment. According to the Health Resources and Services Administration, which is responsible for administering the 340B program, enrolled hospitals and other covered entities can achieve an opportunityaverage savings of 25% to provide technology enabled services designed50% in pharmaceutical purchases. Due to reducethe complexities of adhering to the administrative burden onprocess of the pharmacy340B program, we believe that there are significant opportunities for health systems to improve participation benefits and allow clinicians to operate at the top of their license.maximize program savings through our 340B technology-enabled services.
Retail, Institutional, and Payer. We believe the Retail, Institutional, and Payer market represents a largesignificant opportunity as thehealthcare evolves. A majority of all prescription drugs are distributed in the non-acute sector. The COVID-19 pandemic accelerated the shift of primary healthcare settings from hospitals and doctors’ offices to other convenient channels like the home, digital, and retail pharmacies. New technology isand updated state board regulations are leading to innovation at traditional retail providers, which, combined with the move to value-based care, results, we believe
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will incentivize the market to adopt solutions to help providers and payers engage patients in new ways that lowerimprove patient care and reduce the total cost of care. We believe adoption of our Population Health SolutionsEnlivenHealth® portfolio of software products and services, along with medication adherence packaging, will increase adherence performance rates, increase prescription volume for our customers, and reduce hospital and emergency room visits due to improved adherence. Our EnlivenHealth portfolio has been expanded with two recent acquisitions that will assist in adoption and drive innovation. RxInnovation Inc., operating as FDS Amplicare (“FDS Amplicare”), is a leading provider of financial management, analytics, and population health solutions to the retail pharmacy industry, including independent pharmacies. MarkeTouch Media, LLC (“MarkeTouch Media”) has longstanding pharmacy chain relationships that further broaden EnlivenHealth’s national pharmacy network.
We believe our technology, services, and solutions within these three productmarket categories position us well to address the needs of acute, post-acute, ambulatory, and retail acute, and post-acute pharmacy providers.
Industry Background and Market
We believe our solutions support the vision for fully autonomous medication management and are strongly aligned with trends in the healthcare market and well positioned to address the evolving needs of healthcare institutions.
The healthcare industry continues to experience a significant degree of consolidation, with healthcare providers combining to create larger healthcare delivery organizations in order to achieve greater market power. We believe this trend has increased the market need for more integrated medication management automation solutions on a single platform to help improve patient and financial outcomes for both inpatient and outpatient settings. Our portfolio of products and services, combined with innovation, are designed with this objective in mind.
In addition, healthcare providers and facilities are affected by significant economic pressures. Annual gross spending on medications in the United States (on an invoice basis before rebates or discounts) was estimated to have reached approximately $485 billion in 2018, according to a report published by the IQVIA Institute for Human Data Science in 2019. Annual spending on medications across retail, inpatient, and outpatient settings in the United States on a net basis was calculated to have reached approximately $380 billion in 2018, according to a report published by the Centers for Medicare & Medicaid Services Office of the Actuary in December 2019 and various reports and statistics published by the American Hospital Association. In addition, based on a 2016 report by National Opinion Research Center at the University of Chicago, pharmaceutical costs have substantially outpaced general inflation in recent years. Rising costs of labor, prescription drugs, and new medical technology all contribute to increased spending. Governmental pressures surrounding healthcare reform have led to increased scrutiny of the cost and efficiency with which healthcare providers deliver their services. These factors, combined with continuing consolidation in the healthcare industry, have increased the need for the efficient delivery of healthcare in order to control costs, and have elevated the strategic importance of medication management across the continuum of care.
Furthermore, substantial increases in healthcare administration highlight the need for more complete medication management automation solutions to help drive efficiency and improve patient safety. The number of healthcare administrators grew approximately 3,000% from 1970 to 2016, substantially outpacing the growth in physicians over the same period, according to a statistic derived by the Physicians for a National Health Program using data from the Bureau of Labor Statistics, the National Center for Health Statistics, and the U.S. Census Bureau’s Current Population Survey. Over time, complexities in medication management have increased along with the volume of patients and medications, but many manual processes are still used, resulting in inefficient tracking and delivery of medication and supplies despite the substantial growth in administration staff. Even with the vast increase in administrative positions, many clinical staff are burdened with administrative tasks themselves. According to a survey conducted by the American Society of Health-System Pharmacists in 2015, approximately 76% of pharmacist activities are non-clinical in nature. In addition, many existing healthcare information systems are unable to support the modernization of healthcare delivery processes or address mandated patient safety initiatives. These factors contribute to medical errors and unnecessary process costs across the healthcare sector.
Legislation and industry guidelines, such as those produced by the U.S. Food and Drug Administration (the "FDA"), The Joint Commission, the U.S. Pharmacopeial Convention and the Institute for Safe Medication Practices in the areas of medication management - including storage, security and labeling - have created an environment of increased patient safety awareness and regulatory control. Against this backdrop, healthcare organizations, desiring to improve quality and avoid liability, have been driven to prioritize investment in capital equipment, including pharmacy automation, which is a standard of care, to improve patient safety. While the overall storage and security of medications in hospitals has improved, recent years show increased focus on controlled substance management, particularly in light of the opioid crisis in the United States. According to a research report published by the Butler Center for Research in 2015, studies in the United States have shown that 10% to 15% of healthcare professionals will misuse substances during their lifetime, with significantly higher levels of opioid abuse in particular. Joint Commission surveyors are seeking more documentation from hospitals demonstrating that their medication policies and procedures are adequate.
Medication non-adherence is widely recognized as a common and costly problem. Poor adherence results in increased hospital readmissions, deteriorated treatment outcomes and avoidable healthcare costs. Medication non-adherence is estimated to cost the U.S. healthcare system up to $300.0 billion a year, according to research published in the Risk Management and Healthcare Policy Journal in 2014. In addition, a 2017 study published in the Journal of the American Pharmacists Associationhealth plans.
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found that medication issues are responsible for 26% of hospital readmissions. With more than 38 million Americans taking five or more maintenance medications routinely (based on statistics published by the Centers for Disease Control and Prevention in 2017), pharmacists need ways to support the arduous task of keeping patients compliant. According to a 2011 article by the World Health Organization, “although these medications are effective in combating disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed.” Medication adherence can be improved through attitudinal and behavioral changes, which pharmacists can encourage and help facilitate by providing interventional support, including adherence tools such as blister cards, reminders, prescription synchronization, and patient engagement tools. We believe our Population Health Solutions have the potential to reduce hospitalizations and emergency department visits, and improve patient health by increasing medication adherence.
Healthcare Reform
In 2010, the Patient Protection and Affordable Care Act (“PPACA”) was passed by the U.S. Congress and signed into law by President Obama. The PPACA mandated a broad range of programs to improve access to care, slow the growth of healthcare spending and improve the quality of healthcare. Even though the future of PPACA continues to be unclear under the current administration, the need for increased efficiency in order to provide high-quality healthcare at a lower cost remains a key objective of healthcare systems. Accordingly, in our annual tracking of pharmacy and nursing leadership mindshare, operational efficiency in medication distribution and administration continues to be a top priority.
We believe our products help healthcare organizations leverage and enhance their investments in electronic health record implementation and integration by allowing them to reduce process steps, eliminate manual tracking and waste, enable population-level performance insights, track quality levels, and reduce errors that result in unnecessary cost. By harnessing data provided by our automation systems via our cloud platform and translating them into actionable insights via solutions, such as Performance Center, we help enable our customers to optimize the pharmacy supply chain and lower costs.
Products and Services
As we continue to execute on the industry vision of the autonomous pharmacy,Autonomous Pharmacy, we plan to integrateare enabling our current offerings and technologiesto operate on a cloud infrastructure, and investcloud-based platform in an effort to build out an intelligent medication management infrastructure. We have invested in broadening our solutions across threetwo key areas: automation and advanced services, as explained below.
Automation
Our automation products and technology-enabled services span the evolving continuum of care, including acute, post-acute, ambulatory, and retail pharmacies. We provide a range of advanced automation, including robotics designed to digitize andautomate work, streamline workflows, and reduce human error in central pharmacy and clinical areas, and to support medication adherence initiatives in retail pharmacies. Our automation products and services includeerror. Across these settings, we provide central pharmacy automation solutions for both medication dispensing and IV compounding systems, as well as medication and supply dispensing systems at the point of care, as well as medication adherencecare. We also provide patient engagement solutions which are used by retail, community, and outpatient pharmacies to help improve patient engagement and adherence to prescriptions. With certain automation and technology-enabled service offerings, we provide expert services to optimize utilization through subscription agreements, inclusive of personnel to operate the equipment. Our automation offerings include:
Point of Care
Our point of care automation solutions are designed to improve clinician workflows in patient care areas of the healthcare system, such as nursing units, patient wards, operating rooms, and emergency departments. Automated dispensing systems are an essential part of medication management because they safeguard medications - medications—including controlled substances - substances—and automatically track inventory. We strive to continually develop new innovations forinnovate our automated dispensing systemsystems to close gaps in safety and help enable clinicians to spend less time managing medications and more time caring for patients.
Our XT Series automated dispensing systems for medications and supplies, which are used in nursing units and other clinical areas of the hospital, can be customizedare designed to support workflows specific to each area of the hospital, with various software and hardware options. For the operating room, we also offer specialized automated dispensing systems. Our interoperability solutions integrate all of our automated dispensing systemsystems with key electronic health record systems to help streamline workflow and increase accuracy. We also offer specialized automated dispensing systems for the operating room.
Central Pharmacy
An efficient central pharmacy operation is vital to delivering exceptional patient care. With pharmacist and technician labor requirements increasing and resource shortages escalating over the years, it is critical for pharmacies to find new ways of increasingto increase productivity. Our broad medication management platform offers a broad range of automated hardware and software solutions. Our central pharmacy automation solutions are designed to empower healthcare providers to increase staff efficiency, reduce inventory costs, prevent medication errors, improve compliance, and strengthen security ofsurrounding controlled substances. By automating manual, error-prone processes, we believe our technology helps enableand advanced services directly contribute to clinical care by enabling pharmacy staff to work more efficiently and directly contribute to clinical care.efficiently.
Our central pharmacy automation solutions include: automated storage and retrieval systems, including our XR2 Automated Central Pharmacy System - an important building block to the industry vision of the autonomous pharmacy vision;Autonomous Pharmacy; IV compounding robots and workflow management systems; inventory management software; and controlled substance management systems.
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Medication Adherence
Our medication adherence solutions are used by retail, community, and outpatient pharmacies, as well as by institutional pharmacies serving long-term care and other sites outside the acute care hospital, and are designed to improve pharmacy operations and patient engagement and adherence to prescriptions.
We offer automated systems to aid pharmacies in more accurately and efficiently filling our multimed adherence packaging based on individual patient medication orders. These machines interface with pharmacy information systems to obtain prescription information for each patient receiving the medication blister cards. In addition to robotic automation, we offer software that guides the user through the manual filling process to streamline workflow and increase packing accuracy.
Our single dosesingle-dose automation solutions fill and label a variety of patient-specific, single-dose medication blister packaging based on incoming prescriptions. Our fully automated and semi-automated filling equipment is designed specifically for the long-term care institutional pharmacypharmacies with enough order volume to warrant pre-packaging frequently-usedautomated packaging of medications. Our automated solutions interface with pharmacy information systems to obtain prescription information.
WeFor multi-medication prescriptions, we offer software that guides users through the manual filling process to streamline workflow and increase packaging accuracy. In addition, we also offer a wide range of medication blister card packaging and packaging supplies designed to enhance medication adherence in a variety of non-acute care settings. These products include multimed blister cards (adherence packaging) distributed by retail, community, and outpatient pharmacies to help patients manage their medication regimens at home. These cards organize multiple drugs into a single blister cavity for each dosing time, helping to makemaking it easier for patients on complex regimens to comply with their therapy. For environments where a
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caregiver is present, institutional and retail pharmacies use our single dosesingle-dose blister cards, which provide up to 90-day90 daily doses of a specific single medication.
Other Automation Products and Services
Omnicell Interface Software provides interface and integration between our medication-use products or our supply products and a healthcare facility’sfacilities' in-house information management systems.
Customer service includesOur Technical Services include customer education, and training, and post-installation technical support with phone and web-based support through our U.S.-based technical support centers, on-site service, parts, and access to software upgrades. Product support is available through fixed-period service contracts and on a time and materialstime-and-materials basis. On-site service is provided by our field service team.
Retail Pharmacy and Hospital Automation Outside the United States
Additional products sold outside the United States include robotic dispensing systems used in hospitals and retail pharmacies for handling the stocking and retrieval of boxed medications. For management of medical supplies, a specialized cabinet that uses radio frequency identification is also available.available, which is designed to improve the accuracy of inventory management.
IntelligenceAdvanced Services
With nearly 30 years of experience delivering automation solutions, Omnicell believes that supporting the industry vision of the Autonomous Pharmacy requires the addition of digital workflows, analytics, and experts to achieve more sophisticated outcomes. Leveraging data through predictive and prescriptive analytics, and predictive intelligence,sourced from operational data generated by thousands of facilities utilizing our solutions, we believe we are able to provide actionable insights to help customers better understand their medication usage and improve pharmacy supply chain management. We offer specialized services and analytics software designed to help healthcare facilities improve their bottom line and patient care by harnessing data from automation and other systems.
Our Performance CenterOmnicell OneTM solution, a technology-enabled service, combines a cloud-based predictive intelligence platformanalytics with expert services designed to monitordrive enterprise improvements in medication inventory optimization, medication waste reduction, and drug diversion monitoring.
Our Central Pharmacy IV Compounding Service offers a comprehensive service model inclusive of IV robotic technology, data analytic tools, and clinical support for insourced sterile compounding programs that is intended to reduce medication costs while improving safety and supply chain dependability. Our Central Pharmacy Dispensing Service, inclusive of the XR2 automated central pharmacy operationssystem, is a full-service central pharmacy automation solution designed to improve inventory control, compliance, safety, and recommend opportunitiesefficiency through automation, supported by operational staff, maintenance, and optimization services.
Our 340B solution provides a combination of software, deep knowledge of the 340B program, and technology-enabled services, to help improve efficiency, regulatorydeliver superior outcomes in both savings and compliance, optimizing the 340B program for eligible entities. The suite of offerings includes split billing software, contract pharmacy administration, specialty contract pharmacy administration, and patient outcomes. In addition, we offer analytics softwaredrug discount access solutions.
The newly acquired ReCept solution is focused on specialty pharmacy management services, including specialty pharmacy expertise and operational capabilities, human resources, technology and integration, workflow management, payor access assistance, and other aspects of managing a specialty pharmacy. This total solution for provider groups, federally qualified health centers, and health systems supports on-site management of specialty pharmacy services, including payor contracting, staffing, licensing, quality assurance, 340B administration, and preferred pricing agreements designed to provide a more efficientimprove margin and effective way to monitor potential drug diversion and address inventory management issues.profitability, while keeping the patient at the center of care.
Our Population Health Solutions offerEnlivenHealth offers a portfolio of patient engagement and medication management tools designed to help improve health outcomes. OmnicellEnlivenHealth Patient Engagement is a web-based nexus of solutions designed to comprehensively support improvement in health outcomes related to medication use. OmnicellEnlivenHealth Patient Communications include hosted Interactive Voice Response (IVR), Outbound CommunicationsEngagement includes clinical solutions such as CareScheduler, Medication Synchronization, Immunization and Mobile App,Scheduling, Targeted Patient Interventions, Medication Therapy Management, Opioid Mitigation Solution, and enablean Omnichannel communications platform, which enables tailoring of patient contact to individual preferences. Additionally, we believe our recent acquisition of MarkeTouch Media’s mobile and web-based technology and patient engagement solutions will strengthen the EnlivenHealth suite of industry-leading software-as-a-service (“SaaS”) based solutions. Combined with advanced analytics to stratify populations and prioritize patient interventions, we believe these solutions support improved performance for both pharmacies and health plans, helping them to succeed in value-based healthcare by driving health outcomes - better care, better health, and lower costs.
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The recent acquisition of FDS Amplicare® adds financial management, analytics, and population health solutions to the EnlivenHealth solution. As retail pharmacies continue to play an increasingly vital role in population health following the onset of the COVID-19 pandemic, EnlivenHealth and FDS Amplicare have extended solutions to assist with vaccination programs, testing protocols, patient engagement, and Medicare health plan selection support for patients.
As the introduction of new innovations within our health system customers has become increasingly complex, we also offer Professional Services, such as technology and service implementations, as well as change management services. We view our customers as partners in the pursuit of better health outcomes for patients and improved satisfaction for the clinicians who serve them. Every engagement is an opportunity for us to help our customers reach their clinical and business objectives while we accelerate the time to value for any initiative.
WeThrough our Customer Success service, we provide experttechnology-enabled services that serve as an extension of pharmacy operations to support improved efficiency, regulatory compliance, and patient outcomes. Our experttechnology-enabled services provide comprehensive, customer-centric, outcome-based adoption services designed to help ensure the successful adoption of our technology.
Operating Segments
We manage our operations as a single segment for the purposes of assessing performance and making operating decisions. Our CentralChief Operating Decision Maker (“CODM”) is our Chief Executive Officer. The CODM allocates resources and evaluates the performance of Omnicell at the consolidated level using information about our revenues, gross profit, income from operations, and other key financial data. All significant operating decisions are based upon an analysis of Omnicell as one operating segment, which is the same as our reporting segment.
Industry Background and Market
We believe our solutions support the industry vision of the Autonomous Pharmacy, IV Compounding Service offersare strongly aligned with trends in the healthcare market, and are well positioned to address the evolving needs of healthcare institutions.
The healthcare industry continues to experience a comprehensive service model inclusivesignificant degree of IV roboticconsolidation, with healthcare providers combining to create larger healthcare delivery organizations to achieve greater market power. We believe this trend has increased the market’s need for integrated medication management solutions on a single platform to help improve patient and financial outcomes for both inpatient and outpatient settings. Our portfolio of connected devices, digital workflows, analytics, and experts, combined with innovation, is designed with this objective in mind.
In addition, healthcare providers and facilities are affected by significant economic pressures. Annual prescription drug expenditures in the United States were approximately $535 billion in 2020, according to the IQVIA National Sales Perspective database. Based on a 2018 report by the Health Care Cost Institute, the largest growth in spending for professional services—defined as payments to physicians and other clinical care team members for services provided in physician offices and hospitals—occurred among administered drugs, which accounted for the biggest share, at 39% of the total increase in professional services spending from 2014 to 2018. Rising costs of labor, prescription drugs, and new medical technology data analytic tools,all contribute to increased spending. Governmental pressures surrounding healthcare reform and compliance have led to increased scrutiny of the cost and efficiency with which healthcare providers deliver their services. These factors, combined with continuing consolidation in the healthcare industry, have increased the need for the efficient delivery of healthcare in order to control costs, and elevated the strategic importance of medication management and pharmacy automation across the continuum of care.
Furthermore, while complexities in medication management have increased over time along with the volume of patients and medications, many manual processes are still used, resulting in inefficient tracking and delivery of medications and supplies and increased administrative burden on many clinical staff. According to a survey conducted by the American Society of Health-System Pharmacists in 2019, approximately 75% of pharmacist activities are non-clinical in nature. In addition, many existing healthcare information systems are unable to support the modernization of healthcare delivery processes or address mandated patient safety initiatives. These factors contribute to medical errors and unnecessary process costs across the healthcare sector including in medication management.
Legislation and industry guidelines, such as those issued by the U.S. Food and Drug Administration (the “FDA”), the U.S. Drug Enforcement Administration (the “DEA”), The Joint Commission, the U.S. Pharmacopeial Convention, the Institute for insourced sterile compounding programs. Our Central PharmacySafe Medication Practices, and state boards of pharmacy in the areas of medication management—including storage, security, and labeling—have created an environment of increased patient safety, awareness, and regulatory control. Against this backdrop, healthcare organizations, desiring to improve quality and avoid liability, are driven to prioritize investments in capital equipment, including pharmacy automation, which is a standard of care, to improve patient safety. While the overall storage and security of medications in hospitals have improved, there has been an increased focus on controlled substance management in recent years, particularly in light of the opioid crisis in the United States. According to a research report published by the
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Dispensing ServiceButler Center for Research in 2015, studies in the United States have shown that 10% to 15% of healthcare professionals misuse substances during their lifetime, with significantly higher levels of opioid abuse in particular. Joint Commission surveyors are seeking more documentation from hospitals demonstrating that their medication policies and procedures are adequate to prevent illicit use of controlled substances.
Medication non-adherence is widely recognized as a turnkey, full service centralcommon and costly problem. Poor adherence results in increased hospital readmissions, deteriorated treatment outcomes, and avoidable healthcare costs. The estimated annual cost of prescription-drug related morbidity and mortality resulting from non-optimized medication therapy, including medication non-adherence, was $528 billion in 2016, according to a study published in the Annals of Pharmacotherapy in 2018. In addition, a 2017 study published in the Journal of the American Pharmacists Association found that medication issues are responsible for 26% of hospital readmissions. With more than 40 million Americans taking five or more maintenance medications routinely (based on statistics published by the National Center for Health Statistics in 2018), we believe pharmacists need ways to support the arduous task of maintaining patient compliance. Medication adherence can be improved through attitudinal and behavioral changes, which pharmacists can encourage and help facilitate by providing interventional support, including adherence tools such as blister cards, reminders, prescription synchronization, and patient engagement tools. We believe our EnlivenHealth portfolio has the potential to reduce hospitalizations and emergency department visits, improving patient health by increasing medication adherence.
Furthermore, according to the U.S. Bureau of Labor Statistics, from February 2020 to September 2021 the healthcare industry lost 524,000 workers. Discussions about the healthcare labor crisis tend to highlight the shortfall of nurses. However, the shortage of pharmacy technicians, who are critical to clinical care in inpatient, outpatient and retail settings, is also acute. A nationwide survey conducted in May 2021 by the National Community Pharmacists Association found that nearly 90% of the survey’s 278 independent pharmacy owner/manager respondents said they couldn’t find pharmacy technicians to staff their pharmacies at ideal capacity.
Healthcare workforce labor constraints have come at a time when hospitalizations continue to fluctuate dramatically. In addition, even apart from the impact of the COVID-19 pandemic, patient volume is projected to rebound and exceed pre-pandemic levels. A 2021 McKinsey & Co. survey of the leaders of 100 large private-sector hospitals in the United States—which was conducted several months prior to the emergence of the COVID-19 Omicron variant—concluded that on average hospitals’ inpatient admissions have returned to 2019 levels, and inpatient admissions are projected to increase by 4% in 2022 relative to 2019.
Omnicell’s intelligent infrastructure—incorporating technologies such as automation, solutionrobotics, and data intelligence—is designed to improve inventory control,automate many labor-intensive medication management tasks. We believe this will help optimize the use of existing pharmacy staff, which is expected to free up clinicians’ time for higher-value, patient-engaging activities, such as medication therapy management, immunizations, point-of-care testing, and disease state management.
Government Regulation
Our global operations are affected by complex state, federal, and international laws and regulations. These laws and regulations relate to healthcare, privacy and security, product compliance, import, export, trade, healthcare fraud and abuse (including anti-kickback and false claims laws), environmental standards, anti-corruption, anti-bribery, labor and employment, as well as other areas of focus.
We receive, store, and process personal information and other data from and about our customers, in addition to our employees and service providers, and our customers use our solutions to obtain and store personal information, including personal health information. As a result, we are subject to various laws and regulations related to privacy, data protection, and information security. In the United States, these include federal health information privacy laws (such as the Health Information Portability and Accountability Act of 1996, various state and federal security breach notification laws, consumer protection laws, and state laws addressing privacy and security. Internationally, various foreign jurisdictions in which we operate have established, or are developing, their own data privacy and security legal frameworks with which we or our customers must comply including, for example, the European Union’s General Data Protection Regulation.
The manufacture and sale of most of our current medication and management solutions products are not regulated by the FDA or the DEA, although they are used by other persons (our customers) whose pharmacy, dispensing, and compounding activities may be subject to regulation by those agencies and by state boards of pharmacy. However, we manufacture and develop specifications for products classified as Class I and Class II medical devices, which are subject to FDA regulation and require compliance with the FDA Quality System Regulation as well as medical device reporting, including a sterile disposable product requiring FDA 510(k) review and clearance prior to market and distribution. Medical devices may also be subject to various other regulatory requirements, including as applicable, premarket clearance or approval, clinical trial requirements,
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establishment registration and device listing, complaint handling, notification and repair, replace, refund, mandatory recalls, unique device identifier requirements, reports of removals and corrections, postmarketing surveillance, and device tracking.
Similarly, certain provisions of the Federal Food, Drug, and Cosmetic Act (“FDCA”) govern the approval, manufacture, handling, distribution, and tracking and tracing of pharmaceuticals. The FDCA also regulates which medications may be compounded, and how certain compounded medications may be manufactured, distributed and dispensed. Companies engaged in distributing or dispensing compounded pharmaceuticals may be required to register their facilities with the FDA or operate their businesses according to appropriate quality standards. The law applies to all parts of the drug distribution chain, but generally exempts dispensing pharmaceuticals as long as no drugs are adulterated or misbranded and all are dispensed in accordance with and pursuant to a valid prescription or subject to certain other limitations and controls, as applicable.
Furthermore, our operations are impacted by trade regulations in many countries that govern the import of raw materials and finished products, and we are also subject to laws and regulations that seek to prevent corruption and bribery in the marketplace (including the U.S. Foreign Corrupt Practices Act and the United Kingdom Bribery Act) as well as laws and regulations pertaining to healthcare fraud and abuse, including state and federal anti-kickback and false claims laws in the United States.
Since we manufacture and sell our products outside of the United States, certain products of a local nature and variations of product lines must also meet other local regulatory requirements. Additional risks are inherent to conducting business outside the United States, including more robust information governance and environmental regulations in the European Union, expropriation, nationalization, and other governmental action. Demand for many of our existing and new products is, and will continue to be, affected by the extent to which local regulatory requirements increase our risk and/or expense to do business in those countries.
Compliance with the laws and regulations applicable to our global operations is costly and requires sufficient resources to actively maintain various governance, risk, and compliance systems in several areas, including the FDCA and FDA regulations Controlled Substances Act and DEA regulations, state board of pharmacy regulations, quality, information governance and security, and environmental, health and safety, to enable Omnicell to keep abreast of the constantly evolving regulatory landscape both in the United States and efficiency through automation, supported by operational staff, maintenance,abroad. Any failure to comply with these laws and optimization services.regulations could result in a range of fines, penalties, and/or other sanctions.
Recent Acquisitions
In addition to our own organic development, we have, from time to time, acquired businesses and technologies that expand our product lines and are a strategic fitfits for our business.business, and we expect to continue to seek to acquire business, technologies, or products in the future. The following highlights describe our acquisitions over the past fiscal year. For more information, refer to Item 7, Management’s Discussion of Analysis and Financial Condition and Results of Operations, under the heading “Acquisitions.”
In April 2017,On December 31, 2021, we completed the acquisition of InPharmics,MarkeTouch Media, a providerpharmacy software solutions provider. The MarkeTouch Media acquisition adds mobile and web-based technology and patient engagement solutions, which is expected to expand the footprint of advancedEnlivenHealth across the retail pharmacy informatics solutions to hospital pharmacies. The InPharmics solutions add clinicalsector, while enhancing potential growth opportunities in new market segments like specialty pharmacy and compliance analytics to our Performance Center offering, positioning us as a leading partner for health systems seeking to improve all facets of medicationpharmacy benefits management.
InOn December 2016,29, 2021, we completed the acquisition of Ateb,ReCept, a leading provider of pharmacy-based patient care solutionsspecialty pharmacy management services. The addition of ReCept’s specialty pharmacy management services for health systems, provider groups, and medication synchronizationfederally qualified health centers expands Omnicell’s Advanced Services portfolio in an effort to independentaddress the growing and chain retail pharmacies, an area where we had no prior market penetration. Ateb’s integrated medication synchronization program, combined with Omnicell’s SureMed medication adherence packaging and related automation solutions, uniquely positions us to support pharmacists as they implement and scale their medication adherence programs.complex specialty pharmacy market.
In January 2016,On September 9, 2021, we completed the acquisition of Aesynt,FDS Amplicare, a leader in central pharmacy roboticstechnology provider. The FDS Amplicare acquisition adds a comprehensive and IV compounding automation. We added these two solution setscomplementary suite of SaaS financial management, analytics, and population health solutions to the Omnicell portfolio to give us one of the most comprehensive medication management platform offerings in the industry. With the addition of central pharmacy robotics and IV compounding, we are now able to support customers who desire a centralized cartfill or nurse server medication distribution model all the way to fully decentralized dispensing and hybrid combinations along that continuum. We are also able to offer solutions for preparing IV compounds, including oncology drugs, which is an area where our combined customers have expressed significant interest.EnlivenHealth offering.
Sales and Distribution
We sell our solutionsproducts and services primarily in the United States. Approximately 90% of our revenue was generated in this market for the year ended December 31, 2019. No single customer accounted for greater than 10% of our revenues for the years ended December 31, 2019, 2018, or 2017.2021. Our sales force is organized by geographic region in the United States and Canada, wherewith dedicated account management executives for our top 300 existing customers and dedicated health system executives focused on generating new business. Our sales are primarily made direct to end-user customers with the exception of some distribution of medication adherence consumables. Outside of the United States and Canada, we field direct sales employees in the United Kingdom, France, Germany, the United Arab Emirates, Belgium, and Australia. For other geographies, we generally sell through distributors and resellers. Our foreign operations are discussed in Note 3, Revenues, and Note 7,
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Property and Equipment, of the Notes to Consolidated Financial Statements and Item 7, Management'sManagement’s Discussion and Analysis of Financial Condition and Results of Operations, of this annual report.Annual Report on Form 10-K. Our combined direct, corporate, and international distribution sales teams consisted of approximately 330477 staff members as of December 31, 2019.2021. Nearly all of our direct sales team members have hospital capital equipment, services, or clinical systems experience.
As of December 31, 2021, we have 151 long-term, sole-source agreements with the top 300 U.S. health systems. The sales cycle for our automation systems, from the initial sales meeting to completion of installation, is long and can take in excess of 12 to 24 months. This is due in part to the relative cost of our systems and the number of people within each healthcare facility involved in the purchasing decision and installation process. To initiate the selling process, the sales representative generally targets the chief pharmacy officer, chief information officer, director of pharmacy, the director of nursing, thedirector of information technology, director of materials management, or other decision makers, and is responsible for educatingactively engages with each group within the healthcare facility about the economic, safety, efficiency, and compliance benefits of our solutions relative to competing methods of managing medications or medical and surgical supplies.
We contract with Group Purchasing Organizations (“GPOs”), each of which functions as a purchasing agent on behalf of member hospitals and other healthcare providers, as well as with government entities and agencies.providers. Pursuant to the terms of GPO agreements, each member contracts directly with us and can purchase our product at pre-negotiated contract terms and pricing. These GPO contracts are typically for multiple years with options to renew or extend for up to two years and some of which can be terminated by either party at any time. Our current most significant current GPO contracts include HealthTrust Purchasing Group, Intalere (f.k.a. Amerinet,Vizient, Inc.), Premier Inc., The Resource Group, Resource Optimization & Innovation, LLC, and Vizient, Inc.HealthTrust Purchasing Group. We also have also contracteda Federal Supply Schedule Contract with the U.S. General Services Administration,Department of Veterans Affairs (the “GSA Contract”), allowing the Department of VeteranVeterans Affairs, the Department of Defense, and other Federal government customers to purchase or lease our products. Some of our contracts with these organizations are terminable at the convenience of either party. The accounts receivable balances are with individual members of the GPOs and Federal agencies that purchase under the GSA Contract, and therefore no significant concentration of credit risk exists. During our fiscal year ended December 31, 2019,2021, sales to members of the ten largest GPOs and Federal agencies that purchase under the GSA Contract accounted for approximately 64%67% of our total consolidated revenues.
We offer multi-year, non-cancelable lease payment terms to assist healthcare organizations in purchasing our systems by reducing their cash flow requirements.requirements in a capital lease structure. We sell the majority of our multi-year lease receivables to third-party leasing finance companies.
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Our field operationsclinical and technical consulting representatives support our sales force by providing operational and clinical expertise prior to the close of a sale and during the installation of our automation systems. ThisAlong with professional services, this group assists the customercustomers with the technical implementation of our automation systems, including configuring our systems to address the specific needs of each individual customer. After the systems are installed, on-sitecustomer success representatives provide support is provided byto our field service teamcustomers with a focus on adoption and technical support group.optimization of our solutions.
We offer telephone and web-based technical support through our U.S.-based technical support centers in Illinois, Florida, Pennsylvania and North Carolina.centers. Our support centers are staffed 24 hours a day, 365 days a year. We have found that a majority of our customers’ service issues can be addressed either over the phone or by our support center personnel using theirengineers either by phone or with remote diagnosticsdiagnostic tools. In addition, we use remote dial-in software that monitors customer conditions on a daily basis. We offer aour customers can enable access to allow us to remotely monitor system performance. This suite of remote monitoring features, whichsupport tools proactively monitors system status and alertsis designed to alert service personnel to potential problems before they lead to preempt system failure.
In addition, our international team handles direct sales, installation, and service tofor healthcare facilities in the United Kingdom, France, and Germany, and tofor non-acute customers in Australia. Sales, installation, and service to healthcare facilities is handled through distribution partners in other parts of Europe, Asia, Australia, the Middle East, South Africa, and South America. Our products are available in a variety of languages including Traditional Chinese, Simplified Chinese, Japanese, Korean, French, Swedish, Dutch, Spanish, and German.
We have not sold and have no future plans to sell our products either directly or indirectly to customers located in countries that are identified as state sponsors of terrorism by the U.S. Department of State, or those subject to economic sanctions and export controls.
Manufacturing and Inventory
The manufacturing process for our automation products allows us to uniquely configure hardware and software in unique combinations to meet a wide variety of individual customer needs. The automation product manufacturing process consists primarily consists of the final assembly of components and testing of the completed product. Many of the subassembliessub-assemblies and components we use are provided by third-party contract manufacturers or other suppliers. A portion of these contract manufacturers and other suppliers are based in Asia. We and our partners test these subassembliessub-assemblies and perform inspections to assure the quality and reliability of our products. While many components of our systems are standardized and available fromthrough multiple sources, certain components or subsystems are fabricated by a sole supplier according to our specifications, schedules, and schedulecustomer requirements, or are only available from limited sources. Our medication adherence product manufacturing process consists of fabrication and assembly of equipment and mechanized process manufacturing of consumables. We rely on a limited number of suppliers for the raw materialmaterials that are necessary in the production of our consumable medication packages.
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Our arrangements with our contract manufacturers generally set forth quality, cost, and delivery requirements, as well as manufacturing process terms, such as continuity of supply, inventory management, capacity flexibility, quality and cost management, oversight of manufacturing, and conditions for the use of our intellectual property.
Our manufacturing organization procures components and schedules production based on the backlog of customer orders. Installation of equipment and software typically occurs anywhere between two weeks and twelve months after the initial order is received, depending upon the customer’s particular needs. We deploy a key operational strategy of operating withutilize our backlog levels that approximate the average installation cycle of our customers, which allows us to more efficiently manage our installation, teams,procurement, and production activities that helps to improve production efficiencies,inventory turns, reduce inventory scrap, and lowermanage shipping costs. Shipment of consumables typically occurs between one and four weeks after an order is received.
Competition
The markets in which we operate are intensely competitive. We compete directly with a number of companies in the medication management automation solutions market, as well as the medication adherence solutions market, on the basis of many factors, including price, quality, customer outcome and cost of operation, innovation, product features and capabilities, installation and service, reputation and brand recognition, size of installed base, range of solutions, distribution, and promotion. We expect continued and increased competition from current and future competitors in the markets in which we operate, and are affected by evolving and new technologies, changes in industry standards, and dynamic customer requirements.
Our current direct competitorsFurthermore, the healthcare industry has experienced a significant degree of consolidation. This consolidation may require us to adapt how we market, sell, or distribute our products. Similarly,healthcare providers have consolidated to create larger healthcare delivery organizations in order to achieve economies of scale and/or greater market power. As market demands, government regulations, and societal pressures continue to cause the medication management automation solutions market include Becton, Dickinsonhealthcare industry to evolve, it could result in further business consolidations and Company; ARxIUM; Cerner Corporation; Swisslog Healthcare as a division of KUKA; Cardinal Health, Inc.; PAR Excellence Systems, Inc.; TECSYS Inc.; Baxter Healthcare Corporation; Grifols, S.A.; Willach Pharmacy Solutions; DIH Technologies Corporation; Yuyama Co., Ltd; RoboPharma B.V.; Meditech-Pharma; Knapp AG; KLS Steuerungstechnik GmbH; Gollmann Kommissioniersysteme GmbH;alliances among the industry participants with whom we engage and Loccioni. Our current direct competitors in the medication adherence solutions market include Drug Package, Inc.; ARxIUM; Manchac Technologies, LLC; RX Systems, Inc.; McKesson Corporation; Digital Pharmacist Inc.; Tabula Rasa Healthcare, Inc. (through its acquisition of PrescribeWellness); Synergy Medical Systems; Parata Systems; and Medicine-On-Time in the United States, and Jones Packaging Ltd.; Synergy Medical Systems; and WebsterCare outside the United States.
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We believe our products and services compare favorably with the offerings of our competitors, particularly with respect to proprietary technological advancements, system performance, system reliability, installation, applications training, service response time, and service repair quality.
Intellectual Property and Proprietary Technology
We rely on a combination of patents, trademarks, copyright and trade secret laws, confidentiality procedures, contractual restrictions, and licensing arrangements to protect our intellectual property rights.
We pursue patent protection in the United States and foreign jurisdictions for technology that we believe to be proprietary and that offers a potential competitive advantage for our products. Our issued patents expire on various dates between 20202022 and 2038.2040. We intend to seek and obtain additional United States and foreign patents on our technology.
All of our product software is subject to copyright protection under applicable United States and foreign copyright laws.
We have also obtained United States and, for certain trademarks, foreign registrations of various trademarks, and we intend to seek and obtain registrationadditional registrations of our trademarks in the United States and foreign jurisdictions. We have obtained United States and, for certain marks, foreign registrations of, among others, the following marks: Omnicell, the Omnicell logo, OmniCenter, SafetyStock, SinglePointe, OnDemand, SureMed, AccuFlex, Detect-Rx, Time My Meds, Pharmacy Line, Connect-Rx, MedCarousel, and ROBOT-Rx.
Trade secrets and other confidential information are also important to our business. We protect our trade secrets through a combination of contractual restrictions and confidentiality and licensing agreements.
Research and Development
Our research and development efforts begin with customer collaboration. The insight that we gain through this collaboration helps us to develop solutions to address the unmet needs and challenges faced by our customers. We usecontinue to make significant investments in the industry standard operating systemsvision of the Autonomous Pharmacy, in particular, on our cloud-based platform and databases, but generally developin the migration of our own applicationcustomers from an on-premise infrastructure to our cloud-based platform. We are also investing in the further development of technology-enabled software and interfaceservices including further enhancements to our Advanced Services offerings, as well as continuing to build software that is designed to enable scaling of our current service offerings. In addition, our robotic automation capabilities continue to evolve, while we work to further enhance new-to-market solutions, as well as new solutions currently in development. We have also begun work on longer-term solutions that we believe will benefit our cloud platform offerings. We also continue to enhance the other elements of our product and service portfolio. The results of our research and development facilities. New product development projects are prioritized based on customer input. Researchefforts will further drive the advancement of our cloud-based offerings and development primarily takes place in Mountain View, California; Cranberry Woods, Pennsylvania; St. Petersburg, Florida; Raleigh, North Carolina; Bochum, Germany; Beijing, China; Lancing, UK; and Trieste, Italy. Research and development expenses were $68.6 million, $64.8 million, and $66.0 million foramplify the years ended December 31, 2019, 2018, and 2017, respectively.
Employees
We had approximately 2,700 employees as of December 31, 2019. We have rebalanced our staff as needed, at times eliminating some functional positions and at other times adding new functional-specific positions to meet the evolving needsindustry vision of the business. To our knowledge, none of our domestic employees are represented by a collective bargaining agreement, nor have we experienced any work stoppage. We believe that our employee relations are good.Autonomous Pharmacy.
Business under Government Contracts
A number of our U.S. government-owned or government-run hospital customers signhave signed five-year leases, with payment terms that are subject to one-year government budget funding cycles. Failure of any of our U.S. government customers
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to receive their annual funding could impair our ability to sell to these customers, or to collect payments on our existing unsold leases. Effective September 2021, the U.S. government mandated changes in its Federal Supply Services contract that has resulted in our determination not to enter into future leases with U.S. government customers. Our existing leases with U.S. government customers are unaffected by this change. As such, our volume of U.S. government customer leases will likely decline over time and cease in the future. For additional information regarding these leases, see the section titled “Risk Factors”risk factor captioned “Our U.S. government lease agreements are subject to annual budget funding cycles and mandated changes, which may affect our ability to enter into such leases or to recognize revenues, and sell receivables based on these leases, under Part I, Item 1A below.“Risk Factors”.
Financing Practices Relating to Working Capital
We assist healthcare facilities in financing their cash outlay requirements for the purchase of our systems by offering multi-year, non-cancelable sales contracts. lease payment terms. We typically sell the majority of our multi-year lease receivables to third-party leasing finance companies, although our ability to sell these receivables may be influenced by the perception of our customers’ ability to pay, or other restrictions, which may be influenced by factors outside of our control. For additional information regarding these financing activities, refer to Note 1, Organization and Summary of Significant Accounting Policies, of the Notes to Consolidated Financial Statements in this annual report.Annual Report on Form 10-K.
Product Backlog
Product backlog is the dollar amount of medication management automation solutions and adherence tools for which we have purchase ordersproduct bookings from our customers and for which we believe we will install, bill,have not yet recognized as revenue. A majority of our connected devices and gain customer acceptance generallysoftware license products are installable and recognized as revenues within one year.twelve months of booking, while revenues from SaaS solutions are recorded over the contractual term. Due to industry practice that allows customers to change order configurations with limited advance notice prior to shipment and occasional customer changes in installation schedules, we do not believe that backlog as of any particular date is necessarily indicative of future sales. However, we do believe that backlog is an indication of a customer’s willingness to install our solutions. Our product backlog was $588 million$1.25 billion and $478$924 million as of December 31, 20192021 and 2018,2020, respectively. We consider backlog that is expected to be converted to revenues in more than twelve months to be long-term backlog. The long-term portion of the product backlog was $439 million and $307 million as of December 31, 2021 and 2020, respectively.
Environmental, Social, and Governance (“ESG”) Initiatives
We view Omnicell as a company with a social mission: Our focus on reinventing the pharmacy care delivery model is designed to dramatically improve health outcomes and lower healthcare costs. Our teams are motivated by knowing that our work to improve medication management has a tangible, real-world impact on healthcare workers, patients, and communities.
We recognize that we are accountable not only to our customers and shareholders, but also to the global community. In April 2021, we published our Corporate Responsibility Report, which outlines our approach to corporate responsibility and describes our contributions to achieve a more sustainable future. We define corporate responsibility through four strategic pillars – Innovation, Environmental, Social, and Governance. We are focused on innovating to drive sustainability across our business by adhering to internationally-recognized Organisation for Economic Co-operation and Development guidance for the responsible sourcing of raw materials, and through elevating our diversity and inclusion initiatives.
Furthermore, there are evolving and increasing expectations from regulators, customers, investors, and employees with respect to reducing and limiting greenhouse gas (“GHG”) emissions, without a clear and consistent framework in which to operate globally. The enhanced stakeholder focus on matters relating to ESG activities requires deliberate, conscientious efforts to affect change while the reporting frameworks are still being developed. We are carefully studying ways we can contribute to the reduction in GHG emissions, as well as enhance our Social and Governance initiatives, taking cues from our stakeholders and internal assessments and direction from the Governance Committee of Omnicell’s Board of Directors. As an organization, we have adopted a risk-management approach to assessing and reducing the impact of climate change on our operations. We continually work to innovate and improve our business practices in an effort to ensure the greatest positive impact as we continue to do things in “A Better Way.”
More information on our ESG initiatives and a copy of our Corporate Responsibility Report are available on our corporate website, www.omnicell.com, under the “About Us―Corporate Responsibility” tab.
Human Capital Management
As of December 31, 2021, we had approximately 3,800 employees worldwide (with approximately 3,351 located in either the United States or Canada), excluding individuals who are classified as temporary or contractors, an increase of approximately 940 employees since December 31, 2020. This increase reflects our efforts to grow Omnicell’s operations,
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Company Informationincluding through the impact of incremental headcount in connection with recent acquisitions, while continuing to drive profitability and optimizing resource allocation. We regularly conduct employee engagement surveys, most recently via the Glint platform. Through continued investment in talent processes and acting on employee feedback, we have achieved an overall employee satisfaction score of 74, which is consistent with the average score of similarly-sized companies identified by Glint that use the Glint platform. We believe this reflects our positive employee relations and that Omnicell is viewed by our employees as a good place to work.
Compensation and Benefits
We embrace a strong pay-for-performance total rewards philosophy that we believe is competitive, performance-based, and cost-effective. We offer market-competitive pay and a comprehensive benefits package.
Our quarterly bonus program is designed to incentivize our employees to focus on work that will further our strategic priorities.
We offer reward and recognition programs that embed our core values into our culture and everything we do, allowing for peer-to-peer recognition and motivating our employees to continually work to advance our mission, vision, and values.
Our performance review process enables our talent to reach their optimum levels of contribution to Omnicell’s business strategies and supports our pay-for-performance philosophy.
Health and Wellness
We were incorporatedoffer a comprehensive wellness program designed to promote a healthy lifestyle, including exercise challenges, on-site gym facilities, virtual workouts, and health coaching. In addition to making physical health a priority, we offer mental health counseling and resources, financial coaching, and Teladoc Health services (i.e., telephone health services).
Employee Development
Our Employee & Organizational Development function plays a strategic role in Californiahelping us attract, develop, and retain talent. We strive to develop career growth opportunities while delivering consistent learning experiences irrespective of role, function, or location.
We invest in 1992 underour employees’ learning through robust training programs including Omnicell University, which provides our Core Values in Action training series, our Leadership in Action training series, and our New Employee Orientation program. All employees also have access to LinkedIn Learning for their “on-demand” learning needs.
Our People Manager Leadership in Action series creates one unique global Omnicell approach to talent development. It is designed to enable our organizational transformation by aligning how we lead across all levels.
Recruiting & Retention
Our Talent Acquisition team has recently increased its focus on digital recruiting, social media outlets, and university partnerships to expand Omnicell’s employer brand and reach the nameevolving talent pool to enhance our ability to hire the right talent to drive the organization forward.
In 2022, we plan to add a new applicant tracking system and best-in-class talent experience platform to enhance recruiting efforts. The combination of the two are intended increase recruiter efficiency, enable faster and better decisions, save time for value-added work, improve ease of job posting, and in turn, reduce cost per hire and increase quality of hire.
Diversity, Equity, and Inclusion
“Relationships Matter” is one of our core values and that means we are people who care. We value the whole person, not just the work person. At Omnicell, Technologies, Inc.we have always prohibited discrimination on the basis of any protected characteristic and reincorporated in Delaware in 2001 asmake employment decisions on the basis of merit. We strive to create and maintain a positive, supportive, inclusive, and diverse work environment. Our different backgrounds, education, cultures, and experiences all contribute to the advancement of our business.
We realize we have an opportunity to take more action and that our journey to improve diversity, equity, and inclusion (“DEI”) at Omnicell Inc.will continue to evolve. With a continued commitment to DEI, we plan to hire a leader of Inclusion and Belonging with responsibility to design, support, and implement Omnicell’s DEI strategy. We remain focused on understanding
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how our related data is critical to our success and committed to identifying DEI gaps within the organization and intend to create additional goals that drive and improve overall outcomes.
Available Information
We file reports and other information with, and furnish reports and other information to, the United States Securities and Exchange Commission (“SEC”) including annual reportsour Annual Reports on Form 10-K, quarterly reportsQuarterly Reports on Form 10-Q, current reportsCurrent Reports on Form 8-K, and proxyProxy or information statements.Information Statements. Those reports and statements as well as all amendments to those documents filed or furnished pursuant to Section 13(a) or 15(d) of the Securities and Exchange Act are availableavailable: (1) at the SEC’s Internet site (www.sec.gov) and (2) free of charge through our investor relations website, under the heading “Financials,” as soon as reasonably practicable after electronic filing with, or furnishing to, the SEC. Our website address is www.omnicell.com. Information posted on or accessible through these websiteswww.omnicell.com and our investor relations website is not incorporated by reference nor otherwise included in this report, and any references to these websites are intended to be inactive textual references only.located at ir.omnicell.com.
Information About Our Executive Officers
The following table sets forth certain information about our executive officers as of the date of this annual report:Annual Report on Form 10-K:
NameAgePosition
Randall A. Lipps6264President, Chief Executive Officer, and Chairman of the Board of Directors
Dan S. Johnston5856Executive Vice President and Chief Legal and Administrative Officer
Peter J. Kuipers4850Executive Vice President and Chief Financial Officer
Nhat H. NgoChristine Mellon5947Executive Vice President Marketing, Strategy, and Business DevelopmentChief People Officer
Scott P. Seidelmann4644Executive Vice President and Chief Commercial Officer
Randall A. Lipps was named Chief Executive Officer and President of Omnicell in October 2002. Mr. Lipps has served as Chairman of the Board and a Director of Omnicell since founding Omnicell in September 1992. Mr. Lipps received both a B.S. in economics and a B.B.A. from Southern Methodist University.
Dan S. Johnston joined Omnicell in November 2003 as Vice President and General Counsel. In March 2012, Mr. Johnston was named Executive Vice President and General Counsel. In February 2015, Mr. Johnston was named Executive Vice President and Chief Legal and Administrative Officer. From April 1999 to November 2003, Mr. Johnston was Vice President and General Counsel at Be, Inc., a software company. From September 1994 to March 1999, Mr. Johnston was an attorney with the law firm Cooley LLP. Mr. Johnston received a B.S. in computer information systems from Humboldt State University and a J.D. from the Santa Clara University School of Law.
Peter J. Kuipers joined Omnicell in August 2015 as Executive Vice President and Chief Financial Officer. Prior to Omnicell, Mr. Kuipers served as Senior Vice President and Chief Financial Officer of Quantcast Corp., a global technology company that specializes in digital audience measurement and real-time advertising. From May 2013 to December 2014, Mr. Kuipers served as Executive Vice President and Chief Financial Officer of The Weather Company, a media and global technology leader operating The Weather Channel, weather.com, wunderground.com and its professional services division WSI. From September 2009 to April 2013, Mr. Kuipers served in various financial management positions at Yahoo! Inc., a global internet technology company, most recently as Vice President, Finance for the Americas region. Prior to Yahoo! Inc., Mr. Kuipers held financial leadership roles at Altera Corporation, General Electric Company, and Akzo Nobel. He started his career with Ernst & Young and worked in both the Netherlands and Seattle, Washington. Mr. Kuipers received a Master’s Degree in Economics and Business Administration from Maastricht University and is a Chartered Accountant in the Netherlands.
Nhat H. NgoChristine Mellon joined Omnicell in November 2008February 2021 as Vice President of Strategy and Business Development. In March 2012, Mr. Ngo was named Executive Vice President Strategy and Business Development. InChief People Officer. Prior to joining Omnicell she was Chief Human Resources Officer of CSG International, Inc., a software company, from July 2016 to January 2018, Mr. Ngo was named Executive Vice President, Marketing, Strategy and Business Development.2021. From January 2007June 2013 to October 2008, Mr. NgoJune 2016, Ms. Mellon served as Vice President, of Business Development and Licensing forHuman Capital Management with Oracle Corporation, a business unit of Covidien, aleading global healthcare productsinformation technology company. From June 1999Prior to April 2006, Mr. Ngo worked at BriteSmile, Inc., a direct-to-consumer aesthetic technology company andOracle Corporation, Ms. Mellon served in a variety of seniorHR leadership positions in marketing, sales, operations, strategic planningroles for EchoStar Corporation, Aepona Limited, and corporate development. From September 1997 to June 1999, Mr. Ngo practiced corporate law at Shaw Pittman, LLP. Mr. NgoCigna Corporation. Ms. Mellon received a B.S.B.A. in commerce, with a concentration in finance,Psychology from the University of Virginia McIntire School of Commerce and a J.D. from the University of Virginia School of Law.Villanova University.
Scott P. Seidelmann joined Omnicell in April 2018 as Executive Vice President and Chief Commercial Officer. Prior to joining Omnicell, from January 2015 to August 2017, Mr. Seidelmann served as founder and Chief Executive Officer of
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Candescent Health, Inc., a cloud-based radiology workflow and analytics provider. From 2005 to 2014, Mr. Seidelmann served as co-founder and Chief Executive Officer of Radisphere, Inc., a national radiology practice, prior to its acquisition by Sheridan
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Healthcare. Earlier in his career, Mr. Seidelmann held positions with Merrill Lynch and Ericsson Venture Partners. Mr. Seidelmann received a B.A. from Cornell University.
ITEM 1A.    RISK FACTORS
Summary of Risk Factors
An investment in our company involves various risks. The following is a summary of these risks, but does not address all of the risks that we face. Additional discussion of the risks that we face can be found following this summary and should be carefully considered together with all of the other information appearing in this Annual Report on Form 10-K.
Risk Factors Related to our Business and Industry
COVID-19 Risks. The impact of the COVID-19 pandemic could continue to adversely affect our workforce and operations, as well as those of our customers and suppliers.
Technology Risks. We may be unable to develop new solutions or enhance existing solutions to react to changes in technology and customer requirements in a timely and cost-effective manner.
Market Risks. We are subject to continued and increased competition from current and future competitors in the medication management automation solutions market and the medication adherence solutions market, including price competition, industry and competitor consolidation, competitor brand recognition, and in relationships with our suppliers and current and potential customers.
Economic Conditions and Demand Risks. Weak economic conditions may adversely impact our business, as well as any reduction in demand for or adoption of Omnicell’s medication management solutions, medication packaging systems, or related services.
Debt Risks. We have substantial debt, which could impair our financial flexibility and access to capital, and are subject to covenants in our A&R Credit Agreement (as defined below) that restrict our business and operations.
Strategic Risks. Our investments in new business strategies or initiatives, including our transition to selling more products and services on a subscription basis, are inherently risky and may not be successful. In addition, we may be unable to realize the potential benefits of our acquired businesses, including the 340B Link business of Pharmaceutical Strategies Group, LLC (the “340B Link Business”), RxInnovation Inc., operating as FDS Amplicare (“FDS Amplicare”), ReCept Holdings, Inc. (“ReCept”), and MarkeTouch Media, LLC (“MarkeTouch Media”) and risks related to investments in new business strategies and initiatives could disrupt ongoing business and present risks not originally contemplated.
Legal, Regulatory, and Healthcare Industry Risks. Government regulations, legislative changes, fraud and anti-kickback statues, products liability claims, the outcome of legal proceedings, and other legal obligations related to healthcare, privacy, data protection, and information security, and the costs of compliance with, and potential liability associated with, our actual or perceived failure to comply with such obligations could adversely impact our business and results of operations.
Data Security Risks.A significant disruption in our information technology systems, breaches of data security or cyber-attacks on our systems or solutions could adversely impact our business and results of operations.
International Operations Risks. Our operations in foreign countries expose us to additional risks, including distribution, management, and systems integration issues, reduced intellectual property protections, adverse changes in international laws, fluctuations in currency exchange rates, political unrest, and pandemics or other major public health crises.
Workforce Risks. We may be unable to recruit and retain skilled and motivated personnel.
Intellectual Property Risks. Any failure to protect our intellectual property rights could negatively affect our ability to compete.
Institutional, Retail and Specialty Pharmacy Risks. We may fail to meet the demands of, or maintain relationships with, our institutional and retail pharmacy customers.
Materials Risks. We use raw materials and components that may be subject to price fluctuations, shortages, or interruptions of supply.
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Suppliers/Third-Party Vendors Risks. We may be unable to obtain an adequate supply of components, equipment, and raw materials on a timely basis. We depend on technologies provided by third-party vendors.
Risks Related to Ownership of Our Common Stock
The market price of our common stock may be volatile and the anti-takeover provisions of Delaware law and in our governing documents may make a change in control of our Company more difficult, even if a change in control would be beneficial to our stockholders.
Risks Related to Our Notes
Any conversion of our Notes may dilute the ownership interest of our stockholders, depress the price of our common stock or, if the conditional conversion feature of the Notes is triggered, adversely affect our financial condition and operating results. Also, our convertible note hedge transactions may decrease the value of our common stock.
General Risks
We may be subject to adverse consequences related to tax rates and changes in tax legislation, catastrophic events, and any failure to maintain effective internal control over financial reporting.
Risk Factors
We have identified the following risks and uncertainties that may have a material adverse effect on our business, financial condition or results of operations. Our business faces significant risks and the risks described below may not be the only risks we face. Additional risks not presently known to us or that we currently believe are immaterialnot material may also significantly impair our business operations. If any of these risks occur, our business, results of operations, or financial condition could suffer and the market price of our common stock could decline.
In assessing these risks, you should also refer to other information contained in this annual report on Form 10-K, including the section entitled “Management’sManagement’s Discussion and Analysis of Financial Condition and Results of Operations”Operations and our Consolidated Financial Statements and related Notes.
If we failRisk Factors Related to developour Business and Industry
We face risks related to adverse public health epidemics, including the ongoing global COVID-19 pandemic (including new products or enhance our existing productsvariants of the virus), which could continue to react to rapid technological change and market demands in a timely and cost-effective manner, or if more newly developed solutions, such as our XT Series, XR2 Automated Central Pharmacy System, and IVX Workflow, are not adopted in the same time frame and/or quantity as we anticipate, this could have a material adverse effect onadversely affect our business, financial condition, and results of operations.
The continued spread of COVID-19 (including new variants of the virus), concerns over the pandemic, and related containment measures have adversely impacted our workforce and operations, as well as those of our customers and suppliers, andcould continue to adversely affect our business, financial condition, and results of operations.
Continued disruption to our suppliers as a result of the COVID-19 pandemic and associated containment measures could significantly disrupt our supply chain, increase our procurement costs, and impact our ability to manufacture our products, which would negatively impact our sales and operating results. As a result of disruptions in the supply chain, we are experiencing the impact of price inflation, primarily due to semiconductor and other component costs and, to a lesser extent, freight and raw materials.
If significant or critical portions of our workforce are unable to work effectively as a result of the COVID-19 pandemic, including because of illness, quarantines, facility closures, ineffective remote work arrangements, or technology failures or limitations, our operations would be materially adversely impacted. In addition, if our customers are required to reinstate or implement new restrictions on in-person interaction, whether occasioned by government orders or internal policy changes regarding social distancing and group activity, the ability to install and implement our hardware or software may be impeded, which may have a material impact on our business.
Demand for our solutions, many of which involve a significant initial financial commitment from our customers, is largely dependent on our customers’ financial strength and capital and operating budgets. As a result of the pandemic, health systems have faced financial and operational pressures which we believe led our customers to delay or defer purchasing decisions and/or installations of our solutions during the first half of 2020. Beginning in the third quarter of 2020, we began to see our customers returning to pre-pandemic purchasing patterns consistent with long-term strategic investments and this trend has continued through 2021. However, as the COVID-19 pandemic continues to evolve, any future decisions by our customers to cancel, defer, or delay capital expenditure projects, generally reduced capital expenditures by healthcare facilities, and financial losses sustained by health systems as a result of the COVID-19 pandemic could, again, decrease demand for our
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products and related services, resulting in decreased revenue and lower revenue growth rates, which would adversely affect our operating results—perhaps materially.
Furthermore, the COVID-19 pandemic has significantly increased economic and demand uncertainty and has led to disruption and volatility in the global capital markets, which could increase the cost of capital and adversely impact access to capital not only for us, but also for our customers and suppliers. Weak economic conditions and inability to access capital in a timely manner, or at all, could reduce our customers’ demand for our products and services, which would adversely affect our operating results—perhaps materially. Similarly, in the event our access to the capital markets is constrained, our cost of borrowing could increase or we may be unable to obtain new or additional financing or re-financing in the future, either of which could have a material effect on our operations.
The COVID-19 pandemic continues to rapidly evolve, and the full extent to which COVID-19 (including new variants of the virus) will continue to impact our business, results of operations, and financial position will depend on future developments, which remain highly uncertain and cannot be predicted with confidence, such as the severity, resurgences, and duration of outbreaks, travel restrictions, business closures or disruptions, and the effectiveness of actions taken to contain and treat the disease. While certain COVID-19 vaccinations (including booster vaccinations) have now been approved and are being distributed globally, we are unable to predict the duration of the pandemic and when economic activity and business operations will normalize.
To the extent the COVID-19 pandemic continues to adversely affect our business and financial results, it may also have the effect of heightening certain other risks described in this “Risk Factors” section, including, but not limited to, those relating to unfavorable economic and market conditions, our ability to develop new products or services or enhance existing products or services, the need to compete successfully against new product or service entrants, our need to generate sufficient cash flows to service our indebtedness, our tax rates, and our international operations.
Unfavorable economic and market conditions and a decreased demand in the capital equipment market could adversely affect our operating results.
Customer demand for our products is significantly linked to the strength of the economy. If decreases in demand for capital equipment caused by weak economic conditions and decreased corporate and government spending, any effects of fiscal budget balancing at the federal level or proposed legislative changes, deferrals or delays of capital equipment projects, longer timeframes for capital equipment purchasing decisions, or generally reduced expenditures for capital solutions occur, we will experience decreased revenues and lower revenue growth rates, and our operating results could be materially and adversely affected.
We may fail to develop new solutions or enhance existing solutions to react to changes in technology and customer requirements in a timely and cost-effective manner, or our new or enhanced solutions may not achieve market acceptance.
We must develop new products and services or enhance our existing products with improvedto react to evolving technologies toand industry standards, and meet rapidly evolving customer requirements. We are constantly engaged in the developmentchanging demands of our customers. This process for next generation products,can be time-consuming, costly, and we need to successfully design our next generation and other products for customers who continually require higher performance and functionality at lower costs. The development process for these advancements is lengthycomplex, and usually requires us to accurately anticipate technological innovations and market trends. Developing and enhancing these products can be time-consuming, costly, and complex. Our ability to fund product development and enhancements partially depends on our ability to generate revenues from our existing products. If we inaccurately anticipate technological innovations or market trends or fail to generate sufficient revenue to develop new products or enhance existing products, our ability to generate future revenues or revenue growth may be negatively impacted, which could have a material adverse effect on our business, financial condition, results of operations, and cash flows.
There is a risk that these newNew product and service developments such as our XT Series, XR2 Automated Central Pharmacy System and IVX semi-automated workflow solution, or product enhancements, willmay be late, willdelayed, have technical problems will(including software defects or errors), fail to meet customer or market specifications, or will not be competitive with other products using alternative technologies that offer comparable performance and functionality. For example, we experienced technical quality issues with respect to early shipments of our XT Series automated dispensing systems to customers. These issues required significant resources to analyze the source of the deficiencies and implement corrective actions. We may discover technical quality issuesfunctionality, or not be accepted in the future related to new products, or product enhancements, that require analysis and corrective action,existing markets, which, in any case, could damage our reputation and have a material adverse effect onor otherwise harm our business, financial condition, and results of operations.
While our business strategy includes a goal of advancing our platform with new product introductions annually, we may be unable to successfully develop additional next generation products, new products or product enhancements on an annual basis or at all. Our next generation products, such as our XT Series, or any of our newer products, such as our XR2 Automated Central Pharmacy System or IVX Workflow, or product enhancements may not be accepted in new or existing markets.
Our ability to execute successfully on our recently-launchedthe industry vision of a fully digitized and autonomous pharmacythe Autonomous Pharmacy depends on our ability to continue to develop and introduce new products and services or product and service enhancements, and integrate new products and services with existing offerings, in furtherance of this vision in a timely manner and on a cost-effective basis. If we fail to do so, we may be unable to achieve the industry vision of the autonomous pharmacy,Autonomous Pharmacy, we may not realize the anticipated benefits of our investments in support of this vision, and this could have a material adverse effect on our business, financial condition, and results of operations.
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We operate in highly competitive markets, and we may be unable to compete successfully against new entrants and established companies with greater resources and/or existing business relationships with our current and potential customers.successfully.
The markets in which we operate are intensely competitive. We expect continued and increased competition from current and future competitors, in the medication management automation solutions market and the medication adherence solutions market, many of which have significantly greater financial, technical, marketing, and other resources than we do. Our current direct competitors in the medication management automation solutions market include Becton, Dickinson and Company; ARxIUM; Cerner Corporation; Swisslog Healthcare as a division of KUKA; Cardinal Health, Inc.; PAR Excellence Systems, Inc.; TECSYS Inc.; Baxter Healthcare Corporation; Grifols, S.A.; Willach Pharmacy Solutions; DIH Technologies Corporation; Yuyama Co., Ltd; RoboPharma B.V.; Meditech-Pharma; Knapp AG; KLS Steuerungstechnik GmbH; Gollmann Kommissioniersysteme GmbH, and Loccioni. Our current direct competitors in the medication adherence
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solutions market include Drug Package, Inc.; ARxIUM; Manchac Technologies, LLC; RX Systems, Inc.; McKesson Corporation; Digital Pharmacist Inc.; Tabula Rasa Healthcare, Inc. (through its acquisition of PrescribeWellness); Synergy Medical Systems; Parata Systems; and Medicine-On-Time in the United States, and Jones Packaging Ltd.; Synergy Medical Systems; and WebsterCare outside the United States.
The competitive challenges we face in the markets in which we operate include, but are not limited to, the following:
certaincurrent or future competitors may offer or have the ability to offer a broader range of solutions in the marketplace that we are unable to match;
certain competitors maythan us, develop alternative solutions to the customer problems our products are designed to solve that may provide a better customer outcome or a lower cost of operation;
certain competitors mayoperation, develop new features or capabilities for their products not previously offered that could compete directly with our products;ours, or devote greater resources to the development, promotion, and sale of their products than we do;
competitive pressures could result in increased price competition for our products and services, fewer customer orders, and reduced gross margins, any of which could harm our business;margins;
current and potential competitors may make strategic acquisitions or establish cooperative relationships among themselves or with third parties, including larger, more established healthcare supply companies, thereby increasing their ability to develop and offer a broader suite of products and services to address the needs of our prospective customers;services;
our competitive environmentindustry has recently experienced a significant degree of consolidation which could lead to competitors developing new business models that require us to adapt how we market, sell, or distribute our products; for example, in 2018, we initiated a company-wide organizational realignment in orderproducts or could also lead to align our organizational infrastructurecompetitors with greater economies of scale that have lower cost of operations allowing them to centrally manage our business, including the marketing, sale, and distribution of our products, in part to address the continuing consolidation in the healthcare industry;
other established or emerging companies may enter the markets in which we operate with products and services that are preferred by our current and potential customers based on factors such as features, capabilities, or cost;
our competitors may develop, license, or incorporate new or emerging technologies or devote greater resources to the development, promotion, and sale ofsell their products and services than we do;at a lower cost;
certain competitors have greater brand name recognition and a more extensive installed base of medication management automation solutions or other products and services than we do, and such advantages could be used to increase their market share;
certain competitors may have existing business relationships with our current and potential customers, which may cause these customers to purchase competing products and services from these competitors; and
our competitors may secure products and services from suppliers on more favorable terms or secure exclusive arrangements with suppliers or buyers that may impede the sales of our products and services.
If we fail to compete successfully against new entrants and established companies,current or future competitors, it could materially adversely affect our business, financial condition, results of operations, and cash flows.
Unfavorable economic and market conditions, a decreased demand in the capital equipment market, and uncertainty regarding the rollout of government legislation in the healthcare industry could adversely affect our operating results.
Customer demand for our products is significantly linked to the strength of the economy. If decreases in demand for capital equipment caused by weak economic conditions and decreased corporate and government spending, including any effects of fiscal budget balancing at the federal level, deferrals or delays of capital equipment projects, longer time frames for capital equipment purchasing decisions, or generally reduced expenditures for capital solutions occurs, we will experience decreased revenues and lower revenue growth rates, and our operating results could be materially and adversely affected.
Additionally, as the U.S. Federal Government implements healthcare reform legislation, and as Congress, regulatory agencies, and other state governing organizations continue to review and assess additional healthcare legislation and regulations, there may be an impact on our business. Healthcare facilities may decide to postpone or reduce spending until the implications of such healthcare enactments are more clearly understood, which may affect the demand for our products and harm our business.
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Any reduction in the demand for or adoption of our medication management automation solutions, medication packaging systems, or related services would reduce our revenues.
Our medication management automation solutions represent only one approach to managing the distribution of pharmaceuticals and supplies at acute healthcare facilities, and our medication packaging systems represent only one way of managing medication distribution at non-acute care facilities. While a significant portion of domestic acute care facilities have adopted some level of medication and/or supply automation, aA significant portion of domestic and international healthcare facilities still use traditional approaches to medication and/or supply management in some form that do not include fully automatedfully-automated methods of medication management. As a result, we must continuously educate existing and prospective customers about the potential advantages of our products,medication management solutions and medication packaging systems, which requires significant sales efforts particularly when we are seeking to replace an incumbent supplier of medication management automation solutions and can cause longer sales cycles. Despite our significant efforts and extensive time commitments in sales to healthcare facilities, we cannot be assured that our efforts will result in sales to these customers.
In addition, our medication management automation solutions and our more complex automated packaging systems typically represent a sizable initial capital expenditure for healthcare organizations. Changes in the budgets of these organizations and the timing of spending under these budgets can have a significant effect on the demand for our medication management automation solutions, medication packaging systems, and related services. These budgets are often supported by cash flows that can be negatively affected by declining investment income and influenced by limited resources, increased operational and financing costs, macroeconomic conditions, such as unemployment rates, and conflicting spending priorities among different departments. Any decrease in expenditures or change in spending priorities by healthcare facilities or increased financing costs (including as a result of the impacts of public health crises such as the ongoing COVID-19 pandemic) could decrease demand for our medication management automation solutions, medication packaging systems, and related services, and reduce our revenues.
Also, the continuing gradual transition to a value-based care healthcare delivery model could shift more of the burden for financial risk onto healthcare provider organizations and could decrease utilization of healthcare per patient. Value-based care could also cause a shift in sites of care from traditional venues, such as hospitals and clinics, to the home, and could impact our revenues.
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We have incurred substantial debt, which could impair our flexibility and access to capital and adversely affect our financial position.
On November 15, 2019, we refinanced our existing senior secured credit facility pursuant to an amended and restated agreement with certain lenders, and Wells Fargo Bank, National Association, as administrative agent (as amended, the “A&R Credit Agreement”). The A&R Credit Agreement provides for a five-year revolving credit facility of $500.0 million and an uncommitted incremental loan facility of up to $250.0 million. As of December 31, 2021, there were no outstanding balances under the A&R Credit Agreement.
In addition, on September 25, 2020, we issued $575.0 million aggregate principal amount of 0.25% Convertible Senior Notes due 2025 (the “Notes”), pursuant to an indenture, dated September 25, 2020 (the “Indenture”), between us and U.S. Bank National Association, as trustee. We used a portion of the proceeds from the issuance of the Notes to repay all outstanding borrowings under the revolving credit facility at the time.
Our debt may limit our ability to borrow additional funds or use our existing cash flow for working capital, capital expenditures, acquisitions, or other general business purposes; limit our flexibility to plan for, or react to, changes in our business and industry; place us at a competitive disadvantage compared to our less leveraged competitors; and increase our vulnerability to the impact of adverse economic and industry conditions.
Our ability to make scheduled payments of the principal of, to pay interest on, or to refinance our indebtedness, including the Notes, depends on our future performance, which is subject to economic, financial, competitive, and other factors beyond our control. Our business may not continue to, and we cannot provide assurance that our business will, generate cash flow from operations in the future sufficient to fund our cash requirements, service our debt or make necessary capital expenditures. Our failure to generate sufficient cash flow to pay our debts could have a material adverse effect on our business. In addition, if we are unable to generate such cash flow, we may be required to adopt one or more alternatives, such as borrowing more money, selling assets, restructuring debt, or obtaining additional equity capital on terms that may be onerous or highly dilutive. Any of these actions still may not be sufficient to allow us to service our debt obligations or may otherwise have an adverse effect on our business.
Our ability to refinance our indebtedness will depend on the capital markets and our financial condition at such time. We may not be able to engage in any of these activities or to do so on desirable terms, which could result in a default on our debt obligations. In addition, as more fully described below in the risk factor captioned “Covenants in our A&R Credit Agreement restrict our business and operations in many ways, and if we do not effectively manage our compliance with these covenants, our financial conditions and results of operations could be adversely affected,” the A&R Credit Agreement includes customary restrictive covenants that impose operating and financial restrictions on us.
In addition, borrowings under the A&R Credit Agreement currently bear interest based on the London Interbank Offered Rate (“LIBOR”), however as of December 31, 2021, LIBOR has started being phased out, and LIBOR is expected to be entirely discontinued on June 30, 2023. The phasing out or discontinuance of LIBOR and other pressures may cause LIBOR to disappear entirely or to perform differently than in the past. In addition, the A&R Credit Agreement provide that upon the occurrence of certain triggering events relating to the end of LIBOR, we and the administrative agent will select a different benchmark rate to replace LIBOR. The consequences of these developments cannot be entirely predicted, but changes in, or the inability to agree on, an alternative rate or benchmark could result in an increase in the cost of borrowings under the A&R Credit Agreement and other financial contracts that we may enter into that are currently indexed to LIBOR.
The transition to selling more products which include a software as a service or solution as a service subscription presents a number of risks.
We currently offer our IV compounding robots, Medication Packager products,PakPlus-Rx service, and XR2 Automated Central Pharmacy System together with personnel to operate the equipment and expert services to optimize utilization through subscription agreements. We also offer Performance Center,Omnicell One, EnlivenHealth Patient Engagement, 340B, FDS Amplicare, and certain other products and solutions as a subscription and/or service. IVX Workflow also contains a payment stream as part of the license fees in its pricing structure. As we continue to execute on the autonomous pharmacyindustry vision of the Autonomous Pharmacy and grow subscription and cloud-based offerings, we may offer additional products and services on a subscription basis. The transition to selling more products and services on a subscription basis presents a number of risks. The shift requires an investment of technical, financial, compliance, and sales resources, and we cannot guarantee that we will recoup the costs of such investments, or that these investments will improve our long-term growth and results of operations. If adoption of certain subscription productssolutions takes place faster than anticipated, the shift to subscription revenues from capital equipment sales will deferchange the timing of revenue recognition and we may experience a temporary reduction of revenues.revenues and revenue growth rate. In addition, our cash flows may be impacted by the timing of invoicing of our subscription solutions. If any of our subscription productssolutions do not substantially meet customer requirements, customerscontracts may cancel subscriptions,be modified, causing a decline in revenue. Customers may elect not to renew their subscriptions upon expiration, or they may attempt to renegotiate pricing or other contractual terms at or prior to renewal on
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terms that are less favorable to us. In addition, since revenue isrevenues are generally recognized over the term of the subscription, any decrease in customer purchases of our subscription-based products and services will not be fully reflected in our operating results until future periods, and it will also be more difficult for us to rapidly increase ourwhich may result in inflated revenue throughgrowth rates that do not reflect such decreases initially. Similarly, any additional subscription sales would not be fully reflected in our operating results until future periods.
Delays in installations of our medication management solutions or our more complex medication packaging systems could harm our competitive position, results of operations, and financial condition.
The purchase of our medication management solutions or our more complex medication packaging systems is often part of a customer’s larger initiative to re-engineer its pharmacy and their distribution and materials management systems. The purchase of our systems often entails larger strategic purchases by customers that generally require more complex and stringent contractual requirements, involve a significant commitment of management attention and resources by prospective customers, and require the input and approval of many decision-makers. In addition, new product announcements can cause a delay in our customers’ decisions to purchase our products or convert pending orders for our older products to those of our newer products. For these and other reasons, the sales cycle associated with sales of our systems is often lengthy and subject to a number of delays over which we have little or no control. A delay in, or loss of, sales of these systems (including as a result of the impacts of public health crises such as the ongoing COVID-19 pandemic) could have an adverse effect upon our operating results and could harm our business.
In addition, and in part as a result of the complexities inherent in larger transactions, the time between the purchase and installation of our systems can generally range from two weeks to one year. Delays in installation can occur for reasons that are often outside of our control. We have also experienced fluctuations in our customer and transaction size mix, which makes our ability to forecast our product bookings more difficult. Because we recognize revenues for our medication management solutions and our more complex medication packaging systems only upon installation at a customer’s site, any one period.delay in installation (including as a result of the impacts of public health crises such as the ongoing COVID-19 pandemic) will also cause a delay in the recognition of the revenues for those systems.
We are subject to laws, regulations, and other legal obligations related to privacy, data protection, and information security, and the costs of compliance with, and potential liability associated with, our actual or perceived failure to comply with such obligations could harm our business.
We receive, store, and process personal information and other data from and about customers, in addition to our employees and services providers. In addition, our customers use our solutions to obtain and store personal information, including personal health information. For example, our customers use our OmnicellEnlivenHealth Patient Engagement platform to guide and track patient notes, interventions, and appointments, which involves the collection of personal health information of patients. Our handling of data is subject to a variety of laws and regulations by state, local, and foreign agencies, as well as contractual obligations and industry standards. Regulatory focus on data privacy and security concerns continues to increase globally, and laws and regulations concerning the collection, use, and disclosure of personal information are expanding and becoming more complex. In the United States, these include federal health information privacy laws (such as the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"(“HIPAA”), discussed below), security breach notification laws, and consumer protection laws, as well as state laws addressing privacy and data security. For example, Thesecurity (such as the California Consumer Privacy Act of 2018 (“CCPA”) and the California Privacy Rights Act of 2020 (“CPRA”)).
While HIPAA does not create a private right of action, its standards have been used as the basis for civil suits and HIPAA is enforced by the Department of Health and Human Services Office for Civil Rights (“OCR”), which became effectivecan bring actions against entities for noncompliance, including for failures to implement security measures sufficient to reduce risks to electronic protected health information or to conduct an accurate and thorough risk analysis, among other violations. HIPAA enforcement actions may lead to monetary penalties and costly and burdensome corrective action plans. We are also required to report known breaches of protected health information consistent with applicable breach reporting requirements set forth in applicable laws and regulations. Finally, on December 10, 2020, OCR issued proposed revisions to the Privacy Rule aimed at reducing regulatory burdens that may exist in discouraging coordination of care and patient access to their health information, among other changes. While a final rule has not yet been issued, if adopted, these proposed changes may require us to update our HIPAA policies and procedures to comply with the new requirements. The CCPA provides for civil penalties for violations, as well as a private right of action for data breaches which is expected to increase data breach litigation. Additionally, the CPRA, which goes into effect in January 2020,2023, and imposes additional data protection obligations on companies doing business in California, created a new California data protection agency authorized to issue substantive regulations and could result in increased privacy and information security enforcement. Additional compliance investment and potential business process changes may be required. Laws similar to those in California have passed in Virginia and Colorado, and have been proposed in other states and at the federal level that processmay ultimately have conflicting requirements that would further complicate compliance. Furthermore, new health information standards, whether implemented pursuant to HIPAA, the HITECH Act, congressional action or otherwise could have a significant effect on California residents.the manner in which we handle health-related information, and the cost of
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complying with these standards could be significant. If we do not comply with existing or new laws and regulations related to patient health information, we could be subject to criminal or civil sanctions.
Internationally, various foreign jurisdictions in which we operate have established, or are developing, their own data privacy and security legal frameworkframeworks with which we or our customers must comply. In certain cases, these international laws and regulations are more restrictive than many regulations in the United States. For example, within the European Union, the General Data Protection Regulation (“EU GDPR”) grants individuals various data protection rights (e.g., which became effective in May 2018,the right to erasure of personal data) and imposes more stringent data protection requirements on U.S.-based companies, such as ours, which receivefall within its scope, including inter alia: (i) accountability and transparency requirements; (ii) obligations to consider data protection as any new products or processservices are developed and to limit the amount of personal informationdata processed; and (iii) obligations to report certain personal data breaches to the supervisory authority without undue delay (and no later than 72 hours where feasible). In addition, the EU GDPR prohibits the transfer of personal data from EU residents,the EEA to the United States and establishes greater penalties for non-compliance. Violationsother jurisdictions that the European Commission does not recognize as having “adequate” data protection laws unless a data transfer mechanism has been put in place. In July 2020, the Court of Justice of the European Union limited how organizations could lawfully transfer personal data from the EEA to the United States by invalidating the EU-US Privacy Shield for purposes of international transfers and imposed further restrictions on use of standard contractual clauses (“SCCs”) (i.e., an EU-style data transfer agreement), including a requirement for companies to carry out a transfer privacy impact assessment, which among other things, assesses laws governing access to personal data in the recipient country and considers whether supplementary measures that provide privacy protections additional to those provided under SCCs will need to be implemented to ensure an essentially equivalent level of data protection to that afforded in the EEA. Moreover, new versions of the SCCs (new “EU SCCs”) have recently been published requiring additional compliance and implementation efforts.
Administrative fines for non-compliance with the EU GDPR can result in penaltiesbe significant and can amount to fines of up to the greater of €20.0 million or 4% of global annual revenues,revenues. The EU GDPR also confers a private right of action on data subjects and may also leadconsumer associations to lodge complaints with supervisory authorities, seek judicial remedies and obtain compensation for damages claims by data controllers and data subjects. Such penalties are in addition to any civil litigation claims by data controllers, customers, and data subjects. Further, Brexit (discussed inresulting from violations of the risk factor “TheEU GDPR.
Relatedly, following the United Kingdom’s recent withdrawal from the European Union could adversely affect us” below)EU (i.e., “Brexit”), the EU GDPR has created uncertainty regarding the regulation of data protectionbeen implemented in the United Kingdom. In particular, althoughKingdom (as the United Kingdom enacted a“UK GDPR”). The UK GDPR site alongside the UK Data Protection Act 2018 which implements certain derogations in May 2018the EU GDPR into UK law. The requirements of the UK GDPR are (at this time) largely aligned with those under the EU GDPR and as such, may lead to similar compliance and operational costs with potential fines for non-compliance of up to £17.5 million or 4% of annual worldwide turnover. As a result, we are potentially exposed to two parallel data protection regimes, each of which authorizes fines and the potential for divergent enforcement actions. It should also be noted that the new EU SCCs do not automatically apply in the UK since Brexit, and the UK Government has not yet formally acknowledged the new EU SCCs, (i.e., as a valid data transfer mechanism under the UK GDPR). Indeed, on August 11, 2021, the UK Information Commissioner’s Office launched a public consultation on its draft international data transfer agreement and guidance. This included the publication of a draft UK addendum that can be used with the new EU SCCs – however, this is designednot (at this time) finalized and as such, for the time being transfers from the UK to a third country should continue to be consistent withmade in reliance on the GDPR, uncertainty remains regarding how data transfers to and from the United Kingdom will be regulated following the Brexit Transition Period (also discussed below).“old” SCCs.
In addition to government regulation, privacy advocates and industry groups may propose new and different self-regulatory standards that may legally or contractually apply to us.us, and other regulatory protections may lose their applicability to our business as regulations and legal proceedings continue to evolve globally. We also expect that there will continue to be new proposed laws, regulations, and industry standards relating to privacy, data protection, and information security.security, including in the United Kingdom (see above), where we have business operations. We cannot predict the scope of any such future laws, regulations, and standards that may be applicable to us, or how courts, agencies, or data protection authorities might interpret current ones. It is possible that these laws and other obligations may be interpreted and applied in a manner that is inconsistent with our existing data management practices or the functionality of our solutions, and we cannot predict the impact of such potential, future, inconsistent interpretations.solutions.
Compliance with privacy, data protection, and information security laws, regulations, and other obligations is costly, and we may encounter difficulties, delays, or significant expenses in connection with our compliance, or because of our customers’ need to comply or our customers’ interpretation of their own legal requirements. In addition, any failure or perceived failure by us to comply with laws, regulations, policies, legal or contractual obligations, industry standards, or regulatory guidance relating to privacy or data security could result in governmental investigations and enforcement actions, litigation, fines and penalties, exposure to indemnification obligations or other liabilities, and adverse publicity, all of which could have an adverse effect on our reputation, as well as our business, financial condition, and results of operation.operations. For example, as discussed further in the section entitled “Legal Proceedings”Legal Proceedings in Note 12,13, Commitments and Contingencies, of the Notes to Consolidated Financial Statements included in this annual report on Form 10-K, we are currently and have in the past been subject to certain class action lawsuits asserting, among other allegations, claims of violation of the Illinois Biometric Information Privacy Act.
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If we experience a significant disruption in our information technology systems, breaches of data security, or cyber-attacks on our systems or solutions, our business could be adversely affected.
We rely on information technology (“IT”) systems to keep financial records and corporate records, communicate with staff and external parties, and operate other critical functions, including sales and manufacturing processes. In addition,As our business needs change, we may need to expand or update our IT systems. We also utilize third-party cloud services in connection with our operations.operations, which also may need to be expanded or updated as our business needs change. Our information technologyIT systems and third-party cloud services are potentially vulnerable to disruption due to breakdown, malicious intrusion and computer viruses, public health crises such as the ongoing COVID-19 pandemic, other catastrophic events or environmental impact. If we wereimpact, as well as due to system upgrades and/or new system implementations. Our systems may also experience avulnerabilities from third-party or open source software code that may be incorporated into our own or our vendors’ systems. Any prolonged system disruption in our information technologyIT systems or third-party cloud services it could negatively impact the coordination of our sales, planning, and manufacturing activities, which could adversely affectharm our business. In addition, in order to maximize our information technology efficiency, we have physically consolidated our primary corporate data and computer operations. This concentration, however, exposes us to a greater risk of disruption to our internal information technologyIT systems. Although we maintain offsite back-ups of our data, ifa disruption of operations at our facilities were disrupted, it may cause a material disruption incould materially disrupt our business if we are not capable of restoring function onwithin an acceptable time frame.
Our information technologyIT systems and third-party cloud services are potentially vulnerable to cyber-attacks, including ransomware, or other data security breaches, whetherincidents, by employees or others, which may expose sensitive data to unauthorized persons. Such data security breachesincidents could lead to the loss of trade secrets or other intellectual property, or could lead to the public exposure of sensitive and confidential information of our employees, customers, suppliers, and others, any of which could have a material adverse effect on our business, financial condition, and results of operations. Moreover, a security breach or privacy violation that leads to disclosure or modification of, or prevents access to, patient information, including personally identifiable information or protected health information, could harm our reputation, result in litigation, compel us to comply with federal and/or state breach notification laws, subject us to mandatory corrective action, require us to verify the correctness of database contents, and otherwise subject us to liability under laws and regulations that protect personal data, resulting in increased costs or loss of revenues.
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See, “TableWe are subject to laws, regulations, and other legal obligations related to privacy, data protection, and information security, and the costs of Contentscompliance with, and potential liability associated with, our actual or perceived failure to comply with such obligations could harm our business
” for additional information.
In addition, we sell certain solutions that receive, store, and process our customers’ data. For example, our Performance CenterOmnicell One solution combines a cloud-based predictive intelligence platform with expert services designed to monitor pharmacy operations and recommend opportunities to help improve efficiency, regulatory compliance, and patient outcomes. In addition,As another example, our OmnicellEnlivenHealth Patient Engagement platform is a private cloud-based solution that supports improving patient adherence goals through a single web-based platform that hosts functionality to guide and track patient notes, interventions, and appointments. An effective attack on our solutions could disrupt the proper functioning of our solutions, allow unauthorized access to sensitive and confidential information of our customers (including protected health information), and disrupt our customers’ operations. AnyIn addition to the risks and impacts noted above, any of these events could cause our solutions to be perceived as having security vulnerabilities and reduce demand for our solutions, which could have a material adverse effect on our business, financial condition, and results of operations. These risks are likely to increase as we continue to grow our cloud-based offerings, including in support of the autonomous pharmacyindustry vision of the Autonomous Pharmacy, and as we receive, store, and process more of our customers’ data.
While we have implemented a number of security measures designed to protect our systems and data, including firewalls, antivirus and malware detection tools, patches, log monitors, routine back-ups, system audits, routine password modifications, and disaster recovery procedures, and have designed certain security features into our solutions, we and our third party service providers regularly defend against and respond to data security incidents and such measures may not be adequate or implemented properly to prevent or fully address the adverse effect of such events. In some cases we may be unaware of an incident or its magnitude and effects as breaches and other inappropriate access can be difficult to detect, and any delay in identifying them may lead to increased harm. In addition, while we possess insurance that currently includes coverage for cyber-attacks, we have seen a trend where the amount of coverage being offered by insurance providers for such cyber-attacks is decreasing while the cost of obtaining such coverage is increasing. If this trend continues the insurance coverage we possess may not be adequate or the cost to obtain such coverage may become prohibitive.
We use third-party cloud providers in connection with certain of our cloud-based offerings or third-party providers to host our own data, in which case we rely on the processes, controls, and security such third parties have in place to protect the infrastructure. We also may acquire companies, products, services, and technologies and inherit such risks when we integrate these acquisitions within Omnicell.
While we have implemented a number of security measures designed to protect our systems and data, including firewalls, antivirus and malware detection tools, patches, log monitors, routine back-ups, system audits, routine password modifications, and disaster recovery procedures, and have designed certain security features into our solutions, such measures may not be adequate or implemented properly to prevent or fully address the adverse effect of such events, and in some cases we may be unaware of an incident or its magnitude and effects. Any failure to prevent such security breaches or privacy violations, or implement satisfactory remedial measures, could require us to expend significant resources to remediate any damage, disrupt our operations or the operations of our customers,
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damage our reputation, damage our relationships with our customers, or expose us to a risk of financial loss, litigation, regulatory penalties, contractual indemnification obligations, or other liability because of lost or misappropriated information, including sensitive patient data. In addition, these breaches and other inappropriate access can be difficult to detect, and any delay in identifying them may lead to increased harm of the type described above.
We have incurred substantial debt, which could impair our flexibility and access to capital and adversely affect our financial position.
On November 15, 2019, we refinanced our existing senior secured credit facility pursuant to an amended and restated agreement with certain lenders, and Wells Fargo Bank, National Association, as administrative agent (the “A&R Credit Agreement”). The A&R Credit Agreement provides for a five-year revolving credit facility of $500.0 million and an uncommitted incremental loan facility of up to $250.0 million. At December 31, 2019, the loan balance of the revolving credit facility was $50.0 million.
Our debt may:
limit our ability to borrow additional funds for working capital, capital expenditures, acquisitions, or other general business purposes;
limit our ability to use our cash flow or obtain additional financing for future working capital, capital expenditures, acquisitions, or other general business purposes;
require us to use a substantial portion of our cash flow from operations to make debt service payments;
limit our flexibility to plan for, or react to, changes in our business and industry;
place us at a competitive disadvantage compared to our less leveraged competitors; and
increase our vulnerability to the impact of adverse economic and industry conditions.
Our ability to meet our debt service obligations will depend on our future performance, which will be subject to financial, business, and other factors affecting our operations, many of which are beyond our control. If we do not have sufficient funds to meet our debt service obligations, we may be required to refinance or restructure all or part of our existing debt, sell assets, borrow more money or sell securities, none of which we can assure you that we would be able to do in a timely manner, or at all. In addition, as more fully described in the risk factor titled “Covenants in our A&R Credit Agreement restrict our business and operations in many ways and if we do not effectively manage our compliance with these covenants, our financial conditions and results of operations could be adversely affected” below, the A&R Credit Agreement includes customary restrictive covenants that impose operating and financial restrictions on us, including restrictions on our ability to take actions that could be in our best interests.
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In addition, borrowings under the A&R Credit Agreement bear interest based on the London Interbank Offered Rate (“LIBOR”). LIBOR is the subject of recent national, international and other regulatory guidance and proposals for reform. These reforms and other pressures may cause LIBOR to disappear entirely or to perform differently than in the past. The consequences of these developments cannot be entirely predicted, but could include an increase in the cost of borrowings under the A&R Credit Agreement and other financial contracts that we may enter into that are indexed to LIBOR.liability.
We may fail to realize the potential benefits of acquired businesses, including the 340B Link Business, FDS Amplicare, ReCept, and MarkeTouch Media, which could negatively affect our business, financial condition, and operating results.
We have in the past acquired businesses, including Aesynt and Ateb in 2016 and InPharmics in 2017, and expect to continue to seek to acquire businesses, technologies, or products in the future. For example, we acquired the 340B Link Business in October 2020, FDS Amplicare in September 2021 and ReCept and MarkeTouch Media, each in December 2021, respectively. We cannot provide assurance that any acquisition or any future transaction we complete will result in long-term benefits to us or our stockholders, or that we will be able to effectively integrate or manage the acquired business effectively.businesses, including the 340B Link Business, FDS Amplicare, ReCept or MarkeTouch Media.
These transactions may involve significant challenges, uncertainties, and risks, including:
difficulties in combining previously separate businesses into a single unit and the complexity of managing a more dispersed organization as sites are acquired;
complying with international labor laws that may restrict our ability to right-sizedifficulties in right-sizing organizations and gaingaining synergies across acquired operations;
complying with regulatory requirements, such as those of the FDA,U.S. Food and Drug Administration (the “FDA”), the U.S. Drug Enforcement Administration (the “DEA”), or state boards of pharmacy, that we were not previously subject to;
failure to understand and compete effectively in markets in which we have limited previous experience;
the substantial costs that may be incurred and the substantial diversion of management’s attention from day-to-day business when evaluating and negotiating such transactions and then integrating an acquired business, including any unforeseen delays and expenditures that may result;
discovery, after completion of the acquisition, of liabilities assumed from the acquired business or of assets acquiredin acquisitions that are broader in scope and magnitude or are more difficult to manage than originally assumed;assumed or identified;
difficulties related to assimilating and retaining key personnel of an acquired business, including due to changes in compensation, changes in management, reporting relationships, future prospects, office culture, or the direction of the acquired business;
failure to achieve anticipated benefits such as revenue enhancements and operational and cost savings and revenue enhancements;efficiencies;
difficulties in integrating newly acquirednewly-acquired products and solutions in our offerings, to our customers and anor inability or failure to expand product bookings and sales;sales or effectively coordinate sales and marketing efforts of the combined company;
the inability to maintain business relationships with customers and suppliers of newly acquirednewly-acquired companies due to post-acquisition disruption; and
the inability or failure to effectively coordinate sales and marketing efforts to communicate the capabilities of the combined company;
the inability or failure to successfully integrate and harmonize financial reporting and information technology systems; and
the inability or failure to achieve the expected operational and cost efficiencies.systems.
If we are not able to successfully integrate or manage the acquired businesses and their operations, or if there are delays in combining the businesses, the anticipated benefits of the acquisition may not be realized fully or at all or may take longer to realize than expected and our business, financial condition, and operating results may be negatively impacted.
If goodwill or other intangible assets that we recorded in connection with the Aesynt, Ateb, and InPharmics acquisitions, or have recorded in connection withour prior acquisitions become impaired, we could be required to take significant charges against earnings.
In connection with the accounting for the Aesynt and Ateb acquisitions in 2016, and the InPharmics acquisition in 2017, the 340B Link Business acquisition in October 2020, the FDS Amplicare acquisition in September 2021 and the ReCept and MarkeTouch Media acquisitions, each in December 2021, respectively, we recorded a significant amount of goodwill and other intangible assets, and we maintain significant goodwill and other intangible assets relating toassets. In addition, for our prior acquisitions, such as our acquisitions of MTS Medication Technologies, Inc. (“MTS”), Avantec Healthcare Limited, and Mach4.Mach4 Automatisierungstechnik GmbH, we continue to maintain a significant amount of goodwill and, with respect to MTS, we also continue to maintain a significant amount of other intangible assets. As of December 31, 2019,2021, we had recorded approximately $459.8 million$1.015 billion net, in goodwill and intangible assets, in connection with past acquisitions.
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Under U.S. generally accepted accounting principles,GAAP, we must assess, at least annually and potentially more frequently, whether the value of goodwill and other indefinite-lived intangible assets has been impaired. Amortizing intangibleIntangible assets subject to amortization will be assessed for impairment in the event of an impairment indicator. Any reduction or impairment of the value of goodwill or other intangible assets will result in a charge against earnings, which could materially adversely affect our results of operations and shareholders’ equity in future periods.
Changing customer requirements could decrease the demand for our products and services, and our new product solutions may not achieve market acceptance.
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The markets in which we operate are characterized by evolving technologies and industry standards, frequent new product introductions and dynamic customer requirements that may render existing products obsolete or less competitive. These markets could erode rapidly due to unforeseen changes in the features and functions
Table of competing products, as well as the pricing models for such products. Our future success will depend in part upon our ability to enhance our existing products and services, and to develop and introduce new products and services to meet changing customer requirements. The process of developing products and services such as those we offer is extremely complex, and is expected to become increasingly more complex and expensive in the future as new technologies are introduced. If we are unable to enhance our existing products and services or develop new solutions to meet changing customer requirements, and bring such enhancements and solutions to market in a timely manner, demand for our products or services could decrease.Contents
We cannot provide assurance that we will be successful in marketing any new products or services that we introduce, that new products or services will compete effectively with similar products or services sold by our competitors, or that the level of market acceptance of such products or services will be sufficient to generate expected revenues and synergies with our other products or services. For example, our XT Series, XR2 Automated Central Pharmacy System, and IVX Workflow are relatively new to the market and we cannot guarantee that demand will meet our expectations. Deployment of new products or services often requires interoperability with other Omnicell products or services as well as with healthcare facilities’ existing information management systems. If these products or services fail to satisfy these demanding technological objectives, our customers may be dissatisfied, and we may be unable to generate future sales.
The healthcare industry facesis subject to legislative and regulatory changes, to healthcare legislation and other healthcare reform, as well as financial constraints and consolidation, which could adversely affect the demand for our products and services.
The healthcare industry has faced, and will likely continue to face, significant financial constraints. U.S. government legislation such as the American Recovery and Reinvestment Act of 2009, the Patient Protection and Affordable Care Act of 2010 (the "PPACA"), the Budget Control Act of 2011, and other health reform legislation, or the repeal of all or a portion of any such legislation,program rulemaking may cause customers to postpone purchases of our products due to reductions in federal healthcare program reimbursement rates and/or needed changes to their operations in order to meet the requirements of legislation.legislation or in anticipation of future rulemaking. For example, the Budget Control Act of 2011, among other things, resulted in reductions in payments to Medicare providers of 2% per fiscal year, which went into effect on April 1, 2013 and, due to subsequent legislative amendments to the statute, will remain in effect into 2031 unless additional Congressional action is taken, with the exception of a temporary suspension of the 2% cut in Medicare payments from May 1, 2020 through March 31, 2022 due to the COVID-19 pandemic. Additionally, the American Taxpayer Relief Act of 2012, among other things, reduced Centers for Medicare & Medicaid Services (“CMS”) payments to several types of providers, including hospitals, and increased the statute of limitations period for the government to recover Medicare overpayments to providers from three to five years. Our automation solutions often involve a significant financial commitment from our customers and, as a result, our ability to grow our business is largely dependent on our customers’ capital and operating budgets. To the extent current or proposed legislation promotesand program rules promote spending on other initiatives or healthcare providers’ spending declines or increases more slowly than we anticipate, demand for our products and services could decline.
In addition, certain healthcare legislation and regulations may be challenged from time to time, in an effort to modify or repeal that legislation or those regulations. For example, proposals forthe Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, or collectively, the “ACA,” which was passed in March 2010 and substantially changed the way healthcare reform, such as “Medicare for All” proposals that haveis financed by both governmental and private insurers, has been put forwardsubject to numerous judicial, legislative, and regulatory efforts to replace it or to alter its interpretation or implementation. Most recently, on June 17, 2021, the U.S. Supreme Court dismissed the most recent judicial challenge to the ACA brought by candidates forseveral states without specifically ruling on the 2020 presidential election, have includedconstitutionality of the concept of a “single-payer” government-funded healthcare system. Such a system could reduce our customers’ revenues, as Medicarelaw. It is unclear how this decision, and other publicefforts to challenge, repeal, replace, or otherwise modify, or alter the implementation or interpretation of the ACA will affect our business, financial condition and results of operations.
We cannot predict the success of the Company with respect to any such challenges or the effect that subsequent changes or new resulting legislation or regulations would have on our business or the healthcare industry in general. Any future actions or developments could adversely impact the healthcare industry, including with respect to the cost of prescription drugs, regulation of pharmacy services, the administration of the federal 340B Drug Pricing Program, changes to pharmacy reimbursement rates, areor the way we do business, which could have an adverse impact on average lower than commercial health plan reimbursement rates. While it is not likely that legislation creating such a single-payer system will pass Congress and be signed by the President in the near term, continued introduction of legislation promoting a single-payer system by several members of Congress and presidential candidates could increase uncertainty for our customers and cause them to delay purchases of our products and services.business.
In addition,Furthermore, healthcare providers have consolidated to create larger healthcare delivery organizations in order to achieve economies of scale and/or greater market power. If this consolidation continues, it would increase the size of certain target customers, which could increase the cost, effort, and difficulty in selling our products to such target customers, or could cause our existing customers or potential new customers to begin utilizing our competitors’ products if such customers are acquired by healthcare providers that prefer our competitors’ products to ours. In addition, the resulting organizations could have greater bargaining power, which may lead to price erosion. This consolidation could also result in new entrants in the markets in which we operate, which presents additional risk and could result in adverse impacts on our business, see “We operate in highly competitive markets, and we may be unable to compete successfully” above for additional information.
Government regulation of the healthcare industry could reduce demand for our products, or substantially increase the cost to produce our products.
The manufacture and sale of most of our current medication management solutions products are not directly regulated by the FDA or the Drug Enforcement Administration (“DEA”). Through our acquisitionDEA, although such products are used by other persons (our customers) whose pharmacy, dispensing, and compounding activities may be subject to regulation by those agencies and by state boards of Aesynt, wepharmacy. We have both Class I and Class II 510(k) exemptproducts classified as medical devices, which are subject to FDA regulation and require compliance with the FDA Quality System Regulation as well as medical
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removals and corrections, post-marketing surveillance, and device reporting.tracking. Additional products may be regulated in the future by the FDA, DEA, or other federal agencies due to future legislative and regulatory initiatives or reforms. In addition, certain provisions of the Federal Food, Drug and Cosmetic Act related to the handling, distribution and compounding of pharmaceuticals, govern all parts of the drug distribution chain, which our customers may be required to comply with and which may influence customer demand for our products. Direct regulation of our business and products by the FDA, DEA, or other federal agencies could substantially increase the cost to produce our products and increase the time required to bring those products to market, reduce the demand for our products, and reduce our revenues. In addition, our
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customers include healthcare providers and facilities that use our equipment and dispense controlled substances are subject to regulation by the DEA. TheDEA, pharmacies subject to regulation by the FDA and individual state boards of pharmacy and hospitals subject to accreditation by accrediting organizations approved by the CMS, such as the Joint Commission, and the rules, regulations, and standards of such regulators and accrediting organizations. Any failure of these providers and facilitiesour customers to comply with DEA requirements, including the Controlled Substances Actapplicable rules, regulations, and its implementing regulations,standards could reduce demand for our products and harm our competitive position, results of operations, and financial condition. Pharmacies are regulated by individual state boards of pharmacy that issue rules for pharmacy licensure in their respective jurisdictions. State boards of pharmacy do not license or approveFinally, given our medication management automation solutions; however, pharmacies using our equipment arecustomers, products, and industry relationships, we may also be subject to state board approval. The failure of such pharmacies to meet differing requirements from a significant number of state boards of pharmacy could decrease demand for our productsrules, regulations, standards, and harm our competitive position, results of operations, and financial condition. Similarly, hospitals must be accredited by an accrediting organization approvedenforcement imposed by the Centers for Medicare & MedicaidU.S. Department of Health and Human Services such as The Joint Commission, in order to be eligible for Medicaid(“HHS”), the U.S. Department of Justice, the HHS Office of Inspector General, CMS, and Medicare funds. The Joint Commission does not accredit medication management automation solutions; however, failure by our customers to meet The Joint Commission standards for medication management could decrease demand for our productsthe Health Resources and harm our competitive position, results of operations, and financial condition.Services Administration, among others.
While we have implemented a Privacy and Use of Information Policy and adhere to established privacy principles, use of customer information guidelines, and related federal and state statutes, we cannot assure you that we will be in compliance with all international, federal and state healthcare information privacy and security laws that we are directly or indirectly subject to, including, without limitation, HIPAA. Among other things, this legislation required the Secretary of Health and Human Services to adopt national standards governing the conduct of certain electronic health information transactions and protecting the privacy and security of personally identifiable health information maintained or transmitted by “covered entities,” which include pharmacies and other healthcare providers with which we do business.
The standards adopted to date include, among others, the “Standards for Privacy of Individually Identifiable Health Information,” which restrict the use and disclosure of personally identifiable health information by covered entities, and the “Security Standards,” which require covered entities to implement administrative, physical, and technical safeguards to protect the integrity and security of certain electronic health information. Under HIPAA, we are considered a “business associate” in relation to many of our customers that are covered entities, and, as such, most of these customers have required that we enter into written agreements governing the way we handle and safeguard certain patient health information we may encounter in providing our products and services, and may impose liability on us for failure to meet our contractual obligations. Further,Furthermore, pursuant to changes in HIPAA under the American Recovery and Reinvestment Act of 2009, we are covered under HIPAA similar to other covered entities and, in some cases, subject to the same civil and criminal penalties as a covered entity. A number of states and countries have also enacted privacy and security statutes and regulations that, in some cases, are more stringent than HIPAA and may also apply directly to us. If our past or present operations are found to violate any of these laws, we may be subject to fines, penalties, and other sanctions.
In addition, we cannot predict the potential impact of future HIPAAprivacy standards and other federal, state, and stateinternational privacy and security laws that may be enacted at any time on our customers or on Omnicell. These laws could restrict the ability of Omnicell and/or our customers to obtain, use, or disseminate patient information, which could reduce the demand for our products or force us to redesign our products in order to meet regulatory requirements.
Our software products For more information, you should also refer to the risk factor captioned “We are complexsubject to laws, regulations, and may contain defects, whichother legal obligations related to privacy, data protection, and information security, and the costs of compliance with, and potential liability associated with, our actual or perceived failure to comply with such obligations could harm our reputation, results of operations, and financial condition.business.
We market products that contain software and products that are software only. Although we perform extensive testing priorChanges to releasing software products, these products may contain undetected errors or bugs when first released. These may not be discovered until the product has been used by customers in different application environments. Failure to discover product deficiencies or bugs340B Program could require design modifications to previously shipped products or cause delays in the installation of our products and unfavorable publicity or negatively impact system shipments,our 340B Program-related services.
Any changes to the 340B Drug Pricing Program, such as changes to the scope of the 340B Program, could negatively impact our 340B Program-related services. Current litigation brought by multiple manufacturers is challenging the Health Resources and Services Administration’s requirement to offer the 340B ceiling price on drugs dispensed at contract pharmacies. The decisions that have been issued to date have been narrowly tailored and appeals have been filed in some of the cases. While the litigation is ongoing a number of manufacturers have restricted access to the 340B ceiling price for drugs dispensed at contract pharmacies. It is not yet clear how the litigation will resolve. If 340B ceiling prices are not required to be offered for drugs dispensed at contract pharmacies, our 340B Program-related offerings may become less useful to 340B covered entities and our 340B Program-related businesses could decline. In addition, Congress has considered legislative changes to the 340B Program. Any legislative changes to the 340B Program could also affect our 340B Program-related services. It is unclear how this litigation and any of which could harmlegislative changes would affect our business, financial condition and results of operations.
WhenWe must comply with anti-kickback, fraud and abuse, false claims, transparency, and other healthcare laws and regulations.
Our current and future operations are subject to various federal and state healthcare laws and regulations that affect our sales, marketing and other promotional activities by limiting the kinds of financial arrangements we experience delayscan enter into with respect to our products and services. They also impose additional administrative and compliance burdens on us. These laws include, but are not limited to, the healthcare fraud and abuse laws described in installationsthe section titled “Business – Government Regulation” above.
The scope and enforcement of each of these laws is uncertain and subject to rapid change in the current environment of healthcare reform, and it is possible that some of our medication management automation solutions or our more complex medication packaging systems, resulting in delays in our ability to recognize revenue, our competitive position, results of operations, and financial conditionbusiness activities could be harmed.subject to challenge under one or more of such laws. Ensuring that our business arrangements with third parties comply with applicable healthcare laws, as well as responding to investigations by government authorities (which have increased in recent years as the healthcare industry has come under greater scrutiny) can be time and resource consuming and can divert management’s attention from the business.
The purchaseIf our operations are found to be in violation of any of the laws described above or any other government regulations that apply to us, we may be subject to significant financial penalties and possible exclusion from participation in federal and state funded healthcare programs, and the curtailment or restricting of our medication management automation solutions or our more complex medication packaging systems is often part of a customer’s larger initiative to re-engineer its pharmacy and their distribution and materials management systems. As a result, our sales cycles are often lengthy. The purchase of our systems often entails larger strategic purchases by customers that frequently require more complex and stringent contractual requirements and generally involve aoperations, as well as additional reporting obligations
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significant commitment of management attention and resources by prospective customers. These larger and more complex transactions often require the input and approval of many decision-makers, including pharmacy directors, materials managers, nurse managers, financial managers, information systems managers, administrators, lawyers, and boards of directors. In addition, new product announcements, such as that of our XT Series, can cause a delay in our customers’ decision to purchase our products or convert orders from our older products to those of our newer products, such as the XT Series. For these and other reasons, the sales cycle associated with sales of our medication management automation solutions and our more complex medication packaging systems is often lengthy andoversight if we become subject to a numbercorporate integrity agreement or other agreement to resolve allegations of delays over which we have little or no control. A delay in, or loss of, sales ofnon-compliance with these systems could have an adverse effect upon our operating results andlaws. This could harm our business.
In addition, and in part as a result of the complexities inherent in larger transactions, the time between the purchase and installation of our systems can generally range from two weeks to one year. Delays in installation can occur for reasons that are often outside of our control. We have also experienced fluctuations in our customer and transaction size mix, which makes our ability to forecastoperate our product bookings more difficult. Because we recognize revenues for our medication management automation solutionsbusiness and our more complex medication packaging systems only upon installation at a customer’s site, any delay in installation by our customers will also cause a delay in the recognition of the revenues for that system.financial results.
Our international operations may subject us to additional risks that can adversely affect our operating results.
We currently have operations outside of the United States, including sales efforts centered in Canada, Europe, the Middle East, and the Asia-Pacific regions, and supply chain efforts in Asia. We intend to continue to expand our international operations, particularly in certain markets that we view as strategic, including the Middle East. Our international operations subject us to a variety of risks, including:
our reliance on distributors for the sale and post-sale support of our medication management automation solutions outside the United States, Canada, the United Kingdom, France, and Canada;Germany;
remaining uncertainty regarding the consequences of Brexit and the impact on markets, as well as the potential impact on: (i) our operations; (ii) our customers’ operations and capital planning; and (iii) the healthcare industry overall;
the difficulty of managing an organization operating in various countries;
political sentiment against international outsourcing of production;
reduced protection for intellectual property rights particularly in jurisdictions that have less developed intellectual property regimes, which could make it more costly for us to enforce, and more difficult for us to stop the infringement or misappropriation of, our intellectual property rights in thesecertain jurisdictions;
the imposition of, or adverse changes in, foreign regulatory requirements;
the requirement to comply with a variety of international laws and regulations, including privacy and security, labor, import, export, trade, environmental standards, product compliance, tax, anti-bribery, and employment laws;
fluctuations in currency exchange rates and difficulties in repatriating funds from certain countries;
additional investment, coordination, and lead-time necessary to successfully interface our automation solutions with the existing information systems of our customers or potential customers outside of the United States; and
political unrest, terrorism, and theother potential for other hostilities in areas in which we have facilities or operations; and
natural disasters.epidemics, pandemics, or other major public health crises, such as the ongoing COVID-19 pandemic.
If we are unable to anticipate and address these risks properly, our business or operating results will be harmed.
Furthermore, we face risks related to outbreaks of contagious diseases or other adverse public health epidemics, which could cause us or our suppliers and/or customers to temporarily suspend operations in the affected city or country. For example, following the outbreak of the coronavirus first identified in Wuhan, China in December 2019, the Chinese government has taken certain emergency measures to combat the spread of the virus, including implementation of travel bans and closure of factories and businesses. We import certain critical components from suppliers located in China. While we are closely monitoring developments in China and evaluating mitigation strategies, the full impact of this outbreak is uncertain at this time and any prolonged disruption to our China-based suppliers could significantly disrupt our supply chain and negatively impact our sales and operating results.
In addition, changes in export or import regulation and other trade barriers and uncertainties may have an adverse effect on our business. For example, in recent years, the current U.S. administration hasgovernment advocated greater restrictions on trade generally and tariff increases on certain goods imported into the United States, particularly from China. We cannot predict what actions may
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ultimately be taken with respect to tariffs or trade relations between the United States and other countries (including China), what products may be subject to such actions, or what actions may be taken by the other countries in retaliation. The adoption and expansion of trade restrictions, the occurrence of a trade war, other governmental action related to tariffs or trade agreements or policies, or the related uncertainties, has the potential to adversely impact our ability to do business outside of the United States as well as our supply chain and costs, which could, in turn, adversely affect our business, financial condition, and results of operation.
In the past, we have experienced substantial fluctuations in customer demand, and we cannot be sure that we will be able to respond proactively to future changes in customer demand.
Our ability to adjust to fluctuations in our revenues while still achieving or sustaining profitability is dependent upon our ability to manage costs and control expenses. If our revenues increase or decrease rapidly, we may not be able to manage these changes effectively. Future growth is dependent on the continued demand for our products and services, the volume of installations we are able to complete, our ability to continue to meet our customers’ needs and provide a quality installation experience, and our flexibility in manpower allocations among customers to complete installations on a timely basis.
Our ability to control expenses is dependent on our ability to continue to develop and leverage effective and efficient human and information technology systems, our ability to gain efficiencies in our workforce through the local and worldwide labor markets, and our ability to grow our outsourced vendor supply model. Our expense growth rate may equal or exceed our revenue growth rate if we are unable to streamline our operations, incur significant research and development expenses prior to, or without recognizing the benefits, of those solutions under development, incur acquisition-related integration expenses greater than those we anticipate, or fail to reduce the costs or increase the margins of our products. In addition, we may not be able to reduce our expenses to keep pace with any reduction in our revenue, which could harm our results of operations and financial position.operations.
Covenants in our A&R Credit Agreement restrict our business and operations in many ways, and if we do not effectively manage our compliance with these covenants, our financial conditions and results of operations could be adversely affected.
The A&R Credit Agreement contains various customary covenants that require use to provide financial and other information reporting as well as notice upon certain events and limit or restrict our ability and/or our subsidiaries’ ability to, among other things:
things, incur or assume liens or additional debt or provide guarantees in respect of obligations orof other persons;
issue redeemable preferred stock;
pay dividends or distributions or redeem or repurchase capital stock;
prepay, redeem, or repurchase certain debt;
make loans, investments, acquisitions, and capital expenditures;
enter into agreements that restrict distributions from our subsidiaries;
sell assets and capital stock of our subsidiaries;
enter into certain transactions with affiliates; and
consolidate or merge with or into, or sell substantially all of our assets to, another person.
The A&R Credit Agreement also includes financial covenants requiring us (i) not to exceed a maximum consolidated totalsecured net leverage ratio of 3.50:3.00:1 (subject to certain exceptions) and (ii) to maintain a minimum interest coverage ratio of 3.00:1. Our ability to comply with these financial covenants may be affected by events beyond our control. Our failure to comply with any of the covenants under the A&R Credit Agreement could result in a default under the terms of the A&R Credit Agreement, which could permit the administrative agent or the lenders to declare all or part of any outstanding borrowings to be immediately due and payable or foreclose on our assets, or to refuse to permit additional borrowings under the revolving credit facility, which could restrict our operations, particularly our ability to respond to changes in our business or to take specified actions to take advantage of certain business opportunities that may be presented to us. In addition, if we are unable to repay those amounts, the administrative
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agent and the lenders under the A&R Credit Agreement could proceed against the collateral granted to them to secure that debt and foreclose on our assets, which would seriously harm our business.
Climate change, legal, regulatory or market measures to address climate change and related emphasis on environmental, social and corporate governance (“ESG”) matters by various stakeholders may negatively affect our business and results of operations.
Climate changes, such as extreme weather conditions and natural disasters or the occurrence of extreme weather conditions and natural disasters with increased frequency and severity, resulting from increased concentrations of greenhouse gases in the atmosphere, could present risks to our operations by decreasing the availability or increasing cost of materials needed for manufacturing, or increasing insurance and other operating costs. Natural disasters and extreme weather conditions, such as hurricanes, tornados, earthquakes, wildfires or flooding, may also pose physical risks to our facilities and disrupt the operation of our supply chain.
In addition, increased awareness and concern over climate change may result in new or additional regional and/or federal legal or regulatory requirements designed to reduce greenhouse gas emissions and/or mitigate the effects of climate change on the environment. Currently, there continues to be a lack of consistent climate legislation, which creates economic and regulatory uncertainty. If such laws or regulations are more stringent than current legal or regulatory obligations, we are unablemay experience disruption in, or an increase in the costs associated with sourcing, manufacturing and distribution of our products, which may adversely affect our business, results of operations or financial condition
Furthermore, regulators, customers, investors, and employees expectations for ESG matters have been rapidly evolving and increasing. The enhanced stakeholder focus on these issues requires continuous monitoring of various and evolving standards and the associated reporting requirements. A failure to adequately meet stakeholder expectations, combined with inconsistent standards by which to measure ESG performance, may result in the loss of business, diluted market valuation, an inability to attract customers or an inability to attract and retain top talent.
Our success is dependent on our ability to recruit and retain skilled and motivated personnel, our competitive position, results of operations, and financial condition could be harmed.personnel.
Our success is highly dependent upon the continuing contributions of our key management, sales, technical, and engineering staff. We believe that our future success will depend uponstaff, and on our ability to attract, train, and retain highly skilledhighly-skilled and
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motivated personnel. As more of our products are installed in increasingly complex environments, greater technical expertise will be required. As our installed base of customers increases, we will also facerequire additional resources to meet increased demands on our customer service and support personnel, requiring additional resources to meet these demands.personnel. Furthermore, as we execute on the autonomous pharmacyindustry vision of the Autonomous Pharmacy and grow and develop our cloud-based software as a service and solution as a service offerings, more specialized expertise will be required. We may experience difficultyThis growth and shift in recruiting qualified personnel. Competitionproducts and offerings could lead to increased labor costs, and thereby increased costs of our products and offerings, which could result reduced customer demand and our operating results could be materially and adversely affected. Additionally, competition for qualifiedspecialized and technical engineering, managerial, sales, marketing, financial reporting, and other personnel can be intense, and wethe pool of suitable candidates may be limited. We may not be successful in attracting and retaining qualified personnel. If we lose the services of one or more of our key personnel we may not be able to find a suitable replacement and our business could be materially adversely affected. Furthermore, external and internal factors (such as our continued growth) and events related to the COVID-19 pandemic (including new variants of the virus) may result in greater workloads for our employees compared to those at companies with which we compete for personnel, which may lead to higher levels of employee burnout and turnover. Competitors have in the past attempted, and may in the future attempt, to recruit our employees.
In addition, we have historically used stock options, restricted stock units, and other forms ofsince equity compensation asis a key componentscomponent of our employee compensation program, in orderany failure to align employees’ interests with the interests of our stockholders, encourage employee retention, and provide competitive compensation packages. The effect of managing share-based compensation expense and minimizing shareholder dilution from the issuance of new shares may make it less favorable for us to grant stock options, restricted stock units, or other forms of equity compensation, to employees in the future. In order to continue granting equity compensation at competitive levels, we must seekreceive stockholder approval for anyfuture proposed increases to the number of shares reserved for issuance under our equity incentive plans such as the share increase that was approved at our 2019 Annual Meeting of Stockholders, and we cannot assure you that we will receive such approvals in the future. Any failure to receive approval for future proposed increases could prevent us from granting equity compensation at competitive levels and make it more difficult to attract, retain, and motivate employees. Further, to the extent that we expand our business or product lines through the acquisitionemployees, including key employees of other businesses, any failure to receive any such approvals could prevent us from securing employment commitments from such newly acquired employees.businesses. Failure to attract and retain key personnel could harm our competitive position, results of operations, and financial condition.
Our failure to protect our intellectual property rights could negatively affect our ability to compete.
Our success depends in part on our ability to obtain patent protection for technology and processes, and our ability to preserve our trademarks, copyrights, and trade secrets. We have pursued patent protection in the United States and foreign jurisdictions for technology that we believe to be proprietary and for technology that we find offers us a potential competitive advantage for our products. We intend to continue to pursue such protection in the future. Our issued patents relate to various features of our medication management automation solutions and medication packaging systems. We cannot assure you that we will file any patent applications in the future and that any of our patent applications will result in issued patents, or that, if issued, such patents will provide significant protection for our technology and processes. As an example, in September 2014, an action was brought against us, to, among other matters, correct the inventorship of certain patents owned by us. Furthermore, we cannot assure you that others will not develop technologies that are similar or superior to our technology or that others will not design around the patents we own. All of our system software is copyrighted and subject to the protection of applicable copyright laws. Despite our efforts to protect our proprietary rights, unauthorized parties may attempt to copy aspects of our products or obtain and use information that we regard as proprietary, which could harm our competitive position.
Our quarterly operating results may fluctuate and may cause our stock price to decline.
Our quarterly operating results may vary in the future depending on many factors that include, but are not limited to, the following:
our ability to successfully install our products on a timely basis and meet other contractual obligations necessary to recognize revenue;
our ability to continue cost reduction efforts;
the size, product mix, and timing of orders for our medication management automation solutions and medication packaging systems, and their installation and integration;
the overall demand for healthcare medication management automation solutions and medication adherence solutions;
changes in pricing policies by us or our competitors;
the number, timing, and significance of product enhancements and new product announcements by us or our competitors;
the timing and significance of any acquisition or business development transactions that we may consider or negotiate and the revenues, costs, and earnings that may be associated with these transactions;
the relative proportions of revenues we derive from products and services;
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fluctuations in the percentage of sales attributable to our international business;
our customers’ budget cycles;
changes in our operating expenses and our ability to stabilize expenses;
expenses incurred to remediate product quality, security, or safety issues;
our ability to generate cash from our accounts receivable on a timely basis;
the performance of our products;
changes in our business strategy;
macroeconomic and political conditions, including fluctuations in interest rates, tax increases, availability of credit markets, and trade and tariff actions; and
volatility in our stock price and its effect on equity-based compensation expense.
Due to all of these factors, our quarterly revenues and operating results are difficult to predict and may fluctuate, which in turn may cause the market price of our stock to decline.
If we are unable to maintain our relationships with group purchasing organizations (“GPOs”) or other similar organizations, we may have difficulty selling our products and services to customers represented by these organizations.
A number of GPOs including HealthTrust Purchasing Group, Intalere (f.k.a. Amerinet, Inc.), Premier Inc., The Resource Group, Resource Optimization & Innovation, LLC, and Vizient Inc., have negotiated standard contracts for our products on behalf of their member healthcare organizations. Members of these GPOs may purchase under the terms of these contracts, which obligate us to pay the GPO a fee. We also have also contracteda Federal Supply Schedule contract with the United States General Services Administration,Department of Veterans Affairs, allowing the Department of VeteranVeterans Affairs, the Department of Defense, and other Federal Governmentgovernment customers to purchase our products. These contracts enable us to more readily sell our products and services more readily to customers represented by these organizations. Some of our contracts with these organizations are terminable at the convenience of either party. The loss of any of these relationships could impact the breadth of our customer base and could impair our ability to meet our revenue or revenue growth rate targets or our ability to increase our revenues. These organizations may not renew our contracts on similar terms, if at all, and they may choose to terminate our contracts before they expire, any of which could cause our revenues to decline.
If we are not ableunable to supplymeet the demand fromdemands of, or maintain our relationships with, our institutional and retail pharmacy customers, on schedule and with quality consumable medication packaging products, or if we are otherwise unable to maintain our relationships with major institutional pharmacies, they may use alternative means to distribute medications to their customers and our revenue from sales of blister cardsmedication packages and other consumables as well as other services may decline.decline.
Approximately 10%6% of our revenues during the year ended December 31, 20192021 were generated from the sale of consumable medication packages, most of which are produced in our St. Petersburg, Florida facility on a continuous basis and are shipped out to fulfill the demands of our institutional and retail pharmacy customers domestically and abroad.The demands placed on institutional and retail pharmacies by their customers represent real time requirements of those customers. Our customer agreements for the sale of consumable medication packages are typically short-term in nature and typically do not include anyimpose volume commitments on the part of the customer. Although our packaging may be considered the preferred method of maintaining control of medications during the medication distribution and administration process, institutional and retail pharmacies have alternative methods of distributing medications, including bulk and alternative packaging, and medication adherence packaging may be supplied by our competitors. To the extent thatIf we are unable to supply quality packaging to our customers in a timely manner, that demand will be met viathey may use alternative distribution methods of distributing medications to their customers, including consumable medication packaging sold by our competitors, and our revenues will decline. Any disruption in the production capabilities of our St. Petersburg facilities, including as a result of extreme weather conditions or natural disasters, will adversely affect our ability to ship our consumable medication packages globally and would reduce our revenues.
In addition, the institutional pharmacy market consists of significant national suppliers of medications to non-acute care facilities, smaller regional suppliers, and very small local suppliers. If we are unable to maintain our relationships with the major institutional pharmacies we do business with, they may purchase consumable blister card components from alternative sources, or choose to use alternatives to blister cards for medication control, and our revenues would decline.
Similarly, EnlivenHealth offers a portfolio of web-based patient engagement, medication management, financial management and analytics tools to pharmacies, which is designed to support improvement in health outcomes related to medication use. The success of these services depends on the trust our customers place in us and our reputation and ability to provide high-quality service. If we are unable to maintain the satisfaction or meet the expectations of our customers, our reputation with current and potential customers could be harmed, which could have a material adverse effect on our business, financial condition and results of operations. In addition, if we fail to maintain our relationships with existing customers or are unable to create new relationships with other pharmacies, this could have an adverse effect on our business, financial condition, and results of operations.
Our inability to secure or maintain access to existing and future specialty drugs or pharmacy provider networks for our specialty pharmacy customers could have a material adverse effect on our business.
We provide specialty pharmacy management services to provider groups, federally qualified health centers, and health systems, including providing access to payor networks and limited distribution drugs (“LDD”). We have historically been able to obtain most of the payor and LDD products through our current network. However, if we are unable to obtain access to new LDDs or maintain access to current LDDs for our customers, it could have a material adverse effect on our business, profitability, and results of operations. In addition, if we are not able secure participation in networks of pharmacy providers for our customers at acceptable reimbursement rates or if we lose access to current pharmacy networks, this could result in loss of customers, which could adversely affect our operating results. We endeavor to demonstrate continued value and growth for each of our customers during the term of their respective contracts with the Company. However, if any of our customers elect to manage their own specialty pharmacy business, such customers could reduce or cease doing business with us upon the expiration of such customer’s contract term, which could have a material adverse effect on our business, financial condition, and results of operations.
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Our products use raw materials and components that may be subject to price fluctuations, shortages, or interruptions of supply, and if we are unable to maintain supply sources for such raw materials and components, or if such sources fail to satisfy our supply requirements, in particular with regard to semiconductor chips, we may experience a loss of sales, increased component costs, and reduced profitability.
Factors that are largely beyond our control, such as the cost, quality, and availability of the raw materials and components utilized in the manufacture of our products, may affect the cost of such products, and we may not be able to pass those costs on to our customers. Our products use raw materials and components that may be subject to price fluctuations, shortages, or other disruptions of supply for many reasons outside of our control, including as a result of the COVID-19 pandemic. In addition, we may be dependent upon a limited number of suppliers for certain components which may be unduly affected by supply chain disruptions. The cost, quality, and availability of these raw materials and components are essential to the successful manufacture and sale of our products. If we are unable to successfully interfacemaintain supply sources of these raw materials and components, or if such sources fail to satisfy our automation solutions withsupply requirements, we may lose sales and experience increased component costs.
We have developed and implemented strategies in an effort to mitigate the existing information systemsimpact of price fluctuations, shortages, or other disruptions of supply, but these strategies, particularly in a prolonged inflationary environment, may only offset a portion of the adverse impact. We carry some inventory of critical components and are otherwise working to secure supplies necessary to ensure fulfillment of customer demand, but global shortages could result in our need to secure supplies at higher costs as well as manufacturing delays. We have recently experienced increased delays in shipments of various components used in the manufacture of our customers, theyproducts— particularly with regard to semiconductor chips. As a result, we have sought alternate sources of certain components, which may choose not to use our products and services.
For healthcare facilities to fully benefit from our automation solutions, our systems must interface with certain of their other information systems. This may require substantial cooperation, incremental investment, and coordination on the part of our customers, and may require coordination with third-party suppliers of the existing information systems. There is little uniformity in the systems currently used by our customers, which complicates the interfacing process. If these systems are not successfully interfaced, our customers could choose not to usebe at a higher cost or to reduce their use of our automation solutions, which would harm our business. Also, these information systems are impacted by regulatory forces, such as the Promoting Interoperability Program and HIPAA Omnibus Rules, and may evolve their interoperability functionality accordingly. We expect to comply with the mandatory standards and certifications that enable us to continuously interoperate with partner information systems, but such symbiotic evolution in a changing regulatory environment can at times create an execution risk.
Additionally, our competitors may enter into agreements with providers of hospital information systems that are designed to increase the interoperability of their respective products. To the extent our competitors are able to increase the interoperability of their products with those of the major hospital information systems providers, customers who utilize such information systems may choose not to use our products and services. In addition, hospital and physician office information systems providers may choose to develop their own solutions that could compete with ours. Furthermore, we expect the importance of interoperability tolower quality. Because semiconductor chips continue to increasebe subject to an ongoing and significant shortage, our ability to source components that use semiconductor chips has been adversely affected. These supply interruptions have resulted in increased component delivery lead times and increased costs to obtain components with available semiconductor chips. As the next few years. Regulations such assemiconductor chip shortage continues, or other shortages may continue, the Quality Payment Program are expected to heavily focus on evidence and outcomes. Given our role in care delivery process, the data generated byproduction of our products may be impacted. If the Company or our suppliers are unable to obtain components from third parties in the quantities and of the quality that we require, on a key input for assessingtimely basis and reportingat acceptable prices, we may not be able to deliver our products on clinical outcomes. This may elevate interoperability with information systems to a relative importancetimely or cost-effective basis to our customers, creatingor it may lead to us delivering products that are of a lower quality that may result in increased repair and replacement costs, which could harm our business opportunity and risk.reputation, results of operations, and financial condition. We have also seen a period of sustained price increases for commodities used in the manufacture of our products that may continue as demand increases and supply remains constrained, which has resulted in, and may continue to result in, increased costs for Omnicell and thereby potentially lower profit margins. If the costs of these commodities increase or remain elevated, it could adversely affect Omnicell’s financial condition, operating results, and cash flow.
We depend on a limited number of suppliers for our products, and our business may suffer if we were required to change suppliers to obtain an adequate supply of components, equipment, and raw materials on a timely basis.
Although we generally use parts and components for our products with a high degree of modularity, certain components are presently available only from a single source or limited sources. We rely on a limited number of suppliers for the raw materials that are necessary in the production ofto produce our consumable medication packages. While we have generally been able to obtain adequate supplies of all components and raw materials in a timely manner from existing sources, or where necessary, from alternative sources, of supply, we entered into relationships with new suppliers in connection with the launch of our XT Series products. We engage multiple single source third-party manufacturers to build several of our sub-assemblies. The risks associated with changing to alternative vendors, if necessary, for any of the numerous components used to manufacture our products could limit our ability to manufacture our products or result in the use of substitute components in our products that could lead to additional complexity or cost in maintaining our products and thereby harm our business. Due to our reliance on a few single source partners to build our hardware sub-assemblies and on a limited number of suppliers for the raw materials that are necessary in the production of our consumable medication packages, a reduction or interruption in supply from our partners or suppliers, or a significant increase in the price of one or more components could have an adverse impact on our business, results of operations, and financial condition. In certain circumstances, the failure of any of our suppliers or us to perform adequately could result in quality control issues affecting end users’ acceptance of our products. These impactsproducts, which could damage customer relationships and could harm our business.
Failure to maintain effective internal control over financial reporting in accordance with Section 404 of the Sarbanes-Oxley Act of 2002 could cause our stock price to decline.
Section 404 of the Sarbanes-Oxley Act of 2002 and the related rules and regulations of the Securities and Exchange Commission (“SEC”) require annual management assessments of the effectiveness of our internal control over financial reporting, and a report by our independent registered public accounting firm attesting to the effectiveness of internal control. If we fail to maintain effective internal control over financial reporting, as such standards are modified, supplemented, or amended from time to time, we may not be able to ensure that we can conclude on an ongoing basis that we have effective internal control over financial reporting.
If the market price of our common stock continues to be highly volatile, the investment value of our common stock may decline.
Our common stock traded between $57.81 and $92.59 per share during the year ended December 31, 2019. The market price for shares of our common stock has been and may continue to be highly volatile. In addition, our announcements or external events may have a significant impact on the market price of our common stock. These announcements or external events may include:
actual or anticipated changes in our operating results;
whether our operating results or forecasts meet the expectations of securities analysts or investors;
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developments in our relationships with corporate customers;
developments with respect to recently acquired businesses;
changes in the ratings of our common stock by securities analysts or changes in their earnings estimates;
announcements by us or our competitors of technological innovations or new products;
announcements by us or our competitors of acquisitions of businesses, products or technologies; or other significant transactions by us or our competitors such as strategic partnerships or divestitures;
actions by stockholders or short sellers of our common stock;
the level of demand for our common stock, including short interest in our common stock; or
general economic and market conditions.
Furthermore, the stock market as a whole from time to time has experienced extreme price and volume fluctuations, which have particularly affected the market prices for technology companies. These broad market fluctuations may cause the market price of our common stock to decline irrespective of our performance. In addition, sales of substantial amounts of our common stock in the public market, or the perception that such sales could occur, could lower the market price of our common stock.
In addition, stockholders have initiated class action lawsuits against companies following periods of volatility in the market prices of these companies’ stock. For example, as described in the section entitled "Legal Proceedings" in Note 12, Commitments and Contingencies, of the Notes to Consolidated Financial Statements included in this annual report, in July 2019, a putative class action lawsuit was filed against Omnicell and certain of our officers alleging that the defendants violated federal securities laws by making certain materially false and misleading statements. While this action is concluded following the lead plaintiff's filing of a notice of voluntary dismissal as to all defendants, we may in the future be subject to other class action lawsuits, especially following periods of volatility in the market price of our common stock.
The United Kingdom’s recent withdrawal from the European Union could adversely affect us.
Following the result of a referendum in 2016, the United Kingdom (the “UK”) left the European Union (the “EU”) on January 31, 2020. The UK’s withdrawal from the EU is commonly referred to as “Brexit.” Pursuant to the formal withdrawal arrangements agreed between the UK and the EU, the UK is subject to a transition period until December 31, 2020 (the “Brexit Transition Period”), during which EU rules will continue to apply. Negotiations between the UK and the EU are expected to continue in relation to the customs and trading relationship between the UK and the EU following the expiry of the Brexit Transition Period. The effects of Brexit have been and are expected to continue to be far-reaching. Brexit and the perceptions as to its impact may adversely affect business activity and economic conditions in Europe and globally, and could continue to contribute to instability in global financial markets as well as uncertainty regarding the regulation of data protection in the UK. Brexit could also have the effect of disrupting the free movement of goods, services, and people between the UK and the EU. In addition, Brexit could lead to legal uncertainty and potentially divergent national laws and regulations as the UK determines which EU laws to replace or replicate. The full effects of Brexit are uncertain and will remain so until after the Brexit Transition Period and the UK and EU reach a definitive resolution with regards to outstanding trade and legal matters. Lastly, as a result of Brexit, other European countries may seek to conduct referenda with respect to their continuing membership with the EU. Given these possibilities and others we may not anticipate, as well as the lack of comparable precedent, the full extent to which our business, results of operations, and financial condition could be adversely affected by Brexit is uncertain.
Our U.S. government lease agreements are subject to annual budget funding cycles and mandated unilateral changes, which may affect our ability to enter into such leases or to recognize revenues and sell receivables based on thesesuch leases.
Prior to September 2021, U.S. government customers that leaseleased our equipment typically signsigned contracts with five-year payment terms that are subject to one-year government budget funding cycles. Further,Effective September 2021, the government has in certain circumstances mandated unilateral changes in its Federal Supply Services contract that could renderhas resulted in our lease termsdetermination not to enter into future leases with theU.S. government less attractive. Incustomers. Our existing leases with U.S. government customers are unaffected by this change. As
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a result, our judgmentvolume of U.S. government customer leases will decline over time and based on our history with these accounts, we believe these receivables are collectible. However,cease in the future, thefuture. The failure of any of our U.S. government customers to receive their annual funding, or the government mandating changes to the Federal Supply Services contract, could impair our ability to sell lease equipment to these customers or to sell our U.S. government receivables to third-party leasing companies. In addition, the ability to collect payments on unsold receivables could be impaired and may result in a write-down of our unsold receivables from U.S. government customers. The balance of our unsold leases to U.S. government customers was $17.2$21.8 million as of December 31, 2019.
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2021.
If we fail to manage our inventory properly, our revenue, gross margin, and profitability could suffer.
Managing our inventory of components and finished products is a complex task. A number of factors, including, but not limited to, the need to maintain a significant inventory of certain components that are in short supply, especially in response to the current semiconductor chip shortage, or that must be purchased in bulk to obtain favorable pricing, the general unpredictability of demand for specific products and customer requests for quick delivery schedules, may result in us maintaining large amounts of inventory. Other factors, including changes in market demand, customer requirements, and technology, may cause our inventory to become obsolete. Any excess or obsolete inventory could result in inventory write-downs, which in turn could harm our business and results of operations.
Intellectual property claims against us could harm our competitive position, results of operations, and financial condition.
We expect that developers of medication management automation solutions and medication packaging systems will be increasingly subject to infringement claims as the number of products and competitors in our industry grows and the functionality of products in different industry segments overlaps. In the future, third parties may claim that we have infringed upon, misappropriated, or otherwise violated their intellectual property rights with respect to current or future products. We do not carry special insurance that covers intellectual property infringement claims; however,claims, such claims may be covered under our traditional insurance policies. These policies contain terms, conditions, and exclusions that make recovery for intellectual property infringement claims difficult to guarantee. Any infringement claims, with or without merit, could be time-consuming to defend, result in costly litigation, divert management’s attention and resources, cause product shipment delays or require us to enter into royalty or licensing agreements. These royalty or licensing agreements, if required, may not be available on terms acceptable to us, or at all, which could harm our competitive position, results of operations, and financial condition.
Product liability claims against us could harm our competitive position, results of operations, and financial condition.
Our products include medication management automation solutions and medication adherence products and services for healthcare systems and pharmacies. Despite the presence of healthcare and pharmacy professionals as intermediaries between our products and patients, if our products fail to provide accurate and timely information or operate as designed, customers, patients, or their family members could assert claims against us for product liability. For example, as further discussed under “Legal Proceedings” in Note 12, Commitments and Contingencies, of the Notes to Consolidated Financial Statements included in this annual report, we are currently subject to certain lawsuits, asserting, among other allegations, claims of product liability. Moreover, failure of health care facility and pharmacy employees to use our products for their intended purposes could result in product liability claims against us. Litigation with respect to product liability claims, regardless of any outcome, could result in substantial cost to us, divert management’s attention from operations, and decrease market acceptance of our products. We possess a variety of insurance policies that include coverage for general commercial liability and technology errors and omissions liability. We attempt to mitigate these risks through contractual terms negotiated with our customers. However, these policies and protective contractual terms may not be adequate against product liability claims.claims and in the past we have been subject to certain lawsuits asserting, among other allegations, claims of product liability. A successful claim brought against us, or any claim or product recall that results in negative publicity about us, could harm our competitive position, results of operations, and financial condition. Also, in the event that any of our products is defective, we may be required to recall or redesign those products.products, which could result in increased costs and have an adverse impact on our results of operation.
We are dependent on technologies provided by third-party vendors, the loss of which could negatively and materially affect our ability to market, sell, or distribute our products.
Some of our products incorporate technologies owned by third parties that are licensed to us for use, modification, and distribution. For example, the VBM 200F is manufactured by a third party and sold by us pursuant to a distribution and supplier agreement. In addition, we recently entered into a reseller agreement with Kit Check, Inc. to offer BlueSight“Bluesight for Controlled SubstancesSubstances” diversion prevention software to our customers. If we lose access to third-party technologies, such as our ability to distribute the VBM 200F or BlueSightBluesight for Controlled Substances, or we lose the ongoing rights to modify and distribute these technologies with our products, we will have to devote resources to independently develop, maintain, and support the technologies ourselves, pay increased license costs, or transition to another vendor. Any independent development, maintenance, or support of these technologies by us or the transition to alternative technologies could be costly, time consuming, and could delay our product releases and upgrade schedules. These factors could negatively and materially affect our ability to market, sell, or distribute our products.
Complications in connection with our ongoing business information system upgrades, including those required to transition acquired entities onto information systems already utilized, and those implemented to adopt new accounting standards, may impact our results of operations, financial condition, and cash flows.
We continue to upgrade our enterprise-level business information system with new capabilities and transition acquired entities onto information systems already utilized in the company. For example, we are currently in the process of replacing the legacy Enterprise Requirements Planning systems used at Aesynt with systems currently in use in other parts of Omnicell, and we intend to do the same at Ateb. Based upon the complexity of some of the upgrades, there is risk that we will not see the
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expected benefitInvestment in new business strategies and initiatives could disrupt ongoing business and present risks not originally contemplated.
We have invested, and in the future may invest, in new business strategies or initiatives, including with respect to our software as a service or solution as a service subscription products and services or other subscription and cloud-based offerings. Such endeavors may involve significant risks and uncertainties, including distraction of management from the implementationcurrent operations, lack of these upgradesexpertise to effectively execute such strategies or initiatives, insufficient revenue to offset liabilities assumed and expenses associated with a strategy or initiative, inadequate return of capital, and unidentified issues not discovered in accordance with their anticipated timeline and will incur costs in addition to those we have already planned for. In addition, in future years, we will need to comply with new accounting standards established by the Financial Accounting Standards Board (“FASB”) for components of our financial reporting.due diligence. These new standards will require us to modifyventures may be inherently risky and may not be successful. Even if successful, they may not have the projected or actual impact that we initially expected. As a result, such initiatives may materially adversely affect our accounting policies and financial reporting disclosure. We further anticipate that integration of these and possibly other new standards may require a substantial amount of management’s time and attention, and require integration with our enterprise resource planning system. The implementation of the system and the adoption of future new standards, in isolation as well as together, could result in operating inefficiencies and financial reporting delays, and could impact our ability to timely record certain business transactions. All of these potential results could adversely impact our results of operations, financial condition and cash flows.operating results.
Outstanding employeeRisks Related to Ownership of Our Common Stock
The market price of our common stock optionsmay continue to be highly volatile.
Our common stock traded between $115.78 and $187.29 per share during the year ended December 31, 2021. The market price of our common stock has been and may continue to be highly volatile in response to various factors, many of which are beyond our control, including:
actual or anticipated changes in our operating results, and whether our operating results or forecasts meet the expectations of securities analysts or investors;
changes in the ratings of our common stock by securities analysts or changes in their earnings estimates;
developments in our customer relationships;
announcements by us or our competitors of technological innovations or new products;
mergers, acquisitions, combinations, and other significant transactions involving us or our competitors;
level of demand for our common stock, and actions by stockholders or short sellers of our common stock;
epidemics, pandemics, or other major public health crises, such as the ongoing COVID-19 pandemic; or
general economic and market conditions.
Furthermore, the stock market in general, and the market for technology companies in particular, have experienced extreme price and volume fluctuations. These broad market fluctuations may cause the potentialmarket price of our common stock to dilute stockholder valuedecline irrespective of our performance. In addition, sales of substantial amounts of our common stock in the public market, or the perception that such sales could occur, could lower the market price of our common stock.
In addition, stockholders have initiated class action lawsuits against companies following periods of volatility in the market prices of these companies’ stock. For example, in July 2019, a putative class action lawsuit was filed against Omnicell and certain of our officers alleging that the defendants violated federal securities laws by making certain materially false and misleading statements. While this action was concluded in December 2019 following the lead plaintiff's voluntary dismissal as to all defendants, we may in the future be subject to other class action lawsuits, especially following periods of volatility in our stock price.
Our quarterly and annual operating results may fluctuate, which makes our future operating results difficult to predict, and may cause our stock price to decline.
We grant stock optionsOur quarterly and annual operating results have varied and may vary in the future. In addition to certainother factors discussed in this “Risk Factors” section, factors, many of which are outside of our employees as incentivescontrol and are difficult to join Omnicellpredict, that may cause our quarterly or as an on-going rewardannual operating results to fluctuate include, but are not limited to, the following:
the size, product mix, and retention vehicle. We had options outstandingtiming of orders for our products, and their installation and integration and whether our estimates for the same were proper;
our ability to purchase approximately 3.9 million sharessuccessfully install our products on a timely basis and meet other contractual obligations necessary to recognize revenue;
fluctuations in customer demand for our products, including due to changes in our customers’ budgets, and whether customer demand was properly estimated;
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our common stock, atability to control costs, including operating expenses, and continue cost reduction efforts;
changes in pricing policies by us or our competitors;
the number, timing, and significance of product enhancements and new product announcements by us or our competitors;
the timing and significance of any acquisition or business development transactions that we may consider or negotiate and the revenues, costs, and earnings that may be associated with these transactions;
the relative proportions of revenues we derive from products and services;
our ability to generate cash from our accounts receivable on a weighted-average exercise pricetimely basis;
changes in, and our ability to successfully execute on, our business strategy; and
macroeconomic and political conditions, including fluctuations in interest rates, tax increases, availability of $52.75 per share as of December 31, 2019. If some orcredit markets, and trade and tariff actions.
Due to all of these sharesfactors, our quarterly or annual revenues and operating results are sold intodifficult to predict and may fluctuate, which in turn may cause the public market over a short time period, the price of our common stock may decline, as the market may not be able to absorb those shares at the prevailing market prices. Such sales may also make it more difficult for us to sell equity securities in the future on terms that we deem acceptable.decline.
Raising additional capital may cause dilution to our existing stockholders, restrict our operations or harm our business, financial condition, and results of operations.
We may seek additional capital through a variety of means, including through private and public equity offerings and debt financings. To the extent that we raise additional capital through the sale of equity or convertible debt securities, the ownership interest will be diluted, and the terms may include liquidation or other preferences that adversely affect the rights of our stockholders. Debt financing, if available, may involve agreements that include covenants limiting or restricting our ability to take certain actions, such as incurring additional debt, making capital expenditures, entering into licensing arrangements, or declaring dividends. If we raise additional funds from third parties, we may have to relinquish valuable rights to our technologies, or grant licenses on terms that are not favorable to us.
For example, we filed a “shelf” registration statement on Form S-3 under the Securities Act in November 2017 (the “S-3 Registration Statement”), allowing us, from time to time, to offer any combination of registered common stock, preferred stock, debt securities, and warrants. Under this S-3 Registration Statement, we also entered into a distribution agreement (the “Distribution Agreement”) in November 2017 with J.P. Morgan Securities, LLC, Wells Fargo Securities, LLC, and HSBC Securities (USA) Inc., as our sales agents, pursuant to which we may offer and sell from time to time through “at-the-market” offerings, up to an aggregate of $125.0 million of our common stock through the sales agents. As of December 31, 2019, we had an aggregate of $31.5 million available to be offered under the Distribution Agreement.
If we are unable to raise additional funds through equity or debt financing when needed, our ability to market, sell, or distribute our products and/or fund our operations may be negatively impacted and could harm our business, financial condition, and results of operations.
Certain provisions in our charter documents and under Delaware law may discourage, delay, or prevent an acquisition of us and limit our stockholders’ ability to obtain a favorable judicial forum for certain disputes.
Certain anti-takeover provisions of Delaware law and our charter documents may make a change in control of our Company more difficult, even if a change in control would be beneficial to the stockholders. Our certificate of incorporation provides that stockholders’ meetings may only be called by our Board of Directors. Our bylaws provide that stockholders may not take action by written consent, and require that stockholders comply with advance notice procedures to nominate director candidates for election or to propose matters to be acted upon at a meeting of our stockholders. Delaware law also prohibits corporations from engaging in a business combination with any holders of 15% or more of their capital stock until the holder has held the stock for three years unless, among other possibilities, our Board of Directors approves the transaction. Our Board of Directors may use these provisions to prevent changes in the management and control of our Company. Also, under applicable Delaware law, our Board of Directors may adopt additional anti-takeover measures in the future including, without limitation, a stockholder rights plan.
In addition, our bylaws also establish the Delaware Court of Chancery as the exclusive forum for certain legal actions, including certain stockholder disputes, and establish the federal district courts of the United States of America as the exclusive forum for any action asserting a cause of action arising under the Securities Act of 1933, as amended, which exclusive forum provisions may limit the ability of our stockholders to bring a claim in a judicial forum that such stockholders find favorable for disputes with us or our directors, officers, or other employees.
Risk Factors Related to Our Notes
Conversion of the Notes may dilute the ownership interest of our stockholders, depress the price of our common stock or, if the conditional conversion feature of the Notes is triggered, adversely affect our financial condition and operating results.
The Notes are convertible at the option of the holders on or after May 15, 2025 and, in certain circumstances, prior to May 15, 2025. The initial conversion rate for the Notes is 10.2751 shares of our common stock per $1,000 principal amount of
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Notes, subject to adjustment under certain circumstances in accordance with the terms of the Indenture. On December 13, 2021, we made an irrevocable election under the Indenture to require the principal portion of our Notes to be settled in cash (up to $1,000 in cash per $1,000 principal amount of Notes) and any conversion consideration in excess of $1,000, in cash and/or shares of our common stock, at our option, upon conversion. The conversion of some or all of the Notes may dilute the ownership interests of our stockholders. As we have the option to settle the excess of the principal amount in shares of our common stock, any sales in the public market of our common stock issuable upon such conversion could adversely affect prevailing market prices of our common stock. In addition, the existence of the Notes may encourage short selling of our common stock by market participants because the conversion of the Notes could be used to satisfy short positions, or the anticipated conversion of the Notes into shares of our common stock could depress the price of our common stock.
Following our irrevocable election, only the shares of common stock expected to be settled in excess of the principal amount are considered dilutive for calculating earnings per share under the if-converted method. Accordingly, as the price of our common stock increases, our diluted earnings per share could be adversely affected.
Prior to May 15, 2025, if a circumstance that permits early conversion occurs, holders of the Notes will be entitled to convert their Notes at any time during specified periods at their option. For example, the Notes are currently convertible until March 31, 2022 because our common stock traded above a minimum price specified in our Indenture during the quarter ended December 31, 2021, and may be convertible in the future. If one or more holders elect to convert their Notes, we will be required to settle at least the principal amount of our conversion obligation through the payment of cash (up to $1,000 in cash per $1,000 principal amount of Notes), which could adversely affect our liquidity. In addition, as a result of the irrevocable election, in periods when the conditional conversion feature of the Notes is triggered, we must reclassify all of the outstanding principal of the Notes as a current rather than long-term liability, which could result in a material reduction of our net working capital during those periods.
The convertible note hedge and warrant transactions may affect the value of our common stock.
In connection with the offering of the Notes, we entered into convertible note hedge transactions with an affiliate of one of the initial purchasers of the Notes and certain other financial institutions (the “option counterparties”). We also entered into warrant transactions with the option counterparties. The convertible note hedge transactions are expected generally to reduce the potential dilution to our common stock upon any conversion of Notes and/or offset any cash payments we are required to make in excess of the principal amount of converted Notes, as the case may be. However, the warrant transactions separately have, and could continue to have a dilutive effect on our common stock to the extent that the market price per share of our common stock exceeds the strike price of the warrants. In addition, the option counterparties or their respective affiliates may modify their hedge positions by entering into or unwinding various derivatives with respect to our common stock and/or purchasing or selling our common stock or other securities of ours in secondary market transactions prior to the maturity of the Notes (and are likely to do so in connection with any conversion of the Notes or redemption or repurchase of the Notes), which could cause or avoid an increase or a decrease in the market price of our common stock.
Changes in the credit quality of the option counterparties may affect the efficacy of our hedge and warrant transactions. By entering into the hedge and warrant transactions, we are subject to the risk that the option counterparties may incur significant financial hardships, potentially resulting in their default under the convertible note hedge transactions. Our exposure to the credit risk of the option counterparties will not be secured by any collateral. If an option counterparty becomes subject to insolvency proceedings, we will become an unsecured creditor in those proceedings with a claim equal to our exposure at that time under the convertible note hedge transactions with such option counterparty. Our exposure will depend on many factors but, generally, an increase in our exposure will be correlated to an increase in the market price and in the volatility of our common stock. In addition, upon a default by an option counterparty, we may suffer adverse tax consequences and more dilution than we currently anticipate with respect to our common stock. We can provide no assurances that the hedge or warrant transactions will have the intended effects or as to the financial stability or viability of the option counterparties.
General Risk Factors
Changes in our tax rates, exposure to additional tax liabilities, or the adoption of new tax legislation could adversely affect our business and financial condition.
We are subject to taxes in the United States and foreign jurisdictions.jurisdictions in which we operate. Our future effective tax rates could be affected by several factors, many of which are outside of our control, including: changes in the mix of earnings with differing statutory tax rates, changes in the valuation of deferred tax assets and liabilities, changes in federal, state, and international tax laws or their interpretation, adjustments to income tax expense upon the finalization of tax returns, changes in tax attribute,attributes, or changes in accounting principles. We regularly assess the likelihood of adverse outcomes to determine the adequacy of our provision for taxes. We are also subject to examination of our income tax returns by the Internal Revenue Service and other tax authorities. There can be no assurance that the outcomes from these examinations will not materially
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adversely affect our financial condition and operating results. Forecasting our estimated annual effective tax rate is complex and subject to uncertainty, and there may be a material difference between the forecasted and the accrualaccrued effective tax rates.rates, especially due to the volatility and uncertainty of global economic conditions resulting from the COVID-19 pandemic. Any increase in our effective tax rate would reduce our profitability.
Catastrophic events may disrupt our business and harm our operating results.
We rely on our network infrastructure, data centers, enterprise applications, and technology systems for the development, marketing, support, and sales of our products, and for the internal operation of our business. These systems are susceptible to disruption or failure in the event of a majoran extreme weather condition, including earthquake, fire, flood, ice and snow storms or other natural disasters, as well as cyber-attack, terrorist attack, telecommunications failure, epidemic or pandemic (such as the ongoing COVID-19 pandemic), or other catastrophic event. Many of these systems are housed or supported in or around our corporate headquarters located in Northern California, near major earthquake faults and which may be vulnerable to climate change effects, and where a significant portion of our
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research and development activities and other critical business operations take place. Other critical systems, including our manufacturing facilities for our consumable medication packages, are housed in St. Petersburg, Florida, in communities that have been subject to significant tropical storms.storms, which tropical storms may be intensified or occur with increasing frequency as a result of climate change. Disruptions to, or the failure of any of these systems, and the resulting loss of critical data, which is not quickly recoverable by the effective execution of disaster recovery plans designed to reduce such disruption, could cause delays in our product development, prevent us from fulfilling our customers’ orders, and could severely affect our ability to conduct normal business operations, the result of which would adversely affect our operating results.
Anti-takeover provisionsFailure to maintain effective internal control over financial reporting in accordance with Section 404 of the Sarbanes-Oxley Act of 2002 could cause our stock price to decline.
Section 404 of the Sarbanes-Oxley Act of 2002 and the related rules and regulations of the United States Securities and Exchange Commission (“SEC”) require annual management assessments of the effectiveness of our internal control over financial reporting, and a report by our independent registered public accounting firm attesting to the effectiveness of internal control. If we fail to maintain effective internal control over financial reporting, as such standards are modified, supplemented, or amended from time to time, we may not be able to ensure that we can conclude on an ongoing basis that we have effective internal control over financial reporting. Should that occur, we may not be able to accurately report our financial results, prevent fraud, or file our periodic reports in a timely manner, which may cause investors to lose confidence in our charter documentsreported financial information and under Delaware law, andmay lead to a decline in our stock price. In addition, our failure to timely file our periodic reports could eventually result in the delisting of our common stock, regulatory sanctions from the SEC, and/or the breach of the terms contained in our credit facility, or any stockholders’ rights planpreferred equity or debt securities we may adoptissue in the future, make an acquisitionany of us, which may be beneficial tocould have a material our stockholders, more difficult.
We are incorporated in Delaware. Certain anti-takeover provisions of Delaware lawoperations and our charter documents as currently in effect may make a change in control of our company more difficult, even if a change in control would be beneficial to the stockholders. Our anti-takeover provisions include provisionsyour investment in our certificate of incorporation providing that stockholders’ meetings may only be called by our Board of Directors and provisions in our bylaws providing that the stockholders may not take action by written consent and requiring that stockholders that desire to nominate any person for election to our Board of Directors or to make any proposal with respect to business to be conducted at a meeting of our stockholders be submitted in appropriate form to our Secretary within a specified period of time in advance of any such meeting. Delaware law also prohibits corporations from engaging in a business combination with any holders of 15% or more of their capital stock until the holder has held the stock for three years unless, among other possibilities, our Board of Directors approves the transaction. Our Board of Directors may use these provisions to prevent changes in the management and control of our company. Also, under applicable Delaware law, our Board of Directors may adopt additional anti-takeover measures in the future.
The stockholder rights plan adopted by our Board of Directors in February 2003 expired by its terms in February 2013. Our Board of Directors could adopt a similar plan in the future if it determines that such action is in the best interests of our stockholders. Such a plan may have the effect of discouraging, delaying or preventing a change in control of our company that may be beneficial to our stockholders.common stock.
ITEM 1B.    UNRESOLVED STAFF COMMENTS
There are currently no unresolved issues with respect to any SEC staff’s written comments.
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ITEM 2.    PROPERTIES
Our headquarters are located in a leased facilitiesfacility in Mountain View, California. The following is a list of our material leased facilities and their primary functions:
SiteMajor ActivityApproximate Square Footage
St. Petersburg, FloridaAdministration, marketing, research and development, sales, and manufacturing132,500167,700
Cranberry Township, PennsylvaniaAdministration, marketing, research and development, sales, technical support, and training119,400
Warrendale, PennsylvaniaManufacturing and administration107,400
Mountain View, CaliforniaAdministration, marketing, and research and development99,900
Raleigh, North CarolinaAdministration, sales, marketing, and research and development65,700
Irlam, United KingdomAdministration, sales, marketing, and distribution center61,000
Milpitas, CaliforniaManufacturing46,300
Waukegan, IllinoisTechnical services, support, training, and repair center38,500
Fort Worth, TexasAdministration, sales, marketing, and research and development34,400
Plano, TexasAdministration, sales, marketing, and research and development23,500
Bochum, GermanyAdministration, sales, marketing, distribution, and manufacturing center11,00019,000
We also have smaller rented officesfacilities in Strongsville, Ohio; Austin, Texas; Houston, Texas; Grapevine, Texas; New York, New York; Maryland; Germany; France; Italy; the People’s Republic of China; the United Arab Emirates; Australia; and the United Kingdom.
We believe that these facilities are sufficient for our current operational needs and that suitable additional space will be available on commercially reasonable terms to accommodate expansion of our operations, if necessary.
For additional information regarding our obligations pursuant to operating leases, refer to Note 11,12, Lessee Leases, of the Notes to Consolidated Financial Statements in this annual report.Annual Report on Form 10-K.
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ITEM 3.    LEGAL PROCEEDINGS
Refer to the information set forth under “Legal Proceedings” in Note 12,13, Commitments and Contingencies, of the Notes to Consolidated Financial Statements included in this annual report.Annual Report on Form 10-K.
ITEM 4.    MINE SAFETY DISCLOSURES
Not applicable.
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PART II
ITEM 5.    MARKET FOR REGISTRANT’S COMMON EQUITY, RELATED STOCKHOLDER MATTERS, AND ISSUER PURCHASES OF EQUITY SECURITIES
Market for Our Common Stock
Our common stock is traded on the NASDAQ Global Select Market under the symbol “OMCL.”
Stockholders
There were 8378 registered stockholders of record as of December 31, 2019.February 18, 2022. A substantially greater number of stockholders are beneficial holders, whose shares of record are held by banks, brokers, and other financial institutions.
Dividend Policy
We have never declared or paid any cash dividends on our common stock. We currently expect to retain any future earnings for use in the operation and expansion of our business and do not anticipate paying any cash dividends on our common stock in the foreseeable future.
Performance Graph
The following graph compares total stockholder returns for Omnicell’s common stock for the past five years to three indexes: the NASDAQ Composite Index, the NASDAQ Health Care Index, and the NASDAQ Health Services Index. The graph assumes $100 was invested in each of Omnicell’s common stock, the NASDAQ Composite Index, the NASDAQ Health Care Index, and the NASDAQ Health Services Index as of the market close on December 31, 2014.2016. The total return for Omnicell’s common stock and for each index assumes the reinvestment of all dividends, although cash dividends have never been declared on Omnicell’s common stock, and is based on the returns of the component companies weighted according to their capitalization as of the end of each annual period.
The NASDAQ Composite Index tracks the aggregate price performance of equity securities traded on The NASDAQ Stock Market. The NASDAQ Health Care Index and NASDAQ Health Services Index tracks the aggregate price performance of health carehealthcare and health services equity securities. Omnicell’s common stock is traded on The NASDAQ Global Select Market and is a component of both indexes. The stock price performance shown on the graph is based on historical results and isshould not necessarily indicativebe relied upon as an indication of future price performance.
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COMPARISON OF 5 YEAR CUMULATIVE TOTAL RETURN (1) (2)
Among Omnicell, Inc., the NASDAQ Composite Index, the NASDAQ Health Care Index, and
the NASDAQ Health Services Index
omcl-20191231_g1.jpgomcl-20211231_g1.jpg

(1)$100 invested on December 31, 20142016 in stock or index, including reinvestment of dividends.
(2)This section is not deemed “soliciting material” or to be “filed” with the SEC and is not to be incorporated by reference into any filing of Omnicell, Inc. under the Securities Act or the Exchange Act, whether made before or after the date hereof and irrespective of any general incorporation language in any such filing.
Year Ended December 31,
201420152016201720182019Year Ended December 31,
201620172018201920202021
Omnicell, Inc. Omnicell, Inc. $100.00  $93.84  $102.36  $146.44  $184.90  $246.74  Omnicell, Inc. $100.00 $143.07 $180.65 $241.06 $354.04 $532.27 
NASDAQ CompositeNASDAQ Composite100.00  106.96  116.45  150.96  146.67  200.49  NASDAQ Composite100.00 129.64 125.96 172.17 249.51 304.85 
NASDAQ Health CareNASDAQ Health Care100.00  104.65  86.60  107.70  104.28  127.44  NASDAQ Health Care100.00 126.86 125.46 151.60 190.16 186.02 
NASDAQ Health ServicesNASDAQ Health Services100.00  107.35  86.83  109.24  123.53  160.42  NASDAQ Health Services100.00 116.65 140.03 190.67 307.73 218.38 
Stock Repurchase Program
We did not repurchase any shares of our common stock during 2019.the year ended December 31, 2021. Refer to Note 14,15, Stock Repurchase Program, of the Notes to Consolidated Financial Statements in this annual reportAnnual Report on Form 10-K for additional information.
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Equity Offerings
For the year ended December 31, 2019, we received gross proceeds of $38.5 million from sales of our common stock under our Distribution Agreement and incurred issuance costs of $0.7 million on sales of approximately 460,000 shares of our common stock at an average price of approximately $83.81 per share. Refer to Note 15,16, Equity Offerings, of the Notes to Consolidated Financial Statements in this annual reportAnnual Report on Form 10-K for additional information.
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ITEM 6.    SELECTED FINANCIAL DATA
The following selected consolidated financial data is derived from our Consolidated Financial Statements. This data should be read in conjunction with our Consolidated Financial Statements and related Notes included in this annual report and with Item 7, Management's Discussion and Analysis of Financial Condition and Results of Operations. Historical results may not be indicative of future results.
Year Ended December 31,
20192018
2017 (1) (4)
2016 (2) (4)
2015 (3)
(In thousands, except per share amounts)
Consolidated Statements of Operations Data
Total revenues$897,027  $787,309  $712,714  $695,908  $484,559  
Gross profit436,912  372,330  318,637  317,085  247,930  
Income from operations78,352  44,392  11,145  21,405  48,632  
Net income$61,338  $37,729  $30,518  $9,756  $30,760  
Net income per share:
Basic$1.48  $0.96  $0.81  $0.27  $0.86  
Diluted$1.43  $0.93  $0.79  $0.26  $0.84  
Shares Used in Per Share Calculations 
Basic41,462  39,242  37,483  36,156  35,857  
Diluted42,943  40,559  38,712  36,864  36,718  
[Reserved]
December 31,
20192018
2017 (1) (4)
2016 (2) (4)
2015 (3) (4)
(In thousands)
Consolidated Balance Sheet Data
Total assets$1,240,810  $1,081,242  $1,016,362  $966,884  $602,022  
Long-term debt, net50,000  135,417  194,917  245,731  —  
Total liabilities395,556  401,625  462,021  508,048  181,558  
Total stockholders’ equity$845,254  $679,617  $554,341  $458,836  $420,464  

(1) Includes InPharmics financial results as of April 2017, the acquisition date.
(2) Includes Aesynt and Ateb financial results as of the acquisition dates of January 2016 and December 2016, respectively.
(3) Includes Avantec and Mach4 financial results as of April 2015, the acquisition date.
(4) As adjusted for full retrospective adoption of Accounting Standards Codification 606, Revenue from Contracts with Customers.
ITEM 7.    MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The following discussion and analysis should be read in conjunction with our Consolidated Financial Statements and related Notes in this annual report.Annual Report on Form 10-K. This discussion may contain forward-looking statements based upon current expectations that involve risks and uncertainties. Our actual results and the timing of selected events could differ materially from those anticipated in these forward-looking statements as a result of several factors, including those set forth under Item 1A “Risk Factors” and elsewhere in this annual report.Annual Report on Form 10-K. Unless otherwise stated, references in this reportAnnual Report to particular years or quarters refer to our fiscal year and the associated quarters of those fiscal years.
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We have elected to omit discussion of the earliest of the three years covered by the Consolidated Financial Statements presented. Such omitted discussion can be found under Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, located in our annual reportAnnual Report on Form 10-K for the fiscal year ended December 31, 2018,2020, filed with the SEC on February 27, 2019,24, 2021, for reference to discussion of the fiscal year ended December 31, 2017,2019, the earliest of the three fiscal years presented.
OVERVIEW
Our Business
Omnicell, a leader in transforming the pharmacy care delivery model, is committed to elevating the role of pharmacy within healthcare and transforming medication management as an essential component of the pharmacy care delivery model. We are a leading provider of medication management automation solutionsdoing so with an industry-leading comprehensive intelligent infrastructure, bringing together technology, analytics, and adherence toolsexpert services to equip and empower pharmacists and pharmacies to focus on clinical care rather than administrative tasks. We believe this intelligent infrastructure provides the critical foundation for healthcare systems and pharmacies. As we build onrealizing the industry vision of the autonomousAutonomous Pharmacy, a vision defined by pharmacy - a more fully automatedleaders for improving operational efficiencies and digitized system ofultimately targeting zero-error medication management - we believe we will further help enable healthcare providers to improve patient safety, increase efficiency, lower costs, tighten regulatory compliance, and address population health challenges.management.
Over 6,000 facilitiesFacilities worldwide use our automation and analytics solutions to help increase operational efficiency, reduce medication errors, deliver actionable intelligence, and improve patient safety. More than 40,000 institutionalInstitutional and retail pharmacies across North America, and the United Kingdom, Germany, and Australia leverage our innovative medication adherence and population health solutions to improve patient engagement and adherence to prescriptions, helping to reduce costly hospital readmissions. We sell our product and consumable solutions together with related service offerings. Revenues generated in the United States represented 90% of our total revenues for the year ended December 31, 2019.2021.
Over the past several years, our business has expanded from a single-point solution to a platform of products and services that will help to further advance the industry vision of the autonomous pharmacy.Autonomous Pharmacy. This expansion has resulted in larger deal sizes across multiple products, services, and installationsimplementations for customers and, we believe, more comprehensive, valuable, and enduring relationships.
We utilize product bookings as an indicator of the success of our business. Product bookings generally consist of all firm orders other than for technical services and other less significant items, as evidenced generally by a non-cancelable contract and purchase order for equipment, and software products, and Advanced Services, and by a purchase order for consumables. EquipmentA majority of our connected devices and software license product bookings are generally installable within twelve months of booking, and other than sales based on subscription services, generallyare recorded as revenue upon customer receipts of goods or acceptance of the installation.installation or receipt of goods. Revenues from software-as-a-service (“SaaS”), subscription software, and technology-enabled services product bookings are recorded over the contractual term. Product bookings increased by 14%21%, from $716 million$1.002 billion in 20182020 to $813 million$1.217 billion in 2019,2021, driven by the success of our growth strategies in our comprehensive platform and differentiated products, as well as expanding our customer portfolio.
In addition to product solution sales, we provide services to our customers. We provide installation planning and consulting as part of most product sales which is generally included in the initial price of the solution. We also provide Advanced Services such as Omnicell One, EnlivenHealth, 340B solutions, Central Pharmacy Dispensing Services, and Central Pharmacy Compounding Services. To help assure the maximum availability of our systems, our customers typically purchase maintenance and support contracts in increments of one to five years. As a result of the growth of our installed base of customers and expanded service offerings, our service revenues have also grown.
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The following table summarizes each revenue category:
Revenue Category
Revenue Type (1)
Income Statement ClassificationIncluded in Product Bookings
Connected devices, software licenses, and other
High visibility/
Nonrecurring
Product
Yes (2)
Technical services
High visibility/
Recurring
ServiceNo
Consumables
High visibility/
Recurring
ProductYes
SaaS, subscription software, and technology-enabled services
High visibility/
Recurring
ServiceYes

(1)     All revenue types are highly visible from long-term, sole-source agreements, backlog, or the recurring nature of the revenue stream.
(2)     Freight revenue and certain other insignificant revenue streams are not included in product bookings.
Our full-time employee headcount of approximately 2,7003,800 on December 31, 2019,2021, an increase of approximately 220 from940 employees since December 31, 2018,2020, reflects our efforts to grow Omnicell’s operations, including through the impact of incremental headcount in connection with recent acquisitions, while continuing to drive profitability and optimize resourcesoptimizing resource allocation.
We have not in the past sold, and have no future plans to sell, our products either directly or indirectly, to customers located in countries that are identified as state sponsors of terrorism by the U.S. Department of State, or those subject to economic sanctions and export controls.
Operating Segments
We previously operated and reported our business in two segments: Automation and Analytics, and Medication Adherence. In an effort to deliver on the strategic vision of the autonomous pharmacy and address industry changes including the continuing consolidation of healthcare systems, rising pharmaceutical costs, and increased scrutiny on controlled substances, we initiated a company-wide organizational realignment in the fourth quarter of 2018 to centrally manage our business operations includingas a single segment for the developmentpurposes of assessing performance and marketingmaking operating decisions. Our Chief Operating Decision Maker (“CODM”) is our Chief Executive Officer. The CODM allocates resources and evaluates the performance of all ofOmnicell at the consolidated level using information about our products, salesrevenues, gross profit, income from operations, and distribution, supply chain and inventory management, as well as regulatory and quality functions. As a result of this organizational realignment, allother key financial data. All significant operating decisions are based upon an analysis of Omnicell as one operating segment. Therefore, effective January 1, 2019, we started reporting as only one operating segment, which is the same as theour reporting segment. Accordingly, prior period segment information has been revised to conform with current period presentation.
Business Strategy
We are committed to being the care provider’sproviders’ and retail pharmacies’ most trusted partner and executing on the industry vision of the autonomous pharmacyAutonomous Pharmacy by developing and delivering automation, intelligence,an intelligent medication management infrastructure composed of devices, digital workflows, analytics, and services designed to transformexperts, all powered by the pharmacy care delivery model, helping
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to dramatically improve outcomes and lower costs for our healthcare partners.cloud. We believe there are significant challenges facing the pharmacy practice today including, but not limited to, labor shortages, medication errors, drug shortages, medication loss due to drug diversion, significant medication waste and expiration costs, a high level of manual steps in the medication management process, complexity around compliance requirements, high pharmacy employee turnover rates affecting tenure and expertise, hospitalizations from adverse drug events in outpatient settings, high variability in outcomes, and limited inventory visibility. We believe that these significant challenges to the pharmacy practice drive the demand for increased digitization, visibility, and insights that our solutions enable, and represent large market opportunities in three productfour market categories:
Point of Care. As a market leader, we expect to continue expansion of this product category as customers increase use of our dispensing systems in more areas within their hospitals. In addition, weWe are early inmore than halfway through the replacement, upgrade, and expansion cycle of older models of automated dispensing systems with our XT Series automated dispensing systems within our own customer base, which we believe is a significant market opportunity and we expect to continue to focus on furtheropportunity. We have been successful penetrating markets through competitive conversion.conversions and expect this success to continue. We also believe there is an opportunity for us to define a new standard of care for dispensing systems in perioperative settings. We believe our current portfolio within the Point of Care market and new innovation and services will continue to drive improved outcomes and lower costs for our customers.
Central Pharmacy. This market represents the beginning of the medication management process in Acute Care Settings,acute care settings, and, we believe, the next big automation opportunity to replace high volumes of manual and repetitive processes whichthat are common in the pharmacypharmacies today. Manual processes are prone to significant errors, and products such as IVX Workflow, our IV sterile compounding solutionsSterile Compounding Service (including IV robotics), and our Central Pharmacy Dispensing Service (including the XR2 Automated Central Pharmacy systemSystem), automate these manual processes and are designed to reduce the risk of error for our healthcare partners. Because automation adoption in the Central Pharmacy is still nascent, we believe that the adoption of solutions will be accelerated by bundling those solutions with technology-enabled services that are designed to deliver specific outcomes and leverage intelligence across the enterprise for more actionable insights, and are expected to reduce administrative burden, allowing clinicians to operate at the top of their license. We think that these bundled solutions are becoming more
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critical than ever as health systems appear to face increasing labor shortages and supply chain disruption following the COVID-19 pandemic. Additionally, we believe new products, innovations and innovationour expertise in the Central Pharmacy market create opportunities to replace prior generation Central Pharmacy robotics, especially when combining those robotics with carousels and carousels.technology-enabled services to increase the percentage of medication managed through the intelligent infrastructure.
Specialty Pharmacy and 340B Program. We believe that health systems will invest in more revenue generating activities that improve patient outcomes, and pharmacy will be at the center with specialty pharmacies and the 340B Drug Pricing Program.
Studies have shown that specialty medications represent over 50% of the country’s total spending on retail, mail-order, and provider-administered drugs. Used for treatment of complex conditions, these medications often require intensive patient management and specialized workflows for dispensing and care coordination. Specialty pharmacies serve as the connection between patients, prescribing physicians, and payors to ensure streamlined access and adherence to these specialty drugs, helping to maintain continuity of care throughout the process, and are expected to improve margin and profitability for the health system. The Central Pharmacy also representsnewly acquired ReCept Holdings, Inc. (“ReCept”) solution provides implementation and managed services for health systems and other provider organizations to optimize their specialty pharmacy programs and the related pharmaceutical aspects of patient care.
The 340B market is targeted to covered entities participating in Section 340B of the Public Health Services Act. The Public Health Services Act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to healthcare organizations that care for many uninsured and low-income patients and creates a complex compliance environment. According to the Health Resources and Services Administration, which is responsible for administering the 340B program, enrolled hospitals and other covered entities can achieve an opportunityaverage savings of 25% to provide technology enabled services designed50% in pharmaceutical purchases. Due to reducethe complexities of adhering to the administrative burden onprocess of the pharmacy340B program, we believe that there are significant opportunities for health systems to improve participation benefits and allow clinicians to operate at the top of their license.maximize program savings through our 340B technology-enabled services.
Retail, Institutional, and Payer. We believe the Retail, Institutional, and Payer market represents a largesignificant opportunity as thehealthcare evolves. A majority of all prescription drugs are distributed in the non-acute sector. The COVID-19 pandemic accelerated the shift of primary healthcare settings from hospitals and doctors’ offices to other convenient channels like the home, digital, and retail pharmacies. New technology isand updated state board regulations are leading to innovation at traditional retail providers, which, combined with the move to value-based care, results, we believe will incentivize the market to adopt solutions to help providers and payers engage patients in new ways that lowerimprove patient care and reduce the total cost of care. We believe adoption of our Population Health SolutionsEnlivenHealth portfolio of software products and services, along with medication adherence packaging, will increase adherence performance rates, increase prescription volume for our customers, and reduce hospital and emergency room visits due to improved adherence. Our EnlivenHealth portfolio has been expanded with two recent acquisitions that will assist in adoption and drive innovation. RxInnovation Inc., operating as FDS Amplicare (“FDS Amplicare”), is a leading provider of financial management, analytics, and population health solutions to the retail pharmacy industry, including independent pharmacies. MarkeTouch Media, LLC (“MarkeTouch Media”) has longstanding pharmacy chain relationships that further broaden EnlivenHealth’s national pharmacy network.
We believe our technology, services, and solutions within these three productmarket categories position us well to address the needs of acute, post-acute, ambulatory, and retail acute,pharmacy providers and post-acutehealth plans.
COVID-19 Update
We continue to closely monitor the COVID-19 pandemic and ongoing impacts on the Company. During the first half of 2020, as a result of the COVID-19 pandemic, health systems faced financial and operational pressures which we believe led our customers to delay or defer purchasing decisions and/or implementation of our solutions. Beginning in the third quarter of 2020, we began to see our customers returning to pre-pandemic purchasing patterns consistent with long-term strategic investments and this trend continued through 2021. We believe that the challenges that our customers have faced during the COVID-19 pandemic, including the need for robust visibility throughout their pharmacy providers.supply chains, have increased the strategic relevance of our products and services.
Although COVID-19 vaccines are now available and being widely distributed, there remains significant uncertainty regarding the duration and severity of the continuing impact of the pandemic on the U.S. and world economies, including the impact of new variants of the COVID-19 virus. The ongoing impact of the COVID-19 pandemic on our business remains uncertain, and the duration and scope of such impact cannot currently be predicted. We continue to carefully monitor this
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dynamic situation and may adjust our outlook as appropriate. The ongoing impact of the COVID-19 pandemic may result in increased borrowing costs and other costs of capital or otherwise adversely affect our business, results of operations, financial condition, and liquidity. However, under current circumstances, we believe that our financial position and resources will allow us to manage the anticipated impact of the COVID-19 pandemic on our business for the foreseeable future.
Acquisitions
On April 12, 2017,December 31, 2021, we completed the acquisition of InPharmics,MarkeTouch Media pursuant to the terms and conditions of the Unit Purchase Agreement, dated December 31, 2021, by and among ateb, Inc. (a wholly-owned subsidiary of the Company), MarkeTouch Media, LLC, MarkeTouch Holdings, Inc., Toucan Enterprises, Inc., and certain beneficial stockholders specified therein for a base purchase price of $82.0 million, prior to customary adjustments for closing cash, net working capital, and assumed indebtedness. The MarkeTouch Media acquisition adds mobile and web-based technology and services company that provides advancedpatient engagement solutions, which is expected to expand the footprint of EnlivenHealth across the retail pharmacy informatics solutions to hospital pharmacies. The purchase price consideration was $5.0 million, net of cash acquired of $0.3 million.sector, while enhancing potential growth opportunities in new market segments like specialty pharmacy and pharmacy benefits management. The results of InPharmics’the operations of MarkeTouch Media have been included in our consolidated results of operations beginning April 13, 2017.December 31, 2021.
On December 29, 2021, we completed the acquisition of ReCept pursuant to the terms and conditions of the Agreement and Plan of Merger, dated December 1, 2021, by and among Omnicell, Inc., ReCept Holdings, Inc., Redfish Acquisition Corp, and the representative of the securityholders for a base purchase price of $100.0 million, prior to customary adjustments for closing cash, net working capital, and assumed indebtedness. The addition of ReCept’s specialty pharmacy management services for health systems, provider groups, and federally qualified health centers expands Omnicell’s Advanced Services portfolio in an effort to address the growing and complex specialty pharmacy market. The results of the operations of ReCept have been included in our consolidated results of operations beginning December 29, 2021.
On September 9, 2021, we completed the acquisition of FDS Amplicare pursuant to the terms and conditions of the Agreement and Plan of Merger, dated July 25, 2021, by and among RxInnovation Inc., Omnicell, Inc., Fleming Acquisition Corp., and the representative of the securityholders for a base purchase price of $177.0 million, prior to customary adjustments for closing cash, net working capital, and assumed indebtedness. The FDS Amplicare acquisition adds a comprehensive and complementary suite of SaaS financial management, analytics, and population health solutions to our EnlivenHealth offering. The results of the operations of FDS Amplicare have been included in our consolidated results of operations beginning September 9, 2021.
On October 1, 2020, we completed the acquisition of the 340B Link business (the “340B Link Business”) of Pharmaceutical Strategies Group, LLC pursuant to the terms and conditions of the Equity Purchase Agreement, dated August 11, 2020, as amended, by and among the Company, PSGH, LLC, BW Apothecary Holdings, LLC, the sellers identified therein and the sellers’ representative for total cash consideration of $225.0 million. The acquisition adds a comprehensive and differentiated suite of software-enabled services and solutions used by certain eligible hospitals, health systems, clinics, and entities to manage compliance and capture 340B drug cost savings on outpatient prescriptions filled through the eligible entity’s pharmacy or a contracted pharmacy partner. The results of the operations of the 340B Link Business have been included in our consolidated results of operations beginning October 1, 2020.
CRITICAL ACCOUNTING POLICIES AND ESTIMATES
Our discussion and analysis of our financial condition and results of operations are based on our Consolidated Financial Statements, which have been prepared in accordance with U.S. Generally Accepted Accounting Principles (“GAAP”). The preparation of these financial statements requires us to make certain estimates and assumptions that affect the reported amounts of assets and liabilities, disclosure of any contingent assets and liabilities at the date of the financial statements, and the reported amounts of revenues and expenses during the reporting periods. We regularly review our estimates and assumptions, which are based on historical experience and various other factors that are believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of certain assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates and assumptions. We believe the following critical accounting policies are affected by significant judgments and estimates used in the preparation of our Consolidated Financial Statements:
Revenue Recognition
We earn revenues from sales of our products and related services, which are sold in the healthcare industry, our principal market. The transaction price of each contract with a customer is allocated to the identified performance obligations based on the relative fair value of each obligation. Our customer arrangements typically include one or more of the following performance obligations:
Products. Software-enabled equipment that manages and regulates the storage and dispensing of pharmaceuticals, consumable blister cards and packaging equipment and other medical supplies.
Software. Additional software applications that enable incremental functionality of our equipment or services.
Installation. Installation of equipment as integrated systems at customer sites.
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Post-installation technical support. Phone support, on-site service, parts, and access to unspecified software updates and enhancements, if and when available.
Professional services. Other customer services, such as training and consulting.
Prior to recognizing revenue, we identify the contract, performance obligations, and transaction price, and allocate the transaction price to the performance obligations. All identified contracts meet the following required criteria:
Parties to the contract have approved the contract (in writing, orally, or in accordance with other customary business practices) and are committed to perform their respective obligations. A majority of our contracts are evidenced by a non-cancelable written agreement. Contracts for consumable products are generally evidenced by an order placed via phone or a manual purchase order.
Entity can identify each party’s rights regarding the goods or services to be transferred. Contract terms are documented within the written agreements. Where a written contract does not exist, such as for consumable products, the rights of each party are understood as following our standard business process and terms.
The entity can identify the payment terms for the goods or services to be transferred. Payment terms are documented within the agreement and are generally net 30 to 60 days from shipment of tangible product or services performed for customers in the United States. Where a written contract does not exist, our standard payment terms are net 30 day terms.
The contract has commercial substance (that is the risk, timing, or amount of the entity’s future cash flows is expected to change as a result of the contract.)contract). Our agreements are an exchange of cash for a combination of products and services which result in changes in the amount of our future cash flows.
It is probable the entity will collect the consideration to which it will be entitled in exchange for the goods or services that will be transferred to the customer. We perform a credit check for all significant customers or transactions and where collectability is not probable, payment in full or a substantial down payment prior to shipment is typically required to help assure the full agreed upon contract price will be collected.
We often enter into change orders which modify the product to be received by the customer pursuant to certain contracts. Changes to any contract are accounted for as a modification of the existing contract to the extent the goods and services to be delivered as part of the contract are generally consistent with the nature and type of those to be provided under the terms of the original contract. Examples of such change orders include the addition or removal of units of equipment or changes to the configuration of the equipment where the overall nature of the contract remains intact. Our change orders generally result in the change being accounted for as modifications of existing contracts given the nature of the impacted orders.
Distinct goods or services are identified as performance obligations. A series of distinct goods or services that are substantially the same and that have the same pattern of transfer to the customer are considered a single performance obligation. Where a good or service is determined not to be distinct, we combine the good or service with other promised goods or services until a bundle of goods or services that is distinct is identified. To identify our performance obligations, we consider all of the products or services promised in the contract regardless of whether they are explicitly stated or are implied by customary business practices. When performance obligations are included in separate contracts, we consider an entire customer arrangement to determine if separate contracts should be considered combined for the purposes of revenue recognition. Most of our sales, other than renewals of support and maintenance, contain multiple performance obligations, with a combination of hardware systems, consumables and software products, consumables, support and maintenance, and professional services.
The transaction price of a contract is determined based on the fixed consideration, net of an estimate for variable consideration such as various discounts or rebates provided to customers. As a result of our commercial selling practices, contract prices are generally fixed with minimal, if any, variable consideration.
The transaction price is allocated to separate performance obligations proportionally based on the standalone selling price of each performance obligation. Standalone selling price is best evidenced by the price we charge for the good or service when selling it separately in similar circumstances to similar customers. Other than for the renewal of annual support services contracts, our products and services are not generally sold separately. We use an amount discounted from the list price as a best estimated selling price.
We recognize revenue when the performance obligation has been satisfied by transferring a promised good or service to a customer. The good or service is transferred when or as the customer obtains control of the good or service. Determining when control transfers requires management to make judgments that affect the timing of revenues recognized. Generally, for products requiring a complex implementation, control passes when the product is installed and ready for use. For all other products, control generally passes when product has been shipped and title has passed. For maintenance contracts and certain
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other services, including SaaS, subscription software, and technology-enabled services, provided on a subscription basis, control passes to the customer over time, generally ratably over the service term as we provide a stand-ready service to servicefor the customer’s equipment. Time and material services transfer control to the customer at the time the services are provided. The portion of the transaction price allocated to our unsatisfied performance obligations are recorded as deferred revenues.
Revenues, contract assets, and contract liabilities are recorded net of associated taxes.
We generally invoice customers for products upon shipment. Invoicing associated withFrom time to time, we enter into change orders which modify the service portion of agreements are generally periodic and are billed on a monthly, quarterly, or annual basis. In certain circumstances, multiple years are billed at one time.
The amount invoiced for equipment and software is typically reflected in both accounts receivable and deferred revenues, net. We typically recognize product revenue, and correspondingly reduce deferred revenues, net, for equipment and software upon written customer acceptance of installation. Consumables are recorded as revenue upon shipment to or receiptbe received by the customer depending uponpursuant to certain contracts. Changes to any contract terms. The portionare accounted for as a modification of deferred revenues, net, not expectedthe existing contract to the extent the goods and services to be recognizeddelivered as revenue within twelve monthspart of the balance sheet datecontract are includedgenerally consistent with the nature and type of those to be provided under the terms of the original contract. Examples of such change orders include the addition or removal of units of equipment
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or changes to the configuration of the equipment where the overall nature of the contract remains intact. Our change orders generally result in long-term deferred revenues on the Consolidated Balance Sheets.change being accounted for as modifications of existing contracts given the nature of the impacted orders.
In the normal course of business, we typically do not accept product returns unless the item is defective as manufactured or the configuration of the product is incorrect. We establish provisions for estimated returns based on historical product returns. The allowance for sales returns is not material to our Consolidated Financial Statements for any periods presented.
Contract Assets and Contract Liabilities
A contract asset is a right to consideration in exchange for goods or services that we have transferred to a customer when that right is conditional and is not just subject to the passage of time. A receivable will be recorded on the balance sheet when we have unconditional rights to consideration. A contract liability is an obligation to transfer goods or services for which we have received consideration, or for which an amount of consideration is due from the customer. Contract liabilities include customer deposits under non-cancelable contracts, and current and non-current deferred revenue balances. Our contract balances are reported in a net contract asset or liability position on a contract-by-contract basis at the end of each reporting period.
Contract Costs
We have determined that the incentive portions of our sales commission plans require capitalization since these payments are directly related to sales achieved during a time period. These commissions are earned on the basis of the total purchase order value of new product bookings. Since there are no commensurate commissions earned on renewal of the service bookings, we concluded that the capitalized asset is related to services provided under both the initial contract and renewal periods. We apply a practical expedient to account for the incremental costs of obtaining a contract as part of a portfolio of contracts with similar characteristics as we expect the effect on the financial statements of applying the practical expedient would not differ materially from applying the accounting guidance to the individual contracts within the portfolio. A pool of contracts is defined as all contracts booked in a particular quarter. The amortization for the capitalized asset is an estimate of the pool’s original contract term, generally one to five years, plus an estimate of future customer renewal periods resulting in a total amortization period of ten years. Costs to obtain a contract are allocated amongst performance obligations and recognized as sales and marketing expense consistent with the pattern of revenue recognition. Capitalized costs are periodically reviewed for impairment. A portion of the pool’s capitalized asset is recorded as an expense over the first two quarters after booking, which represents the estimated period during which the product revenue associated with the contract is recorded. The remaining contract cost is recorded as expense ratably over the ten year estimated initial and renewal service periods. The commission expenses paid or due to be paid as of the consolidated balance sheet date to be recognized in future periods are recorded in long-term prepaid commissions on the Consolidated Balance Sheets.
Lessor Leases
We determine if an arrangement is a lease at inception. The transaction price is allocated to separate performance obligations, generally consisting of a combination of hardware andsystems, software products, installation,support and post-installation technical support,maintenance, and professional services, proportionally based on the standalone selling price of each performance obligation. Standalone selling price is best evidenced by the price we charge for the good or service when selling it separately in similar circumstances to similar customers. Other than for the renewal of annual support services contracts, our products and services are not generally sold separately. We use an amount discounted from the list price as a best estimated selling price.
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Sales-Type Leases
We enter into non-cancelable sales-type lease arrangements, most of which do not have an option to extend the lease term. At the end of the lease term, the customer must either return the equipment or negotiate a new agreement, resulting in a new purchase or lease transaction. Failure of the customer to either return the equipment or negotiate a new agreement results in the contract becoming a month-to-month rental. Certain sales-type leases automatically renew for successive one yearone-year periods at the end of each lease term withwithout written notice from the customer. Our sales-type lease agreements do not contain any material residual value guarantees.
For sales-type leases, we recognize revenues for our hardware and software products, net of lease execution costs, post-installation product maintenance, and technical support, at the net present value of the lease payment stream upon customer acceptance. We recognize service revenues associated with sales-type leases ratably over the term of the agreement in service revenues in the Consolidated Statements of Operations. We recognize interest income from sales-type leases using the effective interest method. Both hardware and software revenues, and interest income from sales-types leases are recorded in product revenues in the Consolidated Statements of Operations.
We optimize cash flows by selling a majority of our non-U.S. government sales-type leases to third-party leasing finance companies on a non-recourse basis. We have no obligation to the leasing company once the lease has been sold. Some of our sales-type leases, mostly those relating to U.S. government hospitals, are retained in-house.
Operating LeasesAllowance for Credit Losses
We entered into certain leasing agreements that were classified as operating leases priorare exposed to the adoption of the new lease accounting standard. Those agreements in place prior to January 1, 2019 will continue to be treated as operating leases, however, any new leasing agreements entered into on or after January 1, 2019 under these programs are classified and accounted for as sales-type leases in accordance with the new lease accounting standard. The operating lease arrangements entered into prior to January 1, 2019 are non-cancelable, and most automatically renew for successive one year periods at the end of each lease term absent written notice from the customer.
For operating leases, rental income is generally recognized on a straight-line basis over the term of the associated lease, and recorded in services and other revenues in the Consolidated Statements of Operations. Leased assets under operating leases are carried at amortized cost net of accumulated depreciation in property and equipment, net on the Consolidated Balance Sheets. The depreciation expense of the leased assets is recognized on a straight-line basis over the contractual term of the associated lease, and recorded in cost of revenues in the Consolidated Statements of Operations.
Allowance for Doubtful Accounts and Notes Receivables from Investment in Sales-Type Leases
We maintain an allowance for doubtful accounts for estimatedcredit losses resulting from the inabilityprimarily through sales of our customers to make required payments. We record a specific allowance based on an analysis of individual past-due balances. Additionally, based on historical write-offsproducts and services, as well as our collection experience, we record an additional allowance based on a percentage of outstanding receivables.sales-type leasing arrangements. We perform credit evaluations of our customers’ financial condition.condition in order to assess each customer’s ability to pay. These evaluations require significant judgment and are based on a variety of factors including, but not limited to, current economic trends, payment history, and a financial review of the customer. We continue to monitor customers’ creditworthiness on an ongoing basis.
We maintain an allowance for credit losses for accounts receivable, unbilled receivables, and net investment in sales-type leases based on expected credit losses resulting from the inability of our customers to make required payments. The allowance for credit losses is measured using a loss rate method, considering factors such as customers’ credit risk, historical loss experience, current conditions, and forecasts. The allowance for credit losses is measured on a collective (pool) basis by aggregating customer balances with similar risk characteristics. We also record a specific allowance based on an analysis of individual past due balances or customer-specific information, such as a decline in creditworthiness or bankruptcy. Actual collection losses may differ from management’s estimates, and such differences could be material to our financial position and results of operations.
The retained in-house leases discussed above are considered financing receivables. Our credit policies and our evaluation of credit risk and write-off policies are applied alike to trade receivables and the net investment in sales-type leases. For both, an account is generally past due after thirty days. The financing receivables also have customer-specific reserves for accounts identified for specific impairment and a non-specific reserve applied to the remaining population, based on factors such as current trends, the length of time the receivables are past due and historical collection experience. The retained in-house leases are not stratified by portfolio or class.
Inventory
Inventories are stated at the lower of cost, computed using the first-in, first-out method, and net realizable value. Inbound shipping costs are included in cost of inventory. We regularly monitor inventory quantities on hand and record write-downs for excess and obsolete inventories based on our estimate of demand for our products, potential obsolescence of technology, product life cycles, and whether pricing trends or forecasts indicate that the carrying value of inventory exceeds its estimated selling price. These factors are impacted by market and economic conditions, technology changes, and new product introductions and require estimates that may include elements that are uncertain. Actual demand may differ from forecasted demand and may have a material effect on gross margins. If inventory is written down, a new cost basis is established that
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cannot be increased in future periods. Shipments from suppliers or contract manufacturers before we receive them are recorded as in-transit inventory when title and the significant risks and rewards of ownership have passed to us.
Software Development Costs
We capitalize certain software development costs in accordance with Accounting Standards Codification (“ASC”) 985-20, Costs of Software to Be Sold, Leased, or Marketed, under which certain software developmentthose costs incurred subsequent to the establishment of technological feasibility may be capitalized and amortized over the estimated lives of the related products. We establish technological feasibility when we complete a detail program design or a working model. We amortize development costs over the estimated lives of the related products, ranging from three towhich is generally five years. All development costs prior to the completion of a detail program design or a working model are recognized as research and development expense.
Lessee Leases
We determine if an arrangement is a lease at inception. Operating lease right-of-use assets and liabilities are recognized at the commencement date based on the present value of lease payments over the lease term. As most of our lease contracts do not provide an implicit rate, we use our incremental borrowing rate based on information available at the commencement date in determining the present value of the lease payments. Lease expense is recognized on a straight-line basis over the lease term. We do not recognize a right-of-use asset and a lease liability for leases with an initial term of twelve months or less. We elected the practical expedient to not separate lease components from nonlease components and applied that practical expedient to all material classes of leased assets.
Many of our operating leases include an option to extend the lease. The specific terms and conditions of the extension options vary from lease to lease, but are consistent with standard industry practices in each area that we operate. We review each of our lease options at a time required by the terms of the lease contract, and notify the lessor if we choose to exercise the lease renewal option. Until we are reasonably certain that we will extend the lease contract, the renewal option periods will not be recognized as right-of-use assets or lease liabilities.
Certain leases include provisions for early termination, which allow the contract parties to terminate their obligations under the lease contract. The terms and conditions of the termination options vary by contract. When we have made a decision to exercise an early termination option, the right-of-use assets and associated lease liabilities are remeasured in accordance with the present value of the remaining cash flows under the lease contract.
Certain building lease agreements include rental payments subject to change annually based on fluctuations in various indexes (i.e.(i.e. Consumer Price Index (“CPI”), Retail Price Index, and other international indexes). Certain data center lease agreements include rental payments subject to change based on usage and CPI fluctuations. The changes based on usage and indexes are treated as variable lease costs and recognized in the period in which the obligation for those payments was incurred. 
Business Combinations
We use the acquisition method of accounting under ASC 805, Business Combinations. Each acquired company’s operating results are included in our Consolidated Financial Statements starting on the acquisition date. The purchase price is equivalent to the fair value of consideration transferred. Tangible and identifiable intangible assets acquired and liabilities assumed as of the acquisition date are recorded at the acquisition date fair value. Goodwill is recognized for the excess of purchase price over the net fair value of assets acquired and liabilities assumed.
Amounts allocated to assets and liabilities are based upon fair values. Such valuations require management to make significant estimates and assumptions, especially with respect to the identifiable intangible assets. Management makes estimates of fair value based upon assumptions believed to be reasonable and that of a market participant. These estimates are based on available historical information as well as future expectations, and the estimates are inherently uncertain. The separately identifiable intangible assets generally include customer relationships, acquired technology, backlog, trade names, and non-compete agreements.
Goodwill and Acquired Intangible Assets
Goodwill
We review goodwill for impairment on an annual basis on the first day of the fourth quarter of each year at the reporting unit level. This assessment is also performed whenever there is a change in circumstances that indicates the carrying value of goodwill may be impaired. We have one reporting unit, which is the same as our operating segment. A qualitative assessment is initially made to determine whether it is necessary to perform quantitative testing. A qualitative assessment includes, among others, consideration of: (i) past, current, and projected future earnings and equity; (ii) recent trends and
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market conditions; and (iii) valuation metrics involving similar companies that are publicly-traded and acquisitions of similar companies, if available. If this qualitative assessment indicates that it is more likely than not that impairment exists, or if we decide to bypass this option, we proceed to the quantitative assessment. The quantitative assessment involves a comparison between the estimated fair value of our reporting unit with its carrying amount including goodwill. If the carrying value exceeds estimated fair value, we will record an impairment charge based on that difference. The impairment charge will be limited to the amount of goodwill.
To determine the reporting unit’s fair value under the quantitative approach, we use a combination of income and market approaches, equally weighting the two approaches, such as estimated discounted future cash flows of the reporting unit, multiples of earnings or revenues, and analysis of recent sales or offerings of comparable entities. We also consider our market capitalization on the date of the analysis to ensure the reasonableness of our reporting unit'sunit’s fair value.
Intangible Assets
In connection with our acquisitions, we generally recognize assets for customer relationships, acquired technology, backlog, developed technology,trade names, and trade names.non-compete agreements. Intangible assets are carried at cost less accumulated amortization. Such amortization is provided on a straight-line basis or on an accelerated basis based on a pattern of economic benefit that is expected to be obtained over the estimated useful lives of the respective assets, generally from one to 30 years.assets. Amortization for developedacquired technology and
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backlog is recognized in cost of revenues, and amortization for customer relationships, trade names, non-compete agreements, trade names, and patents is recognized in selling, general, and administrative expenses.
We assess the impairment of identifiable intangible assets whenever events or changes in circumstances indicate that an asset’s carrying amount may not be recoverable. Recoverability of an asset is measured by the comparison of the carrying amount to the sum of the undiscounted estimated future cash flows the asset is expected to generate, offset by estimated future costs to dispose of the product to which the asset relates. If an asset is considered to be impaired, the amount of such impairment would be measured as the difference between the carrying amount of the asset and its fair value. Our cash flow assumptions are based on historical and forecasted future revenue, operating costs, and other relevant factors. Assumptions and estimates about the remaining useful lives of our intangible assets are subjective and are affected by changes to our business strategies. If management’s estimates of future operating results change, or if there are changes to other assumptions, the estimate of the fair value of our assets could change significantly. Such change could result in impairment charges in future periods, which could have a significant impact on our operating results and financial condition.
Convertible Debt
We account for convertible debt and related transactions in accordance with ASC 470-20, Debt with Conversion and Other Options, ASC 815, Derivatives and Hedging, and ASC 480, Distinguishing Liabilities from Equity. We evaluate convertible debt instruments and related transactions at inception to determine if those contracts or embedded components of those contracts qualify as derivatives to be separately accounted for. Convertible debt instruments that may be settled in cash are separated into liability and equity components. The allocation to the liability component is based on the fair value of a similar instrument that does not contain an equity conversion option. Based on this debt-to-equity ratio, debt issuance costs are then allocated to the liability and equity components in a similar manner. The difference between the principal amount of the convertible debt instruments and the liability component, inclusive of issuance costs, represents the debt discount, which is amortized to interest expense over the term of instruments. The determination of the discount rate requires certain estimates and assumptions.
Convertible note hedge and warrant transactions associated with convertible debt instruments are accounted for as equity instruments, and are recorded in additional paid-in capital in the Consolidated Balance Sheets.
Valuation of Share-Based Compensation
We account for share-based compensation in accordance with ASC 718, Stock Compensation. We recognize compensation expense related to share-based compensation based on the grant date estimated fair value.
The fair value of stock options (“options”) on the grant date is estimated using the Black-Scholes option pricing model, which requires the following inputs: expected life, expected volatility, risk-free interest rate, expected dividend yield rate, exercise price, and closing price of our common stock on the date of grant. The expected volatility is based on a combination of historical and market-based implied volatility, and the expected life of the awards is based on our historical experience of employee stock option exercises, including forfeitures. Expense is recognized on a straight-line basis over the requisite service period.
The fair value of restricted stock units (“RSUs”) is based on the stock price on the grant date. The fair value of restricted stock awards (“RSAs”) is their intrinsic value, which is the difference between the fair value of the underlying stock
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at the measurement date and the purchase price. The RSUs and RSAs are subject to a service vesting condition and are recognized on a straight-line basis over the requisite service period.
The fair value of performance-based stock unit awards (“PSUs”) with service and market conditions is estimated using a Monte Carlo simulation model applying a multiple awards approach. Expense is recognized when it is probable that the performance condition will be met using the accelerated attribution method over the requisite service period.
Forfeiture rates are estimated based on our historical experience with equity awards that were granted and forfeited prior to vesting. The valuation assumptions used in estimating the fair value of employee share-based awards may change in future periods.
Accounting for Income Taxes
We record an income tax provision for (benefit from) the anticipated tax consequences of the reported results of operations. In accordance with U.S. GAAP,ASC 740, Income Taxes, the provision for (benefit from) income taxes is computed using the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the financial statements. Under this method, deferred tax assets and liabilities are determined on the basis of the differences between the financial statement and tax bases of assets and liabilities, and for operating losses and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates in effect for the periods in which those tax assets and liabilities are expected to be realized or settled. In the event that these tax rates change, we will incur a benefit or detriment on our income tax expense in the period of change. If we were to determine that all or part of the net deferred tax assets are not realizable in the future, we will record a valuation allowance that would be charged to earnings in the period such determination is made.
In accordance with ASC 740,Income Taxes, we recognize the tax benefit from an uncertain tax position if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the financial statements from such positions are then measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. The calculation of tax liabilities involves significant judgment in estimating the impact of uncertainties in the application of U.S. GAAPASC 740 and complex tax laws. Resolution of these uncertainties in a manner inconsistent with management’s expectations could have a material impact on our financial condition and operating results.
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Recently Issued Authoritative Guidance
Refer to Note 1, Organization and Summary of Significant Accounting Policies, of the Notes to Consolidated Financial Statements in this annual reportAnnual Report on Form 10-K for a description of recently issued accounting pronouncements, including the expected dates of adoption and estimated effects on our results of operations, financial position, and cash flows.
RESULTS OF OPERATIONS
Total Revenues
Year Ended December 31,Change inYear Ended December 31,Change in
20192018$%20212020$%
(Dollars in thousands)(Dollars in thousands)
Product revenuesProduct revenues$659,602  $569,595  $90,007  16%  Product revenues$812,512 $636,031 $176,481 28%
Percentage of total revenuesPercentage of total revenues74%  72%  Percentage of total revenues72%71%
Services and other revenuesServices and other revenues237,425  217,714  19,711  9%  Services and other revenues319,506 256,177 63,329 25%
Percentage of total revenuesPercentage of total revenues26%  28%  Percentage of total revenues28%29%
Total revenuesTotal revenues$897,027  $787,309  $109,718  14%  Total revenues$1,132,018 $892,208 $239,810 27%
Product revenues represented 74%72% and 72%71% of total revenues for the years ended December 31, 20192021 and 2018,2020, respectively. Product revenues increased by $90.0$176.5 million, drivendue to increased customer demand, primarily by the growth of XT Serieswithin our automated dispensing systems and to a lesser extent the growth of XR2 Automated Central Pharmacy system, partially offset by a decrease in revenues of Performance Center primarily due to a large installation duringbusiness. In comparison, results for the year ended December 31, 2018.2020 were impacted by the COVID-19 pandemic as health systems were focusing resources on COVID-19 essential activities.
Services and other revenues represented 26%28% and 28%29% of total revenues for the years ended December 31, 20192021 and 2018,2020, respectively. Services and other revenues include revenues from servicetechnical services; SaaS, subscription software, and maintenance contracts,technology-enabled services; and rentals of automation systems.other services. Services and other revenues increased by $19.7$63.3 million, primarily due to an increaseincremental revenues of $48.8 million from the recent acquisitions of the 340B Link Business and FDS Amplicare, as well as continued growth in our installed customer base as well as an increase in revenues from Population Health Solutions, Performance Center, and subscription-based leasing arrangements for robotic equipment.our expanded portfolio of services and solutions.
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Our international sales represented 10% and 13%11% of total revenues for the years ended December 31, 20192021 and 2018, respectively. We expect our international sales2020, respectively, and are expected to be affected by foreign currency exchange rate fluctuations. We are unable to predict the extent to which revenues in future periods will be impacted by changes in foreign currency exchange rates.
Our ability to continue to grow revenues is dependent on our ability to continue to obtain orders from customers, our ability to produce quality products and consumables to fulfill customer demand, the volume of installations we are able to complete, our ability to meet customer needs by providing a quality installation experience, our ability to develop new or enhance existing solutions, and our flexibility in manpowerworkforce allocations among customers to complete installations on a timely basis. The timing of our product revenues for equipment is primarily dependent on when our customers’ schedules allow for installations.
Cost of Revenues and Gross Profit
Cost of revenues is primarily comprised of three general categories: (i) standard product costs which accountsaccount for the majority of the product cost of revenues that are provided to customers, and are inclusive of purchased material, labor to build the product, and overhead costs associated with production; (ii) costs of providing services and installation costs, as we install our equipment at the customer site and includeincluding costs of the field installation personnel including labor, travel expense, and other expenses; and (iii) other costs, including variances in standard costs and overhead, scrap costs, rework, warranty, provisions for excess and obsolete inventory, and amortization of software development costs and intangibles.
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Year Ended December 31,Change inYear Ended December 31,Change in
20192018$%20212020$%
(Dollars in thousands)(Dollars in thousands)
Cost of revenues:Cost of revenues:Cost of revenues:
Cost of product revenuesCost of product revenues$344,914  $312,360  $32,554  10%  Cost of product revenues$422,855 $354,004 $68,851 19%
As a percentage of related revenuesAs a percentage of related revenues52%  55%  As a percentage of related revenues52%56%
Cost of services and other revenuesCost of services and other revenues115,201  102,619  12,582  12%  Cost of services and other revenues154,510 124,912 29,598 24%
As a percentage of related revenuesAs a percentage of related revenues49%  47%  As a percentage of related revenues48%49%
Total cost of revenuesTotal cost of revenues$460,115  $414,979  $45,136  11%  Total cost of revenues$577,365 $478,916 $98,449 21%
As a percentage of total revenuesAs a percentage of total revenues51%  53%  As a percentage of total revenues51%54%
Gross profitGross profit$436,912  $372,330  $64,582  17%  Gross profit$554,653 $413,292 $141,361 34%
Gross marginGross margin49%  47%  Gross margin49%46%
Cost of revenues for the year ended December 31, 20192021 compared to the year ended December 31, 20182020 increased by $45.1$98.4 million, of which $32.6$68.9 million was attributed to the increase in cost of product revenues and $12.6$29.6 million was attributed to the increase in cost of services and other revenues.
The increase in cost of product revenues was primarily driven by the increase in product revenues of $90.0$176.5 million for the year ended December 31, 20192021 compared to the year ended December 31, 2018,2020, as well as increased inventory-related costs due to inflationary impacts during the second half of 2021. The increase was partially offset by salesthe benefits associated with economies of product portfolios withscale due to higher marginsvolumes during the year ended December 31, 2021 compared to the year ended December 31, 2020, as well as lower costs associated with the XT Series manufacturing ramp up and economiesa reduction of scale. employee-related expenses for restructuring initiatives.
The increase in cost of services and other revenues was primarily driven by the increase in services and other revenues of $19.7$63.3 million, including incremental revenues from the recent acquisitions of the 340B Link Business and FDS Amplicare, for the year ended December 31, 20192021 compared to the year ended December 31, 2018,2020, as well as product mix with lower margins andadditional investments in our service business to support new products.service solutions.
The overall increase in gross margin primarily relates to lower costshigher revenues for the year ended December 31, 2021 due to increased customer demand, benefits associated with the XT Series manufacturing ramp up and economies of scale.scale due to higher volumes, as well as the reduction of employee-related expenses for restructuring initiatives. Gross margins during the year ended December 31, 2020 were impacted by the COVID-19 pandemic. Our gross profit for the year ended December 31, 20192021 was $436.9$554.7 million, as compared to $372.3$413.3 million for the year ended December 31, 2018.2020.
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Operating Expenses and Interest and Other Income (Expense), Net
Year Ended December 31,Change inYear Ended December 31,Change in
20192018$%20212020$%
(Dollars in thousands)(Dollars in thousands)
Operating expenses:Operating expenses:Operating expenses:
Research and developmentResearch and development$68,644  $64,843  $3,801  6%  Research and development$75,716 $70,161 $5,555 8%
As a percentage of total revenuesAs a percentage of total revenues8%  8%  As a percentage of total revenues7%8%
Selling, general, and administrativeSelling, general, and administrative289,916  263,095  26,821  10%  Selling, general, and administrative389,430 307,605 81,825 27%
As a percentage of total revenuesAs a percentage of total revenues32%  33%  As a percentage of total revenues34%34%
Total operating expensesTotal operating expenses$358,560  $327,938  $30,622  9%  Total operating expenses$465,146 $377,766 $87,380 23%
As a percentage of total revenuesAs a percentage of total revenues40%  42%  As a percentage of total revenues41%42%
Interest and other income (expense), netInterest and other income (expense), net$(4,419) $(8,776) $4,357  (50)% Interest and other income (expense), net$(23,500)$(6,177)$(17,323)280%
Research and Development. Research and development expenses increased by $3.8$5.6 million for the year ended December 31, 20192021 compared to the year ended December 31, 2018.2020. The increase was primarily attributed to increasesan increase in consultingemployee-related expenses and higherof approximately $12.6 million due to increased headcount into support the research andcontinued development function,of our intelligent infrastructure, as well as due to incremental headcount from recent acquisitions. This increase is partially offset by higher capitalized software. The increased spend is a resultreduction of our continued investments into automation, intelligence, and$3.6 million in employee-related expenses for restructuring initiatives, as well as various decreases due to the cloud data platform.timing of projects.
Selling, General, and Administrative. Selling, general, and administrative expenses increased $26.8by $81.8 million for the year ended December 31, 20192021 compared to the year ended December 31, 2018, due to overall growth of operations and increase in overall headcount.2020. The increase iswas primarily due to an increase of $11.8approximately $50.4 million in employee-related expenses primarily related to increased headcount, including the incremental headcount from recent acquisitions, as well as an increase in acquisition-related expenses of $5.5$5.1 million, in consulting expenses, and an increase in intangible asset amortization expense of $3.3 million in commissions expense primarily related to increased bookings.$4.3 million. The increase iswas also driven by out-of-period adjustmentsan increase in shipping and handling costs, as well as higher spending related to travel, recruiting, temporary labor, consulting, maintenance contract expenses, and other operating expenses, most of $2.6 million that reduced selling, general, and administrative expenses forwhich were significantly curtailed in 2020 due to the year ended December 31, 2018, as discussed in our annual report on Form 10-K for the year ended December 31, 2018 filed with the SEC on February 27, 2019.COVID-19 pandemic. The increases areincrease was partially offset by $3.6 million related to realignmenta reduction in employee-related expenses for restructuring initiatives during the year ended December 31, 2018.
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Interest and Other Income (Expense), Net. Interest and other income (expense), net, decreasedchanged by $4.4$17.3 million for the year ended December 31, 20192021 compared to the year ended December 31, 2018,2020, primarily driven by a $5.5$16.7 million decreaseincrease in other expenses, partially offset by a $1.1 million decreaseexpenses. The increase in other income. The decrease in other expenses is primarily due to lower interest expense as a result of significant debt repayments during the year ended December 31, 2019, as well as favorable foreign currency fluctuations during the period. The decrease in other income is primarily due2021 compared to the $2.5 million contingent gain recognized during the year ended December 31, 2018 related to a settlement agreement2020 is primarily driven by amortization of discount and debt issuance costs as well as interest expense associated with the Ateb acquisition, partially offset by higher interest income received due to higher cash balances we maintained during 2019.our convertible senior notes issued in September 2020.
Provision for (Benefit from) Income Taxes
Year Ended December 31,Change inYear Ended December 31,Change in
20192018$%20212020$%
(Dollars in thousands)(Dollars in thousands)
Provision for (benefit from) income taxesProvision for (benefit from) income taxes$12,595  $(2,113) $14,708  (696)% Provision for (benefit from) income taxes$(11,842)$(2,845)$(8,997)316%
Effective tax rate on earningsEffective tax rate on earnings17%  (6)% Effective tax rate on earnings(18)%(10)%
We recorded a provision for income taxes of $12.6 million and had an effective tax rate of 17% for the year ended December 31, 2019 compared to an income tax benefit of $2.1$11.8 million and had a negative effective tax rate of 6%18% for the year ended December 31, 2018.2021 compared to an income tax benefit of $2.8 million and a negative effective tax rate of 10% for the year ended December 31, 2020. The 20192021 annual effective tax rate differed from the statutory tax rate of 21%, and resulted in a decrease as compared to the 2020 annual effective tax rate, primarily due to a favorable impact fromof the excess tax benefit from equity-basedshare-based compensation, and favorable impact of research and development credits. The increase incredits, and the annualnet tax benefit of internal legal entity restructuring for the release of uncertain tax positions, partially offset by an unfavorable impact from non-deductible compensation charges. Effective January 1, 2022, the Tax Cuts and Jobs Act of 2017 eliminates the ability to deduct research and development expenditures and requires those expenditures to be amortized over five years. While we do not expect this change to materially impact our effective tax rate, in 2019 as compared to 2018 was primarily due toit could potentially impact our cash flows and increase the increase in the our earnings and the impactamount of the internal legal entity restructuring.cash taxes we pay.
Refer to Note 16,17, Income Taxes, of the Notes to Consolidated Financial Statements included in this annual reportAnnual Report on Form 10-K for more details.additional information.
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LIQUIDITY AND CAPITAL RESOURCES
We had cash and cash equivalents of $127.2$349.1 million at December 31, 2019,2021, compared to $67.2$485.9 million at December 31, 2018.2020. All of our cash and cash equivalents are invested in bank accounts and money market funds held in sweep and asset management accounts with major financial institutions.
Our cash position and working capital at December 31, 20192021 and 20182020 were as follows:
December 31,
20192018
(In thousands)
Cash$127,210  $67,192  
Working Capital$246,242  $192,554  
December 31,
20212020
(In thousands)
Cash and cash equivalents$349,051 $485,928 
Working capital (deficit) (1)
$(95,456)$552,991 

(1)    The working capital deficit as of December 31, 2021 is primarily due to the reclassification of our convertible senior notes as a current rather than long-term liability. Refer to Note 10, Convertible Senior Notes, of the Notes to Consolidated Financial Statements included in this Annual Report on Form 10-K for additional information.
Our ratio of current assets to current liabilities was 2.0:0.9:1 and 3.0:1 at December 31, 20192021 and 1.9:1 at December 31, 2018.2020, respectively.
Sources of Cash
Credit Agreements
On January 5, 2016, we entered into a $400.0 million senior secured credit facility pursuant to a credit agreement with certain lenders, Wells Fargo Securities, LLC as sole lead arranger, and Wells Fargo Bank, National Association, as administrative agent (as subsequently amended as discussed below, the “Prior Credit Agreement”). The Prior Credit Agreement provided for a $200.0 million term loan facility (the “Prior Term Loan Facility”), and prior to the amendment discussed below, a $200.0 million revolving credit facility (the “Prior Revolving Credit Facility” and together with the Prior Term Loan Facility, the “Prior Facilities”). In addition, the Prior Credit Agreement included a letter of credit sub-limit of up to $10.0 million and a swing line loan sub-limit of up to $10.0 million.
On April 11, 2017 and December 26, 2017, we entered into amendments to the Prior Credit Agreement. Under these amendments, the Prior Revolving Credit Facility was increased from $200.0 million to $315.0 million and certain other modifications were made.
On November 15, 2019, we refinanced the Prior Credit Agreement and entered into an Amended and Restated Credit Agreement (the(as subsequently amended, as discussed below, the “A&R Credit Agreement”) with the lenders from time to time party thereto, Wells Fargo Securities, LLC, Citizens Bank, N.A., and JPMorgan Chase Bank, N.A., as joint lead arrangers and Wells Fargo Bank, National Association, as administrative agent. The A&R Credit Agreement replaced the Prior Credit Agreementsuperseded our 2016 senior secured credit facility and provides for (a) a five-year
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revolving credit facility of $500.0 million (the “Current Revolving“Revolving Credit Facility”) and (b) an uncommitted incremental loan facility of up to $250.0 million. In addition, the A&R Credit Agreement includes a letter of credit sub-limit of up to $15.0 million and a swing line loan sub-limit of up to $25.0 million.
On November 15, 2019,September 22, 2020, the $80.0 million outstanding term loan balance under the Prior Facilities was transferredparties entered into an amendment to the Current RevolvingA&R Credit Facility.Agreement to, among other changes, permit the issuance of the convertible senior notes and the purchase of the convertible note hedge transactions described below, expand our flexibility to repurchase our common stock and make other restricted payments, and replace the total net leverage covenant with a new secured net leverage covenant that required us to maintain a consolidated secured net leverage ratio not to exceed 3.50:1 for the calendar quarters ending September 30, 2020, December 31, 2020, and March 31, 2021 and requires us to maintain a consolidated secured net leverage ratio not to exceed 3.00:1 for the calendar quarters ending thereafter.
As of December 31, 2019, the2021, there was no outstanding balance offor the Current Revolving Credit Facility was $50.0 million and we were in full compliance with all covenants. Refer to Note 9, Debt and Credit Agreements, of the Notes to Consolidated Financial Statements included in this annual report.Annual Report on Form 10-K for additional information. We expect to use future loans under the Current Revolving Credit Facility, if any, for working capital, potential acquisitions, and other general corporate purposes.
Distribution AgreementConvertible Senior Notes
On November 3, 2017,September 25, 2020, we entered intocompleted a Distribution Agreementprivate offering of $575.0 million aggregate principal amount of 0.25% convertible senior notes (the “Distribution Agreement”“Notes”) with J.P. Morgan Securities LLC, Wells Fargo Securities, LLC, and HSBC Securities (USA) Inc., as our sales agents, pursuantincluding the exercise in full of the initial purchasers’ option to which we may offer and sell from time to time through the sales agentspurchase up to $125.0an additional $75.0 million maximum aggregateprincipal amount of the Notes. We received proceeds from the issuance of the Notes of $559.7 million, net of $15.3 million of transaction fees and other debt issuance costs. The Notes bear interest at a rate of 0.25% per year, payable semiannually in arrears on March 15 and September 15 of each year, beginning on March 15, 2021. The Notes are general senior, unsecured obligations of the Company and will mature on September 15, 2025, unless earlier redeemed, repurchased, or converted. Refer to Note 10, Convertible Senior Notes, of the Notes to Consolidated Financial Statements included in this Annual Report on Form 10-K for additional information.
During the fourth quarter of 2020, we used approximately $49.3 million of the net proceeds from the offering priceto pay the cost of the convertible note hedge transactions (partially offset by the proceeds to we received from the sale of the warrant transactions), approximately $53.0 million of the net proceeds to repurchase shares of our common stock. Salesstock from purchasers of the common stock pursuantNotes, $150.0 million of the net proceeds to the Distribution Agreement may be made in negotiated transactions or transactions that are deemed to be “at the market” offerings as defined in Rule 415pay down outstanding borrowings under the Securities ActRevolving Credit Facility, and $225.0 million for the acquisition of 1933, including sales made directly on the Nasdaq Stock Market, or sales made to or through a market maker other than on an exchange.340B Link Business. We intend to use the remainder of the net proceeds from the sale, if any,this offering for
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working capital and other general corporate purposes, which may include without limitation, the acquisition of complementary businesses, the repayment of outstanding indebtedness, capital expenditurespotential acquisitions, strategic transactions, and working capital.
For the year ended December 31, 2018, we received gross proceeds of $40.3 million from salespotential future repurchases of our common stock under the Distribution Agreement and incurred issuance costs of $0.7 million on sales of approximately 557,000 shares of our common stock at an average price of approximately $72.40 per share.
For the year ended December 31, 2019, we received gross proceeds of $38.5 million from sales of our common stock under the Distribution Agreement and incurred issuance costs of $0.7 million on sales of approximately 460,000 shares of our common stock at an average price of approximately $83.81 per share. As of December 31, 2019, we had an aggregate of $31.5 million available to be offered under the Distribution Agreement.stock.
Uses of Cash
Our future uses of cash are expected to be primarily for working capital, capital expenditures, loan principal and interest payments, and other contractual obligations. We also expect a continued use of cash for potential acquisitions and acquisition-related activities.activities, as well as repurchases of our common stock.
Our stock repurchase programs have a total of $54.9 million remaining for future repurchases as of December 31, 2019,2021, which may result in additional use of cash. Refer to Note 14,15, Stock Repurchase Program, of the Notes to Consolidated Financial Statements included in this annual report.Annual Report on Form 10-K for additional information. In September 2020, we repurchased 749,300 shares of our common stock from purchasers of the Notes in the offering in privately negotiated transactions effected through one of the initial purchasers or its affiliate at an average price of $70.78 per share for an aggregate purchase price of approximately $53.0 million. The repurchases were made concurrently with the issuance of the Notes. The repurchases were separately authorized by the Board of Directors, and did not impact the total remaining for future purchases under the previously authorized stock purchase programs. There were no stock repurchases during the years ended December 31, 20192021 and 2018.2020 including under our stock repurchase programs, other than the separately-authorized one-time stock repurchase concurrent with the offering of the Notes in September 2020.
Based on our current business plan and revenueproduct backlog, we believe that our existing cash and cash equivalents, our anticipated cash flows from operations, cash generated from the exercise of employee stock options and purchases under our employee stock purchase plan,Employee Stock Purchase Plan (“ESPP”), along with the availability of funds under the Current Revolving Credit Facility will be sufficient to meet our cash needs for working capital, capital expenditures, potential acquisitions, and other contractual obligations for at least the next twelve months. For periods beyond the next twelve months, we also anticipate that our net operating cash flows plus existing balances of cash and cash equivalents will suffice to fund the continued growth of our business.
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Cash Flows
The following table summarizes, for the periods indicated, selected items in our Consolidated Statements of Cash Flows:
Year Ended December 31,Year Ended December 31,
2019201820212020
(In thousands)(In thousands)
Net cash provided by (used in):Net cash provided by (used in):Net cash provided by (used in):
Operating activitiesOperating activities$145,008  $103,966  Operating activities$231,809 $185,870 
Investing activitiesInvesting activities(61,664) (54,374) Investing activities(412,498)(279,866)
Financing activitiesFinancing activities(23,479) (13,597) Financing activities47,363 456,269 
Effect of exchange rate changes on cash and cash equivalentsEffect of exchange rate changes on cash and cash equivalents153  (1,227) Effect of exchange rate changes on cash and cash equivalents(974)437 
Net increase in cash and cash equivalents$60,018  $34,768  
Net increase (decrease) in cash, cash equivalents, and restricted cashNet increase (decrease) in cash, cash equivalents, and restricted cash$(134,300)$362,710 
Operating Activities
We expect cash from our operating activities to fluctuate in future periods as a result of a number of factors, including the timing of our billings and collections, our operating results, and the timing of other liability payments.
Net cash provided by operating activities was $145.0$231.8 million for 2019,the year ended December 31, 2021, primarily consisting of net income of $61.3$77.8 million adjusted for non-cash items of $99.5$157.3 million, offset by changes in assets and liabilities of $15.8$3.3 million. The non-cash items primarily consisted of depreciation and amortization expense of $53.6$73.0 million, share-based compensation expense of $34.0$53.2 million, amortization of discount on convertible senior notes of $18.6 million, amortization of operating lease right-of-use assets of $10.6$11.9 million, amortization of debt issuance costs of $2.2$3.4 million, and a change in deferred income taxes of $1.3$3.3 million. Changes in assets and liabilities include cash outflows from (i) an increase in accounts receivable and unbilled receivables of $21.5$41.0 million primarily due to increasedan increase in billings driven by overall business growth and the timing of billingsshipments as well as collections, (ii) an increase in inventories of $25.7 million to support forecasted sales, including advanced purchases of certain components, and collections, (ii)higher costs of inventory, (iii) a decrease in other long-term liabilities of $14.9 million primarily due to a $6.2 million release of a certain net unrecognized tax benefit as a result of effective settlement with the tax authorities, as well as the release of deferral of certain payroll taxes related to the CARES Act, (iv) a decrease in operating lease liabilities of $10.0 million, (iii) an increase in inventories of $8.1 million for inventory buildup in support of forecasted sales, (iv) an increase in investment in sales-type leases of $3.7$12.5 million, (v) an increase in prepaid commissions of $2.7$6.9 million primarily
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due to timing of bookings and revenue recognition due to larger deal sizes across multiple products, services, and implementations for customers, (vi) an increase in prepaid expenses of $5.7 million, and (vii) an increase in other currentlong-term assets of $2.0$3.3 million. These cash outflows were partially offset by (i) an increase in accounts payablesaccrued liabilities of $7.9$34.9 million primarily due to increased spending with vendorsan increase in rebates and increased consulting costs,lease buyout liabilities, (ii) an increase in other long-term liabilitiesaccounts payables of $6.0$29.1 million primarily due to an overall increase in spending, including inventory spending, as well as timing of payments, (iii) an increase in deferred revenues of $5.4$24.2 million (iv) a decrease in other long-term assets of $4.5 million, (v)primarily due to an increase in accrued liabilitiesbillings driven by the timing of $3.0 million, (vi) a decreaseshipments in prepaid expensesorder to meet customers’ implementation schedules and recognition of $2.9 million, and (vii)revenues for products requiring installation, (iv) an increase in accrued compensation of $2.5$12.3 million primarily due to an increase in accrued commissions, as well as timing of payroll, (v) a decrease in investment in sales-type leases of $3.3 million, and (vi) a decrease in other current assets of $2.8 million.
Net cash provided by operating activities was $104.0$185.9 million for 2018,the year ended December 31, 2020, primarily consisting of net income of $37.7$32.2 million adjusted for non-cash items of $77.0$116.4 million offset byand changes in assets and liabilities of $10.7$37.3 million. The non-cash items primarily consisted of depreciation and amortization expense of $51.4$61.1 million, share-based compensation expense of $28.9$44.7 million, amortization of operating lease right-of-use assets of $10.5 million, amortization of debt issuance costs of $2.3$1.6 million, amortization of discount on convertible senior notes of $4.8 million, and a change in deferred income taxes of $5.7$6.5 million. Changes in assets and liabilities include cash outflowsinflows from (i) a decrease in accounts payablereceivable and unbilled receivables of $9.2$36.8 million primarily due to cash conservation effortshigher collections in 2017, which resultedthe fourth quarter of 2020, (ii) a decrease in high payable balances, andinventories of $12.4 million primarily due to timing of payments,shipments and a focus on supply chain efficiencies, (iii) an increase in accrued compensation of $11.6 million primarily due to an increase in accrued commissions, as well as timing of payroll, (iv) an increase in deferred revenues of $7.6 million primarily due to the timing of shipments in order to meet customers’ implementation schedules and recognition of revenues for products requiring installation, (v) an increase in other long-term liabilities of $7.5 million primarily due to the deferral of certain payroll taxes related to the CARES Act, and (vi) an increase in accrued liabilities of $4.4 million. These cash inflows were partially offset by (i) a decrease in operating lease liabilities of $9.5 million, (ii) an increase in prepaid commissions of $8.1 million primarily due to an increase in bookings, (iii) an increase in other long-term assets of $7.1$7.7 million primarily due to an increase in unbilled receivables, (iii) an increase in inventories of $6.8 million for inventory buildup in support of forecasted sales, (iv) an increase in other current assets of $6.4 million, (v) a decrease in accounts receivable and unbilled receivablespayables of $6.2$6.3 million primarily due to increased billings and thean overall decrease in spending, as well as timing of billingspayments, (vi) an increase in investment in sales-type leases of $2.9 million, and collections, and (v)(vii) an increase in prepaid commissionsexpenses of $4.7 million due to an increase in bookings. These cash outflows were partially offset by an increase in accrued compensation of $14.4 million, an increase in other accrued liabilities of $8.2 million, and an increase in deferred revenues of $3.0 million due to the increased billings and the timing of orders and revenues being recognized for installed products.$2.1 million.
Investing Activities
Net cash used in investing activities was $61.7$412.5 million for 2019,the year ended December 31, 2021, which consisted of $354.2 million consideration paid for our 2021 acquisitions, net of cash acquired, capital expenditures of $15.9$29.0 million for property and equipment, and $45.8$29.4 million for costs of software development for external use.
Net cash used in investing activities was $54.4$279.9 million for 2018,the year ended December 31, 2020, which consisted of $225.0 million consideration paid for the acquisition of the 340B Link Business, capital expenditures of $23.7$22.8 million for property and equipment, and $30.7$32.0 million for costs of software development for external use.
Financing Activities
Net cash used inprovided by financing activities was $23.5$47.4 million for 2019,the year ended December 31, 2021, primarily due to $67.3 million in proceeds from employee stock option exercises and ESPP purchases, partially offset by $16.3 million in employees’ taxes paid related to restricted stock unit vesting and a net decrease in the repaymentcustomer funds balances of $90.0$3.7 million.
Net cash provided by financing activities was $456.3 million for the year ended December 31, 2020, primarily due to proceeds of $559.7 million from the issuance of the Notes, net of issuance costs, proceeds of approximately $51.3 million from the sale of warrants in connection with the issuance of the Notes, $150.0 million of proceeds under the Prior Facilities and the Current Revolving Credit Facility, $9.7$54.3 million in proceeds from employee stock option exercises and ESPP purchases, and a net increase in the customer funds balances of $4.0 million, partially offset by repayments of $200.0 million under the Revolving Credit Facility, $100.6 million for the purchase of the convertible note hedge in connection with the issuance of the Notes, $53.0 million for repurchases of our stock, $8.7 million in employees’ taxes paid related to restricted stock unit vesting, and payments offor debt issuance costs related to the Revolving Credit Facility of $2.3 million, partially offset by $40.7 million in proceeds from employee$0.6 million.
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stock option exercises and employee stock plan purchases, and $37.8 million proceeds from sales of our common stock under the Distribution Agreement.
Net cash used in financing activities was $13.6 million for 2018, primarily due to the repayment of $77.0 million of the Prior Facilities and $6.8 million in employees’ taxes paid related to restricted stock unit vesting, partially offset by $30.6 million in proceeds from employee stock option exercises and employee stock plan purchases, and $39.6 million proceeds from sales of our common stock under the Distribution Agreement.
Contractual Obligations
Contractual obligations as of December 31, 20192021 were as follows:
Payments Due by PeriodPayments Due By Period
Total20202021 - 20222023-20242025 and thereafterTotal20222023 - 20242025 - 20262027 and thereafter
(In thousands) (In thousands)
Operating leases (1)
Operating leases (1)
$74,830  $13,573  $25,041  $16,448  $19,768  
Operating leases (1)
$61,263 $15,434 $21,590 $13,356 $10,883 
Purchase obligations (2)
Purchase obligations (2)
65,913  63,804  1,821  233  55  
Purchase obligations (2)
170,147 158,465 11,612 41 29 
Revolving credit facility (3)
50,000  —  —  50,000  —  
Convertible senior notes (3)
Convertible senior notes (3)
580,750 1,437 2,875 576,438 — 
Other (4)
Other (4)
871 183 440 248 — 
Total (4)(5)
Total (4)(5)
$190,743  $77,377  $26,862  $66,681  $19,823  
Total (4)(5)
$813,031 $175,519 $36,517 $590,083 $10,912 

(1)Commitments under operating leases relate primarily to leased office buildings, data centers, office equipment, and vehicles. Refer to Note 11,12, Lessee Leases, of the Notes to Consolidated Financial Statements included in this annual report.Annual Report on Form 10-K for additional information.
(2)We purchase components from a variety of suppliers and use contract manufacturers to provide manufacturing services for our products. During the normal course of business, we issue purchase orders with estimates of our requirements several months ahead of the delivery dates. These amounts are associated with agreements that are enforceable and legally binding. The amounts under such contracts are included in the table above because we believe that cancellation of these contracts is unlikely and we expect to make future cash payments according to the contract terms or in similar amounts for similar materials.
(3)Amounts shownWe issued convertible senior notes in September 2020 that are due in September 2025. The obligations presented above include both principal and interest for these notes. Although these notes mature in 2025, they may be converted into cash and shares of our common stock prior to maturity if certain conditions are met. Any conversion prior to maturity can result in repayment of the revolving credit facility are principal repayments only. The cash interest expense payments are not reflectedamounts sooner than the scheduled repayment as indicated in the above table.table above. Refer to Note 9,10, Debt and Credit AgreementsConvertible Senior Notes, of the Notes to Consolidated Financial Statements included in this annual report.Annual Report on Form 10-K for additional information.
(4)Other commitments include various finance leases and other financing arrangements.
(5)Refer to Note 12,13, Commitments and Contingencies, of the Notes to Consolidated Financial Statements included in this annual report.Annual Report on Form 10-K for additional information.
Off-Balance Sheet Arrangements
As of December 31, 2019, we had no off-balance sheet arrangements as defined under Regulation S-K 303(a)(4) of the Exchange Act and the instructions thereto.
ITEM 7A.    QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
We are exposed to market risks related to fluctuations in foreign currency exchange rates and interest rates.
Foreign Currency Exchange Risk
We operate in foreign countries which expose us to market risk associated with foreign currency exchange rate fluctuations between the U.S. dollar and various foreign currencies, the most significant of which are the British Pound and the Euro. In order to manage foreign currency risk, at times we enter into foreign exchange forward contracts to mitigate risks associated with changes in spot exchange rates of mainly non-functional currency denominated assets or liabilities of our foreign subsidiaries. In general, the market risk related to these contracts is offset by corresponding gains and losses on the hedged transactions. By working only with major banks and closely monitoring current market conditions, we seek to limit the risk that counterparties to these contracts may be unable to perform. We do not enter into derivative contracts for trading purposes. As of December 31, 2019,2021, we did not have any outstanding foreign exchange forward contracts.
Interest Rate Fluctuation Risk
We are exposed to interest rate risk through our borrowing activities. As of December 31, 2019, we had total debt2021, there was no outstanding balance under the A&R Credit Agreement, and the net carrying amount under our convertible senior notes was $488.2 million. Although our convertible senior notes are based on a fixed rate, changes in interest rates could impact the fair value of $50.0 million.such notes. As of December 31, 2021, the fair market value of our convertible senior notes was $1.085 billion. Refer to Note 9,5, DebtFair Value of Financial Instruments, and Credit AgreementsNote 10, Convertible Senior Notes, of the Notes to Consolidated Financial Statements included in this annual report.Annual Report on Form 10-K for additional information.
We usehave used interest rate swap agreements to protect against adverse fluctuations in interest rates by reducing our exposure to variability in cash flows relating to interest payments on a portion of our outstanding debt. Our interest rate swaps, which are
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were designated as cash flow hedges, involveinvolved the receipt of variable amounts from counterparties in exchange for us making fixed-rate payments over the life of the agreements. We do not hold or issue any derivative financial instruments for
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speculative trading purposes. As of December 31, 2019,2021, we did not have any outstanding interest rate swap agreements. Our interest rate swap agreement matured during the second quarter of 2019.
ITEM 8.    FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA
The following tables presenting our quarterly resultsReport of operations should be read in conjunction with theIndependent Auditors and Consolidated Financial Statements and related Notesare included in Part IV, Item 15 of this annual reportAnnual Report on Form 10-K beginning on page F-1 and are incorporated herein by reference into this Item 8. We have prepared the unaudited information on the same basis as our audited Consolidated Financial Statements. Our operating results for any quarter are not necessarily indicative of results for any future quarters or for a full year.
SUPPLEMENTARY CONSOLIDATED FINANCIAL DATA (UNAUDITED)
Quarter Ended
December 31, 2019September 30, 2019June 30, 2019March 31, 2019
(In thousands, except per share data)
2019 Consolidated Statements of Operations Data
Total revenues$248,292  $228,805  $217,413  $202,517  
Gross profit123,603  112,147  104,045  97,117  
Income from operations22,182  24,646  18,763  12,761  
Net income$22,095  $19,983  $15,976  $3,284  
Net income per share:
Basic$0.53  $0.48  $0.39  $0.08  
Diluted$0.51  $0.46  $0.37  $0.08  
reference.
Quarter Ended
December 31, 2018September 30, 2018June 30, 2018March 31, 2018
(In thousands, except per share data)
2018 Consolidated Statements of Operations Data
Total revenues$211,750  $204,267  $188,673  $182,619  
Gross profit102,183  98,909  88,783  82,455  
Income from operations18,930  17,495  7,334  633  
Net income$14,793  $13,628  $6,588  $2,720  
Net income per share:
Basic$0.37  $0.35  $0.17  $0.07  
Diluted$0.36  $0.33  $0.16  $0.07  
ITEM 9.    CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE
None.
ITEM 9A.    CONTROLS AND PROCEDURES
Evaluation of Disclosure Controls and Procedures
Our management, with the participation of our chief executive officer and chief financial officer, evaluated the effectiveness of our disclosure controls and procedures (as defined in Rule 13a-15(e) or 15d-15(e) under the Exchange Act) as of the end of the period covered by this Annual Report on Form 10-K. In designing and evaluating the disclosure controls and procedures, management recognized that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives. In addition, the design of disclosure controls and procedures must reflect the fact that there are resource constraints and that management is required to apply its judgment in evaluating the benefits of possible controls and procedures relative to their costs.
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Based on that evaluation, our chief executive officer and chief financial officer concluded that our disclosure controls and procedures were effective as of December 31, 20192021 to provide reasonable assurance that information we are required to disclose in reports that we file or submit under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in SEC rules and forms, and that such information is accumulated and communicated to our management, including our chief executive officer and chief financial officer, as appropriate, to allow timely decisions regarding required disclosure.
Management’s Report on Internal Control overOver Financial Reporting
Our management is responsible for establishing and maintaining adequate internal control over financial reporting (as such term is defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act). Our internal control system is designed to provide reasonable assurance regarding the preparation and fair presentation of financial statements for external purposes in accordance with U.S. generally accepted accounting principles. All internal control systems, no matter how well designed, have inherent limitations and can provide only reasonable assurance that the objectives of the internal control system are met.
Under the supervision and with the participation of our management, including our principal executive officer and principal financial officer, we conducted an evaluation of the effectiveness of our internal control over financial reporting as of December 31, 20192021 using the criteria for effective internal control over financial reporting as described in “Internal Control—Integrated Framework,” issued by the Committee of Sponsoring Organization of the Treadway Commission (2013 framework) (the COSO Criteria). Based on this assessment, management concluded that our internal control over financial reporting was effective as of December 31, 2019.2021.
Deloitte & Touche LLP, an independent registered public accounting firm, has issued its attestation report on our internal control over financial reporting as of December 31, 2019,2021, which is included in Part IV, Item 15 of this annual report.Annual Report on Form 10-K.
Changes in Internal Control over Financial Reporting
There have been no changes in our internal control over financial reporting (as such term is defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act) that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting during the year ended December 31, 2019.2021.
ITEM 9B.    OTHER INFORMATION
None.
ITEM 9C.   ��DISCLOSURE REGARDING FOREIGN JURISDICTIONS THAT PREVENT INSPECTIONS.
Not applicable.
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PART III
Certain information required by Part III is omitted from this annual reportAnnual Report on Form 10-K because the registrant will file with the U.S.United States Securities and Exchange Commission a definitive proxy statement pursuant to Regulation 14A in connection with the solicitation of proxies for Omnicell’s Annual Meeting of Stockholders expected to be held in May 20202022 (the “Proxy Statement”) not later than 120 days after the end of the fiscal year covered by this annual report,Annual Report on Form 10-K, and certain information included therein is incorporated herein by reference.
ITEM 10.    DIRECTORS, EXECUTIVE OFFICERS AND CORPORATE GOVERNANCE
The information required by this Item with respect to directors and executive officers may be found under the heading “Information About Our Executive Officers” in Part I, Item 1 of this annual report,Annual Report on Form 10-K, and in the sections entitled “Board and Corporate Governance Matters—Election of Directors” and “Board and Corporate Governance Matters—Information about our Directors and Nominees” appearing in the Proxy Statement. Such information is incorporated herein by reference.
The information required by this Item with respect to our audit committee and audit committee financial expert may be found in the section entitled “Board and Corporate Governance Matters—Information Regarding Committees of the Board of Directors—Audit Committee” appearing in the Proxy Statement. Such information is incorporated herein by reference.
The information required by this Item with respect to compliance with Section 16(a) of the Securities Exchange Act of 1934 may be found in the sections entitled “Delinquent Section 16(a) Reports” appearing in the Proxy Statement. Such information is incorporated herein by reference.
Our written Code of Conduct applies to all of our directors and employees, including executive officers, including without limitation our principal executive officer, principal financial officer, principal accounting officer or controller, or persons performing similar functions. The Code of Conduct is available on our investor relations website is located at www.omnicell.comir.omnicell.com under the hyperlink titled “Corporate Governance.entitled “Leadership & Governance—Governance Documents.” Changes to or waivers of the Code of Conduct will be disclosed on the same website. We intend to satisfy the disclosure requirement under Item 5.05 of Form 8-K regarding any amendment to, or waiver of, any provision of the Code of Conduct by disclosing such information on the same website.
ITEM 11.    EXECUTIVE COMPENSATION
The information required by this Item with respect to director and executive officer compensation is incorporated by reference to the sections of our Proxy Statement entitled “Executive Compensation” and “Board and Corporate Governance Matters—Director Compensation.”
The information required by this Item with respect to Compensation Committee interlocks and insider participation is incorporated herein by reference to the section of our Proxy Statement entitled “Board and Corporate Governance Matters—Information Regarding Committees of the Board of Directors—Compensation Committee—Compensation Committee Interlocks and Insider Participation.”
The information required by this Item with respect to our Compensation Committee’s review and discussion of the Compensation Discussion and Analysis included in the Proxy Statement is incorporated herein by reference to the section of our Proxy Statement entitled “Executive Compensation—Compensation Committee Report.”
ITEM 12.    SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS
The information required by this Item with respect to security ownership of certain beneficial owners and management is incorporated herein by reference to the section of our Proxy Statement entitled “Stock Ownership—Security Ownership of Certain Beneficial Owners and Management.”
The information required by this Item with respect to securities authorized for issuance under our equity compensation plans is incorporated herein by reference to the section of our Proxy Statement entitled “Equity Plan Information—Equity Compensation Plan Information.”
ITEM 13.    CERTAIN RELATIONSHIPS, RELATED TRANSACTIONS AND DIRECTOR INDEPENDENCE
The information required by this Item with respect to related party transactions is incorporated herein by reference to the section of our Proxy Statement entitled “Board and Corporate Governance Matters—Certain Relationships and Related Transactions.”
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The information required by this Item with respect to director independence is incorporated herein by reference to the section of our Proxy Statement entitled “Board and Corporate Governance Matters—Independence of the Board of Directors.”
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ITEM 14.    PRINCIPAL ACCOUNTANT FEES AND SERVICES
The information required by this Item is incorporated herein by reference to the section of our Proxy Statement entitled “Audit Matters—Ratification of Selection of Independent Registered Public Accounting Firm—Principal Accountant Fees and Services.”
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PART IV
ITEM 15.    EXHIBITS AND FINANCIAL STATEMENT SCHEDULE
The following documents are included as part of this annual report:Annual Report on Form 10-K:
(1)    Consolidated Financial Statements:
Index to Financial StatementsPage Number
(2)    Exhibits: The information required by this item is set forth on the exhibit index which precedes the signature page of this report.Annual Report on Form 10-K.
ITEM 16.    FORM 10-K SUMMARY
None.
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REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholdersstockholders and the Board of Directors of Omnicell, Inc.
Opinion on the Financial Statements
We have audited the accompanying consolidated balance sheets of Omnicell, Inc. and subsidiaries (the "Company"“Company”) as of December 31, 20192021 and 2018,2020, the related consolidated statements of operations,comprehensive income, stockholders'stockholders’ equity, and cash flows, for each of the three years in the period ended December 31, 2019,2021, and the related notes and the schedule listed in the Index at Item 15 (collectively referred to as the "financial statements"“financial statements”). In our opinion, the financial statements present fairly, in all material respects, the financial position of the Company as of December 31, 20192021 and 2018,2020, and the results of its operations and its cash flows for each of the three years in the period ended December 31, 2019,2021, in conformity with accounting principles generally accepted in the United States of America.America (U.S. GAAP).
We have also audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the Company'sCompany’s internal control over financial reporting as of December 31, 2019,2021, based on criteria established in Internal Control — Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission and our report dated February 26, 2020,25, 2022, expressed an unqualified opinion on the Company'sCompany’s internal control over financial reporting.
Change in Accounting Principle
As discussed in Note 1 to the financial statements, the Company has changed its method of accounting for leases in fiscal year 2019 due to the adoption of Accounting Standards Codification Topic 842, Leases.
Basis for Opinion
These financial statements are the responsibility of the Company'sCompany’s management. Our responsibility is to express an opinion on the Company'sCompany’s financial statements based on our audits. We are a public accounting firm registered with the Public Company Accounting Oversight Board (United States) (PCAOB)PCAOB and are required to be independent with respect to the Company in accordance with the USU.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the auditsaudit to obtain reasonable assurance about whether the financial statements are free of material misstatement, whether due to error or fraud. Our audits included performing procedures to assess the risks of material misstatement of the financial statements, whether due to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. Our audits also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that our audits provide a reasonable basis for our opinion.
Critical Audit Matters
The critical audit matters communicated below are matters arising from the current-period audit of the financial statements that were communicated or required to be communicated to the audit committee and that (1) relate to accounts or disclosures that are material to the financial statements and (2) involved our especially challenging, subjective, or complex judgments. The communication of critical audit matters does not alter in any way our opinion on the financial statements, taken as a whole, and we are not, by communicating the critical audit matters below, providing separate opinions on the critical audit matters or on the accounts or disclosures to which they relate.
Inventory Valuation - Refer to Note 1 to the financial statements
Critical Audit Matter Description
The Company records write-downs for excess and slow-moving inventory based on the Company’s estimate of demand for its products, potential obsolescence of technology, product life cycles, and whether pricing trends or forecasts indicate that the carrying value of inventory exceeds its estimated selling price. These estimates require management judgment and are impacted by market and economic conditions, technology changes, and new product introductions. The Company had aCompany’s consolidated inventory balance of $108.0is $119.9 million as of December 31, 2019.2021.
We identified the inventory valuation as a critical audit matter because of the assumptions and judgments made by management to estimate the excess and slow-moving inventory, especially considering the presence of various inventory types and evolving product life cycles.cycles, which includes new product development. The analysis of inventory valuation required a high degree of auditor judgment and an increased extent of
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effort when performing audit procedures to evaluate qualitative and quantitative factors considered and the reasonableness of the relevant management judgments.
How the Critical Audit Matter Was Addressed in the Audit
Our audit procedures over the inventory valuation included the following, among others:
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We tested the effectiveness of internal controls over inventory for valuation.
We evaluated the appropriateness of management’s method, assumptions, and judgments used in developing their estimate of the excess and slow-moving inventory, which included consideration of demand for its products, potential obsolescence of technology, product life cycles, and pricing trends.
We tested certain underlying data used and considered in the excess and obsolete inventory assessment, including the amount of inventory on hand, forecasted demand, and historical sales.
We compared actual inventory usage and write-off activity in the current year to the excess and obsolete estimate by management in the prior year to evaluate management’s ability to make accurate estimates.
We evaluated the valuation of excess and obsolete inventory for understatement by making selections of individual inventory items and evaluating the appropriateness of the inventory valuation and management judgments based on relevant product-specificproduct specific information. These procedures also included certain inquiries of production planning and supply chain employees.
We evaluated whether the excess and obsolete inventory may be understated by evaluating write-off activity of inventory subsequent to December 31, 2019.2021.

Capitalized Software - Software Development Costs for External Use — Refer to Notes 1 and 6 to the financial statements
Critical Audit Matter Description
The Company capitalizes certain costs for software that is to be sold, leased or otherwise marketed once technological feasibility has been established and amortizes these costs over the estimated lives of the related products. The Company capitalized $45.8 million of software development costs in the year ended December 31, 2019, and had total capitalized software development costs, net of accumulated amortization, of $85.1 million as of December 31, 2019.
We identified management’s determination of capitalized software development costs to be a critical audit matter. The determination of whether a project’s software development costs are capitalized or expensed could have a significant impact on the financial statements. The Company capitalized $29.4 million of software development costs in the year ended December 31, 2021 and had total external capitalized software development costs, net of accumulated amortization, of $97.0 million as of December 31, 2021.
We identified management’s determination of capitalized software development costs to be a critical audit matter. Evaluating management’sthe Company’s determination of the project and related software development activities to be capitalized under relevant accounting guidance, including the extent to which software development costs incurred were capitalized, required subjective auditor judgment.
How the Critical Audit Matter Was Addressed in the Audit
Our audit procedures to assess the appropriateness of capitalized software development costs included the following, amongstamong others:
We tested the effectiveness of management’s capitalized software development cost internal controls.
We obtained an understanding of management’s process for evaluating software development costs and the nature of software development costs capitalized.
We tested management’s method of calculating capitalized software development costs. For a sample of projects, we performed audit procedures to agree capitalized labor costs to time records and made certain inquiries of project members to further assess the reasonableness of time allocated to the selected projects.
For a sample of software development projects, we obtained an understanding of the new software enhancements and features planned for development by reviewing management’s project documentation and inquiring of project managers and engineers.
For a sample of software development projects, we tested the timing of software development cost recognition as either a capitalized or an expensed development cost, depending on which stage of the project development the software development cost was incurred. We also inquired of project managers and engineers regarding the determination of the date technological feasibility was reached and observed the new features developed in the working model.

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Business Acquisitions - Valuation of Customer Relationship Intangible Assets — Refer to Note 1 and 2 to the financial statements
Critical Audit Matter Description
The Company completed the acquisitions of RxInnovation Inc., operating as FDS Amplicare, ReCept Holdings, Inc., and MarkeTouch Media, LLC (“Acquired Companies”) for consideration of $178.5 million, $102.5 million, and $82.6 million on September 9, 2021, December 29, 2021, and December 31, 2021, respectively. The Company accounted for the acquisitions of the Acquired Companies under the acquisition method. Accordingly, the purchase price paid for assets acquired and liabilities assumed was allocated, based on relative fair value, to the tangible and intangible assets acquired and liabilities assumed based on their estimated fair values. The Company estimated the fair value of Acquired Companies' identifiable intangible assets to be $136.1 million, including $122.1 million related to customer relationships.
There was a high degree of auditor judgment and subjectivity in applying audit procedures relating to the fair value measurement of intangible assets acquired, specifically the customer relationships, and the fair value of the customer relationship intangible assets acquired was estimated by management through a discounted cash flow model using the multi-period excess earnings method, which involved the use of significant estimates and assumptions related to revenue growth rates and other forecasted financial information, discount rates, and customer attrition rates, among certain other assumptions. The audit effort involved the use of professionals with specialized skill and knowledge to assist in evaluating the audit evidence obtained from these procedures.
How the Critical Audit Matter Was Addressed in the Audit
Our audit procedures related to the management’s estimates of the fair value of the customer relationships intangible assets included the following, among others:
•    We tested the effectiveness of internal controls over business combinations including (i) the controls over the valuation of the acquired intangible assets and (ii) controls over the forecasted financial information including assumptions of revenue growth rates and forecasted financial information, discount rates, and customer attrition rates selected by management.
•    With the assistance of our fair value specialists, we evaluated the reasonableness of the (1) valuation methodologies used and (2) discount rates, including testing the underlying source information, testing the mathematical accuracy of the calculations, and developing a range of independent estimates and comparing those to the discount rates selected by management.
Compared the customer attrition rate to an independently developed estimate and for a sample of underlying data, agreed information to historical records of the Acquired Companies.
•    We evaluated the reasonableness of management’s forecasts of revenue growth rates, gross margin and operating income before taxes by comparing to:
Historical forecasting accuracy for previously acquired companies.
Analyst reports for the Company and the Acquired Companies, as well as industry reports, and comparison of historical rates to companies in the peer group.
Inquiries with appropriate individuals within the Company and Acquired Companies’ operations, engineering, and finance departments regarding the forecasts of revenue growth rates, gross margin and operating income before taxes.
•    We evaluated whether the audit evidence obtained through these procedures was consistent with evidence obtained in other areas of the audit.

/s/ DELOITTEDeloitte & TOUCHETouche LLP
San Jose, California
February 26, 202025, 2022
We have served as the Company’s auditor since 2014.
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REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholdersstockholders and the Board of Directors of Omnicell, Inc.
Opinion on Internal Control over Financial Reporting
We have audited the internal control over financial reporting of Omnicell, Inc. and subsidiaries (the “Company”) as of December 31, 2019,2021, based on criteria established in Internal Control — Integrated Framework (2013)issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). In our opinion, the Company maintained, in all material respects, effective internal control over financial reporting as of December 31, 2019,2021, based on criteria established in Internal Control — Integrated Framework (2013)issued by COSO.
We have also audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the consolidated financial statements as of and for the year ended December 31, 2019,2021, of the Company and our report dated February 26, 2020,25, 2022, expressed an unqualified opinion on those financial statements and included an explanatory paragraph regarding the Company’s change in its method of accounting for leases in fiscal year 2019 due to the adoption of Accounting Standards Codification Topic 842, Leases.statements.
Basis for Opinion
The Company’s management is responsible for maintaining effective internal control over financial reporting and for its assessment of the effectiveness of internal control over financial reporting, included in the accompanying Management’s Report on Internal Control Over Financial Reporting. Our responsibility is to express an opinion on the Company’s internal control over financial reporting based on our audit. We are a public accounting firm registered with the PCAOB and are required to be independent with respect to the Company in accordance with the USU.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether effective internal control over financial reporting was maintained in all material respects. Our audit included obtaining an understanding of internal control over financial reporting, assessing the risk that a material weakness exists, testing and evaluating the design and operating effectiveness of internal control based on the assessed risk, and performing such other procedures as we considered necessary in the circumstances. We believe that our audit provides a reasonable basis for our opinion.
Definition and Limitations of Internal Control over Financial Reporting
A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. A company’s internal control over financial reporting includes those policies and procedures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company; and (3) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the financial statements.
Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

/s/ DELOITTEDeloitte & TOUCHETouche LLP

San Jose, California
February 26, 2020
25, 2022
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OMNICELL, INC.
CONSOLIDATED BALANCE SHEETS
December 31,December 31,
2019201820212020
(In thousands, except par value)(In thousands, except par value)
ASSETSASSETSASSETS
Current assets:Current assets:Current assets:
Cash and cash equivalentsCash and cash equivalents$127,210  $67,192  Cash and cash equivalents$349,051 $485,928 
Accounts receivable and unbilled receivables, net of allowances of $3,227 and $2,582, respectively218,362  196,238  
Accounts receivable and unbilled receivables, net of allowances of $5,272 and $4,286, respectivelyAccounts receivable and unbilled receivables, net of allowances of $5,272 and $4,286, respectively240,894 190,117 
InventoriesInventories108,011  100,868  Inventories119,924 96,298 
Prepaid expensesPrepaid expenses14,478  20,700  Prepaid expenses22,499 16,027 
Other current assetsOther current assets15,177  12,136  Other current assets48,334 41,044 
Total current assetsTotal current assets483,238  397,134  Total current assets780,702 829,414 
Property and equipment, netProperty and equipment, net54,246  51,500  Property and equipment, net71,141 59,073 
Long-term investment in sales-type leases, netLong-term investment in sales-type leases, net19,750  17,082  Long-term investment in sales-type leases, net18,391 22,156 
Operating lease right-of-use assetsOperating lease right-of-use assets56,130  —  Operating lease right-of-use assets48,549 55,114 
GoodwillGoodwill336,539  335,887  Goodwill738,900 499,309 
Intangible assets, netIntangible assets, net124,867  143,686  Intangible assets, net277,616 168,211 
Long-term deferred tax assetsLong-term deferred tax assets14,142  15,197  Long-term deferred tax assets15,883 15,019 
Prepaid commissionsPrepaid commissions48,862  46,143  Prepaid commissions63,795 56,919 
Other long-term assetsOther long-term assets103,036  74,613  Other long-term assets127,519 119,289 
Total assetsTotal assets$1,240,810  $1,081,242  Total assets$2,142,496 $1,824,504 
LIABILITIES AND STOCKHOLDERS’ EQUITYLIABILITIES AND STOCKHOLDERS’ EQUITYLIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:Current liabilities:Current liabilities:
Accounts payableAccounts payable$46,380  $38,038  Accounts payable$71,513 $40,309 
Accrued compensationAccrued compensation44,155  41,660  Accrued compensation71,130 55,750 
Accrued liabilitiesAccrued liabilities55,567  43,047  Accrued liabilities133,167 80,311 
Deferred revenues, netDeferred revenues, net90,894  81,835  Deferred revenues, net112,196 100,053 
Convertible senior notes, netConvertible senior notes, net488,152 — 
Total current liabilitiesTotal current liabilities236,996  204,580  Total current liabilities876,158 276,423 
Long-term deferred revenuesLong-term deferred revenues7,083  10,582  Long-term deferred revenues20,194 5,673 
Long-term deferred tax liabilitiesLong-term deferred tax liabilities39,090  41,484  Long-term deferred tax liabilities51,705 39,633 
Long-term operating lease liabilitiesLong-term operating lease liabilities50,669  —  Long-term operating lease liabilities39,911 48,897 
Other long-term liabilitiesOther long-term liabilities11,718  9,562  Other long-term liabilities7,839 19,174 
Long-term debt50,000  135,417  
Convertible senior notes, netConvertible senior notes, net— 467,201 
Total liabilitiesTotal liabilities395,556  401,625  Total liabilities995,807 857,001 
Commitments and contingencies (Note 12) 
Commitments and contingencies (Note 13)Commitments and contingencies (Note 13)00
Stockholders’ equity:Stockholders’ equity:Stockholders’ equity:
Preferred stock, $0.001 par value, 5,000 shares authorized; 0 shares issued—  —  
Common stock, $0.001 par value, 100,000 shares authorized; 51,277 and 49,480 shares issued; 42,132 and 40,335 shares outstanding, respectively51  50  
Treasury stock at cost, 9,145 shares outstanding, respectively(185,074) (185,074) 
Preferred stock, $0.001 par value, 5,000 shares authorized; no shares issuedPreferred stock, $0.001 par value, 5,000 shares authorized; no shares issued— — 
Common stock, $0.001 par value, 100,000 shares authorized; 54,073 and 52,677 shares issued; 44,179 and 42,783 shares outstanding, respectivelyCommon stock, $0.001 par value, 100,000 shares authorized; 54,073 and 52,677 shares issued; 44,179 and 42,783 shares outstanding, respectively54 53 
Treasury stock at cost, 9,894 shares outstanding, respectivelyTreasury stock at cost, 9,894 shares outstanding, respectively(238,109)(238,109)
Additional paid-in capitalAdditional paid-in capital780,931  678,041  Additional paid-in capital1,024,580 920,359 
Retained earningsRetained earnings258,792  197,454  Retained earnings368,571 290,722 
Accumulated other comprehensive lossAccumulated other comprehensive loss(9,446) (10,854) Accumulated other comprehensive loss(8,407)(5,522)
Total stockholders’ equityTotal stockholders’ equity845,254  679,617  Total stockholders’ equity1,146,689 967,503 
Total liabilities and stockholders’ equityTotal liabilities and stockholders’ equity$1,240,810  $1,081,242  Total liabilities and stockholders’ equity$2,142,496 $1,824,504 
The accompanying notes are an integral part of these Consolidated Financial Statements.
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OMNICELL, INC.
CONSOLIDATED STATEMENTS OF OPERATIONS
Year Ended December 31,Year Ended December 31,
201920182017202120202019
(In thousands, except per share data)(In thousands, except per share data)
Revenues:Revenues:Revenues:
Product revenuesProduct revenues$659,602  $569,595  $510,201  Product revenues$812,512 $636,031 $659,602 
Services and other revenuesServices and other revenues237,425  217,714  202,513  Services and other revenues319,506 256,177 237,425 
Total revenuesTotal revenues897,027  787,309  712,714  Total revenues1,132,018 892,208 897,027 
Cost of revenues:Cost of revenues:Cost of revenues:
Cost of product revenuesCost of product revenues344,914  312,360  304,842  Cost of product revenues422,855 354,004 344,914 
Cost of services and other revenuesCost of services and other revenues115,201  102,619  89,235  Cost of services and other revenues154,510 124,912 115,201 
Total cost of revenuesTotal cost of revenues460,115  414,979  394,077  Total cost of revenues577,365 478,916 460,115 
Gross profitGross profit436,912  372,330  318,637  Gross profit554,653 413,292 436,912 
Operating expenses:Operating expenses:Operating expenses:
Research and developmentResearch and development68,644  64,843  66,022  Research and development75,716 70,161 68,644 
Selling, general, and administrativeSelling, general, and administrative289,916  263,095  241,470  Selling, general, and administrative389,430 307,605 289,916 
Total operating expensesTotal operating expenses358,560  327,938  307,492  Total operating expenses465,146 377,766 358,560 
Income from operationsIncome from operations78,352  44,392  11,145  Income from operations89,507 35,526 78,352 
Interest and other income (expense), netInterest and other income (expense), net(4,419) (8,776) (6,633) Interest and other income (expense), net(23,500)(6,177)(4,419)
Income before provision for income taxesIncome before provision for income taxes73,933  35,616  4,512  Income before provision for income taxes66,007 29,349 73,933 
Provision for (benefit from) income taxesProvision for (benefit from) income taxes12,595  (2,113) (26,006) Provision for (benefit from) income taxes(11,842)(2,845)12,595 
Net incomeNet income$61,338  $37,729  $30,518  Net income$77,849 $32,194 $61,338 
Net income per share:Net income per share:Net income per share:
BasicBasic$1.48  $0.96  $0.81  Basic$1.79 $0.76 $1.48 
DilutedDiluted$1.43  $0.93  $0.79  Diluted$1.62 $0.74 $1.43 
Weighted-average shares outstanding:Weighted-average shares outstanding:Weighted-average shares outstanding:
Basic Basic  41,462  39,242  37,483  Basic43,475 42,583 41,462 
DilutedDiluted42,943  40,559  38,712  Diluted47,943 43,743 42,943 
The accompanying notes are an integral part of these Consolidated Financial Statements.

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OMNICELL, INC.
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
Year Ended December 31,Year Ended December 31,
201920182017202120202019
(In thousands) (In thousands)
Net incomeNet income$61,338  $37,729  $30,518  Net income$77,849 $32,194 $61,338 
Other comprehensive income (loss), net of reclassification adjustments:Other comprehensive income (loss), net of reclassification adjustments:Other comprehensive income (loss), net of reclassification adjustments:
Unrealized loss on interest rate swap contracts, net of taxUnrealized loss on interest rate swap contracts, net of tax(420) (421) (404) Unrealized loss on interest rate swap contracts, net of tax— — (420)
Foreign currency translation adjustmentsForeign currency translation adjustments1,828  (4,320) 3,810  Foreign currency translation adjustments(2,885)3,924 1,828 
Other comprehensive income (loss)Other comprehensive income (loss)1,408  (4,741) 3,406  Other comprehensive income (loss)(2,885)3,924 1,408 
Comprehensive incomeComprehensive income$62,746  $32,988  $33,924  Comprehensive income$74,964 $36,118 $62,746 
The accompanying notes are an integral part of these Consolidated Financial Statements.

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OMNICELL, INC.
CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY
Common StockTreasury Stock
Additional
Paid-In
Capital
Accumulated
Earnings
Accumulated Other
Comprehensive Income (Loss)
Stockholders’
Equity
Common StockTreasury Stock
Additional
Paid-In
Capital
Accumulated
Earnings
Accumulated Other
Comprehensive Income (Loss)
Stockholders’
Equity
SharesAmountSharesAmountSharesAmountSharesAmount
(In thousands) (In thousands)
Balances as of December 31, 201645,778  $46  (9,145) $(185,074) $525,758  $127,625  $(9,519) $458,836  
Balances as of December 31, 2018Balances as of December 31, 201849,480 $50 (9,145)$(185,074)$678,041 $197,454 $(10,854)$679,617 
Net incomeNet income—  —  —  —  —  30,518  —  30,518  Net income— — — — — 61,338 — 61,338 
Other comprehensive incomeOther comprehensive income—  —  —  —  —  —  3,406  3,406  Other comprehensive income— — — — — — 1,408 1,408 
At the market equity offering, net of costsAt the market equity offering, net of costs294  —  —  —  13,900  —  —  13,900  At the market equity offering, net of costs460 — — — 37,806 — — 37,806 
Share-based compensationShare-based compensation—  —  —  —  21,857  —  —  21,857  Share-based compensation— — — 34,049 — — 34,049 
Issuance of common stock under employee stock plansIssuance of common stock under employee stock plans1,505   —  —  30,121  —  —  30,123  Issuance of common stock under employee stock plans1,337 — — 40,705 — — 40,706 
Tax payments related to restricted stock unitsTax payments related to restricted stock units—  —  —  —  (5,892) —  —  (5,892) Tax payments related to restricted stock units— — — — (9,670)— — (9,670)
Cumulative effect of a change in accounting principle related to share-based compensation—  —  —  —  —  1,582  —  1,582  
Income tax benefits from employee stock plans—  —  —  —  11  —  —  11  
Balances as of December 31, 201747,577  48  (9,145) (185,074) 585,755  159,725  (6,113) 554,341  
Balances as of December 31, 2019Balances as of December 31, 201951,277 51 (9,145)(185,074)780,931 258,792 (9,446)845,254 
Net incomeNet income—  —  —  —  —  37,729  —  37,729  Net income— — — — — 32,194 — 32,194 
Other comprehensive incomeOther comprehensive income— — — — — — 3,924 3,924 
Share-based compensationShare-based compensation— — — — 44,697 — — 44,697 
Issuance of common stock under employee stock plansIssuance of common stock under employee stock plans1,400 — — 54,268 — — 54,270 
Tax payments related to restricted stock unitsTax payments related to restricted stock units— — — (8,738)— — (8,738)
Stock repurchasesStock repurchases— — (749)(53,035)— — — (53,035)
Equity component of convertible senior note issuance, net of issuance costsEquity component of convertible senior note issuance, net of issuance costs— — — — 97,830 — — 97,830 
Purchase of convertible note hedgePurchase of convertible note hedge— — — — (100,625)— — (100,625)
Sale of warrantsSale of warrants— — — — 51,290 — — 51,290 
Tax benefits related to convertible senior notes and convertible note hedgeTax benefits related to convertible senior notes and convertible note hedge— — — — 706 — — 706 
Cumulative effect of a change in accounting principle related to credit lossesCumulative effect of a change in accounting principle related to credit losses— — — — — (264)— (264)
Balances as of December 31, 2020Balances as of December 31, 202052,677 53 (9,894)(238,109)920,359 290,722 (5,522)967,503 
Net incomeNet income— — — — — 77,849 — 77,849 
Other comprehensive lossOther comprehensive loss—  —  —  —  —  —  (4,741) (4,741) Other comprehensive loss— — — — — — (2,885)(2,885)
At the market equity offering, net of costs557   —  —  39,566  —  —  39,567  
Share-based compensationShare-based compensation—  —  —  —  28,885  —  —  28,885  Share-based compensation— — — — 53,160 — — 53,160 
Issuance of common stock under employee stock plansIssuance of common stock under employee stock plans1,346   —  —  30,610  —  —  30,611  Issuance of common stock under employee stock plans1,396 — — 67,347 — — 67,348 
Tax payments related to restricted stock unitsTax payments related to restricted stock units—  —  —  —  (6,775) —  —  (6,775) Tax payments related to restricted stock units— — — — (16,286)— — (16,286)
Balances as of December 31, 201849,480  50  (9,145) (185,074) 678,041  197,454  (10,854) 679,617  
Net income—  —  —  —  —  61,338  —  61,338  
Other comprehensive income—  —  —  —  —  —  1,408  1,408  
At the market equity offering, net of costs460  —  —  —  37,806  —  —  37,806  
Share-based compensation—  —  —  —  34,049  —  —  34,049  
Issuance of common stock under employee stock plans1,337   —  —  40,705  —  —  40,706  
Tax payments related to restricted stock units—  —  —  —  (9,670) —  —  (9,670) 
Balances as of December 31, 201951,277  $51  (9,145) $(185,074) $780,931  $258,792  $(9,446) $845,254  
Balances as of December 31, 2021Balances as of December 31, 202154,073 $54 (9,894)$(238,109)$1,024,580 $368,571 $(8,407)$1,146,689 
The accompanying notes are an integral part of these Consolidated Financial Statements.
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OMNICELL, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS
Year Ended December 31,Year Ended December 31,
201920182017202120202019
(In thousands)(In thousands)
Operating ActivitiesOperating ActivitiesOperating Activities
Net incomeNet income$61,338  $37,729  $30,518  Net income$77,849 $32,194 $61,338 
Adjustments to reconcile net income to net cash provided by operating activities:Adjustments to reconcile net income to net cash provided by operating activities:Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortizationDepreciation and amortization53,559  51,350  51,511  Depreciation and amortization72,990 61,067 53,559 
Loss on disposal of property and equipmentLoss on disposal of property and equipment445  133  512  Loss on disposal of property and equipment433 267 445 
Share-based compensation expenseShare-based compensation expense34,049  28,885  21,857  Share-based compensation expense53,160 44,697 34,049 
Income tax benefits from employee stock plans—  —  11  
Deferred income taxesDeferred income taxes(1,339) (5,705) (31,365) Deferred income taxes(3,272)(6,546)(1,339)
Amortization of operating lease right-of-use assetsAmortization of operating lease right-of-use assets10,562  —  —  Amortization of operating lease right-of-use assets11,941 10,528 10,562 
Amortization of debt issuance costsAmortization of debt issuance costs2,204  2,292  1,590  Amortization of debt issuance costs3,440 1,597 2,204 
Amortization of discount on convertible senior notesAmortization of discount on convertible senior notes18,608 4,766 — 
Changes in operating assets and liabilities:Changes in operating assets and liabilities:Changes in operating assets and liabilities:
Accounts receivable and unbilled receivablesAccounts receivable and unbilled receivables(21,540) (6,192) (40,598) Accounts receivable and unbilled receivables(40,973)36,842 (21,540)
InventoriesInventories(8,123) (6,763) (26,840) Inventories(25,695)12,359 (8,123)
Prepaid expensesPrepaid expenses2,909  (308) (4,920) Prepaid expenses(5,678)(2,081)2,909 
Other current assetsOther current assets(2,010) 1,170  (2,074) Other current assets2,801 (6,408)(2,010)
Investment in sales-type leasesInvestment in sales-type leases(3,699) (1,680) 6,625  Investment in sales-type leases3,346 (2,882)(3,699)
Prepaid commissionsPrepaid commissions(2,719) (4,711) (3,966) Prepaid commissions(6,876)(8,057)(2,719)
Other long-term assetsOther long-term assets4,528  (7,077) (1,373) Other long-term assets(3,258)(7,675)4,528 
Accounts payableAccounts payable7,893  (9,154) 19,709  Accounts payable29,084 (6,300)7,893 
Accrued compensationAccrued compensation2,495  14,419  519  Accrued compensation12,312 11,595 2,495 
Accrued liabilitiesAccrued liabilities3,045  8,223  4,383  Accrued liabilities34,859 4,374 3,045 
Deferred revenuesDeferred revenues5,445  3,020  (2,334) Deferred revenues24,179 7,620 5,445 
Operating lease liabilitiesOperating lease liabilities(10,040) —  —  Operating lease liabilities(12,503)(9,543)(10,040)
Other long-term liabilitiesOther long-term liabilities6,006  (1,665) 1,069  Other long-term liabilities(14,938)7,456 6,006 
Net cash provided by operating activities Net cash provided by operating activities  145,008  103,966  24,834  Net cash provided by operating activities231,809 185,870 145,008 
Investing ActivitiesInvesting ActivitiesInvesting Activities
Purchase of intangible assets, intellectual property, and patents—  —  (160) 
Software development for external useSoftware development for external use(45,770) (30,677) (15,040) Software development for external use(29,368)(32,024)(45,770)
Purchases of property and equipmentPurchases of property and equipment(15,894) (23,697) (15,341) Purchases of property and equipment(28,967)(22,842)(15,894)
Business acquisitions, net of cash acquiredBusiness acquisitions, net of cash acquired—  —  (4,446) Business acquisitions, net of cash acquired(354,163)(225,000)— 
Net cash used in investing activities Net cash used in investing activities  (61,664) (54,374) (34,987) Net cash used in investing activities(412,498)(279,866)(61,664)
Financing ActivitiesFinancing ActivitiesFinancing Activities
Proceeds from debt and revolving credit facility—  —  59,000  
Proceeds from revolving credit facilityProceeds from revolving credit facility— 150,000 — 
Repayment of debt and revolving credit facilityRepayment of debt and revolving credit facility(90,000) (77,000) (102,500) Repayment of debt and revolving credit facility— (200,000)(90,000)
Payments for debt issuance costs(2,321) —  (2,106) 
Payment for contingent consideration—  —  (2,400) 
At the market offering, net of offering costs37,806  39,567  13,900  
Payments for debt issuance costs for revolving credit facilityPayments for debt issuance costs for revolving credit facility— (550)(2,321)
Proceeds from issuance of convertible senior notes, net of issuance costsProceeds from issuance of convertible senior notes, net of issuance costs— 559,665 — 
Purchase of convertible note hedgePurchase of convertible note hedge— (100,625)— 
Proceeds from sale of warrantsProceeds from sale of warrants— 51,290 — 
At the market equity offering, net of offering costsAt the market equity offering, net of offering costs— — 37,806 
Proceeds from issuances under stock-based compensation plansProceeds from issuances under stock-based compensation plans40,706  30,611  30,121  Proceeds from issuances under stock-based compensation plans67,348 54,270 40,706 
Employees’ taxes paid related to restricted stock unitsEmployees’ taxes paid related to restricted stock units(9,670) (6,775) (5,892) Employees’ taxes paid related to restricted stock units(16,286)(8,738)(9,670)
Net cash used in financing activities  (23,479) (13,597) (9,877) 
Stock repurchasesStock repurchases— (53,035)— 
Change in customer funds, netChange in customer funds, net(3,699)3,992 — 
Net cash provided by (used in) financing activitiesNet cash provided by (used in) financing activities47,363 456,269 (23,479)
Effect of exchange rate changes on cash and cash equivalentsEffect of exchange rate changes on cash and cash equivalents153  (1,227) (2,034) Effect of exchange rate changes on cash and cash equivalents(974)437 153 
Net increase (decrease) in cash and cash equivalents 60,018  34,768  (22,064) 
Cash and cash equivalents at beginning of period67,192  32,424  54,488  
Cash and cash equivalents at end of period$127,210  $67,192  $32,424  
Net increase (decrease) in cash, cash equivalents, and restricted cashNet increase (decrease) in cash, cash equivalents, and restricted cash(134,300)362,710 60,018 
Cash, cash equivalents, and restricted cash at beginning of periodCash, cash equivalents, and restricted cash at beginning of period489,920 127,210 67,192 
Cash, cash equivalents, and restricted cash at end of periodCash, cash equivalents, and restricted cash at end of period$355,620 $489,920 $127,210 
The accompanying notes are an integral part of these Consolidated Financial Statements.
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OMNICELL, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS (CONTINUED)
Year Ended December 31,Year Ended December 31,
201920182017202120202019
(In thousands)(In thousands)
Reconciliation of cash, cash equivalents, and restricted cash to the Consolidated Balance Sheets:Reconciliation of cash, cash equivalents, and restricted cash to the Consolidated Balance Sheets:
Cash and cash equivalentsCash and cash equivalents$349,051 $485,928 $127,210 
Restricted cash included in Other current assetsRestricted cash included in Other current assets6,569 3,992 — 
Cash, cash equivalents, and restricted cash at end of periodCash, cash equivalents, and restricted cash at end of period$355,620 $489,920 $127,210 
Supplemental cash flow informationSupplemental cash flow informationSupplemental cash flow information
Cash paid for interestCash paid for interest$3,582  $7,487  $6,550  Cash paid for interest$1,917 $522 $3,582 
Cash paid for taxes, net of refunds$7,761  $3,489  $7,780  
Income taxes paid (refunds received), netIncome taxes paid (refunds received), net$(1,733)$10,343 $7,761 
Supplemental disclosure of non-cash activitiesSupplemental disclosure of non-cash activitiesSupplemental disclosure of non-cash activities
Non-cash activity business acquisition$—  $—  $3,400  
Unpaid purchases of property and equipmentUnpaid purchases of property and equipment$913  $1,123  $1,691  Unpaid purchases of property and equipment$883 $405 $913 
Transfers between inventory and property and equipment, netTransfers between inventory and property and equipment, net$1,552  $2,032  $—  Transfers between inventory and property and equipment, net$1,876 $— $1,552 
Transfers from prepaid expenses to property and equipmentTransfers from prepaid expenses to property and equipment$3,313  $—  $—  Transfers from prepaid expenses to property and equipment$— $— $3,313 
Right-of-use assets obtained in exchange for new operating lease liabilities$1,204  $—  $—  
Balance transfer from term loan to revolving credit facilityBalance transfer from term loan to revolving credit facility$80,000  $—  $—  Balance transfer from term loan to revolving credit facility$— $— $80,000 
The accompanying notes are an integral part of these Consolidated Financial Statements.
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OMNICELL, INC.
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
Note 1.     Organization and Summary of Significant Accounting Policies
Business
Omnicell, Inc. was incorporated in California in 1992 under the name Omnicell Technologies, Inc. and reincorporated in Delaware in 2001 as Omnicell, Inc. The Company’s major products and related services are medication management automation solutions and adherence tools for healthcare systems and pharmacies, which are sold in its principal market, the healthcare industry. The Company’s market is primarily located in the United States and Europe. “Omnicell” or the “Company” collectively refer to Omnicell, Inc. and its subsidiaries.
Basis of Presentation
The accompanying Consolidated Financial Statements have been prepared in accordance with U.S. Generally Accepted Accounting Principles (“GAAP”) and include all adjustments necessary for the fair presentation of the Company’s consolidated financial position, results of operations, and cash flows for the periods presented.
During 2019, the Company completed a series of intercompany transactions in connection with an internal legal entity restructuring to simplify its organizational structure as described below.
In November 2019, Aesynt Holding B.V. sold its shares in Aesynt Holdings, Inc. ("Aesynt Holdings") to Omnicell International, Inc. (which was subsequently converted into a limited liability company and renamed Omnicell International, LLC) ("Omnicell International"). Omnicell International subsequently distributed the Aesynt Holdings shares to its parent company, Omnicell, Inc. On December 31, 2019, the following series of mergers occurred: (i) Dixie Drawl, LLC d/b/a InPharmics ("InPharmics") merged with and into its parent company, Aesynt Incorporated ("Aesynt"), with Aesynt as the surviving entity; (ii) Aesynt merged with and into its parent company, Aesynt Holdings, with Aesynt Holdings as the surviving entity; and (iii) Aesynt Holdings merged with and into its parent company, Omnicell, Inc., with Omnicell, Inc. as the surviving entity.
On November 25, 2019, Aesynt Canada, Inc. ("Aesynt Canada") entered into an asset purchase agreement with Omnicell, Inc., under which Omnicell, Inc. acquired all assets of Aesynt Canada. On November 29, 2019, Aesynt Canada liquidated into its parent company, Aruba S.r.l ("Aruba"). Prior to the liquidation, all liabilities of Aesynt Canada were settled.
On November 21, 2019, Ateb Canada Ltd. ("Ateb Canada") entered into an asset purchase agreement with Ateb, Inc. ("Ateb"), under which Ateb acquired all assets of Ateb Canada. On November 25, 2019, Ateb Canada liquidated into its parent company, Omnicell, Inc. Prior to the liquidation, all liabilities of Ateb Canada were settled.
The transactions described above were accounted for as transactions between entities under common control as all entities involved were wholly owned subsidiaries of Omnicell, Inc. The transactions did not have a material impact to the Company's Consolidated Financial Statements.
Principles of Consolidation
The Consolidated Financial Statements include the accounts of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions have been eliminated in consolidation.
On April 12, 2017,September 9, 2021, the Company completed its acquisition of InPharmics.RxInnovation Inc., operating as FDS Amplicare (“FDS Amplicare”); on December 29, 2021, the Company completed its acquisition of ReCept Holdings, Inc. (“ReCept”); and on December 31, 2021, the Company completed its acquisition of MarkeTouch Media, LLC (“MarkeTouch Media”). The Consolidated Financial Statements include the results of operations of thisthese recently acquired company,companies, commencing as of itsthe respective acquisition date.dates. The significant accounting policies of the acquired businessbusinesses have been aligned to conform to the accounting policies of Omnicell.
Reclassifications and Adjustments
Certain prior-year amounts have been reclassified to conform with current-period presentation. These reclassifications include (i) a change in the presentation of proceeds from debt and revolving credit facility and payments for debt issuance costs in the Consolidated Statements of Cash Flows for the year ended December 31, 2017, and (ii) a change in the presentation of certain items in the reconciliation of the provision for income taxes for the years ended December 31, 2018 and 2017 in Note 16, Income Taxes, of the Notes to Consolidated Financial Statements. These changes were not deemed material and were included to conform with current-period classification and presentation.
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Use of Estimates
The preparation of financial statements in accordance with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the Company’s Consolidated Financial Statements and accompanying Notes. Management bases its estimates on historical experience and various other assumptions believed to be reasonable. Although these estimates are based on management’s best knowledge of current events and actions that may impact the Company in the future, actual results may be different from the estimates. The Company’s critical accounting policies are those that affect its financial statements materially and involve difficult, subjective, or complex judgments by management. Those policies are revenue recognition; allowance for credit losses for accounts receivable and unbilled receivables; notes receivable from investment in sales-type leases; operating lease right-of-use assets and liabilities; inventory valuation; capitalized software development costs; impairment of goodwill; purchased intangibles and long-lived assets; fair value of assets acquired and liabilities assumed in business combinations; convertible senior notes; share-based compensation; and accounting for income taxes. As of December 31, 2021, the Company is not aware of any events or circumstances that would require an update to its estimates, judgments, or revisions to the carrying value of its assets or liabilities.
Segment Reporting
The Company'sCompany manages its operations as a single segment for the purposes of assessing performance and making operating decisions. The Company’s Chief Operating Decision Maker ("CODM"(“CODM”) is its Chief Executive Officer. The CODM allocates resources and evaluates the performance of the Company at the consolidated level using information about its revenues, gross profit, income from operations, and other key financial data. The Company previously operated and reported its business in 2 segments: Automation and Analytics, and Medication Adherence. In the fourth quarter of 2018, the Company introduced the vision of the autonomous pharmacy, a more fully automated and digitized system of medication management, in order to address changes in the healthcare industry as the Company executes on its plan to deliver end-to-end solutions with greater emphasis on automating manual processes for its customers. These industry changes include the continuing consolidation of healthcare systems, rising pharmaceutical costs, and increased scrutiny on controlled substances. In an effort to deliver on its strategic vision, the Company initiated a company-wide organizational realignment in the fourth quarter of 2018 to centrally manage its business operations, including the development and marketing of all of the Company’s products, sales and distribution, supply chain and inventory management, as well as regulatory and quality functions. As a result of this organizational realignment, allAll significant operating decisions are based upon an analysis of the Company as one operating segment. Therefore, effective January 1, 2019, the Company started reporting as only 1 operating segment, which is the same as theits reporting segment. Accordingly, prior period segment information has been revised to conform with current period presentation.
Foreign Currency Translation and Remeasurement
Most of the Company’s foreign subsidiaries use the local currency of their respective countries as their functional currency. The Company translates the assets and liabilities of such non-U.S. dollar functional currency subsidiaries into U.S. dollars using exchange rates in effect at the end of each period. Revenue and expenses for these subsidiaries are translated using rates that approximate those in effect during the period. Gains and losses from these translations are recorded as foreign currency translation adjustments and included in accumulated other comprehensive income (loss) in stockholders’ equity.
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Assets and liabilities denominated in a currency other than the functional currency are remeasured into the respective entity’s functional currency. Monetary assets and liabilities are remeasured at exchange rates in effect at the end of each period, and non-monetary assets and liabilities are remeasured at historical rates. Gains and losses from foreign currency remeasurement of monetary assets and liabilities are recorded in interest and other income (expense), net.
Revenue Recognition
The Company earns revenues from sales of its products and related services, which are sold in the healthcare industry, its principal market. The transaction price of each contract with a customer is allocated to the identified performance obligations based on the relative fair value of each obligation. The Company’s customer arrangements typically include one or more of the following performance obligations:revenue categories:
Products.Connected devices, software licenses, and other. Software-enabled equipmentconnected devices and software licenses that managesmanage and regulatesregulate the storage and dispensing of pharmaceuticals, consumableconsumables blister cards, and packaging equipment and other medical supplies. This revenue category is often sold through long-term, sole-source agreements with multi-year co-development plans. Solutions in this category include, but are not limited to, XT Series automated dispensing systems, the XR2 Automated Central Pharmacy System, and IV compounding automation solutions.
Software.Technical services. Additional software applications that enable incremental functionality of the Company’s equipment or services.
Installation. Installation of equipment as integrated systems at customer sites.
Post-installation technical support. Phonesupport and other related services, including phone support, on-site service, parts, and access to unspecified software updates and enhancements, if and when available. This revenue category is often supported by multi-year or annual contractual agreements.
ProfessionalConsumables. Medication adherence packaging, labeling, and other one-time use packaging including multimed adherence packaging and single dose blister cards which are used by retail, community, and outpatient pharmacies, as well as by institutional pharmacies serving long-term care and other sites outside the acute care hospital, and are designed to improve patient engagement and adherence to prescriptions.
Software-as-a-service (“SaaS”), subscription software, and technology-enabled services. Other customerEmerging software and service solutions which are offered on a subscription basis with fees typically based either on transaction volume or a fee over a specified period of time. Solutions in this category include, but are not limited to, EnlivenHealth inclusive of FDS Amplicare and MarkeTouch Media, 340B solutions, ReCept management services, such as training and consulting.services associated with Omnicell One, Central Pharmacy Dispensing Services, including the XR2 Automated Central Pharmacy system, and Central Pharmacy Compounding Services, including IV compounding automation solutions.
The following table summarizes revenue recognition for each revenue category which is further discussed below:
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Revenue CategoryTiming of Revenue RecognitionIncome Statement Classification
Connected devices, software licenses, and otherPoint in time, as transfer of control occurs, generally upon installation and acceptance by the customerProduct
Technical servicesOver time, as services are provided, typically ratably over the service termService
ConsumablesPoint in time, as transfer of control occurs, generally upon shipment to or receipt by customerProduct
SaaS, subscription software, and technology-enabled servicesOver time, as services are providedService
Prior to recognizing revenue, the Company identifies the contract, performance obligations, and transaction price, and allocates the transaction price to the performance obligations. All identified contracts meet the following required criteria:
Parties to the contract have approved the contract (in writing, orally, or in accordance with other customary business practices) and are committed to perform their respective obligations. A majority of the Company’s contracts are evidenced by a non-cancelable written agreement. Contracts for consumable products are generally evidenced by an order placed via phone or a manual purchase order.
Entity can identify each party’s rights regarding the goods or services to be transferred. Contract terms are documented within the written agreements. Where a written contract does not exist, such as for consumable products, the rights of each party are understood as following the Company’s standard business process and terms.
The entity can identify the payment terms for the goods or services to be transferred. Payment terms are documented within the agreement and are generally net 30 to 60 days from shipment of tangible product or services performed for customers in the United States. Where a written contract does not exist, the Company’s standard payment terms are net 30 day terms.
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The contract has commercial substance (that is the risk, timing, or amount of the entity’s future cash flows is expected to change as a result of the contract.)contract). The Company’s agreements are an exchange of cash for a combination of products and services which result in changes in the amount of the Company’s future cash flows.
It is probable the entity will collect the consideration to which it will be entitled in exchange for the goods or services that will be transferred to the customer. The Company performs a credit check for all significant customers or transactions and where collectability is not probable, payment in full or a substantial down payment prior to shipment is typically required to help assure the full agreed upon contract price will be collected.
The Company often enters into change orders which modify the product to be received by the customer pursuant to certain contracts. Changes to any contract are accounted for as a modification of the existing contract to the extent the goods and services to be delivered as part of the contract are generally consistent with the nature and type of those to be provided under the terms of the original contract. Examples of such change orders include the addition or removal of units of equipment or changes to the configuration of the equipment where the overall nature of the contract remains intact. The Company’s change orders generally result in the change being accounted for as modifications of existing contracts given the nature of the impacted orders.
Distinct goods or services are identified as performance obligations. A series of distinct goods or services that are substantially the same and that have the same pattern of transfer to the customer are considered a single performance obligation. Where a good or service is determined not to be distinct, the Company combines the good or service with other promised goods or services until a bundle of goods or services that is distinct is identified. To identify its performance obligations, the Company considers all of the products or services promised in the contract regardless of whether they are explicitly stated or are implied by customary business practices. When performance obligations are included in separate contracts, the Company considers an entire customer arrangement to determine if separate contracts should be considered combined for the purposes of revenue recognition. Most of the Company’s sales, other than renewals of support and maintenance, contain multiple performance obligations, with a combination of hardware systems, consumables and software products, consumables, support and maintenance, and professional services.
The transaction price of a contract is determined based on the fixed consideration, net of an estimate for variable consideration such as various discounts or rebates provided to customers. As a result of the Company’s commercial selling practices, contract prices are generally fixed with minimal, if any, variable consideration.
The transaction price is allocated to separate performance obligations proportionally based on the standalone selling price of each performance obligation. Standalone selling price is best evidenced by the price the Company charges for the good or service when selling it separately in similar circumstances to similar customers. Other than for the renewal of annual support services contracts, the Company’s products and services are not generally sold separately. The Company uses an amount discounted from the list price as a best estimated selling price.
The Company recognizes revenue when the performance obligation has been satisfied by transferring a promised good or service to a customer. The good or service is transferred when or as the customer obtains control of the good or service. Determining when control transfers requires management to make judgments that affect the timing of revenues recognized. Generally, for products requiring a complex implementation, control passes when the product is installed and ready for use. For all other products, control generally passes when product has been shipped and title has passed. For maintenance contracts and certain other services, including SaaS, subscription software, and technology-enabled services, provided on a subscription basis, control passes to the customer over time, generally ratably over the service term as the Company provides a stand-ready service to servicefor the customer’s equipment. Time and material services
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transfer control to the customer at the time the services are provided. The portion of the transaction price allocated to the Company’s unsatisfied performance obligations recorded as deferred revenues, net of deferred cost of goods sold, at December 31, 20192021 and 20182020 were $98.0$132.4 million and $92.4$105.7 million, respectively, of which $90.9$112.2 million and $81.8$100.1 million, respectively, are expected to be completed within one year and are presented as current deferred revenues, net on the Consolidated Balance Sheets. Remaining performance obligations primarily relate to maintenance contracts and are recognized ratably over the remaining term of the contract, generally not more than five years.
Revenues, contract assets, and contract liabilities are recorded net of associated taxes.
The Company generally invoices customers for products upon shipment. Invoicing associated with the service portion of agreements are generally periodic and are billed on a monthly, quarterly, or annual basis. In certain circumstances, multiple years are billed at one time.
The amount invoiced for equipment and software is typically reflected in both accounts receivable and deferred revenues, net. The Company typically recognizes product revenue, and correspondingly reduces deferred revenues, net, for equipment and on-premise software upon written customer acceptance of installation. Consumables are recorded as revenue upon shipment to or receipt by the customer, depending upon contract terms. The portion of deferred revenues, net, not expected to be recognized as revenue within twelve months of the balance sheet date are included in long-term deferred revenues on the Consolidated Balance Sheets.
From time to time, the Company enters into change orders which modify the product to be received by the customer pursuant to certain contracts. Changes to any contract are accounted for as a modification of the existing contract to the extent the goods and services to be delivered as part of the contract are generally consistent with the nature and type of those to be provided under the terms of the original contract. Examples of such change orders include the addition or removal of units of
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equipment or changes to the configuration of the equipment where the overall nature of the contract remains intact. The Company’s change orders generally result in the change being accounted for as modifications of existing contracts given the nature of the impacted orders.
In the normal course of business, the Company typically does not accept product returns unless the item is defective as manufactured or the configuration of the product is incorrect. The Company establishes provisions for estimated returns based on historical product returns. The allowance for sales returns is not material to the Consolidated Financial Statements for any periods presented.
The Company contracts with Group Purchasing Organizations (“GPOs”), each of which functions as a purchasing agent on behalf of member hospitals and other healthcare providers, as well asproviders. The Company also has a Federal Supply Schedule Contract with the Department of Veterans Affairs (the “GSA Contract”), allowing the Department of Veterans Affairs, the Department of Defense, and other Federal government entities and agencies.customers to purchase the Company’s products. Pursuant to the terms of GPO agreements and the GSA Contract, each member or agency contracts directly with Omnicell and can purchase the Company’s productproducts at pre-negotiated contract terms and pricing. GPOs are often owned fully or in part by the Company’s customers, and the Company pays fees to the GPO on completed contracts. The Company also pays the Industrial Funding Fee (“IFF”) to the Department of Veterans Affairs under the GSA Contract. The Company considers these fees consideration paid to customers and records them as reductions to revenue. Fees to GPOs and the IFF were $11.1$17.5 million, $8.7$9.7 million, and $7.4$11.1 million for the years ended December 31, 2019, 2018,2021, 2020, and 2017,2019, respectively. The accounts receivable balances are with individual members of the GPOs and Federal agencies that purchase under the GSA Contract, and therefore no significant concentration of credit risk exists. During the year ended December 31, 2019,2021, sales to members of the ten largest GPOs and Federal agencies that purchase under the GSA Contract accounted for approximately 64%67% of the Company’s total consolidated revenues.
Contract Assets and Contract Liabilities
A contract asset is a right to consideration in exchange for goods or services that the Company has transferred to a customer when that right is conditional and is not just subject to the passage of time. A receivable will be recorded on the balance sheet when the Company has unconditional rights to consideration. A contract liability is an obligation to transfer goods or services for which the Company has received consideration, or for which an amount of consideration is due from the customer. Contract liabilities include customer deposits under non-cancelable contracts, and current and non-current deferred revenue balances. The Company’s contract balances are reported in a net contract asset or liability position on a contract-by-contract basis at the end of each reporting period.
Significant changes in the contract assets and the contract liabilities balances during the period are the result of the issuance of invoices and recognition of deferred revenues in the normal course of business. Unbilled contract assets which were invoiced during the year ended December 31, 2019 as a result of the right to invoice for the transaction consideration becoming unconditional were not material. The contract modifications entered into during the year ended December 31, 20192021 did not have a significant impact on the Company’s contract assets or deferred revenues.
Contract Costs
The Company has determined that thecertain incentive portions of its sales commission plans require capitalization since these payments are directly related to sales achieved during a time period. These commissions are earned on the basis of the total purchase order value of new product bookings. Since there are no commensurate commissions earned on renewal of the service bookings, the Company concluded that the capitalized asset is related to services provided under both the initial contract and renewal periods. The Company applies a practical expedient to account for the incremental costs of obtaining a contract as part of a portfolio of contracts with similar characteristics as the Company expects the effect on the financial statements of applying the practical expedient would not differ materially from applying the accounting guidance to the individual contracts within the portfolio. A pool of contracts is defined as all contracts booked in a particular quarter. The amortization for the capitalized asset is an estimate of the pool’s original contract term, generally one to five years, plus an estimate of future
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customer renewal periods resulting in a total amortization period of ten years. Costs to obtain a contract are allocated amongst performance obligations and recognized as sales and marketing expense consistent with the pattern of revenue recognition. Capitalized costs are periodically reviewed for impairment. AIn accordance with GAAP, while certain compensation elements are expensed as incurred, a portion of the pool’s capitalized asset is recorded as an expense over the first twofive quarters after booking, which represents the estimated period during which the product revenue associated with the contract is recorded. The remaining capitalized contract cost iscosts are recorded as expense ratably over the ten year estimated initial and renewal service periods. The Company recognized contract cost expense of $24.4$25.8 million, $21.1$22.1 million, and $17.9$24.4 million during the years ended December 31, 2019, 2018,2021, 2020, and 2017,2019, respectively. The commission expenses paid or due to be paid as of the consolidated balance sheet date to be recognized in future periods are recorded in long-term prepaid commissions on the Consolidated Balance Sheets. There was 0no impairment loss recorded related to capitalized prepaid commissions as of and for the year ended December 31, 2019.2021.
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Lessor Leases
The Company determines if an arrangement is a lease at inception. The transaction price is allocated to separate performance obligations, generally consisting of a combination of hardware andsystems, software products, installation,support and post-installation technical support,maintenance, and professional services, proportionally based on the standalone selling price of each performance obligation. Standalone selling price is best evidenced by the price the Company charges for the good or service when selling it separately in similar circumstances to similar customers. Other than for the renewal of annual support services contracts, the Company’s products and services are not generally sold separately. The Company uses an amount discounted from the list price as a best estimated selling price.
Sales-Type Leases
The Company enters into non-cancelable sales-type lease arrangements, most of which do not have an option to extend the lease term. At the end of the lease term, the customer must either return the equipment or negotiate a new agreement, resulting in a new purchase or lease transaction. Failure of the customer to either return the equipment or negotiate a new agreement results in the contract becoming a month-to-month rental. Certain sales-type leases automatically renew for successive one yearone-year periods at the end of each lease term withwithout written notice from the customer. The Company’s sales-type lease agreements do not contain any material residual value guarantees.
For sales-type leases, the Company recognizes revenues for its hardware and software products, net of lease execution costs, post-installation product maintenance, and technical support, at the net present value of the lease payment stream upon customer acceptance. The Company recognizes service revenues associated with sales-type leases ratably over the term of the agreement in service revenues in the Consolidated Statements of Operations. The Company recognizes interest income from sales-type leases using the effective interest method. Both hardware and software revenues, and interest income from sales-types leases are recorded in product revenues in the Consolidated Statements of Operations.
The Company optimizes cash flows by selling a majority of its non-U.S. government sales-type leases to third-party leasing finance companies on a non-recourse basis. The Company has no obligation to the leasing company once the lease has been sold. Some of the Company'sCompany’s sales-type leases, mostly those relating to U.S. government hospitals which comprise approximately 53%69% of the lease receivable balance, are retained in-house.
Operating Leases
The Company entered into certain leasing agreements that were classified as operating leases prior to the adoption of the new lease accounting standard.Accounting Standards Codification (“ASC”) 842, Leases. Those agreements in place prior to January 1, 2019 will continue to be treated as operating leases, however, any new leasing agreements entered into on or after January 1, 2019 under these programs are classified and accounted for as sales-type leases in accordance with the new lease accounting standard.ASC 842. The operating lease arrangements entered into prior to January 1, 2019 are non-cancelable, and most automatically renew for successive one yearone-year periods at the end of each lease term absent written notice from the customer. The Company’s operating lease agreements do not contain any material residual value guarantees.
For operating leases, rental income is generally recognized on a straight-line basis over the term of the associated lease, and recorded in services and other revenues in the Consolidated Statements of Operations. Leased assets under operating leases are carried at amortized cost net of accumulated depreciation in property and equipment, net on the Consolidated Balance Sheets. The depreciation expense of the leased assets is recognized on a straight-line basis over the contractual term of the associated lease, and recorded in cost of revenues in the Consolidated Statements of Operations.
Allowance for Credit Losses
The Company is exposed to credit losses primarily through sales of its products and services, as well as its sales-type leasing arrangements. The Company performs credit evaluations of its customers’ financial condition in order to assess each customer’s ability to pay. These evaluations require significant judgment and are based on a variety of factors including, but not limited to, current economic trends, payment history, and a financial review of the customer. The Company continues to monitor customers’ creditworthiness on an ongoing basis.
The Company maintains an allowance for credit losses for accounts receivable, unbilled receivables, and net investment in sales-type leases based on expected credit losses resulting from the inability of its customers to make required payments. The allowance for credit losses is measured using a loss rate method, considering factors such as customers’ credit risk, historical loss experience, current conditions, and forecasts. The allowance for credit losses is measured on a collective (pool) basis by aggregating customer balances with similar risk characteristics. The Company also records a specific allowance based on an analysis of individual past due balances or customer-specific information, such as a decline in creditworthiness or
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bankruptcy. Actual collection losses may differ from management’s estimates, and such differences could be material to the Company’s financial position and results of operations.
The allowance for credit losses is presented in the Consolidated Balance Sheets as a deduction from the respective asset balance. As of December 31, 2021 and 2020, the allowance for credit losses for long-term unbilled receivables and net investment in sales-type leases were not material.
Funds Held for Customers and Customer Fund Liabilities
With the acquisition of the 340B Link Business and ReCept, the Company offers certain products and services in which it is customary for pharmacies or insurance payors to owe funds to the Company which are collected on behalf of, and, after a short holding period, disbursed to, the Company’s customers. The Company presents amounts due from pharmacies and amounts due to be disbursed to customers on a gross basis within other current assets and accrued liabilities, respectively, in the Consolidated Balance Sheets, as such amounts are expected to be settled within one year. Generally, any funds received from the pharmacies or insurance payors that are held by the Company are segregated from its other corporate cash accounts. These funds are classified as restricted cash as the Company is contractually obligated to disburse these amounts to customers.
Sales of Accounts Receivable
The Company records the sale of its accounts receivables in accordance with accounting guidance for transfers and servicing of financial assets. The Company transferred non-recourse accounts receivable totaling $46.7 million, $58.8 million, and $48.3 million during the years ended December 31, 2021, 2020, and 2019, respectively, which approximated fair value, to leasing companies on a non-recourse basis. Accounts receivable balance included approximately $5.6 million and $7.8 million due from third-party leasing companies for transferred non-recourse accounts receivable as of December 31, 2021 and 2020, respectively.
Cash and Cash Equivalents
The Company classifies all highly-liquid investments with original maturities of three months or less as cash equivalents. The Company’s cash and cash equivalent balances include bank accounts and highly-liquid U.S. Government money market funds held in sweep and asset management accounts with financial institutions of high credit quality. The Company continuously monitors the credit worthiness of the financial institutions in which it invests. The Company has not experienced any credit losses from its cash equivalents. Cash and cash equivalents were $349.1 million and $485.9 million as of December 31, 2021 and 2020, respectively. As of December 31, 2021 and 2020, cash equivalents were $320.2 million and $447.2 million, respectively, which consisted of money market funds held in sweep and asset management accounts.
Financial Instruments
For assets and liabilities measured at fair value, the amounts are based on an expected exit price representing the amount that would be received from the sale of an asset or paid to transfer a liability in a transaction between market participants. The fair value may be based on assumptions that market participants would use in pricing an asset or liability. The
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ASC 820, Table of ContentsFair Value Measurement
authoritative guidance on fair value measurements, establishes a consistent framework for measuring fair value on either a recurring or nonrecurring basis whereby inputs used in valuation techniques are assigned a hierarchical level. The following methods were used to estimate the fair value of each class oflevel, as follows:
Level 1 – Observable inputs, such as quoted prices in active markets for identical instruments;
Level 2 – Quoted prices for similar instruments in active markets, or quoted prices for identical instruments in inactive markets; and
Level 3 – Unobservable inputs for financial instruments for which it is practical to estimate that value:
Cash and Cash Equivalents and Fair Value of Financial Instruments
The Company classifies investments as cash equivalents if their original or remaining contractual maturity is three months or less at the date of purchase. Cash equivalents are carried at amounts that approximate fair value due to the short period of time to maturity. Thereflecting Company’s cash balances are maintained in demand deposit accounts with financial institutions of high credit quality. The Company continuously monitors the credit worthiness of the financial institutions in which it invests. The Company has not experienced any credit losses from its cash investments.assumptions.
Interest Rate Swap Agreements
The Company uses interest rate swap agreements to protect the Company against adverse fluctuations in interest rates by reducing its exposure to variability in cash flows relating to interest payments on a portion of its outstanding debt. The Company does not hold or issue any derivative financial instruments for speculative trading purposes.
The Company's interest rate swap agreements qualify as cash flow hedging instruments in accordance with the ASC 815, Derivatives and Hedging topic of the Accounting Standards Codification.. The Company records its interest rate swap agreements on its Consolidated Balance Sheets at fair value. The effective portion of changes in fair value are recorded in accumulated other comprehensive loss and subsequently reclassified into earnings in the period that the hedged forecasted transaction affects earnings. Any ineffective portion is recognized in earnings. On a quarterly basis, the Company performs a qualitative assessment to determine effectiveness. For further information, referRefer to Note 5, Cash and Cash Equivalents and Fair Value of Financial Instruments. Instruments, for additional information. As of December 31, 2019,2021, the Company did not have any outstanding interest rate swap agreements.
Debt
On November 15, 2019, the Company entered into an amended and restated credit agreement which provides for a five-year revolving credit facility. The amount borrowed under this facility is recorded at its carrying value at December 31, 2019. The fair value of debt at December 31, 2019 approximates the carrying value.
Allowance for Doubtful Accounts and Notes Receivables from Investment in Sales-Type Leases
The Company maintains an allowance for doubtful accounts for estimated losses resulting from the inability of its customers to make required payments. The Company records a specific allowance based on an analysis of individual past-due balances. Additionally, based on historical write-offs and the Company’s collection experience, the Company records an additional allowance based on a percentage of outstanding receivables. The Company performs credit evaluations of its customers’ financial condition. These evaluations require significant judgment and are based on a variety of factors including, but not limited to, current economic trends, payment history, and a financial review of the customer. Actual collection losses may differ from management’s estimates, and such differences could be material to the Company’s financial position and results of operations.
The retained in-house leases discussed above are considered financing receivables. The Company’s credit policies and its evaluation of credit risk and write-off policies are applied alike to trade receivables and the net investment in sales-type leases. For both, an account is generally past due after thirty days. The financing receivables also have customer-specific reserves for accounts identified for specific impairment and a non-specific reserve applied to the remaining population, based on factors such as current trends, the length of time the receivables are past due, and historical collection experience. The retained in-house leases are not stratified by portfolio or class.
Sales of Accounts Receivable
The Company records the sale of its accounts receivables in accordance with accounting guidance for transfers and servicing of financial assets. The Company transferred non-recourse accounts receivable totaling $48.3 million, $46.6 million, and $40.0 million during the years ended December 31, 2019, 2018, and 2017, respectively, which approximated fair value, to leasing companies on a non-recourse basis. Accounts receivable balance included approximately $4.6 million and $10.6 million due from third-party leasing companies for transferred non-recourse accounts receivable as of December 31, 2019 and 2018, respectively.
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Inventory
Inventories are stated at the lower of cost, computed using the first-in, first-out method, and net realizable value. Inbound shipping costs are included in cost of inventory. The Company regularly monitors inventory quantities on hand and records write-downs for excess and obsolete inventories based on the Company’s estimate of demand for its products, potential obsolescence of technology, product life cycles, and whether pricing trends or forecasts indicate that the carrying value of inventory exceeds its estimated selling price. These factors are impacted by market and economic conditions, technology changes, and new product introductions and require estimates that may include elements that are uncertain. Actual demand may differ from forecasted demand and may have a material effect on gross margins. If inventory is written down, a new cost basis is established that cannot be increased in future periods. Shipments from suppliers or contract manufacturers before the Company receives them are recorded as in-transit inventory when title and the significant risks and rewards of ownership have passed to the Company.
The Company has a supply agreement with one primary supplier for construction and supply of several sub-assemblies and inventory management of sub-assemblies used in its hardware products. There are 0no minimum purchase requirements. The contract with the Company’s supplier may be terminated by either the supplier or by the Company without cause and at any time upon delivery of six months’ notice. Purchases from this supplier were $75.1$103.2 million, $54.8$76.3 million, and $64.5$75.1 million for the years ended December 31, 2021, 2020, and 2019, 2018, and 2017, respectively.
Shipping Costs
Outbound freight billed to customers is recorded as product revenue. The related shipping and handling costs are expensed as part of selling, general, and administrative expense. Shipping and handling expenses were $15.9$18.2 million, $14.1$15.6 million, and $13.6$15.9 million for the years ended December 31, 2019, 2018,2021, 2020, and 2017,2019, respectively.
Property and Equipment
Property and equipment less accumulated depreciation are stated at historical cost. The Company’s expenditures for property and equipment are primarily for computer equipment and software used in the administration of its business, and for leasehold improvements to its leased facilities. The Company also develops molds and dies used in long-term manufacturing arrangements with suppliers and for production automation equipment used in the manufacturing of consumable blister card components.
Depreciation and amortization is computed by use of the straight-line method over the estimated useful lives of the assets as stated below:
Computer equipment and related software3 - 5 years
Leasehold and building improvementsShorter of the lease term or the estimated useful life
Furniture and fixtures5 - 7 years
Equipment32 - 12 years
The Company capitalizes costs related to computer software developed or obtained for internal use in accordance with ASC 350-40, Internal-Use Software. Software obtained for internal use has generally beenincludes enterprise-level business and finance software that the Company customizes to meet its specific operational needs.needs, as well as certain costs for the development of its subscription and cloud-based offerings sold to its customers. Costs incurred in the application development phase are capitalized and amortized over their useful lives, which is generally five years. Costs recognized in the preliminary project phase and the post-implementation phase are expensed as incurred. The Company capitalized $0.3$12.7 million and $1.1$6.8 million of costs related to the application development of enterprise-level software and its subscription and cloud-based offerings that were included in property and equipment during the years ended December 31, 20192021 and 2018,2020, respectively.
Software Development Costs
The Company capitalizes certain software development costs in accordance with ASC 985-20, Costs of Software to Be Sold, Leased, or Marketed, under which certain software developmentthose costs incurred subsequent to the establishment of technological feasibility may be capitalized and amortized over the estimated lives of the related products. The Company establishes technological feasibility when it completes a detail program design or a working model. The Company amortizes development costs over the estimated lives of the related products, ranging from three to which is generally five years. The Company capitalized software development costs of $45.8$29.4 million and $30.7$32.0 million, which are included in other long-term assets as of December 31, 20192021 and 2018,2020, respectively. The Company recorded $17.5$26.4 million, $12.5$23.1 million, and $9.7$17.5 million to cost of revenues for amortization of capitalized software development costs for the years ended December 31, 2019, 2018,2021, 2020, and 2017,2019, respectively. All development costs prior to the completion of a detail program design or a working model are recognized as research and development expense.
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Lessee Leases
The Company determines if an arrangement is a lease at inception. Operating lease right-of-use assets and liabilities are recognized at the commencement date based on the present value of lease payments over the lease term. As most of its lease contracts do not provide an implicit rate, the Company uses its incremental borrowing rate based on information available at the commencement date in determining the present value of the lease payments. Lease expense is recognized on a straight-line basis over the lease term. The Company does not recognize a right-of-use asset and a lease liability for leases with an initial term of twelve months or less. The Company elected the practical expedient to not separate lease components from nonlease components and applied that practical expedient to all material classes of leased assets.
Many of the Company’s operating leases include an option to extend the lease. The specific terms and conditions of the extension options vary from lease to lease, but are consistent with standard industry practices in each area that the Company operates. The Company reviews each of its lease options at a time required by the terms of the lease contract, and notifies the lessor if it chooses to exercise the lease renewal option. Until the Company is reasonably certain that it will extend the lease contract, the renewal option periods will not be recognized as right-of-use assets or lease liabilities.
Certain leases include provisions for early termination, which allow the contract parties to terminate their obligations under the lease contract. The terms and conditions of the termination options vary by contract. When the Company has made a decision to exercise an early termination option, the right-of-use assets and associated lease liabilities are remeasured in accordance with the present value of the remaining cash flows under the lease contract.
Certain building lease agreements include rental payments subject to change annually based on fluctuations in various indexes (i.e. (i.e. Consumer Price Index (“CPI”), Retail Price Index, and other international indexes). Certain data center lease agreements include rental payments subject to change based on usage and CPI fluctuations. The changes based on usage and indexes are treated as variable lease costs and recognized in the period in which the obligation for those payments was incurred. 
The Company’s operating lease agreements do not contain any material residual value guarantees, restrictions, or restriction covenants.
Business Combinations
The Company uses the acquisition method of accounting under the authoritative guidance on business combinations.ASC 805, Business Combinations. Each acquired company’s operating results are included in the Company'sCompany’s Consolidated Financial Statements starting on the date of acquisition.acquisition date. The purchase price is equivalent to the fair value of consideration transferred. Tangible and identifiable intangible assets acquired and liabilities assumed as of the acquisition date of acquisition are recorded at the acquisition date fair value. Goodwill is recognized for the excess of purchase price over the net fair value of assets acquired and liabilities assumed.
Amounts allocated to assets and liabilities are based upon fair values. Such valuations require management to make significant estimates and assumptions, especially with respect to the identifiable intangible assets. Management makes estimates of fair value based upon assumptions believed to be reasonable and that of a market participant. These estimates are based on available historical experience and information obtained from the management of the acquired companiesas well as future expectations, and the estimates are inherently uncertain. The separately identifiable intangible assets generally include customer relationships, backlog, acquired technology, backlog, trade names, and trade names.non-compete agreements.
Goodwill and Acquired Intangible Assets
Goodwill
The Company reviews goodwill for impairment on an annual basis on the first day of the fourth quarter of each year at the reporting unit level. This assessment is also performed whenever there is a change in circumstances that indicates the carrying value of goodwill may be impaired. The Company has one1 reporting unit, which is the same as its operating segment. A qualitative assessment is initially made to determine whether it is necessary to perform quantitative testing. A qualitative assessment includes, among others, consideration of: (i) past, current, and projected future earnings and equity; (ii) recent trends and market conditions; and (iii) valuation metrics involving similar companies that are publicly-traded and acquisitions of similar companies, if available. If this qualitative assessment indicates that it is more likely than not that impairment exists, or if the Company decides to bypass this option, it proceeds to the quantitative assessment. The quantitative assessment involves a comparison between the estimated fair value of the Company’s reporting unit with its carrying amount including goodwill. If the carrying value exceeds estimated fair value, the Company will record an impairment charge based on that difference. The impairment charge will be limited to the amount of goodwill.
To determine the reporting unit’s fair value under the quantitative approach, the Company uses a combination of income and market approaches, equally weighting the two approaches, such as estimated discounted future cash flows of the
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reporting unit, multiples of earnings or revenues, and analysis of recent sales or offerings of comparable entities. The Company also considers its market capitalization on the date of the analysis to ensure the reasonableness of its reporting unit'sunit’s fair value.
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The Company performed a qualitative impairment assessment analysis as of October 1, 20192021 for its reporting unit taking into consideration past, current, and projected future earnings, recent trends, and market conditions, and valuation metrics involving similar companies that are publicly-traded. Based on the result of this analysis, an impairment does not exist as of December 31, 2019,2021, and there were 0no accumulated impairment losses.
Intangible Assets
In connection with its acquisitions, the Company generally recognizes assets for customer relationships, acquired technology, backlog, developed technology,trade names, and trade names.non-compete agreements. Intangible assets are carried at cost less accumulated amortization. Such amortization is provided on a straight-line basis or on an accelerated basis based on a pattern of economic benefit that is expected to be obtained over the estimated useful lives of the respective assets, generally from one to 30 years.assets. Amortization for developedacquired technology and backlog is recognized in cost of revenues, and amortization for customer relationships, trade names, non-compete agreements, trade names, and patents is recognized in selling, general, and administrative expenses.
The Company assesses the impairment of identifiable intangible assets whenever events or changes in circumstances indicate that an asset’s carrying amount may not be recoverable. Recoverability of an asset is measured by the comparison of the carrying amount to the sum of the undiscounted estimated future cash flows the asset is expected to generate, offset by estimated future costs to dispose of the product to which the asset relates. If an asset is considered to be impaired, the amount of such impairment would be measured as the difference between the carrying amount of the asset and its fair value. The Company’s cash flow assumptions are based on historical and forecasted future revenue, operating costs, and other relevant factors. Assumptions and estimates about the remaining useful lives of the Company’s intangible assets are subjective and are affected by changes to its business strategies. If management’s estimates of future operating results change, or if there are changes to other assumptions, the estimate of the fair value of the Company’s assets could change significantly. Such change could result in impairment charges in future periods, which could have a significant impact on the Company’s operating results and financial condition. For the years ended December 31, 20192021 and 2018,2020, there were no events or changes in circumstances to indicate that intangible assets carrying amounts may not be recoverable.
Convertible Debt
The Company accounts for convertible debt and related transactions in accordance with ASC 470-20, Debt with Conversion and Other Options, ASC 815, Derivatives and Hedging, and ASC 480, Distinguishing Liabilities from Equity. The Company evaluates convertible debt instruments and related transactions at inception to determine if those contracts or embedded components of those contracts qualify as derivatives to be separately accounted for. Convertible debt instruments that may be settled in cash are separated into liability and equity components. The allocation to the liability component is based on the fair value of a similar instrument that does not contain an equity conversion option. Based on this debt-to-equity ratio, debt issuance costs are then allocated to the liability and equity components in a similar manner. The difference between the principal amount of the convertible debt instruments and the liability component, inclusive of issuance costs, represents the debt discount, which is amortized to interest expense over the term of instruments. The determination of the discount rate requires certain estimates and assumptions.
Convertible note hedge and warrant transactions associated with convertible debt instruments are accounted for as equity instruments, and are recorded in additional paid-in capital in the Consolidated Balance Sheets.
Valuation of Share-Based Compensation
The Company accounts for share-based compensation in accordance with ASC 718, Stock Compensation. The Company recognizes compensation expense related to share-based compensation based on the grant date estimated fair value.
The fair value of stock options (“options”) on the grant date is estimated using the Black-Scholes option pricing model, which requires the following inputs: expected life, expected volatility, risk-free interest rate, expected dividend yield rate, exercise price, and closing price of its common stock on the date of grant. The expected volatility is based on a combination of historical and market-based implied volatility, and the expected life of the awards is based on the Company’s historical experience of employee stock option exercises, including forfeitures. Expense is recognized on a straight-line basis over the requisite service period.
The fair value of restricted stock units (“RSUs”) is based on the stock price on the grant date. The fair value of restricted stock awards (“RSAs”) is their intrinsic value, which is the difference between the fair value of the underlying stock at the measurement date and the purchase price. The RSUs and RSAs are subject to a service vesting condition and are recognized on a straight-line basis over the requisite service period.
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The fair value of performance-based stock unit awards (“PSUs”) with service and market conditions is estimated using a Monte Carlo simulation model applying a multiple awards approach. Expense is recognized when it is probable that the performance condition will be met using the accelerated attribution method over the requisite service period.
Forfeiture rates are estimated based on the Company’s historical experience with equity awards that were granted and forfeited prior to vesting. The valuation assumptions used in estimating the fair value of employee share-based awards may change in future periods.
Accounting for Income Taxes
The Company records an income tax provision for (benefit from) the anticipated tax consequences of the reported results of operations. In accordance with U.S. GAAP,ASC 740, Income Taxes, the provision for (benefit from) income taxes is computed using the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the financial statements. Under this method, deferred tax assets and liabilities are determined on the basis of the differences between the financial statement and tax bases of assets and liabilities and for operating losses and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates in effect for the periods in which those tax assets and liabilities are expected to be realized or settled. In the event that these tax rates change, the Company will incur a benefit or detriment on its income tax expense in the period of change. If the Company were to determine that all or part of the net deferred tax assets are not realizable in the future, it will record a valuation allowance that would be charged to earnings in the period such determination is made.
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In accordance with ASC 740,Income Taxes, the Company recognizes the tax benefit from an uncertain tax position if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the financial statements from such positions are then measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. The calculation of tax liabilities involves significant judgment in estimating the impact of uncertainties in the application of U.S. GAAPASC 740 and complex tax laws. Resolution of these uncertainties in a manner inconsistent with management’s expectations could have a material impact on the Company’s financial condition and operating results.
Recently Adopted Authoritative Guidance
In February 2016,December 2019, the FASBFinancial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-02, 2019-12,Leases Income Taxes (Topic 842)740): Simplifying the Accounting for Income Taxes. The FASB amended leaseupdate simplifies the accounting requirementsfor income taxes by removing certain exceptions to begin recording assetsthe general principles in ASC 740, Income Taxes, as well as improves consistent application of and liabilities arising from most leases onsimplifies the balance sheet. The new guidance also requires significant additional disclosures about the amountfor other areas of ASC 740 by clarifying and timing of cash flows from leases.amending existing guidance. The Company adopted this new guidanceASU 2019-12 on January 1, 2019. In July 2018, the FASB issued amendments in ASU 2018-11, which provide a transition election to not restate comparative periods for the effects of applying the new standard. This transition election permits entities to change the date of initial application to the beginning of the year of adoption and to recognize the effects of applying the new standard as a cumulative-effect adjustment to the opening balance of retained earnings. The Company has elected this transition approach as well as the package of practical expedients permitted under the transition guidance within the new standard, which allowed the Company to carry forward the historical lease classification of contracts entered into prior to January 1, 2019. As a result of electing the package of practical expedients described above, existing leases and related initial direct costs have not been reassessed prior to the effective date, and therefore, adoption of the lease standard did not have an impact on the Company’s previously reported consolidated financial statements.
The Company also elected the following practical expedients: (i) combining lease and non-lease components for all asset classes, (ii) leases with an initial term of 12 months or less are not recorded in the Consolidated Balance Sheets, and the associated lease payments are recognized in the Consolidated Statements of Operations2021 on a straight-line basis over the lease term, and (iii) applying discount rates to operating leases using a portfolio approach.
From a lessor perspective, certain agreements that were previously classified as operating leases are classified as sales-type leases under the new lease accounting standard. The agreements in place prior to the adoption of the new lease accounting standard on January 1, 2019 will continue to be treated as operating leases.
The Company’s adoption of the new standard impacted the Consolidated Balance Sheets at the beginning of the period of adoption as follows:
January 1, 2019
Pre-ASC 842 BalancesASC 842 Adoption ImpactPost-ASC 842 Balances
(In thousands)
Operating lease right-of-use-assets$—  $66,008  $66,008  
Accrued liabilities (1)
43,047  10,067  53,114  
Long-term operating lease liabilities—  59,791  59,791  
Other long-term liabilities (2)
9,562  (3,850) 5,712  

(1)  Adjustment represents the current portion of the operating lease liabilities of $10.3 million, and reclassification of exit cost obligations and deferred rent of $0.1 million and $0.1 million, respectively, to reduce the operating lease right-of-use assets.
(2) Adjustment represents the reclassification of deferred rent to reduce the operating lease right-of-use assets.
Adoption of the standard did not have an impact on the Company’s stockholders’ equity, Consolidated Statements of Operations, and Consolidated Statements of Cash Flows as of January 1, 2019.
In February 2018, the FASB issued ASU 2018-02, Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income, which permits the reclassification of the income tax effects of the Tax Cuts and Jobs Act of 2017 (the “Tax Act”) on items within accumulated other comprehensive income to retained earnings. These amounts are commonly referred to as “stranded tax effects.” ASU 2018-02 was effective for the Company beginning January 1, 2019.prospective basis. The adoption of this guidance did not have a material effectimpact on the Company’s Consolidated Financial StatementsStatements.
Recently Issued Authoritative Guidance
In August 2020, the FASB issued ASU 2020-06, Debt-Debt with Conversion and thereforeOther Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity’s Own Equity (Subtopic 815-40). The update simplifies the accounting for convertible debt instruments by reducing the number of accounting models and the number of embedded conversion features that could be recognized separately from the primary contract. ASU 2020-06 also enhances transparency and improves disclosures for convertible instruments and earnings per share guidance. ASU 2020-06 also requires the application of the if-converted method for calculating diluted earnings per share and the treasury stock method is no adjustmentlonger permitted for convertible instruments. This update permits the use of either the modified retrospective or fully retrospective method of transition. The Company will adopt ASU 2020-06 on January 1, 2022, and expects to use the modified retrospective method of transition. The Company’s adoption of the update is estimated to result in an increase in convertible senior notes, net of issuance costs, of $75.4 million; a decrease in additional paid-in capital of $72.7 million; a decrease of long-term deferred tax liabilities of $19.8 million; a decrease in long-term deferred tax assets of $0.5 million; and an increase in retained earnings was made.of $16.7 million, all as of January 1, 2022. In December 2021, the Company made an irrevocable election under the indenture to require the principal portion of the Company's convertible senior notes to be settled in cash and any conversion consideration in excess of the principal portion in cash and/or shares of the Company's common stock at the Company's option upon conversion. Following the irrevocable election, only the amounts expected to be settled in excess of the principal portion are considered dilutive in calculating earnings per share under the if-converted method.
In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers. The update addresses diversity in practice by requiring that an acquirer recognize and measure contract assets and liabilities acquired in a business combination in accordance with ASC 606, Revenue from Contracts with Customers. The guidance will be applied prospectively to acquisitions occurring on or after the effective
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Recently Issued Authoritative Guidance
In August 2018, the FASB issueddate. ASU 2018-15, Intangibles-Goodwill and Other-Internal-Use Software (Subtopic 350-40): Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract, to align the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software (and hosting arrangements that include an internal-use software license). ASU 2018-152021-08 will be effective for the Company beginning January 1, 2020.2023, and early adoption is permitted. The Company anticipates adoptingis currently evaluating the impact ASU 2018-15 prospectively and does not expect the standard to2021-08 will have a material impact on its Consolidated Financial Statements.
In June 2016, the FASB issued ASU 2016-13, Financial Instruments-Credit Losses (Topic 326), Measurement of Credit Losses on Financial Instruments, that modifies or replaces existing models for trade and other receivables, debt securities, loans, and certain other financial instruments. For instruments measured at amortized cost, including trade and lease receivables, loans and held-to-maturity debt securities, the standard will replace the current “incurred loss” approach with an “expected loss” model. Entities will be required to estimate expected credit losses over the life of the instrument, considering available relevant information about the collectibility of cash flows, including information about past events, current conditions, and reasonable and supportable forecasts. ASU 2016-13 will be effective for the Company beginning January 1, 2020. In preparation for adoption of the standard, the Company made appropriate changes to necessary processes and controls. The Company’s adoption of the new standard is estimated to result in the recognition of an immaterial cumulative-effect adjustment to retained earnings, using the modified retrospective transition method.
There was no other recently issued and effective authoritative guidance that is expected to have a material impact on the Company’s Consolidated Financial Statements through the reporting date.
Note 2.    Business Combinations
2017 Acquisitions
On April 12, 2017, the Company completed the acquisition of all of the membership interest of InPharmics, a technology and services company that provides advanced pharmacy informatics solutions to hospital pharmacies. The total consideration for the transaction was $5.0 million, net of cash acquired of $0.3 million. Approximately $0.5 million of the total consideration was classified as a long-term liability for potential settlement of performance obligations. The Company accounted for the acquisition of InPharmicsits acquisitions in accordance with the authoritative guidance on business combinations; therefore, theASC 805, Business Combinations. The tangible and intangible assets acquired and liabilities assumed were recorded at fair value on the respective acquisition dates. Intangible assets eligible for recognition separate from goodwill were those that satisfied either the contractual or legal criterion or the separability criterion in the accounting guidance. The preliminary fair values assume management’s best estimates based on information available at the respective acquisition date and may change over the measurement period, which will end no later than one year from the respective acquisition date, as additional information is received. The Company believes that the fair values assigned to the assets acquired and liabilities assumed are based on reasonable assumptions and estimates that market participants would use. Actual results may differ from these estimates and assumptions.
The Company's Consolidated Financial Statements include the results of operations of each acquired company, commencing as of the respective acquisition dates. Acquisition-related costs were expensed as incurred, and are included in selling, general, and administrative expenses in the Company’s Consolidated Statements of Operations.
2021 Acquisitions
MarkeTouch Media
On December 31, 2021, the Company completed the acquisition of all of the outstanding equity interests in MarkeTouch Media pursuant to the terms and conditions of the Unit Purchase Agreement, dated December 31, 2021, by and among ateb, Inc. (a wholly-owned subsidiary of the Company), MarkeTouch Media, LLC, MarkeTouch Holdings, Inc., Toucan Enterprises, Inc., and certain beneficial stockholders specified therein for a base purchase price of $82.0 million, prior to customary adjustments for closing cash, net working capital, and assumed indebtedness. The MarkeTouch Media acquisition adds mobile and web-based technology and patient engagement solutions, which is expected to expand the footprint of EnlivenHealth across the retail pharmacy sector, while enhancing potential growth opportunities in new market segments like specialty pharmacy and pharmacy benefits management.
The Company incurred approximately $1.2 million in acquisition-related costs related to the MarkeTouch Media acquisition during the year ended December 31, 2021.
ReCept
On December 29, 2021, the Company completed the acquisition of all outstanding equity securities of ReCept pursuant to the terms and conditions of the Agreement and Plan of Merger, dated December 1, 2021, by and among Omnicell, Inc., ReCept Holdings, Inc., Redfish Acquisition Corp, and the representative of the securityholders for a base purchase price of $100.0 million, prior to customary adjustments for closing cash, net working capital, and assumed indebtedness. The addition of ReCept’s specialty pharmacy management services for health systems, provider groups, and federally qualified health centers expands Omnicell’s Advanced Services portfolio in an effort to address the growing and complex specialty pharmacy market.
The Company incurred approximately $2.5 million in acquisition-related costs related to the ReCept acquisition during the year ended December 31, 2021.
FDS Amplicare
On September 9, 2021, the Company completed the acquisition of all of the outstanding equity interests in FDS Amplicare pursuant to the terms and conditions of the Agreement and Plan of Merger, dated July 25, 2021, by and among RxInnovation Inc., Omnicell, Inc., Fleming Acquisition Corp., and the representative of the securityholders for a base purchase price of $177.0 million, prior to customary adjustments for closing cash, net working capital, and assumed indebtedness. The FDS Amplicare acquisition adds a comprehensive and complementary suite of SaaS financial management, analytics, and population health solutions to the Company’s EnlivenHealth offering.
The Company incurred approximately $7.0 million in acquisition-related costs related to the FDS Amplicare acquisition during the year ended December 31, 2021. Revenues and net losses from the FDS Amplicare operations since the acquisition date through December 31, 2021 were $11.3 million and $0.9 million, respectively.
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The following tables represent the preliminary allocation of the respective purchase price to the assets acquired and the liabilities assumed by the Company as part of each acquisition included in the Company’s Consolidated Balance Sheets, and is reconciled to the respective purchase price transferred:
FDS Amplicare (1)
ReCept
(Preliminary) (2)
MarkeTouch Media
(Preliminary)
(In thousands)
Purchase price transferred:
Base purchase price$177,000 $100,000 $82,000 
Add: Closing cash465 6,664 191 
Add: Net working capital adjustment1,654 (2,296)448 
Less: Assumed indebtedness(653)(1,902)(13)
Total purchase price transferred$178,466 $102,466 $82,626 
FDS Amplicare (Preliminary) (1)
ReCept
(Preliminary) (2)
MarkeTouch Media
(Preliminary)
Fair value of assets acquired and liabilities assumed:
Cash and cash equivalents$465 $— $237 
Accounts receivable and unbilled receivables5,330 2,383 2,302 
Prepaid expenses506 192 96 
Other current assets45 13,955 — 
Total current assets6,346 16,530 2,635 
Property and equipment444 172 177 
Operating lease right-of-use assets2,252 773 602 
Goodwill117,374 81,588 42,530 
Intangible assets70,000 28,100 38,000 
Other long-term assets51 200 2,850 
Total assets196,467 127,363 86,794 
Accounts payable950 219 473 
Accrued compensation1,312 1,756 — 
Accrued liabilities1,396 18,499 292 
Deferred revenues1,916 222 347 
Long-term deferred tax liabilities11,377 3,587 — 
Long-term operating lease liabilities920 614 206 
Other long-term liabilities130 — 2,850 
Total liabilities18,001 24,897 4,168 
Total purchase price$178,466 $102,466 $82,626 
Total purchase price, net of cash acquired$178,001 $95,897 $82,389 

(1)    During the fourth quarter of 2021, the Company recorded measurement period adjustments of $1.5 million to goodwill, consisting of an increase in intangible assets, accounts receivable and unbilled receivables, and long-term deferred tax liabilities of $0.4 million, $1.1 million, and $0.1 million, respectively, and a net working capital adjustment of $0.1 million.
(2)    Closing cash is included in other current assets due to its restrictive nature as cash held for customers.
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The $117.4 million of goodwill arising from the FDS Amplicare acquisition is primarily attributed to future sales of SaaS solutions and FDS Amplicare’s assembled workforce. None of the FDS Amplicare goodwill is expected to be deductible for tax purposes. The $81.6 million of goodwill arising from the ReCept acquisition is primarily attributed to future sales of its offerings and services and ReCept’s assembled workforce. None of the ReCept goodwill is expected to be deductible for tax purposes. The $42.5 million of goodwill arising from the MarkeTouch Media acquisition is primarily attributed to future sales of SaaS solutions and MarkeTouch Media’s assembled workforce. The full amount of the MarkeTouch Media goodwill is expected to be deductible for tax purposes.
The identifiable intangible assets acquired and their estimated useful lives for amortization are as follows:
FDS Amplicare (1)
ReCeptMarkeTouch Media
Fair valueUseful life
(years)
Fair valueUseful life
(years)
Fair valueUseful life
(years)
(In thousands, except for years)
Customer relationships$59,900 23$28,100 23$34,100 26
Acquired technology7,700 5 - 7— 2,100 4
Backlog— — 1,800 2
Trade names2,400 5— — 
Total purchased intangible assets$70,000 $28,100 $38,000 

(1)    During the fourth quarter of 2021, the Company recorded a measurement period adjustment of $0.4 million in customer relationships.
The customer relationships intangible assets represent the fair values of the underlying relationships and agreements with each acquired company's customers. The acquired technology intangible assets represent the fair values of the portfolio of SaaS solutions that have reached technological feasibility and were part of the respective acquired company’s offerings at their respective acquisition dates. The backlog intangible asset represents contractually committed future billings associated with MarkeTouch Media customer contracts. The trade names intangible asset represents the fair value of brand and name recognition associated with the marketing of certain FDS Amplicare SaaS solutions.
The fair values of the customer relationships and backlog intangible assets were determined based on the excess earnings method, and the fair values of the acquired technology and trade names intangible assets were determined based on the relief-from-royalty method. The key assumptions used in estimating the fair values of intangible assets included forecasted financial information; customer attrition rates; royalty rate of 10.0% for the acquired technology intangible assets for both FDS Amplicare and MarkeTouch Media; royalty rate of 2.0% for the FDS Amplicare trade names intangible asset; discount rate of 13.0% for the FDS Amplicare acquisition; discount rate of 15.0% for the ReCept acquisition; discount rate of 11.5% for the MarkeTouch Media acquisition; and certain other assumptions.
The customer relationships and acquired technology intangible assets are being amortized using a double-declining method of amortization as such method better represents the economic benefits to be obtained. The backlog and trade names intangible assets are being amortized over their respective estimated useful lives using the straight-line method of amortization.
2020 Acquisition
340B Link Business
On October 1, 2020, the Company completed the acquisition of all of the outstanding equity of the 340B Link Business pursuant to the terms and conditions of the Equity Purchase Agreement, dated August 11, 2020, as amended, by and among the Company, PSGH, LLC, BW Apothecary Holdings, LLC, the sellers identified therein and the sellers’ representative for total cash consideration of $225.0 million. The 340B Link Business acquisition adds a comprehensive and differentiated suite of software-enabled services and solutions used by certain eligible hospitals, health systems, clinics, and entities to manage compliance and capture 340B drug cost savings on outpatient prescriptions filled through the eligible entity’s pharmacy or a contracted pharmacy partner.
The Company incurred approximately $6.5 million in acquisition-related costs related to the 340B Link Business acquisition during the year ended December 31, 2020. Revenues and earnings from the 340B Link Business operations since the acquisition date through December 31, 2020 were $10.2 million and $1.3 million, respectively.
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The following table represents the allocation of the purchase price to the assets acquired and the liabilities assumed by the Company as part of the acquisition included in the Company's Consolidated Balance Sheets, and is reconciled to the purchase price transferred:
340B Link Business (1)
(In thousands)
Accounts receivable and unbilled receivables$8,197 
Prepaid expenses232 
Other current assets23,040 
Total current assets31,469 
Property and equipment531 
Operating lease right-of-use assets3,138 
Goodwill160,268 
Intangible assets62,800 
Total assets258,206 
Accounts payable568 
Accrued liabilities23,715 
Long-term deferred tax liabilities6,334 
Long-term operating lease liabilities2,589 
Total liabilities33,206 
Total purchase price$225,000 

(1)    During the third quarter of 2021, the Company recorded measurement period adjustments of $0.9 million to goodwill, consisting of an increase in other current assets, a decrease in accrued liabilities, and a decrease in long-term deferred tax liabilities of $0.3 million, $0.1 million, and $0.5 million, respectively.
The $160.3 million of goodwill arising from the 340B Link Business acquisition is primarily attributed to sales of future software-enabled services and solutions and the 340B Link Business’s assembled workforce. Approximately $93.7 million of the 340B Link Business goodwill is expected to be deductible for tax purposes.
The identifiable intangible assets acquired and their estimated useful lives for amortization are as follows:
340B Link Business
Fair valueUseful life
(years)
(In thousands, except for years)
Customer relationships$53,000 21
Acquired technology9,000 5
Trade names200 1
Non-compete agreements600 3
Total purchased intangible assets$62,800 
The customer relationships intangible asset represents the fair value of the underlying relationships and agreements with the 340B Link Business’s customers. The acquired technology intangible asset represents the fair value of the 340B Link Business’s portfolio of software and solutions that have reached technological feasibility and were part of the 340B Link Business’s offerings at the acquisition date. The purchase pricetrade names intangible asset represents the fair value of brand and name recognition associated with the marketing of the 340B Link Business’s software-enabled services and solutions. The non-compete agreements intangible asset represents the fair value of non-compete agreements with former key members of the 340B Link Business’s management.
The fair value of the customer relationships intangible asset was allocated todetermined based on the excess earnings method; the fair values of the acquired technology and trade names intangible assets were determined based on the relief-from-royalty method; and the fair value of the non-compete agreements intangible asset was determined based on the lost profits method.
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The key assumptions used in estimating the amountfair values of $1.9 million, whichintangible assets included developedforecasted financial information; customer attrition rates; royalty rates of 10.0% and 0.5% for the acquired technology and trade names intangible assets, respectively; discount rate of 14.0% for all intangible assets; and certain other assumptions.
The customer contracts, withrelationships and acquired technology intangible assets are being amortized using a double-declining method of amortization as such method better represents the remainder allocatedeconomic benefits to goodwill.be obtained. The resultstrade names and non-compete agreements are being amortized over their estimated useful lives using the straight-line method of the InPharmics’ operations have been included in the consolidated results of operations.amortization.
Pro Forma Financial Information
The following table presents certain unaudited pro forma consolidated financial information for illustrative purposes only, for the yearyears ended December 31, 20172021, 2020, and 2019 as if thisthe FDS Amplicare, ReCept, and MarkeTouch Media acquisitions had been completed on January 1, 2020 and the 340B Link Business acquisition had been completed on January 1, 2017.2019. The unaudited pro forma financial information is presented for informational purposes only, and is not indicative of what would have occurred had the acquisitionacquisitions taken place on January 1, 2017.those respective dates. The unaudited pro forma financial information combines the historical results of the acquisitionacquisitions with the Company’s consolidated historical results and includes certain adjustments reflecting the estimated impactincluding, but not limited to, amortization and depreciation of fair value adjustments.intangible assets and property and equipment acquired; imputed interest, interest expense, and amortization of debt issuance costs related to acquisitions, as applicable; and certain acquisition-related costs incurred.
Year Ended
December 31, 2017
(In thousands, except per share data)
Pro forma net revenues$713,272 
Pro forma net income$30,683 
Pro forma net income per share$0.82 
Weighted-average number of shares37,483 
Year Ended December 31,
202120202019
(In thousands)
Pro forma revenues$1,195,473 $986,310 $929,106 
Pro forma net income$79,981 $22,615 $56,897 
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Note 3.    Revenues
Disaggregation of Revenues
The following table summarizes the Company’s product revenues disaggregated by revenue type for the years ended December 31, 2019, 2018,2021, 2020, and 2017:2019:
Year Ended December 31,
201920182017
(In thousands) 
Hardware and software$553,039  $464,500  $406,095  
Consumables88,876  89,529  88,100  
Other17,687  15,566  16,006  
Total product revenues$659,602  $569,595  $510,201  
Year Ended December 31,
202120202019
(In thousands)
Connected devices, software licenses, and other$739,074 $560,368 $573,844 
Technical services206,989 202,383 194,183 
Consumables73,438 75,663 85,758 
SaaS, subscription software, and technology-enabled services112,517 53,794 43,242 
Total revenues$1,132,018 $892,208 $897,027 
The following table summarizes the Company’s revenues disaggregated by geographic region, which is determined based on customer location, for the years ended December 31, 2019, 2018,2021, 2020, and 2017:2019:
Year Ended December 31,Year Ended December 31,
201920182017202120202019
(In thousands)(In thousands)
United StatesUnited States$806,900  $685,881  $613,817  United States$1,020,788$797,602$806,900
Rest of world (1)
Rest of world (1)
90,127  101,428  98,897  
Rest of world (1)
111,23094,60690,127
Total revenuesTotal revenues$897,027  $787,309  $712,714  Total revenues$1,132,018$892,208$897,027

(1)    No individual country represented more than 10% of total revenues.
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Contract Assets and Contract Liabilities
The following table reflects the Company’s contract assets and contract liabilities:
December 31,December 31,
2019201820212020
(In thousands)(In thousands)
Short-term unbilled receivables (1)
$11,707  $9,191  
Long-term unbilled receivables (2)
12,260  16,481  
Short-term unbilled receivables, net (1)
Short-term unbilled receivables, net (1)
$17,208 $13,895 
Long-term unbilled receivables, net (2)
Long-term unbilled receivables, net (2)
18,084 17,205 
Total contract assets Total contract assets  $23,967  $25,672  Total contract assets$35,292 $31,100 
Short-term deferred revenues, netShort-term deferred revenues, net$90,894  $81,835  Short-term deferred revenues, net$112,196 $100,053 
Long-term deferred revenuesLong-term deferred revenues7,083  10,582  Long-term deferred revenues20,194 5,673 
Total contract liabilities Total contract liabilities  $97,977  $92,417  Total contract liabilities$132,390 $105,726 

(1)     Included in accounts receivable and unbilled receivables in the Consolidated Balance Sheets.
(2)    Included in other long-term assets in the Consolidated Balance Sheets.
Short-term deferred revenues of $90.9$112.2 million and $81.8$100.1 million include deferred revenues from product sales and service contracts, net of deferred cost of sales of $13.1$22.4 million and $11.1$21.0 million, as of December 31, 20192021 and 2018,2020, respectively. The short-term deferred revenues from product sales relate to delivered and invoiced products, pending installation and acceptance, expected to occur within the next twelve months. During the year ended December 31, 2019,2021, the Company recognized revenues of $80.4$96.8 million that were included in the corresponding gross short-term deferred revenuerevenues balance of $92.9$121.1 million as of December 31, 2018.2020.
Long-term deferred revenues include deferred revenues from product and service contracts of $7.1$20.2 million and $10.6$5.7 million as of December 31, 20192021 and 2018,2020, respectively. Remaining performance obligations are primarily relate to maintenance contracts and are recognized ratably over the remaining term of the contract, generally not more than fiveten years.
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Significant Customers
There were no customers that accounted for more than 10% of the Company’s total revenues for the years ended December 31, 2019, 2018,2021, 2020, and 2017.2019. Also, there were no customers that accounted for more than 10% of the Company’s accounts receivable balance as of December 31, 20192021 and 2018.2020.
Note 4.    Net Income Per Share
Basic net income (loss) per share is computed by dividing net income (loss) for the period by the weighted-average number of shares outstanding during the period. In periods of net loss, all potential common shares are anti-dilutive, so diluted net loss per share equals the basic net loss per share. In periods of net income, diluted net income per share is computed by dividing net income for the period by the basic weighted-average number of shares plus any dilutive potential common stock outstanding during the period.period, using the treasury stock method. Potential common stock includes the effect of outstanding dilutive stock options, restricted stock awards, and restricted stock units, computed usingas well as shares the treasury stock method.Company could be obligated to issue from its convertible senior notes and warrants, as described in Note 10, Convertible Senior Notes. Any anti-dilutive weighted-average dilutive shares related to stock award plans, convertible senior notes, and warrants are excluded from the computation of the diluted net income per share.
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The basic and diluted net income per share calculations for the years ended December 31, 2019, 2018,2021, 2020, and 20172019 were as follows:
Year Ended December 31,
201920182017
(In thousands, except per share data) 
Net income$61,338  $37,729  $30,518  
Weighted-average shares outstanding — basic41,462  39,242  37,483  
Effect of dilutive securities from stock award plans1,481  1,317  1,229  
Weighted-average shares outstanding — diluted42,943  40,559  38,712  
Net income per share - basic$1.48  $0.96  $0.81  
Net income per share - diluted$1.43  $0.93  $0.79  
Anti-dilutive weighted-average shares related to stock award plans926  1,279  501  
Year Ended December 31,
202120202019
(In thousands, except per share data)
Net income$77,849 $32,194 $61,338 
Weighted-average shares outstanding – basic43,475 42,583 41,462 
Effect of dilutive securities from stock award plans2,136 1,160 1,481 
Effect of convertible senior notes2,044 — — 
Effect of warrants288 — — 
Weighted-average shares outstanding – diluted47,943 43,743 42,943 
Net income per share – basic$1.79 $0.76 $1.48 
Net income per share – diluted$1.62 $0.74 $1.43 
Anti-dilutive weighted-average shares related to stock award plans156 2,054 926 
Anti-dilutive weighted-average shares related to convertible senior notes and warrants— 11,816 — 
Note 5. Cash and Cash Equivalents and    Fair Value of Financial Instruments
Cash and cash equivalents of $127.2 million and $67.2 million as of December 31, 2019 and 2018, respectively, consisted of bank accounts with major financial institutions.
Fair Value Hierarchy
The Company measures its financial instruments at fair value. The Company’s cash, cash equivalents, and restricted cash are classified within Level 1 of the fair value hierarchy as they are valued primarily using quoted market prices utilizing market observable inputs. The Company'sCompany’s interest rate swap contracts and credit facility are classified within Level 2 as the valuation inputs are based on quoted prices andor market observable data of similar instruments.
The following table representsCompany’s convertible senior notes are classified within Level 2 as the valuation inputs are based on quoted prices in an inactive market on the last day in the reporting period. As of December 31, 2021 and 2020, the fair value hierarchy of the convertible senior notes was $1.085 billion and $782.3 million, respectively, compared to their carrying value of $488.2 million and $467.2 million, respectively, which are net of unamortized discount and debt issuance costs and excludes amounts classified within additional paid-in capital. Refer to Note 9, Debt and Credit Agreements, for further information regarding the Company’s financial assets measured at fair value as of December 31, 2018:
Level 1Level 2Level 3Total
(In thousands)
Interest rate swap contracts$—  $562  $—  $562  
Total financial assets$—  $562  $—  $562  
Thecredit facility and Note 10, Convertible Senior Notes, for further information regarding the Company’s interest rate swap agreement matured during the second quarter of 2019, and as of December 31, 2019, the Company did not have any outstanding interest rate swap agreements.convertible senior notes.
Interest Rate Swap Contracts
The Company’s interest rate swaps, which are designated as cash flow hedges, involve the receipt of variable amounts from counterparties in exchange for the Company making fixed-rate payments over the life of the agreements.
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During 2016, the Company entered into an interest rate swap agreement with a combined notional amount of $100.0 million with one counterparty that became effective on June 30, 2016 and matured on April 30, 2019. The swap agreement required the Company to pay a fixed rate of 0.8% and provided that the Company receive a variable rate based on the one month LIBOR rate subject to a LIBOR floor of 0.0%. Amounts payable by or due to the Company were net settled with the respective counterparty on the last business day of each month, commencing July 31, 2016.
The Company’s interest rate swap agreement at its inception, qualified formatured during the second quarter of 2019, and, was designated as a cash flow hedging instrument,of December 31, 2021 and was recorded on2020, the Company's Consolidated Balance Sheets at fair value. The fair value of theCompany did not have any outstanding interest rate swap agreement at December 31, 2018 was $0.6 million. There were no amounts reclassified into current earnings due to ineffectiveness during the periods presented.agreements.
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Note 6.    Balance Sheet Components
Balance sheet details as of December 31, 20192021 and 20182020 are presented in the tables below:
December 31,December 31,
2019201820212020
(In thousands)(In thousands)
Inventories:Inventories:Inventories:
Raw materials Raw materials  $31,331  $32,511  Raw materials$48,215 $28,205 
Work in process Work in process  7,620  8,726  Work in process11,009 7,973 
Finished goods Finished goods  69,060  59,631  Finished goods60,700 60,120 
Total inventories Total inventories  $108,011  $100,868  Total inventories$119,924 $96,298 
Other current assets:Other current assets:
Funds held for customers, including restricted cash (1)
Funds held for customers, including restricted cash (1)
$20,405 $18,164 
Net investment in sales-type leases, current portionNet investment in sales-type leases, current portion10,665 10,246 
Prepaid income taxesPrepaid income taxes6,656 10,095 
Other current assetsOther current assets10,608 2,539 
Total other current assetsTotal other current assets$48,334 $41,044 
Other long-term assets:Other long-term assets:Other long-term assets:
Capitalized software, net Capitalized software, net  $85,070  $56,819  Capitalized software, net$96,995 $94,027 
Unbilled receivables  12,260  16,481  
Unbilled receivables, netUnbilled receivables, net18,084 17,205 
Deferred debt issuance costsDeferred debt issuance costs4,700  —  Deferred debt issuance costs3,156 4,253 
Other assets  1,006  1,313  
Other long-term assetsOther long-term assets9,284 3,804 
Total other long-term assets Total other long-term assets  $103,036  $74,613  Total other long-term assets$127,519 $119,289 
Accrued liabilities:Accrued liabilities:Accrued liabilities:
Operating lease liabilities, current portion Operating lease liabilities, current portion  $10,058  $—  Operating lease liabilities, current portion$12,947 $12,197 
Customer fund liabilitiesCustomer fund liabilities31,727 18,164 
Advance payments from customers Advance payments from customers  4,006  8,993  Advance payments from customers8,191 6,981 
Rebates and lease buyouts Rebates and lease buyouts  14,911  11,076  Rebates and lease buyouts44,644 21,815 
Group purchasing organization feesGroup purchasing organization fees5,934  4,455  Group purchasing organization fees7,115 4,412 
Taxes payableTaxes payable3,744  5,885  Taxes payable3,771 3,520 
Other accrued liabilities Other accrued liabilities  16,914  12,638  Other accrued liabilities24,772 13,222 
Total accrued liabilities Total accrued liabilities  $55,567  $43,047  Total accrued liabilities$133,167 $80,311 
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Table(1)    Includes restricted cash of Contents$6.6 million and $4.0 million as of December 31, 2021 and 2020, respectively.
The following table summarizes the changes in accumulated balances of other comprehensive income (loss), which consisted of foreign currency translation adjustments, for the years ended December 31, 20192021 and 2018:2020:
Foreign currency translation adjustmentsUnrealized gain (loss) on interest rate swap hedgesTotal
(In thousands) 
Balance as of December 31, 2017$(6,954) $841  $(6,113) 
Other comprehensive income (loss) before reclassifications(4,320) 777  (3,543) 
Amounts reclassified from other comprehensive income (loss), net of tax—  (1,198) (1,198) 
Net current-period other comprehensive income (loss), net of tax(4,320) (421) (4,741) 
Balance as of December 31, 2018(11,274) 420  (10,854) 
Other comprehensive income (loss) before reclassifications1,828  148  1,976  
Amounts reclassified from other comprehensive income (loss), net of tax—  (568) (568) 
Net current-period other comprehensive income (loss), net of tax1,828  (420) 1,408  
Balance as of December 31, 2019$(9,446) $—  $(9,446) 
(In thousands)
Balance as of December 31, 2019$(9,446)
Other comprehensive income3,924 
Balance as of December 31, 2020(5,522)
Other comprehensive loss(2,885)
Balance as of December 31, 2021$(8,407)
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Note 7.    Property and Equipment
The following table represents the property and equipment balances as of December 31, 20192021 and 2018:2020:
December 31,December 31,
2019201820212020
(In thousands)(In thousands)
Equipment Equipment  $88,569  $75,417  Equipment$89,272 $81,034 
Furniture and fixtures Furniture and fixtures  7,925  7,844  Furniture and fixtures7,580 7,498 
Leasehold improvements Leasehold improvements  18,979  16,274  Leasehold improvements20,623 19,517 
Software Software  48,309  42,048  Software60,856 50,230 
Construction in progress Construction in progress  6,179  10,706  Construction in progress14,757 7,095 
Property and equipment, gross Property and equipment, gross  169,961  152,289  Property and equipment, gross193,088 165,374 
Accumulated depreciation and amortization Accumulated depreciation and amortization  (115,715) (100,789) Accumulated depreciation and amortization(121,947)(106,301)
Total property and equipment, net Total property and equipment, net  $54,246  $51,500  Total property and equipment, net$71,141 $59,073 
Depreciation and amortization expense of property and equipment was $17.2$20.1 million, $15.1$18.3 million, and $16.2$17.2 million for the years ended December 31, 2019, 2018,2021, 2020, and 2017,2019, respectively.
The geographic location of the Company'sCompany’s property and equipment, net, is based on the physical location in which it is located. The following table summarizes the geographic information for property and equipment, net, as of December 31, 20192021 and 2018:2020:
December 31,December 31,
2019201820212020
(In thousands)(In thousands)
United StatesUnited States$48,769  $44,684  United States$66,788 $53,203 
Rest of world (1)
Rest of world (1)
5,477  6,816  
Rest of world (1)
4,353 5,870 
Total property and equipment, netTotal property and equipment, net$54,246  $51,500  Total property and equipment, net$71,141 $59,073 

(1)    No individual country represented more than 10% of the total property and equipment, net.
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Note 8.    Goodwill and Intangible Assets
Goodwill
The following table represents changes in the carrying amount of goodwill:
(In thousands)
Balance as of December 31, 2017$337,751 
Additions— 
Foreign currency exchange rate fluctuations(1,864)
Balance as of December 31, 2018335,887 
Additions— 
Foreign currency exchange rate fluctuations652 
Balance as of December 31, 2019$336,539 
Additions (1)
161,117 
Foreign currency exchange rate fluctuations1,653 
Balance as of December 31, 2020499,309 
Additions (1)
242,964 
Measurement period adjustments (1)
(2,321)
Foreign currency exchange rate fluctuations(1,052)
Balance as of December 31, 2021$738,900 

(1)     Refer to Note 2, Business Combinations, for further information.
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Intangible Assets, Net
The carrying amounts and useful lives of intangible assets as of December 31, 20192021 and 20182020 were as follows:
December 31, 2019December 31, 2021
Gross carrying
amount (1)
Accumulated
amortization
Foreign currency exchange rate fluctuationsNet carrying
amount
Useful life
(years)
Gross carrying
amount (1)
Accumulated
amortization
Foreign currency exchange
rate fluctuations
Net carrying
amount
Useful life
(years)
(In thousands, except for years)(In thousands, except for years)
Customer relationshipsCustomer relationships$135,234  $(54,860) $(1,058) $79,316  10 - 30Customer relationships$309,989 $(78,093)$(933)$230,963 10 - 30
Acquired technologyAcquired technology77,142  (36,194)  40,953  3 - 20Acquired technology95,466 (55,859)39,613 4 - 20
BacklogBacklog1,150  (791) —  359  4Backlog1,800 — — 1,800 2
Trade namesTrade names7,650  (5,037) 11  2,624  6 - 12Trade names9,200 (5,600)14 3,614 5 - 12
PatentsPatents3,217  (1,603)  1,615  2 - 20Patents2,462 (1,186)— 1,276 2 - 20
Non-compete agreementsNon-compete agreements600 (250)— 350 3
Total intangibles assets, netTotal intangibles assets, net$224,393  $(98,485) $(1,041) $124,867  Total intangibles assets, net$419,517 $(140,988)$(913)$277,616 

December 31, 2018December 31, 2020
Gross carrying
amount (1)
Accumulated
amortization
 Foreign currency exchange rate fluctuationsNet carrying
amount
Useful life
(years)
Gross carrying
amount (1)
Accumulated
amortization
 Foreign currency exchange
rate fluctuations
Net carrying
amount
Useful life
(years)
(In thousands, except for years)(In thousands, except for years)
Customer relationshipsCustomer relationships$135,234  $(45,029) $(1,185) $89,020  10 - 30Customer relationships$187,889 $(64,254)$(777)$122,858 10 - 30
Acquired technologyAcquired technology78,122  (29,206) 42  48,958  3 - 20Acquired technology86,029 (44,851)41,184 5 - 20
BacklogBacklog21,350  (20,703) —  647  1 - 4Backlog1,150 (1,078)— 72 4
Trade namesTrade names7,650  (4,361) 17  3,306  6 - 12Trade names7,850 (5,794)14 2,070 1 - 12
PatentsPatents3,239  (1,488)  1,755  2 - 20Patents2,930 (1,455)1,477 2 - 20
Non-compete agreementsNon-compete agreements1,900  (1,900) —  —  3Non-compete agreements600 (50)— 550 3
Total intangibles assets, netTotal intangibles assets, net$247,495  $(102,687) $(1,122) $143,686  Total intangibles assets, net$286,448 $(117,482)$(755)$168,211 

(1)     The differences in gross carrying amounts between periods are primarily due to additions of intangible assets in connection with acquisitions, partially offset by the write-off of certain fully amortized intangible assets.
Amortization expense of intangible assets was $18.9$26.5 million, $23.8$19.7 million, and $25.6$18.9 million for the years ended December 31, 2021, 2020, and 2019, 2018, and 2017, respectively.
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The estimated future amortization expenses for amortizable intangible assets were as follows:
December 31, 2019December 31,
2021
(In thousands)(In thousands)
2020$17,502  
202116,180  
2022202214,832  2022$35,400 
2023202313,724  202331,486 
202420247,972  202422,985 
2025202520,859 
2026202617,885 
Thereafter Thereafter  54,657  Thereafter149,001 
Total Total  $124,867  Total$277,616 
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Note 9.    Debt and Credit Agreements
2016 Senior Credit Facility
On January 5, 2016, the Company entered into a $400.0 million senior secured credit facility pursuant to a credit agreement with certain lenders, Wells Fargo Securities, LLC as sole lead arranger, and Wells Fargo Bank, National Association as administrative agent (as subsequently amended as discussed below, the “Prior Credit Agreement”). The Prior Credit Agreement provided for (a) a five-yearfive-year revolving credit facility of $200.0 million, which was subsequently increased pursuant to the amendment discussed below (the “Prior Revolving Credit Facility”) and (b) a five-yearfive-year $200.0 million term loan facility (the “Prior Term Loan Facility” and, together with the Prior Revolving Credit Facility, the “Prior Facilities”). In addition, the Prior Credit Agreement included a letter of credit sub-limit of up to $10.0 million and a swing line loan sub-limit of up to $10.0 million. The Prior Credit Agreement had an expiration date of January 5, 2021, upon which date all remaining outstanding borrowings were due and payable.
Loans under the Prior Facilities bore interest, at the Company’s option, at a rate equal to either (a) the LIBOR Rate, plus an applicable margin ranging from 1.50% to 2.25% per annum based on the Company’s consolidated total net leverage ratio (as defined in the Prior Credit Agreement), or (b) an alternate base rate equal to the highest of (i) the prime rate, (ii) the federal funds rate plus 0.50%, and (iii) LIBOR for an interest period of one month, plus an applicable margin ranging from 0.50% to 1.25% per annum based on the Company’s consolidated total net leverage ratio (as defined in the Prior Credit Agreement). Undrawn commitments under the Prior Revolving Credit Facility were subject to a commitment fee ranging from 0.20% to 0.35% per annum based on the Company’s consolidated total net leverage ratio on the average daily unused portion of the Prior Revolving Credit Facility.
On each of April 11, 2017 and December 26, 2017, the parties entered into amendments to the Prior Credit Agreement. Under these amendments, the Prior Revolving Credit Facility was increased from $200.0 million to $315.0 million and certain other modifications were made. In connection with the December 2017 amendment, the Company incurred and capitalized an additional $2.1 million of debt issuance costs.
2019 Revolving Credit Facility
On November 15, 2019, the Company refinanced the Prior Credit Agreement and entered into an Amended and Restated Credit Agreement (the(as subsequently amended as discussed below, the “A&R Credit Agreement”) with the lenders from time to time party thereto, Wells Fargo Securities, LLC, Citizens Bank, N.A., and JPMorgan Chase Bank, N.A., as joint lead arrangers, and Wells Fargo Bank, National Association, as administrative agent. The A&R Credit Agreement replacedsuperseded the Prior Credit Agreement and provides for (a) a five-yearfive-year revolving credit facility of $500.0 million (the “Current Revolving“Revolving Credit Facility”) and (b) an uncommitted incremental loan facility of up to $250.0 million (the “Incremental Facility”). In addition, the A&R Credit Agreement includes a letter of credit sub-limit of up to $15.0 million and a swing line loan sub-limit of up to $25.0 million. The A&R Credit Agreement has an expiration date of November 15, 2024, upon which date all remaining outstanding borrowings will be due and payable.
On November 15, 2019, the $80.0 million outstanding term loan balance under the Prior Facilities was transferred to the Current Revolving Credit Facility.
Loans under the Current Revolving Credit Facility bear interest, at the Company’s option, at a rate equal to either (a) the LIBOR Rate, plus an applicable margin ranging from 1.25% to 2.00% per annum based on the Company’s Consolidated Total Net Leverage Ratio (as defined in the A&R Credit Agreement), or (b) an alternate base rate equal to the highest of (i) the
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prime rate, (ii) the federal funds rate plus 0.50%, and (iii) LIBOR for an interest period of one month plus 1.00%, plus an applicable margin ranging from 0.25% to 1.00% per annum based on the Company’s Consolidated Total Net Leverage Ratio. Undrawn commitments under the Current Revolving Credit Facility are subject to a commitment fee ranging from 0.15% to 0.30% per annum based on the Company’s Consolidated Total Net Leverage Ratio on the average daily unused portion of the Current Revolving Credit Facility. The applicable margin for and certain other terms of any term loans under the Incremental Facility will be determined prior to the incurrence of such loans. The Company is permitted to make voluntary prepayments at any time without payment of a premium or penalty.
On September 22, 2020, the parties entered into an amendment (the “Amendment”) to the A&R Credit Agreement to, among other changes, permit the issuance of the convertible senior notes and the purchase of the convertible note hedge transactions, as described in Note 10, Convertible Senior Notes, expand the Company’s flexibility to repurchase its common stock and make other restricted payments, and replace the total net leverage covenant with a new secured net leverage covenant that requires the Company to maintain a consolidated secured net leverage ratio not to exceed 3.50:1 for the calendar quarters ending September 30, 2020, December 31, 2020, and March 31, 2021 and 3.00:1 for the calendar quarters ending thereafter.
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The A&R Credit Agreement contains customary representations and warranties and customary affirmative and negative covenants applicable to the Company and its subsidiaries, including, among other things, restrictions on indebtedness, liens, investments, mergers, dispositions, dividends, and other distributions. The A&R Credit Agreement contains financial covenants that require the Company and its subsidiaries to not exceed a maximum consolidated total secured net leverage ratio (as described above) and maintain a minimum interest coverage ratio. In addition, the A&R Credit Agreement contains certain customary events of default including, but not limited to, failure to pay interest, principal, and fees or other amounts when due, material misrepresentations or misstatements in any representation or warranty, covenant defaults, certain cross defaults to other material indebtedness, certain judgment defaults, and events of bankruptcy. The Company’s obligations under the A&R Credit Agreement and any swap obligations and banking services obligations owing to a lender (or an affiliate of a lender) are guaranteed by certain of its domestic subsidiaries and secured by substantially all of its and such subsidiary guarantors’ assets. In connection with entering into the A&R Credit Agreement, and as a condition precedent to borrowing loans thereunder, the Company and certain of the Company’s other direct and indirect subsidiaries have entered into certain ancillary agreements, including, but not limited to, a reaffirmation agreement, which amends certain terms of the existing collateral agreement and reaffirms their obligations under the existing guaranty agreement. The Company was in full compliance with all covenants as of December 31, 2019.2021.
The refinancing of the Prior Credit Agreement by means of the A&R Credit Agreement was evaluated in accordance with ASC 470-50, Debt - Modifications and Extinguishments. In determining whether the refinancing was to be accounted for as a debt extinguishment or a debt modification, the Company considered whether lenders within the syndicate remained the same or changed and whether the changes in debt terms were substantial. This assessment was performed on an individual lender basis within the syndicate. As a result, the refinancing was accounted for as a modification with the exception of certain lenders that exited the syndicate. The exit of certain lenders resulted in an immaterial write-off of existing unamortized debt issuance costs. The remaining unamortized debt issuance costs related to debt modification, along with the new deferred costs, will be amortized over the remaining term of the A&R Credit Agreement.
In connection with the A&R Credit Agreement, the Company incurred and capitalized an additional $2.3 million of debt issuance costs. In connection with the Amendment on September 22, 2020, the Company incurred and capitalized an additional $0.6 million of debt issuance costs. The debt issuance costs are being amortized to interest expense using the straight-line method through 2024. Amortization expense related to debt issuance costs for credit agreements was approximately $2.2$1.1 million, $2.3$1.0 million, and $1.6$2.2 million for the years ended December 31, 2019, 2018,2021, 2020, and 2017,2019, respectively.
Interest expense (exclusive of fees and debt issuance cost amortization) was approximately $3.6 million, $7.5$0.5 million and $6.3$3.6 million for the years ended December 31, 2020 and 2019, 2018, and 2017, respectively.
The following table represents changes in No interest expense was incurred during the carrying amount ofyear ended December 31, 2021 as there was no outstanding balance under the Company's debt obligations:
Prior Term Loan FacilityCurrent Revolving Credit FacilityTotal
(In thousands)
Balance as of December 31, 2018$140,000  $—  $140,000  
Proceeds—  —  —  
Repayments(60,000) (30,000) (90,000) 
Balance transfer(80,000) 80,000  —  
Balance as of December 31, 2019$—  $50,000  $50,000  
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Revolving Credit Facility.
The following table represents changes in the balance of the Company'sCompany’s deferred debt issuance costs:
(In thousands)
Balance as of December 31, 2018 2020(1)
$4,5834,253 
Additions2,321 
Amortization(2,204)(1,097)
Balance as of December 31, 2019 2021(2)
$4,7003,156 

(1)  Presented asAs of each of December 31, 2021 and 2020, there was no outstanding balance for the Revolving Credit Facility.
Note 10. Convertible Senior Notes
0.25% Convertible Senior Notes due 2025
On September 25, 2020, the Company completed a direct deduction fromprivate offering of $575.0 million aggregate principal amount of 0.25% convertible senior notes (the “Notes”), including the carryingexercise in full of the initial purchasers’ option to purchase up to an additional $75.0 million principal amount of the Notes. The Company received proceeds from the issuance of the Notes of $559.7 million, net of $15.3 million of transaction fees and other debt issuance costs. The Notes bear interest at a rate of 0.25% per year, payable semiannually in arrears on March 15 and September 15 of each year, beginning on March 15, 2021. The Notes were issued pursuant to an indenture, dated September 25, 2020 (the “Indenture”), between the Company and U.S. Bank National Association, as trustee. The Notes are general senior, unsecured obligations of the Company and will mature on September 15, 2025, unless earlier redeemed, repurchased, or converted.
The Notes are convertible at the option of the holders at any time prior to the close of business on the business day immediately preceding May 15, 2025, only under the following circumstances: (i) during any fiscal quarter commencing after the fiscal quarter ended on December 31, 2020 (and only during such fiscal quarter), if the last reported sale price of the
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Company’s common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on, and including, the last trading day of the immediately preceding fiscal quarter is greater than or equal to 130% of the conversion price for the Notes on each applicable trading day; (ii) during the 5 business day period after any 10 consecutive trading day period (the “measurement period”) in which the trading price (as defined in the Indenture) per $1,000 principal amount of the Notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of the Company’s common stock and the conversion rate for the Notes on each such trading day; (iii) if the Company calls such Notes for redemption, at any time prior to the close of business on the scheduled trading day immediately preceding the redemption date, but only with respect to the Notes called (or deemed called) for redemption; and (iv) upon the occurrence of specified corporate events, as specified in the Indenture. On or after May 15, 2025 until the close of business on the second scheduled trading day immediately preceding the maturity date, holders of the Notes may convert all or any portion of their Notes at any time, regardless of the foregoing conditions.
During the three months ended December 31, 2021, the conditional conversion feature of the Notes was triggered, based on the price of the Company’s common stock, as the last reported sale price of the Company’s common stock was greater than or equal to 130% of the then applicable conversion price for the Notes for at least 20 trading days during the period of 30 consecutive trading days ending on December 31, 2021, the last trading day of the fiscal quarter. Accordingly, the Notes are convertible, in whole or in part, at the option of the holders during the first quarter of 2022. Whether the Notes will be convertible following the first fiscal quarter of 2022 will depend on the continued satisfaction of this condition or another conversion condition in the future. The Company classified the Notes as a current liability in its Consolidated Financial Statements as of December 31, 2021 based on its irrevocable election to settle the principal amount in cash as discussed below.
Under the original terms of the Indenture, upon conversion, the Company could satisfy its conversion obligation by paying or delivering a combination of cash and shares of its common stock, at the Company’s election, in the manner and subject to the terms and conditions provided in the Indenture. On December 13, 2021, the Company irrevocably elected to fix its settlement method to a combination of cash and shares of the Company’s common stock with the specified cash amount per $1,000 principal amount of Notes of at least $1,000. As a result, for Notes converted on or after December 13, 2021, a converting noteholder will receive (i) up to $1,000 in cash per $1,000 principal amount of Notes and (ii) cash and/or shares of the Company’s common stock, at the Company’s option for any conversion consideration in excess of $1,000. In addition, the Company continues to have the ability to set the specified cash amount per $1,000 principal amount of Notes above $1,000. The initial conversion rate for the Notes is 10.2751 shares of the Company’s common stock per $1,000 principal amount of Notes, which is equivalent to an initial conversion price of approximately $97.32 per share of the Company’s common stock, subject to adjustment under certain circumstances in accordance with the terms of the Indenture. In addition, following certain corporate events that occur prior to the maturity date of the Notes or if the Company delivers a notice of redemption in respect of the Notes, the Company will, under certain circumstances, increase the conversion rate of the Notes for a holder who elects to convert its Notes (or any portion thereof) in connection with such a corporate event or convert its Notes called (or deemed called) for redemption during the related redemption period (as defined in the Indenture), as the case may be.
If the Company undergoes a fundamental change, holders may require, subject to certain exceptions, the Company to repurchase for cash all or any portion of their Notes at a fundamental change repurchase price equal to 100% of the principal amount of the Notes to be repurchased, plus accrued and unpaid interest to, but excluding, the fundamental change repurchase date. As of December 31, 2021, none of the criteria for a fundamental change or a conversion rate adjustment had been met.
The Company may not redeem the Notes prior to September 20, 2023. The Company may redeem for cash all or any portion of the Notes, at its option, on or after September 20, 2023, if the last reported sale price of the Company’s common stock has been at least 130% of the conversion price for the Notes then in effect for at least 20 trading days (whether or not consecutive) during any 30 consecutive trading day period (including the last trading day of such period) ending on, and including, the trading day immediately preceding the date on which the Company provides notice of redemption at a redemption price equal to 100% of the principal amount of the Notes to be redeemed, plus accrued and unpaid interest to, but excluding, the redemption date. If the Company redeems less than all of the outstanding Notes, at least $150.0 million aggregate principal amount of Notes must be outstanding and not subject to redemption as of the date of the relevant notice of redemption. No sinking fund is provided for in the Notes.
Convertible debt instruments that may be settled in cash are required to be separated into liability and equity components. The allocation to the liability component is based on the fair value of a similar instrument that does not contain an equity conversion option. Based on this debt-to-equity ratio, debt issuance costs are then allocated to the liability and equity components in a similar manner. Accordingly, at issuance, the Company allocated $461.8 million to the debt liability and $72.7 million to additional paid in capital, net of applicable issuance costs and deferred taxes. The difference between the principal amount of the Notes and the liability component, inclusive of issuance costs, represents the debt discount, which the Company will amortize to interest expense over the term of the Notes using an effective interest rate of 4.18%. The
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determination of the discount rate required certain estimates and assumptions. As of December 31, 2021, the remaining life of the Notes and the related debt discount and issuance cost accretion is approximately 3.7 years.
The maximum number of shares issuable upon conversion, including the effect of a fundamental change and subject to other conversion rate adjustments, would be 5.9 million shares. As of December 31, 2021, the if-converted value of the Notes exceeded the principal amount by $491.1 million.
The Notes consisted of the following balances reported in the Consolidated Balance Sheets as of December 31, 2021 and 2020:
December 31,
20212020
(In thousands)
Liability:
Principal amount$575,000 $575,000 
Unamortized discount(77,136)(95,744)
Unamortized debt issuance costs(9,712)(12,055)
Convertible senior notes, liability component (1)
$488,152 $467,201 
Convertible senior notes, equity component (2)
$72,732 $72,732 

(1)    Classified as a current liability as of December 31, 2021 and a long-term liability as of December 30, 2020 in the Consolidated Balance Sheets.
(2)    PresentedIncluded in other long-term assetsadditional paid-in capital in the Consolidated Balance Sheets.
AsThe following table summarizes the components of interest expense resulting from the Notes recognized in interest and other income (expense), net in the Consolidated Statements of Operations for the years ended December 31, 2019,2021 and 2020:
Year Ended December 31,
20212020
(In thousands)
Contractual coupon interest$1,438 $379 
Amortization of discount$18,608 $4,766 
Amortization of debt issuance costs$2,343 $600 
Convertible Note Hedge and Warrant Transactions
In connection with the carrying value of debt of $50.0 million approximates its fair value. The fair valueissuance of the outstanding balanceNotes, the Company entered into convertible note hedge and warrant transactions with an affiliate of one of the Current Revolving Credit Facility was calculated using a discounted cash flow model based on current market interest rates availableinitial purchasers of the Notes and certain other financial institutions (the “option counterparties”) with respect to the Company. Company’s common stock.
The Company's debtconvertible note hedge consists of an option for the Company to purchase up to approximately 5.9 million shares of the Company’s common stock, which is classified within Level 2equal to the number of shares of the Company’s common stock underlying the Notes, at an initial strike price of approximately $97.32 per share. The convertible note hedge will expire upon the maturity of the Notes, if not earlier exercised or terminated. The cost of the convertible note hedge was approximately $100.6 million and was accounted for as an equity instrument, which was recorded in additional paid-in capital in the fair value hierarchy asConsolidated Balance Sheets. The Company recorded a deferred tax asset of $25.8 million at issuance related to the valuation inputs are based onconvertible note hedge transaction. The convertible note hedge is expected generally to reduce the potential dilution to the Company’s common stock upon any conversion of Notes and/or offset any cash payments the Company is required to make in excess of the principal amount of converted Notes.
Separately from the convertible note hedge, the Company entered into warrant transactions to sell to the option counterparties warrants to acquire, subject to customary anti-dilution adjustments, up to approximately 5.9 million shares of its common stock in the aggregate at an initial strike price of $141.56 per share. The warrants require net share or net cash settlement upon the Company’s election. The Company received aggregate proceeds of approximately $51.3 million for the issuance of the warrants, which was recorded in additional paid-in capital at issuance in the Consolidated Balance Sheets. The
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warrants could separately have a dilutive effect to the Company’s common stock to the extent that the market observable dataprice per share of similar instruments.its common stock exceeds the strike price of the warrants.
Note 10.11.     Lessor Leases
Sales-Type Leases
On a recurring basis, the Company enters into multi-year, sales-type lease agreements with the majority varying in length from one to five years. The following table presents the Company’s income recognized from sales-type leases for the years ended December 31, 2019, 2018,2021, 2020, and 2017:2019:
Year Ended December 31,Year Ended December 31,
201920182017202120202019
(In thousands)(In thousands)
Sales-type lease revenuesSales-type lease revenues$37,175  $39,167  $29,675  Sales-type lease revenues$21,887 $26,040 $37,175 
Cost of sales-type lease revenuesCost of sales-type lease revenues(14,985) (16,185) (12,395) Cost of sales-type lease revenues(8,918)(10,624)(14,985)
Selling profit on sales-type lease revenuesSelling profit on sales-type lease revenues$22,190  $22,982  $17,280  Selling profit on sales-type lease revenues$12,969 $15,416 $22,190 
Interest income on sales-type lease receivablesInterest income on sales-type lease receivables$1,756  $1,296  $992  Interest income on sales-type lease receivables$1,869 $1,933 $1,756 
The receivables as a result of these types of transactions are collateralized by the underlying equipment leased and consist of the following components at December 31, 20192021 and 2018:2020:
December 31,December 31,
2019201820212020
(In thousands) (In thousands)
Net minimum lease payments to be receivedNet minimum lease payments to be received$32,360  $28,295  Net minimum lease payments to be received$31,444 $35,331 
Less: Unearned interest income portionLess: Unearned interest income portion(2,840) (2,477) Less: Unearned interest income portion(2,388)(2,929)
Net investment in sales-type leasesNet investment in sales-type leases29,520  25,818  Net investment in sales-type leases29,056 32,402 
Less: Current portion (1)
Less: Current portion (1)
(9,770) (8,736) 
Less: Current portion (1)
(10,665)(10,246)
Long-term investment in sales-type leases, netLong-term investment in sales-type leases, net$19,750  $17,082  Long-term investment in sales-type leases, net$18,391 $22,156 

(1)    The current portion of the net investment in sales-type leases is included in other current assets in the Consolidated Balance Sheets.
The carrying amount of the Company’s sales-type lease receivables is a reasonable estimate of fair value.
The Company evaluates its sales-type leases individually and collectively for impairment. The allowance for credit losses was $0.2 million as of both December 31, 2019 and 2018.
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The maturity schedule of future minimum lease payments under sales-type leases retained in-house and the reconciliation to the net investment in sales-type leases reported on the Consolidated Balance Sheets was as follows:
December 31, 2019December 31,
2021
(In thousands)(In thousands)
2020$10,690  
20217,473  
202220226,768  2022$11,490 
202320234,754  20238,482 
202420241,852  20245,710 
202520253,768 
202620261,607 
ThereafterThereafter823  Thereafter387 
Total future minimum sales-type lease payments Total future minimum sales-type lease payments  32,360  Total future minimum sales-type lease payments31,444 
Present value adjustment Present value adjustment  (2,840) Present value adjustment(2,388)
Total net investment in sales-type leases Total net investment in sales-type leases  $29,520  Total net investment in sales-type leases$29,056 
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Operating Leases
The Company entered into certain leasing agreements that were classified as operating leases prior to the adoption of the new lease accounting standard.ASC 842, Leases. These agreements in place prior to January 1, 2019 will continue to be treated as operating leases, however any new leasing agreements entered into on or after January 1, 2019 under these programs are classified and accounted for as sales-type leases in accordance with the new lease accounting standard.ASC 842. The operating lease arrangements generally have initial terms of one to seven years. The following table represents the Company’s income recognized from operating leases for the years ended December 31, 2019, 2018,2021, 2020, and 2017:2019:
Year Ended December 31,
201920182017
(In thousands)
Rental income$12,660  $12,207  $10,993  
The net carrying value of the leased equipment under operating leases was $2.1 million and $2.6 million, which includes accumulated depreciation of $1.6 million and $1.2 million, as of December 31, 2019 and 2018, respectively. Depreciation expense of the leased equipment for the years ended December 31, 2019, 2018, and 2017 was $0.7 million, $0.5 million, and $0.3 million, respectively.
Year Ended December 31,
202120202019
(In thousands)
Rental income$10,467 $11,668 $12,660 
The maturity schedule of future minimum lease payments under operating leases was as follows:
December 31, 2019December 31, 2021
(In thousands)(In thousands)
2020$10,415  
20216,829  
202220224,941  2022$6,318 
202320232,914  20232,858 
20242024884  2024852 
20252025256 
2026202689 
ThereafterThereafter345  Thereafter179 
Total future minimum operating lease payments Total future minimum operating lease payments  $26,328  Total future minimum operating lease payments$10,552 
Note 11.12. Lessee Leases
The Company has operating leases for office buildings, data centers, office equipment, and vehicles. The Company’s leases have initial terms of one to 12 years. As of December 31, 2019,2021, the Company did not have any additional material operating leases that were entered into, but not yet commenced.
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The maturity schedule of future minimum lease payments under operating leases and the reconciliation to the operating lease liabilities reported on the Consolidated Balance Sheets was as follows:
December 31, 2019December 31, 2021
(In thousands)(In thousands)
2020$13,573  
202113,071  
2022202211,970  2022$15,434 
202320238,487  202311,553 
202420247,961  202410,037 
202520256,899 
202620266,457 
Thereafter Thereafter  19,768  Thereafter10,883 
Total operating lease payments Total operating lease payments  74,830  Total operating lease payments61,263 
Present value adjustment Present value adjustment  (14,103) Present value adjustment(8,405)
Total operating lease liabilities (1)
Total operating lease liabilities (1)
$60,727  
Total operating lease liabilities (1)
$52,858 

(1)    Amount consists of a current and long-term portion of operating lease liabilities of $10.1$12.9 million and $50.7$39.9 million, respectively. The short-termcurrent portion of the operating lease liabilities is included in accrued liabilities in the Consolidated Balance Sheets.
Prior to the adoption of the new lease accounting standard, the maturity schedule of future minimum lease payments under operating leases was as follows:
December 31, 2018
(In thousands)
2019$14,153  
202013,104  
202112,729  
202211,809  
20238,334  
Thereafter27,289  
Total minimum future lease payments  $87,418  
Operating lease costs were $15.0 million, $14.3 million, and $14.6 million for the yearyears ended December 31, 2019.2021, 2020, and 2019, respectively. Short-term lease costs and variable lease costs were immaterial for the year ended December 31, 2019.
Prior to the adoption of the new lease accounting standard, rent expense was $12.7 million and $11.5 millionnot material for the years ended December 31, 20182021, 2020, and 2017.2019, respectively.
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The following table summarizes supplemental cash flow information related to the Company’s operating leases for the yearyears ended December 31, 2021, 2020, and 2019:
Year Ended
December 31, 2019
(In thousands)
Cash paid for amounts included in the measurement of lease liabilities$14,636 
Right-of-use assets obtained in exchange for new lease liabilities$1,204 
Year Ended December 31,
202120202019
(In thousands)
Cash paid for amounts included in the measurement of lease liabilities$15,625 $14,490 $14,636 
Right-of-use assets obtained in exchange for new lease liabilities$5,503 $10,025 $1,204 
The following table summarizes the weighted-average remaining lease term and weighted-average discount rate related to the Company’s operating leases as of December 31, 2019:2021 and 2020:
December 31,
2019
(In thousands)
Weighted-average remaining lease term, years6.4
Weighted-average discount rate, %6.4 %
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December 31,
20212020
Weighted-average remaining lease term, years5.25.9
Weighted-average discount rate, %5.5 %5.8 %
Note 12.13.     Commitments and Contingencies
Purchase Obligations
In the ordinary course of business, the Company issues purchase orders based on its current manufacturing needs. As of December 31, 2019,2021, the Company had non-cancelable purchase commitments of $65.9$170.1 million, of which $63.8$158.5 million are expected to be paid within the next twelve months. 
Legal Proceedings
The Company is currently involved in various legal proceedings. As required under ASC 450, Contingencies, the Company accrues for contingencies when it believes that a loss is probable and that it can reasonably estimate the amount of any such loss. The Company has not recorded any accrual for contingent liabilities associated with the legal proceedings described below based on its belief that any potential loss, while reasonably possible, is not probable. Further, any possible range of loss in these matters cannot be reasonably estimated at this time. The Company believes that it has valid defenses with respect to legal proceedings pending against it. However, litigation is inherently unpredictable, and it is possible that cash flows or results of operations could be materially affected in any particular period by the unfavorable resolution of this contingency or because of the diversion of management’s attention and the creation of significant expenses.
On January 10, 2018, a lawsuit was filed against a number of individuals, governmental agencies, and corporate entities, including the Company and one of its former subsidiaries, Aesynt Incorporated (“Aesynt”), which, through a series of mergers, has been merged into the Company, in the Circuit Court for the City of Richmond, Virginia, captioned Ruth Ann Warner, as Guardian of Jonathan James Brewster Warner v. Centra Health, Inc., et al., Case No. CL18-152-1. The complaint sought monetary recovery of compensatory and punitive damages in addition to certain declaratory relief based upon, as against the individuals, governmental agencies, and corporate entities other than the Company and Aesynt, allegations of the use of excessive force, unlawful detention, false imprisonment, battery, simple and gross negligence and negligent hiring, detention, and training; and, as against the Company and Aesynt, claims of product liability, negligence, and breach of implied warranties. The Company and Aesynt were never served with the complaint. Upon motion of the plaintiff, the Court issued an order on February 21, 2019 nonsuiting (dismissing) the case without prejudice. On August 21, 2019, a newA class action lawsuit was filed against the Company, and Aesynt, in the Circuit Court for the County of Albemarle, Virginia, captioned Ruth Ann Warner, as Guardian of Jonathan James Brewster Warner v. Aesynt Incorporated, et al., Case No CL19-1301. The complaint seeks monetary recovery of damages based upon claims of product liability, negligence, and breach of implied warranties. The Company and Aesynt have not been served with the complaint. The Company intends to defend the lawsuit vigorously.
Onon June 6, 2018, a class action lawsuit was filed against a customer of the Company, the customer’s parent company, and two vendors of medication dispensing systems, one of which is the Company,5, 2019, in the Circuit Court of Cook County, Illinois, Chancery Division, captioned Yana Mazya,Corey Heard, individually and on behalf of all others similarly situated v. Northwestern Lake Forest Hospital, Northwestern Memorial Healthcare, Omnicell, Inc. and Becton Dickinson,, Case No. 2018-CH-071612019-CH-06817 (the “Heard Action”). The complaint soughtseeks class certification, monetary damages in the form of statutory damages for willful and/or reckless or, in the alternative, negligent violation of the Illinois Biometric Information Privacy Act (“BIPA”), and certain declaratory, injunctive, and other relief based on causes of action directed to allegations of violation of BIPA and of negligence by the defendants. The complaint was served on the Company on June 15, 2018. The Company’s obligation to respond to the complaint was held in abeyance pending a decision of the Illinois Supreme Court in a separate case involving BIPA issues. The Illinois Supreme Court issued its decision in that case on January 25, 2019. On April 10, 2019, subsequent to the Court’s issuance of an order granting the plaintiff leave to file an amended complaint, the plaintiff filed an amended complaint adding a second named plaintiff and an affiliate of the Company’s customer as an additional defendant and, in addition to making other modifications to the complaint, removing the separate cause of action directed to negligence. The Court established a deadline of May 13, 2019 for the defendants to answer or otherwise respond to the amended complaint. On May 10, 2019, defendants Northwestern Lake Forest Hospital, Northwestern Memorial Healthcare, and Northwestern Memorial Hospital removed the case to the United States District Court for the Northern District of Illinois, Eastern Division. Subsequently, on May 17, 2019, the Company and the other defendants in the case each filed a motion to dismiss the complaint for failure to state a cause of action upon which relief could be granted. On June 14, 2019, plaintiffs filed a motion to remand the case to state court. The Court then entered an order, on June 19, 2019, denying plaintiffs’ motion to remand, granting defendants’ motions to dismiss with respect to the additionally-named plaintiff, and continuing the motions to dismiss with respect to the originally-named plaintiff. On July 2, 2019, the Court entered an order remanding the case to state court and denying the defendants’ motions to dismiss without prejudice to renewal of the motions in state court. On September 5, 2019, plaintiff filed a motion to voluntarily dismiss the Company from the case without prejudice. The motion was granted by order of the Court dated October 10, 2019 and, as a result, the Company has been finally dismissed from the case without prejudice to plaintiff refiling the action.
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A declaratory judgment action was filed against the Company, on August 30, 2018, in the United States District Court for the Northern District of California, captioned Zurich American Insurance Company; American Guarantee & Liability Company v. Omnicell, Inc. and Does 1-10, inclusive, Case No. 3:18-CV-05345. The complaint seeks a declaration that the plaintiffs have no duty to defend or indemnify the Company in connection with the underlying litigation, the Yana Mazya, et al. v. Northwestern Lake Forest Hospital, et al., Case No. 2018-CH-07161 pending in the Circuit Court of Cook County, Illinois, Chancery Division (“Mazya Action”), disclosed above, together with claims for reimbursement and unjust enrichment relating to the defense of the Mazya Action in the form of attorneys’ fees and other related costs. The Company has not responded to the complaint. On February 12, 2019, the Court stayed the action pending the outcome of the Mazya Action and administratively closed the case. On October 15, 2019, the plaintiffs filed a notice advising the Court of the dismissal of the Company from the Mazya Action and requesting that the Court lift the stay in the case and set dates for filing a responsive pleading by the Company and initial discovery and scheduling matters. By order dated November 13, 2019, the Court (i) lifted the stay in the case, (ii) set a case management conference for February 5, 2020, and (iii) ordered the parties to file a joint case management statement by January 29, 2020. The parties subsequently reached a settlement of the case in principle and the Court, after notice of the parties, continued the case management conference until April 29, 2020 and ordered the parties to file a joint case management statement by April 22, 2020. The Company intends to defend the lawsuit vigorously.
A class action lawsuit was filed against the Company, on June 5, 2019, in the Circuit Court of Cook County, Illinois, Chancery Division, captioned Corey Heard, individually and on behalf of all others similarly situated, v. Omnicell, Inc., Case No. 2019-CH-06817. The complaint seeks class certification, monetary damages in the form of statutory damages for willful and/or reckless or, in the alternative, negligent violation of BIPA, and certain declaratory, injunctive, and other relief based on causes of action directed to allegations of violation of BIPA by the Company. The complaint was served on the Company on June 13, 2019. On July 31, 2019, the Company filed a motion to stay or consolidate the case with the action Yana Mazya, Action.et al. v. Northwestern Lake Forest Hospital, et al., Case No. 2018-CH-07161, pending in the Circuit Court of Cook County, Illinois, Chancery Division (the “Mazya Action”). The Court subsequently, on October 10, 2019, denied the motion, without prejudice, as being moot in view of the Company’s dismissal fromof the claims against the Company in the Mazya Action. The Company filed a motion to dismiss the complaint in the Heard Action on October 31, 2019. The hearing on the Company’s motion to dismiss is fully-briefedwas held on September 2, 2020. The Court ruled from the bench and dismissed the complaint without prejudice giving plaintiff leave to file an amended complaint by September 30, 2020. Plaintiff filed an amended complaint on September 30, 2020 and the Company subsequently filed a motion to dismiss the amended complaint on October 28, 2020, which was fully briefed, but the Court had not heard oral argument on the motion. The parties entered into a settlement agreement on January 25, 2022. On February 1, 2022, the Court granted preliminary approval of the settlement. The Court has scheduled a hearingstatus conference for June 1, 2022. Subject to final approval of the settlement, the Company intends to defend the lawsuit vigorously.
On December 21, 2020, Becton, Dickinson and Company (“BD”) filed a complaint against the Company in the United States District Court for the Middle District of North Carolina, asserting claims of misappropriation under the Defend Trade Secrets Act, misappropriation under the North Carolina Trade Secrets Protection Act, unfair competition, and unfair/deceptive trade practices in violation of North Carolina law (the “BD Complaint”). This action (the “BD Action”) was commenced in relation to another action brought by BD, in the same Court (the “Related Matter”) against a former BD employee who is also a former Company employee (the “Former Employee”) alleging that the Former Employee had violated the Former Employee’s legal obligations to BD regarding BD’s confidential and trade secret information when the Former Employee allegedly downloaded certain documents from BD’s information technology system following the end of the Former Employee’s employment with BD. In connection with the Related Matter, BD, the Former Employee, and the Company entered into a protocol with the purpose of facilitating the return to BD of any BD documents that may have been resident, as a result of the Former Employee’s actions, on any devices belonging to the Former Employee or the Company. The BD Complaint seeks injunctive relief and monetary damages in the form of compensatory, punitive, and exemplary damages, attorneys’ fees and costs, and pre-judgment and post-judgment interest. On March 17, 2021, the parties filed a joint motion forto stay the BD Action,
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which motion was granted by the Court on June 8, 2021. The stay has since been lifted and the Company’s answer to the BD Complaint is due March 16, 2020.9, 2022, unless an extension to such stay is mutually agreed to by the parties and approved by the Court. The Company intends to defend the lawsuit vigorously.
On July 18, 2019, a putative class action lawsuit was filed againstAs required under ASC 450, Contingencies, the Company accrues for contingencies when it believes that a loss is probable and certainthat it can reasonably estimate the amount of its officers in the U.S. District Court for the Northern District of California. The complaint, captioned Bursick v. Omnicell, Inc. et al., Case No. 3:19-cv-04150, alleged that the defendants violated federal securities laws by making materially false and misleading statements beginning in October 2018 regarding revenue recognition, customer concerns about implementation issues, and a purported need to write off inventory. The plaintiff sought unspecified monetary damages and other relief. On October 24, 2019, Frank Bursick was appointed Lead Plaintiff. On December 5, 2019, Lead Plaintiff filed a Notice of Voluntary Dismissal of this action as to all defendants, instead of filing an amended complaint. This action is now concluded.
In August 2019, the Company received a letter from the Denver office of the SEC seeking information related to the Company’s accounting processes and procedures.any such loss. The Company responded and fully cooperatedhas not recorded any material accrual for contingent liabilities associated with the SEC. On February 12, 2020, thelegal proceedings described above based on its belief that any potential material loss, while reasonably possible, is not probable. Further, any possible range of loss in these matters cannot be reasonably estimated at this time or is not deemed material. The Company received a letter from the SEC confirmingbelieves that it has concluded its investigationvalid defenses with respect to these legal proceedings pending against it. However, litigation is inherently unpredictable, and it is possible that cash flows or results of operations could be materially affected in any particular period by the SEC does not intend to recommendunfavorable resolution of any enforcement action againstof these legal proceedings or because of the Company.diversion of management’s attention and the creation of significant expenses.
Guarantees
As permitted under Delaware law andUnder the Company’s certificate of incorporation and bylaws, the Company has agreed to indemnify its directors and executive officers againstto the fullest extent not prohibited by Delaware and other applicable law, subject to certain losses that they may suffer by reason of the fact that such persons are, were or becomeexceptions. The Company has entered into individual indemnification agreements with its directors orand officers. The term of the indemnification period is for the entirety of the director’s or officer’s lifetimeservice to the Company and continues so long as the director or officer may be subject to any claim, action, or proceeding, and there is no limit on the potential amount of future payments that the Company could be required to make under these indemnification agreements. The Company has purchased a directors’ and officers’ liability insurance policy that may enable it to recover a portion of any future payments that it may be required to make under these indemnification agreements. Assuming the applicability of coverage and the willingness of the insurer to assume coverage and subject to certain retention, loss limits, and other policy provisions, the Company believes it is unlikely that the Company will be required to pay any material amounts pursuant to these indemnification obligations. However, no assurances can be given that the insurers will not attempt to dispute the validity, applicability, or amount of coverage without expensive and time-consuming litigation against the insurers.
Additionally, the Company undertakes indemnification obligations in its ordinary course of business in connection with, among other things, the licensing of its products and the provision of its support services. In the ordinary course of the Company’s business, the Company has in the past and may in the future agree to indemnify another party, generally its business affiliates or customers, against certain losses suffered or incurred by the indemnified party in connection with various types of claims, which may include, without limitation, claims of intellectual property infringement, certain tax liabilities, its gross negligence or intentional acts in the performance of support services, and violations of laws. The term of these indemnification obligations is generally perpetual. In general, the Company attempts to limit the maximum potential amount of future payments that it may be required to make under these indemnification obligations to the amounts paid to it by a customer, but in some
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cases the obligation may not be so limited.
In addition, the Company has in the past and may in the future warrant to its customers that its products will conform to functional specifications for a limited period of time following the date of installation (generally not exceeding 30 days) or that its software media is free from material defects. Sales contracts for certain of the Company’s medication packaging systems often include limited warranties for up to six months, but the periodic activity and ending warranty balances the Company records have historically not been immaterial.material.
From time to time, the Company may also warrant that its professional services will be performed in a good and workmanlike manner or in a professional manner consistent with industry standards. The Company generally seeks to disclaim most warranties, including any implied or statutory warranties such as warranties of merchantability, fitness for a particular purpose, title, quality, and non-infringement, as well as any liability with respect to incidental, consequential, special, exemplary, punitive, or similar damages. In some states, such disclaimers may not be enforceable. If necessary, the Company would provide for the estimated cost of product and service warranties based on specific warranty claims and claim history. The Company has not been subject to any significant claims for such losses and has not incurred any material costs in defending or settling claims related to these indemnification obligations. Accordingly, the Company believes it is unlikely that the Company will be required to pay any material amounts pursuant to these indemnification obligations or potential warranty claims and, therefore, no material liabilities have been recorded for such indemnification obligations as of December 31, 20192021 and 2018.2020.
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Note 13.14.     Employee Benefits and Share-Based Compensation
Stock Purchase Plan
1997 Employee Stock Purchase Plan
The Company has an Employee Stock Purchase Plan (“ESPP”), under which employees can purchase shares of its common stock based on a percentage of their compensation, but not greater than 15% of their earnings; provided, however, an eligible employee’s right to purchase shares of the Company’s common stock may not accrue at a rate which exceeds $25,000 of the fair market value of such shares for each calendar year in which such rights are outstanding. The purchase price per share must be equal to the lower of 85% of the fair value of the common stock at the beginning of a 24-month offering period or the end of each six-monthsix-month purchasing period.
There was a total of 1.50.9 million shares reserved for future issuance under the ESPP as of December 31, 2019.2021.
Stock Award Plans
2009 Equity Incentive Plan
The 2009 Equity Incentive Plan (“2009 Plan”), as amended, provides for the issuance of incentive stock options, RSAs, RSUs, PSUs, and other stock awards to the Company’s employees, directors, and consultants. There were 7.55.5 million shares of common stock reserved for future issuance under the 2009 Plan as of December 31, 2019.2021.
Options granted under the 2009 Plan generally become exercisable over periods of up to four years, with one-fourth of the shares vesting one year from the vesting commencement date with respect to initial grants, and the remaining shares vesting in 36 equal monthly installments thereafter. The exercise prices of the options is the fair market value of common stock on the date of grant. RSUs generally vest over periods of up to four years, with one-fourth of the shares vesting one year from the vesting commencement date with respect to initial grants, and the remaining shares vesting in 12 equal quarterly installments thereafter. Awards of restricted stock to non-employee directors are granted on the date of the annual meeting of stockholders and vest in full on the date of the next annual meeting of stockholders, provided such non-employee director remains a director on such date. The fair value of the awards on the date of issuance is amortized to expense from the date of grant to the date of vesting and are expensed ratably on a straight-line basis over the vesting period. PSUs granted to the Company’s executives might include performance and market conditions. PSUs become eligible for vesting when certain market or performance conditions are met.
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Share-Based Compensation Expense
The following table sets forth the total share-based compensation expense recognized in the Company’s Consolidated Statements of Operations:
Year Ended December 31,Year Ended December 31,
201920182017202120202019
(In thousands)(In thousands)
Cost of product and service revenuesCost of product and service revenues$5,648  $4,634  $3,478  Cost of product and service revenues$7,994 $7,469 $5,648 
Research and developmentResearch and development6,604  5,746  3,590  Research and development7,663 6,497 6,604 
Selling, general, and administrativeSelling, general, and administrative21,797  18,505  14,789  Selling, general, and administrative37,503 30,731 21,797 
Total share-based compensation expenseTotal share-based compensation expense$34,049  $28,885  $21,857  Total share-based compensation expense$53,160 $44,697 $34,049 
The Company did not capitalize any material share-based compensation asamounts to inventory, as such amounts were not materialcapitalized software, or internal-use software for the years ended December 31, 20192021 and December 31, 2018.2020. Income tax benefits realized from share-based compensation were $11.0$26.6 million, $6.5$10.3 million, and $8.2$11.0 million, for the years ended December 31, 2019, 2018,2021, 2020, and 2017,2019, respectively.
In
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ESPP
The following assumptions were used to value shares granted under the first quarterESPP for the years ended December 31, 2021, 2020, and 2019:
Year Ended December 31,
202120202019
Expected life, years0.5 - 2.00.5 - 2.00.5 - 2.0
Expected volatility, %27.4% - 53.5%30.4% - 53.5%28.2% - 39.9%
Risk-free interest rate, %0.1% - 2.6%0.1% - 2.7%1.3% - 2.7%
Dividend yield, %— %— %— %
For the years ended December 31, 2021 and 2020, employees purchased approximately 287,000 and 333,000 shares of 2019,common stock, respectively, under the Company modified the termsESPP at a weighted-average price of its stock options by extending the post-employment exercise period for certain employees. The Company recorded share-based compensation expense related to this modification of approximately $0.2 million on the stock options modification date.$62.14 and $48.77, respectively. As of December 31, 2019, share-based2021, the unrecognized compensation expensecost related to unvested stock options impacted by the modificationshares to be purchased under the ESPP was approximately $0.6$1.9 million whichand is expected to be recognized over the remaininga weighted-average vesting period of 1.91.3 years.
Stock Options and ESPP Shares
The following assumptions were used to value stock options and ESPP shares granted pursuant to the Company’s equity incentive plans2009 Plan for the years ended December 31, 2019, 2018,2021, 2020, and 2017:2019:
Year Ended December 31,
201920182017
Stock options
Expected life, years4.44.84.7
Expected volatility, %33.7 %31.1 %29.6 %
Risk-free interest rate, %2.0 %2.8 %1.9 %
Estimated forfeiture rate, %7.2 %6.9 %7.7 %
Dividend yield, %— %— %— %

Year Ended December 31,
201920182017
Employee stock purchase plan shares
Expected life, years0.5 - 2.00.5 - 2.00.5 - 2.0
Expected volatility, %28.2% - 39.9%28.1% - 33.8%25.8% - 32.8%
Risk-free interest rate, %1.3% - 2.7%0.8% - 2.7%0.5% - 1.4%
Dividend yield, %— %— %— %
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Stock Options Activity
Year Ended December 31,
202120202019
Expected life, years4.94.74.4
Expected volatility, %31.5 %39.4 %33.7 %
Risk-free interest rate, %0.9 %0.7 %2.0 %
Estimated forfeiture rate, %7.9 %5.7 %7.2 %
Dividend yield, %— %— %— %
The following table summarizes the sharestock option activity under the Company’s 2009 Plan during the year ended December 31, 2019:2021:
Number of
Shares
Weighted-Average
Exercise Price
Weighted-Average
Remaining Years
Aggregate
Intrinsic Value
Number of
Shares
Weighted-Average
Exercise Price
Weighted-Average
Remaining Years
Aggregate
Intrinsic Value
(In thousands, except per share data)(In thousands, except per share data)
Outstanding at December 31, 20183,748  $41.27  7.6$78,365  
Outstanding at December 31, 2020Outstanding at December 31, 20203,932 $62.50 7.8$226,160 
GrantedGranted1,169  76.44  Granted160 129.21 
ExercisedExercised(744) 33.83  Exercised(901)54.99 
ExpiredExpired(10) 37.79  Expired(14)62.58 
ForfeitedForfeited(261) 48.57  Forfeited(223)76.57 
Outstanding at December 31, 20193,902  $52.75  7.7$113,198  
Exercisable at December 31, 20191,580  $36.48  6.2$71,485  
Vested and expected to vest at December 31, 2019 and thereafter3,677  $51.83  7.7$110,048  
Outstanding at December 31, 2021Outstanding at December 31, 20212,954 $67.35 6.9$334,119 
Exercisable at December 31, 2021Exercisable at December 31, 20211,636 $55.13 6.0$204,949 
Vested and expected to vest at December 31, 2021 and thereafterVested and expected to vest at December 31, 2021 and thereafter2,845 $66.67 6.9$323,666 
The weighted-average fair value per share of options granted during the years ended December 31, 2021, 2020, and 2019 2018,was $35.17, $26.48, and 2017 was $23.54, $17.22, and $13.25, respectively. The intrinsic value of options exercised during the years ended December 31, 2021, 2020, and 2019 2018,was $88.0 million, $39.8 million, and 2017 was $32.8 million, $20.1respectively. The tax benefit realized from stock options exercised was $18.3 million, $7.1 million, and $18.2$6.3 million, for the years ended December 31, 2021, 2020, and 2019, respectively.
As of December 31, 2019,2021, total unrecognized compensation cost related to unvested stock options was $39.5$33.8 million, which is expected to be recognized over a weighted-average vesting period of 2.82.2 years.
Employee
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Restricted Stock PurchaseUnits (“RSU”)
The following table summarizes the RSU activity under the 2009 Plan Activity
Forduring the year ended December 31, 2019, employees purchased approximately 374,000 shares of common stock under the ESPP at a weighted-average price of $41.44. As of December 31, 2019, the unrecognized compensation cost related to the shares to be purchased under the ESPP was approximately $1.6 million and is expected to be recognized over a weighted-average period of 1.3 years.2021:
Restricted Stock Units (RSUs) and Restricted Stock Awards (RSAs)
Summaries of the restricted stock activity under the 2009 Plan are presented below for the year ended December 31, 2019:
Number of
Shares
Weighted-Average
Grant Date Fair Value
Weighted-Average
Remaining Years
Aggregate
Intrinsic Value
Number of
Shares
Weighted-Average
Grant Date Fair Value
Weighted-Average
Remaining Years
Aggregate
Intrinsic Value
(In thousands, except per share data)(In thousands, except per share data)
Restricted stock units
Outstanding at December 31, 2018538  $51.52  1.6$32,935  
Outstanding at December 31, 2020Outstanding at December 31, 2020580 $72.87 1.6$69,670 
Granted (Awarded)Granted (Awarded)277  78.49  Granted (Awarded)481 149.65 
Vested (Released)Vested (Released)(216) 48.88  Vested (Released)(224)74.50 
ForfeitedForfeited(55) 48.40  Forfeited(74)81.79 
Outstanding and unvested at December 31, 2019544  $66.65  1.6$44,492  
Outstanding and unvested at December 31, 2021Outstanding and unvested at December 31, 2021763 $119.93 1.6$137,696 
The weighted-average grant date fair value per share of RSUs granted during the years ended December 31, 2021, 2020, and 2019 2018,was $149.65, $74.52, and 2017 was $78.49, $59.52, and $45.97, respectively. The total fair value of RSUs that vested in the years ended December 31, 2021, 2020, and 2019 2018, and 2017 was $10.6$16.7 million, $7.9$11.2 million, and $6.5$10.6 million, respectively.
As of December 31, 2019,2021, total unrecognized compensation cost related to RSUs was $31.5$76.8 million, which is expected to be recognized over the remaining weighted-average vesting period of 3.03.1 years.
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Restricted Stock Awards (“RSAs”)
Number of
Shares
Weighted-Average
Grant Date Fair Value
(In thousands, except per share data)
Restricted stock awards
Outstanding at December 31, 201821  $46.60  
Granted (Awarded)17  81.86  
Vested (Released)(21) 46.96  
Outstanding and unvested at December 31, 201917  $81.92  
The following table summarizes the RSA activity under the 2009 Plan during the year ended December 31, 2021:
Number of
Shares
Weighted-Average
Grant Date Fair Value
(In thousands, except per share data)
Outstanding at December 31, 202021 $68.11 
Granted (Awarded)11 137.36 
Vested (Released)(21)68.11 
Outstanding and unvested at December 31, 202111 $137.36 
The weighted-average grant date fair value per share of RSAs granted during the years ended December 31, 2021, 2020, and 2019 2018,was $137.36, $68.11, and 2017 was $81.86, $46.60, and $41.10, respectively. The total fair value of RSAs that vested in the years ended December 31, 2021, 2020, and 2019 2018,was $1.4 million, $1.4 million, and 2017 was $1.0 million, for each period.respectively.
As of December 31, 2019,2021, total unrecognized compensation cost related to RSAs was $0.5$0.6 million, which is expected to be recognized over the remaining weighted-average vesting period of 0.4 years.
Performance-Based Restricted Stock Units (PSUs)Unit Awards (“PSUs”)
In 2018,During the year ended December 31, 2020, the Company granted 110,43262,759 PSUs to its executive officers, all of which became eligible for vesting upon the achievement of a certain level of shareholder return. In 2019,During the year ended December 31, 2021, the Company granted 61,09851,110 PSUs to its executive officers, all, none, or a portion of which 0% to 200% may become eligible for vesting depending on the level of shareholder return for the period from March 1, 20192021 through March 1, 2020.2022.
The fair value of a PSU award is determined using a Monte Carlo simulation model. The number of shares that vest at the end of the performance period depends on the percentile ranking of the total shareholder return for Omnicell stock over the performance period relative to the total shareholder return of each of the other companies in the NASDAQ Healthcare Index (the “Index”).
For PSUs granted on February 13, 2019, stock Stock price appreciation is calculated based on the trailing 20-day average stock price just prior to the first trading day of March 2019,in the grant year, compared to the trailing 20-day average stock price just prior to the first trading day of March 2020. For PSUs granted on February 6, 2018, stock price appreciation is calculated based onin the trailing 20-day average stock price just prioryear subsequent to the first trading daygrant year. The fair value of March 2018, comparedPSU awards to the trailing 20-day average stock price just prior to the first trading day of March 2019.executive officers is determined using a Monte Carlo simulation model.
On March 6, 2018,PSUs generally vest over periods of up to four years, with one-fourth of the shares vesting approximately one year from the vesting commencement date with respect to initial grants and upon confirmation by the Compensation Committee confirmedthat the Company's total stockholder return at the 60th percentile rank of the Index. This resulted in 100% of the 2017 PSUs, or 147,830 shares, as eligible for further time-based vesting. The eligible PSUs will vest as follows: 25% of the shares vested immediately on March 6, 2018 withperformance target has been met, and the remaining shares vesting on ain six equal semi-annual basis period of 36 months commencing on June 15, 2018.installments thereafter. Vesting is contingent upon continued service. Of the 147,830 shares eligible for time-based vesting under the 2017 PSUs, 81,322 shares, net of forfeitures, have vested as of December 31, 2019.
On March 5, 2019, the Compensation Committee confirmed the Company's total stockholder return at the 90th percentile rank of the Index. This resulted in 100% of the 2018 PSUs, or 110,432 shares, as eligible for further time-based vesting. The eligible PSUs will vest as follows: 25% of the shares vested immediately on March 5, 2019 with the remaining shares vesting on a semi-annual basis period of 36 months commencing on June 15, 2019. Vesting is contingent upon continued service. Of the 110,432 shares eligible for time-based vesting under the 2018 PSUs, 46,376 shares, net of forfeitures, have vested as of December 31, 2019.
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A summary ofIn addition to executive officers’ PSU awards, from time to time, the performance-based restricted stockCompany may grant PSUs with specific performance and service conditions to certain employees on an ad hoc basis. Historically such grants have not been material.
The following table summarizes the PSU activity under the 2009 Plan is presented below forduring the year ended December 31, 2019:2021:
Number of
Shares
Weighted-Average
Grant Date Fair Value Per Unit
Number of
Shares
Weighted-Average
Grant Date Fair Value Per Unit
(In thousands, except per share data)(In thousands, except per share data)
Outstanding at December 31, 2018197  $34.83  
Outstanding at December 31, 2020Outstanding at December 31, 2020155 $74.26 
GrantedGranted71  73.38  Granted68 162.16 
VestedVested(101) 34.37  Vested(66)67.66 
ForfeitedForfeited(33) 33.84  Forfeited(13)72.89 
Outstanding and unvested at December 31, 2019134  $55.82  
Outstanding and unvested at December 31, 2021Outstanding and unvested at December 31, 2021144 $118.71 
The weighted-average grant date fair value per share of PSUs granted during the years ended December 31, 2021, 2020, and 2019 2018,was $162.16, $82.17, and 2017 was $73.38, $38.03, and $34.05, respectively. The total fair value of PSUs that vested in the years ended December 31, 2021, 2020, and 2019 2018, and 2017 was $3.5$4.4 million, $3.2$3.7 million, and $2.6$3.5 million, respectively.
As of December 31, 2019,2021, total unrecognized compensation cost related to PSUs was approximately $3.1$7.5 million, which is expected to be recognized over the remaining weighted-average vesting period of 1.31.2 years.
Summary of Shares Reserved for Future Issuance under Equity Incentive Plans
The Company had the following ordinary shares reserved for future issuance under its equity incentive plans as of December 31, 2019:2021:
Number of Shares
(In thousands)
Share options outstanding3,9022,954 
Non-vested restricted stock awards696918 
Shares authorized for future issuance2,8731,637 
ESPP shares available for future issuance1,539919 
Total shares reserved for future issuance6,428 9,010 
401(k) Plan
The Company has established a pre-tax savings plan under Section 401(k) of the Internal Revenue Code.Code of 1986, as amended. The 401(k) Plan allows eligible employees in the United States to voluntarily contribute a portion of their pre-tax salary, subject to a maximum limit specified in the Internal Revenue Code. The Company matches 50% of employee contributions up to $3,000, annually. The Company’s contributions under this plan were $5.1$6.8 million, $4.6$5.7 million, and $3.8$5.1 million in the years ended December 31, 2019, 2018,2021, 2020, and 2017,2019, respectively.
Note 14.15. Stock Repurchase Program
On August 2, 2016, the Company’s Board of Directors (the “Board”) authorized a stock repurchase program providing for the repurchase of up to $50.0 million of the Company’s common stock (the “2016 Repurchase Program”). The 2016 Repurchase Program is in addition to the stock repurchase program approved by the Board on November 4, 2014 providing for the repurchase of up to $50.0 million of the Company’s common stock (the “2014 Repurchase Program”). As of December 31, 2019,2021, the maximum dollar value of shares that may yet be purchased under the two2 repurchase programs was $54.9 million.
The timing, price, and volume of repurchases are to be based on market conditions, relevant securities laws, and other factors. The stock repurchases may be made from time to time on the open market, in privately negotiated transactions, or pursuant to a Rule 10b-18 plan, subject to the terms and conditions of that certain A&R Credit Agreement, dated as of November 15, 2019, among the Company, the Lenders party thereto, and Wells Fargo Bank, National Association, as administrative agent.amended. The stock repurchase programs do not obligate the Company to repurchase any specific number of shares, and the Company may terminate or suspend the repurchase programs at any time.
DuringOn September 17, 2020, the years ended December 31, 2019, 2018, and 2017,Board authorized a one-time stock repurchase transaction providing for the Company did 0t repurchase any of its outstandingup to $75.0 million of the Company’s common stock.
stock in privately negotiated transactions concurrently with the issuance of the
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Notes, described in Note 10, Convertible Senior Notes. In September 2020, the Company repurchased 749,300 shares of its common stock from purchasers of the Notes in the offering in privately negotiated transactions effected through one of the initial purchasers or its affiliate at an average price of $70.78 per share for an aggregate purchase price of approximately $53.0 million. There will be no further repurchases under this one-time authorization.
During the years ended December 31, 2021, 2020, and 2019, the Company did not repurchase any of its outstanding common stock, including under the 2014 Repurchase Program or the 2016 Repurchase Program, other than the separately-authorized one-time stock repurchase concurrent with the offering of the Notes in September 2020.
Note 15.16.    Equity Offerings
On November 3, 2017, the Company entered into a Distribution Agreement (the “Distribution Agreement”) with J.P. Morgan Securities LLC, Wells Fargo Securities, LLC, and HSBC Securities (USA) Inc., as its sales agents, pursuant to which the Company maywas able to offer and sell from time to time through the sales agents up to $125.0 million maximum aggregate offering price of the Company’s common stock. Sales of the common stock pursuant to the Distribution Agreement maywere to be made in negotiated transactions or transactions that are deemed to be “at the market” offerings as defined in Rule 415 under the Securities Act of 1933, as amended, including sales made directly on the Nasdaq Stock Market, or sales made to or through a market maker other than on an exchange.
For the year ended December 31, 2017, the Company received gross proceeds of $14.7 million from sales of its common stock under the Distribution Agreement and incurred issuance costs of $0.8 million on sales of approximately 294,000 shares of its common stock at an average price of approximately $49.85 per share.
For the year ended December 31, 2018, the Company received gross proceeds of $40.3 million from sales of its common stock under the Distribution Agreement and incurred issuance costs of $0.7 million on sales of approximately 557,000 shares of its common stock at an average price of approximately $72.40 per share.
For the year ended December 31, 2019, the Company received gross proceeds of $38.5 million from sales of its common stock under the Distribution Agreement and incurred issuance costs of $0.7 million on sales of approximately 460,000 shares of its common stock at an average price of approximately $83.81 per share. As of
For the years ended December 31, 2019,2021 and 2020, the Company had an aggregatedid not sell any of $31.5 million availableits common stock under the Distribution Agreement.
The registration statement under which the shares that could have been sold pursuant to the Distribution Agreement expired on November 3, 2020, and, accordingly, no additional sales will be offered undermade pursuant to the Distribution Agreement.
Note 16.17.     Income Taxes
The following is a geographical breakdown of income (loss) before the provision for income taxes:
Year Ended December 31,Year Ended December 31,
201920182017202120202019
(In thousands) (In thousands)
DomesticDomestic$81,641  $46,528  $25,280  Domestic$67,103 $34,714 $81,641 
ForeignForeign(7,708) (10,912) (20,768) Foreign(1,096)(5,365)(7,708)
Income (loss) before provision for income taxesIncome (loss) before provision for income taxes$73,933  $35,616  $4,512  Income (loss) before provision for income taxes$66,007 $29,349 $73,933 
The provision for (benefit from) income taxes consisted of the following:
Year Ended December 31,Year Ended December 31,
201920182017202120202019
(In thousands) (In thousands)
Current:Current:Current:
FederalFederal$8,006  $1,404  $2,430  Federal$(7,841)$1,874 $8,006 
StateState4,549  1,832  1,852  State187 1,733 4,549 
ForeignForeign1,240  768  745  Foreign(234)647 1,240 
Total current income taxesTotal current income taxes13,795  4,004  5,027  Total current income taxes(7,888)4,254 13,795 
Deferred:Deferred:Deferred:
FederalFederal(1,292) 5,455  (19,822) Federal(2,708)(3,868)(1,292)
StateState(1,609) (909) (3,430) State(1,217)(2,494)(1,609)
ForeignForeign1,701  (10,663) (7,781) Foreign(29)(737)1,701 
Total deferred income taxesTotal deferred income taxes(1,200) (6,117) (31,033) Total deferred income taxes(3,954)(7,099)(1,200)
Total provision for (benefit from) income taxesTotal provision for (benefit from) income taxes$12,595  $(2,113) $(26,006) Total provision for (benefit from) income taxes$(11,842)$(2,845)$12,595 
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The provision for (benefit from) income taxes differs from the amount computed by applying the statutory federal tax rate as follows:
Year Ended December 31,Year Ended December 31,
201920182017202120202019
(In thousands) (In thousands)
U.S. federal tax provision at statutory rateU.S. federal tax provision at statutory rate$15,525  $7,479  $1,579  U.S. federal tax provision at statutory rate$13,861 $6,163 $15,525 
State taxesState taxes2,258  651  224  State taxes(814)(601)2,258 
Section 162(m) limitationSection 162(m) limitation6,382 2,550 2,279 
Non-deductible expensesNon-deductible expenses2,898  1,424  1,373  Non-deductible expenses363 325 619 
Uncertain tax positionsUncertain tax positions(2,472) (412) (295) Uncertain tax positions(835)(394)(2,472)
Share-based compensation tax benefitShare-based compensation tax benefit(7,892) (4,005) (5,887) Share-based compensation tax benefit(20,717)(6,929)(7,892)
Research tax creditsResearch tax credits(3,805) (3,230) (3,233) Research tax credits(5,170)(4,038)(3,805)
Domestic production deduction—  —  (621) 
Restructuring impactRestructuring impact7,432  (4,205) —  Restructuring impact(6,116)— 7,432 
Foreign derived intangible income deductionForeign derived intangible income deduction(449) (349) —  Foreign derived intangible income deduction(68)(204)(449)
Foreign rate differentialForeign rate differential(1,424) 561  938  Foreign rate differential17 (102)(1,424)
One-time impact of the Tax Act—  —  (20,005) 
Transaction costTransaction cost1,097 422 — 
OtherOther524  (27) (79) Other158 (37)524 
Total provision for (benefit from) income taxesTotal provision for (benefit from) income taxes$12,595  $(2,113) $(26,006) Total provision for (benefit from) income taxes$(11,842)$(2,845)$12,595 
Due to continuingThe Company has executed various global operational centralization activities duringand legal entity rationalization in recent years. During the year ended December 31, 2021, the Company recognized a benefit on the release of previously recorded uncertain tax positions related to the sale of certain intellectual property rights by Aesynt B.V. to Omnicell, Inc. and a gain on the transfer of certain assets to Omnicell Pty Ltd, which resulted in a tax benefit, net of tax expense, of $6.1 million. During the year ended December 31, 2020, Aesynt B.V. merged with and into Aesynt Holding B.V., with Aesynt Holding B.V. surviving and changing its name to Omnicell B.V., Aesynt Holding Coöperatief U.A. liquidated into Omnicell, Inc., and Omnicell GmbH merged with and into Mach4 Automatisierungstechnik GmbH (“Mach4”), with Mach4 surviving and changing its name to Omnicell GmbH. During the year ended December 31, 2020, the Company also recognized a gain on Omnicell Limited’s transferring shares of Omnicell GmbH to Omnicell International, LLC, which resulted in an immaterial tax expense. During the year ended December 31, 2019, the Company recognized gain on the sale of certain intellectual property rights by Aesynt B.V. to Omnicell, Inc. and by Mach4 Automatisierungstechnik GmbH to Omnicell, Inc., which resulted in a tax expense, net of tax benefit, of $7.4 million. As a result
On March 27, 2020, the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”) was signed into law in response to the COVID-19 pandemic. The CARES Act, among other provisions, includes provisions related to refundable payroll tax credits, deferment of global operational centralization activities during the year endedemployer portion of certain payroll taxes, net operating losses carryback periods, alternative minimum tax credit refunds, modification to the net interest expense deduction limitation, and technical amendments to tax depreciation methods for qualified improvement property placed in service after December 31, 2018,2017. The provisions of the CARES Act did not have a material impact on the Company’s income taxes.
On March 11, 2021, the President of the United States signed into law the “American Rescue Plan Act of 2021” (the “ARP Act”), which provides additional economic stimulus and tax credits, including the expansion and modification of the employee retention tax credit enacted by the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”) and the refundable tax credits for COVID-related paid sick and family leave enacted by the Family First Act. The Company recognized $4.2 milliondoes not expect these provisions of tax benefit associated with makingthe ARP Act to have a check-the-box electionmaterial impact for income taxes. The ARP Act further expands the “covered employees” definition for purposes of Section 162(m) of the Internal Revenue Code of 1986, as amended, used in determining the limitation on the deduction for excessive employee remuneration rules to treat Aesynt Holding Coöperatief U.A. (Netherlands) asbe applicable for taxable years beginning after December 31, 2026. The provisions of the ARP Act did not have a U.S. disregarded entity beginning inmaterial impact on the first quarter of 2018. Company’s income taxes.
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Significant components of the Company’s deferred tax assets (liabilities) were as follows:
December 31,December 31,
2019201820212020
(In thousands)(In thousands)
Deferred tax assets (liabilities):Deferred tax assets (liabilities):Deferred tax assets (liabilities):
Deferred revenuesDeferred revenues$4,129  $2,943  Deferred revenues$6,892 $5,910 
Share-based compensationShare-based compensation6,483  5,531  Share-based compensation9,265 8,094 
Inventory related items3,507  2,874  
Inventory-related itemsInventory-related items4,834 4,953 
Tax credit carryforwardsTax credit carryforwards13,472  7,413  Tax credit carryforwards15,311 12,105 
Reserves and accrualsReserves and accruals5,712  5,983  Reserves and accruals8,699 8,160 
Loss carryforwardsLoss carryforwards9,484  17,515  Loss carryforwards14,451 8,461 
Lease liabilityLease liability15,471  —  Lease liability13,179 15,465 
Other, netOther, net543  81  Other, net1,824 1,578 
Gross deferred tax assetsGross deferred tax assets58,801  42,340  Gross deferred tax assets74,455 64,726 
Valuation allowanceValuation allowance(1,186) (1,256) Valuation allowance— (1,199)
Total net deferred tax assetsTotal net deferred tax assets57,615  41,084  Total net deferred tax assets74,455 63,527 
IntangiblesIntangibles(18,941) (32,304) Intangibles(41,158)(22,010)
Depreciation and amortizationDepreciation and amortization(35,941) (22,504) Depreciation and amortization(38,924)(36,528)
Prepaid expensesPrepaid expenses(13,395) (12,563) Prepaid expenses(17,775)(15,654)
Right-of-use assetsRight-of-use assets(14,286) —  Right-of-use assets(12,039)(13,949)
Other, netOther, net(381)— 
Total deferred tax liabilitiesTotal deferred tax liabilities(82,563) (67,371) Total deferred tax liabilities(110,277)(88,141)
Net deferred tax liabilitiesNet deferred tax liabilities$(24,948) $(26,287) Net deferred tax liabilities$(35,822)$(24,614)
Deferred income tax assets (liabilities) are provided for temporary differences that will result in future tax deductions or future taxable income, as well as the future benefit of tax credit carryforwards. The Company recognizes deferred tax assets to the extent that it believes these assets are more likely than not to be realized. In making such a determination, the Company considers all available positive and negative evidence, including future reversals of existing temporary differences, projected future taxable income, tax planning strategies, and results of recent operations. On the basis of this evaluation, as of December 31, 2019,2021, previously recorded valuation allowance of $1.2 million of valuation allowance was recorded onfor certain foreign net operating losses carried forward, asloss carryforwards was released, and the Company believes that suchno longer has a valuation allowance against any of its deferred tax assets are not more likely than not to be realized.assets.
As of December 31, 2019,2021, the Company had $3.2$30.5 million of federal net operating loss carryforwards expiring 2037, $7.4losses and $18.0 million of state net operating loss carryforwards expiring at various dates beginning 2023,in 2024, and $29.5$23.5 million of foreign net operating loss carryforwards expiring at various dates beginning 2024. For the year ended December 31, 2019, the Company did not generate a net operating loss.losses carried forward indefinitely. For income tax purposes, the Company has federal and California research tax credits carryforwards of $3.1$5.3 million and $15.0$19.0 million, respectively. Federal research tax credit carryforwards from prior years will begin to expire in 2035.2040. California credits are available indefinitely to reduce cash taxes payable.
It is the Company'sCompany’s practice and intention to reinvest the earnings of its non-U.S. subsidiaries in those operations. As of December 31, 2019,2021, the Company has not made a provision for U.S. federal income, withholding, and state income taxes on the outside basis difference related to certain foreign subsidiaries because earnings are intended to be indefinitely reinvested in operations outside the U.S.
The Company files income tax returns in the United States and various statesstate and foreign jurisdictions. In the normal course of business, the Company is subject to examinationexaminations by taxing authorities, including major jurisdictions such as the United States, Germany, Italy, Netherlands, and the United Kingdom. With few exceptions, as of December 31, 2019,2021, the Company was no longer subject to U.S., state, and foreign examination for years before 2016, 2015,2018, 2017, and 2015,2017, respectively.
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The aggregate change in the balance of gross unrecognized tax benefits, which excludes interest and penalties, for the three years ended December 31, 2019 was as follows:2021, 2020, and 2019:
(In thousands)
Balance as of December 31, 2016$11,616 
Increases related to tax positions taken during a prior period503 
Decreases related to tax positions taken during the prior period(1,782)
Increases related to tax positions taken during the current period805 
Decreases related to settlements— 
Decreases related to expiration of statute of limitations(401)
Balance as of December 31, 201710,741 
Increases related to tax positions taken during a prior period19 
Decreases related to tax positions taken during the prior period(1,257)
Increases related to tax positions taken during the current period870 
Decreases related to settlements— 
Decreases related to expiration of statute of limitations(412)
Balance as of December 31, 2018$9,961 
Increases related to tax positions taken during a prior period10 
Decreases related to tax positions taken during the prior period(6)
Increases related to tax positions taken during the current period9,282 
Decreases related to settlements— 
Decreases related to expiration of statute of limitations(2,472)
Balance as of December 31, 201916,775 
Increases related to tax positions taken during a prior period88 
Decreases related to tax positions taken during the prior period— 
Increases related to tax positions taken during the current period2,294 
Decreases related to settlements— 
Decreases related to expiration of statute of limitations(911)
Balance as of December 31, 202018,246 
Increases related to tax positions taken during a prior period40 
Decreases related to tax positions taken during the prior period(8,908)
Increases related to tax positions taken during the current period1,219 
Decreases related to settlements— 
Decreases related to expiration of statute of limitations(1,636)
Balance as of December 31, 2021$16,7758,961 
The total amounts of gross unrecognized tax benefit that, if realized, would favorably affect the Company'sCompany’s effective income tax rate in future periods, was $16.8$9.0 million and $18.2 million as of December 31, 2019.2021 and 2020, respectively. The decrease in the gross uncertain tax benefits during the year ended December 31, 2021 was primarily due to a release of certain unrecognized tax benefits as a result of an effective settlement with the tax authorities. The Company recognizes interest and/orand penalties related to uncertain tax positions in interest and other income (expense), net in the Consolidated Statements of Operations, accruing $0.5$0.3 million, $0.5$0.4 million, and $0.3$0.5 million for the years ended December 31, 2019, 2018,2021, 2020, and 2017,2019, respectively. Accrued interest and penalties are included within other long-term liabilities on the Consolidated Balance Sheets. The combined amount of cumulative accrued interest and penalties was approximately $1.0$0.6 million, $1.4 million, and $1.4$1.0 million for the years ended December 31, 2019, 2018,2021, 2020, and 2017,2019, respectively. The Company does not believe there will be any significant changes in its unrecognized tax positions over the next twelve months.
Note 17.18.    Restructuring Expenses
In the fourth quarter of 2018,During 2020, the Company announced a company-wide organizational realignment initiative in order to more effectively align its organizational infrastructure for future expected growth.and operations with the industry vision of the Autonomous Pharmacy. During the second quarter of 2020, the Company also initiated a restructuring plan to help mitigate the adverse impact of the COVID-19 pandemic on its business and financial results. During the year ended December 31, 2018,2020, the Company incurred and accrued for $1.3$10.0 million of restructuring expenses, which includesemployee severance costs and consulting-relatedrelated expenses.
During the first quarter of 2021, the Company continued its organizational realignment initiative, incurring $2.0 million of employee severance costs and related expenses. As of December 31, 2019,2021, there was no unpaid balance related to this realignment initiative.
On March 2, 2018,
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The following table summarizes the Company initiatedtotal restructuring expenses recognized in the realignmentCompany’s Consolidated Statements of its Automation and Analytics commercial group in North America and France. DuringOperations for the yearyears ended December 31, 2018, the Company accrued2021, 2020, and paid out $3.0 million of employee severance costs and related expenses.2019:
On February 15, 2017, the Company announced its plan to reduce its workforce by approximately 100 full-time employees and close the Company’s Nashville, Tennessee, and Slovenia facilities, which was completed in fiscal year 2017. The total cost for the plan was $4.2 million, which includes employee severance costs of approximately $3.7 million, and facility-related costs of approximately $0.6 million. For the year ended December 31, 2017, the Company made payments of $4.2 million and the restructuring program was completed.
Year Ended December 31,
202120202019
(In thousands)
Cost of product and service revenues$389 $2,564 $— 
Research and development105 3,716 — 
Selling, general, and administrative1,526 3,681 — 
Total restructuring expenses$2,020 $9,961 $— 
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SCHEDULE II
VALUATION AND QUALIFYING ACCOUNTS
Balance at
Beginning of Period (1)
Charged (Credited) to Costs and Expenses (2)
Debited (Credited) to Other Accounts (3)
Amounts
Written Off (4)
Translation Adjustments (5)
Balance at
End of Period (1)
(In thousands)
Year ended December 31, 2017
Accounts receivable$4,796  $1,008  $ $(402) $333  $5,738  
Investment in sales-type leases254  (62) —  —  —  192  
Total allowances deducted from assets$5,050  $946  $ $(402) $333  $5,930  
Year ended December 31, 2018
Accounts receivable$5,738  $(127) $12  $(3,010) $(31) $2,582  
Investment in sales-type leases192  10  12  —  —  214  
Total allowances deducted from assets$5,930  $(117) $24  $(3,010) $(31) $2,796  
Year ended December 31, 2019
Accounts receivable$2,582  $2,488  $—  $(1,986) $143  $3,227  
Investment in sales-type leases214  11  —  —  —  225  
Total allowances deducted from assets$2,796  $2,499  $—  $(1,986) $143  $3,452  
Balance at
Beginning of Period (1)
Charged (Credited) to
Costs and Expenses (2)
Amounts
Written Off (3)
Other Adjustments (4)
Balance at
End of Period (1)
(In thousands)
Year ended December 31, 2019
Accounts receivable and unbilled receivables$2,582 $2,488 $(1,986)$143 $3,227 
Long-term unbilled receivables— — — — — 
Net investment in sales-type leases214 11 — — 225 
Total allowances deducted from assets$2,796 $2,499 $(1,986)$143 $3,452 
Year ended December 31, 2020
Accounts receivable and unbilled receivables$3,227 $1,095 $(535)$499 $4,286 
Long-term unbilled receivables— — — 30 30 
Net investment in sales-type leases225 40 — — 265 
Total allowances deducted from assets$3,452 $1,135 $(535)$529 $4,581 
Year ended December 31, 2021
Accounts receivable and unbilled receivables$4,286 $2,130 $(2,079)$935 $5,272 
Long-term unbilled receivables30 (4)— 026 
Net investment in sales-type leases265 (37)— — 228 
Total allowances deducted from assets$4,581 $2,089 $(2,079)$935 $5,526 

(1)Allowance for doubtful accounts.credit losses.
(2)Represents amounts charged and credited to bad debt expense.for provisions for credit losses.
(3)Represents amounts debited to trade accounts receivable as recoveries, increasing the allowance.
(4)Represents amounts written-offwritten off from the allowance and accounts receivable.
(5)(4)Represents other adjustments, such as foreign currency translation, adjustments.adoption of new accounting guidance, and purchase price accounting adjustments in connection with acquisitions.
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INDEX TO EXHIBITS
Incorporated By Reference
Exhibit NumberExhibit DescriptionFormFile No.ExhibitFiling Date
2.18-K000-330432.110/29/2015
2.28-K000-330432.111/29/2016
3.110-Q000-330433.19/20/2001
3.210-Q000-330433.28/9/2010
3.310-K000-330433.23/28/2003
3.410-Q000-330433.45/4/2018
4.1Reference is made to Exhibits 3.1, 3.2, 3.3, and 3.4
4.2S-1/A333-570244.17/24/2001
4.3S-3ASR333-2213324.511/3/2017
4.4S-3ASR333-2213324.711/3/2017
4.5S-3ASR333-2213324.811/3/2017
4.6S-3ASR333-2213324.911/3/2017
4.7+
10.1*8-K000-3304310.16/6/2018
10.2*8-K000-3304310.12/19/2019
10.3S-1333-5702410.23/14/2001
10.410-K000-3304310.63/8/2012
10.510-K000-3304310.93/8/2012
10.6S-1333-5702410.123/14/2001
10.7*S-8000-3304399.27/2/2015
10.8*10-K000-3304310.143/23/2007
10.9*S-8333-23166999.15/22/2019
10.10*8-K000-3304310.13/8/2019
10.11*10-K000-3304310.173/11/2011
10.12*Form of Restricted Stock Bonus Grant Notice and Form of Restricted Stock Bonus Agreement for 2009 Equity Incentive Plan, as amended10-K333-22517999.45/24/2018
Incorporated By Reference
Exhibit NumberExhibit DescriptionFormExhibitFiling Date
2.18-K2.110/29/2015
2.28-K2.111/29/2016
2.38-K2.18/12/2020
2.410-Q2.210/30/2020
3.110-Q3.19/20/2001
3.210-Q3.28/9/2010
3.310-K3.23/28/2003
3.48-K3.18/12/2020
4.1Reference is made to Exhibits 3.1, 3.2, 3.3, and 3.4
4.2S-1/A4.17/24/2001
4.310-K4.72/26/2020
4.48-K4.19/25/2020
4.58-K4.29/25/2020
10.1*S-899.27/2/2015
10.2*S-899.16/10/2021
10.3*10-Q10.111/5/2021
10.4*10-Q10.48/9/2012
10.5*10-Q10.58/9/2012
10.6*S-899.45/24/2018
10.7*8-K10.13/8/2019
10.8*10-Q10.17/31/2020
10.9*10-K10.92/24/2021
10.10*10-K10.102/24/2021
10.11*8-K10.13/17/2010


Table of Contents
Incorporated By Reference
Exhibit NumberExhibit DescriptionFormFile No.ExhibitFiling Date
10.13*8-K000-3304310.13/17/2010
10.14*10-K000-3304310.263/8/2004
10.15*10-K000-3304310.143/11/2011
10.16*10-K000-3304310.292/24/2009
10.178-K000-3304310.13/20/2012
10.18*10-Q000-3304310.15/5/2017
10.19*10-Q000-3304310.48/9/2012
10.20*10-Q000-3304310.58/9/2012
10.2110-Q000-3304310.68/9/2012
10.2210-Q000-3304310.78/9/2012
10.2310-Q000-3304310.88/9/2012
10.2410-Q000-3304310.18/9/2013
10.2510-K000-3304310.373/30/2015
10.26*10-Q000-3304310.311/6/2015
10.27*10-Q000-3304310.411/6/2015
10.2810-Q000-3304310.25/6/2016
10.2910-Q000-3304310.35/6/2016
10.3010-Q000-3304310.45/6/2016
10.3110-K000-3304310.362/28/2017
10.3210-Q000-3304310.35/5/2017
10.3310-Q000-3304310.38/4/2017
Incorporated By Reference
Exhibit NumberExhibit DescriptionFormExhibitFiling Date
10.12*10-Q10.15/5/2017
10.13*S-110.123/14/2001
10.14*10-Q10.411/6/2015
10.15*10-K10.263/8/2004
10.16*10-K10.143/11/2011
10.17*10-Q10.311/6/2015
10.18*10-K10.412/27/2019
10.1910-K10.93/8/2012
10.2010-K10.222/24/2021
10.2110-Q10.35/6/2016
10.2210-K10.242/24/2021
10.2310-K10.252/24/2021
10.2410-K10.262/24/2021
10.2510-K10.272/24/2021
10.2610-Q10.35/5/2017
10.2710-K10.392/26/2020
10.288-K10.111/18/2019
10.298-K10.19/22/2020
10.308-K10.19/25/2020
10.318-K10.29/25/2020
10.32*+
10.33*+
21.1+


Table of Contents
Incorporated By Reference
Exhibit NumberExhibit DescriptionFormFile No.ExhibitFiling Date
10.34+
10.358-K000-330431.111/3/2017
10.3610-K000-3304310.412/27/2019
10.3710-Q000-3304310.35/3/2019
10.3810-Q000-3304310.111/1/2019
10.39+
10.408-K000-3304310.111/18/2019
21.1+
23.1+
24.1+
31.1+
31.2+
32.1+
101.INS+
Inline XBRL Instance Document - The instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
101.SCH+
Inline XBRL Taxonomy Extension Schema Document
101.CAL+
Inline XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF+
Inline XBRL Taxonomy Extension Definition Linkbase Document
101.LAB+
Inline XBRL Taxonomy Extension Labels Linkbase Document
101.PRE+
Inline XBRL Taxonomy Extension Presentation Linkbase Document
104+
Cover Page Interactive Data File (formatted as inline XBRL with applicable taxonomy extension information contained in Exhibits 101).
Incorporated By Reference
Exhibit NumberExhibit DescriptionFormExhibitFiling Date
23.1+
24.1+
31.1+
31.2+
32.1+
101.INS+
Inline XBRL Instance Document - The instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
101.SCH+
Inline XBRL Taxonomy Extension Schema Document
101.CAL+
Inline XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF+
Inline XBRL Taxonomy Extension Definition Linkbase Document
101.LAB+
Inline XBRL Taxonomy Extension Labels Linkbase Document
101.PRE+
Inline XBRL Taxonomy Extension Presentation Linkbase Document
104+
Cover Page Interactive Data File (formatted as inline XBRL with applicable taxonomy extension information contained in Exhibits 101).

*    Indicates a management contract, compensation plan, or arrangement.
+    Filed herewith.


Table of Contents
SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this reportAnnual Report to be signed on its behalf by the undersigned, thereunto duly authorized.
OMNICELL, INC.
Date:February 26, 202025, 2022By:/s/ PETER J. KUIPERS
Peter J. Kuipers,
Executive Vice President & Chief Financial Officer
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS, that each of the persons whose signature appears below hereby constitutes and appoints Randall A. Lipps and Peter J. Kuipers, each of them acting individually, as his or her attorney-in-fact, each with the full power of substitution, for him or her in any and all capacities, to sign any and all amendments to this Annual Report on Form 10-K, and to file the same, with all exhibits thereto and other documents in connection therewith, with the Securities and Exchange Commission, granting unto said attorneys-in-fact, and each of them, full power and authority to do and perform each and every act and thing requisite and necessary to be done in and about the premises as fully to all intents and purposes as he or she might or could do in person, hereby ratifying and confirming our signatures as they may be signed by our said attorney-in-fact and any and all amendments to this Annual Report on Form 10-K.
Pursuant to the requirements of the Securities Exchange Act of 1934, this reportAnnual Report has been signed below by the following persons on behalf of the registrant and in the capacities and on the dates indicated.
SignatureTitleDate
/s/ RANDALL A. LIPPSChief Executive Officer, President and Chairman of the Board (Principal Executive Officer)February 26, 202025, 2022
Randall A. Lipps
/s/ PETER J. KUIPERSExecutive Vice President & Chief Financial Officer
(Principal Financial Officer)
February 26, 202025, 2022
Peter J. Kuipers
/s/ JOSEPH B. SPEARSSenior Vice President, Chief Accounting Officer and Corporate Controller (Principal Accounting Officer)February 26, 202025, 2022
Joseph B. Spears
/s/ JOANNE B. BAUERFebruary 26, 202025, 2022
Joanne B. BauerDirector
/s/ EDWARD P. BOUSAFebruary 25, 2022
Edward P. BousaDirector
/s/ JAMES T. JUDSONFebruary 26, 202025, 2022
James T. JudsonDirector
/s/ VANCE B. MOOREFebruary 26, 202025, 2022
Vance B. MooreDirector
/s/ MARK W. PARRISHFebruary 26, 202025, 2022
Mark W. ParrishDirector
/s/ ROBIN G. SEIMFebruary 26, 202025, 2022
Robin G. SeimDirector
/s/ BRUCE E. SCOTTFebruary 26, 202025, 2022
Bruce E. ScottDirector
/s/ BRUCE D. SMITHFebruary 26, 202025, 2022
Bruce D. SmithDirector
/s/ SARA J. WHITEFebruary 26, 202025, 2022
Sara J. WhiteDirector

S-1