Table of Contents


 
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
 
FORM 10-Q
 
(Mark One)
TQUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended September 30, 20172018
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 number: 001-36732
 
PRA Health Sciences, Inc.
(Exact name of registrant as specified in its charter)
 
Delaware    46-3640387
(State or other jurisdiction of (I.R.S. Employer
incorporation or organization) Identification No.)
 
4130 ParkLake Avenue, Suite 400, Raleigh, NC 27612
(Address of principal executive offices) (Zip Code)
 
(919) 786-8200
(Registrant’s telephone number, including area code)
 
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  T No  ☐
 
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted 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  T No  ☐
 
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act. (Check one):
 
Large accelerated filer  x
Accelerated filer  ☐
  
Non-accelerated filer  ☐Smaller reporting company  ☐
  
(Do not check if a smaller reporting company)Emerging growth company   ☐
 
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.    ☐
 
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes  ☐ No  T
 
Indicate the number of shares outstanding of each of the issuer’s classes of common stock, as of the latest practicable date.
 
Class     Number of Shares Outstanding
Common Stock $0.01 par value 63,369,72964,975,144 shares outstanding as of October 23, 2017November 1, 2018
 



PRA HEALTH SCIENCES, INC.
FORM 10-Q
FOR QUARTERLY PERIOD ENDED SEPTEMBER 30, 20172018
TABLE OF CONTENTS
 
Item Number Page
   
  
 
 
 
 
 
 
   
  



PART I - FINANCIAL INFORMATION


Item 1. Financial Statements
PRA HEALTH SCIENCES, INC. AND SUBSIDIARIES
CONSOLIDATED CONDENSED BALANCE SHEETS
(UNAUDITED)
(in thousands, except share amounts)
 
  September 30, December 31,
  2018 2017
ASSETS    
Current assets:    
Cash and cash equivalents $127,517
 $192,229
Restricted cash 318
 661
Accounts receivable and unbilled services, net 616,940
 627,003
Other current assets 75,649
 57,131
Total current assets 820,424
 877,024
Fixed assets, net 149,535
 143,070
Goodwill 1,501,620
 1,512,424
Intangible assets, net 725,009
 783,836
Other assets 54,032
 41,692
Total assets $3,250,620
 $3,358,046
LIABILITIES AND STOCKHOLDERS' EQUITY    
Current liabilities:    
Current portion of borrowings under credit facilities $
 $91,500
Current portion of long-term debt 
 28,789
Accounts payable 59,794
 64,635
Accrued expenses and other current liabilities 380,851
 317,481
Advanced billings 479,686
 469,211
Total current liabilities 920,331
 971,616
Long-term debt, net 1,191,511
 1,225,397
Deferred tax liabilities 107,207
 112,181
Other long-term liabilities 51,195
 112,371
Total liabilities 2,270,244
 2,421,565
Commitments and contingencies (Note 12) 

 

Stockholders' equity:    
Preferred stock (100,000,000 authorized shares; $0.01 par value)    
Issued and outstanding -- none 
 
Common stock (1,000,000,000 authorized shares; $0.01 par value)    
Issued and outstanding -- 64,914,921 and 63,623,950 at September 30, 2018 and December 31, 2017, respectively 649
 636
Additional paid-in capital 940,444
 905,423
Accumulated other comprehensive loss (150,298) (136,470)
Retained earnings 183,048
 161,182
Equity attributable to PRA Health Sciences, Inc. stockholders 973,843
 930,771
Noncontrolling interest 6,533
 5,710
Total stockholders' equity 980,376
 936,481
Total liabilities and stockholders' equity $3,250,620
 $3,358,046
  September 30, December 31,
  2017 2016
ASSETS    
Current assets:    
Cash and cash equivalents $193,581
 $144,623
Restricted cash 697
 4,715
Accounts receivable and unbilled services, net 628,029
 439,053
Other current assets 70,361
 36,346
Total current assets 892,668
 624,737
Fixed assets, net 131,432
 87,577
Goodwill 1,535,057
 971,980
Intangible assets, net 711,727
 473,976
Other assets 38,749
 32,121
Total assets $3,309,633
 $2,190,391
LIABILITIES AND STOCKHOLDERS' EQUITY    
Current liabilities:    
Current portion of long-term debt $56,719
 $31,250
Accounts payable 60,438
 51,335
Accrued expenses and other current liabilities 277,495
 149,113
Advanced billings 493,368
 332,501
Total current liabilities 888,020
 564,199
Long-term debt, net 1,293,498
 797,052
Deferred tax liabilities 128,366
 73,703
Other long-term liabilities 63,452
 26,185
Total liabilities 2,373,336
 1,461,139
Commitments and contingencies (Note 11) 
 
Stockholders' equity:    
Preferred stock, $0.01 par value, 100,000,000 shares authorized; 0 shares issued and outstanding at September 30, 2017 and December 31, 2016, respectively 
 
Common stock, $0.01 par value, 1,000,000,000 authorized shares at September 30, 2017 and December 31, 2016; 63,329,298 and 61,597,705 issued and outstanding at September 30, 2017 and December 31, 2016, respectively 633
 616
Additional paid-in capital 898,862
 879,067
Accumulated other comprehensive loss (146,291) (224,686)
Retained earnings 177,230
 74,255
Equity attributable to PRA Health Sciences, Inc. stockholders 930,434
 729,252
Noncontrolling interest 5,863
 
Total stockholders' equity 936,297
 729,252
Total liabilities and stockholders' equity $3,309,633
 $2,190,391
 
The accompanying notes are an integral part of the consolidated condensed financial statements.



PRA HEALTH SCIENCES, INC. AND SUBSIDIARIES
CONSOLIDATED CONDENSED STATEMENTS OF OPERATIONS
(UNAUDITED)
(in thousands, except per share amounts)
 
 Three Months Ended September 30, Nine Months Ended September 30, Three Months Ended September 30, Nine Months Ended September 30,
 2017 2016 2017 2016 2018 2017 2018 2017
Revenue:        
Service revenue $494,550
 $399,841
 1,379,572
 $1,166,410
Reimbursement revenue 87,459
 53,414
 223,921
 172,915
Total revenue 582,009
 453,255
 1,603,493
 1,339,325
Revenue $717,596
 $582,009
 $2,142,274
 $1,603,493
Operating expenses:                
Direct costs 326,865
 259,910
 914,988
 758,333
Direct costs (exclusive of depreciation and amortization) 371,422
 326,865
 1,134,509
 914,988
Reimbursable out-of-pocket costs 87,459
 53,414
 223,921
 172,915
 77,584
 87,459
 237,307
 223,921
Selling, general and administrative 79,307
 67,190
 229,770
 199,648
Reimbursable investigator fees 65,133
 
 193,585
 
Selling, general and administrative expenses 92,553
 79,307
 275,424
 229,770
Transaction-related costs 12,740
 
 12,740
 31,785
 43,837
 11,741
 32,709
 11,816
Depreciation and amortization 18,853
 17,708
 50,146
 52,246
 28,270
 18,853
 84,163
 50,146
Loss on disposal of fixed assets, net 8
 219
 240
 290
(Gain) loss on disposal of fixed assets, net (15) 8
 21
 240
Income from operations 56,777
 54,814
 171,688
 124,108
 38,812
 57,776
 184,556
 172,612
Interest expense, net (11,557) (13,779) (31,088) (42,525) (14,423) (11,557) (43,860) (31,088)
Loss on modification or extinguishment of debt (3,089) 
 (3,089) (21,485) (454) (3,089) (454) (3,089)
Foreign currency (losses) gains, net (12,794) 1,182
 (35,004) 9,264
Other income (expense), net 1,004
 20
 724
 (85)
Foreign currency losses, net (1,809) (12,794) (1,416) (35,004)
Other (expense) income, net (68) 5
 (201) (200)
Income before income taxes and equity in income of unconsolidated joint ventures 30,341
 42,237
 103,231
 69,277
 22,058
 30,341
 138,625
 103,231
(Benefit from) provision for income taxes (18,241) 10,821
 (165) 17,869
Provision for (benefit from) income taxes 20,248
 (18,241) 55,392
 (165)
Income before equity in income of unconsolidated joint ventures 48,582
 31,416
 103,396
 51,408
 1,810
 48,582
 83,233
 103,396
Equity in income of unconsolidated joint ventures, net of tax 24
 33
 92
 2,742
 44
 24
 118
 92
Net income 48,606
 31,449
 103,488
 54,150
 1,854
 48,606
 83,351
 103,488
Net income attributable to noncontrolling interest (401) 
 (513) 
 (359) (401) (898) (513)
Net income attributable to PRA Health Sciences, Inc. $48,205
 $31,449
 $102,975
 $54,150
 $1,495
 $48,205
 $82,453
 $102,975
Net income per share attributable to common stockholders:                
Basic $0.77
 $0.52
 $1.66
 $0.89
 $0.02
 $0.77
 $1.29
 $1.66
Diluted $0.73
 $0.49
 $1.57
 $0.84
 $0.02
 $0.73
 $1.24
 $1.57
Weighted average common shares outstanding:                
Basic 62,730
 60,937
 62,185
 60,579
 64,261
 62,730
 63,891
 62,185
Diluted 65,872
 64,521
 65,683
 64,268
 66,506
 65,872
 66,258
 65,683
 
The accompanying notes are an integral part of the consolidated condensed financial statements.



PRA HEALTH SCIENCES, INC. AND SUBSIDIARIES
CONSOLIDATED CONDENSED STATEMENTS OF COMPREHENSIVE (LOSS) INCOME
(UNAUDITED)
(in thousands)
 
  Three Months Ended September 30, Nine Months Ended September 30,
  2017 2016 2017 2016
Net income $48,606
 $31,449
 $103,488
 $54,150
Other comprehensive income (loss):        
Foreign currency translation adjustments 26,863
 (11,211) 75,076
 (55,548)
Unrealized income (loss) on derivative instruments, net of income tax of $(11), $0, $(11) and $0 46
 127
 (21) (2,546)
Reclassification adjustments:        
(Gain) loss on derivatives included in net income, net of income taxes of $1,926, $0, $1,926 and $0 (167) 1,617
 3,249
 4,242
Comprehensive income 75,348
 21,982
 181,792
 298
Comprehensive income attributable to noncontrolling interest (373) 
 (423) 
Comprehensive income attributable to PRA Health Sciences, Inc. $74,975
 $21,982
 $181,369
 $298
  Three Months Ended September 30, Nine Months Ended September 30,
  2018 2017 2018 2017
Net income $1,854
 $48,606
 $83,351
 $103,488
Other comprehensive (loss) income:        
Foreign currency translation adjustments (3,996) 26,863
 (23,182) 75,076
Unrealized gains (losses) on derivative instruments, net of income tax of $381, $(11), $2,004 and $(11) 1,041
 46
 5,613
 (21)
Reclassification adjustments:        
Losses (gains) on derivatives included in net income, net of income taxes of $393, $1,926, $1,314 and $1,926 1,070
 (167) 3,666
 3,249
Comprehensive (loss) income (31) 75,348
 69,448
 181,792
Comprehensive income attributable to noncontrolling interest (193) (373) (823) (423)
Comprehensive (loss) income attributable to PRA Health Sciences, Inc. $(224) $74,975
 $68,625
 $181,369
 
The accompanying notes are an integral part of the consolidated condensed financial statements.



PRA HEALTH SCIENCES, INC. AND SUBSIDIARIES
CONSOLIDATED CONDENSED STATEMENTS OF CASH FLOWS
(UNAUDITED)
(in thousands)
 Nine Months Ended September 30, Nine Months Ended September 30,
 2017 2016 2018 2017
Cash flows from operating activities:        
Net income $103,488
 $54,150
 $83,351
 $103,488
Adjustments to reconcile net income to net cash provided by operating activities:        
Depreciation and amortization 50,146
 52,246
 84,163
 50,146
Amortization of debt issuance costs and discount 1,480
 3,514
 1,619
 1,480
Amortization of terminated interest rate swaps 4,931
 3,334
 5,478
 4,931
Stock-based compensation 7,686
 4,940
Stock-based compensation expense 20,469
 7,686
Change in fair value of acquisition-related contingent consideration 32,868
 (924)
Non-cash transaction-related costs 5,294
 29,421
 773
 5,294
Unrealized foreign currency losses (gains) 35,406
 (9,380)
Unrealized foreign currency (gains) losses (131) 35,406
Loss on modification or extinguishment of debt 3,089
 21,485
 454
 3,089
Deferred income taxes (27,340) (8,076) 17,499
 (27,340)
Equity in income of unconsolidated joint ventures (92) (2,742) (118) (92)
Other reconciling items 190
 41
 52
 190
Changes in operating assets and liabilities:        
Accounts receivable, unbilled services, and advanced billings (51,883) (52,290)
Accounts receivable, unbilled services and advanced billings (12,552) (51,883)
Other operating assets and liabilities (14,567) (29,935) (319) (13,643)
Payment of acquisition-related contingent consideration (35,029) 
Net cash provided by operating activities 117,828
 66,708
 198,577
 117,828
Cash flows from investing activities:        
Purchase of fixed assets (39,287) (25,657) (40,086) (39,287)
Cash paid for interest on interest rate swap (763) (913)
Proceeds from the sale of WuXiPRA 
 3,700
Proceeds received (cash paid) for interest on interest rate swap, net 125
 (763)
Proceeds from the sale of marketable securities 183
 
Proceeds from the sale of fixed assets 55
 
 43
 55
Acquisition of Symphony Health Solutions Corporation, net of cash acquired (522,581) 
 
 (522,581)
Acquisition of Parallel 6, Inc., net of cash acquired (39,561) 
 
 (39,561)
Acquisition of Takeda PRA Development Center KK, net of cash acquired 2,680
 
 
 2,680
Acquisition of Takeda Pharmaceutical Data Services, Ltd., net of cash acquired (142) 
 
 (142)
Acquisition of Nextrials, Inc., net of cash acquired 
 (4,268)
Net cash used in investing activities (599,599) (27,138) (39,735) (599,599)
Cash flows from financing activities:        
Payment of acquisition-related contingent consideration (79,663) (400)
Borrowings on accounts receivable financing agreement 20,000
 120,000
 60,000
 20,000
Repayments on accounts receivable financing agreement (20,000) 
 (10,000) (20,000)
Proceeds from issuance of long-term debt 550,000
 
 
 550,000
Repayments of long-term debt (26,875) (133,559) (114,395) (26,875)
Borrowings on line of credit 30,000
 110,000
 
 30,000
Repayments on line of credit (30,000) (110,000) (91,500) (30,000)
Payments for debt issuance costs (5,512) 
 
 (5,512)
Payment of debt prepayment and debt extinguishment costs 
 (17,824)
Proceeds from stock option exercises 6,457
 638
Payment of acquisition-related contingent consideration (400) 
Net cash provided by (used in) financing activities 523,670
 (30,745)
Taxes paid related to net shares settlement of equity awards (5,337) 
Proceeds from stock issued under employee stock purchase plan and stock option exercises 19,273
 6,457
Net cash (used in) provided by financing activities (221,622) 523,670
Effects of foreign exchange changes on cash, cash equivalents, and restricted cash 3,041
 628
 (2,275) 3,041
Change in cash, cash equivalents, and restricted cash 44,940
 9,453
 (65,055) 44,940
Cash, cash equivalents, and restricted cash, beginning of period 149,338
 126,125
 192,890
 149,338
Cash, cash equivalents, and restricted cash, end of period $194,278
 $135,578
 $127,835
 $194,278


The accompanying notes are an integral part of the consolidated condensed financial statements.



PRA HEALTH SCIENCES, INC. AND SUBSIDIARIES
NOTES TO CONSOLIDATED CONDENSED FINANCIAL STATEMENTS
(UNAUDITED)
 
(1) Basis of Presentation
 
The Company
 
PRA Health Sciences, Inc. and its subsidiaries, or the Company, is a full-service global contract research organization providing a broad range of product development and data solution services to pharmaceutical and biotechnology companies around the world. The Company’s integrated services include data management, statistical analysis, clinical trial management, and regulatory and drug development consulting.
 
Unaudited Interim Financial Information
 
The interim consolidated condensed financial statements include the accounts of the Company and variable interest entities where the Company is the primary beneficiary. These financial statements are prepared in conformity with U.S. generally accepted accounting principles, or GAAP, and are unaudited. In the opinion of the Company’s management, all adjustments of a normal recurring nature necessary for a fair presentation have been reflected. Certain financial information that is normally included in annual financial statements prepared in accordance with GAAP, but that is not required for interim reporting purposes, has been omitted. The accompanying interim consolidated condensed financial statements and related notes should be read in conjunction with the Company’s consolidated financial statements and related notes included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2016.2017.
 
The preparation of the interim consolidated condensed financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the interim consolidated condensed financial statements and the reported amounts of revenues and claims and expenses during the reporting period. Actual results could differ from those estimates.
 
Variable Interest EntitiesReclassification

A variable interest entity (“VIE”) isDuring the fourth quarter of 2017, the Company made an entityaccounting policy election to present changes in which a controlling financial interest may be achieved through arrangements that do not involve voting interests. A VIE is required to bethe estimated fair value of contingent consideration as part of income from operations within transaction-related costs on the consolidated by its primary beneficiary, which is the entity that possesses the power to direct the activitiescondensed statements of the VIE that most significantly impact the VIEs economic performance and has the obligation to absorb losses or the right to receive benefits from the VIE that are significant to the entity.operations. The Company consolidates VIEs when it isrecasted the primary beneficiary$1.0 million and $0.9 million changes in estimated fair value of contingent consideration for the VIE, including joint ventures determined to be VIEs.
Forthree and nine months ended September 30, 2017, respectively, that were previously included in other income, net on the consolidated VIEs in which the Company owns less than 100%condensed statements of the ownership interest or is exposed to less than 100% of the VIE’s economic performance, the outside stockholders' interests are shown as noncontrolling interests.operations.
 
Recently Implemented Accounting Pronouncements
 
On January 1, 2018, the Company adopted Accounting Standards Codification, or ASC, Topic 606, "Revenue from Contracts with Customers," or ASC 606, using the modified retrospective method for all contracts that were not completed as of January 1, 2018. Comparative prior period information continues to be reported under the accounting standards in effect for the period presented. The Company recorded a net decrease in opening retained earnings of $60.6 million as of January 1, 2018 due to the cumulative impact of adopting ASC 606. The Company decreased unbilled services by $67.4 million, increased deferred tax assets by $18.3 million, increased accrued expenses by $50.8 million, and decreased advanced billings by $39.3 million as of January 1, 2018. The adoption of ASC 606 had no net impact on the Company’s consolidated condensed statement of cash flows.


The impact of adoption of ASC 606 on the Company's consolidated condensed statements of operations for the three months ended September 30, 2018 is as follows (in thousands):
  As Reported Reclassification from adoption of ASC 606 Impact from adoption of ASC 606 Balances without adoption of ASC 606
Revenue:        
Revenue $717,596
 $(650,514) $(67,082) $
         
Service revenue 
 572,930
 
 572,930
Reimbursement revenue 
 77,584
 
 77,584
Total revenue 717,596
 
 (67,082) 650,514
Operating expenses:        
Direct costs (exclusive of depreciation and amortization) 371,422
 
 
 371,422
Reimbursable out-of-pocket costs 77,584
 
 
 77,584
Reimbursable investigator fees 65,133
 
 (65,133) 
Selling, general and administrative expenses 92,553
 
 
 92,553
Transaction-related costs 43,837
 
 
 43,837
Depreciation and amortization 28,270
 
 
 28,270
Gain on disposal of fixed assets, net (15) 
 
 (15)
Income from operations $38,812
 $
 $(1,949) $36,863

The impact of adoption of ASC 606 on the Company's consolidated condensed statements of operations for the nine months ended September 30, 2018 is as follows (in thousands):
  As Reported Reclassification from adoption of ASC 606 Impact from adoption of ASC 606 Balances without adoption of ASC 606
Revenue:        
Revenue $2,142,274
 $(1,945,138) $(197,136) $
         
Service revenue 
 1,707,831
 
 1,707,831
Reimbursement revenue 
 237,307
 
 237,307
Total revenue 2,142,274
 
 (197,136) 1,945,138
Operating expenses:        
Direct costs (exclusive of depreciation and amortization) 1,134,509
 
 
 1,134,509
Reimbursable out-of-pocket costs 237,307
 
 
 237,307
Reimbursable investigator fees 193,585
 
 (193,585) 
Selling, general and administrative expenses 275,424
 
 
 275,424
Transaction-related costs 32,709
 
 
 32,709
Depreciation and amortization 84,163
 
 
 84,163
Loss on disposal of fixed assets, net 21
 
 
 21
Income from operations $184,556
 $
 $(3,551) $181,005



Periods presented prior to adoption have been recast to conform with the presentation of a single revenue total in the consolidated condensed statement of operations. Previously, the three months ended September 30, 2017 included service revenue of $494.6 million, reimbursement revenue of $87.5 million, and excluded $57.9 million in investigator fees which were reported net of costs incurred. The nine months ended September 30, 2017 included service revenue of $1,379.6 million and reimbursement revenue of $223.9 million, and excluded $181.0 million in investigator fees which were reported net of costs incurred.

In March 2016,May 2017, the Financial Accounting Standards Board, or FASB, issued Accounting Standards Update, or ASU, No. 2016-09,2017-09, “Compensation-Stock Compensation (Topic 718): ImprovementsCompensation: Scope of Modification Accounting,” which provides guidance about what changes to Employee Share-Based Payment Accounting.the terms or conditions of a share-based payment award require an entity to apply modification accounting in accordance with ASC Topic 718, “Stock Compensation.This update includes provisions intendedThe amendments to simplify various aspects of accounting for share-based compensation. In addition, ASU No. 2016-092017-09 went into effect for public companies for annualreporting periods beginning after December 15, 2016.

The Company adopted this ASU beginning with the first quarter of 2017. The adoption of this ASU had the following effects on the consolidated condensed financial statements:
Income taxes - The standard requires excess tax benefits and tax deficiencies to be recorded as income tax benefit or expense in the statement of operations. The Company applied the modified retrospective adoption approach beginning in 2017 and recorded a cumulative-effect adjustment to retained earnings and reduced its deferred tax liabilities by $12.7 million with an offsetting increase to the valuation allowance of $12.7 million. As such, the net impact to retained earnings was zero. The Company continuously evaluates its need for a valuation allowance on its net deferred tax assets based upon the weight of available evidence. If the Company is able to support the recognition of certain net deferred tax assets in the future, it is noted that an additional tax benefit from the release of this additional valuation could occur at that time. This adjustment relates to tax assets that had previously arisen from tax deductions for equity compensation expenses that were greater than the compensation recognized for financial reporting.

Forfeitures – The standard provides an accounting policy election to account for forfeitures as they occur. The Company made this accounting policy election and the modified retrospective adoption for this component of the standardNo. 2017-09 did not have a material impact on itsthe Company's consolidated condensed financial statements.
Statements of Cash Flows - Cash flows related to excess tax benefits are no longer separately classified as a financing activity apart from other income tax cash flows. The Company adopted this component of the standard on a prospective basis. 
Earnings Per Share - The Company uses the treasury stock method to compute diluted earnings per share, unless the effect would be anti-dilutive. Under this method, the Company is no longer required to estimate the tax rate and apply it to the dilutive share calculation for determining the dilutive earnings per share. The Company adopted this component of the standard on a prospective basis.
 
In August 2016,January 2017, the FASB issued ASU No. 2016-15, “Statement2017-01, “Business Combinations: Clarifying the Definition of Cash Flows Classification of Certain Cash Receipts and Cash Payments,a Business,” which clarifies existing guidance relatedthat when substantially all of the fair value of the gross assets acquired (or disposed of) is concentrated in a single identifiable asset or group of similar identifiable assets, it should be treated as an acquisition or disposition of an asset. The amendments to accounting for cash receipts and cash payments and classification on the statement of cash flows. In November 2016, the FASB issued ASU No. 2016-18, “Statement of Cash Flows (Topic 230): Restricted Cash,” which requires restricted cash be included with cash and cash equivalents when reconciling the beginning-of-period and end-of-period total amounts shown on the statement of cash flows. This guidance is effective2017-01 went into effect for fiscal years, and interim periods within those years beginning after December 15, 2017, with early2017. The adoption permitted. The guidance for both standards requires application using a retrospective transition method.
The Company early adopted both ASUs during the fourth quarter of 2016. As a result of the retrospective application of ASU No. 2016-15, $17.8 million of payments of debt prepayment and debt extinguishment costs originally recorded as operating cash outflows were reclassified to financing outflows in2017-01 did not have a material impact on the Company's consolidated condensed statement of cash flows for the nine months ended September 30, 2016. The retrospective application of ASU No. 2016-18 resulted in restricted cash being reclassified as a component of cash, cash equivalents, and restricted cash in the consolidated condensed statement of cash flows for all periods presented.financial statements.
 
Recently Issued Accounting Pronouncements
In May 2014, the FASB issued ASU No. 2014-09, "Revenue from Contracts with Customers.” The new revenue standard establishes a single revenue recognition model for recognizing contracts from customers. Under the new standard, revenue is recognized when a customer obtains control of promised goods or services and is recognized in an amount that reflects the consideration which the entity expects to receive in exchange for those goods or services. In addition, the standard requires disclosure of the nature, amount, timing, and uncertainty of revenue and cash flows arising from contracts with customers. The FASB has issued several amendments to the standard, including clarification on principal versus agent considerations, identifying performance obligations, and accounting for licenses of intellectual property.  The new standard is effective for annual reporting periods beginning after December 15, 2017, including interim periods within that reporting period. The standard permits the use of either the retrospective or modified retrospective (cumulative effect) transition method. 
The Company plans to adopt the new revenue standard effective January 1, 2018 using the modified retrospective approach and continues to evaluate the potential impact to its consolidated financial statements. The Company’s implementation team consists of both internal resources and external advisors to assist with the adoption of the new standard. The Company completed a review of a representative sample of contracts from its contract portfolio and is continuing to evaluate key qualitative judgments associated with the adoption of the new revenue standard. The Company expects its long-term contracts currently accounted for using the proportional performance method may include additional contract value and costs used in the measure of progress as compared to its current accounting policies. The accounting for short-term contracts within the Clinical Research segment is expected to remain materially consistent with the current accounting treatment. The Company will complete its evaluation of the new standard in the fourth quarter, finalize its assessment of potential differences from its current accounting policies, and implement the necessary business processes, systems and controls required to support recognition and disclosure under the new standard. 
 
In February 2016, the FASB issued ASU No. 2016-02, “Leases,” which revises the accounting related to lessee accounting.leases. Under the new guidance, lessees will be required to recognize a lease liability and a right-of-use asset for all leases with terms greater than 12 months. Leases will be classified as either finance or operating, with classification affecting the pattern of expense recognition in the statement of operations. The provisions of ASU No. 2016-02 are effective for fiscal years beginning after December 15, 2018 and should be applied through a modified retrospective transition approach by either adjusting prior periods for leases existing at, or entered into after, the beginning of the earliest comparative period presented in the financial statements. Early

statements or by not adjusting the comparative periods and recording a cumulative effect adjustment as of the adoption is permitted.date. The Company has established an implementation team to assist with the adoption of the new standard. The evaluation and implementation process is currently assessingongoing and is expected to continue through the remainder of 2018 as the Company performs an analysis of its lease portfolio to identify potential impact of ASU No. 2016-02 ondifferences from its current accounting policies, and as it reviews the Company’s consolidated condensed financial statements.
In January 2017,business processes, systems and controls required to support recognition and disclosure under the FASB issued ASU No. 2017-01, “Business Combinations: Clarifyingnew standard. Upon implementation, the Definition of a business,” which clarifies that whenCompany expects to recognize substantially all of the fair value of the gross assets acquired (or disposed of) is concentrated in a single identifiable asset or group of similar identifiable assets, it should be treated as an acquisition or disposal of an asset. The amendments to ASU No. 2017-01 are effective for fiscal years beginning after December 15, 2017, with early adoption permitted. The adoption of ASU No. 2017-01 is not expected to have a material impactits leases on the Company's consolidated condensed financial statements.balance sheet by recording a right-to-use asset and a corresponding lease liability.


In January 2017, the FASB issued ASU No. 2017-04, “ Intangibles-Goodwill“Intangibles-Goodwill and Other: Simplifying the Test for Goodwill Impairment,” in order to simplify the subsequent measurement of goodwill by eliminating the Step 2 goodwill impairment test. Under the amendments in this ASU, an entity should perform its annual or interim goodwill impairment test by comparing the fair value of a reporting unit with its carrying amount. An entity will then recognize an impairment charge for the amount by which the carrying amount exceeds the reporting unit’s fair value; however the loss recognized should not exceed the total amount of goodwill allocated to that reporting unit. The amendments to ASU No. 2017-04 are effective for fiscal years beginning after December 15, 2019, with early adoption permitted. The adoption of ASU No. 2017-04 is not expected to have a material impact on the Company's consolidated condensed financial statements.

In May 2017, the FASB issued ASU No. 2017-09, “Compensation-Stock Compensation: Scope of Modification Accounting,” which provides guidance about what changes to the terms or conditions of a share-based payment award require an entity to apply modification accounting in ASC Topic 718, “Stock Compensation.” The amendments to ASU No. 2017-09 are effective for reporting periods beginning after December 15, 2017, with early adoption permitted. The adoption of ASU No. 2017-09 is not expected to have a material impact on the Company's consolidated condensed financial statements.


In August 2017, the FASB issued ASU No. 2017-12, "Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities," in order to simplify certain aspects of hedge accounting and improve disclosures of hedging arrangements. ASU No. 2017-12 eliminates the need to separately measure and report hedge ineffectiveness and generally requires the entire change in fair value of a hedging instrument to be presented in the same income statement line as the hedged item. Entities must apply the amendments to cash flow and net investment hedge relationships that exist on the date of adoption using a modified retrospective approach. The presentation and disclosure requirements must be applied prospectively. The amendments to ASU No. 2017-12 are effective for fiscal years beginning after December 15, 2018, with early adoption permitted. The adoption of ASU No. 2017-12 is not expected to have a material impact on the Company's consolidated condensed financial statements.

In February 2018, the FASB issued ASU No. 2018-02, "Income Statement - Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income." The amendments in this update allow a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects

Restricted cashresulting from the Tax Cuts and Jobs Act of 2017, or the Act. The amendments in this update also require entities to disclose their accounting policy for releasing income tax effects from accumulated other comprehensive income. The amendments to ASU No. 2018-02 are effective for the reporting period beginning after December 15, 2018, and interim periods therein. Early adoption is permitted. The Company is currently assessing the potential impact of ASU No. 2018-02 on the Company's consolidated financial statements.

In August 2018, the FASB issued ASU No. 2018-15, "Customer's Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract," in order to expand on the FASB's guidance of capitalized costs incurred in a cloud computing arrangement. The amendments in this update require an entity (customer) in a hosting arrangement that is a service contract to follow the guidance in Subtopic 350-40 to determine which implementation costs to capitalize as an asset related to the service contract and which costs to expense. The amendments to ASU No. 2018-15 are effective for the reporting period beginning after December 15, 2019, and interim periods therein, with early adoption permitted. The adoption of ASU No. 2018-15 is not expected to have a material impact on the Company's consolidated financial statements.

(2) Significant Accounting Policies Update
Significant accounting policies are detailed in "Note 2: Significant Accounting Policies" of the Annual Report on Form 10-K for the year ended December 31, 2017. Significant changes to the Company's accounting policies as a result of adopting ASC 606 are discussed below:
Revenue Recognition
All revenue is generated from contracts with customers. Revenue is recognized when control of the performance obligation is transferred to the customer, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those services. Revenue recognition is determined through the application of the following steps:
identification of the contract, or contracts, with a customer;
identification of the performance obligations in the contract;
determination of the transaction price;
allocation of the transaction price to the performance obligations in the contract; and
recognition of revenue when, or as, the Company satisfies a performance obligation.

Clinical Research
The Company receives cash advances from itsgenerally enters into contracts with customers to be usedprovide clinical research services with payments based on either fixed‑fee, time and materials, or fee‑for‑service arrangements. The Company is also entitled to reimbursement for investigator fees and out-of-pocket costs associated with these services. At contract inception, the paymentCompany assesses the services promised in the contracts with customers to identify the performance obligations in the arrangement. The Company’s long term fixed-fee arrangements for clinical research services are considered a single performance obligation because the Company provides a highly-integrated service. A single performance obligation requires the inclusion of investigator fees and other pass-through expenses. out-of-pocket costs in both the contract revenue value and in the cost used to measure progress in transferring control to the customer.

The termsinclusion of certain customerinvestigator fees and out-of-pocket costs in the measurement of progress under these long-term fixed-fee contracts require thatas part of a single performance obligation can create a timing difference between amounts the Company is entitled to receive in reimbursement for costs incurred and the amount of revenue recognized related to such advances be maintained in separate escrow accounts; these accounts are not commingled withcosts on individual projects, which is recognized as unbilled services. The magnitude of this timing difference compared to historical accounting is dependent on the relative size and progress of the direct service portion of the arrangement compared to the progress of the reimbursable investigator fees and reimbursable out-of-pocket costs relative to their respective forecasted costs over the life of the project.

Revenue is recognized for the single performance obligation over time due to the Company’s cashright to payment for work performed to date. The contracts generally provide for the right to invoice the customer as work progresses, either based on units performed or the achievement of billing milestones. The Company generally uses the cost-to-cost measure of progress for the Company's contracts because it best depicts the transfer of control to the customer as the performance obligation is fulfilled. For this method, the Company compares the contract costs incurred to date to the estimated total contract costs through completion. As part of the client proposal and cash equivalentscontract negotiation process, the Company develops a detailed project budget for the direct costs and are presented separately inreimbursable costs based on the consolidated condensed balance sheets as restricted cash.scope of the work, the complexity of the study, the geographical location involved and the Company’s historical experience.

The following table providesestimated total contract costs at the project level are reviewed and revised periodically throughout the lives of the contracts, with adjustments to revenue resulting from such revisions being recorded on a reconciliationcumulative basis in the period in which the revisions are identified. Contract costs consist primarily of cash, cash equivalents,direct labor and restricted cash reported withinother reimbursable project-related costs such as travel, third-party vendor costs and investigator fees.

The Company establishes pricing based on the consolidated condensed balance sheetsCompany’s internal pricing guidelines, discount agreements, if any, and negotiations with the client. The transaction price is the contractually defined amount that sumincludes adjustment for variable consideration such as reimbursable costs, discounts, and bonus or penalties, which are estimable.

A majority of the Company’s contracts undergo modifications over the contract period and the Company’s contracts provide for these modifications. During the modification process, the Company recognizes revenue to the totalextent it incurs costs, provided that a contractual understanding has been reached.
Fixed-fee arrangements for Phase I and Phase II(a) clinical services and bio-analytical services are short-term contracts for accounting purposes as these contracts are cancellable and the termination penalties for exiting these contracts are not substantive. The Company generally bills for services on a milestone basis. The transaction price, representing the value of the services to be provided over the entire contract inclusive of all costs for which the Company is a principal, is the contractually defined amount that includes adjustment for variable consideration, such as reimbursable expenses and discounts, which are estimable. When multiple performance obligations exist, the transaction price is allocated to the performance obligations on a relative standalone selling price basis. Given the highly integrated nature of the services provided, most contracts represent a single performance obligation. Due to the Company's right to payment for work performed, revenue is recognized over time as services are delivered.

Clinical research services delivered under fee-for-service arrangements are recognized over time. The services are accounted for as a single performance obligation that is a series of distinct services with substantially the same amounts shownpattern of transfer to the customer. Clinical research services provided in these types of arrangements are typically linked to the delivery of resources billed at contractual rates, such rates being dependent on the role and the tenure of the resource provided. The fee-for-service is typically billed one month in arrears, which generally results in an unbilled services asset at period-end. In addition, out-of-pocket costs are reimbursed by the customer. Fees are allocated to each distinct month of service using time elapsed as a measure of progress toward the satisfaction of the performance obligation and variable consideration is allocated to the period in which it is incurred.

Revenue from time and materials contracts is recognized as hours are incurred.

The Company often offers volume discounts to certain of its large customers based on annual volume, which is variable consideration that is considered in the contract value. The Company records an estimate of the volume rebate as a reduction of the transaction price based on the estimated total rebates to be earned by the customers for the period.
Data Solutions
The Company provides data reports and analytics to customers based on agreed-upon specifications, including the timing of delivery, which is typically either weekly, monthly, or quarterly. If a customer requests more than one type of data report or series of data reports within a contract, each distinct type of data report is a separate performance obligation. The contracts provide for the Company to be compensated for the value of each deliverable. The transaction price is determined using list prices, discount agreements, if any, and negotiations with the customers, and generally includes any out-of-pocket expenses. Typically, the Company bills in advance of services being provided with the amount being recorded as advanced billings.
When multiple performance obligations exist, the transaction price is allocated to performance obligations on a relative standalone selling price basis. In cases where the Company contracts to provide a series of data reports, or in some cases data, the Company recognizes revenue over time using the ‘units delivered’ output method as the data or reports are delivered. Expense reimbursements are recorded to revenue as the expenses are incurred as they relate directly to the services performed.

Certain Data Solutions arrangements include upfront customization or consultative services for customers; these arrangements often include payments based on the achievement of certain contractual milestones. Under these arrangements, the Company contracts with a customer to carry out a specific study, ultimately resulting in delivery of a custom report or data product. These arrangements are a single performance obligation given the integrated nature of the service being provided. The Company typically recognizes revenue under these contracts over time, using an output-based measure, generally time elapsed,

to measure progress and transfer of control of the performance obligation to the customer. Expense reimbursements are recorded to revenue as the expenses are incurred as they relate directly to the service performed.

The Company's Data Solutions segment enters into contracts with some of its larger data suppliers that involve non-monetary terms. The Company will issue purchase credits to be used toward the data supplier's purchase of the Company's services. In exchange, the Company receives monetary discounts on the data received from the data suppliers. The fair value of the revenue earned from the customer purchases is determined based on similar product offerings to other customers. At the end of the contract year, any unused customer purchase credits may be forfeited or carried over to the next contract year based on the terms of the data supplier contract. For the three and nine months ended September 30, 2018, the Company recognized service in kind revenue of $3.0 million and $12.8 million, respectively, from these transactions, which is included in revenue in the accompanying consolidated condensed statements of cash flows:operations.

Significant Judgments and Estimates
Accounting for the Company’s long term contracts requires estimates of future costs to be incurred to fulfill the contract obligations.
Due to the nature of the work required to be performed by the Company to fulfill performance obligations, the estimation of total revenue and cost at completion is complex, subject to many variables and requires significant judgment. The Company's long-term contracts may contain incentive fees, penalties, or other provisions that can either increase or decrease the transaction price. The Company estimates variable consideration at the most likely amount to which the Company expects to be entitled. The Company includes estimated amounts in the transaction price to the extent it is probable that a significant reversal of cumulative revenue recognized will not occur when the uncertainty associated with the variable consideration is resolved. The Company's estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the anticipated performance and information that is available to the Company. Judgment is also required to identify performance obligations and in determining the relative standalone selling price of those obligations, specifically for the Data Solutions segment. The estimates and assumptions are evaluated on an ongoing basis and adjusted, as needed, using historical experience and contract specific factors. Actual results could differ significantly from these estimates.
Performance Obligations
Revenue recognized for the three and nine months ended September 30, 2018 from services completed in prior periods was $24.4 million and $57.3 million, respectively. This primarily relates to adjustments attributable to changes in estimates such as estimated total contract costs, and from contract modifications on long-term fixed price contracts executed in the current period, which results in changes to the transaction price.

The Company does not disclose the value of the transaction price allocated to unsatisfied performance obligations on contracts that have an original contract term of less than one year. These contracts are short in duration and revenue recognition generally follows the delivery of the promised services. The total transaction price for the undelivered performance obligation on contracts with an original initial contract term greater than one year is $4.6 billion as of September 30, 2018; this amount includes reimbursement revenue and investigator fees. The Company expects to recognize revenue over the remaining contract term of the individual projects, with contract terms generally ranging from one to five years.

Accounts Receivable and Unbilled Services

Accounts receivable represent amounts for which invoices have been sent to clients based upon contract terms. Unbilled services represent amounts earned for services that have been rendered but for which customers have not been billed. Unbilled services where the Company’s right to bill is conditioned on something other than the passage of time are contract assets and are separately disclosed in Note 6.   

Advanced Billings

Advanced billings, also referred to as contract liabilities, consist of advanced payments and billings on a contract in excess of revenue recognized; these amounts represent consideration received or unconditionally due from a customer prior to transferring services to the customer under the terms of the service contract. These balances are reported net of contract assets on a contract-by-contract basis at the end of each reporting period.


  September 30, December 31,
  2017 2016 2016 2015
Cash and cash equivalents $193,581
 $130,343
 $144,623
 $121,065
Restricted cash 697
 5,235
 4,715
 5,060
Total cash, cash equivalents, and restricted cash $194,278
 $135,578
 $149,338
 $126,125
In order to determine revenue recognized in the period from advanced billings liabilities, the Company first allocates revenue from the customer contract to the individual advanced billings liability balance outstanding at the beginning of the period until the revenue exceeds that balance.
    
Secondary Offerings

In August 2017,2018, KKR PRA Investors L.P., or KKR, and certain executive officers of the Company sold 10,000,0006,500,000 shares of the Company’s common stock as part of a secondary offering, or the Secondary Offering. The Company incurred expenses in connection with the Secondary Offering of $1.0$0.5 million during the three and nine months ended September 30, 2017.2018. The

expenses are included in transaction-related costs in the accompanying consolidated condensed statement of operations. As of September 30, 2017,2018, KKR owned 20.8%10.3% of the Company’s outstanding common stock.

(2)(3) Business Combinations
 
Symphony Health Solutions, Inc.


On September 6, 2017, the Company acquired all of the outstanding equity interest of Symphony Health Solutions, Corporation,Inc., or Symphony Health, a provider of data and analytics to help professionals understand the full market lifecycle of products offered for sale by companies in the pharmaceutical industry, for $540.8$539.4 million in cash and contingent consideration, which iswas not capped, in the form of potential earn-out payments based on a multiple of future earnings for the twelve monthtwelve-month periods ending December 2017 and December 2018. The Company recognized a liability of approximately $108.8 million representing the estimated fair value of the earn-out on the acquisition date, $90.4 million is included in accrued expenses and other current liabilities and $18.4 million is included in other long-term liabilities in the consolidated condensed balance sheet as of September 30, 2017. The fair value was based on significant inputs not observed in the market and thus represents a Level 3 measurement. Any change in the fair value of the contingent consideration subsequent to the acquisition date, excluding adjustments that qualify as measurement period adjustments, will be recognized in earnings in the period of any such change. With this acquisition, the Company expects to enhance its ability to serve customers throughout the clinical research and commercialization process with technologies that provide data and analytics.

The fair value of the contingent consideration was determined by using a probability-weighted method that includes key assumptions such as the discount rate and projected future earnings over the earn-out periods. As the fair value was based on significant inputs not observed in the market, the valuation represented a Level 3 measurement. The Company reassesses the fair value of expected contingent consideration and the corresponding liability each reporting period using a probability-weighted method reflecting updated assumptions as of the valuation date. Changes in the fair value of the contingent consideration are recognized in earnings in the period of such change.

During February 2018, the Company made the year-end 2017 preliminary earn-out payment, which totaled $114.7 million that was recognized at December 31, 2017. During April 2018, the Company and the sellers of Symphony Health finalized the 2017 earn-out calculation and the actual 2017 earn-out payment was adjusted to $112.8 million. As a result, the Company recorded a $1.9 million reduction to transaction-related costs during the nine months ended September 30, 2018, and a $1.9 million reduction to accrued expenses and other current liabilities in the consolidated condensed balance sheet as of September 30, 2018.

As of September 30, 2018, the 2018 earn-out liability totaled $83.5 million, which is included in accrued expenses in the consolidated condensed balance sheet. The 2018 earn-out payment, which is based on 2018 earnings and is payable in the first quarter of 2019, could range from $0 to approximately $110.2 million. The Company recorded a $42.6 million and $32.9 million increase to the estimated fair value of the 2018 earn-out liability during the three and nine months ended September 30, 2018, respectively, which is included in transaction-related costs in the consolidated condensed statement of operations. The 2018 earn-out liability varies based on earnings for 2018, including the possible achievement of two thresholds that would each result in an additional $25.0 million payment. Accordingly, the amount of earn-out liability is highly sensitive to changes in the earnings of the business. This uncertainty may result in additional material changes to the liability through its finalization in the fourth quarter of 2018.

The acquisition of Symphony Health was accounted for as a business combination and, accordingly, the assets acquired and the liabilities assumed have been recorded at their respective fair values as of the acquisition date. In connection with the acquisition, the Company recorded approximately $500.5$476.9 million of goodwill, which was assigned to the Data Solutions segment and is not deductible for income tax purposes. The goodwill is attributable to the workforce of the acquired business and expected synergies with the Company’s existing operations. The Company incurred $6.4Since December 31, 2017, goodwill increased by $0.9 million, in acquisition related costs that are included in transaction-related costs inas a result of adjustments made to the consolidated condensed statement of operations.acquired advanced billings balance.
    
Due to the timing of the acquisition, the valuation of net assets acquired has not been finalized and is expected to be completed by the end of December 2017, and in any case, no later than one year from the acquisition date in accordance with GAAP.

The Company’s preliminary estimate of the purchase price allocation is as follows (in thousands):
  Purchase Price Allocation Weighted Amortization Period
Cash and cash equivalents $26,297
  
Accounts receivable and unbilled services 39,132
  
Other current assets��23,726
  
Fixed assets 12,340
  
Customer relationships 190,100
 10 years
Database 137,100
 3 years
Tradename 2,000
 2 years
Accounts payable and accrued expenses (42,222)  
Advanced billings (66,846)  
Deferred tax liabilities (104,869)  
Other long-term liabilities (6,740)  
   Estimated fair value of net assets acquired 210,018
  
   Purchase price, including contingent consideration and working capital adjustment 686,877
  
Total goodwill $476,859
  

  Purchase Price Allocation Weighted Amortization Period
Cash and cash equivalents $26,297
  
Accounts receivable 39,056
  
Other current assets 24,048
  
Fixed assets 12,340
  
Software and other intangibles 13,000
 5 years
Database 64,600
 9 years
Customer relationships 161,000
 12 years
Accounts payable and accrued expenses (42,700)  
Deferred revenue (65,511)  
Deferred tax liabilities (75,056)  
Other long-term liabilities (7,940)  
   Estimated fair value of net assets acquired 149,134
  
   Purchase price, including contingent consideration 649,609
  
Total goodwill $500,475
  

The results of operations for Symphony Health are included in the consolidated condensed financial statements of the Company from the date of acquisition. During this period, Symphony Health's service revenues and net income totaled $19.0 million and $1.1 million, respectively.



The following unaudited pro-forma information assumes the acquisition of Symphony Health occurred as of the beginning of 2016. This pro-forma financial information is not necessarily indicative of operating results if the acquisition had been completed at the date indicated, nor is it necessarily an indication of future operating results.

(in thousands, except per share amounts) Nine Months Ended September 30, 2017
Total revenue $1,752,514
Net income attributable to PRA Health Sciences, Inc. 126,092
Net income per share:  
   Basic $2.03
   Diluted $1.92

 Nine Months Ended
September 30,
(in thousands, except per share amounts)2017 2016
Total revenue$1,752,514
 $1,484,013
Net income attributable to PRA Health Sciences, Inc.126,092
 35,830
Net income per share:   
   Basic$2.03
 $0.59
   Diluted$1.92
 $0.56


The unaudited pro-forma financial informationadjustments primarily relate to the amortization of acquired intangible assets as well as interest expense and amortization of debt issuance costs related to the incremental borrowings to fund the acquisition. In addition, the unaudited pro-forma net income for the nine months ended September 30, 2016 includes the following non-recurring adjustments:

a $6.42017 was adjusted to exclude $3.9 million increase toof nonrecurring transaction-related costs, incurred by the Company during the nine months ended September 30, 2017 attributable to the transaction, withnet of tax, as well as a corresponding $2.5$1.9 million increase to the benefit from income taxes.

a $3.1 million increase to loss on the modification or extinguishment of long-term debt, incurred by the Company during the nine months ended September 30, 2017 attributable to the above transaction, with a corresponding $1.2 million increase to the benefit from income taxes.net of tax.


Takeda Transactions


On June 1, 2017, the Company acquired all of the outstanding shares of Takeda Pharmaceutical Data Services, Ltd., or TDS, from Takeda Pharmaceutical Company Ltd., or Takeda, for $0.7 million in cash. The Company recorded approximately $1.0 million of goodwill, which is assigned to the Clinical Research segment and is not deductible for income tax purposes. pro-forma results of operations and a complete purchase price allocation have not been presented because the results of this acquisition did not have a material effect on the Company's consolidated condensed financial statements.


On June 1, 2017, the Company and Takeda also closed on a joint venture transaction that enables the Company to provide clinical trial delivery and pharmacovigilance services as a strategic partner of Takeda in Japan. The joint venture transaction was effectedeffectuated through the creation of a new legal entity, Takeda PRA Development Center KK, or TDC joint venture. The Company paid $5.4 million for a 50% equity interest in the TDC joint venture, which represents 50% of the fair value of the net assets and workforce that Takeda contributed to the joint venture. The joint venture provides services including clinical trial monitoring, project management, regulatory strategy and submissions, data management, biostatistics, drug safety reporting, and medical monitoring. The Company is required to buy-out Takeda’s 50% interest in the TDC joint venture in two years.years from the date of the closing of the joint venture transaction. The Company also has an early buy-out option of Takeda’s 50% interest in December 2018, if both parties agree.


The Company determined that the TDC joint venture is a variable interest entity, or VIE, in which the Company is the primary beneficiary. Accordingly, the Company accounted for the $5.4 million contribution to the TDC joint venture as a business combination and consolidated the VIE in its financial statements with a noncontrolling interest for the 50% portion

owned by Takeda. The assets acquired and the liabilities assumed have been recorded at their respective estimated fair values as of June 1, 2017. The Company recorded approximately $2.7 million of goodwill, which is assigned to the Clinical Research segment and is not deductible for income tax purposes. The goodwill is primarily attributable to the assembled workforce. The Company incurred $0.6 million in acquisition related costs that are included in selling, general and administrative expenses in the consolidated condensed statement of operations.

Due to the timing of the transaction, the valuation of net assets acquired has not been finalized and is expected to be completed by the end of December 2017, and in any case, no later than one year from the transaction closing date in accordance with GAAP.


The Company’s preliminary estimate of the fair value of the net assets acquired as part of the TDC joint venture transaction at the closing date of the business combination is as follows (in thousands):
  Purchase Price Allocation
Cash and cash equivalents $8,120
Other current assets 1,671
Other assets 799
Accounts payable and accrued expenses (2,380)
Estimated fair value of net assets acquired 8,210
PRA purchase price 5,440
Fair value of Takeda's noncontrolling interest 5,440
Total goodwill $2,670
  Purchase Price Allocation
Cash and cash equivalents $8,120
Other current assets 1,671
Other non-current assets 1,742
Accounts payable and accrued expenses (2,380)
Other long-term liabilities (943)
Estimated fair value of net assets acquired 8,210
PRA purchase price 5,440
Fair value of Takeda's noncontrolling interest 5,440
Total goodwill $2,670
The Company has not disclosed post-acquisition or pro-forma revenue and earnings attributable to the TDC joint venture as they did not have a material effect on the Company’s consolidated condensed financial statements.
 
Parallel 6, Inc.
 
On May 10, 2017, the Company acquired all of the outstanding equity interest of Parallel 6, Inc., or Parallel 6, a developer of technologies for improving patient enrollment, engagement, and management of clinical trials, for $39.7$39.0 million in cash and contingent consideration in the form of a potential earn-out payment of up to $10.0 million. The earn-out payment iswas contingent upon the achievement of certain external software sales targets during the 18-month period following closing. The Company recognized a liability of approximately $8.4 million representing the estimated fair value of the earn-out on the acquisition date, which is included in other long-term liabilities in the consolidated condensed balance sheet as of September 30, 2017. The fair value was based on significant inputs not observed in the market and thus represented a Level 3 measurement. Any change in the fair value of the contingent consideration subsequent to the acquisition date, excluding adjustments that qualify as measurement period adjustments, will be recognized in earnings in the period of any such change. With this acquisition, the Company expects to enhance its ability to serve customers throughout the clinical research process with technologies that provide improved efficiencies by reducing study durations and costs through integrated operational management.
 
The acquisition of Parallel 6 was accounted for as a business combination and, accordingly, the assets acquired and the liabilities assumed have been recorded at their respective fair values as of the acquisition date. In connection with the acquisition, the Company recorded approximately $33.1$31.3 million of goodwill, which was assigned to the Clinical Research segment and is not deductible for income tax purposes. The goodwill is attributable to the workforce of the acquired business and expected synergies with the Company’s existing information technology operations. The Company incurred $1.3Since December 31, 2017, goodwill decreased by $1.1 million, in acquisition related costs that are included in selling, general and administrative expenses in the consolidated condensed statementprimarily as a result of operations.
Dueadjustments made to the timing of the acquisition, the valuation of net assets acquired has not been finalized and is expected to be completed by the end of December 2017, and in any case, no later than one year from the acquisition date in accordance with GAAP.


The Company’s preliminary estimate of the purchase price allocation is as follows (in thousands):
  Purchase Price Allocation Weighted Amortization Period
Cash and cash equivalents $132
  
Accounts receivable 1,231
  
Other current assets 26
  
Software intangible 15,500
 5 years
Other intangibles 920
 5 years
Accounts payable and accrued expenses (885)  
Deferred revenue (994)  
Other long-term liabilities (2,414)  
Estimated fair value of net assets acquired 13,516
  
Purchase price, including contingent consideration 46,652
  
Total goodwill $33,136
  
The Company has not disclosed post-acquisition or pro-forma revenue and earnings attributable to Parallel 6 as they did not have a material effect on the Company’s consolidated condensed financial statements.
Nextrials
On March 18, 2016, the Company acquired all of the outstanding shares of Nextrials, Inc., or Nextrials, a developer of web-based software which integrates electronic health records with clinical trials, for $4.8 million in cash and contingent consideration in the form of potential earn-out payments of up to $3.0 million. Earn-out payments totaling $2.0 million and $1.0 million are contingent upon the achievement of project milestones and certain external software sales targets, respectively, during the 30-month period following closing. The Company recognized a liability of approximately $2.3 million as the estimated acquisition date fair value of the earn-out; the fair value was based on significant inputs not observed in the market and thus represented a Level 3 measurement. Changes in the fair value of the contingent consideration subsequent to the acquisition date are recognized in earnings in the period of the change. The fair value of the contingent consideration increased by $0.1 million for the nine months ended September 30, 2017. The Company made a payment of $0.4 million on the contingent consideration during the nine months ended September 30, 2017. As of September 30, 2017, the earn-out liability totaled $1.4 million; which is included in accrued expenses and other current liabilities in the consolidated condensed balance sheet. With this acquisition, the Company expects to enhance its ability to serve customers throughout the clinical research process with technologies that include improved efficiencies by reducing study durations and costs through integrated operational management.
The acquisition of Nextrials was accounted for as a business combination and, accordingly, the assets acquired and the liabilities assumed have been recorded at their respective fair values as of the acquisition date. In connection with the acquisition, the Company recorded approximately $4.3 million of goodwill, which is assigned to the Clinical Research segment and is not deductible for income tax purposes. The goodwill is attributable to the workforce of the acquired business and expected synergies with the Company’s existing information technology operations.balances.



The Company’s purchase price allocation is as follows (in thousands):
  Purchase Price Allocation Weighted Amortization Period
Cash and cash equivalents $132
  
Accounts receivable and unbilled services 929
  
Other current assets 26
  
Software intangible 15,500
 5 years
Other intangibles 920
 5 years
Accounts payable and accrued expenses (780)  
Advanced billings (692)  
Other long-term liabilities (31)  
Estimated fair value of net assets acquired 16,004
  
Purchase price, including contingent consideration 47,339
  
Total goodwill $31,335
  


  Purchase Price Allocation Weighted Amortization Period
Cash and cash equivalents $94
  
Accounts receivable 211
  
Other current assets 96
  
Property, plant and equipment 111
  
Software intangible 5,574
 5 years
Accounts payable and accrued expenses (1,585)  
Other long-term liabilities (1,663)  
Estimated fair value of net assets acquired 2,838
  
Purchase price, including contingent consideration and net of working capital settlement 7,145
  
Total goodwill $4,307
  

The Company has not disclosed fiscal year 2016 or pro-forma revenue and earnings attributable to Nextrials as they did not have a material effect on the Company’s consolidated condensed financial statements.
(3)(4) Fair Value Measurements
 
The Company records certain assets and liabilities at fair value. Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants at the measurement date. A three-level fair value hierarchy that prioritizes the inputs used to measure fair value is described below. This hierarchy requires entities to maximize the use of observable inputs and minimize the use of unobservable inputs.
The three levels of inputs used to measure fair value are as follows:
 
Level 1 — Quoted prices in active markets for identical assets or liabilities.
Level 2 — Observable inputs other than quoted prices included in Level 1, such as quoted prices for similar assets and liabilities in active markets; quoted prices for identical or similar assets and liabilities in markets that are not active; or other inputs that are observable or can be corroborated by observable market data.
Level 3 — Unobservable inputs that are supported by little or no market activity. This includes certain pricing models, discounted cash flow methodologies and similar techniques that use significant unobservable inputs.


The carrying amount of financial instruments, including cash and cash equivalents, accounts receivable, unbilled services, contract assets, accounts payable and advanced billings, approximate fair value due to the short maturities of these instruments.


Recurring Fair Value Measurements
 
The following table summarizes the fair value of the Company’s financial assets and liabilities that are measured on a recurring basis as of September 30, 20172018 (in thousands):
  Level 1 Level 2 Level 3 Total
Assets:        
Interest rate swaps $
 $7,948
 $
 $7,948
Total $
 $7,948
 $
 $7,948
Liabilities:        
Contingent consideration $
 $
 $83,512
 $83,512
Total $
 $
 $83,512
 $83,512
  Level 1 Level 2 Level 3 Total
Assets:        
Interest rate swap $
 $73
 $
 $73
Marketable securities 366
 
 
 366
Total $366
 $73
 $
 $439
Liabilities:        
Contingent consideration $
 $
 $118,564
 $118,564
Total $
 $
 $118,564
 $118,564

The Company's marketable securities are included in other current assets in the consolidated condensed balance sheet. These marketable securities are recorded at fair value using quoted prices in an active market.
 
The interestCompany values contingent consideration using models that include significant unobservable Level 3 inputs, such as projected financial performance over the earn-out period along with estimates for market volatility and the discount rate swap isapplicable to potential cash payments. Interest rate swaps are measured at fair value using a market approach valuation technique. The valuation is based on an estimate of net present value of the expected cash flows using relevant mid-market observable data inputs and based on the assumption of no unusual market conditions or forced liquidation.
 
The Company values contingent consideration, related to business combinations, using a weighted probability of potential payment scenarios discounted at rates reflective of the weighted average cost of capital for the businesses acquired. Key assumptions used to estimate the fair value of contingent consideration include operational milestones and the probability of achieving the specific milestones
The following table summarizes the changes in Level 3 financial liabilities measured on a recurring basis for the nine months ended September 30, 20172018 (in thousands):
  Contingent Consideration - Accrued expenses and other current liabilities Contingent Consideration - Other long-term liabilities
Balance at December 31, 2017 $
 $50,644
Reclassification adjustment 50,644
 (50,644)
Change in fair value recognized in transaction-related costs 32,868
 
Balance at September 30, 2018 $83,512
 $
  Contingent Consideration - Accrued expenses and other liabilities Contingent Consideration - Other long-term liabilities
Balance at December 31, 2016 $1,735
 $1,019
Initial estimate of Symphony Health contingent consideration 90,394
 18,390
Initial estimate of Parallel 6 contingent consideration 
 8,350
Payments on Nextrials contingent consideration (400) 
Reclassification adjustment 1,019
 (1,019)
Change in fair value recognized in other (income) expense, net (924) 
Balance at September 30, 2017 $91,824
 $26,740

 
During the nine months endedThe $83.5 million balance at September 30, 2017,2018, which was valued using a probability-weighted method, relates to the Company released2018 earn-out payment to Symphony Health and is based on its future adjusted earnings before interest, taxes, depreciation and amortization, or Adjusted EBITDA. Key assumptions include probability adjusted level of Adjusted EBITDA of $56.2 million for the remaining $1.0 million contingent consideration liability associated withyear ended December 31, 2018, and a discount rate of 8%. Refer to Note 3 for additional discussion of the acquisition of ValueSymphony Health Solutions, Inc. as the earn-out targets were not met.acquisition.


Non-recurring Fair Value Measurements
 
Certain assets and liabilities are carried on the accompanying consolidated condensed balance sheets at cost and are not remeasured to fair value on a recurring basis. These assets include finite-lived intangible assets which are tested for impairment when a triggering event occurs and goodwill and identifiable indefinite-lived intangible assets which are tested for impairment annually on October 1 or when a triggering event occurs.
 
As of September 30, 2017,2018, assets carried on the balance sheet and not remeasured to fair value on a recurring basis totaling approximately $2,246.8$2,226.6 million wereand are identified as Level 3.3 assets. These assets are comprised of goodwill of $1,535.1$1,501.6 million and identifiable intangible assets, net of $711.7$725.0 million.
 
Refer to Note 7,8, Revolving Credit Facilities and Long-Term Debt, for additional information regarding the fair value of long-term debt balances.


(4)(5) Concentration of Credit Risk
 
Financial instruments that potentially subject the Company to credit risk consist of cash and cash equivalents, accounts receivable, unbilled services, contract assets and unbilled services.derivatives. As of September 30, 2017,2018, substantially all of the Company’s cash and cash equivalents and derivatives were held in or invested with large financial institutions. Accounts receivable include amounts due from pharmaceutical and biotechnology companies. The Company establishes an allowance for potentially uncollectible receivables. In management’s opinion, there is no additional material credit risk beyond amounts provided for such losses.
 

Service revenueRevenue from individual customers greater than 10% of consolidated service revenue in the respective periods was as follows:
  Three Months Ended September 30, Nine Months Ended September 30,
  2018 2017 2018 2017
Customer A % 10.1% % 10.6%
  Three Months Ended September 30, Nine Months Ended September 30,
  2017 2016 2017 2016
Customer A 10.1% 11.7% 10.6% 10.8%
Customer B 
 10.4% 
 10.7%
Customer C 
 10.2% 
 

 
Accounts receivable and unbilled receivables from individual customers that were equal to or greater than 10% of consolidated accounts receivable and unbilled receivables at the respective dates were as follows:
  September 30, December 31,
  2018 2017
Customer A 12.0% 11.5%
Customer B 11.4% %
  September 30, December 31,
  2017 2016
Customer A 10.7% 12.0%

(5)(6) Accounts Receivable, and Unbilled Services and Advanced Billings

Accounts receivable and unbilled services include service revenue, reimbursement revenue, and amounts associated with work performed by investigators. Accounts receivable and unbilled services were as follows (in thousands):
  September 30, December 31,
  2018 2017
Accounts receivable $485,214
 $457,676
Unbilled services 133,697
 170,760
Total accounts receivable and unbilled services 618,911
 628,436
Less allowance for doubtful accounts (1,971) (1,433)
Total accounts receivable and unbilled services, net $616,940
 $627,003


Unbilled services as of September 30, 2018 includes $67.8 million of contract assets where the Company’s right to bill is conditioned on criteria other than the passage of time. The increase in contract assets from December 31, 2017 to September 30, 2018 was due to the adoption of ASC 606. Impairment losses on contract assets were immaterial in the nine months ended September 30, 2018.


Advanced billings were as follows (in thousands):
  September 30, December 31,
  2018 2017
Advanced billings $479,686
 $469,211

  September 30, December 31,
  2017 2016
Accounts receivable $457,306
 $284,647
Unbilled services 172,152
 155,609
  629,458
 440,256
Less allowance for doubtful accounts (1,429) (1,203)
Total accounts receivable and unbilled services, net $628,029
 $439,053

The $10.5 million increase in advanced billings from December 31, 2017 to September 30, 2018 was primarily due to the adoption of ASC 606 and the timing of customer payments. During the nine months ended September 30, 2018, the Company recognized revenue of $382.5 million related to advanced billings recorded as of January 1, 2018.

(6)(7) Goodwill and Intangible Assets
 
Goodwill
 
The changes in the carrying amount of goodwill by reportable segment are as follows (in thousands):
  Clinical Research Data Solutions Consolidated
Balance at December 31, 2017 $1,036,443
 $475,981
 $1,512,424
Adjustments to Parallel 6 purchase price allocation (1,117) 
 (1,117)
Adjustments to Symphony Health purchase price allocation 
 878
 878
Currency translation (10,565) 
 (10,565)
Balance at September 30, 2018 $1,024,761
 $476,859
 $1,501,620
 Clinical Research Data Solutions Consolidated
Balance at December 31, 2016$971,980
 $
 $971,980
Acquisition of Symphony Health
 500,475
 500,475
Acquisition of Parallel 633,136
 
 33,136
Acquisition of TDC joint venture2,670
 
 2,670
Acquisition of TDS966
 
 966
Currency translation25,830
 
 25,830
Balance at September 30, 2017$1,034,582
 $500,475
 $1,535,057

 
There are no accumulated impairment charges as of September 30, 20172018 and December 31, 2016.2017.



Intangible Assets
 
Intangible assets consist of the following (in thousands):
 September 30, 2018 December 31, 2017
 Gross Amount Accumulated Amortization Net Amount Gross Amount Accumulated Amortization Net Amount
Customer relationships$559,585
 $(95,833) $463,752
 $565,638
 $(72,133) $493,505
Customer backlog122,088
 (121,306) 782
 123,746
 (120,583) 3,163
Trade names (finite-lived)28,521
 (11,926) 16,595
 28,558
 (9,265) 19,293
Patient list and other intangibles44,474
 (29,397) 15,077
 44,474
 (24,226) 20,248
Database137,100
 (26,307)
110,793
 137,100
 (7,544) 129,556
Non-competition agreements2,704
 (2,704) 
 2,767
 (2,706) 61
Total finite-lived intangible assets894,472
 (287,473) 606,999
 902,283
 (236,457) 665,826
            
Trade names (indefinite-lived)118,010
 
 118,010
 118,010
 
 118,010
Total intangible assets$1,012,482
 $(287,473) $725,009
 $1,020,293
 $(236,457) $783,836
  September 30, December 31,
  2017 2016
Customer relationships $535,135
 $360,328
Customer backlog 123,358
 119,223
Trade names (definite-lived) 28,457
 25,740
Patient list, software and other intangibles 55,574
 28,974
Database 64,600
 
Non-competition agreements 2,767
 2,737
Total finite-lived intangible assets, gross 809,891
 537,002
Accumulated amortization (216,174) (181,036)
Total finite-lived intangible assets, net 593,717
 355,966
Trade names (indefinite-lived) 118,010
 118,010
Total intangible assets, net $711,727
 $473,976

 
Amortization expense was $17.9 million and $54.0 million for the three and nine months ended September 30, 2018, respectively, and $11.3 million and $29.5 million for the three and nine months ended September 30, 2017, respectively, and $11.3 million and $34.3 million for the three and nine months ended September 30, 2016, respectively.
 

The estimated future amortization expense of finite-lived intangible assets is expected to be as follows (in thousands):
2018 (remaining)$17,687
201968,791
202069,172
202164,062
202249,672
2023 and thereafter337,615
Total$606,999
2017 (remaining)$16,368
201860,075
201954,375
202052,462
202150,331
2022 and thereafter360,106
Total$593,717

 
The estimated fair value of the Early Development Services, or EDS, reporting unit closely approximated its carrying value when the Company performed its annual goodwill impairment test during the fourth quarter of 2014. The Company made operational improvements during 2015
(8) Revolving Credit Facilities and 2016 in order to improve the profitability of the EDS reporting unit. As a result of these changes, EDS saw growth in both backlog and new business awards that contributed to its improved financial performance during both years and led the Company to update its forecast for future periods. The Company considered all of these factors when it performed its most recent goodwill impairment test during the fourth quarter of 2016 and it was concluded that the estimated fair value of the EDS reporting unit exceeded its carrying value by approximately $70.0 million, or 33%. Any negative changes in assumptions on revenue, new business awards, cancellations, or the Company's ability to improve operations while maintaining a competitive cost structure could adversely affect the fair value of EDS and result in significant goodwill impairment charges in 2017 or later.


(7)Long-Term Debt
 
Long-term debt consists of the following (in thousands):
  September 30, December 31,
  2018 2017
Term loans, first lien $1,026,533
 $1,140,927
Accounts receivable financing agreement 170,000
 120,000
Total debt 1,196,533
 1,260,927
Less current portion of long-term debt 
 (28,789)
Total long-term debt 1,196,533
 1,232,138
Less debt issuance costs (5,022) (6,741)
Total long-term debt, net $1,191,511
 $1,225,397
 September 30, December 31,
 2017 2016
Term loans, first lien$1,148,125
 $625,000
Senior notes91,441
 91,441
Accounts receivable financing agreement120,000
 120,000
 1,359,566
 836,441
Less debt issuance costs and discount(9,349) (8,139)
 1,350,217
 828,302
Less current portion(56,719) (31,250)
Total long-term debt, net$1,293,498
 $797,052

 
Principal payments on long-term debt are due as follows (in thousands):
Current maturities of long-term debt: 
2018 (remaining)$
2019
2020
20211,196,533
Total$1,196,533
2017 (remaining)$11,250
201860,625
2019180,625
202076,250
2021939,375
2022 and thereafter91,441
Total$1,359,566

 
2016 Credit Facilities
 
The senior secured credit facilities, or 2016 Credit Facilities, provide senior secured financing up to $1,400.0 million, consisting of:

a first lien term loan in an aggregate principal amount of up to $1,175.0 million; and
revolving credit facilities, or the 2016 Revolver, in an aggregate principal amount of up to $225.0 million

As collateral for borrowings under the senior secured credit facilities, or 2016 Credit Facilities, the Company granted a pledge on primarily all of its assets, and the stock of wholly-owned U.S. restricted subsidiaries. The Company is subject to certain financial covenants, which require the Company to maintain certain debt-to-EBITDA and interest expense-to-EBITDA ratios. The 2016 Credit Facilities also contain covenants that, among other things, restrict the Company’s ability to create any liens, make investments and acquisitions, incur or guarantee additional indebtedness,enter into mergers or consolidations and other fundamental changes, conduct sales and other dispositions of property or assets, enter into sale-leaseback transactions or hedge agreements, prepay subordinated debt, pay dividends or make other payments in respect of capital stock, change the line of business, enter into transactions with affiliates, enter into burdensome agreements with negative pledge clauses, and clauses restriction, and make subsidiary distributions. After giving effect to the applicable restrictions on the payment of dividends under the 2016 Credit Facilities, subject to compliance with applicable law, as of September 30, 20172018 and December 31, 2016,2017, all amounts in retained earnings were free of restriction and were available for the payment of dividends. The Company does not expect to pay dividends in the foreseeable future. The Company does not expect these covenants to restrict its liquidity, financial condition or access to capital resources in the foreseeable future. The 2016 Credit Facilities also containscontain customary representations, warranties, affirmative covenants, and events of default.

On September 6, 2017, the Company borrowed $550.0 million under the 2016 Credit Facilities, or the Incremental Borrowing. The proceeds were primarily used to fund the acquisition of Symphony Health. In accordance with the guidance in FASB’s Accounting Standards Codification, or ASC, 470-50, "Debt - Modifications and Extinguishments," the Incremental Borrowing was accounted for as a debt modification. The Incremental Borrowing resulted in a $3.1 million loss on modification of debt, which consists of fees associated with the transaction for the nine months ended September 30, 2017.

The 2016 Credit Facilities' first lien term loan's scheduled, fixed quarterly principal payments, including the Incremental Borrowing, are as follows:

$11.3 million per quarter, to be made commencing September 30, 2017 and made on or prior to December 31, 2017;
$15.2 million per quarter, to be made on or after March 31, 2018, but on or prior to December 31, 2019;

$19.1 million per quarter, to be made on or after March 31, 2020, but on or prior to December 31, 2020;
$23.0 million per quarter, to be made on or after March 31, 2021, but prior to September 30, 2021; and
the remaining principal amount of the term loan on December 6, 2021. 

The variable interest rate on the Incremental Borrowing is a rate equal to the London Interbank Offered Rate, or LIBOR, or the adjusted base rate, or ABR, rate, at the election of the Company, plus a margin based on the ratio of total indebtedness to EBITDA andEBITDA. The margin ranges from 1.00% to 2.00%, in the case of LIBOR rate loans,

and 0.00% to 1.00%, in the case of ABR rate loans. There were no other changes toThe Company has the 2016 Credit Facilities as a resultoption of the Incremental Borrowing.1, 2, 3 or 6 month base interest rates. For the nine months ended September 30, 2017,2018, the weighted average interest rate on the first lien term loan was 3.45%3.62%.

During the third quarter of 2018, the Company made an additional $92.8 million in voluntary principal payments. In accordance with the guidance in ASC 470-50, "Debt—Modifications and Extinguishments," the debt repayments were accounted for as a partial debt extinguishment. The repayments resulted in the write-off of $0.5 million in unamortized debt issuance costs which is included in loss on modification or extinguishment of debt in the consolidated condensed statement of operations during the three and nine months ended September 30, 2018.
 
Revolving Credit Facilities2016 Revolver
 
The Company’s revolving credit facilities provide2016 Revolver provides for $125.0$225.0 million of potential borrowings and expire on December 6, 2021. The interest rate on the revolving credit facilities2016 Revolver is based on the LIBOR with a 0% LIBOR floor or ABR, rate, at the election of the Company, plus an applicable margin, based on the leverage ratio of the Company. The Company, at its discretion, may elect interest periods of 1, 2, 3 or 6 months. The Company is required to pay to the lenders a commitment fee ranging fromfor unused commitments of 0.2% to 0.4% based on the Company’s debt-to-EBITDA ratio. At September 30, 2017 and December 31, 2016,2018, the Company had no outstanding borrowings under the revolving credit facilities.2016 Revolver. At December 31, 2017, the Company had $91.5 million outstanding borrowings under the 2016 Revolver. In addition, at September 30, 20172018 and December 31, 2016,2017, the Company had $4.5$5.1 million and $7.0$4.9 million, respectively, in letters of credit outstanding, which are secured by the revolving credit facilities.

Senior Notes
On March 17, 2016 the Company repaid $133.6 million aggregate principal amount of its 9.5% senior notes due 2023, or Senior Notes, as part of a cash tender offer. In accordance with the guidance in the ASC 470-50, "Debt—Modifications and Extinguishments," the debt repayment was accounted for as a partial debt extinguishment. The repayment resulted in a $21.5 million loss on extinguishment of debt, which consists of a $17.4 million early tender premium, a $3.7 million write-off of unamortized debt issuance costs and $0.4 million of fees associated with the transaction for the nine months ended September 30, 2016.
The Senior Notes agreement contains certain provisions that restrict the payment of dividends from the Company’s subsidiaries to the parent company. As a result, there are no material balances present within the parent company that are available for the payment of dividends as the parent company did not have any net income during 2016 or the nine months ended September 30, 2017, that was free of restrictions. The Company does not expect to pay dividends in the foreseeable future.Revolver.
 
Accounts Receivable Financing Agreement
 
In March 2016,On May 31, 2018, the Company entered into a $140.0amended its receivable financing agreement, which the Company refers to as the "accounts receivable financing agreement." The amendment increased the accounts receivable financing agreement's borrowing capacity to $200.0 million, decreased the applicable margin from 1.60% to 1.25%, and extended the termination date to May 31, 2021, unless terminated earlier pursuant to its terms. The Company had $170.0 million and $120.0 million outstanding on the accounts receivable financing agreement of which $120.0 million was outstanding as of September 30, 20172018 and December 31, 2016. The2017, respectively; the additional borrowings during 2018 were used to repay amounts outstanding on the Company’s revolving credit facility that were used to fund the cash tender offer for the Senior Notes.Company's 2016 Revolver.
 
Loans under the accounts receivable financing agreement accrue interest at either a reserve-adjusted LIBOR or a base rate, plus 1.6%1.25%. The Company may prepay loans upon one business dayday's prior notice and may terminate the accounts receivable financing agreement with 15 days’ prior notice. For the nine months ended September 30, 2017,2018, the weighted average interest rate on the accounts receivable financing agreement was 2.91%3.60%.
 
The accounts receivable financing agreement contains various customary representations and warranties and covenants, and default provisions whichthat provide for the termination and acceleration of the commitments and loans under the agreement in circumstances including, but not limited to, failure to make payments when due, breach of representations, warranties or covenants, certain insolvency events or failure to maintain the security interest in the trade receivables, and defaults under other material indebtedness.
 
The accounts receivable financing agreement terminates on March 22, 2019, unless terminated earlier pursuant to its terms. At September 30, 20172018 and December 31, 2016,2017, there was $30.0 million and $20.0 million, respectively, of remaining capacity available under the accounts receivable financing agreement.
 

Fair Value of Debt
 
The estimated fair value of the Company’s debt and outstanding borrowings under its 2016 Revolver was $1,368.8$1,194.0 million and $844.2$1,352.4 million at September 30, 20172018 and December 31, 2016,2017, respectively. The fair value of the Senior Notes, which totaled $100.7 million and $99.2 million at September 30, 2017 and December 31, 2016, respectively, was determined based on Level 2 inputs using the market approach, which is primarily based on rates at which the debt is traded among financial institutions. The fair valuevalues of the term loans, borrowings under credit facilities, and accounts receivable financing agreement which totaled $1,268.1 million and $745.0 million at September 30, 2017 and December 31, 2016, respectively, waswere determined based on Level 3 inputs, which isare primarily based on rates at which the debt is traded among financial institutions adjusted for the Company's credit standing.


(8)(9) Stockholders’ Equity
 
Authorized Shares
 
The Company is authorized to issue up to one billion shares of common stock, with a par value of $0.01. The Company is authorized to issue up to one hundred million shares of preferred stock, with a par value of $0.01.
 

Noncontrolling Interest
 
Below is a summary of noncontrolling interest for the nine months ended September 30 (in thousands):
  2018 2017
Balance as of January 1, $5,710
 $
Investment by noncontrolling interest 
 5,440
Comprehensive income    
Net income 898
 513
Foreign currency adjustments, net of income tax (75) (90)
Balance as of September 30, $6,533
 $5,863

  2017 2016
Balance as of January 1, $
 $
Investment by noncontrolling interest 5,440
 
Comprehensive income (loss)    
Net income 513
 
Foreign currency adjustments, net of income tax (90) 
Balance as of September 30, $5,863
 $

(9)(10) Stock-Based Compensation
 
Stock Option and RSA/RSU Activity

The 2018 Stock Incentive Plan, or the 2018 Plan, was approved by stockholders at the annual meeting on May 31, 2018. The 2018 Plan allows for the issuance of stock options, stock appreciation rights, restricted shares and restricted stock units, other stock-based awards, and performance compensation awards as permitted by applicable laws. The 2018 Plan authorized the issuance of 2,000,000 shares of common stock plus all shares that remained available under the prior plan on May 31, 2018.

The Company granted 1,831,0001,468,000 service-based options and 131,044240,228 restricted stock awards and units, or RSAs/RSUs, with a total grant date fair value of $46.0$49.8 million and $8.3$22.7 million, respectively, during the nine months ended September 30, 2017.2018.
 
Aggregated information regarding the Company’s option plans is summarized below:
  Options Wtd. Average Exercise Price Wtd. Average Remaining Contractual Life (in years) Intrinsic Value (millions)
Outstanding December 31, 2017 5,245,625
 $39.14
 7.6 $272.4
Granted 1,468,000
 97.79
    
Exercised (1,189,254) 21.17
    
Expired or forfeited (257,475) 58.21
    
Outstanding September 30, 2018 5,266,896
 $58.61
 7.8 $271.7
Exercisable September 30, 2018 2,067,067
 $22.69
 5.8 $180.9
  Options Wtd. Average Exercise Price Wtd. Average Remaining Contractual Life (in years) Intrinsic Value (millions)
Outstanding at December 31, 2016 5,507,347
 $15.38
 6.7 $218.9
Granted 1,831,000
 74.93
    
Exercised (1,758,846) 9.47
    
Expired or forfeited (73,072) 26.94
    
Outstanding at September 30, 2017 5,506,429
 $36.91
 7.7 $216.2
Exercisable at September 30, 2017 2,557,710
 $13.70
 6.3 $159.8

 

The Company’s RSAs/RSUs activity in 20172018 is as follows:
  Awards Wtd. Average Grant-Date Fair Value Intrinsic Value (millions)
Unvested December 31, 2017 309,538
 $46.76
 $28.2
Granted 240,228
 94.51
  
Forfeited (32,500) 81.14
  
Vested (156,516) 31.62
  
Unvested September 30, 2018 360,750
 $82.03
 $39.8

  Awards Wtd. Average Grant-Date Fair Value Intrinsic Value (millions)
Unvested at December 31, 2016 188,590
 $32.63
 $10.4
Granted 131,044
 63.05
  
Forfeited (2,000) 58.95
  
Vested (5,805) 38.81
  
Unvested at September 30, 2017 311,829
 $45.14
 $23.8

Employee Stock Purchase Plan
In April 2017, the Board of Directors approved the PRA Health Sciences, Inc. 2017 Employee Stock Purchase Plan, or ESPP, which was approved by the Company’s shareholders on June 1, 2017. The ESPP allows eligible employees to authorize payroll deductions of up to 15% of their base salary or wages to be applied toward the purchase of shares of the Company’s common stock on the last trading day of any offering period. Participating employees will purchase shares of the Company's common stock at a discount of up to 15% on the lesser of the closing price of the Company's common stock on the NASDAQ Global Select Market (i) on the first trading day of the offering period or (ii) the last day of any offering period. Offering periods under the ESPP will generally be in six month increments, commencing on January 1 and July 1 of each calendar year with the Compensation Committee having the right to establish different offering periods. The Company recognized stock-based compensation expense of $0.9 million and $2.5 million associated with the ESPP during the three and nine months ended September 30, 2018, respectively. As of September 30, 2018, there have been 76,116 shares issued and 2,923,884 shares reserved for future issuance under the ESPP.

Stock-based Compensation Expense

Stock-based compensation expense related to employee stock options and RSAs/RSUs isplans are summarized below (in thousands):
  Three Months Ended September 30, Nine Months Ended September 30,
  2018 2017 2018 2017
Direct costs $2,451
 $956
 $6,900
 $2,208
Selling, general and administrative 5,319
 2,493
 13,569
 5,478
Transaction-related costs 773
 5,294
 773
 5,294
Total stock-based compensation expense $8,543
 $8,743
 $21,242
 $12,980

  Three Months Ended September 30, Nine Months Ended September 30,
  2017 2016 2017 2016
Direct costs $956
 $438
 $2,208
 $1,319
Selling, general and administrative 2,493
 1,228
 5,478
 3,621
Transaction-related costs 5,294
 
 5,294
 29,421
Total stock-based compensation expense $8,743
 $1,666
 $12,980
 $34,361

All stock options granted under the 2013 Stock Incentive Plan for Key Employees of PRA Health Sciences, Inc. and its Subsidiaries, or the 2013 Plan, are subject to transfer restrictions of the stock option's underlying shares once vested and exercised. This lack of marketability was included as a discount when calculating the grant date value of these options. In conjunction with secondary offerings, the transfer restrictions on a portion of such shares issuable upon exercise of vested options granted under the 2013 Plan were released. The release of the transfer restrictions is considered a modification under ASC Topic 718, “Stock Compensation.” As a result of these modifications, the Company incurred approximately $5.3$0.8 million and $4.9$5.3 million of incremental compensation expense associated with service-based options during the nine months ended September 30, 20172018 and September 30, 2016,2017, respectively, which is included in transaction-related costs in the accompanying consolidated condensed statement of operations.
In December 2013, the Company granted certain employees market-based options under the Plan that vest only upon the achievement of a specified internal rate of return from a liquidity event (“2.0x Options”). At the time of grant, no compensation expense was recorded as the 2.0x Options vest upon a liquidity event, which is not considered probable until the date it occurs. On January 20, 2016, the Compensation Committee of the Board of Directors adopted a resolution to adjust the vesting criteria for all 2.0x Options granted and still outstanding on such date.  Under the revised vesting criteria, the 2.0x Options vest upon the announcement of a secondary offering. This modification resulted in Type IV Improbable-to-Improbable modification. Since the secondary offering was deemed improbable due to the fact that it is outside of the Company’s control and cannot be considered probable until the date it occurs, no compensation expense was recognized on the January 20, 2016 modification date. On March 2, 2016, the Company announced a secondary offering of shares by KKR and certain management stockholders, and it became probable that the 2.0x Options would vest. In total, 835,551 2.0x Options held by current employees were modified. As a result of this modification, and the modification associated with the transfer restrictions releases noted above, the Company incurred approximately $24.5 million of incremental compensation expense associated with the 2.0x Options during the nine months ended September 30, 2016, which is included in transaction-related costs in the accompanying consolidated condensed statement of operations.
Employee Stock Purchase Plan
In April 2017, the Board of Directors approved the PRA Health Sciences, Inc. 2017 Employee Stock Purchase Plan (“ESPP”) which was approved by the Company’s shareholders on June 1, 2017. The ESPP allows eligible employees to authorize payroll deductions of up to 10% of their base salary or wages to be applied toward the purchase of shares of the Company’s common stock on the last trading day of the offering period. Participating employees will purchase shares of the Company's common stock at a discount of up to 15% on the lesser of the closing price of the Company's common stock on the NASDAQ Global Select Market (i) on the first trading day of the offering period or (ii) the last day of any offering period.

Offering periods under the ESPP will generally be in six month increments, commencing on January 1 and July 1 of each calendar year with the compensation committee having the right to establish different offering periods.
(10)(11) Income Taxes
 
The Company’s effective income tax rate was 40.0% and (0.2)% for the nine months ended September 30, 2018 and 25.8%2017, respectively. The effective tax rate for the nine months ended September 30, 2017 and 2016, respectively.included the effect of a release of a valuation allowance on the Company’s net federal deferred tax assets, which was fully reversed within 2017. The variation between the Company’s effective income tax rate and the U.S. statutory rate of 35%21% for the nine months ended September 30, 20172018 is primarily due to (i) the benefit realized fromU.S. inclusion of amounts related to the estimated tax deductionon global intangible low-taxed income, or GILTI, (ii) the U.S. inclusion of stock awardsamounts related to the estimated base erosion anti abuse tax, or BEAT, and (iii) the increase in excessfair value of the amount recognizedearn-out liability related to the stock acquisition of Symphony Health, which is not deductible for tax but instead increases tax stock basis.

On December 22, 2017, the Act was signed into law making significant changes to the Internal Revenue Code. Changes include, but are not limited to, a corporate tax rate decrease from 35% to 21% effective for tax years beginning after December 31, 2017, the transition of U.S international taxation from a worldwide tax system to a modified territorial system, and a one-time transition tax on the mandatory deemed repatriation of cumulative untaxed foreign earnings as of December 31, 2017. The Company has calculated its best estimate of the impact of the Act at the date of enactment and additional measurement period adjustments related to the 2017 transition tax in our quarterly income tax provision in accordance with our understanding of the Act including recently-released guidance. As a result, the Company has recorded $3.5 million as additional income tax expense for the nine months ended September 30, 2018 relating to the impact of adjustments to the Company’s December 31, 2017 transition tax provisional amounts, of which a $0.1 million benefit relates to adjustments made in the financial statements perthird quarter of 2018. The adjustment to the guidance under ASU No. 2016-09,provisional amount related to opting to offset the one-time transition tax on the mandatory deemed repatriation of untaxed foreign earnings with current losses and (ii)prior year net operating losses in lieu of utilizing foreign tax credits. The Company is continuing to analyze the releaseoverall impact of the valuation allowance againsttransition tax inclusion and will update the Company's federal netprovisional estimate as it completes its analysis during the measurement period. Due to the complexity of the new law, the Company is still in the process of investigating the related accounting implications. Specifically, for the GILTI tax the Company intends to make an accounting policy decision around whether to account for GILTI as a period cost in the relevant period, or to record deferred taxes related to the basis in the Company’s foreign subsidiaries. The Company is currently analyzing recently issued guidance and will make a determination regarding its accounting policy for GILTI tax amounts in the fourth quarter of 2018. Anticipated amounts for GILTI have been included as a component of current tax expense in the Company’s third quarter annual effective tax rate calculation. The Company is currently projecting to be subject to BEAT for 2018. Pursuant to relevant FASB guidance, the Company has accounted for BEAT as a current expense and recorded U.S. deferred tax assets as a resultand liabilities at the regular statutory rate for the period ended September 30, 2018. Adjustments to the recorded provisional amounts or changes resulting from the issuance of additional guidance will be reflected in the acquisition of Symphony Health.period when the Company's analysis is updated or in the period the additional guidance is issued, respectively.


GAAP requires a two-step approach when evaluating uncertain tax positions. The first step is to evaluate the tax position for recognition by determining if the weight of available evidence demonstrates that it is more likely than not that the position will be sustained upon audit, including resolution of any related appeals or litigation processes. The second step is to quantify the amount of tax benefit to recognize as the amount that is cumulatively more than 50% likely to be realized upon ultimate settlement with the taxing authorities.
As of September 30, 2017, There were no material changes to the Company’s liability for unrecognized tax benefits was $13.0 million. If any portion of this $13.0 million is recognized that impactsduring the effective tax rate, the Company will then include that portion in the computation of its effective tax rate. Although the ultimate timing of the resolution of audits is highly uncertain, the Company believes it is reasonably possible that approximately $4.5 million of gross unrecognized tax benefits will change in the next 12three and nine months as a result of pending audit settlements or statute of limitations expirations.ended September 30, 2018.
The Company files federal, state, and foreign tax returns. For federal purposes, the Company is generally no longer subject to tax examinations for years ended December 31, 2013 and prior. For state tax returns, the Company is generally no longer subject to tax examinations for years prior to 2012. For foreign purposes, the Company is generally no longer subject to examination for tax periods 2009 and prior. Certain carryforward tax attributes generated in prior years remain subject to examination and adjustment.


(11)(12) Commitments and Contingencies
 
Legal Proceedings
 
The Company is involved in legal proceedings from time to time in the ordinary course of its business, including employment claims and claims related to other business transactions. Although the outcome of such claims is uncertain, management believes that these legal proceedings will not have a material adverse effect on the financial condition or results of future operations of the Company.

The Company is currently a party to litigation with the City of Sao Paulo, Brazil. The dispute relates to whether the export of services provided by the Company is subject to a local tax on services. The Company has not recorded a liability associated with the claim, which totaled $5.4$4.6 million at September 30, 2017,2018, given that it is not deemed probable the Company will incur a loss related to this case. However, a deposit totaling $5.4$4.6 million has been made to the Brazilian court in order to annul the potential tax obligation and to avoid the accrual of additional interest and penalties. This balance is recorded in other assets on the consolidated condensed balance sheet. In June 2015, the Judiciary Court of Justice of the State of Sao Paulo ruled in the favor of the Company, however, the judgment was appealed by the City of Sao Paulo. The Company expects to recover the full amount of the deposit when the case is settled. In September 2017, a judge from the Superior Court of Justice of Brazil denied relief to the City of Sao Paulo's appeal and upheld the lower court's ruling in the

favor of the Company for the years 2011,2005 to 2012, and in the period from January to October 2013. The judge from the Superior Court of Justice of Brazil also ruled that the Company must appeal the lower court's verdict for October 2013 and the period November 2013 through September 2017subsequent periods as the Judiciary Court of Justice of the State of Sao Paulo only reviewed the facts that pertained to the period before NovemberOctober 2013. The Company expects to recover the full amount of the deposit when the case is settled.

(12)(13) Derivatives
 
The Company is exposed to certain risks relating to its ongoing business operations. The primary risk that the Company seeks to manage by using derivative instruments is interest rate risk.risk arising from movement in market interest rates. Accordingly, the Company has instituted interest rate hedging programs that are accounted for in accordance with ASC 815, “Derivatives and Hedging.” Thean interest rate hedging program is athat uses interest rate swaps designated as cash flow hedge program designedhedges to minimizemitigate interest rate volatility. The Company swaps the difference between fixed and variable interest amounts calculated by reference to an agreed-upon notional principal amount, at specified intervals. The Company’s interest rate contracts are designated as hedging instruments.


On January 5, 2018, the Company entered into two new interest rate swaps in order to manage its cash flow exposure to variable rate debt and also to replace an interest rate swap that was scheduled to mature in September 2018. The first interest rate swap has an aggregate notional amount of $375.0 million and a fixed payment rate of 2.2% offsetting a one-month LIBOR variable rate with an effective date of January 8, 2018, and a maturity date of December 6, 2020. The second interest rate swap has an aggregate notional amount of $250.0 million and a fixed payment rate of 2.3% offsetting a one-month LIBOR variable rate with an effective date of September 6, 2018, and a maturity date of September 6, 2020.
 
The following table presents the notional amounts and fair values (determined using Level 2 inputs) of the Company’s derivatives as of September 30, 20172018 and December 31, 20162017 (in thousands):
    September 30, 2018 December 31, 2017
  Balance Sheet Classification 
Notional
amount
 
Asset/
(Liability)
 
Notional
amount
 
Asset/
(Liability)
Derivatives in an asset position: Other current assets $
 $
 $250,000
 $428
  Other assets 625,000
 7,948
 
 
    $625,000
 $7,948
 $250,000
 $428

    September 30, 2017 December 31, 2016
  Balance Sheet Classification 
Notional
amount
 
Asset/
(Liability)
 
Notional
amount
 
Asset/
(Liability)
Derivatives in an asset position:          
   Interest rate swap Other assets $250,000
 $73
 $
 $
Derivatives in a liability position:          
   Interest rate swap Other long-term liabilities $
 $
 $250,000
 $(590)


The Company records the effective portion of any change in the fair value of derivatives designated as hedging instruments under ASC 815 to accumulated other accumulated comprehensive loss in the Company's consolidated condensed balance sheet, net of deferred taxes, and will later reclassify into earnings when the hedged item affects earnings or is no longer expected to occur. Gains and losses from the ineffective portion of any hedge are recognized in earnings immediately. For other derivative contracts that do not qualify or no longer qualify for hedge accounting, changes in the fair value of the derivatives are recognized in earnings each period.
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The table below presents the effect of the Company's derivatives on the consolidated condensed statements of operations and comprehensive income (loss) for the three and nine months ended September 30, 20172018 and 20162017 (in thousands):
  Three Months Ended September 30, Nine Months Ended September 30,
Derivatives in Cash Flow Hedging Relationships (Interest Rate Swaps) 2018 2017 2018 2017
Amount of pre-tax gain (loss) recognized in other comprehensive income $1,422
 $35
 $7,617
 $(32)
Amount of loss reclassified from accumulated other comprehensive loss into interest expense, net (1,463) (1,758) (4,980) (5,175)
  Three Months Ended September 30, Nine Months Ended September 30,
Derivatives in Cash Flow Hedging Relationships (Interest Rate Contracts) 2017 2016 2017 2016
Amount of pre-tax gain (loss) recognized in other comprehensive income (loss) on derivatives $35
 $127
 $(32) $(2,546)
Amount of loss recognized in other income (expense), net on derivatives (ineffective portion) 
 
 
 
Amount of loss reclassified from accumulated other comprehensive loss into interest expense, net on derivatives (1,758) (1,617) (5,175) (4,242)

 
The Company expects that $6.6$4.1 million of unrealized losses will be reclassified out of accumulated other comprehensive loss and into interest expense, net over the next 12 months.
 

(13)(14) Accumulated Other Comprehensive Loss
 
Below is a summary of the components of accumulated other comprehensive loss (in thousands):
  
Foreign
Currency
Translation
 
Derivative
Instruments, Net of Tax
 Total
Balance at December 31, 2017 $(117,180) $(19,290) $(136,470)
Other comprehensive income before reclassifications (23,107) 5,613
 (17,494)
Reclassification adjustments 
 3,666
 3,666
Balance at September 30, 2018 $(140,287) $(10,011) $(150,298)
  
Foreign
Currency
Translation
 
Derivative
Instruments, Net of Tax
 Total
Balance at December 31, 2016 $(201,091) $(23,595) $(224,686)
Other comprehensive income before reclassifications 75,167
 (21) 75,146
Reclassification adjustments 
 3,249
 3,249
Balance at September 30, 2017 $(125,924) $(20,367) $(146,291)

 
Foreign Currency Translation

The change in the Company's foreign currency translation adjustment was due primarily to the movements in the British pound and Euro exchange rates against the U.S. dollar. The U.S. dollar weakenedstrengthened by 8.6%3.3%, 3.0%, 3.3%, and 12.0%12.2% versus the British pound, Euro, Canadian dollar, and Euro,Russian ruble, respectively, between December 31, 20162017 and September 30, 2017.2018. The movement in the British pound, Euro, Canadian dollar, and EuroRussian ruble represented $42.1$2.7 million, $10.3 million, $1.9 million, and $26.8$3.3 million, respectively, out of the $75.2$23.1 million foreign currency translation adjustment during the nine months ended September 30, 2018.

Accumulated earnings of the Company’s U.K. subsidiary totaling $375.4 million have been previously taxed in the U.S. or were deemed to have been repatriated as part of the one-time transition tax under the Act enacted December 22, 2017. The remainingCompany has deemed a corresponding amount of intercompany accounts between its U.S. and U.K. subsidiaries to be of a long-term investment nature; these balances have been remeasured to foreign currency translation adjustment is primarily attributableduring the nine months ended September 30, 2018.

Derivative Instruments

See Note 13 for further information on changes to accumulated other comprehensive income related to the U.S. dollar’s depreciation against other major world-wide currencies, including the Canadian dollar and the Russian ruble.derivative instruments.

(14)(15) Net Income Per Share

 
Basic net income per share is calculated by dividing net income by the weighted average number of common shares outstanding for the applicable period. Diluted net income per share is calculated after adjusting the denominator of the basic net income per share calculation for the effect of all potentially dilutive common shares, which, in the Company’s case, includes shares issuable under the stock option and incentive award plan.plans.


The following table reconciles the basic to diluted weighted average shares outstanding (in thousands):
 
  Three Months Ended September 30, Nine Months Ended September 30,
  2018 2017 2018 2017
Basic weighted average common shares outstanding 64,261
 62,730
 63,891
 62,185
Effect of dilutive stock options and other awards under share-based compensation programs 2,245
 3,142
 2,367
 3,498
Diluted weighted average common shares outstanding 66,506
 65,872
 66,258
 65,683
         
Anti-dilutive shares 987
 733
 1,670
 381
  Three Months Ended September 30, Nine Months Ended September 30,
  2017 2016 2017 2016
Basic weighted average common shares outstanding 62,730
 60,937
 62,185
 60,579
Effect of dilutive stock options and RSAs/RSUs 3,142
 3,584
 3,498
 3,689
Diluted weighted average common shares outstanding 65,872
 64,521
 65,683
 64,268
         
Anti-dilutive shares 733
 359
 381
 314

 
The dilutive and anti-dilutive shares disclosed above were calculated using the treasury stock method. The treasury stock method calculates dilution assuming the exercise of all in-the-money options and vesting of RSAs/RSUs, reduced by the repurchase of shares with the proceeds from the assumed exercises, and unrecognized compensation expense for outstanding awards.


(15)(16) Segments


In conjunction withSubsequent to the acquisition of Symphony Health, on September 6, 2017, the Company expanded its reporting segments. The Company is now managed through two reportable segments,segments: (i) the Clinical Research segment and Data Solutions. Clinical Research, which primarily serves biopharmaceutical clients, provides outsourced clinical research and clinical trial related services.(ii) the Data Solutions provides mission criticalsegment. In accordance with the provisions of ASC 280, "Segment Reporting", the Company's chief operating decision-maker has been identified as the Chief Executive Officer, who reviews operating results to make decisions about allocating resources and assessing performance for the entire company.

Clinical Research Segment: The Clinical Research segment, which primarily serves biopharmaceutical clients, provides outsourced clinical research and clinical trial related services.

Data Solutions Segment: The Data Solutions segment provides data and analytics, technology solutions and real-world insights and services primarily to the Company’s life science customers.

The Company's chief operating decision-maker uses segment profit as the primary measure of each segment's operating results in order to allocate resources and in assessing the Company's performance. Asset information technology solutions and real-world insights and services to the Company’s life science clients. Reimbursement revenue and reimbursable out-of-pocket costs areby segment is not presented, as this measure is not used by the chief operating decision makerdecision-maker to assess the Company's performance.

The Company’s reportable segment information is presented below (in thousands):

  Three Months Ended September 30, Nine Months Ended September 30,
  2017 2016 2017 2016
Service revenue:        
Clinical Research $475,588
 $399,841
 $1,360,610
 $1,166,410
Data Solutions 18,962
 
 18,962
 
Total service revenue 494,550
 399,841
 1,379,572
 1,166,410
Direct Costs:        
Clinical Research 314,904
 259,910
 903,027
 758,333
Data Solutions 11,961
 
 11,961
 
Total direct costs 326,865
 259,910
 914,988
 758,333
Gross Profit:        
Clinical Research 160,684
 139,931
 457,583
 408,077
Data Solutions 7,001
 
 7,001
 
Total gross profit $167,685
 $139,931
 $464,584
 $408,077
Less expenses not allocated to segments:        
   Selling, general and administrative 79,307
 67,190
 229,770
 199,648
   Transaction-related costs 12,740
 
 12,740
 31,785
   Depreciation and amortization 18,853
 17,708
 50,146
 52,246
   Loss on disposal of fixed assets, net 8
 219
 240
 290
Consolidated income from operations 56,777
 54,814
 171,688
 124,108
   Interest expense, net (11,557) (13,779) (31,088) (42,525)
   Loss on modification or extinguishment of debt (3,089) 
 (3,089) (21,485)
   Foreign currency (losses) gains, net (12,794) 1,182
 (35,004) 9,264
   Other income (expense), net 1,004
 20
 724
 (85)
Consolidated income before income taxes and equity in income of unconsolidated joint ventures $30,341
 $42,237
 $103,231
 $69,277
  Three Months Ended September 30, 2018 Three Months Ended September 30, 2017
  Clinical Research Data Solutions Total Clinical Research Data Solutions Total
Revenue $656,979
 $60,617
 $717,596
 $563,047
 $18,962
 $582,009
             
Direct costs (exclusive of depreciation and amortization) 330,037
 41,385
 371,422
 314,904
 11,961
 326,865
Reimbursable out-of-pocket costs 77,584
 
 77,584
 87,459
 
 87,459
Reimbursable investigator fees 65,133
 
 65,133
 
 
 
Segment profit 184,225
 19,232
 203,457
 160,684
 7,001
 167,685
Less expenses not allocated to segments:            
Selling, general and administrative expenses     92,553
     79,307
Transaction-related costs     43,837
     11,741
Depreciation and amortization     28,270
     18,853
(Gain) loss on disposal of fixed assets, net     (15)     8
Income from operations     38,812
     57,776
Interest expense, net     (14,423)     (11,557)
Loss on modification or extinguishment of debt     (454)     (3,089)
Foreign currency losses, net     (1,809)     (12,794)
Other (expense) income, net     (68)     5
Income before income taxes and equity in income of unconsolidated joint ventures     $22,058
     $30,341


  Nine Months Ended September 30, 2018 Nine Months Ended September 30, 2017
  Clinical Research Data Solutions Total Clinical Research Data Solutions Total
Revenue $1,966,762
 $175,512
 $2,142,274
 $1,584,531
 $18,962
 $1,603,493
             
Direct costs (exclusive of depreciation and amortization) 1,010,915
 123,594
 1,134,509
 903,027
 11,961
 914,988
Reimbursable out-of-pocket costs 237,307
 
 237,307
 223,921
 
 223,921
Reimbursable investigator fees 193,585
 
 193,585
 
 
 
Segment profit 524,955
 51,918
 576,873
 457,583
 7,001
 464,584
Less expenses not allocated to segments:            
Selling, general and administrative expenses     275,424
     229,770
Transaction-related costs     32,709
     11,816
Depreciation and amortization     84,163
     50,146
Loss on disposal of fixed assets, net     21
     240
Income from operations     184,556
     172,612
Interest expense, net     (43,860)     (31,088)
Loss on modification or extinguishment of debt     (454)     (3,089)
Foreign currency losses, net     (1,416)     (35,004)
Other expense, net     (201)     (200)
Income before income taxes and equity in income of unconsolidated joint ventures     $138,625
     $103,231


Revenue by geographic location for each segment is as follows (in thousands):
  Three Months Ended September 30, 2018 Nine Months Ended September 30, 2018
  Clinical Research Data Solutions Total Clinical Research Data Solutions Total
Revenue            
Americas:            
United States $433,050
 $60,617
 $493,667
 $1,284,678
 $175,512
 $1,460,190
Other 11,396
 
 11,396
 35,346
 
 35,346
Total Americas 444,446
 60,617
 505,063
 1,320,024
 175,512
 1,495,536
Europe, Africa, and Asia-Pacific     

      
United Kingdom 170,252
 
 170,252
 516,442
 
 516,442
Netherlands 28,334
 
 28,334
 87,340
 
 87,340
Other 13,947
 
 13,947
 42,956
 
 42,956
Total Europe, Africa, and Asia-Pacific 212,533
 
 212,533
 646,738
 
 646,738
Total revenue $656,979
 $60,617
 $717,596
 $1,966,762
 $175,512
 $2,142,274



Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
 
You should read the following discussion and analysis of our financial condition and results of operations in conjunction with our consolidated condensed financial statements and the notes thereto included elsewhere in this Quarterly Report on Form 10-Q, with our audited consolidated financial statements and the notes thereto included in our Annual Report on Form 10-K for the fiscal year ended December 31, 20162017 and with the information under the heading “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in our Annual Report on Form 10-K for the fiscal year ended December 31, 2016.2017.
 
We use the terms “we,” “us,” “our,” or the “Company”"Company” in this report to refer to PRA Health Sciences, Inc. and its subsidiaries.
 
Overview
 
We are one of the world’s leading global contract research organizations, or CROs, by revenue, providing outsourced clinical research and development services and data solutions to the biotechnology and pharmaceutical industries. We believe we are one of a select group of CROs with the expertise and capability to conduct clinical trials across major therapeutic areas on a global basis. Our therapeutic expertise includes areas that are among the largest in pharmaceutical development, and we focus in particular on oncology, central nervous system inflammation, respiratory, cardiometabolic and infectious diseases. We believe that we further differentiate ourselves from our competitors through our investments in data, medical informatics and clinical technologies designed to enhance efficiencies, improve study predictability and provide better transparency for our clients throughout their clinical development processes.

In September 2017, we completed the acquisition of Symphony Health Our Data Solutions Corporation, or Symphony Health,segment allows us to better serve our clients across their entire product lifecycle by (i) improving clinical trial design, recruitment, and execution; (ii) creating real-world data solutions based on the use of medicines by actual patients in normal situations; and (iii) increasing the efficiency of healthcare companiescompanies' commercial organizations through enhanced analytics and outsourcing services.  The acquisition of Symphony Health was accounted for as a business combination and the acquired results of operations are included in our consolidated financial information since the date of the acquisition. See Note 2 to our consolidated condensed financial statements included elsewhere in this Form 10-Q for additional details regarding our business combinations.
Historically, we reported one segment focused on providing outsourced clinical research and clinical trial related services.  These operations are now being reported as the Clinical Research segment. The acquisition of Symphony Health resulted in a new segment, referred to as the Data Solutions segment, which is focused on providing mission critical information, technology solutions and real-world insights and services to the Company’s life sciences clients. 

Contracts define the relationships with our clients and establish the way we earn revenue. Three types of relationships are most common: a fixed-fee contract, a time and materials contract and fee-for-service arrangements. In cases where the contracts are fixed price, we may bear the cost of overruns for the contracted scope, or we may benefit if the costs are lower than we anticipated for the contracted scope. In cases where our contracts are fee-for-service, the contracts contain an overall budget for contracted resources. If actual resources used are lower than anticipated, the client generally keeps the savings and we may be responsible for covering the cost of the unused resource if we are unable to redeploy the resource. For time and material contracts, we bill the client only for the actual hours we spend to complete the contracted scope based upon stated hourly rates by position. The duration of our contracts range from a few months to several years. Revenue for services is recognized only after persuasive evidence of an arrangement exists, the sales price is determinable, services have been rendered, and collectability is reasonably assured. Once these criteria have been met, we recognize revenue for the services provided on fixed-fee contracts in our Clinical Research segment based on the proportional performance methodology, which determines the proportion of outputs or performance obligations, which have been completed or delivered compared to the total contractual outputs for performance obligations. To measure performance, we compare the contract costs incurred to estimated total contract costs through completion. As part of the client proposal and contract negotiation process, we develop a detailed project budget for the direct costs based on the scope of the work, the complexity of the study, the geographical locations involved and our historical experience. We then establish the individual contract pricing based on our internal pricing guidelines, discount agreements, if any, and negotiations with the client. The estimated total contract costs are reviewed and revised periodically throughout the lives of the contracts, with adjustments to revenue resulting from such revisions being recorded on a cumulative basis in the period in which the revisions are first identified. Our costs consist of expenses necessary to carry out the clinical development project undertaken by us on behalf of the client. These costs primarily include the expense of obtaining appropriately qualified labor to administer the project, which we refer to as direct cost headcount. Other costs we incur are attributable to the expense of operating our business generally, such as leases and maintenance of information technology and equipment. We recognize revenue for services provided on fixed-fee contracts in our Data Solutions segment

either ratably as earned over the contract period (for subscription-based services) or upon delivery (for one-time delivery of data solutions or reports). Revenue from time and materials contracts is recognized as hours are incurred. Revenues and the related costs of fee-for-service contracts are recognized in the period in which services are performed.

How We Assess the Performance of Our Business
 
The Company is managed through two reportable segments: (i) the Clinical Research segment; and (ii) the Data Solutions segment. Our chief operating decision-maker uses segment profit as the primary measure of each segment's operating results in order to allocate resources and in assessing the Company's performance. In addition to our financial measures in conformity with U.S. generally accepted accounting principles, or GAAP, financialincluding revenue, costs and expenses and other measures discussed below, we review various financial and operational metrics, includingmetrics. For our Clinical Research segment, we review new business awards, cancellations, and backlog. Many of our current contracts include clinical trials covering multiple geographic locations. We utilize the same management systems
and reporting tools to monitor and manage these activities on the same basis worldwide.
 
Our gross new business awards for our Clinical Research segment for the nine months ended September 30, 2018 and 2017 and 2016 were $1,999.9$2,286.7 million and $1,686.4$1,999.9 million, respectively. New business awards arise when a client selects us to execute its trial and is documented by written or electronic correspondence, or for our Strategic Solutions offering when the amount of revenue expected to be recognized is measurable. The number of new business awards can vary significantly from year to year, and awards can have terms ranging from several months to several years. For our Strategic Solutions offering, the value of a new business award is the anticipated service revenue to be recognized in the corresponding quarter of the next fiscal year. For the remainder of our business,Clinical Research segment, the value of a new award is the anticipated service revenue over the life of the contract, which does not include reimbursement activityreimbursable out-of-pocket costs or reimbursable investigator fees.
 
In the normal course of business, we experience contract cancellations, which are reflected as cancellations when the client provides us with written or electronic correspondence that the work should cease. During the nine months ended September 30, 20172018 and 20162017 we had $233.4$309.3 million and $197.2$233.4 million, respectively, of cancellations for which we received correspondence from the client for our Clinical Research segment. The number of cancellations can vary significantly from year to year. The value of the cancellation is the remaining amount of unrecognized service revenue, less the estimated effort to transition the work back to the client.
 
Our backlog consists of anticipated service revenue from new business awards that either have not started or are in process but have not been completed for our Clinical Research segment. Backlog varies from period to period depending upon new business awards and contract modifications, cancellations, and the amount of service revenue recognized under existing contracts. Our backlog at September 30, 2018 and 2017 and 2016 was $3.4$4.1 billion and $2.8$3.4 billion, respectively.
 

Sources of Revenue
 
Total revenues are comprised of service revenue and reimbursement revenue, each of which is described below.
Service Revenue
We generally enter into contracts with customers to provide services with payments based on either fixed-fee, time and materials, or fee-for-service arrangements. Revenue for services is recognized only after persuasive evidence of an arrangement exists,revenues from the sales price is determinable, services have been rendered, and collectability is reasonably assured.
Once these criteria have been met, we recognize revenue for the services provided on fixed-fee contracts in our Clinical Research segment based on the proportional performance methodology, which determines the proportion of outputs or performance obligations which have been completed or delivered compared to the total contractual outputs for performance obligations. To measure performance, we compare the contract costs incurred to estimated total contract costs through completion. As part of the client proposal and contract negotiation process, we develop a detailed project budget for the direct costs based on the scope of the work, the complexity of the study, the geographical location involved and our historical experience. We then establish the individual contract pricing based on our internal pricing guidelines, discount agreements, if any, and negotiations with the client. The estimated total contract costs are reviewed and revised periodically throughout the lives of the contracts, with adjustments to revenue resulting from such revisions being recorded on a cumulative basis in the period in which the revisions are first identified. We recognize revenue for services provided on fixed-fee contracts in our Data Solutions segment either ratably as earned over the contract period (for subscription-based services) or upon delivery (for one-time delivery of data solutions or reports). Revenue from time and materials contracts is recognized as hours are incurred. Billable hours typically fluctuate during the terms of individual contracts, as services we provide generally increase at the beginning of a study and decrease toward the end of a study. Revenues and the related costs of fee-for-service contracts are recognized in the period in which services are performed.

A majorityprovision of our contracts undergo modifications over the contract periodservices and our contracts provide for these modifications. During the modification process, we recognize revenue to the extent we incur costs, provided client acceptance and payment is deemed reasonably assured.

We often offer volume discounts to our large customers based on annual volume thresholds. We record an estimate of the annual volume rebate as a reduction of revenue throughout the period based on the estimated total rebate to be earned for the period.
Most of our contracts can be terminated by the client either immediately or after a specified period, typically 30 to 60 days, following notice. In the case of early termination, these contracts typically require payment to us of fees earned to date, and in some cases, a termination fee or some portion of the fees or profit that we could have earned under the contract if it had not been terminated early. Based on ethical, regulatory, and health considerations, this wind-down activity may continue for several quarters or years. Therefore, revenue recognized prior to cancellation generally does not require a significant adjustment upon cancellation.
Increases in the estimated total direct costs to complete a contract without a corresponding proportional increase to the total contract price result in a cumulative adjustment to the amount of revenue recognized in the period the change in estimate is determined.
Our service revenue was $1,379.6 million and $1,166.4 million during the nine months ended September 30, 2017 and 2016, respectively. Changes in service revenuerevenues from period to period are driven primarily by changes in backlog at the beginning of a period, as well as new business awards during such period. Additionally, service revenue and billable hours will generally be impacted by the mix of studiesreimbursed expenses that are active during a period, as different studiesincurred while providing our services. We do not have different staffing requirements, as well as the life cyclesany material product revenues. 

See Note 1, Basis of projects that are active during a period.
Reimbursement RevenuePresentation, and Reimbursable Out-of-Pocket Costs
We incur out-of-pocket costs, which are reimbursable by our customers. We include these out-of-pocket costs as reimbursement revenue and reimbursable out-of-pocket expenses inNote 2, Significant Account Policies Updates, to our consolidated condensed statementfinancial statements included elsewhere in this Form 10-Q for additional details regarding our sources of operations.
As is customary in our industry, we also routinely enter into separate agreements on behalf of our clients with independent physician investigators in connection with clinical trials. We also receive funds from our clients for investigator fees, which are netted against the related costs, since such fees are the obligation of our clients, without risk or reward to us. We are not obligated either to perform the service or to pay the investigator in the event of default by the client. In addition, we do not pay the independent physician investigator until funds are received from the client. Accordingly, unlike reimbursable out-of-pocket costs, we do not recognize these investigator fees in revenue.
Reimbursement costs and investigator fees are not included in our backlog because they are pass-through costs to our clients.
We believe that the fluctuations in reimbursement costs and reimbursement revenue from period to period are not meaningful to our underlying performance.

Costs and Expenses

Our costs and expenses are comprised primarily of our direct costs, selling, general and administrative costs, depreciation and amortization and income taxes. In addition, we incur reimbursable out-of-pocket expenses; however, as noted above, our reimbursable out-of-pocket expenses are directly offset by our reimbursement revenue. Since reimbursement revenue is offset by our out-of-pocket reimbursable expenses, we monitor and measure costs as a percentage of service revenue, excluding reimbursement revenue from out-of-pocket costs and investigator fees, rather than total revenue, as we believe this is a more meaningful comparison and better reflects the operations of our business.

Direct Costs (Exclusive of Depreciation and Amortization)
 
Direct Costs
OurFor our Clinical Research segment, direct costs consist primarily of labor-relatedlabor‑related charges. They include elements such as salaries, benefits and incentive compensation for our employees. In addition, we utilize staffing agencies to procure primarily part time individuals to perform work on our contracts. ForLabor-related charges as a percentage of the Clinical Research segment's total direct costs were 95.9% and 96.4% for the nine months ended September 30, 20172018 and 2016, the labor-related charges were 95.5% and 96.6% of our total direct costs,2017, respectively. The cost of labor procured through staffing agencies is included in these percentages and representedrepresents 4.5% and 5.6% and 5.0% of the Clinical Research segment's total direct costs for the nine months ended September 30, 20172018 and 2016,2017, respectively. Our remaining direct costs are items such as travel, meals, postage and freight, patient costs, medical waste and

supplies. The total of all these items was 4.5%as a percentage of the Clinical Research segment's total direct costs were 4.1% and 3.4%3.6% for the nine months ended September 30, 2018 and 2017, respectively.

For our Data Solutions segment, direct costs consist primarily of data costs. Data costs as a percentage of the Data Solutions segment's total direct costs were 73.0% and 71.1% for the nine months ended September 30, 2018 and 2017, respectively. Labor-related charges, such as salaries, benefits and incentive compensation for our employees, were 20.2% and 23.0% of the Data Solutions segment's total direct costs for the nine months ended September 30, 2018 and 2017, respectively. Our remaining direct costs are items such as travel, meals, and 2016,supplies and were 6.8% and 5.8% of the Data Solutions segment's total direct costs for the nine months ended September 30, 2018 and 2017, respectively.

Historically, direct costs have increased with an increase in service revenues. The future relationship between direct costs and service revenues may vary from historical relationships. Several factors will cause direct costs to decrease as a percentage of service revenues. Deployment of our billable staff in an optimally efficient manner has the greatestmost impact on our ratio of direct cost to service revenue. The most effective deployment of our staff is when they are fully engaged in billable work and are accomplishing contract related activities at a rate that meets or exceeds budgeted targets. We also seek to optimize our efficiency by performing work using the employee with the lowest cost. Generally, the following factors may cause direct costs to increase as a percentage of service revenues: our staff are not fully deployed, as is the case when there are unforeseen cancellations or delays, or when our staff are accomplishing tasks at levels of effort that exceed budget, such as rework, as well as pricing pressure from increased competition.

Reimbursable Out-of-Pocket Costs and Reimbursable Investigator Fees
We incur out-of-pocket costs, which are reimbursable by our customers. We include these out-of-pocket costs as reimbursable out-of-pocket expenses in our consolidated condensed statements of operations.
As is customary in our industry, we also routinely enter into separate agreements on behalf of our clients with independent physician investigators in connection with clinical trials. We also receive funds from our clients for investigator fees. We are not obligated either to perform the service or to pay the investigator in the event of default by the client. In addition, we do not pay the independent physician investigator until funds are received from the client. We include these investigator fees as reimbursable investigator fees in our consolidated condensed statements of operations.
Reimbursable costs and investigator fees are not included in our backlog because they are pass-through costs to our clients.

We believe that the fluctuations in reimbursement costs and the associated revenue are not meaningful to the economic performance given that such costs are passed through to the client. The reimbursable costs are included in our measure of progress for our long-term contracts.

Selling, General and Administrative Expenses
 
Selling, general and administrative expenses consist of administration payroll and benefits, marketing expenditures, and overhead costs such as information technology and facilities costs. These expenses also include central overhead costs that are not directly attributable to our operating business and include certain costs related to insurance, professional fees and property.

Loss on Modification or Extinguishment of Debt

Loss on modificationextinguishment of debt for the nine months ended September 30, 2017 consists of previously capitalized unamortized debt financing costs that were expensed as a result of voluntary debt repayments and fees associated with the incremental borrowing under the 2016 Credit Facilities, or Incremental Borrowing. Loss on extinguishment of debt for the nine months ended September 30, 2016 consists of an early tender premium, the write-off of unamortized debt issuance costs and miscellaneous costs incurred as a result of our repayment of $133.6 million of our 9.5% senior notes due 2023, or Senior Notes.

Transaction-RelatedTransaction-related Costs

Transaction-related costs for the nine months ended September 30, 2017 consists of expenses incurredincludes fees associated with our secondary offering acquisition of Symphony Health Solutions Corporation, or Symphony Health, andcommon stock, stock-based compensation expense related to the release of a portion of the transfer restrictions on vested options. Transaction-related costs foroptions, the nine months ended September 30, 2016 consists of expenses incurred with our secondary offerings, transaction-related stock-based compensation awards and the closing ofamendment to our accounts receivable financing agreement.agreement, costs associated with earn-out liabilities, and expenses associated with our acquisitions.

Depreciation and Amortization
 
Depreciation represents the depreciation charged on our fixed assets. The charge is recorded on a straight-line method, based on estimated useful lives of three to seven years for computer hardware and software and five to seven years for furniture and equipment. Leasehold improvements are depreciated over the lesser of the life of the lease term or the useful life of the improvements.
 
Amortization expense consists of amortization recorded on acquisition-related intangible assets. Customer relationships, backlog and finite-lived trade names are amortized on an accelerated basis, which coincides with the period of economic benefit we expect to receive. All other finite-lived intangibles are amortized on a straight-line basis. In accordance with GAAP, we do not amortize goodwill and indefinite-lived intangible assets.
 
Income Taxes
 
Because we conduct operations on a global basis, our effective tax rate has depended and will continue to depend upon the geographic distribution of our pre-taxpre‑tax earnings among several different taxing jurisdictions. Our effective tax rate can also vary based on changes in the tax rates of the different jurisdictions. Our effective tax rate is also impacted by tax credits and the establishment or release of deferred tax asset valuation allowances and tax reserves, as well as significant non-deductiblenon‑deductible items such as portions of transaction-relatedtransaction‑related costs.


In addition, our effective income tax rate is influenced by U.S. tax law which has been substantially modified by the U.S. Tax Cuts and Jobs Act of 2017, or the Act. The following provisions of the Act could have an adverse effect on our tax rate if it is determined that the provisions are applicable to the Company:

global intangible low-taxed income;
limitations on the U.S. deductions for net business interest;
base erosion anti-abuse provisions; and
performance-based compensation subject to $1 million limit.

Foreign subsidiaries are taxed separately in their respective jurisdictions. We have foreign net operating loss carryforwards in some jurisdictions. The carryforward periods for these losses vary from five years to an indefinite carryforward period depending on the jurisdiction. Our ability to offset future taxable income with the net operating loss carryforwards may be limited in certain instances, including changes in ownership.

On December 22, 2017, the Act was signed into law making significant changes to the Internal Revenue Code. Changes include, but are not limited to, a corporate tax rate decrease from 35% to 21% effective for tax years beginning after

December 31, 2017, the transition of U.S international taxation from a worldwide tax system to a modified territorial system, and a one-time transition tax on the mandatory deemed repatriation of cumulative untaxed foreign earnings as of December 31, 2017. We have calculated our best estimate of the impact of the Act at the date of enactment and additional measurement period adjustments related to the 2017 transition tax in our quarterly income tax provision in accordance with our understanding of the Act including recently-released guidance. As a result, we have recorded $3.5 million as additional income tax expense for the nine months ended September 30, 2018 relating to the impact of adjustments to our December 31, 2017 transition tax provisional amounts, of which $0.1 million benefit related to adjustments made in the third quarter of 2018. The adjustment to the provisional amount related to opting to offset the one-time transition tax on the mandatory deemed repatriation of untaxed foreign earnings with current losses and prior year net operating losses in lieu of utilizing foreign tax credits. We are continuing to analyze the overall impact of the transition tax inclusion and will update the provisional estimate as we complete our analysis during the measurement period. Due to the complexity of the new law, we are still in the process of investigating the related accounting implications. Specifically, for the global intangible low-taxed income, or GILTI, tax we intend to make an accounting policy decision around whether to account for GILTI as a period cost in the relevant period, or to record deferred taxes related to the basis in our foreign subsidiaries. We are currently analyzing recently issued guidance and will make a determination regarding our accounting policy for GILTI tax amounts in the fourth quarter of 2018. Anticipated amounts for GILTI have been included as a component of current tax expense in our third quarter annual effective tax rate calculation. We are currently projecting to be subject to the estimated base erosion anti abuse tax, or BEAT, for 2018. Pursuant to relevant FASB guidance, we have accounted for BEAT as a current expense and recorded U.S. deferred tax assets and liabilities at the regular statutory rate for the period ended September 30, 2018. Adjustments to the recorded provisional amounts or changes resulting from the issuance of additional guidance will be reflected in the period when the Company's analysis is updated or in the period the additional guidance is issued, respectively.
 
Exchange Rate Fluctuations
 
The majority of our foreign operations transact in the Euro, or EUR, or British pound, or GBP. As a result, our revenue and expenses are subject to exchange rate fluctuations with respect to these currencies. We have translated these currencies into U.S. dollars using the following average exchange rates:
 Three Months Ended September 30, Nine Months Ended September 30, Three Months Ended September 30, Nine Months Ended September 30,
 2017 2016 2017 2016 2018 2017 2018 2017
U.S. dollars per:                
Euro 1.17
 1.12
 1.11
 1.12
 1.16
 1.17
 1.19
 1.11
British pound 1.31
 1.31
 1.27
 1.39
 1.30
 1.31
 1.35
 1.27


Results of Operations
 
Consolidated Results of Operations for the Three Months Ended September 30, 20172018 Compared to the Three Months Ended September 30, 2016
2017
 Three Months Ended September 30,   Change  
 2017 2016 Three Months Ended September 30, 2017 $ Change 
Adoption of ASC 606 (1)
 Three Months Ended September 30, 2018
(in thousands)            
Revenue            
Service revenue $494,550
 $399,841
 $494,550
 $78,380
 $
  
Reimbursement revenue 87,459
 53,414
Reimbursement revenue - out-of-pocket costs 87,459
 (9,875) 
  
Total revenue 582,009
 453,255
 582,009
 68,505
 67,082
 $717,596
Operating expenses            
Direct costs 326,865
 259,910
Direct costs (exclusive of depreciation and amortization) 326,865
 44,557
 
 371,422
Reimbursable out-of-pocket costs 87,459
 53,414
 87,459
 (9,875) 
 77,584
Reimbursable investigator fees 
 
 65,133
 65,133
Selling, general and administrative 79,307
 67,190
 79,307
 13,246
 
 92,553
Transaction-related costs 12,740
 
 11,741
 32,096
 
 43,837
Depreciation and amortization 18,853
 17,708
 18,853
 9,417
 
 28,270
Loss on disposal of fixed assets 8
 219
Loss (gain) on disposal of fixed assets 8
 (23) 
 (15)
Income from operations 56,777
 54,814
 57,776
 (20,913) 1,949
 38,812
Interest expense, net (11,557) (13,779) (11,557) (2,866) 
 (14,423)
Loss on modification of debt (3,089) 
Foreign currency (losses) gains, net (12,794) 1,182
Other expense, net 1,004
 20
Loss on modification or extinguishment of debt (3,089) 2,635
 
 (454)
Foreign currency losses, net (12,794) 10,985
 
 (1,809)
Other income (expense), net 5
 (73) 
 (68)
Income before income taxes and equity in income of unconsolidated joint ventures 30,341
 42,237
 30,341
 (10,232) 1,949
 22,058
(Benefit from) provision for income taxes (18,241) 10,821
 (18,241) 36,700
 1,789
 20,248
Income before equity in income of unconsolidated joint ventures 48,582
 31,416
 48,582
 (46,932) 160
 1,810
Equity in income of unconsolidated joint ventures, net of tax 24
 33
 24
 20
 
 44
Net income 48,606
 31,449
 48,606
 (46,912) 160
 1,854
Net income attributable to noncontrolling interest (401) 
 (401) 42
 
 (359)
Net income attributable to PRA Health Sciences, Inc. $48,205
 $31,449
 $48,205
 $(46,870) $160
 $1,495
(1) See Note 1, Basis of Presentation, to our consolidated condensed financial statements for information about the adoption of ASC 606.(1) See Note 1, Basis of Presentation, to our consolidated condensed financial statements for information about the adoption of ASC 606.

Service revenueRevenue increased by $94.7$135.6 million, or 23.7%23.3%, from $399.8$582.0 million during the three months ended September 30, 20162017 to $494.6$717.6 million during the three months ended September 30, 2017. Service revenue2018. Revenue for the three months ended September 30, 20172018 includes $67.1 million in reimbursable investigator fees and adjustments to revenue as a result of the adoption of ASC 606. Excluding the impact of the adoption of ASC 606 and reimbursement revenue, revenue increased $78.4 million. Revenue for the three months ended September 30, 2018 benefited from an increase in billable hours, an increase in the effective rate of hours billed on our studies, a favorable impact of $2.9 million from foreign currency exchange rate fluctuations, and an increase of $19.0$41.7 million due to the acquisition of Symphony Health Solutions, Inc., Symphony Health, which was completed on September 6, 2017. This was offset by an unfavorable impact of $2.3 million from foreign currency exchange rate fluctuations. The growth in service revenue and the increase in billable hours were due largely to the increase in our backlog as we entered the year, the type of services we are providing on our active studies, which was driven by the life cycles of projects that were active during the period, the growth in

new business awards as a result of higher demand for our services across the industries we serve, and more effective sales efforts, and the growth in the overall CRO market. New business awards arise when a client selects us to execute its trial. The number of awards can vary significantly from period to period and our studies have terms ranging from several months to several years. The increase in our effective rate of the hours billed on our studies is attributable to the contract pricing terms on our current mix of active studies and the mix of clients and services that we provide to those clients.
 
Direct costs increased by $67.0$44.6 million, or 25.8%13.6%, from $259.9 million during the three months ended September 30, 2016 to $326.9 million during the three months ended September 30, 2017. Direct costs as a percentage of service revenue increased from 65.0%2017 to $371.4 million during the three months ended September 30, 2016 to 66.1% during the three months ended September 30, 2017. The increase in direct costs as a percentage of service revenue is primarily due to an increase in salaries2018. Salaries and related benefits of $51.3in our Clinical

Research segment increased $11.1 million as we continue to hire billable staff to ensure appropriate staffing levels for our current studies and our future growth an increase by $12.0 million due to the acquisition of Symphony Health, and an unfavorableincludes a favorable impact of $3.7$6.1 million from foreign currency exchange rate fluctuations. The addition of our Data Solutions segment resulted in $29.4 million of incremental direct costs during the third quarter of 2018. Excluding the impact of the adoption of ASC 606 and reimbursement revenue, direct costs as a percentage of revenue were 64.8% and 66.1% during the three months ended September 30, 2018 and 2017, respectively. The decrease in direct costs as a percentage of revenue was primarily due to the favorable impact on foreign currency exchange rate fluctuations and the increased utilization of our staff.

Reimbursable out-of-pocket costs decreased by $9.9 million from $87.5 million during the three months ended September 30, 2017 to $77.6 million during the three months ended September 30, 2018. Reimbursable investigator fees were $65.1 million during the three months ended September 30, 2018. Reimbursable investigator fees were recorded on a net basis prior to our adoption of ASC 606, and therefore we did not record any reimbursable investigator fees during the three months ended September 30, 2017. We believe that the fluctuations in reimbursable costs from period to period are not meaningful to our underlying performance over the full terms of the relevant contracts.
 
Selling, general and administrative expenses increased by $12.1$13.2 million, or 18.0%16.7%, from $67.2 million during the three months ended September 30, 2016 to $79.3 million during the three months ended September 30, 2017.2017 to $92.6 million during the three months ended September 30, 2018. The increase in selling, general and administrative expenses is primarily due to an increase in salaries and related benefits as we continue to hire staff to support our growing business and increased facility costs related to additional office space needed for our growth. Selling,Excluding the impact of the adoption of ASC 606 and reimbursement revenue, selling, general and administrative expenses as a percentage of service revenue decreased from 16.8% during the three months ended September 30, 2016 towere 16.2% and 16.0% during the three months ended September 30, 2017.2018 and 2017, respectively. The decreaseincrease in selling, general and administrative expenses as a percentage of service revenue is primarily related an increase in stock based compensation during the current year.

For the three months ended September 30, 2018, we incurred $43.8 million of transaction-related costs. These costs consisted of $42.6 million for changes in the estimated fair value of contingent consideration related to our continued effortsrecent acquisitions, $0.8 million of stock-based compensation expense related to effectively leveragethe release of the remaining portion of the transfer restrictions on vested options, and $0.5 million of expenses incurred in connection with our selling and administrative functions.
August 2018 secondary offering of common stock. For the three months ended September 30, 2017, we incurred transaction-related costs of $12.7$11.7 million. These costs consistconsisted of $6.4 million of fees incurred in connection with the acquisition of Symphony Health, $5.3 million of stock-based compensation expense related to the release of a portion of the transfer restrictions on vested options, and $1.0 million of expenses incurred in connection with our August 2017 secondary offering. No transaction-related expenses were incurred foroffering of common stock, and a $1.0 million reduction to the three months ended September 30, 2016.estimated Parallel 6, Inc., or Parallel 6, earn-out liability.

Depreciation and amortization expense increased by $1.1$9.4 million, or 6.5%49.9%, from $17.7 million during the three months ended September 30, 2016 to $18.9 million during the three months ended September 30, 2017. Depreciation and amortization expense as a percentage of service revenue was 4.4%2017 to $28.3 million during the three months ended September 30, 2016 and 3.8% during the three months ended September 30, 2017.2018. The decreaseincrease in depreciation and amortization expense as a percentage of service revenue is primarily due to the continued amortization of our acquired intangibles, which are amortized on an accelerated basis.increased as a result of the Symphony Health acquisition in September 2017.

Interest expense, net, decreasedincreased by $2.2$2.9 million, or 16.1%24.8%, from $13.8 million during the three months ended September 30, 2016 to $11.6 million during the three months ended September 30, 2017. The refinancing of our variable rate first lien term loans in December 2016 contributed2017 to a 1.0% decrease in the weighted average interest rate on our outstanding debt as compared to the three months ended September 30, 2016; this decrease in weighted average interest rate resulted in a $1.6 million reduction in interest expense, which was partially offset by a $1.3 million increase in interest expense due to the Incremental Borrowing during the three months ended September 30, 2017. Additionally, interest expense decreased by $0.7 million due to lower amortization of debt issuance costs, which was offset by an increase of $0.1 million related to the amortization of our terminated interest rate swaps and interest expense on our current interest rate swap. 

Loss on modification of debt was $3.1$14.4 million during the three months ended September 30, 20172018. Interest expense on our first lien term loans increased by $4.4 million, primarily due to the Incremental Borrowing to fund the Symphony Health acquisition, and there were no lossesan additional $0.6 million increase in interest expense was attributable to additional borrowings under the accounts receivable financing agreement. This was offset by a decrease of $2.2 million in interest expense associated with repayment of our 9.5% senior notes due 2023, or Senior Notes, in 2017.

Loss on modification of debt duringwas $0.5 million for the three months ended September 30, 2016.2018 consisting of previously capitalized unamortized debt financing costs that were expensed as a result of voluntary debt repayments made during the quarter. The loss on modification of debt incurred during the three months ended September 30, 2017, totaling $3.1 million, was associated with the Incremental Borrowing to fund the acquisition of Symphony Health. The $3.1 million loss consists of fees associated with the transaction for the three months ended September 30, 2017.


Foreign currency (losses) gains,losses, net, changed by $14.0$11.0 million from gains of $1.2 million during the three months ended September 30, 2016 toforeign currency losses of $12.8 million during the three months ended September 30, 2017.2017 to foreign currency losses of $1.8 million during the three months ended September 30, 2018. Foreign exchange gains and losses are due to fluctuations in the U.S. dollar, gains or losses that arise in connection with the revaluation of short-term inter-company balances between our domestic and international subsidiaries, and gains or losses from foreign currency transactions, such as those resulting from the settlement of third-party accounts receivables and payables denominated in a currency other than the local currency of the entity making the payment. During the three months ended September 30, 2017, foreign currency losses were primarily due to the U.S. dollar weakening against the GBP, EUR, Canadian

dollar, or CAD, and the Russian ruble, or RUB by 3.1%, 3.3%, 4.2%, and 2.5%, respectively. During the three months ended September 30, 2016,

The decrease in foreign currency gains were primarily due the strengthening of the U.S. dollar against the GBP by 3.0%, partially offset by a weakening against the EUR by 1.3%,

Provision for income taxes decreased by $29.1 million from a provision of $10.8 millionlosses, net during the three months ended September 30, 20162018 is primarily due to the reclassification of certain intercompany balances that were deemed to be of a long-term investment nature.

Provision for income taxes increased by $38.5 million from a benefit of $18.2 million during the three months ended September 30, 2017. Our effective tax rate was 25.6% and (60.1)%2017 to a provision of $20.2 million during the three months ended September 30, 20162018. Our effective tax rate was (60.1)% and 91.8% during the three months ended September 30, 2017 and 2018, respectively. The decreaseincrease in the effective tax rate of 85.7%151.9% was primarily attributable to (i) the benefit realized fromU.S. inclusion of amounts related to the estimated tax deduction of stock awards in excesson GILTI, (ii) the U.S. inclusion of the amount recognized inestimated amounts related to BEAT, (iii) the financial statements perinclusion of the guidance under ASU No. 2016-09, “Compensation - Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting” and (ii)effect of the release of the valuation allowance againston the Company’s net federal net deferred tax assets as a resultduring the three months ended September 30, 2017, and (iv) the increase in fair value of the earn-out liability related to the stock acquisition of Symphony Health.Health, which is not deductible for tax but instead increases tax stock basis.

Consolidated Results of Operations for the Nine Months Ended September 30, 20172018 Compared to the Nine Months Ended September 30, 20162017
 Nine Months Ended September 30,   Change  
 2017 2016 Nine Months Ended September 30, 2017 $ Change 
Adoption of ASC 606 (1)
 Nine Months Ended September 30, 2018
(in thousands)            
Revenue            
Service revenue $1,379,572
 $1,166,410
 $1,379,572
 $328,259
 $
  
Reimbursement revenue 223,921
 172,915
Reimbursement revenue - out-of-pocket costs 223,921
 13,386
 
  
Total revenue 1,603,493
 1,339,325
 1,603,493
 341,645
 197,136
 $2,142,274
Operating expenses            
Direct costs 914,988
 758,333
Direct costs (exclusive of depreciation and amortization) 914,988
 219,521
 
 1,134,509
Reimbursable out-of-pocket costs 223,921
 172,915
 223,921
 13,386
 
 237,307
Reimbursable investigator fees 
 
 193,585
 193,585
Selling, general and administrative 229,770
 199,648
 229,770
 45,654
 
 275,424
Transaction-related costs 12,740
 31,785
 11,816
 20,893
 
 32,709
Depreciation and amortization 50,146
 52,246
 50,146
 34,017
 
 84,163
Loss on disposal of fixed assets 240
 290
 240
 (219) 
 21
Income from operations 171,688
 124,108
 172,612
 8,393
 3,551
 184,556
Interest expense, net (31,088) (42,525) (31,088) (12,772) 
 (43,860)
Loss on modification or extinguishment of debt (3,089) (21,485) (3,089) 2,635
 
 (454)
Foreign currency (losses) gains, net (35,004) 9,264
Other income (expense), net 724
 (85)
Foreign currency losses, net (35,004) 33,588
 
 (1,416)
Other expense, net (200) (1) 
 (201)
Income before income taxes and equity in income of unconsolidated joint ventures 103,231
 69,277
 103,231
 31,843
 3,551
 138,625
(Benefit from) provision for income taxes (165) 17,869
 (165) 54,137
 1,420
 55,392
Income before equity in income of unconsolidated joint ventures 103,396
 51,408
 103,396
 (22,294) 2,131
 83,233
Equity in income of unconsolidated joint ventures, net of tax 92
 2,742
 92
 26
 
 118
Net income 103,488
 54,150
 103,488
 (22,268) 2,131
 83,351
Net income attributable to noncontrolling interests (513) 
Net income attributable to noncontrolling interest (513) (385) 
 (898)
Net income attributable to PRA Health Sciences, Inc. $102,975
 $54,150
 $102,975
 $(22,653) $2,131
 $82,453
(1) See Note 1, Basis of Presentation, to our consolidated condensed financial statements for information about the adoption of ASC 606.(1) See Note 1, Basis of Presentation, to our consolidated condensed financial statements for information about the adoption of ASC 606.

Service revenueRevenue increased by $213.2$538.8 million, or 18.3%33.6%, from $1,166.4$1,603.5 million during the nine months ended September 30, 20162017 to $1,379.6$2,142.3 million during the nine months ended September 30, 2017. Service revenue2018. Revenue for the nine months ended September 30, 20172018 includes $197.1 million in reimbursable investigator fees and adjustments to revenue as a result of the adoption of ASC 606. Excluding the impact of the adoption of ASC 606 and reimbursement revenue, revenue increased $328.3 million. Revenue for the nine months ended September 30, 2018 benefited from an increase in billable hours, an increase in the effective rate of

hours billed on our studies, a favorable impact of $0.2$14.2 million from foreign currency exchange rate fluctuations, and an increase of $19.0$156.6 million due to the acquisition of Symphony Health, which was completed on September 6, 2017. The growth in service revenue wasand the increase in billable hours were due largely to the increase in our backlog as we entered the year, the type of services we are providing on our active studies, which was driven by the life cycles of projects that were active during the period, the growth in new business awards as a result of higher demand for our services across the industries we serve, and more effective sales efforts and the growth in the overall CRO market. New business awards arise when a client selects us to execute its trial. The number of awards can vary significantly from period to period and our studies have terms ranging from several months to several years. The increase in our effective rate of the hours billed on our studies is attributable to the contract pricing terms on our current mix of active studies and the mix of clients and services that we provide to those clients.
 

Direct costs increased by $156.7$219.5 million, or 20.7%24.0%, from $758.3 million during the nine months ended September 30, 2016 to $915.0 million during the nine months ended September 30, 2017. Direct costs as a percentage of service revenue increased from 65.0%2017 to $1,134.5 million during the nine months ended September 30, 2016 to 66.3% during the nine months ended September 30, 2017. The increase in direct costs as a percentage of revenue is primarily due to an increase in salaries2018. Salaries and related benefits of $140.0in our Clinical Research segment increased $98.4 million as we continue to hire billable staff to ensure appropriate staffing levels for our current studies and our future growth and includes an increase of $12.0 million due to the acquisition of Symphony Health, partially offset by a favorableunfavorable impact of $1.5$13.2 million from foreign currency exchange rate fluctuations. The addition of our Data Solutions segment resulted in $111.6 million of incremental direct costs during the nine months ended September 30, 2018. Excluding the impact of the adoption of ASC 606 and reimbursement revenue, direct costs as a percentage of revenue were 66.4% and 66.3% during the nine months ended September 30, 2018 and 2017, respectively.

Reimbursable out-of-pocket costs increased by $13.4 million from $223.9 million during the nine months ended September 30, 2017 to $237.3 million during the nine months ended September 30, 2018. Reimbursable investigator fees were $193.6 million during the nine months ended September 30, 2018. Reimbursable investigator fees were recorded on a net basis prior to our adoption of ASC 606, and therefore we did not record any reimbursable investigator fees during the nine months ended September 30, 2017. We believe that the fluctuations in reimbursable costs from period to period are not meaningful to our underlying performance over the full terms of the relevant contracts.
 
Selling, general and administrative expenses increased by $30.1$45.7 million or 15.1%19.9%, from $199.6 million during the nine months ended September 30, 2016 to $229.8 million during the nine months ended September 30, 2017.2017 to $275.4 million during the nine months ended September 30, 2018. The increase in selling, general and administrative expenses is primarily due to an increase in salaries and related benefits as we continue to hire staff to support our growing business and increased facility costs related to additional office space needed for our growth. Selling,Excluding the impact of the adoption of ASC 606 and reimbursement revenue, selling, general and administrative expenses as a percentage of service revenue decreased from 17.1% during the nine months ended September 30, 2016 towere 16.1% and 16.7% during the nine months ended September 30, 2017.2018 and 2017, respectively. The decrease in selling, general and administrative expenses as a percentage of service revenue is primarily related to our continued efforts to effectively leverage our selling and administrative functions asfunctions.

For the nine months ended September 30, 2018, we continueincurred $32.7 million in transaction-related costs. These costs consisted of $30.9 million for changes in the estimated fair value of contingent consideration related to grow revenue.
our recent acquisitions, $0.8 million of stock-based compensation expense related to the release of a portion of the transfer restrictions on vested options, $0.5 million of third-party fees associated with the amendment to our accounts receivable financing agreement and $0.5 million of expenses incurred in connection with our August 2018 secondary offering of common stock. For the nine months ended September 30, 2017, we incurred transaction-related costs of $12.7 million. These costs consist of $6.4 million of fees incurred in connection with the acquisition of Symphony Health, $5.3 million of stock-based compensation expense related to the release of a portion of the transfer restrictions on vested options, and $1.0 million of third-party costs incurred in connection with our August 2017 secondary offering. During the nine months ended September 30, 2016, we incurred transaction-related expensesoffering of $31.8 million. These costs consist of $4.9common stock, and a $0.9 million of stock-based compensation expense associated with the release of the transfer restrictions on a portion of shares issuable upon exercise of vested service-based options in connection with the announcement of our March and May 2016 secondary offerings. These costs also include $24.5 million of stock-based compensation expense relatedreduction to the vestingParallel 6 and release of the transfer restrictions of certain performance-based stock options. In addition, we incurred $2.4 million of third-party fees associated with the secondary offering and the closing of our accounts receivable financing agreement.Nextrials, Inc. estimated earn-out liability.

Depreciation and amortization expense decreasedincreased by $2.1$34.0 million, or 4.0%67.8%, from $52.2 million during the nine months ended September 30, 2016 to $50.1 million during the nine months ended September 30, 2017. Depreciation and amortization expense as a percentage of service revenue was 4.5%2017 to $84.2 million during the nine months ended September 30, 2016 and 3.6% during the nine months ended September 30, 2017.2018. The decreaseincrease in depreciation and amortization expense as a percentage of service revenue is primarily due to the continued amortization of our acquired intangibles, which are amortized on an accelerated basis.increased as a result of the Symphony Health acquisition in September 2017.

Interest expense, net, decreasedincreased by $11.4$12.8 million, or 26.9%41.1%, from $42.5 million during the nine months ended September 30, 2016 to $31.1 million during the nine months ended September 30, 2017. The cash tender of our Senior Notes and refinancing of our variable rate first lien term loans contributed2017 to a 1.4% decrease in the weighted average interest rate on our outstanding debt as compared to the nine months ended September 30, 2016; this decrease in weighted average interest rate resulted in a $10.3 million reduction in interest expense. The Incremental Borrowing during the nine months ended September 30, 2017 contributed to a $1.3 million increase in interest expense. Additionally, interest expense decreased by $2.0 million due to lower amortization of debt issuance costs, which was partially offset by an increase of $0.9 million related to the amortization of our terminated interest rate swaps and interest expense on our current interest rate swap.
Loss on modification or extinguishment of debt was $3.1$43.9 million during the nine months ended September 30, 2017 compared2018. Interest expense on our first lien term loans increased by $16.5 million, primarily due to $21.5the Incremental Borrowing to fund the Symphony Health acquisition, and an additional $1.2 million duringincrease in interest expense was attributable to additional borrowings under the accounts receivable financing agreement. This was offset by a decrease of $6.5 million associated with repayment of our Senior Notes in 2017.

Loss on extinguishment of debt was $0.5 million for the nine months ended September 30, 2016 .2018 consisting of previously capitalized unamortized debt financing costs that were expensed as a result of voluntary debt repayments made during the year. The loss on modification of debt during the nine months ended September 30, 2017, consists oftotaling $3.1 million, in

consisted of fees associated with the Incremental Borrowing under the 2016 Credit Facilities to fund the acquisition of Symphony Health. The loss on extinguishment of debt during the nine months ended September 30, 2016 was associated with our cash tender offer on our Senior Notes. The loss consists of the $17.4 million early tender premium, the write-off of $3.7 million of unamortized debt issuance costs, and $0.4 million of other costs associated with the transaction.

Foreign currency (losses) gains,losses, net, changed by $44.3decreased $33.6 million from gains of $9.3 million during the nine months ended September 30, 2016 to losses of $35.0 million during the nine months ended September 30, 2017.2017 to $1.4 million during the nine months ended September 30, 2018. Foreign exchange gains and losses are due to fluctuations in the U.S. dollar, gains or losses that arise in connection with the revaluation of short-term inter-company balances between our domestic and international subsidiaries, and gains or losses from foreign currency transactions, such as those resulting from the settlement of third-party accounts receivables and payables denominated in a currency other than the local currency of the entity making the payment. During the nine months ended September 30, 2017, foreign currency losses were primarily due to the U.S. dollar weakening against the GBP, EUR, CAD, and RUB, by 8.6%, 12.0%, 7.9% and 6.0%, respectively. During the nine months ended September 30, 2016,The decrease in foreign currency gains were primarily

due to the weakening of the GBP against foreign currencies, including the U.S dollar, following Brexit. The U.S. dollar strengthened against the GBP by 12.3%, partially offset by a weakening against the EUR, CAD, and RUB, by 2.8%, 5.8%, and 15.8%, respectively.
Provision for income taxes decreased by $18.0 million from a provision of $17.9 millionlosses, net during the nine months ended September 30, 20162018 is primarily due to the reclassification of certain intercompany balances that were deemed to be of a long-term investment nature.

Provision for income taxes increased by $55.6 million from a benefit of $0.2 million during the nine months ended September 30, 2017. Our effective tax rate was 25.8% and (0.2)%2017 to a provision of $55.4 million during the nine months ended September 30, 20162018. Our effective tax rate was (0.2)% and 40.0% during the nine months ended September 30, 2017 and 2018, respectively. The decreaseincrease in the effective tax rate of 26.0%40.2% was primarily attributable to (i) the benefit realized fromU.S. inclusion of amounts related to the estimated tax deduction of stock awards in excesson GILTI, (ii) the U.S. inclusion of the amount recognized inestimated amounts related to BEAT, (iii) the financial statements perinclusion of the guidance under ASU No. 2016-09, “Compensation - Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting” and (ii)effect of the release of the valuation allowance againston the Company’s net federal net deferred tax assets as a resultduring the nine months ended September 30, 2017, and (iv) the increase in fair value of the earn-out liability related to the stock acquisition of Symphony Health.Health which is not deductible for tax but instead increases tax stock basis.


Segment Results of Operations for the Three Months Ended September 30, 20172018 Compared to the Three Months Ended September 30, 20162017


Clinical Research

  Three Months Ended September 30,    
  2017 2016 Increase/(Decrease) % Change
(in thousands)        
Service Revenue 475,588
 399,841
 75,747
 18.9%
Gross profit 160,684
 139,931
 20,753
 14.8%
Gross profit % 33.8% 35.0% (1.2)%  
    Change  
  Three Months Ended September 30, 2017 $ Change Adoption of ASC 606 (See Note 1) Three Months Ended September 30, 2018
(in thousands)        
Service revenue $475,588
 $36,725
 $
  
Reimbursement revenue - out-of-pocket costs 87,459
 (9,875) 
  
Total revenue 563,047
 26,850
 67,082
 $656,979
Segment profit $160,684
 $21,592
 $1,949
 $184,225


Service revenueRevenue increased by $75.7$93.9 million, or 18.9%16.7%, from $399.8$563.0 million during the three months ended September 30, 20162017 to $475.6$657.0 million during the three months ended September 30, 2017. Service revenue2018. Revenue for the three months ended September 30, 20172018 includes $67.1 million in reimbursement revenue as a result of the adoption of ASC 606. Excluding the impact of the adoption of ASC 606 and reimbursement revenue, revenue increased by $36.7 million. Revenue for the three months ended September 30, 2018 benefited from an increase in billable hours and an increase in the effective rate of hours billed on our studies. The growth in revenue and the increase in billable hours were due largely to the increase in our backlog as we entered the year, the type of services we are providing on our active studies, which was driven by the life cycles of projects that were active during the period, the growth in new business awards as a result of higher demand for our services across the industries we serve, and more effective sales efforts and the growth in the overall CRO market. New business awards arise when a client selects us to execute its trial. The number of awards can vary significantly from period to period and our studies have terms ranging from several months to several years. The increase in our effective rate of the hours billed on our studies is attributable to the contract pricing terms on our current mix of active studies and the mix of clients and services that we provide to those clients.


GrossSegment profit increased by $20.8$23.5 million, or 14.8%14.7%, from $139.9 million during the three months ended September 30, 2016 to $160.7 million during the three months ended September 30, 2017 to $184.2 million during the three months ended September 30, 2018 primarily due to an increase in revenue. GrossExcluding the impact of the adoption of ASC 606 and reimbursement revenue, segment profit as a percentage of revenue decreasedincreased from 35.0%33.8% during the three months ended September 30, 20162017 to 33.8%35.6% for the same period in 2017. Gross profit decreased primarily due to an increase in salaries and related benefits of $51.3 million, as we continue to hire billable staff to ensure appropriate staffing levels for our current studies and our future growth.2018.


Data Solutions

  Three Months Ended September 30,    
  2017 2016 Increase/(Decrease) % Change
(in thousands)        
Service Revenue 18,962
 
 18,962
 n/a
Gross profit 7,001
 
 7,001
 n/a
Gross profit % 36.9% 
 n/a
  
    Change  
  Three Months Ended September 30, 2017 $ Change Adoption of ASC 606 (See Note 1) Three Months Ended September 30, 2018
(in thousands)        
Revenue $18,962
 $41,655
 $
 $60,617
Segment profit $7,001
 $12,231
 $
 $19,232


The Company acquired Symphony Health on September 6, 2017. The Company recognized $19.0$60.6 million of revenue and $12.0$41.4 million in direct costs during the period between September 6, 2017 andthree months ended September 30, 2017.2018. See Note 23, Business Combinations, to our consolidated condensed financial statements for information about the acquisition.


Segment Results of Operations for the Nine Months Ended September 30, 20172018 Compared to the Nine Months Ended September 30, 20162017


Clinical Research

  Nine Months Ended September 30,    
  2017 2016 Increase/(Decrease) % Change
(in thousands)        
Service Revenue 1,360,610
 1,166,410
 194,200
 16.6%
Gross profit 457,583
 408,077
 49,506
 12.1%
Gross profit % 33.6% 35.0% (1.4)%  
    Change  
  Nine Months Ended September 30, 2017 $ Change Adoption of ASC 606 (See Note 1) Nine Months Ended September 30, 2018
(in thousands)        
Service revenue $1,360,610
 $171,709
 $
  
Reimbursement revenue - out-of-pocket costs 223,921
 13,386
 
  
Total revenue 1,584,531
 185,095
 197,136
 $1,966,762
Segment profit $457,583
 $63,821
 $3,551
 $524,955


Service Revenue increased by $194.2$382.2 million, or 16.6%24.1%, from $1,166.4$1,584.5 million during the nine months ended September 30, 20162017 to $1,360.6$1,966.8 million during the threenine months ended September 30, 2017. Service revenue2018. Revenue for the nine months ended September 30, 20172018 includes $197.1 million in reimbursement revenue as a result of the adoption of ASC 606. Excluding the impact of the adoption of ASC 606 and reimbursement revenue, revenue increased by $171.7 million. Revenue for the nine months ended September 30, 2018 benefited from an increase in billable hours and an increase in the effective rate of hours billed on our studies. The growth in revenue and the increase in billable hours were due largely to the increase in our backlog as we entered the year, the type of services we are providing on our active studies, which was driven by the life cycles of projects that were active during the period, the growth in new business awards as a result of higher demand for our services across the industries we serve, and more effective sales efforts and the growth in the overall CRO market. New business awards arise when a client selects us to execute its trial. The number of awards can vary significantly from period to period and our studies have terms ranging from several months to several years. The increase in our effective rate of the hours billed on our studies is attributable to the contract pricing terms on our current mix of active studies and the mix of clients and services that we provide to those clients.


GrossSegment profit increased by $49.5$67.4 million, or 12.1%14.7%, from $408.1 million during the nine months ended September 30, 2016 to $457.6 million during the nine months ended September 30, 2017 to $525.0 million during the nine months ended September 30, 2018 primarily due to an increase in revenue. GrossExcluding the impact of the adoption of ASC 606 and reimbursement revenue, segment profit as a percentage of revenue decreasedincreased from 35.0%33.6% during the nine months ended September 30, 20162017 to 33.6%34.0% for the same period in 2017. Gross profit decreased primarily due to an increase in salaries and related benefits of $140.0 million, as we continue to hire billable staff to ensure appropriate staffing levels for our current studies and our future growth.2018.


Data Solutions

  Nine Months Ended September 30,    
  2017 2016 Increase/(Decrease) % Change
(in thousands)        
Service Revenue 18,962
 
 18,962
 n/a
Gross profit 7,001
 
 7,001
 n/a
Gross profit % 36.9% 
 n/a
  
    Change  
  Nine Months Ended September 30, 2017 $ Change Adoption of ASC 606 (See Note 1) Nine Months Ended September 30, 2018
(in thousands)        
Revenue $18,962
 $156,550
 $
 $175,512
Segment profit $7,001
 $44,917
 $
 $51,918


The Company acquired Symphony Health on September 6, 2017. The Company recognized $19.0$175.5 million of revenue and $12.0$123.6 million in direct costs during the period between September 6, 2017 andnine months ended September 30, 2017.2018. See Note 23, Business Combinations, to our consolidated condensed financial statements for information about the acquisition.


Seasonality
 
Although our business is not generally seasonal, we typically experience a slight decrease in our revenue growth rate during the fourth quarter due to holiday vacations and a similar decrease in new business awards in the first quarter due to our clients’ budgetary cycles and vacations during the year-end holiday period.

Liquidity and Capital Resources
 
We assess our liquidity in terms of our ability to generate cash to fund our operating, investing and financing activities. Our principal source of liquidity is operating cash flows. As of September 30, 2017,2018, we had approximately $193.6

$127.5 million of cash and cash equivalents of which $54.8$48.2 million was held by our foreign subsidiaries. Our expected primary cash needs on both a short and long-term basis are for capital expenditures, expansion of services, geographic expansion, debt repayments, acquisitions and other strategic transactions, and other general corporate purposes. We have historically funded our operations and growth, including acquisitions, with cash flow from operations, borrowings, and issuances of equity securities. We expect to continue expanding our operations through internal growth and strategic acquisitions and investments. We expect these activities will be funded from existing cash, cash flow from operations and, if necessary or appropriate, borrowings under our existing or future credit facilities. Our sources of liquidity could be affected by our dependence on a small number of industries and clients, compliance with regulations, international risks, and personal injury, environmental or other material litigation claims.
 
Cash Collections
 
Cash collections from accounts receivable were $1,780.9$2,133.0 million during the nine months ended September 30, 2017,2018, including $186.4$258.3 million of funds received from customers to pay independent physician investigators, or investigators, as compared to $1,513.6$1,780.9 million during the nine months ended September 30, 2016,2017, including $188.1$186.4 million of funds received from customers to pay investigators. The increase in cash collections during the nine months ended September 30, 20172018 is related to our increase in revenue, driven by an increase in new business awards and an increase in our backlog.
 
Discussion of Cash Flows
 
Cash Flow from Operating Activities
 
During the nine months ended September 30, 2017,2018, net cash provided by operations was $117.8$198.6 million, compared to $66.7$117.8 million for the same period of 2016.2017. Cash provided by operating activities increased over the prior year primarily due to increased cash flows from our operating performance, as well as a decrease in cash outflows from working capital.capital, offset by the portion of acquisition related earn-out payments being classified as an outflow from operating activities. The changes in working capital were driven by changes in our accounts receivable, unbilled services and advanced billings accounts, as a result of an improvement in our days sales outstanding as compared to the prior year.
 
Cash Flow from Investing Activities
 
Net cash used in investing activities was $39.7 million during the nine months ended September 30, 2018, compared to $599.6 million for the same period of 2017. There were no cash outflows from acquisitions during the nine months ended September 30, 2018 compared to $559.6 million of net cash outflows during the nine months ended September 30, 2017. Additionally, cash outflows from capital expenditures increased from $39.3 million during the nine months ended September 30, 2017 compared to $27.1 million for the same period of 2016. The net cash outflows from acquisitions increased from $4.3 million during the nine months ended September 30, 2016 to $559.6$40.1 million during the same period in 2017.  Additionally, capital expenditures increased by $13.6 million compared to the prior year, which is partially offset by $3.7 million received from the sale of our ownership stake in the WuXiPRA joint venture during the nine months ended September 30, 2016.2018. 
 
Cash Flow from Financing Activities
 
Net cash provided byused in financing activities was $523.7$221.6 million during the nine months ended September 30, 20172018 compared to net cash usedprovided by financing activities of $30.7$523.7 million for the same period of 2016. We borrowed $20.0 million2017. During the nine months ended September 30, 2018 our long-term debt balance, including borrowings under our accounts receivable financing agreement and $550.0revolving line of credit, decreased by $155.9 million due to payments on our debt compared to a $523.1 million increase in Incremental Borrowings under our 2016 Term Loandebt during the nine months ended September 30, 2017 compared to $120.0 million in borrowings under our accounts receivable2017. Cash outflows from financing agreementactivities during the same period in the prior year. During the nine months ended September 30, 2017, we repaid $26.9 million principal amount2018 also increased due to the portion of our term loan, $20.0 million principal on our accounts receivableacquisition related earn-out payments being classified as a financing agreement, and $5.5 million in debt issuance costs compared to $133.6 million aggregate principal amount of our Senior Notes and $17.8 million related to debt prepayment and debt extinguishment costs that were paid as part of the cash tender offer in the prior year. During the nine months ended September 30, 2017, we received $6.5 million in proceeds from stock option exercises compared to $0.6 million for the same period of 2016.activity.

 
Indebtedness
 
As of September 30, 2017,2018, we had $1,359.6$1,196.5 million of total indebtedness. Additionally, our senior secured credit agreement2016 Revolver provides for a $125.0$225.0 million revolving credit facilities. There were no amounts drawn on this revolving credit facilities as of potential borrowings. At September 30, 2017. In addition, at September 30, 2017,2018, we had $4.5no outstanding borrowings under our 2016 Revolver and had $5.1 million in letters of credit outstanding, which are secured by the revolving credit facilities.2016 Revolver. We do not expect to pay dividends in the foreseeable future. Our long-term debt arrangements contain usual and customary restrictive covenants, and, as of September 30, 2017,2018, we were in compliance with these covenants.

Incremental Borrowings under the 2016 Credit Facilities


On September 6, 2017, we borrowed $550.0 million under the 2016 Credit Facilities. The proceeds were primarily used to fund the acquisition of Symphony Health. As of September 30, 2017, the weighted average interest rate on the first lien term loan was 3.45%.

The variable interest rate on the Incremental Borrowing is a rate equal to the London Interbank Offered Rate, or LIBOR, or the adjusted base rate, or ABR rate, at the election of the Company, plus a margin based on the ratio of total indebtedness to EBITDA and ranges from 1.00% to 2.00%, in the case of LIBOR rate loans, and 0.00% to 1.00%, in the case of ABR rate loans.There were no other changes to the 2016 Credit Facilities as a result of the Incremental Borrowing.


See Note 78 to our consolidated condensed financial statements included in this report, and “Management’s Discussion and Analysis of Financial Condition and Results of Operations— Liquidity and Capital Resources” and Note 9 to our audited consolidated financial statements, each included in our Annual Report on Form 10-K for the fiscal year ended December 31, 2016,2017, for additional details regarding our credit arrangements.
 
Contractual Obligations and Commercial Commitments
 
In September 2017,May 2018, we amended our receivable financing agreement to increase the Company borrowed an additional $550.0agreement's borrowing capacity to $200.0 million and extend the termination date from March 22, 2019 to May 31, 2021. Additional amounts drawn down under our receivable financing agreement were used to repay amounts outstanding under the 2016 Credit Facilities, orrevolving credit facilities. During the Incremental Borrowing. See Note 7 toyear, we have also made $92.8 million in additional voluntary principal payments on our consolidated condensed financial statements for information about the Incremental Borrowing.first lien term loan. As a result of these changes, our long-term debt obligations as of September 30, 20172018 are updated below. As part of the Symphony Health acquisition, the Company recognized a contingent consideration for the earn-out. As a result of this change an update of our contingent consideration as of September 30, 2017 is included below.



Payments Due by Period
 Payments Due by PeriodRemaining 2018 (3 Months) 2019 to 2020 2021 to 2022 Thereafter Total
 Remaining 2017 (3 Months) 2018 to 2019 2020 to 2021 Thereafter Total(in thousands)
Principal payments on long-term debt (1) $11,250
 $241,250
 $1,015,625
 $91,441
 $1,359,566
$
 $
 $1,196,533
 $
 $1,196,533
Interest payments on long-term debt (1) 11,113
 104,283
 92,720
 15,203
 223,319
11,429
 90,824
 39,355
 
 141,608
Contingent consideration on acquisition (2) 67,789
 50,775
 
 
 118,564
Total $90,152
 $396,308
 $1,108,345
 $106,644
 $1,701,449
$11,429
 $90,824
 $1,235,888
 $
 $1,338,141


(1) Principal payments are based on the terms contained in our agreements. Interest payments are based on the interest rate in effect on September 30, 2017.2018.

(2) Represents contingent payments associated with our acquisitions. These amounts are remeasured at fair value every reporting period with the change in fair value recorded in Other income (expense), net (seeSee Note 28 to our consolidated condensed financial statements). The actual amounts ultimately paid out may be different depending on the level of achievement of certain earnings milestones.

statements for more information. Other than the items included above, there have been no material changes, outside of the ordinary course of business, to our contractual obligations as previously disclosed in our Annual Report on Form 10-K for fiscal year ended December 31, 2016.2017.

Critical Accounting Policies and Estimates
 
ThereOther than the accounting policy changes noted in Note 2, Significant Accounting Policies Update, of the consolidated condensed financial statements in this Quarterly Report on Form 10-Q, there have been no material changes to our critical accounting policies as previously disclosed in our Annual Report on Form 10-K for the fiscal year ended December 31, 2016.2017.
 
Disclosure Regarding Forward-Looking Statements
 
This Quarterly Report on Form 10-Q contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. In addition to historical consolidated condensed financial information, this Quarterly Report on Form 10-Q contains forward-looking statements that reflect, among other things, our current expectations and anticipated results of operations, all of which are subject to known and unknown risks, uncertainties and other factors that may cause our actual results, performance or achievements, market trends, or industry results to differ materially from those expressed or implied by such forward-looking statements. For this purpose, any statements contained herein that are not statements of historical fact may constitute forward-looking statements. Without limiting the foregoing, words such as “anticipates,”

“believes, “believes,” “estimates,” “expects,” “intends,” “may,” “plans,” “projects,” “should,” “targets,” “will” and the negative thereof and similar words and expressions are intended to identify forward-looking statements. Unless legally required, we assume no obligation to update any such forward-looking information to reflect actual results or changes in the factors affecting such forward-looking information.

 
We caution you that actual results may differ materially from our expectations due to a number of factors, including, that most of our contracts may be terminated on short notice, and we may be unable to maintain large customer contracts or to enter into new contracts; the historical indications of the relationship of our backlog to revenues may not be indicative of their future relationship; the market for our services may not grow as we expect; we may underprice our contracts, overrun our cost estimates or fail to receive approval or experience delays in documenting change orders; the historical indications of the relationship of our backlog to revenues may not be indicative of their future relationship; if we are unable to achieve operating efficiencies or grow revenues faster than expenses, operating margins will be adversely affected; if we are unable to attract investigators and patients for our clinical trials, our clinical development business may suffer; we could be subject to employment liability with our embedded and functional outsourcing solutions as we place employees at the physical workplaces of our clients; we may be unable to recruit experienced personnel; changes in accounting standards may adversely affect our financial statements; our effective income tax rate may fluctuate, which may adversely affect our operations, earnings, and earnings per share; we may be unable to maintain information systems or effectively update them; customer or therapeutic concentration could harm our business; our business is subject to risks associated with international operations, including economic, political and other risks, such as compliance with a myriad of laws and regulations, complications from conducting clinical trials in multiple countries simultaneously and changes in exchange rates; due to the global nature of our business, we are subjectmay be exposed to a number of additional risks associated with doing business outside ofliabilities under the United States, including foreign currency exchange fluctuationsForeign Corrupt Practices Act and restrictive regulations, as well as the risks and uncertainties associated with the United Kingdom’s expected withdrawal from the European Union; government regulators or customers may limit the scope of prescription or withdraw products from the market, and government regulators may impose new regulations affecting the biopharmaceutical industry and our business;other similar non-U.S. laws; we may be unable to successfully develop and market new services or enter new markets; our failure to perform services in accordance with contractual requirements, regulatory standards and ethical considerations may subject us to significant costs or liability, damage our reputation and cause us to lose existing business or not receive new business; government regulators or customers may limit the scope of prescription or withdraw products from the market, and government regulators may impose new regulations affecting the biopharmaceutical industry and our business; our services are related to treatment of human patients, and we could face liability if a patient is harmed; our insurance may not cover all of our indemnification obligations and other liabilities; we are subject to a number of additional risks associated with doing business outside of the United States, including foreign currency exchange fluctuations and restrictive regulations, as well as the risks and uncertainties associated with the United Kingdom’s expected withdrawal from the European Union; if we do not keep pace with rapid technological changes, our services may become less competitive or obsolete; our relationships with existing or potential clients who are in competition with each other may adversely impact the degree to which other clients or potential clients use our services; we may be unable to successfully identify, acquire and integrate businesses, services and technologies; our balance sheet includes a significant amount of goodwill and intangible assets and our results of operations may be adversely affected if we fail to realize the Company'sfull value of our goodwill and intangible assets; our ability to utilize our net operating loss carryforwards and certain other tax attributes may be limited; if we are unable to manage our growth effectively our business could be harmed; our reliance on third parties for data, products, services and intellectual property licenses; the biopharmaceutical services industry is fragmented and highly competitive; biopharmaceutical industry outsourcing trends could change and adversely affect our operations and growth rate; current and proposed laws and regulations regarding the protection of personal data could result in increased risks of liability or increased cost or could limit our service offerings; patent and other intellectual property litigation; circumstances beyond our control could cause industry-wide reduction in demand for our services; we have substantial indebtedness and may incur additional indebtedness in the future, which could adversely affect our financial condition; and other factors that are set forth in our filings with the Securities and Exchange Commission, including our most recent Annual Report on Form 10-K filed on February 23, 2017 and this Quarterly Report on Form 10-Q.22, 2018.
 
Website and Social Media Disclosure
 
We use our website (www.prahs.com) and our corporate Twitter account (@PRAHSciences) as channelsa channel of distribution of company information. The information we post through these channelsthis channel may be deemed material. Accordingly, investors should monitor these channels,this channel, in addition to following our press releases, Securities and Exchange Commission, or SEC, filings and public conference calls and webcasts. The contents of our website and social media channels are not, however, a part of this report.


Item 3. Quantitative and Qualitative Disclosures About Market Risk
 
There have been no material changes to our quantitative and qualitative disclosures about market risk as compared to the quantitative and qualitative disclosures about market risk described in our Annual Report on Form 10-K for the fiscal year ended December 31, 2016.2017.


Item 4. Controls and Procedures
 
As of September 30, 2017,2018, we carried out an evaluation under the supervision and with the participation of our management, including the principal executive officer and principal financial officer, of the effectiveness of the design and operation of our disclosure controls and procedures. Regulations under the Securities Exchange Act of 1934, as amended (the "Exchange Act") require public companies, including us, to maintain “disclosure controls and procedures,” which are defined in Rule 13a-15(e) and Rule 15d-15(e) of the Exchange Act to mean a company’s controls and other procedures that are designed to ensure that information required to be disclosed in reports that it files or submits under the Exchange Act is

recorded, processed, summarized, and reported within the time periods specified in the SEC’s rules and forms and that such information is accumulated and communicated to management, including our principal executive officer and principal financial officer, or persons performing similar functions, as appropriate to allow timely decisions regarding required or necessary disclosures. There are inherent limitations to the effectiveness of any system of disclosure controls and procedures, including the possibility of human error and the circumvention or overriding of the controls and procedures. Accordingly, even effective disclosure controls and procedures can only provide reasonable assurance of achieving their control objectives. In accordance with the SEC’s published guidance, the internal control over financial reporting of Symphony Health Solutions Corporation, or Symphony Health, which was acquired on September 6, 2017 and the Takeda PRA Development Center KK joint venture, or the TDC joint venture, formed between us and Takeda Pharmaceutical Company Ltd. on June 1, 2017, were excluded from our evaluation of the effectiveness of our disclosure controls and

procedures as of September 30, 2017. Symphony Health and the TDC joint venture represented 25% and 1%, respectively, of our consolidated total assets, 4% and 1%, respectively, of our consolidated service revenue and 2% and 1%, respectively, of our consolidated net income as of and for the quarter ended September 30, 2017. Based upon our evaluation, our principal executive officer and principal financial officer concluded that our disclosure controls and procedures were effective to accomplish their objective at a reasonable assurance level.
 
There were no changes in our internal control over financial reporting (as that term is defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act) during the quarter ended September 30, 20172018 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting. We are in the process of reviewing themay make appropriate changes to our internal control structureover the financial reporting of Symphony Health, and the TDC joint venture, if necessary, will make appropriate changeswhich was acquired on September 6, 2017, as we integrate Symphony Health and the TDC joint venture into our overall internal control over financial reporting process. See discussion of this acquisition in Note 3, Business Combinations, of the Notes to the Consolidated Condensed Financial Statements contained in Item 1 of this Quarterly Report on Form 10-Q.



PART II—OTHER INFORMATION



Item 1. Legal Proceedings
 
The information required with respect to this item can be found under “Commitments and Contingencies” in Note 1112 to our consolidated condensed financial statements included elsewhere in this Form 10-Q and is incorporated by reference into this Item 1.

 
Item 1A. Risk Factors
 
For a discussion of our potential risks and uncertainties, see the information under the heading “Risk Factors” in our Annual Report on Form 10-K for the fiscal year ended December 31, 2016,2017, or Annual Report. There have been no significant changes from the risk factors previously disclosed in our Annual Report, except as noted below.Report.

We rely on third parties to provide certain data and other information to us. Our suppliers or providers might increase our cost to obtain, restrict our use of or refuse to license data, which could lead to our inability to access certain data or provide certain services and, as a result, materially and adversely affect our operating results and financial condition.

Our services are derived from, or include, the use of data we collect from third parties. We have several data suppliers that provide us a broad and diverse scope of information that we collect, use in our business and sell.

We generally enter into long-term contractual arrangements with many of our data suppliers. At the time we enter into a new data supply contract or renew an existing contract, suppliers may increase our cost to obtain and use the data provided by such supplier, increase restrictions on our ability to use or sell such data, or altogether refuse to license the data to us. Also, our data suppliers may fail to meet or adhere to our quality control standards or fail to deliver the data to us. Although no single supplier is material to our business, if suppliers that collectively provide a significant amount of the data we receive or use were to increase our costs to obtain or use such data, further restrict our access to or use of such data, fail to meet or adhere to our quality control standards, refuse to provide or fail to deliver data to us, our ability to provide data-dependent services to our clients may be adversely impacted, which could have a material adverse effect on our business, results of operations, financial condition or cash flow.

We rely on third parties for important products, services and licenses to certain technology and intellectual property rights and we might not be able to continue to obtain such products, services and licenses.
We depend on certain third parties to provide us with products and services critical to our business. Such services include, among others, suppliers of drugs for patients participating in trials, suppliers of kits for use in our laboratories, suppliers of reagents for use in our testing equipment and providers of maintenance services for our equipment. The failure of any of these third parties to adequately provide the required products or services, or to do so in compliance with applicable regulatory requirements, could have a material adverse effect on our business.

Some of our services rely on intellectual property, technology and other similar property owned and/or controlled by third parties. Our licenses to this property and technology could terminate or expire and we might not be able to replace these licenses in a timely manner. Also, we might not be able to renew these licenses on similar terms and conditions. Failure to renew these licenses, or renewals of these licenses on less advantageous terms, could have a material adverse effect on our business, results of operations, financial condition or cash flow.


Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
 
On July 5, 2017, we issued an aggregate of 4,998 common shares at a price of $75.04 per share as remaining held back consideration for the purchase of the assets of Value Health Solutions Inc. The offer and sale of the common shares was made in reliance upon the exemption from registration under the Securities Act of 1933, as amended, afforded by Section 4(a)(2) thereof, on the basis that it did not involve any public offering.Not applicable.


Item 3. Defaults Upon Senior Securities
 
Not applicable.
 

Item 4. Mine Safety Disclosures
 
Not applicable. 


Item 5. Other Information
 
Not applicable.
 

Item 6. Exhibits
 
Exhibit  
Number    Description of Exhibit
   
 
   
 
   
 
   
 
   
 
   
 
   
 
   
 
   
101 The following financial information from PRA Health Sciences, Inc.’s Quarterly Report on Form 10-Q for the quarter ended September 30, 20172018 formatted in XBRL: (i) Consolidated Condensed Balance Sheets as of September 30, 20172018 and December 31, 2016,2017, (ii) Consolidated Condensed Statements of Operations for the three and nine months ended September 30,30. 2018 and 2017, and 2016, (iii) Consolidated Condensed Statements of Comprehensive (Loss) Income for the three and nine months ended September 30, 20172018 and 2016,2017, (iv) Consolidated Condensed Statements of Cash Flows for the nine months ended September 30, 20172018 and 2016,2017, and (v) Notes to Consolidated Condensed Financial Statements.


     
* Filed herewith
**This document has been identified as a management contract or compensatory plan or arrangement.



SIGNATURES
 
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
 
 PRA HEALTH SCIENCES, INC.
  
 /s/ Linda BaddourMichael J. Bonello
 Linda BaddourMichael J. Bonello
 Executive Vice President and Chief Financial Officer
 (Authorized Signatory)
  
Date: October 26, 2017November 6, 2018 




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