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Option Care Health

opch · NASDAQ Healthcare
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Ticker opch
Exchange NASDAQ
Sector Healthcare
Industry Medical - Care Facilities
Employees 1001-5000
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FY2019 Annual Report · Option Care Health
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20OCH00053 Annual report cover_MARKS.pdf

The numbers tell the story

2019 ANNUAL REPORT

Providing 
extraordinary care 
that changes lives

2,900 1+  

multidisciplinary clinicians

100 1+ 

125 1+ 

infusion full-service pharmacies

Ambulatory Infusion Suites 

Covering 

 98%1 

of all insured lives

MARKET LEADERS  

in providing specialty infusion therapies in open and limited 

distribution networks

More than 

220,000 2 

patients cared for annually

Licensed to treat patients in  

ALL 50 1 

states

95% 3 

overall patient satisfaction

References: 1. Data on file, Option Care Health. 2. January-December 2019, total Option Care Health unique patients serviced.3. January-December 2019 patient satisfaction data. 

Survey of 9,878 patients.

3000 Lakeside Drive  |  Suite 300N  |  Bannockburn, IL 60015   

59 Maiden Lane  |  New York, NY 10038   

Investor Relations:

OPTION CARE HEALTH 

Corporate Office

Phone: 866.827.8203

PRIMARY IR CONTACT

Mike Shapiro, Chief Financial Officer  

Phone: 312.940.2538 

Email: investor.relations@optioncare.com

TRANSFER AGENT

American Stock Transfer & Trust Co.

Phone: 718.921.8124

ACCOUNTANTS

KPMG LLP

Phone: 312.665.1000

200 E. Randolph Street  |  Suite 5500  |  Chicago, IL 60601   

optioncarehealth.com

Option Care Health locations are ACHC accredited. HHA numbers are available to view at optioncarehealth.com.

©2020 Option Care Health, Inc. All rights reserved. 20OCH00053

Trim Size = 16.5 x 10.75 in     Page 1 of 2

March 18, 2020     01:59:59

20OCH00053 Annual report cover_MARKS.pdf

Clinical excellence 
infused with 
compassionate care. 

Option Care Health is the largest independent provider of infusion therapy in the nation. For over 40 years, we’ve delivered cutting-
edge infusion medications, nursing support and seamless transitional care for patients of all ages in their homes and at conveniently 

located Ambulatory Infusion Suites (AIS). 

Through our long-term partnerships with payers, biopharmaceutical manufacturers, healthcare systems, physicians and other referral 

sources, we deliver advanced intravenous treatments available for a wide range of serious, chronic conditions. But the relationships that 

truly drive our commitment to clinical excellence are those between our team of more than 2,900¹ clinicians and the patients they serve. 

Dear Shareholders,

Following the merger of Option Care and BioScrip last August, we began an exciting new chapter as Option Care Health, now the nation’s 
largest independent provider of home and alternate site infusion services.  Since then, there has been tremendous effort around integrating 
two great teams and building a platform for sustainable growth.

In just six months, we launched our new name and brand, initiated a comprehensive integration plan, completed our financial consolidation 
and reporting, and began to leverage our strength and national scale.  With a strong foundation in place, I have tremendous confidence in 
our ability to grow, and at the same time, realize additional synergies.

From a cultural standpoint, it has been truly amazing to see our people rapidly transform into one team focused on a shared Purpose to 
provide extraordinary care that changes lives. We recently introduced our new Purpose statement along with a new Mission, Values and 
Leader Behaviors to ensure our team members feel a part of an organization that has a profound purpose – and a clear path forward.  
We have already seen that building a strong sense of community and purpose not only helps us perform better together, it enables us to 
drive results.

Looking ahead, we are building and investing in our future as we complete our integration. We are investing in an Alternate Infusion Site/
Infusion Center strategy and making renovations to our existing facilities. We are also enhancing and deploying technologies and tools that 
will help each of our team members provide an exceptional customer experience for patients, providers and payers. 

Many things have changed as we’ve transformed into Option Care Health. However, one thing 
that remains steadfast is our focus on providing extraordinary patient care. It is at the heart of 
everything we do and part of our DNA. With nearly 6,000 teammates, including 2,900 clinicians, 
we work compassionately each day to elevate standards of care for patients with acute and 
chronic conditions. 

As the industry landscape continues to change, we are confident we are on the right side of the 
transformation happening in healthcare. As Option Care Health we have the ability to unleash our 
full potential to deliver high-quality care in a lower cost setting where patients want to be treated 
on a national scale. Our deep clinical expertise, broad therapy portfolio and enhanced financial 
profile will allow us to deliver superior care and outcomes, and most importantly, hope for patients 
and their families. 

I encourage you to keep an eye on Option Care Health. The best is yet to come.

Best regards, 

John C. Rademacher 
President and Chief Executive Officer

Trim Size = 16.5 x 10.75 in     Page 2 of 2

At Option Care Health, I’ve had the same caring, professional nurse  

throughout my treatments. I would highly recommend Option Care Health if your 

priorities are cost, schedule and location. Today my symptoms are much improved 

and so is my quality of life.

Derek, Option Care Health patient, Crohn’s disease

March 18, 2020     01:59:59

 
 
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-K

(Mark One)

ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the fiscal year ended December 31, 2019

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: 001-11993

OPTION CARE HEALTH, INC.

(Exact name of registrant as specified in its charter)

Delaware

(State of incorporation)

3000 Lakeside Dr. Suite 300N, Bannockburn, IL

(Address of principal executive offices)

05-0489664

(I.R.S. Employer Identification No.)
60015

(Zip Code)

Registrant’s telephone number, including area code:
312-940-2443
Securities registered pursuant to Section 12(b) of the Act:

Title of each class
Common Stock, $0.0001 par value per share

Trading Symbol
OPCH

Name of each exchange on which registered
Nasdaq Global Select Market

Securities registered pursuant to section 12(g) of the Act: None

Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act.  Yes 

     No 

Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act.  Yes 

     No 

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 
during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing 
requirements for the past 90 days.  Yes 

     No 

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of 
Regulation S-T (§ 232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such 
files).  Yes 

 No 

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, or a non-accelerated filer, a smaller reporting company, or 
an emerging growth company. See definition of “large accelerated filer”, “accelerated filer”, “smaller reporting company” and “emerging growth company” 
in Rule 12b-2 of the Exchange Act.

Large accelerated filer 

     Accelerated filer 

     Non-accelerated filer 

      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 

The aggregate market value of the registrant’s Common Stock held by non-affiliates of the registrant as of June 30, 2019, the last business day of the 
registrant’s most recently completed second fiscal quarter, was approximately $337,013,747 based on the closing price of the registrant’s Common Stock 
on the Nasdaq Global Select Market on such date.

As of March 3, 2020, there were 176,703,983 shares of the registrant’s Common Stock outstanding.

DOCUMENTS INCORPORATED BY REFERENCE
Portions of the registrant’s definitive proxy statement for its 2020 Annual Meeting of Stockholders to be filed with the Securities and Exchange Commission 
(the “SEC”) within 120 days after the close of the registrant’s fiscal year are incorporated by reference into Part III of this Annual Report on Form 10-K.

TABLE OF CONTENTS

Business

Risk Factors

Unresolved Staff Comments

Properties

Legal Proceedings

Mine Safety Disclosures

PART I

PART II

Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity 
Securities

Selected Financial Data

Management’s Discussion and Analysis of Financial Condition and Results of Operations

Item 1.

Item 1A.

Item 1B.

Item 2.

Item 3.

Item 4.

Item 5.

Item 6.

Item 7.

Item 7A.

Quantitative and Qualitative Disclosures About Market Risk

Item 8.

Item 9.

Item 9A.

Item 9B.

Item 10.

Item 11.

Item 12.

Item 13.

Item 14.

Financial Statements and Supplementary Data

Changes in and Disagreements with Accountants on Accounting and Financial Disclosure

Controls and Procedures

Other Information

PART III

Directors, Executive Officers and Corporate Governance

Executive Compensation
Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters

Certain Relationships and Related Transactions, and Director Independence

Principal Accounting Fees and Services

Item 15.

Item 16.

SIGNATURES

Exhibits, Financial Statement Schedules

Form 10-K Summary

PART IV

Page
Number

4

9

21

22

22

22

23

25

26

39

40

75

75

78

78

78

78

78

78

79

81

81

2

 
 
 
 
Forward-Looking Statements

This Annual Report on Form 10-K (“Annual Report”) contains statements not purely historical and which may be 
considered forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended (the 
“Securities Act”), and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act’), including 
statements regarding our expectations, beliefs, future plans and strategies, anticipated events or trends concerning matters that 
are not historical facts or that necessarily depend upon future events. In some cases, you can identify forward-looking 
statements by terms such as “may,” “will,” “should,” “could,” “would,” “expect,” “plan,” “anticipate,” “believe,” “estimate,” 
“project,” “predict,” “potential,” and similar expressions. This Annual Report contains, among others, forward-looking 
statements based upon current expectations that involve numerous risks and uncertainties, including those described in Item 1A 
“Risk Factors”. 

Investors are cautioned that any such forward-looking statements are not guarantees of future performance, involve risks 

and uncertainties and that actual results may differ materially from those possible results discussed in the forward-looking 
statements as a result of various factors.

Do not place undue reliance on such forward-looking statements as they speak only as of the date they are made. Except as 

required by law, Option Care Health, Inc. assumes no obligation to publicly update or revise any forward-looking statement 
even if experience or future changes make it clear that any projected results expressed or implied therein will not be realized.

3

Item 1.  

Business

Overview

PART I

Option Care Health, Inc. (“Option Care Health”, “we”, “us”, “our”, or the “Company”) is the largest independent provider 

of home and alternate site infusion services through its national network of 158 locations in 45 states. Option Care Health 
draws on nearly 40 years of clinical care experience to offer patient-centered, cost-effective infusion therapy. Option Care 
Health’s infusion services include the clinical management of infusion therapy, nursing support and care coordination. Option 
Care Health’s multidisciplinary team of approximately 2,900 clinicians, including pharmacists, pharmacy technicians, nurses 
and dietitians, are able to provide infusion service coverage for nearly all patients across the United States needing treatment 
for complex and chronic medical conditions.

HC Group Holdings II, Inc. (“HC II”) was incorporated under the laws of the State of Delaware on January 7, 2015, with 

its sole shareholder being HC Group Holdings I, LLC. (“HC I”). On April 7, 2015, HC I and HC II collectively acquired 
Walgreens Infusion Services, Inc. and its subsidiaries from Walgreen Co., and the business was rebranded as Option Care, Inc. 
(“Option Care”).

On March 14, 2019, HC I and HC II entered into a definitive agreement (the “Merger Agreement”) to merge with and into 

a wholly-owned subsidiary of BioScrip, Inc. (“BioScrip”), a national provider of infusion and home care management 
solutions, along with certain other subsidiaries of BioScrip and HC II. The merger contemplated by the Merger Agreement (the 
“Merger”) was completed on August 6, 2019 (the “Merger Date”). The Merger was accounted for as a reverse merger under the 
acquisition method of accounting for business combinations with Option Care being considered the accounting acquirer and 
BioScrip being considered the legal acquirer. Following the close of the transaction, BioScrip was rebranded as Option Care 
Health, Inc.

Option Care Health contracts with managed care organizations, third-party payers, hospitals, physicians, and other referral 

sources to provide pharmaceuticals and complex compounded solutions to patients for intravenous delivery in the patients’ 
homes or other nonhospital settings. The Company operates in one segment, infusion services.

The Company’s operating model enables it to provide favorable outcomes to its stakeholders as follows:

•  Patients.   The Company improves patients’ quality of life by allowing them to receive infusion therapy at home or at 
one of its ambulatory infusion suites. In addition, the Company helps manage patients’ conditions through counseling 
and education regarding their treatment and by providing ongoing monitoring to encourage patient compliance with 
the prescribed therapy. The Company also provides services to help patients receive reimbursement benefits.

•  Payers.   The Company provides payers with a comprehensive approach to meeting their pharmacy service needs and 

providing a cost-effective solution. The Company’s provision of infusion pharmacy services in the patient’s home or at 
one of its local ambulatory infusion suites offers a lower cost alternative to providing these therapies in a hospital 
setting. The Company also provides payers with utilization and outcome data to evaluate therapy effectiveness.

•  Physicians.   The Company provides physicians with timely patient clinical support by providing care management 

related to their patients’ pharmacy needs and improving compliance with therapy protocols. The Company eliminates 
the need for physicians to carry inventories of high cost prescriptions by distributing the medications directly to 
patients’ homes. The Company either bills the payer directly or assists the patient in the submission of claims to the 
payer.

•  Pharmaceutical Manufacturers.   The Company collaborates with pharmaceutical manufacturers to provide a broad 
distribution channel for their existing pharmaceuticals and their new product launches. The Company implements 
patient monitoring programs that encourage compliance with the prescribed therapy. The Company also provides 
valuable clinical information in the form of outcomes and compliance data to manufacturers to aid in their evaluation 
of the efficacy of their products.

Quality

Quality is at the core of the Company’s mission as it strives to deliver quality healthcare, leading to favorable outcomes 
and more cost-effective care. The Company offers comprehensive services that align with specific healthcare provider needs 
and has demonstrated success in improving outcomes across a broad range of therapies through improved clinical-reported 
patient adherence rates and decreased rates of un-planned hospital re-admissions.

4

The Company’s commitment to continuous quality improvement to provide optimal outcomes for its patients is evidenced 
by its national accreditations, including accreditations from Accreditation Commission for Health Care (“ACHC”), Pharmacy 
Compounding Accreditation Board (“PCAB”), American Society of Health-System Pharmacists (“ASHP”) and Utilization 
Review Accreditation Commission (“URAC”).

ACHC accreditation is awarded to healthcare organizations that meet regulatory requirements and accreditation standards, 

and PCAB accreditation offers the most comprehensive compliance solution in the industry based on more than 40 sterile 
compounding standards in the U.S. Pharmacopeia Pharmaceutical Compounding - Sterile Preparations Standards (“USP 797”).

Services

The Company is the largest independent provider of home and alternate site infusion services. The Company’s services are 

most typically provided in the patient’s home, but may also be provided at clinics, the physician’s office or at one of its 
ambulatory infusion suites. The Company provides a broad therapy portfolio through its network of 115 full service pharmacies 
and 43 stand-alone ambulatory infusion suites. The Company’s home infusion services include medication and supplies for 
administration and use at home or within one of its ambulatory infusion suites, consultation and education regarding the 
patient’s condition and the prescribed medication nursing support, clinical monitoring and assistance in monitoring potential 
side effects, and assistance in obtaining reimbursement. The Company administers a wide variety of therapies and services, 
including the following:

• 

Immunoglobulin Infusion.   The Company offers industry-leading expertise, access, and support in immunoglobulin 
(“IG”) infusion therapy designed to treat immune deficiencies. Immune deficiencies are disorders that reduce the 
patient’s ability to identify and destroy substances that do not belong in the human body and are characterized by 
reduced levels of antibodies. Intravenous IG infusions are concentrated antibodies that have been purified from large 
numbers of human blood donors.

•  Anti-Infectives Infusion.   The Company provides comprehensive home infusion services to combat serious infections 

in patients of all ages. The Company’s anti-infective therapy and services help avoid hospitalizations for many 
infections that can be safely treated at home.

•  Nutrition Support Infusion.   The Company delivers comprehensive nutrition support across pediatric, adult, and 
geriatric patients. The Company’s expert team provides home parenteral nutrition and enteral nutrition support for 
numerous acute and chronic conditions negatively affecting nutritional status, such as stroke, cancer, and 
gastrointestinal diseases.

•  Bleeding Disorders Infusion.   As a leading provider of home infusion therapy for hemophilia and von Willebrand 

disease, the Company streamlines the administrative burdens associated with infusion therapies for bleeding disorders. 
The Company works with medical specialists across the country to offer access to all approved factor products, a full 
range of therapies, and dedicated support services. Hemophilia is one of the most costly diseases to treat. The 
treatment goal is to raise the level of the deficient clotting factor and maintain it to stop the bleeding. Treatments 
include infusion of the clotting factor products and other biologic prescription drugs. The length of treatment depends 
on the severity of the bleeding episode, and the need for treatment continues throughout the life of the patient.

•  Other.   The Company offers a range of other infusion therapies to treat a variety of conditions, including heart failure, 

pain management, chemotherapy and respiratory medication.

The Company also provides nursing services to support the above therapies, comprised of its nursing team of 

approximately 1,300 employees, and through its network of sub-contracted nursing agencies.

Sales and Marketing

The Company’s sales and marketing efforts focus on three primary objectives: (1) building new relationships and 
expanding existing contracts with managed care organizations; (2) establishing, maintaining and strengthening relationships 
with local and regional patient referral sources; and (3) establishing, maintaining existing and developing new relationships 
with pharmaceutical manufacturers to gain distribution access as they release new products.

The Company’s sales structure is focused on maintaining and expanding its relationships with drug manufacturers to 
establish its position as a participating provider when they release new products. In addition, the Company’s sales structure 
allows it to leverage its national managed care relationships to provide sales and contract pull-through by the Company’s local 
field-based sales personnel. This cross-utility enables the Company to market its services to numerous sources of patient 
referrals, including physicians, hospital discharge planners, hospital personnel, Health Maintenance Organizations (“HMOs”) 
and Preferred Provider Organizations (“PPOs”).

5

Competition

The Company competes in the large and highly fragmented home infusion market for contracts with managed care 
organizations and other third party payers to receive referrals from physicians, case managers and hospital discharge planners. 
Competition in the home infusion market is based on quality of care, clinical outcomes, pricing and cost of service, reputation, 
and reliability of service. Its competitors within the home infusion market include Coram CVS/specialty infusion services (a 
division of CVS Health), Accredo Health Group, Inc. (a unit of Cigna), Briova (a subsidiary of OptumRx, which is a unit of the 
United Healthcare Insurance Company) and various regional and local providers. The Company believes that its reputation for 
providing quality services, the strength of its growing national presence and its ability to effectively market its services at 
national, regional and local levels places it in a strong position against existing and potential competitors. The Company 
believes that the value created by the Merger has put the Company in a unique position to efficiently capture market share 
through its expanded footprint and synergies.

Intellectual Property

The Company owns a variety of trademarks, licenses, and service marks, including but not limited to: “Option Care 
Health”, “Option Care”, “Critical Care Systems”, “Clinical Specialties”, “BioScrip”, “BioScrip Infusion Services”, “BioScrip 
Nursing Services”, “BioScrip Pharmacy Services”, “CarePoint Partners”, “HomeChoice Partners”, “InfuScience”, 
“InfusionCare”, “Infusion Partners”, “Infusion Solutions”, “New England Home Therapies”, “Option Health”, “Professional 
Home Care Services”, “Wilcox Home Infusion”, “Home Solutions”, as well as several others.

Suppliers

The Company purchases pharmaceuticals and medical supplies through pharmaceutical manufacturers, distributors and 
group purchasing organizations. Through the coverage and clinical expertise of its 115 full service pharmacies, the Company 
provides pharmaceutical manufacturers with a broad distribution channel for its existing pharmaceutical products. Many of the 
pharmaceuticals that the Company purchases are available from multiple sources and are available in sufficient quantities to 
meet its needs and the needs of its patients. However, some drugs are only available through the manufacturer and may be 
subject to limits on distribution. In such cases, it is important the Company establishes and maintains good working relations 
with the manufacturer to secure sufficient supply to meet its patients’ needs. Additionally, certain drugs may become subject to 
supply shortages. Such shortages can result in cost increases or hamper the Company’s ability to obtain sufficient quantities to 
meet the needs of its patients. The Company actively manages its relationships with direct manufacturers and distributors to 
ensure consistent supply and cost-effective procurement. These relationships provide the Company the opportunity to become a 
selected partner in the launch of their new products. The Company may receive fees, which it records as other revenue, from 
certain biotech manufacturers for providing them with clinical outcomes data. The Company’s continued growth will be 
dependent on maintaining its existing relationships with manufacturers and establishing new relationships with additional 
manufacturers as the Company launches new specialty products.

For the year ended December 31, 2019, approximately 70% of the Company’s pharmaceutical and medical supply 
purchases are from three vendors. Although there are a limited number of suppliers, the Company believes that other vendors 
could provide similar products on comparable terms. However, a change in suppliers could cause delays in service delivery and 
possible losses in revenue, which could adversely affect the Company’s financial condition or operating results.

Through the purchasing power of its national platform, the Company is able to negotiate favorable terms and economics, 

including volume purchase rebates and vendor administration fees. Such fees are recorded as reductions to cost of revenue 
when the pharmaceuticals are delivered to the patient.

Billing & Significant Payers

The Company generates most of its revenue from contracts with third party payers, including managed care organizations, 

insurance companies, self-insured employers, Medicare, and Medicaid programs. Where permissible, the Company bills 
patients for any amounts not reimbursed by third party payers. The majority of the Company’s infusion pharmacy revenue 
consists of reimbursement for both the cost of the pharmaceuticals sold and the cost of services provided. Pharmaceuticals are 
typically reimbursed on a percentage discount from the published average wholesale price (“AWP”) of each drug or on a 
percentage premium to average sales price (“ASP”). Nursing services are typically billed separately, while other patient support 
services, such as pharmacy compounding service, delivery service and ancillary medical supplies are reimbursed either 
separately or on a per diem basis, where applicable.

The Company’s largest payer is with United Health Group, which represented approximately 16% of its revenue for the 

year ended December 31, 2019. No other single payer represented more than 10% of its revenue. The Company also provides 
services that are reimbursable through government healthcare programs such as Medicare and state Medicaid programs. For the 

6

year ended December 31, 2019, approximately 12% of the Company’s revenue was directly reimbursable through 
governmental programs, such as Medicare and Medicaid.

Governmental Regulation

The home infusion industry is subject to extensive regulation by a number of federal, state and local governmental entities. 
The industry is also subject to frequent regulatory change. Laws and regulations in the healthcare industry are complex and, in 
many instances, the industry does not benefit from significant regulatory or judicial interpretation that would clarify how these 
laws and regulations should be applied. Moreover, the Company’s business is also impacted by certain laws and regulations 
that are applicable to its managed care and other clients. If the Company fails to comply with the laws and regulations directly 
applicable to its business, the Company could suffer civil and/or criminal penalties, and the Company could be excluded from 
participating in Medicare, Medicaid and other federal and state healthcare programs, which would have an adverse impact on 
its business.

Professional Licensure

Nurses, pharmacists and certain other healthcare professionals employed by the Company are required to be individually 
licensed or certified under applicable state law. The Company performs criminal and other background checks on employees 
and takes steps to ensure that its employees possess all necessary licenses and certifications, and the Company believes that its 
employees comply in all material respects with applicable licensure laws.

Pharmacy Licensing and Registration

State laws require that each of its pharmacy locations be licensed as an in-state pharmacy to dispense pharmaceuticals in 

that state. Certain states also require that its pharmacy locations be licensed as an out-of-state pharmacy if the Company 
delivers prescription pharmaceuticals into those states from locations outside of the state. The Company believes that it 
materially complies with all applicable state licensing laws. If the Company is unable to maintain its licenses or if states place 
burdensome regulations on non-resident pharmacies, its ability to operate in some states would be limited, which could have an 
adverse impact on its business. Laws enforced by the Drug Enforcement Administration (“DEA”), as well as some similar state 
agencies, require its pharmacy locations to individually register in order to handle controlled substances, including prescription 
pharmaceuticals. A separate registration is required at each principal place of business where the Company dispenses controlled 
substances. Federal and state laws also require that the Company follow specific labeling, reporting and record-keeping 
requirements for controlled substances. The Company maintains federal and state controlled substance registrations for each of 
its facilities that require such registration and follows procedures intended to comply with all applicable federal and state 
requirements regarding controlled substances.

Many states in which the Company operates also require home infusion companies to be licensed as home health agencies. 

The Company believes it is in compliance with these laws, as applicable.

The Company believes that it materially complies with all applicable state licensing laws, including any applicable change 

of control requirements that may have triggered in connection with the Merger.

Matters Affecting Drug Prices

Pricing benchmarks in the pharmacy industry are periodically published by third parties such as First DataBank, Medi-
Span, RJ Health, and CMS, and the benchmark reimbursement varies by payer contract. The most commonly used benchmarks 
are AWP and ASP. AWP is based on self-reported prices charged by wholesalers and manufacturers. Reimbursement is 
generally AWP minus a percentage and may include a per diem fee or a fixed dispensing fee. ASP is based on actual sales 
transactions reported by wholesalers, and is generally lower than AWP. Reimbursement is generally ASP plus a percentage. The 
Company may also receive a fixed dispensing fee or a per diem fee for each day a patient is on service. Changes to these 
pricing benchmarks may have a significant impact on the profitability of the Company’s business.

Privacy and Security Requirements

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) as amended by the Health Information 
Technology for Economic and Clinical Health Act (“HITECH”), and its implementing regulations regulate the use, disclosure, 
confidentiality, availability and integrity of individually identifiable health information, known as “protected health 
information,” and provide for a number of individual rights with respect to such information. The federal privacy regulations 
(the “Privacy Regulations”) are designed to protect health-related information that could be used to identify an individual’s 
protected health information.

The requirements imposed by HIPAA are extensive, and the Company has taken and intends to continue to take steps to 

ensure its policies and procedures are in compliance with the applicable provisions.

7

Regulations

Food, Drug and Cosmetic Act.  Certain provisions of the Food, Drug and Cosmetic Act (“FDCA”) govern the handling and 

distribution of pharmaceutical products. This law exempts many pharmaceuticals and medical devices from federal labeling 
and packaging requirements as long as they are not adulterated or misbranded and are dispensed in accordance with and 
pursuant to a valid prescription. The Company believes it complies with all applicable requirements. The FDCA also governs 
interstate commerce for pharmaceutical products. The Company cannot predict the impact of any proposed FDCA regulations 
on its ability to ship drugs to different states from its pharmacies.

The Drug Quality and Security Act (“DQSA”) amended the FDCA to grant the Food and Drug Administration (“FDA”) 

authority to regulate the manufacturing of compounded pharmaceutical drugs. The Company complies with the PCAB and 
Accreditation Standards for Sterile and Non-Sterile Pharmacy Compounding, and aggressively pursues accreditation from 
quality associations. The Company believes it complies in all material respects with all applicable requirements of a non-
outsourcing-facility pharmacy.

The FDA also regulates certain medical devices, such as infusion pumps the Company uses to provide its services. In 

recent years, the FDA has increased its oversight of infusion pumps, resulting in additional requirements around patient 
education and adverse event reporting. The Company believes it complies in all material respects with all applicable 
requirements and that its employees have the level of proficiency required to use these devices and provide training to its 
patients.

Anti-Kickback Statute.   The federal Anti-Kickback Statute prohibits individuals and entities from knowingly and willfully 
paying, offering, receiving, or soliciting money or anything else of value in order to induce the referral of patients or to induce 
a person to purchase, lease, order, arrange for, or recommend services or goods covered by Medicare, Medicaid, or other 
government healthcare programs. The Anti-Kickback Statute is broad and potentially covers many standard business 
arrangements. A number of states also have statutes and regulations that prohibit the same general types of conduct as those 
prohibited by the Anti-Kickback Statute described above. Violations can lead to significant criminal or civil penalties, including 
imprisonment. The Office of the Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”) 
has published clarifying regulations that identify a limited number of safe harbors from criminal enforcement or civil 
administrative actions. The Company attempts to structure its business relationships to comply with these statutes and to satisfy 
an applicable safe harbor where applicable. However, in situations where a business relationship does not fully satisfy the 
elements of a safe harbor, or where no safe harbor exists, the Company attempts to satisfy as many elements of an applicable 
safe harbor as possible.

False Claims Act.   The Company is subject to state and federal laws that govern the submission of claims for 
reimbursement. These laws generally prohibit an individual or entity from knowingly and willfully presenting a claim or 
causing a claim to be presented for payment from a federal healthcare program that is false or fraudulent. The standard for 
“knowing and willful” may include conduct that amounts to a reckless disregard for the accuracy of information presented to 
payers. Penalties under these statutes include substantial civil and criminal fines, exclusion from the Medicare or Medicaid 
programs and imprisonment. One of the most prominent of these laws is the federal False Claims Act, which may be enforced 
by the federal government directly or by a private plaintiff by filing a qui tam lawsuit on the government’s behalf. Under the 
False Claims Act, the government and private plaintiffs, if any, may recover monetary penalties in the amount of $5,500 to 
$11,000 per false claim, as well as an amount equal to three times the amount of damages sustained by the government as a 
result of the false claim. A number of states, including states in which the Company operates, have adopted their own false 
claims statutes as well as statutes that allow individuals to bring qui tam actions. The Company believes that it has procedures 
in place to ensure the accuracy of its claims.

Medicare Home Health CY 2020 Home Health Prospective Payment Systems Rate Update. On October 31, 2019, the 

Centers for Medicare & Medicaid Services (“CMS”) issued a final rule that includes updates to payment policies, payment 
rates, and quality provisions for services. The final rule set forth routine updates to the home infusion therapy services for 
calendar year 2021 and subsequent years, and solicits comments on options to enhance future efforts to improve policies related 
to coverage of eligible drugs for home infusion therapy.

Ethics in Patient Referrals Law (Stark Law)

The Stark Law exempts certain business relationships that meet its exception requirements. However, unlike the Anti-

Kickback Statute under which an activity may fall outside a safe harbor and still be lawful, a referral for certain Designated 
Health Services (“DHS”) that does not fall within an exception is strictly prohibited by the Stark Law. In addition to the Stark 
Law, many of the states in which the Company operates have comparable restrictions on the ability of physicians to refer 
patients for certain services to entities with which the Company has a financial relationship. Certain of these state statutes 

8

mirror the Stark Law while others may be more restrictive. The Company attempts to structure all of its business relationships 
with physicians to comply with the Stark Law and any applicable state self-referral laws.

The federal Stark Law generally prohibits a physician from making referrals for certain DHS, reimbursable by Medicare or 
Medicaid, to entities with which the physician or an immediate family member has a financial relationship, unless an exception 
applies. A financial relationship is generally defined as an ownership, investment or compensation relationship. DHS includes 
outpatient pharmaceuticals, parenteral and enteral nutrition products, home health services, durable medical equipment, 
physical and occupational therapy services, and inpatient and outpatient hospital services. Among other sanctions, a civil 
monetary penalty may be imposed for each bill or claim for a service a person knows or should know is for a service for which 
payment may not be made due to the Stark Law. Such persons or entities are also subject to exclusion from the Medicare and 
Medicaid programs. Any person or entity participating in a circumvention scheme to avoid the referral prohibitions is liable for 
civil monetary penalties, and additional fines may be imposed for failure to comply with reporting requirements regarding an 
entity’s ownership, investment and compensation arrangements for each day for which reporting is required to have been made 
under the Stark Law.

Employees

As of December 31, 2019, the Company employed 5,081 persons on a full-time basis and 822 persons on a part-time basis. 

The majority of its part-time employees are clinicians due to the nature and timing of the services the Company provides.

Available Information

The Company’s corporate headquarters is located at 3000 Lakeside Drive, Suite 300N, Bannockburn, IL 60015. The 

Company maintains a website at http://www.optioncarehealth.com. The information contained on our website is not 
incorporated by reference into this Annual Report and should not be considered part of this report. Our Annual Reports on 
Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, and our Proxy Statements are available through 
our website at https://investors.optioncarehealth.com/, free of charge, as soon as reasonably practicable after they are filed with 
or furnished to the SEC.

The SEC maintains a website that contains reports, proxy and information statements, and other information regarding 

issuers that file electronically with the SEC at www.sec.gov.

Item 1A. 

Risk Factors

Investors should carefully consider the following risk factors.

Our revenue and profitability will decline if the pharmaceutical industry undergoes certain changes, including limiting 
or discontinuing research, development, production and marketing of the pharmaceuticals that are compatible with the services 
we provide. 

Our business is highly dependent on the ability of pharmaceutical manufacturers to develop, supply and market pharmaceuticals 
that  are  compatible  with  the  services  we  provide.  Our  revenue  and  profitability  will  decline  if  those  companies  were  to  sell 
pharmaceuticals directly to the public, fail to support existing pharmaceuticals or develop new pharmaceuticals with different 
administration requirements than our service offerings are currently equipped to handle. Our business could also be harmed if the 
pharmaceutical industry experiences any supply shortages, pharmaceutical recalls, changes in the FDA approval processes, or 
changes to how pharmaceutical manufacturers finance, promote or sell pharmaceutical products. A reduction in the supply of and 
market for pharmaceuticals that are compatible with the services we provide may have a material adverse effect on our financial 
condition and results of operations. 

If we lose relationships with managed care organizations (“MCOs”) and other non-governmental third party payers, we 

could lose access to a significant number of patients and our revenue and profitability could decline.

We are highly dependent on reimbursement from MCOs, government programs such as Medicare and Medicaid and commercial 
insurers (collectively, “Third Party Payers”). For the year ended December 31, 2019, 87% of our revenue came from managed 
care organizations and other nongovernmental payers, including Medicare Advantage plans, Managed Medicaid plans, pharmacy 
benefit managers (“PBM’s”), and self-pay patients. Many payers seek to limit the number of providers that supply pharmaceuticals 
to their enrollees in order to build volume that justifies their discounted pricing. From time to time, payers with whom we have 
relationships require that we bid against our competitors to keep their business. As a result of this bidding process, we may not be 
retained, and even if we are retained, the prices at which we are able to retain the business may be reduced. The loss of a payer 
relationship could significantly reduce the number of patients we serve and have a material adverse effect on our revenue and net 
income, and a reduction in pricing could reduce our gross margins and net income.

9

The healthcare industry is highly competitive. 

The healthcare industry is highly competitive. We compete directly with national, regional and local healthcare providers. 
There are many other companies and individuals currently providing healthcare services that we provide, many of which have 
been in business longer and/or have substantially more resources. Other companies could enter the healthcare industry in the 
future and divert some or all of our business. We expect to continue to encounter competition in the future that could limit our 
ability to grow revenue and/or maintain acceptable pricing levels. 

Some of our competitors have vertically integrated business models with commercial payers, or are under common control 

with, or owned by, pharmaceutical wholesalers and distributors, managed care organizations, PBMs or retail pharmacy chains 
and may be better positioned with respect to the cost-effective distribution of pharmaceuticals. In addition, some of our 
competitors may have secured long-term supply or distribution arrangements for prescription pharmaceuticals necessary to treat 
certain chronic disease states on price terms substantially more favorable than the terms currently available to us. Consequently, 
we may be less price competitive than some of these competitors with respect to certain pharmaceutical products. 

Accountable Care Organizations (“ACOs”) and other clinical integration models may result in lower reimbursement rates. 

Some of our competitors may negotiate exclusivity provisions with managed care plans or otherwise interfere with the ability 
of managed care companies to contract with us. Increasing consolidation in the payer and supplier industries, including vertical 
integration efforts among insurers, providers, and suppliers, and cost-reduction strategies by large employer groups and their 
affiliates may limit our ability to negotiate favorable terms and conditions in our contracts and otherwise intensify competitive 
pressure. In addition, our competitive position could be adversely affected by any inability to obtain access to new biotech 
pharmaceutical products.

Delays in reimbursement may adversely affect our liquidity, cash flows and operating results.

The reimbursement process for the services we provide is complex, resulting in delays between the time we bill for a 
service and receipt of payment that can be significant. Reimbursement and procedural issues often require us to resubmit claims 
multiple times and respond to multiple administrative requests before payment is remitted. The collection of accounts 
receivable is challenging, and requires constant focus and involvement by management and ongoing enhancements to 
information systems and billing center operating procedures. While management believes that our controls and processes are 
satisfactory, there can be no assurance that collections of accounts receivable will continue at historical rates. The risks 
associated with Third Party Payers and the inability to collect outstanding accounts receivable could have a material adverse 
effect on our liquidity, cash flows and operating results.

We are subject to pricing pressures and other risks involved with Third Party Payers.

Competition to provide healthcare services, efforts by traditional Third Party Payers to contain or reduce healthcare costs, 
and the increasing influence of managed care payers such as health maintenance organizations, has resulted in reduced rates of 
reimbursement for home infusion and specialty pharmacy services. Changes in reimbursement policies of governmental Third 
Party Payers, including policies relating to Medicare, Medicaid and other federal and state funded programs, could reduce the 
amounts reimbursed to our customers for our products and, in turn, the amount these customers would be willing to pay for our 
products and services, or could directly reduce the amounts payable to us by such payers. Pricing pressures by Third Party 
Payers may continue, and these trends may adversely affect our business. 

Also, continued growth in managed care plans has pressured healthcare providers to find ways of becoming more cost 
competitive. MCOs have grown substantially in terms of the percentage of the population they cover and in terms of the portion 
of the healthcare economy they control. MCOs have continued to consolidate to enhance their ability to influence the delivery 
of healthcare services and to exert pressure to control healthcare costs. A rapid concentration of revenue derived from 
individual managed care payers could harm our business.

If we are unable to maintain relationships with existing patient referral sources, our business and consolidated 

financial condition, results of operations, and cash flows could be materially adversely affected.

Our success depends on referrals from physicians, hospitals, and other sources in the communities we serve and on our 
ability to maintain good relationships with existing referral sources. Our referral sources are not contractually obligated to refer 
patients to us and may refer their patients to other providers. Our growth and profitability depends, in part, on our ability to 
establish and maintain close working relationships with these patient referral sources, and to increase awareness and acceptance 
of the benefits of home infusion by our referral sources and their patients. Our loss of, or failure to maintain, existing 

10

relationships or our failure to develop new referral relationships could have a material adverse effect on our business and 
consolidated financial condition, results of operations, and cash flows.

Changes in industry pricing benchmarks could adversely affect our financial performance.

Our contracts generally use certain published benchmarks to establish pricing for the reimbursement of prescription 
medications we dispense. These benchmarks include AWP, wholesale acquisition cost, and average manufacturer price. Many 
of our contracts utilize the AWP benchmark. Publication of the AWP benchmark was expected to cease in 2011 as a result of the 
settlement of class-action lawsuits brought against First DataBank and Medi-Span, third-party publishers of various pricing 
benchmarks. However, Medi-Span continues to publish the AWP benchmark and has indicated that it will continue to do so 
until a new benchmark is widely accepted. Several industry participants have explored establishing a new benchmark but there 
is not currently a viable generally accepted alternative to the AWP benchmark. Without a suitable pricing benchmark in place, 
many of our contracts will have to be modified and could potentially change the economic structure of our agreements. 

Pending and future litigation could subject us to significant monetary damages and/or require us to change our 

business practices.

We employ pharmacists, dieticians, nurses and other health care professionals. We are subject to liability for negligent acts, 

omissions, or injuries occurring at one of these clinics or caused by one of our employees. We are subject to risks relating to 
asserted claims, litigation and other proceedings in connection with our operations. We are or may face claims or become a 
party to a variety of legal actions that affect our business, including breach of contract actions, employment and employment 
discrimination-related suits, employee benefit claims, stockholder suits and other securities laws claims, and tort claims. Due to 
the nature of our business, we, through our employees and caregivers who provide services on our behalf, may be the subject of 
medical malpractice claims. A court could find these individuals should be considered our agents, and, as a result, we could be 
held liable for their acts or omissions. 

We may incur substantial expenses in defending such claims or litigation, regardless of merit, and such claims or litigation 

could result in a significant diversion of the efforts of our management personnel. Successful claims against us may result in 
monetary liability or a material disruption in the conduct of our business. Similarly, if we settle such legal proceedings, it may 
affect how we operate our business. See Item 3 for a description of material proceedings pending against us. We believe that 
these suits are without merit and, to the extent not already concluded, intend to contest them vigorously. However, an adverse 
outcome in one or more of these suits may have a material adverse effect on our consolidated results of operations, consolidated 
financial position, and/or consolidated cash flow from operations, or may require us to make material changes to our business 
practices.

We may be subject to liability claims for damages and other expenses that are not covered by insurance.

As a result of operating in the home infusion industry, our business entails an inherent risk of claims, losses and potential 

lawsuits alleging incidents involving our employees that are likely to occur in a patient’s home. We maintain professional 
liability insurance to provide coverage to us and our subsidiaries against these risks. A successful product or professional 
liability claim in excess of our insurance coverage could harm our consolidated financial statements. Various aspects of our 
business may subject us to litigation and liability for damages. For example, a prescription drug dispensing error could result in 
a patient receiving the wrong or incorrect amount of medication, leading to personal injury or death. Our business and 
consolidated financial statements could suffer if we pay damages or defense costs in connection with a claim that is outside the 
scope of any applicable contractual indemnity or insurance coverage.

Our insurance coverage also includes fire, property damage and general liability with varying limits. We cannot assure that 

the insurance we maintain will satisfy claims made against us or that insurance coverage will continue to be available to us at 
commercially reasonable rates, in adequate amounts or on satisfactory terms. Any claims made against us, regardless of their 
merit or eventual outcome, could damage our reputation and business. 

Pressures relating to downturns in the economy could adversely affect our business and consolidated financial 

statements. 

Medicare and other federal and state payers account for a portion of our revenues. During economic downturns and periods 

of stagnant or slow economic growth, federal and state budgets are typically negatively affected, resulting in reduced 
reimbursements or delayed payments by the federal and state government health care coverage programs in which we 
participate, including Medicare, Medicaid, and other federal or state assistance plans. Government programs could also slow or 
temporarily suspend payments, negatively impacting our cash flow and increasing our working capital needs and interest 

11

payments. We have seen, and believe we will continue to see, Medicare and state Medicaid programs institute measures aimed 
at controlling spending growth, including reductions in reimbursement rates. 

Higher unemployment rates and significant employment layoffs and downsizings may lead to lower numbers of patients 

enrolled in employer-provided plans. Adverse economic conditions could also cause employers to stop offering, or limit, 
healthcare coverage, or modify program designs, shifting more costs to the individual and exposing us to greater credit risk 
from patients or the discontinuance of therapy. 

Acquisitions, strategic investments and strategic relationships involve certain risks.

We may pursue acquisitions, strategic investments in, or strategic relationships with businesses and technologies. 

Acquisitions may entail numerous risks, including difficulties in assessing values for acquired businesses, intangible assets and 
technologies, difficulties in the assimilation of acquired operations and products, diversion of management’s attention from 
other business concerns, assumption of unknown material liabilities of acquired companies, amortization of acquired intangible 
assets which could reduce future reported earnings, and potential loss of clients or key employees of acquired companies. We 
may not be able to successfully fully integrate the operations, personnel, services or products that we have acquired or may 
acquire in the future. Strategic investments may also entail some of the risks described above. If these investments are 
unsuccessful, we may need to incur charges against earnings. We may also pursue a number of strategic relationships. These 
relationships and others we may enter into in the future may be important to our business and growth prospects. We may not be 
able to maintain these relationships or develop new strategic alliances.

Changes in our relationships with pharmaceutical suppliers, including changes in drug availability or pricing, could 

adversely affect our business and financial results.

We have contractual relationships with pharmaceutical manufacturers to purchase the pharmaceuticals that we dispense. In 

order to have access to these pharmaceuticals, and to be able to participate in the launch of new pharmaceuticals, we must 
maintain a good working relationship with these manufacturers. Most of the manufacturers of the pharmaceuticals we sell have 
the right to cancel their supply contracts with us without cause and after giving only minimal notice. Any changes to these 
relationships, including, but not limited, to loss of a manufacturer relationship, drug shortages or changes in pricing, could have 
an adverse effect on our business and financial results.

Some pharmaceutical manufacturers attempt to limit the number of preferred distributors that may market certain of their 

pharmaceutical products. We cannot provide assurance that we will be selected and retained as a preferred distributor or can 
remain a preferred distributor to market these products. Although we believe we can effectively meet our suppliers’ 
requirements, we cannot provide assurance that we will be able to compete effectively with other providers to retain our 
position as a distributor of each of our core products. Adverse developments with respect to this trend could have a material 
adverse effect on our financial condition and results of operations. 

A disruption in supply could adversely impact our business.

For the year ended December 31, 2019, approximately 70% of our pharmaceutical and medical supply purchases are from 

three vendors. Most of the pharmaceuticals that we purchase are available from multiple sources, and we believe they are 
available in sufficient quantities to meet our needs and the needs of our patients. We keep safety stock to ensure continuity of 
service for reasonable, but limited, periods of time. Should a supply disruption result in the inability to obtain especially high 
margin drugs and compound components necessary for patient care, our consolidated financial statements could be negatively 
impacted.

A shortage of qualified registered nursing staff, pharmacists and other professionals could adversely affect our ability to 

attract, train and retrain qualified personnel and could increase operating costs.

Our business relies on our ability to attract and retain nursing staff, pharmacists and other professionals who possess the 

skills, experience and licenses necessary to meet the requirements of their job responsibilities. From time to time and 
particularly in recent years, there have been shortages of nursing staff, pharmacists and other professionals in certain local and 
regional markets. As a result, we are often required to compete for personnel with other healthcare systems and our 
competitors. Our ability to attract and retain personnel depends on several factors, including our ability to provide them with 
engaging assignments and competitive salaries and benefits. We may not be successful in any of these areas.

In addition, where labor shortages arise in markets in which we operate, we may face higher costs to attract personnel, and 

we may have to provide them with more attractive benefit packages than originally anticipated or are being paid in other 

12

markets where such shortages do not exist at the time. In either case, such circumstances could cause our profitability to 
decline. Finally, if we expand our operations into geographic areas where healthcare providers historically have unionized or 
unionization occurs in our existing geographic areas, negotiating collective bargaining agreements may have a negative effect 
on our ability to timely and successfully recruit qualified personnel and on our financial results. If we are unable to attract and 
retain nursing staff, pharmacists and other professionals, the quality of our services may decline and we could lose patients and 
referral sources, which could have a material adverse effect on our business and consolidated financial condition, results of 
operations and cash flows.

Introduction of new drugs or accelerated adoption of existing lower margin drugs could cause us to experience lower 

revenues and profitability when prescribers prescribe these drugs for their patients or they are mandated by Third Party 
Payers.

The pharmaceutical industry pipeline of new drugs includes many drugs that over the long term may replace older, more 
expensive therapies. As a result of such older drugs losing patent protection and being replaced by generic substitutes, new and 
less expensive delivery methods (such as when an infusion or injectable drug is replaced with an oral drug) or additional 
products are added to a therapeutic class, thereby increasing price competition among competing manufacturer’s products in 
that therapeutic category. In such cases, manufacturers have the ability to increase drug acquisition costs or lower the selling 
price of replaced products. This could negatively impact our revenues and/or margins.

Failure to develop new services or adapt to changes and trends within the industry may adversely affect our business.

We operate in a highly competitive environment. We develop new services from time to time to assist our clients. If we are 

unsuccessful in developing innovative services, our ability to attract new clients and retain existing clients may suffer. 

Technology, including the ability to capture and report outcomes, is also an important component of our business as we 
continue to utilize new and better channels to communicate and interact with our clients, members and business partners. If our 
competitors are more successful than us in employing this technology, our ability to attract new clients, retain existing clients 
and operate efficiently may suffer. Any significant shifts in the structure of the healthcare products and services industry in 
general could alter the industry dynamics and adversely affect our ability to attract or retain clients. Our failure to anticipate or 
appropriately adapt to changes in the industry could negatively impact our competitive position and adversely affect our 
business and results of operations.

Cybersecurity risks could compromise our information and expose us to liability, which may harm our ability to operate 

effectively and may cause our business and reputation to suffer.

Cybersecurity refers to the combination of technologies, processes and procedures established to protect information 
technology systems and data from unauthorized access, attack, or damage. We rely on our information systems to provide 
security for processing, transmission and storage of confidential information about our patients, customers and personnel, such 
as names, addresses and other individually identifiable information protected by HIPAA and other privacy laws. Cyber 
incidents can result from deliberate attacks or unintentional events. Cyber-attacks are increasingly more common, including in 
the health care industry. The regulatory environment surrounding information security and privacy is increasingly demanding, 
with the frequent imposition of new and changing requirements. Compliance with changes in privacy and information security 
laws and with rapidly evolving industry standards may result in our incurring significant expense due to increased investment 
in technology and the development of new operational processes.

We have not experienced any known attacks on our information technology systems that compromised any confidential 

information. We maintain our information technology systems with safeguard protection against cyber-attacks including 
passive intrusion protection, firewalls and virus detection software. However, these safeguards do not ensure that a significant 
cyber-attack could not occur. Although we have taken steps to protect the security of our information systems and the data 
maintained in those systems, it is possible that our safety and security measures will not prevent the systems’ improper 
functioning or damage or the improper access or disclosure of personally identifiable information such as in the event of cyber-
attacks.

Security breaches, including physical or electronic break-ins, computer viruses, attacks by hackers and similar breaches 

can create system disruptions or shutdowns or the unauthorized use or disclosure of confidential information. If personal 
information or protected health information is improperly accessed, tampered with or disclosed as a result of a security breach, 
we may incur significant costs to notify and mitigate potential harm to the affected individuals, and we may be subject to 
sanctions and civil or criminal penalties if we are found to be in violation of the privacy or security rules under HIPAA or other 
similar federal or state laws protecting confidential personal information. In addition, a security breach of our information 

13

systems could damage our reputation, subject us to liability claims or regulatory penalties for compromised personal 
information and could have a material adverse effect on our business, financial condition, and results of operations.

Our business is dependent on the services provided by third party information technology vendors.

Our information technology infrastructure includes hosting services provided by third parties. While we believe these third 

parties are high-performing organizations with secure platforms and customary certifications, they could suffer a security 
breach or business interruption which in turn could impact our operations negatively. In addition, changes in pricing terms 
charged by our technology vendors may adversely affect our financial performance.

Changes in future business conditions could cause business investments and/or recorded goodwill to become impaired, 

and our financial condition, and results of operations could suffer if there is an impairment of goodwill.

 Our acquisitions resulted in significant goodwill reported on our financial statements. Goodwill results when the purchase 

price exceeds the fair value of the net identifiable tangible and intangible assets acquired. We may not realize the full value of 
this goodwill. As such, we evaluate on at least an annual basis whether events and circumstances indicate that all or some of the 
carrying value of goodwill is no longer recoverable, in which case we would recognize the unrecoverable goodwill as a charge 
against our earnings. When evaluating goodwill for potential impairment, we compare the fair value of our reporting units to 
their respective carrying amounts. We estimate the fair value of our reporting units using the income approach. If the carrying 
amount of a reporting unit exceeds its estimated fair value, a goodwill impairment loss is recognized in an amount equal to the 
excess to the extent of the goodwill balance. The income approach requires us to estimate a number of factors for our reporting 
units, including projected future operating results, economic projections, anticipated future cash flows, and discount rates. The 
fair value determined using the income approach is then compared to marketplace fair value data from within a comparable 
industry grouping for reasonableness. Because of the significance of our goodwill, any future impairment could result in 
material non-cash charges to our results of operations, which could have an adverse effect on our financial condition and results 
of operations.

Failure to maintain effective internal control over our financial reporting could have an adverse effect on our ability to 

report our financial results on a timely and accurate basis.

Our management is responsible for establishing and maintaining adequate internal control over financial reporting, as 
defined in Rule 13a-15(f) under the Securities Exchange Act of 1934 (the “Exchange Act”), and is required to evaluate the 
effectiveness of these controls and procedures on a periodic basis and publicly disclose the results of these evaluations and 
related matters in accordance with the requirements of Section 404 of the Sarbanes-Oxley Act of 2002. Effective internal 
control over financial reporting is necessary for us to provide reliable financial reports, to help mitigate the risk of fraud and to 
operate successfully. Any failure to implement and maintain effective internal controls could result in material weaknesses or 
material misstatements in our consolidated financial statements.

If we fail to maintain effective internal control over financial reporting, or our independent registered public accounting 
firm is unable to provide us with an unqualified attestation report on our internal control, we may be required to take corrective 
measures or restate the affected historical financial statements. In addition, we may be subjected to investigations and/or 
sanctions by federal and state securities regulators, and/or civil lawsuits by security holders. Any of the foregoing could also 
cause investors to lose confidence in our reported financial information and in us and would likely result in a decline in the 
market price of our stock and in our ability to raise additional financing if needed in the future.

Acts of God such as major weather disturbances could disrupt our business.

We operate in a network of prescribers, providers, patients and facilities that can be negatively impacted by local weather 

disturbances and other force majeure events. For example, in anticipation of major weather events, patients with impaired 
health may be moved to alternate sites. After a major weather event, availability of electricity, clean water and transportation 
can impact our ability to provide service in the home. Similarly, such events could impact key suppliers or vendors, disrupting 
the services or materials they provide us. In addition, acts of God and other force majeure events may cause a reduction in our 
business or increased costs, such as increased costs in our operations as we incur overtime charges or redirect services to other 
locations, delays in our ability to work with payers, hospitals, physicians and other strategic partners on new business 
initiatives, and disruption to referral patterns as patients are moved out of facilities affected by such events or are unable to 
return to sites of service in the home.

14

An outbreak of a pandemic or epidemic disease could adversely affect our financial performance.

An outbreak of a pandemic or epidemic disease could result in a general economic downturn, supply chain disruption, and/

or a compromise in the ability of our clinicians to access patients, any of which, or a combination of which, could have a 
material adverse effect on our business and financial results. 

A significant change in, or noncompliance with, governmental regulations and other legal requirements could have a 

material adverse effect on our reputation and profitability

We operate in complex, highly regulated environments and could be materially and adversely affected by changes to 
applicable legal requirements including the related interpretations and enforcement practices, new legal requirements and/or 
any failure to comply with applicable regulations. Our home infusion and alternate site infusion businesses are subject to 
numerous federal, state and local regulations including licensing and other requirements for pharmacies and reimbursement 
arrangements. 

The federal and state statutes and regulations to which we are subject include, but are not limited to, laws requiring the 

registration and regulation of pharmacies; laws governing the dispensing of pharmaceuticals and controlled substances; laws 
regulating the protection of the environment and health and safety matters, including those governing exposure to, and the 
management and disposal of, hazardous substances; laws regarding food and drug safety, including those of the FDA and DEA; 
applicable governmental payer regulations, including those applicable to Medicare and Medicaid; data privacy and security 
laws, including HIPAA and its associated regulations; federal and state fraud and abuse laws, including, but not limited to, the 
anti-kickback statute and false claims laws; trade regulations, including those of the U.S. Federal Trade Commission (“FTC”); 
the U.S. Foreign Corrupt Practices Act (the “FCPA”) and similar anti-corruption laws in connection with the services provided 
by certain of our contractors; and the consumer protection and safety laws, including those of the Consumer Product Safety 
Commission. 

We are required to hold valid DEA and state-level licenses, meet various security and operating standards and comply with 
the federal and various state controlled substance acts and related regulations governing the sale, dispensing, disposal, holding 
and distribution of controlled substances. The DEA, FDA and state regulatory authorities have broad enforcement powers, 
including the ability to seize or recall products and impose significant criminal, civil and administrative sanctions for violations 
of these laws and regulations.

We use, disclose and otherwise process personally identifiable information, including health information, making us 
subject to HIPAA and other federal and state privacy and security regulations and failure to comply with those regulations or to 
adequately secure the information we hold could result in significant liability or reputational harm and, in turn, have a material 
adverse effect on our patient base and revenue.

We are also governed by federal and state laws of general applicability, including laws regulating matters of working 
conditions, health and safety and equal employment opportunity and other labor and employment matters as well as employee 
benefit, competition and antitrust matters. In addition, we could have significant exposure if we are found to have infringed 
another party’s intellectual property rights.

Changes in laws, regulations and policies and the related interpretations and enforcement practices may alter the landscape 

in which we do business and may significantly affect our cost of doing business. The impact of new laws, regulations and 
policies and the related interpretations and enforcement practices generally cannot be predicted, and changes in applicable laws, 
regulations and policies and the related interpretations and enforcement practices may require extensive system and operational 
changes, be difficult to implement, increase our operating costs and require significant capital expenditures. Untimely 
compliance or noncompliance with applicable laws and regulations could result in the imposition of civil and criminal penalties 
that could adversely affect the continued operation of our businesses, including:  suspension of payments from government 
programs; loss of required government certifications; loss of authorizations to participate in or exclusion from government 
programs, including the Medicare and Medicaid programs; loss of licenses; and significant fines or monetary penalties. Any 
failure to comply with applicable regulatory requirements could result in significant legal and financial exposure, damage our 
reputation, and have a material adverse effect on our business operations, financial condition and results of operations.

The Affordable Care Act and other healthcare reform efforts could have a material adverse effect on our business.

In recent years, healthcare reform efforts at federal and state levels of government have resulted in sweeping changes to the 

delivery and funding of health care. The Affordable Care Act is the most prominent of these efforts. However, there is 
substantial uncertainty regarding its net effect and its future. The Affordable Care Act has been subject to legislative and 

15

regulatory changes and court challenges. Effective January 2019, Congress eliminated the financial penalty associated with the 
individual mandate to maintain health insurance coverage. Because the penalty associated with the individual mandate was 
eliminated, a federal court in Texas ruled in December 2018 that the entire Affordable Care Act was unconstitutional. However, 
the law remains in place pending appeal. It is impossible to predict the full impact of the Affordable Care Act and related 
regulations or the impact of its modification on our operations in light of the uncertainty regarding whether, when or how the 
law will be changed and what alternative reforms, such as single-payer proposals, may be enacted. Health reform efforts may 
adversely affect our customers, which may cause them to reduce or delay use of our products and services. As such, we cannot 
predict the impact of the Affordable Care Act on our business, operations or financial performance.

Federal actions and legislation may reduce reimbursement rates from governmental payers and adversely affect our 

results of operations.

In recent years, Congress has passed legislation reducing payments to health care providers. The Budget Control Act of 
2011, as amended, requires automatic spending reductions to reduce the federal deficit, including Medicare spending reductions 
of up to 2% per fiscal year that extend through 2027. The Center for Medicare & Medicaid Services (“CMS”) began imposing a 
2% reduction on Medicare claims on April 1, 2013. The Affordable Care Act provides for material reductions in the growth of 
Medicare program spending. More recently, the Cures Act significantly reduced the amount paid by Medicare for drug costs, 
while delaying the implementation of a clinical services payment, although Congress also passed a temporary transitional 
service payment that takes effect January 1, 2019. In addition, from time to time, CMS revises the reimbursement systems used 
to reimburse health care providers, which may result in reduced Medicare payments.

For the year ended December 31, 2019, 12% of our revenue is derived from reimbursement by direct federal and state 
programs such as Medicare and Medicaid. Reimbursement from these and other government programs is subject to statutory 
and regulatory requirements, administrative rulings, interpretations of policy, implementation of reimbursement procedures, 
retroactive payment adjustments, governmental funding restrictions and changes to or new legislation, all of which may 
materially affect the amount and timing of reimbursement payments to us. Changes to the way Medicare pays for our services, 
including mandatory payment reductions such as sequestration, may reduce our revenue and profitability on services provided 
to Medicare patients and increase our working capital requirements. In addition, we are sensitive to possible changes in state 
Medicaid programs.

Because most states must operate with balanced budgets and because the Medicaid program is often a state’s largest 
program, some states have enacted or may consider enacting legislation designed to reduce their Medicaid expenditures. 
Further, many states have taken steps to reduce coverage and/or enroll Medicaid recipients in managed care programs. The 
current economic environment has increased the budgetary pressures on many states, and these budgetary pressures have 
resulted, and likely will continue to result, in decreased spending, or decreased spending growth, for Medicaid programs and 
the Children’s Health Insurance Program in many states. 

In some cases, Third Party Payers rely on all or portions of Medicare payment systems to determine payment rates. 

Changes to government healthcare programs that reduce payments under these programs may negatively impact payments from 
Third Party Payers. Current or future healthcare reform and deficit reduction efforts, changes in other laws or regulations 
affecting government healthcare programs, changes in the administration of government healthcare programs and changes by 
Third Party Payers could have a material, adverse effect on our financial position and results of operations.

We face periodic reviews and billing audits by governmental and private payers, and these audits could have adverse 

findings that may negatively impact our business.

As a result of our participation in the Medicare and Medicaid programs, we are subject to various governmental reviews 

and audits to verify our compliance with these programs and applicable laws and regulations. We also are subject to audits 
under various government programs in which third party firms engaged by CMS conduct extensive reviews of claims data and 
medical and other records to identify potential improper payments under the Medicare program. Third Party Payers may also 
conduct audits. Disputes with payers can arise from these reviews. Payers can claim that payments based on certain billing 
practices or billing errors were made incorrectly. If billing errors are identified in the sample of reviewed claims, the billing 
error can be extrapolated to all claims filed which could result in a larger overpayment than originally identified in the sample 
of reviewed claims. Our costs to respond to and defend claims, reviews and audits may be significant and could have a material 
adverse effect on our business and consolidated financial condition, results of operations and cash flows. Moreover, an adverse 
claim, review or audit could result in:

• 

required refunding or retroactive adjustment of amounts we have been paid by governmental payers or Third Party 
Payers;

16

• 
• 
• 

state or federal agencies imposing fines, penalties and other sanctions on us;
suspension or exclusion from the Medicare program, state programs, or one or more third party payer networks; or
damage to our business and reputation in various markets.

These results could have a material adverse effect on our business and consolidated financial condition, results of 

operations and cash flows.

If any of our pharmacies fail to comply with the conditions of participation in the Medicare program, that pharmacy 

could be terminated from Medicare, which could adversely affect our consolidated financial statements.

Our pharmacies must comply with the extensive conditions of participation in the Medicare program. If a pharmacy fails to 
meet any of the Medicare supplier standards, that pharmacy could be terminated from the Medicare program. We respond in the 
ordinary course to deficiency notices issued by surveyors, and none of our pharmacies has ever been terminated from the 
Medicare program for failure to comply with the supplier standards. Any termination of one or more of our pharmacies from 
the Medicare program for failure to satisfy the Medicare supplier standards could adversely affect our consolidated financial 
statements.

We cannot predict the impact of changing requirements on compounding pharmacies.

Compounding pharmacies are closely monitored by federal and state governmental agencies. We believe that our 

compounding is performed in safe environments and we have clinically appropriate policies and procedures in place. We only 
compound pursuant to a patient-specific prescription and do so in compliance with USP 797 standards. In 2013, Congress 
passed the DQSA, which creates a new category of compounding facilities called outsourcing facilities, which are regulated by 
the FDA. We do not believe that our current compounding practices qualify us as an outsourcing facility and therefore we 
continue to operate consistently with USP 797 standards and applicable state pharmacy laws. Should state regulators or the 
FDA disagree, or should our business practices change to qualify us as an outsourcing facility, there is a risk of regulatory 
action and/or increased resources required to comply with federal requirements imposed pursuant to the DQSA on outsourcing 
facilities that could significantly increase our costs or otherwise affect our results of operations. Furthermore, we cannot predict 
the overall impact of increased scrutiny on compounding pharmacies.

Our existing indebtedness could adversely affect our business and growth prospects.

As of December 31, 2019, we had $1,337.3 million of outstanding borrowings, including (i) $925.0 million under our First 
Lien Term Loan and (ii) $412.3 million under our Second Lien Notes. All obligations under the credit agreements and indenture 
governing these facilities and notes are secured by first-priority perfected security interests in substantially all of our assets and 
the assets of our subsidiaries, subject to permitted liens and other exceptions. Our indebtedness, or any additional indebtedness 
we may incur, could require us to divert funds identified for other purposes for debt service and impair our liquidity position. If 
we cannot generate sufficient cash flow from operations to service our debt, we may need to refinance our debt, dispose of 
assets or issue equity to obtain necessary funds. We do not know whether we will be able to take any of these actions on a 
timely basis, on terms satisfactory to us or at all.

Our indebtedness, the cash flow needed to satisfy our debt and the covenants contained in our credit agreement and 

indenture have important consequences, including but not limited to:

• 

limiting funds otherwise available for financing our capital expenditures by requiring us to dedicate a portion of our cash 
flows from operations to the repayment of debt and the interest on this debt;
limiting our ability to incur additional indebtedness;
limiting our ability to capitalize on significant business opportunities;

• 
• 
•  making us more vulnerable to rising interest rates; and
•  making us more vulnerable in the event of a downturn in our business.

Our level of indebtedness may place us at a competitive disadvantage to our competitors that are not as highly leveraged. 

Fluctuations in interest rates can increase borrowing costs. Increases in interest rates may directly impact the amount of interest 
we are required to pay and reduce earnings accordingly. In addition, developments in tax policy, such as the disallowance of tax 
deductions for interest paid on outstanding indebtedness, could have an adverse effect on our liquidity and our business, 
financial conditions and results of operations. Further, our credit agreements and indenture contain customary affirmative and 
negative covenants and certain restrictions on operations that could impose operating and financial limitations and restrictions 
on us, including restrictions on our ability to enter into particular transactions and to engage in other actions that we may 
believe are advisable or necessary for our business. Our term loan facility is also subject to mandatory prepayments in certain 
17

circumstances and requires a prepayment of a certain percentage of our excess cash flow. This excess cash flow payment, and 
future required prepayments, will reduce our cash available for investment in our business.

We expect to use cash flow from operations to meet current and future financial obligations, including funding our 
operations, debt service requirements and capital expenditures. The ability to make these payments depends on our financial 
and operating performance, which is subject to prevailing economic, industry and competitive conditions and to certain 
financial, business, economic and other factors beyond our control.

Despite our substantial indebtedness, we may still need to incur significantly more debt. This could exacerbate the risks 

associated with our substantial leverage.

We may need to incur substantial additional indebtedness, including additional secured indebtedness, in the future, in 

connection with future acquisitions, strategic investments and strategic relationships. Although the financing documents 
governing our indebtedness contain covenants and restrictions on the incurrence of additional debt, these restrictions are subject 
to a number of qualifications and exceptions and, under certain circumstances, debt incurred in compliance with these 
restrictions, including secured debt, could be substantial. Adding additional debt to current debt levels could exacerbate the 
leverage-related risks described above.

We may not be able to generate sufficient cash flow to service all of our indebtedness, and may be forced to take other 

actions to satisfy our obligations under such indebtedness, which may not be successful.

Our ability to make scheduled payments or to refinance outstanding debt obligations depends on our financial and 
operating performance, which will be affected by prevailing economic, industry and competitive conditions and by financial, 
business and other factors beyond our control. We may not be able to maintain a sufficient level of cash flow from operating 
activities to permit us to pay the principal, premium, if any, and interest on our indebtedness. Any failure to make payments of 
interest and principal on our outstanding indebtedness on a timely basis would likely result in a reduction of our credit rating, 
which would also harm our ability to incur additional indebtedness.

If our cash flows and capital resources are insufficient to fund our debt service obligations, we may be forced to reduce or 

delay capital expenditures, sell assets, seek additional capital or seek to restructure or refinance our indebtedness. Any 
refinancing of our indebtedness could be at higher interest rates and may require us to comply with more onerous covenants. 
These alternative measures may not be successful and may not permit us to meet our scheduled debt service obligations. In the 
absence of such cash flows and resources, we could face substantial liquidity problems and might be required to sell material 
assets or operations to attempt to meet our debt service obligations. The financing documents governing our First Lien Term 
Loan, our ABL Facility and our Second Lien Notes restrict our ability to conduct asset sales and/or use the proceeds from asset 
sales. We may not be able to consummate these asset sales to raise capital or sell assets at prices and on terms that we believe 
are fair and any proceeds that we do receive may not be adequate to meet any debt service obligations then due. If we cannot 
meet our debt service obligations, the holders of our indebtedness may accelerate such indebtedness and, to the extent such 
indebtedness is secured, foreclose on our assets. In such an event, we may not have sufficient assets to repay all of our 
indebtedness.

The transition from the London Interbank Offered Rate (“LIBOR”) could negatively affect our interest rates and 

results of operations.

In 2017, the U.K. Financial Conduct Authority announced that it intends to phase out LIBOR by the end of 2021. In 
addition, other regulators have suggested reforming or replacing other benchmark rates. The discontinuation, reform, or 
replacement of LIBOR or any other benchmark rates may result in fluctuating interest rates that may have a negative impact on 
our interest expense and our profitability.

Continuing to combine businesses between BioScrip and Option Care may be more difficult, costly or time-consuming 

than expected and the anticipated benefits and cost savings of the Merger may not continue to be realized. 

The continuing success of the Merger, including anticipated benefits and cost savings, depend, in part, on our ability to 

successfully combine and integrate both businesses. 

Integration of the businesses following the Merger is a complex, costly and time-consuming process. If we experience 
difficulties with the continued integration process, the anticipated benefits of the Merger may not continue to be realized fully 
or at all, or may take longer to realize than expected. These integration matters could have an adverse effect for an 

18

undetermined period after completion of the Merger. In addition, the actual cost savings of the Merger could be less than 
anticipated.

Our future results may be adversely impacted if we do not effectively manage our expanded operations. 

Following the completion of the Merger, the size of our combined business is significantly larger than the size of either 
Option Care or BioScrip’s respective businesses prior to the Merger. Our ability to successfully manage this expanded business 
depends, in part, upon management’s ability to manage the integration of two discrete companies, as well as the increased scale 
and scope of the combined business with its associated increased costs and complexity. There can be no assurances that we will 
be successful or that we will realize the expected operating efficiencies, cost savings and other benefits currently anticipated 
from the Merger.

We are a “controlled company” within the meaning of the rules of Nasdaq and, as a result, qualify for and rely on, 
exemptions from certain corporate governance standards, which limit the presence of independent directors on our board of 
directors or board committees. 

Following the Merger, approximately 81% of the outstanding shares of our common stock is held by HC Group Holdings I, 

LLC. As a result, we are a “controlled company” for purposes of the Nasdaq listing rules and are exempt from certain 
governance requirements otherwise required by Nasdaq, including requirements that: 

a majority of our board of directors consist of independent directors;

• 
•  we have a nominating and corporate governance committee that is composed entirely of independent 

directors with a written charter addressing the committee's purpose and responsibilities;

•  we have a compensation committee that is composed entirely of independent directors with a written charter 

addressing the committee's purpose and responsibilities;

•  we conduct annual performance evaluation of the nominating and corporate governance and compensation 

committees. 

Accordingly, you will not have the same protections afforded to stockholders of companies that are subject to all of the 

corporate governance requirements of the Nasdaq. 

A significant portion of our total outstanding shares are restricted from immediate resale but may be sold into the 
market in the near future. This could cause the market price of our common stock to drop significantly, even if our business 
is doing well. 

The shares of our common stock issued in the Merger to HC Group Holdings I, LLC as Merger consideration, or 

approximately 81% of the outstanding shares of our common stock as of December 31, 2019, are generally eligible for resale 
subject to a 12-month lockup period beginning on the Merger Date. The market price of our common stock could decline as a 
result of sales of a large number of shares of our common stock in the market after the expiration of the lockup period or even 
the perception that these sales could occur.

As of December 31, 2019, Madison Dearborn Partners is our largest stockholder, controlling approximately 81% of our 

common stock, and has the ability to exercise significant influence over decisions requiring our stockholders’ approval. 

As of December 31, 2019, Madison Dearborn Partners controls approximately 81% of our common stock through its 
control of HC Group Holding I, LLC, with an economic interest in approximately 39% of our common stock. As a result, 
Madison Dearborn Partners has the ability to exercise significant influence over decisions requiring approval of our 
stockholders including the election of directors, amendments to our certificate of incorporation and approval of significant 
corporate transactions, such as a Merger or other sale of us or our assets. 

This concentration of ownership may have the effect of delaying, preventing or deterring a change in control of us and may 

negatively affect the market price of our common stock. Also, Madison Dearborn Partners is in the business of making 
investments in companies and may from time to time acquire and hold interests in businesses that compete with us. Madison 
Dearborn Partners or its affiliates may also pursue acquisition opportunities that are complementary to our business and, as a 
result, those acquisition opportunities may not be available to us.

19

Provisions of our corporate governance documents could make an acquisition of us more difficult and may prevent 

attempts by our stockholders to replace or remove our current management, even if beneficial to our stockholders. 

In addition to HC Group Holding I, LLC’s beneficial ownership of approximately 81% of our common stock, our third 

amended and restated certificate of incorporation contains provisions that could make it more difficult for a third party to 
acquire us, even if doing so might be beneficial to our stockholders. Among other things: 

• 

• 

• 

• 

these provisions allow us to authorize the issuance of undesignated preferred stock, the terms of which may 
be established and the shares of which may be issued without stockholder approval, and which may include 
supermajority voting, special approval, dividend, or other rights or preferences superior to the rights of 
stockholders; 
these provisions provide that, at any time when HC Group Holdings I, LLC beneficially owns, in the 
aggregate, less than 50% in voting power of our stock entitled to vote generally in the election of directors, 
directors may be removed with or without cause only by the affirmative vote of holders of at least 66 2?3% in 
voting power of all the then-outstanding vote thereon, voting together as a single class; 
these provisions prohibit stockholder action by written consent from and after the date on which HC Group 
Holding I, LLC beneficially owns, in the aggregate, less than 50% in voting power of our stock entitled to 
vote generally in the election of directors; and 
these provisions provide that for as long as HC Group Holdings I, LLC beneficially owns, in the aggregate, 
50% or more in voting power of our stock entitled to vote generally in the election of directors, any 
amendment, alteration, rescission or repeal of our bylaws or certificate of incorporation by our stockholders 
will require the affirmative vote of at least a majority in voting power of the outstanding shares of our stock 
and at any time when HC Group Holdings I, LLC beneficially owns, in the aggregate, less than 50% in voting 
power of all outstanding shares of our stock entitled to vote generally in the election of directors, any 
amendment, alteration, rescission or repeal of our bylaws or certificate of incorporation by our stockholders 
will require the affirmative vote of the holders of at least 66 2?3% in voting power of all the then-outstanding 
shares of our stock entitled to vote thereon, voting together as a single class.

These and other provisions in our certificate of incorporation, bylaws and Delaware law could make it more difficult for 
shareholders or potential acquirers to obtain control of our Board or initiate actions that are opposed by our then-current Board, 
including delay or impede a merger, tender offer or proxy contest involving our company. The existence of these provisions 
could negatively affect the price of our common stock and limit opportunities to realize value in a corporate transaction.

Moreover, Section 203 of the General Corporation Law of the State of Delaware (“DGCL”) may discourage, delay, or 
prevent a change of control of our company. Section 203 imposes certain restrictions on mergers, business combinations, and 
other transactions between us and holders of 15% or more of our common stock.

Our third amended and restated certificate of incorporation designates the Court of Chancery of the State of Delaware 

as the exclusive forum for certain litigation that may be initiated by our stockholders, which could limit our stockholders’ 
ability to obtain a favorable judicial forum for disputes with us. 

Pursuant to our third amended and restated certificate of incorporation, unless we consent in writing to the selection of an 

alternative forum, the Court of Chancery of the State of Delaware will be the sole and exclusive forum for (1) any derivative 
action or proceeding brought on our behalf, (2) any action asserting a claim of breach of a fiduciary duty owed by any of our 
directors, officers, employees and stockholders to us or our stockholders, (3) any action asserting a claim against us arising 
pursuant to any provision of the DGCL or as to which the DGCL confers jurisdiction on the Court of Chancery of the State of 
Delaware, our third amended and restated certificate of incorporation or our bylaws or (4) any other action asserting a claim 
against us that is governed by the internal affairs doctrine; provided that for the avoidance of doubt, the forum selection 
provision that identifies the Court of Chancery of the State of Delaware as the exclusive forum for certain litigation, including 
any “derivative action”, will not apply to suits to enforce a duty or liability created by the Exchange Act or any other claim for 
which the federal courts have exclusive jurisdiction. Our third amended and restated certificate of incorporation will further 
provide that any person or entity purchasing or otherwise acquiring any interest in shares of our capital stock is deemed to have 
notice of and consented to the provisions of our certificate of incorporation described above. The forum selection clause in our 
third amended and restated certificate of incorporation may have the effect of discouraging lawsuits against us or our directors 
and officers and may limit our stockholders’ ability to obtain a favorable judicial forum for disputes with us. 

20

We may issue shares of preferred stock in the future, which could make it difficult for another company to acquire us or 

could otherwise adversely affect holders of our common stock, which could depress the price of our common stock.

Our third amended and restated certificate of incorporation authorizes us to issue one or more series of preferred stock. Our 

Board has the authority to determine the preferences, limitations and relative rights of the shares of preferred stock and to fix 
the number of shares constituting any series and the designation of such series, without any further vote or action by our 
stockholders. Our preferred stock could be issued with voting, liquidation, dividend and other rights superior to the rights of our 
common stock. The potential issuance of preferred stock may delay or prevent a change in control, discouraging bids for our 
common stock at a premium to the market price, and materially adversely affect the market price and the voting and other rights 
of the holders of our common stock.

Item 1B. 

Unresolved Staff Comments

None.

21

Item 2. 

Properties

We currently lease all of our properties from third parties under various lease terms expiring over periods extending 
through 2029, in addition to a number of non-material, month-to-month leases. Our corporate headquarters are located at 3000 
Lakeside Drive, Suite 300N, Bannockburn, IL 60015. Our other properties mainly consist of infusion pharmacies equipped 
with clean room and compounding capabilities. Some infusion pharmacies are co-located with an ambulatory infusion center 
where patients receive infusion treatments. As of December 31, 2019 our material property locations, consisting of our 
pharmacies, all in support of our infusion services business, were as follows:

Birmingham, AL

Augusta, GA

Hoover, AL

Mobile, AL

Jonesboro, AR

Little Rock, AR

Tempe, AZ

Bakersfield, CA

Burbank, CA

Chico, CA

Hayward, CA

Irvine, CA

Riverside, CA

Sacramento, CA

San Diego, CA

Peachtree Corners, GA

Savannah, GA

Honolulu, HI

Urbandale, IA

Meridian, ID

Lombard, IL

Wood Dale, IL

Carmel, IN

Overland Park, KS

Ashland, KY

Lexington, KY

Louisville, KY

Baton Rouge, LA

Santa Fe Springs, CA (2)

New Orleans, LA

Sun Valley, CA

Englewood, CO

Cromwell, CT (2)

Shelton, CT

Newark, DE

Fort Myers, FL

Gainesville, FL

Jacksonville, FL

Melbourne, FL

Miramar, FL

St. Petersburg, FL

Tampa, FL

Albany, GA

Shreveport, LA

Marlborough, MA

Southborough, MA

Columbia, MD

Auburn, ME

Farmington Hills, MI

Grand Rapids, MI

Eagan, MN

Roseville, MN

Sauk Rapids, MN

Columbia, MO

Fenton, MO

Pearl, MS

Bozeman, MT

Charlotte, NC

Fayetteville, NC

Morrisville, NC

Wilmington, NC

Lincoln, NE

Omaha, NE

Bedford, NH

Eatontown, NJ

Morris Plains, NJ

Somers Point, NJ

Las Vegas, NV

Reno, NV

College Point, NY

Lake Success, NY

Orchard Park, NY

Brecksville, OH

Canfield, OH

Columbus, OH

Dublin, OH

Milford, OH

Sylvania, OH

Plymouth Meeting, PA

York, PA

Cranston, RI

Smithfield, RI

Duncan, SC

Mount Pleasant, SC

Knoxville, TN

Memphis, TN

Nashville, TN

Austin, TX

Houston, TX (2)

Irving, TX

Richardson, TX

San Antonio, TX

Salt Lake City, UT

Ashland, VA

Chantilly, VA

Newport News, VA

Norfolk, VA

Roanoke, VA

Rutland, VT

Everett, WA

Oklahoma City, OK

Kennewick, WA

Bend, OR

Portland, OR

Audubon, PA

Dunmore, PA

Monroeville, PA

Spokane Valley, WA

Tukwila, WA

Wauwatosa, WI

Charleston, WV

Fairmont, WV

Item 3. 

Legal Proceedings

For a summary of material legal proceedings, if any, refer to Note 15, Commitments and Contingencies, of the consolidated 

financial statements included in Item 8 of this report.

Item 4. 

Mine Safety Disclosures

Item not applicable.

22

PART II

Item 5. 

Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities

Common Stock

During 2019, our Common Stock, par value $0.0001 per share, was traded on the Nasdaq Capital Market under the symbol 

“BIOS”. On February 3, 2020, we changed our symbol to “OPCH” and began trading on the Nasdaq Global Select Market.

Holders of Record

As of March 3, 2020, there were 173 stockholders of record of our Common Stock.

Dividend Policy

We have never paid cash dividends on our Common Stock and do not anticipate doing so in the foreseeable future.

Securities Authorized for Issuance under Equity Compensation Plans

See Item 12, “Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters.”

Recent Sale of Unregistered Securities and Use of Proceeds

None.

Stock Performance Graph

The following graph compares the total cumulative returns of BioScrip through August 6, 2019 and Option Care Health 

from August 7, 2019 through December 31, 2019 with the total cumulative returns of the Nasdaq Composite Index and the 
Nasdaq Health Services Index for the five-year period from December 31, 2014 through December 31, 2019. The graph shows 
the performance of a $100 investment in our Common Stock and each index as of December 31, 2014.

23

2014

2015

2016

2017

2018

2019

Years Ended December 31,

Option Care Health, Inc. $

100.00

Nasdaq Composite Index $

100.00

Nasdaq Health Services Index $

100.00

$

$

$

25.04

104.81

106.86

$

$

$

14.88

112.68

88.78

$

$

$

41.63

144.50

107.70

$

$

$

51.07

138.89

103.21

$

$

$

53.36

187.81

129.87

* $100 invested on December 31, 2014 in stock or index, including reinvestment of dividends.

24

Item 6. 

Selected Financial Data

The selected consolidated financial data presented below should be read in conjunction with, and is qualified in its entirety 
by reference to, Management’s Discussion and Analysis of Financial Condition and Results of Operations and our Consolidated 
Financial Statements and the Notes thereto appearing elsewhere in this Annual Report. The selected consolidated financial data 
for the years ended December 31, 2019 and 2018 reflect the adoption of ASU 2014-09, Revenue from Contracts with 
Customers  (“ASC 606”) and the selected financial data for the year ended December 31, 2019 reflects the adoption of ASU 
2016-02, Leases (“ASC 842”). Further discussion on the impacts of ASC 606 can be found in Note 4, Revenue, and further 
discussion on the impacts of ASC 842 can be found in Note 8, Leases, within the Consolidated Financial Statements included 
in Item 8 of this report. The below periods include the results of operations from BioScrip, Inc. from the August 6, 2019 Merger 
Date onward. Prior to April 7, 2015, Option Care (the “Successor”) was a wholly owned subsidiary of Walgreen Co. operating 
under the name Walgreens Infusion Services, Inc. ( the Predecessor”). The Consolidated Statements of Comprehensive Income 
(Loss) presented below include the Predecessor’s results of operations for the period from January 1, 2015 through April 6, 
2015 and are demarcated by a black line.

Consolidated Balance Sheets Data:

Working capital (1) (2)

Total assets (2)

Total debt, net

Stockholders' equity

December 31,

2019

2018

2017

2016

2015

(in thousands)

$

228,650

$

227,428

$

226,535

$

227,763

$

229,243

2,589,547

1,428,211

1,429,542

1,405,285

1,377,275

1,286,496

906,827

539,375

602,825

540,346

606,105

541,500

600,770

542,888

596,121

(1) Working capital consists of total current assets less total current liabilities.

(2) Working capital and total assets for the year ended December 31, 2019 reflect the adoption of ASU 2016-02, Leases, 

and are, therefore, not comparable to prior periods. For a full discussion on the impacts of the adoption see Note 8. Leases, 
included in Item 8 of this report.

Year Ended December 31,

Successor

Predecessor

2019 (1)

2018

2017

2016

April 7, 2015 -
December 31, 2015

January 1, 2015 -
April 6, 2015

Periods Ended

(in thousands)

Consolidated Statements of 
Comprehensive Income (Loss)

Net revenue (2)

Gross profit (2)

Net income (loss)

Net comprehensive income (loss)

Net income (loss) per share, basic
and diluted (3)

Weighted average common shares
outstanding, basic and diluted (3)

$ 2,310,417

$ 1,939,791

$ 1,828,046

$ 1,711,438

$

1,163,009

$

512,999

422,215

445,999

449,307

Operating income (loss)

(319)

38,269

27,279

52,448

(75,920)

(83,959)

(6,115)

(5,341)

3,878

3,936

(0.49)

(0.04)

0.03

3,910

3,910

0.03

156,280

142,614

142,614

142,614

142,614

379,672

96,518

(1,721)

(5,761)

(5,761)

312,597

6,129

(17,696)

(17,696)

(0.12)

(1) 2019 includes the results of operations of BioScrip from August 6, 2019 onward and are, therefore, not comparable to 

prior periods.

(2) Net revenue and gross profit for the years ended December 31, 2019 and 2018 reflect the adoption of ASU 2014-09, 

Revenue from Contracts with Customers, and are, therefore, not comparable to prior periods. For a full discussion on the 
impacts of the adoption see Note 4, Revenue, included in Item 8 of this report.

25

(3) Predecessor period represents the period prior to the acquisition of Walgreens Infusion Services from Walgreen Co., 

and therefore no shares of common stock were outstanding. As a result, there is no net income (loss) per share or weighted 
average common shares outstanding information available for this period.

Item 7. 

Management’s Discussion and Analysis of Financial Condition and Results of Operations

The following Management’s Discussion and Analysis of Financial Condition and Results of Operations is designed to 
assist the reader in understanding our Consolidated Financial Statements, the changes in certain key items in those financial 
statements from year-to-year and the primary factors that accounted for those changes as well as how certain accounting 
principles affect our Consolidated Financial Statements.

Except for the historical information contained herein, the following discussion contains forward-looking statements that 
are subject to known and unknown risks, uncertainties and other factors that may cause our actual results to differ materially 
from those expressed or implied by such forward-looking statements. We discuss such risks, uncertainties and other factors 
throughout this Annual Report and specifically under the caption “Forward-Looking Statements” and under “Item 1A. Risk 
Factors” in this Annual Report. In addition, the following discussion of financial condition and results of operations should be 
read in conjunction with the Consolidated Financial Statements and Notes thereto appearing in Item 8 in this Annual Report.

Business Overview

Option Care Health, and its wholly-owned subsidiaries, provides infusion therapy and other ancillary health care services 

through a national network of 158 locations around the United States. The Company contracts with managed care 
organizations, third-party payers, hospitals, physicians, and other referral sources to provide pharmaceuticals and complex 
compounded solutions to patients for intravenous delivery in the patients’ homes or other nonhospital settings. Our services are 
provided in coordination with, and under the direction of, the patient’s physician. Our multidisciplinary team of clinicians, 
including pharmacists, nurses, dietitians and respiratory therapists, work with the physician to develop a plan of care suited to 
each patient’s specific needs. We provide home infusion services consisting of anti-infectives, nutrition support, bleeding 
disorder therapies, immunoglobulin therapy, and other therapies for chronic and acute conditions.

HC Group Holdings II, Inc. (“HC II”) was incorporated under the laws of the State of Delaware on January 7, 2015, with 

its sole shareholder being HC Group Holdings I, LLC. (“HC I”). On April 7, 2015, HC I and HC II collectively acquired 
Walgreens Infusion Services, Inc. and its subsidiaries from Walgreen Co., and the business was rebranded as Option Care, Inc. 
(“Option Care”).

On March 14, 2019, HC I and HC II entered into a definitive agreement (the “Merger Agreement”) to merge with and into 

a wholly-owned subsidiary of BioScrip, Inc. (“BioScrip”) (the “Merger”), a national provider of infusion and home care 
management solutions, which was completed on August 6, 2019 (the “Merger Date”). The Merger was accounted for as a 
reverse merger under the acquisition method of accounting for business combinations with Option Care being considered the 
accounting acquirer and BioScrip being considered the legal acquirer. Following the close of the transaction, BioScrip was 
rebranded as Option Care Health, Inc. and the combined company’s stock, par value $0.0001, was listed on the Nasdaq Capital 
Market as of December 31, 2019. Effective February 3, 2020, the Company was listed on the Nasdaq Global Select Market 
under the ticker symbol “OPCH”. See Note 3, Business Acquisitions, of the consolidated financial statements for further 
discussion of the Merger.

Merger Integration Execution

The Merger of Option Care and BioScrip into Option Care Health has created an opportunity to realize cost synergies 
while continuing to drive organic growth in chronic and acute therapies through our expanded national platform. Option Care 
Health is well-positioned to leverage the investments in corporate infrastructure and drive economies of scale as a result of the 
Merger. The forecasted synergy categories are as follows:

• 

Selling, General and Administrative Expenses Savings. Merged corporate infrastructure has created 
significant opportunity for streamlining corporate and administrative costs, including headcount and 
functional spend.

•  Network Optimization. The previous investments in technology and compounding pharmacies, along with the 

• 

overlapping geographic footprint, allow for facility rationalization and the optimization of assets. 
Procurement Savings. The enhanced scale of the Company generates supply chain efficiencies through 
increased purchasing leverage. The Company’s platform is also positioned to be the partner of choice for 
pharmaceutical manufacturers seeking innovative distribution channels and patient support models to access 
the market.

26

We believe the achievement of these synergies will enable the delivery of high-quality, cost-effective solutions to providers 

across the country and help facilitate the introduction of new therapies to the marketplace while improving the profitability 
profile of the Company. 

Since the Merger, we have worked to align our field and sales teams. We have also made strides at combining our 
procurement processes and contracts, all while continuing to focus on serving our patients. Patient health is personal to us, 
which is why, throughout the integration process, we strive to improve and set the standard for quality care that is matched by 
best-in-class service. After completion of the Merger, we have additional resources to invest in our people, processes and 
systems, providing us improved strength and scale to drive better patient outcomes.

Changes to Medicare Reimbursement

In recent years, legislative changes have resulted in reductions in reimbursement under government healthcare programs. 

In December 2016, the Cures Act legislation was signed into law, which decreased reimbursement for Medicare Part B Durable 
Medical Equipment infusion drugs administered in an alternate site setting effective January 1, 2017. The original legislation 
did not provide for reimbursement for the service component until 2021. Center for Medicare and Medicaid Services issued a 
final rule in October 2018 implementing a temporary transition benefit for Medicare Part B home infusion services, which will 
continue from January 1, 2019 until January 1, 2021. This temporary transition benefit defines professional services as only 
including nursing, and not pharmacy, care planning, care coordination, or monitoring, and only pays for an infusion day when 
the nurse is in the home.

Acquisitions

The Company has made strategic acquisitions to expand both its national footprint as well as its service line offering. 

These acquisitions are comprised of the following:

Option Care merged with BioScrip on August 6, 2019. BioScrip was a national provider of infusion and home care 

management, who partnered with physicians, hospital systems, payers, pharmaceutical manufacturers and skilled nursing 
facilities to provide patients access to post-acute care services. The fair value of purchase consideration transferred, net of cash 
acquired, on the closing date of $1,087.2 million includes the value of the number of shares of the combined company to be 
owned by BioScrip shareholders at closing of the Merger, the value of common shares to be issued to certain warrant and 
preferred shareholders in conjunction with the Merger, the value of stock-based instruments that were vested or earned as of the 
Merger, and cash payments made in conjunction with the Merger. The fair value per share of BioScrip’s common stock was 
$2.67 per share on August 6, 2019. For additional information on this transaction, see Note 3, Business Acquisitions, of the 
consolidated financial statements.

In September 2018, we completed the acquisition of 100% of the outstanding shares of Home I.V. Specialists, Inc. (“Home 
IV”), for a purchase price of $11.6 million, net of cash acquired. The Home IV acquisition expands our presence in Arkansas as 
we acquired Home IV’s three pharmacy locations in that state.

Composition of Results of Operations 

The following results of operations include the accounts of Option Care Health and our subsidiaries for the years ended 

December 31, 2019, 2018 and 2017. The BioScrip results have been included since the August 6, 2019 Merger Date.

Net Revenue

Infusion and related health care services revenue is reported at the estimated net realizable amounts from third-party payers 
and patients for goods sold and services rendered. When pharmaceuticals are provided to a patient, revenue is recognized upon 
delivery of the goods. When nursing services are provided, revenue is recognized when the services are rendered.

Due to the nature of the health care industry and the reimbursement environment in which the Company operates, certain 
estimates are required to record revenue and accounts receivable at their net realizable values at the time goods or services are 
provided. Inherent in these estimates is the risk that they will have to be revised or updated as additional information becomes 
available. Specifically, the complexity of many third-party billing arrangements and the uncertainty of reimbursement amounts 
for certain services from certain payers may result in adjustments to amounts originally recorded.

27

Cost of Revenue

Cost of revenue consists of the actual cost of pharmaceuticals and other medical supplies dispensed to patients. In addition 

to product costs, cost of revenue includes warehousing costs, purchasing costs, depreciation expense relating to revenue-
generating assets, such as infusion pumps, shipping and handling costs, and wages and related costs for the pharmacists, nurses, 
and all other employees and contracted workers directly involved in providing service to the patient.

The Company receives volume-based rebates and prompt payment discounts from some of its pharmaceutical and medical 

supplies vendors. These payments are recorded as a reduction of inventory and are accounted for as a reduction of cost of 
revenue when the related inventory is sold.

Operating Costs and Expenses

Selling, General and Administrative Expenses. Selling, general and administrative expenses consist principally of salaries 

for administrative employees that directly and indirectly support the operations, occupancy costs, marketing expenditures, 
insurance, and professional fees.

Depreciation and Amortization Expense. Depreciation within this caption includes infrastructure items such as computer 

hardware and software, office equipment and leasehold improvements. Depreciation of revenue-generating assets, such as 
infusion pumps, is included in cost of revenue.

Other Income (Expense)

Interest Expense, Net. Interest expense consists principally of interest payments on the Company’s outstanding borrowings 
under the ABL Facility, the First Lien Term Loan and Second Lien Notes, as well as the amortization of discount and deferred 
financing fees. Refer to the “Liquidity and Capital Resources” section below for further discussion of these outstanding 
borrowings.

Equity in Earnings of Joint Ventures. Equity in earnings of joint ventures consists of our proportionate share of equity 

earnings or losses from equity investments in two infusion joint ventures with health systems.

Other, Net. Other income (expense) primarily includes third-party fees paid in conjunction with our 2019 debt issuance of 

the Loan Facilities and Second Lien Notes and loss on extinguishment of debt for the Company’s Previous Credit Facilities.

Income Tax Expense (Benefit). The Company is subject to taxation in the United States and various states. The Company’s 

income tax (benefit) expense is reflective of the current federal tax rates.

Change in unrealized (losses) gains on cash flow hedges, net of income taxes. Change in unrealized (losses) gains on cash 

flow hedges, net of income taxes, consists of the gains and losses associated with the changes in the fair value of hedging 
instruments related to the interest rate caps and interest rate swaps, net of income taxes.

Results of Operations

The following table presents Option Care Health’s consolidated results of operations for the years ended December 31, 

2019, 2018, and 2017 (in thousands):

28

NET REVENUE

COST OF REVENUE

GROSS PROFIT

Year Ended December 31,

2019 (1)

2018

2017

Amount

% of
Revenue

Amount

% of
Revenue

Amount

% of
Revenue

$2,310,417

100.0 % $1,939,791

100.0 % $1,828,046

100.0 %

1,797,418

512,999

77.8 % 1,517,576

78.2 % 1,382,047

22.2 %

422,215

21.8 %

445,999

OPERATING COSTS AND EXPENSES:

Selling, general and administrative expenses

459,628

19.9 %

345,884

17.8 %

338,456

Provision for doubtful accounts (2)

Depreciation and amortization expense

      Total operating expenses

OPERATING (LOSS) INCOME

OTHER INCOME (EXPENSE):

Interest expense, net

Equity in earnings of joint ventures

Other, net

      Total other expense

LOSS BEFORE INCOME TAXES

INCOME TAX BENEFIT

NET (LOSS) INCOME

—

53,690

513,318

(319)

(73,724)

2,840

(6,991)

(77,875)

(78,194)

(2,274)

— %

2.3 %

22.2 %

(0.0)%

—

38,062

383,946

38,269

— %

2.0 %

45,602

34,662

19.8 %

418,720

2.0 %

27,279

(3.2)%

0.1 %

(0.3)%

(3.4)%

(3.4)%

(0.1)%

(45,824)

1,020

(2,233)

(47,037)

(2.4)%

0.1 %

(0.1)%

(2.4)%

(44,307)

2,186

135

(41,986)

(8,768)

(2,653)

(0.5)%

(0.1)%

(14,707)

(18,585)

$ (75,920)

(3.3)% $

(6,115)

(0.3)% $

3,878

OTHER COMPREHENSIVE (LOSS) INCOME, NET 
OF TAX:

Change in unrealized (losses) gains on cash flow
hedges, net of income taxes of $259, $234 and $36,
respectively

OTHER COMPREHENSIVE (LOSS) INCOME

(8,039)

(8,039)

(0.3)%

(0.3)%

774

774

0.0 %

0.0 %

58

58

NET COMPREHENSIVE (LOSS) INCOME

$ (83,959)

(3.6)% $

(5,341)

(0.3)% $

3,936

75.6 %

24.4 %

18.5 %

2.5 %

1.9 %

22.9 %

1.5 %

(2.4)%

0.1 %

0.0 %

(2.3)%

(0.8)%

(1.0)%

0.2 %

0.0 %

0.0 %

0.2 %

(1) 2019 includes the results of operations of BioScrip from August 6, 2019 onward and are, therefore, not comparable to prior 
periods.

(2) Provision for doubtful accounts for the years ended December 31, 2019 and 2018 reflect the adoption of ASU 2014-09, 
Revenue from Contracts with Customers, and are, therefore, not comparable to prior periods. For a full discussion on the impacts 
of the adoption see Note 4, Revenue, included in Item 8 of this report.

Year Ended December 31, 2019 Compared to Year Ended December 31, 2018

The following tables present selected consolidated comparative results of operations for the years ended December 31, 

2019 and 2018:

Net Revenue

Year Ended December 31,

2019

2018

Variance

(in thousands, except for percentages)

Net revenue

$ 2,310,417

$ 1,939,791

$

370,626

19.1%

The 19.1% increase in net revenue was primarily driven by additional revenue following the Merger of $308.9 million. 

29

 
 
 
Additional increases in net revenue were the result of growth in the Company’s portfolio of therapies, particularly those 
therapies to treat chronic conditions such as autoimmune inflammatory disorders.

Cost of Revenue

Year Ended December 31,

2019

2018

Variance

(in thousands, except for percentages)

Cost of revenue

Gross profit margin

$1,797,418

$1,517,576

$ 279,842

18.4%

22.2%

21.8%

The 18.4% increase in cost of revenue was primarily attributable to the increase in revenue. The increase in gross margin 

was driven by the therapy mix shift along with favorable formulary management and procurement contracts as we were able to 
take advantage of more favorable pricing due to increased buying power after the Merger.

Operating Expenses

Year Ended December 31,

2019

2018

Variance

(in thousands, except for percentages)

Selling, general and administrative expenses

$

459,628

$

345,884

$

113,744

Depreciation and amortization expense

53,690

38,062

15,628

      Total operating expenses

$

513,318

$

383,946

$

129,372

32.9%

41.1%

33.7%

The increase in selling, general and administrative expenses in dollars and as a percent of revenue (17.8% of revenue for 
the year ended December 31, 2018 to 19.9% for the year ended December 31, 2019) was driven by transaction and integration 
expenses related to the Merger during the year ended December 31, 2019.

The increase in depreciation and amortization was primarily related to the deprecation of fixed assets acquired and the 

amortization of intangibles acquired from the Merger of $6.2 million and $6.5 million, respectively.

Other Income (Expense)

Year Ended December 31,

2019

2018

Variance

(in thousands, except for percentages)

Interest expense, net

$

(73,724) $

(45,824) $

(27,900)

Equity in earnings of joint ventures

Other, net

2,840

(6,991)

1,020

(2,233)

1,820

(4,758)

      Total other expense

$

(77,875) $

(47,037) $

(30,838)

60.9%

178.4%

213.1%

65.6%

The increase in interest expense of 60.9% was primarily attributable to the additional expense related to the new debt 

issued at the close of the Merger.

The increase in other, net of 213.1% was the result of the debt extinguishment costs incurred in 2019 of $5.5 million as a 

result of the extinguishment of debt in conjunction with the Merger.

30

 
 
 
 
 
Income Tax Expense (Benefit)

Year Ended December 31,

2019

2018

Variance

(in thousands, except for percentages)

Income tax expense (benefit)

$

(2,274) $

(2,653) $

379

(14.3)%

The Company’s tax benefit for the year ended December 31, 2019 is comprised of a deferred tax benefit partially offset by 

a change in valuation allowance and state tax liabilities. This results in an effective tax rate of 2.9% for the year ended 
December 31, 2019. During the year ended December 31, 2018, the effective tax rate was 30.3%. These rates differ from the 
Company’s 21% federal statutory rate primarily due to a change in valuation allowance, certain state and local taxes, non-
deductible costs, and resolution of certain tax matters.

Net (Loss) Income and Other Comprehensive (Loss) Income

Year Ended December 31,

2019

2018

Variance

(in thousands, except for percentages)

Net (loss) income

$

(75,920) $

(6,115) $

(69,805)

1,141.5 %

Other comprehensive income (loss), net of tax:

Changes in unrealized (losses) gains on cash
flow hedges, net of income taxes

Other comprehensive (loss) income

(8,039)

(8,039)

774

774

(8,813)

(1,138.6)%

(8,813)

(1,138.6)%

Net comprehensive (loss) income

$

(83,959) $

(5,341) $

(78,618)

1,472.0 %

Net loss increased $69.8 million primarily driven by increased depreciation and amortization expense, transaction expenses 

and integration costs related to the Merger, increased interest expense, as well as the loss on the extinguishment of debt.

Changes in unrealized (losses) gains on cash flow hedges, net of income taxes, decreased as a result of the decrease in the 
variable interest rates during 2019. The interest rate swaps in 2019 are hedging against the first $911.1 million of the First Lien 
Term Loan and the first $400.0 million of the Second Lien Term Loan, whereas the interest rate caps in 2018 through April 
2019 were on the first $250.0 million of the Previous First Lien Term Loan, resulting in a larger impact on unrealized (losses) 
gains on cash flow hedges in 2019.

Net comprehensive loss increased $78.6 million for the year ended December 31, 2019 as a result of the changes in net 

loss, discussed above, further reduced by the impact of the fair value of the hedging instruments.

Year Ended December 31, 2018 Compared to Year Ended December 31, 2017

The following tables present selected consolidated comparative results of operations for the years ended December 31, 

2018 and 2017:

Net Revenue

Year Ended December 31,

2018

2017

Variance

(in thousands, except for percentages)

Net revenue

$ 1,939,791

$ 1,828,046

$

111,745

6.1%

The 6.1% increase in net revenue was primarily driven by growth in the Company’s portfolio of therapies to treat chronic 

conditions such as autoimmune inflammatory disorders, as well as a shift in commercial strategy to better leverage the 
capabilities of its care transition specialists to capture additional market share. The 2017 launch of additional therapies for the 
treatment of amyotrophic lateral sclerosis and Duchenne muscular dystrophy resulted in a $138.9 million increase in the 
Company’s revenue in 2018. The favorable impact of these items offset the disruption impact from the implementation of a 
new pharmacy system, which was deployed from November 2016 to November 2018. Additionally, 2018 net revenue reflects a 

31

 
 
 
 
 
 
decrease of $61.3 million related to the implementation of ASC Topic 606, Revenue from Contracts with Customers, (See 
“Revenue Recognition” within Note 2, Summary of Significant Accounting Policies), which resulted in the previously reported 
provision for doubtful accounts being treated as an implicit price concession that reduces net revenue upon adoption in 2018. 

Cost of Revenue

Year Ended December 31,

2018

2017

Variance

(in thousands, except for percentages)

Cost of revenue

Gross profit margin

$1,517,576

$1,382,047

$ 135,529

9.8%

21.8%

24.4%

The increase in cost of revenue was primarily attributable to the increase in revenue, combined with a number of higher 
cost pharmaceuticals being introduced into the Company’s therapy mix. This impact of the therapy mix shift on gross profit 
margin was partially offset by favorable formulary management and procurement contracts, as well as the introduction of 
generic alternatives. Over the course of the year, the Company focused on pharmacy efficiency through the utilization of 
regional compounding facilities and centers of excellence. In addition, the adoption of ASC 606 in 2018 contributed to the 
decline in gross margin.

Operating Expenses

Year Ended December 31,

2018

2017

Variance

(in thousands, except for percentages)

Selling, general and administrative expenses

$

345,884

$

338,456

$

7,428

2.2 %

Provision for doubtful accounts

Depreciation and amortization expense

—

38,062

45,602

34,662

      Total operating expenses

$

383,946

$

418,720

$

(34,774)

(45,602)

(100.0)%

3,400

9.8 %

(8.3)%

The $7.4 million increase in selling, general and administrative expenses was associated with the increase in sales volume, 

but as a percentage revenue declined to 17.8% in 2018 from 18.5% in 2017 as topline growth outpaced this incremental 
increase in operating costs and expenses.

Provision for doubtful accounts decreased as a result of the implementation of ASC Topic 606 (See “Revenue 

Recognition” within Note 2, Summary of Significant Accounting Policies) which resulted in the previously reported provision 
for doubtful accounts in 2017 being treated as an implicit price concession that reduces net revenue upon adoption in 2018.

The increase in depreciation and amortization expense was primarily due to the investments made into the Company’s 

pharmacy and information technology infrastructure in 2018.

Other Income (Expense)

Year Ended December 31,

2018

2017

Variance

(in thousands, except for percentages)

Interest expense, net

$

(45,824) $

(44,307) $

(1,517)

3.4 %

Equity in earnings of joint ventures

Other, net

1,020

(2,233)

2,186

135

(1,166)

(53.3)%

(2,368)

(1,754.1)%

      Total other expense

$

(47,037) $

(41,986) $

(5,051)

12.0 %

The $1.5 million increase in interest expense was attributable to the increasing variable interest rates associated with the 

outstanding debt. To minimize the impact of these increasing rates, the Company repriced its first lien debt in June 2018 

32

 
 
 
 
 
resulting in a lower spread over the underlying interest rate. Additionally, the interest rate cap contracts entered into in 2017 
partially mitigated the increase in interest expense.

The increase in other, net was primarily due to costs incurred associated with the repricing of the Previous First Lien Term 

Loan.

Income Tax Expense (Benefit)

Year Ended December 31,

2018

2017

Variance

(in thousands, except for percentages)

Income tax benefit

$

(2,653) $

(18,585) $

15,932

(85.7)%

Income tax benefit decreased $15.9 million, or 85.7%. In December 2017, the United States Government enacted the Tax 
Cuts and Jobs Act of 2017 (“TCJA”), which significantly changed U.S. tax law by, among other things, reducing the corporate 
tax rate from 35% to 21%, effective January 1, 2018. Included in the tax benefit for 2017 is a benefit of $17.0 million related to 
the tax rate reduction, resulting in an effective income rate of 126.4%. The Company’s 2018 income tax benefit returned to a 
normalized run-rate with an effective income tax rate of 30.3%.

Net (Loss) Income and Other Comprehensive (Loss) Income

Net (loss) income

Other comprehensive income, net of tax:

Changes in unrealized gains on cash flow hedges, net of income taxes

Other comprehensive income

Net comprehensive (loss) income

Year Ended December 31,

2018

2017

Variance

(in thousands, except for percentages)

$

(6,115) $

3,878

$

(9,993)

(257.7)%

774

774

58

58

716

716

1,234.5 %

1,234.5 %

$

(5,341) $

3,936

$

(9,277)

(235.7)%

Net income decreased $10.0 million. The decrease was primarily driven by the run-rate normalization of the impact of the 

tax reform legislation, which had a favorable impact in 2017.

Changes in unrealized gains on cash flow hedges, net of income taxes, increased $0.7 million. The increase in the variable 

interest rates during 2018 resulted in a corresponding increase in the fair value of the interest rate cap.

Net comprehensive loss was $5.3 million for the twelve months ended December 31, 2018, compared to net 

comprehensive income of $3.9 million for the twelve months ended December 31, 2017, primarily related to the impact of the 
tax reform legislation previously discussed.

Liquidity and Capital Resources

For the years ended December 31, 2019 and 2018, the Company’s primary sources of liquidity were cash on hand of $67.1 

million and $36.4 million, respectively, as well as borrowings under its credit facilities, described further below. During the 
years ended December 31, 2019 and 2018, the Company’s positive cash flows from operations have enabled investments in 
pharmacy and information technology infrastructure to support growth and create additional capacity in the future, as well as 
pursue acquisitions.

The Company’s primary uses of cash include supporting our ongoing business activities, integration efforts, and 
investment in various acquisitions and our infrastructure to support additional business volumes. Ongoing operating cash 
outflows are associated with procuring and dispensing prescription drugs, personnel and other costs associated with servicing 
patients, as well as paying cash interest on the outstanding debt. Ongoing investing cash flows are primarily associated with 
capital projects related to business acquisitions, the improvement and maintenance of our pharmacy facilities and investment in 
our information technology systems. Ongoing financing cash flows are primarily associated with the quarterly principal 

33

 
 
 
 
payments on our outstanding debt. In addition to these ongoing investing and financing activities, during the year ended 
December 31, 2019, the Company entered into the Merger Agreement, and the Merger resulted in cash used in investing 
activities of $700.2 million and net cash provided by financing activities for net proceeds of indebtedness of $724.3 million.

Our business strategy includes the selective acquisition of additional infusion pharmacies and other related healthcare 
businesses. We continue to evaluate acquisition opportunities and view acquisitions as a key part of our growth strategy. The 
Company historically has funded its acquisitions with cash with the exception of the Merger. The Company may require 
additional capital in excess of current availability in order to complete future acquisitions. It is impossible to predict the amount 
of capital that may be required for acquisitions, and there is no assurance that sufficient financing for these activities will be 
available on acceptable terms.

Short-Term and Long-Term Liquidity Requirements

The Company’s ability to make principal and interest payments on any borrowings under our credit facilities and our 
ability to fund planned capital expenditures will depend on our ability to generate cash in the future, which, to a certain extent, 
is subject to general economic, financial, competitive, regulatory and other conditions. Based on our current level of operations 
and planned capital expenditures, we believe that our existing cash balances and expected cash flows generated from operations 
will be sufficient to meet our operating requirements for at least the next 12 months. We may require additional borrowings 
under our credit facilities and alternative forms of financings or investments to achieve our longer-term strategic plans.

Credit Facilities

During 2015, Option Care entered into two credit arrangements administered by Bank of America, N.A. and U.S. Bank. 
The agreements provided for up to $645.0 million in senior secured credit facilities through an $80.0 million revolving credit 
facility (the “Previous Revolving Credit Facility”), a $415.0 million first lien term loan (the “Previous First Lien Term Loan”), 
and a $150.0 million second lien term loan (the “Previous Second Lien Term Loan”, and together with the Previous First Lien 
Term Loan, the “Previous Term Loans”, and the Previous Term Loans, together with the Previous Revolving Credit Facility, the 
“Previous Credit Facilities”). Amounts borrowed under the credit agreements were secured by substantially all of the assets of 
the Company.

On August 6, 2019, the Company repaid the outstanding balance of the Previous Term Loans and retired the outstanding 

credit arrangements for $551.7 million. Proceeds of $575.0 million from the two new credit arrangements and indenture, 
discussed below, were also used, in part, to repay the outstanding debt of BioScrip as of the Merger.

In conjunction with the Merger, the Company entered into an asset-based-lending revolving credit facility and a first lien 
term loan facility. The Company also issued senior secured second lien PIK toggle floating rate notes due 2027 (the “Second 
Lien Notes”). The two new credit agreements and the indenture were entered into on August 6, 2019 and provide for up to 
$1,475.0 million in senior secured credit facilities through a $150.0 million asset-based-lending revolving credit facility (the 
“ABL Facility”), a $925.0 million first lien term loan (the “First Lien Term Loan”, and together with the ABL Facility, the 
“Loan Facilities”), and a $400.0 million issuance of Second Lien Notes. Amounts borrowed under the credit agreements are 
secured by substantially all of the assets of the Company.

The ABL Facility credit agreement provides for borrowings up to $150.0 million, which matures on August 6, 2024. The 
ABL Facility bears interest at a per annum rate that is determined by the Company’s periodic selection of rate type, either the 
Base Rate or the Eurocurrency Rate. The Base Rate is charged between 1.25% and 1.75% and the Eurocurrency Rate is charged 
between 2.25% and 2.75% based on the historical excess availability as a percentage of the Line Cap, as defined in the ABL 
Facility credit agreement. The revolving credit facility contains commitment fees payable on the unused portion of the ABL 
ranging from 0.25% to 0.375%, depending on various factors including the Company’s leverage ratio, type of loan and rate 
type, and letter of credit fees of 2.50%. The Company had no outstanding borrowings under the ABL Facility at December 31, 
2019. The Company had $9.6 million of undrawn letters of credit issued and outstanding, resulting in net borrowing availability 
under the ABL of $140.4 million as of December 31, 2019. 

The principal balance of the First Lien Term Loan is repayable in quarterly installments of $2.3 million plus interest, with a 

final payment of all remaining outstanding principal due on August 6, 2026. The quarterly principal payments will commence 
in March of 2020. Interest on the First Lien Term Loan is payable monthly on Base Rate loans at Base Rate, as defined, plus 
3.25% to 3.50%, depending on the Company’s leverage ratio. Interest is charged on Eurocurrency Rate loans at the 
Eurocurrency Rate, as defined, plus 4.25% to 4.50%, depending on the Company’s leverage ratio. The interest rate on the First 
Lien Term Loan was 6.20% as of December 31, 2019. 

34

The Second Lien Notes mature on August 6, 2027. Interest on the Second Lien Notes is payable quarterly and is at the 

greater of 1.00% or LIBOR, plus 8.75%. The Company elected to pay-in-kind the first quarterly interest payment, due in 
November 2019, which resulted in the Company capitalizing the interest payment to the principal balance on the interest 
payment date, increasing the outstanding principal balance to $412.3 million. The interest rate on the Second Lien Notes was 
10.66% as of December 31, 2019. 

Cash Flows

Year Ended December 31, 2019 Compared to Year Ended December 31, 2018

The following table presents selected data from Option Care Health’s consolidated statements of cash flows for the years 

ended December 31, 2019 and 2018:

Year Ended December 31,

2019

2018

Variance

(in thousands)

Net cash provided by operating activities

$

39,467

$

24,428

$

15,039

Net cash used in investing activities

(727,826)

(37,003)

(690,823)

Net cash provided by (used in) financing activities

Net increase (decrease) in cash and cash equivalents

Cash and cash equivalents - beginning of period

719,024

30,665

36,391

(4,150)

(16,725)

53,116

723,174

47,390

(16,725)

Cash and cash equivalents - end of period

$

67,056

$

36,391

$

30,665

Cash Flows from Operating Activities

For the year ended December 31, 2019, Option Care Health generated $39.5 million in cash flow from operating activities, 

a $15.0 million increase over the year ended December 31, 2018. The cash provided by operating activities for the year ended 
December 31, 2019 was driven by working capital efficiencies, primarily in accounts receivable, as the Company’s efforts to 
increase cash velocity and improve the aging of the accounts receivable balance resulted in stronger cash collections. The 
strong collections were partially offset by the change in accounts payable as the Company had a net pay down of acquired 
payables from the Merger.

Cash Flows from Investing Activities

For the year ended December 31, 2019, Option Care Health used $727.8 million in cash for investing activities as 
compared to $37.0 million for the year ended December 31, 2018. For the year ended December 31, 2019, the cash used was 
primarily attributable to the Merger of $700.2 million as well as investments in pharmacy and information technology 
infrastructure of $28.3 million. Similarly, for the year ended December 31, 2018, $26.3 million was invested in our pharmacies 
and information technology and $10.7 million was deployed for the Baptist Health and Home IV, Inc. acquisitions.

Cash Flows from Financing Activities

Cash flows from financing increased $723.2 million from cash used in financing activities of $4.2 million for the year 

ended December 31, 2018 to cash provided by financing activities of $719.0 million for the year ended December 31, 2019. 
The change is primarily related to the proceeds from the issuance of new debt of $981.1 million, partially offset by the 
retirement of the Company’s previous debt of $226.7 million and the payment of deferred financing costs of $30.0 million for 
the year ended December 31, 2019. Cash used in financing activities for the year ended December 31, 2018 primarily related to 
repayments of the Previous Credit Facilities.

Year Ended December 31, 2018 Compared to Year Ended December 31, 2017

The following table presents selected data from Option Care Health’s consolidated statements of cash flows for the years 

ended December 31, 2018 and 2017:

35

 
 
Year Ended December 31,

2018

2017

Variance

(in thousands)

Net cash provided by operating activities

$

24,428

$

37,871

$

(13,443)

Net cash used in investing activities

Net cash used in financing activities

Net (decrease) increase in cash and cash equivalents

Cash and cash equivalents - beginning of period

(37,003)

(24,472)

(12,531)

(4,150)

(16,725)

53,116

(5,150)

8,249

44,867

1,000

(24,974)

8,249

Cash and cash equivalents - end of period

$

36,391

$

53,116

$

(16,725)

Cash Flows from Operating Activities

For the year ended December 31, 2018, Option Care Health generated $24.4 million in positive cash flow from operating 
activities. This represented a $13.4 million decrease from the $37.9 million generated for the year ended December 31, 2017. 
The primary drivers of the decline in cash provided by operating activities included: (i) a reduction in accounts payable and 
accrued expenses and other current liabilities of $32.1 million related to timing of vendor payments in the ordinary course of 
business; and (ii) an increase in prepaid expenses and other current assets of $17.2 million primarily driven by the timing of 
vendor rebate payments. Partially offsetting these declines were the following improvements: (i) an improvement in accounts 
receivable of $13.0 million as the Company was recovering from the prior year disruption impact of the new pharmacy 
dispensing system deployment and billing center consolidation; (ii) an improvement in operating income of $11.0 million; (iii) 
a $6.7 million increase in accrued compensation and employee benefits related to the timing of payroll cycles; and (iv) a $6.4 
million reduction in inventory.

Cash Flows from Investing Activities

For the year ended December 31, 2018, Option Care Health used $37.0 million in cash for investing activities. This was 

primarily attributable to capital investments in pharmacy and information technology infrastructure, as well as to fund the 
Baptist and Home IV acquisitions.

The increase of $12.5 million in net cash used in investing activities for the year ended December 31, 2018 compared to 

the year ended December 31, 2017 is due primarily to the Baptist and Home IV acquisitions.

Cash Flows from Financing Activities

For the year ended December 31, 2018, Option Care Health used $4.2 million in cash for financing activities. This was 

related to repayments of long-term debt.

Commitments and Contractual Obligations

The following table presents Option Care Health’s commitments and contractual obligations as of December 31, 2019, as 

well as its long-term obligations:

Payments Due by Period

Total

Less than 1
year

1 - 3 years

3-5 years

More than
5 years

(in thousands)

Long-term debt obligations (1)
Interest payments on long-term debt obligations (2)

Operating lease obligations

Total

$ 1,337,256

$

9,250

$

18,500

$

18,500

$ 1,291,006

741,228

94,257

101,121

24,983

200,498

33,160

198,171

18,452

241,438

17,662

$ 2,172,741

$

135,354

$

252,158

$

235,123

$ 1,550,106

(1)  Includes aggregate principal payment on the indebtedness from the First Lien Term Loan and the Second Lien Notes 

incurred in 2019.

(2)  Interest payments calculated based on LIBOR rate as of December 31, 2019. Actual payments are based on changes in 

36

 
 
LIBOR. Calculated interest payments exclude interest rate swap agreements the Company entered into in connection 
with the new indebtedness incurred in 2019.

Other noncurrent liabilities and deferred income taxes were excluded from this table, as the Company is unable to 

determine the timing of future payments. There were no significant capital expenditure commitments as of December 31, 2019. 
The contractual commitment amounts in the table above are associated with agreements that are enforceable and legally 
binding.

Off-Balance Sheet Arrangements

As of December 31, 2019, Option Care Health did not have any off-balance sheet arrangements, as defined in Item 303(a)

(4)(ii) of Regulation S-K.

Critical Accounting Policies and Estimates

The Company prepares its consolidated financial statements in accordance with United States generally accepted 

accounting principles (“GAAP”), which requires the Company to make estimates and assumptions. The Company evaluates its 
estimates and judgments on an ongoing basis. Estimates and judgments are based on historical experience and on various other 
factors that are believed to be reasonable under the circumstances, the results of which form the basis for making judgments 
about the carrying values of assets and liabilities at the date of the financial statements and the reported amounts of revenues 
and expenses for the period presented. The Company’s actual results may differ from these estimates, and different assumptions 
or conditions may yield different estimates.

The following discussion is not intended to be a comprehensive list of all the accounting policies, estimates or judgments 

made in the preparation of our financial statements. A discussion of our significant accounting policies, including further 
discussion of the accounting policies described below, can be found in Note 2, Summary of Significant Accounting Policies, 
within the Notes to the Consolidated Financial Statements included in Item 8 of this Annual Report.

Revenue Recognition and Accounts Receivable

Net revenue is reported at the net realizable value amount that reflects the consideration the Company expects to receive in 

exchange for providing services. Revenues are from commercial payers, government payers, and patients for goods and 
services provided and are based on a gross price based on payer contracts, fee schedules, or other arrangements less any 
implicit price concessions.

Due to the nature of the health care industry and the reimbursement environment in which the Company operates, certain 
estimates are required to record revenue and accounts receivable at their net realizable values at the time goods or services are 
provided. Inherent in these estimates is the risk that they will have to be revised or updated as additional information becomes 
available. 

The Company assesses the expected consideration to be received at the time of patient acceptance based on the verification 

of the patient’s insurance coverage, historical information with the patient, similar patients, or the payer. Performance 
obligations are determined based on the nature of the services provided by the Company. The majority of the Company’s 
performance obligations are to provide infusion services to deliver medicine, nutrients, or fluids directly into the body. 

The Company provides a variety of infusion-related therapies to patients, which frequently include multiple deliverables of 

pharmaceutical drugs and related nursing services. After applying the criteria from ASC 606, the Company concluded that 
multiple performance obligations exist in its contracts with its customers. Revenue is allocated to each performance obligation 
based on relative standalone price, determined based on reimbursement rates established in the third-party payer contracts. 
Pharmaceutical drug revenue is recognized at the time the pharmaceutical drug is delivered to the patient, and nursing revenue 
is recognized on the date of service.

The Company’s accounts receivable are reported at the net realizable value amount that reflects the consideration the 
Company expects to receive in exchange for providing services, which is inclusive of adjustments for price concessions. The 
majority of accounts receivable are due from private insurance carriers and governmental health care programs, such as 
Medicare and Medicaid.

Price concessions may result from patient hardships, patient uncollectible accounts sent to collection agencies, lack of 
recovery due to not receiving prior authorization, differing interpretations of covered therapies in payer contracts, different 
pricing methodologies, or various other reasons. 

37

Included in accounts receivable are earned but unbilled gross receivables. Delays ranging from one day up to several 

weeks between the date of service and billing can occur due to delays in obtaining certain required payer-specific 
documentation from internal and external sources.

Prior to the adoption of ASC 606, estimates of uncollectible accounts receivable were recorded as either a pricing 

adjustment to revenue (“contractual adjustment”) or as an uncollectible account to provision for doubtful accounts. The 
Company recorded an allowance for doubtful accounts based on historical experience and a detailed assessment of the 
collectability of its accounts receivable. In estimating the allowance for doubtful accounts, the Company considered, among 
other factors, (i) the balance and aging composition of the accounts receivable, (ii) the Company’s historical write-offs and 
recoveries, (iii) the creditworthiness of its payers, and (iv) general economic conditions. Accounts receivable were written-off 
as bad debts after all reasonable collection efforts have been exhausted. Subsequent to the adoption of ASC 606, an allowance 
for doubtful accounts is established only as a result of an adverse change in the payers’ ability to pay outstanding billings. The 
Company recorded an allowance for contractual adjustment based on its historical experience of additional revenue being 
recorded or revenue being written off when amounts received are greater than or less than the originally estimated net 
realizable value. The detailed assessments included, among other factors, (i) current over/under payments which had not yet 
been applied to an account, (ii) historical contractual adjustments, and (iii) an estimate for contractual adjustments expected to 
be realized in the future. Contractual allowance estimates were adjusted to actual amounts as cash was received and claims 
were settled.

Goodwill

Goodwill represents the excess of the purchase price over the fair value of assets acquired and liabilities assumed. The 

Company tests goodwill for impairment annually, or more frequently whenever events or circumstances indicate impairment 
may exist. Goodwill is stated at cost less accumulated impairment losses. The Company completes its goodwill impairment test 
annually in the fourth quarter.

Circumstances that could trigger an interim impairment test include: a significant adverse change in the business climate or 

legal factors; an adverse action or assessment by a regulator; unanticipated competition; the loss of key personnel; a change in 
reporting units; the likelihood that a reporting unit or significant portion of a reporting unit will be sold or otherwise disposed 
of; and the results of testing for recoverability of a significant asset group within a reporting unit.

A qualitative impairment analysis was performed in the fourth quarter of 2019 to assess whether it is more likely than not 

that the fair value of the Company’s reporting unit is less than its carrying value. The Company assessed relevant events and 
circumstances including macroeconomic conditions, industry and market considerations, overall financial performance, entity-
specific events, and changes in the Company’s stock price. The Company determined that there was no goodwill impairment in 
2019.

A quantitative impairment analysis was performed in the fourth quarter of 2018 and 2017, and the Company estimated the 
fair value of its reporting unit using an income approach. The income approach requires the Company to estimate a number of 
factors for its reporting unit, including projected future operating results, economic projections, anticipated future cash flows, 
and discount rates. The fair value determined using he income approach was then compared to marketplace fair value data from 
within a comparable industry grouping for reasonableness. The Company determined that there was no goodwill impairment in 
2018 or 2017.

The determination of fair value and the allocation of that value to individual assets and liabilities within the reporting unit 
requires the Company to make significant estimates and assumptions. These estimates and assumptions primarily include, but 
are not limited to, the selection of appropriate peer group companies; control premiums appropriate for acquisitions in the 
industries in which the Company competes; the discount rate; terminal growth rates; and forecasts of revenue, operating 
income, depreciation and amortization, and capital expenditures. Actual financial results could differ from those estimates due 
to inherent uncertainty involved in making such estimates. Changes in assumptions concerning future financial results or other 
underlying assumptions could have a significant impact on either the fair value of the reporting unit, the amount of the goodwill 
impairment charge, or both.

Business Acquisitions

The Company accounts for business acquisitions in accordance with ASC Topic 805 (“ASC 805”), Business Combinations, 
with assets and liabilities being recorded at their acquisition date fair values and goodwill being calculated as the purchase price 
in excess of the net identifiable assets. The application of ASC 805 requires management to make estimates and assumptions 
when determining the acquisition date fair values of acquired assets and assumed liabilities. Management’s estimates and 
assumptions include, but are not limited to, the future cash flows an asset is expected to generate and the weighted-average cost 
of capital.

38

Item 7A.  Quantitative and Qualitative Disclosures about Market Risk

Interest Rate Risk

The Company’s primary market risk exposure is changing LIBOR based interest rates. Interest rate risk is highly sensitive 

due to many factors, including U.S. monetary and tax policies, U.S. and international economic factors and other factors 
beyond our control. Our First Lien Term Loan bears interest at the Eurocurrency Rate, as defined, plus 4.50%, based on our 
leverage ratio as of December 31, 2019. Our Second Lien Notes bear interest at the greater of 1.00% or LIBOR, plus 8.75%. 
Our ABL Facility bears interest at the Eurocurrency Rate, as defined, plus 2.25%. At December 31, 2019, we had total 
outstanding debt of $925.0 million under our First Lien Term Loan. As of December 31, 2019, we had $412.3 million Second 
Lien Notes issued and outstanding. We had no outstanding borrowings under the ABL Facility as of December 31, 2019.

To minimize interest rate risk, the Company entered into two interest rate swap contracts to hedge against fluctuations in 
LIBOR rates on the First Lien Term Loan and Second Lien Term Loan. The first interest rate swap for $925.0 million notional 
was effective in August 2019 with $911.1 million designated as a cash flow hedge against the underlying interest rate on the 
First Lien Term Loan indexed to one-month LIBOR through August 2021. The second interest rate swap for $400.0 million 
notional was effective in November 2019 and is designated as a cash flow hedge against the underlying interest rate on the 
Second Lien Notes interest payment indexed to three-month LIBOR through November 2020.

Based on the amounts outstanding coupled with interest rate swaps, a 100-basis point increase or decrease in market 
interest rates over a twelve-month period would result in a change to interest expense of $0.9 million. We do not anticipate a 
significant impact from a change in market interest rates through the period of the interest rate swaps, discussed further in Note 
13, Derivative Instruments, of the consolidated financial statements and the notes related thereto included in Item 8 of this 
report.

Foreign Exchange Risk

All sales are in the U.S. and are U.S.-dollar denominated. Option Care Health makes a limited amount of purchases from 

foreign sources, which subjects Option Care Health to foreign currency exchange risk. As a result of the limited amount of 
transactions in a foreign currency, Option Care Health does not expect its future cash flows or operating results to be affected to 
any significant degree by foreign currency exchange risk.

Inflation Rate Risk

Based on its analysis of the periods presented, the Company believes that inflation has not had a material effect on its 
operating results. There can be no assurance that future inflation will not have an adverse impact on the Company’s operating 
results and financial condition.

39

Item 8. 

Financial Statements and Supplementary Data

Report of Independent Registered Public Accounting Firm

To the Stockholders and Board of Directors 
Option Care Health, Inc.:

Opinion on the Consolidated Financial Statements

We have audited the accompanying consolidated balance sheets of Option Care Health, Inc. and subsidiaries (the Company) 
as of December 31, 2019 and 2018, the related consolidated statements of comprehensive income (loss), stockholders’ 
equity, and cash flows for each of the years in the three-year period ended December 31, 2019, and the related notes 
(collectively, the consolidated financial statements). In our opinion, the consolidated financial statements present fairly, in all 
material respects, the financial position of the Company as of December 31, 2019 and 2018, and the results of its operations 
and its cash flows for each of the years in the three year period ended December 31, 2019, in conformity with U.S. generally 
accepted accounting principles.

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United 
States) (PCAOB), the Company’s internal control over financial reporting as of December 31, 2019, based on criteria 
established in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of 
the Treadway Commission, and our report dated March 5, 2020 expressed an unqualified opinion on the effectiveness of 
the Company’s internal control over financial reporting.

Change in Accounting Principle

As discussed in Note 2 to the consolidated financial statements, the Company has changed its method of accounting for 
revenue recognition as of January 1, 2018 and leases as of January 1, 2019 due to the adoptions of ASU No. 2014-09, 
“Revenue from Contracts with Customers” and ASU No. 2016-02, “Leases”.

Basis for Opinion

These consolidated financial statements are the responsibility of the Company’s management. Our responsibility is to 
express an opinion on these consolidated financial statements based on our audits. We are a public accounting firm registered 
with the PCAOB and are required to be independent with respect to the Company in accordance with the U.S. federal 
securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.

We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the 
audit to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement, 
whether due to error or fraud. Our audits included performing procedures to assess the risks of material misstatement of the 
consolidated financial statements, whether due to error or fraud, and performing procedures that respond to those risks. Such 
procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the consolidated financial 
statements. Our audits also included evaluating the accounting principles used and significant estimates made by management, 
as well as evaluating the overall presentation of the consolidated financial statements. We believe that our audits provide a 
reasonable basis for our opinion.

/s/ KPMG LLP

We have served as the Company’s auditor since 2015.

Chicago, Illinois 
March 5, 2020

40

OPTION CARE HEALTH, INC. 
CONSOLIDATED BALANCE SHEETS
(IN THOUSANDS, EXCEPT SHARES AND PER SHARE AMOUNTS)

ASSETS

CURRENT ASSETS:

Cash and cash equivalents

Accounts receivable, net

Inventories

Prepaid expenses and other current assets

Total current assets

NONCURRENT ASSETS: 

Property and equipment, net

Operating lease right-of-use asset

Intangible assets, net

Goodwill

Other noncurrent assets

Total noncurrent assets

TOTAL ASSETS 

LIABILITIES AND STOCKHOLDERS’ EQUITY

CURRENT LIABILITIES:

Accounts payable

Accrued compensation and employee benefits

Accrued expenses and other current liabilities

Current portion of operating lease liability

Current portion of long-term debt

Total current liabilities

NONCURRENT LIABILITIES:

Long-term debt, net of discount, deferred financing costs and current portion

Operating lease liability, net of current portion

Deferred income taxes

Other noncurrent liabilities

Total noncurrent liabilities

Total liabilities

STOCKHOLDERS’ EQUITY: 

Preferred stock; $0.0001 par value; 12,500,000 shares authorized, no shares outstanding as
of December 31, 2019. No preferred stock authorized or outstanding as of December 31,
2018.

Common stock; $0.0001 par value: 250,000,000 shares authorized, 176,975,628 shares
issued and 176,591,907 shares outstanding as of December 31, 2019; 142,613,749
shares issued and outstanding as of December 31, 2018.

Treasury stock; 383,722 shares outstanding, at cost, as of December 31, 2019; no shares

outstanding as of December 31, 2018

Paid-in capital

Management notes receivable

Accumulated deficit

41

December 31,

2019

2018

$

67,056

$

324,416

115,876

51,306

558,654

133,198

63,502

385,910

1,425,542

22,741

2,030,893

36,391

310,169

83,340

37,525

467,425

93,142

—

219,713

632,469

15,462

960,786

$

$

2,589,547

$

1,428,211

221,060

$

187,886

45,765

33,538

20,391

9,250

330,004

1,277,246

58,242

2,143

15,085

1,352,716

1,682,720

—

18

(2,403)

1,008,362

—

(91,955)

24,895

23,066

—

4,150

239,997

535,225

—

33,481

16,683

585,389

825,386

—

14

—

619,621

(1,619)

(16,035)

 
 
 
 
Accumulated other comprehensive (loss) income

Total stockholders’ equity

(7,195)

906,827

TOTAL LIABILITIES AND STOCKHOLDERS’ EQUITY

$

2,589,547

$

844

602,825

1,428,211

The notes to consolidated financial statements are an integral part of these statements.

42

OPTION CARE HEALTH, INC. 
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
(IN THOUSANDS, EXCEPT PER SHARE AMOUNTS)

NET REVENUE

COST OF REVENUE

GROSS PROFIT

OPERATING COSTS AND EXPENSES:

Selling, general and administrative expenses

Provision for doubtful accounts

Depreciation and amortization expense

      Total operating expenses

OPERATING (LOSS) INCOME

OTHER INCOME (EXPENSE):

Interest expense, net

Equity in earnings of joint ventures

Other, net

      Total other expense

LOSS BEFORE INCOME TAXES

INCOME TAX BENEFIT

Year Ended December 31,

2019

2018

2017

$

2,310,417

$

1,939,791

$

1,828,046

1,797,418

1,517,576

1,382,047

512,999

422,215

445,999

459,628

345,884

—

53,690

513,318

(319)

(73,724)

2,840

(6,991)

(77,875)

(78,194)

(2,274)

—

38,062

383,946

38,269

(45,824)

1,020

(2,233)

(47,037)

(8,768)

(2,653)

338,456

45,602

34,662

418,720

27,279

(44,307)

2,186

135

(41,986)

(14,707)

(18,585)

NET (LOSS) INCOME

$

(75,920) $

(6,115) $

3,878

OTHER COMPREHENSIVE (LOSS) INCOME, NET OF TAX:

Change in unrealized (losses) gains on cash flow hedges, net of income taxes of $259,
$234 and $36, respectively

OTHER COMPREHENSIVE (LOSS) INCOME

NET COMPREHENSIVE (LOSS) INCOME

(LOSS) EARNINGS PER COMMON SHARE

Net (loss) earnings per share, basic and diluted

(8,039)

(8,039)

774

774

58

58

(83,959) $

(5,341) $

3,936

(0.49) $

(0.04) $

0.03

$

$

Weighted average common shares outstanding, basic and diluted

156,280

142,614

142,614

The notes to consolidated financial statements are an integral part of these statements.

43

 
OPTION CARE HEALTH, INC. 
CONSOLIDATED STATEMENTS OF CASH FLOWS
(IN THOUSANDS)

CASH FLOWS FROM OPERATING ACTIVITIES:

Net (loss) income

Adjustments to reconcile net (loss) income to net cash provided by operations:

Depreciation and amortization expense

Non-cash operating lease costs

Deferred income taxes - net

Loss on sale of assets

Business casualty loss

Loss on extinguishment of debt

Amortization of deferred financing costs

Paid-in-kind interest capitalized as principal

Equity in earnings of joint ventures

Stock-based incentive compensation expense

Interest on management notes receivable

Capital distribution from equity method investments

Change in contingent consideration liability

Changes in operating assets and liabilities:

Accounts receivable, net

Inventories

Prepaid expenses and other current assets

Accounts payable

Accrued compensation and employee benefits

Accrued expenses and other current liabilities

Operating lease liabilities

Other noncurrent assets and liabilities

Net cash provided by operating activities

CASH FLOWS FROM INVESTING ACTIVITIES:

Acquisition of property and equipment

Proceeds from sale of assets

Insurance proceeds from business casualty loss

Business acquisitions, net of cash acquired

Net cash used in investing activities

CASH FLOWS FROM FINANCING ACTIVITIES:

Redemptions to related parties

Sale of management notes receivable

Exercise of stock options, vesting of restricted stock, and related tax withholdings

Payment of contingent consideration liability

Proceeds from debt

Repayments of debt principal

Retirement of debt obligations

Deferred financing costs

Net cash provided by (used in) financing activities

NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS

Cash and cash equivalents - beginning of the period

CASH AND CASH EQUIVALENTS - END OF PERIOD

44

Year Ended December 31,

2019

2018

2017

$

(75,920) $

(6,115) $

3,878

57,869

19,719

(4,607)

3,269

(626)

5,469

4,544

12,256

(2,840)

4,170

(62)

500

(300)

82,285

(12,853)

(2,940)

(30,856)

2,671

(317)

(17,253)

(4,711)

39,467

41,055

38,062

—

—

(3,595)

(19,804)

1,123

3,549

72

3,107

—

(1,020)

2,139

(78)

2,000

—

(21,012)

2,965

(4,715)

10,965

(5,586)

(1,740)

—

1,314

24,428

999

—

—

2,996

—

(2,186)

1,455

(56)

1,250

—

(34,003)

(3,481)

12,452

47,411

(12,246)

(4,095)

—

5,239

37,871

(28,292)

(26,276)

(24,956)

10

626

—

—

(700,170)

(727,826)

(10,727)

(37,003)

(2,000)

1,310

(2,501)

—

981,050

(2,075)

(226,738)

(30,022)

719,024

30,665

36,391

—

—

—

—

1,000

(5,150)

—

—

(4,150)

(16,725)

53,116

$

67,056

$

36,391

$

484

—

—

(24,472)

—

—

—

(1,000)

—

(4,150)

—

—

(5,150)

8,249

44,867

53,116

 
Supplemental disclosure of cash flow information:

   Cash paid for interest

   Cash paid for income taxes

Cash paid for operating leases

$

$

$

50,808

2,405

18,992

$

$

47,173

1,600

$

$

43,485

1,194

The notes to consolidated financial statements are an integral part of these statements.

45

OPTION CARE HEALTH, INC. 
CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY
(IN THOUSANDS)

Balance - 
December 31, 
2016

Interest on 
management 
notes receivable

Stockholders' 
redemptions

Stock-based 
incentive 
compensation

Net income

Reclassification 
of certain tax 
effects

Other 
comprehensive 
income

Balance - 
December 31, 
2017

Stockholders' 
contributions

Interest on 
management 
notes receivable

Stock-based 
incentive 
compensation

Net loss

Other 
comprehensive 
income

Balance - 
December 31, 
2018

Purchase of 
BioScrip, Inc.

Interest on 
management 
notes receivable

Repayment of
management
notes receivable

Stockholders' 
redemptions

Stock-based 
incentive 
compensation

Preferred
Stock

Common
Stock

Treasury
Stock

Paid-in
Capital

Management
Notes
Receivable

Accumulated
Deficit

Accumulated 
Other 
Comprehensive 
(Loss)
Income

Total
Stockholders’
Equity

$

— $

14

$

— $ 615,713

$

(1,171) $

(13,786) $

— $

600,770

—

—

—

—

—

—

—

—

—

—

—

—

—

—

—

—

—

—

—

(111)

1,455

—

—

—

(56)

111

—

—

—

—

—

—

—

3,878

(12)

—

—

—

—

—

12

58

(56)

—

1,455

3,878

—

58

$

— $

14

$

— $ 617,057

$

(1,116) $

(9,920) $

70

$

606,105

—

—

—

—

—

—

—

—

—

—

—

—

—

—

—

425

—

2,139

—

—

(425)

(78)

—

—

—

—

—

—

(6,115)

—

—

—

—

—

(78)

2,139

(6,115)

—

774

774

$

— $

14

$

— $ 619,621

$

(1,619) $

(16,035) $

844

$

602,825

—

—

—

—

—

4

—

—

—

—

—

387,040

—

—

—

—

—

—

(2,371)

4,170

46

—

(62)

1,310

371

—

—

—

—

—

—

—

—

—

—

—

387,044

(62)

1,310

(2,000)

4,170

Exercise of 
stock options, 
vesting of 
restricted stock, 
and related tax 
withholdings

Net loss

Other 
comprehensive 
loss

Balance - 
December 31, 
2019

—

—

—

—

—

—

(2,403)

—

—

(98)

—

—

—

—

—

—

(75,920)

—

—

(2,501)

(75,920)

—

(8,039)

(8,039)

$

— $

18

$ (2,403) $ 1,008,362

$

— $

(91,955) $

(7,195) $

906,827

The notes to consolidated financial statements are an integral part of these statements.

47

OPTION CARE HEALTH, INC.
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

1. NATURE OF OPERATIONS AND PRESENTATION OF FINANCIAL STATEMENTS

Corporate Organization and Business — HC Group Holdings II, Inc. (“HC II”) was incorporated under the laws of the 
State of Delaware on January 7, 2015, with its sole shareholder being HC Group Holdings I, LLC. (“HC I”). On April 7, 2015, 
HC I and HC II collectively acquired Walgreens Infusion Services, Inc. and its subsidiaries from Walgreen Co., and the 
business was rebranded as Option Care (“Option Care”).

On March 14, 2019, HC I and HC II entered into a definitive agreement (the “Merger Agreement”) to merge with and into 

a wholly-owned subsidiary of BioScrip, Inc. (“BioScrip”), a national provider of infusion and home care management 
solutions, along with certain other subsidiaries of BioScrip and HC II. The merger contemplated by the Merger Agreement (the 
“Merger”) was completed on August 6, 2019 (the “Merger Date”). The Merger was accounted for as a reverse merger under the 
acquisition method of accounting for business combinations with Option Care being considered the accounting acquirer and 
BioScrip being considered the legal acquirer.

Under the terms of the Merger Agreement, shares of HC II common stock issued and outstanding immediately prior to the 
Merger Date were converted into 542,261,567 shares (135,565,392 equivalent shares after adjusting for the one share for four 
share reverse stock split - see Note 20, Subsequent Events) of BioScrip common stock, par value $0.0001 (the “BioScrip 
common stock”). BioScrip also issued an additional 28,193,428 shares (7,048,357 equivalent shares after adjusting for the 
reverse stock split) to HC I in respect of certain outstanding unvested contingent restricted stock units of BioScrip, which are 
held in escrow to prevent dilution related to potential additional vesting on certain share-based instruments. See Note 17, 
Stockholders’ Equity, for additional discussion of these shares held in escrow. In conjunction with the Merger, holders of 
BioScrip preferred shares and certain warrants received 3,458,412 additional shares (864,603 equivalent shares after adjusting 
for the reverse stock split) of BioScrip common stock and preferred shares were repurchased for $125.8 million of cash. In 
addition, all legacy BioScrip debt was settled for $575.0 million. As a result of the Merger, BioScrip’s stockholders hold 
approximately 19.2% of the combined company, and HC I holds approximately 80.8% of the combined company. Following 
the close of the transaction, BioScrip was rebranded as Option Care Health, Inc. (“Option Care Health”, or the “Company”). 
The combined company’s stock was listed on the Nasdaq Capital Market as of December 31, 2019. See Note 3, Business 
Acquisitions, for further discussion on the Merger.

Option Care Health, and its wholly-owned subsidiaries, provides infusion therapy and other ancillary health care services 

through a national network of 115 full service pharmacies. The Company contracts with managed care organizations, third-
party payers, hospitals, physicians, and other referral sources to provide pharmaceuticals and complex compounded solutions to 
patients for intravenous delivery in the patients’ homes or other nonhospital settings. The Company operates in one segment, 
infusion services.

Basis of Presentation —  The accompanying consolidated financial statements have been prepared in conformity with 
generally accepted accounting principles (“GAAP”) in the United States. These principals require management to make certain 
estimates and assumptions in determining assets, liabilities, revenue, expenses, and related disclosures. Actual amounts could 
differ materially from those estimates.

Principles of Consolidation — The Company’s consolidated financial statements include the accounts of Option Care 
Health, Inc. and its subsidiaries. The BioScrip results have been included in the consolidated financial results since the Merger 
Date. All intercompany transactions and balances are eliminated in consolidation.

The Company has investments in companies that are 50% owned and are accounted for as equity-method investments. The 

Company’s share of earnings from equity-method investments is included in the line entitled “Equity in earnings of joint 
ventures” in the consolidated statements of comprehensive income (loss). See Note 11, Equity-Method Investments, for further 
discussion of the Company’s equity-method investments. 

 2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Cash and Cash Equivalents —  The Company considers all highly liquid investments with original maturities of three 

months or less to be cash equivalents.

Accounts Receivable — The Company’s accounts receivable are reported at the net realizable value amount that reflects 

the consideration the Company expects to receive in exchange for providing services, which is inclusive of adjustments for 

48

price concessions. The majority of accounts receivable are due from private insurance carriers and governmental health care 
programs, such as Medicare and Medicaid.

Price concessions may result from patient hardships, patient uncollectible accounts sent to collection agencies, lack of 
recovery due to not receiving prior authorization, differing interpretations of covered therapies in payer contracts, different 
pricing methodologies, or various other reasons. Subsequent to the adoption of Financial Accounting Standards Board 
(“FASB”) Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers (“ASC 606”), an 
allowance for doubtful accounts is established only as a result of an adverse change in the Company’s payers’ ability to pay 
outstanding billings. The allowance for doubtful accounts balance is $0 as of December 31, 2019 and 2018, respectively. 

Prior to the adoption of ASC 606, estimates of uncollectible accounts receivable were recorded as either a pricing 

adjustment to revenue (“contractual adjustment”) or as an uncollectible account to provision for doubtful accounts. The 
Company recorded an allowance for doubtful accounts based on historical experience and a detailed assessment of the 
collectability of its accounts receivable. In estimating the allowance for doubtful accounts, the Company considered, among 
other factors, (i) the balance and aging composition of the accounts receivable, (ii) the Company’s historical write-offs and 
recoveries, (iii) the creditworthiness of its payers, and (iv) general economic conditions. Accounts receivable were written-off 
as bad debts after all reasonable collection efforts have been exhausted.

Included in accounts receivable are earned but unbilled gross receivables of $68.7 million and $43.0 million as of 

December 31, 2019 and 2018, respectively. Delays ranging from one day up to several weeks between the date of service and 
billing can occur due to delays in obtaining certain required payer-specific documentation from internal and external sources.

See Revenue Recognition for a further discussion of the Company’s revenue recognition policy.

Inventory — Inventory, which consists primarily of pharmaceuticals, is stated at the lower of first in, first out cost or net 

realizable value basis, which the Company believes is reflective of the physical flow of inventories. 

During the year ended December 31, 2018, one Company location was destroyed by a hurricane, resulting in a loss of $2.9 

million of inventory. This business casualty loss was recorded as a component of operating costs and expenses within the 
consolidated statements of comprehensive income (loss). The Company received insurance proceeds of $0.8 million during the 
year ended December 31, 2018, and recorded a receivable of $1.0 million as a component of prepaid expenses and other current 
assets within the consolidated balance sheets at December 31, 2018. Both of these amounts were recorded as a partial offset to 
the business casualty loss in the consolidated statements of comprehensive income (loss). The $0.8 million of insurance 
proceeds were reflected as a component of cash flows from operating activities in the consolidated statements of cash flows. 
During the year ended December 31, 2019, $3.0 million in proceeds were received related to recovery of inventory and 
business interruption and was included as a component of cash flows from operating activities in the consolidated statements of 
cash flows. These proceeds resulted in a gain on business casualty loss of $2.0 million recorded as a component of selling, 
general and administrative expense in the consolidated statement of comprehensive income (loss).

Leases —  The Company has lease agreements for facilities, warehouses, office space and property and equipment. 
Effective as of January 1, 2019, at the inception of a contract, the Company determines if the contract is a lease or contains an 
embedded lease arrangement. Operating leases are included in the operating lease right-of-use asset (“ROU asset”) and 
operating lease liabilities in the consolidated financial statements.

ROU assets, which represent the Company’s right to use the leased assets, and operating lease liabilities, which represent 

the present value of unpaid lease payments, are both recognized by the Company at the lease commencement date. The 
Company utilizes its estimated incremental borrowing rate at the lease commencement date to determine the present value of 
unpaid lease obligations. The rates were estimated primarily using a methodology dependent on the Company’s 
financial condition, creditworthiness, and availability of certain observable data. In particular, the Company considered its 
actual cost of borrowing for collateralized loans and its credit rating, along with the corporate bond yield curve in estimating its 
incremental borrowing rates. ROU assets are recorded as the amount of operating lease liability, adjusted for prepayments, 
accrued lease payments, initial direct costs, lease incentives, and impairment of the ROU asset. Tenant improvement allowances 
used to fund leasehold improvements are recognized when earned and reduce the related ROU asset. Tenant improvement 
allowances are recognized through the ROU asset as a reduction of expense over the term of the lease.

Leases may contain rent escalations, however the Company recognizes the lease expense on a straight-line basis over the 
expected lease term. The Company reviews the terms of any lease renewal options to determine if it is reasonably certain that 
the renewal options will be exercised. The Company has determined that the expected lease term is typically the minimum non-
cancelable period of the lease.

49

The Company has lease agreements that contain both lease and non-lease components which the Company has elected to 
account for as a single lease component for all asset classes. Leases with an initial term of 12 months or less are not recorded on 
the consolidated balance sheet and are expensed on a straight-line basis over the term of the lease. The Company’s lease 
agreements do not contain any material residual value guarantees or material restrictive covenants. See Note 8, Leases, for 
further discussion on leases.

Goodwill, Intangible Assets, and Property and Equipment — Goodwill represents the excess of the purchase price 

over the fair value of assets acquired and liabilities assumed. The Company accounts for goodwill under ASC Topic 350, 
Intangibles-Goodwill and Other. The Company tests goodwill for impairment annually, or more frequently whenever events or 
circumstances indicate impairment may exist. Goodwill is stated at cost less accumulated impairment losses. The Company 
completes its goodwill impairment test annually in the fourth quarter. See Note 10, Goodwill and Other Intangible Assets, for 
further discussion of the Company’s goodwill and other intangible assets.

Intangible assets arising from the Company’s acquisitions are amortized on a straight line basis over the estimated useful 

life of each asset. Referral sources have a useful life of 15-20 years. Trademarks/names have a useful life ranging from two to 
fifteen years. The useful lives for other amortizable intangible assets range from approximately two to nine years. The 
Company does not have any indefinite lived intangible assets.

Property and equipment is recorded at cost, net of accumulated depreciation. Depreciation on owned property and 
equipment is provided for on a straight line basis over the estimated useful lives of owned assets. Leasehold improvements are 
amortized over the estimated useful life of the property or over the term of the lease, whichever is shorter. Estimated useful 
lives are seven years for infusion pumps and three years to thirteen years for equipment. Major repairs, which extend the useful 
life of an asset, are capitalized in the property and equipment accounts. Routine maintenance and repairs are expensed as 
incurred. Computer software is included in property and equipment and consists of purchased software and internally-
developed software. The Company capitalizes application-stage development costs for significant internally-developed 
software projects. Once the software is ready for its intended use, these costs are amortized on a straight line basis over the 
software’s estimated useful life, generally five years. Costs recognized in the preliminary project phase and the post-
implementation phase, as well as maintenance and training costs, are expensed as incurred.

The Company tests long lived assets for impairment whenever events or circumstances indicate that a certain asset or 

asset group may be impaired. Once identified, the amount of the impairment is computed by comparing the carrying value of 
the respective asset or asset group to its fair value, which is based on the discounted estimated future cash flows.

Equity Method Investments — The Company’s investments in certain unconsolidated entities are accounted for under 
the equity method. The balance of these investments is included in other noncurrent assets in the accompanying consolidated 
balance sheets. The investment is increased to reflect the Company’s capital contributions and equity in earnings of the 
investees. The investment is decreased to reflect the Company’s equity in losses of the investees and for distributions received 
that are not in excess of the carrying amount of the investments. The Company’s proportionate share of earnings or losses of the 
investees are recorded in equity in earnings of joint ventures in the accompanying consolidated statements of comprehensive 
income (loss). See Note 11, Equity-Method Investments, for a further discussion of the Company’s equity method investments.

Hedging Instruments — The Company uses derivative financial instruments to limit its exposure to increases in the 

interest rate of its variable rate debt instruments. The derivative financial instruments are recognized on the consolidated 
balance sheets at fair value. See Note 13, Derivative Instruments, for additional information.

At inception of the hedge, the Company designated the derivative instruments as a hedge of the cash flows related to the 
interest on the variable rate debt. For all hedging relationships, the Company documents the hedging relationships and its risk 
management objective of the hedging relationship. For all hedging instruments, the terms of the hedge perfectly offset the 
hedged expected cash flows. 

Revenue Recognition — Net revenue is reported at the net realizable value amount that reflects the consideration the 
Company expects to receive in exchange for providing services. Revenues are from government payers, commercial payers, 
and patients for goods and services provided and are based on a gross price based on payer contracts, fee schedules, or other 
arrangements less any implicit price concessions.

Due to the nature of the health care industry and the reimbursement environment in which the Company operates, certain 
estimates are required to record revenue and accounts receivable at their net realizable values at the time goods or services are 
provided. Inherent in these estimates is the risk that they will have to be revised or updated as additional information becomes 
available. 

50

The Company assesses the expected consideration to be received at the time of patient acceptance based on the 
verification of the patient’s insurance coverage, historical information with the patient, similar patients, or the payer. 
Performance obligations are determined based on the nature of the services provided by the Company. The majority of the 
Company’s performance obligations are to provide infusion services to deliver medicine, nutrients, or fluids directly into the 
body. 

The Company provides a variety of infusion-related therapies to patients, which frequently include multiple deliverables 
of pharmaceutical drugs and related nursing services. After applying the criteria from ASC 606, the Company concluded that 
multiple performance obligations exist in its contracts with its customers. Revenue is allocated to each performance obligation 
based on relative standalone price, determined based on reimbursement rates established in the third-party payer contracts. 
Pharmaceutical drug revenue is recognized at the time the pharmaceutical drug is delivered to the patient, and nursing revenue 
is recognized on the date of service. 

The Company's outstanding performance obligations relate to contracts with a duration of less than one year. Therefore, the 

Company has elected to apply the practical expedient provided by ASC 606 and is not required to disclose the aggregate 
amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the 
reporting period. Any unsatisfied or partially unsatisfied performance obligations at the end of a reporting period are generally 
completed prior to the patient being discharged. See Note 4, Revenue for a further discussion on revenue.

Cost of Revenue — Cost of revenue consists of the actual cost of pharmaceuticals and other medical supplies dispensed 

to patients, as well as all other costs directly related to the production of revenue. These costs include warehousing costs, 
purchasing costs, freight costs, cash discounts, wages and related costs for pharmacists and nurses, along with depreciation 
expense relating to revenue-generating assets, such as infusion pumps.

The Company receives prompt payment discounts from some of its pharmaceutical and medical supplies vendors. These 
prompt payment discounts are recorded as a reduction of inventory and are accounted for as a reduction of cost of goods sold 
when the related inventory is sold.

The Company also receives rebates from pharmaceutical and medical supply manufacturers. Rebates are generally 
volume-based incentives and are recorded as a reduction of inventory and are accounted for as a reduction of cost of goods sold 
when the related inventory is sold.

Selling, General and Administrative Expenses — Selling, general and administrative expenses mainly consist of 

salaries for administrative employees that directly and indirectly support the operations, occupancy costs, marketing 
expenditures, insurance, and professional fees. 

Stock Based Incentive Compensation -  The Company accounts for stock-based incentive compensation expense in 

accordance with ASC Topic 718, Compensation-Stock Compensation (“ASC 718”). Stock-based incentive compensation 
expense is based on the grant date fair value. The Company estimates the fair value of stock option awards using a Black-
Scholes option pricing model and the fair value of restricted stock unit awards using the closing price of the Company’s 
common stock on the grant date. For awards with a service-based vesting condition, the Company recognizes expense on a 
straight-line basis over the service period of the award. For awards with performance-based vesting conditions, the Company 
will recognize expense when it is probable that the performance-based conditions will be met. When the Company determines 
that it is probable that the performance-based conditions will be met, a cumulative catch-up of expense will be recorded as if 
the award had been vesting on a straight-line basis from the award date. The award will continue to be expensed on a straight-
line basis through the remainder of the vesting period and will be updated if the Company determines that there has been a 
change in the probability of achieving the performance-based conditions. The Company records the impact of forfeited awards 
in the period in which the forfeiture occurs. 

Prior to the Merger, HCI issued incentive units to certain employees of Option Care, who remained employees of the 

Company following the Merger. In accordance with ASC 718, the Company recognizes compensation expense on a straight-
line basis over the shorter of the vesting period of the award or the employee’s expected eligibility date. HC I also issued equity 
incentive units to certain members of the Option Care Board of Directors, who remained members of the Board of Directors 
following the Merger. See Note 16, Stock-Based Incentive Compensation, for a further discussion of equity incentive plans.

Business Acquisitions -  The Company accounts for business acquisitions in accordance with ASC Topic 805, Business 

Combinations, with assets and liabilities being recorded at their acquisition date fair value and goodwill being calculated as the 
purchase price in excess of the net identifiable assets. See Note 3, Business Acquisitions, for further discussion of the 
Company’s business acquisitions.

51

Income Taxes — On December 22, 2017, the U.S. government enacted H.R. 1, commonly known as the Tax Cuts and 

Jobs Act of 2017 (the “Tax Act”). The Tax Act significantly changed U.S. tax law by, among other things, reducing the 
corporate tax rate from 35% to 21%, effective January 1, 2018. In addition, there are many new provisions including changes to 
bonus depreciation, the deduction for executive compensation and interest expense, and usage of future net operating losses. 
Included in the tax benefit for 2017 is the impact of the corporate tax rate reduction which resulted in a $17.0 million non-cash 
adjustment of our net deferred tax liabilities and a corresponding credit to income tax benefit. While the corporate tax rate 
reduction was effective January 1, 2018, the Company accounted for this anticipated rate change in 2017, the period of 
enactment.

The Company accounts for income taxes using the asset and liability method. Deferred tax assets and liabilities are 
reported for book-tax basis differences and are measured based on currently enacted tax laws using rates expected to apply to 
taxable income in the years in which the differences are expected to reverse. The effect of a change in tax rate on deferred taxes 
is recognized in income tax expense in the period that includes the enactment date of the change. 

In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some 
portion or all of the deferred tax assets will not be realized. Valuation allowances are established when necessary to reduce 
deferred tax assets to the amounts more likely than not to be realized. 

The Company recognizes income tax positions that are more likely than not to be sustained on their technical merits. The 
Company measures recognized income tax positions at the maximum benefit that is more likely than not, based on cumulative 
probability, realizable upon final settlement of the position. Interest and penalties related to unrecognized tax benefits are 
reported in income tax expense. 

Concentrations of Business Risk — The Company generates revenue from managed care contracts and other agreements 
with commercial third-party payers. Revenue related to the Company’s largest payer was approximately 16%, 17% and 17% for 
the years ended December 31, 2019, 2018 and 2017, respectively. In December 2019, the Company renewed and expanded its 
multi-year contract with this payer. The contract renewal is effective in February 2020 for a two-year term and auto-renews at 
the end of that term. There were no other managed care contracts that represent greater than 10% of revenue for the years 
presented.

 For the years ended December 31, 2019, 2018 and 2017, approximately 12%, 12% and 14%, respectively, of the 

Company’s revenue was reimbursable through direct government healthcare programs such as Medicare and Medicaid. As of 
December 31, 2019 and 2018, approximately 12% and 13%, respectively, of the Company’s accounts receivable was related to 
these programs. Governmental programs reimburse for services based on fee schedules and rates that are determined by the 
related governmental agency. Laws and regulations pertaining to government programs are complex and subject to 
interpretation. As a result, there is at least a reasonable possibility that recorded estimates will change in the near term. 

The Company does not require its patients nor other payers to carry collateral for any amounts owed for goods or services 
provided. Other than as discussed above, concentrations of credit risk relating to trade accounts receivable is limited due to the 
Company’s diversity of patients and payers. Further, the Company generally does not provide charity care.

For the year ended December 31, 2019, approximately 70% of the Company’s pharmaceutical and medical supply 

purchases were from three vendors. For the years ended December 31, 2018 and 2017, approximately 66% and 73%, 
respectively, of the Company’s pharmaceutical and medical supply purchases were from two vendors. Although there are a 
limited number of suppliers, the Company believes that other vendors could provide similar products on comparable terms. 
However, a change in suppliers could cause delays in service delivery and possible losses in revenue, which could adversely 
affect the Company’s financial condition or operating results.

Fair Value Measurements — The fair value measurement accounting standard, ASC Topic 820, Fair Value Measurement 

(“ASC 820”), provides a framework for measuring fair value and defines fair value as the price that would be received to sell 
an asset or paid to transfer a liability. Fair value is a market-based measurement that should be determined using assumptions 
that market participants would use in pricing an asset or liability. The standard establishes a valuation hierarchy for inputs used 
in measuring fair value that maximizes the use of observable inputs and minimizes the use of unobservable inputs by requiring 
that the most observable inputs be used when available. Observable inputs are inputs market participants would use in valuing 
the asset or liability developed based on independent market data sources. Unobservable inputs are inputs that reflect the 
Company’s assumptions about the factors market participants would use in valuing the asset or liability developed based upon 
the best information available. The valuation hierarchy is composed of three categories. The categorization within the valuation 
hierarchy is based on the lowest level of input that is significant to the fair value measurement. The categories within the 
valuation hierarchy are described as follows: 

52

•  Level 1 - Inputs to the fair value measurement are quoted prices in active markets for identical assets or 

liabilities.

•  Level 2 - Inputs to the fair value measurement include quoted prices in active markets for similar assets or 

liabilities, quoted prices for identical or similar assets or liabilities in markets that are not active, and inputs other 
than quoted prices that are observable for the asset or liability, either directly or indirectly.

•  Level 3 - Inputs to the fair value measurement are unobservable inputs or valuation techniques.

While the Company believes its valuation methods are appropriate and consistent with other market participants, the use of 

different methodologies or assumptions to determine the fair value of certain financial instruments could result in a different 
fair value measurement at the reporting date.

Recently-Adopted Accounting Pronouncements —  In February 2016, the FASB issued ASU No. 2016-02, Leases, 
intended to improve financial reporting about leasing transactions. The new guidance requires entities that lease assets to 
recognize on their balance sheets the ROU assets and lease liabilities for the rights and obligations created by those leases and 
to disclose key information about leasing arrangements. ASU 2016-02 is effective for interim and annual periods beginning 
after December 15, 2018 for public entities and certain not-for-profits. The Company adopted the standard as of January 1, 
2019. ASU 2016-02 allows for an optional transition method, which was elected by the Company, and permits the application 
of the standard as of the effective date without requiring the standard to be applied to the comparative periods presented in the 
consolidated financial statements. The Company elected the transition package of three practical expedients allowed by ASU 
2016-02, which allows the Company not to reassess prior conclusions about lease identification, lease classification and initial, 
direct costs. The Company did not elect the practical expedient to use hindsight and, accordingly, the initial lease term did not 
differ under the new standard versus prior accounting practice. The Company also made a policy election not to apply this 
standard to any leases with a term of 12 months or less. Adoption of ASU 2016-02 resulted in the Company recording an 
operating lease liability of $67.0 million and a corresponding ROU asset of $59.9 million in the consolidated balance sheet as 
of January 1, 2019. See Note 8, Leases, for further discussion on leases.

In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers. The ASU requires that an entity 

recognizes revenue to depict the transfer of promised goods or services to a customer in an amount that reflects the 
consideration to which the Company expects to be entitled in exchange for these goods or services. ASU 2014-09 is effective 
for interim and annual reporting periods beginning after December 15, 2017 for public entities and certain not-for-profits. The 
Company adopted the standard as of January 1, 2018. ASU 2014-09 allows for a modified retrospective approach upon 
adoption, which was elected by the Company, and permits application of the standard only to contracts that are not completed 
at the adoption date with no adjustment to the comparative periods presented in the consolidated financial statements. The 
Company also elected the practical expedient for the portfolio approach, allowing contracts with similar characteristics and 
impacts to the financial statements to be evaluated together. ASU 2014-09 requires the Company to recognize revenue as the 
amount of cash that is ultimately expected to be collected, which resulted in the Company treating its previously-reported 
provision for doubtful accounts as an implicit price concession and a reduction to revenue. Other than the treatment of bad debt 
expense, the adoption of this standard did not have a material impact on the Company’s consolidated financial statements. See 
Note 4, Revenue, for further discussion on revenue.

In May 2017, the FASB issued ASU 2017-09, Compensation-Stock Compensation (Topic 718): Scope of Modification 
Accounting. ASU 2019-09 modifies when a change to the terms or conditions of share-based payment award must be accounted 
for as a modification. The new guidance requires modification accounting if the fair value, vesting condition, or the 
classification of the award is not the same immediately before and after a change to the terms and conditions of the award. The 
effective date for ASU 2017-09 is for annual or interim periods beginning after December 15, 2017. The Company adopted the 
standard as of January 1, 2018. The adoption of this standard did not have a material impact on the Company’s consolidated 
financial statements.

Recent Accounting Pronouncements — In June 2016, the FASB issued ASU 2016-13, Financial Instruments — Credit 
Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, which requires measurement and recognition of 
expected credit losses for financial assets held. The amendments in ASU 2016-13 eliminate the probable threshold for initial 
recognition of a credit loss in current GAAP and reflect an entity’s current estimate of all expected credit losses. ASU 2016-13 
is effective for interim and annual reporting periods beginning after December 15, 2019, and is to be applied using a modified 
retrospective transition method. Early adoption is permitted. The adoption of this standard is not expected to have a material 
impact on the Company’s consolidated financial statements.

53

Immaterial Error Correction —  During the year ended December 31, 2019, the Company identified prior period 

misstatements in the recording of other noncurrent liabilities that resulted in an overstatement of goodwill and other noncurrent 
liabilities in the Company’s consolidated balance sheets. The Company assessed the materiality of these misstatements both 
quantitatively and qualitatively and determined the correction of these errors to be immaterial to the prior consolidated financial 
statements taken as a whole. As a result, the Company has corrected the misstatements by decreasing goodwill and other 
noncurrent liabilities by $6.5 million in the accompanying financial statements. The misstatements had no impact on net (loss) 
income or net cash flows from operating, investing, or financing activities in any of the periods presented.

During the fourth quarter of the year ended December 31, 2019, the Company identified a misstatement in the recording of 
certain transaction fees related to the Merger, which resulted in a $6.5 million understatement of net loss for the three and nine 
months ended September 30, 2019 and a $6.5 million understatement of long term debt, net, at September 30, 2019, as reported 
in the third quarter 2019 report on Form 10-Q. The Company assessed the materiality of these misstatements both 
quantitatively and qualitatively and determined the correction of these errors to be immaterial to the results as reported in the 
third quarter report on Form 10-Q. As a result, the Company has corrected the misstatements by (i) increasing selling, general 
and administrative expense on the statement of comprehensive income (loss), (ii) increasing long-term debt, net and reducing 
retained earnings on the balance sheet, and (iii) decreasing net cash provided by operating activities and increasing net cash 
provided by financing activities on the statement of cash flows in the fourth quarter of 2019.

3. BUSINESS ACQUISITIONS

Merger with BioScrip, Inc. — As discussed in Note 1, Nature of Operations and Presentation of Financial 

Statements, Option Care merged with BioScrip on August 6, 2019. BioScrip was a national provider of infusion and home care 
management solutions. The Merger of Option Care and BioScrip into Option Care Health created an expanded national 
platform and the opportunity to drive economies of scale through procurement savings, facility rationalization and other 
operating cost savings.

The fair value of purchase consideration transferred on the closing date includes the value of the number of shares of the 

combined company owned by BioScrip shareholders at closing of the Merger, the value of common shares issued to certain 
warrant and preferred shareholders in conjunction with the Merger, the fair value of stock-based instruments that were vested or 
earned as of the Merger, and cash payments made in conjunction with the Merger. The fair value per share of BioScrip’s 
common stock was $2.67 per share. This is the closing price of the BioScrip common stock on August 6, 2019.

Under the acquisition method of accounting, the calculation of total consideration exchanged is as follows (in thousands):

Number of BioScrip common shares outstanding at time of the Merger (1)

Common shares issued to warrant and preferred stockholders at time of the Merger (1)

Total shares of BioScrip common stock outstanding at time of the Merger (1)

BioScrip share price as of August 6, 2019

Fair value of common shares

Fair value of share-based instruments

Cash paid in conjunction with the Merger included in purchase consideration

Fair value of total consideration transferred

Less: cash acquired

Fair value of total consideration acquired, net of cash acquired

Amount

129,181

3,458

132,639

2.67

354,146

32,898

714,957

1,102,001

14,787

1,087,214

$

$

$

$

$

$

$

(1) These shares were not adjusted for the one share for four share reverse stock split, which occurred on February 3, 2020. 

See Note 20, Subsequent Events, for further discussion of this stock split.

Cash paid in conjunction with the Merger includes payments made for settlement of $575.0 million in legacy BioScrip 
debt, $125.8 million in existing BioScrip preferred shares, and $14.1 million in legacy BioScrip success-based fees owed to 
third-party advisors. HC II financed these payments primarily through cash on hand and debt financing, which is discussed in 
Note 12, Indebtedness. 

54

The Company's allocation of consideration exchanged to the net tangible and intangible assets acquired and liabilities 
assumed in the Merger is based on estimated fair values as of the Merger Date. The fair values were determined based upon a 
valuation and the estimates and assumptions used in the valuation of certain contingent liabilities are pending completion and 
subject to change, which could be significant, within the measurement period, up to one year from the August 6, 2019 
acquisition date.

The following is a preliminary estimate of the allocation of the consideration transferred to acquired identifiable assets and 

assumed liabilities, net of cash acquired, in the Merger as of August 6, 2019 (in thousands):

Accounts receivable, net (1)

Inventories (2)

Property and equipment, net (3)

Intangible assets, net (4)

Deferred tax assets, net of deferred tax liabilities (5)

Operating lease right-of-use asset (6)

Operating lease liability (6)

Accounts payable  (7)

Other assumed liabilities, net of other acquired assets (7)

Total acquired identifiable assets and liabilities

Goodwill (8)

Amount

$

96,532

19,683

48,732

193,245

26,731

22,378

(28,897)

(64,030)

(20,233)

294,141

793,073

Total consideration transferred

$

1,087,214

(1)  Management has valued accounts receivables based on the estimated future collectability of the receivables portfolio.
(2)  Inventories are stated at fair value as of the Merger Date.
(3)  The fair value of the property and equipment was determined based upon the best and highest use of the property 
with final values determined based upon an analysis of the cost, sales comparison, and income capitalization 
approaches for each property appraised.

(4)  The allocation of consideration exchanged to intangible assets acquired is as follows (in thousands):

Trademarks/Names

Patient referral sources

Licenses

Total intangible assets, net

Fair Value

Weighted Average
Estimated Life (in years)

$

$

12,536

180,329

380

193,245

2

20

1.5

18.8

The Company valued trademarks/names utilizing the relief of royalty method and patient referral sources utilizing 
the multi-period excess earnings method, a form of the income approach.

(5)  Net deferred tax assets represented the expected future tax consequences of temporary differences between the fair 

values of the assets acquired and liabilities assumed and their tax bases. See Note 6, Income Taxes, for additional 
discussion of the Company’s combined income tax position subsequent to the Merger.

(6)  The fair value of the operating lease liability and corresponding right-of-use asset (current and long-term) was based 

on current market rates available to the Company.

(7)  Accounts payable as well as certain other current and non-current assets and liabilities are stated at fair value as of 

the Merger Date. 

(8)  The Merger preliminarily resulted in $793.1 million of goodwill, which is attributable to cost synergies resulting 
from procurement and operational efficiencies and elimination of duplicative administrative costs. The goodwill 
created in the Merger is not expected to be deductible for tax purposes.

Assuming BioScrip had been acquired as of January 1, 2018, and the results of BioScrip had been included in operations 
beginning on January 1, 2018, the following tables provide estimated unaudited pro forma results of operations for the years 
ended December 31, 2019 and 2018 (in thousands). The estimated pro forma net income adjusts for the effect of fair value 

55

adjustments related to the Merger, transaction costs and other non-recurring costs directly attributable to the Merger and the 
impact of the additional debt to finance the Merger. 

Net revenue

Net loss

Year Ended December 31,

2019

2018

$

2,755,361

$

(49,566)

2,648,694

(70,932)

Estimated unaudited pro forma information is not necessarily indicative of the results that actually would have occurred 

had the Merger been completed on the date indicated or the future operating results.

For the periods subsequent to the Merger Date that are included in the results of operations for the years ended 

December 31, 2019, BioScrip had net revenue of $308.9 million and a net loss of $30.1 million.

Acquisition-related costs were expensed as incurred, with the exception of BioScrip success-based fees that are included in 

consideration transferred. The Company recorded transaction costs that are expensed in selling, general and administrative 
expenses during the year ended December 31, 2019 of approximately $25.8 million. Transaction expenses consisted of 
professional fees for advisory, consulting and underwriting services as well as other incremental costs directly related to the 
acquisition.

Baptist Health Asset Acquisition —  In August 2018, pursuant to the Purchase and Sale Agreement dated August 8, 2018, 

Option Care completed the acquisition of certain assets of Baptist Health in Little Rock, Arkansas for a purchase price of $1.0 
million.

Home I.V. Specialists, Inc. Acquisition — In September 2018, pursuant to the Stock Purchase Agreement dated 

September 18, 2018, Option Care completed the acquisition of 100% of the outstanding shares of Home I.V. Specialists, Inc. 
(“Home I.V.”) for a purchase price of $11.6 million, net of cash acquired. The total consideration was comprised of cash paid of 
$9.8 million and a contingent payment of $1.8 million payable one year after the acquisition date. During the year ended 
December 31, 2019, the Company reduced the contingent liability by $0.3 million. Subsequent to December 31, 2019, it was 
determined that the contingent payment was not payable.

Healthy Connections Homecare Services, Inc. Acquisition — In October 2016, pursuant to the Share Purchase 
Agreement dated September 14, 2016, the Company completed the acquisition of 100% of the outstanding shares of Healthy 
Connections Homecare Services, Inc. (“HCHS”), for a purchase price of $5.2 million, net of cash acquired. The total 
consideration was comprised of cash paid of $4.2 million and a contingent payment of $1.0 million payable one year after the 
acquisition date. The contingent payment was determined based on the operations of HCHS. The contingent payment of $1.0 
million was paid by the Company during the year ended December 31, 2017. 

4. REVENUE 

On January 1, 2018, the Company adopted ASC 606, Revenue from Contracts with Customers, using the modified 
retrospective approach applied to those contracts that were not completed as of that date. The Company did not record a 
cumulative catch-up adjustment, as the timing and measurement of revenue for the Company’s customers is similar to its 
prior revenue recognition model. 

ASC 606 requires an entity to recognize revenue to depict the transfer of goods or services to customers in an amount that 
reflects the consideration that it expects to be entitled to in exchange for those goods or services. ASC 606 requires application 
of a five-step model to determine when to recognize revenue and at what amount. The revenue standard applies to all contracts 
with customers and revenues are to be recognized when control of the promised goods or services is transferred to the 
Company’s patients in an amount that reflects consideration expected to be received in exchange for those goods or services.

Adoption of the standard impacted the Company’s results as follows (in thousands):

56

Consolidated Balance Sheets

Accounts receivable, net

Consolidated Statement of Comprehensive Income (Loss)

Net revenue

Provision for doubtful accounts

Operating loss

Consolidated Statements of Cash Flows

Changes in operating cash flows:

Accounts receivable, net

Consolidated Balance Sheets

Accounts receivable, net

Consolidated Statement of Comprehensive Income (Loss)

Net revenue

Provision for doubtful accounts

Operating income

Consolidated Statements of Cash Flows

Changes in operating cash flows:

Accounts receivable, net

Prior to ASC 606
Adoption

Adjustments for
ASC 606

As of December 31, 2019

Subsequent to
ASC 606
Adoption

$

$

$

$

324,416

$

— $

324,416

Year Ended December 31, 2019

2,382,058

$

(71,641) $

2,310,417

(71,641)

(319)

71,641

—

—

(319)

82,285

—

82,285

As of December 31, 2018

310,169

$

— $

310,169

Year Ended December 31, 2018

2,001,132

$

(61,341) $

1,939,791

(61,341)

38,269

61,341

—

—

38,269

(21,012)

—

(21,012)

The following table presents the allowance for doubtful accounts for the years ended December 31, 2019, 2018 and 2017 

(in thousands):

Balance at 
Beginning of 
Period

Write-Off of 
Receivables

Charged to 
Costs and 
Expenses

Balance at 
End of Period

Year ended December 31, 2017

Allowance for doubtful accounts

Year ended December 31, 2018

Allowance for doubtful accounts (1)

Year ended December 31, 2019

Allowance for doubtful accounts (1)

$

$

$

32,144

$

(34,920) $

45,602

$

42,826

— $

— $

— $

— $

— $

— $

—

—

(1) Subsequent to the adoption of ASC 606, an allowance for doubtful accounts is established only as a result of an adverse 

change in the Company’s payers’ ability to pay outstanding billings.

The following table sets forth the net revenue earned by category of payer for the years ended December 31, 2019, 2018 

and 2017 (in thousands): 

57

Commercial payers

Government payers

Patients

Net revenue

5. EMPLOYEE BENEFIT PLANS

Year Ended December 31,

2019

2018

2017

$

2,001,105

$

1,699,450

$

1,598,703

285,128

24,184

217,876

22,465

203,651

25,692

$

2,310,417

$

1,939,791

$

1,828,046

The Company maintains a 401(k) plan and matches 100% of employee contributions, up to 4% of employee compensation. 
The Company recorded expense for the defined contribution plan of $6.4 million, $6.3 million and $6.6 million for the years ended
December 31, 2019, 2018 and 2017, respectively. In the years ended December 31, 2019, 2018 and 2017, Company contributions 
of $6.6 million, $6.3 million and $14.4 million, respectively, were paid. 

6. INCOME TAXES

The income tax benefit consists of the following for the years ended December 31, 2019, 2018 and 2017 (in thousands):

2019

2018

2017

US federal income tax (benefit) expense:

Current

Deferred

State income tax (benefit) expense:

Current

Deferred

$

— $

— $

(3,072)
(3,072)

(2,688)
(2,688)

2,074
(1,276)
798
(2,274) $

1,176
(1,141)
35
(2,653) $

—
(21,944)
(21,944)

1,244

2,115

3,359
(18,585)

Total income tax benefit

$

The difference between the statutory federal income tax rate and the effective tax rate is as follows for the years ended 

December 31, 2019, 2018 and 2017:

US federal statutory tax rate

US federal statutory tax rate change

State income taxes - net of federal benefit

Valuation allowance

Changes in uncertain tax positions

Non-deductible expenses

Other, net

Effective income tax rate

2019

2018

2017

21.0%

—
(0.5)
(13.4)
—
(3.5)
(0.7)
2.9%

21.0%

35.0%

—

2.4

—

14.7
(7.5)
(0.3)
30.3%

115.9
(10.1)
—
(8.8)
(5.6)
—

126.4%

58

The components of deferred income tax assets and liabilities using the 21% U.S. Federal statutory tax rate were as follows 

as of December 31, 2019 and 2018 (in thousands):

Deferred tax assets:

Price concessions

Compensation and benefits

Interest limitation carryforward

Operating lease liability

Net operating losses

Other

Deferred tax assets before valuation allowance

Valuation allowance

Deferred tax assets net of valuation allowance

Deferred tax liabilities:

Accelerated depreciation
Operating lease right-of-use asset

Intangible assets

Goodwill

Other

Deferred tax liabilities

Net deferred tax liabilities

2019

2018

$

12,302

$

14,879

3,672

38,623

19,462

147,749

5,506

227,314
(109,531)
117,783

(10,376)
(15,442)
(71,204)
(20,250)
(2,654)
(119,926)

$

(2,143) $

1,925

3,486

1,640

10,155

3,644

35,729
(1,373)
34,356

(9,483)
—
(39,977)
(14,700)
(3,677)
(67,837)
(33,481)

As a result of the Merger, the Company recorded a full valuation allowance against all of its net U.S. federal and state 
deferred tax assets with the exception of $0.8 million of estimated state net operating losses (“NOL”). The initial recognition of 
this valuation allowance by the Company was reflected in the opening balance sheet of BioScrip and, to that extent, did not 
impact the Company’s tax expense (benefit) for the year ended December 31, 2019. The valuation allowance for deferred tax 
assets as of December 31, 2019 was $109.5 million.

In assessing the realizability of deferred tax assets, the Company considers whether it is more likely than not that some or 

all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets depends on the generation of 
future taxable income during the periods in which those temporary differences are deductible. The Company considers the 
scheduled reversal of deferred tax liabilities (including the effect in available carryback and carryforward periods), projected 
taxable income, and tax-planning strategies in making this assessment. On a quarterly basis, the Company evaluates the 
positive and negative evidence in determining if the valuation allowance is fairly stated. 

The Company is subject to taxation in the United States and various states. As a result of the Merger, BioScrip carried over 

$461.5 million of federal net operating losses, $491.9 million of state net operating losses, and $85.0 million of interest 
limitation carryforwards. At December 31, 2019, the Company had $541.0 million of gross federal NOL carryforwards of 
which $401.2 million are available to offset future taxable income in the United States. These NOL’s will begin to expire in 
2026 if not utilized. The remaining gross federal NOL’s of $139.8 million at December 31, 2019 are expected to expire 
unutilized due to limitations under Internal Revenue Code Section 382. At December 31, 2018, the Company had $38.1 million 
of gross federal NOL’s. At December 31, 2019 and 2018, the Company had $156.6 million and $13.6 million of interest 
limitation carryforwards. At December 31, 2019 and 2018, the Company also had $601.9 million and $43.5 million of 
cumulative gross state NOL carryforwards available to offset future taxable income in various states.

At December 31, 2019 and 2018, the unrecognized tax benefits for uncertain tax positions was $0. 

59

The following table presents the valuation allowance for deferred tax assets for the years ended December 31, 2019, 2018 

and 2017 (in thousands):

Description

Additions

Balance at
Beginning of
Period

Charged
(Benefit) to
Costs and
Expenses

Charged to
Other
Accounts

Balance at
End Period

2017: Valuation allowance for deferred tax assets

2018: Valuation allowance for deferred tax assets

2019: Valuation allowance for deferred tax assets

$

$

$

765

1,263

1,373

$

$

$

498

110

15,395

$

$

$

— $

— $

1,263

1,373

92,763

$

109,531

Currently, the Company is not subject to any U.S. Federal income tax audits. The Company is subject to various state tax 

audits, and believes that the outcome of these audits will not have a material impact on the Company.  

7. (LOSS) EARNINGS PER SHARE

The Company presents basic and diluted (loss) earnings per share for its common stock. Basic (loss) earnings per share is 

calculated by dividing the net (loss) income of the Company by the weighted average number of shares of common stock 
outstanding during the period. Diluted (loss) earnings per share is determined by adjusting the profit or loss and the weighted 
average number of shares of common stock outstanding for the effects of all dilutive potential common shares.

As a result of the Merger, all historical per share data and number of shares and equity awards were retroactively adjusted. 

The (loss) earnings is used as the basis of determining whether the inclusion of common stock equivalents would be anti-
dilutive. Accordingly, the computation of diluted shares for the year ended December 31, 2019 excludes the effect of shares that 
would be issued in connection with warrants, stock options and restricted stock awards, as their inclusion would be anti-dilutive 
to the loss per share. As of December 31, 2019 there were 2,328,120 warrants, 644,975 stock options and 231,562 restricted 
stock awards outstanding that were excluded from the calculation as they would be anti-dilutive. There are no dilutive potential 
common shares for the years ended December 31, 2018 or 2017.

In conjunction with the one share for four share reverse stock split discussed in Note 20, Subsequent Events, all historical 

per share data and number of shares and equity awards were retroactively adjusted.

The following table presents the Company’s basic and diluted (loss) earnings per share and shares outstanding (in thousands, 

except per share data):

Numerator:

Net (loss) income

Denominator:

Year Ended December 31,

2019

2018

2017

$

(75,920) $

(6,115)

$

3,878

Weighted average number of common shares outstanding

156,280

142,614

142,614

(Loss) Earnings per Common Share:

(Loss) earnings per common share, basic and diluted

$

(0.49) $

(0.04)

$

0.03

8. LEASES

During the year ended December 31, 2019, the Company incurred operating lease expenses of $25.8 million including 

short-term lease expenses, which were included as a component of selling, general and administrative expenses in the 
consolidated statements of comprehensive income (loss). As of December 31, 2019, the weighted-average remaining lease term 
was 5.3 years and the weighted-average discount rate was 5.40%.

Operating leases mature as follows (in thousands): 

60

 
 
 
 
 
Year Ending December 31

Minimum Payments

2020

2021

2022

2023

2024

2025 and beyond

Total lease payments

Less: Interest

Present value of lease liabilities

$

$

24,983

19,178

13,982

10,605

7,847

17,662

94,257

(15,624)

78,633

In addition, the Company had $0.7 million of financing leases outstanding at December 31, 2019 which mature over the 

next year.

During the year ended December 31, 2019, the Company did not enter into any significant new operating or financing 
leases. As of December 31, 2019, the Company did not have any significant operating or financing leases that had not yet 
commenced.

During the years ended December 31, 2018 and 2017, the Company incurred rent expense of $17.3 million, respectively, 

under ASC Topic 840, Leases, which was included as a component of selling, general and administrative expenses in the 
consolidated statements of comprehensive income (loss).

9. PROPERTY AND EQUIPMENT

Property and equipment was as follows as of December 31, 2019 and 2018 (in thousands):

December 31, 2019

December 31, 2018

Infusion pumps
Equipment, furniture, and other
Leasehold improvements

Computer software, purchased and internally developed
Assets under development

Less accumulated depreciation
Property and equipment, net

$

$

30,416
51,454
80,916

34,884
14,150
211,820
78,622
133,198

$

$

20,339
34,433
61,302

29,668
5,447
151,189
58,047
93,142

Depreciation expense is recorded within cost of revenue and operating expenses within the consolidated statements of 
comprehensive income (loss), depending on the nature of the underlying fixed assets. The depreciation expense included in cost 
of revenue relates to revenue-generating assets, such as infusion pumps. The depreciation expense included in operating 
expenses is related to infrastructure items, such as furniture, computer and office equipment, and leasehold improvements. The 
following table presents the amount of depreciation expense recorded in cost of revenue and operating expenses for the years 
ended December 31, 2019, 2018 and 2017 (in thousands):

Depreciation expense in cost of revenue

Depreciation expense in operating expenses

Total depreciation expense

$

$

4,179

27,629

31,808

$

$

2,993

18,490

21,483

$

$

3,400

14,868

18,268

Year ended December 31,

2019

2018

2017

During the year ended December 31, 2018, one company location was destroyed by a hurricane, resulting in a loss of $0.6 

million of property and equipment. A business casualty loss was recorded as a component of operating costs and expenses 
within the consolidated statements of comprehensive income (loss). During the year ended December 31, 2019, $0.6 million in 

61

proceeds were received related to recovery of property and equipment. These proceeds resulted in a gain on business casualty 
loss of $0.6 million recorded as a component of selling, general, and administrative expenses in the consolidated statements of 
comprehensive income (loss) during the year ended December 31, 2019. These proceeds were reflected as a component of cash 
flows from investing activities in the consolidated statement of cash flows. 

10. GOODWILL AND OTHER INTANGIBLE ASSETS

Goodwill is not amortized, but is evaluated for impairment annually in the fourth quarter of the fiscal year, or more 
frequently if an event occurs or circumstances change that would more likely than not reduce the fair value of a reporting unit 
below its carrying value. 

Circumstances that could trigger an interim impairment test include: a significant adverse change in the business climate or 

legal factors; an adverse action or assessment by a regulator; unanticipated competition; the loss of key personnel; a change in 
reporting units; the likelihood that a reporting unit or significant portion of a reporting unit will be sold or otherwise disposed 
of; and the results of testing for recoverability of a significant asset group within a reporting unit.

A qualitative impairment analysis was performed in the fourth quarter of 2019 to assess whether it is more likely than not 

that the fair value of the Company’s reporting unit is less than its carrying value. The Company assessed relevant events and 
circumstances including macroeconomic conditions, industry and market considerations, overall financial performance, entity-
specific events, and changes in the Company’s stock price. The Company determined that there was no goodwill impairment in 
2019.

A quantitative impairment analysis was performed in the fourth quarter of 2018 and 2017, and the Company estimated the 
fair value of its reporting unit using an income approach. The income approach requires management to estimate a number of 
factors for its reporting unit, including projected future operating results, economic projections, anticipated future cash flows, 
and discount rates. The fair value determined using the income approach was then compared to marketplace fair value data 
from within a comparable industry grouping for reasonableness. The Company determined that there was no goodwill 
impairment in 2018 or 2017.

The determination of fair value and the allocation of that value to individual assets and liabilities within the reporting unit 
requires the Company to make significant estimates and assumptions. These estimates and assumptions primarily include, but 
are not limited to, the selection of appropriate peer group companies; control premiums appropriate for acquisitions in the 
industries in which the Company competes; the discount rate; terminal growth rates; and forecasts of revenue, operating 
income, depreciation and amortization, and capital expenditures. Actual financial results could differ from those estimates due 
to the inherent uncertainty involved in making such estimates. Changes in assumptions concerning future financial results or 
other underlying assumptions could have a significant impact on either the fair value of the reporting unit, the amount of the 
goodwill impairment charge, or both.

Changes in the carrying amount of goodwill consist of the following activity for the years ended December 31, 2019 and 

2018 (in thousands): 

Balance at December 31, 2017

Acquisitions

Balance at December 31, 2018

Acquisitions

Balance at December 31, 2019

$

$

$

627,392

5,077

632,469

793,073

1,425,542

There was no change in the carrying amount of goodwill for the year ended December 31, 2017. 

The carrying amount and accumulated amortization of intangible assets consists of the following as of December 31, 2019 

and 2018 (in thousands):

62

December 31, 2019

December 31, 2018

Gross intangible assets:

Referral sources

Trademarks/names

Other amortizable intangible assets

Total gross intangible assets

Accumulated amortization:

Referral sources

Trademarks/names

Other amortizable intangible assets

Total accumulated amortization

$

438,121

$

44,536

402

483,059

(84,295)

(12,748)

(106)

(97,149)

Total intangible assets, net

$

385,910

$

257,792

32,000

4,151

293,943

(63,353)

(8,000)

(2,877)

(74,230)

219,713

Amortization expense for intangible assets was $26.1 million, $19.6 million and $19.8 million for the years ended 

December 31, 2019, 2018 and 2017, respectively. 

Expected future amortization expense for intangible assets recorded at December 31, 2019, is as follows (in thousands):

2020

2021

2022

2023

2024

2025 and beyond

Total

$

$

34,859

32,015

28,338

28,338

28,338

234,022

385,910

The weighted average amortization period of intangible assets by class and in total as of December 31, 2019 are as 
follows:  17.1 years for referral sources, 4.2 years for trademarks/names, 1.5 years for other amortizable intangible assets, and 
15.9 years for total intangible assets.

11. EQUITY-METHOD INVESTMENTS

The Company’s two equity-method investments totaled $17.0 million and $14.6 million as of December 31, 2019 and 

2018, respectively, and are included in other noncurrent assets in the accompanying consolidated balance sheets. The 
Company’s related proportionate share of earnings is recorded in equity in earnings of joint ventures in the accompanying 
consolidated statements of comprehensive income (loss). For the years ended December 31, 2019, 2018 and 2017, the 
Company’s proportionate share of earnings in its equity-method investees was $2.8 million, $1.0 million and $2.2 million, 
respectively. 

Legacy Health Systems — The Company’s 50% ownership interest in this limited liability company, which provides 

infusion pharmacy services, expands the Company’s presence in the Portland, Oregon market. In 2005, Option Care’s initial 
cash investment in this joint venture was $1.3 million. The Company received a capital distribution from this investment of 
$0.5 million, $2.0 million and $1.3 million for the years ended December 31, 2019, 2018 and 2017, respectively. The following 
presents condensed financial information as of December 31, 2019 and December 31, 2018 and for the years ended 
December 31, 2019, 2018 and 2017 (in thousands):

63

Consolidated statements of comprehensive income (loss) data:

Year Ended December 31,

2019

2018

2017

$

21,037

$

21,309

$

Net revenue

Cost of revenue

Gross profit

Net income

Equity in net income

Consolidated balance sheet data:

Current assets

Noncurrent assets

Current liabilities

Noncurrent liabilities

As of December 31,

2019

2018

$

7,643

$

3,846

903

659

Vanderbilt Health Services — The Company’s 50% ownership interest in this limited liability company, which provides 

infusion pharmacy services, expands the Company’s presence in the Nashville, Tennessee market. In 2009, Option Care 
contributed both cash and certain operating assets into the joint venture for a total initial investment of $1.1 million. The 
following presents condensed financial information as of December 31, 2019 and 2018 and for the years ended December 31, 
2019, 2018 and 2017, (in thousands):

Consolidated statements of comprehensive income (loss) data:

Year Ended December 31,

2019

2018

2017

$

38,744

$

31,517

$

23,295

17,069

6,226

3,278

1,639

27,805

20,665

7,140

1,094

547

14,792

6,245

1,986

993

29,952

8,792

3,694

1,847

15,042

6,267

1,772

886

5,666

3,403

119

8

24,433

7,084

268

134

6,517

1,008

192

68

Net revenue

Cost of revenue

Gross profit

Net income

Equity in net income

Consolidated balance sheet data:

Current assets

Noncurrent assets

Current liabilities

Noncurrent liabilities

As of December 31,

2019

2018

$

11,111

$

2,033

1,228

956

64

12. INDEBTEDNESS

Long-term debt consisted of the following as of December 31, 2019 (in thousands):

ABL Facility

First Lien Term Loan

Second Lien Notes

Less: current portion

Total long-term debt

Principal Amount

Discount

Debt Issuance
Costs

Net Balance

$

$

— $

— $

— $

925,000

412,256

(8,399)

(11,672)

1,337,256

$

(20,071) $

(22,825)

(7,864)

(30,689)

—

893,776

392,720

1,286,496

(9,250)

$

1,277,246

Long-term debt consisted of the following as of December 31, 2018 (in thousands):

Previous Revolving Credit Facility

Previous First Lien Term Loan

Previous Second Lien Term Loan

Less: current portion

Total long-term debt

Principal Amount

Discount

Debt Issuance
Costs

Net Balance

$

$

— $

— $

— $

401,513

150,000

(1,062)

—

551,513

$

(1,062) $

(5,678)

(5,398)

(11,076)

$

—

394,773

144,602

539,375

(4,150)

535,225

Retired Debt Obligations — During 2015, Option Care entered into two credit arrangements administered by Bank of 

America, N.A. and U.S. Bank. The agreements provided for up to $645.0 million in senior secured credit facilities through an 
$80.0 million revolving credit facility (the “Previous Revolving Credit Facility”), a $415.0 million first lien term loan (the 
“Previous First Lien Term Loan”), and a $150.0 million second lien term loan (the “Previous Second Lien Term Loan”, and 
together with the Previous First Lien Term Loan, the “Previous Term Loans”, and the Previous Term Loans, together with the 
Previous Revolving Credit Facility, the “Previous Credit Facilities”). Amounts borrowed under the credit agreements were 
secured by substantially all of the assets of the Company.

The Company incurred an original issue discount in conjunction with entering into the Previous First Lien Term Loan of 
$2.1 million, and also incurred an aggregate of $21.1 million in debt issuance costs to obtain the two credit agreements. These 
costs were recorded as a reduction to the carrying amount in the consolidated balance sheets and were being amortized over the 
term of the related debt using the effective interest method for the Previous Term Loans and the straight-line method for the 
Previous Revolving Credit Facility.

On August 6, 2019, the Company repaid the outstanding balance of Previous Term Loans and retired the outstanding 
Previous Credit Facilities by entering into two new credit arrangements and a notes indenture, described below under “New 
Debt Obligations”. At the time of repayment, the outstanding balance of the Previous First Lien Term Loan was $393.8 million, 
which was comprised of principal of $399.4 million, net of debt issuance costs of $0.9 million and deferred financing costs of 
$4.7 million. The balance of the Previous Second Lien Term Loan was $145.8 million, which was comprised of principal of 
$150.0 million, net of deferred financing costs of $4.2 million. Proceeds from the two new credit arrangements and notes 
indenture were also used, in part, to repay the outstanding debt of BioScrip as of the Merger Date of $575.0 million.

The principal balance on the Previous First Lien Term Loan was repayable in quarterly installments of $1.0 million. There 
were no quarterly principal payments required for the Previous Second Lien Term Loan. Interest was payable monthly for the 
Previous First Lien Term Loan and quarterly for the Previous Second Lien Term Loan. The interest rate on the Previous First 
Lien Term Loan was 6.10% as of December 31, 2018 and the interest rate on the Previous Second Lien Term Loan was 11.15% 
as of December 31, 2018. The weighted average interest rate paid on the Previous First Lien Term Loan was 6.20% and 6.30% 
for the years ended December 31, 2019 and 2018, respectively, prior to the retirement of the debt obligations. The weighted 
average interest paid on the Previous Second Lien Term Loan was 11.36% and 10.80% for the years ended December 31, 2019 
and 2018, respectively, prior to the retirement of the debt obligations. 

65

New Debt Obligations — In conjunction with the Merger, the Company entered into an asset-based-lending revolving 
credit facility administered by Bank of America, N.A. The Company also issued senior secured second lien PIK toggle floating 
rate notes due 2027 (the “Second Lien Notes”) under an indenture with Ankura Trust Company, LLC. The two new credit 
agreements and the indenture were entered into on August 6, 2019 and provide for up to $1,475.0 million in senior secured 
credit facilities through a $150.0 million asset-based-lending revolving credit facility (the “ABL Facility”), a $925.0 million 
first lien term loan (the “First Lien Term Loan”, and together with the ABL Facility, the “Loan Facilities”), and a $400.0 million 
issuance of Second Lien notes. 

The ABL Facility provides for borrowings up to $150.0 million, which matures on August 6, 2024. The ABL Facility bears 

interest at a per annum rate that is determined by the Company’s periodic selection of rate type, either the Base Rate or the 
Eurocurrency Rate. Interest on the ABL Facility is charged on Base Rate loans at Base Rate, as defined, plus 1.25% to 1.75%,  
depending on the historical excess availability as a percentage of the Line Cap, as defined in the ABL Facility credit agreement. 
Interest on the ABL Facility is charged on Eurocurrency Rate Loans at the Eurocurrency Rate, as defined, plus 2.25% to 2.75%, 
depending on the historical excess availability as a percentage of the Line Cap, as defined in the ABL Facility credit agreement. 
The ABL Facility contains commitment fees payable on the unused portion ranging from 0.25% to 0.375%, depending on 
various factors including the Company’s leverage ratio, type of loan and rate type, and letter of credit fees of 2.50%. 
Borrowings under the ABL Facility are secured by a first priority security interest in the Company’s and each of its subsidiaries’ 
inventory, accounts receivable, cash, deposit accounts and certain assets and property related thereto (the “ABL Priority 
Collateral”), in each case subject to certain exceptions, and a third priority security interest in the Term Loan Priority Collateral, 
as defined below. The Company had no outstanding borrowings under the ABL Facility at December 31, 2019. The Company 
had $9.6 million of undrawn letters of credit issued and outstanding, resulting in net borrowing availability under the ABL of 
$140.4 million as of December 31, 2019. 

The principal balance of the First Lien Term Loan is repayable in quarterly installments commencing in March 2020 of 
$2.3 million plus interest, with a final payment of all remaining outstanding principal due on August 6, 2026. Interest on the 
First Lien Term Loan is payable monthly on Base Rate loans at Base Rate, as defined, plus 3.25% to 3.50%, depending on the 
Company’s leverage ratio. Interest is charged on Eurocurrency Rate loans at the Eurocurrency Rate, as defined, plus 4.25% to 
4.50%, depending on the Company’s leverage ratio. The interest rate on the First Lien Term Loan was 6.20% as of 
December 31, 2019. The weighted average interest rate incurred was 6.47% for the period August 6, 2019 through 
December 31, 2019. Amounts borrowed under the First Lien Term Loan are secured by a first priority security interest in each 
of the Company’s subsidiaries’ capital stock (subject to certain exceptions) and substantially all of the Company’s property and 
assets (other than the ABL Priority Collateral), (the “Term Loan Priority Collateral”), in each case subject to certain exceptions, 
and a second priority security interest in the ABL Priority Collateral.

The Second Lien Notes mature on August 6, 2027. Interest on the Second Lien Notes is payable quarterly and is at the 
greater of 1% or the London Interbank Offered Rate (“LIBOR”), plus 8.75%. The Company elected to pay-in-kind (“PIK”) the 
first quarterly interest payment, due in November 2019, which resulted in the Company capitalizing $12.3 million in interest to 
the principal balance on the interest payment date. In connection with the PIK election, the Company was charged an additional 
1.00% in interest expense on the first quarterly interest payment. The interest rate on the Second Lien Notes was 10.66% as of 
December 31, 2019. The weighted average interest incurred was 11.45% for the period August 6, 2019 through December 31, 
2019.

The Company assessed whether the repayment of the Previous Term Loans and subsequent issuance of the First Lien Term 

Loan and the Second Lien Notes resulted in an insubstantial modification or an extinguishment of the existing debt for each 
loan in the syndication by grouping lenders as follows: (i) Lenders participating in both the Previous Credit Facilities and the 
new Loan Facilities and Second Lien Notes; (ii) previous lenders that exited; and (iii) new lenders. The Company determined 
that $226.7 million of the Previous First Lien Term Loan was extinguished and none of the Previous Second Lien Term Loan 
was extinguished, which is disclosed as an outflow from financing activities in the consolidated statements of cash flows. The 
Company determined that $752.4 million of new debt was issued related to the First Lien Term Loan and $250.0 million of new 
debt was issued related to the Second Lien Notes, which is disclosed as an inflow from financing activities in the consolidated 
statements of cash flows. In connection with the issuance of the First Lien Term Loan, the Second Lien Notes, and the ABL 
Facility, the Company incurred $52.6 million in debt issuance costs and third-party fees, of which $48.1 million was 
capitalized, $1.3 million was expensed as a component of other expense and $3.2 million was expensed as a loss on 
extinguishment as a component of other expense. Further, $21.3 million of the total fees incurred of $52.6 million was netted 
against the $981.1 million of proceeds from debt as a component of the cash flows from financing activities, $30.0 million was 
presented as deferred financing costs as a component of cash flows from financing activities, and the remaining $1.3 million 
was included in cash flows from operating activities.

66

The Company recognized a loss on extinguishment of debt of $5.5 million, of which $3.2 million related to debt issue costs 

incurred with the issuance of the Loan Facilities and Second Lien Notes, as discussed above, and $2.3 million related to 
deferred financing fees on the Previous Credit Facilities, which were written off upon extinguishment. All remaining deferred 
financing fees related to the Previous Credit Facilities of $7.6 million were attributed to modified loans, which are capitalized 
and will be amortized over the remaining term of the Loan Facilities and Second Lien Notes.

Long-term debt matures as follows (in thousands):

Year Ending December 31,

Minimum Payments

2020

2021

2022

2023

2024

2025 and beyond

Total

$

$

9,250

9,250

9,250

9,250

9,250

1,291,006

1,337,256

During the year ended December 31, 2019, the Company engaged in hedging activities to limit its exposure to changes in 

interest rates. See Note 13, Derivative Instruments, for further discussion.

The following table presents the estimated fair values of the Company’s debt obligations as of December 31, 2019  (in 

thousands):

Financial Instrument

First Lien Note Facility

Second Lien Note Facility

Total debt instruments

Carrying Value as 
of December 31, 
2019

Markets for 
Identical Item 
(Level 1)

Significant Other 
Observable Inputs 
(Level 2)

Significant 
Unobservable 
Inputs (Level 3)

$

$

893,776

$

392,720

1,286,496

$

— $

—

— $

922,688

$

—

922,688

$

—

411,119

411,119

The following table sets forth the changes in Level 3 measurements for the year ended December 31, 2019 (in thousands):

Level 3 Measurements

Previous Term Loans fair value as of January 1, 2019

Change in fair value

Repayments of debt principal

Retirements of Previous Term Loans

Issuance of Second Lien Notes as of August 6, 2019

Interest rate PIK

Change in fair value

Second Lien Notes fair value as of December 31, 2019

$

$

See Note 14, Fair Value Measurements, for further discussion.

13. DERIVATIVE INSTRUMENTS

551,882

(369)

(2,075)

(549,438)

388,000

12,256

10,863

411,119

The Company utilizes derivative financial instruments for hedging and non-trading purposes to limit the Company’s 
exposure to its variable interest rate risk. Use of derivative financial instruments in hedging strategies subjects the Company to 
certain risks, such as market and credit risks. Market risk represents the possibility that the value of the derivative financial 
instrument will change. Credit risk related to a derivative financial instrument represents the possibility that the counterparty 
will not fulfill the terms of the contract. The notional, or contractual, amount of the Company’s derivative financial instruments 
is used to measure interest to be paid or received and does not represent the Company’s exposure due to credit risk. Credit risk 
is monitored through established approval procedures, including reviewing credit ratings when appropriate.

67

During 2017, Option Care entered into interest rate caps that reduce the risk of increased interest payments due to rising 
interest rates. The hedges offset the risk of rising interest rates through 2020 on the first $250.0 million of the Previous First 
Lien Term Loan. The interest rate caps perfectly offset the terms of the interest rates associated with the variable interest rate 
Previous First Lien Term Loan. Option Care entered into the interest rate caps as a cash flow hedge for a notional amount of 
$1.9 million. In April 2019, Option Care terminated its interest rate caps and received cash proceeds of $1.7 million, net of 
early termination fees. In conjunction with the termination of the interest rate caps, Option Care discontinued the hedge 
accounting associated with the interest rate caps. 

In August 2019, the Company entered into interest rate swap agreements that reduce the variability in the interest rates on 

the newly-issued debt obligations. The first interest rate swap for $925.0 million notional was effective in August 2019 with 
$911.1 million designated as a cash flow hedge against the underlying interest rate on the First Lien Term Loan interest 
payments indexed to one-month LIBOR through August 2021. The second interest rate swap for $400.0 million notional was 
effective in November 2019 and is designated as a cash flow hedge against the underlying interest rate on the Second Lien 
Notes interest payment indexed to three-month LIBOR through November 2020. In accordance with ASU 2017-12, Targeted 
Improvements to Accounting for Hedges, the Company has determined that the hedges are perfectly effective. The remaining 
$13.9 million notional amount of the first interest rate swap is not designated as a hedging instrument. 

The following table summarizes the amount and location of the Company’s derivative instruments in the consolidated 

balance sheets (in thousands):

Derivative

Interest rate caps designated as cash flow hedges

Total derivatives

Fair value - Derivatives in asset position

Balance Sheet
Caption

Prepaid expenses
and other current
assets

December 31, 2019

December 31, 2018

$

$

— $

— $

2,627

2,627

Fair value - Derivatives in liability position

Derivative

Interest rate swaps designated as cash flow hedges

Interest rate swaps designated as cash flow hedges

Interest rate swaps not designated as hedges

Total derivatives

Balance Sheet
Caption

Accrued expenses
and other current
liabilities

Other noncurrent
liabilities

Other noncurrent
liabilities

$

$

December 31, 2019

December 31, 2018

1,275

$

5,920

90

7,285

$

—

—

—

—

The gain and loss associated with the changes in the fair value of the effective portion of the hedging instrument are 
recorded into other comprehensive (loss) income. The gain and loss associated with the changes in the fair value of the $13.9 
million notional amount not designated as a hedging instrument are recognized in net income through interest expense. The 
following table presents the pre-tax gains (losses) from derivative instruments recognized in other comprehensive (loss) income 
in the Company’s consolidated statements of comprehensive income (loss) (in thousands):

Derivative

Interest rate caps designated as cash flow hedges

Interest rate swaps designated as cash flow hedges

Total

Years Ended December 31,

2019

2018

2017

$

$

(1,103) $

1,008

$

(7,195)

—

(8,298) $

1,008

$

94

—

94

The following table presents the amount and location of pre-tax income (loss) recognized in the Company’s consolidated 

statement of comprehensive income (loss) related to the Company’s derivative instruments (in thousands):

68

Derivative

Income Statement Caption

2019

2018

2017

Interest rate caps designated as cash flow hedges

Interest expense

Interest rate swaps designated as cash flow hedges

Interest expense

Interest rate swaps not designated as hedges

Interest expense

Total

$

$

(125)
(115)
(92)
(332)

$

300

$

—

—

$

300

$

5

—

—

5

Year Ended December 31,

The Company expects to reclassify $5.1 million of total interest rate costs from accumulated other comprehensive loss 

against interest expense during the next 12 months.

14. FAIR VALUE MEASUREMENTS

Fair value measurements are determined by maximizing the use of observable inputs and minimizing the use of 
unobservable inputs.  The hierarchy places the highest priority on unadjusted quoted market prices in active markets for 
identical assets or liabilities (Level 1 measurements) and gives the lowest priority to unobservable inputs (Level 3 
measurements).  The three levels of inputs within the fair value hierarchy are defined in Note 2, Summary of Significant 
Accounting Policies. While the Company believes its valuation methods are appropriate and consistent with other market 
participants, the use of different methodologies or assumptions to determine the fair value of certain financial instruments could 
result in a different fair value measurement at the reporting date.

First Lien Term Loan: The fair value of the First Lien Term Loan is derived from a broker quote on the loans in the 
syndication (Level 2 inputs). See Note 12, Indebtedness, for further discussion on the carrying amount and fair value of the 
First Lien Term Loan.

Second Lien Notes: The fair value of the Second Lien Notes is derived from a cash flow model that discounted the cash 
flows based on market interest rates (Level 3 inputs). See Note 12, Indebtedness, for further discussion on the carrying amount 
and fair value of the Second Lien Notes.

Interest rate swaps: The fair values of interest rate swaps are derived from the interest rates prevalent in the market and 
future expectations of those interest rates (Level 2 inputs). The Company determines the fair value of the investments based on 
quoted prices from third-party brokers. See Note 13, Derivative Instruments, for further discussion on the fair value of the 
interest rate swaps. 

Interest rate caps: The fair values of interest rate caps are derived from the interest rates prevalent in the market and future 
expectations of those interest rates (Level 2 inputs). The Company determines the fair value of the investments based on quoted 
prices from third-party brokers. In April 2019, Option Care terminated its interest rate caps. See Note 13, Derivative 
Instruments, for further discussion on the fair value of the interest rate caps.

There were no other assets or liabilities measured at fair value at December 31, 2019 or 2018.

15. COMMITMENTS AND CONTINGENCIES

The Company is involved in legal proceedings and is subject to investigations, inspections, audits, inquiries, and similar 

actions by governmental authorities, arising in the normal course of the Company’s business. Some of these suits may purport 
or may be determined to be class actions and/or involve parties seeking large and/or indeterminate amounts, including punitive 
or exemplary damages, and may remain unresolved for several years. From time to time, the Company may also be involved in 
legal proceedings as a plaintiff involving antitrust, tax, contract, intellectual property, and other matters. Gain contingencies, if 
any, are recognized when they are realized. The results of legal proceedings are often uncertain and difficult to predict, and the 
costs incurred in litigation can be substantial, regardless of the outcome. The Company believes that its defenses and assertions 
in pending legal proceedings have merit and does not believe that any of these pending matters, after consideration of 
applicable reserves and rights to indemnification, will have a material adverse effect on the Company’s consolidated balance 
sheets. However, substantial unanticipated verdicts, fines, and rulings may occur. As a result, the Company may from time to 
time incur judgments, enter into settlements, or revise expectations regarding the outcome of certain matters, and such 
developments could have a material adverse effect on its results of operations in the period in which the amounts are accrued 
and/or its cash flows in the period in which the amounts are paid.

69

16. STOCK-BASED INCENTIVE COMPENSATION

Equity Incentive Plans — Under the Company’s 2018 Equity Incentive Plan (the “2018 Plan”), approved at the annual 
meeting by the BioScrip stockholders on May 3, 2018, the Company may issue, among other things, incentive stock options, 
non-qualified stock options, stock appreciation rights, restricted stock units, stock grants, and performance units to key 
employees and directors. The 2018 plan is administered by the Company’s Compensation Committee, a standing committee of 
the Board of Directors. A total of 16,406,939 shares (4,101,735 equivalent shares after adjusting for the one share for four share 
reverse stock split) of common stock were initially authorized for issuance under the 2018 Plan. 

Stock Options — Options granted under the 2018 Plan typically vest over a three-year period and, in certain instances, 
may fully vest upon a change in control of the Company. The options also typically have an exercise price that may not be less 
than 100% of its fair market value on the date of grant and are exercisable seven to ten years after the date of grant, subject to 
earlier termination in certain circumstances.

Compensation expense from stock options is recognized on a straight-line basis over the requisite service period. During 
the year ended December 31, 2019, the Company recognized compensation expense related to stock options of $0.4 million. 
The Company did not recognize any compensation expense related to stock options prior to the Merger.

The Company did not grant any options during the year ended December 31, 2019.

A summary of stock option activity from the Merger Date through December 31, 2019 was as follows (all amounts 

adjusted for the one share for four share reverse stock split):

Options

Weighted Average 
Exercise Price

Aggregate Intrinsic 
Value (thousands)

Weighted Average 
Remaining 
Contractual Life

Balance at December 31, 2018

Acquired in Merger

Granted

Exercised

Forfeited and expired

Balance at December 31, 2019

Exercisable at December 31, 2019

— $

812,565

$

— $

(158,270) $

(9,320) $

644,975

597,856

$

$

— $

13.88

$

— $

7.64

17.72

15.36

15.76

$

$

$

$

—

3,935

—

995

29

2,754

2,524

2.4 years

1.9 years

During the year ended December 31, 2019, shares were surrendered to satisfy tax withholding obligations on the exercise 

of stock options with a cost basis of $0.4 million, which are all held as treasury stock as of December 31, 2019. No cash was 
received from stock option exercises under share-based payment arrangements for the years ended December 31, 2019, 2018 or 
2017.

The maximum term of stock options under these plans is ten years. Options outstanding as of December 31, 2019 expire on 

various dates ranging from February 2020 through November 2028. The following table outlines the outstanding and 
exercisable stock options as of December 31, 2019 (all amounts adjusted for the one share for four share reverse stock split):

70

Range of Option 
Exercise Price

Outstanding 
Options

Options Outstanding

Options Exercisable

Weighted 
Average Exercise 
Price

Weighted 
Average 
Remaining 
Contractual Life

Options 
Exercisable

Weighted 
Average Exercise 
Price

$0.00 - $8.24

$8.24 - $16.52

$16.52 - $24.76

$24.76 - $33.00

$33.00 - $41.28

$41.28 - $49.52

$49.52 - $57.76

$57.76 - $66.00

$66.00 - $74.28

All options

139,168

295,224

38,250

148,333

$

$

$

$

— $

18,750

4,000

$

$

— $

1,250

$

644,975

4.87

10.33

20.97

28.57

—

44.16

56.24

—

66.52

1.0 year

3.7 years

2.5 years

0.8 years

—

3.2 years

3.0 years

—

3.6 years

135,867

251,406

38,250

148,333

$

$

$

$

— $

18,750

4,000

$

$

— $

1,250

$

597,856

4.83

10.34

20.97

28.57

—

44.16

56.24

—

66.52

As of December 31, 2019, there was $0.2 million of unrecognized compensation expense related to unvested option grants 

that is expected to be recognized over a weighted-average period of 1.5 years.

Restricted Stock — Restricted stock grants subject solely to an employee’s continued service with the Company generally 
will become fully vested within one to three years from the grant date and, in certain instances, may fully vest upon a change in 
control of the Company. Restricted stock grants subject solely to a Director’s continued service with the Company generally 
will become fully vested within one year from the date of grant. 

Compensation expense from restricted stock is recognized on a straight-line basis over the requisite service period. During 

the year ended December 31, 2019, the Company recognized compensation expense related to restricted stock awards of $1.9 
million. The Company did not recognize any compensation expense related to restricted stock awards prior to the Merger.

A summary of restricted stock award activity from the Merger Date through December 31, 2019 was as follows:

Balance at December 31, 2018

Acquired in Merger (1)

Granted

Vested and issued (1)

Forfeited and expired (1)

Balance at December 31, 2019

Restricted Stock

Weighted Average 
Grant Date Fair 
Value

— $

280,120

$

169,123
$
(214,926) $
(2,755) $
$

231,562

—

10.68

10.72

10.68

10.68

10.68

(1) Weighted average grant date fair value was calculated as $2.67 stock price on the August 6, 2019 Merger Date, 

multiplied by four to adjust for the one share for four share reverse stock split.

During the year ended December 31, 2019, shares were surrendered to satisfy tax withholding obligations on the vesting of 

restricted stock awards with a cost basis of $2.1 million, of which $2.0 million is held as treasury stock as of December 31, 
2019.

As of December 31, 2019, there was $2.4 million in unrecognized compensation expense related to unvested restricted 
stock awards that is expected to be recognized over a weighted average period of 2.7 years. The total fair value of restricted 
stock awards vested during the years ended December 31, 2019, 2018 and 2017 was $1.9 million, $0 and $0, respectively.

HC I Incentive Units —  Beginning in October 2015, HC I implemented an equity incentive plan for certain officers and 
employees of the Company. Incentive units are equity-based awards subject to time and performance vesting restrictions. The 
compensation expense related to this plan has been reflected in the Company’s financial statements.

71

In accordance with ASC Topic 718, Compensation-Stock Compensation, compensation expense is recognized on a 
straight-line basis over the vesting period of the award or the employee’s retirement eligible date, if earlier. During the years 
ended December 31, 2019, 2018 and 2017, the Company recognized compensation expense related to the HC I incentive units 
of $1.9 million, $2.1 million and $1.4 million, respectively. 

The fair value of each award was determined using a Monte-Carlo simulation with the following weighted average 

assumptions used for the years ended December 31, 2019 and 2018: 

Risk-free interest rate (1)

Average time to liquidity (years) (2)

Volatility (3)

Discount for lack of marketability (4)

Weighted-average grant-date fair value per share

2.25%

2.13

47.00%

30.00%

$1.13

(1) Represents the US Treasury security rate for the expected time to liquidity event.

(2) Represents the period of time expected prior to liquidity event.

(3) Based on historical volatility of comparable public companies.

(4) Represents a discount taken to reflect the private nature of the investment.

17. STOCKHOLDERS’ EQUITY

As further discussed in Note 20, Subsequent Events, on February 3, 2020, the Company completed a one share for four share 
reverse stock split. All common shares, warrants and stock awards have been retrospectively adjusted for the reverse stock split 
for all periods presented in these consolidated financial statements.

2017 Warrants — Prior to the Merger, BioScrip issued warrants to certain debt holders pursuant to a Warrant Purchase 

Agreement dated as of June 29, 2017. In conjunction with the Merger, the 2017 Warrants were amended to entitle the 
purchasers of the warrants to purchase 8.3 million shares (2.1 million equivalent shares after adjusting for the reverse stock 
split) of common stock. The 2017 Warrants have a 10-year term and an exercise price of $2.00 per share ($8.00 per share after 
adjusting for the reverse stock split), and may be exercised by payment of the exercise price in cash or surrender of shares of 
common stock into which the 2017 Warrants are being converted in an aggregate amount sufficient to pay the exercise price. 
The 2017 Warrants are classified as equity instruments, and the fair value of these warrants of $14.1 million was recorded in 
paid-in capital as of the Merger Date. Subsequent to the Merger Date through December 31, 2019, warrant holders exercised 
warrants to purchase 2.6 million shares (0.7 million equivalent shares after adjusting for the reverse stock split) of common 
stock. No proceeds were received from these exercises as the warrant holders elected to surrender shares to pay the exercise 
price. At December 31, 2019, the remaining warrant holders are entitled to purchase 5.7 million shares (1.4 million equivalent 
shares after adjusting for the reverse stock split) of common stock.

2015 Warrants — Prior to the Merger, BioScrip issued warrants pursuant to a Common Stock Warrant Agreement dated 
as of March 9, 2015 which entitle the holders to purchase 3.7 million shares (0.9 million equivalent shares after adjusting for 
the reverse stock split) of common stock. The 2015 Warrants have a 10-year term and have exercise prices in a range of $5.17 
per share to $6.45 per share ($20.68 per share to $25.80 per share after adjusting for the reverse stock split).  The 2015 
Warrants were assumed by the Company in conjunction with the Merger and are classified as equity instruments, and the fair 
value of these warrants of $4.6 million was recorded in paid in capital as of the Merger Date.

Home Solutions Restricted Stock — In conjunction with BioScrip’s 2016 acquisition of Home Solutions, Inc., 7.1 
million (1.8 million equivalent shares after adjusting for the reverse stock split) restricted shares of common stock were issued, 
of which 3.1 million (0.8 million equivalent shares after adjusting for the reverse stock split) of these units vest upon the 
closing price of the Company’s common stock averaging at or above $4.00 per share ($16.00 per share after adjusting for the 
reverse stock split) over 20 consecutive trading days prior to December 31, 2019 and 4.0 million (1.0 million equivalent shares 
after adjusting for the reverse stock split) of these units vest upon the closing price of the Company’s common stock averaging 
at or above $5.00 per share ($20.00 per share after adjusting for the reverse stock split) over 20 consecutive trading days prior 
to December 31, 2019. The restricted stock expired on December 31, 2019. As discussed in Note 1, Nature of Operations and 
Presentation of Financial Statements, 28,193,428 common shares (7,048,357 equivalent shares after adjusting for the reverse 
stock split) issued to HC I in conjunction with the Merger are held in escrow to prevent dilution related to the vesting of the 
Home Solutions restricted stock. In the event the Home Solutions restricted stock expires unvested, the 28,193,428 common 

72

shares (7,048,357 equivalent shares after adjusting for the reverse stock split) held in escrow will be returned to the Company 
and canceled. As of December 31, 2019, the Home Solutions restricted stock remained in escrow pending final resolution of 
this matter.

Treasury Stock — During the year ended December 31, 2019, 1,160,469 shares (290,117 equivalent shares after adjusting 

for the reverse stock split) were surrendered to satisfy tax withholding obligations on the exercise of stock options and the 
vesting of restricted stock awards with a cost basis of $2.5 million, of which $2.4 million remains held in treasury as of 
December 31, 2019. At December 31, 2019, the Company held 1,534,886 shares (383,722 equivalent shares after adjusting for 
the reverse stock split) of treasury stock. No treasury stock existed prior to the Merger. 

Preferred Stock — In conjunction with the Merger, all legacy BioScrip preferred stock was settled, and no preferred stock 

is outstanding as of December 31, 2019. There was no preferred stock existing as of December 31, 2018.

18. RELATED-PARTY TRANSACTIONS

Management Services — In conjunction with the Option Care Acquisition, the Company entered into two separate 
Management Services Agreements with Madison Dearborn Partners VI-B, L.P. and Walgreen Co. Each Management Services 
Agreement required the Company to pay $0.3 million to each party quarterly beginning July 1, 2015 for on-going management, 
consulting and financial services provided to the Company. Following the close of the Merger, both Management Services 
Agreements were terminated. In 2019, prior to the Merger, the Company incurred $1.5 million of management services 
expense, which has been reflected as a component of selling, general and administrative expense in the consolidated statements 
of comprehensive income (loss) for the year ended December 31, 2019. During the years ended December 31, 2018 and 2017, 
management services expense of $2.0 million was recorded as a component of selling, general, and administrative expense in 
the consolidated statements of comprehensive income (loss). 

Management Equity Ownership Plan —  In October 2015, HC I implemented an equity ownership and incentive plan 
for certain officers and employees of Option Care. The officers were able to purchase membership units in HC I and could fund 
a portion of the purchase with a loan from Option Care. These loans were treated as a shareholder contribution in Option Care. 
For the year ended December 31, 2019, 2018 and 2017,  $0,  $0.4 million, and $0, respectively, were credited to paid-in capital 
related to HC I membership units purchased with a loan from Option Care. During the year ended December 31, 2019, 
shareholder redemptions totaled $2.4 million, comprised of a cash distribution to HC I of $2.0 million and notes redeemed of 
$0.4 million. There were no shareholder redemptions during the year ended December 31, 2018. During the year ended 
December 31, 2017, shareholder redemptions totaled $0.1 million for notes redeemed by the officers, which was treated as a 
shareholder redemption that reduced paid-in-capital. 

During the year ended December 31, 2019, prior to the Merger, Option Care sold its notes receivable from management, 

along with all accrued interest expense, to a third-party bank. Option Care received cash proceeds of $1.3 million, which 
represented payment of $1.1 million in outstanding notes receivable from management and payment of $0.2 million in accrued 
interest expense. Notes receivable from management of $0 and $1.6 million remained outstanding as of December 31, 2019 and 
2018, respectively. The notes receivable from management and associated interest receivable are recorded in management notes 
receivable as a reduction to equity on the Company’s consolidated balance sheets as of December 31, 2018.

Transactions with Equity-Method Investees — The Company provides management services to its joint ventures such as 

accounting, invoicing and collections in addition to day-to-day managerial support of the operations of the businesses. The 
Company recorded management fee income of $2.5 million, $2.2 million and $1.3 million for the years ended December 31, 
2019, 2018 and 2017, respectively. Management fees are recorded in net revenues in the accompanying consolidated statements 
of comprehensive income (loss).

The Company had amounts due to its joint ventures of $4.3 million as of December 31, 2019. The Company also had 
amounts due to its joint ventures of $0.9 million and amounts due from its joint ventures of $0.1 million as of December 31, 
2018. These payables were included in accrued expenses and other current liabilities in the accompanying balance sheets and 
these receivables were included in prepaid expenses and other current assets in the accompanying balance sheets. These 
balances primarily relate to cash collections received by the Company on behalf of the joint ventures, offset by certain 
pharmaceutical inventories purchased by the Company on behalf of the joint ventures.

73

19. SELECTED QUARTERLY FINANCIAL DATA (UNAUDITED)

A summary of unaudited quarterly financial information for the years ended December 31, 2019 and 2018  is as follows (in 

thousands except per share amounts).

First Quarter

Second Quarter

Third Quarter

Fourth Quarter

Year ended December 31, 2019

Net revenue

Gross profit

Operating income (loss)

Net loss

Loss per share, basic and diluted

Year ended December 31, 2018

Net revenue

Gross profit

Operating income

Net (loss) income

$

$

$

$

$

476,492

$

98,194

5,438

(3,712) $

497,266

$

101,390
(8,005)
(13,603) $

615,880

$

137,773
(11,725)
(42,794) $

720,779

175,642

13,973
(15,811)

(0.03) $

(0.10) $

(0.26) $

(0.09)

First Quarter

Second Quarter

Third Quarter

Fourth Quarter

460,643

$

479,490

$

493,928

$

101,696

3,065

(6,851) $

101,274

8,897
(4,309) $

108,245

12,759

1,791

505,730

111,000

13,548

3,254

0.02

$

$

(Loss) income per share, basic and diluted $

(0.05) $

(0.03) $

0.01

The net loss in the third quarter of 2019 included transaction expenses, integration costs and loss on extinguishment of debt 

incurred in conjunction with the Merger.

    20. SUBSEQUENT EVENTS

The Company has evaluated whether any subsequent events occurred since December 31, 2019 and noted the following 

subsequent events:

On January 3, 2020, the Company’s board of directors and HC I, the stockholder of a majority of the Company’s common 

stock, approved a reverse stock split of the Company’s issued and outstanding common stock on a one share for four share basis 
and appropriately amended the Company’s Third Amended and Restated Certificate of Incorporation to reflect the change. On 
February 3, 2020, the reverse stock split became effective. In connection with the reverse stock split, the Company changed its 
ticker symbols from “BIOS” to “OPCH” and transferred the Company’s common stock from the Nasdaq Capital Market to the 
Nasdaq Global Select Market. The par value of the Company’s common stock remained unchanged as a result of the reverse 
stock split, resulting in a decrease to the aggregate par value of common stock and corresponding increase to paid-in capital in 
the Company’s consolidated financial statements, which was retrospectively applied to all periods presented in the consolidated 
financial statements.

74

Item 9. 

Changes in and Disagreements with Accountants on Accounting and Financial Disclosure

None.

Item 9A. 

Controls and Procedures   

Evaluation of Disclosure Controls and Procedures

The Company maintains disclosure controls and procedures (as such term is defined under Rule 13a-15(e) promulgated 
under the Exchange Act) that are designed to ensure that information required to be disclosed by the Company in the reports we 
file or submit 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 the Company’s management, including 
its Chief Executive Officer (“CEO”) and Chief Financial Officer (“CFO”), as appropriate to allow timely decisions regarding 
required disclosure. Under the supervision and with the participation of the Company’s management, including its Chief 
Executive Officer and Chief Financial Officer, management evaluated the effectiveness of the Company’s disclosure controls 
and procedures as of December 31, 2019. Based on that evaluation, the Company’s Chief Executive Officer and its Chief 
Financial Officer concluded that our disclosure controls and procedures were effective as of December 31, 2019.

Management Report on Internal Control over Financial Reporting

Our management is responsible for establishing and maintaining adequate internal control over financial reporting for the 

Company, as defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act. Our internal control system is designed to 
provide reasonable assurance regarding the reliability of financial reporting and the preparation of the Company’s financial 
statements for external purposes in accordance with U.S. GAAP. 

On August 6, 2019, BioScrip and Option Care completed the Merger, and, after giving effect to the Merger, the 

stockholders of Option Care as of immediately prior to the Merger Date owned approximately 80% of BioScrip common stock 
on a fully diluted basis following the closing, and the stockholders of BioScrip as of immediately prior to the Merger Date 
owned approximately 20% of BioScrip common stock on a fully diluted basis following the closing. BioScrip was the legal 
acquirer in the Merger. Option Care was the accounting acquirer in the Merger under U.S. GAAP. Prior to the Merger, Option 
Care was a privately-held company and was not subject to Section 404 of the Sarbanes-Oxley Act (“SOX”), while BioScrip 
was a publicly-traded company subject to Section 404 of SOX. For all filings under the Exchange Act after the Merger, the 
historical financial statements for the period prior to the Merger are and will be those of Option Care. BioScrip’s businesses are 
and will be included in consolidated financial statements for all periods subsequent to the Merger. 

As noted above, BioScrip was the legal acquirer in the Merger and subject to Section 404 of SOX. As of the date of its 
report, management was able to evaluate the effectiveness of the design and operation of our ongoing internal controls related 
to BioScrip. As the Merger occurred during the third quarter of 2019, and Option Care was the accounting acquirer and not 
previously subject to Section 404 of SOX, management concluded there was insufficient time to complete its assessment of the 
internal controls over financial reporting related to Option Care, and, therefore, Option Care internal control over financial 
reporting was excluded from our report on internal control over financial reporting.

Our management, with the participation of the CEO and CFO, assessed the effectiveness of the Company’s internal control 

over financial reporting, by focusing on those controls that relate exclusively to ongoing BioScrip operations (covering 
approximately 13% of the revenue on the Consolidated Statements of Income for the year ended December 31, 2019 and 7% of 
the total assets on the Consolidated Balance Sheet as of December 31, 2019). Based on the criteria for effective internal control 
over financial reporting established in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring 
Organizations of the Treadway Commission (“COSO”), management concluded that the internal control over financial 
reporting was effective as of December 31, 2019.

All internal control systems, no matter how well designed, have inherent limitations and may not prevent or detect 
misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may 
become inadequate because of changes in conditions or that the degree of compliance with the policies or procedures may 
deteriorate.

75

Changes in Internal Controls over Financial Reporting

The Merger, which was completed on August 6, 2019, has had a material impact on the financial position, results of 
operations, and cash flows of the combined company from the date of acquisition through December 31 2019. The business 
combination also resulted in material changes in the combined company's internal controls over financial reporting. The 
Company is in the process of designing and integrating policies, processes, operations, technology, and other components of 
internal controls over financial reporting of the combined company. Management will monitor the implementation of new 
controls and test the operating effectiveness when instances are available in future periods.

76

Report of Independent Registered Public Accounting Firm

To the Stockholders and Board of Directors

Option Care Health, Inc.:

Opinion on Internal Control Over Financial Reporting

We have audited Option Care Health, Inc. and subsidiaries’ (the Company) internal control over financial reporting as of 
December 31, 2019, based on criteria established in Internal Control - Integrated Framework (2013) issued by the 
Committee of Sponsoring Organizations of the Treadway Commission. In our opinion, the Company maintained, in all 
material respects, effective internal control over financial reporting as of December 31, 2019, based on “criteria established 
in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway 
Commission”.

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United 
States) (PCAOB), the consolidated balance sheets of the Company as of December 31, 2019 and 2018, the related 
consolidated statements of comprehensive income (loss), stockholders’ equity, and cash flows for each of the years in the 
three-year period ended December 31, 2019, and the related notes (collectively, the consolidated financial statements), 
and our report dated March 5, 2020 expressed an unqualified opinion on those consolidated financial statements.

As described in the Management Report on Internal Control Over Financial Reporting, HC Group Holdings I, Inc. and HC 
Group Holdings II, Inc. (collectively, Option Care) merged with and into a wholly owned subsidiary of BioScrip, Inc. 
(BioScrip) on August 6, 2019, forming the Company, and management excluded from its assessment of the effectiveness of 
the Company’s internal control over financial reporting as of December 31, 2019, Option Care’s internal control over 
financial reporting associated with 93% of total assets and 87% of total revenues included in the consolidated financial 
statements of the Company as of and for the year ended December 31, 2019. Our audit of internal control over financial 
reporting of the Company also excluded an evaluation of the internal control over financial reporting of Option Care.

Basis for Opinion

The Company’s management is responsible for maintaining effective internal control over financial reporting and for its 
assessment of the effectiveness of internal control over financial reporting, included in the accompanying Management 
Report on Internal Control over Financial Reporting. Our responsibility is to express an opinion on the Company’s 
internal control over financial reporting based on our audit. We are a public accounting firm registered with the PCAOB 
and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and 
the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.

We conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the 
audit to obtain reasonable assurance about whether effective internal control over financial reporting was maintained in all 
material respects. Our audit of internal control over financial reporting included obtaining an understanding of internal control 
over financial reporting, assessing the risk that a material weakness exists, and testing and evaluating the design and operating 
effectiveness of internal control based on the assessed risk. Our audit also included performing such other procedures as we 
considered necessary in the circumstances. We believe that our audit provides a reasonable basis for our opinion.

Definition and Limitations of Internal Control Over Financial Reporting

A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the 
reliability of financial reporting and the preparation of financial statements for external purposes in accordance with 
generally accepted accounting principles. A company’s internal control over financial reporting includes those policies and 
procedures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the 
transactions and dispositions of the assets of the company; (2) provide reasonable assurance that transactions are recorded as 
necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that 
receipts and expenditures of the company are being made only in accordance with authorizations of management and 
directors of the company; and (3) provide reasonable assurance regarding prevention or timely detection of unauthorized 
acquisition, use, or disposition of the company’s assets that could have a material effect on the financial statements.

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, 
projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate 
because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

Chicago, Illinois 
March 5, 2020

/s/ KPMG LLP

77

Item 9B. 

Other Information

None.

Item 10. 

Directors, Executive Officers and Corporate Governance

PART III

We have adopted a Code of Ethics that applies to all of our directors, officers and employees, including our principal 
executive, principal financial and principal accounting officers, or persons performing similar functions. Our Code of Ethics is 
posted on our website located at http://investors.optioncarehealth.com/corporate-governance/highlights. We intend to disclose 
future amendments to certain provisions of the Code of Ethics, and waivers of the Code of Ethics granted to executive officers 
and directors.

The other information required by this item s incorporated by reference from the information contained in our definitive 
proxy statement to be filed with the SEC no later than 120 days after December 31, 2019 in connection with our 2020 Annual 
Meeting of Stockholders.

Item 11. 

Executive Compensation

The information required by this item is incorporated by reference from the information contained in our definitive proxy 

statement to be filed with the SEC no later than 120 days after December 31, 2019 in connection with our 2020 Annual 
Meeting of Stockholders.

Item 12. 

Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters

The information required by this item is incorporated by reference from the information contained in our definitive proxy 

statement to be filed with the SEC no later than 120 days after December 31, 2019 in connection with our 2020 Annual 
Meeting of Stockholders.

Item 13. 

Certain Relationships and Related Transactions, and Director Independence

The information required by this item is incorporated by reference from the information contained in our definitive proxy 

statement to be filed with the SEC no later than 120 days after December 31, 2019 in connection with our 2020 Annual 
Meeting of Stockholders.

Item 14. 

Principal Accountant Fees and Services

The information required by this item is incorporated by reference from the information contained in our definitive proxy 

statement to be filed with the SEC no later than 120 days after December 31, 2019 in connection with our 2020 Annual 
Meeting of Stockholders.

78

Item 15. 

Exhibits, Financial Statement Schedules

PART IV

(a)(1) Financial Statements.

The following financial statements appear in Part II, Item 8:

Report of Independent Registered Public Accounting Firm

Consolidated Balance Sheets as of December 31, 2019 and 2018

Consolidated Statements of Comprehensive Income (Loss) for the years ended December 31, 2019, 2018 and 2017

Consolidated Statements of Cash Flows for the years ended December 31, 2019, 2018 and 2017

Consolidated Statements of Stockholders’ Equity for the years ended December 31, 2019, 2018 and 2017

Notes to Consolidated Financial Statements

All other schedules not listed above have been omitted since they are not applicable or are not required.

Page

40

41

43

44

46

48

(a)(3) Exhibits. 

Exhibit
Number 

2.1+

2.2+

2.3

2.4

2.5

2.6

2.7+

3.1

3.2

3.3

4.1

4.2

4.3

4.4

Index to Exhibits

Description

Agreement and Plan of Merger, dated as of January 24, 2010, by and among BioScrip, Inc. (the “Company”), and the 
parties set forth on the signature page (Incorporated by reference to Exhibit 2.1 to the Company’s Current Report on 
Form 8-K filed on January 27, 2010, SEC File Number 0-28740).

Stock Purchase Agreement, dated as of December 12, 2012, by and among HomeChoice Partners, Inc., DaVita 
HealthCare Partners Inc., Mary Ann Cope, R.Ph., Kathy F. Puglise, RN, CRNI, Joseph W. Boyd, R.Ph., Barbara J. Exum, 
PharmD and the Company  (Incorporated by reference to Exhibit 2.1 to the Company’s Current Report on Form 8-K filed 
on February 4, 2013, SEC File Number 0-28740).

Asset Purchase Agreement, dated June 11, 2016, by and among HS Infusion Holdings, Inc., the direct and indirect 
subsidiaries of HS Infusion Holdings, Inc. set forth on the signature pages, the Company and HomeChoice Partners, Inc. 
(the “Home Solutions Agreement”). (Incorporated by reference to Exhibit 2.1 to the Company’s Current Report on Form 
8-K filed on June 13, 2016, SEC File Number 000-28740).

First Amendment, dated June 16, 2016, to the Home Solutions Agreement (Incorporated by reference to Exhibit 2.1 to the 
Company’s Current Report on Form 8-K/A filed on June 20, 2016, SEC File Number 000-28740).

Second Amendment, dated September 2, 2016, to the Home Solutions Agreement (Incorporated by reference to Exhibit 2.1 
to the Company’s Current Report on Form 8-K filed on September 7, 2016, SEC File Number 001-11993).

Third Amendment, dated September 9, 2016, to the Home Solutions Agreement (Incorporated by reference to Exhibit 2.1 
to the Company’s Current Report on Form 8-K filed on September 12, 2016, SEC File Number 001-11993).

Agreement and Plan of Merger, dated as of March 14, 2019, by and among BioScrip, Inc., Beta Sub, Inc., Beta Sub, LLC, 
HC Group Holdings I, LLC, HC Group Holdings II, Inc. and HC Group Holdings III, Inc. (incorporated by reference to 
Exhibit 2.1 to the Company’s Current Report on Form 8-K filed on March 15, 2019, SEC File Number 001-11993).
Third Amended and Restated Certificate of Incorporation of BioScrip, Inc. (incorporated by reference to Exhibit 3.1 to the 
Company’s Current Report on Form 8-K filed on August 7, 2019, SEC File Number 001-11993). 
Certificate  of Amendment  to  Certificate  of  Incorporation,  amending  the  Third Amended  and  Restated  Certificate  of 
Incorporation of BioScrip, Inc.  (incorporated by reference to Exhibit 3.3 to the Company’s Current Report on Form 8-K 
filed on August 7, 2019, SEC File Number 001-11993).
Amended and Restated Bylaws of Option Care Health, Inc., formerly known as BioScrip, Inc. (incorporated by reference 
to Exhibit 3.4 to the Company’s Current Report on Form 8-K filed on August 7, 2019, SEC File Number 001-11993).

Registration Rights Agreement, dated as of March 9, 2015, by and among the Company, Coliseum Capital Partners, L.P., 
Coliseum Capital Partners II, L.P., and Blackwell Partners, LLC, Series A. (Incorporated by reference to Exhibit 4.1 to the 
Company’s Current Report on Form 8-K filed on March 10, 2015, SEC File Number 000-28740).

Amendment No. 1 to the Registration Rights Agreement dated June 10, 2016, by and among the Company, Coliseum Capital 
Partners, L.P., Coliseum Capital Partners II, L.P. and Blackwell Partners, LLC Series A. (Incorporated by reference to Exhibit 
4.1 to the Company’s Current Report on Form 8-K filed on June 13, 2016, SEC File Number 000-28740).

Amendment No. 2 to the Registration Rights Agreement dated June 14, 2016, by and among the Company and the PIPE 
Investors. (Incorporated by reference to Exhibit 4.1 to the Company’s Current Report on Form 8-K filed on June 14, 2016, 
SEC File Number 000-28740).

Form of Subscription Rights Certificate. (Incorporated by reference to Exhibit 4.1 to the Company’s Registration Statement 
on Form S-3/A filed on May 29, 2015, SEC File Number 000-28740).

79

4.5

4.6

4.7

4.8

4.9

4.10

4.11

4.12
10.1†
10.2†

10.3†

10.4†

10.5

10.6

10.7

10.8

10.9

10.10

10.11

10.12†

10.13†

10.14†

21.1

Common Stock Warrant Agreement, dated July 28, 2015, by and between the Company and the American Stock Transfer 
& Trust Company, LLC. (Incorporated by reference to Exhibit 4.1 to the Company’s Current Report on Form 8-K filed on 
July 28, 2015, SEC File Number 000-28740).

Registration  Rights  Agreement,  dated  March  1,  2017,  by  and  among  the  Company  and  the  investors  named 
therein. (Incorporated by reference to Exhibit 4.1 to the Company’s Current Report on Form 8-K filed on March 2, 2017, 
SEC File Number 001-11993).

Registration  Rights  Agreement,  dated  June  29,  2017,  by  and  among  the  Company  and  the  parties  signatory 
thereto (Incorporated by reference to Exhibit 4.2 to the Company’s Current Report on Form 8-K filed on June 29, 2017, 
SEC File Number 001-11993).

Amendment No. 1 to Registration Rights Agreement by and between BioScrip, Inc. and the stockholders of the Company 
signatory thereto (incorporated by reference to Exhibit 10.4 to the Company’s Current Report on Form 8-K filed on 
March 15, 2019, SEC File Number 001-11993).

Warrant Agreement, dated June 29, 2017, by and among the Company and the subscribers signatory thereto (Incorporated 
by  reference  to  Exhibit  4.1  to  the  Company’s  Current  Report  on  Form  8-K  filed  on  June  29,  2017,  SEC  File  Number 
001-11993).
Second Lien Notes Indenture, dated as of August 6, 2019, among HC Group Holdings II, LLC, as the Initial Issuer, BioScrip, 
Inc., as the Parent Issuer, subsidiary issuers and guarantors party thereto from time to time, and Ankura Trust Company, 
LLC, as the Trustee and Collateral Agent (incorporated by reference to Exhibit 4.1 to the Company’s Current Report on 
Form 8-K filed on August 7, 2019, SEC File Number 001-11993).

Supplemental Indenture, dated November 18, 2019, by and between Option Care Health, Inc., as parent issuer, and 
Ankura Trust Company, LLC, as trustee and collateral agent (incorporated by reference to Exhibit 4.1 to the Company’s 
Current Report on Form 8-K filed on November 19, 2019, SEC File Number 001-11993).

Description of Option Care Health Inc.’s registered securities (filed herewith).

Employee Stock Purchase Plan. (Incorporated by reference to the definitive proxy statement filed on April 2, 2013).

First Amendment to Employee Stock Purchase Plan. (Incorporated by reference to Exhibit 10.5 to the Company’s Form 10-
Q filed on August 10, 2015, SEC File Number 000-28740).

BioScrip, Inc. 2018 Equity Incentive Plan (Incorporated by reference to Appendix A to the definitive proxy statement filed 
on April 4, 2018).

Second Amendment to Employee Stock Purchase Plan (Incorporated by reference to Appendix B to the definitive proxy 
statement filed on April 4, 2018).

Amended and Restated Warrant Agreement, dated as of March 14, 2019, by and among BioScrip, Inc. and the Holders (as 
defined therein) signatory thereto (incorporated by reference to Exhibit 10.2 to the Company’s Current Report on Form 8-
K filed on March 15, 2019, SEC File Number 001-11993).

Form of Letter Agreement, dated March 14, 2019, by and among BioScrip, Inc. and each of the Holders (incorporated by 
reference to Exhibit 10.3 to the Company’s Current Report on Form 8-K filed on March 15, 2019, SEC File Number 
001-11993).
Registration Rights Agreement, dated as of August 6, 2019, by and among BioScrip, Inc. and HC Group Holdings I, LLC 
(incorporated by reference to Exhibit 10.1 to the Company’s Current Report on Form 8-K filed on August 7, 2019, SEC File 
Number 001-11993).

Director Nomination Agreement, dated as of August 6, 2019, by and among the BioScrip, Inc. and HC Group Holdings I, 
LLC (incorporated by reference to Exhibit 10.2 to the Company’s Current Report on Form 8-K filed on August 7, 2019, 
SEC File Number 001-11993).

First Lien Credit Agreement, dated as of August 6, 2019, among HC Group Holdings II, LLC, as the Initial Borrower, 
BioScrip,  Inc.,  as  the  Parent  Borrower,  the  guarantors  party  thereto  from  time  to  time,  Bank  of America,  N.A.,  as  the 
Administrative Agent, the lenders party thereto from time to time, BofA Securities, Inc., as Lead Arranger and Bookrunner 
and as Syndication Agent and Documentation Agent (incorporated by reference to Exhibit 10.3 to the Company’s Current 
Report on Form 8-K filed on August 7, 2019, SEC File Number 001-11993). 

ABL Credit Agreement, dated as of August 6, 2019, among HC Group Holdings II, LLC, as the Initial Borrower, BioScrip, 
Inc., as the Parent Borrower, and Bank of America N.A., as the Administrative Agent, Issuing Bank and Swing Line Lender, 
the other lenders party thereto from time to time and Bank of America, N.A. and ACF Finco I LP as Joint Lead Arrangers 
and Joint Lead Bookrunners (incorporated by reference to Exhibit 10.4 to the Company’s Current Report on Form 8-K filed 
on August 7, 2019, SEC File Number 001-11993).

Note Purchase Agreement, dated as of August 6, 2019, among HC Group Holdings II, LLC, as the Initial Issuer, BioScrip, 
Inc., as the Parent Issuer, subsidiary issuers and guarantors party thereto from time to time, and the several initial purchasers 
party thereto (incorporated by reference to Exhibit 10.5 to the Company’s Current Report on Form 8-K filed on August 7, 
2019, SEC File Number 001-11993).

John Rademacher Amended and Restated Employment Agreement entered into on February 23, 2018 (incorporated by 
reference to Exhibit 10.1 to the Company’s Current Report on Form 8-K filed on August 7, 2019, SEC File Number 
001-11993).
Michael Shapiro Employment Agreement entered into on October 13, 2015 (incorporated by reference to Exhibit 10.2 to 
the Company’s Current Report on Form 8-K filed on August 7, 2019, SEC File Number 001-11993).

Harriet Booker Employment Agreement entered into on June 3, 2019 (incorporated by reference to Exhibit 10.3 to the 
Company’s Current Report on Form 8-K filed on August 7, 2019, SEC File Number 001-11993).

List of subsidiaries of Option Care Health, Inc. (filed herewith).

80

23.1

31.1

31.2

32.1

32.2

101

101.INS

101.SCH

101.CAL

101.DEF

101.LAB

101.PRE

†
+

Consent of Independent Registered Public Accounting Firm (filed herewith).

Certification of Chief Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 302 of the 
Sarbanes-Oxley Act of 2002.
Certification of Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 302 of the 
Sarbanes-Oxley Act of 2002.

Certification of Chief Executive Officer pursuant to 18 U.S. C. Section 1350, as adopted pursuant to Section 906 of the 
Sarbanes-Oxley Act of 2002.

Certification of Chief Financial Officer pursuant to 18 U.S. C. Section 1350, as adopted pursuant to Section 906 of the 
Sarbanes-Oxley Act of 2002.

The following financial information from the Company’s Form 10-K for the fiscal year ended December 31, 2019, formatted 
in XBRL (Extensible Business Reporting Language): (i) Consolidated Statements of Comprehensive Income (Loss) for the 
fiscal years ended December 31, 2019, 2018 and 2017, (ii) Consolidated Balance Sheets as of December 31, 2019 and 2018, 
(iii) Consolidated Statements of Stockholders’ Equity for the fiscal years ended December 31, 2019, 2018 and 2017, (iv) 
Consolidated Statements of Cash Flows for the fiscal years ended December 31, 2019, 2018 and 2017, and (v) Notes to 
Consolidated Financial Statements.
XBRL Instance Document

XBRL Taxonomy Extension Schema Document

XBRL Taxonomy Extension Calculation Linkbase Document

XBRL Taxonomy Extension Definition Linkbase Document

XBRL Taxonomy Extension Labels Linkbase Document

XBRL Taxonomy Extension Presentation Linkbase Document

Designates the Company’s management contracts or compensatory plan or arrangement.

Certain schedules attached to the Agreement and Plan of Merger have been omitted pursuant to Item 601(b)(2) of Regulation 
S-K. The Company will furnish copies of the omitted schedules to the Securities and Exchange Commission upon request 
by the Commission.

Item 16. 

Form 10-K Summary

None.

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, on March 5, 2020.

                                                          OPTION CARE HEALTH, INC.

                                                         /s/  Michael Shapiro

Michael Shapiro

Chief Financial Officer and Senior Vice President (Principal Financial Officer and Duly Authorized Officer)

Pursuant to the requirements of the Securities Exchange Act of 1934,  this report has been signed below by the following 

persons on behalf of the registrant and in the capacities on the dates indicated.

81

 
Signature

/s/ John C. Rademacher
John C. Rademacher

Title(s)

Chief Executive Officer, President and Director
 (Principal Executive Officer) 

Date

March 5, 2020

/s/ Michael Shapiro
Michael Shapiro

Chief Financial Officer and Senior Vice President
 (Principal Financial Officer) 

March 5, 2020

/s/ Robert R. Kampstra
Robert R. Kampstra

Senior Vice President, Finance and Chief Accounting Officer
(Principal Accounting Officer)

March 5, 2020

/s/ Harry M. Jansen Kraemer, Jr.
Harry M. Jansen Kraemer, Jr.

Non-Executive Chairman of the Board

March 5, 2020

/s/ John J. Arlotta
John J. Arlotta

/s/ Elizabeth Q. Betten
Elizabeth Q. Betten

/s/ David W. Golding
David W. Golding

/s/ Alan Nielsen
Alan Nielsen

/s/ R. Carter Pate
R. Carter Pate

/s/ Nitin Sahney
Nitin Sahney

/s/ Timothy P. Sullivan
Timothy P. Sullivan

/s/ Mark Vainisi
Mark Vainisi

March 5, 2020

March 5, 2020

March 5, 2020

March 5, 2020

March 5, 2020

March 5, 2020

March 5, 2020

March 5, 2020

Director

Director

Director

Director

Director

Director

Director

Director

82

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(This page has been left blank intentionally.) 

20OCH00053 Annual report cover_MARKS.pdf

Clinical excellence 

infused with 

compassionate care. 

Option Care Health is the largest independent provider of infusion therapy in the nation. For over 40 years, we’ve delivered cutting-

edge infusion medications, nursing support and seamless transitional care for patients of all ages in their homes and at conveniently 

located Ambulatory Infusion Suites (AIS). 

Through our long-term partnerships with payers, biopharmaceutical manufacturers, healthcare systems, physicians and other referral 

sources, we deliver advanced intravenous treatments available for a wide range of serious, chronic conditions. But the relationships that 

truly drive our commitment to clinical excellence are those between our team of more than 2,900¹ clinicians and the patients they serve. 

Dear Shareholders,

Following the merger of Option Care and BioScrip last August, we began an exciting new chapter as Option Care Health, now the nation’s 

largest independent provider of home and alternate site infusion services.  Since then, there has been tremendous effort around integrating 

two great teams and building a platform for sustainable growth.

In just six months, we launched our new name and brand, initiated a comprehensive integration plan, completed our financial consolidation 

and reporting, and began to leverage our strength and national scale.  With a strong foundation in place, I have tremendous confidence in 

our ability to grow, and at the same time, realize additional synergies.

From a cultural standpoint, it has been truly amazing to see our people rapidly transform into one team focused on a shared Purpose to 

provide extraordinary care that changes lives. We recently introduced our new Purpose statement along with a new Mission, Values and 

Leader Behaviors to ensure our team members feel a part of an organization that has a profound purpose – and a clear path forward.  

We have already seen that building a strong sense of community and purpose not only helps us perform better together, it enables us to 

drive results.

Looking ahead, we are building and investing in our future as we complete our integration. We are investing in an Alternate Infusion Site/

Infusion Center strategy and making renovations to our existing facilities. We are also enhancing and deploying technologies and tools that 

will help each of our team members provide an exceptional customer experience for patients, providers and payers. 

Many things have changed as we’ve transformed into Option Care Health. However, one thing 

that remains steadfast is our focus on providing extraordinary patient care. It is at the heart of 

everything we do and part of our DNA. With nearly 6,000 teammates, including 2,900 clinicians, 

we work compassionately each day to elevate standards of care for patients with acute and 

chronic conditions. 

As the industry landscape continues to change, we are confident we are on the right side of the 

transformation happening in healthcare. As Option Care Health we have the ability to unleash our 

full potential to deliver high-quality care in a lower cost setting where patients want to be treated 

on a national scale. Our deep clinical expertise, broad therapy portfolio and enhanced financial 

profile will allow us to deliver superior care and outcomes, and most importantly, hope for patients 

I encourage you to keep an eye on Option Care Health. The best is yet to come.

and their families. 

Best regards, 

John C. Rademacher 

President and Chief Executive Officer

Trim Size = 16.5 x 10.75 in     Page 2 of 2

At Option Care Health, I’ve had the same caring, professional nurse  

throughout my treatments. I would highly recommend Option Care Health if your 

priorities are cost, schedule and location. Today my symptoms are much improved 

and so is my quality of life.

Derek, Option Care Health patient, Crohn’s disease

March 18, 2020     01:59:59

 
 
2019 ANNUAL REPORT

Providing 

extraordinary care 

that changes lives

20OCH00053 Annual report cover_MARKS.pdf

The numbers tell the story

2,900 1+  

multidisciplinary clinicians

100 1+ 

infusion full-service pharmacies

125 1+ 

Ambulatory Infusion Suites 

Covering 

 98%1 

of all insured lives

MARKET LEADERS  

in providing specialty infusion therapies in open and limited 
distribution networks

More than 

Licensed to treat patients in  

220,000 2 

patients cared for annually

ALL 50 1 

states

95% 3 

overall patient satisfaction

References: 1. Data on file, Option Care Health. 2. January-December 2019, total Option Care Health unique patients serviced.3. January-December 2019 patient satisfaction data. 
Survey of 9,878 patients.

Investor Relations:

OPTION CARE HEALTH 

TRANSFER AGENT

Corporate Office
3000 Lakeside Drive  |  Suite 300N  |  Bannockburn, IL 60015   
Phone: 866.827.8203

American Stock Transfer & Trust Co.
59 Maiden Lane  |  New York, NY 10038   
Phone: 718.921.8124

PRIMARY IR CONTACT

Mike Shapiro, Chief Financial Officer  
Phone: 312.940.2538 
Email: investor.relations@optioncare.com

ACCOUNTANTS

KPMG LLP
200 E. Randolph Street  |  Suite 5500  |  Chicago, IL 60601   
Phone: 312.665.1000

optioncarehealth.com

Option Care Health locations are ACHC accredited. HHA numbers are available to view at optioncarehealth.com.

©2020 Option Care Health, Inc. All rights reserved. 20OCH00053

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March 18, 2020     01:59:59