Syneos Health (SYNH) 10-Q 1 Aug 22 2022 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2022	Jul. 27, 2022
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2022
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q2
Entity Registrant Name	SYNEOS HEALTH, INC.
Entity Central Index Key	0001610950
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		102,653,017
Entity Shell Company	false
Entity Small Business	false
Entity Emerging Growth Company	false
Entity File Number	001-36730
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	27-3403111
Entity Address, Address Line One	1030 Sync Street
Entity Address, City or Town	Morrisville
Entity Address, State or Province	NC
Entity Address, Postal Zip Code	27560-5468
City Area Code	919
Local Phone Number	876-9300
Document Quarterly Report	true
Document Transition Report	false
Title of 12(b) Security	Class A Common Stock, $0.01 par value per share
Trading Symbol	SYNH
Security Exchange Name	NASDAQ

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF INCOME (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Income Statement [Abstract]
Revenue	$ 1,360,739	$ 1,282,611	$ 2,696,992	$ 2,491,356
Costs and operating expenses:
Direct costs (exclusive of depreciation and amortization)	1,034,897	992,581	2,079,329	1,937,831
Selling, general, and administrative expenses	139,040	144,669	279,206	281,983
Restructuring and other costs	8,983	3,966	24,540	11,194
Depreciation	21,241	18,158	41,820	36,605
Amortization	39,980	39,553	81,603	79,044
Total operating expenses	1,244,141	1,198,927	2,506,498	2,346,657
Income from operations	116,598	83,684	190,494	144,699
Total other expense, net:
Interest income	(36)		(39)	(71)
Interest expense	18,102	22,619	33,867	45,947
Loss on extinguishment of debt	0	2,199	0	2,802
Other (income) expense, net	(5,152)	7,827	(510)	(2,029)
Total other expense, net	12,914	32,645	33,318	46,649
Income before provision for income taxes	103,684	51,039	157,176	98,050
Income tax expense	25,940	9,134	33,256	17,421
Net income	$ 77,744	$ 41,905	$ 123,920	$ 80,629
Earnings per share:
Basic (USD per share)	$ 0.76	$ 0.40	$ 1.20	$ 0.77
Diluted (USD per share)	$ 0.75	$ 0.40	$ 1.19	$ 0.77
Weighted average common shares outstanding:
Basic (in shares)	102,596	103,937	103,130	104,105
Diluted (in shares)	103,072	105,019	103,741	105,238

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 77,744	$ 41,905	$ 123,920	$ 80,629
Unrealized gain on derivative instruments, net of income tax expense of $0, $1,596, $0, and $3,609, respectively	4,528	4,708	14,168	10,645
Foreign currency translation adjustments, net of income tax expense (benefit) of $0, $550, $0, and $(158), respectively	(69,826)	8,825	(87,212)	4,515
Comprehensive income	$ 12,446	$ 55,438	$ 50,876	$ 95,789

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (Unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Statement Of Income And Comprehensive Income [Abstract]
Income tax expense related to unrealized gain on derivative instruments recorded in other comprehensive loss	$ 1,607	$ 1,596	$ 5,027	$ 3,609
Other comprehensive income (loss), foreign currency translation adjustment, tax	$ 1,745	$ 550	$ (966)	$ (158)

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Current assets:
Cash, cash equivalents, and restricted cash	$ 105,988	$ 106,475
Accounts receivable and unbilled services, net	1,606,951	1,524,890
Prepaid expenses and other current assets	168,932	135,091
Total current assets	1,881,871	1,766,456
Property and equipment, net	254,891	222,657
Operating lease right-of-use assets	185,031	209,408
Goodwill	4,898,050	4,956,015
Intangible assets, net	759,436	854,067
Deferred income tax assets	33,670	35,387
Other long-term assets	203,723	193,103
Total assets	8,216,672	8,237,093
Current liabilities:
Accounts payable	99,319	107,535
Accrued expenses	656,874	614,441
Deferred revenue	887,180	868,455
Current portion of operating lease obligations	40,408	43,058
Current portion of finance lease obligations	23,678	20,627
Total current liabilities	1,707,459	1,654,116
Long-term debt	2,811,831	2,775,721
Operating lease long-term obligations	181,994	205,798
Finance lease long-term obligations	49,389	34,181
Deferred income tax liabilities	82,519	78,062
Other long-term liabilities	54,415	76,660
Total liabilities	4,887,607	4,824,538
Commitments and contingencies (Note 16)
Shareholders’ equity:
Preferred stock, $0.01 par value; 30,000 shares authorized, 0 shares issued and outstanding as of June 30, 2022 and December 31, 2021	0	0
Common stock, $0.01 par value; 600,000 shares authorized, 102,647 and 103,764 shares issued and outstanding as of June 30, 2022 and December 31, 2021, respectively	1,026	1,038
Additional paid-in capital	3,425,584	3,474,088
Accumulated other comprehensive loss, net of taxes	(122,662)	(49,618)
Retained earnings (accumulated deficit)	25,117	(12,953)
Total shareholders’ equity	3,329,065	3,412,555
Total liabilities and shareholders’ equity	$ 8,216,672	$ 8,237,093

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares	Jun. 30, 2022	Dec. 31, 2021
Statement Of Financial Position [Abstract]
Preferred stock par value (USD per share)	$ 0.01	$ 0.01
Preferred stock shares authorized (in shares)	30,000,000	30,000,000
Preferred stock shares issued (in shares)	0	0
Preferred stock shares outstanding (in shares)	0	0
Common stock par value (USD per share)	$ 0.01	$ 0.01
Common stock shares authorized (in shares)	600,000,000	600,000,000
Common stock shares issued (in shares)	102,647,000	103,764,000
Common stock shares outstanding (in shares)	102,647,000	103,764,000

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021
Cash flows from operating activities:
Net income	$ 123,920	$ 80,629
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	123,423	115,649
Share-based compensation	33,524	33,792
Recovery from doubtful accounts	(426)	(473)
Provision for (benefit from) deferred income taxes	4,206	(13,024)
Foreign currency transaction adjustments	(9,069)	(3,563)
Fair value adjustment of contingent obligations	0	(597)
Loss on extinguishment of debt	0	2,802
Other non-cash items	(5,636)	5,007
Changes in operating assets and liabilities, net of effect of acquisitions:
Accounts receivable, unbilled services, and deferred revenue	(77,602)	(8,269)
Accounts payable and accrued expenses	40,772	30,117
Other assets and liabilities	(62,323)	(26,275)
Net cash provided by operating activities	170,789	215,795
Cash flows from investing activities:
Payments related to acquisitions of businesses, net of cash acquired	(1,574)	(14,635)
Proceeds from notes receivables from divestiture	0	5,000
Purchases of property and equipment	(47,912)	(22,337)
(Investments in) proceeds from unconsolidated affiliates	(1,577)	692
Net cash used in investing activities	(51,063)	(31,280)
Cash flows from financing activities:
Proceeds from issuance of long-term debt, net of discount	0	494,505
Payments of debt financing costs	0	(544)
Repayments of long-term debt	0	(602,277)
Proceeds from accounts receivable financing agreement	0	65,000
Proceeds from revolving line of credit	130,000	0
Repayments of revolving line of credit	(95,000)	0
Payments of contingent consideration related to acquisitions	0	(6,196)
Payments of finance leases	(1,886)	(8,380)
Payments for repurchases of common stock	(149,961)	(117,521)
Proceeds from exercises of stock options	12,390	14,482
Payments related to tax withholdings for share-based compensation	(30,062)	(29,892)
Net cash used in financing activities	(134,519)	(190,823)
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	14,306	(4,730)
Net change in cash, cash equivalents, and restricted cash	(487)	(11,038)
Cash, cash equivalents, and restricted cash - beginning of period	106,475	272,173
Cash, cash equivalents, and restricted cash - end of period	$ 105,988	$ 261,135

CONDENSED CONSOLIDATED STATEM_5

CONDENSED CONSOLIDATED STATEMENTS OF SHAREHOLDERS' EQUITY (Unaudited) - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Loss	Retained earnings (accumulated Deficit)
Balance at beginning of period at Dec. 31, 2020	$ 3,242,112	$ 1,039	$ 3,461,747	$ (40,801)	$ (179,873)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchases of common stock		(15)	(49,595)		(67,911)
Issuances of common stock		11	(15,569)
Share-based compensation			33,792
Unrealized gain on derivative instruments, net of taxes				10,645
Foreign currency translation adjustment, net of taxes	4,515			4,515
Net income	80,629				80,629
Balance at end of period at Jun. 30, 2021	3,238,614	1,035	3,430,375	(25,641)	(167,155)
Balance at beginning of period at Mar. 31, 2021	3,236,877	1,042	3,440,840	(39,174)	(165,831)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchases of common stock		(9)	(29,778)		(43,229)
Issuances of common stock		2	2,874
Share-based compensation			16,439
Unrealized gain on derivative instruments, net of taxes				4,708
Foreign currency translation adjustment, net of taxes	8,825			8,825
Net income	41,905				41,905
Balance at end of period at Jun. 30, 2021	3,238,614	1,035	3,430,375	(25,641)	(167,155)
Balance at beginning of period at Dec. 31, 2021	3,412,555	1,038	3,474,088	(49,618)	(12,953)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchases of common stock		(19)	(64,092)		(85,850)
Issuances of common stock		7	(17,936)
Share-based compensation			33,524
Unrealized gain on derivative instruments, net of taxes				14,168
Foreign currency translation adjustment, net of taxes	(87,212)			(87,212)
Net income	123,920				123,920
Balance at end of period at Jun. 30, 2022	3,329,065	1,026	3,425,584	(122,662)	25,117
Balance at beginning of period at Mar. 31, 2022	3,301,559	1,026	3,410,524	(57,364)	(52,627)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuances of common stock			(1,131)
Share-based compensation			16,191
Unrealized gain on derivative instruments, net of taxes				4,528
Foreign currency translation adjustment, net of taxes	(69,826)			(69,826)
Net income	77,744				77,744
Balance at end of period at Jun. 30, 2022	$ 3,329,065	$ 1,026	$ 3,425,584	$ (122,662)	$ 25,117

Basis of Presentation

Basis of Presentation	6 Months Ended
	Jun. 30, 2022
Accounting Policies [Abstract]
Basis of Presentation	1. Basis of Presentation Nature of Operations Syneos Health, Inc. (the “Company”) is a global provider of end-to-end biopharmaceutical outsourcing solutions. The Company operates under two reportable segments, Clinical Solutions and Commercial Solutions, and derives its revenue through a suite of services designed to enhance its customers’ ability to successfully develop, launch, and market their products. The Company offers its solutions on both a standalone and integrated basis with biopharmaceutical development and commercialization services ranging from Phase I to IV clinical trial services to services associated with the commercialization of biopharmaceutical products. The Company’s customers include small, mid-sized, and large companies in the pharmaceutical, biotechnology, and medical device industries. Unaudited Interim Financial Information The Company prepared the accompanying unaudited condensed consolidated financial statements in accordance with generally accepted accounting principles in the United States of America (“GAAP”) for interim financial information. The significant accounting policies followed by the Company for interim financial reporting are consistent with the accounting policies followed for annual financial reporting. The unaudited condensed consolidated financial statements, in management’s opinion, include all adjustments of a normal recurring nature necessary for a fair presentation. The information included in this Quarterly Report on Form 10-Q should be read in conjunction with the Company’s audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2021 (the “2021 Form 10-K”), filed with the Securities and Exchange Commission on February 17, 2022. The results of operations for the three and six months ended June 30, 2022 are not necessarily indicative of the results to be expected for the full year ending December 31, 2022 or any other future period. The unaudited condensed consolidated balance sheet as of December 31, 2021 is derived from the amounts in the audited consolidated balance sheet included in the 2021 Form 10-K. Reclassification Certain previously reported amounts have been reclassified to conform to the current year presentation. COVID-19 Pandemic The ongoing COVID-19 pandemic and associated economic repercussions have significantly impacted, and are expected to continue to impact, the Company’s business and operations. The continued availability and effectiveness of vaccines may partially mitigate the risks around the continued spread of COVID-19, however, with the spread of COVID-19 variants, the ongoing impacts of the COVID-19 pandemic could adversely impact the Company’s business and results of operations. For further discussion of the potential impact of the pandemic on its business, refer to Part I, Item 1A, “Risk Factors” in the 2021 Form 10-K.

Financial Statement Details

Financial Statement Details	6 Months Ended
	Jun. 30, 2022
Investments Debt And Equity Securities [Abstract]
Financial Statement Details	2. Financial Statement Details Cash, Cash Equivalents, and Restricted Cash Certain of the Company’s subsidiaries participate in a notional cash pooling arrangement to manage global liquidity requirements. As part of a master netting arrangement, the participants combine their cash balances in pooling accounts at the same financial institution with the ability to offset bank overdrafts of one participant against positive cash account balances held by another participant. Under the terms of the master netting arrangement, the financial institution has the right, ability, and intent to offset a positive balance in one account against an overdrawn amount in another account. Amounts in each of the accounts are unencumbered and unrestricted with respect to use. As such, the net cash balance related to this pooling arrangement is included in cash, cash equivalents, and restricted cash in the condensed consolidated balance sheets. The Company’s net cash pool position consisted of the following (in thousands): June 30, 2022 December 31, 2021 Gross cash position $ 145,866 $ 179,160 Less: cash borrowings ( 138,840 ) ( 167,507 ) Net cash position $ 7,026 $ 11,653 Accounts Receivable and Unbilled Services, net Accounts receivable and unbilled services (including contract assets), net of allowance for doubtful accounts, consisted of the following (in thousands): June 30, 2022 December 31, 2021 Accounts receivable billed $ 904,775 $ 873,265 Accounts receivable unbilled 235,692 241,799 Contract assets 473,911 417,411 Less: Allowance for doubtful accounts ( 7,427 ) ( 7,585 ) Accounts receivable and unbilled services, net $ 1,606,951 $ 1,524,890 Accounts Receivable Factoring Arrangement The Company has an accounts receivable factoring agreement to sell certain eligible unsecured trade accounts receivable, at its option, without recourse, to an unrelated third-party financial institution for cash. For the six months ended June 30, 2022 and 2021 , the Company factored $ 66.8 million and $ 68.7 million, respectively, of trade accounts receivable on a non-recourse basis and received $ 66.5 million and $ 68.6 million, respectively, in cash proceeds from the sale. The fees associated with these transactions were insignificant. Goodwill The changes in the carrying amount of goodwill by segment for the six months ended June 30, 2022 were as follows (in thousands): Clinical Commercial Total Balance as of December 31, 2021 $ 3,448,699 $ 1,507,316 $ 4,956,015 Acquisitions (b) 1,903 — 1,903 Impact of foreign currency translation ( 40,441 ) ( 19,427 ) ( 59,868 ) Balance as of June 30, 2022 $ 3,410,161 $ 1,487,889 $ 4,898,050 (a) No impairment of goodwill was recorded for the six months ended June 30, 2022 . (b) Amount represents goodwill recognized in connection with an insignificant acquisition and measurement period adjustments in connection with insignificant 2021 acquisitions during the six months ended June 30, 2022 within the Clinical Solutions segment . Accumulated Other Comprehensive Loss, Net of Taxes Accumulated other comprehensive loss, net of taxes, consisted of the following (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Beginning balance $ ( 57,364 ) $ ( 39,174 ) $ ( 49,618 ) $ ( 40,801 ) Derivative instruments: Beginning balance 7,019 ( 12,824 ) ( 2,621 ) ( 18,761 ) Other comprehensive income (loss) before reclassifications 4,827 ( 488 ) 13,439 284 Reclassification adjustments ( 299 ) 5,196 729 10,361 Ending balance 11,547 ( 8,116 ) 11,547 ( 8,116 ) Foreign currency translation: Beginning balance ( 64,383 ) ( 26,350 ) ( 46,997 ) ( 22,040 ) Other comprehensive (loss) income before reclassifications ( 69,826 ) 8,825 ( 87,212 ) 4,515 Ending balance ( 134,209 ) ( 17,525 ) ( 134,209 ) ( 17,525 ) Accumulated other comprehensive loss, net of taxes $ ( 122,662 ) $ ( 25,641 ) $ ( 122,662 ) $ ( 25,641 ) Changes in accumulated other comprehensive loss consisted of the following (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Unrealized gain on derivative instruments: Unrealized gain (loss) during period, before taxes $ 6,540 $ ( 654 ) $ 18,207 $ 380 Income tax expense (benefit) 1,713 ( 166 ) 4,768 96 Unrealized gain (loss) during period, net of taxes 4,827 ( 488 ) 13,439 284 Reclassification adjustment, before taxes ( 405 ) 6,958 988 13,874 Income tax (benefit) expense ( 106 ) 1,762 259 3,513 Reclassification adjustment, net of taxes ( 299 ) 5,196 729 10,361 Total unrealized gain on derivative instruments, net of taxes 4,528 4,708 14,168 10,645 Foreign currency translation adjustment: Foreign currency translation adjustment, before taxes ( 68,081 ) 9,375 ( 88,178 ) 4,357 Income tax expense (benefit) 1,745 550 ( 966 ) ( 158 ) Foreign currency translation adjustment, net of taxes ( 69,826 ) 8,825 ( 87,212 ) 4,515 Total other comprehensive (loss) income, net of taxes $ ( 65,298 ) $ 13,533 $ ( 73,044 ) $ 15,160 Other (Income) Expense, Net Other (income) expense, net consisted of the following (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Net realized foreign currency loss $ 4,799 $ 570 $ 7,254 $ 1,762 Net unrealized foreign currency (gain) loss ( 9,503 ) 5,959 ( 9,069 ) ( 3,563 ) Equity investment income — — — ( 1,100 ) Other, net ( 448 ) 1,298 1,305 872 Total other (income) expense, net $ ( 5,152 ) $ 7,827 $ ( 510 ) $ ( 2,029 )

Investments and Divestitures

Investments and Divestitures	6 Months Ended
	Jun. 30, 2022
Business Combinations [Abstract]
Investments and Divestitures	3. Investments and Divestitures Investments During 2020, the Company made a non-cash investment of $ 27.3 million to acquire certain intellectual property rights from a customer in lieu of cash payment for services rendered. During the second quarter of 2021, the Company exchanged the intellectual property for an equity method investment in an unconsolidated variable interest entity. The Company provided the entity $ 3.8 million in cash, in the form of a loan, during the third quarter of 2021. Based on the hypothetical liquidation book value of its investment as of June 30, 2022, the Company recorded losses of $ 1.1 million and $ 2.3 million to other (income) expense, net in the accompanying condensed consolidated statements of income for the three and six months ended June 30, 2022, respectively. Based on the hypothetical liquidation book value of its investment as of June 30, 2021, the Company recorded a $ 2.8 million loss to other (income) expense, net in the accompanying condensed and consolidated statement of income for the three months ended June 30, 2021. As of June 30, 2022 and December 31, 2021, the book value of the Company’s investment was $ 12.2 million and $ 16.2 million, respectively, and was included in other long-term assets in the accompanying condensed consolidated balance sheets, with a maximum exposure to loss of approximately $ 15.9 million as of June 30, 2022, which includes funding of the loan. Divestitures During the second quarter of 2020, the Company sold its contingent staffing business to a related party in exchange for potential future cash consideration not to exceed $ 4.0 million. Based on the financial results of the business through May 31, 2022 and 2021, the Company recognized $ 2.2 million and $ 1.8 million of contingent consideration in other (income) expense, net in the accompanying condensed consolidated statements of income for the three months ended June 30, 2022 and 2021, respectively, which reflects the maximum amount of future cash consideration. The contingent cash consideration related to financial results through May 31, 2022 had not been received as of June 30, 2022, and therefore was recorded as a receivable in prepaid expenses and other current assets in the accompanying condensed consolidated balance sheet.

Long-Term Debt Obligations

Long-Term Debt Obligations	6 Months Ended
	Jun. 30, 2022
Debt Disclosure [Abstract]
Long-Term Debt Obligations	4. Long-Term Debt Obligations The Company’s debt obligations consisted of the following (in thousands): June 30, 2022 December 31, 2021 Secured Debt Term Loan A - tranche one due March 2024 $ 149,195 $ 149,195 Term Loan A - tranche two due August 2024 1,636,797 1,636,797 Revolving credit facility due August 2024 35,000 — Accounts receivable financing agreement due October 2024 400,000 400,000 Total secured debt 2,220,992 2,185,992 Unsecured Debt Senior notes due January 2029 (the “Notes”) 600,000 600,000 Total debt obligations 2,820,992 2,785,992 Less: Term loan original issuance discount ( 1,809 ) ( 2,228 ) Less: Unamortized deferred issuance costs ( 7,352 ) ( 8,043 ) Total long-term debt $ 2,811,831 $ 2,775,721 Credit Agreement The Company is party to a credit agreement (as amended, the “Credit Agreement”) that includes a Term Loan A facility (“Term Loan A”) that has two tranches (as detailed in the table above), and a $ 600.0 million revolving credit facility that matures on August 1, 2024 (the “Revolver”). As a result of previous voluntary prepayments, the Company is not required to make a mandatory payment against the principal balance of Term Loan A until October 2023. As of June 30, 2022 , the interest rate on Term Loan A was 2.92 %. Revolver and Letters of Credit The Revolver includes letters of credit (“LOCs”) with a sublimit of $ 150.0 million . As of June 30, 2022, there were $ 35.0 million of outstanding Revolver borrowings and $ 14.1 million of LOCs outstanding, leaving $ 550.9 million of available borrowings under the Revolver, including $ 135.9 million available for LOCs. As of June 30, 2022 , the interest rate on the Revolver was 2.84 %. The Notes The Notes bear interest at a rate of 3.625% per annum, payable semi-annually in arrears that began on July 15, 2021, and will mature on January 15, 2029 . Accounts Receivable Financing Agreement The Company has an accounts receivable financing agreement (as amended) with a termination date of October 2024, unless terminated earlier pursuant to its terms. As of June 30, 2022, the Company had $ 400.0 million of outstanding borrowings under this agreement, which are recorded in long-term debt on the accompanying condensed consolidated balance sheet. There was no remaining borrowing capacity available under this agreement as of June 30, 2022. As of June 30, 2022 , the interest rate on the accounts receivable financing agreement was 2.58 %. Maturities of Debt Obligations As of June 30, 2022, the contractual maturities of the Company’s debt obligations (excluding finance leases) were as follows (in thousands): Principal Remainder of 2022 $ — 2023 21,732 2024 2,199,260 2025 — 2026 — 2027 and thereafter 600,000 Less: Term loan original issuance discount ( 1,809 ) Less: Unamortized deferred issuance costs ( 7,352 ) Total $ 2,811,831

Derivatives

Derivatives	6 Months Ended
	Jun. 30, 2022
Derivative Instruments And Hedging Activities Disclosure [Abstract]
Derivatives	5. Derivatives Interest Rate Swaps The Company has entered into various interest rate swaps to mitigate its exposure to changes in interest rates on its term loan. In March 2020, the Company entered into interest rate swaps with multiple counterparties. The interest rate swaps had an initial aggregate notional value of $ 549.2 million that increased to $ 1.42 billion on June 30, 2021, an effective date of March 31, 2020, and will expire on March 31, 2023. As of June 30, 2022, the notional value of these interest rate swaps was $ 1.07 billion . Foreign Exchange Forward On October 30, 2020, the Company entered into a foreign exchange forward in order to minimize monthly foreign currency remeasurement gains or losses on non-functional currency monetary balances. The foreign exchange forward notional value may be adjusted each month as the exposure balance changes. The Company did not designate the derivative as a hedge. All changes in the fair value of the foreign exchange forward are recorded in earnings every month to other (income) expense, net in the accompanying condensed consolidated statements of income. The Company recognized $ 5.6 million and $ 7.5 million of realized losses during the three and six months ended June 30, 2022 , respectively, and $ 0.4 million and $ 1.5 million of realized gains during the three and six months ended June 30, 2021, respectively, related to this foreign exchange forward. As of June 30, 2022 , the notional value of this foreign exchange forward was $ 75.0 million. Fair Values The fair values of the Company’s derivative financial instruments and the line items on the accompanying condensed consolidated balance sheets to which they were recorded were as follows (in thousands): Balance Sheet Classification June 30, 2022 December 31, 2021 Interest rate swaps - current Prepaid expenses and other current assets $ 18,317 $ — Interest rate swaps - non-current Other long-term assets — 948 Fair value of derivative assets $ 18,317 $ 948 Interest rate swaps - current Accrued expenses $ — $ 1,827 Fair value of derivative liabilities $ — $ 1,827

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2022
Fair Value Disclosures [Abstract]
Fair Value Measurements	6. Fair Value Measurements Assets and Liabilities Carried at Fair Value As of June 30, 2022 and December 31, 2021, the Company’s financial assets and liabilities carried at fair value included cash and cash equivalents, restricted cash, trading securities, accounts receivable, unbilled services (including contract assets), accounts payable, accrued expenses, deferred revenue, contingent obligations, liabilities under the accounts receivable financing agreement, and derivative instruments. The fair values of cash and cash equivalents, restricted cash, accounts receivable, unbilled services (including contract assets), accounts payable, accrued expenses, deferred revenue, and the liabilities under the accounts receivable financing agreement approximate their respective carrying amounts because of the liquidity and short-term nature of these financial instruments. Financial Instruments Subject to Recurring Fair Value Measurements As of June 30, 2022, the fair values of the major classes of the Company’s assets and liabilities measured at fair value on a recurring basis were as follows (in thousands): Level 1 Level 2 Level 3 Investments Total Assets: Trading securities (a) $ 20,207 $ — $ — $ — $ 20,207 Partnership interests (b) — — — 12,753 12,753 Derivative instruments (c) — 18,317 — — 18,317 Total assets $ 20,207 $ 18,317 $ — $ 12,753 $ 51,277 Liabilities: Contingent obligations related to acquisitions (d) $ — $ — $ 17,747 $ — $ 17,747 Total liabilities $ — $ — $ 17,747 $ — $ 17,747 As of December 31, 2021, the fair values of the major classes of the Company’s assets and liabilities measured at fair value on a recurring basis were as follows (in thousands): Level 1 Level 2 Level 3 Investments Total Assets: Trading securities (a) $ 24,775 $ — $ — $ — $ 24,775 Partnership interests (b) — — — 11,176 11,176 Derivative instruments (c) — 948 — — 948 Total assets $ 24,775 $ 948 $ — $ 11,176 $ 36,899 Liabilities: Derivative instruments (c) $ — $ 1,827 $ — $ — $ 1,827 Contingent obligations related to acquisitions (d) — — 17,997 — 17,997 Total liabilities $ — $ 1,827 $ 17,997 $ — $ 19,824 (a) Represents the fair value of investments in mutual funds based on quoted market prices that are used to fund the liability associated with the Company’s deferred compensation plan. (b) The Company has committed to invest $ 21.5 million as a limited partner in two private equity funds. The private equity funds invest in opportunities in the healthcare and life sciences industry. As of June 30, 2022 , the Company’s remaining unfunded commitment in the private equity funds was $ 11.2 million. The Company holds minor ownership interests (less than 3 %) in each of the private equity funds and has determined that it does not exercise significant influence over the private equity funds’ operating and finance activities. As the private equity funds do not have readily determinable fair values, the Company has estimated the fair values using each fund’s Net Asset Value, the amount by which the value of all assets exceeds all debt and liabilities, in accordance with Accounting Standards Codification (“ASC”) Topic 946, Financial Services – Investment Companies . (c) Represents the fair value of interest rate swap arrangements (see “Note 5 – Derivatives” for further information). (d) Represents the fair value of contingent consideration obligations related to acquisitions. The fair values of these liabilities are determined based on the Company’s best estimate of the probable timing and amount of settlement. The following table presents a reconciliation of changes in the carrying amount of contingent obligations classified as Level 3 for the six months ended June 30, 2022 (in thousands): Balance as of December 31, 2021 $ 17,997 Additions — Changes in fair value recognized in earnings ( 250 ) Payments — Balance as of June 30, 2022 $ 17,747 During the six months ended June 30, 2022 , there were no transfers of assets or liabilities between Level 1, Level 2, or Level 3 fair value measurements. Financial Instruments Subject to Non-Recurring Fair Value Measurements Certain assets, including goodwill and identifiable intangible assets, are carried on the accompanying condensed consolidated balance sheets at cost and, subsequent to initial recognition, are measured at fair value on a non-recurring basis when certain identified events or changes in circumstances that may have a significant adverse effect on the carrying values of these assets occur. These assets are classified as Level 3 fair value measurements within the fair value hierarchy. Goodwill is tested for impairment annually or more frequently if events or changes in circumstances indicate a triggering event has occurred. Intangible assets are tested for impairment upon the occurrence of certain triggering events. As of June 30, 2022 and December 31, 2021, assets carried on the condensed consolidated balance sheets and not remeasured to fair value on a recurring basis totaled $ 5.67 billion and $ 5.83 billion , respectively. Fair Value Disclosures for Financial Instruments Not Carried at Fair Value The estimated fair values of the term loan (based on tranche) and the Notes are determined based on the price that the Company would have had to pay to settle the liabilities. As these liabilities are not actively traded, they are classified as Level 2 fair value measurements. The estimated fair values of the Company’s term loan (based on tranche) and the Notes were as follows (in thousands): June 30, 2022 December 31, 2021 Carrying Estimated Carrying Estimated Term Loan A - tranche one due March 2024 $ 149,043 $ 146,957 $ 149,008 $ 148,945 Term Loan A - tranche two due August 2024 1,635,140 1,588,167 1,634,756 1,635,138 Senior notes due January 2029 600,000 513,000 600,000 595,500 (a) The carrying value of the term loan debt is shown net of original issue discounts.

Restructuring and Other Costs

Restructuring and Other Costs	6 Months Ended
	Jun. 30, 2022
Restructuring And Related Activities [Abstract]
Restructuring and Other Costs	7. Restructuring and Other Costs During the three and six months ended June 30, 2022 and 2021, the Company incurred employee severance and benefit costs, facility and lease termination costs, and other costs related to its restructuring activities. These costs were primarily related to the Company’s ForwardBound margin enhancement initiative. Restructuring and other costs consisted of the following (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Employee severance and benefit costs $ 2,368 $ 2,084 $ 17,188 $ 8,377 Facility and lease termination costs 3,671 1,882 3,352 2,770 Other costs 2,944 — 4,000 47 Total restructuring and other costs $ 8,983 $ 3,966 $ 24,540 $ 11,194 The Company expects to continue to incur costs related to restructuring of its operations in order to achieve cost savings and the targeted synergies related to its acquisitions. However, the timing and the amount of these costs depends on various factors, including, but not limited to, identifying and realizing synergy opportunities and executing the integration of its combined operations. The Company may also continue to incur additional restructuring and other costs during 2022 and beyond related to its ForwardBound margin enhancement initiative. Accrued Restructuring Liabilities The following table summarizes activity related to employee severance and benefit costs within accrued restructuring liabilities for the six months ended June 30, 2022 (in thousands): Balance as of December 31, 2021 $ 6,657 Expenses incurred (a) 17,188 Payments ( 13,376 ) Balance as of June 30, 2022 $ 10,469 (a) The amount of expenses incurred for the six months ended June 30, 2022 excludes $ 4.0 million of other costs that are included in accounts payable and $ 3.4 million of facility lease closure and lease termination costs that are reflected as reductions of operating lease right-of-use assets, current portion of operating lease obligations, and operating lease long-term obligations under ASC Topic 842, Leases, on the accompanying condensed consolidated balance sheet. The Company expects the employee severance and benefit costs accrued as of June 30, 2022 will be paid within the next twelve months and are included within accrued expenses on the accompanying condensed consolidated balance sheet

Shareholders' Equity

Shareholders' Equity	6 Months Ended
	Jun. 30, 2022
Equity [Abstract]
Shareholders' Equity	8. Shareholders’ Equity Shares Outstanding Shares of common stock outstanding were as follows (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Common stock shares, beginning balance 102,558 104,226 103,764 103,935 Repurchases of common stock — ( 900 ) ( 1,929 ) ( 1,500 ) Issuances of common stock 89 147 812 1,038 Common stock shares, ending balance 102,647 103,473 102,647 103,473 Stock Repurchase Programs On November 17, 2020, the Company’s Board of Directors (the “Board”) authorized the repurchase of up to an aggregate of $ 300.0 million of the Company’s Class A common stock, par value $ 0.01 per share, to be executed from time to time in open market transactions effected through a broker at prevailing market prices, in block trades, or through privately negotiated transactions through December 31, 2022 (the “2021 Stock Repurchase Program”). The 2021 Stock Repurchase Program took effect on January 1, 2021. On May 25, 2022, the Board approved a new stock repurchase program (the “2022 Stock Repurchase Program”) that took effect immediately and replaced the 2021 Stock Repurchase Program. The 2022 Stock Repurchase Program authorizes the Company to repurchase up to $ 350.0 million of the Company’s Class A common stock, par value $ 0.01 , and will expire on December 31, 2024. The 2022 Stock Repurchase Program does not obligate the Company to repurchase any particular amount of the Company’s common stock, and may be modified, extended, suspended, or discontinued at any time. The timing and amount of repurchases will be determined by the Company’s management based on a variety of factors such as the market price of the Company’s common stock, the Company’s corporate cash requirements, and overall market conditions. The 2022 Stock Repurchase Program is subject to applicable legal requirements, including federal and state securities laws and applicable Nasdaq rules. The Company may also repurchase shares of its common stock pursuant to a trading plan meeting the requirements of Rule 10b5-1 under the Securities Exchange Act of 1934, as amended, which would permit shares of the Company’s common stock to be repurchased when the Company might otherwise be precluded from doing so by law. During the three months ended June 30, 2022, there were no repurchases under the 2021 Stock Repurchase Program or the 2022 Stock Repurchase Program. The following table sets forth repurchase activity under the 2021 Stock Repurchase Program from inception through the program’s termination on May 25, 2022: Total number of Average price Approximate March 2021 600,000 $ 74.18 $ 44,505 May 2021 400,000 81.04 32,416 June 2021 500,000 81.20 40,600 February 2022 515,003 78.52 40,439 March 2022 1,413,920 77.46 109,522 Total 3,428,923 $ 267,482 The Company immediately retired all of the repurchased common stock and charged the par value of the shares to common stock. The excess of the repurchase price over the par value was applied on a pro rata basis against additional paid-in capital, with the remainder applied to accumulated deficit. As of June 30, 2022, the Company had remaining authorization to repurchase up to $ 350.0 million of shares of its common stock under the 2022 Stock Repurchase Program.

Earnings Per Share

Earnings Per Share	6 Months Ended
	Jun. 30, 2022
Earnings Per Share [Abstract]
Earnings Per Share	9. Earnings Per Share The following table provides a reconciliation of the numerators and denominators of the basic and diluted earnings per share computations (in thousands, except per share data): Three Months Ended Six Months Ended 2022 2021 2022 2021 Numerator: Net income $ 77,744 $ 41,905 $ 123,920 $ 80,629 Denominator: Basic weighted average common shares outstanding 102,596 103,937 103,130 104,105 Effect of dilutive securities: Stock options and other awards under deferred share-based compensation programs 476 1,082 611 1,133 Diluted weighted average common shares outstanding 103,072 105,019 103,741 105,238 Earnings per share: Basic $ 0.76 $ 0.40 $ 1.20 $ 0.77 Diluted $ 0.75 $ 0.40 $ 1.19 $ 0.77 Potential common shares outstanding that are considered anti-dilutive are excluded from the computation of diluted earnings per share. Potential common shares related to stock options and other awards under share-based compensation programs may be determined to be anti-dilutive based on the application of the treasury stock method. Potential common shares are also considered anti-dilutive in periods when the Company incurs a net loss. The number of potential shares outstanding that were anti-dilutive and therefore excluded from the computation of diluted earnings per share, weighted for the portion of the period they were outstanding, were 774,405 , 143,958 , 469,724 , and 155,062 for the three and six months ended June 30, 2022 and 2021 , respectively.

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2022
Income Tax Disclosure [Abstract]
Income Taxes	10. Income Taxes Income Tax Expense For the three and six months ended June 30, 2022, the Company recorded income tax expense of $ 25.9 million and $ 33.3 million , respectively, compared to pre-tax income of $ 103.7 million and $ 157.2 million , respectively. Income tax expense for the three and six months ended June 30, 2022 included discrete tax benefits of $ 0.3 million and $ 6.4 million, respectively, primarily related to excess tax benefits from share-based compensation. The effective tax rates for the three and six months ended June 30, 2022 , excluding discrete items, varied from the United States (“U.S.”) federal statutory income tax rate of 21.0 % primarily due to state and local taxes on U.S. income, foreign income inclusions such as the Global Intangible Low-Taxed Income (“GILTI”) provisions, and research and development credits. For the three and six months ended June 30, 2021, the Company recorded income tax expense of $ 9.1 million and $ 17.4 million , respectively, compared to pre-tax income of $ 51.0 million and $ 98.1 million , respectively. Income tax expense for the three and six months ended June 30, 2021 included discrete tax benefits of $ 2.2 million and $ 5.8 million, respectively, primarily related to excess tax benefits from share-based compensation. The effective tax rates for the three and six months ended June 30, 2021 , excluding discrete items, varied from the U.S. federal statutory income tax rate of 21.0 % primarily due to foreign tax credits, foreign income inclusions such as the GILTI provisions, and state and local taxes on U.S. income. Unrecognized Tax Benefits The Company’s gross unrecognized tax benefits, exclusive of associated interest and penalties, were $ 11.7 million and $ 12.1 million as of June 30, 2022 and December 31, 2021 , respectively. The decrease of $ 0.4 million was primarily due to lapses in statutes of limitations and changes in exchange rates. The Company believes it is reasonably possible that its unrecognized tax benefits may decrease by approximately $ 1.4 million within the next 12 months as a result of lapses in statutes of limitations. Tax Returns under Audit The Company is not currently under any U.S. federal income tax audits, however, income tax returns are under examination by tax authorities in several state and foreign jurisdictions. The Company’s federal and state tax filings are open to investigations in numerous years due to net operating loss carryforwards. Additionally, the Company currently has an ongoing examination for tax years 2014 to 2019 in the United Kingdom. The United Kingdom is the jurisdiction with the Company’s largest foreign operations. The Company believes that its reserve for uncertain tax positions is adequate to cover existing risks or exposures related to all open tax years and jurisdictions.

Revenue from Contracts with Cus

Revenue from Contracts with Customers	6 Months Ended
	Jun. 30, 2022
Revenue From Contract With Customer [Abstract]
Revenue from Contract with Customers	11. Revenue from Contracts with Customers Unsatisfied Performance Obligations As of June 30, 2022, the total aggregate transaction price allocated to the unsatisfied performance obligations under contracts with contract terms greater than one year and that are not accounted for as a series pursuant to ASC Topic 606, Revenue from Contracts with Customers and all the related amendments was $ 6.57 billion . This amount includes revenue associated with reimbursable out-of-pocket expenses. The Company expects to recognize revenue over the remaining contract term of the individual projects, with contract terms generally ranging from one to five years . The amount of unsatisfied performance obligations is presented net of any constraints and, as a result, is lower than the potential contractual revenue. The contracts excluded due to constraints include contracts that do not commence within a certain period of time or that require the Company to undertake numerous activities to fulfill these performance obligations, including various activities that are outside of the Company’s control. Timing of Billing and Performance During the three and six months ended June 30, 2022, the Company recognized approximately $ 389.3 million and $ 547.8 million , respectively, of revenue that was included in the deferred revenue balance at the beginning of the respective periods. During the three and six months ended June 30, 2022, there were reductions of approximately $ 1.5 million and $ 2.4 million , respectively, in the Company’s revenue recognized related to performance obligations partially satisfied in previous periods. The gross and net amounts of revenue recognized solely from changes in estimates were not material.

Segment Information

Segment Information	6 Months Ended
	Jun. 30, 2022
Segment Reporting [Abstract]
Segment Information	12. Segment Information The Company is managed through two reportable segments: Clinical Solutions and Commercial Solutions. Each reportable segment consists of multiple service offerings that, when combined, create a fully integrated biopharmaceutical services organization . Clinical Solutions offers comprehensive global services for the development of diagnostics, drugs, biologics, devices, and digital therapeutics that span Phases I to IV of clinical development. The segment is organized around clinical pharmacology and bioanalytical services, workforce deployment, full-service clinical studies, real world evidence, and consulting. This segment offers individual services including product development and regulatory consulting, project management, protocol development, investigational site recruitment, clinical monitoring, technology-enabled patient recruitment and engagement, clinical home health services, clinical trial diversity, biometrics, and regulatory affairs; all across a comprehensive range of therapeutic areas. Commercial Solutions provides the pharmaceutical, biotechnology, and healthcare industries with commercialization services, including deployment solutions, communication solutions (public relations, advertising, and medical communications), and consulting services. The Company’s Chief Operating Decision Maker (the “CODM”) reviews segment performance and allocates resources based upon segment revenue and income from operations. Inter-segment revenue is eliminated from the segment reporting provided to the CODM and is not included in the segment revenue presented in the table below. Certain costs are not allocated to the Company’s reportable segments and are reported as general corporate expenses. These costs primarily consist of share-based compensation, general operating expenses associated with the Board and the Company’s senior leadership, finance, investor relations, and internal audit functions, and transaction and integration-related expenses. The Company does not allocate depreciation, amortization, asset impairment charges, or restructuring and other costs to its segments. Prior period segment results have been recast to conform to insignificant changes to management reporting in 2022. Additionally, the CODM reviews the Company’s assets on a consolidated basis and does not allocate assets to its reportable segments for purposes of assessing segment performance or allocating resources. Information about reportable segment operating results was as follows (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Revenue: Clinical Solutions $ 1,025,715 $ 992,936 $ 2,044,085 $ 1,932,503 Commercial Solutions 335,024 289,675 652,907 558,853 Total revenue 1,360,739 1,282,611 2,696,992 2,491,356 Segment direct costs: Clinical Solutions 753,451 752,171 1,528,119 1,469,526 Commercial Solutions 273,578 232,283 534,543 451,083 Total segment direct costs 1,027,029 984,454 2,062,662 1,920,609 Segment selling, general, and administrative expenses: Clinical Solutions 88,863 89,303 178,765 176,835 Commercial Solutions 21,094 20,318 42,829 41,289 Total segment selling, general, and administrative expenses 109,957 109,621 221,594 218,124 Segment operating income: Clinical Solutions 183,401 151,462 337,201 286,142 Commercial Solutions 40,352 37,074 75,535 66,481 Total segment operating income 223,753 188,536 412,736 352,623 Direct costs and operating expenses not allocated to segments: Share-based compensation included in direct costs 7,868 8,127 16,667 17,222 Share-based compensation included in selling, general, and administrative expenses 8,323 8,312 16,857 16,570 Corporate selling, general, and administrative expenses 20,760 26,736 40,755 47,289 Restructuring and other costs 8,983 3,966 24,540 11,194 Depreciation and amortization 61,221 57,711 123,423 115,649 Total income from operations $ 116,598 $ 83,684 $ 190,494 $ 144,699

Operations by Geographic Locati

Operations by Geographic Location	6 Months Ended
	Jun. 30, 2022
Segments Geographical Areas [Abstract]
Operations by Geographic Location	13. Operations by Geographic Location The following table summarizes total revenue by geographic area (in thousands, all intercompany transactions have been eliminated): Three Months Ended Six Months Ended 2022 2021 2022 2021 Revenue: North America (a) $ 806,640 $ 774,228 $ 1,588,294 $ 1,513,229 Europe, Middle East, and Africa 340,384 328,895 695,977 645,071 Asia-Pacific 172,965 144,233 333,768 270,690 Latin America 40,750 35,255 78,953 62,366 Total revenue $ 1,360,739 $ 1,282,611 $ 2,696,992 $ 2,491,356 (a) Revenue for the North America region includes revenue attributable to the U.S. of $ 754.7 million and $ 722.8 million , or 55.5 % and 56.4 % of total revenue, for the three months ended June 30, 2022 and 2021, respectively. Revenue for the North America region includes revenue attributable to the U.S. of $ 1,491.2 million and $ 1,416.7 million, or 55.3 % and 56.9 % of total revenue, for the six months ended June 30, 2022 and 2021, respectively. No other country represented more than 10% of total revenue for any period. The following table summarizes long-lived assets by geographic area (in thousands, all intercompany transactions have been eliminated): June 30, 2022 December 31, 2021 Property and equipment, net: North America (a) $ 193,233 $ 165,446 Europe, Middle East, and Africa 34,330 37,004 Asia-Pacific 19,639 13,615 Latin America 7,689 6,592 Total property and equipment, net $ 254,891 $ 222,657 (a) Long-lived assets for the North America region include property and equipment, net attributable to the U.S. of $ 186.1 million and $ 160.0 million as of June 30, 2022 and December 31, 2021 , respectively.

Concentration of Credit Risk

Concentration of Credit Risk	6 Months Ended
	Jun. 30, 2022
Risks And Uncertainties [Abstract]
Concentration of Credit Risk	14. Concentration of Credit Risk Financial assets that subject the Company to credit risk primarily consist of cash and cash equivalents, accounts receivable, and unbilled services (including contract assets). The Company’s cash and cash equivalents consist principally of cash and are maintained at several financial institutions with reputable credit ratings. The Company maintains cash depository accounts with several financial institutions worldwide and is exposed to credit risk related to the potential inability to access liquidity in financial institutions where its cash and cash equivalents are concentrated. The Company has not historically incurred any losses with respect to these balances and believes that they bear minimal credit risk. As of June 30, 2022 and December 31, 2021, substantially all of the Company’s cash and cash equivalents were held within the U.S. No single customer accounted for greater than 10 % of the Company’s revenue for the three and six months ended June 30, 2022 or 2021. As of June 30, 2022 and December 31, 2021 , no single customer accounted for greater than 10 % of the Company’s accounts receivable and unbilled services (including contract assets) balances.

Related-Party Transactions

Related-Party Transactions	6 Months Ended
	Jun. 30, 2022
Related Party Transactions [Abstract]
Related-Party Transactions	15. Related-Party Transactions For the three and six months ended June 30, 2022 , the Company had combined revenue of $ 2.2 million and $ 3.6 million, respectively, from four customers whose board of directors each included a member who was also a member of the Company’s Board. As of June 30, 2022 , the Company had combined receivables of $ 0.3 million from two customers whose board of directors included a member who was also a member of the Company’s Board. On February 8, 2022, the Company completed an insignificant acquisition, which was associated with the 2021 acquisition of RxDataScience, Inc., through an arm’s-length transaction. A member of the Company’s management was a minority shareholder of the acquired company. For additional information, refer to “Note 2 – Financial Statements Details – Goodwill.” For the three and six months ended June 30, 2021, the Company had combined revenue of $ 1.2 million and $ 1.9 million, respectively, and, as of June 30, 2021, combined receivables of $ 1.6 million from two customers whose board of directors each included a member who was also a member of the Company’s Board.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2022
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	16. Commitments and Contingencies Legal Proceedings In the opinion of management, the outcome of any existing claims and legal or regulatory proceedings, other than Vaitkuvienë v. Syneos Health, Inc., et al, No. 18-0029 (E.D.N.C.) (the “Vaitkuvienë action”), if decided adversely, is not expected to have a material adverse effect on the Company’s business, financial condition, results of operations, or cash flows. There have been no updates from the description of the Vaitkuvienë action included in “Note 17 – Commitments and Contingencies” to the consolidated financial statements included in Part II, Item 8, “Financial Statements and Supplementary Data” in the 2021 Form 10-K.

Basis of Presentation (Policies

Basis of Presentation (Policies)	6 Months Ended
	Jun. 30, 2022
Accounting Policies [Abstract]
Unaudited Interim Financial Information	Unaudited Interim Financial Information The Company prepared the accompanying unaudited condensed consolidated financial statements in accordance with generally accepted accounting principles in the United States of America (“GAAP”) for interim financial information. The significant accounting policies followed by the Company for interim financial reporting are consistent with the accounting policies followed for annual financial reporting. The unaudited condensed consolidated financial statements, in management’s opinion, include all adjustments of a normal recurring nature necessary for a fair presentation. The information included in this Quarterly Report on Form 10-Q should be read in conjunction with the Company’s audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2021 (the “2021 Form 10-K”), filed with the Securities and Exchange Commission on February 17, 2022. The results of operations for the three and six months ended June 30, 2022 are not necessarily indicative of the results to be expected for the full year ending December 31, 2022 or any other future period. The unaudited condensed consolidated balance sheet as of December 31, 2021 is derived from the amounts in the audited consolidated balance sheet included in the 2021 Form 10-K.
Reclassification	Reclassification Certain previously reported amounts have been reclassified to conform to the current year presentation.
Revenue from Contracts with Customers	The Company expects to recognize revenue over the remaining contract term of the individual projects, with contract terms generally ranging from one to five years . The amount of unsatisfied performance obligations is presented net of any constraints and, as a result, is lower than the potential contractual revenue. The contracts excluded due to constraints include contracts that do not commence within a certain period of time or that require the Company to undertake numerous activities to fulfill these performance obligations, including various activities that are outside of the Company’s control.

Financial Statement Details (Ta

Financial Statement Details (Tables)	6 Months Ended
	Jun. 30, 2022
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Schedule Of Cash Pool Position	The Company’s net cash pool position consisted of the following (in thousands): June 30, 2022 December 31, 2021 Gross cash position $ 145,866 $ 179,160 Less: cash borrowings ( 138,840 ) ( 167,507 ) Net cash position $ 7,026 $ 11,653
Schedule of Billed Accounts Receivable, Net	Accounts receivable and unbilled services (including contract assets), net of allowance for doubtful accounts, consisted of the following (in thousands): June 30, 2022 December 31, 2021 Accounts receivable billed $ 904,775 $ 873,265 Accounts receivable unbilled 235,692 241,799 Contract assets 473,911 417,411 Less: Allowance for doubtful accounts ( 7,427 ) ( 7,585 ) Accounts receivable and unbilled services, net $ 1,606,951 $ 1,524,890
Schedule of Goodwill	The changes in the carrying amount of goodwill by segment for the six months ended June 30, 2022 were as follows (in thousands): Clinical Commercial Total Balance as of December 31, 2021 $ 3,448,699 $ 1,507,316 $ 4,956,015 Acquisitions (b) 1,903 — 1,903 Impact of foreign currency translation ( 40,441 ) ( 19,427 ) ( 59,868 ) Balance as of June 30, 2022 $ 3,410,161 $ 1,487,889 $ 4,898,050 (a) No impairment of goodwill was recorded for the six months ended June 30, 2022 . (b) Amount represents goodwill recognized in connection with an insignificant acquisition and measurement period adjustments in connection with insignificant 2021 acquisitions during the six months ended June 30, 2022 within the Clinical Solutions segment .
Schedule of Accumulated Other Comprehensive Loss, Net of Tax	Accumulated other comprehensive loss, net of taxes, consisted of the following (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Beginning balance $ ( 57,364 ) $ ( 39,174 ) $ ( 49,618 ) $ ( 40,801 ) Derivative instruments: Beginning balance 7,019 ( 12,824 ) ( 2,621 ) ( 18,761 ) Other comprehensive income (loss) before reclassifications 4,827 ( 488 ) 13,439 284 Reclassification adjustments ( 299 ) 5,196 729 10,361 Ending balance 11,547 ( 8,116 ) 11,547 ( 8,116 ) Foreign currency translation: Beginning balance ( 64,383 ) ( 26,350 ) ( 46,997 ) ( 22,040 ) Other comprehensive (loss) income before reclassifications ( 69,826 ) 8,825 ( 87,212 ) 4,515 Ending balance ( 134,209 ) ( 17,525 ) ( 134,209 ) ( 17,525 ) Accumulated other comprehensive loss, net of taxes $ ( 122,662 ) $ ( 25,641 ) $ ( 122,662 ) $ ( 25,641 )
Reclassification out of Accumulated Other Comprehensive (Loss) Income	Changes in accumulated other comprehensive loss consisted of the following (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Unrealized gain on derivative instruments: Unrealized gain (loss) during period, before taxes $ 6,540 $ ( 654 ) $ 18,207 $ 380 Income tax expense (benefit) 1,713 ( 166 ) 4,768 96 Unrealized gain (loss) during period, net of taxes 4,827 ( 488 ) 13,439 284 Reclassification adjustment, before taxes ( 405 ) 6,958 988 13,874 Income tax (benefit) expense ( 106 ) 1,762 259 3,513 Reclassification adjustment, net of taxes ( 299 ) 5,196 729 10,361 Total unrealized gain on derivative instruments, net of taxes 4,528 4,708 14,168 10,645 Foreign currency translation adjustment: Foreign currency translation adjustment, before taxes ( 68,081 ) 9,375 ( 88,178 ) 4,357 Income tax expense (benefit) 1,745 550 ( 966 ) ( 158 ) Foreign currency translation adjustment, net of taxes ( 69,826 ) 8,825 ( 87,212 ) 4,515 Total other comprehensive (loss) income, net of taxes $ ( 65,298 ) $ 13,533 $ ( 73,044 ) $ 15,160
Schedule of Other Expense (Income),Net	Other (Income) Expense, Net Other (income) expense, net consisted of the following (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Net realized foreign currency loss $ 4,799 $ 570 $ 7,254 $ 1,762 Net unrealized foreign currency (gain) loss ( 9,503 ) 5,959 ( 9,069 ) ( 3,563 ) Equity investment income — — — ( 1,100 ) Other, net ( 448 ) 1,298 1,305 872 Total other (income) expense, net $ ( 5,152 ) $ 7,827 $ ( 510 ) $ ( 2,029 )

Long-Term Debt Obligations (Tab

Long-Term Debt Obligations (Tables)	6 Months Ended
	Jun. 30, 2022
Debt Disclosure [Abstract]
Schedule of Debt Obligations	The Company’s debt obligations consisted of the following (in thousands): June 30, 2022 December 31, 2021 Secured Debt Term Loan A - tranche one due March 2024 $ 149,195 $ 149,195 Term Loan A - tranche two due August 2024 1,636,797 1,636,797 Revolving credit facility due August 2024 35,000 — Accounts receivable financing agreement due October 2024 400,000 400,000 Total secured debt 2,220,992 2,185,992 Unsecured Debt Senior notes due January 2029 (the “Notes”) 600,000 600,000 Total debt obligations 2,820,992 2,785,992 Less: Term loan original issuance discount ( 1,809 ) ( 2,228 ) Less: Unamortized deferred issuance costs ( 7,352 ) ( 8,043 ) Total long-term debt $ 2,811,831 $ 2,775,721
Contractual Maturities of Debt Obligations	As of June 30, 2022, the contractual maturities of the Company’s debt obligations (excluding finance leases) were as follows (in thousands): Principal Remainder of 2022 $ — 2023 21,732 2024 2,199,260 2025 — 2026 — 2027 and thereafter 600,000 Less: Term loan original issuance discount ( 1,809 ) Less: Unamortized deferred issuance costs ( 7,352 ) Total $ 2,811,831

Derivatives (Tables)

Derivatives (Tables)	6 Months Ended
	Jun. 30, 2022
Derivative Instruments And Hedging Activities Disclosure [Abstract]
Interest Rate Swaps Designated as Hedging Instruments on Consolidated Balance Sheets	The fair values of the Company’s derivative financial instruments and the line items on the accompanying condensed consolidated balance sheets to which they were recorded were as follows (in thousands): Balance Sheet Classification June 30, 2022 December 31, 2021 Interest rate swaps - current Prepaid expenses and other current assets $ 18,317 $ — Interest rate swaps - non-current Other long-term assets — 948 Fair value of derivative assets $ 18,317 $ 948 Interest rate swaps - current Accrued expenses $ — $ 1,827 Fair value of derivative liabilities $ — $ 1,827

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2022
Fair Value Disclosures [Abstract]
Schedule of Assets and Liabilities Measured at Fair Value on a Recurring Basis	As of June 30, 2022, the fair values of the major classes of the Company’s assets and liabilities measured at fair value on a recurring basis were as follows (in thousands): Level 1 Level 2 Level 3 Investments Total Assets: Trading securities (a) $ 20,207 $ — $ — $ — $ 20,207 Partnership interests (b) — — — 12,753 12,753 Derivative instruments (c) — 18,317 — — 18,317 Total assets $ 20,207 $ 18,317 $ — $ 12,753 $ 51,277 Liabilities: Contingent obligations related to acquisitions (d) $ — $ — $ 17,747 $ — $ 17,747 Total liabilities $ — $ — $ 17,747 $ — $ 17,747 As of December 31, 2021, the fair values of the major classes of the Company’s assets and liabilities measured at fair value on a recurring basis were as follows (in thousands): Level 1 Level 2 Level 3 Investments Total Assets: Trading securities (a) $ 24,775 $ — $ — $ — $ 24,775 Partnership interests (b) — — — 11,176 11,176 Derivative instruments (c) — 948 — — 948 Total assets $ 24,775 $ 948 $ — $ 11,176 $ 36,899 Liabilities: Derivative instruments (c) $ — $ 1,827 $ — $ — $ 1,827 Contingent obligations related to acquisitions (d) — — 17,997 — 17,997 Total liabilities $ — $ 1,827 $ 17,997 $ — $ 19,824 (a) Represents the fair value of investments in mutual funds based on quoted market prices that are used to fund the liability associated with the Company’s deferred compensation plan. (b) The Company has committed to invest $ 21.5 million as a limited partner in two private equity funds. The private equity funds invest in opportunities in the healthcare and life sciences industry. As of June 30, 2022 , the Company’s remaining unfunded commitment in the private equity funds was $ 11.2 million. The Company holds minor ownership interests (less than 3 %) in each of the private equity funds and has determined that it does not exercise significant influence over the private equity funds’ operating and finance activities. As the private equity funds do not have readily determinable fair values, the Company has estimated the fair values using each fund’s Net Asset Value, the amount by which the value of all assets exceeds all debt and liabilities, in accordance with Accounting Standards Codification (“ASC”) Topic 946, Financial Services – Investment Companies . (c) Represents the fair value of interest rate swap arrangements (see “Note 5 – Derivatives” for further information). (d) Represents the fair value of contingent consideration obligations related to acquisitions. The fair values of these liabilities are determined based on the Company’s best estimate of the probable timing and amount of settlement.
Reconciliation of Changes in the Carrying Amount of Contingent Consideration	The following table presents a reconciliation of changes in the carrying amount of contingent obligations classified as Level 3 for the six months ended June 30, 2022 (in thousands): Balance as of December 31, 2021 $ 17,997 Additions — Changes in fair value recognized in earnings ( 250 ) Payments — Balance as of June 30, 2022 $ 17,747
Schedule of Estimated Fair Value	The estimated fair values of the Company’s term loan (based on tranche) and the Notes were as follows (in thousands): June 30, 2022 December 31, 2021 Carrying Estimated Carrying Estimated Term Loan A - tranche one due March 2024 $ 149,043 $ 146,957 $ 149,008 $ 148,945 Term Loan A - tranche two due August 2024 1,635,140 1,588,167 1,634,756 1,635,138 Senior notes due January 2029 600,000 513,000 600,000 595,500 (a) The carrying value of the term loan debt is shown net of original issue discounts.

Restructuring and Other Costs (

Restructuring and Other Costs (Tables)	6 Months Ended
	Jun. 30, 2022
Restructuring And Related Activities [Abstract]
Schedule of Restructuring and Related Costs	Restructuring and other costs consisted of the following (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Employee severance and benefit costs $ 2,368 $ 2,084 $ 17,188 $ 8,377 Facility and lease termination costs 3,671 1,882 3,352 2,770 Other costs 2,944 — 4,000 47 Total restructuring and other costs $ 8,983 $ 3,966 $ 24,540 $ 11,194 The following table summarizes activity related to employee severance and benefit costs within accrued restructuring liabilities for the six months ended June 30, 2022 (in thousands): Balance as of December 31, 2021 $ 6,657 Expenses incurred (a) 17,188 Payments ( 13,376 ) Balance as of June 30, 2022 $ 10,469 (a) The amount of expenses incurred for the six months ended June 30, 2022 excludes $ 4.0 million of other costs that are included in accounts payable and $ 3.4 million of facility lease closure and lease termination costs that are reflected as reductions of operating lease right-of-use assets, current portion of operating lease obligations, and operating lease long-term obligations under ASC Topic 842, Leases, on the accompanying condensed consolidated balance sheet.

Shareholders' Equity (Tables)

Shareholders' Equity (Tables)	6 Months Ended
	Jun. 30, 2022
Equity [Abstract]
Shares of Common Stock Outstanding	Shares of common stock outstanding were as follows (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Common stock shares, beginning balance 102,558 104,226 103,764 103,935 Repurchases of common stock — ( 900 ) ( 1,929 ) ( 1,500 ) Issuances of common stock 89 147 812 1,038 Common stock shares, ending balance 102,647 103,473 102,647 103,473
Schedule of Repurchase Activity	The following table sets forth repurchase activity under the 2021 Stock Repurchase Program from inception through the program’s termination on May 25, 2022: Total number of Average price Approximate March 2021 600,000 $ 74.18 $ 44,505 May 2021 400,000 81.04 32,416 June 2021 500,000 81.20 40,600 February 2022 515,003 78.52 40,439 March 2022 1,413,920 77.46 109,522 Total 3,428,923 $ 267,482

Earnings Per Share (Tables)

Earnings Per Share (Tables)	6 Months Ended
	Jun. 30, 2022
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted	The following table provides a reconciliation of the numerators and denominators of the basic and diluted earnings per share computations (in thousands, except per share data): Three Months Ended Six Months Ended 2022 2021 2022 2021 Numerator: Net income $ 77,744 $ 41,905 $ 123,920 $ 80,629 Denominator: Basic weighted average common shares outstanding 102,596 103,937 103,130 104,105 Effect of dilutive securities: Stock options and other awards under deferred share-based compensation programs 476 1,082 611 1,133 Diluted weighted average common shares outstanding 103,072 105,019 103,741 105,238 Earnings per share: Basic $ 0.76 $ 0.40 $ 1.20 $ 0.77 Diluted $ 0.75 $ 0.40 $ 1.19 $ 0.77

Segment Information (Tables)

Segment Information (Tables)	6 Months Ended
	Jun. 30, 2022
Segment Reporting [Abstract]
Schedule of Segment Information	Information about reportable segment operating results was as follows (in thousands): Three Months Ended Six Months Ended 2022 2021 2022 2021 Revenue: Clinical Solutions $ 1,025,715 $ 992,936 $ 2,044,085 $ 1,932,503 Commercial Solutions 335,024 289,675 652,907 558,853 Total revenue 1,360,739 1,282,611 2,696,992 2,491,356 Segment direct costs: Clinical Solutions 753,451 752,171 1,528,119 1,469,526 Commercial Solutions 273,578 232,283 534,543 451,083 Total segment direct costs 1,027,029 984,454 2,062,662 1,920,609 Segment selling, general, and administrative expenses: Clinical Solutions 88,863 89,303 178,765 176,835 Commercial Solutions 21,094 20,318 42,829 41,289 Total segment selling, general, and administrative expenses 109,957 109,621 221,594 218,124 Segment operating income: Clinical Solutions 183,401 151,462 337,201 286,142 Commercial Solutions 40,352 37,074 75,535 66,481 Total segment operating income 223,753 188,536 412,736 352,623 Direct costs and operating expenses not allocated to segments: Share-based compensation included in direct costs 7,868 8,127 16,667 17,222 Share-based compensation included in selling, general, and administrative expenses 8,323 8,312 16,857 16,570 Corporate selling, general, and administrative expenses 20,760 26,736 40,755 47,289 Restructuring and other costs 8,983 3,966 24,540 11,194 Depreciation and amortization 61,221 57,711 123,423 115,649 Total income from operations $ 116,598 $ 83,684 $ 190,494 $ 144,699

Operations by Geographic Loca_2

Operations by Geographic Location (Tables)	6 Months Ended
	Jun. 30, 2022
Segments Geographical Areas [Abstract]
Total Revenue by Geographic Area	The following table summarizes total revenue by geographic area (in thousands, all intercompany transactions have been eliminated): Three Months Ended Six Months Ended 2022 2021 2022 2021 Revenue: North America (a) $ 806,640 $ 774,228 $ 1,588,294 $ 1,513,229 Europe, Middle East, and Africa 340,384 328,895 695,977 645,071 Asia-Pacific 172,965 144,233 333,768 270,690 Latin America 40,750 35,255 78,953 62,366 Total revenue $ 1,360,739 $ 1,282,611 $ 2,696,992 $ 2,491,356
Long-Lived Assets by Geographic Area	The following table summarizes long-lived assets by geographic area (in thousands, all intercompany transactions have been eliminated): June 30, 2022 December 31, 2021 Property and equipment, net: North America (a) $ 193,233 $ 165,446 Europe, Middle East, and Africa 34,330 37,004 Asia-Pacific 19,639 13,615 Latin America 7,689 6,592 Total property and equipment, net $ 254,891 $ 222,657

Basis of Presentation - Narrati

Basis of Presentation - Narrative (Details)	6 Months Ended
	Jun. 30, 2022 Segment
Accounting Policies [Abstract]
Number of reportable segments	2

Financial Statement Details - S

Financial Statement Details - Schedule Of Cash Pool Position (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Gross cash position	$ 145,866	$ 179,160
Less: cash borrowings	(138,840)	(167,507)
Net cash position	$ 7,026	$ 11,653

Financial Statement Details - A

Financial Statement Details - Accounts Receivable and Unbilled Services, net (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Receivables [Abstract]
Accounts receivable billed	$ 904,775	$ 873,265
Accounts receivable unbilled	235,692	241,799
Contract assets	473,911	417,411
Less: Allowance for doubtful accounts	(7,427)	(7,585)
Accounts receivable and unbilled services, net	$ 1,606,951	$ 1,524,890

Financial Statement Details - N

Financial Statement Details - Narrative (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Trade receivables sold	$ 66.8	$ 68.7
Proceeds from sale of trade receivables	$ 66.5	$ 68.6

Financial Statement Details -_2

Financial Statement Details - Schedule of Goodwill (Details)	6 Months Ended
	Jun. 30, 2022 USD ($)
Goodwill [Roll Forward]
Balance as of December 31, 2021	$ 4,956,015,000
Acquisitions	1,903,000	[1]
Impact of foreign currency translation	(59,868,000)
Balance as of June 30, 2022	4,898,050,000
Clinical Solutions
Goodwill [Roll Forward]
Balance as of December 31, 2021	3,448,699,000	[2]
Acquisitions	1,903,000	[1],[2]
Impact of foreign currency translation	(40,441,000)	[2]
Balance as of June 30, 2022	3,410,161,000	[2]
Impairment of goodwill	0
Commercial Solutions
Goodwill [Roll Forward]
Balance as of December 31, 2021	1,507,316,000	[2]
Impact of foreign currency translation	(19,427,000)	[2]
Balance as of June 30, 2022	1,487,889,000	[2]
Impairment of goodwill	$ 0
[1] (b) Amount represents goodwill recognized in connection with an insignificant acquisition and measurement period adjustments in connection with insignificant 2021 acquisitions during the six months ended June 30, 2022 within the Clinical Solutions segment (a) No impairment of goodwill was recorded for the six months ended June 30, 2022

Financial Statement Details -_3

Financial Statement Details - Accumulated Other Comprehensive Loss, Net of Taxes (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	$ 3,301,559	$ 3,236,877	$ 3,412,555	$ 3,242,112
Other comprehensive income (loss) before reclassifications	4,827	(488)	13,439	284
Balance at end of period	3,329,065	3,238,614	3,329,065	3,238,614
Accumulated Other Comprehensive Loss
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(57,364)	(39,174)	(49,618)	(40,801)
Other comprehensive income (loss) before reclassifications	(69,826)		(87,212)
Balance at end of period	(122,662)	(25,641)	(122,662)	(25,641)
Foreign Currency Translation
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(64,383)	(26,350)	(46,997)	(22,040)
Other comprehensive income (loss) before reclassifications	(69,826)	8,825	(87,212)	4,515
Balance at end of period	(134,209)	(17,525)	(134,209)	(17,525)
Accumulated Gain (Loss), Net, Cash Flow Hedge, Parent
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	7,019	(12,824)	(2,621)	(18,761)
Other comprehensive income (loss) before reclassifications	4,827	(488)	13,439	284
Reclassification adjustments	(299)	5,196	729	10,361
Balance at end of period	$ 11,547	$ (8,116)	$ 11,547	$ (8,116)

Financial Statement Details - T

Financial Statement Details - Tax Effects Allocated to Each Component of Other Comprehensive (Loss) Income (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Accumulated Other Comprehensive Income (Loss) [Line Items]
Income tax expense (benefit)	$ 1,713	$ (166)	$ 4,768	$ 96
Unrealized gain (loss) during period, net of taxes	4,827	(488)	13,439	284
Income tax expense (benefit)	1,745	550	(966)	(158)
Total unrealized gain (loss) on derivative instruments, net of taxes	(65,298)	13,533	(73,044)	15,160
Accumulated Gain (Loss), Net, Cash Flow Hedge, Parent
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized gain (loss) during period, before taxes	6,540	(654)	18,207	380
Unrealized gain (loss) during period, net of taxes	4,827	(488)	13,439	284
Reclassification adjustment, before taxes	(405)	6,958	988	13,874
Income tax expense (benefit)	(106)	1,762	259	3,513
Reclassification adjustment, net of taxes	(299)	5,196	729	10,361
Total unrealized gain (loss) on derivative instruments, net of taxes	4,528	4,708	14,168	10,645
Foreign Currency Translation
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized gain (loss) during period, before taxes	(68,081)	9,375	(88,178)	4,357
Unrealized gain (loss) during period, net of taxes	(69,826)	8,825	(87,212)	4,515
Income tax expense (benefit)	$ 1,745	$ 550	$ (966)	$ (158)

Financial Statement Details -_4

Financial Statement Details - Schedule of Other Expense (Income) ,Net (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Other (income) expense, net:
Net realized foreign currency loss	$ 4,799	$ 570	$ 7,254	$ 1,762
Net unrealized foreign currency loss (gain)	(9,503)	5,959	(9,069)	(3,563)
Equity investment income				(1,100)
Other, net	(448)	1,298	1,305	872
Total other expense (income), net	$ (5,152)	$ 7,827	$ (510)	$ (2,029)

Investments and Divestitures -

Investments and Divestitures - Narrative (Details) - USD ($) $ in Millions	3 Months Ended					6 Months Ended
	Jun. 30, 2022	Sep. 30, 2021	Jun. 30, 2021	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Non-cash investment in acquire property					$ 27.3
Assets exchanged in cash		$ 3.8
Gain (loss) on equity investments	$ 1.1		$ 2.8			$ 2.3
Other long-term investments	12.2					12.2	$ 16.2
Maximum loss on investment for a VIE	15.9					15.9
Related Party
Business Acquisition [Line Items]
Contingent consideration	$ 2.2		$ 1.8			$ 2.2
Maximum | Related Party
Business Acquisition [Line Items]
Cash consideration				$ 4

Long-Term Debt Obligations - Sc

Long-Term Debt Obligations - Schedule of Debt Obligations (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Less: Term loan original issuance discount	$ (1,809)	$ (2,228)
Less: Unamortized deferred issuance costs	(7,352)	(8,043)
Total debt obligations, non-current portion	2,811,831	2,775,721
Secured Debt
Debt Instrument [Line Items]
Total debt obligations	2,220,992	2,185,992
Secured Debt | Term Loan A - tranche one due March 2024
Debt Instrument [Line Items]
Total debt obligations	149,195	149,195
Secured Debt | Term Loan A - tranche two due August 2024
Debt Instrument [Line Items]
Total debt obligations	1,636,797	1,636,797
Secured Debt | Revolving Credit Facility Due August 2024
Debt Instrument [Line Items]
Total debt obligations	35,000
Secured Debt | Accounts receivable financing agreement due October 2022 | Accounts Receivable Securitization
Debt Instrument [Line Items]
Total debt obligations	400,000	400,000
Unsecured Debt
Debt Instrument [Line Items]
Total debt obligations	2,820,992	2,785,992
Unsecured Debt | Senior Unsecured Notes due January 2029
Debt Instrument [Line Items]
Total debt obligations	$ 600,000	$ 600,000

Long-Term Debt Obligations - Na

Long-Term Debt Obligations - Narrative (Details) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Debt Instrument [Line Items]
Repayments of Long-term debt			$ 0	$ 602,277,000
Loss on extinguishment of debt	$ 0	$ (2,199,000)	$ 0	$ (2,802,000)
Due date, description			The Notes bear interest at a rate of 3.625% per annum, payable semi-annually in arrears that began on July 15, 2021, and will mature on January 15, 2029
Secured Debt | Revolving credit facility due August 2024
Debt Instrument [Line Items]
Outstanding borrowings	$ 35,000,000		$ 35,000,000
Debt, weighted average interest rate	2.84%		2.84%
Secured Debt | Letter of Credit
Debt Instrument [Line Items]
Line of credit facility, capacity available for trade purchases	$ 135,900,000		$ 135,900,000
Secured Debt | 2017 Credit Agreement - Amendment No 2 - Term Loan B Due August 2024 | Term Loan
Debt Instrument [Line Items]
Debt Instrument, Interest Rate, Stated Percentage	2.92%		2.92%
Secured Debt | 2017 Credit Agreement - Amendment No 2 - Term Loan B Due August 2024 | Revolving credit facility due August 2024
Debt Instrument [Line Items]
Maximum borrowing capacity under accounts receivable financing agreement	$ 600,000,000		$ 600,000,000
Secured Debt | Revolving Credit Facility Due August 2024
Debt Instrument [Line Items]
Remaining capacity available under accounts receivable financing agreement	550,900,000		550,900,000
Secured Debt | Revolving Credit Facility Due August 2024 | Letter of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity under accounts receivable financing agreement	150,000,000		150,000,000
Outstanding borrowings	$ 14,100,000		$ 14,100,000

Long-Term Debt Obligations - Ac

Long-Term Debt Obligations - Accounts Receivable Financing Agreement (Details) $ in Thousands	Jun. 30, 2022 USD ($)
Debt Instrument [Line Items]
Long-term debt	$ 2,811,831
Accounts Receivable Financing Agreement Due September2021 | Secured Debt | Accounts Receivable Securitization
Debt Instrument [Line Items]
Long-term debt	$ 400,000
Weighted average imputed interest rate	2.58%
Accounts Receivable Financing Agreement Due September2021 | Secured Debt | Accounts Receivable Securitization | Subsidiaries
Debt Instrument [Line Items]
Remaining capacity available under accounts receivable financing agreement	$ 0

Long-Term Debt Obligations - Co

Long-Term Debt Obligations - Contractual Maturities of Debt Obligations (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Principal
2023	$ 21,732
2024	2,199,260
2027 and thereafter	600,000
Less: Term loan original issuance discount	(1,809)	$ (2,228)
Less: Unamortized deferred issuance costs	(7,352)	$ (8,043)
Total	$ 2,811,831

Derivatives - Narrative (Detail

Derivatives - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021	Mar. 31, 2020
Derivative [Line Items]
Foreign Currency Forward Loss, Realized	$ (4,799)	$ (570)	$ (7,254)	$ (1,762)
Interest Rate Swap, expiring March 31, 2023
Derivative [Line Items]
Notional amount	1,070,000	1,420,000	1,070,000	1,420,000	$ 549,200
Foreign Exchange Forward
Derivative [Line Items]
Notional amount	75,000		75,000
Foreign Currency Forward Loss, Realized	$ 5,600	$ 400	$ 7,500	$ 1,500

Derivatives - Interest Rate Swa

Derivatives - Interest Rate Swaps Designated as Hedging Instruments on Consolidated Balance Sheets (Details) - Interest Rate Swap - Designated as Hedging Instrument - Cash Flow Hedging - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Derivatives, Fair Value [Line Items]
Derivative assets	$ 18,317	$ 948
Derivative liability		1,827
Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Derivative assets -current	$ 18,317
Accrued expenses
Derivatives, Fair Value [Line Items]
Derivative liability - current		1,827
Other Noncurrent Assets
Derivatives, Fair Value [Line Items]
Derivative assets - non-current		$ 948

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of Assets and Liabilities Measured at Fair Value on a Recurring Basis (Details) - Recurring - USD ($) $ in Thousands		Jun. 30, 2022	Dec. 31, 2021
Assets:
Trading securities	[1]	$ 20,207	$ 24,775
Derivative instruments	[2]	18,317	948
Total assets		51,277	36,899
Liabilities:
Derivative instruments	[2]		1,827
Contingent obligations related to acquisitions	[3]	17,747	17,997
Total liabilities		17,747	19,824
Partnership Interests
Assets:
Partnership interests	[4]	12,753	11,176
Level 1
Assets:
Trading securities	[1]	20,207	24,775
Total assets		20,207	24,775
Level 2
Assets:
Derivative instruments	[2]	18,317	948
Total assets		18,317	948
Liabilities:
Derivative instruments	[2]		1,827
Total liabilities			1,827
Level 3
Liabilities:
Contingent obligations related to acquisitions	[3]	17,747	17,997
Total liabilities		17,747	17,997
Investments Measured at Net Asset Value
Assets:
Total assets		12,753	11,176
Investments Measured at Net Asset Value | Partnership Interests
Assets:
Partnership interests	[4]	$ 12,753	$ 11,176
[1] (a) Represents the fair value of investments in mutual funds based on quoted market prices that are used to fund the liability associated with the Company’s deferred compensation plan. (c) Represents the fair value of interest rate swap arrangements (see “Note 5 – Derivatives” for further information). (d) Represents the fair value of contingent consideration obligations related to acquisitions. The fair values of these liabilities are determined based on the Company’s best estimate of the probable timing and amount of settlement. (b) The Company has committed to invest $ 21.5 million as a limited partner in two private equity funds. The private equity funds invest in opportunities in the healthcare and life sciences industry. As of June 30, 2022 , the Company’s remaining unfunded commitment in the private equity funds was $ 11.2 million. The Company holds minor ownership interests (less than 3 %) in each of the private equity funds and has determined that it does not exercise significant influence over the private equity funds’ operating and finance activities. As the private equity funds do not have readily determinable fair values, the Company has estimated the fair values using each fund’s Net Asset Value, the amount by which the value of all assets exceeds all debt and liabilities, in accordance with Accounting Standards Codification (“ASC”) Topic 946, Financial Services – Investment Companies .

Fair Value Measurements - Sch_2

Fair Value Measurements - Schedule of Assets and Liabilities Measured at Fair Value on a Recurring Basis (Parenthetical) (Details) $ in Millions	6 Months Ended
	Jun. 30, 2022 USD ($) EquityFund
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Commitment to invest a limited partner in private equity funds	$ 21.5
Remaining unfunded commitment	$ 11.2
Number of private equity funds | EquityFund	2
Healthcare and Life Sciences Industry
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Minority interest ownership percentage	3%

Fair Value Measurements - Recon

Fair Value Measurements - Reconciliation of Changes in the Carrying Amount of Contingent Consideration (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2022 USD ($)
Fair Value Disclosures [Abstract]
Balance at Beginning of period	$ 17,997
Additions	0
Changes in fair value recognized in earnings	(250)
Payments	0
Balance at End of period	$ 17,747

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2022	Dec. 31, 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Fair value assets transferred from level 1 to level 2	$ 0
Fair value assets transferred from level 2 to level 1	0
Fair value liabilities transferred from level 1 to level 2	0
Fair value liabilities transferred from level 2 to level 1	0
Fair value assets transferred into level 3	0
Fair value assets transferred out of level 3	0
Fair value liabilities transferred into level 3	0
Fair value liabilities transferred out of level 3	0
Nonrecurring
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Goodwill and identifiable intangible assets	$ 5,670,000	$ 5,830,000

Fair Value Measurements - Sch_3

Fair Value Measurements - Schedule of Estimated Fair Value (Details) - Level 2 - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Term Loan A - Tranche One Due March 2024 | Secured Debt | Reported Value Measurement
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, carrying value	$ 149,043	$ 149,008
Term Loan A - Tranche One Due March 2024 | Secured Debt | Estimate of Fair Value Measurement
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, fair value	146,957	148,945
Term Loan A - Tranche Two Due August 2024 | Secured Debt | Reported Value Measurement
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, carrying value	1,635,140	1,634,756
Term Loan A - Tranche Two Due August 2024 | Secured Debt | Estimate of Fair Value Measurement
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, fair value	1,588,167	1,635,138
Senior Notes Due January 2029 | Unsecured Debt | Reported Value Measurement
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, carrying value	600,000	600,000
Senior Notes Due January 2029 | Unsecured Debt | Estimate of Fair Value Measurement
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, fair value	$ 513,000	$ 595,500

Restructuring and Other Costs -

Restructuring and Other Costs - Schedule of Restructuring and Related Costs (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Restructuring Cost And Reserve [Line Items]
Total restructuring and other costs	$ 8,983	$ 3,966	$ 24,540	$ 11,194
Employee severance and benefit costs
Restructuring Cost And Reserve [Line Items]
Total restructuring and other costs	2,368	2,084	17,188	8,377
Facility and lease termination costs
Restructuring Cost And Reserve [Line Items]
Total restructuring and other costs	3,671	$ 1,882	3,352	2,770
Other costs
Restructuring Cost And Reserve [Line Items]
Total restructuring and other costs	$ 2,944		$ 4,000	$ 47

Restructuring and Other Costs_2

Restructuring and Other Costs - Employee Severance and Benefit Costs within Accrued Restructuring Liabilities (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2022 USD ($)
Accounts Payable
Restructuring Reserve
Business exit other costs that included in accounts payable	$ 4,000
Business Restructuring Reserves
Restructuring Reserve
Balance at the beginning of the period	6,657
Expenses incurred	17,188
Payments	(13,376)
Balance at the end of the period	10,469
Business exit costs and (gain) loss on termination of lease	$ 3,400

Shareholders' Equity - Shares o

Shareholders' Equity - Shares of Common Stock Outstanding (Details) - Common Stock - shares	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Common stock shares, beginning balance	102,558,000	104,226,000	103,764,000	103,935,000
Repurchases of common stock	0	(900,000)	(1,929,000)	(1,500,000)
Issuances of common stock	89,000	147,000	812,000	1,038,000
Common stock shares, ending balance	102,647,000	103,473,000	102,647,000	103,473,000

Shareholders' Equity - Narrativ

Shareholders' Equity - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions	1 Months Ended					6 Months Ended
	Mar. 31, 2022	Feb. 28, 2022	Jun. 30, 2021	May 31, 2021	Mar. 31, 2021	Jun. 30, 2022	May 25, 2022	Dec. 31, 2021	Nov. 17, 2020
Class Of Stock [Line Items]
Common stock par value (USD per share)						$ 0.01		$ 0.01
Common Class A | 2021 Stock Repurchase Program
Class Of Stock [Line Items]
Stock repurchase program, authorized amount									$ 300
Common stock par value (USD per share)									$ 0.01
Common Class A | 2022 Stock Repurchase Program
Class Of Stock [Line Items]
Stock repurchase program, authorized amount							$ 350
Common stock par value (USD per share)							$ 0.01
Common Stock
Class Of Stock [Line Items]
Stock repurchased during period, shares	1,413,920	515,003	500,000	400,000	600,000	3,428,923
Common Stock | 2022 Stock Repurchase Program
Class Of Stock [Line Items]
Stock repurchase program, remaining authorization to repurchase						$ 350

Shareholders' Equity - Repurcha

Shareholders' Equity - Repurchase Activity (Details) - Common Stock - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended					6 Months Ended
	Mar. 31, 2022	Feb. 28, 2022	Jun. 30, 2021	May 31, 2021	Mar. 31, 2021	Jun. 30, 2022
Class Of Stock [Line Items]
Stock repurchased (in shares)	1,413,920	515,003	500,000	400,000	600,000	3,428,923
Stock repurchased, average price paid per share (USD per share)	$ 77.46	$ 78.52	$ 81.20	$ 81.04	$ 74.18
Stock repurchase program, shares purchased, value	$ 109,522	$ 40,439	$ 40,600	$ 32,416	$ 44,505	$ 267,482

Earnings Per Share - Schedule o

Earnings Per Share - Schedule of Earnings Per Share, Basic and Diluted (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Numerator:
Net income	$ 77,744	$ 41,905	$ 123,920	$ 80,629
Weighted Average Number of Shares Outstanding Reconciliation [Abstract]
Basic weighted average common shares outstanding (in shares)	102,596	103,937	103,130	104,105
Effect of dilutive securities:
Stock options and other awards under deferred share-based compensation programs (in shares)	476	1,082	611	1,133
Diluted weighted average common shares outstanding (in shares)	103,072	105,019	103,741	105,238
Earnings per share:
Basic (USD per share)	$ 0.76	$ 0.40	$ 1.20	$ 0.77
Diluted (USD per share)	$ 0.75	$ 0.40	$ 1.19	$ 0.77

Earnings Per Share - Narrative

Earnings Per Share - Narrative (Details) - shares	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Earnings Per Share [Abstract]
Anti-dilutive shares outstanding excluded from the computation of diluted earnings per share	774,405	143,958	469,724	155,062

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2021
Condensed Balance Sheet Statements, Captions [Line Items]
Income tax expense	$ 25,940	$ 9,134	$ 33,256	$ 17,421
Income before provision for income taxes	103,684	51,039	157,176	98,050
Discrete tax benefits (expense)	$ 300	$ 2,200	$ 6,400	$ 5,800
U.S. state and local statutory rate	21%		21%
U.S. federal statutory rate	21%	21%	21%	21%
Gross unrecognized tax benefits	$ 11,700		$ 11,700		$ 12,100
Decrease in unrecognized tax benefits resulting from lapses of applicable statutes of limitations			1,400
Foreign Jurisdictions
Condensed Balance Sheet Statements, Captions [Line Items]
Decrease in unrecognized tax benefit in foreign jurisdictions			$ 400

Revenue from Contracts with C_2

Revenue from Contracts with Customers - Narrative (Details) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2022 USD ($)	Jun. 30, 2022 USD ($)
Revenue Remaining Performance Obligation Expected Timing Of Satisfaction [Line Items]
Unsatisfied performance obligations under contracts with a contract term greater than one year	$ 6,570	$ 6,570
Revenue recognized, included in contract liabilities balance at beginning of period	389.3	$ 547.8
Minimum [Member]
Revenue Remaining Performance Obligation Expected Timing Of Satisfaction [Line Items]
Contract term		1 year
Maximum [Member]
Revenue Remaining Performance Obligation Expected Timing Of Satisfaction [Line Items]
Contract term		5 years
Increase (decrease) in revenue recognized, allocated to performance obligation partially satisfied in previous periods	$ 1.5	$ 2.4

Segment Information (Details)

Segment Information (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022 USD ($)	Jun. 30, 2021 USD ($)	Jun. 30, 2022 USD ($) Segment	Jun. 30, 2021 USD ($)
Segment Reporting Information [Line Items]
Number of reportable segments | Segment			2
Revenue	$ 1,360,739	$ 1,282,611	$ 2,696,992	$ 2,491,356
Direct costs (exclusive of depreciation and amortization)	1,034,897	992,581	2,079,329	1,937,831
Selling, general, and administrative expenses	139,040	144,669	279,206	281,983
Operating income (loss)	116,598	83,684	190,494	144,699
Restructuring and other costs	8,983	3,966	24,540	11,194
Operating Segments
Segment Reporting Information [Line Items]
Direct costs (exclusive of depreciation and amortization)	1,027,029	984,454	2,062,662	1,920,609
Selling, general, and administrative expenses	109,957	109,621	221,594	218,124
Operating income (loss)	223,753	188,536	412,736	352,623
Corporate
Segment Reporting Information [Line Items]
Selling, general, and administrative expenses	20,760	26,736	40,755	47,289
Restructuring and other costs	8,983	3,966	24,540	11,194
Depreciation and amortization	61,221	57,711	123,423	115,649
Corporate | Direct costs
Segment Reporting Information [Line Items]
Share-based compensation expense	7,868	8,127	16,667	17,222
Corporate | Selling, general, and administrative expenses
Segment Reporting Information [Line Items]
Share-based compensation expense	8,323	8,312	16,857	16,570
Clinical Solutions | Operating Segments
Segment Reporting Information [Line Items]
Revenue	1,025,715	992,936	2,044,085	1,932,503
Direct costs (exclusive of depreciation and amortization)	753,451	752,171	1,528,119	1,469,526
Selling, general, and administrative expenses	88,863	89,303	178,765	176,835
Operating income (loss)	183,401	151,462	337,201	286,142
Commercial Solutions | Operating Segments
Segment Reporting Information [Line Items]
Revenue	335,024	289,675	652,907	558,853
Direct costs (exclusive of depreciation and amortization)	273,578	232,283	534,543	451,083
Selling, general, and administrative expenses	21,094	20,318	42,829	41,289
Operating income (loss)	$ 40,352	$ 37,074	$ 75,535	$ 66,481

Operations by Geographic Loca_3

Operations by Geographic Location - Total Revenue by Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Revenues by Geographic Location
Revenue	$ 1,360,739	$ 1,282,611	$ 2,696,992	$ 2,491,356
North America
Revenues by Geographic Location
Revenue	806,640	774,228	1,588,294	1,513,229
Europe, Middle East, and Africa
Revenues by Geographic Location
Revenue	340,384	328,895	695,977	645,071
Asia-Pacific
Revenues by Geographic Location
Revenue	172,965	144,233	333,768	270,690
Latin America
Revenues by Geographic Location
Revenue	40,750	35,255	78,953	62,366
United States
Revenues by Geographic Location
Revenue	$ 754,700	$ 722,800	$ 1,491,200	$ 1,416,700
United States | Geographic Concentration Risk | Net Service Revenue
Revenues by Geographic Location
Concentration risk percentage	55.50%	56.40%	55.30%	56.90%

Operations by Geographic Loca_4

Operations by Geographic Location - Long-Lived Assets by Geographic Area (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Long-Lived Assets by Geographic Location
Total property and equipment, net	$ 254,891	$ 222,657
North America
Long-Lived Assets by Geographic Location
Total property and equipment, net	193,233	165,446
Europe, Middle East, and Africa
Long-Lived Assets by Geographic Location
Total property and equipment, net	34,330	37,004
Asia-Pacific
Long-Lived Assets by Geographic Location
Total property and equipment, net	19,639	13,615
Latin America
Long-Lived Assets by Geographic Location
Total property and equipment, net	7,689	6,592
United States
Long-Lived Assets by Geographic Location
Total property and equipment, net	$ 186,100	$ 160,000

Concentration of Credit Risk -

Concentration of Credit Risk - Narrative (Details) - Customer Concentration Risk - Major Customer	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2021
Revenue
Concentration Risk
Concentration risk percentage	10%	10%	10%	10%
Accounts Receivable
Concentration Risk
Concentration risk percentage			10%		10%

Related-Party Transactions - Na

Related-Party Transactions - Narrative (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022 USD ($) Customer	Jun. 30, 2021 USD ($) Customer	Jun. 30, 2022 USD ($) Customer	Jun. 30, 2021 USD ($) Customer
Related Party Transaction [Line Items]
Revenue from related parties	$ 2,200	$ 1,200	$ 3,600	$ 1,900
Number of counterparties | Customer	2	2	2	2
Potential future cash consideration, in exchange of sale of company's contingent staffing business to related party			$ 0	$ 597
Director
Related Party Transaction [Line Items]
Receivables from related party	$ 300	$ 1,600	$ 300	$ 1,600
Number of counterparties | Customer	4		4