Syneos Health (SYNH) 10-Q 8 Aug 23 2023 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2023	Jul. 31, 2023
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2023
Document Fiscal Year Focus	2023
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 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
Entity Common Stock, Shares Outstanding		103,719,179

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Income Statement [Abstract]
Revenue	$ 1,366,080	$ 1,360,739	$ 2,722,880	$ 2,696,992
Costs and operating expenses:
Direct costs (exclusive of depreciation and amortization)	1,071,363	1,034,897	2,159,912	2,079,329
Selling, general, and administrative expenses	182,523	139,040	344,040	279,206
Restructuring and other costs	10,641	8,983	95,328	24,540
Depreciation	20,777	21,241	43,950	41,820
Amortization	38,555	39,980	76,969	81,603
Total operating expenses	1,323,859	1,244,141	2,720,199	2,506,498
Income from operations	42,221	116,598	2,681	190,494
Total other expense, net:
Interest income	(1,708)	(36)	(2,236)	(39)
Interest expense	37,877	18,102	64,664	33,867
Other expense (income), net	5,391	(5,152)	14,754	(510)
Total other expense, net	41,560	12,914	77,182	33,318
Income (loss) before provision for income taxes	661	103,684	(74,501)	157,176
Income tax (benefit) expense	(132)	25,940	(3,145)	33,256
Net income (loss)	$ 793	$ 77,744	$ (71,356)	$ 123,920
Earnings (loss) per share:
Basic (USD per share)	$ 0.01	$ 0.76	$ (0.69)	$ 1.20
Diluted (USD per share)	$ 0.01	$ 0.75	$ (0.69)	$ 1.19
Weighted average common shares outstanding:
Basic (in shares)	103,679	102,596	103,502	103,130
Diluted (in shares)	104,344	103,072	103,502	103,741

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE (LOSS) INCOME (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Statement Of Income And Comprehensive Income [Abstract]
Net income (loss)	$ 793	$ 77,744	$ (71,356)	$ 123,920
Unrealized gain (loss) on derivative instruments, net of income tax expense (benefit) of $3,082, $1,607, ($36), $5,027, respectively	9,329	4,528	(110)	14,168
Foreign currency translation adjustments, net of income tax (benefit) expense of ($140), $1,745, ($149), ($966), respectively	9,772	(69,826)	28,361	(87,212)
Comprehensive income (loss)	$ 19,894	$ 12,446	$ (43,105)	$ 50,876

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE (LOSS) INCOME (Unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Statement Of Income And Comprehensive Income [Abstract]
Income tax expense related to unrealized gain on derivative instruments recorded in other comprehensive loss	$ 3,082	$ 1,607	$ (36)	$ 5,027
Income tax (benefit) expense	$ (141)	$ 1,745	$ (150)	$ (966)

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Current assets:
Cash, cash equivalents, and restricted cash	$ 82,276	$ 112,004
Accounts receivable and unbilled services, net	1,699,537	1,645,162
Prepaid expenses and other current assets	169,947	186,770
Total current assets	1,951,760	1,943,936
Property and equipment, net	236,697	264,295
Operating lease right-of-use assets	95,951	172,794
Goodwill	4,911,596	4,897,518
Intangible assets, net	608,433	680,863
Deferred income tax assets	57,628	50,677
Other long-term assets	213,316	189,135
Total assets	8,075,381	8,199,218
Current liabilities:
Accounts payable	137,017	118,621
Accrued expenses	617,945	614,200
Deferred revenue	803,922	923,875
Current portion of operating lease obligations	39,502	43,984
Current portion of finance lease obligations	20,335	24,011
Current portion of long-term debt	8,437	0
Total current liabilities	1,627,158	1,724,691
Long-term debt	2,641,566	2,611,166
Operating lease long-term obligations	150,248	175,568
Finance lease long-term obligations	35,137	44,124
Deferred income tax liabilities	69,335	92,155
Other long-term liabilities	58,183	56,513
Total liabilities	4,581,627	4,704,217
Commitments and contingencies (Note 15)
Shareholders’ equity:
Preferred stock, $0.01 par value; 30,000 shares authorized, 0 shares issued and outstanding as of June 30, 2023 and December 31, 2022	0	0
Class A common stock, $0.01 par value; 600,000 shares authorized, 103,714 and 102,911 shares issued and outstanding as of June 30, 2023 and December 31, 2022, respectively	1,037	1,029
Additional paid-in capital	3,502,002	3,460,152
Accumulated other comprehensive loss, net of taxes	(105,623)	(133,874)
Retained earnings	96,338	167,694
Total shareholders’ equity	3,493,754	3,495,001
Total liabilities and shareholders’ equity	$ 8,075,381	$ 8,199,218

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares	Jun. 30, 2023	Dec. 31, 2022
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
Class A common stock
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)	103,714,000	102,911,000
Common stock shares outstanding (in shares)	103,714,000	102,911,000

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Cash flows from operating activities:
Net income (loss)	$ (71,356)	$ 123,920
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Depreciation and amortization	120,919	123,423
Share-based compensation	38,826	33,524
Provision for (recovery from) doubtful accounts	6,758	(426)
(Benefit from) provision for deferred income taxes	(30,628)	4,206
Foreign currency transaction adjustments	10,421	(9,069)
Other non-cash items	17,085	(5,636)
Changes in operating assets and liabilities, net of effect of acquisitions:
Accounts receivable, unbilled services, and deferred revenue	(174,116)	(77,602)
Accounts payable and accrued expenses	35,115	40,772
Operating lease assets and liabilities	48,688	(814)
Other assets and liabilities	(4,970)	(61,509)
Net cash provided by operating activities	(3,258)	170,789
Cash flows from investing activities:
Payments related to acquisitions of businesses, net of cash acquired	0	(1,574)
Purchases of property and equipment	(45,471)	(47,912)
Investments in unconsolidated affiliates	(1,056)	(1,577)
Net cash used in investing activities	(46,527)	(51,063)
Cash flows from financing activities:
Proceeds from revolving line of credit	113,000	130,000
Repayments of revolving line of credit	(75,000)	(95,000)
Payments of contingent consideration related to acquisitions	(8,600)	0
Payments of finance leases	(6,435)	(1,886)
Payments for repurchases of Class A common stock	0	(149,961)
Proceeds from exercises of stock options	12,152	12,390
Payments related to tax withholdings for share-based compensation	(8,969)	(30,062)
Net cash provided by (used in) financing activities	26,148	(134,519)
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	(6,091)	14,306
Net change in cash, cash equivalents, and restricted cash	(29,728)	(487)
Cash, cash equivalents, and restricted cash - beginning of period	112,004	106,475
Cash, cash equivalents, and restricted cash - end of period	$ 82,276	$ 105,988

CONDENSED CONSOLIDATED STATEM_5

CONDENSED CONSOLIDATED STATEMENTS OF SHAREHOLDERS' EQUITY (Unaudited) - USD ($) $ in Thousands	Total	Common Stock Class A common stock	Additional Paid-in Capital	Accumulated Other Comprehensive Loss	Retained earnings (accumulated Deficit)
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 (loss) on derivative instruments, net of taxes				14,168
Foreign currency translation adjustment, net of taxes	87,212			(87,212)
Net income (loss)	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]
Repurchases of common stock		0	0		0
Issuances of common stock		0	(1,131)
Share-based compensation			16,191
Unrealized gain (loss) on derivative instruments, net of taxes				4,528
Foreign currency translation adjustment, net of taxes	69,826			(69,826)
Net income (loss)	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
Balance at beginning of period at Dec. 31, 2022	3,495,001	1,029	3,460,152	(133,874)	167,694
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchases of common stock		0	0		0
Issuances of common stock		8	3,024
Share-based compensation			38,826
Unrealized gain (loss) on derivative instruments, net of taxes				(110)
Foreign currency translation adjustment, net of taxes	(28,361)			28,361
Net income (loss)	(71,356)				(71,356)
Balance at end of period at Jun. 30, 2023	3,493,754	1,037	3,502,002	(105,623)	96,338
Balance at beginning of period at Mar. 31, 2023	3,454,471	1,036	3,482,614	(124,724)	95,545
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchases of common stock		0	0		0
Issuances of common stock		1	(746)
Share-based compensation			20,134
Unrealized gain (loss) on derivative instruments, net of taxes				9,329
Foreign currency translation adjustment, net of taxes	(9,772)			9,772
Net income (loss)	793				793
Balance at end of period at Jun. 30, 2023	$ 3,493,754	$ 1,037	$ 3,502,002	$ (105,623)	$ 96,338

Insider Trading Arrangement

Insider Trading Arrangement	3 Months Ended
	Jun. 30, 2023
Insider Trading Arr [Lineitems]
Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Terminated	false

Basis of Presentation

Basis of Presentation	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation	1. Basis of Presentation The Company 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 biopharmaceutical, biotechnology, and medical device industries. On May 10, 2023, the Company entered into an Agreement and Plan of Merger (the “Merger Agreement”) with Star Parent, Inc., an affiliated entity of Elliott Investment Management, Patient Square Capital, Veritas Capital (“Parent”), and Star Merger Sub, Inc., a wholly owned subsidiary of Parent (“Merger Sub”). The Merger Agreement provides that, at closing (the “Effective Time”), Merger Sub will merge with and into the Company (the “Merger”), with the Company continuing as the surviving corporation and a wholly owned subsidiary of Parent. At closing, each share of Class A common stock of the Company issued and outstanding immediately prior to the Effective Time will be cancelled and extinguished and, except for limited exceptions, automatically converted into the right to receive $ 43.00 in cash (the “Merger Consideration”). At a special meeting held on August 2, 2023, the Company’s stockholders approved the Merger Agreement. Certain regulatory approvals relating to the Merger remain pending. If the Merger is consummated, the Company’s shares of Class A common stock will no longer trade on the Nasdaq Stock Market LLC ("Nasdaq") and will be deregistered under the Securities Exchange Act of 1934, as amended. As a result, the Company will become a private company. As of June 30, 2023 , the Company has incurred approximately $ 23.0 million of costs in connection with the Merger and expects to continue to incur significant costs and expenses, including fees for professional services and other transaction costs. 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, 2022 (the “2022 Form 10-K”), filed with the Securities and Exchange Commission on February 16, 2023. The results of operations for the three and six months ended June 30, 2023 are not necessarily indicative of the results to be expected for the full year ending December 31, 2023 or any other future period. The unaudited condensed consolidated balance sheet as of December 31, 2022 is derived from the amounts in the audited consolidated balance sheet included in the 2022 Form 10-K.

Financial Statement Details

Financial Statement Details	6 Months Ended
	Jun. 30, 2023
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 accompanying condensed consolidated balance sheets. The Company’s net cash pool position consisted of the following (in thousands): June 30, 2023 December 31, 2022 Gross cash position $ 434,921 $ 283,337 Less: cash borrowings ( 433,825 ) ( 283,029 ) Net cash position $ 1,096 $ 308 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, 2023 December 31, 2022 Accounts receivable billed $ 891,249 $ 898,839 Accounts receivable unbilled 257,827 227,210 Contract assets 565,432 531,234 Less: Allowance for doubtful accounts ( 14,971 ) ( 12,121 ) Accounts receivable and unbilled services, net $ 1,699,537 $ 1,645,162 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, 2023 and 2022, the Company factored $ 51.0 million and $ 66.8 million, respectively, of trade accounts receivable on a non-recourse basis and received $ 50.7 million and $ 66.5 million, respectively, in cash proceeds from the sales. The fees associated with thes e transactions were insignificant. Goodwill The changes in the carrying amount of goodwill by segment for the six months ended June 30, 2023 were as follows (in thousands): Clinical Commercial Total Balance as of December 31, 2022 $ 3,405,877 $ 1,491,641 $ 4,897,518 Impact of foreign currency translation 16,031 ( 1,953 ) 14,078 Balance as of June 30, 2023 $ 3,421,908 $ 1,489,688 $ 4,911,596 (a) No impairment of goodwill was recorded for the six months ended June 30, 2023 . 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 2023 2022 2023 2022 Accumulated other comprehensive loss, net of taxes beginning balance $ ( 124,724 ) $ ( 57,364 ) $ ( 133,874 ) $ ( 49,618 ) Derivative instruments: Beginning balance ( 3,829 ) 7,019 5,610 ( 2,621 ) Other comprehensive income before reclassifications 10,771 4,827 8,992 13,439 Reclassification adjustments ( 1,442 ) ( 299 ) ( 9,102 ) 729 Ending balance 5,500 11,547 5,500 11,547 Foreign currency translation: Beginning balance ( 120,895 ) ( 64,383 ) ( 139,484 ) ( 46,997 ) Other comprehensive income (loss) before reclassifications 9,772 ( 69,826 ) 28,361 ( 87,212 ) Ending balance ( 111,123 ) ( 134,209 ) ( 111,123 ) ( 134,209 ) Accumulated other comprehensive loss, net of taxes ending balance $ ( 105,623 ) $ ( 122,662 ) $ ( 105,623 ) $ ( 122,662 ) Changes in accumulated other comprehensive income (loss) consisted of the following (in thousands): Three Months Ended Six Months Ended 2023 2022 2023 2022 Unrealized gain (loss) on derivative instruments: Unrealized gain during period, before taxes $ 14,330 $ 6,540 $ 11,964 $ 18,207 Income tax expense 3,559 1,713 2,972 4,768 Unrealized gain during period, net of taxes 10,771 4,827 8,992 13,439 Reclassification adjustment, before taxes ( 1,919 ) ( 405 ) ( 12,110 ) 988 Income tax (benefit) expense ( 477 ) ( 106 ) ( 3,008 ) 259 Reclassification adjustment, net of taxes ( 1,442 ) ( 299 ) ( 9,102 ) 729 Total unrealized gain (loss) on derivative instruments, net of taxes 9,329 4,528 ( 110 ) 14,168 Foreign currency translation adjustment: Foreign currency translation adjustment, before taxes 9,631 ( 68,081 ) 28,211 ( 88,178 ) Income tax (benefit) expense ( 141 ) 1,745 ( 150 ) ( 966 ) Foreign currency translation adjustment, net of taxes 9,772 ( 69,826 ) 28,361 ( 87,212 ) Total other comprehensive income (loss), net of taxes $ 19,101 $ ( 65,298 ) $ 28,251 $ ( 73,044 ) Other Expense (Income), Net Other expense (income), net consisted of the following (in thousands): Three Months Ended Six Months Ended 2023 2022 2023 2022 Net realized foreign currency (gain) loss $ ( 973 ) $ 4,799 $ 1,679 $ 7,254 Net unrealized foreign currency loss (gain) 5,523 ( 9,503 ) 10,421 ( 9,069 ) Equity investment loss — — 550 — Other, net 841 ( 448 ) 2,104 1,305 Total other expense (income), net $ 5,391 $ ( 5,152 ) $ 14,754 $ ( 510 )

Long-Term Debt Obligations

Long-Term Debt Obligations	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Long-Term Debt Obligations	3. Long-Term Debt Obligations The Company’s debt obligations consisted of the following (in thousands): June 30, 2023 December 31, 2022 Secured Debt Term A Facility due November 2027 $ 1,350,000 $ 1,350,000 Revolver due November 2027 158,993 120,993 Accounts receivable financing agreement due October 2025 550,000 550,000 Total secured debt 2,058,993 2,020,993 Unsecured Debt Senior notes due January 2029 (the “Notes”) 600,000 600,000 Total debt obligations 2,658,993 2,620,993 Less: Term loan original issuance discount ( 2,988 ) ( 3,322 ) Less: Unamortized deferred issuance costs ( 6,002 ) ( 6,505 ) Less: Current portion of long-term debt ( 8,437 ) — Total long-term debt $ 2,641,566 $ 2,611,166 Credit Agreement The Company is party to an Amended & Restated Credit Agreement (“A&R Credit Agreement”) that matures in November 2027 and includes a $ 1.35 billion term loan A facility (“Term A Facility”) and a $ 1.00 billion revolving credit facility (the “Revolver”). As of June 30, 2023 , the interest rate on the Term A Facility was 6.45 %. Revolver and Letters of Credit The Revolver includes letters of credit (“LOCs”) with a sublimit of $ 150.0 million . As of June 30, 2023, there were $ 159.0 million of outstanding borrowings under the Revolver and $ 14.2 million of LOCs outstanding, leaving $ 826.8 million of available borrowings under the Revolver, including $ 135.8 million available for LOCs. As of June 30, 2023 , the interest rate on the Revolver was 6.40 %. 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 (the “Receivables Financing Agreement”) with a termination date of October 2025, unless terminated earlier pursuant to its terms. As of June 30, 2023, the Company had $ 550.0 million of outstanding borrowings under this agreement, which were 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, 2023. As of June 30, 2023 , the interest rate on the accounts receivable financing agreement was 6.09 %. Maturities of Debt Obligations As of June 30, 2023, the contractual maturities of the Company’s debt obligations (excluding finance leases) were as follows (in thousands): Principal Remainder of 2023 $ — 2024 33,750 2025 617,500 2026 67,500 2027 1,340,243 2028 and thereafter 600,000 Less: Term loan original issuance discount ( 2,988 ) Less: Unamortized deferred issuance costs ( 6,002 ) Less: Current portion of long-term debt ( 8,437 ) Total $ 2,641,566

Derivatives

Derivatives	6 Months Ended
	Jun. 30, 2023
Derivative Instruments And Hedging Activities Disclosure [Abstract]
Derivatives	. Derivatives Interest Rate Swaps The Company has entered into various interest rate swaps to mitigate its exposure to changes in interest rates on its variable rate debt. 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 expired on March 31, 2023. In March 2023, the Company entered into interest rate swaps with multiple counterparties. The interest rate swaps had an initial aggregate notional value of $ 650.0 million , an effective date of March 31, 2023, and will expire on March 31, 2026. As of June 30, 2023 , the notional value of these interest rate swaps was $ 650.0 million. Upon termination of the interest rate swaps in conjunction with the consummation of the Merger, the Company expects that it will remit or receive the difference between the fair value of the interest rate swaps and the replacement value in cash. 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, 2023 December 31, 2022 Interest rate swaps – current Prepaid expenses and other current assets $ 9,005 $ 10,073 Fair value of derivative assets $ 9,005 $ 10,073 Interest rate swaps – non-current Other long-term assets $ 921 $ — Fair value of derivative assets $ 921 $ —

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Fair Value Measurements	5. Fair Value Measurements Assets and Liabilities Carried at Fair Value As of June 30, 2023 and December 31, 2022, 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, 2023, 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) $ 22,856 $ — $ — $ — $ 22,856 Partnership interests (b) — — — 15,873 15,873 Derivative instruments (c) — 9,005 — — 9,005 Total assets $ 22,856 $ 9,005 $ — $ 15,873 $ 47,734 Liabilities: Derivative instruments (c) $ — $ 921 $ — $ — $ 921 Contingent obligations related to acquisitions (d) — — 7,500 — 7,500 Total liabilities $ — $ 921 $ 7,500 $ — $ 8,421 As of December 31, 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) $ 20,465 $ — $ — $ — $ 20,465 Partnership interests (b) — — — 15,367 15,367 Derivative instruments (c) — 10,073 — — 10,073 Total assets $ 20,465 $ 10,073 $ — $ 15,367 $ 45,905 Liabilities: Contingent obligations related to acquisitions (d) — — 16,100 — 16,100 Total liabilities $ — $ — $ 16,100 $ — $ 16,100 (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, 2023 , the Company’s remaining unfunded commitment in the private equity funds was $ 5.9 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 4 – 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, 2023 (in thousands): Balance as of December 31, 2022 $ 16,100 Additions — Changes in fair value recognized in earnings — Payments (a) ( 8,600 ) Balance as of June 30, 2023 $ 7,500 (a) During the three months ended June 30, 2023, the Company made payments in connection with the acquisition of RxDataScience, Inc. (“RxDataScience”) completed during 2021. During the six months ended June 30, 2023 , 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, 2023 and December 31, 2022, assets carried on the accompanying condensed consolidated balance sheets and not remeasured to fair value on a recurring basis totaled $ 5.53 billion and $ 5.59 billion , respectively. Fair Value Disclosures for Financial Instruments Not Carried at Fair Value The estimated fair values of the Term A Facility 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 A Facility and the Notes were as follows (in thousands): June 30, 2023 December 31, 2022 Carrying Estimated Carrying Estimated Term A Facility due November 2027 $ 1,347,012 $ 1,353,375 $ 1,346,678 $ 1,329,750 Senior notes due January 2029 600,000 591,000 600,000 484,500 (a) The carrying value of the Term A Facility is shown net of original issue discounts.

Restructuring and Other Costs

Restructuring and Other Costs	6 Months Ended
	Jun. 30, 2023
Restructuring And Related Activities [Abstract]
Restructuring and Other Costs	6. Restructuring and Other Costs During the three and six months ended June 30, 2023 and 2022, the Company incurred employee severance and benefit costs, leased facility closure and related costs, and other costs related to its restructuring activities. The costs incurred during the current year were primarily related to the Company’s real estate optimization initiative to close or reduce office space that is no longer being utilized. For the six months ended June 30, 2023, t his includes $ 56.7 million of accelerated amortization of operating lease right-of-use assets and $ 18.3 million of accelerated depreciation of property and equipment, both of which are non-cash expenses. The costs incurred during the prior year were primarily related to the Company’s margin enhancement initiatives and specific actions focused on streamlining the operations of its Clinical Solutions segment to optimize efficiency and enhance the delivery of customer projects. The Company expects to continue to incur costs related to its business transformation initiatives during the remainder of 2023 and beyond as the Company continues the ongoing evaluations of its global workforce and facilities infrastructure needs to improve customer engagement, increase innovation, and achieve operating efficiencies. However, in connection with the pendency of the Merger, the Company has suspended certain aspects of its business transformation initiatives. Restructuring and other costs consisted of the following (in thousands): Three Months Ended Six Months Ended 2023 2022 2023 2022 Employee severance and benefit costs $ 5,569 $ 2,368 $ 15,749 $ 17,188 Leased facility closure and related costs 4,803 3,671 79,116 3,352 Other costs 269 2,944 463 4,000 Total restructuring and other costs $ 10,641 $ 8,983 $ 95,328 $ 24,540 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, 2023 (in thousands): Balance as of December 31, 2022 $ 12,804 Expenses incurred (a) 15,749 Payments ( 19,881 ) Balance as of June 30, 2023 $ 8,672 (a) The amount of expenses incurred for the six months ended June 30, 2023 excludes $ 0.5 million of other costs that were paid through accounts payable and $ 79.1 million of leased facility closure and related costs that are primarily reflected as reductions of operating lease right-of-use assets and property and equipment, net on the accompanying condensed consolidated balance sheet. The Company expects the employee severance and benefit costs accrued as of June 30, 2023 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, 2023
Equity [Abstract]
Shareholders' Equity	. Shareholders’ Equity Shares Outstanding Shares of Class A common stock outstanding were as follows (in thousands): Three Months Ended Six Months Ended 2023 2022 2023 2022 Class A common stock shares, beginning balance 103,641 102,558 102,911 103,764 Repurchases of Class A common stock — — — ( 1,929 ) Issuances of Class A common stock 73 89 803 812 Class A common stock shares, ending balance 103,714 102,647 103,714 102,647 Stock Repurchase Programs On May 25, 2022, the Company’s Board of Directors (the “Board”) authorized the repurchase of up to an aggregate of $ 350.0 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, 2024 (the “2022 Stock Repurchase Program”). The 2022 Stock Repurchase Program replaced a prior repurchase program approved on November 17, 2020, that took effect on January 1, 2021. The 2022 Stock Repurchase Program does not obligate the Company to repurchase any particular amount of the Company’s Class A 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 Class A 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 Class A 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 Class A common stock to be repurchased when the Company might otherwise be precluded from doing so by law. During the three months ended June 30, 2023 , there were no repurchases under the 2022 Stock Repurchase Program. As of June 30, 2023 , the Company had remaining authorization to repurchase up to $ 350.0 million of shares of its Class A common stock under the 2022 Stock Repurchase Program.

Earnings (Loss) Per Share

Earnings (Loss) Per Share	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Earnings (Loss) Per Share	. Earnings (Loss) 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 2023 2022 2023 2022 Numerator: Net income (loss) $ 793 $ 77,744 $ ( 71,356 ) $ 123,920 Denominator: Basic weighted average common shares outstanding 103,679 102,596 103,502 103,130 Effect of dilutive securities: Stock options and other awards under deferred share-based compensation programs 665 476 — 611 Diluted weighted average common shares outstanding 104,344 103,072 103,502 103,741 Earnings (loss) per share Basic $ 0.01 $ 0.76 $ ( 0.69 ) $ 1.20 Diluted $ 0.01 $ 0.75 $ ( 0.69 ) $ 1.19 Potential common shares outstanding that are considered anti-dilutive are excluded from the computation of diluted earnings (loss) 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 (loss) per share, weighted for the portion of the period they were outstanding, were as follows (in thousands): Three Months Ended Six Months Ended 2023 2022 2023 2022 Anti-dilutive stock options and other awards 1,102 774 1,207 470 Anti-dilutive stock options and other awards under share-based compensation programs excluded based on reporting a net loss for the period — — 552 — Total Class A common stock equivalents excluded from diluted loss per share 1,102 774 1,759 470

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2023
Income Tax Disclosure [Abstract]
Income Taxes	9. Income Taxes Income Tax (Benefit) Expense For the three and six months ended June 30, 2023, the Company recorded income tax benefits of $ 0.1 million and $ 3.1 million , respectively, on pre-tax income of $ 0.7 million and a pre-tax loss of $ 74.5 million , respectively. The income tax benefits for the three and six months ended June 30, 2023 included discrete tax expense of $ 0.9 million and $ 6.5 million, respectively, primarily related to tax shortfalls from share-based compensation. The effective tax rates for the three and six months ended June 30, 2023 , excluding discrete items, varied from the United States (“U.S.”) federal statutory income tax rate of 21.0 % primarily due to foreign tax credits, 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, 2022, the Company recorded income tax expense of $ 25.9 million and $ 33.3 million , respectively, on 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 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 GILTI provisions, and research and development credits. Unrecognized Tax Benefits The Company’s gross unrecognized tax benefits, exclusive of associated interest and penalties, were $ 19.8 million and $ 16.8 million as of June 30, 2023 and December 31, 2022 , respectively. The increase of $ 3.0 million was primarily due to new positions related to prior years. The Company believes it is reasonably possible that its unrecognized tax benefits may decrease by approximately $ 3.4 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 2020 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, 2023
Revenue From Contract With Customer [Abstract]
Revenue from Contract with Customers	10. Revenue from Contracts with Customers Unsatisfied Performance Obligations As of June 30, 2023, 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 $ 5.50 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, 2023, the Company recognized approximately $ 357.2 million and $ 549.4 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, 2023, there were reductions of approximately $ 27.0 million and $ 36.6 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, 2023
Segment Reporting [Abstract]
Segment Information	11. 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 leading fully integrated biopharmaceutical solutions organization built to accelerate customer success. The Company translates unique clinical, medical affairs and commercial insights into outcomes to address modern market realities. Clinical Solutions offers comprehensive global services for the development of diagnostics, drugs, biologics, devices, and digital therapeutics that span Phase 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 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, communications 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, integration-related, and other expenses. The Company does not allocate depreciation, amortization, asset impairment charges, or restructuring and other costs to its segments. 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 2023 2022 2023 2022 Revenue: Clinical Solutions $ 1,021,792 $ 1,025,715 $ 2,035,457 $ 2,044,085 Commercial Solutions 344,288 335,024 687,423 652,907 Total revenue 1,366,080 1,360,739 2,722,880 2,696,992 Segment direct costs: Clinical Solutions 777,442 753,451 1,564,830 1,528,119 Commercial Solutions 282,307 273,578 572,946 534,543 Total segment direct costs 1,059,749 1,027,029 2,137,776 2,062,662 Segment selling, general, and administrative expenses: Clinical Solutions 89,930 88,863 177,491 178,765 Commercial Solutions 22,804 21,094 44,928 42,829 Total segment selling, general, and administrative expenses 112,734 109,957 222,419 221,594 Segment operating income: Clinical Solutions 154,420 183,401 293,136 337,201 Commercial Solutions 39,177 40,352 69,549 75,535 Total segment operating income 193,597 223,753 362,685 412,736 Direct costs and operating expenses not allocated to segments: Share-based compensation included in direct costs 11,614 7,868 22,136 16,667 Share-based compensation included in selling, general, and administrative expenses 8,520 8,323 16,690 16,857 Corporate selling, general, and administrative expenses 61,269 20,760 104,931 40,755 Restructuring and other costs 10,641 8,983 95,328 24,540 Depreciation and amortization 59,332 61,221 120,919 123,423 Total income from operations $ 42,221 $ 116,598 $ 2,681 $ 190,494

Operations by Geographic Locati

Operations by Geographic Location	6 Months Ended
	Jun. 30, 2023
Segments Geographical Areas [Abstract]
Operations by Geographic Location	12. 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 June 30, 2023 2022 2023 2022 Revenue: North America (a) $ 818,329 $ 806,640 $ 1,653,114 $ 1,588,294 Europe, Middle East, and Africa 326,826 340,384 647,825 695,977 Asia-Pacific 183,223 172,965 348,210 333,768 Latin America 37,702 40,750 73,731 78,953 Total revenue $ 1,366,080 $ 1,360,739 $ 2,722,880 $ 2,696,992 (a) Revenue for the North America region includes revenue attributable to the U.S. of $ 767.4 million and $ 754.7 million , or 56.2 % and 55.5 % of total revenue, for the three months ended June 30, 2023 and 2022, respectively. Revenue for the North America region includes revenue attributable to the U.S. of $ 1,553.2 million and $ 1,491.2 million , or 57.0 % and 55.3 % of total revenue, for the six months ended June 30, 2023 and 2022, 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, 2023 December 31, 2022 Property and equipment, net: North America (a) $ 188,091 $ 202,645 Europe, Middle East, and Africa 28,835 33,827 Asia-Pacific 15,678 21,360 Latin America 4,093 6,463 Total property and equipment, net $ 236,697 $ 264,295 (a) Long-lived assets for the North America region include property and equipment, net attributable to the U.S. of $ 180.9 million and $ 196.4 million as of June 30, 2023 and December 31, 2022 , respectively.

Concentration of Credit Risk

Concentration of Credit Risk	6 Months Ended
	Jun. 30, 2023
Risks And Uncertainties [Abstract]
Concentration of Credit Risk	13. 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's deposits at certain of these institutions exceed insured limits. 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. In the event of failure of any of the financial institutions where the Company maintains its cash and cash equivalents, there can be no assurance that the Company will be able to access uninsured funds in a timely manner or at all. The Company has not historically incurred any losses with respect to these balances and believes that it bears minimal credit risk. As of June 30, 2023 and December 31, 2022, 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, 2023 and 2022. As of June 30, 2023 and December 31, 2022 , 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, 2023
Related Party Transactions [Abstract]
Related-Party Transactions	14. Related-Party Transactions For the three and six months ended June 30, 2023 , the Company had combined revenue of $ 2.3 million and $ 4.7 million, respectively, from five customers whose board of directors each included a member who was also a member of the Company’s Board. As of June 30, 2023 , the Company had combined receivables of $ 1.5 million from three 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, through an arm’s-length transaction. A member of the Company’s management was a minority shareholder of the acquired company. 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.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2023
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	15. Commitments and Contingencies Legal Proceedings From time to time, the Company is a party to various litigation matters that are considered routine litigation arising in the ordinary course of business. In the opinion of management, the outcome of any existing claims and legal or regulatory proceedings, other than certain proceedings relating to the Merger and the putative class action lawsuit filed on July 27, 2023, as described below, 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. Securities Class Actions On July 27, 2023, a putative stockholder of the Company (the “Plaintiff”) filed a putative class action lawsuit, captioned United Association of Plumbers and Pipefitters, Journeymen, Local #38 Defined Benefit Pension Plan vs. Syneos Health, Inc. et al. in the U.S. District Court for the Southern District of New York against the Company and certain of its current and former executive officers (the “UAPP Defendants”). In its complaint, the Plaintiff alleges that the UAPP Defendants violated Section 10(b) and Section 20(a) of the Securities Exchange Act of 1934, as amended, by allegedly disseminating or approving statements, which they knew or deliberately disregarded were false and misleading. The lawsuit brings claims on behalf of a putative class of purchasers of the Company’s Class A common stock between September 9, 2020 and November 3, 2022, and seeks compensatory damages, attorneys’ fees and costs, and any equitable or injunctive relief the court deems just and proper. On December 1, 2017, the first of two virtually identical actions alleging federal securities law claims was filed against the Company and certain of its officers on behalf of a putative class of its shareholders. The first action, captioned Bermudez v. INC Research, Inc., et al, No. 17-09457 (S.D.N.Y.), was filed in the Southern District of New York (the “Bermudez action”), and the second action, Vaitkuvienë v. Syneos Health, Inc., et al, No. 18-0029 (E.D.N.C.), was filed on January 25, 2018 in the Eastern District of North Carolina (the “Vaitkuvienë action”). On March 30, 2018, the Bermudez action was dismissed voluntarily. After the San Antonio Fire & Police Pension Fund and El Paso Firemen & Policemen’s Pension Fund were appointed as Lead Plaintiffs in the Vaitkuvienë action, Lead Plaintiffs filed an amended complaint on July 30, 2018, which named as defendants the Company, Alistair Macdonald, Gregory S. Rush, Michael A. Bell, and each member of the Company’s Board at the time of the stockholder vote on the 2017 merger (the “Merger”) of INC Research with an affiliate of inVentiv Health, Inc. (“inVentiv”) (collectively, the “Vaitkuvienë Defendants”). The amended complaint alleged claims under Sections 10(b), 14(a) and 20(a) of the Securities Exchange Act of 1934 on behalf of a putative class of purchasers of the Company’s common stock between May 10, 2017 and November 8, 2017, contending that the Company published inaccurate or incomplete information regarding, among other things, the financial performance and business outlook for inVentiv’s business prior to and following the Merger. Lead Plaintiffs sought, among other things, orders (i) declaring that the lawsuit is a proper class action and (ii) awarding compensatory damages in an amount to be proven at trial, including interest thereon, and reasonable costs and expenses incurred in this action, including attorneys’ fees and expert fees, to Lead Plaintiffs and other class members. On September 20, 2018, the Vaitkuvienë Defendants moved to dismiss the action. On August 30, 2021, the District Court entered an order granting the motion to dismiss in its entirety, and on October 21, 2021, the Court entered judgment for the Vaitkuvienë Defendants. On November 19, 2021, Lead Plaintiffs appealed from this judgment to the U.S. Court of Appeals for the Fourth Circuit, and, on July 24, 2023, the U.S. Court of Appeals for the Fourth Circuit affirmed the District Court judgment in favor of defendants. Merger-Related Proceedings Five lawsuits (collectively, the “Merger Lawsuits”) have been filed by alleged stockholders of the Company against the Company, its directors, and its advisors related to the Merger: O’Dell v. Syneos Health, Inc. et al, Case No. 23-cv-5312, was filed in the United States District Court for the Southern District of New York on June 22, 2023; Wang v. Syneos Health, Inc. et al, Case No. 23-cv-05410, was filed in the United States District Court for the Southern District of New York on June 26, 2023; Delman v. Syneos Health, Inc. et al, Case No. 616711/2023, was filed in the Supreme Court of the State of New York, County of Suffolk, on July 7, 2023; Kent v. Syneos Health, Inc. et al, Case No. 1:23-cv-00749, was filed in the United States District Court of Delaware on July 10, 2023; and Williams v. Syneos Health, Inc. et al, Case No. 23-cv-05867, was filed in the United States District Court for the Southern District of New York on July 10, 2023. Each of the complaints name as defendants the Company and certain members of the Board, and the Delman complaint also names as defendants Centerview, BofA Securities, Broadridge, and the Company's proxy solicitors. Each of the complaints (other than the Delman complaint) allege violations of Sections 14(e) and 20(a) of the Securities Exchange Act of 1934 and Rule 14a-9 promulgated thereunder. The O’Dell and Wang complaints generally allege that the Schedule 14(a) Preliminary Proxy Statement, filed with the SEC on June 15, 2023, and the Kent and Williams complaints generally allege that the definitive proxy statement filed with the SEC on June 27, 2023 (the “Proxy Statement”), omit material information with respect to the proposed transaction and the valuation analyses performed by the Company’s financial advisors regarding the proposed transaction, which renders the Proxy Statement false and misleading. The Delman complaint alleged violations of the North Carolina Securities Act and negligent misrepresentation and concealment under North Carolina and New York common law by the Company, the members of the Board, Centerview, BofA Securities, Broadridge, and the Company’s proxy solicitors. The complaints seek, among other relief, to enjoin the Company from consummating the Merger and to be awarded rescissory damages, as well as attorneys’ fees, costs, and disbursements. On August 1 and August 2, 2023, respectively, the O'Dell and Delman actions were voluntarily dismissed following the publication of additional disclosures by the Company. The Company believes that the putative class action lawsuit filed on July 27, 2023 and the Merger Lawsuits are without merit and intends to defend vigorously against the allegations made by the respective plaintiffs; however, the Company cannot predict the amount of time and expense that will be required to resolve the complaints. In addition, the outcome of such litigation or any other litigation is necessarily uncertain. The Company is presently unable to predict the duration, scope, or result of the putative class action lawsuit filed on July 27, 2023 or the Merger Lawsuits, or any other related lawsuit. As such, the Company is presently unable to develop a reasonable estimate of a possible loss or range of losses, if any, related to these matters. The Company could be forced to expend significant resources in the defense of these lawsuits or future ones, and it may not prevail. As such, these matters could have a material adverse effect on the Company’s business, annual, or interim results of operations, cash flows, or its financial condition. The Company is not aware of the filing of other lawsuits challenging the Merger or the related Proxy Statement; however, additional lawsuits arising out of the Merger or the Proxy Statement may be filed in the future, which could prevent or delay completion of the Merger and result in substantial costs to the Company, including any costs associated with indemnification.

Basis of Presentation (Policies

Basis of Presentation (Policies)	6 Months Ended
	Jun. 30, 2023
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, 2022 (the “2022 Form 10-K”), filed with the Securities and Exchange Commission on February 16, 2023. The results of operations for the three and six months ended June 30, 2023 are not necessarily indicative of the results to be expected for the full year ending December 31, 2023 or any other future period. The unaudited condensed consolidated balance sheet as of December 31, 2022 is derived from the amounts in the audited consolidated balance sheet included in the 2022 Form 10-K.
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, 2023
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, 2023 December 31, 2022 Gross cash position $ 434,921 $ 283,337 Less: cash borrowings ( 433,825 ) ( 283,029 ) Net cash position $ 1,096 $ 308
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, 2023 December 31, 2022 Accounts receivable billed $ 891,249 $ 898,839 Accounts receivable unbilled 257,827 227,210 Contract assets 565,432 531,234 Less: Allowance for doubtful accounts ( 14,971 ) ( 12,121 ) Accounts receivable and unbilled services, net $ 1,699,537 $ 1,645,162
Schedule of Goodwill	The changes in the carrying amount of goodwill by segment for the six months ended June 30, 2023 were as follows (in thousands): Clinical Commercial Total Balance as of December 31, 2022 $ 3,405,877 $ 1,491,641 $ 4,897,518 Impact of foreign currency translation 16,031 ( 1,953 ) 14,078 Balance as of June 30, 2023 $ 3,421,908 $ 1,489,688 $ 4,911,596 (a) No impairment of goodwill was recorded for the six months ended June 30, 2023 .
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 2023 2022 2023 2022 Accumulated other comprehensive loss, net of taxes beginning balance $ ( 124,724 ) $ ( 57,364 ) $ ( 133,874 ) $ ( 49,618 ) Derivative instruments: Beginning balance ( 3,829 ) 7,019 5,610 ( 2,621 ) Other comprehensive income before reclassifications 10,771 4,827 8,992 13,439 Reclassification adjustments ( 1,442 ) ( 299 ) ( 9,102 ) 729 Ending balance 5,500 11,547 5,500 11,547 Foreign currency translation: Beginning balance ( 120,895 ) ( 64,383 ) ( 139,484 ) ( 46,997 ) Other comprehensive income (loss) before reclassifications 9,772 ( 69,826 ) 28,361 ( 87,212 ) Ending balance ( 111,123 ) ( 134,209 ) ( 111,123 ) ( 134,209 ) Accumulated other comprehensive loss, net of taxes ending balance $ ( 105,623 ) $ ( 122,662 ) $ ( 105,623 ) $ ( 122,662 )
Reclassification out of Accumulated Other Comprehensive (Loss) Income	Changes in accumulated other comprehensive income (loss) consisted of the following (in thousands): Three Months Ended Six Months Ended 2023 2022 2023 2022 Unrealized gain (loss) on derivative instruments: Unrealized gain during period, before taxes $ 14,330 $ 6,540 $ 11,964 $ 18,207 Income tax expense 3,559 1,713 2,972 4,768 Unrealized gain during period, net of taxes 10,771 4,827 8,992 13,439 Reclassification adjustment, before taxes ( 1,919 ) ( 405 ) ( 12,110 ) 988 Income tax (benefit) expense ( 477 ) ( 106 ) ( 3,008 ) 259 Reclassification adjustment, net of taxes ( 1,442 ) ( 299 ) ( 9,102 ) 729 Total unrealized gain (loss) on derivative instruments, net of taxes 9,329 4,528 ( 110 ) 14,168 Foreign currency translation adjustment: Foreign currency translation adjustment, before taxes 9,631 ( 68,081 ) 28,211 ( 88,178 ) Income tax (benefit) expense ( 141 ) 1,745 ( 150 ) ( 966 ) Foreign currency translation adjustment, net of taxes 9,772 ( 69,826 ) 28,361 ( 87,212 ) Total other comprehensive income (loss), net of taxes $ 19,101 $ ( 65,298 ) $ 28,251 $ ( 73,044 )
Schedule of Other Expense (Income),Net	Other Expense (Income), Net Other expense (income), net consisted of the following (in thousands): Three Months Ended Six Months Ended 2023 2022 2023 2022 Net realized foreign currency (gain) loss $ ( 973 ) $ 4,799 $ 1,679 $ 7,254 Net unrealized foreign currency loss (gain) 5,523 ( 9,503 ) 10,421 ( 9,069 ) Equity investment loss — — 550 — Other, net 841 ( 448 ) 2,104 1,305 Total other expense (income), net $ 5,391 $ ( 5,152 ) $ 14,754 $ ( 510 )

Long-Term Debt Obligations (Tab

Long-Term Debt Obligations (Tables)	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Schedule of Debt Obligations	The Company’s debt obligations consisted of the following (in thousands): June 30, 2023 December 31, 2022 Secured Debt Term A Facility due November 2027 $ 1,350,000 $ 1,350,000 Revolver due November 2027 158,993 120,993 Accounts receivable financing agreement due October 2025 550,000 550,000 Total secured debt 2,058,993 2,020,993 Unsecured Debt Senior notes due January 2029 (the “Notes”) 600,000 600,000 Total debt obligations 2,658,993 2,620,993 Less: Term loan original issuance discount ( 2,988 ) ( 3,322 ) Less: Unamortized deferred issuance costs ( 6,002 ) ( 6,505 ) Less: Current portion of long-term debt ( 8,437 ) — Total long-term debt $ 2,641,566 $ 2,611,166
Contractual Maturities of Debt Obligations	As of June 30, 2023, the contractual maturities of the Company’s debt obligations (excluding finance leases) were as follows (in thousands): Principal Remainder of 2023 $ — 2024 33,750 2025 617,500 2026 67,500 2027 1,340,243 2028 and thereafter 600,000 Less: Term loan original issuance discount ( 2,988 ) Less: Unamortized deferred issuance costs ( 6,002 ) Less: Current portion of long-term debt ( 8,437 ) Total $ 2,641,566

Derivatives (Tables)

Derivatives (Tables)	6 Months Ended
	Jun. 30, 2023
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, 2023 December 31, 2022 Interest rate swaps – current Prepaid expenses and other current assets $ 9,005 $ 10,073 Fair value of derivative assets $ 9,005 $ 10,073 Interest rate swaps – non-current Other long-term assets $ 921 $ — Fair value of derivative assets $ 921 $ —

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Schedule of Assets and Liabilities Measured at Fair Value on a Recurring Basis	As of June 30, 2023, 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) $ 22,856 $ — $ — $ — $ 22,856 Partnership interests (b) — — — 15,873 15,873 Derivative instruments (c) — 9,005 — — 9,005 Total assets $ 22,856 $ 9,005 $ — $ 15,873 $ 47,734 Liabilities: Derivative instruments (c) $ — $ 921 $ — $ — $ 921 Contingent obligations related to acquisitions (d) — — 7,500 — 7,500 Total liabilities $ — $ 921 $ 7,500 $ — $ 8,421 As of December 31, 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) $ 20,465 $ — $ — $ — $ 20,465 Partnership interests (b) — — — 15,367 15,367 Derivative instruments (c) — 10,073 — — 10,073 Total assets $ 20,465 $ 10,073 $ — $ 15,367 $ 45,905 Liabilities: Contingent obligations related to acquisitions (d) — — 16,100 — 16,100 Total liabilities $ — $ — $ 16,100 $ — $ 16,100 (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, 2023 , the Company’s remaining unfunded commitment in the private equity funds was $ 5.9 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 4 – 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, 2023 (in thousands): Balance as of December 31, 2022 $ 16,100 Additions — Changes in fair value recognized in earnings — Payments (a) ( 8,600 ) Balance as of June 30, 2023 $ 7,500 (a) During the three months ended June 30, 2023, the Company made payments in connection with the acquisition of RxDataScience, Inc. (“RxDataScience”) completed during 2021.
Schedule of Estimated Fair Value	The estimated fair values of the Company’s Term A Facility and the Notes were as follows (in thousands): June 30, 2023 December 31, 2022 Carrying Estimated Carrying Estimated Term A Facility due November 2027 $ 1,347,012 $ 1,353,375 $ 1,346,678 $ 1,329,750 Senior notes due January 2029 600,000 591,000 600,000 484,500 (a) The carrying value of the Term A Facility is shown net of original issue discounts.

Restructuring and Other Costs (

Restructuring and Other Costs (Tables)	6 Months Ended
	Jun. 30, 2023
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 2023 2022 2023 2022 Employee severance and benefit costs $ 5,569 $ 2,368 $ 15,749 $ 17,188 Leased facility closure and related costs 4,803 3,671 79,116 3,352 Other costs 269 2,944 463 4,000 Total restructuring and other costs $ 10,641 $ 8,983 $ 95,328 $ 24,540 The following table summarizes activity related to employee severance and benefit costs within accrued restructuring liabilities for the six months ended June 30, 2023 (in thousands): Balance as of December 31, 2022 $ 12,804 Expenses incurred (a) 15,749 Payments ( 19,881 ) Balance as of June 30, 2023 $ 8,672

Shareholders' Equity (Tables)

Shareholders' Equity (Tables)	6 Months Ended
	Jun. 30, 2023
Equity [Abstract]
Shares of Common Stock Outstanding	Shares of Class A common stock outstanding were as follows (in thousands): Three Months Ended Six Months Ended 2023 2022 2023 2022 Class A common stock shares, beginning balance 103,641 102,558 102,911 103,764 Repurchases of Class A common stock — — — ( 1,929 ) Issuances of Class A common stock 73 89 803 812 Class A common stock shares, ending balance 103,714 102,647 103,714 102,647

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	6 Months Ended
	Jun. 30, 2023
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 2023 2022 2023 2022 Numerator: Net income (loss) $ 793 $ 77,744 $ ( 71,356 ) $ 123,920 Denominator: Basic weighted average common shares outstanding 103,679 102,596 103,502 103,130 Effect of dilutive securities: Stock options and other awards under deferred share-based compensation programs 665 476 — 611 Diluted weighted average common shares outstanding 104,344 103,072 103,502 103,741 Earnings (loss) per share Basic $ 0.01 $ 0.76 $ ( 0.69 ) $ 1.20 Diluted $ 0.01 $ 0.75 $ ( 0.69 ) $ 1.19
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share	The number of potential shares outstanding that were anti-dilutive and therefore excluded from the computation of diluted earnings (loss) per share, weighted for the portion of the period they were outstanding, were as follows (in thousands): Three Months Ended Six Months Ended 2023 2022 2023 2022 Anti-dilutive stock options and other awards 1,102 774 1,207 470 Anti-dilutive stock options and other awards under share-based compensation programs excluded based on reporting a net loss for the period — — 552 — Total Class A common stock equivalents excluded from diluted loss per share 1,102 774 1,759 470

Segment Information (Tables)

Segment Information (Tables)	6 Months Ended
	Jun. 30, 2023
Segment Reporting [Abstract]
Schedule of Segment Information	Information about reportable segment operating results was as follows (in thousands): Three Months Ended Six Months Ended 2023 2022 2023 2022 Revenue: Clinical Solutions $ 1,021,792 $ 1,025,715 $ 2,035,457 $ 2,044,085 Commercial Solutions 344,288 335,024 687,423 652,907 Total revenue 1,366,080 1,360,739 2,722,880 2,696,992 Segment direct costs: Clinical Solutions 777,442 753,451 1,564,830 1,528,119 Commercial Solutions 282,307 273,578 572,946 534,543 Total segment direct costs 1,059,749 1,027,029 2,137,776 2,062,662 Segment selling, general, and administrative expenses: Clinical Solutions 89,930 88,863 177,491 178,765 Commercial Solutions 22,804 21,094 44,928 42,829 Total segment selling, general, and administrative expenses 112,734 109,957 222,419 221,594 Segment operating income: Clinical Solutions 154,420 183,401 293,136 337,201 Commercial Solutions 39,177 40,352 69,549 75,535 Total segment operating income 193,597 223,753 362,685 412,736 Direct costs and operating expenses not allocated to segments: Share-based compensation included in direct costs 11,614 7,868 22,136 16,667 Share-based compensation included in selling, general, and administrative expenses 8,520 8,323 16,690 16,857 Corporate selling, general, and administrative expenses 61,269 20,760 104,931 40,755 Restructuring and other costs 10,641 8,983 95,328 24,540 Depreciation and amortization 59,332 61,221 120,919 123,423 Total income from operations $ 42,221 $ 116,598 $ 2,681 $ 190,494

Operations by Geographic Loca_2

Operations by Geographic Location (Tables)	6 Months Ended
	Jun. 30, 2023
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 June 30, 2023 2022 2023 2022 Revenue: North America (a) $ 818,329 $ 806,640 $ 1,653,114 $ 1,588,294 Europe, Middle East, and Africa 326,826 340,384 647,825 695,977 Asia-Pacific 183,223 172,965 348,210 333,768 Latin America 37,702 40,750 73,731 78,953 Total revenue $ 1,366,080 $ 1,360,739 $ 2,722,880 $ 2,696,992
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, 2023 December 31, 2022 Property and equipment, net: North America (a) $ 188,091 $ 202,645 Europe, Middle East, and Africa 28,835 33,827 Asia-Pacific 15,678 21,360 Latin America 4,093 6,463 Total property and equipment, net $ 236,697 $ 264,295

Basis of Presentation - Narrati

Basis of Presentation - Narrative (Details) - Agreement And Plan Of Merger	6 Months Ended
	Jun. 30, 2023 USD ($)
Schedule of Share-Based Compensation Arrangements by Share-Based Payment Award [Table]
Significant costs and expenses	$ 23,000,000
Common stock converted in cash	$ 43,000

Financial Statement Details - S

Financial Statement Details - Schedule Of Cash Pool Position (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Gross cash position	$ 434,921	$ 283,337
Less: cash borrowings	(433,825)	(283,029)
Net cash position	$ 1,096	$ 308

Financial Statement Details - A

Financial Statement Details - Accounts Receivable and Unbilled Services, net (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Receivables [Abstract]
Accounts receivable billed	$ 891,249	$ 898,839
Accounts receivable unbilled	257,827	227,210
Contract assets	565,432	531,234
Less: Allowance for doubtful accounts	(14,971)	(12,121)
Accounts receivable and unbilled services, net	$ 1,699,537	$ 1,645,162

Financial Statement Details - N

Financial Statement Details - Narrative (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Trade receivables sold	$ 51	$ 66.8
Proceeds from sale of trade receivables	$ 50.7	$ 66.5

Financial Statement Details -_2

Financial Statement Details - Schedule of Goodwill (Details)	6 Months Ended
	Jun. 30, 2023 USD ($)
Goodwill [Roll Forward]
Beginning balance	$ 4,897,518,000
Impact of foreign currency translation	14,078,000
Ending balance	4,911,596,000
Clinical Solutions
Goodwill [Roll Forward]
Beginning balance	3,405,877,000	[1]
Impact of foreign currency translation	16,031,000	[1]
Ending balance	3,421,908,000	[1]
Impairment of goodwill	0
Commercial Solutions
Goodwill [Roll Forward]
Beginning balance	1,491,641,000	[1]
Impact of foreign currency translation	1,953,000	[1]
Ending balance	$ 1,489,688,000	[1]
[1] (a) No impairment of goodwill was recorded for the six months ended June 30, 2023

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, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	$ 3,454,471	$ 3,301,559	$ 3,495,001	$ 3,412,555
Balance at end of period	3,493,754	3,329,065	3,493,754	3,329,065
Accumulated Other Comprehensive Loss
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(124,724)	(57,364)	(133,874)	(49,618)
Balance at end of period	(105,623)	(122,662)	(105,623)	(122,662)
Foreign Currency Translation
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(120,895)	(64,383)	(139,484)	(46,997)
Other comprehensive income before reclassifications	9,772	(69,826)	28,361	(87,212)
Balance at end of period	(111,123)	(134,209)	(111,123)	(134,209)
Accumulated Gain (Loss), Net, Cash Flow Hedge, Parent
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(3,829)	7,019	5,610	(2,621)
Other comprehensive income before reclassifications	10,771	4,827	8,992	13,439
Reclassification adjustments	1,442	299	9,102	(729)
Balance at end of period	$ 5,500	$ 11,547	$ 5,500	$ 11,547

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, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Accumulated Other Comprehensive Income (Loss) [Line Items]
Income tax (benefit) expense	$ (141)	$ 1,745	$ (150)	$ (966)
Total other comprehensive income (loss), net of taxes	19,101	(65,298)	28,251	(73,044)
Accumulated Gain (Loss), Net, Cash Flow Hedge, Parent
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized gain during period, before taxes	14,330	6,540	11,964	18,207
Income tax expense	3,559	1,713	2,972	4,768
Foreign currency translation adjustment, net of taxes	10,771	4,827	8,992	13,439
Income tax (benefit) expense	(141)	1,745	(150)	(966)
Reclassification adjustment, before taxes	(1,919)	(405)	(12,110)	988
Reclassification adjustment, net of taxes	1,442	299	9,102	(729)
Total other comprehensive income (loss), net of taxes	9,329	4,528	(110)	14,168
Foreign Currency Translation
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized gain during period, before taxes	9,631	(68,081)	28,211	(88,178)
Foreign currency translation adjustment, net of taxes	9,772	(69,826)	28,361	(87,212)
Income tax (benefit) expense	$ (477)	$ (106)	$ (3,008)	$ 259

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, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Other (income) expense, net:
Net realized foreign currency loss	$ 973	$ 4,799	$ 1,679	$ 7,254
Net unrealized foreign currency loss	5,523	9,503	10,421	9,069
Equity investment loss	0	0	(550)	0
Other, net	841	448	2,104	1,305
Total other expense (income), net	$ 5,391	$ (5,152)	$ 14,754	$ (510)

Investments - Narrative (Detail

Investments - Narrative (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Business Acquisition [Line Items]
Goodwill	$ 4,911,596	$ 4,897,518

Long-Term Debt Obligations - Sc

Long-Term Debt Obligations - Schedule of Debt Obligations (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Less: Term loan original issuance discount	$ (2,988)	$ (3,322)
Less: Unamortized deferred issuance costs	(6,002)	(6,505)
Less: Current portion of long-term debt	(8,437)	0
Total debt obligations, non-current portion	2,641,566	2,611,166
Secured Debt
Debt Instrument [Line Items]
Total debt obligations	2,058,993	2,020,993
Secured Debt | Term Loan A - tranche one due March 2024
Debt Instrument [Line Items]
Total debt obligations	1,350,000	1,350,000
Secured Debt | Revolver due November 2027
Debt Instrument [Line Items]
Total debt obligations	158,993	120,993
Secured Debt | Accounts receivable financing agreement due October 2025
Debt Instrument [Line Items]
Total debt obligations	550,000	550,000
Unsecured Debt
Debt Instrument [Line Items]
Total debt obligations	2,658,993	2,620,993
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) $ in Millions	6 Months Ended
	Jun. 30, 2023 USD ($)
Debt Instrument [Line Items]
Debt Instrument, Interest Rate, Stated Percentage	3.625%
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
Credit Agreement Amendment No 5 Term Loan A [Member] | Incremental Term Loan A [Member]
Debt Instrument [Line Items]
Debt Instrument, Interest Rate, Stated Percentage	6.45%
Secured Debt | Revolving credit facility
Debt Instrument [Line Items]
Interest rate on the Revolver	6.40%
Secured Debt | Letter of Credit
Debt Instrument [Line Items]
Line of credit facility, capacity available for trade purchases	$ 135.8
Secured Debt | 2017 Credit Agreement - Amendment No 2 - Term Loan B Due March 2024 | Term Loan
Debt Instrument [Line Items]
Term loan facility	1,350
Secured Debt | 2017 Credit Agreement - Amendment No 2 - Term Loan B Due March 2024 | Revolving credit facility
Debt Instrument [Line Items]
Maximum borrowing capacity under accounts receivable financing agreement	1,000
Secured Debt | Revolving Credit Facility Due August 2024 | Revolving credit facility
Debt Instrument [Line Items]
Outstanding borrowings	159
Available borrowings	826.8
Secured Debt | Revolving Credit Facility Due August 2024 | Letter of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity under accounts receivable financing agreement	150
Outstanding borrowings	$ 14.2

Long-Term Debt Obligations - Ac

Long-Term Debt Obligations - Accounts Receivable Financing Agreement (Details) $ in Thousands	Jun. 30, 2023 USD ($)
Debt Instrument [Line Items]
Long-term debt	$ 2,641,566
Accounts Receivable Financing Agreement Due September2021 | Secured Debt | Accounts Receivable Securitization
Debt Instrument [Line Items]
Long-term debt	$ 550,000
Interest rate on the accounts receivable	6.09%
Weighted average imputed interest rate	6.09%
Accounts Receivable Financing Agreement Due September2021 | Secured Debt | Accounts Receivable Securitization | Subsidiaries
Debt Instrument [Line Items]
Available borrowings	$ 0

Long-Term Debt Obligations - Co

Long-Term Debt Obligations - Contractual Maturities of Debt Obligations (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Principal
Remainder of 2023	$ 0
2024	33,750
2025	617,500
2026	67,500
2027	1,340,243
2028 and thereafter	600,000
Less: Term loan original issuance discount	(2,988)	$ (3,322)
Less: Unamortized deferred issuance costs	(6,002)	(6,505)
Less: Current portion of long-term debt	(8,437)	$ 0
Total	$ 2,641,566

Derivatives - Narrative (Detail

Derivatives - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Mar. 31, 2023	Jun. 30, 2021	Mar. 31, 2020
Derivative [Line Items]
Foreign Currency Forward Loss, Realized	$ (973)	$ (4,799)	$ (1,679)	$ (7,254)
Interest Rate Swap, expiring March 31, 2023
Derivative [Line Items]
Notional amount	$ 650,000		$ 650,000		$ 650,000	$ 1,420,000	$ 549,200

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, 2023	Dec. 31, 2022
Derivatives, Fair Value [Line Items]
Derivative Asset, Current, Statement of Financial Position [Extensible Enumeration]	Prepaid Expense And Other Assets Current
Derivative Asset, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Other Assets Noncurrent
Derivative assets -current	$ 9,005	$ 10,073
Derivative assets - non-current	921	0
Derivative assets	9,005	10,073
Derivative liability	$ 921	$ 0

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, 2023	Dec. 31, 2022
Assets:
Trading securities	[1]	$ 22,856	$ 20,465
Derivative instruments	[2]	9,005	10,073
Total assets		47,734	45,905
Liabilities:
Derivative instruments	[2]	921
Contingent obligations related to acquisitions	[3]	7,500	16,100
Total liabilities		8,421	16,100
Partnership Interests
Assets:
Partnership interests	[4]	15,873	15,367
Level 1
Assets:
Trading securities	[1]	22,856	20,465
Derivative instruments	[2]	0	0
Total assets		22,856	20,465
Liabilities:
Derivative instruments	[2]	0
Contingent obligations related to acquisitions	[3]	0	0
Total liabilities		0	0
Level 1 | Partnership Interests
Assets:
Partnership interests	[4]	0	0
Level 2
Assets:
Trading securities	[1]	0	0
Derivative instruments	[2]	9,005	10,073
Total assets		9,005	10,073
Liabilities:
Derivative instruments	[2]	921
Contingent obligations related to acquisitions	[3]	0	0
Total liabilities		921	0
Level 2 | Partnership Interests
Assets:
Partnership interests	[4]	0	0
Level 3
Assets:
Trading securities	[1]	0	0
Derivative instruments	[2]	0	0
Total assets		0	0
Liabilities:
Derivative instruments	[2]	0
Contingent obligations related to acquisitions	[3]	7,500	16,100
Total liabilities		7,500	16,100
Level 3 | Partnership Interests
Assets:
Partnership interests	[4]	0	0
Investments Measured at Net Asset Value
Assets:
Trading securities	[1]	0	0
Derivative instruments	[2]	0	0
Total assets		15,873	15,367
Liabilities:
Derivative instruments	[2]	0
Contingent obligations related to acquisitions	[3]	0	0
Total liabilities		0	0
Investments Measured at Net Asset Value | Partnership Interests
Assets:
Partnership interests	[4]	$ 15,873	$ 15,367
[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 4 – 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, 2023 , the Company’s remaining unfunded commitment in the private equity funds was $ 5.9 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, 2023 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	$ 5.9
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, 2023 USD ($)
Fair Value Disclosures [Abstract]
Balance at Beginning of period	$ 16,100
Additions	0
Changes in fair value recognized in earnings	0
Payments	(8,600)
Balance at End of period	$ 7,500

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Dec. 31, 2022
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	$ 5,530,000	$ 5,590,000

Fair Value Measurements - Sch_3

Fair Value Measurements - Schedule of Estimated Fair Value (Details) - Level 2 - USD ($) $ in Thousands		Jun. 30, 2023	Dec. 31, 2022
Term A Facility due November 2027 [Member] | Secured Debt | Reported Value Measurement
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, carrying value	[1]	$ 1,347,012	$ 1,346,678
Term A Facility due November 2027 [Member] | 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		1,353,375	1,329,750
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	[1]	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		$ 591,000	$ 484,500
[1] The carrying value of the Term A Facility is shown net of original issue discounts.

Restructuring and Other Costs_2

Restructuring and Other Costs (Additional Information) (Details) $ in Millions	6 Months Ended
	Jun. 30, 2023 USD ($)
Restructuring And Related Activities [Abstract]
Accelerated amortization of operating lease right-of-use assets	$ 56.7
Accelerated depreciation of property and equipment	$ 18.3

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, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Restructuring Cost And Reserve [Line Items]
Total restructuring and other costs	$ 10,641	$ 8,983	$ 95,328	$ 24,540
Employee severance and benefit costs
Restructuring Cost And Reserve [Line Items]
Total restructuring and other costs	5,569	2,368	15,749	17,188
Facility and lease termination costs
Restructuring Cost And Reserve [Line Items]
Total restructuring and other costs	4,803	3,671	79,116	3,352
Other costs
Restructuring Cost And Reserve [Line Items]
Total restructuring and other costs	$ 269	$ 2,944	$ 463	$ 4,000

Restructuring and Other Costs_3

Restructuring and Other Costs - Employee Severance and Benefit Costs within Accrued Restructuring Liabilities (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($)
Accounts Payable
Restructuring Reserve
Business exit costs and (gain) loss on termination of lease	$ 79,100
Expenses incurred
Restructuring Reserve
Business exit other costs that included in accounts payable	500
Business Restructuring Reserves
Restructuring Reserve
Balance at the beginning of the period	12,804
Balance at the end of the period	8,672
Business Restructuring Reserves | Expenses incurred
Restructuring Reserve
Expenses incurred	15,749
Payments	$ (19,881)

Shareholders' Equity - Shares o

Shareholders' Equity - Shares of Common Stock Outstanding (Details) - Common Class A [Member] - shares	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Common stock shares, beginning balance			102,911,000
Common Stock
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Common stock shares, beginning balance	103,641,000	102,558,000	102,911,000	103,764,000
Repurchases of common stock	0	0	0	(1,929,000)
Issuances of common stock	73,000	89,000	803,000	812,000
Common stock shares, ending balance	103,714,000	102,647,000	103,714,000	102,647,000

Shareholders' Equity - Narrativ

Shareholders' Equity - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions	6 Months Ended
	Jun. 30, 2023	Dec. 31, 2022	May 25, 2022
2022 Stock Repurchase Program
Class Of Stock [Line Items]
Stock repurchased during period, shares	0
Class A common stock
Class Of Stock [Line Items]
Common stock par value (USD per share)	$ 0.01	$ 0.01
Class A common stock | 2022 Stock Repurchase Program
Class Of Stock [Line Items]
Stock repurchase program, authorized amount	$ 350		$ 350
Common stock par value (USD per share)			$ 0.01

Earnings (Loss) Per Share - Sch

Earnings (Loss) 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, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Numerator:
Net income (loss)	$ 793	$ 77,744	$ (71,356)	$ 123,920
Weighted Average Number of Shares Outstanding Reconciliation [Abstract]
Basic weighted average common shares outstanding (in shares)	103,679	102,596	103,502	103,130
Effect of dilutive securities:
Stock options and other awards under deferred share-based compensation programs	665	476	0	611
Diluted weighted average common shares outstanding	104,344	103,072	103,502	103,741
Earnings per share:
Basic (USD per share)	$ 0.01	$ 0.76	$ (0.69)	$ 1.20
Diluted (USD per share)	$ 0.01	$ 0.75	$ (0.69)	$ 1.19

Earnings (Loss) Per Share - S_2

Earnings (Loss) Per Share - Schedule of potential shares outstanding excluded from the computation of diluted (loss) earnings per share (Details) - shares	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Class A common stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive shares outstanding excluded from the computation of diluted earnings per share	1,102	774	1,759	470
Option and other awards[Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive shares outstanding excluded from the computation of diluted earnings per share	1,102	774	1,207	470
Share-Based Payment Arrangement, Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive shares outstanding excluded from the computation of diluted earnings per share	0	0	552	0

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Condensed Balance Sheet Statements, Captions [Line Items]
Income tax (benefit) expense	$ (132)	$ 25,940	$ (3,145)	$ 33,256
Income (loss) before provision for income taxes	661	103,684	(74,501)	157,176
Discrete tax benefits (expense)	$ 900	$ 300	$ 6,500	$ 6,400
U.S. state and local statutory rate	21%			21%
U.S. federal statutory rate		21%	21%
Gross unrecognized tax benefits	$ 19,800		$ 19,800		$ 16,800
Increase in unrecognized tax benefit in foreign jurisdictions			3,000
Decrease in unrecognized tax benefits resulting from lapses of applicable statutes of limitations			$ 3,400

Revenue from Contracts with C_2

Revenue from Contracts with Customers - Narrative (Details) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2023 USD ($)	Jun. 30, 2023 USD ($)
Revenue Remaining Performance Obligation Expected Timing Of Satisfaction [Line Items]
Unsatisfied performance obligations under contracts with a contract term greater than one year	$ 5,500	$ 5,500
Revenue recognized, included in contract liabilities balance at beginning of period	357.2	$ 549.4
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	$ 27	$ 36.6

Segment Information Narrative (

Segment Information Narrative (Details)	6 Months Ended
	Jun. 30, 2023 Segment
Segment Reporting [Abstract]
Number Of Reportable Segments	2

Segment Information (Details)

Segment Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Segment Reporting Information [Line Items]
Revenue	$ 1,366,080	$ 1,360,739	$ 2,722,880	$ 2,696,992
Direct costs (exclusive of depreciation and amortization)	1,071,363	1,034,897	2,159,912	2,079,329
Selling, general, and administrative expenses	182,523	139,040	344,040	279,206
Operating income (loss)	42,221	116,598	2,681	190,494
Restructuring and other costs	10,641	8,983	95,328	24,540
Operating Segments
Segment Reporting Information [Line Items]
Direct costs (exclusive of depreciation and amortization)	1,059,749	1,027,029	2,137,776	2,062,662
Selling, general, and administrative expenses	112,734	109,957	222,419	221,594
Operating income (loss)	193,597	223,753	362,685	412,736
Corporate
Segment Reporting Information [Line Items]
Selling, general, and administrative expenses	61,269	20,760	104,931	40,755
Restructuring and other costs	10,641	8,983	95,328	24,540
Depreciation and amortization	59,332	61,221	120,919	123,423
Corporate | Direct costs
Segment Reporting Information [Line Items]
Share-based compensation expense	11,614	7,868	22,136	16,667
Corporate | Selling, general, and administrative expenses
Segment Reporting Information [Line Items]
Share-based compensation expense	8,520	8,323	16,690	16,857
Clinical Solutions | Operating Segments
Segment Reporting Information [Line Items]
Revenue	1,021,792	1,025,715	2,035,457	2,044,085
Direct costs (exclusive of depreciation and amortization)	777,442	753,451	1,564,830	1,528,119
Selling, general, and administrative expenses	89,930	88,863	177,491	178,765
Operating income (loss)	154,420	183,401	293,136	337,201
Commercial Solutions | Operating Segments
Segment Reporting Information [Line Items]
Revenue	344,288	335,024	687,423	652,907
Direct costs (exclusive of depreciation and amortization)	282,307	273,578	572,946	534,543
Selling, general, and administrative expenses	22,804	21,094	44,928	42,829
Operating income (loss)	$ 39,177	$ 40,352	$ 69,549	$ 75,535

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, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Revenues by Geographic Location
Revenue		$ 1,366,080	$ 1,360,739	$ 2,722,880	$ 2,696,992
North America
Revenues by Geographic Location
Revenue	[1]	818,329	806,640	1,653,114	1,588,294
Europe, Middle East, and Africa
Revenues by Geographic Location
Revenue		326,826	340,384	647,825	695,977
Asia-Pacific
Revenues by Geographic Location
Revenue		183,223	172,965	348,210	333,768
Latin America
Revenues by Geographic Location
Revenue		37,702	40,750	73,731	78,953
United States
Revenues by Geographic Location
Revenue		$ 767,400	$ 754,700	$ 1,553,200	$ 1,491,200
United States | Geographic Concentration Risk | Net Service Revenue
Revenues by Geographic Location
Concentration risk percentage		56.20%	55.50%	57%	55.30%
[1] Revenue for the North America region includes revenue attributable to the U.S. of $ 767.4 million and $ 754.7 million , or 56.2 % and 55.5 % of total revenue, for the three months ended June 30, 2023 and 2022, respectively. Revenue for the North America region includes revenue attributable to the U.S. of $ 1,553.2 million and $ 1,491.2 million , or 57.0 % and 55.3 % of total revenue, for the six months ended June 30, 2023 and 2022, respectively. No other country represented more than 10% of total revenue for any period.

Operations by Geographic Loca_4

Operations by Geographic Location - Long-Lived Assets by Geographic Area (Details) - USD ($) $ in Thousands		Jun. 30, 2023	Dec. 31, 2022
Long-Lived Assets by Geographic Location
Total property and equipment, net		$ 236,697	$ 264,295
North America
Long-Lived Assets by Geographic Location
Total property and equipment, net	[1]	188,091	202,645
Europe, Middle East, and Africa
Long-Lived Assets by Geographic Location
Total property and equipment, net		28,835	33,827
Asia-Pacific
Long-Lived Assets by Geographic Location
Total property and equipment, net		15,678	21,360
Latin America
Long-Lived Assets by Geographic Location
Total property and equipment, net		4,093	6,463
United States
Long-Lived Assets by Geographic Location
Total property and equipment, net		$ 180,900	$ 196,400
[1] Long-lived assets for the North America region include property and equipment, net attributable to the U.S. of $ 180.9 million and $ 196.4 million as of June 30, 2023 and December 31, 2022 , respectively.

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, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
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 Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)	Jun. 30, 2023 USD ($) Customer	Jun. 30, 2022 USD ($) Customer
Related Party Transaction [Line Items]
Revenue from related parties	$ 2.3	$ 2.2	$ 4.7	$ 3.6
Receivables from related party				$ 0.3
Number of counterparties | Customer				2
Director
Related Party Transaction [Line Items]
Receivables from related party			$ 1.5
Number of counterparties | Customer			5	4