Syneos Health (SYNH) 10-Q 6 Aug 20 2020 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2020	Jul. 31, 2020
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q2
Entity Registrant Name	SYNEOS HEALTH, INC.
Entity Central Index Key	0001610950
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		104,284,564
Entity Shell Company	false
Entity Small Business	false
Entity Emerging Growth Company	false
Entity File Number	001-36730
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	27-3403111
Entity Address, Address Line One	1030 Sync Street
Entity Address, City or Town	Morrisville
Entity Address, State or Province	NC
Entity Address, Postal Zip Code	27560-5468
City Area Code	919
Local Phone Number	876-9300
Document Quarterly Report	true
Document Transition Report	false
Title of 12(b) Security	Class A Common Stock, $0.01 par value per share
Trading Symbol	SYNH
Security Exchange Name	NASDAQ

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Income Statement [Abstract]
Revenue	$ 1,013,399	$ 1,166,827	$ 2,176,754	$ 2,285,833
Costs and operating expenses:
Direct costs (exclusive of depreciation and amortization)	805,892	917,529	1,729,906	1,804,331
Selling, general, and administrative expenses	104,976	110,879	222,946	223,996
Restructuring and other costs	8,171	11,882	16,891	26,295
Transaction and integration-related expenses	3,368	7,654	10,945	24,312
Depreciation	17,304	19,248	34,529	38,819
Amortization	38,717	41,501	77,599	83,130
Total operating expenses	978,428	1,108,693	2,092,816	2,200,883
Income from operations	34,971	58,134	83,938	84,950
Other (income) expense, net:
Interest income	(122)	(2,133)	(458)	(3,635)
Interest expense	21,684	34,263	48,142	68,893
Loss on extinguishment of debt	0	0	0	4,355
Other expense (income), net	5,761	(7,573)	(13,169)	1,348
Total other expense, net	27,323	24,557	34,515	70,961
Income before provision for income taxes	7,648	33,577	49,423	13,989
Income tax expense	3,737	22,285	11,938	32,701
Net income (loss)	$ 3,911	$ 11,292	$ 37,485	$ (18,712)
Earnings (loss) per share:
Basic (USD per share)	$ 0.04	$ 0.11	$ 0.36	$ (0.18)
Diluted (USD per share)	$ 0.04	$ 0.11	$ 0.36	$ (0.18)
Weighted average common shares outstanding:
Basic (in shares)	104,198	103,699	104,232	103,532
Diluted (in shares)	105,219	104,818	105,430	103,532

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Statement Of Income And Comprehensive Income [Abstract]
Net income (loss)	$ 3,911	$ 11,292	$ 37,485	$ (18,712)
Unrealized loss on derivative instruments, net of income tax expense (benefit) of $52, $(237), $(6,587) and $(332), respectively	(1,131)	(8,962)	(11,861)	(13,178)
Foreign currency translation adjustments, net of income tax expense of $0, $0, $0 and $0, respectively	2,870	(11,919)	(45,918)	8,685
Comprehensive income (loss)	$ 5,650	$ (9,589)	$ (20,294)	$ (23,205)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (Unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Statement Of Income And Comprehensive Income [Abstract]
Income tax benefit related to unrealized loss on derivative instruments recorded in other comprehensive loss	$ 52		$ (6,587)
Income tax benefit related to unrealized loss on derivative instruments recorded in other comprehensive loss		$ (237)		$ (332)
Other comprehensive income (loss), foreign currency translation adjustment, tax	$ 0	$ 0	$ 0	$ 0

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Current assets:
Cash, cash equivalents, and restricted cash	$ 343,030	$ 163,689
Accounts receivable and unbilled services, net	1,174,021	1,303,641
Prepaid expenses and other current assets	80,348	94,834
Total current assets	1,597,399	1,562,164
Property and equipment, net	197,074	203,926
Operating lease right-of-use assets	211,295	218,531
Goodwill	4,323,229	4,350,380
Intangible assets, net	913,375	973,081
Deferred income tax assets	34,312	37,012
Other long-term assets	130,447	108,701
Total assets	7,407,131	7,453,795
Current liabilities:
Accounts payable	92,488	136,686
Accrued expenses	532,356	568,911
Deferred revenue	657,980	696,907
Current portion of operating lease obligations	40,982	38,055
Current portion of finance lease obligations	15,728
Current portion of finance lease obligations		17,777
Current portion of long-term debt	87,187	58,125
Total current liabilities	1,426,721	1,516,461
Long-term debt	2,653,363	2,550,395
Operating lease long-term obligations	207,588	218,343
Finance lease long-term obligations	27,969
Finance lease long-term obligations		36,914
Deferred income tax liabilities	9,510	11,101
Other long-term liabilities	82,296	90,927
Total liabilities	4,407,447	4,424,141
Commitments and contingencies (Note 15)
Shareholders' equity:
Preferred stock, $0.01 par value; 30,000 shares authorized, 0 shares issued and outstanding at June 30, 2020 and December 31, 2019	0	0
Common stock, $0.01 par value; 600,000 shares authorized, 104,236 and 103,866 shares issued and outstanding at June 30, 2020 and December 31, 2019, respectively	1,042	1,039
Additional paid-in capital	3,446,852	3,441,471
Accumulated other comprehensive loss, net of taxes	(129,372)	(71,593)
Accumulated deficit	(318,838)	(341,263)
Total shareholders' equity	2,999,684	3,029,654
Total liabilities and shareholders' equity	$ 7,407,131	$ 7,453,795

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares	Jun. 30, 2020	Dec. 31, 2019
Statement Of Financial Position [Abstract]
Preferred stock par value (USD per share)	$ 0.01	$ 0.01
Preferred stock shares authorized (in shares)	30,000,000	30,000,000
Preferred stock shares issued (in shares)	0	0
Preferred stock shares outstanding (in shares)	0	0
Common stock par value (USD per share)	$ 0.01	$ 0.01
Common stock shares authorized (in shares)	600,000,000	600,000,000
Common stock shares issued (in shares)	104,236,000	103,866,000
Common stock shares outstanding (in shares)	104,236,000	103,866,000

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Cash flows from operating activities:
Net income (loss)	$ 37,485	$ (18,712)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization	112,128	121,949
Share-based compensation	32,173	28,061
Provision for doubtful accounts	379	783
Provision for deferred income taxes	8,750	8,793
Foreign currency transaction gains	(12,541)	(957)
Fair value adjustment of contingent obligations	(3,943)	(940)
Loss on extinguishment of debt	0	4,355
Other non-cash items	1,501	1,147
Changes in operating assets and liabilities, net of effect of business combinations:
Accounts receivable, unbilled services, and deferred revenue	52,670	(89,535)
Accounts payable and accrued expenses	(64,757)	32,005
Other assets and liabilities	(8,680)	(3,435)
Net cash provided by operating activities	155,165	83,514
Cash flows from investing activities:
Purchases of property and equipment	(30,078)	(28,066)
Investments in unconsolidated affiliates	(7,202)	(3,000)
Net cash used in investing activities	(37,280)	(31,066)
Cash flows from financing activities:
Proceeds from issuance of long-term debt, net of discount	0	183,195
Payments of debt financing costs	0	(1,032)
Repayments of long-term debt	(19,375)	(256,136)
Proceeds from accounts receivable financing agreement	6,600	38,200
Repayments of accounts receivable financing agreement	(6,600)	(22,400)
Proceeds from revolving line of credit	300,000	0
Repayments of revolving line of credit	(150,000)	0
Payments of contingent consideration related to business combinations	(26,634)	(8)
Payments of finance leases	(8,904)	(4,677)
Payments for repurchases of common stock	(32,029)	(49,671)
Proceeds from exercises of stock options	12,784	24,377
Payments related to tax withholdings for share-based compensation	(19,604)	(11,763)
Net cash provided by (used in) financing activities	56,238	(99,915)
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	5,218	(1,209)
Net change in cash, cash equivalents, and restricted cash	179,341	(48,676)
Cash, cash equivalents, and restricted cash - beginning of period	163,689	155,932
Cash, cash equivalents, and restricted cash - end of period	$ 343,030	$ 107,256

CONDENSED CONSOLIDATED STATEM_5

CONDENSED CONSOLIDATED STATEMENTS OF SHAREHOLDERS' EQUITY (Unaudited) - USD ($) $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Loss	Accumulated Deficit	Accumulated DeficitCumulative Effect, Period of Adoption, Adjustment
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Adjusted beginning balance	$ 2,856,144					$ (459,333)
Balance at beginning of period at Dec. 31, 2018	$ 2,856,144		$ 1,034	$ 3,402,638	$ (88,195)	(459,333)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Repurchases of common stock			(12)	(38,867)		(10,792)
Issuances of common stock			13	12,557
Share-based compensation				28,061
Unrealized loss on derivative instruments, net of taxes					(13,178)
Foreign currency translation adjustment, net of taxes	$ 8,685				8,685
Net income (loss)	(18,712)					(18,712)
Balance at end of period at Jun. 30, 2019	2,823,899		1,035	3,404,389	(92,688)	(488,837)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Adjusted beginning balance	2,838,370					(493,814)
Balance at beginning of period at Mar. 31, 2019	$ 2,838,370		1,038	3,402,953	(71,807)	(493,814)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Repurchases of common stock			(5)	(16,735)		(6,315)
Issuances of common stock			2	4,377
Share-based compensation				13,794
Unrealized loss on derivative instruments, net of taxes					(8,962)
Foreign currency translation adjustment, net of taxes	$ (11,919)				(11,919)
Net income (loss)	11,292					11,292
Balance at end of period at Jun. 30, 2019	2,823,899		1,035	3,404,389	(92,688)	(488,837)
Balance at beginning of period at Dec. 31, 2019	3,029,654	$ (2,771)	1,039	3,441,471	(71,593)	(341,263)	$ (2,771)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]		us-gaap:AccountingStandardsUpdate201613Member
Balance at end of period at Jan. 01, 2020		$ 2,800
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Adjusted beginning balance	3,026,883					(344,034)
Balance at beginning of period at Dec. 31, 2019	$ 3,029,654	$ (2,771)	1,039	3,441,471	(71,593)	(341,263)	$ (2,771)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Repurchases of common stock			(6)	(19,734)		(12,289)
Issuances of common stock			9	(7,058)
Share-based compensation				32,173
Unrealized loss on derivative instruments, net of taxes					(11,861)
Foreign currency translation adjustment, net of taxes	$ (45,918)				(45,918)
Net income (loss)	37,485					37,485
Balance at end of period at Jun. 30, 2020	2,999,684		1,042	3,446,852	(129,372)	(318,838)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Adjusted beginning balance	2,977,922					(322,749)
Balance at beginning of period at Mar. 31, 2020	$ 2,977,922		1,042	3,430,740	(131,111)	(322,749)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Issuances of common stock				(63)
Share-based compensation				16,175
Unrealized loss on derivative instruments, net of taxes					(1,131)
Foreign currency translation adjustment, net of taxes	$ 2,870				2,870
Net income (loss)	3,911					3,911
Balance at end of period at Jun. 30, 2020	$ 2,999,684		$ 1,042	$ 3,446,852	$ (129,372)	$ (318,838)

Basis of Presentation and Chang

Basis of Presentation and Changes in Significant Accounting Policies	6 Months Ended
	Jun. 30, 2020
Accounting Policies [Abstract]
Basis of Presentation and Changes in Significant Accounting Policies	1. Basis of Presentation and Changes in Significant Accounting Policies Nature of Operations Syneos Health, Inc. (the “Company”) is a global provider of end-to-end biopharmaceutical outsourcing solutions. The Company operates under two reportable segments, Clinical Solutions and Commercial Solutions, and derives its revenue through a suite of services designed to enhance its customers’ ability to successfully develop, launch, and market their products. The Company offers its solutions on both a standalone and integrated basis with biopharmaceutical development and commercialization services ranging from Phase I-IV clinical trial services to services associated with the commercialization of biopharmaceutical products. The Company’s customers include small, mid-sized, and large companies in the pharmaceutical, biotechnology, and medical device industries. Unaudited Interim Financial Information The Company prepared the accompanying unaudited condensed consolidated financial statements in accordance with generally accepted accounting principles in the United States of America (“GAAP”) for interim financial information. The significant accounting policies followed by the Company for interim financial reporting are consistent with the accounting policies followed for annual financial reporting. The unaudited condensed consolidated financial statements, in management’s opinion, include all adjustments of a normal recurring nature necessary for a fair presentation. The information included in this Quarterly Report on Form 10-Q should be read in conjunction with the Company’s audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019, filed with the Securities and Exchange Commission (“SEC”) on February 20, 2020. The results of operations for the three and six months ended June 30, 2020 are not necessarily indicative of the results to be expected for the full year ending December 31, 2020 or any other future period. The unaudited condensed consolidated balance sheet at December 31, 2019 is derived from the amounts in the audited consolidated balance sheet included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019. COVID-19 Pandemic On March 11, 2020, the World Health Organization designated the outbreak of the novel strain of coronavirus that causes the disease known as COVID-19 as a global pandemic. Governments and businesses around the world have taken unprecedented actions to mitigate the spread of COVID-19, including, but not limited to, shelter-in-place orders, quarantines, significant restrictions on travel, as well as restrictions that prohibit many employees from going to work. The Company experienced significant impacts to its business and results of operations for the three and six months ended June 30, 2020 due to COVID-19. While certain governments began to ease restrictions during the latter part of the second quarter, the pandemic continues to be disruptive to the Company’s business. Uncertainty with respect to the economic impacts of the pandemic has introduced significant volatility in the financial markets. The extent to which COVID-19 impacts the Company’s future results will depend on future developments. The pandemic and associated economic impacts could continue to significantly impact the Company’s future financial condition, results of operations and cash flows. Recently Adopted Accounting Standards In June 2016, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2016-13 ("ASU 2016-13"), Financial Instruments - Credit Losses (Topic 326) In March 2020, the FASB issued ASU No. 2020-04 ("ASU 2020-04"), Reference Rate Reform (Topic 848)

Financial Statement Details

Financial Statement Details	6 Months Ended
	Jun. 30, 2020
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. 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. The net cash balance related to this pooling arrangement is included in cash, cash equivalents, and restricted cash in the unaudited condensed consolidated balance sheets. During the three months ended June 30, 2020, the Company made a non-cash investment of $27.3 million to acquire certain intellectual property rights from a customer in lieu of cash payment for services rendered. 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, 2020 December 31, 2019 Accounts receivable billed $ 659,556 $ 787,652 Unbilled services (including contract assets) 522,414 521,370 Less: Allowance for doubtful accounts (7,949 ) (5,381 ) Accounts receivable and unbilled services, net $ 1,174,021 $ 1,303,641 Unbilled services is comprised of approximately equal parts of unbilled accounts receivables and contract assets. Unbilled accounts receivables arise when the right to bill is contingent solely on the passage of time (e.g., in the following month) and contract assets arise in instances where the right to bill is associated with a contingency (e.g., achievement of a milestone). Accounts Receivable Factoring Arrangement The Company has an accounts receivable factoring agreement to sell certain eligible unsecured trade accounts receivable, without recourse, to an unrelated third-party financial institution for cash. For the six months ended June 30, 2020 and 2019, the Company factored $77.6 million and $113.7 million, respectively, of trade accounts receivable on a non-recourse basis and received $77.3 million and $112.8 million, respectively, in cash proceeds from the sale. The fees associated with these transactions were insignificant. Goodwill The changes in the carrying amount of goodwill by segment for the six months ended June 30, 2020 were as follows (in thousands): Clinical Solutions (a) Commercial Solutions (b) Total Balance as of January 1, 2020 $ 2,784,952 $ 1,565,428 $ 4,350,380 Impact of foreign currency translation (20,473 ) (6,678 ) (27,151 ) Balance as of June 30, 2020 $ 2,764,479 $ 1,558,750 $ 4,323,229 (a) Accumulated impairment losses of $8.1 million associated with the Clinical Solutions segment were recorded prior to 2016 and related to the former Phase I Services segment, now a component of the Clinical Solutions segment. No impairment of goodwill was recorded for the six months ended June 30, 2020. (b) Accumulated impairment losses of $8.0 million associated with the Commercial Solutions segment were recorded prior to 2015 and related to the former Global Consulting segment, now a component of the Commercial Solutions segment. No impairment of goodwill was recorded for the six months ended June 30, 2020. As of June 30, 2020, the Company evaluated whether a triggering event had occurred because of the broad impacts of the COVID-19 pandemic. The COVID-19 pandemic negatively impacted the Company’s results of operations during the three and six months ended June 30, 2020 and the Company expects the pandemic to continue to negatively impact its full year 2020 results of operations. However, at this time, the Company does not believe there has been a significant change in the long-term fundamentals of its business. The Company has concluded a triggering event did not occur, and, as a result, no interim impairment testing was required. The Company will continue to evaluate the impacts of the COVID-19 pandemic on its business. Depending on the extent to which future developments negatively impact the Company's results of operations and financial outlook, an interim impairment test may be required in the future. Transaction and Integration-Related Expenses Transaction and integration-related expenses consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Professional fees $ 2,438 $ 6,678 $ 12,561 $ 19,523 Debt modification and related expenses 71 1,732 71 3,973 Integration and personnel retention-related costs 707 909 2,256 1,756 Fair value adjustments to contingent obligations 152 (1,665 ) (3,943 ) (940 ) Total transaction and integration-related expenses $ 3,368 $ 7,654 $ 10,945 $ 24,312 Accumulated Other Comprehensive Loss , Net of Taxes Accumulated other comprehensive loss, net of taxes, consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Beginning balance $ (131,111 ) $ (71,807 ) $ (71,593 ) $ (88,195 ) Foreign currency translation: Beginning balance (105,545 ) (60,351 ) (56,757 ) (80,955 ) Other comprehensive income (loss) before reclassifications 2,870 (11,919 ) (45,918 ) 8,685 Ending balance (102,675 ) (72,270 ) (102,675 ) (72,270 ) Derivative instruments: Beginning balance (25,566 ) (11,456 ) (14,836 ) (7,240 ) Other comprehensive loss before reclassifications (5,461 ) (9,544 ) (17,971 ) (14,246 ) Reclassification adjustments 4,330 582 6,110 1,068 Ending balance (26,697 ) (20,418 ) (26,697 ) (20,418 ) Accumulated other comprehensive loss, net of taxes $ (129,372 ) $ (92,688 ) $ (129,372 ) $ (92,688 ) Changes in accumulated other comprehensive loss consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Foreign currency translation adjustments: Foreign currency translation adjustments, net of taxes $ 2,870 $ (11,919 ) $ (45,918 ) $ 8,685 Unrealized loss on derivative instruments: Unrealized loss during period, before taxes (6,876 ) (9,800 ) (26,659 ) (14,616 ) Income tax benefit (1,415 ) (256 ) (8,688 ) (370 ) Unrealized loss during period, net of taxes (5,461 ) (9,544 ) (17,971 ) (14,246 ) Reclassification adjustment, before taxes 5,797 601 8,211 1,106 Income tax expense 1,467 19 2,101 38 Reclassification adjustment, net of taxes 4,330 582 6,110 1,068 Total unrealized loss on derivative instruments, net of taxes (1,131 ) (8,962 ) (11,861 ) (13,178 ) Total other comprehensive income (loss), net of taxes $ 1,739 $ (20,881 ) $ (57,779 ) $ (4,493 ) Other Expense (Income), Net Other expense (income), net consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Net realized foreign currency loss (gain) $ 3,045 $ (7,275 ) $ (2,051 ) $ 1,131 Net unrealized foreign currency loss (gain) 2,478 (880 ) (12,541 ) (957 ) Other, net 238 582 1,423 1,174 Total other expense (income), net $ 5,761 $ (7,573 ) $ (13,169 ) $ 1,348

Long-Term Debt Obligations

Long-Term Debt Obligations	6 Months Ended
	Jun. 30, 2020
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, 2020 December 31, 2019 Term Loan A due March 2024 $ 1,530,625 $ 1,550,000 Term Loan B due August 2024 795,564 795,564 Revolving credit facility due March 2024 150,000 — Accounts receivable financing agreement due September 2021 275,000 275,000 Total debt obligations 2,751,189 2,620,564 Less: Term loan original issuance discount (4,312 ) (4,928 ) Less: Unamortized deferred issuance costs (6,327 ) (7,116 ) Less: Current portion of debt (87,187 ) (58,125 ) Total debt obligations, non-current portion $ 2,653,363 $ 2,550,395 The Company is party to a credit agreement (as amended, the "Credit Agreement") that includes a $1.55 billion Term Loan A facility that matures on March 26, 2024 ("Term Loan A”), a $1.60 billion Term Loan B facility that matures on August 1, 2024 (“Term Loan B”), and a $600.00 million revolving credit facility (the “Revolver”) that matures on March 26, 2024. During the six months ended June 30, 2020, the Company made $19.4 million of mandatory principal payments towards Term Loan A. During the six months ended June 30, 2020, the Company did not make any voluntary prepayments against Term Loan B. As a result of previous voluntary prepayments, the Company is not required to make a mandatory payment against the Term Loan B principal balance until maturity in August 2024. Letters of Credit The Revolver includes letters of credit ("LOCs") with a sublimit of $150.0 million. As of June 30, 2020, there were $150.0 million of outstanding Revolver borrowings and $18.9 million of LOCs outstanding, leaving $431.1 million of available borrowings under the Revolver. During July 2020, the Company repaid the remaining $150.0 million balance on the Revolver. The lease agreement for the corporate headquarters in Morrisville, North Carolina includes a provision that may require the Company to issue LOCs in certain amounts to the landlord based on the debt rating of the Company issued by Moody’s Investors Service (or other nationally-recognized debt rating agency). As of June 30, 2020 (and through the date of this filing), the Company’s debt rating was such that no LOCs were required. Any required LOCs could be issued under the Company’s Revolver, and, if issued under the Revolver, would reduce its available borrowing capacity by the same amount accordingly. Accounts Receivable Financing Agreement The Company has an accounts receivable financing agreement ( as amended) As of June 30, 2020, the Company had $275.0 million of outstanding borrowings under the accounts receivable financing agreement, which are recorded in long-term debt on the accompanying unaudited condensed consolidated balance sheet. There was no remaining borrowing capacity under this agreement as of June 30, 2020. As of June 30, 2020, the contractual maturities of the Company’s debt obligations (excluding leases) were as follows (in thousands): Principal Interest (a) 2020 $ 38,750 $ 24,589 2021 381,563 46,435 2022 145,312 42,011 2023 155,000 39,380 2024 2,030,564 13,108 Less: Deferred issuance costs (6,327 ) Less: Term loan original issuance discount (4,312 ) Total $ 2,740,550 $ 165,523 (a) The interest payments on long-term debt in the above table are based on interest rates in effect as of June 30, 2020.

Derivatives

Derivatives	6 Months Ended
	Jun. 30, 2020
Derivative Instruments And Hedging Activities Disclosure [Abstract]
Derivatives	4. Derivatives The Company has entered into various interest rate swaps to mitigate its exposure to changes in interest rates on its term loans. In May 2016, the Company entered into interest rate swaps that had an initial notional value of $300.0 million and became effective on June 30, 2016. A portion of the interest rate swaps expired on June 30, 2018, and the remainder expired on May 14, 2020. In June 2018, the Company entered into an interest rate swap with multiple counterparties that had an initial aggregate notional value of $1.01 billion, an effective date of December 31, 2018, and will expire on June 30, 2021. As of June 30, 2020, the notional value of this interest rate swap was $928.7 million. 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, increasing to $1.42 billion in 2021, an effective date of March 31, 2020, and will expire on March 31, 2023. As of June 30, 2020, the notional value of these interest rate swaps was $604.1 million. 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, 2020 December 31, 2019 Interest rate swaps - current Prepaid expenses and other current assets $ — $ 155 Fair value of derivative assets $ — $ 155 Interest rate swaps - current Accrued expenses $ 27,593 $ 11,358 Interest rate swaps - non-current Other long-term liabilities 8,154 6,095 Fair value of derivative liabilities $ 35,747 $ 17,453

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2020
Fair Value Disclosures [Abstract]
Fair Value Measurements	5. Fair Value Measurements Assets and Liabilities Carried at Fair Value As of June 30, 2020 and December 31, 2019, 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, 2020, 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 Measured at Net Asset Value Total Assets: Trading securities (a) $ 19,872 $ — $ — $ — $ 19,872 Partnership interest (b) — — — 7,678 7,678 Total assets $ 19,872 $ — $ — $ 7,678 $ 27,550 Liabilities: Derivative instruments (c) $ — $ 35,747 $ — $ — $ 35,747 Contingent obligations related to business combinations (d) — — 6,490 — 6,490 Total liabilities $ — $ 35,747 $ 6,490 $ — $ 42,237 As of December 31, 2019, 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 Measured at Net Asset Value Total Assets: Trading securities (a) $ 21,552 $ — $ — $ — $ 21,552 Partnership interest (b) — — — 7,226 7,226 Derivative instruments (c) — 155 — — 155 Total assets $ 21,552 $ 155 $ — $ 7,226 $ 28,933 Liabilities: Derivative instruments (c) $ — $ 17,453 $ — $ — $ 17,453 Contingent obligations related to business combinations (d) — — 37,324 — 37,324 Total liabilities $ — $ 17,453 $ 37,324 $ — $ 54,777 (a) Represents 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, 2020, the Company’s remaining unfunded commitment in the private equity funds was $14.2 million. The Company holds minor ownership interests (less than 3%) in each of the private equity funds and has determined that it does not exercise significant influence over the private equity funds' operating and finance activities. As the private equity funds do not have readily determinable fair values, the Company has estimated the fair values using each fund’s Net Asset Value, the amount by which the value of all assets exceeds all debt and liabilities, in accordance with 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 business combinations. 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, 2020 (in thousands): Balance as of December 31, 2019 $ 37,324 Additions — Changes in fair value recognized in earnings (4,200 ) Payments (26,634 ) Balance as of June 30, 2020 $ 6,490 During the six months ended June 30, 2020, 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, 2020 and December 31, 2019, assets carried on the condensed consolidated balance sheets and not remeasured to fair value on a recurring basis totaled $5.24 billion and $5.32 billion, respectively. Fair Value Disclosures for Financial Instruments Not Carried at Fair Value The estimated fair values of the outstanding term loans are determined based on quoted market prices. As these liabilities are not actively traded, they are classified as Level 2 fair value measurements. The estimated fair values of the Company’s outstanding term loans were as follows (in thousands): June 30, 2020 December 31, 2019 Carrying Value (a) Estimated Fair Value Carrying Value (a) Estimated Fair Value Term Loan A due March 2024 $ 1,526,897 $ 1,484,706 $ 1,545,721 $ 1,550,000 Term Loan B due August 2024 794,981 771,697 794,915 795,564 (a) The carrying value of the term loan debt is shown net of original issue debt discounts.

Restructuring and Other Costs

Restructuring and Other Costs	6 Months Ended
	Jun. 30, 2020
Restructuring And Related Activities [Abstract]
Restructuring and Other Costs	6. Restructuring and Other Costs Merger-Related Restructuring During 2017, in connection with the merger (the "Merger") with Double Eagle Parent, Inc. ("inVentiv"), the parent company of inVentiv Health, Inc., the Company established a restructuring plan to eliminate redundant positions and reduce its facility footprint worldwide. The Company expects to continue the ongoing evaluations of its workforce and facilities infrastructure needs in an effort to optimize its resources. During the six months ended June 30, 2020, the Company recognized approximately $1.0 million of employee severance and benefits related costs and $0.8 million of facility closure and lease termination costs. The Company expects to continue to incur costs related to restructuring of its operations in order to achieve targeted synergies. However, the timing and the amount of these costs depend on various factors, including, but not limited to, identifying and realizing synergy opportunities and executing the integration of its combined operations. Non Merger-Related Restructuring and Other Costs During the six months ended June 30, 2020, the Company recognized approximately $14.3 million of costs related to employee severance and benefits, $0.3 million of facility closure and lease termination costs, and $0.5 million of other costs in its continued efforts to optimize its resources worldwide. The costs incurred during the three months ended June 30, 2020 were primarily related to the Company’s cost management strategies in response to the COVID-19 pandemic as well as the Company’s ForwardBound Accrued Restructuring Liabilities The following table summarizes activity related to the liabilities associated with restructuring and other costs during the six months ended June 30, 2020 (in thousands): Employee Severance Costs Other Costs Total Balance as of December 31, 2019 $ 5,728 $ 22 $ 5,750 Expenses incurred (a) 15,310 473 15,783 Cash payments made (14,949 ) (495 ) (15,444 ) Balance as of June 30, 2020 $ 6,089 $ — $ 6,089 (a) The amount of expenses incurred for the six months ended June 30, 2020 excludes $1.1 million of facility lease closure and lease termination costs that are reflected as a reduction of operating lease right-of-use assets on the unaudited condensed consolidated balance sheet under ASC 842. The Company expects the employee severance costs accrued as of June 30, 2020 will be paid within the next twelve months. Certain facility costs will be paid over the remaining lease terms of the exited facilities that range from 2020 through 2027. Liabilities associated with these costs are included in accrued expenses and other long-term liabilities on the accompanying condensed consolidated balance sheets.

Shareholders' Equity

Shareholders' Equity	6 Months Ended
	Jun. 30, 2020
Equity [Abstract]
Shareholders' Equity	7. Shareholders' Equity Shares Outstanding Shares of common stock outstanding were as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Common stock shares, beginning balance 104,161 103,753 103,866 103,372 Repurchases of common stock — (509 ) (600 ) (1,182 ) Issuances of common stock 75 216 970 1,270 Common stock shares, ending balance 104,236 103,460 104,236 103,460 Stock Repurchase Program On February 26, 2018, the Company’s Board of Directors (the "Board") authorized the repurchase of up to an aggregate of $250.0 million of the Company’s common stock 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 (the "stock repurchase program”). On December 5, 2019, the Board increased the dollar amount authorized under the stock repurchase program to up to an aggregate of $300.0 million and extended the term of the stock repurchase program to December 31, 2020. The Company intends to use cash on hand and future operating cash flow to fund the stock repurchase program. The stock repurchase program does not obligate the Company to repurchase any particular amount of the Company’s common stock and may be modified, extended, suspended, or discontinued at any time. The timing and amount of repurchases will be determined by the Company’s management based on a variety of factors such as the market price of the Company’s common stock, the Company’s corporate requirements for cash, and overall market conditions. The stock repurchase program is subject to applicable legal requirements, including federal and state securities laws and applicable Nasdaq rules. The Company may also repurchase shares of its common stock pursuant to a trading plan meeting the requirements of Rule 10b5-1 under the Securities Exchange Act of 1934, as amended, which would permit shares of the Company’s common stock to be repurchased when the Company might otherwise be precluded from doing so by law. The following table sets forth repurchase activity under the stock repurchase program from inception through June 30, 2020: Total number of shares purchased Average price paid per share Approximate value of shares purchased (in thousands) March 2018 948,100 $ 39.55 $ 37,493 April 2018 1,024,400 36.60 37,492 January 2019 552,100 39.16 21,623 February 2019 120,600 41.40 4,993 June 2019 509,100 45.29 23,055 August 2019 141,100 49.93 7,045 March 2020 600,000 53.38 32,029 Total 3,895,400 $ 163,730 The Company immediately retired all of the repurchased common stock and charged the par value of the shares to common stock. The excess of the repurchase price over the par value was applied on a pro rata basis against additional paid-in capital, with the remainder applied to accumulated deficit. As of June 30, 2020, the Company had remaining authorization to repurchase up to approximately $136.3 million of shares of its common stock under the stock repurchase program.

Earnings (Loss) Per Share

Earnings (Loss) Per Share	6 Months Ended
	Jun. 30, 2020
Earnings Per Share [Abstract]
Earnings (Loss) Per Share	8. Earnings (Loss) Per Share The following table provides a reconciliation of the numerators and denominators of the basic and diluted earnings (loss) per share computations (in thousands, except per share data): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Numerator: Net income (loss) $ 3,911 $ 11,292 $ 37,485 $ (18,712 ) Denominator: Basic weighted average common shares outstanding 104,198 103,699 104,232 103,532 Effect of dilutive securities: Stock options and other awards under deferred share-based compensation programs 1,021 1,119 1,198 — Diluted weighted average common shares outstanding 105,219 104,818 105,430 103,532 Earnings (loss) per share: Basic $ 0.04 $ 0.11 $ 0.36 $ (0.18 ) Diluted $ 0.04 $ 0.11 $ 0.36 $ (0.18 ) 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 June 30, Six Months Ended June 30, 2020 2019 2020 2019 Anti-dilutive stock options and other awards 1,052 373 981 333 Anti-dilutive stock options and other awards under share-based compensation programs excluded based on reporting a net loss for the period — — — 1,279 Total common stock equivalents excluded from diluted earnings (loss) per share 1,052 373 981 1,612

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2020
Income Tax Disclosure [Abstract]
Income Taxes	9. Income Taxes Income Tax Expense For the three and . The effective tax rate for the three and six months ended June 30, 2020, excluding discrete items, varied from the United States federal statutory income tax rate of 21.0% primarily d For the three and six months ended June 30, 2019, the Company recorded income tax expense of $22.3 million and $32.7 million, respectively, compared to pre-tax income of $33.6 million and $14.0 million, respectively. Income tax expense for the three and six months ended June 30, 2019 included discrete tax expense in both periods of $10.4 million, primarily related to a reduction in deferred tax assets associated with the closing of a Canadian business unit and prior year adjustments. The effective tax rate for the three and six months ended June 30, 2019, excluding discrete items, varied from the United States federal statutory income tax rate of 21.0% primarily due to base erosion and anti-abuse minimum tax ("BEAT"), foreign income inclusions such as GILTI, and a valuation allowance change on domestic deferred tax assets. BEAT The Tax Cuts and Jobs Act of 2017 introduced a tax on United States corporations that derive tax benefits from deductible payments to non-United States affiliates called BEAT. BEAT applies when base eroding payments are in excess of three percent of the Company’s total deductible payments and also where BEAT exceeds regular United States taxable income, similar to an alternate minimum tax. Changes to the Company’s contractual arrangements, operating structure, and/or final regulations that modify the application of this provision could have a significant impact on the Company’s tax provision. The Company does not anticipate its base eroding payments to exceed the three percent threshold of its deductible payments in 2020; therefore, the Company has not recorded any associated BEAT liability for the three and six months ended June 30, 2020. Unrecognized Tax Benefits The Company's gross unrecognized tax benefits, exclusive of associated interest and penalties, were $23.7 million and $23.2 million as of June 30, 2020 and December 31, 2019, respectively. The increase of $0.5 million was primarily due to an unrecognized tax benefit in the United States, partially offset by recognized benefits as a result of statute expirations in a foreign jurisdiction. Management believes that it is reasonably possible the amount of unrecognized income tax benefits may decrease during the next 12 months by approximately $15.5 million related to the expiration of statutes of limitations. Tax Returns under Audit During the first quarter of 2019, the Company was notified by the Internal Revenue Service that the legacy inVentiv federal income tax return was under audit for the tax year beginning November 10, 2016 and ending December 31, 2016. The examination commenced on May 8, 2019 and was closed during the second quarter of 2020 with no significant adjustments. Additionally, income tax returns are currently under examination by tax authorities in several state and foreign jurisdictions. Management regularly assesses the potential outcomes of both ongoing and potential future examinations and has concluded that the provisions for income taxes adequately reflects their impact. Tax Legislation The Coronavirus Aid, Relief, and Economic Security Act ("CARES Act") was enacted on March 27, 2020 in the United States to address the economic impacts of the COVID-19 pandemic. The CARES Act includes corporate income tax, payroll tax, and other provisions. The Company does not expect there to be a significant impact to its income tax provision as a result of the CARES Act and other global measures for the year ending December 31, 2020. The Company qualifies for certain employer payroll tax credits, which will be treated as government subsidies to offset related operating expenses, as well as the deferral of payroll and other tax payments into the future. The Company has deferred, and plans to continue deferring, the timing of income tax payments and other taxes as permitted by the CARES Act and other stimulus measures enacted globally.

Revenue from Contracts with Cus

Revenue from Contracts with Customers	6 Months Ended
	Jun. 30, 2020
Revenue From Contract With Customer [Abstract]
Revenue from Contract with Customers	10. Revenue from Contracts with Customers Unsatisfied Performance Obligations As of June 30, 2020, 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 ASU No. 2014-09, Revenue from Contracts with Customers Timing of Billing and Performance During the three and six months ended June 30, 2020, the Company recognized approximately $301.5 million and $431.4 million, respectively,

Segment Information

Segment Information	6 Months Ended
	Jun. 30, 2020
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 fully integrated . spanning Phase I-IV of clinical development Commercial Solutions provides the pharmaceutical, biotechnology, and healthcare industries with commercialization services, including deployment solutions, communication solutions (public relations and advertising), and consulting services. The Company’s Chief Operating Decision Maker (“CODM”) reviews segment performance and allocates resources based upon segment revenue and income from operations. Inter-segment revenue is eliminated from the segment reporting presented 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 and general operating expenses associated with the Board and the Company’s senior leadership, finance, investor relations, and internal audit functions. The Company does not allocate depreciation, amortization, asset impairment charges, restructuring and other costs, or transaction and integration-related expenses 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 June 30, Six Months Ended June 30, 2020 2019 2020 2019 Revenue: Clinical Solutions $ 747,179 $ 849,922 $ 1,622,005 $ 1,654,880 Commercial Solutions 266,220 316,905 554,749 630,953 Total revenue 1,013,399 1,166,827 2,176,754 2,285,833 Segment direct costs: Clinical Solutions 590,303 654,403 1,267,394 1,280,170 Commercial Solutions 207,483 255,814 446,224 508,687 Total segment direct costs 797,786 910,217 1,713,618 1,788,857 Segment selling, general, and administrative expenses: Clinical Solutions 63,164 67,625 137,723 137,327 Commercial Solutions 20,431 22,202 44,826 48,255 Total segment selling, general, and administrative expenses 83,595 89,827 182,549 185,582 Segment operating income: Clinical Solutions 93,712 127,894 216,888 237,383 Commercial Solutions 38,306 38,889 63,699 74,011 Total segment operating income 132,018 166,783 280,587 311,394 Direct costs and operating expenses not allocated to segments: Share-based compensation included in direct costs 8,106 7,312 16,288 15,474 Share-based compensation included in selling, general, and administrative expenses 8,069 6,482 15,885 12,587 Corporate selling, general, and administrative expenses 13,312 14,570 24,512 25,827 Restructuring and other costs 8,171 11,882 16,891 26,295 Transaction and integration-related expenses 3,368 7,654 10,945 24,312 Depreciation and amortization 56,021 60,749 112,128 121,949 Total income from operations $ 34,971 $ 58,134 $ 83,938 $ 84,950

Operations by Geographic Locati

Operations by Geographic Location	6 Months Ended
	Jun. 30, 2020
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 June 30, Six Months Ended June 30, 2020 2019 2020 2019 Revenue: North America (a) $ 638,564 $ 791,281 $ 1,391,609 $ 1,518,979 Europe, Middle East, and Africa 242,326 258,787 510,348 517,134 Asia-Pacific 110,186 94,295 227,239 205,861 Latin America 22,323 22,464 47,558 43,859 Total revenue $ 1,013,399 $ 1,166,827 $ 2,176,754 $ 2,285,833 (a) Revenue for the North America region includes revenue attributable to the United States of $608.7 million and $741.2 million, or 60.1% and 63.5% of total revenue, for the three months ended June 30, 2020 and 2019, respectively. Revenue for the North America region includes revenue attributable to the United States of $1,322.2 million and $1,445.3 million, or 60.7% and 63.2% of total revenue, for the six months ended June 30, 2020 and 2019, respectively. No other country represented more than 10% of total revenue for any period. The following table summarizes long-lived assets by geographic area June 30, 2020 December 31, 2019 Property and equipment, net: North America (a) $ 152,677 $ 159,709 Europe, Middle East, and Africa 29,765 28,514 Asia-Pacific 11,216 12,742 Latin America 3,416 2,961 Total property and equipment, net $ 197,074 $ 203,926 (a) Long-lived assets for the North America region include property and equipment, net attributable to the United States of $146.8 million and $153.1 million as of June 30, 2020 and December 31, 2019, respectively.

Concentration of Credit Risk

Concentration of Credit Risk	6 Months Ended
	Jun. 30, 2020
Risks And Uncertainties [Abstract]
Concentration of Credit Risk	Financial assets that subject the Company to credit risk primarily consist of cash and cash equivalents, accounts receivable and unbilled services (including contract assets). The Company's cash and cash equivalents consist principally of cash and are maintained at several financial institutions with reputable credit ratings. The Company maintains cash depository accounts with several financial institutions worldwide and is exposed to credit risk related to the potential inability to access liquidity in financial institutions where its cash and cash equivalents are concentrated. The Company has not historically incurred any losses with respect to these balances and believes that they bear minimal credit risk. As of June 30, 2020 and December 31, 2019, substantially all of the Company’s cash and cash equivalents were held within the United States. No single customer accounted for greater than 10% of the Company’s revenue for the three and six months ended June 30, 2020. As of June 30, 2020 and December 31, 2019, 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, 2020
Related Party Transactions [Abstract]
Related-Party Transactions	14. Related-Party Transactions During the three months ended June 30, 2020, the Company sold its contingent staffing business to a related party in exchange for potential future cash consideration not to exceed $4.0 million. The future cash consideration is contingent on the financial performance of the sold business over the next three years. The Company will recognize the contingent consideration in the consolidated statements of operations as it is resolved. No significant related-party revenue was recorded for the six months ended June 30, 2020. No related party expenses were recorded for the three months ended June 30, 2019. For the six months ended June 30, 2019, the Company incurred reimbursable out-of-pocket expenses of $1.1 million for professional services obtained from a provider whose board of directors included a member who was also a member of the Company's Board. This provider ceased to be a related party as of December 31, 2019. No significant related-party revenue was recorded for the six months ended June 30, 2019.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2020
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	15. Commitments and Contingencies Legal Proceedings The Company is party to legal proceedings incidental to its business. While the Company's management currently believes the ultimate outcome of these proceedings, individually and in the aggregate, will not have a significant adverse effect on the Company's consolidated financial statements, litigation is subject to inherent uncertainties. Were an unfavorable ruling to occur, there exists the possibility of a significant adverse impact on the Company's financial condition and results of operations. 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.) in the Southern District of New York, names as defendants the Company, Michael Bell, Alistair MacDonald, Michael Gilbertini, and Gregory S. Rush (the "Bermudez action"), and the second action, Vaitkuvienë v. Syneos Health, Inc., et al, No. 18-0029 (E.D.N.C.) in the Eastern District of North Carolina, filed on January 25, 2018 (the "Vaitkuvienë action"), names as defendants the Company, Alistair MacDonald, and Gregory S. Rush (the "Initial Defendants"). Both complaints allege similar claims under Section 10(b) and Section 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 and November 9, 2017. The complaints allege that the Company published inaccurate or incomplete information regarding, among other things, the financial performance and business outlook for inVentiv’s business prior to the Merger and with respect to the combined company following the Merger. On January 30, 2018, two alleged shareholders separately filed motions seeking to be appointed lead plaintiff and approving the selection of lead counsel. On March 30, 2018, Plaintiff Bermudez filed a notice of voluntary dismissal of the Bermudez action, without prejudice, and as to all defendants. On May 29, 2018, the Court in the Vaitkuvienë action appointed the San Antonio Fire & Police Pension Fund and El Paso Firemen & Policemen’s Pension Fund as Lead Plaintiffs and, on June 7, 2018, the Court entered a schedule providing for, among other things, Lead Plaintiffs to file an amended complaint by July 23, 2018 (later extended to July 30, 2018). Lead Plaintiffs filed their amended complaint on July 30, 2018, which also includes a claim against the Initial Defendants, as well as each member of the board of directors at the time of the INC Research - inVentiv Health merger vote in July 2017 (the “Defendants”), contending that the inVentiv merger proxy was misleading under Section 14(a) of the Act. Lead Plaintiffs seek, 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. Defendants filed a Motion to Dismiss Plaintiffs’ Amended Complaint on September 20, 2018. Lead Plaintiffs filed a Response in Opposition to such motion on November 21, 2018, and Defendants filed a Reply to such response on December 5, 2018. On September 26, 2019, the Court ordered, among other things, that this action be stayed. The Company and the other defendants deny the allegations in these complaints and intend to defend vigorously against these claims. The Company is presently unable to predict the duration, scope, or result of the Vaitkuvienë action, 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 this matter. While the Company intends to defend the putative class action litigation vigorously, the outcome of such litigation or any other litigation is necessarily uncertain. The Company could be forced to expend significant resources in the defense of this lawsuit or future ones, and it may not prevail. As such, these matters could have a significant adverse effect on the Company's business, annual, or interim results of operations, cash flows, or its financial condition. Assumed Contingent Tax-Sharing Obligations As a result of the Merger, the Company assumed contingent tax-sharing obligations arising from inVentiv Health, Inc.'s 2016 merger with Double Eagle Parent, Inc. As of June 30, 2020 and December 31, 2019, the estimated fair value of the assumed contingent tax-sharing obligations was $6.5 million and $32.7 million, respectively. Contingent Earn-out Liability In connection with the acquisition of Kinapse Topco Limited ("Kinapse") in August 2018, the Company recorded a contingent earn-out liability to be paid based on Kinapse meeting revenue targets as of March 31, 2021. The estimated fair value of the contingent earn-out liability was $4.6 million as of December 31, 2019 and was included in other long-term liabilities in the condensed consolidated balance sheet. During the three months ended March 31, 2020, the Company adjusted the fair value of the contingent earn-out liability to zero to reflect the updated probability of achievement of the revenue targets. The change in fair value of the earn-out liability was recorded in transaction and integration-related expenses in the condensed consolidated statement of operations.

Basis of Presentation and Cha_2

Basis of Presentation and Changes in Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2020
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 year ended December 31, 2019, filed with the Securities and Exchange Commission (“SEC”) on February 20, 2020. The results of operations for the three and six months ended June 30, 2020 are not necessarily indicative of the results to be expected for the full year ending December 31, 2020 or any other future period. The unaudited condensed consolidated balance sheet at December 31, 2019 is derived from the amounts in the audited consolidated balance sheet included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019.
Recently Adopted Accounting Standards	Recently Adopted Accounting Standards In June 2016, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2016-13 ("ASU 2016-13"), Financial Instruments - Credit Losses (Topic 326) In March 2020, the FASB issued ASU No. 2020-04 ("ASU 2020-04"), Reference Rate Reform (Topic 848)
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, 2020
Organization Consolidation And Presentation Of Financial Statements [Abstract]
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, 2020 December 31, 2019 Accounts receivable billed $ 659,556 $ 787,652 Unbilled services (including contract assets) 522,414 521,370 Less: Allowance for doubtful accounts (7,949 ) (5,381 ) Accounts receivable and unbilled services, net $ 1,174,021 $ 1,303,641
Schedule of Goodwill	The changes in the carrying amount of goodwill by segment for the six months ended June 30, 2020 were as follows (in thousands): Clinical Solutions (a) Commercial Solutions (b) Total Balance as of January 1, 2020 $ 2,784,952 $ 1,565,428 $ 4,350,380 Impact of foreign currency translation (20,473 ) (6,678 ) (27,151 ) Balance as of June 30, 2020 $ 2,764,479 $ 1,558,750 $ 4,323,229 (a) Accumulated impairment losses of $8.1 million associated with the Clinical Solutions segment were recorded prior to 2016 and related to the former Phase I Services segment, now a component of the Clinical Solutions segment. No impairment of goodwill was recorded for the six months ended June 30, 2020. (b) Accumulated impairment losses of $8.0 million associated with the Commercial Solutions segment were recorded prior to 2015 and related to the former Global Consulting segment, now a component of the Commercial Solutions segment. No impairment of goodwill was recorded for the six months ended June 30, 2020.
Schedule of Transaction and Integration-Related Expenses	Transaction and integration-related expenses consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Professional fees $ 2,438 $ 6,678 $ 12,561 $ 19,523 Debt modification and related expenses 71 1,732 71 3,973 Integration and personnel retention-related costs 707 909 2,256 1,756 Fair value adjustments to contingent obligations 152 (1,665 ) (3,943 ) (940 ) Total transaction and integration-related expenses $ 3,368 $ 7,654 $ 10,945 $ 24,312
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 June 30, Six Months Ended June 30, 2020 2019 2020 2019 Beginning balance $ (131,111 ) $ (71,807 ) $ (71,593 ) $ (88,195 ) Foreign currency translation: Beginning balance (105,545 ) (60,351 ) (56,757 ) (80,955 ) Other comprehensive income (loss) before reclassifications 2,870 (11,919 ) (45,918 ) 8,685 Ending balance (102,675 ) (72,270 ) (102,675 ) (72,270 ) Derivative instruments: Beginning balance (25,566 ) (11,456 ) (14,836 ) (7,240 ) Other comprehensive loss before reclassifications (5,461 ) (9,544 ) (17,971 ) (14,246 ) Reclassification adjustments 4,330 582 6,110 1,068 Ending balance (26,697 ) (20,418 ) (26,697 ) (20,418 ) Accumulated other comprehensive loss, net of taxes $ (129,372 ) $ (92,688 ) $ (129,372 ) $ (92,688 )
Reclassification out of Accumulated Other Comprehensive (Loss) Income	Changes in accumulated other comprehensive loss consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Foreign currency translation adjustments: Foreign currency translation adjustments, net of taxes $ 2,870 $ (11,919 ) $ (45,918 ) $ 8,685 Unrealized loss on derivative instruments: Unrealized loss during period, before taxes (6,876 ) (9,800 ) (26,659 ) (14,616 ) Income tax benefit (1,415 ) (256 ) (8,688 ) (370 ) Unrealized loss during period, net of taxes (5,461 ) (9,544 ) (17,971 ) (14,246 ) Reclassification adjustment, before taxes 5,797 601 8,211 1,106 Income tax expense 1,467 19 2,101 38 Reclassification adjustment, net of taxes 4,330 582 6,110 1,068 Total unrealized loss on derivative instruments, net of taxes (1,131 ) (8,962 ) (11,861 ) (13,178 ) Total other comprehensive income (loss), net of taxes $ 1,739 $ (20,881 ) $ (57,779 ) $ (4,493 )
Schedule of Other Expense (Income), Net (Details)	Other expense (income), net consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Net realized foreign currency loss (gain) $ 3,045 $ (7,275 ) $ (2,051 ) $ 1,131 Net unrealized foreign currency loss (gain) 2,478 (880 ) (12,541 ) (957 ) Other, net 238 582 1,423 1,174 Total other expense (income), net $ 5,761 $ (7,573 ) $ (13,169 ) $ 1,348

Long-Term Debt Obligations (Tab

Long-Term Debt Obligations (Tables)	6 Months Ended
	Jun. 30, 2020
Debt Disclosure [Abstract]
Schedule of Debt Obligations	The Company’s debt obligations consisted of the following (in thousands): June 30, 2020 December 31, 2019 Term Loan A due March 2024 $ 1,530,625 $ 1,550,000 Term Loan B due August 2024 795,564 795,564 Revolving credit facility due March 2024 150,000 — Accounts receivable financing agreement due September 2021 275,000 275,000 Total debt obligations 2,751,189 2,620,564 Less: Term loan original issuance discount (4,312 ) (4,928 ) Less: Unamortized deferred issuance costs (6,327 ) (7,116 ) Less: Current portion of debt (87,187 ) (58,125 ) Total debt obligations, non-current portion $ 2,653,363 $ 2,550,395
Contractual Maturities of Debt Obligations	As of June 30, 2020, the contractual maturities of the Company’s debt obligations (excluding leases) were as follows (in thousands): Principal Interest (a) 2020 $ 38,750 $ 24,589 2021 381,563 46,435 2022 145,312 42,011 2023 155,000 39,380 2024 2,030,564 13,108 Less: Deferred issuance costs (6,327 ) Less: Term loan original issuance discount (4,312 ) Total $ 2,740,550 $ 165,523 (a) The interest payments on long-term debt in the above table are based on interest rates in effect as of June 30, 2020.

Derivatives (Tables)

Derivatives (Tables)	6 Months Ended
	Jun. 30, 2020
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, 2020 December 31, 2019 Interest rate swaps - current Prepaid expenses and other current assets $ — $ 155 Fair value of derivative assets $ — $ 155 Interest rate swaps - current Accrued expenses $ 27,593 $ 11,358 Interest rate swaps - non-current Other long-term liabilities 8,154 6,095 Fair value of derivative liabilities $ 35,747 $ 17,453

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2020
Fair Value Disclosures [Abstract]
Schedule of Assets and Liabilities Measured at Fair Value on a Recurring Basis	As of June 30, 2020, 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 Measured at Net Asset Value Total Assets: Trading securities (a) $ 19,872 $ — $ — $ — $ 19,872 Partnership interest (b) — — — 7,678 7,678 Total assets $ 19,872 $ — $ — $ 7,678 $ 27,550 Liabilities: Derivative instruments (c) $ — $ 35,747 $ — $ — $ 35,747 Contingent obligations related to business combinations (d) — — 6,490 — 6,490 Total liabilities $ — $ 35,747 $ 6,490 $ — $ 42,237 As of December 31, 2019, 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 Measured at Net Asset Value Total Assets: Trading securities (a) $ 21,552 $ — $ — $ — $ 21,552 Partnership interest (b) — — — 7,226 7,226 Derivative instruments (c) — 155 — — 155 Total assets $ 21,552 $ 155 $ — $ 7,226 $ 28,933 Liabilities: Derivative instruments (c) $ — $ 17,453 $ — $ — $ 17,453 Contingent obligations related to business combinations (d) — — 37,324 — 37,324 Total liabilities $ — $ 17,453 $ 37,324 $ — $ 54,777 (a) Represents 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, 2020, the Company’s remaining unfunded commitment in the private equity funds was $14.2 million. The Company holds minor ownership interests (less than 3%) in each of the private equity funds and has determined that it does not exercise significant influence over the private equity funds' operating and finance activities. As the private equity funds do not have readily determinable fair values, the Company has estimated the fair values using each fund’s Net Asset Value, the amount by which the value of all assets exceeds all debt and liabilities, in accordance with 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 business combinations. 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, 2020 (in thousands): Balance as of December 31, 2019 $ 37,324 Additions — Changes in fair value recognized in earnings (4,200 ) Payments (26,634 ) Balance as of June 30, 2020 $ 6,490
Schedule of Estimated Fair Value	The estimated fair values of the Company’s outstanding term loans were as follows (in thousands): June 30, 2020 December 31, 2019 Carrying Value (a) Estimated Fair Value Carrying Value (a) Estimated Fair Value Term Loan A due March 2024 $ 1,526,897 $ 1,484,706 $ 1,545,721 $ 1,550,000 Term Loan B due August 2024 794,981 771,697 794,915 795,564 (a) The carrying value of the term loan debt is shown net of original issue debt discounts.

Restructuring and Other Costs (

Restructuring and Other Costs (Tables)	6 Months Ended
	Jun. 30, 2020
Restructuring And Related Activities [Abstract]
Schedule of Restructuring and Related Costs	The following table summarizes activity related to the liabilities associated with restructuring and other costs during the six months ended June 30, 2020 (in thousands): Employee Severance Costs Other Costs Total Balance as of December 31, 2019 $ 5,728 $ 22 $ 5,750 Expenses incurred (a) 15,310 473 15,783 Cash payments made (14,949 ) (495 ) (15,444 ) Balance as of June 30, 2020 $ 6,089 $ — $ 6,089 (a) The amount of expenses incurred for the six months ended June 30, 2020 excludes $1.1 million of facility lease closure and lease termination costs that are reflected as a reduction of operating lease right-of-use assets on the unaudited condensed consolidated balance sheet under ASC 842.

Shareholders' Equity (Tables)

Shareholders' Equity (Tables)	6 Months Ended
	Jun. 30, 2020
Equity [Abstract]
Shares of Common Stock Outstanding	Shares of common stock outstanding were as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Common stock shares, beginning balance 104,161 103,753 103,866 103,372 Repurchases of common stock — (509 ) (600 ) (1,182 ) Issuances of common stock 75 216 970 1,270 Common stock shares, ending balance 104,236 103,460 104,236 103,460
Schedule of Repurchase Activity	The following table sets forth repurchase activity under the stock repurchase program from inception through June 30, 2020: Total number of shares purchased Average price paid per share Approximate value of shares purchased (in thousands) March 2018 948,100 $ 39.55 $ 37,493 April 2018 1,024,400 36.60 37,492 January 2019 552,100 39.16 21,623 February 2019 120,600 41.40 4,993 June 2019 509,100 45.29 23,055 August 2019 141,100 49.93 7,045 March 2020 600,000 53.38 32,029 Total 3,895,400 $ 163,730

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	6 Months Ended
	Jun. 30, 2020
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 (loss) per share computations (in thousands, except per share data): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Numerator: Net income (loss) $ 3,911 $ 11,292 $ 37,485 $ (18,712 ) Denominator: Basic weighted average common shares outstanding 104,198 103,699 104,232 103,532 Effect of dilutive securities: Stock options and other awards under deferred share-based compensation programs 1,021 1,119 1,198 — Diluted weighted average common shares outstanding 105,219 104,818 105,430 103,532 Earnings (loss) per share: Basic $ 0.04 $ 0.11 $ 0.36 $ (0.18 ) Diluted $ 0.04 $ 0.11 $ 0.36 $ (0.18 )
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 June 30, Six Months Ended June 30, 2020 2019 2020 2019 Anti-dilutive stock options and other awards 1,052 373 981 333 Anti-dilutive stock options and other awards under share-based compensation programs excluded based on reporting a net loss for the period — — — 1,279 Total common stock equivalents excluded from diluted earnings (loss) per share 1,052 373 981 1,612

Segment Information (Tables)

Segment Information (Tables)	6 Months Ended
	Jun. 30, 2020
Segment Reporting [Abstract]
Schedule of Segment Information	Information about reportable segment operating results was as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Revenue: Clinical Solutions $ 747,179 $ 849,922 $ 1,622,005 $ 1,654,880 Commercial Solutions 266,220 316,905 554,749 630,953 Total revenue 1,013,399 1,166,827 2,176,754 2,285,833 Segment direct costs: Clinical Solutions 590,303 654,403 1,267,394 1,280,170 Commercial Solutions 207,483 255,814 446,224 508,687 Total segment direct costs 797,786 910,217 1,713,618 1,788,857 Segment selling, general, and administrative expenses: Clinical Solutions 63,164 67,625 137,723 137,327 Commercial Solutions 20,431 22,202 44,826 48,255 Total segment selling, general, and administrative expenses 83,595 89,827 182,549 185,582 Segment operating income: Clinical Solutions 93,712 127,894 216,888 237,383 Commercial Solutions 38,306 38,889 63,699 74,011 Total segment operating income 132,018 166,783 280,587 311,394 Direct costs and operating expenses not allocated to segments: Share-based compensation included in direct costs 8,106 7,312 16,288 15,474 Share-based compensation included in selling, general, and administrative expenses 8,069 6,482 15,885 12,587 Corporate selling, general, and administrative expenses 13,312 14,570 24,512 25,827 Restructuring and other costs 8,171 11,882 16,891 26,295 Transaction and integration-related expenses 3,368 7,654 10,945 24,312 Depreciation and amortization 56,021 60,749 112,128 121,949 Total income from operations $ 34,971 $ 58,134 $ 83,938 $ 84,950

Operations by Geographic Loca_2

Operations by Geographic Location (Tables)	6 Months Ended
	Jun. 30, 2020
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 June 30, Six Months Ended June 30, 2020 2019 2020 2019 Revenue: North America (a) $ 638,564 $ 791,281 $ 1,391,609 $ 1,518,979 Europe, Middle East, and Africa 242,326 258,787 510,348 517,134 Asia-Pacific 110,186 94,295 227,239 205,861 Latin America 22,323 22,464 47,558 43,859 Total revenue $ 1,013,399 $ 1,166,827 $ 2,176,754 $ 2,285,833 (a) Revenue for the North America region includes revenue attributable to the United States of $608.7 million and $741.2 million, or 60.1% and 63.5% of total revenue, for the three months ended June 30, 2020 and 2019, respectively. Revenue for the North America region includes revenue attributable to the United States of $1,322.2 million and $1,445.3 million, or 60.7% and 63.2% of total revenue, for the six months ended June 30, 2020 and 2019, respectively. No other country represented more than 10% of total revenue for any period.
Long-Lived Assets by Geographic Area	The following table summarizes long-lived assets by geographic area June 30, 2020 December 31, 2019 Property and equipment, net: North America (a) $ 152,677 $ 159,709 Europe, Middle East, and Africa 29,765 28,514 Asia-Pacific 11,216 12,742 Latin America 3,416 2,961 Total property and equipment, net $ 197,074 $ 203,926 (a) Long-lived assets for the North America region include property and equipment, net attributable to the United States of $146.8 million and $153.1 million as of June 30, 2020 and December 31, 2019, respectively.

Basis of Presentation and Cha_3

Basis of Presentation and Changes in Significant Accounting Policies - Narrative (Details) $ in Thousands	Jan. 01, 2020USD ($)	Jun. 30, 2020USD ($)	Jun. 30, 2019USD ($)	Jun. 30, 2020USD ($)Segment	Jun. 30, 2019USD ($)	Mar. 31, 2020USD ($)	Dec. 31, 2019USD ($)	Mar. 31, 2019USD ($)	Dec. 31, 2018USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Number of reportable segments | Segment				2
Impact from adoption of ASU		$ 2,999,684	$ 2,823,899	$ 2,999,684	$ 2,823,899	$ 2,977,922	$ 3,029,654	$ 2,838,370	$ 2,856,144
Accounting Standards Update [Extensible List]		us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member
Cumulative Effect, Period of Adoption, Adjustment
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Impact from adoption of ASU	$ 2,800						$ (2,771)
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Change in accounting principle, accounting standards update, adopted [true/false]		true		true
Change in accounting principle, accounting standards update, adoption date		Jan. 1, 2020		Jan. 1, 2020

Financial Statement Details - N

Financial Statement Details - Narrative (Details) - USD ($) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2020	Jun. 30, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Non-cash investment in acquire prpoerty	$ 27.3
Trade receivables sold		$ 77.6	$ 113.7
Proceeds from sale of trade receivables		$ 77.3	$ 112.8

Financial Statement Details - A

Financial Statement Details - Accounts Receivable and Unbilled Services, net (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Receivables [Abstract]
Accounts receivable billed	$ 659,556	$ 787,652
Unbilled services (including contract assets)	522,414	521,370
Less: Allowance for doubtful accounts	(7,949)	(5,381)
Accounts receivable and unbilled services, net	$ 1,174,021	$ 1,303,641

Financial Statement Details - S

Financial Statement Details - Schedule of Goodwill (Details) - USD ($)	6 Months Ended
	Jun. 30, 2020	Dec. 31, 2019
Goodwill [Roll Forward]
Balance as of January 1, 2020	$ 4,350,380,000
Impact of foreign currency translation	(27,151,000)
Balance as of June 30, 2020	4,323,229,000
Clinical Solutions
Goodwill [Roll Forward]
Balance as of January 1, 2020	2,784,952,000
Impact of foreign currency translation	(20,473,000)
Balance as of June 30, 2020	2,764,479,000
Accumulated impairment losses	8,100,000	$ 8,100,000
Impairment of goodwill	0
Commercial Solutions
Goodwill [Roll Forward]
Balance as of January 1, 2020	1,565,428,000
Impact of foreign currency translation	(6,678,000)
Balance as of June 30, 2020	1,558,750,000
Accumulated impairment losses	8,000,000	$ 8,000,000
Impairment of goodwill	$ 0

Financial Statement Details - T

Financial Statement Details - Transaction and Integration-Related Expenses (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Income Statement [Abstract]
Professional fees	$ 2,438	$ 6,678	$ 12,561	$ 19,523
Debt modification and related expenses	71	1,732	71	3,973
Integration and personnel retention-related costs	707	909	2,256	1,756
Fair value adjustment of contingent obligations	152	(1,665)	(3,943)	(940)
Total transaction and integration-related expenses	$ 3,368	$ 7,654	$ 10,945	$ 24,312

Financial Statement Details -_2

Financial Statement Details - Accumulated Other Comprehensive Loss, Net of Taxes (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	$ 2,977,922	$ 2,838,370	$ 3,029,654	$ 2,856,144
Balance at end of period	2,999,684	2,823,899	2,999,684	2,823,899
Accumulated Other Comprehensive Loss
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(131,111)	(71,807)	(71,593)	(88,195)
Balance at end of period	(129,372)	(92,688)	(129,372)	(92,688)
Foreign Currency Translation
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(105,545)	(60,351)	(56,757)	(80,955)
Other comprehensive income (loss) before reclassifications	2,870	(11,919)	(45,918)	8,685
Balance at end of period	(102,675)	(72,270)	(102,675)	(72,270)
Derivative Instruments
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(25,566)	(11,456)	(14,836)	(7,240)
Other comprehensive income (loss) before reclassifications	(5,461)	(9,544)	(17,971)	(14,246)
Reclassification adjustments	4,330	582	6,110	1,068
Balance at end of period	$ (26,697)	$ (20,418)	$ (26,697)	$ (20,418)

Financial Statement Details -_3

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, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Accumulated Other Comprehensive Income (Loss) [Line Items]
Total other comprehensive income (loss), net of taxes	$ 1,739	$ (20,881)	$ (57,779)	$ (4,493)
Foreign Currency Translation
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized loss during period, net of taxes	2,870	(11,919)	(45,918)	8,685
Total other comprehensive income (loss), net of taxes	2,870	(11,919)	(45,918)	8,685
Derivative Instruments
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized loss during period, before taxes	(6,876)	(9,800)	(26,659)	(14,616)
Income tax benefit	(1,415)	(256)	(8,688)	(370)
Unrealized loss during period, net of taxes	(5,461)	(9,544)	(17,971)	(14,246)
Reclassification adjustment, before taxes	5,797	601	8,211	1,106
Income tax expense	1,467	19	2,101	38
Reclassification adjustment, net of taxes	4,330	582	6,110	1,068
Total other comprehensive income (loss), net of taxes	$ (1,131)	$ (8,962)	$ (11,861)	$ (13,178)

Financial Statement Details - O

Financial Statement Details - Other Expense (Income), Net (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Other (income) expense, net:
Net realized foreign currency loss (gain)	$ 3,045	$ (7,275)	$ (2,051)	$ 1,131
Net unrealized foreign currency loss (gain)	2,478	(880)	(12,541)	(957)
Other, net	238	582	1,423	1,174
Total other expense (income), net	$ 5,761	$ (7,573)	$ (13,169)	$ 1,348

Long-Term Debt Obligations - Sc

Long-Term Debt Obligations - Schedule of Debt Obligations (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Less: Term loan original issuance discount	$ (4,312)	$ (4,928)
Less: Unamortized deferred issuance costs	(6,327)	(7,116)
Less: Current portion of debt	(87,187)	(58,125)
Total debt obligations, non-current portion	2,653,363	2,550,395
Secured Debt
Debt Instrument [Line Items]
Total debt obligations	2,751,189	2,620,564
Secured Debt | Term Loan A due March 2024
Debt Instrument [Line Items]
Total debt obligations	1,530,625	1,550,000
Secured Debt | Term Loan B due August 2024
Debt Instrument [Line Items]
Total debt obligations	795,564	795,564
Secured Debt | Revolving credit facility due March 2024
Debt Instrument [Line Items]
Total debt obligations	150,000
Secured Debt | Accounts receivable financing agreement due September 2021 | Accounts Receivable Securitization
Debt Instrument [Line Items]
Total debt obligations	$ 275,000	$ 275,000

Long-Term Debt Obligations - Na

Long-Term Debt Obligations - Narrative (Details) - Secured Debt - USD ($)	6 Months Ended
	Jun. 30, 2020	Jul. 31, 2020
Term Loan A due March 2024 | Term Loan
Debt Instrument [Line Items]
Term loan facility	$ 1,550,000,000
Principal payment	19,400,000
Term Loan B due August 2024 | Term Loan
Debt Instrument [Line Items]
Term loan facility	1,600,000,000
Amendment No 2 - Revolving Credit Facility due March 2024 | Revolving credit facility due March 2024
Debt Instrument [Line Items]
Maximum borrowing capacity under accounts receivable financing agreement	600,000,000
Revolving Credit Facility Due August 2024
Debt Instrument [Line Items]
Long-term line of credit	150,000,000
Remaining capacity available under accounts receivable financing agreement	431,100,000
Revolving Credit Facility Due August 2024 | Letter of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity under accounts receivable financing agreement	150,000,000
Long-term line of credit	$ 18,900,000
Revolving Credit Facility Due August 2024 | Letter of Credit | Subsequent Event
Debt Instrument [Line Items]
Long-term line of credit		$ 150,000,000

Long-Term Debt Obligations - Ac

Long-Term Debt Obligations - Accounts Receivable Financing Agreement (Details)	6 Months Ended
	Jun. 30, 2020USD ($)
Debt Instrument [Line Items]
Long-term debt	$ 2,740,550,000
Wholly-owned Special Purpose Entity
Debt Instrument [Line Items]
Prepay notice, term	1 day
Termination or reduction to limit notice, term	15 days
Accounts receivable financing agreement due September 2021 | Secured Debt | Accounts Receivable Securitization
Debt Instrument [Line Items]
Long-term debt	$ 275,000,000
Accounts receivable financing agreement due September 2021 | Secured Debt | Accounts Receivable Securitization | Wholly-owned Special Purpose Entity
Debt Instrument [Line Items]
Remaining capacity available under accounts receivable financing agreement	$ 0
Accounts receivable financing agreement due September 2021 | Secured Debt | Accounts Receivable Securitization | Wholly-owned Special Purpose Entity | Federal Funds Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.50%

Long-Term Debt Obligations - Co

Long-Term Debt Obligations - Contractual Maturities of Debt Obligations (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Principal
2020	$ 38,750
2021	381,563
2022	145,312
2023	155,000
2024	2,030,564
Less: Unamortized deferred issuance costs	(6,327)	$ (7,116)
Less: Term loan original issuance discount	(4,312)	$ (4,928)
Total	2,740,550
Interest
2020	24,589
2021	46,435
2022	42,011
2023	39,380
2024	13,108
Total	$ 165,523

Derivatives - Narrative (Detail

Derivatives - Narrative (Details) - USD ($) $ in Millions	Jan. 01, 2021	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2018	May 31, 2016
Interest Rate Swap, expiring March 31, 2023
Derivative [Line Items]
Notional amount		$ 604.1	$ 549.2
Interest Rate Swaps, expiring on June 30, 2018 and May 14, 2020
Derivative [Line Items]
Notional amount					$ 300
Interest Rate Swap, expiring June 30, 2021
Derivative [Line Items]
Notional amount		$ 928.7		$ 1,010
Forecast | Interest Rate Swap, expiring March 31, 2023
Derivative [Line Items]
Notional amount	$ 1,420

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, 2020	Dec. 31, 2019
Derivatives, Fair Value [Line Items]
Derivative asset - current	$ 0	$ 155
Derivative liability	35,747	17,453
Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Derivative asset - current	0	155
Accrued expenses
Derivatives, Fair Value [Line Items]
Derivative liability - current	27,593	11,358
Other long-term liabilities
Derivatives, Fair Value [Line Items]
Derivative liability - non-current	$ 8,154	$ 6,095

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, 2020	Dec. 31, 2019
Assets:
Trading securities	$ 19,872	$ 21,552
Derivative instruments		155
Total assets	27,550	28,933
Liabilities:
Derivative instruments	35,747	17,453
Contingent obligations related to business combinations	6,490	37,324
Total liabilities	42,237	54,777
Partnership Interest
Assets:
Partnership interest	7,678	7,226
Level 1
Assets:
Trading securities	19,872	21,552
Derivative instruments		0
Total assets	19,872	21,552
Liabilities:
Derivative instruments	0	0
Contingent obligations related to business combinations	0	0
Total liabilities	0	0
Level 1 | Partnership Interest
Assets:
Partnership interest	0	0
Level 2
Assets:
Trading securities	0	0
Derivative instruments		155
Total assets	0	155
Liabilities:
Derivative instruments	35,747	17,453
Contingent obligations related to business combinations	0	0
Total liabilities	35,747	17,453
Level 2 | Partnership Interest
Assets:
Partnership interest	0	0
Level 3
Assets:
Trading securities	0	0
Derivative instruments		0
Total assets	0	0
Liabilities:
Derivative instruments	0	0
Contingent obligations related to business combinations	6,490	37,324
Total liabilities	6,490	37,324
Level 3 | Partnership Interest
Assets:
Partnership interest	0	0
Investments Measured at Net Asset Value
Assets:
Trading securities	0	0
Derivative instruments		0
Total assets	7,678	7,226
Liabilities:
Derivative instruments	0	0
Contingent obligations related to business combinations	0	0
Total liabilities	0	0
Investments Measured at Net Asset Value | Partnership Interest
Assets:
Partnership interest	$ 7,678	$ 7,226

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, 2020USD ($)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	$ 14.2
Number of private equity funds | EquityFund	2
Healthcare and Life Sciences Industry
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Minority interest ownership percentage	3.00%

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, 2020USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance as of December 31, 2019	$ 37,324
Additions	0
Changes in fair value recognized in earnings	(4,200)
Payments	(26,634)
Balance as of June 30, 2020	$ 6,490

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($)	6 Months Ended
	Jun. 30, 2020	Dec. 31, 2019
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	$ 5,240,000,000	$ 5,320,000,000

Fair Value Measurements - Sch_3

Fair Value Measurements - Schedule of Estimated Fair Value (Details) - Level 2 - Secured Debt - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Term Loan A due March 2024 | Carrying Value
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, carrying value	$ 1,526,897	$ 1,545,721
Term Loan A due March 2024 | Estimated Fair Value
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, fair value	1,484,706	1,550,000
Term Loan B due August 2024 | Carrying Value
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, carrying value	794,981	794,915
Term Loan B due August 2024 | Estimated Fair Value
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Long-term debt, fair value	$ 771,697	$ 795,564

Restructuring and Other Costs -

Restructuring and Other Costs - Narrative (Details) $ in Millions	6 Months Ended
	Jun. 30, 2020USD ($)
Employee Severance Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	$ 14.3
Facility Closure and Lease Termination Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	0.3
Other Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	0.5
InVentiv Merger | Employee Severance Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	1
InVentiv Merger | Facility Closure and Lease Termination Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	$ 0.8

Restructuring and Other Costs_2

Restructuring and Other Costs - Schedule of Restructuring and Related Costs (Details) - Business Restructuring Reserves $ in Thousands	6 Months Ended
	Jun. 30, 2020USD ($)
Restructuring Reserve
Balance as of December 31, 2019	$ 5,750
Expenses incurred	15,783
Cash payments made	(15,444)
Balance as of June 30, 2020	6,089
Facility lease closure and lease termination costs	1,100
Employee Severance Costs
Restructuring Reserve
Balance as of December 31, 2019	5,728
Expenses incurred	15,310
Cash payments made	(14,949)
Balance as of June 30, 2020	6,089
Other Costs
Restructuring Reserve
Balance as of December 31, 2019	22
Expenses incurred	473
Cash payments made	$ (495)

Shareholders' Equity - Shares o

Shareholders' Equity - Shares of Common Stock Outstanding (Details) - Common Stock - shares	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Common stock shares, beginning balance	104,161,000	103,753,000	103,866,000	103,372,000
Repurchases of common stock		(509,000)	(600,000)	(1,182,000)
Issuances of common stock	75,000	216,000	970,000	1,270,000
Common stock shares, ending balance	104,236,000	103,460,000	104,236,000	103,460,000

Shareholders' Equity - Narrativ

Shareholders' Equity - Narrative (Details) - USD ($)	Jun. 30, 2020	Dec. 05, 2019	Feb. 26, 2018
Class of Stock [Line Items]
Stock repurchase program, authorized amount		$ 300,000,000	$ 250,000,000
Common Stock
Class of Stock [Line Items]
Stock repurchase program, remaining authorization to repurchase	$ 136,300,000

Shareholders' Equity - Repurcha

Shareholders' Equity - Repurchase Activity (Details) - Common Stock - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended							28 Months Ended
	Mar. 31, 2020	Aug. 31, 2019	Jun. 30, 2019	Feb. 28, 2019	Jan. 31, 2019	Apr. 30, 2018	Mar. 31, 2018	Jun. 30, 2020
Class of Stock [Line Items]
Stock repurchased (in shares)	600,000	141,100	509,100	120,600	552,100	1,024,400	948,100	3,895,400
Stock repurchased, average price paid per share (USD per share)	$ 53.38	$ 49.93	$ 45.29	$ 41.40	$ 39.16	$ 36.60	$ 39.55
Stock repurchase program, shares purchased, value	$ 32,029	$ 7,045	$ 23,055	$ 4,993	$ 21,623	$ 37,492	$ 37,493	$ 163,730

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, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Numerator:
Net income (loss)	$ 3,911	$ 11,292	$ 37,485	$ (18,712)
Weighted Average Number of Shares Outstanding Reconciliation [Abstract]
Basic weighted average common shares outstanding (in shares)	104,198	103,699	104,232	103,532
Effect of dilutive securities:
Stock options and other awards under deferred share-based compensation programs (in shares)	1,021	1,119	1,198	0
Diluted weighted average common shares outstanding (in shares)	105,219	104,818	105,430	103,532
Earnings (loss) per share:
Basic (USD per share)	$ 0.04	$ 0.11	$ 0.36	$ (0.18)
Diluted (USD per share)	$ 0.04	$ 0.11	$ 0.36	$ (0.18)

Earnings (Loss) Per Share - S_2

Earnings (Loss) Per Share - Schedule of Antidilutive Securities Excluded from Computation of Earnings (Loss) Per Share (Details) - shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share
Total common stock equivalents excluded from diluted loss per share (in shares)	1,052	373	981	1,612
Stock-Based Compensation Plans
Antidilutive Securities Excluded from Computation of Earnings Per Share
Total common stock equivalents excluded from diluted loss per share (in shares)	1,052	373	981	333
Stock-Based Compensation Plans | Anti-dilutive stock options and other awards under share-based compensation programs excluded based on reporting a net loss for the period
Antidilutive Securities Excluded from Computation of Earnings Per Share
Total common stock equivalents excluded from diluted loss per share (in shares)	0	0	0	1,279

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Income tax expense	$ 3,737	$ 22,285	$ 11,938	$ 32,701
Income before provision for income taxes	7,648	33,577	49,423	13,989
Discrete tax benefits (expense)	$ (1,600)	$ (10,400)	$ 5,500	$ (10,400)
U.S. federal statutory rate	21.00%	21.00%	21.00%	21.00%
Gross unrecognized tax benefits	$ 23,700		$ 23,700		$ 23,200
Increase (decrease) in unrecognized tax benefit			500
Decrease in unrecognized tax benefits related to the expiration of statutes of limitations			$ 15,500

Revenue from Contracts with C_2

Revenue from Contracts with Customers - Narrative (Details) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2020USD ($)	Jun. 30, 2020USD ($)
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Unsatisfied performance obligations under contracts with a contract term greater than one year	$ 5,270	$ 5,270
Revenue recognized, included in contract liabilities balance at beginning of period	301.5	431.4
Increase (decrease) in revenue recognized, allocated to performance obligation partially satisfied in previous periods	$ 4.9	$ 5.2
Minimum
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Contract term		1 year
Maximum
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Contract term		5 years

Segment Information (Details)

Segment Information (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020USD ($)	Jun. 30, 2019USD ($)	Jun. 30, 2020USD ($)Segment	Jun. 30, 2019USD ($)
Segment Reporting Information [Line Items]
Number of reportable segments | Segment			2
Revenue	$ 1,013,399	$ 1,166,827	$ 2,176,754	$ 2,285,833
Direct costs (exclusive of depreciation and amortization)	805,892	917,529	1,729,906	1,804,331
Selling, general, and administrative expenses	104,976	110,879	222,946	223,996
Operating income (loss)	34,971	58,134	83,938	84,950
Restructuring and other costs	8,171	11,882	16,891	26,295
Transaction and integration-related expenses	3,368	7,654	10,945	24,312
Operating Segments
Segment Reporting Information [Line Items]
Direct costs (exclusive of depreciation and amortization)	797,786	910,217	1,713,618	1,788,857
Selling, general, and administrative expenses	83,595	89,827	182,549	185,582
Operating income (loss)	132,018	166,783	280,587	311,394
Corporate
Segment Reporting Information [Line Items]
Selling, general, and administrative expenses	13,312	14,570	24,512	25,827
Restructuring and other costs	8,171	11,882	16,891	26,295
Transaction and integration-related expenses	3,368	7,654	10,945	24,312
Depreciation and amortization	56,021	60,749	112,128	121,949
Corporate | Direct costs
Segment Reporting Information [Line Items]
Share-based compensation expense	8,106	7,312	16,288	15,474
Corporate | Selling, general, and administrative expenses
Segment Reporting Information [Line Items]
Share-based compensation expense	8,069	6,482	15,885	12,587
Clinical Solutions | Operating Segments
Segment Reporting Information [Line Items]
Revenue	747,179	849,922	1,622,005	1,654,880
Direct costs (exclusive of depreciation and amortization)	590,303	654,403	1,267,394	1,280,170
Selling, general, and administrative expenses	63,164	67,625	137,723	137,327
Operating income (loss)	93,712	127,894	216,888	237,383
Commercial Solutions | Operating Segments
Segment Reporting Information [Line Items]
Revenue	266,220	316,905	554,749	630,953
Direct costs (exclusive of depreciation and amortization)	207,483	255,814	446,224	508,687
Selling, general, and administrative expenses	20,431	22,202	44,826	48,255
Operating income (loss)	$ 38,306	$ 38,889	$ 63,699	$ 74,011

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, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Revenues by Geographic Location
Revenue	$ 1,013,399	$ 1,166,827	$ 2,176,754	$ 2,285,833
North America
Revenues by Geographic Location
Revenue	638,564	791,281	1,391,609	1,518,979
Europe, Middle East, and Africa
Revenues by Geographic Location
Revenue	242,326	258,787	510,348	517,134
Asia-Pacific
Revenues by Geographic Location
Revenue	110,186	94,295	227,239	205,861
Latin America
Revenues by Geographic Location
Revenue	22,323	22,464	47,558	43,859
United States
Revenues by Geographic Location
Revenue	$ 608,700	$ 741,200	$ 1,322,200	$ 1,445,300
United States | Geographic Concentration Risk | Net Service Revenue
Revenues by Geographic Location
Concentration risk percentage	60.10%	63.50%	60.70%	63.20%

Operations by Geographic Loca_4

Operations by Geographic Location - Long-Lived Assets by Geographic Area (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Long-Lived Assets by Geographic Location
Total property and equipment, net	$ 197,074	$ 203,926
North America
Long-Lived Assets by Geographic Location
Total property and equipment, net	152,677	159,709
Europe, Middle East, and Africa
Long-Lived Assets by Geographic Location
Total property and equipment, net	29,765	28,514
Asia-Pacific
Long-Lived Assets by Geographic Location
Total property and equipment, net	11,216	12,742
Latin America
Long-Lived Assets by Geographic Location
Total property and equipment, net	3,416	2,961
United States
Long-Lived Assets by Geographic Location
Total property and equipment, net	$ 146,800	$ 153,100

Concentration of Credit Risk -

Concentration of Credit Risk - Narrative (Details) - Customer Concentration Risk	3 Months Ended	6 Months Ended	12 Months Ended
	Jun. 30, 2020	Jun. 30, 2020	Dec. 31, 2019
Net Service Revenue
Concentration Risk
Concentration risk percentage	10.00%	10.00%
Accounts Receivable
Concentration Risk
Concentration risk percentage		10.00%	10.00%

Related-Party Transactions - Na

Related-Party Transactions - Narrative (Details) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Related Party Transaction [Line Items]
Potential future cash consideration, in exchange of sale of company's contingent staffing business to related party	$ (152,000)	$ 1,665,000	$ 3,943,000	$ 940,000
Related-party revenue			$ 0	0
Affiliated Entity
Related Party Transaction [Line Items]
Incurred professional services costs, related party		$ 0		$ 1,100,000
Maximum
Related Party Transaction [Line Items]
Potential future cash consideration, in exchange of sale of company's contingent staffing business to related party	$ 4,000,000

Commitments and Contingencies -

Commitments and Contingencies - Narrative (Details)	Jan. 30, 2018numberOfAction	Dec. 01, 2017numberOfAction	Jun. 30, 2020USD ($)	Mar. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Recurring
Loss Contingencies [Line Items]
Contingent obligations related to business combinations			$ 6,490,000		$ 37,324,000
InVentiv Merger | Recurring
Loss Contingencies [Line Items]
Contingent obligations related to business combinations			$ 6,500,000		32,700,000
Kinapse Acquisition
Loss Contingencies [Line Items]
Contingent obligations related to business combinations				$ 0	$ 4,600,000
Pending Litigation | Bermudez and Vaitkuviene Actions
Loss Contingencies [Line Items]
Number of actions taken by plaintiff | numberOfAction		2
Number of plaintiffs | numberOfAction	2