Syneos Health (SYNH) 10-Q 29 Oct 20 2020 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2020	Oct. 26, 2020
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q3
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		103,997,108
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		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Statement [Abstract]
Revenue	$ 1,099,004	$ 1,177,028	$ 3,275,758	$ 3,462,861
Costs and operating expenses:
Direct costs (exclusive of depreciation and amortization)	820,228	913,674	2,550,134	2,718,005
Selling, general, and administrative expenses	111,096	109,864	334,042	333,860
Restructuring and other costs	6,523	13,456	23,414	39,751
Transaction and integration-related expenses	6,955	10,454	17,900	34,766
Depreciation	17,301	18,844	51,830	57,663
Amortization	38,147	41,293	115,746	124,423
Total operating expenses	1,000,250	1,107,585	3,093,066	3,308,468
Income from operations	98,754	69,443	182,692	154,393
Total other expense (income), net:
Interest expense, net	20,442	30,181	68,126	95,439
Loss on extinguishment of debt	346	0	346	4,355
Other expense (income), net	10,596	(30,713)	(2,573)	(29,365)
Total other expense (income), net	31,384	(532)	65,899	70,429
Income before provision for income taxes	67,370	69,975	116,793	83,964
Income tax expense	3,954	11,055	15,892	43,756
Net income	$ 63,416	$ 58,920	$ 100,901	$ 40,208
Earnings per share:
Basic (USD per share)	$ 0.61	$ 0.57	$ 0.97	$ 0.39
Diluted (USD per share)	$ 0.60	$ 0.56	$ 0.96	$ 0.38
Weighted average common shares outstanding:
Basic (in shares)	104,277	103,594	104,247	103,553
Diluted (in shares)	105,588	105,021	105,483	104,881

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 63,416	$ 58,920	$ 100,901	$ 40,208
Unrealized gain (loss) on derivative instruments, net of income tax expense (benefit) of $1,384; $0; $(5,203); and $(332), respectively	5,219	74	(6,642)	(13,104)
Foreign currency translation adjustments, net of income tax expense of $0 for all periods	33,832	(34,421)	(12,086)	(25,736)
Comprehensive income	$ 102,467	$ 24,573	$ 82,173	$ 1,368

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (Unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Statement Of Income And Comprehensive Income [Abstract]
Income tax benefit related to unrealized gain (loss) on derivative instruments recorded in other comprehensive loss	$ 1,384		$ (5,203)
Income tax benefit related to unrealized gain (loss) on derivative instruments recorded in other comprehensive loss		$ 0		$ (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	Sep. 30, 2020	Dec. 31, 2019
Current assets:
Cash, cash equivalents, and restricted cash	$ 248,896	$ 163,689
Accounts receivable and unbilled services, net	1,264,502	1,303,641
Prepaid expenses and other current assets	82,315	94,834
Total current assets	1,595,713	1,562,164
Property and equipment, net	196,258	203,926
Operating lease right-of-use assets	213,056	218,531
Goodwill	4,343,354	4,350,380
Intangible assets, net	882,485	973,081
Deferred income tax assets	18,256	37,012
Other long-term assets	135,609	108,701
Total assets	7,384,731	7,453,795
Current liabilities:
Accounts payable	104,936	136,686
Accrued expenses	583,015	568,911
Deferred revenue	710,170	696,907
Current portion of operating lease obligations	39,568	38,055
Current portion of finance lease obligations	0
Current portion of finance lease obligations	16,689	17,777
Current portion of long-term debt	56,875	58,125
Total current liabilities	1,511,253	1,516,461
Long-term debt	2,465,358	2,550,395
Operating lease long-term obligations	209,809	218,343
Finance lease long-term obligations	28,300
Finance lease long-term obligations		36,914
Deferred income tax liabilities	7,931	11,101
Other long-term liabilities	65,602	90,927
Total liabilities	4,288,253	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 September 30, 2020 and December 31, 2019	0	0
Common stock, $0.01 par value; 600,000 shares authorized, 103,994 and 103,866 shares issued and outstanding at September 30, 2020 and December 31, 2019, respectively	1,040	1,039
Additional paid-in capital	3,454,381	3,441,471
Accumulated other comprehensive loss, net of taxes	(90,321)	(71,593)
Accumulated deficit	(268,622)	(341,263)
Total shareholders’ equity	3,096,478	3,029,654
Total liabilities and shareholders’ equity	$ 7,384,731	$ 7,453,795

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares	Sep. 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)	103,994,000	103,866,000
Common stock shares outstanding (in shares)	103,994,000	103,866,000

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Cash flows from operating activities:
Net income	$ 100,901	$ 40,208
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	167,576	182,086
Share-based compensation	47,266	40,864
Provision for doubtful accounts	1,357	948
Provision for deferred income taxes	21,306	13,091
Foreign currency transaction gains	(7,747)	(6,090)
Fair value adjustment of contingent obligations	(3,791)	(571)
Loss on extinguishment of debt	346	4,355
Other non-cash items	1,881	1,177
Changes in operating assets and liabilities, net of effect of business combinations:
Accounts receivable, unbilled services, and deferred revenue	15,542	(110,083)
Accounts payable and accrued expenses	(2,226)	12,337
Other assets and liabilities	(31,244)	(20,389)
Net cash provided by operating activities	311,167	157,933
Cash flows from investing activities:
Purchases of property and equipment	(38,493)	(50,645)
Investments in unconsolidated affiliates	(6,859)	(9,227)
Net cash used in investing activities	(45,352)	(59,872)
Cash flows from financing activities:
Proceeds from issuance of long-term debt, net of discount	0	183,195
Payments of debt financing costs	(300)	(2,593)
Repayments of long-term debt	(113,750)	(370,936)
Proceeds from accounts receivable financing agreement	31,600	128,000
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	(300,000)	0
Payments of contingent consideration related to business combinations	(26,634)	(178)
Payments of finance leases	(12,735)	(9,429)
Payments for repurchases of common stock	(62,029)	(56,716)
Proceeds from exercises of stock options	22,973	39,675
Payments related to tax withholdings for share-based compensation	(20,701)	(12,503)
Net cash used in financing activities	(188,176)	(123,885)
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	7,568	(904)
Net change in cash, cash equivalents, and restricted cash	85,207	(26,728)
Cash, cash equivalents, and restricted cash - beginning of period	163,689	155,932
Cash, cash equivalents, and restricted cash - end of period	$ 248,896	$ 129,204

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			(13)	(43,515)		(13,188)
Issuances of common stock			17	25,839
Share-based compensation				40,864
Unrealized gain (loss) on derivative instruments, net of taxes					(13,104)
Foreign currency translation adjustment, net of taxes	$ (25,736)				(25,736)
Net income	40,208					40,208
Balance at end of period at Sep. 30, 2019	2,867,516		1,038	3,425,826	(127,035)	(432,313)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Adjusted beginning balance	2,823,899					(488,837)
Balance at beginning 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]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Repurchases of common stock			(1)	(4,648)		(2,396)
Issuances of common stock			4	13,282
Share-based compensation				12,803
Unrealized gain (loss) on derivative instruments, net of taxes					74
Foreign currency translation adjustment, net of taxes	$ (34,421)				(34,421)
Net income	58,920					58,920
Balance at end of period at Sep. 30, 2019	2,867,516		1,038	3,425,826	(127,035)	(432,313)
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
Balance at end of period at Jan. 01, 2020		$ 2,800
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			(11)	(36,529)		(25,489)
Issuances of common stock			12	2,173
Share-based compensation				47,266
Unrealized gain (loss) on derivative instruments, net of taxes					(6,642)
Foreign currency translation adjustment, net of taxes	$ (12,086)				(12,086)
Net income	100,901					100,901
Balance at end of period at Sep. 30, 2020	3,096,478		1,040	3,454,381	(90,321)	(268,622)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Adjusted beginning balance	2,999,684					(318,838)
Balance at beginning 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]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Repurchases of common stock			(5)	(16,795)		(13,200)
Issuances of common stock			3	9,231
Share-based compensation				15,093
Unrealized gain (loss) on derivative instruments, net of taxes					5,219
Foreign currency translation adjustment, net of taxes	$ 33,832				33,832
Net income	63,416					63,416
Balance at end of period at Sep. 30, 2020	$ 3,096,478		$ 1,040	$ 3,454,381	$ (90,321)	$ (268,622)

Basis of Presentation and Chang

Basis of Presentation and Changes in Significant Accounting Policies	9 Months Ended
	Sep. 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 on February 20, 2020. The results of operations for the three and nine months ended September 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, social distancing practices 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 nine months ended September 30, 2020 due to COVID-19. While certain governments have eased restrictions, the pandemic continues to be disruptive to the Company’s business. 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	9 Months Ended
	Sep. 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 nine months ended September 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): September 30, 2020 December 31, 2019 Accounts receivable billed $ 663,065 $ 787,652 Unbilled services (including contract assets) 609,596 521,370 Less: Allowance for doubtful accounts (8,159 ) (5,381 ) Accounts receivable and unbilled services, net $ 1,264,502 $ 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 nine months ended September 30, 2020 and 2019, the Company factored $113.1 million and $162.0 million, respectively, of trade accounts receivable on a non-recourse basis and received $112.7 million and $160.8 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 nine months ended September 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 (6,858 ) (168 ) (7,026 ) Balance as of September 30, 2020 $ 2,778,094 $ 1,565,260 $ 4,343,354 (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 nine months ended September 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 nine months ended September 30, 2020. As of September 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 nine months ended September 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 during the three months ended September 30, 2020. The Company will continue to evaluate the impacts of the COVID-19 pandemic on its business. Transaction and Integration-Related Expenses Transaction and integration-related expenses consisted of the following (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Professional fees $ 5,656 $ 7,108 $ 18,217 $ 26,632 Debt modification and related expenses 4 1,582 75 5,555 Integration and personnel retention-related costs 1,143 1,394 3,399 3,150 Fair value adjustments to contingent obligations 152 370 (3,791 ) (571 ) Total transaction and integration-related expenses $ 6,955 $ 10,454 $ 17,900 $ 34,766 Accumulated Other Comprehensive Loss , Net of Taxes Accumulated other comprehensive loss, net of taxes, consisted of the following (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Beginning balance $ (129,372 ) $ (92,688 ) $ (71,593 ) $ (88,195 ) Foreign currency translation: Beginning balance (102,675 ) (72,270 ) (56,757 ) (80,955 ) Other comprehensive income (loss) before reclassifications 33,832 (34,421 ) (12,086 ) (25,736 ) Ending balance (68,843 ) (106,691 ) (68,843 ) (106,691 ) Derivative instruments: Beginning balance (26,697 ) (20,418 ) (14,836 ) (7,240 ) Other comprehensive income (loss) before reclassifications 1 (1,105 ) (17,970 ) (15,351 ) Reclassification adjustments 5,218 1,179 11,328 2,247 Ending balance (21,478 ) (20,344 ) (21,478 ) (20,344 ) Accumulated other comprehensive loss, net of taxes $ (90,321 ) $ (127,035 ) $ (90,321 ) $ (127,035 ) Changes in accumulated other comprehensive loss consisted of the following (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Foreign currency translation adjustments: Foreign currency translation adjustments, net of taxes $ 33,832 $ (34,421 ) $ (12,086 ) $ (25,736 ) Unrealized loss on derivative instruments: Unrealized loss during period, before taxes (478 ) (1,144 ) (27,137 ) (15,760 ) Income tax benefit (479 ) (39 ) (9,167 ) (409 ) Unrealized gain (loss) during period, net of taxes 1 (1,105 ) (17,970 ) (15,351 ) Reclassification adjustment, before taxes 7,081 1,218 15,292 2,324 Income tax expense 1,863 39 3,964 77 Reclassification adjustment, net of taxes 5,218 1,179 11,328 2,247 Total unrealized gain (loss) on derivative instruments, net of taxes 5,219 74 (6,642 ) (13,104 ) Total other comprehensive income (loss), net of taxes $ 39,051 $ (34,347 ) $ (18,728 ) $ (38,840 ) Other Expense (Income), Net Other expense (income), net consisted of the following (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Net realized foreign currency loss (gain) $ 4,823 $ (26,762 ) $ 2,772 $ (25,631 ) Net unrealized foreign currency loss (gain) 4,794 (5,131 ) (7,747 ) (6,090 ) Other, net 979 1,180 2,402 2,356 Total other expense (income), net $ 10,596 $ (30,713 ) $ (2,573 ) $ (29,365 )

Long-Term Debt Obligations

Long-Term Debt Obligations	9 Months Ended
	Sep. 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): September 30, 2020 December 31, 2019 Term Loan A due March 2024 $ 1,471,250 $ 1,550,000 Term Loan B due August 2024 760,564 795,564 Accounts receivable financing agreement due October 2022 300,000 275,000 Total debt obligations 2,531,814 2,620,564 Less: Term loan original issuance discount (3,883 ) (4,928 ) Less: Unamortized deferred issuance costs (5,698 ) (7,116 ) Less: Current portion of debt (56,875 ) (58,125 ) Total debt obligations, non-current portion $ 2,465,358 $ 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 $600.0 million revolving credit facility (the “Revolver”) that matures on March 26, 2024. During the three months ended September 30, 2020, the Company made $40.0 million and $35.0 million of voluntary prepayments against Term Loan A and Term Loan B, respectively, and repaid the outstanding $150.0 million balance on the Revolver. The Term Loan A prepayments were applied to the mandatory principal payments due October 2020 and January 2021, and to a partial principal payment for April 2021. Additionally, during the three and nine months ended September 30, 2020, the Company made $19.4 million and $38.8 million of mandatory principal payments towards Term Loan A, respectively. 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. Revolver and Letters of Credit The Revolver includes letters of credit (“LOCs”) with a sublimit of $150.0 million. As of September 30, 2020, there were $18.6 million of LOCs outstanding, leaving $581.4 million of available borrowings under the Revolver, including $131.4 million available for LOCs. 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 September 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 On September 25, 2020, the Company amended its accounts receivable financing agreement to increase the amount it can borrow from $275.0 million to $300.0 million and to extend the maturity to October 2022, unless terminated earlier pursuant to its terms, and drew down the additional $25.0 million. Under this agreement, certain of the Company’s consolidated subsidiaries sell accounts receivable and unbilled services (including contract assets) balances to a wholly-owned, bankruptcy-remote special purpose entity (“SPE”), which is the borrower under the facility. T he facility is without recourse to the Company or any subsidiaries of the Company other than the SPE, other than with respect to limited indemnity obligations of the selling entities and the servicer of the receivables in respect of the character of the receivables sold by them and the performance of the servicing duties. The Company has guaranteed the performance of these obligations. The available borrowing capacity varies according to the levels of the Company’s eligible accounts receivable and unbilled services (including contract assets) sold to the SPE. Loans under this agreement will accrue interest at a reserve-adjusted LIBOR rate or a base rate equal to the higher of the overnight bank funding rate plus 0.50% and the applicable lender’s prime rate. The Company may prepay loans upon one business day’s prior notice and may terminate or reduce the facility limit of the accounts receivable financing agreement with 15 days’ prior notice. As of September 30, 2020, the Company had $300.0 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 available under this agreement as of September 30, 2020. As of September 30, 2020, the contractual maturities of the Company’s debt obligations (excluding leases) were as follows (in thousands): Principal Interest (a) 2020 $ — $ 11,581 2021 85,937 45,234 2022 445,313 41,985 2023 155,000 36,233 2024 1,845,564 12,050 Less: Deferred issuance costs (5,698 ) Less: Term loan original issuance discount (3,883 ) Total $ 2,522,233 $ 147,083 (a) The interest payments on long-term debt in the above table are based on interest rates in effect as of September 30, 2020.

Derivatives

Derivatives	9 Months Ended
	Sep. 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 September 30, 2020, the notional value of this interest rate swap was $917.1 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 September 30, 2020, the notional value of these interest rate swaps was $573.5 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 September 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 $ 22,165 $ 11,358 Interest rate swaps - non-current Other long-term liabilities 6,979 6,095 Fair value of derivative liabilities $ 29,144 $ 17,453

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2020
Fair Value Disclosures [Abstract]
Fair Value Measurements	5. Fair Value Measurements Assets and Liabilities Carried at Fair Value As of September 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 September 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) $ 20,864 $ — $ — $ — $ 20,864 Partnership interest (b) — — — 7,336 7,336 Total assets $ 20,864 $ — $ — $ 7,336 $ 28,200 Liabilities: Derivative instruments (c) $ — $ 29,144 $ — $ — $ 29,144 Contingent obligations related to business combinations (d) — — 6,641 — 6,641 Total liabilities $ — $ 29,144 $ 6,641 $ — $ 35,785 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 September 30, 2020, the Company’s remaining unfunded commitment in the private equity funds was $14.4 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 nine months ended September 30, 2020 (in thousands): Balance as of December 31, 2019 $ 37,324 Additions — Changes in fair value recognized in earnings (4,049 ) Payments (26,634 ) Balance as of September 30, 2020 $ 6,641 During the nine months ended September 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 September 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 $5.23 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): September 30, 2020 December 31, 2019 Carrying Value (a) Estimated Fair Value Carrying Value (a) Estimated Fair Value Term Loan A due March 2024 $ 1,467,892 $ 1,452,859 $ 1,545,721 $ 1,550,000 Term Loan B due August 2024 760,039 751,536 794,915 795,564 (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	9 Months Ended
	Sep. 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 nine months ended September 30, 2020, the Company recognized approximately $1.0 million of employee severance and benefits related costs and $1.2 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 nine months ended September 30, 2020, the Company recognized approximately $20.2 million of costs related to employee severance and benefits, $0.4 million of facility closure and lease termination costs, and $0.6 million of other costs in its continued efforts to optimize its resources worldwide. The costs incurred during the three months ended September 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 nine months ended September 30, 2020 (in thousands): Employee Severance Costs Other Costs Total Balance as of December 31, 2019 $ 5,728 $ 22 $ 5,750 Expenses incurred (a) 21,214 595 21,809 Cash payments made (22,245 ) (617 ) (22,862 ) Balance as of September 30, 2020 $ 4,697 $ — $ 4,697 (a) The amount of expenses incurred for the nine months ended September 30, 2020 excludes $1.6 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 September 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	9 Months Ended
	Sep. 30, 2020
Equity [Abstract]
Shareholders' Equity	7. Shareholders’ Equity Shares Outstanding Shares of common stock outstanding were as follows (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Common stock shares, beginning balance 104,236 103,460 103,866 103,372 Repurchases of common stock (506 ) (141 ) (1,106 ) (1,323 ) Issuances of common stock 264 474 1,234 1,744 Common stock shares, ending balance 103,994 103,793 103,994 103,793 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 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 amend ed, which permit s shares of the Company’s common stock to be repurchased when the Company might otherwise be precluded from doing so by law. During the three months ended September 30, 2020, the Company repurchased 506,244 shares of its Class A common stock in a private transaction under the stock repurchase program described above, for a total purchase price of approximately $30.0 million. The following table sets forth repurchase activity under the stock repurchase program from inception through September 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 September 2020 506,244 59.26 30,000 Total 4,401,644 $ 193,730 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 September 30, 2020, the Company had remaining authorization to repurchase up to approximately $106.3 million of shares of its common stock under the stock repurchase program.

Earnings Per Share

Earnings Per Share	9 Months Ended
	Sep. 30, 2020
Earnings Per Share [Abstract]
Earnings Per Share	8. Earnings Per Share The following table provides a reconciliation of the numerators and denominators of the basic and diluted earnings per share computations (in thousands, except per share data): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Numerator: Net income $ 63,416 $ 58,920 $ 100,901 $ 40,208 Denominator: Basic weighted average common shares outstanding 104,277 103,594 104,247 103,553 Effect of dilutive securities: Stock options and other awards under deferred share-based compensation programs 1,311 1,427 1,236 1,328 Diluted weighted average common shares outstanding 105,588 105,021 105,483 104,881 Earnings per share: Basic $ 0.61 $ 0.57 $ 0.97 $ 0.39 Diluted $ 0.60 $ 0.56 $ 0.96 $ 0.38 Potential common shares outstanding that are considered anti-dilutive are excluded from the computation of diluted earnings per share. Potential common shares related to stock options and other awards under share-based compensation programs may be determined to be anti-dilutive based on the application of the treasury stock method. Potential common shares are also considered anti-dilutive in periods when the Company incurs a net loss. The number of potential shares outstanding that were anti-dilutive and therefore excluded from the computation of diluted earnings per share, weighted for the portion of the period they were outstanding, were 177,330 and 220,269 for the three months ended September 30, 2020 and 2019, respectively, and 713,269 and 295,706 for the nine months ended September 30, 2020 and 2019, respectively.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 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 nine months ended September 30, 2020, excluding discrete items, varied from the United States federal statutory income tax rate of 21.0% primarily d For the three and nine months ended September 30, 2019, the Company recorded income tax expense of $11.1 million and $43.8 million, respectively, compared to pre-tax income of $70.0 million and $84.0 million, respectively. Income tax expense for the three and nine months ended September 30, 2019 included a discrete tax benefit of $0.1 million and discrete tax expense of $10.3 million, respectively, 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 nine months ended September 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 nine months ended September 30, 2020. Unrecognized Tax Benefits The Company’s gross unrecognized tax benefits, exclusive of associated interest and penalties, were $8.4 million and $23.2 million as of September 30, 2020 and December 31, 2019, respectively. The decrease of $14.8 million was primarily due to statute lapses related to domestic unrecognized tax benefits. Tax Returns under Audit The Company is not currently under any United States Federal income tax audit; however, 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 provision 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 certain payroll and other tax payments into the future. The Company has deferred, and plans to continue deferring, the timing of certain income tax payments and other taxes as permitted by the CARES Act and other stimulus measures enacted globally. Numerous final and proposed tax regulations were issued during the three months ended September 30, 2020, including additional guidance related to changes included in the Tax Cuts and Jobs Act. The regulations included updated guidance related to items such as interest expense limitations pursuant to Section 163(j), GILTI high-tax exclusion, and Foreign Tax Credits. These regulations included certain elective provisions and may be retroactively applied to the 2018 and 2019 tax years. The Company is continuing to evaluate these elective provisions.

Revenue from Contracts with Cus

Revenue from Contracts with Customers	9 Months Ended
	Sep. 30, 2020
Revenue From Contract With Customer [Abstract]
Revenue from Contract with Customers	10. Revenue from Contracts with Customers Unsatisfied Performance Obligations As of September 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 nine months ended September 30, 2020, the Company recognized approximately $298.6 million and $485.0 million, respectively,

Segment Information

Segment Information	9 Months Ended
	Sep. 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 Phases 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 September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Revenue: Clinical Solutions $ 829,163 $ 867,427 $ 2,451,168 $ 2,522,307 Commercial Solutions 269,841 309,601 824,590 940,554 Total revenue 1,099,004 1,177,028 3,275,758 3,462,861 Segment direct costs: Clinical Solutions 600,634 655,851 1,868,028 1,936,021 Commercial Solutions 211,894 250,904 658,118 759,591 Total segment direct costs 812,528 906,755 2,526,146 2,695,612 Segment selling, general, and administrative expenses: Clinical Solutions 66,431 68,659 204,154 205,986 Commercial Solutions 21,171 21,416 65,997 69,671 Total segment selling, general, and administrative expenses 87,602 90,075 270,151 275,657 Segment operating income: Clinical Solutions 162,098 142,917 378,986 380,300 Commercial Solutions 36,776 37,281 100,475 111,292 Total segment operating income 198,874 180,198 479,461 491,592 Direct costs and operating expenses not allocated to segments: Share-based compensation included in direct costs 7,700 6,919 23,988 22,393 Share-based compensation included in selling, general, and administrative expenses 7,393 5,884 23,278 18,471 Corporate selling, general, and administrative expenses 16,101 13,905 40,613 39,732 Restructuring and other costs 6,523 13,456 23,414 39,751 Transaction and integration-related expenses 6,955 10,454 17,900 34,766 Depreciation and amortization 55,448 60,137 167,576 182,086 Total income from operations $ 98,754 $ 69,443 $ 182,692 $ 154,393

Operations by Geographic Locati

Operations by Geographic Location	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Revenue: North America (a) $ 694,286 $ 780,460 $ 2,085,895 $ 2,299,439 Europe, Middle East, and Africa 258,590 251,519 768,938 768,653 Asia-Pacific 121,155 119,268 348,394 325,129 Latin America 24,973 25,781 72,531 69,640 Total revenue $ 1,099,004 $ 1,177,028 $ 3,275,758 $ 3,462,861 (a) Revenue for the North America region includes revenue attributable to the United States of $659.6 million and $745.6 million, or 60.0% and 63.3% of total revenue, for the three months ended September 30, 2020 and 2019, respectively. Revenue for the North America region includes revenue attributable to the United States of $1,981.7 million $2,190.9 million The following table summarizes long-lived assets by geographic area September 30, 2020 December 31, 2019 Property and equipment, net: North America (a) $ 149,485 $ 159,709 Europe, Middle East, and Africa 31,095 28,514 Asia-Pacific 11,440 12,742 Latin America 4,238 2,961 Total property and equipment, net $ 196,258 $ 203,926 (a) Long-lived assets for the North America region include property and equipment, net attributable to the United States of $143.9 million and $153.1 million as of September 30, 2020 and December 31, 2019, respectively.

Concentration of Credit Risk

Concentration of Credit Risk	9 Months Ended
	Sep. 30, 2020
Risks And Uncertainties [Abstract]
Concentration of Credit Risk	13. Concentration of Credit Risk Financial assets that subject the Company to credit risk primarily consist of cash and cash equivalents, accounts receivable and unbilled services (including contract assets). The Company’s cash and cash equivalents consist principally of cash and are maintained at several financial institutions with reputable credit ratings. The Company 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 September 30, 2020 and December 31, 2019, the majority 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 nine months ended September 30, 2020. As of September 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	9 Months Ended
	Sep. 30, 2020
Related Party Transactions [Abstract]
Related-Party Transactions	14. Related-Party Transactions No related party expenses were recorded for the three months ended September 30, 2020. During the second quarter of 2020, the Company sold its contingent staffing business to a related party in exchange for potential future cash consideration not to exceed $4.0 million. 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 nine months ended September 30, 2020. No related party expenses were recorded for the three months ended September 30, 2019. For the nine months ended September 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 nine months ended September 30, 2019.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 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 in the Bermudez action 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. The District Court referred the Motion to Dismiss to a magistrate judge for a report and recommendation. On September 26, 2019, the magistrate judge stayed the action and, on August 7, 2020, the magistrate judge lifted the stay. Also on August 7, 2020, the magistrate judge issued a report (the “Magistrate Report”) recommending to the District Court that Defendants’ Motion to Dismiss be denied. On September 4, 2020, Defendants filed written objections to the Magistrate Report, requesting that the District Court grant the Motion to Dismiss. 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 September 30, 2020 and December 31, 2019, the estimated fair value of the assumed contingent tax-sharing obligations was $6.6 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.

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2020
Subsequent Events [Abstract]
Subsequent Events	16. Subsequent Event On October 26, 2020, the Company entered into a stock purchase agreement for the purchase of 100% of the outstanding shares of SHCR Holdings Corporation (“Synteract”) for an aggregate purchase price of approximately $400 million in cash. Synteract is a contract research organization focused on the emerging biopharmaceutical industry. The transaction is expected to close in the fourth quarter of 2020, subject to the satisfaction or waiver of the closing conditions.

Basis of Presentation and Cha_2

Basis of Presentation and Changes in Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 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 on February 20, 2020. The results of operations for the three and nine months ended September 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)	9 Months Ended
	Sep. 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): September 30, 2020 December 31, 2019 Accounts receivable billed $ 663,065 $ 787,652 Unbilled services (including contract assets) 609,596 521,370 Less: Allowance for doubtful accounts (8,159 ) (5,381 ) Accounts receivable and unbilled services, net $ 1,264,502 $ 1,303,641
Schedule of Goodwill	The changes in the carrying amount of goodwill by segment for the nine months ended September 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 (6,858 ) (168 ) (7,026 ) Balance as of September 30, 2020 $ 2,778,094 $ 1,565,260 $ 4,343,354 (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 nine months ended September 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 nine months ended September 30, 2020.
Schedule of Transaction and Integration-Related Expenses	Transaction and integration-related expenses consisted of the following (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Professional fees $ 5,656 $ 7,108 $ 18,217 $ 26,632 Debt modification and related expenses 4 1,582 75 5,555 Integration and personnel retention-related costs 1,143 1,394 3,399 3,150 Fair value adjustments to contingent obligations 152 370 (3,791 ) (571 ) Total transaction and integration-related expenses $ 6,955 $ 10,454 $ 17,900 $ 34,766
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 September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Beginning balance $ (129,372 ) $ (92,688 ) $ (71,593 ) $ (88,195 ) Foreign currency translation: Beginning balance (102,675 ) (72,270 ) (56,757 ) (80,955 ) Other comprehensive income (loss) before reclassifications 33,832 (34,421 ) (12,086 ) (25,736 ) Ending balance (68,843 ) (106,691 ) (68,843 ) (106,691 ) Derivative instruments: Beginning balance (26,697 ) (20,418 ) (14,836 ) (7,240 ) Other comprehensive income (loss) before reclassifications 1 (1,105 ) (17,970 ) (15,351 ) Reclassification adjustments 5,218 1,179 11,328 2,247 Ending balance (21,478 ) (20,344 ) (21,478 ) (20,344 ) Accumulated other comprehensive loss, net of taxes $ (90,321 ) $ (127,035 ) $ (90,321 ) $ (127,035 )
Reclassification out of Accumulated Other Comprehensive (Loss) Income	Changes in accumulated other comprehensive loss consisted of the following (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Foreign currency translation adjustments: Foreign currency translation adjustments, net of taxes $ 33,832 $ (34,421 ) $ (12,086 ) $ (25,736 ) Unrealized loss on derivative instruments: Unrealized loss during period, before taxes (478 ) (1,144 ) (27,137 ) (15,760 ) Income tax benefit (479 ) (39 ) (9,167 ) (409 ) Unrealized gain (loss) during period, net of taxes 1 (1,105 ) (17,970 ) (15,351 ) Reclassification adjustment, before taxes 7,081 1,218 15,292 2,324 Income tax expense 1,863 39 3,964 77 Reclassification adjustment, net of taxes 5,218 1,179 11,328 2,247 Total unrealized gain (loss) on derivative instruments, net of taxes 5,219 74 (6,642 ) (13,104 ) Total other comprehensive income (loss), net of taxes $ 39,051 $ (34,347 ) $ (18,728 ) $ (38,840 )
Schedule of Other Expense (Income), Net (Details)	Other expense (income), net consisted of the following (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Net realized foreign currency loss (gain) $ 4,823 $ (26,762 ) $ 2,772 $ (25,631 ) Net unrealized foreign currency loss (gain) 4,794 (5,131 ) (7,747 ) (6,090 ) Other, net 979 1,180 2,402 2,356 Total other expense (income), net $ 10,596 $ (30,713 ) $ (2,573 ) $ (29,365 )

Long-Term Debt Obligations (Tab

Long-Term Debt Obligations (Tables)	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Schedule of Debt Obligations	The Company’s debt obligations consisted of the following (in thousands): September 30, 2020 December 31, 2019 Term Loan A due March 2024 $ 1,471,250 $ 1,550,000 Term Loan B due August 2024 760,564 795,564 Accounts receivable financing agreement due October 2022 300,000 275,000 Total debt obligations 2,531,814 2,620,564 Less: Term loan original issuance discount (3,883 ) (4,928 ) Less: Unamortized deferred issuance costs (5,698 ) (7,116 ) Less: Current portion of debt (56,875 ) (58,125 ) Total debt obligations, non-current portion $ 2,465,358 $ 2,550,395
Contractual Maturities of Debt Obligations	As of September 30, 2020, the contractual maturities of the Company’s debt obligations (excluding leases) were as follows (in thousands): Principal Interest (a) 2020 $ — $ 11,581 2021 85,937 45,234 2022 445,313 41,985 2023 155,000 36,233 2024 1,845,564 12,050 Less: Deferred issuance costs (5,698 ) Less: Term loan original issuance discount (3,883 ) Total $ 2,522,233 $ 147,083 (a) The interest payments on long-term debt in the above table are based on interest rates in effect as of September 30, 2020.

Derivatives (Tables)

Derivatives (Tables)	9 Months Ended
	Sep. 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 September 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 $ 22,165 $ 11,358 Interest rate swaps - non-current Other long-term liabilities 6,979 6,095 Fair value of derivative liabilities $ 29,144 $ 17,453

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 2020
Fair Value Disclosures [Abstract]
Schedule of Assets and Liabilities Measured at Fair Value on a Recurring Basis	As of September 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) $ 20,864 $ — $ — $ — $ 20,864 Partnership interest (b) — — — 7,336 7,336 Total assets $ 20,864 $ — $ — $ 7,336 $ 28,200 Liabilities: Derivative instruments (c) $ — $ 29,144 $ — $ — $ 29,144 Contingent obligations related to business combinations (d) — — 6,641 — 6,641 Total liabilities $ — $ 29,144 $ 6,641 $ — $ 35,785 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 September 30, 2020, the Company’s remaining unfunded commitment in the private equity funds was $14.4 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 nine months ended September 30, 2020 (in thousands): Balance as of December 31, 2019 $ 37,324 Additions — Changes in fair value recognized in earnings (4,049 ) Payments (26,634 ) Balance as of September 30, 2020 $ 6,641
Schedule of Estimated Fair Value	The estimated fair values of the Company’s outstanding term loans were as follows (in thousands): September 30, 2020 December 31, 2019 Carrying Value (a) Estimated Fair Value Carrying Value (a) Estimated Fair Value Term Loan A due March 2024 $ 1,467,892 $ 1,452,859 $ 1,545,721 $ 1,550,000 Term Loan B due August 2024 760,039 751,536 794,915 795,564 (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)	9 Months Ended
	Sep. 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 nine months ended September 30, 2020 (in thousands): Employee Severance Costs Other Costs Total Balance as of December 31, 2019 $ 5,728 $ 22 $ 5,750 Expenses incurred (a) 21,214 595 21,809 Cash payments made (22,245 ) (617 ) (22,862 ) Balance as of September 30, 2020 $ 4,697 $ — $ 4,697 (a) The amount of expenses incurred for the nine months ended September 30, 2020 excludes $1.6 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)	9 Months Ended
	Sep. 30, 2020
Equity [Abstract]
Shares of Common Stock Outstanding	Shares of common stock outstanding were as follows (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Common stock shares, beginning balance 104,236 103,460 103,866 103,372 Repurchases of common stock (506 ) (141 ) (1,106 ) (1,323 ) Issuances of common stock 264 474 1,234 1,744 Common stock shares, ending balance 103,994 103,793 103,994 103,793
Schedule of Repurchase Activity	The following table sets forth repurchase activity under the stock repurchase program from inception through September 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 September 2020 506,244 59.26 30,000 Total 4,401,644 $ 193,730

Earnings Per Share (Tables)

Earnings Per Share (Tables)	9 Months Ended
	Sep. 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 per share computations (in thousands, except per share data): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Numerator: Net income $ 63,416 $ 58,920 $ 100,901 $ 40,208 Denominator: Basic weighted average common shares outstanding 104,277 103,594 104,247 103,553 Effect of dilutive securities: Stock options and other awards under deferred share-based compensation programs 1,311 1,427 1,236 1,328 Diluted weighted average common shares outstanding 105,588 105,021 105,483 104,881 Earnings per share: Basic $ 0.61 $ 0.57 $ 0.97 $ 0.39 Diluted $ 0.60 $ 0.56 $ 0.96 $ 0.38

Segment Information (Tables)

Segment Information (Tables)	9 Months Ended
	Sep. 30, 2020
Segment Reporting [Abstract]
Schedule of Segment Information	Information about reportable segment operating results was as follows (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Revenue: Clinical Solutions $ 829,163 $ 867,427 $ 2,451,168 $ 2,522,307 Commercial Solutions 269,841 309,601 824,590 940,554 Total revenue 1,099,004 1,177,028 3,275,758 3,462,861 Segment direct costs: Clinical Solutions 600,634 655,851 1,868,028 1,936,021 Commercial Solutions 211,894 250,904 658,118 759,591 Total segment direct costs 812,528 906,755 2,526,146 2,695,612 Segment selling, general, and administrative expenses: Clinical Solutions 66,431 68,659 204,154 205,986 Commercial Solutions 21,171 21,416 65,997 69,671 Total segment selling, general, and administrative expenses 87,602 90,075 270,151 275,657 Segment operating income: Clinical Solutions 162,098 142,917 378,986 380,300 Commercial Solutions 36,776 37,281 100,475 111,292 Total segment operating income 198,874 180,198 479,461 491,592 Direct costs and operating expenses not allocated to segments: Share-based compensation included in direct costs 7,700 6,919 23,988 22,393 Share-based compensation included in selling, general, and administrative expenses 7,393 5,884 23,278 18,471 Corporate selling, general, and administrative expenses 16,101 13,905 40,613 39,732 Restructuring and other costs 6,523 13,456 23,414 39,751 Transaction and integration-related expenses 6,955 10,454 17,900 34,766 Depreciation and amortization 55,448 60,137 167,576 182,086 Total income from operations $ 98,754 $ 69,443 $ 182,692 $ 154,393

Operations by Geographic Loca_2

Operations by Geographic Location (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Revenue: North America (a) $ 694,286 $ 780,460 $ 2,085,895 $ 2,299,439 Europe, Middle East, and Africa 258,590 251,519 768,938 768,653 Asia-Pacific 121,155 119,268 348,394 325,129 Latin America 24,973 25,781 72,531 69,640 Total revenue $ 1,099,004 $ 1,177,028 $ 3,275,758 $ 3,462,861 (a) Revenue for the North America region includes revenue attributable to the United States of $659.6 million and $745.6 million, or 60.0% and 63.3% of total revenue, for the three months ended September 30, 2020 and 2019, respectively. Revenue for the North America region includes revenue attributable to the United States of $1,981.7 million $2,190.9 million
Long-Lived Assets by Geographic Area	The following table summarizes long-lived assets by geographic area September 30, 2020 December 31, 2019 Property and equipment, net: North America (a) $ 149,485 $ 159,709 Europe, Middle East, and Africa 31,095 28,514 Asia-Pacific 11,440 12,742 Latin America 4,238 2,961 Total property and equipment, net $ 196,258 $ 203,926 (a) Long-lived assets for the North America region include property and equipment, net attributable to the United States of $143.9 million and $153.1 million as of September 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 ($)	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)	Sep. 30, 2020USD ($)Segment	Sep. 30, 2019USD ($)	Jun. 30, 2020USD ($)	Dec. 31, 2019USD ($)	Jun. 30, 2019USD ($)	Dec. 31, 2018USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Number of reportable segments | Segment				2
Impact from adoption of ASU		$ 3,096,478	$ 2,867,516	$ 3,096,478	$ 2,867,516	$ 2,999,684	$ 3,029,654	$ 2,823,899	$ 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	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Non-cash investment in acquire property	$ 27.3
Trade receivables sold	113.1	$ 162
Proceeds from sale of trade receivables	$ 112.7	$ 160.8

Financial Statement Details - A

Financial Statement Details - Accounts Receivable and Unbilled Services, net (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Receivables [Abstract]
Accounts receivable billed	$ 663,065	$ 787,652
Unbilled services (including contract assets)	609,596	521,370
Less: Allowance for doubtful accounts	(8,159)	(5,381)
Accounts receivable and unbilled services, net	$ 1,264,502	$ 1,303,641

Financial Statement Details - S

Financial Statement Details - Schedule of Goodwill (Details) - USD ($)	9 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Goodwill [Roll Forward]
Balance as of January 1, 2020	$ 4,350,380,000
Impact of foreign currency translation	(7,026,000)
Balance as of September 30, 2020	4,343,354,000
Clinical Solutions
Goodwill [Roll Forward]
Balance as of January 1, 2020	2,784,952,000
Impact of foreign currency translation	(6,858,000)
Balance as of September 30, 2020	2,778,094,000
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	(168,000)
Balance as of September 30, 2020	1,565,260,000
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		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Statement [Abstract]
Professional fees	$ 5,656	$ 7,108	$ 18,217	$ 26,632
Debt modification and related expenses	4	1,582	75	5,555
Integration and personnel retention-related costs	1,143	1,394	3,399	3,150
Fair value adjustment of contingent obligations	152	370	(3,791)	(571)
Total transaction and integration-related expenses	$ 6,955	$ 10,454	$ 17,900	$ 34,766

Financial Statement Details -_2

Financial Statement Details - Accumulated Other Comprehensive Loss, Net of Taxes (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	$ 2,999,684	$ 2,823,899	$ 3,029,654	$ 2,856,144
Other comprehensive income (loss) before reclassifications	1	(1,105)	(17,970)	(15,351)
Balance at end of period	3,096,478	2,867,516	3,096,478	2,867,516
Accumulated Other Comprehensive Loss
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(129,372)	(92,688)	(71,593)	(88,195)
Balance at end of period	(90,321)	(127,035)	(90,321)	(127,035)
Foreign Currency Translation
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(102,675)	(72,270)	(56,757)	(80,955)
Other comprehensive income (loss) before reclassifications	33,832	(34,421)	(12,086)	(25,736)
Balance at end of period	(68,843)	(106,691)	(68,843)	(106,691)
Derivative Instruments
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(26,697)	(20,418)	(14,836)	(7,240)
Other comprehensive income (loss) before reclassifications	1	(1,105)	(17,970)	(15,351)
Reclassification adjustments	5,218	1,179	11,328	2,247
Balance at end of period	$ (21,478)	$ (20,344)	$ (21,478)	$ (20,344)

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		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized gain (loss) during period, net of taxes	$ 1	$ (1,105)	$ (17,970)	$ (15,351)
Total other comprehensive income (loss), net of taxes	39,051	(34,347)	(18,728)	(38,840)
Foreign Currency Translation
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized gain (loss) during period, net of taxes	33,832	(34,421)	(12,086)	(25,736)
Total other comprehensive income (loss), net of taxes	33,832	(34,421)	(12,086)	(25,736)
Derivative Instruments
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized loss during period, before taxes	(478)	(1,144)	(27,137)	(15,760)
Income tax benefit	(479)	(39)	(9,167)	(409)
Unrealized gain (loss) during period, net of taxes	1	(1,105)	(17,970)	(15,351)
Reclassification adjustment, before taxes	7,081	1,218	15,292	2,324
Income tax expense	1,863	39	3,964	77
Reclassification adjustment, net of taxes	5,218	1,179	11,328	2,247
Total other comprehensive income (loss), net of taxes	$ 5,219	$ 74	$ (6,642)	$ (13,104)

Financial Statement Details - O

Financial Statement Details - Other Expense (Income), Net (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Total other expense (income), net:
Net realized foreign currency loss (gain)	$ 4,823	$ (26,762)	$ 2,772	$ (25,631)
Net unrealized foreign currency loss (gain)	4,794	(5,131)	(7,747)	(6,090)
Other, net	979	1,180	2,402	2,356
Total other expense (income), net	$ 10,596	$ (30,713)	$ (2,573)	$ (29,365)

Long-Term Debt Obligations - Sc

Long-Term Debt Obligations - Schedule of Debt Obligations (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Less: Term loan original issuance discount	$ (3,883)	$ (4,928)
Less: Unamortized deferred issuance costs	(5,698)	(7,116)
Less: Current portion of debt	(56,875)	(58,125)
Total debt obligations, non-current portion	2,465,358	2,550,395
Secured Debt
Debt Instrument [Line Items]
Total debt obligations	2,531,814	2,620,564
Secured Debt | Term Loan A due March 2024
Debt Instrument [Line Items]
Total debt obligations	1,471,250	1,550,000
Secured Debt | Term Loan B due August 2024
Debt Instrument [Line Items]
Total debt obligations	760,564	795,564
Secured Debt | Accounts receivable financing agreement due October 2022 | Accounts Receivable Securitization
Debt Instrument [Line Items]
Total debt obligations	$ 300,000	$ 275,000

Long-Term Debt Obligations - Na

Long-Term Debt Obligations - Narrative (Details) - USD ($)	3 Months Ended	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2020	Sep. 30, 2019
Debt Instrument [Line Items]
Repayments of Long-term debt		$ 113,750,000	$ 370,936,000
Secured Debt | Revolving credit facility due March 2024
Debt Instrument [Line Items]
Long-term line of credit	$ 150,000,000	150,000,000
Secured Debt | Letter of Credit
Debt Instrument [Line Items]
Line of credit facility, capacity available for trade purchases	131,400,000	131,400,000
Secured Debt | Term Loan A due March 2024
Debt Instrument [Line Items]
Repayments of Long-term debt	40,000,000
Principal payment	19,400,000	38,800,000
Secured Debt | Term Loan A due March 2024 | Term Loan
Debt Instrument [Line Items]
Term loan facility	1,550,000,000	1,550,000,000
Secured Debt | Term Loan B due August 2024
Debt Instrument [Line Items]
Repayments of Long-term debt	35,000,000
Secured Debt | Term Loan B due August 2024 | Term Loan
Debt Instrument [Line Items]
Term loan facility	1,600,000,000	1,600,000,000
Secured Debt | 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	600,000,000
Secured Debt | Revolving Credit Facility Due August 2024
Debt Instrument [Line Items]
Remaining capacity available under accounts receivable financing agreement	581,400,000	581,400,000
Secured Debt | Revolving Credit Facility Due August 2024 | Letter of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity under accounts receivable financing agreement	150,000,000	150,000,000
Long-term line of credit	$ 18,600,000	$ 18,600,000

Long-Term Debt Obligations - Ac

Long-Term Debt Obligations - Accounts Receivable Financing Agreement (Details) - USD ($)	9 Months Ended
	Sep. 30, 2020	Sep. 25, 2020	Sep. 24, 2020
Debt Instrument [Line Items]
Long-term debt	$ 2,522,233,000
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 October 2022
Debt Instrument [Line Items]
Line of credit facility, decrease, forgiveness	$ 25,000,000
Accounts receivable financing agreement due October 2022 | Secured Debt | Accounts Receivable Securitization | Wholly-owned Special Purpose Entity
Debt Instrument [Line Items]
Maximum borrowing capacity under accounts receivable financing agreement		$ 300,000,000	$ 275,000,000
Accounts receivable financing agreement due October 2022 | Secured Debt | Accounts Receivable Securitization | Wholly-owned Special Purpose Entity | Federal Funds Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.50%
Accounts receivable financing agreement due September 2021 | Secured Debt | Accounts Receivable Securitization
Debt Instrument [Line Items]
Long-term debt	$ 300,000,000
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

Long-Term Debt Obligations - Co

Long-Term Debt Obligations - Contractual Maturities of Debt Obligations (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Principal
2021	$ 85,937
2022	445,313
2023	155,000
2024	1,845,564
Less: Unamortized deferred issuance costs	(5,698)	$ (7,116)
Less: Term loan original issuance discount	(3,883)	$ (4,928)
Total	2,522,233
Interest
2020	11,581
2021	45,234
2022	41,985
2023	36,233
2024	12,050
Total	$ 147,083

Derivatives - Narrative (Detail

Derivatives - Narrative (Details) - USD ($) $ in Millions	Jan. 01, 2021	Sep. 30, 2020	Mar. 31, 2020	Dec. 31, 2018	May 31, 2016
Interest Rate Swap, expiring March 31, 2023
Derivative [Line Items]
Notional amount		$ 573.5	$ 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		$ 917.1		$ 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	Sep. 30, 2020	Dec. 31, 2019
Derivatives, Fair Value [Line Items]
Derivative asset - current	$ 0	$ 155
Derivative liability	29,144	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	22,165	11,358
Other long-term liabilities
Derivatives, Fair Value [Line Items]
Derivative liability - non-current	$ 6,979	$ 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	Sep. 30, 2020	Dec. 31, 2019
Assets:
Trading securities	$ 20,864	$ 21,552
Derivative instruments		155
Total assets	28,200	28,933
Liabilities:
Derivative instruments	29,144	17,453
Contingent obligations related to business combinations	6,641	37,324
Total liabilities	35,785	54,777
Partnership Interest
Assets:
Partnership interest	7,336	7,226
Level 1
Assets:
Trading securities	20,864	21,552
Derivative instruments		0
Total assets	20,864	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	29,144	17,453
Contingent obligations related to business combinations	0	0
Total liabilities	29,144	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	6,641	37,324
Total liabilities	6,641	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	7,336	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	$ 7,336	$ 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	9 Months Ended
	Sep. 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	$ 14.4
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	9 Months Ended
	Sep. 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	(4,049)
Payments	(26,634)
Balance as of September 30, 2020	$ 6,641

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($)	9 Months Ended
	Sep. 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	$ 5,230,000,000	$ 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	Sep. 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	$ 1,467,892	$ 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	1,452,859	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	760,039	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	$ 751,536	$ 795,564

Restructuring and Other Costs -

Restructuring and Other Costs - Narrative (Details) $ in Millions	9 Months Ended
	Sep. 30, 2020USD ($)
Employee Severance Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	$ 20.2
Facility Closure and Lease Termination Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	0.4
Other Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	0.6
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	$ 1.2

Restructuring and Other Costs_2

Restructuring and Other Costs - Schedule of Restructuring and Related Costs (Details) - Business Restructuring Reserves $ in Thousands	9 Months Ended
	Sep. 30, 2020USD ($)
Restructuring Reserve
Balance as of December 31, 2019	$ 5,750
Expenses incurred	21,809
Cash payments made	(22,862)
Balance as of September 30, 2020	4,697
Facility lease closure and lease termination costs	1,600
Employee Severance Costs
Restructuring Reserve
Balance as of December 31, 2019	5,728
Expenses incurred	21,214
Cash payments made	(22,245)
Balance as of September 30, 2020	4,697
Other Costs
Restructuring Reserve
Balance as of December 31, 2019	22
Expenses incurred	595
Cash payments made	$ (617)

Shareholders' Equity - Shares o

Shareholders' Equity - Shares of Common Stock Outstanding (Details) - Common Stock - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Common stock shares, beginning balance	104,236,000	103,460,000	103,866,000	103,372,000
Repurchases of common stock	(506,000)	(141,000)	(1,106,000)	(1,323,000)
Issuances of common stock	264,000	474,000	1,234,000	1,744,000
Common stock shares, ending balance	103,994,000	103,793,000	103,994,000	103,793,000

Shareholders' Equity - Narrativ

Shareholders' Equity - Narrative (Details) - USD ($)

1 Months Ended

3 Months Ended

31 Months Ended

Sep. 30, 2020

Mar. 31, 2020

Aug. 31, 2019

Jun. 30, 2019

Feb. 28, 2019

Jan. 31, 2019

Apr. 30, 2018

Mar. 31, 2018

Sep. 30, 2020

Sep. 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 Class A [Member]

Class of Stock [Line Items]

Stock repurchased during period, shares

506,244

Stock repurchased during period, value

$ 30,000,000

Common Stock

Class of Stock [Line Items]

Stock repurchased during period, shares

506,244

600,000

141,100

509,100

120,600

552,100

1,024,400

948,100

4,401,644

Stock repurchase program, remaining authorization to repurchase

$ 106,300,000

$ 106,300,000

$ 106,300,000

Shareholders' Equity - Repurcha

Shareholders' Equity - Repurchase Activity (Details) - Common Stock - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended								31 Months Ended
	Sep. 30, 2020	Mar. 31, 2020	Aug. 31, 2019	Jun. 30, 2019	Feb. 28, 2019	Jan. 31, 2019	Apr. 30, 2018	Mar. 31, 2018	Sep. 30, 2020
Class of Stock [Line Items]
Stock repurchased (in shares)	506,244	600,000	141,100	509,100	120,600	552,100	1,024,400	948,100	4,401,644
Stock repurchased, average price paid per share (USD per share)	$ 59.26	$ 53.38	$ 49.93	$ 45.29	$ 41.40	$ 39.16	$ 36.60	$ 39.55
Stock repurchase program, shares purchased, value	$ 30,000	$ 32,029	$ 7,045	$ 23,055	$ 4,993	$ 21,623	$ 37,492	$ 37,493	$ 193,730

Earnings Per Share - Schedule o

Earnings Per Share - Schedule of Earnings Per Share, Basic and Diluted (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Numerator:
Net income	$ 63,416	$ 58,920	$ 100,901	$ 40,208
Weighted Average Number of Shares Outstanding Reconciliation [Abstract]
Basic weighted average common shares outstanding (in shares)	104,277	103,594	104,247	103,553
Effect of dilutive securities:
Stock options and other awards under deferred share-based compensation programs (in shares)	1,311	1,427	1,236	1,328
Diluted weighted average common shares outstanding (in shares)	105,588	105,021	105,483	104,881
Earnings per share:
Basic (USD per share)	$ 0.61	$ 0.57	$ 0.97	$ 0.39
Diluted (USD per share)	$ 0.60	$ 0.56	$ 0.96	$ 0.38

Earnings Per Share - Narrative

Earnings Per Share - Narrative (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Earnings Per Share [Abstract]
Anti-dillutive shares outstanding excluded from the computation of diluted earnings per share	177,330	220,269	713,269	295,706

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Income tax expense	$ 3,954	$ 11,055	$ 15,892	$ 43,756
Income before provision for income taxes	67,370	69,975	116,793	83,964
Discrete tax benefits (expense)	$ 18,800	$ 100	$ 24,300	$ (10,300)
U.S. federal statutory rate	21.00%	21.00%	21.00%	21.00%
Gross unrecognized tax benefits	$ 8,400		$ 8,400		$ 23,200
Increase (decrease) in unrecognized tax benefit			$ (14,800)

Revenue from Contracts with C_2

Revenue from Contracts with Customers - Narrative (Details) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2020USD ($)	Sep. 30, 2020USD ($)
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Unsatisfied performance obligations under contracts with a contract term greater than one year	$ 5,760	$ 5,760
Revenue recognized, included in contract liabilities balance at beginning of period	298.6	485
Increase (decrease) in revenue recognized, allocated to performance obligation partially satisfied in previous periods	$ 32.8	$ 25.6
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		9 Months Ended
	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)	Sep. 30, 2020USD ($)Segment	Sep. 30, 2019USD ($)
Segment Reporting Information [Line Items]
Number of reportable segments | Segment			2
Revenue	$ 1,099,004	$ 1,177,028	$ 3,275,758	$ 3,462,861
Direct costs (exclusive of depreciation and amortization)	820,228	913,674	2,550,134	2,718,005
Selling, general, and administrative expenses	111,096	109,864	334,042	333,860
Operating income (loss)	98,754	69,443	182,692	154,393
Restructuring and other costs	6,523	13,456	23,414	39,751
Transaction and integration-related expenses	6,955	10,454	17,900	34,766
Operating Segments
Segment Reporting Information [Line Items]
Direct costs (exclusive of depreciation and amortization)	812,528	906,755	2,526,146	2,695,612
Selling, general, and administrative expenses	87,602	90,075	270,151	275,657
Operating income (loss)	198,874	180,198	479,461	491,592
Corporate
Segment Reporting Information [Line Items]
Selling, general, and administrative expenses	16,101	13,905	40,613	39,732
Restructuring and other costs	6,523	13,456	23,414	39,751
Transaction and integration-related expenses	6,955	10,454	17,900	34,766
Depreciation and amortization	55,448	60,137	167,576	182,086
Corporate | Direct costs
Segment Reporting Information [Line Items]
Share-based compensation expense	7,700	6,919	23,988	22,393
Corporate | Selling, general, and administrative expenses
Segment Reporting Information [Line Items]
Share-based compensation expense	7,393	5,884	23,278	18,471
Clinical Solutions | Operating Segments
Segment Reporting Information [Line Items]
Revenue	829,163	867,427	2,451,168	2,522,307
Direct costs (exclusive of depreciation and amortization)	600,634	655,851	1,868,028	1,936,021
Selling, general, and administrative expenses	66,431	68,659	204,154	205,986
Operating income (loss)	162,098	142,917	378,986	380,300
Commercial Solutions | Operating Segments
Segment Reporting Information [Line Items]
Revenue	269,841	309,601	824,590	940,554
Direct costs (exclusive of depreciation and amortization)	211,894	250,904	658,118	759,591
Selling, general, and administrative expenses	21,171	21,416	65,997	69,671
Operating income (loss)	$ 36,776	$ 37,281	$ 100,475	$ 111,292

Operations by Geographic Loca_3

Operations by Geographic Location - Total Revenue by Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Revenues by Geographic Location
Revenue	$ 1,099,004	$ 1,177,028	$ 3,275,758	$ 3,462,861
North America
Revenues by Geographic Location
Revenue	694,286	780,460	2,085,895	2,299,439
Europe, Middle East, and Africa
Revenues by Geographic Location
Revenue	258,590	251,519	768,938	768,653
Asia-Pacific
Revenues by Geographic Location
Revenue	121,155	119,268	348,394	325,129
Latin America
Revenues by Geographic Location
Revenue	24,973	25,781	72,531	69,640
United States
Revenues by Geographic Location
Revenue	$ 659,600	$ 745,600	$ 1,981,700	$ 2,190,900
United States | Geographic Concentration Risk | Net Service Revenue
Revenues by Geographic Location
Concentration risk percentage	60.00%	63.30%	60.50%	63.30%

Operations by Geographic Loca_4

Operations by Geographic Location - Long-Lived Assets by Geographic Area (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Long-Lived Assets by Geographic Location
Total property and equipment, net	$ 196,258	$ 203,926
North America
Long-Lived Assets by Geographic Location
Total property and equipment, net	149,485	159,709
Europe, Middle East, and Africa
Long-Lived Assets by Geographic Location
Total property and equipment, net	31,095	28,514
Asia-Pacific
Long-Lived Assets by Geographic Location
Total property and equipment, net	11,440	12,742
Latin America
Long-Lived Assets by Geographic Location
Total property and equipment, net	4,238	2,961
United States
Long-Lived Assets by Geographic Location
Total property and equipment, net	$ 143,900	$ 153,100

Concentration of Credit Risk -

Concentration of Credit Risk - Narrative (Details) - Customer Concentration Risk	3 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2020	Sep. 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			9 Months Ended
	Sep. 30, 2020	Jun. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Related Party Transaction [Line Items]
Incurred professional services costs, related party	$ 0
Potential future cash consideration, in exchange of sale of company's contingent staffing business to related party	$ (152,000)		$ (370,000)	$ 3,791,000	$ 571,000
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	Sep. 30, 2020USD ($)	Mar. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Recurring
Loss Contingencies [Line Items]
Contingent obligations related to business combinations			$ 6,641,000		$ 37,324,000
InVentiv Merger | Recurring
Loss Contingencies [Line Items]
Contingent obligations related to business combinations			$ 6,600,000		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

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail) - Subsequent Event [Member] $ in Millions	Oct. 26, 2020USD ($)
Subsequent Event [Line Items]
Purchase Obligation	$ 400
Percentage of Outstanding Shares Purchase	100.00%
Purchase Agreement Closing Date	the fourth quarter of 2020