Syneos Health (SYNH) 10-Q 6 Aug 19 2019 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2019	Jul. 31, 2019
Cover page.
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q2
Entity Registrant Name	SYNEOS HEALTH, INC.
Entity Central Index Key	0001610950
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		103,485,261
Entity Shell Company	false
Entity Small Business	false
Entity Emerging Growth Company	false
Title of 12(b) Security	Class A Common Stock, $0.01 par value per share
Trading Symbol	SYNH
Security Exchange Name	NASDAQ
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

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Income Statement [Abstract]
Revenue	$ 1,166,827	$ 1,072,530	$ 2,285,833	$ 2,129,726
Costs and operating expenses:
Direct costs (exclusive of depreciation and amortization)	917,529	847,465	1,804,331	1,688,288
Selling, general, and administrative expenses	110,879	100,218	223,996	199,477
Restructuring and other costs	11,882	8,591	26,295	22,298
Transaction and integration-related expenses	7,654	18,032	24,312	43,243
Depreciation	19,248	17,557	38,819	35,585
Amortization	41,501	49,945	83,130	99,938
Total operating expenses	1,108,693	1,041,808	2,200,883	2,088,829
Income from operations	58,134	30,722	84,950	40,897
Other expense, net:
Interest income	2,133	1,655	3,635	2,494
Interest expense	(34,263)	(32,894)	(68,893)	(64,630)
Loss on extinguishment of debt	0	(1,877)	(4,355)	(2,125)
Other income (expense), net	7,573	32,001	(1,348)	19,447
Total other expense, net	(24,557)	(1,115)	(70,961)	(44,814)
Income (loss) before provision for income taxes	33,577	29,607	13,989	(3,917)
Income tax expense	(22,285)	(16,047)	(32,701)	(7,075)
Net income (loss)	$ 11,292	$ 13,560	$ (18,712)	$ (10,992)
Earnings (loss) per share:
Basic (USD per share)	$ 0.11	$ 0.13	$ (0.18)	$ (0.11)
Diluted (USD per share)	$ 0.11	$ 0.13	$ (0.18)	$ (0.11)
Weighted average common shares outstanding:
Basic (in shares)	103,699	102,899	103,532	103,674
Diluted (in shares)	104,818	104,005	103,532	103,674

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Statement of Comprehensive Income [Abstract]
Net income (loss)	$ 11,292	$ 13,560	$ (18,712)	$ (10,992)
Unrealized loss on derivative instruments, net of income tax benefit of $237, $0, $332 and $0, respectively	(8,962)		(13,178)
Unrealized loss on derivative instruments, net of income tax benefit of $237, $0, $332 and $0, respectively		(1,717)		(1,283)
Foreign currency translation adjustments, net of income tax benefit (expense) of $0, $0, $0 and $(2,868), respectively	(11,919)	(69,169)	8,685	(35,246)
Comprehensive loss	$ (9,589)	$ (57,326)	$ (23,205)	$ (47,521)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Statement of Comprehensive Income [Abstract]
Unrealized (loss) gain on derivative instruments, income tax benefit (expense)	$ 237		$ 332
Unrealized (loss) gain on derivative instruments, income tax benefit (expense)		$ 0		$ 0
Foreign currency translation adjustments, income tax benefit (expense)	$ 0	$ 0	$ 0	$ (2,868)

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Current assets:
Cash, cash equivalents, and restricted cash	$ 107,256	$ 155,932
Accounts receivable and unbilled services, net	1,287,509	1,256,731
Prepaid expenses and other current assets	71,985	79,299
Total current assets	1,466,750	1,491,962
Property and equipment, net	187,747	183,486
Operating lease right-of-use assets	227,715	0
Goodwill	4,336,355	4,333,159
Intangible assets, net	1,051,065	1,133,612
Deferred income tax assets	9,111	9,317
Other long-term assets	118,238	103,373
Total assets	7,396,981	7,254,909
Current liabilities:
Accounts payable	128,812	98,624
Accrued expenses	569,446	563,527
Deferred revenue	710,905	777,141
Current portion of operating lease obligations	29,760	0
Current portion of finance lease obligations	16,004
Current portion of finance lease obligations		13,806
Current portion of long-term debt	199,575	50,100
Total current liabilities	1,654,502	1,503,198
Long-term debt	2,534,842	2,737,019
Operating lease long-term obligations	228,704	0
Finance lease long-term obligations	28,390
Finance lease long-term obligations		26,759
Deferred income tax liabilities	33,223	25,120
Other long-term liabilities	93,421	106,669
Total liabilities	4,573,082	4,398,765
Commitments and contingencies (Note 17)
Shareholders' equity:
Preferred stock, $0.01 par value; 30,000 shares authorized, 0 shares issued and outstanding at June 30, 2019 and December 31, 2018	0	0
Common stock, $0.01 par value; 600,000 shares authorized, 103,460 and 103,372 shares issued and outstanding at June 30, 2019 and December 31, 2018, respectively	1,035	1,034
Additional paid-in capital	3,404,389	3,402,638
Accumulated other comprehensive loss, net of tax	(92,688)	(88,195)
Accumulated deficit	(488,837)	(459,333)
Total shareholders' equity	2,823,899	2,856,144
Total liabilities and shareholders' equity	$ 7,396,981	$ 7,254,909

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares	Jun. 30, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Common stock shares authorized (in shares)	600,000,000	600,000,000
Common stock par value (USD per share)	$ 0.01	$ 0.01
Common stock shares issued (in shares)	103,460,000	103,372,000
Common stock shares outstanding (in shares)	103,460,000	103,372,000
Preferred stock shares authorized (in shares)	30,000,000	30,000,000
Preferred stock par value (USD per share)	$ 0.01	$ 0.01
Preferred stock shares issued (in shares)	0	0
Preferred stock shares outstanding (in shares)	0	0

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
Cash flows from operating activities:
Net loss	$ (18,712)	$ (10,992)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	121,949	135,523
Share-based compensation	28,061	16,254
Provision for doubtful accounts	783	(1,734)
Provision for (benefit from) deferred income taxes	8,793	(7,682)
Foreign currency transaction adjustments	(957)	(19,633)
Fair value adjustment of contingent obligations	(940)	2,388
Loss on extinguishment of debt	4,355	2,125
Other non-cash items	1,147	4,024
Changes in operating assets and liabilities, net of effect of business combinations:
Accounts receivable, unbilled services, and deferred revenue	(89,535)	(68,629)
Accounts payable and accrued expenses	32,005	(3,269)
Other assets and liabilities	(3,435)	16,799
Net cash provided by operating activities	83,514	65,174
Cash flows from investing activities:
Purchases of property and equipment	(28,066)	(32,586)
Investments in unconsolidated affiliates	(3,000)	0
Net cash used in investing activities	(31,066)	(32,586)
Cash flows from financing activities:
Proceeds from issuance of long-term debt, net of discount	183,195	0
Payments of debt financing costs	(1,032)	(3,421)
Repayments of long-term debt	(256,136)	(97,500)
Proceeds from accounts receivable financing agreement	38,200	0
Repayments of accounts receivable financing agreement	(22,400)	0
Payments of contingent consideration related to business combinations	(8)	0
Payments of finance leases	(4,677)
Payments of finance leases		(8,863)
Payments for repurchase of common stock	(49,671)	(74,985)
Proceeds from exercise of stock options	24,377	7,458
Payments related to tax withholding for share-based compensation	(11,763)	(2,383)
Net cash used in financing activities	(99,915)	(179,694)
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	(1,209)	(1,151)
Net change in cash, cash equivalents, and restricted cash	(48,676)	(148,257)
Cash, cash equivalents, and restricted cash - beginning of period	155,932	321,976
Cash, cash equivalents, and restricted cash - end of period	$ 107,256	$ 173,719

CONDENSED CONSOLIDATED STATEM_5

CONDENSED CONSOLIDATED STATEMENTS OF SHAREHOLDERS' EQUITY (Unaudited) - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive (Loss) Income	Accumulated Deficit
Balance at beginning of period at Dec. 31, 2017	$ 3,022,579	$ 1,044	$ 3,414,389	$ (22,385)	$ (370,469)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock repurchase		(19)	(64,482)		(10,483)
RSU distributions net of shares for tax withholding		1	(2,384)
Stock option exercises		3	7,539
Stock option exercises			16,254
Unrealized loss on derivative instruments, net of taxes				(1,283)
Foreign currency translation adjustment, net of taxes	(35,246)			(35,246)
Net income (loss)	(10,992)				(10,992)
Balance at end of period at Jun. 30, 2018	2,822,672	1,029	3,371,316	(55,064)	(494,609)
Balance at beginning of period at Mar. 31, 2018	2,907,259	1,038	3,394,586	15,822	(504,187)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock repurchase		(10)	(33,500)		(3,982)
RSU distributions net of shares for tax withholding		0	(60)
Stock option exercises		1	1,915
Stock option exercises			8,375
Unrealized loss on derivative instruments, net of taxes				(1,717)
Foreign currency translation adjustment, net of taxes	(69,169)			(69,169)
Net income (loss)	13,560				13,560
Balance at end of period at Jun. 30, 2018	2,822,672	1,029	3,371,316	(55,064)	(494,609)
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]
Stock repurchase		(12)	(38,867)		(10,792)
RSU distributions net of shares for tax withholding		4	(11,778)
Stock option exercises		9	24,335
Stock option exercises			28,061
Unrealized loss on derivative instruments, net of taxes	(13,178)			(13,178)
Foreign currency translation adjustment, net of taxes	8,685			8,685
Net income (loss)	(18,712)
Balance at end of period at Jun. 30, 2019	2,823,899	1,035	3,404,389	(92,688)	(488,837)
Balance at beginning of period at Mar. 31, 2019	2,838,370	1,038	3,402,953	(71,807)	(493,814)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock repurchase		(5)	(16,735)		(6,315)
RSU distributions net of shares for tax withholding		0	(241)
Stock option exercises		2	4,618
Stock option exercises			13,794
Unrealized loss on derivative instruments, net of taxes	(8,962)			(8,962)
Foreign currency translation adjustment, net of taxes	(11,919)			(11,919)
Net income (loss)	11,292
Balance at end of period at Jun. 30, 2019	$ 2,823,899	$ 1,035	$ 3,404,389	$ (92,688)	$ (488,837)

Basis of Presentation and Chang

Basis of Presentation and Changes in Significant Accounting Policies	6 Months Ended
	Jun. 30, 2019
Accounting Policies [Abstract]
Basis of Presentation and Changes in Significant Accounting Policies	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 to Phase 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, 2018 , filed with the Securities and Exchange Commission on March 18, 2019 . The results of operations for the three and six months ended June 30, 2019 are not necessarily indicative of the results to be expected for the full year ending December 31, 2019 or any other future period. The unaudited condensed consolidated balance sheet at December 31, 2018 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, 2018 . Allowance for Doubtful Accounts The Company maintains a credit approval process and makes judgments in connection with assessing its customers’ ability to pay throughout the contractual obligation period. Generally, the Company has the ability to limit credit exposure by discontinuing services in the event of non-payment. The Company has certain customers that may depend on the ability to continue to raise capital in order to complete the development or commercialization of their products. The Company monitors its customers’ credit worthiness and applies judgment in establishing a provision for estimated credit losses based on historical experience, current receivables aging, and identified customer-specific circumstances that would affect the customers’ ability to meet their obligation. Despite this assessment, from time to time, customers are unable to meet their payment obligations, which could impact the Company’s results of operations. Recently Adopted Accounting Standards Leases . In February 2016, the Financial Accounting Standards Board issued Accounting Standards Update No. 2016-02 (“ASU 2016-02”), Leases (Topic 842) , as further amended, to increase transparency and comparability among organizations by requiring the recognition of, at the lease commencement date, a lease liability for the obligation to make lease payments, and a right-of-use ("ROU") asset for the right to use the underlying asset, on the balance sheet. The Company adopted ASU 2016-02, and all related amendments, collectively “ASC 842”, as of January 1, 2019, using the modified retrospective approach. Results for reporting periods beginning on January 1, 2019 are presented under ASC 842, while prior period amounts continue to be reported and disclosed in accordance with the Company’s historical accounting treatment under Accounting Standards Codification 840 , Leases (“ASC 840”). In addition, the Company elected the package of practical expedients permitted under the transition guidance within the new standard, which among other things, does not require the Company to reassess if a contract is or contains a lease and allows the Company to carry forward the historical lease classifications and historical initial direct costs. The Company made an accounting policy election under ASC 842 not to recognize ROU assets and lease liabilities for leases with a term of 12 months or less. Lease payments for these leases are recognized as lease costs on a straight-line basis over the lease term. The Company also elected to account for lease components and the associated non-lease components in the contracts as a single lease component for all classes of underlying assets. Adoption of the new standard resulted in the recording of additional net lease assets and lease liabilities, mainly related to operating leases, of approximately $214.0 million

Financial Statement Details

Financial Statement Details	6 Months Ended
	Jun. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Financial Statement Details	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. Accounts Receivable and Unbilled Services, net Accounts receivable and unbilled services, net of allowance for doubtful accounts, consisted of the following (in thousands): June 30, 2019 December 31, 2018 Accounts receivable billed $ 781,440 $ 733,142 Less: Allowance for doubtful accounts (5,296 ) (4,587 ) Accounts receivable billed, net 776,144 728,555 Accounts receivable unbilled 419,337 422,860 Contract assets 92,028 105,316 Accounts receivable and unbilled services, net $ 1,287,509 $ 1,256,731 Accounts Receivable Factoring Arrangement In May 2017, the Company entered into an accounts receivable factoring agreement to sell certain eligible unsecured trade accounts receivable, without recourse, to an unrelated third-party financial institution for cash. For the six months ended June 30, 2019 and 2018 , the Company factored $113.7 million and $100.9 million , respectively, of trade accounts receivable on a non-recourse basis and received $112.8 million and $100.5 million , respectively, in cash proceeds from the sale. The fees associated with these transactions were insignificant. Goodwill The changes in the carrying amount of goodwill by segment for the six months ended June 30, 2019 were as follows (in thousands): Total Clinical Commercial Balance at December 31, 2018: Gross carrying amount $ 4,349,325 $ 2,780,945 $ 1,568,380 Accumulated impairment losses (a) (16,166 ) (8,142 ) (8,024 ) Goodwill, net of accumulated impairment losses 4,333,159 2,772,803 1,560,356 2019 Activity: Business combinations (b) (250 ) — (250 ) Impact of foreign currency translation 3,446 1,209 2,237 Balance at June 30, 2019: Gross carrying amount 4,352,521 2,782,154 1,570,367 Accumulated impairment losses (a) (16,166 ) (8,142 ) (8,024 ) Goodwill, net of accumulated impairment losses $ 4,336,355 $ 2,774,012 $ 1,562,343 (a) Accumulated impairment losses associated with the Clinical Solutions segment were recorded prior to 2019 and related to the former Phase I Services segment, now a component of the Clinical Solutions segment. Accumulated impairment losses associated with the Commercial Solutions segment were recorded prior to 2019 and related to the former Global Consulting segment, now a component of the Commercial Solutions segment. No impairment of goodwill was recorded for the six months ended June 30, 2019 . (b) Amount represents measurement period adjustments to goodwill recognized in connection with the acquisition of Kinapse Topco Limited (“Kinapse”). Transaction and Integration-Related Expenses Transaction and integration-related expenses consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Professional fees $ 6,678 $ 11,073 $ 19,523 $ 25,774 Debt modification and related expenses 1,732 1,317 3,973 1,317 Integration and personnel retention-related costs 909 4,448 1,756 13,741 Fair value adjustments to contingent obligations (1,665 ) 1,194 (940 ) 2,388 Other — — — 23 Total transaction and integration-related expenses $ 7,654 $ 18,032 $ 24,312 $ 43,243 Accumulated Other Comprehensive Loss, Net of Tax Accumulated other comprehensive loss, net of tax, consisted of the following (in thousands): June 30, 2019 December 31, 2018 Foreign currency translation adjustments $ (72,270 ) $ (80,955 ) Unrealized loss on derivative instruments (20,418 ) (7,240 ) Accumulated other comprehensive loss $ (92,688 ) $ (88,195 ) Changes in accumulated other comprehensive loss, net of tax, for the three months ended June 30, 2019 were as follows (in thousands): Unrealized Loss on Derivative Instruments Foreign Currency Translation Adjustments Total Balance at March 31, 2019 $ (11,456 ) $ (60,351 ) $ (71,807 ) Other comprehensive loss before reclassifications (9,544 ) (11,919 ) (21,463 ) Amount of gain reclassified from accumulated other comprehensive loss into statement of operations 582 — 582 Net current period other comprehensive loss, net of tax (8,962 ) (11,919 ) (20,881 ) Balance at June 30, 2019 $ (20,418 ) $ (72,270 ) $ (92,688 ) Changes in accumulated other comprehensive loss, net of tax, for the six months ended June 30, 2019 were as follows (in thousands): Unrealized Loss on Derivative Instruments Foreign Currency Translation Adjustments Total Balance at December 31, 2018 $ (7,240 ) $ (80,955 ) $ (88,195 ) Other comprehensive (loss) gain before reclassifications (14,246 ) 8,685 (5,561 ) Amount of gain reclassified from accumulated other comprehensive loss into the statement of operations 1,068 — 1,068 Net current period other comprehensive (loss) gain, net of tax (13,178 ) 8,685 (4,493 ) Balance at June 30, 2019 $ (20,418 ) $ (72,270 ) $ (92,688 ) The income tax effects allocated to each component of other comprehensive income (loss) for the three months ended June 30, 2019 were as follows (in thousands): Before-Tax Amount Tax Benefit Net-of-Tax Amount Foreign currency translation adjustments $ (11,919 ) $ — $ (11,919 ) Unrealized (loss) gain on derivative instruments: Unrealized loss during period (9,800 ) 256 (9,544 ) Reclassification adjustment for gains realized in net income 601 (19 ) 582 Net unrealized loss on derivative instruments (9,199 ) 237 (8,962 ) Other comprehensive loss $ (21,118 ) $ 237 $ (20,881 ) The income tax effects allocated to each component of other comprehensive income (loss) for the six months ended June 30, 2019 were as follows (in thousands): Before-Tax Amount Tax Benefit Net-of-Tax Amount Foreign currency translation adjustments $ 8,685 $ — $ 8,685 Unrealized (loss) gain on derivative instruments: Unrealized loss during period (14,616 ) 370 (14,246 ) Reclassification adjustment for gains realized in net loss 1,106 (38 ) 1,068 Net unrealized loss on derivative instruments (13,510 ) 332 (13,178 ) Other comprehensive loss $ (4,825 ) $ 332 $ (4,493 ) For the three months ended June 30, 2018 , the income tax provision related to the components of other comprehensive loss was fully offset by the increase in the valuation allowance, resulting in no income tax impact for the period. The income tax effects allocated to each component of other comprehensive loss for the six months ended June 30, 2018 were as follows (in thousands): Before-Tax Amount Tax Benefit Net-of-Tax Amount Foreign currency translation adjustments $ (32,378 ) $ (2,868 ) $ (35,246 ) Unrealized loss on derivative instruments: Unrealized loss during the period (685 ) — (685 ) Reclassification adjustment of realized gains to net loss (598 ) — (598 ) Net unrealized loss on derivative instruments (1,283 ) — (1,283 ) Other comprehensive loss $ (33,661 ) $ (2,868 ) $ (36,529 ) Other Income (Expense), Net Other income (expense), net consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Net realized foreign currency gain (loss) $ 7,275 $ 5,685 $ (1,131 ) $ 168 Net unrealized foreign currency gain 880 25,997 957 19,633 Other, net (582 ) 319 (1,174 ) (354 ) Total other income (expense), net $ 7,573 $ 32,001 $ (1,348 ) $ 19,447

Business Combinations

Business Combinations	6 Months Ended
	Jun. 30, 2019
Business Combinations [Abstract]
Business Combinations	Business Combinations inVentiv Health Merger On August 1, 2017 , the Company completed a merger (the “Merger”) with Double Eagle Parent, Inc. (“inVentiv”), the parent company of inVentiv Health, Inc., with the Company surviving as the accounting and legal entity acquirer. The Merger was accounted for as a business combination using the acquisition method of accounting in accordance with ASC Topic 805, Business Combinations . The purchase price has been allocated to the tangible assets and identifiable intangible assets acquired and liabilities assumed based upon their fair values. The excess of the purchase price over the tangible and intangible assets acquired and liabilities assumed has been recorded as goodwill. The goodwill in connection with the Merger is primarily attributable to the assembled workforce of inVentiv and the expected synergies of the Merger. In connection with the Merger, the Company assumed certain contingent tax-sharing obligations of inVentiv. The fair value of the contingent tax-sharing liability is remeasured at the end of each reporting period, with changes in the estimated fair value reflected in earnings until the liability is fully settled. The estimated fair value of the contingent tax-sharing obligations liability was $14.7 million and $15.7 million as of June 30, 2019 and December 31, 2018 , respectively. The liability is included in accrued expenses and other long-term liabilities on the accompanying unaudited condensed consolidated balance sheets. Kinapse Limited Acquisition In August 2018, the Company completed its acquisition of Kinapse, a provider of advisory and operational solutions to the global life sciences industry. The total purchase consideration was $100.1 million plus assumed debt, and included cash acquired of $4.9 million . The Company recognized $74.5 million of goodwill and $57.3 million of intangible assets, principally customer relationships, as a result of the acquisition. The goodwill is not deductible for income tax purposes. The Company’s assessment of fair value and the purchase price allocation related to this acquisition is preliminary and further adjustments may be necessary as additional information related to the fair values of assets acquired and liabilities assumed is assessed during the measurement period (up to one year from the acquisition date). The operating results from the Kinapse acquisition have been included in the Company’s Commercial Solutions segment from the date of acquisition.

Long-Term Debt Obligations

Long-Term Debt Obligations	6 Months Ended
	Jun. 30, 2019
Debt Disclosure [Abstract]
Long-Term Debt Obligations	Long-Term Debt Obligations The Company’s debt obligations consisted of the following (in thousands): June 30, 2019 December 31, 2018 Secured Debt Term Loan A due March 2024 $ 1,150,000 $ 975,000 Term Loan B due August 2024 977,364 1,221,000 Accounts receivable financing agreement due June 2020 185,200 169,400 Total secured debt 2,312,564 2,365,400 Unsecured Debt 7.5% Senior Unsecured Notes due 2024 403,000 403,000 Total debt obligations 2,715,564 2,768,400 Add: unamortized Senior Notes premium, net of term loan original issuance discount 28,250 32,303 Less: unamortized deferred issuance costs (9,397 ) (13,584 ) Less: current portion of debt (199,575 ) (50,100 ) Total debt obligations, non-current portion $ 2,534,842 $ 2,737,019 Concurrent with the completion of the Merger on August 1, 2017, the Company entered into a credit agreement (as amended, the "Credit Agreement") for: (i) a $1.0 billion Term Loan A facility that would mature on August 1, 2022 (the “Term Loan A”); (ii) a $1.6 billion Term Loan B facility that would mature on August 1, 2024 (the “Term Loan B”); and (iii) a five -year $500.0 million revolving credit facility (the “Revolver”) that would mature on August 1, 2022 . On May 4, 2018, the Company entered into Amendment No. 1 to the Credit Agreement, which, among other things, modified the terms of the Credit Agreement to reduce by 0.25% overall the applicable margins for Alternate Base Rate (as defined in the Credit Agreement) loans and Adjusted Eurocurrency Rate (as defined in the Credit Agreement) loans with respect to both the Term Loan A and Term Loan B facilities. During the six months ended June 30, 2019 , the Company voluntarily prepaid $65.0 million towards reducing its outstanding Term Loan B balance, which was applied against the regularly-scheduled quarterly principal payments. As a result of these and previous voluntary prepayments, the Company is not required to make a mandatory principal payment against the Term Loan B principal balance until maturity in August 2024. Additionally, during the six months ended June 30, 2019 , the Company made mandatory principal repayments of $12.5 million towards its Term Loan A. Amendment No. 2 to the Credit Agreement On March 26, 2019, the Company entered into Amendment No. 2 to the Credit Agreement (“the Second Amendment”). The Second Amendment, among other things, modifies the terms of the Credit Agreement to refinance the existing Term Loan A facility and the Revolver as follows: (a) to increase the existing Term Loan A facility by $587.5 million to $1.55 billion . $187.5 million of such increase was applied at closing to repay a portion of the Company’s existing Term Loan B facility and the fees and expenses incurred in connection with the Second Amendment, and the remaining $400.0 million will be available to be funded in multiple draws within nine months of closing and applied to further prepay loans under the Term Loan B facility and/or redeem, repay, defease or discharge all or a portion of the Company’s 7.5% Senior Unsecured Notes due 2024 (the “Senior Notes”); (b) to increase the existing Revolver commitments available by $100.0 million to $600.0 million , and reduce the margin spread by 0.25% overall, resulting in (i) for Adjusted Eurocurrency Rate loans, a margin spread of 1.50% and (ii) for Alternate Base Rate loans, a margin spread of 0.50% , with a single 0.25% step-down based on the achievement of certain leverage ratios; and (c) to extend the maturity of the Term Loan A facility and the Revolver to March 26, 2024. The Term Loan A facility and the Revolver will continue to be subject to the same affirmative covenants and negative covenants. The financial covenant will be set at a First Lien Leverage Ratio (as defined in the Credit Agreement) of 5.00 : 1.00 with a single step-down to 4.50 : 1.00 commencing with the fiscal quarter ending March 31, 2020. The Company was in compliance with all covenants of the Credit Agreement as of June 30, 2019 . In connection with the Second Amendment, during the three months ended March 31, 2019, the Company recorded a $4.4 million loss on extinguishment of debt, mainly due to the write-off of the deferred issuance costs and debt discount. The funded amount of the Term Loan A facility was issued net of a discount and debt issuance costs totaling $2.8 million . These costs are being accreted as a component of interest expense using the effective interest rate method over the term of this facility. The Company recorded debt issuance costs and related fees in connection with the Revolver and the unfunded amount of the Term Loan A facility of approximately $3.5 million , which are included in other long-term assets in the unaudited condensed consolidated balance sheet. These costs are amortized as a component of interest expense on a straight-line basis over the related terms. Covenant Restrictions under our Lease Agreement The lease agreement for the Company’s new corporate headquarters in Morrisville, North Carolina includes a provision that requires the Company to issue a letter of credit in certain amounts to the landlord based on the Company’s debt rating issued by Moody’s Investors Service (or other nationally-recognized debt rating agency). As of June 30, 2019 (and through the date of this filing), the Company’s credit rating was Ba3. As such, no letter of credit was required through the date of this filing. Any letters of credit issued in accordance with the aforementioned requirements would be issued under the Revolver, and would reduce its available borrowing capacity by the same amount. As of June 30, 2019 , the Company ha d $580.5 million (net of $19.5 million in outstanding letters of credit) of available borrowings for working capital and other purposes under the Revolver and $0.8 million of letters of credit that were not secured by the Revolver. Accounts Receivable Financing Agreement On June 29, 2018, the Company entered into an accounts receivable financing agreement ( as amended) with a termination date of June 29, 2020, unless terminated earlier pursuant to its terms. Under this agreement, certain of the Company’s consolidated subsidiaries will sell accounts receivable and unbilled services (including contract assets) balances to a wholly-owned, bankruptcy-remote special purpose entity (“SPE”). The SPE can borrow up to $250.0 million from a third-party lender, secured by liens on certain receivables and other assets of the SPE. The Company has guaranteed the performance of the obligations of existing and future subsidiaries that sell and service the accounts receivable under this agreement. The available borrowing capacity varies monthly according to the levels of the Company’s eligible accounts receivable and unbilled receivables. Loans under this agreement will accrue interest at a reserve-adjusted LIBOR rate or a base rate equal to the higher of (i) the applicable lender’s prime rate and (ii) the federal funds rate plus 0.50% . 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 June 30, 2019 , the Company had $185.2 million of outstanding borrowings under the accounts receivable financing agreement, which are recorded in the current portion of long-term debt on the accompanying unaudited condensed consolidated balance sheet. The remaining maximum capacity available for borrowing under this agreement was $64.8 million as of June 30, 2019 . The Company expects to renew this accounts receivable financing agreement prior to June 29, 2020. Maturities of Debt Obligations As of June 30, 2019 , the contractual maturities of the Company’s debt obligations were as follows (in thousands): Principal Interest 2019 $ — $ 65,827 2020 228,325 126,766 2021 79,063 120,320 2022 107,813 116,384 2023 115,000 110,852 2024 and thereafter 2,185,363 56,376 Less: deferred issuance costs (9,397 ) Unamortized Senior Notes premium, net of term loan original issuance discount 28,250 Total $ 2,734,417 $ 596,525

Leases

Leases	6 Months Ended
	Jun. 30, 2019
Leases [Abstract]
Leases	Leases The Company’s operating leases are primarily related to its office facilities. The Company’s finance leases are related to vehicles that the Company leases for certain sales representatives in its Commercial Solutions segment. These leases have remaining lease terms of less than one year to 13 years, some of which include options to extend the term or terminate the lease. These options to extend or terminate a lease are included in the lease terms when it is reasonably certain that the Company will exercise that option. ROU assets and lease liabilities are recognized based on the present value of the fixed lease payments over the lease term at the commencement date. The ROU assets also include any initial direct costs incurred and lease payments made at or before the commencement date, and are reduced by lease incentives. The Company uses its incremental borrowing rate as the discount rate to determine the present value of the lease payments for leases that do not have a readily determinable implicit discount rate. The Company’s incremental borrowing rate is the rate of interest that it would have to borrow on a collateralized basis over a similar term and amount in a similar economic environment. The Company determines the incremental borrowing rates for its leases by adjusting the local risk free interest rate with a credit risk premium corresponding to the Company’s credit rating. The Company records rent expense for its operating leases on a straight-line basis from the lease commencement date until the end of the lease term. The Company records finance lease cost as a combination of the amortization expense for the ROU assets and interest expense for the outstanding lease liabilities using the discount rate discussed above. Variable lease payments for operating leases are related to the office facilities and include but are not limited to common area maintenance, parking, electricity, and management fees. The variable lease payments for finance leases are related to maintenance programs for leased vehicles. Variable lease payments are based on occurrence or based on usage; therefore, they are not included as part of the initial calculations of the ROU assets and liabilities. The components of lease cost were as follows (in thousands): Three Months Ended Six Months Ended Classification June 30, 2019 June 30, 2019 Operating leases: Fixed lease costs Selling, general, and administrative expenses $ 16,965 $ 34,105 Short-term lease costs Selling, general, and administrative expenses 195 574 Variable lease costs Selling, general, and administrative expenses 8,864 16,654 Total operating lease costs $ 26,024 $ 51,333 Finance leases: Amortization of right-of-use assets Depreciation $ 3,991 $ 8,310 Interest on lease liabilities Interest expense 414 808 Variable lease costs Selling, general, and administrative expenses 1,803 3,630 Total finance lease costs $ 6,208 $ 12,748 Supplemental balance sheet information related to finance leases was as follows (in thousands): June 30, 2019 Property and equipment, gross $ 59,344 Accumulated depreciation (20,741 ) Property and equipment, net $ 38,603 Current portion of finance lease obligations $ 16,004 Finance lease long-term obligations 28,390 Total finance lease liabilities $ 44,394 Supplemental cash flow information related to leases was as follows (in thousands): Six Months Ended June 30, 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ (28,452 ) Operating cash flows for finance leases (808 ) Financing cash flows for finance leases (4,677 ) Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 41,286 Finance leases 12,286 Lease obligations closed out in exchange for right-of-use assets: Operating leases $ (573 ) Weighted average remaining lease term: June 30, 2019 Operating leases 8 years Finance leases 3 years Weighted average discount rate: June 30, 2019 Operating leases 4.9 % Finance leases 3.3 % As of June 30, 2019 , maturities of lease liabilities were as follows (in thousands): Operating Leases Finance Leases Total 2019 (remaining 6 months) $ 16,149 $ 9,536 $ 25,685 2020 50,811 15,825 66,636 2021 45,255 12,629 57,884 2022 39,394 8,254 47,648 2023 35,626 1,284 36,910 2024 and thereafter 131,401 — 131,401 Total lease payments 318,636 47,528 $ 366,164 Less: management fee (624 ) Less: imputed interest (60,172 ) (2,510 ) Total lease liabilities $ 258,464 $ 44,394 Under ASC 840, as of December 31, 2018 , the Company had total capital lease assets of $55.3 million and accumulated depreciation of $17.6 million , which are included within property and equipment, net, on the unaudited condensed consolidated balance sheet. The related capital lease obligations totaled $40.6 million as of December 31, 2018 . For the three and six months ended June 30, 2018 , the Company recorded rent expense of $16.6 million and $33.3 million
Leases	Leases The Company’s operating leases are primarily related to its office facilities. The Company’s finance leases are related to vehicles that the Company leases for certain sales representatives in its Commercial Solutions segment. These leases have remaining lease terms of less than one year to 13 years, some of which include options to extend the term or terminate the lease. These options to extend or terminate a lease are included in the lease terms when it is reasonably certain that the Company will exercise that option. ROU assets and lease liabilities are recognized based on the present value of the fixed lease payments over the lease term at the commencement date. The ROU assets also include any initial direct costs incurred and lease payments made at or before the commencement date, and are reduced by lease incentives. The Company uses its incremental borrowing rate as the discount rate to determine the present value of the lease payments for leases that do not have a readily determinable implicit discount rate. The Company’s incremental borrowing rate is the rate of interest that it would have to borrow on a collateralized basis over a similar term and amount in a similar economic environment. The Company determines the incremental borrowing rates for its leases by adjusting the local risk free interest rate with a credit risk premium corresponding to the Company’s credit rating. The Company records rent expense for its operating leases on a straight-line basis from the lease commencement date until the end of the lease term. The Company records finance lease cost as a combination of the amortization expense for the ROU assets and interest expense for the outstanding lease liabilities using the discount rate discussed above. Variable lease payments for operating leases are related to the office facilities and include but are not limited to common area maintenance, parking, electricity, and management fees. The variable lease payments for finance leases are related to maintenance programs for leased vehicles. Variable lease payments are based on occurrence or based on usage; therefore, they are not included as part of the initial calculations of the ROU assets and liabilities. The components of lease cost were as follows (in thousands): Three Months Ended Six Months Ended Classification June 30, 2019 June 30, 2019 Operating leases: Fixed lease costs Selling, general, and administrative expenses $ 16,965 $ 34,105 Short-term lease costs Selling, general, and administrative expenses 195 574 Variable lease costs Selling, general, and administrative expenses 8,864 16,654 Total operating lease costs $ 26,024 $ 51,333 Finance leases: Amortization of right-of-use assets Depreciation $ 3,991 $ 8,310 Interest on lease liabilities Interest expense 414 808 Variable lease costs Selling, general, and administrative expenses 1,803 3,630 Total finance lease costs $ 6,208 $ 12,748 Supplemental balance sheet information related to finance leases was as follows (in thousands): June 30, 2019 Property and equipment, gross $ 59,344 Accumulated depreciation (20,741 ) Property and equipment, net $ 38,603 Current portion of finance lease obligations $ 16,004 Finance lease long-term obligations 28,390 Total finance lease liabilities $ 44,394 Supplemental cash flow information related to leases was as follows (in thousands): Six Months Ended June 30, 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ (28,452 ) Operating cash flows for finance leases (808 ) Financing cash flows for finance leases (4,677 ) Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 41,286 Finance leases 12,286 Lease obligations closed out in exchange for right-of-use assets: Operating leases $ (573 ) Weighted average remaining lease term: June 30, 2019 Operating leases 8 years Finance leases 3 years Weighted average discount rate: June 30, 2019 Operating leases 4.9 % Finance leases 3.3 % As of June 30, 2019 , maturities of lease liabilities were as follows (in thousands): Operating Leases Finance Leases Total 2019 (remaining 6 months) $ 16,149 $ 9,536 $ 25,685 2020 50,811 15,825 66,636 2021 45,255 12,629 57,884 2022 39,394 8,254 47,648 2023 35,626 1,284 36,910 2024 and thereafter 131,401 — 131,401 Total lease payments 318,636 47,528 $ 366,164 Less: management fee (624 ) Less: imputed interest (60,172 ) (2,510 ) Total lease liabilities $ 258,464 $ 44,394 Under ASC 840, as of December 31, 2018 , the Company had total capital lease assets of $55.3 million and accumulated depreciation of $17.6 million , which are included within property and equipment, net, on the unaudited condensed consolidated balance sheet. The related capital lease obligations totaled $40.6 million as of December 31, 2018 . For the three and six months ended June 30, 2018 , the Company recorded rent expense of $16.6 million and $33.3 million

Derivatives

Derivatives	6 Months Ended
	Jun. 30, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivatives	Derivatives In May 2016, the Company entered into interest rate swaps with a combined notional value of $300.0 million in an effort to limit its exposure to variable interest rates on its term loans. The swaps became effective on June 30, 2016 and a portion of the interest rate swaps expired on June 30, 2018, with the remainder expiring on May 14, 2020. As of June 30, 2019 , the remaining notional value of these interest rate swaps was $100.0 million . In June 2018, the Company entered into an interest rate swap with an aggregate notional value of $1.01 billion , that became effective on December 31, 2018 and will expire on June 30, 2021. The significant terms of these derivatives are substantially the same as those contained within the Credit Agreement, including monthly settlements with the swap counterparties. Interest rate swaps are designated as hedging instruments. During the three and six months ended June 30, 2019 , the amount of loss recognized in other income (expense), net with respect to these contracts was inconsequential. As a result of an acquisition that occurred during the third quarter of 2018, the Company became a party to certain foreign currency exchange rate forward contracts. These contracts expired on various dates through April 2019. During the three and six months ended June 30, 2019 , the amount of loss recognized in other income (expense), net with respect to these contracts was inconsequential. The fair values of the Company’s derivative financial instruments and the line items on the accompanying unaudited condensed consolidated balance sheets to which they were recorded were as follows (in thousands): Balance Sheet Classification June 30, 2019 December 31, 2018 Interest rate swaps - current Prepaid expenses and other current assets $ 543 $ 1,355 Interest rate swaps - non-current Other long-term assets — 441 Foreign currency exchange rate swaps - current Accrued expenses — (138 ) Interest rate swaps - current Accrued expenses (9,172 ) (3,031 ) Interest rate swaps - non-current Other long-term liabilities (12,463 ) (6,201 )

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2019
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements Assets and Liabilities Carried at Fair Value As of June 30, 2019 and December 31, 2018 , the Company’s financial assets and liabilities carried at fair value included cash and cash equivalents, restricted cash, trading securities, billed and unbilled accounts receivable (including contract assets), accounts payable, accrued expenses, deferred revenue, assumed contingent obligations, finance leases, liabilities under the accounts receivable financing agreement, and derivative instruments. The fair values of cash and cash equivalents, restricted cash, billed and unbilled accounts receivable (including contract assets), accounts payable, accrued expenses, deferred revenue, and the liabilities under the accounts receivable financing agreement approximate their respective carrying amounts because of the liquidity and short-term nature of these financial instruments. Financial Instruments Subject to Recurring Fair Value Measurements As of June 30, 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 Total Assets: Trading securities (a) $ 21,392 $ — $ — $ 21,392 Derivative instruments (b) — 543 — 543 Total assets $ 21,392 $ 543 $ — $ 21,935 Liabilities: Derivative instruments (b) $ — $ 21,635 $ — $ 21,635 Contingent obligations related to business combinations (c) — — 19,152 19,152 Total liabilities $ — $ 21,635 $ 19,152 $ 40,787 As of December 31, 2018 , 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 Total Assets: Trading securities (a) $ 14,945 $ — $ — $ 14,945 Derivative instruments (d) — 1,796 — 1,796 Total assets $ 14,945 $ 1,796 $ — $ 16,741 Liabilities: Derivative instruments (d) $ — $ 9,370 $ — $ 9,370 Contingent consideration obligations related to business combinations (c) — — 20,127 20,127 Total liabilities $ — $ 9,370 $ 20,127 $ 29,497 (a) Represents fair value of investments in mutual funds based on quoted market prices that are used to fund the liability associated with the deferred compensation plan. (b) Represents fair value of interest rate swap arrangements (see "Note 6 - Derivatives" for further information). (c) Represents fair value of contingent consideration obligations related to business combinations (see "Note 3 - Business Combinations" for further information). The fair value of these liabilities are determined based on the Company’s best estimate of the probable timing and amount of settlement. (d) Represents fair value of interest rate swap and foreign currency exchange rate forward contract arrangements (see "Note 6 - Derivatives" for further information). The following table presents changes in the carrying amount of obligations classified as Level 3 category within the fair value hierarchy for the six months ended June 30, 2019 (in thousands): Balance at December 31, 2018 $ 20,127 Additions — Changes in fair value recognized in earnings (975 ) Balance at June 30, 2019 $ 19,152 During the six months ended June 30, 2019 , 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 balance sheets at cost and, subsequent to initial recognition, are measured at fair value on a non-recurring basis when certain identified events or changes in circumstances that may have a significant adverse effect on the carrying values of these assets occur. These assets are classified as Level 3 fair value measurements within the fair value hierarchy. Goodwill is tested for impairment annually or more frequently if events or changes in circumstances indicate a triggering event has occurred. Intangible assets are tested for impairment upon the occurrence of certain triggering events. As of June 30, 2019 and December 31, 2018 , assets subject to non-recurring fair value measurements totaled $5.39 billion and $5.47 billion , respectively. Fair Value Disclosures for Financial Instruments Not Carried at Fair Value The estimated fair value of the outstanding term loans and the Senior Notes is determined based on the price that the Company would have to pay to settle the liabilities. As these liabilities are not actively traded, they are classified as Level 2 fair value measurements. The estimated fair values of the Company’s outstanding term loans and Senior Notes were as follows (in thousands): June 30, 2019 December 31, 2018 Carrying Value (a) Estimated Fair Value Carrying Value (a) Estimated Fair Value Term Loan A due March 2024 $ 1,146,458 $ 1,150,000 $ 973,218 $ 975,000 Term Loan B due August 2024 976,421 977,364 1,219,755 1,221,000 7.5% Senior Unsecured Notes due 2024 435,735 423,130 438,330 423,150 (a) The carrying value of the term loan debt is shown net of original issue debt discounts. The carrying value of the Senior Notes is inclusive of unamortized premiums.

Restructuring and Other Costs

Restructuring and Other Costs	6 Months Ended
	Jun. 30, 2019
Restructuring and Related Activities [Abstract]
Restructuring and Other Costs	Restructuring and Other Costs Merger-Related Restructuring In connection with the Merger, 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 through 2020 in an effort to optimize its resources. During the six months ended June 30, 2019 , the Company recognized approximately: (i) $12.2 million of employee severance and benefits related costs; and (ii) $8.4 million of facility closure and lease termination costs. Over the next 12 to 18 months, the Company expects to incur significant costs related to the restructuring of its operations in order to achieve targeted synergies as a result of the Merger. 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 the Company’s operations. Non-Merger Restructuring and Other Costs During the six months ended June 30, 2019 , the Company incurred $0.3 million of facility closure and lease termination costs related to the Company’s pre-Merger activities aimed at optimizing its resources worldwide. Additionally, during the six months ended June 30, 2019 , the Company recognized approximately $5.3 million of employee severance and benefits related costs. Accrued Restructuring Liabilities The following table summarizes activity related to the liabilities associated with restructuring and other costs during the six months ended June 30, 2019 (in thousands): Employee Facility Closure and Lease Termination Costs Other Costs Total Balance at December 31, 2018 $ 7,474 $ 16,761 $ 52 $ 24,287 Adoption of ASC 842 (a) — (16,761 ) — (16,761 ) Expenses incurred (b) 17,522 — 40 17,562 Cash payments made (20,059 ) — (70 ) (20,129 ) Balance at June 30, 2019 $ 4,937 $ — $ 22 $ 4,959 (a) As a result of the adoption of ASC 842, accrued expenses related to facility closure and lease termination costs are now reflected within the current portion of operating lease obligations and operating lease long-term obligations on the unaudited condensed consolidated balance sheets as of June 30, 2019 . These facility costs will be paid over the remaining terms of exited facilities, which range from 2019 through 2027. (b) The amount of expenses incurred for the six months ended June 30, 2019 excludes $2.8 million of non-cash restructuring and other expenses, because these expenses were not subject to accrual prior to the period in which they were incurred, and $5.9 million of facility lease closure and lease termination costs. Under ASC 842, these costs are reflected as a reduction of operating lease right-of-use assets on the unaudited condensed consolidated balance sheets. The Company expects that substantially all of the employee severance costs accrued as of June 30, 2019 will be paid within the next twelve months. Liabilities associated with these costs are included in accrued expenses on the accompanying unaudited condensed consolidated balance sheets. Restructuring and other costs included in net loss for the three and six months ended June 30, 2019

Shareholders' Equity

Shareholders' Equity	6 Months Ended
	Jun. 30, 2019
Equity [Abstract]
Shareholders' Equity	Shareholders' Equity Shares Outstanding Shares of common stock outstanding were as follows (in thousands): Three Months Ended Six Months Ended June 30, 2019 June 30, 2018 June 30, 2019 June 30, 2018 Common stock shares, beginning balance 103,753 103,804 103,372 104,436 Stock repurchase (509 ) (1,025 ) (1,182 ) (1,973 ) RSU distributions net of shares for tax withholding 10 3 390 103 Stock option exercises 206 89 880 305 Common stock shares, ending balance 103,460 102,871 103,460 102,871 2018 Stock Repurchase Program On February 26, 2018, the Company’s Board of Directors 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 (“2018 stock repurchase program”). The 2018 stock repurchase program commenced on March 1, 2018 and will end no later than December 31, 2019. The Company intends to use cash on hand and future operating cash flow to fund the 2018 stock repurchase program. The 2018 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 2018 stock repurchase program is subject to applicable legal requirements, including federal and state securities laws and the applicable Nasdaq rules. The Company may also repurchase shares of its common stock pursuant to a trading plan meeting the requirements of Rule 10b5-1 under the Securities Exchange Act of 1934, as amended, which would permit shares of the Company’s common stock to be repurchased when the Company might otherwise be precluded from doing so by law. In March 2018, the Company repurchased 948,100 shares of its common stock in open market transactions at an average price of $39.55 per share, resulting in a total purchase price of approximately $37.5 million . In April 2018, the Company repurchased 1,024,400 shares of its common stock in open market transactions at an average price of $36.60 per share, resulting in a total purchase price of approximately $37.5 million . In January 2019, the Company repurchased 552,100 shares of its common stock in open market transactions at an average price of $39.16 per share, resulting in a total purchase price of approximately $21.6 million . In February 2019, the Company repurchased 120,600 shares of its common stock in open market transactions at an average price of $41.40 per share, resulting in a total purchase price of approximately $5.0 million . In June 2019, the Company repurchased 509,100 shares of its common stock in open market transactions at an average price of $45.29 per share, resulting in a total purchase price of approximately $23.1 million . The Company immediately retired all of the repurchased common stock and charged the par value of the shares to common stock. The excess of the repurchase price over the par value was applied on a pro rata basis against additional paid-in capital, with the remainder applied to accumulated deficit. As of June 30, 2019 , the Company had remaining authorization to repurchase up to approximately $125.3 million of shares of its common stock under the 2018 stock repurchase program.

Earnings (Loss) Per Share

Earnings (Loss) Per Share	6 Months Ended
	Jun. 30, 2019
Earnings Per Share [Abstract]
Earnings (Loss) Per Share	Earnings (Loss) Per Share The following table provides a reconciliation of the numerators and denominators of the basic and diluted earnings (loss) per share computations (in thousands, except per share data): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Numerator: Net income (loss) $ 11,292 $ 13,560 $ (18,712 ) $ (10,992 ) Denominator: Basic weighted average common shares outstanding 103,699 102,899 103,532 103,674 Effect of dilutive securities: Stock options and other awards under deferred share-based compensation programs 1,119 1,106 — — Diluted weighted average common shares outstanding 104,818 104,005 103,532 103,674 Earnings (loss) per share: Basic $ 0.11 $ 0.13 $ (0.18 ) $ (0.11 ) Diluted $ 0.11 $ 0.13 $ (0.18 ) $ (0.11 ) Potential common shares outstanding that are considered anti-dilutive are excluded from the computation of diluted earnings (loss) per share. Potential common shares related to stock options and other awards under deferred 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 the event of a net loss. The number of potential shares outstanding that were considered anti-dilutive using the treasury stock method and therefore excluded from the computation of diluted earnings (loss) per share, weighted for the portion of the period they were outstanding were as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Anti-dilutive stock options and other awards 373 1,017 333 1,057 Anti-dilutive stock options and other awards under share-based compensation programs excluded based on reporting a net loss for the period — — 1,279 1,002 Total common stock equivalents excluded from diluted loss per share 373 1,017 1,612 2,059

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2019
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes Income Tax Expense For the three and six months ended June 30, 2019 , the Company recorded income tax expense of $22.3 million and $32.7 million , respectively, compared to pre-tax income of $33.6 million and $14.0 million , respectively. The effective tax rate for the three and six months ended June 30, 2019 varied from the U.S. federal statutory income tax rate of 21.0% primarily due to: (i) base erosion anti-abuse minimum tax, (ii) foreign income inclusions such as the Global Intangible Low-Taxed Income provisions (“GILTI”), and (iii) valuation allowance change on domestic deferred tax assets. For the three and six months ended June 30, 2018 , the Company recorded an income tax expense of $16.0 million and $7.1 million , respectively, compared to pre-tax income of $29.6 million and pre-tax loss of $3.9 million , respectively. The effective tax rate for the three and six months ended June 30, 2018 varied from the U.S. federal statutory income tax rate of 21.0% primarily due to: (i) research tax credits in foreign jurisdictions; (ii) a valuation allowance change on domestic deferred tax assets; and (iii) the geographical split of pre-tax income. BEAT The Tax Cuts and Jobs Act of 2017 introduced a new tax on U.S. corporations that derive tax benefits from deductible payments to non-U.S. affiliates called the base erosion and anti-abuse tax (“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 U.S. 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 material impact on the Company’s tax provision. Unrecognized Tax Benefits The Company's gross unrecognized tax benefits, exclusive of associated interest and penalties, were $20.0 million and $19.2 million as of June 30, 2019 and December 31, 2018 , respectively. The increase of $0.8 million was primarily due to unrecognized tax benefits in foreign jurisdictions. Tax Returns Under Audit During the first quarter of 2019, the Company was notified by the Internal Revenue Service that the legacy inVentiv federal income tax return was under audit for the tax year beginning November 10, 2016 and ending December 31, 2016. The examination commenced on May 8, 2019.

Revenue from Contracts with Cus

Revenue from Contracts with Customers	6 Months Ended
	Jun. 30, 2019
Revenue from Contract with Customer [Abstract]
Revenue from Contract with Customers	Revenue from Contracts with Customers Unsatisfied Performance Obligations As of June 30, 2019 , the total aggregate transaction price allocated to the unsatisfied performance obligations under contracts with contract terms greater than one year and which are not accounted for as a series pursuant to ASU No. 2014-09, Revenue from Contracts with Customers (“ASC 606”) was $5.52 billion . This amount includes revenue associated with reimbursable out-of-pocket expenses. The Company expects to recognize revenue over the remaining contract term of the individual projects, with contract terms generally ranging from one to five years . The amount of unsatisfied performance obligations is presented net of any constraints and as a result, is lower than the potential contractual revenue. Specifically, contracts that do not commence within a certain period of time require the Company to undertake numerous activities to fulfill these performance obligations, including various activities that are outside of the Company’s control. Accordingly, such contracts have been excluded from the unsatisfied performance obligations balance presented above. Timing of Billing and Performance During the three and six months ended June 30, 2019 , the Company recognized approximately $367.0 million and $510.8 million , respectively, of revenue that was included in the deferred revenue balance at the beginning of the periods. During the three and six months ended June 30, 2019 , approximately $34.8 million and $9.3 million , respectively, of the Company’s revenue recognized was allocated to performance obligations partially satisfied in previous periods and predominately related to changes in scope and estimates in full service clinical studies. Changes in the contract assets and deferred revenue balances during the three and six months ended June 30, 2019

Segment Information

Segment Information	6 Months Ended
	Jun. 30, 2019
Segment Reporting [Abstract]
Segment Information	Segment Information The Company has two reportable segments: Clinical Solutions and Commercial Solutions. Each reportable business segment comprises multiple similar service offerings that, when combined, create a fully integrated biopharmaceutical outsourcing solutions organization . Clinical Solutions offers a variety of services spanning Phase I to Phase IV of clinical development , including full-service global studies, as well as individual service offerings such as clinical monitoring, investigator recruitment, patient recruitment, data management, and study startup to assist customers with their drug development process. Commercial Solutions provides commercialization services to the pharmaceutical, biotechnology, and healthcare industries, which include deployment solutions (formerly selling solutions), communication solutions (public relations and advertising), and consulting related 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 Company’s senior leadership, finance, Board of Directors, investor relations, and internal audit functions. The Company does not allocate depreciation, amortization, restructuring, or transaction and integration-related costs to its segments. Additionally, the CODM reviews the Company’s assets on a consolidated basis and the Company does not allocate assets to its reportable segments as they are not included in the review performed by the CODM for purposes of assessing segment performance or allocating resources. Information about reportable segment operating results was as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Revenue: Clinical Solutions $ 849,922 $ 783,913 $ 1,654,880 $ 1,570,752 Commercial Solutions 316,905 288,617 630,953 558,974 Total consolidated revenue 1,166,827 1,072,530 2,285,833 2,129,726 Segment direct costs: Clinical Solutions 654,403 608,994 1,280,170 1,224,365 Commercial Solutions 255,814 232,899 508,687 454,599 Total segment direct costs 910,217 841,893 1,788,857 1,678,964 Segment selling, general, and administrative expenses: Clinical Solutions 67,625 68,110 137,327 134,056 Commercial Solutions 22,202 21,667 48,255 41,185 Total segment selling, general, and administrative expenses 89,827 89,777 185,582 175,241 Segment operating income: Clinical Solutions 127,894 106,809 237,383 212,331 Commercial Solutions 38,889 34,051 74,011 63,190 Total segment operating income 166,783 140,860 311,394 275,521 Direct costs and operating expenses not allocated to segments: Corporate selling, general, and administrative expenses 14,570 7,638 25,827 17,397 Share-based compensation included in direct costs 7,312 5,572 15,474 9,324 Share-based compensation included in selling, general, and administrative expenses 6,482 2,803 12,587 6,839 Restructuring and other costs 11,882 8,591 26,295 22,298 Transaction and integration-related expenses 7,654 18,032 24,312 43,243 Depreciation and amortization 60,749 67,502 121,949 135,523 Total consolidated income from operations $ 58,134 $ 30,722 $ 84,950 $ 40,897

Operations by Geographic Locati

Operations by Geographic Location	6 Months Ended
	Jun. 30, 2019
Segment Reporting [Abstract]
Operations by Geographic Location	Operations by Geographic Location The following table summarizes information about revenue by geographic area (in thousands and with all intercompany transactions eliminated): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Revenue: North America (a) $ 791,281 $ 726,546 $ 1,518,979 $ 1,458,311 Europe, Middle East, and Africa 258,787 232,120 517,134 460,958 Asia-Pacific 94,295 93,647 205,861 171,627 Latin America 22,464 20,217 43,859 38,830 Total revenue $ 1,166,827 $ 1,072,530 $ 2,285,833 $ 2,129,726 (a) Revenue for the North America region includes revenue attributable to the United States of $741.2 million and $690.3 million , or 63.5% and 64.4% of total revenue, for the three months ended June 30, 2019 and 2018 , respectively. Revenue for the North America region includes revenue attributable to the United States of $1,445.3 million and $1,386.8 million , or 63.2% and 65.1% of total revenue, for the six months ended June 30, 2019 and June 30, 2018 , respectively. No other country represented more than 10% of revenue for any period. Long-lived assets by geographic area for each period were as follows (in thousands and all intercompany transactions have been eliminated): June 30, 2019 December 31, 2018 Property and equipment, net: North America (a) $ 139,913 $ 133,593 Europe, Middle East and Africa 30,288 33,053 Asia-Pacific 14,314 13,328 Latin America 3,232 3,512 Total property and equipment, net $ 187,747 $ 183,486 (a) Long-lived assets for the North America region include property and equipment, net attributable to the United States of $134.5 million and $128.3 million as of June 30, 2019 and December 31, 2018

Concentration of Credit Risk

Concentration of Credit Risk	6 Months Ended
	Jun. 30, 2019
Risks and Uncertainties [Abstract]
Concentration of Credit Risk	Concentration of Credit Risk 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 December 31, 2018 , the amount of cash and cash equivalents held outside the United States by the Company’s foreign subsidiaries was $43.6 million , or approximately 28% of the total consolidated cash and cash equivalents balance. As of June 30, 2019 , substantially all of the Company’s cash and cash equivalents were held within the United States. During both the three and six months ended June 30, 2019 , one customer accounted for approximately 10% of the Company’s revenue. During both the three and six months ended June 30, 2018 , one customer accounted for 11% of the Company’s revenue. As of June 30, 2019 and December 31, 2018 , one customer accounted for approximately 12% and 13%

Related-Party Transactions

Related-Party Transactions	6 Months Ended
	Jun. 30, 2019
Related Party Transactions [Abstract]
Related-Party Transactions	Related-Party Transactions For the six months ended June 30, 2019 , the Company incurred reimbursable out-of-pocket expenses of $1.1 million for professional services obtained from a provider whose member of the Board of Directors was also a member of the Company’s Board of Directors. No related party expenses were recorded for the three months ended June 30, 2019 . For the three and six months ended June 30, 2018 , the Company incurred reimbursable out-of-pocket expenses of $1.0 million and $1.2 million , respectively, for professional services obtained from two providers, one whose significant shareholder was also a significant shareholder of the Company and the other whose member of the Board of Directors was also a member of the Company’s Board of Directors. No material related-party revenue was recorded for the three and six months ended June 30, 2019 or 2018

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Legal Proceedings The Company is involved in various claims and legal actions arising in the ordinary course of business. The Company accrues a liability when a loss is considered probable and the amount can be reasonably estimated. When a material loss contingency is reasonably possible but not probable, the Company does not record a liability, but instead discloses the nature and the amount of the claim, and an estimate of the loss or range of loss, if such an estimate can be made. Legal fees are expensed as incurred. In the opinion of management, the outcome of any existing claims and legal or regulatory proceedings, other than the specific matters described below, if decided adversely, is not expected to have a material adverse effect on the Company's business, financial condition, results of operations, or cash flows. 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.), 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.), filed on January 25, 2018 (the “Vaitkuvienë action"), names as defendants the Company, Alistair MacDonald, and Gregory S. Rush (the "Initial Defendants"). Both complaints allege similar claims under Section 10(b) and Section 20(a) of the Securities Exchange Act of 1934 on behalf of a putative class of purchasers of the Company's common stock between May 10, 2017 and November 8, 2017 and November 9, 2017. The complaints allege that the Company published inaccurate or incomplete information regarding, among other things, the financial performance and business outlook for inVentiv’s business prior to the Merger and with respect to the combined company following the Merger. On January 30, 2018, two alleged shareholders separately filed motions seeking to be appointed lead plaintiff and approving the selection of lead counsel. On March 30, 2018, Plaintiff Bermudez filed a notice of voluntary dismissal of the Bermudez action, without prejudice, and as to all defendants. On May 29, 2018, the Court in the Vaitkuvienë action appointed the San Antonio Fire & Police Pension Fund and El Paso Firemen & Policemen’s Pension Fund as Lead Plaintiffs and, on June 7, 2018, the Court entered a schedule providing for, among other things, Lead Plaintiffs to file an amended complaint by July 23, 2018 (later extended to July 30, 2018). Lead Plaintiffs filed their amended complaint on July 30, 2018, which also includes a claim against the Initial Defendants, as well as each member of the board of directors at the time of the INC Research - inVentiv Health merger vote in July 2017 (the “Defendants”), contending that the inVentiv merger proxy was misleading under Section 14(a) of the Act. Lead Plaintiffs seek, among other things, orders (i) declaring that the lawsuit is a proper class action and (ii) awarding compensatory damages in an amount to be proven at trial, including interest thereon, and reasonable costs and expenses incurred in this action, including attorneys’ fees and expert fees, to Lead Plaintiffs and other class members. Defendants filed a Motion to Dismiss Plaintiffs’ Amended Complaint on September 20, 2018. Lead Plaintiffs filed a Response in Opposition to such motion on November 21, 2018, and Defendants filed a Reply to such response on December 5, 2018. On May 23, 2019, Lead Plaintiffs filed a Notice of Filings in Related Case regarding the New Jersey shareholder action filed on March 1, 2019 described below, and Defendants filed their response on May 31, 2019. The Company and the other defendants deny the allegations in these complaints and intend to defend vigorously against these claims. In the Company's opinion, the ultimate outcome of this matter is not expected to have a material adverse effect on the Company's financial position, results of operations, or cash flows. On September 24, 2018, the Court unsealed a civil complaint captioned United States, et. al vs. AstraZeneca PLC, et. al, No. 2:17-cv-01328-RSL (W.D. Wa.) against inVentiv Health, Inc. and other co-defendants. The complaint alleges that the Company and co-defendants violated the Federal False Claims Act (and various state analogues) and Anti-Kickback Statute through the provision of clinical education services. On December 17, 2018, the United States moved to dismiss this lawsuit, as well as other similar lawsuits supported by the relator in this action. The Company denies the allegations in the complaint and intends to defend vigorously against these claims. In the Company’s opinion, the ultimate outcome of this matter is not expected to have a material adverse effect on the Company’s financial position, results of operations, or cash flows. On February 21, 2019, the SEC notified the Company that it has commenced an investigation into the Company’s revenue accounting policies, internal controls and related matters, and requested that the Company retain certain documents for the periods beginning with January 1, 2017. On March 22, 2019, the SEC subpoenaed certain documents in connection with its investigation. The timing of the conclusion of the SEC’s review is unknown. On March 1, 2019, a complaint was filed in the United States District Court for the District of New Jersey on behalf of a putative class of shareholders who purchased the Company's common stock during the period between May 10, 2017 and February 27, 2019. The complaint names the Company and certain of its executive officers as defendants and alleges violations of the Securities Exchange Act of 1934, as amended, based on allegedly false or misleading statements about its business, operations, and prospects. The plaintiffs seek awards of compensatory damages, among other relief, and their costs and attorneys’ and experts’ fees. On March 28, 2019, Lead Plaintiffs in the Vaitkuvienë action filed a motion to intervene, and the Company filed its response on April 22, 2019. On April 30, 2019, a shareholder filed a motion seeking to be appointed lead plaintiff and approving the selection of lead counsel. Both motions remain pending. The Company is presently unable to predict the duration, scope or result of the SEC’s investigation, the related putative class action, or any other related lawsuit or investigation. As such, the Company is presently unable to develop a reasonable estimate of a possible loss or range of losses, if any, related to these matters. The SEC has a broad range of civil sanctions available should it commence an enforcement action, including injunctive relief, disgorgement, fines, penalties, or an order to take remedial action. The Company could incur additional expenses related to fines or to remedial measures. Furthermore, 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 material adverse effect on the Company's business, annual or interim results of operations, cash flows, or its financial condition. Self-Insurance Reserves The Company is self-insured for certain losses relating to health insurance claims for the majority of its employees located within the United States. Additionally, the Company maintains certain self-insurance retention limits related to automobile and workers’ compensation insurance. Assumed Contingent Tax-Sharing Obligations As a result of the Merger, the Company assumed contingent tax-sharing obligations arising from inVentiv’s 2016 merger with Double Eagle Parent, Inc. As of June 30, 2019 and December 31, 2018 , the estimated fair value of the assumed contingent tax-sharing obligations was $14.7 million and $15.7 million , respectively. Contingent Earn-out Liability In connection with the Kinapse acquisition, the Company recorded a contingent earn-out liability to be paid based on Kinapse meeting revenue targets as of March 31, 2021. The fair value of the earn-out liability is remeasured at the end of each reporting period, with changes in the estimated fair value reflected in earnings until the liability is settled. The estimated fair value of the contingent earn-out liability was $4.4 million as of June 30, 2019 and December 31, 2018

Basis of Presentation and Cha_2

Basis of Presentation and Changes in Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2019
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, 2018 , filed with the Securities and Exchange Commission on March 18, 2019 . The results of operations for the three and six months ended June 30, 2019 are not necessarily indicative of the results to be expected for the full year ending December 31, 2019 or any other future period. The unaudited condensed consolidated balance sheet at December 31, 2018 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, 2018
Allowance for Doubtful Accounts	Allowance for Doubtful Accounts The Company maintains a credit approval process and makes judgments in connection with assessing its customers’ ability to pay throughout the contractual obligation period. Generally, the Company has the ability to limit credit exposure by discontinuing services in the event of non-payment. The Company has certain customers that may depend on the ability to continue to raise capital in order to complete the development or commercialization of their products. The Company monitors its customers’ credit worthiness and applies judgment in establishing a provision for estimated credit losses based on historical experience, current receivables aging, and identified customer-specific circumstances that would affect the customers’ ability to meet their obligation. Despite this assessment, from time to time, customers are unable to meet their payment obligations, which could impact the Company’s results of operations.
Recently Adopted Accounting Standards	Recently Adopted Accounting Standards Leases . In February 2016, the Financial Accounting Standards Board issued Accounting Standards Update No. 2016-02 (“ASU 2016-02”), Leases (Topic 842) , as further amended, to increase transparency and comparability among organizations by requiring the recognition of, at the lease commencement date, a lease liability for the obligation to make lease payments, and a right-of-use ("ROU") asset for the right to use the underlying asset, on the balance sheet. The Company adopted ASU 2016-02, and all related amendments, collectively “ASC 842”, as of January 1, 2019, using the modified retrospective approach. Results for reporting periods beginning on January 1, 2019 are presented under ASC 842, while prior period amounts continue to be reported and disclosed in accordance with the Company’s historical accounting treatment under Accounting Standards Codification 840 , Leases (“ASC 840”). In addition, the Company elected the package of practical expedients permitted under the transition guidance within the new standard, which among other things, does not require the Company to reassess if a contract is or contains a lease and allows the Company to carry forward the historical lease classifications and historical initial direct costs. The Company made an accounting policy election under ASC 842 not to recognize ROU assets and lease liabilities for leases with a term of 12 months or less. Lease payments for these leases are recognized as lease costs on a straight-line basis over the lease term. The Company also elected to account for lease components and the associated non-lease components in the contracts as a single lease component for all classes of underlying assets. Adoption of the new standard resulted in the recording of additional net lease assets and lease liabilities, mainly related to operating leases, of approximately $214.0 million
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
Leases	The Company’s operating leases are primarily related to its office facilities. The Company’s finance leases are related to vehicles that the Company leases for certain sales representatives in its Commercial Solutions segment. These leases have remaining lease terms of less than one year to 13 years, some of which include options to extend the term or terminate the lease. These options to extend or terminate a lease are included in the lease terms when it is reasonably certain that the Company will exercise that option. ROU assets and lease liabilities are recognized based on the present value of the fixed lease payments over the lease term at the commencement date. The ROU assets also include any initial direct costs incurred and lease payments made at or before the commencement date, and are reduced by lease incentives. The Company uses its incremental borrowing rate as the discount rate to determine the present value of the lease payments for leases that do not have a readily determinable implicit discount rate. The Company’s incremental borrowing rate is the rate of interest that it would have to borrow on a collateralized basis over a similar term and amount in a similar economic environment. The Company determines the incremental borrowing rates for its leases by adjusting the local risk free interest rate with a credit risk premium corresponding to the Company’s credit rating.

Financial Statement Details (Ta

Financial Statement Details (Tables)	6 Months Ended
	Jun. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Billed Accounts Receivable, Net	Accounts receivable and unbilled services, net of allowance for doubtful accounts, consisted of the following (in thousands): June 30, 2019 December 31, 2018 Accounts receivable billed $ 781,440 $ 733,142 Less: Allowance for doubtful accounts (5,296 ) (4,587 ) Accounts receivable billed, net 776,144 728,555 Accounts receivable unbilled 419,337 422,860 Contract assets 92,028 105,316 Accounts receivable and unbilled services, net $ 1,287,509 $ 1,256,731
Schedule of Goodwill	The changes in the carrying amount of goodwill by segment for the six months ended June 30, 2019 were as follows (in thousands): Total Clinical Commercial Balance at December 31, 2018: Gross carrying amount $ 4,349,325 $ 2,780,945 $ 1,568,380 Accumulated impairment losses (a) (16,166 ) (8,142 ) (8,024 ) Goodwill, net of accumulated impairment losses 4,333,159 2,772,803 1,560,356 2019 Activity: Business combinations (b) (250 ) — (250 ) Impact of foreign currency translation 3,446 1,209 2,237 Balance at June 30, 2019: Gross carrying amount 4,352,521 2,782,154 1,570,367 Accumulated impairment losses (a) (16,166 ) (8,142 ) (8,024 ) Goodwill, net of accumulated impairment losses $ 4,336,355 $ 2,774,012 $ 1,562,343 (a) Accumulated impairment losses associated with the Clinical Solutions segment were recorded prior to 2019 and related to the former Phase I Services segment, now a component of the Clinical Solutions segment. Accumulated impairment losses associated with the Commercial Solutions segment were recorded prior to 2019 and related to the former Global Consulting segment, now a component of the Commercial Solutions segment. No impairment of goodwill was recorded for the six months ended June 30, 2019 . (b) Amount represents measurement period adjustments to goodwill recognized in connection with the acquisition of Kinapse Topco Limited (“Kinapse”).
Transaction and Integration-Related Expenses	Transaction and integration-related expenses consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Professional fees $ 6,678 $ 11,073 $ 19,523 $ 25,774 Debt modification and related expenses 1,732 1,317 3,973 1,317 Integration and personnel retention-related costs 909 4,448 1,756 13,741 Fair value adjustments to contingent obligations (1,665 ) 1,194 (940 ) 2,388 Other — — — 23 Total transaction and integration-related expenses $ 7,654 $ 18,032 $ 24,312 $ 43,243
Schedule of Accumulated Other Comprehensive Income (Loss), Net of Taxes	Accumulated other comprehensive loss, net of tax, consisted of the following (in thousands): June 30, 2019 December 31, 2018 Foreign currency translation adjustments $ (72,270 ) $ (80,955 ) Unrealized loss on derivative instruments (20,418 ) (7,240 ) Accumulated other comprehensive loss $ (92,688 ) $ (88,195 ) Changes in accumulated other comprehensive loss, net of tax, for the three months ended June 30, 2019 were as follows (in thousands): Unrealized Loss on Derivative Instruments Foreign Currency Translation Adjustments Total Balance at March 31, 2019 $ (11,456 ) $ (60,351 ) $ (71,807 ) Other comprehensive loss before reclassifications (9,544 ) (11,919 ) (21,463 ) Amount of gain reclassified from accumulated other comprehensive loss into statement of operations 582 — 582 Net current period other comprehensive loss, net of tax (8,962 ) (11,919 ) (20,881 ) Balance at June 30, 2019 $ (20,418 ) $ (72,270 ) $ (92,688 ) Changes in accumulated other comprehensive loss, net of tax, for the six months ended June 30, 2019 were as follows (in thousands): Unrealized Loss on Derivative Instruments Foreign Currency Translation Adjustments Total Balance at December 31, 2018 $ (7,240 ) $ (80,955 ) $ (88,195 ) Other comprehensive (loss) gain before reclassifications (14,246 ) 8,685 (5,561 ) Amount of gain reclassified from accumulated other comprehensive loss into the statement of operations 1,068 — 1,068 Net current period other comprehensive (loss) gain, net of tax (13,178 ) 8,685 (4,493 ) Balance at June 30, 2019 $ (20,418 ) $ (72,270 ) $ (92,688 )
Reclassification out of Accumulated Other Comprehensive Income (Loss)	The income tax effects allocated to each component of other comprehensive income (loss) for the three months ended June 30, 2019 were as follows (in thousands): Before-Tax Amount Tax Benefit Net-of-Tax Amount Foreign currency translation adjustments $ (11,919 ) $ — $ (11,919 ) Unrealized (loss) gain on derivative instruments: Unrealized loss during period (9,800 ) 256 (9,544 ) Reclassification adjustment for gains realized in net income 601 (19 ) 582 Net unrealized loss on derivative instruments (9,199 ) 237 (8,962 ) Other comprehensive loss $ (21,118 ) $ 237 $ (20,881 ) The income tax effects allocated to each component of other comprehensive income (loss) for the six months ended June 30, 2019 were as follows (in thousands): Before-Tax Amount Tax Benefit Net-of-Tax Amount Foreign currency translation adjustments $ 8,685 $ — $ 8,685 Unrealized (loss) gain on derivative instruments: Unrealized loss during period (14,616 ) 370 (14,246 ) Reclassification adjustment for gains realized in net loss 1,106 (38 ) 1,068 Net unrealized loss on derivative instruments (13,510 ) 332 (13,178 ) Other comprehensive loss $ (4,825 ) $ 332 $ (4,493 ) For the three months ended June 30, 2018 , the income tax provision related to the components of other comprehensive loss was fully offset by the increase in the valuation allowance, resulting in no income tax impact for the period. The income tax effects allocated to each component of other comprehensive loss for the six months ended June 30, 2018 were as follows (in thousands): Before-Tax Amount Tax Benefit Net-of-Tax Amount Foreign currency translation adjustments $ (32,378 ) $ (2,868 ) $ (35,246 ) Unrealized loss on derivative instruments: Unrealized loss during the period (685 ) — (685 ) Reclassification adjustment of realized gains to net loss (598 ) — (598 ) Net unrealized loss on derivative instruments (1,283 ) — (1,283 ) Other comprehensive loss $ (33,661 ) $ (2,868 ) $ (36,529 )
Schedule of Other Expense (Income), Net	Other income (expense), net consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Net realized foreign currency gain (loss) $ 7,275 $ 5,685 $ (1,131 ) $ 168 Net unrealized foreign currency gain 880 25,997 957 19,633 Other, net (582 ) 319 (1,174 ) (354 ) Total other income (expense), net $ 7,573 $ 32,001 $ (1,348 ) $ 19,447

Long-Term Debt Obligations (Tab

Long-Term Debt Obligations (Tables)	6 Months Ended
	Jun. 30, 2019
Debt Disclosure [Abstract]
Schedule of Debt Obligations	The Company’s debt obligations consisted of the following (in thousands): June 30, 2019 December 31, 2018 Secured Debt Term Loan A due March 2024 $ 1,150,000 $ 975,000 Term Loan B due August 2024 977,364 1,221,000 Accounts receivable financing agreement due June 2020 185,200 169,400 Total secured debt 2,312,564 2,365,400 Unsecured Debt 7.5% Senior Unsecured Notes due 2024 403,000 403,000 Total debt obligations 2,715,564 2,768,400 Add: unamortized Senior Notes premium, net of term loan original issuance discount 28,250 32,303 Less: unamortized deferred issuance costs (9,397 ) (13,584 ) Less: current portion of debt (199,575 ) (50,100 ) Total debt obligations, non-current portion $ 2,534,842 $ 2,737,019
Contractual Maturities of Debt Obligations	As of June 30, 2019 , the contractual maturities of the Company’s debt obligations were as follows (in thousands): Principal Interest 2019 $ — $ 65,827 2020 228,325 126,766 2021 79,063 120,320 2022 107,813 116,384 2023 115,000 110,852 2024 and thereafter 2,185,363 56,376 Less: deferred issuance costs (9,397 ) Unamortized Senior Notes premium, net of term loan original issuance discount 28,250 Total $ 2,734,417 $ 596,525

Leases (Tables)

Leases (Tables)	6 Months Ended
	Jun. 30, 2019
Leases [Abstract]
Components of Lease Cost and Supplemental Cash Flow Information Related to Leases	The components of lease cost were as follows (in thousands): Three Months Ended Six Months Ended Classification June 30, 2019 June 30, 2019 Operating leases: Fixed lease costs Selling, general, and administrative expenses $ 16,965 $ 34,105 Short-term lease costs Selling, general, and administrative expenses 195 574 Variable lease costs Selling, general, and administrative expenses 8,864 16,654 Total operating lease costs $ 26,024 $ 51,333 Finance leases: Amortization of right-of-use assets Depreciation $ 3,991 $ 8,310 Interest on lease liabilities Interest expense 414 808 Variable lease costs Selling, general, and administrative expenses 1,803 3,630 Total finance lease costs $ 6,208 $ 12,748 Supplemental cash flow information related to leases was as follows (in thousands): Six Months Ended June 30, 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ (28,452 ) Operating cash flows for finance leases (808 ) Financing cash flows for finance leases (4,677 ) Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 41,286 Finance leases 12,286 Lease obligations closed out in exchange for right-of-use assets: Operating leases $ (573 ) Weighted average remaining lease term: June 30, 2019 Operating leases 8 years Finance leases 3 years Weighted average discount rate: June 30, 2019 Operating leases 4.9 % Finance leases 3.3 %
Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to finance leases was as follows (in thousands): June 30, 2019 Property and equipment, gross $ 59,344 Accumulated depreciation (20,741 ) Property and equipment, net $ 38,603 Current portion of finance lease obligations $ 16,004 Finance lease long-term obligations 28,390 Total finance lease liabilities $ 44,394
Maturities of Lease Liabilities	As of June 30, 2019 , maturities of lease liabilities were as follows (in thousands): Operating Leases Finance Leases Total 2019 (remaining 6 months) $ 16,149 $ 9,536 $ 25,685 2020 50,811 15,825 66,636 2021 45,255 12,629 57,884 2022 39,394 8,254 47,648 2023 35,626 1,284 36,910 2024 and thereafter 131,401 — 131,401 Total lease payments 318,636 47,528 $ 366,164 Less: management fee (624 ) Less: imputed interest (60,172 ) (2,510 ) Total lease liabilities $ 258,464 $ 44,394
Maturities of Lease Liabilities	As of June 30, 2019 , maturities of lease liabilities were as follows (in thousands): Operating Leases Finance Leases Total 2019 (remaining 6 months) $ 16,149 $ 9,536 $ 25,685 2020 50,811 15,825 66,636 2021 45,255 12,629 57,884 2022 39,394 8,254 47,648 2023 35,626 1,284 36,910 2024 and thereafter 131,401 — 131,401 Total lease payments 318,636 47,528 $ 366,164 Less: management fee (624 ) Less: imputed interest (60,172 ) (2,510 ) Total lease liabilities $ 258,464 $ 44,394

Derivatives (Tables)

Derivatives (Tables)	6 Months Ended
	Jun. 30, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Interest Rate Swaps Designated as Hedging Instruments on the Consolidated Balance Sheets	The fair values of the Company’s derivative financial instruments and the line items on the accompanying unaudited condensed consolidated balance sheets to which they were recorded were as follows (in thousands): Balance Sheet Classification June 30, 2019 December 31, 2018 Interest rate swaps - current Prepaid expenses and other current assets $ 543 $ 1,355 Interest rate swaps - non-current Other long-term assets — 441 Foreign currency exchange rate swaps - current Accrued expenses — (138 ) Interest rate swaps - current Accrued expenses (9,172 ) (3,031 ) Interest rate swaps - non-current Other long-term liabilities (12,463 ) (6,201 )

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2019
Fair Value Disclosures [Abstract]
Schedule of Assets and Liabilities Measured at Fair Value on a Recurring Basis	As of June 30, 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 Total Assets: Trading securities (a) $ 21,392 $ — $ — $ 21,392 Derivative instruments (b) — 543 — 543 Total assets $ 21,392 $ 543 $ — $ 21,935 Liabilities: Derivative instruments (b) $ — $ 21,635 $ — $ 21,635 Contingent obligations related to business combinations (c) — — 19,152 19,152 Total liabilities $ — $ 21,635 $ 19,152 $ 40,787 As of December 31, 2018 , 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 Total Assets: Trading securities (a) $ 14,945 $ — $ — $ 14,945 Derivative instruments (d) — 1,796 — 1,796 Total assets $ 14,945 $ 1,796 $ — $ 16,741 Liabilities: Derivative instruments (d) $ — $ 9,370 $ — $ 9,370 Contingent consideration obligations related to business combinations (c) — — 20,127 20,127 Total liabilities $ — $ 9,370 $ 20,127 $ 29,497 (a) Represents fair value of investments in mutual funds based on quoted market prices that are used to fund the liability associated with the deferred compensation plan. (b) Represents fair value of interest rate swap arrangements (see "Note 6 - Derivatives" for further information). (c) Represents fair value of contingent consideration obligations related to business combinations (see "Note 3 - Business Combinations" for further information). The fair value of these liabilities are determined based on the Company’s best estimate of the probable timing and amount of settlement. (d) Represents fair value of interest rate swap and foreign currency exchange rate forward contract arrangements (see "Note 6 - Derivatives" for further information).
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	The following table presents changes in the carrying amount of obligations classified as Level 3 category within the fair value hierarchy for the six months ended June 30, 2019 (in thousands): Balance at December 31, 2018 $ 20,127 Additions — Changes in fair value recognized in earnings (975 ) Balance at June 30, 2019 $ 19,152
Schedule of Estimated Fair Value of Financial Instruments Not Recorded at Fair Value	The estimated fair values of the Company’s outstanding term loans and Senior Notes were as follows (in thousands): June 30, 2019 December 31, 2018 Carrying Value (a) Estimated Fair Value Carrying Value (a) Estimated Fair Value Term Loan A due March 2024 $ 1,146,458 $ 1,150,000 $ 973,218 $ 975,000 Term Loan B due August 2024 976,421 977,364 1,219,755 1,221,000 7.5% Senior Unsecured Notes due 2024 435,735 423,130 438,330 423,150 (a) The carrying value of the term loan debt is shown net of original issue debt discounts. The carrying value of the Senior Notes is inclusive of unamortized premiums.

Restructuring and Other Costs (

Restructuring and Other Costs (Tables)	6 Months Ended
	Jun. 30, 2019
Restructuring and Related Activities [Abstract]
Schedule of Restructuring and Related Costs	The following table summarizes activity related to the liabilities associated with restructuring and other costs during the six months ended June 30, 2019 (in thousands): Employee Facility Closure and Lease Termination Costs Other Costs Total Balance at December 31, 2018 $ 7,474 $ 16,761 $ 52 $ 24,287 Adoption of ASC 842 (a) — (16,761 ) — (16,761 ) Expenses incurred (b) 17,522 — 40 17,562 Cash payments made (20,059 ) — (70 ) (20,129 ) Balance at June 30, 2019 $ 4,937 $ — $ 22 $ 4,959 (a) As a result of the adoption of ASC 842, accrued expenses related to facility closure and lease termination costs are now reflected within the current portion of operating lease obligations and operating lease long-term obligations on the unaudited condensed consolidated balance sheets as of June 30, 2019 . These facility costs will be paid over the remaining terms of exited facilities, which range from 2019 through 2027. (b) The amount of expenses incurred for the six months ended June 30, 2019 excludes $2.8 million of non-cash restructuring and other expenses, because these expenses were not subject to accrual prior to the period in which they were incurred, and $5.9 million of facility lease closure and lease termination costs. Under ASC 842, these costs are reflected as a reduction of operating lease right-of-use assets on the unaudited condensed consolidated balance sheets.

Shareholders' Equity (Tables)

Shareholders' Equity (Tables)	6 Months Ended
	Jun. 30, 2019
Equity [Abstract]
Shares of Common Stock Outstanding	Shares of common stock outstanding were as follows (in thousands): Three Months Ended Six Months Ended June 30, 2019 June 30, 2018 June 30, 2019 June 30, 2018 Common stock shares, beginning balance 103,753 103,804 103,372 104,436 Stock repurchase (509 ) (1,025 ) (1,182 ) (1,973 ) RSU distributions net of shares for tax withholding 10 3 390 103 Stock option exercises 206 89 880 305 Common stock shares, ending balance 103,460 102,871 103,460 102,871

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	6 Months Ended
	Jun. 30, 2019
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted	The following table provides a reconciliation of the numerators and denominators of the basic and diluted earnings (loss) per share computations (in thousands, except per share data): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Numerator: Net income (loss) $ 11,292 $ 13,560 $ (18,712 ) $ (10,992 ) Denominator: Basic weighted average common shares outstanding 103,699 102,899 103,532 103,674 Effect of dilutive securities: Stock options and other awards under deferred share-based compensation programs 1,119 1,106 — — Diluted weighted average common shares outstanding 104,818 104,005 103,532 103,674 Earnings (loss) per share: Basic $ 0.11 $ 0.13 $ (0.18 ) $ (0.11 ) Diluted $ 0.11 $ 0.13 $ (0.18 ) $ (0.11 )
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share	The number of potential shares outstanding that were considered anti-dilutive using the treasury stock method and therefore excluded from the computation of diluted earnings (loss) per share, weighted for the portion of the period they were outstanding were as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Anti-dilutive stock options and other awards 373 1,017 333 1,057 Anti-dilutive stock options and other awards under share-based compensation programs excluded based on reporting a net loss for the period — — 1,279 1,002 Total common stock equivalents excluded from diluted loss per share 373 1,017 1,612 2,059

Segment Information (Tables)

Segment Information (Tables)	6 Months Ended
	Jun. 30, 2019
Segment Reporting [Abstract]
Schedule of Segment Information	Information about reportable segment operating results was as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Revenue: Clinical Solutions $ 849,922 $ 783,913 $ 1,654,880 $ 1,570,752 Commercial Solutions 316,905 288,617 630,953 558,974 Total consolidated revenue 1,166,827 1,072,530 2,285,833 2,129,726 Segment direct costs: Clinical Solutions 654,403 608,994 1,280,170 1,224,365 Commercial Solutions 255,814 232,899 508,687 454,599 Total segment direct costs 910,217 841,893 1,788,857 1,678,964 Segment selling, general, and administrative expenses: Clinical Solutions 67,625 68,110 137,327 134,056 Commercial Solutions 22,202 21,667 48,255 41,185 Total segment selling, general, and administrative expenses 89,827 89,777 185,582 175,241 Segment operating income: Clinical Solutions 127,894 106,809 237,383 212,331 Commercial Solutions 38,889 34,051 74,011 63,190 Total segment operating income 166,783 140,860 311,394 275,521 Direct costs and operating expenses not allocated to segments: Corporate selling, general, and administrative expenses 14,570 7,638 25,827 17,397 Share-based compensation included in direct costs 7,312 5,572 15,474 9,324 Share-based compensation included in selling, general, and administrative expenses 6,482 2,803 12,587 6,839 Restructuring and other costs 11,882 8,591 26,295 22,298 Transaction and integration-related expenses 7,654 18,032 24,312 43,243 Depreciation and amortization 60,749 67,502 121,949 135,523 Total consolidated income from operations $ 58,134 $ 30,722 $ 84,950 $ 40,897

Operations by Geographic Loca_2

Operations by Geographic Location (Tables)	6 Months Ended
	Jun. 30, 2019
Segment Reporting [Abstract]
Total Revenue by Geographic Area	The following table summarizes information about revenue by geographic area (in thousands and with all intercompany transactions eliminated): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Revenue: North America (a) $ 791,281 $ 726,546 $ 1,518,979 $ 1,458,311 Europe, Middle East, and Africa 258,787 232,120 517,134 460,958 Asia-Pacific 94,295 93,647 205,861 171,627 Latin America 22,464 20,217 43,859 38,830 Total revenue $ 1,166,827 $ 1,072,530 $ 2,285,833 $ 2,129,726 (a) Revenue for the North America region includes revenue attributable to the United States of $741.2 million and $690.3 million , or 63.5% and 64.4% of total revenue, for the three months ended June 30, 2019 and 2018 , respectively. Revenue for the North America region includes revenue attributable to the United States of $1,445.3 million and $1,386.8 million , or 63.2% and 65.1% of total revenue, for the six months ended June 30, 2019 and June 30, 2018 , respectively. No other country represented more than 10% of revenue for any period.
Long-Lived Assets by Geographic Area	Long-lived assets by geographic area for each period were as follows (in thousands and all intercompany transactions have been eliminated): June 30, 2019 December 31, 2018 Property and equipment, net: North America (a) $ 139,913 $ 133,593 Europe, Middle East and Africa 30,288 33,053 Asia-Pacific 14,314 13,328 Latin America 3,232 3,512 Total property and equipment, net $ 187,747 $ 183,486 (a) Long-lived assets for the North America region include property and equipment, net attributable to the United States of $134.5 million and $128.3 million as of June 30, 2019 and December 31, 2018 , respectively.

Basis of Presentation and Cha_3

Basis of Presentation and Changes in Significant Accounting Policies - Narrative (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)segment	Jan. 01, 2019USD ($)	Dec. 31, 2018USD ($)
Accounting Policies [Abstract]
Number of reportable segments | segment	2
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Operating lease right-of-use assets	$ 227,715		$ 0
Operating lease, liability	$ 258,464
Accounting Standards Update 2016-02
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Operating lease right-of-use assets		$ 214,000
Operating lease, liability		$ 214,000

Financial Statement Details - A

Financial Statement Details - Accounts Receivable and Unbilled Services, net (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Receivables [Abstract]
Accounts receivable billed	$ 781,440	$ 733,142
Less: Allowance for doubtful accounts	(5,296)	(4,587)
Accounts receivable billed, net	776,144	728,555
Accounts receivable unbilled	419,337	422,860
Contract assets	92,028	105,316
Accounts receivable and unbilled services, net	$ 1,287,509	$ 1,256,731

Financial Statement Details - N

Financial Statement Details - Narrative (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Trade receivables sold	$ 113.7	$ 100.9
Proceeds from sale of trade receivables	$ 112.8	$ 100.5

Financial Statement Details - S

Financial Statement Details - Schedule of Goodwill (Details)	6 Months Ended
	Jun. 30, 2019USD ($)
Goodwill [Roll Forward]
Gross carrying amount, beginning balance	$ 4,349,325,000
Accumulated impairment losses, beginning balance	(16,166,000)
Goodwill net of accumulated impairment losses, beginning balance	4,333,159,000
Business combinations	(250,000)
Impact of foreign currency translation	3,446,000
Gross carrying amount, ending balance	4,352,521,000
Accumulated impairment losses, ending balance	(16,166,000)
Goodwill net of accumulated impairment losses, ending balance	4,336,355,000
Impairment of goodwill	0
Clinical Solutions
Goodwill [Roll Forward]
Gross carrying amount, beginning balance	2,780,945,000
Accumulated impairment losses, beginning balance	(8,142,000)
Goodwill net of accumulated impairment losses, beginning balance	2,772,803,000
Business combinations	0
Impact of foreign currency translation	1,209,000
Gross carrying amount, ending balance	2,782,154,000
Accumulated impairment losses, ending balance	(8,142,000)
Goodwill net of accumulated impairment losses, ending balance	2,774,012,000
Commercial Solutions
Goodwill [Roll Forward]
Gross carrying amount, beginning balance	1,568,380,000
Accumulated impairment losses, beginning balance	(8,024,000)
Goodwill net of accumulated impairment losses, beginning balance	1,560,356,000
Business combinations	(250,000)
Impact of foreign currency translation	2,237,000
Gross carrying amount, ending balance	1,570,367,000
Accumulated impairment losses, ending balance	(8,024,000)
Goodwill net of accumulated impairment losses, ending balance	$ 1,562,343,000

Financial Statement Details - T

Financial Statement Details - Transaction and Integration-Related Expenses (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Income Statement [Abstract]
Professional fees	$ 6,678	$ 11,073	$ 19,523	$ 25,774
Debt modification and related expenses	1,732	1,317	3,973	1,317
Integration and personnel retention-related costs	909	4,448	1,756	13,741
Fair value adjustment of contingent obligations	(1,665)	1,194	(940)	2,388
Other	0	0	0	23
Total transaction and integration-related expenses	$ 7,654	$ 18,032	$ 24,312	$ 43,243

Financial Statement Details -_2

Financial Statement Details - Accumulated Other Comprehensive Income (Loss), Net of Taxes (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]
Foreign currency translation adjustments	$ (72,270)	$ (80,955)
Unrealized loss on derivative instruments	(20,418)	(7,240)
Accumulated other comprehensive loss	$ (92,688)	$ (88,195)

Financial Statement Details -_3

Financial Statement Details - Summary of Changes in Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2019	Jun. 30, 2018
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	$ 2,838,370	$ 2,856,144	$ 3,022,579
Other comprehensive (loss) gain before reclassifications	(21,463)	(5,561)
Amount of gain reclassified from accumulated other comprehensive loss into the statement of operations	582	1,068
Net current period other comprehensive (loss) gain, net of tax	(20,881)	(4,493)	(36,529)
Balance at end of period	2,823,899	2,823,899	2,822,672
Total
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(71,807)	(88,195)	(22,385)
Balance at end of period	(92,688)	(92,688)	(55,064)
Unrealized Loss on Derivative Instruments
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(11,456)	(7,240)
Other comprehensive (loss) gain before reclassifications	(9,544)	(14,246)
Amount of gain reclassified from accumulated other comprehensive loss into the statement of operations	582	1,068
Net current period other comprehensive (loss) gain, net of tax	(8,962)	(13,178)
Balance at end of period	(20,418)	(20,418)
Foreign Currency Translation Adjustments
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Balance at beginning of period	(60,351)	(80,955)
Other comprehensive (loss) gain before reclassifications	(11,919)	8,685
Amount of gain reclassified from accumulated other comprehensive loss into the statement of operations	0	0
Net current period other comprehensive (loss) gain, net of tax	(11,919)	8,685	$ (35,246)
Balance at end of period	$ (72,270)	$ (72,270)

Financial Statement Details -_4

Financial Statement Details - Tax Effects Allocated to Each Component of Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2019	Jun. 30, 2018
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized loss arising during period, Net-of-Tax Amount	$ (21,463)	$ (5,561)
Reclassification adjustment for gains realized in net loss, Net-of-Tax Amount	582	1,068
Other comprehensive loss, Before-Tax Amount	(21,118)	(4,825)	$ (33,661)
Other comprehensive loss, Tax Benefit	237	332	(2,868)
Net current period other comprehensive (loss) gain, net of tax	(20,881)	(4,493)	(36,529)
Foreign Currency Translation Adjustments
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized loss arising during period, Net-of-Tax Amount	(11,919)	8,685
Reclassification adjustment for gains realized in net loss, Net-of-Tax Amount	0	0
Other comprehensive loss, Before-Tax Amount	(11,919)	8,685	(32,378)
Other comprehensive loss, Tax Benefit	0	0	(2,868)
Net current period other comprehensive (loss) gain, net of tax	(11,919)	8,685	(35,246)
Unrealized Loss on Derivative Instruments
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized loss arising during period, Before-Tax Amount	(9,800)	(14,616)
Unrealized loss arising during period, Tax Benefit	256	370
Unrealized loss arising during period, Net-of-Tax Amount	(9,544)	(14,246)
Reclassification adjustment for gains realized in net loss, Before-Tax-Amount	601	1,106
Reclassification adjustment for gains realized in net loss, Tax Benefit	(19)	(38)
Reclassification adjustment for gains realized in net loss, Net-of-Tax Amount	582	1,068
Other comprehensive loss, Before-Tax Amount	(9,199)	(13,510)
Other comprehensive loss, Tax Benefit	237	332
Net current period other comprehensive (loss) gain, net of tax	$ (8,962)	$ (13,178)
Unrealized Loss on Derivative Instruments
Accumulated Other Comprehensive Income (Loss) [Line Items]
Unrealized loss arising during period, Before-Tax Amount			(685)
Unrealized loss arising during period, Tax Benefit			0
Unrealized loss arising during period, Net-of-Tax Amount			(685)
Reclassification adjustment for gains realized in net loss, Before-Tax-Amount			(598)
Reclassification adjustment for gains realized in net loss, Tax Benefit			0
Reclassification adjustment for gains realized in net loss, Net-of-Tax Amount			(598)
Other comprehensive loss, Before-Tax Amount			(1,283)
Other comprehensive loss, Tax Benefit			0
Net current period other comprehensive (loss) gain, net of tax			$ (1,283)

Financial Statement Details - O

Financial Statement Details - Other Income (Expense), Net (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Other Income and Expenses [Abstract]
Net realized foreign currency gain (loss)	$ 7,275	$ 5,685	$ (1,131)	$ 168
Net unrealized foreign currency gain	880	25,997	957	19,633
Other, net	(582)	319	(1,174)	(354)
Total other income (expense), net	$ 7,573	$ 32,001	$ (1,348)	$ 19,447

Business Combinations - Narrati

Business Combinations - Narrative (Details) - USD ($)	1 Months Ended
	Aug. 31, 2018	Jun. 30, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Goodwill		$ 4,336,355,000	$ 4,333,159,000
Recurring
Business Acquisition [Line Items]
Contingent obligations related to business combinations		19,152,000	20,127,000
InVentiv Merger | Recurring
Business Acquisition [Line Items]
Contingent obligations related to business combinations		14,700,000	15,700,000
Kinapse Acquisition
Business Acquisition [Line Items]
Contingent obligations related to business combinations		$ 4,400,000	$ 4,400,000
Consideration transferred	$ 100,100,000
Cash acquired	4,900,000
Goodwill	74,500,000
Intangible assets	57,300,000
Goodwill deductible for income tax purposes	$ 0

Long-Term Debt Obligations - Sc

Long-Term Debt Obligations - Schedule of Debt Obligations (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Debt Instrument [Line Items]
Total debt obligations	$ 2,715,564	$ 2,768,400
Add: unamortized Senior Notes premium, net of term loan original issuance discount	28,250	32,303
Less: unamortized deferred issuance costs	(9,397)	(13,584)
Less: current portion of debt	(199,575)	(50,100)
Total debt obligations, non-current portion	2,534,842	2,737,019
Secured Debt
Debt Instrument [Line Items]
Total debt obligations	2,312,564	2,365,400
Secured Debt | Term Loan A due March 2024
Debt Instrument [Line Items]
Total debt obligations	1,150,000	975,000
Secured Debt | Term Loan B due August 2024
Debt Instrument [Line Items]
Total debt obligations	977,364	1,221,000
Secured Debt | Accounts receivable financing agreement due June 2020 | Accounts Receivable Securitization
Debt Instrument [Line Items]
Total debt obligations	$ 185,200	169,400
Unsecured Debt | 7.5% Senior Unsecured Notes due 2024
Debt Instrument [Line Items]
Interest rate	7.50%
Total debt obligations	$ 403,000	$ 403,000

Long-Term Debt Obligations - Cr

Long-Term Debt Obligations - Credit Agreement Narrative (Details) - USD ($)	Mar. 26, 2019	May 04, 2018	Aug. 01, 2017	Jun. 30, 2019	Jun. 30, 2018
Debt Instrument [Line Items]
Repayments of long-term debt				$ 256,136,000	$ 97,500,000
Term Loan A due August 2022 | Secured Debt | Term Loan
Debt Instrument [Line Items]
Term loan facility			$ 1,000,000,000
Term Loan B due August 2024 | Secured Debt | Term Loan
Debt Instrument [Line Items]
Term loan facility			$ 1,600,000,000
Revolving Credit Facility Due August 2022 | Secured Debt | Revolving Credit Facility
Debt Instrument [Line Items]
Debt instrument term			5 years
Maximum borrowing capacity under accounts receivable financing agreement			$ 500,000,000
Repricing Amendment - Term Loan A due August 2022 and Term Loan B due August 2024 | Secured Debt
Debt Instrument [Line Items]
Decrease to margin spread		0.25%
Amendment 2 - Term Loan B due August 2024 | Secured Debt
Debt Instrument [Line Items]
Repayments of long-term debt	$ 187,500,000			65,000,000
Amendment 2 - Term Loan A due March 2024 | Secured Debt
Debt Instrument [Line Items]
Repayments of long-term debt				$ 12,500,000
Amendment 2 - Term Loan A due March 2024 | Secured Debt | Term Loan
Debt Instrument [Line Items]
Term loan facility	$ 1,550,000,000

Long-Term Debt Obligations - Am

Long-Term Debt Obligations - Amendment No. 2 to the Credit Agreement Narrative (Details)	Mar. 26, 2019USD ($)	Jun. 30, 2019USD ($)	Mar. 31, 2019USD ($)	Jun. 30, 2018USD ($)	Jun. 30, 2019USD ($)	Jun. 30, 2018USD ($)
Debt Instrument [Line Items]
Repayments of long-term debt					$ 256,136,000	$ 97,500,000
Loss on extinguishment of debt		$ 0	$ 4,400,000	$ 1,877,000	4,355,000	$ 2,125,000
Amendment 2 - Term Loan A due March 2024 | Secured Debt
Debt Instrument [Line Items]
Repayments of long-term debt					12,500,000
Amendment 2 - Term Loan A due March 2024 | Secured Debt | Term Loan
Debt Instrument [Line Items]
Increase to term loan facility	$ 587,500,000
Term loan facility	1,550,000,000
Amendment 2 - Term Loan B due August 2024 | Secured Debt
Debt Instrument [Line Items]
Repayments of long-term debt	187,500,000				$ 65,000,000
Term Loan A due March 2024, available within 9 months of closing | Secured Debt | Term Loan
Debt Instrument [Line Items]
Increase to term loan facility	400,000,000
7.5% Senior Unsecured Notes due 2024 | Unsecured Debt
Debt Instrument [Line Items]
Interest rate		7.50%			7.50%
Amendment No 2 - Revolving Credit Facility due March 2024 | Secured Debt | Revolving Credit Facility
Debt Instrument [Line Items]
Increase to existing commitments available	100,000,000
Maximum borrowing capacity under accounts receivable financing agreement	$ 600,000,000
Decrease to margin spread	0.25%
Amendment No 2 - Revolving Credit Facility due March 2024 | Secured Debt | Revolving Credit Facility | ABR
Debt Instrument [Line Items]
Decrease to margin spread	0.25%
Margin spread	0.50%
Amendment No 2 - Revolving Credit Facility due March 2024 | Secured Debt | Revolving Credit Facility | Adjusted Eurocurrency Rate
Debt Instrument [Line Items]
Margin spread	1.50%
Term Loan A and Revolving Credit Facility | December 31, 2017 through December 31, 2018
Debt Instrument [Line Items]
Maximum first lien leverage ratio					5
Term Loan A and Revolving Credit Facility | First Quarter Ending March 31, 2019
Debt Instrument [Line Items]
Maximum first lien leverage ratio					4.50
Amendment No 2 - Term Loan A due March 2024 (funded portion) | Secured Debt | Term Loan
Debt Instrument [Line Items]
Discount and debt issuance costs		$ 2,800,000			$ 2,800,000
Amendment No 2 - Term Loan A (unfunded portion), and Revolving Credit Facility due March 2024 | Secured Debt
Debt Instrument [Line Items]
Discount and debt issuance costs		$ 3,500,000			$ 3,500,000

Long-Term Debt Obligations - Co

Long-Term Debt Obligations - Covenant Restrictions under Lease Agreement (Details) $ in Millions	Jun. 30, 2019USD ($)
Revolving Credit Facility Due August 2022 | Secured Debt | Revolving Credit Facility
Debt Instrument [Line Items]
Remaining capacity available under accounts receivable financing agreement	$ 580.5
Revolving Credit Facility Due August 2022 | Secured Debt | Letter of Credit
Debt Instrument [Line Items]
Long-term Line of Credit	19.5
Term B Loan | Unsecured Debt | Letter of Credit
Debt Instrument [Line Items]
Long-term Line of Credit	$ 0.8

Long-Term Debt Obligations - Ac

Long-Term Debt Obligations - Accounts Receivable Financing Agreement (Details) - USD ($)	Jun. 29, 2018	Jun. 30, 2019
Debt Instrument [Line Items]
Long-term debt		$ 2,734,417,000
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 June 29, 2020 | Secured Debt | Accounts Receivable Securitization
Debt Instrument [Line Items]
Long-term debt		185,200,000
Accounts receivable financing agreement due June 29, 2020 | Secured Debt | Accounts Receivable Securitization | Wholly-owned Special Purpose Entity
Debt Instrument [Line Items]
Maximum borrowing capacity under accounts receivable financing agreement		250,000,000
Remaining capacity available under accounts receivable financing agreement		$ 64,800,000
Accounts receivable financing agreement due June 29, 2020 | Secured Debt | Accounts Receivable Securitization | Wholly-owned Special Purpose Entity | Federal Funds Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.50%

Long-Term Debt Obligations - _2

Long-Term Debt Obligations - Contractual Maturities of Debt Obligations (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Principal
2019	$ 0
2020	228,325
2021	79,063
2022	107,813
2023	115,000
2024 and thereafter	2,185,363
Less: deferred issuance costs	(9,397)	$ (13,584)
Unamortized Senior Notes premium, net of term loan original issuance discount	28,250	$ 32,303
Total	2,734,417
Interest
2019	65,827
2020	126,766
2021	120,320
2022	116,384
2023	110,852
2024 and thereafter	56,376
Total	$ 596,525

Leases - Additional Information

Leases - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018	Dec. 31, 2018
Lessee, Lease, Description [Line Items]
Capital lease obligation				$ 40.6
Operating Lease, Expense	$ 16.6		$ 33.3
Minimum
Lessee, Lease, Description [Line Items]
Leases, remaining term		1 year
Maximum
Lessee, Lease, Description [Line Items]
Leases, remaining term		13 years
Vehicles
Lessee, Lease, Description [Line Items]
Capital lease obligation, gross				55.3
Capital lease obligation, accumulated depreciation				$ 17.6

Leases - Components of Lease Co

Leases - Components of Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2019
Leases [Abstract]
Fixed Lease, Costs	$ 16,965	$ 34,105
Short-term lease costs	195	574
Variable lease costs	8,864	16,654
Fixed lease costs	26,024	51,333
Amortization of right-of-use assets	3,991	8,310
Interest on lease liabilities	414	808
Variable lease costs	1,803	3,630
Total finance lease costs	$ 6,208	$ 12,748

Leases - Supplemental Balance S

Leases - Supplemental Balance Sheet Information Related to Leases (Details) $ in Thousands	Jun. 30, 2019USD ($)
Leases [Abstract]
Property and equipment, gross	$ 59,344
Accumulated depreciation	(20,741)
Property and equipment, net	38,603
Current portion of finance lease obligations	16,004
Finance lease long-term obligations	28,390
Total finance lease liabilities	$ 44,394

Leases - Supplemental Cash Flow

Leases - Supplemental Cash Flow Information Related to Leases (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Leases [Abstract]
Operating cash flows for operating leases	$ (28,452)
Operating cash flows for finance leases	(808)
Financing cash flows for finance leases	(4,677)
Right-of-Use Asset Obtained in Exchange for Operating leases	41,286
Right-of-Use Asset Obtained in Exchange for Finance leases	12,286
Lease obligations closed out in exchange for right-of-use assets, Operating leases	$ (573)
Operating leases, Weighted Average Remaining Lease Term	8 years
Finance leases, Weighted Average Remaining Lease Term	3 years
Operating leases, Weighted Average Discount Rate, Percent	4.90%
Finance leases, Weighted Average Discount Rate, Percent	3.30%

Leases - Maturities of Lease Li

Leases - Maturities of Lease Liabilities (Details) $ in Thousands	Jun. 30, 2019USD ($)
Operating Leases
2019 (remaining 6 months)	$ 16,149
2020	50,811
2021	45,255
2022	39,394
2023	35,626
2024 and thereafter	131,401
Total lease payments	318,636
Less: imputed interest	(60,172)
Total lease liabilities	258,464
Finance Leases
2019 (remaining 6 months)	9,536
2020	15,825
2021	12,629
2022	8,254
2023	1,284
2024 and thereafter	0
Total lease payments	47,528
Less: management fee	(624)
Less: imputed interest	(2,510)
Total lease liabilities	44,394
2019 (remaining 6 months)	25,685
2020	66,636
2021	57,884
2022	47,648
2023	36,910
2024 and thereafter	131,401
Total lease payments	$ 366,164

Derivatives - Narrative (Detail

Derivatives - Narrative (Details) - USD ($) $ in Millions	Jun. 30, 2019	Jun. 30, 2018	May 31, 2016
Interest Rate Swaps, expiring on June 30, 2018 and May 14, 2020
Derivative [Line Items]
Interest rate swaps, notional amount	$ 100		$ 300
Interest Rate Swap, expiring June 30, 2021
Derivative [Line Items]
Interest rate swaps, notional amount		$ 1,010

Derivatives - Interest Rate Swa

Derivatives - Interest Rate Swaps Designated as Hedging Instruments on Consolidated Balance Sheets (Details) - Designated as Hedging Instrument - Cash Flow Hedging - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Interest Rate Swap | Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Derivative asset - current	$ 543	$ 1,355
Interest Rate Swap | Other long-term assets
Derivatives, Fair Value [Line Items]
Derivative asset - non-current	0	441
Interest Rate Swap | Accrued expenses
Derivatives, Fair Value [Line Items]
Derivative liability - current	(9,172)	(3,031)
Interest Rate Swap | Other long-term liabilities
Derivatives, Fair Value [Line Items]
Derivative liability - non-current	(12,463)	(6,201)
Foreign Currency Exchange Rate Swap | Accrued expenses
Derivatives, Fair Value [Line Items]
Derivative liability - current	$ 0	$ (138)

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of Assets and Liabilities Measured at Fair Value on a Recurring Basis (Details) - Recurring - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Assets:
Trading securities	$ 21,392	$ 14,945
Derivative instruments	543	1,796
Total assets	21,935	16,741
Liabilities:
Derivative instruments	21,635	9,370
Contingent obligations related to business combinations	19,152	20,127
Total liabilities	40,787	29,497
Level 1
Assets:
Trading securities	21,392	14,945
Derivative instruments	0	0
Total assets	21,392	14,945
Liabilities:
Derivative instruments	0	0
Contingent obligations related to business combinations	0	0
Total liabilities	0	0
Level 2
Assets:
Trading securities	0	0
Derivative instruments	543	1,796
Total assets	543	1,796
Liabilities:
Derivative instruments	21,635	9,370
Contingent obligations related to business combinations	0	0
Total liabilities	21,635	9,370
Level 3
Assets:
Trading securities	0	0
Derivative instruments	0	0
Total assets	0	0
Liabilities:
Derivative instruments	0	0
Contingent obligations related to business combinations	19,152	20,127
Total liabilities	$ 19,152	$ 20,127

Fair Value Measurements - Recon

Fair Value Measurements - Reconciliation of Changes in the Carrying Amount of Contingent Tax Sharing Obligations (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Fair Value Disclosures [Abstract]
Balance at December 31, 2018	$ 20,127
Additions	0
Changes in fair value recognized in earnings	(975)
Balance at June 30, 2019	$ 19,152

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Millions	Jun. 30, 2019	Dec. 31, 2018
Nonrecurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Goodwill and identifiable intangible assets	$ 5,390	$ 5,470

Fair Value Measurements - Sch_2

Fair Value Measurements - Schedule of Estimated Fair Value (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
7.5% Senior Unsecured Notes due 2024 | Unsecured Debt
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Interest rate	7.50%
Level 2 | Carrying Value | Term Loan A due March 2024 | Secured Debt
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt, carrying value	$ 1,146,458	$ 973,218
Level 2 | Carrying Value | Term Loan B due August 2024 | Secured Debt
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt, carrying value	976,421	1,219,755
Level 2 | Carrying Value | 7.5% Senior Unsecured Notes due 2024 | Unsecured Debt
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt, carrying value	435,735	438,330
Level 2 | Estimated Fair Value | Term Loan A due March 2024 | Secured Debt
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt, fair value	1,150,000	975,000
Level 2 | Estimated Fair Value | Term Loan B due August 2024 | Secured Debt
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt, fair value	977,364	1,221,000
Level 2 | Estimated Fair Value | 7.5% Senior Unsecured Notes due 2024 | Unsecured Debt
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt, fair value	$ 423,130	$ 423,150

Restructuring and Other Costs -

Restructuring and Other Costs - Narrative (Details) $ in Millions	6 Months Ended
	Jun. 30, 2019USD ($)
Employee Severance Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	$ 5.3
Facility Closure and Lease Termination Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	0.3
InVentiv Merger | Employee Severance Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	12.2
InVentiv Merger | Facility Closure and Lease Termination Costs
Restructuring Cost and Reserve [Line Items]
Restructuring charges incurred	$ 8.4

Restructuring and Other Costs_2

Restructuring and Other Costs - Schedule of Restructuring and Related Costs (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Restructuring Reserve
Expenses incurred	$ 11,882	$ 8,591	$ 26,295	$ 22,298
Facility lease closure and lease termination costs			5,900
Other Costs
Restructuring Reserve
Non-cash restructuring and other expenses			2,800
Business Restructuring Reserves
Restructuring Reserve
Balance at beginning of period			24,287
Expenses incurred			17,562
Cash payments made			(20,129)
Balance at end of period	4,959		4,959
Business Restructuring Reserves | Accounting Standards Update 2016-02
Restructuring Reserve
Adoption of ASC 842			(16,761)
Business Restructuring Reserves | Employee Severance Costs
Restructuring Reserve
Balance at beginning of period			7,474
Expenses incurred			17,522
Cash payments made			(20,059)
Balance at end of period	4,937		4,937
Business Restructuring Reserves | Employee Severance Costs | Accounting Standards Update 2016-02
Restructuring Reserve
Adoption of ASC 842			0
Business Restructuring Reserves | Facility Closure and Lease Termination Costs
Restructuring Reserve
Balance at beginning of period			16,761
Expenses incurred			0
Cash payments made			0
Balance at end of period	0		0
Business Restructuring Reserves | Facility Closure and Lease Termination Costs | Accounting Standards Update 2016-02
Restructuring Reserve
Adoption of ASC 842			(16,761)
Business Restructuring Reserves | Other Costs
Restructuring Reserve
Balance at beginning of period			52
Expenses incurred			40
Cash payments made			(70)
Balance at end of period	$ 22		22
Business Restructuring Reserves | Other Costs | Accounting Standards Update 2016-02
Restructuring Reserve
Adoption of ASC 842			$ 0

Shareholders' Equity - Shares o

Shareholders' Equity - Shares of Common Stock Outstanding (Details) - Common Stock - shares	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Common stock shares, beginning balance	103,460	102,871	103,460	102,871
Stock repurchase	(509)	(1,025)	(1,182)	(1,973)
RSU distributions net of shares for tax withholding	10	3	390	103
Stock option exercises	206	89	880	305
Common stock shares, ending balance	103,753	103,804	103,372	104,436

Shareholders' Equity - Narrati

Shareholders' Equity - Narrative (Details) - USD ($)	1 Months Ended
	Jun. 30, 2019	Feb. 28, 2019	Jan. 31, 2019	Apr. 30, 2018	Mar. 31, 2018	Feb. 26, 2018
Class of Stock [Line Items]
Stock repurchase program, authorized amount						$ 250,000,000
Common Stock
Class of Stock [Line Items]
Stock repurchased (in shares)	509,100	120,600	552,100	1,024,400	948,100
Stock repurchased, average price per share (USD per share)	$ 45.29	$ 41.40	$ 39.16	$ 36.60	$ 39.55
Stock repurchased, total purchase price	$ 23,100,000	$ 5,000,000	$ 21,600,000	$ 37,500,000	$ 37,500,000
Stock repurchase program, remaining authorization to repurchase	$ 125,300,000

Earnings (Loss) Per Share - Sch

Earnings (Loss) Per Share - Schedule of Earnings Per Share, Basic and Diluted (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Numerator:
Net income (loss)	$ 11,292	$ 13,560	$ (18,712)	$ (10,992)
Denominator:
Basic weighted average common shares outstanding (in shares)	103,699	102,899	103,532	103,674
Effect of dilutive securities:
Stock options and other awards under deferred share-based compensation programs (in shares)	1,119	1,106	0	0
Diluted weighted average common shares outstanding (in shares)	104,818	104,005	103,532	103,674
Earnings (loss) per share:
Basic (USD per share)	$ 0.11	$ 0.13	$ (0.18)	$ (0.11)
Diluted (USD per share)	$ 0.11	$ 0.13	$ (0.18)	$ (0.11)

Earnings (Loss) Per Share - S_2

Earnings (Loss) Per Share - Schedule of Antidilutive Securities Excluded from Computation of Earnings (Loss) Per Share (Details) - shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Antidilutive Securities Excluded from Computation of Earnings Per Share
Total common stock equivalents excluded from diluted loss per share (in shares)	373	1,017	1,612	2,059
Stock-Based Compensation Plans
Antidilutive Securities Excluded from Computation of Earnings Per Share
Total common stock equivalents excluded from diluted loss per share (in shares)	373	1,017	333	1,057
Stock-Based Compensation Plans | Anti-dilutive stock options and other awards under share-based compensation programs excluded based on reporting a net loss for the period
Antidilutive Securities Excluded from Computation of Earnings Per Share
Total common stock equivalents excluded from diluted loss per share (in shares)	0	0	1,279	1,002

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Income tax expense	$ 22,285	$ 16,047	$ 32,701	$ 7,075
Income (loss) before provision for income taxes	33,577	$ 29,607	13,989	$ (3,917)
Gross unrecognized tax benefits	$ 20,000		20,000		$ 19,200
Decrease in unrecognized tax benefits, audit settlements and remeasurement of acquired positions			$ 800

Revenue from Contracts with C_2

Revenue from Contracts with Customers - Narrative (Details) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2019USD ($)	Jun. 30, 2019USD ($)
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Unsatisfied performance obligations under contracts with a contract term greater than one year	$ 5,520	$ 5,520
Revenue recognized, included in contract liabilities balance at beginning of period	367	510.8
Increase (decrease) in revenue recognized, allocated to performance obligation partially satisfied in previous periods	$ 34.8	$ 9.3
Minimum
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Contract term		1 year
Maximum
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Contract term		5 years

Segment Information (Details)

Segment Information (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019USD ($)	Jun. 30, 2018USD ($)	Jun. 30, 2019USD ($)segment	Jun. 30, 2018USD ($)
Segment Reporting [Abstract]
Number of reportable segments | segment			2
Segment Reporting Information [Line Items]
Revenue	$ 1,166,827	$ 1,072,530	$ 2,285,833	$ 2,129,726
Direct costs (exclusive of depreciation and amortization)	917,529	847,465	1,804,331	1,688,288
Selling, general, and administrative expenses	110,879	100,218	223,996	199,477
Operating income (loss)	58,134	30,722	84,950	40,897
Restructuring and other costs	11,882	8,591	26,295	22,298
Transaction and integration-related expenses	7,654	18,032	24,312	43,243
Operating Segments
Segment Reporting Information [Line Items]
Direct costs (exclusive of depreciation and amortization)	910,217	841,893	1,788,857	1,678,964
Selling, general, and administrative expenses	89,827	89,777	185,582	175,241
Operating income (loss)	166,783	140,860	311,394	275,521
Corporate
Segment Reporting Information [Line Items]
Selling, general, and administrative expenses	14,570	7,638	25,827	17,397
Restructuring and other costs	11,882	8,591	26,295	22,298
Transaction and integration-related expenses	7,654	18,032	24,312	43,243
Depreciation and amortization	60,749	67,502	121,949	135,523
Corporate | Direct costs
Segment Reporting Information [Line Items]
Share-based compensation expense	7,312	5,572	15,474	9,324
Corporate | Selling, general, and administrative expenses
Segment Reporting Information [Line Items]
Share-based compensation expense	6,482	2,803	12,587	6,839
Clinical Solutions | Operating Segments
Segment Reporting Information [Line Items]
Revenue	849,922	783,913	1,654,880	1,570,752
Direct costs (exclusive of depreciation and amortization)	654,403	608,994	1,280,170	1,224,365
Selling, general, and administrative expenses	67,625	68,110	137,327	134,056
Operating income (loss)	127,894	106,809	237,383	212,331
Commercial Solutions | Operating Segments
Segment Reporting Information [Line Items]
Revenue	316,905	288,617	630,953	558,974
Direct costs (exclusive of depreciation and amortization)	255,814	232,899	508,687	454,599
Selling, general, and administrative expenses	22,202	21,667	48,255	41,185
Operating income (loss)	$ 38,889	$ 34,051	$ 74,011	$ 63,190

Operations by Geographic Loca_3

Operations by Geographic Location - Total Revenue by Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Revenues by Geographic Location
Revenue	$ 1,166,827	$ 1,072,530	$ 2,285,833	$ 2,129,726
North America
Revenues by Geographic Location
Revenue	791,281	726,546	1,518,979	1,458,311
United States
Revenues by Geographic Location
Revenue	$ 741,200	$ 690,300	$ 1,445,300	$ 1,386,800
United States | Geographic Concentration Risk | Net Service Revenue
Revenues by Geographic Location
Concentration risk percentage	63.50%	64.40%	63.20%	65.10%
Europe, Middle East, and Africa
Revenues by Geographic Location
Revenue	$ 258,787	$ 232,120	$ 517,134	$ 460,958
Asia-Pacific
Revenues by Geographic Location
Revenue	94,295	93,647	205,861	171,627
Latin America
Revenues by Geographic Location
Revenue	$ 22,464	$ 20,217	$ 43,859	$ 38,830

Operations by Geographic Loca_4

Operations by Geographic Location - Long-Lived Assets by Geographic Area (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Long-Lived Assets by Geographic Location
Total property and equipment, net	$ 187,747	$ 183,486
North America
Long-Lived Assets by Geographic Location
Total property and equipment, net	139,913	133,593
United States
Long-Lived Assets by Geographic Location
Total property and equipment, net	134,500	128,300
Europe, Middle East, and Africa
Long-Lived Assets by Geographic Location
Total property and equipment, net	30,288	33,053
Asia-Pacific
Long-Lived Assets by Geographic Location
Total property and equipment, net	14,314	13,328
Latin America
Long-Lived Assets by Geographic Location
Total property and equipment, net	$ 3,232	$ 3,512

Concentration of Credit Risk -

Concentration of Credit Risk - Concentration of Cash Balances (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018	Dec. 31, 2018
Geographic Concentration Risk | Cash and cash equivalents | Non-US
Concentration Risk [Line Items]
Cash, cash equivalents, and restricted cash					$ 43.6
Concentration risk percentage					28.00%
Customer Concentration Risk | Total consolidated service revenue
Concentration Risk [Line Items]
Concentration risk percentage	10.00%	11.00%	10.00%	11.00%
Customer Concentration Risk | Accounts Receivable
Concentration Risk [Line Items]
Concentration risk percentage			12.00%		13.00%

Related-Party Transactions (Det

Related-Party Transactions (Details) - Affiliated Entity	3 Months Ended		6 Months Ended
	Jun. 30, 2019USD ($)	Jun. 30, 2018USD ($)	Jun. 30, 2019USD ($)Counterparty	Jun. 30, 2018USD ($)
Related Party Transaction [Line Items]
Incurred professional services costs, related party | $	$ 0	$ 1,000,000	$ 1,100,000	$ 1,200,000
Related party transactions, number of counterparties | Counterparty			2

Commitments and Contingencies -

Commitments and Contingencies - Narrative (Details) $ in Thousands	Jan. 30, 2018plaintiff	Dec. 01, 2017action	Jun. 30, 2019USD ($)	Dec. 31, 2018USD ($)
Recurring
Loss Contingencies [Line Items]
Contingent obligations related to business combinations			$ 19,152	$ 20,127
InVentiv Merger | Recurring
Loss Contingencies [Line Items]
Contingent obligations related to business combinations			14,700	15,700
Kinapse Acquisition
Loss Contingencies [Line Items]
Contingent obligations related to business combinations			$ 4,400	$ 4,400
Pending Litigation | Bermudez and Vaitkuviene Actions
Loss Contingencies [Line Items]
Number of actions taken by plaintiff | action		2
Number of plaintiffs | plaintiff	2

Uncategorized Items - q22019for

Label	Element	Value
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	$ 2,907,259,000
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	2,838,370,000
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	2,923,764,000
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	2,856,144,000
AOCI Attributable to Parent [Member]
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	15,822,000
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	(88,195,000)
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	(71,807,000)
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	(18,535,000)
Retained Earnings [Member]
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	(459,333,000)
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	(493,814,000)
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	(504,187,000)
Stockholders' Equity Attributable To Parent, Adjusted Balance	synh_StockholdersEquityAttributableToParentAdjustedBalance	(473,134,000)
Accounting Standards Update 2018-02 [Member] | AOCI Attributable to Parent [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	3,850,000
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Accounting Standards Update 2018-02 [Member] | Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	(3,850,000)
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Accounting Standards Update 2014-09 [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	(98,815,000)
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Accounting Standards Update 2014-09 [Member] | Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	(98,815,000)
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 0