0001564590-21-006072 | 10-K | XBRL Viewer

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Document and Entity Information - USD ($) $ in Billions	12 Months Ended
Document and Entity Information - USD ($) $ in Billions	Dec. 31, 2020	Feb. 12, 2021	Jun. 30, 2020
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	FY
Trading Symbol	MEDP
Entity Registrant Name	Medpace Holdings, Inc.
Entity Central Index Key	0001668397
Current Fiscal Year End Date	--12-31
Entity Interactive Data Current	Yes
Entity File Number	001-37856
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	32-0434904
Entity Address, Address Line One	5375 Medpace Way
Entity Address, City or Town	Cincinnati
Entity Address, State or Province	OH
Entity Address, Postal Zip Code	45227
City Area Code	513
Local Phone Number	579-9911
Document Annual Report	true
Document Transition Report	false
Title of 12(b) Security	Common Stock $0.01 par value
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	Yes
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		35,734,291
Entity Public Float			$ 2.5
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE Portions of the registrant's definitive proxy statement to be filed with the Securities and Exchange Commission relating to the 2021 Annual Meeting of Stockholders are incorporated herein by reference into Part III of this Annual Report on Form 10-K to the extent stated herein.

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 277,766	$ 131,920
Accounts receivable and unbilled, net (includes $2.6 million and $1.9 million with related parties at December 31, 2020 and 2019, respectively)	160,962	155,662
Prepaid expenses and other current assets	34,923	29,446
Total current assets	473,651	317,028
Property and equipment, net	85,017	47,292
Operating lease right-of-use assets	113,809	52,152
Goodwill	662,396	662,396
Intangible assets, net	46,474	54,350
Deferred income taxes	536	376
Other assets	8,794	9,477
Total assets	1,390,677	1,143,071
Current liabilities:
Accounts payable (includes $0.2 million and $0.2 million with related parties at December 31, 2020 and 2019, respectively)	26,552	22,404
Accrued expenses	134,367	109,252
Advanced billings (includes $6.5 million and $3.0 million with related parties at December 31, 2020 and 2019, respectively)	255,664	192,359
Other current liabilities	23,527	18,987
Total current liabilities	440,110	343,002
Operating lease liabilities	115,143	45,212
Deferred income tax liability	13,551	12,849
Other long-term liabilities	16,094	15,725
Total liabilities	584,898	416,788
Commitments and contingencies (see Note 12)
Shareholders’ equity:
Preferred stock - $0.01 par-value; 5,000,000 shares authorized; no shares issued and outstanding at December 31, 2020 and 2019, respectively	0	0
Common stock - $0.01 par-value; 250,000,000 shares authorized at December 31, 2020 and 2019, respectively; 35,519,989 and 36,065,278 shares issued and outstanding at December 31, 2020 and 2019, respectively	355	360
Treasury stock - 185,000 and 200,000 shares at December 31, 2020 and 2019, respectively	(5,578)	(6,030)
Additional paid-in capital	695,904	666,585
Retained earnings	115,229	68,109
Accumulated other comprehensive loss	(131)	(2,741)
Total shareholders’ equity	805,779	726,283
Total liabilities and shareholders’ equity	$ 1,390,677	$ 1,143,071

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Statement Of Financial Position [Abstract]
Accounts receivable, unbilled services with related parties	$ 2.6	$ 1.9
Accounts payable includes related parties	0.2	0.2
Advanced billings with related parties	$ 6.5	$ 3.0
Preferred stock, par value	$ 0.01	$ 0.01
Preferred stock shares authorized	5,000,000	5,000,000
Preferred stock shares issued	0	0
Preferred stock shares outstanding	0	0
Common stock, par value	$ 0.01	$ 0.01
Common stock shares authorized	250,000,000	250,000,000
Common stock shares issued	35,519,989	36,065,278
Common stock shares outstanding	35,519,989	36,065,278
Treasury stock shares	185,000	185,000

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Revenue, net (includes $15.9 million, $18.9 million and $15.1 million with related parties for the years ended December 31, 2020, 2019 and 2018, respectively)	$ 925,925	$ 860,969	$ 704,589
Operating expenses:
Total direct costs	647,199	615,272	489,059
Selling, general and administrative	92,156	95,245	75,681
Depreciation	11,652	8,360	9,240
Amortization	7,876	14,829	29,561
Total operating expenses	758,883	733,706	603,541
Income from operations	167,042	127,263	101,048
Other expense, net:
Miscellaneous income (expense), net	1,183	(863)	1,060
Interest income (expense), net	307	(1,568)	(8,157)
Total other income (expense), net	1,490	(2,431)	(7,097)
Income before income taxes	168,532	124,832	93,951
Income tax provision	23,148	24,389	20,766
Net income	$ 145,384	$ 100,443	$ 73,185
Net income per share attributable to common shareholders:
Basic	$ 4.07	$ 2.79	$ 2.05
Diluted	$ 3.84	$ 2.67	$ 1.97
Weighted average common shares outstanding:
Basic	35,635	35,881	35,547
Diluted	37,708	37,576	36,912
Direct Costs
Operating expenses:
Total direct costs	$ 354,426	$ 321,006	$ 252,284
Reimbursable Out of Pocket Costs
Operating expenses:
Total direct costs	$ 292,773	$ 294,266	$ 236,775

CONSOLIDATED STATEMENTS OF OPERATIONS (Parenthetical) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Revenue Net
Revenue with related parties	$ 15.9	$ 18.9	$ 15.1

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 145,384	$ 100,443	$ 73,185
Other comprehensive income (loss)
Foreign currency translation adjustments, net of taxes	2,610	(224)	(1,783)
Comprehensive income	$ 147,994	$ 100,219	$ 71,402

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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CONSOLIDATED STATEMENTS OF SHAREHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Previously Reported	Revision of Prior Period, Accounting Standards Update, Adjustment	Common Stock	Common Stock Previously Reported	Treasury Stock	Treasury Stock Previously Reported	Additional Paid-in Capital	Additional Paid-in Capital Previously Reported	(Accumulated Deficit) Retained Earnings	(Accumulated Deficit) Retained Earnings Previously Reported	(Accumulated Deficit) Retained Earnings Revision of Prior Period, Accounting Standards Update, Adjustment	Accumulated Other Comprehensive Loss	Accumulated Other Comprehensive Loss Previously Reported
Balance at Dec. 31, 2017	$ 509,260	$ 503,530	$ 5,730	$ 355	$ 355	$ (6,030)	$ (6,030)	$ 630,341	$ 630,341	$ (114,672)	$ (120,402)	$ 5,730	$ (734)	$ (734)
Accounting Standards Update [Extensible List]			us-gaap:AccountingStandardsUpdate201409Member									us-gaap:AccountingStandardsUpdate201409Member
Net income	73,185									73,185
Foreign currency translation	(1,783)												(1,783)
Stock-based compensation expense	6,499							6,499
Stock options exercised	2,542			1				2,541
Balance at Dec. 31, 2018	598,856	$ 589,703	$ 9,153	356	$ 356	(6,030)	$ (6,030)	639,381	$ 639,381	(32,334)	$ (41,487)	$ 9,153	(2,517)	$ (2,517)
Accounting Standards Update [Extensible List]			us-gaap:AccountingStandardsUpdate201602Member									us-gaap:AccountingStandardsUpdate201602Member
Net income	100,443									100,443
Foreign currency translation	(224)												(224)
Stock-based compensation expense	20,741							20,741
Stock options exercised	6,467			4				6,463
Balance at Dec. 31, 2019	726,283			360		(6,030)		666,585		68,109			(2,741)
Net income	145,384									145,384
Foreign currency translation	2,610												2,610
Stock-based compensation expense	13,784							13,784
Stock options exercised	15,992			5		452		15,535
Repurchases of common stock	(98,274)			(10)						(98,264)
Balance at Dec. 31, 2020	$ 805,779			$ 355		$ (5,578)		$ 695,904		$ 115,229			$ (131)

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Reference 29: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 326
-SubTopic 10
-Section 65
-Paragraph 4
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=121646688&loc=SL121648383-210437

Reference 30: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 40
-Section 65
-Paragraph 2
-Subparagraph (g)(2)(ii)
-URI http://asc.fasb.org/extlink&oid=121370832&loc=SL117420844-207641

Reference 31: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 65
-Paragraph 8
-Subparagraph (d)(2)

Reference 32: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 65
-Paragraph 8
-Subparagraph (d)(3)

+ Details

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

+ Details

- Definition

Total of all stockholders' equity (deficit) items, net of receivables from officers, directors, owners, and affiliates of the entity which are attributable to the parent. The amount of the economic entity's stockholders' equity attributable to the parent excludes the amount of stockholders' equity which is allocable to that ownership interest in subsidiary equity which is not attributable to the parent (noncontrolling interest, minority interest). This excludes temporary equity and is sometimes called permanent equity.

+ References + Details

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income	$ 145,384	$ 100,443	$ 73,185
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation	11,652	8,360	9,240
Amortization	7,876	14,829	29,561
Stock-based compensation expense	13,784	20,741	6,499
Amortization of debt issuance costs and discount	0	954	615
Noncash lease expense	13,924	9,949	0
Deferred income tax provision	527	10,050	3,942
Amortization and adjustment of deferred credit	(706)	(801)	(7,712)
Other	(22)	1,754	1,653
Changes in assets and liabilities:
Accounts receivable and unbilled, net	(5,530)	(21,256)	(27,047)
Prepaid expenses and other current assets	(3,724)	(7,381)	(1,241)
Accounts payable	(2,597)	4,730	1,342
Accrued expenses	24,231	21,824	29,029
Advanced billings	63,407	44,584	35,593
Lease liabilities	(11,506)	(9,034)	0
Other assets and liabilities, net	1,976	2,121	1,925
Net cash provided by operating activities	258,676	201,867	156,584
CASH FLOWS FROM INVESTING ACTIVITIES:
Property and equipment expenditures	(31,340)	(17,912)	(16,024)
Other	126	(1,232)	(949)
Net cash used in investing activities	(31,214)	(19,144)	(16,973)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from stock option exercises	15,992	6,520	2,489
Repurchases of common stock	(98,274)	0	0
Payment of debt	0	(80,438)	(72,188)
Payments on revolving loan	0	0	(70,000)
Payment of deemed landlord liability	0	0	(1,881)
Net cash used in financing activities	(82,282)	(73,918)	(141,580)
EFFECT OF EXCHANGE RATES ON CASH, CASH EQUIVALENTS, AND RESTRICTED CASH	666	(167)	(1,241)
INCREASE (DECREASE) IN CASH, CASH EQUIVALENTS, AND RESTRICTED CASH	145,846	108,638	(3,210)
CASH, CASH EQUIVALENTS, AND RESTRICTED CASH — Beginning of period	131,920	23,282	26,492
CASH, CASH EQUIVALENTS, AND RESTRICTED CASH — End of period	277,766	131,920	23,282
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION—
Cash paid during the period for income taxes	23,105	13,235	23,311
Cash paid during the period for interest	104	1,489	7,589
Acquisition of property and equipment—non-cash	$ 18,980	$ 2,529	$ 1,551

Basis of Presentation

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Basis of Presentation

1. BASIS OF PRESENTATION

Description of Business

Medpace Holdings, Inc. together with its subsidiaries, (“Medpace” or the “Company”), a Delaware corporation, is a global provider of clinical research-based drug and medical device development services. The Company partners with pharmaceutical, biotechnology, and medical device companies in the development and execution of clinical trials. The Company’s drug development services focus on full service Phase I-IV clinical development services and include development plan design, coordinated central laboratory, project management, regulatory affairs, clinical monitoring, data management and analysis, pharmacovigilance new drug application submissions, and post-marketing clinical support. The Company also provides bio-analytical laboratory services, clinical human pharmacology, imaging services, and electrocardiography reading support for clinical trials.

The Company’s operations are principally based in North America, Europe, and Asia.

Share Repurchases

In the first quarter of 2018, the Board of Directors approved a share repurchase program authorizing up to $50.0 million in share repurchases. In the first quarter of 2020, the Board of Directors approved an increase in the stock repurchase authorization by $50.0 million. In the fourth quarter of 2020, the Board approved the stock repurchase authorization up to $150.0 million. For the year ended December 31, 2020, the Company repurchased 1,183,095 shares for $98.3 million. As of December 31, 2020, we have remaining authorization of $102.6 million remaining under the repurchases program.

Repurchases under the share repurchase program are executed in the open market or negotiated transactions under trading plans established pursuant to Rule 10b5-1. The Company constructively retired the repurchased shares associated with these approved share repurchase programs, with all amounts paid in excess of par value reflected within Retained earnings in the Company’s consolidated balance sheets. The repurchase program may be suspended or discontinued at any time without notice.

Secondary Offering

During the year ended December 31, 2018, Cinven sold a total of 16,399,997 shares of the Company’s common stock as part of multiple secondary offerings. The Company incurred professional fees in connection with the secondary offerings of $0.7 million during the year ended December 31, 2018. The fees are included within operating expenses in the accompanying consolidated statement of operations. As of August 27, 2018, Cinven does not beneficially own any shares of the Company’s outstanding common stock. The Company did not sell any shares in or receive any proceeds from the secondary offerings.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Principles of Consolidation and Presentation

The accompanying consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America (“US GAAP”) and include the accounts and operations of the Company and its subsidiaries. All intercompany accounts and transactions have been eliminated in consolidation.

Use of Estimates

The preparation of financial statements in conformity with US GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from these estimates.

Significant items that are subject to management estimates and assumptions include revenue, net, allowances for doubtful accounts, acquisition purchase price allocations, long-lived asset impairment and useful lives, exit liabilities, stock-based compensation, uncertain income tax positions and contingencies.

Reportable Segments

The Company emphasizes its full service outsourcing model, providing services focused on the development, management and execution of clinical trials. As part of this full service approach, the Company utilizes centralized systems, customer interface technology, support functions and processes that cross service offerings and align resources to deliver efficient clinical trial services. Given the full service approach, the chief executive officer, who is the chief operating decision maker (“CODM”) assesses the allocation of resources based on key metrics including revenue, backlog, and net awards by service offering and consolidated profitability and consolidated cash flows. Based on the Company’s full service model, internal management and reporting structure, and key metrics used by the CODM to make resource allocation decisions, management has determined that the Company’s operations consist of a single operating segment. Therefore, results of operations are presented as a single reportable segment.

Foreign Currencies

Assets and liabilities recorded in foreign currencies on foreign subsidiary financial statements are translated at the exchange rate on the balance sheet date, while equity accounts are translated at historical exchange rates. Revenue and expenses are recorded at average rates of exchange during the year. Translation adjustments are recorded to Accumulated other comprehensive loss in the consolidated statements of shareholders’ equity and consolidated statements of comprehensive income.

Separately, net realized gains and losses on foreign currency transactions are included in Miscellaneous income (expense), net, on the consolidated statements of operations. Foreign currency transactions resulted in a net gain/(loss) of $0.5 million, ($0.6) million, and $0.4 million during the years ended December 31, 2020, 2019, and 2018, respectively.

Revenue Recognition

The Company generally enters into contracts with customers to provide services ranging in duration from a few months to several years. The contract terms generally provide for payments based on a fixed fee or unit-of-service arrangement. The Company accounts for revenue in accordance with ASC 606, Revenue from Contracts with Customers, which the Company adopted on January 1, 2018 using the modified retrospective implementation method. Revenue on contracts is recognized when or as the Company satisfies the contract performance obligations, at the amount that reflects the Company’s cumulative progress toward delivery of the performance obligation. This progress assessment is applied to the amount of consideration to which the Company expects to be paid for delivery of the performance obligation. The Company’s performance obligations are generally satisfied over time and related revenue is recognized as services are provided to meet these obligations.

Contract Assumptions

An arrangement is accounted for as a contract within the scope of ASC 606 when the Company and its customers approve the contract, are committed to perform their respective obligations, each party can identify its rights regarding the goods or services to be transferred, commercial substance is present, and it is probable that the Company will collect substantially all of the consideration to which it will be entitled in exchange for the goods or services that will be transferred to the customer.

For the Company’s services to meet this criteria, contracts generally need to be written, pending regulatory hurdles required to commence work must be cleared, the study protocol must be completed, the customer must have adequate funding or reasonable path to funding to execute the contracted portion of the study, and the study must be actively moving forward. Once these criteria have been met, it is deemed that the Company and its customers are committed to perform their respective obligations. Depending on the timing of when these criteria are met, revenue recognition may vary significantly on a period over period basis.

Accounting for contracts performed over a period of time involves the use of various assumptions to estimate total contract revenue and costs. The Company estimates expected costs to complete a contract and recognizes contracted revenue over the life of the contract as those costs are incurred.

Cost estimates are based on a detailed project budget and are developed based on many variables, including, but not limited to, the scope of the work, the complexity of the study, the participating geographic locations and the Company’s historical experience. To assist with the estimation of costs expected at completion over the life of a project, regular contract reviews are performed in which performance to date is compared to the most current estimate to complete assumptions. The reviews include an assessment of costs incurred to date compared to expectations based on budget assumptions and other circumstances specific to the project. The total estimated costs necessary to complete is updated and any revisions to the existing cost estimate results in cumulative adjustments to the amount of revenue recognized in the period in which the revisions are identified. In the case of cost estimates related to activities legally contracted as reimbursable in nature, including but not limited to investigator fee activity, these estimates also influence the Company’s assumed contract value and assumed remaining performance obligations. Because of the uncertainties inherent in estimating the costs necessary to fulfill contractual obligations, it is possible that estimates may change in the near term, resulting in a material change in revenue reported.

Contracts generally provide for pricing modifications upon scope of work changes. The Company recognizes revenue, at an amount to which it expects to be entitled, related to work performed in connection with scope changes when the underlying services are performed and a binding contractual commitment has been established with the customer. If the Company’s customers do not agree to contract changes upon changes in the Company’s scope of work, the Company could be exposed to cost overruns and reduced contract profitability. Costs are not deferred in anticipation of contracts being awarded or amendments being finalized, but are expensed as incurred.

Most contracts are terminable by the customer, either immediately or according to advance notice terms specified within the contracts. These contracts require payment of fees for services rendered through the date of termination and may require payment for subsequent services necessary to conclude the study or close out the contract. Final settlement amounts are agreed to with the customer based on remaining work to be performed. These amounts are included in revenue when the Company believes the amount can be estimated reliably and its realization is probable. In evaluating the probability of recognition, the Company considers the contractual basis for the settlement amount and the objective evidence available to support the amount.

Certain contracts contain volume rebate arrangements with our customers that provide for rebates if certain specified spending thresholds are met. These obligations are considered as a reduction in revenue when it appears probable that the arrangement thresholds will be met, which can be at contract inception. Total revenue is presented net of rebates of $4.8 million, $6.2 million and $1.2 million in the consolidated statements of operations during the years ended December 31, 2020, 2019 and 2018, respectively.

The Company occasionally enters into incentive fee arrangements with customers that provide for additional compensation if certain defined contractual milestones or performance thresholds are met. These additional fees are included in the estimated transaction price when there is a basis to reasonably estimate the amount of the fee and when achievement of the incentive milestone is deemed probable. These estimates are based on anticipated performance, the Company’s best judgment at the time or ultimately, upon achievement of the threshold or milestone.

The Company records revenue net of any tax assessments by governmental authorities that are imposed and concurrent with specific revenue generating transactions.

Performance Obligations

Substantially all of the Company’s contracts consist of a single performance obligation, as the promise to transfer the individual services described in the contracts are not separately identifiable from other promises in the contracts, and therefore not distinct. Revenue recognition is determined by assessing the progress of performance completed or delivered to date compared to total services to be delivered under the terms of the arrangement. The measures utilized to assess progress on the satisfaction of performance are specific to the performance obligation identified in the contract.

For the majority of the Company’s contract performance obligations, it utilizes the input method of cost to cost to measure progress, as the Company has determined that it is the most consistent measure of progress among contract tasks and represents the most faithful depiction of the transfer of services over the contract life. Under this method, the Company determines cost incurred to date for the services it provides compared to the total estimated costs at completion.

For certain other contractual performance obligations, the Company has determined that an output method is the best measure of progress. These relate to certain unitized contracts, and the Company recognizes revenue in the period in which the unit is delivered compared to total contracted units.

As of December 31, 2020 and 2019, the Company had approximately $1.6 billion and $1.4 billion of performance obligations remaining to be performed for active projects.

Concentration of Credit Risk

Financial instruments that subject the Company to credit risk primarily consist of cash and cash equivalents and accounts receivable. The cash and cash equivalent balances are held and maintained with financial institutions with reputable credit ratings and, consequently, the Company believes that such funds are subject to minimal credit risk.

The Company generally does not require collateral or other securities to support customer receivables. In the years ended December 31, 2020, 2019 and 2018, credit losses have been immaterial and within management’s expectations. At December 31, 2020 and 2019, there were no customers accounting for more than 10% of the Company’s accounts receivable.

Costs and Expenses

The Company incurs costs associated with service delivery including direct labor and related employee benefits, laboratory supplies, and other expenses. These costs are recorded in Direct service costs, excluding depreciation and amortization as a component of Total direct costs in the accompanying consolidated statements of operations. In addition, the Company incurs expenses on behalf of its customers for various project expenditures including, but not limited to, investigator site payments, travel, meetings, printing, and shipping and handling fees that are reimbursed by its customers at cost. These costs are included in Reimbursable out-of-pocket expenses as a component of Total direct costs in the accompanying consolidated statements of operations. Total direct costs are expensed as incurred and are not deferred in anticipation of contracts being awarded or finalization of changes in scope. Selling, general and administrative includes administrative payroll and related employee benefits, sales and marketing expenses, administrative travel, and other expenses not directly related to service delivery. Rent, utilities, supplies, and software license expenses are allocated between Total direct costs, and Selling, general and administrative based on the estimated contribution among service delivery and support function efforts on a percentage basis. Depreciation and amortization is reported separately in the accompanying consolidated statements of operations. Costs of sales and marketing activities not subject to recovery pursuant to customer contracts, such as feasibility assessments and negotiation of contracts, are expensed as incurred and recorded as a component of Selling, general and administrative in the accompanying consolidated statements of operations.

Advertising expenses are recorded as a component of Selling, general and administrative expenses in the accompanying consolidated statements of operations. Total advertising expenses of $0.7 million, $0.7 million and $0.8 million were incurred during the years ended December 31, 2020, 2019 and 2018, respectively.

Income Taxes

The Company’s consolidated US federal income tax return is comprised of its US subsidiaries, one of its foreign branches located in Korea and certain foreign subsidiaries.

The Company provides for income taxes on all transactions that have been recognized in the consolidated financial statements in accordance with accounting guidance governing income tax accounting. Accordingly, the impact of changes in income tax laws on deferred tax assets and deferred tax liabilities are recognized in net earnings in the period during which such changes are enacted.

The Company records deferred tax assets and liabilities based on temporary differences between the financial statement bases and tax bases of assets and liabilities. Deferred tax assets are recorded for tax benefit carryforwards using tax rates anticipated to be in effect in the year in which the temporary differences are expected to reverse. If it does not appear more likely than not that the full value of a deferred tax asset will be realized, the Company records a valuation allowance against the deferred tax asset, with an offsetting charge to the Company’s income tax provision or benefit. The value of the Company’s deferred tax assets is estimated based on, among other things, the Company’s ability to generate a sufficient level of future taxable income. In estimating future taxable income, the Company has considered both positive and negative evidence, such as historical and forecasted results of operations, and has considered the implementation of prudent and feasible tax planning strategies.

The Company’s accounting position is that unremitted foreign earnings are indefinitely reinvested. Therefore, the Company has not recorded deferred foreign withholding taxes on the unremitted foreign earnings. Refer to Note 11 for further information regarding this assertion.

The Company follows accounting guidance related to accounting for uncertainty in income taxes which requires significant judgment in determining what constitutes an individual tax position as well as assessing the possible outcome of each tax position. Changes in judgments as to recognition or measurement of tax positions can materially affect the estimate of the effective tax rate, and, consequently, the Company’s consolidated financial results. The Company considers many factors when evaluating and estimating tax positions and tax benefits, which may require periodic adjustments and which may not accurately anticipate actual outcomes. In addition, the calculation of tax liabilities involves dealing with uncertainties in the application of complex tax regulations in a multitude of jurisdictions. The Company determines its liability for uncertain tax positions globally. If the payment of these amounts ultimately proves to be unnecessary, the reversal of liabilities would result in tax benefits being recognized in the period when it is determined the liabilities are no longer necessary. If the calculation of the liability related to uncertain tax positions proves to be more or less than the ultimate assessment, a tax expense or tax benefit would result. Interest and penalties associated with uncertain tax positions are recognized as components of the Company’s Income tax provision.

Research and Development Credits

Research and development credits are available to the Company under tax laws in certain jurisdictions, based on qualifying research and development spend as defined under those tax laws. Certain tax jurisdictions provide refundable credits that are not wholly dependent on the Company’s income tax status or income tax position. In these circumstances the benefit of the credits is recorded as a reduction of operating expense. When they are wholly dependent upon the Company’s income tax position, research and development credits are recognized as a reduction of income tax expense.

Stock-Based Compensation

The Company has stock-based employee compensation plans for which it incurs compensation expense.

Equity Awards

In connection with the Company's initial public offering (IPO), the Board approved the formation of the 2016 Incentive Award Plan (the “2016 Plan”), which replaced our 2014 Equity Incentive Plan (the “2014 Plan”). The 2016 Plan provides for long-term equity incentive compensation for key employees, officers and non-employee directors. A variety of discretionary awards (collectively, the “Awards”) for employees and non-employee directors are authorized under the 2016 Plan, including vested common shares, stock options, stock appreciation rights (“SARs”), restricted stock awards (“RSAs”), restricted stock units (“RSUs”), or other cash based or stock dividend equivalent awards. The vesting of such awards may be conditioned upon either a specified period of time or the attainment of specific performance goals as determined by the administrator of the 2016 Plan. The option price and term are also subject to determination by the administrator with respect to each grant. Option prices are generally expected to be set at the market price of our common stock at the date of grant and option terms are not expected to exceed ten years. All outstanding Awards under the 2016 Plan are equity classified awards.

The Company created the 2014 Plan, providing for the future issuance of vested shares, stock options, RSAs and RSUs in Medpace Holdings, Inc.’s common stock (the “2014 Plan Awards”). The 2014 Plan Awards were subject to either equity or liability-classification pursuant to the terms of the participant’s award agreement and the 2014 Plan based on accounting guidance which governs such transactions. All outstanding Awards under the 2014 Plan are equity classified awards.

Stock-based compensation expense for both the 2016 Plan and 2014 Plan is calculated using the fair value method on the grant date. The Company expenses stock-based compensation over the term of the award based on the vesting described in the award agreement. Stock-based compensation expense is allocated between Total direct costs, and Selling, general and administrative in the consolidated statements of operations based on the underlying classification and scope of work for the employees receiving the Awards.

Net Income Per Share

Basic and diluted earnings or loss per share (“EPS”) are computed using the two-class method, which is an earnings allocation that determines EPS for each class of common stock and participating securities according to dividends declared and participation rights in undistributed earnings. The Company’s RSAs are considered participating securities because they are legally issued at the date of grant and holders are entitled to receive non-forfeitable dividends during the vesting term.

The computation of diluted EPS includes additional common shares, such as unvested RSUs and stock options with exercise prices less than the average market price of the Company’s common stock during the period (“in-the-money options”), which would be considered outstanding. This assumes that additional shares would have to be issued in cases where the exercise price of stock options is less than the value of the common stock being acquired because the cash proceeds received from the stock option holder would not be sufficient to acquire that same number of shares. The Company does not compute diluted EPS in cases where the inclusion of such additional shares would be anti-dilutive in effect.

The following table sets forth the computation of basic and diluted earnings per share for the years ended December 31, 2020, 2019 and 2018 (in thousands, except for earnings per share):



	Year Ended December 31,
	2020		2019		2018
Weighted-average shares:
Common shares outstanding		35,635		35,881		35,547
RSAs		112		100		142
Total weighted-average shares		35,747		35,981		35,689
Earnings per common share—Basic
Net income	$	145,384	$	100,443	$	73,185
Less: Undistributed earnings allocated to RSAs		459		279		291
Net income available to common shareholders—Basic	$	144,925	$	100,164	$	72,894

Net income per common share—Basic	$	4.07	$	2.79	$	2.05

Basic weighted-average common shares outstanding		35,635		35,881		35,547
Effect of diluted shares		2,073		1,695		1,365
Diluted weighted-average shares outstanding		37,708		37,576		36,912

Net income per common share—Diluted	$	3.84	$	2.67	$	1.97

For the years ended December 31, 2020, 2019 and 2018, the computation of diluted EPS excludes the effect of (in thousands) 204, 248 and 121 stock options, respectively, due to each respective period’s average fair value of the Company’s common stock not exceeding the exercise prices.

Fair Value Measurements

The Company follows accounting guidance related to fair value measurements that defines fair value, establishes a framework for measuring fair value, and establishes a hierarchy for inputs used in measuring fair value. This hierarchy maximizes the use of “observable” inputs and minimizes the use of unobservable inputs by requiring that the most observable inputs be used when available. The hierarchy specifies three levels based on the inputs, as follows:

Level 1: Valuations based on quoted prices in active markets for identical assets or liabilities.

Level 2: Valuations based on directly observable inputs or unobservable inputs corroborated by market data.

Level 3: Valuations based on unobservable inputs supported by little or no market activity representing management’s determination of assumptions of how market participants would price the assets or liabilities.

The fair value of financial instruments such as cash and cash equivalents, accounts receivable and unbilled, net, accounts payable, accrued expenses, and advanced billings approximate their carrying amounts due to their short term maturities.

The Company does not have any recurring fair value measurements as of December 31, 2020. There were no transfers between Level 1, Level 2, or Level 3 during the years ended December 31, 2020, 2019 and 2018.

Cash and Cash Equivalents, including Restricted Cash

Cash and cash equivalents, including restricted cash, are invested in demand deposits and money market funds, all of which have an original maturity of three months or less. Restricted cash consists of customer funds received in advance and subject to specific restrictions, as well as amounts placed in escrow for contingent payments resulting from acquisitions or other contractual arrangements.

Accounts Receivable and Unbilled, Net

Accounts receivable represent amounts due from the Company’s customers who are concentrated primarily in the pharmaceutical, biotechnology, and medical device industries. Unbilled services represent revenue recognized to date that is currently not billable to the customer pursuant to contractual terms. In general, amounts become billable upon the achievement of negotiated contractual events or in accordance with predetermined payment schedules. Amounts classified to unbilled services are those billable to customers within one year from the respective balance sheet date.

The Company grants credit terms to its customers prior to signing a service contract and monitors the creditworthiness of its customers on an ongoing basis. The Company maintains an allowance for doubtful accounts based on specific identification of accounts receivable that are at risk of not being collected. Uncollectible accounts receivable are written off only after all reasonable collection efforts have been exhausted. Moreover, in some cases the Company requires advance payment from its customers for a portion of the study contract price upon the signing of a service contract. These advance payments are deferred and recognized as revenue as services are performed.

Inventory

Inventory, which consists primarily of laboratory supplies, is valued at the lower of cost or market. Inventory is stated at purchased cost using the first-in, first out (FIFO) cost method. The inventory balance is included in Prepaid expenses and other current assets in the consolidated balance sheets.

Property and Equipment

Property and equipment is recorded at cost. Depreciation is provided on the straight-line method at rates adequate to allocate the cost of the applicable assets over their estimated useful lives, which is three to five years for computer hardware, software, phone, and medical imaging equipment, five to seven years for furniture and fixtures and other equipment, and thirty to forty years for buildings. The Company capitalizes costs of computer software developed for internal use and amortizes these costs on a straight-line basis over the estimated useful life, not to exceed three years. Leasehold improvements and deemed assets from landlord building construction are capitalized and amortized on a straight-line basis over the shorter of the estimated useful life of the improvement or the associated remaining lease term. Repairs and maintenance are expensed as incurred.

Leases

The Company enters into contracts to lease facilities and equipment to be used in its operations. At contract inception, the Company determines whether a contract contains a lease within the scope of Accounting Standard Codification Topic 842, Leases (“ASC 842”), and determines the appropriate classification of the lease as either operating or finance.

Contracts containing operating leases are recorded on the consolidated balance sheets within Operating lease right-of-use (“ROU”) assets, Other current liabilities, and Operating lease liabilities. Operating lease ROU assets and operating lease liabilities are recognized based on the present value of the future lease payments over the lease term as of the lease commencement date. In addition, operating ROU assets also include lease payments made and exclude lease incentives and initial direct costs incurred. Operating lease expense for lease payments is recognized on a straight-line basis over the lease term within Total direct costs and Selling, general, and administrative expenses. Variable lease costs are primarily related to adjustments for inflation, common area maintenance and property tax and are recognized within Total direct costs and Selling, general and administrative expenses.

Contracts containing finance leases are recognized initially in the same manner as Operating lease ROU assets and liabilities; however, they are recorded on the consolidated balance sheets within Property and equipment, net, Other current liabilities, and Other long-term liabilities. Finance lease assets are subsequently amortized on a straight line basis over the lease term within Depreciation expense, while the lease liability is accreted within Interest expense, net utilizing the discount rate determined at lease commencement and reduced by periodic lease payments over the lease term. Currently, the Company does not have any finance leases.

The discount rate utilized in determining the present value of future payments for both operating and finance leases, unless implicit in the lease contract, is determined based on the Company’s collateralized incremental borrowing rate based on the information available at lease commencement.

Lease terms may include options to extend or terminate the lease when it is reasonably certain that the Company will exercise that option as determined at lease commencement.

Many of our lease agreements have both lease and non-lease components, which the Company has elected to treat as a single lease component for recognition purposes.

The Company may enter into short-term leases (leases with a lease term of less than one year), which it has elected not to capitalize as assets and liabilities on the consolidated balance sheets, but instead recognizes lease payments within Total direct costs and Selling, general, and administrative expenses on a straight line basis over the lease term.

Goodwill and Intangible Assets

Goodwill

Goodwill represents the excess of purchase price over the fair value of net assets acquired in business combinations. The carrying value of goodwill is reviewed at least annually for impairment, or as indicators of potential impairment

are identified, at the reporting unit level. The reporting units are Phase I-IV clinical research services and Laboratories as of December 31, 2020.

The Company performs its annual impairment tests during the fourth quarter each year, comparing the fair value of each of our reporting units with its carrying amount, inclusive of goodwill. A goodwill impairment charge would be recognized for the amount by which the carrying amount exceeds the reporting unit’s fair value. Fair value is estimated using a combination of the income approach, a discounted cash flow analysis, and the market approach, utilizing the guideline company method. There was no indication of impairment related to goodwill based on the fourth quarter 2020 assessment.

Intangible Assets

The Company has an indefinite lived intangible asset related to its trade name. The carrying value of the trade name asset is reviewed at least annually for impairment, or as indicators of potential impairment are identified. The Company performs its annual impairment test in the fourth quarter each year in conjunction with its annual assessment of goodwill. The assessment consists of comparing the carrying value of the indefinite lived intangible asset to its estimated fair value, utilizing the relief from royalty method, an income approach valuation. There was no indication of impairment related to the trade name asset based on the fourth quarter 2020 assessment.

Finite-lived intangible assets consist mainly of the value assigned to customer relationships and developed technologies. Finite-lived intangible assets are amortized straight-line or using an accelerated method over their estimated useful lives, which range in term from five to fifteen years.

Impairment of Long-Lived Assets

Long-lived assets, primarily property and equipment and finite-lived intangible assets, are reviewed for impairment and the reasonableness of the estimated useful lives whenever events or changes in circumstances indicate that the carrying amounts of the assets may not be recoverable or that a change in useful life may be appropriate. Recoverability for long-lived assets is determined by comparing the forecasted undiscounted cash flows of the operation to which the assets relate to the carrying amount of the assets. If the undiscounted cash flows are less than the carrying amount of the assets, then the Company reduces the carrying value of the assets to estimated fair values, which are primarily based upon forecasted discounted cash flows. Fair value of long-lived assets is determined based on a combination of discounted cash flows and market multiples.

Advanced Billings

Advanced billings represents cash received from customers, or billed amounts per an agreed upon payment schedule, in advance of services being performed or revenue being recognized.

Other Current Liabilities and Other Long-Term Liabilities

Deferred credit represents tax credits recognized initially in conjunction with the Nephrogenex asset acquisition that will be recognized within Income tax provision in proportion to the realization of the deferred tax assets and federal tax credits prospectively.

Asset retirement obligations, to the extent they exist, are recorded at their net present value and accreted to the Company’s estimate of liability at the time the obligation would be required to be satisfied.

Recently Adopted Accounting Standards

In May 2014, the FASB issued ASU No. 2014-09 ‘‘Revenue from Contracts with Customers,’’ (“ASC 606”) to clarify the principles of recognizing revenue and create common revenue recognition guidance between US GAAP and International Financial Reporting Standards. The new standard became effective for the Company in the first quarter of 2018.

Under ASC 606, the majority of the Company’s contracts will have a single performance obligation that is satisfied over time, with revenue recognized based on overall project progress measured as of the financial statement date. This represents a change in the Company’s previous revenue accounting methodology, Accounting Standards Codification Topic 605, Revenue Recognition (“ASC 605”), as a majority of contracts were accounted for under the multiple element arrangement guidance. Under the previous revenue recognition accounting methodology, certain revenue related to reimbursable expenses was presented either as a separate line item within Reimbursable out-of-pocket revenue or net of related expenses within Service revenue, net in the consolidated statements of operations. As a result of having a single performance obligation, the Company accounts for all revenue related to reimbursable expenses on a gross basis within a single revenue line item. Measurement of progress on contracts with customers will generally be based on the input measurement of cost incurred relative to the total expected costs to satisfy the performance obligation.

The Company elected to utilize the modified retrospective implementation method for its transition to ASC 606 as of January 1, 2018 (the “Implementation Date”). Under this implementation method, the Company recognized the cumulative effect of initially applying the ASC 606 revenue recognition guidance to contracts that were not completed at the Implementation Date. At the Implementation Date, the Company elected to reflect the aggregate effect of all contract modifications that occurred before January 1, 2018 in determining the satisfied and unsatisfied performance obligations and determination of the transaction price.

The cumulative effect adjustment was recorded as a reduction to the opening balance of Accumulated deficit in the consolidated balance sheets in the amount of $5.7 million, with offsetting amounts of $23.9 million to Accounts receivable and unbilled, net, $(1.6) million to Deferred income taxes, $35.1 million to Accrued expenses, $(57.4) million to Pre-funded study costs and $38.9 million to Advanced billings, respectively. The amounts recorded to Accounts receivable and unbilled, net, Deferred income taxes, Accrued expenses, Pre-funded study costs, and Advanced billings reflect differences between revenue recognized and billings to customers by project as well as costs incurred but not settled as of the Implementation Date. The above disclosed cumulative effect adjustments have been revised from the amounts previously disclosed in the Company’s interim financial statements filed on Form 10-Q for the quarterly periods ended March 31, 2018, June 30, 2018 and September 30, 2018 to correct certain immaterial misstatements to the opening balance sheet adoption impact of the standard. The effects of these misstatements were immaterial to the Company’s results of operations.

In connection with the implementation of ASC 606 on the modified retrospective method, the Company is presenting additional information to assist with the comparability of select line items of the current and prior period year to date reporting in its consolidated balance sheets and consolidated statements of operations. Below the Company has presented the amount by which each financial statement line item is affected in the current reporting period by the application of ASC 606 as compared with the guidance that was in effect before the change (ASC 605).

	Year Ended December 31, 2018
	As Reported		Adjustments			As Revised under ASC 605
Revenue:
Revenue, net	$	704,589	$	(704,589	)	$	-
Service revenue, net		-		478,063			478,063
Reimbursed out-of-pocket revenue		-		71,305			71,305
Total revenue		704,589		(155,221	)		549,368
Operating expenses:
Direct service costs, excluding depreciation and amortization		252,284		-			252,284
Reimbursed out-of-pocket expenses		236,775		(165,470	)		71,305
Total direct costs		489,059		(165,470	)		323,589
Total operating expenses		603,541		(165,470	)		438,071
Income from operations		101,048		10,249			111,297
Income before income taxes		93,951		10,249			104,200
Income tax provision		20,766		1,882			22,648
Net income	$	73,185	$	8,367		$	81,552
Net income per share attributable to common shareholders:
Basic	$	2.05	$	0.24		$	2.29
Diluted	$	1.97	$	0.23		$	2.20
Weighted average common shares outstanding:
Basic		35,547		-			35,547
Diluted		36,912		-			36,912

ASSETS	As of December 31, 2018
Current assets:	As Reported			Adjustments			As Revised under ASC 605
Accounts receivable and unbilled, net		133,449			(28,729	)		104,720
Prepaid expenses and other current assets		21,383			1,147			22,530
Total current assets		178,114			(27,582	)		150,532
Deferred income taxes		713			(389	)		324
Total assets	$	967,933		$	(27,971	)	$	939,962
LIABILITIES AND SHAREHOLDERS’ EQUITY
Current liabilities:
Accrued expenses		87,493			(51,109	)		36,384
Pre-funded study costs		-			61,156			61,156
Advanced billings		147,935			(41,732	)		106,203
Other current liabilities		4,861			(590	)		4,271
Total current liabilities		257,026			(32,275	)		224,751
Deferred income tax liability		439			2,049			2,488
Other long-term liabilities		16,560			(382	)		16,178
Total liabilities		378,230			(30,608	)		347,622
Shareholders’ equity:
Accumulated deficit		(41,487	)		2,637			(38,850	)
Total shareholders’ equity		589,703			2,637			592,340
Total liabilities and shareholders’ equity	$	967,933		$	(27,971	)	$	939,962

CASH FLOWS FROM OPERATING ACTIVITIES:	Year Ended December 31, 2018
	As Reported			Adjustments			As Revised under ASC 605
Net income		73,185			8,367			81,552
Adjustments to reconcile net income to net cash provided by operating activities:
Deferred income tax provision		3,942			4,002			7,944
Changes in assets and liabilities:
Accounts receivable and unbilled, net		(27,047	)		4,842			(22,205	)
Prepaid expenses and other current assets		(1,241	)		(1,147	)		(2,388	)
Accrued expenses		29,029			(15,967	)		13,062
Pre-funded study costs		-			3,782			3,782
Advanced billings		35,593			(2,907	)		32,686
Other assets and liabilities, net		1,925			(972	)		953
Net cash provided by operating activities		156,584			-			156,584

In February 2016, the FASB issued ASU 2016-02, “Leases (Topic 842)” (“ASC 842”). The guidance in ASC 842 supersedes the lease recognition requirements in ASC Topic 840, Leases (FAS 13) (“ASC 840”). The objective of ASC 842 is to increase transparency and comparability among organizations by requiring the recognition of Right-of-use assets (“ROU assets”) and Lease liabilities on the balance sheet. In addition, ASC 842 introduces additional disclosure requirements that are meant to enable users of the financial statements to assess the amount, timing, and uncertainty of cash flows arising from leases. ASC 842 became effective for the Company in the first quarter of 2019.

ASC 842 allows by policy election, an entity to choose its transition approach. Entities must adopt ASC 842 on a either a modified retrospective basis to each prior reporting period presented or through an optional alternative method referred to as the “Comparatives Under ASC 840 Option” transition approach which allows entities to apply the new requirements to only those leases that exist as of January 1, 2019. The Company has elected to adopt ASC 842 utilizing the Comparatives Under ASC 840 Option. As such, ASC 842 is applied on a prospective basis as of January 1, 2019 and any cumulative catch up adjustment for differences between ASC 842 and ASC 840 were recorded upon adoption.

ASC 842 also allows for the election of certain practical expedients that are meant to ease the burden of transitioning to ASC 842 while still achieving compliance. The Company elected the “package of three” practical expedient allowing the Company to carry forward decisions made and documented under current U.S. GAAP, rather than reassessing all of the Company’s contracts to determine whether they are or contain leases and how they would be classified under ASC 842. The Company has decided not to elect the hindsight practical expedient, which had it been elected, would require the Company to reassess the lease term and assessment of impairment for all of the Company’s leases using the facts and circumstances known up to the adoption date of the standard.

ASC 842 had a material impact on our consolidated balance sheets, as all leases currently classified as operating were recognized as ROU assets and lease liabilities upon adoption. In addition, it was determined that two contracts entered into with a related party for two of the Company’s corporate offices that were classified as deemed assets and deemed liabilities under ASC 840 were determined to be operating leases under ASC 842. These deemed assets and liabilities were reclassified on the consolidated balance sheets to ROU assets and lease liabilities and an adjustment to retained earnings was recorded as a cumulative adjustment for the difference in depreciation expense and operating lease expense as of the date of adoption.

The impact of the adoption of ASC 842 as of January 1, 2019 is as follows:

ASSETS	As of
	January 1, 2019			Adjustments			December 31, 2018
Current assets:
Prepaid expenses and other current assets		21,013			(370	)		21,383
Total current assets		177,744			(370	)		178,114
Property and equipment, net		37,613			(14,642	)		52,255
Operating lease right-of-use assets		51,854			51,854			-
Total assets	$	1,004,775		$	36,842		$	967,933
LIABILITIES AND SHAREHOLDERS’ EQUITY
Current liabilities:
Other current liabilities		10,951			6,090			4,861
Total current liabilities		263,116			6,090			257,026
Operating lease liabilities		45,294			45,294			-
Deemed landlord liability, less current portion		-			(24,484	)		24,484
Deferred income tax liability		3,158			2,719			439
Other long-term liabilities		14,630			(1,930	)		16,560
Total liabilities		405,919			27,689			378,230
Shareholders’ equity:
Accumulated deficit		(32,334	)		9,153			(41,487	)
Total shareholders’ equity		598,856			9,153			589,703
Total liabilities and shareholders’ equity	$	1,004,775		$	36,842		$	967,933

In February 2018, the FASB issued ASU 2018-02, “Income Statement - Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income.” ASU 2018-02 allows for an entity to elect to reclassify the income tax effects on items within accumulated other comprehensive income resulting from U.S. tax reform to retained earnings. The guidance is effective for fiscal years beginning after December 15, 2018 with early adoption permitted, including interim periods within those years. The Company adopted this standard in the first quarter of 2019 and it had no impact on the consolidated financial statements.

In January 2017, the FASB issued ASU 2017-04, “Intangibles- Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment.” ASU 2017-04 simplifies how an entity assesses goodwill for impairment by eliminating Step 2 from the goodwill impairment test. As amended, the goodwill impairment test will consist of comparing the fair value of a reporting unit with its carrying amount. An entity should recognize a goodwill impairment charge for the amount by which the carrying amount exceeds the reporting unit’s fair value. The guidance is effective for fiscal years beginning after December 15, 2019 with early adoption permitted. The Company adopted this standard on a prospective basis in the first quarter of 2019 and it had no impact to the consolidated financial statements.

In June 2016, the FASB issued ASU 2016-13, “Financial Instruments-Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments” intended to provide financial statement users with more decision-useful information about expected credit losses and other commitments to extend credit held by the reporting entity. The standard replaces the incurred loss impairment methodology with one that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to inform credit loss estimates. The guidance is effective for fiscal years beginning after December 15, 2019 with early adoption permitted. The Company adopted this standard in the first quarter of 2020 and it had no material impact to the consolidated financial statements.

Contract Assets and Contract Liabilities

12 Months Ended

Dec. 31, 2020

Revenue From Contract With Customer [Abstract]

Contract Assets and Contract Liabilities

3. CONTRACT ASSETS AND CONTRACT LIABILITIES

Contract assets and liabilities are reflected in the Company’s consolidated balance sheets within the accounts reflected below.

Contract Assets

Accounts receivable represent amounts due from the Company’s customers who are concentrated primarily in the pharmaceutical, biotechnology, and medical device industries. Unbilled represents revenue recognized to date that has not been billed or is not yet contractually billable to the customer. In general, amounts become billable upon the achievement of negotiated contractual events, in accordance with predetermined payment schedules or when a reimbursable expense has been incurred. Amounts classified to unbilled are those billable to customers within one year from the respective balance sheet date.

Accounts receivable and unbilled, net consisted of the following (in thousands):

	As of
	December 31,			December 31,
	2020			2019
Accounts receivable	$	137,912		$	127,877
Unbilled receivables		23,396			28,368
Less: allowance for doubtful accounts		(346	)		(583	)
Total accounts receivable and unbilled, net	$	160,962		$	155,662

Contract Liabilities

Advanced billings represents cash received from customers, or billed amounts per an agreed upon payment schedule, in advance of services being performed or revenue being recognized. During the year ended December 31, 2020, the Company recognized approximately $165.6 million of revenue that was included in the Advanced billings balance at the beginning of the year.

Advanced billings consisted of the following (in thousands):

	As of
	December 31,		December 31,
	2020		2019
Advanced billings	$	255,664	$	192,359

A rollforward of allowance for doubtful account activity is as follows:


	Year Ended December 31,
	2020			2019			2018
Allowance for doubtful accounts - beginning balance	$	(583	)	$	(1,032	)	$	(673	)
Current year provision		(167	)		(263	)		(791	)
Write-offs, recoveries and the effects of foreign currency exchange		404			712			432
Allowance for doubtful accounts - ending balance	$	(346	)	$	(583	)	$	(1,032	)

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI http://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 10
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130556-203045

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 9
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130550-203045

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (e)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 15
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130558-203045

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

+ Details

Property and Equipment, Net

12 Months Ended

Dec. 31, 2020

Property Plant And Equipment [Abstract]

Property and Equipment, Net

4. PROPERTY AND EQUIPMENT, NET

Property and equipment, net consisted of the following at December 31 (in thousands):


	2020			2019
Land	$	2,492		$	1,577
Equipment		24,049			20,225
Furniture, fixtures, and leasehold improvements		61,238			24,624
Computer hardware, software, and phone equipment		18,111			15,958
Buildings		14,309			13,272
Construction-in-progress		3,926			3,265
Property and equipment at cost		124,125			78,921
Less: Accumulated depreciation		(39,108	)		(31,629	)
Property and equipment, net	$	85,017		$	47,292

Depreciation expense was $11.7 million, $8.4 million and $9.2 million for the years ended December 31, 2020, 2019 and 2018, respectively.

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2020

Goodwill And Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

5. GOODWILL AND INTANGIBLE ASSETS

Goodwill

Total assets carried on the balance sheet and not remeasured to fair value on a recurring basis, identified as Level 3 measurements, as of December 31, 2020 are $694.0 million, comprised of $662.4 million of goodwill and $31.6 million of identified indefinite-lived intangible assets. Accumulated goodwill impairment losses to date amounts to $9.3 million, all of which was recognized in 2015.

Intangible Assets, Net

Intangible assets, net consisted of the following at December 31 (in thousands):

	2020			2019
Intangible assets:
Finite-lived intangible assets:
Carrying amount:
Customer relationships	$	145,051		$	145,051
Other		3,074			3,074
Total finite-lived intangible assets		148,125			148,125
Accumulated amortization:
Customer relationships		(130,223	)		(122,426	)
Other		(3,074	)		(2,995	)
Total accumulated amortization		(133,297	)		(125,421	)
Total finite-lived intangible assets, net		14,828			22,704
Trade name (indefinite-lived)		31,646			31,646
Total intangible assets, net	$	46,474		$	54,350

As of December 31, 2020, estimated amortization expense of the Company’s intangible assets for each of the next five years and thereafter is as follows (in thousands):

	Amortization
2021	$	5,114
2022		3,353
2023		2,199
2024		1,443
2025		946
Later years		1,773
	$	14,828

Accrued Expenses

12 Months Ended

Dec. 31, 2020

Payables And Accruals [Abstract]

Accrued Expenses

6. ACCRUED EXPENSES

Accrued expenses consisted of the following at December 31 (in thousands):

	2020		2019
Employee compensation and benefits	$	40,208	$	34,119
Project related reimbursable expenses		87,092		68,696
Other		7,067		6,437
Total accrued expenses	$	134,367	$	109,252

Debt

12 Months Ended

Dec. 31, 2020

Debt Disclosure [Abstract]

Debt

7. DEBT

On September 30, 2019 (the “Closing Date”), the Company obtained an unsecured credit facility in an aggregate principal amount up to $50.0 million (the “Credit Facility”) through its wholly owned subsidiaries, Medpace, Inc., as borrower (the “Borrower”), and Medpace IntermediateCo, Inc., as guarantor (the “Guarantor”).

On the Closing Date, the Borrower and lender entered into a Loan Agreement (the “Loan Agreement”) providing for the Credit Facility, and the Guarantor executed a Guaranty Agreement providing for its guarantee of the payment and performance of the obligations under the Loan Agreement. The Loan Agreement provides that outstanding balances under the Credit Facility will bear interest at a rate of LIBOR plus 100 basis points (1.00%). The Loan Agreement also provides that the Credit Facility will expire in 364 days from the Closing Date. On March 30, 2020, the Company amended the credit facility to extend its expiration date to March 31, 2021 and add provisions for alternative interest rates when certain interbank market offered rates are not available.

The Loan Agreement contains other customary loan terms, representations and warranties, and affirmative and negative covenants, in each case, subject to customary limitations, exceptions and exclusions. The Loan Agreement contains certain events of default, including, among others, non-payment of principal or interest and breach of the covenants.

As of December 31, 2020 and 2019, respectively, there were no outstanding borrowings under the Credit Facility and $0.2 million in letters of credit outstanding related to certain operating lease obligations, which are secured by the Credit Facility.

Leases

12 Months Ended

Dec. 31, 2020

Leases [Abstract]

Leases

8. LEASES

The Company enters into leases for real estate and equipment. Real estate leases are for our corporate office space and laboratories around the world. Real estate leases have remaining lease terms of less than one year to 20 years. Many of the Company’s leases include options to extend the leases on a month to month basis or for set periods for up to 20 years. Many leases also include options to terminate the leases within one year or per other contractual terms.

The components of lease expense were as follows (in thousands):

	Year Ended December 31,
	2020		2019
Operating lease cost	$	19,842	$	13,151
Variable lease cost		5,335		2,813

Supplemental cash flow information related to the leases was as follows (in thousands):

	Year Ended December 31,
	2020		2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	13,956	$	9,773

Right-of-use assets obtained in exchange for lease obligations:
Operating leases		73,905		10,294

Supplemental balance sheet information related to the leases was as follows (in thousands):

	As of
	December 31,			December 31,
	2020			2019
Operating lease right-of-use assets	$	113,809		$	52,152

Other current liabilities	$	15,890		$	10,977
Operating lease liabilities		115,143			45,212
Total operating lease liabilities	$	131,033		$	56,189

Weighted Average Remaining Lease Term (years)
Operating leases	12.9			6.3
Weighted Average Discount Rate
Operating leases		5.9	%		6.0	%

Lease payments due related to lease liabilities as of December 31, 2020 were as follows (in thousands):

	Related Party			Non-Related Parties			Total
	Operating Leases			Operating Leases			Operating Leases
2021	$	10,510		$	11,905		$	22,415
2022		10,301			8,960			19,261
2023		8,771			7,477			16,248
2024		8,900			5,206			14,106
2025		9,032			3,746			12,778
Later years		103,006			8,657			111,663
Total lease payments		150,520			45,951			196,471
Less: imputed interest		(59,799	)		(5,639	)		(65,438	)
Total	$	90,721		$	40,312		$	131,033

Comparative period disclosures under ASC 840:

Rental expense under operating leases totaled $9.2 million for the year ended December 31, 2018 and is allocated between Total direct costs, and Selling, general and administrative in the consolidated statements of operations.

Shareholders' Equity

12 Months Ended

Dec. 31, 2020

Equity [Abstract]

Shareholders' Equity

9. SHAREHOLDERS’ EQUITY

Stock-Based Compensation

2016 Incentive Award Plan

On August 11, 2016 in connection with the Company's IPO, the Board approved the formation of the 2016 Incentive Award Plan (the “2016 Plan”), which replaced our 2014 Equity Incentive Plan (the “2014 Plan”). The 2016 Plan provides for long-term equity incentive compensation for key employees, officers and non-employee directors. A variety of discretionary awards (collectively, the “Awards”) for employees and non-employee directors are authorized under the 2016 Plan, including vested shares, stock options, stock appreciation rights (“SARs”), restricted stock awards (“RSAs”), restricted stock units (“RSUs”), or other cash based or stock dividend equivalent awards, which are all equity-classified instruments under the 2016 Plan. The number of shares registered and available for grant under the 2016 Plan is 6,000,000. The vesting of such awards may be conditioned upon either a specified period of time or the attainment of specific performance goals as determined by the administrator of the 2016 Plan. The option price and term are also subject to determination by the administrator with respect to each grant. Option prices are generally expected to be set at the market price of the Company’s common stock at the date of grant and option terms are not expected to exceed ten years.

The Company granted 405,237 awards to employees under the 2016 Incentive Award Plan during the year ended December 31, 2020, consisting of 20,724 restricted stock awards (“RSA”) and 177,808 restricted stock units (“RSU”) vesting after four years, 4,800 stock option awards and 2,500 RSU vesting after three years and 199,405 fully-vested stock option awards. The Company granted an additional 23,148 stock option awards to non-employee directors under the 2016 Incentive Award Plan, during the year ended December 31, 2020. These awards will vest on the earlier of (a) the day immediately preceding the date of the first annual meeting following the date of grant and (b) the first anniversary of the date of grant, subject to the non-employee director continuing in service through the applicable vesting date.

The Company granted 816,286 awards to employees under the 2016 Incentive Award Plan during the year ended December 31, 2019, consisting of 10,000 stock option awards and 227,610 RSU vesting after four years, 5,000 stock option awards vesting after one year, 551,676 fully-vested stock option awards and 22,000 stock option awards with vesting in twelve equal monthly installments beginning on March 31, 2019. The Company granted an additional 41,853 stock option awards to non-employee directors under the 2016 Incentive Award Plan, during the year ended December 31, 2019. These awards will vest on the earlier of (a) the day immediately preceding the date of the first annual meeting following the date of grant and (b) the first anniversary of the date of grant, subject to the non-employee director continuing in service through the applicable vesting date.

The Company granted 850,700 awards to employees under the 2016 Plan during the year ended December 31, 2018, consisting of 550,500 stock option awards and 300,200 RSU, all vesting after four years. The Company granted an additional 33,801 stock option awards to non-employee directors under the 2016 Incentive Award Plan, during the year ended December 31, 2018. These awards will vest on the earlier of (a) the day immediately preceding the date of the first annual meeting following the date of grant and (b) the first anniversary of the date of grant, subject to the non-employee director continuing in service through the applicable vesting date.

The 2016 Plan expires in 2026, except for awards then outstanding, and is administered by the Board. All Awards granted at the IPO or thereafter were or will be issued under the 2016 Plan.

The company satisfies stock option exercises and vested stock awards with treasury shares or newly issued shares. Shares available for future stock compensation grants under the 2016 Plan totaled 2.9 million and 3.2 million at December 31, 2020 and 2019.

2014 Equity Incentive Plan

The 2014 Plan for employees and directors provided the issuance of vested shares, stock options, RSAs and RSUs in Medpace Holdings, Inc.’s common stock. The awards were granted to key employees as additional compensation for services rendered and as a means of retention over the vesting period, typically three to four years. RSAs awarded under the 2014 Plan were subject to automatic forfeiture upon departure until vested and entitle the shareholder to all rights of common stock ownership except that they may not be sold, transferred, pledged or otherwise disposed of during the restriction period, except as noted in the following paragraph. The 2014 Plan allowed for the issuance of non-qualified stock options to employees, officers, and directors under this plan (collectively, “the Participants”). Under the 2014 Plan, options could be granted with an exercise price equal to or greater than the fair value of common stock at the grant date as determined by the Board of Directors. The stock options, if unexercised, expired seven years from the date of grant. The awards under the 2014 Plan were equity classified instruments for all periods presented.

In the third quarter of 2019, Medpace Investors, LLC (“MPI”), a related party to the Company, filed a Tender Offer Statement (“Tender Offer”) offering to purchase, for cash, vested stock options of employee holders of options outstanding from the 2014 Incentive Award Plan. The Tender Offer resulted in the tender and purchase of 229,431 vested options from employee holders of options by MPI. Under generally accepted accounting guidance governing such transactions, because the Tender Offer was made by an economic interest holder in the Company, this transaction is accounted for as a settlement of vested options and a reissuance of options at fair value as of the transaction date. Expense related to the reissuance of options to MPI is included as stock-based compensation expense of $5.1 million within Selling, general and administrative expenses during the year ended December 31, 2019.

Equity Awards

Valuation Assumptions

The Company determines the fair value of stock options using the Black-Scholes-Merton option pricing model (the “BSM Model”). The BSM Model is primarily affected by the fair value of the Company’s common stock (see restricted share valuation discussion below), the expected holding period for the option, expected stock price volatility over the term of the awards, the risk-free interest rate, and expected dividends.

The following table sets forth the key weighted-average assumptions used in the BSM Model to calculate the fair value of options:



	Year Ended December 31,
	2020		2019		2018
Expected holding period – years	3.1		2.6		5.4
Expected volatility	31.0%		26.3%		27.0%
Risk-free interest rate	1.0%		2.0%		2.8%
Expected dividend yield		0.0%		0.0%		0.0%

The assumptions used in the table above reflect grant date inputs to arrive at the grant date fair values for stock options subject to equity-classified stock compensation accounting.

The expected holding period represents the period of time the grants are expected to be outstanding. The Company uses the simplified method, as prescribed by accounting guidance governing such awards, to calculate the expected holding period for options granted to employees as we do not have sufficient historical evidence data to provide a reasonable basis upon which to estimate the expected holding period. For options valued by the Company for the years ended December 31, 2020, 2019 and 2018, respectively, the expected holding period is based on an average between the midpoint of the vesting date and the expiration date of the options.

The Company estimates expected volatility primarily by using the historical volatility of a publicly traded peer group that operates in the clinical research and development industry. The Company does not have adequate history to calculate its own historical or implied volatility and believes the Company’s expected volatility will approximate the historical experience of the peer group.

The risk-free interest rate is based on the yield on U.S. Treasury obligations with remaining durations equal to the expected holding period of the options. The expected dividend yield is assumed to be zero based on recent and anticipated dividend activity.

Subsequent to the Company’s Initial Public Offering (IPO) in August 2016, the fair value of common stock is based upon the market price of the Company’s common stock on the date of grant as listed on the NASDAQ. Due to the absence of an active market for the Company’s common stock prior to the IPO, the Company determined the fair value of restricted shares by obtaining an independent valuation of the fair value of the Company’s equity, applying a discount for lack of marketability, and then calculating the implied share price. The fair value of the Company was estimated primarily using an income approach which is based on assumptions and estimates made by management and, secondarily, using other market-related factors in current industry trends as well as observed transaction values. In determining the estimated future cash flows used in the income approach, the Company developed and applied certain estimates and judgments, including current and projected future levels of income based on management’s plans, business trends, prospects and market and economic conditions, including market-participant considerations. Significant assumptions utilized in the income approach were based on company specific information and projections, which were not observable in the market and are thus considered Level 3 measurements by authoritative guidance. The discount for lack of marketability (the “Marketability Discount”) was applied to reflect what a market participant would consider in relation to the post-vesting restrictions imposed regarding the inability to sell, transfer, or pledge the shares during the restriction period. The Marketability Discount was estimated by using the BSM Model to calculate the cost of a theoretical put option to hedge the fluctuation in value of the investment between the valuation date and an anticipated liquidity date.

The following table summarizes the grant date fair values of stock options and restricted shares issued during the period as well as the allocation of stock-based compensation expense to Total direct costs, and Selling, general and administrative reported in the consolidated statements of operations:



	Year Ended December 31,
	2020		2019		2018
Weighted average, grant date fair value
Stock options	$	15.19	$	14.06	$	11.51
Restricted shares (RSAs and RSUs)	$	98.61	$	60.53	$	49.38

Stock-based compensation expense allocated to:
Total direct costs	$	7,781	$	6,999	$	4,132
Selling, general, and administrative		6,003		13,742		2,367
Total stock-based compensation expense	$	13,784	$	20,741	$	6,499

Award Activity

The following table sets forth the Company’s stock option activity:


	Year Ended December 31,
	2020						2019							2018
				Weighted Average							Weighted Average							Weighted Average
	Options			Exercise Price		Options				Exercise Price			Options				Exercise Price
Outstanding - beginning of Period		3,030,071		$	34.50			2,945,040			$	24.18			2,782,868			$	20.73
Granted		227,353		$	105.77			859,960			$	54.97			584,301			$	37.72
Exercised		(637,806	)	$	25.07			(399,368	)		$	16.19			(169,771	)		$	14.98
Forfeited/Expired		(118,891	)	$	37.16			(375,561	)		$	19.91			(252,358	)		$	23.69
Outstanding - end of period		2,500,727		$	43.26			3,030,071			$	34.50			2,945,040			$	24.18

Exercisable - end of period		1,498,829		$	48.99			1,435,088			$	38.62			1,096,116			$	16.01

The following table sets forth the Company’s Restricted Share activity:



	Year Ended December 31,
	2020			2019			2018
	Shares/Units			Shares/Units			Shares/Units
Outstanding and unvested - beginning of period		569,770			421,200			183,629
Granted		201,032			227,610			300,200
Vested		-			-			(29,629	)
Forfeited		(75,240	)		(79,040	)		(33,000	)
Outstanding and unvested - end of period		695,562			569,770			421,200

Cumulative vested shares - end of period		1,913,916			1,913,916			1,913,916

The following table summarizes information about stock options expected to vest, stock options exercisable, and unvested restricted share awards expected to vest at December 31, 2020:

	Weighted Average						Weighted Average
	Exercise		Stock		Restricted		Remaining
	Price		Options		Shares		Life (Years)
December 31, 2020
Number of stock options expected to vest	$	43.26		2,500,727		-		3.4
Number of Restricted Shares expected to vest				-		695,562
Total expected to vest - December 31, 2020				2,500,727		695,562
Total stock options exercisable - December 31, 2020	$	48.99		1,498,829				3.1
Unrecognized compensation cost - December 31, 2020 (in thousands)			$	2,487	$	26,760
Weighted average years over which unrecognized compensation cost will be recognized				1.3		2.9

The following table sets forth the aggregate intrinsic value of stock options exercised, the fair values of awards vested, and share based liabilities settled during the respective periods (in thousands):



	Year Ended December 31,
	2020		2019		2018
Total intrinsic value of stock options exercised	$	57,927	$	19,807	$	5,326
Total grant-date fair value of stock options vested	$	6,833	$	12,117	$	1,417
Total grant-date fair value of restricted shares vested	$	-	$	-	$	447
Total settlement date fair value of restricted shares vested	$	-	$	-	$	1,568

The actual tax benefits recognized related to stock-based compensation totaled $11.7 million, $5.5 million and $1.0 million for the years ended December 31, 2020, 2019 and 2018, respectively.

Employee Benefit Plans

12 Months Ended

Dec. 31, 2020

Employee Benefit Plans

10. EMPLOYEE BENEFIT PLANS

The Company provides a 401(k) plan that covers substantially all U.S. employees. Participants can elect to contribute up to 50% of their eligible earnings on a pre-tax basis, subject to Internal Revenue Service annual limitations.

The U.S.-based plan offers a year-end employer matching contribution, requiring the participant to be an employee at year-end to qualify for the match. Participants with one year or more of service are eligible for the matching contribution. Participants fully vest in the employer contributions after three years of service. The employer contribution represents a percentage of a participant’s eligible compensation. The Company’s 401(k) Plan costs were $3.7 million, $3.1 million and $2.7 million during the years ended December 31, 2020, 2019 and 2018, respectively, and were allocated between Total direct costs, and Selling, general and administrative in the consolidated statements of operations.

The Company has various defined contribution arrangements for eligible employees of non-U.S. entities. These defined contribution arrangements provide employees with retirement savings and life insurance benefits. The Company incurred expenses related to these arrangements of $1.5 million, $1.2 million and $1.0 million in the years ended December 31, 2020, 2019 and 2018, respectively, and were allocated between Total direct costs, and Selling, general and administrative in the consolidated statements of operations.

The Company is also required to pay certain minimum statutory post-employment benefits. The Company recognizes a liability and the associated expense for these benefits when it is probable that employees are entitled to the benefit.

Income Taxes

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Income Taxes

11. INCOME TAXES

The Company files income tax returns for U.S. federal and various U.S. states, as well as various foreign jurisdictions. The liabilities for unrecognized tax benefits are carried in Other long-term liabilities on the consolidated balance sheets because the payment of cash is not anticipated within one year of the balance sheet date.

The components of income before income taxes consisted of the following (in thousands):



	Year Ended December 31,
	2020		2019		2018
Domestic	$	158,432	$	117,326	$	88,014
Foreign jurisdictions		10,100		7,506		5,937
Income before income taxes	$	168,532	$	124,832	$	93,951

Income tax provision consisted of the following (in thousands):

	Current		Deferred			Total
Year ended December 31, 2020
U.S. Federal	$	16,405	$	436		$	16,841
U.S. state and local		4,588		95			4,683
Foreign jurisdictions		1,586		38			1,624
	$	22,579	$	569		$	23,148

Year ended December 31, 2019
U.S. Federal	$	10,577	$	8,922		$	19,499
U.S. state and local		1,761		987			2,748
Foreign jurisdictions		2,023		119			2,142
	$	14,361	$	10,028		$	24,389

Year ended December 31, 2018
U.S. Federal	$	13,372	$	4,172		$	17,544
U.S. state and local		1,912		(116	)		1,796
Foreign jurisdictions		1,408		18			1,426
	$	16,692	$	4,074		$	20,766

The difference between the statutory rate for federal income tax and the effective income tax rate was as follows (in thousands):



	Year Ended December 31,
	2020					2019					2018
Income tax expense calculated at the federal statutory rate	$	35,392		21.0	%	$	26,215		21.0	%	$	19,730		21.0	%
Effect of:
State and local taxes, net of federal benefit		2,639		1.6			2,021		1.6			1,978		2.1
Tax on foreign earnings, net of tax credits and deductions		(1,773	)	(1.1	)		593		0.4			172		0.2
Tax reform adjustment		-		-			-		-			(195	)	(0.2	)
Write off of Deferred Tax Assets		-		-			-		-			509		0.6
Deferred credit		(700	)	(0.4	)		(802	)	(0.6	)		(802	)	(0.9	)
Permanent items:
Stock-based awards		(10,019	)	(5.9	)		(3,011	)	(2.4	)		(651	)	(0.7	)
Tax reform		-		-			-		-			126		0.1
Deduction for FDII		(2,593	)	(1.5	)		(2,283	)	(1.8	)		-		-
Other		144		0.1			964		0.8			687		0.7
State/Local tax credits		(780	)	(0.5	)		(793	)	(0.6	)		(1,253	)	(1.3	)
Foreign tax credits		-		-			-		-			(727	)	(0.8	)
Change in liability for uncertain tax positions		1,120		0.7			1,325		1.0			1,102		1.2
Other		(282	)	(0.3	)		160		0.1			90		0.1
	$	23,148		13.7	%	$	24,389		19.5	%	$	20,766		22.1	%

Prior to the passage of the “Tax Cuts and Jobs Act” (TCJA), the Company asserted that all of the undistributed foreign earnings of its foreign subsidiaries were considered indefinitely reinvested and accordingly, no deferred taxes were provided. Beginning in 2018, the TCJA provides a 100% deduction for dividends received from 10-percent owned foreign corporations by U.S. corporate shareholders, subject to a one-year holding period. Although dividend income is now exempt from U.S. federal tax in the hands of the U.S. corporate shareholders, companies must still apply the guidance of ASC 740-30-25-18 to account for the tax consequences of outside basis differences and other tax impacts of their investments in non-U.S. subsidiaries. As of December 31, 2020, the Company’s accounting position is that unremitted foreign earnings are indefinitely reinvested. Therefore, the Company has not recorded deferred foreign withholding taxes on the unremitted foreign earnings and it is not practicable to determine the amount of the additional taxes that would result if these earnings were repatriated. The undistributed earnings of foreign subsidiaries was approximately $27.8 million.

Components of the Company’s net deferred tax asset (liability) included in the consolidated balance sheets consisted of the following at December 31 (in thousands):


	2020			2019
Deferred tax assets:
Accrued liabilities	$	16,634		$	12,229
Depreciation and amortization		881			1,121
Foreign operating loss carryforward		311			447
U.S. state and local tax credits and carryforward		-			184
Other		246			96
Valuation allowance		(578	)		(755	)
Total deferred tax assets		17,494			13,322

Deferred tax liabilities:
Depreciation and amortization		(26,119	)		(21,787	)
Prepaid expenses		(829	)		(808	)
Advanced billings		(3,513	)		(3,147	)
Other		(48	)		(53	)
Total deferred tax liabilities		(30,509	)		(25,795	)
Net deferred tax liability	$	(13,015	)	$	(12,473	)

The Company has foreign operating loss carryforwards for which a deferred tax asset of $0.3 million has been established. The Company has a valuation allowance of $0.3 million against this deferred tax asset based upon its assessment that it is more likely than not that this amount will not be realized. The ultimate realization of this tax benefit is dependent upon the generation of sufficient operating income in the respective tax jurisdictions. Approximately 12% of the foreign net operating loss carryforwards can be utilized over an indefinite period whereas the remainder will expire at various times from 2023 to 2029 if not utilized.

Annual activity related to the Company’s valuation allowance is as follows (in thousands):



	Year Ended December 31,
	2020			2019			2018
Beginning Balance	$	755		$	169		$	2,394
Additions charged to expense		-			375			-
Additions due to asset acquisition		-			265			-
Reductions from utilization, reassessments and expirations		(177	)		(54	)		(2,225	)
Ending Balance	$	578		$	755		$	169

A reconciliation of the beginning and ending balances of the total amounts of gross unrecognized tax benefits is as follows (in thousands):



	Year Ended December 31,
	2020			2019			2018
Beginning Balance	$	9,718		$	8,525		$	6,890
Increases in tax positions for prior years		-			-			-
Decreases in tax positions for prior years		(181	)		(888	)		(579	)
Increases in tax positions for current year		2,881			2,081			2,214
Lapse in statute of limitations		(1,727	)		-			-
Ending Balance	$	10,691		$	9,718		$	8,525

Interest and penalties associated with uncertain tax positions are recognized as components of Income tax provision in the consolidated statements of operations. There was no material change to tax-related interest and penalties during the years ended December 31, 2020, 2019 and 2018. As of December 31, 2020 and 2019, respectively, the Company has a liability for interest and penalties of $2.1 million and $1.4 million that is associated with related tax liabilities of $8.6 million and $8.2 million for uncertain tax positions.

The Company operates in various foreign, state and local jurisdictions. The number of tax years for which the statute of limitations remains open for foreign, state and local jurisdictions varies by jurisdiction and is approximately four years (2016 through 2020). For federal tax purposes, the Company’s open tax years are 2017 through 2020.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References + Details

Commitments, Contingencies, and Guarantees

12 Months Ended

Dec. 31, 2020

Commitments And Contingencies Disclosure [Abstract]

Commitments, Contingencies, and Guarantees

12. COMMITMENTS, CONTINGENCIES, AND GUARANTEES

Legal Proceedings

Medpace periodically becomes involved in various claims and lawsuits that are incidental to its business. Management believes, after consultation with counsel, that no matters currently pending would, in the event of an adverse outcome, have a material impact on the Company’s consolidated balance sheets, statements of operations, or cash flows for the years ended December 31, 2020, 2019 and 2018.

Purchase Commitments

The Company has several minimum purchase commitments for project related supplies totaling $12.5 million as of December 31, 2020. In return for the commitment, Medpace receives preferential pricing. The commitments expire at various times through 2027.

Miscellaneous Income (Expense), Net

12 Months Ended

Dec. 31, 2020

Other Income And Expenses [Abstract]

Miscellaneous Income (Expense), Net

13. MISCELLANEOUS INCOME (EXPENSE), NET

Miscellaneous income (expense), net consisted of the following (in thousands):



	Year Ended December 31,
	2020		2019			2018
Net gain (loss) on foreign-currency transactions	$	514	$	(581	)	$	386
Other income (expense)		669		(282	)		674
Miscellaneous income (expense), net	$	1,183	$	(863	)	$	1,060

Related Party Transactions

12 Months Ended

Dec. 31, 2020

Related Party Transactions

14. RELATED PARTY TRANSACTIONS

Employee Loans

The Company periodically extends short term loans or advances to employees, typically upon commencement of employment. Total receivables as a result of these employee advances of $0.2 million existed at December 31, 2020

and 2019, respectively, and are included in the Prepaid expenses and other current assets and Other assets line items of the consolidated balance sheets, respectively, depending on the contractual repayment date.

Director Fees

The Company paid fees for director services provided by Cinven employees that were members of the Company’s Board of Directors and any related committees. The director fees were paid directly to Cinven in accordance with the Company’s non-employee director compensation policy. During the third quarter of 2018, Cinven sold its remaining shares of the Company’s common stock and all three members of the Company’s Board affiliated with Cinven subsequently resigned. During the year ended December 31, 2018, the Company incurred director fees of $0.1 million and related travel expenses of less than $0.1 million.

Service Agreements

Cymabay Therapeutics, Inc. (“Cymabay”)

Cymabay is a clinical-stage biopharmaceutical company developing therapies to treat metabolic diseases with high unmet medical need, including serious rare and orphan disorders. A Medpace employee was a member Cymabay’s board of directors from the first quarter of 2016 until his resignation in the first quarter of 2020. The Company and Cymabay entered into a Master Service Agreement (“MSA”) dated October 21, 2016. Subsequently, the Company and Cymabay have entered into several task orders for the Company to perform clinical trial related services. The Company recognized total revenue from Cymabay of $13.2 million and $10.8 million during the years ended December 31, 2019 and 2018, respectively, in the Company’s consolidated statements of operations. As of December 31, 2019, the Company had Advanced billings from Cymabay of $1.6 million recorded in the consolidated balance sheets. In addition, as of December 31, 2019, the Company had Accounts receivable and unbilled, net from Cymabay of $1.4 million recorded in the consolidated balance sheets. As of the first quarter of 2020, Cymabay is no longer considered a related party.

LIB Therapeutics LLC and subsidiaries (“LIB”)

Certain executives and employees of the Company, including the chief executive officer, are members of LIB’s board of managers and/or have equity investments in LIB. The Company entered into a MSA dated November 24, 2015 with LIB, a company that engages in research, development, marketing and commercialization of pharmaceutical drugs. Subsequently, the Company and LIB have entered into several task orders for the Company to perform clinical trial related services. The Company recognized total revenue from LIB of $2.6 million, $2.0 million and $3.7 million during the years ended December 31, 2020, 2019 and 2018 in the Company’s consolidated statement of operations. As of December 31, 2020 and 2019, the Company had, from LIB, Advanced billings of $0.7 million and $0.5 million in the consolidated balance sheets, respectively. In addition, the Company had Accounts receivable and unbilled, net from LIB of $0.3 million in the consolidated balance sheets at December 31, 2020 and 2019, respectively.

CinRX Pharma and subsidiaries (“CinRx”)

Certain executives and employees of the Company, including the chief executive officer, are members of CinRx’s board of managers and/or have equity investments in CinRx, a biotech company. The Company and CinRx have entered into several task orders for the Company to perform clinical trial related services. During the years ended December 31, 2020, 2019 and 2018, the Company recognized total revenue from CinRx of $13.2 million, $3.7 million and $0.5 million in the Company’s consolidated statements of operations. As of December 31, 2020 and 2019, the Company had Advanced billings from CinRx of $5.8 million and $0.9 million in the consolidated balance sheets, respectively. As of December 31, 2020 and 2019 the Company had Accounts receivable and unbilled, net from CinRx of $2.2 million and $0.2 million in the consolidated balance sheets.

The Summit Hotel (“The Summit”)

The Summit Hotel, located on the Medpace campus, is owned by the chief executive officer, and managed by an unrelated hospitality management entity. Medpace incurs travel lodging and meeting expenses at The Summit. During the years ended December 31, 2020, 2019 and 2018, Medpace incurred expenses of $0.4 million, $0.6 million and $0.4 million at The Summit.

Medpace Investors, LLC (“MPI”)

MPI is a noncontrolling shareholder and related party of Medpace Holdings, Inc. MPI is owned and managed by employees of the Company. The chief executive officer of Medpace is also the manager and majority unit holder of MPI. The Company acted as a paying agent for MPI with taxing authorities principally in instances when employee tax payments or remittance of withholdings related to equity compensation are required. Refer to Note 9 of the Notes to Consolidated Financial Statements for details of the Tender Offer transaction.

Leased Real Estate

Headquarters Lease

The Company has entered into operating leases for its corporate headquarters and a storage space facility with an entity that is wholly owned by the Company’s chief executive officer. The Company has evaluated its relationship with the related party and concluded that the related party is not a variable interest entity because the Company has no direct ownership interest or relationship other than the leases. The lease for headquarters is for an initial term of twelve years through November 2022 with a renewal option for one 10-year term at prevailing market rates. The Company pays rent, taxes, insurance, and maintenance expenses that arise from the use of the properties. Annual base rent for the corporate headquarters allows for adjustments to the rental rate annually for increases in the consumer price index. Operating lease cost recognized for the years ended December 31, 2020 and 2019 was $2.0 million, respectively, and was allocated between Direct service costs, excluding depreciation and amortization, and Selling, general and administrative in the consolidated statements of operations. The Operating lease right-of-use assets at December 31, 2020 and 2019 were $3.5 million and $5.3 million in the consolidated balance sheets. The current and long-term portions of the lease liabilities at December 31, 2020 were $1.9 million and $1.6 million, respectively, and were recognized in Other current liabilities and Operating lease liabilities in the consolidated balance sheets. The current and long-term portions of the lease liabilities at December 31, 2019 were $1.8 million and $3.5 million, respectively, and were recognized in Other current liabilities and Operating lease liabilities in the consolidated balance sheets. Under ASC 840, lease expense recognized for the years ended December 31, 2018 was $2.2 million and was allocated between Direct service costs, excluding depreciation and amortization, and Selling, general and administrative in the consolidated statements of operations.

In 2018, Medpace, Inc. entered into a multi-year lease agreement governing future occupancy of additional office space in Cincinnati, Ohio with an entity that is wholly owned by the Company’s chief executive officer and certain members of his immediate family. The Company began to occupy the premises in the second quarter of fiscal year 2020. The lease expires in 2040 and the Company has two 10-year options to extend the term of the lease. The Company pays rent, taxes, insurance, and maintenance expenses that arise from the use of the property. Annual base rent for the corporate headquarters allows for adjustments to the rental rate annually for increases in the consumer price index. The Company has determined that the lease is an operating lease. Operating lease cost recognized for the year ended December 31, 2020 was $3.6 million. The operating lease cost was allocated between Total direct costs and Selling, general and administrative in the consolidated statements of operations. The Operating lease right-of-use assets at December 31, 2020 were $56.6 million in the consolidated balance sheets. The current and long-term portions of the lease liabilities at December 31, 2020 were $0.7 million and $66.8 million, respectively and were recognized in Other current liabilities and Operating lease liabilities in the consolidated balance sheets.

The Company entered into two multi-year lease agreements governing the occupancy of space of two buildings in Cincinnati, Ohio with an entity that is wholly owned by the Company’s chief executive officer and certain members of his immediate family. The Company assumed occupancy in 2012 and the leases expire in 2027 with the Company having one 10-year option to extend the lease term. The Company pays rent, taxes, insurance, and maintenance expenses that arise from the use of the property. Annual base rent for the corporate headquarters allows for adjustments to the rental rate annually for increases in the consumer price index. The Company has determined that the leases are operating leases. Operating lease cost recognized for the years ended December 31, 2020 and 2019 was $3.6 million, respectively. The lease cost was allocated between Total direct costs and Selling, general and

administrative in the consolidated statements of operations. The Operating lease right-of-use assets at December 31, 2020 and 2019 were $19.7 million and $21.9 million, respectively, in the consolidated balance sheets. The current and long-term portions of the lease liabilities at December 31, 2020 were $2.4 million and $17.2 million, respectively, and were recognized in Other current liabilities and Operating lease liabilities in the consolidated balance sheets. The current and long-term portions of the lease liabilities at December 31, 2019 were $2.3 million and $19.7 million, respectively, and were recognized in Other current liabilities and Operating lease liabilities in the consolidated balance sheets.

ASC 840 - Deemed Assets and Deemed Landlord Liabilities

The Company paid $3.8 million during the year ended December 31, 2018 related to leases recognized as deemed assets and deemed landlord liabilities under ASC 840.

Travel Services

The Company incurs expenses for travel services for company executives provided by a private aviation charter company that is owned by the chief executive officer and the executive vice president of operations of the Company (“private aviation charter”). The Company may contract directly with the private aviation charter for the use of its aircraft or indirectly through a third party aircraft management and jet charter company (the “Aircraft Management Company”). The travel services provided are primarily for business purposes, with certain personal travel paid for as part of the executives’ compensation arrangements. The Aircraft Management Company also makes the private aviation charter aircraft available to third parties. The Company incurred travel expenses of $0.7 million, $1.2 million and $1.3 million during the years ended December 31, 2020, 2019 and 2018, respectively. These travel expenses are recorded in Selling, general and administrative in the Company’s consolidated statements of operations.

Entity Wide Disclosures

12 Months Ended

Dec. 31, 2020

Entity Wide Disclosures [Abstract]

Entity Wide Disclosures

15. ENTITY WIDE DISCLOSURES

Operations By Geographic Location

The Company conducts operations in North America, Europe, Africa, Asia-Pacific and Latin America through wholly-owned subsidiaries and representative sales offices. The Company attributes revenue to geographical locations based upon the location of the contracting entity. For the years ended December 31, 2020, 2019 and 2018, total revenue attributable to the U.S. represented approximately 96%, 95% and 97%, respectively, of total consolidated total revenue.

The following table summarizes property and equipment, net by geographic region and is further broken down to show countries which account for 10% or more of total as of December 31, if any (in thousands):


	2020		2019
Property and equipment, net:
United States	$	58,124	$	25,603
Europe
Belgium		12,024		10,045
Other		7,961		5,728
Total Europe		19,985		15,773
Asia-Pacific		6,566		5,671
Other		342		245
Total property and equipment, net	$	85,017	$	47,292

Revenue by Category

The following table disaggregates the Company’s revenue by major source (in thousands):

	Years Ended December 31,
	2020		2019		2018
Therapeutic Area
Oncology	$	297,675	$	256,766	$	189,056
Other		215,370		196,159		163,983
Metabolic		126,075		138,650		124,837
AVAI		103,259		86,390		77,271
Cardiology		95,153		91,258		95,213
Central Nervous System		88,393		91,746		54,229
Total revenue	$	925,925	$	860,969	$	704,589

In the current year and for all periods presented, the revenue associated with medical device projects, previously a separate therapeutic area, has been included in the respective therapeutic area that best aligns with the therapeutic focus of the medical device project and represents how management evaluates disaggregated revenue in its internal reporting.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Share Repurchases

Secondary Offerings

Secondary Offering

Principles of Consolidation and Presentation

Contract Assumptions

The Company records revenue net of any tax assessments by governmental authorities that are imposed and concurrent with specific revenue generating transactions.

Performance Obligations

As of December 31, 2020 and 2019, the Company had approximately $1.6 billion and $1.4 billion of performance obligations remaining to be performed for active projects.

Concentration of Credit Risk

Costs and Expenses

Income Taxes

The Company’s consolidated US federal income tax return is comprised of its US subsidiaries, one of its foreign branches located in Korea and certain foreign subsidiaries.

Research and Development Credits

Stock-Based Compensation

The Company has stock-based employee compensation plans for which it incurs compensation expense.

Equity Awards

Net Income Per Share

The following table sets forth the computation of basic and diluted earnings per share for the years ended December 31, 2020, 2019 and 2018 (in thousands, except for earnings per share):



	Year Ended December 31,
	2020		2019		2018
Weighted-average shares:
Common shares outstanding		35,635		35,881		35,547
RSAs		112		100		142
Total weighted-average shares		35,747		35,981		35,689
Earnings per common share—Basic
Net income	$	145,384	$	100,443	$	73,185
Less: Undistributed earnings allocated to RSAs		459		279		291
Net income available to common shareholders—Basic	$	144,925	$	100,164	$	72,894

Net income per common share—Basic	$	4.07	$	2.79	$	2.05

Basic weighted-average common shares outstanding		35,635		35,881		35,547
Effect of diluted shares		2,073		1,695		1,365
Diluted weighted-average shares outstanding		37,708		37,576		36,912

Net income per common share—Diluted	$	3.84	$	2.67	$	1.97

Fair Value Measurements

Level 1: Valuations based on quoted prices in active markets for identical assets or liabilities.

Level 2: Valuations based on directly observable inputs or unobservable inputs corroborated by market data.

Cash and Cash Equivalents, including Restricted Cash

Accounts Receivable and Unbilled, Net

Inventory

Property and Equipment

Leases

Lease terms may include options to extend or terminate the lease when it is reasonably certain that the Company will exercise that option as determined at lease commencement.

Many of our lease agreements have both lease and non-lease components, which the Company has elected to treat as a single lease component for recognition purposes.

Goodwill and Intangible Assets

Goodwill

are identified, at the reporting unit level. The reporting units are Phase I-IV clinical research services and Laboratories as of December 31, 2020.

Intangible Assets

Impairment of Long-Lived Assets

Advanced Billings

Advanced billings represents cash received from customers, or billed amounts per an agreed upon payment schedule, in advance of services being performed or revenue being recognized.

Other Current Liabilities and Other Long-Term Liabilities

Recently Adopted Accounting Standards and Issued Accounting Pronouncements

Recently Adopted Accounting Standards

	Year Ended December 31, 2018
	As Reported		Adjustments			As Revised under ASC 605
Revenue:
Revenue, net	$	704,589	$	(704,589	)	$	-
Service revenue, net		-		478,063			478,063
Reimbursed out-of-pocket revenue		-		71,305			71,305
Total revenue		704,589		(155,221	)		549,368
Operating expenses:
Direct service costs, excluding depreciation and amortization		252,284		-			252,284
Reimbursed out-of-pocket expenses		236,775		(165,470	)		71,305
Total direct costs		489,059		(165,470	)		323,589
Total operating expenses		603,541		(165,470	)		438,071
Income from operations		101,048		10,249			111,297
Income before income taxes		93,951		10,249			104,200
Income tax provision		20,766		1,882			22,648
Net income	$	73,185	$	8,367		$	81,552
Net income per share attributable to common shareholders:
Basic	$	2.05	$	0.24		$	2.29
Diluted	$	1.97	$	0.23		$	2.20
Weighted average common shares outstanding:
Basic		35,547		-			35,547
Diluted		36,912		-			36,912

ASSETS	As of December 31, 2018
Current assets:	As Reported			Adjustments			As Revised under ASC 605
Accounts receivable and unbilled, net		133,449			(28,729	)		104,720
Prepaid expenses and other current assets		21,383			1,147			22,530
Total current assets		178,114			(27,582	)		150,532
Deferred income taxes		713			(389	)		324
Total assets	$	967,933		$	(27,971	)	$	939,962
LIABILITIES AND SHAREHOLDERS’ EQUITY
Current liabilities:
Accrued expenses		87,493			(51,109	)		36,384
Pre-funded study costs		-			61,156			61,156
Advanced billings		147,935			(41,732	)		106,203
Other current liabilities		4,861			(590	)		4,271
Total current liabilities		257,026			(32,275	)		224,751
Deferred income tax liability		439			2,049			2,488
Other long-term liabilities		16,560			(382	)		16,178
Total liabilities		378,230			(30,608	)		347,622
Shareholders’ equity:
Accumulated deficit		(41,487	)		2,637			(38,850	)
Total shareholders’ equity		589,703			2,637			592,340
Total liabilities and shareholders’ equity	$	967,933		$	(27,971	)	$	939,962

CASH FLOWS FROM OPERATING ACTIVITIES:	Year Ended December 31, 2018
	As Reported			Adjustments			As Revised under ASC 605
Net income		73,185			8,367			81,552
Adjustments to reconcile net income to net cash provided by operating activities:
Deferred income tax provision		3,942			4,002			7,944
Changes in assets and liabilities:
Accounts receivable and unbilled, net		(27,047	)		4,842			(22,205	)
Prepaid expenses and other current assets		(1,241	)		(1,147	)		(2,388	)
Accrued expenses		29,029			(15,967	)		13,062
Pre-funded study costs		-			3,782			3,782
Advanced billings		35,593			(2,907	)		32,686
Other assets and liabilities, net		1,925			(972	)		953
Net cash provided by operating activities		156,584			-			156,584

The impact of the adoption of ASC 842 as of January 1, 2019 is as follows:

ASSETS	As of
	January 1, 2019			Adjustments			December 31, 2018
Current assets:
Prepaid expenses and other current assets		21,013			(370	)		21,383
Total current assets		177,744			(370	)		178,114
Property and equipment, net		37,613			(14,642	)		52,255
Operating lease right-of-use assets		51,854			51,854			-
Total assets	$	1,004,775		$	36,842		$	967,933
LIABILITIES AND SHAREHOLDERS’ EQUITY
Current liabilities:
Other current liabilities		10,951			6,090			4,861
Total current liabilities		263,116			6,090			257,026
Operating lease liabilities		45,294			45,294			-
Deemed landlord liability, less current portion		-			(24,484	)		24,484
Deferred income tax liability		3,158			2,719			439
Other long-term liabilities		14,630			(1,930	)		16,560
Total liabilities		405,919			27,689			378,230
Shareholders’ equity:
Accumulated deficit		(32,334	)		9,153			(41,487	)
Total shareholders’ equity		598,856			9,153			589,703
Total liabilities and shareholders’ equity	$	1,004,775		$	36,842		$	967,933

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2020

Schedule of Reconciliation of Denominators and Additional Shares that are Excluded from the Calculation of EPS

The following table sets forth the computation of basic and diluted earnings per share for the years ended December 31, 2020, 2019 and 2018 (in thousands, except for earnings per share):



	Year Ended December 31,
	2020		2019		2018
Weighted-average shares:
Common shares outstanding		35,635		35,881		35,547
RSAs		112		100		142
Total weighted-average shares		35,747		35,981		35,689
Earnings per common share—Basic
Net income	$	145,384	$	100,443	$	73,185
Less: Undistributed earnings allocated to RSAs		459		279		291
Net income available to common shareholders—Basic	$	144,925	$	100,164	$	72,894

Net income per common share—Basic	$	4.07	$	2.79	$	2.05

Basic weighted-average common shares outstanding		35,635		35,881		35,547
Effect of diluted shares		2,073		1,695		1,365
Diluted weighted-average shares outstanding		37,708		37,576		36,912

Net income per common share—Diluted	$	3.84	$	2.67	$	1.97

Summary of Impact of Adoption of Accounting Standards

	Year Ended December 31, 2018
	As Reported		Adjustments			As Revised under ASC 605
Revenue:
Revenue, net	$	704,589	$	(704,589	)	$	-
Service revenue, net		-		478,063			478,063
Reimbursed out-of-pocket revenue		-		71,305			71,305
Total revenue		704,589		(155,221	)		549,368
Operating expenses:
Direct service costs, excluding depreciation and amortization		252,284		-			252,284
Reimbursed out-of-pocket expenses		236,775		(165,470	)		71,305
Total direct costs		489,059		(165,470	)		323,589
Total operating expenses		603,541		(165,470	)		438,071
Income from operations		101,048		10,249			111,297
Income before income taxes		93,951		10,249			104,200
Income tax provision		20,766		1,882			22,648
Net income	$	73,185	$	8,367		$	81,552
Net income per share attributable to common shareholders:
Basic	$	2.05	$	0.24		$	2.29
Diluted	$	1.97	$	0.23		$	2.20
Weighted average common shares outstanding:
Basic		35,547		-			35,547
Diluted		36,912		-			36,912

ASSETS	As of December 31, 2018
Current assets:	As Reported			Adjustments			As Revised under ASC 605
Accounts receivable and unbilled, net		133,449			(28,729	)		104,720
Prepaid expenses and other current assets		21,383			1,147			22,530
Total current assets		178,114			(27,582	)		150,532
Deferred income taxes		713			(389	)		324
Total assets	$	967,933		$	(27,971	)	$	939,962
LIABILITIES AND SHAREHOLDERS’ EQUITY
Current liabilities:
Accrued expenses		87,493			(51,109	)		36,384
Pre-funded study costs		-			61,156			61,156
Advanced billings		147,935			(41,732	)		106,203
Other current liabilities		4,861			(590	)		4,271
Total current liabilities		257,026			(32,275	)		224,751
Deferred income tax liability		439			2,049			2,488
Other long-term liabilities		16,560			(382	)		16,178
Total liabilities		378,230			(30,608	)		347,622
Shareholders’ equity:
Accumulated deficit		(41,487	)		2,637			(38,850	)
Total shareholders’ equity		589,703			2,637			592,340
Total liabilities and shareholders’ equity	$	967,933		$	(27,971	)	$	939,962

CASH FLOWS FROM OPERATING ACTIVITIES:	Year Ended December 31, 2018
	As Reported			Adjustments			As Revised under ASC 605
Net income		73,185			8,367			81,552
Adjustments to reconcile net income to net cash provided by operating activities:
Deferred income tax provision		3,942			4,002			7,944
Changes in assets and liabilities:
Accounts receivable and unbilled, net		(27,047	)		4,842			(22,205	)
Prepaid expenses and other current assets		(1,241	)		(1,147	)		(2,388	)
Accrued expenses		29,029			(15,967	)		13,062
Pre-funded study costs		-			3,782			3,782
Advanced billings		35,593			(2,907	)		32,686
Other assets and liabilities, net		1,925			(972	)		953
Net cash provided by operating activities		156,584			-			156,584

ASU 2016-02

Summary of Impact of Adoption of Accounting Standards

The impact of the adoption of ASC 842 as of January 1, 2019 is as follows:

ASSETS	As of
	January 1, 2019			Adjustments			December 31, 2018
Current assets:
Prepaid expenses and other current assets		21,013			(370	)		21,383
Total current assets		177,744			(370	)		178,114
Property and equipment, net		37,613			(14,642	)		52,255
Operating lease right-of-use assets		51,854			51,854			-
Total assets	$	1,004,775		$	36,842		$	967,933
LIABILITIES AND SHAREHOLDERS’ EQUITY
Current liabilities:
Other current liabilities		10,951			6,090			4,861
Total current liabilities		263,116			6,090			257,026
Operating lease liabilities		45,294			45,294			-
Deemed landlord liability, less current portion		-			(24,484	)		24,484
Deferred income tax liability		3,158			2,719			439
Other long-term liabilities		14,630			(1,930	)		16,560
Total liabilities		405,919			27,689			378,230
Shareholders’ equity:
Accumulated deficit		(32,334	)		9,153			(41,487	)
Total shareholders’ equity		598,856			9,153			589,703
Total liabilities and shareholders’ equity	$	1,004,775		$	36,842		$	967,933

Contract Assets and Contract Liabilities (Tables)

12 Months Ended

Dec. 31, 2020

Revenue From Contract With Customer [Abstract]

Summary of Company's Contract Asset and Contract Liability

Accounts receivable and unbilled, net consisted of the following (in thousands):

	As of
	December 31,			December 31,
	2020			2019
Accounts receivable	$	137,912		$	127,877
Unbilled receivables		23,396			28,368
Less: allowance for doubtful accounts		(346	)		(583	)
Total accounts receivable and unbilled, net	$	160,962		$	155,662

Advanced billings consisted of the following (in thousands):

	As of
	December 31,		December 31,
	2020		2019
Advanced billings	$	255,664	$	192,359

Schedule of Allowance for Doubtful Account Activity

A rollforward of allowance for doubtful account activity is as follows:


	Year Ended December 31,
	2020			2019			2018
Allowance for doubtful accounts - beginning balance	$	(583	)	$	(1,032	)	$	(673	)
Current year provision		(167	)		(263	)		(791	)
Write-offs, recoveries and the effects of foreign currency exchange		404			712			432
Allowance for doubtful accounts - ending balance	$	(346	)	$	(583	)	$	(1,032	)

Property and Equipment, Net (Tables)

12 Months Ended

Dec. 31, 2020

Property Plant And Equipment [Abstract]

Summary of Property and Equipment, Net

Property and equipment, net consisted of the following at December 31 (in thousands):


	2020			2019
Land	$	2,492		$	1,577
Equipment		24,049			20,225
Furniture, fixtures, and leasehold improvements		61,238			24,624
Computer hardware, software, and phone equipment		18,111			15,958
Buildings		14,309			13,272
Construction-in-progress		3,926			3,265
Property and equipment at cost		124,125			78,921
Less: Accumulated depreciation		(39,108	)		(31,629	)
Property and equipment, net	$	85,017		$	47,292

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2020

Goodwill And Intangible Assets Disclosure [Abstract]

Schedule of Intangible Assets, Net

Intangible assets, net consisted of the following at December 31 (in thousands):

	2020			2019
Intangible assets:
Finite-lived intangible assets:
Carrying amount:
Customer relationships	$	145,051		$	145,051
Other		3,074			3,074
Total finite-lived intangible assets		148,125			148,125
Accumulated amortization:
Customer relationships		(130,223	)		(122,426	)
Other		(3,074	)		(2,995	)
Total accumulated amortization		(133,297	)		(125,421	)
Total finite-lived intangible assets, net		14,828			22,704
Trade name (indefinite-lived)		31,646			31,646
Total intangible assets, net	$	46,474		$	54,350

Schedule of Estimated Amortization Expense of Intangible Assets

As of December 31, 2020, estimated amortization expense of the Company’s intangible assets for each of the next five years and thereafter is as follows (in thousands):

	Amortization
2021	$	5,114
2022		3,353
2023		2,199
2024		1,443
2025		946
Later years		1,773
	$	14,828

Accrued Expenses (Tables)

12 Months Ended

Dec. 31, 2020

Payables And Accruals [Abstract]

Schedule of Accrued Expenses

Accrued expenses consisted of the following at December 31 (in thousands):

	2020		2019
Employee compensation and benefits	$	40,208	$	34,119
Project related reimbursable expenses		87,092		68,696
Other		7,067		6,437
Total accrued expenses	$	134,367	$	109,252

Leases (Tables)

12 Months Ended

Dec. 31, 2020

Leases [Abstract]

Summary of Components of Lease Expense

The components of lease expense were as follows (in thousands):

	Year Ended December 31,
	2020		2019
Operating lease cost	$	19,842	$	13,151
Variable lease cost		5,335		2,813

Summary of Supplemental Cash Flow Information Related to Leases

Supplemental cash flow information related to the leases was as follows (in thousands):

	Year Ended December 31,
	2020		2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	13,956	$	9,773

Right-of-use assets obtained in exchange for lease obligations:
Operating leases		73,905		10,294

Summary of Supplemental Balance Sheet Information Related to Leases

Supplemental balance sheet information related to the leases was as follows (in thousands):

	As of
	December 31,			December 31,
	2020			2019
Operating lease right-of-use assets	$	113,809		$	52,152

Other current liabilities	$	15,890		$	10,977
Operating lease liabilities		115,143			45,212
Total operating lease liabilities	$	131,033		$	56,189

Weighted Average Remaining Lease Term (years)
Operating leases	12.9			6.3
Weighted Average Discount Rate
Operating leases		5.9	%		6.0	%

Schedule of Lease Payments Due Related To Lease Liabilities

Lease payments due related to lease liabilities as of December 31, 2020 were as follows (in thousands):

	Related Party			Non-Related Parties			Total
	Operating Leases			Operating Leases			Operating Leases
2021	$	10,510		$	11,905		$	22,415
2022		10,301			8,960			19,261
2023		8,771			7,477			16,248
2024		8,900			5,206			14,106
2025		9,032			3,746			12,778
Later years		103,006			8,657			111,663
Total lease payments		150,520			45,951			196,471
Less: imputed interest		(59,799	)		(5,639	)		(65,438	)
Total	$	90,721		$	40,312		$	131,033

Shareholders' Equity (Tables)

12 Months Ended

Dec. 31, 2020

Equity [Abstract]

Schedule of Weighted-Average Assumptions Used in BSM Model to Calculate Fair Value of Options

The following table sets forth the key weighted-average assumptions used in the BSM Model to calculate the fair value of options:



	Year Ended December 31,
	2020		2019		2018
Expected holding period – years	3.1		2.6		5.4
Expected volatility	31.0%		26.3%		27.0%
Risk-free interest rate	1.0%		2.0%		2.8%
Expected dividend yield		0.0%		0.0%		0.0%

Schedule of Grant Date Fair Value and Stock-based Compensation Expense Allocated



	Year Ended December 31,
	2020		2019		2018
Weighted average, grant date fair value
Stock options	$	15.19	$	14.06	$	11.51
Restricted shares (RSAs and RSUs)	$	98.61	$	60.53	$	49.38

Stock-based compensation expense allocated to:
Total direct costs	$	7,781	$	6,999	$	4,132
Selling, general, and administrative		6,003		13,742		2,367
Total stock-based compensation expense	$	13,784	$	20,741	$	6,499

Schedule of Stock Option Activity

The following table sets forth the Company’s stock option activity:


	Year Ended December 31,
	2020						2019							2018
				Weighted Average							Weighted Average							Weighted Average
	Options			Exercise Price		Options				Exercise Price			Options				Exercise Price
Outstanding - beginning of Period		3,030,071		$	34.50			2,945,040			$	24.18			2,782,868			$	20.73
Granted		227,353		$	105.77			859,960			$	54.97			584,301			$	37.72
Exercised		(637,806	)	$	25.07			(399,368	)		$	16.19			(169,771	)		$	14.98
Forfeited/Expired		(118,891	)	$	37.16			(375,561	)		$	19.91			(252,358	)		$	23.69
Outstanding - end of period		2,500,727		$	43.26			3,030,071			$	34.50			2,945,040			$	24.18

Exercisable - end of period		1,498,829		$	48.99			1,435,088			$	38.62			1,096,116			$	16.01

Schedule of Restricted Share Activity

The following table sets forth the Company’s Restricted Share activity:



	Year Ended December 31,
	2020			2019			2018
	Shares/Units			Shares/Units			Shares/Units
Outstanding and unvested - beginning of period		569,770			421,200			183,629
Granted		201,032			227,610			300,200
Vested		-			-			(29,629	)
Forfeited		(75,240	)		(79,040	)		(33,000	)
Outstanding and unvested - end of period		695,562			569,770			421,200

Cumulative vested shares - end of period		1,913,916			1,913,916			1,913,916

Schedule of Stock Options Expected To Vest, Stock Options Exercisable, and Unvested Restricted Share Awards Expected To Vest

The following table summarizes information about stock options expected to vest, stock options exercisable, and unvested restricted share awards expected to vest at December 31, 2020:

	Weighted Average						Weighted Average
	Exercise		Stock		Restricted		Remaining
	Price		Options		Shares		Life (Years)
December 31, 2020
Number of stock options expected to vest	$	43.26		2,500,727		-		3.4
Number of Restricted Shares expected to vest				-		695,562
Total expected to vest - December 31, 2020				2,500,727		695,562
Total stock options exercisable - December 31, 2020	$	48.99		1,498,829				3.1
Unrecognized compensation cost - December 31, 2020 (in thousands)			$	2,487	$	26,760
Weighted average years over which unrecognized compensation cost will be recognized				1.3		2.9

Schedule of Aggregate Intrinsic Value of Stock Options Exercised, Fair Values of Awards Vested, and Share Based Liabilities Settled



	Year Ended December 31,
	2020		2019		2018
Total intrinsic value of stock options exercised	$	57,927	$	19,807	$	5,326
Total grant-date fair value of stock options vested	$	6,833	$	12,117	$	1,417
Total grant-date fair value of restricted shares vested	$	-	$	-	$	447
Total settlement date fair value of restricted shares vested	$	-	$	-	$	1,568

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Schedule of Components of Income Before Income Taxes

The components of income before income taxes consisted of the following (in thousands):



	Year Ended December 31,
	2020		2019		2018
Domestic	$	158,432	$	117,326	$	88,014
Foreign jurisdictions		10,100		7,506		5,937
Income before income taxes	$	168,532	$	124,832	$	93,951

Schedule of Income Tax Provision

Income tax provision consisted of the following (in thousands):

	Current		Deferred			Total
Year ended December 31, 2020
U.S. Federal	$	16,405	$	436		$	16,841
U.S. state and local		4,588		95			4,683
Foreign jurisdictions		1,586		38			1,624
	$	22,579	$	569		$	23,148

Year ended December 31, 2019
U.S. Federal	$	10,577	$	8,922		$	19,499
U.S. state and local		1,761		987			2,748
Foreign jurisdictions		2,023		119			2,142
	$	14,361	$	10,028		$	24,389

Year ended December 31, 2018
U.S. Federal	$	13,372	$	4,172		$	17,544
U.S. state and local		1,912		(116	)		1,796
Foreign jurisdictions		1,408		18			1,426
	$	16,692	$	4,074		$	20,766

Summary Of Difference Between Statutory Rate for Federal Income Tax and Effective Income Tax Rate

The difference between the statutory rate for federal income tax and the effective income tax rate was as follows (in thousands):



	Year Ended December 31,
	2020					2019					2018
Income tax expense calculated at the federal statutory rate	$	35,392		21.0	%	$	26,215		21.0	%	$	19,730		21.0	%
Effect of:
State and local taxes, net of federal benefit		2,639		1.6			2,021		1.6			1,978		2.1
Tax on foreign earnings, net of tax credits and deductions		(1,773	)	(1.1	)		593		0.4			172		0.2
Tax reform adjustment		-		-			-		-			(195	)	(0.2	)
Write off of Deferred Tax Assets		-		-			-		-			509		0.6
Deferred credit		(700	)	(0.4	)		(802	)	(0.6	)		(802	)	(0.9	)
Permanent items:
Stock-based awards		(10,019	)	(5.9	)		(3,011	)	(2.4	)		(651	)	(0.7	)
Tax reform		-		-			-		-			126		0.1
Deduction for FDII		(2,593	)	(1.5	)		(2,283	)	(1.8	)		-		-
Other		144		0.1			964		0.8			687		0.7
State/Local tax credits		(780	)	(0.5	)		(793	)	(0.6	)		(1,253	)	(1.3	)
Foreign tax credits		-		-			-		-			(727	)	(0.8	)
Change in liability for uncertain tax positions		1,120		0.7			1,325		1.0			1,102		1.2
Other		(282	)	(0.3	)		160		0.1			90		0.1
	$	23,148		13.7	%	$	24,389		19.5	%	$	20,766		22.1	%

Schedule of Components of Company's Net Deferred Tax Asset (Liability)

Components of the Company’s net deferred tax asset (liability) included in the consolidated balance sheets consisted of the following at December 31 (in thousands):


	2020			2019
Deferred tax assets:
Accrued liabilities	$	16,634		$	12,229
Depreciation and amortization		881			1,121
Foreign operating loss carryforward		311			447
U.S. state and local tax credits and carryforward		-			184
Other		246			96
Valuation allowance		(578	)		(755	)
Total deferred tax assets		17,494			13,322

Deferred tax liabilities:
Depreciation and amortization		(26,119	)		(21,787	)
Prepaid expenses		(829	)		(808	)
Advanced billings		(3,513	)		(3,147	)
Other		(48	)		(53	)
Total deferred tax liabilities		(30,509	)		(25,795	)
Net deferred tax liability	$	(13,015	)	$	(12,473	)

Schedule of Annual Activity Related to Valuation Allowance

Annual activity related to the Company’s valuation allowance is as follows (in thousands):



	Year Ended December 31,
	2020			2019			2018
Beginning Balance	$	755		$	169		$	2,394
Additions charged to expense		-			375			-
Additions due to asset acquisition		-			265			-
Reductions from utilization, reassessments and expirations		(177	)		(54	)		(2,225	)
Ending Balance	$	578		$	755		$	169

Schedule of Gross Unrecognized Tax Benefits

A reconciliation of the beginning and ending balances of the total amounts of gross unrecognized tax benefits is as follows (in thousands):



	Year Ended December 31,
	2020			2019			2018
Beginning Balance	$	9,718		$	8,525		$	6,890
Increases in tax positions for prior years		-			-			-
Decreases in tax positions for prior years		(181	)		(888	)		(579	)
Increases in tax positions for current year		2,881			2,081			2,214
Lapse in statute of limitations		(1,727	)		-			-
Ending Balance	$	10,691		$	9,718		$	8,525

Miscellaneous Income (Expense), Net (Tables)

12 Months Ended

Dec. 31, 2020

Other Income And Expenses [Abstract]

Components of Miscellaneous Income (Expense), Net

Miscellaneous income (expense), net consisted of the following (in thousands):



	Year Ended December 31,
	2020		2019			2018
Net gain (loss) on foreign-currency transactions	$	514	$	(581	)	$	386
Other income (expense)		669		(282	)		674
Miscellaneous income (expense), net	$	1,183	$	(863	)	$	1,060

Entity Wide Disclosures (Tables)

12 Months Ended

Dec. 31, 2020

Entity Wide Disclosures [Abstract]

Summary of Property and Equipment, Net by Geographic Region


	2020		2019
Property and equipment, net:
United States	$	58,124	$	25,603
Europe
Belgium		12,024		10,045
Other		7,961		5,728
Total Europe		19,985		15,773
Asia-Pacific		6,566		5,671
Other		342		245
Total property and equipment, net	$	85,017	$	47,292

Summary of Revenue by Major Source

The following table disaggregates the Company’s revenue by major source (in thousands):

	Years Ended December 31,
	2020		2019		2018
Therapeutic Area
Oncology	$	297,675	$	256,766	$	189,056
Other		215,370		196,159		163,983
Metabolic		126,075		138,650		124,837
AVAI		103,259		86,390		77,271
Cardiology		95,153		91,258		95,213
Central Nervous System		88,393		91,746		54,229
Total revenue	$	925,925	$	860,969	$	704,589

Basis of Presentation - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Mar. 31, 2020	Mar. 31, 2018
Basis Of Presentation [Line Items]
Repurchases of shares, value	$ 98,274,000	$ 0	$ 0
Secondary Offering \| Operating Expenses
Basis Of Presentation [Line Items]
Professional fees			$ 700,000
Cinven \| Secondary Offering
Basis Of Presentation [Line Items]
Shares issued and sold			16,399,997
Share Repurchase Program
Basis Of Presentation [Line Items]
Stock repurchase program, additional amount authorized				$ 50,000,000.0
Repurchases of shares	1,183,095
Repurchases of shares, value	$ 98,300,000
Remaining amount of repurchase program	102,600,000
Share Repurchase Program \| Maximum
Basis Of Presentation [Line Items]
Stock repurchase program, authorized amount	$ 150,000,000.0				$ 50,000,000.0

Summary of Significant Accounting Policies - Additional Information (Details) shares in Thousands	12 Months Ended
	Dec. 31, 2020 USD ($) Customer shares	Dec. 31, 2019 USD ($) Customer shares	Dec. 31, 2018 USD ($) shares	Jan. 01, 2019 USD ($)	Jan. 01, 2018 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Sales rebates	$ 4,800,000	$ 6,200,000	$ 1,200,000
Performance obligations remaining to be performed		$ 1,600,000,000	1,400,000,000
Number of customers accounted for more than 10% of accounts receivable \| Customer	0	0
Fair value measurements transfers between level 1, level 2, or level 3	$ 0	$ 0	0
Accumulated deficit	115,229,000	68,109,000		$ (32,334,000)
Accounts receivable and unbilled, net	160,962,000	155,662,000
Deferred income tax liability	13,551,000	12,849,000		$ 3,158,000
Accrued expenses	134,367,000	109,252,000
Advanced billings	$ 255,664,000	$ 192,359,000
ASU 2014-09
Summary Of Significant Accounting Policies [Line Items]
Accumulated deficit			(41,487,000)
Accounts receivable and unbilled, net			133,449,000
Deferred income tax liability			439,000
Accrued expenses			87,493,000
Pre-funded study costs			0
Advanced billings			147,935,000
ASU 2014-09 \| Impact of Adoption of ASC 606 - Adjustments
Summary Of Significant Accounting Policies [Line Items]
Accumulated deficit			2,637,000		$ 5,700,000
Accounts receivable and unbilled, net			(28,729,000)		23,900,000
Deferred income tax liability			2,049,000		(1,600,000)
Accrued expenses			(51,109,000)		35,100,000
Pre-funded study costs			61,156,000		(57,400,000)
Advanced billings			$ (41,732,000)		$ 38,900,000
Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of intangible assets	15 years
Maximum \| Computer Hardware Software Phone and Medical Imaging Equipment
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of assets	5 years
Maximum \| Furniture and Fixtures and Other Equipment
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of assets	7 years
Maximum \| Buildings
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of assets	40 years
Maximum \| Computer Software Developed Costs
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of assets	3 years
Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of intangible assets	5 years
Minimum \| Computer Hardware Software Phone and Medical Imaging Equipment
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of assets	3 years
Minimum \| Furniture and Fixtures and Other Equipment
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of assets	5 years
Minimum \| Buildings
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of assets	30 years
Stock Options
Summary Of Significant Accounting Policies [Line Items]
Anti-dilutive securities excluded from computation of diluted EPS \| shares	204	248	121
Miscellaneous Income (Expense), Net
Summary Of Significant Accounting Policies [Line Items]
Net gain/(loss) on foreign currency transactions	$ 500,000	$ (600,000)	$ 400,000
Selling, General and Administrative
Summary Of Significant Accounting Policies [Line Items]
Advertisement expenses	$ 700,000	$ 700,000	$ 800,000

Summary of Significant Accounting Policies - Schedule of Reconciliation of Denominators and Additional Shares that are Excluded from the Calculation of EPS (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Weighted-average shares:
Basic weighted-average common shares outstanding	35,635	35,881	35,547
Total weighted-average shares	35,747	35,981	35,689
Earnings per common share—Basic
Net income	$ 145,384	$ 100,443	$ 73,185
Net income available to common shareholders—Basic	$ 144,925	$ 100,164	$ 72,894
Net income per common share—Basic	$ 4.07	$ 2.79	$ 2.05
Basic weighted-average common shares outstanding	35,635	35,881	35,547
Effect of diluted shares	2,073	1,695	1,365
Diluted weighted-average shares outstanding	37,708	37,576	36,912
Net income per common share—Diluted	$ 3.84	$ 2.67	$ 1.97
RSAs
Weighted-average shares:
Basic weighted-average common shares outstanding	112	100	142
Earnings per common share—Basic
Less: Undistributed earnings allocated to RSAs	$ 459	$ 279	$ 291
Basic weighted-average common shares outstanding	112	100	142
Common Stock
Weighted-average shares:
Basic weighted-average common shares outstanding	35,635	35,881	35,547
Earnings per common share—Basic
Basic weighted-average common shares outstanding	35,635	35,881	35,547

Summary of Significant Accounting Policies - Summary of Impact of Adoption of Accounting Standards (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Jan. 01, 2019	Jan. 01, 2018	Dec. 31, 2017
Revenue:
Total revenue	$ 925,925	$ 860,969	$ 704,589
Operating expenses:
Total direct costs	647,199	615,272	489,059
Total operating expenses	758,883	733,706	603,541
Income from operations	167,042	127,263	101,048
Income before income taxes	168,532	124,832	93,951
Income tax provision	23,148	24,389	20,766
Net income	$ 145,384	$ 100,443	$ 73,185
Net income per share attributable to common shareholders:
Basic	$ 4.07	$ 2.79	$ 2.05
Diluted	$ 3.84	$ 2.67	$ 1.97
Weighted average common shares outstanding:
Basic	35,635	35,881	35,547
Diluted	37,708	37,576	36,912
Current assets:
Accounts receivable and unbilled, net	$ 160,962	$ 155,662
Prepaid expenses and other current assets	34,923	29,446		$ 21,013
Total current assets	473,651	317,028		177,744
Deferred income taxes	536	376
Property and equipment, net	85,017	47,292		37,613
Operating lease right-of-use assets	113,809	52,152		51,854
Total assets	1,390,677	1,143,071		1,004,775
Current liabilities:
Accrued expenses	134,367	109,252
Advanced billings	255,664	192,359
Other current liabilities	23,527	18,987		10,951
Total current liabilities	440,110	343,002		263,116
Operating lease liabilities	115,143	45,212		45,294
Deemed landlord liability, less current portion				0
Deferred income tax liability	13,551	12,849		3,158
Other long-term liabilities	16,094	15,725		14,630
Total liabilities	584,898	416,788		405,919
Shareholders’ equity:
Accumulated deficit	115,229	68,109		(32,334)
Total shareholders’ equity	805,779	726,283	$ 598,856	598,856		$ 509,260
Total liabilities and shareholders’ equity	1,390,677	1,143,071		1,004,775
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income	145,384	100,443	73,185
Adjustments to reconcile net income to net cash provided by operating activities:
Deferred income tax provision	527	10,050	3,942
Changes in assets and liabilities:
Accounts receivable and unbilled, net	(5,530)	(21,256)	(27,047)
Prepaid expenses and other current assets	(3,724)	(7,381)	(1,241)
Accrued expenses	24,231	21,824	29,029
Advanced billings	63,407	44,584	35,593
Other assets and liabilities, net	1,976	2,121	1,925
Net cash provided by operating activities	258,676	201,867	156,584
Revenue Net
Revenue:
Total revenue	925,925	860,969	704,589
Direct Costs
Operating expenses:
Total direct costs	354,426	321,006	252,284
Reimbursable Out of Pocket Costs
Operating expenses:
Total direct costs	$ 292,773	$ 294,266	236,775
ASU 2014-09
Revenue:
Total revenue			704,589
Operating expenses:
Total direct costs			489,059
Total operating expenses			603,541
Income from operations			101,048
Income before income taxes			93,951
Income tax provision			20,766
Net income			$ 73,185
Net income per share attributable to common shareholders:
Basic			$ 2.05
Diluted			$ 1.97
Weighted average common shares outstanding:
Basic			35,547
Diluted			36,912
Current assets:
Accounts receivable and unbilled, net			$ 133,449
Prepaid expenses and other current assets			21,383
Total current assets			178,114
Deferred income taxes			713
Total assets			967,933
Current liabilities:
Accrued expenses			87,493
Pre-funded study costs			0
Advanced billings			147,935
Other current liabilities			4,861
Total current liabilities			257,026
Deferred income tax liability			439
Other long-term liabilities			16,560
Total liabilities			378,230
Shareholders’ equity:
Accumulated deficit			(41,487)
Total shareholders’ equity			589,703
Total liabilities and shareholders’ equity			967,933
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income			73,185
Adjustments to reconcile net income to net cash provided by operating activities:
Deferred income tax provision			3,942
Changes in assets and liabilities:
Accounts receivable and unbilled, net			(27,047)
Prepaid expenses and other current assets			(1,241)
Accrued expenses			29,029
Pre-funded study costs			0
Advanced billings			35,593
Other assets and liabilities, net			1,925
Net cash provided by operating activities			156,584
ASU 2014-09 \| Revenue Net
Revenue:
Total revenue			704,589
ASU 2014-09 \| Direct Service Revenue
Revenue:
Total revenue			0
ASU 2014-09 \| Reimbursed Out-of-Pocket Revenue
Revenue:
Total revenue			0
ASU 2014-09 \| Direct Costs
Operating expenses:
Total direct costs			252,284
ASU 2014-09 \| Reimbursable Out of Pocket Costs
Operating expenses:
Total direct costs			236,775
ASU 2014-09 \| Impact of Adoption of ASC 606 - Adjustments
Revenue:
Total revenue			(155,221)
Operating expenses:
Total direct costs			(165,470)
Total operating expenses			(165,470)
Income from operations			10,249
Income before income taxes			10,249
Income tax provision			1,882
Net income			$ 8,367
Net income per share attributable to common shareholders:
Basic			$ 0.24
Diluted			$ 0.23
Weighted average common shares outstanding:
Basic			0
Diluted			0
Current assets:
Accounts receivable and unbilled, net			$ (28,729)		$ 23,900
Prepaid expenses and other current assets			1,147
Total current assets			(27,582)
Deferred income taxes			(389)
Total assets			(27,971)
Current liabilities:
Accrued expenses			(51,109)		35,100
Pre-funded study costs			61,156		(57,400)
Advanced billings			(41,732)		38,900
Other current liabilities			(590)
Total current liabilities			(32,275)
Deferred income tax liability			2,049		(1,600)
Other long-term liabilities			(382)
Total liabilities			(30,608)
Shareholders’ equity:
Accumulated deficit			2,637		$ 5,700
Total shareholders’ equity			2,637
Total liabilities and shareholders’ equity			(27,971)
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income			8,367
Adjustments to reconcile net income to net cash provided by operating activities:
Deferred income tax provision			4,002
Changes in assets and liabilities:
Accounts receivable and unbilled, net			4,842
Prepaid expenses and other current assets			(1,147)
Accrued expenses			(15,967)
Pre-funded study costs			3,782
Advanced billings			(2,907)
Other assets and liabilities, net			(972)
Net cash provided by operating activities			0
ASU 2014-09 \| Impact of Adoption of ASC 606 - Adjustments \| Revenue Net
Revenue:
Total revenue			(704,589)
ASU 2014-09 \| Impact of Adoption of ASC 606 - Adjustments \| Direct Service Revenue
Revenue:
Total revenue			478,063
ASU 2014-09 \| Impact of Adoption of ASC 606 - Adjustments \| Reimbursed Out-of-Pocket Revenue
Revenue:
Total revenue			71,305
ASU 2014-09 \| Impact of Adoption of ASC 606 - Adjustments \| Direct Costs
Operating expenses:
Total direct costs			0
ASU 2014-09 \| Impact of Adoption of ASC 606 - Adjustments \| Reimbursable Out of Pocket Costs
Operating expenses:
Total direct costs			(165,470)
ASU 2014-09 \| Impact of Adoption of ASC 606 - As Revised under ASC 605
Revenue:
Total revenue			549,368
Operating expenses:
Total direct costs			323,589
Total operating expenses			438,071
Income from operations			111,297
Income before income taxes			104,200
Income tax provision			22,648
Net income			$ 81,552
Net income per share attributable to common shareholders:
Basic			$ 2.29
Diluted			$ 2.20
Weighted average common shares outstanding:
Basic			35,547
Diluted			36,912
Current assets:
Accounts receivable and unbilled, net			$ 104,720
Prepaid expenses and other current assets			22,530
Total current assets			150,532
Deferred income taxes			324
Total assets			939,962
Current liabilities:
Accrued expenses			36,384
Pre-funded study costs			61,156
Advanced billings			106,203
Other current liabilities			4,271
Total current liabilities			224,751
Deferred income tax liability			2,488
Other long-term liabilities			16,178
Total liabilities			347,622
Shareholders’ equity:
Accumulated deficit			(38,850)
Total shareholders’ equity			592,340
Total liabilities and shareholders’ equity			939,962
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income			81,552
Adjustments to reconcile net income to net cash provided by operating activities:
Deferred income tax provision			7,944
Changes in assets and liabilities:
Accounts receivable and unbilled, net			(22,205)
Prepaid expenses and other current assets			(2,388)
Accrued expenses			13,062
Pre-funded study costs			3,782
Advanced billings			32,686
Other assets and liabilities, net			953
Net cash provided by operating activities			156,584
ASU 2014-09 \| Impact of Adoption of ASC 606 - As Revised under ASC 605 \| Revenue Net
Revenue:
Total revenue			0
ASU 2014-09 \| Impact of Adoption of ASC 606 - As Revised under ASC 605 \| Direct Service Revenue
Revenue:
Total revenue			478,063
ASU 2014-09 \| Impact of Adoption of ASC 606 - As Revised under ASC 605 \| Reimbursed Out-of-Pocket Revenue
Revenue:
Total revenue			71,305
ASU 2014-09 \| Impact of Adoption of ASC 606 - As Revised under ASC 605 \| Direct Costs
Operating expenses:
Total direct costs			252,284
ASU 2014-09 \| Impact of Adoption of ASC 606 - As Revised under ASC 605 \| Reimbursable Out of Pocket Costs
Operating expenses:
Total direct costs			71,305
ASU 2016-02
Current assets:
Prepaid expenses and other current assets			21,383
Total current assets			178,114
Property and equipment, net			52,255
Operating lease right-of-use assets			0
Total assets			967,933
Current liabilities:
Other current liabilities			4,861
Total current liabilities			257,026
Operating lease liabilities			0
Deemed landlord liability, less current portion			24,484
Deferred income tax liability			439
Other long-term liabilities			16,560
Total liabilities			378,230
Shareholders’ equity:
Accumulated deficit			(41,487)
Total shareholders’ equity			589,703
Total liabilities and shareholders’ equity			$ 967,933
ASU 2016-02 \| Adjustments
Current assets:
Prepaid expenses and other current assets				(370)
Total current assets				(370)
Property and equipment, net				(14,642)
Operating lease right-of-use assets				51,854
Total assets				36,842
Current liabilities:
Other current liabilities				6,090
Total current liabilities				6,090
Operating lease liabilities				45,294
Deemed landlord liability, less current portion				(24,484)
Deferred income tax liability				2,719
Other long-term liabilities				(1,930)
Total liabilities				27,689
Shareholders’ equity:
Accumulated deficit				9,153
Total shareholders’ equity				9,153
Total liabilities and shareholders’ equity				$ 36,842

Contract Assets and Contract Liabilities - Summary of Accounts Receivable and Unbilled, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Revenue From Contract With Customer [Abstract]
Accounts receivable	$ 137,912	$ 127,877
Unbilled receivables	23,396	28,368
Less: allowance for doubtful accounts	(346)	(583)	$ (1,032)	$ (673)
Total accounts receivable and unbilled, net	$ 160,962	$ 155,662

Contract Assets and Contract Liabilities - Additional Information (Details) $ in Millions	12 Months Ended
	Dec. 31, 2020 USD ($)
Revenue From Contract With Customer [Abstract]
Revenue recognized	$ 165.6

Contract Assets and Contract Liabilities - Summary of Advanced Billings (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Revenue From Contract With Customer [Abstract]
Advanced billings	$ 255,664	$ 192,359

Contract Assets and Contract Liabilities - Schedule of Allowance for Doubtful Account Activity (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Revenue From Contract With Customer [Abstract]
Allowance for doubtful accounts - beginning balance	$ (583)	$ (1,032)	$ (673)
Current year provision	(167)	(263)	(791)
Write-offs, recoveries and the effects of foreign currency exchange	404	712	432
Allowance for doubtful accounts - ending balance	$ (346)	$ (583)	$ (1,032)

Property and Equipment, Net - Summary of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019	Jan. 01, 2019
Property Plant and Equipment [Line Items]
Property and equipment at cost	$ 124,125	$ 78,921
Less: Accumulated depreciation	(39,108)	(31,629)
Property and equipment, net	85,017	47,292	$ 37,613
Land
Property Plant and Equipment [Line Items]
Property and equipment at cost	2,492	1,577
Equipment
Property Plant and Equipment [Line Items]
Property and equipment at cost	24,049	20,225
Furniture, fixtures, and leasehold improvements
Property Plant and Equipment [Line Items]
Property and equipment at cost	61,238	24,624
Computer hardware, software, and phone equipment
Property Plant and Equipment [Line Items]
Property and equipment at cost	18,111	15,958
Buildings
Property Plant and Equipment [Line Items]
Property and equipment at cost	14,309	13,272
Construction-in-Progress
Property Plant and Equipment [Line Items]
Property and equipment at cost	$ 3,926	$ 3,265

Property and Equipment, Net - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Property Plant And Equipment [Abstract]
Depreciation	$ 11,652	$ 8,360	$ 9,240

Goodwill and Intangible Assets - Additional Information (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019	Jan. 01, 2019
Goodwill And Intangible Assets [Line Items]
Fair value assets measured on non-recurring basis	$ 1,390,677	$ 1,143,071	$ 1,004,775
Goodwill	662,396	$ 662,396
Accumulated goodwill impairment losses to date	9,300
Fair Value Measurement Non-Recurring \| Level 3
Goodwill And Intangible Assets [Line Items]
Fair value assets measured on non-recurring basis	694,000
Goodwill	662,400
Indefinite-lived intangible assets	$ 31,600

- Definition

Sum of the carrying amounts as of the balance sheet date of all assets that are recognized. Assets are probable future economic benefits obtained or controlled by an entity as a result of past transactions or events.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 210
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-03(11))
-URI http://asc.fasb.org/extlink&oid=120398452&loc=d3e534808-122878

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(g)(1)(ii))
-URI http://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 825
-SubTopic 10
-Section 50
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-Subparagraph (f)
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 810
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 210
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-03(a)(12))
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 323
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-Subparagraph (c)
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
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-Paragraph 30
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8906-108599

+ Details

Goodwill and Intangible Assets - Schedule of Intangible Assets, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Finite-lived intangible assets:
Total finite-lived intangible assets	$ 148,125	$ 148,125
Accumulated amortization:
Total accumulated amortization	(133,297)	(125,421)
Total finite-lived intangible assets, net	14,828	22,704
Trade name (indefinite-lived)	31,646	31,646
Total intangible assets, net	46,474	54,350
Customer Relationships
Finite-lived intangible assets:
Total finite-lived intangible assets	145,051	145,051
Accumulated amortization:
Total accumulated amortization	(130,223)	(122,426)
Other
Finite-lived intangible assets:
Total finite-lived intangible assets	3,074	3,074
Accumulated amortization:
Total accumulated amortization	$ (3,074)	$ (2,995)

Goodwill and Intangible Assets - Schedule of Estimated Amortization Expense of Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Goodwill And Intangible Assets Disclosure [Abstract]
2021	$ 5,114
2022	3,353
2023	2,199
2024	1,443
2025	946
Later years	1,773
Total finite-lived intangible assets, net	$ 14,828	$ 22,704

Accrued Expenses - Schedule of Accrued Expenses (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Accrued Liabilities And Other Liabilities [Abstract]
Employee compensation and benefits	$ 40,208	$ 34,119
Project related reimbursable expenses	87,092	68,696
Other	7,067	6,437
Total accrued expenses	$ 134,367	$ 109,252

Debt - Additional Information (Details) - Credit Facility - USD ($)	Sep. 30, 2019	Dec. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Outstanding borrowings		$ 0	$ 0
Outstanding letters of credit		$ 200,000	$ 200,000
Maximum
Debt Instrument [Line Items]
Debt instrument, principal amount	$ 50,000,000.0
Loan Agreement
Debt Instrument [Line Items]
Debt instrument, basis points	1.00%
Debt instrument, term	364 days

Leases - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2018
Lessee Lease Description [Line Items]
Rent expense under ASC 840		$ 9.2
Real Estate and Equipment
Lessee Lease Description [Line Items]
Lease renewal term, operating lease	20 years
Description of option to extend the lease	Many of the Company’s leases include options to extend the leases on a month to month basis or for set periods for up to 20 years.
Operating lease, existense of option to extend	true
Description of option to terminate the lease	Many leases also include options to terminate the leases within one year or per other contractual terms.
Lessee, operating lease, existence of option to terminate	true
Minimum \| Real Estate
Lessee Lease Description [Line Items]
Remaining lease term, operating lease	1 year
Maximum \| Real Estate
Lessee Lease Description [Line Items]
Remaining lease term, operating lease	20 years
Maximum \| Real Estate and Equipment
Lessee Lease Description [Line Items]
Operating lease, options to terminate lease term	1 year

Leases - Summary of Components of Lease Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Lease Cost [Abstract]
Operating lease cost	$ 19,842	$ 13,151
Variable lease cost	$ 5,335	$ 2,813

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 13,956	$ 9,773
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$ 73,905	$ 10,294

Leases - Summary of Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019	Jan. 01, 2019
Assets And Liabilities Lessee [Abstract]
Operating lease right-of-use assets	$ 113,809	$ 52,152	$ 51,854
Other current liabilities	$ 15,890	$ 10,977
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	us-gaap:OtherLiabilitiesCurrent	us-gaap:OtherLiabilitiesCurrent
Operating lease liabilities	$ 115,143	$ 45,212	$ 45,294
Total operating lease liabilities	$ 131,033	$ 56,189
Weighted Average Remaining Lease Term (years)
Operating leases	12 years 10 months 24 days	6 years 3 months 18 days
Weighted Average Discount Rate
Operating leases	5.90%	6.00%

Leases - Schedule of Lease Payments Due Related To Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Operating Lease Liabilities Payments Due [Line Items]
2021	$ 22,415
2022	19,261
2023	16,248
2024	14,106
2025	12,778
Later years	111,663
Total lease payments	196,471
Less: imputed interest	(65,438)
Total	131,033	$ 56,189
Related Party
Operating Lease Liabilities Payments Due [Line Items]
2021	10,510
2022	10,301
2023	8,771
2024	8,900
2025	9,032
Later years	103,006
Total lease payments	150,520
Less: imputed interest	(59,799)
Total	90,721
Non-Related Party
Operating Lease Liabilities Payments Due [Line Items]
2021	11,905
2022	8,960
2023	7,477
2024	5,206
2025	3,746
Later years	8,657
Total lease payments	45,951
Less: imputed interest	(5,639)
Total	$ 40,312

Shareholders' Equity - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended	12 Months Ended
	Sep. 30, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Aug. 11, 2016
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options granted		227,353	859,960	584,301
Actual tax benefits recognized related to stock-based compensation		$ 11.7	$ 5.5	$ 1.0
2016 Incentive Award Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of shares registered and available for grant					6,000,000
Shares available for future stock compensation grants		2,900,000	3,200,000
2016 Incentive Award Plan \| Granted to Employees
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Awards granted to employees		405,237	816,286	850,700
2016 Incentive Award Plan \| Non Employee Directors
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options granted			41,853
Award vesting description		These awards will vest on the earlier of (a) the day immediately preceding the date of the first annual meeting following the date of grant and (b) the first anniversary of the date of grant, subject to the non-employee director continuing in service through the applicable vesting date.
2016 Incentive Award Plan \| Non Employee Directors \| Restricted Stock Awards (RSA)
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options granted				33,801
2016 Incentive Award Plan \| Non Employee Directors \| Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options granted		23,148
2016 Incentive Award Plan \| Vesting After Four Years \| Restricted Stock Awards (RSA)
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted		20,724
Award vesting period		4 years
2016 Incentive Award Plan \| Vesting After Four Years \| Restricted Stock Units (RSU)
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted		177,808	227,610	300,200
Award vesting period		4 years	4 years	4 years
2016 Incentive Award Plan \| Vesting After Four Years \| Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Award vesting period			4 years	4 years
Stock options granted			10,000	550,500
2016 Incentive Award Plan \| Vesting After Three Years \| Restricted Stock Units (RSU)
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted		2,500
Award vesting period		3 years
2016 Incentive Award Plan \| Vesting After Three Years \| Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Award vesting period		3 years
Stock options granted		4,800
2016 Incentive Award Plan \| Fully-vested Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options granted		199,405	551,676
2016 Incentive Award Plan \| Vesting After One Year
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Award vesting period			1 year
Stock options granted			5,000
2016 Incentive Award Plan \| Vesting in Twelve Equal Monthly Installments
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options granted			22,000
2016 Incentive Award Plan \| Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share-based compensation option terms		10 years
2014 Equity Incentive Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share-based compensation option terms		7 years
2014 Equity Incentive Plan \| Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Award vesting period		4 years
2014 Equity Incentive Plan \| Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Award vesting period		3 years
2014 Incentive Award Plan \| Stock Options \| MPI \| Tender Offer
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of vested options purchased by related party	229,431
2014 Incentive Award Plan \| Stock Options \| MPI \| Selling, General and Administrative Expenses \| Tender Offer
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation expense			$ 5.1

Shareholders' Equity -Schedule of Weighted-Average Assumptions Used in BSM Model to Calculate Fair Value of Options (Details)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share Based Compensation Arrangement By Share Based Payment Award Fair Value Assumptions And Methodology [Abstract]
Expected holding period – years	3 years 1 month 6 days	2 years 7 months 6 days	5 years 4 months 24 days
Expected volatility	31.00%	26.30%	27.00%
Risk-free interest rate	1.00%	2.00%	2.80%
Expected dividend yield	0.00%	0.00%	0.00%

Shareholders' Equity - Schedule of Grant Date Fair Value and Stock-based Compensation Expense Allocated (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 13,784	$ 20,741	$ 6,499
Stock Options
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Weighted average, grant date fair value	$ 15.19	$ 14.06	$ 11.51
Restricted Shares (RSAs and RSUs)
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Weighted average, grant date fair value	$ 98.61	$ 60.53	$ 49.38
Total Direct Costs
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 7,781	$ 6,999	$ 4,132
Selling, General and Administrative
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 6,003	$ 13,742	$ 2,367

Shareholders' Equity - Schedule of Stock Option Activity (Details) - $ / shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Equity [Abstract]
Number of Stock Options, Outstanding - beginning of Period	3,030,071	2,945,040	2,782,868
Number of Stock Options, Granted	227,353	859,960	584,301
Number of Stock Options, Exercised	(637,806)	(399,368)	(169,771)
Number of Stock Options, Forfeited/Expired	(118,891)	(375,561)	(252,358)
Number of Stock Options, Outstanding - end of period	2,500,727	3,030,071	2,945,040
Number of Stock Options, Exercisable - end of period	1,498,829	1,435,088	1,096,116
Weighted Average Exercise Price, Outstanding - beginning of Period	$ 34.50	$ 24.18	$ 20.73
Weighted Average Exercise Price, Granted	105.77	54.97	37.72
Weighted Average Exercise Price, Exercised	25.07	16.19	14.98
Weighted Average Exercise Price, Forfeited/Expired	37.16	19.91	23.69
Weighted Average Exercise Price, Outstanding - end of period	43.26	34.50	24.18
Weighted Average Exercise Price, Exercisable - end of period	$ 48.99	$ 38.62	$ 16.01

Shareholders' Equity - Schedule of Restricted Share Activity (Details) - Restricted Shares (RSAs and RSUs) - shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Outstanding and unvested - beginning of period	569,770	421,200	183,629
Granted	201,032	227,610	300,200
Vested	0	0	(29,629)
Forfeited	(75,240)	(79,040)	(33,000)
Outstanding and unvested - end of period	695,562	569,770	421,200
Cumulative vested shares - end of period	1,913,916	1,913,916	1,913,916

Shareholders' Equity - Schedule of Stock Options Expected To Vest, Stock Options Exercisable, and Unvested Restricted Share Awards Expected To Vest (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Weighted Average Exercise Price, Number of stock options expected to vest	$ 43.26
Weighted Average Exercise Price, Total stock options exercisable - December 31, 2020	$ 48.99	$ 38.62	$ 16.01
Number of stock options expected to vest	2,500,727
Number of Restricted Shares expected to vest	695,562
Weighted Average Remaining Life (Years), Number of stock options expected to vest	3 years 4 months 24 days
Weighted Average Remaining Life (Years), Total stock options exercisable - December 31, 2020	3 years 1 month 6 days
Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of stock options expected to vest	2,500,727
Total stock options exercisable - December 31, 2020	1,498,829
Unrecognized compensation cost - December 31, 2020	$ 2,487
Weighted average years over which unrecognized compensation cost will be recognized	1 year 3 months 18 days
RSAs
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Weighted average years over which unrecognized compensation cost will be recognized	2 years 10 months 24 days
Number of Restricted Shares expected to vest	695,562
Unrecognized compensation cost - December 31, 2020	$ 26,760

Shareholder's Equity - Schedule of Aggregate Intrinsic Value of Stock Options Exercised, Fair Values of Awards Vested, and Share Based Liabilities Settled (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total intrinsic value of stock options exercised	$ 57,927	$ 19,807	$ 5,326
Total grant-date fair value of stock options vested	6,833	12,117	1,417
Restricted Shares (RSAs and RSUs)
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total grant-date fair value of restricted shares vested	0	0	447
Total settlement date fair value of restricted shares vested	$ 0	$ 0	$ 1,568

Employee Benefit Plans - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Defined Contribution Plan Disclosure [Line Items]
Maximum annual contribution by employee, percentage of pre-tax earnings	50.00%
U.S. Employees
Defined Contribution Plan Disclosure [Line Items]
Recognized cost of employee benefit plan	$ 3.7	$ 3.1	$ 2.7
Minimum period of service required for matching contribution eligibility	1 year
Minimum required period of service for employer contributions to fully vest	3 years
Non-U.S. Employees \| Defined Contribution Arrangements
Defined Contribution Plan Disclosure [Line Items]
Recognized cost of employee benefit plan	$ 1.5	$ 1.2	$ 1.0

Income Taxes - Schedule of Components of Income Before Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Domestic	$ 158,432	$ 117,326	$ 88,014
Foreign jurisdictions	10,100	7,506	5,937
Income before income taxes	$ 168,532	$ 124,832	$ 93,951

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (c)
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Income Taxes - Schedule of Income Tax Provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Loss From Continuing Operations Before Income Taxes Minority Interest And Income Loss From Equity Method Investments [Abstract]
U.S. Federal, Current	$ 16,405	$ 10,577	$ 13,372
U.S. Federal, Deferred	436	8,922	4,172
U.S. Federal, Total	16,841	19,499	17,544
U.S. state and local, Current	4,588	1,761	1,912
U.S. state and local, Deferred	95	987	(116)
U.S. state and local, Total	4,683	2,748	1,796
Foreign jurisdictions, Current	1,586	2,023	1,408
Foreign jurisdictions, Deferred	38	119	18
Foreign jurisdictions, Total	1,624	2,142	1,426
Income tax provision (benefit), Current	22,579	14,361	16,692
Income tax provision (benefit), Deferred	569	10,028	4,074
Income tax provision (benefit), Total	$ 23,148	$ 24,389	$ 20,766

Income Taxes - Summary Of Difference Between Statutory Rate for Federal Income Tax and Effective Income Tax Rate (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Income tax expense calculated at the federal statutory rate	$ 35,392	$ 26,215	$ 19,730
State and local taxes, net of federal benefit	2,639	2,021	1,978
Tax on foreign earnings, net of tax credits and deductions	(1,773)	593	172
Tax reform adjustment	0	0	(195)
Write off of Deferred Tax Assets	0	0	509
Deferred credit	(700)	(802)	(802)
Stock-based awards	(10,019)	(3,011)	(651)
Tax reform	0	0	126
Deduction for FDII	(2,593)	(2,283)	0
Other	144	964	687
State/Local tax credits	(780)	(793)	(1,253)
Foreign tax credits	0	0	(727)
Change in liability for uncertain tax positions	1,120	1,325	1,102
Other	(282)	160	90
Income tax provision (benefit), Total	$ 23,148	$ 24,389	$ 20,766
Income tax expense calculated at the federal statutory rate	21.00%	21.00%	21.00%
State and local taxes, net of federal benefit	1.60%	1.60%	2.10%
Tax on foreign earnings, net of tax credits and deductions	(1.10%)	0.40%	0.20%
Tax reform adjustment	0.00%	0.00%	(0.20%)
Write off of Deferred Tax Assets	0.00%	0.00%	0.60%
Deferred credit	(0.40%)	(0.60%)	(0.90%)
Stock-based awards	(5.90%)	(2.40%)	(0.70%)
Tax reform	0.00%	0.00%	0.10%
Deduction for FDII	(1.50%)	(1.80%)	0.00%
Other	0.10%	0.80%	0.70%
State/Local tax credits	(0.50%)	(0.60%)	(1.30%)
Foreign tax credits	0.00%	0.00%	(0.80%)
Change in liability for uncertain tax positions	0.70%	1.00%	1.20%
Other	(0.30%)	0.10%	0.10%
Effective Income Tax Rate Reconciliation, Percent	13.70%	19.50%	22.10%

Income Taxes - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Line Items]
Deferred tax liability not recognized from undistributed earnings of foreign subsidiaries			$ 0
Deduction for dividends received in tax reform act			100.00%
Dividends received from owned foreign corporations by us corporate shareholders			10.00%
Foreign corporations shareholders holding period			1 year
Amount of undistributed earnings of foreign subsidiaries for which deferred foreign withholding taxes not recorded	$ 27,800,000
Deferred tax assets, foreign operating loss carryforwards	311,000	$ 447,000
Deferred tax assets, valuation allowance	578,000	$ 755,000
Percentage of foreign net operating loss carryforward over indefinite period		12.00%
Liability for interest and penalties	2,100,000	$ 1,400,000
Liability for uncertain tax position	$ 8,600,000	$ 8,200,000
Number of tax years	4 years
Minimum
Income Tax Disclosure [Line Items]
Foreign net operating loss carryforwards expiration year	2023
Maximum
Income Tax Disclosure [Line Items]
Foreign net operating loss carryforwards expiration year	2029
Foreign Tax Authority
Income Tax Disclosure [Line Items]
Deferred tax assets, valuation allowance	$ 300,000
Foreign, State and Local Jurisdictions \| Earliest Tax Year
Income Tax Disclosure [Line Items]
Open tax year	2016
Foreign, State and Local Jurisdictions \| Latest Tax Year
Income Tax Disclosure [Line Items]
Open tax year	2020
Federal \| Earliest Tax Year
Income Tax Disclosure [Line Items]
Open tax year	2017
Federal \| Latest Tax Year
Income Tax Disclosure [Line Items]
Open tax year	2020

Income Taxes - Schedule of Components of Company's Net Deferred Tax Asset (Liability) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Deferred tax assets:
Accrued liabilities	$ 16,634	$ 12,229
Depreciation and amortization	881	1,121
Foreign operating loss carryforward	311	447
U.S. state and local tax credits and carryforward	0	184
Other	246	96
Valuation allowance	(578)	(755)
Total deferred tax assets	17,494	13,322
Deferred tax liabilities:
Depreciation and amortization	(26,119)	(21,787)
Prepaid expenses	(829)	(808)
Advanced billings	(3,513)	(3,147)
Other	(48)	(53)
Total deferred tax liabilities	(30,509)	(25,795)
Net deferred tax liability	$ (13,015)	$ (12,473)

Income Taxes - Schedule of Annual Activity Related to Valuation Allowance (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Beginning Balance	$ 755	$ 169	$ 2,394
Additions charged to expense	0	375	0
Additions due to asset acquisition	0	265	0
Reductions from utilization, reassessments and expirations	(177)	(54)	(2,225)
Ending Balance	$ 578	$ 755	$ 169

Income Taxes - Schedule of Gross Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Beginning balance	$ 9,718	$ 8,525	$ 6,890
Increases in tax positions for prior years	0	0	0
Decreases in tax positions for prior years	(181)	(888)	(579)
Increases in tax positions for current year	2,881	2,081	2,214
Lapse in statute of limitations	(1,727)	0	0
Ending Balance	$ 10,691	$ 9,718	$ 8,525

Commitments, Contingencies, and Guarantees - Additional Information (Details) $ in Millions	12 Months Ended
	Dec. 31, 2020 USD ($)
Commitments And Contingencies Disclosure [Abstract]
Minimum purchase commitments for project related supplies	$ 12.5
Minimum purchase commitments, description	The Company has several minimum purchase commitments for project related supplies totaling $12.5 million as of December 31, 2020. In return for the commitment, Medpace receives preferential pricing. The commitments expire at various times through 2027.

Miscellaneous Income (Expense), Net - Components of Miscellaneous Income (Expense), Net (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Other Income And Expenses [Abstract]
Net gain (loss) on foreign-currency transactions	$ 514	$ (581)	$ 386
Other income (expense)	669	(282)	674
Miscellaneous income (expense), net	$ 1,183	$ (863)	$ 1,060

Related Party Transactions - Additional Information (Details)	3 Months Ended	12 Months Ended
	Sep. 30, 2018 Director	Dec. 31, 2020 USD ($) RenewalOption Agreement Building	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($) RenewalOption Agreement	Jan. 01, 2019 USD ($)
Related Party Transaction [Line Items]
Advanced billings		$ 6,500,000	$ 3,000,000.0
Accounts receivable and unbilled, net		2,600,000	1,900,000
Operating lease cost recognized		19,842,000	13,151,000
Lease expense recognized under 840				$ 9,200,000
Operating lease right-of-use assets		113,809,000	52,152,000		$ 51,854,000
Current portion of lease liability		15,890,000	10,977,000
Long-term portion of lease liabilities		115,143,000	45,212,000		45,294,000
Deemed landlord liability, long-term portions, under ASC 840					$ 0
Office Space
Related Party Transaction [Line Items]
Number of lease agreements \| Agreement				1
Direct Costs And Selling General And Administrative \| Office Space
Related Party Transaction [Line Items]
Operating lease cost recognized		3,600,000
Cinven
Related Party Transaction [Line Items]
Members of board of directors resigned as result of remaining shares of common stock sold \| Director	3
Director fees with related party				$ 100,000
Cinven \| Maximum
Related Party Transaction [Line Items]
Travel expenses with related party				100,000
Operating Lease Right-of-Use Assets \| Office Space
Related Party Transaction [Line Items]
Operating lease right-of-use assets		56,600,000
Other Current Liabilities \| Office Space
Related Party Transaction [Line Items]
Current portion of lease liability		700,000
Operating Lease Liabilities \| Office Space
Related Party Transaction [Line Items]
Long-term portion of lease liabilities		66,800,000
Employee Loans \| Prepaid Expenses and Other Current Assets and Other Assets
Related Party Transaction [Line Items]
Employee advances receivables		200,000	200,000
Service Agreements \| Cymabay
Related Party Transaction [Line Items]
Advanced billings			1,600,000
Accounts receivable and unbilled, net			1,400,000
Service Agreements \| Cymabay \| Revenue Net
Related Party Transaction [Line Items]
Revenue with related parties			13,200,000	10,800,000
Service Agreements \| LIB
Related Party Transaction [Line Items]
Advanced billings		700,000	500,000
Accounts receivable and unbilled, net		300,000	300,000
Service Agreements \| LIB \| Revenue Net
Related Party Transaction [Line Items]
Revenue with related parties		2,600,000	2,000,000.0	3,700,000
Service Agreements \| CinRx Pharma and Subsidiaries
Related Party Transaction [Line Items]
Advanced billings		5,800,000	900,000
Accounts receivable and unbilled, net		2,200,000	200,000
Service Agreements \| CinRx Pharma and Subsidiaries \| Revenue Net
Related Party Transaction [Line Items]
Revenue with related parties		13,200,000	3,700,000	500,000
Service Agreements \| The Summit
Related Party Transaction [Line Items]
Expenses incurred		$ 400,000	600,000	400,000
Leased Real Estate \| Chief Executive Officer
Related Party Transaction [Line Items]
Term of lease		12 years
Lease expiration period		2022-11
Number of lease renewal, 10-year option \| RenewalOption		1
Lease term upon renewal		10 years
Lease expense recognized under 840				$ 2,200,000
Leased Real Estate \| Chief Executive Officer \| Office Space
Related Party Transaction [Line Items]
Number of lease renewal, 10-year option \| RenewalOption				2
Lease term upon renewal				10 years
Lease expiration year				2040
Leased Real Estate \| Chief Executive Officer \| Direct Service Costs, Excluding Depreciation and Amortization, and Selling, General and Administrative
Related Party Transaction [Line Items]
Operating lease cost recognized		$ 2,000,000.0	2,000,000.0
Leased Real Estate \| Chief Executive Officer And Immediate Family \| Building
Related Party Transaction [Line Items]
Number of lease renewal, 10-year option \| RenewalOption		1
Lease term upon renewal		10 years
Lease expiration year		2027
Number of lease agreements \| Agreement		2
Number of buildings \| Building		2
Lease occupancy year		2012
Related party capital lease payments under ASC 840				$ 3,800,000
Leased Real Estate \| Chief Executive Officer And Immediate Family \| Direct Service Costs, Excluding Depreciation and Amortization, and Selling, General and Administrative \| Building
Related Party Transaction [Line Items]
Operating lease cost recognized		$ 3,600,000	3,600,000
Leased Real Estate \| Operating Lease Right-of-Use Assets \| Chief Executive Officer
Related Party Transaction [Line Items]
Operating lease right-of-use assets		3,500,000	5,300,000
Leased Real Estate \| Operating Lease Right-of-Use Assets \| Chief Executive Officer And Immediate Family \| Building
Related Party Transaction [Line Items]
Operating lease right-of-use assets		19,700,000	21,900,000
Leased Real Estate \| Other Current Liabilities \| Chief Executive Officer
Related Party Transaction [Line Items]
Current portion of lease liability		1,900,000	1,800,000
Leased Real Estate \| Other Current Liabilities \| Chief Executive Officer And Immediate Family \| Building
Related Party Transaction [Line Items]
Current portion of lease liability		2,400,000	2,300,000
Leased Real Estate \| Operating Lease Liabilities \| Chief Executive Officer
Related Party Transaction [Line Items]
Long-term portion of lease liabilities		1,600,000	3,500,000
Leased Real Estate \| Operating Lease Liabilities \| Chief Executive Officer And Immediate Family \| Building
Related Party Transaction [Line Items]
Long-term portion of lease liabilities		17,200,000	19,700,000
Travel Services \| Chief Executive Officer
Related Party Transaction [Line Items]
Travel expenses with related party		$ 700,000	$ 1,200,000	$ 1,300,000

Entity Wide Disclosures - Additional Information (Details)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
U.S. \| Total Revenue \| Geographical Locations
Product And Services Information [Line Items]
Percentage of total revenue to consolidated total revenue	96.00%	95.00%	97.00%

Entity Wide Disclosures - Summary of Property and Equipment, Net by Geographic Region (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019	Jan. 01, 2019
Property and equipment, net:
Property and equipment, net	$ 85,017	$ 47,292	$ 37,613
U.S.
Property and equipment, net:
Property and equipment, net	58,124	25,603
Europe, Belgium
Property and equipment, net:
Property and equipment, net	12,024	10,045
Europe, Other
Property and equipment, net:
Property and equipment, net	7,961	5,728
Europe
Property and equipment, net:
Property and equipment, net	19,985	15,773
Asia-Pacific
Property and equipment, net:
Property and equipment, net	6,566	5,671
Other
Property and equipment, net:
Property and equipment, net	$ 342	$ 245

Entity Wide Disclosures - Summary of Revenue by Major Source (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Disaggregation Of Revenue [Line Items]
Total revenue	$ 925,925	$ 860,969	$ 704,589
Oncology
Disaggregation Of Revenue [Line Items]
Total revenue	297,675	256,766	189,056
Other
Disaggregation Of Revenue [Line Items]
Total revenue	215,370	196,159	163,983
Metabolic
Disaggregation Of Revenue [Line Items]
Total revenue	126,075	138,650	124,837
AVAI
Disaggregation Of Revenue [Line Items]
Total revenue	103,259	86,390	77,271
Cardiology
Disaggregation Of Revenue [Line Items]
Total revenue	95,153	91,258	95,213
Central Nervous System
Disaggregation Of Revenue [Line Items]
Total revenue	88,393	91,746	54,229
Revenue Net
Disaggregation Of Revenue [Line Items]
Total revenue	$ 925,925	$ 860,969	$ 704,589

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130545-203045

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-Name Accounting Standards Codification
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-Section S99
-Paragraph 1
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-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details