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Syneos Health

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FY2017 Annual Report · Syneos Health
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549 

(Mark One)

FORM 10-K 

ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

         For the fiscal year ended December 31, 2017 

or

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

           For the transition period from _______ to ______

Commission File Number: 001-36730

SYNEOS HEALTH, INC. 
(Exact name of registrant as specified in its charter)

(State or other jurisdiction of incorporation or organization)

(I.R.S. Employer Identification No.)

Delaware

27-3403111

3201 Beechleaf Court, Suite 600
Raleigh, North Carolina

(Address of principal executive offices)

27604-1547

(Zip Code)

Registrant’s telephone number, including area code: (919) 876-9300 

Securities registered pursuant to Section 12(b) of the Act: 

Title of each class

Name of each exchange on which registered

Class A Common Stock, par value $0.01 per share

The NASDAQ Stock Market LLC

Securities registered pursuant to Section 12(g) of the Act: None

Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes  

   No  

Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or section 15(d) of the Exchange Act.  Yes  

   No  

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 
during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing 
requirements for the past 90 days.    Yes  

   No  

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File 
required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the 
registrant was required to submit and post such files).     Yes  

   No  

Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K is not contained herein, and will not be contained, to the 
best of registrant’s knowledge, in definitive proxy or information statements incorporated by reference in Part III of this Form 10-K or any amendment to 
this Form 10-K.   

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company. 
See definition of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and "emerging growth company" in Rule 12b-2 of the 
Exchange Act. (Check one): 

Large accelerated filer   

Non-accelerated filer   

  (Do not check if a smaller reporting company)

   Accelerated filer  
   Smaller reporting company   

Emerging growth company    

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any 
new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. 

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    Yes  

    No  

The aggregate market value of the registrant’s common stock held by non-affiliates of the registrant, based on the closing sale price of $58.50 on 
June 30, 2017, was approximately $3,169,493,379. Common stock held by each officer and director and by each person known to the registrant who 
owned 10% or more of the outstanding common stock have been excluded in that such persons may be deemed to be affiliates. This determination of 
affiliate status is not necessarily a conclusive determination for other purposes.

As of February 21, 2018, there were approximately 104,584,053 shares of the registrant's common stock outstanding. 

Portions of the registrant’s Proxy Statement for its 2018 Annual Meeting of Stockholders are incorporated by reference into Part III hereof. 

 
            
 
 
 
 
 
 
  
SYNEOS HEALTH, INC. 
FORM 10-K
For the Fiscal Year Ended December 31, 2017 

TABLE OF CONTENTS

PART I

Item 1.

Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Item 1A.

Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Item 1B.

Unresolved Staff Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Item 2.

Item 3.

Item 4.

Item 5.

Item 6

Item 7.

Properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Legal Proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mine Safety Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART II

Market for Registrants' Common Equity, Related Stockholder Matters, and Issuer Purchases of 
Equity Securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Selected Financial Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Management's Discussion and Analysis of Financial Condition and Results of Operations . . . . . . . .

Item 7A.

Quantitative and Qualitative Disclosures About Market Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Item 8.

Item 9.

Financial Statements and Supplementary Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Changes in and Disagreements with Accountants on Accounting and Financial Disclosure . . . . . . .

Item 9A.

Controls and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Item 9B.

Other Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART III

Item 10.

Directors, Executive Officers and Corporate Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Item 11.

Executive Compensation  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Item 12.

Security Ownership of Certain Beneficial Owners and Management and Related Stockholder 
Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Item 13.

Certain Relationships and Related Transactions and Director Independence . . . . . . . . . . . . . . . . . .

Item 14.

Principal Accountant Fees and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Item 15.

Exhibits and Financial Statement Schedules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Signatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Exhibit Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part IV

Page

2

26

53

53

54

54

55

58

65

87

88

145

145

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147

147

147

148

148

149

154

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PART I 

FORWARD-LOOKING STATEMENTS

This Annual Report on Form 10-K contains forward-looking statements within the meaning of Section 27A of 
the Securities Act of 1933, as amended, or the Securities Act, and Section 21E of the Securities Exchange Act 
of 1934, as amended, or the Exchange Act. Such forward-looking statements reflect, among other things, our 
current expectations and anticipated results of operations, all of which are subject to known and unknown 
risks, uncertainties and other factors that may cause our actual results, performance or achievements, market 
trends, or industry results to differ materially from those expressed or implied by such forward-looking 
statements. Therefore, any statements contained herein that are not statements of historical fact may be 
forward-looking statements and should be evaluated as such. Without limiting the foregoing, the words 
“anticipates,” “believes,” "can," "continue," "could," “estimates,” “expects,” “intends,” “may,” "might," “plans,” 
“projects,” “should,” "would," “targets,” “will” and the negative thereof and similar words and expressions are 
intended to identify forward-looking statements. These forward-looking statements are subject to a number of 
risks, uncertainties and assumptions, including those described in Part I, Item 1A, "Risk Factors" in this 
Annual Report on Form 10-K. Unless legally required, we assume no obligation to update any such forward-
looking information to reflect actual results or changes in the factors affecting such forward-looking 
information. 

As used in this report, the terms "Syneos Health, Inc.," "Company," "we," "us," and "our" mean Syneos 
Health, Inc. and its subsidiaries unless the context indicates otherwise.

Item 1.  Business.

Overview

We are a leading global biopharmaceutical services organization providing product development and 
commercial solutions through our clinical end-to-end contract research organization (“CRO”) and contract 
commercial organization (“CCO”). We offer both standalone and integrated biopharmaceutical solutions 
ranging from Early Phase (Phase I) clinical trials to the full commercialization of biopharmaceutical products. 
Our ability to achieve end-to-end solutions is based on our biopharmaceutical acceleration model ("BAM") 
where we synchronize our clinical and commercial capabilities – sharing knowledge, data, and insights. 

Our customers include large and small to mid-sized companies in the biopharmaceutical, biotechnology, and 
medical device industries. Our revenue is derived through a broad suite of services designed to enhance our 
customers’ ability to successfully develop, launch, and market products. Our competitive strengths include our 
broad continuum of clinical and commercial solutions, with our proprietary Trusted Process® methodology 
leading to faster, better-informed product development decisions, a focused effort on clinical research site 
relationships, robust data assets, and clinical trial design fueled by patient-centric commercial insights. 

Our organization has been recognized for innovative and best-in-class work. Our Clinical Solutions 
organization was named the "Top CRO to Work With" among the top global CROs in the 2017 CenterWatch 
Global Investigative Site Relationship Survey and the 2017 Society for Clinical Research Sites ("SCRS") 
Eagle Award in the CRO category. In addition, we also participate at the highest level of membership within 
the SCRS as a Global Impact Partner. Across our Commercial Solutions organization, our consulting business 
has been recognized by Forbes magazine as one of America’s Best Management Consulting Firms for the 
past two years, and our communications businesses have won more than 1,000 awards over the last decade. 
These awards include, among others, the 2017 Medical Marketing & Media Agency of the Year, PM360 
Greatest Creators and Trailblazer awards, and SABRE Superior Achievement in Branding, Reputation & 
Engagement. 

Founded more than three decades ago as an academic organization dedicated to central nervous system 
("CNS") research, we have translated that expertise into a global organization with deep therapeutic 
specialties, as well as full data services and regulatory advisory and implementation support capabilities. Over 
the past decade, we have built our scale and capabilities to become a leading global provider of Phase I to 
Phase IV clinical development services. We were established as INC Research in 1998, and our corporate 

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headquarters is located in Raleigh, North Carolina. As a result of a corporate reorganization in connection 
with a business combination transaction, INC Research Holdings, Inc., was incorporated in Delaware in 
August 2010, and we changed our name to Syneos Health, Inc. after our 2017 Merger with inVentiv Health 
(the "Merger"). The merger of these two companies combined clinical and commercial expertise, scale, data, 
and insights to facilitate faster delivery of evidence-based medicines to patients worldwide. With 
approximately 21,000 employees in more than 60 countries across six continents as of December 31, 2017, 
our combined broad global presence allows us to deliver our services in more than 110 countries, providing 
our customers with access to diverse markets and patient populations, local regulatory expertise, and local 
market knowledge. See further discussion in "Note 3 - Business Combinations" to our consolidated financial 
statements included in Part II, Item 8, "Financial Statements and Supplementary Data" of this Annual Report 
on Form 10-K for additional details on the Merger. 

Following the Merger, effective August 1, 2017, we realigned our operating segments into two reportable 
segments: Clinical Solutions and Commercial Solutions to reflect the current structure under which we 
operate, evaluate our performance, make strategic decisions, and allocate resources. 

Our Clinical Solutions segment offers a variety of clinical development services spanning Phase I to Phase IV, 
including full-service global studies, as well as unbundled service offerings such as clinical monitoring, 
investigator recruitment, patient recruitment, data management, and study startup to assist customers with 
their drug development process. Our Commercial Solutions segment provides customers with a full range of 
commercialization services, including outsourced field selling solutions, medication adherence, 
communications (advertising and public relations), and consulting services. Our strategic, insights-driven 
approach provides our customers with a single source, integrated end-to end solution that spans the entire 
product lifecycle, designed to increase the likelihood of a successful product launch and commercial 
profitability. We offer those services in either a full service or individual, unbundled basis depending on 
customers' needs. 

Our management reviews segment performance and allocates resources based upon segment revenue and 
segment operating income. Historical segment reporting has been revised to reflect these changes to our 
segment structure. Prior to the Merger, our Commercial Solutions segment consisted solely of consulting 
services. For further information about the Company's reportable segments, please see "Note 14 - Segment 
Information" in our consolidated financial statements included in Part II, Item 8, "Financial Statements and 
Supplementary Data” of this Annual Report on Form 10-K. For financial information about our revenue and 
long-lived assets by geographic area, please see "Note 15 - Operations by Geographic Location" in our 
consolidated financial statements included in Part II, Item 8, "Financial Statements and Supplementary Data” 
of this Annual Report on Form 10-K. Our international operations expose us to risks that differ from those 
applicable to operating in the United States, including foreign currency translation and transaction risks, risks 
of changes in tax and labor laws, and other risks described further in Part I, Item 1A, "Risk Factors" of this 
Annual Report on Form 10-K.

For the year ended December 31, 2017, total net service revenue was $1.85 billion, net loss was $138.5 
million, Adjusted Net Income was $196.0 million, and Adjusted EBITDA was $391.9 million. For important 
disclosures about our non-GAAP measures and a reconciliation of Adjusted Net Income and Adjusted 
EBITDA to our GAAP net income (loss), see Part II, Item 6, "Selected Financial Data" of this Annual Report on 
Form 10-K. For further information about our consolidated revenues and earnings, see our consolidated 
financial statements included in Part II, Item 8, "Financial Statements and Supplementary Data" and Part II, 
Item 7, "Management's Discussion and Analysis of Financial Condition and Results of Operations" of this 
Annual Report on Form 10-K.  

Our Market

The market for our integrated solutions is primarily the biopharmaceutical industry that utilizes outsourced 
clinical drug development and commercialization services. We believe we are well-positioned to benefit from 
the following market trends:

Trends in clinical drug development.  Biopharmaceutical companies continue to prioritize the outsourcing 
of Phase I to Phase IV clinical trials, particularly in complex, high-growth therapeutic areas such as CNS, 

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oncology and other complex diseases. Additionally, small and mid-sized biopharmaceutical companies 
typically have limited infrastructure and therefore are far more likely to outsource their clinical development to 
CROs. We estimate, based on industry sources (including analysts' reports), and management's knowledge, 
that the market for CRO services for Phase I to Phase IV clinical development services will grow at an 
average annual rate of 5% to 7% through 2020, driven by a combination of increased development spending 
and further outsourcing penetration. In addition, we estimate that total biopharmaceutical spending on drug 
development in 2017 was approximately $89.0 billion, of which the clinical development market, which is the 
market for drug development following pre-clinical research, was approximately $77.0 billion. Of the $77.0 
billion, we estimate our total addressable market to be $62.0 billion, after excluding $15.0 billion of indirect 
fees paid to principal investigators and clinical research sites, which are not a part of the CRO market. We 
estimate that total biopharmaceutical spending on clinical development will grow at a rate of 2% to 4% 
annually through 2020. In 2017, we estimate biopharmaceutical companies outsourced approximately $31.0 
billion of clinical development spending to CROs, representing a 7% increase compared to 2016 and a 
penetration rate of 49% of our total addressable market. We estimate that this penetration rate will increase to 
approximately 52% of our total addressable market by 2020. 

Within the overall Phase I to Phase IV market segment, the Phase IV/post-approval/Real World Evidence 
sub-segment represents a large area of spending where outsourcing penetration is lower than traditional 
clinical development and pharmaceutical industry trends are creating increasing demand. 

Trends in commercialization outsourcing.  

We believe that, based on industry sources (including analysts' reports), and management's knowledge, that 
the market for CCO services will grow at an average annual rate of 7% through 2020, driven by a combination 
of increased sales and marketing spending and further outsourcing penetration. We estimate that the total 
addressable market for commercialization services was approximately $154.0 billion in 2017, as determined 
by our analysis of biopharmaceutical selling, general, and administrative ("SG&A") trends and related sales 
and marketing budgets over the past 10 years. In 2017, we estimate biopharmaceutical companies 
outsourced approximately $24.0 billion of this commercialization spending to CCOs, representing a 
penetration rate of approximately 16% of the total addressable commercial market. We estimate that this 
penetration rate will increase to approximately 19% of our total addressable market by 2020, while the 
underlying biopharmaceutical sales and marketing spending will grow at a rate of 1% to 3% annually during 
this same time period. We project that over time this market may follow a similar outsourcing penetration 
trajectory as the clinical development market, resulting in the potential for long-term revenue growth. We 
believe this potential for growth is supported by: (i) significant biopharmaceutical sales and marketing budgets 
– generally at least 10% greater than research and development ("R&D") budgets at large biopharmaceutical 
companies; (ii) a continuing shift toward specialty and more complex therapies requiring more complex and 
integrated sales and marketing execution and experience; (iii) a robust funding environment, which provides 
capital to fuel growth in development and commercialization spending, particularly with small to mid-sized 
companies that wish to remain independent, (iv) significant outsourcing penetration opportunities; (v) an 
evolving industry landscape illustrated by a shift to longer and more strategic relationships; and (vi) significant 
downward pressure on pharmaceutical pricing. 

Increasingly challenging development and commercialization environment. The biopharmaceutical 
industry is currently facing a number of challenges, including: (i) margin deterioration; (ii) reimbursement and 
provider access hurdles; (iii) the declining attractiveness of non-core brands resulting in fewer blockbuster 
and higher profitability drugs reaching the market; (iv) continued pressure from generic brand exposure 
resulting from expiring patents; and (v) the consolidation of payers, health systems, providers, and 
pharmacies. These challenges are also making physicians and patients more difficult to engage, making new 
product launches more difficult. At the same time, the industry is experiencing growing demand for specialty 
drugs, pressure to achieve improvements in R&D productivity, the transition of the healthcare industry 
worldwide from a volume-based to a value-based reimbursement structure, and growing political and pricing 
pressures. Existing approaches to address these challenges include reducing overhead costs, optimizing the 
deployment of marketing and field assets, and refocusing product portfolios around therapeutic areas with 
depth of presence and expanded market access capabilities. 

4

Optimization of biopharmaceutical R&D efficiency.  Market forces and healthcare reform, including the 
Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act, 
the 21st Century Cures Act, and other governmental initiatives, place significant pressure on 
biopharmaceutical companies to improve cost efficiency. Companies need to demonstrate the relative 
improvement in quality, safety, and effectiveness of new therapies as compared to existing approved 
therapies as early as possible in the development process. CROs can help biopharmaceutical companies 
deploy capital more efficiently as many biopharmaceutical companies do not have adequate in-house 
development resources. In response to high clinical trial costs, particularly in therapeutic areas such as CNS 
and oncology, which we believe present the highest mean cost per patient across all clinical trials, 
biopharmaceutical companies are streamlining operations and shifting development to external providers to 
lower fixed costs. 

Globalization of clinical trials.  Clinical trials have become increasingly global as biopharmaceutical 
companies seek to accelerate patient recruitment, particularly within protocol-eligible, treatment-naïve patient 
populations without co-morbidities that could skew clinical outcomes. Biopharmaceutical companies are also 
increasingly seeking to expand the commercial potential of their products by applying for regulatory approvals 
in multiple countries, including fast-growing economies that are spending more on healthcare. As part of the 
biopharmaceutical approval process in newer markets, especially in certain Asian and emerging markets, 
regulators now often require trials to include specific percentages or numbers of people from local 
populations, resulting in a combination of multinational and domestic trials. 

Management of increasingly complex trials.  The biopharmaceutical industry operates in an increasingly 
sophisticated and highly-regulated environment and has responded to the demands of novel therapeutics by 
adapting efficient drug development processes. Complex trial design expertise has emerged as a significant 
competitive advantage for select CROs that have a track record of successfully navigating country-specific 
regulatory, trial protocol, and patient enrollment barriers, including sometimes subjective, evolving clinical 
endpoints. In addition, the therapeutic areas where we have significant experience and expertise, including 
CNS, oncology, and other complex diseases, often require more complicated testing protocols than other 
disease indications. Many of these studies have longer durations due to these factors resulting in demand for 
greater clinical trial proficiency and expertise in these therapeutic areas, particularly in light of new methods of 
testing, such as the use of biomarkers and gene therapy. 

Evolving commercialization outsourcing needs for large vs. small to mid-sized pharma.  Given the 
increasingly challenging commercialization environment outlined previously, the needs of biopharmaceutical 
companies are ever-changing. The needs of large versus small to mid-sized customers are developing 
differently based upon infrastructure and corporate commercialization goals, requiring diverse approaches 
and capabilities. Large biopharmaceutical companies tend to have more robust internal resources, and are 
more often seeking to augment these resources with individual services on a brand-by-brand basis. They are 
also frequently looking for enterprise vendor relationships that achieve broader cost savings based upon 
volume considerations of their products. Smaller biopharmaceutical companies typically have a limited 
number of products, and very limited internal resources and expertise for commercialization, requiring the full 
spectrum of commercialization capabilities, similar to outsourced clinical development patterns. Historically 
these commercialization considerations may have required small to mid-sized companies to surrender a 
significant portion of their long-term economic value in licensing arrangements. 

Our Competitive Strengths

We believe that our ability to provide integrated clinical drug development and commercial solutions positions 
us to address market realities where these disciplines must work together to accelerate the delivery of 
important therapies to market. Our key competitive strengths are:

Global leadership in biopharmaceutical outsourcing with differentiated positioning. We believe our 
comprehensive suite of clinical and commercial services differentiates us in the marketplace. We offer our 
services through a highly skilled staff of approximately 21,000 employees located in more than 60 countries 
as of December 31, 2017, and have conducted work in more than 110 countries. Over 84% of all new 
molecular entities approved by the U.S. Food and Drug Administration ("FDA") and 70% of the products 

5

granted marketing authorization by the European Medicines Agency ("EMA") over the last five years have 
been developed or commercialized with our support. We believe our scale, global reach, and breadth of 
services, coupled with our deep industry expertise and experience, enable us to offer the solutions our 
customers require to navigate an increasingly complex and evolving market. In addition, we believe our 
customers are seeking to consolidate their outsourcing to a smaller set of large global providers in order to 
address changing industry dynamics. 

Innovative operating model - the Trusted Process®. Since 2006, we have conducted clinical trials using 
our innovative Trusted Process® operating model, which is designed to standardize methodologies, increase 
the predictability of the delivery of our services, and reduce operational risk. We accomplish standardized 
delivery through support from a company-wide Project Management Office, which defines, maintains, and 
improves procedures relating to the Trusted Process® and ensures consistent application globally. Since 
initiation of the Trusted Process®, we have reduced median clinical study start-up time (defined as the period 
from finalized protocol to first patient enrolled) on new projects. Based on industry sources for the median 
study start-up time for the biopharmaceutical industry, we believe we achieve this milestone for our customers 
at a faster pace than the industry, due in part to this proprietary methodology. In addition to the absolute 
reduction of cycle times in critical path milestones, we believe we provide greater operating efficiency, more 
predictable project schedules, and a reduction in overall project timelines. The metrics-driven Trusted 
Process® methodology is divided into four sub-processes which correlate to the key phases of a clinical 
project:

•  PlanActivation® — the design phase, where a project is analyzed and a strategy developed utilizing 
our therapeutic and clinical experience, forming the basis of a customized project proposal. The 
strategy continues to be refined based on discussions with the customer through new business 
award; 

•  QuickStart® — the initiating phase, which serves to align the customer and our project team to a 

single set of objectives, create shared expectations and develop a joint plan for project 
implementation;

•  ProgramAccelerate® — the execution and control phase, which includes the processes of patient 
recruitment, clinical monitoring and data management. In this phase, we proactively process and 
review data to ensure quality and project timelines are actively managed, while maintaining strong 
relationships with investigative sites; and

•  QualityFinish® — the closing phase, which is triggered by the first enrolled patient completing the 

clinical trial. This phase focuses on ensuring high quality, actionable data is used to develop the final 
deliverables which make up the basis of the documentation necessary for filing with regulatory 
agencies.

While initially developed to better manage clinical trial complexity, the Trusted Process® is being actively 
deployed across our commercial service portfolio to further drive consistency and quality in our integrated 
operations.

Functional Service Provider Model. Our Functional Service Provider ("FSP") model provides flexible 
resourcing solutions in the areas of biostatistics and programming, data management, drug safety and 
pharmacovigilance, medical writing and clinical monitoring. Our model includes a comprehensive plan 
designed to ensure both speed and quality for operations, relationship management, communication, quality 
and risk mitigation, and internal processes and tools. We collaborate extensively across functional teams to 
ensure customer needs are appropriately identified and supported. Additionally, we provide clinical staffing 
solutions in the areas of contract staffing and direct placement hire.

Adding value across the biopharmaceutical product lifecycle. Our broad suite of services allows us to 
deliver customized solutions and provide value to biopharmaceutical companies and other key constituents 
across the healthcare delivery system. We are uniquely positioned to leverage our broad experience and 
proprietary data assets across our offerings, providing end-to-end solutions that help biopharmaceutical 

6

customers optimize execution and reduce costs throughout the product lifecycle using the following 
capabilities:

•  Superior clinical trial design: We leverage our expanding clinical and commercial knowledge capital 
and access claims data from over 100 million patients in the United States to inform and enhance 
clinical trial design. These insights facilitate shorter and more efficient trials intended to improve the 
likelihood of regulatory and subsequent commercial success.

•  Enhanced site selection and patient recruitment: We utilize proprietary data assets, behavioral 

insights, social media and communications capabilities to enhance the speed and success of site 
selection and patient recruitment.

•  Proactive pre-launch reimbursement and formulary management: We bridge the gap between clinical 
development and commercialization by using our diverse capabilities and ability to communicate 
clinical benefits to payers and Pharmacy Benefit Managers ("PBMs") to help optimize reimbursement 
and patient access.

•  Highly effective commercial product launch capabilities: We help our customers navigate the global 
complexities of launching a product by orchestrating interconnected work streams to develop and 
execute an effective product launch strategy.

•  Proprietary programs to improve medication adherence: We have the ability to reach over 193 million 
patients through multi-channel medication adherence programs designed to mitigate costs related to 
non-adherence, which are estimated by the Centers for Disease Control and Prevention to exceed 
$100 billion to $300 billion annually.

•  Full commercialization solutions: We enable new companies to develop, launch, and commercially 

support their brands by accessing our comprehensive outsourced services, and acting as their virtual 
commercialization infrastructure.

•  Efficient project ramp-up: We scale clinical or commercial projects rapidly and effectively through our 

recruiting, training, and deployment capabilities, leveraging over 150 dedicated recruiting personnel 
and our proprietary database of over 700,000 industry professionals.

Access to robust data assets. We have access to significant data assets through our clinical and 
commercial operations, our medication adherence services, and a variety of third party providers. These data 
assets provide insights to our customers to support their product development and commercialization efforts. 
With more than 50% of all U.S. retail prescriptions ("scripts") and relationships with more than 30 of the top 
retail pharmacy chains that represent more than 28,750 pharmacies, 193 million patients, and 2.25 billion 
unique scripts each year, we are able to support all aspects of our end-to-end product development services, 
including clinical trial protocol design, site selection, patient recruitment, selling solutions program design and 
management, and pricing and market access consulting, among others. Furthermore, relationships we have 
in place with third-party partners provide us a breadth of coverage for these insights that reaches Europe and 
allow us to reach more than 400 million patients throughout North America and the European Union ("EU") 
and United Kingdom.

We place a high importance on leveraging the insights we derive from our Adheris Health Patient 
Performance and Outcomes platform to improve our site and investigator interactions. Our market leading 
commercial capabilities enable our teams to focus their efforts on proactively enhancing planning, driving 
improved adherence with therapies, and producing more predictable outcomes for our customers. Also, by 
utilizing our exclusive retail network, we provide patient-level insights that enhance our decision-making and 
collaboration with our clinical customers who can then leverage these insights to make informed, actionable, 
and impactful decisions in an increasingly competitive market. 

Deep and long-standing therapeutic expertise and organization.  We provide our customers with highly-
differentiated, specialized teams that leverage our broad offering of world-class therapeutic expertise in both 
our Clinical Solutions and Commercial Solutions segments. Our therapeutic expertise is managed by our 

7

senior leadership and delivered by our senior scientific and medical staff and our clinical research associates 
("CRAs") within our various therapeutic areas. Importantly, we believe we are unique in organizing our 
therapeutic business units down to the CRA level, rather than operating with a broader pool of these 
resources. We believe this therapeutic alignment improves the effectiveness and efficiency of our customers' 
clinical trials by ensuring that our clinical staff working at our investigative sites have the therapeutic expertise 
and experience to manage the trial. Industry analysts have reported that therapeutic expertise is the most 
influential factor for sponsors of clinical trials in selecting a CRO. We believe that our expertise in managing 
complex clinical trials differentiates us from our competitors and has played a key role in our growth, our 
ability to win new clinical trials, and our successful relationship development with clinical research sites. We 
also believe our specialized therapeutic expertise within our Commercial Solutions segment is unique in our 
industry and becoming increasingly important to our customers as therapies become more complex and 
targeted. Our experienced medical and scientific professionals include more than 950 employees with M.D.s, 
Ph.D.s, or Pharm D.s. These employees apply innovative insights and science to clinical trials as well as to 
the commercialization of products and support customers across both our Clinical Solutions and Commercial 
Solutions segments. 

Industry-leading principal investigator and clinical research site relationships.  We have extensive 
relationships with principal investigators and clinical research sites. We believe these quality relationships are 
critical for delivering clinical trial results on time and on budget for our customers. Motivated and engaged 
investigative sites can facilitate faster patient recruitment, increase retention, maintain safety, ensure 
compliance with protocols as well as with local and international regulations, and streamline reporting.  The 
ability to recruit and retain principal investigators and patients is an integral part of the clinical trial process. 
We have dedicated personnel focused on enhancing clinical research site relationships; we work with these 
sites in collaborative partnerships to improve cycle times and standardize start-up activities to drive efficiency. 

Diversified and loyal customer base.  We are diversified across our segments, deriving 79% and 21% of 
our net service revenue during 2017 from our Clinical Solutions and Commercial Solutions segments, 
respectively. We have a well-diversified, loyal customer base of over 500 customers that includes each of the 
50 largest global biopharmaceutical companies (based on annual investment in research and development) 
as well as high-growth, small and mid-sized biopharmaceutical companies. During 2017, we provided both 
clinical and commercial services to 64 customers. We have several customers with whom we have achieved 
"preferred provider" or strategic alliance relationships. We define these customers as relationships from which 
we generate significant revenue and where we have executed master service agreements in addition to 
regularly scheduled strategy meetings to discuss the status of our relationship, and for which we serve as a 
preferred supplier of services. We believe these relationships provide us enhanced opportunities for more 
business, although they are not a guarantee of future business. Our top five customers accounted for 
approximately 22% of our net service revenue in 2017. 

Our customer base is geographically diverse with well-established relationships in the United States, Europe, 
and Asia. As of December 31, 2017, our top ten customers had worked with us for an average of 18 years. 
We believe that the tenure of our customer relationships as well as the depth of penetration of our services 
reflect our strong reputation and track record. We believe we are uniquely positioned to further penetrate our 
existing customer base and expand our services across the biopharmaceutical industry, as a significant 
number of the top 50 biopharmaceutical companies utilize both clinical and commercial services. The 
flexibility and depth of our services enables us to scale our commercialization solutions to address our 
customers' needs. We connect and integrate clinical and commercial disciplines, enabling biopharmaceutical 
companies of all sizes to accelerate the commercialization of assets by bringing market access insights into 
the clinical trial design, reducing complexity, maximizing speed, and enhancing economic efficiency.

Highly experienced management team with a deep-rooted culture of quality and innovation.  We are 
led by a dedicated and experienced senior management team with significant experience and knowledge 
focused on the biopharmaceutical industry. Each member of our senior management team has 20 years or 
more of relevant experience, including experience with biopharmaceutical companies, payers, and health 
systems. This team has successfully grown our company into a leading biopharmaceutical solutions 
organization through a combination of organic growth and strategic acquisitions. 

8

Our Business Strategy

Our goal is to generate profitable revenue growth, achieve differentiation in the marketplace in both of our 
segments, and increase margins through operational efficiency initiatives. We believe our end-to-end product 
development model, where clinical insights inform commercialization and commercial insights improve clinical 
trial design and execution, is unique to the industry. The key elements of our business strategy include:

Increase market share through our unmatched service offerings and scale. We believe we are 
uniquely positioned to meet our customers’ evolving needs as the only provider of a full suite of services 
through the clinical development and commercialization continuum. Our size and scale enable us to 
provide solutions designed to accelerate our customers’ clinical or commercial projects, driving speed and 
cost efficiencies. Our ability to engage customers in the early phases of clinical trials with respect to 
commercial insights allows them to make more informed decisions on clinical trial design and strategies, 
which we believe is a key differentiator from our competitors. Our Real World and Late Phase offering 
acts as the critical bridge from clinical effectiveness to commercial viability. The capabilities to move from 
development to commercialization require a comprehensive approach that integrates strategic, creative, 
and operational expertise. Our Integrated Solutions Group ("ISG") is comprised of dedicated industry 
veterans and product strategists with regulatory, clinical, commercial, and real world expertise that 
uniquely positions us to help our customers determine the right mix of clinical and commercial solutions 
needed throughout the product life cycle. Our unique integration of strategy and operations results in 
multiple selling points along the operational timeline of product development.

We intend to leverage our differentiated service offerings to increase our share of the growing market for 
outsourced clinical and commercialization services. We believe the need for a full suite of services is 
particularly strong with our small to mid-sized customers, given their rapid growth and limited internal 
resources. We intend to capitalize on this market opportunity with existing and potential customers 
through a variety of channels, but primarily through the consultative sales approach of our ISG. The ISG is 
a dedicated group of industry veterans and product strategists with regulatory, clinical, commercial and 
Real World Evidence expertise. The ISG is uniquely positioned to determine the appropriate mix of clinical 
and commercial solutions to help customers optimize the development process for their products and 
maximize the return on their investment. 

Leverage our market leadership position in large and attractive markets.  Our Clinical Solutions and 
Commercial Solutions segments are benefiting from specific industry trends that are expected to drive 
attractive growth. We believe outsourcing late-stage clinical development services to CROs optimizes returns 
on invested R&D for biopharmaceutical companies. As business models continue to evolve in the healthcare 
sector, we believe that the rate of commercial outsourcing may follow a similar long-term path to the clinical 
development market. Global demand for biopharmaceutical products continues to increase, driven by 
expanding access to care, increasing life expectancy, and the growing prevalence of chronic conditions in 
both developed and emerging markets. Higher costs and increased complexity are driving our customers to 
seek efficiency and expertise through outsourcing services. We intend to capitalize on these trends by 
continuing to provide the services our customers need. Additionally, we believe that our differentiated 
approach of investing in highly experienced people, making better use of enabling technology, improving the 
process of clinical development and commercialization, and integrating our significant data and insights 
across these disciplines will allow our customers to generate superior returns. 

Leverage our expertise in delivering complex clinical trials and deepen our therapeutic expertise in 
fast-growing areas.  We intend to continue to develop and leverage our therapeutic and operational 
expertise in delivering complex clinical trials. Our extensive use of insights gained from fit-for-purpose data 
sources and our relationships with principal investigators and clinical research sites with longstanding patient 
relationships are especially critical in delivering complex clinical trials. This is enhanced by the use of our 
proprietary Trusted Process® methodology that reduces operational risk and variability by standardizing 
processes, minimizing delays, instilling quality throughout the clinical development process, and leading 
customers to more confident, better-informed drug development decisions.  We believe this collective 
expertise, data, and insights into complex clinical trials uniquely informs our customers’ decisions about their 
regulatory and payer approvals, market access, reimbursement and formulary inclusion, and other steps that 
are critical to optimizing their returns in the commercialization process.  

9

Drive acceleration of commercial outsourcing.  We have continuously expanded and invested in our 
commercial outsourcing capabilities and we intend to leverage our extensive knowledge, experience and 
broad offerings to drive expansion of the commercial outsourcing opportunity with new and existing 
customers. We believe the market for our full suite of services is evolving based upon the different needs 
of large biopharmaceutical companies compared to small to mid-sized companies, based upon their 
infrastructure and corporate commercialization goals. Large biopharmaceutical companies are often 
seeking broader cost savings through enterprise vendor relationships that leverage their volume of 
products. However, smaller biopharmaceutical companies typically require the full spectrum of 
commercialization capabilities, given their limited internal resources. Historically, this may have required 
these smaller companies to surrender a significant portion of their long term economic value in a licensing 
arrangement to achieve commercialization. However, with sufficient capital given today’s funding 
environment, we believe these companies may be more receptive to commercialization alternatives that 
allow them to maintain their independence. Although we are well positioned to capitalize on the needs of 
both customer types, we believe that the market dynamics for these small to mid-sized customers will be 
a key catalyst to driving further adoption of commercial outsourcing. Our ISG is purpose-built to leverage 
this market dynamic, using our strong clinical presence and relationships in the small to mid-sized 
customer segment. We believe that having the capability to provide our customers with a 
commercialization plan may increase their overall success with the sales of a drug once FDA approval is 
received.

Increase cross-selling with existing customers.  We believe that we have substantial opportunities to 
expand the reach of our services that we provide to our existing customers. During 2017, 64 customers, 
of which 43 were also in our top 100 customers, utilized services from both our Clinical Solutions and 
Commercial Solutions segments demonstrating our belief that there is both market precedent and 
significant potential to sell additional services to our existing customer base. Given our past success in 
expanding the scope of services provided to current customers, we intend to further expand our business 
with our existing customers by cross-selling additional clinical and commercial services. As part of our 
cross-selling efforts, we market the potential operational and economic efficiencies that customers can 
achieve by using more of our services throughout the product lifecycle.

Capitalize on our geographic scale.  We intend to leverage our global breadth and scale to drive continued 
growth and target segments of the biopharmaceutical market in which we are underpenetrated. Additionally, 
we have developed a global platform with a presence in all of the major biopharmaceutical markets in the 
world and intend to further expand our business outside of the United States. We are focused on replicating 
our success in the U.S. market to other major biopharmaceutical markets around the world. We have 
expanded our capabilities, existing relationships, and local regulatory knowledge, which should continue to 
position us well for new customer wins in a wide array of markets. We have added geographic reach through 
both acquisitions and organic growth in areas such as Asia-Pacific, Latin America, and the Middle East and 
Africa, which we believe is critical to obtaining larger new business awards from large and mid-sized 
biopharmaceutical companies. Our long-term growth opportunities are enhanced by our strong reputation in 
emerging markets and our proven track record of performance. We may also selectively identify and acquire 
complementary businesses to enhance our services, capabilities, and geographic presence. 

Continue to enhance our Trusted Process® methodology to deliver superior outcomes.  We intend to 
continue the development and enhancement of our Trusted Process® methodology, which has delivered 
measurable, beneficial results for our customers and improved drug development decisions. While originally 
developed through years of experience and refinement in our Clinical Solutions segment, we also intend to 
adapt and deploy the Trusted Process® across our Commercial Solutions segment. We believe our Trusted 
Process® will continue to lead to high levels of customer satisfaction. 

Continue our proven track record of successfully integrating companies to augment our organic 
growth. Over the past decade, we have developed a systematic approach for integrating operations. We 
have successfully integrated ten companies, including both strategic and tuck-in acquisitions. These strategic 
acquisitions have increased our size, scale, and reach, complementing our organic growth profile as we have 
become a leading biopharmaceutical solutions organization. Our mergers and acquisitions have enabled us to 
provide fully integrated clinical and commercial solutions to our customers and expand our global service 
offerings while also allowing us to achieve significant synergies and cost reductions. In the near term, our 

10

primary focus will be continuing the successful integration related to the Merger, but we intend to continue 
evaluating selective tuck-in acquisition opportunities that we believe will enhance our services offerings and 
geographic presence. 

Drive our human capital asset base to grow existing relationships.  Our employees are critical to our 
ability to deliver our innovative operational model by engaging with customers, delivering clinical development 
services in a complex environment, and supporting and executing our growth strategy. Our recruiting and 
retention efforts are geared toward maintaining and growing a stable workforce, focused on delivering results 
for customers. We have a successful track record of integrating talent from prior acquisitions and believe we 
have a best-in-class pool of highly experienced project management professionals, CRAs, and 
communications, advertising, and consulting experts. Based on industry reporting, we also believe that our 
employee retention rates are consistent or better than the industry averages, and we intend to continue 
fostering an employee-friendly environment that promotes retention. 

Our Services

We provide services through two reportable segments: Clinical Solutions and Commercial Solutions. Each 
reportable segment provides multiple service offerings that – when combined through the sharing of critical 
insights and data, which we refer to as our Biopharmaceutical Acceleration Model – creates a fully-integrated 
biopharmaceutical outsourced services provider. Our Clinical Solutions segment offers a variety of clinical 
development services spanning Phase I to Phase IV, including full-service global studies, unbundled service 
offerings, and Real World Evidence studies. Our Commercial Solutions segment provides customers with the 
full range of commercialization solutions, which include outsourced field promotion and medication 
adherence services, communication solutions (advertising and public relations), and consulting services.

Clinical Solutions 

Our extensive range of clinical solutions supports the entire clinical development process from Phase I to 
Phase IV and allows us to offer our customers an integrated suite of investigative site support and clinical 
development services. We offer these services across a wide variety of therapeutic areas with deep clinical 
expertise with a primary focus on Phase II to Phase IV clinical trials. We believe our therapeutic focus and 
proprietary project management methodology have set us apart within our industry. We have particular 
strengths in the complex therapeutic areas such as CNS and Oncology which represent the largest and 
fastest growing therapeutic areas. We provide total biopharmaceutical program development through our Full 

11

Service platform, while also providing discrete services for any part of a trial, often known as FSP, primarily 
through our Strategic Resourcing Group. The combination of service area experts and the depth of clinical 
capability allows for enhanced protocol design and actionable trial data. Importantly, all of our services in 
Clinical Solutions operate with the discipline of the Trusted Process®, which we believe improves overall 
quality, consistency, and delivery timelines. Our comprehensive suite of clinical development services and 
delivery platforms includes, but is not limited to:

Full Service Clinical Development 

Our full service clinical development offering provides comprehensive solutions to address the clinical 
development needs of our customers, primarily in Phase II-IV. Our solutions can be delivered on a full-service 
project basis, on a functional or resource basis (see Strategic Resourcing below), or through a combination or 
hybrid approach depending on the needs of our customers. We are able to customize our services to provide 
customers support within an individual clinical study, a single function, multiple functions within a single 
therapeutic area, or across a customer’s entire product portfolio. We can leverage our extensive knowledge 
capital across both our Clinical Solutions and Commercial Solutions segments to inform clinical development 
strategy and trial design. Our comprehensive suite of clinical development services includes the following, 
among others:

•  Patient Recruitment and Retention.  Our patient recruitment services group helps identify and 

manage appropriate vendors, focuses on patient recruitment and retention strategies, and acts as a 
liaison to media outlets and other vendors that we have validated.

•  Site Start Up. Our site start up team helps maximize the enrollment period of the study by arranging 
applicable regulatory authority and ethics committee approvals, site contract negotiation, regulatory 
authority submissions, and the corresponding oversight of those activities. 

•  Project Management.  Our project managers and directors provide customer-focused leadership in 

managing clinical trials and are accountable for the successful execution of all assigned projects, 
where success includes on-time, on-budget, and high quality results that lead to satisfied customers. 
Project managers and directors have the skills, education, experience, and training to support the 
successful conduct of clinical studies.

•  Clinical Monitoring.  Our clinical monitors oversee the conduct of a clinical trial by working with and 
monitoring clinical research sites to ensure the quality of the data. The clinical monitor ensures the 
trial is conducted according to Good Clinical Practice ("GCP"), International Conference on 
Harmonisation ("ICH") guidelines, and local regulations, to meet the customers' and regulatory 
authorities' requirements according to the study protocol. CRAs engage with clinical research sites in 
site initiation, training, and patient recruitment. We deploy and manage clinical monitoring staff in all 
regions of the globe. By maintaining a therapeutic focus, we attract CRAs who have a strong desire to 
dedicate themselves to working within a specific therapeutic area, providing an environment where 
they can further develop their expertise in their chosen area of interest.

•  Drug Safety/Pharmacovigilance.  Our drug safety teams are strategically located across the United 

States, Europe, Latin America, and Asia-Pacific. We provide global drug safety expertise in all phases 
of clinical research for serious adverse event/adverse event collection, evaluation, classification, 
reporting, reconciliation, post-marketing safety, and pharmacovigilance.

•  Medical Affairs.  We have in-house physicians who provide 24/7 medical monitoring, scientific and 

medical support for project management teams and clinical research sites. These in-house 
physicians consist of senior clinicians and former clinical researchers with patient care and trial 
management expertise.

•  Quality Assurance.  Quality control steps are built into all of our processes. We have an independent 

quality assurance department that, in addition to conducting independent audits of all ongoing 
projects and processes as part of our internal quality assurance program, offers contracted quality 
assurance services to customers, including audits of clinical research sites and of various vendors to 

12

the clinical research industry, mock regulatory inspections and clinical research site inspection-
readiness training, standard operating procedure development, and quality assurance program 
development/consultation. Our customers also engage us to conduct third-party audits on behalf of 
their studies. 

•  Regulatory and Medical Writing.  We offer regulatory and medical writing expertise across the entire 

biopharmaceutical product lifecycle. Our team has hands-on regulatory and medical writing 
knowledge gained through experience from working in large biopharmaceutical companies, as well as 
high-growth, small and mid-sized biopharmaceutical companies, CROs, and the FDA. Additionally, 
each member is trained in FDA regulations, including GCP/standard operating practice compliance 
guidelines and guidelines established by the ICH.

•  Clinical Data Management.  Our clinical data management services allow us to confirm that the 
clinical trial database is ready, accurately populated, and locked in an expeditious manner, with 
verification and validation procedures throughout every phase of a clinical trial. This processing is 
done in synchronization with the clinical team, utilizing the information provided from the trial to help 
ensure efficient processes are employed, regardless of the data collection method used.

•  Electronic Data Capture.  To compete in today's changing global drug and device development 
environment, companies must collect and distribute data faster than ever. We have the ability to 
manage electronic data capture ("EDC") to help our customers take advantage of the efficiencies 
available through EDC, which include improved access to data, reduced cycle time, increased 
productivity, and improved relationships with customers, vendors, and other parties. We utilize three 
leading EDC platforms: Medidata Rave, Oracle Clinical Remote Data Capture, and Oracle Health 
Sciences InForm products. Our ability to design, build, and deliver high quality databases in all three 
platforms enables our team to deliver effective EDC solutions.

•  Biostatistics.  Our biostatistics team has a depth of experience with the FDA and EMA which allows 

our teams to provide customers with guidance on building a statistical plan to meet regulatory and 
safety requirements as well as a careful analysis of the resulting study data. In addition, we provide 
support for independent drug safety monitoring boards and a full range of related services. Our 
biostatisticians are also heavily involved in our Trusted Process® methodology, so that protocol and 
project development can be grounded in advanced statistical methodology. As part of a project team, 
our biostatisticians can provide data oversight throughout a clinical trial and address any data or data 
handling issues that may arise.

Strategic Resourcing 

Our FSP offering helps sponsors review their approach to key functional areas of clinical research, specifically 
those areas not core to their clinical development business or in areas where they need to augment their own 
internal resources. We are able to customize our full services offering to provide customers support within an 
individual clinical study, a single function, multiple functions within a single therapeutic area, or across a 
customer’s entire product portfolio. Any of our full service clinical solutions outlined above can be delivered on 
an unbundled or functional basis or on a hybrid approach, based on our customers' specific needs. We 
believe our FSP service offering provides greater predictability, improved visibility and reporting, and more 
consistent delivery of services across all protocols. We currently operate FSP hubs in North America, South 
America, Europe, and Asia.

Early Stage 

Our Early Stage offering provides a full range of services for Phase I and Phase IIA clinical trial conduct, 
bioanalytical analysis assay development, and clinical pharmacology services, including modeling and 
simulation. We also provide validation and sample analysis services from preclinical development through 
post-marketing support and purpose-built phase biometrics support from North America and India. We 
conduct clinical trial studies at our facilities located in Quebec City and Toronto, Canada and Miami, Florida. 
We have extensive experience in first-in-human, proof-of concept, bioequivalence and bioavailability, 
biosimilars, and clinical pharmacology study conduct and are a leader in the provision of abuse-liability and 

13

dependency studies. We have built direct partnerships with leading hospitals for conduct of early development 
and clinical pharmacology studies that require access to patients. The combination of our facilities and 
partnerships can provide access in the North American and Asia-Pacific geographies. We have a large base 
of available subjects, including patient populations with specific medical conditions and healthy volunteers, 
which provide efficient and rapid patient recruitment. Furthermore, we can also provide early stage and 
clinical pharmacology studies through our Asia-Pacific Catalyst Model with Phase I - IIA conduct capabilities in 
Australia, New Zealand, South Korea, Japan, and China. 

Our two bioanalytical laboratories located in Quebec, Canada and Princeton, New Jersey have extensive 
experience in method development, validation, and bioanalytical analysis support for both small molecule 
therapeutics and biologics using a variety of analytical techniques and instrumentation platforms, as well as 
the provision of critical reagents handling services for biologics.

Real World and Late Phase Services

Our Real World and Late Phase group conducts “real world” studies to understand how a treatment, service 
or method of delivering care works when applied in real world, clinical practice environments. We provide both 
consultative and operational expertise to our customers in real world data generation, from concept through 
core development, launch and commercialization. By utilizing our successful drug life cycle management, we 
ensure we partner with our customers to gain better outcomes for patients, physicians, payers, and 
regulators. These services allow our customers to make timely and cost effective advances in clinical 
treatment by providing data about actual experience of doctors and patients outside of the regulated 
environment of clinical development. We also leverage the data and insights from our experience across the 
commercialization spectrum to inform the design and conduct of these studies. Our services include patient 
registries, surveillance and observational studies, patient/health outcomes research, and economic studies. 

Commercial Solutions

Our Commercial Solutions business provides a broad suite of complementary commercialization services 
including selling solutions, communications (advertising and public relations) and consulting services. 

Selling Solutions Services

Selling solutions services include field-based promotional and market access solutions, field-based clinical 
solutions, inside sales and contact center, insight and strategy design, patient support services, training, talent 
sourcing, end-to-end sales operations, and medication adherence. We provide contract field promotion teams 
with a broad array of capabilities, support services and non-personal engagement solutions including tele-
detailing and electronic detailing (e-detailing) to help our customers accelerate the commercialization of their 
products. Our field promotion teams are supported by recruiting and training capabilities that are 
complemented by highly-qualified clinical and scientific professionals who serve as advocates and educators 
to inform markets of new and novel therapies as well as customized patient behavioral models built on 
extensive data insights and analytics through our extensive and proprietary data-driven platform. Services 
offered include market research, commercial analytics, managed markets access, biotechnology and 
specialty managed markets, integrated commercialization, and medication adherence. Our field promotion 
teams can be supported by our communications and consulting services.

•  Clinical Field Teams. We are a leading provider of outsourced Clinical Field Team solutions to the 

biopharmaceutical industry. As Medical Science Liaisons ("MSLs"), Contract US Medical Directors, 
and/or Clinical Nurse Educators, our Clinical Field Teams deliver education, preparing healthcare 
professionals, patients, advocacy organizations, and others with the latest evidence-based scientific 
and practical information about disease states, current treatments, and the use of customers’ 
products. 

•  Promotional Field Teams and Support. We have the industry-leading, scalable capabilities to recruit, 
train, target, deploy, and support successful sales teams for our customers to achieve their business 
goals. As one of the largest providers of outsourced sales teams and sales solutions to the healthcare 

14

industry, we have well-established flexible processes and infrastructure to efficiently build, scale, 
deploy, execute, and retain a high-performing field sales team.

•  Commercial Recruiting Solutions. We are an exclusive recruiting partner who has experience in the 
commercial life science industry and a talent network of the top MSL, Nurse Educator, Sales, Sales 
Management, and Market Access performers. Our proprietary database, industry-leading recruiters 
and branding and talent assessment process are keys to accelerating our customers’ commercial 
recruiting success.

•  Operations Support Services. We maintain a comprehensive set of best-in-class operations support 

services that include field automation hardware/software, data management, targeting and 
alignments, analytics and reporting, incentive plan design and implementation, quality management, 
and help desk. These capabilities are used both individually and collectively to ensure that our 
deployed field teams perform optimally, respond rapidly to changing marketplace dynamics, and 
continuously improve.  

•  Medication Adherence. We believe that we have the largest comprehensive network for patient and 

prescriber access, and provide dynamic patient performance programs that activate patients, improve 
outcomes, and elevate brand performance. With customized patient behavioral models built on 
extensive data insights and analytics, we have the ability to communicate with various patient types 
as they move throughout their individual patient journeys - in the doctor’s office, at the pharmacy, and 
in their home - through our extensive and proprietary data-driven platform. 

Communications Services

Communications services include healthcare advertising, medical communications, digital marketing, 
communications planning, public relations, and naming/branding services. We offer a broad array of 
advertising and public relations services to customers looking to commercialize their products domestically 
and/or internationally. Communications services are deployed throughout a product’s existence, beginning 
well before commercial launch, encompassing regulatory approval and market introduction, and continuing 
throughout the life of a product. Our communications services offering is focused on healthcare, and provides 
advertising, public relations, interactive digital strategies, and branding and identity consulting services, as 
well as medical communications and education services.

•  Healthcare Advertising. We believe that we offer the largest independent healthcare communications 
network in the world. Our advertising teams are immersed in healthcare data and connected to 
frontline experts who help them delve deep into the real life experience of health, harvesting insights 
that allow us to create optimal communications strategies for our customers. We help our customers 
excel at some of the most critical challenges in healthcare, including, but not limited to, brand launch, 
leveraging mass and personalized media, creating advertising content and campaigns, patient 
analysis, disease state campaigns, and market perception analysis. Our advertising teams have deep 
therapeutic expertise, with agencies solely dedicated to oncology, chronic disease care and 
activation, biologics, and industry innovation. 

•  Public Relations. Our Public Relations teams develop breakthrough creative campaigns grounded in 

deep customer insight and integrated under a multi-channel strategy. These programs raise 
awareness and produce meaningful, measurable behavior change among audiences. With a diverse 
set of healthcare communications specialties under one umbrella, we are able to deliver integrated 
advice and expert insight from a variety of strategic perspectives. We offer best-in-class capabilities 
spanning public relations, digital and social media, medical and scientific education, and research and 
analytics. Our teams create communications that enhance brand perception, drive engagement, 
activate behavior shifts and deliver on the bottom line.

•  Medical Communications. Medical Communications helps our customers to frame their product 

position in a way that clinicians will find relevant, and creates strategies, campaigns and tactics to 
help these stakeholders at the right time, with the right content. Our Medical Communications team 

15

provides support through strategic planning, publication planning, content development, and peer-to-
peer education.

Consulting Services

Consulting services include commercial strategy development and planning, pricing and market access, 
medical affairs advisory, and risk and program management. We offer specialized practices in business 
development, managed markets, and brand management, including strategic product launch planning. 
Consulting services are focused on addressing the needs of the pharmaceutical and biotechnology industries 
to support critical decision-making throughout the evolution of a product, from licensing, to product and 
portfolio strategy development, to drug commercialization. Consulting services professionals have a deep, 
functional knowledge of our customers’ core business, which produces value-added insights and mission-
critical solutions, both creative and standard. Consulting services are centered on maximizing the commercial 
value of a client’s product pipeline, helping clinical leaders better and more strategically deploy resources and 
improve efficiency, as well as enhance the effectiveness of marketing and sales activities.

•  Commercial Strategy Development and Planning. Our strategic consulting group focuses on 

maximizing the value of scientific knowledge, intellectual property and portfolio content. The key 
areas of advisory services include strategic drug development, clinical development plans, 
registration strategies, exit strategies, transitional clarity, good clinical practice compliance strategies, 
clinical operations optimization, pricing and reimbursement, and due diligence. Strategic consultants 
include senior personnel from medical and regulatory affairs, clinical research, biostatistics and data 
management. These individuals provide expertise gained through hands-on experience as former 
executives from biopharmaceutical companies, CROs, and regulatory agencies.  

•  Pricing and Market Access. Our team offers a full spectrum of market access solutions and services, 

including market assessment and analysis, comparative effectiveness research, pricing 
reimbursement, patient assistance services, and legislative and regulatory analysis. 

•  Medical Affairs Advisory. Our team brings more than 20 years of practical experience and expertise in 
helping our customers realize medical transformation. Our modular medical transformation solution 
allows customers to assess where they are in their medical transformation by helping them identify 
their competitive position, prioritize their needs, understand their brand perception, and inform their 
market engagement strategy.  

•  Quality Management and Regulatory Compliance Advisory.  Our quality and compliance team 

delivers independent quality management services through audit, inspection and implementation 
services, and assist our customers with developing and executing a clinical regulatory strategy 
through regulatory consulting, publishing and submission services globally.

•  Risk and Program Management. Our communications consultants provide advice and subject matter 

expertise for risk evaluation on medicine affordability, compassionate use, and litigation and access 
barriers. We provide an evidence-based approach to avoiding policy, patient, and provider pushback 
on price; using best practices for how life-sciences companies can deploy effective preventative 
strategies;  implementing compliance strategies to prepare for expanded access and compassionate 
use inquiries; and executing an Institute for Clinical and Economic Review review strategy to 
demonstrate product value.

Customers

We have a well-diversified, loyal customer base that includes each of the world's largest biopharmaceutical 
companies, which we define as the top 50 biopharmaceutical companies measured by annual R&D spend. 
We serve over 500 customers, including each of the 20 largest global biopharmaceutical companies, as well 
as numerous emerging and specialty biotechnology companies, medical device and diagnostics companies. 
In addition, we have strong relationships with small and mid-sized biopharmaceutical customers that seek our 
services for our therapeutic expertise and full-service offering.

16

For the year ended December 31, 2017, our net service revenue attributable to large biopharmaceutical 
companies represented approximately 61% of our total net service revenue and net service revenue 
attributable to small and mid-sized biopharmaceutical companies represented approximately 39%. 
Additionally, we serve customers in a variety of locations throughout the world, with approximately 63% of our 
2017 net service revenue generated from customers in the United States and Canada; 25% generated from 
Europe, the Middle East, and Africa; 9% generated from Asia-Pacific; and 3% generated from Latin America. 
This diversification allows us to grow our business in multiple customer segments and geographies. 

For the year ended December 31, 2017, our top five customers accounted for approximately 22% of our net 
service revenue. No single customer accounted for greater than 10% of our total consolidated net service 
revenue for the years ended December 31, 2017, 2016 or 2015.

Our top ten customers have worked with us for an average of approximately 18 years as of December 31, 
2017. We also have a growing list of "preferred provider" and/or strategic alliance relationships. Further, 
among the majority of our customers, revenue is diversified by multiple projects and services. For example, 
during 2017, we provided both clinical and commercial services to 64 customers. We believe that the tenure 
of our customer relationships as well as the depth of penetration of our services reflects our strong reputation 
and track record. 

New Business Awards and Backlog

In connection with the Merger, we re-evaluated our existing backlog policy for our Clinical Solutions segment. 
As a result of this evaluation, effective during the third quarter of 2017, we changed our policy for calculating 
and reporting the amounts of our net new business awards and backlog. Under the new backlog policy for our 
Clinical Solutions segment, we add new business awards to backlog when we enter into a contract or when 
we receive a written commitment from the customer selecting us as a service provider, provided that:

• 

• 

• 

• 

the customer has received appropriate internal funding approval and collection of the award value is 
probable;

the project or projects are not contingent upon completion of another trial or event; 

the project or projects are expected to commence within the next six months; 

the customer has entered or intends to enter into a comprehensive contract as soon as practicable; 
and

• 

for awards related to our FSP offering, only a maximum of twelve months of services are included.

In addition, we continually evaluate our backlog to determine if any of the previously awarded work is no 
longer expected to be performed, regardless of whether we have received formal cancellation notice from the 
customer. If we determine that any previously awarded work is no longer probable of being performed, we 
remove the value from our backlog based on risk. We recognize revenue from these awards as services are 
performed, provided we have entered into a contractual commitment with the customer. The primary changes 
made to our net new business awards and backlog policy related to reducing the commencement date 
requirement from twelve months to six months and only recording one year’s worth of an FSP award. These 
adjustments resulted in a reduction to our backlog of approximately $284.5 million as of September 30, 2017. 
We have recorded the backlog assumed in the Merger consistently with our new backlog policy.

We do not currently report new business awards or backlog data for our Commercial Solutions segment. 
Accordingly, all disclosures related to net new service awards and backlog pertain solely to our Clinical 
Solutions segment.

Our Clinical Solutions backlog consists of anticipated future net service revenue from business awards that 
have not started but are anticipated to begin in the future, or that are in process and have not been 
completed. Our backlog also reflects any cancellation or adjustment activity related to these contracts. The 
average duration of our contracts will fluctuate from period to period in the future based on the contracts 

17

comprising our backlog at any given time. The majority of our Clinical Solutions segment contracts can be 
terminated by the customer with a 30-day notice. 

As adjusted for the policy changes discussed above, our new business awards, net of award cancellations, 
for the years ended December 31, 2017, 2016, and 2015 were $1.82 billion, $1.22 billion, and $1.11 billion, 
respectively. Additionally, as of December 31, 2017 and 2016, our backlog was $3.80 billion and $1.88 billion, 
respectively, with prior years adjusted to conform to the policy changes discussed above. Included in our 
Clinical Solutions backlog at December 31, 2017 is $1.51 billion of backlog assumed in the Merger. We 
expect approximately $1.88 billion of our Clinical Solutions backlog at December 31, 2017 will be recognized 
as revenue in 2018, with the remainder expected to be recorded as revenue beyond 2018. 

We believe that our backlog and net new business awards might not be consistent indicators of future 
revenue because they have been, and likely will be, affected by a number of factors, including the variable 
size and duration of projects, many of which are performed over several years, and cancellations and 
changes to the scope of work during the course of projects. Additionally, projects may be canceled or delayed 
by the customer or regulatory authorities. Projects that have been delayed for less than six months generally 
remain in backlog, but the anticipated timing of the recognition of revenue is uncertain. We generally do not 
have a contractual right to the full amount of the awards reflected in our backlog. If a customer cancels an 
award, we might be reimbursed for the costs we have incurred. As we increasingly compete for and enter into 
large contracts that are more global in nature, we expect that the rate at which our backlog and net new 
business awards convert into revenue is likely to decrease, and  the duration of projects and the period over 
which related revenue is recognized is likely to increase. No assurance can be given that we will be able to 
realize the net service revenue that is included in the backlog. See Part I, Item 1A, "Risk Factors - Risks 
Related to Our Business - Our Clinical Solutions backlog might not be indicative of our future revenues, and 
we might not realize all the anticipated future revenue reflected in our backlog," and Part II, Item 7, 
"Management's Discussion and Analysis of Financial Condition and Results of Operations - New Business 
Awards and Backlog" of this Annual Report on Form 10-K for more information.

Sales and Marketing

We employ a team of business development sales representatives and support staff that promote, market and 
sell our services to biopharmaceutical companies. In addition to significant selling experience, many of these 
individuals have technical and/or scientific backgrounds.

Our business development team works with our senior executives, therapeutic and commercial leaders and 
project team leaders to maintain key customer relationships and engage in business development activities. 
For many of our largest customer relationships, we have dedicated strategic account management teams to 
provide customers with a single point of contact to support delivery, cultural and process integration and to 
facilitate cross-selling opportunities.

We use integrated and customer-focused business development teams to develop joint sales plans for key 
accounts. We also place our business development personnel with strong operational experience around the 
globe to help ensure project demands are fulfilled. Each business development employee is generally 
responsible for a specific group of customers and for strengthening and expanding an effective relationship 
with that customer. Each individual is responsible for developing his or her customer base on our behalf, 
responding to customer requests for information, developing and defending proposals, and making 
presentations to customers.

As part of each customer proposal, our business development personnel consult with potential 
biopharmaceutical customers early in the project consideration stage in order to determine their requirements. 
We involve our therapeutic, operational, technical and/or scientific personnel early in each proposal and, 
accordingly, these individuals along with our business development representatives invest significant time to 
determine the optimal means to design and execute the potential customer's program requirements. As an 
example, recommendations we make to a potential customer with respect to a drug development study or 
commercial launch strategy design and implementation are an integral part of our bid proposal process and 
an important aspect of the integrated services we offer. Our preliminary efforts relating to the evaluation of a 

18

proposed clinical or commercial solution, along with the therapeutic, operational, and technical expertise and 
advice we provide during this process, enhance the opportunity for accelerated initiation and overall success 
of the partnership and work.

To drive brand awareness and positioning, our marketing team supports our business development 
organization through various marketing activities consisting primarily of market and competitive analysis, 
brand management, market information and collateral development, participation in industry conferences, 
content-driven thought leadership advertising, e-marketing, publications, and website development and 
maintenance.

As part of the Syneos Health brand launch, a significant investment has been made to carve out a 
differentiated positioning based on our unique Biopharmaceutical Acceleration Model where clinical insights 
inform commercialization and commercial insights inform clinical trial design. From our brand identity that 
delivers on our ability to “sync” clinical and commercial solutions, to our proprietary tagline, “Shortening the 
Distance from Lab to Life™,” to curated customer content including commercialization trends impacting real-
time outsourcing solutions, all marketing efforts are delivered through multi-channel platforms to reach the 
right customers at the right time. Over time and with enhanced education and reinforcement, we are confident 
that brand recognition and our unique value proposition will position us as a preferred strategic outsourcing 
partner.

Competition

We operate in highly competitive industries. Our competitors include a variety of companies providing 
services to the biopharmaceutical industry, including large and smaller specialty CROs, large global 
communications holding companies, smaller specialized communications agencies, and a wide range of 
consulting companies. Each of our reportable segments faces distinct competitors within the markets they 
serve.

Clinical Solutions

Our Clinical Solutions segment competes primarily against other full-service CROs and services provided by 
in-house R&D departments of biopharmaceutical companies, universities and teaching hospitals. Although the 
CRO industry has experienced increased consolidation over the past three years, the landscape remains 
fragmented. Our major competitors include ICON plc, IQVIA (formerly Quintiles IMS Holdings, Inc.), 
Laboratory Corporation of America Holdings (formerly Covance, Inc.), Medpace Holdings, Inc., PAREXEL 
International Corporation, Pharmaceutical Product Development, LLC, PRA Health Sciences, Inc., and 
numerous specialty and regional players. We generally compete on the basis of the following factors:

• 

• 

• 

• 

• 

• 

experience within specific therapeutic areas;

the quality of staff and services;

the range of services provided;

the ability to recruit principal investigators and patients into studies expeditiously;

the ability to organize and manage large-scale, global clinical trials;

an international presence with strategically located facilities;

•  medical database management capabilities;

• 

• 

• 

• 

• 

• 

the ability to deploy and integrate IT systems to improve the efficiency of contract research;

experience with a particular customer;

the ability to form strategic partnerships;

speed to completion;

financial strength and stability;

price; and

19

• 

overall value.

Commercial Solutions 

Our Commercial Solutions segment's largest competitors in the outsourced sales market are Ashfield (UDG 
Healthcare PLC), IQVIA, and Publicis Touchpoint Solutions, Inc. Our primary competitors in the 
communications market are large global communications holding companies such as: Havas SA, Omnicom 
Group Inc., Publicis Groupe S.A., The Interpublic Group of Companies, Inc., and WPP Group plc. Our 
consulting services’ competitors include IQVIA, L.E.K. Consulting LLC, McKinsey & Company, Inc., and ZS 
Associates, Inc. We also compete in our addressable market with the internal operations of biopharmaceutical 
companies that choose to perform the clinical development and commercialization tasks we provide internally. 
We generally compete on the basis of the following factors:

• 

• 

• 

• 

• 

• 

• 

experience within the specific therapeutic area;

quality of the staff and services; 

creativity of the proposed solution;

perceived "chemistry" with the staff to be deployed; 

previous experience with a particular customer;

price; and

overall value.

Notwithstanding these competitive factors, we believe that our deep therapeutic expertise, global reach and 
operational strengths differentiate us from our competitors across both of our segments.

Government Regulation

The biopharmaceutical industry is subject to a high degree of governmental regulation in both domestic and 
international markets. Regardless of the country or region in which approval is being sought, before a 
marketing application for a drug is ready for submission to regulatory authorities, the candidate drug must 
undergo rigorous testing in clinical trials. The clinical trial process must be conducted in accordance with the 
Federal Food, Drug and Cosmetic Act in the United States and similar laws and regulations in the relevant 
foreign jurisdictions. These laws and regulations require the drug to be tested and studied in certain ways 
prior to submission for approval. 

Regulation of Our Clinical Solutions Segment 

In the United States, the FDA regulates the conduct of clinical trials of drug products in human subjects, and 
the form and content of regulatory applications. The FDA also regulates the development, approval, 
manufacture, safety, labeling, storage, record keeping, and marketing of drug products. The FDA has similar 
authority and similar requirements with respect to the clinical testing of biological products and medical 
devices. In the EU and other jurisdictions where our customers intend to apply for marketing authorization, 
similar laws and regulations apply. Within the EU, these requirements are enforced by the EMA, and 
requirements vary slightly from one member state to another. In Canada, clinical trials are regulated by the 
Health Products Food Branch of Health Canada as well as provincial regulations. Similar requirements also 
apply in other jurisdictions, including Australia, Japan, and other Asian countries, where we operate or where 
our customers intend to apply for marketing authorization. Sponsors of clinical trials also follow the ICH GCP 
guidelines. An addendum to the ICH GCP Guidelines was adopted by the ICH committee in November 2016 
and will now be implemented through national and regional guidance in ICH member states. The changes aim 
to encourage sponsors to implement improved oversight and management of clinical trials, utilizing a Quality 
Risk Management approach while continuing to ensure protection of human subjects participating in trials and 
clinical trial data integrity.

20

Our services are subject to various regulatory requirements designed to ensure the quality and integrity of the 
clinical trial process. In the United States, we must perform our clinical development services in compliance 
with applicable laws, rules and regulations, including GCP, which govern, among other things, the design, 
conduct, performance, monitoring, auditing, recording, analysis, and reporting of clinical trials. Before a 
human clinical trial may begin, the manufacturer or sponsor of the clinical product candidate must file an 
investigational new drug application ("IND") with the FDA, which contains, among other things, the results of 
preclinical tests, manufacturer information, and other analytical data. A separate submission to an existing 
IND must also be made for each successive clinical trial conducted during product development. Each clinical 
trial must be conducted pursuant to, and in accordance with, an effective IND. In addition, under GCP, each 
human clinical trial we conduct is subject to the oversight of an independent institutional review board ("IRB") 
which is an independent committee that has the regulatory authority to review, approve and monitor a clinical 
trial. The FDA, the IRB, or the sponsor may suspend or terminate a clinical trial at any time on various 
grounds, including a finding that the study subjects are being exposed to an unacceptable health risk.

Clinical trials conducted outside the United States are subject to the laws and regulations of the country 
where the trials are conducted. These laws and regulations might not be similar to the laws and regulations 
administered by the FDA and other laws and regulations regarding the protection of patient safety and privacy 
and the control of study pharmaceuticals, medical devices or other study materials. Studies conducted 
outside the United States can also be subject to regulation by the FDA if the studies are conducted pursuant 
to an IND or an investigational device exemption for a product candidate that will seek FDA approval or 
clearance. It is the responsibility of the study sponsor or the parties conducting the studies to ensure that all 
applicable legal and regulatory requirements are fulfilled.

In order to comply with GCP and other regulations, we must, among other things:

• 

• 

• 

• 

• 

• 

comply with specific requirements governing the selection of qualified principal investigators and 
clinical research sites;

obtain specific written commitments from principal investigators;

obtain review, approval and supervision of the clinical trials by an IRB or ethics committee;

obtain favorable opinion from regulatory agencies to commence a clinical trial;

verify that appropriate patient informed consents are obtained before the patient participates in a 
clinical trial;

ensure that adverse drug reactions resulting from the administration of a drug or biologic during a 
clinical trial are medically evaluated and reported in a timely manner;

•  monitor the validity and accuracy of data;

•  monitor drug or biologic accountability at clinical research sites; and

• 

verify that principal investigators and study staff maintain records and reports and permit appropriate 
governmental authorities access to data for review.

Similar guidelines exist in various states and in other countries. We may be subject to regulatory action if we 
fail to comply with applicable rules and regulations. Failure to comply with certain regulations can also result 
in the termination of ongoing research and disqualification of data collected during the clinical trials. For 
example, violations of GCP could result, depending on the nature of the violation and the type of product 
involved, in the issuance of a warning letter, suspension or termination of a clinical study, refusal of the FDA to 
approve clinical trial or marketing applications or withdrawal of such applications, injunction, seizure of 
investigational products, civil penalties, criminal prosecutions, or debarment from assisting in the submission 
of new drug applications. See Part I, Item 1A, "Risk Factors—Risks Related to Our Business—If we fail to 
perform our services in accordance with contractual requirements, regulatory standards and ethical 
considerations, we could be subject to significant costs or liability and our reputation could be harmed" in this 
Annual Report on Form 10-K.

We monitor our clinical trials to test for compliance with applicable laws and regulations in the United States 
and the foreign jurisdictions in which we operate. We have adopted standard operating procedures that are 

21

designed to satisfy regulatory requirements and serve as a mechanism for controlling and enhancing the 
quality of our clinical trials. In the United States, our procedures were developed to ensure compliance with 
GCP and associated guidelines.

In addition to its comprehensive regulation of safety in the workplace, the U.S. Occupational Safety and 
Health Administration has established extensive requirements relating to workplace safety for healthcare 
employers whose workers might be exposed to blood-borne pathogens such as HIV and the hepatitis B virus. 
Furthermore, certain employees might have to receive initial and periodic training to ensure compliance with 
applicable hazardous materials regulations and health and safety guidelines. We are subject to similar 
regulations in Canada and Spain.

Regulation of Our Commercial Solutions Segment

Our field personnel are subject to all laws, rules and regulations governing the promotion of pharmaceutical 
products in the United States and in every other country where such personnel performs work. In particular, 
these rules and regulations include limitations on the indications for which a product may be promoted and on 
promotional spending. Violations of these rules may leave us at risk of direct regulatory enforcement action 
and/or cause us to be in breach of contract with our customers. 

Some of our field personnel handle and distribute samples of pharmaceutical products. In the United States, 
the handling and distribution of prescription drug products are subject to regulation under the Prescription 
Drug Marketing Act and other applicable federal, state and local laws and regulations and other countries may 
have similar laws or regulations. These laws and regulations regulate the distribution of drug samples by 
mandating procedures for storage and record-keeping requirements for drug samples and ban the purchase 
or sale of drug samples. Further, companies holding or distributing controlled substances are subject to 
regulation by the U.S. Drug Enforcement Agency. 

Our communications solutions offerings are subject to all regulatory risks applicable to similar 
communications businesses as well as risks that relate specifically to the provision of these services to the 
biopharmaceutical industry. Such regulatory risks include enforcement by the FDA, Health Canada, the 
Department of Health in the United Kingdom, EMA and the Federal Trade Commission as well as state 
agencies and other foreign regulators enforcing laws relating to product advertising, false advertising, and 
unfair and deceptive trade practices. In addition to enforcement actions initiated by government agencies, 
there has been an increasing tendency in the United States among biopharmaceutical companies to resort to 
the courts and industry and self-regulatory bodies to challenge comparative prescription drug advertising on 
the grounds that the advertising is false and deceptive. There continues to be an expansion of specific rules, 
prohibitions, media restrictions, labeling disclosures and warning requirements with respect to the advertising 
for certain products.

Regulation of Patient Information

The confidentiality of patient-specific information and records and the circumstances under which such 
patient-specific information and records may be released for inclusion in our databases or used in other 
aspects of our business are heavily regulated. The U.S. Department of Health and Human Services has 
promulgated rules under the Health Information Technology for Economic and Clinical Health Act in 
connection with the application of security and privacy provisions under the Health Information Portability and 
Accountability Act (collectively, "HIPAA"). These regulations govern the use, handling and disclosure of 
personally identifiable medical information and require the use of standard transactions, privacy and security 
standards and other administrative simplification provisions by covered entities, which include many 
healthcare providers, health plans, and healthcare clearinghouses. Although we do not consider that our 
business activities generally cause us to be subject to HIPAA as a directly covered entity, we endeavor to 
embrace sound identity protection practices. These regulations also establish procedures for the exercise of 
an individual's rights and the methods permissible for de-identification of health information. We are also 
subject to privacy legislation in Canada under the federal Personal Information and Electronic Documents Act, 
the Act Respecting the Protection of Personal Information in the Private Sector and the Personal Health 
Information Protection Act, and privacy legislation in the EU under the 95/46/EC Privacy Directive on the 
protection and free movement of personal data. 

22

Intellectual Property

We develop and use a number of proprietary methodologies, analytics, systems, technologies and other 
intellectual property in the conduct of our business. We rely upon a combination of confidentiality policies, 
nondisclosure agreements and other contractual arrangements to protect our trade secrets, and copyright and 
trademark laws to protect other intellectual property rights. We have obtained or applied for trademarks and 
copyright protection in the United States and in a number of foreign countries. Our material trademarks 
include Trusted Process®, PlanActivation®, QuickStart®, ProgramAccelerate®, QualityFinish®, "Shortening the 
distance from lab to life™, Syneos Health, Inc., and other corporate emblems. Although the duration of 
trademark registrations varies from country to country, trademarks generally may be renewed indefinitely so 
long as they are in use and/or their registrations are properly maintained, and so long as they have not been 
found to have become generic. Although we believe the ownership of trademarks is an important factor in our 
business and that our success does depend in part on the ownership thereof, we rely primarily on the 
innovative skills, technical competence and marketing abilities of our employees. We do not have any 
material licenses, franchises or concessions.

Employees

The level of competition among employers in the United States and overseas for skilled personnel is high. We 
believe that our brand recognition and our multinational presence are advantages in attracting qualified 
candidates. As of December 31, 2017, we had approximately 21,000 employees worldwide, with 
approximately 58% located in the United States and Canada, 22% in Europe, 16% in Asia-Pacific, 3% in Latin 
America and 1% in the Middle East and Africa. The majority of our employees are employed on a full-time 
basis. None of our employees are covered by a collective bargaining agreement and we believe our overall 
relations with our employees are good. Employees in certain of our non-U.S. locations are represented by 
workers' councils as required by local laws. 

Indemnification and Insurance 

In conjunction with our Clinical Solutions services, we employ or contract with research institutions and, in 
some jurisdictions, principal investigators and pharmacies on behalf of biopharmaceutical companies to serve 
as research centers and principal investigators in conducting clinical trials to test new drugs on human 
volunteers. Such testing creates the risk of liability for personal injury or death of volunteers, particularly to 
volunteers with life-threatening illnesses, resulting from adverse reactions to the drugs administered. It is 
possible that we could be held liable for claims and expenses arising from any professional malpractice of the 
principal investigators with whom we contract or engage, or in the event of personal injury to or death of 
persons participating in clinical trials. In addition, as a result of our operation of Phase I clinical trial facilities, 
we could be liable for the general risks associated with clinical trials including, but not limited to, adverse 
events resulting from the administration of drugs to clinical trial participants or the professional malpractice of 
medical care providers. We also could be held liable for errors or omissions in connection with the services 
we perform through each of our service groups. For example, we could be held liable for errors, omissions, or 
breach of contract, if monitoring obligations have been transferred to us and one of our CRA's inaccurately 
reports from source documents or fails to adequately monitor a human clinical trial resulting in inaccurately 
recorded results.

We have sought to reduce our risks by implementing the following where practicable:

• 

• 

securing contractual assurances such as indemnification provisions and provisions seeking to limit or 
exclude liability contained in our contracts with customers, institutions, pharmacies, vendors and 
principal investigators;

securing contractual and other assurances that adequate insurance will be maintained to the extent 
applicable by customers, institutions, pharmacies, vendors, principal investigators and us; and

23

• 

complying with various regulatory requirements, including monitoring that the oversight of 
independent review boards and ethics committees are intact where obligations are transferred to us 
and monitoring the oversight of the procurement by the principal investigator of each participant's 
informed consent to participate in the study.

Our contractual indemnifications generally do not fully protect us against certain of our own actions, such as 
negligence. Contractual arrangements are subject to negotiation with customers, and the terms and scope of 
any indemnification, limitation of liability or exclusion of liability varies from customer to customer and from 
trial to trial. Additionally, financial performance of these indemnities is not secured. Therefore, we bear the risk 
that any indemnifying party against which we have claims may not have the financial ability to fulfill its 
indemnification obligations to us.

While we maintain a global insurance program including professional liability and other types of insurance 
standard to our industry to cover our liability while conducting our business activities and contracted services, 
including drug safety issues as well as data processing and other errors and omissions, it is possible that we 
could become subject to claims not covered by insurance or that exceed our coverage limits. We could be 
materially and adversely affected if we were required to pay damages or bear the costs of defending any 
claim that is outside the scope of, or in excess of, a contractual indemnification provision, beyond the level of 
insurance coverage or not covered by insurance, or in the event that an indemnifying party does not fulfill its 
indemnification obligations.

Executive Officers

The following table sets forth information concerning our executive officers as of December 31, 2017: 

Name

Alistair Macdonald

Jason Meggs

Gregory S. Rush

Christopher L. Gaenzle

Age

Position

47

42

50

51

Chief Executive Officer and Director

Executive Vice President and Interim Chief Financial Officer

Former Executive Vice President and Chief Financial Officer

Former Chief Administrative Officer, General Counsel and Secretary

The following is a biographical summary of the experience of our executive officers:

Alistair Macdonald - Chief Executive Officer and Director

Alistair Macdonald has been our Chief Executive Officer ("CEO") and a member of our Company's Board of 
Directors (the "Board") since October 2016. He joined our Company in May 2002 and has served in various 
senior leadership roles during that time. Prior to his current role, Mr. Macdonald most recently served as 
President and Chief Operating Officer from January 2015 to September 2016 and Chief Operating Officer 
from January 2013 to January 2015. He also served as our President, Clinical Development Services from 
March 2012 to January 2013, Executive Vice President of our Global Oncology Unit from February 2011 to 
March 2012, Executive Vice President, Strategic Development from October 2009 to February 2011, and 
Senior Vice President, Biometrics from May 2002 to September 2009. He received his Master of Science in 
Environmental Diagnostics from Cranfield University. 

Jason Meggs - Executive Vice President and Interim Chief Financial Officer

Jason Meggs was appointed Executive Vice President and Interim Chief Financial Officer ("CFO") on 
February 21, 2018. Prior to his appointment to this role, he served as Executive Vice President and CFO of 
the Commercial Solutions segment of the Company beginning in August 2017. He also previously served as 
Executive Vice President, Oncology Operations at the Company from January 2017 to August 2017 and 
Senior Vice President, Business Finance with the Company from 2014 to 2016. Prior to joining the Company, 
Mr. Meggs was Global Vice President, Internal Audit, at Quintiles Transnational Corporation from 2013 to 
2014 and held a number of finance roles at Quintiles from 2005 to 2013. He began his career as an auditor 
with Deloitte & Touche LLP and Arthur Anderson LLP, and is a certified public accountant. He received his 

24

Bachelor of Science in Business Administration degree with a Major in Accounting from Western Carolina 
University.

Gregory S. Rush - Former Executive Vice President and Chief Financial Officer

Greg Rush joined our Company in August 2013 as Executive Vice President and Chief Financial Officer 
("CFO"). From April 2010 to August 2013, Mr. Rush served as Senior Vice President and Chief Financial 
Officer of Tekelec, Inc., which was acquired by Oracle Corporation in June 2013, after serving as Interim Chief 
Financial Officer beginning in March 2010. Mr. Rush joined Tekelec as Vice President and Corporate 
Controller in May 2005 and served as Vice President, Corporate Controller and Chief Accounting Officer from 
May 2006 to March 2010. His previous experience also includes roles in various senior financial positions with 
Siebel Systems, Inc., Quintiles, PricewaterhouseCoopers and Ernst & Young. Mr. Rush received his Bachelor 
of Science in Business and Master of Accounting degrees from the University of North Carolina at Chapel Hill, 
graduating with honors, and is a Certified Public Accountant. As disclosed in a Form 8-K filing on February 21, 
2018, Mr. Rush stepped down as CFO of the Company and ceased to be an executive officer, he will remain 
an employee of the Company through April 30, 2018.

Christopher L. Gaenzle - Former Chief Administrative Officer, General Counsel, and Secretary

Chris Gaenzle joined our Company in April 2012 as General Counsel and Secretary. Since August 2013, he 
has also served as our Chief Administrative Officer. Prior to joining our Company, Mr. Gaenzle served for five 
years in various senior legal positions at Pfizer Inc., where he was most recently Assistant General Counsel 
from 2010 to 2012. Prior to Pfizer, Mr. Gaenzle was a partner at Hunton and Williams LLP, where he was a 
practicing attorney from 1998 to 2007. Mr. Gaenzle has 20 years of private practice and corporate legal 
experience, the majority of which is in the pharmaceutical, medical and clinical research industries. Mr. 
Gaenzle received his Bachelor of Arts from Colgate University and his J.D. from Syracuse University. As 
disclosed in a Form 8-K filing on February 21, 2018, Mr. Gaenzle stepped down as Chief Administrative 
Officer, General Counsel, and Secretary of the Company and ceased to be an executive officer as of 
February 19, 2018, he will remain an employee of the Company through April 15, 2018.

Available Information 

Our website address is syneoshealth.com. Information on our website is not incorporated by reference herein. 
Copies of our annual reports on Form 10-K, quarterly reports on Form 10-Q, current reports on Form 8-K and 
our proxy statements for our annual stockholders meetings, and any amendments to those reports, as well as 
Section 16 reports filed by our insiders, are available free of charge on our website as soon as reasonably 
practicable after we file the reports with, or furnish the reports to, the Securities and Exchange Commission 
(the "SEC"). Our SEC filings are also available for reading and copying at the SEC’s Public Reference Room 
at 100 F Street, NE, Washington, D.C. 20549. Information on the operation of the Public Reference Room 
may be obtained by calling the SEC at 1-800-SEC-0330. In addition, the SEC maintains an Internet site 
(http://www.sec.gov) containing reports, proxy and information statements, and other information regarding 
issuers that file electronically with the SEC. 

25

Item 1A. Risk Factors.

We operate in a rapidly changing environment that involves a number of risks, some of which are beyond our 
control. In evaluating our company, you should consider carefully the risks and uncertainties described below 
together with the other information included in this Annual Report on Form 10-K, including our consolidated 
financial statements and related notes included in Part II, Item 8, "Financial Statements and Supplementary 
Data" in this Annual Report on Form 10-K.  The occurrence of any of the following risks may materially and 
adversely affect our business, financial condition, results of operations and future prospects. 

Risks Related to Our Business

If we do not generate a large number of new business awards, or if new business awards are delayed, 
terminated, reduced in scope or fail to go to contract, our business, financial condition, results of 
operations, or cash flows may be materially adversely affected.

Our business is dependent on our ability to generate new business awards from new and existing customers 
and maintain existing customer contracts. Our inability to generate new business awards on a timely basis 
and subsequently enter into contracts for such awards could have a material adverse effect on our business, 
financial condition, results of operations or cash flows.

There is risk of cancelability in both the clinical and commercial businesses. The time between when a clinical 
study is awarded and when it goes to contract is typically several months, and prior to a new business award 
going to contract, our customer can cancel the award without notice. Once an award goes to contract, the 
majority of our customers can terminate the contract with little notice, in many cases 30 days or less. Our 
contracts may be delayed or terminated by our customers or reduced in scope for a variety of reasons beyond 
our control, including but not limited to:

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

decisions to forego or terminate a particular trial;

budgetary limits or changing priorities;

actions by regulatory authorities;

production problems resulting in shortages of the drug being tested;

failure of products being tested to satisfy safety requirements or efficacy criteria;

unexpected or undesired clinical results for products;

insufficient patient enrollment in a trial;

insufficient principal investigator recruitment;

production problems resulting in shortages of the product being tested;

the customers’ decision to terminate or scale back the development or commercialization of a product 
or to end a particular project; 

shift of business to a competitor or internal resources; or

product withdrawal following market launch.

Our commercial services contracts typically have a significantly shorter wind down period than clinical 
contracts, particularly within our selling solutions offerings. Furthermore, many of our communications 
services and consulting services projects are tied to a customer’s annual marketing budget or ad hoc service 
requests, which can lead to seasonal variability in revenue and less predictability in future revenues. In 
addition, many of our biopharmaceutical selling solutions service contracts provide our customers with the 
opportunity to internalize the resources provided under the contract and terminate all or a portion of the 
services we provide under the contract. Our customers may also decide to shift their business to a competitor. 
Each of these factors results in less visibility to future revenues and higher volatility in future revenues.

Contract terminations, delays and modifications are a regular part of our business across each of our 
segments. For example, our full-service offering within our Clinical Solutions business has been, and may 
continue to be, negatively impacted by project delays, which impact near term revenue disproportionately. In 

26

addition, project delays, downsizings and cancellations, particularly within our selling solutions and 
communications offerings, which are part of our Commercial Solutions business, have impacted our results in 
the past and might impact them in the future. The loss, reduction in scope or delay of a large project or of 
multiple projects could have a material adverse effect on our business, results of operations and financial 
condition. In addition, we might not realize the full benefits of our backlog if our customers cancel, delay or 
reduce their commitments to us.

In the event of termination, our contracts often provide for fees for winding down the project, which include 
both fees incurred and actual and non-cancellable expenditures and may include a fee to cover a percentage 
of the remaining professional fees on the project. These fees might not be sufficient for us to maintain our 
margins, and termination may result in lower resource utilization rates and therefore lower operating margins. 
In addition, cancellation of a contract or project for the reasons noted above may result in the unwillingness or 
inability of our customer to satisfy its existing obligations to us such as payments of accounts receivable, 
which may in turn result in a material impact to our results of operations and cash flow. Historically, 
cancellations and delays have negatively impacted our operating results, and they might again. In addition, 
we might not realize the full benefits of our backlog if our customers cancel, delay or reduce their 
commitments to us, which may occur if, among other things, a customer decides to shift its business to a 
competitor or revoke our status as a preferred provider. Thus, the loss or delay of a large business award or 
the loss or delay of multiple awards could adversely affect our service revenues and profitability. Additionally, 
a change in the timing of a new business award could affect the period over which we recognize revenue and 
reduce our revenue in any one quarter. 

Our Clinical Solutions backlog might not be indicative of our future revenues, and we might not 
realize all of the anticipated future revenue reflected in our backlog.

Our Clinical Solutions backlog consists of anticipated net service revenue awarded from contract and pre-
contract commitments that are supported by written communications. Once work begins on a project, revenue 
is recognized over the duration of the project, provided the award has gone to contract. Projects may be 
canceled or delayed by the customer or delayed by regulatory authorities for reasons beyond our control. To 
the extent projects are delayed, the timing of our revenue could be adversely affected. In addition, if a 
customer terminates a contract, we typically would be entitled to receive payment for all services performed 
up to the termination date and subsequent customer-authorized services related to terminating the canceled 
project. Typically, however, we have no contractual right to the full amount of the future revenue reflected in 
our Clinical Solutions backlog in the event of a contract termination or subsequent changes in scope that 
reduce the value of the contract. The duration of the projects included in our Clinical Solutions backlog, and 
the related revenue recognition, typically range from a few months to several years. Our Clinical Solutions 
backlog might not be indicative of our future revenues, and we might not realize all the anticipated future 
revenue reflected in that backlog. A number of factors may affect backlog, including:

• 

• 

• 

• 

the size, complexity and duration of projects or strategic relationships;

the cancellation or delay of projects;

the failure of one or more business awards to go to contract; and

changes in the scope of work during the course of projects.

The rate at which our Clinical Solutions backlog converts to revenue may vary over time. The revenue 
recognition on larger, more global projects could be slower than on smaller, more regional projects for a 
variety of reasons, including, but not limited to, an extended period of negotiation between the time the project 
is awarded to us and the actual execution of the contract, as well as an increased time frame for obtaining the 
necessary regulatory approvals.

Our Clinical Solutions backlog at December 31, 2017 was $3.80 billion. Although an increase in Clinical 
Solutions backlog will generally result in an increase in revenues over time, an increase in backlog at a 
particular point in time does not necessarily correspond directly to an increase in revenues during any 
particular period, or at all. The extent to which contracts in Clinical Solutions backlog will result in revenue 
depends on many factors, including, but not limited to, delivery against project schedules, scope changes, 
contract terminations and the nature, duration and complexity of the contracts, and can vary significantly over 
time. Subsequent to the August 2017 Merger with inVentiv, our Clinical Solutions segment represents only a 

27

portion of our overall business resulting in our reported backlog becoming less meaningful as an indicator of 
our future total revenues.

We do not currently report new business awards or backlog data for our Commercial Solutions segment. 

Failure to adopt the new accounting standard of recognizing revenue from contracts with customers 
in a timely manner could cause our business, financial condition, results of operations or cash flows 
to be materially adversely affected.

Effective January 1, 2018, the Company is required to adopt the Financial Accounting Standards Board 
("FASB") Accounting Standards Update ("ASU") No. 2014-09, Revenue from Contracts with Customers, the 
new comprehensive accounting standard for recognizing revenue from contracts with customers. If the 
Company is unable to accurately and efficiently adopt the new standard effective on January 1, 2018, is 
unable to adopt the new standard for the combined company after the Merger, is unable to get its information 
systems and processes in place to facilitate compliance, or is unable to effectively communicate the changes 
in revenue recognition policy to investors, the Company may lose investor confidence, its ability to raise 
capital, and/or its business, financial condition, results of operations or cash flows may be materially 
adversely affected. See "Note 1 - Basis of Presentation and Changes in Significant Accounting Policies" to the 
consolidated financial statements in Part II, Item 8, "Financial Statements and Supplementary Data” in this 
Annual Report on Form 10-K for further information regarding ASU 2014-09. 

Our operating results have historically fluctuated between fiscal quarters and may continue to 
fluctuate in the future, which may adversely affect the market price of our stock.

Our operating results have fluctuated in previous quarters and years and may continue to vary significantly 
from quarter to quarter and are influenced by a variety of factors, such as:

• 

• 

• 

• 

• 

• 

• 

timing of contract amendments for changes in scope that could affect the value of a contract and 
potentially impact the amount of net new business awards and net service revenues from quarter to 
quarter;

commencement, completion, execution, postponement or termination of large contracts;

contract terms for the recognition of revenue milestones;

progress of ongoing contracts and retention of customers;

timing of and charges associated with completion of acquisitions, integration of acquired businesses, 
and other events;

changes in the mix of services delivered, both in terms of geography and type of services;

potential customer disputes, penalties or other issues that may impact the revenue we are able to 
recognize or the collectability of our related accounts receivable; and

• 

exchange rate fluctuations.

Our operating results for any particular quarter are not necessarily a meaningful indicator of future results and 
fluctuations in our quarterly operating results could negatively affect the market price and liquidity of our stock.

If we underprice our contracts, overrun our cost estimates or fail to receive approval for or experience 
delays in documentation of change orders, our business, financial condition, results of operations or 
cash flows may be materially adversely affected.

We price our contracts based on assumptions regarding the scope of work required and cost to complete the 
work. We bear the financial risk if we initially underprice our contracts or otherwise overrun our cost 
estimates, which could adversely affect our cash flows and financial performance. In addition, contracts with 
our customers are subject to change orders, which occur when the scope of work we perform needs to be 
modified from that originally contemplated in our contract with the customers. This can occur, for example, 
when there is a change in a key study assumption or parameter or a significant change in timing. We may be 
unable to successfully negotiate changes in scope or change orders on a timely basis or at all, which could 
require us to incur cost outlays ahead of the receipt of any additional revenue. In addition, under generally 
accepted accounting principles in the United States of America ("GAAP") we cannot recognize additional 

28

revenue anticipated from change orders until appropriate documentation is received by us from the customer 
authorizing the change. However, if we incur additional expense in anticipation of receipt of that 
documentation, we must recognize the expense as incurred. Any of the foregoing could have a material 
adverse effect on our business, financial condition, results of operations or cash flows.

Our business depends on the continued effectiveness and availability of our information systems, 
including the information systems we use to provide services to our customers and to store 
employee data, and failures of these systems, including cyber-attacks, may materially limit our 
operations or have an adverse effect on our reputation.

Our information systems are comprised of systems we have purchased or developed, legacy information 
systems from organizations we have acquired, including inVentiv and, increasingly, web-enabled and other 
integrated information systems. In using these information systems, we frequently rely on third-party vendors 
to provide hosting services, where our infrastructure is dependent upon the reliability of their underlying 
platforms, facilities and communications systems. We also utilize integrated information systems that we 
provide customers access to or install for our customers in conjunction with our delivery of services.

As the breadth and complexity of our information systems continue to grow, we will increasingly be exposed 
to the risks inherent in maintaining the stability of our legacy systems due to prior customization, attrition of 
employees or vendors involved in their development, and obsolescence of the underlying technology as well 
as risks from the increasing number and scope of external data breaches on multi-national companies. In 
addition, during 2017 we began a major integration of the legacy inVentiv financial and operational systems to 
our financial and operating systems. Please refer to the risk factor “Upgrading the information systems that 
support our operating processes and evolving the technology platform for our services pose risks to our 
business” below for additional risk related to integrating information technology systems and processes. 
Because certain customers, clinical trials, and other long-term projects depend upon these legacy systems, 
we also face an increased level of embedded risk in maintaining the legacy systems and limited options to 
mitigate such risk. We are also exposed to risks associated with the availability of all our information systems, 
including:

• 

• 

disruption, impairment or failure of data centers, telecommunications facilities or other key 
infrastructure platforms, including those maintained by our third-party vendors;

security breaches of, cyber-attacks on and other failures or malfunctions in our internal systems, 
including our employee data and communications, critical application systems or their associated 
hardware; and

• 

excessive costs, excessive delays or other deficiencies in systems development and deployment.

The materialization of any of these risks may impede the processing of data, the delivery of databases and 
services, and the day-to-day management of our business and could result in the corruption, loss or 
unauthorized disclosure of proprietary, confidential or other data. While we have disaster recovery plans in 
place, they might not adequately protect us in the event of a system failure. Despite any precautions we take, 
damage from fire, floods, hurricanes, power loss, telecommunications failures, computer viruses, break-ins 
and similar events at our various computer facilities or those of our third-party vendors could result in 
interruptions in the flow of data to us and from us to our customers. Corruption or loss of data may result in 
the need to repeat a project at no cost to the customer, but at significant cost to us, the termination of a 
contract or damage to our reputation. Additionally, significant delays in system enhancements or inadequate 
performance of new or upgraded systems once completed could damage our reputation and harm our 
business. Finally, long-term disruptions in the infrastructure caused by events such as natural disasters, the 
outbreak of war, the escalation of hostilities and acts of terrorism, particularly involving cities in which we have 
offices, and cyber-attacks such as those recently faced by other multi-national companies could adversely 
affect our businesses. As our business continues to expand globally, these types of risks may be further 
increased by instability in the geopolitical climate of certain regions, underdeveloped and less stable utilities 
and communications infrastructure, and other local and regional factors. Although we carry property and 
business interruption insurance that we believe is customary for our industry, our coverage might not be 
adequate to compensate us for all losses that may occur.

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Unauthorized disclosure of sensitive or confidential data, whether through systems failure or employee 
actions, cyber-attacks, fraud or misappropriation, could damage our reputation and cause us to lose 
customers. Similarly, we have been and expect that we will continue to be subject to attempts to gain 
unauthorized access to or through our information systems or those we internally or externally develop for our 
customers, including a cyber-attack by computer programmers and hackers who may develop and deploy 
viruses, worms or other malicious software programs, process breakdowns, denial-of-service attacks, 
malicious social engineering or other malicious activities, or any combination of the foregoing. In addition, we 
may be susceptible to physical or computer-based attacks by terrorists or hackers due to our role in the 
biopharmaceutical service industry. These concerns about security are increased when information is 
transmitted over the Internet. Threats include cyber-attacks such as computer viruses, worms or other 
destructive or disruptive software, and any of these could result in a degradation or disruption of our services 
or damage to our properties, equipment and data. They could also compromise data security, including the 
security of personal data. If such attacks are not detected immediately, their effect could be compounded. To 
date these attacks have not had a material impact on our operations or financial results. However, successful 
attacks in the future could result in negative publicity, significant remediation and recovery costs, legal liability 
and damage to our reputation and could have a material adverse effect on our financial condition, results of 
operations and cash flows. In addition, our liability insurance might not be sufficient in type or amount to cover 
us against claims related to security breaches, cyber-attacks and other related breaches.

Additionally, we rely on service providers for the timely transmission of information across our global data 
network. If a service provider fails to provide the communications capacity or services we require for similar 
reasons, the failure could interrupt our services. Because of the centrality of our processing systems to our 
business, any interruption or degradation could adversely affect the perception of our brands' reliability and 
harm our business. If a service provider experiences the unauthorized disclosure of sensitive or confidential 
data they are processing on our behalf, whether through systems failure or employee actions, cyber-attacks, 
fraud, or misappropriation, it could damage our reputation and cause us to lose customers. Similarly, such 
disclosure could result in negative publicity, significant remediation and recovery costs, legal liability and 
damage to our reputation, and could have a material adverse effect on our financial condition, results of 
operations, and cash flows. In addition, contractual indemnity, the service provider’s liability insurance and our 
liability insurance might not be sufficient in type or amount to cover us against claims related to security 
breaches, cyber-attacks, and other related breaches.

We are subject to regulation in the areas of consumer privacy and data use and security.

Privacy, data use and security continue to receive heightened legislative and regulatory focus in the United 
States, Europe and elsewhere. For example, in many jurisdictions victims must be notified in the event of a 
data breach and those jurisdictions that have these laws are continuing to increase the circumstances and the 
breadth of these notices. Our failure or the failure of our customers to comply with these laws and regulations 
could result in fines, sanctions, litigation, damages, cost for mitigation activities and damage to our global 
reputation and our brands.

Our customer or therapeutic area concentration may have a material adverse effect on our business, 
financial condition, results of operations or cash flows.

If any large customer decreases or terminates its relationship with us, our business, financial condition, 
results of operations or cash flows could be materially adversely affected. For the year ended December 31, 
2017, our top ten customers based on revenue accounted for approximately 37% of our consolidated net 
service revenue and our top ten Clinical Solutions customers based on backlog accounted for approximately 
39% of our total backlog. No single customer accounted for greater than 10% of our total consolidated net 
service revenue for the years ended December 31, 2017, 2016 or 2015. It is possible that an even greater 
portion of our revenues will be attributable to a smaller number of customers in the future, including as a 
result of our entering into strategic provider relationships with customers. Also, consolidation in our potential 
customer base results in increased competition for important market segments and fewer available customer 
accounts.

Additionally, conducting multiple clinical trials for different sponsors in a single therapeutic class involving 
drugs with the same or similar chemical action may adversely affect our business if some or all of the trials 
are canceled because of new scientific information or regulatory judgments that affect the drugs as a class. 
Similarly, marketing and selling products for different sponsors with similar drug action subjects us to risk if 

30

new scientific information or regulatory judgment prejudices the products as a class, leading to compelled or 
voluntary prescription limitations or withdrawal of some or all of the products from the market.

Our business is subject to international economic, political and other risks that could have a material 
adverse effect on our business, financial condition, results of operations, cash flows or reputation.

We have operations in many foreign countries, including, but not limited to, countries in the Asia-Pacific 
region, Europe, Latin America and the Middle East and Africa. As of December 31, 2017, approximately 47% 
of our workforce was located outside of the United States, and for the fiscal year ended December 31, 2017, 
approximately 39% of our net service revenue was billed to locations outside the United States. Our 
international operations are subject to risks and uncertainties inherent in operating in these regions, including:

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

conducting a single project across multiple countries is complex, and issues in one country, such as a 
failure to comply with or unanticipated changes to local regulations or restrictions such as restrictions 
on import or export of clinical trial material or availability of clinical trial data may affect the progress of 
the trial in the other countries, resulting in delays or potential termination of contracts, which in turn 
may result in loss of revenue;

the United States or other countries could enact legislation or impose regulations or other restrictions, 
including unfavorable labor regulations, tax policies, data protection regulations or economic 
sanctions, which could have an adverse effect on our ability to conduct business in or expatriate 
profits from the countries in which we operate;

foreign countries are expanding or may expand their banking regulations that govern international 
currency transactions, particularly cross-border transfers, which may inhibit our ability to transfer 
funds into or within a jurisdiction, impeding our ability to pay our principal investigators, vendors and 
employees, thereby impacting our ability to conduct trials in such jurisdictions;

foreign countries are expanding or may expand their regulatory framework with respect to patient 
informed consent, protection and compensation in clinical trials, or transparency reporting 
requirements (similar to the Physician Payments Sunshine Act in the United States), which could 
delay, inhibit or prohibit our ability to conduct projects in such jurisdictions;

the regulatory or judicial authorities of foreign countries might not enforce legal rights and recognize 
business procedures in a manner in which we are accustomed or would reasonably expect;

changes in political and economic conditions, including the June 2016 vote by the U.K. to exit from 
the European Union and the results of the U.S. presidential election, may lead to changes in the 
business environment in which we operate, as well as changes in inflation and foreign currency 
exchange rates;

potential violations of applicable anti-bribery/anti-corruption laws, including the United States Foreign 
Corrupt Practices Act ("FCPA") and the UK Bribery Act of 2010, may cause a material adverse effect 
on our business, financial condition, results of operations, cash flows or reputation;

customers in foreign jurisdictions may have longer payment cycles, and it may be more difficult to 
collect receivables in those jurisdictions;

natural disasters, pandemics or international conflict, including terrorist acts, could interrupt our 
services, endanger our personnel or cause project delays or loss of trial materials or results;

political unrest, such as the current situations in the Middle East, could delay or disrupt the ability to 
conduct clinical trials or other business; and

foreign governments may enact currency exchange controls that may limit the ability to fund our 
operations or significantly increase the cost of maintaining operations.

These risks and uncertainties could negatively impact our ability to, among other things, perform large, global 
projects for our customers. Furthermore, our ability to deal with these issues could be affected by applicable 
U.S. laws. Any such risks could have an adverse impact on our business, financial condition, results of 
operations, cash flows or reputation.

31

Governmental authorities may question our intercompany transfer pricing policies or change their 
laws in a manner that could increase our effective tax rate or otherwise harm our business.

As a U.S. company doing business in international markets through subsidiaries, we are subject to foreign tax 
and intercompany pricing laws, including those relating to the flow of funds between legal entities in various 
international jurisdictions. Tax authorities in the United States and in international markets have the right to 
examine our corporate structure and how we account for intercompany fund transfers. If such authorities 
challenge our corporate structure, transfer pricing mechanisms or intercompany transfers and the resulting 
assessments are upheld, our operations may be negatively impacted and our effective tax rate may increase. 
Tax rates vary from country to country and if a tax authority determines that our profits in one jurisdiction 
should be increased, we might not be able to realize the full tax benefits in the event we cannot utilize all 
foreign tax credits that are generated, or we do not realize a compensating offsetting adjustment in another 
taxing jurisdiction. The effects of either would increase our effective tax rate. Additionally, the Organization for 
Economic Cooperation and Development has issued certain guidelines regarding base erosion and profit 
shifting. As these guidelines continue to be formally adopted by separate taxing jurisdictions, we may need to 
change our approach to intercompany transfer pricing in order to maintain compliance under the new rules. 
Our effective tax rate may increase or decrease depending on the current location of global operations at the 
time of the change. Finally, we might not always be in compliance with all applicable customs, exchange 
control, Value Added Tax and transfer pricing laws despite our efforts to be aware of and to comply with such 
laws. If these laws change we may need to adjust our operating procedures and our business could be 
adversely affected.

If we are unable to successfully increase our market share, our ability to grow our business and 
execute our growth strategies could be materially adversely affected.

A key element of our growth strategy is increasing our market share within the biopharmaceutical services 
market, the clinical development market and in the geographic markets in which we operate. In addition, we 
continue to invest in expanding new services such as our late phase offerings, along with solutions for our 
medical device customers. As we grow our market share within the biopharmaceutical services and clinical 
development markets and make investments in growing our newer service offerings, we might not have or 
adequately build the competencies necessary to perform our services satisfactorily or may face increased 
competition. If we are unable to succeed in increasing our market share or realize the benefits of our 
investments in our new service offerings, we may be unable to implement this element of our growth strategy, 
and our ability to grow our business or maintain our operating margins could be adversely affected.

Upgrading the information systems that support our operating processes and evolving the 
technology platform for our services pose risks to our business.

Continued efficient operation of our business requires that we implement standardized global business 
processes and evolve our information systems to enable this implementation, especially in the course of 
integrating inVentiv into our company. We have continued to undertake significant programs to optimize 
business processes with respect to our services. Our inability to effectively manage the implementation of 
new information systems or upgrades and adapt to new processes designed into these new or upgraded 
systems in a timely and cost-effective manner may result in disruption to our business and negatively affect 
our operations.

We have entered into agreements with certain vendors to provide systems development, integration, and 
hosting services that develop or license to us the information technology ("IT") platforms and capacity for 
programs to optimize our business processes. If such vendors or their products fail to perform as required or if 
there are substantial delays in developing, implementing, and updating our IT platforms, our customer 
delivery may be impaired, and we may have to make substantial further investments, internally or with third 
parties, to achieve our objectives. For example, we rely on an external vendor to provide the clinical trial 
management software used in managing the completion of our customer clinical trials. If that externally 
provided system is not properly maintained we might not be able to meet the obligations of our contracts or 
may need to incur significant costs to replace the system or capability. Additionally, our progress may be 
limited by parties with existing or claimed patents who seek to enjoin us from using preferred technology or 
seek license payments from us.

32

Meeting our objectives is dependent on a number of factors which might not take place as we anticipate, 
including obtaining adequate technology-enabled services, depending upon our third-party vendors to 
develop and enhance existing applications to adequately support our business, creating IT-enabled services 
that our customers will find desirable and implementing our business model with respect to these services. 
Also, increased IT-related expenditures and our potential inability to anticipate increases in service costs may 
negatively impact our business, financial condition, results of operations or cash flows.

If we fail to perform our services in accordance with contractual requirements, regulatory standards 
and ethical considerations, we could be subject to significant costs or liability and our reputation 
could be harmed.

We contract with biopharmaceutical companies to perform a wide range of services to assist them in bringing 
new drugs to market and to support the commercial activity of products already in the marketplace. Our 
services include monitoring clinical trials, data and laboratory analysis, EDC, patient recruitment, product 
launch consulting, selling solutions, advertising, publications and medical communications, and other related 
services. Such services are complex and subject to contractual requirements, regulatory standards and 
ethical considerations. For example, we must adhere to applicable regulatory requirements such as those 
required by the Food and Drug Administration, European Medicines Agency, and current Good Clinical 
Practice regulations, which govern, among other things, the design, conduct, performance, monitoring, 
auditing, recording, analysis, and reporting of clinical trials and the promotion, sales and marketing of 
biopharmaceutical products. If we fail to perform our services in accordance with these requirements, 
regulatory agencies may take action against us or our customers. Such actions may include sanctions such 
as injunctions or failure of such regulatory authorities to grant marketing approval of products, imposition of 
clinical holds or delays, suspension or withdrawal of approvals, rejection of data collected in our studies, 
license revocation, product seizures or recalls, operational restrictions, civil or criminal penalties or 
prosecutions, damages or fines. Additionally, there is a risk that actions by regulatory authorities, if they result 
in significant inspectional observations or other measures, could harm our reputation and cause customers 
not to award us future contracts or to cancel existing contracts. Any such action could have a material 
adverse effect on our business, financial condition, results of operations, cash flows or reputation.

Such consequences could arise if, among other things, the following occur:

Improper performance of our services.  The performance of our clinical development and other 
biopharmaceutical services is complex and time-consuming. For example, we may make mistakes in 
conducting a clinical trial that could negatively impact or obviate the usefulness of the trial or cause the results 
of the trial to be reported improperly. If the trial results are compromised, we could be subject to significant 
costs or liability, which could have an adverse impact on our ability to perform our services and our reputation 
could be harmed. For example:

• 

• 

non-compliance generally could result in the termination of ongoing clinical trials or the 
disqualification of data for submission to regulatory authorities;

compromise of data from a particular trial, such as failure to verify that adequate informed consent 
was obtained from subjects or improper monitoring of data, could require us to repeat the trial under 
the terms of our contract at no further cost to our customer, but at a substantial cost to us; and

• 

breach of a contractual term could result in liability for damages or termination of the contract.

Large clinical trials can cost hundreds of millions of dollars and improper performance of our services could 
have a material adverse effect on our financial condition, damage our reputation, and result in the termination 
of current contracts or failure to obtain future contracts from the affected customer or other customers.

Interactive Voice/Web Response Technology malfunction.  We develop, maintain, and use third-party 
computer-based interactive voice/web response systems to automatically manage the randomization of 
patients in a given clinical trial to different treatment arms and regulate the supply of investigational drugs, all 
by means of interactive voice/web response systems. An error in the design, programming, or validation of 
these systems could lead to inappropriate assignment or dosing of patients which could give rise to patient 
safety issues, invalidation of the trial, or liability claims against us. Furthermore, negative publicity associated 
with such a malfunction could have an adverse effect on our business and reputation. Additionally, errors in 

33

randomization may require us to repeat the trial at no further cost to our customer, but at a substantial cost to 
us.

Investigation of customers.  From time to time, one or more of our customers are audited or investigated by 
regulatory authorities or enforcement agencies with respect to regulatory compliance of their clinical trials, 
programs or the marketing and sale of their drugs. In these situations, we have often provided services to our 
customers with respect to the clinical trials, programs, or activities being audited or investigated, and we are 
called upon to respond to requests for information by the authorities and agencies. There is a risk that either 
our customers or regulatory authorities could claim that we performed our services improperly or that we are 
responsible for clinical trial or program compliance. If our customers or regulatory authorities make such 
claims against us and prove them, we could be subject to damages, fines, or penalties. In addition, negative 
publicity regarding regulatory compliance of our customers' clinical trials, programs, or drugs could have an 
adverse effect on our business and reputation.

Insufficient customer funding to complete a clinical trial.  As noted above, clinical trials can cost hundreds of 
millions of dollars. There is a risk that we may initiate a clinical trial for a customer, and then the customer 
becomes unwilling or unable to fund the completion of the trial. In such a situation, notwithstanding the 
customer's ability or willingness to pay for or otherwise facilitate the completion of the trial, we may be 
ethically bound to complete or wind down the trial at our own expense.

In addition to the above U.S. laws and regulations, we must comply with the laws of all countries where we do 
business, including laws governing clinical trials in the jurisdiction where the trials are performed. Failure to 
comply with applicable requirements could subject us to regulatory risk, liability, and potential costs 
associated with redoing the trials, which could damage our reputation and adversely affect our operating 
results.

Any future litigation against us could be costly and time-consuming to defend.

We may become subject, from time to time, to legal proceedings and claims that arise in the ordinary course 
of business or pursuant to governmental or regulatory enforcement activity. While we do not believe that the 
resolution of any currently pending lawsuits against us will, individually or in the aggregate, have a material 
adverse effect on our business, financial condition, results of operations, or cash flows, we might be wrong, 
and future litigation might result in substantial costs and divert management's attention and resources, which 
might seriously harm our business, financial condition, results of operations, and cash flows. Insurance might 
not cover such claims, provide sufficient payments to cover all of the costs to resolve one or more such 
claims, or continue to be available on terms acceptable to us. In particular, any claim could result in potential 
liability for us if the claim is outside the scope of the indemnification agreement we have with our customers, 
our customers do not abide by the indemnification agreement as required or the liability exceeds the amount 
of any applicable indemnification limits or available insurance coverage. A claim brought against us that is 
uninsured or underinsured could result in unanticipated costs and could have a material adverse effect on our 
financial condition, results of operations, cash flows, or reputation.

The operation of our early stage (Phase I and IIA) clinical facilities and the services we provide there 
as well as our clinical trial management, including direct interaction with clinical trial patients or 
volunteers, could create potential liability that may adversely affect our business, financial condition, 
results of operations, cash flows, and reputation. 

We operate facilities where early stage clinical trials are conducted, which ordinarily involve testing an 
investigational drug on a limited number of individuals to evaluate a product’s safety, determine a safe dosage 
range and identify side effects. Additionally, our business involves clinical trial management, which is one of 
our clinical development service offerings, and includes the testing of new drugs on human volunteers. Some 
of these trials involve the administration of investigational drugs to known substance abusers or volunteers 
and patients that are already seriously ill and are at risk for further illness or death. Failure to operate any of 
our early stage facilities in accordance with applicable regulations could result in that facility being shut down, 
which could disrupt our operations and adversely affect our business, financial condition, results of 
operations, cash flows, and reputation. 

Additionally, we face risks resulting from the administration of drugs to volunteers, including adverse events, 
and the professional malpractice of medical care providers, including improper administration of a drug or 

34

device. We also directly employ doctors, nurses, and other trained employees who assist in implementing the 
testing involved in our clinical trials, such as drawing blood from healthy volunteers. Although we attempt to 
negotiate indemnification arrangements with our customers or vendors, we might not be able to collect under 
these arrangements and our exposure could exceed any contractual limits on indemnification. Any 
professional malpractice or negligence by such doctors, nurses, principal investigators, or other employees 
could potentially result in liability to us in the event of personal injury to or death of a volunteer in clinical trials. 
This liability, particularly if it were to exceed the limits of any indemnification agreements and insurance 
coverage we may have, may adversely affect our business and financial condition, results of operations, cash 
flows, and reputation.

If our insurance does not cover all of our indemnification obligations and other liabilities associated 
with our operations, our business, financial condition, results of operations, or cash flows may be 
materially adversely affected.

We maintain insurance designed to provide coverage for ordinary risks associated with our operations and 
our ordinary indemnification obligations that we believe to be customary for our industry. The coverage 
provided by such insurance might not be adequate for all claims we make or may be contested by our 
insurance carriers. If our insurance is not adequate or available to pay all claims or exposures associated with 
our operations, or if we are unable to purchase adequate insurance at reasonable rates in the future, our 
business, financial condition, results of operations or cash flows may be materially adversely affected.

If we are unable to attract suitable principal investigators and recruit and enroll patients for clinical 
trials, our clinical development business might suffer.

The recruitment of principal investigators and patients for clinical trials is essential to our business. Principal 
investigators are typically located at hospitals, clinics, or other sites and supervise the administration of the 
investigational drug to patients during the course of a clinical trial. Patients generally include people from the 
communities in which the clinical trials are conducted. Several of our competitors have purchased site 
networks or site management organizations as a strategy for priority access to a specific site, which could put 
us at a competitive disadvantage. Our clinical development business could be adversely affected if we are 
unable to attract suitable and willing principal investigators or recruit and enroll patients for clinical trials on a 
consistent basis. The expanding global nature of clinical trials increases the risk associated with attracting 
suitable principal investigators and patients, especially if these trials are conducted in regions where our 
resources or experience may be more limited. For example, if we are unable to engage principal investigators 
to conduct clinical trials as planned or enroll sufficient patients in clinical trials, we might need to expend 
additional funds to obtain access to more principal investigators and patients than planned or else be 
compelled to delay or modify the clinical trial plans, which may result in additional costs to us or cancellation 
of the trial by our customer. If realized, these risks may also inhibit our ability to attract new business, 
particularly in certain regions.

Our business could result in liability to us if a drug causes harm to a patient. While we are generally 
indemnified and insured against such risks, we may still suffer financial losses.

When we market drugs under contract for a biopharmaceutical company, we could suffer liability for harm 
allegedly caused by those drugs, either as a result of a lawsuit against the biopharmaceutical company to 
which we are joined, a lawsuit naming us or any of our subsidiaries, or an action launched by a regulatory 
body. While we are generally indemnified by the biopharmaceutical company for the action of the drugs we 
market on its behalf and carry insurance to cover harm caused by our negligence in performing services, it is 
possible that we could nonetheless incur financial losses, regulatory penalties, or both. In particular, any claim 
could result in potential liability for us if the claim is outside the scope of the indemnification agreement we 
have with the biopharmaceutical company, the biopharmaceutical company does not abide by the 
indemnification agreement as required, or the liability exceeds the amount of any applicable indemnification 
limits or available insurance coverage. Such a result could have an adverse impact on our financial condition, 
results of operations, cash flows, and reputation. Furthermore, negative publicity associated with harm 
caused by drugs we helped to market could have an adverse effect on our business and reputation.

35

Investments in our customers’ businesses or drugs and our related commercial rights strategies 
could have a negative impact on our financial performance.

We may enter into arrangements with our customers or other drug companies in which we take on some of 
the risk of the potential success or failure of their businesses or drugs, including making strategic investments 
in our customers or other drug companies, providing financing to customers or other drug companies, or 
acquiring an interest in the revenues from customers’ drugs or in entities developing a limited number of 
drugs. Before entering into any such arrangements, we carefully analyze and select the customers and drugs 
with which we are willing to structure our risk-based deals. Our financial results could be adversely affected if 
these investments or the underlying drugs result in losses, do not achieve the level of success that we 
anticipate, and/or our return or payment from the drug investment or financing is less than our direct and 
indirect costs with respect to these arrangements. Additionally, there is a risk that we are not awarded projects 
by other customers who believe we are in competition with them because of these investments, which would 
negatively impact future awards.

If we lose the services of key personnel or are unable to recruit experienced personnel, our business, 
financial condition, results of operations, cash flows, or reputation could be materially adversely 
affected.

Our success substantially depends on the collective performance, contributions, and expertise of our senior 
management team and other key personnel including qualified management, professional, scientific, and 
technical operating staff, and business development personnel, particularly as we integrate inVentiv into our 
company. There is significant competition for qualified personnel, particularly those with higher educational 
degrees, in the biopharmaceutical and related services industries. In addition, the close proximity of some of 
our facilities to offices of our major competitors could adversely impact our ability to successfully recruit and 
retain key personnel. The departure of any key executive, or our inability to continue to identify, attract and 
retain qualified personnel or replace any departed personnel in a timely fashion, might impact our ability to 
grow our business and compete effectively in our industry and might negatively affect our business, financial 
condition, results of operations, cash flows, or reputation.

Foreign currency exchange rate fluctuations may have a material adverse effect on our financial 
condition, results of operations, and cash flows.

Approximately 17% of our fiscal year 2017 net service revenues were contracted in currencies other than U.S. 
dollars and 32% of our direct and operating costs are incurred in countries with functional currencies other 
than the U.S. dollar. Our financial statements are reported in U.S. dollars and changes in foreign currency 
exchange rates could significantly affect our financial condition, results of operations, or cash flows. Our 
primary exposure to fluctuations in foreign currency exchange rates is related to the following risks:

Foreign Currency Risk from Differences in Customer Contract Currency and Operating Costs Currency.  The 
majority of our global contracts are denominated in U.S. dollars or Euros while our operating costs in foreign 
countries are denominated in various local currencies. Fluctuations in the exchange rates of the currencies 
we use to contract with our customers and the currencies in which we incur cost to fulfill those contracts can 
have a significant impact on our results of operations.

Foreign Currency Translation Risk.  The revenue and expenses of our international operations are generally 
denominated in local currencies and translated into U.S. dollars for financial reporting purposes. Accordingly, 
exchange rate fluctuations between the value of the U.S. dollar versus local currencies will affect the U.S. 
dollar value of our foreign currency denominated revenue, costs, and results of operations.

Foreign Currency Transaction Risk.  We earn revenue from our service contracts over a period of several 
months and, in many cases, over several years, resulting in timing differences between the consummation 
and cash settlement of a transaction. Accordingly, profitability of the transactions denominated in foreign 
currencies is subject to effects of fluctuations in foreign currency exchange rates during the period of time 
between the consummation and cash settlement of a transaction.

We may seek to limit our exposure to these risks through inclusion of foreign currency exchange rate 
provisions in our service contracts, and/or by hedging certain exposures with foreign exchange derivative 
instruments. These measures, however, might not offset or mitigate any, or all of the adverse financial effects 
of unfavorable movements in foreign currency exchange rates.

36

Unfavorable economic conditions could have a material adverse effect on our business, financial 
condition, results of operations, or cash flows.

Unfavorable economic conditions and other adverse macroeconomic factors on global and domestic markets 
might result, among other matters, in tightening in the credit and capital markets, low liquidity, and volatility in 
fixed income, credit, currency, and equity markets. Such conditions could have a negative effect on our 
business, financial condition, results of operations, or cash flows. For example, our customers might not be 
able to raise money to conduct existing clinical trials, or to fund new drug development and related future 
clinical trials. Resource-sharing customers may also scale back commercial support for their products. In 
addition, economic or market disruptions could negatively impact our vendors, contractors, or principal 
investigators which might have a negative effect on our business.

Our effective income tax rate may fluctuate, which may adversely affect our results of operations. 

Our effective income tax rate is influenced by our projected profitability in the various taxing jurisdictions in 
which we operate. Changes in the distribution of profits and losses among taxing jurisdictions may have a 
significant impact on our effective income tax rate, which in turn could have an adverse effect on our results of 
operations. Factors that may affect our effective income tax rate include, but are not limited to:

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• 

the requirement to exclude from our quarterly worldwide effective income tax calculations the benefit 
for losses in jurisdictions where no income tax benefit can be recognized;

actual and projected full year pre-tax income;

the repatriation of foreign earnings to the United States;

uncertain tax positions;

changes in tax laws in various taxing jurisdictions;

audits by taxing authorities;

the establishment of valuation allowances against deferred income tax assets if we determine that it 
is more likely than not that future income tax benefits will not be realized;

the release of a previously established valuation allowances against deferred income tax assets if we 
determine that it is more likely than not that future income tax benefits will be realized; 

changes in the relative mix and size of clinical studies in various tax jurisdictions; and

the timing and amount of the vesting and exercising of share-based compensation.

These changes may cause fluctuations in our effective income tax rate that could adversely affect our results 
of operations and cause fluctuations in our earnings and earnings per share.

On December 22, 2017, the U.S. government enacted comprehensive tax legislation commonly referred to as 
the Tax Cuts and Jobs Act (the “Tax Act”). The Tax Act makes broad and complex changes to the U.S. tax 
code, including, but not limited to: (i) reducing the U.S. federal corporate tax rate from 35% to 21%; (ii) 
requiring companies to pay a one-time transition tax on certain undistributed earnings of foreign subsidiaries; 
(iii) generally eliminating U.S. federal income taxes on dividends from foreign subsidiaries; (iv) introducing a 
new provision designed to tax global intangible low-taxed income ("GILTI"); (v) eliminating the corporate 
alternative minimum tax ("AMT") and changing how existing AMT credits can be realized; (vi) creating the 
base erosion anti-abuse tax ("BEAT"), a new minimum tax; (vii) creating a new limitation on deductible 
interest expense; (viii) introducing limitations on the deductibility of certain executive compensation; and (ix) 
changing rules related to uses and limitations of net operating loss carryforwards created in tax years 
beginning after December 31, 2017.

Our effective tax rate may fluctuate as we continue to quantify and implement the various aspects of the Tax 
Act over the next 12 to 24 months. If any regulations or clarifications about the Tax Act are published that 
cause us to change how we originally accounted for these new provisions, then our effective tax rate could 
fluctuate as a result. 

37

We have only a limited ability to protect our intellectual property rights, and these rights are important 
to our success.

We develop, use, and protect our proprietary methodologies, analytics, systems, technologies, and other 
intellectual property. Existing laws of the various countries in which we provide services or solutions offer only 
limited protection of our intellectual property rights, and the protection in some countries may be very limited. 
We rely upon a combination of trade secrets, confidentiality policies, nondisclosure agreements, and other 
contractual arrangements, as well as copyright and trademark laws, to protect our intellectual property rights. 
These laws are subject to change at any time and certain agreements might not be fully enforceable, which 
could further restrict our ability to protect our innovations. Our intellectual property rights might not prevent 
competitors from independently developing services similar to or duplicative of ours or alleging infringement of 
their intellectual property rights in certain jurisdictions. The steps we take in this regard might not be adequate 
to prevent or deter infringement or misappropriation of our intellectual property or claims against us for 
alleged infringement or misappropriation by competitors, former employees, or other third parties. 
Furthermore, we might not be able to detect unauthorized use of, or take appropriate and timely steps to 
enforce, our intellectual property rights. Enforcing our rights might also require considerable time, money, and 
oversight, and we might not be successful in enforcing our rights.

Our acquisition strategy may present additional risks. 

We have historically grown our business both organically and through acquisitions, most recently and notably 
of inVentiv. We have and will continue to assess the need and opportunity to offer additional services through 
acquisitions of other companies. Acquisitions involve numerous risks, including the following: 

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• 

ability to identify suitable acquisition opportunities or obtain any necessary financing on commercially 
acceptable terms; 

increased risk to our financial position and liquidity through changes to our capital structure and 
assumption of acquired liabilities, including any indebtedness incurred to finance the acquisitions and 
related interest expense; 

diversion of management’s attention from normal daily operations of the business; 

insufficient revenues to offset increased expenses associated with acquisitions; 

assumption of liabilities and exposure to unforeseen liabilities of acquired companies, including 
liabilities for their failure to comply with healthcare, tax, and other regulations; 

inability to achieve identified operating and financial synergies anticipated to result from an 
acquisition; 

ability to integrate acquired operations, products, and technologies into our business; 

difficulties integrating acquired personnel and distinct cultures into our business; and 

the potential loss of key employees, customers, or projects. 

We may also spend time and money investigating and negotiating with potential acquisition targets but not 
complete the merger. Any acquisition could involve other risks, including, among others, the assumption of 
additional liabilities and expenses, difficulties and expenses in connection with integrating the acquired 
companies and achieving the expected benefits, issuances of potentially dilutive securities or interest-bearing 
debt, loss of key employees of the acquired companies, transaction expenses, diversion of management's 
attention from other business concerns, and, with respect to the acquisition of international companies, the 
inability to overcome differences in international business practices, language and customs. Our failure to 
successfully integrate inVentiv and potential future acquisitions could have a material adverse effect on our 
business, financial condition, results of operations, and cash flows.

If we are unable to successfully integrate acquisitions, our business, financial condition, results of 
operations, and cash flows could be materially adversely affected.

We have completed a number of acquisitions in the past, most recently and notably inVentiv, and anticipate 
that a portion of our future growth may come from strategic or tuck-in acquisitions. The success of any 
acquisition will depend upon, among other things, our ability to execute against identified synergies and 

38

effectively integrate acquired personnel, operations, products, and technologies into our business, and to 
retain the key personnel and customers of our acquired businesses. In addition, we may be unable to identify 
suitable acquisition opportunities or obtain any necessary financing on commercially acceptable terms. 

Our relationships with existing or potential customers who are in competition with each other may 
adversely impact the degree to which other customers or potential customers use our services, which 
may adversely affect our business, financial condition, results of operations, or cash flows.

The biopharmaceutical industry is highly competitive, with biopharmaceutical companies each seeking to 
persuade payers, providers, and patients that their drug therapies are better and more cost-effective than 
competing therapies marketed or being developed by competing firms. In addition to the adverse competitive 
interests that biopharmaceutical companies have with each other, biopharmaceutical companies also have 
adverse interests with respect to drug selection and reimbursement with other participants in the healthcare 
industry, including payers and providers. Biopharmaceutical companies also compete to be first to market with 
new drug therapies. We regularly provide services to biopharmaceutical companies who compete with each 
other, and we sometimes provide services to such customers regarding competing drugs in the market and in 
development. Our existing or future relationships, particularly broader strategic provider and commercial 
relationships, with our biopharmaceutical customers may therefore deter other biopharmaceutical customers 
from using our services or may result in our customers seeking to place limits on our ability to serve other 
biopharmaceutical industry participants. In addition, our further expansion into the broader healthcare market 
may adversely impact our relationships with biopharmaceutical customers, and such customers may elect not 
to use our services, reduce the scope of services that we provide to them or seek to place restrictions on our 
ability to serve customers in the broader healthcare market with interests that are adverse to theirs. Any loss 
of customers or reductions in the level of revenues from a customer could have a material adverse effect on 
our business, financial condition, results of operations, or cash flows.

Our results of operations may be adversely affected if we fail to realize the full value of our goodwill 
and intangible assets.

As of December 31, 2017, our goodwill and net intangible assets were valued at $5.58 billion, which 
constituted approximately 77% of our total assets. 

Our goodwill is principally related to the Merger completed in August 2017. Goodwill is tested for impairment 
at the reporting unit level, which is one level below the operating segment level. This test requires us to 
determine if the implied fair value of the reporting unit's goodwill is less than its carrying amount. The 
impairment analysis requires significant judgments, estimates and assumptions. There is no assurance that 
the actual future earnings or cash flows of the reporting units will not decline significantly from the projections 
used in the impairment analysis. Goodwill impairment charges may be recognized in future periods in one or 
more of the reporting units to the extent changes in factors or circumstances occur, including deterioration in 
the macroeconomic environment or industry, deterioration in our performance or our future projections, or 
changes in plans for one or more of our reporting units. As of October 1, 2017 and December 31, 2017, we 
assigned goodwill to five reporting units. We completed our annual impairment test for potential impairment as 
of October 1, 2017 for all of our reporting units, determining that there were no impairments. 

Intangible assets consist of backlog, customer relationships, and trademarks. We review intangible assets at 
the end of each reporting period to determine if facts and circumstances indicate that the useful life is shorter 
than originally estimated or that the carrying amount of the assets might not be recoverable. If such facts and 
circumstances exist, we assess the recoverability of identified assets by comparing the projected 
undiscounted net cash flows associated with the related asset or group of assets over their remaining lives to 
their respective carrying amounts. Impairments, if any, are based on the excess of the carrying amount over 
the fair value of those assets and occur in the period in which the impairment determination was made. In 
connection with the Merger we announced our intentions to relaunch our operations under a new brand name 
in January 2018. As a result, in the third quarter of 2017 we determined that the useful life of our intangible 
asset related to the INC Research trademark with carrying value of $35.0 million was no longer indefinite and 
recorded a $30.0 million impairment charge with the remaining value amortized over the remainder of 2017.

39

We face risks arising from the restructuring of our operations, which could adversely affect our 
financial condition, results of operations, cash flows, or business reputation.

From time to time, we have adopted cost savings initiatives to improve our operating efficiency through 
various means such as: (i) the reduction of overcapacity, primarily in our costs of services (billable) function; 
(ii) elimination of non-billable support roles; and (iii) the consolidation or other realignment of our resources. In 
connection with the Merger, we have established a restructuring plan to eliminate redundant positions and 
reduce our facility footprint worldwide. We expect to continue the ongoing evaluations of our workforce and 
facilities infrastructure needs through 2020 in an effort to optimize our resources worldwide. Additionally, in 
conjunction with the Merger, we assumed certain liabilities related to employee severance and facility closure 
costs as a result of actions taken by inVentiv prior to the Merger. During the year ended December 31, 2017, 
we recognized approximately $11.3 million of employee severance and benefit costs, facility closure and 
lease termination costs of $2.2 million, and other costs of $2.0 million related to the Merger. Additionally, 
during the year ended December 31, 2017, we recognized approximately $9.4 million of non-Merger related  
employee severance costs and incurred $1.3 million of non-Merger related facility closure and lease 
termination costs related to our focus on optimizing our resources worldwide. 

Restructuring actions present significant risks that could have a material adverse effect on our operations, 
financial condition, results of operations, cash flows, or business reputation. Such risks include:

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a decrease in employee morale and retention of key employees; 

a greater number of employment claims;

actual or perceived disruption of service or reduction in service standards to customers; 

the failure to preserve supplier relationships and distribution, sales and other important relationships 
and to resolve conflicts that may arise;

the failure to achieve targeted cost savings; and 

the failure to meet operational targets and customer requirements due to the loss of employees and 
any work stoppages that might occur.

We operate in many different jurisdictions and we could be adversely affected by violations of the 
FCPA, UK Bribery Act of 2010, and/or similar worldwide anti-corruption and anti-bribery laws.

The FCPA, UK Bribery Act of 2010, and similar worldwide anti-corruption laws prohibit companies and their 
intermediaries from making improper payments for the purpose of obtaining or retaining business. Our 
internal policies mandate compliance with these anti-corruption laws. We operate in many parts of the world 
that have experienced corruption to some degree and, in certain circumstances, anti-corruption laws have 
appeared to conflict with local customs and practices. Despite our training and compliance programs, we 
cannot assure that our internal control policies and procedures will protect us from acts in violation of anti-
corruption laws committed by persons associated with us, and our continued expansion outside the United 
States, including in developing countries, could increase such risk in the future. Violations of the FCPA or 
other non-U.S. anti-corruption laws, or even allegations of such violations, could disrupt our business and 
result in a material adverse effect on our financial condition, results of operations, cash flows, and reputation. 
For example, violations of anti-corruption laws can result in restatements of, or irregularities in, our financial 
statements as well as severe criminal or civil sanctions. In some cases, companies that violate the FCPA 
might be debarred by the U.S. government and/or lose their U.S. export privileges. In addition, U.S. or other 
governments might seek to hold us liable for successor liability FCPA violations or violations of other anti-
corruption laws committed by companies that we acquire or in which we invest. Changes in anti-corruption 
laws or enforcement priorities could also result in increased compliance requirements and related costs which 
could adversely affect our business, financial condition, results of operations, and cash flows.

The failure of third parties to provide us critical support services could adversely affect our business, 
financial condition, results of operations, cash flows, or reputation.

We depend on third parties for support services vital to our business. Such support services include, but are 
not limited to, IT services, laboratory services, third-party transportation and travel providers, freight 
forwarders and customs brokers, drug depots and distribution centers, suppliers or contract manufacturers of 

40

drugs for patients participating in clinical trials, and providers of licensing agreements, maintenance contracts 
or other services. In addition, we also rely on third-party CROs and other contract clinical personnel for clinical 
services either in regions where we have limited resources, or in cases where demand cannot be met by our 
internal staff. The failure of any of these third parties to adequately provide us critical support services could 
have a material adverse effect on our business, financial condition, results of operations, cash flows or 
reputation.

We might not be able to utilize certain of our net operating loss carryforwards and certain other tax 
attributes, which could harm our profitability.

As of December 31, 2017, we had approximately $1.0 billion of net operating loss carry forwards (“NOLs”) 
available to reduce U.S. federal taxable income in future years. Under Section 382 and similar provisions of 
the Internal Revenue Code (“the Code”), if a corporation undergoes an “ownership change,” that corporation’s 
ability to use its pre-change NOL carryforwards and other pre-change tax attributes, such as research tax 
credits, to offset its post-change income and taxes may be limited for U.S. federal income tax purposes (or 
similar provisions of other jurisdictions). These limitations may be subject to certain exceptions, including if 
there is “net unrealized built-in gain” in the assets of the corporation undergoing the ownership change.

inVentiv had significant NOLs for U.S. federal income tax purposes, which, until they expire, generally can be 
carried forward to reduce taxable income in future years. In addition, certain of inVentiv’s NOLs and tax 
attributes are subject to existing limitations under Section 382 and similar provisions of the Code as a result of 
inVentiv’s prior ownership changes. The application of these provisions with respect to inVentiv’s NOLs and 
other tax attributes, including the determination of the amount of any “net unrealized built-in gain” in inVentiv’s 
assets, is complex, involving, among other things, certain factual determinations regarding value and built-in 
gain amounts. Accordingly, no assurance can be given that the IRS (or other taxing authority in a jurisdiction 
applying similar law) would not assert our ability to utilize inVentiv’s NOLs and other tax attributes is subject to 
limitations that are different from the limitations as determined by us, or that a court would not agree with such 
an assertion. 

The benefit of the inVentiv NOLs is uncertain even without regard to the Section 382 rules. Due to the 
corporate income tax rate change pursuant to the Tax Act, the value of our NOLs was significantly decreased. 
In addition, a portion of inVentiv’s NOLs arise from certain transaction tax deductions associated with Double 
Eagle’s acquisition of inVentiv on November 9, 2016. Pursuant to that acquisition, inVentiv generally has a 
contingent obligation to pay former shareholders of inVentiv Group Holdings the value of U.S. federal, state 
and local tax benefits arising from those transaction tax deductions as such benefits are realized and, 
consequently, the ability of the combined company to benefit from inVentiv’s NOLs will be limited to the extent 
of such contingent obligation.

Further, as of December 31, 2017, we assessed both positive and negative evidence in evaluating whether 
we could support the recognition of our U.S. net deferred tax asset position or if a valuation allowance would 
be required. A significant piece of objective negative evidence that we considered was the cumulative loss 
over the three-year period ended December 31, 2017. This objective evidence limited our ability to consider 
subjective positive evidence, such as forecasted projections of income. Therefore, the Company recorded a 
charge to income tax expense in the amount of $52.6 million for the net increase in the valuation allowance.

However, given our anticipated future earnings and the new GILTI and BEAT provisions under the Tax Act, we 
believe there is a reasonable possibility that within the next 12 to 24 months, sufficient positive evidence may 
become available to allow us to reach a conclusion that a significant portion of the valuation allowance will no 
longer be needed. Consequently, such release of the valuation allowance would result in the recognition of 
certain deferred tax assets and a decrease to the tax expense in the period that the release is recorded. 
However, the exact timing and amount of the valuation allowance release is unknown at this time.

Downgrades of our credit ratings could adversely affect us. 

We can be adversely affected by downgrades of our credit ratings because ratings are a factor influencing our 
ability to access capital and the terms of any new indebtedness, including covenants and interest rates. Our 
customers and vendors may also consider our credit profile when negotiating contract terms, and if they were 
to change the terms on which they deal with us, it could have a material adverse effect on our business, 
results of operations, cash flows, and financial condition. 

41

Many of our vendors have the right to declare us in default of our agreements if any such vendor, including 
the lessors under our vehicle fleet leases, determines that a change in our financial condition poses a 
substantially increased credit risk. Upon default, the lessors can repossess the vehicles and require us to 
compensate them for any remaining lease payments in excess of the value of the repossessed vehicles. As of 
December 31, 2017, we had $36.8 million in capital lease obligations, primarily related to vehicles used in our 
Selling Solutions offering in the United States. Our Selling Solutions offering may be negatively impacted if we 
lose the use of vehicles for any period of time. 

Our 2017 Credit Agreement contains covenants that may restrict our ability to, among other things, borrow 
money, pay dividends, make capital expenditures, make strategic acquisitions and effect a consolidation, 
merger, or disposal of all or substantially all of our assets. Refer to "Risks Related to Our Indebtedness - 
Covenant restrictions under our 2017 Credit Agreement may limit our ability to operate our business" for 
further details on our covenant restrictions.

Risks Related to Our Industry

The biopharmaceutical services industry is highly competitive and our business could be materially 
impacted if we do not compete effectively.

The biopharmaceutical services industry is highly competitive. Our business often competes with other 
biopharmaceutical services companies, internal discovery departments, development departments, sales and 
marketing departments, information technology departments, and other departments within our customers, 
some of which could be considered large biopharmaceutical services companies in their own right with 
greater resources than ours. We also compete with universities, teaching hospitals, governmental agencies 
and others. If we do not compete successfully, our business will suffer. The industry is highly fragmented, with 
numerous smaller specialized companies and a handful of companies with global capabilities similar to 
certain of our own capabilities. Increased competition has led to price and other forms of competition (such as 
acceptance of less favorable contract terms) that could adversely affect our operating results. There are few 
barriers to entry for companies considering offering any one or more of the services we offer. Because of their 
size and focus, these companies might compete effectively against us, which could have a material adverse 
impact on our business.

In recent years, our industry has experienced increased consolidation and might continue to, which might put 
us at risk of growing more slowly than our competitors that make acquisitions. This trend is likely to produce 
more competition from the resulting larger companies, and ones without the cost pressures of being public, 
for both customers and acquisition candidates. One specific aspect of this consolidation competition involves 
CROs entering into transactions to attempt to control more access to clinical trial participants, like acquisition 
of site networks and data. These trends could make it harder for us to compete successfully.

Our future growth and success will depend on our ability to successfully compete with other companies that 
provide similar services in the same markets, some of which may have financial, marketing, technical, and 
other advantages. We also expect that competition will continue to increase as a result of consolidation 
among these various companies. Large technology companies with substantial resources, technical 
expertise, and greater brand power could also decide to enter or further expand in the markets where our 
business operates and compete with us. If one or more of our competitors or potential competitors were to 
merge or partner with another of our competitors, or if a new entrant emerged with substantial resources, the 
change in the competitive landscape could adversely affect our ability to compete effectively. We compete on 
the basis of various factors, including breadth and depth of services, reputation, reliability, quality, innovation, 
security, price, and industry expertise and experience. In addition, our ability to compete successfully may be 
impacted by the growing availability of health information from social media, government health information 
systems, and other free or low-cost sources. In addition, consolidation or integration of wholesalers, retail 
pharmacies, health networks, payers, or other healthcare stakeholders may lead any of them to provide 
information services directly to customers or indirectly through a designated service provider, resulting in 
increased competition from firms that may have lower costs to market (e.g., no data supply costs). Any of the 
above may result in lower demand for our services, which could result in a material adverse impact on our 
operating results and financial condition.

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Outsourcing trends in the biopharmaceutical industry and changes in aggregate spending and 
research and development budgets could adversely affect our operating results and growth rate.

Our revenues depend on the level of R&D and commercialization expenditures, size of the drug-development 
pipelines and outsourcing trends of the biopharmaceutical industry, including the amount of such R&D spend 
that is outsourced and subject to competitive bidding amongst us and our competitors. Accordingly, economic 
factors and industry trends that affect biopharmaceutical companies affect our business. 

Biopharmaceutical companies continue to seek long-term strategic collaborations with global CROs with 
favorable pricing terms. Competition for these collaborations is intense and we might not be selected, in which 
case a competitor may enter into the collaboration and our business with the customer, if any, may be limited. 
Our success depends in part on our ability to establish and maintain preferred provider relationships with 
large biopharmaceutical companies. Our failure to develop or maintain these preferred provider relationships 
could have a material adverse effect on our business and results of operations. Furthermore, in order to 
obtain preferred provider relationships, we may have to reduce the prices for our services, which could 
negatively impact our gross margin for these services.

In addition, if the biopharmaceutical industry reduces its outsourcing of clinical trials or commercialization 
services or such outsourcing fails to grow at projected rates, our business, financial condition, results of 
operations, and cash flows could be materially and adversely affected. We may also be negatively impacted 
by consolidation and other factors in the biopharmaceutical industry, which may slow decision making by our 
customers, result in the delay or cancellation of existing projects, cause reductions in overall R&D 
expenditures, or lead to increased pricing pressures. Further, in the event that one of our customers combines 
with a company that is using the services of one of our competitors, the combined company could decide to 
use the services of that competitor or another provider. All of these events could adversely affect our 
business, financial condition, cash flows or results of operations.

Actions by government regulators or customers to limit a prescription’s scope or withdraw an 
approved product from the market could adversely affect our business, results of operations, and 
financial condition.

Government regulators have the authority, after approving a biopharmaceutical product, to limit its scope of 
prescription or withdraw it from the market completely based on safety concerns. Similarly, customers may act 
to voluntarily limit the scope of prescription of biopharmaceutical products or withdraw them from the market. 
Actions by payors to limit a product on a formulary list can influence customer decisions to withdraw or limit 
market support for a product. In the past, we have provided services with respect to products that have been 
limited or withdrawn. If we are providing services to customers for products that are limited or withdrawn, we 
may be required to narrow the scope of or terminate our services with respect to such products, which would 
prevent us from earning the full amount of revenues anticipated under the related contracts with negative 
impacts to our business, results of operations, cash flows, and financial condition.

If we fail to comply with federal, state, and foreign healthcare laws, including fraud and abuse laws, 
we could face substantial penalties and our business, financial condition, results of operations, cash 
flows, and prospects could be adversely affected.

Even though we do not and will not order healthcare services or bill directly to Medicare, Medicaid, or other 
third-party payers, certain federal and state healthcare laws and regulations pertaining to fraud and abuse are 
and will be applicable to our business. We could be subject to healthcare fraud and abuse laws of both the 
federal government and the states in which we conduct our business. Because of the breadth of these laws 
and the narrowness of available statutory and regulatory exceptions, it is possible that some of our business 
activities could be subject to challenge under one or more of such laws. If we or our operations are found to 
be in violation of any of the laws described above or any other governmental regulations that apply to us, we 
may be subject to penalties, including civil and criminal penalties, damages, fines, imprisonment, and the 
curtailment or restructuring of our operations, any of which could materially adversely affect our ability to 
operate our business and our financial results.

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We may be affected by healthcare reform and potential additional reforms which may adversely 
impact the biopharmaceutical industry and reduce the need for our services or negatively impact our 
profitability.

Numerous government bodies are considering or have adopted healthcare reforms and may undertake, or 
are in the process of undertaking, efforts to control healthcare costs through legislation, regulation, and 
agreements with healthcare providers and biopharmaceutical companies, including many of our customers. 
As governmental administrations change and reforms take place, we are unable to predict what legislative 
proposals, if any, will be adopted in the future. If regulatory cost-containment efforts limit the profitability of 
new drugs by, for example, continuing to place downward pressure on pharmaceutical pricing and/or 
increasing regulatory burdens and operating costs of the biopharmaceutical industry, our customers may 
reduce their commercialization and R&D spending, which could reduce the business they outsource to us. In 
addition, if regulatory requirements are relaxed or simplified drug approval procedures are adopted, the 
demand for our services could decrease.

Government bodies have adopted and may continue to adopt new healthcare legislation or regulations that 
are more burdensome than existing regulations. For example, product safety concerns and recommendations 
by the Drug Safety Oversight Board could change the regulatory environment for drug products, and new or 
heightened regulatory requirements may increase our expenses or limit our ability to offer some of our 
services. We might have to incur additional costs to comply with these or other new regulations, and failure to 
comply could harm our financial condition, results or operations, cash flows, and reputation. Additionally, new 
or heightened regulatory requirements may have a negative impact on the ability of our customers to conduct 
industry-sponsored clinical trials, which could reduce the need for our post-approval development services.

Current and proposed laws and regulations regarding the protection of personal data could result in 
increased risks of liability or increased cost to us or could limit our service offerings.

The confidentiality, collection, use, and disclosure of personal data, including clinical trial patient-specific 
information, are subject to governmental regulation generally in the country in which the personal data was 
collected or used. For example, U.S. federal regulations under the Health Insurance Portability and 
Accountability Act of 1996, as amended, ("HIPAA") generally require individuals' written authorization, in 
addition to any required informed consent, before protected health information ("PHI") may be used for 
research and such regulations specify standards for de-identification and for limited data sets. We may also 
be subject to applicable state privacy and security laws and regulations in states in which we operate. We are 
indirectly affected by the privacy provisions surrounding individual authorizations because many principal 
investigators with whom we are involved in clinical trials are directly subject to them as a HIPAA "covered 
entity." In addition, we obtain identifiable health information from third parties that are subject to such 
regulations. While we do not believe we are a "business associate" under HIPAA, regulatory agencies may 
disagree. Because of amendments to the HIPAA data security and privacy rules that were promulgated on 
January 25, 2013, some of which went into effect on March 26, 2013, there are some instances where HIPAA 
"business associates" of a "covered entity" may be directly liable for breaches of PHI and other HIPAA 
violations. These amendments may subject "business associates" to HIPAA's enforcement scheme, which, as 
amended, can yield up to $1.5 million in annual civil penalties for each HIPAA violation.

In the EU and many other data privacy laws outside of the U.S., personal data includes any information that 
relates to an identified or identifiable natural person, with health, genetic, biometric, and other sensitive 
personal information carrying additional obligations, including obtaining the explicit consent from the individual 
for collection, use, or disclosure of the information. In addition, we are subject to EU rules with respect to 
cross-border transfers of such data out of the EU. The United States, the EU and its member states, and 
other countries where we have operations, such as Japan, China, South Korea, Malaysia, the Philippines, 
Russia, and Singapore, continue to issue new privacy and data protection laws, rules, and regulations that 
relate to personal data and health information. Failure to comply with certain certification/registration and 
annual re-certification/registration provisions associated with these data protection and privacy laws, rules, 
and regulations in various jurisdictions, or to resolve any serious privacy or security complaints, could subject 
us to regulatory sanctions, delays in clinical trials, criminal prosecution, or civil liability. Federal, state, and 
foreign governments may propose or have adopted additional legislation governing the collection, possession, 
use, or dissemination of personal data, such as personal health information, and personal financial data as 
well as security breach notification rules for loss or theft of such data. Additional legislation or regulation of 

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this type might, among other things, require us to implement new security measures and processes or to 
pseudonymize or de-identify health or other personal data, each of which may require substantial 
expenditures or limit our ability to offer some of our services. Additionally, if we violate applicable laws, rules, 
or regulations relating to the collection, use, privacy, or security of personal data, we could be subject to civil 
liability or criminal prosecution, be forced to alter our business practices and suffer reputational harm. The 
European General Data Protection Regulation ("GDPR") goes into effect on May 25, 2018, replacing the 
existing EU data protection framework. The GDPR contains new provisions specifically directed at the 
processing of health information, rights of data subjects, higher sanctions, and extra-territoriality measures 
intended to bring non-EU companies under the regulation.

Our customers face intense competition from lower cost generic products and other competing 
products, which may lower the amount that they spend on our services and could have a material 
adverse effect on our business, results of operations, cash flows, and financial condition. 

Our customers face increasing competition from competing products and, in particular, from lower cost 
generic products, which in turn may affect their ability to pursue clinical development and commercialization 
activities. In the United States, the EU and Japan, political pressure to reduce spending on prescription 
products has led to legislation and other measures which encourage the use of generic products. In addition, 
proposals emerge from time to time in the United States and other countries for legislation to further 
encourage the early and rapid approval of generic products. Loss of patent protection for a product typically is 
followed promptly by generic substitutes, reducing our customers’ sales of that product and their overall 
profitability. Availability of generic substitutes for our customers’ products or other competing products may 
cause them to lose market share and, as a result, may adversely affect their results of operations and cash 
flow, which in turn may mean that they would not have adequate capital to purchase our services. If 
competition from generic or other products impacts our customers’ finances such that they decide to curtail 
our services, our net revenues may decline and this could have a material adverse effect on our business, 
results of operations, and financial condition. 

If we do not keep pace with rapid technological change, our services may become less competitive or 
obsolete.

The biopharmaceutical industry generally, and drug development and clinical research more specifically, are 
subject to rapid technological change. Our current competitors or other businesses might develop 
technologies or services that are more effective or commercially attractive than, or render obsolete, our 
current or future technologies and services. If our competitors introduce superior technologies or services and 
if we cannot make enhancements to remain competitive, our competitive position would be harmed. If we are 
unable to compete successfully, we may lose customers or be unable to attract new customers, which could 
lead to a decrease in our revenue and have an adverse impact on our financial condition.

In addition, the operation of our business relies on IT infrastructure and systems delivered across multiple 
platforms. The failure of our systems to perform could severely disrupt our business and adversely affect our 
results of operations. Our systems are also vulnerable to demise from natural or man-made disasters, terrorist 
attacks, computer viruses or hackers, power loss, or other technology system failures. These events could 
adversely affect our business or results of operations.

The biopharmaceutical industry has a history of patent and other intellectual property litigation and 
we might be involved in costly intellectual property lawsuits.

The biopharmaceutical industry has a history of intellectual property litigation and these lawsuits will likely 
continue in the future. Accordingly, we may face patent infringement suits or be called upon to provide 
documentation by companies that have patents for similar business processes or other suits alleging 
infringement of their intellectual property rights. Legal proceedings relating to intellectual property could be 
expensive, take significant time, and divert management's attention from other business concerns, regardless 
of the outcome of the litigation. In the event an infringement lawsuit were brought against us and we did not 
prevail, we might have to pay substantial damages and we could be required to stop infringing activity or 
obtain a license to use technology on unfavorable terms.

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Risks Related to Our Indebtedness

Our substantial debt could adversely affect our financial condition and cash flows from operations.

On August 1, 2017, we entered into a credit agreement (the “2017 Credit Agreement”) and used the proceeds 
to: (i) repay the Company’s and inVentiv’s pre-Merger term loans; (ii) partially redeem inVentiv’s Senior Notes; 
and (iii) pay certain fees and expenses related to the Merger. As of December 31, 2017, our total principal 
amount of indebtedness was $2.99 billion, which was comprised of: (i) a $1.0 billion Term Loan A facility; (ii) a 
$1.55 billion Term Loan B facility; and (iii) $403.0 million of Senior Notes. Our substantial indebtedness could 
adversely affect our financial condition and cash flows from operations and thus make it more difficult for us to 
satisfy our obligations with respect to our senior secured facilities. If our cash flow is not sufficient to service 
our debt and adequately fund our business, we may be required to seek further additional financing or 
refinancing or dispose of assets. We might not be able to influence any of these alternatives on satisfactory 
terms or at all. Our substantial indebtedness could also:

• 

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• 

• 

• 

• 

• 

• 

• 

• 

increase our vulnerability to adverse general economic, industry, or competitive developments;

require us to dedicate a more substantial portion of our cash flows from operations to payments on 
our indebtedness, thereby reducing the availability of our cash flows to fund working capital, 
investments, acquisitions, capital expenditures, and other general corporate purposes;

limit our ability to make required payments under our existing contractual commitments, including our 
existing long-term indebtedness;

limit our ability to fund a change of control offer;

require us to sell certain assets;

restrict us from making strategic investments, including acquisitions, or causing us to make non-
strategic divestitures;

limit our flexibility in planning for, or reacting to, changes in our business and the industry in which we 
operate;

place us at a competitive disadvantage compared to our competitors that have less debt;

cause us to incur substantial fees from time to time in connection with debt amendments or 
refinancings;

increase our exposure to rising interest rates because a substantial portion of our borrowings is at 
variable interest rates; and

• 

limit our ability to borrow additional funds or to borrow on terms that are satisfactory to us.

Despite our level of indebtedness, we are able to incur more debt and undertake additional 
obligations. Incurring such debt or undertaking such additional obligations could further exacerbate 
the risks to our financial condition.

We may be able to incur additional indebtedness in the future. Although covenants under our 2017 Credit 
Agreement limit our ability to incur certain additional indebtedness, these restrictions are subject to a number 
of qualifications and exceptions, and the indebtedness incurred in compliance with these restrictions could be 
substantial. To the extent we incur additional indebtedness, the risks associated with our leverage described 
above, including our possible inability to service our debt obligations, would increase. 

46

Servicing our debt will require a significant amount of cash, and our ability to generate sufficient cash 
depends on many factors, some of which are beyond our control.

Our ability to make payments on and refinance our debt, make strategic acquisitions, and fund capital 
expenditures depends on our ability to generate cash flow in the future. To some extent, our ability to 
generate future cash flow is subject to general economic, financial, competitive, and other factors that are 
beyond our control. We cannot assure you that:

• 

our business will generate sufficient cash flow from operations;

•  we will continue to realize the cost savings, revenue growth, and operating improvements that 

resulted from the execution of our long-term strategic plan; or

• 

future sources of funding will be available to us in amounts sufficient to enable us to fund our liquidity 
needs.

We also may experience difficulties repatriating cash from foreign subsidiaries and accounts due to law, 
regulation or contracts which could further constrain our liquidity. If we cannot fund our liquidity needs, we will 
have to take actions such as reducing or delaying capital expenditures, marketing efforts, strategic 
acquisitions, investments and alliances, selling assets, restructuring or refinancing our debt, or seeking 
additional equity capital. We cannot assure you that any of these remedies could, if necessary, be effected on 
commercially reasonable or favorable terms, or at all, or that they would permit us to meet our scheduled debt 
service obligations. Any inability to generate sufficient cash flow or refinance our debt on favorable terms 
could have a material adverse effect on our financial condition. In addition, if we incur additional debt, the 
risks associated with our substantial leverage, including the risk that we will be unable to service our debt or 
generate enough cash flow to fund our liquidity needs, could increase.

Covenant restrictions under our 2017 Credit Agreement may limit our ability to operate our business.

Our 2017 Credit Agreement contains covenants that may restrict our ability to, among other things, borrow 
money, pay dividends, make capital expenditures, make strategic acquisitions and effect a consolidation, 
merger or disposal of all or substantially all of our assets. Although the covenants in our 2017 Credit 
Agreement are subject to various exceptions, we cannot assure you that these covenants will not adversely 
affect our ability to finance future operations, capital needs, or to engage in other activities that may be in our 
best interest. In addition, in certain circumstances, our long-term debt requires us to maintain a specified 
financial ratio and satisfy certain financial condition tests, which may require that we take action to reduce our 
debt or to act in a manner contrary to our business objectives. A breach of any of these covenants could result 
in a default under our senior secured facilities. If an event of default under our 2017 Credit Agreement occurs, 
the lenders thereunder could elect to declare all amounts outstanding, together with accrued interest, to be 
immediately due and payable. In such case, we might not have sufficient funds to repay all the outstanding 
amounts. In addition, our 2017 Credit Agreement is secured by first priority security interests on substantially 
all of our real and personal property, including the capital stock of certain of our subsidiaries. If an event of 
default under our 2017 Credit Agreement occurs, the lenders thereunder could exercise their rights under the 
related security documents. Any acceleration of amounts due under our 2017 Credit Agreement or the 
substantial exercise by the lenders of their rights under the security documents would likely have a material 
adverse effect on us.

Under the terms of the lease agreement for our new corporate headquarters in Morrisville, North Carolina we 
are required to issue a letter of credit ("LOC") to the landlord based on our debt rating issued by Moody’s 
Investors Service (or other nationally-recognized debt rating agency). From June 14, 2017 through June 14, 
2020, if our debt rating is Ba3 or better, no LOC is required, or if our debt rating is B1 or lower, a LOC equal to 
25% of the remaining minimum annual rent and estimated operating expenses (or a LOC of approximately 
$24.2 million as of December 31, 2017) is required to be issued to the landlord. This LOC would remain in 
effect until our debt rating increased to Ba3 or higher for a twelve-month period. After June 14, 2020, if our 
debt rating is Ba2 or better, no LOC is required; if our debt rating is Ba3 or lower, a LOC equal to 25% of the 
then remaining minimum annual rent and estimated operating expenses is required to be issued to the 
landlord (estimated at approximately $22.0 million as of December 31, 2017); or if our debt rating is B1 or 
lower, a LOC equal to 100% of the then remaining minimum annual rent and estimated operating expenses is 
required to be issued to the landlord (estimated at approximately $87.9 million as of December 31, 2017). 

47

These letters of credit would remain in effect until our debt rating is back above the required threshold for a 
twelve-month period. 

As of December 31, 2017 (and through the date of this filing), our debt rating was Ba3. As such, no LOC is 
currently required. Any letters of credit issued in accordance with the aforementioned requirements would be 
issued under our Revolver, and would reduce our available borrowing capacity by the same amount 
accordingly.

Interest rate fluctuations may have a material adverse effect on our business, financial condition, 
results of operations or cash flows.

Because we have substantial variable rate debt, fluctuations in interest rates may affect our business, 
financial condition, results of operations or cash flows. We currently utilize interest rate swaps to limit our 
exposure to interest rate fluctuations; however, such instruments may not be effective. At December 31, 2017, 
we had approximately $2.99 billion of total principal indebtedness comprised of $2.55 billion in term loan debt, 
$403.0 million in Senior Notes, and $36.8 million of capital leases, of which $2.43 billion was subject to 
variable interest rates. 

Risks Related to Ownership of Our Common Stock

Our stock price is subject to volatility, which could have a material adverse impact on investors and 
employee retention.

Since our initial public offering in November 2014 (the "IPO"), the price of our stock, as reported by NASDAQ, 
has ranged from a low of $19.61 on November 7, 2014 to a high of $61.10 on June 19, 2017. In addition, 
securities markets worldwide have experienced, and are likely to continue to experience, significant price and 
volume fluctuations. This market volatility, as well as general economic, market or political conditions, could 
affect stock price in ways that may be unrelated to our operating performance. The trading price of our stock 
is subject to significant price fluctuations in response to many factors, including:

•  market conditions or trends in our industry, including with respect to the regulatory environment, or 

the economy as a whole; 

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fluctuations in quarterly operating results, as well as differences between our actual financial and 
operating results and those expected by investors, especially as we integrate inVentiv into our 
company;

future performance guidance, if any, that we provide to the public, any changes in this guidance or 
our failure to meet this guidance;

changes in financial estimates or ratings by any securities analysts who follow our stock, our failure to 
meet those estimates or the failure of those analysts to initiate or maintain coverage of our stock; 

changes in key personnel; 

entry into new markets; 

announcements by us or our competitors of new service offerings or significant acquisitions, 
divestitures, strategic partnerships, joint ventures or capital commitments;

actions by competitors;

changes in operating performance and market valuations of other companies in the industry; 

investors' perceptions of our prospects and the prospects of the industry;

investors' perceptions of the investment opportunity associated with our stock relative to other 
investment alternatives; 

the public's reaction to press releases or other public announcements by us or third parties, including 
our filings with the SEC; 

• 

announcements related to litigation;

48

• 

• 

• 

• 

changes in the credit ratings of our debt;

the sustainability of an active trading market for our stock; 

future sales of our stock by our significant shareholders, officers and directors; and

other events or factors, including those resulting from system failures and disruptions, cyber-attacks, 
earthquakes, hurricanes, war, acts of terrorism, other natural disasters or responses to these events.

These and other factors may cause the market price and demand for shares of our stock to fluctuate 
substantially, which could result in reduced liquidity and a decline in the price of our stock. When the market 
price of a stock is volatile, security holders often institute class action litigation against the company that 
issued the stock. If we become involved in this type of litigation, regardless of the outcome, we could incur 
substantial legal costs and our management's attention could be diverted from the operation of our business, 
which could have a material adverse effect on our business, financial condition, results of operations and 
cash flows.

We do not expect to pay any cash dividends for the foreseeable future.

We do not anticipate that we will pay any dividends to holders of our stock for the foreseeable future. Any 
payment of cash dividends will be at the discretion of the Board and will depend on our financial condition, 
capital requirements, legal requirements, earnings and other factors. Our ability to pay dividends is restricted 
by the terms of our 2017 Credit Agreement and might be restricted by the terms of any indebtedness that we 
incur in the future. Consequently, you should not rely on dividends in order to receive a return on your 
investment. For additional information on our dividend policy, see Part II, Item 5, "Market for Registrant's 
Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities" in this Annual 
Report on Form 10-K.

Future sales of our stock in the public market could cause the market price of our stock to decrease 
significantly.

As of December 31, 2017, we had 104,435,501 outstanding shares of Class A common stock. In addition, we 
had 3,425,085 shares of outstanding options and restricted stock units that, if exercised or sold, would result 
in these additional shares becoming available for sale subject, in some cases, to Rule 144 and Rule 701 
under the Securities Act. Our private equity sponsors (the “Sponsors”) together own approximately 46% of our 
outstanding shares and have contractual rights to cause us to register resales of those shares starting in 
February 2018.

Sales or issuances of substantial amounts of our stock in the public market by us or our shareholders may 
cause the market price of our stock to decrease significantly. The perception that such sales or issuances 
could occur could also depress the market price of our stock. Any such sales or issuances could also create 
public perception of difficulties or problems with our business and might also make it more difficult for us to 
raise capital through the sale of equity securities in the future at a time and price that we deem appropriate.

Our Sponsors have significant influence over our company, and their interests may be different from 
or conflict with those of our other shareholders.

Our Sponsors collectively beneficially own approximately 46% of our outstanding common stock. As a 
consequence, the Sponsors continue to be able to exert a significant degree of influence over our 
management, affairs, and matters requiring shareholder approval, including the election of directors, a 
merger, consolidation or sale of all or substantially all of our assets, and any other significant transaction. 
Additionally, each of the Sponsors is party to a stockholders agreement with us (the "Stockholders 
Agreements"). The Stockholders Agreements, among other things, requires such shareholders to vote in favor 
of certain nominees to our Board. The interests of the Sponsors might not always coincide with our interests 
or the interests of our other shareholders. For instance, this concentration of ownership and/or the restrictions 
imposed by the Stockholders Agreements may have the effect of delaying or preventing a change in control of 
us otherwise favored by our other shareholders and could depress our stock price.

The Sponsors each make investments in companies and may, from time to time, acquire and hold interests in 
businesses that compete directly or indirectly with us. Each of the Sponsors may also pursue, for its own 
account, acquisition opportunities that may be complementary to our business, and as a result, those 

49

acquisition opportunities might not be available to us. Our organizational documents contain provisions 
renouncing any interest or expectancy held by our directors affiliated with the Sponsors in certain corporate 
opportunities. Accordingly, the interests of the Sponsors may supersede ours, causing the Sponsors or their 
affiliates to compete against us or to pursue opportunities instead of us, for which we have no recourse. Such 
actions on the part of the Sponsors and inaction on our part could have a material adverse effect on our 
business, financial condition, results of operations and cash flows.

The Sponsors control four seats on our Board. Since the Sponsors could invest in entities that directly or 
indirectly compete with us, when conflicts arise between the interests of the Sponsors and the interests of our 
shareholders, these directors might not be disinterested.

Provisions of our corporate governance documents and Delaware law could make an acquisition of 
our company more difficult and may prevent attempts by our shareholders to replace or remove our 
current management, even if beneficial to our shareholders.

Provisions of our certificate of incorporation and our amended and restated bylaws contain provisions that 
delay, defer or discourage transactions involving an actual or potential change in control of us or change in 
our management that shareholders may consider favorable, including transactions in which you might 
otherwise receive a premium for your shares. These provisions could also limit the price that investors might 
be willing to pay in the future for shares of our stock, thereby depressing the market price of our stock. In 
addition, these provisions may frustrate or prevent any attempts by our shareholders to replace or remove our 
current management by making it more difficult for shareholders to replace members of the Board. Because 
the Board is responsible for appointing the members of our management team, these provisions could in turn 
affect any attempt to replace current members of our management team. Among others, these provisions 
include: (i) our ability to issue preferred stock without shareholder approval; (ii) the requirement that our 
shareholders may not act without a meeting; (iii) requirements for advance notification of shareholder 
nominations and proposals contained in our bylaws; (iv) the absence of cumulative voting for our directors; 
(v) requirements for shareholder approval of certain business combinations; and (vi) the limitations on director 
nominations contained in our Stockholders Agreement.

Additionally, Section 203 of the Delaware General Corporation Law (the "DGCL") prohibits a publicly held 
Delaware corporation from engaging in a business combination with an interested shareholder, generally a 
person which together with its affiliates owns, or within the last three years has owned, 15% of our voting 
stock, for a period of three years after the date of the Merger in which the person became an interested 
shareholder, unless the business combination is approved in a prescribed manner. The existence of the 
foregoing provision could also limit the price that investors might be willing to pay in the future for shares of 
our stock, thereby depressing the market price of our stock.

If securities analysts or industry analysts downgrade our shares, publish negative research or 
reports, or do not publish reports about our business, stock price, and trading volume could decline.

The trading market for our stock is to some extent influenced by the research and reports that industry or 
securities analysts publish about us, our business and our industry. If one or more analysts adversely change 
their recommendation regarding our shares or our competitors' stock, our share price would likely decline. If 
one or more analysts cease coverage of us or fail to regularly publish reports on us, we might lose visibility in 
the financial markets, which in turn could cause our share price or trading volume to decline.

We are incurring increased costs and obligations as a result of being a public company.

As a public company, we are required to comply with certain additional corporate governance and financial 
reporting practices and policies. As a result, due to compliance requirements of the Exchange Act, the 
Sarbanes-Oxley Act of 2002 ("Sarbanes-Oxley"), the Dodd-Frank Act, the listing requirements of the 
NASDAQ, and other applicable securities rules and regulations, we have and will continue to incur significant 
legal, accounting and other expenses. The Exchange Act requires, among other things, that we file annual, 
quarterly, and current reports with respect to our business and operating results with the SEC. We are also 
required to ensure that we have the ability to prepare financial statements and other disclosures that are fully 
compliant with all SEC reporting requirements on a timely basis. Compliance with these rules and regulations 
has increased and may continue to increase our legal and financial compliance costs, make some activities 
more difficult, time-consuming, or costly, and increase demand on our systems and resources.

50

We might not be successful in complying with these requirements and the significant amount of resources 
required to ensure compliance could have a material adverse effect on our business, financial condition, 
results of operations and cash flows.

Our internal controls over financial reporting are required to meet all the standards of Section 404 of 
Sarbanes-Oxley, and failure to achieve and maintain effective internal controls over financial reporting 
could have a material adverse effect on our stock price, reputation, business, financial condition, 
results of operations and cash flows.

Section 404 of Sarbanes-Oxley requires management and our independent registered public accounting firm 
to assess and attest to the effectiveness of internal control over financial reporting on an annual basis. The 
rules governing the standards that must be met to assess our internal control over financial reporting are 
complex and require significant documentation, testing and possible remediation of our existing controls and 
could result in incurring significant additional expenditures. We are required to design, implement and test our 
internal controls over financial reporting in order to comply with this obligation. The effort necessary to meet 
these requirements is time consuming, costly, and complicated, and we must continually evaluate and refine 
these processes on an ongoing basis. We might encounter problems or delays in completing the 
implementation of any required improvements and therefore fail to receive a favorable attestation provided by 
our independent registered public accounting firm. 

As a private company, inVentiv was not subject to the requirements of Section 404 of Sarbanes-Oxley. Now 
that the Merger has been completed, we must devote significant management time and other resources to 
ensure that the combined company complies with the requirements of Section 404, and there can be no 
assurance that it will. 

Further, material weaknesses or significant deficiencies in our internal control over financial reporting may 
exist or otherwise be discovered in the future. If we fail to maintain an effective internal control environment, 
such failure could limit our ability to report our financial results accurately and timely, resulting in 
misstatements and/or restatements of our consolidated financial statements, which may cause investors to 
lose confidence and have a material adverse effect on our stock price, reputation, business, financial 
condition, results of operations, and cash flows.

We are a holding company and rely on dividends and other payments, advances and transfers of 
funds from our subsidiaries to meet our obligations and pay any dividends.

We have no direct operations and no significant assets other than ownership of 100% of the capital stock of 
our subsidiaries. Because we conduct our operations through our subsidiaries, we depend on those entities 
for dividends and other payments to generate the funds necessary to meet our financial obligations, and to 
pay any dividends with respect to our stock. Legal and contractual restrictions in our 2017 Credit Agreement 
and other agreements which may govern future indebtedness of our subsidiaries, as well as the financial 
condition and operating requirements of our subsidiaries, may limit our ability to obtain cash from our 
subsidiaries. The earnings from, or other available assets of, our subsidiaries might not be sufficient to pay 
dividends, make distributions, or loans to enable us to pay any dividends on our stock or other obligations. 
Any of the foregoing could materially and adversely affect our business, financial condition, results of 
operations, and cash flows.

Risks Relating to the Merger

We may be unable to fully realize the competitive and operating synergies that are projected to be 
achieved through the combination of INC Research’s and inVentiv Health’s offerings.

The success of the Merger will depend on, among other things, our ability to combine the business of INC 
Research with the business of inVentiv Health and to achieve operating synergies. If we are not able to 
successfully achieve this objective, the anticipated benefits of the Merger might not be realized fully, or at all, 
or may take longer to realize than expected. The difficulties of combining the operations of the companies 
include, among others:

• 

difficulties in achieving anticipated cost savings, synergies, business opportunities and growth 
prospects from the combination;

51

• 

• 

• 

• 

challenges in attracting, retaining and replacing key personnel;

challenges in creating a new culture for the combined company and maintaining employee morale 
throughout the post-Merger period of integration and combining the operations of the two companies;

difficulties in managing the expanded operations of a significantly larger and more complex 
company; and

potential unknown liabilities and unforeseen increased expenses or delays associated with the 
Merger.

For example, we incurred and will incur substantial expenses in connection with consummation of the Merger 
and combining the businesses, operations, networks, systems, technologies, policies and procedures of the 
two companies. Many of the expenses incurred and to be incurred, by their nature, are difficult to estimate 
accurately at the present time and as result may exceed the savings that the combined company expects to 
achieve from the elimination of duplicative expenses and the realization of economies of scale and cost 
savings related to the combination of the businesses following the Merger Date.

It is possible that the integration process or other factors could result in the disruption of our ongoing business 
or inconsistencies in standards, controls, procedures and policies. These transition matters could have an 
adverse effect on us for an undetermined amount of time after the Merger Date. In addition, events outside of 
our control, including changes in regulations and laws, as well as economic trends, could adversely affect our 
ability to realize the expected benefits from the Merger.

We may fail to realize all of the anticipated benefits of the Merger or those benefits may take longer to 
realize than expected. We may also encounter significant difficulties in integrating the two 
businesses.

Our ability to realize the anticipated benefits of the Merger will depend, to a large extent, on our ability to 
integrate the two businesses. The combination of two independent businesses is a complex, costly and time-
consuming process. As a result, we are required to devote significant management attention and resources to 
integrating business practices and operations. The integration process may disrupt the businesses and, if 
implemented ineffectively, would restrict the realization of the full expected benefits. The failure to meet the 
challenges involved in integrating the two businesses and to realize the anticipated benefits of the Merger 
could cause an interruption of, or a loss of momentum in, our activities and could adversely affect our results 
of operations.

In addition, the overall integration of the businesses may result in material unanticipated problems, expenses, 
liabilities, competitive responses, loss of customer relationships, and diversion of management’s attention. 
Further, we may not have identified a significant risk within the inVentiv business that existed at the time of the 
Merger or that may develop in the future as a result of past practice of inVentiv. These unidentified risks may 
result in material unanticipated problems, expenses, liabilities, competitive responses, loss of customer 
relationships, and diversion of management’s attention. The difficulties of combining the operations of the 
companies include, among others:

• 

• 

• 

• 

• 

• 

• 

difficulties in achieving anticipated cost savings, synergies, business opportunities and growth 
prospects from the combination;

difficulties in the integration of the companies’ businesses;

difficulties in managing the expanded operations of a significantly larger and more complex company;

difficulties in integrating employees from the two companies;

current and prospective employees may experience uncertainty regarding their future roles with our 
company, which might adversely affect our ability to retain, recruit and motivate key employees;

lost customers and customer awards as a result of customers deciding not to do business with the 
combined company;

difficulties in managing supplier relationships of both companies and resolving potential conflicts and 
consolidation issues that may arise;

52

• 

• 

• 

difficulties in systems integration, particularly information technology and finance systems, and 
conforming standards, controls, procedures and policies, business cultures and compensation 
structures between the entities;

difficulties in integrating and documenting processes and controls in conformance with the 
requirements of Section 404 of the Sarbanes-Oxley Act of 2002, which were not applicable to inVentiv 
prior to the Merger; and

potential unknown liabilities and unforeseen increased expenses and delays associated with the 
Merger.

Many of these factors will be outside of our control and any one of them could result in increased costs, 
decreases in the amount of expected revenues and diversion of management’s time and energy, which could 
materially impact our business, financial condition and results of operations. In addition, even if the operations 
of the businesses of INC Research and inVentiv Health are integrated successfully, the full benefits of the 
Merger might not be realized, including the synergies, cost savings or sales or growth opportunities that are 
expected. These benefits might not be achieved within the anticipated time frame, or at all. Further, additional 
unanticipated costs may be incurred in the integration of the businesses of INC Research and inVentiv Health. 
All of these factors could negatively impact our earnings per share, decrease or delay the expected accretive 
effect of the Merger and negatively impact the price of our shares. As a result, there is no assurance that the 
combination of INC Research and inVentiv Health will result in the realization of the full benefits anticipated.

Our future results will suffer if we do not effectively manage our expanded operations following the 
completion of the Merger.

Following the completion of the Merger, the size of our business increased significantly beyond the former 
size of either INC Research’s or inVentiv Health’s businesses on a standalone basis. Our Company has no 
prior experience integrating a business of the size and scale of inVentiv Health. Our future success depends, 
in part, upon our ability to manage this expanded business, which poses substantial challenges for 
management, including challenges related to the management and monitoring of new operations and 
associated increased costs and complexity. If we are unsuccessful in managing our integrated operations, or 
if we do not realize the expected operating efficiencies, cost savings and other benefits currently anticipated 
from the Merger, our operations and financial condition could be adversely affected and we might not be able 
to take advantage of business development opportunities.

Item 1B. Unresolved Staff Comments.

None.

Item 2. Properties.

As of December 31, 2017, we had 146 facilities located in 47 countries. During the year ended December 31, 
2017, we utilized approximately 78% of our available facility space; however, as we continue to expand in 
new locations, the utilization of our facilities may decline in the short term. Most of our facilities consist solely 
of office space. We lease all of our facilities, with the exception of office space owned in Madrid, Spain. Our 
headquarters and principal executive offices are located in Raleigh, North Carolina, where we lease space in 
two locations totaling approximately 187,700 square feet. The leases for both of our Raleigh locations expire 
in February 2019. 

In January 2017, we entered into a 12-year lease for our new corporate headquarters building in Morrisville, 
North Carolina, where we intend to relocate all employees from our two existing locations in Raleigh, North 
Carolina. In June 2017, this lease was amended to add additional office space and extend the term of the 
lease to 13 years. We expect the construction of the new building to be completed in late 2018 and anticipate 
completing our relocation efforts prior to the current leases expiring in early 2019. In February 2017, we 
entered into an 11-year lease agreement for new office space in Farnborough, United Kingdom, which is near 
our existing Camberley site. In January 2018, we replaced our lease agreement for the Farnborough location 
with a new 10-year lease agreement. The new agreement provides for additional office space to 
accommodate our operating plans following the Merger. We also anticipate completing our relocation efforts 
to the Farnborough location prior to the Camberley lease expiring in 2018. 

53

In addition, we lease substantial facilities in Columbus, Ohio; Camberley, United Kingdom; Gurgaon, India; 
Hyderabad, India; Madrid, Spain; Maidenhead, United Kingdom; Mexico City, Mexico; Munich, Germany; New 
York, New York; Newtown, Pennsylvania; Princeton, New Jersey; Pune, India; Quebec City, Canada; 
Somerset, New Jersey; Tokyo, Japan; and Toronto, Canada. We also maintain offices in various other Asian-
Pacific, European, Latin American and North American locations, including Australia, the Middle East and 
Africa. None of our leases is individually material to our business model and all either have options to renew 
or are located in major markets where we believe there are adequate opportunities to continue business 
operations at terms satisfactory to us. 

Item 3. Legal Proceedings.

We are party to legal proceedings incidental to our business. While our management currently believes the 
ultimate outcome of these proceedings, individually and in the aggregate, will not have a material adverse 
effect on our consolidated financial statements, litigation is subject to inherent uncertainties. Were an 
unfavorable ruling to occur, there exists the possibility of a material adverse impact on our financial condition 
and results of operations. 

On December 1, 2017, the first of two virtually identical actions alleging federal securities law claims was filed 
against us and certain of our officers on behalf of a putative class of our shareholders. The first action, 
captioned Bermudez v. INC Research, Inc., et al, No. 17-09457 (S.D.N.Y.), names as defendants us, Michael 
Bell, Alistair MacDonald, Michael Gilbertini and Gregory Rush, and the second action, Vaitkuvienë v. Syneos 
Health, Inc., et al, No. 18-0029 (E.D.N.C.), names as defendants us, Alistair MacDonald, and Gregory S. 
Rush. Both complaints allege similar claims under Section 10(b) and Section 20(a) of the Securities 
Exchange Act of 1934 on behalf of a putative class of purchasers of our common stock between May 10, 
2017 and November 8, 2017 (Vaitkuvienë action) and November 9, 2017 (Bermudez action). The complaints 
allege that we published inaccurate or incomplete information regarding, among other things, the financial 
performance and business outlook for inVentiv’s business prior to the Merger and with respect to the 
combined company following the merger.  On January 30, 2018, two alleged shareholders of ours filed 
motions both seeking to be appointed lead plaintiff and approving the selection of lead counsel. These 
motions remain pending. We and the other defendants deny the allegations in these complaints and intend to 
defend vigorously against these claims.

Item 4. Mine Safety Disclosures.

Not applicable.

54

PART II

Item 5. Market for Registrants' Common Equity, Related Stockholder Matters, and Issuer Purchases of 
Equity Securities.

Market Information for Common Stock 

The following table sets forth the high and low sales prices per share of our common stock as reported by the 
NASDAQ for the periods indicated:

Fiscal Year 2017:

Fourth Quarter

Third Quarter

Second Quarter

First Quarter

Fiscal Year 2016:

Fourth Quarter

Third Quarter

Second Quarter

First Quarter

Holders of Record 

High

Low

$

$

$

$

$

$

$

$

59.45

59.80

61.10

56.88

High

52.75

47.39

57.11

48.13

$

$

$

$

$

$

$

$

33.60

51.00

40.65

40.85

Low

41.10

37.27

36.70

34.19

On February 21, 2018, there were approximately 72 shareholders of record of our common stock. This 
number does not include shareholders for whom shares are held in "nominee" or "street" name. 

Dividend Policy

Since becoming a public company, we have not declared or paid cash dividends on our common stock, nor 
do we intend to pay cash dividends on our common stock in the foreseeable future. However, in the future, 
subject to the factors described below and our future liquidity and capitalization, we may change this policy 
and choose to pay dividends.

We are a holding company that does not conduct any business operations of our own. As a result, our ability 
to pay cash dividends on our common stock is dependent upon cash dividends, distributions, and other 
transfers from our subsidiaries. Our ability to pay dividends is currently restricted by the terms of our 2017 
Credit Agreement, and may be further restricted by any future indebtedness we or our subsidiaries incur. In 
addition, under Delaware law, the Board may declare dividends only to the extent of our surplus (which is 
defined as total assets at fair market value minus total liabilities, minus statutory capital) or, if there is no 
surplus, out of our net profits for the then current and/or immediately preceding fiscal year.

Any future determination to pay dividends will be at the discretion of the Board and will take into account 
restrictions in our debt instruments, including our 2017 Credit Agreement, general economic business 
conditions, our financial condition, results of operations and cash flows, our capital requirements, our 
business prospects, the ability of our operating subsidiaries to pay dividends and make distributions to us, 
legal restrictions, and such other factors as the Board may deem relevant. For additional information on these 
restrictive covenants, see Part II, Item 7, "Management's Discussion and Analysis of Financial Condition and 
Results of Operations - Liquidity and Capital Resources" and "Note 4 - Long-Term Debt Obligations" to our 
audited consolidated financial statements included in Part II, Item 8, "Financial Statements and 
Supplementary Data" in this Annual Report on Form 10-K.

Recent Sales of Unregistered Securities

We did not have any sales of unregistered securities during 2017.

55

Purchases of Equity Securities by the Issuer

We did not purchase any equity securities during 2017.

Stock Performance Graph

The information included under the heading “Stock Performance Graph” is “furnished” and not “filed” for 
purposes of Section 18 of the Exchange Act, or otherwise subject to the liabilities of that section, nor shall it 
be deemed to be “soliciting material” subject to Regulation 14A or incorporated by reference in any filing 
under the Securities Act of 1933, as amended, or the Exchange Act of 1934, as amended.

In connection with our rebranding under the name Syneos Health, Inc., effective January 8, 2018, our 
common stock is traded on the NASDAQ under the symbol “SYNH”. From November 7, 2014 through 
January 7, 2018, our common stock was listed on the NASDAQ under the symbol "INCR". The Stock Price 
Performance Graph set forth below compares the cumulative total shareholder return on our common stock 
for the period from November 7, 2014 through December 31, 2017, with the cumulative total return of the 
Nasdaq Composite Index and the Nasdaq Health Care Index over the same period. The comparison assumes 
$100 was invested on November 7, 2014 in the common stock of Syneos Health, Inc., in the Nasdaq 
Composite Index, and in the Nasdaq Health Care Index and assumes reinvestment of dividends, if any. 

The stock price performance shown on the graph above is not necessarily indicative of future price 
performance. Information used in the graph was obtained from the Nasdaq Stock Market, a source believed 
to be reliable, but we are not responsible for any errors or omissions in such information. 

56

Equity Compensation Plans

The information required by Part II, Item 5, "Market for Registrant's Common Equity, Related Stockholder 
Matters and Issuer Purchases of Equity Securities" in this Annual Report on Form 10-K regarding equity 
compensation plans is incorporated herein by reference to Part III, Item 12, "Security Ownership of Certain 
Beneficial Owners and Management and Related Stockholder Matters” in this Annual Report on Form 10-K. 

57

Item 6. Selected Financial Data.

The following tables set forth our selected consolidated financial data for the periods ending on and as of the 
dates indicated. We derived the consolidated statements of operations data for the years ended December 31, 
2017, 2016 and 2015 and the consolidated balance sheet data as of December 31, 2017 and 2016 from our 
audited consolidated financial statements included in Part II, Item 8, "Financial Statements and Supplementary 
Data" in this Annual Report on Form 10-K. We derived the consolidated statements of operations data for the 
years ended December 31, 2014 and 2013 and the consolidated balance sheet data as of December 31, 2015, 
2014, and 2013 from our audited consolidated financial statements not included in this Annual Report on Form 
10-K. You should read the consolidated financial data set forth below together with our consolidated financial 
statements and the related notes thereto included in Part II, Item 8, "Financial Statements and Supplementary 
Data" and Part II, Item 7 "Management's Discussion and Analysis of Financial Condition and Results of 
Operations" in this Annual Report on Form 10-K. Our historical results are not necessarily indicative of future 
results of operations.

Statement of Operations Data:

Net service revenue

$ 1,852,843

$ 1,030,337

$

914,740

$ 809,728

$

652,418

Year Ended December 31,

2017(a)

2016

2015

2014

2013

(in thousands, except per share amounts)

Reimbursable out-of-pocket expenses

819,221

580,259

484,499

369,071

Total revenue

2,672,064

1,610,596

1,399,239

1,178,799

Costs and operating expenses:

Direct costs (exclusive of depreciation and 
amortization)

1,232,023

Reimbursable out-of-pocket expenses

Selling, general, and administrative

Restructuring and other costs(b)

Transaction and integration-related
expenses(c)

Asset impairment charges(d)

Depreciation

Amortization

(Loss) income from operations

Other (expense) income, net:

Interest expense, net

Loss on extinguishment of debt

Other (expense) income, net

819,221

282,620

33,315

123,815

30,000

44,407

135,529

626,633

580,259

172,386

13,612

3,143

—

21,353

37,851

542,404

484,499

156,609

1,785

1,637

3,931

18,140

37,874

(28,866)

155,359

152,360

515,059

369,071

145,143

6,192

7,902

17,245

21,619

32,924

63,644

(62,543)

(11,800)

(15,448)

(622)

(19,846)

(439)

(9,002)

(9,795)

3,857

(52,787)

(46,750)

7,689

(Loss) income before provision for income taxes

(111,877)

134,118

130,974

(28,204)

Income tax (expense) benefit

(26,592)

(21,488)

(13,927)

4,734

Net (loss) income

(138,469)

112,630

117,047

(23,470)

Class C common stock dividends

Redemption of New Class C common stock

—

—

—

—

—

—

(375)

(3,375)

Net (loss) income attributable to common 
shareholders

Earnings per share attributable to common 
shareholders:

$

(138,469) $

112,630

$

117,047

$ (27,220) $

(42,029)

Basic

Diluted

$

$

(1.85) $

(1.85) $

2.08

2.03

$

$

2.02

1.95

$

$

(0.51) $

(0.51) $

(0.81)

(0.81)

Weighted average common shares outstanding:

Basic

Diluted

74,913

74,913

54,031

55,610

57,888

60,146

53,301

53,301

52,009

52,009

58

342,672

995,090

432,261

342,672

117,890

11,828

508

—

19,175

39,298

31,458

(60,489)

—

(1,649)

(30,680)

(10,849)

(41,529)

(500)

—

 
 
 
 
 
 
 
2017(a)

2016

As of December 31,
2015

(in thousands)

2014

2013

Balance Sheet Data:

Cash and cash equivalents

$

321,262

$

102,471

$

85,011

$

126,453

$

96,972

Total assets(e)

7,285,867

1,288,507

1,211,219

1,241,365

1,227,455

Total debt and capital leases(e)(f)

Total shareholders' equity

Other Financial Data:

Backlog(g)

Net new business awards(g)

Net Book-to-Bill ratio(h)

3,007,724

3,022,579

497,724

301,473

501,839

217,434

416,257

392,209

588,823

276,207

$ 3,796,444

$ 1,878,267

$ 1,701,587

$ 1,532,051

$ 1,433,024

1,819,348

1,216,871

1,114,065

1.25x

1.19x

1.23x

942,283

1.18x

851,234

1.32x

2017(a)

Year Ended December 31,
2015

2014

2016

2013

Statement of Cash Flow Data:

Net cash provided by (used in):

Operating activities

Investing activities

Financing activities

Other Financial Data:

Capital expenditures

Dividends paid

Redemption of New Class C common stock

Non-GAAP Financial Measures(i):

(in thousands)

$

198,258

$

109,332

$

204,740

$

131,447

$

37,270

(1,722,907)

1,734,368

(31,353)

(53,316)

(21,111)

(211,399)

(27,853)

(67,698)

(17,714)

(6,841)

$

(43,896) $

(31,353) $

(21,111) $

(25,551) $

(17,714)

—

—

—

—

—

—

(375)

(3,375)

(500)

—

EBITDA

$

130,602

$

205,122

$

202,436

$

79,126

$

88,282

Adjusted Net Service Revenue

Adjusted EBITDA

Adjusted Net Income

1,885,533

1,030,337

391,899

195,955

244,506

139,007

914,740

221,360

120,174

800,728

145,276

44,647

652,418

105,521

16,290

Adjusted Diluted Earnings per share

$

2.57

$

2.50

$

2.00

$

0.83

$

0.31

(a)  We completed our Merger with inVentiv on August 1, 2017. Our consolidated financial results include the financial 

results of inVentiv as of and since the date of the Merger.

(b)  Restructuring and other costs consist primarily of: (i) severance costs associated with merger related workforce 

reductions; (ii) severance costs associated with a reduction/optimization of our workforce in line with our expectations of 
future business operations; (iii) transition costs associated with the change in our Chief Executive Officer (2016 and 
2017 only), (iv) termination costs in connection with abandonment and closure of redundant facilities and other lease-
related charges; and (v) consulting costs incurred for the continued consolidation of legal entities and restructuring of 
our contract management process to meet the requirements of upcoming accounting regulation changes.

(c)  Transaction and integration-related expenses were $123.8 million for the year ended December 31, 2017 and primarily 
related legal and professional fees associated with the Merger. Included in transaction and integration-related expenses 
for 2017 is a benefit of $12.3 million from the reduction in fair value of contingent tax-sharing obligations payable to the 
former shareholders of inVentiv as a result of the enactment of the Tax Act of 2017. Transaction expenses for the year 
ended December 31, 2016 were $3.1 million and represented fees associated with secondary stock offerings and the 
August 2016 stock repurchase, debt refinancing costs and legal fees associated with other corporate transactions. 
Transaction expenses for the year ended December 31, 2015 were $1.6 million and primarily consisted of fees 
associated with our secondary stock offerings, debt placement and refinancing and other corporate transactions. 
Transaction expenses for the year ended December 31, 2014 were $7.9 million and primarily consisted of debt 
issuance costs and third-party fees associated with our debt refinancings, fees associated with the termination of the 
Avista Capital Partners, L.P. consulting agreement, and legal fees associated with the MEK Consulting acquisition. 
Transaction expenses of $0.5 million for the year ended December 31, 2013 related to third-party fees associated with 

59

 
 
 
 
 
 
 
 
 
debt refinancing and the legal fees associated with our acquisition of MEK Consulting which was completed in March 
2014. 

(d)  During the year ended December 31, 2017, we recorded an impairment charge of $30.0 million related to the 

impairment of the Company's INC Research tradename in connection with the Company’s announced rebranding. 
During the year ended December 31, 2015, we recorded a $3.9 million impairment charge related to goodwill and long-
lived assets associated with our Phase I Services reporting unit, a component of our Clinical Solutions segment. During 
the year ended December 31, 2014, we recorded a $17.2 million impairment charge related to intangible assets and 
goodwill associated with our Global Consulting reporting unit, a component of the Commercial Solutions segment, and 
Phase I Services reporting unit, a component of our Clinical Solutions segment.

(e)  Total assets, total debt and capital leases have been reduced by $20.7 million, $2.3 million, $3.2 million, $3.7 

million, and $5.7 million of debt issuance costs associated with the Term Loans as of December 31, 2017, 2016, 2015, 
2014, and 2013, respectively. 

(f)  Total debt and capital leases include $38.7 million of a premium related to our Senior Notes, net of original issue debt 
discount for the Term Loan B as of December 31, 2017. Total debt and capital leases include $5.5 million and $4.6 
million of unamortized discounts as of December 31, 2014 and 2013, respectively.

(g)  Backlog consists of anticipated future net service revenue from contract and pre-contract commitments that are 

supported by written communications. Net new business awards represent the value of future net service revenue 
awarded during the period. In connection with the Merger, we re-evaluated our existing backlog policy for our Clinical 
Solutions segment. As a result of this evaluation, effective during the third quarter of 2017, we changed our policy for 
calculating and reporting the amounts of our net new business awards and backlog. Refer to Part II, Item 7, 
"Management's Discussion and Analysis - New Business Awards and Backlog" in this Annual Report on Form 10-K for a 
description of our current policy. The majority of our contracts can be terminated by our customers with 30 days notice. 
These adjustments resulted in a reduction to our backlog of approximately $284.5 million as of September 30, 2017 and 
prior periods have been retroactively adjusted for comparability purposes. We have recorded the backlog assumed in 
the Merger consistent with our new backlog policy. We do not currently report new business awards or backlog data for 
our Commercial Solutions segment.

(h)  Net book-to-bill ratio represents "net new business awards" divided by Clinical Solutions net service revenue. We 

believe net book-to-bill ratio is commonly used in our industry and represents a useful indicator of our potential future 
revenue growth rate in that it measures the rate at which we are generating net new business awards compared to our 
current revenues.  We cannot assure you that the net book-to-bill ratio is predictive of future financial performance 
because it will likely be impacted by a number of factors, including the size and duration of projects, which can be 
performed over several years, project change orders resulting in increases or decreases in project scope, and 
cancellations. As a result of the policy changes to backlog and net new business awards discussed above, we have 
retroactively adjusted net book-to-bill ratio for prior periods for comparability purposes.

(i)  We report our financial results in accordance with U.S. GAAP. To supplement this information, we also use the following 

non-GAAP financial measures in this report: Adjusted Net Service Revenue, EBITDA, Adjusted EBITDA, Adjusted Net 
Income and Adjusted Diluted Earnings per share. For a discussion of the non-GAAP financial measures in this Annual 
Report on Form 10-K, see "Non-GAAP Financial Measures" below. Investors are encouraged to review the following 
reconciliations of these non-GAAP measures to our closest reported GAAP measures.

60

Reconciliation of GAAP Measures to Non-GAAP Measures

Net Service Revenue (as reported)

$ 1,852,843

$ 1,030,337

$

914,740

$

809,728

$

652,418

Year Ended December 31,

2017(a)

2016

2015

2014

2013

(in thousands, except per share amounts)

Acquisition-related revenue adjustments(b)

Change order adjustment(c)

Adjusted Net Service Revenue

EBITDA and Adjusted EBITDA:

Net (loss) income

Interest expense, net

Income tax expense (benefit) 

Depreciation

Amortization

EBITDA

Acquisition-related revenue adjustments(b)

Change order adjustment(c)

Restructuring and other costs(d)

Transaction and integration-related expenses(e)

Asset impairment charges(f)

Share-based compensation(g)

Contingent consideration and other expense(h)

Monitoring and advisory fees(i)

R&D tax credit adjustment(j)

Other expense (income)(k)

Loss on unconsolidated affiliates(l)

Loss on extinguishment of debt(m)

32,690

—

—

—

—

—

—

(9,000)

—

—

$ 1,885,533

$ 1,030,337

$

914,740

$

800,728

$

652,418

$ (138,469) $

112,630

$

117,047

$

(23,470) $

(41,529)

62,543

26,592

44,407

135,529

130,602

32,690

—

33,315

123,815

30,000

24,577

—

—

(3,568)

19,846

—

622

11,800

21,488

21,353

37,851

15,448

13,927

18,140

37,874

205,122

202,436

—

—

1,785

1,637

3,931

5,074

559

—

—

—

—

13,612

3,143

—

14,020

1,696

—

(2,528)

9,002

—

439

52,787

(4,734)

21,619

32,924

79,126

—

(9,000)

6,192

7,902

17,245

3,370

918

462

—

60,489

10,849

19,175

39,298

88,282

—

—

11,828

508

—

2,419

253

582

—

1,453

196

—

(3,857)

(7,689)

—

9,795

—

46,750

Adjusted EBITDA

$

391,899

$

244,506

$

221,360

$

145,276

$

105,521

61

 
 
 
 
 
 
 
Reconciliation of GAAP Measures to Non-GAAP Measures (continued) 

Adjusted Net Income:

Net (loss) income

Amortization

Acquisition-related revenue adjustments(b)

Change order adjustment(c)

Restructuring and other costs(d)

Transaction and integration-related expenses(e)

Asset impairment charges(f)

Share-based compensation(g)

Contingent consideration and other expense(h)

Monitoring and advisory fees(i)

R&D tax credit adjustment(j)

Other expense (income)(k)

Loss on unconsolidated affiliates(l)

Loss on extinguishment of debt(m)

Bridge financing fee(n)

Year Ended December 31,

2017(a)

2016

2015

2014

2013

(in thousands, except per share amounts)

$ (138,469) $

112,630

$

117,047

$

(23,470) $

(41,529)

37,851

37,874

32,924

39,298

135,529

32,690

—

33,315

123,815

30,000

24,577

—

—

(3,568)

19,846

—

622

5,815

—

—

13,612

3,143

—

14,020

1,696

—

(2,528)

9,002

—

439

—

—

—

1,785

1,637

3,931

5,074

559

—

—

—

(9,000)

6,192

7,902

17,245

3,370

918

462

—

(3,857)

(7,689)

—

9,795

—

—

46,750

—

—

—

11,828

508

—

2,419

253

582

—

1,453

196

—

—

1,282

—

Adjust income tax to normalized rate(o)

(162,632)

(50,858)

(53,671)

(30,957)

Impact of Tax Cut and Jobs Act(p) 

94,415

—

—

—

Adjusted Net Income

Adjusted Diluted Earnings Per Share:

Adjusted diluted earnings per share

$

$

Adjusted Diluted weighted average common shares 
outstanding(q)

195,955

$

139,007

$

120,174

$

44,647

$

16,290

2.57

$

2.50

$

2.00

$

0.83

$

0.31

76,168

55,610

60,146

53,858

52,033

(a)  We completed our Merger with inVentiv on August 1, 2017. Our consolidated financial results include the financial 

results of inVentiv as of and since the date of the Merger.

(b)  Represents non-cash adjustments resulting from the revaluation of deferred revenue and the subsequent 

elimination of revenue in purchase accounting in connection with business combinations. As a result of the Merger, 
we conformed inVentiv's revenue recognition accounting policies with ours, which resulted in recognition of 
additional $6.0 million of revenue in the fourth quarter of 2017. Under revenue recognition accounting policies of 
inVentiv, this revenue has historically been recognized in the first quarter of each fiscal year. We have eliminated 
this one-time benefit from our non-GAAP financial measures. 

(c)  During the second and third quarters of 2014, we experienced higher-than-normal change order activity estimated 
to be between $6 million and $12 million. Adjusted Net Service Revenue, Adjusted EBITDA, Adjusted Net Income, 
and Adjusted Diluted Earnings per share for 2014 have been adjusted by $9.0 million to remove the impact of this 
higher-than-normal change order activity.

(d)  Restructuring and other costs consist of: (i) severance costs associated with merger related workforce reductions; 
(ii) severance costs associated with a reduction/optimization of our workforce in line with our expectations of future 
business operations; (iii) transition costs associated with the change in our Chief Executive Officer (2016 and 2017 
only); (iv) termination costs in connection with abandonment and closure of redundant facilities and other lease-
related charges; and (v) consulting costs incurred for the continued consolidation of legal entities and restructuring 
of our contract management process to meet the requirements of upcoming accounting regulation changes.

(e)  Represents fees associated with business combinations, stock repurchases and secondary stock offerings, debt 

placement and refinancings, IPO costs, and other corporate transactions costs.

(f)  Represents impairment of goodwill, intangible assets, and long-lived assets.

(g)  Represents share-based compensation expense related to awards granted under equity incentive plans.

62

 
 
 
 
 
 
(h)  Consists of contingent consideration expense incurred as a result of acquisitions and other expenses accounted for 

as compensation expense under U.S. GAAP. 

(i)  Represents monitoring and advisory fees paid to affiliates of Avista Capital Partners, L.P in the periods prior to the 
initial public offering in November 2014, as well as reimbursements of expenses paid to affiliates of Avista Capital 
Partners, L.P. and affiliates of Teachers' Private Capital pursuant to the Expense Reimbursement Agreement. 
These arrangements were terminated upon completion of our initial public offering.

(j)  Represents research and development tax credits in certain international locations for expenses incurred and 

recorded as a reduction of direct costs. 

(k)  Represents other expense (income) comprised primarily of foreign exchange gains and losses.

(l)  Represents losses (gains) associated with unconsolidated affiliates.

(m)  Represents loss on extinguishment of debt associated with our debt modifications and refinancing activities.

(n)  Represents bridge financing fees incurred in connection with the Merger related to an unused financing 

commitment taken out prior to securing our 2017 Credit Agreement.

(o)  Our effective tax rate has been adjusted to an overall effective rate of 32.6% in 2017, 34% in 2016, 36% in 2015 
and 37% in 2014, and 2013. This rate has been adjusted to exclude tax impacts related to valuation allowances 
recorded against deferred tax assets.

(p)  Represents the direct and indirect net income tax expense recorded in the three months and year ended 

December 31, 2017 as a result of the enactment of the Tax Act. For further details on the impact of the Tax Act refer 
to "Note 12 - Income Taxes" to our consolidated financial statements included in Part II, Item 8, "Financial 
Statements and Supplementary Data " in this Annual Report on Form 10-K.

(q)  Diluted weighted average common shares outstanding has been adjusted to give effect to dilutive securities for 

purposes of calculating adjusted diluted earnings per share by 1,255, 557, and 24 shares for the years ended 
December 31, 2017, 2014, and 2013, respectively. These shares were excluded from the calculation of GAAP 
earnings per share as we reported a net loss for the period.

Non-GAAP Financial Measures 

We report our financial results in accordance with U.S. GAAP. To supplement this information, we also use the 
following non-GAAP financial measures in this Annual Report on Form 10-K: Adjusted Net Service Revenue, 
EBITDA, Adjusted EBITDA, Adjusted Net Income and Adjusted Diluted Earnings per share. Management 
believes that these non-GAAP measures provide useful supplemental information to management and 
investors regarding the underlying performance of our business operations. We use these non-GAAP 
measures to, among other things, evaluate our operating performance on a consistent basis, calculate 
incentive compensation for our employees and assess compliance with various metrics associated with our 
Credit Agreement.

Adjusted Net Service Revenue is the consolidated net service revenue adjusted to: (i) include revenue 
eliminated under purchase accounting; (ii) exclude revenue due to conforming inVentiv revenue recognition 
policies; and (iii) reduce revenue to adjust for higher-than-normal change order activity during the period.

EBITDA represents earnings before interest, taxes, depreciation, and amortization. Adjusted EBITDA 
represents EBITDA, further adjusted to include revenue eliminated under purchase accounting and an 
increase in revenue due to conforming the legacy inVentiv revenue recognition policy and to exclude the 
impact of higher-than-normal revenue change order activity, and certain expenses and transactions that we 
believe are not representative of our core operating results, including: management fees that terminated upon 
our IPO; restructuring and other costs; transaction and integration-related expenses; non-cash share-based 
compensation expense; contingent consideration and other expenses; asset impairment charges; loss on 
extinguishment of debt; R&D tax credit adjustments; results of and gains or losses from the sale of 
unconsolidated affiliates; and other income (expense).

Adjusted Net Income and Adjusted Diluted Earnings per share represent net income (loss) adjusted to include 
revenue eliminated under purchase accounting and an increase in revenue due to conforming the legacy 
63

inVentiv revenue recognition policy and to exclude the impact of higher-than-normal revenue change order 
activity and certain expenses and transactions that we believe are not representative of our core operating 
results, including: acquisition-related amortization; restructuring and other costs; transaction and integration-
related expenses; asset impairment charges: non-cash share-based compensation expense; contingent 
consideration and other expenses; management fees that terminated upon our IPO; R&D tax credit 
adjustments: other income (expense); results of and gains or losses from the sale of unconsolidated affiliates; 
loss on extinguishment of debt: bridge financing fees related to unused financing commitments;  adjustments 
to our tax rate to reflect an expected long-term tax rate that excludes the impact of our valuation allowances 
and historical NOLs; and adjustments related to the estimated of the enactment of the Tax Act. 

We believe that EBITDA is a useful metric for investors as it is a common metric used by investors, analysts 
and debt holders to measure our ability to service our debt obligations, fund capital expenditures and meet 
working capital requirements.

Each of the non-GAAP measures are used by management and the Board to evaluate our core operating 
results as it excludes certain items whose fluctuations from period-to-period do not necessarily correspond to 
changes in the core operations of the business. Adjusted Net Income (including Adjusted Diluted Earnings per 
Share) are used by management and the Board to assess our business, as well as by investors and analysts, 
to measure our performance. 

These non-GAAP measures are performance measures only and are not measures of our cash flows or 
liquidity. Adjusted Net Service Revenue, EBITDA, Adjusted EBITDA, Adjusted Net Income and Adjusted 
Diluted Earnings per share are non-GAAP financial measures that are not in accordance with, or an 
alternative for, measures of financial performance prepared in accordance with U.S. GAAP and may be 
different from similarly titled non-GAAP measures used by other companies. Non-GAAP measures have 
limitations in that they do not reflect all of the amounts associated with our results of operations as determined 
in accordance with U.S. GAAP. Some of the limitations are:

•  EBITDA and Adjusted EBITDA do not reflect the significant interest expense, or the cash 

requirements necessary to service interest or principal payments, on our debt;

• 

although depreciation and amortization are non-cash charges, the assets being depreciated and 
amortized may have to be replaced in the future, and EBITDA, Adjusted EBITDA and Adjusted Net 
Income do not reflect the cash requirements for such replacements; and

•  EBITDA, Adjusted EBITDA, and Adjusted Net Income do not reflect our actual tax expense or, in the 

case of EBITDA and Adjusted EBITDA, the cash requirements to pay our taxes.

See the consolidated financial statements included in Part II, Item 8, "Financial Statements and 
Supplementary Data" in this Annual Report on Form 10-K for our GAAP results. Additionally, for 
reconciliations of Adjusted Net Service Revenue, EBITDA, Adjusted EBITDA, Adjusted Net Income and 
Adjusted Diluted Earnings per share to our closest reported GAAP measures see "Selected Financial Data - 
Reconciliation of GAAP Measures to Non-GAAP Measures" above.

64

Item 7. Management's Discussion and Analysis of Financial Condition and Results of Operations.

The following discussion and analysis of our financial condition and results of operations should be read 
together with Part II, Item 6, "Selected Financial Data" in this Annual Report on Form 10-K and the 
consolidated financial statements and the related notes included in Part II, Item 8, "Financial Statements and 
Supplementary Data" in this Annual Report on Form 10-K. This discussion contains forward-looking 
statements related to future events and our future financial performance that are based on current 
expectations and subject to risks and uncertainties. Our actual results may differ materially from those 
anticipated in these forward-looking statements as a result of many factors, including those described in Part 
I, Item 1A, "Risk Factors" and elsewhere in this Annual Report on Form 10-K.

Overview of Our Business and Services

Syneos Health, Inc. (the “Company,” “we,” “us,” and “our”) is a leading global biopharmaceutical services 
organization comprised of an end-to-end clinical contract research organization (“CRO”) and contract 
commercial organization (“CCO”). We offer both standalone and integrated biopharmaceutical development 
and commercialization services ranging from Phase I to Phase IV clinical trial services to services associated 
with the commercialization of biopharmaceutical products. Our customers include small, mid-sized, and large 
companies in the pharmaceutical, biotechnology, and medical device industries, and our revenue is derived 
through a broad suite of services designed to enhance our customers’ ability to successfully develop, launch, 
and market their products. We consistently and predictably deliver our services in a complex environment and 
offer a proprietary, operational approach to the delivery of our projects through our Trusted Process® 
methodology. 

On August 1, 2017, we completed a merger (the “Merger”) with Double Eagle Parent, Inc. (“inVentiv”), the 
parent company of inVentiv Health, Inc. under the terms of the merger agreement, dated May 10, 2017 (the 
“Merger Agreement”). Upon closing, inVentiv was merged with and into the Company, and the separate 
corporate existence of inVentiv ceased. In conjunction with the Merger, we entered into the 2017 Credit 
Agreement to: (i) repay the Company’s and inVentiv’s pre-Merger term loans; (ii) partially redeem inVentiv’s 
Senior Unsecured Notes; and (iii) pay fees and expenses related to the Merger. See further discussion in 
"Note 3 - Business Combinations" to our consolidated financial statements included in Part II, Item 8, 
"Financial Statements and Supplementary Data" in this Annual Report on Form 10-K for additional details on 
the Merger. 

Following the Merger, we realigned our operating segments to reflect the current structure under which we 
evaluate our performance, make strategic decisions and allocate resources. As a result of this realignment, 
effective August 1, 2017, we began managing our business through two reportable segments: Clinical 
Solutions and Commercial Solutions.

Our Clinical Solutions segment offers a variety of services spanning Phase I to Phase IV of clinical 
development, including full-service global studies, as well as individual service offerings such as clinical 
monitoring, investigator recruitment, patient recruitment, data management, and study startup to assist 
customers with their drug development process. Our Commercial Solutions segment provides the 
pharmaceutical, biotechnology, and healthcare industries commercialization services, which include 
outsourced selling solutions, communication solutions (public relations and advertising), and consulting 
services. Our management reviews segment performance and allocates resources based upon segment 
revenue and segment operating income. Historical segment reporting has been revised to reflect these 
changes to our segment structure. Prior to the Merger, our Commercial Solutions segment consisted solely of 
a consulting offering. See further discussion in "Note 14 - Segment Information" to our consolidated financial 
statements included in Part II, Item 8, "Financial Statements and Supplementary Data" in this Annual Report 
on Form 10-K.

For financial information regarding revenue and long-lived assets by geographic areas, see "Note 15 - 
Operations by Geographic Location" to our consolidated financial statements included in Part II, Item 8, 
"Financial Statements and Supplementary Data" in this Annual Report on Form 10-K.

65

New Business Awards and Backlog

In connection with the Merger, we re-evaluated our existing backlog policy for our Clinical Solutions segment. 
As a result of this evaluation, effective during the third quarter of 2017, we changed our policy for calculating 
and reporting the amounts of our net new business awards and backlog. Under the new backlog policy for our 
Clinical Solutions segment, we add new business awards to backlog when we enter into a contract or when 
we receive a written commitment from the customer selecting us as a service provider, provided that:

• 

• 

• 

• 

the customer has received appropriate internal funding approval and collection of the award value is 
probable;

the project or projects are not contingent upon completion of another trial or event; 

the project or projects are expected to commence within the next six months; 

the customer has entered or intends to enter into a comprehensive contract as soon as practicable; 
and

• 

for awards related to our FSP offering, only a maximum of twelve months of services are included.

In addition, we continually evaluate our backlog to determine if any of the previously awarded work is no 
longer expected to be performed, regardless of whether we have received formal cancellation notice from the 
customer. If we determine that any previously awarded work is no longer probable of being performed, we 
remove the value from our backlog based on risk. We recognize revenue from these awards as services are 
performed, provided we have entered into a contractual commitment with the customer. We recorded the 
backlog assumed in the Merger consistent with our new backlog policy.

We do not currently report new business awards or backlog data for our Commercial Solutions segment. 
Accordingly, all disclosures related to net new service awards and backlog pertain solely to our Clinical 
Solutions segment.

Backlog

Our Clinical Solutions backlog consists of anticipated future net service revenue from business awards that 
either have not started but are anticipated to begin in the future (as noted above), or that are in process and 
have not been completed. Our backlog also reflects any cancellation or adjustment activity related to these 
contracts. The average duration of our contracts will fluctuate from period to period in the future based on the 
contracts comprising our backlog at any given time. The majority of our Clinical Solutions segment contracts 
can be terminated by the customer with a 30-day notice. 

As of December 31, 2017 and 2016, our Clinical Solutions backlog was $3.80 billion and $1.88 billion, 
respectively (inVentiv contributed approximately $1.51 billion of our December 31, 2017 Clinical Solutions 
backlog). We expect approximately $1.88 billion of our Clinical Solutions backlog at December 31, 2017 will 
be recognized as revenue during 2018, with the remainder expected to be translated into revenue beyond 
2018. We adjust the amount of our backlog each quarter for the effects of fluctuations in foreign currency 
exchange rates. During the year ended December 31, 2017, fluctuations in foreign currency exchange rates 
resulted in a favorable impact on our December 31, 2017 backlog in the amount of $47.3 million, primarily due 
to the strengthening of the Euro against the U.S. dollar. 

We believe that our backlog and net new business awards might not be consistent indicators of future 
revenue because they have been, and likely will be, affected by a number of factors, including the variable 
size and duration of projects, many of which are performed over several years, and cancellations and 
changes to the scope of work during the course of projects. Additionally, projects may be canceled or delayed 
by the customer or regulatory authorities. Projects that have been delayed for less than six months generally 
remain in backlog, but the anticipated timing of the recognition of revenue is uncertain. We generally do not 
have a contractual right to the full amount of the awards reflected in our backlog. If a customer cancels an 
award, we might be reimbursed for the costs we have incurred. As we increasingly compete for and enter into 
large contracts that are more global in nature, we expect that the rate at which our backlog and net new 
business awards convert into revenue is likely to decrease, and the duration of projects and the period over 

66

which related revenue is recognized to lengthen. In addition, our adoption of the new revenue recognition 
accounting standard on January 1, 2018 might affect our backlog. See "Note 1 - Basis of Presentation and 
Summary of Principal Accounting Policies - Recently Issued Accounting Standards Not Yet Adopted - 
Revenue from Contracts with Customers." For more information about risks related to our backlog see Part I, 
Item 1A "Risk Factors—Risks Related to Our Business—Our backlog might not be indicative of our future 
revenues, and we might not realize all of the anticipated future revenue reflected in our backlog" in this 
Annual Report on Form 10-K.

Net New Business Awards

Our new business awards, net of award cancellations, for the years ended December 31, 
2017, 2016, and 2015 were $1.82 billion, $1.22 billion, and $1.11 billion, respectively, representing a 49.5% 
increase from 2016 to 2017 and a 9.2% increase from 2015 to 2016. Net new business awards were higher 
for the year ended December 31, 2017, due to the Merger and an estimated organic increase in net awards of 
$76.2 million, or 6.3%. New business awards have varied and may continue to vary significantly from quarter 
to quarter. Fluctuations in our net new business award levels often result from the fact that we may receive a 
small number of relatively large orders in any given reporting period. Because of these large orders, our 
backlog and net new business awards in a reporting period may reach levels that are not sustainable in 
subsequent reporting periods.

67

Results of Operations

Year Ended December 31, 2017 Compared to the Years Ended December 31, 2016 and 2015 

The following table sets forth amounts from our consolidated financial statements along with the percentage 
change for years ended December 31, 2017, 2016 and 2015 (dollars in thousands): 

Years Ended December 31,

Change

2017

2016

2015

2017 to 2016

2016 to 2015

Net service revenue

$ 1,852,843

$1,030,337

$ 914,740

$ 822,506

79.8 % $ 115,597

12.6 %

Reimbursable out-of-pocket 
expenses

819,221

580,259

484,499

238,962

41.2 %

95,760

Total revenue

2,672,064

1,610,596

1,399,239

1,061,468

65.9 % 211,357

19.8 %

15.1 %

Costs and operating 
expenses:

Direct costs (exclusive of 
depreciation and 
amortization)

Reimbursable out-of-pocket
expenses

Selling, general, and
administrative

Restructuring and other 
costs

Transaction and integration-
related expenses

Asset impairment charges

Depreciation and 
amortization

Total operating
expenses

(Loss) income from 
operations

1,232,023

626,633

542,404

605,390

96.6 %

84,229

15.5 %

819,221

580,259

484,499

238,962

41.2 %

95,760

19.8 %

282,620

172,386

156,609

110,234

63.9 %

15,777

10.1 %

33,315

13,612

1,785

19,703

144.7 %

11,827

662.6 %

123,815

30,000

3,143

—

1,637

3,931

120,672

30,000

n/m

n/m

1,506

92.0 %

(3,931)

(100.0)%

179,936

59,204

56,014

120,732

203.9 %

3,190

5.7 %

2,700,930

1,455,237

1,246,879

1,245,693

85.6 % 208,358

16.7 %

Total other expense, net

(83,011)

(21,241)

(21,386)

(61,770)

(290.8)%

(28,866)

155,359

152,360

(184,225)

(118.6)%

2,999

145

2.0 %

0.7 %

(Loss) income before 
provision for income taxes

(111,877)

134,118

130,974

(245,995)

(183.4)%

3,144

2.4 %

Income tax benefit (expense)

(26,592)

(21,488)

(13,927)

(5,104)

(23.8)%

(7,561)

(54.3)%

Net (loss) income

$ (138,469) $ 112,630

$ 117,047

$ (251,099)

(222.9)% $

(4,417)

(3.8)%

Net Service Revenue 

Net service revenue increased by $822.5 million, or 79.8%, to $1,852.8 million for the year ended 
December 31, 2017 from $1,030.3 million for the year ended December 31, 2016. The increase in our total 
net service revenue during 2017 was due solely to the Merger with inVentiv in August 2017, which resulted in 
an increase in total net service revenue of $839.0 million. This increase was partially offset by a year-over-
year decline in organic revenues resulting from significant customer, regulatory, and other delays impacting 
our awarded projects during 2017, and higher than normal levels of cancellations of previously awarded 
projects. Our net service revenue for the year ended December 31, 2017 was negatively impacted by 
fluctuations in foreign exchange rates and contractual currency adjustment provisions of $4.8 million, as the 
U.S. dollar has strengthened compared to the prior year. 

Net service revenue increased $115.6 million, or 12.6%, to $1,030.3 million for the year ended December 
31, 2016 from $914.7 million for the year ended December 31, 2015. In 2016, our revenue grew across all 
therapeutic areas and has been particularly strong in the central nervous system, oncology and other 
complex therapeutic areas. The growth in revenue during 2016 was primarily due to our strong backlog at 
the beginning of the year, the acceleration of a group of projects with one of our sponsors, revenue mix, 
and the growth of our functional service provider business. Our net service revenue for the year ended 

68

 
 
 
 
 
 
 
 
 
December 31, 2016 was negatively impacted by fluctuations in foreign exchange rates and contractual 
currency adjustment provisions of $11.7 million, as the U.S. dollar has strengthened compared to the prior 
year.

We will adopt the new revenue recognition standard on January 1, 2018 using the modified retrospective 
approach. As a result of adopting the new standard, our future revenue recognition may be delayed at 
certain phases of the customer contract life cycle, particularly during the first couple of years of the contract 
as the inclusion of reimbursable costs in the measure of progress may result in a disproportionately lower 
percentage of costs incurred until those contracts mature. Such deferral of revenue could differ materially 
from that applied under the revenue recognition standard used in previous years. While we expect our 
revenue to be deferred in the early stages of the contract, we do not expect any changes in the total 
revenue or profitability recognized over the life of the contract. Further, any impact from delays in the early 
stages of the contract may be partially mitigated on an aggregate basis because at any given time, our 
portfolio consists of contracts in varying stages of completion.

Net service revenue from our top five customers accounted for approximately 22.3%, 33.3% and 33.5% of net 
service revenue for the years ended December 31, 2017, 2016 and 2015, respectively. No single customer 
accounted for greater than 10% of our total consolidated net service revenue for the years ended 
December 31, 2017, 2016 or 2015.

Net service revenue for each of our segments was comprised of the following (in thousands, except 
percentages):

Years Ended December 31,

Change

2017

2016

2015

2017 to 2016

2016 to 2015

Clinical Solutions

$ 1,459,968

$1,021,017

$ 906,528

$ 438,951

43.0% $ 114,489

12.6%

% of total

78.8%

Commercial Solutions

392,875

% of total

21.2%

99.1%

9,320

0.9%

99.1%

8,212

383,555

n/m

1,108

13.5%

0.9%

Total net service revenue

$ 1,852,843

$1,030,337

$ 914,740

$ 822,506

79.8% $ 115,597

12.6%

Clinical Solutions

Our Clinical Solutions segment is a leading global CRO that is therapeutically-focused and offers a variety of 
clinical development services spanning Phase I to Phase IV, including full-service global studies, as well as 
unbundled service offerings such as clinical monitoring, investigator recruitment, patient recruitment, data 
management, and study startup to assist customers with their drug development process. For the years 
ended December 31, 2017, 2016 and 2015, our Clinical Solutions segment generated net service revenue 
of $1,460.0 million, $1,021.0 million, and $906.5 million, respectively, representing approximately 78.8%, 
99.1% and 99.1%, respectively, of net service revenue for the periods. 

For the year ended December 31, 2017, our net service revenue attributable to the Clinical Solutions 
segment increased compared to the same period in 2016 solely due to the Merger with inVentiv in August 
2017, which resulted in an increase in Clinical Solutions net service revenue of $456.7 million. This increase 
was partially offset by a decline in organic revenue of $17.8 million as a result of higher than normal 
customer and regulatory delays and cancellations, among other factors, which impacted our awarded 
projects during 2017. 

For the year ended December 31, 2016, our net service revenue attributable to the Clinical Solutions 
segment increased compared to the same period in 2015 primarily due to our strong backlog at the 
beginning of the year, the acceleration of a group of projects with one of our sponsors, and our revenue 
mix. 

69

Commercial Solutions

Our Commercial Solutions segment is a leading provider of a full suite of complementary commercialization 
services including outsourced field selling solutions, medical adherence, communications (advertising and 
public relations), and consulting services. For the years ended December 31, 2017, 2016 and 2015, our 
Commercial Solutions segment generated net service revenue of $392.9 million, $9.3 million, and $8.2 
million, respectively, representing approximately 21.2%, 0.9% and 0.9%, respectively, of net service 
revenue. 

For the year ended December 31, 2017, our net service revenue attributable to the Commercial Solutions 
segment increased compared to the same period in 2016 primarily due to the Merger with inVentiv in 
August 2017, which resulted in an increase in Commercial Solutions net service revenue of $382.2 million. 
While our Commercial Solutions net service revenue increased on a comparative basis due to the Merger, 
net service revenue associated with this segment declined compared to the amounts reported by inVentiv 
in periods prior to the Merger as a result of project cancellations, particularly within our selling solutions 
and communications service offerings, lower year-over-year business awards, and lower new drug 
approval activity during 2016. 

For the years ended December 31, 2016 and 2015, our net service revenue attributable to the Commercial 
Solutions segment was not material and related to our legacy global consulting business.

Direct Costs 

Our direct costs consist principally of compensation expense and benefits associated with our employees 
and other employee-related costs. While we have some ability to manage the majority of these costs 
relative to the amount of contracted services we have during any given period, direct costs as a percentage 
of net service revenue can vary from period to period. Such fluctuations are due to a variety of factors, 
including, among others: (i) the level of staff utilization created by our ability to effectively manage our 
workforce; (ii) adjustments to the timing of work on specific customer contracts; (iii) the experience mix of 
personnel assigned to projects; and (iv) the service mix and pricing of our contracts. In addition, as global 
projects wind down or as delays and cancellations occur, staffing levels in certain countries or functional 
areas can become misaligned with the current business volume.

Direct costs increased by $605.4 million, or 96.6%, to $1,232.0 million for the year ended December 31, 2017 
from $626.6 million for the year ended December 31, 2016. These increases were driven by the Merger with 
inVentiv, which increased our worldwide employee base by approximately 15,000 employees in August 2017 
and resulted in an increase of $596.0 million in direct costs for the year. In addition to the increase in direct 
costs associated with the Merger, we incurred higher organic compensation and benefits related expense as 
a result of increased personnel resulting from: (i) new business awarded in the first half of 2017; (ii) our 
investment in additional personnel to support the bidding process for new business opportunities; and (iii) an 
increase in underutilized personnel that we retained in anticipation of work that was delayed or canceled. 
These increases were partially offset by a reduction in direct costs from lower incentive based compensation 
and a $1.5 million reduction related to foreign currency exchange rate fluctuations during the year ended 
December 31, 2017 compared to the prior year. 

Direct costs increased by $84.2 million, or 15.5%, to $626.6 million for the year ended December 31, 2016 
from $542.4 million for the year ended December 31, 2015. These increases were primarily driven by: (i) the 
growth in our revenues and the resulting need for additional resources; (ii) our need to utilize a higher 
percentage of third party contractors during 2016 compared to 2015 as the result of our commitment to a 
customer to accelerate work originally planned for 2017 into 2016; and (iii) one-time benefits received in 2015 
related to a favorable resolution of several VAT and other tax items, a change in employee incentive 
compensation, and favorable resolutions to disputed pass-through costs. The increases were partially offset 
by a reduction in direct costs of $15.5 million related to fluctuations in foreign currency exchange rates during 
the year ended December 31, 2016 compared to 2015.

70

Direct costs for each of our segments, excluding share-based compensation expense, were comprised of 
the following (in thousands, except percentages):

Years Ended December 31,

Change

Clinical Solutions

$

930,176

$ 612,201

$

533,277

$ 317,975

51.9% $

78,924

14.8%

2017

2016

2015

2017 to 2016

2016 to 2015

% of related net
service revenue

Gross margin

63.7%

36.3%

60.0%

40.0%

58.8%

41.2%

Commercial Solutions

291,310

7,881

6,845

283,429

n/m

1,036

15.1%

% of related net
service revenue

Gross margin

74.1%

25.9%

84.6%

15.4%

83.4%

16.6%

Total direct costs

$ 1,221,486

$ 620,082

$

540,122

$ 601,404

97.0% $

79,960

14.8%

% of total net service
revenue

65.9%

60.2%

59.0%

Clinical Solutions

For the years ended December 31, 2017, 2016 and 2015, direct costs related to our Clinical Solutions 
segment were $930.2 million, $612.2 million and $533.3 million, respectively, representing approximately 
76.2%, 98.7% and 98.7%, respectively, of our total direct costs for the period. Clinical Solutions direct costs 
as a percentage of related net service revenue for the years ended December 31, 2017, 2016 and 2015, 
were 63.7%, 60.0% and 58.8%, respectively. The increase in direct costs associated with our Clinical 
Solutions segment in 2017 compared to 2016 was primarily due to increased personnel costs for the 
reasons discussed above, particularly increases resulting from the Merger and retention of underutilized 
staff. 

The increase in direct costs associated with our Clinical Solutions segment in 2016 compared to 2015 was 
primarily due to increased growth in our revenues resulting in the need for additional resources, including 
third party contractors, and one-time benefits received in 2015, as discussed previously. 

Gross margin for the Clinical Solutions segment was 36.3%, 40.0% and 41.2% for the years ended 
December 31, 2017, 2016 and 2015, respectively. Gross margin declined in 2017 compared to 2016 
primarily due to: (i) the mix of customers and services obtained in the Merger having a lower gross margin 
profile compared to our historical mix of customers and services; (ii) the elimination of $28.6 million of 
revenue in purchase accounting that otherwise would have been recognized by inVentiv; and (iii) the impact 
of carrying excess staff throughout 2017. Specifically, inVentiv’s legacy Clinical Solutions business has 
historically had a higher mix of contracts from the top 20 biopharmaceutical companies and a higher mix of 
FSP services revenue, both of which typically have a lower margin profile than our historical mix of 
customers and services.

Commercial Solutions

For the years ended December 31, 2017, 2016 and 2015, direct costs related to our Commercial Solutions 
segment were $291.3 million, $7.9 million and $6.8 million, respectively, representing approximately 23.8%, 
1.3% and 1.3%, respectively, of our total direct costs for the period. Commercial Solutions direct costs as a 
percentage of related net service revenue for the years ended December 31, 2017, 2016 and 2015, were 
74.1%, 84.6% and 83.4%, respectively. The increase in direct costs associated with our Commercial 
Solutions segment in 2017 compared to 2016 was due to increased personnel costs as a result of the 
Merger. The increase in direct costs associated with our Commercial Solutions segment in 2016 compared 
to 2015 was were not material.

Gross margin for the Commercial Solutions segment was 25.9%, 15.4% and 16.6% for the years ended 
December 31, 2017, 2016 and 2015, respectively. The increase in gross margin in 2017 compared to 2016 

71

was due to the Merger, where the services obtained in the Merger have historically had a higher margin 
profile than our legacy consulting business. 

Reimbursable Out-of-Pocket Expenses

Reimbursable out-of-pocket expenses represent expenses typically not associated with our services which 
are passed through and reimbursed by our customers at actual cost. Such expenses are incurred within both 
our clinical and commercial businesses and are generally comprised of (i) physician and investigator fees, 
project management, data management and other site-facing study costs, (ii) travel-related expenses, (iii) 
certain compensation and bonuses of sales representatives and other project team personnel, and (iv) 
various vendor and third-party fees related to meetings, transportation, sales, marketing, communication, 
training, storage and other miscellaneous project expenses incurred under contracts. These expenses 
fluctuate significantly from period to period based on the timing of program initiation or closeout and the mix of 
program complexity, and do not necessarily change in direct correlation to net service revenue. 

Reimbursable out-of-pocket expenses increased 41.2%, or $239.0 million, to $819.2 million for the year 
ended December 31, 2017 from $580.3 million for the year ended December 31, 2016. Reimbursable out-of-
pocket expenses increased 19.8%, or $95.8 million, to $580.3 million for the year ended December 31, 2016 
from $484.5 million for the year ended December 31, 2015. These increases were principally due to the 
Merger in 2017, overall increases in net service revenue during both periods, and an increase in the number 
of studies in which we procured principal investigator services. The reimbursable out-of-pocket expenses 
included in “Total revenue” are offset by an equal amount shown under the same caption in the “Costs and 
operating expenses” section in our consolidated statements of operations and, accordingly, have no impact 
on income from operations.

As a result of adopting the new revenue recognition standard, beginning in fiscal year 2018 we will no longer 
present net service revenue and reimbursable out-of-pocket expenses separately in the statements of 
operations as, under the new revenue recognition standard, they represent a single performance obligation 
and such presentation is no longer permitted. 

Selling, General and Administrative Expenses

For the years ended December 31, 2017, 2016 and 2015, selling, general and administrative expenses were 
as follows (dollars in thousands):

Selling, general and
administrative

Percent of total net service
revenue

Years Ended December 31,

Change

2017

2016

2015

2017 to 2016

2016 to 2015

$ 282,620

$ 172,386

$ 156,609

$ 110,234

63.9% $

15,777

10.1%

15.3%

16.7%

17.1%

Selling, general and administrative expenses increased by $110.2 million, or 63.9%, to $282.6 million for the 
year ended December 31, 2017 from $172.4 million for the year ended December 31, 2016, including a $0.4 
million benefit from favorable fluctuations in foreign currency exchange rates compared to the prior year. 
These increases were primarily due to the Merger with inVentiv, which increased our overall employee base 
by approximately 15,000 employees in August 2017 and resulted in an increase of approximately $97.1 
million in compensation related selling, general, and administrative expenses during 2017 compared to 2016. 

Selling, general and administrative expenses increased by $15.8 million, or 10.1%, to $172.4 million for the 
year ended December 31, 2016 from $156.6 million for the year ended December 31, 2015, including a $4.0 
million benefit from favorable fluctuations in foreign currency exchange rates compared to the prior year. The 
increase was primarily driven by: (i) an increase in salaries, benefits and incentive compensation, principally 
as a result of the additions in personnel to support the growth of our business and the one-time benefit from 
settlement of certain employee related liabilities in 2015; (ii) an increase in bad debt expense resulting from 
an increase in billed and unbilled receivables exposure; and (iii) an increase in travel costs primarily driven by 
increased headcount. These cost increases were offset by reductions in: (i) professional fees for legal and 

72

 
 
 
 
 
 
accounting fees associated with implementing Sarbanes-Oxley and tax planning that occurred in 2015; and 
(ii) facilities and IT related costs through improved utilization of our existing infrastructure. During the year 
ended December 31, 2015, our selling, general and administrative expenses were positively impacted by 
settlement of certain employee related liabilities totaling approximately $1.1 million. 

Selling, general and administrative expense as a percentage of total net service revenue has declined to 
15.3% from 16.7% and 17.1% for years ended December 31, 2017, 2016 and 2015, respectively. Fluctuations 
in foreign currency exchange rates could significantly impact our selling, general and administrative expenses 
as a percentage of revenue in the future.

Restructuring and Other Costs

Restructuring and other costs were $33.3 million for the year ended December 31, 2017. In connection with 
the Merger, we established a restructuring plan to eliminate redundant positions and reduce our facility 
footprint worldwide. Accordingly, during the year ended December 31, 2017, we recognized approximately 
$11.3 million of employee severance and benefit costs, facility closure and lease termination costs of $2.2 
million, and other costs of $2.0 million related to the Merger. We expect to incur significant additional costs 
related to the restructuring of our operations in order to achieve the targeted synergies as a result of the 
Merger over the next several years. The timing and the estimate of the amount of these costs depends on 
various factors, including, but not limited to, the identification of synergy opportunities and the execution of the 
integration of our combined operations.

In addition to costs incurred as a result of the Merger, during the year ended December 31, 2017, we 
recognized approximately $9.4 million of employee severance costs and incurred $1.3 million of facility 
closure and lease termination costs related to non-Merger restructuring activities. Included in restructuring 
and other costs during 2017 are $5.0 million of consulting costs related to the continued consolidation of our 
legal entities and restructuring of our contract management process to meet the requirements of upcoming 
accounting regulation changes and $2.1 million of other costs. 

Restructuring and other costs were $13.6 million for the year ended December 31, 2016. In March 2016, 
management approved a global plan to eliminate certain positions worldwide in an effort to ensure that our 
organizational focus and resources were properly aligned with our strategic goals and to continue 
strengthening the delivery of our growing backlog to customers. Accordingly, we made changes to our 
therapeutic unit structure designed to realign with management focus and optimize the efficiency of our 
resourcing to achieve our strategic plan. As a result, we eliminated approximately 200 positions and 
incurred $7.0 million related to employee severance costs during the year ended December 31, 2016. All 
actions under this plan were completed by December 31, 2017. During the third quarter of 2016, we also 
announced the closure of one of our facilities associated with this restructuring and we incurred facility 
closure costs of $1.5 million, which were partially offset by unamortized deferred rent of $0.5 million during 
the year ended December 31, 2016.

On July 27, 2016, we entered into a transition agreement with our former CEO related to the transition to 
a new CEO as of October 1, 2016. The CEO transition agreement was effective through February 28, 
2017. In addition, in mid-September 2016, we entered into retention agreements with certain key 
employees for various dates through September 2017. For the year ended December 31, 2016, we 
recognized $4.8 million of costs associated with the CEO transition and retention agreements, which will 
be paid through August 2018.

Restructuring and other costs were $1.8 million for the year ended December 31, 2015, primarily consisting of 
employee severance costs of $2.7 million, partially offset by a net reduction in facility closure costs of $0.9 
million. 

73

Transaction and Integration-Related Expenses

Transaction and integration-related expenses consisted of the following (in thousands):

Years Ended December 31,

2017

2016

2015

Investment banker, professional fees, and other

$

68,967

$

Share-based compensation expense

Debt modification and related expenses

Personnel integration and retention-related costs

Benefit from change in fair value of contingent tax-sharing 
obligation

Other

31,327

5,255

28,616

(12,276)

1,926

Total transaction and integration-related expenses

$

123,815

$

2,975 $
—

168

—

—

—
3,143 $

1,637
—
—
—

—
—
1,637

During the year ended December 31, 2017, we incurred transaction and integration related expenses of 
$123.8 million. We expect to incur additional expenses associated with the Merger; however, the timing and 
the amount of these expenses depends on various factors such as, but not limited to, the execution of 
integration activities and the aggregate amount of synergies we achieve from these activities. 

The transaction and integration related costs incurred during 2017 consisted primarily of professional fees of 
approximately $69.0 million associated with investment banking and other advisory fees incurred, along with 
costs associated with the related financing of $5.3 million. In addition, the vesting of certain employee stock 
compensation arrangements was accelerated in accordance with their terms, resulting in additional share-
based compensation expense of approximately $31.3 million. 

During the year ended December 31, 2017, we also incurred personnel integration and retention-related 
costs of $28.6 million, consisting primarily of $23.5 million of expenses associated with Merger-related 
retention agreements with certain key employees. We expect to incur a minimum of $9.2 million of such 
additional expenses which are expected to be paid in May 2018. Partially offsetting the above expenses is a 
benefit of $12.3 million from the reduction in the fair value of our contingent tax-sharing obligations payable 
to the former shareholders of inVentiv as a result of the enactment of the Tax Act of 2017. 

During the year ended December 31, 2016, we incurred transaction expenses of $3.1 million, primarily 
consisting of third-party fees associated with: (i) our secondary stock offerings in May and August 2016; (ii) 
our stock repurchase and debt amendment in August 2016; and (iii) other corporate projects. During the year 
ended December 31, 2015, we incurred transaction expenses of $1.6 million, primarily consisting of third-
party fees associated with our stock repurchases in May and December of 2015 and our secondary common 
stock offerings in May, August and December of 2015.

Goodwill and Intangible Asset Impairment Charges

We evaluate goodwill for impairment annually, or more frequently if events or changes in circumstances 
indicate that goodwill might be impaired. In connection with the Merger, we announced our intention to 
relaunch our operations under a new brand name in January 2018. As a result, we determined that the useful 
life of the intangible asset related to the INC Research trademark with a carrying value of $35.0 million was no 
longer indefinite as of August 1, 2017. Based on this change in circumstances, we tested the asset for 
impairment as an indefinite-lived intangible asset and recorded a $30.0 million impairment charge during the 
year ended December 31, 2017. We also determined that the remaining useful life of this asset did not extend 
beyond the anticipated date of Merger-related rebranding which, as of August 1, 2017, approximated five 
months. In addition, the Company assigned a value of $8.8 million to the inVentiv Health trade name in 
connection with the Merger, which was amortized over the same five month period. As of December 31, 2017, 
these trademarks were fully amortized. 

During the first quarter of 2015, we continued to observe deteriorating performance within our Phase I 
Services reporting unit, a component of the Clinical Solutions segment, due to reduced revenue resulting from 

74

 
cancellations and lower than expected new business awards. This resulted in a triggering event, requiring an 
evaluation of both long-lived assets and goodwill for potential impairment. As a result of this evaluation, we 
recorded a total asset impairment charge of $3.9 million, comprised of a long-lived assets impairment charge 
of $1.0 million and a goodwill impairment charge of $2.9 million, which was the total remaining goodwill 
balance of our Phase I Services reporting unit, a component of the Clinical Solutions segment, as of the 
evaluation date. There were no asset impairment charges during 2016.

Depreciation and Amortization Expense

Total depreciation and amortization expense increased to $179.9 million for the year ended December 31, 
2017 from $59.2 million for the year ended December 31, 2016. These increases were primarily due to: (i) an 
increase in amortization expense of $97.7 million primarily related to the assumption of intangible assets as 
part of the Merger; and (ii) an increase in depreciation expense due to assets obtained in the Merger and our 
continued investment in information technology and facilities to support growth in our operational capabilities 
and optimization of our infrastructure.

Total depreciation and amortization expense increased to $59.2 million for the year ended December 31, 
2016 from $56.0 million for the year ended December 31, 2015. This increase was a result of an increase in 
depreciation expense of $3.2 million for the year ended December 31, 2016 as compared to the year ended 
December 31, 2015, principally due to higher capital expenditures in 2016.

Other Expense, Net

For the years ended December 31, 2017, 2016 and 2015, the components of total other (expense) income, 
net were as follows (dollars in thousands):

Years Ended December 31,

Change

2017

2016

2015

2017 to 2016

2016 to 2015

Interest income

Interest expense

$

1,182

$

216

$

192

$

966

447.2 % $

(63,725)

(12,016)

(15,640)

(51,709)

(430.3)%

24

3,624

12.5 %

23.2 %

Loss on extinguishment of 
debt

(622)

Other (expense) income, net

(19,846)

(439)

(9,002)

(9,795)

(183)

(41.7)%

9,356

95.5 %

3,857

(10,844)

(120.5)%

(12,859)

(333.4)%

Total other expense, net

$ (83,011) $ (21,241) $ (21,386) $ (61,770)

(290.8)% $

145

0.7 %

Total other expense, net was $83.0 million, $21.2 million and $21.4 million for the years ended 
December 31, 2017, 2016 and 2015, respectively. The increase in 2017 compared to 2016 predominantly 
relates to: (i) an increase in interest expense due to our increased debt that resulted from the Merger; and 
(ii) foreign currency losses incurred due to exchange rate fluctuations related to monetary asset balances 
denominated in currencies other than functional currency. 

Interest expense increased by $51.7 million for 2017 compared to 2016, primarily due to our increased 
leverage as a result of the Merger with inVentiv in August 2017. Interest expense decreased by $3.6 million 
for 2016 compared to 2015, primarily due to the decreased interest rates as a result of our debt repayment 
and refinancing activities during the second quarter of 2015 and third quarter of 2016.

The loss on extinguishment of debt was $0.6 million, $0.4 million and $9.8 million for the years ended 
December 31, 2017, 2016 and 2015, respectively, incurred primarily as a result of our debt prepayments and 
refinancing transactions.

Other (expense) income, net, increased expense by $10.8 million for 2017 compared to 2016 and by $12.9 
million for 2016 compared to 2015. Other (expense) income, net is primarily comprised of foreign currency 
gains and losses and the changes are principally driven by exchange rate fluctuations related to monetary 
asset balances denominated in currencies other than functional currency. Strengthening of foreign currencies 
against the U.S. dollar may create losses in future periods to the extent that our subsidiaries who use local 

75

 
 
currency as their functional currency maintain net assets and liabilities balances not denominated in their 
functional currency. 

Income Tax Expense

Income tax expense was $26.6 million for the year ended December 31, 2017 on a pre-tax loss of $111.9 
million, compared to an expense of $21.5 million for the year ended December 31, 2016, on a pre-tax income 
of $134.1 million. For the year ended December 31, 2017, variances from the statutory rate of 35% were due 
to: (i) the direct and indirect impacts of the December 2017 Tax Cuts and Jobs Act (the "Tax Act"), resulting in 
income tax expense of $94.4 million; (ii) a benefit from the geographical split of pre-tax income from foreign 
subsidiaries of $16.8 million; (iii) a $8.9 million benefit associated with stock-based compensation; and (iv) 
research and development tax credits of $5.7 million. With regard to the impact of the Tax Act during the 
fourth quarter of 2017 we recorded the following: (i) income tax expense of $63.1 million related to our 
estimated transition tax; (ii) income tax expense of $37.5 million related to the rate change impact on our U.S. 
deferred tax assets; (iii) income tax expense of $52.6 million related to the net valuation allowance increase 
on our deferred tax assets; and (iv) income tax benefit of $58.7 million related to the net reversal of the 
deferred tax liabilities previously accrued on our foreign earnings (consisting of a $112.1 million reversal, net 
of $53.4 million of taxes accrued), all as described in, "Note 12 - Income Taxes" to our consolidated financial 
statements included in Part II, Item 8, "Financial Statements and Supplementary Data " in this Annual Report 
on Form 10-K.

Income tax expense was $21.5 million for the year ended December 31, 2016, compared to $13.9 million for 
the year ended December 31, 2015, as we achieved our second consecutive year of profitability. For the year 
ended December 31, 2016, variances from the statutory rate of 35% were due to: (i) an income tax benefit of 
$12.9 million related to excess tax benefits for share-based compensation; (ii) the release of reserves for 
uncertain tax positions and valuation allowances on net operating loss carryforwards related to certain 
international jurisdictions in aggregate totaling $6.6 million; and (iii) the geographical split of pre-tax income, 
net of deemed dividends from foreign subsidiaries.

Net (Loss) Income

Net loss was $138.5 million for the year ended December 31, 2017 compared to net income of $112.6 million 
for the year ended December 31, 2016. This year-over-year change from an income to a loss position was 
primarily due to a decrease in income from operations as a result of the Merger. Specifically, our operating 
costs increased significantly during the year related to: (i) restructuring and other costs; (ii) transaction and 
integration-related costs; (iii) depreciation and amortization expense; and (iv) asset impairment charges. 
Additionally, other expense, net, increased predominantly as a result of higher debt balances, which 
increased interest expense during 2017 compared to 2016.

Net income was $112.6 million for the year ended December 31, 2016 compared to $117.0 million for the year 
ended December 31, 2015. The year-over-year decrease was primarily due to increases in: (i) our direct costs 
as a percentage of net service revenue; (ii) restructuring and other costs; (iii) transaction and integration-
related costs; (iv) depreciation expense; (v) foreign exchange losses in 2016 compared to gains in 2015, and 
(vi) income tax expense. These increases in expenses were offset by: (i) the impact of increased net service 
revenue; (ii) a decrease in our selling, general and administrative costs as a percentage of net service 
revenue; (iii) a decrease in asset impairment charges compared to the prior year; (iv) a decrease in loss on 
extinguishment of debt; and (v) a decrease in interest expense as a result of our 2015 and 2016 debt 
refinancing activities.

76

Liquidity and Capital Resources

Key measures of our liquidity are as follows (in thousands):

Balance sheet statistics:
Cash and cash equivalents (a)
Working capital (excluding restricted cash)

December 31, 2017

December 31, 2016

$

321,262

$

261,903

102,471

55,295

(a) As of December 31, 2017, cash and cash equivalents held by our foreign subsidiaries was $192.0 million. A portion of 
these cash and cash equivalent balances may be subject to foreign withholding taxation, if repatriated.

As of December 31, 2017, we had $321.3 million of cash and cash equivalents, including $57.3 million of 
cash acquired as part of the Merger with InVentiv. In addition, we had $481.4 million available for borrowing 
under our $500.0 million revolving credit facility.

As disclosed in "Note 3 - Business Combinations" in our consolidated financial statements included in Part 
II, Item 8, in this Annual Report on Form 10-K, in August 2017 we completed the Merger with inVentiv. 
Concurrently with the completion of the Merger, we entered into the 2017 Credit Agreement for: (i) a $1.0 
billion Term Loan A facility that matures on August 1, 2022; (ii) a $1.6 billion Term Loan B facility that 
matures on August 1, 2024; and (iii) a five- year $500.0 million revolving credit facility. We used the 
proceeds from the 2017 Credit Agreement to, among other things: (i) repay $445.0 million of outstanding 
loans and obligations under our previously existing long-term credit facility; (ii) repay $1.7 billion of 
outstanding obligations under inVentiv’s long-term credit facility, which was treated as Merger consideration; 
(iii) pay approximately $290.3 million to partially redeem obligations under the Senior Notes assumed in the 
Merger, which included an early redemption penalty of $20.3 million; and (iv) pay fees, premiums, and other 
transaction expenses related to the Merger.

We have historically funded our operations and growth, including acquisitions, primarily with our working 
capital, cash flow from operations and funds available through various borrowing arrangements. Our 
principal liquidity requirements are to fund our debt service obligations, capital expenditures, expansion of 
service offerings, possible acquisitions, integration and restructuring costs, geographic expansion, working 
capital and other general corporate expenses. Based on past performance and current expectations, we 
believe our cash and cash equivalents, cash generated from operations, and funds available under our 
revolving credit facility will be sufficient to meet our working capital needs, capital expenditures, scheduled 
debt and interest payments, income tax obligations and other currently anticipated liquidity requirements for 
at least the next 12 months.

Indebtedness

As of December 31, 2017, we had approximately $2.99 billion of total principal indebtedness (including 
$36.8 million of capital leases), comprised of $2.55 billion in term loan debt and $403.0 million in Senior 
Notes, of which $2.43 billion was subject to variable interest rates. In addition, as of December 31, 2017 we 
had $481.4 million (net of $18.6 million in outstanding letters of credit) of available borrowings for working 
capital and other purposes under the Revolver. In addition, as of December 31, 2017, we had $1.2 million of 
LOCs that were not secured by the Revolver.

Under the terms of the lease for our new corporate headquarters in Morrisville, North Carolina we are 
required to issue a LOC to the landlord based on our debt rating issued by Moody’s Investors Service (or 
other nationally-recognized debt rating agency). From June 14, 2017 through June 14, 2020, if our debt rating 
is Ba3 or better, no LOC is required, or if our debt rating is B1 or lower, a LOC equal to 25% of the remaining 
minimum annual rent and estimated operating expenses (or a LOC of approximately $24.2 million as of 
December 31, 2017) is required to be issued to the landlord. This LOC would remain in effect until our debt 
rating was increased to Ba3 or higher for a 12-month period. After June 14, 2020, if our debt rating is Ba2 or 
better, no LOC is required; if our debt rating is Ba3 or lower, a LOC equal to 25% of the then remaining 
minimum annual rent and estimated operating expenses is required to be issued to the landlord; or if our debt 
rating is B1 or lower, a LOC equal to 100% of the then remaining minimum annual rent and estimated 

77

 
 
operating expenses is required to be issued to the landlord.  These letters of credit would remain in effect until 
our debt rating is back above the required threshold for a 12-month period. 

As of December 31, 2017 (and through the date of this filing), our debt rating was Ba3. As such, no LOC is 
currently required. Any letters of credit issued in accordance with the aforementioned requirements would 
be issued under our Revolver, and would reduce its available borrowing capacity by the same amount 
accordingly.

Our ability to make payments on our indebtedness and to fund planned capital expenditures and necessary 
working capital will depend on our ability to generate cash in the future. Our ability to meet our cash needs 
through cash flows from operations will depend on the demand for our services, as well as general 
economic, financial, competitive and other factors, many of which are beyond our control. Our business 
might not generate cash flow in an amount sufficient to enable us to pay the principal of, or interest on, our 
indebtedness, or to fund our other liquidity needs, including working capital, capital expenditures, 
acquisitions, investments and other general corporate requirements. If we cannot fund our liquidity needs, 
we will have to take actions such as reducing or delaying capital expenditures, acquisitions or investments, 
selling assets, restructuring or refinancing our debt, reducing the scope of our operations and growth plans, 
or seeking additional capital. We cannot assure you that any of these remedies could, if necessary, be 
affected on commercially reasonable terms, or at all, or that they would permit us to meet our scheduled 
debt service obligations. Our 2017 Credit Agreement contains covenants that limit our ability to direct the 
use of proceeds from any disposition of assets and, as a result, we might not be allowed to use all of the 
proceeds from any such dispositions to satisfy current debt service obligations.

Cash and Cash Equivalents

Our cash flows from operating, investing, and financing activities were as follows (in thousands, except 
percentages):

Years Ended December 31,

Change

2017

2016

2015

2017 to 2016

2016 to 2015

Net cash provided by operating 
activities

Net cash used in investing
activities

Net cash provided by (used in) 
financing activities

$

198,258

$ 109,332

$204,740

$

88,926

81.3% $ (95,408)

(46.6)%

(1,722,907)

(31,353)

(21,111)

(1,691,554)

n/m

(10,242)

(48.5)%

1,734,368

(53,316)

(211,399)

1,787,684

n/m

158,083

74.8 %

Cash Flows from Operating Activities

For the year ended December 31, 2017, our operating activities provided $198.3 million of cash, consisting of 
a net loss of $138.5 million, adjusted for net non-operating and non-cash items of $289.7 million primarily 
related to depreciation and amortization, share-based compensation, asset impairment charges, fair value 
adjustments related to our contingent tax sharing obligations, deferred income tax expense, and foreign 
currency adjustments. Additionally, cash provided by changes in operating assets and liabilities was $47.0 
million (excluding the effects of the Merger), consisting primarily of cash inflow as a result of a decrease in 
billed and unbilled accounts receivable and an increase in deferred revenue, partially offset by a decrease in 
accounts payable and accrued expenses. See further discussion in "Note 3 - Business Combinations" to our 
consolidated financial statements included in Part II, Item 8, "Financial Statements and Supplementary Data" 
in this Annual Report on Form 10-K for additional details on the net assets acquired in the Merger. 

For the year ended December 31, 2016, our operating activities provided $109.3 million in cash flow, 
consisting of a net income of $112.6 million, adjusted for net non-operating and non-cash items of $75.9 
million primarily related to depreciation and amortization of intangible assets, changes in deferred income 
taxes, foreign currency adjustments, share-based compensation expense, and changes to the provision 
for doubtful accounts. Offsetting these increases was $79.2 million of cash used by changes in operating 
assets and liabilities, consisting primarily of an increase in billed and unbilled accounts receivable.

78

 
 
For the year ended December 31, 2015, our operating activities provided $204.7 million in cash flow, 
consisting of a net income of $117.0 million, adjusted for net non-operating and non-cash items of $79.9 
million primarily related to depreciation and amortization of intangible assets, loss on extinguishment of debt, 
share-based compensation and related tax benefits, changes in deferred income taxes, asset impairment 
charges, stock repurchase costs, amortization of capitalized loan fees, and foreign currency adjustments. In 
addition, $7.8 million of cash was provided by changes in operating assets and liabilities, consisting primarily 
of an increase in deferred revenue and accounts payables and accrued expenses, partially offset by the 
increase in billed and unbilled accounts receivable and other assets and liabilities.

Cash flows from operations increased by $88.9 million during the year ended December 31, 2017 compared 
to the year ended December 31, 2016, primarily due to an increase of $213.8 million in net non-operating and 
non-cash items and an increase in cash received from working capital of $126.2 million, partially offset by the 
decrease in net income of $251.1 million as we incurred a net loss of $138.5 million during 2017 compared to 
net income of $112.6 million in 2016. 

Cash flows from operations decreased by $95.4 million during the year ended December 31, 2016 compared 
to the year ended December 31, 2015, primarily due to the decline in cash received from working capital of 
$87.0 million and the decrease in net income of $4.4 million.

The changes in operating assets and liabilities result primarily from the net change in billed and unbilled 
accounts receivable and deferred revenue, coupled with changes in accrued liabilities. Fluctuations in billed 
and unbilled receivables and deferred revenue occur on a regular basis as we perform services, achieve 
milestones or other billing criteria, send invoices to customers and collect outstanding accounts receivable. 
This activity varies by individual customer and contract. We attempt to negotiate payment terms that provide 
for payment of services prior to or soon after the provision of services, but the levels of unbilled services and 
deferred revenue can vary significantly from period to period.

Impact of the Merger on Cash Flows from Operating Activities

As a result of the Merger with inVentiv, our operating cash might be significantly negatively affected in future 
periods. In particular, we have incurred and continue to incur substantial expenses related to the 
consummation of the Merger and subsequent integration activities that we anticipate will continue for the 
next 12 to 18 months. For example, during the year ended December 31, 2017, we incurred $123.8 million 
in transaction expenses related to the Merger of which $104.8 million has impacted our operating working 
capital cash flows in 2017 or will impact operating cash flows in the future.

In addition, as a result of the Merger, our total indebtedness (including capital leases) increased by $2.49 
billion to $2.99 billion as of December 31, 2017, of which $2.43 billion is subject to variable interest rates, as 
compared to total indebtedness of $500.0 million as of December 31, 2016. As a result, we anticipate that 
our interest expense and corresponding operating cash outflows will be significantly higher in future periods 
on a comparative basis. This additional expense will place further demand on, and might significantly 
reduce, our cash flows from operations in future periods. Our business might not continue to generate cash 
from operations in the future sufficient to service and repay our increased debt obligations.

Please refer to the “Risks Related to the Merger” and “Risks Related to Our Indebtedness” sections of 
Item 1A “Risk Factors” included in this Annual Report on Form 10-K for further information related to risks 
associated with the Merger that might negatively affect our cash flows from operations.

Cash Flows from Investing Activities

For the years ended December 31, 2017, we used $1.72 billion in cash for investing activities. In 
particular, as part of the Merger consideration and on behalf of inVentiv, we repaid $1.74 billion of 
inVentiv’s outstanding long-term debt obligations and associated accrued interest. This cash outflow was 
partially offset by $57.3 million of cash acquired as part of the Merger. In addition, our capital expenditures 
related to purchases of property and equipment used $43.9 million of cash during the period. 

79

For the years ended December 31, 2016 and 2015 we used $31.4 million, and $21.1 million, respectively, 
in cash for investing activities, comprised of the purchases of property and equipment primarily related to 
our ongoing headcount growth and investments to improve the efficiency of our operations and utilization 
of our facilities. 

We continue to closely monitor our capital expenditures while making strategic investments in the 
development of our information technology infrastructure to meet the needs of our workforce. For 2018, 
we expect our total capital expenditures to be between approximately $85.0 million to $95.0 million. This 
estimate includes expenditures associated with planned consolidation of our corporate headquarters 
facility in Morrisville, North Carolina (and providing for future expansion at this location), as well as 
expenditures related to a new site in Farnborough, United Kingdom which will replace our Camberley, 
United Kingdom location. These moves will coincide with the near-term expiration of our existing leases. 
The new Morrisville location will be our corporate headquarters and the Farnborough office will remain a 
key international location.

Cash Flows from Financing Activities

For the year ended December 31, 2017, financing activities provided $1.73 billion in cash, consisting primarily 
of net proceeds of $2.10 billion from the issuance of long-term debt under our 2017 Credit Agreement and 
proceeds of $19.3 million from the exercise of stock options. These cash inflows were partially offset by: (i) 
payments of $292.4 million related to the partial redemption of the Senior Notes assumed in the Merger, 
payments for our Senior Notes repurchased on the open market, and payments of early redemption penalties 
associated with our Senior Notes; (ii) net repayments of $25.0 million under our Revolver; and (iii) principal 
Term Loan B prepayments of $50.0 million. 

For the year ended December 31, 2016, financing activities used $53.3 million in cash, primarily driven by 
payments of $64.5 million related to the stock repurchase in August of 2016, net revolver repayments of 
$5.0 million, debt refinancing costs of $0.9 million and $0.8 million related to payments for tax withholdings 
related to employee stock option exercises. These cash outflows were partially offset by proceeds of $17.9 
million from the exercise of stock options.

For the year ended December 31, 2015, financing activities used $211.4 million in cash, primarily driven by 
payments of $285.0 million related to the stock repurchases in May and December of 2015, $3.2 million 
related to payments for tax withholdings related to employee stock option activity, stock repurchase costs of 
$1.4 million and payments of $1.0 million related to the 2014 MEK Consulting acquisition. These cash 
outflows were partially offset by net inflows of $79.6 million, consisting primarily of: (i) the proceeds of $95.0 
million from the 2015 debt refinancing and $30.0 million under our revolver; and (ii) proceeds of $3.7 million 
from the exercise of stock options, partially offset by the June 2015 prepayment of $50.0 million of debt 
principal under the 2017 Credit Agreement.

Inflation

Our long-term contracts, those in excess of one year, generally include inflation or cost of living adjustments 
for the portion of the services to be performed beyond one year from the contract date. In the event actual 
inflation rates are greater than our contractual inflation rates or cost of living adjustments, inflation could have 
a material adverse effect on our operations or financial condition.

80

Contractual Obligations and Commitments

The following table summarizes our expected material contractual obligations as of December 31, 2017 (in 
thousands):

Long-term debt

Interest on long-term debt

Noncancellable purchase commitments

Operating leases

Capital leases, including interest

Merger retention bonuses
Deferred compensation plan (a)
Contingent tax-sharing obligation 
assumed in business combinations (b)
Total

Payment Due by Period

Total

2018

2019 to 
2020

2021 to 
2022

2023 and 
thereafter

$ 2,953,000

$

25,000

$

125,000

$ 880,000

$ 1,923,000

714,749

97,493

342,312

38,761

20,666

15,900

50,480

119,990

235,796

215,008

143,955

50,570

60,671

17,526

20,666

—

22,345

39,856

97,356

19,335

—

—

—

7,067

72,173

1,900

—

—

—

—

112,112

—

—

—

28,135

$ 4,233,361

$

316,768

$

517,343

$1,176,148

$ 2,207,202

(a)  The deferred compensation plan liability is recorded in the “Other long-term liabilities” line item on the consolidated 
balance sheets. The obligations are payable upon retirement or termination of employment. We have established an 
irrevocable trust to hold assets to partially fund benefit obligations under the deferred compensation plan, but cannot 
reasonably estimate the amount or timing of payments, if any, which we will make related to this liability.

(b) Due to the uncertainties of our ability to realize certain pre-Merger transaction tax deductions, we are not able to 
estimate the timing of the assumed contingent tax-sharing obligation payments beyond one year.

The interest payments on long-term debt in the above table are based on interest rates in effect as of 
December 31, 2017. See "Note 4 - Long-Term Debt Obligations" to our consolidated financial statements 
included in Part II, Item 8, "Financial Statements and Supplementary Data" in this Annual Report on Form 10-
K for further information on the terms and conditions of our 2017 Credit Agreement.

As of December 31, 2017, we have recorded a tax liability for unrecognized tax benefits for uncertain tax 
positions of $43.7 million which has not been included in the above table due to the uncertainties in the timing 
of the settlement of the income tax positions.

In January 2018, we replaced our lease agreement for the Farnborough location with a new ten-year lease 
agreement. The new agreement provides for additional office space to accommodate our operating plans 
following the Merger and increases our future lease obligations for this location by $11.8 million which has not 
been reflected in the table above. 

We are a party to supplier contracts related to clinical services that if canceled would require payment for 
services performed and potentially additional services required to protect the safety of subjects. The value of 
these potential wind-down provisions is not practical to estimate.

Off-balance Sheet Arrangements

We do not have any off-balance sheet arrangements except for operating leases entered into in the normal 
course of business.

81

 
 
Critical Accounting Policies and Estimates

The preparation of financial statements in conformity with U.S. GAAP requires management to make 
estimates, judgments and assumptions that affect the reported amounts of assets and liabilities, revenues 
and expenses during the period, as well as disclosures of contingent assets and liabilities at the date of the 
financial statements. We evaluate our estimates on an ongoing basis, including those related to revenue 
recognition, share-based compensation, valuation of goodwill and identifiable intangibles, tax-related 
contingencies and valuation allowances, allowance for doubtful accounts, and litigation contingencies, among 
others. These estimates are based on the information available to management at the time these estimates, 
judgments and assumptions are made. Actual results may differ materially from these estimates.

Business Combinations

We account for business combinations in accordance with ASC Topic 805, Business Combinations, using the 
acquisition method of accounting. The purchase price, or total consideration transferred, is determined as the 
fair value of assets exchanged, equity instruments issued, and liabilities assumed at the acquisition date. The 
acquisition method of accounting requires that the identifiable assets acquired, the liabilities assumed, and 
any non-controlling interest in the acquiree are measured and recorded at their fair values on the date of a 
business combination. Goodwill represents the excess of the purchase price over the estimated fair value of 
the net assets acquired, including the amount assigned to identifiable intangible assets. Acquisition-related 
costs are expensed as incurred. The consolidated financial statements reflect the results of operations of the 
acquiree from the date of the acquisition. For additional information, see Part II, Item 8, "Financial Statements 
and Supplemental Data - Note 3 - Business Combinations."

Revenue Recognition

We recognize revenue when all of the following conditions are satisfied: (1) there is persuasive evidence of an 
arrangement; (2) the service offering has been delivered to the customer; (3) the collection of the fees is 
reasonably assured; and (4) the arrangement consideration is fixed or determinable. We record revenues net 
of any tax assessments by governmental authorities, such as value added taxes, that are imposed on and 
concurrent with specific revenue generating transactions. In some cases, contracts provide for consideration 
that is contingent upon the occurrence of uncertain future events. We recognize contingent revenue when the 
contingency has been resolved and all other criteria for revenue recognition have been met.

Our arrangements are primarily service contracts and historically, a majority of the net service revenue has 
been earned under contracts which range in duration from several months to several years. Most of our 
contracts can be terminated by the customer with a 30-day notice.  In the event of termination, our contracts 
often provide for fees for winding down the project, which include both fees incurred and actual expenses and 
non-cancellable expenditures and may include a fee to cover a percentage of the remaining professional fees 
on the project. We do not recognize revenue with respect to start-up activities including contract and scope 
negotiation, feasibility analysis and conflict of interest review associated with contracts. The costs for these 
activities are expensed as incurred.

We recognize revenue from our service contracts either using a fee-for-service method or proportional 
performance method. The majority of our service contracts represent a single unit of accounting. For fee-for-
service contracts, we record revenue as contractual items (i.e., “units”) are delivered to the customer, or, in 
the event the contract is time and materials based, when labor hours are incurred. We use the proportional 
performance method when the fees for a service obligation are fixed pursuant to the contractual terms. 
Revenue is recognized as services are performed and measured on a proportional performance basis, 
generally using output measures specific to the services provided. We believe the best indicator of effort 
expended to complete the performance requirement related to a contractual obligation are the actual units 
delivered to the customer or the incurrence of labor hours when no other pattern of performance exists. In the 
event we use labor hours as the basis for determining proportional performance, we estimate the number of 
hours remaining to complete our service obligation. Actual hours incurred to complete the service requirement 
may differ from our estimate, and any differences are accounted for prospectively. Examples of output 
measures used by us are site or investigator recruitment, patient enrollment, data management, or other 
deliverables common to our Clinical Solutions segment. 

82

We enter into multiple element arrangements in which we are engaged to provide multiple services under one 
agreement. In such arrangements, we record revenue as each separate service, or element, is delivered to 
the customer. Such arrangements reside predominantly within our Commercial Solutions segment where we 
are engaged to provide recruiting, deployment, and detailing services. These services may be sold 
individually or in combination with contractual fees based on fixed fees for each element, variable fees for 
each element, or a combination of both. For the arrangements that include multiple elements, arrangement 
consideration is allocated at inception to units of accounting based on the relative selling price. The best 
evidence of selling price of a unit of accounting is vendor-specific objective evidence (“VSOE”), which is the 
price charged when the deliverable is sold separately. When VSOE is not available to determine selling price, 
relevant third-party evidence (“TPE”) of selling price is used, if available. When neither VSOE nor TPE of 
selling price exists, the best estimate of selling price is used, which generally consists of an expected margin 
on the cost of services.

Changes in the scope of work are common, especially under long-term contracts, and generally result in a 
renegotiation of future contract pricing terms and change in contract value. If the customer does not agree to 
contract modification, we could bear the risk of cost overruns. Renegotiated amounts are not included in net 
revenues until written authorization is received, the amount is earned and realization is assured.

We offer volume rebates to our large customers based on annual volume thresholds. We record an estimate 
of the annual volume rebate as a reduction of revenue throughout the period based on the estimated total 
rebate to be earned for the period.

Billed and Unbilled Accounts Receivable

Accounts receivable are recorded at net realizable value. Unbilled accounts receivable arise when services 
have been rendered for which revenue has been recognized but the customers have not been billed. In 
general, prerequisites for billings and payments are established by contractual provisions, including 
predetermined payment schedules, which may or may not correspond to the timing of the performance of 
services under the contract.

Deferred Revenue

Deferred revenue represents receipts of payments from customers in advance of services being provided and 
the related revenue being earned or reimbursable expenses being incurred. As the contracted services are 
subsequently performed and the associated revenue is recognized, the deferred revenue balance is reduced 
by the amount of the revenue recognized during the period.

Under certain contracts, we are entitled to additional compensation if performance-based criteria are 
achieved. Because there is substantive uncertainty regarding the ability to realize such amounts at the onset 
of the arrangements, we do not recognize such revenues until it has met the performance-based criteria and 
other revenue recognition criteria described above.

Allowance for Doubtful Accounts

We maintain a credit approval process and make judgments in connection with assessing our customers' 
ability to pay throughout the contractual obligation. Despite this assessment, from time to time, customers are 
unable to meet their payment obligations. We monitor customers' credit worthiness and apply judgment in 
establishing a provision for estimated credit losses based on historical experience, current receivables aging, 
and identified customer-specific circumstances that would affect the customers' ability to meet their 
obligations.

Goodwill and Intangible Assets

In January 2017, the FASB issued ASU No. 2017-04, Intangibles - Goodwill and Other (Topic 350): 
Simplifying the Test for Goodwill Impairment, which eliminates the second step of the previous FASB 
guidance for testing goodwill for impairment and is intended to reduce cost and complexity of goodwill 
impairment testing. The amendments in this ASU modify the concept of impairment from the condition that 
exists when the carrying amount of goodwill exceeds its implied fair value to the condition that exists when the 

83

carrying amount of a reporting unit exceeds its fair value. After determining if the carrying amount of a 
reporting unit exceeds its fair value, the entity should take an impairment charge of the same amount to the 
goodwill for that reporting unit, not to exceed the total goodwill amount for that reporting unit. This eliminates 
the second step of calculating the implied fair value of goodwill by assigning the fair value of a reporting unit 
to all of its assets and liabilities as if that reporting unit had been acquired in a business combination. ASU 
2017-04 is effective for annual periods beginning after December 15, 2019, including interim periods within 
those annual periods. Early adoption is permitted for interim or annual goodwill impairment tests performed on 
testing dates after January 1, 2017. We have elected to early adopt this standard effective January 1, 2017.

Goodwill represents the excess of purchase price over the estimated fair value of net assets acquired, 
including the amount assigned to identifiable intangible assets, in business combinations. In accordance with 
ASC Topic 350, Intangibles - Goodwill and Other, goodwill is not subject to amortization but must be tested for 
impairment annually or more frequently if events or changes in circumstances indicate that goodwill might be 
impaired. Goodwill is tested for impairment at the reporting unit level, which is one level below the operating 
segment level. This test requires us to determine if the implied fair value of the reporting unit's goodwill is less 
than its carrying amount. 

We completed our annual impairment test for potential impairment as of October 1, 2017 for all of its reporting 
units, determining that there were no impairments. As of October 1, 2017 and December 31, 2017, we 
assigned goodwill to five reporting units. Our goodwill is principally related to the Merger completed in August 
2017. 

Intangible assets consist of backlog, customer relationships, and trademarks. We amortize intangible assets 
related to customer relationships and trademarks on a straight-line basis over the estimated useful life of the 
asset. Intangible assets related to backlog are amortized based on our expectations of when revenue 
associated with the backlog is expected to be earned. 

We review intangible assets at the end of each reporting period to determine if facts and circumstances 
indicate that the useful life is shorter than originally estimated or that the carrying amount of the assets might 
not be recoverable. If such facts and circumstances exist, we assess the recoverability of identified assets by 
comparing the projected undiscounted net cash flows associated with the related asset or group of assets 
over their remaining lives to their respective carrying amounts. Impairments, if any, are based on the excess 
of the carrying amount over the fair value of those assets and occur in the period in which the impairment 
determination was made.

Share-Based Compensation

We measure and recognize compensation expense related to all share-based awards based on the estimated 
fair value of the awards. The fair value of restricted stock and stock unit awards is measured on the grant date 
based on the fair market value of our common stock. The fair value of stock option awards and Employee 
Stock Purchase Plan ("ESPP") awards is estimated on the grant date using the Black-Scholes option-pricing 
model and is affected by our stock price and a number of highly complex and subjective assumptions. These 
assumptions include, but are not limited to, the following:

Expected Term - Given our limited history with employee share-based awards, we do not have 
sufficient company-specific information related to the life of the awards. As permitted by the SEC Staff, 
we estimate expected term using the "simplified" method which represents the average of the time-to-
vest and the contractual life of the options. 

Expected Volatility - Beginning in 2017, expected volatility of our stock price is estimated based on (i) 
the historical volatility of our stock for periods in which we have sufficient information, or (ii) the simple 
average of the historical stock volatilities of several comparable publicly traded companies from the 
CRO industry for periods for which we do not have sufficient information. Prior to 2017, due to the 
limited trading history of our stock, the expected volatility estimate was based solely on the historical 
stock volatilities of comparable publicly traded companies.

84

Risk-Free Interest Rate - The risk-free interest rate is based on the yield in effect at the time of grant 
for United States Treasury zero-coupon notes with maturities approximating each grant's expected 
term.

Expected Dividend Yield - We have not paid and do not anticipate paying cash dividends on our 
common stock; therefore, the expected dividend yield is assumed to be zero. 

Share-based compensation expense is recognized on a straight-line basis over the shorter of the requisite 
service period or the vesting term. For awards with performance conditions, stock-based compensation 
expense is recognized when the achievement of each individual performance target becomes probable, and 
the number of shares expected to vest is adjusted for the weighted probability of attainment of the relevant 
performance targets.

In March 2016, the FASB issued ASU No. 2016-09, Compensation - Stock Compensation: Improvements to 
Employee Share-Based Payment Accounting. In accordance with the guidance, the Company elected to early 
adopt this ASU effective in the first quarter of 2016. The following summarizes the changes made as a result 
of this adoption:

• 

Income taxes - All excess tax benefits and tax deficiencies (including tax benefits of dividends on 
share-based payment awards) are recognized as income tax expense or benefit in the statement of 
operations. The tax effects of exercised or vested awards are treated as discrete items in the 
reporting period in which they occur. We also recognize excess tax benefits regardless of whether the 
benefit reduces taxes payable in the current period. 

•  Forfeitures - Prior to adoption, share-based compensation expense was recognized on a straight line 
basis, net of estimated forfeitures, such that expense was recognized only for share-based awards 
that are expected to vest. A forfeiture rate was estimated annually and revised, if necessary, in 
subsequent periods if actual forfeitures differed from initial estimates. Upon adoption, we no longer 
apply a forfeiture rate and instead account for forfeitures as they occur. 

•  Statements of Cash Flows - We historically accounted for excess tax benefits on the consolidated 

statement of cash flows as a financing activity.  Upon adoption of this standard, excess tax benefits 
are classified along with other income tax cash flows as an operating activity. 

•  Earnings Per Share - We use the treasury stock method to compute diluted earnings per share, 

unless the effect would be anti-dilutive. Under this method, we are no longer required to estimate the 
tax rate and apply it to the dilutive share calculation for determining the dilutive earnings per share. 

See "Note 1 - Basis of Presentation and Summary of Significant Accounting Policies" to our consolidated 
financial statements included in Part II, Item 8, "Financial Statements and Supplementary Data" in this Annual 
Report on Form 10-K for further information on the impact of this adoption.

Income Taxes

We and our U.S. subsidiaries file a consolidated U.S. federal income tax return. Our other subsidiaries file tax 
returns in their local jurisdictions.

We provide for income taxes on all transactions that have been recognized in the consolidated financial 
statements. Specifically, we estimate our tax liability based on current tax laws in the statutory jurisdictions in 
which we operate. 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. We record 
deferred tax assets and liabilities based on temporary differences between the financial statement and tax 
bases of assets and liabilities and for tax benefit carryforwards using enacted tax rates in effect in the year in 
which the differences are expected to reverse. 

We provide valuation allowances against deferred tax assets for amounts that are not considered more likely 
than not to be realized. The valuation of the deferred tax asset is dependent on, among other things, our 
ability to generate a sufficient level of future taxable income. In estimating future taxable income, we have 
considered both positive and negative evidence, such as historical and forecasted results of operations, and 

85

have considered the implementation of prudent and feasible tax planning strategies. If the objectively 
verifiable negative evidence outweighs any available positive evidence (or the only available positive is 
subjective and cannot be verified), then a valuation allowance will likely be deemed necessary. If a valuation 
allowance is deemed to be unnecessary, such allowance is released and any related benefit is recognized in 
the period of the change.

We recognize a tax benefit from an uncertain tax position only if we believe it is more likely than not to be 
sustained upon examination based on the technical merits of the position. Judgment is required in 
determining what constitutes an individual tax position, as well as the assessment of the outcome of each tax 
position. We consider many factors when evaluating and estimating tax positions and tax benefits. In addition, 
the calculation of tax liabilities involves dealing with uncertainties in the application of complex tax regulations 
in domestic and foreign jurisdictions. The amount of the accrual for which an exposure exists is measured as 
the largest amount of benefit determined on a cumulative probability basis that we believe is more likely than 
not to be realized upon ultimate settlement of the position. If the calculation of liability related to uncertain tax 
positions proves to be more or less than the ultimate assessment, a tax expense or benefit, respectively, 
would result. Unrecognized tax benefits, or a portion of unrecognized tax benefits, are presented as a 
reduction to a deferred tax asset for a NOL carryforward, a similar tax loss, or a tax credit carryforward. 

As a result of the tax reform and the new GILTI and BEAT provisions under the Tax Act, we believe there is a 
reasonable possibility that within the next 12 to 24 months, sufficient positive evidence may become available 
to allow the Company to reach a conclusion that a significant portion of the valuation allowance will no longer 
be needed. Consequently, such release of the valuation allowance would result in the recognition of certain 
deferred tax assets and a decrease to the income tax expense in the period that the release is recorded. 

Recently Issued Accounting Standards

For a description of recently issued accounting pronouncements, including the expected dates of adoption 
and the estimated effects, if any, on our consolidated financial statements, see "Note 1 - Basis of Presentation 
and Changes in Significant Accounting Policies" to our consolidated financial statements in Part II, Item 8, 
"Financial Statements and Supplementary Data" in this Annual Report on Form 10-K.

86

Item 7A. Quantitative and Qualitative Disclosures About Market Risk.

Market risk is the potential loss arising from adverse changes in market rates and prices, such as foreign 
currency exchange rates, interest rates and other relevant market rate or price changes. In the ordinary 
course of business, we are exposed to various market risks, including changes in foreign currency exchange 
rates and interest rates, and we regularly evaluate our exposure to such changes. Our overall risk 
management strategy seeks to balance the magnitude of the exposure and the cost and availability of 
appropriate financial instruments. From time to time, we have utilized forward exchange contracts to manage 
our foreign currency exchange rate and interest rate risk.

Foreign Currency Exchange Rates

Approximately 17%, 21% and 25% of our net service revenues for the years ended December 31, 2017, 2016 
and 2015, respectively, were denominated in currencies other than the U.S. dollar. Our financial statements 
are reported in U.S. dollars and, accordingly, fluctuations in exchange rates will affect the translation of our 
revenues and expenses denominated in foreign currencies into U.S. dollars for purposes of reporting our 
consolidated financial results. During 2017, 2016 and 2015, the most significant currency exchange rate 
exposures were the Euro, British Pound, Canadian Dollar, and Japanese Yen. A hypothetical change of 10% 
in average exchange rates used to translate all foreign currencies to U.S. dollars would have impacted 
income before income taxes for 2017 by approximately $22.5 million. The impact of this could be partially 
offset by exchange rate fluctuation provisions stated in some of our contracts with customers designed to 
mitigate our exposure to fluctuations in currency exchange rates over the life of the contract. For example 
during the year ended December 31, 2017, our revenue was reduced by $8.0 million to reflect the reduced 
operating costs required to fulfill the contracts as a result of the fluctuations in foreign currency exchange 
rates. We do not have significant operations in countries in which the economy is considered to be highly 
inflationary.

We are subject to foreign currency transaction risk for fluctuations in exchange rates during the period of time 
between the consummation and cash settlement of a transaction. Accordingly, exchange rate fluctuations 
during this period may affect our profitability with respect to such contracts. We are able to partially offset our 
foreign currency transaction risk through exchange rate fluctuation adjustment provisions stated in our 
contracts with customers, or we may hedge our transaction risk with foreign currency exchange contracts.

Interest Rates

We are subject to market risk associated with changes in interest rates. At December 31, 2017 and 2016, we 
had $2.99 billion and $500.0 million, respectively, of total principal indebtedness (including $36.8 million of 
capital leases), of which $2.43 billion and $241.7 million, was subject to variable interest rates. Each quarter-
point increase or decrease in the applicable interest rate at December 31, 2017 and 2016 would change our 
annual interest expense by approximately $6.1 million and $0.6 million, respectively.

87

Item 8. Financial Statements and Supplementary Data.

Index to Consolidated Financial Statements

Reports of Independent Registered Public Accounting Firms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Consolidated Statements of Operations for the years ended December 31, 2017, 2016 and 2015 . . . . . . . . . . . .

Consolidated Statements of Comprehensive (Loss) Income for the years ended December 31, 2017, 2016 and 
2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Consolidated Balance Sheets as of December 31, 2017 and 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Consolidated Statements of Cash Flows for the years ended December 31, 2017, 2016 and 2015. . . . . . . . . . . .

Consolidated Statements of Shareholders' Equity for the years ended December 31, 2017, 2016 and 2015 . . . .

Notes to Consolidated Financial Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page

89

92

93

94

95

97

98

88

REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM 

To the shareholders and the Board of Directors of Syneos Health, Inc. 

Opinion on the Financial Statements 

We have audited the accompanying consolidated balance sheets of Syneos Health, Inc. (formerly INC 
Research Holdings, Inc.) and subsidiaries (the "Company") as of December 31, 2017 and 2016, the related 
consolidated statements of operations, comprehensive (loss) income, shareholders’ equity, and cash flows, 
for each of the two years in the period ended December 31, 2017, and the related notes (collectively referred 
to as the "financial statements"). In our opinion, the financial statements present fairly, in all material respects, 
the financial position of the Company as of December 31, 2017 and 2016, and the results of its operations 
and its cash flows for the two years then ended, in conformity with accounting principles generally accepted in 
the United States of America.

We have also audited, in accordance with the standards of the Public Company Accounting Oversight Board 
(United States) (PCAOB), the Company's internal control over financial reporting as of December 31, 2017, 
based on criteria established in Internal Control - Integrated Framework (2013) issued by the Committee of 
Sponsoring Organizations of the Treadway Commission and our report dated February 28, 2018, expressed 
an unqualified opinion on the Company's internal control over financial reporting. 

Basis for Opinion 

These financial statements are the responsibility of the Company's management. Our responsibility is to 
express an opinion on the Company's financial statements based on our audits. We are a public accounting 
firm registered with the PCAOB and are required to be independent with respect to the Company in 
accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and 
Exchange Commission and the PCAOB.

We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we 
plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of 
material misstatement, whether due to error or fraud. Our audits included performing procedures to assess 
the risks of material misstatement of the financial statements, whether due to error or fraud, and performing 
procedures that respond to those risks. Such procedures included examining, on a test basis, evidence 
regarding the amounts and disclosures in the financial statements. Our audits also included evaluating the 
accounting principles used and significant estimates made by management, as well as evaluating the overall 
presentation of the financial statements. We believe that our audits provide a reasonable basis for our 
opinion.

/s/ Deloitte & Touche LLP
Raleigh, North Carolina
February 28, 2018

We have served as the Company's auditor since 2016.

89

REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM 

To the shareholders and the Board of Directors of Syneos Health, Inc. 

Opinion on Internal Control over Financial Reporting 

We have audited the internal control over financial reporting of Syneos Health, Inc. (formerly INC Research Holdings, Inc.) 
and subsidiaries (the “Company”) as of December 31, 2017, based on criteria established in Internal Control - Integrated 
Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). In our 
opinion, the Company maintained, in all material respects, effective internal control over financial reporting as of 
December 31, 2017, based on criteria established in Internal Control - Integrated Framework (2013) issued by COSO. 

We have also audited, in accordance with the standards of the Public Company Accounting Oversight Board (United 
States) (PCAOB), the consolidated financial statements as of and for the year ended December 31, 2017, of the 
Company and our report dated February 28, 2018, expressed an unqualified opinion on those financial statements. 

As described in Management’s Annual Report on Internal Control Over Financial Reporting, management excluded from 
its assessment the internal control over financial reporting at Double Eagle Parent, Inc. (“inVentiv”), which was acquired 
on August 1, 2017, and whose financial statements constitute 30% of total assets (excluding goodwill which was included 
in management’s assessment of internal control over financial reporting as of December 31, 2017), and 41% of total 
revenues of the consolidated financial statement amounts as of and for the year ended December 31, 2017. Accordingly, 
our audit did not include the internal control over financial reporting at inVentiv.

Basis for Opinion 

The Company’s management is responsible for maintaining effective internal control over financial reporting and for its 
assessment of the effectiveness of internal control over financial reporting, included in the accompanying Management’s 
Annual Report on Internal Control Over Financial Reporting. Our responsibility is to express an opinion on the Company’s 
internal control over financial reporting based on our audit. We are a public accounting firm registered with the PCAOB 
and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and 
the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.

We conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and 
perform the audit to obtain reasonable assurance about whether effective internal control over financial reporting was 
maintained in all material respects. Our audit included obtaining an understanding of internal control over financial 
reporting, assessing the risk that a material weakness exists, testing and evaluating the design and operating 
effectiveness of internal control based on the assessed risk, and performing such other procedures as we considered 
necessary in the circumstances. We believe that our audit provides a reasonable basis for our opinion. 

Definition and Limitations of Internal Control over Financial Reporting 

A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the 
reliability of financial reporting and the preparation of financial statements for external purposes in accordance with 
generally accepted accounting principles. A company’s internal control over financial reporting includes those policies and 
procedures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the 
transactions and dispositions of the assets of the company; (2) provide reasonable assurance that transactions are 
recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting 
principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of 
management and directors of the company; and (3) provide reasonable assurance regarding prevention or timely 
detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the 
financial statements. 

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, 
projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become 
inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may 
deteriorate. 

/s/ Deloitte & Touche LLP
Raleigh, North Carolina
February 28, 2018

90

Report of Independent Registered Public Accounting Firm

The Board of Directors and Shareholders of Syneos Health, Inc.

We  have  audited  the  accompanying  consolidated  statements  of  operations,  comprehensive  (loss)  income, 
shareholders' equity, and cash flows of Syneos Health Inc. (formerly INC Research Holdings, Inc.) for the year 
ended December 31, 2015. These financial statements are the responsibility of the Company's management. 
Our responsibility is to express an opinion on these financial statements based on our audit.

We conducted our audit in accordance with the standards of the Public Company Accounting Oversight Board 
(United States). Those standards require that we plan and perform the audit to obtain reasonable assurance 
about whether the financial statements are free of material misstatement. An audit includes examining, on a test 
basis,  evidence  supporting  the  amounts  and  disclosures  in  the  financial  statements. An  audit  also  includes 
assessing the accounting principles used and significant estimates made by management, as well as evaluating 
the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion.

In our opinion, the financial statements referred to above present fairly, in all material respects, the consolidated 
results of operations and cash flows of Syneos Health, Inc. for year ended December 31, 2015, in conformity 
with U.S. generally accepted accounting principles.

/s/ Ernst & Young LLP
Raleigh, North Carolina
February 24, 2016

except for the effects of the operating segments changes discussed in Note 1 and Note 14 and the changes 
to the net service revenues by geographic location as discussed in Note 15 as to which the date is 

February 28, 2018

91

SYNEOS HEALTH, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF OPERATIONS

Net service revenue

Reimbursable out-of-pocket expenses

Total revenue

Costs and operating expenses:

Year Ended December 31,

2017

2016

2015

(in thousands, except per share data)

$

1,852,843

$

1,030,337

$

819,221

580,259

914,740

484,499

2,672,064

1,610,596

1,399,239

Direct costs (exclusive of depreciation and amortization)

1,232,023

Reimbursable out-of-pocket expenses

Selling, general, and administrative

Restructuring and other costs

Transaction and integration-related expenses

Asset impairment charges

Depreciation

Amortization

Total operating expenses

(Loss) income from operations

Other (expense) income, net:

Interest income

Interest expense

Loss on extinguishment of debt

Other (expense) income, net

Total other expense, net

(Loss) income before provision for income taxes

Income tax benefit (expense)

Net (loss) income

Earnings per share attributable to common shareholders:

Basic

Diluted

Weighted average common shares outstanding:

Basic

Diluted

819,221

282,620

33,315

123,815

30,000

44,407

135,529

626,633

580,259

172,386

13,612

3,143

—

21,353

37,851

542,404

484,499

156,609

1,785

1,637

3,931

18,140

37,874

2,700,930

1,455,237

1,246,879

(28,866)

155,359

152,360

1,182

(63,725)

(622)

(19,846)

(83,011)

(111,877)

(26,592)

216

(12,016)

(439)

(9,002)

(21,241)

134,118

(21,488)

192

(15,640)

(9,795)

3,857

(21,386)

130,974

(13,927)

(138,469) $

112,630

$

117,047

(1.85) $

(1.85) $

2.08

2.03

$

$

74,913

74,913

54,031

55,610

2.02

1.95

57,888

60,146

$

$

$

The accompanying notes are an integral part of these consolidated financial statements.

92

 
 
 
 
 
SYNEOS HEALTH, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF COMPREHENSIVE (LOSS) INCOME

Year Ended December 31,

2017

2016

2015

(in thousands)

Net (loss) income

$

(138,469) $

112,630

$

117,047

Unrealized gain on derivative instruments, net of income tax benefit 
(expense) of $10, $(707), and $0, respectively

Foreign currency translation adjustments, net of income tax 
(expense) of $(9,005), $0, and $0, respectively

Comprehensive (loss) income

23

1,106

—

19,842

(1,813)

(15,343)

$

(118,604) $

111,923

$

101,704

The accompanying notes are an integral part of these consolidated financial statements.

93

 
 
SYNEOS HEALTH, INC. AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEETS

ASSETS

Current assets:

Cash and cash equivalents

Restricted cash

Accounts receivable billed, net

Accounts receivable unbilled

Prepaid expenses and other current assets

Total current assets

Property and equipment, net

Goodwill

Intangible assets, net

Deferred income tax assets

Other long-term assets

Total assets

LIABILITIES AND SHAREHOLDERS' EQUITY

Current liabilities:

Accounts payable

Accrued liabilities

Deferred revenue

Current portion of capital lease obligations

Current portion of long-term debt

Total current liabilities

Capital lease obligations, non-current

Long-term debt, non-current

Deferred income tax liabilities

Other long-term liabilities

Total liabilities

Commitments and contingencies (Note 18)

Shareholders' equity:

December 31,

2017

2016

(in thousands, except share data)

$

321,262

$

102,471

714

642,985

373,003

84,215

1,422,179

180,412

4,292,571

1,286,050

20,159

84,496

607

211,476

173,873

34,202

522,629

58,306

552,502

114,486

14,726

25,858

$

7,285,867

$

1,288,507

$

58,575

$

500,303

559,270

16,414

25,000

1,159,562

20,376

2,945,934

37,807

99,609

23,693

153,559

277,600

—

11,875

466,727

—

485,849

8,295

26,163

$

4,263,288

$

987,034

Preferred stock, $0.01 par value; 30,000,000 shares authorized, 0 shares issued 
and outstanding at December 31, 2017 and 2016, respectively

—

Common stock, $0.01 par value; 600,000,000 shares authorized, 104,435,501 
and 53,762,786 shares issued and outstanding at December 31, 2017 and 2016, 
respectively

Additional paid-in capital

Accumulated other comprehensive loss, net of tax

Accumulated deficit

Total shareholders' equity

1,044

3,414,389

(22,385)

(370,469)

3,022,579

—

538

573,176

(42,250)

(229,991)

301,473

Total liabilities and shareholders' equity

$

7,285,867

$

1,288,507

The accompanying notes are an integral part of these consolidated financial statements.

94

 
 
 
 
 
 
 
 
 
 
 
 
SYNEOS HEALTH, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS

Year Ended December 31,

2017

2016

2015

(in thousands)

$

(138,469) $

112,630

$

117,047

59,204

—

972

14,020

2,570

(22,260)

20,681

—

—

439

—

286

56,014

1,637

1,346

5,074

(144)

4,134

(795)

3,931

—

9,795

(975)

(82)

(103,748)

(54,073)

6,658

4,060

13,820

109,332

—

(31,353)

—

8,186

68,500

(14,855)

204,740

—

(21,111)

—
(21,111)   

Cash flows from operating activities:

Net (loss) income

Adjustments to reconcile net (loss) income to net cash provided by 
operating activities:

Depreciation and amortization

Stock repurchase costs

Amortization of capitalized loan fees and original issue discount, net 
of Senior Notes premium

Share-based compensation

Provision for (recovery of) doubtful accounts

Provision for (benefit from) deferred income taxes

Foreign currency transaction losses

Asset impairment charges

Fair value adjustment of contingent tax-sharing obligation

Loss on extinguishment of debt

Excess income tax benefits from share-based awards

Other non-cash items

Changes in operating assets and liabilities, net of effect of business 
combinations:

Billed and unbilled accounts receivable

Accounts payable and accrued expenses

Deferred revenue

Other assets and liabilities

Net cash provided by operating activities

179,936

—

500

59,696

4,167

14,431

7,912

30,000

(12,276)

622

—

4,712

31,656

(16,982)

28,967

3,386

198,258

Cash flows from investing activities:

Payments associated with business acquisitions, net of cash acquired

(1,678,814)

Purchases of property and equipment

Other, net

(43,896)

(197)

Net cash used in investing activities

$ (1,722,907) $

(31,353) $

The accompanying notes are an integral part of these consolidated financial statements.

95

 
 
 
 
 
 
 
 
 
 
 
 
 
 
SYNEOS HEALTH, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
 (Continued)

Cash flows from financing activities:

Proceeds from issuance of long-term debt

Payments of debt financing costs

Repayments of long-term debt

Proceeds from revolving line of credit

Repayments of revolving line of credit

Redemption of Senior Notes and associated breakage fees

Payments of contingent consideration related to business combinations

Payments of capital leases

Payments of stock repurchase costs

Payments for repurchase of common stock

Proceeds from exercise of stock options

Payments related to tax withholding for share-based compensation

Excess income tax benefits from share-based awards

Year Ended December 31,

2017

2016

2015

(in thousands)

$

2,598,000

$

— $

525,000

(25,476)

(525,097)

15,000

(40,000)

(292,425)

—

(8,145)

—

—

19,335

(6,824)

—

(868)

—

100,000

(105,000)

—

—

—

—

(64,500)

17,891

(839)

—

(4,987)

(475,001)

45,000

(15,000)

—

(973)

(452)

(1,423)

(285,000)

3,656

(3,194)

975

Net cash provided by (used in) financing activities

1,734,368

(53,316)

(211,399)

Effect of exchange rate changes on cash and cash equivalents

Net change in cash and cash equivalents

Cash and cash equivalents, beginning of period

9,072

218,791

102,471

(7,203)

17,460

85,011

Cash and cash equivalents, end of period

$

321,262

$

102,471

$

(13,672)

(41,442)

126,453

85,011

Supplemental disclosure of cash flow information

Cash paid for income taxes

Cash paid for interest

Supplemental disclosure of noncash investing and financing 
activities

$

13,300

$

24,337

$

64,949

11,627

8,251

17,533

Fair value of shares issued and share-based awards assumed in 
business combinations

$

2,769,471

$

— $

Purchases of property and equipment included in liabilities

Vehicles acquired through capital lease agreements

14,801

8,730

7,157

—

—

2,869

—

The accompanying notes are an integral part of these consolidated financial statements.

96

 
 
 
 
 
 
SYNEOS HEALTH, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF SHAREHOLDERS' EQUITY

Common Stock

Shares

Amount

Additional
Paid-in
Capital

Accumulated
Other
Comprehensive
(Loss) Income

(in thousands)

Accumulated
Deficit

Total
Shareholders'
Equity

Balance at December 31, 2014

61,234

$

612

$

634,946

$

(26,200) $

(217,149) $

392,209

Stock repurchase

(8,054)

(80)

(83,550)

(201,370)

(285,000)

Stock option exercises net of shares 
for tax withholding
Stock option exercises

Share-based compensation

Income tax benefit from share-
based award activities
Net income

Foreign currency translation 
adjustment

Balance at December 31, 2015

Impact to Retained Earnings from 
adoption of ASU 2016-09
Balance at January 1, 2016

Stock repurchase

RSU distributions net of shares for 
tax withholding

Stock option exercises

Share-based compensation

Net income

Unrealized gain on derivative 
instruments, net of tax expense of 
($707)

Foreign currency translation 
adjustment

Balance at December 31, 2016

Impact to Retained Earnings from 
adoption of ASU 2016-16

Balance at January 1, 2017

Issuance of common stock 
associated with business 
combinations

RSU distributions net of shares for 
tax withholding

Stock option exercises

Share-based compensation

Net loss

Unrealized gain on derivative 
instruments, net of tax benefit of $10

Foreign currency translation 
adjustment, net of tax expense of 
($9,005)

156

535

—

—

—

—

53,871

—

53,871

(1,500)

33

1,359

—

—

—

—

53,763

—

53,763

2

5

—

—

—

—

539

—

539

(15)

—

14

—

—

—

—

538

—

538

(3,196)

5,661

5,074

975

—

—

559,910

—

559,910

(15,782)

(839)

15,867

14,020

—

—

—

573,176

—

573,176

—

—

—

—

—

—

(15,343)

(41,543)

—

(41,543)

—

—

—

—

—

1,106

(1,813)

(42,250)

—

—

—

—

117,047

—

(301,472)

7,554

(293,918)

(48,703)

—

—

—

112,630

—

—

(229,991)

—

(2,009)

(42,250)

(232,000)

(3,194)

5,666

5,074

975

117,047

(15,343)

217,434

7,554

224,988

(64,500)

(839)

15,881

14,020

112,630

1,106

(1,813)

301,473

(2,009)

299,464

49,297

493

2,768,978

198

1,178

—

—

—

—

2

11

—

—

—

—

(6,826)

19,365

59,696

—

—

—

—

—

—

—

—

23

19,842

—

—

—

—

2,769,471

(6,824)

19,376

59,696

(138,469)

(138,469)

—

—

23

19,842

Balance at December 31, 2017

104,436

$ 1,044

$ 3,414,389

$

(22,385) $

(370,469) $

3,022,579

The accompanying notes are an integral part of these consolidated financial statements.

97

 
 
Syneos Health, Inc. and Subsidiaries
Notes to Consolidated Financial Statements

1. Basis of Presentation and Summary of Significant Accounting Policies

Principal Business

Syneos Health, Inc. (the “Company”) is a global end-to-end outsourcing biopharmaceutical solutions 
organization. The Company operates under two reportable segments, Clinical Solutions and Commercial 
Solutions, and derives its revenue through a suite of services designed to enhance its customers’ ability to 
successfully develop, launch, and market their products. The Company offers its solutions on both a 
standalone and integrated basis with biopharmaceutical development and commercialization services ranging 
from Phase I-IV clinical trial services to services associated with the commercialization of biopharmaceutical 
products. The Company’s customers include small, mid-sized, and large companies in the pharmaceutical, 
biotechnology, and medical device industries. 

Organization

On August 13, 2010, the Company was incorporated in the State of Delaware for the purpose of acquiring the 
outstanding equity of INC Research, Inc. through INC Research Intermediate, LLC, ("INC Intermediate") a 
wholly-owned subsidiary of the Company. On November 7, 2014, in conjunction with the initial public offering 
("IPO"), the Company effected a corporate reorganization, whereby INC Intermediate was merged with and 
into the Company. On August 1, 2017, the Company completed the merger (the “Merger”) with Double Eagle 
Parent, Inc. (“inVentiv”), the parent company of inVentiv Health, Inc. Upon closing, inVentiv was merged with 
and into the Company, with the Company continuing as the surviving corporation. Following the Merger, the 
Company amended and restated its certificate of incorporation to change its name from “INC Research 
Holdings, Inc.” to “Syneos Health, Inc.” effective as of January 4, 2018. Beginning August 1, 2017, inVentiv’s 
results of operations are included in the accompanying audited consolidated financial statements. For 
additional information related to the Merger, see "Note 3 - Business Combinations." 

Principles of Consolidation

The accompanying consolidated financial statements have been prepared in accordance with accounting 
principles generally accepted in the United States of America ("U.S. GAAP"), and include the accounts and 
results of operations of the Company and its controlled subsidiaries. All intercompany balances and 
transactions have been eliminated. 

Use of Estimates

The preparation of the consolidated financial statements in conformity with U.S. GAAP requires management 
to make estimates and assumptions. These estimates and assumptions affect the reported amounts of assets 
and liabilities and the disclosures of contingent assets and liabilities as of the date of the financial statements, 
and the reported amounts of revenue and expenses for the periods presented in the financial statements. 
Examples of estimates and assumptions include, but are not limited to, determining the fair value of goodwill 
and intangible assets and their potential impairment, useful lives of tangible and intangible assets, useful lives 
of assets subject to capital leases, allowances for doubtful accounts, potential future outcomes of events for 
which income tax consequences have been recognized in the Company’s consolidated financial statements 
or tax returns, valuation of allowances for deferred tax assets, fair value of share-based compensation and its 
recognition period, claims and insurance accruals, loss contingencies, fair value of derivative instruments and 
related hedge effectiveness, fair value of contingent tax sharing obligations, and judgments related to revenue 
recognition, among others. In addition, estimates and assumptions are used in the accounting for the Merger 
and other business combinations, including the fair value and useful lives of acquired tangible and intangible 
assets and the fair value of assumed liabilities.

The Company evaluates its estimates and assumptions on an ongoing basis and bases its estimates on 
historical experience, current and expected future conditions, third-party evaluations, and various other 
assumptions that management believes are reasonable under the circumstances based on the information 
available to management at the time these estimates and assumptions are made. Actual results and 
outcomes may differ materially from these estimates and assumptions.

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Business Combinations

The Company accounts for business combinations in accordance with ASC Topic 805, Business 
Combinations, using the acquisition method of accounting. The purchase price, or total consideration 
transferred, is determined as the fair value of assets exchanged, equity instruments issued, and liabilities 
assumed at the acquisition date. The acquisition method of accounting requires that the identifiable assets 
acquired, the liabilities assumed, and any non-controlling interest in the acquiree are measured and recorded 
at their fair values on the date of a business combination. Goodwill represents the excess of the purchase 
price over the estimated fair value of the net assets acquired, including the amount assigned to identifiable 
intangible assets. Acquisition-related costs are expensed as incurred. The audited consolidated financial 
statements reflect the results of operations of the acquiree from the date of the acquisition. For additional 
information, see "Note 3 - Business Combinations."

Segment Information

The Company discloses financial information concerning its operating segments in accordance with ASC 
Topic 280, Segment Reporting, which requires segmentation based on the Company's internal organization 
and reporting of revenues and operating income based upon internal accounting methods commonly referred 
to as the "management approach." Operating segments are defined as components of an enterprise about 
which separate financial information is available. This information is evaluated regularly by the Chief 
Operating Decision Maker (“CODM”) or decision-making group, in deciding how to allocate resources and in 
assessing performance. The Company's CODM is its Chief Executive Officer (“CEO”). 

During the third quarter of 2017, the Company realigned its operating segments as a result of the Merger with 
inVentiv to reflect the current structure under which performance is evaluated, strategic decisions are made, 
and resources are allocated. As a result of this realignment, effective August 1, 2017, the Company began 
evaluating its financial performance based on two reportable segments, Clinical Solutions and Commercial 
Solutions (see "Note 14 - Segment Information" for further information). The Company has reflected this 
change to its segment information retrospectively to the earliest period presented. Amounts of net service 
revenue, direct costs, and contribution margin transferred between segments as a result of this change were 
immaterial. In addition, this change resulted in the reclassification of gross goodwill and accumulated goodwill 
impairment losses between segments as discussed in "Note 2 - Financial Statement Details." These changes 
had no impact on the Company's previously reported total consolidated net service revenue, income from 
operations, net income, or earnings per share.

Foreign Currency Translation and Transactions

The majority of the Company's foreign subsidiaries maintain their accounting records in their local currency 
which is determined to be their functional currency. All of the assets and liabilities of these subsidiaries are 
converted to U.S. dollars at the exchange rate in effect at the balance sheet date, and equity accounts are 
carried at historical exchange rates. Revenue and expenses are translated at average exchange rates in 
effect during each reporting period. The net effect of foreign currency translation adjustments is included in 
shareholder's equity as a component of "Accumulated other comprehensive loss" line item in the 
accompanying consolidated balance sheets.

Foreign currency transaction gains and losses are the result of exchange rate changes during the period of 
time between the consummation and cash settlement of transactions denominated in currencies other than 
the functional currency. Foreign currency transaction gains and losses are recognized in current period 
earnings as incurred and are included in "Other expense, net" line item in the accompanying consolidated 
statements of operations.

Comprehensive (Loss) Income 

The Company has elected to present comprehensive (loss) income and its components as a separate 
financial statement. Other comprehensive (loss) income refers to revenue, expenses, gains, and losses that 
under U.S. GAAP are recorded as an element of shareholders' equity but are excluded from net income 
(loss). The Company's other comprehensive (loss) income consists of foreign currency translation 
adjustments, net of applicable taxes, resulting from the translation of foreign subsidiaries with functional 

99

currencies other than the U.S. dollar and the effective portions of the unrealized gains or losses associated 
with derivative instruments designated and accounted for as hedging instruments.

Cash and Cash Equivalents

Cash and cash equivalents consist of demand deposits with banks and other financial institutions and highly 
liquid investments with an original maturity of three months or less at the date of purchase. Cash and cash 
equivalents are carried at cost, which approximates their fair value.

Certain of our subsidiaries participate in a notional cash pooling arrangement to manage global liquidity 
requirements. The parties to the arrangement combine their cash balances in pooling accounts with the 
ability to offset bank overdrafts of one subsidiary against positive cash account balances maintained in 
another subsidiary’s bank account at the same financial institution. The net cash balance related to this 
pooling arrangement is included in the “Cash and cash equivalents” line item in the audited consolidated 
balance sheet. As of December 31, 2017, the net cash position in the pool was $107.2 million, consisting of 
the gross cash balance of $195.4 million and gross bank overdraft balances of $88.2 million.

Restricted Cash

Restricted cash represents cash and term deposits held as security over bank deposits, lease guarantees, 
and insurance obligations that are restricted as to withdrawal or use. Restricted cash is classified as a current 
or long-term asset based on the timing and nature of when and how the cash is expected to be used or when 
the restrictions are expected to lapse. The Company includes changes in restricted cash balances as part of 
investing activities in the consolidated statements of cash flows. 

Fair Value

The Company records certain assets and liabilities at fair value in accordance with ASC Topic 820, Fair Value 
Measurement (see "Note 7 - Fair Value Measurements"). Fair value is defined as the price that would be 
received to sell an asset or paid to transfer a liability in the principal or most advantageous market for the 
asset or liability in an orderly transaction between market participants at the measurement date. This 
guidance also specifies a fair value hierarchy that distinguishes between valuation assumptions developed 
based on market data obtained from independent external sources and the reporting entity's own 
assumptions. In accordance with this guidance, fair value measurements are classified under the following 
hierarchy:

Level 1 — Unadjusted quoted prices in active markets for identical instruments;

Level 2 — Quoted prices for similar instruments in active markets; quoted prices for identical or similar 
instruments in markets that are not active; and model-derived valuations in which all significant inputs 
or significant value-drivers are observable in active markets; and

Level 3 — Model-derived valuations in which one or more significant inputs or significant value-drivers 
are unobservable.

Fair value measurements are classified according to the lowest level input or value-driver that is significant to 
the valuation. When available, the Company uses quoted market prices to determine fair value and classifies 
such instruments within the Level 1 category. In cases where market prices are not available, the Company 
estimates fair value using observable market inputs, in which case the measurements are classified within 
Level 2. If quoted or observable market prices are not available, fair value estimates are based upon valuation 
techniques in which one or more significant inputs are unobservable, including internally developed models. 
These measurements are classified within the Level 3 category.

Derivative Financial Instruments

The Company uses interest rate swaps designated as cash flow hedges to manage exposure to variable 
interest rates on its debt obligations. The Company designates its interest rate swaps as cash flow hedges 
because they are executed to hedge the Company's exposure to the variability in expected future cash flows 
that are attributable to changes in interest rates. 

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Derivative financial instruments are recognized on the accompanying balance sheets in the "Prepaid 
expenses and other current assets" and "Other long-term assets" line items and are measured at fair value. 
The fair value of interest rate swaps is determined using the market standard methodology of discounted 
future variable cash receipts. The variable cash receipts are determined by discounting the future expected 
cash receipts that would occur if variable interest rates rise above the fixed rate of the swaps. The variable 
interest rates used in the calculation of projected receipts on the swap are based on an expectation of future 
interest rates derived from observable market interest rate curves and volatilities. Changes in the fair value of 
derivative instruments designated as hedging instruments are recorded each period according to the 
determination of the derivative's effectiveness. The effective portion of changes in the fair value of derivatives 
designated as cash flow hedges is recorded in accumulated other comprehensive loss and subsequently 
reclassified into earnings in the period during which the hedged transaction is recognized in earnings. The 
ineffective portion of the change in fair value of the derivatives is recognized as non-operating income or 
expense immediately when incurred and included in the "Interest expense" line item in the accompanying 
consolidated statements of operations. 

Billed and Unbilled Accounts Receivable

Accounts receivable are recorded at net realizable value. Unbilled accounts receivable arise when services 
have been rendered for which revenue has been recognized but the customers have not been billed. In 
general, prerequisites for billings and payments are established by contractual provisions, including 
predetermined payment schedules, which may or may not correspond to the timing of the performance of 
services under the contract.

Deferred Revenue

Deferred revenue represents receipts of payments from customers in advance of services being provided and 
the related revenue being earned or reimbursable expenses being incurred. As the contracted services are 
subsequently performed and the associated revenue is recognized, the deferred revenue balance is reduced 
by the amount of the revenue recognized during the period.

Under certain contracts, the Company is entitled to additional compensation if performance-based criteria are 
achieved. Because there is substantive uncertainty regarding the ability to realize such amounts at the onset 
of the arrangements, the Company does not recognize such revenues until it has met the performance-based 
criteria and other revenue recognition criteria described above.

Allowance for Doubtful Accounts

The Company maintains a credit approval process and makes judgments in connection with assessing its 
customers' ability to pay throughout the contractual obligation period. Despite this assessment, from time to 
time, customers are unable to meet their payment obligations. The Company monitors customers' credit 
worthiness and applies judgment in establishing a provision for estimated credit losses based on historical 
experience, current receivables aging, and identified customer-specific circumstances that would affect the 
customers' ability to meet their obligation.

Property and Equipment

Property and equipment is primarily comprised of furniture, vehicles, software, office equipment, computer 
equipment, and lab equipment. Purchased and constructed property and equipment is initially recorded at 
historical cost plus the estimated value of any associated legally or contractually required retirement 
obligations. Property and equipment acquired in a business combination are recorded based on the estimated 
fair value as of the acquisition date. The Company leases vehicles for certain sales representatives in the 
Commercial Solutions segment. These leases are classified and accounted for as capital leases in 
accordance with ASC Topic 840, Leases. For further information about lease arrangements, see "Note 5 - 
Leases."

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Property and equipment assets are depreciated using the straight-line method over the respective estimated 
useful lives as follows:

Buildings

Furniture and fixtures

Equipment

Computer equipment and software
Vehicles

Leasehold improvements

Useful Life

39 years

7 years

5 to 10 years

3 years

Lesser of lease term or the estimated economic
life of the leased asset

Lesser of remaining life of lease or the useful
life of the asset

Expenditures for repairs and maintenance are expensed as incurred and expenditures for major 
improvements that increase the functionality or extend the useful life of the asset are capitalized and 
depreciated over the estimated useful life of the asset.

The Company capitalizes costs of computer software obtained for internal use and amortizes these costs on a 
straight-line basis over the estimated useful life of the product, not to exceed three years. Software cloud 
computing arrangements containing a software license are accounted for consistently with the acquisition of 
other software licenses. In the event such an arrangement does not contain a software license, the Company 
accounts for the arrangement as a service contract. 

The Company reviews property and equipment for impairment whenever facts and circumstances indicate 
that the carrying amounts of these assets might not be recoverable. For assessment purposes, property and 
equipment are grouped with other assets and liabilities at the lowest level of which identifiable cash flows are 
largely independent of the cash flows of other assets and liabilities. Recoverability of the carrying amount of 
the asset group to be held is assessed by comparing the carrying amount of the asset group to the estimated 
undiscounted future net cash flows expected to be generated by this asset group. If the carrying value of the 
asset group is not recoverable and exceeds its fair value, an impairment charge is recognized for the amount 
by which the carrying amount of the asset group exceeds its fair value.

Leases

The Company accounts for leased properties under the provisions of ASC Topic 840, Leases. The Company 
evaluates each lease for classification as either a capital lease or an operating lease. The Company performs 
this evaluation at the inception of the lease and when a modification is made to a lease. Under lease 
arrangements that are classified as capital leases, the Company records property as part of its property and 
equipment assets, and a capital lease obligation in an amount equal to the lesser of the present value of the 
minimum lease payments to be made over the life of the lease at the beginning of the lease term, or the fair 
value of the leased property. The property under capital lease is amortized on a straight-line basis as a 
charge to depreciation expense over the lesser of the lease term, as defined, or the economic life of the 
leased property. During the lease term, as defined, each minimum lease payment is allocated between a 
reduction of the lease obligation and interest expense so as to produce a constant periodic rate of interest on 
the remaining balance of the lease obligation. The Company’s capital lease assets consist primarily of 
vehicles that the Company leases for certain sales representatives in the Commercial Solutions segment.

The majority of the Company's operations are conducted in premises occupied under lease agreements 
containing predominantly reasonable and standard market terms. The Company, at its option, can renew a 
substantial portion of the leases at defined terms or at the then fair rental rates for various periods. Office 
facilities leases are classified and accounted for as operating leases. The Company records rent expense for 
its operating leases with contractual rent increases on a straight-line basis from the "lease commencement 
date" as specified in the lease agreement until the end of the lease term. 

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Goodwill and Intangible Assets

Goodwill represents the excess of purchase price over the estimated fair value of net assets acquired, 
including the amount assigned to identifiable intangible assets, in business combinations. In accordance with 
ASC Topic 350, Intangibles - Goodwill and Other, goodwill is not subject to amortization but must be tested for 
impairment annually or more frequently if events or changes in circumstances indicate that goodwill might be 
impaired. Goodwill is tested for impairment at the reporting unit level, which is one level below the operating 
segment level. This test requires the Company to determine if the implied fair value of the reporting unit's 
goodwill is less than its carrying amount. 

The Company completed the annual impairment test for potential impairment as of October 1, 2017 for all of 
its reporting units, determining that there were no impairments. As of October 1, 2017 and December 31, 
2017, the Company had assigned goodwill to five reporting units. The Company's goodwill is principally 
related to the Merger completed in August 2017. 

The impairment analysis requires significant judgments, estimates and assumptions. There is no assurance 
that the actual future earnings or cash flows of the reporting units will not decline significantly from the 
projections used in the impairment analysis. Goodwill impairment charges may be recognized in future 
periods in one or more of the reporting units to the extent changes in factors or circumstances occur, including 
deterioration in the macroeconomic environment, industry, deterioration in the Company’s performance or its 
future projections, or changes in plans for one or more of its reporting units. 

Intangible assets consist primarily of backlog, customer relationships, and trademarks. The Company 
amortizes intangible assets related to customer relationships and trademarks on a straight-line basis over the 
estimated useful life of the asset. Intangible assets related to backlog are amortized based on the Company’s 
expectations of when revenue associated with the backlog is expected to be earned. 

The Company reviews intangible assets at the end of each reporting period to determine if facts and 
circumstances indicate that the useful life is shorter than originally estimated or that the carrying amount of 
the assets might not be recoverable. If such facts and circumstances exist, the Company assesses the 
recoverability of identified assets by comparing the projected undiscounted net cash flows associated with the 
related asset or group of assets over their remaining lives to their respective carrying amounts. Impairments, 
if any, are based on the excess of the carrying amount over the fair value of those assets and occur in the 
period in which the impairment determination was made.

As of December 31, 2017 and 2016, the weighted average estimated useful lives of the Company's intangible 
assets were as follows:

Customer relationships

Acquired backlog

Trademarks

December 31, 2017

December 31, 2016

9.2 years

2.2 years

3.5 years

5.0 years

—

—

Due to the Company’s intention to relaunch its operations under a new brand name in January 2018, the 
Company determined that the useful life of the intangible asset related to the INC Research trademark with a 
carrying value of $35.0 million was no longer indefinite as of August 1, 2017. Based on this change in 
circumstances, the Company tested the asset for impairment as an indefinite-lived intangible asset and 
recorded a $30.0 million impairment charge during the third quarter of 2017. The Company also determined 
that the remaining useful life of this asset did not extend beyond the anticipated date of the Merger-related 
rebranding and, as of August 1, 2017, approximated five months. Therefore, the Company reclassified this 
intangible asset from the indefinite-lived to the definite-lived category and began amortizing its remaining 
value on a straight-line basis over its remaining estimated useful life of five months. In addition, the Company 
assigned a value of $8.8 million to the inVentiv Health trade name in connection with the Merger, which was 
amortized over the same five month period. As of December 31, 2017, these trademarks were fully amortized. 
For additional information regarding the carrying values of intangible assets, see "Note 2 - Financial 
Statement Details."

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Contingencies

In the normal course of business, the Company periodically becomes involved in various proceedings and 
claims, including investigations, disputes, litigations, and regulatory matters that are incidental to its business. 
The Company evaluates the likelihood of an unfavorable outcome of all legal and regulatory matters to which 
it is a party and records accruals for loss contingencies related to these matters when it is probable that a 
liability has been incurred and the amount of the loss can be reasonably estimated. Gain contingencies are 
not recognized until realized. Legal fees are expensed as incurred.

Because these matters are inherently unpredictable, and unfavorable developments or resolutions can occur, 
assessing contingencies is highly subjective and requires judgments about future events. These judgments 
and estimates are based, among other factors, on the status of the proceedings, the merits of the Company’s 
defenses, and the consultation with in-house and external counsel. The Company regularly reviews 
contingencies to determine whether its accruals and related disclosures are adequate. Although the Company 
believes that it has substantial defenses in these matters, the amount of losses incurred as a result of actual 
outcomes may differ significantly from the Company’s estimates.

Self-Insured and Other Insurance Risks Reserves

The Company carries insurance coverage for protection of its assets and operations from certain risks 
including automobile liability, general liability, real property, workers’ compensation coverage, directors’ and 
officers’ liability, employee healthcare benefits and other coverages the Company believes are customary to 
the industry. The Company’s exposure to loss for insurance and benefit claims is generally limited to the per 
incident deductible under the related insurance policy. 

The Company retains the risk with respect to the self-insured portion of the above programs. For the self-
insured retention limits, the Company estimates and accrues the liability for unpaid claims and associated 
expenses, including for losses incurred but not yet reported. The estimates are based on a number of factors, 
including the number of asserted claims and reported incidents, estimates of losses for these claims based on 
recent and historical settlement amounts, estimates of incurred but not yet reported claims based on historical 
experience, and estimates of amounts recoverable under the commercial insurance policies. A significant 
number of these claims typically take several years to develop and even longer to ultimately settle. Although 
the Company continuously monitors and considers these factors, the ultimate liability for claims could change 
materially from the current estimates due to inherent uncertainties and judgments involved in making these 
estimates. The Company reviews and adjusts its self-insured reserves at each reporting period, with changes 
recognized in current period earnings. For further information regarding self-insured reserve accruals and 
balances, see "Note 18 - Commitments and Contingencies."

Revenue Recognition

The Company recognizes revenue when all of the following conditions are satisfied: (i) there is persuasive 
evidence of an arrangement; (ii) the service offering has been delivered to the customer; (iii) the collection of 
the fees is reasonably assured; and (iv) the arrangement consideration is fixed or determinable. The 
Company records revenues net of any tax assessments by governmental authorities, such as value added 
taxes, that are imposed on and concurrent with specific revenue generating transactions. In some cases, 
contracts provide for consideration that is contingent upon the occurrence of uncertain future events. The 
Company recognizes contingent revenue when the contingency has been resolved and all other criteria for 
revenue recognition have been met.

The Company's arrangements are principally service contracts and historically, a majority of the net service 
revenue has been earned under contracts that range in duration from a few months to several years. Most of 
the Company's contracts can be terminated by the customer with a 30-day notice. In the event of termination, 
the Company's contracts provide that the customer pay the Company for fees earned through the termination 
date, as well as fees and expenses for winding down the project, which include both fees incurred and actual 
expenses, as well as non-cancellable expenditures and in some cases may include a fee to cover a portion of 
the remaining professional fees on the project. The Company does not recognize revenue with respect to 

104

start-up activities including contract and scope negotiation, feasibility analysis and conflict of interest reviews. 
The costs for these activities are expensed as incurred.

The Company recognizes revenue from its service contracts either using a fee-for-service method or 
proportional performance method. The majority of the Company’s service contracts represent a single unit of 
accounting. For fee-for-service contracts, the Company records revenue as contractual items (i.e., “units”) are 
delivered to the customer, or, in the event the contract is time and materials based, when labor hours are 
incurred. The Company uses the proportional performance method when its fees for a service obligation are 
fixed pursuant to the contractual terms. Revenue is recognized as services are performed and measured on a 
proportional performance basis, generally using output measures specific to the services provided. The 
Company believes the best indicator of effort expended to complete its performance requirement related to its 
contractual obligation are the actual units delivered to the customer or the incurrence of labor hours when no 
other pattern of performance exists. In the event the Company uses labor hours as the basis for determining 
proportional performance, the Company estimates the number of hours remaining to complete its service 
obligation. Actual hours incurred to complete the service requirement may differ from the Company’s estimate, 
and any differences are accounted for prospectively. Examples of output measures used by the Company are 
site or investigator recruitment, patient enrollment, data management, or other deliverables common to its 
Clinical Solutions segment. 

The Company enters into multiple element arrangements in which the Company is engaged to provide 
multiple services under one agreement. In such arrangements, the Company records revenue as each 
separate service, or element, is delivered to the customer. Such arrangements reside predominantly within 
the Company’s Commercial Solutions segment where the Company is engaged to provide recruiting, 
deployment, and detailing services. These services may be sold individually or in combination with 
contractual fees based on fixed fees for each element, variable fees for each element, or a combination of 
both. For the arrangements that include multiple elements, arrangement consideration is allocated at 
inception to units of accounting based on the relative selling price. The best evidence of selling price of a 
unit of accounting is vendor-specific objective evidence (“VSOE”), which is the price the Company charges 
when the deliverable is sold separately. When VSOE is not available to determine selling price, the 
Company uses relevant third-party evidence (“TPE”) of selling price, if available. When neither VSOE nor 
TPE of selling price exists, the Company uses its best estimate of selling price, which generally consists of 
an expected margin on the cost of services.

Changes in the scope of work are common, especially under long-term contracts, and generally result in a 
renegotiation of future contract pricing terms and change in contract value. If the customer does not agree to 
contract modification, the Company could bear the risk of cost overruns. Renegotiated amounts are not 
included in net revenues until written authorization is received, the amount is earned and realization is 
assured.

The Company offers volume rebates to its large customers based on annual volume thresholds. The 
Company records an estimate of the annual volume rebate as a reduction of revenue throughout the period 
based on the estimated total rebate to be earned for the period.

Reimbursable Out-of-Pocket Expenses

In connection with management of multi-site clinical trials, the Company is reimbursed by its customers for 
fees paid to principal investigators and for other out-of-pocket costs (such as travel expenses for the 
Company's clinical monitors). The Company includes these costs in total operating expenses, and the related 
reimbursements are reflected in total revenue, as the Company is deemed to be the primary obligor in the 
applicable arrangements. 

Share-Based Compensation

The Company measures and recognizes compensation expense related to all share-based awards based on 
the estimated fair value of the awards. The fair value of restricted stock and stock unit awards is measured on 
the grant date based on the fair market value of the Company's common stock. The fair value of stock option 
awards and Employee Stock Purchase Plan ("ESPP") awards is estimated on the grant date using the Black-
Scholes option-pricing model and is affected by the Company's stock price and a number of highly complex 
and subjective assumptions. These assumptions include, but are not limited to, the following:

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Expected Term - Given the Company's limited history with employee share-based awards, the 
Company does not have sufficient Company-specific information related to the life of the awards. As 
permitted by the SEC Staff, the Company estimates expected term using the "simplified" method  
which represents the average of the time-to-vest and the contractual life of the options. 

Expected Volatility - Beginning in 2017, expected volatility of the Company's stock price is estimated 
based on (i) the historical volatility of the Company's stock for periods in which the Company has 
sufficient information, or (ii) the simple average of the historical stock volatilities of several comparable 
publicly traded companies from the CRO industry for periods for which the Company does not have 
sufficient information. Prior to 2017, due to the limited trading history of the Company's stock, the 
expected volatility estimate was based solely on the historical stock volatilities of comparable publicly 
traded companies.

Risk-Free Interest Rate - The risk-free interest rate is based on the yield in effect at the time of grant 
for United States Treasury zero-coupon notes with maturities approximating each grant's expected 
term.

Expected Dividend Yield - The Company has not paid and does not anticipate paying cash dividends 
on its common stock; therefore, the expected dividend yield is assumed to be zero. 

Share-based compensation expense is recognized on a straight-line basis over the shorter of the requisite 
service period or the vesting term. For awards with performance conditions, stock-based compensation 
expense is recognized when the achievement of each individual performance target becomes probable, and 
the number of shares expected to vest is adjusted for the weighted probability of attainment of the relevant 
performance targets.

In March 2016, the Financial Accounting Standards Board ("FASB") issued ASU No. 2016-09, Compensation 
- Stock Compensation: Improvements to Employee Share-Based Payment Accounting. In accordance with 
the guidance, the Company elected to early adopt this ASU effective in the first quarter of 2016. The following 
summarizes the effects of the adoption on the Company's consolidated financial statements:

Income taxes - Upon adoption of this standard, all excess tax benefits and tax deficiencies (including 
tax benefits of dividends on share-based payment awards) are recognized as income tax expense or 
benefit in the statement of operations. The tax effects of exercised or vested awards are treated as 
discrete items in the reporting period in which they occur. The Company also recognizes excess tax 
benefits regardless of whether the benefit reduces taxes payable in the current period. As a result, the 
Company recognized discrete adjustments to income tax expense for the year ended December 31, 
2016 of $12.9 million related to excess tax benefits. The Company applied the modified retrospective 
adoption approach beginning in 2016 and recorded a cumulative-effect adjustment to retained 
earnings and reduced its deferred tax liability by $7.6 million. This adjustment related to tax assets that 
had previously arisen from tax deductions for equity compensation expenses that were greater than 
the compensation recognized for financial reporting. These assets had been excluded from the 
deferred tax assets and liabilities totals on the balance sheet as a result of realization requirements 
previously included in ASC 718, Stock Compensation. Prior periods have not been adjusted. 

Forfeitures - Prior to adoption, share-based compensation expense was recognized on a straight line 
basis, net of estimated forfeitures, such that expense was recognized only for share-based awards 
that were expected to vest. A forfeiture rate was estimated annually and revised, if necessary, in 
subsequent periods if actual forfeitures differed from initial estimates. Upon adoption, the Company no 
longer applies a forfeiture rate and instead accounts for forfeitures as they occur. The Company 
applied the modified retrospective adoption approach beginning in 2016 and booked an immaterial 
cumulative-effect adjustment to additional paid-in-capital and share-based compensation expense. 
Prior periods have not been adjusted.

Statements of Cash Flows - The Company historically accounted for excess tax benefits on the 
Statement of Cash Flows as a financing activity.  Upon adoption of this standard, excess tax benefits 
are classified along with other income tax cash flows as an operating activity. The Company elected to 

106

adopt this portion of the standard on a prospective basis beginning in 2016. Prior periods have not 
been adjusted. 

Earnings Per Share - The Company uses the treasury stock method to compute diluted earnings per 
share, unless the effect would be anti-dilutive. Under this method, the Company is no longer required 
to estimate the tax rate and apply it to the dilutive share calculation for determining the dilutive 
earnings per share.  The Company utilized the modified retrospective adoption approach and applied 
this methodology beginning in 2016. Prior periods have not been adjusted.

Income Taxes

The Company and its United States (U.S.) subsidiaries file a consolidated U.S. federal income tax return. 
Other subsidiaries of the Company file tax returns in their local jurisdictions.

The Company estimates its tax liability based on current tax laws in the statutory jurisdictions in which it 
operates. 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 
and tax bases of assets and liabilities and for tax benefit carryforwards using enacted tax rates in effect in the 
year in which the differences are expected to reverse. 

Valuation allowances are provided to reduce the related deferred income tax assets to an amount which will, 
more likely than not, be realized. 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. If the objectively verifiable negative 
evidence outweighs any available positive evidence (or the only available positive is subjective and cannot be 
verified), then a valuation allowance will likely be deemed necessary. If a valuation allowance is deemed to be 
unnecessary, such allowance is released and any related benefit is recognized in the period of the change.

Judgment is required in determining what constitutes an uncertain tax position, as well as the assessment of 
the outcome of each tax position. The Company considers many factors when evaluating and estimating tax 
positions and tax benefits. In addition, the calculation of tax liabilities involves dealing with uncertainties in the 
application of complex tax regulations in domestic and foreign jurisdictions. 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 
benefit to expense, respectively, would result. Unrecognized tax benefits, or a portion of unrecognized tax 
benefits, are presented as a reduction to a deferred tax asset for a net operating loss ("NOL") carryforward, a 
similar tax loss, or a tax credit carryforward.

Advertising Costs

Advertising costs include costs incurred to promote the Company's business and are expensed as incurred. 
Advertising costs were $6.5 million, $5.0 million and $4.4 million for the years ended December 31, 2017, 
2016 and 2015, respectively.

Restructuring and Other Costs

Restructuring and other costs primarily consist of one-time employee termination benefits, contract 
termination costs, CEO transition costs, and other costs associated with an exit or disposal activity. The 
Company accounts for restructuring costs in accordance with the authoritative guidance in ASC Topic 420, 
Exit or Disposal Cost Obligations. This guidance requires that a liability for a cost associated with an exit or 
disposal activity be recognized in the period in which the liability is incurred, as opposed to the period in which 
management commits to a plan of action for termination. The guidance also requires that the liabilities 
associated with an exit or disposal activity be measured at the fair value in the period in which the liability is 
incurred, except for: (i) liabilities related to one-time employee termination benefits, which shall be measured 
and recognized at the date the entity notifies employees of termination, unless employees are required to 
render services beyond minimum retention period, in which case the liability is recognized ratably over the 
future service period; and (ii) liabilities related to an operating lease contract, which shall be measured and 

107

recognized when the contract does not have any future economic benefit to the entity (i.e., the entity ceases 
to utilize the rights conveyed by the contract).

The guidance requires that the fair value of the restructuring liabilities is determined using best available 
representation of fair value or using other appropriate technique. In determining the fair value of the liabilities 
associated with contract terminations, the Company considers terms and conditions of the contractual 
obligations to be terminated, including the type and amount of payments and their anticipated timing. In 
determining the fair value of the liabilities associated with employee terminations, the Company considers 
termination notification date and associated legal notification requirements and minimum retention period as 
stipulated by the applicable laws and regulations, the type and amount of benefits employees will receive 
upon involuntary termination, as well as the timing of employees' departure.

CEO transition costs consist of CEO separation benefits and retention bonuses granted to key employees. 
The Company accounts for CEO transition costs in accordance with the authoritative guidance in ASC Topic 
712, Compensation - Nonretirement Postemployment Benefits. This guidance requires that (i) a liability for 
benefits offered as special termination benefits to an employee is recognized when the employee accepts the 
offer and the amount can be reasonably estimated, (ii) a liability for other contractual termination benefits is 
recognized when it is probable that employees will be entitled to benefits and the amount can be reasonably 
estimated, and (iii) a liability for other postemployment benefits are recognized and accounted for in 
accordance with guidance in ASC Topic 710, Compensation - General.

Restructuring liabilities are included in "Accrued liabilities" and "Other long-term liabilities" in the 
accompanying consolidated balance sheets.

Earnings Per Share

The Company determines earnings per share in accordance with the authoritative guidance in ASC Topic 260, 
Earnings Per Share. The Company has one class of common stock for purposes of the earnings per share 
calculation and therefore computes basic earnings per share by dividing net income (loss) by the weighted 
average number of common shares outstanding for the applicable period. Diluted earnings per share are 
computed in the same manner as basic earnings per share, except that the number of shares is increased to 
assume exercise of potentially dilutive stock options using the treasury stock method, unless the effect of 
such increase would be anti-dilutive. Under the treasury stock method, the amount the employee must pay for 
exercising stock options and the amount of compensation cost for future service that the Company has not 
yet recognized are assumed to be used to repurchase shares.

Subsequent Events

The Company considers events or transactions that occur after the balance sheet date but before the 
financial statements are issued to provide additional evidence relative to certain estimates or to identify 
matters that require additional disclosure. The Company evaluated all events and transactions through the 
date that these financial statements were issued.

Recently Adopted Accounting Standards

Income Taxes.  Effective January 1, 2017, the Company elected to early adopt Accounting Standard Update 
(“ASU”) No. 2016-16, Income Taxes - Intra-Entity Transfers of Assets Other Than Inventory. Under the 
updated accounting guidance the Company recognizes income tax consequences immediately when the 
transfer of an inter-entity asset other than inventory occurs across jurisdictions rather than deferring the tax 
effects of those transactions until a transfer is made to a third party. The Company adopted this standard 
using the modified retrospective approach and recorded a cumulative-effect adjustment as of January 1, 
2017. As a result, the Company recorded (i) a reduction in prepaid income taxes of $11.7 million, (ii) a net 
increase in deferred income tax assets of $9.7 million, and (iii) a decrease in retained earnings of $2.0 million. 
Prior periods have not been adjusted.

Goodwill.  In January 2017, the Financial Accounting Standards board (“FASB”) issued ASU No. 
2017-04, Intangibles - Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment, which 
eliminates the second step of the previous FASB guidance for testing goodwill for impairment and is intended 
to reduce cost and complexity of goodwill impairment testing. The amendments in this ASU modify the 
concept of impairment from the condition that exists when the carrying amount of goodwill exceeds its implied 

108

fair value to the condition that exists when the carrying amount of a reporting unit exceeds its fair value. After 
determining if the carrying amount of a reporting unit exceeds its fair value, the entity should take an 
impairment charge of the same amount to the goodwill for that reporting unit, not to exceed the total goodwill 
amount for that reporting unit. This eliminates the second step of calculating the implied fair value of goodwill 
by assigning the fair value of a reporting unit to all of its assets and liabilities as if that reporting unit had been 
acquired in a business combination. ASU 2017-04 is effective for annual periods beginning after December 
15, 2019, including interim periods within those annual periods. Early adoption is permitted for interim or 
annual goodwill impairment tests performed on testing dates after January 1, 2017. The Company has 
elected to early adopt this standard effective January 1, 2017.

Recently Issued Accounting Standards Not Yet Adopted 

Income Statement - Reporting Comprehensive Income. In February 2018, the FASB issued ASU No. 
2018-02, Income Statement - Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax 
Effects from Accumulated Other Comprehensive Income, which allows for the reclassification from 
accumulated other comprehensive income to retained earnings for stranded tax effects resulting from the Tax 
Cuts and Jobs Act. The amendments in this update also require entities to disclose their accounting policy for 
releasing income tax effects from accumulated other comprehensive income. ASU No. 2018-02 is effective for 
the reporting periods beginning after December 15, 2018, including interim periods within those annual 
periods. Early adoption is permitted. The Company is currently assessing the potential impact of ASU No. 
2018-02 on its consolidated financial statements.

Leases.  In February 2016, the FASB issued ASU No. 2016-02, Leases. ASU 2016-02 requires organizations 
to recognize lease assets and lease liabilities on the balance sheet, including leases that were previously 
classified as operating leases. The ASU also requires additional disclosures about leasing arrangements 
related to the amount, timing, and uncertainty of cash flows arising from leases. The amendments in this ASU 
are effective for financial statements issued for fiscal years beginning after December 15, 2018, and interim 
periods within those fiscal years. Early adoption of the amendments is permitted and the new guidance will be 
applied using a modified retrospective approach. The Company plans to adopt this standard on January 1, 
2019. 

Revenue from Contracts with Customers.  In May 2014, FASB issued ASU No. 2014-09, Revenue from 
Contracts with Customers. ASU 2014-09 eliminates transaction- and industry-specific revenue recognition 
guidance under current U.S. GAAP and replaces it with a single principles based model for determining 
revenue recognition. ASU 2014-09 requires that companies recognize revenue when a customer obtains 
control of promised goods or services. Revenue will be recognized in the amount that reflects the 
consideration that the entity expects to receive in exchange for those goods or services. The standard also 
requires disclosure about the nature, amount, timing and uncertainty of revenue and cash flows arising from 
contracts with customers, including significant judgments and changes in judgments, as well as assets 
recognized from costs incurred to obtain or fulfill a contract. The FASB issued several amendments to the 
standard, including clarifications on principal versus agent considerations, identifying performance obligations, 
disclosure of prior-period performance obligations and accounting for licenses of intellectual property.

For public entities, the standard is effective for reporting periods beginning after December 15, 2017.  Earlier 
adoption is permitted only as of annual reporting periods beginning after December 15, 2016, including 
interim reporting periods within that reporting period. Entities can adopt the standard either retrospectively to 
each period presented (full retrospective approach), or retrospectively with the cumulative effect of initially 
applying the guidance recognized as of the date of adoption (modified retrospective or cumulative effect 
approach). 

In preparation for adoption of the standard, the Company established a project management and 
implementation team consisting of internal resources and external advisors. The Company reached 
conclusions on certain key accounting assessments related to the standard and is finalizing its evaluation of 
the impact of adopting this new standard on its financial reporting and disclosures, accounting policies, 
business processes and internal controls. In particular, the Company has concluded that under the new 
standard, the majority of its contracts will contain a single performance obligation. The Company expects to 
account for the majority of revenue related to customer clinical trials in its Clinical Solutions segment under 

109

single performance obligations over time using project costs as an input method to measure progress. The 
Company anticipates that under the new standard the majority of arrangements in its Commercial Solutions 
segment will consist of a single performance obligation as the pattern of services delivered are substantially 
the same over the contract period. Additionally, net service revenue and reimbursable costs represent a single 
performance obligation and separate presentation on the statement of operations is no longer permitted under 
the standard. 

The Company anticipates that, as a result of adopting the new standard, revenue recognition may be delayed 
at certain phases of the customer contract life cycle, particularly during the first years of the contract as the 
inclusion of reimbursable costs in the measure of progress may result in a disproportionately lower 
percentage of costs incurred until those contracts mature. Such deferral of revenue recognition could differ 
materially from that applied under the current revenue recognition standard. While the Company expects its 
revenue to be deferred in the early stages of the contract, such impact may be partially mitigated on an 
aggregate basis because at any given time, the Company’s portfolio of contracts consists of contracts in 
varying stages of completion. On our consolidated balance sheet, long-term contracts will be reported in a net 
contract asset or contract liability position on a contract-by-contract basis at the end of each reporting period. 
The assessment of our consolidated balance sheet under the new standard will result in some 
reclassifications among financial statement accounts. The Company continues to gather and track new 
information to meet the expanded disclosure requirements, and is nearing completion of finalizing the 
financial impact of adopting this standard on the opening balance of retained earnings. The Company will 
adopt the new standard effective January 1, 2018 using the modified retrospective approach. 

2. Financial Statement Details

Accounts Receivable Billed, net 

Accounts receivable, net of allowance for doubtful accounts, consisted of the following (in thousands):

Accounts receivable billed

Allowance for doubtful accounts

Accounts receivable billed, net

December 31, 2017

December 31, 2016

$

$

652,061

$

(9,076)

642,985

$

217,360

(5,884)

211,476

The following table summarizes the changes in the allowance for doubtful accounts (in thousands):

Balance at the beginning of the period

Current year (provision) recovery

Write-offs, net of recoveries and the effects of foreign currency 
exchange

Balance at the end of the period

Years Ended December 31,

2017

2016

2015

(5,884) $

(3,557) $

(3,727)

(4,167)

(2,570)

975

243

144

26

(9,076) $

(5,884) $

(3,557)

$

$

110

 
 
Property and Equipment, net

Property and equipment, net of accumulated depreciation, consisted of the following (in thousands):

Software

Vehicles

Computer equipment

Leasehold improvements

Office furniture, fixtures, and equipment

Buildings and land

Assets not yet placed in service

Property and equipment, gross

Less: accumulated depreciation

Property and equipment, net

December 31, 2017

December 31, 2016

$

65,102

$

38,938

61,659

58,975

19,317

4,552

29,215

277,758

(97,346)

$

180,412

$

52,531

—

26,311

14,814

10,894

4,004

13,396

121,950

(63,644)

58,306

As of December 31, 2017, the gross book value of vehicles under capital leases was $38.9 million and 
accumulated depreciation was $7.6 million. Amortization charges related to these assets, net of rebates, were 
$5.9 million for 2017 and are included in the “Depreciation” line item of the accompanying consolidated 
statements of operations. 

Goodwill and Intangible Assets

Effective August 1, 2017, the Company realigned its segment financial reporting to reflect changes in the 
organizational structure following the Merger (see "Note 14 - Segment Information" for further information). 
The Company has reflected this change to its segment information retrospectively to the earliest period 
presented. The change resulted in the reclassification of gross goodwill and previously recognized 
accumulated goodwill impairment losses of $8.1 million from the former Phase I Services segment to the 
Clinical Solutions segment. In addition, gross goodwill and previously recognized accumulated goodwill 
impairment losses of $8.0 million related to the Global Consulting business unit, which previously had been 
included in the Clinical Solutions segment was reclassified into the Commercial Solutions segment as a result 
of the Merger.

111

 
The changes in carrying amount of goodwill were as follows (in thousands):

Total

Clinical
Solutions

Commercial
Solutions

Balance at December 31, 2015:

Gross carrying amount

Accumulated impairment losses

Total goodwill and accumulated impairment losses

2016 Activity:

$

569,174

$

561,150

$

(16,166)

553,008

(8,142)

553,008

Impact of foreign currency translation and other

(506)

(506)

Balance at December 31, 2016:

Gross carrying amount
Accumulated impairment losses (a)

Goodwill net of accumulated impairment losses

568,668

(16,166)

552,502

560,644

(8,142)

552,502

8,024

(8,024)

—

—

8,024

(8,024)

—

2017 Activity:
Business combinations (b)
Impact of foreign currency translation

Balance at December 31, 2017:

Gross carrying amount
Accumulated impairment losses (a)

3,733,495

2,240,971

1,492,524

6,574

7,360

(786)

4,308,737

2,808,975

1,499,762

(16,166)

(8,142)

(8,024)

Goodwill net of accumulated impairment losses

$

4,292,571

$

2,800,833

$

1,491,738

(a) Accumulated impairment losses associated with the Clinical Solutions segment were recorded in fiscal periods prior to 
2017 and related to the former Phase I Services segment, now a component of the Clinical Solutions segment. 
Accumulated impairment losses associated with the Commercial Solutions segment were recorded in fiscal periods prior 
to 2017 and related to the former Global Consulting segment, now a component of the Commercial Solutions segment. 
No impairment of goodwill was recorded for the year ended December 31, 2017.

(b) The 2017 activity represents goodwill recognized in connection with the Merger and is subject to further adjustments 
before the close of the measurement period. Goodwill associated with the Merger is not deductible for income tax 
purposes. See "Note 3 - Business Combinations" for further information.

As discussed in "Note 3 - Business Combinations," in conjunction with the Merger, the Company acquired 
certain intangible assets related to customer relationships, acquired backlog, and trademarks. Additionally, 
due to the Company’s intention to relaunch its operations under a new brand name in January 2018, the 
Company determined that the useful life of the intangible asset related to the INC Research trademark with a 
carrying value of $35.0 million was no longer indefinite as of August 1, 2017. The Company tested the asset 
for impairment as an indefinite-lived intangible asset and recorded a $30.0 million impairment charge during 
the three months ended September 30, 2017. The Company also determined that the remaining useful life of 
this asset did not extend beyond the anticipated date of the rebranding and, as of August 1, 2017, 
approximated five months. Therefore, the Company reclassified the remaining value of the INC Research 
trademark from an indefinite-lived intangible asset to a definite-lived intangible asset and began amortizing its 
remaining value on a straight-line basis over its remaining estimated useful life of five months.

112

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

December 31, 2017

December 31, 2016

Gross

Accumulated
Amortization

Net

Gross

Accumulated
Amortization

Net

Intangible assets with finite 
lives:

Customer relationships

$ 1,440,178

$

(266,158) $ 1,174,020

$ 267,703

$

(188,217) $

79,486

Acquired backlog

Trademarks 

137,442

32,428

(42,095)

(15,745)

95,347

16,683

—

—

—

—

Total finite-lived intangibles

1,610,048

(323,998)

1,286,050

267,703

(188,217)

Trademarks — indefinite-lived

—

—

—

35,000

—

—

—

79,486

35,000

Intangible assets, net

$ 1,610,048

$

(323,998) $ 1,286,050

$ 302,703

$

(188,217) $ 114,486

The identifiable intangible assets are amortized over their estimated useful lives. The future estimated 
amortization expense for intangible assets is expected to be as follows (in thousands):

Fiscal Year Ending:

2018

2019

2020

2021

2022

2023 and thereafter

Total

Accrued Liabilities and Other Long-Term Liabilities

Accrued liabilities consisted of the following (in thousands):

Compensation, including bonuses, fringe benefits, and payroll taxes
Accrued professional, investigator fees, and pass-through costs
Accrued rebates to customers

Contingent tax-sharing obligations assumed through business 
combinations, current portion
Accrued taxes
Accrued restructuring and other costs, current portion
Accrued interest
Facility-related obligations
Other liabilities

$

199,586

160,664

143,881

126,597

121,080

534,242

$

1,286,050

December 31, 2017
215,657
$
132,356
27,930

December 31, 2016
77,049
$
43,010
13,580

22,345
16,810
13,280
9,399
8,943
53,583
500,303

$

—
1,072
6,084
72
5,117
7,575
153,559

Total accrued liabilities

$

Other long-term liabilities consisted of the following (in thousands):

Uncertain tax positions

Accrued restructuring and other costs, non-current portion

Contingent tax-sharing obligations assumed through business 
combinations, non-current portion

Deferred compensation, long-term

Other liabilities

Total other long-term liabilities

113

December 31, 2017

December 31, 2016

$

$

25,033

$

3,513

28,135

15,900

27,028

99,609

$

14,813

2,508

—

—

8,842

26,163

 
 
 
Accumulated other comprehensive loss, net of taxes

Accumulated other comprehensive loss, net of taxes consisted of the following (in thousands):

Foreign currency translation adjustments, net of tax

Unrealized gains on derivative instruments, net of tax

Accumulated other comprehensive loss, net of tax

December 31, 2017

December 31, 2016

$

$

(23,514) $

1,129

(22,385) $

(43,356)

1,106

(42,250)

Changes in accumulated other comprehensive loss, net of tax were as follows (in thousands):

Unrealized 
gain on 
derivative 
instruments, 
net of tax

Foreign 
currency 
translation 
adjustments, 
net of tax

Total

Balance at December 31, 2015

$

— $

(41,543) $

(41,543)

Other comprehensive gain before reclassifications

Amount of gain reclassified from accumulated other 
comprehensive loss into statement of operations

Net current period other comprehensive gain (loss), net of tax

Balance at December 31, 2016

Other comprehensive gain before reclassifications

Amount of gain reclassified from accumulated other 
comprehensive loss into statement of operations

Net current period other comprehensive gain, net of tax

901

205

1,106

1,106

443

(420)

23

Balance at December 31, 2017

$

1,129

$

(1,813)

—

(1,813)

(43,356)

19,842

$

— $

19,842

$

(23,514) $

(912)

205

(707)

(42,250)

20,285

(420)

19,865

(22,385)

Amounts reported in accumulated other comprehensive loss related to derivatives will be reclassified to interest 
expense as interest payments are made on the Company’s term loan. Amounts to be reclassified as an increase 
to interest expense in the next 12 months are expected to be immaterial.  

The tax effects allocated to each component of other comprehensive loss for the year ended December 31, 
2017 were as follows (in thousands):

Foreign currency translation adjustments

Unrealized gain on derivative instruments:

Unrealized gains arising during period

Reclassification adjustment for gains realized in net income

Net unrealized gain

Other comprehensive income

Before-Tax 
Amount

Tax (Expense) 
or Benefit

Net-of-Tax 
Amount

$

28,847

$

(9,005) $

19,842

694

(681)

13

(251)

261

10

443

(420)

23

$

28,860

$

(8,995) $

19,865

114

The tax effects allocated to each component of other comprehensive income for the year ended 
December 31, 2016 were as follows (in thousands):

Foreign currency translation adjustments

Unrealized gain on derivative instruments:

Unrealized gains arising during period

Reclassification adjustment for gains realized in net income

Net unrealized gain

Other comprehensive income

Other (Expense) Income, Net

Before-Tax 
Amount

Tax (Expense) 
or Benefit

Net-of-Tax 
Amount

(1,813) $

— $

(1,813)

1,477

336

1,813

— $

(576)

(131)

(707) $

(707) $

901

205

1,106

(707)

$

$

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

Net realized foreign currency (loss) gain

Net unrealized foreign currency (loss) gain

Other, net

Total other expense, net

3. Business Combinations

Transaction Overview

Years Ended December 31,

2017

2016

2015

$

$

(10,833) $

12,357

$

(7,912)

(1,101)

(20,681)

(678)

(19,846) $

(9,002) $

2,237

795

825

3,857

On August 1, 2017 (the “Merger Date”), the Company completed the Merger with inVentiv with the Company 
surviving as the accounting and legal entity acquirer. The Merger was accounted for as a business 
combination using the acquisition method of accounting in accordance with ASC Topic 805, Business 
Combinations. The purchase price has been preliminarily allocated to the tangible assets and identifiable 
intangible assets acquired and liabilities assumed based upon their fair values. The excess of the purchase 
price over the tangible and intangible assets acquired and liabilities assumed has been recorded as goodwill. 
The goodwill in connection with the Merger is primarily attributable to the assembled workforce of inVentiv and 
the expected synergies of the Merger.

At the Merger Date, the shares of inVentiv’s outstanding common stock were converted into 49,297,022 
shares of the Company’s common stock at an exchange ratio of 3.4928. In addition, inVentiv equity awards 
held by current employees and certain members of the former inVentiv board of directors were converted into 
Company equity awards using the exchange ratio. The value of the Merger consideration was approximately 
$4.51 billion, as discussed below. 

Concurrent with the completion of the Merger, on August 1, 2017, the Company entered into a Credit 
Agreement (the “2017 Credit Agreement”) for: (i) a $1.0 billion Term Loan A facility that matures on August 1, 
2022 (“Term Loan A”); (ii) a $1.6 billion Term Loan B facility that matures on August 1, 2024 (“Term Loan B”); 
and (iii) a five-year $500.0 million revolving credit facility (the “Revolver”). The Company used available cash 
and borrowings under the 2017 Credit Agreement to (among other things): (i) repay and extinguish 
approximately $445.0 million of outstanding loans and obligations under the Company’s existing long-term 
credit facility; (ii) repay approximately $1.74 billion of outstanding obligations under inVentiv’s long-term 
borrowings and associated accrued interest, which was treated as Merger consideration; (iii) pay 
approximately $290.3 million to partially redeem the principal balance of the 7.5% Senior Unsecured Notes 
due 2024 (“Senior Notes”) assumed in the Merger, which included an early redemption penalty of $20.3 
million; and (iv) pay certain fees and other transaction expenses related to the Merger. For additional 
information related to the 2017 Credit Agreement, see "Note 4 - Long-Term Debt Obligations."

115

 
For the year ended December 31, 2017, the Company incurred $123.8 million of Merger-related expenses 
which were accounted for separately from the business combination and expensed as incurred within the 
“Transaction and integration related expenses” line item of the audited consolidated statements of operations. 
These costs consisted primarily of investment banker fees, advisory fees, legal costs, accounting and 
consulting fees, share-based compensation expense, and employee retention bonuses. The Company also 
incurred approximately $5.8 million of bridge financing fees which are included in the “Interest expense” line 
item in the audited consolidated statements of operations for the year ended December 31, 2017. The 
Company deferred $25.5 million of financing costs incurred as a result of the 2017 Credit Agreement. These 
costs will be amortized over the term of the related debt.  

In connection with the Merger, the Company assumed certain contingent tax-sharing obligations of inVentiv. 
The fair value of the assumed contingent tax-sharing obligation payable to the former shareholders of inVentiv 
was estimated to be $62.8 million at the Merger Date. The assumed contingent tax-sharing obligation is 
based on the future realization of certain transaction tax deductions that created net operating losses 
acquired or generated by the Company in the Merger (the “Acquired NOLs”) which arose in connection with 
inVentiv’s 2016 acquisition by Double Eagle Parent, Inc. As such transaction tax deductions are realized as a 
result of reducing federal or state income taxes payable, the Company is obligated to make payments to the 
former stockholders of inVentiv. The amount of Acquired NOLs are estimated to be approximately $187.8 
million ($71.5 million of estimated net tax benefits). However, in no event are the Acquired NOLs permitted to 
exceed $220.0 million, and the associated net tax benefits will be paid to the former shareholders of inVentiv if 
and when such deductions reduce income taxes payable. 

The tax sharing agreement was contingent consideration of inVentiv that was acquired in the Merger. The fair 
value of the contingent tax-sharing liability is remeasured at the end of each reporting period, with changes in 
the estimated fair value reflected in earnings until the liability is fully settled. During 2017, the Company 
recorded adjustments reducing the fair value of the contingent tax-sharing obligations by $12.3 million, driven 
primarily by the effect of enactment of the Tax Act which reduced the corporate income tax rate from 35% to 
21% effective January 1, 2018. These adjustments have been included in the "Transaction and integration-
related expense" line item in the accompanying consolidated statement of operations for the year ended 
December 31, 2017. As of December 31, 2017, the estimated fair value of the contingent tax-sharing 
obligations liability was $50.5 million, which is included in the “Accrued liabilities” and “Other long-term 
liabilities” line items of the accompanying audited consolidated balance sheet.

The results of inVentiv’s operations are included in the Company’s consolidated statements of operations 
beginning on the Merger Date. For the year ended December 31, 2017, net service revenue attributable to 
inVentiv was $839.0 million and reimbursable out-of-pocket revenue was $260.0 million. Following the closing 
of the Merger, the Company began integrating inVentiv’s operations. As a result, computing a separate 
measure of inVentiv’s stand-alone profitability for the period after the Merger Date is impracticable.

Fair Value of Consideration Transferred

The preliminary Merger Date fair value of the consideration transferred consisted of the following (in 
thousands, except for share and per share amounts):

Fair value of common stock issued to acquiree stockholders (a)
Fair value of replacement share-based awards issued to acquiree employees (b)
Repayment of term loan obligations and accrued interest (c)

Total consideration transferred

$

$

2,753,239

16,232

1,736,152

4,505,623

(a) Represents the fair value of 49,297,022 shares of the Company’s common stock at $55.85 per share, the closing price 
per share on the Merger closing date of August 1, 2017.

(b) Represents the fair value of replacement share-based awards attributable to pre-combination services. For further 
information about the valuation of share-based awards, see "Note 10 - Share-Based Compensation."

(c) Represents repayment of inVentiv’s term loan obligations and related accrued interest as part of the Merger 
consideration on the Merger Date. For further information, see "Note 4 - Long-Term Debt Obligations."  

116

Allocation of Consideration Transferred

The following table summarizes the preliminary allocation of the consideration transferred based on 
management’s estimates of Merger Date fair values of assets acquired and liabilities assumed, with the 
excess of the purchase price over the estimated fair values of the identifiable net assets acquired recorded as 
goodwill (in thousands): 

Assets acquired:

Cash and cash equivalents

Restricted cash

Accounts receivable

Unbilled accounts receivable

Other current assets

Property and equipment

Intangible assets

Other assets

Total assets acquired

Liabilities assumed:

Accounts payable

Accrued liabilities

Deferred revenue

Capital leases

Long-term debt, current and non-current

Deferred income taxes, net

Other liabilities

Total liabilities assumed

Total identifiable assets acquired, net

Goodwill

$

$

57,338

433

363,137

261,585

95,506

113,674

1,334,200

50,052

2,275,925

38,871

306,649

247,474

40,928

737,872

11,382

120,621

1,503,797

772,128

3,733,495

The goodwill recognized in connection with the Merger was $3.73 billion, of which $2.24 billion was assigned 
to the Clinical Solutions segment and $1.49 billion to the Commercial Solutions segment. Goodwill generated 
in the Merger is not deductible for income tax purposes. The Company’s assessment of fair value and 
purchase price allocation are preliminary and subject to change as discussed below. During the fourth quarter 
of 2017, the Company made certain adjustments to the preliminary fair value of acquired assets and assumed 
liabilities to reflect additional information obtained in connection with the Merger. The net effect of the 
adjustments was an increase in goodwill by $25.1 million. Further adjustments may be necessary as 
additional information related to the fair values of assets acquired and liabilities assumed is assessed during 
the measurement period (up to one year from the Merger Date). 

The following table summarizes the preliminary estimates of the fair value of identified intangible assets and 
their respective useful lives as of the Merger Date (in thousands, except for estimated useful lives): 

Customer relationships

Backlog

Trademarks subject to amortization

Total intangible assets

Estimated Fair Value

Estimated Useful Life

$

$

1,169,700

6 years - 11 years

137,100

5 months - 2 years

27,400

5 months - 6 years

1,334,200

117

 
 
Unaudited Pro Forma Financial Information

The following unaudited pro forma financial information was derived from the historical financial statements of 
the Company and inVentiv, and presents the combined results of operations as if the Merger had occurred on 
January 1, 2016. The pro forma financial information is presented for comparative purposes only and is not 
necessarily indicative of the results that would have actually occurred had the Merger been completed on 
January 1, 2016. In addition, the unaudited pro forma financial information does not give effect to any 
anticipated cost savings, operating efficiencies or other synergies that may result from the Merger, or any 
estimated costs that have been or will be incurred by the Company to integrate the assets and operations of 
inVentiv. Consequently, actual future results of the Company will differ from the unaudited pro forma financial 
information presented below (in thousands, except per share data).

Pro forma total revenue

Pro forma net loss

Pro forma loss per share:

   Basic

   Diluted

December 31, 2017

December 31, 2016

$

$

$

4,221,936

$

(58,545)

4,354,038

(208,013)

(0.64) $

(0.64) $

(2.01)

(2.01)

The unaudited pro forma adjustments primarily relate to the depreciation of acquired property and equipment, 
amortization of acquired intangible assets and interest expense and amortization of deferred financing costs 
related to the new financing arrangements. In addition, the unaudited pro forma net loss for the year ended 
December 31, 2017 was adjusted to exclude certain merger-related nonrecurring adjustments; these 
adjustments were included in the year ended December 31, 2016 giving effect to the Merger as if it had 
occurred on January 1, 2016. The nonrecurring merger-related adjustments include transaction costs, 
retention and severance payments, share-based compensation expense related to the acceleration of share-
based compensation awards and replacement share-based awards, and financing fees. These nonrecurring 
adjustments to net loss in the aggregate, net of tax effects (where applicable), were $111.8 million and 
$(111.8) million for the years ended December 31, 2017 and 2016, respectively. 

4. Long-Term Debt Obligations

The Company’s debt obligations consisted of the following (in thousands):

December 31, 2017

December 31, 2016

Secured Debt

Term Loan A due August 2021

Revolving credit facility due August 2021

Term Loan A due August 2022

Term Loan B due August 2024 

Revolving credit facility due August 2022

Total secured debt

Unsecured Debt

7.5% Senior Unsecured Notes due 2024

Total debt obligations

Add: unamortized Senior Notes premium, net of original issue debt 
discount

Less: unamortized deferred issuance costs

Less: current portion of debt

$

— $

—

1,000,000

1,550,000

—

2,550,000

403,000

2,953,000

38,656

(20,722)

(25,000)

Total debt obligations, non-current portion

$

2,945,934

$

118

475,000

25,000

—

—

—

500,000

—

500,000

—

(2,276)

(11,875)

485,849

2017 Credit Agreement

Concurrent with the completion of the Merger on August 1, 2017, the Company entered into the 2017 Credit 
Agreement for: (i) a $1.0 billion Term Loan A facility that matures on August 1, 2022; (ii) a $1.6 billion Term 
Loan B facility that matures on August 1, 2024; and (iii) a five-year $500.0 million revolving credit facility (the 
“Revolver”) that matures on August 1, 2022. The Company used available cash and the borrowings under the 
2017 Credit Agreement to (among other things); (i) repay and extinguish approximately $445.0 million of 
outstanding loans and obligations under the Company’s previously existing long-term credit facility; (ii) repay 
approximately $1.74 billion of outstanding obligations under inVentiv’s long-term credit facility; (iii) pay 
approximately $290.3 million to partially redeem the principal of the Senior Notes assumed in the Merger, 
which included an early redemption penalty of $20.3 million; and (iv) pay fees, premiums, and other 
transaction expenses related to the Merger.

All obligations under the 2017 Credit Agreement are guaranteed by the Company and certain of the 
Company's direct and indirect wholly-owned domestic subsidiaries. The obligations under the 2017 Credit 
Agreement are secured by substantially all of the assets of the Company and the guarantors, including 65% 
of the capital stock of certain controlled foreign subsidiaries.

Beginning on January 31, 2018 through July 31, 2022, the Term Loan A has scheduled quarterly principal 
payments of the initial principal borrowed of 0.625%, or $6.25 million per quarter in year 1; 1.25%, or $12.5 
million per quarter in year 2; 1.875%, or $18.75 million per quarter in year 3; and 2.50%, or $25.0 million per 
quarter thereafter; with the remaining outstanding principal due on August 1, 2022. 

Under the 2017 Credit Agreement, the Company is required to make quarterly principal payments of the initial 
principal borrowed under the Term Loan B of 0.25%, or $4.0 million per quarter; with the remaining 
outstanding principal due on August 1, 2024. During 2017, the Company made voluntary prepayments 
of $50.0 million on the Term Loan B, which was applied against the regularly-scheduled quarterly principal 
payments. As a result of the prepayments, the Company is not required to make a mandatory principal 
payment against the Term Loan B until January 31, 2021. 

The term loans and the Revolver bear interest at a rate per annum equal to the adjusted Eurocurrency Rate 
(“Eurocurrency Rate”) plus an applicable rate or an alternate base rate (“Base Rate”) plus an applicable rate. 
The Company may select among the Eurocurrency Rate or the Base Rate, whichever is lower, except in 
circumstances where the Company request a loan with less than a three-day notice.  In such cases, the 
Company must use the Base Rate. The Eurocurrency Rate is equal to LIBOR, subject to adjustment for 
reserve requirements. The Base Rate is equal to the highest of: (i) the federal funds rate plus 0.50%; (ii) the 
Eurocurrency Rate for an interest period of one month plus 1.00%; (iii) the rate of interest per annum publicly 
announced from time to time by Credit Suisse as its prime rate; and (iv) 0.00%. 

Eurocurrency Rate term loans are one-, two-, three-, or six-month loans (or, with permission, twelve-month 
loans) and interest is due on the last day of each three-month period of the loans. Base Rate term loans have 
interest due the last day of each three-month period beginning in January 2018. In advance of the last day of 
the then-current type of loan, the Company may select a new type of loan, so long as it does not extend 
beyond the term loan’s maturity date. Additionally, the 2017 Credit Agreement permits the Borrower to 
increase its term loan or Revolver commitments under the term loan facilities and/or revolving credit facility 
and/or to request the establishment of one or more new term loan facilities and/or revolving facilities in an 
aggregate amount to be no less than $725.0 million, if certain net leverage requirements are met. The 
availability of such additional capacity is subject to, among other things, receipt of commitments from existing 
lenders or other financial institutions. 

119

The applicable margins with respect to Base Rate and Eurocurrency Rate borrowings are determined 
depending on the “First Lien Leverage Ratio” or the "Secured Net Leverage Ratio" (as defined in the 2017 
Credit Agreement) and range as follows:

Term Loan A

Term Loan B

Revolver

Base Rate

Eurocurrency Rate

0.50% - 0.75%

1.50% - 1.75%

1.00% - 1.25%

2.00% - 2.25%

0.25% - 0.75%

1.25% - 1.75%

The Company also pays a quarterly commitment fee between 0.25% and 0.375% on the average daily 
unused balance of the Revolver depending on the “First Lien Leverage Ratio” at the adjustment date. As of 
December 31, 2017, the interest rate on the Term Loan A and the Revolver was 3.319% and the interest rate 
on the Term Loan B was 3.819%.

Letters of Credit

The Revolver includes letters of credit ("LOCs") with a sublimit of $150.0 million. Fees are charged on all 
outstanding LOCs at an annual rate equal to the margin in effect on Eurocurrency Rate revolving loans plus 
fronting fees. The fee is payable quarterly in arrears on the last day of the calendar quarter after the issuance 
date until the underlying LOC expires. As of December 31, 2017, there were no outstanding Revolver 
borrowings and $18.6 million of LOCs outstanding, leaving $481.4 million in available borrowings under the 
Revolver. In addition, as of December 31, 2017, the Company had $1.2 million of LOCs that were not secured 
by the Revolver.

Additionally, the lease for the new corporate headquarters in Morrisville, North Carolina includes a provision 
which requires the Company to issue a letter of credit ("LOC") in certain amounts to the landlord based on the 
debt rating of the Company issued by Moody’s Investors Service (or other nationally-recognized debt rating 
agency). From June 14, 2017 through June 14, 2020, if the debt rating of the Company is Ba3 or better, no 
LOC is required, or if the debt rating of the Company is B1 or lower, a LOC equal to 25% of the remaining 
minimum annual rent and estimated operating expenses (approximately $24.2 million as of December 31, 
2017) is required to be issued to the landlord. This LOC would remain in effect until the Company’s debt rating 
was increased to Ba3 and maintained for a twelve-month period. After June 14, 2020, if the debt rating of the 
Company is Ba2 or better, no LOC is required; if the debt rating is Ba3, a LOC equal to 25% of the then 
remaining minimum annual rent and estimated operating expenses is required to be issued to the landlord; or 
if the debt rating of the Company is B1 or lower, a LOC equal to 100% of the then remaining minimum annual 
rent and estimated operating expenses is required to be issued to the landlord. These LOCs would remain in 
effect until the Company’s debt rating is Ba2 or better and maintained for a twelve-month period. 

As of December 31, 2017 (and through the date of this filing), the Company’s debt rating was Ba3. As such, 
no LOC is currently required. Any LOCs issued in accordance with the aforementioned requirements would be 
issued under the Company’s Revolver, and would reduce its available borrowing capacity by the same 
amount accordingly.

Debt Covenants

The 2017 Credit Agreement contains usual and customary restrictive covenants that, among other things, 
place limitations on the Company's ability to pay dividends or make other restricted payments; prepay, 
redeem or purchase debt; incur liens; make loans and investments; incur additional indebtedness; amend or 
otherwise alter debt and other material arrangements; make acquisitions and dispose of assets; transact with 
affiliates; and engage in transactions that are not related to the Company's existing business. Each of the 
restrictive covenants is subject to important exceptions and qualifications that would allow the Company to 
engage in these activities under certain conditions, including the Company’s ability to: (i) pay dividends each 
year in an amount up to the greater of (a) 6% of the net cash proceeds received by the Company from any 
public offering and (b) 5% of the Company’s market capitalization; and (ii) pay unlimited dividends if the 
Company’s Secured Leverage Ratio is no greater than 3.0 to 1.0. As of December 31, 2017, the Company 
was in compliance with all applicable debt covenants.

120

In addition, with respect to the Term Loan A and Revolver, the 2017 Credit Agreement requires the Company 
to maintain a maximum First Lien Leverage Ratio of no more than 5.0 to 1.0 as of the last day of each fiscal 
quarter ending on or before December 31, 2018 (beginning with the first full fiscal quarter ending after the 
closing date of the 2017 Credit Agreement), and 4.5 to 1.0 from and after March 31, 2019. 

7.5% Senior Unsecured Notes due 2024

As a result of the August 2017 Merger, the Company assumed $675.0 million of principal balance of Senior 
Unsecured Notes. Upon closing of the Merger, the Company immediately redeemed $270.0 million of the 
principal balance of Senior Notes and paid $20.3 million of the applicable early redemption penalty. 

Interest on the remaining Senior Notes is payable semi-annually on the first day of April and October of each 
year and are guaranteed by the Company and certain of the Company's direct and indirect wholly-owned 
domestic subsidiaries. The Senior Notes are unsecured obligations and will (i) rank equal in right of payment 
to all of the Company’s existing and future senior unsecured obligations, (ii) be effectively subordinated to the 
Company’s secured indebtedness, including the 2017 Credit Agreement, to the extent of the value of the 
assets securing such indebtedness, (iii) rank senior in right of payment to any of the Company’s future 
indebtedness that is expressly subordinated in right of payment to the Senior Notes and the guarantees and 
(iv) be structurally subordinated to any existing and future obligations of any subsidiaries of the Company that 
do not guarantee the Senior Notes. 

On or after October 1, 2019, the Company may redeem the Senior Notes in whole or in part, at a redemption 
price equal to the percentage of principal amount set forth below, plus accrued and unpaid interest during the 
twelve-month period beginning on the first of October of each of the years indicated below:

Year

2019

2020

2021 and thereafter

Percentage

103.750%

101.875%

100.000%

In December 2017, the Company acquired $2.0 million of principal amount of the Senior Notes through an 
open market purchase for a cash payment of $2.2 million and immediately retired the principal amount. 

Maturities of Debt Obligations

As of December 31, 2017, the contractual maturities of the Company’s debt obligations (excluding capital 
leases which are presented in "Note 5 - Leases") were as follows (in thousands):

2018

2019

2020

2021

2022

2023 and thereafter

Less: deferred issuance costs

Senior Notes premium, net of original issue debt discount

Total long-term debt

Less: current portion of debt

Total debt obligations, non-current portion

121

$

$

25,000

50,000

75,000

114,000

766,000

1,923,000

(20,722)

38,656

2,970,934

(25,000)

2,945,934

 
Debt Extinguishment Costs and Senior Notes Redemption Penalty

On the Merger Date, the Company paid a contractual early redemption penalty of $20.3 million to redeem 
40% of the Senior Notes that were assumed in the Merger. In accordance with ASC Topic 805, Business 
Combinations, the carrying value of the Senior Notes assumed in the Merger was adjusted to estimated fair 
value, which resulted in an increase of the amount of the Company’s consolidated debt and recognition of a 
premium on the Senior Notes, of which $20.3 million was allocated to the redeemed portion of the Senior 
Notes. This portion of the premium offset the early redemption penalty, resulting in no gain or loss on the 
extinguishment of the Senior Notes. The remaining balance of the premium associated with the fair value 
adjustment is being amortized as a component of interest expense using the effective interest rate method 
over the term of the remaining Senior Notes.

In August 2016, the Company entered into the First Amendment to 2017 Credit Agreement and Increase 
Revolving Joinder, which amended the 2015 Credit Agreement (as amended, the "2016 Credit Agreement"). 
The five-year $675.0 million 2016 Credit Agreement was comprised of a $475.0 million term loan and a 
$200.0 million revolving line of credit. In conjunction with this amendment, the Company recognized a loss on 
extinguishment of debt of $0.4 million. As of December 31, 2016, $475.0 million was outstanding on the term 
loan, bearing interest at 2.11%, and $25.0 million was outstanding on the revolving line of credit, bearing 
interest at 2.11%.

In May 2015, the Company entered into the 2015 Credit Agreement and used the proceeds to repay all of its 
outstanding obligations under the 2014 Credit Agreement and to pay transaction costs associated with the 
2017 Credit Agreement. As a result, the Company recognized a $9.4 million loss on extinguishment of debt 
related to the 2014 Credit Agreement, which was comprised of $5.1 million of unamortized discount and $4.3 
million of unamortized debt issuance costs. In addition, in June 2015 the Company made a prepayment 
of $50.0 million under the 2015 Credit Agreement and as a result recognized an additional loss on 
extinguishment of debt of $0.4 million. As of December 31, 2015, $475.0 million was outstanding on the Term 
Loan, bearing interest at 2.16%, and $30.0 million was outstanding on the revolving line of credit, bearing 
interest at 4.25%.

Debt Issuance Costs and Debt Discount

The Company recorded debt issuance costs related to its term loans of approximately $20.7 million and $2.3 
million as of December 31, 2017 and 2016, respectively. These costs were recorded as a reduction of the 
principal balance of the associated debt and are being amortized as a component of interest expense using 
the effective interest method over the term of the term loans.

The Company recorded total debt issuance costs related to its revolving lines of credit of approximately $5.2 
million and $1.0 million as of December 31, 2017 and 2016, respectively. Debt issuance costs associated with 
the revolving line of credit are included in other assets in the consolidated balance sheets. The debt issuance 
costs are amortized as a component of interest expense using the effective interest method over the term of 
the Revolver. 

Borrowings under the 2017 Credit Agreement were issued net of a discount. As of December 31, 2017, the 
balance associated with this discount was $1.9 million, which is being accreted as a component of interest 
expense using the effective interest rate method over the term of the 2017 Credit Agreement.

122

5. Leases

Operating Leases

The Company leases its office facilities, office equipment, and other assets under non-cancellable operating 
lease agreements. Operating leases are expensed on a straight-line basis over the term of the lease and may 
include certain renewal options and escalation clauses. 

The Company has a lease agreement for its corporate headquarters in Raleigh, North Carolina, that extends 
through February of 2019. In January 2017, the Company entered into a 12-year lease for a new corporate 
headquarters building in Morrisville, North Carolina, where it intends to relocate all employees from its two 
existing locations in Raleigh, North Carolina. In June 2017, this lease was amended to add office space and 
to extend the term of the lease to 13 years. The Company expects the construction of the new building to be 
completed in late-2018 and anticipates completing its relocation efforts prior to the current leases expiring in 
early 2019. 

In February 2017, the Company entered into an 11-year lease agreement for new office space in 
Farnborough, United Kingdom, which is near its existing Camberley site. In January 2018, the Company 
replaced its lease agreement for the Farnborough location with a new 10-year lease agreement. The new 
agreement provides for additional office space to accommodate the Company's operating plans following the 
Merger. Rent payments associated with the new lease agreements are scheduled to commence in May 2019. 
The new lease agreement increases the Company's future lease obligations for this location by approximately 
$11.8 million. This amount has not been included in the future minimum lease payments table presented in 
"Future Minimum Lease Payments" section below. The Company anticipates completing its relocation efforts 
to the Farnborough location prior to its Camberley lease expiring in 2018. 

Rent expense under the operating lease agreements was $40.9 million, $20.7 million, and $18.3 million for 
the years ended December 31, 2017, 2016, and 2015, respectively.

In connection with the Merger, the Company has established a restructuring plan to consolidate its facilities 
worldwide. For additional information related to the restructuring activities associated with the Merger, see 
"Note 8 - Restructuring and Other Costs."

Capital Leases

The Company leases vehicles for certain sales representatives in its Commercial Solutions segment. These 
lease arrangements are classified and accounted for as capital leases. Certain vendors have the right to 
declare the Company in default of its agreements if any such vendor, including the lessors under its vehicle 
leases, determines that a change in the Company’s financial condition poses a substantially increased credit 
risk. 

As of December 31, 2017, the Company had total capital lease obligations related to vehicles under capital 
leases of $36.8 million. The Company had no lease arrangements classified as capital leases and thus no 
capital lease obligations as of December 31, 2016.

123

Future Minimum Lease Payments

As of December 31, 2017, future minimum rental payments under the Company’s non-cancellable operating 
leases with terms in excess of one year, and maturities of the future minimum lease payments under capital 
lease obligations are summarized as follows (in thousands):

Fiscal Year

2018

2019

2020

2021

2022

2023 and thereafter

Total future minimum lease payments (a) (b)
Less: amounts representing interest and fees (b)
Present value of capital lease obligations (c)

Less: current portion

Operating Leases

Capital Leases

$

$

60,671

$

52,485

44,871

39,710

32,463

112,112

342,312

17,526

13,293

6,042

1,900

—

—

38,761

(1,971)

36,790

(16,414)

20,376

Capital lease obligations, non-current portion

$

(a) Amounts related to leases that are included within our restructuring accrual as of December 31, 2017 have not been 
included in the table above. For additional information related to the facility restructuring activities, see "Note 8 - 
Restructuring and Other Costs."

(b) Future capital lease commitments include interest and management fees, which are not recorded on the consolidated 
balance sheet as of December 31, 2017 and will be expensed as incurred.

(c) Capital lease obligations have a weighted average imputed interest rate of approximately 3.4% and mature in various 
installments through December, 2022. 

6. Derivatives

In May 2016, the Company entered into interest rate swaps with a combined notional value of $300.0 million in 
an effort to limit its exposure to variable interest rates on its Term Loan. Interest began accruing on the swaps 
on June 30, 2016 and the interest rate swaps will expire on June 30, 2018 and May 14, 2020. The material terms 
of these derivatives are substantially the same as those contained within the 2017 Credit Agreement, including 
monthly settlements with the swap counterparty. 

The fair values of the Company’s interest rate swaps designated as hedging instruments and the line items on 
the accompanying consolidated balance sheets to which they were recorded are as follows (in thousands):

Balance Sheet Classification

December 31, 2017

December 31, 2016

Interest rate swaps - current 

Prepaid expenses and other
current assets

Interest rate swaps - non-current

Other long-term assets

$

$

916

1,263

$

$

461

1,717

The amounts of hedge ineffectiveness recorded in net income during the years ended December 31, 2017 
and December 31, 2016 were immaterial and were attributable to the inconsistencies in certain terms 
between the interest rate swaps and the 2017 Credit Agreement.

124

 
 
 
 
7. Fair Value Measurements

Assets and Liabilities Carried at Fair Value

As of December 31, 2017 and 2016, the Company’s financial assets and liabilities carried at fair value 
included cash and cash equivalents, restricted cash, trading securities, billed and unbilled accounts 
receivable, accounts payable, accrued liabilities, and interest rate derivative instruments. As of December 31, 
2017, the assumed contingent tax-sharing obligations and capital leases were also included in the Company’s 
financial assets and liabilities carried at fair value.

The fair value of cash and cash equivalents, restricted cash, billed and unbilled accounts receivable, accounts 
payable, and accrued liabilities approximates their respective carrying amounts because of the liquidity and 
short-term nature of these financial instruments.  

Financial Instruments Subject to Recurring Fair Value Measurements

As of December 31, 2017, the fair values of the major classes of the Company’s assets and liabilities 
measured at fair value on a recurring basis were as follows (in thousands):

Assets:
Trading securities (a)
Derivative instruments (b)

Total assets

Liabilities:

Level 1

Level 2 

Level 3

Total

$

$

16,318

$

—

16,318

$

— $

2,179

2,179

$

— $

—

— $

16,318

2,179

18,497

Contingent tax-sharing obligation assumed 
through business combinations (c)
Total liabilities

$

$

— $

— $

— $

— $

50,480

50,480

$

$

50,480

50,480

(a) Represents fair value of investments in mutual funds based on quoted market prices which are used to offset the 
liability associated with the deferred compensation plan (see "Note 13 - Employee Benefit Plans" for further information). 

(b) Represents fair value of interest rate swap arrangements. 
(c) Represents fair value of contingent tax-sharing obligations assumed as a result of the Merger (see "Note 3 - Business 
Combinations" for further information). The fair value of this liability is determined based on the Company’s 
best estimate of the probable timing and amount of settlement.

As of December 31, 2016, the fair value of the interest rate swaps was as follows (in thousands):

Assets:

Derivative instruments

$

— $

2,178

$

— $

2,178

Level 1

Level 2

Level 3

Total

125

The following table presents a reconciliation of changes in the carrying amount of contingent tax-sharing 
obligations classified as Level 3 category of fair value measurements for the year ended December 31, 2017 
(in thousands):

Balance at December 31, 2016

Additions (a)
Changes in fair value recognized in earnings (b)

Payments

Balance at December 31, 2017

$

$

—

62,756

(12,276)

—

50,480

(a) Represents the fair value of the contingent tax-sharing obligations in connection with the Merger described in "Note 3 - 
Business Combinations."

(b) The change in fair value of the contingent tax-sharing arrangement is primarily due to the Tax Act and the resulting US 
corporate tax rate change from 35% to 21%. 

During the years ended December 31, 2017 and 2016, there were no transfers of assets or liabilities between 
Level 1, Level 2 or Level 3 fair value measurements.

Financial Instruments Subject to Non-Recurring Fair Value Measurements

Certain assets, including goodwill and identifiable intangible assets, are carried on the accompanying audited 
consolidated balance sheets at cost and are not remeasured to fair value on a recurring basis. These assets 
are classified as Level 3 fair value measurements within the fair value hierarchy. Goodwill and indefinite-lived 
intangible assets are tested for impairment annually or more frequently if events or changes in circumstances 
indicate a triggering event has occurred. The Company tests finite-lived intangible assets for impairment upon 
the occurrence of certain triggering events. During 2017, the Company recognized approximately $30.0 
million of impairment related to intangible assets, as discussed in "Note 2 - Financial Statement Details." As of 
December 31, 2017 and December 31, 2016, assets carried on the balance sheet and not remeasured to fair 
value on a recurring basis totaled $5,578.6 million and $667.0 million, respectively. 

Fair Value Disclosures for Financial Instruments Not Carried at Fair Value

The Company’s financial instruments not recorded at fair value that are subject to fair value disclosure 
requirements include long-term borrowings. The estimated fair value of the outstanding term loans and Senior 
Unsecured Notes is determined based on the market prices for similar financial instruments or model-derived 
valuations based on observable inputs. These liabilities were considered to be Level 2 fair value 
measurements. The estimated fair values of the Company’s outstanding term loans, Revolver, and Senior 
Unsecured Notes were as follows (in thousands):

December 31, 2017

December 31, 2016

Carrying
Value

Estimated
Fair Value

Carrying
Value

Estimated
Fair Value

Term Loan A due August 2021

$

Revolving credit facility due August 2021

— $

—

— $
—

475,000

$

475,000

25,000

25,000

Term Loan A due August 2022

1,000,000

1,000,000

Term Loan B due August 2024 (net of original issue 
debt discount)

7.5% Senior Unsecured Notes due 2024 (inclusive of 
unamortized premium)

1,548,149

1,550,000

443,507

433,729

—

—

—

—

—

—

126

8. Restructuring and Other Costs

Merger Related Restructuring

In connection with the Merger, the Company has established a restructuring plan to eliminate redundant 
positions and reduce its facility footprint worldwide. The Company expects to continue the ongoing 
evaluations of its workforce and facilities infrastructure needs through 2020 in an effort to optimize its 
resources worldwide. Additionally, in conjunction with the Merger, the Company assumed certain liabilities 
related to employee severance and facility closure costs as a result of actions taken by inVentiv prior to the 
Merger. During the year ended December 31, 2017, the Company recognized approximately $11.3 million of 
employee severance and benefit costs, facility closure and lease termination costs of $2.2 million, and other 
costs of $2.0 million related to the Merger. The Company expects to incur significant costs related to the 
restructuring of its operations in order to achieve the targeted synergies as a result of the Merger over the 
next several years. However, the timing and the estimate of the amount of these costs depends on various 
factors, including, but not limited to, identifying and realizing synergy opportunities and executing the 
integration of our combined operations.

2017 Restructuring

In addition to costs incurred as a result of the Merger, during the year ended December 31, 2017, the 
Company recognized approximately $9.4 million of employee severance costs, including CEO transition 
costs, and incurred $1.3 million of facility closure and lease termination costs related to the Company’s non-
Merger related restructuring activities. Included in restructuring and other costs during the year ended 
December 31, 2017 are $5.0 million of consulting costs related to the restructuring of its contract 
management process to meet the requirements of upcoming accounting regulation changes and $2.1 million 
of other costs.

2016 Realignment Plan and CEO Transition

In March 2016, management approved a global plan to eliminate certain positions worldwide in an effort to 
ensure that the Company's organizational focus and resources were properly aligned with its strategic goals 
and to continue strengthening the delivery of its growing backlog to customers. Accordingly, the Company 
made changes to its therapeutic unit structure designed to realign with management focus and optimize the 
efficiency of its resourcing to achieve its strategic plan. As a result, the Company eliminated 
approximately 200 positions and incurred $7.0 million related to employee severance costs during the year 
ended December 31, 2016. All actions under this plan were completed by December 31, 2017. 

During the third quarter of 2016, the Company also announced the closure of one of its facilities associated 
with this restructuring and incurred facility closure costs of $1.5 million, which were partially offset by 
unamortized deferred rent of $0.5 million during the year ended December 31, 2016.

In July 2016, the Company entered into a transition agreement with its former Chief Executive Officer ("CEO") 
related to the transition to a new CEO as of October 1, 2016. The CEO transition agreement is effective 
through February 28, 2017. In addition, in mid-September 2016, the Company entered into retention 
agreements with certain key employees for various dates through September 2017. For the year 
ended December 31, 2016, the Company recognized $4.8 million of costs associated with the CEO transition 
and retention agreements, which will be paid through August 2018.

2015 Realignment Plan

During the second and fourth quarters of 2015, the Company initiated restructuring activities to better align its 
resources worldwide. Specifically, the Company initiated a plan to reduce its workforce by approximately 70  
employees, primarily in the United States and certain countries in Europe primarily within clinical operations,  
principally within the Clinical Development Services operations group and several corporate administrative 
functions. The Company completed the majority of these actions by December 31, 2015. Under this plan, the 
Company incurred $2.7 million of severance costs related to these activities during 2015.  

127

For the year ended December 31, 2015, the Company recorded a net reduction in facility closure expenses of 
$0.9 million.  During the year, the Company reversed previously accrued liabilities as a result of completing 
negotiations with respect to exiting certain facilities and reduced its exit cost estimates related to certain lease 
agreements as a result of subleasing a portion of facilities previously exited along with the return of a tenant 
improvement allowance. These adjustments were partially offset by expenses related to early lease 
termination fees and accruals for closure of smaller locations as the Company continues to optimize its 
facilities portfolio.  

Accrued Restructuring Liabilities

The following table summarizes activity related to the liabilities associated with restructuring and other costs 
during the years ended December 31, 2017, 2016 and 2015 (in thousands):

Employee Severance
Costs, Including 
Executive Transition 
Costs

Facility
Closure
Charges

Other
Charges

Total

Balance at December 31, 2014

$

— $

6,144

$

— $

Expenses incurred

Payments made

Balance at December 31, 2015

Expenses incurred

Reclassification of deferred rent

Payments made

Balance at December 31, 2016

Restructuring liabilities assumed 
through business combinations
Expenses incurred(a)
Payments made

2,666

(1,601)

1,065

11,765

—

(8,135)

4,695

3,362

16,878

(16,077)

(881)

(1,602)

3,661

987

507

(1,338)

3,817

7,449

1,749

(5,604)

—

—

—

860

—

(780)

80

—

5,801

(5,357)

Balance at December 31, 2017

$

8,858

$

7,411

$

524

$

6,144

1,785

(3,203)

4,726

13,612

507

(10,253)

8,592

10,811

24,428

(27,038)

16,793

(a) Total restructuring and other costs for the year ended December 31, 2017 include $8.9 million of other non-cash 
expenses that were not recorded as a restructuring liability and are therefore excluded from the roll-forward above.

The Company expects the employee severance costs accrued as of December 31, 2017 will be paid within 
the next twelve months. Certain facility costs will be paid over the remaining lease terms of the exited facilities 
which range from 2018 through 2027. Liabilities associated with these costs are included in the “Accrued 
liabilities” and “Other long-term liabilities” line items in the accompanying audited consolidated balance 
sheets. Costs recognized in net income during the period related to these activities are included in the 
“Restructuring and other costs” line item in the consolidated statements of operations. These costs are not 
allocated to the Company’s reportable segments because they are not part of the segment performance 
measures regularly reviewed by management.  

9. Shareholders' Equity

Merger

On August 1, 2017, the Company completed its Merger with inVentiv. In accordance with the terms of the 
Merger Agreement, the Company issued 49,297,022 fully diluted shares of the Company’s common stock 
with a par value of $0.01 per share in exchange for all outstanding inVentiv shares of common stock.

128

 
Stock Repurchases and Secondary Offerings

In May 2016, the Company's former sponsors sold 8,000,000 shares of the Company's Class A common 
stock in a registered secondary common stock offering.

In July 2016, the Company announced a stock repurchase program for shares of the Company’s common 
stock pursuant to which the Company was authorized to repurchase up to $150.0 million of its outstanding 
common stock in the open market, in block trades, or in privately negotiated transactions. The program 
commenced on August 1, 2016 and was scheduled to end no later than December 31, 2017. Through this 
program, in August 2016, the Company repurchased 4,500,000 shares of its common stock in a private 
transaction for a total purchase price of approximately $64.5 million. The Company immediately retired all of 
the repurchased common stock and charged the par value of the shares to common stock. The excess of the 
repurchase price over par was applied on a pro rata basis against additional paid-in-capital, with the 
remainder applied to accumulated deficit. On July 23, 2017, the Company terminated the repurchase 
program. 

The following is a summary of the Company's authorized, issued and outstanding shares:

Shares Authorized:

Class A common stock

Class B common stock

Preferred stock

Total shares authorized

Shares Issued and Outstanding:

Class A common stock

Class B common stock

Preferred stock

December 31, 2017

December 31, 2016

300,000,000

300,000,000

30,000,000

630,000,000

300,000,000

300,000,000

30,000,000

630,000,000

104,435,501

53,762,786

—

—

—

—

Total shares issued and outstanding

104,435,501

53,762,786

Voting Rights and Conversion Rights of the Common Stock

Each share of Class A common stock is entitled to one vote on all matters to be voted on by the shareholders 
of the Company, including the election of directors. Each share of Class B common stock is entitled to one 
vote on all matters to be voted on by the shareholders of the Company, except for the right to vote in the 
election of directors. Additionally, each share of Class B common stock is convertible (on a one-for-one basis) 
into Class A common stock at any time at the election of the holder.  

Dividend Rights and Preferences of the Common Stock

The holders of Class A and Class B common stock are entitled to dividends on a pro rata basis at such time 
and in such amounts as, if and when declared by Board of Directors (the “Board”). There were no dividends 
paid during the years ended December 31, 2017, 2016, or 2015. 

Liquidation Rights and Preferences of the Common Stock

The holders of Class A and Class B common stock are entitled to participate on a pro rata basis in all 
distributions made in connection with a voluntary or involuntary liquidation, dissolution or winding up of the 
affairs of the Company.

2018 Stock Repurchase Program

On February 26, 2018, the Board authorized the repurchase of up to an aggregate of $250.0 million of the 
Company’s common stock, par value $0.01 per share, from time to time in open market transactions effected 
through a broker at prevailing market prices, in block trades, or privately negotiated transactions. The stock 

129

 
 
 
 
 
repurchase program will commence on March 1, 2018 and end no later than December 31, 2019. The 
Company intends to use cash on hand and future free cash flow to fund the stock repurchase program. The 
stock repurchase program does not obligate the Company to repurchase any particular amount of the 
Company’s common stock, and may be modified, extended, suspended or discontinued at any time. The 
timing and amount of repurchases will be determined by the Company’s management based on a variety of 
factors such as the market price of the Company’s common stock, the Company’s corporate requirements, 
and overall market conditions. The stock repurchase program will be subject to applicable legal requirements, 
including federal and state securities laws. The Company may also repurchase shares of its common stock 
pursuant to a trading plan meeting the requirements of Rule 10b5-1 under the Securities Exchange Act of 
1934, as amended, which would permit shares of the Company’s common stock to be repurchased when the 
Company might otherwise be precluded from doing so by law.

10. Share-Based Compensation

Overview of Employee Share-Based Compensation Plans

The Company currently has two equity-based compensation plans, the INC Research Holdings, Inc. 2014 
Equity Incentive Plan ("2014 Plan") and the INC Research Holdings, Inc. 2016 Employee Stock Purchase 
Plan ("ESPP"), from which share-based awards are currently granted. In addition, the Company had the INC 
Research Holdings, Inc. 2010 Equity Incentive Plan ("2010 Plan") that was terminated effective October 30, 
2014, except as to outstanding awards. No further awards can be issued under the 2010 Plan. The 2014 Plan 
was established on November 3, 2014 and permits granting of stock options, stock appreciation rights, 
restricted stock awards, restricted stock units ("RSUs"), cash performance awards or stock awards to 
employees, as well as non-employee directors and consultants. The terms of equity-based instruments 
granted are determined at the time of grant and are typically subject to such conditions as continued 
employment, passage of time and/or satisfaction of performance criteria. Stock options and RSUs typically 
vest ratably over three-year to four-year periods from the grant date. The Board and the Compensation 
Committee have the discretion to determine different vesting schedules. Stock options have a maximum term 
of ten years. The exercise price per share of stock options may not be less than the fair market value of a 
share of the Company's common stock on the date of grant. Upon the exercise of stock options or vesting of 
RSUs, the Company issues new shares of common stock.  

On August 1, 2017, the Company filed a Form S-8 Registration Statement for the Double Eagle Parent, Inc. 
2016 Omnibus Equity Incentive Plan ("Double Eagle Plan"). The number of shares registered in that filing was 
1,500,000. Under this plan, the Company issued replacement awards consisting of options and RSUs. No 
further awards can be issued under the Double Eagle Plan. 

As of December 31, 2017, the Company had equity grants outstanding under the 2010 Plan, 2014 Plan, and 
the Double Eagle Plan. The maximum number of shares reserved for issuance under the Plans was 
8,437,325, of which 2,455,372 shares were available for future grants as of December 31, 2017. In addition, 
under the 2014 Plan outstanding stock award or stock option grants forfeited prior to vesting or exercise 
become available for future grants.

Employee Stock Purchase Plan 

In March 2016, the Board approved the ESPP, which was also approved by the Company’s shareholders in 
May 2016. The ESPP allows eligible employees to authorize payroll deductions of up to 10% of their annual 
base salary or wages to be applied toward the purchase of full shares of the Company’s common stock on the 
last trading day of the offering period. Participating employees can purchase shares of the Company's 
common stock at a 15% discount to the lesser of the closing price of the Company's common stock as quoted 
on the NASDAQ Stock Exchange on (i) the first trading day of the offering period or (ii) the last trading day of 
the offering period. Offering periods under the ESPP are six months in duration, and the first offering period 
began on September 1, 2016. Under this plan, the Company recognized share-based compensation expense 
of $1.7 million and $0.5 million for the years ended December 31, 2017 and 2016, respectively. As of 
December 31, 2017, there were 125,974 shares issued and 874,026 shares reserved for future issuance 
under the ESPP.

130

Share-Based Awards Exchanged in Business Combination

As a result of the Merger, the Company assumed the equity incentive plans formerly related to inVentiv.  In 
connection with the Merger, the vesting conditions of certain outstanding time- and performance-based stock 
option awards and RSUs of inVentiv were modified at the discretion of its board of directors. These 
modifications were treated as modifications of share-based awards and accounted for according to the 
provisions of ASC Topic 718, Compensation - Stock Compensation. As provided by the merger agreement, 
each vested option to purchase shares of inVentiv common stock outstanding immediately prior to the 
effective date of the Merger was automatically converted into a vested option to acquire shares of the 
Company’s common stock, on substantially the same terms and conditions, adjusted by the 3.4928 exchange 
ratio; and each restricted stock unit of inVentiv outstanding immediately prior to the effective date of the 
Merger was automatically converted into shares of the Company’s common stock at an exchange ratio of 
3.4928. The fair value of these awards was allocated to the purchase consideration in the amount of $16.2 
million and post-combination expense in the amount of $27.1 million, based on the portion of the vesting 
period completed prior to the date of the Merger. The assumed awards related to the Merger have been 
identified as applicable in the tables that follow.

Similarly, at the discretion of the Company’s board of directors, upon the Merger certain share-based awards 
of the Company outstanding immediately prior to the effective date of the Merger vested, and certain 
performance-based restricted stock units were converted into time-based restricted stock units at 100% of the 
target. The outstanding awards of approximately 50 employees were impacted. The aggregate incremental 
fair value of these awards was approximately $2.7 million, of which approximately $1.5 million was recognized 
during the year ended December 31, 2017. The remainder of the incremental fair value will be recognized 
over the remaining requisite service period of approximately 2.0 years.

Stock Option Awards

The following table sets forth the summary of option activity under our Plans for the year ended December 31, 
2017:

Weighted
Average
Exercise
Price

Weighted
Average
Remaining
Contractual Life
(in years)

Aggregate 
Intrinsic Value
(in thousands)(b)

Number of
Options

Outstanding at December 31, 2016

2,170,235

$

Assumed through business combinations(a)
Granted

Exercised

Forfeited

Expired

Outstanding at December 31, 2017

Vested and expected to vest at December 31,
2017

Exercisable at December 31, 2017

1,336,406

64,899

(991,894)

(55,484)

(6,657)

2,517,505

2,517,505

2,149,974

$

$

$

22.15

28.63

56.32

16.50

31.77

35.90

28.45

28.45

26.01

7.41

7.41

7.31

$

$

$

38,993

38,993

38,660

(a) Represents fully vested stock options issued as replacement awards in connection with the Merger.

(b) Represents the total pre-tax intrinsic value (i.e., the aggregate difference between the closing price of the Company’s 
common stock on December 31, 2017 of $43.60 and the exercise price for in-the-money options) that would have been 
received by the holders if all instruments had been exercised on December 31, 2017. 

As of December 31, 2017, there was $3.8 million of unrecognized compensation expense related to non-
vested stock options, which is expected to be recognized over a weighted average period of 2.0 years.  

131

 
Other information pertaining to the Company's stock option awards is as follows (in thousands, except per 
share data):

Weighted average grant date fair value of options granted

Total intrinsic value of options exercised

Years Ended December 31,

2017

2016

2015

$

$

13.88

37,928

$

$

14.26

45,126

$

$

13.80

27,560

Fair Value Assumptions

The fair value of stock option awards and ESPP offerings was determined using the Black-Scholes valuation 
model and the following assumptions:

Expected volatility: 

Stock options

ESPP

Risk-free interest rate:

Stock options

ESPP

Expected term (in years):

Stock options

ESPP

Dividend yield:

Stock options

ESPP

Restricted Stock Units Awards

Years Ended December 31,

2017

2016

2015

24.5% - 24.6%

29.4% - 30.9%

30.5% - 32.8%

36.0% - 46.5%

31.4%

—

1.80%

1.17% - 1.88%

1.38% - 1.88%

0.79% - 1.08%

0.47%

4.75 - 5.0

0.5

—%

—%

6.25

0.5

—%

—%

—

6

—

—%

—%

The following table sets forth a summary of RSUs outstanding under the 2014 Plan as of December 31, 2017 
and changes during the year then ended:

Non-vested at December 31, 2016

Assumed through business combinations(a)
Granted

Vested

Forfeited

Non-vested at December 31, 2017

Number of
Shares

Weighted Average
Grant Date Fair Value

708,695

$

35,752

628,794

(422,353)

(43,308)

907,580

$

42.76

55.85

52.62

45.19

47.84

49.30

(a) Represents fully vested RSUs issued as replacement awards and immediately converted into shares of the Company’s 
common stock in connection with the Merger with inVentiv.

At December 31, 2017, there was $30.5 million of unrecognized compensation expense related to unvested 
RSUs, which is expected to be recognized over a weighted average period of 2.2 years. 

Merger-Related Performance-Based Awards

In August 2017, the Board of Directors and Compensation Committee granted certain executive officers a 
total of 127,917 performance-based RSUs (“PRSUs”). These performance-based awards are subject to the 

132

 
Company achieving a certain level of annual net income growth over the vesting period by reducing operating 
costs through execution of the cost saving initiatives. These PRSUs will vest on January 1, 2021 provided the 
performance criteria are met and will settle no later than March 15, 2021. These awards are included in the 
table above. Compensation expense related to PRSUs is recorded based on the estimated quantity of awards 
that are expected to vest. At each reporting period, management re-assesses the probability that the 
performance conditions will be achieved and adjusts compensation expense to reflect any changes in the 
estimated probability of vesting until the actual level of achievement of the performance targets is known. 

Share-Based Compensation Expense

Total share-based compensation expense recognized was as follows (in thousands):

Direct costs

Selling, general, and administrative expenses

Restructuring and other costs

Transaction and integration-related expenses

Total share-based compensation expense

Years Ended December 31,

2017

2016

2015

$

10,537

$

6,551

$

14,041

3,791

31,327

7,469

—

—

2,282

2,792

—

—

$

59,696

$

14,020

$

5,074

The total income tax benefit recognized in the consolidated statements of operations for share-based 
compensation arrangements was approximately $1.6 million, $4.7 million, and $1.6 million for the years 
ended December 31, 2017, 2016 and 2015, respectively.

11. Earnings Per Share

The following table provides a reconciliation of the numerators and denominators of the basic and diluted 
earnings per share computations for the years ended December 31, 2017, 2016 and 2015 (in thousands, 
except per share data):

Numerator:

Net (loss) income

Denominator:

Years Ended December 31,

2017

2016

2015

$

(138,469) $

112,630

$

117,047

Basic weighted average common shares outstanding

74,913

54,031

57,888

Effect of dilutive securities:

Stock options and other awards under deferred share-based
compensation programs

Diluted weighted average common shares outstanding

(Loss) earnings per share:

Basic

Diluted

—

74,913

1,579

55,610

2,258

60,146

$

$

(1.85) $

(1.85) $

2.08

2.03

$

$

2.02

1.95

Potential common shares outstanding that are considered anti-dilutive are excluded from the computation of 
diluted earnings per share. Potential common shares related to stock options and other awards under 
deferred share-based compensation programs may be determined to be anti-dilutive based on the application 
of the treasury stock method. Potential common shares are also considered anti-dilutive in the event of net 
loss from operations. 

133

 
The number of potential shares outstanding that were considered anti-dilutive using the treasury stock 
method and therefore excluded from the computation of diluted earnings per share, weighted for the portion of 
the period they were outstanding are as follows (in thousands):

Anti-dilutive stock options and other awards 

Anti-dilutive stock options and other awards under deferred share-based 
compensation programs excluded based on reporting of net loss for the 
period

Total common stock equivalents excluded from diluted earnings per share 
computation

531

1,255

1,786

788

—

788

268

—

268

Years Ended December 31,

2017

2016

2015

12. Income Taxes

The components of income (loss) before provision for income taxes were as follows (in thousands):

Domestic

Foreign

(Loss) income before provision for income taxes

Years Ended December 31,

2017

2016

2015

$

$

(204,352) $

53,613

$

92,475

80,505

61,392

69,582

(111,877) $

134,118

$

130,974

The components of income tax (expense) benefit were as follows (in thousands):

Federal income taxes:

Current

Deferred

Foreign income taxes:

Current

Deferred

State income taxes:

Current

Deferred

Years Ended December 31,

2017

2016

2015

$

6,299

$

(30,247) $

(18,731)

16,936

(18,030)

312

(430)

3,988

(10,347)

5,178

(3,154)

146

(3,563)

(3,600)

(5,805)

(4,314)

(425)

3,780

Income tax benefit (expense)

$

(26,592) $

(21,488) $

(13,927)

Tax Cuts and Jobs Act of 2017

On December 22, 2017, the U.S. government enacted comprehensive tax legislation commonly referred to as 
the Tax Cuts and Jobs Act (the “Tax Act”). The Tax Act makes broad and complex changes to the U.S. tax 
code, including, but not limited to: (i) reducing the U.S. federal corporate tax rate from 35% to 21%; (ii) 
requiring companies to pay a one-time transition tax on certain undistributed earnings of foreign subsidiaries; 
(iii) generally eliminating U.S. federal income taxes on dividends from foreign subsidiaries; (iv) introducing a 
new provision designed to tax global intangible low-taxed income ("GILTI"); (v) eliminating the corporate 
alternative minimum tax ("AMT") and changing how existing AMT credits can be realized; (vi) creating the 
base erosion anti-abuse tax ("BEAT"), a new minimum tax; (vii) creating a new limitation on deductible 
interest expense; (viii) introducing limitations on the deductibility of certain executive compensation; and (ix) 
changing rules related to uses and limitations of net operating loss carryforwards created in tax years 
beginning after December 31, 2017.

134

 
 
 
 
 
 
 
 
 
 
 
 
 
U.S. GAAP requires companies to recognize the effect of tax law changes in the period of enactment. As a 
result, for the year ended December 31, 2017, the Company recognized income tax expense of $94.4 million 
comprised of (i) income tax expense of $37.5 million due to the re-measurement of net deferred tax assets; 
(ii) income tax expense of $63.1 million related to the accrual of the transition tax; (iii) net income tax benefit 
of $58.7 million from the reversal of previously accrued income taxes on the expected repatriation of foreign 
earnings (comprised of a $112.1 million reversal, net of $53.4 million accrual); and (iv) income tax expense of 
$52.6 million for the increase in the valuation allowance on the Company's net deferred tax assets. The 
accrual of the transition tax and the remeasurement of the net deferred tax assets are provisional and may be 
adjusted in future periods during 2018 when additional information is obtained. Additional information that may 
affect these provisional amounts would include, among others: (i) further clarification and guidance regarding 
how the IRS will implement the Tax Act, (ii) further clarifications and guidance regarding how state tax 
authorities will implement the Tax Act and the related effect on the Company's state income tax returns, and 
(iii) potential additional clarifications and guidance from the U.S. Securities and Exchange Commission or the 
FASB.

In December 2017, the SEC staff issued Staff Accounting Bulletin 118 ("SAB 118"), which provides guidance 
on accounting for the tax effects of the Tax Act. SAB 118 provides a measurement period that should not 
extend beyond one year from the Tax Act enactment date for companies to complete the accounting under 
ASC Topic 740 - Income Taxes ("ASC 740"). In accordance with SAB 118, a company must reflect the income 
tax effects of those aspects of the Tax Act for which the accounting under ASC 740 is complete. To the extent 
that a company’s accounting for certain income tax effects of the Tax Act is incomplete but the Company is 
able to determine a reasonable estimate, it must record a provisional estimate in the financial statements. If a 
company cannot determine a provisional estimate to be included in the financial statements, it should 
continue to apply ASC 740 on the basis of the provisions of the tax laws that were in effect immediately before 
the enactment of the Tax Act.

Reduction of U.S. Federal Corporate Income Tax Rate 

The Tax Act lowered the federal corporate tax rate from 35% to 21%, effective January 1, 2018. As a result, 
for the year ended December 31, 2017, the Company recorded a decrease in related net deferred tax assets, 
with a corresponding increase in deferred income tax expense, of $37.5 million.

Deemed Repatriation Transition Tax 

The Deemed Repatriation Transition Tax ("Transition Tax") is a tax on previously untaxed accumulated and 
current earnings and profits of certain foreign subsidiaries. The Company has not yet completed its 
accounting for the effects of the Transition Tax. However, the Company has made a reasonable estimate, and 
in the three months and year ended December 31, 2017, recognized provisional income tax expense of $63.1 
million. The Company computed this amount based on currently available information; however, there is still 
uncertainty as to the application of the Tax Act, in particular as it relates to state income taxes. Furthermore, 
the Company has not yet completed its analysis of the components of the computation, including the amount 
of the foreign earnings subject to the U.S. income tax, and the portion of foreign earnings held in cash or 
other specified assets. As a result of the accrual of the Transition Tax, the Company reversed deferred tax 
liabilities previously accrued on foreign earnings and recognized a net tax benefit of $58.7 million in the fourth 
quarter of 2017.

Global Intangible Low Taxed Income

The Tax Act created a new requirement related to global intangible low taxed income ("GILTI"). In particular, 
GILTI earned by controlled foreign corporations ("CFCs") must be included currently in the gross income of 
the CFC’s U.S. parent. GILTI is computed as the excess of the U.S. parent’s “net CFC tested income” over 
the net deemed intangible income return, which is currently defined as the excess of (i) 10% of the aggregate 
of the U.S. parent’s pro rata share of the qualified business asset investment of each CFC with respect to 
which it is a U.S. parent over, and (ii) the amount of certain interest expense taken into account in the 
determination of net CFC-tested income.

135

The Company's expectation for future U.S. taxable income inclusions of GILTI depends on (i) its current 
structure, (ii) estimated future results of its global operations, and (iii) its ability to modify its structure and/or 
business. The Company has not yet recorded any adjustments to its financial results relating to the potential 
impacts of the GILTI tax and has elected to record future GILTI impacts in the period in which the costs are 
incurred.

Actual income tax (expense) benefit differed from the amount computed by applying the U.S. federal tax rate 
of 35% to pre-tax income (loss) as a result of the following (in thousands):

Expected income tax (expense) benefit at statutory rate

$

39,157

$

(46,941) $

(45,844)

Years Ended December 31,

2017

2016

2015

Increase (decrease) in income tax benefit (expense) resulting from:

Foreign income inclusion
Foreign earnings reinvestment assertion reversal (a)
Foreign earnings reinvestment assertion accrual (a)
Changes in income tax valuation allowance (a)
Change in fair value of contingent tax-sharing obligation 

Share-based compensation

Research and general business tax credits

State and local taxes, net of federal benefit

Capitalized transaction costs

Foreign rate differential

Changes in reserve for uncertain tax positions

Provision to tax return and other deferred tax adjustments

Goodwill impairment
Federal rate change (a)
Transition tax (a)
Other, net

(780)

(8,868)

(7,056)

112,087

(53,421)

(52,563)

4,344

8,901

5,718

1,330

(6,486)

16,778

947

(536)

—

(37,468)

(63,050)

(1,550)

—

—

3,419

—

12,940

4,063

(745)

—

12,200

3,136

(1,524)

—

—

—

832

—

—

31,929

—

—

1,879

(4,184)

—

11,490

4,375

(5,322)

(1,023)

—

—

(171)

Income tax benefit (expense)

$

(26,592) $

(21,488) $

(13,927)

(a) As a result of enactment of the Tax Act, during the fourth quarter of 2017 the Company recorded direct and indirect 
charges to income tax expense of $94.4 million which is comprised of the following line items noted in the table above: (i) 
foreign earnings reinvestment assertion reversal; (ii) foreign earnings reinvestment assertion accrual; (iii) change in 
income tax valuation allowance; (iv) federal rate change; and (v) transition tax.

Acquired Deferred Income Tax Assets and Liabilities

As a result of the Merger, the Company assumed a net deferred tax liability of approximately $11.4 million 
which consisted primarily of (i) a deferred tax liability of approximately $455.3 million related to temporary 
differences associated with amortization of intangible assets, (ii) a deferred tax liability of approximately $53.7 
million related to unremitted foreign earnings, (iii) a deferred tax asset of approximately $444.0 million related 
to net operating loss (“NOL”) carryforwards, and (iv) a deferred tax asset of $50.6 million for deferred 
financing costs. The NOL carryforwards acquired in the Merger consisted of (i) $1.1 billion of U.S. federal NOL 
carryforwards, (ii) $1.0 billion of domestic state and local NOL carryforwards, and (iii) $66.8 million of foreign 
NOL carryforwards.

A portion of the NOL carryforwards acquired from inVentiv was generated prior to their acquisition by the 
Company and therefore is subject to ownership change provisions under Section 382 of the Internal Revenue 
Code (“Section 382”). Section 382 requires a corporation to limit the amount of its future periods taxable 
income that can be offset by historic NOL carryforwards and tax credit carryforwards in the event of an 
“ownership change”, as defined in Section 382. As a result of the Tax Act, the Company recorded a valuation 
allowance in 2017 due to uncertainties related to the Company’s ability to utilize some of the U.S. deferred tax 
assets associated with the NOL carryforwards discussed above. The valuation allowance is based on the 

136

 
Company’s estimate of taxable income in the U.S. and various state jurisdictions and the period over which 
the deferred income tax assets will be recoverable. Should the Company generate sufficient taxable income 
in future periods, the Company does not expect that the Section 382 limitations will significantly impact the 
Company’s ability to utilize its federal NOL carryforwards within the applicable expiration periods. 
Furthermore, the Company has assumed a contingent tax-sharing obligation related to certain pre-Merger 
transaction tax deductions. As the transaction tax deductions are realized through the utilization of certain 
acquired NOLs, the Company is obligated to make payments to the former stockholders of inVentiv. The 
amount of acquired NOLs subject to this contingent tax-sharing obligation is estimated to be approximately 
$187.8 million.

As a result of the Merger and associated debt financing, the Company re-evaluated and changed its assertion 
related to whether the Company would repatriate the majority of its undistributed foreign earnings. As a result 
of concluding that earnings of certain foreign subsidiaries would be repatriated, the Company recorded a 
corresponding deferred tax liability of $53.4 million. Furthermore, due to the accrual of the Transition Tax 
required by the Tax Act, the Company reversed the full balance of the deferred tax liability (including the 
deferred tax liability acquired as part of the Merger), resulting in a tax benefit of $112.1 million. As a result of 
the Transition Tax, the Company has approximately $649.4 million of previously taxed foreign earnings in the 
U.S., of which approximately $254.9 million will remain permanently reinvested in the foreign jurisdictions. 
These earnings are expected to be used to support the growth and working capital needs of the Company's 
foreign subsidiaries. The Company intends to repatriate its remaining foreign earnings of approximately 
$394.5 million and, as of December 31, 2017, has accrued anticipated withholding taxes.

The changes in the valuation allowance for deferred tax assets were as follows (in thousands):

Years Ended December 31,

2017

2016

2015

Balance at the beginning of the period

$

5,238

$

16,731

$

48,660

Deferred tax assets assumed through business combinations
Charged (credited) to income tax expense (a)
Foreign tax credit conversion

Foreign currency exchange 
Other adjustments (b)
Balance at the end of the period

101,527

52,563

—

—

318

—

(3,419)

(6,707)

(890)

(477)

—

(31,929)

—

—

—

$

159,646

$

5,238

$

16,731

(a)  For the year ended December 31, 2017, charge to income tax expense was calculated at 21% federal income tax 

rate as enacted by the Tax Act.

(b)  Other adjustments denote the effects of write-offs and recoveries in various jurisdictions with no net tax impact.

As of December 31, 2017, the valuation allowance increased by $154.4 million, which primarily consisted of 
(i) an increase of $52.6 million primarily as a result of recording a valuation allowance for U.S. federal and 
state deferred tax assets, and (ii) an increase of $101.5 million related to a valuation allowance acquired as a 
result of the Merger. Of this change to the valuation allowance, $52.6 million was charged to income tax 
expense during the fourth quarter of 2017. 

As of December 31, 2017, the Company assessed both positive and negative evidence in evaluating whether 
it could support the recognition of its U.S. net deferred tax asset position or if a valuation allowance would be 
required. A significant piece of objective negative evidence that the Company considered was the cumulative 
loss over the three-year period ended December 31, 2017. This objective negative evidence was weighed 
against the subjective positive evidence available to the Company and it was determined that the positive 
evidence was not sufficient to overcome the substantial negative evidence. Therefore, the Company recorded 
a charge to income tax expense in the amount of $52.6 million for the net increase in the valuation allowance.

As of December 31, 2016, the Company released a portion of the valuation allowance primarily related to 
foreign deferred tax assets based on the Company's current and anticipated future earnings in certain foreign 
operations. The release of the valuation allowance resulted in an income tax benefit of $3.4 million during the 
year ended December 31, 2016. 

137

 
As of December 31, 2015, the Company assessed both positive and negative evidence available to estimate 
whether future taxable income would be available to permit the use of the existing deferred tax assets. 
Accordingly, based on the Company achieving sustained profitability in 2015, the Company reevaluated its 
ability to consider other subjective evidence, such as the reliability of the Company's projections for future 
growth. The Company expected it would no longer need a significant portion of the valuation allowance 
related to these deferred tax assets. As a result of this change in assertion, the valuation allowance was 
released on the net deferred tax assets in the United States. The release of these valuation allowances 
resulted in an income tax benefit of $31.9 million during the year ended December 31, 2015. 

The tax effects of temporary differences that give rise to significant portions of the deferred tax assets and 
liabilities are as follows (in thousands):

Deferred tax assets:

Net operating losses

Tax credits

Deferred revenue

Foreign exchange

Employee compensation and other benefits

Allowance for doubtful accounts

Deferred rent

Accrued liabilities

Other

Total deferred tax assets

Less: valuation allowance

Net deferred tax assets

Deferred tax liabilities:

Undistributed foreign earnings

Foreign branch operations

Depreciation and amortization

Other

Total deferred tax liabilities

Net deferred tax assets (liabilities)

December 31,
2017

December 31,
2016

$

308,606

$

12,607

55,920

15,719

978

31,956

1,975

2,258

9,306

2,698

429,416

(159,646)

269,770

(7,346)

(1,652)

(276,502)

(1,918)

(287,418)

$

(17,648) $

4,690

4,630

10,430

18,382

1,660

729

5,280

68

58,476

(5,238)

53,238

—

(2,564)

(42,272)

(1,971)

(46,807)

6,431

As of December 31, 2017 and 2016, the Company had U.S. Federal NOL carryforwards, including those from 
inVentiv discussed above, of approximately $1.0 billion and $5.4 million, respectively. A valuation allowance 
has been established for jurisdictions where future benefit is uncertain. As of December 31, 2017, the 
Company established a full valuation allowance against the federal NOL carryforward balance. 

As of December 31, 2017 and 2016, the Company had state NOL carryforwards, including those from 
inVentiv discussed above, of approximately $1.2 billion and $52.0 million, respectively, a portion of which will 
expire annually beginning in 2018. The Company also had foreign NOL carryforwards, including those from 
inVentiv discussed above, of $124.8 million and $54.3 million as of December 31, 2017 and 2016, 
respectively. A valuation allowance has been established for jurisdictions where the future benefit of the NOL 
carryforwards is uncertain. 

The Company recognizes a tax benefit from any uncertain tax positions only if they are more likely than not to 
be sustained upon examination based on the technical merits of the position. The amount of the accrual for 
which an exposure exists is measured as the largest amount of benefit determined on a cumulative probability 
basis that the Company believes is more likely than not to be realized upon ultimate settlement of the 
position. Components of the reserve are classified as either a current or a long-term liability in the 
accompanying consolidated balance sheets based on when the Company expects each of the items to be 
settled.

138

 
 
 
 
 
The Company had gross unrecognized tax benefits, exclusive of associated interest and penalties, of 
approximately $43.7 million and $15.7 million as of December 31, 2017 and 2016, respectively. The Company 
recognizes accrued interest and penalties related to uncertain tax positions in income tax expense. As of 
December 31, 2017 and 2016, the Company had accrued interest and penalties related to uncertain tax 
positions of $5.0 million and $0.1 million, respectively. For the year ended December 31, 2017, the Company 
recorded in the accompanying consolidated statements of operations a tax expense of $0.9 million related to 
interest and penalties associated with uncertain tax positions. For the years ended December 31, 2016 and 
2015, the Company recorded in the accompanying consolidated statements of operations a tax expense of 
$2.0 million, and $0.3 million, respectively, related to interest and penalties associated with uncertain tax 
positions. If recognized, the total amount of unrecognized tax benefits that would impact the effective tax rate 
is $21.2 million.

The Company anticipates that during the next 12 months, the unrecognized tax benefits will decrease by 
approximately $1.4 million. A reconciliation of the beginning and ending balances of unrecognized tax 
benefits, excluding accrued interest and penalties, is as follows (in thousands):

Unrecognized tax benefits balance at December 31, 2014

$

21,566

Lapse of statute of limitations

Increases for tax positions of prior years

Decreases for tax positions of prior years

Impact of foreign currency translation

Unrecognized tax benefits balance at December 31, 2015

Lapse of statute of limitations

Increases for tax positions of prior years

Decreases for tax positions of prior years

Impact of foreign currency translation

Unrecognized tax benefits balance at December 31, 2016

Increases for tax positions in the current year

Increases for tax positions of prior years

Decreases for tax positions in prior year

Impact of foreign currency translation

(2,106)

2,001

(1,594)

(837)

19,030

(1,446)

308

(2,275)

121

15,738

191

27,974

(226)

1

Unrecognized tax benefits at December 31, 2017

$

43,678

Due to the geographic breadth of the Company's operations, numerous tax audits may be ongoing throughout 
the world at any point in time. Income tax liabilities are recorded based on estimates of additional income 
taxes which will be due upon the conclusion of these audits. Estimates of these income tax liabilities are 
made based upon prior experience and are updated in light of changes in facts and circumstances. However, 
due to the uncertain and complex application of tax regulations, it is possible that the ultimate resolution of 
audits may result in liabilities which could be materially different from these estimates. In such an event, the 
Company will record additional income tax expense or benefit in the period in which such resolution occurs.

The Company remains subject to audit by the IRS and various state taxing jurisdictions back to 1998 due to 
NOL carryforwards. The Company's tax filings are open to investigation from 2014 forward in the United 
Kingdom, which is the jurisdiction of the Company's largest foreign operation.

inVentiv’s federal income tax return for tax year 2014 is currently under examination by the Internal Revenue 
Service. In addition, inVentiv’s income tax returns for various tax years are currently under examination by the 
respective tax authorities in Germany, India, and Japan. The Company believes that its reserve for uncertain 
tax positions is adequate to cover existing risks or exposures related to all open tax years.

Recently Adopted Accounting Standards

Effective January 1, 2017, the Company adopted new guidance under ASU No. 2016-16, Income Taxes - 
Intra-Entity Transfers of Assets Other Than Inventory. For additional discussion of the new guidance, see 
"Note 1 - Basis of Presentation and Summary of Significant Accounting Policies" to the accompanying 
consolidated financial statements.

139

13. Employee Benefit Plans

Defined Contribution Retirement Plans

The Company offers defined contribution retirement benefit plans that comply with Section 401(k) of the IRS 
Code under which it matches employee deferrals at varying percentages and specified limits of the 
employee’s salary. 

The Company’s contributions related to its defined contribution retirement plans were as follows (in 
thousands):

Years Ended December 31,

2017

2016

2015

Total defined contribution retirement plan contributions

$

15,429

$

9,604

$

5,546

The Company's contributions associated with these defined contribution benefit plans are recorded in the 
"Direct costs" and "Selling, general and administrative" expense line items in the accompanying consolidated 
statements of operations.

Deferred Compensation Plan

As a result of the Merger, the Company assumed inVentiv’s nonqualified Deferred Compensation Plan for 
certain executives pursuant to Section 409A of the IRC (“NQDC Plan”). Under this plan, participants can 
defer, on a pre-tax basis, from 1.0% up to a maximum of 100.0% of salary and performance and non-
performance based bonus. The Company does not make matching contributions into the NQDC Plan. 
Distributions will be made to participants upon termination of employment or death in a lump sum, unless 
installments are selected. 

As of December 31, 2017, the NQDC Plan deferred compensation liabilities were $15.9 million and are 
included in the “Other long-term liabilities” line item in the accompanying consolidated balance sheets. The 
assets associated with the NQDC Plan are subject to the claims of the creditors and primarily consist of 
investments in mutual funds maintained in a “rabbi trust”. These investments are classified as trading 
securities and included in the “Other long-term assets” line item in the accompanying consolidated balance 
sheets. During the year ended December 31, 2017, gains (losses) on these investments were immaterial and 
were included in “Selling, general and administrative” expense line item of the accompanying consolidated 
statement of operations.

14. Segment Information

During the third quarter of 2017, the Company realigned its operating segments as a result of the Merger to 
reflect the current structure under which performance is evaluated, strategic decisions are made and 
resources are allocated. As a result of this realignment, effective August 1, 2017, the Company began 
evaluating its financial performance based on two reportable segments: Clinical Solutions and Commercial 
Solutions. Historical segment reporting has been revised to reflect these changes to the Company’s segment 
structure.

Each reportable business segment is comprised of multiple service offerings that, when combined, create a 
fully integrated biopharmaceutical services organization. Clinical Solutions offers a variety of services 
spanning Phase I to Phase IV of clinical development, including full-service global studies, as well as 
individual service offerings such as clinical monitoring, investigator recruitment, patient recruitment, data 
management, and study startup to assist customers with their drug development process. Commercial 
Solutions provides commercialization services to the pharmaceutical, biotechnology, and healthcare 
industries, which include outsourced selling solutions, communication solutions (public relations and 
advertising), and consulting related services. 

140

The Company’s CODM reviews segment performance and allocates resources based upon segment revenue 
and income from operations. Revenue and costs for reimbursed out-of-pocket expenses are not allocated to 
the Company’s segments. Inter-segment revenue is eliminated from the segment reporting provided to the 
CODM and is not included in the segment revenue presented in the table below. Certain costs are not 
allocated to the Company’s reportable segments and are reported as general corporate expenses. These 
costs primarily consist of share-based compensation and general operational expenses associated with the 
Company’s senior leadership, finance, human resources, information technology, facilities, and legal 
functions. The Company does not allocate depreciation, amortization, asset impairment charges, 
restructuring, or transaction and integration-related costs to its segments. Additionally, the CODM reviews the 
Company’s assets on a consolidated basis and does not allocate assets to its reportable segments for 
purposes of assessing segment performance or allocating resources.

Information about reportable segment operating results is as follows (in thousands):   

Net service revenue:
Clinical Solutions
Commercial Solutions

Total segment net service revenue

Reimbursable out-of-pocket expenses not allocated to segments

Total consolidated net service revenue

Segment direct costs:
Clinical Solutions
Commercial Solutions

Total segment direct costs

Segment selling, general, and administrative expenses:
Clinical Solutions
Commercial Solutions

Total segment selling, general, and administrative expenses

Segment operating income:
Clinical Solutions
Commercial Solutions

Total segment operating income

Operating expenses not allocated to segments:

Reimbursable out-of-pocket expenses not allocated to segments
Share-based compensation not allocated to direct costs

Share-based compensation not allocated to selling, general, and 
administrative expenses

Corporate selling, general, and administrative expenses not 
allocated to segments
Restructuring and other costs
Transaction and integration-related expenses
Asset impairment charges
Depreciation and amortization
Total consolidated (loss) income from operations

Years Ended December 31,
2016

2017 (a)

2015

$

$

$

$

$

$

$

$

$

1,459,968
392,875
1,852,843
819,221
2,672,064

930,176
291,310
1,221,486

203,206
40,236
243,442

326,586
61,329
387,915

819,221
10,537

$

$

$

$

1,021,017
9,320
1,030,337
580,259
1,610,596

612,201
7,881
620,082

148,102
—
148,102

260,714
1,439
262,153

580,259
6,551

906,528
8,212
914,740
484,499
1,399,239

533,277
6,845
540,122

136,934
—
136,934

236,317
1,367
237,684

484,499
2,282

14,041

7,469

2,792

25,137
33,315
123,815
30,000
179,936
(28,866) $

16,815
13,612
3,143
—
59,204
155,359

$

16,883
1,785
1,637
3,931
56,014
152,360

(a) Following the Company’s Merger with inVentiv, beginning August 1, 2017, the Company’s consolidated results of 
operations include results of operations of inVentiv.

141

 
 
 
 
 
 
15. Operations by Geographic Location

The Company conducts its global operations through wholly-owned subsidiaries and representative sales 
offices. Prior to the Merger, net service revenue was attributed to geographical locations based upon the 
location to which the Company invoiced the end customer. Following the Merger, the Company began to 
attribute net service revenues to geographical locations based upon the location of where the work is 
performed to reflect its expanded geographic presence and increases in scale of its operations. All prior 
periods have been recast to reflect the effect of this change. The following table summarizes total revenue by 
geographic area (in thousands and with all intercompany transactions eliminated):

Net service revenues:
North America (a)
Europe, Middle East and Africa

Asia-Pacific

Latin America

Total net service revenue

Reimbursable-out-of-pocket expenses

Years Ended December 31,

2017

2016

2015

$

1,174,462

$

602,133

$

458,264

174,345

45,772

1,852,843

819,221

319,189

74,268

34,747

1,030,337

580,259

536,526

288,221

57,871

32,122

914,740

484,499

Total revenue

$

2,672,064

$

1,610,596

$

1,399,239

(a)  Net service revenue for the North America region include revenue attributable to the U.S. of $1,128.1 million, $577.3 
million and $513.8 million, or 60.9%, 56.0% and 56.2% of net service revenues, for the years ended December 31, 2017, 
2016 and 2015, respectively. No other countries represented more than 10% of net service revenue for any period.

The following table summarizes long-lived assets by geographic area (in thousands and all intercompany 
transactions have been eliminated):

Property and equipment, net:

North America (a)
Europe, Middle East and Africa

Asia-Pacific

Latin America

Total property and equipment, net

December 31, 2017

December 31, 2016

$

$

136,101

$

25,517

14,700

4,094

180,412

$

41,057

11,235

5,101

913

58,306

(a) Long-lived assets for the North America region include property and equipment, net attributable to the U.S. of $128.5 
million and $40.6 million as of December 31, 2017 and 2016, respectively.

16.  Concentration of Credit Risk

Financial assets that subject the Company to credit risk primarily consist of cash and cash equivalents and 
billed and unbilled accounts receivable. The Company's cash and cash equivalents consist principally of cash 
and are maintained at several financial institutions with reputable credit ratings. The Company maintains cash 
depository accounts with several financial institutions worldwide and is exposed to credit risk related to the 
potential inability to access liquidity in financial institutions where its cash and cash equivalents are 
concentrated. The Company has not historically incurred any losses with respect to these balances and 
believes that they bear minimal credit risk. 

As of December 31, 2017, the amount of cash and cash equivalents held outside the United States by the 
Company’s foreign subsidiaries was $192.0 million, or 59.8% of the total consolidated cash and cash 
equivalents balance. As of December 31, 2016, the amount of cash and cash equivalents held outside the 
United States by the Company’s foreign subsidiaries was $86.4 million, or 84.3% of the total consolidated 
cash and cash equivalents balance.

142

 
 
 
 
 
 
 
Substantially all of the Company's net service revenue is earned by performing services under contracts with 
pharmaceutical and biotechnology companies. The concentration of credit risk is equal to the outstanding 
billed and unbilled accounts receivable, less deferred revenue related thereto. The Company does not require 
collateral or other securities to support customer receivables. The Company maintains a credit approval 
process and makes significant judgments in connection with assessing customers' ability to pay throughout 
the contractual obligation. Despite this assessment, from time to time, customers are unable to meet their 
payment obligations. The Company continuously monitors customers' credit worthiness and applies judgment 
in establishing a provision for estimated credit losses based on historical experience and any specific 
customer collection issues that have been identified.

No single customer accounted for greater than 10% of the Company’s total consolidated net service revenue 
for the years ended December 31, 2017, 2016 or 2015.

As of December 31, 2017, one customer accounted for 13.4% of the Company’s billed and unbilled trade 
accounts receivable balances. As of December 31, 2016 and 2015, no single customer accounted for greater 
than 10% of the Company’s billed and unbilled trade accounts receivable balance.

17. Related-Party Transactions

For the year ended December 31, 2017, the Company incurred reimbursable out-of-pocket expenses of $0.4 
million for professional services obtained from a provider whose significant shareholder was also a significant 
shareholder of the Company. There were no material related party expenses for the years ended 
December 31, 2016 and 2015.

The Company recorded net service revenue of $0.5 million and $0.1 million during the years ended 
December 31, 2016 and 2015, respectively, from a customer who has a significant shareholder who was also 
a significant shareholder of the Company through August 2016. No related-party revenue was recorded for 
the year ended December 31, 2017.

18. Commitments and Contingencies

Legal Proceedings

Through the Merger, the Company became a party to a lawsuit initiated and outstanding against inVentiv prior 
to the Merger. On October 31, 2013, Cel-Sci Corporation ("Claimant") made a demand for arbitration under a 
Master Services Agreement (the "MSA"), dated as of April 6, 2010 between Claimant and two of the 
Company’s subsidiaries, inVentiv Health Clinical, LLC (formerly known as PharmaNet, LLC) and PharmaNet 
GmbH (currently known as inVentiv Health Switzerland GmbH and formerly known as PharmaNet AG) 
(collectively, "PharmaNet"). Under the MSA and related project agreement, which were terminated by 
Claimant in April 2013, Claimant engaged PharmaNet in connection with a Phase III Clinical Trial of its 
investigational drug. The arbitration claim alleges (i) breach of contract, (ii) fraud in the inducement, and (iii) 
common law fraud on the part of PharmaNet, and seeks damages of at least $50.0 million. In December 
2013, inVentiv Health Clinical, LLC filed a counterclaim against Claimant that alleges breach of contract and 
seeks at least $2.0 million in damages. The matter proceeded to the discovery phase. In January 2015, 
inVentiv Health Clinical, LLC filed additional counterclaims against Claimant that allege (i) breach of contract, 
(ii) opportunistic breach, restitution and unjust enrichment, and (iii) defamation, and seek at least $2.0 million 
in damages and $20.0 million in other equitable remedies. The arbitration is currently underway and it is 
expected that the arbitrator will issue a decision in 2018. The Company continues to maintain and intends to 
vigorously defend its position in this matter. In the Company’s opinion, the ultimate outcome of this matter, net 
of liabilities accrued in the Company’s balance sheet, is not expected to have a material adverse effect on the 
Company’s financial position or results of operations.

Self-Insurance Reserves

The Company is self-insured for certain losses relating to health insurance claims for the majority of its 
employees located within the United States. Additionally, in connection with the Merger, the Company 

143

assumed liabilities associated with certain self-insurance retention limits of inVentiv related to employee 
medical, automobile, and workers’ compensation insurance. As of December 31, 2017 and 2016, the 
Company had accrued self-insurance reserves of $16.6 million and $3.6 million.

Assumed Contingent Tax-Sharing Obligation

As a result of the Merger, the Company assumed contingent tax-sharing obligations arising from inVentiv’s 
2016 merger with Double Eagle Parent, Inc. As of December 31, 2017, the estimated fair value of the 
assumed contingent tax-sharing obligation was $50.5 million (see "Note 3 - Business Combinations" for 
further information).

19. Quarterly Results of Operations — Unaudited

The following is a summary of the Company's consolidated quarterly results of operations for each of the 
fiscal years ended December 31, 2017 and 2016 (in thousands, except per share data):

Net service revenue (a)
Income (loss) from operations (a)(b)(c)(d)
Net income (loss) (a)(e)(f)(g)
Basic earnings (loss) per share (a)
Diluted earnings (loss) per share (a)

Net service revenue
Income from operations (b)(c)
Net income (e)(f)(g)
Basic earnings per share 

Diluted earnings per share

Three Months Ended

March 31,
2017

June 30,
2017

September 30,
2017

December 31,
2017

252,078

$

258,087

$

592,207

$

34,752

21,187

0.39

0.38

$

$

10,250

3,389

0.06

0.06

$

$

(88,888)

(147,998)

(1.70) $

(1.70) $

750,471

15,020

(15,047)

(0.14)

(0.14)

Three Months Ended

March 31,
2016

June 30,
2016

September 30,
2016

December 31,
2016

248,997

$

258,804

$

259,557

$

262,979

32,508

17,405

0.32

0.31

$

$

39,655

30,403

0.56

0.54

$

$

39,396

27,331

0.50

0.49

$

$

43,800

37,491

0.70

0.68

$

$

$

$

$

$

(a)  Following the Company’s Merger with inVentiv, beginning August 1, 2017, the Company’s consolidated results of 

operations include results of operations of inVentiv.

(b)  Transaction and integration-related expenses for the three months ended June 30, 2017, September 30, 2017, and 

December 31, 2017 were $23.7 million, $84.3 million and $15.7 million, respectively. There were no material 
transaction and integration-related expenses for the three months ended March 31, 2017. Transaction expenses for 
the three months ended March 31, 2016, June 30, 2016, September 30, 2016 and December 31, 2016 were $0.6 
million, $1.2 million, $1.1 million and $0.3 million, respectively. Transaction expenses include legal fees associated 
with (i) corporate transactions and integration-related activities which primarily related to the Merger in 2017 (ii) the 
2017 and 2016 debt agreement amendments, (iii) fair value adjustments associated with the Company's assumed 
contingent tax-sharing obligations; (iv) secondary stock offerings and stock repurchase activities during 2016, and (v) 
other corporate projects. 

(c)  Restructuring and other costs for the three months ended March 31, 2017, June 30, 2017, September 30, 2017, and 
December 31, 2017 were $1.9 million, $4.0 million, $6.7 million and $20.7 million, respectively. Restructuring and 
other costs for the three months ended March 31, 2016, June 30, 2016, September 30, 2016 and December 31, 2016 
were $6.0 million, $1.4 million, $2.9 million and $3.3 million, respectively. 

(d)  Asset impairment charges were $30.0 million for the three months ended September 30, 2017. Asset impairment 

charges related to the impairment of the INC Research tradename in connection with the Company's merger-related 
rebranding.

(e)  During the three months ended September 30, 2017 and December 31, 2017, the Company recorded a loss on 
extinguishment of debt of $0.1 million and $0.5 million, respectively, associated with the 2017 Credit Agreement 

144

 
 
 
 
amendments and refinancing. During the three months ended September 30, 2016, the Company recorded a loss on 
extinguishment of debt of $0.4 million associated with the 2016 Credit Agreement and debt refinancing. 

(f)  During the three months ended December 31, 2017, the Company's income tax expense included a charge of $94.4 
million as a result of the Tax Act. During the three months ended December 2016, the Company determined that 
certain valuation allowances were no longer required and recorded an income tax benefit related to the release of 
valuation allowances totaling $3.4 million. See "Note 12 - Income Taxes" for additional information.

(g)  During the three months ended December 31, 2017 and 2016, the Company determined that it qualified for additional 

research and development tax credits in certain international locations for expenses incurred during 2017 and 2016 
and as a result recorded a $3.6 million and $2.5 million reduction of direct costs, respectively. 

Item 9. Changes in and Disagreements with Accountants on Accounting and Financial Disclosure. 

None.

Item 9A. Controls and Procedures.

Evaluation of Disclosure Controls and Procedures

As required by Rule 13a-15(b) under the Exchange Act, we carried out an evaluation under the supervision 
and with the participation of our management, including our CEO and CFO, of the effectiveness of the design 
and operation of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under 
the Exchange Act). There are inherent limitations to the effectiveness of any system of disclosure controls and 
procedures, including the possibility of human error and the circumvention or overriding of the controls and 
procedures. Accordingly, even effective disclosure controls and procedures can only provide reasonable 
assurance of achieving their control objectives. Based upon their evaluation, our CEO and CFO concluded 
that our disclosure controls and procedures were effective to provide reasonable assurance that information 
required to be disclosed by us in the reports that we file or submit under the Exchange Act is recorded, 
processed, summarized and reported within the time periods specified in the applicable rules and forms, and 
that it is accumulated and communicated to our management, including our CEO and CFO, as appropriate, to 
allow timely decisions regarding required disclosure. 

Changes in Internal Control Over Financial Reporting

During the quarter ended December 31, 2017, we implemented a plan that called for modifications and 
additions to internal control over financial reporting related to the accounting for revenue as a result of the 
new revenue recognition standard. The modified and new controls have been designed to address risks 
associated with recognizing revenue under the new standard. We have therefore augmented our internal 
control over financial reporting as follows: 

•  Enhanced the risk assessment process to take into account risks associated with the new revenue  

standard.

•  Added controls that address risks associated with the five-step model for recording revenue, including 

the revision of our contract review controls. 

There have been no other changes in our internal control over financial reporting (as defined in Rules 
13a-15(f) and 15d-15(f) under the Exchange Act) during the quarter ended December 31, 2017 that has 
materially affected, or is reasonably likely to materially affect, our internal control over financial reporting. 

Management's Annual Report on Internal Control Over Financial Reporting

The management of Syneos Health, Inc. (the “Company”) is responsible for establishing and maintaining 
adequate internal control over financial reporting. Internal control over financial reporting is a process 
designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of 
financial statements for external purposes in accordance with generally accepted accounting principles. A 
company’s internal control over financial reporting includes those policies and procedures that pertain to the 

145

maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and 
dispositions of the assets of the company; provide reasonable assurance that transactions are recorded as 
necessary to permit preparation of financial statements in accordance with generally accepted accounting 
principles in the United States of America, and that receipts and expenditures of the company are being made 
only in accordance with authorizations of management and directors of the company; and provide reasonable 
assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the 
company’s assets that could have a material effect on the financial statements.

Because of its inherent limitations, internal control over financial reporting might not prevent or detect 
misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that 
controls may become inadequate because of changes in conditions, or that the degree of compliance with the 
policies or procedures may deteriorate.

Management assessed the effectiveness of the Company’s internal control over financial reporting as of 
December 31, 2017. In making this assessment, management used the framework established in the Internal 
Control-Integrated Framework issued in 2013 by the Committee of Sponsoring Organizations of the Treadway 
Commission (“COSO”). As a result of this assessment and based on the criteria in the COSO framework, 
management has concluded that, as of December 31, 2017, the Company’s internal control over financial 
reporting was effective.

As previously noted, we completed the Merger with inVentiv during the third quarter of 2017. Management 
considers this transaction to be material to our consolidated financial statements and believes that the internal 
controls and procedures of inVentiv have a material effect on our internal control over financial reporting. We 
are currently in the process of incorporating the internal controls and procedures of inVentiv into our internal 
controls over financial reporting and extending our Section 404 compliance program under the Sarbanes-
Oxley Act of 2002 and the applicable rules and regulations under such Act to include inVentiv. We will report 
on our assessment of the consolidated operations within the time period provided by the Act and the 
applicable SEC rules and regulations concerning business combinations, which is the annual management 
report for the fiscal year ending December 31, 2018. inVentiv’s total assets (excluding goodwill which was 
included in management’s assessment of internal control over financial reporting as of December 31, 2017), 
and total revenues represented approximately 30% and 41%, respectively, of the related consolidated 
financial statement amounts as of and for the year ended December 31, 2017.

The effectiveness of the Company’s internal control over financial reporting as of December 31, 2017 has 
been audited by Deloitte & Touche LLP, an independent registered public accounting firm, as stated in their 
report which appears herein.

Item 9B. Other Information.

None.

146

PART III

Item 10. Directors, Executive Officers and Corporate Governance. 

Pursuant to General Instruction G(3) on Form 10-K, information required by this Item concerning our directors 
and corporate governance is incorporated by reference from the sections captioned “Election of Directors” 
and “Corporate Governance Matters” contained in our 2018 Proxy Statement related to Our Annual Meeting 
of Stockholders which we intend to file with the SEC within 120 days of the end of our fiscal year.

We have adopted a code of business conduct and ethics relating to the conduct of our business by all of our 
employees, officers, and directors, as well as a code of ethics specifically for our principal executive officer 
and senior financial officers. Each of these policies is posted on our website: www.syneoshealth.com.

The information required by this Item concerning our executive officers is set forth at the end of Part I, Item 1,  
"Business" in this Annual Report on Form 10-K.

The information required by this Item concerning compliance with Section 16(a) of the United States 
Securities Exchange Act of 1934, as amended, is incorporated by reference from the section of the 2018 
Proxy Statement captioned “Section 16(a) Beneficial Ownership Reporting Compliance.”

Item 11. Executive Compensation. 

The information required by this Item is incorporated by reference to the information under the sections 
captioned “Executive Compensation and Other Matters” and “Director Compensation for Fiscal year 2017” in 
the 2018 Proxy Statement.

Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder 
Matters. 

The following table sets forth the indicated information as of December 31, 2017 with respect to our equity 
compensation plans approved by security holders:

Plan Description

2016 Employee Stock Purchase Plan

2014 Equity Incentive Plan

2010 Equity Incentive Plan

2016 Omnibus Equity Incentive Plan

Total

Number of securities
to be issued upon
exercise of
outstanding options,
warrants and rights

Weighted-average
exercise price of
outstanding options,
warrants and rights

Number of securities
remaining available
for future issuance
under equity
compensation plans

— $

586,217

601,880

1,329,408

2,517,505

$

$

$

—

12.29

41.57

29.98

874,026

2,455,372

—

—

3,329,398

Our equity compensation plans consist of the 2016 Employee Stock Purchase Plan, the 2014 Equity Incentive 
Plan, the 2010 Equity Incentive Plan, and the 2016 Omnibus Equity Incentive Plan, which were approved by 
our shareholders. We do not have any equity compensation plans or arrangements that have not been 
approved by our shareholders. 

Information regarding security ownership and securities authorized for issuance under equity compensation 
plans required by this Item is incorporated by reference to the information under the section captioned 
“Security Ownership of Certain Beneficial Owners and Management” in the 2018 Proxy Statement.

147

Item 13. Certain Relationships and Related Transactions and Director Independence. 

The information required by this Item is incorporated by reference to the information under the section 
captioned “Transactions With Related Persons” and “Corporate Governance Matters” in the 2018 Proxy 
Statement.

Item 14. Principal Accounting Fees and Services. 

The information required by this Item is incorporated by reference to the information under the section 
captioned “Audit Committee Report” in the 2018 Proxy Statement.

148

PART IV

Item 15. Exhibits and Financial Statement Schedules. 

(a) 

The following documents are filed as part of this report: 

(1) Financial Statements 

The financial statements and report of the independent registered public accounting firm are filed as part of 
this Annual Report (see "Index to Consolidated Financial Statements" at Item 8).

(2) Financial Statement Schedules

The financial statements schedules are omitted because they are not applicable or the required information is 
shown in the consolidated financial statements or notes thereto.

149

(b) Exhibits 

Exhibit   
Number   

Exhibit Description

2.1 Agreement and Plan of Merger, dated as of May 10, 

2017, by and between Double Eagle Parent, Inc. and 
INC Research Holdings, Inc. 

Incorporated by Reference (Unless
Otherwise Indicated)

Form    File No.    
001-36730
8-K

Exhibit    Filing Date    
May 10, 2017
2.1

3.1 Certificate of Incorporation of INC Research Holdings, 

8-K

001-36730

3.1

August 1, 2017

Inc.

3.2 Certificate of Amendment of Certificate of Incorporation 

8-K

001-36730

3.1

of Syneos Health, Inc.

3.3 Amended and Restated Bylaws of Syneos Health, Inc.

8-K

001-36730

3.2

4.1 Specimen Certificate for Class A Common Stock.

S-1/A 333-199178

4.1

4.2 Second Amended and Restated Stockholders 

8-K

001-36730

4.2

Agreement, dated as of November 6, 2014, among INC 
Research Holdings, Inc. and certain stockholders 
named therein.

January 8,
2018

January 8,
2018

October 27,
2014

November 13,
2014

4.3 Second Supplemental Indenture, dated as of August 7, 

8-K

001-36730

10.1

August 9, 2017

2017, among INC Research Holdings, Inc., inVentiv 
Health, Inc., inVentiv Health Clinical, Inc., the 
guarantors party thereto and Wilmington Trust, National 
Association, as trustee.

4.4

Indenture, dated as of October 14, 2016, among 
Double Eagle Acquisition Sub, Inc., the guarantors 
party thereto and Wilmington Trust, National 
Association, as trustee.

8-K

001-36730

10.2

August 9, 2017

10.3.1#

Triangle Acquisition Holdings, Inc. 2010 Equity 
Incentive Plan.

S-1

333-199178

10.3.1

10.3.2# Amendment No. 1 to INC Research Holdings, Inc. 2010 

S-1

333-199178

10.3.2

Equity Incentive Plan.

10.3.3# Amendment No. 2 to INC Research Holdings, Inc. 2010 

S-1

333-199178

10.3.3

Equity Incentive Plan.

10.4#

10.6#

Form of Nonqualified Stock Option Award Agreement 
under INC Research Holdings, Inc. 2010 Equity 
Incentive Plan.

Form of Stock Option Award Agreement for U.S. 
Participants under INC Research Holdings, Inc. 2014 
Equity Incentive Plan.

S-1

333-199178

10.4

S-1/A 333-199178

10.6

10.7#

2013 Management Incentive Plan.

S-1

333-199178

10.7

10.8#

Form of Management Incentive Plan.

S-1

333-199178

10.8

10.9.1

10.9.2

10.9.3

10.9.4

Lease, dated May 6, 2010, by and between Highwoods 
Realty Limited Partnership and INC Research, Inc.

S-1

333-199178

10.9.1

Lease Amendment Number One, dated August 26, 
2010, by and between Highwoods Realty Limited 
Partnership and INC Research, Inc. 

Lease Amendment Number Two, dated August 23, 
2011, by and between Highwoods Realty Limited 
Partnership and INC Research, LLC.  

Lease Amendment Number Three, dated January 4, 
2013, by and between Highwoods Realty Limited 
Partnership and INC Research, LLC. 

S-1

333-199178

10.9.2

S-1

333-199178

10.9.3

S-1

333-199178

10.9.4

10.10# Executive Employment Agreement, effective as of July 

S-1

333-199178

10.10

31, 2014, by and between INC Research, LLC and 
Duncan Jamie Macdonald.

October 6,
2014

October 6,
2014

October 6,
2014

October 6,
2014

October 17,
2014

October 6,
2014

October 6,
2014

October 6,
2014

October 6,
2014

October 6,
2014

October 6,
2014

October 6,
2014

150

 
 
10.11.1# Executive Employment Agreement, effective as of 

S-1

333-199178

10.11

August 5, 2013, by and between INC Research, LLC 
and Greg S. Rush.

10.11.2#

Letter Agreement, dated January 3, 2018, between 
Syneos Health, Inc. and Gregory S. Rush

8-K

001-36730

10.1

10.12.1# Executive Service Agreement, dated July 31, 2014, by 

S-1

333-199178

10.12

and between INC Research Holdings Limited and 
Alistair Macdonald.

October 6,
2014

January 3,
2018

October 6,
2014

10.12.2# Amendment Two to the Executive Service Agreement, 

10-Q 001-36730

10.1

April 27, 2015

effective as of January 1, 2015, by and between INC 
Research Holdings Limited and Alistair Macdonald.

10.13# Executive Employment Agreement, effective as of July 

S-1

333-199178

10.13

31, 2014, by and between INC Research, LLC and 
Christopher L. Gaenzle.

10.14#

10.15#

10.16#

10.17#

10.18#

10.19#

10.20#

10.21#

10.22#

10.23#

Form of Restricted Stock Award Agreement under INC 
Research Holdings, Inc. 2014 Equity Incentive Plan.

S-1/A 333-199178

10.14

Form of Stock Option Award Agreement for Non-U.S. 
Participant under INC Research Holdings, Inc. 2014 
Equity Incentive Plan.

Form of 2010 Equity Incentive Plan Stock Option 
Adjustment Letter.

Form of 2010 Equity Incentive Plan Stock Option 
Amendment Letter.

Form of Stock Option Award Agreement for U.S. 
Participants under INC Research Holdings, Inc. 2014 
Equity Incentive Plan.

Form of Stock Option Award Agreement for Non-U.S. 
Participants under INC Research Holdings, Inc. 2014 
Equity Incentive Plan.

Form of Stock Option Award Agreement for U.S. 
Participants under INC Research Holdings, Inc. 2014 
Equity Incentive Plan.

Form of Restricted Stock Unit Award Agreement for 
U.S. Participants under INC Research Holdings, Inc. 
2014 Equity Incentive Plan.

Form of Restricted Stock Unit Award Agreement for 
Non-U.S. Participants under INC Research Holdings, 
Inc. 2014 Equity Incentive Plan.

Form of Restricted Stock Unit Award Agreement for 
U.S. Participants under INC Research Holdings, Inc. 
2014 Equity Incentive Plan.

S-1/A 333-199178

10.15

S-1/A 333-199178

10.16

S-1/A 333-199178

10.17

10-Q 001-36730

10.1

10-Q 001-36730

10.2

10-Q 001-36730

10.3

10-Q 001-36730

10.4

10-Q 001-36730

10.5

10-Q 001-36730

10.6

10.24# Executive Employment Agreement, effective as of July 

10-K

001-36730

10.29

October 6,
2014

October 17,
2014

October 17,
2014

October 27,
2014

October 17,
2014

October 29,
2015

October 29,
2015

October 29,
2015

October 29,
2015

October 29,
2015

October 29,
2015

February 25,
2016

10.25#

10.26#

31, 2014, by and between INC Research, LLC and 
Michael Gibertini.

Form of Performance Restricted Stock Unit Award 
Agreement for U.S. Participants under INC Research 
Holdings, Inc. 2014 Equity Incentive Plan.

Form of Performance Restricted Stock Unit Award 
Agreement for Non-U.S. Participants under INC 
Research Holdings, Inc. 2014 Equity Incentive Plan.

10.27#

INC Research Holdings, Inc. 2016 Employee Stock 
Purchase Plan.

10.28#

10.29#

INC Research Holdings, Inc. 2014 Equity Incentive 
Plan, as Amended and Restated.

Transition Agreement, by and among Duncan Jamie 
Macdonald, INC Research, LLC and INC Research 
Holdings, Inc. entered into as of July 27, 2016.

10-Q 001-36730

10.1

May 2, 2016

10-Q 001-36730

10.2

May 2, 2016

S-8

333-212154

4.3

June 21, 2016

S-8

333-212154

4.4

June 21, 2016

8-K

001-36730

10.1

July 28, 2016

10.30# Executive Service Agreement, by and between INC 

8-K

001-36730

10.2

July 28, 2016

Research Holding Limited and Alistair Macdonald, 
dated July 27, 2016.

151

10.31#

10.32#

Letter Agreement, by and between INC Research 
Holdings Limited and Alistair Macdonald, dated July 27, 
2016.

Letter Agreement, by and between INC Research 
Holdings, Inc. and Alistair Macdonald, dated July 27, 
2016.

8-K

001-36730

10.3

July 28, 2016

8-K

001-36730

10.4

July 28, 2016

10.33 Stock Repurchase Agreement, dated August 12, 2016, 

8-K

001-36730

10.1

10.34

by and between INC Research Holdings, Inc. and 
certain stockholders named therein.

First Amendment to Credit Agreement and Increase 
Revolving Joinder, dated August 31, 2016, among INC 
Research, LLC, as the Borrower, INC Research 
Holdings, Inc., Subsidiary Guarantors, lenders party to 
the Credit Agreement, dated May 14, 2015, and Wells 
Fargo Bank, National Association, as Administrative 
Agent.

8-K

001-36730

10.1

10.35#

Form of Retention Agreement for Participants.

8-K

001-36730

10.1

10.36#

10.37#

INC Research Holdings, Inc. Executive Severance Plan 
adopted September 15, 2016.

8-K

001-36730

10.2

Form of Restricted Stock Unit Award Agreement under 
INC Research Holdings, Inc. 2014 Equity Incentive 
Plan.

10-Q 001-36730

10.8

August 18,
2016

August 31,
2016

September 15,
2016

September 15,
2016

October 31,
2016

10.38# Amendment One to the Executive Service Agreement, 

8-K

001-36730

10.1

April 6, 2017

10.39#

10.40#

10.41#

made as of April 1, 2017, between INC Research 
Holdings Limited and Alistair Macdonald.

Form of Global Restricted Stock Unit Award Agreement 
under INC Research Holdings, Inc. 2014 Equity 
Incentive Plan, as Amended and Restated.

Form of Global Performance Restricted Stock Unit 
Award Agreement under INC Research Holdings, Inc. 
2014 Equity Incentive Plan, as Amended and Restated.

Form of Restricted Stock Unit Award Agreement for 
Non-Employee Directors under INC Research Holdings, 
Inc. 2014 Equity Incentive Plan, as Amended and 
Restated.

10-Q 001-36730

10.1

May 10, 2017

10-Q 001-36730

10.2

May 10, 2017

10-Q 001-36730

10.3

May 10, 2017

10.42 Voting Agreement, dated as of May 10, 2017, by and 

8-K

001-36730

10.1

May 10, 2017

among Double Eagle Parent, Inc., INC Research 
Holdings, Inc. and Stockholders listed therein.

10.43 Voting Agreement, dated as of May 10, 2017, by and 

8-K

001-36730

10.2

May 10, 2017

among Double Eagle Parent, Inc., INC Research 
Holdings, Inc. and Stockholders listed therein.

10.44 Stockholders’ Agreement, dated as of May 10, 2017, by 
and among INC Research Holdings, Inc. and the 
stockholders party thereto.

10.45 Stockholders’ Agreement, dated as of May 10, 2017, by 
and among INC Research Holdings, Inc. and the 
stockholders party thereto.

8-K

001-36730

10.3

May 10, 2017

8-K

001-36730

10.4

May 10, 2017

10.46# Employment, Severance and Non-Competition 

S-4/A 333-197719

10.18

February 10,
2015

Agreement, effective as of September 24, 2014, 
between Michael Bell and inVentiv Health, Inc. 

10.47#

10.48#

Letter Agreement, dated May 10, 2017, by and among 
INC Research Holdings, Inc., inVentiv Health, Inc. and 
Michael A. Bell.

Letter Agreement, dated December 5, 2017, by and 
among INC Research Holdings, Inc. and Michael A. 
Bell.

10.49 Credit Agreement, dated as of August 1, 2017, among 
INC Research Holdings, Inc., the Administrative 
Borrower, other Borrowers party thereto, the financial 
institution party thereto as lenders party thereto, Credit 
Suisse AG, as Administrative Agent, and each of the 
other parties as Joint Lead Arrangers and Joint 
Bookrunners party thereto.

152

8-K

001-36730

10.5

May 10, 2017

8-K

001-36730

10.1

December 7,
2017

8-K

001-36730

10.1

August 1, 2017

10.50#

Letter Agreement, dated November 13, 2017, by and 
among INC Research Holdings, Inc. and Michael 
Gibertini, Ph.D.

8-K

001-36730

10.1

November 17,
2017

10.51# Double Eagle Parent, Inc. 2016 Omnibus Equity 

S-8

333-219607

4.3

August 1, 2017

Incentive Plan.

21.1

List of Significant Subsidiaries of the Registrant.

23.1 Consent of Ernst & Young LLP.

23.2 Consent of Deloitte & Touche LLP.

31.1 Certification of Chief Executive Officer pursuant to 

Section 302 of the Sarbanes-Oxley Act of 2002.

31.2 Certification of Executive Vice President and Interim 
Chief Financial Officer pursuant to Section 302 of the 
Sarbanes-Oxley Act of 2002.

32.1 Certification of Chief Executive Officer pursuant to 

Section 906 of the Sarbanes-Oxley Act of 2002.

32.2 Certification of Executive Vice President and Interim 
Chief Financial Officer pursuant to Section 906 of the 
Sarbanes-Oxley Act of 2002.

101.INS XBRL Instance Document.

101.SCH XBRL Taxonomy Extension Schema Document.

101.CAL XBRL Taxonomy Extension Calculation Linkbase

Document.

101.DEF XBRL Taxonomy Extension Definition Linkbase

Document.

—

—

—

—

—

—

—

—

—

—

—

101.LAB XBRL Taxonomy Extension Label Linkbase Document. —

101.PRE Taxonomy Extension Presentation Linkbase Document. —

—

—

—

—

—

—

—

—

—

—

—

—

—

# Denotes management contract or compensatory plan.

—

—

—

—

—

—

—

—

—

—

—

—

—

Filed herewith

Filed herewith

Filed herewith

Filed herewith

Filed herewith

Furnished
herewith

Furnished
herewith

Furnished
herewith

Furnished
herewith

Furnished
herewith

Furnished
herewith

Furnished
herewith

Furnished
herewith

153

Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has 
duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized. 

SIGNATURES

Syneos Health, Inc.

By:

  /s/ Alistair Macdonald
  Name:

Alistair Macdonald

Title:

Date:

Chief Executive Officer (Principal
Executive Officer) and Director

February 28, 2018

Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been signed below by 
the following persons on behalf of the registrant in the capacities and on the dates indicated. 

Signature

  Title

  Date

/s/ Alistair Macdonald
Alistair Macdonald

/s/ Jason Meggs
Jason Meggs

/s/ Michael Bell
Michael Bell

/s/ Todd Abbrecht
Todd Abbrecht

/s/ Thomas Allen
Thomas Allen

/s/ Linda Harty
Linda Harty

/s/ William E. Klitgaard

William E. Klitgaard

/s/ John Maldonado

John Maldonado

/s/ Kenneth F. Meyers

Kenneth F. Meyers

/s/ Matthew E. Monaghan
Matthew E. Monaghan

/s/ Joshua M. Nelson

Joshua M. Nelson

Chief Executive Officer (Principal
Executive Officer) and Director

February 28, 2018

Executive Vice President and
Interim Chief Financial Officer
(Principal Financial and Accounting
Officer)

February 28, 2018

Chairman and Director

February 28, 2018

February 28, 2018

February 28, 2018

February 28, 2018

February 28, 2018

February 28, 2018

February 28, 2018

February 28, 2018

February 28, 2018

Director

Director

Director

Director

Director

Director

Director

Director

154

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EXHIBIT INDEX

Exhibit   
Number   

Exhibit Description

2.1 Agreement and Plan of Merger, dated as of May 10,
2017, by and between Double Eagle Parent, Inc. and
INC Research Holdings, Inc.

Incorporated by Reference (Unless Otherwise
Indicated)

Form    File No.    
001-36730
8-K

Exhibit    Filing Date    
May 10, 2017
2.1

3.1 Certificate of Incorporation of INC Research Holdings,

8-K

001-36730

3.1

August 1, 2017

Inc.

3.2 Certificate of Amendment of Certificate of Incorporation

8-K

001-36730

3.1

January 8, 2018

of Syneos Health, Inc.

3.3 Amended and Restated Bylaws of Syneos Health, Inc.

8-K

001-36730

3.2

January 8, 2018

4.1 Specimen Certificate for Class A Common Stock.

S-1/A 333-199178

4.1

4.2 Second Amended and Restated Stockholders

8-K

001-36730

4.2

Agreement, dated as of November 6, 2014,
among INC Research Holdings, Inc. and certain
stockholders named therein.

October 27,
2014

November 13,
2014

4.3 Second Supplemental Indenture, dated as of August 7,

8-K

001-36730

10.1

August 9, 2017

2017, among INC Research Holdings, Inc., inVentiv
Health, Inc., inVentiv Health Clinical, Inc., the
guarantors party thereto and Wilmington Trust, National
Association, as trustee.

4.4

Indenture, dated as of October 14, 2016, among
Double Eagle Acquisition Sub, Inc., the guarantors
party thereto and Wilmington Trust, National
Association, as trustee.

8-K

001-36730

10.2

August 9, 2017

10.3.1# Triangle Acquisition Holdings, Inc. 2010 Equity

S-1

333-199178

10.3.1 October 6, 2014

Incentive Plan.

10.3.2# Amendment No. 1 to INC Research Holdings, Inc. 2010

S-1

333-199178

10.3.2 October 6, 2014

Equity Incentive Plan.

10.3.3# Amendment No. 2 to INC Research Holdings, Inc. 2010

S-1

333-199178

10.3.3 October 6, 2014

Equity Incentive Plan.

10.4# Form of Nonqualified Stock Option Award Agreement

S-1

333-199178

10.4

October 6, 2014

under INC Research Holdings, Inc. 2010 Equity
Incentive Plan.

10.6# Form of Stock Option Award Agreement for U.S.

S-1/A 333-199178

10.6

Participants under INC Research Holdings, Inc. 2014
Equity Incentive Plan.

October 17,
2014

10.7#

2013 Management Incentive Plan.

10.8# Form of Management Incentive Plan.

10.9.1

10.9.2

10.9.3

10.9.4

Lease, dated May 6, 2010, by and between Highwoods
Realty Limited Partnership and INC Research, Inc.

Lease Amendment Number One, dated August 26,
2010, by and between Highwoods Realty Limited
Partnership and INC Research, Inc.

Lease Amendment Number Two, dated August 23,
2011, by and between Highwoods Realty Limited
Partnership and INC Research, LLC.

Lease Amendment Number Three, dated January 4,
2013, by and between Highwoods Realty Limited
Partnership and INC Research, LLC.

S-1

S-1

S-1

333-199178

333-199178

10.7

10.8

October 6, 2014

October 6, 2014

333-199178

10.9.1 October 6, 2014

S-1

333-199178

10.9.2 October 6, 2014

S-1

333-199178

10.9.3 October 6, 2014

S-1

333-199178

10.9.4 October 6, 2014

10.10# Executive Employment Agreement, effective as of July

S-1

333-199178

10.10

October 6, 2014

31, 2014, by and between INC Research, LLC and
Duncan Jamie Macdonald.

10.11.1# Executive Employment Agreement, effective as of

S-1

333-199178

10.11

October 6, 2014

August 5, 2013, by and between INC Research, LLC
and Greg S. Rush.

155

 
 
10.11.2#

Letter Agreement, dated January 3, 2018, between
Syneos Health, Inc. and Gregory S. Rush

8-K

001-36730

10.1

January 3, 2018

10.12.1# Executive Service Agreement, dated July 31, 2014, by

S-1

333-199178

10.12

October 6, 2014

and between INC Research Holdings Limited and
Alistair Macdonald.

10.12.2# Amendment Two to the Executive Service Agreement,

10-Q 001-36730

10.1

April 27, 2015

effective as of January 1, 2015, by and between INC
Research Holdings Limited and Alistair Macdonald.

10.13# Executive Employment Agreement, effective as of July

S-1

333-199178

10.13

October 6, 2014

31, 2014, by and between INC Research, LLC and
Christopher L. Gaenzle.

10.14# Form of Restricted Stock Award Agreement under INC

S-1/A 333-199178

10.14

Research Holdings, Inc. 2014 Equity Incentive Plan.

10.15# Form of Stock Option Award Agreement for Non-U.S.

S-1/A 333-199178

10.15

Participant under INC Research Holdings, Inc. 2014
Equity Incentive Plan.

10.16# Form of 2010 Equity Incentive Plan Stock Option

S-1/A 333-199178

10.16

Adjustment Letter.

10.17# Form of 2010 Equity Incentive Plan Stock Option

S-1/A 333-199178

10.17

Amendment Letter.

10.18# Form of Stock Option Award Agreement for U.S.

10-Q 001-36730

10.1

Participants under INC Research Holdings, Inc. 2014
Equity Incentive Plan.

10.19# Form of Stock Option Award Agreement for Non-U.S.
Participants under INC Research Holdings, Inc. 2014
Equity Incentive Plan.

10-Q 001-36730

10.2

10.20# Form of Stock Option Award Agreement for U.S.

10-Q 001-36730

10.3

Participants under INC Research Holdings, Inc. 2014
Equity Incentive Plan.

10.21# Form of Restricted Stock Unit Award Agreement for
U.S. Participants under INC Research Holdings, Inc.
2014 Equity Incentive Plan.

10-Q 001-36730

10.4

10.22# Form of Restricted Stock Unit Award Agreement for

10-Q 001-36730

10.5

Non-U.S. Participants under INC Research Holdings,
Inc. 2014 Equity Incentive Plan.

10.23# Form of Restricted Stock Unit Award Agreement for
U.S. Participants under INC Research Holdings, Inc.
2014 Equity Incentive Plan.

10-Q 001-36730

10.6

10.24# Executive Employment Agreement, effective as of July

10-K

001-36730

10.29

31, 2014, by and between INC Research, LLC and
Michael Gibertini.

October 17, 
2014

October 17, 
2014

October 27, 
2014

October 17, 
2014

October 29, 
2015

October 29, 
2015

October 29, 
2015

October 29, 
2015

October 29, 
2015

October 29, 
2015

February 25, 
2016

10.25# Form of Performance Restricted Stock Unit Award

10-Q 001-36730

10.1

May 2, 2016

Agreement for U.S. Participants under INC Research
Holdings, Inc. 2014 Equity Incentive Plan.

10.26# Form of Performance Restricted Stock Unit Award

10-Q 001-36730

10.2

May 2, 2016

Agreement for Non-U.S. Participants under INC
Research Holdings, Inc. 2014 Equity Incentive Plan.

10.27#

10.28#

INC Research Holdings, Inc. 2016 Employee Stock
Purchase Plan.

INC Research Holdings, Inc. 2014 Equity Incentive
Plan, as Amended and Restated.

10.29# Transition Agreement, by and among Duncan Jamie
Macdonald, INC Research, LLC and INC Research
Holdings, Inc. entered into as of July 27, 2016.

S-8

333-212154

4.3

June 21, 2016

S-8

333-212154

4.4

June 21, 2016

8-K

001-36730

10.1

July 28, 2016

10.30# Executive Service Agreement, by and between INC

8-K

001-36730

10.2

July 28, 2016

Research Holding Limited and Alistair Macdonald,
dated July 27, 2016.

10.31#

Letter Agreement, by and between INC Research
Holdings Limited and Alistair Macdonald, dated July 27,
2016.

8-K

001-36730

10.3

July 28, 2016

156

10.32#

Letter Agreement, by and between INC Research
Holdings, Inc. and Alistair Macdonald, dated July 27,
2016.

8-K

001-36730

10.4

July 28, 2016

10.33 Stock Repurchase Agreement, dated August 12, 2016,

8-K

001-36730

10.1

August 18, 2016

by and between INC Research Holdings, Inc. and
certain stockholders named therein.

10.34 First Amendment to Credit Agreement and Increase

8-K

001-36730

10.1

August 31, 2016

Revolving Joinder, dated August 31, 2016, among INC
Research, LLC, as the Borrower, INC Research
Holdings, Inc., Subsidiary Guarantors, lenders party to
the Credit Agreement, dated May 14, 2015, and Wells
Fargo Bank, National Association, as Administrative
Agent.

10.35# Form of Retention Agreement for Participants.

8-K

001-36730

10.1

10.36#

INC Research Holdings, Inc. Executive Severance Plan
adopted September 15, 2016.

8-K

001-36730

10.2

10.37# Form of Restricted Stock Unit Award Agreement under

10-Q 001-36730

10.8

INC Research Holdings, Inc. 2014 Equity Incentive
Plan.

September 15, 
2016

September 15, 
2016

October 31, 
2016

10.38# Amendment One to the Executive Service Agreement,

8-K

001-36730

10.1

April 6, 2017

made as of April 1, 2017, between INC Research
Holdings Limited and Alistair Macdonald.

10.39# Form of Global Restricted Stock Unit Award Agreement
under INC Research Holdings, Inc. 2014 Equity
Incentive Plan, as Amended and Restated.

10-Q 001-36730

10.1

May 10, 2017

10.40# Form of Global Performance Restricted Stock Unit

10-Q 001-36730

10.2

May 10, 2017

Award Agreement under INC Research Holdings, Inc.
2014 Equity Incentive Plan, as Amended and Restated.

10.41# Form of Restricted Stock Unit Award Agreement for

10-Q 001-36730

10.3

May 10, 2017

Non-Employee Directors under INC Research
Holdings, Inc. 2014 Equity Incentive Plan, as Amended
and Restated.

10.42 Voting Agreement, dated as of May 10, 2017, by and

8-K

001-36730

10.1

May 10, 2017

among Double Eagle Parent, Inc., INC Research
Holdings, Inc. and Stockholders listed therein.

10.43 Voting Agreement, dated as of May 10, 2017, by and

8-K

001-36730

10.2

May 10, 2017

among Double Eagle Parent, Inc., INC Research
Holdings, Inc. and Stockholders listed therein.

10.44 Stockholders’ Agreement, dated as of May 10, 2017, by
and among INC Research Holdings, Inc. and the
stockholders party thereto.

10.45 Stockholders’ Agreement, dated as of May 10, 2017, by
and among INC Research Holdings, Inc. and the
stockholders party thereto.

8-K

001-36730

10.3

May 10, 2017

8-K

001-36730

10.4

May 10, 2017

10.46# Employment, Severance and Non-Competition

S-4/A 333-197719

10.18

February 10,
2015

Agreement, effective as of September 24, 2014,
between Michael Bell and inVentiv Health, Inc.

10.47#

10.48#

Letter Agreement, dated May 10, 2017, by and among
INC Research Holdings, Inc., inVentiv Health, Inc. and
Michael A. Bell.

Letter Agreement, dated December 5, 2017, by and
among INC Research Holdings, Inc. and Michael A.
Bell.

10.49 Credit Agreement, dated as of August 1, 2017, among
INC Research Holdings, Inc., the Administrative
Borrower, other Borrowers party thereto, the financial
institution party thereto as lenders party thereto, Credit
Suisse AG, as Administrative Agent, and each of the
other parties as Joint Lead Arrangers and Joint
Bookrunners party thereto.

10.50#

Letter Agreement, dated November 13, 2017, by and
among INC Research Holdings, Inc. and Michael
Gibertini, Ph.D.

8-K

001-36730

10.5

May 10, 2017

8-K

001-36730

10.1

December 7,
2017

8-K

001-36730

10.1

August 1, 2017

8-K

001-36730

10.1

November 17,
2017

10.51# Double Eagle Parent, Inc. 2016 Omnibus Equity

S-8

333-219607

4.3

August 1, 2017

Incentive Plan.

157

21.1

List of Significant Subsidiaries of the Registrant.

23.1 Consent of Ernst & Young LLP.

23.2 Consent of Deloitte & Touche LLP.

31.1 Certification of Chief Executive Officer pursuant to

Section 302 of the Sarbanes-Oxley Act of 2002.

31.2 Certification of Executive Vice President and Interim
Chief Financial Officer pursuant to Section 302 of the
Sarbanes-Oxley Act of 2002.

32.1 Certification of Chief Executive Officer pursuant to

Section 906 of the Sarbanes-Oxley Act of 2002.

32.2 Certification of Executive Vice President and Interim
Chief Financial Officer pursuant to Section 906 of the
Sarbanes-Oxley Act of 2002.

101.INS XBRL Instance Document.

101.SCH XBRL Taxonomy Extension Schema Document.

101.CAL XBRL Taxonomy Extension Calculation Linkbase 

Document. 

101.DEF XBRL Taxonomy Extension Definition Linkbase 

Document.

—

—

—

—

—

—

—

—

—

—

—

101.LAB XBRL Taxonomy Extension Label Linkbase Document. —

101.PRE Taxonomy Extension Presentation Linkbase Document. —

—

—

—

—

—

—

—

—

—

—

—

—

—

# Denotes management contract or compensatory plan.

—

—

—

—

—

—

—

—

—

—

—

—

—

Filed herewith

Filed herewith

Filed herewith

Filed herewith

Filed herewith

Furnished 
herewith

Furnished 
herewith

Furnished 
herewith

Furnished 
herewith

Furnished 
herewith

Furnished 
herewith

Furnished 
herewith

Furnished 
herewith

158