Syneos Health, Inc. (Form: 10-Q, Received: 08/02/2018 06:17:07)

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EXECUTION VERSION EXHIBIT A to FIRST AMENDMENT, dated as of August 1, 2018 RECEIVABLES FINANCING AGREEMENT Dated as of June 29, 2018 by and among SYNEOS HEALTH RECEIVABLES LLC, as Borrower, THE PERSONS FROM TIME TO TIME PARTY HERETO, as Lenders, PNC BANK, NATIONAL ASSOCIATION, as Administrative Agent, INC RESEARCH, LLC, as initial Servicer, and PNC CAPITAL MARKETS LLC, as Structuring Agent 729557511 18569090

including the particular default, if any) to funding a Loan under this Agreement cannot be satisfied) or generally under other agreements in which it commits to extend credit, (c) has failed, within three (3) Business Days after request by a Credit Party, acting in good faith, to provide a certification in writing from an authorized officer of such Lender that it will comply with its obligations (and is financially able to meet such obligations) to fund prospective Loans under this Agreement, provided that such Lender shall cease to be a Defaulting Lender pursuant to this clause (c) upon such Credit Party’s receipt of such certification in form and substance satisfactory to it and the Administrative Agent, or (d) has become the subject of an Insolvency Proceeding. “Delinquency Ratio” means the ratio (expressed as a percentage and rounded to the nearest 1/100 of 1%, with 5/1000th of 1% rounded upward) computed as of the last day of each Fiscal Month by dividing: (a) the aggregate Outstanding Balance of all Pool Receivables that were Delinquent Receivables on such day, by (b) the aggregate Outstanding Balance of all Pool Receivables on such day. “Delinquent Receivable” means a Receivable as to which any payment, or part thereof, remains unpaid for 91 days or more from the original due date for such payment; provided, however, that such amount shall be calculated without giving effect to any netting of credits that have not been matched to a particular Receivable for the purposes of aged trial balance reporting. “Dilution Horizon Ratio” means, for any Fiscal Month, the ratio (expressed as a percentage and rounded to the nearest 1/100th of 1%, with 5/1000th of 1% rounded upward) computed as of the last day of such Fiscal Month by dividing: (a) the sum of (i) the aggregate initial Outstanding Balance of all Pool Receivables (other than Unbilled Receivables) generated by the Originators during such Fiscal Month, plus (ii) the aggregate initial Outstanding Balance of all Pool Receivables (other than Unbilled Receivables) generated by the Originators during the preceding Fiscal Month, by (b) the Net Receivables Pool Balance as of the last day of such Fiscal Month. Within thirty (30) days of the completion and the receipt by the Administrative Agent of the results of any annual audit or field exam of the Receivables and the servicing and origination practices of the Servicer and the Originators, the numerator of the Dilution Horizon Ratio may be adjusted, after consultation with the Borrower, by the Administrative Agent upon not less than five (5) Business Days notice to the Borrower to reflect such number of Fiscal Months as the Administrative Agent reasonably believes best reflects the business practices of the Servicer and the Originators and the actual amount of dilution and Deemed Collections that occur with respect to Pool Receivables based on the weighted average dilution lag calculation completed as part of such audit or field exam. “Dilution Ratio” means, for any Fiscal Month, the ratio (expressed as a percentage and rounded to the nearest 1/100th of 1%, with 5/1000th of 1% rounded upward), computed as of the last day of each Fiscal Month by dividing: (i) the aggregate amount of Deemed Collections during such Fiscal Month (other than any Deemed Collections with respect to any Receivables that were both (x) generated by an Originator during such Fiscal Month and (y) written off the applicable Originator’s or the Borrower’s books as uncollectible during such Fiscal Month), by (ii) the aggregate initial Outstanding Balance of all Pool Receivables (other than Unbilled Receivables) generated by the Originators during the Fiscal Month that is one (1) month prior to such Fiscal Month. 10 729557511 18569090

“Dilution Reserve Percentage” means, at any time of determination, the product (expressed as a percentage and rounded to the nearest 1/100th of 1%, with 5/1000th of 1% rounded upward) of (a) the Dilution Horizon Ratio, multiplied by (b) the sum of (i) the Stress Factor times the average of the Dilution Ratios for the twelve (12) most recent Fiscal Months, plus (ii) the Dilution Volatility Component. “Dilution Volatility Component” means, for any Fiscal Month, the product (expressed as a percentage and rounded to the nearest 1/100th of 1%, with 5/1000th of 1% rounded upward) of: (a) the positive difference, if any, between: (i) the highest Dilution Ratio for any Fiscal Month during the twelve (12) most recent Fiscal Months and (ii) the arithmetic average of the Dilution Ratios for such twelve (12) Fiscal Months; multiplied by (b) the quotient of (i) the highest Dilution Ratio for any Fiscal Month during the twelve (12) most recent Fiscal Months, divided by (ii) the arithmetic average of the Dilution Ratios for such twelve (12) Fiscal Months. “Dollars” and “$” each mean the lawful currency of the United States of America. “Eligible Assignee” means (i) any Lender or any of its Affiliates, (ii) any Person managed by a Lender or any of its Affiliates and (iii) any other financial or other institution. “Eligible Foreign Obligor” means an Obligor with respect to any Receivable that is either (i) an Eligible OECD Country Obligor or (ii) an Eligible Non-OECD Country Obligor. “Eligible Non-OECD Country Obligor” means an Obligor with respect to any Receivable that is organized in or that has a head office (domicile), registered office, and chief executive office located in any country (other than the United States) that is not an OECD Country, is not a Sanctioned Country and has a long-term foreign currency rating of at least “BBB-” by S&P and “Baa3” by Moody’s. “Eligible OECD Country Obligor” means an Obligor with respect to any Receivable that is organized in or that has a head office (domicile), registered office, and chief executive office located in an OECD Country (other than the United States). “Eligible Receivable” means, at any time of determination, a Pool Receivable: (a) the Obligor of which is: (i) either a U.S. Obligor or an Eligible Foreign Obligor; (ii) not a Governmental Authority; (iii) not a Sanctioned Person; (iv) not subject to any Insolvency Proceeding; (v) not an Affiliate of the Borrower, the Servicer, the Parent, the Performance Guarantor or any Originator; (vi) not the Obligor with respect to Delinquent Receivables with an aggregate Outstanding Balance exceeding 50% of the aggregate Outstanding Balance of all such Obligor’s Pool Receivables; (vii) not a natural person and (viii) not a material supplier to any Originator or an Affiliate of a material supplier; 11 729557511 18569090

(t) which does not relate to the sale of any consigned goods or finished goods which have incorporated any consigned goods into such finished goods; (u) for which the related Originator has recognized the related revenue on its financial books and records in accordance with GAAP; (v) for which the related invoice does not include any Excluded Receivable; (w) for which neither the related Originator nor any Affiliate thereof is holding any deposits received by or on behalf of the related Obligor; provided that only the portion of such Pool Receivable in an amount equal to such deposits shall be ineligible; and (x) that, if such Receivable is an Unbilled Receivable, is an Eligible Unbilled Receivable. “Eligible Tier I Non-OECD Country Obligor” means an Obligor with respect to any Receivable that is organized in or that has a head office (domicile), registered office, and chief executive office located in any country (other than the United States) that is not an OECD Country, is not a Sanctioned Country and has a long-term foreign currency rating of at least “A” by S&P and “A2” by Moody’s. “Eligible Tier II Non-OECD Country Obligor” means any Eligible Non-OECD Country Obligor that is not an Eligible Tier I Non-OECD Country Obligor. “Eligible Unbilled Receivable” means, at any time, any Unbilled Receivable that satisfies each of the following: (a) the related Originator has recognized the related revenue on its financial books and records under GAAP and (b) if the Outstanding Balance of such Unbilled Receivable were included in the definition of Modified Days’ Sales Outstanding, Modified Days’ Sales Outstanding would not exceed the Maximum Term; provided, however, for purposes of exclusion of any Unbilled Receivable pursuant to this clause (b), Unbilled Receivables shall be excluded in order based on the Outstanding Balance (with the smallest amount excluded first). For purposes of this definition of “Eligible Unbilled Receivable”, “Maximum Term” means 105 days. “ERISA” means the Employee Retirement Income Security Act of 1974, as amended from time to time, and any rule or regulation issued thereunder. “ERISA Affiliate” means, with respect to any Person, any corporation, trade or business which together with the Person is a member of a controlled group of corporations or a controlled group of trades or businesses and would be deemed a “single employer” within the meaning of Sections 414(b), (c), (m) of the Code or Section 4001(b) of ERISA. “Euro-Rate Reserve Percentage” means, the maximum effective percentage in effect on such day as prescribed by the Board of Governors of the Federal Reserve System (or any successor) for determining the reserve requirements (including without limitation, supplemental, marginal, and emergency reserve requirements) with respect to eurocurrency funding (currently referred to as “Eurocurrency Liabilities”). 14 729557511 18569090

“Event of Default” has the meaning specified in Section 10.01. For the avoidance of doubt, any Event of Default that occurs shall be deemed to be continuing at all times thereafter unless and until waived in accordance with Section 14.01. “Excess Concentration” means the sum of the following amounts, without duplication: (a) the sum of the amounts calculated for each of the Obligors equal to the excess (if any) of (i) the aggregate Outstanding Balance of the Eligible Receivables of such Obligor, over (ii) the product of (x) such Obligor’s Concentration Percentage, multiplied by (y) the aggregate Outstanding Balance of all Eligible Receivables then in the Receivables Pool; plus (b) the excess (if any) of (i) the aggregate Outstanding Balance of all Eligible Receivables that are Eligible Unbilled Receivables, over (ii) the product of (x) (A) so long as a Ratings Event has not occurred and is continuing, 50.060.0% or (B) if a Ratings Event has occurred and is continuing, 25.030.0%, multiplied by (y) the aggregate Outstanding Balance of all Receivables then in the Receivables Pool; plus (c) the excess (if any) of (i) the aggregate Outstanding Balance of all Eligible Receivables, the Obligors of which are Eligible ForeignOECD Country Obligors, over (ii) the product of (x) 10.0%, multiplied by (y) the aggregate Outstanding Balance of all Receivables then in the Receivables Pool; plus (d) the excess (if any) of (i) the aggregate Outstanding Balance of all Eligible Receivables, the Obligors of which are Eligible Tier I Non-OECD Country Obligors, over (ii) the product of (x) 2.5%, multiplied by (y) the aggregate Outstanding Balance of all Receivables then in the Receivables Pool; plus (e) the excess (if any) of (i) the aggregate Outstanding Balance of all Eligible Receivables, the Obligors of which are Eligible Tier II Non-OECD Country Obligors, over (ii) the product of (x) 1.0%, multiplied by (y) the aggregate Outstanding Balance of all Receivables then in the Receivables Pool; plus (f) the excess (if any) of (i) the aggregate Outstanding Balance of all Eligible Receivables that have remained unpaid for more than 60 days but less than 91 days after the original due date of such Receivable, over (ii) the product of (x) 15.0%, multiplied by (y) the aggregate initial Outstanding Balance of all Pool Receivables (other than Unbilled Receivables) generated by the Originators during the month that is three (3) Fiscal Months before the then-current Fiscal Month as of the date of determination; plus (g) (d) the excess (if any) of (i) the aggregate Outstanding Balance of all Eligible Receivables that have a due date which is more than 90 days but less than 121 days after the original invoice date of such Receivable, over (ii) the product of (x) 10.0%, multiplied by (y) the aggregate Outstanding Balance of all Receivables then in the Receivables Pool. “Exchange Act” means the Securities Exchange Act of 1934, as amended or otherwise modified from time to time. 15 729557511 18569090

and which is listed on Schedule II (as such schedule may be modified from time to time in connection with the addition or removal of any Lock-Box in accordance with the terms hereof). “Loss Horizon Ratio” means the ratio (expressed as a percentage and rounded to the nearest 1/100 of 1%, with 5/1000th of 1% rounded upward) computed as of the last day of each Fiscal Month by dividing: (a) the sum of (x) the aggregate initial Outstanding Balance of all Pool Receivables (other than Unbilled Receivables) generated by the Originators during the sevensix (76) most recent Fiscal Months plus (y) 5065% of the aggregate initial Outstanding Balance of all Pool Receivables (other than Unbilled Receivables) generated by the Originators during the eighth most recent Fiscal Month; by (b) the Net Receivables Pool Balance as of such date. “Loss Reserve Percentage” means, at any time of determination, the product (expressed as a percentage and rounded to the nearest 1/100th of 1%, with 5/1000th of 1% rounded upward) of (a) the Stress Factor, multiplied by (b) the highest average of the Default Ratios for any three (3) consecutive Fiscal Months during the twelve (12) most recent Fiscal Months, multiplied by (c) the Loss Horizon Ratio. “Management Investors” means the officers, directors, managers, employees and members of management of Parent, any Parent Company and/or any subsidiary of Parent. “Majority Lenders” means Lenders representing more than 50% of the aggregate Commitments of all Lenders (or, if the Commitments have been terminated, Lenders representing more than 50% of the aggregate outstanding Capital held by all the Lenders). “Material Adverse Effect” means relative to any Person (provided that if no particular Person is specified, “Material Adverse Effect” shall be deemed to be relative to the Performance Guarantor, the Servicer and the Originators, in the aggregate) with respect to any event or circumstance, a material adverse effect on any of the following: (a) the assets, operations, business or financial condition of such Person or, if no Person is specified, of the Servicer, the Performance Guarantor and the Originators taken as a whole; (b) the ability of such Person, or if no Person is specified, of the Servicer, the Performance Guarantor and any Originators, taken as a whole, to perform its or their obligations under this Agreement or any other Transaction Document to which it is or they are a party; (c) the validity or enforceability of this Agreement or any other Transaction Document, or the validity, enforceability, value or collectability of any material portion of the Pool Receivables; (d) the status, perfection, enforceability or priority of the Administrative Agent’s security interest in the Collateral; or 22 729557511 18569090

and available at: http://www.treasury.gov/resource-center/sanctions/ Programs/Pages/Programs.aspx, or as otherwise published from time to time “Sanctioned Person” (i) A person named on the list of “Specially Designated Nationals” or “Blocked Persons” maintained by OFAC available at: http://www.treasury.gov/ resource-center/sanctions/SDN-List/Pages/default.aspx, or as otherwise published from time to time, (ii) (A) an agency of the government of a Sanctioned Country, (B) an organization controlled by a Sanctioned Country or (C) a person resident in a Sanctioned Country, to the extent subject to a sanctions program administered by OFAC, or (iii) any individual person, group, regime, entity or thing listed or otherwise recognized as a specially designated, prohibited, sanctioned or debarred person, group, regime, entity or thing, or subject to any limitations or prohibitions (including but not limited to the blocking of property or rejection of transactions), under any Anti-Terrorism Law. “Scheduled Termination Date” means June 29, 2021.2020. “SEC” means the U.S. Securities and Exchange Commission or any governmental agencies substituted therefor. “Secured Parties” means each Credit Party, each Borrower Indemnified Party and each Affected Person. “Servicer” has the meaning set forth in the preamble to this Agreement. “Servicer’s Account” means the deposit account with an account number ending in 4824 maintained by the Servicer or its Affiliate at Bank of America, N.A. “Servicer Indemnified Amounts” has the meaning set forth in Section 13.02(a). “Servicer Indemnified Party” has the meaning set forth in Section 13.02(a). “Servicing Fee” means the fee referred to in Section 9.06(a) of this Agreement. “Servicing Fee Rate” means the rate referred to in Section 9.06(a) of this Agreement. “Settlement Date” means with respect to any Portion of Capital for any Interest Period or any Interest or Fees, (i) prior to the Termination Date and so long as no Event of Default has occurred and is continuing, the Monthly Settlement Date and (ii) on and after the Termination Date or if an Event of Default has occurred and is continuing, each day selected from time to time by the Administrative Agent (with the consent or at the direction of the Majority Lenders) (it being understood that the Administrative Agent (with the consent or at the direction of the Majority Lenders) may select such Settlement Date to occur as frequently as daily), or, in the absence of such selection, the Monthly Settlement Date. “Settlement Item” means (i) each check or other payment order drawn on or payable against any Linked Account, which any Collection Account Bank takes for deposit or value, cashes or exchanges for a cashier’s check or official check in the ordinary course of business, and which is presented for settlement against any Collection Account, (ii) each check or other 28 729557511 18569090

(i) the conditions in Section 6.01(a) have been satisfied; (ii) the Administrative Agent shall have received a fully executed copy of an Account Control Agreement with respect to each Collection Account set forth on Schedule II hereto, in each case, in form and substance acceptable to the Administrative Agent; (ii) (iii) the Administrative Agent shall have received such historical receivables data with respect to the Originators, as reasonably requested by the Administrative Agent and in such format as is acceptable to the Administrative Agent; (iii) (iv) the Administrative Agent shall have received satisfactory results of an audit or field exam (performed by representatives of the Administrative Agent) of the Servicer’s and each Originator’s collection, operating and reporting systems, the Credit and Collection Policy and historical receivables data; (iv) (v) each amendment to this Agreement and each other Transaction Document reasonably requested by the Administrative Agent on or after the Closing Date in connection with the audit or field exam results referenced in clause (iv) above and the historical receivables data referenced in clause (iii) above, in each case, shall have become effective; such amendments may include, but shall not be limited to, amendments to the definitions of “Concentration Percentage”, “Defaulted Receivable”, “Delinquent Receivable”, “Eligible Unbilled Receivable”, “Eligible Receivable” and “Excess Concentration” contained in this Agreement and amendments to Section 10.01(f); (v) (vi) the Administrative Agent shall have received such documents, reports, agreements, opinions of counsel, certificates, resolutions and other deliverables, in each case, in form and substance acceptable to the Administrative Agent as may be reasonably requested by the Administrative Agent in connection with the items referenced in clauses (iiiii) through (viv) above; (vi) (vii) receipt by each of the Lenders of customary internal credit approvals and bank authorizations for their entry into the amendments contemplated in clause (viv) above; (vii) (viii) the Borrower shall have identified the “Commencement Date” in a writing delivered to the Administrative Agent and such “Commencement Date” is on or prior to the date of such initial Credit Extension; and (viii) (ix) the Servicer shall have delivered to the Administrative Agent (A) an Information Package as of the most recently completed Fiscal Month and (B) if a Ratings Event has occurred and is continuing, an Interim Report as of the last day of the immediately preceding calendar week. SECTION 6.02. Conditions Precedent to All Credit Extensions. Each Credit Extension hereunder on or after the Closing Date shall be subject to the conditions precedent that: 48 729557511 18569090

books and records necessary to identify Collections received from time to time on Pool Receivables and to segregate such Collections from other property of the Servicer and the Originators. If any payments on the Pool Receivables or other Collections are received by the Borrower, the Servicer or an Originator, it shall hold such payments in trust for the benefit of the Administrative Agent, the Lenders and the other Secured Parties and promptly (but in any event within one (1) Business Day after becoming aware of such receipt) remit such funds into a Collection Account. The Borrower (or the Servicer on its behalf) will use commercially reasonable efforts to ensure that each Collection Account Bank complies with the terms of each applicable Account Control Agreement. The Borrower shall use commercially reasonable efforts to ensure that no funds other than Collections on Pool Receivables and other Collateral are deposited into any Collection Account. If such funds are nevertheless deposited into any Collection Account, the Borrower (or the Servicer on its behalf) will within two (2) Business Days identify and transfer such funds to the appropriate Person entitled to such funds. The Borrower will not, and will not permit the Servicer, any Originator or any other Person to commingle Collections or other funds to which the Administrative Agent, any Lender or any other Secured Party is entitled, with any other funds. The Borrower shall only add a Collection Account (or a related Lock-Box) or a Collection Account Bank to those listed on Schedule II to this Agreement, if the Administrative Agent has received notice of such addition and an executed and acknowledged copy of an Account Control Agreement (or an amendment thereto) in form and substance acceptable to the Administrative Agent from the applicable Collection Account Bank. The Borrower shall only terminate a Collection Account Bank or close a Collection Account (or a related Lock-Box) with the prior written consent of the Administrative Agent. Commencing on the date that is 3060 days following the Closing Date, the Borrower shall ensure that no disbursements are made from any Collection Account, other than such disbursements that are made at the direction and for the account of the Borrower. (i) Sales, Liens, etc. Except as otherwise provided herein, the Borrower will not sell, assign (by operation of law or otherwise) or otherwise dispose of, or create or suffer to exist any Adverse Claim (other than a Permitted Adverse Claim) upon (including, without limitation, the filing of any financing statement) or with respect to, any Pool Receivable or other Collateral, or assign any right to receive income in respect thereof. (j) Extension or Amendment of Pool Receivables. Except as otherwise permitted in Section 9.02, the Borrower will not, and will not permit the Servicer to, alter the delinquency status or adjust the Outstanding Balance or otherwise modify the terms of any Pool Receivable in any material respect, or amend, modify or waive, in any material respect, any term or condition of any related Contract. The Borrower shall at its expense, timely and fully perform and comply in all material respects with all provisions, covenants and other promises required to be observed by it under the Contracts related to the Pool Receivables, and timely and fully comply in all material respects with the Credit and Collection Policy with regard to each Pool Receivable and the related Contract. (k) Change in Credit and Collection Policy. The Borrower will not make any change in the Credit and Collection Policy that would reasonably be expected to either (x) have a material adverse effect on the collectability of the Pool Receivables or (y) have a Borrower Material Adverse Effect or a Material Adverse Effect, in each case, without the prior written consent of the Administrative Agent and the Majority Lenders. Promptly following any material 62 729557511 18569090

Administrative Agent or any Lender may reasonably request. The Servicer will, at the Servicer’s expense, during regular business hours with reasonable prior written notice, (i) permit the Administrative Agent and each Lender or their respective agents or representatives to (A) examine and make copies of and abstracts from all books and records relating to the Pool Receivables or other Collateral, (B) visit the offices and properties of the Servicer for the purpose of examining such books and records and (C) discuss matters relating to the Pool Receivables, the other Collateral or the Servicer’s performance hereunder or under the other Transaction Documents to which it is a party with any of the officers, directors, employees or independent public accountants of the Servicer (provided that representatives of the Servicer are present during such discussions) having knowledge of such matters and (ii) without limiting the provisions of clause (i) above, during regular business hours, at the Servicer’s expense, upon reasonable prior written notice from the Administrative Agent, permit certified public accountants or other auditors acceptable to the Administrative Agent to conduct a review of its books and records with respect to the Pool Receivables and other Collateral; provided, that the Servicer shall be required to reimburse the Administrative Agent for only one (1) combined review of the Borrower pursuant to Section 8.01(g) and the Servicer, the Borrower and the Originators pursuant to clause (ii) above in any twelve-month period unless an Event of Default has occurred and is continuing. (f) Payments on Receivables, Collection Accounts. The Servicer will at all times, instruct all Obligors to deliver payments on the Pool Receivables to a Collection Account or a Lock-Box. The Servicer will, at all times, maintain such books and records necessary to identify Collections received from time to time on Pool Receivables and to segregate such Collections from other property of the Servicer and the Originators. If any payments on the Pool Receivables or other Collections are received by the Borrower, the Servicer or an Originator, it shall hold such payments in trust for the benefit of the Administrative Agent, the Lenders and the other Secured Parties and promptly (but in any event within one (1) Business Day after becoming aware of such receipt) remit such funds into a Collection Account. The Servicer shall instruct (i) all obligors on Excluded Receivables and (ii) all payors of amounts owing to the Originators or their Affiliates (which do not constitute Pool Receivables or other Collateral), in each case, to remit payments with respect thereto to any bank account or other location that does not constitute a Collection Account or a Lock-Box. The Servicer shall use commercially reasonable efforts to ensure that no funds other than Collections on Pool Receivables and other Collateral are deposited into any Collection Account. If such funds are nevertheless deposited into any Collection Account, the Servicer will within two (2) Business Days identify and transfer such funds to the appropriate Person entitled to such funds. The Servicer will not, and will not permit the Borrower, any Originator or any other Person to commingle Collections or other funds to which the Administrative Agent, any Lender or any other Secured Party is entitled, with any other funds. The Servicer shall only add a Collection Account (or a related Lock-Box), or a Collection Account Bank to those listed on Schedule II to this Agreement, if the Administrative Agent has received notice of such addition and an executed and acknowledged copy of an Account Control Agreement (or an amendment thereto) in form and substance acceptable to the Administrative Agent from the applicable Collection Account Bank. The Servicer shall only terminate a Collection Account Bank or close a Collection Account (or a related Lock-Box) with the prior written consent of the Administrative Agent. Commencing on the date that is 3060 days following the Closing Date, the Servicer shall ensure that no disbursements are made from any 70 729557511 18569090

(f) on or after the Commencement Date, (i) the average for three consecutive Fiscal Months of: (A) the Default Ratio shall exceed 2.03.5%, (B) the Delinquency Ratio shall exceed 3.07.5% or (C) the Dilution Ratio shall exceed 7.517.5% or (ii) the Days’ Sales Outstanding shall exceed 80 days; (g) a Change in Control shall occur; (h) a Borrowing Base Deficit shall occur, and shall not have been cured within two (2) Business Days; (i) (i) the Borrower shall fail to pay any principal of or premium or interest on any of its Debt when the same becomes due and payable (whether by scheduled maturity, required prepayment, acceleration, demand or otherwise), and such failure shall continue after the applicable grace period, if any, specified in the agreement, mortgage, indenture or instrument relating to such Debt (whether or not such failure shall have been waived under the related agreement); (ii) any Originator, the Performance Guarantor or the Servicer, or any of their respective Subsidiaries, individually or in the aggregate, shall fail to pay any principal of or premium or interest on (x) any Debt under the Credit Agreement or (y) any of its other Debt that is outstanding in a principal amount of at least the Threshold Amount in the aggregate when the same becomes due and payable (whether by scheduled maturity, required prepayment, acceleration, demand or otherwise), and such failure shall continue after the applicable grace period (not to exceed 30 days), if any, specified in the Credit Agreement or such agreement, mortgage, indenture or instrument relating to such Debt (whether or not such failure shall have been waived under the related agreement); (iii) any other event shall occur or condition shall exist under the Credit Agreement or any other agreement, mortgage, indenture or instrument relating to any such Debt (as referred to in clause (i) or (ii) of this paragraph and shall continue after the applicable grace period (not to exceed 30 days), if any, specified in the Credit Agreement or such other agreement, mortgage, indenture or instrument, if the effect of such event or condition is to give the applicable debtholders the right (whether acted upon or not) to accelerate the maturity of such Debt (as referred to in clause (i) or (ii) of this paragraph) or to terminate the commitment of any lender thereunder, unless such event or condition shall have been waived under and in accordance with the related agreement or (iv) any such Debt (as referred to in clause (i) or (ii) of this paragraph) shall be declared to be due and payable, or required to be prepaid (other than by a regularly scheduled required prepayment), redeemed, purchased or defeased, or an offer to repay, redeem, purchase or defease such Debt shall be required to be made or the commitment of any lender thereunder terminated, in each case before the stated maturity thereof; (j) (i) any “Event of Default” (as defined in the Credit Agreement) shall occur under the Credit Agreement that relates to the failure to pay any principal of or premium or interest on any of the Debt thereunder when the same becomes due and payable (whether by scheduled maturity, required prepayment, acceleration, demand or otherwise) or (ii) any other “Event of Default” (as defined in the Credit Agreement) shall occur under the Credit Agreement that has not been waived under and in accordance with the Credit Agreement (for the avoidance of doubt, this clause (j) shall not be construed to limit the preceding clause (i)); 83 729557511 18569090

SECTION 14.15. USA Patriot Act. Each of the Administrative Agent and each of the other Credit Parties hereby notifies the Borrower and the Servicer that pursuant to the requirements of the USA PATRIOT Act, Title III of Pub. L. 107-56 (signed into law October 26, 2001) (the “PATRIOT Act”), the Administrative Agent and the other Credit Parties may be required to obtain, verify and record information that identifies the Borrower, the Originators, the Servicer and the Performance Guarantor, which information includes the name, address, tax identification number and other information regarding the Borrower, the Originators, the Servicer and the Performance Guarantor that will allow the Administrative Agent and the other Credit Parties to identify the Borrower, the Originators, the Servicer and the Performance Guarantor in accordance with the PATRIOT Act. This notice is given in accordance with the requirements of the PATRIOT Act. Each of the Borrower and the Servicer agrees to provide the Administrative Agent and each other Credit Parties, from time to time, with all documentation and other information required by bank regulatory authorities under “know your customer” and anti-money laundering rules and regulations, including, without limitation, the PATRIOT Act. SECTION 14.16. Right of Setoff. Each Credit Party is hereby authorized (in addition to any other rights it may have), at any time during the continuance of an Event of Default, to setoff, appropriate and apply (without presentment, demand, protest or other notice which are hereby expressly waived) any deposits and any other indebtedness held or owing by such Credit Party (including by any branches or agencies of such Credit Party) to, or for the account of, the Borrower or the Servicer against amounts owing by the Borrower or the Servicer hereunder (even if contingent or unmatured); provided that such Credit Party shall notify the Borrower or the Servicer, as applicable, promptly following such setoff. SECTION 14.17. Severability. Any provisions of this Agreement which are prohibited or unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining provisions hereof, and any such prohibition or unenforceability in any jurisdiction shall not invalidate or render unenforceable such provision in any other jurisdiction. SECTION 14.18. Mutual Negotiations. This Agreement and the other Transaction Documents are the product of mutual negotiations by the parties thereto and their counsel, and no party shall be deemed the draftsperson of this Agreement or any other Transaction Document or any provision hereof or thereof or to have provided the same. Accordingly, in the event of any inconsistency or ambiguity of any provision of this Agreement or any other Transaction Document, such inconsistency or ambiguity shall not be interpreted against any party because of such party’s involvement in the drafting thereof. SECTION 14.19. Captions and Cross References. The various captions (including the table of contents) in this Agreement are provided solely for convenience of reference and shall not affect the meaning or interpretation of any provision of this Agreement. Unless otherwise indicated, references in this Agreement to any Section, Schedule or Exhibit are to such Section Schedule or Exhibit to this Agreement, as the case may be, and references in any Section, subsection, or clause to any subsection, clause or subclause are to such subsection, clause or subclause of such Section, subsection or clause. 102 729557511 18569090

SECTION 14.20. Post-Closing Covenant. The Borrower and the Servicer shall deliver to the Administrative Agent, no later than August 31, 2018, a fully executed copy of an Account Control Agreement with respect to each Collection Account set forth on Schedule II hereto, in each case, in form and substance acceptable to the Administrative Agent, along with such documents, reports, agreements, opinions of counsel, certificates, resolutions and other deliverables, in each case, in form and substance acceptable to the Administrative Agent as may be reasonably requested by the Administrative Agent in connection each such Account Control Agreement. Failure to timely comply with this Section 14.20 shall constitute an immediate Event of Default with no grace period. [Signature Pages Follow] 103 729557511 18569090



Delaware		27-3403111
(State or other jurisdiction of incorporation or organization)		(I.R.S. Employer Identification No.)




	PART I - FINANCIAL INFORMATION
		Page
Item 1.	Financial Statements	3
	Condensed Consolidated Statements of Operations for the three and six months ended June 30, 2018 and 2017 (unaudited)	3
	Condensed Consolidated Statements of Comprehensive Income (Loss) for the three and six months ended June 30, 2018 and 2017 (unaudited)	4
	Condensed Consolidated Balance Sheets as of June 30, 2018 and December 31, 2017 (unaudited)	5
	Condensed Consolidated Statements of Cash Flows for the six months ended June 30, 2018 and 2017 (unaudited)	6
	Notes to Condensed Consolidated Financial Statements (unaudited)	7
Item 2.	Management's Discussion and Analysis of Financial Condition and Results of Operations	34
Item 3.	Quantitative and Qualitative Disclosures About Market Risk	53
Item 4.	Controls and Procedures	54

	PART II - OTHER INFORMATION

Item 1.	Legal Proceedings	55
Item 1A.	Risk Factors	55
Item 2.	Unregistered Sales of Equity Securities, Use of Proceeds and Issuer Purchases of Equity Securities	55
Item 5.	Other Information	56
Item 6.	Exhibits	57
	Signatures	58
	Exhibit Index	59



	Three Months Ended June 30,						Six Months Ended June 30,
	2018			2017			2018			2017
	(In thousands, except per share data)
Service revenue	$	1,072,530		$	258,087		$	2,129,726		$	510,165
Reimbursable out-of-pocket expenses	—			133,048			—			262,888
Total revenue	1,072,530			391,135			2,129,726			773,053

Costs and operating expenses:
Direct costs (exclusive of depreciation and amortization)	547,993			162,010			1,080,050			316,845
Reimbursable out-of-pocket expenses	299,472			133,048			608,238			262,888
Selling, general, and administrative	100,218			42,531			199,477			87,465
Restructuring and other costs	8,591			4,029			22,298			5,956
Transaction and integration-related expenses	18,032			23,739			43,243			23,741
Depreciation	17,557			6,066			35,585			12,230
Amortization	49,945			9,462			99,938			18,926
Total operating expenses	1,041,808			380,885			2,088,829			728,051
Income from operations	30,722			10,250			40,897			45,002

Other (expense) income, net:
Interest income	1,655			152			2,494			264
Interest expense	(32,894		)	(3,286		)	(64,630		)	(6,386		)
Loss on extinguishment of debt	(1,877		)	—			(2,125		)	—
Other income (expense), net	32,001			(6,754		)	19,447			(10,211		)
Total other expense, net	(1,115		)	(9,888		)	(44,814		)	(16,333		)
Income (loss) before provision for income taxes	29,607			362			(3,917		)	28,669
Income tax (expense) benefit	(16,047		)	3,027			(7,075		)	(4,093		)
Net income (loss)	$	13,560		$	3,389		$	(10,992	)	$	24,576

Earnings (loss) per share:
Basic	$	0.13		$	0.06		$	(0.11	)	$	0.45
Diluted	$	0.13		$	0.06		$	(0.11	)	$	0.45
Weighted average common shares outstanding:
Basic	102,899			54,123			103,674			54,069
Diluted	104,005			55,307			103,674			55,215



	Three Months Ended June 30,						Six Months Ended June 30,
	2018			2017			2018			2017
	(In thousands)
Net income (loss)	$	13,560		$	3,389		$	(10,992	)	$	24,576
Unrealized loss on derivative instruments, net of income tax benefit of $0, $178, $0, and $91, respectively	(1,717		)	(283		)	(1,283		)	(133		)
Foreign currency translation adjustments, net of income tax (expense) of $0, $0, ($2,868) and $0, respectively	(69,169		)	7,486			(35,246		)	12,332
Comprehensive (loss) income	$	(57,326	)	$	10,592		$	(47,521	)	$	36,775



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



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



	June 30, 2018			December 31, 2017
	(In thousands, except share data)
ASSETS
Current assets:
Cash and cash equivalents	$	171,528		$	321,262
Restricted cash	2,191			714
Accounts receivable billed, net	682,415			642,985
Accounts receivable unbilled	346,608			373,003
Contract assets	131,367			—
Prepaid expenses and other current assets	82,964			84,215
Total current assets	1,417,073			1,422,179
Property and equipment, net	163,500			180,412
Goodwill	4,275,485			4,292,571
Intangible assets, net	1,182,571			1,286,050
Deferred income tax assets	32,813			20,159
Other long-term assets	101,758			84,496
Total assets	$	7,173,200		$	7,285,867

LIABILITIES AND SHAREHOLDERS' EQUITY
Current liabilities:
Accounts payable	$	85,810		$	58,575
Accrued liabilities	502,646			500,303
Contract liabilities	719,932			559,270
Current portion of capital lease obligations	15,201			16,414
Current portion of long-term debt	37,500			25,000
Total current liabilities	1,361,089			1,159,562
Capital lease obligations, non-current	13,241			20,376
Long-term debt, non-current	2,835,321			2,945,934
Deferred income tax liabilities	32,557			37,807
Other long-term liabilities	108,320			99,609
Total liabilities	4,350,528			4,263,288

Commitments and contingencies (Note 17)

Shareholders' equity:
Preferred stock, $0.01 par value; 30,000,000 shares authorized, 0 shares issued and outstanding at June 30, 2018 and December 31, 2017, respectively	—			—
Common stock, $0.01 par value; 600,000,000 shares authorized, 102,871,399 and 104,435,501 shares issued and outstanding at June 30, 2018 and December 31, 2017, respectively	1,029			1,044
Additional paid-in capital	3,371,316			3,414,389
Accumulated other comprehensive loss, net of tax	(55,064		)	(22,385		)
Accumulated deficit	(494,609		)	(370,469		)
Total shareholders' equity	2,822,672			3,022,579
Total liabilities and shareholders' equity	$	7,173,200		$	7,285,867



	June 30, 2018			December 31, 2017
Gross cash position	$	131,577		$	195,376
Less: cash borrowings	(97,508		)	(88,226		)
Net cash position	$	34,069		$	107,150



	June 30, 2018			December 31, 2017
Accounts receivable billed	$	689,797		$	652,061
Allowance for doubtful accounts	(7,382		)	(9,076		)
Accounts receivable billed, net	$	682,415		$	642,985



	Total			Clinical Solutions			Commercial Solutions
Balance at December 31, 2017:
Gross carrying amount	$	4,308,737		$	2,808,975		$	1,499,762
Accumulated impairment losses ^(a)	(16,166		)	(8,142		)	(8,024		)
Goodwill net of accumulated impairment losses	4,292,571			2,800,833			1,491,738
2018 Activity:
Business combinations ^(b)	(6,339		)	(3,808		)	(2,531		)
Impact of foreign currency translation	(10,747		)	(10,263		)	(484		)
Balance at June 30, 2018:
Gross carrying amount	4,291,651			2,794,904			1,496,747
Accumulated impairment losses ^(a)	(16,166		)	(8,142		)	(8,024		)
Goodwill net of accumulated impairment losses	$	4,275,485		$	2,786,762		$	1,488,723



	Unrealized gain (loss) on derivative instruments, net of tax			Foreign currency translation adjustments, net of tax			Total
Balance at March 31, 2018	$	1,819		$	14,003		$	15,822
Other comprehensive loss before reclassifications	(1,396		)	(69,169		)	(70,565		)
Amount of gain reclassified from accumulated other comprehensive loss into statement of operations	(321		)	—			(321		)
Net current period other comprehensive loss, net of tax	(1,717		)	(69,169		)	(70,886		)
Balance at June 30, 2018	$	102		$	(55,166	)	$	(55,064	)



	Before-Tax Amount			Tax (Expense) Benefit			Net-of-Tax Amount
Foreign currency translation adjustments	$	(32,378	)	$	(2,868	)	$	(35,246	)
Unrealized loss on derivative instruments:
Unrealized loss arising during period	(685		)	—			(685		)
Reclassification adjustment of realized gains to net income	(598		)	—			(598		)
Net unrealized loss on derivative instruments	(1,283		)	—			(1,283		)
Other comprehensive loss	$	(33,661	)	$	(2,868	)	$	(36,529	)



	Before-Tax Amount			Tax (Expense) or Benefit		Net-of-Tax Amount
Foreign currency translation adjustments	$	7,486		$	—	$	7,486
Unrealized gain (loss) on derivative instruments:
Unrealized gain (loss) arising during period	(271		)	105		(166		)
Reclassification adjustment for gains realized in net income	(190		)	73		(117		)
Net unrealized gain (loss) on derivative instruments	(461		)	178		(283		)
Other comprehensive income	$	7,025		$	178	$	7,203



	June 30, 2018
Assets acquired:
Cash and cash equivalents	$	57,338
Restricted cash	433
Accounts receivable	367,595
Unbilled accounts receivable	261,585
Other current assets	95,506
Property and equipment	113,674
Intangible assets	1,334,200
Other assets	50,052
Total assets acquired	2,280,383
Liabilities assumed:
Accounts payable	38,072
Accrued liabilities	304,341
Contract liabilities	247,474
Capital leases	40,928
Long-term debt, current and non-current	737,872
Deferred income taxes, net	11,988
Other liabilities	121,241
Total liabilities assumed	1,501,916
Total identifiable assets acquired, net	778,467
Goodwill	$	3,727,156



	Base Rate				Eurocurrency Rate
Term Loan A	0.25	%	-	0.50%	1.25	%	-	1.50%
Term Loan B	0.75	%	-	1.00%	1.75	%	-	2.00%



	Level 1		Level 2		Level 3		Total
Assets:
Trading securities	$	16,578	$	—	$	—	$	16,578
Derivative instruments	—		2,600		—		2,600
Total assets	$	16,578	$	2,600	$	—	$	19,178

Liabilities:
Derivative instruments	$	—	$	1,933	$	—	$	1,933
Contingent tax-sharing obligations assumed through business combinations	—		—		52,868		52,868
Total liabilities	$	—	$	1,933	$	52,868	$	54,801



	Level 1		Level 2		Level 3		Total
Assets:
Trading securities	$	16,318	$	—	$	—	$	16,318
Derivative instruments	—		2,179		—		2,179
Total assets	$	16,318	$	2,179	$	—	$	18,497

Liabilities:
Contingent tax-sharing obligations assumed through business combinations	$	—	$	—	$	50,480	$	50,480
Total liabilities	$	—	$	—	$	50,480	$	50,480



	June 30, 2018				December 31, 2017
	Carrying Value (a)		Estimated Fair Value		Carrying Value (a)		Estimated Fair Value
Term Loan A due August 2022	$	985,441	$	987,500	$	1,000,000	$	1,000,000
Term Loan B due August 2024	1,463,386		1,465,000		1,548,149		1,550,000
7.5% Senior Unsecured Notes due 2024	440,854		430,203		443,507		433,729



	Three Months Ended June 30, 2017		Six Months Ended June 30, 2017
	(In thousands, except per share data)
Pro forma total revenue	$	1,054,348	$	2,119,311
Pro forma net income	4,180		7,299
Pro forma income per share:
Basic	$	0.04	$	0.07
Diluted	$	0.04	$	0.07



	June 30, 2018			December 31, 2017
Secured Debt
Term Loan A due August 2022	$	987,500		$	1,000,000
Term Loan B due August 2024	1,465,000			1,550,000
Revolving credit facility due August 2022	—			—
Accounts receivable financing agreement due June 2020	—			—
Total secured debt	2,452,500			2,550,000
Unsecured Debt
7.5% Senior Unsecured Notes due 2024	403,000			403,000
Total debt obligations	2,855,500			2,953,000
Add: unamortized Senior Notes premium, net of original issue debt discount	34,181			38,656
Less: unamortized deferred issuance costs	(16,860		)	(20,722		)
Less: current portion of debt	(37,500		)	(25,000		)
Total debt obligations, non-current portion	$	2,835,321		$	2,945,934



	Balance Sheet Classification	June 30, 2018			December 31, 2017
Interest rate swaps - current	Prepaid expenses and other current assets	$	1,293		$	916
Interest rate swaps - non-current	Other long-term assets	$	1,307		$	1,263
Interest rate swaps - current	Accrued liabilities	$	(1,590	)	$	—
Interest rate swaps - non-current	Other long-term liabilities	$	(343	)	$	—



Balance at December 31, 2017	$	50,480
Changes in fair value recognized in earnings	2,388
Payments	—
Balance at June 30, 2018	$	52,868



	Employee Severance Costs, Including Executive Transition Costs			Facility Closure and Lease Termination Costs			Other Costs			Total
Balance at December 31, 2017	$	8,858		$	7,411		$	524		$	16,793
Expenses incurred ^(a)	12,180			3,108			3,276			18,564
Cash payments made	(13,429		)	(4,607		)	(3,665		)	(21,701		)
Balance at June 30, 2018	$	7,609		$	5,912		$	135		$	13,656



	Number of Shares		Weighted Average Grant Date Fair Value
Non-vested at December 31, 2017	907,580		$	49.30
Granted	1,858,183		$	38.32
Vested	(187,400	)	$	49.64
Forfeited	(203,310	)	$	47.38
Non-vested at June 30, 2018	2,375,053		$	40.85



	Three Months Ended June 30,				Six Months Ended June 30,
Statement of Operations Classification	2018		2017		2018		2017
Direct costs	$	5,572	$	2,954	$	9,324	$	5,667
Selling, general, and administrative expenses	2,803		3,275		6,839		6,381
Restructuring and other costs	—		—		91		—
Total share-based compensation expense	$	8,375	$	6,229	$	16,254	$	12,048



	June 30, 2018
Capitalized costs incurred to obtain or fulfill contracts with customers	$	20,389



	Three Months Ended June 30, 2018		Six Months Ended June 30, 2018
Amortization of capitalized costs	$	4,568	$	7,702



	As Reported			Adjustments			Adjusted
	December 31, 2017			ASC 606 Adoption			January 1, 2018
ASSETS
Current assets:
Cash and cash equivalents	$	321,262		$	—		$	321,262
Restricted cash	714			—			714
Accounts receivable billed, net	642,985			—			642,985
Accounts receivable unbilled	373,003			(152,644		)	220,359
Contract assets	—			94,567			94,567
Prepaid expenses and other current assets	84,215			19,452			103,667
Total current assets	1,422,179			(38,625		)	1,383,554
Property and equipment, net	180,412			—			180,412
Goodwill	4,292,571			—			4,292,571
Intangible assets, net	1,286,050			—			1,286,050
Deferred income tax assets	20,159			5,857			26,016
Other long-term assets	84,496			12,601			97,097
Total assets	$	7,285,867		$	(20,167	)	$	7,265,700

LIABILITIES AND SHAREHOLDERS' EQUITY
Current liabilities:
Accounts payable	$	58,575		$	—		$	58,575
Accrued liabilities	500,303			49,611			549,914
Contract liabilities	559,270			34,075			593,345
Current portion of capital lease obligations	16,414			—			16,414
Current portion of long-term debt	25,000			—			25,000
Total current liabilities	1,159,562			83,686			1,243,248
Capital lease obligations, non-current	20,376			—			20,376
Long-term debt, non-current	2,945,934			—			2,945,934
Deferred income tax liabilities	37,807			(8,355		)	29,452
Other long-term liabilities	99,609			3,317			102,926
Total liabilities	4,263,288			78,648			4,341,936
Shareholders' equity:
Preferred stock	—			—			—
Common stock	1,044			—			1,044
Additional paid-in capital	3,414,389			—			3,414,389
Accumulated other comprehensive loss, net of tax	(22,385		)	—			(22,385		)
Accumulated deficit	(370,469		)	(98,815		)	(469,284		)
Total shareholders' equity	3,022,579			(98,815		)	2,923,764
Total liabilities and shareholders' equity	$	7,285,867		$	(20,167	)	$	7,265,700



	Three Months Ended June 30, 2018						Six Months Ended June 30, 2018
	ASC 606 As Reported			ASC 605 As Adjusted			ASC 606 As Reported			ASC 605 As Adjusted
Service revenue	$	1,072,530		$	796,461		$	2,129,726		$	1,556,519
Reimbursable out-of-pocket expenses	—			299,445			—			609,543
Total revenue	1,072,530			1,095,906			2,129,726			2,166,062
Direct costs (exclusive of depreciation and amortization)	547,993			548,122			1,080,050			1,085,010
Reimbursable out-of-pocket expenses	299,472			299,445			608,238			609,543
Selling, general, and administrative	100,218			100,813			199,477			200,529
Restructuring and other costs	8,591			8,591			22,298			22,298
Transaction and integration-related expenses	18,032			18,032			43,243			43,243
Depreciation	17,557			17,557			35,585			35,585
Amortization	49,945			49,945			99,938			99,938
Total operating expenses	1,041,808			1,042,505			2,088,829			2,096,146
Income from operations	30,722			53,401			40,897			69,916
Other expense, net:
Interest income	1,655			1,655			2,494			2,494
Interest expense	(32,894		)	(32,894		)	(64,630		)	(64,630		)
Loss on extinguishment of debt	(1,877		)	(1,877		)	(2,125		)	(2,125		)
Other income, net	32,001			32,001			19,447			19,447
Total other expense, net	(1,115		)	(1,115		)	(44,814		)	(44,814		)
Income (loss) before provision for income taxes	29,607			52,286			(3,917		)	25,102
Income tax expense	(16,047		)	(21,553		)	(7,075		)	(13,376		)
Net income (loss)	$	13,560		$	30,733		$	(10,992	)	$	11,726
Earnings (loss) per share attributable to common shareholders:
Basic	$	0.13		$	0.30		$	(0.11	)	$	0.11
Diluted	$	0.13		$	0.30		$	(0.11	)	$	0.11
Weighted average common shares outstanding:
Basic	102,899			102,899			103,674			103,674
Diluted	104,005			104,005			103,674			104,676



	June 30, 2018		December 31, 2017
Property and equipment, net:
North America ^(a)	$	120,402	$	136,101
Europe, Middle East and Africa	26,964		25,517
Asia-Pacific	12,330		14,700
Latin America	3,804		4,094
Total property and equipment, net	$	163,500	$	180,412


•	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 a certain period of time from the end of the quarter in which the award was granted;


•	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.



	Balance at June 30,
	2018		2017		Change
Clinical Solutions	$	4,090.6	$	2,038.8	$	2,051.8	100.6	%
Commercial Solutions - Selling Solutions ^(a)	424.7		—		424.7		n/m
Total Backlog	$	4,515.3	$	2,038.8	$	2,476.5	121.5	%



	Three Months Ended June 30,
	2018		% of total		2017		% of total		Change
Clinical Solutions	$	783,913	73.1	%	$	255,504	99.0	%	$	528,409	206.8	%
Commercial Solutions	288,617		26.9	%	2,583		1.0	%	286,034		n/m
Total service revenue	$	1,072,530			$	258,087			$	814,443	315.6	%



	Three Months Ended June 30,
	2018 ^(a)			2017 ^(b)			Change
Direct costs (exclusive of depreciation and amortization)	$	547,993		$	162,010		$	385,983	238.2	%
Reimbursable out-of-pocket expenses	299,472			133,048			166,424		125.1	%
Total direct costs and reimbursable out-of-pocket expenses	$	847,465		$	295,058		$	552,407	187.2	%
Percentage of service revenue	79.0		%	62.8		%
Gross margin percentage	21.0		%	37.2		%