v3.25.4

ENTITY WIDE DISCLOSURES (Tables)

12 Months Ended

Dec. 31, 2025

Entity Wide Disclosures [Abstract]

Summary of Property and Equipment, Net by Geographic Region

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

			2025						2024
Property and equipment, net:
United States			$	83,898					$	80,692
Europe
Belgium			22,998						18,557
Other			6,822						7,456
Total Europe			29,820						26,013
Asia-Pacific			14,910						14,552
Other			2,427						2,358
Total property and equipment, net			$	131,055					$	123,615

Summary of Revenue by Major Source

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

			Year Ended December 31,
			2025						2024						2023
Therapeutic Area
Oncology			$	747,585					$	651,237					$	587,097
Metabolic			744,957						457,542						376,842
Other			408,548						431,384						404,844
Central Nervous System			254,838						181,977						160,057
Cardiology			239,371						230,454						193,690
AVAI			134,935						156,460						163,312
Total revenue			$	2,530,234					$	2,109,054					$	1,885,842

Schedule of Segment Reporting Information, by Segment

Information about the reportable segment, significant segment expenses and a reconciliation to consolidated net income is as follows (in thousands):

			Year Ended December 31,
			2025						2024						2023
Revenue, net			$	2,530,234					$	2,109,054					$	1,885,842
Operating expenses:
Direct service costs, excluding depreciation and amortization - Employee compensation			588,786						545,417						499,528
Direct service costs, excluding depreciation and amortization - Other segment items (a)			143,342						136,678						138,721
Reimbursed out-of-pocket expenses			1,037,488						770,654						723,088
Total direct costs			1,769,616						1,452,749						1,361,337
Selling, general and administrative			197,559						180,184						161,352
Depreciation			27,178						27,808						24,129
Amortization			946						1,443						2,199
Total operating expenses			1,995,299						1,662,184						1,549,017
Income from operations			534,935						446,870						336,825
Other income (expense), net:
Miscellaneous (expense) income, net			(5,338)						4,056						(655)
Interest income (expense), net			12,780						24,996						(488)
Total other income (expense), net			7,442						29,052						(1,143)
Income before income taxes			542,377						475,922						335,682
Income tax provision			91,254						71,536						52,872
Segment net income			$	451,123					$	404,386					$	282,810
Reconciliation of profit or loss
Adjustments and reconciling items			—						—						—
Consolidated net income			$	451,123					$	404,386					$	282,810

(a) Direct service costs, excluding depreciation and amortization - Other segment items includes costs related to inventory, leases, project subcontractors and other direct service costs.

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Tabular disclosure of disaggregation of revenue into categories depicting how nature, amount, timing, and uncertainty of revenue and cash flows are affected by economic factor.

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Tabular disclosure of the names of foreign countries in which material long-lived assets other than financial instruments, long-term customer relationships of a financial institution, mortgage and other servicing rights, deferred policy acquisition costs, and deferred tax assets are located, and amount of such long-lived assets located in that country or foreign geographic area.

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Tabular disclosure of the profit or loss and total assets for each reportable segment. An entity discloses certain information on each reportable segment if the amounts (a) are included in the measure of segment profit or loss reviewed by the chief operating decision maker or (b) are otherwise regularly provided to the chief operating decision maker, even if not included in that measure of segment profit or loss.

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