Medpace is a contract research organization (CRO) that manages clinical trials on behalf of biopharmaceutical and medical device companies. Medpace handles end-to-end trial execution — study design, regulatory strategy, patient recruitment, site monitoring, data collection, biostatistics, and regulatory submission support — allowing sponsors to outsource trial operations rather than build internal infrastructure. Customers are primarily small and mid-sized biopharma companies, which represent roughly 80% of revenue, with the top 10 customers accounting for only ~35% of revenue. Revenue splits into direct service fees (Medpace's own labor — project managers, data scientists, medical writers, biostatisticians) and pass-through costs (investigator site fees and vendor costs remitted to third parties), with pass-throughs running at roughly 38-42% of total revenue. Medpace uses fixed-price or milestone-based contracts, recognizing revenue over the life of a trial as work is performed. Key profitability drivers are backlog conversion rates, headcount utilization, and cancellation rates. Medpace operates a fully integrated, full-service model — it does not use a functional service provider structure — which management argues improves accountability. Oncology is the largest therapeutic area, while metabolic disease (obesity, GLP-1 programs) has grown to roughly 27-30% of revenue. Growth is entirely organic; Medpace does not pursue M&A. The company generates strong free cash flow, benefits from negative net working capital, and returns capital primarily through share repurchases.