Medpace Holdings, Inc. Common Stock

Natural and catastrophic events · Natural disasters and extreme weather

Our operations might be affected by the occurrence of a natural disaster or other catastrophic event. These events, including terrorist attacks, pandemic flu, hurricanes, floods and ice and snow storms, could nevertheless disrupt our operations and IT systems or those of our customers, investigators and collaboration partners.

Geopolitical and trade · Trade policies tariffs and sanctions

Tariffs imposed by the U.S. government on certain imported goods, equipment, technology, or supplies used in our clinical trials, any retaliatory and/or reciprocal tariffs imposed on U.S. exports by foreign countries, including China, as well as any additional tariffs, duties, or other trade measures or restrictions could increase our operating costs, disrupt our global supply chain, or otherwise have a material adverse effect on our business.

Geopolitical and trade · Regulatory and policy uncertainty

We are uncertain as to the full effects of healthcare reforms on our business and are unable to predict what legislative proposals, if any, will be adopted in the future. These developments and the lack of clarity regarding future healthcare policies and regulations have created significant uncertainty that could adversely affect our business.

Corporate governance · Board composition and independence

Our Chief Executive Officer and founder controls a substantial amount of our outstanding common stock and his interests may be different from or conflict with those of our other shareholders. August J. Troendle controls approximately 19.0% of the outstanding shares of our common stock and is able to exert a significant degree of influence or actual control over our management and affairs.

Corporate governance · Shareholder rights and activism

We are party to transactions with related persons that may increase the risk of allegations of conflicts of interest, and such allegations may impair our ability to realize the benefits we expect from these transactions. We are subject to the risk that our stockholders may challenge any such related person transactions and the agreements entered into as part of them.

Legal and litigation · Intellectual property disputes

The biopharmaceutical industry has a history of patent and other intellectual property litigation, and we might be involved in costly intellectual property lawsuits. Even without wrongdoing on our part, we may face patent infringement suits by companies that have patents for similar business processes or other suits alleging infringement of their intellectual property rights.

Data and privacy · Regulatory investigations and penalties

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, results of operations, financial condition and prospects could be adversely affected. We could be subject to healthcare fraud and abuse laws of both the federal government and the states in which we conduct our business.

Tax and financial reporting · Tax compliance and changes in tax law

Our effective income tax rate may fluctuate, which may adversely affect our operations, earnings and earnings per share. Changes in tax laws, or in the interpretation or application of tax laws, in various taxing jurisdictions could materially impact our effective tax rate. The global nature of our business increases our tax risks.

Industry regulation · Licensing and permits

Our business could be harmed from the loss or suspension of a license or imposition of a fine or penalties under, or future changes in, or interpretations of, the law or regulations of the Clinical Laboratory Improvement Act of 1967, and the Clinical Laboratory Improvement Amendments of 1988 (CLIA). The sanction for failure to comply with CLIA requirements may be suspension, revocation or limitation of a laboratory's CLIA certificate.

Industry regulation · Safety and environmental regulations

Our operations involve the use and disposal of hazardous substances and waste which can give rise to liability that could adversely impact our financial condition. Our operations pose the risk of accidental contamination or injury caused by the release of these materials and/or the creation of hazardous substances, including medical waste and other highly regulated substances.

Project and contract management · Service level and performance guarantees

We bear financial risk if we underprice our fixed-fee contracts or overrun cost estimates. The majority of our Phase I–IV contracts are fixed-fee contracts. We bear the financial risk if we initially underprice our contracts or otherwise overrun our cost estimates.

Human capital and workforce · Talent acquisition and retention

If we are unable to recruit suitable investigators and enroll patients for our customers' clinical trials, our clinical development business may suffer. The recruitment of investigators and patients for clinical trials is essential to our business. If we are unable to attract suitable and willing investigators or patients for clinical trials on a consistent basis, we may need to expend additional funds or be compelled to delay or modify clinical trial plans.

International and currency · Foreign exchange and currency exposure

Our operating results are influenced by exchange rate fluctuations. Changes in political and economic conditions, including but not limited to inflation, trade policy and tariffs, may lead to changes in foreign currency exchange rates.

Market and investment · Market volatility and economic cycles

Our operating results are influenced by decisions to downsize product development portfolios due to general economic conditions, market conditions or otherwise. Biopharmaceutical companies may commit less capital to our services if they become less able to access capital in the future.

Credit and liquidity · Credit risk and customer defaults

The potential loss, delay or non-renewal of our contracts, or the non-payment by our customers for services that we have performed, could adversely affect our results. Clinical trials can be costly and we provide services to our customers before they pay us for some of our services. There is a risk that we may initiate a clinical trial for a customer, and the customer subsequently becomes unwilling or unable to fund the completion of the trial.

Customer and revenue · Customer concentration and key customer dependence

Although we did not have any customer that represented 10% or more of our net revenue during the year ended December 31, 2025, we derive approximately 35.1% of our net revenue from our top ten customers. 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.

Technology infrastructure · Technology systems and infrastructure failure

Our business depends on the continued effectiveness and availability of our information systems, including the information systems we use to provide our services to our customers, such as ClinTrak, and failures of these systems may materially limit our operations. Disruption, impairment or failure of data centers, telecommunications facilities or other key infrastructure platforms could result in the corruption, loss or unauthorized disclosure of proprietary, confidential or other data.

Digital transformation and innovation · Artificial intelligence and automation

Continued evolution and use of machine learning and generative artificial intelligence (AI), including risks arising from insufficient human oversight of AI or a lack of controls and procedures monitoring the use of AI in day-to-day operations as well as from potential future competitive disadvantages related to a lack of investment in AI tools, could have a negative impact on our financial results.

Digital transformation and innovation · Technology implementation and upgrades

In order for our information systems to continue to be effective going forward, we periodically need to upgrade our technology systems and increase our capacity to keep pace with technological developments and our growth as a company. Significant delays in system enhancements or inadequate performance of new or upgraded systems could damage our reputation and harm our business.

Cybersecurity and data protection · Third party data security and vendors

We depend on third parties for support services vital to our business. 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.