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Q3 2026FINANCIAL RESULTSOCTOBER 21, 2026
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MAKING THE COMPLEX SEAMLESS FORWARD LOOKING STATEMENTS &NON-GAAP FINANCIAL MEASURESForward-Looking StatementsThis presentation contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements contained in this presentation that do not relate to matters of historical fact should be considered forward-looking statements, including without limitation, statements regarding our forecasted financial results and the effective tax rate used for non-GAAP adjustment purposes. In this context, forward-looking statements often address expected future businessand financial performance and financial condition, and often contain words such as “guidance,” “expect,” “anticipate,” “intend,” “plan,” “believe,” “seek,” “see,” “will,” “would,” “target,” “forecast,” “may,” “could,” “likely,” “project,” “goal,” “objective,” “potential,”“range,” “estimate,” “preliminary,” “opportunity,” “outlook,” “trend,” “can,” “might,” “drives,” “hope,” “future,” “predict” and similar expressions, and variations or negatives of these words. However, the absence of these words does not mean that a statement isnot forward-looking.These forward-looking statements are largely based on management’s current expectations and projections about future events and financial trends that we believe may affect, among other things, our financial condition, results of operations, businessstrategy, short-term and long-term business operations and objectives, and financial needs. These statements are neither promises nor guarantees, but involve known and unknown risks, uncertainties and other factors that may cause our financialcondition, actual results, performance (including share price performance), or achievements to be materially different from any future results, performance or achievements expressed or implied by the forward-looking statements, including, but not limited to,the following: the potential loss, delay or non-renewal of our contracts, or the non-payment by customers for services we have performed; the failure to convert backlog to revenue at our present or historical conversion rate(s); the failure to maintain orgenerate new business awards; fluctuation in our results between fiscal quarters and years; the risks and uncertainties related to disruptions to or reductions in business operations or prospects due to pandemics, epidemics, widespread healthemergencies, or outbreaks of infectious diseases; decreased operating margins due to increased pricing pressure or other factors; our failure to perform our services or operate our business in accordance with contractual requirements, governmentregulations and ethical considerations; the impact of underpricing our contracts, overrunning our cost estimates or failing to receive approval for or experiencing delays with documentation of change orders; the failure of third parties to provide us criticalsupport services; our failure to increase our market share, grow our business, successfully execute our growth strategies or manage our growth effectively; the impact of a failure to retain key executives or other personnel or recruit qualified personnel; therisks associated with our information systems infrastructure, including potential cybersecurity breaches and other disruptions which could compromise patient information or our information; risks from use of machine learning and generative artificialintelligence (“AI”), including risks from insufficient human oversight of AI or lack of controls and procedures monitoring AI use; adverse results from customer or therapeutic area concentration; the risks associated with doing business internationally,including the effects of tariffs and trade wars; the risks associated with the Foreign Corrupt Practices Act and other anti-corruption laws; future net losses; the impact of changes in tax laws and regulations; our failure to attract suitable investigators andpatients to our clinical trials; the liability risks associated with our research and development services, including risks of liability resulting from harm to patients; inadequate insurance coverage for our operations and indemnification obligations; fluctuations inexchange rates; general economic conditions, including inflation, in the markets in which we and our customers operate, including financial market conditions; the impact of unfavorable economic conditions, including conditions caused by the uncertaininternational economic environment and current and future international conflicts; the impact of a natural disaster or other catastrophic event; negative outsourcing trends in the biopharmaceutical industry and a reduction in aggregate expenditures andresearch and development budgets; our inability to compete effectively with other CROs; the impact of healthcare reform; the impact of consolidation in the biopharmaceutical industry; our failure to comply with federal, state and foreign healthcare laws; theeffect of current and proposed laws and regulations regarding the protection of personal data; our potential involvement in costly intellectual property lawsuits; actions by regulatory authorities or customers to limit the scope of indications related to orwithdraw an approved drug, biologic or medical device from the market; and the impact of industry-wide reputational harm to CROs. Moreover, we operate in a very competitive and rapidly changing environment in which new risks emerge from time to time.It is not possible for our management to predict all risks, nor can we assess the impact of all factors on our business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in anyforward-looking statements we may make.These and other factors discussed under the caption “Risk Factors” in Item 1A, Part I of our Annual Report on Form 10-K filed with the Securities and Exchange Commission, or SEC, and our other reports filed with the SEC could cause actual results todiffer materially from those indicated by the forward-looking statements made in this presentation. These factors should not be construed as exhaustive and should be read in conjunction with the other cautionary statements that are included in this releaseand in our filings with the SEC. Any such forward-looking statements represent management’s estimates as of the date of this presentation. We cannot guarantee that any forward-looking statement will be realized. Achievement of anticipated results issubject to substantial risks, uncertainties and inaccurate assumptions. If known or unknown risks or uncertainties materialize or if underlying assumptions prove inaccurate, actual results could vary materially from past results and those anticipated,estimated or projected. While we may elect to update such forward-looking statements at some point in the future, we disclaim any obligation to do so, even if subsequent events, developments or circumstances cause our views to change. These forward-looking statements should not be relied upon as representing our views as of any date subsequent to the date of this presentation.Non-GAAP Financial MeasuresCertain financial measures presented in this presentation, such as EBITDA, EBITDA margin, and Free Cash Flow, are not recognized under generally accepted accounting principles in the United States of America, or U.S. GAAP. Management usesEBITDA, EBITDA margin, and Free Cash Flow or comparable metrics as a measurement used in evaluating our operating performance on a consistent basis, as a consideration to assess incentive compensation for our employees, for planning purposes,including the preparation of our internal annual operating budget, and to evaluate the performance and effectiveness of our operational strategies.We believe that EBITDA and EBITDA margin are useful to provide additional information to investors about certain material non-cash and non-recurring items. While we believe these financial measures are commonly used by investors to evaluate ourperformance and that of our competitors, because not all companies use identical calculations, this presentation of EBITDA and EBITDA margin may not be comparable to other similarly titled measures of other companies and should not be considered asan alternative to performance measures derived in accordance with U.S. GAAP. EBITDA is calculated as net income attributable to Medpace Holdings, Inc. before income tax expense, interest income, net, depreciation and amortization. EBITDA margin iscalculated by dividing EBITDA by Revenue, net for each period. Our presentation of EBITDA and EBITDA margin should not be construed as an inference that our future results will be unaffected by unusual or non-recurring items.We utilize Free Cash Flow as a measure of profitability and an assessment of our ability to generate cash. Free Cash Flow is a commonly utilized metric that companies provide to investors, although the calculation of Free Cash Flow may not becomparable to other similarly titled metrics of other companies and should not be considered as an alternative to cash flow measures derived in accordance with U.S. GAAP. We define Free Cash Flow as net cash provided by operating activities, lesscapital expenditures and the principal portion of payments related to campus leases classified for accounting purposes as deemed landlord liabilities.EBITDA, EBITDA margin, and Free Cash Flow have important limitations as analytical tools and you should not consider them in isolation, or as a substitute for, analysis of our results as reported under U.S. GAAP. See the condensed consolidated financialstatements included elsewhere in this prospectus for our U.S. GAAP results. Additionally, for reconciliations of EBITDA to our closest reported U.S. GAAP measures, refer to the appendix of this presentation.2
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MAKING THE COMPLEX SEAMLESS Q3 2026 – KEY OPERATING HIGHLIGHTS 3A. LTM: Last twelve monthsB. Backlog Conversion Rate: Revenue, net, for the quarter divided by beginning backlog. Year-to-date backlog conversion figures represent the average backlog for all quarters. Year-to-DateThird Quarter($ in millions)% Change20252026% Change2025202616.9 %$ 1,821.8$ 2,129.98.5 %$ 659.9$ 716.0Revenue, net19.8 %$ 1,910.2$ 2,287.610.6 %$ 789.6$ 873.4Net New Business Awards------23.9%$ 2,439.9$ 3,024.2Net New Business Awards (LTM) (A)------5.6 %$ 3,000.6$ 3,167.2Ending Backlogn.m.21.1 %23.7 %n.m.23.0 %23.8 %Backlog Conversion Rate (B)------7.3 %6,1746,626Headcount
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MAKING THE COMPLEX SEAMLESS A. Amount of backlog estimated to convert to revenue in the next twelve months. BACKLOG AND NEW AWARD TRENDS 4 Backlog Conversion RateEnding Backlog and Est. NTM Backlog Conversion(A)Net New Business AwardsLTM Net New Business Awards($ in millions) Represents estimated midpoint of NTM conversion(A)(A)
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MAKING THE COMPLEX SEAMLESS Q3 2026 – KEY FINANCIAL HIGHLIGHTS A. See the appendix for the non-GAAP reconciliation of the EBITDA calculations.B. On a constant currency basis, in the third quarter of 2026, revenue increased 8.6% and EBITDA increased 16.0%.On a constant currency basis, for the year-to-date 2026, revenue increased 16.7% and EBITDA increased 20.4%.5 Year-to-DateThird Quarter($ in millions, except per share data)% Change(B)20252026% Change(B)2025202616.9 %$ 1,821.8$ 2,129.98.5 %$ 659.9$ 716.0Revenue, net19.5 %$ 397.5$ 474.916.0 %$ 148.4$ 172.1EBITDA(A)n.m.21.8 %22.3 %n.m.22.5 %24.0 %% Margin21.1 %$ 316.0$ 382.723.7 %$ 111.1$ 137.5Net Income25.7 %$ 10.64$ 13.3725.4 %$ 3.86$ 4.84Net Income per diluted share
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MAKING THE COMPLEX SEAMLESS KEY FINANCIAL TRENDS 6Net IncomeNet Income per diluted shareEBITDA(A)Revenue, net A. See the appendix for the non-GAAP reconciliation of the EBITDA calculations. ($ in millions)($ in millions)($ in millions)Represents percent of Revenue
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MAKING THE COMPLEX SEAMLESS KEY FINANCIAL TRENDS 7A. See the appendix for the non-GAAP reconciliation of the EBITDA calculations.EBITDA(A)Revenue($ in millions)($ in millions)Guidance Range$2,835 - $2,855Guidance Range$638 - $652+11.8% YOY+12.0% - 12.8% YOY+32.5% YOY+14.4% - 16.9% YOY+27.8% YOY+38.1% YOY+29.2% YOY+17.7% YOY+20.0% YOY+16.1% YOY
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MAKING THE COMPLEX SEAMLESS KEY FINANCIAL TRENDS 8 Net Income per diluted shareNet Income($ in millions)Guidance Range $17.97 - $18.32Guidance Range$514 - $524+42.2% YOY+17.6% - 19.9% YOY+43.0% YOY+13.9% - 16.2% YOY+34.9% YOY+51.4% YOY+22.0% YOY+15.3% YOY+11.6% YOY+21.0% YOY
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MAKING THE COMPLEX SEAMLESS REVENUE COMPOSITIONCustomer TierConcentration(B)Top 10 CustomerConcentration A. Other primarily includes Nephrology, Rheumatology, Musculoskeletal, Dermatology, Gastroenterology, and Ophthalmology therapeutic areas.B. Current period customer tiers classified by Evaluate Ltd. via EvaluatePharma© as well as management analysis. Large Pharma represents the top 20 pharma companies worldwide based on annual sales as of 12/31/25. Mid-sized biopharma represents customers with >$250M of annual sales. Small Biopharma represents customers with <$250M of annual sales. (A)LTM Q3 2026 LTM Q3 2025Therapeutic Area Concentration (A)All OtherTop 5Rest of Top 10Top 5Rest of Top 10All OtherSmall BiopharmaLarge PharmaMid-sized BiopharmaLarge PharmaMid-sized BiopharmaSmall Biopharma9
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MAKING THE COMPLEX SEAMLESS $705.3$502.7$652.7$497.0$285.4Cash(B)(66.1)(59.6)(58.8)(58.7)(64.3)Net DSO(C)Q3 2026 – CASH POSITION 10A. Free Cash Flow Conversion % is equal to Free Cash Flow divided by EBITDA.B. Cash is defined as Cash and Cash Equivalents.C. Net Days Sales Outstanding (DSO) reflects Revenue, net, and is based on billed and unbilled Accounts receivable, net of Advanced billings, including Reimbursed out-of-pocket revenue and expenses.Note: Numbers may not sum due to rounding Free Cash Flow and Free Cash Flow Conversion(A)($ in millions) (A)Year-to-DateThird Quarter($ in millions)2025202620252026Free Cash Flow$ 520.6$ 530.4$ 246.2$ 216.6Operating Cash Flow (GAAP)26.850.910.720.2Less: CAPEX$ 493.8$ 479.5$ 235.5$ 196.4Free Cash Flow (non-GAAP)$ 397.5$ 474.9$ 148.4$ 172.1EBITDA (non-GAAP)124.2 %101.0 %158.7 %114.1 %Free Cash Flow Conversion %(A)(non-GAAP)Year-to-DateThird Quarter($ in millions)2025202620252026$ 912.9$ 294.7$ 4.5$ —Share Repurchases
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MAKING THE COMPLEX SEAMLESS FULL YEAR 2026 GUIDANCE 11Note: See appendix for a detailed reconciliation. As of October 21, 2026As of July 22, 2026($ in millions, except per share data)Growth RateGuidance RangeGrowth RateGuidance Range12.0% - 12.8%$2,835.0 - $2,855.010.9% - 14.0%$2,805.0 - $2,885.0Revenue, net14.4% - 16.9%$638.0 - $652.010.8% - 15.1%$618.0 - $642.0EBITDA13.9% - 16.2%$514.0 - $524.09.5% - 13.9%$494.0 - $514.0Net Income17.6% - 19.9%$17.97 - $18.3212.9% - 17.5%$17.25 - $17.95Net Income per diluted share
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APPENDIX
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MAKING THE COMPLEX SEAMLESS Q3 2026 – INCOME STATEMENT 13Note: Numbers may not sum due to rounding 3Q26 vs. 3Q25% Revenue,% Revenue,% Change$ Changenet3Q25net3Q26($ in millions, except per share amounts)8.5 %$ 56.1100.0 %$ 659.9100.0 %$ 716.0Revenue, netOperating expenses:9.9 %18.528.2 %186.328.6 %204.9Direct service costs, excluding depreciation and amortization3.8 %10.641.9 %276.640.1 %287.3Reimbursed out-of-pocket expenses6.3 %29.270.2 %463.068.7 %492.1Total direct costs7.7 %3.77.3 %48.17.2 %51.8Selling, general and administrative(5.7)%(0.4)1.0 %6.80.9 %6.4Depreciation(34.3)%(0.1)— %0.2— %0.2Amortization6.2 %32.478.5 %518.176.9 %550.5Total operating expenses 23.721.5 %141.823.1 %165.5Income from operations Other income, net:0.5(0.1)%(0.5)— %0.0Miscellaneous income (expense), net3.80.2 %1.50.7 %5.3Interest income, net4.30.2 %1.00.7 %5.4Total other income, net28.121.6 %142.823.9 %170.9Income before income taxes1.74.8 %31.74.7 %33.4Income tax provision23.7 %$ 26.316.8 %$ 111.119.2 %$ 137.5Net income24.6 %$ 0.97$ 3.95$ 4.92Basic EPS (GAAP)25.4 %$ 0.98$ 3.86$ 4.84Diluted EPS (GAAP)16.0 %$ 23.8$ 148.4$ 172.1EBITDA1.6 %22.5 %24.0 %EBITDA Margin
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MAKING THE COMPLEX SEAMLESS EBITDA RECONCILIATION 14Note: Numbers may not sum due to rounding YTDYTD202620253Q262Q261Q264Q253Q252Q251Q254Q24($ in millions)$ 382.7$ 316.0$137.5$121.4$123.9$135.1$111.1$ 90.3$114.6$117.0Net income as reported (GAAP)87.569.633.430.323.721.731.734.33.616.9Income tax provision(15.5)(9.1)(5.3)(5.0)(5.1)(3.7)(1.5)(1.1)(6.5)(7.9)Interest income, net19.720.36.46.66.86.96.86.86.77.1Depreciation0.50.70.20.20.20.20.20.20.20.4Amortization$ 474.9$ 397.5$172.1$153.4$149.4$160.2$148.4$130.5$118.6$133.5EBITDA (non-GAAP)18.0 %17.3 %19.2 %17.2 %17.5 %19.1 %16.8 %15.0 %20.5 %21.8 %Net income margin (GAAP)22.3 %21.8 %24.0 %21.7 %21.1 %22.6 %22.5 %21.6 %21.2 %24.9 %EBITDA margin (non-GAAP)Full YearFull YearFull YearFull YearFull Year20252024202320222021($ in millions)$ 451.1$ 404.4$ 282.8$ 245.4$ 181.8Net income as reported (GAAP)91.371.552.937.520.0Income tax provision(12.8)(25.0)0.52.90.1Interest expense (income), net27.227.824.119.016.0Depreciation0.91.42.23.45.1Amortization$ 557.7$ 480.2$ 362.5$ 308.1$ 223.1EBITDA (non-GAAP)17.8 %19.2 %15.0 %16.8 %15.9 %Net income margin (GAAP)22.0 %22.8 %19.2 %21.1 %19.5 %EBITDA margin (non-GAAP)
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MAKING THE COMPLEX SEAMLESS FY2026 GUIDANCE RECONCILIATION 15Note: Guidance represents a tax rate for FY2026 in the range of 19.0% to 19.5% and does not reflect the potential impact of any additional share repurchases. Net Income per diluted shareNet Income($ in millions, except per share amounts)HighLowHighLow$ 18.32$ 17.97$ 524.0$ 514.0Net income and net income per diluted share (GAAP)123.5119.5Income tax provision(22.9)(22.9)Interest income, net26.826.8Depreciation0.60.6Amortization$ 652.0$ 638.0EBITDA (non-GAAP)