AMN Healthcare Services (AMN) 10-Q 5 Nov 21 2021 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2021	Nov. 03, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2021
Document Transition Report	false
Entity File Number	001-16753
Entity Registrant Name	AMN HEALTHCARE SERVICES, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	06-1500476
Entity Address, Address Line One	8840 Cypress Waters Boulevard
Entity Address, Address Line Two	Suite 300
Entity Address, City or Town	Dallas
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75019
City Area Code	866
Local Phone Number	871-8519
Title of 12(b) Security	Common Stock, $0.01 par value
Trading Symbol	AMN
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (excluding treasury shares)		47,275,009
Entity Central Index Key	0001142750
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q3
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 137,041	$ 29,213
Accounts receivable, net of allowances of $6,148 and $7,043 at September 30, 2021 and December 31, 2020, respectively	570,101	376,099
Accounts receivable, subcontractor	141,626	73,985
Prepaid expenses	19,367	13,629
Other current assets	31,396	40,809
Total current assets	899,531	533,735
Restricted cash, cash equivalents and investments	63,603	61,347
Fixed assets, net of accumulated depreciation of $190,578 and $161,752 at September 30, 2021 and December 31, 2020, respectively	127,762	116,174
Operating lease right-of-use assets	36,487	77,735
Other assets	157,909	135,120
Goodwill	893,283	864,485
Intangible assets, net of accumulated amortization of $262,253 and $215,234 at September 30, 2021 and December 31, 2020, respectively	530,422	564,911
Total assets	2,708,997	2,353,507
Current liabilities:
Accounts payable and accrued expenses	284,094	167,881
Accrued compensation and benefits	321,938	213,414
Current portion of notes payable	0	4,688
Current portion of operating lease liabilities	14,396	15,032
Deferred revenue	17,904	11,004
Other current liabilities	2,854	10,938
Total current liabilities	641,186	422,957
Notes payable, net of unamortized fees and premium	842,027	857,961
Deferred income taxes, net	61,187	67,205
Operating lease liabilities	15,004	77,800
Other long-term liabilities	107,115	107,907
Total liabilities	1,666,519	1,533,830
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at September 30, 2021 and December 31, 2020	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 49,836 issued and 47,275 outstanding at September 30, 2021 and 49,614 issued and 47,053 outstanding at December 31, 2020	498	496
Additional paid-in capital	480,364	468,726
Treasury stock, at cost; 2,561 shares at September 30, 2021 and December 31, 2020	(119,143)	(119,143)
Retained earnings	680,729	469,558
Accumulated other comprehensive income	30	40
Total stockholders’ equity	1,042,478	819,677
Total liabilities and stockholders’ equity	$ 2,708,997	$ 2,353,507

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 6,148	$ 7,043
Accumulated depreciation - fixed assets	190,578	161,752
Accumulated amortization	$ 262,253	$ 215,234
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	200,000,000	200,000,000
Common stock, shares issued (in shares)	49,836,000	49,614,000
Common stock, shares outstanding (in shares)	47,275,000	47,053,000
Treasury stock (in shares)	2,561,000	2,561,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Statement of Comprehensive Income [Abstract]
Revenue	$ 877,800	$ 551,631	$ 2,621,190	$ 1,762,443
Cost of revenue	571,935	366,998	1,745,914	1,178,204
Gross profit	305,865	184,633	875,276	584,239
Operating expenses:
Selling, general and administrative	173,932	111,235	491,773	394,537
Depreciation and amortization (exclusive of depreciation included in cost of revenue)	26,104	26,936	74,098	69,096
Total operating expenses	200,036	138,171	565,871	463,633
Income from operations	105,829	46,462	309,405	120,606
Interest expense, net, and other	5,223	12,564	24,278	35,061
Income before income taxes	100,606	33,898	285,127	85,545
Income tax expense	26,583	7,831	73,956	24,188
Net income	74,023	26,067	211,171	61,357
Net income	74,023	26,067	211,171	61,357
Other comprehensive income (loss):
Foreign currency translation and other	11	(14)	(10)	(119)
Other comprehensive income (loss)	11	(14)	(10)	(119)
Comprehensive income	$ 74,034	$ 26,053	$ 211,161	$ 61,238
Net income per common share:
Basic (in dollars per share)	$ 1.55	$ 0.55	$ 4.43	$ 1.29
Diluted (in dollars per share)	$ 1.54	$ 0.55	$ 4.40	$ 1.29
Weighted average common shares outstanding:
Basic (in shares)	47,737	47,476	47,666	47,406
Diluted (in shares)	48,080	47,676	48,022	47,647

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Additional Paid-in Capital	Treasury Stock	Retained Earnings	Retained EarningsCumulative Effect, Period of Adoption, Adjustment	Accumulated Other Comprehensive Income
Beginning balance (in shares) at Dec. 31, 2019			49,283		2,561
Beginning balance at Dec. 31, 2019	$ 736,742	$ (1,154)	$ 493	$ 455,193	$ (119,143)	$ 400,047	$ (1,154)	$ 152
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			140
Equity awards vested and exercised, net of shares withheld for payroll taxes	(4,353)		$ 1	(4,354)
Share-based compensation	4,927			4,927
Comprehensive income (loss)	12,918					12,965		(47)
Ending balance (in shares) at Mar. 31, 2020			49,423		2,561
Ending balance at Mar. 31, 2020	749,080		$ 494	455,766	$ (119,143)	411,858		105
Beginning balance (in shares) at Dec. 31, 2019			49,283		2,561
Beginning balance at Dec. 31, 2019	736,742	(1,154)	$ 493	455,193	$ (119,143)	400,047	(1,154)	152
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Comprehensive income (loss)	61,238
Ending balance (in shares) at Sep. 30, 2020			49,550		2,561
Ending balance at Sep. 30, 2020	807,073		$ 495	465,438	$ (119,143)	460,250		33
Beginning balance (in shares) at Dec. 31, 2019			49,283		2,561
Beginning balance at Dec. 31, 2019	$ 736,742	$ (1,154)	$ 493	455,193	$ (119,143)	400,047	$ (1,154)	152
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible Enumeration]	Accounting Standards Update 2016-13 [Member]
Ending balance (in shares) at Dec. 31, 2020			49,614		2,561
Ending balance at Dec. 31, 2020	$ 819,677		$ 496	468,726	$ (119,143)	469,558		40
Beginning balance (in shares) at Mar. 31, 2020			49,423		2,561
Beginning balance at Mar. 31, 2020	749,080		$ 494	455,766	$ (119,143)	411,858		105
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			119
Equity awards vested and exercised, net of shares withheld for payroll taxes	(288)		$ 1	(289)
Share-based compensation	6,347			6,347
Comprehensive income (loss)	22,267					22,325		(58)
Ending balance (in shares) at Jun. 30, 2020			49,542		2,561
Ending balance at Jun. 30, 2020	777,406		$ 495	461,824	$ (119,143)	434,183		47
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			8
Equity awards vested and exercised, net of shares withheld for payroll taxes	(158)			(158)
Share-based compensation	3,772			3,772
Comprehensive income (loss)	26,053					26,067		(14)
Ending balance (in shares) at Sep. 30, 2020			49,550		2,561
Ending balance at Sep. 30, 2020	807,073		$ 495	465,438	$ (119,143)	460,250		33
Beginning balance (in shares) at Dec. 31, 2020			49,614		2,561
Beginning balance at Dec. 31, 2020	819,677		$ 496	468,726	$ (119,143)	469,558		40
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			132
Equity awards vested and exercised, net of shares withheld for payroll taxes	(5,258)		$ 1	(5,259)
Share-based compensation	9,287			9,287
Comprehensive income (loss)	70,354					70,378		(24)
Ending balance (in shares) at Mar. 31, 2021			49,746		2,561
Ending balance at Mar. 31, 2021	894,060		$ 497	472,754	$ (119,143)	539,936		16
Beginning balance (in shares) at Dec. 31, 2020			49,614		2,561
Beginning balance at Dec. 31, 2020	819,677		$ 496	468,726	$ (119,143)	469,558		40
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Comprehensive income (loss)	211,161
Ending balance (in shares) at Sep. 30, 2021			49,836		2,561
Ending balance at Sep. 30, 2021	1,042,478		$ 498	480,364	$ (119,143)	680,729		30
Beginning balance (in shares) at Mar. 31, 2021			49,746		2,561
Beginning balance at Mar. 31, 2021	894,060		$ 497	472,754	$ (119,143)	539,936		16
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			78
Equity awards vested and exercised, net of shares withheld for payroll taxes	(470)		$ 1	(471)
Share-based compensation	6,019			6,019
Comprehensive income (loss)	66,773					66,770		3
Ending balance (in shares) at Jun. 30, 2021			49,824		2,561
Ending balance at Jun. 30, 2021	966,382		$ 498	478,302	$ (119,143)	606,706		19
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			12
Equity awards vested and exercised, net of shares withheld for payroll taxes	(527)			(527)
Share-based compensation	2,589			2,589
Comprehensive income (loss)	74,034					74,023		11
Ending balance (in shares) at Sep. 30, 2021			49,836		2,561
Ending balance at Sep. 30, 2021	$ 1,042,478		$ 498	$ 480,364	$ (119,143)	$ 680,729		$ 30

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Cash flows from operating activities:
Net income	$ 211,171	$ 61,357
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization (inclusive of depreciation included in cost of revenue)	75,871	70,077
Non-cash interest expense and other	(4,541)	3,727
Write-off of fees on credit facilities and senior notes	158	1,773
Change in fair value of contingent consideration	0	(1,700)
Increase in allowance for credit losses and sales credits	2,103	7,580
Provision for deferred income taxes	(4,328)	(17,923)
Share-based compensation	17,895	15,046
Loss on disposal or sale of fixed assets	386	3,664
Amortization of discount on investments	(41)	(96)
Net loss on deferred compensation balances	96	798
Non-cash lease expense	(257)	244
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	(196,342)	15,151
Accounts receivable, subcontractor	(67,641)	16,414
Income taxes receivable	5,472	6,157
Prepaid expenses	(5,695)	(3,361)
Other current assets	3,411	2,977
Other assets	780	3,378
Accounts payable and accrued expenses	112,183	(5,484)
Accrued compensation and benefits	96,666	7,630
Other liabilities	(26,268)	29,592
Deferred revenue	6,276	(32)
Restricted investments balance	16	12
Net cash provided by operating activities	227,371	216,981
Cash flows from investing activities:
Purchase and development of fixed assets	(38,710)	(27,357)
Purchase of investments	(32,437)	(37,418)
Proceeds from maturity of investments	40,000	21,500
Purchase of equity investment	(500)	0
Payments to fund deferred compensation plan	(6,094)	(7,171)
Proceeds from sale of equity investment	78	303
Purchase of convertible promissory notes	0	(490)
Cash paid for acquisitions, net of cash and restricted cash received	(41,264)	(476,491)
Cash paid for other intangibles	(90)	(1,400)
Cash received for working capital adjustments for prior year acquisitions	0	66
Net cash used in investing activities	(79,017)	(528,458)
Cash flows from financing activities:
Payments on term loans	(21,875)	(203,125)
Proceeds from term loans	0	250,000
Payments on revolving credit facility	(70,000)	(205,000)
Proceeds from revolving credit facility	70,000	245,000
Proceeds from senior notes	0	202,000
Payment of financing costs	0	(6,898)
Earn-out payments to settle contingent consideration liabilities for prior acquisitions	(3,100)	(10,622)
Cash paid for shares withheld for taxes	(6,255)	(4,798)
Net cash provided by (used in) financing activities	(31,230)	266,557
Effect of exchange rate changes on cash	(10)	(119)
Net increase (decrease) in cash, cash equivalents and restricted cash	117,114	(45,039)
Cash, cash equivalents and restricted cash at beginning of period	83,990	153,962
Cash, cash equivalents and restricted cash at end of period	201,104	108,923
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	35,066	15,079
Cash paid for interest (net of $248 and $300 capitalized for the nine months ended September 30, 2021 and 2020, respectively)	19,301	13,848
Cash paid for income taxes	72,863	30,727
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received	1,906	35,704
Goodwill	28,135	274,427
Intangible assets	12,440	228,000
Liabilities assumed	(1,217)	(61,640)
Net cash paid for acquisitions	41,264	476,491
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 5,080	$ 1,007

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Statement of Cash Flows [Abstract]
Interest capitalized	$ 248	$ 300

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	BASIS OF PRESENTATION The condensed consolidated balance sheets and related condensed consolidated statements of comprehensive income and cash flows contained in this Quarterly Report on Form 10-Q (this “Quarterly Report”), which are unaudited, include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries (collectively, the “Company”). All significant intercompany balances and transactions have been eliminated in consolidation. In the opinion of management, all entries necessary for a fair presentation of such unaudited condensed consolidated financial statements have been included. These entries consisted of all normal recurring items. The results of operations for the interim period are not necessarily indicative of the results to be expected for any other interim period or for the entire fiscal year or for any future period. The unaudited condensed consolidated financial statements do not include all information and notes necessary for a complete presentation of financial position, results of operations and cash flows in conformity with accounting principles generally accepted in the United States (“U.S. GAAP”). Please refer to the Company’s audited consolidated financial statements and the related notes for the fiscal year ended December 31, 2020, contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2020, filed with the Securities and Exchange Commission on February 26, 2021 (“2020 Annual Report”). The preparation of financial statements in conformity with U.S. GAAP requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to intangible assets purchased in a business combination, asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, contingent consideration liabilities associated with acquisitions, and income taxes. Actual results could differ from those estimates under different assumptions or conditions. The impact of the novel coronavirus (COVID-19) pandemic did not have a material effect on the Company’s estimates as of September 30, 2021. Recently Adopted Accounting Pronouncements In December 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2019-12, “Simplifying the Accounting for Income Taxes.” The standard is expected to reduce cost and complexity related to accounting for income taxes. The new guidance eliminates certain exceptions and clarifies and amends existing guidance to promote consistent application among reporting entities. Depending on the amended guidance within this standard, adoption is to be applied on a retrospective, modified retrospective or prospective basis. The Company adopted this standard effective January 1, 2021, and the adoption did not have a material effect on the Company’s consolidated financial statements. In January 2020, the FASB issued ASU 2020-01, “Clarifying the Interactions between Topic 321, Topic 323, and Topic 815.” The new guidance clarifies the interactions between accounting standards that apply to equity investments without readily determinable fair values. Specifically, it addresses the accounting for the transition into and out of the equity method. The Company adopted this standard effective January 1, 2021 on a prospective basis, and the adoption did not have a material effect on the Company’s consolidated financial statements. Cash, Cash Equivalents and Restricted Cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions, money market funds, commercial paper and other highly liquid investments. Restricted cash and cash equivalents primarily includes cash and commercial paper that serve as collateral for the Company’s captive insurance subsidiary claim payments. See Note (7), “Fair Value Measurement” for additional information. The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. September 30, 2021 December 31, 2020 Cash and cash equivalents $ 137,041 $ 29,213 Restricted cash and cash equivalents (included in other current assets) 18,118 18,626 Restricted cash, cash equivalents and investments 63,603 61,347 Total cash, cash equivalents and restricted cash and investments 218,762 109,186 Less restricted investments (17,658) (25,196) Total cash, cash equivalents and restricted cash $ 201,104 $ 83,990 Accounts Receivable The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions. The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable: 2021 2020 Balance as of January 1, $ 7,043 $ 3,332 Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings — 1,334 Provision for expected credit losses 325 5,178 Amounts written off charged against the allowance (1,220) (1,333) Balance as of September 30, $ 6,148 $ 8,511

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2021
Business Combination and Asset Acquisition [Abstract]
Acquisitions	ACQUISITIONS As set forth below, the Company completed two acquisitions from January 1, 2020 through September 30, 2021, which were accounted for using the acquisition method of accounting. Accordingly, the Company recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the applicable date of acquisition. Since the applicable date of acquisition, the Company has revised the allocation of the purchase price to the tangible and intangible assets acquired and liabilities assumed based on analysis of information that has been made available through September 30, 2021. The allocations will continue to be updated through the measurement period, if necessary. The Company recognizes acquisition-related costs in selling, general and administrative expenses in the consolidated statements of comprehensive income. Synzi and SnapMD Acquisition On April 7, 2021, the Company completed its acquisition of Synzi Holdings, Inc. (“Synzi”) and its wholly-owned subsidiary, SnapMD, LLC (“SnapMD”). Synzi is a virtual care communication platform that enables organizations to conduct virtual visits and use secure messaging, text, and email for clinician-to-patient and clinician-to-clinician communications. SnapMD is a full-service virtual care management company, specializing in providing software to enable healthcare providers to better engage with their patients. The initial purchase price of $42,240 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded primarily through borrowings under the Senior Credit Facility (as defined below). The results of Synzi and SnapMD have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the second quarter of 2021, $92 was returned to the Company in respect of the final working capital settlement. The preliminary allocation of the $42,148 purchase price, which was reduced by the final working capital settlement, consisted of (1) $2,790 of fair value of tangible assets acquired, which included $884 cash received, (2) $1,217 of liabilities assumed, (3) $12,440 of identified intangible assets, and (4) $28,135 of goodwill, of which $6,085 is deductible for tax purposes. The provisional items pending finalization are income tax related matters and the assessment of additional information related to determining the fair value of certain assets acquired and liabilities assumed. The fair value of intangible assets primarily includes $10,890 of developed technology and $1,220 of trademarks with a weighted average useful life of approximately seven years. Stratus Video Acquisition On February 14, 2020, the Company completed its acquisition of Stratus Video, a remote video interpreting company that provides healthcare interpretation via remote video, over the phone, and onsite in-person, all supported by proprietary technology platforms. The initial purchase price of $485,568 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded primarily through (1) borrowings under the Company’s $400,000 secured revolving credit facility (the “Senior Credit Facility”), provided for under a credit agreement (the “New Credit Agreement”), and (2) the Second Amendment (as defined in Note (6) below) to the New Credit Agreement, which provided $250,000 of additional available borrowings to the Company. The Senior Credit Facility, New Credit Agreement and Second Amendment are more fully described in Note (6), “Notes Payable and Credit Agreement.” The results of Stratus Video have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the second quarter of 2020, an additional $99 of cash consideration was paid to the selling shareholders in respect of the final working capital settlement. The Company incurred $10,548 of acquisition-related costs during the nine months ended September 30, 2020 as a result of its acquisition of Stratus Video. The allocation of the $485,667 purchase price, which included the additional cash consideration paid for the final working capital settlement and was finalized during the first quarter of 2021, consisted of (1) $44,092 of fair value of tangible assets acquired, which included $9,176 cash received, (2) $56,059 of liabilities assumed, (3) $228,000 of identified intangible assets, and (4) $269,634 of goodwill, of which $10,182 is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately seventeen years. The following table summarizes the fair value and useful life of each intangible asset acquired as of the acquisition date: Fair Value Useful Life (in years) Identifiable intangible assets Customer Relationships $ 171,000 20 Tradenames and Trademarks 40,000 5 - 10 Developed Technology 16,000 5 Interpreter Database 1,000 4 $ 228,000 During the third quarter of 2020, the Company revised the estimated useful lives for the tradenames and trademarks intangible assets as a result of its plan to rebrand the language services business. Based on this change in circumstances since the date of acquisition, the Company determined that the remaining useful lives of the assets are 5 years and is amortizing the remaining value on a straight-line basis over the remaining useful life. The Company will continue to evaluate the remaining useful lives of other intangible assets impacted by its brand consolidation efforts. Approximately $35,329 of revenue and $8,322 of income before income taxes of Stratus Video were included in the unaudited condensed consolidated statement of comprehensive income for the three months ended September 30, 2020. Approximately $78,080 of revenue and $13,787 of income before income taxes of Stratus Video were included in the unaudited condensed consolidated statement of comprehensive income for the nine months ended September 30, 2020. Pro Forma Financial Information (Unaudited) The following summary presents unaudited pro forma consolidated results of operations of the Company as if the acquisition of Stratus Video had occurred on January 1, 2019, which gives effect to certain adjustments, including acquisition-related costs of $1,023 and $11,662, that were reclassified from the three and nine months ended September 30, 2020, respectively, to the three and nine months ended September 30, 2019, respectively. The unaudited pro forma financial information is not necessarily indicative of the operating results that would have occurred had the acquisition been consummated as of the date indicated, nor is it necessarily indicative of the Company’s future operating results. Three Months Ended September 30, Nine Months Ended September 30, 2020 2020 Revenue $ 551,631 $ 1,776,315 Income from operations $ 50,465 $ 135,618 Net income $ 29,030 $ 71,434

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2021
Revenue from Contract with Customer [Abstract]
Revenue Recognition	REVENUE RECOGNITION Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from its software as a service (“SaaS”)-based technologies, including vendor management systems and scheduling software, and outsourced workforce services, including language interpretation and recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from permanent placement and outsourced workforce services is recognized as the services are rendered. Depending on the arrangement, the Company’s SaaS-based revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. During the nine months ended September 30, 2021 and 2020, previously deferred revenue recognized as revenue was $10,515 and $11,408, respectively. The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: • Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. • Recognize revenue in the amount of consideration that the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date. • Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration that the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation. See Note (5), “Segment Information,” for additional information regarding the Company’s revenue disaggregated by service type.

Net Income Per Common Share

Net Income Per Common Share	9 Months Ended
	Sep. 30, 2021
Earnings Per Share [Abstract]
Net Income Per Common Share	NET INCOME PER COMMON SHARE Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period. The following table sets forth the computation of basic and diluted net income per common share: Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net income $ 74,023 $ 26,067 $ 211,171 $ 61,357 Net income per common share - basic $ 1.55 $ 0.55 $ 4.43 $ 1.29 Net income per common share - diluted $ 1.54 $ 0.55 $ 4.40 $ 1.29 Weighted average common shares outstanding - basic 47,737 47,476 47,666 47,406 Plus dilutive effect of potential common shares 343 200 356 241 Weighted average common shares outstanding - diluted 48,080 47,676 48,022 47,647 Share-based awards to purchase 21 and 26 shares of common stock were not included in the above calculation of diluted net income per common share for the three and nine months ended September 30, 2021, respectively, because the effect of these instruments was anti-dilutive. Share-based awards to purchase 84 and 79 shares of common stock were not included in the above calculation of diluted net income per common share for the three and nine months ended September 30, 2020, respectively, because the effect of these instruments was anti-dilutive.

Segment Information

Segment Information	9 Months Ended
	Sep. 30, 2021
Segment Reporting [Abstract]
Segment Information	SEGMENT INFORMATION The Company’s operating segments are identified in the same manner as they are reported internally and used by the Company’s chief operating decision maker for the purpose of evaluating performance and allocating resources. The Company has three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions. The nurse and allied solutions segment includes the Company’s travel nurse staffing, rapid response nurse staffing and labor disruption, allied staffing, local staffing, and revenue cycle solutions businesses. The physician and leadership solutions segment includes the Company’s locum tenens staffing, healthcare interim leadership staffing, executive search, and physician permanent placement businesses. The technology and workforce solutions segment includes the Company’s language services, vendor management systems, workforce optimization, recruitment process outsourcing, telehealth, credentialing, and flex pool management and other outsourced solutions businesses. The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed. The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes: Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Revenue Nurse and allied solutions $ 627,049 $ 382,699 $ 1,908,195 $ 1,251,509 Physician and leadership solutions 150,663 109,116 430,523 355,580 Technology and workforce solutions 100,088 59,816 282,472 155,354 $ 877,800 $ 551,631 $ 2,621,190 $ 1,762,443 Segment operating income Nurse and allied solutions $ 92,564 $ 52,923 $ 283,768 $ 173,706 Physician and leadership solutions 19,301 15,538 62,366 45,432 Technology and workforce solutions 47,210 25,680 131,952 62,814 159,075 94,141 478,086 281,952 Unallocated corporate overhead 23,867 16,490 74,915 76,223 Depreciation and amortization 26,104 26,936 74,098 69,096 Depreciation (included in cost of revenue) 686 481 1,773 981 Share-based compensation 2,589 3,772 17,895 15,046 Interest expense, net, and other 5,223 12,564 24,278 35,061 Income before income taxes $ 100,606 $ 33,898 $ 285,127 $ 85,545 The following tables present the Company’s revenue disaggregated by service type: Three Months Ended September 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 627,049 $ 132,848 $ — $ 759,897 Permanent placement — 17,815 — 17,815 Outsourced workforce — — 58,802 58,802 SaaS-based technologies — — 41,286 41,286 Total revenue $ 627,049 $ 150,663 $ 100,088 $ 877,800 Three Months Ended September 30, 2020 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 382,699 $ 95,648 $ — $ 478,347 Permanent placement — 13,468 — 13,468 Outsourced workforce — — 38,159 38,159 SaaS-based technologies — — 21,657 21,657 Total revenue $ 382,699 $ 109,116 $ 59,816 $ 551,631 Nine Months Ended September 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 1,908,195 $ 379,814 $ — $ 2,288,009 Permanent placement — 50,709 — 50,709 Outsourced workforce — — 164,595 164,595 SaaS-based technologies — — 117,877 117,877 Total revenue $ 1,908,195 $ 430,523 $ 282,472 $ 2,621,190 Nine Months Ended September 30, 2020 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 1,251,509 $ 310,945 $ — $ 1,562,454 Permanent placement — 44,635 — 44,635 Outsourced workforce — — 87,705 87,705 SaaS-based technologies — — 67,649 67,649 Total revenue $ 1,251,509 $ 355,580 $ 155,354 $ 1,762,443 The following table summarizes the activity related to the carrying value of goodwill by reportable segment: Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Balance, January 1, 2021 $ 339,015 $ 152,800 $ 372,670 $ 864,485 Goodwill adjustment for Stratus Video acquisition — — 663 663 Goodwill from Synzi and SnapMD acquisition — — 28,135 28,135 Balance, September 30, 2021 $ 339,015 $ 152,800 $ 401,468 $ 893,283 Accumulated impairment loss as of December 31, 2020 and September 30, 2021 $ 154,444 $ 60,495 $ — $ 214,939

Notes Payable and Credit Agreem

Notes Payable and Credit Agreement	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Notes Payable and Credit Agreement	NOTES PAYABLE AND CREDIT AGREEMENTOn February 9, 2018, the Company entered into the New Credit Agreement with several lenders to provide for the $400,000 Senior Credit Facility to replace its then-existing credit facilities. On June 14, 2019, the Company entered into the first amendment to the New Credit Agreement (the “First Amendment”) to provide for, among other things, a $150,000 secured term loan credit facility (the “Term Loan”). The Company fully repaid all amounts under the Term Loan in 2019. On February 14, 2020, the Company entered into the second amendment to the New Credit Agreement (the “Second Amendment”) to provide for, among other things, a $250,000 secured term loan credit facility (the “Additional Term Loan”). The Second Amendment (together with the New Credit Agreement and the First Amendment, collectively, the “Amended Credit Agreement”) extended the maturity date of the Senior Credit Facility to be coterminous with the Additional Term Loan. The Company used the proceeds from the Additional Term Loan, together with a drawdown of a portion of the Senior Credit Facility, to complete its acquisition of Stratus Video as more fully described in Note (2), “Acquisitions.” The Company repaid its outstanding indebtedness under the Additional Term Loan in the first quarter of 2021. The maturity date of the Senior Credit Facility is February 14, 2025.

Fair Value Measurement

Fair Value Measurement	9 Months Ended
	Sep. 30, 2021
Fair Value Disclosures [Abstract]
Fair Value Measurement	FAIR VALUE MEASUREMENT The Company’s valuation techniques and inputs used to measure fair value and the definition of the three levels (Level 1, Level 2, and Level 3) of the fair value hierarchy are disclosed in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note 3—Fair Value Measurement” of the 2020 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the nine months ended September 30, 2021. Assets and Liabilities Measured on a Recurring Basis Beginning in the third quarter of 2021, the Company invests a portion of its cash and cash equivalents in non-federally insured money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs. The Company has a deferred compensation plan for certain executives and employees, which is composed of deferred compensation and all related income and losses attributable thereto. The Company’s obligation under its deferred compensation plan is measured at fair value based on quoted market prices of the participants’ elected investments, which are Level 1 inputs. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company primarily consist of commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. The Company’s cash equivalents also include commercial paper classified as Level 2 in the fair value hierarchy. Of the $126,584 commercial paper issued and outstanding as of September 30, 2021, $17,658 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2020, the Company had $58,345 commercial paper issued and outstanding, of which $25,196 had original maturities greater than three months and were considered available-for-sale securities. The Company’s contingent consideration liabilities associated with acquisitions are measured at fair value using a probability-weighted discounted cash flow analysis or a simulation-based methodology for the acquired companies, which are Level 3 inputs. The Company recognizes changes to the fair value of its contingent consideration liabilities in selling, general and administrative expenses in the condensed consolidated statements of comprehensive income. The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value: Fair Value Measurements as of September 30, 2021 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 31,569 $ 31,569 $ — $ — Deferred compensation (117,020) (117,020) — — Commercial paper 126,584 — 126,584 — Fair Value Measurements as of December 31, 2020 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 2,198 $ 2,198 $ — $ — Deferred compensation (97,184) (97,184) — — Commercial paper 58,345 — 58,345 — Acquisition contingent consideration liabilities (8,000) — — (8,000) Level 3 Information The following tables set forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy: 2021 2020 Balance as of July 1, $ — $ (8,100) Change in fair value of contingent consideration liability from b4health acquisition — 6,700 Balance as of September 30, $ — $ (1,400) 2021 2020 Balance as of January 1, $ (8,000) $ (23,100) Settlement of Advanced contingent consideration liability for year ended December 31, 2019 — 20,000 Settlement of b4health contingent consideration liability for year ended December 31, 2020 8,000 — Change in fair value of contingent consideration liability from b4health acquisition — 1,700 Balance as of September 30, $ — $ (1,400) Assets Measured on a Non-Recurring Basis The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments. The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever events or changes in circumstances indicate that it is more likely than not that an impairment exists. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs. The Company’s equity investment represents an investment in a non-controlled corporation without a readily determinable market value. The Company has elected to measure the investment at cost minus impairment, if any, plus or minus changes resulting from observable price changes. The fair value is determined by using quoted prices for identical or similar investments of the same issuer, which are Level 2 inputs, and other information available to the Company such as the rights and obligations of the securities. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the condensed consolidated statements of comprehensive income. The balance of the equity investment was $22,633 and $15,449 as of September 30, 2021 and December 31, 2020, respectively. There were no triggering events identified, no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, long-lived assets, or equity investments, and no impairment charges recorded during the nine months ended September 30, 2021 and 2020. Fair Value of Financial Instruments The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. The fair value of the Company’s 4.625% senior notes due 2027 (the “2027 Notes”) and 4.000% senior notes due 2029 (the “2029 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2027 Notes and the 2029 Notes are presented in the following table. See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2020 Annual Report. As of September 30, 2021 As of December 31, 2020 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 518,750 $ 500,000 $ 521,250 2029 Notes 350,000 359,625 350,000 357,000

Leases

Leases	9 Months Ended
	Sep. 30, 2021
Leases [Abstract]
LEASES	LEASESDuring the three months ended September 30, 2021, the Company entered into an arrangement to terminate the lease agreement (as amended to date) for its office space in San Diego. The termination will occur in two phases: the first phase terminates the Company’s right to use certain floors effective February 28, 2022 and the second phase reduces the remaining lease term to December 31, 2024 from its original termination date of July 31, 2027. As a result of the arrangement, which was accounted for as a modification, the Company paid a termination fee of $17,000, remeasured the lease liability using its incremental borrowing rate as the discount rate, and recorded decreases to its operating lease liabilities and right-of-use assets of $27,340 during the three months ended September 30, 2021. Prior to the modification, the total remaining lease payments for this office lease were $62,487. Under the modified lease terms, the total remaining lease payments (excluding the termination fee paid during the three months ended September 30, 2021) are $9,564.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2021
Income Tax Disclosure [Abstract]
Income Taxes	INCOME TAXES The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of September 30, 2021, the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2011, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2017. Notwithstanding the foregoing, the Company could adjust its provision for income taxes and contingent tax liability based on future developments. CARES Act On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) was enacted and signed into law in response to the COVID-19 pandemic. Among other things, the CARES Act contains significant business tax provisions, including a deferral of payment of employer payroll taxes and an employer retention credit for employer payroll taxes. The Company has deferred payment of the employer’s share of payroll taxes of $48,452, which is included in accrued compensation and benefits and other long-term liabilities in the consolidated balance sheet as of September 30, 2021, with half of such taxes to be paid by the end of 2021 and the other half to be paid by the end of 2022. The Company has claimed an employee retention employment tax credit of $1,756.

Commitments and Contingencies_

Commitments and Contingencies: Legal Proceedings	9 Months Ended
	Sep. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies: Legal Proceedings	COMMITMENTS AND CONTINGENCIES: LEGAL PROCEEDINGSFrom time to time, the Company is involved in various lawsuits, claims, investigations, and proceedings that arise in the ordinary course of business. These matters typically relate to professional liability, tax, compensation, contract, competitor disputes and employee-related matters and include individual and class action lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment and compensation practices. Additionally, some of the Company’s clients may also become subject to claims, governmental inquiries and investigations, and legal actions relating to services provided by the Company’s healthcare professionals. Depending upon the particular facts and circumstances, the Company may also be subject to indemnification obligations under its contracts with such clients relating to these matters. The Company accrues for contingencies and records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant matters for which the Company has established loss contingencies are class actions related to wage and hour claims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that certain expense reimbursements should be considered wages and included in the regular rate of pay for purposes of calculating overtime rates. On May 26, 2016, former travel nurse Verna Maxwell Clarke filed a complaint against AMN Services, LLC, in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:16-cv-04132-DSF-KS) (the “Clarke Matter”). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. On June 26, 2018, the district court denied the plaintiffs’ Motion for Summary Judgment in its entirety, and granted the Company’s Motion for Summary Judgment with respect to the Plaintiffs’ per diem and overtime claims. The plaintiffs filed an appeal of the judgment relating to the per diem claims with the Ninth Circuit Court of Appeals (the “Ninth Circuit”). On February 8, 2021, a three-judge panel of the Ninth Circuit issued an opinion that reversed the district court’s granting of the Company’s Motion for Summary Judgment and remanded the matter to the district court instructing the district to enter partial summary judgment in favor of the Plaintiffs. On May 7, 2021, the Ninth Circuit issued an order denying the Company’s petition for rehearing. On August 26, 2021, the Company filed a Petition for Writ of Certiorari in the United States Supreme Court seeking review of the Ninth Circuit’s decision. At this time, it is unknown whether the Supreme Court will consider the appeal. On May 2, 2019, former travel nurse Sara Woehrle filed a complaint against AMN Services, LLC, and Providence Health System – Southern California in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:19-cv-05282 DSF-KS). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. The Complaint also alleges that the putative class members were denied required meal periods, denied proper overtime compensation, were not compensated for all time worked, including reporting time and training time, and received non-compliant wage statements. The Company has reached a preliminary agreement to settle this matter in its entirety. Final settlement is not expected until the fourth quarter of 2022. The Company believes that its wage and hour practices, including those associated with the cases described above, conform with the applicable law in all material respects. However, because of the February 2021 ruling by the Ninth Circuit in the Clarke Matter and the inherent uncertainty of litigation, the Company is not able to reasonably predict if any matter will be resolved in a manner that is materially adverse to the Company. Accordingly, the Company recorded an increase to its accruals established in connection with the matters described above amounting to $20,000 during the fourth quarter of 2020, and the ultimate resolution could result in a loss of up to $15,000, excluding penalties, in excess of the amounts currently accrued. For all other matters, the Company is unable to currently estimate the possible loss or range of loss beyond the amounts already accrued. Loss contingencies accrued as of September 30, 2021 are included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets.

Balance Sheet Details

Balance Sheet Details	9 Months Ended
	Sep. 30, 2021
Balance Sheet Related Disclosures [Abstract]
Balance Sheet Details	BALANCE SHEET DETAILS The consolidated balance sheets detail is as follows: September 30, 2021 December 31, 2020 Other current assets: Restricted cash and cash equivalents $ 18,118 $ 18,626 Income taxes receivable 1,119 6,591 Other 12,159 15,592 Other current assets $ 31,396 $ 40,809 Fixed assets: Furniture and equipment $ 54,634 $ 47,355 Software 254,090 220,971 Leasehold improvements 9,616 9,600 318,340 277,926 Accumulated depreciation (190,578) (161,752) Fixed assets, net $ 127,762 $ 116,174 Other assets: Life insurance cash surrender value $ 114,037 $ 98,161 Other 43,872 36,959 Other assets $ 157,909 $ 135,120 Accounts payable and accrued expenses: Trade accounts payable $ 48,468 $ 28,089 Subcontractor payable 147,776 79,364 Accrued expenses 60,414 37,849 Loss contingencies 11,627 7,613 Professional liability reserve 6,773 8,897 Other 9,036 6,069 Accounts payable and accrued expenses $ 284,094 $ 167,881 Accrued compensation and benefits: Accrued payroll $ 114,299 $ 59,721 Accrued bonuses and commissions 66,215 34,514 Accrued travel expense 2,673 1,998 Health insurance reserve 6,627 5,590 Workers compensation reserve 10,297 10,244 Deferred compensation 117,020 97,184 Other 4,807 4,163 Accrued compensation and benefits $ 321,938 $ 213,414 Other long-term liabilities: Workers compensation reserve $ 20,716 $ 20,930 Professional liability reserve 31,768 31,997 Unrecognized tax benefits 5,403 5,447 Other 49,228 49,533 Other long-term liabilities $ 107,115 $ 107,907

Basis of Presentation (Policies

Basis of Presentation (Policies)	9 Months Ended
	Sep. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Use of Estimates	The preparation of financial statements in conformity with U.S. GAAP requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to intangible assets purchased in a business combination, asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, contingent consideration liabilities associated with acquisitions, and income taxes. Actual results could differ from those estimates under different assumptions or conditions. The impact of the novel coronavirus (COVID-19) pandemic did not have a material effect on the Company’s estimates as of September 30, 2021.
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In December 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2019-12, “Simplifying the Accounting for Income Taxes.” The standard is expected to reduce cost and complexity related to accounting for income taxes. The new guidance eliminates certain exceptions and clarifies and amends existing guidance to promote consistent application among reporting entities. Depending on the amended guidance within this standard, adoption is to be applied on a retrospective, modified retrospective or prospective basis. The Company adopted this standard effective January 1, 2021, and the adoption did not have a material effect on the Company’s consolidated financial statements. In January 2020, the FASB issued ASU 2020-01, “Clarifying the Interactions between Topic 321, Topic 323, and Topic 815.” The new guidance clarifies the interactions between accounting standards that apply to equity investments without readily determinable fair values. Specifically, it addresses the accounting for the transition into and out of the equity method. The Company adopted this standard effective January 1, 2021 on a prospective basis, and the adoption did not have a material effect on the Company’s consolidated financial statements.
Cash, Cash Equivalents and Restricted Cash	Cash, Cash Equivalents and Restricted Cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions, money market funds, commercial paper and other highly liquid investments. Restricted cash and cash equivalents primarily includes cash and commercial paper that serve as collateral for the Company’s captive insurance subsidiary claim payments. See Note (7), “Fair Value Measurement” for additional information.
Accounts Receivable	Accounts Receivable The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions.
Revenue Recognition	Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from its software as a service (“SaaS”)-based technologies, including vendor management systems and scheduling software, and outsourced workforce services, including language interpretation and recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from permanent placement and outsourced workforce services is recognized as the services are rendered. Depending on the arrangement, the Company’s SaaS-based revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. During the nine months ended September 30, 2021 and 2020, previously deferred revenue recognized as revenue was $10,515 and $11,408, respectively. The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: • Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. • Recognize revenue in the amount of consideration that the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date. • Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration that the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation.
Net Income per Common Share	Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period.
Segment Information	The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed.
Fair Value of Assets and Liabilities	Assets and Liabilities Measured on a Recurring Basis Beginning in the third quarter of 2021, the Company invests a portion of its cash and cash equivalents in non-federally insured money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs. The Company has a deferred compensation plan for certain executives and employees, which is composed of deferred compensation and all related income and losses attributable thereto. The Company’s obligation under its deferred compensation plan is measured at fair value based on quoted market prices of the participants’ elected investments, which are Level 1 inputs. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company primarily consist of commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. The Company’s cash equivalents also include commercial paper classified as Level 2 in the fair value hierarchy. Of the $126,584 commercial paper issued and outstanding as of September 30, 2021, $17,658 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2020, the Company had $58,345 commercial paper issued and outstanding, of which $25,196 had original maturities greater than three months and were considered available-for-sale securities. The Company’s contingent consideration liabilities associated with acquisitions are measured at fair value using a probability-weighted discounted cash flow analysis or a simulation-based methodology for the acquired companies, which are Level 3 inputs. The Company recognizes changes to the fair value of its contingent consideration liabilities in selling, general and administrative expenses in the condensed consolidated statements of comprehensive income. Assets Measured on a Non-Recurring Basis The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments. The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever events or changes in circumstances indicate that it is more likely than not that an impairment exists. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs. Fair Value of Financial Instruments The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. The fair value of the Company’s 4.625% senior notes due 2027 (the “2027 Notes”) and 4.000% senior notes due 2029 (the “2029 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2027 Notes and the 2029 Notes are presented in the following table. See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2020 Annual Report. As of September 30, 2021 As of December 31, 2020 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 518,750 $ 500,000 $ 521,250 2029 Notes 350,000 359,625 350,000 357,000

Basis of Presentation (Tables)

Basis of Presentation (Tables)	9 Months Ended
	Sep. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Reconciliation of Cash, Cash Equivalents and Restricted Cash	The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. September 30, 2021 December 31, 2020 Cash and cash equivalents $ 137,041 $ 29,213 Restricted cash and cash equivalents (included in other current assets) 18,118 18,626 Restricted cash, cash equivalents and investments 63,603 61,347 Total cash, cash equivalents and restricted cash and investments 218,762 109,186 Less restricted investments (17,658) (25,196) Total cash, cash equivalents and restricted cash $ 201,104 $ 83,990
Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable	The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable: 2021 2020 Balance as of January 1, $ 7,043 $ 3,332 Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings — 1,334 Provision for expected credit losses 325 5,178 Amounts written off charged against the allowance (1,220) (1,333) Balance as of September 30, $ 6,148 $ 8,511

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2021
Business Combination and Asset Acquisition [Abstract]
Schedule of Intangible Assets Acquired	The following table summarizes the fair value and useful life of each intangible asset acquired as of the acquisition date: Fair Value Useful Life (in years) Identifiable intangible assets Customer Relationships $ 171,000 20 Tradenames and Trademarks 40,000 5 - 10 Developed Technology 16,000 5 Interpreter Database 1,000 4 $ 228,000
Schedule of Pro Forma Financial Information	The unaudited pro forma financial information is not necessarily indicative of the operating results that would have occurred had the acquisition been consummated as of the date indicated, nor is it necessarily indicative of the Company’s future operating results. Three Months Ended September 30, Nine Months Ended September 30, 2020 2020 Revenue $ 551,631 $ 1,776,315 Income from operations $ 50,465 $ 135,618 Net income $ 29,030 $ 71,434

Net Income Per Common Share (Ta

Net Income Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2021
Earnings Per Share [Abstract]
Computation of Basic and Diluted Net Income Per Common Share	The following table sets forth the computation of basic and diluted net income per common share: Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net income $ 74,023 $ 26,067 $ 211,171 $ 61,357 Net income per common share - basic $ 1.55 $ 0.55 $ 4.43 $ 1.29 Net income per common share - diluted $ 1.54 $ 0.55 $ 4.40 $ 1.29 Weighted average common shares outstanding - basic 47,737 47,476 47,666 47,406 Plus dilutive effect of potential common shares 343 200 356 241 Weighted average common shares outstanding - diluted 48,080 47,676 48,022 47,647

Segment Information (Tables)

Segment Information (Tables)	9 Months Ended
	Sep. 30, 2021
Segment Reporting [Abstract]
Reconciliation of Revenue and Segment Operating Income by Reportable Segment	The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes: Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Revenue Nurse and allied solutions $ 627,049 $ 382,699 $ 1,908,195 $ 1,251,509 Physician and leadership solutions 150,663 109,116 430,523 355,580 Technology and workforce solutions 100,088 59,816 282,472 155,354 $ 877,800 $ 551,631 $ 2,621,190 $ 1,762,443 Segment operating income Nurse and allied solutions $ 92,564 $ 52,923 $ 283,768 $ 173,706 Physician and leadership solutions 19,301 15,538 62,366 45,432 Technology and workforce solutions 47,210 25,680 131,952 62,814 159,075 94,141 478,086 281,952 Unallocated corporate overhead 23,867 16,490 74,915 76,223 Depreciation and amortization 26,104 26,936 74,098 69,096 Depreciation (included in cost of revenue) 686 481 1,773 981 Share-based compensation 2,589 3,772 17,895 15,046 Interest expense, net, and other 5,223 12,564 24,278 35,061 Income before income taxes $ 100,606 $ 33,898 $ 285,127 $ 85,545
Disaggregation of Revenue	The following tables present the Company’s revenue disaggregated by service type: Three Months Ended September 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 627,049 $ 132,848 $ — $ 759,897 Permanent placement — 17,815 — 17,815 Outsourced workforce — — 58,802 58,802 SaaS-based technologies — — 41,286 41,286 Total revenue $ 627,049 $ 150,663 $ 100,088 $ 877,800 Three Months Ended September 30, 2020 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 382,699 $ 95,648 $ — $ 478,347 Permanent placement — 13,468 — 13,468 Outsourced workforce — — 38,159 38,159 SaaS-based technologies — — 21,657 21,657 Total revenue $ 382,699 $ 109,116 $ 59,816 $ 551,631 Nine Months Ended September 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 1,908,195 $ 379,814 $ — $ 2,288,009 Permanent placement — 50,709 — 50,709 Outsourced workforce — — 164,595 164,595 SaaS-based technologies — — 117,877 117,877 Total revenue $ 1,908,195 $ 430,523 $ 282,472 $ 2,621,190 Nine Months Ended September 30, 2020 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 1,251,509 $ 310,945 $ — $ 1,562,454 Permanent placement — 44,635 — 44,635 Outsourced workforce — — 87,705 87,705 SaaS-based technologies — — 67,649 67,649 Total revenue $ 1,251,509 $ 355,580 $ 155,354 $ 1,762,443
Summary of Goodwill by Reportable Segment	The following table summarizes the activity related to the carrying value of goodwill by reportable segment: Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Balance, January 1, 2021 $ 339,015 $ 152,800 $ 372,670 $ 864,485 Goodwill adjustment for Stratus Video acquisition — — 663 663 Goodwill from Synzi and SnapMD acquisition — — 28,135 28,135 Balance, September 30, 2021 $ 339,015 $ 152,800 $ 401,468 $ 893,283 Accumulated impairment loss as of December 31, 2020 and September 30, 2021 $ 154,444 $ 60,495 $ — $ 214,939

Fair Value Measurement (Tables)

Fair Value Measurement (Tables)	9 Months Ended
	Sep. 30, 2021
Fair Value Disclosures [Abstract]
Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis	The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value: Fair Value Measurements as of September 30, 2021 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 31,569 $ 31,569 $ — $ — Deferred compensation (117,020) (117,020) — — Commercial paper 126,584 — 126,584 — Fair Value Measurements as of December 31, 2020 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 2,198 $ 2,198 $ — $ — Deferred compensation (97,184) (97,184) — — Commercial paper 58,345 — 58,345 — Acquisition contingent consideration liabilities (8,000) — — (8,000)
Reconciliations of Changes in the Fair Value of Contingent Consideration Liabilities	The following tables set forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy: 2021 2020 Balance as of July 1, $ — $ (8,100) Change in fair value of contingent consideration liability from b4health acquisition — 6,700 Balance as of September 30, $ — $ (1,400) 2021 2020 Balance as of January 1, $ (8,000) $ (23,100) Settlement of Advanced contingent consideration liability for year ended December 31, 2019 — 20,000 Settlement of b4health contingent consideration liability for year ended December 31, 2020 8,000 — Change in fair value of contingent consideration liability from b4health acquisition — 1,700 Balance as of September 30, $ — $ (1,400)
Schedule of Fair Value of Financial Instruments	See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2020 Annual Report. As of September 30, 2021 As of December 31, 2020 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 518,750 $ 500,000 $ 521,250 2029 Notes 350,000 359,625 350,000 357,000

Balance Sheet Details (Tables)

Balance Sheet Details (Tables)	9 Months Ended
	Sep. 30, 2021
Balance Sheet Related Disclosures [Abstract]
Schedule of Supplemental Balance Sheet Disclosures	The consolidated balance sheets detail is as follows: September 30, 2021 December 31, 2020 Other current assets: Restricted cash and cash equivalents $ 18,118 $ 18,626 Income taxes receivable 1,119 6,591 Other 12,159 15,592 Other current assets $ 31,396 $ 40,809 Fixed assets: Furniture and equipment $ 54,634 $ 47,355 Software 254,090 220,971 Leasehold improvements 9,616 9,600 318,340 277,926 Accumulated depreciation (190,578) (161,752) Fixed assets, net $ 127,762 $ 116,174 Other assets: Life insurance cash surrender value $ 114,037 $ 98,161 Other 43,872 36,959 Other assets $ 157,909 $ 135,120 Accounts payable and accrued expenses: Trade accounts payable $ 48,468 $ 28,089 Subcontractor payable 147,776 79,364 Accrued expenses 60,414 37,849 Loss contingencies 11,627 7,613 Professional liability reserve 6,773 8,897 Other 9,036 6,069 Accounts payable and accrued expenses $ 284,094 $ 167,881 Accrued compensation and benefits: Accrued payroll $ 114,299 $ 59,721 Accrued bonuses and commissions 66,215 34,514 Accrued travel expense 2,673 1,998 Health insurance reserve 6,627 5,590 Workers compensation reserve 10,297 10,244 Deferred compensation 117,020 97,184 Other 4,807 4,163 Accrued compensation and benefits $ 321,938 $ 213,414 Other long-term liabilities: Workers compensation reserve $ 20,716 $ 20,930 Professional liability reserve 31,768 31,997 Unrecognized tax benefits 5,403 5,447 Other 49,228 49,533 Other long-term liabilities $ 107,115 $ 107,907

Basis of Presentation - Reconci

Basis of Presentation - Reconciliation of Cash, Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020	Sep. 30, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Cash and cash equivalents	$ 137,041	$ 29,213
Restricted cash and cash equivalents (included in other current assets)	18,118	18,626
Restricted cash, cash equivalents and investments	63,603	61,347
Total cash, cash equivalents and restricted cash and investments	218,762	109,186
Less restricted investments	(17,658)	(25,196)
Total cash, cash equivalents and restricted cash	$ 201,104	$ 83,990	$ 108,923	$ 153,962

Basis of Presentation - Recon_2

Basis of Presentation - Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable (Details) - USD ($) $ in Thousands	9 Months Ended		12 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020	Dec. 31, 2019
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 7,043	$ 3,332	$ 3,332
Accounting Standards Update [Extensible Enumeration]			Accounting Standards Update 2016-13 [Member]	Accounting Standards Update 2016-13 [Member]
Provision for expected credit losses	325	5,178
Amounts written off charged against the allowance	(1,220)	(1,333)
Ending balance	6,148	8,511	$ 7,043	$ 3,332
Cumulative Effect, Period of Adoption, Adjustment
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 0	$ 1,334	1,334
Ending balance			$ 0	$ 1,334

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details)

Sep. 30, 2021USD ($)

Apr. 07, 2021USD ($)

Feb. 14, 2020USD ($)

Jun. 30, 2021USD ($)

Mar. 31, 2021USD ($)

Sep. 30, 2020USD ($)

Jun. 30, 2020USD ($)

Sep. 30, 2021USD ($)acquisition

Sep. 30, 2020USD ($)

Dec. 31, 2020USD ($)

Jun. 14, 2019USD ($)

Feb. 09, 2018USD ($)

Business Acquisition [Line Items]

Number of acquisitions | acquisition

2

Goodwill

$ 893,283,000

$ 893,283,000

$ 864,485,000

Net loss

(211,171,000)

$ (61,357,000)

Synzi

Business Acquisition [Line Items]

Cash consideration

$ 42,240,000

Cash returned to the Company for final working capital settlement

$ 92,000

Purchase price, net of working capital adjustment

42,148,000

Fair value of tangible assets acquired

2,790,000

2,790,000

Cash received

884,000

884,000

Liabilities assumed

1,217,000

1,217,000

Identifiable intangible assets

12,440,000

12,440,000

Goodwill

28,135,000

28,135,000

Goodwill expected to be deductible for tax purposes

$ 6,085,000

$ 6,085,000

Intangible assets acquired, weighted average useful life

7 years

Synzi | Developed Technology

Business Acquisition [Line Items]

Identifiable intangible assets

$ 10,890,000

Synzi | Trademarks

Business Acquisition [Line Items]

Identifiable intangible assets

$ 1,220,000

Stratus Video

Business Acquisition [Line Items]

Cash consideration

$ 485,568,000

$ 99,000

Purchase price, net of working capital adjustment

$ 485,667,000

Cash received

9,176,000

Liabilities assumed

56,059,000

Identifiable intangible assets

$ 228,000,000

228,000,000

Goodwill

269,634,000

Goodwill expected to be deductible for tax purposes

10,182,000

Intangible assets acquired, weighted average useful life

17 years

Acquisition-related costs

10,548,000

Fair value of tangible assets acquired

$ 44,092,000

Pro forma information, revenue of acquiree since acquisition date

$ 35,329,000

78,080,000

Pro forma information, income before income taxes of acquiree since acquisition date

8,322,000

13,787,000

Stratus Video | Acquisition-related Costs

Business Acquisition [Line Items]

Net loss

$ 1,023,000

$ 11,662,000

Stratus Video | Developed Technology

Business Acquisition [Line Items]

Identifiable intangible assets

$ 16,000,000

Useful Life

5 years

Stratus Video | Tradenames and Trademarks

Business Acquisition [Line Items]

Identifiable intangible assets

$ 40,000,000

Useful Life

5 years

Revolving Credit Facility | Line of Credit

Business Acquisition [Line Items]

Maximum borrowing capacity

$ 400,000,000

Term Loan | Term Debt

Business Acquisition [Line Items]

Term loan credit facility

$ 250,000,000

$ 150,000,000

Acquisitions - Schedule of Inta

Acquisitions - Schedule of Intangible Assets Acquired (Details) - Stratus Video - USD ($) $ in Thousands	Feb. 14, 2020	Sep. 30, 2020	Mar. 31, 2021
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 228,000		$ 228,000
Customer Relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 171,000
Useful Life	20 years
Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 40,000
Useful Life		5 years
Developed Technology
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 16,000
Useful Life	5 years
Interpreter Database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 1,000
Useful Life	4 years
Minimum | Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	5 years
Maximum | Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	10 years

Acquisitions - Schedule of Pro

Acquisitions - Schedule of Pro Forma Financial Information (Details) - Stratus Video - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2020
Business Acquisition [Line Items]
Revenue	$ 551,631	$ 1,776,315
Income from operations	50,465	135,618
Net income	$ 29,030	$ 71,434

Revenue Recognition (Details)

Revenue Recognition (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Revenue from Contract with Customer [Abstract]
Previously deferred revenue recognized during period	$ 10,515	$ 11,408

Net Income Per Common Share (De

Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Earnings Per Share [Abstract]
Net income	$ 74,023	$ 26,067	$ 211,171	$ 61,357
Net Income - diluted	$ 74,023	$ 26,067	$ 211,171	$ 61,357
Net income per common share - basic (in dollars per share)	$ 1.55	$ 0.55	$ 4.43	$ 1.29
Net income per common share - diluted (in dollars per share)	$ 1.54	$ 0.55	$ 4.40	$ 1.29
Weighted average common shares outstanding - basic (in shares)	47,737	47,476	47,666	47,406
Plus dilutive effect of potential common shares (in shares)	343	200	356	241
Weighted average common shares outstanding - diluted (in shares)	48,080	47,676	48,022	47,647
Common stock excluded from calculation of EPS (in shares)	21	84	26	79

Segment Information - Narrative

Segment Information - Narrative (Details)	9 Months Ended
	Sep. 30, 2021segment
Segment Reporting [Abstract]
Number of reportable segments	3

Segment Information - Reconcili

Segment Information - Reconciliation of Revenue and Segment Operating Income by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 877,800	$ 551,631	$ 2,621,190	$ 1,762,443
Segment operating income	105,829	46,462	309,405	120,606
Depreciation and amortization (exclusive of depreciation included in cost of revenue)	26,104	26,936	74,098	69,096
Depreciation (included in cost of revenue)	686	481	1,773	981
Share-based compensation	2,589	3,772	17,895	15,046
Interest expense, net, and other	5,223	12,564	24,278	35,061
Income before income taxes	100,606	33,898	285,127	85,545
Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	627,049	382,699	1,908,195	1,251,509
Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	150,663	109,116	430,523	355,580
Technology and workforce solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	100,088	59,816	282,472	155,354
Operating segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	877,800	551,631	2,621,190	1,762,443
Segment operating income	159,075	94,141	478,086	281,952
Operating segments | Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	627,049	382,699	1,908,195	1,251,509
Segment operating income	92,564	52,923	283,768	173,706
Operating segments | Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	150,663	109,116	430,523	355,580
Segment operating income	19,301	15,538	62,366	45,432
Operating segments | Technology and workforce solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	100,088	59,816	282,472	155,354
Segment operating income	47,210	25,680	131,952	62,814
Unallocated corporate overhead
Segment Reporting, Revenue Reconciling Item [Line Items]
Unallocated corporate overhead	$ 23,867	$ 16,490	$ 74,915	$ 76,223

Segment Information - Disaggreg

Segment Information - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Segment Reporting Information [Line Items]
Revenue	$ 877,800	$ 551,631	$ 2,621,190	$ 1,762,443
Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	627,049	382,699	1,908,195	1,251,509
Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	150,663	109,116	430,523	355,580
Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	100,088	59,816	282,472	155,354
Temporary staffing
Segment Reporting Information [Line Items]
Revenue	759,897	478,347	2,288,009	1,562,454
Temporary staffing | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	627,049	382,699	1,908,195	1,251,509
Temporary staffing | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	132,848	95,648	379,814	310,945
Temporary staffing | Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Permanent placement
Segment Reporting Information [Line Items]
Revenue	17,815	13,468	50,709	44,635
Permanent placement | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Permanent placement | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	17,815	13,468	50,709	44,635
Permanent placement | Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Outsourced workforce
Segment Reporting Information [Line Items]
Revenue	58,802	38,159	164,595	87,705
Outsourced workforce | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Outsourced workforce | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Outsourced workforce | Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	58,802	38,159	164,595	87,705
SaaS-based technologies
Segment Reporting Information [Line Items]
Revenue	41,286	21,657	117,877	67,649
SaaS-based technologies | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
SaaS-based technologies | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
SaaS-based technologies | Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	$ 41,286	$ 21,657	$ 117,877	$ 67,649

Segment Information - Summary o

Segment Information - Summary of Goodwill by Reportable Segment (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Dec. 31, 2020
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 864,485
Goodwill adjustment for Stratus Video acquisition	663
Goodwill from Synzi and SnapMD acquisition	28,135
Goodwill, ending balance	893,283
Accumulated impairment loss	214,939	$ 214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	339,015
Goodwill adjustment for Stratus Video acquisition	0
Goodwill from Synzi and SnapMD acquisition	0
Goodwill, ending balance	339,015
Accumulated impairment loss	154,444	154,444
Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	152,800
Goodwill adjustment for Stratus Video acquisition	0
Goodwill from Synzi and SnapMD acquisition	0
Goodwill, ending balance	152,800
Accumulated impairment loss	60,495	60,495
Technology and workforce solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	372,670
Goodwill adjustment for Stratus Video acquisition	663
Goodwill from Synzi and SnapMD acquisition	28,135
Goodwill, ending balance	401,468
Accumulated impairment loss	$ 0	$ 0

Notes Payable and Credit Agre_2

Notes Payable and Credit Agreement (Details) - USD ($)	Feb. 14, 2020	Jun. 14, 2019	Feb. 09, 2018
Senior Credit Facility | Line of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity			$ 400,000,000
Term Loan | Term Debt
Debt Instrument [Line Items]
Term loan credit facility	$ 250,000,000	$ 150,000,000

Fair Value Measurement - Narrat

Fair Value Measurement - Narrative (Details) - USD ($)	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020	Oct. 20, 2020	Aug. 13, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment charges	$ 0	$ 0
2027 Notes | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate					4.625%
2029 Notes | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate				4.00%
Fair Value, Measurements, Nonrecurring | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment balance	22,633,000		$ 15,449,000
Commercial paper | Fair Value, Measurements, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper	126,584,000		58,345,000
Commercial paper | Fair Value, Measurements, Recurring | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper	126,584,000		58,345,000
Available-for-sale securities	$ 17,658,000		$ 25,196,000

Fair Value Measurement - Financ

Fair Value Measurement - Financial Assets and Liabilities (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Deferred compensation
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	$ (117,020)	$ (97,184)
Deferred compensation | Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	(117,020)	(97,184)
Deferred compensation | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	0	0
Deferred compensation | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	0	0
Acquisition contingent consideration liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value		(8,000)
Acquisition contingent consideration liabilities | Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value		0
Acquisition contingent consideration liabilities | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value		0
Acquisition contingent consideration liabilities | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value		(8,000)
Money market funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	31,569	2,198
Money market funds | Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	31,569	2,198
Money market funds | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	0	0
Money market funds | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	0	0
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	126,584	58,345
Commercial paper | Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	0	0
Commercial paper | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	126,584	58,345
Commercial paper | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	$ 0	$ 0

Fair Value Measurement - Reconc

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Acquisition contingent consideration liabilities - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 0	$ (8,100)	$ (8,000)	$ (23,100)
Ending balance	0	(1,400)	0	(1,400)
Advanced
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of contingent consideration liability			0	20,000
b4health
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of contingent consideration liability			8,000	0
Change in fair value of contingent consideration liability from acquisition	$ 0	$ 6,700	$ 0	$ 1,700

Fair Value Measurement - Fair V

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($)	Sep. 30, 2021	Dec. 31, 2020
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	$ 500,000,000	$ 500,000,000
Estimated Fair Value	518,750,000	521,250,000
2029 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	350,000,000	350,000,000
Estimated Fair Value	$ 359,625,000	$ 357,000,000

Leases (Details)

Leases (Details) $ in Thousands	3 Months Ended
	Sep. 30, 2021USD ($)phase
Leases [Abstract]
Number of phases of lease termination agreement | phase	2
Payments of lease termination fee	$ 17,000
Operating lease, right-of-use asset, decrease from modification	27,340
Operating lease, liability, decrease from modification	27,340
Remaining lease payments, premodification	62,487
Remaining lease payments, postmodification	$ 9,564

Income Taxes (Details)

Income Taxes (Details) $ in Thousands	Sep. 30, 2021USD ($)
Income Tax Disclosure [Abstract]
Deferred payroll taxes, CARES Act	$ 48,452
Employee retention employment tax credit, CARES Act	$ 1,756

Commitments and Contingencies_2

Commitments and Contingencies: Legal Proceedings (Details) - Wage and Hour claims - Pending Litigation - USD ($) $ in Thousands	3 Months Ended
	Dec. 31, 2020	Sep. 30, 2021
Loss Contingencies [Line Items]
Increase to loss contingency accruals	$ 20,000
Maximum
Loss Contingencies [Line Items]
Estimate of possible loss		$ 15,000

Balance Sheet Details (Details)

Balance Sheet Details (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Other current assets:
Restricted cash and cash equivalents	$ 18,118	$ 18,626
Income taxes receivable	1,119	6,591
Other	12,159	15,592
Other current assets	31,396	40,809
Fixed assets:
Furniture and equipment	54,634	47,355
Software	254,090	220,971
Leasehold improvements	9,616	9,600
Fixed assets, gross	318,340	277,926
Accumulated depreciation	(190,578)	(161,752)
Fixed assets, net	127,762	116,174
Other assets:
Life insurance cash surrender value	114,037	98,161
Other	43,872	36,959
Other assets	157,909	135,120
Accounts payable and accrued expenses:
Trade accounts payable	48,468	28,089
Subcontractor payable	147,776	79,364
Accrued expenses	60,414	37,849
Loss contingencies	11,627	7,613
Professional liability reserve	6,773	8,897
Other	9,036	6,069
Accounts payable and accrued expenses	284,094	167,881
Accrued compensation and benefits:
Accrued payroll	114,299	59,721
Accrued bonuses and commissions	66,215	34,514
Accrued travel expense	2,673	1,998
Health insurance reserve	6,627	5,590
Workers compensation reserve	10,297	10,244
Deferred compensation	117,020	97,184
Other	4,807	4,163
Accrued compensation and benefits	321,938	213,414
Other long-term liabilities:
Workers compensation reserve	20,716	20,930
Professional liability reserve	31,768	31,997
Unrecognized tax benefits	5,403	5,447
Other	49,228	49,533
Other long-term liabilities	$ 107,115	$ 107,907