Cover Page
Cover Page - shares | 6 Months Ended | |
Jun. 30, 2022 | Aug. 03, 2022 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Jun. 30, 2022 | |
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, $0.01 par value | |
Trading Symbol | AMN | |
Security Exchange Name | NYSE | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding (excluding treasury shares) | 43,272,573 | |
Entity Central Index Key | 0001142750 | |
Current Fiscal Year End Date | --12-31 | |
Document Fiscal Year Focus | 2022 | |
Document Fiscal Period Focus | Q2 | |
Amendment Flag | false |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Jun. 30, 2022 | Dec. 31, 2021 |
Current assets: | ||
Cash and cash equivalents | $ 79,357 | $ 180,928 |
Accounts receivable, net of allowances of $7,522 and $6,838 at June 30, 2022 and December 31, 2021, respectively | 781,404 | 789,131 |
Accounts receivable, subcontractor | 247,707 | 239,719 |
Prepaid expenses | 27,430 | 72,460 |
Other current assets | 54,324 | 66,830 |
Total current assets | 1,190,222 | 1,349,068 |
Restricted cash, cash equivalents and investments | 61,744 | 64,482 |
Fixed assets, net of accumulated depreciation of $204,384 and $189,954 at June 30, 2022 and December 31, 2021, respectively | 136,490 | 127,114 |
Operating lease right-of-use assets | 20,318 | 27,771 |
Other assets | 148,570 | 156,670 |
Goodwill | 935,675 | 892,341 |
Intangible assets, net of accumulated amortization of $318,208 and $278,249 at June 30, 2022 and December 31, 2021, respectively | 515,761 | 514,460 |
Total assets | 3,008,780 | 3,131,906 |
Current liabilities: | ||
Accounts payable and accrued expenses | 458,985 | 425,257 |
Accrued compensation and benefits | 416,375 | 354,381 |
Current portion of operating lease liabilities | 7,429 | 11,383 |
Deferred revenue | 15,942 | 15,950 |
Other current liabilities | 58,648 | 162,419 |
Total current liabilities | 957,379 | 969,390 |
Notes payable, net of unamortized fees and premium | 842,914 | 842,322 |
Deferred income taxes, net | 51,010 | 47,814 |
Operating lease liabilities | 12,486 | 13,364 |
Other long-term liabilities | 105,647 | 96,989 |
Total liabilities | 1,969,436 | 1,969,879 |
Commitments and contingencies | ||
Stockholders’ equity: | ||
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at June 30, 2022 and December 31, 2021 | 0 | 0 |
Common stock, $0.01 par value; 200,000 shares authorized; 50,032 issued and 43,272 outstanding at June 30, 2022 and 49,849 issued and 47,263 outstanding at December 31, 2021 | 500 | 498 |
Additional paid-in capital | 496,682 | 486,709 |
Treasury stock, at cost; 6,760 and 2,586 shares at June 30, 2022 and December 31, 2021 | (523,722) | (121,831) |
Retained earnings | 1,066,754 | 796,946 |
Accumulated other comprehensive loss | (870) | (295) |
Total stockholders’ equity | 1,039,344 | 1,162,027 |
Total liabilities and stockholders’ equity | $ 3,008,780 | $ 3,131,906 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands | Jun. 30, 2022 | Dec. 31, 2021 |
Statement of Financial Position [Abstract] | ||
Accounts receivable, allowance | $ 7,522 | $ 6,838 |
Accumulated depreciation - fixed assets | 204,384 | 189,954 |
Accumulated amortization | $ 318,208 | $ 278,249 |
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) | 50,032,000 | 49,849,000 |
Common stock, shares outstanding (in shares) | 43,272,000 | 47,263,000 |
Treasury stock (in shares) | 6,760,000 | 2,586,000 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2022 | Jun. 30, 2021 | Jun. 30, 2022 | Jun. 30, 2021 | |
Statement of Comprehensive Income [Abstract] | ||||
Revenue | $ 1,426,607 | $ 857,445 | $ 2,979,145 | $ 1,743,390 |
Cost of revenue | 966,370 | 576,902 | 2,022,740 | 1,173,979 |
Gross profit | 460,237 | 280,543 | 956,405 | 569,411 |
Operating expenses: | ||||
Selling, general and administrative | 244,430 | 156,629 | 502,009 | 317,841 |
Depreciation and amortization (exclusive of depreciation included in cost of revenue) | 32,274 | 24,740 | 62,930 | 47,994 |
Total operating expenses | 276,704 | 181,369 | 564,939 | 365,835 |
Income from operations | 183,533 | 99,174 | 391,466 | 203,576 |
Interest expense, net, and other | 10,080 | 10,111 | 19,669 | 19,055 |
Income before income taxes | 173,453 | 89,063 | 371,797 | 184,521 |
Income tax expense | 49,653 | 22,293 | 101,989 | 47,373 |
Net income | 123,800 | 66,770 | 269,808 | 137,148 |
Other comprehensive income (loss): | ||||
Unrealized gains (losses) on available-for-sale securities, net, and other | 332 | 3 | (575) | (21) |
Other comprehensive income (loss) | 332 | 3 | (575) | (21) |
Comprehensive income | $ 124,132 | $ 66,773 | $ 269,233 | $ 137,127 |
Net income per common share: | ||||
Basic (in dollars per share) | $ 2.78 | $ 1.40 | $ 5.90 | $ 2.88 |
Diluted (in dollars per share) | $ 2.77 | $ 1.39 | $ 5.87 | $ 2.86 |
Weighted average common shares outstanding: | ||||
Basic (in shares) | 44,504 | 47,659 | 45,702 | 47,629 |
Diluted (in shares) | 44,740 | 48,019 | 45,972 | 47,976 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands | Total | Common Stock | Additional Paid-in Capital | Treasury Stock | Retained Earnings | Accumulated Other Comprehensive Income |
Beginning balance (in shares) at Dec. 31, 2020 | 49,614 | |||||
Beginning balance at Dec. 31, 2020 | $ 819,677 | $ 496 | $ 468,726 | $ (119,143) | $ 469,558 | $ 40 |
Beginning balance (in shares) at Dec. 31, 2020 | (2,561) | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Equity awards vested, net of shares withheld for payroll taxes (in shares) | 132 | |||||
Equity awards vested, 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 | |||||
Ending balance (in shares) at Mar. 31, 2021 | (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 | |||||
Beginning balance at Dec. 31, 2020 | 819,677 | $ 496 | 468,726 | $ (119,143) | 469,558 | 40 |
Beginning balance (in shares) at Dec. 31, 2020 | (2,561) | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Comprehensive income (loss) | 137,127 | |||||
Ending balance (in shares) at Jun. 30, 2021 | 49,824 | |||||
Ending balance (in shares) at Jun. 30, 2021 | (2,561) | |||||
Ending balance at Jun. 30, 2021 | 966,382 | $ 498 | 478,302 | $ (119,143) | 606,706 | 19 |
Beginning balance (in shares) at Mar. 31, 2021 | 49,746 | |||||
Beginning balance at Mar. 31, 2021 | 894,060 | $ 497 | 472,754 | $ (119,143) | 539,936 | 16 |
Beginning balance (in shares) at Mar. 31, 2021 | (2,561) | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Equity awards vested, net of shares withheld for payroll taxes (in shares) | 78 | |||||
Equity awards vested, 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 | |||||
Ending balance (in shares) at Jun. 30, 2021 | (2,561) | |||||
Ending balance at Jun. 30, 2021 | $ 966,382 | $ 498 | 478,302 | $ (119,143) | 606,706 | 19 |
Beginning balance (in shares) at Dec. 31, 2021 | 47,263 | 49,849 | ||||
Beginning balance at Dec. 31, 2021 | $ 1,162,027 | $ 498 | 486,709 | $ (121,831) | 796,946 | (295) |
Beginning balance (in shares) at Dec. 31, 2021 | (2,586) | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Repurchase of common stock into treasury (in shares) | (2,298) | |||||
Repurchase of common stock into treasury | (228,024) | $ (228,024) | ||||
Equity awards vested, net of shares withheld for payroll taxes (in shares) | 164 | |||||
Equity awards vested, net of shares withheld for payroll taxes | (9,431) | $ 2 | (9,433) | |||
Share-based compensation | 11,259 | 11,259 | ||||
Comprehensive income (loss) | 145,101 | 146,008 | (907) | |||
Ending balance (in shares) at Mar. 31, 2022 | 50,013 | |||||
Ending balance (in shares) at Mar. 31, 2022 | (4,884) | |||||
Ending balance at Mar. 31, 2022 | $ 1,080,932 | $ 500 | 488,535 | $ (349,855) | 942,954 | (1,202) |
Beginning balance (in shares) at Dec. 31, 2021 | 47,263 | 49,849 | ||||
Beginning balance at Dec. 31, 2021 | $ 1,162,027 | $ 498 | 486,709 | $ (121,831) | 796,946 | (295) |
Beginning balance (in shares) at Dec. 31, 2021 | (2,586) | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Comprehensive income (loss) | $ 269,233 | |||||
Ending balance (in shares) at Jun. 30, 2022 | 43,272 | 50,032 | ||||
Ending balance (in shares) at Jun. 30, 2022 | (6,760) | |||||
Ending balance at Jun. 30, 2022 | $ 1,039,344 | $ 500 | 496,682 | $ (523,722) | 1,066,754 | (870) |
Beginning balance (in shares) at Mar. 31, 2022 | 50,013 | |||||
Beginning balance at Mar. 31, 2022 | 1,080,932 | $ 500 | 488,535 | $ (349,855) | 942,954 | (1,202) |
Beginning balance (in shares) at Mar. 31, 2022 | (4,884) | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Repurchase of common stock into treasury (in shares) | (1,876) | |||||
Repurchase of common stock into treasury | (173,867) | $ (173,867) | ||||
Equity awards vested, net of shares withheld for payroll taxes (in shares) | 19 | |||||
Equity awards vested, net of shares withheld for payroll taxes | (366) | (366) | ||||
Share-based compensation | 8,513 | 8,513 | ||||
Comprehensive income (loss) | $ 124,132 | 123,800 | 332 | |||
Ending balance (in shares) at Jun. 30, 2022 | 43,272 | 50,032 | ||||
Ending balance (in shares) at Jun. 30, 2022 | (6,760) | |||||
Ending balance at Jun. 30, 2022 | $ 1,039,344 | $ 500 | $ 496,682 | $ (523,722) | $ 1,066,754 | $ (870) |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2022 | Jun. 30, 2021 | |
Cash flows from operating activities: | ||
Net income | $ 269,808 | $ 137,148 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||
Depreciation and amortization (inclusive of depreciation included in cost of revenue) | 64,757 | 49,081 |
Non-cash interest expense and other | 953 | (251) |
Write-off of fees on credit facilities and senior notes | 0 | 158 |
Change in fair value of contingent consideration | 580 | 0 |
Increase (decrease) in allowance for credit losses and sales credits | 13,803 | (526) |
Provision for deferred income taxes | 3,421 | (1,390) |
Share-based compensation | 19,772 | 15,306 |
Loss on disposal or sale of fixed assets | 479 | 383 |
Net loss (gain) on investments in available-for-sale securities | 536 | (35) |
Net loss (gain) on deferred compensation balances | (39) | 245 |
Non-cash lease expense | 3,542 | (794) |
Changes in assets and liabilities, net of effects from acquisitions: | ||
Accounts receivable | (3,535) | (91,911) |
Accounts receivable, subcontractor | (7,988) | (56,424) |
Income taxes receivable | (1,022) | 4,791 |
Prepaid expenses | 45,083 | (4,186) |
Other current assets | 15,338 | 3,308 |
Other assets | 1,002 | 962 |
Accounts payable and accrued expenses | 29,461 | 91,823 |
Accrued compensation and benefits | 73,349 | 65,101 |
Other liabilities | (104,729) | (5,765) |
Deferred revenue | 106 | 3,582 |
Restricted investments balance | 0 | 19 |
Net cash provided by operating activities | 424,677 | 210,625 |
Cash flows from investing activities: | ||
Purchase and development of fixed assets | (30,811) | (23,069) |
Purchase of investments | (10,659) | (17,995) |
Proceeds from sale and maturity of investments | 9,085 | 30,700 |
Purchase of equity investment | 0 | (500) |
Proceeds from sale of equity investment | 68 | 0 |
Payments to fund deferred compensation plan | (12,584) | (1,391) |
Cash paid for acquisitions, net of cash and restricted cash received | (69,801) | (41,264) |
Cash paid for other intangibles | (1,060) | (90) |
Net cash used in investing activities | (115,762) | (53,609) |
Cash flows from financing activities: | ||
Payments on term loans | 0 | (21,875) |
Payments on revolving credit facility | 0 | (70,000) |
Proceeds from revolving credit facility | 0 | 70,000 |
Repurchase of common stock | (401,891) | 0 |
Earn-out payments to settle contingent consideration liabilities for prior acquisitions | 0 | (3,100) |
Cash paid for shares withheld for taxes | (9,797) | (5,728) |
Net cash used in financing activities | (411,688) | (30,703) |
Effect of exchange rate changes on cash | 0 | (21) |
Net increase (decrease) in cash, cash equivalents and restricted cash | (102,773) | 126,292 |
Cash, cash equivalents and restricted cash at beginning of period | 246,714 | 83,990 |
Cash, cash equivalents and restricted cash at end of period | 143,941 | 210,282 |
Supplemental disclosures of cash flow information: | ||
Cash paid for amounts included in the measurement of operating lease liabilities | 7,922 | 9,740 |
Cash paid for interest (net of $254 and $195 capitalized for the six months ended June 30, 2022 and 2021, respectively) | 18,887 | 19,028 |
Cash paid for income taxes | 120,660 | 44,061 |
Acquisitions: | ||
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received | 2,731 | 1,910 |
Goodwill | 43,301 | 27,726 |
Intangible assets | 40,200 | 12,440 |
Liabilities assumed | (8,431) | (812) |
Contingent consideration liabilities | (8,000) | 0 |
Supplemental disclosures of non-cash investing and financing activities: | ||
Purchase of fixed assets recorded in accounts payable and accrued expenses | $ 7,562 | $ 3,665 |
Condensed Consolidated Statem_4
Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2022 | Jun. 30, 2021 | |
Statement of Cash Flows [Abstract] | ||
Interest capitalized | $ 254 | $ 195 |
Basis of Presentation
Basis of Presentation | 6 Months Ended |
Jun. 30, 2022 | |
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, 2021, contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2021, filed with the Securities and Exchange Commission on February 24, 2022 (the “2021 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. 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, corporate bonds and commercial paper that serve as collateral for the Company’s captive insurance subsidiary claim payments. See Note (6), “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. June 30, 2022 December 31, 2021 Cash and cash equivalents $ 79,357 $ 180,928 Restricted cash and cash equivalents (included in other current assets) 31,041 29,262 Restricted cash, cash equivalents and investments 61,744 64,482 Total cash, cash equivalents and restricted cash and investments 172,142 274,672 Less restricted investments (28,201) (27,958) Total cash, cash equivalents and restricted cash $ 143,941 $ 246,714 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: 2022 2021 Balance as of January 1, $ 6,838 $ 7,043 Provision for expected credit losses 1,280 (1,213) Amounts written off charged against the allowance (596) (317) Balance as of June 30, $ 7,522 $ 5,513 |
Acquisitions
Acquisitions | 6 Months Ended |
Jun. 30, 2022 | |
Business Combination and Asset Acquisition [Abstract] | |
Acquisitions | ACQUISITIONS As set forth below, the Company completed two acquisitions during the period of January 1, 2021 through June 30, 2022, 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 June 30, 2022. The allocations will continue to be updated through the measurement period, if necessary. The goodwill recognized for these acquisitions is attributable to expected growth as the Company leverages its brand and diversifies its services offered to clients, including potential revenue growth and margin expansion. For each acquisition, the Company did not incur any material acquisition-related costs. Connetics Acquisition On May 13, 2022, the Company completed its acquisition of Connetics Communications, LLC (“Connetics”), which specializes in the direct hire recruitment and permanent placement of international nurse and allied health professionals with healthcare facilities in the United States. The initial purchase price of $78,764 included (1) $70,764 cash consideration paid upon acquisition, funded through cash on hand, and (2) a contingent earn-out payment of up to $12,500 with an estimated fair value of $8,000 as of the acquisition date. The contingent earn-out payment is based on the operating results of Connetics for the twelve months ending May 31, 2023. The results of Connetics have been included in the Company’s nurse and allied solutions segment since the date of acquisition. The preliminary allocation of the $78,764 consisted of (1) $3,694 of fair value of tangible assets acquired, which included $963 cash received, (2) $8,431 of liabilities assumed, (3) $40,200 of identified intangible assets, and (4) $43,301 of goodwill, of which $35,317 is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately thirteen 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 $ 32,800 15 Staffing database 4,200 5 Tradenames and trademarks 3,200 5 $ 40,200 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 Company’s $400,000 senior secured revolving credit facility (the “Senior Credit Facility”). See additional information regarding the Senior Credit Facility in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report. 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 allocation of the $42,148 purchase price, which was reduced by the final working capital settlement and was finalized during the second quarter of 2022, consisted of (1) $2,757 of fair value of tangible assets acquired, which included $884 cash received, (2) $275 of liabilities assumed, (3) $12,440 of identified intangible assets, and (4) $27,226 of goodwill, of which $6,044 is deductible for tax purposes. 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. |
Revenue Recognition
Revenue Recognition | 6 Months Ended |
Jun. 30, 2022 | |
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 technology-enabled services, including language interpretation and vendor management systems, and talent planning and acquisition services, including 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 recruitment process outsourcing services is recognized as the services are rendered. Depending on the arrangement, the Company’s technology-enabled service 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. 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 | 6 Months Ended |
Jun. 30, 2022 | |
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 June 30, Six Months Ended June 30, 2022 2021 2022 2021 Net income $ 123,800 $ 66,770 $ 269,808 $ 137,148 Net income per common share - basic $ 2.78 $ 1.40 $ 5.90 $ 2.88 Net income per common share - diluted $ 2.77 $ 1.39 $ 5.87 $ 2.86 Weighted average common shares outstanding - basic 44,504 47,659 45,702 47,629 Plus dilutive effect of potential common shares 236 360 270 347 Weighted average common shares outstanding - diluted 44,740 48,019 45,972 47,976 Share-based awards to purchase 60 and 48 shares of common stock were not included in the above calculation of diluted net income per common share for the three and six months ended June 30, 2022, respectively, because the effect of these instruments was anti-dilutive. Share-based awards to purchase 4 and 24 shares of common stock were not included in the above calculation of diluted net income per common share for the three and six months ended June 30, 2021, respectively, because the effect of these instruments was anti-dilutive. |
Segment Information
Segment Information | 6 Months Ended |
Jun. 30, 2022 | |
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 (including international nurse staffing and rapid response nurse staffing), labor disruption staffing, local staffing, international nurse and allied permanent placement, allied 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, virtual care, credentialing solutions, and 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 June 30, Six Months Ended June 30, 2022 2021 2022 2021 Revenue Nurse and allied solutions $ 1,101,478 $ 624,485 $ 2,329,517 $ 1,281,146 Physician and leadership solutions 175,697 139,104 355,203 279,860 Technology and workforce solutions 149,432 93,856 294,425 182,384 $ 1,426,607 $ 857,445 $ 2,979,145 $ 1,743,390 Segment operating income Nurse and allied solutions $ 160,870 $ 89,674 $ 355,959 $ 191,204 Physician and leadership solutions 19,995 21,849 40,376 43,065 Technology and workforce solutions 82,501 42,653 161,381 84,742 263,366 154,176 557,716 319,011 Unallocated corporate overhead 38,073 23,627 81,721 51,048 Depreciation and amortization 32,274 24,740 62,930 47,994 Depreciation (included in cost of revenue) 973 616 1,827 1,087 Share-based compensation 8,513 6,019 19,772 15,306 Interest expense, net, and other 10,080 10,111 19,669 19,055 Income before income taxes $ 173,453 $ 89,063 $ 371,797 $ 184,521 The following tables present the Company’s revenue disaggregated by service type. Prior period amounts have been reclassified to conform with current period presentation. These reclassifications have no impact on total revenue by reportable segment. Three Months Ended June 30, 2022 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 775,668 $ — $ — $ 775,668 Labor disruption services 83,070 — — 83,070 Local staffing 33,394 — — 33,394 Allied staffing 207,309 — — 207,309 Locum tenens staffing — 105,936 — 105,936 Interim leadership staffing — 47,606 — 47,606 Temporary staffing 1,099,441 153,542 — 1,252,983 Permanent placement 2,037 22,155 — 24,192 Language services — — 53,291 53,291 Vendor management systems — — 75,144 75,144 Other technologies — — 6,839 6,839 Technology-enabled services — — 135,274 135,274 Talent planning and acquisition — — 14,158 14,158 Total revenue $ 1,101,478 $ 175,697 $ 149,432 $ 1,426,607 Three Months Ended June 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 457,551 $ — $ — $ 457,551 Labor disruption services 1,934 — — 1,934 Local staffing 29,975 — — 29,975 Allied staffing 135,025 — — 135,025 Locum tenens staffing — 77,841 — 77,841 Interim leadership staffing — 43,911 — 43,911 Temporary staffing 624,485 121,752 — 746,237 Permanent placement — 17,352 — 17,352 Language services — — 45,566 45,566 Vendor management systems — — 30,818 30,818 Other technologies — — 7,852 7,852 Technology-enabled services — — 84,236 84,236 Talent planning and acquisition — — 9,620 9,620 Total revenue $ 624,485 $ 139,104 $ 93,856 $ 857,445 Six Months Ended June 30, 2022 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 1,745,777 $ — $ — $ 1,745,777 Labor disruption services 83,070 — — 83,070 Local staffing 77,451 — — 77,451 Allied staffing 421,182 — — 421,182 Locum tenens staffing — 218,608 — 218,608 Interim leadership staffing — 91,960 — 91,960 Temporary staffing 2,327,480 310,568 — 2,638,048 Permanent placement 2,037 44,635 — 46,672 Language services — — 102,529 102,529 Vendor management systems — — 150,166 150,166 Other technologies — — 14,497 14,497 Technology-enabled services — — 267,192 267,192 Talent planning and acquisition — — 27,233 27,233 Total revenue $ 2,329,517 $ 355,203 $ 294,425 $ 2,979,145 Six Months Ended June 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 955,826 $ — $ — $ 955,826 Labor disruption services 2,553 — — 2,553 Local staffing 57,660 — — 57,660 Allied staffing 265,107 — — 265,107 Locum tenens staffing — 164,196 — 164,196 Interim leadership staffing — 82,770 — 82,770 Temporary staffing 1,281,146 246,966 — 1,528,112 Permanent placement — 32,894 — 32,894 Language services — — 86,571 86,571 Vendor management systems — — 62,619 62,619 Other technologies — — 13,972 13,972 Technology-enabled services — — 163,162 163,162 Talent planning and acquisition — — 19,222 19,222 Total revenue $ 1,281,146 $ 279,860 $ 182,384 $ 1,743,390 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, 2022 $ 339,015 $ 152,800 $ 400,526 $ 892,341 Goodwill adjustment for Synzi and SnapMD acquisition — — 33 33 Goodwill from Connetics acquisition 43,301 — — 43,301 Balance, June 30, 2022 $ 382,316 $ 152,800 $ 400,559 $ 935,675 Accumulated impairment loss as of December 31, 2021 and June 30, 2022 $ 154,444 $ 60,495 $ — $ 214,939 |
Fair Value Measurement
Fair Value Measurement | 6 Months Ended |
Jun. 30, 2022 | |
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 2021 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the six months ended June 30, 2022. Assets and Liabilities Measured on a Recurring Basis 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 include 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 $28,702 commercial paper issued and outstanding as of June 30, 2022, none had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $80,596 commercial paper issued and outstanding, of which none had original maturities greater than three months and were considered available-for-sale securities. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company also include corporate bonds that are measured using readily available pricing sources that utilize observable market data, including the current interest rate for comparable instruments, which are Level 2 inputs. As of June 30, 2022, the Company had $28,201 corporate bonds issued and outstanding, all of which had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $29,159 corporate bonds issued and outstanding, of which $27,958 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 June 30, 2022 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 609 $ 609 $ — $ — Deferred compensation (117,311) (117,311) — — Corporate bonds 28,201 — 28,201 — Commercial paper 28,702 — 28,702 — Acquisition contingent consideration liabilities (8,580) — — (8,580) Fair Value Measurements as of December 31, 2021 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 91,454 $ 91,454 $ — $ — Deferred compensation (119,617) (119,617) — — Corporate bonds 29,159 — 29,159 — Commercial paper 80,596 — 80,596 — 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: 2022 2021 Balance as of April 1, $ — $ — Contingent consideration liability from Connetics acquisition on May 13, 2022 (8,000) — Change in fair value of contingent consideration liability from Connetics acquisition (580) — Balance as of June 30, $ (8,580) $ — 2022 2021 Balance as of January 1, $ — $ (8,000) Settlement of b4health contingent consideration liability for year ended December 31, 2020 — 8,000 Contingent consideration liability from Connetics acquisition on May 13, 2022 (8,000) — Change in fair value of contingent consideration liability from Connetics acquisition (580) — Balance as of June 30, $ (8,580) $ — 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 as of both June 30, 2022 and December 31, 2021. 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 six months ended June 30, 2022 and 2021. 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 2021 Annual Report. As of June 30, 2022 As of December 31, 2021 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 456,250 $ 500,000 $ 517,500 2029 Notes 350,000 294,875 350,000 353,500 |
Income Taxes
Income Taxes | 6 Months Ended |
Jun. 30, 2022 | |
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 June 30, 2022, 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 2018. The Company believes its liability for unrecognized tax benefits and contingent tax issues is adequate with respect to all open years. 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 deferred payment of the employer’s share of payroll taxes of $48,452. Approximately half of such taxes was paid during 2021 and the other half is to be paid by the end of 2022, which is included in accrued compensation and benefits in the consolidated balance sheets as of both June 30, 2022 and December 31, 2021. The Company claimed an employee retention tax credit of $1,756. |
Commitments and Contingencies
Commitments and Contingencies | 6 Months Ended |
Jun. 30, 2022 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | COMMITMENTS AND CONTINGENCIES Legal Proceedings From 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, 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 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, which was denied on December 13, 2021. This case is proceeding in the United States District Court. 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 an agreement to settle this matter in its entirety and is awaiting court approval. Final approval of the settlement is expected in late 2022 or early 2023. Because of 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. The Company has recorded accruals in connection with the matters described above amounting to $37,225. The Company is currently unable to estimate the possible loss or range of loss beyond amounts already accrued. Loss contingencies accrued as of both June 30, 2022 and December 31, 2021 are included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets. Operating Leases In the first quarter of 2022, the Company entered into a lease agreement for an office building located in Dallas, Texas, with future undiscounted lease payments of approximately $29,514, excluding lease incentives. Because the Company does not control the underlying asset during the construction period, the Company is not considered the owner of the asset under construction for accounting purposes. The lease will commence upon completion of the construction of the office building which is expected be in the first quarter of 2023. The initial term of the lease is approximately eleven years with options to renew the lease during the lease term. A right-of-use asset and lease liability will be recognized in the consolidated balance sheet in the period the lease commences. |
Balance Sheet Details
Balance Sheet Details | 6 Months Ended |
Jun. 30, 2022 | |
Balance Sheet Related Disclosures [Abstract] | |
Balance Sheet Details | BALANCE SHEET DETAILS The consolidated balance sheets detail is as follows: June 30, 2022 December 31, 2021 Other current assets: Restricted cash and cash equivalents $ 31,041 $ 29,262 Income taxes receivable 1,022 — Other 22,261 37,568 Other current assets $ 54,324 $ 66,830 Prepaid expenses: Prepaid payroll deposits $ 10,733 $ 60,014 Other 16,697 12,446 Prepaid expenses 27,430 72,460 Fixed assets: Furniture and equipment $ 44,352 $ 43,134 Software 293,631 265,137 Leasehold improvements 2,891 8,797 340,874 317,068 Accumulated depreciation (204,384) (189,954) Fixed assets, net $ 136,490 $ 127,114 Other assets: Life insurance cash surrender value $ 107,641 $ 115,095 Other 40,929 41,575 Other assets $ 148,570 $ 156,670 Accounts payable and accrued expenses: Trade accounts payable $ 85,863 $ 77,325 Subcontractor payable 263,582 261,689 Accrued expenses 80,216 61,220 Loss contingencies 10,774 10,400 Professional liability reserve 6,723 7,127 Other 11,827 7,496 Accounts payable and accrued expenses $ 458,985 $ 425,257 Accrued compensation and benefits: Accrued payroll $ 137,063 $ 98,817 Accrued bonuses and commissions 120,272 105,155 Accrued travel expense 2,964 3,058 Health insurance reserve 6,739 6,041 Workers compensation reserve 12,051 12,384 Deferred compensation 117,311 119,617 Other 19,975 9,309 Accrued compensation and benefits $ 416,375 $ 354,381 Other current liabilities: Income taxes payable — 21,162 Client deposits 56,159 141,102 Other 2,489 155 Other current liabilities $ 58,648 $ 162,419 June 30, 2022 December 31, 2021 Other long-term liabilities: Workers compensation reserve $ 24,471 $ 24,130 Professional liability reserve 34,068 34,544 Unrecognized tax benefits 4,731 4,633 Acquisition related liabilities 8,580 — Other 33,797 33,682 Other long-term liabilities $ 105,647 $ 96,989 |
Basis of Presentation (Policies
Basis of Presentation (Policies) | 6 Months Ended |
Jun. 30, 2022 | |
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. |
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, corporate bonds and commercial paper that serve as collateral for the Company’s captive insurance subsidiary claim payments. See Note (6), “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 technology-enabled services, including language interpretation and vendor management systems, and talent planning and acquisition services, including 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 recruitment process outsourcing services is recognized as the services are rendered. Depending on the arrangement, the Company’s technology-enabled service 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. 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 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 include 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 $28,702 commercial paper issued and outstanding as of June 30, 2022, none had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $80,596 commercial paper issued and outstanding, of which none had original maturities greater than three months and were considered available-for-sale securities. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company also include corporate bonds that are measured using readily available pricing sources that utilize observable market data, including the current interest rate for comparable instruments, which are Level 2 inputs. As of June 30, 2022, the Company had $28,201 corporate bonds issued and outstanding, all of which had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $29,159 corporate bonds issued and outstanding, of which $27,958 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 2021 Annual Report. As of June 30, 2022 As of December 31, 2021 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 456,250 $ 500,000 $ 517,500 2029 Notes 350,000 294,875 350,000 353,500 |
Basis of Presentation (Tables)
Basis of Presentation (Tables) | 6 Months Ended |
Jun. 30, 2022 | |
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. June 30, 2022 December 31, 2021 Cash and cash equivalents $ 79,357 $ 180,928 Restricted cash and cash equivalents (included in other current assets) 31,041 29,262 Restricted cash, cash equivalents and investments 61,744 64,482 Total cash, cash equivalents and restricted cash and investments 172,142 274,672 Less restricted investments (28,201) (27,958) Total cash, cash equivalents and restricted cash $ 143,941 $ 246,714 |
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: 2022 2021 Balance as of January 1, $ 6,838 $ 7,043 Provision for expected credit losses 1,280 (1,213) Amounts written off charged against the allowance (596) (317) Balance as of June 30, $ 7,522 $ 5,513 |
Acquisitions (Tables)
Acquisitions (Tables) | 6 Months Ended |
Jun. 30, 2022 | |
Business Combination and Asset Acquisition [Abstract] | |
Finite-Lived and Indefinite-Lived Intangible Assets Acquired as Part of Business Combination | 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 $ 32,800 15 Staffing database 4,200 5 Tradenames and trademarks 3,200 5 $ 40,200 |
Net Income Per Common Share (Ta
Net Income Per Common Share (Tables) | 6 Months Ended |
Jun. 30, 2022 | |
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 June 30, Six Months Ended June 30, 2022 2021 2022 2021 Net income $ 123,800 $ 66,770 $ 269,808 $ 137,148 Net income per common share - basic $ 2.78 $ 1.40 $ 5.90 $ 2.88 Net income per common share - diluted $ 2.77 $ 1.39 $ 5.87 $ 2.86 Weighted average common shares outstanding - basic 44,504 47,659 45,702 47,629 Plus dilutive effect of potential common shares 236 360 270 347 Weighted average common shares outstanding - diluted 44,740 48,019 45,972 47,976 |
Segment Information (Tables)
Segment Information (Tables) | 6 Months Ended |
Jun. 30, 2022 | |
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 June 30, Six Months Ended June 30, 2022 2021 2022 2021 Revenue Nurse and allied solutions $ 1,101,478 $ 624,485 $ 2,329,517 $ 1,281,146 Physician and leadership solutions 175,697 139,104 355,203 279,860 Technology and workforce solutions 149,432 93,856 294,425 182,384 $ 1,426,607 $ 857,445 $ 2,979,145 $ 1,743,390 Segment operating income Nurse and allied solutions $ 160,870 $ 89,674 $ 355,959 $ 191,204 Physician and leadership solutions 19,995 21,849 40,376 43,065 Technology and workforce solutions 82,501 42,653 161,381 84,742 263,366 154,176 557,716 319,011 Unallocated corporate overhead 38,073 23,627 81,721 51,048 Depreciation and amortization 32,274 24,740 62,930 47,994 Depreciation (included in cost of revenue) 973 616 1,827 1,087 Share-based compensation 8,513 6,019 19,772 15,306 Interest expense, net, and other 10,080 10,111 19,669 19,055 Income before income taxes $ 173,453 $ 89,063 $ 371,797 $ 184,521 |
Disaggregation of Revenue | The following tables present the Company’s revenue disaggregated by service type. Prior period amounts have been reclassified to conform with current period presentation. These reclassifications have no impact on total revenue by reportable segment. Three Months Ended June 30, 2022 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 775,668 $ — $ — $ 775,668 Labor disruption services 83,070 — — 83,070 Local staffing 33,394 — — 33,394 Allied staffing 207,309 — — 207,309 Locum tenens staffing — 105,936 — 105,936 Interim leadership staffing — 47,606 — 47,606 Temporary staffing 1,099,441 153,542 — 1,252,983 Permanent placement 2,037 22,155 — 24,192 Language services — — 53,291 53,291 Vendor management systems — — 75,144 75,144 Other technologies — — 6,839 6,839 Technology-enabled services — — 135,274 135,274 Talent planning and acquisition — — 14,158 14,158 Total revenue $ 1,101,478 $ 175,697 $ 149,432 $ 1,426,607 Three Months Ended June 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 457,551 $ — $ — $ 457,551 Labor disruption services 1,934 — — 1,934 Local staffing 29,975 — — 29,975 Allied staffing 135,025 — — 135,025 Locum tenens staffing — 77,841 — 77,841 Interim leadership staffing — 43,911 — 43,911 Temporary staffing 624,485 121,752 — 746,237 Permanent placement — 17,352 — 17,352 Language services — — 45,566 45,566 Vendor management systems — — 30,818 30,818 Other technologies — — 7,852 7,852 Technology-enabled services — — 84,236 84,236 Talent planning and acquisition — — 9,620 9,620 Total revenue $ 624,485 $ 139,104 $ 93,856 $ 857,445 Six Months Ended June 30, 2022 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 1,745,777 $ — $ — $ 1,745,777 Labor disruption services 83,070 — — 83,070 Local staffing 77,451 — — 77,451 Allied staffing 421,182 — — 421,182 Locum tenens staffing — 218,608 — 218,608 Interim leadership staffing — 91,960 — 91,960 Temporary staffing 2,327,480 310,568 — 2,638,048 Permanent placement 2,037 44,635 — 46,672 Language services — — 102,529 102,529 Vendor management systems — — 150,166 150,166 Other technologies — — 14,497 14,497 Technology-enabled services — — 267,192 267,192 Talent planning and acquisition — — 27,233 27,233 Total revenue $ 2,329,517 $ 355,203 $ 294,425 $ 2,979,145 Six Months Ended June 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 955,826 $ — $ — $ 955,826 Labor disruption services 2,553 — — 2,553 Local staffing 57,660 — — 57,660 Allied staffing 265,107 — — 265,107 Locum tenens staffing — 164,196 — 164,196 Interim leadership staffing — 82,770 — 82,770 Temporary staffing 1,281,146 246,966 — 1,528,112 Permanent placement — 32,894 — 32,894 Language services — — 86,571 86,571 Vendor management systems — — 62,619 62,619 Other technologies — — 13,972 13,972 Technology-enabled services — — 163,162 163,162 Talent planning and acquisition — — 19,222 19,222 Total revenue $ 1,281,146 $ 279,860 $ 182,384 $ 1,743,390 |
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, 2022 $ 339,015 $ 152,800 $ 400,526 $ 892,341 Goodwill adjustment for Synzi and SnapMD acquisition — — 33 33 Goodwill from Connetics acquisition 43,301 — — 43,301 Balance, June 30, 2022 $ 382,316 $ 152,800 $ 400,559 $ 935,675 Accumulated impairment loss as of December 31, 2021 and June 30, 2022 $ 154,444 $ 60,495 $ — $ 214,939 |
Fair Value Measurement (Tables)
Fair Value Measurement (Tables) | 6 Months Ended |
Jun. 30, 2022 | |
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 June 30, 2022 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 609 $ 609 $ — $ — Deferred compensation (117,311) (117,311) — — Corporate bonds 28,201 — 28,201 — Commercial paper 28,702 — 28,702 — Acquisition contingent consideration liabilities (8,580) — — (8,580) Fair Value Measurements as of December 31, 2021 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 91,454 $ 91,454 $ — $ — Deferred compensation (119,617) (119,617) — — Corporate bonds 29,159 — 29,159 — Commercial paper 80,596 — 80,596 — |
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: 2022 2021 Balance as of April 1, $ — $ — Contingent consideration liability from Connetics acquisition on May 13, 2022 (8,000) — Change in fair value of contingent consideration liability from Connetics acquisition (580) — Balance as of June 30, $ (8,580) $ — 2022 2021 Balance as of January 1, $ — $ (8,000) Settlement of b4health contingent consideration liability for year ended December 31, 2020 — 8,000 Contingent consideration liability from Connetics acquisition on May 13, 2022 (8,000) — Change in fair value of contingent consideration liability from Connetics acquisition (580) — Balance as of June 30, $ (8,580) $ — |
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 2021 Annual Report. As of June 30, 2022 As of December 31, 2021 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 456,250 $ 500,000 $ 517,500 2029 Notes 350,000 294,875 350,000 353,500 |
Balance Sheet Details (Tables)
Balance Sheet Details (Tables) | 6 Months Ended |
Jun. 30, 2022 | |
Balance Sheet Related Disclosures [Abstract] | |
Schedule of Supplemental Balance Sheet Disclosures | The consolidated balance sheets detail is as follows: June 30, 2022 December 31, 2021 Other current assets: Restricted cash and cash equivalents $ 31,041 $ 29,262 Income taxes receivable 1,022 — Other 22,261 37,568 Other current assets $ 54,324 $ 66,830 Prepaid expenses: Prepaid payroll deposits $ 10,733 $ 60,014 Other 16,697 12,446 Prepaid expenses 27,430 72,460 Fixed assets: Furniture and equipment $ 44,352 $ 43,134 Software 293,631 265,137 Leasehold improvements 2,891 8,797 340,874 317,068 Accumulated depreciation (204,384) (189,954) Fixed assets, net $ 136,490 $ 127,114 Other assets: Life insurance cash surrender value $ 107,641 $ 115,095 Other 40,929 41,575 Other assets $ 148,570 $ 156,670 Accounts payable and accrued expenses: Trade accounts payable $ 85,863 $ 77,325 Subcontractor payable 263,582 261,689 Accrued expenses 80,216 61,220 Loss contingencies 10,774 10,400 Professional liability reserve 6,723 7,127 Other 11,827 7,496 Accounts payable and accrued expenses $ 458,985 $ 425,257 Accrued compensation and benefits: Accrued payroll $ 137,063 $ 98,817 Accrued bonuses and commissions 120,272 105,155 Accrued travel expense 2,964 3,058 Health insurance reserve 6,739 6,041 Workers compensation reserve 12,051 12,384 Deferred compensation 117,311 119,617 Other 19,975 9,309 Accrued compensation and benefits $ 416,375 $ 354,381 Other current liabilities: Income taxes payable — 21,162 Client deposits 56,159 141,102 Other 2,489 155 Other current liabilities $ 58,648 $ 162,419 June 30, 2022 December 31, 2021 Other long-term liabilities: Workers compensation reserve $ 24,471 $ 24,130 Professional liability reserve 34,068 34,544 Unrecognized tax benefits 4,731 4,633 Acquisition related liabilities 8,580 — Other 33,797 33,682 Other long-term liabilities $ 105,647 $ 96,989 |
Basis of Presentation - Reconci
Basis of Presentation - Reconciliation of Cash, Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands | Jun. 30, 2022 | Dec. 31, 2021 | Jun. 30, 2021 | Dec. 31, 2020 |
Accounting Policies [Abstract] | ||||
Cash and cash equivalents | $ 79,357 | $ 180,928 | ||
Restricted cash and cash equivalents (included in other current assets) | 31,041 | 29,262 | ||
Restricted cash, cash equivalents and investments | 61,744 | 64,482 | ||
Total cash, cash equivalents and restricted cash and investments | 172,142 | 274,672 | ||
Less restricted investments | (28,201) | (27,958) | ||
Total cash, cash equivalents and restricted cash | $ 143,941 | $ 246,714 | $ 210,282 | $ 83,990 |
Basis of Presentation - Recon_2
Basis of Presentation - Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable (Details) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2022 | Jun. 30, 2021 | |
Accounts Receivable, Allowance for Credit Loss [Roll Forward] | ||
Beginning balance | $ 6,838 | $ 7,043 |
Provision for expected credit losses | 1,280 | (1,213) |
Amounts written off charged against the allowance | (596) | (317) |
Ending balance | $ 7,522 | $ 5,513 |
Acquisitions - Narrative (Detai
Acquisitions - Narrative (Details) | 18 Months Ended |
Jun. 30, 2022 acquisition | |
Business Combination and Asset Acquisition [Abstract] | |
Number of acquisitions | 2 |
Acquisitions - Connetics Acquis
Acquisitions - Connetics Acquisition (Details) - USD ($) $ in Thousands | May 13, 2022 | Jun. 30, 2022 | Dec. 31, 2021 |
Business Acquisition [Line Items] | |||
Contingent earn-out based on future operating performance (up to) | $ 8,580 | $ 0 | |
Goodwill | $ 935,675 | $ 892,341 | |
Connetics Communications, LLC | |||
Business Acquisition [Line Items] | |||
Initial purchase price | $ 78,764 | ||
Cash consideration | 70,764 | ||
Contingent earn-out based on future operating performance (up to) | 12,500 | ||
Fair value of contingent earn-out | 8,000 | ||
Fair value of tangible assets acquired | 3,694 | ||
Cash received | 963 | ||
Liabilities assumed | 8,431 | ||
Identifiable intangible assets | 40,200 | ||
Goodwill | 43,301 | ||
Goodwill expected to be deductible for tax purposes | $ 35,317 | ||
Intangible assets acquired, weighted average useful life | 13 years | ||
Connetics Communications, LLC | Customer relationships | |||
Business Acquisition [Line Items] | |||
Identifiable intangible assets | $ 32,800 | ||
Useful Life | 15 years | ||
Connetics Communications, LLC | Staffing database | |||
Business Acquisition [Line Items] | |||
Identifiable intangible assets | $ 4,200 | ||
Useful Life | 5 years | ||
Connetics Communications, LLC | Tradenames and trademarks | |||
Business Acquisition [Line Items] | |||
Identifiable intangible assets | $ 3,200 | ||
Useful Life | 5 years |
Acquisitions - Synzi and SnapMD
Acquisitions - Synzi and SnapMD Acquisition (Details) - USD ($) | 3 Months Ended | |||||
May 13, 2022 | Apr. 07, 2021 | Jun. 30, 2022 | Jun. 30, 2021 | Dec. 31, 2021 | Feb. 09, 2018 | |
Business Acquisition [Line Items] | ||||||
Goodwill | $ 935,675,000 | $ 892,341,000 | ||||
Contingent earn-out based on future operating performance (up to) | 8,580,000 | $ 0 | ||||
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 | 2,757,000 | |||||
Cash received | 884,000 | |||||
Liabilities assumed | 275,000 | |||||
Identifiable intangible assets | 12,440,000 | |||||
Goodwill | 27,226,000 | |||||
Goodwill expected to be deductible for tax purposes | $ 6,044,000 | |||||
Intangible assets acquired, weighted average useful life | 7 years | |||||
Synzi | Developed Technology Rights | ||||||
Business Acquisition [Line Items] | ||||||
Identifiable intangible assets | $ 10,890,000 | |||||
Synzi | Trademarks | ||||||
Business Acquisition [Line Items] | ||||||
Identifiable intangible assets | $ 1,220,000 | |||||
Connetics Communications, LLC | ||||||
Business Acquisition [Line Items] | ||||||
Cash consideration | $ 70,764,000 | |||||
Cash received | 963,000 | |||||
Liabilities assumed | 8,431,000 | |||||
Identifiable intangible assets | 40,200,000 | |||||
Goodwill | 43,301,000 | |||||
Contingent earn-out based on future operating performance (up to) | 12,500,000 | |||||
Goodwill expected to be deductible for tax purposes | $ 35,317,000 | |||||
Intangible assets acquired, weighted average useful life | 13 years | |||||
Revolving Credit Facility | Line of Credit | ||||||
Business Acquisition [Line Items] | ||||||
Maximum borrowing capacity | $ 400,000,000 |
Net Income Per Common Share (De
Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2022 | Jun. 30, 2021 | Jun. 30, 2022 | Jun. 30, 2021 | |
Earnings Per Share [Abstract] | ||||
Net income | $ 123,800 | $ 66,770 | $ 269,808 | $ 137,148 |
Net income per common share - basic (in dollars per share) | $ 2.78 | $ 1.40 | $ 5.90 | $ 2.88 |
Net income per common share - diluted (in dollars per share) | $ 2.77 | $ 1.39 | $ 5.87 | $ 2.86 |
Weighted average common shares outstanding - basic (in shares) | 44,504 | 47,659 | 45,702 | 47,629 |
Plus dilutive effect of potential common shares (in shares) | 236 | 360 | 270 | 347 |
Weighted average common shares outstanding - diluted (in shares) | 44,740 | 48,019 | 45,972 | 47,976 |
Common stock excluded from calculation of EPS (in shares) | 60 | 4 | 48 | 24 |
Segment Information - Narrative
Segment Information - Narrative (Details) | 6 Months Ended |
Jun. 30, 2022 segment | |
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 | 6 Months Ended | ||
Jun. 30, 2022 | Jun. 30, 2021 | Jun. 30, 2022 | Jun. 30, 2021 | |
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 1,426,607 | $ 857,445 | $ 2,979,145 | $ 1,743,390 |
Segment operating income | 183,533 | 99,174 | 391,466 | 203,576 |
Depreciation and amortization | 32,274 | 24,740 | 62,930 | 47,994 |
Depreciation (included in cost of revenue) | 973 | 616 | 1,827 | 1,087 |
Share-based compensation | 8,513 | 6,019 | 19,772 | 15,306 |
Interest expense, net, and other | 10,080 | 10,111 | 19,669 | 19,055 |
Income before income taxes | 173,453 | 89,063 | 371,797 | 184,521 |
Nurse and allied solutions | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 1,101,478 | 624,485 | 2,329,517 | 1,281,146 |
Physician and leadership solutions | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 175,697 | 139,104 | 355,203 | 279,860 |
Technology and workforce solutions | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 149,432 | 93,856 | 294,425 | 182,384 |
Operating segments | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 1,426,607 | 857,445 | 2,979,145 | 1,743,390 |
Segment operating income | 263,366 | 154,176 | 557,716 | 319,011 |
Operating segments | Nurse and allied solutions | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 1,101,478 | 624,485 | 2,329,517 | 1,281,146 |
Segment operating income | 160,870 | 89,674 | 355,959 | 191,204 |
Operating segments | Physician and leadership solutions | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 175,697 | 139,104 | 355,203 | 279,860 |
Segment operating income | 19,995 | 21,849 | 40,376 | 43,065 |
Operating segments | Technology and workforce solutions | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 149,432 | 93,856 | 294,425 | 182,384 |
Segment operating income | 82,501 | 42,653 | 161,381 | 84,742 |
Unallocated corporate overhead | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Unallocated corporate overhead | $ 38,073 | $ 23,627 | $ 81,721 | $ 51,048 |
Segment Information - Disaggreg
Segment Information - Disaggregation of Revenue (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2022 | Jun. 30, 2021 | Jun. 30, 2022 | Jun. 30, 2021 | |
Segment Reporting Information [Line Items] | ||||
Revenue | $ 1,426,607 | $ 857,445 | $ 2,979,145 | $ 1,743,390 |
Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 1,101,478 | 624,485 | 2,329,517 | 1,281,146 |
Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 175,697 | 139,104 | 355,203 | 279,860 |
Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 149,432 | 93,856 | 294,425 | 182,384 |
Travel nurse staffing | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 775,668 | 457,551 | 1,745,777 | 955,826 |
Travel nurse staffing | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 775,668 | 457,551 | 1,745,777 | 955,826 |
Travel nurse staffing | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Travel nurse staffing | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Labor disruption services | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 83,070 | 1,934 | 83,070 | 2,553 |
Labor disruption services | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 83,070 | 1,934 | 83,070 | 2,553 |
Labor disruption services | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Labor disruption services | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Local staffing | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 33,394 | 29,975 | 77,451 | 57,660 |
Local staffing | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 33,394 | 29,975 | 77,451 | 57,660 |
Local staffing | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Local staffing | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Allied staffing | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 207,309 | 135,025 | 421,182 | 265,107 |
Allied staffing | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 207,309 | 135,025 | 421,182 | 265,107 |
Allied staffing | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Allied staffing | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Locum tenens staffing | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 105,936 | 77,841 | 218,608 | 164,196 |
Locum tenens staffing | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Locum tenens staffing | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 105,936 | 77,841 | 218,608 | 164,196 |
Locum tenens staffing | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Interim leadership staffing | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 47,606 | 43,911 | 91,960 | 82,770 |
Interim leadership staffing | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Interim leadership staffing | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 47,606 | 43,911 | 91,960 | 82,770 |
Interim leadership staffing | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Temporary staffing | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 1,252,983 | 746,237 | 2,638,048 | 1,528,112 |
Temporary staffing | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 1,099,441 | 624,485 | 2,327,480 | 1,281,146 |
Temporary staffing | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 153,542 | 121,752 | 310,568 | 246,966 |
Temporary staffing | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Permanent placement | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 24,192 | 17,352 | 46,672 | 32,894 |
Permanent placement | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 2,037 | 0 | 2,037 | 0 |
Permanent placement | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 22,155 | 17,352 | 44,635 | 32,894 |
Permanent placement | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Language services | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 53,291 | 45,566 | 102,529 | 86,571 |
Language services | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Language services | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Language services | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 53,291 | 45,566 | 102,529 | 86,571 |
Vendor management systems | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 75,144 | 30,818 | 150,166 | 62,619 |
Vendor management systems | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Vendor management systems | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Vendor management systems | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 75,144 | 30,818 | 150,166 | 62,619 |
Other technologies | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 6,839 | 7,852 | 14,497 | 13,972 |
Other technologies | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Other technologies | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Other technologies | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 6,839 | 7,852 | 14,497 | 13,972 |
Technology-enabled services | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 135,274 | 84,236 | 267,192 | 163,162 |
Technology-enabled services | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Technology-enabled services | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Technology-enabled services | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 135,274 | 84,236 | 267,192 | 163,162 |
Talent planning and acquisition | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 14,158 | 9,620 | 27,233 | 19,222 |
Talent planning and acquisition | Nurse and Allied Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Talent planning and acquisition | Physician and Leadership Solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | 0 | 0 | 0 | 0 |
Talent planning and acquisition | Technology and workforce solutions | ||||
Segment Reporting Information [Line Items] | ||||
Revenue | $ 14,158 | $ 9,620 | $ 27,233 | $ 19,222 |
Segment Information - Summary o
Segment Information - Summary of Goodwill by Reportable Segment (Details) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2022 | Dec. 31, 2021 | |
Goodwill [Roll Forward] | ||
Goodwill, beginning balance | $ 892,341 | |
Goodwill, ending balance | 935,675 | |
Accumulated impairment loss | 214,939 | $ 214,939 |
Synzi and SnapMD | ||
Goodwill [Roll Forward] | ||
Goodwill | 33 | |
Connetics Communications, LLC | ||
Goodwill [Roll Forward] | ||
Goodwill | 43,301 | |
Nurse and Allied Solutions | ||
Goodwill [Roll Forward] | ||
Goodwill, beginning balance | 339,015 | |
Goodwill, ending balance | 382,316 | |
Accumulated impairment loss | 154,444 | 154,444 |
Nurse and Allied Solutions | Synzi and SnapMD | ||
Goodwill [Roll Forward] | ||
Goodwill | 0 | |
Nurse and Allied Solutions | Connetics Communications, LLC | ||
Goodwill [Roll Forward] | ||
Goodwill | 43,301 | |
Physician and Leadership Solutions | ||
Goodwill [Roll Forward] | ||
Goodwill, beginning balance | 152,800 | |
Goodwill, ending balance | 152,800 | |
Accumulated impairment loss | 60,495 | 60,495 |
Physician and Leadership Solutions | Synzi and SnapMD | ||
Goodwill [Roll Forward] | ||
Goodwill | 0 | |
Physician and Leadership Solutions | Connetics Communications, LLC | ||
Goodwill [Roll Forward] | ||
Goodwill | 0 | |
Technology and workforce solutions | ||
Goodwill [Roll Forward] | ||
Goodwill, beginning balance | 400,526 | |
Goodwill, ending balance | 400,559 | |
Accumulated impairment loss | 0 | $ 0 |
Technology and workforce solutions | Synzi and SnapMD | ||
Goodwill [Roll Forward] | ||
Goodwill | 33 | |
Technology and workforce solutions | Connetics Communications, LLC | ||
Goodwill [Roll Forward] | ||
Goodwill | $ 0 |
Fair Value Measurement - Narrat
Fair Value Measurement - Narrative (Details) - USD ($) | 6 Months Ended | ||||
Jun. 30, 2022 | Jun. 30, 2021 | Dec. 31, 2021 | Oct. 20, 2020 | Aug. 13, 2020 | |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | |||||
Asset 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% | ||||
Fair Value, Measurements, Nonrecurring | Significant Other Observable Inputs (Level 2) | |||||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | |||||
Equity investment balance | 22,633,000 | $ 22,633,000 | |||
Commercial paper | Fair Value, Measurements, Recurring | |||||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | |||||
Assets (liabilities) measured at fair value on a recurring basis | 28,702,000 | 80,596,000 | |||
Commercial paper | Fair Value, Measurements, Recurring | 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 on a recurring basis | 28,702,000 | 80,596,000 | |||
Securities classified as available-for-sale | 0 | 0 | |||
Corporate bonds | Fair Value, Measurements, Recurring | 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 on a recurring basis | 28,201,000 | 29,159,000 | |||
Securities classified as available-for-sale | $ 28,201,000 | $ 27,958,000 |
Fair Value Measurement - Financ
Fair Value Measurement - Financial Assets and Liabilities (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands | Jun. 30, 2022 | Dec. 31, 2021 |
Deferred compensation | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Assets (liabilities) measured at fair value on a recurring basis | $ (117,311) | $ (119,617) |
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 on a recurring basis | (117,311) | (119,617) |
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 on a recurring basis | 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 on a recurring basis | 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 on a recurring basis | (8,580) | |
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 on a recurring basis | 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 on a recurring basis | 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 on a recurring basis | (8,580) | |
Money market funds | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Assets (liabilities) measured at fair value on a recurring basis | 609 | 91,454 |
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 on a recurring basis | 609 | 91,454 |
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 on a recurring basis | 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 on a recurring basis | 0 | 0 |
Corporate bonds | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Assets (liabilities) measured at fair value on a recurring basis | 28,201 | 29,159 |
Corporate bonds | 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 on a recurring basis | 0 | 0 |
Corporate bonds | 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 on a recurring basis | 28,201 | 29,159 |
Corporate bonds | Significant Unobservable Inputs (Level 3) | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Assets (liabilities) measured at fair value on a recurring basis | 0 | 0 |
Commercial paper | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Assets (liabilities) measured at fair value on a recurring basis | 28,702 | 80,596 |
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 on a recurring basis | 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 on a recurring basis | 28,702 | 80,596 |
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 on a recurring basis | $ 0 | $ 0 |
Fair Value Measurement - Reconc
Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Acquisition contingent consideration liabilities - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2022 | Jun. 30, 2021 | Jun. 30, 2022 | Jun. 30, 2021 | |
Fair Value, Measurements, Recurring | ||||
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward] | ||||
Beginning balance | $ 0 | $ 0 | $ 0 | $ (8,000) |
Ending balance | (8,580) | 0 | (8,580) | 0 |
b4health | Fair Value, Measurements, Recurring | ||||
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward] | ||||
Settlement of b4health contingent consideration liability for year ended December 31, 2020 | 0 | 8,000 | ||
Connetics Communications, LLC | ||||
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward] | ||||
Contingent consideration liability from Connetics acquisition on May 13, 2022 | (8,000) | 0 | (8,000) | 0 |
Change in fair value of contingent consideration liability from Connetics acquisition | $ (580) | $ 0 | $ (580) | $ 0 |
Fair Value Measurement - Fair V
Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($) $ in Thousands | Jun. 30, 2022 | Dec. 31, 2021 |
2027 Notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Carrying Amount | $ 500,000 | $ 500,000 |
Estimated Fair Value | 456,250 | 517,500 |
2029 Notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Carrying Amount | 350,000 | 350,000 |
Estimated Fair Value | $ 294,875 | $ 353,500 |
Income Taxes (Details)
Income Taxes (Details) $ in Thousands | Jun. 30, 2022 USD ($) |
Income Tax Disclosure [Abstract] | |
Deferred payroll taxes, CARES Act | $ 48,452 |
Employee retention tax credit, CARES Act | $ 1,756 |
Commitments and Contingencies (
Commitments and Contingencies (Details) - USD ($) $ in Thousands | Jun. 30, 2022 | Mar. 31, 2022 |
Commitments and Contingencies [Line Items] | ||
Future undiscounted lease payments | $ 29,514 | |
Lease term | 11 years | |
Wage and Hour claims | Pending Litigation | ||
Commitments and Contingencies [Line Items] | ||
Litigation matters accrual | $ 37,225 |
Balance Sheet Details (Details)
Balance Sheet Details (Details) - USD ($) $ in Thousands | Jun. 30, 2022 | Dec. 31, 2021 |
Other current assets: | ||
Restricted cash and cash equivalents | $ 31,041 | $ 29,262 |
Income taxes receivable | 1,022 | 0 |
Other | 22,261 | 37,568 |
Other current assets | 54,324 | 66,830 |
Prepaid expenses: | ||
Prepaid payroll deposits | 10,733 | 60,014 |
Other | 16,697 | 12,446 |
Prepaid expenses | 27,430 | 72,460 |
Fixed assets: | ||
Furniture and equipment | 44,352 | 43,134 |
Software | 293,631 | 265,137 |
Leasehold improvements | 2,891 | 8,797 |
Fixed assets, gross | 340,874 | 317,068 |
Accumulated depreciation | (204,384) | (189,954) |
Fixed assets, net | 136,490 | 127,114 |
Other assets: | ||
Life insurance cash surrender value | 107,641 | 115,095 |
Other | 40,929 | 41,575 |
Other assets | 148,570 | 156,670 |
Accounts payable and accrued expenses: | ||
Trade accounts payable | 85,863 | 77,325 |
Subcontractor payable | 263,582 | 261,689 |
Accrued expenses | 80,216 | 61,220 |
Loss contingencies | 10,774 | 10,400 |
Professional liability reserve | 6,723 | 7,127 |
Other | 11,827 | 7,496 |
Accounts payable and accrued expenses | 458,985 | 425,257 |
Accrued compensation and benefits: | ||
Accrued payroll | 137,063 | 98,817 |
Accrued bonuses and commissions | 120,272 | 105,155 |
Accrued travel expense | 2,964 | 3,058 |
Health insurance reserve | 6,739 | 6,041 |
Workers compensation reserve | 12,051 | 12,384 |
Deferred compensation | 117,311 | 119,617 |
Other | 19,975 | 9,309 |
Accrued compensation and benefits | 416,375 | 354,381 |
Other current liabilities: | ||
Income taxes payable | 0 | 21,162 |
Client deposits | 56,159 | 141,102 |
Other | 2,489 | 155 |
Other current liabilities | 58,648 | 162,419 |
Other long-term liabilities: | ||
Workers compensation reserve | 24,471 | 24,130 |
Professional liability reserve | 34,068 | 34,544 |
Unrecognized tax benefits | 4,731 | 4,633 |
Acquisition related liabilities | 8,580 | 0 |
Other | 33,797 | 33,682 |
Other long-term liabilities | $ 105,647 | $ 96,989 |