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Summary of Significant Accounting Policies - Revenue Recognition (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($)
Accounting Policies [Abstract]
Previously deferred revenue recognized during period	$ 9,972
Incremental cost to obtain and fulfill contract	$ 11,369

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 82,985	$ 13,856
Accounts receivable, net of allowances of $8,027 and $10,560 at December 31, 2019 and 2018, respectively	352,685	365,871
Accounts receivable, subcontractor	72,714	50,143
Prepaid expenses	11,669	12,409
Other current assets	40,446	39,887
Total current assets	560,499	482,166
Restricted cash, cash equivalents and investments	62,170	59,331
Fixed assets, net of accumulated depreciation of $132,900 and $114,413 at December 31, 2019 and 2018, respectively	104,832	90,419
Operating lease right-of-use assets	89,866
Other assets	120,254	96,152
Goodwill	595,551	438,506
Intangible assets, net of accumulated amortization of $151,417 and $114,924 at December 31, 2019 and 2018, respectively	398,474	326,147
Total assets	1,931,646	1,492,721
Current liabilities:
Accounts payable and accrued expenses	156,140	149,603
Accrued compensation and benefits	170,932	135,059
Current portion of operating lease liabilities	13,943
Deferred revenue	11,788	12,365
Other current liabilities	25,302	10,243
Total current liabilities	378,105	307,270
Revolving credit facility	0	120,000
Notes payable, less unamortized fees	617,159	320,607
Deferred income taxes, net	46,618	27,326
Operating lease liabilities	91,209
Other long-term liabilities	61,813	78,528
Total liabilities	1,194,904	853,731
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at December 31, 2019 and 2018	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 49,283 issued and 46,722 outstanding at December 31, 2019 and 48,809 issued and 46,643 outstanding at December 31, 2018	493	488
Additional paid-in capital	455,193	452,730
Treasury stock, at cost (2,561 and 2,166 shares at December 31, 2019 and 2018, respectively)	(119,143)	(100,438)
Retained earnings	400,047	286,059
Accumulated other comprehensive income	152	151
Total stockholders’ equity	736,742	638,990
Total liabilities and stockholders’ equity	$ 1,931,646	$ 1,492,721

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 (Loss)
Beginning balance, shares at Dec. 31, 2016		48,055		(443)
Beginning balance at Dec. 31, 2016	$ 449,383	$ 481	$ 452,491	$ (13,261)	$ 9,671	$ 1
Statement of Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes, shares		356
Equity awards vested and exercised, net of shares withheld for payroll taxes	(9,374)	$ 3	(9,377)
Repurchase of common stock into treasury (in shares)				(487)
Repurchase of common stock into treasury	(20,164)			$ (20,164)
Share-based compensation	10,237		10,237
Comprehensive income (loss)	132,445				132,558	(113)
Ending balance, shares at Dec. 31, 2017		48,411		(930)
Ending balance at Dec. 31, 2017	562,527	$ 484	453,351	$ (33,425)	142,229	(112)
Statement of Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes, shares		398
Equity awards vested and exercised, net of shares withheld for payroll taxes	$ (11,432)	$ 4	(11,436)
Repurchase of common stock into treasury (in shares)	(1,236)			(1,236)
Repurchase of common stock into treasury	$ (67,013)			$ (67,013)
Share-based compensation	10,815		10,815
Comprehensive income (loss)	142,004				141,741	263
Ending balance, shares at Dec. 31, 2018		48,809		(2,166)
Ending balance at Dec. 31, 2018	638,990	$ 488	452,730	$ (100,438)	286,059	151
Statement of Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes, shares		474
Equity awards vested and exercised, net of shares withheld for payroll taxes	$ (13,773)	$ 5	(13,778)
Repurchase of common stock into treasury (in shares)	(395)			(395)
Repurchase of common stock into treasury	$ (18,705)			$ (18,705)
Share-based compensation	16,241		16,241
Comprehensive income (loss)	113,989				113,988	1
Ending balance, shares at Dec. 31, 2019		49,283		(2,561)
Ending balance at Dec. 31, 2019	$ 736,742	$ 493	$ 455,193	$ (119,143)	$ 400,047	$ 152

Leases - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
Leases - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Leases [Abstract]
Option to extend, term	10 years
Option to terminate, term	3 years
Lessee, Lease, Description [Line Items]
Rent expense		$ 21,402	$ 20,529
Minimum
Lessee, Lease, Description [Line Items]
Lease term		1 year

Quarterly Financial Data (Unaudited) (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Selected Quarterly Financial Information [Abstract]
Revenue	$ 586,892	$ 567,597	$ 535,177	$ 532,441	$ 528,635	$ 526,842	$ 558,108	$ 522,489	$ 2,222,107	$ 2,136,074	$ 1,988,454
Gross profit	197,133	190,031	179,542	176,759	172,456	175,147	180,956	167,824	743,465	696,383	644,419
Net income	$ 27,482	$ 23,515	$ 28,869	$ 34,122	$ 35,613	$ 27,918	$ 35,529	$ 42,681	$ 113,988	$ 141,741	$ 132,558
Basic (in dollars per share)	$ 0.59	$ 0.50	$ 0.62	$ 0.73	$ 0.76	$ 0.59	$ 0.75	$ 0.89	$ 2.44	$ 2.99	$ 2.77
Diluted (in dollars per share)	$ 0.58	$ 0.49	$ 0.61	$ 0.71	$ 0.74	$ 0.58	$ 0.73	$ 0.87	$ 2.40	$ 2.91	$ 2.68

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

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- Definition

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

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+ Details

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

(a) General

AMN Healthcare Services, Inc. was incorporated in Delaware on November 10, 1997. AMN Healthcare Services, Inc. and its subsidiaries (collectively, the “Company”) provide healthcare workforce solutions and staffing services at acute and sub-acute care hospitals and other healthcare facilities throughout the United States.

(b) Principles of Consolidation

The accompanying consolidated financial statements include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries. All significant intercompany balances and transactions have been eliminated in consolidation.

The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America 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 goodwill and indefinite-lived intangible assets, professional liability reserve, contingent liabilities, and income taxes. The Company bases these estimates on the information that is currently available and on various other assumptions that it believes are reasonable under the circumstances. Actual results could differ from those estimates under different assumptions or conditions.

(d) Cash and Cash Equivalents

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 and highly liquid investments.

(e) Restricted Cash, Cash Equivalents and Investments

Restricted cash and cash equivalents primarily represent cash and money market funds on deposit with financial institutions and investments represents commercial paper that serves as collateral for the Company’s outstanding letters of credit and captive insurance subsidiary claim payments. See Note (3), “Fair Value Measurement” and Note (8), “Notes Payable and Credit Agreement” for additional information.

The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets and related notes to the amounts presented in the accompanying consolidated statements of cash flows.



	December 31, 2019			December 31, 2018
Cash and cash equivalents	$	82,985		$	13,856
Restricted cash and cash equivalents (included in other current assets)	18,393			26,329
Restricted cash, cash equivalents and investments	62,170			59,331
Total cash, cash equivalents and restricted cash and investments	163,548			99,516
Less restricted investments	(9,586		)	(15,192		)
Total cash, cash equivalents and restricted cash	$	153,962		$	84,324

(f) Fixed Assets

The Company records furniture, equipment, leasehold improvements and capitalized software at cost less accumulated amortization and depreciation. The Company records equipment acquired under finance leases at the present value of the future

minimum lease payments. The Company capitalizes major additions and improvements, and it expenses maintenance and repairs when incurred. The Company calculates depreciation on furniture, equipment and technology and software using the straight-line method based on the estimated useful lives of the related assets (three to ten years). The Company depreciates leasehold improvements and equipment obtained under finance leases over the shorter of the term of the lease or their estimated useful lives. The Company includes depreciation of equipment obtained under finance leases with depreciation expense in the accompanying consolidated financial statements.

The Company capitalizes costs it incurs to develop software during the application development stage. Application development stage costs generally include costs associated with software configuration, coding, installation and testing. The Company also capitalizes costs of significant upgrades and enhancements that result in additional functionality, whereas it expenses as incurred costs for maintenance and minor upgrades and enhancements. The Company amortizes capitalized costs using the straight-line method over three to ten years once the software is ready for its intended use.

The Company reviews long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset group to the future undiscounted net cash flows that are expected to be generated by the asset group. If such asset group is considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the asset group exceeds the fair value of the asset group. The Company reports assets to be disposed of at the lower of the carrying amount or fair value less costs to sell.

(g) Leases

The Company recognizes operating lease right-of-use assets and liabilities at commencement date based on the present value of the future minimum lease payments over the lease term. Leases with an initial term of 12 months or less are not recorded on the balance sheet in accordance with the short-term lease recognition exemption. The Company applies the practical expedient to not separate lease and non-lease components for all leases that qualify. Lease expense is recognized on a straight-line basis over the lease term. See Note (5), “Leases,” for additional information.

(h) Goodwill

The Company records as goodwill the portion of the purchase price that exceeds the fair value of net assets of entities acquired. The Company evaluates goodwill annually for impairment at the reporting unit level and whenever circumstances occur indicating that goodwill may be impaired. The Company may first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount. If, after assessing the totality of events and circumstances, the Company determines that it is more likely than not that the fair value of the reporting unit is greater than its carrying amount, the quantitative impairment test is unnecessary. The performance of the quantitative impairment test involves a two-step process. The first step of the test involves comparing the fair value of the Company’s reporting units with the reporting unit’s carrying amount, including goodwill. The Company generally determines the fair value of its reporting units using a combination of the income approach (using discounted future cash flows) and the market valuation approach. If the carrying amount of a Company’s reporting unit exceeds its fair value, the Company performs the second step of the test to determine the amount of impairment loss. The second step of the test involves comparing the implied fair value of the Company’s reporting unit’s goodwill with the carrying amount of that goodwill. The amount by which the carrying value of the goodwill exceeds its implied fair value, if any, is recognized as an impairment loss.

(i) Intangible Assets

Intangible assets consist of identifiable intangible assets acquired through acquisitions, which include tradenames and trademarks, customer relationships, staffing databases, developed technology and non-compete agreements. The fair value of identifiable intangible assets are determined using either the income approach (relief-from-royalty method or multi-period excess earnings method) or the cost approach (replacement cost method). The Company amortizes intangible assets, other than tradenames and trademarks with an indefinite life, using the straight-line method over their useful lives. The Company amortizes non-compete agreements using the straight-line method over the lives of the related agreements. The Company reviews for impairment intangible assets with estimable useful lives whenever events or changes in circumstances indicate that the carrying amount may not be recoverable.

The Company does not amortize indefinite-lived tradenames and trademarks and instead reviews them for impairment annually. The Company may first perform a qualitative assessment to determine whether it is more likely than not that an indefinite-lived intangible asset is impaired. If, after assessing the totality of events and circumstances, the Company determines that it is more likely than not that the indefinite-lived intangible asset is not impaired, no quantitative fair value measurement is necessary. If a quantitative fair value measurement calculation is required for an indefinite-lived intangible

asset, the Company compares its fair value with its carrying amount. If the carrying amount exceeds the fair value, the Company records the excess as an impairment loss.

(j) Insurance Reserves

The Company maintains an accrual for professional liability that is included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets. The expense is included in the selling, general and administrative expenses in the consolidated statement of comprehensive income. The Company determines the adequacy of this accrual by evaluating its historical experience and trends, loss reserves established by the Company’s insurance carriers, management and third-party administrators, and independent actuarial studies. The Company obtains actuarial studies on a semi-annual basis that use the Company’s actual claims data and industry data to assist the Company in determining the adequacy of its reserves each year. For periods between the actuarial studies, the Company records its accruals based on loss rates provided in the most recent actuarial study and management’s review of loss history and trends. In November 2012, the Company established a captive insurance subsidiary, which provides coverage, on an occurrence basis, for professional liability within its nurse and allied solutions segment. Liabilities include provisions for estimated losses incurred but not yet reported (“IBNR”), as well as provisions for known claims. IBNR reserve estimates involve the use of assumptions that are primarily based upon historical loss experience, industry data and other actuarial assumptions. The Company maintains excess insurance coverage through a commercial carrier for losses above the per occurrence retention.

The Company maintains an accrual for workers compensation, which is included in accrued compensation and benefits and other long-term liabilities in the consolidated balance sheets. The expense relating to healthcare professionals is included in cost of revenue, while the expense relating to corporate employees is included in the selling, general and administrative expenses in the consolidated statement of comprehensive income. The Company determines the adequacy of this accrual by evaluating its historical experience and trends, loss reserves established by the Company’s insurance carriers and third-party administrators, and independent actuarial studies. The Company obtains actuarial studies on a semi-annual basis that use the Company’s payroll and historical claims data, as well as industry data, to determine the appropriate reserve for both reported claims and IBNR claims for each policy year. For periods between the actuarial studies, the Company records its accruals based on loss rates provided in the most recent actuarial study.

(k) Revenue Recognition

Revenue primarily consists of fees earned from the temporary and permanent placement of healthcare professionals and executives as well as from the Company’s software as a service (“SaaS”)-based technologies, including its vendor management systems and its scheduling software. Revenue is recognized when control of these services is transferred to the customers, in an amount that reflects the consideration the Company expects to be entitled to 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 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 executive search, physician permanent placement, and recruitment process outsourcing services is recognized as the services are rendered. The Company’s SaaS-based revenue is recognized ratably over the applicable arrangement’s service period.

The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. During the year ended December 31, 2019, previously deferred revenue recognized as revenue was $9,972.

The Company recognizes assets from incremental costs to obtain a contract with a customer and costs incurred to fulfill a contract with a customer, which are deferred and amortized using the portfolio approach on a straight line basis over the average period of benefit consistent with the timing of transfer of services to the customer. Aggregate expense for these costs was $11,369 for the year ended December 31, 2019.

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 to which 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 to which 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.

(l) Accounts Receivable

The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for doubtful accounts based on the Company’s historical write-off experience and an assessment of its customers’ financial conditions. The Company also maintains a sales allowance to reserve for potential credits issued to customers, which is based on the Company’s historical experience. The Company has not experienced material bad debts or sales adjustments during the past three years.

(m) Concentration of Credit Risk

The majority of the Company’s business activity is with hospitals located throughout the United States. Credit is extended based on the evaluation of each entity’s financial condition. One customer primarily within the Company’s nurse and allied solutions segment comprised approximately 13% of the consolidated revenue of the Company for each of the fiscal years ended December 31, 2019, 2018 and 2017.

The Company’s cash and cash equivalents and restricted cash, cash equivalents and investments accounts are financial instruments that are exposed to concentration of credit risk. The Company maintains most of its cash, cash equivalents and investment balances with high-credit quality and federally insured institutions. However, restricted cash equivalents and investment balances may be invested in a non-federally insured money market account and commercial paper. As of December 31, 2019 and 2018, there were $62,170 and $59,331, respectively, of restricted cash, cash equivalents and investments, a portion of which was invested in a non-federally insured money market fund and commercial paper. See Note (3), “Fair Value Measurement,” for additional information.

(n) Income Taxes

The Company records income taxes using the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax basis. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in the period the changes are enacted. In assessing the realizability of deferred tax assets, the Company considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. The Company considers the scheduled reversal of deferred tax liabilities (including the impact of available carryback and carryforward periods), projected future taxable income, and tax-planning strategies in making this assessment. The Company recognizes the effect of income tax positions only if it is more likely than not that such positions will be sustained. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs. The Company records interest and penalties related to unrecognized tax benefits in income tax expense.

(o) Fair Value of Financial Instruments

The carrying amounts of the Company’s cash equivalents and restricted cash equivalents and investments approximate their respective fair values due to the short-term nature and liquidity of these financial instruments. The fair value of the Company’s equity investment is determined by using prices for identical or similar investments of the same issuer, which is more fully described in Note (3), “Fair Value Measurement.” As it relates to the Company’s 2024 Notes and 2027 Notes (as both defined in Note (3) below), fair value disclosure is detailed in Note (3), “Fair Value Measurement.” See Note (8), “Notes Payable and Credit Agreement,” for additional information. The fair value of the long-term portion of the Company’s insurance accruals cannot be estimated because the Company cannot reasonably determine the timing of future payments.

(p) Share-Based Compensation

The Company accounts for its share-based employee compensation plans by expensing the estimated fair value of share-based awards on a straight-line basis over the requisite employee service period, which typically is the vesting period, except for awards granted to retirement-eligible employees, which are expensed on an accelerated basis. Restricted stock units

(“RSUs”) typically vest at the end of a three-year vesting period, however, 33% of the awards may vest on the 13th month anniversary of the grant date and 34% on the second anniversary of the grant date if certain performance targets are met. Share-based compensation cost of RSUs is measured by the market value of the Company’s common stock on the date of grant, and the Company records share-based compensation expense only for those awards that are expected to vest. Performance restricted stock units (“PRSUs”) primarily consist of PRSUs that contain a performance condition dependent on the Company’s adjusted EBITDA margin during the third year of the three-year vesting period, with a range of 0% to 175% of the target amount granted to be issued under the award. Share-based compensation cost for these PRSUs is measured by the market value of the Company’s common stock on the date of grant, and the amount recognized is adjusted for estimated achievement of the performance conditions. A limited amount of PRSUs contain a market condition dependent upon the Company’s relative and absolute total stockholder return over a three-year period, with a range of 0% to 175% of the target amount granted to be issued under the award. Share-based compensation cost for these PRSUs is measured using the Monte-Carlo simulation valuation model and is not adjusted for the achievement, or lack thereof, of the performance conditions.

(q) Net Income per Common Share

Share-based awards to purchase 43, 23 and 20 shares of common stock for the years ended December 31, 2019, 2018 and 2017, respectively, were not included in the calculation of diluted net income per common share because the effect of these instruments was anti-dilutive.

The following table sets forth the computation of basic and diluted net income per common share for the years ended December 31, 2019, 2018 and 2017, respectively:



	Years Ended December 31,
	2019		2018		2017
Net income	$	113,988	$	141,741	$	132,558

Net income per common share - basic	$	2.44	$	2.99	$	2.77
Net income per common share - diluted	$	2.40	$	2.91	$	2.68

Weighted average common shares outstanding - basic	46,704		47,371		47,807
Plus dilutive effect of potential common shares	889		1,297		1,623
Weighted average common shares outstanding - diluted	47,593		48,668		49,430

(r) 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) locum tenens solutions, and (3) other workforce solutions. The nurse and allied solutions segment consists of the Company’s nurse, allied, local and labor disruption and rapid response staffing businesses. The locum tenens solutions segment consists of the Company’s locum tenens staffing business. The other workforce solutions segment consists of the following Company businesses (i) physician permanent placement services, (ii) healthcare interim leadership staffing and executive search services, (iii) vendor management systems, (iv) recruitment process outsourcing, (v) education, (vi) revenue cycle solutions, (vii) workforce optimization services, and (viii) credentialing services.

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:



	Years Ended December 31,
	2019		2018		2017
Revenue
Nurse and allied solutions	$	1,419,965	$	1,306,516	$	1,238,543
Locum tenens solutions	324,653		393,366		430,615
Other workforce solutions	477,489		436,192		319,296
	$	2,222,107	$	2,136,074	$	1,988,454
Segment operating income
Nurse and allied solutions	$	199,806	$	183,427	$	182,792
Locum tenens solutions	25,108		41,348		51,422
Other workforce solutions	110,225		104,541		81,154
	335,139		329,316		315,368
Unallocated corporate overhead	83,463		74,436		60,412
Depreciation and amortization	58,520		41,237		32,279
Share-based compensation	16,241		10,815		10,237
Interest expense, net, and other	28,427		16,143		19,677
Income before income taxes	$	148,488	$	186,685	$	192,763

The Company offers a comprehensive managed services program, in which the Company manages all or a portion of a client’s contingent staffing needs. This service includes both the placement of the Company’s own healthcare professionals and the utilization of other staffing agencies to fulfill the client’s staffing needs. See additional information in (j), “Revenue Recognition.” For the years ended December 31, 2019, 2018 and 2017, revenue under the Company’s managed services program arrangements comprised approximately 63%, 62% and 58% for nurse and allied solutions revenue, 23%, 17% and 13% for locum tenens solutions revenue and 8%, 7% and 8% for other workforce solutions revenue, respectively.

(s) Recently Adopted Accounting Pronouncements

In February 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2016-02, “Leases.” This standard requires organizations that lease assets to recognize the assets and liabilities created by those leases. The standard also requires disclosures to help investors and other financial statement users better understand the amount, timing, and uncertainty of cash flows arising from leases. A modified retrospective transition approach is required, applying the standard to all leases existing at the date of initial application. In addition, the FASB has also issued several amendments to the standard, which clarify certain aspects of the guidance, including an optional transition method for adoption of this standard, which allows organizations to initially apply the new requirements at the effective date, recognize a cumulative effect adjustment to the opening balance of retained earnings, and continue to apply the legacy guidance in Accounting Standards Codification (“ASC”) 840, Leases, including its disclosure requirements, in the comparative periods presented. The new standard provides a number of optional practical expedients in transition. The Company elected the ‘package of practical expedients’, which permits organizations not to reassess under the new standard prior conclusions about lease identification, lease classification and initial direct costs. The Company did not elect to use the hindsight practical expedient to determine the lease term or evaluate impairment for existing leases.

The Company adopted ASU 2016-02 effective January 1, 2019, using the optional transition method described above. The Company recognized the cumulative effect of adopting this guidance as an adjustment as of the effective date, primarily related to the recognition of lease liabilities of $114,807 and corresponding right-of-use assets of $99,525 for existing operating leases. The Company also derecognized existing deferred rent liabilities of $15,302. These adjustments had no effect on opening retained earnings and prior periods were not retrospectively adjusted and continue to be reported in accordance with ASC 840. The new standard also provides practical expedients for an organization’s ongoing accounting. The Company elected the short-term lease recognition exemption and the practical expedient to not separate lease and non-lease components for all leases that qualify. The adoption did not have a material effect on the Company’s results of operations.

There were no other material impacts to the Company’s consolidated financial statements as a result of adopting these updated standards.

Retirement Plans - Deferred Compensation Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Deferred Compensation Arrangement with Individual, Postretirement Benefits [Line Items]
Cash surrender value of life insurance	$ 79,515	$ 55,028
Key Executives and Key Employees
Deferred Compensation Arrangement with Individual, Postretirement Benefits [Line Items]
Service vesting period	5 years
Maximum percent of base salary deferrable	80.00%
Maximum percent of bonus deferrable	90.00%
Maximum percent of vested RSUs and PRSUs deferrable	100.00%
Employer contributions	$ 5,551	$ 4,708	$ 4,545

Goodwill and Identifiable Intangible Assets - Acquired Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 460,491	$ 351,671
Accumulated Amortization	(151,417)	(114,924)
Net Carrying Amount	309,074	236,747
Acquired Indefinite-lived Intangible Assets [Line Items]
Intangible assets excluding goodwill	398,474	326,147
Tradenames and trademarks
Acquired Indefinite-lived Intangible Assets [Line Items]
Tradenames and trademarks	89,400	89,400
Staffing databases
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	35,836	25,536
Accumulated Amortization	(13,369)	(10,174)
Net Carrying Amount	22,467	15,362
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	273,839	201,759
Accumulated Amortization	(94,206)	(75,081)
Net Carrying Amount	179,633	126,678
Tradenames and trademarks
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	126,269	112,769
Accumulated Amortization	(33,545)	(22,529)
Net Carrying Amount	92,724	90,240
Non-compete agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	4,117	2,877
Accumulated Amortization	(2,035)	(1,410)
Net Carrying Amount	2,082	1,467
Acquired technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	20,430	8,730
Accumulated Amortization	(8,262)	(5,730)
Net Carrying Amount	$ 12,168	$ 3,000

Notes Payable and Credit Agreement

12 Months Ended

Dec. 31, 2019

Debt Disclosure [Abstract]

Notes Payable and Credit Agreement

(a) The Company’s Credit Agreement and Related Credit Facilities

On February 9, 2018, the Company entered into the New Credit Agreement with several lenders to provide for the $400,000 Senior Credit Facility to replace its then-existing credit facilities. The Senior Credit Facility includes a $50,000 sublimit for the issuance of letters of credit and a $50,000 sublimit for swingline loans. On June 14, 2019, the Company entered into the first amendment to the New Credit Agreement (the “First Amendment”) to provide for, among other things, a $150,000 secured term loan credit facility (the “Term Loan”). The First Amendment (together with the New Credit Agreement, the “Amended Credit Agreement”) also extended the maturity date of the Senior Credit Facility to be coterminous with the Term

Loan. The obligations of the Company under the Amended Credit Agreement are secured by substantially all of the assets of the Company. The Company used the proceeds from the Term Loan, together with a drawdown of a portion of the Senior Credit Facility, to complete its acquisition of Advanced, as more fully described in Note (2), “Acquisitions.”

Borrowings under the Senior Credit Facility and the Term Loan (together, the “Credit Facilities”) bear interest at floating rates, at the Company’s option, based upon either LIBOR plus a spread of 1.00% to 2.00% or a base rate plus a spread of 0.00% to 1.00%. The applicable spread is determined quarterly based upon the Company’s consolidated net leverage ratio. The Term Loan is subject to amortization of principal of 2.50% per year for the first year of the term and 5.00% per year thereafter, payable in equal quarterly installments. The Senior Credit Facility is available for working capital, capital expenditures, permitted acquisitions and general corporate purposes. The maturity date of the Credit Facilities is June 14, 2024.

In connection with the First Amendment, the Company incurred $875 in fees paid to lenders and other third parties, which were capitalized and are amortized to interest expense over the term of the Credit Facilities. In addition, $1,702 of unamortized financing fees incurred in connection with obtaining the New Credit Agreement will continue to be amortized to interest expense over the term of the Credit Facilities.

On February 14, 2020, the Company entered into the second amendment to the New Credit Agreement (the “Second Amendment”) to provide for, among other things, a $250,000 secured term loan credit facility (the “Additional Term Loan”). The Second Amendment also extended the maturity date of the Senior Credit Facility to be coterminous with the Additional Term Loan. The Company used the proceeds from the Additional Term Loan, together with a drawdown of a portion of the Senior Credit Facility, to complete its acquisition of Stratus Video, as more fully described in Note (14), “Subsequent Events.” The Additional Term Loan is subject to amortization of principal of 2.50% per year for the first year of the term and 5.00% per year thereafter, payable in equal quarterly installments. The maturity date of the Additional Term Loan is February 14, 2025.

At December 31, 2019, with $17,445 of outstanding letters of credit collateralized by the Senior Credit Facility, there was $382,555 of available credit under the Senior Credit Facility.

(b) The Company’s 4.625% Senior Notes Due 2027

On October 1, 2019, the Company completed the issuance and sale of $300,000 aggregate principal amount of the 2027 Notes, which mature on October 1, 2027. Interest on the 2027 Notes is fixed at 4.625% and payable semi-annually in arrears on April 1 and October 1 of each year, commencing April 1, 2020. With the proceeds from the 2027 Notes and cash generated from operations, the Company (1) repaid $149,063 of existing Term Loan indebtedness, (2) repaid $146,000 under the Senior Credit Facility, and (3) paid $4,348 of fees and expenses related to the issuance and sale of the 2027 Notes, which were recorded as a reduction of the notes payable balance and are being amortized to interest expense over the term of the 2027 Notes.

The indenture governing the 2027 Notes contains covenants that, among other things, restrict the ability of the Company to:

•sell assets,

•pay dividends or make other distributions on capital stock, make payments in respect of subordinated indebtedness or make other restricted payments,

•make certain investments,

•incur or guarantee additional indebtedness or issue preferred stock,

•create certain liens,

•enter into agreements that restrict dividends or other payments from restricted subsidiaries,

•consolidate, merge or transfer all or substantially all of its assets,

•engage in transactions with affiliates, and

•create unrestricted subsidiaries.

These covenants are subject to a number of important exceptions and qualifications. The indenture governing the 2027 Notes contains affirmative covenants and events of default that are customary for indentures governing high yield securities. The 2027 Notes and the related guarantees thereof are not subject to any registration rights agreements.

Outstanding debt balances as of December 31, 2019 and 2018 consisted of the following:



	As of December 31,
	2019			2018
Senior Credit Facility	—			120,000
2024 Notes	325,000			325,000
2027 Notes	300,000			—
Total debt outstanding	625,000			445,000
Less unamortized fees	(7,841		)	(4,393		)
Long-term portion of notes payable	$	617,159		$	440,607

The 2024 Notes were issued in October 2016 and have a fixed rate of 5.125%. The aggregate principal amounts of the 2024 Notes and the 2027 Notes mature on October 1, 2024 and October 1, 2027, respectively.

(d) Letters of Credit

At December 31, 2019, the Company maintained outstanding standby letters of credit totaling $19,752 as collateral in relation to its workers compensation insurance agreements and a corporate office lease agreement. Of the $19,752 outstanding letters of credit, the Company has collateralized $2,307 in cash and cash equivalents and the remaining $17,445 is collateralized by the Senior Credit Facility. Outstanding standby letters of credit at December 31, 2018 totaled $17,632.

Notes Payable and Credit Agreement - Schedule of Outstanding Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Debt Instrument [Line Items]
Total debt outstanding	$ 625,000	$ 445,000
Less unamortized fees	(7,841)	(4,393)
Long-term portion of notes payable	617,159	440,607
Line of Credit \| 2024 Notes
Debt Instrument [Line Items]
Total debt outstanding	325,000	325,000
Line of Credit \| 2027 Notes
Debt Instrument [Line Items]
Total debt outstanding	300,000	0
Senior Credit Facility \| Line of Credit
Debt Instrument [Line Items]
Total debt outstanding	$ 0	$ 120,000

Leases - Components of Lease Expense (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($)
Leases [Abstract]
Operating lease cost	$ 18,725
Short-term lease cost	20,112
Variable and other lease cost	2,880
Net lease cost	$ 41,717

Share-Based Compensation - (Details) - USD ($) $ in Thousands					12 Months Ended
	Apr. 19, 2017	Apr. 18, 2012	Apr. 09, 2009	Apr. 18, 2007	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Feb. 28, 2014	Dec. 31, 2006
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Document Period End Date					Dec. 31, 2019
Stock Options and Stock Appreciation Rights
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total intrinsic value of share-based payment award exercised					$ 9,177	$ 1,535	$ 555
Total intrinsic value of share-based payment award outstanding and exercisable					645	10,841
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation cost					$ 14,762
Unrecognized compensation cost, weighted average remaining period					1 year 7 months 6 days
RSUs and Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate intrinsic value					$ 47,242	$ 46,336
Stock Option Plan \| Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options outstanding (in shares)					0
Equity Plan \| Stock Options and Stock Appreciation Rights
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized for issuance									723,000
Contractual life of stock options and SARs					10 years
Additional number of shares authorized	1,400,000	2,400,000	1,850,000	3,000,000
Number of equity awards reserved for future issuance (shares)					2,930,000	3,051,000
2014 Employee Inducement Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized for issuance								200,000
Number of shares of common stock available for future grants					175,000

Acquisitions (Tables)

12 Months Ended

Dec. 31, 2019

Business Combinations [Abstract]

Schedule of fair value and useful life of intangible assets acquired

The following table summarizes the fair value and useful life of each intangible asset acquired:



		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Tradenames and Trademarks	$	46,000	20
	Customer Relationships	57,000		12
		$	103,000

The following table summarizes the fair value and useful life of each intangible asset acquired:



		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer Relationships	$	68,000	10
	Tradenames and Trademarks	10,000		5
	Staffing Database	10,300		10
	Developed Technology	3,400		3
		$	91,700

Fair Value Measurement - Financial Assets and (Liabilities) (Details) - Fair Value, Recurring - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
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	$ 2,508	$ 2,461
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	59,243	63,243
Quoted Prices in Active Markets for Identical Assets (Level 1) \| 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	2,508	2,461
Quoted Prices in Active Markets for Identical Assets (Level 1) \| 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	0	0
Significant Other Observable Inputs (Level 2) \| 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	0	0
Significant Other Observable Inputs (Level 2) \| 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	59,243	63,243
Debt Securities, Available-for-sale	9,586	15,192
Significant Unobservable Inputs (Level 3) \| 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	0	0
Significant Unobservable Inputs (Level 3) \| 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	0	0
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	(81,064)	(55,720)
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	(81,064)	(55,720)
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	(23,100)	(7,700)
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	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	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	$ (23,100)	$ (7,700)

Retirement Plans - 401(k) Retirement Savings Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Retirement Benefits [Abstract]
Employer contributions, net of forfeitures	$ 5,516	$ 5,250	$ 4,486

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Reconciliation of cash, cash equivalents and restricted cash



	December 31, 2019			December 31, 2018
Cash and cash equivalents	$	82,985		$	13,856
Restricted cash and cash equivalents (included in other current assets)	18,393			26,329
Restricted cash, cash equivalents and investments	62,170			59,331
Total cash, cash equivalents and restricted cash and investments	163,548			99,516
Less restricted investments	(9,586		)	(15,192		)
Total cash, cash equivalents and restricted cash	$	153,962		$	84,324

Computation of basic and diluted net income (loss) per common share

The following table sets forth the computation of basic and diluted net income per common share for the years ended December 31, 2019, 2018 and 2017, respectively:



	Years Ended December 31,
	2019		2018		2017
Net income	$	113,988	$	141,741	$	132,558

Net income per common share - basic	$	2.44	$	2.99	$	2.77
Net income per common share - diluted	$	2.40	$	2.91	$	2.68

Weighted average common shares outstanding - basic	46,704		47,371		47,807
Plus dilutive effect of potential common shares	889		1,297		1,623
Weighted average common shares outstanding - diluted	47,593		48,668		49,430

Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results



	Years Ended December 31,
	2019		2018		2017
Revenue
Nurse and allied solutions	$	1,419,965	$	1,306,516	$	1,238,543
Locum tenens solutions	324,653		393,366		430,615
Other workforce solutions	477,489		436,192		319,296
	$	2,222,107	$	2,136,074	$	1,988,454
Segment operating income
Nurse and allied solutions	$	199,806	$	183,427	$	182,792
Locum tenens solutions	25,108		41,348		51,422
Other workforce solutions	110,225		104,541		81,154
	335,139		329,316		315,368
Unallocated corporate overhead	83,463		74,436		60,412
Depreciation and amortization	58,520		41,237		32,279
Share-based compensation	16,241		10,815		10,237
Interest expense, net, and other	28,427		16,143		19,677
Income before income taxes	$	148,488	$	186,685	$	192,763

Goodwill and Identifiable Intangible Assets - Estimated Amortization Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Aggregate amortization expense, intangible assets	$ 36,493	$ 24,239
Year ending December 31, 2020	44,017
Year ending December 31, 2021	41,735
Year ending December 31, 2022	40,754
Year ending December 31, 2023	39,647
Year ending December 31, 2024	33,400
Thereafter	109,521
Net Carrying Amount	$ 309,074	$ 236,747

Leases - Supplemental Cash Flow Information Regarding Leases (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($)
Leases [Abstract]
Cash paid for amounts included in the measurement of operating lease liabilities	$ 17,817
Operating lease right-of-use assets obtained in exchange for lease obligations	$ 0

Leases - Assumptions Used for Operating Leases (Details)	Dec. 31, 2019
Leases [Abstract]
Weighted average remaining lease term	7 years
Weighted average discount rate	4.80%

Fair Value Measurement - Reconciliation of Equity Investments Included in Net Income (Details) - Significant Other Observable Inputs (Level 2) - Fair Value, Nonrecurring $ in Thousands	Dec. 31, 2019 USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment, beginning balance	$ 15,449
Equity investment, ending balance	$ 15,449

Income Taxes - Operating Loss Carryforwards (Details) $ in Thousands	Dec. 31, 2019 USD ($)
Federal
Operating Loss Carryforwards
Operating loss carryforwards	$ 16,418

Share-Based Compensation - Share Based Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Share-based Payment Arrangement [Abstract]
Share-based employee compensation, before tax	$ 16,241	$ 10,815	$ 10,237
Related income tax benefits	(4,223)	(2,812)	(3,985)
Share-based employee compensation, net of tax	$ 12,018	$ 8,003	$ 6,252

Share-Based Compensation

12 Months Ended

Dec. 31, 2019

Share-based Payment Arrangement [Abstract]

Share-Based Compensation

(a) Equity Award Plans

Equity Plan

The Company established the AMN Healthcare Equity Plan (as amended or amended and restated from time to time, the “Equity Plan”), which has been approved by the Company’s stockholders. At the time of the Equity Plan’s original adoption in 2006, equity awards, based on the Company’s common stock, could be issued for a maximum of 723 shares plus the number of shares of common stock underlying any grants under the Stock Option Plan (under which there are no longer any outstanding awards) that were forfeited, canceled or terminated (other than by exercise) from and after the effective date of the Equity Plan. Pursuant to the Equity Plan, stock options and stock appreciation rights (“SARs”) granted have a maximum contractual life of ten years and have exercise prices that will be determined at the time of grant, which will be no less than fair market value of the underlying common stock on the date of grant. Any shares to be issued under the Equity Plan will be issued by the Company from authorized but unissued common stock or shares of common stock reacquired by the Company. On April 18, 2007, April 9, 2009, April 18, 2012 and April 19, 2017, the Company amended the Equity Plan, with stockholder approval, to increase the number of shares authorized under the Equity Plan by 3,000, 1,850, 2,400 and 1,400, respectively. At December 31, 2019 and 2018, 2,930 and 3,051 shares of common stock were reserved for future grants under the Equity Plan, respectively.

Other Plans

From time to time, the Company grants, and has granted, key employees inducement awards outside of the Equity Plan (collectively, “Other Plans”), which have consisted of SARs, options or RSUs. Although these awards are not made under the Equity Plan, the key terms and conditions of the grant are typically the same as equity awards made under the Equity Plan.

Additionally, in February 2014, the Company established the 2014 Employment Inducement Plan, which reserves for issuance 200 shares of common stock for prospective employees of the Company. As of December 31, 2019, 175 shares of common stock remained available for future grants under the 2014 Employment Inducement Plan.

(b) Share-Based Compensation

Restricted Stock Units

RSUs and PRSUs (subject to a PRSU being earned) granted under the Equity Plan generally entitle the holder to receive, at the end of a vesting period, a specified number of shares of the Company’s common stock. The following table summarizes RSU and PRSU activity for non-vested awards for the years ended December 31, 2019, 2018 and 2017:



	Number of Shares		Weighted Average Grant Date Fair Value per Share
Unvested at January 1, 2016	1,075		$	22.14
Granted—RSUs	166		$	40.73
Granted—PRSUs (1)	317		$	27.51
Vested	(637	)	$	16.88
Canceled/forfeited/expired	(66	)	$	30.02
Unvested at December 31, 2017	855		$	30.98
Granted—RSUs	279		$	53.73
Granted—PRSUs (1)	266		$	35.28
Vested	(499	)	$	23.04
Canceled/forfeited/expired	(83	)	$	42.32
Unvested at December 31, 2018	818		$	43.84
Granted—RSUs	191		$	54.99
Granted—PRSUs (1)	201		$	48.32
Vested	(400	)	$	35.46
Canceled/forfeited/expired	(52	)	$	41.09
Unvested at December 31, 2019	758		$	52.45

(1) PRSUs granted included both the PRSUs granted during the year at the target amount and the additional shares of prior period granted PRSUs vested during the year in excess of the target shares.

As of December 31, 2019, there was $14,762 unrecognized compensation cost related to non-vested RSUs and PRSUs. The Company expects to recognize such cost over a period of 1.6 years. As of December 31, 2019 and 2018, the aggregate intrinsic value of the RSUs and PRSUs outstanding was $47,242 and $46,336, respectively.

Stock Options and SARs

Stock options entitle the holder to purchase, at the end of a vesting period, a specified number of shares of the Company’s common stock at a price per share set at the date of grant. SARs entitle the holder to receive, at the end of a vesting period, shares of the Company’s common stock equal in value to the difference between the exercise price of the SAR, which is set at the date of grant, and the fair market value of the Company’s common stock on the date of exercise.

A summary of stock option and SAR activity under the Equity Plan and Other Plans are as follows:



	Number Outstanding		Weighted- Average Exercise Price per Share
Outstanding at December 31, 2016	286		$	9.67
Granted	—		$	—
Exercised	(24	)	$	18.85
Canceled/forfeited/expired	—		$	—
Outstanding at December 31, 2017	262		$	8.81
Granted	—		$	—
Exercised	(35	)	$	10.12
Canceled/forfeited/expired	—		$	—
Outstanding at December 31, 2018	227		$	8.61
Granted	—		$	—
Exercised	(215	)	$	8.67
Canceled/forfeited/expired	—		$	—
Outstanding at December 31, 2019	12		$	7.51
Vested and expected to vest at December 31, 2019	12		$	7.51
Exercisable at December 31, 2019	12		$	7.51

As of December 31, 2019, all SARs were fully vested, and there were no stock options outstanding. The total intrinsic value of stock options and SARs exercised was $9,177, $1,535 and $555 for 2019, 2018 and 2017, respectively. At December 31, 2019 and 2018, the total intrinsic value of stock options and SARs outstanding and exercisable was $645 and $10,841, respectively.

Share-Based Compensation

Total share-based compensation expense for the years ended December 31, 2019, 2018 and 2017 was as follows:



	Years Ended December 31,
	2019			2018			2017
Share-based employee compensation, before tax	$	16,241		$	10,815		$	10,237
Related income tax benefits	(4,223		)	(2,812		)	(3,985		)
Share-based employee compensation, net of tax	$	12,018		$	8,003		$	6,252

Label	Element	Value
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 2,089,000
Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 2,089,000

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($) $ in Thousands	Dec. 31, 2019	Oct. 01, 2019	Dec. 31, 2018
2024 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying amount of notes	$ 325,000		$ 325,000
Fair value of notes	337,188		310,375
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying amount of notes	300,000	$ 300,000	0
Fair value of notes	$ 301,500		$ 0

Balance Sheet Details

12 Months Ended

Dec. 31, 2019

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Details

The consolidated balance sheets detail is as follows as of December 31, 2019 and 2018:



	As of December 31,
	2019			2018
Other current assets:
Restricted cash and cash equivalents	$	18,393		$	26,329
Income taxes receivable	5,984			799
Other	16,069			12,759
Other current assets	$	40,446		$	39,887

Fixed assets:
Furniture and equipment	$	37,315		$	34,211
Technology and software	191,050			162,006
Leasehold improvements	9,367			8,615
	237,732			204,832
Accumulated depreciation	(132,900		)	(114,413		)
Fixed assets, net	$	104,832		$	90,419

Accounts payable and accrued expenses:
Trade accounts payable	$	26,985		$	31,537
Subcontractor payable	75,562			50,892
Accrued expenses	36,344			30,236
Loss contingencies	6,146			24,549
Professional liability reserve	7,925			8,633
Other	3,178			3,756
Accounts payable and accrued expenses	$	156,140		$	149,603

Accrued compensation and benefits:
Accrued payroll	$	47,381		$	42,571
Accrued bonuses and commissions	22,613			18,021
Accrued travel expense	2,459			3,417
Health insurance reserve	4,019			3,559
Workers compensation reserve	8,782			7,817
Deferred compensation	81,064			55,720
Other	4,614			3,954
Accrued compensation and benefits	$	170,932		$	135,059

Other current liabilities:
Acquisition related liabilities	$	20,000		$	7,918
Other	5,302			2,325
Other current liabilities	$	25,302		$	10,243

Other long-term liabilities:
Workers compensation reserve	$	18,291		$	19,454
Professional liability reserve	34,606			38,324
Deferred rent	—			15,012
Unrecognized tax benefits	5,431			4,862
Other	3,485			876
Other long-term liabilities	$	61,813		$	78,528

Subsequent Events	12 Months Ended
Subsequent Events	Dec. 31, 2019
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events On February 14, 2020, the Company completed its acquisition of Stratus Video, a remote video interpreting company, for $475,000 in cash. Stratus Video provides healthcare interpretation via remote video, over the phone, and onsite in-person, all supported by proprietary technology platforms. To help finance the acquisition, the Company (1) entered into the Second Amendment, which provided $250,000 of additional borrowings to the Company, and (2) borrowed $175,000 under the Senior Credit Facility. The Second Amendment and Senior Credit Facility are more fully described in Note (8), “Notes Payable and Credit Agreement.”

Income Taxes

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Income Taxes

The provision for income taxes from operations for the years ended December 31, 2019, 2018 and 2017 consists of the following:



	Years Ended December 31,
	2019		2018			2017
Current income taxes:
Federal	$	25,255	$	33,564		$	45,899
State	8,332		12,047			8,699
Total	33,587		45,611			54,598
Deferred income taxes:
Federal	625		(1,372		)	1,754
State	288		705			3,853
Total	913		(667		)	5,607
Provision for income taxes from operations	$	34,500	$	44,944		$	60,205

The Company’s income tax expense differs from the amount that would have resulted from applying the federal statutory rate of 21% for both 2019 and 2018 and 35% for 2017 to pretax income from operations because of the effect of the following items during the years ended December 31, 2019, 2018 and 2017:



	Years Ended December 31,
	2019			2018			2017
Tax expense at federal statutory rate	$	31,253		$	39,272		$	67,467
State taxes, net of federal benefit	6,810			9,902			7,880
Non-deductible expenses	3,840			2,956			3,849
Share-based compensation	(4,770		)	(4,343		)	(4,889		)
Corporate tax rate change impact on deferred income taxes	—			—			(14,039		)
Unrecognized tax benefit	(207		)	413			(1,175		)
Other, net	(2,426		)	(3,256		)	1,112
Income tax expense from operations	$	34,500		$	44,944		$	60,205

The adoption of ASU 2016-09, “Stock Compensation - Improvements to Employee Share-Based Payment Accounting” in the first quarter of 2017, resulted in recording reductions in income tax expense of $5,915, $5,401, and $5,449 for the years ended December 31, 2019, 2018, and 2017. Prior to adoption, this amount would have been recorded as additional paid-in capital.

The tax effects of temporary differences that give rise to significant portions of deferred tax assets and liabilities are presented below as of the years ended December 31, 2019 and 2018:



	Years Ended December 31,
	2019			2018
Deferred tax assets:
Stock compensation	$	5,848		$	6,606
Deferred compensation	20,564			13,869
Accrued expenses	18,572			21,643
Deferred rent	—			4,000
Operating lease liabilities	27,206			—
Net operating losses	3,448			1,846
Other	570			1,030
Total deferred tax assets	$	76,208		$	48,994
Deferred tax liabilities:
Intangibles	$	(71,646	)	$	(51,493	)
Fixed assets	(22,896		)	(19,802		)
Operating lease right-of-use assets	(23,234		)	—
Other	(5,050		)	(5,025		)
Total deferred tax liabilities	$	(122,826	)	$	(76,320	)
Valuation allowance	$	—		$	—
Net deferred tax liabilities	$	(46,618	)	$	(27,326	)

In the current year, the Company recognized deferred tax assets and deferred tax liabilities associated with operating lease liabilities and right-of-use assets, respectively, in accordance with ASU 2016-02. The Company also derecognized existing deferred rent liabilities, but consistent with its adoption of ASU 2016-02 and the optional transition method, there has been no change to the prior year deferred tax assets related to deferred rent liabilities. The Company’s adoption of ASU 2016-02 is more fully described in Note (1), “Summary of Significant Accounting Policies.”

In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. Management believes it is more likely than not that the Company will realize the benefits of its deferred tax assets.

The amount of federal net operating losses (“NOL”) carryforward that is available for use in years subsequent to December 31, 2019 is $16,418, which is set to expire by 2029. The amount of state NOL carryforward that is available for use in years subsequent to December 31, 2019 is not material.

A summary of the changes in the amount of unrecognized tax benefits (excluding interest and penalties) for 2019, 2018 and 2017 is as follows:



	2019			2018			2017
Beginning balance of unrecognized tax benefits	$	4,393		$	4,663		$	6,842
Additions based on tax positions related to the current year	588			475			513
Additions based on tax positions of prior years	990			753			731
Reductions due to lapse of applicable statute of limitation	(1,034		)	(547		)	(949		)
Settlements	—			(951		)	(2,474		)
Ending balance of unrecognized tax benefits	$	4,937		$	4,393		$	4,663

At December 31, 2019, if recognized, approximately $4,695 net of $736 of temporary differences would affect the effective tax rate (including interest and penalties).

The Company recognizes interest related to unrecognized tax benefits in income tax expense. The Company had approximately $493, $467 and $606 of accrued interest related to unrecognized tax benefits at December 31, 2019, 2018 and 2017, respectively. The amount of interest expense (benefit) recognized in 2019, 2018 and 2017 was $26, $(139) and $(1,016), respectively.

The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of December 31, 2019, the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2010, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2016. The IRS conducted, completed, and settled audits of the Company’s 2011-2012 and 2013 tax years related to income and employment tax issues for the Company’s treatment of certain non-taxable per diem allowances and travel benefits in November 2017 and May 2018, respectively. Prior to the Company’s acquisition of Advanced, on June 14, 2019, Advanced was under an IRS audit for the years 2011-2013 for various payroll tax matters related to the treatment of certain non-taxable per diem allowances and travel benefits. This audit was completed and an assessment was issued for $8,300 in July 2018. Advanced filed a protest in August 2018 and had their first IRS Appeals meeting in May 2019. The Company received a final determination from the IRS in November 2019. The Company is indemnified for the potential contingent liability by Advanced. The Advanced acquisition is more fully described in Note (2), “Acquisitions.”

The Company believes its reserve 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.

Tax Cuts and Jobs Act

On December 22, 2017, the U.S. government enacted comprehensive tax legislation commonly referred to as the Tax Cuts and Jobs Act (the “Tax Act”). The Tax Act makes broad and complex changes to the U.S. tax code, including, but not limited to, reducing the U.S. federal corporate tax rate from 35% to 21%.

The Tax Act changes that affected the Company in 2017 are primarily tax rate changes on certain deferred tax assets (“DTAs”) and deferred tax liabilities (“DTLs”). The Tax Act also establishes new tax laws that will affect 2018 and beyond, including, but not limited to, (1) reduction of the U.S. federal corporate tax rate; (2) the repeal of the domestic production activity deduction; (3) limitations on the deductibility of certain executive compensation; and (4) limitations on various entertainment and meals deductions.

The SEC staff issued Staff Accounting Bulletin No. 118 (“SAB 118”), which provides guidance on accounting for the tax effects of the Tax Act. SAB 118 provides a measurement period that should not extend beyond one year from the Tax Act enactment date for companies to complete the accounting under ASC 740. To the extent that a company’s accounting for certain income tax effects of the Tax Act is incomplete but it is able to determine a reasonable estimate, it must record a provisional estimate in the financial statements.

The Company’s accounting for the following elements of the Tax Act was incomplete as of the year ended December 31, 2017. The Company was able to make reasonable estimates of executive compensation and accounting methods and, therefore, recorded provisional adjustments for these items. Final adjustments were made in the quarter ended December 31, 2018 which were not material and the accounting for these elements is now considered complete.

Leases - Maturity of Lease Liabilities (Details) $ in Thousands	Dec. 31, 2019 USD ($)
Leases [Abstract]
2020	$ 18,651
2021	18,599
2022	18,227
2023	17,895
2024	16,711
Thereafter	33,666
Total lease payments	123,749
Less imputed interest	(18,597)
Present value of lease liabilities	$ 105,152

Summary of Significant Accounting Policies - Segment Information (Details) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019 USD ($)	Sep. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Mar. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Sep. 30, 2018 USD ($)	Jun. 30, 2018 USD ($)	Mar. 31, 2018 USD ($)	Dec. 31, 2019 USD ($) segment	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)
Accounting Policies [Abstract]
Number of reportable segments \| segment									3
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	$ 586,892	$ 567,597	$ 535,177	$ 532,441	$ 528,635	$ 526,842	$ 558,108	$ 522,489	$ 2,222,107	$ 2,136,074	$ 1,988,454
Segment operating income									176,915	202,828	212,440
Depreciation and amortization									58,520	41,237	32,279
Share-based compensation									16,241	10,815	10,237
Interest expense, net, and other									28,427	16,143	19,677
Income before income taxes									148,488	186,685	192,763
Operating Segments
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									2,222,107	2,136,074	1,988,454
Segment operating income									335,139	329,316	315,368
Operating Segments \| Nurse and Allied Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									1,419,965	1,306,516	1,238,543
Segment operating income									199,806	183,427	182,792
Operating Segments \| Locum Tenens Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									324,653	393,366	430,615
Segment operating income									25,108	41,348	51,422
Operating Segments \| Other Workforce Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									477,489	436,192	319,296
Segment operating income									110,225	104,541	81,154
Corporate, Non-Segment
Segment Reporting Information, Profit (Loss) [Abstract]
Unallocated corporate overhead									$ 83,463	$ 74,436	$ 60,412
Managed Services Program Arrangements \| Nurse and Allied Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue from program arrangements, percent									63.00%	62.00%	58.00%
Managed Services Program Arrangements \| Locum Tenens Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue from program arrangements, percent									23.00%	17.00%	13.00%
Managed Services Program Arrangements \| Other Workforce Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue from program arrangements, percent									8.00%	7.00%	8.00%

Summary of Significant Accounting Policies - Fixed Assets (Details)	12 Months Ended
	Dec. 31, 2019
Furniture, Equipment and Technology and Software \| Minimum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	3 years
Furniture, Equipment and Technology and Software \| Maximum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	10 years
Software Development \| Minimum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	3 years
Software Development \| Maximum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	10 years

Acquisitions (Details)						3 Months Ended			12 Months Ended			36 Months Ended
Acquisitions (Details)	Dec. 19, 2019 USD ($)	Jun. 14, 2019 USD ($)	Jan. 30, 2019 USD ($)	Apr. 09, 2018 USD ($)	Apr. 06, 2018 USD ($) aquisition	Sep. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Sep. 30, 2018 USD ($)	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Dec. 31, 2019 USD ($) aquisition	Feb. 09, 2018 USD ($)
Business Combination, Description
Number of acquisitions \| aquisition												5
Cash consideration									$ 247,906,000	$ 217,360,000	$ 0
Additional cash paid for working capital adjustment settlement									0	0	1,500,000
Goodwill									595,551,000	438,506,000	340,596,000	$ 595,551,000
Earn-out settlement for prior acquisition									5,700,000	1,713,000	3,677,000
Nurse and Allied Solutions
Business Combination, Description
Goodwill									222,946,000	103,107,000	103,107,000	222,946,000
Locum Tenens Solutions
Business Combination, Description
Goodwill									19,743,000	19,743,000	19,743,000	19,743,000
Other Workforce Solutions
Business Combination, Description
Goodwill									$ 352,862,000	$ 315,656,000	$ 217,746,000	$ 352,862,000
b4health acquisition
Business Combination, Description
Purchase price of the acquisition	$ 23,006,000
Cash consideration	19,906,000
Fair value of contingent earn-out	3,100,000
Contingent earn-out based on future operating performance (up to)	12,000,000
Fair value of tangible assets acquired	1,169,000
Cash received	222,000
Liabilities assumed	823,000
Identified intangible assets	9,000,000
Goodwill expected to be tax deductible	$ 13,660,000
Weighted average useful life of intangible assets	7 years
b4health acquisition \| Developed Technology
Business Combination, Description
Identified intangible assets	$ 3,000,000
b4health acquisition \| Trademarks
Business Combination, Description
Identified intangible assets	2,000,000
b4health acquisition \| Customer Relationships
Business Combination, Description
Identified intangible assets	$ 4,000,000
Advanced Acquisition
Business Combination, Description
Purchase price of the acquisition		$ 211,743,000				$ 211,816,000
Cash consideration		201,121,000				$ 73,000
Fair value of contingent earn-out		10,622,000
Contingent earn-out based on future operating performance (up to)		20,000,000
Fair value of tangible assets acquired		29,035,000
Cash received		2,497,000
Liabilities assumed		28,758,000
Identified intangible assets		91,700,000
Goodwill		119,839,000
Goodwill expected to be tax deductible		$ 57,121,000
Weighted average useful life of intangible assets		9 years
Advanced Acquisition \| Developed Technology
Business Combination, Description
Identified intangible assets		$ 3,400,000
Useful life		3 years
Advanced Acquisition \| Tradenames and Trademarks
Business Combination, Description
Identified intangible assets		$ 10,000,000
Useful life		5 years
Advanced Acquisition \| Customer Relationships
Business Combination, Description
Identified intangible assets		$ 68,000,000
Useful life		10 years
Advanced Acquisition \| Staffing Database
Business Combination, Description
Identified intangible assets		$ 10,300,000
Useful life		10 years
Silversheet, Inc. Acquisition
Business Combination, Description
Purchase price of the acquisition			$ 31,676,000
Cash consideration			30,176,000
Fair value of contingent earn-out			1,500,000
Contingent earn-out based on future operating performance (up to)			25,000,000
Fair value of tangible assets acquired			2,826,000
Cash received			651,000
Liabilities assumed			1,567,000
Identified intangible assets			6,880,000
Goodwill			$ 23,537,000
Weighted average useful life of intangible assets			8 years
Silversheet, Inc. Acquisition \| Developed Technology
Business Combination, Description
Identified intangible assets			$ 5,300,000
Silversheet, Inc. Acquisition \| Trademarks
Business Combination, Description
Identified intangible assets			1,500,000
Silversheet, Inc. Acquisition \| Based on operating results for the twelve months ending December 31, 2019
Business Combination, Description
Contingent earn-out based on future operating performance (up to)			6,000,000
Silversheet, Inc. Acquisition \| Based on operating results for the twelve months ending December 31, 2020
Business Combination, Description
Contingent earn-out based on future operating performance (up to)			$ 19,000,000
MedPartners Acquisition
Business Combination, Description
Purchase price of the acquisition				$ 200,933,000			$ 200,711,000
Cash consideration				196,533,000
Fair value of contingent earn-out				4,400,000
Contingent earn-out based on future operating performance (up to)				20,000,000
Final working capital settlement								$ 222,000
Fair value of tangible assets acquired				28,508,000
Cash received				8,403,000
Liabilities assumed				11,933,000
Identified intangible assets				103,000,000
Goodwill				$ 81,136,000
Weighted average useful life of intangible assets				16 years
MedPartners Acquisition \| Tradenames and Trademarks
Business Combination, Description
Identified intangible assets				$ 46,000,000
Useful life				20 years		5 years
MedPartners Acquisition \| Customer Relationships
Business Combination, Description
Identified intangible assets				$ 57,000,000
Useful life				12 years
MedPartners Acquisition \| Based on operating results for the twelve months ending December 31, 2019
Business Combination, Description
Contingent earn-out based on future operating performance (up to)				$ 10,000,000
MedPartners Acquisition \| Based on operating results for the twelve months ending December 31, 2020
Business Combination, Description
Contingent earn-out based on future operating performance (up to)				$ 10,000,000
PDA and LFT
Business Combination, Description
Number of acquisitions \| aquisition					2
Purchase price of the acquisition					$ 35,968,000		$ 35,503,000
Cash consideration					30,268,000
Fair value of contingent earn-out					5,700,000
Contingent earn-out based on future operating performance (up to)					7,000,000
Final working capital settlement								$ 465,000
Fair value of tangible assets acquired					4,389,000
Cash received					351,000
Liabilities assumed					4,779,000
Identified intangible assets					19,110,000
Goodwill					$ 16,783,000
Weighted average useful life of intangible assets					12 years
PDA and LFT \| Trademarks
Business Combination, Description
Identified intangible assets					$ 5,400,000
PDA and LFT \| Customer Relationships
Business Combination, Description
Identified intangible assets					8,000,000
PDA and LFT \| Staffing Database
Business Combination, Description
Identified intangible assets					$ 5,710,000
Revolving Credit Facility \| Line of Credit
Business Combination, Description
Maximum borrowing capacity													$ 400,000,000
Secured Debt \| Line of Credit
Business Combination, Description
Maximum borrowing capacity		$ 150,000,000

Cover Page - USD ($)	12 Months Ended
Cover Page - USD ($)	Dec. 31, 2019	Feb. 20, 2020	Jun. 30, 2019
Cover page.
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2019
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 Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
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 Public Float			$ 2,500,498,215
Entity Common Stock, Shares Outstanding		46,854,215
Entity Central Index Key	0001142750
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	FY
Amendment Flag	false

Share-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2019

Share-based Payment Arrangement [Abstract]

Schedule of RSU and PRSU activity for non-vested awards

The following table summarizes RSU and PRSU activity for non-vested awards for the years ended December 31, 2019, 2018 and 2017:



	Number of Shares		Weighted Average Grant Date Fair Value per Share
Unvested at January 1, 2016	1,075		$	22.14
Granted—RSUs	166		$	40.73
Granted—PRSUs (1)	317		$	27.51
Vested	(637	)	$	16.88
Canceled/forfeited/expired	(66	)	$	30.02
Unvested at December 31, 2017	855		$	30.98
Granted—RSUs	279		$	53.73
Granted—PRSUs (1)	266		$	35.28
Vested	(499	)	$	23.04
Canceled/forfeited/expired	(83	)	$	42.32
Unvested at December 31, 2018	818		$	43.84
Granted—RSUs	191		$	54.99
Granted—PRSUs (1)	201		$	48.32
Vested	(400	)	$	35.46
Canceled/forfeited/expired	(52	)	$	41.09
Unvested at December 31, 2019	758		$	52.45

(1) PRSUs granted included both the PRSUs granted during the year at the target amount and the additional shares of prior period granted PRSUs vested during the year in excess of the target shares.

Schedule of stock option and SAR activity

A summary of stock option and SAR activity under the Equity Plan and Other Plans are as follows:



	Number Outstanding		Weighted- Average Exercise Price per Share
Outstanding at December 31, 2016	286		$	9.67
Granted	—		$	—
Exercised	(24	)	$	18.85
Canceled/forfeited/expired	—		$	—
Outstanding at December 31, 2017	262		$	8.81
Granted	—		$	—
Exercised	(35	)	$	10.12
Canceled/forfeited/expired	—		$	—
Outstanding at December 31, 2018	227		$	8.61
Granted	—		$	—
Exercised	(215	)	$	8.67
Canceled/forfeited/expired	—		$	—
Outstanding at December 31, 2019	12		$	7.51
Vested and expected to vest at December 31, 2019	12		$	7.51
Exercisable at December 31, 2019	12		$	7.51

Schedule of share-based compensation expense

Total share-based compensation expense for the years ended December 31, 2019, 2018 and 2017 was as follows:



	Years Ended December 31,
	2019			2018			2017
Share-based employee compensation, before tax	$	16,241		$	10,815		$	10,237
Related income tax benefits	(4,223		)	(2,812		)	(3,985		)
Share-based employee compensation, net of tax	$	12,018		$	8,003		$	6,252

Quarterly Financial Data (Unaudited)

12 Months Ended

Dec. 31, 2019

Quarterly Financial Information Disclosure [Abstract]

Quarterly Financial Data (Unaudited)



	Year Ended December 31, 2019
	First Quarter		Second Quarter		Third Quarter		Fourth Quarter		Total Year
	(In thousands, except per share data)
Revenue	$	532,441	$	535,177	$	567,597	$	586,892	$	2,222,107
Gross profit	$	176,759	$	179,542	$	190,031	$	197,133	$	743,465
Net income	$	34,122	$	28,869	$	23,515	$	27,482	$	113,988
Net income per share from:
Basic	$	0.73	$	0.62	$	0.50	$	0.59	$	2.44
Diluted	$	0.71	$	0.61	$	0.49	$	0.58	$	2.40



	Year Ended December 31, 2018
	First Quarter		Second Quarter		Third Quarter		Fourth Quarter		Total Year
	(In thousands, except per share data)
Revenue	$	522,489	$	558,108	$	526,842	$	528,635	$	2,136,074
Gross profit	$	167,824	$	180,956	$	175,147	$	172,456	$	696,383
Net income	$	42,681	$	35,529	$	27,918	$	35,613	$	141,741
Net income per share from:
Basic	$	0.89	$	0.75	$	0.59	$	0.76	$	2.99
Diluted	$	0.87	$	0.73	$	0.58	$	0.74	$	2.91

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 8,027	$ 10,560
Accumulated depreciation	132,900	114,413
Accumulated amortization	$ 151,417	$ 114,924
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	49,283,000	48,809,000
Common stock, shares outstanding	46,722,000	46,643,000
Treasury Stock, shares	2,561,000	2,166,000

Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Statement of Cash Flows [Abstract]
Interest capitalized	$ 536	$ 460	$ 188

Summary of Significant Accounting Policies - Net Income per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Computation of Basic and Diluted Net Income Per Common Share [Abstract]
Net income	$ 27,482	$ 23,515	$ 28,869	$ 34,122	$ 35,613	$ 27,918	$ 35,529	$ 42,681	$ 113,988	$ 141,741	$ 132,558
Net income per common share - basic (in dollars per share)	$ 0.59	$ 0.50	$ 0.62	$ 0.73	$ 0.76	$ 0.59	$ 0.75	$ 0.89	$ 2.44	$ 2.99	$ 2.77
Net income per common share - diluted (in dollars per share)	$ 0.58	$ 0.49	$ 0.61	$ 0.71	$ 0.74	$ 0.58	$ 0.73	$ 0.87	$ 2.40	$ 2.91	$ 2.68
Weighted average common shares outstanding - basic (shares)									46,704	47,371	47,807
Plus dilutive effect of potential common shares (shares)									889	1,297	1,623
Weighted average common shares outstanding - diluted (shares)									47,593	48,668	49,430
Stock Compensation Plan
Class of Stock [Line Items]
Common stock excluded from calculation of EPS (shares)									43	23	20

Fair Value Measurement (Tables)

12 Months Ended

Dec. 31, 2019

Fair Value Disclosures [Abstract]

Schedule of financial assets and liabilities measured at fair value on recurring basis

The following tables present information about assets and liabilities measured at fair value on a recurring basis and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value:



	Fair Value Measurements as of December 31, 2019
Assets (Liabilities)	Total			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Money market funds	$	2,508		$	2,508		$	—	$	—
Deferred compensation	(81,064		)	(81,064		)	—		—
Commercial paper	59,243			—			59,243		—
Acquisition contingent consideration liabilities	(23,100		)	—			—		(23,100		)



	Fair Value Measurements as of December 31, 2018
Assets (Liabilities)	Total			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Money market funds	$	2,461		$	2,461		$	—	$	—
Deferred compensation	(55,720		)	(55,720		)	—		—
Commercial paper	63,243			—			63,243		—
Acquisition contingent consideration liabilities	(7,700		)	—			—		(7,700		)

Reconciliation of changes in fair value of contingent consideration liabilities

The following table sets forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy:



	2019			2018
Balance as of January 1,	$	(7,700	)	$	(2,070	)
Settlement of HealthSource Global contingent consideration liability for year ended December 31, 2016	—			70
Settlement of HealthSource Global contingent consideration liability for year ended December 31, 2017	—			2,000
Settlement of PDA and LFT contingent consideration liability for year ended December 31, 2018	7,000			—
Contingent consideration liability from PDA and LFT acquisition on April 6, 2018	—			(5,700		)
Contingent consideration liability from MedPartners acquisition on April 9, 2018	—			(4,400		)
Contingent consideration liability from Silversheet acquisition on January 30, 2019	(1,500		)	—
Contingent consideration liability from Advanced acquisition on June 14, 2019	(10,622		)	—
Contingent consideration liability from b4health acquisition on December 19, 2019	(3,100		)	—
Change in fair value of contingent consideration liability from PDA and LFT acquisition	—			(1,300		)
Change in fair value of contingent consideration liability from MedPartners acquisition	700			3,700
Change in fair value of contingent consideration liability from Silversheet acquisition	1,500			—
Change in fair value of contingent consideration liability from Advanced acquisition	(9,378		)	—
Balance as of December 31,	$	(23,100	)	$	(7,700	)

Fair Value of Financial Instruments

The carrying amounts and estimated fair value of the 2024 Notes and the 2027 Notes, which are more fully described in Note (8), “Notes Payable and Credit Agreement,” are presented in the following table:



	As of December 31, 2019				As of December 31, 2018
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2024 Notes	$	325,000	$	337,188	$	325,000	$	310,375
2027 Notes	300,000		301,500		—		—

Summary of Significant Accounting Policies - Restricted Cash, Cash Equivalents and Investments (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Accounting Policies [Abstract]
Cash and cash equivalents	$ 82,985	$ 13,856
Restricted cash and cash equivalents (included in other current assets)	18,393	26,329
Restricted cash, cash equivalents and investments	62,170	59,331
Total cash, cash equivalents and restricted cash and investments	163,548	99,516
Less restricted investments	(9,586)	(15,192)
Total cash, cash equivalents and restricted cash	$ 153,962	$ 84,324	$ 98,894	$ 51,028

Capital Stock	12 Months Ended
Capital Stock	Dec. 31, 2019
Equity [Abstract]
Capital Stock	Capital Stock (a) Preferred Stock The Company has 10,000 shares of preferred stock authorized for issuance in one or more series (including preferred stock designated as Series A Conditional Convertible Preferred Stock), at a par value of $0.01 per share. At December 31, 2019 and 2018, no shares of preferred stock were outstanding. (b) Treasury Stock On November 1, 2016, the Company’s Board of Directors approved a share repurchase program under which the Company may repurchase up to $150,000 of its outstanding common stock. The amount and timing of the purchases will depend on a number of factors including the price of the Company’s shares, trading volume, Company performance, Company liquidity, general economic and market conditions and other factors that the Company’s management believes are relevant. The share repurchase program does not require the purchase of any minimum number of shares and may be suspended or discontinued at any time. The Company intends to make all repurchases and to administer the plan in accordance with applicable laws and regulatory guidelines, including Rule 10b-18 of the Exchange Act, and in compliance with its debt instruments. Repurchases may be made from cash on hand, free cash flow generated from the Company’s business or from the Company’s Senior Credit Facility. Repurchases may be made from time to time through open market purchases or privately negotiated transactions. Repurchases may also be made pursuant to one or more plans established pursuant to Rule 10b5-1 under the Exchange Act, which would permit shares to be repurchased when the Company might otherwise be precluded from doing so under insider trading restrictions. During 2019, the Company repurchased 395 shares of its common stock at an average price of $47.30 per share, resulting in an aggregate purchase price of $18,705. During 2018, the Company repurchased 1,236 shares of its common stock at an average price of $54.17 per share, resulting in an aggregate purchase price of $67,013.

Goodwill and Identifiable Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of acquired intangible assets by major class

As of December 31, 2019 and 2018, the Company had the following acquired intangible assets:



	As of December 31, 2019							As of December 31, 2018
	Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount
Intangible assets subject to amortization:
Staffing databases	$	35,836	$	(13,369	)	$	22,467	$	25,536	$	(10,174	)	$	15,362
Customer relationships	273,839		(94,206		)	179,633		201,759		(75,081		)	126,678
Tradenames and trademarks	126,269		(33,545		)	92,724		112,769		(22,529		)	90,240
Non-compete agreements	4,117		(2,035		)	2,082		2,877		(1,410		)	1,467
Acquired technology	20,430		(8,262		)	12,168		8,730		(5,730		)	3,000
	$	460,491	$	(151,417	)	$	309,074	$	351,671	$	(114,924	)	$	236,747
Intangible assets not subject to amortization:
Tradenames and trademarks						$	89,400						$	89,400
						$	398,474						$	326,147

Schedule of estimated amortization expense

Based on the current amount of intangibles subject to amortization, the estimated future amortization expense as of December 31, 2019 is as follows:



	Amount
Year ending December 31, 2020	$	44,017
Year ending December 31, 2021	41,735
Year ending December 31, 2022	40,754
Year ending December 31, 2023	39,647
Year ending December 31, 2024	33,400
Thereafter	109,521
	$	309,074

Schedule of goodwill

The following table summarizes the activity related to the carrying value of goodwill by reportable segment:



	Nurse and Allied Solutions		Locum Tenens Solutions		Other Workforce Solutions			Total
Balance, January 1, 2018	$	103,107	$	19,743	$	217,746		$	340,596
Goodwill from MedPartners acquisition	—		—		81,113			81,113
Goodwill from PDA and LFT acquisition	—		—		16,797			16,797
Balance, December 31, 2018	103,107		19,743		315,656			438,506
Goodwill adjustment for MedPartners acquisition	—		—		23			23
Goodwill adjustment for PDA and LFT acquisition	—		—		(14		)	(14		)
Goodwill from Silversheet acquisition	—		—		23,537			23,537
Goodwill from Advanced acquisition	119,839		—		—			119,839
Goodwill from b4health acquisition	—		—		13,660			13,660
Balance, December 31, 2019	$	222,946	$	19,743	$	352,862		$	595,551
Accumulated impairment loss as of December 31, 2018 and 2019	$	154,444	$	53,940	$	6,555		$	214,939

Retirement Plans	12 Months Ended
Retirement Plans	Dec. 31, 2019
Retirement Benefits [Abstract]
Retirement Plans	Retirement Plans The Company maintains the AMN Services 401(k) Retirement Savings Plan (the “AMN Plan”), which the Company believes complies with the IRC Section 401(k) provisions. The AMN Plan covers all employees that meet certain age and other eligibility requirements. An annual discretionary matching contribution is determined by the Compensation and Stock Plan Committee of the Board of Directors each year. Employer contribution expenses incurred under the AMN Plan were $5,516, $5,250 and $4,486 for the years ended December 31, 2019, 2018 and 2017, respectively. The Company has a deferred compensation plan for certain executives and key employees (the “Plan”). The Plan is not intended to be tax qualified and is an unfunded plan. The Plan is composed of deferred compensation and all related income and losses attributable thereto. Discretionary matching contributions to the Plan are made that vest incrementally so that the employee is fully vested in the match following five years of employment with the Company. Under the Plan, participants can defer up to 80% of their base salary, 90% of their bonus and 100% of their vested RSUs or vested PRSUs. An annual discretionary matching contribution is determined by the Compensation and Stock Plan Committee of the Board of Directors each year. Employer contributions under the Plan were $5,551, $4,708 and $4,545 for the years ended December 31, 2019, 2018 and 2017, respectively. In connection with the administration of the Plan, the Company has purchased company-owned life insurance policies insuring the lives of certain officers and key employees. The cash surrender value of these policies was $79,515 and $55,028 at December 31, 2019 and 2018, respectively. The cash surrender value of these insurance policies is included in other assets in the consolidated balance sheets.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Principles of Consolidation

Use of Estimates

Cash and Cash Equivalents

Restricted Cash, Cash Equivalents, and Investments

Restricted Cash, Cash Equivalents and Investments

asset, the Company compares its fair value with its carrying amount. If the carrying amount exceeds the fair value, the Company records the excess as an impairment loss.

Insurance Reserves

Revenue Recognition

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 to which 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.

•

Accounts Receivable

Concentration of Credit Risk

The majority of the Company’s business activity is with hospitals located throughout the United States. Credit is extended based on the evaluation of each entity’s financial condition. The Company’s cash and cash equivalents and restricted cash, cash equivalents and investments accounts are financial instruments that are exposed to concentration of credit risk. The Company maintains most of its cash, cash equivalents and investment balances with high-credit quality and federally insured institutions. However, restricted cash equivalents and investment balances may be invested in a non-federally insured money market account and commercial paper.

Income Taxes

Fair Value of Financial Instruments

Share-Based Compensation

Segment Information

Recently Adopted Accounting Pronouncements

There were no other material impacts to the Company’s consolidated financial statements as a result of adopting these updated standards.

Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Statement of Comprehensive Income [Abstract]
Revenue	$ 2,222,107	$ 2,136,074	$ 1,988,454
Cost of revenue	1,478,642	1,439,691	1,344,035
Gross profit	743,465	696,383	644,419
Operating expenses:
Selling, general and administrative	508,030	452,318	399,700
Depreciation and amortization	58,520	41,237	32,279
Total operating expenses	566,550	493,555	431,979
Income from operations	176,915	202,828	212,440
Interest expense, net, and other	28,427	16,143	19,677
Income before income taxes	148,488	186,685	192,763
Income tax expense	34,500	44,944	60,205
Net income	113,988	141,741	132,558
Other comprehensive income (loss):
Foreign currency translation and other	1	263	(98)
Cash flow hedge, net of income taxes	0	0	(15)
Other comprehensive income (loss)	1	263	(113)
Comprehensive income	$ 113,989	$ 142,004	$ 132,445
Net income per common share:
Net income per common share - basic (in dollars per share)	$ 2.44	$ 2.99	$ 2.77
Net income per common share - diluted (in dollars per share)	$ 2.40	$ 2.91	$ 2.68
Weighted average common shares outstanding:
Weighted average common shares outstanding - basic (shares)	46,704	47,371	47,807
Weighted average common shares outstanding - diluted (shares)	47,593	48,668	49,430

Balance Sheet Details (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Other current assets:
Restricted cash and cash equivalents	$ 18,393	$ 26,329
Income taxes receivable	5,984	799
Other	16,069	12,759
Other current assets	40,446	39,887
Fixed assets:
Furniture and equipment	37,315	34,211
Technology and software	191,050	162,006
Leasehold improvements	9,367	8,615
Fixed assets, gross	237,732	204,832
Accumulated depreciation	(132,900)	(114,413)
Fixed assets, net	104,832	90,419
Accounts payable and accrued expenses:
Trade accounts payable	26,985	31,537
Subcontractor payable	75,562	50,892
Accrued expenses	36,344	30,236
Loss contingencies	6,146	24,549
Professional liability reserve	7,925	8,633
Other	3,178	3,756
Accounts payable and accrued expenses	156,140	149,603
Accrued compensation and benefits:
Accrued payroll	47,381	42,571
Accrued bonuses and commissions	22,613	18,021
Accrued travel expense	2,459	3,417
Health insurance reserve	4,019	3,559
Workers compensation reserve	8,782	7,817
Deferred compensation	81,064	55,720
Other	4,614	3,954
Accrued compensation and benefits	170,932	135,059
Other current liabilities:
Acquisition related liabilities	20,000	7,918
Other	5,302	2,325
Other current liabilities	25,302	10,243
Other long-term liabilities:
Workers compensation reserve	18,291	19,454
Professional liability reserve	34,606	38,324
Deferred rent		15,012
Unrecognized tax benefits	5,431	4,862
Other	3,485	876
Other long-term liabilities	$ 61,813	$ 78,528

Share-Based Compensation - Restricted Stock Units (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Number of Shares
Unvested, Beginning Balance (shares)	818	855	1,075
Vested (shares)	(400)	(499)	(637)
Canceled/forfeited/expired (shares)	(52)	(83)	(66)
Unvested, Ending Balance (shares)	758	818	855
Weighted Average Grant Date Fair Value per Share
Unvested, Beginning Balance (in dollars per share)	$ 43.84	$ 30.98	$ 22.14
Vested (in dollars per share)	35.46	23.04	16.88
Canceled/forfeited/expired (in dollars per share)	41.09	42.32	30.02
Unvested, Ending Balance (in dollars per share)	$ 52.45	$ 43.84	$ 30.98
Restricted Stock Units (RSUs)
Number of Shares
Granted (shares)	191	279	166
Weighted Average Grant Date Fair Value per Share
Granted (in dollars per share)	$ 54.99	$ 53.73	$ 40.73
Performance Restricted Stock Units (PRSUs)
Number of Shares
Granted (shares)	201	266	317
Weighted Average Grant Date Fair Value per Share
Granted (in dollars per share)	$ 48.32	$ 35.28	$ 27.51

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies 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 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 employees were not afforded required breaks or compensated for all time worked, employees’ wage statements are not sufficiently clear, and certain expense reimbursements should be included in the regular rate of pay for purposes of calculating overtime rates. The Company believes that its wage and hour practices conform with law in all material respects, but litigation is always subject to inherent uncertainty. With regards to loss contingencies accrued as of December 31, 2019, which are included in accounts payable and accrued expenses in the consolidated balance sheet, the Company believes that such matters will not, either individually or in the aggregate, have a material adverse effect on its business, consolidated financial position, results of operations, or cash flows.

Income Taxes - Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income tax reconciliation
Tax expense at federal statutory rate	$ 31,253	$ 39,272	$ 67,467
State taxes, net of federal benefit	6,810	9,902	7,880
Non-deductible expenses	3,840	2,956	3,849
Share-based compensation	(4,770)	(4,343)	(4,889)
Corporate tax rate change impact on deferred income taxes	0	0	(14,039)
Unrecognized tax benefit	(207)	413	(1,175)
Other, net	(2,426)	(3,256)	1,112
Income tax expense from operations	34,500	44,944	60,205
Accounting Standards Update 2016-09
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Tax benefits related to excess tax benefit on share-bases compensation	$ 5,915	$ 5,401	$ 5,449

Balance Sheet Details (Tables)

12 Months Ended

Dec. 31, 2019

Balance Sheet Related Disclosures [Abstract]

Consolidated balance sheet details

The consolidated balance sheets detail is as follows as of December 31, 2019 and 2018:



	As of December 31,
	2019			2018
Other current assets:
Restricted cash and cash equivalents	$	18,393		$	26,329
Income taxes receivable	5,984			799
Other	16,069			12,759
Other current assets	$	40,446		$	39,887

Fixed assets:
Furniture and equipment	$	37,315		$	34,211
Technology and software	191,050			162,006
Leasehold improvements	9,367			8,615
	237,732			204,832
Accumulated depreciation	(132,900		)	(114,413		)
Fixed assets, net	$	104,832		$	90,419

Accounts payable and accrued expenses:
Trade accounts payable	$	26,985		$	31,537
Subcontractor payable	75,562			50,892
Accrued expenses	36,344			30,236
Loss contingencies	6,146			24,549
Professional liability reserve	7,925			8,633
Other	3,178			3,756
Accounts payable and accrued expenses	$	156,140		$	149,603

Accrued compensation and benefits:
Accrued payroll	$	47,381		$	42,571
Accrued bonuses and commissions	22,613			18,021
Accrued travel expense	2,459			3,417
Health insurance reserve	4,019			3,559
Workers compensation reserve	8,782			7,817
Deferred compensation	81,064			55,720
Other	4,614			3,954
Accrued compensation and benefits	$	170,932		$	135,059

Other current liabilities:
Acquisition related liabilities	$	20,000		$	7,918
Other	5,302			2,325
Other current liabilities	$	25,302		$	10,243

Other long-term liabilities:
Workers compensation reserve	$	18,291		$	19,454
Professional liability reserve	34,606			38,324
Deferred rent	—			15,012
Unrecognized tax benefits	5,431			4,862
Other	3,485			876
Other long-term liabilities	$	61,813		$	78,528

Acquisitions

12 Months Ended

Dec. 31, 2019

Business Combinations [Abstract]

Acquisitions

As set forth below, the Company completed five acquisitions from January 1, 2017 through December 31, 2019. The Company accounted for each acquisition using the acquisition method of accounting. Accordingly, it 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 December 31, 2019. The allocations will continue to be updated through the measurement period, if necessary. For each acquisition, the Company did not incur any material acquisition-related costs.

b4health Acquisition

On December 19, 2019, the Company completed its acquisition of B4Health, LLC (“b4health”), an innovative technology company and a leading provider of a web-based internal float pool management solution and vendor management system for healthcare facilities. The initial purchase price of $23,006 included (1) $19,906 cash consideration paid upon acquisition and (2) a contingent earn-out payment of up to $12,000 with an estimated fair value of $3,100 as of the acquisition date. The contingent earn-out payment is based on the operating results of b4health for the twelve months ending December 31, 2020. The results of b4health have been included in the Company’s other workforce solutions segment since the date of acquisition.

The allocation of the $23,006 purchase price consisted of (1) $1,169 of fair value of tangible assets acquired, which included $222 cash received, (2) $823 of liabilities assumed, (3) $9,000 of identified intangible assets, and (4) $13,660 of goodwill, all of which is deductible for tax purposes. The fair value of intangible assets includes $3,000 of developed technology, $4,000 of customer relationships, and $2,000 of trademarks with a weighted average useful life of approximately seven years.

Advanced Acquisition

On June 14, 2019, the Company completed its acquisition of Advanced Medical Personnel Services, Inc. (“Advanced”), a national healthcare staffing company that specializes in placing therapists and nurses across multiple settings. The initial purchase price of $211,743 included (1) $201,121 cash consideration paid upon acquisition and (2) a contingent earn-out payment of up to $20,000 with an estimated fair value of $10,622 as of the acquisition date. The contingent earn-out payment is based on the operating results of Advanced for the twelve months ending December 31, 2019. The acquisition was funded primarily through (1) borrowings under the Company’s $400,000 secured revolving credit facility (the “Senior Credit Facility”), provided for under a credit agreement (the “New Credit Agreement”), dated as of February 9, 2018, and (2) the First Amendment (as defined in Note (8) below) to the New Credit Agreement, which provided $150,000 of additional available borrowings to the Company. The New Credit Agreement and the First Amendment are more fully described in Note (8), “Notes Payable and Credit Agreement.” The results of Advanced have been included in the Company’s nurse and allied solutions segment since the date of acquisition. During the third quarter of 2019, an additional $73 of cash consideration was paid to the selling shareholders for the final working capital settlement.

The allocation of the $211,816 purchase price, which included the additional cash consideration paid for the final working capital settlement, consisted of (1) $29,035 of fair value of tangible assets acquired, which included $2,497 cash and restricted cash received, (2) $28,758 of liabilities assumed, (3) $91,700 of identified intangible assets, and (4) $119,839 of goodwill, of which $57,121 is expected to be deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately nine years. The following table summarizes the fair value and useful life of each intangible asset acquired:



		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer Relationships	$	68,000	10
	Tradenames and Trademarks	10,000		5
	Staffing Database	10,300		10
	Developed Technology	3,400		3
		$	91,700

Silversheet Acquisition

On January 30, 2019, the Company completed its acquisition of Silversheet, Inc. (“Silversheet”), which provides innovative software and services to reduce the complexities and challenges of the credentialing process for clinicians and healthcare organizations. The initial purchase price of $31,676 included (1) $30,176 cash consideration paid upon acquisition, funded primarily through borrowings under the Senior Credit Facility, and (2) a contingent earn-out payment of up to $25,000 with an estimated fair value of $1,500 as of the acquisition date. The contingent earn-out payment is based on (A) up to $6,000 based on the operating results of Silversheet for the twelve months ending December 31, 2019, and (B) up to $19,000 based on the operating results of Silversheet for the twelve months ending December 31, 2020. The results of Silversheet have been included in the Company’s other workforce solutions segment since the date of acquisition.

The allocation of the $31,676 purchase price consisted of (1) $2,826 of fair value of tangible assets acquired, which included $651 cash received, (2) $1,567 of liabilities assumed, (3) $6,880 of identified intangible assets, and (4) $23,537 of goodwill, none of which is deductible for tax purposes. The fair value of intangible assets primarily includes $5,300 of developed technology and $1,500 of trademarks with a weighted average useful life of approximately eight years.

MedPartners Acquisition

On April 9, 2018, the Company completed its acquisition of MedPartners HIM (“MedPartners”), which provides case management, clinical documentation improvement, medical coding and registry services to hospitals and physician medical groups nationwide. The initial purchase price of $200,933 included (1) $196,533 cash consideration paid upon acquisition, funded through borrowings under the Senior Credit Facility, (2) a contingent earn-out payment of up to $20,000 with an estimated fair value of $4,400 as of the acquisition date. The contingent earn-out payment is based on (A) up to $10,000 based on the operating results of MedPartners for the twelve months ending December 31, 2018, which resulted in no earn-out payment, and (B) up to $10,000 based on the operating results of MedPartners for the six months ending June 30, 2019, which resulted in no earn-out payment. The results of MedPartners have been included in the Company’s other workforce solutions segment since the date of acquisition. During the third quarter of 2018, $222 was returned to the Company for the final working capital settlement.

The allocation of the $200,711 purchase price, which was reduced by the final working capital settlement and finalized during the second quarter of 2019, consisted of (1) $28,508 of fair value of tangible assets acquired, which included $8,403 cash received, (2) $11,933 of liabilities assumed, (3) $103,000 of identified intangible assets, and (4) $81,136 of goodwill, all of which is deductible for tax purposes. The intangible assets acquired had a weighted average useful life of approximately sixteen years. The following table summarizes the fair value and useful life of each intangible asset acquired:



		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Tradenames and Trademarks	$	46,000	20
	Customer Relationships	57,000		12
		$	103,000

During the third quarter of 2019, the Company shortened the estimated useful life for the tradenames and trademarks intangible asset as a result of its plan to rebrand the revenue cycle solutions business. Based on this change in circumstances since the date of acquisition, the Company determined that the remaining useful life of this asset was five years and began amortizing its remaining value on a straight-line basis over the remaining useful life.

Phillips DiPisa and Leaders For Today Acquisition

On April 6, 2018, the Company completed its acquisition of two related entities, Phillips DiPisa and Leaders For Today (“PDA and LFT”), which offer a range of leadership staffing and permanent placement solutions for the healthcare industry. The initial purchase price of $35,968 included (1) $30,268 cash consideration paid upon acquisition, funded through cash on hand, and (2) a contingent earn-out payment of up to $7,000 with an estimated fair value of $5,700 as of the acquisition date. The contingent earn-out payment is based on the operating results of PDA and LFT for the twelve months ending December 31, 2018, which was settled in full during the second quarter of 2019. The results of PDA and LFT have been included in the Company’s other workforce solutions segment since the date of acquisition. During the third quarter of 2018, $465 was returned to the Company for the final working capital settlement.

The allocation of the $35,503 purchase price, which was reduced by the final working capital settlement and finalized during the second quarter of 2019, consisted of (1) $4,389 of fair value of tangible assets acquired, which included $351 cash received, (2) $4,779 of liabilities assumed, (3) $19,110 of identified intangible assets, and (4) $16,783 of goodwill, all of which is deductible for tax purposes. The fair value of intangible assets includes $5,400 of trademarks, $8,000 of customer relationships and $5,710 of staffing databases with a weighted average useful life of approximately twelve years.

Goodwill and Identifiable Intangible Assets

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Identifiable Intangible Assets

As of December 31, 2019 and 2018, the Company had the following acquired intangible assets:



	As of December 31, 2019							As of December 31, 2018
	Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount
Intangible assets subject to amortization:
Staffing databases	$	35,836	$	(13,369	)	$	22,467	$	25,536	$	(10,174	)	$	15,362
Customer relationships	273,839		(94,206		)	179,633		201,759		(75,081		)	126,678
Tradenames and trademarks	126,269		(33,545		)	92,724		112,769		(22,529		)	90,240
Non-compete agreements	4,117		(2,035		)	2,082		2,877		(1,410		)	1,467
Acquired technology	20,430		(8,262		)	12,168		8,730		(5,730		)	3,000
	$	460,491	$	(151,417	)	$	309,074	$	351,671	$	(114,924	)	$	236,747
Intangible assets not subject to amortization:
Tradenames and trademarks						$	89,400						$	89,400
						$	398,474						$	326,147

Aggregate amortization expense for intangible assets was $36,493 and $24,239 for the years ended December 31, 2019 and 2018, respectively. Based on the current amount of intangibles subject to amortization, the estimated future amortization expense as of December 31, 2019 is as follows:



	Amount
Year ending December 31, 2020	$	44,017
Year ending December 31, 2021	41,735
Year ending December 31, 2022	40,754
Year ending December 31, 2023	39,647
Year ending December 31, 2024	33,400
Thereafter	109,521
	$	309,074

The following table summarizes the activity related to the carrying value of goodwill by reportable segment:



	Nurse and Allied Solutions		Locum Tenens Solutions		Other Workforce Solutions			Total
Balance, January 1, 2018	$	103,107	$	19,743	$	217,746		$	340,596
Goodwill from MedPartners acquisition	—		—		81,113			81,113
Goodwill from PDA and LFT acquisition	—		—		16,797			16,797
Balance, December 31, 2018	103,107		19,743		315,656			438,506
Goodwill adjustment for MedPartners acquisition	—		—		23			23
Goodwill adjustment for PDA and LFT acquisition	—		—		(14		)	(14		)
Goodwill from Silversheet acquisition	—		—		23,537			23,537
Goodwill from Advanced acquisition	119,839		—		—			119,839
Goodwill from b4health acquisition	—		—		13,660			13,660
Balance, December 31, 2019	$	222,946	$	19,743	$	352,862		$	595,551
Accumulated impairment loss as of December 31, 2018 and 2019	$	154,444	$	53,940	$	6,555		$	214,939

Income Taxes - Provision (Details) - USD ($)	12 Months Ended
Income Taxes - Provision (Details) - USD ($)	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Current income taxes:
Federal	$ 25,255,000	$ 33,564,000	$ 45,899,000
State	8,332,000	12,047,000	8,699,000
Total	33,587,000	45,611,000	54,598,000
Deferred income taxes:
Federal	625,000	(1,372,000)	1,754,000
State	288,000	705,000	3,853,000
Total	913,000	(667,000)	5,607,000
Income tax expense from operations	$ 34,500,000	$ 44,944,000	$ 60,205,000

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Contingent consideration liability - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (7,700)	$ (2,070)
Ending balance	(23,100)	(7,700)
PDA and LFT
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement earn-out	7,000	0
Contingent consideration earn-out liability from acquisition	0	(5,700)
Change in fair value of contingent consideration earn-out liability from acquisition	0	(1,300)
MedPartners
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration earn-out liability from acquisition	0	(4,400)
Change in fair value of contingent consideration earn-out liability from acquisition	700	3,700
Silversheet, Inc.
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration earn-out liability from acquisition	(1,500)	0
Change in fair value of contingent consideration earn-out liability from acquisition	1,500	0
Advanced
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration earn-out liability from acquisition	(10,622)	0
Change in fair value of contingent consideration earn-out liability from acquisition	(9,378)	0
b4health
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration earn-out liability from acquisition	(3,100)	0
Contingent consideration liability for year ended December 31, 2016 \| HSG
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement earn-out	0	70
Contingent consideration liability for year ended December 31, 2017 \| HSG
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement earn-out	$ 0	$ 2,000

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Schedule of provision for income taxes from continuing operations

The provision for income taxes from operations for the years ended December 31, 2019, 2018 and 2017 consists of the following:



	Years Ended December 31,
	2019		2018			2017
Current income taxes:
Federal	$	25,255	$	33,564		$	45,899
State	8,332		12,047			8,699
Total	33,587		45,611			54,598
Deferred income taxes:
Federal	625		(1,372		)	1,754
State	288		705			3,853
Total	913		(667		)	5,607
Provision for income taxes from operations	$	34,500	$	44,944		$	60,205

Schedule of income tax reconciliation



	Years Ended December 31,
	2019			2018			2017
Tax expense at federal statutory rate	$	31,253		$	39,272		$	67,467
State taxes, net of federal benefit	6,810			9,902			7,880
Non-deductible expenses	3,840			2,956			3,849
Share-based compensation	(4,770		)	(4,343		)	(4,889		)
Corporate tax rate change impact on deferred income taxes	—			—			(14,039		)
Unrecognized tax benefit	(207		)	413			(1,175		)
Other, net	(2,426		)	(3,256		)	1,112
Income tax expense from operations	$	34,500		$	44,944		$	60,205

Schedule of deferred tax assets and liabilities

The tax effects of temporary differences that give rise to significant portions of deferred tax assets and liabilities are presented below as of the years ended December 31, 2019 and 2018:



	Years Ended December 31,
	2019			2018
Deferred tax assets:
Stock compensation	$	5,848		$	6,606
Deferred compensation	20,564			13,869
Accrued expenses	18,572			21,643
Deferred rent	—			4,000
Operating lease liabilities	27,206			—
Net operating losses	3,448			1,846
Other	570			1,030
Total deferred tax assets	$	76,208		$	48,994
Deferred tax liabilities:
Intangibles	$	(71,646	)	$	(51,493	)
Fixed assets	(22,896		)	(19,802		)
Operating lease right-of-use assets	(23,234		)	—
Other	(5,050		)	(5,025		)
Total deferred tax liabilities	$	(122,826	)	$	(76,320	)
Valuation allowance	$	—		$	—
Net deferred tax liabilities	$	(46,618	)	$	(27,326	)

Schedule of unrecognized tax benefits

A summary of the changes in the amount of unrecognized tax benefits (excluding interest and penalties) for 2019, 2018 and 2017 is as follows:



	2019			2018			2017
Beginning balance of unrecognized tax benefits	$	4,393		$	4,663		$	6,842
Additions based on tax positions related to the current year	588			475			513
Additions based on tax positions of prior years	990			753			731
Reductions due to lapse of applicable statute of limitation	(1,034		)	(547		)	(949		)
Settlements	—			(951		)	(2,474		)
Ending balance of unrecognized tax benefits	$	4,937		$	4,393		$	4,663

Leases - Minimum Lease Payments Under ASC 840 (Details) $ in Thousands	Dec. 31, 2018 USD ($)
Leases [Abstract]
2019	$ 18,218
2020	18,149
2021	18,349
2022	18,144
2023	17,990
Thereafter	50,436
Total minimum lease payments	$ 141,286

(Tables)

12 Months Ended

Dec. 31, 2019

Leases [Abstract]

Supplemental Cash Flow Disclosures Related to Leases

The components of lease expense were as follows:



	Year Ended December 31,
	2019
Lease Cost
Operating lease cost	$	18,725
Short-term lease cost	20,112
Variable and other lease cost	2,880
Net lease cost	$	41,717

Supplemental cash flow information related to leases was as follows:



	Year Ended December 31,
	2019
Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows)	$	17,817
Operating lease right-of-use assets obtained in exchange for lease obligations	$	—

Maturity of Lease Liabilities

The maturities of lease liabilities as of December 31, 2019 were as follows:



	Operating Leases
Years ending December 31,
2020	$	18,651
2021	18,599
2022	18,227
2023	17,895
2024	16,711
Thereafter	33,666
Total lease payments	$	123,749
Less imputed interest	(18,597		)
Present value of lease liabilities	$	105,152

Assumptions Used for Operating Leases



Weighted average remaining lease term	7 years
Weighted average discount rate	4.8	%

Schedule of Future Minimum Payments for Operating Leases Under ASC 840

Future minimum lease payments under noncancelable operating leases (with initial or remaining lease terms in excess of one year) as of December 31, 2018 were as follows:



	Operating Leases
Years ending December 31,
2019	$	18,218
2020	18,149
2021	18,349
2022	18,144
2023	17,990
Thereafter	50,436
Total minimum lease payments	$	141,286

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
Consolidated Statements of Cash Flows - USD ($)	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Cash flows from operating activities:
Net income	$ 113,988,000	$ 141,741,000	$ 132,558,000
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	58,520,000	41,237,000	32,279,000
Non-cash interest expense and other	1,984,000	(4,841,000)	2,231,000
Change in fair value of contingent consideration	7,178,000	(2,400,000)	184,000
Increase in allowances for doubtful accounts and sales credits	6,275,000	9,006,000	10,339,000
Provision for deferred income taxes	913,000	(667,000)	5,607,000
Share-based compensation	16,241,000	10,815,000	10,237,000
Loss on disposal or sale of fixed assets	484,000	117,000	227,000
Write-off of fees on credit facilities	594,000	574,000	0
Amortization of discount on investments	(298,000)	(202,000)	(127,000)
Non-cash lease expense	5,000
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	28,278,000	(1,453,000)	(18,858,000)
Accounts receivable, subcontractor	(22,571,000)	(9,131,000)	8,221,000
Income taxes receivable	(4,464,000)	15,099,000	(15,537,000)
Prepaid expenses	774,000	4,465,000	(2,316,000)
Other current assets	2,847,000	(1,259,000)	4,301,000
Other assets	(12,751,000)	5,239,000	(5,406,000)
Accounts payable and accrued expenses	1,925,000	17,154,000	(7,862,000)
Accrued compensation and benefits	32,758,000	10,252,000	13,430,000
Other liabilities	(6,090,000)	(8,980,000)	(8,442,000)
Deferred revenue	(1,806,000)	319,000	(548,000)
Restricted investments balance	78,000	(92,000)	0
Net cash provided by operating activities	224,862,000	226,993,000	160,518,000
Cash flows from investing activities:
Purchase and development of fixed assets	(35,218,000)	(35,206,000)	(26,529,000)
Purchase of investments	(26,309,000)	(33,824,000)	(15,096,000)
Proceeds from maturity of investments	32,135,000	25,000,000	20,301,000
Equity investment	0	(6,100,000)	(2,000,000)
Payments to fund deferred compensation plan	(12,507,000)	(9,917,000)	(10,537,000)
Purchase of convertible promissory note	(779,000)	(750,000)	0
Cash paid for acquisitions, net of cash received	(247,906,000)	(217,360,000)	0
Cash paid for other intangibles	(1,240,000)	(1,180,000)	0
Cash paid for other liabilities, working capital adjustments and holdback liability for prior year acquisitions	0	0	(1,500,000)
Net cash used in investing activities	(291,824,000)	(279,337,000)	(35,361,000)
Cash flows from financing activities:
Payments on term loans	(150,000,000)	0	(44,063,000)
Proceeds from term loan	150,000,000	0	0
Payments on revolving credit facility	(221,000,000)	(75,000,000)	0
Proceeds from revolving credit facility	101,000,000	195,000,000	0
Proceeds from senior notes	300,000,000	0	0
Repurchase of common stock	(18,705,000)	(67,013,000)	(20,164,000)
Payment of financing costs	(5,223,000)	(2,331,000)	0
Earn-out payments for prior acquisitions	(5,700,000)	(1,713,000)	(3,677,000)
Proceeds from termination of derivative contract	0	0	85,000
Cash paid for shares withheld for taxes	(13,773,000)	(11,432,000)	(9,374,000)
Net cash provided by (used in) financing activities	136,599,000	37,511,000	(77,193,000)
Effect of exchange rate changes on cash	1,000	263,000	(98,000)
Net increase (decrease) in cash, cash equivalents and restricted cash	69,638,000	(14,570,000)	47,866,000
Cash, cash equivalents and restricted cash at beginning of year	84,324,000	98,894,000	51,028,000
Cash, cash equivalents and restricted cash at end of year	153,962,000	84,324,000	98,894,000
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	17,817,000
Cash paid for interest (net of $536, $460 and $188 capitalized in 2019, 2018 and 2017, respectively)	23,730,000	21,283,000	17,936,000
Cash paid for income taxes	37,747,000	30,593,000	73,746,000
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash received	29,660,000	24,026,000	0
Goodwill	157,036,000	97,910,000	0
Intangible assets	107,580,000	122,110,000	0
Liabilities assumed	(31,148,000)	(16,586,000)	0
Earn-out liabilities	(15,222,000)	(10,100,000)	0
Net cash paid for acquisitions	247,906,000	217,360,000	0
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 2,301,000	$ 1,706,000	$ 2,962,000

Summary of Significant Accounting Policies - Recently Adopted Accounting Pronouncements (Details) - USD ($) $ in Thousands	Jan. 01, 2019	Dec. 31, 2019
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Recognition of lease liabilities		$ 105,152
Operating lease right-of-use assets		$ 89,866
Accounting Standards Update 2016-02
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Recognition of lease liabilities	$ 114,807
Operating lease right-of-use assets	99,525
Derecognition of existing deferred rent liabilities	$ 15,302

Quarterly Financial Data (Unaudited) (Tables)

12 Months Ended

Dec. 31, 2019

Quarterly Financial Information Disclosure [Abstract]

Schedule of quarterly financial information



	Year Ended December 31, 2019
	First Quarter		Second Quarter		Third Quarter		Fourth Quarter		Total Year
	(In thousands, except per share data)
Revenue	$	532,441	$	535,177	$	567,597	$	586,892	$	2,222,107
Gross profit	$	176,759	$	179,542	$	190,031	$	197,133	$	743,465
Net income	$	34,122	$	28,869	$	23,515	$	27,482	$	113,988
Net income per share from:
Basic	$	0.73	$	0.62	$	0.50	$	0.59	$	2.44
Diluted	$	0.71	$	0.61	$	0.49	$	0.58	$	2.40



	Year Ended December 31, 2018
	First Quarter		Second Quarter		Third Quarter		Fourth Quarter		Total Year
	(In thousands, except per share data)
Revenue	$	522,489	$	558,108	$	526,842	$	528,635	$	2,136,074
Gross profit	$	167,824	$	180,956	$	175,147	$	172,456	$	696,383
Net income	$	42,681	$	35,529	$	27,918	$	35,613	$	141,741
Net income per share from:
Basic	$	0.89	$	0.75	$	0.59	$	0.76	$	2.99
Diluted	$	0.87	$	0.73	$	0.58	$	0.74	$	2.91

Acquisitions - Schedule of Intangible Assets Acquired (Details) - USD ($) $ in Thousands			3 Months Ended
	Jun. 14, 2019	Apr. 09, 2018	Sep. 30, 2019
Advanced Acquisition
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 91,700
Advanced Acquisition \| Customer Relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 68,000
Useful Life	10 years
Advanced Acquisition \| Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 10,000
Useful Life	5 years
Advanced Acquisition \| Staffing Database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 10,300
Useful Life	10 years
Advanced Acquisition \| Developed Technology
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 3,400
Useful Life	3 years
MedPartners Acquisition
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 103,000
MedPartners Acquisition \| Customer Relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 57,000
Useful Life		12 years
MedPartners Acquisition \| Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 46,000
Useful Life		20 years	5 years

Notes Payable and Credit Agreement (Details) - USD ($)				12 Months Ended
Notes Payable and Credit Agreement (Details) - USD ($)	Feb. 14, 2020	Oct. 01, 2019	Jun. 14, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Feb. 09, 2018	Oct. 31, 2016
Line of Credit Facility [Line Items]
Repayments of debt				$ 221,000,000	$ 75,000,000	$ 0
Standby Letters of Credit
Line of Credit Facility [Line Items]
Debt collateral				2,307,000
Letters of credit, amount outstanding				19,752,000	17,632,000
Line of Credit
Line of Credit Facility [Line Items]
Debt issuance fees incurred			$ 875,000
Unamortized debt issuance costs			1,702,000
Line of Credit \| Revolving Credit Facility
Line of Credit Facility [Line Items]
Maximum borrowing capacity							$ 400,000,000
Repayments of debt		$ 146,000,000
Line of Credit \| Secured Debt
Line of Credit Facility [Line Items]
Maximum borrowing capacity			$ 150,000,000
Annual amortization percentage, first year			2.50%
Annual amortization percentage, after first year			5.00%
Repayments of debt		$ 149,063,000
Line of Credit \| Senior Credit Facility
Line of Credit Facility [Line Items]
Maximum borrowing capacity							50,000,000
Debt collateral				17,445,000
Available credit				382,555,000
Line of Credit \| Revolving Credit Facility, Swing Line Loan
Line of Credit Facility [Line Items]
Maximum borrowing capacity							$ 50,000,000
Line of Credit \| LIBOR \| Revolving Credit Facility and Secured Debt \| Minimum
Line of Credit Facility [Line Items]
Interest rates spread over LIBOR and base rate			1.00%
Line of Credit \| LIBOR \| Revolving Credit Facility and Secured Debt \| Maximum
Line of Credit Facility [Line Items]
Interest rates spread over LIBOR and base rate			2.00%
Line of Credit \| Base Rate \| Revolving Credit Facility and Secured Debt \| Minimum
Line of Credit Facility [Line Items]
Interest rates spread over LIBOR and base rate			0.00%
Line of Credit \| Base Rate \| Revolving Credit Facility and Secured Debt \| Maximum
Line of Credit Facility [Line Items]
Interest rates spread over LIBOR and base rate			1.00%
Senior Notes \| 5.125% Senior Notes due 2024
Line of Credit Facility [Line Items]
Interest rate								5.125%
Aggregate principal amount				325,000,000	325,000,000
Senior Notes \| 4.625% Senior Notes due 2027
Line of Credit Facility [Line Items]
Interest rate		4.625%
Aggregate principal amount		$ 300,000,000		$ 300,000,000	$ 0
Senior Notes \| 4.625% Senior Notes due 2027 \| Revolving Credit Facility
Line of Credit Facility [Line Items]
Payment of debt issuance fees and expenses		$ 4,348,000
Subsequent Event
Line of Credit Facility [Line Items]
Annual amortization percentage, first year	2.50%
Annual amortization percentage, after first year	5.00%
Subsequent Event \| Line of Credit \| Senior Credit Facility
Line of Credit Facility [Line Items]
Maximum borrowing capacity	$ 250,000,000

Summary of Significant Accounting Policies - Concentration of Credit Risk (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Concentration Risk [Line Items]
Restricted cash, cash equivalents and investments	$ 62,170	$ 59,331
Healthcare System \| Consolidated Revenue \| Customer Concentration Risk
Concentration Risk [Line Items]
Concentration risk percentage	13.00%	13.00%	13.00%

Goodwill and Identifiable Intangible Assets - Changes in the Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Goodwill [Roll Forward]
Beginning Balance	$ 438,506	$ 340,596
Ending Balance	595,551	438,506
Accumulated impairment loss	214,939	214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Beginning Balance	103,107	103,107
Ending Balance	222,946	103,107
Accumulated impairment loss	154,444	154,444
Locum Tenens Solutions
Goodwill [Roll Forward]
Beginning Balance	19,743	19,743
Ending Balance	19,743	19,743
Accumulated impairment loss	53,940	53,940
Other Workforce Solutions
Goodwill [Roll Forward]
Beginning Balance	315,656	217,746
Ending Balance	352,862	315,656
Accumulated impairment loss	6,555	6,555
MedPartners Acquisition
Goodwill [Roll Forward]
Goodwill from acquisition		81,113
Goodwill adjustment for acquisition	23
MedPartners Acquisition \| Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill from acquisition		81,113
Goodwill adjustment for acquisition	23
PDA and LFT
Goodwill [Roll Forward]
Goodwill from acquisition		16,797
Goodwill adjustment for acquisition	(14)
PDA and LFT \| Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill from acquisition		$ 16,797
Goodwill adjustment for acquisition	(14)
Silversheet, Inc.
Goodwill [Roll Forward]
Goodwill from acquisition	23,537
Silversheet, Inc. \| Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	23,537
Advanced
Goodwill [Roll Forward]
Goodwill from acquisition	119,839
Advanced \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	119,839
b4health
Goodwill [Roll Forward]
Goodwill from acquisition	13,660
b4health \| Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	$ 13,660

Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Deferred tax assets
Stock compensation	$ 5,848	$ 6,606
Deferred compensation	20,564	13,869
Accrued expenses	18,572	21,643
Deferred rent	0	4,000
Operating lease liabilities	27,206
Net operating losses	3,448	1,846
Other	570	1,030
Total deferred tax assets	76,208	48,994
Deferred tax liabilities
Intangibles	(71,646)	(51,493)
Fixed assets	(22,896)	(19,802)
Operating lease right-of-use assets	(23,234)
Other	(5,050)	(5,025)
Total deferred tax liabilities	(122,826)	(76,320)
Valuation allowance	0	0
Net deferred tax liabilities	$ (46,618)	$ (27,326)

Fair Value Measurement

12 Months Ended

Dec. 31, 2019

Fair Value Disclosures [Abstract]

Fair Value Measurement

Fair value represents the price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. When determining fair value, the Company considers the principal or most advantageous market in which the Company would conduct a transaction, in addition to the assumptions that market participants would use when pricing the related assets or liabilities, including non-performance risk.

A three-level hierarchy prioritizes the inputs to valuation techniques used to measure fair value and requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value. The three levels of the fair value hierarchy are as follows:

Level 1—Quoted prices in active markets for identical assets or liabilities.

Level 2—Observable inputs other than Level 1 prices such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.

Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.

Assets and Liabilities Measured on a Recurring Basis

The Company’s restricted cash equivalents that serve as collateral for the Company’s outstanding letters of credit typically consist of money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs.

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 deferred compensation plan is more fully described in Note (9), “Retirement Plans.”

As of December 31, 2019, the Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company consist of commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. Of the $59,243 commercial paper issued and outstanding as of December 31, 2019, $9,586 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2018, the Company had $63,243 commercial paper issued and outstanding, of which $15,192 had original maturities greater than three months and were considered available-for-sale securities. The increase in commercial paper issued and outstanding is due to additional restricted investments related to the captive insurance company.

The Company’s contingent consideration liabilities are measured at fair value using 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 consolidated statements of comprehensive income.



	Fair Value Measurements as of December 31, 2019
Assets (Liabilities)	Total			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Money market funds	$	2,508		$	2,508		$	—	$	—
Deferred compensation	(81,064		)	(81,064		)	—		—
Commercial paper	59,243			—			59,243		—
Acquisition contingent consideration liabilities	(23,100		)	—			—		(23,100		)



	Fair Value Measurements as of December 31, 2018
Assets (Liabilities)	Total			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Money market funds	$	2,461		$	2,461		$	—	$	—
Deferred compensation	(55,720		)	(55,720		)	—		—
Commercial paper	63,243			—			63,243		—
Acquisition contingent consideration liabilities	(7,700		)	—			—		(7,700		)

The following table sets forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy:



	2019			2018
Balance as of January 1,	$	(7,700	)	$	(2,070	)
Settlement of HealthSource Global contingent consideration liability for year ended December 31, 2016	—			70
Settlement of HealthSource Global contingent consideration liability for year ended December 31, 2017	—			2,000
Settlement of PDA and LFT contingent consideration liability for year ended December 31, 2018	7,000			—
Contingent consideration liability from PDA and LFT acquisition on April 6, 2018	—			(5,700		)
Contingent consideration liability from MedPartners acquisition on April 9, 2018	—			(4,400		)
Contingent consideration liability from Silversheet acquisition on January 30, 2019	(1,500		)	—
Contingent consideration liability from Advanced acquisition on June 14, 2019	(10,622		)	—
Contingent consideration liability from b4health acquisition on December 19, 2019	(3,100		)	—
Change in fair value of contingent consideration liability from PDA and LFT acquisition	—			(1,300		)
Change in fair value of contingent consideration liability from MedPartners acquisition	700			3,700
Change in fair value of contingent consideration liability from Silversheet acquisition	1,500			—
Change in fair value of contingent consideration liability from Advanced acquisition	(9,378		)	—
Balance as of December 31,	$	(23,100	)	$	(7,700	)

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 method investment.

The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever circumstances occur indicating that goodwill or indefinite-lived intangible assets might be impaired. 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. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the consolidated statements of comprehensive income.

The balance of the equity investment classified as Level 2 in the fair value hierarchy was $15,449 for years ended December 31, 2019 and 2018, respectively. There were no changes to the fair value of the equity investment recognized during the year ended December 31, 2019 .

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 three years ended December 31, 2019 requiring such measurements.

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 5.125% senior notes due 2024 (the “2024 Notes”) and 4.625% senior notes due 2027 (the “2027 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 2024 Notes and the 2027 Notes, which are more fully described in Note (8), “Notes Payable and Credit Agreement,” are presented in the following table:



	As of December 31, 2019				As of December 31, 2018
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2024 Notes	$	325,000	$	337,188	$	325,000	$	310,375
2027 Notes	300,000		301,500		—		—

The fair value of the Company’s long-term self-insurance accruals cannot be estimated as the Company cannot reasonably determine the timing of future payments.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Summary of Significant Accounting Policies - Share-Based Compensation (Details)	12 Months Ended
	Dec. 31, 2019
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period	3 years
Performance Shares, EBITDA-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Period for relative and absolute shareholder return	3 years
Performance Shares, Shareholder Return-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Period for relative and absolute shareholder return	3 years
Minimum \| Performance Shares, EBITDA-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	0.00%
Minimum \| Performance Shares, Shareholder Return-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	0.00%
Maximum \| Performance Shares, EBITDA-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	175.00%
Maximum \| Performance Shares, Shareholder Return-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	175.00%
Vesting Period, Thirteen Month Aniversary of Grant Date \| Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage	33.00%
Vesting anniversary term	13 months
Vesting Period, Second Anniversary of Grant Date \| Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage	34.00%
Vesting anniversary term	2 years

Capital Stock (Details) - USD ($)	12 Months Ended
Capital Stock (Details) - USD ($)	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Nov. 01, 2016
Preferred Stock, Number of Shares, Par Value and Other Disclosures [Abstract]
Preferred stock total shares including Series A	10,000,000	10,000,000
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares outstanding	0	0
Treasury Stock, Number of Shares and Restriction Disclosures [Abstract]
Stock repurchase program, authorized amount				$ 150,000,000
Treasury stock acquired (shares)	395,000	1,236,000
Treasury stock acquired (in dollars per share)	$ 47.30	$ 54.17
Aggregate purchase price of treasury stock	$ 18,705,000	$ 67,013,000	$ 20,164,000

Income Taxes - Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Jul. 31, 2018
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Beginning balance of unrecognized tax benefits	$ 4,393	$ 4,663	$ 6,842
Additions based on tax positions related to the current year	588	475	513
Additions based on tax positions of prior years	990	753	731
Reductions due to lapse of applicable statute of limitation	(1,034)	(547)	(949)
Settlements	0	(951)	(2,474)
Ending balance of unrecognized tax benefits	4,937	4,393	4,663
Unrecognized tax benefits that would affect the effective tax rate, net of temporary differences	4,695
Temporary differences	736
Accrued interest and penalties related to uncertain tax positions	493	467	606
Interest and penalties recognized	$ 26	$ (139)	$ (1,016)
IRS
Income Tax Contingency [Line Items]
Audit assessment				$ 8,300

Notes Payable and Credit Agreement (Tables)

12 Months Ended

Dec. 31, 2019

Debt Disclosure [Abstract]

Schedule of outstanding debt

Outstanding debt balances as of December 31, 2019 and 2018 consisted of the following:



	As of December 31,
	2019			2018
Senior Credit Facility	—			120,000
2024 Notes	325,000			325,000
2027 Notes	300,000			—
Total debt outstanding	625,000			445,000
Less unamortized fees	(7,841		)	(4,393		)
Long-term portion of notes payable	$	617,159		$	440,607

Leases

12 Months Ended

Dec. 31, 2019

Leases [Abstract]

Leases

The Company leases certain office facilities, data centers, and equipment under various operating leases. The Company’s short-term leases (with initial lease terms of 12 months or less) are primarily related to housing arrangements for healthcare professionals on assignment. Most leases include one or more options to renew, with renewal terms that can extend the lease term up to 10 years. Certain leases also include options to terminate the leases within 3 years.

The components of lease expense were as follows:



	Year Ended December 31,
	2019
Lease Cost
Operating lease cost	$	18,725
Short-term lease cost	20,112
Variable and other lease cost	2,880
Net lease cost	$	41,717

The maturities of lease liabilities as of December 31, 2019 were as follows:



	Operating Leases
Years ending December 31,
2020	$	18,651
2021	18,599
2022	18,227
2023	17,895
2024	16,711
Thereafter	33,666
Total lease payments	$	123,749
Less imputed interest	(18,597		)
Present value of lease liabilities	$	105,152

Supplemental cash flow information related to leases was as follows:



	Year Ended December 31,
	2019
Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows)	$	17,817
Operating lease right-of-use assets obtained in exchange for lease obligations	$	—



Weighted average remaining lease term	7 years
Weighted average discount rate	4.8	%

Future minimum lease payments under noncancelable operating leases (with initial or remaining lease terms in excess of one year) as of December 31, 2018 were as follows:



	Operating Leases
Years ending December 31,
2019	$	18,218
2020	18,149
2021	18,349
2022	18,144
2023	17,990
Thereafter	50,436
Total minimum lease payments	$	141,286

Rent expense under operating leases (with initial lease terms in excess of one year) was $21,402 and $20,529 for the years ended December 31, 2018 and 2017, respectively.

Fair Value Measurement - (Details) - USD ($)	12 Months Ended
Fair Value Measurement - (Details) - USD ($)	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Oct. 01, 2019	Oct. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Asset impairment charges	$ 0	$ 0	$ 0
Fair Value, Nonrecurring \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment balance	15,449,000	15,449,000
Commercial paper \| Fair Value, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper - total	59,243,000	63,243,000
Commercial paper \| Fair Value, Recurring \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper - total	59,243,000	63,243,000
Commercial paper - AFS securities	$ 9,586,000	$ 15,192,000
5.125% Senior Notes due 2024 \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate					5.125%
4.625% Senior Notes due 2027 \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate				4.625%

Subsequent Events (Details) - USD ($)		12 Months Ended
Subsequent Events (Details) - USD ($)	Feb. 14, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Feb. 09, 2018
Subsequent Event [Line Items]
Cash consideration		$ 247,906,000	$ 217,360,000	$ 0
Amount borrowed, line of credit		$ 101,000,000	$ 195,000,000	$ 0
Stratus Video \| Subsequent Event
Subsequent Event [Line Items]
Cash consideration	$ 475,000,000
Senior Credit Facility \| Line of Credit
Subsequent Event [Line Items]
Amount borrowed, debt					$ 50,000,000
Senior Credit Facility \| Line of Credit \| Subsequent Event
Subsequent Event [Line Items]
Amount borrowed, debt	250,000,000
Amount borrowed, line of credit	$ 175,000,000

Share-Based Compensation - Summary of Stock Option and SAR Activity (Details) - Equity Plan and Other Plans - Stock Appreciation Rights (SARs) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Equity Plan and Other Plans, Number Outstanding
Outstanding, Beginning balance (shares)	227	262	286
Granted (shares)	0	0	0
Exercised (shares)	(215)	(35)	(24)
Canceled/forfeited/expired (shares)	0	0	0
Outstanding, Ending balance (shares)	12	227	262
Vested and expected to vest (shares)	12
Exercisable (shares)	12
Equity Plan and Other Plans, Weighted-Average Exercise Price per Share
Outstanding, Beginning balance (in dollars per share)	$ 8.61	$ 8.81	$ 9.67
Granted (in dollars per share)	0	0	0
Exercised (in dollars per share)	8.67	10.12	18.85
Canceled/forfeited/expired (in dollars per share)	0	0	0
Outstanding, Ending balance (in dollars per share)	7.51	$ 8.61	$ 8.81
Vested and expected to vest (in dollars per share)	7.51
Exercisable (in dollars per share)	$ 7.51