0001142750-21-000012 | 10-K | XBRL Viewer | AMN Healthcare Services INC

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Summary of Significant Accounting Policies - Allowance for Credit Losses (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2017
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 3,332
Accounting Standards Update [Extensible List]		us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201409Member
Provision for expected credit losses	4,428
Amounts written off charged against the allowance	(2,051)
Ending balance	7,043	$ 3,332
Cumulative Effect, Period of Adoption, Adjustment
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 1,334
Ending balance		$ 1,334

- Definition

Indicates amendment to accounting standards.

+ References

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+ Details

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 29,213	$ 82,985
Accounts receivable, net of allowances of $7,043 and $3,332 at December 31, 2020 and 2019, respectively	376,099	352,685
Accounts receivable, subcontractor	73,985	72,714
Prepaid expenses	13,629	11,669
Other current assets	40,809	40,446
Total current assets	533,735	560,499
Restricted cash, cash equivalents and investments	61,347	62,170
Fixed assets, net of accumulated depreciation of $161,752 and $132,900 at December 31, 2020 and 2019, respectively	116,174	104,832
Operating lease right-of-use assets	77,735	89,866
Other assets	135,120	120,254
Goodwill	864,485	595,551
Intangible assets, net of accumulated amortization of $215,234 and $151,417 at December 31, 2020 and 2019, respectively	564,911	398,474
Total assets	2,353,507	1,931,646
Current liabilities:
Accounts payable and accrued expenses	167,881	156,140
Accrued compensation and benefits	213,414	170,932
Current portion of notes payable	4,688	0
Current portion of operating lease liabilities	15,032	13,943
Deferred revenue	11,004	11,788
Other current liabilities	10,938	25,302
Total current liabilities	422,957	378,105
Notes payable, net of unamortized fees and premium	857,961	617,159
Deferred income taxes, net	67,205	46,618
Operating lease liabilities	77,800	91,209
Other long-term liabilities	107,907	61,813
Total liabilities	1,533,830	1,194,904
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at December 31, 2020 and 2019	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 49,614 issued and 47,053 outstanding at December 31, 2020 and 49,283 issued and 46,722 outstanding at December 31, 2019	496	493
Additional paid-in capital	468,726	455,193
Treasury stock, at cost; 2,561 shares at December 31, 2020 and 2019	(119,143)	(119,143)
Retained earnings	469,558	400,047
Accumulated other comprehensive income	40	152
Total stockholders’ equity	819,677	736,742
Total liabilities and stockholders’ equity	$ 2,353,507	$ 1,931,646

Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Additional Paid-in Capital	Treasury Stock	Retained Earnings	Retained Earnings Cumulative Effect, Period of Adoption, Adjustment	Accumulated Other Comprehensive Income (Loss)
Beginning balance, shares at Dec. 31, 2017			48,411,000		930,000
Beginning balance at Dec. 31, 2017	$ 562,527	$ 2,089	$ 484	$ 453,351	$ (33,425)	$ 142,229	$ 2,089	$ (112)
Statement of Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			398,000
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)					(1,236,000)
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			48,809,000		2,166,000
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 (in shares)			474,000
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)	(395,000)				(395,000)
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			49,283,000		2,561,000
Ending balance at Dec. 31, 2019	$ 736,742	$ (1,154)	$ 493	455,193	$ (119,143)	400,047	$ (1,154)	152
Statement of Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			331,000
Equity awards vested and exercised, net of shares withheld for payroll taxes	$ (6,929)		$ 3	(6,932)
Repurchase of common stock into treasury (in shares)	0
Share-based compensation	$ 20,465			20,465
Comprehensive income (loss)	70,553					70,665		(112)
Ending balance, shares at Dec. 31, 2020			49,614,000		2,561,000
Ending balance at Dec. 31, 2020	$ 819,677		$ 496	$ 468,726	$ (119,143)	$ 469,558		$ 40

Notes Payable and Credit Agreement - Debt Balances (Details) - USD ($) $ in Thousands	1 Months Ended	12 Months Ended
	Feb. 26, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Oct. 20, 2020	Aug. 13, 2020	Feb. 14, 2020	Oct. 01, 2019	Oct. 31, 2016
Debt Instrument [Line Items]
Total debt outstanding		$ 871,875	$ 625,000
Less unamortized fees and premium		(9,226)	(7,841)
Less current portion of notes payable		(4,688)	0
Long-term portion of notes payable		857,961	617,159
Proceeds from line of credit		245,000	101,000	$ 195,000
Senior Notes \| 2024 Notes
Debt Instrument [Line Items]
Total debt outstanding		$ 0	325,000
Interest rate		5.125%							5.125%
Senior Notes \| 2027 Notes
Debt Instrument [Line Items]
Total debt outstanding		$ 500,000	300,000
Interest rate						4.625%		4.625%
Senior Notes \| 2029 Notes
Debt Instrument [Line Items]
Total debt outstanding		$ 350,000	0
Interest rate		4.00%			4.00%
Secured Debt \| Term Loan Credit Facility
Debt Instrument [Line Items]
Total debt outstanding		$ 21,875	$ 0
Long-term portion of notes payable							$ 250,000
Senior Credit Facility \| Line of Credit \| Subsequent Event
Debt Instrument [Line Items]
Proceeds from line of credit	$ 25,000

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2020

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.

On March 11, 2020, the World Health Organization declared the outbreak of a novel strain of coronavirus, also known as COVID-19, a global pandemic. Due to the pandemic, there has been uncertainty and disruption in the global economy and significant volatility of financial markets. The Company is closely monitoring the impact of the pandemic, which continues to evolve, and its effects and risks on our operations, liquidity, financial condition and financial results. The Company also implemented remote-work arrangements effective mid-March 2020 and, to date, transitioning to a remote-work environment has not had a material adverse impact on the Company’s ability to continue to operate its business, financial reporting process or internal controls and procedures.

(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 such as legal accruals, 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.

The estimates used for, but not limited to, determining the collectability of accounts receivable, fair value of long-lived assets, and goodwill could be impacted by the COVID-19 pandemic. While the full impact of COVID-19, including the duration and severity of the pandemic, remains unknown, the Company has made appropriate estimates based on the facts and circumstances available as of the reporting date. Specifically, the Company continues to monitor the impacts of the pandemic on its customers’ liquidity and capital resources and, therefore, the Company’s ability to collect, or the timeliness of collection of accounts receivable. The impact of COVID-19 did not have a material effect on the Company’s estimates as of December 31, 2020. These estimates may change as new events occur and additional information is obtained. See additional information below regarding the allowance for credit losses for accounts receivable.

(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, 2020		December 31, 2019
Cash and cash equivalents	$	29,213	$	82,985
Restricted cash and cash equivalents (included in other current assets)	18,626		18,393
Restricted cash, cash equivalents and investments	61,347		62,170
Total cash, cash equivalents and restricted cash and investments	109,186		163,548
Less restricted investments	(25,196)		(9,586)
Total cash, cash equivalents and restricted cash	$	83,990	$	153,962

(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 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. If the reporting unit does not pass the qualitative assessment, then the reporting unit’s carrying value is compared to its fair value. The amount by which the carrying value of the goodwill exceeds its fair value 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 primarily 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.

In December 2017, the Company transferred legacy liabilities related to its self-insured retention portion of both the workers compensation and locum tenens business professional liability to its captive insurance subsidiary. These legacy liabilities follow the same accounting policies as described in the paragraphs above.

(k) Revenue Recognition

Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from its software as a service (“SaaS”)-based technologies, including vendor management systems and scheduling software, and outsourced workforce services, including language interpretation and recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from permanent placement and outsourced workforce services is recognized as the services are rendered.

Depending on the arrangement, the Company’s SaaS-based revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. See additional information below regarding the Company’s revenue disaggregated by service type.

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 years ended December 31, 2020 and 2019, previously deferred revenue recognized as revenue was $11,729 and $9,972, respectively.

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 $11,208 and $11,369 for the years ended December 31, 2020 and 2019, respectively.

The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition:

•Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses.

•Recognize revenue in the amount of consideration 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 expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions. See additional information below regarding the Company’s adoption of the credit loss standard effective January 1, 2020.

The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable:


	2020
Balance as of January 1,	$	3,332
Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings	1,334
Provision for expected credit losses	4,428
Amounts written off charged against the allowance	(2,051)

Balance as of December 31,	$	7,043

The Company reclassified its allowance for accounts receivable in the prior year’s consolidated balance sheet to conform to the current year presentation. The prior year balance of accounts receivable (net of allowances) remains unchanged.

(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 14%, 13% and 13% of the consolidated revenue of the Company for the fiscal years ended December 31, 2020, 2019 and 2018, respectively.

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, 2020 and 2019, there were $61,347 and $62,170, 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 2027 Notes and 2029 Notes (as defined in Note (8) and Note (3), respectively, 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 over a three-year period. 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 performance conditions dependent on defined targets of the Company’s adjusted EBITDA, with a range of 0% to 200% 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 market conditions.

(q) Net Income per Common Share

Share-based awards to purchase 41, 43 and 23 shares of common stock for the years ended December 31, 2020, 2019 and 2018, 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, 2020, 2019 and 2018, respectively:


	Years Ended December 31,
	2020		2019		2018
Net income	$	70,665	$	113,988	$	141,741

Net income per common share - basic	$	1.49	$	2.44	$	2.99
Net income per common share - diluted	$	1.48	$	2.40	$	2.91

Weighted average common shares outstanding - basic	47,424		46,704		47,371
Plus dilutive effect of potential common shares	266		889		1,297
Weighted average common shares outstanding - diluted	47,690		47,593		48,668

(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. Effective March 8, 2020, the Company modified its reportable segments. The Company previously utilized three reportable segments, which it identified as follows: (1) nurse and allied solutions, (2) locum tenens solutions, and (3) other workforce solutions. In light of the Company’s recent acquisitions and organizational changes to better align its organizational structure with its strategy and operations, the Company’s management reorganized its reportable segments to better reflect how the business is evaluated by the chief operating decision maker. Beginning in the first quarter of 2020, the Company has disclosed the following three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions. The nurse and allied solutions segment includes the Company’s travel nurse staffing, rapid response nurse staffing and labor disruption, allied staffing, local staffing, and revenue cycle solutions businesses. The physician and leadership solutions segment includes the Company’s locum tenens staffing, healthcare interim leadership staffing, executive search, and physician permanent placement businesses. The technology and workforce solutions segment includes the Company’s language interpretation services, vendor management systems, workforce optimization, recruitment process outsourcing, credentialing, and flex pool management businesses.

The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed.

The following table, which includes reclassified prior period amounts to conform to the new segment reporting structure, 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,
	2020		2019		2018
Revenue
Nurse and allied solutions	$	1,699,311	$	1,562,588	$	1,431,018
Physician and leadership solutions	466,622		562,762		617,488
Technology and workforce solutions	227,781		96,757		87,568
	$	2,393,714	$	2,222,107	$	2,136,074
Segment operating income
Nurse and allied solutions	$	232,005	$	219,862	$	201,866
Physician and leadership solutions	62,342		71,378		86,077
Technology and workforce solutions	93,212		43,899		41,373
	387,559		335,139		329,316
Unallocated corporate overhead	123,642		83,463		74,436
Depreciation and amortization	92,766		58,520		41,237
Depreciation (included in cost of revenue)	1,421		—		—
Share-based compensation	20,465		16,241		10,815
Interest expense, net, and other	57,742		28,427		16,143
Income before income taxes	$	91,523	$	148,488	$	186,685

The following tables present the Company’s revenue disaggregated by service type:


	Year Ended December 31, 2020
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Temporary staffing	$	1,699,311	$	408,228	$	—	$	2,107,539
Permanent placement	—		58,394		—		58,394
Outsourced workforce	—		—		134,468		134,468
SaaS-based technologies	—		—		93,313		93,313
Total revenue	$	1,699,311	$	466,622	$	227,781	$	2,393,714


	Year Ended December 31, 2019
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Temporary staffing	$	1,562,588	$	482,984	$	—	$	2,045,572
Permanent placement	—		79,778		—		79,778
Outsourced workforce	—		—		16,096		16,096
SaaS-based technologies	—		—		80,661		80,661
Total revenue	$	1,562,588	$	562,762	$	96,757	$	2,222,107


	Year Ended December 31, 2018
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Temporary staffing	$	1,431,018	$	543,117	$	—	$	1,974,135
Permanent placement	—		74,371		—		74,371
Outsourced workforce	—		—		15,042		15,042
SaaS-based technologies	—		—		72,526		72,526
Total revenue	$	1,431,018	$	617,488	$	87,568	$	2,136,074

(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.

In June 2016, the FASB issued ASU 2016-13, “Measurement of Credit Losses on Financial Instruments.” The FASB also issued a series of other ASUs, which update ASU 2016-13 (collectively, the “credit loss standard”). This new standard introduces new accounting models for determining and recognizing credit losses on certain financial instruments based on an estimate of current expected credit losses. The Company adopted this standard effective January 1, 2020 using the modified retrospective transition method. The Company recognized the cumulative effect of adopting this guidance as an adjustment to the opening balance of retained earnings of $1,154, net of tax, primarily related to its allowance for credit losses for accounts receivable. Prior period amounts are not retrospectively adjusted. The impact of the adoption of the new standard was not material to the Company’s consolidated financial statements. The Company expects the impact to be immaterial on an ongoing basis.

In January 2017, the FASB issued ASU 2017-04, “Simplifying the Test for Goodwill Impairment.” The standard simplifies the subsequent measurement of goodwill by removing the requirement to perform a hypothetical purchase price allocation to compute the implied fair value of goodwill to measure impairment. Instead, any goodwill impairment will equal the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. Further, the guidance eliminates the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment and, if it fails that qualitative test, to perform Step 2 of the goodwill impairment test. The Company adopted this standard effective January 1, 2020 and the adoption did not have a material effect on the Company’s consolidated financial statements.

In August 2018, the FASB issued ASU 2018-13, “Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement.” The standard modifies the current disclosure requirements on fair value measurements. The Company adopted this standard effective January 1, 2020. Refer to information regarding fair value measurements in Note (3), “Fair Value Measurement.”

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

Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Deferred tax assets:
Stock compensation	$ 6,198	$ 5,848
Deferred compensation	24,604	20,564
Accrued bonus	7,607	4,294
Accrued payroll taxes	12,445	60
Accrued expenses	18,185	14,218
Operating lease liabilities	23,826	27,206
Net operating losses	9,557	3,448
Loss contingencies	6,459	0
Other	989	570
Total deferred tax assets	109,870	76,208
Deferred tax liabilities
Intangibles	(126,833)	(71,646)
Fixed assets	(25,252)	(22,896)
Operating lease right-of-use assets	(19,933)	(23,234)
Other	(5,057)	(5,050)
Total deferred tax liabilities	(177,075)	(122,826)
Net deferred tax liabilities	$ (67,205)	$ (46,618)

Share-Based Compensation - Narrative (Details) - USD ($) $ in Thousands					12 Months Ended
	Apr. 19, 2017	Apr. 18, 2012	Apr. 09, 2009	Apr. 18, 2007	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Feb. 28, 2014	Dec. 31, 2006
Stock Options and Stock Appreciation Rights
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards outstanding (in shares)					0
Total intrinsic value of share-based payment award exercised					$ 828	$ 9,177	$ 1,535
Total intrinsic value of share-based payment award outstanding and exercisable						645
RSUs and Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation cost					$ 16,972
Unrecognized compensation cost, weighted average remaining period					1 year 8 months 12 days
Aggregate intrinsic value					$ 48,945	$ 47,242
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 (in shares)									723,000
Contractual life					10 years
Additional number of shares authorized (in shares)	1,400,000	2,400,000	1,850,000	3,000,000
Number of equity awards reserved for future issuance (in shares)					2,830,000	2,930,000
2014 Employee Inducement Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized for issuance (in shares)								200,000
Number of shares of common stock available for future grants (in shares)					179,000

Acquisitions - MedPartners Acquisition (Details) - USD ($)		3 Months Ended			12 Months Ended
	Apr. 09, 2018	Sep. 30, 2019	Jun. 30, 2019	Sep. 30, 2018	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Cash consideration					$ 476,491,000	$ 247,906,000	$ 217,360,000
Goodwill					$ 864,485,000	$ 595,551,000	$ 438,506,000
MedPartners Acquisition
Business Acquisition [Line Items]
Purchase price	$ 200,933,000
Cash consideration	196,533,000
Contingent earn-out based on future operating performance (up to)	20,000,000
Fair value of contingent earn-out	4,400,000
Working capital returned to Company for working capital settlement				$ 222,000
Purchase price, net of working capital adjustment			$ 200,711,000
Fair value of tangible assets acquired			28,508,000
Cash and restricted cash received			8,403,000
Liabilities assumed			11,933,000
Identified intangible assets	$ 103,000,000		103,000,000
Goodwill			$ 81,136,000
Weighted average useful life of intangible assets	16 years
MedPartners Acquisition \| Tradenames and trademarks
Business Acquisition [Line Items]
Identified intangible assets	$ 46,000,000
Useful Life	20 years	5 years
MedPartners Acquisition \| Based on operating results for the twelve months ending December 31, 2019
Business Acquisition [Line Items]
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 Acquisition [Line Items]
Contingent earn-out based on future operating performance (up to)	$ 10,000,000

Notes Payable and Credit Agreement

12 Months Ended

Dec. 31, 2020

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. On June 14, 2019, the Company entered into the first amendment to the New Credit Agreement (the “First Amendment”) to provide for, among other things, a $150,000 secured term loan credit facility (the “Term Loan”). The Company 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.” The Company fully repaid all amounts under the Term Loan in 2019.

On February 14, 2020, the Company entered into the second amendment to the New Credit Agreement (the “Second Amendment”) to provide for, among other things, a $250,000 secured term loan credit facility (the “Additional Term Loan”). The Second Amendment (together with the New Credit Agreement and the First Amendment, collectively, the “Amended Credit Agreement”) extended the maturity date of the Senior Credit Facility to be coterminous with the Additional Term Loan. The 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 Additional Term Loan, together with a drawdown of a portion of the Senior Credit Facility, to complete its acquisition of Stratus Video, as more fully described in Note (2), “Acquisitions.”

In connection with the Second Amendment, the Company incurred $4,144 in fees paid to lenders and other third parties, which were capitalized and are being amortized to interest expense over the term of the Credit Facilities (as defined below). In addition, $1,681 of unamortized financing fees incurred in connection with obtaining the New Credit Agreement and First Amendment will continue to be amortized to interest expense over the term of the Credit Facilities.

Borrowings under the Senior Credit Facility and the Additional 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 1.75% or a base rate plus a spread of 0.00% to 0.75%. The applicable spread is determined quarterly based upon the Company’s consolidated net leverage ratio (as calculated per the Amended Credit Agreement). 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 Senior Credit Facility, which includes a $75,000 sublimit for the issuance of letters of credit and a $75,000 sublimit for swingline loans, is available for working capital, capital expenditures, permitted acquisitions and general corporate purposes. The maturity date of the Credit Facilities is February 14, 2025.

At December 31, 2020, with $21,910 of outstanding letters of credit collateralized by the Senior Credit Facility, there was $378,090 of available credit under the Senior Credit Facility. The interest rate for the Additional Term Loan was 1.65% on a LIBOR basis as of December 31, 2020.

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

On August 13, 2020, the Company completed the issuance of an additional $200,000 aggregate principal amount of 4.625% senior notes due 2027 (the “New 2027 Notes”), which were issued at a price of 101.000% of the aggregate principal amount. The New 2027 Notes were issued pursuant to the existing indenture, dated as of October 1, 2019, under which the Company previously issued $300,000 aggregate principal amount of 4.625% senior notes due 2027 (the “Existing 2027 Notes” and together with the New 2027 Notes, the “2027 Notes”). The New 2027 Notes will be treated as a single series with the Existing 2027 Notes and will have the same terms (other than issue price, issue date and the date from which interest accrues) as those of the Existing 2027 Notes. 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 October 1, 2020 with respect to the New 2027 Notes. The aggregate principal amount of the 2027 Notes matures on October 1, 2027.

With proceeds from the New 2027 Notes and cash on hand, the Company (1) repaid $200,000 of its indebtedness under the Additional Term Loan and (2) paid $2,620 of fees and expenses related to the issuance of the New 2027 Notes, which were recorded as a reduction of the notes payable balance and are being amortized to interest expense over the remaining term of the 2027 Notes.

On October 20, 2020, the Company completed the issuance of $350,000 aggregate principal amount of the 2029 Notes, which mature on April 15, 2029. Interest on the 2029 Notes is fixed at 4.000% and payable semi-annually in arrears on April 15 and October 15 of each year, commencing April 15, 2021. With the proceeds from the 2029 Notes and cash generated from operations, the Company (1) redeemed all of its outstanding $325,000 aggregate principal amount of the 2024 Notes on November 4, 2020, (2) paid $9,857 consisting of the associated redemption premium and accrued and unpaid interest on the 2024 Notes, (3) repaid $40,000 under the Senior Credit Facility and (4) incurred $4,744 in fees and expenses related to the issuance and sale of the 2029 Notes, which were recorded as a reduction of the notes payable balance and are being amortized to interest expense over the term of the 2029 Notes. In addition, the Company wrote off $2,992 of unamortized financing fees incurred in connection with the issuance of the 2024 Notes, which was recognized in interest expense, net, and other in the consolidated statements of comprehensive income for the year ended December 31, 2020.

The indenture governing the 2029 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 2029 Notes contains affirmative covenants and events of default that are customary for indentures governing high yield securities. The 2029 Notes and the related guarantees thereof are not subject to any registration rights agreements.

(d) Debt Balances

Outstanding debt balances as of December 31, 2020 and 2019 consisted of the following:


	As of December 31,
	2020		2019
Additional Term Loan	$	21,875	$	—

2024 Notes	—		325,000
2027 Notes	500,000		300,000
2029 Notes	350,000		—
Total debt outstanding	871,875		625,000
Less unamortized fees and premium	(9,226)		(7,841)
Less current portion of notes payable	(4,688)		—
Long-term portion of notes payable	$	857,961	$	617,159

The 2024 Notes, which were redeemed by the Company during the fourth quarter of 2020, were issued in October 2016 and had a fixed interest rate of 5.125%. The Company repaid its outstanding indebtedness under the Additional Term Loan in January 2021. Additionally, in February 2021, the Company borrowed $25,000 under the Senior Credit Facility in the ordinary course of business.

(e) Letters of Credit

At December 31, 2020, the Company maintained outstanding standby letters of credit totaling $24,064 as collateral in relation to its workers compensation insurance agreements and a corporate office lease agreement. Of the $24,064 outstanding letters of credit, the Company has collateralized $2,154 in cash and cash equivalents and the remaining $21,910 is collateralized by the Senior Credit Facility. Outstanding standby letters of credit at December 31, 2019 totaled $19,752.

Income Taxes - Provision for Income Taxes (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Current income taxes:
Federal	$ 32,673,000	$ 25,255,000	$ 33,564,000
State	9,813,000	8,332,000	12,047,000
Total	42,486,000	33,587,000	45,611,000
Deferred income taxes:
Federal	(15,092,000)	625,000	(1,372,000)
State	(6,536,000)	288,000	705,000
Total	(21,628,000)	913,000	(667,000)
Income tax expense from operations	$ 20,858,000	$ 34,500,000	$ 44,944,000

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Share-Based Compensation - Share Based Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share-based Payment Arrangement [Abstract]
Share-based employee compensation, before tax	$ 20,465	$ 16,241	$ 10,815
Related income tax benefits	(5,321)	(4,223)	(2,812)
Share-based employee compensation, net of tax	$ 15,144	$ 12,018	$ 8,003

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Contingent consideration liability - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (23,100)	$ (7,700)
Ending balance	(8,000)	(23,100)
PDA and LFT
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of contingent liability	0	7,000
Advanced
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of contingent liability	20,000	0
Contingent consideration liability	0	(10,622)
Change in fair value of contingent consideration liability	0	(9,378)
Silversheet, Inc.
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration liability	0	(1,500)
Change in fair value of contingent consideration liability	0	1,500
b4health
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration liability	0	(3,100)
Change in fair value of contingent consideration liability	(4,900)	0
MedPartners
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Change in fair value of contingent consideration liability	$ 0	$ 700

Income Taxes - Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	1 Months Ended		12 Months Ended
	Nov. 30, 2019	Jul. 31, 2018	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Beginning balance of unrecognized tax benefits			$ 4,937	$ 4,393	$ 4,663
Additions based on tax positions related to the current year			667	588	475
Additions based on tax positions of prior years			255	990	753
Reductions due to lapse of applicable statute of limitation			(943)	(1,034)	(547)
Settlements			0	0	(951)
Ending balance of unrecognized tax benefits			4,916	4,937	4,393
Unrecognized tax benefits that would affect the effective tax rate, net of temporary differences			4,616
Temporary differences			831
Accrued interest and penalties related to uncertain tax positions			530	493	467
Interest and penalties recognized			$ 37	$ 26	$ (139)
Advanced Acquisition
Business Acquisition [Line Items]
Income tax assessment	$ 1,300	$ 8,300

Fair Value Measurement (Tables)

12 Months Ended

Dec. 31, 2020

Fair Value Disclosures [Abstract]

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

The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value:


	Fair Value Measurements as of December 31, 2020
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	$	2,198	$	2,198	$	—	$	—
Deferred compensation	(97,184)		(97,184)		—		—
Commercial paper	58,345		—		58,345		—
Acquisition contingent consideration liabilities	(8,000)		—		—		(8,000)


	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)

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:


	2020		2019
Balance as of January 1,	$	(23,100)	$	(7,700)
Settlement of PDA and LFT contingent consideration liability for year ended December 31, 2018	—		7,000
Settlement of Advanced contingent consideration liability for year ended December 31, 2019	20,000		—
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 MedPartners acquisition	—		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)
Change in fair value of contingent consideration liability from b4health acquisition	(4,900)		—
Balance as of December 31,	$	(8,000)	$	(23,100)

Schedule of carrying amounts and estimated fair value of Notes

The carrying amounts and estimated fair value of the 2024 Notes, the 2027 Notes and the 2029 Notes, which are more fully described in Note (8), “Notes Payable and Credit Agreement,” are presented in the following table:


	As of December 31, 2020				As of December 31, 2019
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2024 Notes	$	—	$	—	$	325,000	$	337,188
2027 Notes	500,000		521,250		300,000		301,500
2029 Notes	350,000		357,000		—		—

Acquisitions - Business Acquisition, Pro Forma Financial Information (Details) - Stratus Video and Advanced - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Revenue	$ 2,407,586	$ 2,383,405
Income from operations	165,196	145,069
Net income	$ 81,422	$ 85,154

Income Taxes - Income Tax Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income tax reconciliation
Tax expense at federal statutory rate	$ 19,220	$ 31,253	$ 39,272
State taxes, net of federal benefit	4,161	6,810	9,902
Non-deductible expenses	3,621	3,840	2,956
Share-based compensation	(2,311)	(4,770)	(4,343)
Unrecognized tax benefit	(78)	(207)	413
Other, net	(3,755)	(2,426)	(3,256)
Income tax expense from operations	$ 20,858	$ 34,500	$ 44,944

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Acquisitions (Tables)

12 Months Ended

Dec. 31, 2020

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 as of the acquisition date:


		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer Relationships	$	171,000	20
	Tradenames and Trademarks	40,000		5 - 10
	Developed Technology	16,000		5
	Interpreter Database	1,000		4
		$	228,000

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

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

Schedule of pro forma financial information

The unaudited pro forma financial information is not necessarily indicative of the operating results that would have occurred had the acquisitions been consummated as of the date indicated, nor is it necessarily indicative of the Company’s future operating results.


	Years Ended December 31,
	2020		2019
Revenue	$	2,407,586	$	2,383,405
Income from operations	165,196		145,069
Net income	81,422		85,154

Acquisitions - Phillips DiPisa and Leaders For Today Acquisition (Details)		3 Months Ended		12 Months Ended			36 Months Ended
	Apr. 06, 2018 USD ($) acquisition	Jun. 30, 2019 USD ($)	Sep. 30, 2018 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Dec. 31, 2020 USD ($) acquisition
Business Acquisition [Line Items]
Number of acquisitions \| acquisition							6
Cash consideration				$ 476,491,000	$ 247,906,000	$ 217,360,000
Goodwill				$ 864,485,000	$ 595,551,000	$ 438,506,000	$ 864,485,000
PDA and LFT
Business Acquisition [Line Items]
Number of acquisitions \| acquisition	2
Purchase price	$ 35,968,000
Cash consideration	30,268,000
Contingent earn-out based on future operating performance (up to)	7,000,000
Fair value of contingent earn-out	$ 5,700,000
Working capital returned to Company for working capital settlement			$ 465,000
Purchase price, net of working capital adjustment		$ 35,503,000
Fair value of tangible assets acquired		4,389,000
Cash and restricted 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 Acquisition [Line Items]
Identified intangible assets	$ 5,400,000
PDA and LFT \| Customer Relationships
Business Acquisition [Line Items]
Identified intangible assets	8,000,000
PDA and LFT \| Staffing Database
Business Acquisition [Line Items]
Identified intangible assets	$ 5,710,000

Goodwill and Identifiable Intangible Assets - Acquired Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 690,745	$ 460,491
Accumulated Amortization	(215,234)	(151,417)
Net Carrying Amount	475,511	309,074
Acquired Indefinite-lived Intangible Assets [Line Items]
Intangible assets excluding goodwill	564,911	398,474
Tradenames and trademarks
Acquired Indefinite-lived Intangible Assets [Line Items]
Intangible assets not subject to amortization	89,400	89,400
Staffing databases
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	36,836	35,836
Accumulated Amortization	(16,706)	(13,369)
Net Carrying Amount	20,130	22,467
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	444,839	273,839
Accumulated Amortization	(122,105)	(94,206)
Net Carrying Amount	322,734	179,633
Tradenames and trademarks
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	166,269	126,269
Accumulated Amortization	(58,299)	(33,545)
Net Carrying Amount	107,970	92,724
Non-compete agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	6,371	4,117
Accumulated Amortization	(3,402)	(2,035)
Net Carrying Amount	2,969	2,082
Acquired technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	36,430	20,430
Accumulated Amortization	(14,722)	(8,262)
Net Carrying Amount	$ 21,708	$ 12,168

Goodwill and Identifiable Intangible Assets - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Aggregate amortization expense, intangible assets	$ 63,817,000	$ 36,493,000
Goodwill, impairment loss	$ 0

Acquisitions - Advanced Acquisition (Details) - USD ($)		3 Months Ended		12 Months Ended
Acquisitions - Advanced Acquisition (Details) - USD ($)	Jun. 14, 2019	Jun. 30, 2020	Sep. 30, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Cash consideration				$ 476,491,000	$ 247,906,000	$ 217,360,000
Goodwill				$ 864,485,000	$ 595,551,000	$ 438,506,000
Secured Debt \| Term Loan Credit Facility
Business Acquisition [Line Items]
Maximum borrowing capacity	$ 150,000,000
Advanced Acquisition
Business Acquisition [Line Items]
Purchase price	211,743,000
Cash consideration	201,121,000		$ 73,000
Contingent earn-out based on future operating performance (up to)	20,000,000
Fair value of contingent earn-out	10,622,000
Purchase price, net of working capital adjustment		$ 211,816,000
Fair value of tangible assets acquired		29,020,000
Cash and restricted cash received		2,497,000
Liabilities assumed		28,772,000
Identified intangible assets	$ 91,700,000	91,700,000
Goodwill		119,868,000
Goodwill expected to be tax deductible		$ 57,236,000
Weighted average useful life of intangible assets	9 years

Leases - Supplemental Cash Flow Information Regarding Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Cash paid for amounts included in the measurement of operating lease liabilities	$ 20,052	$ 17,817

Notes Payable and Credit Agreement - Senior Notes (Details) - USD ($)				2 Months Ended	12 Months Ended
	Nov. 04, 2020	Oct. 20, 2020	Aug. 13, 2020	Sep. 30, 2020	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Oct. 01, 2019
Debt Instrument [Line Items]
Repayments of line of credit					$ 245,000,000	$ 221,000,000	$ 75,000,000
Term Loan Credit Facility \| Secured Debt
Debt Instrument [Line Items]
Extinguishment of debt				$ 200,000,000
2027 Notes \| Senior Notes
Debt Instrument [Line Items]
Interest rate			4.625%					4.625%
Aggregate principal amount			$ 200,000,000		$ 500,000,000	300,000,000		$ 300,000,000
Issuance price, percentage of principal amount			101.00%
Payment of debt issuance fees and expenses				$ 2,620,000
2029 Notes \| Senior Notes
Debt Instrument [Line Items]
Interest rate		4.00%			4.00%
Aggregate principal amount		$ 350,000,000			$ 350,000,000	$ 0
Payment of debt issuance fees and expenses		4,744,000
2029 Notes \| Senior Notes \| Revolving Credit Facility
Debt Instrument [Line Items]
Repayments of line of credit		$ 40,000,000
2024 Notes \| Senior Notes
Debt Instrument [Line Items]
Extinguishment of debt	$ 325,000,000
Payments for redemption premium and accrued and unpaid interest	$ 9,857,000
Write off of unamortized financing fees					$ 2,992,000

Share-Based Compensation

12 Months Ended

Dec. 31, 2020

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. As of December 31, 2020 and 2019, 2,830 and 2,930 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 recently consisted of 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, 2020, 179 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, 2020, 2019 and 2018:


	Number of Shares	Weighted Average Grant Date Fair Value per Share
Unvested at January 1, 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
Granted—RSUs	271	$	60.02
Granted—PRSUs (1)	155	$	64.59
Vested	(283)	$	49.18
Canceled/forfeited/expired	(184)	$	53.84
Unvested at December 31, 2020	717	$	58.88

(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, 2020, there was $16,972 unrecognized compensation cost related to unvested RSUs and PRSUs. The Company expects to recognize such cost over a period of 1.7 years. As of December 31, 2020 and 2019, the aggregate intrinsic value of the RSUs and PRSUs outstanding was $48,945 and $47,242, 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, 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
Granted	—	$	—
Exercised	(12)	$	7.51
Canceled/forfeited/expired	—	$	—
Outstanding at December 31, 2020	—	$	—
Vested and expected to vest at December 31, 2020	—	$	—
Exercisable at December 31, 2020	—	$	—

As of December 31, 2020, there were no stock options or SARs outstanding. The total intrinsic value of stock options and SARs exercised was $828, $9,177 and $1,535 for 2020, 2019 and 2018, respectively. As of December 31, 2019, the total intrinsic value of stock options and SARs outstanding and exercisable was $645.

Share-Based Compensation

Total share-based compensation expense for the years ended December 31, 2020, 2019 and 2018 was as follows:


	Years Ended December 31,
	2020		2019		2018
Share-based employee compensation, before tax	$	20,465	$	16,241	$	10,815
Related income tax benefits	(5,321)		(4,223)		(2,812)
Share-based employee compensation, net of tax	$	15,144	$	12,018	$	8,003

Commitments and Contingencies (Details) - Pending Litigation - Wage and Hour Claims $ in Thousands	3 Months Ended
	Dec. 31, 2020 USD ($)
Loss Contingencies [Line Items]
Increase in litigation matters accrual	$ 20,000
Maximum
Loss Contingencies [Line Items]
Estimate of possible loss	$ 15,000

Acquisitions - Silversheet Acquisition (Details) - USD ($)		3 Months Ended	12 Months Ended
	Jan. 30, 2019	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Cash consideration			$ 476,491,000	$ 247,906,000	$ 217,360,000
Goodwill			$ 864,485,000	$ 595,551,000	$ 438,506,000
Silversheet, Inc.
Business Acquisition [Line Items]
Purchase price	$ 31,676,000
Cash consideration	30,176,000
Contingent earn-out based on future operating performance (up to)	25,000,000
Fair value of contingent earn-out	$ 1,500,000
Purchase price, net of working capital adjustment		$ 31,676,000
Fair value of tangible assets acquired		2,826,000
Cash and restricted cash received		651,000
Liabilities assumed		1,567,000
Identified intangible assets		6,880,000
Goodwill		23,537,000
Goodwill expected to be tax deductible		$ 0
Weighted average useful life of intangible assets	8 years
Silversheet, Inc. \| Developed Technology
Business Acquisition [Line Items]
Identified intangible assets	$ 5,300,000
Silversheet, Inc. \| Trademarks
Business Acquisition [Line Items]
Identified intangible assets	1,500,000
Silversheet, Inc. \| Based on operating results for the twelve months ending December 31, 2019
Business Acquisition [Line Items]
Contingent earn-out based on future operating performance (up to)	6,000,000
Silversheet, Inc. \| Based on operating results for the twelve months ending December 31, 2020
Business Acquisition [Line Items]
Contingent earn-out based on future operating performance (up to)	$ 19,000,000

Balance Sheet Details

12 Months Ended

Dec. 31, 2020

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Details

The consolidated balance sheets detail is as follows:


	December 31,
	2020		2019
Other current assets:
Restricted cash and cash equivalents	$	18,626	$	18,393
Income taxes receivable	6,591		5,984
Other	15,592		16,069
Other current assets	$	40,809	$	40,446

Fixed assets:
Furniture and equipment	$	47,355	$	37,315
Software	220,971		191,050
Leasehold improvements	9,600		9,367
	277,926		237,732
Accumulated depreciation	(161,752)		(132,900)
Fixed assets, net	$	116,174	$	104,832

Accounts payable and accrued expenses:
Trade accounts payable	$	28,089	$	26,985
Subcontractor payable	79,364		75,562
Accrued expenses	37,849		36,344
Loss contingencies	7,613		6,146
Professional liability reserve	8,897		7,925
Other	6,069		3,178
Accounts payable and accrued expenses	$	167,881	$	156,140

Accrued compensation and benefits:
Accrued payroll	$	59,721	$	47,381
Accrued bonuses and commissions	34,514		22,613
Accrued travel expense	1,998		2,459
Health insurance reserve	5,590		4,019
Workers compensation reserve	10,244		8,782
Deferred compensation	97,184		81,064
Other	4,163		4,614
Accrued compensation and benefits	$	213,414	$	170,932

Other current liabilities:
Acquisition related liabilities	$	8,000	$	20,000
Other	2,938		5,302
Other current liabilities	$	10,938	$	25,302

Other long-term liabilities:
Workers compensation reserve	$	20,930	$	18,291
Professional liability reserve	31,997		34,606

Unrecognized tax benefits	5,447		5,431
Other	49,533		3,485
Other long-term liabilities	$	107,907	$	61,813

Share-Based Compensation - Summary of Stock Option and SAR Activity (Details) - Equity Plan and Other Plans - Stock Options and Stock Appreciation Rights - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Equity Plan and Other Plans, Number Outstanding
Outstanding, beginning balance (in shares)	12	227	262
Granted (in shares)	0	0	0
Exercised (in shares)	(12)	(215)	(35)
Canceled/forfeited/expired (in shares)	0	0	0
Outstanding, ending balance (in shares)	0	12	227
Vested and expected to vest (in shares)	0
Exercisable (in shares)	0
Equity Plan and Other Plans, Weighted-Average Exercise Price per Share
Outstanding, beginning balance (in dollars per share)	$ 7.51	$ 8.61	$ 8.81
Granted (in dollars per share)	0	0	0
Exercised (in dollars per share)	7.51	8.67	10.12
Canceled/forfeited/expired (in dollars per share)	0	0	0
Outstanding, ending balance (in dollars per share)	0	$ 7.51	$ 8.61
Vested and expected to vest (in dollars per share)	0
Exercisable (in dollars per share)	$ 0

Summary of Significant Accounting Policies (Policies)	12 Months Ended
Summary of Significant Accounting Policies (Policies)	Dec. 31, 2020
Accounting Policies [Abstract]
Coronavirus Pandemic	On March 11, 2020, the World Health Organization declared the outbreak of a novel strain of coronavirus, also known as COVID-19, a global pandemic. Due to the pandemic, there has been uncertainty and disruption in the global economy and significant volatility of financial markets. The Company is closely monitoring the impact of the pandemic, which continues to evolve, and its effects and risks on our operations, liquidity, financial condition and financial results. The Company also implemented remote-work arrangements effective mid-March 2020 and, to date, transitioning to a remote-work environment has not had a material adverse impact on the Company’s ability to continue to operate its business, financial reporting process or internal controls and procedures.
Principles of Consolidation	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.
Use of Estimates	Use of Estimates 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 such as legal accruals, 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. The estimates used for, but not limited to, determining the collectability of accounts receivable, fair value of long-lived assets, and goodwill could be impacted by the COVID-19 pandemic. While the full impact of COVID-19, including the duration and severity of the pandemic, remains unknown, the Company has made appropriate estimates based on the facts and circumstances available as of the reporting date. Specifically, the Company continues to monitor the impacts of the pandemic on its customers’ liquidity and capital resources and, therefore, the Company’s ability to collect, or the timeliness of collection of accounts receivable. The impact of COVID-19 did not have a material effect on the Company’s estimates as of December 31, 2020. These estimates may change as new events occur and additional information is obtained.
Cash and Cash Equivalents	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.
Restricted Cash, Cash Equivalents, and Investments	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.
Fixed Assets	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 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.
Leases	LeasesThe 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.
Goodwill	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. If the reporting unit does not pass the qualitative assessment, then the reporting unit’s carrying value is compared to its fair value. The amount by which the carrying value of the goodwill exceeds its fair value is recognized as an impairment loss.
Intangible Assets	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.
Insurance Reserves	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 primarily 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. In December 2017, the Company transferred legacy liabilities related to its self-insured retention portion of both the workers compensation and locum tenens business professional liability to its captive insurance subsidiary. These legacy liabilities follow the same accounting policies as described in the paragraphs above.
Revenue Recognition	Revenue RecognitionRevenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from its software as a service (“SaaS”)-based technologies, including vendor management systems and scheduling software, and outsourced workforce services, including language interpretation and recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from permanent placement and outsourced workforce services is recognized as the services are rendered. Depending on the arrangement, the Company’s SaaS-based revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. See additional information below regarding the Company’s revenue disaggregated by service type. 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 years ended December 31, 2020 and 2019, previously deferred revenue recognized as revenue was $11,729 and $9,972, respectively. 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 $11,208 and $11,369 for the years ended December 31, 2020 and 2019, respectively. The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: •Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. •Recognize revenue in the amount of consideration 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.
Accounts Receivable	Accounts Receivable The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions.The Company reclassified its allowance for accounts receivable in the prior year’s consolidated balance sheet to conform to the current year presentation. The prior year balance of accounts receivable (net of allowances) remains unchanged.
Concentration of Credit Risk	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	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.
Fair Value of Financial Instruments	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 2027 Notes and 2029 Notes (as defined in Note (8) and Note (3), respectively, 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.
Share-Based Compensation	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 over a three-year period. 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 performance conditions dependent on defined targets of the Company’s adjusted EBITDA, with a range of 0% to 200% 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 market conditions.
Segment Information	Segment Information The Company’s operating segments are identified in the same manner as they are reported internally and used by the Company’s chief operating decision maker for the purpose of evaluating performance and allocating resources. Effective March 8, 2020, the Company modified its reportable segments. The Company previously utilized three reportable segments, which it identified as follows: (1) nurse and allied solutions, (2) locum tenens solutions, and (3) other workforce solutions. In light of the Company’s recent acquisitions and organizational changes to better align its organizational structure with its strategy and operations, the Company’s management reorganized its reportable segments to better reflect how the business is evaluated by the chief operating decision maker. Beginning in the first quarter of 2020, the Company has disclosed the following three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions. The nurse and allied solutions segment includes the Company’s travel nurse staffing, rapid response nurse staffing and labor disruption, allied staffing, local staffing, and revenue cycle solutions businesses. The physician and leadership solutions segment includes the Company’s locum tenens staffing, healthcare interim leadership staffing, executive search, and physician permanent placement businesses. The technology and workforce solutions segment includes the Company’s language interpretation services, vendor management systems, workforce optimization, recruitment process outsourcing, credentialing, and flex pool management businesses. The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed.
Recently Adopted Accounting Pronouncements	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. In June 2016, the FASB issued ASU 2016-13, “Measurement of Credit Losses on Financial Instruments.” The FASB also issued a series of other ASUs, which update ASU 2016-13 (collectively, the “credit loss standard”). This new standard introduces new accounting models for determining and recognizing credit losses on certain financial instruments based on an estimate of current expected credit losses. The Company adopted this standard effective January 1, 2020 using the modified retrospective transition method. The Company recognized the cumulative effect of adopting this guidance as an adjustment to the opening balance of retained earnings of $1,154, net of tax, primarily related to its allowance for credit losses for accounts receivable. Prior period amounts are not retrospectively adjusted. The impact of the adoption of the new standard was not material to the Company’s consolidated financial statements. The Company expects the impact to be immaterial on an ongoing basis. In January 2017, the FASB issued ASU 2017-04, “Simplifying the Test for Goodwill Impairment.” The standard simplifies the subsequent measurement of goodwill by removing the requirement to perform a hypothetical purchase price allocation to compute the implied fair value of goodwill to measure impairment. Instead, any goodwill impairment will equal the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. Further, the guidance eliminates the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment and, if it fails that qualitative test, to perform Step 2 of the goodwill impairment test. The Company adopted this standard effective January 1, 2020 and the adoption did not have a material effect on the Company’s consolidated financial statements. In August 2018, the FASB issued ASU 2018-13, “Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement.” The standard modifies the current disclosure requirements on fair value measurements. The Company adopted this standard effective January 1, 2020. Refer to information regarding fair value measurements in Note (3), “Fair Value Measurement.” There were no other material impacts to the Company’s consolidated financial statements as a result of adopting these updated standards.

Income Taxes

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Income Taxes

The provision for income taxes from operations for the years ended December 31, 2020, 2019 and 2018 consists of the following:


	Years Ended December 31,
	2020		2019		2018
Current income taxes:
Federal	$	32,673	$	25,255	$	33,564
State	9,813		8,332		12,047
Total	42,486		33,587		45,611
Deferred income taxes:
Federal	(15,092)		625		(1,372)
State	(6,536)		288		705
Total	(21,628)		913		(667)
Provision for income taxes from operations	$	20,858	$	34,500	$	44,944

The Company’s income tax expense differs from the amount that would have resulted from applying the federal statutory rate of 21% for 2020, 2019 and 2018 to pretax income from operations because of the effect of the following items during the years ended December 31, 2020, 2019 and 2018:


	Years Ended December 31,
	2020		2019		2018
Tax expense at federal statutory rate	$	19,220	$	31,253	$	39,272
State taxes, net of federal benefit	4,161		6,810		9,902
Non-deductible expenses	3,621		3,840		2,956
Share-based compensation	(2,311)		(4,770)		(4,343)

Unrecognized tax benefit	(78)		(207)		413
Other, net	(3,755)		(2,426)		(3,256)
Income tax expense from operations	$	20,858	$	34,500	$	44,944

Certain reclassifications have been made to the prior year’s presentation of deferred tax assets in order to conform to the current year presentation. There is no change to the prior year total deferred tax assets. The tax effects of temporary differences that give rise to significant portions of deferred tax assets and liabilities are presented below as of December 31, 2020 and 2019:


	December 31,
	2020		2019
Deferred tax assets:
Stock compensation	$	6,198	$	5,848
Deferred compensation	24,604		20,564
Accrued bonus	7,607		4,294
Accrued payroll taxes	12,445		60
Accrued expenses	18,185		14,218

Operating lease liabilities	23,826		27,206
Net operating losses	9,557		3,448
Loss contingencies	6,459		—
Other	989		570
Total deferred tax assets	$	109,870	$	76,208
Deferred tax liabilities:
Intangibles	$	(126,833)	$	(71,646)
Fixed assets	(25,252)		(22,896)
Operating lease right-of-use assets	(19,933)		(23,234)
Other	(5,057)		(5,050)
Total deferred tax liabilities	$	(177,075)	$	(122,826)

Net deferred tax liabilities	$	(67,205)	$	(46,618)

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, 2020 is $41,430, primarily related to the Stratus Video acquisition, which begins to expire by 2030. The amount of state NOL carryforward that is available for use in years subsequent to December 31, 2020 is $16,631, primarily related to the Stratus Video acquisition, which begins to expire by 2021. The Stratus Video acquisition is more fully described in Note (2), “Acquisitions.”

A summary of the changes in the amount of unrecognized tax benefits (excluding interest and penalties) for 2020, 2019 and 2018 is as follows:


	2020		2019		2018
Beginning balance of unrecognized tax benefits	$	4,937	$	4,393	$	4,663
Additions based on tax positions related to the current year	667		588		475
Additions based on tax positions of prior years	255		990		753
Reductions due to lapse of applicable statute of limitation	(943)		(1,034)		(547)
Settlements	—		—		(951)
Ending balance of unrecognized tax benefits	$	4,916	$	4,937	$	4,393

At December 31, 2020, if recognized, approximately $4,616 net of $831 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 $530, $493 and $467 of accrued interest related to unrecognized tax benefits at December 31, 2020, 2019 and 2018, respectively. The amount of interest expense (benefit) recognized in 2020, 2019 and 2018 was $37, $26 and $(139), respectively.

The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of December 31, 2020, the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2011, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2017. 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. The Company received a final determination from the IRS in November 2019 for $1,300. The Company is indemnified by Advanced for the potential contingent liability for all pre-acquisition open years. The Advanced acquisition is more fully described in Note (2), “Acquisitions.”

The Company believes its indemnification by Advanced for all pre-acquisition years and its reserve for unrecognized tax benefits and contingent tax issues are adequate with respect to all open years. Notwithstanding the foregoing, the Company could adjust its provision for income taxes and contingent tax liability based on future developments.

CARES Act

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) was enacted and signed into law in response to the COVID-19 pandemic. Among other things, the CARES Act contains significant business tax provisions, including a deferral of payment of employer payroll taxes and an employer retention credit for employer payroll taxes.

The Company deferred payment of the employer’s share of payroll taxes of $48,249, which is included in accrued compensation and benefits and other long-term liabilities in the consolidated balance sheet as of December 31, 2020, with half of such taxes to be paid by the end of 2021 and the other half to be paid by the end of 2022. The Company claimed an employee retention employment tax credit of $1,183.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References + Details

Retirement Plans - Deferred Compensation Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Deferred Compensation Arrangement with Individual, Postretirement Benefits [Line Items]
Cash surrender value of life insurance	$ 98,161	$ 79,515
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	$ 2,845	$ 5,551	$ 4,708

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($)	Dec. 31, 2020	Oct. 20, 2020	Aug. 13, 2020	Dec. 31, 2019	Oct. 01, 2019
2024 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	$ 0			$ 325,000,000
Estimated Fair Value	0			337,188,000
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	500,000,000		$ 200,000,000	300,000,000	$ 300,000,000
Estimated Fair Value	521,250,000			301,500,000
2029 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	350,000,000	$ 350,000,000		0
Estimated Fair Value	$ 357,000,000			$ 0

Summary of Significant Accounting Policies - Segment Information (Details) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020 USD ($)	Sep. 30, 2020 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Sep. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Mar. 31, 2019 USD ($)	Dec. 31, 2020 USD ($) segment	Dec. 31, 2019 USD ($) segment	Dec. 31, 2018 USD ($)
Accounting Policies [Abstract]
Number of reportable segments \| segment									3	3
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	$ 631,271	$ 551,631	$ 608,351	$ 602,461	$ 586,892	$ 567,597	$ 535,177	$ 532,441	$ 2,393,714	$ 2,222,107	$ 2,136,074
Segment operating income									149,265	176,915	202,828
Depreciation and amortization									92,766	58,520	41,237
Depreciation (included in cost of revenue)									1,421	0	0
Share-based compensation									20,465	16,241	10,815
Interest expense, net, and other									57,742	28,427	16,143
Income before income taxes									91,523	148,488	186,685
Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									2,107,539	2,045,572	1,974,135
Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									58,394	79,778	74,371
Outsourced workforce
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									134,468	16,096	15,042
SaaS-based technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									93,313	80,661	72,526
Nurse and Allied Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									1,699,311	1,562,588	1,431,018
Nurse and Allied Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									1,699,311	1,562,588	1,431,018
Nurse and Allied Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									0	0	0
Nurse and Allied Solutions \| Outsourced workforce
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									0	0	0
Nurse and Allied Solutions \| SaaS-based technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									0	0	0
Physician and Leadership Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									466,622	562,762	617,488
Physician and Leadership Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									408,228	482,984	543,117
Physician and Leadership Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									58,394	79,778	74,371
Physician and Leadership Solutions \| Outsourced workforce
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									0	0	0
Physician and Leadership Solutions \| SaaS-based technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									0	0	0
Technology and Workforce Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									227,781	96,757	87,568
Technology and Workforce Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									0	0	0
Technology and Workforce Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									0	0	0
Technology and Workforce Solutions \| Outsourced workforce
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									134,468	16,096	15,042
Technology and Workforce Solutions \| SaaS-based technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									93,313	80,661	72,526
Operating Segments
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									2,393,714	2,222,107	2,136,074
Segment operating income									387,559	335,139	329,316
Operating Segments \| Nurse and Allied Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									1,699,311	1,562,588	1,431,018
Segment operating income									232,005	219,862	201,866
Operating Segments \| Physician and Leadership Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									466,622	562,762	617,488
Segment operating income									62,342	71,378	86,077
Operating Segments \| Technology and Workforce Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue									227,781	96,757	87,568
Segment operating income									93,212	43,899	41,373
Corporate, Non-Segment
Segment Reporting Information, Profit (Loss) [Abstract]
Unallocated corporate overhead									$ 123,642	$ 83,463	$ 74,436

Summary of Significant Accounting Policies - Revenue Recognition (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Previously deferred revenue recognized during period	$ 11,729	$ 9,972
Capitalized contract cost amortization	$ 11,208	$ 11,369

Quarterly Financial Data (Unaudited) (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Selected Quarterly Financial Information [Abstract]
Revenue	$ 631,271	$ 551,631	$ 608,351	$ 602,461	$ 586,892	$ 567,597	$ 535,177	$ 532,441	$ 2,393,714	$ 2,222,107	$ 2,136,074
Gross profit	207,539	184,633	197,540	202,066	197,133	190,031	179,542	176,759	791,778	743,465	696,383
Net income	$ 9,308	$ 26,067	$ 22,325	$ 12,965	$ 27,482	$ 23,515	$ 28,869	$ 34,122	$ 70,665	$ 113,988	$ 141,741
Net income per share from:
Basic (in dollars per share)	$ 0.20	$ 0.55	$ 0.47	$ 0.27	$ 0.59	$ 0.50	$ 0.62	$ 0.73	$ 1.49	$ 2.44	$ 2.99
Diluted (in dollars per share)	$ 0.19	$ 0.55	$ 0.47	$ 0.27	$ 0.58	$ 0.49	$ 0.61	$ 0.71	$ 1.48	$ 2.40	$ 2.91

- 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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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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Aggregate revenue less cost of goods and services sold or operating expenses directly attributable to the revenue generation activity.

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+ Details

Acquisitions - Additional Information (Details)	36 Months Ended
Acquisitions - Additional Information (Details)	Dec. 31, 2020 acquisition
Business Combinations [Abstract]
Number of acquisitions	6

Cover Page - USD ($)	12 Months Ended
Cover Page - USD ($)	Dec. 31, 2020	Feb. 24, 2021	Jun. 30, 2020
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2020
Current Fiscal Year End Date	--12-31
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
ICFR Auditor Attestation Flag	true
Entity Shell Company	false
Entity Public Float			$ 2,111,094,202
Entity Common Stock, Shares Outstanding (excluding treasury shares)		47,180,479
Documents Incorporated by Reference	Portions of the registrant’s definitive proxy statement for the annual meeting of stockholders scheduled to be held on April 21, 2021 have been incorporated by reference into Part III of this Form 10-K.
Entity Central Index Key	0001142750
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	FY
Amendment Flag	false

Quarterly Financial Data (Unaudited) (Tables)

12 Months Ended

Dec. 31, 2020

Quarterly Financial Information Disclosure [Abstract]

Schedule of quarterly financial information


	Year Ended December 31, 2020
	First Quarter		Second Quarter		Third Quarter		Fourth Quarter		Total Year
	(In thousands, except per share data)
Revenue	$	602,461	$	608,351	$	551,631	$	631,271	$	2,393,714
Gross profit	$	202,066	$	197,540	$	184,633	$	207,539	$	791,778
Net income	$	12,965	$	22,325	$	26,067	$	9,308	$	70,665
Net income per share from:
Basic	$	0.27	$	0.47	$	0.55	$	0.20	$	1.49
Diluted	$	0.27	$	0.47	$	0.55	$	0.19	$	1.48


	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

Quarterly Financial Data (Unaudited)

12 Months Ended

Dec. 31, 2020

Quarterly Financial Information Disclosure [Abstract]

Quarterly Financial Data (Unaudited)


	Year Ended December 31, 2020
	First Quarter		Second Quarter		Third Quarter		Fourth Quarter		Total Year
	(In thousands, except per share data)
Revenue	$	602,461	$	608,351	$	551,631	$	631,271	$	2,393,714
Gross profit	$	202,066	$	197,540	$	184,633	$	207,539	$	791,778
Net income	$	12,965	$	22,325	$	26,067	$	9,308	$	70,665
Net income per share from:
Basic	$	0.27	$	0.47	$	0.55	$	0.20	$	1.49
Diluted	$	0.27	$	0.47	$	0.55	$	0.19	$	1.48


	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

Capital Stock (Details) - USD ($)	12 Months Ended
Capital Stock (Details) - USD ($)	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Nov. 01, 2016
Preferred Stock, Number of Shares, Par Value and Other Disclosures [Abstract]
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares outstanding (in shares)	0	0
Treasury Stock, Number of Shares and Restriction Disclosures [Abstract]
Stock repurchase program, authorized amount (up to)				$ 150,000,000
Treasury stock acquired (in shares)	0	395,000
Treasury stock acquired (in dollars per share)		$ 47.30
Aggregate purchase price of treasury stock		$ 18,705,000	$ 67,013,000

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 7,043	$ 3,332
Accumulated depreciation	161,752	132,900
Accumulated amortization	$ 215,234	$ 151,417
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	200,000,000	200,000,000
Common stock, shares issued (in shares)	49,614,000	49,283,000
Common stock, shares outstanding (in shares)	47,053,000	46,722,000
Treasury stock (in shares)	2,561,000	2,561,000

Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Statement of Cash Flows [Abstract]
Interest capitalized	$ 389	$ 536	$ 460

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, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Accounting Policies [Abstract]
Common stock excluded from calculation of EPS (in shares)									41	43	23
Computation of Basic and Diluted Net Income Per Common Share [Abstract]
Net income	$ 9,308	$ 26,067	$ 22,325	$ 12,965	$ 27,482	$ 23,515	$ 28,869	$ 34,122	$ 70,665	$ 113,988	$ 141,741
Net income per common share - basic (in dollars per share)	$ 0.20	$ 0.55	$ 0.47	$ 0.27	$ 0.59	$ 0.50	$ 0.62	$ 0.73	$ 1.49	$ 2.44	$ 2.99
Net income per common share - diluted (in dollars per share)	$ 0.19	$ 0.55	$ 0.47	$ 0.27	$ 0.58	$ 0.49	$ 0.61	$ 0.71	$ 1.48	$ 2.40	$ 2.91
Weighted average common shares outstanding - basic (in shares)									47,424	46,704	47,371
Plus dilutive effect of potential common shares (in shares)									266	889	1,297
Weighted average common shares outstanding - diluted (in shares)									47,690	47,593	48,668

- Definition

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

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

+ References

+ Details

Goodwill and Identifiable Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2020

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of acquired intangible assets by major class

As of December 31, 2020 and 2019, the Company had the following acquired intangible assets:


	As of December 31, 2020						As of December 31, 2019
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Intangible assets subject to amortization:
Staffing databases	$	36,836	$	(16,706)	$	20,130	$	35,836	$	(13,369)	$	22,467
Customer relationships	444,839		(122,105)		322,734		273,839		(94,206)		179,633
Tradenames and trademarks	166,269		(58,299)		107,970		126,269		(33,545)		92,724
Non-compete agreements	6,371		(3,402)		2,969		4,117		(2,035)		2,082
Acquired technology	36,430		(14,722)		21,708		20,430		(8,262)		12,168
	$	690,745	$	(215,234)	$	475,511	$	460,491	$	(151,417)	$	309,074
Intangible assets not subject to amortization:
Tradenames and trademarks					$	89,400					$	89,400
					$	564,911					$	398,474

Schedule of estimated amortization expense

Based on the current amount of intangibles subject to amortization, the estimated future amortization expense as of December 31, 2020 is as follows:


	Amount
Year ending December 31, 2021	$	61,234
Year ending December 31, 2022	60,351
Year ending December 31, 2023	58,694
Year ending December 31, 2024	52,161
Year ending December 31, 2025	39,199
Thereafter	203,872
	$	475,511

Schedule of goodwill

The following table, which includes reclassified prior period amounts to conform to the new segment reporting structure, summarizes the activity related to the carrying value of goodwill by reportable segment:


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2019	$	224,454	$	163,362	$	50,690	$	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	344,316		163,348		87,887		595,551
Goodwill adjustment for Advanced acquisition	29		—		—		29
Goodwill adjustment for b4health acquisition	—		—		(66)		(66)
Goodwill from Stratus Video acquisition	—		—		268,971		268,971
Reallocation due to change in segments	(5,330)		(10,548)		15,878		—
Balance, December 31, 2020	$	339,015	$	152,800	$	372,670	$	864,485
Accumulated impairment loss as of December 31, 2019 and 2020	$	154,444	$	60,495	$	—	$	214,939

Summary of Significant Accounting Policies - Fixed Assets (Details)	12 Months Ended
	Dec. 31, 2020
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

Capital Stock	12 Months Ended
Capital Stock	Dec. 31, 2020
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, 2020 and 2019, 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 that would permit shares to be repurchased when the Company might otherwise be precluded from doing so under the Company’s securities trading policy. During the year ended December 31, 2020, the Company did not repurchase any shares of its common stock. During the year ended December 31, 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.

Leases (Tables)

12 Months Ended

Dec. 31, 2020

Leases [Abstract]

Schedule of components of lease expense

The components of lease expense were as follows:


	Years Ended December 31,
	2020		2019
Operating lease cost	$	20,176	$	18,725
Short-term lease cost	8,702		20,112
Variable and other lease cost	2,526		2,880
Net lease cost	$	31,404	$	41,717

Supplemental cash flow information related to leases was as follows:


	Years Ended December 31,
	2020		2019
Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows)	$	20,052	$	17,817

Schedule of maturities of lease liabilities

The maturities of lease liabilities as of December 31, 2020 were as follows:


	Operating Leases
Years ending December 31,
2021	$	19,108
2022	18,552
2023	18,207
2024	17,030
2025	15,160
Thereafter	18,733
Total lease payments	106,790
Less imputed interest	(13,958)
Present value of lease liabilities	$	92,832

Schedule of assumptions used for operating leases

The weighted average remaining lease term and discount rate as of December 31, 2020 and 2019 were as follows:


	December 31,
	2020		2019
Weighted average remaining lease term	6 years		7 years
Weighted average discount rate	4.8	%	4.8	%

Retirement Plans	12 Months Ended
Retirement Plans	Dec. 31, 2020
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. A discretionary matching contribution is determined by the Company each year. Employer contribution expenses incurred under the AMN Plan were $4,256, $5,516 and $5,250 for the years ended December 31, 2020, 2019 and 2018, 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. A discretionary matching contribution is determined by the Company each year. Employer contributions under the Plan were $2,845, $5,551 and $4,708 for the years ended December 31, 2020, 2019 and 2018, 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 $98,161 and $79,515 at December 31, 2020 and 2019, respectively. The cash surrender value of these insurance policies is included in other assets in the consolidated balance sheets.

- Definition

The entire disclosure for retirement benefits.

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+ Details

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Reconciliation of cash, cash equivalents and restricted cash


	December 31, 2020		December 31, 2019
Cash and cash equivalents	$	29,213	$	82,985
Restricted cash and cash equivalents (included in other current assets)	18,626		18,393
Restricted cash, cash equivalents and investments	61,347		62,170
Total cash, cash equivalents and restricted cash and investments	109,186		163,548
Less restricted investments	(25,196)		(9,586)
Total cash, cash equivalents and restricted cash	$	83,990	$	153,962

Reconciliation of activity in the allowance for credit losses

The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable:


	2020
Balance as of January 1,	$	3,332
Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings	1,334
Provision for expected credit losses	4,428
Amounts written off charged against the allowance	(2,051)

Balance as of December 31,	$	7,043

Schedule of computation of basic and diluted net income per common share

The following table sets forth the computation of basic and diluted net income per common share for the years ended December 31, 2020, 2019 and 2018, respectively:


	Years Ended December 31,
	2020		2019		2018
Net income	$	70,665	$	113,988	$	141,741

Net income per common share - basic	$	1.49	$	2.44	$	2.99
Net income per common share - diluted	$	1.48	$	2.40	$	2.91

Weighted average common shares outstanding - basic	47,424		46,704		47,371
Plus dilutive effect of potential common shares	266		889		1,297
Weighted average common shares outstanding - diluted	47,690		47,593		48,668

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


	Years Ended December 31,
	2020		2019		2018
Revenue
Nurse and allied solutions	$	1,699,311	$	1,562,588	$	1,431,018
Physician and leadership solutions	466,622		562,762		617,488
Technology and workforce solutions	227,781		96,757		87,568
	$	2,393,714	$	2,222,107	$	2,136,074
Segment operating income
Nurse and allied solutions	$	232,005	$	219,862	$	201,866
Physician and leadership solutions	62,342		71,378		86,077
Technology and workforce solutions	93,212		43,899		41,373
	387,559		335,139		329,316
Unallocated corporate overhead	123,642		83,463		74,436
Depreciation and amortization	92,766		58,520		41,237
Depreciation (included in cost of revenue)	1,421		—		—
Share-based compensation	20,465		16,241		10,815
Interest expense, net, and other	57,742		28,427		16,143
Income before income taxes	$	91,523	$	148,488	$	186,685

Schedule of revenue disaggregated by service type

The following tables present the Company’s revenue disaggregated by service type:


	Year Ended December 31, 2020
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Temporary staffing	$	1,699,311	$	408,228	$	—	$	2,107,539
Permanent placement	—		58,394		—		58,394
Outsourced workforce	—		—		134,468		134,468
SaaS-based technologies	—		—		93,313		93,313
Total revenue	$	1,699,311	$	466,622	$	227,781	$	2,393,714


	Year Ended December 31, 2019
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Temporary staffing	$	1,562,588	$	482,984	$	—	$	2,045,572
Permanent placement	—		79,778		—		79,778
Outsourced workforce	—		—		16,096		16,096
SaaS-based technologies	—		—		80,661		80,661
Total revenue	$	1,562,588	$	562,762	$	96,757	$	2,222,107


	Year Ended December 31, 2018
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Temporary staffing	$	1,431,018	$	543,117	$	—	$	1,974,135
Permanent placement	—		74,371		—		74,371
Outsourced workforce	—		—		15,042		15,042
SaaS-based technologies	—		—		72,526		72,526
Total revenue	$	1,431,018	$	617,488	$	87,568	$	2,136,074

Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Statement of Comprehensive Income [Abstract]
Revenue	$ 2,393,714	$ 2,222,107	$ 2,136,074
Cost of revenue	1,601,936	1,478,642	1,439,691
Gross profit	791,778	743,465	696,383
Operating expenses:
Selling, general and administrative	549,747	508,030	452,318
Depreciation and amortization	92,766	58,520	41,237
Total operating expenses	642,513	566,550	493,555
Income from operations	149,265	176,915	202,828
Interest expense, net, and other	57,742	28,427	16,143
Income before income taxes	91,523	148,488	186,685
Income tax expense	20,858	34,500	44,944
Net income	70,665	113,988	141,741
Other comprehensive income (loss):
Foreign currency translation and other	(112)	1	263
Other comprehensive income (loss)	(112)	1	263
Comprehensive income	$ 70,553	$ 113,989	$ 142,004
Net income per common share:
Net income per common share - basic (in dollars per share)	$ 1.49	$ 2.44	$ 2.99
Net income per common share - diluted (in dollars per share)	$ 1.48	$ 2.40	$ 2.91
Weighted average common shares outstanding:
Weighted average common shares outstanding - basic (in shares)	47,424	46,704	47,371
Weighted average common shares outstanding - diluted (in shares)	47,690	47,593	48,668

Goodwill and Identifiable Intangible Assets - Changes in the Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Goodwill [Roll Forward]
Beginning balance	$ 595,551	$ 438,506
Reallocation due to change in segments	0
Ending balance	864,485	595,551
Accumulated impairment loss	214,939	214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Beginning balance	344,316	224,454
Reallocation due to change in segments	(5,330)
Ending balance	339,015	344,316
Accumulated impairment loss	154,444	154,444
Physician and Leadership Solutions
Goodwill [Roll Forward]
Beginning balance	163,348	163,362
Reallocation due to change in segments	(10,548)
Ending balance	152,800	163,348
Accumulated impairment loss	60,495	60,495
Technology and Workforce Solutions
Goodwill [Roll Forward]
Beginning balance	87,887	50,690
Reallocation due to change in segments	15,878
Ending balance	372,670	87,887
Accumulated impairment loss	0	0
MedPartners Acquisition
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		23
MedPartners Acquisition \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		23
MedPartners Acquisition \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
MedPartners Acquisition \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
PDA and LFT
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		(14)
PDA and LFT \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
PDA and LFT \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		(14)
PDA and LFT \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
Silversheet, Inc.
Goodwill [Roll Forward]
Goodwill from acquisition		23,537
Silversheet, Inc. \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill from acquisition		0
Silversheet, Inc. \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill from acquisition		0
Silversheet, Inc. \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill from acquisition		23,537
Advanced
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	29
Goodwill from acquisition		119,839
Advanced \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	29
Goodwill from acquisition		119,839
Advanced \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	0
Goodwill from acquisition		0
Advanced \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	0
Goodwill from acquisition		0
b4health
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	(66)
Goodwill from acquisition		13,660
Ending balance	13,594
b4health \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	0
Goodwill from acquisition		0
b4health \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	0
Goodwill from acquisition		0
b4health \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	(66)
Goodwill from acquisition		$ 13,660
Stratus Video
Goodwill [Roll Forward]
Goodwill from acquisition	268,971
Ending balance	268,971
Stratus Video \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	0
Stratus Video \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	0
Stratus Video \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	$ 268,971

Retirement Plans - 401(k) Retirement Savings Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Retirement Benefits [Abstract]
Employer contributions, net of forfeitures	$ 4,256	$ 5,516	$ 5,250

Income Taxes - CARES Act (Details) $ in Thousands	Dec. 31, 2020 USD ($)
Income Tax Disclosure [Abstract]
Deferred payroll taxes, CARES Act	$ 48,249
Employee retention employment tax credit, CARES Act	$ 1,183

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2020
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 accrues for contingencies and records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant matters for which the Company has established loss contingencies are class actions related to wage and hour claims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that certain expense reimbursements should be considered wages and included in the regular rate of pay for purposes of calculating overtime rates. On May 26, 2016, former travel nurse Verna Maxwell Clarke filed a complaint against AMN Services, LLC, in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:16-cv-04132-DSF-KS) (the “Clarke Matter”). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation; and that the Company’s wage statements do not comply with the requirements of California law. On June 26, 2018, the Court denied the plaintiffs’ Motion for Summary Judgment in its entirety, and granted the Company’s Motion for Summary Judgment with respect to the Plaintiffs’ per diem and overtime claims. The plaintiffs filed an appeal of the judgment relating to the per diem claims with the Ninth Circuit Court of Appeals. On February 8, 2021, a three-judge panel of the Ninth Circuit Court of Appeals issued an opinion that reversed the district court’s granting of the Company’s Motion for Summary Judgment and remanded the matter to the district court instructing the district to enter partial summary judgment in favor of the Plaintiffs. The Company intends to appeal the Ninth Circuit’s decision and continue to defend the lawsuit vigorously. On May 2, 2019, former travel nurse Sara Woehrle filed a complaint against AMN Services, LLC, and Providence Health System – Southern California in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:19-cv-05282 DSF-KS). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. The Complaint also alleges that the putative class members were denied required meal periods, denied proper overtime compensation, were not compensated for all time worked, including reporting time and training time, and received non-compliant wage statements. The case was stayed pending a decision by the 9th circuit in the Clarke Matter. The Company believes that its wage and hour practices, including those associated with the cases described above, conform with the applicable law in all material respects. However, because of the recent ruling by the 9th Circuit of Appeals, the inherent uncertainty of litigation, and the Company is not able to reasonably predict if any matter will be resolved in a manner that is materially adverse to the Company, it recorded an increase to its accruals established in connection with the matters described above amounting to $20,000 during the fourth quarter of 2020. In addition, while the Company continues to believe that it has meritorious defenses against the suits described above, the ultimate resolution of these matters could result in a loss of up to $15,000, excluding interest and penalties, in excess of the amounts currently accrued. For all other matters, the Company is unable to currently estimate the possible loss or range of loss beyond the amounts already accrued. Loss contingencies accrued as of December 31, 2020 are included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets.

Leases - Components of Lease Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Operating lease cost	$ 20,176	$ 18,725
Short-term lease cost	8,702	20,112
Variable and other lease cost	2,526	2,880
Net lease cost	$ 31,404	$ 41,717

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2020

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, 2020, 2019 and 2018 consists of the following:


	Years Ended December 31,
	2020		2019		2018
Current income taxes:
Federal	$	32,673	$	25,255	$	33,564
State	9,813		8,332		12,047
Total	42,486		33,587		45,611
Deferred income taxes:
Federal	(15,092)		625		(1,372)
State	(6,536)		288		705
Total	(21,628)		913		(667)
Provision for income taxes from operations	$	20,858	$	34,500	$	44,944

Schedule of income tax reconciliation


	Years Ended December 31,
	2020		2019		2018
Tax expense at federal statutory rate	$	19,220	$	31,253	$	39,272
State taxes, net of federal benefit	4,161		6,810		9,902
Non-deductible expenses	3,621		3,840		2,956
Share-based compensation	(2,311)		(4,770)		(4,343)

Unrecognized tax benefit	(78)		(207)		413
Other, net	(3,755)		(2,426)		(3,256)
Income tax expense from operations	$	20,858	$	34,500	$	44,944

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 December 31, 2020 and 2019:


	December 31,
	2020		2019
Deferred tax assets:
Stock compensation	$	6,198	$	5,848
Deferred compensation	24,604		20,564
Accrued bonus	7,607		4,294
Accrued payroll taxes	12,445		60
Accrued expenses	18,185		14,218

Operating lease liabilities	23,826		27,206
Net operating losses	9,557		3,448
Loss contingencies	6,459		—
Other	989		570
Total deferred tax assets	$	109,870	$	76,208
Deferred tax liabilities:
Intangibles	$	(126,833)	$	(71,646)
Fixed assets	(25,252)		(22,896)
Operating lease right-of-use assets	(19,933)		(23,234)
Other	(5,057)		(5,050)
Total deferred tax liabilities	$	(177,075)	$	(122,826)

Net deferred tax liabilities	$	(67,205)	$	(46,618)

Schedule of unrecognized tax benefits

A summary of the changes in the amount of unrecognized tax benefits (excluding interest and penalties) for 2020, 2019 and 2018 is as follows:


	2020		2019		2018
Beginning balance of unrecognized tax benefits	$	4,937	$	4,393	$	4,663
Additions based on tax positions related to the current year	667		588		475
Additions based on tax positions of prior years	255		990		753
Reductions due to lapse of applicable statute of limitation	(943)		(1,034)		(547)
Settlements	—		—		(951)
Ending balance of unrecognized tax benefits	$	4,916	$	4,937	$	4,393

Acquisitions

12 Months Ended

Dec. 31, 2020

Business Combinations [Abstract]

Acquisitions

As set forth below, the Company completed six acquisitions from January 1, 2018 through December 31, 2020. 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, 2020. The allocations will continue to be updated through the measurement period, if necessary. The Company recognizes acquisition-related costs in selling, general and administrative expenses in the consolidated statements of comprehensive income.

Stratus Video Acquisition

On February 14, 2020, the Company completed its acquisition of Stratus Video, a remote video interpreting company that provides healthcare interpretation via remote video, over the phone, and onsite in-person, all supported by proprietary technology platforms. The initial purchase price of $485,568 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded primarily through (1) borrowings under the Company’s $400,000 secured revolving credit facility (the “Senior Credit Facility”), provided for under a credit agreement (the “New Credit Agreement”), and (2) the Second Amendment (as defined in Note (8) below) to the New Credit Agreement, which provided $250,000 of additional available borrowings to the Company. The New Credit Agreement and the Second Amendment are more fully described in Note (8), “Notes Payable and Credit Agreement.” The results of Stratus Video have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the second quarter of 2020, an additional $99 of cash consideration was paid to the selling shareholders for the final working capital settlement. The Company incurred $11,467 of acquisition-related costs during the year ended December 31, 2020 as a result of its acquisition of Stratus Video.

The allocation of the $485,667 purchase price, which included the additional cash consideration paid for the final working capital settlement, consisted of (1) $44,909 of fair value of tangible assets acquired, which included $9,176 cash received, (2) $56,213 of liabilities assumed, (3) $228,000 of identified intangible assets, and (4) $268,971 of goodwill, of which $10,182 is expected to be deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately seventeen years. The following table summarizes the fair value and useful life of each intangible asset acquired as of the acquisition date:


		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer Relationships	$	171,000	20
	Tradenames and Trademarks	40,000		5 - 10
	Developed Technology	16,000		5
	Interpreter Database	1,000		4
		$	228,000

During the third quarter of 2020, the Company revised the estimated useful lives for the tradenames and trademarks intangible assets as a result of its plan to rebrand the language interpretation business. Based on this change in circumstances since the date of acquisition, the Company determined that the remaining useful lives of the assets are five years and will amortize the remaining value on a straight-line basis over the remaining useful life. The Company will continue to evaluate the remaining useful lives of other intangible assets impacted by its brand consolidation efforts.

Approximately $116,054 of revenue and $20,164 of income before income taxes of Stratus Video were included in the consolidated statement of comprehensive income for the year ended December 31, 2020. The following summary presents unaudited pro forma consolidated results of operations of the Company as if the Stratus Video and Advanced (as defined below) acquisitions had occurred on January 1, 2019, which gives effect to certain adjustments, including incremental acquisition-related costs of $25,311, of which $14,468 was reclassified from the year ended December 31, 2020, amortization of intangible assets of $15,014, and interest expense of $6,722 for the year ended December 31, 2019. The unaudited pro forma financial information is not necessarily indicative of the operating results that would have occurred had the acquisitions been consummated as of the date indicated, nor is it necessarily indicative of the Company’s future operating results.


	Years Ended December 31,
	2020		2019
Revenue	$	2,407,586	$	2,383,405
Income from operations	165,196		145,069
Net income	81,422		85,154

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 technology and workforce solutions segment since the date of acquisition. During the first quarter of 2020, $66 was returned to the Company for the final working capital settlement.

The allocation of the $22,940 purchase price, which was reduced by the final working capital settlement and finalized during the fourth quarter of 2020, 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) $13,594 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, which was settled in full during the first quarter of 2020. The acquisition was funded primarily through (1) borrowings under the Senior Credit Facility 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 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 and was finalized during the second quarter of 2020, consisted of (1) $29,020 of fair value of tangible assets acquired, which included $2,497 cash and restricted cash received, (2) $28,772 of liabilities assumed, (3) $91,700 of identified intangible assets, and (4) $119,868 of goodwill, of which $57,236 is 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, which resulted in no earn-out payment, 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 technology and workforce solutions segment since the date of acquisition.

The allocation of the $31,676 purchase price, which was finalized during the first quarter of 2020, 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 nurse and allied 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 physician and leadership 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, 2020

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Identifiable Intangible Assets

As of December 31, 2020 and 2019, the Company had the following acquired intangible assets:


	As of December 31, 2020						As of December 31, 2019
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Intangible assets subject to amortization:
Staffing databases	$	36,836	$	(16,706)	$	20,130	$	35,836	$	(13,369)	$	22,467
Customer relationships	444,839		(122,105)		322,734		273,839		(94,206)		179,633
Tradenames and trademarks	166,269		(58,299)		107,970		126,269		(33,545)		92,724
Non-compete agreements	6,371		(3,402)		2,969		4,117		(2,035)		2,082
Acquired technology	36,430		(14,722)		21,708		20,430		(8,262)		12,168
	$	690,745	$	(215,234)	$	475,511	$	460,491	$	(151,417)	$	309,074
Intangible assets not subject to amortization:
Tradenames and trademarks					$	89,400					$	89,400
					$	564,911					$	398,474

Aggregate amortization expense for intangible assets was $63,817 and $36,493 for the years ended December 31, 2020 and 2019, respectively. Based on the current amount of intangibles subject to amortization, the estimated future amortization expense as of December 31, 2020 is as follows:


	Amount
Year ending December 31, 2021	$	61,234
Year ending December 31, 2022	60,351
Year ending December 31, 2023	58,694
Year ending December 31, 2024	52,161
Year ending December 31, 2025	39,199
Thereafter	203,872
	$	475,511

In connection with the reorganization of its reportable segments effective March 8, 2020, the Company reassigned the goodwill balances to the reporting units, the composition of which changed under the reorganized reportable segments, using the relative fair value reallocation approach. The Company performed a goodwill impairment test at the reporting unit level both immediately before and after the reorganization. The Company determined the fair values of its reporting units using a combination of the income approach (using discounted future cash flows) and the market valuation approach. Based on the results of this testing, the Company determined that the fair values of its reporting units were each greater than their respective carrying values both before and after the reorganization. Therefore, there was no impairment loss recognized during the year ended December 31, 2020.


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2019	$	224,454	$	163,362	$	50,690	$	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	344,316		163,348		87,887		595,551
Goodwill adjustment for Advanced acquisition	29		—		—		29
Goodwill adjustment for b4health acquisition	—		—		(66)		(66)
Goodwill from Stratus Video acquisition	—		—		268,971		268,971
Reallocation due to change in segments	(5,330)		(10,548)		15,878		—
Balance, December 31, 2020	$	339,015	$	152,800	$	372,670	$	864,485
Accumulated impairment loss as of December 31, 2019 and 2020	$	154,444	$	60,495	$	—	$	214,939

Leases - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
Leases - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2018
Leases [Abstract]
Option to extend, term (up to)	10 years
Option to terminate, term (within)	3 years
Rent expense		$ 21,402

Acquisitions - b4health Acquisition (Details) - USD ($)		3 Months Ended		12 Months Ended
Acquisitions - b4health Acquisition (Details) - USD ($)	Dec. 19, 2019	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Cash consideration				$ 476,491,000	$ 247,906,000	$ 217,360,000
Goodwill		$ 864,485,000		864,485,000	$ 595,551,000	$ 438,506,000
b4health acquisition
Business Acquisition [Line Items]
Purchase price	$ 23,006,000
Cash consideration	19,906,000
Contingent earn-out based on future operating performance (up to)	12,000,000
Fair value of contingent earn-out	$ 3,100,000
Working capital returned to Company for working capital settlement			$ 66,000
Purchase price, net of working capital adjustment		22,940,000
Fair value of tangible assets acquired		1,169,000		1,169,000
Cash and restricted cash received		222,000		222,000
Liabilities assumed		823,000		823,000
Identified intangible assets		9,000,000		9,000,000
Goodwill		13,594,000		13,594,000
Weighted average useful life of intangible assets	7 years
b4health acquisition \| Developed Technology
Business Acquisition [Line Items]
Identified intangible assets		3,000,000		3,000,000
b4health acquisition \| Customer Relationships
Business Acquisition [Line Items]
Identified intangible assets		4,000,000		4,000,000
b4health acquisition \| Trademarks
Business Acquisition [Line Items]
Identified intangible assets		$ 2,000,000		$ 2,000,000

Notes Payable and Credit Agreement (Tables)

12 Months Ended

Dec. 31, 2020

Debt Disclosure [Abstract]

Schedule of outstanding debt

Outstanding debt balances as of December 31, 2020 and 2019 consisted of the following:


	As of December 31,
	2020		2019
Additional Term Loan	$	21,875	$	—

2024 Notes	—		325,000
2027 Notes	500,000		300,000
2029 Notes	350,000		—
Total debt outstanding	871,875		625,000
Less unamortized fees and premium	(9,226)		(7,841)
Less current portion of notes payable	(4,688)		—
Long-term portion of notes payable	$	857,961	$	617,159

Goodwill and Identifiable Intangible Assets - Estimated Future Amortization (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
Year ending December 31, 2021	$ 61,234
Year ending December 31, 2022	60,351
Year ending December 31, 2023	58,694
Year ending December 31, 2024	52,161
Year ending December 31, 2025	39,199
Thereafter	203,872
Net Carrying Amount	$ 475,511	$ 309,074

Balance Sheet Details (Tables)

12 Months Ended

Dec. 31, 2020

Balance Sheet Related Disclosures [Abstract]

Consolidated balance sheet details

The consolidated balance sheets detail is as follows:


	December 31,
	2020		2019
Other current assets:
Restricted cash and cash equivalents	$	18,626	$	18,393
Income taxes receivable	6,591		5,984
Other	15,592		16,069
Other current assets	$	40,809	$	40,446

Fixed assets:
Furniture and equipment	$	47,355	$	37,315
Software	220,971		191,050
Leasehold improvements	9,600		9,367
	277,926		237,732
Accumulated depreciation	(161,752)		(132,900)
Fixed assets, net	$	116,174	$	104,832

Accounts payable and accrued expenses:
Trade accounts payable	$	28,089	$	26,985
Subcontractor payable	79,364		75,562
Accrued expenses	37,849		36,344
Loss contingencies	7,613		6,146
Professional liability reserve	8,897		7,925
Other	6,069		3,178
Accounts payable and accrued expenses	$	167,881	$	156,140

Accrued compensation and benefits:
Accrued payroll	$	59,721	$	47,381
Accrued bonuses and commissions	34,514		22,613
Accrued travel expense	1,998		2,459
Health insurance reserve	5,590		4,019
Workers compensation reserve	10,244		8,782
Deferred compensation	97,184		81,064
Other	4,163		4,614
Accrued compensation and benefits	$	213,414	$	170,932

Other current liabilities:
Acquisition related liabilities	$	8,000	$	20,000
Other	2,938		5,302
Other current liabilities	$	10,938	$	25,302

Other long-term liabilities:
Workers compensation reserve	$	20,930	$	18,291
Professional liability reserve	31,997		34,606

Unrecognized tax benefits	5,447		5,431
Other	49,533		3,485
Other long-term liabilities	$	107,907	$	61,813

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
Consolidated Statements of Cash Flows - USD ($)	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Cash flows from operating activities:
Net income	$ 70,665,000	$ 113,988,000	$ 141,741,000
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	94,187,000	58,520,000	41,237,000
Non-cash interest expense and other	4,349,000	1,984,000	(4,841,000)
Write-off of fees on credit facilities and senior notes	4,956,000	594,000	574,000
Change in fair value of contingent consideration	4,900,000	7,178,000	(2,400,000)
Increase in allowance for credit losses and sales credits	6,535,000	6,275,000	9,006,000
Provision for deferred income taxes	(21,628,000)	913,000	(667,000)
Share-based compensation	20,465,000	16,241,000	10,815,000
Net loss on deferred compensation balances	1,646,000	0	0
Loss on disposal or sale of fixed assets	4,322,000	484,000	117,000
Amortization of discount on investments	(109,000)	(298,000)	(202,000)
Non-cash lease expense	(589,000)	5,000
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	(7,338,000)	28,278,000	(1,453,000)
Accounts receivable, subcontractor	(1,271,000)	(22,571,000)	(9,131,000)
Income taxes receivable	(412,000)	(4,464,000)	15,099,000
Prepaid expenses	(1,342,000)	774,000	4,465,000
Other current assets	2,322,000	2,847,000	(1,259,000)
Other assets	3,220,000	(12,751,000)	5,239,000
Accounts payable and accrued expenses	5,562,000	1,925,000	17,154,000
Accrued compensation and benefits	25,856,000	32,758,000	10,252,000
Other liabilities	41,640,000	(6,090,000)	(8,980,000)
Deferred revenue	(1,119,000)	(1,806,000)	319,000
Restricted investments balance	9,000	78,000	(92,000)
Net cash provided by operating activities	256,826,000	224,862,000	226,993,000
Cash flows from investing activities:
Purchase and development of fixed assets	(37,702,000)	(35,218,000)	(35,206,000)
Purchase of investments	(48,311,000)	(26,309,000)	(33,824,000)
Proceeds from maturity of investments	32,800,000	32,135,000	25,000,000
Purchase of equity investments	0	0	(6,100,000)
Proceeds from sale of equity investment	527,000	0	0
Purchase of convertible promissory notes	(490,000)	(779,000)	(750,000)
Payments to fund deferred compensation plan	(7,171,000)	(12,507,000)	(9,917,000)
Cash paid for acquisitions, net of cash and restricted cash received	(476,491,000)	(247,906,000)	(217,360,000)
Cash paid for other intangibles	(1,400,000)	(1,240,000)	(1,180,000)
Cash received for working capital adjustments for prior year acquisitions	66,000	0	0
Net cash used in investing activities	(538,172,000)	(291,824,000)	(279,337,000)
Cash flows from financing activities:
Payments on term loans	(228,125,000)	(150,000,000)	0
Proceeds from term loan	250,000,000	150,000,000	0
Payments on revolving credit facility	(245,000,000)	(221,000,000)	(75,000,000)
Proceeds from revolving credit facility	245,000,000	101,000,000	195,000,000
Proceeds from senior notes	552,000,000	300,000,000	0
Redemption of senior notes	(333,330,000)	0	0
Repurchase of common stock	0	(18,705,000)	(67,013,000)
Payment of financing costs	(11,508,000)	(5,223,000)	(2,331,000)
Earn-out payments for prior acquisitions	(10,622,000)	(5,700,000)	(1,713,000)
Cash paid for shares withheld for taxes	(6,929,000)	(13,773,000)	(11,432,000)
Net cash provided by financing activities	211,486,000	136,599,000	37,511,000
Effect of exchange rate changes on cash	(112,000)	1,000	263,000
Net increase (decrease) in cash, cash equivalents and restricted cash	(69,972,000)	69,638,000	(14,570,000)
Cash, cash equivalents and restricted cash at beginning of year	153,962,000	84,324,000	98,894,000
Cash, cash equivalents and restricted cash at end of year	83,990,000	153,962,000	84,324,000
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	20,052,000	17,817,000
Cash paid for interest (net of $389, $536 and $460 capitalized in 2020, 2019 and 2018, respectively)	22,652,000	23,730,000	21,283,000
Cash paid for income taxes	46,258,000	37,747,000	30,593,000
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received	35,733,000	29,660,000	24,026,000
Goodwill	268,971,000	157,036,000	97,910,000
Intangible assets	228,000,000	107,580,000	122,110,000
Liabilities assumed	(56,213,000)	(31,148,000)	(16,586,000)
Earn-out liabilities	0	(15,222,000)	(10,100,000)
Net cash paid for acquisitions	476,491,000	247,906,000	217,360,000
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 3,103,000	$ 2,301,000	$ 1,706,000

Summary of Significant Accounting Policies - Recently Adopted Accounting Pronouncements (Details) - USD ($) $ in Thousands	Jan. 01, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Present value of lease liabilities	$ 114,807	$ 92,832
Operating lease right-of-use assets	99,525	77,735	$ 89,866
Derecognition of existing deferred rent liabilities	$ 15,302
Reduction to retained earnings		(819,677)	(736,742)	$ (638,990)	$ (562,527)
Retained Earnings
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Reduction to retained earnings		$ (469,558)	(400,047)	$ (286,059)	(142,229)
Cumulative Effect, Period of Adoption, Adjustment
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Reduction to retained earnings			1,154		(2,089)
Cumulative Effect, Period of Adoption, Adjustment \| Retained Earnings
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Reduction to retained earnings			$ 1,154		$ (2,089)

- Definition

Total of all stockholders' equity (deficit) items, net of receivables from officers, directors, owners, and affiliates of the entity which are attributable to the parent. The amount of the economic entity's stockholders' equity attributable to the parent excludes the amount of stockholders' equity which is allocable to that ownership interest in subsidiary equity which is not attributable to the parent (noncontrolling interest, minority interest). This excludes temporary equity and is sometimes called permanent equity.

+ References + Details

Summary of Significant Accounting Policies - Restricted Cash, Cash Equivalents and Investments (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Accounting Policies [Abstract]
Cash and cash equivalents	$ 29,213	$ 82,985
Restricted cash and cash equivalents (included in other current assets)	18,626	18,393
Restricted cash, cash equivalents and investments	61,347	62,170
Total cash, cash equivalents and restricted cash and investments	109,186	163,548
Less restricted investments	(25,196)	(9,586)
Total cash, cash equivalents and restricted cash	$ 83,990	$ 153,962	$ 84,324	$ 98,894

Acquisitions - Stratus Video Acquisition (Details) - USD ($)		3 Months Ended								12 Months Ended
	Feb. 14, 2020	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Jun. 14, 2019
Business Acquisition [Line Items]
Cash consideration										$ 476,491,000	$ 247,906,000	$ 217,360,000
Long-term portion of notes payable		$ 857,961,000				$ 617,159,000				857,961,000	617,159,000
Goodwill		864,485,000				595,551,000				864,485,000	595,551,000	438,506,000
Revenue		631,271,000	$ 551,631,000	$ 608,351,000	$ 602,461,000	$ 586,892,000	$ 567,597,000	$ 535,177,000	$ 532,441,000	2,393,714,000	2,222,107,000	2,136,074,000
Aggregate amortization expense, intangible assets										63,817,000	36,493,000
Interest expense										57,742,000	28,427,000	$ 16,143,000
Secured Debt \| Term Loan Credit Facility
Business Acquisition [Line Items]
Maximum borrowing capacity													$ 150,000,000
Long-term portion of notes payable	$ 250,000,000
Stratus Video and Advanced
Business Acquisition [Line Items]
Acquisition related costs										14,468,000
Incremental acquisition-related costs											25,311,000
Aggregate amortization expense, intangible assets											15,014,000
Interest expense											$ 6,722,000
Stratus Video
Business Acquisition [Line Items]
Cash consideration	485,568,000			$ 99,000
Acquisition related costs										11,467,000
Purchase price, net of working capital adjustment		485,667,000
Fair value of tangible assets acquired		44,909,000								44,909,000
Cash and restricted cash received		9,176,000								9,176,000
Liabilities assumed		56,213,000								56,213,000
Identified intangible assets	$ 228,000,000	228,000,000								228,000,000
Goodwill		268,971,000								268,971,000
Goodwill expected to be tax deductible		$ 10,182,000								10,182,000
Weighted average useful life of intangible assets	17 years
Revenue										116,054,000
Income before income taxes										$ 20,164,000
Stratus Video \| Tradenames and trademarks
Business Acquisition [Line Items]
Identified intangible assets	$ 40,000,000
Useful life			5 years

Share-Based Compensation - Restricted Stock Units (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Number of Shares
Unvested, beginning balance (in shares)	758	818	855
Vested (in shares)	(283)	(400)	(499)
Canceled/forfeited/expired (in shares)	(184)	(52)	(83)
Unvested, ending balance (in shares)	717	758	818
Weighted Average Grant Date Fair Value per Share
Unvested, beginning balance (in dollars per share)	$ 52.45	$ 43.84	$ 30.98
Vested (in dollars per share)	49.18	35.46	23.04
Canceled/forfeited/expired (in dollars per share)	53.84	41.09	42.32
Unvested, ending balance (in dollars per share)	$ 58.88	$ 52.45	$ 43.84
Restricted Stock Units (RSUs)
Number of Shares
Granted (in shares)	271	191	279
Weighted Average Grant Date Fair Value per Share
Granted (in dollars per share)	$ 60.02	$ 54.99	$ 53.73
Performance Restricted Stock Units (PRSUs)
Number of Shares
Granted (in shares)	155	201	266
Weighted Average Grant Date Fair Value per Share
Granted (in dollars per share)	$ 64.59	$ 48.32	$ 35.28

Balance Sheet Details (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Other current assets:
Restricted cash and cash equivalents	$ 18,626	$ 18,393
Income taxes receivable	6,591	5,984
Other	15,592	16,069
Other current assets	40,809	40,446
Fixed assets:
Furniture and equipment	47,355	37,315
Software	220,971	191,050
Leasehold improvements	9,600	9,367
Fixed assets, gross	277,926	237,732
Accumulated depreciation	(161,752)	(132,900)
Fixed assets, net	116,174	104,832
Accounts payable and accrued expenses:
Trade accounts payable	28,089	26,985
Subcontractor payable	79,364	75,562
Accrued expenses	37,849	36,344
Loss contingencies	7,613	6,146
Professional liability reserve	8,897	7,925
Other	6,069	3,178
Accounts payable and accrued expenses	167,881	156,140
Accrued compensation and benefits:
Accrued payroll	59,721	47,381
Accrued bonuses and commissions	34,514	22,613
Accrued travel expense	1,998	2,459
Health insurance reserve	5,590	4,019
Workers compensation reserve	10,244	8,782
Deferred compensation	97,184	81,064
Other	4,163	4,614
Accrued compensation and benefits	213,414	170,932
Other current liabilities:
Acquisition related liabilities	8,000	20,000
Other	2,938	5,302
Other current liabilities	10,938	25,302
Other long-term liabilities:
Workers compensation reserve	20,930	18,291
Professional liability reserve	31,997	34,606
Unrecognized tax benefits	5,447	5,431
Other	49,533	3,485
Other long-term liabilities	$ 107,907	$ 61,813

Summary of Significant Accounting Policies - Concentration of Credit Risk (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Concentration Risk [Line Items]
Restricted cash, cash equivalents and investments	$ 61,347	$ 62,170
One Customer \| Consolidated Revenue \| Customer Concentration Risk
Concentration Risk [Line Items]
Concentration risk percentage	14.00%	13.00%	13.00%

Fair Value Measurement - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Oct. 20, 2020	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	58,345,000	59,243,000
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	58,345,000	59,243,000
Commercial paper - AFS securities	$ 25,196,000	$ 9,586,000
2024 Notes \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate	5.125%				5.125%
2029 Notes \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate	4.00%			4.00%

Leases - Maturity of Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Jan. 01, 2019
December 31,
2021	$ 19,108
2022	18,552
2023	18,207
2024	17,030
2025	15,160
Thereafter	18,733
Total lease payments	106,790
Less imputed interest	(13,958)
Present value of lease liabilities	$ 92,832	$ 114,807

Fair Value Measurement

12 Months Ended

Dec. 31, 2020

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.”

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 $58,345 commercial paper issued and outstanding as of December 31, 2020, $25,196 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2019, the Company had $59,243 commercial paper issued and outstanding, of which $9,586 had original maturities greater than three months and were considered available-for-sale securities.

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.

The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value:


	Fair Value Measurements as of December 31, 2020
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	$	2,198	$	2,198	$	—	$	—
Deferred compensation	(97,184)		(97,184)		—		—
Commercial paper	58,345		—		58,345		—
Acquisition contingent consideration liabilities	(8,000)		—		—		(8,000)


	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)

Level 3 Information

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:


	2020		2019
Balance as of January 1,	$	(23,100)	$	(7,700)
Settlement of PDA and LFT contingent consideration liability for year ended December 31, 2018	—		7,000
Settlement of Advanced contingent consideration liability for year ended December 31, 2019	20,000		—
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 MedPartners acquisition	—		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)
Change in fair value of contingent consideration liability from b4health acquisition	(4,900)		—
Balance as of December 31,	$	(8,000)	$	(23,100)

As of December 31, 2020 and 2019, the fair value measurement of contingent consideration liabilities for b4health and Advanced, respectively, was based on actual operating results of the acquired company.

Assets Measured on a Non-Recurring Basis

The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments.

The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever 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 as of both December 31, 2020 and 2019. There were no changes to the fair value of the equity investment recognized during the years ended December 31, 2020 and 2019, respectively.

There were no triggering events identified, no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, long-lived assets, or equity investments, and no impairment charges recorded during the three years ended December 31, 2020 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”), the 2027 Notes (as defined in Note (8) below), and 4.000% senior notes due 2029 (the “2029 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2024 Notes, the 2027 Notes and the 2029 Notes, which are more fully described in Note (8), “Notes Payable and Credit Agreement,” are presented in the following table:


	As of December 31, 2020				As of December 31, 2019
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2024 Notes	$	—	$	—	$	325,000	$	337,188
2027 Notes	500,000		521,250		300,000		301,500
2029 Notes	350,000		357,000		—		—

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, 2020
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period	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	200.00%
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%

Income Taxes - Operating Loss Carryforwards (Details) $ in Thousands	Dec. 31, 2020 USD ($)
Federal
Operating Loss Carryforwards
Operating loss carryforwards	$ 41,430
State
Operating Loss Carryforwards
Operating loss carryforwards	$ 16,631

Leases - Assumptions Used for Operating Leases (Details)	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Weighted average remaining lease term	6 years	7 years
Weighted average discount rate	4.80%	4.80%

Share-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2020

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, 2020, 2019 and 2018:


	Number of Shares	Weighted Average Grant Date Fair Value per Share
Unvested at January 1, 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
Granted—RSUs	271	$	60.02
Granted—PRSUs (1)	155	$	64.59
Vested	(283)	$	49.18
Canceled/forfeited/expired	(184)	$	53.84
Unvested at December 31, 2020	717	$	58.88

(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, 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
Granted	—	$	—
Exercised	(12)	$	7.51
Canceled/forfeited/expired	—	$	—
Outstanding at December 31, 2020	—	$	—
Vested and expected to vest at December 31, 2020	—	$	—
Exercisable at December 31, 2020	—	$	—

Schedule of share-based compensation expense

Total share-based compensation expense for the years ended December 31, 2020, 2019 and 2018 was as follows:


	Years Ended December 31,
	2020		2019		2018
Share-based employee compensation, before tax	$	20,465	$	16,241	$	10,815
Related income tax benefits	(5,321)		(4,223)		(2,812)
Share-based employee compensation, net of tax	$	15,144	$	12,018	$	8,003

Leases

12 Months Ended

Dec. 31, 2020

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:


	Years Ended December 31,
	2020		2019
Operating lease cost	$	20,176	$	18,725
Short-term lease cost	8,702		20,112
Variable and other lease cost	2,526		2,880
Net lease cost	$	31,404	$	41,717

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

The maturities of lease liabilities as of December 31, 2020 were as follows:


	Operating Leases
Years ending December 31,
2021	$	19,108
2022	18,552
2023	18,207
2024	17,030
2025	15,160
Thereafter	18,733
Total lease payments	106,790
Less imputed interest	(13,958)
Present value of lease liabilities	$	92,832

Supplemental cash flow information related to leases was as follows:


	Years Ended December 31,
	2020		2019
Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows)	$	20,052	$	17,817

The weighted average remaining lease term and discount rate as of December 31, 2020 and 2019 were as follows:


	December 31,
	2020		2019
Weighted average remaining lease term	6 years		7 years
Weighted average discount rate	4.8	%	4.8	%

The Company uses its incremental borrowing rate as the discount rate to measure its lease liabilities. The incremental borrowing rate is determined for each operating lease based on the Company’s borrowing capabilities over a similar term of the lease arrangement, which is estimated by utilizing the Company’s credit rating and the effects of full collateralization.

Acquisitions - Schedule of Intangible Assets Acquired (Details) - USD ($) $ in Thousands				3 Months Ended
	Feb. 14, 2020	Jun. 14, 2019	Apr. 09, 2018	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2020	Jun. 30, 2020	Jun. 30, 2019
Stratus Video
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 228,000					$ 228,000
Stratus Video \| Customer Relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 171,000
Useful Life	20 years
Stratus Video \| Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 40,000
Useful Life				5 years
Stratus Video \| Tradenames and Trademarks \| Minimum
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	5 years
Stratus Video \| Tradenames and Trademarks \| Maximum
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	10 years
Stratus Video \| Developed Technology
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 16,000
Useful Life	5 years
Stratus Video \| Interpreter Database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 1,000
Useful Life	4 years
Advanced Acquisition
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 91,700					$ 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					$ 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 - Letters of Credit (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Standby Letters of Credit
Line of Credit Facility [Line Items]
Letters of credit, amount outstanding	$ 24,064	$ 19,752
Debt collateral	2,154
Senior Credit Facility \| Line of Credit
Line of Credit Facility [Line Items]
Debt collateral	$ 21,910

Notes Payable and Credit Agreement - The Company’s Credit Agreement and Related Credit Facilities (Details) - USD ($)	Feb. 14, 2020	Dec. 31, 2020	Dec. 31, 2019	Jun. 14, 2019	Feb. 09, 2018
Debt Instrument [Line Items]
Long-term portion of notes payable		$ 857,961,000	$ 617,159,000
Term Loan Credit Facility
Debt Instrument [Line Items]
Debt issuance fees incurred	$ 4,144,000
Unamortized debt issuance costs	1,681,000
Secured Debt \| Term Loan Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity				$ 150,000,000
Long-term portion of notes payable	$ 250,000,000
Annual amortization percentage, first year	2.50%
Annual amortization percentage, after first year	5.00%
Secured Debt \| Term Loan Credit Facility \| LIBOR
Debt Instrument [Line Items]
Interest rate at period end		1.65%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Minimum \| LIBOR
Debt Instrument [Line Items]
Basis spread on variable rate	1.00%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Minimum \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.00%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Maximum \| LIBOR
Debt Instrument [Line Items]
Basis spread on variable rate	1.75%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Maximum \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.75%
Senior Credit Facility \| Line of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 75,000,000				$ 400,000,000
Debt collateral		$ 21,910,000
Available credit		$ 378,090,000
Revolving Credit Facility, Swing Line Loan \| Line of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 75,000,000

Fair Value Measurement - Financial Assets and (Liabilities) (Details) - Fair Value, Recurring - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
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	$ 2,198	$ 2,508
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	58,345	59,243
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	2,198	2,508
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	58,345	59,243
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	(97,184)	(81,064)
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	(97,184)	(81,064)
Deferred compensation \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Deferred compensation \| Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Acquisition contingent consideration liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	(8,000)	(23,100)
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	$ (8,000)	$ (23,100)